Características y causas de muerte de pacientes fallecidos con enfermedad renal crónica. Cuba 2011-2016 / Deceased patients with chronic kidney disease. Characteristics and causes in Cuba during 2011-2016

Introducción: La morbimortalidad por enfermedad renal crónica (ERC) ha presentado en las dos últimas décadas un incremento desconcertante. En Cuba, aunque la mortalidad por esta causa ha tenido un comportamiento estable, la incidencia y la prevalencia se mantienen elevadas. Objetivo: Caracterizar los pacientes fallecidos con ERC según variables demográficas, causas de muerte y otras variables seleccionadas. Material y Métodos: Estudio descriptivo, transversal. El universo de estudio estuvo constituido por todos los fallecidos del país en el período, en cuyos certificados de defunción se incluyó entre una de las causas, la ERC. La información fue obtenida de las bases de datos de mortalidad de la Dirección Nacional de Registros Médicos y Estadísticos de Salud del MINSAP. Procesamiento de forma automatizada (SPSS versión 22.0). Fueron calculadas las frecuencias absolutas y relativas. Resultados: La frecuencia global de pacientes fallecidos se incrementó de forma mantenida y resultó mayor en la provincia La Habana (23,6 por ciento). La media de la edad fue de 70 años. Prevaleció el sexo masculino, el color de piel blanco y el grupo de edad de 80 años y más. Los porcentajes más altos según la causa básica de muerte correspondieron a enfermedad renal hipertensiva y Diabetes Mellitus. Conclusiones: Los fallecidos con ERC son mayormente hombres, de piel blanca, y con edades avanzadas. Las principales causas de muerte son la enfermedad hipertensiva y la Diabetes Mellitus(AU)

Introduction: Chronic kidney disease (CKD) has increased at an alarming rate worldwide over the last two decades. Although mortality due to CKD has registered stable behavior in Cuba, its prevalence and incidence are showing higher rates. Objective: To describe the main demographic features of deceased patients with CKD in Cuba, the causes of death and other variables during the period 2011-2016. Material and Methods: A descriptive cross-sectional study was conducted. The study universe included all deceased patients in Cuba during the period mentioned. CKD was listed on their death certificates as one of the causes of death. The information used was obtained from the mortality database available on the National Directorate of Medical Records and Health Statistics of the Cuban Ministry of Public Health. Data was processed using SPSS version 22.0. Absolute and relative frequencies were calculated. Results: The global frequency of deceased patients showed a steady increase. Havana was the city that presented the highest percentage (23,6 percent). Nonetheless, the rest of the cities showed an increased frequency rate. The median age was 70 years. The male gender prevailed over the female one as well as white ethnicity and the 80 years and over age group. Regarding the cause of death, the highest percentages corresponded to hypertensive kidney disease and Diabetes Mellitus. Conclusions: Most of the deceased patients with CKD are male, white and at advanced ages. The main causes of death are hypertensive disease and Diabetes Mellitus(AU)

Cardiovascular autonomic neuropathy in type 2 diabetic patients

SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.

RESUMO Diabetes é uma das mais frequentes patologias crônicas em todo o mundo, cujo tratamento envolve uma equipe multidisciplinar, médicos generalistas, endocrinologistas, cardiologistas, nefrologistas e oftalmologistas. Pacientes com diabetes mellitus tipo 2 (DMT2) podem apresentar neuropatia autonômica cardíaca (NAC), levando a aumento de mortalidade e morbidade. Nesta revisão, apresentaremos atuais conceitos, características clínicas, diagnóstico, prognóstico e possíveis tratamentos. Novas drogas recentemente desenvolvidas para redução de níveis glicêmicos apresentaram efeito pleiotrópico de redução de morte súbita, sugerindo um potencial uso neste perfil de pacientes.

Carga da doença para as amputações de membros inferiores atribuíveis ao diabetes mellitus no Estado de Santa Catarina, Brasil, 2008-2013 / Carga de enfermedad para las amputaciones de miembros inferiores, atribuibles a la diabetes mellitus en el Estado de Santa Catarina, Brasil, 2008-2013 / Burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, 2008-2013

O objetivo foi estimar a carga da doença para as amputações de membros inferiores atribuíveis ao diabetes mellitus no Estado de Santa Catarina, Brasil, no período de 2008 a 2013. Realizou-se um estudo epidemiológico descritivo, utilizando-se o cálculo de anos de vida perdidos ajustados por incapacidade (DALY - disability-adjusted life years). A carga da doença foi alta, mais de 8 mil DALY, distribuídos entre homens e mulheres. A incapacidade respondeu por 93% do DALY e a mortalidade por 7,5%. A carga dos homens foi 5.580,6 DALY, praticamente o dobro das mulheres (2.894,8), sendo que a participação do componente anos de vida saudável perdidos em virtude de incapacidade (YLD - years lost due to disability) dos homens impulsionou esta taxa para 67,6% do total do DALY. Os homens vivem mais tempo com a amputação, por isto perdem mais anos de vida sadia (65,8%), e a mortalidade é maior entre as mulheres (61%). As distribuições das taxas de DALY no estado não mostraram distribuição homogênea. A intensificação de avaliação, planejamento e desenvolvimento de estratégias custo-efetivas para a prevenção e educação em saúde para o pé diabético deve ser considera a partir da maior vulnerabilidade masculina.

El objetivo fue estimar la carga de enfermedad para las amputaciones de miembros inferiores, atribuibles a la diabetes mellitus en el Estado de Santa Catarina, Brasil, durante el período de 2008 a 2013. Se realizó un estudio epidemiológico descriptivo, utilizándose el cálculo de años de vida ajustados por discapacidad (DALY - disability-adjusted life years). La carga de la enfermedad fue alta, más de 8 mil DALY distribuidos entre hombres y mujeres. La incapacidad supuso un 93% del DALY y la mortalidad un 7,5%. La carga de los hombres fue 5.580,6 DALY, prácticamente el doble de las mujeres (2.894,8), siendo que la participación del componente años de vida saludable perdidos por discapacidad (YLD - years lost due to disability) de los hombres impulsó esta tasa hacia un 67,6% del total del DALY. Los hombres viven más tiempo con la amputación, por ello pierden más años de vida sana (65,8%), y la mortalidad es mayor entre las mujeres (61%). Las distribuciones de las tasas de DALY en el estado no mostraron distribución homogénea. La intensificación de evaluación, planificación y desarrollo de estrategias costo-efectivas para la prevención y educación en salud para el pie diabético debe ser considerada a partir de la mayor vulnerabilidad masculina

The objective was to estimate the burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, from 2008 to 2013. A descriptive epidemiological study was performed by calculating disability-adjusted life years (DALY). Burden of disease was high, more than 8,000 DALY in men and women. Disability accounted for 93% of DALY and mortality for 7.5%. The burden in men was 5,580.6 DALY, almost double that in women (2,894.8), and the share of the years lost due to disability (YLD) component in men pushed this rate to 67.6% of total DALY. Men live longer following amputation, so they lose more years of healthy life (65.8%), while mortality is higher in women (61%). DALY rates were not distributed homogeneously across the state. The intensification of evaluation, planning, and development of cost-effective strategies for prevention and health education for diabetic foot should be oriented according to higher male vulnerability.

Carga do diabetes mellitus tipo 2 no Brasil / Carga de la diabetes mellitus tipo 2 en Brasil / Burden of type 2 diabetes mellitus in Brazil

O diabetes mellitus tipo 2 se destaca, atualmente, na composição dos indicadores dos Estudos de Carga Global de Doença. Este estudo estimou a carga de doença atribuível ao diabetes mellitus tipo 2 e suas complicações crônicas no Brasil, 2008. Foram calculados os anos de vida perdidos ajustados por incapacidade (DALY), anos de vida perdidos por morte prematura (YLL) e os anos de vida perdidos por conta da incapacidade (YLD) estratificados por sexo, faixa etária e região. O diabetes mellitus tipo 2 representou 5% da carga de doença no Brasil, posicionando-se como a 3ª causa mais importante nas mulheres e a 6ª nos homens na construção do DALY. A maioria do DALY se concentrou na faixa etária entre 30 e 59 anos e foi representado majoritariamente pelo YLD. As maiores taxas de YLL e YLD se concentraram nas regiões Nordeste e Sul, respectivamente. As complicações crônicas do diabetes mellitus tipo 2 representaram 80% do YLD. O diabetes mellitus tipo 2 representou um dos principais agravos de saúde no Brasil em 2008, contribuindo com relevantes parcelas de mortalidade e morbidade.

La diabetes mellitus tipo 2 se destaca, actualmente, en la composición de los indicadores de los Estudios de Carga Global de Enfermedad. Este estudio estimó la carga de la enfermedad, atribuible a la diabetes mellitus tipo 2 y sus complicaciones crónicas en Brasil, 2008. Se calcularon los años de vida perdidos, ajustados por incapacidad (DALY), años de vida perdidos por muerte prematura (YLL) y los años de vida perdidos, debido a la incapacidad (YLD), estratificados por sexo, franja de edad y región. La diabetes mellitus tipo 2 representó un 5% de la carga de enfermedad en Brasil, posicionándose como la 3ª causa más importante en las mujeres y la 6ª en los hombres en la construcción del DALY. La mayoría del DALY se concentró en la franja de edad entre 30 y 59 años y fue representado mayoritariamente por el YLD. Las mayores tasas de YLL y YLD se concentraron en las regiones del nordeste y sur, respectivamente. Las complicaciones crónicas de la diabetes mellitus tipo 2 representaron un 80% del YLD. El diabetes mellitus tipo 2 representó uno de los principales agravios de salud en Brasil en 2008, contribuyendo con relevantes cuotas de mortalidad y morbilidad.

Type 2 diabetes mellitus currently ranks high among indicators used in Global Burden of Disease Studies. The current study estimated the burden of disease attributable to type 2 diabetes mellitus and its chronic complications in Brazil, 2008. We calculated disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) stratified by gender, age bracket, and major geographic region. Type 2 diabetes mellitus accounted for 5% of the burden of disease in Brazil, ranking 3rd in women and 6th in men in the composition of DALYs. The largest share of DALYs was concentrated in the 30-59-year age bracket and consisted mainly of YLDs. The highest YLL and YLD rates were in the Northeast and South of Brazil, respectively. Chronic complications represented 80% of YLDs from type 2 diabetes mellitus. Type 2 diabetes mellitus ranked as a leading health problem in Brazil in 2008, accounting for relevant shares of mortality and morbidity.

Alteraciones corneales en pacientes diabéticos / Corneal alterations in diabetic patients

La diabetes mellitus, afección frecuente a nivel mundial, tiene gran impacto en la sociedad no solo por su alta prevalencia, sino por sus complicaciones crónicas y su alta mortalidad. Afecta a unos 180 millones de personas en el mundo. La prevalencia de la diabetes (tipos I y II) se estima en el 13 % en pacientes mayores de 60 años. La estructura corneal sufre modificaciones en los pacientes diabéticos; la hiperglucemia afecta la hidratación de la córnea, y con esto varía el espesor corneal y aparecen cambios queratométricos visibles mediante topografía corneal. Las córneas de los pacientes con diabetes presentan alteraciones epiteliales, estromales y endoteliales. Además, existe una disminución de la permeabilidad endotelial durante la fase de hipoxia, que relacionan estos efectos de la diabetes en las células endoteliales. El objetivo de nuestro estudio es abordar las diferentes alteraciones corneales en los pacientes diabéticos(AU)

Diabetes Mellitus, a frequent disease worldwide, has a great impact on the society, not only for their high prevalence, but for their chronic complications and high mortality. It has an effect on 180 million people approximately in the world. The prevalence of diabetes (type I and II) is estimated to be 13 % in patients older than 60 years. The corneal structure undergoes changes in diabetic patients; the hyperglycemia affects the corneal hydration and causes variations in the corneal thickness, with occurrence of visible keratometric changes detected in the corneal topography. The corneas of diabetic patients show epithelial, stromal and endothelial alterations. Additionally, there is decrease in endothelial permeability during the phase of hypoxia that relate these effects of diabetes in the endothelial cells. The objective of our study was to deal with the different corneal alterations in diabetic patients(AU)

Prognosis and Complications of Diabetic Patients Undergoing Isolated Coronary Artery Bypass Surgery

Abstract Objective: Compare the prognosis and complications of diabetic and non-diabetic patients undergoing isolated coronary artery bypass surgery at a hospital with a high surgical volume. Methods: Data of patients who underwent coronary artery bypass surgery from June 2009 to July 2010 were analyzed. We selected diabetic and non-diabetic patients and evaluated their postoperative and long-term prognosis based on clinical complications. To reduce the disparity within the sample, statistical analyses were performed using propensity scores. Results: We included 2,688 patients who underwent coronary artery bypass surgery; 36% of them had diabetes, their mean age was 62.1±9.49 years and 70% (1,884) of them were men. Patients with diabetes were older (63±9 years vs. 61±10 years; P<0.001), more often obese (BMI>25 kg/m2: 70.7% vs.64.5%; P<0.001), dyslipidemic (50.4%vs. 41.1%; P<0.001), hypertensive (89.2% vs. 78.7%; P<0.001), and presented chronic renal failure (8.3% vs. 3.8%;P<0.001). They also presented higher rates of acute renal failure (5.6% vs. 2.7%, P<0.001), infection (11.4% vs. 7.2%, P<0.001) and mortality after one year (9.1% vs. 5.6%,P<0.001). Pneumonia was more common among patients with diabetes (7.7% vs. 4.0%, P<0.001). According to propensity scoring, 430 patients (215 diabetics and 215 non-diabetics) had a mean age of 61.3±8.97 years, and 21.2% (91 of 430) were women. However, diabetes was not an independent factor for poor prognosis. Conclusion: Patients with diabetes were at higher risk for postoperative complications and mortality after undergoing coronary artery bypass surgery. However, diabetes did not explain the poor prognosis of these patients after pairing this factor with the propensity score.

One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study / Mortalidade em um Ano após Evento Coronário Agudo e seus Preditores Clínicos: O estudo ERICO

Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease / Uso de próteses em amputados de membros inferiores por doença arterial periférica

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients. .

Objetivo Avaliar a protetização, durante a reabilitação, e a manutenção do uso da prótese, e o índice de abandono da mesma após a alta, bem como a mortalidade dos pacientes amputados de membros inferiores por doença arterial periférica. Métodos Estudo retrospectivo e transversal com pacientes amputados de membros inferiores nos níveis transtibial e transfemoral de etiologia vascular. A amostra foi composta por 310 pacientes (205 homens e 105 mulheres, média de idade de 61,8 anos), nos níveis transfemoral (142) e transtibial (150), unilateralmente ou bilateralmente (18). Foram protetizados 217 pacientes e 93 não. Foram utilizados testes estatísticos não paramétricos de igualdade de duas proporções, intervalo de confiança para média de 95% (IC95%) e valor de p<0,05 Resultados . Dos 195 pacientes contatados, 151 haviam sido protetizados e 44 não. Dos protetizados, 54 mantinham-se usando suas próteses, 80 haviam abandonado o uso e 17 faleceram. No grupo dos não protetizados, 27 continuavam usando cadeira de rodas e 17 tinham evoluído para óbito. A mortalidade é estatisticamente maior nos pacientes não protetizados e os 34 óbitos ocorreram, em média, após 3,91 anos da amputação. O tempo de sobrevida dos pacientes não protetizados foi menor que o dos protetizados. Conclusão A protetização de pacientes amputados de membros inferiores de etiologia vascular durante a reabilitação é alta, mas a manutenção do uso da prótese é baixa após o término do tratamento. A mortalidade desses pacientes é elevada e ...

Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention / Diabetes Mellitus e Glicemia como Preditores de Mortalidade na Intervenção Coronariana Primária

Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients. .

Fundamento: Diabetes Mellitus e glicemia de admissão são importantes fatores de risco para mortalidade em pacientes com infarto agudo do miocárdio com elevação do segmento ST, mas a contribuição relativa e independente de cada um deles permanece em debate na literatura. Objetivo: Analisar a influência de diabetes mellitus e da glicemia de admissão na mortalidade de pacientes com infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronariana percutânea primária. Métodos: Estudo de coorte prospectivo incluindo todos os pacientes com infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronariana percutânea primária em um centro terciário de cardiologia no período de dezembro de 2010 a maio de 2012. Foram coletados dados clínicos, laboratoriais e angiográficos, com seguimento clínico de 30 dias após o evento. A análise multivariada dos fatores de risco estudados foi ajustada para as variáveis do escore GRACE. Resultados: Dentre os 740 pacientes incluídos, a prevalência de diabetes mellitus relatada foi de 18%. Na análise simples, tanto diabetes mellitus quanto glicemia de admissão foram preditores de mortalidade em 30 dias. Entretanto, após ajuste de potenciais confundidores na análise multivariada, o risco proporcionado pelo diabetes mellitus deixou de ser significativo (risco relativo: 2,41, intervalo de confiança de 95%: 0,76 - 7,59; p = 0,13) enquanto a glicemia de admissão permaneceu como preditor independente de mortalidade em 30 dias (risco relativo: 1,05, intervalo de confiança de 95%: 1,02 - 1,09; p ≤ 0,01) Conclusão: Em pacientes com infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção ...

Extracranial and transcranial doppler sonography alterations in diabetic and non-diabetic patients with thrombotic stroke

Diabetes is a major risk factor for stroke. Some studies have shown that difference between clinical signs and prognosis in diabetic patients with stroke compared to non-diabetic patients with stroke is due to difference in pattern of cerebral vascular involvement. This study was done to compare the findings of extracranial and transcranial doppler sonography in diabetic and nondiabetic patients with thrombotic stroke. This case - control study was done on 70 diabetic patients and 70 non-diabetic patients with thrombotic stroke. All patients were new cases. Extracranial and transcranial Doppler sonography was performed for all subjects. Basilar artery stenosis was significantly more frequent in diabetic cases in comparison with non-diabetic patients [P<0.05]. The prevalenc of posterior circulation stenosis in diabetic patients was significantly higher than non-diabetic patients [P<0.05]. In diabetic patients, stenosis in vertebrobasilar circulation was more frequent. Higher morbidity and mortality in diabetic patients may be due to vascular stenosis pattern

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery? / Diabetes mellitus aumenta risco cirúrgico imediato em pacientes octogenários submetidos à cirurgia de revascularização miocárdica?

INTRODUCTION: Diabetes is a well known risk factor for early and late adverse outcomes in patients undergoing coronary artery bypass graft surgery (CABG); however, few studies have investigated the impact of this risk factor in the group of older patients, especially octogenarians. OBJECTIVES: To compare in-hospital mortality and morbidity of diabetic and nondiabetic patients aged > 80 years submitted to CABG. METHODS: A total of 140 consecutive cases were studied, of whom 37 (26.4%) were diabetics, in a retrospective cross-sectional study, that included all patients aged > 80 years submitted to isolated/associated CABG. The patients' mean age was 82.5 ± 2.2 years and 55.7% were males. RESULTS: The hospital mortality rate did not significantly differ in multivariate analysis: 16.2% diabetic x 13.6% nondiabetic (P = 0.554), as well as morbidity: 43.2% x 37.9%, respectively (P = 0.533). Regarding to operative morbidity, the occurrence of stroke was significantly higher in diabetic patients in the univariate analysis (10.8% x 1.9%, P = 0.042). In multivariate analysis, however, the incidence of stroke was not associated with the presence of diabetes (P = 0.085), but it was associated with atrial fibrillation (P = 0.044). There was no significant difference related to other complications. CONCLUSION: In this small consecutive retrospectively analyzed series, there was no significant increase in hospital mortality and morbidity related to diabetes for CABG in octogenarian patients. The impact of the results of this study is limited by the sample size and might be confirmed by future randomized clinical trials.

INTRODUÇÃO: O diabetes é um fator de risco conhecido para eventos adversos precoces e tardios em pacientes submetidos à cirurgia de revascularização miocárdica (CRM); entretanto, poucos estudos investigaram sua influência no grupo de pacientes mais idosos, especialmente nos octogenários. OBJETIVOS: Comparar a mortalidade e a morbidade hospitalar de pacientes com idade > 80 anos diabéticos e não-diabéticos submetidos à CRM. MÉTODOS: Foram estudados 140 casos consecutivos, sendo 37 (26,4%) diabéticos, em um estudo transversal retrospectivo incluindo todos os pacientes com idade > 80 anos submetidos à CRM isolada/associada. A idade média dos pacientes foi de 82,5 ± 2,2 anos e 55,7% eram do sexo masculino. RESULTADOS: A taxa de mortalidade hospitalar não diferiu de maneira significativa na análise multivariada entre os grupos, 16,2% diabéticos x 13,6% não-diabéticos (P=0,554), assim como a morbidade pós-operatória, 43,2 x 37,9%, respectivamente (P=0,533). Em relação à morbidade, a ocorrência de acidente vascular cerebral foi significativamente maior em pacientes diabéticos na análise univariada (10,8% x 1,9%; P = 0,042). Na análise multivariada, no entanto, a incidência dessa complicação não foi associada com a presença de diabetes (P=0,085), mas com a presença de fibrilação atrial (P=0,044). Não se observou nenhuma diferença significativa em relação às outras complicações. CONCLUSÃO: Nessa pequena série de casos retrospectiva, não houve um aumento significativo da morbimortalidade hospitalar no grupo de pacientes octogenários diabéticos. O impacto dos resultados desta série é limitado pelo tamanho amostral e poderá ser confirmado por futuros ensaios clínicos randomizados.

Asociación de la neuropatía autonómica cardiovascular y el intervalo QT prolongado con la morbimortalidad cardiovascular en pacientes con diabetes mellitus tipo 2 / Association of cardiovascular autonomic neuropathy and prolonged QT interval with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus

Con el objetivo de evaluar la relación entre la neuropatía autonómica cardiovascular (NACV) y el intervalo QT corregido (QTc) con la morbimortalidad cardiovascular en pacientes con diabetes mellitus tipo 2, se realizó el seguimiento a 5 años de 67 pacientes que acudieron a consulta externa del Servicio de Endocrinología. Se presentaron eventos cardiovasculares en 16 pacientes; el 82 por ciento completó el seguimiento y se encontró que el intervalo QTc prolongado fue la única variable que se asoció de forma significativa a morbimortalidad cardiovascular en el análisis de regresión logística múltiple (RR: 13,56; IC 95 por ciento: 2,01-91,36) (p=0,0074).

In order to evaluate the relationship between cardiovascular autonomic neuropathy and corrected QT interval (QTc) with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus, we followed up for 5 years 67 patients attending the outpatient Endocrinology Service. 82 percent completed follow-up and cardiovascular events occurred in 16 patients. We found that long QTc interval was the only variable significantly associated with cardiovascular morbidity and mortality in the multiple logistic regression analysis (RR: 13.56, 95 percent CI: 2.01-91.36) (p = 0.0074).

[Prevalence and pattern of infections among diabetes mellitus in-patients of Avesina Teaching Hospital of Qazvin [2009-2010]]

Infections are believed to occur with increased frequency in patients with diabetes mellitus. The goal of this study was to determine the common infections in diabetic patients referred to Avesina Hospital in Qazvin. This was a cross-sectional study performed on 656 diabetic patients who were referred to Avesina Hospital in Qazvin [Iran] during September 2009 to April 2010. A questionnaire containing demographic information, type of diabetes, duration of disease, and type of infection was completed for each patient. Data were later analyzed using SPSS software and chi- Square of 656 patients, 126 cases [19.2%] suffered infection and the commonest infections involved were diabetic foot [52%] and urinary tract infection [26%]. Considering the data found in our study, attempts to immediately diagnose the type of infection in diabetic patients to reduce the rate of mortality are necessary

Estudo retrospectivo das implicações maternas, fetais e perinatais em mulheres portadoras de diabetes, em 20 anos de acompanhamento no Hospital Escola da Universidade Federal do Triângulo Mineiro / Retrospective study of the maternal, fetal and perinatal outcomes in diabetic women in twenty years of assistance in the Universidade Federal do Triângulo Mineiro School Hospital

OBJETIVOS: Avaliar implicações do diabetes melito (DM) na morbimortalidade materno-fetal, segundo experiência da Universidade Federal do Triângulo Mineiro. MATERIAIS E METODOS: Procedeu-se à análise retrospectiva dos prontuários de gestantes diabéticas assistidas entre 1990 e 2009 focando dados e complicações maternas e neonatais. RESULTADOS: A última gestação de 93 diabéticas foi avaliada, sendo 34 com DM tipo 1, em que se observou maior ocorrência de tocotrauma (p = 0,023) e retinopatia (p = 0,023). Vinte e uma pacientes tinham DM tipo 2; suas necessidades de insulina aumentaram progressivamente (p < 0,01) e observou-se maior prevalência de tabagismo (p = 0,004). Trinta e oito tiveram diabetes gestacional e iniciaram acompanhamento do diabetes em idade gestacional mais tardia (p < 0,001), tiveram mais antecedentes de macrossomia fetal (p = 0,028) e maior prevalência de fatores de risco cardiovascular. CONCLUSÕES: Não obstante melhora do controle glicêmico durante a gestação, nenhum dos grupos atingiu alvos glicêmicos ideais. Ainda assim, a maioria das gestações em diabéticas, conduzidas em nosso meio, evoluiu favoravelmente.

OBJECTIVES: Evaluation of the consequences of diabetes mellitus (DM) on maternal and fetal morbidity and mortality at Universidade Federal do Triângulo Mineiro. MATERIALS AND METHODS: A retrospective review of medical records of pregnant women with diabetes was carried out at the hospital between 1990-2009, focusing on maternal and neonatal data and complications. RESULTS: The last pregnancy of 93 diabetics was evaluated. In thirty-four patients with type 1 diabetes a higher incidence of birth trauma (p = 0.023) and retinopathy (p = 0.023) was observed. Twenty-one type 2 DM subjects required progressively increased insulin therapy (p < 0.01) and showed a higher prevalence of smoking (p = 0.004). Thirty-eight had gestational diabetes. Their diabetic follow-up started at a later gestational age (p < 0.001), had more fetal macrosomia histories (p = 0.028) and cardiovascular risk factors. CONCLUSIONS: Despite improvement of glycemic control during pregnancy neither group attained the glycemic target. However, the majority of DM pregnancies evaluated in our group presented successful outcomes.

Fração da carga global do diabetes mellitus atribuível ao excesso de peso e à obesidade no Brasil / Fraction of the global burden of diabetes mellitus attributable to overweight and obesity in Brazil

OBJETIVO: Estimar a carga global do diabetes mellitus (DM) para o período de 2002 a 2003 e calcular, para o mesmo período, a fração do diabetes atribuível ao excesso de peso e à obesidade para o Brasil e suas regiões. MÉTODOS: A prevalência de excesso de peso e obesidade por sexo e faixa etária (> 20 anos) e os riscos relativos (obtidos de estudos internacionais) para o desenvolvimento do DM atribuíveis ao excesso de peso e à obesidade foram utilizados para o cálculo da carga global do diabetes. A prevalência de excesso de peso e obesidade para o Brasil e suas regiões foi obtida da Pesquisa de Orçamento Familiar. Foram calculados, para o DM, os anos de vida ajustados para incapacidade (disability-adjusted life years, DALY) a partir da soma de duas parcelas: anos de vida perdidos por morte prematura (years of life lost, YLL) e anos de vida perdidos devido à incapacidade (years lived with disability, YLD). RESULTADOS: Do total de DALY estimados para o DM no Brasil, 70 por cento provinham dos YLD. Para o Brasil como um todo, 61,8 e 45,4 por cento do DM no sexo feminino foram atribuíveis a excesso de peso e obesidade, respectivamente. No sexo masculino, esses percentuais foram de 52,8 e 32,7 por cento. As maiores frações atribuíveis foram encontradas nas regiões Sul, Sudeste e Centro-Oeste e para o grupo populacional entre 35 a 44 anos de idade. CONCLUSÃO: Grande parte da carga do diabetes é atribuível a fatores de risco evitáveis. Medidas voltadas para a prevenção e controle desses fatores de risco, como o excesso de peso e a obesidade, devem estar inseridas na agenda de saúde pública brasileira.

OBJECTIVE: To estimate the global burden of diabetes mellitus (DM) in 2002-2003 and to calculate the fraction of diabetes attributable to excess weight and obesity for Brazil and its regions. METHODS: The prevalence of excess weight and obesity according to sex and age (> 20 years) and the relative risks for the development of DM (derived from international studies) attributable to excess weight and obesity were used to calculate the global burden of DM. The prevalence of excess weight and obesity for Brazil and its regions was obtained from the Family Budget Survey (Pesquisa de Orçamento Familiar). Disability-adjusted life years (DALY) were calculated for DM based on the sum of two components: years of life lost (YLL) and years lived with disability (YLD). RESULTS: Of the total DALY estimated for DM in Brazil, YLD accounted for 70 percent. For Brazil as a whole, 61.8 percent and 45.4 percent of DM in females was attributable to excess weight and obesity, respectively. Among males, the proportions were 52.8 percent and 32.7 percent. The largest excess weight/obesity-attributable fractions were observed in the South, Southeast, and Midwest regions and in the 35-44-year-old age groups. CONCLUSIONS: A large fraction of the burden of DM is attributable to preventable individual risk factors. Measures targeting prevention and control of risk factors such as excess weight and obesity must be included in the Brazilian public health agenda.

Mortalidad por diabetes mellitus y sus complicaciones, Ciudad de La Habana, 1990-2002 / Mortality rate due to diabetes mellitus and its complications, Ciudad de La Habana, 1990-2002

OBJETIVO: identificar la mortalidad por diabetes mellitus y sus complicaciones que constituyeron causa directa de muerte en Ciudad de La Habana, y su distribución según variables demográficas en el período 1990-2002. MÉTODOS: se realizó una investigación retrospectiva descriptiva. Se utilizaron las bases de datos de fallecidos por diabetes mellitus, registradas en el Departamento Provincial de Estadística. RESULTADOS: hubo tendencia a la disminución de la mortalidad por diabetes mellitus como causa básica y sus complicaciones como causas directas de muerte, excepto para las complicaciones renales que tuvieron un discreto incremento. Como causa directa de muerte más frecuente se encontraron las complicaciones cardiovasculares; la mortalidad resultó mayor después de los 65 años de edad, sobre todo en el grupo de 80 a 84 años, y en el sexo femenino. Los municipios con mayores tasas ajustadas de muerte fueron Habana del Este, Guanabacoa, Diez de Octubre, San Miguel del Padrón, Marianao y Lisa. CONCLUSIONES: en estas localidades se deben incrementar los cuidados médicos a las personas con diabetes y tratar de disminuir la mortalidad por esta enfermedad(AU)

OBJECTIVE: to identify the mortality due to diabetes mellitus and its complications as a direct cause of death in Ciudad de La Habana and its distribution according to demographic variables during 1990-2002. METHODS: a descriptive and retrospective research was conducted. Databases of those deceased due to diabetes mellitus registered in the Statistics Provincial Department were used. RESULTS: there was a trend to decrease of diabetes mellitus mortality as a basic cause and its complications as direct cause of death, except for a moderate increase of renal complications. As more frequent direct causes of death were the cardiovascular complications; mortality was greater after 65 years old mainly in the 80-84 age groups and in the female sex. The municipalities with higher death adjusted rates were Habana del Este, Guanabacoa, Diez de Octubre, San Miguel del Padrón, Marianao and Lisa. CONCLUSIONS: in these places the medical care must to be increased to diabetes persons and try to decrease the mortality due this disease(AU)

Global burden of disease attributable to diabetes mellitus in Brazil / Carga global de doença devida e atribuível ao diabetes mellitus no Brasil

Type II diabetes mellitus accounts for 90 percent of all cases of diabetes, and its inclusion in health evaluation has shown that its complications have a considerable impact on the population's quality of life. The current article presents the results of the Global Burden of Disease Study in Brazil for the year 1998, with an emphasis on diabetes mellitus and its complications. The indicator used was disability-adjusted life years (DALY), using a discount rate of 3 percent. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7 percent of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries. Retinopathy and neuropathy were the complications that contributed most to YLDs. According to forecasts, diabetes mellitus will have an increasing impact on years of life lost due to premature death and disability in the world, shifting from the 11th to 7th cause of death by 2030. It is thus urgent to implement effective measures for prevention, early diagnosis, counseling, and adequate follow-up of patients with diabetes mellitus.

O diabetes mellitus tipo II é responsável por 90 por cento de todos os casos de diabetes, e sua inclusão na avaliação de saúde evidencia que as suas complicações têm um considerável impacto na qualidade de vida de uma população. O presente artigo apresenta os resultados do Estudo de Carga Global de Doença, realizado no Brasil para o ano de 1998, com ênfase no diabetes mellitus e suas complicações. O indicador utilizado foi o disability-adjusted life years (DALY), ao qual aplicou-se a taxa de desconto de 3 por cento. No Brasil, doenças isquêmicas do coração, doenças cardiovasculares e diabetes contribuíram com 14,7 por cento do total de DALY. Observou-se uma maior participação do years lived with disability (YLD) no total de DALY para o diabetes quando comparado a outros países. As complicações retinopatias e neuropatias foram as que mais contribuíram para o YLD. Projeções indicam que o diabetes mellitus terá crescente impacto sobre a perda de anos de vida por morte prematura e incapacidade no mundo, e que se deslocará de 11ª para 7ª causa de morte em 2030. Faz-se urgente a implantação e implementação de medidas efetivas para prevenção, diagnóstico precoce, aconselhamento e adequado acompanhamento dos pacientes com diabetes mellitus.

Prevalencia de diabetes mellitus en un servicio de medicina interna: causas de hospitalización y factores asociados a morbimortalidad / Prevalence of diabetes mellitus among patients admitted to a medical service of a general hospital

Background: Hyperglycemia among hospitalized patients is a common finding as is associated with a worse prognosis in patients with an without a history of diabetes. An optimal control of blood glucose reduces complications in these patients. Although the national prevalence of diabetes in Chile is well know, data on its prevalence among hospitalized patients is scanty. Aim: To assess the prevalence of diabetes and its association with hospital evolution among patients admitted to a medical service of a public hospital. Patients and Methods: In a prospective study from august to october of 2006 period, the cause of admission and the presence of diabetes mellitus was registered for every patient admitted to the medicine service. Among diabetics, the type of diabetes and the length of disease was recorded. Patients were followed during hospital stay, registering length of hospitalization, complications and mortality. Results: A total of 367 patients were studied and 92 (26 percent) were diabetics. Among the latter, 96 percent had type 2 diabetes and the main causes of admission were cardiovascular diseases in 38 (40 percent), infections in 18 (19 percent) and acute complications of diabetes in 13 (13 percent). Hospital mortality among diabetic and non diabetic patients was 6 and 4 percent, respectively (p = NS). Complications during hospital stay among diabetic and non diabetic patients, occurred in 15 and 9 percent, respectively (p = 0.064). The length of hospital stay was 8.8 and 9.2 days in diabetic and non diabetic patients, respectively (p = NS). Those patients with a diabetes lasting for more than 10 years had a higher rate of complications. Conclusions: The prevalence diabetes mellitus among hospitalized diabetic patients is higher than registered in national statistics. Patients with a diabetes lasting more than 10 years have more complications during hospital stay.

Foot care among male diabetics in family practice center, Abha, Saudi Arabia

This study aims to assess the behaviors of diabetic males towards their foot care at Al-Manhal Center of Family Practice, Aseer Region, KSA. A cross-sectional study was conducted for male diabetics in the Aseer region, KSA, during the first quarter of the year 2004.A questionnaire and physical examination of the foot were used to assess their behaviors towards foot care. All the male diabetic patients [107] who attended during the study period were assessed Mean age was 58 years, mean duration of DM was 10 years. Good diabetic control was 24%, 37% did not know the negative effect of DM on the feet, 9-22% had different symptoms of diabetic foot, 53% checked their fret regularly, 31% had fungal infection while an absence of pulse was detected in 7%.This study revealed that many diabetics had negative behaviors towards foot care. There is a need for intensive health education and regular assessment in order to detect, prevent and manage diabetic foot as early as possible