The quality of care in type 1 and type 2 diabetes - A 2023 update of the AMD Annals Initiative.

AIMS: An initiative of continuous monitoring of the quality of diabetes care, promoted by the Association of Medical Diabetologists, is in place in Italy since 2006 (AMD Annals). The initiative was effective in improving quality of care indicators, assessed periodically through standardized measures. Here, we show the 2023 AMD Annals data on type 2 (T2D) and type 1 (T1D) diabetes. METHODS: A network of over 1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic medical records, using a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. RESULTS: 296 centers provided data on 573,164 T2D (mean age 69.7±11.2 years) and 42,611 T1D subjects (mean age 48.6±16.9 years). A HbA1c value ≤7.0% was documented in 56.3% of patients with T2D and 35.9% of those with T1D. Only 6.6% of T2D patients and 3.5% of those with T1D reached the composite outcome of HbA1c ≤7.0% + LDL-C <70 mg/dl + BP <130/80 mmHg. Notably, only 2.8% and 3.2% of T2D and T1D patients, respectively, showed a Q score <15, which correlates with an 80% higher risk of incident CVD events compared to scores >25. CONCLUSIONS: We documented an overall good quality of care in both T1D and T2D subjects. However, the failure to achieve the targets of the main risk factors, especially if combined, in a still too large proportion of patients testify the difficulty to apply the more and more stringent indications recommended by guidelines in the everyday clinical practice.

Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals.

BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia. METHODS: This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score. RESULTS: Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM. CONCLUSIONS: In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.

Temporal trends in the starting of insulin therapy in type 2 diabetes in Italy: data from the AMD Annals initiative.

AIMS: Opportunities and needs for starting insulin therapy in Type 2 diabetes (T2D) have changed overtime. We evaluated clinical characteristics of T2D subjects undergoing the first insulin prescription during a 15-year-observation period in the large cohort of the AMD Annals Initiative in Italy. METHODS: Data on clinical and laboratory variables, complications and concomitant therapies and the effects on glucose control after 12 months were evaluated in T2D patients starting basal insulin as add-on to oral/non-insulin injectable agents, and in those starting fast-acting in add-on to basal insulin therapy in three 5-year periods (2005-2019). RESULTS: We evaluated data from 171.688 T2D subjects who intensified therapy with basal insulin and 137.225 T2D patients who started fast-acting insulin. Overall, intensification with insulin occurred progressively earlier over time in subjects with shorter disease duration. Moreover, the percentage of subjects with HbA1c levels > 8% at the time of basal insulin initiation progressively decreased. The same trend was observed for fast-acting formulations. Clinical characteristics of subjects starting insulin did not change in the three study-periods, although all major risk factors improved overtime. After 12 months from the starting of basal or fast-acting insulin therapy, mean HbA1c levels decreased in all the three investigated time-periods, although mean HbA1c levels remained above the recommended target. CONCLUSIONS: In this large cohort of T2D subjects, a progressively earlier start of insulin treatment was observed during a long observation period, suggesting a more proactive prescriptive approach. However, after 12 months from insulin prescription, in many patients, HbA1c levels were still out-of-target.

The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care.

AIMS: Since 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D). METHODS: A network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. RESULTS: 295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25. CONCLUSIONS: The 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review.

Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.

Predictors of treatment response to liraglutide in type 2 diabetes in a real-world setting.

AIMS: There is an unmet need among healthcare providers to identify subgroups of patients with type 2 diabetes who are most likely to respond to treatment. METHODS: Data were taken from electronic medical records of participants of an observational, retrospective study in Italy. We used logistic regression models to assess the odds of achieving glycated haemoglobin (HbA1c) reduction ≥ 1.0% point after 12-month treatment with liraglutide (primary endpoint), according to various patient-related factors. RECursive Partitioning and AMalgamation (RECPAM) analysis was used to identify distinct homogeneous patient subgroups with different odds of achieving the primary endpoint. RESULTS: Data from 1325 patients were included, of which 577 (43.5%) achieved HbA1c reduction ≥ 1.0% point (10.9 mmol/mol) after 12 months. Logistic regression showed that for each additional 1% HbA1c at baseline, the odds of reaching this endpoint were increased 3.5 times (95% CI: 2.90-4.32). By use of RECPAM analysis, five distinct responder subgroups were identified, with baseline HbA1c and diabetes duration as the two splitting variables. Patients in the most poorly controlled subgroup (RECPAM Class 1, mean baseline HbA1c > 9.1% [76 mmol/mol]) had a 28-fold higher odds of reaching the endpoint versus patients in the best-controlled group (mean baseline HbA1c ≤ 7.5% [58 mmol/mol]). Mean HbA1c reduction from baseline was as large as - 2.2% (24 mol/mol) in the former versus - 0.1% (1.1 mmol/mol) in the latter. Mean weight reduction ranged from 2.5 to 4.3 kg across RECPAM subgroups. CONCLUSIONS: Glycaemic response to liraglutide is largely driven by baseline HbA1c levels and, to a lesser extent, by diabetes duration.

Characterization and application of cellulose acetate synthesized from sugarcane bagasse.

The synthesis and application of cellulose acetate (CA) from sugarcane bagasse were investigated. Firstly, cellulose was extracted by a sequential treatment with H2SO4 (10% v/v), NaOH (5% w/v), EDTA (0.5% w/V), and H2O2 (5% v/v), and characterized by X-ray diffraction (DRX). After the acetylation of the extracted cellulose, CA was characterized using Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and thermogravimetry analysis (TGA), and was applied in the membrane production. The membranes were analyzed by DSC and atomic force microscopy (AFM), and tested in the flux of water vapor to determinate the best conditions for membrane manufacturing. FTIR analysis proved the replacement of free OH groups by acetyl groups, and the thermal analysis showed that sugarcane bagasse CA possessed thermal properties compared to commercial grade CA. The best conditions to prepare membrane were: 3% (w/v) of polymer/solvent relation, 10min of solvent evaporation time, and 20°C as temperature for the coagulation bath. These results show that CA can be successfully synthesized from sugarcane bagasse and applied in membrane preparation.

Synthesis of cellulose acetate and carboxymethylcellulose from sugarcane straw.

Sugarcane straw (SCS) is a raw material with high potential for production of cellulose derivatives due to its morphology and structure. The proposal of this work was to synthesize cellulose acetate (CA) and carboxymethylcellulose (CMC) from sugarcane straw cellulose, and applied the CA in the preparation of a membrane. The cellulose extraction was carried out in four steps. Firstly, SCS was treated with H2SO4 (10% v/v) followed by NaOH (5% w/v) treatment. Subsequently, a chelating process was performed before ending the extraction process with chemical bleaching using H2O2 (5% v/v). The extracted cellulose was employed in the obtainment of CA and CMC. The CA presented a degree of substitution (DS) of 2.72. Its FTIR spectrum showed that practically all hydroxyl groups were replaced by acetate groups. The membrane synthesized from CA was dense and homogeneous. The presence of small particles on the top and bottom surfaces decreased the mechanical resistance of the membrane. The CMC presented a low DS (0.4) demonstrating the carboxymethylation reaction was not very effective due to the presence of lignin. These results proved that SCS can be utilized in the synthesis of CA and CMC.

How can we monitor glycaemic variability in the clinical setting?

No universal consensus exists on how to express glycaemic variability. Among other parameters, standard deviation of blood glucose values, mean amplitude of glycaemic excursions (MAGE), the Low Blood Glucose Index (LBGI) and the High Blood Glucose Index (HBGI), which were subsequently combined into the Average Daily Risk Range (ADRR), mean of daily differences (MODD) and glycaemic variability index (GVI) are highlighted. The continuous glucose monitoring in research and clinical settings has been a great help for a comprehensive approach to circadian blood glucose evaluation and identification of individual patterns, mainly in type 1 diabetes, but recently also in type 2 diabetes. In everyday clinical practice the judicious use of self-monitoring of blood glucose in an educational setting involving the patient and the care team is an unreplaceable tool to effectively and safely guide behavioural and drug therapy.

Which patients should be evaluated for blood glucose variability?

Diabetes is characterized by glycaemic disorders that include both sustained chronic hyperglycaemia and acute fluctuations (i.e. glycaemic variability). Increasing attention is being paid to the role of glycaemic variability as a relevant determinant for diabetes control and prevention of its vascular complications. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of glycaemic control (i.e. HbA1c, fasting and postprandial glucose, as well as glycaemic variability). Subjects at risk of hypoglycaemia, subjects with postprandial hyperglycaemia and patients who need to adjust or start insulin seem to be the categories that require glycaemic variability monitoring. The analysis of blood glucose variability represents an additional tool in the global assessment of glycaemic control and can serve as a guide to the clinician in the management of therapy and for the patients both in the prevention of acute complications, in particular hypoglycaemia, and chronic disease, in particular macrovascular complications.

The worrisome liaison between left ventricular systolic dysfunction and mitral annulus calcification in type 2 diabetes without coronary artery disease: data from the SHORTWAVE study.

BACKGROUND AND AIM: Mitral annulus calcification (MAC) is a marker for coronary artery disease (CAD) and predicts poor outcome in the general population. No data are available on MAC in patients with type 2 diabetes. In these patients we assessed prevalence of MAC and the relation between MAC and left ventricular (LV) systolic function. METHODS AND RESULTS: As many as 386 patients with type 2 diabetes without CAD were studied with Doppler echocardiography. LV systolic dysfunction was defined by analyzing 120 healthy subjects. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (peak S') were considered as indexes of LV circumferential and longitudinal shortening and classified low if <89% and <8.5 cm/s, respectively (10th percentiles of controls). Patients who had MAC (107 = 28%) were older with longer duration of DM and were receiving more anti-hypertension medications than those who had not. At echocardiographic evaluation patients with MAC showed higher LV mass, larger left atrial volume (LAV), reduced sc-MS (88.4 ± 14.9 vs 92.6 ± 14.3%; p = 0.01) and peak S' (8.9 ± 2.2 vs 10.0 ± 2.0 cm/s; p < 0.001) than patients without MAC. Multiple logistic regression demonstrated older age (OR 1.03 [IC 1.01-1.06], p = 0.009), larger LAV (OR 1.19 [IC 1.11-1.28], p < 0.001) and combined reduction in sc-MS and peak S' (OR 3.00 [IC 1.57-5.72], p = 0.001) as independent factors associated with MAC. CONCLUSIONS: MAC is detectable in one fourth of patients with type 2 diabetes without CAD and is mostly related to LV systolic dysfunction expressed as combined impairment of LV circumferential and longitudinal fibers, independent of age and LAV.

Prospective study of Kawasaki disease complications: review of 115 cases.

OBJECTIVE: To draw attention to complications that might arise in any Kawasaki disease (KD) stage, risk factors contributing to the onset of complications and possible transient or permanent disease sequelae. METHODS: Prospective study (clinical cohort) conducted between April 2002 and April 2009 of 115 patients with KD admitted to the Pediatric Rheumatology Clinic of the General Hospital of the Federal District, Brazil. All patients were sequentially assessed with clinical and laboratory examinations, Doppler echocardiography, imitanciometry, auditory evoked potentials, psychological evaluation, ophthalmologic examination and, in one patient with chorea, cerebral magnetic resonance angiography. In all patients, a questionnaire assessing the possible presence of cognitive, emotional, behavioral and social disorders was applied. RESULTS: Twenty-five patients (21.7%) had coronary aneurisms. Thirty eight patients (33%) had a sensorineural auditory loss during the acute and subacute phases of the disease and 13 patients (11.3%) maintained the auditory loss six months after the first assessment. Other complications observed were as follows: facial palsy in one patient (0.9%), ataxia in acute and subacute phases in 11 (9.5%); 15 patients had ophthalmologic complications (13.2%), with uveitis in 13, papilledema in one patient, and conjunctival hemorrhage in another patient. One patient experienced chorea (0.9%), with a magnetic resonance angiography showing changes consistent with cerebral ischemia. In one patient, a thoracic aorta aneurism was found (0.9%) and another patient had a necrotizing vasculitis progressing to peripheral gangrene and tongue tip loss (0.9%). Behavioral changes over convalescence were observed in 23 children. CONCLUSION: KD may progress with several complications even within months of the disease acute phase, eventually resulting in permanent sequelae. The earlier the diagnosis and therapeutic intervention with IV IgG administration are, the lower will be the occurrence of complications; the presence of thrombocytosis, anemia and elevated and extended inflammatory activity are risk factors for complication arising.

Estudo prospectivo das complicações da Doença de Kawasaki: análise de 115 casos / Prospective study of Kawasaki Disease complications: review of 115 cases

OBJETIVO: Chamar a atenção para as complicações, que podem surgir em qualquer fase da Doença de Kawasaki (DK), para os fatores de risco que contribuem para o aparecimento dessas complicações e para as possíveis sequelas da doença, sejam elas transitórias ou permanentes. MÉTODOS: Estudo prospectivo (coorte clínica) realizado entre abril de 2002 e abril de 2009 de 115 pacientes com DK internados no serviço de Reumatologia Pediátrica do Hospital Geral do Distrito Federal. Todos os pacientes foram sequencialmente avaliados com exames clínicos e laboratoriais, ecocardiogramas com Doppler, imitanciometria, potenciais evocados auditivos, avaliação psicológica, exame oftalmológico e, em um paciente com coreia, angiorressonância magnética cerebral. Em todos os pacientes foram aplicados questionários avaliando a possível presença de dificuldades cognitivas, emocionais, comportamentais e sociais. RESULTADOS: Vinte e cinco pacientes (21,7 por cento) apresentaram aneurismas de coronárias. Trinta e oito pacientes (33 por cento) apresentaram perda auditiva neurossensorial durante a doença aguda e subaguda, e 13 pacientes (11,3 por cento) mantiveram a perda auditiva seis meses após a primeira avaliação. Outras complicações observadas foram: paralisia facial em um paciente (0,9 por cento), ataxia na fase aguda e subaguda em 11 pacientes (9,5 por cento), complicações oftalmológicas em 15 pacientes (13,2 por cento), constatando-se uveíte em 13, edema de papila em um paciente e hemorragia conjuntival em outro. Um paciente apresentou coreia (0,9 por cento) sendo que a angioressonância magnética evidenciou alterações compatíveis com isquemia cerebral. Em um paciente constatou-se a presença de aneurisma de aorta torácica (0,9 por cento), e outro apresentou vasculite necrosante que evoluiu com gangrena periférica e perda da ponta da língua (0,9 por cento). Alterações de comportamento durante a convalescença (20 por cento) foi observada em 23 crianças. CONCLUSÃO: A DK pode evoluir com complicações diversas, mesmo meses após a fase aguda da doença, eventualmente resultando em sequelas permanentes. Quanto mais precoce forem o diagnóstico e a intervenção terapêutica com a administração de IgG IV, menor será a ocorrência de complicações. Presença de trombocitose, anemia e de atividade inflamatória elevada e por tempo prolongado são fatores de risco para o aparecimento de complicações.

OBJECTIVE: To draw attention to complications that might arise in any Kawasaki disease (KD) stage, risk factors contributing to the onset of complications and possible transient or permanent disease sequelae. METHODS: Prospective study (clinical cohort) conducted between April 2002 and April 2009 of 115 patients with KD admitted to the Pediatric Rheumatology Clinic of the General Hospital of the Federal District, Brazil. All patients were sequentially assessed with clinical and laboratory examinations, Doppler echocardiography, imitanciometry, auditory evoked potentials, psychological evaluation, ophthalmologic examination and, in one patient with chorea, cerebral magnetic resonance angiography. In all patients, a questionnaire assessing the possible presence of cognitive, emotional, behavioral and social disorders was applied. RESULTS: Twenty-five patients (21.7 percent) had coronary aneurisms. Thirty eight patients (33 percent) had a sensorineural auditory loss during the acute and subacute phases of the disease and 13 patients (11.3 percent) maintained the auditory loss six months after the first assessment. Other complications observed were as follows: facial palsy in one patient (0.9 percent), ataxia in acute and subacute phases in 11 (9.5 percent); 15 patients had ophthalmologic complications (13.2 percent), with uveitis in 13, papilledema in one patient, and conjunctival hemorrhage in another patient. One patient experienced chorea (0.9 percent), with a magnetic resonance angiography showing changes consistent with cerebral ischemia. In one patient, a thoracic aorta aneurism was found (0.9 percent) and another patient had a necrotizing vasculitis progressing to peripheral gangrene and tongue tip loss (0.9 percent). Behavioral changes over convalescence were observed in 23 children. CONCLUSION: KD may progress with several complications even within months of the disease acute phase, eventually resulting in permanent sequelae. The earlier the diagnosis and therapeutic intervention with IV IgG administration are, the lower will be the occurrence of complications; the presence of thrombocytosis, anemia and elevated and extended inflammatory activity are risk factors for complication arising.

Innate immunity, through late complement components activation, contributes to the development of early vascular inflammation and morphologic alterations in experimental diabetes.

OBJECTIVE: To verify if innate immunity, and namely the assembly of terminal complement complex (TCC) could be involved in the development of early diabetic vascular damage. METHODS AND RESULTS: At first in 2 groups of diabetic or non-diabetic Wistar rats the occurrence of basal or stimulated stable adherence to the endothelial layer and extravasation of circulating fluorescently-labelled leukocytes was assessed by using an in vivo videomicroscopy technique. In a second part of the study, the development of vascular damage in short term diabetes was studied in the genetically C6 deficient rats of the PVG strain, and compared with those observed in the wild-type C6 sufficient animals. Here, the analysis of mesentery vascular expression of mRNA for vascular cell adhesion molecule (VCAM)-1, transforming growth factor-ß (TGF-ß), connective tissue growth factor (CTGF), and platelet-derived growth factor (PDGF), the evaluation of intravascular protein levels of VCAM-1, TGF-ß, CTGF, proliferative cell nuclear antigen (PCNA), as well as the assessment of structural changes and Complement components deposition at the mesentery arterial vascular wall were also performed. CONCLUSIONS: Leukocyte trafficking, mesentery arteries hypertrophy, extracellular matrix deposition, local vascular gene and protein expression of VCAM-1, TGF-ß, CTGF and PCNA, as well as PGDF gene expression were all increased by short term diabetes, but all significantly reduced in the C6 deficient diabetic animals, thus suggesting an active role for TCC in the development of vascular inflammation in the early phases of experimental diabetes.

La educación en valores humanos: fundamento de las estrategias educativas / Education on Human Values: Basis for educative strategies

El presente trabajo responde esencialmente a la necesidad de capacitar a los recursos humanos que intervienen en el proceso de formación de los profesionales de la salud (docentes, trabajadores no docentes y directivos) para asumir con plenitud la tarea del desarrollo del trabajo formativo sobre las actuales concepciones filosóficas, pedagógicas y psicológicas, que están elaboradas tanto a escala nacional como internacional. Este diplomado contribuye al desarrollo sobre bases científicas de la estrategia educativa y los proyectos educativos que se elaboran en el Centro. Por ello el objetivo es el de hacer una propuesta de actividad de postgrado (Diplomado) que permita la preparación teórica y metodológica del personal docente y de dirección de la Educación Médica Superior para desarrollar la educación en valores a través del proyecto educativo, así como brindar herramientas prácticas para el diseño de las estrategias educativas. El diplomado que se muestra está aprobado como actividad de los programas nacionales e internacionales de postgrados del MINSAP y la ENSAP, y ha sido impartido en dos versiones en el ISCM Carlos J Finlay de Camaguey con resultados positivos. Este curso de superación es el resultado lógico del desarrollo de tesis de maestrías y de otros cursos cortos contemplados en el plan de superación del Instituto de varios profesores involucrados en el mismo (AU)

This work responds essentially to the necessity of qualifying the human resources that intervene in the health professionals' formation process to assume with great quality the carrying out of the formative work, taking into consideration the current philosophical, pedagogical and psychological conceptions elaborated at national as well as international levels. This postgraduate course contributes to the development on scientific bases of the educational strategy and the educational projects that are elaborated. For this reason, the main objective is making a proposal of postgraduate studies that foster professors ' theoretical and methodological preparation, to develop values education through the educational project, as well as to offer practical tools for the design of educational strategies. The postgraduate course that is presented is approved as an activity of the national and international programs of postgraduate studies of MINSAP and ENSAP, and it has been carried out in two versions in Carlos J Finlay Medical School in Camagüey with positive results. This course is the logical result of the development of master degree scientific papers and of other short courses contemplated in the Medical School professors' development planning (AU)

Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14.

AIMS: To determine the ability of probiotic lactobacilli to improve the treatment of vulvovaginal candidiasis (VVC) using a randomized, double-blind and placebo-controlled trial. METHODS AND RESULTS: Fifty-five women diagnosed with VVC by vaginal discharge positive for Candida spp. (according to culture method) associated with at least one of the symptoms (itching and burning vaginal feeling, dyspareunia and dysuria), were treated with single dose of fluconazole (150 mg) supplemented every morning for the following 4 weeks with two placebo or two probiotic capsules (containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14). At 4 weeks, the probiotic treated group showed significantly less vaginal discharge associated with any of the above mentioned symptoms (10.3%vs 34.6%; P = 0.03) and lower presence of yeast detected by culture (10.3%vs 38.5%; P = 0.014). CONCLUSION: This study has shown that probiotic lactobacilli can increase the effectiveness of an anti-fungal pharmaceutical agent in curing disease. SIGNIFICANCE AND IMPACT OF THE STUDY: This novel finding of probiotic lactobacilli augmenting the cure rate of yeast vaginitis, not only offers an alternative approach to a highly prevalent condition that adversely affects the quality of life of women around the world, but also raises the question of how this combination works.

Orally administered microencapsulated lysozyme downregulates serum AGE and reduces the severity of early-stage diabetic nephropathy.

AIM: Diabetic nephropathy is the leading cause of end-stage kidney disease in developed countries and is related to chronic hyperglycaemia. The increased production and tissue deposition of advanced glycation end products (AGE) are known to play a major role in the pathogenesis of diabetic kidney damage. This study was undertaken to determine if lysozyme (LZ), microencapsulated in orally administrable chitosan-coated alginate microspheres (MS), is effective against the early changes seen in the initial stages of diabetic nephropathy. METHODS: LZ-containing MS (MSLZ) and an equivalent dose (equidose) of nonencapsulated LZ were given as oral treatments. LZ was administered to Wistar rats for seven weeks after diabetes induction with streptozotocin. RESULTS: The results showed that microencapsulated LZ treatment significantly reduced the concentration of serum AGE in the circulation and their deposition in the kidneys. Likewise, MSLZ significantly prevented the development of microalbuminuria compared with untreated diabetic rats. Furthermore, MSLZ significantly prevented the development of glomerular and renal hypertrophy as well as overexpression of AGE receptors (RAGE). An equidose of free LZ had little or no effect whatsoever. CONCLUSION: Our study supports a relationship between serum AGE and nephropathy in diabetes, and suggests that orally administered microencapsulated LZ can exert kidney-protective activity in a diabetic animal model.

La educación en valores humanos: fundamento de las estrategias educativas / Education on Human Values: basis for educative strategies

El presente trabajo responde esencialmente a la necesidad de capacitar a los recursos humanos que intervienen en el proceso de formación de los profesionales de la salud (docentes, trabajadores no docentes y directivos) para asumir con plenitud la tarea del desarrollo del trabajo formativo sobre las actuales concepciones filosóficas, pedagógicas y psicológicas, que están elaboradas tanto a nivel nacional como internacional. Este diplomado contribuye al desarrollo sobre bases científicas de la estrategia educativa y los proyectos educativos que se elaboran en el Centro. Por ello el objetivo es el de hacer una propuesta de actividad de postgrado (Diplomado) que permita la preparación teórica y metodológica del personal docente y de dirección de la Educación Médica Superior para desarrollar la educación en valores a través del proyecto educativo, así como brindar herramientas prácticas para el diseño de las estrategias educativas. El diplomado que se muestra está aprobado como actividad de los programas nacionales e internacionales de postgrados del MINSAP y la ENSAP, y ha sido impartido en dos versiones en el ISCM “Carlos J Finlay” de Camaguey con resultados positivos. Este curso de superación es el resultado lógico del desarrollo de tesis de maestrías y de otros cursos cortos contemplados en el plan de superación del Instituto de varios profesores involucrados en el mismo(AU)

La educación en valores humanos: fundamento de las estrategias educativas / Education on Human Values: Basis for educative strategies

El presente trabajo responde esencialmente a la necesidad de capacitar a los recursos humanos que intervienen en el proceso de formación de los profesionales de la salud (docentes, trabajadores no docentes y directivos) para asumir con plenitud la tarea del desarrollo del trabajo formativo sobre las actuales concepciones filosóficas, pedagógicas y psicológicas, que están elaboradas tanto a escala nacional como internacional. Este diplomado contribuye al desarrollo sobre bases científicas de la estrategia educativa y los proyectos educativos que se elaboran en el Centro. Por ello el objetivo es el de hacer una propuesta de actividad de postgrado (Diplomado) que permita la preparación teórica y metodológica del personal docente y de dirección de la Educación Médica Superior para desarrollar la educación en valores a través del proyecto educativo, así como brindar herramientas prácticas para el diseño de las estrategias educativas. El diplomado que se muestra está aprobado como actividad de los programas nacionales e internacionales de postgrados del MINSAP y la ENSAP, y ha sido impartido en dos versiones en el ISCM “Carlos J Finlay” de Camaguey con resultados positivos. Este curso de superación es el resultado lógico del desarrollo de tesis de maestrías y de otros cursos cortos contemplados en el plan de superación del Instituto de varios profesores involucrados en el mismo.

This work responds essentially to the necessity of qualifying the human resources that intervene in the health professionals’ formation process to assume with great quality the carrying out of the formative work, taking into consideration the current philosophical, pedagogical and psychological conceptions elaborated at national as well as international levels.  This postgraduate course contributes to the development on scientific bases of the educational strategy and the educational projects that are elaborated.   For this reason, the main objective is making a proposal of postgraduate studies that foster professors’ theoretical and methodological preparation, to develop values education through the educational project, as well as to offer practical tools for the design of educational strategies. The postgraduate course that is presented is approved as an activity of the national and international programs of postgraduate studies of MINSAP and ENSAP, and it has been carried out in two versions in “Carlos J Finlay” Medical School in Camagüey with positive results. This course is the logical result of the development of master degree scientific papers and of other short courses contemplated in the Medical School professors’ development planning.