[Assessment of calcium intake in Costa Rica and Panama with the International Osteoporosis Foundation calcium calculator]. / Evaluación del consumo de calcio en Costa Rica y Panamá con la calculadora de calcio de la International Osteoporosis Foundation.

Introduction: Introduction: calcium intake is fundamental over the whole life cycle; despite this, the world consumption of calcium is deficient. In Central America, there is little data on calcium intake. Objective: to evaluate daily calcium intake in the adult population of Costa Rica and Panama. Methods: an adult's population (> 18) survey was conducted in both countries. A questionnaire specifically design for the study was applied to subjects that were willing to participate after they signed of the informed consent form. The International Osteoporosis Foundation (IOF) calcium calculator was used to quantify their calcium intake. Results: the study included 1189 participants, 50 % were men. The median calcium intake was 862 mg/d (IQR, 650.5 to 1115) in Costa Rica and 825.5 mg/d (IQR, 579.75 to 1029.2) in Panama. Significant differences were found between calcium intake and age group in Costa Ricans, while in the Panamanian population differences were found in calcium intake according to educational level. Conclusion: this study is the first one conducted in Central America using the IOF calcium intake calculator. The study shows that calcium intake is deficient in Costa Rica and Panama. It is necessary to establish educational campaigns in both countries to correct this deficiency.

Introducción: Introducción: una ingesta adecuada de calcio es fundamental durante todo el curso de la vida. A pesar de esto, el consumo mundial de calcio es deficiente. En Centroamérica se tienen pocos datos sobre el tema. Objetivo: evaluar el consumo diario de calcio en la población adulta de Costa Rica y Panamá. Métodos: se realizó una encuesta a la población adulta (> 18 años) en ambos países. En aquellos sujetos que aceptaron ser encuestados, se aplicó un cuestionario específicamente diseñado para el estudio con información demográfica, estilos de vida y dieta. Se utilizó la calculadora de calcio de la International Osteoporosis Foundation (IOF) para cuantificar su ingesta de calcio. Resultados: el estudio incluyó a 1189 participantes, el 50 % eran hombres. La mediana de la ingesta de calcio fue de 862 mg/d (RIC: 650,5 a 1115) en Costa Rica y de 825,5 mg/d (RIC: 579,75 a 1029,2) en Panamá. Se encontraron diferencias significativas entre la ingesta de calcio y el grupo de edad en los costarricenses, mientras que en la población panameña se encontraron diferencias en la ingesta de calcio de acuerdo con el nivel educativo. Conclusiones: este estudio es el primero realizado en América Central con la calculadora de calcio de la IOF. Nuestro estudio muestra que la ingesta de calcio es deficiente en Costa Rica y Panamá. Es necesario establecer campañas educativas en ambos países para corregir esta deficiencia.

Guías de diagnóstico y tratamiento de la diabetes gestacional. ALAD, 2016 / Guidelines of diagnosis and treatment of gestational diabetes. Alad, 2016

En los últimos años el aumento de la prevalencia de obesidad y diabetes mellitus tipo 2 (DM2), la aparición a edades más tempranas de DM2, así como el desplazamiento del embarazo a edades mayores conllevan a un aumento de casos de diabetes (DM) en el embarazo. En algunas pacientes la diabetes no se diagnostica y obviamente no se trata. Este hecho puede complicar un embarazo, especialmente en el período embriogénico. La aplicación de nuevos criterios de diagnóstico para la diabetes gestacional, la controversia en el uso y la seguridad de los antidiabéticos orales durante el embarazo, así como el uso de determinados análogos de insulina hacen indispensable que Latinoamérica, a través del Grupo de Trabajo de Diabetes y Embarazo de la Asociación Latinoamericana de Diabetes (ALAD), actualice sus recomendaciones. El desarrollo de las mismas se realizó en varias reuniones y trabajo conjunto del grupo. Se tuvo en cuenta el grado de nivel de evidencia, la experiencia de los referentes y la adaptación cultural según las regiones donde se implementarán las recomendaciones descriptas

TRANSCULTURALIZATION RECOMMENDATIONS FOR DEVELOPING LATIN AMERICAN CLINICAL PRACTICE ALGORITHMS IN ENDOCRINOLOGY--PROCEEDINGS OF THE 2015 PAN-AMERICAN WORKSHOP BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) convened their first Workshop for recommendations to optimize Clinical Practice Algorithm (CPA) development for Latin America (LA) in diabetes (focusing on glycemic control), obesity (focusing on weight loss), thyroid (focusing on thyroid nodule diagnostics), and bone (focusing on postmenopausal osteoporosis) on February 28, 2015, in San Jose, Costa Rica. A standardized methodology is presented incorporating various transculturalization factors: resource availability (including imaging equipment and approved pharmaceuticals), health care professional and patient preferences, lifestyle variables, socio-economic parameters, web-based global accessibility, electronic implementation, and need for validation protocols. A standardized CPA template with node-specific recommendations to assist the local transculturalization process is provided. Participants unanimously agreed on the following five overarching principles for LA: (1) there is only one level of optimal endocrine care, (2) hemoglobin A1C should be utilized at every level of diabetes care, (3) nutrition education and increased pharmaceutical options are necessary to optimize the obesity care model, (4) quality neck ultrasound must be part of an optimal thyroid nodule care model, and (5) more scientific evidence is needed on osteoporosis prevalence and cost to justify intervention by governmental health care authorities. This 2015 AACE/ACE Workshop marks the beginning of a structured activity that assists local experts in creating culturally sensitive, evidence-based, and easy-to-implement tools for optimizing endocrine care on a global scale.

Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus from Latin America.

OBJECTIVE: This post hoc analysis evaluated the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) from Latin America. RESEARCH DESIGN AND METHODS: Analyses were performed in subgroups of patients from Latin America based on data from three individual, 26-week, placebo-controlled studies of canagliflozin (monotherapy [n = 116/584], add-on to metformin [n = 199/918], and add-on to metformin plus sulfonylurea [n = 76/469]) and three individual, 52-week, active-controlled studies of canagliflozin (add-on to metformin versus sitagliptin [n = 240/1101], add-on to metformin versus glimepiride [n = 155/1450], and add-on to metformin plus sulfonylurea versus sitagliptin [n = 156/755]). MAIN OUTCOME MEASURES: Changes from baseline in HbA1c, body weight, and systolic blood pressure (BP) with canagliflozin 100 and 300 mg versus placebo or active comparator (i.e., sitagliptin or glimepiride) were evaluated in the overall study populations and Latin American subgroups. Safety was assessed based on adverse event (AE) reports. RESULTS: Canagliflozin 100 and 300 mg provided reductions in HbA1c, body weight, and systolic BP across studies in patients from Latin America that were generally similar to those seen in the overall populations of patients with T2DM. The AE profile in patients from Latin America was equivalent to that in the overall populations; higher rates of genital mycotic infections and osmotic diuresis-related AEs were seen with canagliflozin versus comparators. Limitations of this study include the post hoc analysis of data and the small sample size of patients from Latin America. CONCLUSION: Canagliflozin improved glycemic control, reduced body weight and systolic BP, and was generally well tolerated in patients with T2DM from Latin America. CLINICAL TRIAL REGISTRATION: NCT01081834; NCT01106677; NCT01106625; NCT00968812; NCT01137812.