Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19 / Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic

Objetivo: Valorar la repercusión de la alteración de la continuidad asistencial en pacientes con diabetes mellitus tipo 2 (DM2) durante la pandemia de COVID-19. Material y método: Estudio de seguimiento entre los años 2018 y 2020 de los pacientes con DM2 de un centro de salud. Las actividades asistenciales y preventivas realizadas para su seguimiento fueron comparadas con pruebas estadísticas adecuadas al tipo y distribución de cada variable para un nivel de significación p≤0,05. Resultados: La muestra inicial fue de 587 pacientes con hemoglobina glicosilada (A1c) en 2018 (54% varones), con una edad de 66±11 años en un rango de 29-91 años. En 2020 disminuyeron todos los indicadores de atención: se determinó A1c al 68% de los pacientes (382/558 tras 29 fallecimientos); el 59% permanecía con buen control, el 17% con mal control, el 10% mejoró y el 14% empeoró (p<0,001). Empeoraron menos los pacientes que tenían realizados ECG y retinografía en 2018, aunque no en 2020, que aquellos que no los tenían en 2018, pero sí en 2020 (16 vs. 25%; p<0,001 y 13 vs. 42%; p=0,002). Quienes disminuyeron sus visitas al médico de familia y enfermera presentaron menor empeoramiento que los que las aumentaron (14 vs. 26%; p<0,001 y 17 vs. 23%; p<0,001). Conclusiones: La desatención impidió el control del 32% de los pacientes. El peor control en 2020 fue menor en quienes estaban controlados en 2018, y en quienes disminuyeron su asistencia al centro de salud en 2020. Probablemente una adecuada formación pre-pandémica en autocuidados ha llevado al empoderamiento del paciente durante periodo pandémico (AU)

Aim: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. Material and method: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. Results: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). Conclusions: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period (AU)

[Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic]. / Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19.

AIM: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. MATERIAL AND METHOD: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. RESULTS: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). CONCLUSIONS: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period.

Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. / Renuncias en cirugía del antepié. Análisis crítico de las listas de espera.

INTRODUCTION: The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM). MATERIAL AND METHODS: Retrospective study of the surgical cancellations on 2,399 patients included in the SWL of the Foot and Ankle Unit of our center for forefoot surgery, between January/2014 and March/2018, both included. RESULTS: We have found 389 renunciations, which represent 16.22% of the inclusions in SWL, with 84.83% of women. The pathologies with the highest rate of resignation have been Morton metatarsalgia (24%) and hallux rigidus (20.16%). The most frequent pathology, hallux valgus, records 15.96% of resignations that occur mostly between 6 and 9 months. In the CTS and IM, the resignation rate has been 17.42 and 8.92%, respectively, with higher resignation rates in the first 3 months. CONCLUSIONS: The withdrawal of a scheduled intervention on the forefoot registers a high frequency in our environment, which can be related to factors such as the type of pathology, its natural history, response to orthopedic interventions, time in LEQ, and other non-specific ones on which we must investigate, to rationalize and establish duties in our SWL.

Corrección del Hallux valgus en metatarso adductus / Hallux valgus correction in metatarsus adductus

Objetivo. Señalar la frecuente asociación de metatarso adductus y Hallux valgus en el adulto como causa de corrección insuficiente de éste tras la aplicación de técnicas quirúrgicas comunes. Material y método. Se han revisado retrospectivamente 16 casos en 15 pacientes operados de Hallux valgus entre los años 2006 y 2008, presentaban metatarso adductus clínico y radiológico y en los que se observaba una corrección de la deformidad inferior a 10°. Resultados. La corrección media presentada fue de 9°. La oblicuidad media de la primera articulación cuneometatarsiana fue de 65°. No apareció relación entre grado de metatarso adductus y corrección observada. Las mejores correcciones se obtuvieron con la osteotomía en Scarf. Discusión. Existe controversia en cuanto a la relación entre metatarso adductus y Hallux valgus. Aunque una inadecuada aplicación de las técnicas quirúrgicas es la causa más importante de fracaso en la corrección, la poca bibliografía existente y la comparación con resultados propios, nos pueden señalar esta asociación como una causa de dificultad en la aplicación de técnicas quirúrgicas convencionales. Conclusión. La presencia de metatarso adductus en un paciente adulto que va a ser operado de Hallux valgus debe ser detectada y consignada como una causa que dificulta la corrección. La planificación y la elección de la técnica deben tener en cuenta estos defectos angulares para evitar un resultado decepcionante para el paciente (AU)

Background. To describe the frequent association of Metatarsus adductus and Hallux valgus in the adult foot as a cause of insufficient correction after application of common surgical techniques. Method and material A retrospective review was made of 16 cases in 15 patients with clinical and radiologic metatarsus adductus operated by Hallux valgus from 2006 to 2008. In all cases, a correction of the deformity lower than 10° was observed. Results. The mean postoperative correction was 9°. The mean inclination of first cuneometatarsal joint was 65°. We did not find any relationship between Metatarsus adductus magnitude and postoperative Hallux valgus correction. The best results were observed with Scarf Osteotomy. Discussion. There is controversy on the Metatarsus adductus and Hallux valgus relationship. Although poor application of the surgical techniques is the most important cause of correction failure, the limited literature references and the comparison with similar results, may show this association as a cause of the difficulty in the application of conventional surgical techniques. Poor performance of these techniques is an important cause of correction failure and must be evaluated. Conclusion. Metatarsus adductus in the adult foot with Hallux valgus to be operated must be detected and seen as a deformity that is difficult to correct. Preoperative planning and choice of surgical technique must assess these angular deformities to avoid a poor result for the patient (AU)

Flutter auricular de presentación fetal: aportación de dos casos / Flutter atrial in fetuses: contribution with two cases

El flutter auricular (AA) es una arritmia poco común en la infancia. Aun así, si es diagnosticada en la época fetal o neonatal, debe conducir a una rápida actuación terapéutica dada su potencial morbilidad y mortalidad. La prevalencia de arritmias malignas en el feto es muy baja (aproximadamente 1/5.000 gestaciones) y entre las taquiarritmias, el flutter auricular representa el 25-30% de éstas. La morbimortalidad causada por esta entidad no es despreciable. El hidrops a causa de la insuficiencia cardíaca y como consecuencia, el daño neurológico no es infrecuente. Sin embargo, el pronóstico a largo plazo es bueno dado que casi ningún paciente presenta recurrencias. Aportamos dos casos acontecidos en dos hospitales de nuestra red entre noviembre de 1998 y julio de 2005. En ambos, una rápida actuación obstétrica, pediátrica y cardiológica, lograron una total recuperación. La cardioversión eléctrica fue exitosa en los dos, no se produjeron complicaciones y ninguno sufrió recurrencias (AU)

A trial Flutter (AA) is an uncommon arrhythmia in childhood. Eve so, if it is diagnosed in foetal or neonatal age, it forces to a rapid therapeutic action because its potential morbidity and mortality. The prevalence of malignant arrhythmias in fetuses is very small – aprox 1/5.000 gestations-, and among tachyarrhythmia’s the atrial flutter represents 25-30% (1-3). The morbidity/mortality that is caused by this entity in perinatal age is not worthless. Hydrops form intrauterine cardiac failure secondary to arrhythmia and, as a result of that, the neurological damage is not unusual. However there is a good long-term prognosis because hardly anyone patients has recurrences of this arrhythmia. The reason of this report is to contribute with two cases, detected between November of 19998 and July of 2005 in two maternity-paediatrics hospitals. In both, a rapid obstetrician, paediatrician and cardiologist actuation achieved a total and lasting recuperation. Electrocardioversion was successful in two newborn; there were not complications and they had not recurrences (AU)