[Stages of grief in diabetes and metabolic control]. / Etapas del duelo en diabetes y control metabólico.

BACKGROUND: To identify type 2 diabetic patients, the stages of grief and its association with metabolic control. METHODS: 186 patients both sexes, without recent loss of a loved one or a terminal illness. We applied a previously validated instrument, which explored the stages of grief (denial, anger/disbelief, bargaining, depression, and acceptance). There was measured BMI, waist circumference, and 6-month averages of glucose, cholesterol and triglycerides. RESULTS: The associations between the stages of grief and clinical variables showed that BMI is greater denial 33.1 ± 6.2 vs 28.9 ± 4.6 33.1 with p = 0.001, in disbelief stage glucose is greater 190 ± 67 vs 167 ± 51 with p < 0.05. The negotiation phase is associated with older age, 65.6 ± 10 vs 59.1 ± 11 years with p = 0.001 and higher cholesterol level against 229.4 ± 39.1 vs 206.6 ± 40 with p < 0.05. The stage of depression was associated with increased diagnostic time vs. 13.3 ± 8.9 vs 9.4 ± 7.1 years with p < 0.05 and the blood glucose level 198.9 ± 60, vs 164 ± 51 mg/dL p = 0.001. CONCLUSIONS: There are logical associations between clinical variables and stages of grief. Identify the stages of grief, as an additional element in the evaluation of patients with diabetes will develop strategies to improve adherence to medical management and metabolic control.

Introducción: el objetivo de este artículo es identificar las etapas del duelo y su asociación con el control metabólico en pacientes diabéticos tipo 2. Métodos: se incluyeron 186 sujetos diabéticos, de ambos sexos, sin pérdida reciente de un ser querido ni enfermedades terminales. Se les aplicó un instrumento validado que exploró las etapas del duelo (negación, ira/incredulidad, negociación, depresión, y aceptación). Se midió: IMC, perímetro de cintura, niveles promedio de glucosa, colesterol y triglicéridos en los últimos 6 meses. Resultados: las asociaciones entre las etapas del duelo y las variables clínicas mostraron que en la negación, el IMC es mayor 33.1 ± 6.2 contra 28.9 ± 4.6 con p = 0.001; en etapa de incredulidad, la glucemia es mayor 190 ± 67 frente a 16 ± 51 con p < 0.05; la etapa de negociación se asocia a mayor edad 65.6 ± 10 contra 59.1 ± 11 años con p = 0.001 y con nivel de colesterol mayor de 229.4 ± 39.1 frente a 206.6 ± 40 con p < 0.05; la etapa de depresión se asoció con mayor tiempo de diagnóstico 13.3 ± 8.9 frente a 9.4 ± 7.1 años, con p < 0.05 y con el nivel de glucemia de 198.9 ± 60 frente a 164 ± 51 mg/dL con p = 0.001. Conclusiones: existen asociaciones lógicas entre variables clínicas y etapas del duelo. Se debe identificar el duelo como un elemento adicional en la evaluación de pacientes con diabetes y establecer estrategias que mejoren la adherencia al tratamiento y el control metabólico.

[Life style and metabolic control in DiabetIMSS program]. / Estilo de vida y control metabólico en diabéticos del programa DiabetIMSS.

OBJECTIVE: To compare the lifestyle and metabolic control of diabetes patients included and not included in the DiabetIMSS program. METHODS: Subjects with diabetes in the DiabetIMSS program and the general clinic were divided into three groups: group 1 first attended the program, group 2 were enrolled during the study, and group 3 had not been included the program. Demographic and clinical aspects were measured and the IMEVID instrument was applied. RESULTS: We included 539 type-2 diabetes patients, predominantly females (73.3%), mainly of primary school level, and more frequently on double-drug therapy. There were clinical differences between the three groups for program leavers in terms of weight, waist, blood pressure, fasting glucose, HbA1c, triglycerides, and IMEVID qualification, all p < 0.05; correlation analysis of the variables with the qualification of IMEVID was significant at p < 0.05. The higher number of variable control targets was for leavers (71% of group); those who were enrolled in the study was 32%, and who had not was 17.2%. CONCLUSIONS: There are significant differences in lifestyle and control target parameters in subjects who completed the DiabetIMSS program.

[Asymptomatic bacteruiria frequency in pregnant women and uropathogen in vitro antimicrobial sensitivity]. / Frecuencia de bacteriuria asintomática en embarazadas y sensibilidad antimicrobiana in vitro de los uropatógenos.

OBJECTIVES: To estimate the frequency of asymptomatic bacteriuria in pregnant women attended in Family Medicine Units of the Instituto Mexicano del Seguro Social and to determine the in vitro sensitivity rate of the microorganisms to ampicillin, trimethoprim-sulfamethoxazole, nitrofurantoin and amikacin. PATIENTS AND METHODS: We carried out an observational, prospective and transversal study at Family Medicine Units 62 and 64 of the Mexico State Delegation, located in the urban area of Mexico City. Women with lesser than 32 weeks of pregnancy without urinary tract symptoms were included. Urine culture of a midstream urine specimen with > or = 10(5) colony forming units/mL urine of an only germen was used as the gold standard. The in vitro antimicrobial sensitivity was established according to the Bauer Kirby technique. RESULTS: 874 pregnant women were included and 73 had a positive urine culture, with a frequency of 8.4%, IC 95% = 6.6 - 10.2%, of asymptomatic bacteriuria. Escherichia coil was the most frequent isolated agent (77%). In vitro sensitivity to ampicillin of the microorganisms isolated was of 27%, IC 95% = 16 - 38%; to trimethoprim-sulfamethoxazole of 40%, IC95% = 29 - 51%; to amikacin of 68%, IC 95% = 57 - 79%, and to nitrofurantoin of 79%, IC 95% = 70 - 88%. CONCLUSIONS: The frequency of asymptomatic bacteriuria in the studied population is similar to the reported by the literature. The in vitro sensitivity rates of E. coil to ampicillin and to trimethoprim-sulfamethoxazole are very low. The best sensitivity corresponded to the nitrofurantoin. The treatment of the asymptomatic bacteriuria must be based on the local patterns of antimicrobial sensitivity and resistance.

[Age related spirometric changes in diabetic patients]. / Cambios espirométricos relacionados con la edad en pacientes diabéticos.

BACKGROUND: Pulmonary volumes and expiratory flows progressively decline during aging, and some studies suggest that such decline is steeper among diabetic people. OBJECTIVE: To evaluate if diabetes mellitus (DM) accelerates the decline of pulmonary function occurring with aging. METHODS: A spirometric study was carried out in type-2 DM outpatients attending the family physician office, as well as in a control group of nondiabetic subjects. RESULTS: 144 type-2 DM patients (30-78 years old) and 139 nondiabetic subjects (31-78 years old) were studied. From all spirometric variables, only the forced vital capacity (FVC) and the forced expiratory volume at one second (FEV1) were significantly lower in diabetic patients (p < 0.001). Multiple regression analysis corroborated that age and DM were associated with a lower pulmonary function, ruling out the influence of tobacco habit and body mass index. Nevertheless, the analysis of covariance showed that slopes of regression lines (age vs. spirometric variable) were not different between both groups. CONCLUSIONS: Diabetic patients had lower values of FVC and FEV1, as compared with nondiabetic subjects. However, the rate at which pulmonary function declined through age was similar in both groups.

Cambios espirométricos relacionados con la edad en pacientes diabéticos / Age related spirometric changes in diabetic patients

Background. Pulmonary volumes and expiratory flows progressively decline during aging, and some studies suggest that such decline is steeper among diabetic people. Objective. To evaluate if diabetes mellitus (DM) accelerates the decline of pulmonary function occurring with aging. Methods. A spirometric study was carried out in type-2 DM outpatients attending the family physician office, as well as in a control group of nondiabetic subjects. Results. 144 type-2 DM patients (30-78 years old) and 139 nondiabetic subjects (31-78 years old) were studied. From all spirometric variables, only the forced vital capacity (FVC) and the forced expiratory volume at one second (FEV1) were significantly lower in diabetic patients (p < 0.001). Multiple regression analysis corroborated that age and DM were associated with a lower pulmonary function, ruling out the influence of tobacco habit and body mass index. Nevertheless, the analysis of covariance showed that slopes of regression lines (age vs. spirometric variable) were not different between both groups. Conclusions. Diabetic patients had lower values of FVC and FEV1, as compared with nondiabetic subjects. However, the rate at which pulmonary function declined through age was similar in both groups.

Antecedentes. Durante el envejecimiento ocurre una caída progresiva de los volúmenes pulmonares y flujos espiratorios, y algunos estudios sugieren que esto es más pronunciado entre las personas diabéticas. Objetivo. Evaluar si la diabetes mellitus (DM) acelera la caída de la función pulmonar que ocurre con la edad. Métodos. Se realizó una espirometría a pacientes con DM tipo 2 que acudían a la Consulta Externa de Medicina Familiar, así como a un grupo control de sujetos no diabéticos. Resultados. Se estudiaron 144 pacientes con DM (30-78 años de edad) y 139 sujetos no diabéticos (31-78 años de edad). De las variables espirométricas, sólo la capacidad vital forzada (FVC) y el volumen espiratorio forzado en un segundo (FEV1,) fueron significativamente menores en los pacientes diabéticos (p < 0.001). El análisis de regresión múltiple comprobó que la edad y la presencia de DM se asociaban a una menor función pulmonar, descartando la influencia del tabaquismo o el índice de masa corporal. Sin embargo, el análisis de covarianza mostró que las pendientes de las líneas de regresión (edad vs. variable espirométrica) no eran diferentes entre los dos grupos. Conclusión. Los pacientes diabéticos tuvieron menores valores de FVC y FEV1 en comparación con los sujetos no diabéticos. Sin embargo, la velocidad con que disminuyó la función pulmonar conforme avanzaba la edad fue similar en ambos grupos.

[Inverse relationship between age and pulmonary function decline in the postoperative period of laparoscopic cholecystectomy]. / Relación inversa entre edad y caída de la función pulmonar en el postoperatorio de colecistectomía laparoscópica.

BACKGROUND: Abnormal lung mechanics with diminution of pulmonary volumes and airflows is an adverse effect occurring during the immediate postoperative period of the upper-abdomen surgery. OBJECTIVE: To evaluate the influence of age on the lung function decline occurring during the immediate postoperative period of laparascopic cholecystectomy. METHODS: Patients planned to be submitted to elective laparoscopic cholecystectomy were recruited from July to November 2000. A first basal spirometric study was performed the day before surgery and a second one between 21 and 27 h after surgery. RESULTS: Twenty three patients (3 men) aged 22 to 81 years old were studied. Patients had a significant drop of pulmonary function in the immediate postoperative period. There was a statistically significant inverse correlation between age and the degree of postoperative decline of the forced expiratory volume at one second (FEV1, r = -0.54, p < 0.01), the midexpiratory flow (FEF25-75, r = -0.48, p < 0.05), and the peak expiratory flow (PEF, r = - 0.49, p < 0.05). CONCLUSION: Our results suggest that age is inversely related to the pulmonary function decline observed one day after laparoscopic cholecystectomy, which might be explained by the increment of the pain threshold or the decrease of postoperative inhibitory reflexes occurring with aging.

Relación inversa entre edad y caída de la función pulmonar en el postoperatorio de colecistectomía laparoscópica / Inverse relationship between age and pulmonary function decline in the postoperative period of laparoscopic cholecystectomy

Background. Abnormal lung mechanics with diminution of pulmonary volumes and airflows is an adverse effect occurring during the immediate postoperative period of the upper-abdomen surgery. Objective. To evaluate the influence of age on the lung function decline occurring during the immediate postoperative period of laparascopic cholecystectomy. Methods. Patients planned to be submitted to elective laparoscopic cholecystectomy were recruited from July to November 2000. A first basal spirometric study was performed the day before surgery and a second one between 21 and 27 h after surgery. Results. Twenty three patients (3 men) aged 22 to 81 years old were studied. Patients had a significant drop of pulmonary function in the immediate postoperative period. There was a statistically significant inverse correlation between age and the degree of postoperative decline of the forced expiratory volume at one second (FEV1, r = -0.54, p < 0.01), the midexpiratory flow (FEF25-75, r = -0.48, p < 0.05), and the peak expiratory flow (PEF, r = -0.49, p < 0.05). Conclusion. Our results suggest that age is inversely related to the pulmonary function decline observed one day after laparoscopic cholecystectomy, which might be explained by the increment of the pain threshold or the decrease of postoperative inhibitory reflexes occurring with aging.

Antecedentes. Un efecto adverso de la cirugía de la parte superior del abdomen es la alteración de la mecánica pulmonar durante el postoperatorio inmediato, manifestada por disminución de los volúmenes y flujos pulmonares. Objetivo. Evaluar la influencia de la edad en la caída de la función pulmonar en el postoperatorio inmediato de la colecistectomía laparoscópica. Métodos. De julio a noviembre de 2000 se reclutaron pacientes que iban a ser sometidos a colecistectomía laparoscópica electiva. Se les realizó una espirometría basal el día anterior a la cirugía y una más entre 21 y 27 h después de la misma. La relación de algunas variables con la caída posquirúrgica de la función pulmonar se evaluó por correlación de Pearson (r). Resultados. Se estudiaron 23 pacientes (tres hombres) de 22 a 81 años de edad. Los pacientes tuvieron una caída significativa de la función pulmonar en el postoperatorio inmediato. Hubo una correlación inversa estadísticamente significativa de la edad con el grado de caída posquirúrgica del flujo espiratorio forzado al primer segundo (FEV1 r = -0.54, p < 0.01), el flujo mesoespiratorio (FEF25-75, r = -0.48, p < 0.05) y el flujo espiratorio máximo (PEF, r = -0.49, p < 0.05). Conclusión. Nuestros resultados sugieren que la caída de la función pulmonar que ocurre un día después de la colecistectomía laparoscópica está inversamente relacionada con la edad, lo que tal vez pudiera ser explicado por el mayor umbral al dolor o la menor intensidad de reflejos inhibitorios posquirúrgicos conforme avanza la edad.