Testes de Triagem Prevendo Metástase de Câncer na Etiologia do Derrame Pericárdico: HALP Score e PNI / Screening Tests Predicting Cancer Metastasis in the Etiology of Pericardial Effusion: HALP Score and PNI

Resumo Fundamento: A triagem do câncer é absolutamente necessária em pacientes com derrame pericárdico, pois o câncer é uma das doenças mais graves em sua etiologia. Estudos anteriores indicaram que o índice de inflamação imunológica sistêmica (IIS), o índice prognóstico nutricional (PNI) e o escore de hemoglobina, albumina, linfócitos e plaquetas (HALP) podem ser escores relacionados ao câncer. Objetivos: Este estudo foi iniciado considerando que esses sistemas de pontuação poderiam prever o câncer na etiologia de pacientes com derrame pericárdico. Métodos: Os pacientes submetidos à pericardiocentese entre 2006 e 2022 foram analisados retrospectivamente. A pericardiocentese foi realizada em um total de 283 pacientes com derrame pericárdico ou tamponamento cardíaco de moderado a grande no período especificado. Os índices de HALP, PNI e IIS foram calculados do sangue venoso periférico retirado antes do procedimento de pericardiocentese. O nível de significância estatística foi aceito em p<0,05. Resultados: O escore HALP foi de 0,173 (0,125-0,175) em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi de 0,32 (0,20-0,49; p<0,001). O escore de PNI foi de 33,1±5,6 em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi 39,8±4,8 (p<0,001). Conclusão: Os escores HALP e PNI são testes de triagem de câncer fáceis e rápidos que podem prever metástases de câncer na etiologia de pacientes com derrame pericárdico.

Abstract Background: Cancer screening is absolutely necessary in patients with pericardial effusion, given that cancer is one of the most serious diseases in the etiology of pericardial effusion. In previous studies, it was stated that the systemic immune-inflammation index (SII); the prognostic nutrition index (PNI); and the hemoglobin, albumin, lymphocyte, platelet (HALP) score can produce scores related to cancer. Objectives: This study began considering that these scoring systems could predict cancer in the etiology of patients with pericardial effusion. Methods: This study produced a retrospective analysis of patients who underwent pericardiocentesis between 2006 and 2022. Pericardiocentesis was performed in a total of 283 patients with moderate-to-large pericardial effusion or pericardial tamponade within the specified period. HALP, PNI, and SII scores were calculated according to the peripheral venous blood taken before the pericardiocentesis procedure. The statistical significance level was set at p<0.05. Results: The HALP score proved to be 0.173 (0.125-0.175) in cancer patients and 0.32 (0.20-0.49) in non-cancer patients (p<0.001). The PNI score proved to be 33.1±5.6 in cancer patients and 39.8±4.8 in non-cancer patients (p<0.001). Conclusion: The HALP score and PNI proved to be easy and fast cancer screening tests that can predict cancer metastasis in the etiology of patients with pericardial effusion.

Complicaciones vasculares en pacientes diabéticos con hemoglobina glicosilada alterada internados en el Centro Médico Nacional - Hospital Nacional periodo 2022 - 2023 / Vascular complications in diabetic patients with altered glycated hemoglobin admitted to Centro Médico Nacional - Hospital Nacional period 2022 ­ 2023

Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

Use of probiotics and similar in pediatric patients with Type 1 Diabetes Mellitus: a systematic review / Uso de probióticos e similares em pacientes pediátricos com Diabetes Mellitus tipo 1: uma revisão sistemática

ABSTRACT Objective: To perform a systematic review of randomized controlled trials, evaluating the effect of probiotics, prebiotics or symbiotics supplementation on glycemic and inflammatory control in children with Type 1 Diabetes Mellitus (T1DM). Data source: The Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO) databases were searched. Randomized clinical trials of pediatric patients with DM1 using probiotics, prebiotics or symbiotics were included, regardless of year or language of publication. Studies that did not evaluate glycated hemoglobin (HbA1c) were excluded. Metabolic results (HbA1c, total insulin dose and C-peptide) and inflammatory control [interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)] during probiotic supplementation or similar, related to modification of the intestinal microbiota, were analyzed. PROSPERO ID: CRD42022384485. Data synthesis: Five studies were selected for a systematic review. Regarding metabolic markers, only one of the articles that analyzed HbA1c showed a significant decrease (p=0.03) in the intervention group. One study identified a reduction in the total dose of insulin and increased C-peptide levels. Regarding the evaluation of inflammatory parameters (IL-10, TNF-α, INF-γ), there were no statistical relevant modifications. Conclusions: Current data from the literature were not conclusive in identifying an improvement in glycemic control and did not observe changes in inflammatory parameters with the use of probiotics, prebiotics or symbiotics in pediatric patients with T1DM.

RESUMO Objetivo: Realizar uma revisão sistemática de ensaios clínicos randomizados controlados avaliando o efeito da suplementação de probióticos, prebióticos ou simbióticos no controle glicêmico e inflamatório em crianças com diabetes mellitus tipo 1 (DM1). Fontes de dados: As bases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO) foram pesquisadas. Foram incluídos ensaios clínicos randomizados de pacientes pediátricos com DM1 em uso de probióticos, prebióticos ou simbióticos, independentemente de ano ou idioma de publicação. Foram excluídos os trabalhos que não avaliaram hemoglobina glicada (HbA1c). Os resultados metabólicos (HbA1c, dose de insulina total e peptídeo C) e o controle inflamatório [interleucina-10 — IL-10), fator de necrose tumoral-alfa (TNF-α) e interferon-gama (IFN-γ)] durante a suplementação de probióticos ou similares, relacionados à modificação da microbiota intestinal, foram analisados. ID PROSPERO: CRD42022384485. Síntese dos dados: Cinco estudos foram selecionados para revisão sistemática. Com relação aos marcadores metabólicos, apenas um dos artigos que analisaram a HbA1c apresentou diminuição significativa (p=0,03) no grupo intervenção. Um estudo identificou redução da dose total de insulina e aumento dos níveis de peptídeo C. Quanto à avaliação dos parâmetros inflamatórios (IL-10, TNF-α, INF-γ), não houve modificações de relevância estatística. Conclusões: Os dados atuais da literatura não foram conclusivos em identificar melhora no controle glicêmico e não observaram mudanças nos parâmetros inflamatórios com o uso de probióticos, prebióticos ou simbióticos em pacientes pediátricos com DM1.

Bilateral tractional retinal detachment in hemoglobin SC disease patient / Descolamento tracional de retina bilateral em hemoglobinopatia S-C

ABSTRACT A 36-year-old black male presented with a progressive loss of visual acuity in both eyes for 7 years. He had a history of tractional retinal detachment in the right eye and vitreous hemorrhage followed by retinal detachment in the left eye. He denied any systemic illness, trauma, or drug abuse. After clinical investigation, he was diagnosed with SC hemoglobinopathy and proliferative sickle cell retinopathy stage V in both eyes.

RESUMO Paciente do sexo masculino, 36 anos, negro, apresentou baixa acuidade visual progressiva em ambos os olhos por 7 anos. Possuía antecedentes de descolamento tracional de retina no olho direito e hemorragia vítrea, seguida de descolamento de retina no olho esquerdo. Negava doenças sistêmicas, trauma ou abuso de drogas. Após investigação clínica, foi diagnosticado com hemoglobinopatia S-C e retinopatia falciforme proliferativa estágio V em ambos os olhos.

Use of FGF21 analogs for the treatment of metabolic disorders: a systematic review and meta-analysis

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far.

Diabetes tipo II. A terapia periodontal não cirúrgica pode favorecer o controle glicêmico do paciente? / Type II Diabetes. Does nonsurgical periodontal therapy improve glycemic control in patientes? / Diabetes tipo II. ¿Puede la terapia periodontal no quirúrgica mejorar el control glicémico del paciente?

Introdução:A doença periodontal corresponde àcondição que acomete os tecidos de proteção e/ou suporte do dente através de uma inflamação crônica causadapor patógenos.Estacondição pode ser modificada ou associada às doenças sistêmicas, como por exemplo, o diabetes mellitus tipo II (DM2).Objetivo:Avaliar quais os efeitos da terapia periodontal não cirúrgica sobre o controle glicêmico de pacientes diagnosticados com DM2.Metodologia:Revisão integrativa elaborada a partir de pesquisas clínicas randomizadas indexadas nas bases de dados Pubmed, Embase, Cochrane, Web of Science e BVS, na qual foram utilizados os descritores "periodontal diseases treatment", "glycemic control" e "metabolic control".Resultados:Dos trabalhos avaliados, seis foram selecionados para compor a revisão, tendo em vista os critérios de inclusão e exclusão estabelecidos. Logo, é notório que a terapia periodontal básica indica melhora no controle glicêmico dos pacientes com DM2, de acordo comanálise da HbA1c e PCR,portanto, com base nos resultados dessa pesquisa, o tratamento periodontal não cirúrgico parece contribuir para o controle metabólico. Apesar disso, alguns estudos se opõem aoresultadodo controle glicêmicodesses pacientes, reforçando a existência de variáveis que interferem nos resultados da pesquisa, como os níveis de hemoglobina, estágio da doença periodontal, amostra, dietae atividade física dos pacientes.Conclusões:O resultado deverá ser avaliado com maior cautela, tendo em vista as possibilidades de variáveis presentes nesse tipo de pesquisa. Por fim, ensaios controlados devem ser realizados para alcançar um maior esclarecimento a respeito dos efeitos da terapia periodontal não cirúrgica no controle glicêmico de pacientes com DM2 (AU).

Introduction:Periodontal disease is a condition in which protective or supportive tissues of the tooth are affected by chronic inflammation caused by pathogens. This condition may be modified or associated with systemic diseases such as type 2 diabetes mellitus (T2DM).Objective:To evaluate the effects of nonsurgical periodontal therapy on glycemic control in patients diagnosed with T2DM. Methodology:An integrative review was performed using randomized clinical trials indexed in PubMed, Embase, Cochrane, Web of Science, and BVS databases. The descriptors "periodontal disease treatment," "glycemic control," and "metabolic control" were used. Results:From the reviewed studies, six were selected for the review considering the established inclusion and exclusion criteria.Basic periodontal therapy improves glycemic control in patients with T2DM, as evidenced by analysis of glycated hemoglobin (HbA1c) and polymerase chain reaction (PCR). Therefore, based on the results of this research, nonsurgical periodontal treatment contributes to metabolic control. However, some studies contradict the effect of glycemic control in these patients, reinforcing the presence of variables that interfere with research results, such as hemoglobin levels, stage of periodontal disease, sample, dietand physical activity of patients. Conclusions:The results should be evaluated with more caution considering the potential variables present in this type of research. Finally, controlled trials should be conducted to understand better the effects of nonsurgical periodontal therapy on glycemic control in patients with T2DM (AU).

Introducción: La enfermedad periodontal es una condición en la cual los tejidos protectores o de soportedel diente se ven afectados por una inflamación crónica causada por patógenos. Esta condición puede modificarse o asociarse a enfermedades sistémicas como la diabetes mellitus tipo 2 (DM2). Objetivo: Evaluar los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes diagnosticados con DM2. Metodología: Se realizó una revisión integradora utilizando ensayos clínicos aleatorizados indexados en las bases de datos de PubMed, Embase, Cochrane, Web of Science y BVS. Se utilizaron los descriptores "tratamiento de enfermedades periodontales", "control glucémico" y "control metabólico". Resultados: De los estudios revisados, se seleccionaron seis para la revisión, considerando los criterios de inclusión y exclusión establecidos. La terapia periodontal básica mejora el control glucémico en pacientes con DM2, como se evidencia en el análisis de la hemoglobina glicosilada (HbA1c) y la reacción en cadena de la polimerasa (PCR). Por lo tanto, basándose en los resultados de esta investigación, el tratamiento periodontal no quirúrgico contribuye al control metabólico. Sin embargo, algunos estudios contradicen el efecto del control glucémico en estos pacientes, lo que refuerza la presencia de variables que interfieren en los resultados de la investigación, como los niveles de hemoglobina, el estadio de la enfermedad periodontal, la muestra, la dieta y la actividad física de los pacientes. Conclusiones: Los resultados deben evaluarse con mayor precaución, considerando las posibles variables presentes en este tipo de investigación. Por último, se deben realizar ensayos controlados para comprender mejor los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes con DM2 (AU).

Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.

Efectividad del consumo de Brownies de sangrecita y el nivel de hemoglobina en niños de una institución educativa inicial pública, Ica / Effectiveness of the consumption of sangrecita brownies and the hemoglobin level in children of the Initial Educational Institution Public, Ica

Según la OPS, los países desarrollados alcanzan un 11% de prevalencia de anemia, mientras que en los países en vías de desarrollo afecta al tercio poblacional, llegando a superar el 50% en el continente africano y asiático. El estudio tuvo como Objetivo: Analizar la efectividad del consumo de brownies de sangrecita sobre los niveles de hemoglobina en niños de la Institución Educativa Inicial Pública, Ica. Material y métodos: Para el desarrollo se utilizó la metodología de tipo cuasi experimental, nivel aplicativo y de enfoque cuantitativo. La población de estudio estuvo conformada por 100 niños, se realizó el descarte de anemia mediante el analizador de hemoglobina (hemo Q), micro cubetas, lancetas y demás implementos médicos. Para analizar los resultados se tuvo en consideración los valores normales emitidos por el Ministerio de Salud(MINSA) y se utilizaron fichas de control. Resultados: Se captó a 4 niños de la IEI Nº14 Mercedes Dibós de Camino al realizar el tamizaje inicial de anemia, quienes tenían un nivel de hemoglobina inferior a los valores normales de acuerdo a la normativa del MINSA; luego de consumir los brownies de sangrecita en un intervalo de 3 veces por semana durante 7 semanas se evidenció un incremento en sus niveles de hemoglobina respecto al tamizaje inicial. Conclusiones: El consumo de brownie de sangrecita es efectivo en el tratamiento de la anemia en los niños, incrementando su nivel de hemoglobina entre 1.9 g/dl a 2.3 g/dl

According to PAHO, developed countries reach an 11% prevalence of anemia, while in developing countries it affects one third of the population, reaching over 50% in the African and Asian continents. The study had the Objective: To analyze the effectiveness of the consumption of sangrecita brownies on hemoglobin levels in children of the Initial Educational Institution Public, Ica. Material and methods: A quasi-experimental methodology with a quantitative approach was used for the development of the study. The study population consisted of 100 children. Anemia was ruled out using the hemoglobin analyzer (hemoQ), micro cuvettes, lancets and other medical implements. To analyze the results, the normal values issued by MINSA were taken into consideration and control cards were used. Results:4 children from the IEI Nº14 Mercedes Dibós de Camino were caught during the initial screening for anemia, who had a hemoglobin level below the normal values according to MINSA regulations; but after consuming the blood brownies at an interval of 3 times per week for 7 weeks, an increase in their hemoglobin levels was evidenced with respect to the initial screening. Conclusion: The consumption of sangrecita brownie is effective in the treatment of anemia in children by increasing their hemoglobin level, the increase value was between 1.9 g/dl and 2.3 g/dl.Key Words:Anemia, sangrecita brownie, hemoglobin, fortification, children.

Niveles plasmáticos de Vitamina D en adultos mayores de Lima Metropolitana, Perú

Objetivo. Determinar los niveles plasmáticos de vitamina D y su relación con la ocupación, procedencia y los valores de calcio, leucocitos, hemoglobina y plaquetas en adultos mayores de Lima Metropolitana. Método. Estudio observacional descriptivo de corte transversal, participaron 100 adultos mayores de uno u otro sexo de Lima Metropolitana, ellos fueron reclutados durante las estaciones de invierno-primavera del 2022, los niveles de vitamina D se categorizó como suficiente, insuficiente y deficiente, las concentraciones séricas de vitamina D se midieron por radioinmunoensayo. La relación de variables se realizó con el coeficiente de correlación de Spearman y regresión logística. Resultados. La edad media fue 69.6 años, el 71%, fueron del sexo femenino, la concentración media de vitamina D fue 36.56 ng/ml, el 13% tuvieron niveles de deficiente, y el 32% de insuficiente y el 53% suficientes. Según sexo, el 77,7% de los que tuvieron niveles de deficiente/insuficiente fueron mujeres. En el análisis bivariado no hubo correlación entre los valores de vitamina D con calcio, hemoglobina leucocitos y plaquetas, los que procedieron de distritos de menor temperatura tuvieron 2,25 veces más riesgo de tener niveles insuficientes/deficiente de vitamina D. Conclusiones. El 45% de los adultos mayores tuvieron niveles deficientes/insuficiente de vitamina D, siendo más frecuente en las mujeres y de los procedentes de distritos de menor promedio de temperatura.

Objective. To determine the plasmatic levels of vitamin D and its relationship with the occupation, origin and the values of calcium, leukocytes, hemoglobin and platelets in older adults of Metropolitan Lima. Methods Observational descriptive cross-sectional study, 100 older adults of either sex from Metropolitan Lima participated, they were recruited during the winter-spring seasons of 2022, vitamin D levels were categorised as sufficient, insufficient, and deficient, serum vitamin D concentrations were measured by radioimmunoassay. The relationship of variables was established with the Spearman correlation coefficient and logistic regression. Results. The mean age was 69.6 years, 71% were women, the mean vitamin D concentration was 36.56 ng/ml, 13% had deficient levels, 32% were insufficient and 53% sufficient. By sex, 77.7% of those with deficient/insufficient levels were women. In the bivariate analysis, there was no correlation between vitamin D values with calcium, hemoglobin, leukocytes and platelets; those who came from districts with lower temperatures had a 2.25 times greater risk of having insufficient/deficient levels of vitamin D. Conclusions. 45% of older adults had deficient/insufficient levels of vitamin D, more frequent in women and those coming from districts with lower average temperatures.

Hemoglobina Denver, una causa de desaturación en oximetría de pulso. Reporte de caso en un paciente pediátrico / Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report

Las hemoglobinopatías son trastornos genéticos que afectan a la molécula de hemoglobina (Hb). Las mutaciones en las cadenas a o b que alteran el tetrámero de Hb pueden modificar la capacidad de la molécula para unirse al oxígeno. Las hemoglobinopatías con baja afinidad al oxígeno pueden presentarse con cianosis y una lectura alterada de la oximetría de pulso, lo que lleva a pruebas innecesarias y, a veces, invasivas para descartar afecciones cardiovasculares y respiratorias. En el siguiente reporte de caso, presentamos a una paciente pediátrica, asintomática, que se presentó a la consulta por detección de desaturación en oximetría de pulso. Las pruebas de laboratorio iniciales mostraron una anemia normocítica, normocrómica. Las muestras de gas venoso demostraron una p50 elevada. Después de extensas herramientas de diagnóstico, se diagnosticó una variante de Hb con baja afinidad al oxígeno, Hb Denver.

Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.

MTHFR C677T Polymorphism, Plasma Homocysteine, and PDGF-AA Levels and Transcranial Doppler Velocity in Children With Sickle Cell Disease

Objective: To evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism on plasma homocysteine (tHcy) and platelet-derived growth factor (PDGF-AA) levels in children with sickle cell disease (SCD), and ascertain their role in predicting high transcranial doppler velocity (TCD). Methods: We estimated MTHFRC677T gene polymorphism, plasma tHyc and PDGF-AA in 44 SCD patients and 44 healthy children. Results: The prevalence of mutant homozygous MTHFR (C677TT) in SCD was 13.6%. Significantly higher plasma tHcy was observed in mutant homozygous MTHFRC677TT patients. Significantly higher plasma tHcy and PDGF-AA levels were observed in SCD patients than in controls. Median (IQR) PDGF-AA levels were significantly higher in conditional and high-risk TCD patients as compared to low-riskTCD patients [325 (93.1-368) and 368 (111-480) vs 111 (56-201) pg/mL, respectively; P<0.001]. Mean (SD) tHcy levels were significantly higher in high-risk TCD children than low-risk TCD children (12.9 (2.7) vs 9.9 (2.5) µmol/L; P=0.006). The receiver operating characteristic revealed that the area under the curve (AUC) of PDGF-AA for high TCD velocity was 0.934 (95% CI 0.845-1.00; P<0.001) and tHcy had an AUC of 0.675 (95% CI 0.517-0.833; P=0.04). Conclusion: PDGF-AA and tHcy levels could be used as predictive markers for stroke in SCD children. MTHFR Polymorphism contributes to elevated tHcy levels.

Differences in the distribution of hemoglobin variants according to the geographic regions in a Colombian population

ABSTRACT Introduction: Colombia has been subject to intense genetic and cultural currents due to its geographical location. Hemoglobinopathies are the most common recessive diseases found worldwide and represent an important public health problem, according to the region and ancestry of each country. Objectives: To evaluate the frequency of hemoglobin variants according to the geographical region in a population group adjusted to sex and age in Colombia. Methods: This was a descriptive retrospective study of hemoglobin variants performed by electrophoresis in patients treated at and/or referred to specialized care institutions in Bogota, Colombia between January 2009 and December 2020. Results: A total of 2,224 results were analyzed, 48.4% male and 51.5% female; 63.3% of patients were without alterations, 14.3% presented with thalassemia, 17.3%, HbS, 2.3%, HbS/C, 1.8%, HbC, 0.5%, HbE and 0.5% persistent HbF, with HbS being more prevalent in males (p = 0.005). When assessing the geographical regions of Colombia, a higher prevalence of HbS was found in the Pacific (p = 0.005) and Caribbean regions, while Thalassemia and HbS were more prevalent in the Andean and Orinoquia regions, and it was rare to find any hemoglobinopathies (p = 0.0001) in the Amazonian region. Conclusions: The main hemoglobinopathies found in Colombia are HbS, predominantly in males, and Thalassemia. The distribution of hemoglobinopathies in different geographical regions of Colombia is influenced by ancestry.

Fetal hemoglobin, blood transfusion, and retinopathy of prematurity in preterm infants: An observational, prospective study

Purpose: The objective of this study was to identify the association between fetal hemoglobin (HbF) concentration, blood transfusion, and retinopathy of prematurity (ROP) in preterm infants. Methods: This was an observational, prospective study. A total of 410 preterm infants born with <36 weeks gestational age and <2.0 kg birth weight in a tertiary care center of central India for a period of 1 year were included in this study. Clinical data were obtained from case notes. HbF of infants was measured in the blood sample using high?performance liquid chromatography at the first visit and after 1 month follow?up and was analyzed statistically. Dilated fundus examination was done as per ROP screening guidelines, and ROP was classified as per the International Classification of Retinopathy of Prematurity (ICROP), 2021. The study subjects were divided into two groups based on the status of ROP. The relationship among HbF, blood transfusion, and ROP was evaluated in both the groups. The relationship between other clinical characteristics and various neonatal risk factors was also studied between the groups. Results: A total of 410 preterm infants were included in this study, of which 110 infants had ROP (26.8%). Blood transfusion was found to be significantly associated with the development of ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP. HbF was also inversely related with the severity of ROP. Conclusion: Replacing HbF by adult hemoglobin during blood transfusion may promote the development of ROP. Conversely, maintaining a higher percentage of HbF may be a protective factor against ROP.

Efectividad del mousse de sangrecita y nivel de hemoglobina en los niños de 3 años en las instituciones educativas iniciales, Ica-Perú / Effectiveness of sangrecita mousse little blood and hemoglobin level in children from 3 years of age in the initial educational institutions Ica-Peru

El estudio tuvo como Objetivo: Evaluar la efectividad del mousse de sangrecita en los niveles de hemoglobina en los niños de dos instituciones Educativas iniciales. Materiales y métodos: Estudio Experimental con diseño cuasi experimental de corte longitudinal, la población de estudio estuvo conformada por 80 niños los cuales todos participaron (consentimiento de los padres), 52 niños fueron de la IEI de Ica y 28 de la IEI de Comatrana, para la muestra se realizó un muestreo no probabilístico mediante el descarte de anemia utilizando el analizador de hemoglobina (hemoQ), microcubetas, lancetas y demás implementos, de ellos 9 niños tuvieron una hemoglobina <=11gr/dl quienes ingresaron al programa de mousse de sangrecita. Se elaboró una ficha de control. Resultados: Después de 7 semanas de consumir el mousse de sangrecita los 9 niños que ingresaron al programa de las dos IEI, se evidencio un incremento en sus niveles de hemoglobina superior al primer control. Conclusiones: El consumo de mousse de sangrecita es efectiva en el tratamiento de la anemia en niños de la IEI incrementando el nivel de hemoglobina. (AU)

The Objective of the study was to evaluate the effectiveness of blood mousse on hemoglobin levels in children from two initial educational institutions. Materials and Methods: Study experimental Quasi-experimental desing of longitudinal cut, the study population was made up of 80 children who all participated (parental consent), 52 children were from the IEI of Ica and 28 from the IEI of Comatrana, for the sample a non-probability sampling was carried out by discarding anemia using the hemoglobin analyzer (hemoQ), microcuvettes, lancets andother implements, of them 9 children had a hemoglobin < = 11gr / dl who would enter the blood mousse program. A control sheet was drawn up. Results: After 7 weeks of consuming the blood mousse of the 9 children who entered the program of the two IEI, there was evidence of an increase in their hemoglobin levels higher than the first control. Conclusions: The consumption of blood mousse is effective in the treatment of anemia in children with IEI by increasing the level of hemoglobin. (AU)

Effect of megaloblastic anemia on hemoglobin A2 and diagnosis of ?-thalassemia trait

Context: ?-thalassemia trait is usually diagnosed by raised hemoglobin A2 (HbA2). The presence of megaloblastic anemia can cause an increase in HbA2 and create a diagnostic dilemma. Here, we have analyzed the effect of vitamin B12 and folic acid supplementation on HbA2 and diagnosis of ?-thalassemia trait in cases of megaloblastic anemia with raised HbA2. Materials and Methods: Cases of megaloblastic anemia with raised HbA2 on high-performance liquid chromatography (HPLC) were supplemented with vitamin B12 and folic acid. Post-treatment evaluation was done after 2 months. Cases showing adequate hematological response were subjected to statistical analysis. Based on post-treatment HbA2 value, the cases were diagnosed as normal, borderline raised HbA2, or ?-thalassemia trait. Pre- and post-treatment values of red cell parameters and HbA2 were analyzed. Results: There was a significant decrease in HbA2 value after vitamin B12 and folic acid supplementation. The diagnosis was changed in 70.97% of the cases after treatment. The chance of inconclusive diagnosis was decreased from more than 50% to less than 10%. Pre-treatment mean corpuscular volume (MCV) and HbA2% showed a significant difference between the thalassemic and normal groups. Conclusions: Megaloblastic anemia can lead to false-positive diagnosis of ?-thalassemia trait on HPLC. Repeat HPLC should be done after adequate supplementation of vitamin B12 and folic acid in cases of megaloblastic anemia with raised HbA2. Red cell parameters are not helpful to suspect ?-thalassemia trait in presence of megaloblastic anemia. However, HbA2% on HPLC can be a useful parameter to suspect or exclude ?-thalassemia trait in cases of megaloblastic anemia.

Third trimester HbA1c as a prognostic indicator in the prediction of large-for-gestational age babies in South Indian women with gestational diabetes mellitus: A cross-sectional study

Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.

Carbohydrate counting as a strategy to optimize glycemic control in type 1 diabetes mellitus

ABSTRACT Objective: The objective of this study was to verify the impact of carbohydrate counting (CC) on glycemic control and body weight variation (primary and secondary outcomes, respectively) between consultations in patients with diabetes mellitus (T1D) followed at a tertiary hospital in southern Brazil in a public health system environment. We also sought to investigate CC adherence. Materials and methods: This retrospective cohort study included 232 patients with T1D who underwent nutritional monitoring at a referral hospital for diabetes care between 2014 and 2018. To assess primary and secondary outcomes, data from 229 patients, 49 of whom underwent CC during this period and 180 individuals who used fixed doses of insulin, were analyzed. The impact of CC on glycemic control was assessed with the mean glycated hemoglobin (HbA1c) level at all consultations during the follow-up period. Results: In the model adjusted for the most confounders (except pregnancy), the mean HbA1c was better in the CC group (8.66 ± 0.4% vs. 9.36 ± 0.39%; p = 0.016), and body weight variation was lower (0.13 ± 0.28 kg vs. 0.53 ± 0.24 kg; p = 0.024). Adherence to CC was reported in 69.2% of consultations. Conclusion: CC optimized the glycemic control of individuals with T1D, resulting in less weight variation than in the fixed insulin dose group, which indicates that CC is an important care strategy for these patients.

Flash glucose monitoring system in patients with type 1 diabetes in healthcare center in Brazil: real world data from a short-term prospective study

ABSTRACT Objectives: To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D). Materials and methods: Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (-FGMi − SMBGi-) / SMBGi, where it was a paired data sample. Results: In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively. Conclusion: FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.

Estrés psicológico y angustia por diabetes en adultos con diabetes mellitus tipo 2: una revisión sistemática / Psychological Stress and Diabetes Distress in Adults with Type 2 Diabetes Mellitus: A Systematic Review / Estresse psicológico e angústia causada por diabetes em adultos com diabetes mellitus tipo 2: uma revisão sistemática

Introducción: la diabetes mellitus tipo 2 es una enfermedad crónica que puede causar estrés psicológico en el desarrollo de la enfermedad y como suceso estresante, mientras que la angustia por la diabetes se asocia con estresores como el descontrol de las concentraciones de glucosa, presencia de complicaciones agudas o crónicas, disciplina y apego en el tratamiento integral. El objetivo del estudio fue analizar la literatura científica disponible sobre el estrés psicológico y angustia por diabetes en relación con el con- trol glucémico en adultos con diabetes mellitus tipo 2. Materiales y métodos: para la búsqueda de literatura se utilizaron las bases de datos Pubmed, Medline, Biblioteca Virtual en Salud, CINAHL, EBSCO, Wiley y Google Académico. Se incluyeron artículos indexados en bases de datos con idioma inglés, español y portugués, de diseños descriptivos, correlacionales y experimentales publicados en el periodo 2010-2020. Los artículos se evaluaron a través de la lista de revisión del Joanna Briggs Institute. Resultados: se encontró que el estrés psicológico ocurre mayormente en mujeres y que la angustia por diabetes es predictora del control glucémico pobre, provoca un manejo inadecuado de la glucosa, aumenta la hemoglobina glucosilada y también es una de las causas de mortalidad en hombres. Conclusiones: los hallazgos muestran que existe mayor relación entre la angustia por diabetes y el control glucémico en estos pacientes

Introduction: type 2 diabetes mellitus is a chronic disease that can cause psychological stress in the development of the disease and as a stressful event, while diabetes distress is associated to stressors such as uncontrolled diabetes, presence of acute or chronic complications, discipline and adherence in comprehensive treatment. The aim of the study is to analyze the available scientific literature on psychological stress and diabetes distress in relation to glycemic control in adults with type 2 diabetes mellitus. Materials and methods: For the literature search, Pubmed, Medline, Virtual Health Library, CINAHL, EBSCO, Wiley and Google databases were used. Articles indexed with English, Spanish and Portuguese languages, with descriptive, correlational and experimental designs published in the period 2010 to 2020. The articles were evaluated through the Joanna Briggs Institute Check list. Results: 10 articles that met the inclusion criteria were analyzed, some studies showed an associated of psychological stress and diabetes distress with glycated hemoglobin, in addition, it was found that psychological stress is mostly in women and diabetes distress is a predictor of poor glycemic control, it causes inadequate glucose management, increases glycated hemoglobin and is also one of the causes of mortality in men. Conclusions: The findings show that there is a relationship mainly between diabetes distress and glycemic control in these patients.

Introdução: A diabetes mellitus tipo 2 é uma doença crônica que pode causar estresse psicológico no surgimento da doença e ser um evento estressante, enquanto que a angústia por diabetes está associada a estressores como os níveis glicose descontrolados, presença de complicações agudas ou crônicas, disciplina e aderência a um tratamento integral. O objetivo do estudo foi analisar a literatura científica disponível sobre o estresse psicológico e a angústia por diabetes em relação ao controle glicêmico em adultos com diabetes mellitus tipo 2. Materiais e métodos: As bases de dados Pubmed, Medline, Biblioteca Virtual en Salud, CINAHL, EBSCO, Wiley e Google foram utilizadas para a pesquisa bibliográfica. Foram incluídos artigos indexados em bases de dados em inglês, espanhol e português, com desenhos descritivos, correlacionais e experimentais publicados no período de 2010 a 2020. Os artigos foram avaliados através do Check List do Instituto Joanna Briggs. Resultados: Foram analisados 10 artigos que cumpriram com os critérios de inclusão, alguns estudos mostraram associação do estresse psicológico e angústia por diabetes com a hemoglobina glicosilada, além disso, descobriu-se que o estresse psicológico apresenta principalmente nas mulheres e a angústia por diabetes é um preditor de controle glicêmico deficiente, provocando manejo inadequado da glicose, aumentando a hemoglobina glicosilada e também, é uma das causas de mortalidade nos homens. Conclusões: Os resultados mostraram que existe uma maior relação entre a angustia por diabetes e o controle glicêmico nestes pacientes