Severity of new-onset type 1 diabetes in children and adolescents during the coronavirus-19 disease pandemic.

INTRODUCTION: ß-pancreatic cells are susceptible to SARS-CoV-2 infection and replication; this could lead to infection-related diabetes or precipitate the onset of type 1 diabetes. This study aimed to determine the severity at diagnosis, analyzing clinical and epidemiological features at debut in children under 16 years of age in the context of the SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective observational multicenter study was carried out in 7 hospitals of the public health network located in the south of our community. The severity at debut is compared with that of the two previous years (2018 and 2019). The level of statistical significance is set at p<0.05. RESULTS: In 2020, 61 patients debuted at the 7 hospital centres. The mean age was 10.1 years (SD: 2.6), 50.8% older than 10 years. The clinical profile at diagnosis was ketoacidosis in 52.5% compared to 39.5% and 26.5% in the previous two years (p<0.01). The mean pH (7.24 vs 7.30/7.30) and excess of bases (-11.9 vs -7.43/-7.9) was lower than in the previous two years, and the glycated haemoglobin higher (11.9 vs 11/10.6), p<0.05. At least 10% of the patients had a positive history of SARS-CoV-2 infection. CONCLUSIONS: There has been an increase in the frequency of diabetic ketoacidosis in type 1 diabetes onset during the first year of the COVID-19 pandemic.

[Severity of new-onset type 1 diabetes in children and adolescents during the coronavirus-19 disease pandemic]. / Gravedad al comienzo de la diabetes tipo 1 en niños y adolescentes durante la pandemia por la enfermedad por coronavirus-19.

Introduction: ß-pancreatic cells are susceptible to SARS-CoV-2 infection and replication; this could lead to infection-related diabetes or precipitate the onset of type 1 diabetes. This study aimed to determine the severity at diagnosis, analyzing clinical and epidemiological features at onset in children under 16 years of age in the context of the SARS-CoV-2 pandemic. Material and methods: A retrospective observational multicenter study was carried out in 7 hospitals of the public health network located in the south of our community. The severity at debut is compared with that of the two previous years (2018 and 2019). The level of statistical significance is set at P < .05. Results: In 2020, 61 patients were diagnosed at the 7 hospital centres. The mean age was 10.1 years (SD: 2.6), 50.8% were older than 10 years. The clinical profile at diagnosis was ketoacidosis in 52.5% compared to 39.5% and 26.5% in the previous two years (P < .01). The mean pH (7.24 vs 7.30 / 7.30) and excess of bases (-11.9 vs -7.43 / -7.9) was lower than in the previous two years, and the glycated haemoglobin higher (11.9 vs 11 / 10.6)%, p < 0.05. At least 10% of the patients had a positive history of SARS-CoV-2 infection. Conclusions: There has been an increase in the frequency of diabetic ketoacidosis in type 1 diabetes onset during the first year of the COVID-19 pandemic.

Social network of PESCA (Open Source Platform for eHealth).

Information and Communication Technologies (ICTs) are revolutionizing how healthcare systems deliver top-quality care to citizens. In this way, Open Source Software (OSS) has demonstrated to be an important strategy to spread ICTs use. Several human and technological barriers in adopting OSS for healthcare have been identified. Human barriers include user acceptance, limited support, technical skillfulness, awareness, resistance to change, etc., while Technological barriers embrace need for open standards, heterogeneous OSS developed without normalization and metrics, lack of initiatives to evaluate existing health OSS and need for quality control and functional validation. The goals of PESCA project are to create a platform of interoperable modules to evaluate, classify and validate good practices in health OSS. Furthermore, a normalization platform will provide interoperable solutions in the fields of healthcare services, health surveillance, health literature, and health education, knowledge and research. Within the platform, the first goal to achieve is the setup of the collaborative work infrastructure. The platform is being organized as a Social Network which works to evaluate five scopes of every existing open source tools for eHealth: Open Source Software, Quality, Pedagogical, Security and privacy and Internationalization/I18N. In the meantime, the knowledge collected from the networking will configure a Good Practice Repository on eHealth promoting the effective use of ICT on behalf of the citizen's health.

Aproximación al estado nutricional de una población en atención domiciliaria / Approach to the nutritional status of a population under home care

Objetivo: evaluar el estado nutricional de los pacientes incluidos en el programa de atención domiciliaria (PAD) de un centro de salud y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos: estudio descriptivo transversal. Tras realizar muestreo sistemático estratificado, se recogieron datos sociodemográficos, enfermedades crónicas, capacidad funcional, cognitiva, síntomas depresivos y/o de ansiedad. Estado nutricional: valoración antropométrica y analítica completa (sideremia, ferritina, ácido fólico, vitamina B12, proteínas totales y albúmina) y riesgo de malnutrición (cuestionario MNA). Resultados: sobre una muestra inicial de 96 pacientes (intervalo de confianza [IC] del 95%, precisión = 0,08), se obtienen datos completos en 91 (94,8%). El 75,8% fueron mujeres, con edad media ± desviación estándar de 80,4 ± 7,4 años. El 70,5% presentaba más de 2 enfermedades crónicas, consumo medio de fármacos 5,4 ± 2,8. Comorbilidad psíquica: cuadro depresivo 47,3%, alteración cognitiva moderada-grave 45,9%, ansiedad 38,6%. Un 89,9% precisaban ayuda para realizar actividades instrumentales y el 82,2%, para las básicas. Un 23,1% (IC del 95%, 14,5-31,7) presentaba malnutrición y el 35,2% (IC del 95%, 25,4-45,0) tenía riesgo de presentarla. Presentaron valores séricos inferiores a los normales: ácido fólico 41,4%, proteínas totales 40,3%, hemoglobina 38,8% y albúmina 33,8%. Se encontró asociación entre malnutrición o riesgo de tenerla con: menor peso, circunferencia braquial y pantorrilla, mayor edad y menor puntuación en escalas de Lawton y Barthel (p < 0,05). Solamente los valores de Barthel y mayor edad mantuvieron asociación en el análisis multivariante. Conclusiones: se destaca la importancia de evaluar de forma sistemática y periódica la situación nutricional de ancianos atendidos en los PAD, estableciendo medidas de prevención e intervención, especialmente en aquellos con peor capacidad funcional y mayor edad

Objective: to evaluate the risk of malnutrition in patients included in a home care program in a health center and its association with sociodemographic, clinical, and functional variables. Material and methods: we performed a cross-sectional descriptive study. Stratified systematic sampling was performed and data on sociodemographic characteristics, chronic diseases, functional and cognitive status, and symptoms of depression and/or anxiety were gathered. Nutritional assessment included anthropometric evaluation, complete blood analysis (iron, ferritin, folic acid, vitamin B12, total proteins and albumin) and risk of malnutrition (mini-nutritional assessment [MNA] questionnaire). Results: of an initial sample of 96 patients (95% confidence interval [CI], precision = 0.08), data collection was complete in 91 (94.8%); 75.8% were women, and the mean age ± standard deviation was 80.4 ± 7.4 years. More than two chronic diseases were found in 70.5% and the mean number of drugs was 5.4 ± 2.8. Depressive symptoms were present in 47.3%, with moderate-severe cognitive impairment in 45.9% and symptoms of anxiety in 38.6%. A total of 89.9% required help for instrumental activities and 82.2% for basic activities. Risk of malnutrition was found in 35.2% (95% CI = 25.4-45.0) and malnutrition was found in 23.1% (95% CI = 14.5-31.7). Levels were below normal for serum folic acid (41.4%), total serum proteins (40.3%), haemoglobin (38.8%) and albumin (33.8%). Malnutrition or malnutrition risk was associated with low weight, smaller brachial and calf circumference, greater age, and lower Lawton and Barthel scores (p < 0.05). The only statistically significant association in the multivariate analysis was between lower Barthel scores and greater age. Conclusions: systematic nutritional assessment should be performed periodically in elderly patients in home care programs. Prevention and intervention measures should be established, especially in patients with worse functional capacity and greater age

Inseguridad alimentaria y experiencias de hambre en hogares venezolanos menos privilegiados

El objetivo de esta publicación es presentar, comparar y analizar los resultados de tres investigaciones que buscan estimar el nivel de inseguridad alimentaria y experiencias de hambre en hogares menos privilegiados. Se realizó en comunidades pobres de Venezuela: Ojo de Agua (1995), El Petróleo (1997-98) y en ocho estados (2000-01).El proceso se inició en 1995 con el diseño, pre-prueba y aplicación de un método simple para estimar la seguridad alimentaria en hogares pobres. Posteriormente, se repitió en otras comunidades para su validación externa. La escala que mide la inseguridad alimentaria y experiencias de hambre se adaptó a partir de la escala del "Community Childhood Hunger Identification Project" (CCHIP) utilizada en Estados Unidos. Los resultados obtenidos de los tres estudios considerados son comparables debido a que utilizan la misma metodología. La escala aplicada capta dos dimensiones de la seguridad alimentaria en el hogar: la falta de recursos económicos y experiencias de hambre. Consistentemente, los datos señalan que la falta de dinero para comprar alimentos es el primer indicador de la inseguridad alimentaria reportado en más de la mitad de la muestra para cada estudio. Entre 5 y 30 por ciento de los hogares pobres y muy pobres señalan que los adultos pasan hambre antes de reducir la alimentación de sus hijos, sobre todo en el estudio del año 2000-01. A pesar de ello, entre 4 y 24 por ciento de los hogares muy pobres señalan experiencias de hambre en niños. Al comparar las investigaciones se nota una disminución de la inseguridad alimentaria entre 1995 y 1997, la cual aumenta para el periodo 2000-01. Es necesario continuar el estudio de mecanismos de ajuste de hogares pobres para enfrentar la inseguridad alímentaria y experiencias de hambre en Venezuela y otras regiones del mundo. (AU)

Measuring household food security in poor Venezuelan households.

OBJECTIVE: To validate abbreviated methods that estimate food security level among poor communities in Caracas, Venezuela. DESIGN: Two independent cross-sectional studies were undertaken to internally and externally validate simple quantitative/qualitative methods. The quantitative measure was constructed from data on household food availability, gathered using the list-recall method. It is a count of the foods that explain 85% or more of household energy availability. The qualitative measure is a score of female-perceived food insecurity level estimated with a modified 'hunger index', reflecting food resource constraints and hunger experiences within the home. Socio-economic and food behaviour data that may predict household food security (HFS) levels were gathered. The second study was repeated a year later to measure the impact of an increase in the minimum wage on HFS levels. SETTING: Two poor urban communities in Caracas, Venezuela. SUBJECTS: All households in both communities that complied with selection criteria(poor and very poor families that share food resources) and were willing to participate. The sample comprised 238 and 155 female household food managers in the two communities. RESULTS: In 1995, data from females in 238 urban poor households provided evidence for the overall validity of the method. Its application in 1997 to 155 households in the other community gave support to the external validity of the method. Measures were repeated in 1998 on 133 subjects of the above sample, when the minimum wage was increased by 23%. Evidence is presented showing the sensitivity of the method to changes in the determinants of HFS. Data analysed during these three periods suggest that the method can be simplified further by using the food diversity score instead of the quantitative measure since these variables correlate highly with one another(r > or = 2 0.854). CONCLUSIONS: This simple method is a valid and precise measure of food security among poor urban households in Caracas. Th equalitative/quantitative measures complement each other as they capture different dimensions of HFS.

Sustained leves of ascorbic acid are toxic and immunosuppressive for human T cells

Ascorbate (vitamin C) can protect from oxidative damage to DNA and lipids that may lead to aging, cancer, and other dysfunctions. However, we find that purified human T cells deteriorate if maintained in ascorbate in culture for 18 hrs. or more; viability and Il-2 synthesis are over 90 percent curtailed by scorbate at 50 micrograms/ml. T cell proliferation and adhesion are severely suppressed at 10-25 micrograms/ml. Dihydro-ascorbate was much less toxic or suppressive. The suppressive effect of ascorbate appears irreversible, since removal of ascorbate after 18 hrs. did not restore the mitogenic response. Although moderate dietary levels of ascorbate often reach 250-1000 mg or more daily and appear beneficial, our data caution against sustained megadoses of ascorbate for treatment of patients with AIDS and cancer