Antonio José Morales Hernández

Gastroesophageal reflux in diabetes mellitus

OBJECTIVE:Although abnormal gastroesophageal (GE) reflux is the most frequent alteration of the gastrointestinal tract, its prevalence in diabetes mellitus (DM) is not widely known. The objective of this study was to analyze both the presence of abnormal GE reflux in diabetic patients with no esophageal symptoms and the influence of cardiovascular autonomic neuropathy (CVAN) in the development of abnormal GE reflux.METHODS:Fifty insulin-dependent diabetic patients, averaging 29.2 ± 9.0 yr of age, who had had diabetes for > 5 yr and showed no symptoms or history of gastroesophageal disease, were compared with a control group composed of 36 healthy volunteers (18 men, 18 women) whose average age was 35.9 ± 10.1 yr. The cardiovascular autonomic nervous system was examined in the diabetics and control subjects who complied with inclusion criteria. Long-term (24-h) ambulatory esophageal pH monitoring was performed, as well as a manometric study of the lower esophageal sphincter.RESULTS:The parameters obtained from the monitoring showed significant differences (p < 0.01) between DM and control subjects. Abnormal GE reflux, defined as any percentage of time with esophageal pH < 4 exceeding 3.5% of total time (8.7 ± 5.6%; range, 4.1–24.4%), was detected in 14 patients. Diabetic subjects were classified according to cardiovascular autonomic neuropathy tests (without CVAN [n = 19, 38%] and with abnormal CVAN tests [n = 31, 62%]). The pH monitoring parameters showed significant differences between these two groups (p < 0.05).CONCLUSIONS:A higher prevalence (28%) of abnormal GE reflux appeared among asymptomatic diabetic patients than among the general population. The presence of abnormal GE reflux in diabetic patients was associated with the existence of cardiovascular autonomic neuropathy (abnormal GE reflux = 38.7% in diabetic patients with abnormal CVAN tests vs 10.5% in diabetic patients without CVAN).

Cardiovascular autonomic neuropathy in Type 1 diabetic patients with and without peripheral neuropathy

One hundred Type 1 diabetic patients (54 men, 46 women) mean age 28.9+/-8.4 years, were selected from among individuals referred to our hospital, with no previous diagnosis of diabetic chronic complications including diabetic neuropathy. After clinical and physical examinations, subjects were divided into two groups: with (n = 37) and without (n = 63) peripheral neuropathy. The percentage of subjects with cardiovascular autonomic neuropathy (AN), diagnosed by positive results to at least two of the five cardiovascular tests (Valsalva ratio, EI ratio, 30/15 ratio, blood-pressure response to standing up and handgrip test), was 40%: 72.9% in the group with peripheral neuropathy and 20.6% in the group without peripheral neuropathy (P < 0.0001). The prevalence of cardiovascular AN was related to the duration of the diabetes (P < 0.0001) and to HbA1c (P < 0.02). The presence of microalbuminuria and the existence of retinopathy were higher (P < 0.01 ) in group 1 (with peripheral neuropathy). Logistic regression analysis showed that only the presence of higher excretion of albumin is independently related to the presence of peripheral neuropathy. In conclusion, cardiovascular AN is frequent in Type 1 diabetes; furthermore, prevalence increases with the existence of peripheral neuropathy and with duration of the diabetes.

Aprendiendo a plantear problemas en el medio. Análisis de una experiencia con estudiantes del Máster de Investigación en Didácticas específicas

El Master de Investigacion en Didacticas especificas permite al profesorado en formacion consolidar toda una serie de conocimientos previos y reflexionar acerca de determinados enfoques, representaciones y recursos trabajados durante sus estudios de Grado. Asimismo, lo prepara para la realizacion de futuras investigaciones que sirvan como base para la innovacion educativa. La primera parte de cualquier proceso investigador radica en la deteccion y concrecion de una problematica. Por ello, utilizando como recurso las salidas de campo realizadas en la asignatura de Bases Didacticas del citado Master, se propuso a los estudiantes que detectaran problemas socioambientales que sirvieran de eje para una investigacion escolar. Tras el analisis de los materiales elaborados por el alumnado, hemos podido comprobar que la vision idealizada de determinados entornos presentada por los futuros docentes al inicio del Master ha dado lugar, tras la intervencion, a una imagen mas problematizada del medio. Esto repercute en el planteamiento y concrecion del problema y evidencia la necesidad de un enfoque interdisciplinar para analizar cuestiones que, como las senaladas, pueden y deben ser abordadas desde diferentes opticas.