Gac Med Mex
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Poor metabolic control is a constant in patients with diabetes worldwide, despite resources demonstrated to achieve therapeutic targets. The object of this study was to identify causes of poor metabolic control in patients with diabetes treated in Family Medicine Clinics in metropolitan Mexico City at the Instituto Mexicano del Seguro Social. ⋯ The main factors associated with higher HbA1c were: disease progression, an inadequate diet, and lack of treatment intensification. Any program designed to improve the conditions of these patients must consider these factors.
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A complication underserved in diabetic patients is the cognitive deficits that can reach dementia. Studying the association between electrophysiological, neuropsychological, and biochemical measures could provide a breakthrough in the understanding of this phenomenon. ⋯ The P200 parameters of the somatosensory system are sensitive to metabolic deterioration of diabetic patients, so its use in monitoring the cognitive state of patients is recommended.
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Mechanical ventilation is a therapy for vital support used in a significant proportion of critically ill patients. The right time to successfully discontinue this therapy is a challenge for the intensive care specialist. For this reason it is still a subject for research. The echocardiographic evaluation of the diastolic dysfunction, the diaphragm, and the lung have become an invaluable tool for weaning from mechanical ventilation protocols, especially in patients with difficult or prolonged weaning from mechanical ventilation. There is still a need to validate, in controlled trials, the efficacy of an ultrasound protocol for weaning from mechanical ventilation that integrates the three modalities in a single protocol. ⋯ The use of math models for decision-making is of great importance, as it sets an objective parameter within the existing evaluations. We proposed the use of inequations to set intervals of solution with the three points of care for ultrasound-guided weaning from mechanical ventilation. With this, the inequations proposed generate an area of certainty within the proposed values and the solution intervals.
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With the modernization of healthcare and management of a Hospital as a bussiness, There is the risk of changing the words "patient" and "doctor" into "client" and "provider", risking the humanitarian care, thrustworthiness, and doctor-patient relationship. Using first and last names could be an option for communication.