RESUMEN
OBJECTIVE: to evaluate a personalized diet customize for present comorbidity, on metabolic control indicators and renal function. METHODS: a non-randomized clinical trial was conducted during a three-month period in a group of patients with microalbuminuria and in a group with macroalbuminuria. The patients received personalized dietary counseling customize to their comorbidity (obesity, hypertension, and dislypidemia). The effect of the diet was measured through metabolic control variables: body mass index (BMI), waist circumference, fasting glucose levels, glycated hemoglobin (HbA(1))c and lipids profile; the renal function variables were: glomerular filtration rate (GFR) and urine albumin excretion (UAE). Statistical analysis was done with t-paired test. RESULTS: thirty-nine patients were included (21 women and 18 men). After the intervention, the weight and waist circumference had significantly decreased (p = 0.01); the fasting glucose levels and HbA(1)c were significantly lower (p = 0.001). The HDL-cholesterol increased significantly (p = 0.009); UAE decreased significantly in patients with micro and macroalbuminuria; 123.0 +/- 73.4 to 105.3 +/- 61.3 mg/24-h; p = 0.040 and 1482.7 +/- 1200.6 to 1093.5 +/- 601.8 mg/24-h; p = 0.02. The GFR increased in both groups: 68.9 +/- 35.4 to 74.7 +/- 41.6 mL/min, p = 0.04; and 62.2 +/- 26.6 to 68.5 +/- 25.3 mL/min, p = 0.02. CONCLUSIONS: the dietary intervention improved the metabolic control and renal function in type 2 diabetes patients with comorbidity.
Asunto(s)
Albuminuria/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Nefropatías Diabéticas/dietoterapia , Dieta para Diabéticos , Adulto , Anciano , Albuminuria/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/fisiopatología , Ingestión de Energía , Femenino , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/dietoterapia , Hipertensión/dietoterapia , Masculino , Persona de Mediana Edad , Obesidad/dietoterapiaRESUMEN
BACKGROUND: The present study was primarily designed to assess the prevalence of chronic kidney disease in a Mexican urban population residing in Mexico and to evaluate certain biologic and socioeconomic conditions as risk factors for the development of renal disease. METHODS: A population-based cross-sectional survey was conducted, which included 3564 patients of either gender aged >18 years, who were randomly selected from lists of patients assigned to primary care facilities in the city of Morelia. A questionnaire about personal current health status, kidney disease, diabetes, hypertension, or heart disease in close relatives, anthropometric and blood pressure measurements, and blood and urine samples to measure glucose, blood urea nitrogen, and creatinine was obtained for each patient. Creatinine clearance (Ccr) was calculated by the Cockcroft-Gault formula. Patients were classified in 1 of the 5 Ccr categories established by the Kidney Disease Outcomes Quality Initiative guidelines. RESULTS: The prevalence rate of Ccr < 15 mL/min was 1142 per million population, and that of Ccr <60 mL/min 80,788 per million population. Alcohol and tobacco consumption, female gender, age >65 years, educational level < primary school, and income < US $4.00/day were significantly associated with reduced Ccr. CONCLUSION: Chronic kidney disease prevalence in this population is similar to that seen in industrialized countries. If these figures are similar to those of the entire Mexican population, only l out of 4 patients requiring renal replacement therapy in the country currently has access to it.
Asunto(s)
Enfermedades Renales/epidemiología , Adulto , Factores de Edad , Anciano , Presión Sanguínea/fisiología , Estatura , Peso Corporal , Enfermedad Crónica , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Enfermedades Renales/etiología , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Proteinuria/diagnóstico , Proteinuria/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Población UrbanaRESUMEN
OBJECTIVE: To measure the frequency of goiter and the presence of potential goitrogens in a sample of school-age children and pregnant women. METHODS: Cross-sectional study in a purposive sample in three regions, one with known high prevalence of goiter (Huejutla), one with unknown prevalence (Ixmiquilpan) and one with no expected deficiency (Pachuca). Children were sampled from schools and pregnant women from rural reference hospitals. Goiter was evaluated by manual exam and ultrasound. RESULTS: Goiter prevalence in 673 children between 6 and 14 years old was 8% in Pachuca, 9% in Ixmiquilpan, and 14% in Huejutla. In 300 pregnant women, goiter prevalence was 19% in Pachuca, 20% in Ixmiquilpan, and 52% in Huejutla. In 936 interviews on salt consumption, 98% of families consumed table salt, but only 50% of the samples were adequately iodized. Twenty-four percent of families obtained water from wells contaminated with arsenicum and mercury in Pachuca and Ixmiquilpan, and with colibacilli in Ixmiquilpan. CONCLUSIONS: Even at the end of the millenium, endemic goiter is still a public health problem in this sample of school-age children and pregnant women. Despite consumption of iodized salt, ingestions of goitrogens may be contributing to the persistence of this problem.
Asunto(s)
Bocio Endémico/etiología , Yodo/deficiencia , Complicaciones del Embarazo/etiología , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Bocio Endémico/epidemiología , Humanos , Masculino , México , Embarazo , Complicaciones del Embarazo/epidemiología , PrevalenciaRESUMEN
OBJECTIVE: To measure the frequency of goiter and the presence of potential goitrogens in a sample of school-age children and pregnant women. METHODS: Cross-sectional study in a purposive sample in three regions, one with known high prevalence of goiter (Huejutla), one with unknown prevalence (Ixmiquilpan) and one with no expected deficiency (Pachuca). Children were sampled from schools and pregnant women from rural reference hospitals. Goiter was evaluated by manual exam and ultrasound. RESULTS: Goiter prevalence in 673 children between 6 and 14 years old was 8 in Pachuca, 9 in Ixmiquilpan, and 14 in Huejutla. In 300 pregnant women, goiter prevalence was 19 in Pachuca, 20 in Ixmiquilpan, and 52 in Huejutla. In 936 interviews on salt consumption, 98 of families consumed table salt, but only 50 of the samples were adequately iodized. Twenty-four percent of families obtained water from wells contaminated with arsenicum and mercury in Pachuca and Ixmiquilpan, and with colibacilli in Ixmiquilpan. CONCLUSIONS: Even at the end of the millenium, endemic goiter is still a public health problem in this sample of school-age children and pregnant women. Despite consumption of iodized salt, ingestions of goitrogens may be contributing to the persistence of this problem.
Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Niño , Adolescente , Adulto , Bocio Endémico/etiología , Complicaciones del Embarazo/etiología , Yodo , Bocio Endémico/epidemiología , Complicaciones del Embarazo/epidemiología , Estudios Transversales , México , PrevalenciaRESUMEN
Para evaluar la asociación entre falta de seguimiento al tratamiento farmacológico y des-control de la hipertensión arterial, se estudiaron 230 pacientes en la Unidad de Medicina Familiar 77, en La Piedad, Michoacán. Se definió como descontrol de la hipertensión al promedio de 140-180/90-105 mm Hg en las tres últimas mediciones de las cifras de tensión arterial. Se consideró incumplimiento del tratamiento farmacológico a la incongruencia entre la información obtenida del paciente respecto a dosis y horarios, y las indicaciones prescritas en la receta y expediente clínico. De los pacientes estudiados, 123 (53 por ciento) se encontraron con descontrol y en ellos la frecuencia de no adherencia al tratamiento farmacológico fue de 78 por ciento. Existió 10 veces más riesgo (ORp 10) de que un sujeto sin adherencia al tratamiento farmacológico tuviera descontrol de las cifras tensionales, comparado con quien sí llevó un seguimiento adecuado de las indicaciones médicas.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Seguridad Social , Negativa del Paciente al Tratamiento , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Selección de Paciente , Conductas Relacionadas con la Salud , Factores de RiesgoRESUMEN
Con objeto de identificar la proporción de pacientes diabéticos tipo 2 integrados dentro del programa de diálisis peritoneal continua ambulatoria y evaluar la calidad de vida de los mismos, se revisaron 382 expedientes clínicos de individuos con insuficiencia renal, identificando 38.5 % con tipo 2 y 61.5 % con otras patologías. Se entrevistaron 117 pacientes, hombres en su mayoría. Se utilizó el perfil del impacto de la enfermedad para evaluar las dimensiones física, psicosocial e independiente. Según la puntuación obtenida, 51 % tuvo mala calidad de vida, con mayor deterioro en la dimensión física, es decir, en ambulación, ejercicio, cuidado e higiene del cuerpo. El analfabetismo fue la única variable de comportamiento diferente.
The objective of the study is to identify the ratio of type two diabetic patients included in a continuing ambulatory peritoneal dialysis program (CAPD) and to evaluate their quality of life. 382 clinical files of renal failure patients were reviewed. We found 38.5% type two diabetics, while 61.5% had other pathologies. 117 patients, mostly males, were interviewed. To evaluate the physical, psychosocial and independent dimensions, the Disease Impact Profile was use. According to the score, 51% had poor quality of life, with large damage in the physical dimension, like walking, exercise, care and hygiene of the body. The only one different behavior variable was illiteracy