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La Cardiografía por Impedancia (CI), o monitoreo hemodinámico no invasivo, es un nuevo método de diagnóstico para el control del tratamiento de la: Insuficiencia Cardíaca (1), Hipertensión Arterial Sistémica (2-3), Disnea (4), Optimización del uso del Marcapasos (5) y otras muchas aplicaciones en las diferentes especialidades médicas. La Hipertensión Arterial Sistémica es una enfermedad hemodinámica que a pesar de haber sido estudiada muy intensamente, hasta ahora su control es muy bajo en todo el mundo. Presentamos en este estudio una manera muy práctica de poder alcanzar un control más efectivo de esta patología de alta prevalencia

Un nuevo método de diagnóstico no invasivo, utiliza la Cardiografía por impedancia (CI) para rápidamente obtener una información del estado hemodinámico que permita un mejor control clínico para evaluación, diagnóstico, pronóstico y tratamiento de nuestros pacientes. (1) El método registra el flujo sanguíneo, la resistencia vascular, la contractilidad cardíaca y el estado de los líquidos corporales, completando 17 parámetros o más dependiendo del tipo de equipo que se utilice. La CI nos permite evaluar mejor al paciente para controlar el tratamiento de la: Insuficiencia Cardíaca (2-3), Hipertensión Arterial Sistémica (4), Disnea (5), Optimización del uso de marcapasos (6) y otras muchas aplicaciones en las diferentes especialidades Médicas.

Revisamos el caso de una paciente del sexo femenino de 41 años de edad, procedente y residente en Cuenca, de estado civil casada que recibe tratamiento desde hace 3 años para Hipertensión arterial pero que no se ha podido normalizar sus valores. Hace 24 horas acude a consulta de facultativo por presentar sin causa aparente intensa cefalea occipital acompañada de nausea, mareos, trastornos visuales (fosfenos). En la exploración y examen general se le encuentra con cifras tensionales muy elevadas 170/110 mmHg, por lo que se le administra Captopril Sub lingual de emergencia y se envía para control de especialista. Después de la evaluación clínica, se realiza exámenes complementarios como laboratorio clínico, electrocardiograma y cardiografía por impedancia y se hace la estratificación del riesgo cardiovascular. Se decide tratamiento con terapia combinada con calcioantagonista (CA). Antagonista de los receptores de la Angiotensina ARA II, y un Alfa-beta bloqueador. Los controles a la semana, un mes y dos meses posteriores muestran una paciente controlada y sin la presencia de daños de órgano blanco. Cuatro años más tarde acude a control porque se siente bien, pero quiere una valoración de su estado de salud. Se realizan los exámenes de control, en particular una cardiografía por impedancia y se verifica la normalidad de su estado hemodinámico.

Background: We provide updated crude and adjusted prevalence estimates of major birth defects in the United States for the period 2016-2020., Methods: Data were collected from 13 US population-based surveillance programs that used active or a combination of active and passive case ascertainment methods to collect all birth outcomes. These data were used to calculate pooled prevalence estimates and national prevalence estimates adjusted for maternal race/ethnicity for all conditions, and maternal age for trisomies and gastroschisis. Prevalence was compared to previously published national estimates from 1999 to 2014., Results: Adjusted national prevalence estimates per 10,000 live births ranged from 0.63 for common truncus to 18.65 for clubfoot. Temporal changes were observed for several birth defects, including increases in the prevalence of atrioventricular septal defect, tetralogy of Fallot, omphalocele, trisomy 18, and trisomy 21 (Down syndrome) and decreases in the prevalence of anencephaly, common truncus, transposition of the great arteries, and cleft lip with and without cleft palate., Conclusion: This study provides updated national estimates of selected major birth defects in the United States. These data can be used for continued temporal monitoring of birth defects prevalence. Increases and decreases in prevalence since 1999 observed in this study warrant further investigation., (© 2024 Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Simultaneous pancreas-kidney (SPK) transplantation is the treatment of choice for type 1 diabetics with end-stage renal disease. Recently patients with type 2 diabetes have been considered for transplantation. Despite that the patient and graft survival rates have improved over the past years, it continues to be a procedure with high surgical complication rates. We herein report a case of a pancreatic graft with a duodenal complication rescued using a total duodenectomy, a procedure that is seldom used. A 57-year-old type 2 diabetic underwent a SPK transplantation with systemic-enteric drainage. He was converted to a Roux en Y at day 7 for a small duodenal fistula without peritonitis. At day 13, with good graft function, he presented with gastrointestinal and abdominal bleeding. At laparotomy he had a congestive duodenum with intraluminal bleeding and an anastomotic fistula. We performed a total duodenectomy with enteric drainage. The patient was discharged home on day 39 with a pancreatic fistula on intramuscular Octretotide that lasted for 3 months. He was never readmitted and has good pancreas and kidney function at 16 months of follow-up. We think this is an option to rescue a pancreas graft with duodenal complications in selected cases.

Objective: To determine whether skin intrinsic fluorescence (SIF) is associated with long-term complications of type 1 diabetes (T1D) and, if so, whether it is independent of chronic glycemic exposure and previous intensive therapy., Research Design and Methods: We studied 1,185 (92%) of 1,289 active Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) participants from 2010 to 2011. SIF was determined using a fluorescence spectrometer and related cross-sectionally to recently determined measures of retinopathy (stereo fundus photography), cardiac autonomic neuropathy (CAN; R-R interval), confirmed clinical neuropathy, nephropathy (albumin excretion rate [AER]), and coronary artery calcification (CAC)., Results: Overall, moderately strong associations were seen with all complications, before adjustment for mean HbA1c over time, which rendered these associations nonsignificant with the exception of sustained AER>30 mg/24 h and CAC, which were largely unaffected by adjustment. However, when examined within the former DCCT treatment group, associations were generally weaker in the intensive group and nonsignificant after adjustment, while in the conventional group, associations remained significant for CAN, sustained AER>30 mg/24 h, and CAC even after mean HbA1c adjustment., Conclusions: SIF is associated with T1D complications in DCCT\EDIC. Much of this association appears to be related to historical glycemic exposure, particularly in the previously intensively treated participants, in whom adjustment for HbA1c eliminates statistical significance.

Background: The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications(EDIC) studies have established multiyear mean hemoglobin A1c (HbA1c) as predictive of microvascular complications in persons with type 1 diabetes. However, multiyear mean HbA1c is not always available in the clinical setting. Skin advanced glycation end products (AGEs) are thought to partially reflect effects of hyperglycemia over time, and measurement of skin AGEs might be a surrogate for multiyear mean HbA1c. As certain AGEs fluoresce and skin fluorescence has been demonstrated to correlate with the concentration of skin AGEs, noninvasive measurement by skin intrinsic fluorescence(SIF) facilitates the exploration of the association of mean HbA1c and other clinical/technical factors with SIF using the detailed phenotypic database available in DCCT/EDIC., Subjects and Methods: Of the subjects, 1,185 (53% male) had measurements of SIF during years 16/17 of EDIC with mean age and diabetes duration of 51.5 and 29.8 years, respectively. SIF measurements were obtained on the underside of the forearm near the elbow using a skin fluorescence spectrometer. Demographic data and health history were self-reported, and an annual standardized examination measured clinical status. Linear regression models were constructed to identify significant clinical and technical factors associated with SIF, and the final models only used factors that were significant., Results: SIF ranged from 8.7 to 54.0 arbitrary units and was log-normally distributed. Log(SIF) correlated more with mean HbA1c as the time period increased. In multivariate analyses log(SIF) was significantly associated with mean HbA1c, age,estimated glomerular filtration rate < 60mL/min/m2, smoking status, skin tone, and clinic latitude <37 N., Conclusions: SIF reflects age, mean HbA1c over time, smoking, and renal damage, which are known risk factors for diabetes complications.