Impact of Functional Mitral Regurgitation on Left Ventricular Strain in Nonischemic Dilated Cardiomyopathy Patients with Type 2 Mellitus Diabetes: A Magnetic Resonance Feature Tracking Study.

BACKGROUND: The impact of functional mitral regurgitation and type 2 mellitus diabetes (T2DM) on left ventricular (LV) strain in nonischemic dilated cardiomyopathy (NIDCM) patients remains unclear. PURPOSE: To evaluate the impact of mitral regurgitation severity on LV strain, and explore additive effect of T2DM on LV function across varying mitral regurgitation severity levels in NIDCM patients. STUDY TYPE: Retrospective. POPULATION: 352 NIDCM (T2DM-) patients (49.1 ± 14.6 years, 67% male) (207, 85, and 60 no/mild, moderate, and severe mitral regurgitation) and 96 NIDCM (T2DM+) patients (55.2 ± 12.4 years, 77% male) (47, 30, and 19 no/mild, moderate, and severe mitral regurgitation). FIELD STRENGTH/SEQUENCE: 3.0 T/balanced steady-state free precession sequence. ASSESSMENT: LV geometric parameters and strain were measured and compared among groups. Determinants of LV strain were investigated. STATISTICAL TEST: Student's t-test, Mann-Whitney U test, one-way ANOVA, Kruskal-Wallis test, univariable and multivariable linear regression. P < 0.05 was considered statistically significant. RESULTS: LV GLPS and longitudinal PDSR decreased gradually with increasing mitral regurgitation severity in NIDCM patients with T2DM(GLPS: -5.7% ± 2.1% vs. -4.3% ± 1.6% vs. -2.6% ± 1.3%; longitudinal PDSR:0.5 ± 0.2 sec-1 vs. 0.4 ± 0.2 sec-1 vs. 0.3 ± 0.1 sec-1). NIDCM (T2DM+) demonstrated decreased GCPS and GLPS in the no/mild subgroup, reduced LV GCPS, GLPS, and longitudinal PDSR in the moderate subgroup, and reduced GRPS, GCPS, GLPS, and longitudinal PDSR in the severe subgroup compared with NIDCM (T2DM-) patients. Multivariable regression analysis identified that mitral regurgitation severity (ß = -0.13, 0.15, and 0.25 for GRPS, GCPS, and GLPS) and the presence of T2DM (ß = 0.14 and 0.13 for GCPS and GLPS) were independent determinants of LV strains in NIDCM patients. DATA CONCLUSION: Increased mitral regurgitation severity is associated with reduced LV strains in NIDCM patients with T2DM. The presence of T2DM exacerbated the decline of LV function across various mitral regurgitation levels in NIDCM patients, resulting in reduced LV strains. TECHNICAL EFFICACY: Stage 3.

Relación entre la apnea obstructiva del sueño y la diabetes mellitus tipo 2 / Relationship between obstructive sleep apnea and type 2 diabetes mellitus

Introducción: La asociación entre la apnea obstructiva del sueño (AOS) y el metabolismo de la glucosa sigue siendo controvertida. Este estudio investiga la relación entre la AOS y la diabetes mellitus tipo 2 (DM) y prediabetes (preDM) incidentes, así como el efecto del tratamiento con presión positiva continua en la vía aérea (CPAP) a largo plazo. Métodos: Estudio de seguimiento en cohorte retrospectiva clínica de pacientes con AOS y controles seleccionados de manera aleatoria. Los datos sobre DM incidente y preDM, así como de la CPAP se obtuvieron de los registros hospitalarios. La relación entre AOS basal y la DM incidente se examinó con modelos de regresión de Cox. Resultados: De un total de 356 pacientes, 169 con AOS y 187 controles fueron seguidos por una mediana de 98 meses; 47 enfermos (13,2%) desarrollaron DM y 43 (12,1%) preDM. La incidencia acumulada a los cinco años de DM fue de 10,7% (6,5-13,9%). De los sujetos con preDM en la muestra basal, 87% evolucionaron a DM incidente. Se demuestra que el índice de masa corporal (IMC), la hipoxia nocturna y el índice de apnea hipopnea (IAH) son factores de riesgo para el desarrollo de DM, y que la CPAP los disminuye. Conclusiones: Los pacientes con AOS tienen mayor probabilidad de desarrollar DM. Los factores de riesgo implicados son el IMC, la hipoxia nocturna y el IAH. El uso regular de CPAP a largo plazo se asoció con una disminución de estos. (AU)

Introduction: The association between obstructive sleep apnea (OSA) and glucose metabolism remains controversial. This study investigates the relationship between OSA and incident type 2 diabetes (DM) and prediabetes (preDM), as well as the effect of long-term CPAP (continuous positive airway pressure) treatment. Methods: Follow-up study in a retrospective clinical cohort of patients with OSA and randomly selected controls. Data on incident DM and preDM as well as CPAP were obtained from hospital records. The relationship between baseline OSA and incident DM was examined using COX regression models. Results: Three hundred and fifty-six patients, 169 with OSA and 187 controls were followed for a median of 98 months; 47 patients (13.2%) developed DM and 43 (12.1%) developed preDM. The 5-year cumulative incidence of DM was 10.7% (6.5–13.9%). 87% of subjects with preDM in the baseline sample progressed to incident DM. It is shown that body mass index (BMI), nocturnal hypoxia and apnea hypopnea index (AHI) are risk factors for the development of DM and that CPAP reduces this risk. Conclusions: Patients with OSA have a higher risk of developing DM. The risk factors involved are BMI, nocturnal hypoxia and AHI. Regular long-term CPAP use was associated with a decreased risk. (AU)

Diabetes severity and the risk of depression: A nationwide population-based study.

BACKGROUND: In consideration of the substantial occurrence rates of diabetes mellitus (DM) and depression, it is imperative to identify patients with DM who are at an elevated risk of developing depression. Accordingly, this study aimed to examine whether the risk of depression escalated proportionally with the severity of diabetes. METHODS: 2,067,017 adults diagnosed with type 2 DM, with the exception of those diagnosed with depression either before or within one year of the index date, were identified from a nationwide population-based cohort in Korea. Severity scores for DM were established based on various factors, including insulin use, DM duration of at least 5 years, use of three or more oral hypoglycemic agents, the presence of chronic kidney disease (CKD), cardiovascular diseases (CVD), or diabetic retinopathy. Each of these attributes was assigned a score of one point for diabetes severity, and their cumulative sum was defined as a diabetes severity score, ranging from 0 to 6. RESULTS: During a median follow-up of 6.2 years, 407,047 cases of major depression were identified. Each component contributing to the DM severity score was significantly associated with an increased risk of depression (all P-values <0.001), with insulin use and the presence of CVD demonstrating the most significant correlation with depression risk. As the DM severity score increased, the risk of depression was observed to significantly escalate (P for trend <0.001). After adjusting for potential confounding variables, the hazard ratios (95% confidence intervals) of depression were 1.15 (1.14-1.16) in 1 point, 1.28 (1.27-1.29) in 2 points, 1.45 (1.43-1.47) in 3 points, 1.70 (1.67-1.73) in 4 points, 1.91 (1.84-1.98) in 5 points, and 2.01 (1.79-2.26) in 6 points, respectively. CONCLUSION: The results of this study indicate that diabetes severity is positively associated with an elevated risk of developing major depression. Based on these findings, it is feasible to consider targeting depression screening efforts towards individuals with higher diabetes severity scores.

[Relationship between obstructive sleep apnea and type 2 diabetes mellitus]. / Relación entre la apnea obstructiva del sueño y la diabetes mellitus tipo 2.

INTRODUCTION: The association between obstructive sleep apnea (OSA) and glucose metabolism remains controversial. This study investigates the relationship between OSA and incident type 2 diabetes (DM) and prediabetes (preDM), as well as the effect of long-term CPAP (continuous positive airway pressure) treatment. METHODS: Follow-up study in a retrospective clinical cohort of patients with OSA and randomly selected controls. Data on incident DM and preDM as well as CPAP were obtained from hospital records. The relationship between baseline OSA and incident DM was examined using COX regression models. RESULTS: Three hundred and fifty-six patients, 169 with OSA and 187 controls were followed for a median of 98 months; 47 patients (13.2%) developed DM and 43 (12.1%) developed preDM. The 5-year cumulative incidence of DM was 10.7% (6.5-13.9%). 87% of subjects with preDM in the baseline sample progressed to incident DM. It is shown that body mass index (BMI), nocturnal hypoxia and apnea hypopnea index (AHI) are risk factors for the development of DM and that CPAP reduces this risk. CONCLUSIONS: Patients with OSA have a higher risk of developing DM. The risk factors involved are BMI, nocturnal hypoxia and AHI. Regular long-term CPAP use was associated with a decreased risk.

Enfermedad renal crónica y factores de progresión en pacientes con diabetes mellitus tipo 2 / Chronic kidney disease and progression factors in patients with type 2 diabetes mellitus / Antimicrobial resistance: a problem aggravated by the COVID-19 pandemic / Doença renal crônica e fatores de progressão em pacientes com diabetes mellitus tipo 2

Introducción: La enfermedad renal crónica es una agravante afección para el sistema de salud pública. La detección y seguimiento oportuno de los factores desencadenantes y de progresión de la enfermedad son una prioridad en cada sistema de salud. Objetivo: Caracterizar la enfermedad renal crónica en pacientes con diabetes mellitus tipo2 con mal control metabólico. Método: Se realizó un estudio descriptivo, de corte transversal en pacientes con diabetes mellitus tipo 2 que ingresaron al programa de enfermedad renal crónica del Hospital Dr. Docente Clínico Quirúrgico Dr. Miguel Enríquez desde octubre 2021 a enero 2023. El universo estuvo compuesto por 175 pacientes, de ellos, se seleccionó la muestra, 74 pacientes que cumplieron con los criterios de inclusión luego de firmar el consentimiento informado. Resultados: Existió predominio de enfermedad renal crónica en pacientes jóvenes (64 porciento en 18 a 49 años); así mismo el sexo femenino representó el 65,3 porciento; y un tiempo de evolución de la diabetes mellitus tipo 2 de 1 a 5 años con 49,3 porciento; las comorbilidades más frecuentes fueron: dislipidemia, hipertensión arterial e insuficiencia cardiaca con una prevalencia de 89,3 porciento; 79,3 porciento y 41,3 porciento; el estadio según el daño renal predominante fue el grado 2 con 20,0 porciento; el 4 porciento de los pacientes necesitó tratamiento renal sustitutivo. Conclusiones: La enfermedad renal suele progresar más en mujeres y en pacientes con múltiples factores de riesgo cardiovasculares. Se asocia a la progresión de la enfermedad renal el inadecuado control glucémico. El daño de la función renal depende en gran medida del control metabólico.(AU)

Introduction: Chronic kidney disease is an aggravating condition for the public health system.The detection and timely monitoring of the triggering and progression factors of the disease are a priority in each health system. Objective: To characterize chronic kidney disease in patients with type 2 diabetes mellitus with poor metabolic control. Method: A descriptive, cross-sectional study was carried out on patients with type 2 diabetes mellitus who entered the chronic kidney disease program of the Hospital Dr. Miguel Enríquez from October 2021 to January 2023. The population was made up of 175 patients; the sample selected was of 74 patients, who met the inclusion criteria after signing the informed consent. Results: There was a predominance of chronic kidney disease in young patients (64 percent in 18 to 49 years olds);likewise, the female sex represented a 65.3percent;and a duration of type 2 diabetes mellitus of 1 to 5 years in 49.3 percent; the most frequent comorbidities were: dyslipidemia, arterial hypertension and heart failure with a prevalence of 89. percent,79.3percent and 41.3percent respectively. The predominant kidney damage stage was grade 2 in a 20.0percent;4percent of patients required renal replacement treatment. Conclusions: Kidney disease usually progresses more in women and in patients with multiple cardiovascular risk factors.Inadequate glycemic control is associated with the progression of kidney disease. Damage to kidney function largely depends on metabolic control.(AU)

Introdução: A doença renal crônica é um agravante para o sistema público de saúde. A detecção e monitorização atempada dos factores desencadeantes e de progressão da doença são uma prioridade em cada sistema de saúde. Objetivo: Caracterizar a doença renal crônica em pacientes com diabetes mellitus tipo 2 com mau controle metabólico. Método: Foi realizado um estudo descritivo e transversal com pacientes com diabetes mellitus tipo 2 que ingressaram no programa de doença renal crônica do Hospital Dr. Miguel Enríquez de outubro de 2021 a janeiro de 2023. O universo foi composto por 175 pacientes, de deles, a amostra foi selecionada, 74 pacientes que atenderam aos critérios de inclusão após assinatura do termo de consentimento livre e esclarecido. Resultados: Houve predomínio de doença renal crônica em pacientes jovens (64 porcento entre 18 e 49 anos),da mesma forma, o sexo feminino representou 65,3 porcento; e tempo de diabetes mellitus tipo 2 de 1 a 5 anos com 49,3 porcento; as comorbidades mais frequentes foram: dislipidemia, hipertensão arterial e insuficiência cardíaca com prevalência de 89,3 porcento, 79,3 porcento e 41,3 porcento respectivamente. O estágio de acordo com a lesão renal predominante foi grau 2 com 20,0 porcento; 4 porcento dos pacientes necessitaram de tratamento de substituição renal. Conclusões: A doença renal costuma progredir mais em mulheres e em pacientes com múltiplos fatores de risco cardiovascular.O controle glicêmico inadequado está associado à progressão da doença renal.Os danos à função renal dependem em grande parte do controle metabólico.(AU)

Acceso para cirugía de catarata en diabetes. Un estudio cualitativo con enfoque gerencial / Access for cataract surgery in patients with diabetes. A qualitative study with a managerial approach

Resumen Objetivo: Explorar las brechas que existen para el acceso a la cirugía de catarata en personas con diabetes tipo 2. Materiales y métodos: Se realizó una investigación cualitativa de tipo fenomenológica con enfoque gerencial. Se emplearon herramientas y técnicas de gestión por procesos en salud y metodología Lean- sanidad. El trabajo de campo se realizó en los municipios La Lisa, Marianao y Playa donde se exploraron las experiencias y expectativas de 46 pacientes en seis grupos de discusión, se obtuvo el criterio de nueve médicos de familia y seis oftalmólogos del nivel primario de salud, en dos grupos de discusión. Resultados: Las experiencias de pacientes, médicos de familia y oftalmólogos, organizadas por categorías (diagnóstico, continuidad y comunicación, apoyo social y carga laboral) tienen en su contenido las brechas presentes en el proceso asistencial. Conclusión: Las brechas identificadas en este estudio son suficientes para explicar por qué muchos pacientes no acceden de manera oportuna a la cirugía de catarata.

Abstract Objective: To explore the gaps that exist for access to cataract surgery in people with type 2 diabetes. Materials and methods: A qualitative research of a phenomenological type with a managerial approach was carried out. Management tools and techniques by health processes and Lean-health methodology were used. The field work was carried out in the municipalities of La Lisa, Marianao and Playa where the experiences and expectations of 46 patients were explored in six discussion groups, the criteria of nine family doctors and six ophthalmologists from the primary health level were obtained, in two discussion groups. Results: The experiences of patients, family doctors and ophthalmologists, organized by categories (diagnosis, continuity and communication, social support and workload) have in their content the gaps present in the care process. Conclusion: The gaps identified in this study are sufficient to explain why many patients do not access cataract surgery in a timely manner.

¿Existe correlación metabólica hipoglucémica y el síndrome de Percheron? Reporte de caso / Is there a metabolic correlation between hypoglycemia and Percheron syndrome? Case report

Introducción: El síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: Presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatologia inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: Los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome.

Factores asociados a mayor sobrevida en pacientes con cáncer de páncreas tratados mediante pancreatoduodenectomía. Estudio de casos y controles

Introducción: El cáncer de páncreas (CP) tiene un pronóstico ominoso a pesar de los avances en técnica quirúrgica y en los cuidados peri/postoperatorios. Nuestro objetivo fue identificar factores asociados a mayor sobrevida en pacientes con CP tratados mediante pancreatoduodenectomía (PD). Material y Método: Estudio de casos y controles de pacientes con CP tratados mediante PD en el Hospital Clínico de la Universidad Católica entre 2002-2015. Se definió como caso al paciente con sobrevida ≥ 3 años y como control a aquel con sobrevida inferior a ese plazo. Se comparó entre casos y controles datos biodemográficos, clínicos, histopatológicos, de morbilidad y mortalidad mediante regresión logística. Resultados: Se analizaron 70 pacientes, con una edad media de 62 ± 11 años; 40 (57%) mujeres. Hubo morbilidad en 26 enfermos (37,1%); Clavien-Dindo ≥ Illa en 8 (11,4%). La mediana (rango) de días de hospitalización fue 12 (7-84). La sobrevida actuarial a 1, 3 y 5 años fue 77%, 32% y 22% respectivamente. Se identificaron 21 casos (30%) y 49 controles (70%). En el análisis univariable, la resección R0, los ganglios regionales negativos, la ausencia de infiltración perineural, los estadios más precoces (IA, IB y IIA) y la ausencia de diabetes mellitus (DM2) al momento del diagnóstico, fueron variables asociadas a sobrevida ≥ 3 años (p 100 U/mL) y los tratamientos complementarios no se asociaron a diferencias significativas en sobrevida. En el análisis multivariable, se identificó la ausencia de DM2 (OR ajustado: 12; IC95% 1,7-84,3), la ausencia de infiltración perineural (OR ajustado: 7; IC95% 1,3-36,3) y los estadios precoces IA, IB y IIA (OR ajustado: 10,3; IC95% 2,1-49,1) como los factores independientes asociados a sobrevida mayor a 3 años. Conclusión: Los pacientes no diabéticos, con etapas precoces del CP sin infiltración perineural, resecados R0 mediante PD pueden obtener una sobrevida mayor a 3 años.

Introduction: Pancreatic cancer (PC) remains one of the most lethal malignancies, despite developments in surgical and non-surgical therapies. Significant improvements in long-term survival have not been achieved. Only radical surgical resection has obtained a moderate extension in survival. We aim to identify factors associated with longer survival in patients with PC treated by pancreatoduodenectomy (PD). Material and Method: We designed a case-control study of patients with PC treated by PD in our center between 2002-2015. We compare patients who survived ≥ 3 years (case) with those not achieving it (control). Bio-demographic, clinical, histopathological, morbidity and mortality data were compared between cases and controls using logistic regression. Results: Seventy patients were analyzed; mean age 62 ± 11 years; 40 (57%) women. Morbidity was found in 26 patients (37.1%); Clavien-Dindo ≥ Illa in 8 (11.4%). The median (range) of hospitalization days was 12 (7-84). The actuarial 1, 3, and 5 years survival was 77%, 32%, and 22%, respectively, for the entire series. Twenty-one cases (30%), and 49 controls (70%) were identified. In the univariate analysis, R0 resection, negative regional lymph nodes, the absence of perineural infiltration, the earliest stages (IA, IB, and IIA) and the absence of diabetes mellitus (DM) at time of diagnosis were variables associated with survival ≥ 3 years (p 100 U / mL), and neo/adjuvant treatments, did not significantly show differences in survival. In the multivariate analysis, no DM at diagnosis (adjusted OR: 12; 95% CI 1.7 - 84.3), no perineural infiltration (adjusted OR: 7; 95% CI 1.3 - 36.3) and early stages IA, IB, and IIA (adjusted OR: 10.3; 95% CI 2.1 - 49.1) were identified as independent factors associated with survival > 3 years. Conclusion: Nondiabetic patients with early stages PC without perineural infiltration, resected R0 by PD can achieve survival over 3 years.

Caracterización de la mortalidad por diabetes mellitus en la provincia Cienfuegos durante los primeros nueve meses del 2020

Fundamento: según la Organización Mundial de la Salud la diabetes causa 300 000 muertes al año en América Latina y el Caribe y en la provincia Cienfuegos desde el año 2020 se ubica como séptima causa de fallecimientos. Objetivo caracterizar la mortalidad por diabetes mellitus en la provincia Cienfuegos en los primeros nueve meses del año 2020. Métodos: se realizó una investigación en sistemas y servicios de salud de tipo descriptiva a partir de una serie de casos para caracterizar la mortalidad por diabetes mellitus en Cienfuegos en los primeros nueve meses del año 2020. Los fallecidos se compilaron teniendo en cuenta: sexo, edad, color de la piel, nivel de escolaridad, lugar de residencia, estrato territorial, enfermedad, factores de riesgo asociados y causas de muertes directas. Se emplearon la media aritmética y la desviación estándar. Los resultados se presentan en forma de tablas y gráficos. Resultados la mayor afectación estuvo en las últimas décadas de la vida para el género femenino, así como la residencia en un territorio urbano, están entre las primeras causas directas de muerte el tromboembolismo pulmonar, así como la insuficiencia renal crónica agudizada, se destaca el desequilibrio hidroelectrolítico en un número considerable de las defunciones. Conclusiones las últimas décadas de la vida fueron las más afectadas y el sexo femenino, las principales causas de muerte fueron: el tromboembolismo pulmonar y la insuficiencia renal crónica agudizada. El desequilibrio hidroelectrolítico sobresale en un considerable número de los fallecidos.

Foundation: according to the World Health Organization, diabetes causes 300,000 deaths a year in Latin America and the Caribbean and in the Cienfuegos province since 2020 it ranks as the seventh cause of death. Objective: to characterize mortality from diabetes mellitus in the Cienfuegos province in the first nine months of 2020. Methods: a descriptive investigation was carried out on health systems and services based on a series of cases to characterize mortality from diabetes mellitus in Cienfuegos in the first nine months of 2020. The deceased were compiled taking into account: sex, age, skin color, educational level, place of residence, territorial stratum, disease, associated risk factors and direct causes of death. The arithmetic mean and standard deviation were used. The results are presented in the form of tables and graphs. Results: the greatest affectation was in the last decades of life for the female gender, as well as residence in an urban territory, among the first direct causes of death are pulmonary thromboembolism, as well as acute chronic renal failure; hydroelectrolytic imbalance stands out in a considerable number of deaths. Conclusions: the last decades of life were the most affected and the female sex, the main causes of death were: pulmonary thromboembolism and acute chronic renal failure. The hydroelectrolytic imbalance stands out in a considerable number of the deceased.

El control glicémico perioperatorio: principal factor en la disminución de complicaciones postoperatorias en pacientes diabéticos

La incidencia y prevalencia de la diabetes mellitus ha aumentado exponencialmente a nivel mundial en las últimas décadas. Los pacientes diabéticos presentan mayor probabilidad de sufrir graves complicaciones, en los procedimientos quirúrgicos en relación a la población general. El presente artículo tiene como objetivo, describir la repercusión del estado hiperglucémico perioperatorio en la etapa postoperatoria en pacientes diabéticos. Para el logro del objetivo planteado se realizó la consulta de diversas obras, que abarcan los resultados de investigación con diferentes modalidades relacionadas con la temática. Se pudo apreciar que la hiperglucemia perioperatoria se vincula con resultados adversos en pacientes a los que se les realiza cirugía general y que padecen diabetes mellitus, sin embargo, en los pacientes que se ha logrado control glicémico con terapia insulínica antes de la intervención, no presentaron mayor riesgo, que el que aparece en sujetos con buen control metabólico. La regulación de la glucosa en la etapa perioperatoria es un parámetro importante en el paciente diabético, que reduce considerablemente las complicaciones en los procedimientos quirúrgicos, las prolongadas estancias en las Unidades de Cuidados Intensivos, e incluso, la muerte.

The incidence and prevalence of diabetes mellitus has increased exponentially worldwide in recent decades. Diabetic patients are more likely to suffer serious complications in surgical procedures compared to the general population. The objective of this article is to describe the repercussion of the perioperative hyperglycemic state in the post-surgical stage in diabetic patients. In order to achieve the stated objective, various works were consulted, which include the results of research with different modalities related to the subject. It was possible to appreciate that perioperative hyperglycemia is associated with adverse results in general surgery patients with diabetes mellitus, however, in patients who have achieved glycemic control with insulin therapy before the intervention, they did not present a greater risk than that which appears in subjects with good metabolic control. Glucose regulation in the perioperative stage is an important parameter in diabetic patients, which considerably reduces complications in surgical procedures, long stays in Intensive Care Units, and even death.

Relación de las Enfermedades Crónicas no Transmisibles y Ejercicio Físico en la Población Chilena entre los años 2015-2016 / Risk of Retention of Secretions in Patients with Invasive Mechanical Ventilation

Introducción. Las prevalencias de la inactividad física, el sedentarismo y el sobrepeso y obesidad han aumentado sus índices durante los últimos años en Chile, lo que conlleva al desarrollo y aparición de diversas enfermedades crónicas no transmisibles, como por ejemplo, hipertensión arterial, diabetes mellitus e inclusive enfermedades respiratorias, las cuales repercuten negativamente en la población y deterioran la calidad de vida de las personas, independientemente el sexo y el rango etario. El ejercicio físico es una de las principales herramientas utilizadas por diversos profesionales de la salud como método de prevención y tratamiento en la población afectada, inclusive representa una alternativa de menor costo. Objetivo. Relacionar el ejercicio físico de alta y mediana intensidad con las enfermedades crónicas no transmisibles en personas mayores a 18 años residentes en Chile durante el periodo 2015-2016. Métodos. Análisis cuantitativo, descriptivo, transversal y retrospectivo de base secundaria ENCAVI 2015-2016, de residentes en Chile mayores de 18 años y con al menos una de las siguientes condiciones de salud: Hipertensión arterial, Diabetes Mellitus y enfermedades respiratorias crónicas no transmisibles. Resultados. Todas las variables presentan relaciones significativas (p<0,005) (HTA, DM, enfermedades respiratorias, edad, horas sentado, ejercicio físico de moderada y alta intensidad. Sin embargo, las variables de ejercicio físico moderada intensidad y enfermedades respiratorias (p=0,578) y las variables de sexo y horas sentado (p=0,005) no presentan relación significativa. Discusión. El ejercicio físico de moderada intensidad es el que tiene mejor respuesta ante las diferentes patologías según diferentes autores, por otro lado, en la recopilación de datos podemos encontrar que este tipo de ejercicio es efectivo en la Diabetes Mellitus. Conclusiones. Según los datos analizados, mientras mayor frecuencia de ejercicio físico de alta intensidad (en días) y ejercicio físico de moderada intensidad (en horas) se realice durante los últimos días de la semana, los diagnósticos de las enfermedades crónicas no transmisibles (HTA, DM) y enfermedades respiratorias se verán controladas, mientras que, cuando existe menor frecuencia del ejercicio físico realizado durante los últimos días de la semana, tiende a existir mayor diagnóstico.

Background. The prevalence of physical inactivity, sedentary lifestyle, and overweight and obesity have increased their rates in recent years in Chile, which leads to the development and appearance of various chronic non-communicable diseases, such as for example, arterial hypertension, diabetes mellitus and even respiratory diseases, which have a negative impact on the population and deteriorate the quality of life of people, regardless of gender and age range (7). Physical exercise is one of the main tools used by various health professionals as a method of prevention and treatment in the affected population, even representing a lower cost alternative. Objetive. To relate high and medium intensity physical exercise with chronic non-communicable diseases in people over 18 years of age residing in Chile during the period 2015-2016. Methods. Quantitative, descriptive, cross-sectional and retrospective analysis of the ENCAVI 2015-2016 secondary base of residents in Chile over 18 years of age and with at least one of the following health conditions: High blood pressure, Diabetes Mellitus and chronic non-communicable respiratory diseases. Results. All the variables present significant relationships (p<0.005) (HTN, DM, respiratory diseases, age, hours sitting, moderate and high intensity physical exercise. However, the variables of moderate intensity physical exercise and respiratory diseases (p=0.578) and the variables of sex and sitting hours (p=0.005) do not present a significant relationship. Discussion. Moderate intensity physical exercise is the one that has the best response to different pathologies according to different authors, on the other hand, in data collection we can found that this type of exercise is effective in Diabetes Mellitus. Conclusions. According to the data analyzed, the greater the frequency of high-intensity physical exercise (in days) and moderate-intensity physical exercise (in hours) performed during the last days of the week, the diagnoses of chronic non-communicable diseases (HTN, DM) and respiratory diseases will be controlled, while, when there is less frequency of physical exercise carried out during the last days of the week, there tends to be a greater diagnosis.

Úlceras de pie diabético infectadas con bacterias multirresistentes a los antimicrobianos en pacientes venezolanos / Diabetic Foot Ulcers Infected with Bacteria Multiresistant to Antimicrobials in Venezuelan patients

Introducción: Las úlceras de pie diabético tienen una importante morbimortalidad, más aun, si están asociadas a bacterias multirresistentes a los antimicrobianos. Objetivo: Analizar las características de las úlceras de pie diabético infectadas con bacterias multirresistentes a los antimicrobianos. Métodos: Se realizó una investigación descriptiva, no experimental y transversal, en 87 pacientes con úlceras de pie diabético infectadas, atendidos en una consulta especializada del estado Zulia, Venezuela. Se realizó la anamnesis y exploración física, especialmente centrada en las características de las úlceras de pie diabético. Se obtuvieron muestras de tejido ulceroso para identificar las bacterias presentes y el antimicrobiano correspondiente. Resultados: Todos los pacientes tenían úlcera previa, con agudización de la infección (75,86 por ciento), rehospitalización (59,77 por ciento), amputación previa (36,78 por ciento), úlceras de pie diabético infectadas de larga duración (86,21 por ciento). El 95,40 por ciento recibieron antibióticos previos y 57,62 por ciento habían sido hospitalizados, la antigüedad de la enfermedad fue 16,17 ± 8,41 años y la HbA1c 8,87 ± 1,23. Las úlceras de pie diabético infectadas más frecuente fue neuroisquémica (71,26 por ciento). Predominó la flora monomicrobiana con un (62,07 por ciento) y bacterias gramnegativas (87,36 por ciento). El 79,3 por ciento presentaron bacterias multirresistentes a los antimicrobianos y el 20,69 por ciento panresistencia. Las bacterias multirresistentes fueron predominantemente gramnegativas, y para las grampositivas solo estuvo el Staphylococcus aureus. Conclusiones: Se presenció una alta frecuencia de úlceras de pie diabético infectadas con multirresistencia, predominantemente monomicrobianas y todas con resistencia a betalactámicos y fluoroquinolonas(AU)

Introduction: Diabetic foot ulcers have significant morbidity and mortality, even more so if they are associated with multi-resistant bacteria to antimicrobials. Objective: To analyze the characteristics of diabetic foot ulcers infected with bacteria multi-resistant to antimicrobials. Methods: A descriptive, non-experimental and cross-sectional investigation was carried out in 87 patients with infected diabetic foot ulcers. They were treated in a specialized clinic in Zulia state, Venezuela. Anamnesis and physical examination were performed, especially focused on the characteristics of diabetic foot ulcers. Ulcer tissue samples were obtained to identify the bacteria existing and the corresponding antimicrobial. Results: All the patients had previous ulcer, with exacerbation of the infection (75.86percent), rehospitalization (59.77percent), previous amputation (36.78percent), long-lasting infected diabetic foot ulcers (86.21percent). 95.40percent received previous antibiotics and 57.62percent had been hospitalized, the disease age was 16.17 ± 8.41 years and Hb A1c was 8.87 ± 1.23. The most frequent infected diabetic foot ulcers were neuroischemic (71.26percent). The monomicrobial flora (62.07percent) and gram-negative bacteria (87.36percent) predominated. 79.3percent had multi-resistant bacteria to antimicrobials and 20.69percent pan-resistance. Multi-resistant bacteria were predominantly gram-negative and for gram-positive only staphylococcus aureus. Conclusions: High frequency of multidrug-resistant infected diabetic foot ulcers was found, predominantly monomicrobial and all with resistance to beta-lactams and fluoroquinolones(AU)

Quantitatively Evaluating the Relationships between Insulin Resistance and Retinal Neurodegeneration with Optical Coherence Tomography in Early Type 2 Diabetes Mellitus.

INTRODUCTION: The aim of this study was to quantitatively assess retinal neurodegenerative changes with optical coherence tomography (Cirrus HD-OCT) in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR) and evaluate their relationships with insulin resistance (IR) and associated systemic indicators. METHODS: 102 T2DM patients without DR and 48 healthy controls were included in this observational cross-sectional study. The OCT parameters of macular retinal thickness (MRT) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were evaluated between diabetic and normal eyes. The receiver operating characteristics (ROC) curve was generated to evaluate the discrimination power of early diabetes. Correlation and multiple regression analysis were performed between ophthalmological parameters and T2DM-related demographic and anthropometric variables, and serum biomarkers and homeostasis model assessment of insulin resistance (HOMA-IR) scores. RESULTS: MRT and GCIPL thicknesses showed significant thinning in patients, especially in inferotemporal area. High body mass index (BMI) correlated with decreased GCIPL thicknesses and elevated intraocular pressure (IOP). A negative correlation between waist-to-hip circumference ratio (WHR) and GCIPL thicknesses was also found. High-density lipoprotein (HDL) and fasting C-peptide (CP0) were associated with GCIPL thickness but only in inferotemporal region (r = 0.20, p = 0.04; r = -0.20, p = 0.05, respectively). Multiple regression analysis showed that increased HOMA-IR scores independently predicted both average (ß = -0.30, p = 0.05) and inferotemporal (ß = -0.34, p = 0.03) GCIPL thinning. CONCLUSION: Retinal thinning in early T2DM was associated with obesity-related metabolic disorders. IR as an independent risk factor for retinal neurodegeneration may increase the risk of developing glaucoma.

La semaglutida en el tratamiento de las personas con diabesidad / Semaglutide in the Treatment of Diabesity Individuals

Introducción: La semaglutida es un fármaco que contribuye a la liberación de insulina por el páncreas y a la supresión del apetito por lo que lo convierte en un importante candidato para ser usado en el tratamiento de la diabesidad. Objetivo: Describir el efecto de la semaglutida en el tratamiento de las personas con diabesidad. Métodos: Se revisó la literatura publicada en el período comprendido de enero-febrero de 2021. Las palabras clave utilizadas fueron obesidad; diabetes mellitus; diabesidad; semaglutida; análogo del péptido similar al glucagón tipo 1. Se utilizaron como motores de búsqueda las bases de datos de Google Académico, PubMed y SciELO. Se evaluaron diferentes trabajos de revisión, investigación y páginas web que tenían menos de 10 años de publicados en idioma español, portugués o inglés, y que por el título trataban el tema de estudio. Fueron excluidos los artículos que no abordaron la relación entre diabetes y obesidad, así como el tratamiento con análogos del péptido similar al glucagón tipo 1. Esto permitió la consulta de 84 artículos, de los cuales 59 fueron referenciados. Conclusiones: El empleo de semaglutida favorece una mejor evolución en paciente con diabesidad, como complemento de una dieta y una actividad física adecuada. Al optimizar el control glucémico, contribuir a la pérdida de peso y a la mejoraría de ciertas comorbilidades, entre ellas la salud cardiovascular(AU)

Introduction: Semaglutide is a drug that contributes to the release of insulin from the pancreas and suppresses appetite, which makes it an important candidate for treating diabesity. Objective: To describe the role of semaglutide in the treatment of diabesity individuals. Methods: The necessary information to write this article was obtained in the 2022 two-month period January-February. The keywords used were obesity; Mellitus diabetes; diabesity; semaglutide; type 1 glucagon-like peptide analogue. The search engines corresponding to the Google Scholar, PubMed and SciElO databases were used. Different review, research and web pages were evaluated, which in general were published no more than 10 years ago, in Spanish, Portuguese or English and which dealt with the subject of study by title. Articles that did not address the relationship between diabetes and obesity, as well as treatment with glucagon-like peptide 1 analogues, were excluded. This allowed the consultation of 84 articles, 59 of them were referenced. Conclusions: The use of semaglutide, as a complement to a diet and physical activity appropriate to the needs of patients with diabesity, brought about several effects that favor better evolution of this health problem, by optimizing glycemic control, contributing to the loss of weight and the improvement of certain comorbidities, including cardiovascular health(AU)

Necrotizing fasciitis in a patient with COVID-19 / Fascitis Necrotizante en paciente portador de COVID-19 / Fasceíte necrotizante em paciente com COVID-19

Introduction: SARS-CoV-2 infection generates a higher risk of complications and mortality in previously ill patients, patients with diabetes mellitus have a weaker immune system and the increase in blood glucose can compromise innate immunity and humoral immunity. Therefore, these patients are more susceptible to soft tissue infections. Objective: To describe the evolution and complications of a patient with type II diabetes mellitus with SARS-CoV-2 infection who presented necrotizing fasciitis on the 15th day of disease evolution. Case presentation: A 52-year-old male patient, white, with type II diabetes mellitus and high blood pressure for which he was treated with slow insulin, metformin, enalapril, and hydrochlorothiazide, was admitted as a positive case of COVID-19, at Fifteenth day of stay began with fever, heat and flushing, swelling beyond the area of erythema and crepitus in both lower limbs, surgical intervention was decided. In the operating room, drainage, debridement, and necrectomy were performed on both lower limbs. Microbiological analysis through culture detected the growth of Pantoea agglomerans . Conclusions: Diabetes mellitus, the use of glucocorticoids, were the risk factors found to cause the state of immunosuppression in the case presented, and the use of biological anti-TNF drugs (Nimotuzumab). It is necessary to be insistent on prevention measures: maximum asepsis in the handling of intravenous access, and judicious use of antibiotics.

Introducción: La infección por SARS-CoV-2 genera un mayor riesgo de complicaciones y mortalidad en pacientes previamente enfermos, los pacientes con diabetes mellitus tienen un sistema inmunológico más débil y el aumento de glucosa en sangre puede comprometer la inmunidad innata y la inmunidad humoral, por lo que estos pacientes son más susceptibles a sufrir infecciones de partes blandas. Objetivo: Describir la evolución y complicaciones de un paciente portador de diabetes mellitus tipo II con infección por SARS-CoV-2 que presentó una fascitis necrotizante al 15to día de evolución de la enfermedad. Presentación de caso: Paciente de 52 años de edad, sexo masculino, blanco, portador de diabetes mellitus tipo II e hipertensión arterial para lo cual llevó tratamiento con insulina lenta, metformina, enalapril e hidroclorotiazida, ingresó como caso positivo de COVID-19, al décimo quinto día de estadía comenzó con fiebre, calor y rubor, tumefacción más allá del área de eritema y crepitación en ambos miembros inferiores, se decidió intervención quirúrgica. En el salón de operaciones se realizó drenaje, desbridamiento y necrectomía en ambos miembros inferiores, el análisis microbiológico a través de cultivo detectó el crecimiento de Pantoea Agglomerans. Conclusiones: La diabetes mellitus, el uso de glucocorticoides, fueron los factores de riesgo encontrados como causantes del estado de inmunodepresión en el caso presentado, y el uso de medicamentos biológicos anti-TNF (Nimotuzumab). Es necesario ser insistente en las medidas de prevención: la máxima asepsia en la manipulación de accesos intravenosos, y el uso juicioso de antibióticos.

Introdução: A infecção por SARS-CoV-2 gera maior risco de complicações e mortalidade em pacientes previamente enfermos, pacientes com diabetes mellitus têm sistema imunológico mais fraco e o aumento da glicemia pode comprometer a imunidade inata e a imunidade humoral. suscetível a infecções de tecidos moles. Objetivo: Descrever a evolução e complicações de um paciente com diabetes mellitus tipo II com infecção por SARS-CoV-2 que apresentou fasceíte necrosante no 15º dia de evolução da doença. Apresentação do caso: Paciente do sexo masculino, 52 anos, branco, com diabetes mellitus tipo II e hipertensão arterial, para o qual fazia tratamento com insulina lenta, metformina, enalapril e hidroclorotiazida, foi admitido como caso positivo de COVID-19, No décimo quinto dia de internação, ela começou com febre, calor e rubor, inchaço além da área de eritema e crepitação em ambos os membros inferiores, sendo decidida a cirurgia. Na sala cirúrgica foi realizada drenagem, desbridamento e necrectomia em ambos os membros inferiores, a análise microbiológica por meio de cultura detectou o crescimento de Pantoea Aglomerans. Conclusões: Diabetes mellitus, uso de glicocorticóides foram os fatores de risco encontrados para causar o estado de imunossupressão no caso apresentado e uso de drogas biológicas anti-TNF (Nimotuzumab). É preciso insistir nas medidas preventivas: a máxima assepsia no manuseio dos acessos intravenosos e o uso criterioso de antibióticos.

Pruritus as a microvascular equivalent in diabetes.

Pruritis is a common symptom of many systemic and cutaneous localized diseases and diabetes mellitus is a common syndrome with multiple long term complications, including diabetic painful neuropathy. The involvement of small fibre neurons, in diabetic neuropathy, is recognized as the main pathophysiology. While the C fibres that mediate the sensation of pain and pruritus may belong to different neuronal circuits, there is evidence of cross talk between them. We therefore posit that pruritus may be a symptom of diabetic neuropathy. It should be viewed as an equivalent of microvascular disease, with its accompanying clinical significance and therapeutic implications.

Blood glucose monitoring during hospitalisation: Advanced practice nurse and semi-automated insulin prescription tools.

INTRODUCTION: Hyperglycemia is very common in hospitalized patients and is associated with worse clinical outcomes. AIMS: We implemented a clinical and educational program to improve the overall glycemic control during hospital admission, and, in patients with HbA1c > 8%, to improve their metabolic control after hospital admission. METHODS: Non-critical patients admitted to cardiovascular areas between October-2017 and February-2019. The program was led by an advanced nurse practitioner (ANP) and included a semiautomated insulin prescription tool. Program in 3 phases: 1) observation of routine practice, 2) implementation, and 3) follow-up after discharge. RESULTS: During the implementation phase the availability of HbA1c increased from 42 to 81%, and the ANP directly intervened in 73/685 patients (11%), facilitating treatment progression at discharge in 48% (de novo insulin in 36%). One-year after discharge, HbA1c in patients who were admitted during the observation phase with HbA1c > 8% (n = 101) was higher than similar patients admitted during implementation phase (8,6 ±â€¯1,5 vs. 7,3 ±â€¯1,2%, respectively, p < 0,001). We evaluated 47710 point of care capillary blood glucose (POC-glucose) in two 9 months periods (one before, one during the program) in cardiology and cardiovascular surgery wards. POC-glucose ≥250 mg/dl (pre vs. during: cardiology 10,7 vs. 8,4%, and surgery 7,4 vs. 4,5%, both p < 0,05) and <70 mg/dl (2,3 vs. 0,8% y 1,5 vs 1%, p < 0,05), respectively, improved during the program. CONCLUSIONS: The program allowed improving inpatient glycemic control, detect patients with poor glycemic control, and optimize metabolic control 1-year after discharge.

Evolución del paciente diagnosticado de sindrome respiratorio agudo severo por coronavirus tipo 2 en función de la comorbilidad de la población adscrita al Centro de Salud Zona VI de Albacete / Risk factors for severity and mortality in adults testing positive for COVID-19 in the VI Health Area of Albacete

Objetivos: La bibliografía consultada, en su mayoría estudios descriptivos, establece asociación entre factores de riesgo para la salud, en su mayoría cardiovasculares, y la mala evolución de la COVID-19. Este estudio pretende mostrar dicha asociación entre la población perteneciente al área de salud zona vi de Albacete (España). Método: Estudio de cohortes de carácter retrospectivo. Mediante muestreo consecutivo se ha obtenido una muestra de 372 pacientes, mayores de 14 años, con diagnóstico confirmado de COVID-19. Los grupos se han dividido entre buena y mala evolución, entendiendo esta última como ingreso en UCI y/o muerte. Los datos obtenidos mediante la explotación de historias clínicas han sido analizados obteniendo frecuencias, Chi cuadrado con intervalo de confianza al 95% y ajustando por factores de confusión.ResultadosPor edad los pacientes con mala evolución tenían una media de 76 años, frente a los 48,7 años de los pacientes que evolucionaron favorablemente.Los pacientes con HTA presentaron peor evolución; siendo la Chi cuadrado <0,001 y la OR, para un intervalo de confianza del 95%, estuvo entre 3,97 y 21,42.En los paciente con DM también se relacionó la mala evolución de la enfermedad, siendo la Chi cuadrado <0,001 y la OR, para un intervalo de confianza del 95%, entre 2.766 y 12.690. Los pacientes que presentaban DM+HTA tenían un riesgo 5 veces superior de mala evolución respecto a los que solo presentaban una de las enfermedades.Nuestro estudio no pudo encontrar diferencias estadísticamente significativas entre el IMC, el sexo y los hábitos tóxicos (consumo de alcohol, tabaco y drogas) y la mala evolución de la COVID-19. Conclusiones: Los pacientes de mayor edad tuvieron un peor desenlace de la enfermedad, así como los hipertensos y diabéticos. No se encontró relación entre la evolución y la distribución por sexos. No se pudo establecer relación entre el IMC y hábitos tóxicos y la mala evolución.(AU)

Objectives: There are several retrospective studies that establish a relationship between some risk factors (cardiovascular risks mainly) and the development of COVID-19 and a severe outcome. Thus, our aim with this study is to find out the former relationship among the population within our basic health area. Method: Cohort study. The study sample consisted of 372 patients aged 14 or older who had tested positive for COVID-19 in our health centre by consecutive sampling. Data collected from medical records will be analysed using Frequencies, X2 with a Confidence interval of 95% and those carrying out the study will have prior experience/training in research and will be specifically trained for the aim of this research. Results: A worse outcome in patients aged 76 years old on average was found versus patients aged 48.7. Regarding high blood pressure patients, X2 was<.001 and OR between 3.975 and 21.425 with confidence interval of 95%, finding a worse outcome in these patients. With regard to Diabetes Mellitus (DM), X2 was<.001 and OR rated between 2.766 and 12.690 with a confidence interval of 95%, also resulting in a worse outcome in these patients. No significant differences regarding a worse outcome were found in Body Mass Index, gender, or toxic habits. Conclusions: Older patients had a worse outcome from COVID- 19, as well as patients with high blood pressure or DM. We found no differences regarding gender and neither could we find any differences regarding BMI.(AU)

Needs assessment survey regarding effectiveness of chronic care in diabetes in a hospital setting.

OBJECTIVE: To assess the current knowledge level about diabetes and acceptance of nurse-led educational programmes among diabetic patients. Methods: The cross-sectional study was conducted at a community health centre in Karachi from August, 2018 to December, 2019 and comprised adult patients of either gender with diabetes. Data was collected using a predesigned questionnaire to record demographic information, participants' DM knowledge, self-management aspects and their opinions along with preferences for a DM educational support group. Data was analysed using STATA/SE 15.1. RESULTS: Of the 215 participants, 80(37%) were males and 135(63%) were females. The overall mean age was 55.8±14.5 yrs. Most participants had diabetes for ≥5 years 127(59%) and 141(66%) did not know their type of diabetes. Most participants were prescribed anti-diabetic medications 201(94%), and 45(2%) had forgotten to take their medication recently. Insulin was being used by 65(30%) participants, and, among them, 27(42%) reused syringes. Most patients struggled to make lifestyle modifications 133(62%), and 144 (67%) were willing to attend nurse-led diabetic education sessions. Conclusion: There was found to be a need of diabetes education support programme to address knowledge deficiencies, and a nurse-led programme was found to be acceptable to the majority of study subjects.