Análisis de coste-efectividad de la monitorización glucémica en la diabetes / Cost-effectiveness analysis of self-monitoring of blood glucose in diabetes

La prevalencia y los costes asociados a la diabetes mellitus (DM) aumentanprogresivamente. Mejorar el control glucémico ha demostrado reducir suscomplicaciones, y la automonitorización de la glucosa capilar es una de lasherramientas básicas para conseguirlo. Es comúnmente aceptada la automonitorizaciónglucémica como una herramienta indispensable en la DM tipo 1.En el caso de pacientes con DM tipo 2 tratados con insulina, varios estudiosseñalan que se trata de un recurso coste-efectivo, especialmente cuando lainformación se utiliza para ajustar el tratamiento. Más complejo es cuantificarsu efectividad en pacientes con diabetes tipo 2 no tratados con insulina. Losmetaanálisis publicados indican una discreta reducción de la hemoglobina glicosilada(HbA1c) (~0,3%) en los sujetos que utilizan la automonitorización, sibien el resultado depende de la HbA1c inicial y de otros condicionantes. Losdatos en España confirman un continuo aumento del presupuesto asignado aeste concepto. Su adopción parece coste-efectiva, especialmente en determinadasindicaciones. Es necesario realizar nuevos estudios con un tamañomuestral y un tipo de población adecuados. Una decidida intervención paramejorar la educación terapéutica en diabetes permitiría conseguir una mejorratio de coste-efectividad de la automonitorización de la glucosa capilar(AU)

Prevalence and the costs associated with diabetes care are gradually increasing.Improving glycaemic control has proven to reduce the complications ofdiabetes, and self-monitoring of blood glucose (SMBG) is one of the basictools for achieving it. It is commonly accepted as an indispensable tool in type1 diabetes. In the case of patients with type 2 diabetes treated with insulin,several studies suggest that this is a cost-effective resource, especially whenthe information is used to adjust treatment. More complex is to quantify its effectivenessin type 2 diabetic patients not treated with insulin. Published metaanalysisshow a modest reduction in HbA1c (~0.3%) of subjects using SMBG,although the result depends on the initial HbA1c and other constraints. In Spain,data confirm a continuous increase in the budget for this concept. Its adoptionseems to be cost-effective, especially in certain indications. New studies areneeded with appropriate sample size and type of population to be studied. Adetermined intervention to improve therapeutic education in diabetes may allowachieving better cost-effectiveness ratio of SMBG(AU)

Saccharomyces cerevisiae en la fabricación del licor cocuy / Sacchromyces cerevisiae in the manufacturing of cocoy liquor

El licor "cocuy" es una bebida artesanal, producida por las comunidades rurales en el Occidente de Venezuela mediante un proceso de fermentación y destilación del mosto extraído del Agave cocui. Este estudio fue enmarcado en el "Programa Agave" con el propósito de contribuir a rescatar esta actividad productiva tradicional. En vista de la falta de información en relación al proceso autóctono se hicieron estudios de las levaduras fermentadoras, la optimización de la producción de etanol y la utilización del residuo de la destilización (vinaza) como medio de cultivo. Los aislados con mayor capacidad fermentativa fueron seleccionados e identificados mediante parámetros morfológicos y metabólicos. Se compararon los niveles de consumo de azúcar de las levaduras con mayor capacidad fermentativa. Se estudió el efecto de la adición del azúcar blanca comercial y/o del fosfato de amonio y en la producción del alcohol en el proceso artesanal. Las concentraciones de azúcares en el mosto se evaluaron por refractometría, y el contenido de alcohol de licor por hidrometría. La utilización de la vinaza para la producción de biomasa como un componente del medio de cultivo fue comparada con un medio sintético mediante medidas del peso seco de la biomasa. Se confirma el papel de sccharomyces ceravisiae en el proceso fermentativo espontáneo. Los resultados in situ evidenciaron un efecto favorable de la elevación del contenido de azúcar (11 a 18 °Brix) y de la adición de fosfato de amonio dibásico (0,2 g/l). En estas condiciones, el tiempo de fermentación del mosto se acortó y la producción de licor aumentó hasta un 92 por ciento. Se demostró la posibilidad de utilizar la vinaza como un componente para un medio de cultivo de esta levadura, para iniciar la fermentación y para la producción de biomasa como fuente de nutrientes de alto valor nutritivo para aves de corral o caprinos. Se recomienda apoyar los esfuerzos para desarrollar de esta importante fuente para los campesinos que habitan las zonas semiáridas de los estados Falcón y Lara

Use of a low-cost, PC-based image review workstation at a radiology department.

Despite the increasing use of diagnostic workstations, film reading is still commonplace in most radiology departments all over the world. The purpose of this work is to assess the adoption of image review workstations in a radiology department where the usual primary diagnosis is film-based and cannot be replaced with diagnostic workstations. At our institution, a tertiary care center specialized in diagnostic imaging, a pair of PC-based review workstations running a Digital Imaging and Communications in Medicine (DICOM)-conformant public domain software for image display and analysis were installed in two reading rooms. Studies are automatically routed after acquisition from the picture archiving and communication system (PACS) server to the workstations and remain available for visualization for approximately 15 to 20 days. Data from two radiologists and two technologists collected over a 3-month period were analyzed, including purpose of use, time savings as compared to traditional manual methods, and overall user satisfaction. The results from the analysis presented in this work indicate a high degree of approval from the users, who report significant timesavings in numerous circumstances, in particular when it comes to discussing findings with referring physicians whenever films are not available. It also enriches communication between radiologists, facilitating peer review on the telephone when one of them has questions at the outcome of any given study. One of the main advantages associated with the system is the possibility of using it as a powerful tool for teaching and research. In conclusion, even when primary diagnosis is performed on film, the availability of a PACS for review can be helpful to enhance communication with referring physicians, as well as technologists and radiologists' efficiency. Our experience shows that it is possible to implement such a system using low-cost or freely available components without compromising ease of use while keeping costs down, which is a major concern in developing countries.

Analysis of glial fibrillary acidic protein, neurofilament protein, actin and heat shock proteins in human fetal brain during the second trimester.

Glial fibrillary acidic protein (GFAP), the 66 kDa neurofilament protein (NF-66), actin, the 27 kDa heat shock protein (HSP27) and the 70 kDa constitutive heat shock protein (HSC70) were analyzed in human fetal brain during the second trimester, from 10 to 24 gestational weeks (GW). By immunohistochemistry, cell-type specific localization of GFAP and NF-66 in astrocytes and neurons, respectively, was confirmed. HSP27 was expressed mostly in the nuclear region of neurons and non-neuronal cells, and HSC70 was widely distributed throughout the tissue. By quantitative immunoblotting, GFAP was not detectable in gray matter of prefrontal cortex prior to 16 GW. Between 16 and 21 GW, the content of GFAP rose slowly. Thereafter, GFAP accumulated rapidly. The content of GFAP in different brain regions (prefrontal, parietal, and occipital cortices) differed significantly at 22 GW. In contrast, NF-66 was already highly expressed at 10 GW, slowly rose to maximal values by 18 GW, and thereafter remained stationary. In contrast to GFAP, the content of NF-66 was similar in different brain regions at 22 GW. Although actin was abundant throughout the second trimester, a sharp drop in its content in the prefrontal cortex was detected at 17 GW. To explain such a decrease, two heat shock proteins were analyzed. HSP27, known to modulate actin polymerization, was found to increase sharply at 16-17 GW. In contrast, HSC70 remained constant during the second trimester and was highly expressed in the fetal brain, at a level comparable to that in the adult brain.

Expression of neurofilament proteins during retinoic acid-induced differentiation of P19 embryonal carcinoma cells.

Retinoic acid (RA) induces P19 embryonal carcinoma cells to differentiate into neurons with the extension of neuritic processes. We used the P19 cell as a model system to elucidate the regulation of neurofilament (NF) expression. Four mammalian NF proteins, NF-66 (alpha-internexin), peripherin, NF-L and NF-M, and the neural-specific, growth-associated gene, GAP-43, were studied during the RA treatment of P19 cells in vitro. As controls, untreated P19 cells were maintained in parallel. Indirect immunofluorescent staining showed that in RA-treated, morphologically differentiated P19 cells NF-66 was expressed in neuron-like cells characterized by phase bright cell bodies and long neuritic processes. At various times P19 cells were harvested for protein analysis by immunoblotting with antibodies to individual NF proteins or for total RNA extraction and Northern blotting with cDNA probes for NF-66, -L, -M, peripherin and GAP-43. During induction, both NF-66 and NF-L were expressed but in distinct patterns. NF-66 mRNA and protein were detected after 6 days of induction. In contrast, NF-L mRNA, but not protein, was expressed in both induced and control cells. Neither NF-M nor peripherin were expressed during induction. During differentiation of P19 cells, NF-66 mRNA levels rose markedly by the 1st day, reached a plateau between the 3rd-5th days and declined by the 7th day. NF-66 protein accumulation lagged slightly, reaching maximum abundance about the 5th day. The kinetics of NF-66 expression were similar to that of GAP-43. However, the pattern of NF-L expression was distinct from that of NF-66. NF-L mRNA, and some protein, was expressed in both RA-treated and control cells within 6 h after plating, but was down-regulated to baseline level thereafter in both populations. Neither NF-M or peripherin expression was detected during the differentiation. In summary, NF-66 was up-regulated most robustly among the four NF proteins during differentiation in P19 cells and was the major NF protein correlated with neurite extension.

Purification of cell populations from human fetal brain using flow cytometric techniques.

We recently established primary cultures from dissociated second trimester human fetal brains using a novel spin seeding method and characterized cellular populations with distinct phenotypes in these cultures. Here, we report that these neural cultures can be dissociated to single-cell suspensions, sorted by size using flow cytometry and re-seeded to yield cultures selectively enriched for the neuronal and glial cell populations. Sorted neurons were highly homogeneous, viable and extended processes, by one day after re-seeding. These neurons expressed immunoreactivity for neurofilament protein, retained their GABAergic phenotype and were electrically excitable. Re-seeded astrocytes proliferated in culture and expressed glial fibrillary acidic protein. We describe the conditions required for the flow cytometric sorting and tissue culture assays as well as the morphological, immunocytochemical and electrophysiological characteristics of the sorted neuronal population.

Malignant transformation of the human endometrium is associated with overexpression of lactoferrin messenger RNA and protein.

In the mouse uterus, lactoferrin is a major estrogen-inducible uterine secretory protein, and its expression correlates directly with the period of peak epithelial cell proliferation. In this study, we examine the expression of lactoferrin mRNA and protein in human endometrium, endometrial hyperplasias, and adenocarcinomas using immunohistochemistry, Western immunoblotting, and Northern and in situ RNA hybridization techniques. Our results reveal that lactoferrin is expressed in normal cycling endometrium by a restricted number of glandular epithelial cells located deep in the zona basalis. Two thirds (8 of 12) of the endometrial adenocarcinomas examined overexpress lactoferrin. This tumor-associated increase in lactoferrin expression includes an elevation in the mRNA and protein of individual cells and an increase in the number of cells expressing the protein. In comparison, only 1 of the 10 endometrial hyperplasia specimens examined demonstrates an increase in lactoferrin. We also observe distinct cytoplasmic and nuclear immunostaining patterns under different fixation conditions in both normal and malignant epithelial cells, similar to those previously reported in the mouse reproductive tract. Serial sections of malignant specimens show a good correlation between the localization of lactoferrin mRNA and protein in individual epithelial cells by in situ RNA hybridization and immunohistochemistry. Although the degree of lactoferrin expression in the adenocarcinomas did not correlate with the tumor stage, grade, or depth of invasion in these 12 patients, there was a striking inverse correlation between the presence of progesterone receptors and lactoferrin in all 8 lactoferrin-positive adenocarcinomas. In summary, lactoferrin is expressed in a region of normal endometrium known as the zona basalis which is not shed with menstruation and is frequently overexpressed by progesterone receptor-negative cells in endometrial adenocarcinomas.