Relación entre la velocidad de conducción nerviosa motora y la hemoglobina glicosilada en pacientes diabéticos de la Clínica del Diabético del Hospital Santo Tomás.

La Diabetes mellitus afecta a más de 346 millones de personas en todo el mundo y la neuropatía es la complicación crónica más frecuente de los pacientes diabéticos que afecta la calidad de vida y es la principal causa de amputación no traumática. Los factores de riesgo involucrados en el desarrollo y progresión de la enfermedad están relacionados con un mal control metabólico y la evolución de la enfermedad. El objetivo del estudio fue determinar la correlación entre la velocidad de conducción nerviosa motora y la hemoglobina glicosilada en pacientes diabéticos tratados en la Clínica del Diabético del Hospital Santo Tomás, en un período de Julio 2010 a Diciembre de 2010. Métodos: En este estudio descriptivo correlacional, un total de trece pacientes con diabetes tipo 2 de la Clínica del Diabético del Hospital Santo Tomás fueron seleccionados de acuerdo a los criterios de inclusión previamente establecidos. La evaluación electrofisiológica determinó variables como la velocidad de conducción nerviosa motora (VCNm), dentro de los registros se obtuvieron las latencias, las amplitudes y duración del potencial de acción muscular. Adicional se determinaron la onda F y el reflejo H como parte del protocolo que ejecuta esta unidad hospitalaria. La evaluación de la hemoglobina HbA 1C se les realizó a todos los pacientes dentro del período establecido, por la unidad del laboratorio. Los valores de referencia son la base de datos del Hospital Santo Tomás. Resultados: La asociación entre la velocidad de conducción nerviosa motora y la hemoglobiná HBA1C fue estadísticamente significativa, a uña P< 0.05% pata los nervios evaluados, la correlación de Pearson, r, para los nervios tibiales posteriores r= - 0.61, para los medianos derecho e izquierdo r= -0.65 y r= - 0.83 y para los ulnares la r= - 0.66 y r= -0.73. Conclusión: En un 83.3% de la muestra obtuvimos una correlación inversa entre la asociación de la velocidad de conducción nerviosa motora y la hemoglobina glicosilada

RELACION ENTRE LA VELOCIDAD DE CONDUCCION NERVIOSA MOTORA Y LA HEMOGLOBINA GLICOSILADA EN PACIENTES DIABETICOS

Diabetes mellitus affects more than 346 million people worldwide and the neuropathy is the most common chronic complication of diabetes. 8% of the population in Panama is affected by this disease. The risk factors involved in the development and progression of the disease are associated with poor metabolic control and disease progression. The objective of this study was to determine the correlation between motor nerve conduction velocity and glycosylated hemoglobin in diabetic patients in the Diabetic Clinic of Santo Tomas Hospital. In this descriptive correlational study, a total of thirteen patients with type 2 diabetes mellitus were selected. The electrophysiological evaluation determined variables such as motor nerve conduction velocity (VCNm). Hemoglobin A1c values were measured in all patients. The reference values are based on Santo Tomas Hospital data base. The association between motor nerve conduction velocity and the hemoglobin HbA1c was statistically significant at (P &lt;0.05). Pearson correlation for posterior tibial nerve for r = - 0.61, for medium right and left r = -0.65 and r = - 0.83 and respectively for ulnar r = - 0.66 and r = - 0.73 right and left. An inverse correlation between the association of motor nerve conduction velocity and glycated hemoglobin was observed in 83.3% of sample studied.&nbsp;&nbsp; &nbsp;La diabetes mellitus afecta a más de 346 millones de personas en todo el mundo y la neuropatía es la complicación crónica más frecuente. En Panamá, el 8% de la población padece dicha enfermedad. Los factores de riesgo involucrados en el desarrollo y progresión de la enfermedad están relacionados con un mal control metabólico y la evolución de la enfermedad. El objetivo del estudio fue determinar la correlación entre la velocidad de conducción nerviosa motora y el porcentaje de hemoglobina glicosilada en pacientes diabéticos tratados en la Clínica del Diabético del Hospital Santo Tomás. En este estudio descriptivo correlacional, fueron seleccionados un total de trece pacientes diagnosticados con diabetes mellitus tipo 2. La evaluación electrofisiológica determinó variables como la velocidad de conducción nerviosa motora (VCNm). La evaluación de la hemoglobina HbA1c se les realizó a todos los pacientes. Los valores de referencia electrofisiológicos y sanguíneos son de la base de datos del Hospital Santo Tomás. La asociación entre la velocidad de conducción nerviosa motora y la hemoglobina HBA1c fue estadísticamente significativa, (P&lt; 0.05). Los índices de correlación de Pearson, para los nervios tibiales posteriores r = - 0.61, para los medianos derecho e izquierdo r = -0.65 y r = - 0.83, respectivamente y para los ulnares la r = - 0.66 y r = - 0.73, derecho e izquierdo. En un 83.3% de la muestra obtuvimos una correlación inversa entre la asociación de la velocidad de conducción nerviosa motora y la hemoglobina glicosilada.&nbsp

Drug prescription and delirium in older inpatients: Results from the nationwide multicenter Italian Delirium Day 2015-2016

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship

Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically