Prevalence and systemic associations of retinal vascular occlusions in Sub­Saharan Africa

Background: Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA. Materials and Methods: This was a hospital based, cross sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05. Results: A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001. Conclusion: Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region

Polifarmacia en pacientes con diabetes tipo 2 e hipertensión arterial atendidos en un hospital provincial

Fundamento: las enfermedades crónicas conforme evolucionan requieren del uso de varios medicamentos para su control. Este uso se incrementa mientras más tiempo tengan desde su diagnóstico, situación que puede repercutir negativamente en la salud de los pacientes por las interacciones medicamentosas. Objetivo: asociar la polifarmacia con las principales enfermedades crónicas en pacientes atendidos en un hospital provincial peruano. Métodos: se realizó un estudio descriptivo, retrospectivo y transversal, ejecutado en setiembre del 2022, con 159 pacientes con diabetes tipo 2 e hipertensión arterial atendidos en el Hospital José Hernán Soto Cadenillas de Chota. Los datos de caracterización, fármacos consumidos y de las enfermedades crónicas se obtuvieron del Sistema de Padrón Nominal de pacientes inscritos en el Hospital. El análisis independiente de variables se hizo mediante frecuencias absolutas y relativas, intervalos de confianza al 95 %, media, desviación estándar, mínimo, máximo y la asociación entre variables con chi cuadrado de independencia, con p < 0,05 de significancia estadística. Resultados el 72,3 % de pacientes fueron mujeres, su media de edad fue de 68,6 años, el consumo de 4 fármacos fue el promedio para la comorbilidad de diabetes tipo 2 e hipertensión arterial, seguido de 3 fármacos en la hipertensión arterial, lo que representó polifarmacia para ambos casos (30,2 y 23,8 %, respectivamente). Existe asociación estadística significativa entre el padecimiento de enfermedad crónica y la polifarmacia (p = 0,002). Conclusión: la mayoría de pacientes consumen de 3 a más fármacos, máxime si padecen ambas enfermedades, por lo que la polifarmacia se asocia significativamente a la ocurrencia de enfermedades crónicas.

Background: chronic diseases as they evolve require the use of several medications for their control. This use increases the longer they have been since their diagnosis, a situation that can have a negative impact on the health of patients due to drug interactions. Objective: to associate polypharmacy with the main chronic diseases in patients treated in a Peruvian provincial hospital. Methods: a descriptive, retrospective and cross-sectional study was carried out, carried out in September 2022, with 159 patients with type 2 diabetes and arterial hypertension treated at the José Hernán Soto Cadenillas Hospital in Chota. Characterization data, drugs consumed and chronic diseases were obtained from the Nominal Register System of patients enrolled in the Hospital. The independent analysis of variables was done using absolute and relative frequencies, 95 % confidence intervals, mean, standard deviation, minimum, maximum and the association between variables with chi-square of independence, with p < 0.05 of statistical significance. Results: 72.3 % of patients were women, their mean age was 68.6 years, the consumption of 4 drugs was the average for the comorbidity of type 2 diabetes and arterial hypertension, followed by 3 drugs in arterial hypertension, which represented polypharmacy for both cases (30.2 and 23.8 %, respectively). There is a significant statistical association between suffering from chronic disease and polypharmacy (p = 0.002). Conclusion: most patients consume 3 or more drugs, especially if they suffer from both diseases, so polypharmacy is significantly associated with the occurrence of chronic diseases.

Presentation and character for adult patients with diabetes in Libya

Diabetes is a global issue, the diabetes epidemic is expected to continue, and the burden of diabetes causes catastrophic expenditure for healthcare system. The current study aimed to determine the presentation, the clinical feature and cardio-vascular risk factors in patients with diabetes. A retrospective observational study had been conducted in out-patients department at Almustaqpal Almosherq Centre during September, 2013 till September, 2020, the total number of attended out-patients department were 1 024, 820 patients who were selected for this study. A special perform was completed for every patient, which included details about patient's demographics, points in clinical history, relevant investigations and clinical examinations were recorded. The study reported that out of 820 patients, 66% (n = 538) was female and their age range was between 14 - 87 years with a mean age of 56.53 ± 13.49 years, 96% (n = 791) were clinically diagnosed as type II diabetes, 07% of the patients were diagnosed as pre-diabetes, the duration of diabetes ranged from newly diagnosed to more than 10 years, with 46% (n = 379) of the studied population were more than 10 years diabetes duration, 70% (581) were presented with classical symptoms of diabetes. Initial treatment for diabetes also different in the studied sample, were absent of anti-diabetic medications in 30% (n = 248) of the patients, they refused to start glucose lowering drugs, 34.6% (n = 284) of them have morbid obesity (body mass index is more than 40), 80% (n = 662) have high HBA1c (more than 8 g%), 40.3% (n = 240/596) were uncontrolled hypertension on anti-hypertension drugs, 95.6% (n = 682/713) were controlled on treatment of lipid lowering drugs. This study showing the presentation of diabetes were the common, type II diabetes, at age group between 41 - 66 years about 65%, female sex, with high body mass index, high glycated hemglobulin and uncontrolled hypertension. There is concern that diabetic patients were occurring at a high frequency in younger adults, where longer duration of illness could increase the risk of developing more complications in later life. The rate of coexist cardiovascular risk factors (hypertension, dyslipidaemia and obesity) in Libyan patients with diabetes is highlighted.

Factors associated with metabolic syndrome and quality of life of adults in a northeast brazilian municipality

Introduction: Metabolic Syndrome (MS) is currently considered a multi-factorial disease related to the asymptomatic, insidious, and deleterious inflammation that predisposes the individual to vulnerability by aggregating cardiovascular risk markers. Objective: to analyze the factors associated with Metabolic Syndrome and Quality of Life (QOL) in adult users of a health unit. Material and Methods: a cross-sectional study carried out with 108 adult users. Data collection was performed using a sociodemographic, clinical, and metabolic structured questionnaire and The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire. For the diagnosis of Metabolic Syndrome, the following criteria were used: increased abdominal circumference and arterial hypertension, diabetes, hypertriglyceridemia, and low HDL-cholesterol. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) 21.0 software. Results: Metabolic Syndrome was identified in 88.0% of the adults. Of this total of users evaluated with the syndrome, 87.4% of the individuals were female; 71.7% had diabetes; 87.0% had arterial hypertension; sedentary lifestyle was identified in 53.7%. In the assessment of the BMI, overweight and obesity predominated in 68.4% and 24.9%, respectively. The domains with the lowest quality of life scores were General Health and Vitality. Conclusions: The study made it possible to identify the Metabolic Syndrome in most of the adults evaluated. There was a low perception of quality of life among adults in all domains, except for physical aspects and vitality. Thus, there is a need for surveillance and health education for the studied population and improvement of their quality of life.

Introducción: El Síndrome Metabólico (SM) se considera actualmente una enfermedad multifactorial relacionada con la inflamación asintomática, insidiosa y deletérea que predispone al individuo a la vulnerabilidad al agregar marcadores de riesgo cardiovascular. Objetivo: analizar los factores asociados al síndrome metabólico y calidad de vida en adultos usuarios de una unidad de salud. Materiales y Métodos: estudio transversal realizado con 108 usuarios adultos. La recogida de datos se realizó mediante un cuestionario sociodemográfico, clínico y metabólico, estructurado y mediante el cuestionario The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Para el diagnóstico de Síndrome Metabólico se utilizaron los siguientes criterios: aumento de la circunferencia abdominal e hipertensión arterial, diabetes, hipertrigliceridemia y colesterol HDL bajo. El análisis estadístico se realizó utilizando el software Statistical Package for Social Sciences (SPSS) 21.0. Resultados: Se identificó síndrome metabólico en el 88,0% de los adultos. De este total de usuarios evaluados con el síndrome, el 87,4% de los individuos eran mujeres; 71,7% con diabetes; 87,0% tenía hipertensión arterial; Se identificó sedentarismo en 53,7%. En la valoración del IMC, predominaron el sobrepeso y la obesidad en 68,4% y 24,9%, respectivamente. Los dominios con las puntuaciones más bajas de calidad de vida fueron Salud general y Vitalidad. Conclusiones: el estudio permitió identificar el Síndrome Metabólico en la mayoría de los adultos evaluados. Hubo una baja percepción de la calidad de vida entre los adultos en todos los dominios, excepto en los aspectos físicos y vitalidad. Por tanto, es necesaria la vigilancia y educación sanitaria de la población estudiada y la mejora de su calidad de vida.

Introdução: A Síndrome Metabólica (SM) é atualmente considerada uma doença multifatorial relacionada à inflamação assintomática, insidiosa e deletéria que predispõe o indivíduo à vulnerabilidade por agregar marcadores de risco cardiovascular. Objetivo: analisar os fatores associados à Síndrome Metabólica e a Qualidade de Vida (QV) em adultos, usuários de uma unidade de saúde. Materiales e Métodos: estudo transversal realizado com 108 usuários, adultos. A coleta de dados foi realizada por meio de um questionário sociodemográfico, clínico e metabólico, estruturado e pelo questionário The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Para diagnóstico da Síndrome Metabólica utilizou-se como critérios: a circunferência abdominal aumentada e hipertensão arterial, Diabetes, hipertrigliceridemia e baixo HDL-colesterol. A análise estatística foi realizada com auxílio do software Statistical Package for Social Sciences (SPSS) 21.0. Resultados: a Síndrome Metabólica foi identificada em 88,0% dos adultos. Desse total de usuários avaliados com a síndrome, 87,4% dos indivíduos eram do sexo feminino; 71,7% com Diabetes; 87,0% apresentaram hipertensão arterial; o sedentarismo foi identificado em 53,7%. Na avaliação do IMC preponderou o excesso de peso e a obesidade em 68,4% e 24,9%, respectivamente. Os domínios com menores escores da qualidade de vida foram Estado Geral de Saúde e Vitalidade. Conclusões: o estudo possibilitou a identificação da Síndrome Metabólica na maioria dos adultos avaliados. Observou-se, em todos os domínios, uma baixa percepção da qualidade de vida entre os adultos, exceto nos aspectos físicos e vitalidade. Assim, faz-se necessária vigilância e educação em saúde para a população estudada e melhoria de sua qualidade de vida.

La Extensión universitaria como herramienta para mejorar conocimientos de pacientes con diabetes e hipertensión / The University extension as a tool to improve knowledge of patients with diabetes and hypertension

Introducción: Las enfermedades crónicas no transmisibles (ECNT) son las principales causas de muerte en el mundo, que corresponde al 26% de las muertes en nuestro país y su prevalencia se ha incrementado en un 10 % en los últimos 15 años. La forma de prevenir y controlar las ECNT es a través de una acción global e integrada. La extensión universitaria es un proceso pedagógico transformador en el que alumnos y docentes pueden influir en los estilos de vida de la población, mediante proyectos de intervención comunitaria. Metodología: El proyecto se desarrollo en 3 fases; la primera fase de diagnostico y primera encuesta sobre conocimiento de ECNT, la segunda de intervención y una tercera donde se aplico una segunda encuesta. Resultados: El proyecto se extendió en el año 2017 con 4 visitas. Dando como resultados los siguientes datos socios demográficos: 36 familias estables, 59 habitantes corresponden al género femenino y 54 al masculino. El 97% son paraguayos. 38,5% finalizo la primaria. En el sexo masculino la profesión fue de empleados 34,6%, de comerciante 18,6%; en el sexo femenino fue de quehaceres domésticos 63,4%. La jefatura de hogar masculina predomina en un 75% el sexo masculino. La patología predominante en adultos es la de HTA. Luego de aplicadas las intervenciones educativas se logró mejorar el conocimiento sobre la diabetes de nivel de conocimiento malo a regular y respecto a la hipertensión el nivel de conocimiento aumento de regular a buena. Conclusión: Los pacientes mejoraron el conocimiento sobre las ECNT, por lo cual se demostró el beneficio de la intervención mediante este proyecto de extensión universitaria.

Introduction: Chronic noncommunicable diseases (NCDs) are the main causes of death in the world, which corresponds to 26% of deaths in our country and its prevalence has increased by 10% in the last 15 years. The way to prevent and control CNCDs is through a global and integrated action. The university extension is a transformative pedagogical process in which students and teachers can influence the lifestyles of the population through community intervention projects. Methodology: The project was developed in 3 phases; the first phase of diagnosis and first survey on knowledge of NCDs, the second of intervention and a third where a second survey was applied. Results: The project was extended in 2017 with 4 visits. Giving as results the following data demographic partners: 36 stable families, 59 inhabitants correspond to the feminine gender and 54 to the masculine. 97% are Paraguayan. 38.5% finished primary school. In the male sex, the profession was 34.6% employees, 18.6% merchant; in the female sex, it was household chores 63.4%. The male head of household dominates the male sex by 75%. The predominant pathology in adults is that of HTN. After applying the educational interventions, it was possible to improve the knowledge about diabetes from the level of bad knowledge to regular and regarding hypertension, the level of knowledge increased from regular to good. Conclusion: Patients improved their knowledge about CNCDs, which is why the benefit of the intervention was demonstrated through this university extension project.

Evaluation of reliability and validity of Chinese version of Diabetes, Hypertension and Hyperlipidemia (DHL) Knowledge Instrument in community diabetic patients / 中华全科医师杂志

Objective To evaluate the reliability and validity of the Chinese version of the Diabetes,Hypertension and Hyperlipidemia(DHL) Knowledge Instrument in community diabetic patients.Methods A face-to-face interview was conducted among 513 patients with diabetes in the community from January to March 2016 by using the Chinese version of DHL Knowledge Instrument.Forty of them were randomly sampled and reinvestigated 4 weeks later.The analyses on Cronbach's α coefficient,test-retest reliability,content validity,discriminant validity and construct validity were performed to evaluate reliability and validity of the DHL Knowledge Instrument.Results The qualified questionnaires were collected from 488 participants,including 232 males and 256 females with a mean age of (66 ± 6)years.The overall scores of the Chinese version of DHL Knowledge Instrument was 67.7 ± 18.0 and the scores of diabetes,hypertension,hyperlipidemia,medications and general issues sub-scales were 82.0 ± 22.5,65.9 ± 25.2,38.2 ± 34.3,75.5 ± 20.8 and 72.1 ± 22.9,respectively.The standardized Cronbach's α coefficient of the total scale was 0.849 and the test-retest reliability of the total scale was 0.706 (P ＜ 0.01).In term of content validity,the correlation coefficient was from 0.580 to 0.827 among total scale and sub-scales (P ＜ 0.01).In term of discriminant validity,the difference between the high and the low score group on total scale and sub-scales were significant (t value =-13.486 to-35.528,all P ＜ 0.01).In term of construct validity,based on exploratory factor analysis,the scale was revised.According to confirmatory factor analysis of revised scale,four factor model containing 20 items was well fitted (X2 =159.689,df =134,P =0.064);the GFI (goodness of fit index) =0.966,AGFI (adjusted goodness of fit index) =0.952,RMSEA (root mean square error of approximation) =0.020.Conclusion The Chinese version of DHL Knowledge Instrument possesses good reliability and validity and is suitable to evaluate the knowledge of community diabetic patients,and the modified version may work better than the original one.

Assessment the effects of kidney protection of Enalapril in patients with kidney failure at I, II stages follow by hypertensive type 2 diabetes

Study on 50 male patients with hypertension of I-II degrees; kidney failure at I, II stages and type 2 diabetes according to the criteria of WHO. Results: Enalapril is a drug of angiotensine-converting enzyme inhibitors which had effect of decrease of systolic, diastolic and mean blood pressure. This drug slow down a process of chronic kidney failure at stage I-II (there were no changes in level of filting kidney, blood creatinine, decrease of ureteral protein); the unexpected effects were small so that drug seems to safe and well tolerated.