Search

Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1).Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up.We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control.Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.

Clinical case A 22 year-old woman complained about blurred vision after an episode of recovered cardiorespiratory arrest. She had bilateral low visual acuity (“count fingers”) and no ophthalmological or visual pathways changes. She also had an apparent lack of awareness of the deficit. The magnetic resonance imaging (MRI) showed ischaemic changes in both occipital lobes. As a result, she was diagnosed with Anton–Babinski syndrome. Discussion This is a rare disease that should be suspected in strange or poorly congruent visual loss. It is usually due to an ischemic injury in this region of brain, manifesting itself with low vision not perceived by the patient (visual confabulation). It can simulate a non-organic visual loss or psychiatric disease.

The Prestige oil spill crisis (2002–2003), one of the worst oil spills that affected the Atlantic Spanish coastal line, pointed out that some management tools are needed in the form of laws, regulations and technical procedures. In particular, the issues are contingency planning and prevention against marine pollution and prediction for a proper response. In that background, the Catalan local government approved the CAMCAT (2004), a Regional contingency plan against marine pollution, to be framed within the (Spanish) National Contingency Plan. The CAMCAT contemplated the implementation of a Regional Forecasting System for the North-Western Mediterranean area, intended to help Catalan Authorities during any pollution emergency. The Laboratory of Maritime Engineering (LIM/UPC) has been responsible for the implementation of this Regional CAMCAT Forecasting System that is based (nested) on existing larger Forecasting Systems/Products, and it integrates several coastal observational data. The present paper is aiming to make an overview of the several scientific and technical activities related to the implementation and validation of the CAMCAT System.

espanolIntroduccion: la sedacion profunda con propofol controlada por endoscopista en las diferentes unidades de endoscopia ha sido un tema de continua controversia a lo largo de los ultimos anos, origen de conflictos de intereses entre las distintas sociedades cientificas de Anestesiologia y Gastroenterologia. Numerosos estudios han demostrado ya la eficacia, eficiencia y escasa aparicion de complicaciones en la sedacion controlada por un endoscopista formado frente al anestesiologo. Material y metodos: hemos revisado en nuestra base de datos el porcentaje de complicaciones cardiorrespiratorias graves en nuestra unidad, en el periodo comprendido entre 2011 y 2016, en las distintas exploraciones endoscopicas que realizamos (gastroscopia, colonoscopia, colangiopancreatografia retrograda endoscopica [CPRE] y ecoendoscopia [USE]) y cuya sedacion es controlada por un endoscopista. Resultados: se llevo a cabo el analisis de 33.195 exploraciones durante el periodo de estudio. Obtuvimos un 0,13% de complicaciones cardiorrespiratorias, la mayor parte de ellas desaturaciones graves (la mayoria respondieron a la apertura de la via aerea asociada a la interrupcion de la infusion del farmaco, precisando la necesidad de ambu en contadas ocasiones). No existieron diferencias estadisticamente significativas entre los diferentes grupos excepto en edad media, riesgo por tipo de exploracion y riesgo ASA, donde la CPRE presento una p EnglishIntroduction: deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. Material and methods: the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. Results: during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. Conclusion: there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective

Objetivo: Evaluar el efecto del glaucoma en la función visual, la calidad de vida en los niños y la calidad de vida percibida por los cuidadores en niños de hasta 16 años. Material y métodos: Se diseñó un estudio observacional y prospectivo. Se aplicó el cuestionario GQL-15 (Glaucoma Quality of Life) a los niños y a los cuidadores, y el cuestionario VFQ-25 (Visual Functioning Questionnarie) a los niños. Se registraron diferentes variables de la historia clínica que podrían influir en la calidad de vida y la función visual. Resultados: Se incluyó a un total de 24 pacientes con una edad media de 9,13 ± 3,08 años, de los cuales 3 tenían afectación unilateral y 20 presentaban glaucoma congénito primario. Los padres reportaron una peor calidad de vida que los niños: el resultado de la encuesta GQL-15 fue de 32,30 ± 11,56 puntos en los niños y de 37,52 ± 14,59 puntos en los cuidadores (p = 0,001). El parámetro que más se relacionó con la calidad de vida y la función visual fue el defecto medio del campo visual en el mejor ojo. Se encontró una correlación estadísticamente significativa entre el resultado de GQL-15 y el defecto medio del campo visual (niños: R = 0,63; p < 0,01 y cuidadores: R = 0,81; p < 0,001). Conclusiones: El daño funcional visual producido por el glaucoma tiene un impacto importante en la calidad de vida y en la función visual de los niños con glaucoma, si bien la calidad de vida percibida por los cuidadores es peor que la percibida por el niño. Objective: To evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age. Material and methods: An observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded. Results: The study included 24 patients with a mean age of 9.13 ± 3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3 ± 11.56 points in children and 37.52 ± 14.59 points in caregivers (P = .001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R = 0.63, P < .01, caregivers: R = 0.81, P< .001). Conclusions: Functional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child.

Long-Term Oncologic Outcomes in Colon Cancer Patients With “Bridge to Surgery” Stenting. Comparative Study With TNM Matched Controls Francisco Igea, Sergio Maestro, Rocio Silvana Castillo, Antonio Perez Millan, Henar Nunez, Rosa Eva Madrigal, Esther Saracibar, Javier Barcenilla Complejo Hospitalario de Palencia, Palencia, Spain Background: Expandable metal stents are frecquently used as a bridge to surgery in colon cancer occlusions. Recently worse oncologic outcomes have been described comparing stented patients with control group matched by TNM staging (1). This could be a serious limitation for continuing stenting occluded colon cancers. At present moment,there are no randomized, prospective data. Aims: Compare oncologic outcomes of patients stented vs controls matched by age,sex,TNM stage and year of diagnosis. Methods: We reviewed all our colon cancer patients stented as bridge to surgery during the period nov 1999 nov 2007. A control group of colon cancer patients matched by sex , age, TNM staging and year of diagnosis was extracted from our database. All the patients were treated in our institution by the same surgeons and oncologysts. Global survival and presence of disease at 3 and five years were compared. Results: Population and TNM stagin carachteristics are reflected in Table 1. We found 41 stent patients and 73 non-stented matched controls. Stage IV was finally excluded in this study because serious difference in treatment approach between both groups. Three year survival in groups II & III was 65,7 % in stented group vs 75% in control group (ns.). Presence of disease was 13 % vs 7,8% in control group. Results at five years follow up in stage II & III are summarized in table 2 No significant difference was observed between both groups. Conclusions: 1) There are no significant diference in survival and disease free survival at 3 and five years in our experience 2)Prospective randomized studies are needed to elucidate this point(1)World J Surg. 2009 Jun;33(6)1281-6. Oncologic outcomes of selfexpanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. Kim JS,et al.

This article presents a case study of development of a Payments for Ecosystem Services (PES) program related to drinking water in the city of Copán Ruinas, Honduras. The methodology used for the design and the implementation of this program is based on an integrated and adaptive management approach. It includes the following elements: general diagnostic, definition of objectives, analysis of enabling conditions, technical design, implementation and evaluation. This paper presents the empirical results of the application of this methodology and, in particular, highlights the application of a performance-based payment system to remunerate local peasants in accordance to their land use decisions. Este artículo presenta el desarrollo de una iniciativa de pagos por servicios ecosistémicos relacionados con la provisión de agua potable en la comunidad de Copán Ruinas, Honduras. La metodología para diseñar e implementar este programa se basa en un enfoque integral y de gestión adaptativa, compuesto por varios componentes: definición de objetivos y diagnóstico general, análisis de condiciones habilitadoras, diseño técnico del programa, implementación y evaluación. El artículo presenta la aplicación de este enfoque y los resultados obtenidos en términos del diseño e implementación inicial del programa de pagos. Un resultado particularmente interesante tiene que ver con la construcción de un sistema de pagos basados en desempeño en donde los finqueros reciben pagos diferenciados de acuerdo al tipo y cantidad de cambios que logran en los sistemas productivos. La idea es que los pagos envíen señales acerca de cuáles cambios y usos del suelo son más deseables en términos de mejoramiento de la calidad y disponibilidad de agua para consumo humano.