Morphometric magnetic resonance imaging study of the quadriceps tendon in hemodialysis patients: comparison with non-dialyzed controls / Estudo morfométrico do tendão do quadríceps em pacientes em hemodiálise: avaliação por ressonância magnética e comparação com grupo controle

Abstract Objective: To evaluate the knees of individuals with renal failure who are on hemodialysis, using magnetic resonance imaging (MRI), comparing them with those of a group of individuals with normal renal function. Materials and Methods: This was a cross-sectional, observational, controlled study conducted between August 2018 and February 2020. The cases consisted of 15 patients who had been on hemodialysis for ≥ 5 years and did not have a quadriceps tendon rupture. The controls consisted of 15 individuals with normal renal function who were matched (1:1) to the cases for sex, age, and physical activity level. The subjects in both groups underwent MRI of the right knee only. Results: The mean ages of the cases and controls were 50 ± 15 years and 49 ± 14 years, respectively. The median time on hemodialysis was 11 years (range, 10-14 years). Serum levels of parathyroid hormone, ferritin, alkaline phosphatase, phosphorus, and creatinine were higher among the cases than among the controls, whereas serum albumin and hemoglobin were lower (p < 0.05 for all). The MRI study showed a hyperintense signal in the quadriceps tendon in 11 of the cases and in three of the controls (p = 0.009). Knee joint effusion was observed in nine of the cases and in three of the controls (p < 0.05). The thickness, length, and width of the tendon did not differ between the groups. A hyperintense signal in the tendon was not associated with the time on hemodialysis; nor with the levels of intact parathyroid hormone, hemoglobin, or alkaline phosphatase. Conclusion: Patients on chronic hemodialysis, even those without a tendon rupture, show a hyperintense signal in the quadriceps tendon on MRI.

Resumo Objetivo: Avaliar joelhos de indivíduos com falência renal em hemodiálise por meio de ressonância magnética, em comparação com um grupo controle sem doença renal crônica. Materiais e Métodos: Estudo transversal, observacional, controlado, realizado entre agosto/2018 e fevereiro/2020. Os 15 casos consistiram de pacientes com cinco anos ou mais em hemodiálise, sem ruptura do tendão do quadríceps. Os 15 controles, sem doença renal crônica, foram pareados (1:1) por sexo, idade e nível de atividade física. Resultados: A média de idade dos casos foi 50 ± 15 anos e a dos controles, 49 ± 14 anos. A mediana do tempo em hemodiálise foi 11 anos (variação: 10-14 anos). Nos casos, os níveis séricos de paratormônio, ferritina, fosfatase alcalina, fósforo e creatinina estavam mais altos e os de albumina e hemoglobina, mais baixos (p < 0,05). Hipersinal no tendão foi demonstrado em 11 casos e três controles (p = 0,009). Derrame articular foi observado em nove casos e três controles (p < 0,05). A espessura, o comprimento e a largura do tendão não diferiram entre os grupos. Hipersinal no tendão do quadríceps não mostrou associação com o tempo em hemodiálise ou com os níveis de paratormônio intacto, hemoglobina e fosfatase alcalina. Conclusão: Pacientes em hemodiálise sem episódios de ruptura já apresentam hipersinal no tendão do quadríceps nas imagens de ressonância magnética.

Complicaciones crónicas y enfermedades asociadas en adultos mayores con diabetes mellitus tipo 2 en Punta Brava, Cuba de enero a junio de 2019 / Chronic complications and associated diseases in older adults with type 2 diabetes mellitus in Punta Brava, Cuba from January to June 2019

Introducción: Con el envejecimiento de las poblaciones se produce un aumento de las enfermedades crónicas no trasmisibles, entre ellas la diabetes mellitus tipo 2. Esta constituye un serio problema de salud pública a nivel mundial por su elevada prevalencia, crecimiento constante, complicaciones crónicas y mortalidad. Objetivo: Identificar las complicaciones crónicas de la diabetes mellitus tipo 2 y las enfermedades asociadas en personas de 60 años y más en el poblado de Punta Brava. Métodos: Se realizó un estudio descriptivo y transversal a partir de los gerontes con diabetes que asistieron a la consulta de Medicina Interna en el periodo de enero a junio de 2019. Con la información recopilada de las historias clínicas se creó una base de datos en Visual FoxPro 8.0. Resultados: Predominó el grupo de edad de 60 a 69 años y el sexo femenino. La hipertensión arterial fue la enfermedad asociada más frecuente con 86,0 por ciento, seguida por la cardiopatía isquémica con 70,6 por ciento y la enfermedad cerebrovascular con 67,0 por ciento. La polineuropatía diabética fue la complicación crónica más representativa (79,3 por ciento), seguida de la nefropatía (15,0 por ciento) que aparece a mayor tiempo de evolución de la enfermedad. Conclusiones: Predominó la hipertensión arterial y la enfermedad cerebrovascular como padecimientos asociados en adultos mayores con diabetes tipo 2. La polineuropatía y la nefropatía diabéticas fueron las complicaciones crónicas más frecuentes con diferencias según el sexo y relacionadas con el mayor tiempo de evolución(AU)

Introduction: The aging of populations also brings an increase in chronic non-communicable diseases, including type 2 diabetes mellitus, which constitutes a serious public health problem worldwide due to the high prevalence, constant growth, chronic complications and mortality. Objective: To identify the chronic complications of type 2 diabetes mellitus and associated diseases in people aged 60 years and older in Punta Brava town. Methods: A descriptive and cross-sectional study was carried out from the elderly with diabetes who attended the Internal Medicine consultation from January to June 2019. A database was created in Visual Fox Pro 8.0 with the information collected from the medical records. Results: The age group of 60 to 69 years and the female sex prevailed. Hypertension was the most frequent associated disease (86.0 percent), followed by ischemic heart disease (70.6 percent) and cerebrovascular disease (67.0 percent). Diabetic polyneuropathy was the most representative chronic complication (79.3 percent), followed by nephropathy (15.0 percent), appearing later in the course of the disease. Conclusions: Hypertension and cerebrovascular disease predominated as associated conditions in older adults with type 2 diabetes. Diabetic polyneuropathy and nephropathy were the most frequent chronic complications, with differences according to sex and related to the longest evolution time(AU)

Physical fitness assessment and management of patients with diabetes mellitus / 中华全科医师杂志

Physical fitness is the basic ability necessary to meet daily living activities,including walking, running, jumping, throwing, climbing, and so on. Adequate physical fitness is essential for the prevention and management of metabolic diseases. Impaired physical fitness is common in patients with diabetes mellitus and its chronic complications. This article reviews the impact of diabetes and its complications on physical fitness, current methods for assessment and management to provide a reference for comprehensive prevention and treatment of diabetic patients.

Comportamiento y manejo actual de la infección por virus de la hepatitis B / Behavior and current management of hepatitis B virus infection

RESUMEN Introducción: Las hepatitis virales son un problema de salud a nivel mundial, provocan elevada mortalidad y morbilidad. A pesar de los avances en la prevención, diagnóstico y tratamiento de la hepatitis B, esta enfermedad es todavía preocupación de las autoridades sanitarias. Objetivo: Realizar una actualización acerca del comportamiento y manejo actual de la infección por el virus de la hepatitis B. Métodos: Se realizó una revisión bibliográfica durante abril y mayo de 2021, se consultaron 211 artículos en idioma inglés y español en las bases de datos como SciELO, PubMed, Lilacs y Medigraphic, de ellos se utilizaron 30 citas. Se empleó la combinación de términos y operadores booleanos y métodos teóricos como: análisis-síntesis, inducción-deducción e histórico-lógico. Resultados: Se abordó el comportamiento de la infección causada por el virus de la hepatitis B, se hizo hincapié en su epidemiología, características morfológicas y funcionales que permiten su infectividad, evolución y manifestaciones clínicas, complicaciones, tratamiento y perspectivas actuales. Conclusiones: La historia natural de la infección es dinámica y las manifestaciones clínicas dependen de diversos factores. La infección por el virus de la hepatitis B puede causar complicaciones como: la cirrosis hepática y el carcinoma hepatocelular y su principal vía de transmisión es la parenteral. El diagnóstico se realiza a través de técnicas serológicas. Es imprescindible la atención diferenciada a los grupos con riesgo y, aunque se cuenta con una vacuna eficaz, aún existen casos y se han desarrollado tratamientos con resultados positivos.

ABSTRACT Introduction: Viral hepatitis is a global health problem, causing high mortality and morbidity. Despite advances in the prevention, diagnosis and treatment of hepatitis B, this disease is still a concern of health authorities. Objective: Toupdate on current behavior and management of hepatitis B virus infection. Methods: A bibliographic review was carried out during April and May 2021, consulting 211 articles in English and Spanish from databases such as SciELO, PubMed, Lilacs and Medigraphic, of which 30 citations were used. The combination of Boolean terms and operators and theoretical methods such as: analysis-synthesis, induction-deduction and historical-logical were used. Results: The behavior of the infection caused by the hepatitis B virus was addressed, emphasizing its epidemiology, morphological and functional characteristics that allow its infectivity, evolution and clinical manifestations, complications, treatment and current perspectives. Conclusions: The natural history of infection is dynamic, and clinical manifestations depend on various factors. Hepatitis B virus infection can cause complications such as liver cirrhosis and hepatocellular carcinoma, and its main route of transmission is parenterally. The diagnosis is made mainly through serological techniques. Differentiated care for groups at risk is essential and, although there is an effective vaccine, there are still cases and treatments have been developed with positive results.

Asociación entre conocimientos y actitudes preventivas sobre complicaciones crónicas en diabéticos de un policlínico peruano / Association between knowledge and preventive attitudes about chronic complications in diabetics in a Peruvian polyclinic

Introducción: Hay escasos estudios realizados para valorar la asociación entre el nivel de conocimientos sobre la diabetes mellitus tipo 2 y las actitudes que tienen los pacientes para mejorar el control de su enfermedad. Objetivo: Determinar la asociación entre el nivel de conocimientos y las actitudes preventivas sobre las complicaciones crónicas en pacientes con diabetes mellitus tipo 2. Métodos: Estudio transversal analítico en pacientes con diabetes tipo 2 de Chiclayo, Perú. Se indagó la asociación entre actitudes preventivas y nivel de conocimientos, además se exploró asociación con edad, sexo, nivel de instrucción, instrucción diabetológica previa, antecedentes familiares, hospitalizaciones previas, tiempo de enfermedad. Resultados: De 150 pacientes, el 60 por ciento fueron mujeres. El 40,0 por ciento presentó un nivel de conocimientos intermedio y un 84,7 por ciento reportaron actitudes preventivas favorables. Se encontró que los pacientes con nivel de conocimiento adecuado tenían 43 por ciento mayor frecuencia de presentar actitudes preventivas favorables (razón de prevalencia = 1,43). Los pacientes que tenían entre 7 a 15 años de enfermedad resultaron asociados positivamente a tener actitudes preventivas favorables (razón de prevalencia = 1,32). Conclusiones: Los pacientes diabéticos con conocimientos adecuados sobre su enfermedad tienen actitudes preventivas favorables frente a su padecimiento y sus complicaciones crónicas. Adicionalmente, los pacientes diagnosticados entre 7 - 15 años atrás tienen mejores actitudes preventivas(AU)

Introduction: There are few studies carried out to assess the association between the level of knowledge about type 2 diabetes mellitus and the attitudes that patients have to improve the control of their disease. Objective: To determine the association between the level of knowledge and preventive attitudes about chronic complications in patients with type 2 diabetes mellitus. Methods: Analytical cross-sectional study in patients with type 2 diabetes in Chiclayo, Peru. The association between preventive attitudes and level of knowledge was investigated, as well as the association with age, sex, level of education, previous diabetic education, family history, previous hospitalizations, time of illness. Results: Of 150 patients, 60 percent were women. 40.0 percent presented an intermediate level of knowledge and 84.7 percent reported favorable preventive attitudes. It was found that patients with an adequate level of knowledge had a 43 percent higher frequency of presenting favorable preventive attitudes (Prevalence ratio = 1,43). Patients who had between 7 and 15 years of disease were positively associated with having favorable preventive attitudes (Prevalence ratio = 1,32). Conclusions: Diabetic patients with adequate knowledge about their disease have favorable preventive attitudes towards their condition and its chronic complications. In addition, patients diagnosed between 7 - 15 years ago have better preventive attitudes(AU)

Avaliação das complicações em pacientes com Diabetes Mellitus tipo 1 atendidos em uma clínica particular especializada e ambulatório público de Joinville ­ SC / A screening of type 1 Diabetes' complications in a private clinic and a public health care center in Joinville ­ SC

Este trabalho teve como objetivo avaliar o controle metabólico e a prevalência de complicações em pacientes com diagnóstico de diabetes mellitus tipo 1 (DM1) atendidos em uma clínica privada e em um ambulatório público em Joinville ­ SC. Realizou-se um estudo descritivo e retrospectivo, onde foram analisados 64 prontuários de pacientes com diagnóstico de DM1, sendo 25 da rede pública (RP) e 39 da privada (RPV). Observamos que na RP a idade média ao diagnóstico do DM1 foi 16,2 (±7,63) contra 12,8 (±9,80) anos na RPV, que foram realizadas em média 1,9 (±1,2) consultas nos últimos 12 meses na RP e 3,0 (±1,3) na RPV. Em relação à presença de complicações microvasculares, havia informação da presença de retinopatia em 8 de 48 pacientes (16,7%), de nefropatia em 12 de 54 pacientes (22,2%) e neuropatia em 8 de 50 pacientes (16%). Quanto ao controle metabólico, apenas 2 pacientes (8%) de RP e 10 (25%) da RPV apresentavam HbA1c < 7,0%. A maioria dos pacientes, tanto da RP quanto da RPV, atingiu a meta de colesterol total (78,3 e 86,8%), que define bom controle clínico e metabólico do diabetes tipo 1, segundo a Associação Americana de Diabetes (ADA). Os dados mostram a dificuldade de se atingir um bom controle glicêmico, independente do local de atendimento (público ou privado), embora o grupo RPV tenha apresentado um maior percentual de pacientes que atingiram as metas de bom controle clínico e metabólico do diabetes tipo 1 definidas pela ADA, inclusive menor índice de tabagismo e etilismo.

This study aims to evaluate the prevalence of complications and metabolic control in patients diagnosed with Type 1 Diabetes Mellitus (T1D) treated in a private clinic and a public outpatient clinic in Joinville - Santa Catarina. A descriptive and retrospective study was carried out, where 64 medical records of patients diagnosed with T1D were analyzed, 25 of which were treated in the public outpatient clinic and 39 in the private clinic. Mean age at diagnosis of T1D in the public institution was 16.2 (± 7.63) years versus 12.8 (± 9.80) years in the private institution, patients had 1.92 (± 1.22) medical appointments in the last 12 months in the public institution and 3 (± 1.32) in the private institution. We assessed the presence of microvascular complications, there was data about retinopathy in 8 of 48 patients (16.7%), nephropathy in 12 of 54 patients (22.2%) and neuropathy in 8 of 50 patients (16%). Most patients did not reach a good glycemic control: only 2 patients (8%) from public institution and 10 (25%) from private institution showed HbA1c < 7.0%. The majority of patients from public and private institution reached the American Diabetes Association (ADA) goals for total cholesterol (78.3 and 86.8%). This data confirms the difficulty of achieving good glycemic control regardless of the institution (public or private), although the private group has shown best results in clinical control with a higher proportion in patients that reached the ADA goals, including the lowest number of smokers and alcohol use.

Morbilidad en pacientes hemodializados / Morbidity in hemodialyzed patients

RESUMEN Fundamento: cada día se incrementa el número de enfermos con una enfermedad renal crónica, tributarios de hemodiálisis, procedimiento que no está exento de producir complicaciones por la complejidad de su realización, en la que intervienen el ambiente y condiciones de la unidad de hemodiálisis, la calidad del agua empleada y el buen funcionamiento de la planta de tratamiento de esta agua. Objetivo: caracterizar la morbilidad infecciosa de los pacientes con enfermedad renal crónica. Métodos: se realizó un estudio observacional, descriptivo, transversal. La población de estudio estuvo constituida por 85 pacientes con enfermedad renal crónica que fueron atendidos en el servicio de hemodiálisis del Hospital General Provincial Universitario Camilo Cienfuegos de Sancti Spíritus durante el período comprendido entre el 1ro de Octubre de 2016 al 31 de Marzo de 2018. Resultados: la mayor cantidad de casos hemodializados se correspondió con el grupo de edad mayor de 60 años del género masculino. Los factores ambientales y microbiológicos indicaron que la calidad del agua utilizada en el proceso de atención de pacientes hemodializados fue satisfactoria y el peligro de riesgo en la planta de tratamiento, en la categoría de bajo riesgo. El tipo de acceso vascular de los pacientes que con mayor frecuencia se utilizó y el de mayor morbilidad infecciosa fue el catéter transitorio. Conclusiones: la mayoría de los enfermos eran hombres en la sexta década de la vida, la calidad del agua utilizada fue adecuada, con escaso riesgo en la planta de tratamiento y el catéter transitorio mostró mayor proporción de infecciones asociadas.

ABSTRACT Background: every day the number of patients with chronic kidney disease increases, tributaries of hemodialysis, a procedure that is not exempt from complications due to the complexity of its realization, in which the environment and conditions of the hemodialysis unit intervene, the quality of the water used for it and the proper functioning of the water treatment plant. Objective: to characterize the infectious morbidity of patients with Chronic Kidney Disease. Methods: an observational, descriptive, cross-sectional, prospective study was carried out. The study population consisted of 85 patients with chronic kidney disease receiving hemodialysis in University General Hospital Camilo Cienfuegos of Sancti Spíritus from October 1st, 2016 to March 31st, 2018. Results: the largest number of hemodialysis cases corresponded to the age group over 60 years of the male gender. The environmental and microbiological factors indicated that the quality of the water used in the process of care of hemodialysis patients was satisfactory and the risk of risk in the treatment plant, in the low risk category. According to the type of vascular access to the patient, the most frequently used route was the transient catheter and the highest infectious morbidity. Conclusions: most of the cases were over 60 years old, of the male gender, the water quality was satisfactory and low risk in the treatment plant, and the transient catheter was used more frequently, who presented the highest proportion of associated infections.

Características clínico patológicas de la nefritis lúpica / Clinical pathological characteristics of the lupus nephritis

RESUMEN Fundamento: la nefritis lúpica es una complicación frecuente y grave asociada al lupus eritematosos sistémico. Objetivo: caracterizar la nefritis lúpica en el servicio de nefrología del Hospital Universitario Manuel Ascunce Domenech. Métodos: se realizó un estudio descriptivo, transversal y retrospectivo en el Hospital Manuel Ascunce Domenech de la provincia Camagüey entre enero de 2012 hasta diciembre de 2017. El universo estuvo formado por pacientes con nefritis lúpica que tenían biopsia renal. Como fuente se utilizaron las historias clínicas y una planilla confeccionada para vaciar los datos. Las variables fueron: edad, sexo, raza, criterios diagnósticos, estadio histopatológico, complicaciones de la enfermedad y efectos nocivos relacionados con el tratamiento. Resultados: se encontró que cuatro de cada diez pacientes estaba entre los 30 y los 44 años, mientras que seis de cada diez fueron mujeres. La cuarta parte de la muestra fue de la raza blanca. Predominaron en los pacientes los criterios renales, cutáneos y hematológicos por ese orden. Los patrones histopatológicos observados fueron la proliferación mesangial, los cambios mínimos y la glomerulopatía membranosa. Las complicaciones más frecuentes que se presentaron fueron el síndrome nefrótico y la insuficiencia renal crónica. La gran mayoría de los pacientes estudiados presentaron como efectos nocivos del tratamiento infecciones y manifestaciones cardiovasculares. Conclusiones: fue más frecuente entre 30 a 44 años, en mujeres y en la raza blanca. Se presentó más como síndrome nefrótico e insuficiencia renal crónica. Los patrones histopatológicos más observados: la proliferación mesangial, cambios mínimos y glomerulopatía membranosa.

ABSTRACT Background: the lupus nephritis is a frequent and serious complication associated to the systemic lupus erythematosus. Objective: to characterize the lupus nephritis in the nephrology service of the University Hospital Manuel Ascunce Domenech. Methods: a descriptive, transverse and retrospective study was carried out in the Hospital Manuel Ascunce Domenech of Camagüey from January, 2012 to December, 2017. The universe was constituted for patients with systemic lupus erythematosus. As source clinical charts and forms made to empty data were used. The universe was constituted by all the patients with lupus nephritis whose biopsy was useful for the diagnosis. The variables were: age, sex, race, diagnosis criteria, histopathological stage, complications of the illness and noxious effects related with the treatment. Results: was found that four of each ten patients were between the 30 and the 44 years, while six of each ten were women. The fourth part of the sample was of the white race. The renal, cutaneous and hematologic approaches prevailed in the patients in that order. The histopathological patterns observed were the mesangial proliferation, the minimum changes and the membranous glomerulonephritis. The most frequent complications that were presented were the nephrotic syndrome and the chronic renal failure. The great majority of the studied patients presented as noxious effects of the treatment infections and cardiovascular manifestations. Conclusions: it is more frequent between 30 to 44 years, in women and in the white race. It is presented more as Nephrotic syndrome and chronic renal failure. The histopathological pattern more observed: the mesangial proliferation, minimum changes and membranous glomerulonephritis.

Nivel de conocimientos y aptitudes sobre complicaciones crónicas de la diabetes mellitus 2, hospital nacional PNP. Luis N. Saenz, 2016 / Level of knowledge and skills on chronic complications of diabetes mellitus 2, hospital national PNP Luis N. Saenz, 2016

Objetivo: Determinar la relación entre conocimientos y aptitudes en pacientes diabéticos sobre las complicaciones crónicas de la diabetes mellitus 2 en el servicio de endocrinología del Hospital Nacional PNP Luis N. Suárez el 2016. Métodos: Estudio cuantitativo, descriptivo, transversal y correlacional. Se encuestaron a 110 pacientes diabéticos con un cuestionario para valorar los conocimientos (10 ítems con respuesta de selección múltiple) y otro para las aptitudes (tipo Lickert modificado). Los conocimientos se clasificaron como nivel alto, medio y bajo y las aptitudes como favorables, desfavorables e indiferentes según la Escala de Estanones. Se determinó la normalidad de las puntuaciones con la Prueba de Kolmogorov-Smirnov y las asociaciones con chi cuadrado, p<0.05 y prueba de correlación de Pearson. Resultados: La edad media fue 49.85±6.97 años, 74.5% sexo femenino, 75.5% con tiempo de enfermedad entre 1-5 años, 67.3% con buena adherencia al tratamiento farmacológico. El nivel de conocimientos fue: alto 28.2%, medio 49.1% y bajo 22.7%; y las aptitudes fueron: favorables 23.6%, desfavorables 58.2% e indiferentes 18.2%. No existe relación entre conocimientos y aptitudes (p=0.247). Sólo se encontró asociación estadística entre conocimiento y tratamiento farmacológico (p<0.05). Conclusión: Los pacientes diabéticos tienen un nivel de conocimiento medio sobre sus complicaciones crónicas y sus aptitudes fueron predominantemente desfavorables. Es necesario realizar estrategias educativas para mejorar los conocimiento y las aptitudes de los diabéticos.

Objective: To determine the relationship between knowledge and aptitude in diabetic patients regarding the chronic complications of diabetic mellitus 2 in the endocrinology service of National Hospital PNP Luis N. Saenz. Methods: Quantitative, descriptive, transverse and correlational study. 110 diabetic patients were surveyed with a questionnaire to assess the knowledge (10 items with a multiple choice response) and another one for the skills (modified Lickert type). The knowledge was classified as high, medium and low level and the skills as favorable, unfavorable and indifferent according to the Estanones Scale. The normality of the scores with the Kolmogorov-Smirnov test and associations with chi-square, p <0.05 and Pearson's correlation test were determined. Results: The mean age was 49.85 ± 6.97 years, 74.5% female, 75.5% with disease time between 1-5 years, 67.3% with good adherence to pharmacological treatment. The level of knowledge was: high 28.2%, medium 49.1% and low 22.7%; And the skills were: favorable 23.6%, unfavorable 58.2% and indifferent 18.2%. There is no relation between knowledge and skills (p = 0.247). Only statistical association was found between knowledge and pharmacological treatment (p <0.05). Conclusion: Diabetic patients have an average level of knowledge about their chronic complications and their abilities were predominantly unfavorable. It is necessary to carry out educational strategies to improve the knowledge and skills of diabetics.

Correlation between chronic complications of type 2 diabetes mellitus and obstructive sleep apnea syndrome / 中国实用内科杂志

OBJECTIVE: To explore the relationship between chronic complications of type 2 diabetes mellitus(T2 DM)and obstructive sleep apnea syndrome(OSAS). METHODS: The data of 153 hospitalized T2 DM patients aged 40-65 years were collected; the demograhic data was recorded, biochemical indicators were recorded and analyzed, and the patients were screened for chronic complications of diabetes and OSAS. The patients with ketosis, acidosis and infection, and those who were addicted to alcohol,smoking or drug or with mental illness, or severe organ dysfunction were excluded.According to whether OSAS was combined, they were divided into the OSAS group and the control group were divided into groups. The differences in the incidence of chronic complications between the two groups were compared.Spearman correlation analysis was used to determine the relationship between chronic complications and OSAS.RESULTS: The incidence of diabetic peripheral neuropathy(DPN)in the OSAS group was higher than in the control group(45% vs. 26.9%, P=0.017). The incidence of coronary heart disease was significantly higher in the OSAS group than in the control group(20% vs. 8.6%, P=0.038). The differences were statistically significant.Spearman correlation analysis showed that OSAS was positively correlated with diabetic peripheral neuropathy(P=0.021)and coronary heart disease(P=0.041). CONCLUSION: OSAS may be associated with peripheral neuropathy and coronary heart disease in patients with T2 DM.

The prevalence and related direct medical costs of chronic complications among patients with type 2 diabetes in China / 中华内分泌代谢杂志

Objective To estimate the prevalence and related direct medical costs of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy in patients with type 2 diabetes mellitus (T2DM) in China.Method Data were extracted from the hospital information system(HIS) database of 4 top level Chinese hospitals from January 1st,2012 to May 31st,2017.Patients with T2DM were identified through international classification of diseases,tenth version (ICD-10) diagnosis supplemented with Chinese descriptions.The prevalences of complications including cardiovascular diseases,cerebrovascular diseases,nephropathy,diabetic foot,lower extremity vascular diseases,diabetic retinopathy,and diabetic neuropathy were estimated among all identified patients with T2DM.The costs per hospitalization and per outpatient visit under the primary diagnoses of each chronic complication were further estimated.Results There were 61 139 patients with T2DM,with mean age of(62.1 ± 13.6) years,50.5％ being males.66.8％ of them had chronic complications,and patient suffered from more than 2 complications on average.The most common complication was nephropathy (30.5％),followed by diabetic neuropathy (26.8％),diabetic retinopathy (26.3％),cardiovascular disease (24.9％),and cerebrovascular disease (19.2％).The cost per hospitalization was highest for cardiovascular disease(21 176 yuan),followed by diabetic foot disease(18 999 yuan) and cerebrovascular disease (16 583 yuan).The cost per outpatients visit varied from 826 to 976 yuan across different complications except for lower extremity vascular diseases (522 yuan).Conclusions The majority of patients with T2DM suffered from chronic complications.The occurrence and development of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy,led to increased direct medical costs among patients with T2DM.Effective interventions,such as regular physical examinations and proper glycemic control,should be implemented to prevent complications among the diabetic patients.

Indice RECODE: aplicación y análisis en una población hospitalaria / Analysis and application of the RECODE Index in a hospital population

Las complicaciones crónicas de la diabetes mellitus pueden resultar en una baja calidad de vida, por lo cual la aplicación de un índice pronóstico puede ser una herramienta útil para mejorar esta situación.Objetivo: Asociar la presencia actual de complicaciones crónicas de la Diabetes Mellitus tipo 2, con las presentes 10 años antes aplicando la formula RECODE. Métodos: estudio observacional, analítico, longitudinal, retro-prospectivo en pacientes mayores de 30 años, se evaluaron las complicaciones crónicas en el presente y se aplicó la formula RECODE tomando los datos de la historia anterior. Tratamiento estadístico: estadística descriptiva para cada variable a través de análisis de frecuencia y porcentaje, además de la formula RECODE. Resultados: Se evaluaron 593 pacientes, con 308 exclusiones. El promedio de edad fue 63 años ± 15,5 DE. Hubo leve predominio de mujeres en 55%. En 75% de los pacientes había hipertensión. Las complicaciones crónicas encontradas fueron: nefropatía diabética 44%, neuropatía en 41% y afección cardiovascular en 14%. La mortalidad fue de 2%. Al confrontar las complicaciones crónicas que predice la formula RECODE en la actualidad, con los resultados de la fórmula con datos de 10 años previos, se encontró que todos los eventos ya estaban presentes durante la evaluación actual y la fórmula estimaba una menor frecuencia de los hallazgos documentados, con excepción de la cardiopatía isquémica o enfermedad cerebrovascular. Conclusión: La presencia de complicaciones crónicas actuales fue mayor a la que estimada según RECODE 10 años antes; aún así se concluye que dicha fórmula es útil para el cálculo de riesgo de complicaciones crónicas(AU)

The chronic complications of diabetes mellitus can result in a low quality of life for these patients. The application of a prognostic index can be a useful medical tool to improve this issue. Objective: To associate the present chronic complications of Type 2 Diabetes Mellitus, with the result of the application of the RECODE formula in the recent past. Methods: observational, analytical, longitudinal, retro-prospective study of patients older than 30 years. the chronic complications were assesed in the clinical record and at the present time using the RECODE formula as well as for the former 10 years Statistics:descriptive statistics for each variable through frequency and percentage analysis, in addition to the RECODE formula. Results: 593 patients were evaluated, with 308 exclusions. The average age was 63 years ± 15.5 SD. There was a slight predominance of women in 55%. Hypertension was present in 75%. Among the chronic complications found were: diabetic nephropathy 44%, followed by neuropathy in 41% and cardiovascular disease in 14%. Mortality was 2%. When comparing the present chronic complications predicted by the RECODE formula, with the results of the formula dated 10 years before we found that all the events were already present during the current evaluation and the formula estimated a lower frequency of the documented findings, with the exception of ischemic heart disease or cerebrovascular disease in 10 patients. Conclusion: The presence of current chronic complications was greater than estimated according to RECODE 10 years before.(AU)

Chronic complications of type 2 diabetes mellitus inpatients in Ningxia and its influence factors / 实用医学杂志

Objective To investigate the incidence and influence factors of chronic complications of inpa-tients with type 2 diabetes mellitus(T2DM)and to provide reference for the comprehensive prevention and treat-ment. Methods A retrospective analysis was conducted to analyze the occurrence and development of chronic complications of T2DM hospitalized patients in a third-level first-class hospital of Ningxia from January to Decem-ber in 2015.Results All of the 739 T2DM patients,the total incidence of chronic complications was 74.6%.The top five chronic diseases were large vessel disease,renal disease,retinopathy,peripheral vascular disease and neuropathy. Multivariate logistic regression analysis showed that the duration of disease(OR = 1.004,95% CI:1.002~1.006)and occupation(taking workers as controls,farmers' OR =3.122,95% CI:1.420~6.861,unem-ployed persons' OR=2.771,95% CI:1.389~5.527)were the independent risk factors of chronic complications of T2DM.Conclusions The total incidence of chronic complications of T2DM is high.We should strengthen the com-prehensive intervention of controllable risk factors for reducing the incidence of complications,decreasing medical costs and enhancing overall quality of life of patients.

Complications and midterm outcomes of hemiarthroplasty in hemodialysis patients / Complicações e resultados a médio prazo da hemiartroplastia em pacientes de hemodiálise

ABSTRACT Objective: The aim of this study was to evaluate the functional results, complications, and morbidity and mortality rates in patients with end-stage chronic renal failure (ESCRF) with collum femoris fractures who were treated with hemiarthroplasty. Methods: From 2005 to 2013, patients with ESCRF admitted to our hospital with collum femoris fracture and treated with hemiarthroplasty were retrospectively evaluated, and 44 hips in 42 patients were included in the study. Duration of hospital stay, bleeding, complications, morbidity and mortality were recorded for each patient. At the last control evaluation, patients were assessed via pelvis x-ray and functional status according to Harris Hip Score (HHS). Results: Patients required a mean 2.7 units of erythrocyte suspension. Mean hospital stay was 19.74 days. The most common complication was bleeding. The complication rate was 38.1%; mortality rate at first-year follow-up was 42.8%, and mean HHS was 74.5. Conclusion: Collum femoris fractures are more common in ESCRF patients due to metabolic bone disease, and these patients had many comorbidities which may exacerbate high complication and mortality rates. Orthopedic surgeons should consider these higher complication rates and inform patients about the consequences of this treatment. Level of Evidence IV, Case Series.

RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados funcionais, as complicações e as taxas de morbidade e mortalidade em pacientes com insuficiência renal crônica em estágio terminal (IRCT) com fraturas do colo do fêmur tratados com hemiartroplastia. Métodos: De 2005 a 2013, pacientes com IRCT internados em nosso hospital com fratura do colo do fêmur e tratados com hemiartroplastia foram avaliados retrospectivamente, e 44 quadris em 42 pacientes foram incluídos no estudo. Durante a estadia hospitalar, hemorragia, complicações, morbidade e mortalidade foram registradas para cada paciente. Na última avaliação de controle, os pacientes foram examinados com radiografias da pelve e quanto ao estado funcional, de acordo com o Harris Hip Score (HHS). Resultados: Os pacientes precisaram em média 2,7 unidades de suspensão de eritrócitos. A estadia hospitalar média foi 19,74 dias. A complicação mais comum foi hemorragia. A taxa de complicações foi 38,1%; a taxa de mortalidade no primeiro ano de acompanhamento foi 42,8% e o HHS médio foi 74,5. Conclusão: As fraturas de colo do fêmur são mais comuns em pacientes com IRCT, em decorrência da doença óssea metabólica, e esses pacientes apresentam muitas comorbidades que podem exacerbar as altas taxas de complicação e mortalidade. Os cirurgiões ortopédicos precisam considerar esses altos índices de complicações e informar os pacientes sobre as consequências desse tratamento. Nível de Evidência IV, Série de Casos.

A study on the relationship between chronic complications of type 2 diabetic and stroke incidence / 预防医学

Objective To learn the relationship between chronic complications of type 2 diabetic and stroke incidence.Methods Based on the surveillance data of type 2 diabetes and stroke in Xiuzhou district of Jiaxing City from 2009 to 2014, using logistic regression model method to analysis the relationships between chronic complications of type 2 diabetic and stroke incidence.Results Among 6 108 participants, 462 subjects developed stroke (7.56%);479 (7.84%) diabetes patients were diagnosed with chronic complications simultaneously and 116 subjects developed stroke (24.21%), higher than those no chronic complications (6.15%, P<0.05).The proportion of diabetic vasculopathy, nephropathy, neuropathy, retinopathy and skin infection were 33.33%, 24.64%, 23.23%, 13.48% and 5.32%, respectively.After adjusted for gender, age, occupation, urban and rural, obesity, hypertension and hyperlipidemia, there were significant statistical correlations between vasculopathy, neuropathy and stroke, the OR values and 95%CI were 4.95(3.41-7.19) and 2.79(1.80-4.32);patients who combined with any one,two, three or more chronic complications were significantly associated with the onset of stroke when compared with those without chronic complication, the OR values were 1.28, 2.75 and 5.38, respectively.Conclusion Vasculopathy and neuropathy of type 2 diabetes patients which found at diagnosed were risk factors of stroke,and the more for type 2 diabetes patients combined with the chronic complications, the greater the risk of stroke.

Perfil sociodemográfico, condiciones de salud y atención a personas con diabetes / Socio-demographic profile, health conditions and care for people with diabetes / Perfil sócio demográfico, condições de saúde e cuidados para as pessoas com diabetes

Objetivo: Analizar el perfil sociodemográfico, condiciones de salud y atención a personas con diabetes, a partir de la revisión de historias clínicas. Materiales y Métodos: Estudio descriptivo transversal. La población fue de 821 historias clínicas de pacientes con diabetes mellitus. En total la muestra fue de 230 historias clínicas por método aleatorio simple. Se utilizó el instrumento Impacto en la Condición de Salud y Calidad de Vida de las Atenciones de Salud en Pacientes Diabéticos Tipo 2 de Macul, que evalúa el perfil sociodemográfico, las condiciones de salud y el tipo de atención otorgada. Resultados: 39 % de los pacientes presentó el valor de la última hemoglobina glicosilada mayor de 12 %, el 41,3 % no presentó ningún riesgo de pie diabético, 46,9 % tuvo diagnóstico de obesidad y el 23,9 % presentó sobrepeso. El porcentaje de cumplimiento de citas al mes por parte del médico y la enfermera fue del 100 %, a diferencia del control por parte de la nutricionista que debe realizase cada 6 meses, sólo se registró un cumplimiento del 71,7 %. No se encontró relación estadísticamente significativa entre asistencia al programa con adherencia al tratamiento, o con compensación de la enfermedad. Conclusiones: Los pacientes con diabetes a pesar de estar en un programa de atención integral, no tienen un óptimo control glicémico, lo cual sugiere la revisión del cumplimiento del régimen terapéutico por parte de los profesionales de la salud para prevenir complicaciones que se puedan presentar a corto, mediano o largo plazo.

Objective: To analyze the socio-demographic profile, health conditions and attention to people with diabetes from a review of medical records. Materials and Methods: Cross-sectional descriptive study. The population was of 821 medical records of patients with diabetes mellitus. In total the sample was of 230 medical records through a simple aleatory method. The Impact instrument was used in the Health Condition and Life Quality of the Health Care in Diabetic Patients Type 2 from Macul, that evaluates the socio-demographic profile, the health conditions and the type of attention given. Results: 39% of the patients presented the value of the last glycosylated hemoglobin greater than 12%, 41,3% did not present any risks of diabetic foot, 46,9% had an obesity diagnose and 23,9% presented overweight. The doctor and the nurse percentage of compliance of appointments per month was 100%, as opposed to the control by the nutritionist that must be performed every 6 months, only a of 71,1% of compliance was registered. A statistically significant relationship was not found between compliance to the program and treatment adherence, or with compensation for the disease. Conclusions: Patients with diabetes despite of being in a program of comprehensive care, do not have an optimal glycemic control, which suggests a review of the compliance of the therapeutic regime by the health professionals to prevent complications that may occur in a short, medium, or long term.

Objetivo: Analisar o perfil sócio demográfico, condições de saúde e cuidados para as pessoas com diabetes a partir da revisão de histórias clínicas. Materiais e Métodos: Estudo descritivo transversal. A população foi de 821 historias clínicas de pacientes com diabetes mellitus. Em total a amostra foi de 230 historias clínicas por método aleatório simples. Utilizou-se o instrumento Impacto na Condição de Saúde e Qualidade de Vida das Assistências Médicas em Pacientes Diabéticos Tipo 2 de Macul, que avalia o perfil sócio demográfico, as condições de saúde e o tipo de atendimento recebido. Resultados: 39% dos pacientes apresentaram o valor da última hemoglobina glicada (Hb A1c) maior de 12%, o 41,3% não apresentou nenhum risco de pé diabético, 46,9% tiveram diagnóstico de obesidade e o 23,9% apresentaram excesso de peso. A porcentagem de cumprimento de consultas ao mês por parte do médico e a enfermeira foi do 100%, a diferença do controle por parte da nutricionista que deve realizar-se a cada 6 meses, apenas registrou-se um cumprimento do 71,7%. Não se encontrou relação estatisticamente significativa entre assistência ao programa com aderência ao tratamento, ou com compensação da doença. Conclusões: Os pacientes com diabetes a pesar de estar num programa de atendimento integral, não tem um óptimo controle glicémico, o qual sugere a revisão do cumprimento do regime terapêutico por parte dos professionais da saúde para prevenir complicações que se possam apresentar a curto, médio ou longo prazo.

Depresión en pacientes con diabetes tipo 2 que acuden a una consulta externa de medicina interna / Depression in patients with type 2 diabetes who attend an outpatient clinic of internal medicine

Resumen Introducción: las personas con diabetes pueden desarrollar cualquier síndrome psiquiátrico, siendo los más comunes la ansiedad y la depresión debido al impacto social de esta enfermedad, que está muy relacionada con los estilos de vida del individuo, cambios en el entorno social, apego o no a tratamiento y aceptación de la enfermedad. Objetivos: determinar la frecuencia de depresión en los pacientes diabéticos tipo 2 que acuden a la consulta externa de medicina interna del Hospital Central de San Cristóbal (Táchira, Venezuela) y brindar evidencia sobre la asociación con características demográficas y clínicas. Material y métodos: se realizó un estudio observacional, prospectivo, descriptivo y transversal donde se incluyeron 100 pacientes con diagnóstico de diabetes mellitus tipo 2 durante el tiempo comprendido entre marzo y octubre del año 2013, a quienes se les aplicó el Inventario de Beck para diagnóstico de depresión. Se procesaron los datos mediante el paquete estadístico Epi Info Versión 7. Se realizaron cálculos mediante estadística descriptiva e inferencial. Resultados: la frecuencia de depresión en los pacientes diabéticos tipo 2 fue 82%, porcentual-mente mayor en sexo femenino (59.76%), y se encontró asociación estadísticamente significativa entre depresión y grupo etario de 39-48 años (p = 0.014043), estado civil soltero (p = 0.048476), sin ocupación actual (p = 0.033012), con complicaciones crónicas de la diabetes (p = 0.0005378911); tratamiento hipoglicemiante oral (p = 0.0098842716) y con el uso de insulina (p = 0.0430326871). Discusión: existe alta prevalencia de depresión en pacientes diabéticos tipo 2, mayormente asociada a sexo, grupo etario, estado civil, complicaciones crónicas y tipo de tratamiento. (Acta Med Colomb 2016; 41: 102-110).

Abstract Introduction: people with diabetes can develop any psychiatric syndrome, being anxiety and depression the most common, due to the social impact of this disease, which is closely related to the lifestyle of the individual, changes in the social environment, attachment or not to treatment and acceptance of disease. Objectives: to determine the frequency of depression in type 2 diabetic patients attending the outpatient department of Internal Medicine of the Central Hospital of San Cristobal (Tachira, Venezuela) and provide evidence of association with demographic and clinical characteristics. Materials and Methods: an observational, prospective, descriptive and cross-sectional study in which 100 patients diagnosed with type 2 diabetes mellitus were included during the period between March and October 2013, to whom the Beck Depression Inventory (BDI) was applied. Data were processed using the statistical package Epi Info Version 7. Calculations were performed using descriptive and inferential statistics. Results: the frequency of depression in type 2 diabetic patients was in percentage terms 82% higher in female (59.76%), and statistically significant association between depression and age group of 39-48 years (p = 0.014 043), single marital status (p = 0.048476), no current occupation (p = 0.033012), with chronic complications of diabetes (p = 0.0005378911), oral hypoglycemic treatment (p = 0.0098842716) and with the use of insulin (p = 0.0430326871) was found. Discussion: there is a high prevalence of depression in patients with type 2 diabetes, mostly associated with sex, age group, marital status, chronic complications and type of treatment. (Acta Med Colomb 2016; 41: 102-110).

Delayed treatment of diabetic foot / 中华内分泌外科杂志

Diabetic foot is one of the chronic complications of diabetes,which has great harm.Through active treatment such as anti-infection,debridement,surgical intervention,amputation rate can be declined.