Predictores de mal pronóstico en pacientes con la COVID-19 / Predictors of poor prognosis in patients with COVID-19

Introducción: La COVID-19 se ha caracterizado por un amplio espectro de manifestaciones y formas clínicas que comprenden desde enfermedad ligera hasta la muerte. Es de suma importancia identificar a aquellos con mayores probabilidades de desarrollar las complicaciones. Objetivo: Identificar factores de riesgo para desarrollar complicaciones en los pacientes atendidos con la COVID-19. Métodos: Fueron revisadas las 250 historias clínicas de pacientes ingresados por la COVID-19. Se recopilaron edad, sexo, antecedentes patológicos personales, exámenes de laboratorio y la presencia o no de complicaciones. Se utilizó ji cuadrado para identificar relación entre las complicaciones y el sexo. Fue calculado el Odds Ratio (OR) para complicaciones por grupos de edad, antecedentes patológicos personales y parámetros humorales. Resultados: El distrés respiratorio fue más frecuente en hombres (p = 0,023). Los grupos de edad más afectados fueron de 60 a 79 años y de 80 años y más (OR = 4,85 y 30,53 respectivamente). Fueron factores de riesgo los antecedentes de hipertensión arterial, cardiopatía isquémica, diabetes mellitus, insuficiencia renal crónica y demencia (OR = 4,48; 4,22; 8,75; 17,98 y 10,39 respectivamente). Predispusieron a complicaciones, hematocrito y linfocitos bajo, así como neutrófilos, glucemia, creatinina, ASAT, GGT y LDH altos. Conclusiones: El mayor riesgo de complicaciones lo tuvieron pacientes mayores de 60 años, con enfermedades cardiovasculares, diabetes mellitus, insuficiencia renal y demencia. La presencia de hematocrito y linfocitos bajo, o neutrófilos, glucemia, creatinina, ASAT, GGT y LDH altos, alerta sobre posibles complicaciones(AU)

Introduction: COVID-19 has been characterized by a wide spectrum of manifestations and clinical forms that range from mild illness to death. Identifying those most likely to develop complications is critical. Objective: To identify risk factors for developing complications in patients treated with COVID-19. Methods: 250 medical records of patients admitted for COVID-19 were reviewed. Age, sex, personal pathological history, laboratory tests and the presence or absence of complications were collected. Chi-square was used to identify the relationship between complications and sex. The Odds Ratio (OR) was calculated for complications by age groups, personal pathological history, and humoral parameters. Results: Respiratory distress was more frequent in men (p=0.023). The most affected age groups were 60 to 79 years and 80 years and over (OR=4.85 and 30.53 respectively). Risk factors were the history of arterial hypertension, ischemic heart disease, diabetes mellitus, chronic kidney insufficiency and dementia (OR=4.48, 4.22, 8.75, 17.98 and 10.39 respectively). Low hematocrit and lymphocytes were predisposed to complications, as well as high neutrophils, glycaemia, creatinine, ASAT, GGT and LDH. Conclusions: The highest risk of complications was in patients older than 60 years, with cardiovascular diseases, diabetes mellitus, kidney insufficiency and dementia. The presence of low hematocrit and lymphocytes, or high neutrophils, glycaemia, creatinine, ASAT, GGT and LDH, alerts you to possible complications(AU)

Profile of patients with hypertension and/or diabetes mellitus from Primary Healthcare units / Perfil de pacientes com hipertensão arterial e/ou diabetes mellitus de unidades de Atenção Primária à Saúde

ABSTRACT Objective To analyze the characteristics of patients with hypertension and/or diabetes mellitus from Primary Healthcare units. Methods This is a retrospective study, with data collected from December 2014 of patients with hypertension and/or diabetes from 13 Primary Healthcare units located in the Southern region of Sao Paulo (SP, Brazil). Patients were compared by sex, diagnosis and cardiovascular risk using student t test, one way analysis of variance (ANOVA), and Mann-Whitney, Kruskal-Wallis and χ2 tests. Results We evaluated 28,496 patients aged 20 years to 79 years (mean of 57.8 years). Most of patients were women (63.2%) and aged 50 years old or older (74.2%). The participation in the Programa Remédio em Casa (Medicine at Home Program) was higher among women (12.7%), and the proportions of hypertension, diabetes and both diseases were 68.0%, 7.9% and 24.1%, respectively. Patients with hypertension and diabetes had higher participation in Medicine at Home Program (13.3%), and those with diabetes only had higher participation in Programa de Automonitoramento Glicêmico (Self-Monitoring Glucose Program) (20.0%). The proportions of low, moderate, and high cardiovascular risk were 33.0%, 15.5%, and 51.5%, respectively. Conclusion The sample of this study consisted of patients who were mostly women, aged 50 years or older and diagnosed with hypertension. Almost a quarter of patients also had diabetes and approximately one third and half of them were classified as low and high cardiovascular risk.

RESUMO Objetivo Analisar as características de pacientes com hipertensão arterial e/ou diabetes mellitus de unidades de Atenção Primária à Saúde. Métodos Estudo retrospectivo, com dados de dezembro de 2014 de pacientes com hipertensão e/ou diabetes, de 13 unidades de Atenção Primária à Saúde localizadas na região sul da cidade de São Paulo (SP). Os pacientes foram comparados por sexo, diagnósticos e risco cardiovascular, por meio dos testes t de Student, análise de variância de um fator, Mann-Whitney, Kruskal-Wallis e χ2. Resultados Foram avaliados 28.496 pacientes, de 20 anos a 79 anos de idade (média de 57,8 anos), sendo a maioria do sexo feminino (63,2%) e com 50 anos ou mais de idade (74,2%). A participação no Programa Remédio em Casa foi maior no sexo feminino (12,7%) e as proporções de hipertensão, diabetes e de ambas as doenças foram de 68,0%, 7,9% e 24,1%, respectivamente. Os pacientes com hipertensão e diabetes apresentaram maior proporção de participação no Programa Remédio em Casa (13,3%) e aqueles com apenas diabetes apresentaram maior proporção de participação no Programa de Automonitoramento Glicêmico (20,0%). As proporções de risco cardiovascular baixo, moderado e alto foram de 33,0%, 15,5% e 51,5%, respectivamente. Conclusão A amostra deste estudo foi constituída por pacientes em sua maioria do sexo feminino, com 50 anos ou mais de idade e diagnóstico de hipertensão. Cerca de um quarto dos pacientes apresentava também diabetes e aproximadamente um terço e metade deles foram categorizados como risco cardiovascular baixo e alto, respectivamente.

Tuberculose e diabetes: associação com características sociodemográficas e de diagnóstico e tratamento. Brasil, 2007-2011 / Tuberculosis and diabetes: association with sociodemographic characteristics and diagnosis and treatment of tuberculosis. Brazil, 2007-2011

RESUMO: Introdução: A comorbidade tuberculose e diabetes ainda continua um desafio para a saúde pública mundial. Objetivo: Analisar o perfil sociodemográfico e as características do diagnóstico e tratamento dos casos de tuberculose com e sem diabetes no Brasil. Métodos: Estudo transversal, com dados do Sistema de Informação de Agravos de Notificação e do Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica, no período de 2007 a 2011. Modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência (RP) e seus respectivos intervalos de confiança. Resultados: A comorbidade estudada foi encontrada em 7,2% dos casos. Modelo hierárquico mostrou maior RP entre indivíduos do sexo feminino (RP = 1,31; intervalo de confiança de 95% - IC95% 1,27 - 1,35); maior associação nas faixas etárias 40-59 anos e ≥ 60 anos (RP = 11,70; IC95% 10,21 - 13,39 e RP = 17,49; IC95% 15,26-20,05) e com resultado positivo da baciloscopia - primeira amostra (RP = 1,40; IC95% 1,35 - 1,47). Reingresso após abandono e abandono foram inversamente associados na comorbidade (RP = 0,66; IC95% 0,57 - 0,76 e RP = 0,79; IC95% 0,72 - 0,87). Conclusão: Os achados, como a relação inversa do abandono ao tratamento da tuberculose no grupo das pessoas com comorbidade, reforçam a importância de ações integradas nos serviços para mudar o cenário dessa desafiadora comorbidade.

ABSTRACT: Introduction: Tuberculosis and diabetes comorbidity remains a challenge for global public health. Objective: To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. Methods: This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. Results: We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). Conclusion: The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.

The relation between echocardiographic epicardial fat thickness and cha2ds2-vasc score in patients with sinus rhythm

Abstract Objective: To evaluate the predictive value of epicardial fat thickness (EFT) in CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) score risk groups. Methods: A total of 158 consecutive patients (75 females, 83 males, mean age 70.8±6.3 years) admitted routinely for cardiologic control were divided into two groups according to their CHA2DS2-VASc scores (scores 0 and 1 were regarded as low risk, and score ≥2 as high risk). One hundred twenty-five of 158 patients had a high-risk score. Results: Mean EFT was significantly higher in the high-risk group than in the low-risk group (4.34±0.62 vs. 5.37±1.0; P<0.001). EFT was positively correlated with CHA2DS2-VASc score (r=0.577, P<0.001). According to receiver operating characteristics (ROC) analysis, EFT value of 4.4 mm was found to be predictive of high risk in CHA2DS2-VASc score with 80% of sensitivity and 79% of specificity (C-statistic = 0.875, P<0.001, 95% confidence interval [CI] = 0.76-0.90). And according to multivariate logistic regression analysis, EFT was an independent predictor of high thromboembolic risk in terms of CHA2DS2-VASc score. Conclusion: Our findings suggest that echocardiographic EFT measurement could provide additional information on assessing cardiovascular risks, such as thromboembolic events, and individuals with increased EFT should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.

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.

Advances in early biomarkers of diabetic nephropathy

Summary Diabetic nephropathy is the main cause of chronic kidney disease, and represents the most common and serious complication of diabetes. The exact pathogenesis is complex and not elucidated. Several factors and mechanisms contribute to the development and outcome of diabetic nephropathy. An early diagnosis and intervention may slow down disease progression. A variety of biological markers associated with diabetic nephropathy were found in recent years, which was important for predicting the occurrence and development of the disease. Therefore, this article provides an overview of early biomarkers that are associated with diabetic nephropathy.

Microalbuminuria como factor pronóstico de mortalidad en pacientes con estado de choque / Microalbuminuria as a prognostic factor for mortality in patients with shock

La detección de micro albuminuria permite el rápido diagnóstico de nefropatía incipiente, predecir desarrollo de proteinuria y aumento de mortalidad; siendo la medición en orina de 24 horas Gold standard para su diagnóstico. En sepsis el aumento de permeabilidad vascular favorece paso de sustancias como albúmina y con ello producir micro albuminuria, cuya medición es pronostica de mortalidad en unidad de terapia intensiva. Diseño: estudio descriptivo transversal donde se evaluaron 27 pacientes ingresados en unidad de terapia intensiva de adultos del hospital general de enfermedades debiendo cumplir con: antecedentes de hipertensión arterial y/o diabetes mellitus, tener diagnóstico de choque hipovolémico o séptico, medición de escalas pronosticas de mortalidad y tener examen de orina de 24 horas para evaluar presencia de micro albuminuria, posteriormente se evaluó la condición de egreso como vivo o muerto. Métodos: Se realizó cálculo de Chi2 de homogeneidad o Test Exacto de Fisher para variables categóricas. La normalidad de variables numéricas se determinó con Shaphiro Wilk; si era normal se realizó t de Student de Muestras independientes y de lo contrario U de Mann Whitney. Resultados: Edad media de 50.29 años, principalmente hombres con antecedente de diabetes y diagnóstico de choque séptico. Obteniéndose una media para micro albuminuria en 31.93 mg/dl en pacientes vivos y para fallecidos 58.69 mg/dl. Las escalas pronosticas de mortalidad fueron estadísticamente significativas (p =0.03) para SOFA y (p =0.010) para escala APACHE, así también se obtuvo (p =0.03) para presencia de Micro albuminuria. Conclusiones: La cuantificación de Micro albuminuria en orina de 24 horas en pacientes con estado de choque en unidadde terapia intensiva es un factor pronóstico de mortalidad al ingreso del paciente.(AU)

Liposarcoma retroperitoneal: Reporte de caso / Retroperitoneal Liposarcoma: Case report

Los liposarcomas son tumores poco frecuentes, de comportamiento clínico silencioso y evolución variable dependiendo del tipo histológico, la recurrencia local y las metástasis a distancia. El tratamiento de elección es la resección quirúrgica total del tumor. Se presenta el caso de paciente femenina de 57 años de edad que consultó por tumor retroperitoneal cuyo diagnóstico por patología fue de liposarcoma bien diferenciado. Se reseca la totalidad el tumor, preservando el riñón derecho. Conclusión. La cirugía en caso de liposarcoma retroperitoneal es el tratamiento de elección donde la radioterapia y la quimioterapia juegan un papel controversial.

Liposarcomas are rare tumours, of silent clinical behavior and variable evoluton depending on histological type, local recurrence and distant metastases. Treatment of choice is tumors' complete surgical resecton. We hereby report the case of a 57-year-old female patent with a retroperitoneal tumor, whose fnal diagnosis was well-diferentated liposarcoma. The entre tumor was resected, preserving the right kidney. Conclusion. For Retroperitoneal Liposarcoma, surgery is the treatment of choice

Diabetes mellitus and hyperkalemic renal tubular acidosis: case reports and literature review / Diabetes mellitus e acidose tubular renal hipercalêmica: relatos de caso e revisão da literatura

ABSTRACT Hyporeninemic hypoaldosteronism, despite being common, remains an underdiagnosed entity that is more prevalent in patients with diabetes mellitus. It presents with asymptomatic hyperkalemia along with hyperchloraemic metabolic acidosis without significant renal function impairment. The underlying pathophysiological mechanism is not fully understood, but it is postulated that either aldosterone deficiency (hyporeninemic hypoaldosteronism) and/or target organ aldosterone resistance (pseudohypoaldosteronism) may be responsible. Diagnosis is based on laboratory parameters. Treatment strategy varies according to the underlying pathophysiological mechanism and etiology and aims to normalize serum potassium. Two clínical cases are reported and the relevant literature is revisited.

RESUMO Apesar de comum, o hipoaldosteronismo hiporeninêmico continua a ser uma entidade sub-diagnosticada, com maior prevalência em pacientes com diabetes mellitus. A doença cursa com hipercalemia assintomática acompanhada de acidose metabólica hiperclorêmica sem disfunção renal significativa. O mecanismo fisiopatológico subjacente não é entendido em sua totalidade, mas postula-se que a deficiência de aldosterona (hipoaldosteronismo hiporeninêmico) e/ou a resistência à aldosterona no órgão-alvo (pseudo-hipoaldosteronismo) possam ser responsáveis. O diagnóstico é fundamentado em parâmetros laboratoriais. A estratégia terapêutica varia de acordo com o mecanismo fisiopatológico subjacente e a etiologia, mas seu objetivo é normalizar o potássio sérico. O presente artigo relata dois casos e analisa a literatura relevante sobre o assunto.

Tamizaje en el diagnóstico y prevalencia de retinopatía diabética en atención primaria / Coverage of a screening program and prevalence of diabetic retinopathy in primary care

Background: Diabetic retinopathy is the first cause of blindness during working years. Aim: Provide knowledge of screening coverage, prevalence and level of diabetic retinopathy in patients that belong to the Cardiovascular Health Program in primary care. Material and Methods: Analysis of retinographies performed to 9076 diabetic patients aged 61 ± 13 years (61% women) adscribed to a Cardiovascular Health program in primary care centers of South-East Metropolitan Santiago. The examination was carried out by the evaluation of retinographies by trained optometrists. Results: The coverage of the screening program was 21%. The prevalence of sight threatening diabetic retinopathy was 3,1%. The prevalence of these entities was 45% higher in people aged between 18 and 44 years than in older people. Their prevalence in urban communities was 32% higher than in rural locations. Conclusions: The coverage of the screening program is low. Diabetic patients aged 18 to 44 years and those coming from urban communities have a higher prevalence of severe non-proliferative and proliferative diabetic retinopathy.

Diabetes mellitus and sensorineural hearing loss: is there an association? Baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVES: Although several studies have investigated the effects of diabetes on hearing loss, the relationship between these two conditions remains unclear. Some studies have suggested that diabetes may cause sensorineural hearing loss, whereas others have failed to find an association. The biggest challenge in investigating the association between diabetes and hearing loss is the presence of confounding variables and the complexity of the auditory system. Our study investigated the association between diabetes and sensorineural hearing loss. We evaluated the influence of time from diabetes diagnosis on this association after controlling for age, gender, and hypertension diagnosis and excluding those subjects with exposure to noise. METHODS: This cross-sectional study evaluated 901 adult and elderly Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participants from São Paulo, Brazil who underwent audiometry testing as part of ELSA-Brasil’s baseline assessment. RESULTS: Hearing thresholds and speech test results were significantly worse in the group with diabetes than in the group without diabetes. However, no significant differences were found between participants with and without diabetes after adjusting for age, gender, and the presence of hypertension. Hearing thresholds were not affected by occupational noise exposure in the groups with and without diabetes. In addition, no association between the duration of diabetes and hearing thresholds was observed after adjusting for age, gender, and hypertension. CONCLUSION: We found no association between the duration of diabetes and worse hearing thresholds after models were adjusted for age, gender, and the presence of hypertension.

Diarrea crónica en el diabético: Una revisión de la literatura / Chronic diarrhea in the diabetic: A review of the literature

Desde hace más de 70 años se conoce la asociación de diarrea con diabetes mellitus. En pacientes diabéticos su prevalencia es de alrededor del 20%. Sus manifestaciones clínicas son diversas, y representa un reto diagnóstico y terapéutico. Existen ciertos diagnósticos de mayor prevalencia en pacientes diabéticos que en la población general. Las distintas etiologías relacionadas pueden ser diagnosticadas adecuadamente a través de la historia clínica y pruebas diagnósticas complementarias. Los medicamentos utilizados por el paciente diabético para el manejo de su enfermedad, frecuentemente causan diarrea crónica, por lo que se debe profundizar en los antecedentes farmacológicos al momento de estudiar la diarrea. Los pacientes diabéticos pueden presentar otras condiciones patológicas asociadas, como enfermedad celíaca o colitis microscópica, cuya molestia única es la diarrea. La función del páncreas exocrino puede estar disminuida en el paciente diabético, frecuentemente llevando a insuficiencia pancreática exocrina. Factores dietarios, como los edulcorantes libres de azúcar y otros agentes, pueden causar diarrea en el paciente diabético. La presencia de condiciones como la neuropatía autonómica y neuropatía periférica secundarias a la diabetes mellitus, pueden explicar desordenes como la disfunción anorrectal y la incontinencia fecal. Finalmente, la enteropatía diabética per se o con sobrecrecimiento bacteriano asociado, puede causar diarrea. Lograr un control glicémico adecuado constituye el pilar del tratamiento de la diarrea en el diabético, después de esto existen medidas adicionales que se aplican según el contexto especifico del paciente. En el presente artículo se revisan las causas de mayor incidencia diarrea en el paciente diabético y los mecanismos fisiopatológicos implicados

The association of diarrhea with diabetes mellitus has been known for more than 70 years. In diabetic patients its prevalence is around 20%.Its clinical manifestations are diverse, and represents a diagnostic and therapeutic challenge.There are certain diagnoses of higher prevalence in diabetic patients than in the general population.The different related etiologies can be adequately diagnosed through the clinical history and complementary diagnostic tests.The medications used by the diabetic patient to manage their disease often cause chronic diarrhea, so the pharmacological background should be studied at the time of the study of diarrhea.Diabetic patients can present other associated pathological conditions, such as celiac disease or microscopic colitis, which only discomfort is diarrhea.Exocrine pancreatic function may be decreased in the diabetic patient, frequently leading to exocrine pancreatic insufficiency. Dietary factors, such as sugar-free sweeteners and other agents, can cause diarrhea in the diabetic patient.The presence of conditions such as autonomic neuropathy and peripheral neuropathy secondary to diabetes mellitus may explain disorders such as anorectal dysfunction and faecal incontinence. Finally, diabetic enteropathy alone or with associated bacterial overgrowth can cause diarrhea.Achieving adequate glycemic control is the pillar of the treatment of diarrhea in the diabetic, after which there are additional measures that are applied according to the specific context of the patient.This article reviews the causes of higher diarrhea incidence in the diabetic patient and the pathophysiological mechanisms involved

Escores de neuropatia periférica em diabéticos / Peripheral neuropathy scores in diabetic

OBJETIVO: Diabetes mellitus é uma doença crônica prevalente, associada a inúmeras complicações. A neuropatia periférica diabética é a mais comum, acometendo 50% dos diabéticos, mas muitas vezes não é diagnosticada. Por cursar com insensibilidade distal e alterações arquiteturais dos pés, predispõe a úlceras, podendo culminar no pé diabético com risco de amputação. O diabetes mellitus é responsável por 70% das amputações de membros, que poderiam ser prevenidas com o diagnóstico precoce da neuropatia periférica diabética. Sugere-se avaliar o grau de neuropatia em diabéticos por meio de escores, visando homogeneizar o diagnóstico, quantificar a prevalência e promover medidas preventivas. MÉTODOS: Realizou-se entrevista, exame físico e coleta de dados de diabéticos atendidos ambulatorialmente, para pontuação e qualificação no Escore de Sintomas Neuropáticos e no Escore de Comprometimento Neuropático, validados na língua portuguesa para avaliar neuropatia periférica diabética, além de análise das características clínicas e epidemiológicas associadas. RESULTADOS: Foram incluídos 116 pacientes, constatando-se neuropatia periférica diabética em 31,9%. Houve correlação significativa de neuropatia periférica diabética coma idade dos pacientes, mas não com as demais variáveis clínicas e laboratoriais. Os pacientes avaliados apresentaram médias de idade de 55±15 anos e tempo de diabetes de 14,8±10,9 anos, sendo predominantemente caucasianos, mulheres e portadores de diabetes mellitus tipo 2. Eram hipertensos 67,2% e 42,2%, obesos. CONCLUSÃO: A prevalência encontrada corrobora a literatura, embora poucos estudos tenham utilizado critérios similares para diagnosticar neuropatia periférica diabética. Empregando os escores padronizados, de baixo custo e fácil aplicação possibilitamos o diagnóstico precoce e embasado dessa entidade, sendo possível, com isso, reduzir a prevalência de graves complicações do pé diabético e disseminar informações a respeito.

OBJECTIVE: Diabetes mellitus is a prevalent chronic disease, associated with numerous complications. Diabetic peripheral neuropathy is the most common, affecting 50% of diabetics, although is often not diagnosed. Presenting with distal numbness and architectural alterations of the feet, it predisposes ulcers and may culminate in diabetic foot at risk for amputation. Diabetes mellitus is responsible for 70% of limb amputations, which could be prevented with early diagnosis of diabetic peripheral neuropathy. This study aims to evaluate the degree of neuropathy in diabetics through validated scores, in order to standardize the diagnosis, quantify the prevalence and promote preventive actions. METHODS: We performed an interview, physical examination and data collection of diabetic outpatients, for rating in the Neuropathy Symptom Score and the Neuropathy Disability Score, validated in Portuguese, to assess diabetic peripheral neuropathy, in addition to analysis of clinical and epidemiological associated characteristics. RESULTS: We included 116 patients and diabetic peripheral neuropathy was found in 31.9%. There was significant correlation diabetic peripheral neuropathy with age, but not with other clinical and laboratory variables. The mean age was 55±15 years, diabetes duration was 14.8±10.9 years and patients were predominantly Caucasian, women and had type 2 diabetes mellitus. Of the patients, 67.2 % were hypertensive and 42.2% obese. CONCLUSION: The prevalence found is supported by previous data, although few studies have used similar criteria to diagnose diabetic peripheral neuropathy. Employing the standard scores, of low cost and easy implementation, we enable early and accurate diagnosis of this condition, allowing to reduce the prevalence of severe diabetic foot complications and spread information about it.

Diagnóstico y tratamiento de la embarazada con diabetes mellitus y con diabetes gestacional / Diagnosis and treatment of pregnant women with diabetes mellitus and with gestational diabetes

En la actualidad hay una creciente aumento de diabetes mellitus tipo II y casos de mujeres en edad reproductiva, hay ciertos elementos a tomar en cuenta para abordar la consejería en la preconcepción. El artículo toca esos elementos a tomar en cuenta para ese tema para llevar a un felíz término el embarazo en dichos casos con un adecuado control.

Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

A fasceíte necrotizante cervical (FNC) é uma infecção rara de tecidos moles, potencialmente fatal, caracterizada por necrose no tecido subcutâneo e fascia com progressão rápida. Um caso de FNC de origem odontogênica em um paciente diabético, complicado por dependência alcoólica e abuso de tabaco, é relatado junto a uma revisão da literatura. O procedimento de emergência compreendeu hidratação, administração de colóide, controle glicêmico e antibioticoterapia de amplo espectro, seguido de debridamento cirúrgico agressivo. Necrose no músculo platisma foi verificada por análise histopatológica. Cirurgia reconstrutiva foi feita após resolução da infecção e a ferida foi fechada com enxerto dérmico autógeno. O paciente teve um longo período de internação hospitalar, em parte devido ao abuso de substâncias, o que levou a uma recuperação difícil. Os princípios de diagnóstico imediato, debridamento cirúrgico agressivo, antibioticoterapia de amplo espectro e cuidados em terapia intensiva no tratamento da FNC foram confirmados no presente caso. Foi concluído que diante da ocorrência de FNC na presença de diabetes mellitus e de abuso de substâncias como álcool e tabaco, o profissional assistente deve considerar uma resposta mais difícil ao tratamento e maior tempo de internação.

Manejo de las complicaciones oftalmológicas de la Diabetes Mellitus / Management of ophthalmological complications of Diabetes Mellitus

Esta guìa contiene datos generales relacionados con la ceguera la edad en pacientes diabeticos no controlada. hay un incremento de casos por ceguera a nivel mundial que son de alta prevalencia y severidad. algunas clsificaciones de la diabetes mellitus oftalmopatìas; retinopatìa, opacidades del cristalino o cataratas, glaucoma, lesiones de la cornea, paresia o paralisis de musculos extraoculares secundario a neuropatìa. aunque existen alguna medidas de estricto control metabolico.

Relationship of Liver Stiffness and Controlled Attenuation Parameter Measured by Transient Elastography with Diabetes Mellitus in Patients with Chronic Liver Disease

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.

Relationship of Liver Stiffness and Controlled Attenuation Parameter Measured by Transient Elastography with Diabetes Mellitus in Patients with Chronic Liver Disease

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.