Diabetes con ecv ldlc<70.

En un hombre diabético de 70 años con antecedentes de cardiopatía isquémica, ¿cuál es la diana terapéutica respecto a cifras de colesterol LDL y Hemoglobina glicosilada (Hb A1c)?

Health coaching

Efficacy Several studies have shown health coaching to be effective in improving various aspects of health. One study on type 2 diabetes concludes that after six months, individuals who were coached showed improvement in medication adherence. Coaching had a positive effect on patients' knowledge, skill, self-efficacy and behavior change while a non-coached control group did not show any improvement. Additionally, coached participants with a hemoglobin A1C over 7% showed significant improvement in A1C. A study on coronary heart disease indicated that patients in a coaching program achieved a significantly greater change in total cholesterol of 14 mg/dl than the non-coached patients, with a considerable reduction in LDL-C. Those involved in the coaching program showed improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life, less anxiety, and improvement in overall health and mood.

The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus.

To compare the effects of a 4-month strength training (ST) versus aerobic endurance training (ET) program on metabolic control, muscle strength, and cardiovascular endurance in subjects with type 2 diabetes mellitus (T2D). Randomized controlled trial. Large public tertiary hospital. Twenty-two T2D participants (11 men, 11 women; mean age +/- standard error, 56.2+/-1.1 y; diabetes duration, 8.8+/-3.5 y) were randomized into a 4-month ST program and 17 T2D participants (9 men, 8 women; mean age, 57.9+/-1.4 y; diabetes duration, 9.2+/-1.7 y) into a 4-month ET program. ST (up to 6 sets per muscle group per week) and ET (with an intensity of maximal oxygen consumption of 60% and a volume beginning at 15 min and advancing to a maximum of 30 min 3x/wk) for 4 months. Laboratory tests included determinations of blood glucose, glycosylated hemoglobin (Hb A1c), insulin, and lipid assays. A significant decline in Hb A1c was only observed in the ST group (8.3%+/-1.7% to 7.1%+/-0.2%, P=.001). Blood glucose (204+/-16 mg/dL to 147+/-8 mg/dL, P<.001) and insulin resistance (9.11+/-1.51 to 7.15+/-1.15, P=.04) improved significantly in the ST group, whereas no significant changes were observed in the ET group. Baseline levels of total cholesterol (207+/-8 mg/dL to 184+/-7 mg/dL, P<.001), low-density lipoprotein cholesterol (120+/-8 mg/dL to 106+/-8 mg/dL, P=.001), and triglyceride levels (229+/-25 mg/dL to 150+/-15 mg/dL, P=.001) were significantly reduced and high-density lipoprotein cholesterol (43+/-3 mg/dL to 48+/-2 mg/dL, P=.004) was significantly increased in the ST group; in contrast, no such changes were seen in the ET group. ST was more effective than ET in improving glycemic control. With the added advantage of an improved lipid profile, we conclude that ST may play an important role in the treatment of T2D.

[Trends in the level of control of patients with type 2 diabetes from 2010 to 2015].

Aim: To examine the trend in the level of control of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL) in patients with type 2 diabetes mellitus between 2010 and 2015. Setting: 3 cut-offs in the years 2010, 2013, and 2015. Southeast area of Madrid. Descriptive and cross-sectional epidemiological study. Patients diagnosed and registered with type 2 diabetes. N=41,096 (2010), n=49,658 (2013), n=6,674 (2015) MAIN MEASUREMENTS: Measurement or not in the last year of HbA1c, BP, and LDL. Control of HbA1c (<7% individual targeting), BP (<140/90mmHg), and LDL (<100mg/dL, if cardiovascular disease <70mg/dL). Data were collected from electronic records of clinical history. The Chi-square test was used. The percentages of patients with each parameter measured in 2010, 2013 and 2015 were: HbA1c: 36.4%, 37.0%, 62.0% (P<.001); BP: 33.2%, 43.3%, 65.0% (P<.001); LDL: 32.9%, 33.2%, 43.5% (P<.001). The percentages of patients with each parameter measured and controlled in 2010, 2013, and 2015 were: HbA1c: 59.6%, 59.1%, 79.6% (P<.001); BP: 74.9%, 67.4%, 79.2% (P<.001); LDL: 41.8%, 58.3%, 58.8% (P<.001) CONCLUSION: In the 2010-2015 period, a sustained but insufficient trend of better control of HbA1c, BP and LDL was observed in patients with diabetes. The frequency of the measurements of these parameters improved more than the control of them. It seems that efforts to improve care for the patient with diabetes pay off, but they still have to be maintained.

[La educación multimedia como apoyo en el manejo de pacientes con diabetes tipo 2. Estudio cuasi experimental].

Evaluar la eficacia de la educación a través de un sistema de información multimedia en el control del paciente con diabetes tipo 2. Ensayo clínico abierto aleatorizado. El grupo de intervención fue instruido para consultar una herramienta educativa multimedia en la sala de espera de los consultorios, misma que fue diseñada de acuerdo a las caracteristicas de la población y centrada en automonitoreo de indicadores, información sobre diabetes tipo 2 y nutrición. Se midieron en sangre venosa las concentraciones de glucosa, hemoglobina glucosilada (HbA1c), triglicéridos, colesterol total, colesterol ligado a lipoproteínas de alta densidad (HDL-c) y colesterol ligado a lipoproteínas de baja densidad. Con la t de Student pareada se evaluó el efecto de la intervención. Se incluyeron 2334 pacientes, 958 en el grupo de intervención y 1376 en el grupo control. Se observó en el grupo de intervención un incremento del HDL-c (de 40.45 a 47.40 mg/dl; p = 0.001) y una disminución de los triglicéridos (de 227.78 a 210.38 mg/dl; p = 0.001). En el grupo control disminuyeron los triglicéridos (de 232.64 a 210.84 mg/dl; p = 0.016). En ambos grupos se incrementó de forma significativa el colesterol total. No se observaron cambios en los valores de glucosa y HbA1c posterior a la intervención. La implementación de un sistema de información multimedia mejora el HDL-c y los triglicéridos del paciente con diabetes. Se requiere un reforzamiento continuo de la intervención educativa por parte del profesional de la salud para incidir en el control glucémico y otros indicadores del control metabólico. To evaluate the efficacy of education through a multimedia information system, in controlling patients with type 2 diabetes. Randomized open clinical trial. The intervention group was trained to consult an educative multimedia tool in the waiting room, which was developed according to the population characteristics and centered on monitoring indicators, information on type 2 diabetes and nutrition. Venous blood concentrations of glucose, glycated hemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Paired t Student was used to assess the effect of the intervention. 2,334 patients were included, 958 in the intervention group and 1,376 in the control group. In the intervention group, an increase in HDL-c values was observed (from 40.45 to 47.40 mg/dL; p=0.001) as well as a descent on triglycerides values (from 227.78 to 210.38 mg/dL; p=0.001). There was a reduction on triglycerides levels in the control group (from 232.64 to 210.84 mg/dL; p=0.016). There was a significative increase in total cholesterol values in both groups. There were no changes in the mean values of glucose and HbA1c after the intervention. Implementation of a multimedia information system improves HDL-c and triglycerides in patients with diabetes. There is a need for a continuous reinforcement of the educative intervention by health professionals to improve glycemic and other indicators in metabolic control.

[Level at which control objectives are reached in patients in different population groups with type 2 diabetes].

There is evidence of increased macro- and micro-vascular risk in diabetic patients. The objective of this study was to determine the level of control in patients in different population groups with type 2 diabetes.  Descriptive cross-sectional study. Primary care. Madrid Health Service. Year: 2014. Patients over 14 years with type 2 diabetes. Number of patientes: n=6674. Variables on the degree of control (HbA1c, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL-c) and variables on patient characteristics (demographic, other cardiovascular risk factors, complications). The mean age of patients with controlled HbA1c was 67.8 years vs. 62.9 years in the uncontrolled (P<.001). Patients diagnosed with hypertension have a higher percentage of control with respect to the undiagnosed in HbA1c, SBP, DBP and LDL-c: 51 vs. 37%, 62 vs. 43%, 75 vs. 47% and 57 vs. 44% respectively; diagnosed with dyslipidaemia: 51 vs. 39%, 60 vs. 49%, 70 vs. 56% and 56 vs. 46%. With a diagnosis of macroangiopathy: 46 vs. 45%, 58 vs. 54%, 71 vs. 62% and 15 vs. 60%. All differences were statistically significant (P<.001). Over 50% of patients without a diagnosis of hypertension had an SBP> 140mmHg or DBP> 90mmHg. Over 25% of patients with hypertension or DL and uncontrolled levels were not receiving drug treatment. Control was improved in all groups, especially in younger patients, with particularly high cardiovascular risk by the presence of other cardiovascular risk factors or macroangiopathy. A significant percentage of patients with uncontrolled BP and cLDL were not diagnosed or receiving drug treatment.

[Not Available].

Introducción: la anemia es un factor de riesgo en la población infantil con consecuencias graves para su crecimiento y desarrollo. Los programas de ayuda alimentaria pueden contribuir a su prevención y control. Objetivo: estudiar la adherencia al consumo de suplementos y su relación con la prevalencia de anemia en niños menores de tres años de edad en San Luis Potosí, México beneficiarios del programa PROSPERA.Métodos: se realizó un análisis comparativo en niños de 12 a 36 meses que consumen diferentes suplementos alimenticios: 414 pertenecientes al grupo de intervención y 334 al de comparación. Se midió la hemoglobina (Hb) por Hemocue clasificando como anémicos a quienes tuvieron valores <110 g/l. Se aplicaron pruebas de t de Student y X2. Se estimaron efectos de intervención mediante el método de diferencias en diferencias y un puntaje de adherencia al consumo de suplementos.Resultados: al final del estudio la prevalencia de anemia disminuyó 11.2 pp en el grupo de intervención y 8.7 pp en el de comparación; la interacción del puntaje de adherencia por suplemento y etapa de observación mostró que la adherencia al consumo de Bebida láctea + Vitaniño reduce el riesgo de presentar anemia (p = 0,14). El consumo de Nutrisano + Vitaniño se asoció con menor riesgo (0,2), ambos con respecto al consumo de Nutrisano.Conclusiones: el programa PROSPERA tuvo efectos importantes en la disminución de las prevalencias de anemia. Se recomienda llevar a cabo acciones para mejorar la adherencia al consumo de suplementos alimenticios, a fIn de mejorar la efectividad de los programas.

[Evaluation and care of patients with type Ii diabetes regarding recommendations concerning cardiovascular risk factors and adherence to values in general medicine in the Grand Duchy of Luxembourg].

The objective of this study was to assess the adherence to national guidelines on cardiovascular prevention and target attainment for patients with type 2 diabetes mellitus followed-up in general practice. Non-interventional, cross-sectional survey. 606 patients have been considered in this analysis. Type 2 diabetes patients remain undertreated with statins (63% treated), even so those with a cardiovascular history (80% treated). Although more patients received antihypertensive treatment (82%) compared to hypolipidemic medication (69%), the proportion of patients attaining targets for total (35%), HDL (65%), and LDL-cholesterol (42%) exceeded far those attaining blood pressure control (13%). The primary endpoint of reaching the goal for LDL-cholesterol (<100 mg/dL) was attained by 42% of patients, of which only 13% reached the more stringent target of LDL-C <70 mg/dL. About half of the patients attained glycemic control (HbA1c <7%, 49%) and had triglycerides <150 mg/dL (55%). The majority of type 2 diabetes patients are treated for hypercholesterolemia and hypertension, although, there is still undertreatment with statins, especially in patients with CV disease. Only 42% of patients were on target for LDL-cholesterol and 13% for blood pressure. Therefore, wider implementation of process and outcome indicators, which proved to be related, and continuous evaluation of their result, is needed.

[In Process Citation].

Introducción y objetivos: el cobre (Cu) es un oligoelemento muy estudiado, pero poco se sabe de su evolución en los pacientes alimentados por gastrostomía endoscópica (GEP). Pretendemos evaluar la evolución del Cu sérico desde la gastrostomía hasta 12 semanas después de la intervención en estos pacientes alimentados con preparaciones domésticas.  Métodos: realizamos un estudio observacional prospectivo para evaluar el Cu sérico, la albúmina, la transferrina y el índice de masa corporal (IMC) en el momento de la GEP, tras 4 semanas y 12 semanas después de la intervención. Los datos incluyen edad, género, NRS 2002 y enfermedad subyacente: cánceres de cabeza y cuello (CCC) y disfagia neurológica (DN). Después de la intervención, estos pacientes fueron alimentados conpreparaciones domésticas. Resultados: 146 enfermos (89 hombres), entre 21-95 años: CCC-56, DN-90. Valores de Cu entre 42-160 μg/dl (normal: 70-140 μg/dl); normales 89% (n = 130); bajos 11% (n = 16), albúmina baja: 53% (n = 77), transferrina baja: 65% (n = 94), IMC bajo: 53% (n = 78). Después de 4 semanas: valores normales de Cu en 93% y bajos en 7%, albúmina baja en 34%, transferrina baja en 52%. Tras 12 semanas: valores normales de Cu en 95% y bajos en 5%, albúmina baja en 25%, transferrina baja en 32%. No encontramos diferencias significativas en el Cusérico cuando se compara edad, género, enfermedad subyacente, IMC, albúmina y transferrina. Conclusiones: la mayoría de los enfermos presentan Cu sérico normal en el momento de la gastrostomía. Para los enfermos con Cu sérico bajo antes del procedimiento, la alimentación con preparaciones domésticas parece suficiente para su normalización progresiva.

[Prevalence of inapropriate LDL cholesterol levels in patients with coronary disease and/or type 2 diabetes].

Clinical practice guidelines recommend achieving concentrations of LDL cholesterol less than 100 mg/dl (and in some cases less than 70 mg/dl) in patients with coronary artery disease and/or diabetes mellitus type 2 (DM2). We have examined the compliance with these objectives in patients treated in Spain with these conditions. Cross-sectional epidemiological study. Data were obtained during the visit of the study or, in their absence, based on data contained in the medical record by 874 doctors of the 17 autonomous communities in Spain. Demographic information, risk factors, cardiovascular and prescribed treatments were collected. In the final analysis 6.988 (62.7% male) patients were included. 2586 (37%) had coronary disease, 2654 (38%) DM2 and 1748 (25%) both conditions. 65% had metabolic syndrome. Vascular risk factors median number was 4. 57% and 86% showed a concentration of LDL cholesterol >100 and >70 mg/dl respectively. The proportion patients with LDL concentration >100 mg/dl was 4% greater in the DM2 (62.4%) than in coronary patients (57.1%; p0.0001). Concentration of triglycerides >150 mg/dl was higher in patients with DM2 (50.5%) than in coronary patients (43.5%; p0.0001). The proportion of patients with LDL>70 mg/dl was similar in the coronary group and in the DM2 Group (88.4% and 87.0%, respectively). More than half of patients with coronary heart disease (57.5%) or DM2 (55.7%) showed inadequate levels of HDL (<40 mg/dl men; <50 mg/dl women). More than a half of patients with diabetes mellitus and/or coronary artery disease enrolled in the CODIMET study do not achieve the recommended LDL cholesterol target for high cardiovascular risk patients.

[Síndrome metabólico, lipoproteína(a) y aterosclerosis subclínica en población mexicana].

Objetivo: Investigar la asociación del síndrome metabólico y la lipoproteína(a) [Lp(a)] con el riesgo de aterosclerosis subclínica en adultos mexicanos. Método: En 953 mujeres y hombres se evaluaron datos clínicos, bioquímicos y tomográficos de grasa abdominal visceral, subcutánea, hepática y calcio arterial coronario. La Lp(a) se determinó mediante nefelometría y el síndrome metabólico se diagnosticó con los criterios del Adult Treatment Panel III. La asociación independiente de estas variables con el calcio arterial coronario se obtuvo con análisis de regresión logística multivariada. Resultados: La edad, el peso, el índice de masa corporal, la presión arterial sistólica y diastólica, los volúmenes de grasa abdominal, los lípidos, la glucosa, la insulina y el índice de resistencia a insulina fueron significativamente mayores en los sujetos con síndrome metabólico, mientras que la mediana de Lp(a) fue más baja en comparación con los sujetos sin el síndrome (3.7 [rango intercuartílico (RIC): 2.3-9.2 vs. 5.9 [RIC: 2.5-13.1) mg/dl; p < 0.01). El número de componentes y el síndrome metabólico se asociaron inversamente con la Lp(a) elevada (> 30 mg/dl). La presencia de síndrome metabólico se asoció con un riesgo de calcio arterial coronario > 0 (odds ratio [OR]: 2.19; intervalo de confianza del 95% [IC95%]: 1.64-2.94; p < 0.001), independientemente de la Lp(a) elevada. La glucemia > 100 mg/dl (OR: 2.42; IC95%: 1.7-3.4; p < 0.0001) y la presión arterial elevada (OR: 2.14; IC95%: 1.5-3.1; p > 0.0001) se asociaron con calcio arterial coronario > 0. Conclusiones: En población mexicana existe una asociación inversa entre la concentración de Lp(a) y el síndrome metabólico. Este y sus componentes se asociaron positivamente con aterosclerosis subclínica. La elevada prevalencia de obesidad, diabetes, hipertensión arterial, triglicéridos elevados y concentración de colesterol unido a lipoproteínas de alta densidad que caracterizan a la población mexicana pudieran explicar las diferencias con otras poblaciones.

[Degree of control of cardiovascular risk factors among a patient population with diabetes mellitus type 1 and 2].

To evaluate the degree of control of metabolic goals in a group of very selected type 1 and 2 diabetic patients. A cross-sectional and descriptive study was done. Patients were enrolled consecutively in the Diabetes Clinic in a tertiary-care hospital in México City during the period between april and july 2005. The population at this clinic is very selected as demonstrated by the fact that all type 2 diabetic patients were treated with drugs for diabetic control, including insulin in 43% of them. We used the goals recommended by the American Diabetes Association (ADA) as parameters to analyze and additionally included non-HDL cholesterol and the atherogenic index. A total of 530 patients were included; 468 (58.8% female) had type 2 diabetes, with an average age of 58.5 years; 62 (65% female) patients had type 1 diabetes, with an average age of 31.2 years. The mean HbA1c values were 10.2 +/- 2.8 and 9.0 +/- 2.4 in type 1 and type 2 diabetic patients, respectively. The proportion of diabetic type 1 and 2 patients reaching treatment goals were 12.9% and 23.7% for HbA1c (p=0.02), 82.2% and 57.2% for both systolic and diastolic blood pressure (p=0.0001), 75.8% and 49.3% for triglycerides (p=0.0001), 45.1% and 35.6% for LDL-c (p=0.16), 51.6% and 53.4% for HDL-c (p=0.79), 56.4% and 43.3% for non-HDL cholesterol (p=0.03) and 58.0% and 55.1% for atherogenic index (p=0.66), respectively. The proportion of patients reaching all the optimal treatment goals (non-HDL cholesterol, HbA1c, arterial blood pressure and triglycerides) was 6.4% for type 1 diabetic patients and 4.4% for type 2 patients (p=0.6). Factors associated with achieving goal values in a multiple regression analysis were drug treatment for high blood pressure, use of lipid lowering drugs, insulin use and a history of stroke. Our results are not comparable with other publications of series evaluating the same parameters in open populations. The results show that the degree of control of evaluated risk factors is not good, principally in the case of glucemic control; it is necessary to plan strategies that help to reach these goals in diabetic patients.

Revisiting the oral glucose tolerance test criterion for the diagnosis of diabetes.

The Expert Committee on the Diagnosis and Classification of Diabetes retained the 2-hour glucose concentration on an oral glucose tolerance test of >/=11.1 mmol/L (200 mg/dL) as a criterion to diagnose diabetes. Since glycated hemoglobin levels have emerged as the best measure of long-term glycemia and an important predictor of microvascular and neuropathic complications, we evaluated the distribution of hemoglobin A1C (Hb A1C) levels in individuals who had undergone an oral glucose tolerance test to determine how well 2-hour values could identify those with normal versus increased Hb A1C levels. A cross-sectional analysis of 2 large data sets was performed. We cross-tabulated 2-hour glucose concentrations on an oral glucose tolerance test separated into 4 intervals (<7.8 mmol/L [140 mg/dL], 7.8-11.0 mmol/L [140-199 mg/dL], 11.1-13.3 mmol/L [200-239 mg/dL], and >/=13.3 mmol/L [240 mg/dL]) with Hb A1C levels separated into 3 intervals (normal; <1% above the upper limit of normal; and greater than or equal to the upper limit of normal + 1%). Approximately two thirds of patients in both data sets with 2-hour glucose concentrations of 11.1 to 13.3 mmol/L (200-239 mg/dL) had normal Hb A1C levels. In contrast, 60% to 80% of patients in both data sets with 2-hour glucose concentrations >/=13.3 mmol/L (240 mg/dL) had elevated Hb A1C levels. Since Hb A1C levels are the best measures presently available that reflect long-term glycemia, we conclude that the 2-hour glucose concentration criterion on an oral glucose tolerance test for the diagnosis of diabetes should be raised from >/= 11.1 mmol/L (200 mg/dL) to >/= 13.3 mmol/L (240 mg/dL) to remain faithful to the concept that diagnostic concentrations of glucose should predict the subsequent development of specific diabetic complications (e.g., retinopathy).

[Comparison of glycemic control in diabetic patients with and without metabolic syndrome].

To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6%). SM Criteria were : low HDL: 62.9%; hypertriglyceridemia: 56.3%; obesity abdominal (OA) 90.1%, hypertension (HBP): 62.5%. The prevalence of MS was 86.6% (95% CI 83% to 89%). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9% 2.3 vs 8.5% 2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95% in 1.010 to 1.016). We not found differences significant glycemic level in patients with and without MS.

[Compliance with the 2002 consensus document of the Spanish Society of Nephrology for the control of diabetic nephropathy in Catalonia (ECCODIAB)].

To evaluate the level of compliance with the 2002 consensus document (Spanish Society of Nephrology) on guidelines for the detection, prevention and treatment of diabetic nephropathy in Catalonia. Multicenter (23 hospitals), observational, cross-sectional, descriptive study conducted in 413 diabetic patients (61.7% men, 38.3% women) with a median age of 66.2 +/-11.5 years (26-93 years). The ANOVA test (post-hoc analysis; p value< 0.05) was used to study the relationships between the stages of diabetic nephropathyand different variables. 90.3% of the patients had type 2 DM. The following anthropometric parameters were observed: BMI 29.8 +/- 5 kg/m2 (BMI > 30 kg/m2: 48.7%) and waist circumference 104.1 +/- 14 cm (48.6% men > 102 cm and 78.9% women > 88 cm). Serum creatinine 1.9 +/- 1.3 mg/dl and simplified MDRD equation 45.3 +/- 25.0 ml/min/1.73 m2 [65.8%with CKD stages 3 and 4]. 80% of patients had ophthalmologic examination and 52.8% antiplatelet treatment. Hb A1c was 7.3 +/- 1.3%, but the percentage of patients with glycated hemoglobin > 7% and 8% was 54.9 and 28.6% [only 50.2% had been seen by an endocrinologist in the last 6 months]. 52.8% of patients were treated with insulin and 44.1% with anti-diabetic drugs, although only 19.6% used the new anti-diabetic drugs. 61% of patients had an LDLc > 100 mg/dl (61% treated) and 44% had triglycerides (TG) > 150 mg/dl (72% treated). 95% of patients presented with hypertension (BP > or = 130/80 mmHg),91% were undergoing antihypertensive treatment (79.7% with angiotensin-converting enzyme inhibitors and / or angiotensin receptor blockers). 81% with microalbuminuria and 78%with established proteinuria were receiving anti-proteinuric treatment. Of the patients considered to be refractory to BP (>3 drugs), only 28.9% underwent ambulatory BP monitoring. Significant differences were observed between stages of diabetic nephropathy and glycated hemoglobin (HBA1c; p = 0.048), systolic blood pressure (SBP; p = 0.024), lipidic control (HDLc; p = 0.015 and TG; p = 0.034), anemia (Hb; p = 0.010) and CKD (creatinine and sMDRD; p = 0.000). The levels of compliance with the therapeutic objectives regarding lipid control (LDL < or = 100 mg/dl and TG< or = 150 mg/dl), BP < or = 130/80 mmHg and HbA1c < or =7% were 1 objective: 68%, 2 objectives: 21.8% and 3 objectives: only 4% of patients. According to the results of our study, only a reduced proportion of patients fulfilled the different therapeutic end-points indicated. Future measures will be directed at improving physician-patient relationships with the main aim of intensifying the therapeutic measures to attain better metabolic and blood pressure control, nephroprotection and prevention in the appearance of cardiovascular events.

[Therapeutic approach to dyslipidemia and goal achievement in a Spanish population with type 2 diabetes without cardiovascular disease].

To assess the therapeutic approach and lipid goal achievement in a spanish diabetic population at high cardiovascular risk. A multicenter, descriptive, cross-sectional study consecutively recruited the first 10 patients who attended the primary care office and had been seen in the 12 months prior to the study visit. Inclusion criteria were type 2 diabetes without cardiovascular disease, LDL cholesterol levels ≤160mg/dL, triglyceride levels ≤600mg/dL, and at least one of the following: retinopathy, albuminuria, current smoking, or hypertension. A total of 2412 patients were evaluated (aged 61.3±8.3 years, 46.8% women, diabetes duration 8.6±7.4 years). As compared to the previous visit (8.1±5 months before), the proportion of patients who achieved LDL-C levels <100mg/dL (22.7% vs 28.6%), non-HDL-C levels <130mg/dL (27.7% vs 33.8%) and both goals (17.6% vs 22.1%) significantly increased at the time of assessment. Statins were the most widely prescribed lipid-lowering drugs (65.5%) and the lipid-lowering drug was changed from the previous visit in 38.7% of patients, drug dosage was increased in 17.3%, and another drug was added in 5%. Use of more potent statins and higher statin doses were the most commonly used therapeutic strategies for improving control of dyslipidemia in patients with type 2 diabetes, but these changes were clearly inadequate to achieve lipid goals in most patients with type 2 diabetes.

Cardiac sympathetic denervation for conventional treatment refractory arrhythmias.

La denervación simpática cardiaca izquierda (DSCI) por toracoscopia se ha convertido en una alternativa terapéutica para el manejo de arritmias cardíacas refractarias al tratamiento convencional en pacientes con cardiopatía estructural, principalmente isquémicos, y enfermedades hereditarias asociadas con muerte súbita como el síndrome de QT largo. Generalmente se realiza en quienes manifiestan episodios recurrentes de arritmias ventriculares o incluso tormenta eléctrica a pesar del tratamiento convencional. El objetivo de este estudio es mostrar la experiencia de esta institución con la DSCI en pacientes refractarios al manejo convencional y los resultados derivados de su aplicación. Se revisaron los registros de 6 pacientes con antecedente de arritmias ventriculares tratados previamente con medicamentos y en algunos casos con ablación con catéter y la mayoría con desfibrilador automático implantable, que fueron llevados DSCI por toracoscopia video-asistida (VATS). La principal enfermedad de base fue la cardiopatía estructural, la indicación más prevalente fue tormenta arrítmica incontrolable, la edad promedio fue de 56 ± 16 años, el 67% de los individuos fueron hombres. Este procedimiento no mostró complicaciones en ninguno de los pacientes y se encontró mejoría sintomática en todos los casos. Se realizó seguimiento por 24 meses; dos pacientes tuvieron recurrencias por taquicardia ventricular lenta sin síntomas severos y uno por fibrilación ventricular. La DSCI por VATS debe considerarse como opción terapéutica para pacientes con arritmias de difícil manejo.

[Factors associated to glycaemic control in patients with type 2 diabetes].

Evaluate the factors influencing blood glucose control of type 2 diabetic patients attended at a tertiary health care center. A retrospective study by review of medical records of patients who attended the Diabetes Clinic at the University of Caxias do Sul was carried out. Patients were evaluated for glycaemic and metabolic control and divided according to glycated hemoglobin at the beginning and end of the period in question, in compensated and not compensated. The factors associated with glycaemic control were analyzed. Seventy three patients were included in the analysis. On the average, improvement of parameters related to glycaemic, pressure and lipid control during the average of 20 months of treatment was observed. In the beginning of the follow-up period, 25% of patients had glycated hemoglobin < 7%, 22.7% had LDL cholesterol < 100mg/dL, 8.7% had systolic blood pressure < 130 mmHg and diastolic < 80 mmHg and no patients had all parameters meeting the recommended goals. At the last visit the percentages were, 42.3%, 37.5%, 30.2% and 9.6% respectively. In the multivariate analysis, younger age, higher levels of LDL cholesterol and insulin use were associated with poor blood glucose control. A small part of the sample simultaneously achieved the goals for blood glucose, lipids and blood pressure control. Some factors, such as age and gender can be determinants to achieve control of diabetes. Greater efforts are still needed to achieve the goals for treatment in type 2 diabetic patients.

Severity of preeclampsia: data from a high specialty hospital in Mexico City.

La severidad de la preeclampsia puede variar según la población en estudio. Identificar la frecuencia y el tipo de datos de severidad de la preeclampsia en pacientes atendidas en una unidad médica de alta especialidad de la Ciudad de México. Estudio observacional, retrospectivo y transversal de una serie de 100 pacientes embarazadas con preeclampsia grave atendidas en un hospital de tercer nivel de la Ciudad de México, del 1 de agosto al 31 de diciembre de 2018. Se registraron los datos de severidad de la preeclampsia descritos por el American College of Obstetricians and Gynecologists en 2013 y 2019. Las variables se ordenaron en cuantitativas y cualitativas. Se utilizó estadística descriptiva con el programa SPSS versión 20. Edad materna de 30.45 ± 6.95 años y edad gestacional de 33.03 ± 4.09 semanas. Datos cuantitativos: presión arterial sistólica ≥ 160 mmHg en el 78%, presión arterial diastólica ≥ 110 mmHg en el 35%, aspartato aminotransferasa > 70 U/l en el 33%, deshidrogenasa láctica > 600 U/l en el 32%, cuenta plaquetaria < 100,000 plaquetas/ml en el 30% y creatinina sérica > 1.1 mg/dl en el 8%. Datos cualitativos: cefalea en el 61%, dolor epigástrico en el 37%, hiperreflexia en el 33%, dolor en el hipocondrio derecho en el 8%, acúfenos en el 7%, fosfenos en el 7%, eclampsia en el 3%, visión borrosa en el 2%, hematoma hepático no roto en el 1% y amaurosis en 1%. No hubo ninguna muerte materna. Los datos de severidad más frecuentes -fueron cuantitativos (presión arterial sistólica y diastólica), relacionados con síntomas y signos neurológicos de vasoespasmo (cefalea, hiperreflexia) y con síntomas de origen hepático (dolor epigástrico, dolor en hipocondrio derecho). The severity of preeclampsia may vary according to the features of the population being studied. Identify the frequency and type of data related to severity of pre-eclampsia in patients treated in a highly specialized medical unit in Mexico City. Observational, retrospective and cross-sectional study, which included a series of 100 pregnant patients with severe pre-eclampsia, attended at a third level care center in Mexico City, from August 1 to December 31, 2018. Data collected on severity of preeclampsia corresponds to that described by the American College of Gynecology and Obstetrics in 2013 and 2019. Variables were ordered into quantitative and qualitative. Descriptive statistics were used with the SPSS version 20 program. Maternal age 30.45 ± 6.95 years and gestational age 33.03 ± 4.09 weeks. Quantitative data: systolic blood pressure ≥ 160 mm Hg was found in 78%, diastolic blood pressure ≥ 110 mmHg 35%, aspartate aminotransferase > 70 U/L 33%, lactic dehydrogenase > 600 U/L 32%, platelet count < 100,000 platelets/mL 30% and serum creatinine > 1.1 mg/dl 8%. Qualitative data: headache 61%, epigastric pain 37%, hyperreflexia 33%, pain in the right hypochondrium 8%, tinnitus 7%, phosphenes 7%, eclampsia 3%, blurred vision 2%, unbroken liver hematoma 1%, and amaurosis 1 %. No cases of maternal death occurred. Most frequent severity data were quantitative values (systolic and diastolic blood pressure) related to symptoms and neurological signs of vasospasm (headache, hyperreflexia), and to symptoms of hepatic origin (epigastric pain, pain in the right hypochondrium).

[Effect of glucose control on lipid levels in patients with type 2 diabetes].

The dyslipoproteinemia characterizing patients with type 2 diabetes is a major risk factor for atherosclerosis. Prospective studies indicate that an improved glucose control is associated with lower lipid levels. In this study we evaluated whether an improvement of the lipid status can also be observed in a routine clinical setting. Furthermore, we evaluated how many patients achieve lipid target levels by improving glucose control. In 51 type 2 diabetics (60 +/- 12 ys., 29 men, 22 women) lipid values were determined before and after improvement of glucose metabolism (6 - 12 weeks, HbA1c 7.9 +/- 1.9 % vs. 7.1 +/- 1.3 %). Patients on lipid-lowering medication or with atherosclerosis were excluded. The improved glucose control was achieved by starting/intensifying treatment with diet (n = 5), acarbose (n = 5), metformin (n = 10), sulfonylurea/glinide (n = 12) or insulin (n = 19). The decrease in HbA1c was associated with a decrease in total cholesterol (232 +/- 64 vs. 216 +/- 35 mg/dl, p < 0.05) and triglycerides (348 +/- 448 vs. 216 +/- 139 mg/dl, p < 0.01), while HDL- and LDL-cholesterol did not change significantly. Only in patients with triglycerides > 200 mg/dl did changes in HbA1c-levels correlate with changes in triglyceride-levels (r(2) = 0.32, p = 0.012). Lipid target levels were reached in seven of 51 patients (five of 51 patients before improvement of HbA1c). Although in routine clinical practice an improvement in HbA1c results in better lipid values. This improvement is small and is usually not sufficient to reach lipid target levels.

Hemoglobin

To a small extent, hemoglobin A slowly combines with glucose at the terminal valine (an alpha aminoacid) of each β chain. The resulting molecule is often referred to as Hb A1c, a glycated hemoglobin. The binding of glucose to amino acids in the hemoglobin takes place spontaneously (without the help of an enzyme) in many proteins, and is not known to serve a useful purpose. However, as the concentration of glucose in the blood increases, the percentage of Hb A that turns into Hb A1c increases. In diabetics whose glucose usually runs high, the percent Hb A1c also runs high. Because of the slow rate of Hb A combination with glucose, the Hb A1c percentage reflects a weighted average of blood glucose levels over the lifetime of red cells, which is approximately 120 days. The levels of glycated hemoglobin are therefore measured in order to monitor the long-term control of the chronic disease of type 2 diabetes mellitus (T2DM). Poor control of T2DM results in high levels of glycated

[Which HbA1c and lipid targets in patients with type 2 diabetes?].

Patients with type 2 diabetes are at high cardiovascular risk and require a global management targeting all risk factors. Target values for blood pressure have been discussed in a previous paper. The present clinical case summarizes the most important arguments concerning the choice of the target values for glucose control (glycated haemoglobin or HbA1c) and lipid management. As far as glucose control is concerned, the objective should be individually adjusted, based on the benefits/risks ratio, with a less stringent HbA1c level in presence of coronary heart disease and risk of severe hypoglycaemia. However, in absence of these two risks factors, the objective should be reinforced (HbA1c < 7%), essentially to prevent or retard microangiopathic lesions. As far as lipid management is concerned, the most crucial goal remains LDL cholesterol lowering, with a target value < 100 mg/dL in patients at high cardiovascular risk and <70 mg/dL in patients at very high risk, according to the recent European guidelines. Dyslipidaemia related to the metabolic syndrome (hypertriglyceridaemia, low HDL cholesterol) may also represent a therapeutic target (non-HDL cholesterol), although evidence is mostly missing in the literature.

Hemoglobin

Long-term control of blood sugar concentration can be measured by the concentration of Hb A1c. Measuring it directly would require many samples because blood sugar levels vary widely through the day. Hb A1c is the product of the irreversible reaction of hemoglobin A with glucose. A higher glucose concentration results in more Hb A1c. Because the reaction is slow, the Hb A1c proportion represents glucose level in blood averaged over the half-life of red blood cells, is typically ~120 days. An Hb A1c proportion of 6.0% or less show good long-term glucose control, while values above 7.0% are elevated. This test is especially useful for diabetics. The functional magnetic resonance imaging (fMRI) machine uses the signal from deoxyhemoglobin, which is sensitive to magnetic fields since it is paramagnetic. Combined measurement with NIRS shows good correlation with both the oxy- and deoxyhemoglobin signal compared to the BOLD signal.

Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the Community of Madrid (Spain).

Our aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain). From 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period. A significant decrease in serum glucose levels (143±42mg/dl vs 137±43mg/dl, p<0.00), HbA1c (7.09±1.2% vs 7.02±1.2%, p<0.00), total cholesterol (191.4±38mg/dl vs 181.5±36mg/dl, p<0.00), LDL cholesterol (114.7±31mg/dl vs 105.5±30mg/dl, p<0.00) and triglyceride levels (144.5±93mg/dl vs 138±84mg/dl, p<0.00) during study period was documented. On the contrary, a significant elevation in HDL cholesterol levels was observed (49.2±14mg/dl vs 49.9±16mg/dl, p<0.00). The incidence of diabetic complications throughout the study period was low, with a incidence of coronary heart disease of 6.2%, peripheral arterial disease 3%, ischemic stroke 2.8%, diabetic foot 11.2%, nephropathy 5.9%, retinopathy 4.5%, and neuropathy 3%. Metabolic control in T2D patients attended in primary care in the Community of Madrid throughout 3 years is adequate and is accompanied by low percent of chronic diabetic complications during this period of follow-up.

Diabetes management

"Perfect glycemic control" would mean that glucose levels were always normal (70–130 mg/dl, or 3.9–7.2 mmol/L) and indistinguishable from a person without diabetes. In reality, because of the imperfections of treatment measures, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time. In addition, one survey of type 2 diabetics found that they rated the harm to their quality of life from intensive interventions to control their blood sugar to be just as severe as the harm resulting from intermediate levels of diabetic complications. In the 1990s the American Diabetes Association conducted a publicity campaign to persuade patients and physicians to strive for average glucose and hemoglobin A1c values below 200 mg/dl (11 mmol/l) and 8%. Currently, many patients and physicians attempt to do better than that.

Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries. The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements. The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear β for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P < 0.05 for all). The findings were consistent across categories of sex, race, obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia. Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in Brazilian adults without diagnosed diabetes. This trial was registered at clinicaltrials.com as NCT02320461.

[Lipid profile in diabetic patients, according to changes in glucose control: a 2-year study].

Disorders of the lipoprotein metabolism in diabetic patients are of great interest because their association to the presence of atheromatosis and because cardiovascular diseases are the major cause of mortality in diabetic patients. The aim of this study was to compare the lipidic scheme of our diabetic patients according to the type of diabetes, the age of onset and the evolution over the years, and to analyze the impact of variations in the glycemic control on such lipidic scheme. In the insulin-dependent diabetes mellitus, total cholesterol, LDL, HDL and triglycerides were within the recommended values for the age of the patients. There was a significant correlation between glycemia and HbAlc and triglycerides, total cholesterol and its LDL and HDL fractions. In non-insulin-dependent diabetes mellitus, we observed average values of total cholesterol and LDL fraction higher than what is recommended for diabetic patients with the characteristics of this group. There was a significant correlation between basal glycemia, HbAlc and triglycerides, as in the insulin-dependent diabetes, although there was no correlation with total cholesterol and HDL. This absence of correlation may be due to the effect of other factors: age, inadequate dietary follow-up obesity and hyperinsulinism.

[Efectos metabólicos en pacientes obesos posoperados de bypass gástrico laparoscópico: 5 años de experiencia en un hospital de tercer nivel].

La obesidad se define como una enfermedad caracterizada por una acumulación anormal o excesiva de grasa que puede ser perjudicial para la salud. La cirugía bariátrica es un método efectivo y seguro en el tratamiento de la obesidad extrema. Se realizó una revisión y análisis de 90 expedientes clínicos de pacientes post-operados de bypass gástrico laparoscópico. De los 38 pacientes incluidos para el presente análisis, 17 pacientes (43.6%), contaron con el diagnóstico de diabetes mellitus tipo 2 previo al procedimiento quirúrgico y 21 pacientes (56.4%), carecieron de este diagnóstico previo al procedimiento quirúrgico. En los pacientes no diabéticos, se encontraron diferencias estadísticamente significativas en los valores de índice de masa corporal en la comparación de medias entre el estado basal y a los 12 meses después de haber realizado el bypass gástrico, sin embargo, la hemoglobina glucosilada y la creatinina no mostraron diferencia significativa. En contraste, el grupo de pacientes diabéticos presentó diferencias estadísticamente significativas en las cifras de índice de masa corporal, hemoglobina glucosilada y ácido úrico. El bypass gástrico laparoscópico proporciona pérdida de peso y reducción del IMC satisfactoria, en específico, el porcentaje de exceso de IMC perdido, con la mejora simultánea de comorbilidades relacionadas con la obesidad. Obesity is defined as a disease characterized by an abnormal or excessive accumulation of adipose tissue that may be hazardous to the health. Bariatric surgery is an effective and safe treatment of morbid obesity. A review and analysis of 90 clinical records of postoperative patients with laparoscopic gastric bypass was performed. 38 patients were included in the study; 17 (43.6%) of which were diagnosed with diabetes mellitus before the procedure and 21 patients (56.4%) without diabetes mellitus. In non-diabetic patients, it was found statistical differences in the value of body-mass index (BMI). In the group of diabetic patients, statistical differences were found in the value of BMI, glycated hemoglobin and uric acid. Laparoscopic gastric bypass (LRYGB) provides a satisfactory weight loss and BMI reduction, specifically, percent of excess BMI lost with the simultaneous improvement of comorbid disease.

Prevalence, treatment, and control of dyslipidemia in diabetic participants of two brazilian cohorts: a place far from heaven.

Diabetes is one of the leading causes of cardiovascular mortality. Over the last years, mortality has decreased significantly, more in individuals with diabetes than in healthy ones. That is mostly due to the control of other cardiovascular risk factors. The objective of our study was to analyze the dyslipidemia control in two diabetes cohorts. Patients from two distinct cohorts were studied, 173 patients from the BHS (Brasília Heart Study) and 222 patients from the BDS (Brazilian Diabetes Study). The data on dyslipidemia control were studied in both different populations. All patients had diabetes. There are significant differences concerning comorbidities between the LDL-C and BDS groups. The average glycated hemoglobin is of 8.2 in the LDL-C > 100 group in comparison with 7.7 and 7.5 in the 70-100 and < 70 groups, respectively (p = 0.024). There is a higher percentage of hypertensive patients with LDL between 70-100 (63.9%), when comparing the < 70 and > 100 groups (54.3% and 54.9%, respectively; p = 0.005). Diastolic pressure is higher in the group with LDL > 100, with an average of 87 mmHg, in comparison with 82.6 mmHg and 81.9 mmHg in the 70-100 and < 70 groups, respectively (p = 0.019). The group with LDL > 100 has the greatest percentage of smokers (8.7%) in comparison with the groups with LDL between 70-100 and < 70 (5.6% and 4.3%, respectively; p = 0.015). There is also a difference in the previous incidence of coronaropathy. In the group with LDL < 70, 28.3% of patients had already experienced a previous infarction, compared with 11.1% and 10.6% in the 70-100 and > 100 groups, respectively (p < 0.001). The data in our study have shown that the dyslipidemia control in diabetic patients is inadequate and there is a tendency of direct association between lack of blood glucose control and lack of dyslipidemia control, in addition to the association with other cardiovascular risk factors, such as diastolic hypertension and smoking. This worsened control might be related to the plateau in the descending curve of mortality, and investments in this regard can improve the cardiovascular health in diabetic patients.

[Utilidad de la proteína C reactiva en el diagnóstico oportuno de fuga de anastomosis en cirugía colorrectal].

La fuga de anastomosis (FA) en cirugía colorrectal es una complicación temida por el incremento de la morbimortalidad. La tasa de FA se reporta desde el 1 hasta el 25%. Realizar el diagnóstico de forma temprana es difícil. Determinar el rendimiento diagnóstico de la proteína C reactiva (PCR) en una cohorte de pacientes sometidos a cirugía colorrectal electiva con anastomosis. Se realizó un estudio prospectivo, comparativo, en 138 pacientes sometidos a cirugía colorrectal con anastomosis de forma electiva, analizando los valores séricos de la PCR los días 1, 3, 5 y 7 del posoperatorio, así como los de leucocitos y otros datos de sepsis abdominal. La tasa de FA fue del 6.5%, y los valores de la PCR fueron significativamente más altos en el grupo de pacientes con FA en el tercer día del posoperatorio. Con un punto de corte de 18.5 mg/dl en el tercer día del posoperatorio se obtuvo una sensibilidad del 81%, una especificidad del 91%, un valor predictivo positivo del 45% y un valor predictivo negativo del 98%. La medición de la PCR en el tercer día del posoperatorio en pacientes sometidos a cirugía colorrectal electiva con anastomosis primaria o secundaria permite identificar las complicaciones sépticas, incluida la FA. The anastomotic leakage (AL) in colorectal surgery is a complication feared by the increase in morbidity and mortality. The rate of AF is reported from 1 to 25%. Making the diagnosis early is difficult. To determine the diagnostic performance of the C reactive protein (CRP) in a cohort of patients undergoing elective colorectal surgery with anastomosis. A prospective, comparative study was conducted in 138 patients undergoing elective anastomosis with colorectal surgery, analyzing the serum values of CRP on postoperative days 1, 3, 5 and 7, as well as leukocytes and other abdominal sepsis data. The AL rate was 6.5%, the CRP values were significantly higher in the group of patients with AF on the 3<suprd</sup postoperative day; with a cut-off point of 18.5 mg/dl on the third postoperative day, it obtained sensitivity 81%, specificity 91%, positive predictive value 45%, negative predictive value 98%. Measurement of CRP on the third postoperative day in patients undergoing elective colorectal surgery with primary or secondary anastomosis allows the identification of septic complications including leakage of anastomosis.

[Achievement of cardiovascular goals in patients diagnosed with type 2 diabetes with and without cardiovascular disease].

To determine the proportion of patients with type 2 diabetes with and without cardiovascular disease achieving the main cardiovascular goals.  Cross-sectional study. A regional health district in a European country, Spain. Year: 2013. Adult patients diagnosed with type 2 diabetes with and without cardiovascular disease. Study using secondary data obtained from electronic records of clinical history. Haemoglobin A1c, blood pressure, LDL cholesterol, smoking and medication were covered. n=49,658 RESULTS: The proportion of patients with diabetes achieving cardiovascular goals (among those with recent measurement) was: haemoglobin A1c 68.8% (CI95%:68.2%-69.4%), blood pressure 74.3% (CI95%:73.9%-74.7%), LDL cholesterol 59.8% (CI95%:59.0%-60.6%), tobacco 80.2% (CI95%:79.6%-80.8%). Only 40%-67% of patients has recent measurement. Only 48.0% (CI95%: 46.6%-49.4%) of patients who needed statins were receiving them. Higher proportion of patients with cardiovascular disease were achiving goals. Differences were small but significant. Cardiovascular goals were measured in around half of patients with diabetes. Proportion of patients achiving cardiovascular goals were similar to published and best in patients with cardiovascular disease but it could improve. This points to prioritising interventions in this group of patients at very high risk, improving the implementation of guidelines and patient adherence.

InternalMed_Harrison

<7.0%c 4.4–7.2 mmol/L (80–130 mg/dL) <10.0 mmol/L (<180 mg/dL) <2.6 mmol/L (100 mg/dL)g >1 mmol/L (40 mg/dL) in men >1.3 mmol/L (50 mg/dL) in women <1.7 mmol/L (150 mg/dL) aAs recommended by the American Diabetes Association; goals should be individualized for each patient (see text). Goals may be different for certain patient populations. bHbA1c is primary goal. cDiabetes Control and Complications Trial–based assay. d1–2 h after beginning of a meal. eGoal of <130/80 mmHg may be appropriate for younger individuals fIn decreasing order of priority. Recent guidelines from the American College of Cardiology and American Heart Association no longer advocate specific LDL and HDL goals (see Chaps. 291e and 419). gGoal of <1.8 mmol/L (70 mg/dL) may be appropriate for individuals with cardiovascular disease. Abbreviation: HbA1c, hemoglobin A1c. Source: Adapted from American Diabetes Association: Diabetes Care 38(Suppl 1):S1, 2015. PATIENT EDUCATION ABOUT DM, NUTRITION, AND EXERCISE

Third trimester gestational anemia: frequency and severity according to maternal age.

La anemia es muy frecuente durante el embarazo y tiene repercusiones en la madre y en su hijo. Determinar la frecuencia y la gravedad de la anemia gestacional del tercer trimestre (hemoglobinemia < 11 g/dl), según la edad materna de los nacimientos atendidos en el Hospital Vicente Corral, entre septiembre de 2016 y febrero de 2017. Estudio transversal. Muestra: 428 gestantes. Criterios de inclusión: embarazadas con ≥ 27 semanas de gestación, reporte de hemoglobina y neonato vivo. Criterios de exclusión: embarazo gemelar, neonato con malformaciones congénitas mayores, madre con enfermedades crónicas. Análisis estadístico: para las variables cuantitativas se calcularon la mediana y los valores mínimo y máximo; para las variables cualitativas, las frecuencias absolutas y relativas; para establecer una asociación se utilizó la prueba de ji al cuadrado, y para la significancia estadística se consideró p < 0.05. La mediana de edad materna fue de 23 años y 4 meses. Hemoglobina en mujeres: anémicas 9.9 g/dl, no anémicas 12.2 g/dl (p = 0.000). Frecuencia de anemia: global 31.8%, en < 20 años 41.5%, en 20-34 años 26.5% y en > 35 años 35.6%. Gravedad de la anemia: leve 18.7%, moderada 12.6%, grave 0.5%. La edad materna influyó en la frecuencia de la anemia (ji al cuadrado de Pearson = 8.911, p = 0.012), pero no en su gravedad (ji al cuadrado de Pearson = 1.078, p = 0.898). Frecuencia de microcitosis: 36.9% en mujeres anémicas. El volumen corpuscular medio y la gravedad de la anemia mostraron asociación (p = 0.019). La frecuencia de la anemia en el tercer trimestre de la gestación fue alta, con predominio de la anemia leve. Afectó en especial a mujeres < 20 años y ≥ 35 años. Anemia is very frequent condition in pregnant women and it has repercussions for both mother and child. Determine the frequency and severity of third trimester gestational anemia (hemoglobinemia < 11 g/dL) according to maternal age, in women whose child was born at the Hospital Vicente Corral, between September 2016 and February 2017. Transversal study. Sample: 428 pregnant women. Inclusion criteria: pregnancy of ≥ 27 weeks, hemoglobin report and live neonate. Exclusion criteria: twin newborns, neonate with major congenital malformations, mother with chronic diseases. Statistical analysis: in the quantitative variables, median, minimum and maximum values were calculated; in qualitative variables, absolute and relative frequencies were obtained; to demonstrate association Chi square was used and for statistical significance p-valor < 0.05. Median for maternal age: 23 years 4 months. Hemoglobin: in anemic women 9.9 g/dl, in non-anemic 12.2 g/dl (p = 0.000). Anemia frequency: overall 31.8%, in < 20 years 41.5%, in women 20-34 years 26.5% and in > 35 years 35.6%. Severity of anemia: mild 18.7%, moderate 12.6, severe 0.5%. Maternal age influenced the frequency of anemia (Pearson’s Chi square = 8.911, p-value = 0.012), but not in its severity (Pearson’s Chi square = 1.078, p-value = 0.898). Microcytosis frequency was 36.9% in anemic women. The mean corpuscular volume was associated with the severity of the anemia (p-value = 0.019). The frequency of anemia in the third trimester of pregnancy was high, the mild anemia was predominant. It mainly affected women < 20 and > 35 years old.