Evaluación de temas sexuales por profesionales que asisten a hombres con diabetes tipo 2 / Evaluation of sexual issues by professionals who assist type 2 diabetic men

Resumen Introducción: Los trastornos andrológicos son frecuentes en varones con diabetes tipo 2. El objetivo fue evaluar si los médicos que atienden a personas con diabetes tipo 2 abordan problemas andro lógicos como disfunción sexual eréctil, disminución de libido y síntomas de hipogonadismo. Métodos: Se llevó a cabo una encuesta anónima a 171 médicos, de ellos 113 fueron mujeres (66.1%) con una edad media de 46 ± 10 años (mujeres: 45 ± 10 y varones: 49 ± 10, p = 0.006). Resultados: No hubo diferencias en las res puestas según el género. El 44.4% (n = 76) y el 55.6% (n = 95) no preguntan sobre la presencia de disfunción sexual eréctil y/o disminución de libido, respectivamente. El 50.9% (n = 87) no solicitó medición de testosterona en pacientes con síntomas de hipogonadismo. El 65.8% de los participantes respondió que el reemplazo con testosterona puede mejorar el perfil metabólico de la diabetes mellitus tipo 2 y los síntomas sexuales. El 74.7% de los encuestados afirmó que la medición de testosterona debería realizarse ante la presencia de síntomas compatibles con hipogonadismo. El 63.2% (n = 108) mostró interés en formación sobre temas relacionados a diabetes tipo 2 y trastornos de la esfera sexual. Conclusión: Un gran porcentaje de médicos que asisten a varones con diabetes tipo 2 no indaga sobre trastornos andrológicos. Es necesario concientizar y entrenar a los médicos, para detectar, tratar y/o derivar estos problemas de salud tan frecuentes, no solo para mejorar la calidad de vida de los pacientes sino para responder y prevenir efectivamente a un problema mayor de salud.

Abstract Introduction: Our objective was to assess whether physicians who care for people with type 2 dia betes address andrological symptoms such as erectile sexual dysfunction, decreased libido, and symptoms and/ or signs of hypogonadism. Methods: An anonymous survey was carried out with 171 doctors, 113 were females (66.1%), the mean age was 46 ± 10 years (females: 45 ± 10 and males: 49 ± 10, p = 0.006). Results: There were no differences in responses according to gender. Regarding the presence of erectile sexual dysfunction and/or decreased libido, 44.4% (n = 76) and 55.6% (n = 95) did not ask about them, respectively. In patients with symptoms of hypogonadism, 50.9% (n = 87) did not request a testosterone measurement. Regarding the improvement of the metabolic profile of type 2 diabetes mellitus and sexual symptoms after replacement with testosterone, 65.8% of the respondents answered that both conditions could improve after treatment. In the presence of symptoms compatible with hypogonadism, 74.7% of those surveyed stated that the measurement of testosterone should be performed. A total of 108 (63.2%) showed interest in being trained on topics related to type 2 diabetes and disorders of the sexual sphere. Conclusion: A large percentage of physicians who take care of men with type 2 diabetes do not inquire about andrological disorders. It is necessary to raise awareness and train doctors to detect, treat and/or refer these frequent health problems, not only to improve the quality of life of patients but also to effectively respond and prevent a major health problem.

Feasibility of a ketamine anesthesia package in support of obstetric and gynecologic procedures in Kenya when no anesthetist is available

The objective was to assess the feasibility and safety of the _Every Second Matters for Emergency and Essential Surgery ­ Ketamine' (ESM-Ketamine) package in support of obstetric and gynecologic emergency and essential surgery when no anesthetist is available. A consecutive case series was conducted in twelve hospitals across five severely resource-limited counties in Kenya. 530 women underwent obstetric or gynecological operative procedures supported by non-anesthetist clinicians using the ESM-Ketamine package between November 1, 2013 and September 30, 2017. Main outcomes included reasons for ESM-Ketamine activations and ketamine-related adverse events. There were two (0.4%) prolonged (>30 seconds) oxygen desaturations below 92%. Brief oxygen desaturations (<30 seconds) below 92% occurred in 15 (2.8%) cases and 113 (21.3%) were administered diazepam to treat hallucinations or agitation. There were no ketamine-related deaths or injuries. The ESM-Ketamine package appears feasible and safe for use in support of obstetric and gynecologic surgeries when no anesthetist is available

Trastornos de la fertilidad en el hombre con diabetes tipo 1 y 2 / Fertility alterations in men wiht type 1 and 2

La diabetes mellitus (DM) es una de las mayores amenazas para la Salud Publica en las sociedades modernas. Si bien durante varios años se sugirió que la DM no tenía efecto significativo en la función reproductiva masculina, esta visión fue cambiando. La creciente incidencia de la DM a nivel mundial afectara a cada vez más hombres y de menor edad, y por lo tanto podría afectar su potencial reproductivo.

La ética de la investigación en seres humanos en debate / The ongoing debate on research involving human beings

La investigación en seres humanos permite mejorar el diagnóstico y el tratamiento de las enfermedades. Sin perjuicio de los beneficios indudables para la humanidad, se debe tener presente que la historia de este tipo de investigación muestra que cada vez que su práctica se separó de la reflexión moral y del control social, se produjeron hechos aberrantes y diversos atropellos a los derechos humanos (antes, durante y después de la Segunda Guerra Mundial). Actualmente se asiste a un vivo debate entre las tendencias favorables a una flexibilización ética, que permita abatir los tiempos y los costos de la experimentación, y las contrarias, que sostienen que es inaceptable permitir un doble estándar ético que convertiría a personas y poblaciones vulnerables en meros medios para el logro de un beneficio para la humanidad o la ciencia. El debate se centra en abrir la puerta o no al uso de placebo en ensayos clínicos controlados cuando existe un tratamiento conocido y en asegurarle o no a los participantes los beneficios de tratamientos sin costo. Hasta el momento, la legislación nacional en la materia (decreto 379/008) ha resistido la tendencia a la flexibilización. Pero el país no escapa al debate global en la materia. La revisión de las normativas éticas es un proceso necesario, producto de la reflexión ética permanente. Sin embargo, esta actualización no debe retroceder en los estándares éticos consensuados, priorizando la protección de los participantes de la investigación sobre cualquier otro interés.

Research involving human beings enables improvement of diagnosis and treatment of diseases. Without prejudice of its doubtless benefits for humanity, we need to bear in mind that historically, this kind of research proved that every time it moved away from moral reflection and social control, aberrant facts took place and several human rights were ran over (before, during and after World War II). Today, we witness the ongoing debate between trends that favor an increased ethical flexibility that allows better times and costs of research, and the opposite trends that believe a double ethical standard resulting in vulnerable people and populations being mere means for the accomplishment of benefits for humanity or science is unacceptable. The debate focuses on whether or not to open the door to the use of placebo in controlled clinical trials when there is a well known treatment, and whether or not to ensure participants are guaranteed the benefits of treatment for free. Until now, the relevant legal provisions in force (Decree 379/008) have endured the trend to increase flexibility.However, our country cannot ignore the global debate on this issue.Ethical regulations need to be revised through an ongoing ethical reflection. Notwithstanding this process, this update must not give up agreed ethical standards that prioritize the protection of participants in research over any other interest.

A pesquisa em seres humanos permite melhorar o diagnóstico e o tratamento das doenças. Sem perder de vista os óbvios benefícios para a humanidade, é importante lembrar que cada vez que sua realização se afastou da reflexão moral e do controle social foram observadas praticas aberrantes e os direitos humanos não foram respeitados (antes, durante e depois da Segunda Guerra Mundial). Atualmente se observa o debate entre os grupos favoráveis a flexibilização da ética, que permitiria reduzir os tempos e os custos das experiências y os grupos contrários que afirmam que é inaceitável permitir um padrão ético duplo que faria que as pessoas e populações vulneráveis se transformassem em um meio para alcançar benefícios para a humanidade e a ciência. O ponto central do debate é autorizar ou não o uso de placebo em estudos clínicos controlados quando existe tratamento conhecido e garantir ou não, aos participantes, os benefícios de tratamentos sem custo. Até agora a legislação nacional (decreto 379/008) vem resistindo à tendência a flexibilização. Mas o país não escapa do debate global sobre o tema. A revisão das normas éticas é um processo necessário, resultado da reflexão ética permanente.