Grado de conocimiento de insulinización por los médicos de atención primaria y su repercusión en el control de la diabetes / Level of knowledge about insulinization by Primary Care physicians and its impact on diabetes control

OBJETIVO: Analizar el grado de conocimiento y manejo actual de la insulinización por los médicos de atención primaria (AP), así como su impacto sobre el grado de control metabólico. MATERIALES Y MÉTODOS: Estudio secuencial exploratorio, principalmente cualitativo con un enfoque fenomenológico y posterior fase cuantitativa. Participaron 37 médicos de AP del Servicio Andaluz de Salud. Se realizó análisis univariado y bivariado de variables sociodemográficas y clínico-asistenciales. RESULTADOS: Existió una gran variabilidad entre los médicos de AP acerca del conocimiento sobre el tratamiento con insulinas (conocimiento bajo: 13,5%; medio: 59,5%; alto: 27,0%). Hubo una relación directa entre el conocimiento sobre insulinización y el grado de consecución de objetivos de HbA1c: a mayor grado de conocimiento, mejor control metabólico. Las insulinas basales más prescritas fueron la insulina glargina100 (56,8%), seguida de la insulina glargina300 (29,7%) y después la insulina NPH (8,1%). Hubo tendencia a presentar un diferente perfil de prescripción respecto a las insulinas basales, de tal forma que la prescripción de insulina NPH y de insulinas mixtas coincidía con el nivel más bajo de conocimiento. El 35,1% de los médicos de AP desconocían patrones de insulinización más complejos. CONCLUSIONES: Solo el 27% de los médicos de AP tienen un conocimiento elevado sobre el tratamiento con insulinas. Existe una relación directa entre el nivel de conocimiento sobre las insulinas y el grado de control glucémico. Es necesario mejorar el conocimiento sobre el tratamiento con insulinas para optimizar el control metabólico y disminuir el riesgo de complicaciones

OBJECTIVE: To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. MATERIALS AND METHODS: A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. RESULTS: There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. CONCLUSIONS: Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications

[Level of knowledge about insulinization by Primary Care physicians and its impact on diabetes control]. / Grado de conocimiento de insulinización por los médicos de atención primaria y su repercusión en el control de la diabetes.

OBJECTIVE: To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. MATERIALS AND METHODS: A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. RESULTS: There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. CONCLUSIONS: Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications.

[Renal cell carcinoma metastatic to the duodenum and Vater ampulla: report of two cases]. / Metástasis de cáncer renal a duodeno y ámpula de Vater; informe de dos casos.

These two cases of metastatic renal cell carcinoma to the duodenum, adds to the limited experience reported in the literature. Both patients initially presented with upper gastrointestinal bleeding years after they had a nephrectomy. After an extensive diagnostic work-up, they were both submitted to a classic pancreaticoduodenectomy (Whipple's procedure). Only the final histopathological report revealed the diagnosis. Basic recommendations on diagnosis and treatment are discussed in this article and a review of the literature is given.

Evaluación prospectiva del PaP Score en pacientes hospitalizados en una unidad de Cuidados Paliativos / No disponible

Objetivo: validar el Palliative Prognostic (PaP) Score en pacientes con cáncer avanzado ingresados en un hospital de agudos, a cargo de una unidad de cuidados paliativos española. Pacientes y método: se calculó el PaP Score en una población de 100 pacientes consecutivos ingresados en la Unidad de Medicina Paliativa de Albacete. Se analizó la supervivencia, usando el método de Kaplan-Meier y el test de log-rank para comparar la distribución de la supervivencia en los tres grupos del PaP Score. Resultados: el PaP Score dividió la muestra de pacientes en tres categorías pronósticas, con 36 pacientes en el grupo A (con una probabilidad de supervivencia a 1 mes mayor del 70%), 35 pacientes en el grupo B (con una probabilidad del 30 al 70%) y 29 pacientes en el grupo C (con una probabilidad menor del 30%). La supervivencia a 1 mes en los grupos fue 89, 63 y 14% respectivamente. La mediana de supervivencia estimada fue 89 días (IC95%, de 64 a 114 días), 39 días (IC95%, de 18 a 60 días) y 6 días (IC95%, de 5 a 7 días), respectivamente. Estas diferencias fueron muy significativas (log-rank = 33,56; p < 0,0001). Conclusiones: el PaP Score es capaz de dividir correctamente a los pacientes en tres categorías pronósticas. Por tanto, esta herramienta ofrece una mejoría sobre la estimación clínica de la supervivencia en pacientes con cáncer avanzado, ingresados en una unidad de cuidados paliativos (AU)

Objetive: to validate the Palliative Prognostic (PaP) score in the acute care setting, in hospitalized patients with advanced cancer in a Spanish palliative care unit. Patients and method: the PaP score was calculated for a population of 100 consecutive patients hospitalized in a palliative care unit at Albacete (Spain). A survival analysis was performed; the Kaplan-Meier method and log-rank test were used to compare survival distributions for patients in three PaP score groups. Results: the PaP score split the patient sample into three prognostic categories, with 36 patients in group A (>70% chance of surviving for 1 month), 35 patients in group B (30-70% chance), and 29 patients in group C ( <30% chance). One-month survival for these three groups was 89%, 63% and 14%, respectively. The estimated median survival of these groups was 89 days (95% CI, 64 to 114 days), 39 days (95% CI, 18 to 60), and 6 days (95% CI, 5 to 7), respectively. These survival differences were highly significant (log-rank = 33.56; p < 0.0001). Conclusions: the PaP score can accurately assign patients to three prognostic categories. Therefore, this tool represents an improvement over clinical estimates of survival in patients on advanced care hospitalized in a palliative care unit (AU)

Association of HLA-DRB1*16 with chronic discoid lupus erythematosus in Mexican mestizo patients.

BACKGROUND: Chronic discoid lupus erythematosus (CDLE) is present in 15-30% of patients with systemic lupus erythematosus (SLE). Approximately 5% of CDLE cases can evolve to SLE at some stage of the disease. AIM: The aim of this study was to determine gene frequencies of HLA-DRB1 alleles in Mexican mestizo patients with CDLE, irrespective of the presence of systemic disease. METHODS: The study comprised 28 Mexican mestizo patients with CDLE who were attending the Passover Dermatology Centre, in Mexico City. HLA-DRB1 and DQ allele typing was performed by sequence-specific oligotyping after DNA amplification using PCR. The study also included 99 ethnically matched healthy individuals as controls. RESULTS: In the patient group, a significantly increased gene frequency was found for the HLA-DR4 (P = 0.016, OR = 2.24, 95% CI 1.14-4.38) and HLA-DR16 alleles (P = 0.005, OR = 5.51, 95% CI 1.49-21.08). CONCLUSION: HLA-DRB1 alleles seem to be involved in the genetic susceptibility to CDLE in the Mexican mestizo population.

[Internal medicine at a health center. Experience evaluation]. / Medicina interna en un centro de salud. Evaluación de una experiencia.

UNLABELLED: GROUND: The current situation of internal medicine is evolving to alternative asistential plans related to traditional hospital attention. We present in this article the resulte obtained in an experience conducted to share the assistential task with a primary care center which is located in our Health Area. METHODS: During the period of time between 11-15-93 and 06-30-94 it was prospectively analyzed all the outpatients studied by an internist of the Department of Internal Medicine of the Albacete General Hospital in the Primary Care Center of Almansa. After a definitive diagnosis the following parameters were evaluated: age, sex, type of consult, first and second diagnosis and follow-up. Data of the evaluation according to the request new consults and waiting list patients was taken. RESULTS: The total consults analyzed were 1,651 (578 first visits and 1,073 second visits). Definitive diagnosis were obtained in 752 patients during this time (342 males and 406 females). The average age was 55.56 +/- 0.72 years and the number of diagnosis 1.7 +/- 0.32. The weekly request of new consults decreased from 25.7 to 12.25. Number of patients in waiting list decreased from 94 to 37. CONCLUSIONS: Approach between Internal Medicine and Primary Care is a feasible plan useful for both and for the assistential quality in the Primary Care Centers.