RESUMO
Objetivos: el objetivo de este artículo es informar acerca de la seguridad y la efectividad de iniciar o cambiar a un tratamiento con insulinas análogas en la subpoblación argentina del estudio A1chieve. Materiales y métodos: estudio observacional, de no intervención. En la cohorte argentina participaron 607 pacientes con diabetes tipo 2 (DM2), con o sin tratamiento previo con insulina, quienes inciaron un tratamiento con insulina aspártica bifásica 30, insulina detemir o insulina aspártica con o sin antidiabéticos orales (ADOs). Resultados: el grado de control metabólico al inicio del estudio, medido por HbA1c basal (± DE) fue pobre: 9,4 ± 2,1 %. A los 6 meses, se observó una reducción de HbA1c de -1,8 ± 2,1 % en la cohorte completa, y -2,3 ± 2,1% y -1,1 ± 1,8 % para los pacientes sin tratamiento previo con insulina y con tratamiento previo con insulina, respectivamente. En general, la tasa de hipoglucemia se incrementó en aquellos pacientes que recibieron insulina por primera vez, mientras que se observó una disminución en los pacientes que, previamente, recibían otras insulinas. Se observó un incremento del peso corporal (± DE) en los pacientes sin tratamiento previo con insulina (0,8 ± 4,3 kg). Conclusiones: en la población argentina del estudio A1chieve, se observó un control metabólico deficiente. Se logró una mejoría de la HbA1c al iniciar un tratamiento con análogos de insulina, ya sea en pacientes naïve usuarios previos de insulina,siendo una gran oportunidad para lograr amplias mejorías en el autocuidado y en el control metabólico, independientemente del tipo de regimen insulínico utilizado, con buena tolerabilidad y seguridad. Estos hallazgos coinciden con los resultados obtenidos en la cohorte completa del estudio.
Objectives: The aim of this paper is to report the safety and effectiveness of initiating or switching to insulin analogue therapy in the Argentinean subpopulation of the A1chieve study. Materials and methods: Observational, non-interventional study. The Argentinean cohort included 607 patients with type 2 diabetes (T2D), both insulin-naïve and prior insulin users, who initiated treatment with biphasic insulin aspart 30, insulin detemir or insulin aspart ± oral antidiabetic agents. Results: Baseline HbA1c (±SD) was poor: 9.4 ± 2.1 %. At 6 months, a reduction in the HbA1c of -1.8 ± 2.1 % was observed in the entire cohort, and of -2.3 ± 2.1 % and -1.1 ± 1.8 % in insulin-naïve patients and prior insulin users, respectively. Overall, the rate of hypoglycaemia increased in insulin-naïve patients, whereas a reduction was observed in those switching from other insulins. An increase in the body weight (±SD) was noted in insulin-naïve patients (0.8 ± 4.3 kg). Conclusions: Poor glycemic control was observed in the Argentinean population of the A1chieve study. The initiation of insulin analogue therapy showed an improvement in HbA1c, in both insulin-naïve patients and previous insulin users, which was a good opportunity for improvements in self-care and metabolic control, regardless of the type of insulin regimen used, with a good tolerability and safety profile. These findings are consistent with those obtained from the entire A1chieve study cohort.
RESUMO
Objetivos: el objetivo de este artículo es informar acerca de la seguridad y la efectividad de iniciar o cambiar a un tratamiento con insulinas análogas en la subpoblación argentina del estudio A1chieve. Materiales y métodos: estudio observacional, de no intervención. En la cohorte argentina participaron 607 pacientes con diabetes tipo 2 (DM2), con o sin tratamiento previo con insulina, quienes inciaron un tratamiento con insulina aspártica bifásica 30, insulina detemir o insulina aspártica con o sin antidiabéticos orales (ADOs). Resultados: el grado de control metabólico al inicio del estudio, medido por HbA1c basal (± DE) fue pobre: 9,4 ± 2,1 %. A los 6 meses, se observó una reducción de HbA1c de -1,8 ± 2,1 % en la cohorte completa, y -2,3 ± 2,1% y -1,1 ± 1,8 % para los pacientes sin tratamiento previo con insulina y con tratamiento previo con insulina, respectivamente. En general, la tasa de hipoglucemia se incrementó en aquellos pacientes que recibieron insulina por primera vez, mientras que se observó una disminución en los pacientes que, previamente, recibían otras insulinas. Se observó un incremento del peso corporal (± DE) en los pacientes sin tratamiento previo con insulina (0,8 ± 4,3 kg). Conclusiones: en la población argentina del estudio A1chieve, se observó un control metabólico deficiente. Se logró una mejoría de la HbA1c al iniciar un tratamiento con análogos de insulina, ya sea en pacientes na´ve usuarios previos de insulina,siendo una gran oportunidad para lograr amplias mejorías en el autocuidado y en el control metabólico, independientemente del tipo de regimen insulínico utilizado, con buena tolerabilidad y seguridad. Estos hallazgos coinciden con los resultados obtenidos en la cohorte completa del estudio.(AU)
Objectives: The aim of this paper is to report the safety and effectiveness of initiating or switching to insulin analogue therapy in the Argentinean subpopulation of the A1chieve study. Materials and methods: Observational, non-interventional study. The Argentinean cohort included 607 patients with type 2 diabetes (T2D), both insulin-na´ve and prior insulin users, who initiated treatment with biphasic insulin aspart 30, insulin detemir or insulin aspart ± oral antidiabetic agents. Results: Baseline HbA1c (±SD) was poor: 9.4 ± 2.1 %. At 6 months, a reduction in the HbA1c of -1.8 ± 2.1 % was observed in the entire cohort, and of -2.3 ± 2.1 % and -1.1 ± 1.8 % in insulin-na´ve patients and prior insulin users, respectively. Overall, the rate of hypoglycaemia increased in insulin-na´ve patients, whereas a reduction was observed in those switching from other insulins. An increase in the body weight (±SD) was noted in insulin-na´ve patients (0.8 ± 4.3 kg). Conclusions: Poor glycemic control was observed in the Argentinean population of the A1chieve study. The initiation of insulin analogue therapy showed an improvement in HbA1c, in both insulin-na´ve patients and previous insulin users, which was a good opportunity for improvements in self-care and metabolic control, regardless of the type of insulin regimen used, with a good tolerability and safety profile. These findings are consistent with those obtained from the entire A1chieve study cohort.(AU)
RESUMO
To evaluate the admission criteria and to select indicators that identify patients for whom hospitalization is not necessary, we studied 75 patients with community acquired pneumonia (CAP) who were admitted to a clinical service. According to Appropriateness Evaluation Protocol (AEP) only 60% of our patients justified their hospitalization (Group A) while 40% did not (Group B). The most frequent hospitalization criteria found in Group A were tachypnea (> 30x min.) (40%), respiratory failure (38%) and encefalopathy (18%). The average age in Group A was 62 versus 47 in Group B (p < 0.001). Comorbid conditions were present in 100% of Group A and 71% had two or more while only 33% of patients in Group B had two or more (p < 0.01). During the evolution, Group A had more organ failure than B (53 vs. 17%) (p < 0.001) and a longer period of hospitalization (14 vs. 9 days) (p < 0.01). The differences between groups A and B is best visualized in the incidence of sepsis (4 vs. 0%), and mortality rates (15% vs. 0%) (p < 0.05). Using the Fine risk criteria for a complicated course, we selected 14 patients from Group B, with one or more criteria (Group C) that were compared with 16 patients without them (Group D). The presence of a poor clinical status at admission was the only difference between Group D and C (79 vs. 0%) (p < 0.001). When three or more risk factors were present the differences were significant (79 vs. 6%) (p < 0.001). We conclude that the utilization of hospitalization criteria together with the risk factors for a complicated course, specifically when two or more factors per patient are present, permit the identification of a population with CAP that needs hospitalization with 71.4% sensitivity and 100% specificity. The presence of two or less risk factors in patients without admission criteria has a highly predictable negative value (100%) and anticipates an uneventful evolution without complications.
Assuntos
Admissão do Paciente , Seleção de Pacientes , Pneumonia/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Fatores de RiscoRESUMO
To evaluate the admission criteria and to select indicators that identify patients for whom hospitalization is not necessary, we studied 75 patients with community acquired pneumonia (CAP) who were admitted to a clinical service. According to Appropriateness Evaluation Protocol (AEP) only 60
of our patients justified their hospitalization (Group A) while 40
did not (Group B). The most frequent hospitalization criteria found in Group A were tachypnea (> 30x min.) (40
), respiratory failure (38
) and encefalopathy (18
). The average age in Group A was 62 versus 47 in Group B (p < 0.001). Comorbid conditions were present in 100
of Group A and 71
had two or more while only 33
of patients in Group B had two or more (p < 0.01). During the evolution, Group A had more organ failure than B (53 vs. 17
) (p < 0.001) and a longer period of hospitalization (14 vs. 9 days) (p < 0.01). The differences between groups A and B is best visualized in the incidence of sepsis (4 vs. 0
), and mortality rates (15
vs. 0
) (p < 0.05). Using the Fine risk criteria for a complicated course, we selected 14 patients from Group B, with one or more criteria (Group C) that were compared with 16 patients without them (Group D). The presence of a poor clinical status at admission was the only difference between Group D and C (79 vs. 0
) (p < 0.001). When three or more risk factors were present the differences were significant (79 vs. 6
) (p < 0.001). We conclude that the utilization of hospitalization criteria together with the risk factors for a complicated course, specifically when two or more factors per patient are present, permit the identification of a population with CAP that needs hospitalization with 71.4
sensitivity and 100
specificity. The presence of two or less risk factors in patients without admission criteria has a highly predictable negative value (100
) and anticipates an uneventful evolution without complications.
RESUMO
Signs and local symptoms of leukemia in the oral cavity include paleness of the oral mucosa with gingival bleeding that develops into painless gingival hyperplasia, hemorrhages, and ulcerative necrotic lesions. These findings are common clinical manifestations of leukemias and frequently herald the onset of the disease. Because of their clinical importance, all such lesions deserve the full attention of dentists and physicians.
Assuntos
Leucemia/patologia , Boca/patologia , Adolescente , Adulto , Feminino , Gengiva/patologia , Humanos , Freio Labial/patologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/patologia , Mucosa Bucal/patologia , Palato/patologiaRESUMO
The present study had the purpose to evaluate the clinical diagnosis of the oral lesions observed on children. The author examined 1396 children and observed 1670 different alterations. The result were analysed and it is discussed the most prevalent lesions. It is also emphasized the role of the Dentists in performing a more detailed examination in order to reach a better diagnosis and indicate the corresponding preventive nd therapeutic measures.
Assuntos
Doenças da Boca/epidemiologia , Mucosa Bucal/patologia , População Negra , Brasil/epidemiologia , Criança , Feminino , Doenças da Gengiva/epidemiologia , Humanos , Doenças Labiais/epidemiologia , Masculino , Prevalência , Doenças da Língua/epidemiologiaRESUMO
The authors, examining or revising 1.006 files of handicapped patients, found 214 with 25 different kinds of soft tissue alterations. To reach the final diagnosis they used, in 204 patients with 20 kinds of alterations, clinical criteria; in 10, they used histopathological exams. The purpose of this work was to study the presence of these alterations in handicapped patients. The authors found a great number and variety of pathological changes, and want to emphasize the needing of accuracy in the clinical exam of such patients.
Assuntos
Pessoas com Deficiência , Doenças da Boca/epidemiologia , Adolescente , Adulto , Criança , Feminino , Hiperplasia Gengival/patologia , Humanos , Masculino , Doenças da Boca/patologiaRESUMO
O presente trabalho relata o achado de tecido epitelial intestinal na mucosa alveolar de um paciente de 18 anos. A entidade manifestou-se apos a extracao do dente da area e recebeu as hipoteses clinicas de lesao de celulas gigantes perifericas e granuloma piogenico. A localizacao da heterotopia, pela primeira vez relatada na literatura, e a idade do paciente levaram os autores a questionar a provavel origem e natureza da entidade em questao
Assuntos
Adolescente , Humanos , Coristoma , Mucosa IntestinalRESUMO
Os aspectos clinicos, histologicos e da ultra-estrutura das lesoes bucais de um paciente com doenca de Darier foram estudados e comparados com os achados da literatura. O aspecto clinico basico de lesao bucal esta representado por papulas esbranquicadas de superficie aspera, sendo a caracteristica histologica diagnostica a presenca de lacunas, corpos redondos e graos. A observacao da ultra-estrutura mostrou que a formacao da fenda parece estar relacionada com a perda dos desmossomas, sem condensacao dos tomofilamentos e comprometimento do citoesqueleto