Influences of a Supplemental Blend of Essential Oils Plus 25-Hydroxy-Vit-D3 and Zilpaterol Hydrochloride (ß2 Agonist) on Growth Performance and Carcass Measures of Feedlot Lambs Finished under Conditions of High Ambient Temperature.

Forty-eight Pelibuey × Katahdin male intact lambs (25.12 ± 3.79 kg LW) were used in a 70-d growing-finishing trial. Dietary treatments consisted of total mixed corn-based diet supplemented with: (1) no feed additives (Control); (2) 150 mg of essential oils blend plus 0.10 mg of 25-hydroxy-Vit-D3/kg diet offered throughout the 70-d experimental period (EOD3); (3) Control diet fed during the first 35 days and zilpaterol hydrochloride (ZH) supplementation at 6 mg/kg diet offered during the final 35 days of the experiment (32 days with ZH with a withdrawal 3-d before harvest), and (4) basal diet supplemented with EOD3 during first 35 days finishing, and EOD3 in combination with ZH (EOD3 + ZH) during the subsequent 32-days with ZH withdrawal 3 days before harvest. The temperature-humidity index during the experiment averaged 80.4 ± 3.2. There were no treatment interactions (p > 0.20) on growth performance and carcass measures. Supplemental EOD3 did not affect (p = 0.43) dry matter intake (DMI), but increased (p < 0.01) carcass adjusted average daily gain (ADG, 9.2%), gain efficiency (GF, 6.7%), and observed vs. expected dietary net energy for maintenance (NEm, 4.8%) and for gain (NEg, 6.4%). Supplemental ZH did not affect dry matter intake (DMI, p = 0.50) but increased (p < 0.01) carcass adjusted ADG (14.5%), GF (13%) and observed vs. expected dietary NEm (9%) and NEg (11.7%). Compared to control lambs, the combination of both additives increased ADG (24.9%), GF (21.2%), and observed vs. expected dietary NEm and NEg (14.2% and 18.9%, respectively). There were no treatment interactions on carcass characteristics, visceral organ mass, or on gene expression of IGF1, IGF2 and mTOR in longissimus muscle (LM). Supplemental EOD3 increased hot carcass weight (HCW; 4.0%, p < 0.01) but did not affect other carcass measures. Supplemental EOD3 decreased (3%, p = 0.03) intestine mass weight (g intestine/kg empty body weight). Supplemental ZH increased HCW (6%, p < 0.01), dressing percentage (1.7%, p = 0.04), and LM area (9.7%, p < 0.01), and decreased kidney-pelvic-fat percentage (16.2%, p < 0.01), fat thickness (14.7%, p = 0.03), and visceral fat. Compared to controls, the combination of EOD3 with ZH increased HCW (10.2%). It is concluded that growth performance responses to supplemental EOD3 and ZH are additive. Both supplements can be fed in combination without detrimental effects on expected benefits when fed separately. In addition, ZH supplementation improves carcass traits.

Atrial placement of Aveir-VR leadless pacemaker in a patient with complex cardiac anatomy.

Leadless pacemakers have provided new treatment modalities that can be especially useful in patients with complex cardiac anatomy and contraindications toward other pacemaker approaches. The Aveir™ single-chamber (VR) leadless pacemaker (LP) (Abbott Laboratories, Chicago, IL) is a recently approved device that can be placed in the right ventricle for patients with bradycardia. In this case, we present a novel use for the device through placement in the atrium to control atrial flutter in a patient with a hypoplastic right ventricle.

Aveir retrievable, 38-mm length, leadless pacemaker implantation in a 23-kg pediatric patient with congenital heart disease.

INTRODUCTION: Complications are more prevalent in pediatric patients receiving pacemaker implants. METHODS: We performed a retrospective review of a retrievable, 38 mm leadless pacemaker implantation in a 23-kg pediatric patient. CASE/DISCUSSION: An active 9-year-old, 23 kg male patient with tetralogy of Fallot with intermittent pacing need presented with a fractured lead and pacing need. He underwent implant of a retrievable leadless pacemaker (Abbott Aveir) via internal jugular vein access, without complication, and with echocardiographic guidance. His threshold was stable at 1.25 V @0.4 ms, with stable impedance and sensing at 5-month follow-up. CONCLUSION: Aveir retrievable leadless pacemakers can be implanted safely in a child with tetralogy of Fallot, as small as 23 kilograms.

Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high-risk infected device extraction.

INTRODUCTION: Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime. METHODS: We present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy. RESULTS: A 27-year-old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status-post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy-based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser-lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial-mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices. CONCLUSION: Our case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices.

Retrievable leadless pacemakers (Aveir VR) may be beneficial in adult patients with congenital heart disease.

INTRODUCTION: Congenital heart disease may present in up to 1.6 % of newborns. Given high burden of pacing need in adult patients with repaired congenital heart disease and availability of different pacing options, more information on outcomes of newer pacemaker types are needed. Retrievable leadless pacemaker implants in adult congenital patients have not been described. METHODS: Retrospective review of three Aveir (Abbott) retrievable leadless pacemaker implants were reviewed at the UC Davis Medical Center. All patients underwent implant via femoral access. RESULTS: All patients had one deployment only, after mapping prior. No complications occurred. Implant thresholds were 0.5 V (V) @0.2msilliseconds (ms) for patients 1 and 2 and 1 V @0.4 ms for patient 3. With impedances between 500 and 1290 Ω. Sensing was 5.5-8 mV (mV). Follow-up occurred up to one year (for two patients) with similar values overall. The predicted longevities of each device were between 22.6 and >25 years. CONCLUSION: Safety and short-mid-term parameters of retrievable leadless pacemaker implantation is reported in three patients with adult congenital heart disease.

Capacidade funcional e qualidade de vida de adultos e idosos com feridas crônicas / Functional capacity and quality of life of adults and elderly people with wounds

Introdução: As feridas crônicas afetam a população em geral e comprometem negativamente a qualidade de vida e geram impactos biopsicossociais. Objetivo: Analisar a associação entre a capacidade funcional e a qualidade de vida de adultos e idosos com feridas crônicas. Métodos: Estudo transversal com 135 acometidas por feridas crônicas cadastradas nos serviços de atenção primária à saúde de um município de Minas Gerais, Brasil. Para a coleta de dados realizada no período de 2017 a 2018, utilizaram-se os instrumentos i) Cardiff Wound Impact Schedule que foi traduzido, adaptado culturalmente e validado para a língua portuguesa do Brasil; ii) Índice de Katz e iii) questionário sociodemográfico com informações sobre o perfil de saúde/doença e características das feridas. Resultados: Houve predomínio de participantes do sexo feminino (59,3%), com idade acima de 60 anos (70,4%) e até 4 anos de estudo (72,6%). No questionário Cardiff Wound Impact Schedule, o domínio com menor pontuação foi o de bem-estar (média 45,6 ± 18,2). Na avaliação da funcionalidade realizada por meio do Índice de Katz, destaca-se que 30 (22,2%) pessoas foram consideradas dependentes para tomar banho e 33 (24,4%) necessitavam de ajuda para se locomover. Houve associação estatisticamente significativa entre as seguintes variáveis independentes do Índice de Katz e do Cardiff Wound Impact Schedule para "vida social" e "banho", "vida social" e "vestir-se", "vida social" e "higiene pessoal", "vida social" e "locomoção", "vida social" e "alimentação", "sintomas físicos e vida diária" e "vestir-se", "bem-estar" e "continência". Conclusão: A incapacidade funcional está associada à diminuição da qualidade de vida de adultos e idosos com feridas crônicas (AU).

Introdução: As feridas crônicas afetam a população em geral e comprometem negativamente a qualidade de vida e geram impactos biopsicossociais. Objetivo: Analisar a associação entre a capacidade funcional e a qualidade de vida de adultos e idosos com feridas crônicas. Métodos: Estudo transversal com 135 acometidas por feridas crôni-cas cadastradas nos serviços de atenção primária à saúde de um município de Minas Gerais, Brasil. Para a coleta de dados realizada no período de 2017 a 2018, utilizaram-se os instrumentos i) Cardiff Wound Impact Schedule que foi traduzido, adaptado culturalmente e validado para a língua portuguesa do Brasil; ii) Índice de Katz e iii) questio-nário sociodemográfico com informações sobre o perfil de saúde/doença e características das feridas. Resultados: Houve predomínio de participantes do sexo feminino (59,3%), com idade acima de 60 anos (70,4%) e até 4 anos de estudo (72,6%). No questionário Cardiff Wound Impact Schedule, o domínio com menor pontuação foi o de bem-estar (média 45,6 ± 18,2). Na avaliação da funcionalidade realizada por meio do Índice de Katz, destaca-se que 30 (22,2%) pessoas foram consideradas dependentes para tomar banho e 33 (24,4%) necessitavam de ajuda para se locomover. Houve associação estatisticamente significativa entre as seguintes variáveis independentes do Índice de Katz e do Cardiff Wound Impact Schedule para "vida social" e "banho", "vida social" e "vestir-se", "vida social" e "higiene pessoal", "vida social" e "locomoção", "vida social" e "alimentação", "sintomas físicos e vida diária" e "vestir-se", "bem-estar" e "continência". Conclusão: A incapacidade funcional está associada à diminuição da qualidade de vida de adultos e idosos com feridas crônicas (AU).

Catheter ablation of atrioventricular nodal reentrant tachycardia, when AVNRT presented as a fetus or infant.

BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) does not commonly present during infancy. Although relative safety of catheter ablation of AVNRT has been demonstrated in pediatrics, this procedure is rarely indicated in children <15 kg. METHODS: Retrospective review of seven cases of AVNRT that presented in children younger than 1 year of age and required catheter ablation for definitive management. Electrophysiology (EP) study was planned with two or three catheters. Area of ablation determined by voltage mapping, propagation sinus wave collision and slow pathway potential location. Ablation performed with cryothermal energy. No fluoroscopy was used. RESULTS: Presentation ranged from 36 weeks of gestation to 11 months of age. Two presented in fetal life and two in the neonatal period. The median age of ablation was 20 months (range 17-31 months). The median weight at ablation was 11.4 kg (range 8.9-14.9 kg). Median follow-up time was 16 months. All had typical AVNRT. The median tachycardia cycle length was 216 ms. 100% successful rate using cryoablation. No complications. No recurrence of tachycardia during the follow-up period. CONCLUSION: Slow AV nodal pathway cryoablation may be safely performed, with good short and medium-term outcomes in patients under 15 kg.

Acute Bowel Ischemia in a Premature Neonate with Miller-Dieker Syndrome and Anomalous Right Coronary Artery From the Pulmonary Artery.

Miller-Dieker syndrome (MDS) is a rare disease characterized by type I lissencephaly, craniofacial dysmorphisms, intellectual disability, seizures, and death in early childhood. We report a case of a premature infant with MDS with an anomalous right coronary artery from the pulmonary artery who developed sudden bowel ischemia. This case prompts the reconsideration of cardiovascular involvement in patients with MDS. In addition, this review highlights key clinical features and reviews the critical manifestations of MDS that persist into childhood. [Pediatr Ann. 2023;52(8):e283-e291.].

Loop recorder implantation in patients as young as 3-months of age; the benefit of the sub-scapular approach.

BACKGROUND: Loop recorder implants may have value in pediatric patients; however, size limitations exist due to the risk of erosion. METHODS: Retrospective review of five patients who underwent subscapular loop recorder implantation were reviewed. RESULTS: No complications occurred. Stable R-waves were noted but could be positional but with adequate diagnostics provided. CONCLUSION: Subscapular loop recorder implantation is feasible in patients as young as 3 months of age.

First report of an Aveir retrievable leadless pacemaker in a pediatric patient, via internal jugular vein access.

BACKGROUND: The Aveir device allows retrievability and mapping prior to fixation over alternative leadless pacemakers. CASE SUMMARY: We describe the first case of Aveir leadless pacemaker implantation into a 44.5 kg, pediatric patient with symptomatic sinus dysfunction. Access by the right internal jugular vein (RIJ) with 1st attempt implantation into the septal location. DISCUSSION: Placement of the Aveir leadless pacemaker is feasible in a 44.5 kg pediatric patient via a RIJ approach.

Decreased vector magnitudes may help identify events in patients with Long QT syndrome.

INTRODUCTION: All Long QT syndrome (LQTS) patients are at elevated risk for channelopathy-induced delayed myocardial repolarization and consequently potentially life-threatening cardiac events with 90% of initial cardiac events occurring between preteen and 40 years old. Utilizing ECG and derived vectorcardiographic parameters, including T wave Vector Magnitude (TwVM) measurement data, this study attempts to determine whether TwVM from baseline ECGs is effectively predictive of future cardiac events for genotype-positive LQTS patients. METHODS: Verified carriers of established LQTS disease-causing genotypes were selected from University of Minnesota patient encounters between 2010 and 2020 for inclusion in this retrospective study. Baseline and predictive ECG and derived vectorcardiographic parameter evaluation, clinical data, and statistical analysis were compared between patients with and patients without cardiac events. First recorded ECG was at presentation to our hospital and final ECG is defined as ECG just prior to cardiac event (event defined below in Methods) or the most final documented ECG before cut-off year of 2020 for the event-free group. RESULTS: Of 41 participants, 15 experienced cardiac events and 26 did not. While many baseline electrocardiographic parameter measurements did not show significant differences between patient groups, vectorcardiographic parameters at baseline, specifically the QRS vector magnitude (QRSVM) and azimuth of the spatial ventricular gradient, showed significance. Additionally, final vectorcardiographic parameters, particularly the QRSVM, TwVM, and azimuth of the spatial ventricular gradient showed significant differences between patient groups. Final T-wave frontal axis was significantly larger in those without cardiac events. Significant Kaplan-Meier curve separation between patient groups was noted based on a QRSVM of 1.43 mV or lower, with additional consideration to patient age, genotype, and beta blocker use. CONCLUSION: This study shows evidence of ECG and derived vectorcardiographic parameters, including TwVM, being effective in early prediction of cardiac events in genotype-positive LQTS patients.

Transcatheter Leadless Pacing in Children: A PACES Collaborative Study in the Real-World Setting.

BACKGROUND: Transcatheter Leadless Pacemakers (TLP) are a safe and effective option for adults with pacing indications. These devices may be an alternative in pediatric patients and patients with congenital heart disease for whom repeated sternotomies, thoracotomies, or transvenous systems are unfavorable. However, exemption of children from clinical trials has created uncertainty over the indications, efficacy, and safety of TLP in the pediatric population. The objectives of this study are to evaluate clinical indications, procedural characteristics, electrical performance, and outcomes of TLP implantation in children. METHODS: Retrospective data were collected from patients enrolled in the Pediatric and Congenital Electrophysiology Society TLP registry involving 15 centers. Patients ≤21 years of age who underwent Micra (Medtronic Inc, Minneapolis, MN) TLP implantation and had follow-up of ≥1 week were included in the study. RESULTS: The device was successfully implanted in 62 of 63 registry patients (98%) at a mean age of 15±4.1 years and included 20 (32%) patients with congenital heart disease. The mean body weight at TLP implantation was 55±19 kg and included 8 patients ≤8 years of age and ≤30 kg in weight. TLP was implanted by femoral (n=55, 87%) and internal jugular (n=8, 12.6%) venous approaches. During a mean follow-up period of 9.5±5.3 months, there were 10 (16%) complications including one cardiac perforation/pericardial effusion, one nonocclusive femoral venous thrombus, and one retrieval and replacement of TLP due to high thresholds. There were no deaths, TLP infections, or device embolizations. Electrical parameters, including capture thresholds, R wave sensing, and pacing impedances, remained stable. CONCLUSIONS: Initial results from the Pediatric and Congenital Electrophysiology Society TLP registry demonstrated a high level of successful Micra device implants via femoral and internal venous jugular approaches with stable electrical parameters and infrequent major complications. Long-term prospective data are needed to confirm the reproducibility of these initial findings.

Endothelial Progenitor Cells May Be Related to Major Amputation after Angioplasty in Patients with Critical Limb Ischemia.

BACKGROUND: Critical limb ischemia represents an advanced stage of peripheral arterial disease. Angioplasty improves blood flow to the limb; however, some patients progress irreversibly to lower limb amputation. Few studies have explored the predictive potential of biomarkers during postangioplasty outcomes. AIM: To evaluate the behavior of endothelial progenitor cells in patients with critical limb ischemia, in relation to their postangioplasty outcome. METHODS: Twenty patients with critical limb ischemia, candidates for angioplasty, were enrolled. Flow-mediated dilation, as well as endothelial progenitor cells (subpopulations CD45+/CD34+/CD133+/CD184+ and CD45+/CD/34+/KDR[VEGFR-2]+ estimated by flow cytometry) from blood flow close to vascular damage, were evaluated before and after angioplasty. Association with lower limb amputation during a 30-day follow-up was analyzed. RESULTS: Endothelial progenitor cells were related with flow-mediated dilation. A higher number of baseline EPCs CD45+CD34+KDR+, as well as an impaired reactivity of endothelial progenitor cells CD45+CD34+CD133+CD184+ after angioplasty, were observed in cases further undergoing major limb amputation, with a significant discrimination ability and risk (0.75, specificity 0.83 and RR 4.5 p < 0.05). CONCLUSIONS: Endothelial progenitor cells were related with endothelial dysfunction, whereas a higher baseline number of the subpopulation CD45+CD34+KDR+, as well as an impaired reactivity of subpopulation CD45+CD34+CD133+CD184+ after angioplasty, showed a predictive ability for major limb amputation in patients with critical limb ischemia.

Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease.

BACKGROUND: Dyssynchrony-associated left ventricular systolic dysfunction is a major contributor to heart failure in congenital heart disease (CHD). Although conventional cardiac resynchronization therapy (CRT) has shown benefit, the comparative efficacy of cardiac conduction system pacing (CSP) is unknown. OBJECTIVES: The purpose of this study was compare the clinical outcomes of CSP vs conventional CRT in CHD with biventricular, systemic left ventricular anatomy. METHODS: Retrospective CSP data from 7 centers were compared with propensity score-matched conventional CRT control subjects. Outcomes were lead performance, change in left ventricular ejection fraction (LVEF), and QRS duration at 12 months. RESULTS: A total of 65 CSP cases were identified (mean age 37 ± 21 years, 46% men). The most common CHDs were tetralogy of Fallot (n = 12 [19%]) and ventricular septal defect (n = 12 [19%]). CSP was achieved after a mean of 2.5 ± 1.6 attempts per procedure (38 patients with left bundle branch pacing, 17 with HBP, 10 with left ventricular septal myocardial). Left bundle branch area pacing [LBBAP] vs HBP was associated with a smaller increase in pacing threshold (Δ pacing threshold 0.2 V vs 0.8 V; P = 0.05) and similar sensing parameters at follow-up. For 25 CSP cases and control subjects with baseline left ventricular systolic dysfunction, improvement in LVEF was non-inferior (Δ LVEF 9.0% vs 6.0%; P = 0.30; 95% confidence limits: -2.9% to 10.0%) and narrowing of QRS duration was more pronounced for CSP (Δ QRS duration 35 ms vs 14 ms; P = 0.04). Complications were similar (3 [12%] CSP, 4 [16%] conventional CRT; P = 1.00). CONCLUSIONS: CSP can be reliably achieved in biventricular, systemic left ventricular CHD patients with similar improvement in LVEF and greater QRS narrowing for CSP vs conventional CRT at 1 year. Among CSP patients, pacing electrical parameters were superior for LBBAP vs HBP.

Incidence of the first diabetic foot ulcer: A systematic review and meta-analysis.

AIM: Investigate the incidence of the first diabetic foot ulcer. METHOD: This is a systematic review with meta-analysis of cohort studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. A systematic search of Medline databases via PubMed, Embase, Lilacs, Scopus databases, and Web of Science was performed until July 2021. In addition to investigating the incidence of the first diabetic foot ulcer, the influence of the variables of the Human Development Index (HDI), glycated hemoglobin, and follow-up time of the participants on the incidence of the first diabetic foot ulcer (DFU) was analyzed through meta-regression. For the meta-analysis of cumulative incidence and possible variable associations, RevMan software was used in the Metaprop data package with 95% confidence interval (CI). RESULTS: A total of 9,772 articles were identified out of which 87 were selected and 12 studies ultimately included in the systematic review and meta-analysis. The meta-analysis of cumulative incidence was 5.65% (95% CI: 4.20; 7.57). By meta-regression, a significant inverse association was identified between DFU incidence and HDI (estimate - 2.38; 95% CI - 4.10--0.67; p = 0.01). CONCLUSION: The study presents the cumulative incidence for the first DFU, an inexistent datum in the national and international literature, and the HDI was inversely associated with the incidence of DFU.

Leadless pacemaker implantation for pediatric patients through internal jugular vein approach: A case series of under 30 kg.

BACKGROUND: We demonstrate a case series of 8 pediatric patients, all under 30 kg, who had leadless pacemaker implants via the internal jugular vein. METHODS: A retrospective review of pediatric leadless pacing placement via the internal jugular vein at the University of Minnesota Masonic Children's Hospital and UC Davis Medical Center from 2018 through 2021 was performed. Rationales for pacing, demographics of patients, pacing thresholds, and longevity of devices were recorded. RESULTS: Eight internal jugular pacemaker insertions were performed successfully in patients weighing between 10.9 kg and 29 kg. Five patients had Micra implantation via the right internal jugular vein, whereas 3 patients had insertion via the left internal jugular vein. No surgical cut-downs were performed. No venous complications occurred. Up to 3 years of follow-up were noted. CONCLUSION: Leadless pacemaker implantation, via left or right internal jugular veins, is feasible without surgical cutdown in patients <30 kg.

Atitudes dos profissionais da saúde em relação ao cuidado em diabetes tipo 2 na atenção primária / Actitudes de los profesionales de la salud hacia elcuidado a la diabetes tipo 2 en la atención primaria / Attitudes of health professionals towards type 2 diabetes care in primary care

RESUMO Objetivo: analisar as atitudes de profissionais que atuam na Atenção Primária à Saúde em relação ao cuidado de pessoas com diabetes mellitus tipo 2 (DM2). Método: estudo transversal realizado com 56 profissionais da atenção primária à saúde em Divinópolis, município do centro-oeste mineiro. As atitudes dos profissionais foram medidas por meio do instrumento Escala de Atitudes dos profissionais em relação ao diabetes Mellitus (EAP-DM) aplicado via plataforma web e-Surv. Os dados foram coletados entre maio e julho de 2019. Para análise, utilizaram-se os testes Mann Whitney e de Kruskal Wallis. Resultados: dos 56 profissionais, 36 (64,3%) possuíam menos de 10 anos de atuação na atenção primária e 40 (71,4%) concluíram especialização na área de atuação. Os participantes apresentaram atitudes positivas em relação ao diabetes, com pontuação média de 4,37 (DP: 0.22), variando entre 3,76 e 4,85. Médicos e psicólogos demonstraram atitudes menos favoráveis em relação aos cuidados em DM2, quando comparados aos enfermeiros e fisioterapeutas (valor de p <0,05). Conclusão: todos os profissionais apresentaram atitudes positivas e o nível destas atitudes variou conforme categoria profissional.

RESUMEN Objetivo: analizar las actitudes de profesionales que actúan en la Atención Primaria de Salud con relación al cuidado de personas con diabetes mellitus tipo 2 (DM2). Método: estudio transversal realizado con 56 profesionales de la atención primaria a la salud en Divinópolis, municipio del centro-oeste del Estado de Minas Gerais-Brasil. Las actitudes de los profesionales fueron medidas a través del instrumento Escala de Actitudes de los profesionales respecto al diabetes Mellitus (EAP-DM) aplicado vía plataforma web e-Surv. Los datos fueron recogidos entre mayo y julio de 2019. Para el análisis, se utilizaron las pruebas Mann Whitney y de Kruskal Wallis. Resultados: de los 56 profesionales, 36 (64,3%) poseían menos de 10 años de actuación en la atención primaria y 40 (71,4%) concluyeron especialización en el área de actuación. Los participantes presentaron actitudes positivas con relación a la diabetes, con puntuación media de 4,37 (DP: 0.22), variando entre 3,76 y 4,85. Médicos y psicólogos demostraron actitudes menos favorables hacia los cuidados en DM2, cuando comparados a los enfermeros y fisioterapeutas (valor de p <0,05). Conclusión: todos los profesionales presentaron actitudes positivas y el nivel de estas actitudes varió según categoría profesional.

ABSTRACT Objective: to analyze the attitudes of professionals working in Primary Health Care in relation to the care of people with type 2 diabetes mellitus (T2DM). Method: cross-sectional study conducted with 56 primary health care professionals in Divinópolis, a city in the center-west of Minas Gerais. The attitudes of professionals were measured through the instrument Scale of Attitudes of professionals in relation to diabetes Mellitus (EAP-DM) applied via e-Surv web platform. Data were collected between May and July 2019. For analysis, the Mann Whitney and Kruskal Wallis tests were used. Results: of the 56 professionals, 36 (64.3%) had less than 10 years of experience in primary care and 40 (71.4%) completed specialization in the area of activity. Participants showed positive attitudes towards diabetes, with a mean score of 4.37 (SD: 0.22), ranging from 3.76 to 4.85. Physicians and psychologists showed less favorable attitudes towards T2DM care when compared to nurses and physical therapists (p-value <0.05). Conclusion: all professionals showed positive attitudes and the level of these attitudes varied according to professional category.

Epidemiological Profile and Social Welfare Index as Factors Associated with COVID-19 Hospitalization and Severity in Mexico City: A Retrospective Analysis.

Epidemiological data indicate that Mexico holds the 19th place in cumulative cases (5506.53 per 100,000 inhabitants) of COVID-19 and the 5th place in cumulative deaths (256.14 per 100,000 inhabitants) globally and holds the 4th and 3rd place in cumulative cases and deaths in the Americas region, respectively, with Mexico City being the most affected area. Several modifiable and non-modifiable risk factors have been linked to a poor clinical outcome in COVID-19 infection; however, whether socioeconomic and welfare factors are associated with clinical outcome has been scanty addressed. This study tried to investigate the association of Social Welfare Index (SWI) with hospitalization and severity due to COVID-19. A retrospective analysis was conducted at the Centro Médico Nacional "20 de Noviembre"-ISSSTE, based in Mexico City, Mexico. A total of 3963 patients with confirmed or suspected COVID-19, registered from March to July 2020, were included, retrieved information from the Virology Analysis and Reference Unit Database. Demographic, symptoms and clinical data were analyzed, as well as the SWI, a multidimensional parameter based on living and household conditions. An adjusted binary logistic regression model was performed in order to compare the outcomes of hospitalization, mechanical ventilation requirement (MVR) and mortality between SWI categories: Very high (VHi), high (Hi), medium (M) and low (L). The main findings show that lower SWI were independently associated with higher probability for hospital entry: VHi vs. Hi vs. M vs. L-SWI (0 vs. +0.24 [OR = 1.24, CI95% 1.01-1.53] vs. +0.90 [OR = 1.90, CI95% 1.56-2.32] vs. 0.73 [OR = 1.73, CI95% 1.36-2.19], respectively); Mechanical Ventilation Requirement: VHi vs. M vs. L-SWI (0 vs. +0.45 [OR = 1.45, CI95% 1.11-1.87] vs. +0.35 [OR = 1.35, CI95% 1.00-1.82]) and mortality: VHi vs. Hi vs. M (0 vs. +0.54 [OR = 1.54, CI95% 1.22-1.94] vs. +0.41 [OR = 1.41, CI95% 1.13-1.76]). We concluded that SWI was independently associated with the poor clinical outcomes in COVID-19, beyond demographic, epidemiological and clinical characteristics.