Atención médica y acciones de autocuidado en personas que viven con diabetes, según nivel socioeconómico / Medical care and self-care actions in people living with diabetes, according to socioeconomic level

Resumen: Objetivo: Caracterizar la atención médica y las acciones de autocuidado en población con diabetes, en localidades de menos de 100 000 habitantes. Material y métodos: Con información de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), se obtuvieron dos modelos de regresión logística: no realizar las cinco acciones básicas en la última consulta médica y no realizar acciones prioritarias de autocuidado. Resultados: Tener baja escolaridad, pertenecer al estrato económico bajo y hablar lengua indígena incrementan las posibilidades de no realizar acciones de autocuidado. Por el contrario, al incrementarse la edad, se disminuyen las posibilidades de autocuidado en 3%. Pertenecer a un hogar indígena y al tercil bajo incrementan las posibilidades de que el personal de salud no realice las cinco acciones básicas durante la consulta. Conclusión: Es indispensable que se establezca un programa de control de diabetes que incluya educación a pacientes y cursos de actualización al personal médico.

Abstract: Objective: To characterize medical care and self-care actions in a population with diabetes in locations smaller than 100 000 inhabitants Materials and methods: With information from the Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), two logistic regression models were obtained: not performing five basic actions in the last consultation and not taking priority self-care actions. Results: Having low schooling, belonging to the low economic stratum, and speaking indigenous language, increase the probability of not taking self-care actions. On the contrary, as age increases, the chances of self-care are reduced by 3%. Belonging to an indigenous household and the low tercile, increases the chances that health personnel will not perform the five basic actions during the consultation. Conclusions: It is essential that a diabetes control program be established that includes patient education and update courses for medical staff

Effect of carotid artery stenting on CBF and CVR in patients with unilateral internal carotid artery symptomatic severe stenosis / 中华老年心脑血管病杂志

Objective To study the effect of carotid artery stenting (CAS) on rCBF and rCVR.Methods Seventeen patients with unilateral internal carotid artery symptomatic severe stenosis who underwent CAS in our hospital were included in this study.Their rCBF volume and rCVR were measured by single photon emission CT scanning combined with CO2 loading test 1 week be fore and 3 months after CAS.Their data were analyzed according to the ROI in ipsilateral middle cerebral artery blood supply territory.Results Sixty eight ROIs were detected in the 17 patients with impaired rCBF in 16 ROIs (23.5％) before CAS.The mean improved rate of rCBF was significantly higher in impaired rCBF and rCVR ROI before CAS than that of rCBF in normal and impaired rCVR ROI after CAS (P=0.001).The mean improved rate of rCVR was significantly higher in normal rCBF and impaired rCVR ROI after CAS than before CAS (P=0.014).The improved rate of rCBF was significantly higher in impaired rCBF and rCVR ROI after CAS than that of normal and impaired rCVR ROI before CAS (81.3％ vs 50.0％,P=0.027).The improved rate of rCVR was significantly higher in normal rCBF ROI and impaired rCVR ROI before CAS than in impaired rCBF and rCVR ROI after CAS (59.6％ vs 31.3％,P=0.047).Conclusion CAS can improve the ROI rCBF and rCVR in patients with unilateral ICA symptomatic severe stenosis.Its modified model is closely related with rCBF before CAS.

Comparison of the in-vitro effects of bevacizumab, mitomycin-C, 5-fluorouracil,and triamcinolone acetonide on the viability of cultured human tenon's fibroblasts

@#<p style="text-align: justify;"><strong>Objective:</strong> To evaluate and compare the effects of bevacizumab, mitoinycin-C (MMC), 5-fluorouracil (5-FU), and triamcinolone acetonide (TA) on the viability of cultured human Tenon's capsule fibroblasts (cHTF) in vitro.</p> <p style="text-align: justify;"><strong>Methods:</strong> Human Tenon's fibroblasts (HTF) were harvested and cultured in a Roswell-Park-Memorial 1-Institute (RPMI) media. MMC, 5-FU, bevaciz. umab, and TA were administered to the cHTF at 3-fold decreasing concentrations starting from 20 ug, 5 mg, 25 mg, and 4 mg respectively. A negative control/untreated group containing RPMI media only was included in the study. Fibroblast cell viability was assessed using resazurin fluorim etric assay. Half¬maximal inhibitory concentration (IC50) was computed for agents which showed significant decrease in cHTF viability compared to the untreated group.</p> <p style="text-align: justify;"><strong>Results:</strong> There was no significant difference in cH IF viability between the untreated control group compared to 5-FU (p=0.97), bevacizumab (p=0.10), and TA (p=0.06) groups. Mitomycin-C showed a significant decrease in cHTF viability (p<0.001) which was dose dependent. The IC50 of MMC was computed at 12.16 ug using the prism software.</p> <p style="text-align: justify;"><strong>Conclusion:</strong> Mitomycin-C demonstrated dose-dependent decrease in viability of cultured human Tenon's fibroblasts. 5-FU, bevacizumab, and triamcinolone did not show this effect.</p> <p style="text-align: justify;"><strong>Key Words:</strong> Mitomycin-C, 5-fluorouracil, Bevaciz. umab, Tria. mcinolone acetonide, Fibroblast, Trabeculectomy</p>

Leading causes of new patient consults at the out-patient general eye clinic of the Sentro Oftalmologico Jose Rizal, Philippine General Hospital

OBJECTIVE:To determine the current leading causes of new patient consults at the out-patient general clinic of the Department of Ophthalmology and Visual Sciences (DOVS), Sentro Oftalmologico Jose Rizal (SOJR). METHODS: The data were gathered from the DOVS out-patient general clinic monthly census. Compilation and tabulation of the diagnoses of all new patients from January to December 2009 were done.RESULTS: The leading causes of new patient consults were cataract (30.8%), error of refraction (20.1%), pterygium (6.1%), conjunctivitis (4.9%), dysfunctional tear syndrome (4.5%), glaucoma (4.3%), diabetic retinopathy (3.7%), and hypertensive retinopathy (3.4%). CONCLUSION: Cataract and error of refraction comprise the majority of all causes of consultation among new patients.

Nuevas perspectivas en el síndrome de QT largo / New perspectives in long QT syndrome

Long QT Syndrome (LQTS) is a cardiac channelopathy characterized by prolonged ventricular repolarization and increased risk to sudden death secondary to ventricular dysrrhythmias. Was the first cardiac channelopathy described and is probably the best understood. After a decade of the sentinel identification of ion channel mutation in LQTS, genotype-phenotype correlations have been developed along with important improvement in risk stratification and genetic guided-treatment. Genetic screening has shown that LQTS is more frequent than expected and interestingly, ethnic specific polymorphism conferring increased susceptibility to drug induced QT prolongation and torsades de pointes have been identified. A better understanding of ventricular arrhythmias as an adverse effect of ion channel binding drugs, allow the development of more safety formulas and better control of this public health problem. Progress in understanding the molecular basis of LQTS has been remarkable; eight different genes have been identified, however still 25% of patients remain genotype-negative. This article is an overview of the main LQTS knowledge developed during the last years.

El síndrome de QT largo (SQTL) es una canalopatía que genera grave alteración en la repolarización ventricular predispone a arritmias malignas y muerte súbita. Fue la primera canalopatía arritmogénica descrita y quizá la mejor entendida hasta ahora. Transcurrida ya más de una década de la identificación de la primera mutación asociada al SQTL, se ha hecho evidente que este trastorno es mucho más frecuente de lo que inicialmente se pensaba; los avances en el conocimiento de la fisiopatología molecular de esta enfermedad han permitido hacer una correlación genotipo-fenotipo, optimizando el tratamiento y permitiendo estratificar el riesgo en forma precisa. Se ha logrado entender con mayor detalle los efectos adversos de distintas drogas que interactúan con los canales iónicos, permitiendo así generar fármacos más seguros y, en su defecto, monitorizar de cerca aquellos que a pesar de tener este efecto adverso, es necesaria su administración. Los avances son importantes pero no todo está dicho, 25% de los casos no tienen mutaciones en los genes descritos hasta la fecha, por lo que el SQTL continúa siendo motivo de investigación. El presente artículo constituye un resumen de los principales conceptos desarrollados en los últimos diez años que han sido cruciales en el manejo de esta enfermedad.

Understanding structure and function in glaucoma

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.

A prospective, randomized comparison of Nd:YAG and sequential argon-YAG laser iridotomy in Filipino eyes

Methods: A prospective, randomized, controlled trial was performed involving patients requiring laser iridotomy who were randomized either to Nd:YAG laser or sequential argon-Nd:YAG laser iridotomy. Iris-perforation success rate, the average number of laser shots and amount of laser energy used, the intraocular pressure (IOP) after laser treatment, and the rate of complications were compared. The prelaser pupil size was correlated with the iris perforation success rate. Results: Forty-one eyes underwent laser iridotomy (23 Nd:YAG and 18 sequential). All eyes had patent iridotomies. There was no difference between the two groups in terms of the number of Nd:YAG laser shots delivered (p=0.97) and amount of Nd:YAG energy used (p=0.64). The total amount of laser energy used was higher in the sequential group (p=0.003). There was no significant difference in the IOP and complication rates after treatment. A positive correlation was seen between prelaser pupil size and number of Nd:YAG shots needed to enlarge (r=0.38, P=0.01). Conclusion: Nd:YAG laser alone and sequential argon-Nd:YAG have comparable success in attaining patency of laser iridotomy, IOP control, and rate of complications in dark irides of Filipinos.

Comparison of outcomes of trabeculectomies using 0.4 mg/ml versus 0.2 mg/ml concentrations of mitomycin-C

Methods: A prospective, randomized, comparative study was performed involving patients undergoing trabeculectomy who were randomly assigned to either 0.2 mg/ml MMC for 4 minutes or 0.4 mg/ml for 2 minutes. The IOP, bleb characteristics, and occurrence of complications were compared. Age and gender of the patients, preoperative IOP, MMC concentration, bleb characteristics, angle status, and age of the surgery were analyzed to determine if they are predictive factors of the postoperative IOP using univariate and multivariate analyses. Results Seventy-four eyes of 68 patients underwent trabeculectomy: 36 eyes were treated with 0.2 mg/ml MMC for 4 minutes and 38 eyes with 0.4 mg/ml MMC for 2 minutes. There was no statistically significant difference in the mean preoperative IOP and postoperative IOP, as well as in the mean percent change in IOP (p = 0.87) between the 2 groups. Univariate and multivariate analyses showed the preoperative IOP (p = 0.02) and the type of filtering bleb (cystic p < 0.001; diffuse p = 0.045) as predictive factors of postoperative IOP. KaplanMeier survival curves showed no significant difference between the 2 groups at an average follow-up of 20 weeks. Conclusion: There is no significant difference in the outcomes of trabeculectomies using 0.2 mg/ml and 0.4 mg/ml MMC. Preoperative IOP and bleb characteristics are factors predictive of successful filtration surgery.

Correlation of central corneal thickness and Goldmann applanation tonometry among Filipinos

Methods: A prospective cross-sectional study was performed among Filipino patients consulting at the General Ophthalmology Clinic of the Philippine General Hospital. They underwent a comprehensive eye examination. CCT obtained by ultrasonic pachymetry and IOP by Goldmann applanation tonometry were correlated using linear regression analysis. Factors affecting CCT measurements were analyzed by ANOVA. Results: Two hundred twenty two eyes of 112 patients were included in the study. CCT ranged from 451.0 mm to 653.6 mm with a mean of 531.5 mm +/- 33.8 mm. There was a significant linear correlation between CCT and IOP (r=0.63). The IOP was noted to rise by 4.3 mm Hg/100 mm CCT. Conclusion: The CCT among Filipinos is normally distributed and is comparable to the distribution obtained by metaanalysis of worldwide data. The study also found a direct correlation between CCT and IOP among Filipinos.

A Study comparing latanoprost and unoprostone in open angle glaucoma and ocular hypertension

A 1-month randomized study comparing the intraocular pressure (IOP) reducing effect of latanoprost 0.005% administered in the evening with unoprostone 0.12% given twice a day in primary open angle glaucoma and ocular hypertension was performed.A total of 27 patients were included:12 were in the latanoprost group and 15 in the unonoprostone group.Mean IOP was reduced from 27.38 mm HG with latanoprost and from 26.59 to 22.16 mm Hg with unoprostone as determined at the end of the 1-month period.No upward drift in IOP was seen with either drug during the treatment period.Thus,latanoprost 0.005% administered once daily in the evening, reduced IOP more than the unoprostone given twice daily in primary open angle glaucoma and ocular hypertension.

FDG PET imaging in the follow up of nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To investigate the clinical value of FDG PET imaging in the follow up of nasopharyngeal carcinoma after radiotherapy. Methods Twelve patients with nasopharyngeal carcinoma underwent FDG PET, CT and/or MRI during the follow up of 12 18 months after radiotherapy. The results of FDG PET were double blind evaluated and compared with these of CT and MRI. The recurrent lesions in six of these patients were pathologically confirmed and six by CT scan. Results Nine of 12 patients did not show any recurrence by CT and MRI scans. However, FDG PET scans showed significantly increased FDG metabolism, indicating recurrence in 3 of these patients. In 2 patients, both CT/MRI and FDG PET indicated recurrence. The remaining one patient had radiotherapy induced cerebral necrosis. He was misdiagnozed as an intracranial recurrence by MRI, but FDG imaging was negative. Conclusions FDG PET imaging has an advantage in distinguishing the relapse or necrosis in the follow up of post radiotherapy nasopharyngeal carcinoma patients. PET, CT and MRI is able to give a detail both in morphological and functional changes of disease. They are especially useful in the follow up or the set up of treatment planning for recurrent nasopharyngeal carcinoma.