El objetivo principal fue evaluar el uso de recursos y costes de los pacientes con diabetes mellitus tipo 2 que inician tratamiento con insulina o análogos del receptor de GLP-1 (AR GLP-1) inyectables en un ámbito poblacional español. Por otro lado, se determinó la adherencia y persistencia al tratamiento en ambos grupos de tratamiento.Diseño observacional, no-intervencionista, de carácter retrospectivo. Se incluyeron pacientes ≥ 20 años que iniciaron tratamiento con insulina o AR GLP-1 durante 2010-2012. Se determinó el consumo de recursos sanitarios relacionados con la actividad asistencial (visitas médicas, días de hospitalización, visitas a urgencias, solicitudes diagnósticas o terapéuticas, medicación) para evaluar el coste sanitario en estos 2 grupos de pacientes. Se recogió información clínica como índice de masa corporal (kg/m2) control metabólico (HbA1c), adherencia, persistencia y complicaciones (hipoglucemias y eventos cardiovasculares). El seguimiento se realizó durante 12 meses. Solo se tuvo en cuenta los costes sanitarios directos.Se reclutaron 1.301 pacientes, con una edad media de 67,6 años, el 51,6% varones. El 71,9% en tratamiento con insulina y el 28,1% con AR GLP-1. Al año de seguimiento los pacientes tratados con AR GLP-1 tuvieron menos consultas a atención primaria (8 vs 11; p < 0,001), a especializada (1,0 vs 1,8; p < 0,001), hospitalizaciones (0,3 vs 0,7; p = 0,030) y visitas a urgencias (0,8 vs 1,6; p < 0,001). Los pacientes tratados con GLP-1 mostraron una mayor adherencia (88,1% vs 82,7%; p < 0,001), persistencia (62,0% vs 55,9%; p = 0,046) y menor proporción de hipoglucemias (13,4% vs 18,7%; p = 0,022) con similar control metabólico (HbA1c: 7,2% vs 7,4%; p = 0,049), índice de masa corporal (29,1 vs 30,9 kg/m2) y tasa de eventos cardiovasculares (9,1% vs 11,5%; p = 0,330), respectivamente. El promedio/unitario de los costes sanitarios directos corregidos fue de 1.787 € vs 2.005 €; p = 0,046.Los pacientes en tratamiento con AR GLP-1 ocasionaron menores costes sanitarios directos para el Sistema Nacional de Salud que los pacientes en tratamiento con insulinas. Los resultados obtenidos podrían explicarse por una mayor adherencia al tratamiento y menores tasas de hipoglucemias en los pacientes tratados con AR GLP-1. Se necesitan más estudios para poder confirmar estas posibles razones.The main objective was to assess resource use and costs of starting treatment with insulin or injectable GLP-1 receptor analogues (GLP-1 RAs) in a Spanish population of patients with type 2 diabetes mellitus. Treatment adherence and persistence were also determined for both treatment groups.A retrospective, non-interventional, observational study was conducted. Patients aged ≥ 20 years who started treatment with insulin or GLP-1 RAs in the 2010-2012 period were recruited. Use of healthcare resources was estimated to evaluate healthcare costs in these two groups of patients (medical visits, hospital stay, emergency visits, diagnostic or treatment requests, medication). Clinical information including body mass index (BMI, kg/m2), metabolic control (HbA1c), adherence, persistence, and complications (hypoglycemia, and cardiovascular events (CVE) was collected. The follow-up period was 12 months. Only direct healthcare costs were considered.A total of 1301 patients with a mean age of 67.6 years (51.6% males) were recruited. Of these, 71.9% and 28.1% were on treatment with insulin and GLP-1 RA respectively. After one year of follow-up, patients treated with GLP-1 RAs were found less visits to primary care (8 vs. 11; P < .001) and specialized care (1.0 vs. 1.8; P < .001), hospital stays (0.3 vs. 0.7; P = .030) and less visits to the emergency room (0.8 vs. 1.6; P < .001). Patients treated with GLP-1 showed greater adherence (88.1% vs. 82.7%; P < .001) and persistence (62.0% vs. 55.9%; P = .046), and had less hypoglycemia episodes (13.4% vs. 18.7%; P = .022), with similar metabolic control (HbA1c: 7.2% vs. 7.4%; P = .049), BMI (29.1 vs. 30.9 kg/m2), and CVE rate (9.1% vs. 11.5%; P = .330) respectively. The mean corrected direct healthcare cost per patient was €1787 vs. €2005 (P = .046.)Patients treated with GLP-1 RAs caused lower direct healthcare costs for the National Health System than patients treated with insulin. The results may be explained by greater treatment adherence and lower hypoglycemia rates in patients treated with GLP-1 RAs. Additional studies are needed to confirm these possibilities.
Obstructive sleep apnea (OSA) has been historically underdiagnosed and may be associated with grave perioperative complications. The ASA and American Academy of Sleep Medicine recommend OSA screening prior to surgery; however, only a minority of patients are screened. The objective of this study was to determine the proficiency of anesthesiologists, otolaryngologists, and internists at predicting the presence of OSA by visual photographic analysis without the use of a computer program to assist, and determine if prediction accuracy varies by provider type.Prospective case seriesTertiary care hospital–based academic centerFifty-six consecutive patients presenting to the sleep laboratory undergoing polysomnography had frontal and lateral photographs of the face and torso taken.Not applicable.Polysomnography outcomes and physician ratings. An obstructive apnea hypopnea index (oAHI) ≥ 15 was considered “positive.” Twenty anesthesiologists, 10 otolaryngologists, and 11 internists viewed patient photographs and scored them as OSA “positive” or “negative” before and after being informed of patient comorbidities.Nineteen patients had an oAHI < 15, 18 were ≥ 15 but < 30, and 19 were ≥ 30. The mean oAHI was 28.7 ± 26.7 events/h (range, 0-125.7), and the mean body mass index was 34.1 ± 9.7 kg/m2 (range, 17.4-63.7). Overall, providers predicted the correct answer with 61.8% accuracy without knowledge of comorbidities and 62.6% with knowledge (P < .0001). There was no difference between provider groups (P = .307). Prediction accuracy was unrelated to patient age (P = .067), gender (P = .306), or race (P = .087), but was related to body mass index (P = .0002).The ability to predict OSA based on visual inspection of frontal and lateral photographs is marginally superior to chance and did not differ by provider type. Knowledge of comorbidities did not improve prediction accuracy.
Conocer el flujo de atención entre la atención primaria y la atención especializada (AE), así como los criterios usados para la derivación y posterior seguimiento, en relación con el paciente con hipertensión arterial (HTA) y diabetes mellitus tipo 2 (DM2). Estudio descriptivo, transversal y multicéntrico. Se realizó un muestreo probabilístico, de conveniencia y estratificado por número de médicos en cada CCAA. Participaron 999 médicos, 78,1% (n = 780) especialistas en atención primaria (EAP), 11,9% (n = 119) especialistas en hipertensión y 10,0% (n = 100) especialistas en diabetes. Se emplearon 2 formularios de recogida de datos, autoadministrados vía online. El 63,7% y el 55,5% de los EAP y el 79,8% y el 45,0% de la AE declararon la falta de un protocolo de coordinación entre los niveles para el manejo del paciente con HTA y DM2, respectivamente. El método de comunicación más frecuentemente usado entre los niveles asistenciales fue la hoja de derivación (94,6% en EAP y 92,4% en AE). Los principales criterios de derivación al médico de AE del paciente con HTA fueron la hipertensión resistente (80,9%) y la sospecha de hipertensión secundaria (75,6%), siendo la sospecha de DM específica (71,9%) y el embarazo (71,7%) en el paciente con DM2. Aunque se observaron coincidencias en algunos aspectos de la práctica clínica habitual entre ambos niveles asistenciales, las discrepancias evidenciadas mostraron una escasa coordinación entre EAP y AE. To determine the flow of care for patients with type 2 diabetes mellitus (T2DM) and hypertension between primary care (PC) and specialized care (SC) in clinical practice, and the criteria used for referral and follow-up within the Spanish National Health System (NHS). A descriptive, cross-sectional, multicenter study. A probability convenience sampling stratified by number of physicians participating in each Spanish autonomous community was performed. Nine hundred and ninety-nine physicians were surveyed, of whom 78.1% (n = 780) were primary care physicians (PCPs), while 11.9% (n = 119) and 10.0% (n = 100) respectively were specialists in hypertension and diabetes. was conducted using two self administered online surveys. A majority of PCPs (63.7% and 55.5%) and specialists (79.8% and 45.0%) reported the lack of a protocol to coordinate the primary and specialized settings for both hypertension and T2DM respectively. The most widely used method for communication between specialists was the referral sheet (94.6% in PC and 92.4% in SC). The main reasons for referral to a specialist were refractory hypertension (80.9%) and suspected secondary hypertension (75.6%) in hypertensive patients, and suspicion of a specific diabetes (71.9%) and pregnancy (71.7%) in T2DM patients. Although results showed some common characteristics between PCPs and specialists in disease management procedures, the main finding was a poor coordination between PC and SC.
Hypertriglyceridemia induces acute recurrent pancreatitis, but its role in the etiology of chronic pancreatitis (CP) is controversial. This study aimed to evaluate the clinical, laboratory and radiological findings of 7 patients with CP due to type 1 hyperlipidemia compared to CP patients with other or undefined etiological factors.We retrospectively analyzed the clinical, laboratory and radiological findings of 7 CP patients with type 1 hyperlipidemia compared to CP patients without hypertriglyceridemia. These 7 patients had multiple episodes of acute pancreatitis and had features of CP on abdominal CT, endoscopic retrograde cholangiopancreatography and/or endoscopic ultrasonography.All CP patients were classified into two groups: a group with type 1 hyperlipidemia (n=7) and a group with other etiologies (n=58). The mean triglyceride level was 2323±894 mg/dL in the first group. Age at the diagnosis of CP in the first group was significantly younger than that in the second group (16.5±5.9 vs 48.3±13.5, P<0.001). The number of episodes of acute pancreatitis in the first group was significantly higher than that in the second group (15.0±6.8 vs 4.0±4.6, P=0.011). The number of splenic vein thrombosis in the first group was significantly higher than that in the second group (4/7 vs 9/58, P=0.025). Logistic regression analysis found that younger age was an independent predictor of CP due to hypertriglyceridemia (r=0.418, P=0.000).Type 1 hyperlipidemia appears to be an etiological factor even for a minority of patients with CP. It manifests at a younger age, and the course of the disease might be severe.
La hipercaliemia (HK) es un hallazgo frecuente en la enfermedad renal crónica (ERC), sobre todo en sus estadios más avanzados. El mecanismo patogénico más común de esta alteración es la ingesta-absorción de potasio que sobrepasa la capacidad excretora renal. La investigación sobre el papel relativo de cada uno de los elementos patogénicos en el desarrollo de HK podría ayudar a su tratamiento.Analizar el manejo renal de potasio en pacientes con ERC avanzada prediálisis, y establecer qué diferencias existen entre los que presentan o no HK.Estudio transversal de observación en pacientes adultos con ERC estadio 4-5 prediálisis. Entre los pacientes incidentes en la consulta ERCA se seleccionaron aquellos clínicamente estables con capacidad para recoger adecuadamente la orina de 24 horas. Se midieron parámetros bioquímicos en sangre y orina que incluyeron las concentraciones de sodio y potasio (K). Se calculó la fracción de excreción de K (FEK) y la carga de K relativa al filtrado glomerular (Ko/FG). Se definió la HK como una concentración de K sérico ≥ 5,5 mmol/l.Se incluyeron 212 pacientes (edad 65 ± 14 años, 92 mujeres) con un FG 15,0 ± 4,2 ml/min/1,73 m2. Sesenta y tres pacientes (30%) presentaban HK. Los pacientes con HK tenían un bicarbonato sérico más bajo (20,3 ± 3,1 vs. 22,8 ± 3,2 mEq/l, p < 0,0001), y un menor filtrado glomerular (14,1 ± 3,3 vs. 15,4 ± 4,4 ml/min/1,73 m2, p = 0,028), pero no mostraban diferencias en la excreción urinaria total de sodio o K. La FEK era inferior en los pacientes con HK con respecto a los que presentaban normocaliemia (32,1 ± 12,1% vs. 36,4 ± 14,3%, p = 0,038), mientras que la Ko/FG fue mayor (4,2 ± 1,5 vs. 3,7 ± 1,4 mmol por cada ml/min, p = 0,049). Existía una fuerte correlación lineal entre Ko/FG y FEK (R2 = 0,74), y en regresiones parciales se observó que a igual carga de K, la FEK era inferior en los pacientes con HK. Mediante regresión lineal y regresión logística multivariable, tanto la FEK como la Ko/FG fueron los principales determinantes del K sérico y de la HK.Aunque la carga de K relativa a la función renal (Ko/FG) se asocia de forma relevante a la HK de la ERC, la principal característica asociada a esta alteración bioquímica es la incompleta excreción renal compensatoria de K, expresada como una menor FEK.Hyperkalemia (HK) is a common electrolyte disorder in chronic kidney disease (CKD), mainly in the advanced stages. A positive potassium balance due to reduced renal excretory capacity is likely the main pathogenic mechanism of HK. Research into the relative role of each pathogenic element in the development of HK in CKD may help to implement more suitable therapies.To investigate renal potassium handling in advanced CKD patients, and to determine the differences between patients with or without HK.Cross-sectional observational study in adult patients with stage 4-5 CKD pre-dialysis. Selection criteria included clinically stable patients and the ability to collect a 24 hour urine sample correctly. Blood and urinary biochemical parameters were analysed including sodium and potassium (K). Fractional excretion of K (FEK) and K load relative to glomerular filtration (Ku/GFR) were calculated. HK was defined as a serum K concentration ≥ 5.5 mmol/l.The study group consisted of 212 patients (mean age 65 ± 14 years, 92 females) with a mean GFR of 15.0 ± 4.2 ml/min/1.73 m2. 63 patients (30%) had HK. Patients with HK had lower mean bicarbonate levels with respect to patients with normal K levels (NK) (20.3 ± 3.1 vs. 22.8 ± 3.2 mEq/l, P < .0001), but no differences were noted in total urinary sodium and K excretion. While mean FEK values were lower in patients with HK (32.1 ± 12.1% vs. 36.4 ± 14.3%, P = .038), Ku/GFR values were significantly greater with respect to the NK subgroup (4.2 ± 1.5 vs. 3.7 ± 1.4 mmol/ml/min, P = 0,049). FEK showed a strong linear correlation with Ku/GFR (R2 = 0.74), and partial linear regressions demonstrated that at a similar Ku/GFR level, the FEK of patients with HK was lower than that of NK patients. By multivariate linear and logistic regression analyses, both FEK and Ku/GFR were shown to be the main determinants of K serum levels and HK.Although the K load relative to glomerular filtration (Ku/GFR) is an important determinant of HK in advanced CKD, the most noteworthy characteristic associated with HK in these patients was the limitation of compensatory urinary K excretion, as indicated by lower FEK.
We investigate the bifurcation of artificial halo orbits from the Lyapunov planar family of periodic orbits around the collinear libration points of the circular, spatial, restricted three-body problem. Beside the gravitational forces, our model includes also the effect of the Solar Radiation Pressure (SRP) and this motivates the use of the term ‘artificial’ halo orbits. Indeed, as a typical problem, one may think of a solar sail, which is characterized by a performance parameter measuring the strength of the effect of the SRP on the spacecraft.To settle the model, we determine the position of the collinear points as a function of the mass and performance parameters and the energy values at which Hill׳s surfaces allow for transit orbits between the primaries. To analyze the dynamics we use a consolidated procedure which consists in the computation of a resonant normal form, allowing the reduction to the center manifold and providing an integrable approximation of the Hamiltonian dynamical system. Finally, we compute the bifurcation thresholds of the 1:1 resonant periodic orbit families (which have the standard ‘halo’ orbits as their first member) as a function of the performance and mass parameters.The results show that SRP is indeed a relevant ingredient for new dynamical features and must definitely be considered when planning a mission of a solar sail with trajectories in the neighborhoods of collinear points.
The design of carriers for insulin delivery has recently attracted major research attentions in the biomedical field. In general, the release of drug from polymers is driven via a variety of polymers. Several mechanisms such as matrix release, leaching of drug, swelling, and diffusion are usually adopted for the release of drug through polymers. Insulin is one of the most predominant therapeutic drugs for the treatment of both diabetes mellitus; type-I (insulin-dependent) and type II (insulin-independent). Currently, insulin is administered subcutaneously, which makes the patient feel discomfort, pain, hyperinsulinemia, allergic responses, lipodystrophy surrounding the injection area, and occurrence of miscarried glycemic control. Therefore, significant research interest has been focused on designing and developing new insulin delivery technologies to control blood glucose levels and time, which can enhance the patient compliance simultaneously through alternative routes as non-invasive insulin delivery. The aim of this review is to emphasize various non-invasive insulin delivery mechanisms including oral, transdermal, rectal, vaginal, ocular, and nasal. In addition, this review highlights different smart stimuli-responsive insulin delivery systems including glucose, pH, enzymes, near-infrared, ultrasound, magnetic and electric fields, and the application of various polymers as insulin carriers. Finally, the advantages, limitations, and the effect of each non-invasive route on insulin delivery are discussed in detail.
Se revisa el concepto de prebióticos, probióticos y simbióticos y su empleo en diferentes situaciones de la práctica clínica diaria relacionados con la nutrición clínica. Se analiza su papel en el tratamiento y/o prevención de la diarrea (aguda, por antibióticos, rádica), en la enfermedad inflamatoria intestinal (colitis ulcerosa y reservoritis), sobre la salud colónica (estreñimiento, intestino irritable), hepatopatías (esteatosis y encefalopatía mínima), en pacientes de cuidados intensivos, quirúrgicos y sometidos a trasplante hepático. Si bien parece demostrada su eficacia en la prevención de la diarrea por antibióticos y en la reservoritis en la colitis ulcerosa, son necesarios más estudios para poder establecer recomendaciones en la mayoría de escenarios clínicos. El riesgo de infección asociado al uso de probióticos es relativamente bajo; no obstante, existen grupos seleccionados de pacientes en los que se recomienda emplearos con cautela (como la infusión a nivel yeyunal).
To compare the effect of different hypoglycemic drugs on laboratory and ultrasonographic markers of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes not controlled on metformin alone.Prospective study of diabetic patients treated with metformin in combination with gliclazide, pioglitazone, sitagliptin, exenatide, or liraglutide. NAFLD was assessed by abdominal ultrasound and NAFLD fibrosis score was calculated at baseline and 6 months.Fifty-eight patients completed 6 months of follow-up: 15 received gliclazide, 13 pioglitazone, 15 sitagliptin, 7 exenatide, and 8 liraglutide. NAFLD affected 57.8% of patients at baseline, and its ultrasonographic course varied depending on changes in weight (P=.009) and waist circumference (P=.012). The proportions of patients who experienced ultrasonographic improvement in the different treatment groups were: 33.3% with gliclazide, 37.5% with pioglitazone, 45.5% with sitagliptin, 80% with exenatide, and 33% with liraglutide (P=.28).Qualitative ultrasonographic NAFLD improvement in diabetic patients treated with metformin in combination with other hypoglycemic drugs is associated to change over time in weight and waist circumference. Long-term clinical trials are needed to assess whether incretin therapies result in better liver outcomes than other hypoglycemic therapies.
Management of diabetic nephropathy includes reduction of albuminuria, blood pressure and weight. The GLP-1 receptor agonist liraglutide may possess these pleiotropic effects in addition to the glucose lowering effect. We aimed to elucidate the individual liraglutide treatment response by determining if high responders (highest reduction) in each risk factor also had high response in other renal risk factors (cross-dependency).Open-label study: 31 type 2 diabetics treated with liraglutide for 7 weeks. After 3 weeks washout 23 re-started treatment and were followed for 1 year.HbA1c, weight, systolic blood pressure (SBP), urinary albumin excretion rate (UAER) and mGFR (51Cr-EDTA) were evaluated. Changes in high (Q4) vs. low responders (Q1–Q3) were compared for each renal risk factor. The effects of treatment/off treatment/re-treatment (off–on/off–on effect) were evaluated to account for random effects.After 7 weeks HbA1c was reduced 6(95% CI: 3;9) mmol/mol, weight 2.5(1.8;3.2) kg, SBP 4(− 1;9) mmHg, UAER 30(12;44)% and mGFR 11(7;14) ml/min per 1.73 m2. mGFR high responders had a significant reduction in weight compared to low responders (4.3 vs. 1.9 kg; p = 0.002). SBP high responders had a tendency of a higher reduction in UAER compared to low responders (47 vs. 23%, p = 0.14). No cross-dependency was observed in any of the other renal risk factors (p ≥ 0.16). Treatment response did not differ after 7 weeks and 1 year (p ≥ 0.12).Liraglutide possesses pleiotropic effects on renal risk factors. On patient level, effect on the individual risk factor cannot be anticipated based on response in other risk factors. Response when re-starting treatment did not differ, indicating that our primary findings were not random.
Laboratory tests are crucial for diagnosis and monitoring of thyroid disorders. It is therefore necessary to study the pattern and variability in requests of thyroid function tests. The study objectives were to compare the inter-regional variability in the request of laboratory thyroid tests by general practitioners (GPs) in Spain, and to investigate the potential economic savings if the goals set for some suitability indicators were reached.Test requests per 1,000 inhabitants and test ratios (free thyroxine (FT4)/thyrotropin (TSH), free triiodothyronine (FT3)/TSH, thyroglobulin antibody (TgAb)/peroxidase antibody (TPOAb)) were compared between the different areas, according to their setting, location, and management. The resulting savings if each department achieved the goals for indicator (0.25 for FT4/TSH, 0.1 for FT3/TSH) were estimated.Seventy-six laboratories covering a population of 17,679,195 inhabitants participated in the study. TSH was requested significantly less in urban-rural areas, and the requests for FT3/1,000 inhabitants, FT3/TSH, and TgAb/TPOAb were higher in departments with private management. The savings generated if specifications for the ratios of related tests were met would be 937,260.5 €.The high variability reported in requests for thyroid function and autoimmunity tests in Spain suggests the need for implementing strategies to improve use of such tests.
Vascular risk factors such as hyperglycemia and platelet hyperactivation play a significant role in type 2 diabetes (T2D), a risk factor for AD. We investigated the relationships between glycemia levels, platelet indices (platelet count; mean platelet volume (MPV)) and AD neuroimaging markers in 105 cognitively unimpaired adults, including 21 amyloid-negative older adults (Aβ-neg controls), and 45 amyloid-positive patients with mild cognitive impairment or dementia (Aβ-pos patients). We assessed between-group differences on the two T2D-related vascular risk factors, then the association between blood parameters and multimodal neuroimaging (structural MRI, 18F-fluorodeoxyglucose, and 18F-florbetapir-PET) in cognitively unimpaired adults and Aβ-pos patients using multiple regressions. Compared to Aβ-neg controls, Aβ-pos patients showed lower platelet count and higher MPV. In cognitively unimpaired adults, increased glycemia levels were associated with atrophy and hypometabolism in AD-sensitive regions. In Aβ-pos patients, increased MPV was associated with entorhinal and perirhinal cortex atrophy. Subclinical but high glycemia levels in healthy individuals and MPV in AD patients are associated with neurodegeneration in AD-sensitive brain regions but not with amyloid deposition.
The 3PAs association describes the coexistence of pituitary adenoma, pheochromocytoma (PHEO), and paraganglioma (PGL). There are 90 3PAs cases reported in the literature (with and without genetic mutations/variants) since 1952. Most cases carry SDHx defects, whereas MEN1 and MAX are the second and third most common genes involved. Overall, pituitary adenomas in 3PAs with genetic defects are significantly more common among familial cases, more frequently macroadenomas secreting PRL or growth hormone; they often lead to multiple phenotypes within the same family and require multiple treatment modalities. A distinctive pathologic feature of SDHx-mutated pituitary adenomas is an extensive vacuolization of the cytoplasm. Utilizing the Sdhb+/− mouse model, we found increased HIF-1 expression in adenohypophyseal cells and mitochondrial and nuclear abnormalities. Patients presenting with 3PAs should be initially screened for SDHx mutations, particularly if there is a history of PHEOs/PGLs in other family members. If family history is negative, screening for SDHx, MEN1, and MAX mutations may be considered.
Describir los costos y el impacto económico de la atención de pacientes diagnosticados con hipercolesterolemia en México en el año 2016.Se desarrolla una evaluación económica del tipo análisis de costo de la enfermedad donde se cuantifican los recursos médicos utilizados para el tratamiento de la hipercolesterolemia así como para sus complicaciones. Los costos de los recursos médicos utilizados son obtenidos de los costos unitarios por nivel de atención del Instituto Mexicano del Seguro Social (IMSS) así como de las licitaciones publicadas en el portal de compras del IMSS. El uso de recursos se obtiene mediante un panel de expertos y para el porcentaje de presencia de las complicaciones se efectúa una revisión de literatura. Los costos médicos directos son estimados multiplicando la frecuencia de uso por el costo unitario, agrupándolos y obteniendo así los costos individuales de cada recurso médico.Los casos de hipercolesterolemia en prevención secundaria con enfermedad coronaria y enfermedad cardiovascular representan un mayor costo promedio anual ($111,835.19, D.E. $84,276.37), seguido de la hipercolesterolemia en prevención secundaria con enfermedad coronaria sin enfermedad cardiovascular ($56,352.13, D.E. $29,004.04), los cuales no incluyen los costos generados por las complicaciones. El resto de los grupos de hipercolesterolemia representan una carga económica menor.La carga económica de la hipercolesterolemia representa en promedio por caso al año $258,761.37, esto traducido a los aproximadamente 445,075 de casos diagnosticados y tratados al año representaría un impacto económico en el sistema de salud de más de ciento quince mil millones ($115,168,331,355.11).
Type 2 diabetes mellitus (T2DM) is a chronic, highly prevalent disease that increases with age. Because of this, and due to its chronic complications, T2DM causes high human, social, and financial costs. In addition, the elderly population with T2DM has a marked clinical heterogeneity. Therefore, our main objective was to analyze the relationship of age with the clinical and biological manifestations of the disease and the prevalence of chronic complications in patients with T2DM.
SummaryPaget's disease of bone is characterised by focal areas of increased bone turnover affecting one or several bones throughout the skeleton. Where indicated, pharmacological management is primarily based on the use of anti-resorptive drugs. In this respect, bisphosphonates are the drugs of choice. However, they are contraindicated in patients with advanced renal dysfunction. Here, we report the efficacy and safety of one denosumab injection (60mg) in a patient with Paget's disease of bone and impaired renal function, who benefited from this treatment but developed a severe hypocalcemia.RésuméLa maladie de Paget est une maladie osseuse localisée qui se caractérise par un remodelage osseux excessif d'un ou plusieurs os. Lorsque qu'une prise en charge pharmacologique est indiquée, elle repose principalement sur la prescription d'agents anti-résorptifs. Les bisphosphonates sont le traitement de premier choix mais une insuffisance rénale sévère contre-indique leur utilisation. Nous rapportons l'efficacité et la tolérance d'une injection de dénosumab (60mg) chez un patient insuffisant rénal avec une maladie osseuse de Paget, ayant été bien amélioré par le traitement mais au prix d'une hypocalcémie sévère.
La diabetes mellitus tipo 2 es una patología con una enorme prevalencia y morbilidad, que van en aumento. La fractura osteoporótica se encuentra entre las denominadas complicaciones «no clásicas» de la diabetes y ha sido durante tiempo ignorada, tal vez por su complejo abordaje tanto diagnóstico como terapéutico. Las herramientas habituales para la prevención de la fractura por fragilidad, como el FRAX y la densitometría ósea, no han demostrado la suficiente eficacia en estos pacientes, ya que infraestiman el riesgo. Nuevas técnicas de evaluación ósea, como el trabecular bone score o los marcadores de remodelado óseo, podrían ser de utilidad, aunque requieren una mayor evidencia científica para recomendar su uso en la práctica clínica habitual. Las características especiales de su fisiopatología condicionan la aparición de fracturas sin existir alteraciones densitométricas, en lo que podemos calificar de «paradoja diabética».
The aim of this study was to detect people at risk of suffering diabetes or changes in carbohydrate metabolism and to refer them for possible diagnosis to health care centers. The number of diagnoses and costs for the pharmacy were recorded. A cross-sectional, observational study was conducted in community pharmacies in Pontevedra in September–October of 2014. The Findrisc questionnaire was completed by pharmacy users over 18 years old. If Findrisc score was ≥15, capillary blood glucose was measured, and the participant was referred to a physician if the value was ≥110 mg/dL. The main variables included score in the Findrisc questionnaire, number of diabetes diagnosed, and cost of the service. Differences between the groups were calculated using a Chi-squared test, a Student's t test, and/or a Wilcoxon test. This study was conducted in 180 pharmacies on a sample of 4222 users, including 992 (23.5%) with a high or very high risk of diabetes (F ≥ 15). In the 1060 basal capillary blood glucose tests performed, mean glucose level was 110.2 (SD = 20.4) mg/dL (56–254). The Galician Health Service sent information about 83 of the 384 (9.1%) subjects referred to a physician: 28 (33.7%) of them were diagnosed with diabetes (3.1% of the sample), and 26 (31.3%) were diagnosed with prediabetes (2.8% of the sample). Cost per diagnosed subject was €184.22 per subject with diabetes and €96.86 per subject with prediabetes. The proportion of subjects with new diagnosis of diabetes (3.1%) shows the high efficiency of a screening program for hidden diabetics implemented at community pharmacies as the one presented here. Pilotar una actividad profesional consistente en la detección de personas en riesgo de padecer diabetes o alteraciones del metabolismo de los hidratos de carbono y derivación para posible diagnóstico en los centros de salud. Comprobación del número de diagnósticos y evaluación del coste para la farmacia. Estudio observacional transversal en farmacias comunitarias de Pontevedra en septiembre-octubre de 2014. Cuestionario Findrisc a usuarios de la farmacia con más de 18 años. Con Findrisc ≥ 15 determinación de la glucemia basal capilar y derivación al médico con ≥110 mg/dL. Variables principales: puntos en cuestionario Findrisc, número de diagnósticos de diabetes, coste del servicio. Las diferencias entre grupos se calcularon con el test de chi-cuadrado, t de Student o test de Wilcoxon. El estudio se realizó en 180 farmacias. La muestra incluyó a 4.222 usuarios. De ellos, 992 (23,5%) tenían alto o muy alto riesgo de diabetes (F ≥ 15). Se realizaron 1.060 test de glucemia basal capilar, con un resultado medio de 110,2 (DE = 20,4) mg/dL (56-254). De los 384 (9,1%) sujetos derivados al médico, el Servicio Gallego de Salud envió información de 83: 28 (33,7%) diagnosticados de diabetes (3,1% de la muestra) y 26 (31,3%) de prediabetes (2,8%). El coste por sujeto diagnosticado fue de 184,22 € y por sujeto con diabetes o prediabetes fue de 96,86 €. El número de diagnósticos de nuevos pacientes diabéticos, 3,1% de la muestra total, muestra la alta eficiencia de un programa de cribado para diabéticos ocultos realizado en farmacias comunitarias como el que aquí se presenta.
