RESUMO
To differentiate among different types of diabetes is becoming an increasingly challenging task. We investigated whether the patient's genetic profile is useful to identify the particular type of diabetes, to determine the corresponding hyperglycemia pathogenesis and treat accordingly. Three hundred and thirty-eight diabetic patients, diagnosed according to American Diabetes Association criteria, were recruited from 2004 to 2008 in diabetes health reference centers. We analyzed the major gene for type 1 diabetes susceptibility (HLA DQ/DR). In order to improve our understanding of the pathogenesis of the resulting hyperglycemia and to implement a more adequate treatment for the patients, we reclassified our sample according to the presence or absence of the genetic markers. We found that a higher percentage of people than expected have immunological disease, independent of their phenotype, with a relative risk of 4.62 (95% confidence interval). This methodology allowed us to establish an association between the genotype and its resulting phenotype. We found significant differences; the phenotypic classification did not reflect immunological disease based on genotype. Moreover, when we examined markers, body mass index and age of onset, we found that many people have an intermediate phenotype between type 1 and type 2. This genetic data can help provide an accurate definition of the disease and would therefore provide the physician a better possibility of providing adequate treatment.
Assuntos
Diabetes Mellitus Tipo 1/genética , Adolescente , Adulto , Criança , Pré-Escolar , Predisposição Genética para Doença , Genótipo , Humanos , Lactente , Fenótipo , UruguaiRESUMO
BACKGROUND: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. METHODS: As a modification of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding excess weight loss and complications of the gastric pouch during the first year after surgery were compared. RESULTS: Age, sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding from the staple-line. CONCLUSIONS: These preliminary data suggest that complications of the gastric pouch can be reduced by interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are pending.
Assuntos
Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Gastroplastia/efeitos adversos , Gastroplastia/métodos , Obesidade Mórbida/cirurgia , Adulto , Anastomose Cirúrgica/efeitos adversos , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Jejuno/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Different surgical alternatives for the treatment of severe obesity have been described. The two most common surgical procedures are the Vertical Banded Gastroplasty (VBG) and the Roux-en-Y Gastric Bypass (GBP). METHODS: This work describes the results seen during the first 12 months after a surgical technique named Vertical Banded Gastroplasty-Gastric Bypass on 221 Mexican patients with severe obesity operated on between March 1993 and August 1996. RESULTS: 73.3% of the patients were female with an average age of 33.4 years with a standard deviation (SD) of 10 years. The initial mean overweight was 62.2 kg (SD = 26.5 kg). The percentage of ideal weight was 202.3% (SD = 39.4%). The initial body mass index (BMI) was 44.9 kg/m2 (SD = 9.1). The average of excess weight loss in a year was 81.2% (SD = 15.6%) and the BMI was lowered to 26.7 kg/m2 (SD = 5.9). An interesting finding was that the greater the initial overweight, the lesser the resulting weight loss (r = 0.57, P < 0.001). CONCLUSIONS: The procedure was fairly easy to perform. The results were excellent in terms of weight loss and postoperative complications. It is an early experience and the long-term results are still inconclusive; regular check-ups should indicate the procedure's long-term effectiveness.
Assuntos
Derivação Gástrica/métodos , Gastroplastia/métodos , Adulto , Anastomose em-Y de Roux/efeitos adversos , Índice de Massa Corporal , Peso Corporal , Feminino , Seguimentos , Derivação Gástrica/efeitos adversos , Gastroplastia/efeitos adversos , Hérnia Ventral/etiologia , Humanos , Jejuno/cirurgia , Estudos Longitudinais , Masculino , México , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Polipropilenos , Elastômeros de Silicone , Grampeamento Cirúrgico/métodos , Infecção da Ferida Cirúrgica/etiologia , Redução de PesoRESUMO
This paper describes a unique system through which health care-related human rights are now being monitored and protected in Mexico. Based on the ombudsman concept, the system focuses on identifying and responding to violations of human rights and dignity which may occur in the context of health care delivery. Experience thus far has been encouraging; the Mexican population has identified and used the National Commission of Human Rights as a forum for a variety of health-related complaints. The Mexican system, while requiring strengthening and expansion, is an effort to integrate the monitoring and protection of health-related human rights into the broader field of human rights work in Mexico.
RESUMO
Se buscó analizar la incidencia de las hiponatremias en la unidad de cuidados intensivos del Hospital de Niños "Ricardo Gutiérrez" en el período comprendido entre junio y setiembre de 1991. Las hiponatremias (valor del sodio igual o menor a 130 meq/litro) se presentaron en 13 pacientes (20 por ciento) de los 64 ingresos en dicho período. Se dividió a los pacientes en dos grupos: hiponatremia aguda (cuando el ritmo de descenso fue mayor de 0,5 mmol/l/hora) y crónica (cuando fue menor de dicho valor). En base a este factor fundamental y a la fisiopatología productora y perpetuadora de la hiponatremia se decidió su tratamiento
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Hiponatremia/diagnóstico , Unidades de Terapia Intensiva/estatística & dados numéricos , Hiponatremia/classificação , Hiponatremia/terapia , Estudos RetrospectivosRESUMO
Se buscó analizar la incidencia de las hiponatremias en la unidad de cuidados intensivos del Hospital de Niños "Ricardo Gutiérrez" en el período comprendido entre junio y setiembre de 1991. Las hiponatremias (valor del sodio igual o menor a 130 meq/litro) se presentaron en 13 pacientes (20 por ciento) de los 64 ingresos en dicho período. Se dividió a los pacientes en dos grupos: hiponatremia aguda (cuando el ritmo de descenso fue mayor de 0,5 mmol/l/hora) y crónica (cuando fue menor de dicho valor). En base a este factor fundamental y a la fisiopatología productora y perpetuadora de la hiponatremia se decidió su tratamiento (AU)