Efficacy and safety of basal insulin degludec 100 IU/mL versus glargine 300 IU/mL for type 1 diabetes: The single-center INEOX randomized controlled trial.

AIMS: To compare efficacy and safety of degludec 100 IU/mL (Deg-100) and glargine 300 IU/mL (Gla-300) in adults with type 1 diabetes. METHODS: Open-label, single-center, randomized, parallel-group, 24-week trial in adults with type 1 diabetes, on basal-bolus insulin therapy, HbA1c ≤ 10%, using self-monitoring blood glucose. Participants were randomized 1:1 to a basal-bolus insulin regimen with Deg-100 (N = 129) or Gla-300 (N = 131). Primary efficacy endpoint: mean change in HbA1c from baseline to week-24. Main safety outcome: incidence rate of hypoglycemia during the study. Quality of life (DQOL) and satisfaction with diabetes treatment (DTSQ) were assessed. RESULTS: At week 24, after adjusting for baseline HbA1c, the decrease in HbA1c did not differ between groups: Deg-100 (-0.07 ± 0.7%) and Gla-300 (-0.16 ± 0.77%) (P = 0.320). There were no significant differences between groups in HbA1c, nocturnal hypoglycemia, severe hypoglycemia, DQOL, or DTSQ scores. The incidence rates of hypoglycemia < 3.9 mmol/L (Deg-100: 115.24 events/person-year vs Gla-300: 99.01 events/person-year, p < 0.001); and < 3.0 mmol/L (Deg-100: 41.17 events/person-year vs Gla-300: 34.29 events/person-year, p < 0.001) were different between groups. CONCLUSIONS: Deg-100 and Gla-300 have similar metabolic efficacy, incidence ratio of nocturnal and severe hypoglycemia, DQOL and DTSQ scores. Differences in the incidence rate of hypoglycemia < 3.9 mmol/L and < 3.0 mmol/L should be confirmed.

Relationship between glucose control, glycemic variability, and oxidative stress in children with type 1 diabetes / Relación entre control metabólico, variabilidad glucémica y estrés oxidativo en niños con diabetes tipo 1

Introduction: Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. Objective: To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2alfa) in children with T1DM. Materials and methods: A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. - Capillary HbA1c level. - 24-h urine sample to measure 8-iso-PGF2alfa. Results: There were no statistically significant differences in urinary 8-iso-PGF2alfa levels (142 ± 37 vs. 172 ± 61 pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2alfa and HbA1c levels (r = 0.53), MBG (r = 0.72), standard deviation (r = 0.49), and MAGE (r = 0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2alfa excretion were found in the 1st phase. Conclusions: A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health

Introducción: En niños con diabetes tipo 1 (DM1) hay pocos estudios que evalúen la relación entre estrés oxidativo y variabilidad glucémica, y la mayoría de ellos no encuentran resultados significativos. Objetivo: Evaluar la relación entre control metabólico, variabilidad glucémica y estrés oxidativo medido por la excreción urinaria de 8-iso-prostaglandina F2 alfa (8-iso-PGF2alfa) en niños con DM1. Material y método: Estudio transversal que incluyó 25 niños con DM1. Los participantes fueron evaluados durante 5 días en 2 situaciones diferentes: 1.a fase durante un campamento de verano y 2.a fase durante su actividad habitual en domicilio. En cada fase se recogieron:- Seis determinaciones de glucemia capilar diarias. Se calcularon glucemia media y parámetros de variabilidad glucémica: desviación estándar, coeficiente de variación y «mean amplitude of glycemic excursions» (MAGE). - HbA1c capilar. - Muestra de orina de 24h para la determinación de 8-iso-PGF2alfa. Resultados: No se encontraron diferencias estadísticamente significativas en excreción urinaria de 8-iso-PGF2alfa (142 ± 37 vs. 172 ± 61 pg/mg creatinina) y parámetros de control y variabilidad glucémicos entre las fases. En la 2.a fase se observaron correlaciones estadísticamente significativas entre 8-iso-PGF2alfa urinario con HbA1c (r = 0,53), glucemia media (r = 0,72), desviación estándar (r = 0,49) y MAGE (r = 0,42). En la 1.a fase del estudio no se han detectado correlaciones significativas. Conclusiones: Se ha encontrado una correlación significativa entre parámetros de variabilidad glucémica y HbA1c con la excreción urinaria de 8-iso-PGF2alfa en un grupo de niños con DM1 evaluados durante su vida diaria. Son necesarios más estudios para confirmar estos resultados y evaluar el impacto a largo plazo sobre la salud

Relationship between glucose control, glycemic variability, and oxidative stress in children with type 1 diabetes.

INTRODUCTION: Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. OBJECTIVE: To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2α) in children with T1DM. MATERIALS AND METHODS: A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. - Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. - Capillary HbA1c level. - 24-h urine sample to measure 8-iso-PGF2α. RESULTS: There were no statistically significant differences in urinary 8-iso-PGF2α levels (142±37 vs. 172±61pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2α and HbA1c levels (r=0.53), MBG (r=0.72), standard deviation (r=0.49), and MAGE (r=0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2α excretion were found in the 1st phase. CONCLUSIONS: A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health.

Importancia de la detección precoz y el seguimiento clínico enfermero del niño afectado con trastorno del déficit de atención e hiperactividad / Importance of early detection and clinical nurse monitoring in children affected with attention deficit and hiperactivity disorder

El trastorno del déficit de atención es un trastorno de origen neurológico que afecta al desarrollo normal del niño [1]. En los países desarrollados, el trastorno por déficit de atención (TDA) tiene una prevalencia del 5 al 10 % en niños en edad escolar [2]. La sintomatología de este proceso se manifiesta por una exagerada e inapropiada hiperactividad, impulsividad e incapacidad para mantener la atención. La no intervención por parte del personal sanitario supone el deterioro en la calidad de vida del niño y posteriormente del adulto, el cual, con el paso del tiempo, tiene una alta probabilidad de desarrollar comorbilidades asociadas al trastorno. El tratamiento ideal es multimodal, una combinación entre farmacología, psicología y psicopedagogía. En el programa del niño sano, la enfermería ejerce un papel muy importante frente al diagnóstico y seguimiento del paciente [1]. Con el presente artículo, pretendemos facilitar esa labor de diagnóstico y seguimiento del niño por parte de la enfermera de Atención Primaria, así como determinar la forma de llevar a cabo un seguimiento correcto del mismo (AU)

Attention Deficit Disorder (ADD) is a neurological disorder that affects a child’s normal development [1]. In developed countries, ADD has a prevalence ranging from 5 to 10% in school-aged children [2]. The symptoms of this process include excessive and inappropriate hyperactivity, impulsivity and the inability to sustain attention. The lack of health intervention results in the impairment of the child’s quality of life, leading to negative effects during adulthood, due to the high likelihood of developing disorder comorbidities over time. The ideal treatment is multimodal: a combination of pharmacology, psychology and psycho-pedagogy. Aligned with the healthy child program, nursing has a very important role on the diagnosis and monitoring of patients. [1]. Our aim with this article is to facilitate the task of diagnosis and correct monitoring of these children by primary nurses (AU)

Related factors to semi-recumbent position compliance and pressure ulcers in patients with invasive mechanical ventilation: An observational study (CAPCRI study).

BACKGROUND: Semi-recumbent position is recommended to prevent ventilator-associated pneumonia. Its implementation, however, is below optimal. OBJECTIVES: We aimed to assess real semi-recumbent position compliance and the degree of head-of-bed elevation in Spanish intensive care units, along with factors determining compliance and head-of-bed elevation and their relationship with the development of pressure ulcers. Finally, we investigated the impact that might have the diagnosis of pressure ulcers in the attitude toward head-of-bed elevation. METHODS: We performed a prospective, multicenter, observational study in 6 intensive care units. Inclusion criteria were patients ≥18 years old and expected to remain under mechanical ventilator for ≥48h. Exclusion criteria were patients with contraindications for semi-recumbent position from admission, mechanical ventilation during the previous 7 days and prehospital intubation. Head-of-bed elevation was measured 3 times/day for a maximum of 28 days using the BOSCH GLM80(®) device. The variables collected related to patient admission, risk of pressure ulcers and the measurements themselves. Bivariate and multivariate analyses were carried out using multiple binary logistic regression and linear regression as appropriate. Statistical significance was set at p<0.05. All analyses were performed with IBM SPSS for Windows Version 20.0. RESULTS: 276 patients were included (6894 measurements). 45.9% of the measurements were <30.0°. The mean head-of-bed elevation was 30.1 (SD 6.7)° and mean patient compliance was 53.6 (SD 26.1)%. The main reasons for non-compliance according to the staff nurses were those related to the patient's care followed by clinical reasons. The factors independently related to semi-recumbent position compliance were intensive care unit, ventilation mode, nurse belonging to the research team, intracranial pressure catheter, beds with head-of-bed elevation device, type of pathology, lateral position, renal replacement therapy, nursing shift, open abdomen, abdominal vacuum therapy and agitation. Twenty-five patients (9.1%) developed a total of 34 pressure ulcers. The diagnosis of pressure ulcers did not affect the head-of-bed elevation. In the multivariate analysis, head-of-bed elevation was not identified as an independent risk factor for pressure ulcers. CONCLUSIONS: Semi-recumbent position compliance is below optimal despite the fact that it seems achievable most of the time. Factors that affect semi-recumbent position include the particular intensive care unit, abdominal conditions, renal replacement therapy, agitation and bed type. Head-of-bed elevation was not related to the risk of pressure ulcers. Efforts should be made to clarify semi-recumbent position contraindications and further analysis of its safety profile should be carried out.

Análisis de la importancia del programa de donación de sangre de cordón umbilical y su relación con la información ofrecida por el personal sanitario / Analysis of the importance of the blood donation program of umbilical cord and its relation with the infomation given by the health workers

La sangre de cordón umbilical (SCU) ofrece una fuente rica de células progenitoras hematopoyéticas, caracterizadas por su capacidad de proliferación, diferenciación y renovación celular de los tejidos sobre los que se encuentran. Los beneficiarios de esta donación son todas aquellas personas con enfermedades de la médula ósea. Desde que en el año 1988 se realizara con éxito el primer trasplante de sangre de cordón umbilical entre hermanos HLA idénticos, se han llevado a cabo numerosas donaciones, de manera que, actualmente, cualquier mujer que dé a luz en alguno de los centros autorizados para ello de nuestro país podrá donar, de forma voluntaria, este material hematopoyético al Banco de Cordón Umbilical más cercano del cual dependa su comunidad. La puesta en marcha del protocolo de recogida de muestras ha sido y es una tarea difícil que ha precisado de formación, motivación y colaboración tanto interprofesional como entre distintos niveles asistenciales, además de suponer un esfuerzo que consideramos aún poco difundido (AU)

Umbilical Cord Blood has a rich source of haematopoietic progenitor cells (HSC) characterized by their capacity for proliferation, differentiation and cell renewal of tissues on which they are located. The beneficiaries of this donation are all these people with diseases of the bone marrow. Since the year 1988 will be held the first successful transplantation of umbilical cord blood from HLA-identical siblings, have conducted numerous donations, so that, today, any woman who gives birth in any of the centers authorized may donate voluntarily to this material hematopoietic to the Cord Blood Bank which depends their community. Sample collection, has been and is a difficult task that has required training, motivation and collaboration both interprofessional and between different levels of care, while making an effort to consider an information still little known (AU)

Aportando valor al cuidado en la etapa final de la cronicidad / Adding value to the care at the final stage of chronic diseases

Existe un creciente número de personas con condiciones de salud crónicas avanzadas y necesidades de atención paliativa que fallecen sin haberles ayudado a satisfacer sus necesidades sanitarias y sociales. Este es motivo suficiente para redefinir los modelos tradicionales de atención con vistas a centrarlos en la persona, más que en la enfermedad. En estos nuevos modelos el protagonismo de la Enfermería es incuestionable para promover un enfoque basado en la atención integral, la coordinación y la continuidad, y el nivel sociosanitario puede ser el camino adecuado para responder a la atención de las personas que precisan cuidados complejos de larga duración. La aportación enfermera en la etapa final de la cronicidad se concreta en el valor de los cuidados. Cuidar a una persona es preocuparse de ella, y esto tiene que ver con la actitud, el compromiso y la responsabilidad. Mediante las tareas cotidianas en el cuidado de la persona que vive una situación de extrema vulnerabilidad, es posible contribuir a que se sienta acogida, confiada, a aliviar su sufrimiento, respetar su autonomía y ayudarle a encontrar sentido y esperanza. A través de los gestos, palabras y miradas que acompañan a estos cuidados es posible preservar la sublime dignidad de la persona

There is a growing number of people with advanced chronic health conditions and with palliative care needs who die without their health and social needs satisfied. This is enough to redefine the traditional models of care in order to focus on the person, rather than on the disease. In these new models, the important role of nursing is unquestionably to promote an approach based on comprehensive care, coordination and continuity, and at a social health level appropriate to respond to the care of patients who require complex long-term care. The nurse contribution in the end stages of chronic conditions must be in the value of care. Taking care of someone is to be concerned about them. And this is related to attitude, commitment and responsibility. In the care of patients who live in a situation of extreme vulnerability it is possible to help them feel warmth, confident, relieve their suffering, respect their autonomy, and help them them find sense and hope, through daily tasks. With gestures, words and facial expressions that go with this care, it is possible to preserve patient dignity

[Adding value to the care at the final stage of chronic diseases]. / Aportando valor al cuidado en la etapa final de la cronicidad.

There is a growing number of people with advanced chronic health conditions and with palliative care needs who die without their health and social needs satisfied. This is enough to redefine the traditional models of care in order to focus on the person, rather than on the disease. In these new models, the important role of nursing is unquestionably to promote an approach based on comprehensive care, coordination and continuity, and at a social health level appropriate to respond to the care of patients who require complex long-term care. The nurse contribution in the end stages of chronic conditions must be in the value of care. Taking care of someone is to be concerned about them. And this is related to attitude, commitment and responsibility. In the care of patients who live in a situation of extreme vulnerability, it is possible to help them feel warmth, confident, relieve their suffering, respect their autonomy, and help them them find sense and hope, through daily tasks. With gestures, words and facial expressions that go with this care, it is possible to preserve patient dignity.

[Breast self-examination as main technique for breast cancer prevention]. / La autoexploración mamaria como principal técnica de prevención del cáncer de mama.

Breast cancer is the most common malignancy in women. Breast self-examination stands out as the main preventive measure, since almost 95% of breast tumours are detected by the woman herself through this technique. Nursing is the group most closely related to health education appropriate guidelines to perform the technique correctly: monthly technical realization, recognition of abnormalities in the breast, go to the doctor for possible doubt about changes in them, etc.

La autoexploración mamaria como principal técnica de prevención del cáncer de mama / Breast self-examination as main technique for breast cancer prevention

El cáncer de mama es la neoplasia más frecuente en la mujer. Como principal medida preventiva destaca la autoexploración mamaria, ya que casi el 95% de los tumores mamarios es detectado por la propia mujer a través de esta técnica. La enfermería constituye el grupo sanitario más relacionado con la enseñanza de las pautas adecuadas para realizar la técnica de forma correcta: práctica mensual, reconocimiento de anomalías en la mama, acudir al médico especialista ante posibles dudas de cambios en las mismas, etc(AU)

Breast cancer is the most common malignancy in women. Breast self-examination stands out as the main preventive measure, since almost 95% of breast tumours are detected by the woman herself through this technique. Nursing is the group most closely related to health education appropriate guidelines to perform the technique correctly: monthly technical realization, recognition of abnormalities in the breast, go to the doctor for possible doubt about changes in them, etc(AU)

Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring.

We evaluated a telemedicine system in patients with type 1 diabetes who had optimized treatment with an insulin pump and a real-time continuous glucose monitoring system. We conducted a prospective, one-year study of 15 subjects. Three medical visits took place: pre-baseline, baseline and at 6 months. Each month the subjects transmitted information from the glucose meter, glucose sensor and insulin pump. We adjusted the treatment and returned the information by email. We evaluated psychological and metabolic variables, including HbA(1c), hypoglycaemia, hyperglycaemia and glucose variability. At baseline the mean age of the subjects was 40 years and the mean duration of diabetes was 22 years. There was a significant reduction in HbA(1c) (7.50 to 6.97%) at 6 months, a significant increase in the number of self-monitoring blood glucose checks per day (5.2 to 6.2), and significant improvements in variability: MODD, mean of daily difference (67 to 53) and MAGE, mean amplitude of glycaemic excursions (136 to 102). There were significant improvements in quality of life (92 to 87), satisfaction with the treatment (34 to 32) and less fear of hypoglycaemia (36 to 32). Adult subjects with type 1 diabetes on treatment with a continuous insulin infusion system and a real time glucose sensor and who have acceptable metabolic control and optimized treatment can benefit from the addition of a telemetry system to their usual outpatient follow-up.

Análisis microbiológico de úlceras de presión en pacientes del Centro Nacional de Rehabilitación (CENARE) / Analysis microbiological the pressure sores on the National Center of the Rehabilitation (CENARE)

Justificación y objetivo: Las úlceras de presión son áreas localizadas de tejido necrótico que tienden a desarrollarse cuando los tejidos blando son comprimidos entre una prominencia ósea y una superficie externa. La principal complicación de estas lesiones es que pueden constituirse en focos primarios de infecciones bacterianas. El objetivo del presente estudio fue realizar un análisis microbilógico de las úlceras de presión en pacientes de las unidades de Lesionados Medulares, Neurotrauma y Fisiatría General del Centro Nacional de Rehabilitación para determinar cuáles bacterias aerobias predominan en dichas lesiones y determinar el perfil de susceptibilidad a los antibióticos de los aislamientos bacterianos. Métodos: En este estudio se incluyeron 50 muestras recolectadas de 35 úlceras de presión en un total de 22 pacientes con daños en la médula espinal atendidos durante el período de agosto de 1998 a marzo de 1999. Las muestras fueron cultivadas en medios convencionales para el aislamiento de bacterias aerobias. La identificación de los aislamientos se realizó mediante pruebas bioquímicas y el sistema Vitek(R). El perfil de susceptibilidad a antibióticos se realizó mediante la técnica Kirby-Bauer con respaldo por el sistema Vitek(R). Resultados: Los microorganismos más frecuentemente aislados fueron Paeroginosa, Staphylococcus coagulasanegativa, S. intermedius y A. baumannii, los cuales prestaron resistencia contra diversos antibióticos. No se encontró ningún aislamiento de Stahylococcus aureus meticilina-resistente en las lesiones estudiadas. A lo largo del estudio se observó variabilidad en los perfiles de resistencia en aislamientos de P. aeruginosa, Staphyloccus coagulasa-negativa y S. intermedius. Conclusiones: El presente estudio indica que la biota bacteriana encontrada en la úlcera de presión en pacientes con lesiones medulares del CENARE está constituida principalmente por E. aeruginosa, Staphylococcus coagulasa-negativa, S. intermedius y A. bauma...

Importancia de la determinación de hidroxiprolina urinaria en diferentes patologías óseas / Importance of urinary hydroxyproline determination in various bones pathologies

Se estudiaron 130 pacientes que presentaban diferentes patologías óseas, determinándoseles la hidroxiprolina urinaria en muestras recolectadas durante 24 horas. Los rangos de referencia para una población normal de: 0,5 a 2,4 para mujeres y de 0,5 a 3,4 para varones, expresados como índices de hidroxiprolina/creatinina x 100. Las muestras se clasificaron de acuerdo con la patología del paciente en hiperparatiroidismo, osteoporosis, carcinomas de prostata y mama con o sin metástasis óseas, acromegalia, litiasis a repetición y otros carcinomas. Los índices más elevados los presentaron los pacientes con hiperparatiroidismo, carcinomas de próstata, de mama, de tiroides y melanoma