Prevalencia de mano zamba radial en Hospital Shriners-México y revisión de la literatura / Radial club hand prevalence at Shriners Hospital-Mexico and literature review

Resumen: Introducción: La mano zamba radial congénita se caracteriza por la desviación radial de la mano como resultado de hipoplasia o ausencia del radio. Material y métodos: Se realizó un estudio descriptivo, retrospectivo, transversal y observacional de los pacientes activos con diagnóstico de mano zamba radial. Resultados: Se estudiaron 71 pacientes y 92 extremidades, la prevalencia en nuestro hospital fue de 0.08%, 64.7% fueron hombres y 35.3% mujeres. Se observaron 22 pacientes con afectación de la extremidad torácica derecha, 28 de la izquierda y 21 pacientes bilateral. Se encontró que 93% de los pacientes presentaban un síndrome asociado. El tipo de displasia longitudinal radial más común fue la tipo I. Cincuenta y ocho extremidades no contaban con pulgar. El Estado de México es el más afectado y 91.6% contaban con un responsable tutelar con escolaridad máxima de preparatoria.

Abstract: Introduction: Radial club hand is characterized by radial deviation of the hand, as a result of hypoplasia or absence of the radius. Material and methods: A descriptive, retrospective, cross-sectional and observational study of active patients diagnosed with radial club hand at the Shriners-Mexico Hospital was carried out. Results: We studied 71 patients and 92 limbs, the prevalence was 0.08%, 64.7% were men and 35.3% women. We observed 22 patients with involvement of the right thoracic extremity, 28 left and 21 bilateral. It was found that 93% of the patients had an associated syndrome. The most common type of radial longitudinal dysplasia was type 1. 58 limbs did not have a thumb. The State of Mexico is the most affected and 91.6% had a guardian with maximum high school education.

Resección hepática radioguiada con 18F-DOPA en un paciente con carcinoma medular de tiroides metastásico / Radioguided hepatic resection with 18F-DOPA in a patient with metastatic medullary thyroid carcinoma

Introducción: El carcinoma medular representa el 1-2% de todas las neoplasias tiroideas malignas. El 13-20% de los pacientes presenta metástasis a distancia, afectando al hígado en el 45% de los casos. Presentación de un caso: Una mujer de 50 años de edad, diagnosticada de carcinoma medular de tiroides, fue sometida a tiroidectomía total y disección cervical modificada en 1999. Se trataron con resección quirúrgica 2 recidivas ganglionares en el cuello; durante el periodo de vigilancia, la paciente desarrolló niveles elevados de calcitonina, identificándose la localización de la recidiva en el hígado mediante PET/TC con 18F-DOPA. La actividad metabólica no se asoció a lesión visible en TC, RM y ecografía. La cirugía radioguiada con 18F-DOPA permitió la resección anatómica de los segmentos IVb y V. Discusión: En pacientes con carcinoma medular y elevación de calcitonina durante el periodo de vigilancia, la PET/TC con 18F-DOPA es una opción para evaluar la localización de la recidiva. La resección radioguiada fue posible en esta paciente, cuya recidiva hepática no resultó visible con ningún otro método de imagen. Conclusión: La resección hepática radioguiada con 18F-DOPA en el carcinoma medular de tiroides metastásico es factible cuando la localización de la recidiva no puede identificarse anatómicamente mediante otros estudios de imagen

Introduction: Medullary carcinoma accounts for 1-2% of all thyroid malignancies. 13-20% of patients present with distant metastasis, with 45% of the cases affecting the liver. Clinical case: A 50-year-old woman, diagnosed with medullary thyroid carcinoma, was treated with total thyroidectomy and a modified neck dissection in 1999. Two lymph node recurrences in the neck were treated with surgical resection; during surveillance, she developed elevated calcitonin levels, the recurrence site was identified with 18F-DOPA PET/CT in the liver. Metabolic activity was not associated with a visible lesion in CT, MRI nor ultrasound. Radioguided surgery with 18F-DOPA allowed an anatomic resection of segments IVb and V. Discussion: In patients with medullary carcinoma and elevated calcitonin during surveillance, 18F-DOPA PET/CT is an option to evaluate the site of recurrence. Radioguided resection was feasible in this patient, whose hepatic recurrence was not visible with any other imaging method. Conclusion: Radioguided hepatic resection with 18F-DOPA in metastatic medullary thyroid carcinoma is feasible when the recurrence site is not anatomically identified by any other imaging studies

El oxígeno disuelto en plasma sí importa... Empleo de la monitorización tisular de oxígeno para valorar la viabilidad de un colgajo microvascular en paciente sometido a oxigenoterapia hiberbárica / Oxygen dissolved in plasma does matter. Tissue oxygen monitoring to assess the feasability of a microvascular flap in a patient undergoing hyperbaric oxygen therapy

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Plan Universitario de Formación en Dolor de la Sociedad Española del Dolor / No disponible

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Glaucoma melanomalítico secundario a melanoma de iris / Melanomalytic glaucoma secondary to iris melanoma

Caso clínico: Varón de 35 años con hipertensión ocular en el ojo derecho (OD). En segmento anterior se observó una masa melanótica. La presión intraocular (PIO) fue de 40mmHg en el OD. En la gonioscopia se observó una masa iridiana con extensión camerular. Se realizó biopsia escisional confirmando el diagnóstico de melanoma de iris y glaucoma melanomalítico. Se asoció tratamiento con braquiterapia epiescleral adyuvante. Discusión: A los pacientes que presentan glaucoma unilateral, con aumento de pigmentación en malla trabecular, es esencial realizar pruebas de imagen. La resección mediante iridectomía junto con braquiterapia adyuvante es eficaz en el control de la enfermedad (AU)

Clinical case: A 35-year-old male with unilateral ocular hypertension in the right eye (RE). Anterior segment examination of the RE showed a melanotic lesion. Intraocular pressure (IOP) was 40mmHg in RE. Gonioscopy revealed extension into the anterior chamber angle. Excisional biopsy was performed and consistent with iris melanoma and secondary melanomalytic glaucoma. Brachytherapy was performed as adjuvant therapy. Discussion: In patients presenting with unilateral glaucoma and increased pigmentation in the trabecular meshwork, it is crucial to perform imaging studies. Resection by iridectomy with adjuvant episcleral brachytherapy is effective in controlling the disease (AU)

Melanoma amelanótico de íris / Amelanotic iris melanoma

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Treatment of intimal sarcoma of peripheral veins.

INTRODUCTION: Intimal sarcoma is an extremely rare group of undifferentiated pleomorphic sarcoma arising from the intimal layer of vessels accounting for only 1% of all sarcomas, intimal sarcoma of large veins are even less common. CASES PRESENTATION: We present two cases of intima sarcoma, one originated form the basilar vein and the other from the cephalic vein, the first one was treated with surgery and postoperative chemotherapy followed by Radiotherapy (RT), the second case was treated with isolated limb perfusion followed by marginal resection and RT. Both patients progressed to the lungs in a short time, the first case was treated with metastasectomy of the lung and is without evidence of disease 7months after surgery; the second case treated with isolated limb perfusion has stable disease. DISCUSSION: Intimal sarcoma are very aggressive tumors, with a high metastatic potential, the two patients progressed to lung in a short time (2months) after local treatment. Both cases exhibit good response to chemotherapy and metastasectomy with a disease - free period of 7months. CONCLUSION: We propose that given the aggressive behavior of these tumors, they should be treated with chemoradiotherapy postoperative, either by systemic chemotherapy or isolated limb perfusion for the limp sparing surgery in this histology.

Follow a recipe to prescribe phosphate during hemodialysis. / Receta para prescribir fósforo durante hemodiálisis.

The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification of the problems that may can occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise.

Metastatic pheochromocytoma to liver without elevation of metanephrines and catecholamines.

INTRODUCTION: Malignant pheochromocytoma represents 10% of all patients with pheochromocytoma. Of these cases, only 5-9% presents without elevation of metanephrines and catecholamines. PRESENTATION OF CASE: A 43-year-old female patient presented with an abdominal tumor. An exploratory laparotomy was performed and the final report was a pheochromocytoma. After ten years, multiple liver lesions were detected and surgical treatment was performed. Pathological evaluation revealed a malignant pheochromocytoma with negative margins after 5 years of follow-up without evidence of disease. DISCUSSION: The recurrence rate of malignant pheochromocytoma is 15-20% at ten years and a 5-year survival rate that ranges from 50% to 80%. The presence of synchronous metastases is rare (10-27%), but have been reported until 20 years later with the most common metastatic sites being the local lymph nodes, bone (50%), liver (50%) and lung (30%). The prognostic factor such as size >6cm, age over 45 years, synchronous metastasis and no tumor excision are related with poor prognosis. CONCLUSION: Surgical treatment offers the best survival rate and the only chance of cure so far and the goal is an R0 resection as in our case. So it should be the treatment of choice.

Papillary carcinoma of hyoid.

INTRODUCTION: Thyroglosal duct cyst is a common anomaly with an incidence of 7% in adults, the rate of carcinoma in TGDC is 0.7-1.6%, and are extremely rare those originated in the hyoid bone. PRESENTATION OF CASE: A 60 years old male patient, had a hard mass in the anterior neck. CT revealed a hyoid tumor. Hyoid bone resection was performed, the pathological report show a conventional papillary carcinoma in bone tissue. We rule out primary tumor in thyroid gland. Five years later, he developed a neck node recurrence. Total thyroidectomy and a selective left neck dissection (II-IV levels) was performed. He received radioiodine adjuvant treatment. DISCUSSION: Hyoid cancer originates of a persistent thyroglosal duct remnants inside hyoid bone. CONCLUSION: We propose to add a new subdivision to pathology derived from thyroglosal duct remnants). The diagnostic approach with ultrasound and CT are necessary. A primary in te hyoid gland mustang be discorded, and then the entire hyoid bone must be removed. Treatment of the thyroid gland and neck should be considered when there are significant risk factors of recurrence, similarly to thyroid cancer based on the risk assessment.

Deficiencia en vitamina D: un reto diagnóstico / Vitamin D deficiency: a diagnostic challenge

Desde hace varios años la literatura científica prolifera en torno a un nuevo problema de salud que parece constatarse a escala mundial: el déficit de vitamina D. El establecimiento de nuevos y más bajos umbrales de deficiencia asumidos por la mayor parte de sociedades científicas internacionales, ante los insólitos vínculos que esta vitamina podría tener con la salud global de la población, ha generado multitud de estudios que publican cifras de prevalencia de déficit elevadas, y con una amplia variabilidad. La controversia sobre el nivel considerado como límite de suficiencia es especialmente evidente en la población infantil, en la que la investigación es más limitada. No obstante, una nueva hipótesis acerca de la fracción libre de la vitamina D como posible y óptimo marcador en la evaluación de su estatus está estimulando una novedosa e interesante línea de investigación. Tras mucha polémica bibliográfica parecía que ya teníamos una respuesta aceptable. La Academia Nacional de las Ciencias recogía en 2010, en su 'Dietary references intakes for calcium and vitamin D', que 'aunque el nivel sérico de 25-hidroxivitamina (25OHD) no está validado como sustituto de resultados en salud, puede servir como referencia', concluyendo que es razonable considerar 20 ng/mL como el umbral para casi toda la población1. '20' pasó a ser la cifra mágica. Pero la pregunta ahora ha cambiado: ¿es realmente la 25OHD total el parámetro que mejor mide la suficiencia en vitamina D?, ¿podría ser la fracción libre de 25OHD el marcador que cabría considerar? Encontrar una respuesta casi nunca es el fin de la búsqueda..., afortunadamente (AU)

In the last years, the number of scientific publications related to vitamin D has remarkably increased. The possible role of vitamin D in the non-bone health outcomes has led to the establishment by most international scientific societies of a new and lower threshold of deficiency and it has generated great concern the prevalence of vitamin D deficiency. Many reports have suggested that vitamin D deficiency is common worldwide. The controversy as to what constitutes adequate or optimal serum vitamin D status is especially evident in pediatric population in which epidemiologic studies are scarce. The free vitamin D hypothesis suggests that this fraction of circulating vitamin D may be a better indicator of vitamin D status, so promoting a new and interesting line of research. In 2011, the Institute of Medicine published its Review 'Dietary reference intakes for calcium and vitamin D' recognizing that, the serum 25OHD, although not validated as a substitute for health outcomes, could be used as an indexof vitamin D status, concluding that it is reasonable to consider 20 ng/mL as the threshold for most of people. '20' became the magic figure. But nowadays, the question becomes more complicated: what is the best marker of vitamin D status, total or free serum 25OHD? To find an answer rarely is the end of the search... fortunately (AU)

Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool / Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool

Introducción. La implantación del listado de verificación quirúrgica (LVQ) por la OMS ha permitido mejorar la seguridad de los pacientes. El objetivo ha sido evaluar el grado de cumplimiento del LVQ incorporando los no cumplimientos como triggers o pistas en la herramienta Global Trigger Tool (GTT). Material y métodos. Ámbito: hospital geriátrico de agudos con 200 camas. Estudio retrospectivo. Periodo de estudio: 2011-2014. Se utilizó el formulario del LVQ y la metodología del GTT para el análisis de historias clínicas y el cumplimiento del LVQ desde el año 2011 hasta el año 2014. Para el grado del daño se usaron las categorías del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Resultados. Se analizaron 227 historias de pacientes dados de alta (23,6%) de todas las historias electrónicas (1,7% de las intervenciones en los 4 años). El 100% de las historias contenían el LVQ, el 94,4% de los ítems estaban cubiertos y 28,2% de los LVQ tenían todos los ítems cumplimentados en las 3 fases del proceso. Los efectos adversos quirúrgicos disminuyeron del 16,3% en el año 2011 al 9,4% en el año 2014 (p=0,2838, no significativo) y el cumplimiento de todos los ítems del LVQ aumentó del 18,6 al 39,1% (p=0,0246, significativo). Conclusiones. La herramienta GTT permite sistematizar con un menor coste de tiempo la búsqueda de historias clínicas al azar para evaluar el cumplimiento del LVQ y considerar a los no cumplimientos del LVQ como triggers para su análisis posterior. Esta estrategia no ha sido nunca contemplada en el GTT ni en la sistemática del LVQ (AU)

Introduction. The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers» in the Global Trigger Tool (GTT). Material and methods. Setting: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. Results. Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). Conclusions. The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers» for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary (AU)

Unidad de Endocrinología y Diabetes Pediátrica / Pediatric endocrinology and diabetes unit

La Unidad de Endocrinología y Diabetes Pediátrica del Hospital Universitario Ramón y Cajal ha tenido siempre como objetivo conseguir los más altos estándares internacionales de calidad en la atención al niño y al adolescente. En particular y para el paciente con diabetes, las nuevas tecnologías, así como la educación diabetológica, son el centro de nuestro trabajo, implicando no solo a padres y pacientes sino a los profesores y a todos aquellos que conviven a su alrededor, buscando así el mejor control metabólico y la mejor calidad de vida (AU)

The objective of the Pediatric and Endocrinology Unit of the University Hospital Ramón y Cajal has always been that of achieving the highest international standards of quality in the care of children and adolescents. Specifically, and for the patient with diabetes, the new technologies and education in diabetes are the center of our work, this not only involving parents and patients but also the professors and all those within their surroundings, seeking in this way the best metabolic control and best quality of life (AU)

Off-label prescription of drugs at hospital.

OBJECTIVES: To develop a procedure for management of off-label medications, and to analyze the treatments, indications, and hospital units which will request them more frequently, as well as which variables will have an impact on the authorization decision, and its economic impact. METHODS: A procedure was designed where clinicians would complete request forms and the Hospital Unit would prepare reports assessing their efficacy, safety, convenience, and cost. The request forms for the past five years were analyzed. RESULTS: A total of 834 applications were received, and 88.1% of these were accepted. The authorization rates were higher for Paediatric Units (95.7% vs. 86.6%; p<0.05). The reasons for considering prescriptions as off-label were: different indication (73.2%), different combination (10.2%), different line of treatment (8.6%) and different age (8%). A 73.4% of requests were for antineoplastic drugs, and the most frequently prescribed were rituximab (120) and bevacizumab (103). The quality of evidence supporting the prescriptions was moderate-low, though no direct relationship with the likelihood of approval was demonstrated (p = 0.413). The cost of the approved medications was 8,567,537 €, and the theoretical savings for those drugs rejected was of 2,268,642 €. There was a statistically significant decrease in the authorization rate (p < 0.05, Student's t test) when spending increased. CONCLUSIONS: The responsibility for assessing off-label prescriptions has fallen on the Pharmacy Unit. It has not been demonstrated that the quality of evidence represents a decisive variable for approval of treatment; on the other hand, age and cost have demonstrated a significant impact.

Objetivos: Desarrollar un proceso de gestión de medicamentos en condiciones fuera de ficha técnica y analizar los tratamientos, indicaciones y unidades clínicas que los solicitan, qué variables influyen en la decisión de autorización y su impacto económico. Métodos: Se diseñó un procedimiento según el cual los clínicos cumplimentarían las solicitudes, el Servicio de Farmacia redactaría los informes valorando su eficacia, seguridad, conveniencia y coste, y la dirección médica tomaría la decisión de aceptar o no su uso. Se analizaron las solicitudes de los últimos cinco años. Resultados: Se recibieron 834 solicitudes, autorizándose el 88,1%. Las tasas de autorización fueron mayores para los Servicios Pediátricos (95,7% frente a 86,6%; p < 0,05). Las razones por las que las prescripciones se consideraron fuera de ficha técnica fueron: diferente indicación (73,2%), combinación diferente (10,2%), línea diferente (8,6%) y edad diferente (8%). El 73,4% de las solicitudes fueron de antineoplásicos, siendo rituximab (120) y bevacizumab (103) los más prescritos. La calidad de la evidencia que avalaba las prescripciones fue moderada-baja, aunque sin demostrar relación directa con la probabilidad de aprobación (p = 0,413). El coste de los medicamentos aprobados fue de 8.567.537 € y el ahorro teórico de los denegados 2.268.642 €. El porcentaje de autorización disminuyó según aumentó el gasto de manera estadísticamente significativa (p < 0,05, test t de Student). Conclusiones: La responsabilidad de evaluación de las prescripciones fuera de ficha técnica ha recaído en los Servicios de Farmacia. La calidad de la evidencia no ha demostrado ser una variable decisiva para la aprobación de los tratamientos. En cambio, la edad y el coste sí que han demostrado influir significativamente.

Detección de enfermedad renal crónica oculta en pacientes de las unidades de salud familiar de loma Pyta- asunción / Detection of occult chronic kidney disease in family health units hospital loma Pyta

Introducción: La Enfermedad Renal Crónica (ERC) es una epidemia de salud pública a nivel mundial y su prevalencia aumentó en los últimos años, en relación al aumento de la prevalencia de diabetes, hipertensión arterial y obesidad. Objetivo: Identifcar la frecuencia de Enfermedad Renal Crónica oculta en la población que asiste a control en Atención Primaria de Salud, en las Unidades de Salud Familiar del Hospital Loma Pyta-Asunción y determinar los estadios y las patologías concomitantes. Material y Métodos:Estudio descriptivo de corte transverso en 173 sujetos, >18 años y de ambos sexos. Se analizaron: Edad, Sexo, Antecedentes de consumo crónico de antiinflamatorio y de exposición a agrotóxicos, presión arterial, glicemia, creatinina plasmática, perfl lipídico y proteinuria. Se calculó Indice de Masa Corporal, y Filtrado Glomerular por ecuación MDRD. Resultados: Se encuentran con ERC el 25,5%.El FG fue normal en el 74,5%; en Estadio 1: 15,6% en Estadio 2: 9,2% y en Estadio 3: 0,6%. Se halló HTA y DM como patologías asociadas a ERC, en Estadio1: HTA: 51,8%, DM el 33,3%, con IVU 11,1%. En Estadio 2 con HTA: 12,4%; con DM: 18,5%; solo Obesidad: 18,8% y con proteinuria aislada el 50% y un paciente en Estadio 3 con HTA. Proteinuria en el 32% de los hipertensos y el 24% de los diabeticos y un grupo de pacientes obesos en un 24%. Conclusiones: El hallazgo fue 25,5% de ERC en estadios iniciales, etapa ideal para tratar y evitar la progresión a diálisis, alta frecuencia de DM, HTA y obesidad que son factores de riesgo de enfermedad renal y cardiovascular. Palabras claves: Factores de Riesgo- Enfermedad renal crónica- Atención Primaria de Salud

Introduction: Chronic kidney disease (CKD) is a public health epidemic worldwide and its prevalence has increased in recent years, probably related to the increased prevalence of diabetes, hypertension and obesity.Objective: To determine frequency of Occult CKD population attending family health units Loma Pyta Hospital, and determine the different stages and comorbidities. Material and Methods: Transverse sectional descriptive study. Universe of 19,100 people; sample of 173,> 18 years and of both sexes. They were analyzed: age, sex, past medical history of chronic inflammatory consumption and exposure to pesticides, blood pressure, blood glucose, blood creatinine and lipid profle. Proteinuria dipstick. Body Mass Index, and glomerular fltration rate calculated by MDRD equation 4.Results: The glomerular fltration rate was normal in 74.5%. The study group, whith CKD are 25.5%, of which in Stage 1: 15.6% (n = 27) in Stage 2 9.2 Stage 3% and 0.6%. Arterial hypertension and Mellitus diabetes was found as pathologies associated with CKD. In Estadio1: hypertension: 51.8%, and 33.3% DM. In Stage 2 with hypertension: 12.4%; and DM: 18.5%; Obesity 18.8% and 50% isolated proteinuria and one patient in stage 3 with hypertension. 32% of hypertensive patients and 24% of diabetics with proteinuria, and there is a group of obese patients, who are not diabetic or hypertensive patients who presented proteinuria 24%, the possibility of rapid progression of renal insuffciency higher in this group of patients. Conclusions: The fnding was 24.5% of ERC ideal to treat and prevent progression to dialysis stage early stages, the high frequency of DM, hypertension and obesity are risk factors for renal and cardiovascular disease is confrmed. Keywords: Risk Factors- occult chronic kidney disease, family health units

Achievement of metabolic control goals set by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes in pediatric patients with type 1 diabetes from Spain.

AIM: The "T1D Exchange Clinic Registry" of 13.316 pediatric patients with type 1 diabetes (T1D) in U.S. recently revealed that most children have HbA1c values above target levels established by the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). The aim of this study is to assess the proportion of youngsters with T1D who meet the internationally accepted targets for good metabolic control of diabetes at a single, referral Pediatric Diabetes Center in Spain. PATIENTS AND METHODS: Cross-sectional study of 236 children and adolescents with T1D controlled at our Pediatric Diabetes Unit. We analyzed the compliance to metabolic goals set by ADA and ISPAD and the differences between patients treated with continuous subcutaneous insulin infusion and multiple daily injections. STATISTICS: SPSS™ version 21.0. RESULTS: Mean age: 12.6 ± 4.6 years old, mean age at diagnosis: 6.1 ± 4.3 years old and mean diabetes duration: 6.4 ± 4.3 years; 47% female. HbA1c average: 6.7 ± 0.7% (49.7 ± 7.6 mmol/mol). The age-specific ADA and ISPAD HbA1c targets were achieved by 93% and 91% of patients, respectively. Among pump users, 97%/97% met ADA/ISPAD HbA1c targets compared to 87%/88% of MDI users (p = 0.04/p = 0.03), without significant differences in the analysis by groups of age. Among participants, 95%, 62%, 95%, 98% and 89% met HDLc, LDLc, triglycerides, BP and BMI targets. CONCLUSIONS: Most patients in our children and adolescent cohort of T1D patients correctly achieve metabolic goals established by ADA and ISPAD with low incidence of hypoglycemia.

Evaluación de la transición desde la Unidad de Diabetes Pediátrica a la de Adultos en adolescentes con diabetes mellitus tipo 1 / Evaluation of the transition from pediatric to adult diabetic unit for adolescents with type 1 diabetes

OBJETIVO: Analizar el control metabólico y grado de satisfacción en un grupo de pacientes con DM1 tras cambiar de Unidad (Pediátrica [UDP], Adultos [UDA]). PACIENTES Y MÉTODOS: Estudio retrospectivo: 49 pacientes, 43% mujeres. Analizamos: edad al diagnóstico y paso a adultos, tiempo evolución, control metabólico (HbA1c), complicaciones diabéticas y características del seguimiento. Estudio estadístico: programa SPSS-versión-17.0. RESULTADOS: Edad media ± desviación estándar al diagnóstico 8,3 ± 4,6 y en transferencia 19,2 ± 1,8 años. Tiempo seguimiento en UDP, UDA y global: 10,8 ± 5,0, 4,1 ± 2,6 y 15,0 ± 5,7 años; el 6% perdió el seguimiento médico. En UDA: el 6% desconocía última HbA1c y el 29%las complicaciones crónicas. El control metabólico empeoró en 52% pacientes (aumento HbA1c +0,79 ± 0,70%). No encontramos correlación entre el tiempo evolución y la HbA1c. El 96% de los pacientes refirieron grado satisfacción bueno/muy bueno respecto a UDP y el 74% respecto a UDA. CONCLUSIÓN: Parece necesaria una mejor planificación de la transición de pacientes con DM1 alas UDA para evitar el empeoramiento del control clínico y/o la pérdida de seguimiento

INTRODUCTION: The transition between pediatric and adult care for young people with type 1 diabetes (T1D) is often poorly managed, with adverse consequences for health, as well as a decrease in the follow-up OBJECTIVE: To analyze the metabolic control and the degree of satisfaction in a group of patients with T1D after being transferred from the Pediatric Diabetes Unit (PDU) to Adult Diabetes Unit (ADU). PATIENTS AND METHODS: Retrospective study in a cohort of 49 patients (43% female) with T1D. The age at diagnosis and transfer to ADU, time of onset of the disease, metabolic control (HbA1c), presence of diabetic complications and characteristics of medical follow-up wereanalysed using the statistics program: SPSS, version 17.0. RESULTS: Mean age at diagnosis 8.3±4.6 years and transfer to ADU 19.2±1.8 years. Mean time since onset of T1D in pediatrics, adults and overall: 10.8±5.0, 4.1±2.6 and 15.0±5.7 years, respectively. The 6% of adult patients were not being medically tracked. Among adults, 25% did not provide data about chronic complications, and 6% did not know their last HbA1c. The metabolic control after their transfer to the ADU worsened in 52% of the patients (HbA1c +0.79±0.70%). No correlation was found between the time since onset and the HbA1c value. Degree of satisfaction was either good or very good in 96% of patients in the PDU and 74% in ADU. CONCLUSION: Better planning for the transfer of pediatric patients with T1D to ADU is highly recommended, in order to avoid deterioration of control and/or loss of follow-up