Relationship Between Lipohypertrophy, Glycemic Control, and Insulin Dosing: A Systematic Meta-Analysis.

Background: Lipohypertrophy is a common complication in patients with diabetes receiving insulin therapy. There is a lack of consensus regarding how much lipohypertrophy affects diabetes management. Our study aimed to assess the potential correlation between lipohypertrophy and glycemic control, as well as insulin dosing in patients with diabetes. Methods: We performed a systematic review followed by a meta-analysis to collect data about glycemic control and insulin dosing in diabetic patients with and without lipohypertrophy. To identify relevant studies published in English, we searched medical databases (MEDLINE/PubMed, Embase, and CENTRAL) from 1990 to January 20, 2023. An additional hand-search of references was performed to retrieve publications not indexed in medical databases. Results of meta-analyses were presented either as prevalence odds ratios (pORs) or mean differences (MDs) with 95% confidence intervals (95% CIs). This study was registered on PROSPERO (CRD42023393103). Results: Of the 5540 records and 240 full-text articles screened, 37 studies fulfilled the prespecified inclusion criteria. Performed meta-analyses showed that patients with lipohypertrophy compared with those without lipohypertrophy were more likely to experience unexplained hypoglycemia (pOR [95% CI] = 6.98 [3.30-14.77]), overall hypoglycemia (pOR [95% CI] = 6.65 [1.37-32.36]), and glycemic variability (pOR [95% CI] = 5.24 [2.68-10.23]). Patients with lipohypertrophy also had higher HbA1c (MD [95% CI] = 0.55 [0.23-0.87] %), and increased daily insulin consumption (MD [95% CI] = 7.68 IU [5.31-10.06]). Conclusions: These results suggest that overall glycemic control is worse in patients with lipohypertrophy than in those without this condition.

Predominant low Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) score in a Mexican referral center: a selection bias caused by limited-resources?

Abstract Introduction: To date, many studies have validated the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) scoring system in allogeneic hematopoietic stem cell transplantation (allo-HSCT), but studies from developing countries remain scarce. Objective: The aim of this study was to evaluate and categorize Mexican patients using the HCT-CI at a referral center. Methods: One hundred and nineteen consecutive patients undergoing allo-HSCT at the National Institute of Medical Sciences and Nutrition in Mexico City were included. Patients were classified according to the HCT-CI scores. Results: The median age was 31 years and most were males (56%). Most patients had hematological malignancies (73%) and a low HCT-CI score (72%). The non-relapse mortality and survival were predicted according to the score. Conclusions: This is one of the few studies to evaluate the HCT-CI in adults with HLA-matched donors in a developing country and our findings suggest that the high percentage of patients with a low HCT-CI scores, contrary to international reports, could be explained by different comorbidities and demographics, but mainly due to stricter filters applied to HSCT candidates and consequently, a potential selection bias caused by limited resources.

Predominant low Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) score in a Mexican referral center: a selection bias caused by limited-resources?

INTRODUCTION: To date, many studies have validated the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) scoring system in allogeneic hematopoietic stem cell transplantation (allo-HSCT), but studies from developing countries remain scarce. OBJECTIVE: The aim of this study was to evaluate and categorize Mexican patients using the HCT-CI at a referral center. METHODS: One hundred and nineteen consecutive patients undergoing allo-HSCT at the National Institute of Medical Sciences and Nutrition in Mexico City were included. Patients were classified according to the HCT-CI scores. RESULTS: The median age was 31 years and most were males (56%). Most patients had hematological malignancies (73%) and a low HCT-CI score (72%). The non-relapse mortality and survival were predicted according to the score. CONCLUSIONS: This is one of the few studies to evaluate the HCT-CI in adults with HLA-matched donors in a developing country and our findings suggest that the high percentage of patients with a low HCT-CI scores, contrary to international reports, could be explained by different comorbidities and demographics, but mainly due to stricter filters applied to HSCT candidates and consequently, a potential selection bias caused by limited resources.

NPWT in diabetic foot wounds-a systematic review and meta-analysis of observational studies.

PURPOSE: Negative-pressure wound therapy (NPWT) is an adjunct modality in diabetic foot ulcerations (DFUs). Randomized controlled trials (RCTs) have shown its advantage over standard approaches; however, data from observational studies remain scarce.We performed a systematic review of observational non-RCTs evaluating NPWT efficacy and safety in patients with DFU. METHODS: Electronic databases were searched for observational studies involving NPWT. The results of single-arm studies were presented as percentages of patients with the outcome of interest. A meta-analysis of comparative studies provided point estimates of outcomes. Continuous outcomes were reported as either weighted or standardized mean differences and dichotomous data as relative risks (RR). RESULTS: The search identified 16 relevant observational studies, 12 single-arm, and 4 comparative, reporting on a total of 18,449 patients with DFU, of whom 1882 were managed with NPWT. In the NPWT-treated patients, ulcers were larger (average size range 6.6-27.9 cm2), as compared with controls (≤3 cm2). The pooled results showed healing and major amputation in 51% and 5% of NPWT patients, respectively. The meta-analysis of comparative studies revealed lower risk of major amputation [RR = 0.23 (0.07; 0.80)] in NPWT-treated patients. The pooled results for healing rate and risk of any amputation were inconclusive due to large between-study heterogeneity. Overall, 6 deaths out of 158 patients were reported, none of them related to NPWT. Serious adverse events occurred in 6% of patients on NPWT. CONCLUSIONS: This systematic review of observational studies provided supportive evidence that NWPT is an efficient and safe adjunct treatment in the management of DFUs.

Incidence and characteristics of metabolic syndrome in patients of the National Cancer Institute of Mexico.

INTRODUCTION: Objective: the exact prevalence of obesity in Mexico is not well known and varies between sources, but more than 30% of Mexico's population are obese. Obesity is associated with several diseases such as metabolic syndrome; the latter, along with cancer, have become public health concerns worldwide, and their association has been widely studied in developed countries. The aim of this study was to identify the overall prevalence of metabolic syndrome and to describe its characteristics among first-time cancer patients at a referral center in Mexico. Methods: a prospective, observational, cohort study of first-time patients of the National Cancer Institute of Mexico in the period of September 2016-2017. We identified 1,165 first-time patients, and 316 patients with known or recently diagnosed metabolic syndrome were included. Results: median age was 55 years old and most were female (81%). The most frequent tumors were breast, gynecological, and hematological. Obesity (class 1-3) and abnormal glucose and/or previous diabetes mellitus diagnosis were mostly observed in patients with skin and soft tissue tumors; dyslipidemia, high triglycerides, and/or low HDL-cholesterol were mostly observed in patients with gastrointestinal tumors. Conclusion: the prevalence of metabolic syndrome among first-time cancer patients was 27%. As obesity and cancer are of public concern in Mexico, the implementation of preventive strategies for metabolic syndrome patients, focusing on the first level of care during early stages in order to reduce the risk of cancer, is needed.

INTRODUCCIÓN: Objetivo: la prevalencia de la obesidad en México es mayor del 30% de la población total. La obesidad se asocia con diversas enfermedades, entre ellas el síndrome metabólico; este y el cáncer se han convertido en problemas de salud pública a nivel mundial, y su asociación ha sido ampliamente estudiada en países desarrollados. El objetivo de este estudio fue identificar la prevalencia del síndrome metabólico y describir las características entre pacientes oncológicos de primera vez en un hospital de tercer nivel en México. Métodos: estudio prospectivo, observacional y de cohortes que incluye a pacientes oncológicos atendidos por primera vez en el Instituto Nacional de Cancerología durante el periodo de septiembre 2016 a 2017. Identificamos 1165 pacientes; 316 tenían el diagnóstico de síndrome metabólico y fueron incluidos en el presente estudio. Resultados: la mediana de edad fue de 55 años y la mayoría de los pacientes eran del sexo femenino (81%). Las neoplasias más frecuentes fueron las de mama, ginecológicas y hematológicas. La obesidad (clase 1-3) y la glucosa anormal y/o un diagnóstico previo de diabetes mellitus se observaron mayormente en pacientes con neoplasias de piel y tejidos blandos; los pacientes con neoplasias gastrointestinales presentaron mayormente dislipidemia, triglicéridos elevados y/o HDL bajo. Conclusiones: la prevalencia del síndrome metabólico en nuestros pacientes oncológicos fue de 27%. Al ser la obesidad y el cáncer problemas de salud pública en México, la implementación de medidas preventivas para pacientes con síndrome metabólico debe enfocarse en el primer nivel de atención, durante etapas tempranas, para poder reducir el riesgo de cáncer.

Bioactivity of Scytonema hofmanni (Cyanobacteria) in Lilium alexandrae in vitro propagation

Cyanobacteria produces bioactive compounds including plant growth regulators. Naphthalene acetic acid (NAA), a toxic substance, is a synthetic plant regulator used in micropropagation. The aim of this work was to evaluate morphogenetic and antioxidant effects produced by intra and extracellular substances from Scytonema hofmanni (Cyanobacteria) during the multiplication in vitro of Lilium alexandrae and to compare them to those produced by NAA. Intra and extracellular cyanobacterial products increased a) bulblets production reaching 83 percent and 78 percent of NAA effect, respectively; b) the bulblet diameter compared to NAA; and c) the bulblet survival due to the promotion of antioxidant activity measured as catalase, ascorbate peroxidase, and glutathione reductase activity. The cyanobacterial substances stimulated regeneration and delayed bulblet senescence. They could replace NAA, dangerous for the operator, not only during the regeneration phase but also during the storage of the viable bulblets cultivated in vitro.