Calidad de vida relacionada con la salud en la diabetes mellitus tipo 1 / Health related quality of life in type 1 diabetes mellitus

Introducción: El impacto diario del tratamiento de la DM1 en los aspectos psicosociales de los pacientes, demostrado científicamente, y la necesidad de un abordaje preventivo y educativo en los procesos de cuidado de esta enfermedad crónica llevan a considerar la importancia del estudio de la calidad de vida relacionada con la salud (CVRS) durante las etapas de la infancia y la adolescencia. Objetivos: a) Evaluar las dimensiones de la CVRS más afectadas por la enfermedad, y b) determinar su variación en función del período escolar, el sexo y el número de años de diagnóstico. Material y método: Estudio descriptivo de carácter aplicado. La muestra la constituyen 126 pacientes de 6 a 18 años con DM1, controlados en 4 hospitales públicos de Extremadura. El cuestionario de medida de la CVRS aplicado es la versión española del EQ-5D-Y.ResultadosLa dimensión más afectada para el total de la muestra es la ansiedad/depresión, con una diferencia significativa en el grupo de adolescentes (p=0,004). Conclusiones: Es necesario considerar la CVRS en la etapa de la adolescencia, poniendo especial atención al ámbito psicosocial en la propuesta de tratamiento y en el diseño de intervenciones educativas(AU)

Introduction: The daily impact of DM1 treatment on the psychological aspects of patients, scientifically proven, and the need for preventive and educational approaches in the care processes of this chronic disease, leads to consider the importance of studying the health-related quality of life (HRQOL) during the childhood and adolescence stages. Objectives: a) To assess the dimensions of HRQoL most affected by the disease, and b) to determine its variation as a function of the school year, sex and number of years from diagnosis. Material and method: An applied-descriptive study was used. The sample consisted of 126 patients from 6 to 18 years with type 1 diabetes, controlled in four public hospitals in Extremadura. The questionnaire measuring HRQoL is the Spanish version of EQ-5D-Y.ResultsThe most affected dimension for the total sample is anxiety/depression, with a significant difference in the adolescent group (P=0.004). Conclusions: It is necessary to consider the HRQOL assessment should be considered in adolescence, with special attention to the psychological aspects in the proposed treatment and design of educational interventions(AU)

[Health related quality of life in type 1 diabetes mellitus]. / Calidad de vida relacionada con la salud en la diabetes mellitus tipo 1.

INTRODUCTION: The daily impact of DM1 treatment on the psychological aspects of patients, scientifically proven, and the need for preventive and educational approaches in the care processes of this chronic disease, leads to consider the importance of studying the health-related quality of life (HRQOL) during the childhood and adolescence stages. OBJECTIVES: a) To assess the dimensions of HRQoL most affected by the disease, and b) to determine its variation as a function of the school year, sex and number of years from diagnosis. MATERIAL AND METHOD: An applied-descriptive study was used. The sample consisted of 126 patients from 6 to 18 years with type 1 diabetes, controlled in four public hospitals in Extremadura. The questionnaire measuring HRQoL is the Spanish version of EQ-5D-Y. RESULTS: The most affected dimension for the total sample is anxiety/depression, with a significant difference in the adolescent group (P=.004). CONCLUSIONS: It is necessary to consider the HRQOL assessment should be considered in adolescence, with special attention to the psychological aspects in the proposed treatment and design of educational interventions.

[Gastroesophageal reflux disease refractory to esomeprazole]. / Enfermedad por reflujo gastroesofágico refractaria a esomeprazol.

Resistance to proton pump inhibitors (PPI) in gastroesophageal reflux disease (GERD), which has been described in patients treated with omeprazole, could explain some exceptional cases of treatment failure and the need for surgery. The objective test of resistance to PPI is obtained with 24-hour intragastric pH-metry performed during treatment. A gastric pH of less than 4 for more than 50% of recording time indicates resistance. We present a patient with non-erosive GERD and treatment failure to omeprazole and proven resistance to esomeprazole which, to our knowledge, has only been reported in patients with Barrett's esophagus.

The SstI polymorphism of the apo C-III gene is associated with insulin sensitivity in young men.

AIMS/HYPOTHESIS: Insulin resistance is considered to be a risk factor for diabetes and coronary heart disease and is determined by the interaction between genetic and environmental factors. The SstI polymorphism in the apolipoprotein C-III gene has been related to the presence of different features of the insulin resistance syndrome. We investigate if this mutation influences the peripheral effect of insulin in healthy young subjects (30 men and 29 women) eating a westernised diet. METHODS: We investigated peripheral insulin sensitivity with the insulin suppression test after a 28-day westernised high-saturated fat diet (38% total fat and 18% saturated fat with 115 mg of cholesterol per 1000 Ju). RESULTS: Steady state plasma glucose values were lower in S1-S1 compared with S1-S2 men (p=0.018 by ANOVA), but not in women (p=0.723). CONCLUSION/INTERPRETATION: There was no difference between carriers and non-carriers of the S2 allele in relation to incidence and sensitivity; although on subgroup analysis there was an effect in men but not in women.

A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons.

AIMS/HYPOTHESIS: Insulin resistance usually precedes the diagnosis of Type II (non-insulin-dependent) diabetes mellitus. However, in most patients, the clinical expression of the disease could be prevented by dietary and lifestyle changes. We investigated the effects of a diet enriched in monounsaturated fatty acids (Mediterranean diet) and a low fat, high-carbohydrate diet on in vivo and in vitro glucose metabolism in 59 young subjects (30 men and 29 women). METHODS: We carried out an intervention dietary study with a saturated fat phase and two randomized-crossover dietary periods: a high-carbohydrate diet and a Mediterranean diet for 28 days each. We analysed the plasma lipoproteins fractions, free fatty acids, insulin sensitivity and glucose uptake in isolated monocytes at the end of the three dietary periods. RESULTS: In comparison to the saturated fat diet, the CHO and Mediterranean diets induced a decrease of LDL-cholesterol (p < 0.001) and HDL-cholesterol (p < 0.001). Steady-state plasma glucose decreased (p = 0.023) and basal and insulin-stimulated 2-deoxiglucose uptake in peripheral monocytes increased in both diets (CHO and Mediterranean), (p = 0.007) indicating an improvement in insulin sensitivity. Fasting free fatty acids plasma values were correlated positively with steady state plasma glucose (r = 0.45; p < 0.0001). In addition, there was an inverse correlation between the mean glucose of the steady state plasma glucose period and logarithmic values of basal (r = -0.34; p = 0.003) and insulin stimulated glucose uptake in monocytes (r = -0.32; p = 0.006). CONCLUSION/INTERPRETATION: Isocaloric substitution of carbohydrates and monounsaturated fatty acids for saturated fatty acids improved insulin sensitivity in vivo and in vitro, with an increase in glucose disposal. Both diets are an adequate alternatives for improving glucose metabolism in healthy young men and women.

Performance of a color indicator in a disinfecting solution for the maintenance of soft contact lenses.

An experimental study of Allergan's Oxysept Comfort system was performed by measuring the slight reddish hue that appears in the disinfecting solution, indicating to the users that their lenses are again ready to be worn. The temporal evolution of the color of the solution has been measured under standardized conditions and analyzed in the CIELAB system, from the perspective of the typical threshold discrimination of the human eye. Color differences between neutralized and non-neutralized solutions occurred in an appropriate direction of the color space to enhance discrimination and were clearly perceptible by normal observers (greater than 9.7 +/- 1.2 CIELAB units). Colorimetric analyses have been used to draw conclusions regarding observers with defective color vision. The color of the solution changes abruptly, approximately 25 min after the neutralization process begins, and remains nearly constant after about 60 min, this agreeing well with the temporal evolution of the hydrogen peroxide concentration.

A three-dimensional virtual model of the head generated from digitalized CT or MR images for anatomical-radiological and neurosurgical evaluations.

A computer-generated virtual model has been developed that reconstructs the head in three dimensions from digitalized images obtained with magnetic resonance and computerized tomography. Through programming and the use of commercial graphic animation software, we have developed the whole process of the rotation of the head on different spatial planes. The procedure permits multidirectional anatomical sections to be made on the structure of the head, providing a true dynamic and user-friendly anatomical-radiological atlas. The system serves as a virtual model for the localization of an ideal surgical approach to any lesion thus avoiding possible neurological lesions.

Variations in corneal sensitivity with hydrogel contact lenses.

Changes in corneal sensitivity were studied in two groups of healthy subjects who wore hydrogel contact lenses: 44 persons whose lenses contained 38% water, and 23 who wore lenses of 55% water content. Corneal sensitivity decreased in both groups during the first 8 h following insertion; the decrease was more marked in the group who wore 38% water lenses. Changes in corneal tactile sensitivity were greater in women than in men, and determinations in different corneal zones showed that the central zone was less affected in sensitivity than any of the peripheral zones. After lenses were removed, tactile sensitivity showed full recovery within 4 h.