Introduction: Self-monitoring blood glucose (SMBG) has been considered a key element in the management of Type 2 Diabetes Mellitus (T2DM). However, its role in glycemic control in non-insulin users has been long discussed.Objective: To conduct a narrative literature review of the benefits of SMBG in non-insulin-treated patients with T2DM.Materials and Methods: A scientific literature search was conducted in the following databases: Pubmed, ScienceDirect, Embase, SciELO, Cochrane and Medline. Relevant articles were selected according to the established criteria. In addition, some studies included in the references of the initially selected articles were added to the review since they were considered relevant for its objective.Results: The following records were included in the review: 14 controlled clinical trials, 13 observational studies, 10 clinical practice guidelines, 7 narrative reviews, 5 meta-analyses, and 1 systematic review.Conclusion: based on the evidence found in this review it is possible to say that the use of SMBG in patients with T2DM is beneficial and that it has a positive impact on non-insulin users in terms of achieving glycemic control and defining therapeutic changes.
ResumenLa acidosis tubular renal distal es causada por un defecto en la excreción de iones de hidrogeno a nivel tubular distal, lo que aumenta el pH de la orina y disminuye el pH plasmático; esta es una enfermedad con varias manifestaciones clínicas asociadas. En este artículo se hace una revisión profunda sobre la acidosis tubular renal distal y se presenta el caso de tres hermanos (dos hombres y una mujer) con la entidad, siendo este uno de los primeros casos familiares reportados en Colombia. Los tres pacientes recibieron el diagnóstico durante el período de lactancia, presentaron nefrocalcinosis y tuvieron buena respuesta a la terapia con álcali iniciada de forma temprana, logrando eventualmente su suspensión. De manera curiosa, uno de los pacientes también presentó deficiencia de mevalonato quinasa con hiperinmunoglobulinemia D, una alteración no descrita con anterioridad. Esta asociación y la aparente falta de necesidad de continuar el manejo con álcali son atípicas a la luz del conocimiento actual, mereciendo especial consideración.
Background Rockall score is the most widely used prognostic scale for assessing risk of complications from non-varicose upper gastrointestinal bleeding (UGIB). Several studies have been conducted in adult populations with non-varicose UGIB in different parts of the world, with conflicting findings regarding the extent of association between the score and some morbidity and mortality outcomes. Also, there is controversy regarding the best cut-off point for the score. Moreover, no studies validating this score in Colombia have been carried out. Objective To assess the diagnostic performance of the Rockall score in predicting rebleeding and mortality in patients with non-varicose UGIB. Methods A prospective cohort study was conducted in patients requiring upper gastrointestinal endoscopy (UGIE) for non-varicose bleeding. The pre-and post-endoscopy Rockall scores were calculated and outcomes, including mortality, UGIB-associated mortality and in hospital rebleeding were determined at the 1 and 3-month time points. The association between the scores and these outcomes was assessed using the chi2 or the Fisher test, whereas the discrimination ability of the score was determined using the areas under the ROC curve (AUC). High discrimination ability was considered to exist in cases in which an AUC ≤0.7 with α=0.05 could be rejected. Results Overall, 177 patients were analyzed. In-hospital outcomes at 1 and 3 months were 12%, 17% and 23% for general mortality, 6%, 12% and 15% for UGIB mortality, and 19%, 30% and 37% for rebleeding. The post-endoscopy Rockall score was associated with the three outcomes at the three time points assessed, while the pre-endoscopy score was only associated with general mortality at the three time points, and rebleeding at 1 and 3 months. Regarding discrimination ability, although the AUC was greater than expected by randomness (0.5) in all cases, only one AUC ≤0.7 was rejected in the post-endoscopy score for in-hospital UGIB mortality (AUC=0.901; 95%CI: 0.845—0.958), at 1 month (AUC=0.836; 95%CI: 0.717—0.954) and at 3 months (AUC=0.869; 95%CI: 0.771—0.967), and for rebleeding at 1 month (AUC=0.793; 95%CI: 0.725—0.861) and at 3 months (AUC=0.806; 95%CI: 0.741—0.871). Conclusion An association was found between the Rockall score and rebleeding and mortality in patients with non-varicose UGIB. Only the post-endoscopy score had a high predictive ability for rebleeding and UGIB mortality.
Introduction: Buerger’s disease (BD) generally affects men, young people, and smokers, but it can also affect women. Its incidence is rare in Latin America. Case report: A 40-year-old Colombian woman, active smoker and user of psychoactive substances, attended the emergency department of a tertiary care center due to symptoms of 3 days consisting of retraction of the corner of the mouth, drooling, and involuntary tongue movements. The patient, who had a history of uncontrolled diabetes and recent acute ischemia of the right upper limb due to acute thrombosis, required surgical management and subsequent use of oral anticoagulation. She later developed necrotic changes in the distal phalanges of the right hand that required ablative therapy. Since age, sex and limb involvement were not typical for BD, collagenosis, vasculitis or thrombophilia were ruled out, but after excluding these disorders, BD with atypical features was considered. The patient was discharged with oral anticoagulation, aspirin, combined analgesia, physiotherapy, and recommendation for smoking cessation. Conclusions: Age, sex, smoking and comorbidities such as diabetes are risk factors for BD. Imaging and histopathology are the gold standard for the definitive diagnosis of this entity. Multidisciplinary management, lifestyle changes, smoking cessation, pain control, good wound healing and social support are key aspects for better clinical outcomes in patients with BD.
La diabetes mellitus gestacional (DMG) es un estado de intolerancia a los carbohidratos que se reconoce por primera vez durante la gestación. Los criterios iniciales para su diagnóstico fueron establecidos hace más de 50 años por O’Sullivan & Mahan, desde entonces se les han hecho modificaciones. En la actualidad, para el diagnóstico se tienen en cuenta dos métodos: el enfoque de un paso, consistente en una prueba de tolerancia oral a la glucosa (PTOG) de 2 horas con 75g de glucosa, y el enfoque de dos pasos, que se compone por una prueba de tamizaje inicial con 50g de glucosa y una PTOG con 100g de glucosa si el tamizaje fue positivo. Ambos enfoques diagnósticos han sido justificados por consensos de expertos, sin embargo aún no se ha establecido un concepto absoluto sobre qué método aplicar; para la elección del método, el clínico debe tener en cuenta diversos factores. Este artículo propone hacer una descripción histórica y exponer el estado actual del diagnóstico de la DMG.
El espectro de enfermedades asociadas con la deficiencia de la vitamina B 12 es amplio y abarca desde la ausencia de síntomas hasta el síndrome de malabsorción, insuficiencia medular, o síntomas neurológicos acompañados de parestesias, mielopatía o neuropatía. Existe evidencia sugestiva que indica que el empleo de inhibidores de bomba de protones (IBP) a largo plazo puede disminuir los niveles séricos de vitamina B12. Igualmente, estudios previos han asociado el déficit de vitamina B 12 a consumo en dosis altas de metformina, sin embargo, el mecanismo por el cual se genera la descompensación no está claro. Se ha llegado a describir una asociación aditiva de la administración de inhibidores bomba de protones/ Antagonistas receptor Histamina - 2 y metformina, sugiriendo que promueven la malabsorción de Vitamina B 12. Ambas categorías de medicamentos son ampliamente utilizadas, y en muchos casos sin prescripción médica, y su uso no debería ser pasado por alto. Cuando están clínicamente indicados, su uso debería ser monitorizado debido a la posibilidad de malabsorción de vitamina B 12 y sus consecuencias. Por tanto, en este artículo se revisan aspectos generales sobre la vitamina B12 y el estado del arte sobre la deficiencia de vitamina B12 en pacientes con consumo de metformina o uso de inhibidor de bomba de protones.
Introducción: la epidemiología de la disfagia está pobremente definida. Es un síntoma que se asocia con el envejecimiento, y en poblaciones jóvenes sigue siendo tema de incertidumbre. También es un problema que no siempre informan los pacientes y es poco comprendido en la población general. Objetivo: describir las características clínicas y epidemiológicas de la disfagia a partir de una muestra de pacientes adultos remitidos a un centro especializado en gastroenterología. Metodología: estudio observacional, descriptivo y retrospectivo, realizado en un centro especializado en gastroenterología en Bogotá D. C. durante 2016, en el cual se revisaron 3148 historias clínicas y se recopilaron aquellas de pacientes cuyo motivo de consulta fuera disfagia o la refirieran como síntoma asociado, y cuyo diagnóstico se confirmara con pruebas complementarias. Resultados: de 3148 historias clínicas, 85 (2,7 %) presentaron disfagia como motivo de consulta principal o síntoma asociado. La mayoría correspondió a mujeres (70,5 %). El grupo de edad más afectado fue entre 70 y 79 años. La enfermedad por reflujo gastroesofágico (ERGE) representó el diagnóstico más frecuente. Conclusión: la prevalencia de disfagia encontrada es similar a la reportada en la literatura. La ERGE es causa frecuente de disfagia. La disfagia continúa siendo un problema predominantemente de adultos mayores.
Background. Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality due to misdiagnosis and inappropriate treatment approaches. Objective. To assess the performance of the CORB score in subjects with CAP for predicting in-hospital mortality, death within 30 days of admission, and requirement for invasive mechanical ventilation (IMV) and vasopressor support. Methods. A retrospective, cohort study with diagnostic test analysis of CORB and CURB-65 scores in subjects with CAP according to ATS criteria was undertaken. An alternative CORB score was estimated by replacing SpO2 ≤90% by the SpO2/FiO2 ratio. Crude and adjusted odd ratios (AOR) were calculated for each variable. The area under the receiver operating characteristics curve (AUROC) was constructed for each score, and outcomes were analyzed. AUROCs were compared with the DeLong test, considering a p value < 0,05 statistically significant. Results. From 1,811 subjects who entered the analysis, 15.1% (273/1,811) died in hospital, 8.78% required IMV (159/1,811), and 9.77% (177/1,811) needed vasopressor support. CORB had an AUROC of 0,660 (95% CI: 0,623–0,697) for in-hospital mortality; an AUROC of 0,657 (95% CI: 0,621–0,692) for 30-day mortality; an AUROC of 0,637 (CI 95%: 0,589–0,685) for IMV requirement; and an AUROC of 0,635 (95% CI: 0,589–0,681) for vasopressor support. CORB performance increases when the SpO2/FiO2 ratio <300 is used as oxygenation criterion in the prediction of requirement for IMV and vasopressor support, with AUROC of 0,700 (95% CI: 0,654–0,746; p < 0.001 ) and AUROC of 0,702 (95% CI: 0,66–0,745; p < 0.001 ), respectively. CURB-65 score presents an in-hospital mortality AUROC of 0,727 (95% CI: 0,695–0,759) and 30-day mortality AUROC of 0,726 (95% CI: 0,695–0,756). Conclusions. CORB score has a good performance in predicting the need for IMV and vasopressor support in CAP patients. This performance improves when the SpO2/FiO2 ratio <300 is used instead of the SpO2 ≤90% as the oxygenation parameter. CURB-65 score is superior in the prediction of mortality.
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