Introduction. Insulin allergy is a rare complication of insulin therapy, especially in type 1 diabetes mellitus (T1DM). Key manifestations are hypersensitivity-related symptoms and poor metabolic control. T1DM, as well as insulin allergy, may develop in the context of autoimmune polyendocrine syndrome (APS), further complicating management. Case Report. A 17-year-old male patient, diagnosed with T1DM, was treated with various insulin therapy schemes over several months, which resulted in recurrent anaphylactoid reactions and poor glycemic control, after which he was referred to our Endocrinology and Immunology Department. A prick test was carried out for all commercially available insulin presentations and another insulin scheme was designed but proved unsuccessful. A desensitization protocol was started with Glargine alongside administration of Prednisone, which successfully induced tolerance. Observation of skin lesions typical of vitiligo prompted laboratory workup for other autoimmune disorders, which returned positive for autoimmune gastritis/pernicious anemia. These findings are compatible with APS type 4. Discussion. To our knowledge, this is the first documented case of insulin allergy in type 4 APS, as well as this particular combination in APS. Etiopathogenic components shared by insulin allergy and APS beg for further research in immunogenetics to further comprehend pathophysiologic aspects of these diseases.
Background. Lipoprotein(a) [Lp(a)] is a known risk factor for cardiovascular disease, yet its influence on metabolic syndrome (MS) is still controversial. The purpose of this study was to assess the impact generated by this diagnosis in serum Lp(a) concentrations. Materials and Methods. A total of 1807 subjects of both genders (55.3% women and 44.7% men) belonging to the Maracaibo City Metabolic Syndrome Prevalence Study were evaluated. Results were expressed as Mean ± SD, determining differences through Student's t-test and One-Way ANOVA test. Multiple logistic regression models were utilized for analyzing factors associated with elevated serum Lp(a) levels and MS. Total cholesterol and LDL-C were corrected according to Lp(a)-Cholesterol when necessary. Results. No differences were found in Lp(a) values between genders; P = 0,292. The association between MS and the classification of Lp(a) was statistically significant (χ 2 = 28.33; P < 0,0001), with greater levels in subjects with this diagnosis. In the univariate analysis, subjects with each of the separate diagnostic criteria showed higher serum Lp(a) concentrations, except for hyperglycemia. Conclusions. Lp(a) values exhibit important variations regarding MS and each of its components. Impaired fasting glucose appeared as a protecting factor against elevated Lp(a) concentrations, whereas its association with LDL-C and hs-CRP suggests a potential pro-inflammatory role.
Waste stabilisation ponds are an efficient means of wastewater treatment in many parts of the world wherever suitable land is available at reasonable cost and solar energy is an abundant energy resource. This study evaluated the removal of total coliforms TC, faecal coliforms FC and coliphages C in waste stabilisation ponds functioning as a pilot system in the tropical climate of Maracaibo, Venezuela. Sampling points included raw sewage and each pond effluent. Turbidity, pH and temperature were recorded. The results for raw sewage show average levels of 4.1×106 TC, 2.8×106 FC and 7.0×105 C/100mL. Temperature, pH and turbidity ranges between 26–31°C, 6.2–9.5 and 15–98 NTU respectively. Removal of microorganisms in the three systems ranged between 93–98%. Despite the high removal efficiency of microorganisms, the final effluents showed average counts of 5.4×104−1.4×105 TC, 5.2×104−1.3×105 FC and 1.6×104−4.7×104 C/100mL. This study shows that the microbiological quality of the final effluents did not achieve the WHO water quality requirement for FC (103/100mL); therefore, they cannot be used for irrigation. Additional treatments, such as slow sand filtration, are needed in order to improve the quality of the water.
Introduction In an autonomous region in Spain, the heads of cardiovascular disease from four hospitals, forty-three primary care centres and the ambulance provider, have come together to collectively reduce variability, improve outcomes and patient experience, increase efficiency and focus on population health through prevention. As a result, a cardiovascular network was founded to address the needs of the population through eight projects, each with a group of professionals dedicated to its completion. This region has Beveridge-type universal healthcare and the clinical network must operate under a choice model in which patients can choose where they wish to be treated. This approach has never been carried forward in Spain previously nor, as far as we are aware, in Europe from the bottom-up with clinical leaders achieving buy-in from the political level. Purpose With the well-known demographic challenge putting the system under strain, our hypothesis is that this innovative collaborative approach where by hospitals pool resources and implement collective improvements from the bottom-up will results in better health for its population of over one million people. Methods The Institute for Healthcare Improvement's Assessment Scale for Collaboratives is used to track project progress through the valuation of project leads assigned to each project and the senior project manager. This scale divides progress from: forming team, activity but no changes, modest improvement, significant improvement, and outstanding sustainable results; some are further subdivided as shown in the image. Projects each have their set of indicators to ensure project objectives are achieved. Results The network has 8 working projects which include different specialists, professional groups and organizations including primary care and the main ambulance provider. The four hospitals have pulled together their resources to recruit two project managers. Progress measured with the Assessment Scale for Collaboratives indicates that projects have moved forward 18% in a three month period, reaching an average progress of 35%. Conclusion The closer collaboration across four hospital sites has put this network at the forefront of Spanish health policy by focusing work on diseases rather than by geographical areas. This allows clinical leaders to decide and focus on objectives that most suit the needs of its population whilst building a culture of continuous improvement across multiple care sites and professional groups. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Fundaciόn Interhospitalaria para la Investigaciόn Cardiovascular - Fundaciόn FIC
Shading (S), bioregulators (BR) and biostimulants (BS) techniques are alternatives that promote sprouting and production of grass. The objective was to evaluate the effect of S, BR and BSt on the growth and yield of Mombaza grass in Ecuador. A complete randomized block design, with split plot arrangement and three replications, was used, the main plot represented by condition S (S1: full solar exposure, S2: shade of trees) and secondary one by BR and BS application (A0: control; A1: minimum doses of BR, 250 mL.ha-1 Cytokin + 10 g.ha-1 New Gibb 10 %; A2: maximum doses of BR, 500 mL.ha-1 Cytokin + 20 g.ha-1 New Gibb 10 %; A3: commercial dose of BS Algamar, seaweed, 750 g.ha-1). Three cuts of grass were made, 35 days after staring experiment; in each one, tiller height (TH), number of tillersm-2 (NTM) and stemstiller-1 (NST), and dry matter yield (DMY) were evaluated. It is found effects (P<0.05) of S on the four variables in each cut; and application of BR and BS on TH in cuts 1, period of least precipitation. It is concluded that the grass cultivated in S1 increased the growth and DMY in cuts 1, 2 and 3 (0.180, 0.300 y 0.398 kg.m-2). NTM was stimulated with S2 and TH with the minimum dose of BR.
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