Severe hypoglycaemia in type 1 diabetes mellitus: underlying drivers and potential strategies for successful prevention

Hypoglycaemia remains an over-riding factor limiting optimal glycaemic control in type 1 diabetes. Severe hypoglycaemia is prevalent in almost half of those with long-duration diabetes and is one of the most feared diabetes-related complications. In this review, we present an overview of the increasing body of literature seeking to elucidate the underlying pathophysiology of severe hypoglycaemia and the limited evidence behind the strategies employed to prevent episodes. Drivers of severe hypoglycaemia including impaired counter-regulation, hypoglycaemia-associated autonomic failure, psychosocial and behavioural factors and neuroimaging correlates are discussed. Treatment strategies encompassing structured education, insulin analogue regimens, continuous subcutaneous insulin infusion pumps, continuous glucose sensing and beta-cell replacement therapies have been employed, yet there is little randomized controlled trial evidence demonstrating effectiveness of new technologies in reducing severe hypoglycaemia. Optimally designed interventional trials evaluating these existing technologies and using modern methods of teaching patients flexible insulin use within structured education programmes with the specific goal of preventing severe hypoglycaemia are required. Individuals at high risk need to be monitored with meticulous collection of data on awareness, as well as frequency and severity of all hypoglycaemic episodes.

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

OBJETIVO: A peridural (AP) e a técnica de duplo bloqueio (DB) são utilizadas em analgesia para o trabalho de parto. Este estudo comparou os efeitos na mãe e no feto de ambas as técnicas em analgesia e anestesia para o parto. MÉTODOS: Quarenta parturientes ASA I e II receberam por via peridural 15 ml de ropivacaína a 0,125% (grupo AP) e 5 µg de sufentanil com 2,5 mg bupivacaína por via subaracnóidea (grupo DB). Foram avaliados: intensidade de dor, altura do bloqueio sensitivo, tempo de latência, bloqueio motor, duração da analgesia de parto, tempo para a resolução do parto, hipotensão materna e presença de prurido. Os recém-nascidos foram avaliados pelo índice de Apgar e escore da capacidade adaptativa e neurológica (ECAN), método de Amiel-Tison. RESULTADOS: Não houve diferenças significativas entre os grupos na intensidade da dor, no tempo de latência, no nível do bloqueio sensitivo e no índice de Apgar. O bloqueio motor, a duração da analgesia e o tempo para resolução do parto foram maiores no grupo DB, do qual sete parturientes apresentaram prurido leve. ECAN foi maior no grupo AP após meia hora, duas horas e 24 horas. Noventa e cinco por cento dos recém-nascidos do grupo AP e 60% do grupo DB foram considerados neurologicamente vigorosos ao exame de 24 horas. CONCLUSÃO: As duas técnicas mostraram-se eficazes para analgesia do trabalho de parto. As parturientes do grupo DB apresentaram prurido e trabalho de parto mais prolongado. Recém-nascidos de mães que receberam analgesia de parto via peridural apresentaram melhor ECAN.

Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

CONTEXTO E OBJETIVO: A associação entre ropivacaína e clonidina agiria menos que a ropivacaína isolada na mãe e no feto? Foram pesquisados os efeitos materno-fetais de duas técnicas farmacológicas: pequena dose de ropivacaína ou dose menor de ropivacaína mais clonidina na analgesia peridural para parto. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, Departamento de Anestesiologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. MÉTODOS: Trinta e duas parturientes, estado físico de acordo com a American Society of Anesthesiologists I e II, foram aleatoriamente submetidas à analgesia peridural com 15 ml de ropivacaína 0,125% (grupo R) ou 15 ml de ropivacaína 0,0625% mais clonidina, 75 µg (grupo RC). Foram avaliados: intensidade da dor, nível do bloqueio sensitivo, latência, intensidade do bloqueio motor, duração da analgesia de parto e da analgesia peridural. Os neonatos foram avaliados pelo Apgar e método de Amiel-Tison (capacidade neurológica e adaptativa). RESULTADOS: Não houve diferenças significativas entre grupos para dor, nível de bloqueio sensitivo, duração da analgesia peridural e Apgar. Para latência, duração da analgesia de parto e bloqueio motor, grupo R < grupo RC. O escore da capacidade neurológica e adaptativa de meia e duas horas foi maior para o grupo R. Cem por cento dos neonatos do grupo R e 75% dos do grupo RC estavam neurologicamente saudáveis ao exame de 24 horas. CONCLUSÃO: Pequena dose de ropivacaína e dose menor mais clonidina aliviaram a dor materna durante o parto. Neonatos de mães que receberam apenas ropivacaína mostraram melhores escores da capacidade neurológica e adaptativa.

Bupivacaína, Ropivacaína e Levobupivacaína em Analgesia e Anestesia de Parto. Repercussões Materno-Fetais

Background and Objectives - Bupivacaine has been a very useful local anesthetic in Obstetrics in spite of its potential cardiotoxicity. In obstetric analgesia, ropivacaine is preferred to bupivacaine, and levobupivacaine is less cardiotoxic than the racemic mixture. The aim of this study was to compare the maternal-fetal effects of bupivacaine, ropivacaine and levobupivacaine in obstetric analgesia and anesthesia. Methods - Participated in this study 33 term pregnant women, physical status ASA I and II submitted to epidural anesthesia who received 18.75 mg (in 15 ml completed with 9% saline) of: GI - bupivacaine, GII - ropivacaine, and GIII - levobupivacaine. Pain intensity, sensory block level, onset time, quality of analgesia, motor block intensity, analgesia duration and time for labor resolution were evaluated. For vaginal delivery, 40 mg (in 8 ml of saline) of the same local anesthetic were used; for cesarean delivery, the dose has been mg in 20 ml solution. Newborns of these mothers were evaluated through the Apgar score in minutes 1, 5 and 10, and through the Amiel-Tison method (neurologic and adaptative capacity score - NACS) at 30 min, 2 h, and 24 h. Results - There were no significant statistical differences among groups as to sensory block level, onset time, quality of analgesia, labor analgesia duration, time for labor resolution, and Apgar scores at minute 1. Ast to motor block, GIII > GII and GI was intermediary. In relation to pain intensity, there was a trend for GI > GIII. For Apgar scores in minute 5, GII > (GI = GIII), and in minute 10 (GI = GII) < GIII. NACS at 2 h showed, GII > GI > GIII, and at 24 h, GII > GIII > GI. Conclusions - Ropivacaine has relieved maternal pain with less motor block. Newborns of GII mothers (ropivacaine) showed the best Apgar and NACS scores.

Inversión extranjera directa en la Argentina: crisis, reestructuración y nuevas tendencias después de la convertibilidad

Incluye Bibliografía

Inversión extranjera directa en la Argentina. Crisis, reestructuración y nuevas tendencias después de la convertibilidad

Incluye Bibliografía

L’œuvre scientifique de Cyprien Ayer (1825-1884). Grammaire, Pédagogie et Dialectologie

Cyprien Ayer (1825–1888), figure marquante de la vie intellectuelle en Suisse au XIXe siècle, est l'auteur d’une vaste œuvre scientifique, journalistique et littéraire. Parmi ses travaux linguistiques les plus importants il faut mentionner sa Grammaire comparée de la langue française (1876; nombreuses rééditions), sa Phonologie de la langue française (1875), et son Introduction à l’étude des dialectes du pays (1878). Ce dernier texte, ouvrage pionnier dans le domaine des études francoprovençales, est réimprimé ici, précédé d'une introduction. Le présent recueil regroupe des contributions qui concernent l’œuvre linguistique et littéraire d’Ayer et ses rapports avec une autre figure-clef de la vie littéraire et intellectuelle en Suisse, Henri-Frédéric Amiel. Le recueil s’ouvre par une étude de la carrière d’Ayer et par une bibliographie de ses travaux scientifiques (grammaire, dialectologie, pédagogie, économie, géographie, statistique, politique, ethnographie).

Perinatal mental health service provision in Switzerland and in the UK.

QUESTIONS UNDER STUDY The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. METHODS Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. RESULTS Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. CONCLUSIONS The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

Gregorio Marañón y Miguel de Unamuno, lectores de un alma abrasada en un diario : Apuntes para una psicología de la timidez

Tras describir las líneas principales de las interpretaciones que Gregorio Marañón y Miguel de Unamuno hicieron del diario de Henri-Frédéric Amiel, en este artículo se trae a colación la obra de Otto Weininger con el fin de contemplar ambas interpretaciones desde una perspectiva más amplia que permita vislumbrar cuáles eran los intereses de Marañón y Unamuno cuando analizaron la vida y la personalidad de Amiel

Gregorio Marañón y Miguel de Unamuno, lectores de un alma abrasada en un diario : Apuntes para una psicología de la timidez

Tras describir las líneas principales de las interpretaciones que Gregorio Marañón y Miguel de Unamuno hicieron del diario de Henri-Frédéric Amiel, en este artículo se trae a colación la obra de Otto Weininger con el fin de contemplar ambas interpretaciones desde una perspectiva más amplia que permita vislumbrar cuáles eran los intereses de Marañón y Unamuno cuando analizaron la vida y la personalidad de Amiel

Gregorio Marañón y Miguel de Unamuno, lectores de un alma abrasada en un diario : Apuntes para una psicología de la timidez

Tras describir las líneas principales de las interpretaciones que Gregorio Marañón y Miguel de Unamuno hicieron del diario de Henri-Frédéric Amiel, en este artículo se trae a colación la obra de Otto Weininger con el fin de contemplar ambas interpretaciones desde una perspectiva más amplia que permita vislumbrar cuáles eran los intereses de Marañón y Unamuno cuando analizaron la vida y la personalidad de Amiel

Gregorio Marañón y Miguel de Unamuno, lectores de un alma abrasada en un diario : Apuntes para una psicología de la timidez

Tras describir las líneas principales de las interpretaciones que Gregorio Marañón y Miguel de Unamuno hicieron del diario de Henri-Frédéric Amiel, en este artículo se trae a colación la obra de Otto Weininger con el fin de contemplar ambas interpretaciones desde una perspectiva más amplia que permita vislumbrar cuáles eran los intereses de Marañón y Unamuno cuando analizaron la vida y la personalidad de Amiel

Global database of surface ocean particulate organic carbon export fluxes diagnosed from the 234Th technique

Through the processes of the biological pump, carbon is exported to the deep ocean in the form of dissolved and particulate organic matter. There are several ways by which downward export fluxes can be estimated. The great attraction of the 234Th technique is that its fundamental operation allows a downward flux rate to be determined from a single water column profile of thorium coupled to an estimate of POC/234Th ratio in sinking matter. We present a database of 723 estimates of organic carbon export from the surface ocean derived from the 234Th technique. Data were collected from tables in papers published between 1985 and 2013 only. We also present sampling dates, publication dates and sampling areas. Most of the open ocean Longhurst provinces are represented by several measurements. However, the Western Pacific, the Atlantic Arctic, South Pacific and the South Indian Ocean are not well represented. There is a variety of integration depths ranging from surface to 220m. Globally the fluxes ranged from -22 to 125 mmol of C/m**2/d. We believe that this database is important for providing new global estimate of the magnitude of the biological carbon pump.

La France; an American magazine.

Editors: Aug. 1917-Mar. 1919, Denys Amiel. --May 1919- Claude Rivière.