ABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Drug Hypersensitivity/complications , Drug Hypersensitivity/epidemiology , Thyroxine/adverse effects , Exanthema/chemically induced , Exanthema/complications , Thyroxine/chemical synthesis , Thyroxine/pharmacokineticsABSTRACT
La Asociación Americana de Diabetes recomendó por primera vez en 1997 el uso de aspirina en dosis bajas (75-162 mg/día) para la prevención primaria de episodios cardiovasculares en todo paciente con diabetes, tipo1 o tipo 2, mayor de 40 años, y en todos los menores de 40 y mayores de 30 años que presentasen otro factor de riesgo cardiovascular, además de la diabetes (antecedentes familiares de enfermedad vascular, hipertensión arterial, tabaquismo, dislipidemia o microalbuminuria). La alergia a la aspirina, la predisposición a sufrir hemorragias, la terapia anticoagulante, el sangrado digestivo reciente o la enfermedad hepática activa constituyen contraindicaciones para el empleo de aspirina y se sugiere que otros antiagregantes serían una alternativa aceptable para pacientes en esta situación y con riesgo cardiovascular elevado. La terapia combinada con aspirina y clopidogrel se reserva como estrategia para la prevención secundaria. Estas directrices continúan vigentes en 2008. Muchas otras sociedades científicas y autores a título particular han aceptado la conveniencia de la antiagregación generalizada en los pacientes con diabetes para la prevención cardiovascular primaria, aunque reconocen que las pruebas que existen sobre su beneficio son escasas. Este trabajo es una revisión actualizada de tales pruebas, sobre las que, en definitiva, deberían basarse las recomendaciones.
The American Association of Diabetes recommended forthe first time in 1997 the use of low dose of aspirin (75-162 mg/day) for the primary prevention of cardiovascularevents in every type 1 or type 2 diabetic patient over 40years of age, and in everyone less than 40 and over 30years that may have another factor of cardiovascular risk, besides diabetes (family history of cardiovascular disease, hypertension, smoking, dyslipidemia or albuminuria). Other antiplatelet agents may be a reasonable alternativefor high-risk patients with aspirin allergy, with bleedingtendency, who are receiving anticoagulant therapy, withrecent gastrointestinal bleeding, and with clinically active hepatic disease who are not candidates for aspirintherapy. Combination therapy using other antiplateleta agents such as clopidogrel in addition to aspirin is reservedto secondary prevention strategy. These directivescontinue effective in 2008. Many other scientific societiesand individual authors have accepted the convenienceof the generalized antiaggregation for primarycardiovascular prevention in patients with diabetes, although they recognize that available evidence of benefitis scarce. This work is an updated revision of suchevidence, on which the recommendations would haveto be based.
Subject(s)
Aspirin , Cardiovascular Diseases , Diabetes Mellitus , Primary Prevention , Dyslipidemias , Hypertension , Secondary Prevention , SmokingABSTRACT
Type 2 diabetes is a highly prevalent disease and its management is performed mainly in primary health care. In the present article, focused on the nursing point of view, we propose a comprehensive and very simple approach to the treatment of patients with diabetes, based on the authors' broad clinical experience. There are 5 pillars of type 2 diabetes treatment: diet, exercise, blood glucose autoanalysis, drugs, and control of vascular risk factors (an important question that is not dealt with in this article). A diabetic diet is always required at all phases of the disease. Regular, moderate-intensity aerobic exercise has demonstrated benefits in the treatment of diabetes. Blood glucose autoanalysis is recommended in certain subgroups of patients. Throughout the natural history of type 2 diabetes, drug therapy is structured in stages, which are analyzed in depth in the present article.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Drug Therapy/methods , Health Education , Hygiene/education , Patient Education as Topic , Primary Health Care/methods , Diet , Exercise , HumansABSTRACT
La diabetes mellitus tipo 2 (DM2) es una enfermedad de alta prevalencia, cuyo tratamiento depende básicamente de atención primaria. En este trabajo se propone una visión integral (desde el punto de vista enfermero) del tratamiento del paciente diabético, muy sencilla y basada en la experiencia asistencial de los autores. Los pilares del tratamiento de la DM2 son 5: la dieta, el ejercicio, el autoanálisis glucémico, los fármacos y el control de los factores de riesgo vascular (cuestión fundamental que no se aborda). La dieta antidiabética es necesaria siempre, en todas las fases de la enfermedad. Una actividad aeróbica regular, de mediana intensidad, ha demostrado beneficios en el tratamiento de la diabetes. El autoanálisis glucémico se recomienda para ciertos subgrupos de pacientes. A lo largo de la historia natural de la DM2, el tratamiento farmacológico se estructura en escalones, que se analizan detalladamente en este trabajo
Type 2 diabetes is a highly prevalent disease and its management is performed mainly in primary health care. In the present article, focused on the nursing point of view, we propose a comprehensive and very simple approach to the treatment of patients with diabetes, based on the authors' broad clinical experience. There are 5 pillars of type 2 diabetes treatment: diet, exercise, blood glucose autoanalysis, drugs, and control of vascular risk factors (an important question that is not dealt with in this article). A diabetic diet is always required at all phases of the disease. Regular, moderate-intensity aerobic exercise has demonstrated benefits in the treatment of diabetes. Blood glucose autoanalysis is recommended in certain subgroups of patients. Throughout the natural history of type 2 diabetes, drug therapy is structured in stages, which are analyzed in depth in the present article
Subject(s)
Humans , Nursing Care/methods , Diabetes Mellitus, Type 2/therapy , Primary Health Care/trends , Diet, Diabetic/methods , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Autoanalysis , Patient Education as Topic/trends , Glycemic IndexABSTRACT
OBJECTIVE: We report a case of non-traumatic adrenal hemorrhage in a man with antiplatelet treatment. METHODS: The patient was admitted to the Critical Care Unit because of a non-controlled hypertensive crisis. Pheochromocytoma was analytically excluded. The patient underwent a delayed adrenalectomy. RESULTS: Pathologic study of the specimen showed a wide hemorrhagic necrosis. CONCLUSIONS: Association of high blood pressure and adrenal hemorrhage is not pathognomonic of pheochromocytoma.
Subject(s)
Adrenal Gland Diseases/complications , Hemorrhage/complications , Hypertension/complications , Platelet Aggregation Inhibitors/therapeutic use , Aged , Humans , MaleABSTRACT
Objetivo: Presentación de un caso de hemorragia suprarrenal no traumática en un paciente antiagregado. Métodos: El paciente fue ingresado en la Unidad de Cuidados Intensivos por una crisis hipertensiva no controlada. Se descartó analíticamente la existencia de un feocromocitoma y se practicó una suprarrenalectomía diferida. Resultados: El examen histológico de la glándula mostró una extensa necrosis hemorrágica. Conclusiones: La asociación de hipertensión arterial y hemorragia suprarrenal no es diagnóstica de feocromocitoma (AU)
Objective: We report a case of non-traumatic adrenal hemorrhage in a man with antiplatelet treatment. Methods: The patient was admitted to the Critical Care Unit because of a non-controlled hypertensive crisis. Pheochromocytoma was analytically excluded. The patient underwent a delayed adrenalectomy. Results: Pathologic study of the specimen showed a wide hemorrhagic necrosis. Conclusions: Association of high blood pressure and adrenal hemorrhage is not pathognomonic of pheochromocytoma (AU)
Subject(s)
Male , Middle Aged , Humans , Hypertension/complications , Hypertension/diagnosis , Pheochromocytoma/diagnosis , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnosis , Heart Rate/physiology , Tomography, Emission-Computed/methods , Pheochromocytoma/complications , Kidney Cortex Necrosis/complications , Kidney Cortex Necrosis/diagnosis , Retroperitoneal Space/pathology , Retroperitoneal SpaceSubject(s)
Aspirin/therapeutic use , Cardiovascular Diseases/prevention & control , Diabetes Mellitus, Type 2/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Adult , Age Factors , Aspirin/administration & dosage , Clinical Trials as Topic , Confidence Intervals , Female , Humans , Male , Middle Aged , Odds Ratio , Platelet Aggregation Inhibitors/administration & dosage , Primary Prevention , Sex FactorsABSTRACT
No disponible
No disponible
Subject(s)
Humans , Aspirin/therapeutic use , Diabetes Mellitus/complications , Cardiovascular Diseases/prevention & control , Risk Factors , Primary Prevention/methods , EffectivenessABSTRACT
The benefits of aspirin treatment in reducing the risk of myocardial infarction, cerebrovascular accidents and vascular death is well-documented among individuals having prior cardiovascular disease, including the subgroup with diabetes mellitus. The role of aspirin in primary prevention is less clear and debatable: the results of the clinical trials currently available are not consistent, although the meta-analyses are favorable in some aspects. There seems to be a disparity between the type of benefit (when found to exist) and gender, the findings being particularly contradictory for diabetic subjects, totalling a minor percentage of the population sample included in the studies. Despite this fact, in 1997, the American Diabetes Association and more recently other scientific societies (including several Spanish societies) have been recommending the use of aspirin in low doses in primary prevention in all type 1 or type 2 diabetic patients over 40 years of age and in all those within the 21-40 age range having any other cardiovascular risk factor in addition to diabetes (family history of vascular disease, hypertension, smoking, dyslipidemia or albuminuria). This study reviews the findings of the randomized, controlled clinical trials on primary cardiovascular prevention with aspirin, on which the official American Diabetes Association guidelines might be based, the conclusion being reached that there is not currently sufficient scientific evidence to uphold these guidelines.
Subject(s)
Aspirin/therapeutic use , Cardiovascular Diseases/prevention & control , Diabetes Complications/prevention & control , Platelet Aggregation Inhibitors/therapeutic use , Primary Prevention , Humans , Risk FactorsABSTRACT
El beneficio del tratamiento con aspirina en la reducción del riesgode infarto de miocardio, accidente vascular cerebral y muerte deorigen vascular, está bien documentado en personas con enfermedadcardiovascular previa, incluido el subgrupo portador de una diabetesmellitus. Sin embargo el papel de la aspirina en prevención primariaes menos claro y objeto de discusión: los resultados de los ensayosclínicos disponibles no son consistentes, aunque los meta-análisisson favorables en algunos aspectos. Parece existir una disparidadentre el tipo de beneficio (cuando se observa) y el sexo. Y en particularlos resultados son contradictorios en personas diabéticas, lascuales representan un pequeño porcentaje de la muestra de poblaciónincluida en los estudios. A pesar de esto, la American Diabetes Associationdesde 1997, y otras sociedades científicas (incluidas variasespañolas) desde tiempos más recientes, recomiendan el uso de aspirinaa dosis bajas en prevención primaria en todo paciente diabéticomayor de 40 años, tipo 1 o tipo 2; y en todos los menores de 40 ymayores de 21 años que presenten otro factor de riesgo cardiovascular,además de la diabetes (antecedentes familiares de enfermedadvascular, hipertensión arterial, tabaquismo, dislipidemia o albuminuria).En este trabajo se revisan los resultados de los ensayos clínicosrandomizados y controlados sobre la prevención cardiovascular primariacon aspirina, en los que se podrían apoyar las directrices oficialesde la American Diabetes Association, y se llega a la conclusiónde que no existen actualmente pruebas científicas suficientes parasostenerlas(AU)
The benefits of aspirin treatment in reducing the risk of myocardialinfarction, cerebrovascular accidents and vascular death iswell-documented among individuals having prior cardiovasculardisease, including the subgroup with diabetes mellitus. The role ofaspirin in primary prevention is less clear and debatable: the resultsof the clinical trials currently available are not consistent, althoughthe meta-analyses are favorable in some aspects. There seems to bea disparity between the type of benefit (when found to exist) andgender, the findings being particularly contradictory for diabeticsubjects, totalling a minor percentage of the population sampleincluded in the studies. Despite this fact, in 1997, the AmericanDiabetes Association and more recently other scientific societies(including several Spanish societies) have been recommending theuse of aspirin in low doses in primary prevention in all type 1 ortype 2 diabetic patients over 40 years of age and in all those withinthe 21-40 age range having any other cardiovascular risk factor inaddition to diabetes (family history of vascular disease, hypertension,smoking, dyslipidemia or albuminuria). This study reviewsthe findings of the randomized, controlled clinical trials on primarycardiovascular prevention with aspirin, on which the official AmericanDiabetes Association guidelines might be based, the conclusionbeing reached that there is not currently sufficient scientificevidence to uphold these guidelines(AU)
Subject(s)
Humans , Male , Female , Aspirin/administration & dosage , Aspirin/therapeutic use , Cardiovascular Diseases/complications , Cardiovascular Diseases/pathology , Cardiovascular Diseases/prevention & control , Diabetes Mellitus/prevention & controlABSTRACT
No disponible
Subject(s)
Female , Pregnancy , Humans , Guideline Adherence , Diabetes, Gestational/diagnosis , Glucose/analogs & derivativesABSTRACT
OBJECTIVES: To report one case of adrenal incidentaloma and to review the sensitivity and specificity of urine methanephrines in the diagnosis of pheochromocytoma. METHODS: We report the case of a patient with high blood pressure and a left adrenal incidentaloma. Surgical excision of the mass was indicated after elevated urine methanephrine. RESULTS: Pathologic study of the nodule established the diagnosis of cortical adenoma. CONCLUSIONS: The elevation of urine normethanephrine is a non-specific parameter for the diagnosis of pheochromocytoma.
