•La pandemia de COVID-19 nos ha obligado a diseñar nuevas formas de dispensar cuidados médicos. En este contexto, la telemedicina se propone como principal alternativa a la clásica atención sanitaria ...presencial.•El colapso de los centros sanitarios durante la pandemia ha dificultado el seguimiento de los problemas crónicos de salud como la diabetes tipo 2, impidiendo un seguimiento o tratamiento adecuado.•Adaptar las guías de práctica clínica en forma de recomendaciones y algoritmos de decisión adaptados al nuevo escenario profesional permite homogeneizar y estandarizar la atención sanitaria que se ofrece a los pacientes con diabetes tipo 2.
Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
ResumenEl adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la ...metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo 2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia.
Chronic kidney disease (CKD) patients are at high-risk for severe Covid-19. The multicentric, observational and prospective SENCOVAC study aims to describe the humoral response and safety of ...SARS-CoV-2 vaccines in CKD patients. Safety and immediate humoral response results are reported here.
Four cohorts of patients were included: kidney transplant (KT) recipients, haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis CKD patients from 50 Spanish centres. Adverse events after vaccine doses were recorded. At baseline and on day 28 after the last vaccine dose, anti-Spike antibodies were measured and compared between cohorts. Factors associated with development of anti-Spike antibodies were analyzed.
1746 participants were recruited: 1116 HD, 171 PD, 176 non-dialysis CKD patients and 283 KT recipients. Most patients (98%) received mRNA vaccines. At least one vaccine reaction developed after the first dose in 763 (53.5%) and after the second dose in 741 (54.5%) of patients. Anti-Spike antibodies were measured in the first 301 patients. At 28 days, 95% of patients had developed antibodies: 79% of KT, 98% of HD, 99% of PD and 100% of non-dialysis CKD patients (p<0.001). In a multivariate adjusted analysis, absence of an antibody response was independently associated to KT (OR 20.56, p = 0.001) and to BNT162b2 vaccine (OR 6.03, p = 0.023).
The rate of anti-Spike antibody development after vaccination in KT patients was low but in other CKD patients it approached 100%; suggesting that KT patients require persistent isolation measures and booster doses of a Covid-19 vaccine. Potential differences between Covid-19 vaccines should be explored in prospective controlled studies.
Treatment of diabetes mellitus type2 (DM2) includes healthy eating and exercise (150minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except ...contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used.
A phase I clinical trial was performed to examine the safety and immunogenicity of a multi-epitope polypeptide comprising the central 15 amino acids of the V3 loop from six HIV-1 isolates. This ...protein called TAB9 was emulsified in Montanide ISA720 (Seppic, Paris) and administered intramuscularly at doses of 0, 0.2 and 1 mg to 24 healthy, HIV-1 seronegative adult males. Three immunisations were given at months 0, 1 and 6 in a randomised, double blind, placebo controlled clinical trial. The placebo was generally well tolerated. However, severe local reactions were observed in TAB9 vaccinated subjects after the second and third inoculations. Seven out of eight volunteers from the lower dose group showed moderate or severe local inflammation, while four out of eight subjects from the higher dose group developed granulomas and sterile abscesses. In general, the reactogenicity depended on the number of inoculations given and the dose of TAB9. Both doses were immunogenic, all immunised volunteers seroconverted and antibodies were broadly reactive against the V3 peptides included in the protein. All vaccine's sera reacted against gp120 in Western blot and 50% of them also neutralised at least one out of five laboratory isolates tested. No differences between doses were found. Anti TAB9 lymphoproliferative responses were observed, being more intense in the high dose group. Due to the strong local reactions that were found in this study, a change in the formulation will be required for further trials with this vaccine candidate in humans.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the ...remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
To find out to what extent The "Reflective Practice Guide" (RPG) (a semi-structured Portfolio guide) has been implemented in a Spanish Family Medicine Vocational Training Region (Unidad Docente ...Provincial) and the opinions of trainees and trainers after using it in actual conditions.
Cross-sectional study
A Provincial Family Medicine Teaching Unit (a Spanish Vocational Training Region).
43 trainers and 70 residents (trainees).
The participants carried out a formative assessment for 12 months on the competency areas described in the RPG. The information was collected by means of specific card notes. Trainers and Trainees filled in an ad hoc survey.
The trainees carried out 295 (80%) tasks and reflections out of those recommended in the GPR. First and third year trainees completed 81/108 (75%) and 65/108 (60%) of the tasks, respectively. Trainees and trainers considered that the new method is useful for reflecting on clinical practice, for knowing their own competencies better and for strengthening the trainer-trainee relationship.
The GPR is a formative tool that trainees carried out with their trainers even to a greater extent than that recommended by the GPR. Both groups perceive this tool as useful for effectively reflecting the trainees practice and for strengthening their relationship.
Resumen Objetivos Valorar el grado de implementación de la «Guía de práctica reflexiva» (GPR) tipo portafolio del libro del especialista en Medicina de Familia, en condiciones reales en una unidad ...docente y conocer las opiniones que tutores y residentes tienen sobre su uso. Diseño Observacional descriptivo. Emplazamiento Unidad Docente Provincial de Medicina de Familia. Participantes Cuarenta y tres tutores y 70 residentes. Métodos Durante 12 meses los participantes realizaron una evaluación formativa en las áreas de competencia que prescribe la GPR. La información se recogió mediante los modelos para la valoración de los informes de reflexión y tareas en las distintas áreas de competencia propuestos en ella. Tutores y residentes completaron un cuestionario ad hoc. Resultados Los residentes realizaron 295 tareas e informes de reflexión de los indicados en la GPR (80%) y además 62 tareas extras: 357 (97%). Todos los residentes de primer año realizaron la totalidad de las tareas recomendadas: 149 de 150 (99%); los residentes de segundo año realizaron 81 de 108 (75%) tareas, y los de tercer año sólo realizaron 65 de 108 (60%) tareas. Tutores y residentes consideran que el nuevo método puede ser útil para reflexionar sobre la práctica, conocer las competencias y fortalecer la relación entre tutor y residente. Conclusiones La GPR es una herramienta que los residentes implementan con sus tutores en un grado mayor al recomendado por la propia Comisión Nacional de la Especialidad. Ambos colectivos la perciben como útil para reflexionar sobre la práctica y para fortalecer su relación.
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