Discapacidad visual asociada a retinopatía diabética y edema macular: un estudio de base hospitalaria / Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study

Resumen Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. Objetivo: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. Material y métodos: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. Resultados: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). Conclusión: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

Abstract Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. Objective: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Material and methods: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. Results: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30 %. DR was found in 62 % of patients (30 % had sight-threatening DR [STDR]), 17 % had referable DME, and 3 %, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Conclusion: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

I. The role of research ethics committees in observational studies: epidemiological registries, case reports, interviews, and retrospective studies

Abstract It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.

Parámetros de práctica para el manejo del dolor neuropático / Practice guidelines for neuropathic pain management

Neuropathic pain (NP) is a heterogeneous entity with wide diversity of symptoms. Despite the controversies regarding its definition and classification, which difficult its epidemiology, it has been estimated that 4 million people, in USA develop NP. Objective. A task force was created to generate a series of recommendations which facilitate the decision making and therapeutic approach of this kind of pain. Method. A search of medical literature was made in different electronic data bases (MEDLINE, EMBASE, COCHRANE); after this search we conducted three work-sessions and evaluated the evidence regarding the diagnosis and treatment of pain in painful diabetic polineuropathy, post-herpetic neuralgia, and trigeminal neuralgia were evaluated. Results. We found 329 documents for further analysis, and with the aid of the literature results we generate this practice guidelines.

El dolor neuropático (DN) es una entidad heterogénea con una sintomatología diversa. Las controversias existentes respecto a su definición y clasificación dificultan conocer su epidemiología, a pesar de esto se ha estimado que cerca de cuatro millones de personas en Estados Unidos son portadoras de este problema médico. Objetivo. Se conformó un grupo de consenso con la finalidad de crear recomendaciones médicas que faciliten la toma de decisiones y el abordaje terapéutico del mismo. Método. Se realizó una búsqueda en la literatura en diferentes bases de datos electrónicas (MEDLINE, EMBASE, COCHRANE). Se efectuaron tres sesiones de trabajo en las cuales se evaluaron las evidencias médicas científicas sobre el diagnóstico y tratamiento de la polineuropatía diabética dolorosa, la neuralgia postherpética y neuralgia trigeminal. Resultados. Se encontraron 329 documentos para su análisis, con base en este sustento bibliográfico se delinearon estos parámetros de práctica.

Epidemiología de las anormalidades metabólicas en pacientes con infección por VIH / Epidemiology of the metabolic abnormalitis in patients with HIV infections

Analizamos la epidemiología de las complicaciones metabólicas del tratamiento antirretroviral. Resultan de la interacción de factores del individuo y de los efectos del tratamiento. Resultados divergentes son frecuentes en este campo debido a limitaciones metodológicas. La prevalencia depende de la actividad de la infección y del tipo de tratamiento. En casos no tratados, la dislipidemia más común es colesterol-HDL bajo (< 35 mg/dL, 25.5%), seguido de la hipertrigliceridemia (> 200 mg/dL, 15.2%). La prevalencia de hipercolesterolemia es tres veces mayor en los casos tratados, en especial cuando se incluye inhibidores de proteasa (IPs). La prevalencia de hipertensión se ha reportado como baja debido al uso de definiciones con puntos de corte muy altos. La diabetes se observa en 6-7% de los casos. Prevalencias similares se encontraron en un estudio retrolectivo realizado en 464 casos. En individuos no tratados, la hipertrigliceridemia se observó preferentemente en sujetos por debajo de su peso ideal; lo opuesto se observó después del tratamiento. Después de un año, las prevalencias de hipertensión (≥ 130/85), hipertrigliceridemia (≥ 150), hipercolesterolemia (> 200 mg/dL), diabetes y colesterol HDL bajo (< 35 mg/dL) fueron 38.5, 71.1, 47.6, 2.2 y 36%. Las prevalencias fueron aún mayores en los casos con un IP. El tabaquismo fue otro factor de riesgo modificable frecuente (42.3%). Así, son muchos los aspectos que permanecen por ser analizados; se requieren de cohortes prospectivas cuyo análisis sirva para el diseño de estrategias preventivas. En población mexicana la hipertrigliceridemia, la hipertensión y el consumo de tabaco son los factores de riesgo cardiovascular más frecuentes en los pacientes con VIH.

The epidemiology of the metabolic complications of antiretroviral agents is discussed here. Contradictory findings are common in this field due to methodological problems.The prevalence depends on the activitiy of the infection and on the type of treatment. Before treatment, the most common lipid abnormalities are low HDL-cholesterol (< 35 mg/dL, 25.5%) and hypertriglyceridemia (> 200 mg/dL, 15.2%). The prevalence of hypercholesterolemia is 3 times higher during treatment, espacially if a protease inhibitor (IP) is used. Hypertension has been described as not common because high thresholds have been used in previous reports. Diabetes has been found in 6-7%. Similar prevalences were found in a retrolective study including 464 cases. Before treatment, hypertriglyceridemia was found mainly in cases with a body weight below normal; the opposite trend was found after treatment. After one year of treatment the prevalence of hypertension (≥ 130/85), hypertriglyceridemia (≥ 150), hypercholesterolemia (> 200 mg/dL), diabetes and low HDL cholesterol (< 35 mg/dL) were 38.5, 71.1, 47.6, 2.2% and 36%, respectively. The frequencies were even greater in IP-treated cases. Smoking was a frequent modifiable risk factor in this group (42.3%). Thus, many aspects remain to be explored; the follow-up of multicentric cohorts will provide evidence for preventive actions. In Mexican HIV infected patients, hypertriglyceridemia, arterial hypertension and smoking are the most common cardiovascular risk factors.