Prácticas de autocuidado en el adulto mayor con Diabetes Mellitus Tipo II / Self-care prectices in the elderly with Diabetes Mellitus II

Objetivo: Describir la vivencia del cuidado y el autocuidado en el adulto mayor diagnosticado de diabetes mellitus II. Material y método: Estudio cualitativo fenomenológico de enfoque explicativo-interpretativo. Se persigue entender las vivencias ante los autocuidados en personas diabéticas mayores de 65 años. Se lleva a término en el CAP Les Planes de Sant Joan Despí, Barcelona (España). Se realizó un muestreo opinático, no probabilístico intencionado y razonado. La muestra final se compuso de 13 participantes. Para la recogida de datos se utilizó la entrevista semiestructurada e individual. Las entrevistas se llevaron a cabo entre junio del 2019 y diciembre del 2020. Se realizó un análisis temático siendo concomitante a la recogida de estos. Resultados: El diagnóstico de diabetes supone para la persona el conocimiento sobre la pérdida de su salud, de la vivencia de este momento dependerá la forma en que afrontará la enfermedad. La mayoría de los pacientes de este estudio afirman no haber recibido ningún tipo de información sobre los cuidados a realizar respecto a la dieta, el ejercicio físico o el cuidado de los pies, aunque sí que recuerdan el tratamiento farmacológico. Conclusiones: El cuidado de enfermería en las personas con Diabetes Mellitus tipo II debe incluir la consideración de los aspectos físicos, tecnológicos, económicos y educativos de la persona cuidada, adaptando la planificación de los cuidados a cada una de ellas, según dichos factores. (AU)

Objective: To describe the experience of care and self-care in the elderly diagnosed with diabetes mellitus II Material and method: Qualitative phenomenological study with an explanatory-interpretive approach. The aim is to understand the experiences of self-care in diabetic people over 65 years of age. It takes place at the CAP Les Planes de Sant Joan Despí, Barcelona (Spain). An opinionated, non-probabilistic intentional and reasoned sampling was carried out. The final sample consisted of 13 participants. For data collection, the semi-structured and individual interview was used. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out, concomitant with the collection of these. Results: Diagnosis of diabetes supposes for the person the knowledge about the loss of his health, the experience of this moment will depend on the way in which he will face the disease. Most of the patients in this study claim not to have received any type of information about the care to be taken regarding diet, physical exercise or foot care, although they do remember the pharmacological treatment Conclusions: Nursing care in people with type II Diabetes Mellitus should include the consideration of the physical, technological, economic and educational aspects of the person cared for, adapting the care planning to each one of them, according to these factors. (AU)

Autocuidado de los pies en personas con diabetes tipo 2. Un estudio cualitativo / "Self-care of the feet in people with type 2 diabetes. A qualitative study"

Objetivo: Entender las vivencias de los adultos mayores de 65 años con diabetes mellitus tipo 2 respecto al autocuidado de los pies. Método: Estudio cualitativo fenomenológico de enfoque descriptivo. Se lleva a término en las dependencias del Centro de Atención Primaria de Les Planes de Sant Joan Despí, Barcelona, perteneciente al Instituto Catalán de la Salud. Para la recogida de datos se utilizó una entrevista semiestructurada e individual, con un guion de aspectos básicos a explorar, no cerrado y centrado en los objetivos de la investigación. Las entrevistas se llevaron a cabo entre junio del 2019 y diciembre del 2020. Se realizó un análisis temático siendo concomitante a la recogida de estos. Resultados: Una muestra final de 13 personas (4 hombres y 9 mujeres) participaron en el estudio. La adherencia a las recomendaciones del autocuidado del pie diabético es irregular. Los participantes explican conductas de riesgo a pesar de saber que pueden suponer una lesión para unos pies considerados previamente de alto riesgo. La valoración del podólogo supone un coste económico que no pueden permitirse algunas personas. Conclusiones: La enfermera ha de hacer un seguimiento exhaustivo de cómo las personas con diabetes cuidan sus pies, insistiendo en las recomendaciones preventivas no solo en la revisión anual, sino cada vez que la persona acude a la consulta de seguimiento de la diabetes. Es necesaria una comunicación efectiva enfermera-podólogo para mejorar la prevención y el seguimiento de las personas con riesgo de sufrir pie diabético.(AU)

Objective: To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care. Method: Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these. Results: A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviors despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford. Conclusions. The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.

Self-care of the feet in people with type 2 diabetes. A qualitative study.

OBJECTIVE: To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care. METHOD: Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these. RESULTS: A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviours despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford. CONCLUSIONS: The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.

Role of the SARS-CoV-2 virus in the appearance of new onset type 1 diabetes mellitus in children in Gran Canaria, Spain.

OBJECTIVES: It has been hypothesized that SARS-CoV-2 may play a role in the development of different forms of diabetes mellitus (DM). The Canary Islands have the highest incidence of type 1 DM (T1DM) reported in Spain (30-35/100,000 children under 14 years/year). In 2020-2021 we observed the highest incidence so far on the island of Gran Canaria, as a result of which we decided to evaluate the possible role of COVID-19 in the increased number of onsets. METHODS: We examined the presence of IgG antibodies against SARS-CoV-2 in children with new onset T1DM between October 2020 and August 2021. We compared recent T1DM incidence with that of the previous 10 years. RESULTS: Forty-two patients were diagnosed with T1DM (48.1/100,000 patients/year), representing a nonsignificant 25.7% increase from the expected incidence. Of the 33 patients who consented to the study, 32 presented negative IgG values, with only one patient reflecting undiagnosed past infection. Forty-four percent of patients presented with ketoacidosis at onset, which was similar to previous years. CONCLUSIONS: We conclude that there is no direct relationship between the increased incidence of T1DM and SARS-CoV-2 in the region. The COVID-19 pandemic did not result in an increased severity of T1DM presentation.

Efectividad de la estimulación cognitiva en pacientes del hospital de dia del parc sanitari pere virgili / Effectiveness of cognitive stimulation in patients of the parc sanitari day hospital pere virgili

La demencia en España se da hasta en el 15% de los mayores de 65 años, y el 17,2% de los mayores de 70 años. Su abordaje no farmacológico incluye la estimulación cognitiva que aporta claros beneficios según la literatura. Objetivo: Evaluar la eficacia de la estimulación cognitiva en pacientes ingresados en el hospital de día del Hospital de día (HD) del Parc Sanitari Pere Virgili (PSPV), evaluando su impacto sobre el paciente a nivel cognitivo, funcional, social y emocional. Metodología: Se realizó un estudio longitudinal prospectivo de intervención. Se realizó un corte transversal antes de iniciar la terapia y un corte transversal al finalizarla. Se compararon ambos cortes concluyendo si había diferencias significativas entre ellos. El estudio se realizó en el HD del PSPV. Los sujetos de estudio fueron los pacientes ingresados en el HD del PSPV, que cumplan los criterios de inclusión y exclusión del estudio. Se recogieron los datos de los pacientes que realizaron la Estimulación Cognitiva desde Enero/febrero hasta noviembre/diciembre del 2018. Los participantes en el estudio fueron 56. La intervención realizada fueron las terapias que se llevan a cabo en el HD, estimulación cognitiva oral, escrita o a través de ordenador y gimnasia colectiva: en el caso que lo precisaran, también realizaron fisioterapia o terapia ocupacional. Las diferentes variables se recogieron en el Cuaderno de recogida de datos, incluyeron: Edad, Género, MMSE, Barthel y Lawton. El análisis estadístico de los datos se realizó mediante el programa estadístico SPSS® (Statistical Product and Service Solutions) versión 20.0.Se realizó un análisis descriptivo de todas las variables recogidas. El estudio cuenta con algunas limitaciones y aspectos éticos que se han tenido en cuenta en el desarrollo de este. El presupuesto que se precisó para dicha actividad fue limitado, ya que la intervención ya se estaba realizando previamente. Se llevó a cabo durante el año 2018 (AU)

Dementia in Spain occurs up to 15% of those over 65 years of age, and the 17.2% of those over the age of 70. Its nonpharmacological approach includes the cognitive stimulation which provides clear benefits according to the literature. Objective:To evaluate the efficacy of cognitive stimulation in patients admitted to the Parc Sanitari Pere Virgili (PSPV) day hospital (HD), evaluating it’s cognitive, functional, social and emotional impact on the patient. Methodology: A prospective longitudinal study of intervention. A transversal cut was made before starting the therapy and a cut cross when finished. Both cuts were compared concluding if there was significant differences between them. The study was carried out in the HD of the PSPV. Its subjects were the patients admitted to the HD of the PSPV, who met the inclusion and exclusion criteria of the study. The data was collected from the patients who underwent Cognitive Stimulation from January/February to November/December or 2018. There was a total of 56 participants in the study. Intervention carried out were the therapies are being fulfilled at the HD, including, oral, written or computerized cognitive stimulation and collective gymnastics: if it was required, they also could performe physiotherapy or occupational therapy. The different variables were collected in the Data Collection Notebook, they included: Age, Gender, MMSE, Barthel and Lawton. The statistical analysis of the data was carried out using the statistical program SPSS® (Statistical Product and Service Solutions) version 20.0. A descriptive analysis of all variables was performed. The study has some limitations and ethical aspects that have been taken into account in its development. The budget required for said activity was limited, since the intervention was already being carried out previously. It was executed out during the year 2018 (AU)

INFOSA-DEM: programa dirigido a figuras cuidadoras de personas con demencia / INFOSA-DEM: a programme targeted to caregivers of persons with dementia

OBJETIVO: evaluar el impacto del Programa Informativo, Formativo y de Apoyo Social para figuras cuidadoras de personas con demencia (INFOSA-DEM), en relación al bienestar emocional, evaluando el tiempo de permanencia del efecto del programa a los tres y seis meses post-intervención. MÉTODO: se llevó a cabo un diseño cuasi-experimental, multicéntrico, no aleatorizado con grupo intervención (GI) y grupo control (GC). La asignación al GI y GC se realizó a través de muestreo no probabilístico, de asignación intencional, teniendo en cuenta la disponibilidad de las figuras cuidadoras para asistir a las sesiones del proprama diseñado. La recogida de datos fue efectuada por medio de entrevistas personales con la cuidadora o cuidador en el domicilio de la persona con demencia, antes de la intervención y a los tres y seis meses de seguimiento. Se recogieron variables de bienestar emocional y calidad de vida, entre otras. Se llevó a cabo análisis descriptivo y comparativo en los tres momentos de medida. RESULTADOS: participaron 160 figuras cuidadoras, 74 en GC y 86 en GI. A los tres meses se observó un efecto positivo en el bienestar emocional en el GI en comparación con un pequeño efecto negativo entre los controles. Teniendo en cuenta las tres visitas se comprobó que la mejora en dimensión salud relacionada con el bienestar emocional de los cuidadores del GI se mantuvo incluso después de seis meses, aunque las diferencias no fueron estadísticamente significativas. CONCLUSIÓN: los programas educativos dirigidos a cuidadores informales basados en terapias psicoeducativas y teorías cognitivo-conductuales parecen tener efectos positivos en la mejora del bienestar emocional de los cuidadores, y mejora la calidad del rol de la figura cuidadora

OBJECTIVE: to evaluate the impact of the Information, Training and Social Support programme for caregivers of persons with dementia (INFOSA-DEM) in terms of emotional wellbeing, evaluating the duration of the effect of the program at three and six months after the intervention. METHOD: a multicenter and non-randomized study was conducted, with quasi-experimental design, and with an Intervention Arm (IA) and a Control Arm (CA). Participants were allocated to IA or CA though non-probabilistic sample, with intentional allocation, taking into account the availability of the caregivers to attend the sessions of the programme designed. Data were collected through personal interviews with the caregiver at the home of the person with dementia, before the intervention and at three and six months of follow-up. Emotional wellbeing and quality of life variables were collected, among others. Descriptive and comparative analysis was conducted at the three points of measurement. RESULTS: the study included 160 caregivers, 74 in the CA and 86 in the IA. At three months, a positive effect was observed in the emotional wellbeing of the Intervention Arm, vs. a slight negative effect among Control participants. Taking into account all three visits, it was confirmed that the improvement in the dimension health associated with the emotional wellbeing of caregivers in the Intervention Arm was sustained even after six months; however, differences were not statistically significant. CONCLUSION: educational programs targeted to informal caregivers and based on psychoeducational therapies and cognitive-behavioural theories seem to have positive effects in terms of an improvement in the emotional wellbeing of caregivers, and there is an improvement in the quality of the caregiver role

Compressive symptoms due to thrombosed or hypertrophic collateral circulation in infrarenal inferior vena cava agenesis.

Agenesis of the infrarenal segment of inferior vena cava is an uncommon and often asymptomatic congenital abnormality with an approximate incidence of 0.005-1% in the general population. Presentation of this condition as deep venous thrombosis associated with symptoms secondary to thrombosis or hypertrophy of collateral vessels is a rare clinical form. Two cases of this rare form are described, and an analysis of the related literature is presented. The first case was that of a 35-year-old man with symptoms of acute obstructive pyelonephritis with no apparent cause and swelling of the lower limb. The second case involved a 30-year-old man with lower limb swelling associated with paresthesia and motor deficit. Both patients were found to have infrarenal inferior vena cava agenesis associated with iliofemoral deep venous thrombosis and compression of anatomic structures by collateral vessels (ureteral compression due to thrombosis of an ectatic gonadal vein and L5 nerve root compression due to a hypertrophic epidural venous plexus). Patients were conservatively managed with anticoagulation therapy, with a favorable outcome and no recurrence in either case. In a young patient with iliac deep venous thrombosis of uncertain etiology, and particularly in those with atypical associated symptoms (mainly abdominal or neurologic), it is important to investigate congenital vena cava anomalies and carry out diagnostic imaging studies. Anticoagulation therapy is currently considered the best treatment option for this condition, but it should be individualized. The need for long-term anticoagulation should also be assessed in each case.

Impact of liposomal amphotericin B on renal function in critically ill patients with renal function impairment

Objetivo: Evaluar la tolerabilidad de anfotericina B liposomal (L-AmB) en pacientes críticos con concentraciones elevadas de creatinina sérica (Cr) (> 1,5 mg/dL) al inicio del tratamiento con L-AmB. Métodos: Estudio retrospectivo, multicéntrico y comparativo de dos cohortes de pacientes críticos tratados con L-AmB durante tres o más días, que se diferenciaban según el nivel de creatinina al inicio del tratamiento. Se estableció como punto de corte un valor de Cr de 1,5 mg/dL. Se excluyeron los pacientes con técnicas de depuración extrarrenal antes o 48 horas después del inicio de L-AmB. La variable principal fue la diferencia entre el valor de creatinina al final comparado con el inicio de tratamiento con L-AmB. Otros parámetros secundarios fueron: abandonos relacionados con el tratamiento, necesidad de técnicas de depuración extrarrenal (TDE) y acontecimientos adversos graves (AAG) relacionados con el tratamiento. Se recogieron datos demográficos, enfermedad subyacente, motivo de prescripción, factores concomitantes de riesgo de nefrotoxicidad y estado vital al alta de UCI y del hospital. Resultados: Se reclutaron 122 pacientes en 26 UCI (Cr > 1,5 g/dL, n= 16; Cr normal, n= 106). Los motivos principales por los que se indicó L-AmB en ambos grupos fueron el amplio espectro y la presencia de inestabilidad hemodinámica. Se administró como tratamiento de 1ª línea en el 68,8% de los pacientes con Cr elevada y en el 52,8% con Cr normal. La puntuación APACHE II al ingreso en UCI fue 25 en pacientes con Cr elevada y 17 en aquellos con Cr normal (p< 0,001). La duración del tratamiento con L-AmB fue 16 y 12 días en pacientes con Cr elevada y normal y una dosis media de 3,5 vs 3,9 mg/kg/día. El uso concomitante de otros fármacos nefrotóxicos, la tasa de mortalidad, y la estancia en UCI y hospitalaria fueron similares en ambas cohortes. En los pacientes con función renal alterada al inicio de L-AmB se observó una reducción absoluta de Cf-Ci de 1,08 mg/dl (P<0,001). La Cr bajó a valores normales en el 50% de los pacientes, descendió pero sin llegar a valores normales en el 37,5% y sólo se elevó en 1 (6,25%) paciente. En ningún paciente se suspendió L-AmB por nefrotoxicidad ni se precisaron técnicas de depuración extrarrenal. No se reportaron AAG relacionados con el tratamiento. Conclusiones: El tratamiento con L-AmB en pacientes críticos con función renal deteriorada tuvo un impacto mínimo en la función renal. L-AmB puede utilizarse para el tratamiento de infecciones fúngicas en pacientes críticos independientemente de la función renal al inicio del tratamiento(AU)

Objetive: To assess the tolerability of liposomal amphotericin B (L-AmB) in critically ill patients with elevated serum creatinine concentrations (Cr) (> 1.5 mg/dL) at starting L-AmB therapy. Methods: Retrospective, multicenter, comparative study of two cohorts of critically ill patients treated with L-AmB during 3 or more days, the difference between them was the level of Cr at the beginning of treatment. A cutoff value of Cr of 1.5 mg/dL was established. Patients undergoing extrarenal depuration procedures before or 48 hours after starting L-AmB were excluded. The primary endpoint was the difference between Cr values at the end of treatment as compared with Cr at starting L-AmB. Secondary endpoints were treatment-related withdrawals, need of extrarenal depuration techniques, and treatment-related severe adverse events. Demographic data, underlying illness, indication of L-AmB therapy, concomitant risk factors of nephrotoxicity, and vital status at ICU and hospital discharge were recorded. Results: A total of 122 patients admitted to 26 ICUs (16 with Cr > 1.5 g/dL; 106 with normal Cr levels) were recruited. Main reasons for the use of L-AmB in both groups were the broad spectrum of the drug and the presence of hemodynamic instability. L-AmB was administered as first-line treatment in 68.8% of patients with elevated Cr and in 52.8% with normal Cr. The APACHE II score on ICU admission was 25 in patients with elevated Cr and 17 in those with normal Cr values (p < 0.001). Duration of treatment with L-AmB was 16 and 12 days in patients with elevate and normal Cr values, respectively, with a mean dose of 3.5 vs 3.9 mg/kg/day. The use of concomitant nephrotoxic drugs, mortality rate, and ICU and hospital length of stay were similar in both cohorts. In patients with renal function impairment at the initiation of L-AmB treatment, an absolute decrease of Cf-Ci of 1.08 mg/dL was observed (P < 0.001). A decrease of Cr levels to normal limits was observed in 50% of the patients; in 37.5% of patients there was a decrease but normal levels were not achieved, whereas a Cr increased occurred in only one (6.25%) patient. None of the patients required withdrawal of L-AmB or use of extrarenal depuration procedures. Treatment-related severe adverse events were not reported. Conclusions: In critically ill patients with impaired renal function, the impact of L-AmB on renal function was minimal. L-AmB can be used for the treatment of fungal infections in critically ill patients independently of renal function at the initiation of treatmen(AU)

Innominate artery aneurysm with hemoptysis and airway compression in a patient with bovine aortic arch.

We present the case of a 63-year-old man with a bovine aortic arch variation, who presented episodes of mild hemoptysis secondary to a 4.5-cm (diameter) aneurysm of the innominate artery that compressed the trachea and obliterated the right subclavian artery. Surgery, performed through a median sternotomy, consisted of a bypass from the ascending aorta to both common carotid arteries using a Dacron graft, and exclusion of the aneurysm by ligature and direct thrombin injection. Computed tomography angiography at 30 days showed a patent bypass, successful aneurysm exclusion, and improvement of the tracheal compression. The patient is currently asymptomatic at 12 months following the procedure.

Relationship between plasma homocysteine and the morphological and immunohistochemical study of carotid plaques in patients with carotid stenosis over 70%.

BACKGROUND: Several clinical and epidemiological studies describe hyperhomocysteinemia as an independent cardiovascular risk factor. Implication of cellular immunity in atherosclerosis also seems clear. This study aimed to analyze the association among plasma hyperhomocysteinemia, neurological clinical events, and the morphology and immunocytology of carotid plaques in patients with carotid stenosis >70% receiving surgical treatment. METHODS: Sixty-two patients with carotid stenosis >70% receiving surgical treatment were studied; 58% had a history of stroke in the ipsilateral carotid territory. Plasma homocysteine concentrations were determined by considering pathological values >12.4 µmol/L. Histopathological (stable and unstable plaques) and immunohistochemical (macrophages, T lymphocytes, and active T lymphocytes counts) studies were performed. Hyperhomocysteinemia prevalence was calculated in this population, as were the possible relationships between homocysteine plasma concentrations, and the carotid plaque type and the cell types in it. The relationship between this risk factor and the presence of a neurological event relating to carotid stenosis was also investigated. RESULTS: Hyperhomocysteinemia prevalence was 43.5%, with a mean value of 11.8 µmol/L (median; range = 2-41.8 µmol/L). No significant differences were found between homocysteine levels and the plaque's morphological characteristics, or between the cell types analyzed. Elevated concentrations of homocysteine were not significantly higher in patients with a history of stroke. CONCLUSION: The present study confirms high hyperhomocysteinemia prevalence in patients with extracranial cerebrovascular disease, although no relationship between plaque complication phenomena and this cardiovascular risk factor was observed.