RESUMO
Continuous glucose monitoring (CGM) is a tool that allows constant evaluation of glycemic control, providing data such as the trend and fluctuation of interstitial glucose levels over time. In clinical practice, there are two modalities: the professional or retrospective and the personal or real-time CGM (RT-CGM). The latest-generation sensors are more accurate and sensitive for hypoglycemia, improving adherence to self-monitoring, which has allowed optimizing glycemic control. The development of algorithms that allow the suspension of the infusion of insulin during hypoglycemia gave rise to the integrated therapy or sensor-augmented insulin pump therapy with low glucose suspend, which has proven to be an effective and safe alternative in the treatment of diabetic patients with high risk of hypoglycemia. The objective of this review is to present the evidence of the advantages of RT-CGM, the clinical impact of integrated therapy, and cost-effectiveness of its implementation in the treatment of patients with diabetes mellitus.
RESUMO
Genetically modified crops: promises and good intentions are not enough (refutation to Espinoza et al. 2004, Rev. Biol. Trop. 52 (3): 727-732). The arguments presented by Espinoza et al. in their paper "Relationship of genetically modified crops with the environment and health of the Costa Rican human population" published in this journal (Rev. Biol. Trop. 52: 727-732, 2004) are questioned and refuted. The arguments are confronted with evidence offered by scientists and national and international independent organizations around the world (e.g. World Health Organization, Consumers international, Physicians and Scientists for Responsible Application of Science and Technology, international Union for Conservation of Nature and Natural Resources, the Council of the University of Costa Rica, and the independent Science Panel) showing the current uncertainty and limitations of science in this area, as well as those of proposed and applied biosafety approaches. Environment, biodiversity and food security are so important and basic matters, that there is need of serious testing, particularly when promises seem to be based on environmentally dangerous ideas promoted half a century ago by the so called "green revolution". Debate should continue, based on a holistic analysis of facts and with ethical reasoning, avoiding emotional positions that can confuse virtual reality with reality. Rev. Biol. Trop. 55 (2): 347-364. Epub 2007 June, 29.
Se refutan y cuestionan los razonamientos expuestos por las autoras en el artículo "Relación de los cultivos modificados genéticamente con el ambiente y la salud de la población costarricense" publicado en esta revista por Espinoza et al. (52: 727-732, 2004). Para ello se contraponen éstos con las evidencias expuestas y analizadas tanto por científicos como por organizaciones nacionales e internacionales independientes de diverso tipo en diferentes lugares del mundo (e.g. Organización Mundial de la Salud, internacional de Consumidores, Médicos y Científicos por una Aplicación Responsable de la Ciencia y la Tecnología, Unión internacional para la Conservación de la Naturaleza, Consejo Universitario de la Universidad de Costa Rica y el Panel de Ciencias independiente), que confirman la incertidumbre y limitaciones actuales de la ciencia en esta área, así como de los mecanismos de bioseguridad propuestos y puestos en vigor. En materias tan importantes y básicas para la supervivencia como las que nos ocupan -el ambiente, la biodiversidad y la seguridad alimentaria- no es prudente apostar a promesas basadas en la misma lógica promocionada desde hace poco más de cinco décadas por la denominada "revolución verde". Es necesario continuar este debate basado en el análisis holístico de los hechos, así como en razonamientos éticos, evitando caer en posiciones emocionales que llegan a confundir la realidad virtual con la verdadera realidad.