RESUMEN
BACKGROUND: The importance of optimising blood glucose (BG) control in hospitalised patients is widely accepted. To determine whether focused education of physicians and nurses would result in measurable changes in glycaemic control, the effect of a diabetes-focused educational programme on point of care (POC) BG measures was monitored. METHODS: This programme included 2 h symposium and 2 h interactive session. The POC BG measures were determined at 2-month period prior to implementing the programme and the ensuing 7 months after. Outcome parameters included the mean BG values, the incidence of hyperglycaemia (BG > 180 mg/dl) and hypoglycaemia (BG < 60 mg/dl). The outcome parameters were analysed by comparing the Internal Medicine (target service) to other such as Neurology and Surgical Trauma where no programme was offered. RESULTS: On Internal Medicine, the mean BG decreased soon after implementing the programme and stayed lower than the baseline values over 7 months. The changes were significant at the third, fourth, seventh and the ninth month of the study. Hyperglycaemia decreased significantly (p < 0.05) on the third, fourth, seventh and eighth month, while hypoglycaemia increased following the education programmes. On Neurology and Surgical Trauma, the mean BG values were significantly higher, and hypoglycaemia was significantly lower during the same time frame. CONCLUSIONS: Implementing an educational programme for healthcare providers had significant effects on the lowering of mean BG values and the incidence of hyperglycaemia, but increased the risk of hypoglycaemia. The merits of such programmes need to be tested before their widespread implementation.
Asunto(s)
Glucemia , Diabetes Mellitus/terapia , Educación de Postgrado en Medicina/métodos , Educación en Enfermería/métodos , Cuerpo Médico de Hospitales/educación , Hospitalización , Humanos , Hiperglucemia/terapia , Hipoglucemia/etiología , Medicina Interna/educación , Neurología/educación , Sistemas de Atención de Punto , Calidad de la Atención de SaludRESUMEN
OBJECTIVE: To determine the incidence of Hashimoto's disease in nodular goitre and to ascertain the degree of the concordance between serological and cytological findings. METHODS: We retrospectively reviewed data from 188 patients who underwent a fine needle aspiration biopsy of the thyroid for uninodular or multinodular goitre with a documented serological level of antithyroid peroxidase (TPO) antibodies. AntiTPO antibodies were measured by immunochemiluminescent assay (Quest Diagnostics, Madison, NJ, USA). RESULTS: The study cohort consisted of 170 female and 18 male patients with a mean (+/- SD) age of 47.8 +/- 14.9 years. AntiTPO antibodies were positive in 74 (39.36%) of the individuals and negative in 114 (60.63%). The cytodiagnoses were as follows: 5 (2.6%) cancerous, 18 (9.5%) suspicious, 12 (6.3%) inadequate, 92 (48.9%) benign and 61 (32.4%) consistent with chronic lymphocytic thyroiditis (CLT). For further analysis, we excluded all inadequate specimens. Based on the final sample of 176 patients, the sensitivity and specificity of antiTPO antibody test to detect CLT in nodular goitre were estimated to be 76.38% and 94.23% respectively. The prevalence of CLT in nodular goitre based on cytological criteria was (35.46%) compared with (31.97%) goitre based on positive antiTPO titres only. CONCLUSION: There is a high degree of concordance between serological and cytological findings of CLT in people with nodular goitres. The high prevalence of CLT in nodular goitre justifies the use of antiTPO antibodies as part of the workup in this population.
Asunto(s)
Bocio Nodular/complicaciones , Enfermedad de Hashimoto/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos/metabolismo , Autoanticuerpos/inmunología , Autoantígenos/inmunología , Biopsia con Aguja Fina , Femenino , Bocio Nodular/inmunología , Bocio Nodular/patología , Enfermedad de Hashimoto/inmunología , Enfermedad de Hashimoto/patología , Humanos , Yoduro Peroxidasa/inmunología , Proteínas de Unión a Hierro/inmunología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
During apnoea following induction of anaesthesia, morbidly obese patients may suffer a rapid decrease in oxygen saturation. This study compares pre-oxygenation alone with pre-oxygenation followed by nasopharyngeal oxygen insufflation on the onset of desaturation occurring during the subsequent apnoea. A randomised controlled trial was performed in 34 morbidly obese patients undergoing gastric bypass or gastric band surgery. Seventeen patients received nasopharyngeal oxygen supplementation following pre-oxygenation (Study group, body mass index = 41.8 (6.9) kg.m(-2)), and the other 17 patients received pre-oxygenation alone (Control group, body mass index = 42.7 (5.4) kg.m(-2)). Time from the onset of apnoea until S(p)o(2) fell to 95% was compared between the two groups with a cut-off of 4 min. In the control group, the S(p)o(2) fell from 100% to 95% during the subsequent apnoea in 145 (27) s, with a significantly negative correlation (r(2) = 0.66, p < 0.05) between the time to desaturation to 95% and the body mass index. In the study group, the S(p)o(2) was maintained in 16 of 17 patients at 100% for 4 min when apnoea was terminated. In conclusion, nasopharyngeal oxygen insufflation following pre-oxygenation in morbidly obese patients delays the onset of oxyhaemoglobin desaturation during the subsequent apnoea.
Asunto(s)
Insuflación/métodos , Obesidad Mórbida/cirugía , Terapia por Inhalación de Oxígeno/métodos , Cuidados Preoperatorios/métodos , Adulto , Cirugía Bariátrica , Constitución Corporal , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe , Obesidad Mórbida/sangre , Obesidad Mórbida/complicaciones , Oxígeno/sangre , Oxihemoglobinas/metabolismoRESUMEN
OBJECTIVE: To determine the role of repeated fine-needle aspiration (FNA) biopsy in the evaluation of thyroid nodules initially classified as benign. METHODS: We retrospectively reviewed data on 235 patients with clinically palpable thyroid nodules who underwent a repeated FNA biopsy after an initially benign diagnosis. All the nodules were evaluated and biopsies were obtained by the same endocrinologist. Cytodiagnoses were divided into four major categories: inadequate, benign, suspicious, or malignant. RESULTS: The study cohort consisted of 211 female and 24 male patients with a mean age of 47.1 years. The repeated FNA cytodiagnoses were as follows: 204 (86.8%) remained benign and 19 (8.1%), 11 (4.7%), and 1 (0.4%) became inadequate, suspicious, and malignant, respectively. All patients with benign or inadequate cytologic results on repeated FNA who underwent thyroid surgical resection had benign histologic findings (N = 23). The mean follow-up period between the initial and the last benign FNA cytodiagnosis in the 186 patients without surgical intervention was 1,078 days (2.95 years). Nine of 11 patients with suspicious cytologic results underwent a thyroid surgical procedure, which revealed a benign lesion in 7 and malignant disease in 2 (18%). The other two patients with suspicious cytologic findings had a 13-year clinical follow-up without any clinical evidence of a thyroid malignant lesion. The only patient with malignant cytologic findings on repeated FNA (a 76-year-old woman) refused surgical treatment and was lost to follow-up. CONCLUSION: Although the yield of finding a malignant lesion on repeated FNA biopsy in the follow-up of a presumably benign thyroid nodule may be low, rebiopsy reduces the rate of false-negative diagnosis from an average of 5.2% to <1.3%.
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Biopsia con Aguja , Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Niño , Citodiagnóstico , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Factores de TiempoRESUMEN
Several new pharmacological agents have recently been developed to optimise the management of type 2 (non-insulin-dependent) diabetes mellitus. The aim of this article is to briefly review the various therapeutic agents available for management of patients with type 2 diabetes mellitus and to suggest a potential approach to drug selection. There are three general therapeutic modalities relevant to diabetes care. The first modality is lifestyle adjustments aimed at improving endogenous insulin sensitivity or insulin effect. This can be achieved by increased physical activity and bodyweight reduction with diet and behavioural modification, and the use of pharmacological agents or surgery. This first modality is not discussed in depth in this article. The second modality involves increasing insulin availability by the administration of exogenous insulin, insulin analogues, sulphonylureas and the new insulin secretagogue, repaglinide. The most frequently encountered adverse effect of these agents is hypoglycaemia. Bodyweight gain can also be a concern, especially in patients who are obese. The association between hyperinsulinaemia and premature atherosclerosis is still a debatable question. The third modality consists of agents such as biguanides and thiazolidinediones which enhance insulin sensitivity, or agents that decrease insulin requirements like the alpha-glucosidase inhibitors. Type 2 diabetes mellitus is a heterogeneous disease with multiple underlying pathophysiological processes. Therapy should be individualised based on the degree of hyperglycaemia, hyperinsulinaemia or insulin deficiency. In addition, several factors have to be considered when prescribing a specific therapeutic agent. These factors include efficacy, safety, affordability and ease of administration.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Diabetes Mellitus Tipo 2/fisiopatología , Predicción , Humanos , Hipoglucemiantes/farmacología , Insulina/farmacologíaRESUMEN
To determine if aging is associated with altered serum leptin response to diet-induced changes in endogenous hyperinsulinemia, male Fisher 344 (F344) rats at different age groups were studied while on regular rat chow and following 10 days of experimental diets consisting of 60% of the weight as fructose or glucose. The serum leptin concentration (ng/ml) gradually increased from basal levels of 2.5+/-0.1 at age of 4 months to 3.7+/-0.1, 6.9+/-0.9, 9. 4+/-0.3 and 8.9+/-1.1 at 6, 12, 18 and 24 months of age, respectively (P<0.001). Hyperinsulinemia associated with 60% fructose diet was associated with increased serum leptin levels in 4, 12, and 24 month old rats to 5.1+/-0.8, 6.7+/-1.2, and 8.6+/-1.1, respectively (P<0.001). Feeding 60% glucose diet also was associated with increased serum leptin levels in 4, 12 and 24 month old rats to 7.6+/-0.6, 7.2+/-0.7, and 9.1+/-1.1, respectively (P<0.001). Restricting dietary intake to 60% of the calories consumed by control rats for 10 days resulted in a decrease in serum leptin to 1.0+/-0.02 in 4 month old rats and 2.5+/-0.4 in 24 month old rats (P<0.01). It is concluded that aging in F344 rats is associated with increased serum leptin concentrations. However, diet-related hyperinsulinemic effect on leptin is blunted in aging rats although leptin response to caloric restriction is maintained. The inability of aging rats to mount hyperleptinemic response to dietary changes may contribute to the age-related increase in adiposity.
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Envejecimiento/sangre , Hiperinsulinismo/sangre , Leptina/sangre , Animales , Sacarosa en la Dieta/administración & dosificación , Sacarosa en la Dieta/farmacología , Ingestión de Energía , Fructosa/administración & dosificación , Fructosa/farmacología , Glucosa/administración & dosificación , Glucosa/farmacología , Masculino , Concentración Osmolar , Ratas , Ratas Endogámicas F344RESUMEN
To determine the age-related changes in thyroid hormone (TH) effects on cardiac glucose transporter one (GLUT-1) and four (GLUT-4) isoforms, male Fischer 344 rats at 4, 12, and 25 months of age were studied at euthyroid, hyperthyroid and hypothyroid conditions. Hyperthyroidism was induced with daily intraperitoneal injections of triiodothyronine (15 microg/100 gm) for 10 days. Hypothyroidism was achieved with 0.025% methimazole in the drinking water for 4 weeks. Immunoblot analysis indicated that at euthyroid basal conditions GLUT-1 protein was not significantly altered with age while GLUT-4 protein was significantly reduced in 25 month old rats (82.0 +/- 28.8% of a 4 month old rat p <0.01). In 4 months old rats, GLUT-1 was increased in both hypothyroidism (432.5 +/- 208.7% of age-matched euthyroid control) and to a lesser extent in hyperthyroidism (242.0 +/- 93.3% of control) p<0.01. In 25 month old rats, hyperthyroidism was also associated with increased GLUT-1 mass (190.8 +/- 117.6% of age-matched euthyroid control) p<0.01. Hypothyroidism in this age group was not associated with significant change in GLUT-1 protein. The cardiac GLUT-4 protein was increased during both hypothyroidism and hyperthyroidism. The changes of GLUT-4 in aged rats were similar to those found in young rats. It is concluded that TH effect on GLUT-1 expression in the heart is altered with age while TH effects on GLUT-4 are age independent.