Neuropatía autonómica diabética: manifestaciones clínicas poco conocidas / Diabetic autonomic neuropathy: little known clinical manifestations

La neuropatía crónica es la complicación más prevalente de la diabetes. De las distintas formas de neuropatía diabética, la polineuropatía distal y simétrica y la neuropatía autonómica, particularmente la neuropatía autonómica cardíaca, son las más estudiadas y en ocasiones son asintomáticas. Los pacientes con prediabetes también pueden desarrollar neuropatías similares a la neuropatía diabética. La prevención es un componente clave en la atención de estas complicaciones. La neuropatía autonómica diabética afecta varios órganos y sistemas de la economía. Nuestro objetivo es describir aquellas manifestaciones clínicas poco conocidas, y en consecuencia poco tenidas en cuenta, que afectan el sistema cardiovascular, el gastrointestinal y el compromiso vesical

Chronic neuropathy is the most prevalent of the diabetic complications. Distal and symmetric sensitive polyneuropathy, and autonomic compromise, particularly cardiac autonomic neuropathy,are the most studied; occasionally they are asymptomatic. Like diabetic patients, prediabetics can also develop neuropathy. Prevention is a key component in these complications. Autonomic neuropathy affects several body´s organs and systems. Our goal is to describe those less known clinical manifestations, and because of this, less considered complications that affect cardiovascular, gastrointestinal system and bladder functioning

Investigação da técnica de administração de medicamentos por sondas enterais em hospital geral / Investigation of the technique of medication administration through enteral feeding tubes in a general hospital / Investigación de la técnica de administración de medicamentos por sondas enterales en hospital general

A administração de fármacos por sondas enterais é uma prática cotidiana nos hospitais indicada para pacientes com transtornos de deglutição. O objetivo do estudo foi verificar a técnica empregada pela equipe de enfermagem no preparo e administração de medicamentos por sondas enterais em hospital geral de Dourados, MS. Tratou-se de estudo exploratório e descritivo realizado entre agosto de 2004 e maio de 2005. Como método, realizou-se a observação não-participante e direta das técnicas de administração, entrevista estruturada e análise dos prontuários. Constatou-se que 78,26% dos medicamentos foram administrados por sonda nasogástrica nas 23 situações observadas. Cerca de 97% dos fármacos estavam em formas farmacêuticas sólidas, tendo que passar por processo de derivação. Foram observados erros no preparo e administração, como trituração de comprimidos de liberação controlada, administração ao mesmo tempo de mais de um medicamento e associação do medicamento com a dieta enteral, levando à possível redução do efeito farmacológico.

The administration of drugs through enteral feeding tubes is an everyday practice in hospitals and indicated for patients with swallowing disorders. The aim of the study was to ascertain the technique applied by the nursing team in preparing and administering drugs through enteral feeding tubes in a general hospital in Dourados, Mato Grosso do Sul State. This exploratory and descriptive study was conducted between August 2004 and May 2005. The method used was non-participant, direct observation of the administration techniques, structured interview and chart analysis. In the 23 situations observed, 78.26% of the medication was administered through nasal-gastric tubes. About 97% of the drugs were in solid pharmaceutical form and required manipulation before application. Mistakes were observed in preparation and administration, such as grinding of time release tablets, administration of more than one medication at the same time and association of medication with enteral diet, leading to possible reduced pharmacological effect.

La administración de fármacos por sonda enteral es una práctica cotidiana en los hospitales indicada para pacientes con trastornos de deglución. El objetivo del estudio fue verificar la técnica empleada por el equipo de enfermería en el preparo y administración de medicamentos por sonda enteral en hospital general de Dourados, MS-Brasil. Es un estudio exploratorio y descriptivo realizado entre agosto de 2004 hasta mayo de 2005. Como método se ha hecho la observación no participante y directa de las técnicas de administración, entrevista estructurada y análisis de los prontuarios. Se ha constatado que 78,26% de los medicamentos fueron administrados por sonda nasogástrica en las 23 situaciones observadas. Cerca de 97% de los fármacos estaban en formas farmacéuticas sólidas, habiendo que pasar por proceso de derivación. Fueron observados errores en el preparo y administración, como trituración de comprimidos de liberación controlada, administración al mismo tiempo de más de un medicamento y asociación del medicamento con la dieta enteral, llevando a la posible reducción del efecto farmacológico.

Electronic Endoscopy of the Upper Gastrointestinal Tract in Pediatric Patients

PURPOSE: Since 1990 upper intestinal endoscopy has become frequently used tools for the diagnosis and treatment of a variety of upper intestinal tract disease. The purposes of this study was to assess the usefulness of small electronic endoscope in pediatric patients. METHODS: Upper intestinal endoscopy was performed in 104 cases of children for 15 months using electronic endoscope (Olympus EVIS XQ 200, outer diameter 9.2 mm). During procedure all patients were lightly sedated with midazolam over 7 years or valium and demerol under 6 years. RESULTS: The majority of cases were between 7-15 years of age and the youngest patient were 12 months of age. The indications in order of frequency were acute epigastric pain(41.3%), recurrent abdominal pain(17.3%), upper intestinal bleeding (13.5%), chronic dyspepsia and abdominal discomfort(9.6%), chest pain(3.8%), foreign body ingestion(3.8%), caustic ingestion(2.9%) and miscellaneous. The common abnormal endoscopic findings in order were gastritis(30.6%), ulcerative lesion(6.7%), duodenitis (6.7%). The 47.1 % of cases were endoscopically normal. Among 43 patients with acute epigastric pain, erosive gastritis(14.0%), nodular gastritis(11.6%), superficial gastritis (9.3%), duodenitis(9.3%), duodenal postbulbar ulcer(4.7%), esophagitis(2.3%), gastritis with duodenitis (2.3%) were diagnosed endoscopically. The rest of patients(44.2%) were normal. Twelve patients with upper gastrointestinal bleeding has erosive gastitis(16.7%), nodular gastritis(16.7%), gastric ulcer(16.7%). The rest(50.0%) were endoscopically normal. All 10 patients complaining chronic dyspepsia and abdominal discomfort showed abnormal findings such as erosive gastritis(30%), nodular gastritis(30%), superficial gastritis(40%). The 77.8% of patients with recurrent abdominal pain were normal and only 22.2% of patients showed superficial gastritis. The removal of foreign body was performed under the general anesthesia(3 cases) and light sedation(1 case). During and following endoscopy there was no significant complications. CONCLUSIONS: In the hands of a skilled pedatric endoscopist, endoscopic procedures are not only enhance diagnostic accuracy but can performed safely. Small electronic endoscope widely used in adults has been safely adapted to children over 1 year of age.