Abstract Objective To develop and validate a brief intervention strategy based on the concept of implementation intention to promote adherence to oral antidiabetics in people with type 2 diabetes mellitus being monitored in primary care. Method This is a methodological study carried out in a primary health unit in Carmo do Cajuru, Minas Gerais, Brazil, from May 2022 to April 2023. The stages taken involved intervention construction based on the concept of implementation intention, with validity of its content by seven experts and assessment of its comprehensibility by 11 people with type 2 diabetes mellitus. An expert committee assessed the intervention’s relevance, comprehensibility and comprehensiveness, and the target audience exclusively assessed their comprehensibility through a cognitive interview. Agreement among experts was assessed by the item and total Content Validity Index (CVI), with item and total CVI being considered satisfactory ≥ 0.85. Results The intervention strategy was called “Plan for coping with difficulties in taking oral antidiabetics”, and its final validated version was composed of a set of initial instructions, a topic on intended behavior, a column with 13 possible difficulties and a column with 16 possible solutions to the difficulties listed. A total CVI of 0.99 was obtained, and the intervention strategy was understood by the target audience. Conclusion The brief intervention strategy obtained evidence of content validity. This technology can support and motivate healthcare professionals’ practice, especially nurses, to improve their approach to users with type 2 diabetes mellitus in relation to adherence to oral antidiabetic medications. care Cajuru Gerais Brazil 202 2023 1 interventions s relevance comprehensiveness interview CVI, , (CVI) 085 0 85 0.85 Plan antidiabetics, antidiabetics” instructions behavior listed 099 99 0.9 professionals practice nurses medications 20 (CVI 08 8 0.8 09 9 0.

Resumo Objetivo Desenvolver e validar uma estratégia de intervenção breve baseada no conceito de implementation intention para promover adesão aos antidiabéticos orais em pessoas com diabetes mellitus tipo 2 em acompanhamento na atenção primária. Método Estudo metodológico realizado em uma unidade de saúde primária de Carmo do Cajuru, Minas Gerais, Brasil, no período de Mai/2022-Abri/2023. As etapas percorridas envolveram a construção da intervenção baseada no conceito de implementation intention, com a validação de seu conteúdo por sete especialistas e avaliação da sua compreensibilidade por 11 pessoas com diabetes mellitus tipo 2. O comitê de especialistas avaliou a relevância, compreensibilidade e abrangência da intervenção e o público-alvo avaliou exclusivamente sua compreensibilidade por meio de uma entrevista cognitiva. A concordância entre os especialistas foi avaliada pelo índice de validade de conteúdo (IVC) do item e total, sendo considerado satisfatório, IVC do item e total ≥ 0,85. Resultados A estratégia de intervenção foi denominada “Plano de enfrentamento de dificuldades para tomar os antidiabéticos orais” e sua versão final validada foi composta por um conjunto de instruções iniciais, um tópico sobre o comportamento pretendido, uma coluna com 13 possíveis dificuldades e uma coluna com 16 possíveis soluções para as dificuldades listadas. Foi obtido um IVC-total de 0,99; a estratégia de intervenção foi compreendida pelo público-alvo. Conclusão A estratégia de intervenção breve obteve evidência de validade de conteúdo. Esta tecnologia poderá fundamentar e motivar a prática de profissionais da saúde, principalmente do(a)s enfermeiro(a)s, para melhorar sua abordagem junto aos usuários com diabetes mellitus tipo 2 em relação à adesão aos antidiabéticos orais. Cajuru Gerais Brasil Mai/2022Abri/2023. Mai2022Abri2023 MaiAbri Mai/2022 Abri/2023. Mai 2022 Abri 2023 Mai/2022-Abri/2023 1 relevância públicoalvo público alvo cognitiva (IVC satisfatório 085 0 85 0,85 Plano iniciais pretendido listadas IVCtotal 0,99 099 99 públicoalvo. alvo. doas s enfermeiroas, enfermeiroas enfermeiro s, enfermeiro(a)s 2022Abri Mai/2022Abri/2023 Mai2022Abri202 Mai2022 Mai/202 Abri2023 Abri/2023 202 Mai/2022-Abri/202 08 8 0,8 0,9 09 9 Mai/2022Abri/202 Mai2022Abri20 Mai202 Mai/20 Abri202 Abri/202 20 Mai/2022-Abri/20 0, Mai/2022Abri/20 Mai2022Abri2 Mai20 Mai/2 Abri20 Abri/20 Mai/2022-Abri/2 Mai/2022Abri/2 Mai2022Abri Mai2 Mai/ Abri2 Abri/2 Mai/2022-Abri/ Mai/2022Abri/ Abri/ Mai/2022-Abri Mai/2022Abri

Resumen Objetivo Elaborar y validar una estrategia de intervención breve basada en el concepto de implementation intention para promover la adhesión a los antidiabéticos orales en personas con diabetes mellitus tipo 2 que realizan seguimiento en la atención primaria. Métodos Estudio metodológico realizado en una unidad de salud primaria de Carmo do Cajuru, Minas Gerais, Brasil, entre mayo de 2022 y abril de 2023. Las etapas llevadas a cabo fueron la elaboración de la intervención basada en el concepto de implementation intention, la validación del contenido por siete especialistas y la evaluación de la comprensibilidad por 11 personas con diabetes mellitus tipo 2. El comité de especialistas evaluó la relevancia, la comprensibilidad y el alcance de la intervención, y el público destinatario evaluó solo la comprensibilidad mediante una entrevista cognitiva. La concordancia entre los especialistas se evaluó mediante el índice de validez de contenido (IVC) de los ítems y total, donde se consideró satisfactorio IVC de los ítems y total ≥ 0,85. Resultados La estrategia de la intervención fue denominada “Plan para enfrentar las dificultades de tomar antidiabéticos orales” y su versión final validada estuvo compuesta por un conjunto de instrucciones iniciales, un tópico sobre el comportamiento esperado, una columna con 13 dificultades posibles y una columna con 16 soluciones posibles para las dificultades enumeradas. Se obtuvo un IVC total de 0,99, y la estrategia de intervención fue comprendida por el público destinatario. Conclusión La estrategia de intervención breve obtuvo evidencia de validez de contenido. Esta tecnología podrá justificar y motivar la práctica de profesionales de la salud, principalmente de enfermeros(as), para mejorar su forma de abordar a los pacientes con diabetes mellitus tipo 2 respecto a la adhesión a los antidiabéticos orales. Cajuru Gerais Brasil 202 2023 1 relevancia cognitiva (IVC 085 0 85 0,85 Plan iniciales esperado enumeradas 099 99 0,99 enfermerosas, enfermerosas enfermeros as , enfermeros(as) 20 08 8 0,8 09 9 0,9 enfermeros(as 0,

Abstract Introduction: The nursing process is the method that allows us to administer care to people with chronic diseases through the disease stages, that is, assessment, diagnostic reasoning, nursing care plan and evaluation. Objective: Evaluate a nursing care plan for an older adult with type 2 diabetes mellitus and osteoporosis with a focus on therapeutic health education. Methodology: Observational, descriptive, and longitudinal clinical case study of a 63-year-old patient with diabetes mellitus and osteoporosis; the Marjory Gordon instrument was used for assessment, and standardized language was used for diagnostic reasoning, planning, execution and evaluation. Under bioethical principles, this is a minimal risk research, and the privacy and data of the elderly are protected. Results: Alteration was found in the pattern of perception/maintenance of health, nutritional/metabolic, exercise activity and coping with stress; with the establishment of activities to control glucose, priority was given to prescribed diet, exercise, adherence to treatment and coping with stress. Acceptance of the disease, learning to take capillary glucose and glycemic control was achieved, as well as adherence to the prescribed diet and exercise. Conclusions: Therapeutic health education achieved adherence to pharmacological and non-pharmacological treatment, as well as the acceptance of the health status, which allows acquiring self-control of the disease. Continuous and long-term follow-up is important due to the pathological progress, age and general deterioration of the patient.

Abstrato Introdução. O processo de enfermagem é o método que nos permite administrar a assistência a pessoas com doenças crônicas por meio dos estágios da doença, ou seja, avaliação, raciocínio diagnóstico, plano de assistência de enfermagem e avaliação. Objetivo: Avaliar um plano de cuidados de enfermagem para um adulto mais velho com diabetes mellitus tipo 2 e osteoporose com foco na educação terapêutica em saúde. Metodologia: Estudo de caso clínico observacional, descritivo e longitudinal de uma paciente de 63 anos com diabetes mellitus e osteoporose; para a avaliação foi utilizado o instrumento Marjory Gordon para raciocínio diagnóstico, planejamento, execução e avaliação, para raciocínio diagnóstico, planejamento, execução e avaliação, foi utilizada a linguagem padronizada. De acordo com os princípios bioéticos, essa é uma pesquisa de risco mínimo, e a privacidade e os dados dos idosos são protegidos. Resultados: Foi encontrada alteração no padrão de percepção/manutenção da saúde, nutricional/metabólico, atividade física e enfrentamento do estresse; com o estabelecimento de atividades para controlar a glicose, a prioridade foi dada à dieta prescrita, aos exercícios, à adesão ao tratamento e ao enfrentamento do estresse. Houve aceitação da doença, aprendizado da medição da glicose capilar e controle glicêmico, além de adesão à dieta e aos exercícios prescritos. Conclusões: A educação terapêutica em saúde conseguiu a adesão ao tratamento farmacológico e não farmacológico, bem como a aceitação do estado de saúde, que permite adquirir o autocontrolo da doença, sendo importante a monitorização contínua e a longo prazo da evolução patológica, da idade e da deterioração geral do paciente.

Resumen Introducción: El proceso de enfermería es el método que nos permite administrar los cuidados a personas con enfermedades crónicas a través de sus etapas: valoración, razonamiento diagnóstico, plan de cuidados de enfermería y evaluación. Objetivo: Evaluar un plan de cuidados de enfermería a una adulta mayor con diabetes mellitus tipo 2 y osteoporosis con enfoque a la educación para la salud terapéutica. Metodología: Estudio de caso clínico, observacional, descriptivo y longitudinal, a paciente de 63 años con diabetes mellitus y osteoporosis; para la valoración se empleó el instrumento de Marjory Gordon, para el razonamiento diagnóstico, planeación, ejecución y evaluación se utilizó el lenguaje estandarizado de enfermería. Bajo los principios bioéticos es una investigación de riesgo mínimo, se protege la privacidad y datos del adulto mayor. Resultados: Se encontró alteración en el patrón percepción / mantenimiento de la salud, nutricional / metabólico, actividad ejercicio y afrontamiento del estrés; estableciendo actividades para el control de su glucosa, se priorizó en dieta prescrita, ejercicio, adherencia al tratamiento y afrontamiento al estrés. Se logró aceptación de la enfermedad, aprendizaje de toma de glucosa capilar y control glucémico, además del apego a dieta y ejercicio prescrito. Conclusiones: La educación para la salud terapéutica logró el apego al tratamiento farmacológico y no farmacológico, así como la aceptación del estado de salud le permite adquirir el autocontrol de su enfermedad, es importante el seguimiento continuo y a largo plazo por el avance patológico, edad y deterioro general de la paciente.

Abstract Type 2 Diabetes Mellitus (T2DM) is a set of metabolic disorders that increase the risk of multisystemic diseases. In Mexico, Clinical Practice Guidelines (CPG) have been proposed for the healthcare of people with T2DM, from prevention to rehabilitation. However, although these guidelines emphasize the active participation of patients in their treatment to enhance treatment adherence, the necessary information on the procedures has not been provided. Therefore, the aim of this paper is to propose Human-Centered Design Thinking (HCDP) as a strategy for this purpose. The steps that constitute this methodology are described, as well as the results found in the international literature. The coherence of the HCDP with Mexican CPG recommendations is discussed, as is the importance of the methodological clarity provided by this model to improve treatment adherence in people with T2DM.

Resumen La diabetes mellitus tipo 2 (DMT2) es un conjunto de desórdenes metabólicos que aumenta el riesgo de afecciones multisistémicas. En México se han propuesto Guías de Práctica Clínica (GPC) para la atención de la salud en personas con DMT2, que van desde la prevención hasta la rehabilitación. Sin embargo, a pesar de enfatizar la participación activa de los pacientes en sus tratamientos para mejorar la adherencia al tratamiento, no cuenta con procedimientos claros. Por ello, el objetivo de este trabajo es proponer el pensamiento de diseño centrado en la persona (PDCP) como una estrategia para esta meta. Se describen los pasos que integran esta metodología, así como los resultados observados en la literatura internacional. Se discute la coherencia del PDCP con las recomendaciones de las GPC mexicanas, y la importancia de la claridad metodológica que brinda este modelo para mejorar la adherencia al tratamiento en personas con DMT2.

Resumen Objetivo: recopilar información de factores de riesgo de la enfermedad arterial coronaria en población adulta evidenciados mediante estudios de aleatorización mendeliana. Métodos: de acuerdo con las recomendaciones de la escala para la Evaluación de Artículos de Revisión Narrativa (SANRA), se realizó una revisión desde el usuario de la Universidad Militar Nueva Granada en las bases de datos de PubMed, EMBASE y BIREME. Resultados: se obtuvieron 757 artículos, luego se aplicaron los criterios de inclusión y exclusión, y se eligieron 29 artículos en los que se investiga la asociación de la enfermedad arterial coronaria con la apolipoproteína B, colesterol LDL, triglicéridos, colesterol total, apolipoproteina C3, proteína de transferencia de ésteres de colesterol, HDL, omega 6, lipoproteína (a), obesidad, hemoglobina A1C, diabetes mellitus tipo 2, glucosa en ayunas, inicio del hábito de fumar, presión arterial, hormona paratiroidea sérica, niveles de fosfato sérico, enfermedad del hígado graso no alcohólico, síndrome de ovario poliquístico, globulina fijadora de hormonas sexuales, testosterona, filoquinona circulante, proteína gla de la matriz inactiva, antioxidantes circulantes derivados de la dieta, glicina, homocisteína, ácido úrico, marcadores inflamatorios, hemoglobina, hematocrito y recuento de glóbulos rojos. Conclusión: esta revisión sugiere nuevos estudios con información genética colombiana para respaldar los factores de riesgo aquí presentados, teniendo en cuenta que en ninguno de los estudios evaluados se utilizó información genética latinoamericana, lo cual puede limitar la extrapolación de los resultados.

Summary: Objective: To compile information on risk factors for coronary artery disease in the adult population evidenced by Mendelian randomization studies.. Methods: A search was carried out from the user of the Nueva Granada Military University in the databases of PubMed, EMBASE and BIREME and a narrative review of the literature was carried out in accordance with the recommendations of the scale for the Evaluation of Narrative Review Articles (SANRA). Results: 757 articles were obtained, after the application of inclusion and exclusion criteria, 29 articles were chosen that investigated the association of apolipoprotein B, LDL cholesterol, triglycerides, total cholesterol, apolipoprotein C3, cholesterol ester transfer protein, HDL, omega 6, lipoprotein (a), obesity, hemoglobin A1C, type 2 diabetes mellitus, fasting glucose, smoking initiation, blood pressure, serum parathyroid hormone, serum phosphate levels, non-alcoholic fatty liver disease, polycystic ovary syndrome , sex hormone-binding globulin, testosterone, circulating phylloquinone, inactive matrix protein gla, circulating dietary-derived antioxidants, glycine, homocysteine, uric acid, inflammatory markers, hemoglobin, hematocrit, and red blood cell count, with coronary artery disease. Conclusion: This review suggests new studies with Colombian genetic information to support the risk factors presented here, considering that none of the studies evaluated used Latin American genetic information, which may limit the extrapolation of the results.

RESUMEN Introducción: La diabetes mellitus tipo 2 (DM2) es un problema de salud pública creciente, frecuentemente asociada con sobrepeso y obesidad. El índice de masa corporal (IMC) y la hemoglobina glicosilada (HbA1c) son indicadores clave en el manejo de la DM2. Objetivo: Correlacionar el IMC y la HbA1c en pacientes con DM2 atendidos en el Hospital Distrital de Capiatá, Paraguay, en diciembre de 2022. Materiales y métodos: Estudio correlacional con datos secundarios de 38 pacientes DM2. Se recolectaron datos demográficos, clínicos, antropométricos y bioquímicos. Se utilizó la correlación de Pearson para determinar la correlación entre IMC y HbA1c, con un nivel de significancia de p<0,05. El protocolo de investigación fue aprobado por el Comité de Ética en Investigaciones de la FCQ-UNA (CEI913/2022). Resultados: El 65,8% fueron mujeres, con edad promedio de 55,8±5,2 años. El 86,8% presentó exceso de peso. La glucemia en ayunas promedio fue 245,0±57,0mg/dL y la HbA1c 8,8±3,4%. Se observó una tendencia al aumento de los niveles de HbA1c con el incremento del IMC. Los pacientes con peso normal presentaron una HbA1c promedio de 6,8±1,5% (buen control), mientras que aquellos con sobrepeso y obesidad mostraron valores de 8,6±2,7% (mal control) y 11,2±3,0% (control crítico), respectivamente. Estas diferencias resultaron estadísticamente significativas (p<0,01). Se observó una correlación fuerte y significativa entre IMC y HbA1c (r=0,681, p<0,01). Conclusión: Existe una correlación directamente proporcional entre el IMC y el control glucémico en pacientes con DM2. Estos hallazgos resaltan la importancia del control del peso en el manejo de la DM2.

ABSTRACT Introduction: Type 2 diabetes mellitus (T2DM) is a growing public health problem, frequently associated with overweight and obesity. Body mass index (BMI) and glycated hemoglobin (HbA1c) are key indicators in the management of T2DM. Objective: To correlate BMI and HbA1c in patients with DM2 treated at the Capiatá District Hospital, Paraguay, in December 2022. Materials and methods: Correlational study with secondary data from 38 DM2 patients. Demographic, clinical, anthropometric and biochemical data were collected. Pearson's correlation was used to determine the correlation between BMI and HbA1c, with a significance level of p<0.05. The research protocol was approved by the Research Ethics Committee of the FCQ-UNA (CEI913/2022). Results: 65.8% were women, with an average age of 55.8±5.2 years. 86.8% were overweight. The average fasting blood glucose was 245.0±57.0mg/dL and the HbA1c was 8.8±3.4%. A tendency to increase HbA1c levels with increasing BMI was observed. Patients with normal weight had an average HbA1c of 6.8±1.5% (good control), while those with overweight and obesity showed values of 8.6±2.7% (poor control) and 11.2± 3.0% (critical control), respectively. These differences were statistically significant (p<0.01). A strong and significant correlation was observed between BMI and HbA1c (r=0.681, p<0.01). Conclusion: There is a directly proportional correlation between BMI and glycemic control in patients with DM2. These findings highlight the importance of weight control in the management of T2DM.

Abstract The accumulation of advanced glycation end-products (AGEs) elicits morphofunctional kidney impairment. AGEs levels can be noninvasively estimated by skin autofluorescence (SAF). We explored whether high SAF predicts kidney outcomes in type 2 diabetes (T2D) individuals. The study was conducted as a predefined analysis of the Brazilian Diabetes Study, a prospective single-center cohort of T2D adults. Data from 155 individuals followed for up to 1716 days were considered. The incidence of major adverse kidney events (MAKE) was 9.6%. Individuals with above-median SAF had a higher incidence of MAKEs (4.6% vs. 21%; p = 0.002), with an HR of 3.39 [95% CI: 1.06–10.85; p = 0.040] after adjustment by age and gender. The mean adjusted eGFR change was 1.08 units (SE: 1.15; 95%CI: –1.20, 3.37) in the low SAF and –5.19 units [SE: 1.93; 95%CI: –9.10, –1.29] in the high SAF groups (between-subject difference: F: 5.62, p = 0.019). The high-SAF group had a greater prevalence of rapid decliners than the low-SAF group (36.7% vs. 15.8%; p = 0.028). In conclusion, high SAF was related to increased incidence of MAKEs and faster decline in eGFR among T2D subjects. This should be considered by healthcare providers when identifying individuals more prone to diabetes-related kidney complications. endproducts end products (AGEs impairment SAF. . (SAF) TD T D (T2D Study singlecenter single center adults 15 171 MAKE (MAKE 96 9 6 9.6% abovemedian above median 4.6% 46 4 (4.6 vs 21% 21 0.002, 0002 0.002 , 0 002 0.002) 339 3 39 3.3 95% 95 [95 CI 1.06–10.85 1061085 1 06 10 85 0.040 0040 040 gender 108 08 1.0 SE (SE 1.15 115 95%CI 95CI 120 20 –1.20 3.37 337 37 519 5 19 –5.1 [SE 1.93 193 93 910 –9.10 –1.29 129 29 betweensubject between subject difference F 562 62 5.62 0.019. 0019 0.019 019 0.019) highSAF lowSAF 36.7% 367 36 7 (36.7 15.8% 158 8 0.028. 0028 0.028 028 0.028) conclusion subjects diabetesrelated complications (SAF 17 9.6 4.6 (4. 000 0.00 00 33 3. [9 1.06–10.8 106108 0.04 004 04 1. 1.1 11 12 –1.2 51 –5. 1.9 91 –9.1 56 5.6 001 0.01 01 36.7 (36. 15.8 0.02 02 9. 4. (4 0.0 [ 1.06–10. 10610 –1. –5 –9. 5. 36. (36 15. ( 0. 1.06–10 1061 –1 – –9 (3 1.06–1 106 1.06– 1.06

Resumo O acúmulo de produtos finais de glicação avançada (AGEs, do inglês advanced glycation end-products) provoca comprometimento morfofuncional dos rins. Os níveis de AGEs podem ser estimados de forma não invasiva por autofluorescência da pele (sAF). Exploramos se a sAF elevada prediz desfechos renais em indivíduos com diabetes tipo 2 (DT2). O estudo foi realizado como uma análise predefinida do Estudo Brasileiro sobre Diabetes, uma coorte prospectiva de centro único de adultos com DT2. Foram considerados os dados de 155 indivíduos acompanhados por até 1.716 dias. A incidência de eventos renais adversos maiores (MAKE, por sua sigla em inglês) foi de 9,6%. Indivíduos com sAF acima da mediana apresentaram maior incidência de MAKEs (4,6% vs. 21%; p = 0,002), com HR de 3,39 [IC 95%: 1,06–10,85; p = 0,040] após ajuste por idade e sexo. A alteração média da TFGe ajustada foi de 1,08 unidades (EP: 1,15; IC95%: –1,20, 3,37) no grupo de baixa sAF e de –5,19 unidades [EP: 1,93; IC95%: –9,10, –1,29] no grupo de elevada sAF (diferença entre sujeitos: F: 5,62; p = 0,019). O grupo sAF elevada apresentou maior prevalência de declínio rápido em comparação ao grupo sAF baixa (36,7% vs. 15,8%; p = 0,028). Em conclusão, a sAF elevada foi relacionada ao aumento da incidência de MAKEs e ao declínio mais rápido da TFGe entre indivíduos com DT2. Tal fato deve ser considerado pelos profissionais de saúde ao identificar indivíduos mais propensos a complicações renais relacionadas ao diabetes. AGEs, (AGEs endproducts end products end-products rins sAF. . (sAF) DT2 DT (DT2) Diabetes 15 1716 1 716 1.71 dias MAKE, MAKE (MAKE 96 9 6 9,6% 4,6% 46 4 (4,6 vs 21% 21 0,002, 0002 0,002 , 0 002 0,002) 339 3 39 3,3 IC 95% 95 1,06–10,85 1061085 06 10 85 0,040 0040 040 sexo 108 08 1,0 EP (EP 1,15 115 IC95% IC95 120 20 –1,20 3,37 337 37 519 5 19 –5,1 [EP 1,93 193 93 910 –9,10 –1,29 129 29 diferença sujeitos F 5,62 562 62 0,019. 0019 0,019 019 0,019) 36,7% 367 36 7 (36,7 15,8% 158 8 0,028. 0028 0,028 028 0,028) conclusão (sAF (DT2 171 71 1.7 9,6 4,6 (4, 000 0,00 00 33 3, 1,06–10,8 106108 0,04 004 04 1, 1,1 11 IC9 12 –1,2 51 –5, 1,9 91 –9,1 5,6 56 001 0,01 01 36,7 (36, 15,8 0,02 02 (DT 17 1. 9, 4, (4 0,0 1,06–10, 10610 –1, –5 –9, 5, 36, (36 15, ( 0, 1,06–10 1061 –1 – –9 (3 1,06–1 106 1,06– 1,06

Abstract Invasive liver abscess syndrome caused by hyper virulent Klebsiella. pneumoniae is a rare disease. This type of K. pneumoniae is aggressive and invasive, despite its sensitivity profile. We report the case of a 62-year-old man with diabetes mellitus, who was admitted to our hospital with meningeal syndrome. Within 24 hours of admission, Gram negative bacilli were isolated blood and cerebrospinal fluid cultures, which were later identified as K. pneumoniae. Liver abscess was detected by com puted tomography. Despite early antibiotic treatment, the patient developed back pain that prevented him from moving and right hemiparesis. Increased signal from the central region of the spinal medulla compat ible with myelitis was identified by magnetic resonance, for which he received methylprednisolone 1 g/day for 5 days. The patient evolved favorably. Infections caused by hypermucoviscous K. pneumoniae are aggressive and invasive, and more common in men with a history of diabetes mellitus, as in this case. These infections require early antibiotic treatment and the search of metastatic infections.

Resumen El síndrome de absceso hepático invasivo causado por cepas hipermucoviscosas de Klebsiella pneumoniae es una enfermedad poco frecuente. Esta serovariedad de Klebsiella se caracteriza por ser agresiva e invasiva pese a su perfil de sensibilidad. Se presenta el caso de un varón de 62 años con antecedentes de diabetes mellitus, que ingresó a nuestro centro con síndrome meníngeo. A las 24 horas del ingreso se aislaron en hemocultivos y en líquido cefalorraquídeo (LCR) bacilos Gram negativos que luego fueron tipificados como Klebsiella pneumoniae. Se identificó la presencia de un absceso hepático mediante tomografía computarizada. Pese al tratamiento antibiótico instaurado de manera temprana, el paciente evolucionó con dolor dorsal que le impedía movilizarse y hemiparesia dere cha. En la resonancia magnética nuclear de columna se identificó aumento de la señal de la región central de la médula espinal compatible con mielitis por lo cual reci bió tratamiento con metilprednisolona 1g/día por 5 días consecutivos. El paciente evolucionó de manera favorable. Las infecciones por K. pneumoniae hipermucoviscosas son agresivas e invasoras y más frecuentes en varones con antecedentes de diabetes mellitus, como en este caso. Su control requiere de un tratamiento antibiótico temprano y búsqueda de focos a distancia.

Abstract The relationship between bullous pemphigoid (BP) and neoplasms has been debated in the medical litera ture. Although numerous case reports have described the coexistence of BP with various neoplasms, case-control studies have yielded conflicting results. We present the case of a male patient who developed BP shortly after being diagnosed with mycosis fungoides (MF). He was a 77-year-old man with a history of type 2 dia betes mellitus and hypertension who was diagnosed with MF. Subsequently, he developed blisters after sun exposure, and was diagnosed with BP through histopathology and direct immunofluorescence. The patient was treated with prednisone and methotrexate, with favorable evolution without recurrence of MF or appearance of new blisters. The association between cutaneous T-cell lymphoma and autoimmune blistering disease is rare, although similar cases have been reported, some associated with phototherapy. In this case, the onset of BP after sun expo sure suggests a potential connection. The coexistence of BP and MF remains controversial, and this case highlights the importance of considering autoimmune blistering diseases in patients with oncohematological neoplasms.

Resumen La relación entre el penfigoide ampollar (PA) y las neoplasias ha sido objeto de debate en la literatura mé dica. Aunque numerosos informes de casos han descrito la coexistencia del PA con diversas neoplasias, estudios de casos y controles han arrojado resultados contradic torios. Presentamos el caso de un paciente masculino que desarrolló un PA poco después de ser diagnosticado con una micosis fungoide (MF). Se trata de un hombre de 77 años con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial que fue diagnosticado con MF. Posteriormente, desarrolló ampollas después de una exposición solar, siendo diag nosticado con PA mediante histopatología e inmunofluo rescencia directa. El paciente fue tratado con mepred nisona y metotrexato, evolucionando favorablemente sin recurrencia de MF ni aparición de nuevas ampollas. La asociación entre un linfoma cutáneo de células T y una enfermedad ampollar autoinmune es rara, aunque han sido reportados casos similares, algunos asociados con fototerapia. En este caso la aparición del PA después de la exposición solar sugiere una conexión potencial. La coexistencia entre PA y MF sigue siendo controver tida, y este caso destaca la importancia de considerar enfermedades ampollares autoinmunes en pacientes con neoplasias oncohematológicas.

The main aim of this article is to provide a practical diagnostic approach to phenocopies of Huntington disease (HD). These are defined as conditions characterized by a phenotype similar to HD but with no pathogenic repeat expansion in the HTT gene. Their frequency ranges from 2% to 40% depending on ethnicity and geographic location. The most frequent genetic causes are Huntington Disease-like 2/JHP3, followed by spinocerebellar ataxia genes (SCA17/TBP, SCA12/PPP2R2B and SCA3/ATXN3, CACNA1A), and frontotemporal dementia genes (C9orf72, and VCP). There is current recognition that a growing number of acquired causes can mimic HD. Autoimmune causes such as primary antiphospholipid syndrome, paraneoplastic chorea, and anti-IGLON5 antibodies, as well as stroke, and diabetes mellitus type 2 complications are the leading acquired causes of HD phenocopies. Finally, we provide practical recommendations on how to approach HD phenocopies considering age at onset, ethnicity, and geographic location of individuals.

BACKGROUND: Smoking and alcohol misuse are lifestyle factors that can be controlled and have significant health effects. Both these factors increase the risk of developing conditions such as diabetes mellitus because they affect glucose metabolism and can interfere with blood glucose control in individuals with diabetes. Research on tobacco and alcohol use and specific health outcomes among adults with prediabetes or type 2 diabetes mellitus (T2DM) could provide valuable information leading to more efficient treatment and management of this disease OBJECTIVES: To assess the association between tobacco and alcohol use and specific health outcomes among South African adults with prediabetes or T2DM METHODS: Data from the 2016 South African Demographic and Health Survey were analysed using Stata vl7. Participants were classified into prediabetes or T2DM groups, based on a glycated haemoglobin cut-off of 5.7% or self-report of a previous diagnosis of T2DM. Exposures of interest were self-reported current tobacco smoking and problem/risky alcohol use. The associations between these exposures and health outcomes in the different groups were assessed using multivariable logistic regression analysis. We adjusted for specific confounders in the regression models RESULTS: Of a total of 6 108 participants (mean (standard deviation) age 41 (19) years), 72.2% (n=4 409) had prediabetes and 27.8% (n=1 699) T2DM; 17.7% (n=1 084) were current smokers and 9.3% (n=565) reported problem/risky alcohol use. Current smoking was significantly associated with 40% increased odds of shortness of breath (adjusted odds ratio (aOR) 1.40; 95% confidence interval (CI) 1.1 - 1.7; p<0.001) and 67% increased odds of chronic obstructive pulmonary disease (COPD)/asthma (aOR 1.67; 95% CI 1.2 - 2.2; p<0.001). Problem/risky alcohol use was significantly associated with 40% increased odds of COPD/asthma (aOR 1.40; 95% CI 1.1 - 1.7; p=0.001) and 92% increased odds of having cancer (aOR 1.92; 95% CI 1.5 - 2.5; p<0.001 CONCLUSION: There is a need for targeted smoking cessation programmes and alcohol misuse counselling among individuals living with diabetes and prediabetes

Introduction: The liver plays a critical role in glucose and lipid homeostasis. Insulin resistance (IR) has been increasingly recognized as a primary etiological factor in metabolic disorders. Hepatic insulin resistance (HIR) is a specific manifestation of IR characterized by the liver's reduced responsiveness to insulin despite elevated circulating insulin levels. Objective: This review aims to elucidate the role of HIR in the pathogenesis of metabolic disorders, focusing on its relationship with metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM). Methods: A comprehensive literature search was conducted to explore the underlying mechanisms of HIR, its clinical implications, and its association with MAFLD and T2DM. Results: HIR is characterized by impaired insulin-mediated glucose uptake and increased hepatic glucose output. This metabolic dysfunction contributes to the development of hepatic steatosis, dyslipidemia, and insulin resistance in peripheral tissues. The interplay between HIR and lipogenesis is important in the progression of MAFLD and its association with T2DM, and could be described as a hepatic equivalent of T2DM. Conclusion: The understanding of a T2DM-like condition in the liver is decisive for developing more targeted and effective treatments.

Introdução: O fígado desempenha um papel crítico na homeostase da glicose e lipídios. A resistência à insulina (RI) tem sido cada vez mais reconhecida como um fator etiológico primário em distúrbios metabólicos. A resistência à insulina hepática (RIH) é uma manifestação específica da RI caracterizada pela redução da resposta hepática à insulina, apesar dos níveis elevados de insulina circulante. Objetivo: Este manuscrito visa avaliar o papel da RIH na patogênese dos distúrbios metabólicos, com foco em sua relação com a doença hepática gordurosa associada à disfunção metabólica (DHGDM) e o diabetes mellitus tipo 2 (DMT2). Métodos: Foi realizada uma busca abrangente na literatura para explorar os mecanismos subjacentes da RIH, suas implicações clínicas e sua associação com a DHGDM e o DMT2. Resultados: A RIH é caracterizada pela redução da captação de glicose mediada pela insulina e pelo aumento da produção hepática de glicose. Essa disfunção metabólica contribui para o desenvolvimento de esteatose hepática, dislipidemia e RI em tecidos periféricos. A interação entre RIH e lipogênese é importante na progressão da DHGDM e sua associação com o DMT2, podendo ser descrita como um equivalente hepático do DMT2. Conclusão: A compreensão de uma condição semelhante ao DMT2 no fígado é decisiva para o desenvolvimento de tratamentos mais direcionados e eficazes.

Abstract Objective: This systematic review aims to clarify COVID-19’s impact on the onset of T2D in adults. Material and methods: Following PRISMA guidelines, this systematic review sourced data from multiple databases from 2019 to April 20th, 2023. Two reviewers handled screening, with a third-party resolving disagreement. The focus was on COVID-19 cases with post-infection T2D symptoms persisting for two or more months. Exclusions included those outside the 18-70 age range, prior T2D history, pregnancy, and animal studies. Rayyan software facilitated article screening, STATA 18 performed meta-analysis, and bias was assessed using JBI tools. The study is registered in PROSPERO (ID: CRD42023414096). Results: A total of 173 articles were retrieved, of which 23 (11.6%) remained for extraction. 13 cohort studies with 11.551.026 participants were included for the meta-analysis, which found that the COVID-19 population had 1.4 greater risk of being diagnosed with T2D in comparison with the population without COVID-19or with other respiratory diseases. The other study designs were narratively analyzed, describing similar results as the meta-analysis. Discussion: New onset T2D is a potential consequence of LC. While T2D increases COVID-19 complications, the relationship appears bidirectional. Given the novelty of the topic and potential newer studies, further reviews are needed to understand LC’s impact on chronic diseases like T2D globally. Further studies should be carried out on this specific topic that could raise the burden of T2D between all the other symptoms that may be caused by LC. In addition, it is necessary to adapt the interventions according to each country’s possibilities.

Resumen Objetivo: El objetivo de esta revisión es aclarar el impacto del COVID-19 en nuevos diagnósticos de DM2. Material y Métodos: Esta revisión se elaboró en base a las guías PRISMA. Dos revisores realizaron una búsqueda en bases de datos, incluyendo artículos desde el 2019 hasta el 20 de abril de 2023 en adultos, diagnosticados al menos una vez con COVID-19, sin diagnóstico previo de DM2. Excluyeron: embarazadas, niños y diabetes mellitus I. Esta revisión se registró en PROSPERO (ID: CRD42023414096) el 6 de abril de 2023. Resultados: Un total de 173 artículos se obtuvieron luego de la búsqueda, de los cuales 23 (11,6%) quedaron para extracción. 13 estudios de cohorte con 11.551.026 participantes se incluyeron en el metaanálisis, que encontraron que la población que tuvo COVID tiene un 1,4 veces más riesgo de ser diagnosticados con DM2 en comparación a quienes no tuvieron el diagnóstico o fueron diagnosticados con otra patología respiratoria. Los diseños de estudio se describieron narrativamente, describiendo resultados similares a los del metaanálisis. Discusión: El nuevo diagnóstico de DM2 es una potencial consecuencia de LC. Mientras aumenta la DM2, aumentan las complicaciones de COVID-19, la relación aparenta ser bidireccional. Ya que estos hallazgos son medianamente recientes, no existe mucha evidencia disponible al respecto, por lo tanto, se requiere un mayor número de estudios al respecto, además de la creación de nuevas políticas de salud pública ad hoc a las posibilidades de cada país.

RESUMEN Introducción: los pacientes con enfermedad renal crónica con requerimiento de terapia sustitutiva renal (hemodiálisis) son frecuentes en el Paraguay, lo que afecta la calidad de vida de los que la padecen. Objetivo: conocer la calidad de vida de los pacientes con enfermedad renal crónica en tratamiento hemodialítico en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional en el período 2022-2023. Metodología: observacional, descriptivo, de corte transversal realizado en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional de Paraguay. Se incluyeron en el estudio 189 pacientes en que acudieron para tratamiento hemodialítico entre los años 2022-2023. La muestra fue censal. Para determinar la calidad de vida se utilizó el cuestionario Kidney Disease Quality of Life - 36 ítems. Los datos fueron analizados con el programa Epiinfo. Resultados: la edad media de los pacientes fue de 53 años, varones 58.2 %. El 98 % refirió la presencia de algún tipo de comorbilidad concomitante, las más frecuentes fueron diabetes Mellitus 43 % e hipertensión arterial 86 %. La media de meses en tratamiento hemodialítico fue de 20 meses. El cuestionario, Kidney Disease Quality of Life - 36 ítems, arrojó puntajes promedios menores a 50 en el componente mental (65.08) y en el componente físico (71.95) así como en la subescala carga de la enfermedad (55.55). Conclusión: la mayoría de los pacientes con enfermedad renal crónica con tratamiento hemodialítico en el Hospital Nacional evidencian una baja calidad de vida.

ABSTRACT Introduction: patients with chronic kidney disease requiring renal replacement therapy (hemodialysis) are common in Paraguay, which affects the quality of life of those who suffer from it. Objective: to know the quality of life of patients with chronic kidney disease undergoing hemodialysis treatment in the Departmento de Nefrología of the Centro Médico Nacional-Hospital Nacional in the period 2022-2023. Methodology: observational, descriptive, cross-sectional carried out in the Nephrology Department of the Centro Médico Nacional-Hospital Nacional of Paraguay. 189 patients who came for hemodialysis treatment between 2022-2023 were included in the study. The sample was census. To determine quality of life, the Kidney Disease Quality of Life questionnaire - 36 items was used. The data were analyzed with the Epi Info program. Results: the average age of the patients was 53 years, 58.2 % men. 98 % reported the presence of some type of concomitant comorbidity, the most frequent being diabetes mellitus 43 % and arterial hypertension 86 %. The average number of months on hemodialysis treatment was 20 months. The questionnaire, Kidney Disease Quality of Life - 36 items, showed average scores less than 50 in the mental component (65.08) and in the physical component (71.95) as well as in the burden of the disease subscale (55.55). Conclusion: the majority of patients with chronic kidney disease with hemodialysis treatment at the National Hospital show a low quality of life.

RESUMEN Introducción: la diabetes mellitus es una patología prevalente y por ello la implementación de estrategias prácticas para su diagnóstico son importantes desde la Atención Primaria. Objetivo: determinar los parámetros laboratoriales de los pacientes de la Unidad de Salud Familiar del barrio Chaipe (Encarnación, Paraguay) con moderado a muy alto riesgo de diabetes mellitus tipo 2 según la prueba de FINDRISK. Metodología: estudio prospectivo, observacional, descriptivo, transversal. Se incluyeron pacientes mayores de 18 años que acudieron a consultar en la Unidad de Salud Familiar del barrio Chaipe desde setiembre del 2022 a febrero del 2023. Se aplicó la prueba de FINDRISK para seleccionar a aquellos con moderado a muy alto riesgo de diabetes mellitus tipo 2 para las determinaciones laboratoriales. Resultados: la muestra estuvo conformada por 142 pacientes, con rango de edad menor a 45 años y predominio del sexo femenino. El 42,96 % tenía índice de masa corporal aumentado y 62,68 % circunferencia abdominal de riesgo. El 52,11 % no realizaba actividad física y el 27,46 % no consumía frutas y verduras diariamente. El 25,35 % eran hipertensos, el 11,97 % presentó en alguna oportunidad glicemia elevada y el 56,34 % tenía familiares con diabetes mellitus. El 4,93 % presentó glicemia ≥ 126 mg/dl y el 10,56 % valores de hemoglobina glicosilada (HBA1C) ≥ 6,5 %. El 14,08 % presentó colesterol total ≥ 200 mg/dl y 19,72 % triglicéridos ≥ 150 mg/dl. El 26,65 % presentó 3 o más criterios para síndrome metabólico y se encontró una relación significativa con el riesgo de diabetes mellitus. Conclusiones: se encontró una proporción significativa de pacientes con parámetros laboratoriales de glicemia, HBA1C, colesterol y triglicéridos aumentados.

ABSTRACT Introduction: diabetes mellitus is a prevalent pathology and therefore the implementation of practical strategies for its diagnosis are important from Primary Care. Objective: to determine the laboratory parameters of patients from the United Family Healthcare of the Chaipe neighborhood (Encarnación, Paraguay) with moderate to very high risk of diabetes mellitus type 2 according to the FINDRISK test. Methodology: prospective, observational, descriptive, cross-sectional study. Patients over 18 years of age who came to consult at the United Family Healthcare in the Chaipe neighborhood from September 2022 to February 2023 were included. The FINDRISK test was applied to select those with moderate to very high risk of diabetes mellitus type 2 for the laboratory’s determinations. Results: the sample was made up of 142 patients, with an age range of less than 45 years and a predominance of the female sex. 42.96 % had an increased body mass index and 62.68 % had an abdominal circumference at risk. 52.11 % did not do physical activity and 27.46 % did not consume fruits and vegetables daily. 25.35 % were hypertensive, 11.97 % had high blood glucose at some point and 56.34 % had family members with diabetes mellitus. 4.93 % had blood glucose ≥ 126 mg/dl and 10.56 % had glycosylated hemoglobin (HBA1C) values ≥ 6.5 %. 14.08 % had total cholesterol ≥ 200 mg/dl and 19.72 % had triglycerides ≥ 150 mg/dl. 26.65 % presented 3 or more criteria for metabolic syndrome and a significant relationship was found with the risk of diabetes mellitus. Conclusions: a significant proportion of patients with increased laboratory parameters of glycemia, HBA1C, cholesterol and triglycerides were found.

RESUMEN Introducción: las enfermedades del pie relacionadas a la diabetes mellitus representan una de las causas de mayor morbilidad e incapacidad en las personas con diabetes mellitus tipo 2, siendo la causa más frecuente de ingreso hospitalario en dicho grupo. Objetivo: describir las características clínicas de los pacientes con enfermedad del pie relacionadas a la diabetes mellitus del Hospital Nacional 2022-2023. Metodología: se seleccionaron 113 pacientes portadores de diabetes mellitus tipo 2 con pie diabético mayores de 18 años. Se evaluaron las variables demográficas, medidas antropométricas, características de la enfermedad, comorbilidades y características clínicas del pie. Resultados: de los 113 estudiados 42 pacientes (37 %) correspondieron al sexo femenino y 71 (63 %) al sexo masculino, promedio de edad fue de 65 años DE 12,191. 75 pacientes (66 %) presentaron pie diabético, con lesión Wagner grado 4. El 81 % (92) tenía hipertensión arterial, sedentarismo 65 % (84), en menor frecuencia pacientes con sobrepeso 38 % (43), obesidad 25 % (38), tabaquismo 23 % (26) y dislipidemia 18 % (20). Conclusión: las características clínicas de los pacientes con diabetes tipo 2 con lesión en el pie coinciden con otros trabajos obtenidos a nivel mundial. Es muy importante prestar atención a este grupo de riesgo, mediante medidas preventivas y realizar el tratamiento precoz para disminuir las complicaciones.

ABSTRACT Introduction: foot diseases related to diabetes mellitus represent one of the causes of greatest morbidity and disability in people with type 2 diabetes mellitus, being the most frequent cause of hospital admission in said group. Objective: to describe the clinical characteristics of patients with foot disease related to diabetes mellitus at Hospital Nacional 2022-2023. Methodology: 113 patients with type 2 diabetes mellitus with diabetic foot over 18 years of age were selected. Demographic variables, anthropometric measurements, disease characteristics, comorbidities, and clinical characteristics of the foot were evaluated. Results: of the 113 studied, 42 patients (37 %) were female and 71 (63 %) were male, average age was 65 years SD 12,191. 75 patients (66 %) presented diabetic foot, with Wagner grade 4 lesion. 81 % (92) had high blood pressure, sedentary lifestyle 65 % (84), less frequently overweight patients 38 % (43), obesity 25% (38) ), smoking 23 % (26) and dyslipidemia 18 % (20). Conclusion: the clinical characteristics of patients with type 2 diabetes with foot injury coincide with other works obtained worldwide. It is very important to pay attention to this risk group, through preventive measures and carry out early treatment to reduce complications.