Papel del laboratorio en el control metabólico del paciente diabético / Role of laboratory in the metabolic control of the diabetic patient

Los objetivos planteados en el presente estudio son, evaluar el grado de control glucémico a largo plazo de pacientes diabéticos de nuestra área sanitaria en función de la glicohemoglobina (HbA1c), según los criterios definidos por el European NIDDM Policy Group, así como evaluar una de las complicaciones crónicas más frecuentes de los diabéticos, la afectación renal, mediante la cuantificación de microalbuminuria (MA) como marcador precoz para predecir el desarrollo de nefropatía diabética en dichos pacientes, y de esta forma permitir que se inicien tratamientos destinados a revertir o enlentecer su progresión hacia la enfermedad renal. Los resultados que se presentan se obtuvieron del análisis de HbA1c de sangre procedentes de 6374 pacientes diabéticos, y del análisis de las muestras de orina procedentes de 2961 pacientes diabéticos. De los pacientes a los que se les midió la HbA1c, 1803 (28,2 por ciento) presentaban resultados óptimos (8 por ciento). De los pacientes a los que se les midió la microalbuminuria, 1997 (67,4 por ciento) presentaban valores de microalbuminuria negativas (01,9 mg/dl), 520 (17,5 por ciento) presentaban valores altos (2,0-5,7 mg/dl) y 444 (14,9 por ciento) presentaban valores muy altos de microalbuminuria (>5,7 mg/dl). La frecuencia de microalbuminuria (32,4 por ciento) encontrada en nuestro estudio es similar a la hallada en otros estudios, por lo que habrá que incidir en este grupo de población, con una atención integral e individual de dichos pacientes en los que la determinación de microalbuminuria tiene interés pronóstico en los diabéticos tipo 1 en los que anuncia una nefropatía diabética. También permite evaluar un riesgo de naturaleza cardiovascular. En los diabéticos tipo 2, la microalbuminuria predice una mortalidad prematura, estando asociada a factores de riesgo cardiovasculares clásicos, no específicos de la diabetes, aunque frecuentemente, más precoces y más graves como hipertensión arterial y dislipemias (AU)

[Postoperative enteral nutrition with a high content of mono- and polyunsaturated fatty acids]. / Nutrición enteral postoperatoria con alto contenido en ácidos grasos mono y poliinsaturados.

We have done a clinical study in patients with benign biliary disease and indication for surgery, with the aim of analyzing some parameters of gastric secretion, biliary and pancreatic function, and gastrointestinal hormones in relation to the quantity and quality of the dietary fat (monounsaturated and polyunsaturated fatty acids), acting on the postoperative enteral ingestion, modifying the lipid source by its elaboration. In the present work we show the results derived from the analysis of the gastric and duodenal juices in relation to the type of fat administered, with a global description of the study being necessary. The studied sample consisted of 20 patients diagnosed with simple gallstones, who were divided into two groups (n = 10) according to the usual ingestion of fats: olive oil (Olive Group) or sunflower oil (Sunflower Group). A control group (n = 10) has also been considered, without taking into account their dietary habits. The patients were subjected to surgery, and after the immediate postoperative period they were fed, orally, with an enteral diet prepared with commercially available formulae (modular EDA); as a lipid source we have added olive oil, rich in monounsaturated fatty acids, for the Olive Group, and sunflower oil, rich in polyunsaturated oil, for the Sunflower Group. In the control group cream was added as lipid source (mono and polyunsaturated fatty acids). The caloric value of the diet is calculated based on the caloric value of its components (protein: 17%, carbohydrate: 53%, lipid 30%). The daily caloric requirements are determined based on the daily basal metabolism, according to the Harris-Benedick formula.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of the Dreimlich probe for obtaining samples in a postoperative study of biliopancreatic function in cholecystectomized patients]. / Uso de la sonda de Dreimlich para la obtención de muestras en un estudio de función bilipancreática postoperatorio en pacientes colecistectomizados.

We have performed a clinical study involving patients with symptomatic gallstones and indications for surgery, to analyze the biliary and pancreatic response to the quality of dietary fat (degree of unsaturation). As part of the investigative method, we have designed a clinical protocol adapted to the needs of the study, in this respect, we have used gastrointestinal intubation to obtain independent samples of gastric and duodenal juices, by means of a long nasoduodenal tube or a modified Dreimlich tube, placed manually in the intraoperative period, during the cholecystectomy. The characteristics of the tube are such that its manipulation is difficult, which led to situations postoperatively and during sampling, which may alter or invalidate the obtained drainage material. In the present study we define the protocol and the phases of the investigation, and we reflect on the usefulness of the Dreimlich tube as a method, analyzing its advantages and disadvantages.