Manejo de la hiperglucemia en el paciente ingresado en UCI médicas y quirúrgicas / Inpatient glucose management in medical and surgical ICUs

La hiperglucemia, defi nida estrictamente como una glucemia plasmática basal >=126 mg/dL, se presenta en la gran mayoría de los pacientes críticos. La elevación de estas cifras de glucemia durante la hospitalización se ha asociado de forma consistente con un deterioro del pronóstico del paciente, incluso en ausencia de antecedentes previos de diabetes y con elevaciones mínimas sobre los niveles considerados normales. Sin embargo, conocer cuál debería ser la actitud terapéutica en función del perfil del paciente y qué objetivos se deberían plantear, así como el beneficio, si lo hubiere, de nuestra actuación médica y, sobre todo, la forma de lograr dichos objetivos, es todavía un tema controvertido y muy poco implantado en la práctica clínica habitual, incluso para aquellos endocrinólogos dedicados preferentemente a la atención de la diabetes en el área hospitalaria. Aun así, probablemente sea en el ámbito de las unidades de cuidados intensivos (UCI) y en pacientes críticos en general donde se han realizado los mejores estudios. Por ello, el desarrollo y la implantación de protocolos específicos de uso de insulina intravenosa en las UCI y de otras estrategias terapéuticas con la finalidad de normalizar las cifras de glucemia se consideran un criterio de calidad de estas unidades. Por esta razón, el control adecuado de la hiperglucemia en el hospital, y en las UCI en particular, es en la actualidad una medida médicamente efectiva: disminuye la mortalidad, reduce la morbilidad de los procesos y es coste-efectiva para los sistemas públicos de salud

Hyperglycemia, strictly defined as blood glucose >=126 mg/dL, occurs in the majority of critically ill patients. Elevated glucose values during hospitalization have been consistently linked to a poorer prognosis, even in the absence of preexisting diabetes and with nearly normal blood glucose levels. Nevertheless, the most appropriate strategies according to the patient profile, what benefits should be expected, if any, depending on medical care and how these objectives can be achieved, remain controversial, even for endocrinologists working in a hospital setting. Even so, the major randomized clinical studies dealing with the management of in hospital hyperglycemia have been carried out in critical care patients. Thus, the development and introduction of specific protocols for the intravenous administration of insulin to critically ill patients and other strategies to restore normal blood glucose values are quality criteria in any intensive care unit (ICU). For this reason, at the present time, proper hyperglycemia management in the hospital and, in particular, in the ICUs reduces mortality and morbidity and is cost-effective as well

[Diabetic neuroarthropathy in acute phase: a diagnostic dilemma. Two cases and bibliographic review]. / Neuroartropatía diabética en fase aguda: un dilema diagnóstico. A propósito de dos casos y revisión de la bibliografía.

INTRODUCTION: Charcot's neuroarthropathy is a progressive deterioration of bones and joints, mainly the ankle and foot of the diabetic patients suffering severe neuropathy. Its pathogeny is not well known, although mechanical, vascular and neurological factors are thought to be involved, generally with a precipitating minor traumatic even. Charcot's foot acute phase is inflammatory, and it is often confused with other diseases such as arthritis, cellulitis and deep venous thrombosis (DVT). This leads to delays or errors in the diagnosis, the patient coming to the hospital too late with severe foot deformation. OBJECTIVE: Thus, it must always be posed as differential diagnosis in a diabetic patient who comes with a warm and inflamed foot, generally without fever, even more if he has a severe autonomic or somatic neuropathy. In the acute onset, the only treatment has been complete and long term off-loading with a total contact cast that should be initiated immediately after diagnosis. More recent studies show promising results with biphosphonates to decrease bone turnover in acute phase. CONCLUSION: We present two cases of acute Charcot's foot and we briefly review the bibliography.

Neuroartropatía diabética en fase aguda: un dilema diagnóstico. A propósito de dos casos y revisión de la bibliografía / Diabetic neuroarthropathy in acute phase: a diagnostic dilemma. Two cases and bibliographic review

Introducción. La neuroartropatía de Charcot consiste en un progresivo deterioro de los huesos y articulaciones, principalmente del tobillo y pie, de pacientes diabéticos afectos de una neuropatía grave. Su patogenia no es bien conocida, aunque se consideran implicados factores mecánicos, vasculares y neurológicos, precipitados generalmente por un traumatismo. La fase inflamatoria aguda pasa a menudo inadvertida o se confunde con patologías como artritis, celulitis o trombosis venosa profunda (TVP), lo que determina retraso o errores en el diagnóstico, presentándose el paciente en la consulta ya con deformidad en el pie. Objetivo. Así, ha de plantearse siempre como diagnóstico diferencial ante un paciente diabético que acude con un pie caliente e inflamado habitualmente sin fiebre, sobre una neuropatía grave somática y/o autonómica. En esta fase precoz el único tratamiento que ha demostrado una clara ventaja es la descarga completa y prolongada del pie mediante prótesis que debería iniciarse inmediatamente después del diagnóstico. Estudios más recientes muestran resultados positivos con la administración de bifosfonatos que logran frenar la reacción inflamatoria propia de esta fase aguda. Conclusión. A continuación se describen dos casos de neuroartropatía de Charcot en fase aguda y se realiza una revisión de la bibliografía

Introduction. Charcot's neuroarthropathy is a progressive deterioration of bones and joints, mainly the ankle and foot of the diabetic patients suffering severe neuropathy. Its pathogeny is not well known, although mechanical, vascular and neurological factors are thought to be involved, generally with a precipitating minor traumatic even. Charcot's foot acute phase is inflammatory, and it is often confused with other diseases such as arthritis, cellulitis and deep venous thrombosis (DVT). This leads to delays or errors in the diagnosis, the patient coming to the hospital too late with severe foot deformation. Objective. Thus, it must always be posed as differential diagnosis in a diabetic patient who comes with a warm and inflamed foot, generally without fever, even more if he has a severe autonomic or somatic neuropathy. In the acute onset, the only treatment has been complete and long term off-loading with a total contact cast that should be initiated immediately after diagnosis. More recent studies show promising results with biphosphonates to decrease bone turnover in acute phase

Effects of minor constituents (non-glyceride compounds) of virgin olive oil on plasma lipid concentrations in male Wistar rats.

We aimed to assess the effects of minor constituents (MC) from virgin olive oil upon the plasma lipid profile of experimental animals. Therefore, 32 Wistar rats were fed for 6 weeks with one of four different diets with a similar fatty acid composition but different MC: high-oleic sunflower oil (HOSO), virgin olive oil (VOO), 400%-MC enriched olive oil (EOO) and MC poor (impoverished) olive oil (IOO). At the end of the week 6 of dietary treatment, blood samples were obtained for analysis of lipid composition. A statistically significant influence was observed upon both total HDL (1.593+/-0.4, 1.204+/-0.212, 0.991+/-0.244 and 0.827+/-0.279 mmol/L for EOO, HOSO, VOO and IOO, respectively, Kruskal-Wallis test, P<0.05) and HDL(2)cholesterol levels (1.16+/-0.26, 0.576+/-0.191, 0.585+/-0.216 and 0.583+/-0.207 mmol/L for EOO, HOSO, VOO and IOO, respectively, Kruskal-Wallis test, P<0.05). No statistically significant effect was observed upon LDL-cholesterol or triglycerides. Thus, MC supplementation has beneficial effects on HDL concentrations in Wistar rats.

[Non-classical 21-hydroxylase deficiency: clinico-hormonal discrepancies and intrafamilial phenotypic variability]. / Deficiencia no clásica de 21-hidroxilasa: discrepancias clínico-hormonales y variabilidad fenotípica intrafamiliar.

BACKGROUND: We report here two families illustrating the intrafamilial phenotypic variety of the non-classical 21-hydroxylase deficiency and other discrepancies between clinical and hormonal data. PATIENTS, METHODS AND RESULTS: The index case in the first family had a mild hirsutism which appeared peripuberally and basal 17-hydroxyprogesterone over the measurement limit. One of her sister, without hair excess, had the same biochemical abnormality. The index case in the second family was detected at five years because of early appearance of public hair and basal 17-hydroxyprogesterone over the measurement limit. One of her siblings, a 16-year old girl, was also diagnosed of mild hirsutism and increased levels of basal and post-stimulation 17-hydroxyprogesterone. CONCLUSIONS: The association of marked biochemical abnormalities with scarce or no clinical expression in the first family and the different presentation form of both cases in the second family suggest that there is something else than the mutation in the CYP 21B gene in the non-classic deficiency of 21-hydroxylase.