Abstract Introduction : Type 2 diabetes (T2DM) together (along) with age and the presence of atrial fibrillation, high blood pressure, smoking, dyslipidemia (DLP), carotid stenosis, and an unhealthy lifestyle are risk factors (RF) to develop an ischemic stroke. The objective of this work was to analyze and compare risk factors and evolution of inpatients with ischemic stroke with and without T2DM. Materials and methods : This study was a retrospective and observational analysis. Data on habits, comorbidities, medication and laboratory parameters were collected patients’ medical records hospitalized for stroke between January 1, 2022 and December 31, 2022. The sample was divided into patients with and without T2DM. Results : One hundred and ninety three patients experienced stroke. The average age: 73.6 ±11.8 years. Among them, 100 patients had T2DM, displaying a higher prevalence of obesity (p= 0.000), DLP (p=0.000), and chronic kidney disease (p= 0.045). Elevated levels of glycemia (p=0.001), HbA1C (p=0.001), triglycerides (TG) (p=<0.001) and TG/HDL index (p= <0.001) as well as and lower HDL (p=<0.001) were also observed. Patients with T2DM showed lower survival (p= 0.012). Discussion : Patients hospitalized for stroke with T2DM had more risk factors and higher mortality than the population without T2DM.

Resumen Introducción : La diabetes tipo 2 (DM2) junto con la edad y la presencia de fibrilación auricular, hiperten sión arterial, tabaquismo, dislipidemia (DLP), estenosis carotídea, y un estilo de vida no saludable, son facto res de riesgo (FR) para el desarrollo de un accidente cerebrovascular isquémico (ACVi). El objetivo de este trabajo fue analizar y comparar factores de riesgo y evolución de pacientes internados con ACV isquémico con y sin DM2. Materiales y métodos : Estudio retrospectivo y longi tudinal. Se recolectaron datos (hábitos, comorbilidades, medicación y laboratorio) de las historias clínicas de pacientes internados por ACVi desde el 1 de enero de 2022 al 31 de diciembre de 2022. Se dividió la muestra en pacientes con y sin DM2. Resultados : Ciento noventa y tres pacientes pre sentaron ACVi. La edad promedio: 73.6 ±11.8 años; 100 pacientes tenían DM2, quienes presentaron mayor obe sidad (p=<0.001, DLP (p=<0.001), enfermedad renal cró nica (p=0.045). También se observó mayores niveles de glucemia (p=0.001), HbA1C (p=0.001), triglicéridos (TG) (p=<0.001) e índice TG/HDL (p=<0.001) y HDL más bajo (p=<0.001). Los pacientes con DM2 presentaron menor supervivencia (p=0.012). Discusión : Los enfermos hospitalizados por acci dente cerebrovascular con DM2 tuvieron más factores de riesgo y mayor mortalidad que la población sin DM2.

Abstract Introduction : SARS-CoV-2 can cause mild upper re spiratory tract involvement to pulmonary disease of varying severity, as well as cardiovascular complications with increased mortality. The prevalence is similar in men and women, although there are sex differences in disease characteristics and outcome. In this study, we analyze the clinical characteristics, progression, and in-hospital outcome by sex of patients included in the RACCOVID-19 registry. Materials and methods : We included data from 2750 patients consecutively admitted to 50 centers in 11 provinces of the country, from May 18 to October 31, 2020. Results : A total of 1541 men (60.2%) and 1018 women (39.8%) were included (p<0.001). The prevalence of car diovascular risk factors (because of current smoking) was higher in men. During hospitalization, men had a higher incidence of cardiovascular complications (17.9% vs. 12.5%; p=0.0002) and mortality (20.8% vs. 16.8%; p=0.01). Poor performance status on hospital admission was more common in men (53.9% vs. 42.6%, p<0.0001). On multivariate analysis, male sex, the presence of hypertension and diabetes, and a history of other medical conditions were independent predictors of in-hospital mortality. Discussion : In the RACCOVID-19 registry, men had worse performance status and higher incidence of cardiovascular complications with higher in-hospital mortality. Male sex, hypertension, diabetes, and his tory of other diseases were independent predictors of in-hospital mortality.

Resumen Introducción : SARS-CoV-2 puede causar desde afec ción leve de la vía área superior hasta enfermedad pulmonar con diferentes niveles de gravedad, así como también complicaciones cardiovasculares, con mayor mortalidad. La prevalencia es similar en hombres y mu jeres, aunque existen diferencias en cuanto a las carac terísticas de la enfermedad y su evolución según el sexo. En este trabajo, se analizan las características clí nicas, evolución y pronóstico intrahospitalario de los pacientes incluidos en el registro RACCOVID-19, de acuerdo al sexo. Materiales y métodos : Se incluyen datos de 2750 pacientes ingresados consecutivamente en 50 centros de 11 provincias del país, desde el 18 de mayo hasta el 31 de octubre de 2020. Resultados : Se incluyeron 1541 hombres (60.2%) y 1018 mujeres (39.8%) (p<0.001). Se observó en el sexo masculino una mayor prevalencia de factores de riesgo cardiovascular, en especial el tabaquismo. En la evolución intrahospitalaria, los varones pre sentaron mayor incidencia de complicaciones cardio vasculares (17.9% vs. 12.5%; p=0.0002) así como una mayor mortalidad (20.8% vs. 16.8%; p=0.01). El estado clínico comprometido fue mayor en varones (53.9 vs. 42.6%; p<0.0001). En el análisis multivariado, el sexo masculino, la presencia de hipertensión arterial, diabetes y otros ante cedentes patológicos fueron predictores independientes de mortalidad hospitalaria. Discusión : Los hombres en el RACCOVID-19 pre sentaron peor estado clínico y más complicaciones cardiovasculares con una mayor mortalidad intrahos pitalaria. El sexo masculino, la hipertensión arterial, la diabetes y la presencia de otros antecedentes patoló gicos fueron predictores independientes de mortalidad hospitalaria.

ABSTRACT: Necrotizing fasciitis (NF) is a rare, rapidly progressing, and severe infection of subcutaneous tissues and muscle fascia that can be fatal. It causes rapid tissue necrosis through pathogen-induced vasoconstriction and thrombosis. While commonly found in the torso, abdomen, and limbs, it rarely affects the head and neck. Effective treatment includes early diagnosis, surgery, antibiotics, and hyperbaric oxygen therapy, though mortality remains high. A 40-year-old man with a history of uncontrolled diabetes mellitus (DM) presented with increased volume, erythema, and cramps in the cervical and upper thoracic area. The main diagnosis was NF, requiring surgical debridement of the affected tissue. Despite therapeutic efforts, the patient succumbed to sepsis and multiple organ failure. NF is a life-threatening infection with a very low incidence but a high mortality rate. Cervical NF often arises from odontogenic infections and is associated with systemic factors like diabetes and obesity. Early diagnosis is challenging, but Computed tomography (CT) and the Laboratory risk indicator score for necrotizing fasciitis (LRINEC) score are essential. Effective treatment includes surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy. NF remains a critical condition with high mortality, underscoring the need for early recognition and aggressive treatment strategies to improve patient outcomes.

RESUMEN: La fascitis necrosante (FN) es una infección rara, de rápida progresión y grave de los tejidos subcutáneos y la fascia muscular que puede ser fatal. Causa necrosis tisular rápida a través de la vasoconstricción y trombosis inducidas por patógenos. Aunque se encuentra comúnmente en el torso, abdomen y membros, rara vez afecta la cabeza y el cuello. El tratamiento efectivo incluye un diagnóstico temprano, cirugía, antibióticos y terapia de oxígeno hiperbárico, aunque la mortalidad sigue siendo alta. Un hombre de 40 años con antecedentes de diabetes mellitus (DM) no controlada se presentó con aumento de volumen, eritema y calambres en la zona cervical y torácica superior. El diagnóstico principal fue FN, requiriendo desbridamiento quirúrgico del tejido afectado. A pesar de los esfuerzos terapéuticos, el paciente sucumbió a sepsis y falla multiorgánica. La FN es una infección potencialmente mortal con una incidencia muy baja pero una alta tasa de mortalidad. La FN cervical a menudo surge de infecciones odontogénicas y está asociada con factores sistémicos como la diabetes y la obesidad. El diagnóstico temprano es un desafío, pero la tomografía computarizada (TC) y el puntaje de indicadores de riesgo de laboratorio para fascitis necrosante (LRINEC) son esenciales. El tratamiento efectivo incluye desbridamiento quirúrgico, antibióticos de amplio espectro y terapia de oxígeno hiperbárico. La FN sigue siendo una condición crítica con alta mortalidad, lo que subraya la necesidad de un reconocimiento temprano y estrategias de tratamiento agresivas para mejorar los resultados de los pacientes.

BACKGROUND. Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterised by an isolated thrombocytopenia of <100 × 10(9)/L in the absence of identifiable secondary causes. Treatment is indicated when the platelet count is <20 - 30 × 10(9)/L, but may be commenced at higher platelet counts when the risk of bleeding is high. Corticosteroids are the backbone of initial treatment of ITP. There is a paucity of data in South Africa (SA) on the outcomes of newly diagnosed ITP patients treated with corticosteroids. OBJECTIVES. To describe the response, remission and clinical outcomes of newly diagnosed primary ITP patients on first-line corticosteroids. METHODS. This was a retrospective cohort study of 68 patients with a new diagnosis of ITP, seen at the Clinical Haematology Unit at Groote Schuur Hospital, Cape Town, SA, over a 5-year period (2016 - 2020). Demographic and clinical data were obtained from paper and electronic record systems. All participants with secondary causes were excluded. The initial platelet responses to corticosteroids and the final outcomes at last follow-up were determined. Initial platelet responses were classified into no response (NR), partial response (PR) and complete response (CR) in accordance with consensus definitions. Remission was defined as maintenance of a CR after being off corticosteroids for <6 months. Categorical variables were described by frequencies and percentages, while numerical variables were described by medians and interquartile ranges (IQRs) as data were non-parametric. RESULTS. The majority of patients were female (88.2%) and the median (IQR) age at diagnosis was 36 (23.0 - 55.5) years. The female to male ratio was 7.5:1. Most (92.4%) patients responded to corticosteroids, with 74.2% achieving a CR and 18.2% achieving a PR. Only five patients failed to respond (7.6%). The median (IQR) time to achieve CR was 15 (8 - 25) days, and the median (IQR) time to achieve PR was 10.5 (8 - 22) days. Half of the patients went into remission. Following remission, two patients (6.1%) subsequently relapsed at day 344 and day 777, respectively. Hypertension and/or diabetes mellitus were newly diagnosed in 10.6% of patients. CONCLUSION. Corticosteroids are effective first-line therapy for ITP, but are not remission-inducing in all patients. For those patients progressing to chronic ITP, there is a need to investigate cost-effective treatment. Some patients are at high risk of developing new hypertension and diabetes mellitus on corticosteroids, and should be monitored.

Abstract Twenty-two different countries participate in the EurA1c programme each year using two samples with a value assigned by the reference method developed by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Data obtained from more than 4000 participating laboratories provide a global overview of the performance of glycated hemoglobin (HbA1c) measurements. Since 2017, Mexico has been the only Latin American country participating in EurA1c. In this article, the Mexican experience was described and the results obtained over six years were analysed. Samples were analysed by the most used methodologies since some of them are applied in a great diversity of instruments. It was shown that most of the errors were due to imprecision and that there were significant differences between methods. Factors such as differences in equipment, the use of heterogeneous systems and different regulations or the lack of them were shown in the performances of the participating laboratories. The annual EurA1c evaluations showed a decrease in the dispersion of the average results reported by the Mexican participants, which was translated into a trend of improvement. An annual statistical performance test was carried out and the quality objective proposed by the IFCC for HbA1c determinations was used. EurA1c has become a driver of changes that are reflected in better performance of the participant laboratories, and consequently, in better patient care.

Resumen En el programa EurA1c participan 22 países cada año utilizando dos muestras con valor asignado por el método de referencia desarrollado por la Federación Internacional de Química Clínica y Medicina de Laboratorio (IFCC). Los datos obtenidos de más de 4000 laboratorios participantes proporcionan un panorama global del desempeño de las determinaciones de hemoglobina glicada (HbA1c). Desde 2017 México participa en el EurA1c y es el único participante de Latinoamérica. En este artículo se describe la experiencia mexicana donde se analizan los resultados obtenidos a lo largo de seis años. Las muestras fueron cuantificadas por metodologías comúnmente usadas debido a que algunas de ellas se aplican en una gran diversidad de instrumentos, donde se demuestra que la mayor parte del error proviene de la imprecisión y que existen diferencias significativas entre métodos. Factores como la diferencia en equipamiento, el uso de sistemas heterogéneos y las distintas regulaciones o la falta de éstas se reflejan en los desempeños de los laboratorios participantes. Las evaluaciones anuales del EurA1c muestran una disminución de la dispersión de los promedios de los resultados informados por los participantes mexicanos, lo que se traduce en una tendencia de mejora. Se realizó un análisis estadístico anual del desempeño y, además, se utilizó el modelo de objetivos de calidad propuesto por la IFCC para las determinaciones de HbA1c. El EurA1c se ha convertido en un impulsor de cambios que se reflejan en mejores desempeños obtenidos por los laboratorios participantes y, por lo tanto, en una mejor atención de los pacientes.

Resumo Todos os anos, 22 países participam no programa EurA1c utilizando duas amostras com um valor atribuído pelo método de referência desenvolvido pela Federação Internacional de Química Clínica e Medicina Laboratorial (IFCC). Os dados obtidos de mais de 4.000 laboratórios participantes fornecem uma visão global do desempenho das determinações de hemoglobina glicada (HbA1c). Desde 2017, o México participa da EurA1c e é o único participante da América Latina. Este artigo descreve a experiência mexicana e analisa os resultados obtidos ao longo de seis anos. As amostras foram quantificadas por metodologias comumente utilizadas porque algumas delas são aplicadas em uma grande diversidade de instrumentos, onde se mostra que a maior parte do erro provém da imprecisão e que existem diferenças significativas entre os métodos. Fatores como a diferença de equipamentos, a utilização de sistemas heterogêneos e as diferentes regulamentações ou a falta delas se refletem no desempenho dos laboratórios participantes. As avaliações anuais da EurA1c mostram uma diminuição na dispersão das médias dos resultados reportados pelos participantes mexicanos, o que se traduz numa tendência de melhoria. Foi realizada uma análise estatística anual de desempenho e, além disso, o modelo objetivo de qualidade proposto pela IFCC foi utilizado para determinações de HbA1c. A EurA1c se tornou um motor de mudanças refletidas em melhores desempenhos obtidos pelos laboratórios participantes e, portanto, em melhores cuidados aos pacientes.

Resumo Pacientes com doença renal diabética (DRD) enfrentam um risco elevado de apresentar injúria renal aguda (IRA), o que agrava a progressão da DRD. Este artigo oferece uma revisão abrangente da literatura e do conhecimento dos principais mecanismos fisiopatológicos relacionados ao dano renal, bem como das implicações biológicas do reparo renal mal adaptativo no contexto da DRD complicada por IRA. Além disso, examinamos detalhadamente os achados de ensaios clínicos que avaliam a eficácia e a segurança do tratamento intensivo com insulina para pacientes hiperglicêmicos em unidades de terapia intensiva, juntamente com os riscos potenciais de hipoglicemia e mortalidade. Ainda, por meio da análise crítica dos resultados de ensaios clínicos, são identificadas oportunidades para abordagens personalizadas baseadas na segurança, a fim de mitigar efeitos colaterais. É imperativo realizar estudos randomizados e controlados para avaliar o impacto do tratamento intensivo com insulina em pacientes diabéticos com DRD e validar os biomarcadores de IRA nessa população de pacientes. Tais estudos ajudarão a adaptar as estratégias de tratamento para melhorar os desfechos dos pacientes e preservar a função renal.

Abstract Patients with diabetic kidney disease (DKD) face an elevated risk of experiencing acute kidney injury (AKI), exacerbating the progression of DKD. This article offers a comprehensive review of the literature and knowledge of the primary pathophysiologic mechanisms underlying kidney damage, as well as the biological implications of maladaptive kidney repair in the context of DKD complicated by AKI. Additionally, we examine in detail the findings of clinical trials evaluating the efficacy and safety of intensive insulin treatment for hyperglycemic patients in intensive care units, alongside the potential risks of hypoglycemia and mortality. Furthermore, through critical analysis of clinical trial results, opportunities for personalized safety-based approaches to mitigate side effects are identified. It is imperative to conduct randomized-controlled studies to assess the impact of intensive insulin treatment on diabetic patients with DKD, and to validate AKI biomarkers in this patient population. Such studies will help to tailor treatment strategies to improve patient outcomes and preserve kidney function.

BACKGROUND: Many serious adverse events associated with gestational diabetes mellitus (GDM) can be mitigated by timely glucose control during pregnancy, achieved through education and lifestyle choices. The aim of this study was to translate and cross-culturally adapt and test the preliminary internal consistency and test-retest reliability of the South African English, Afrikaans and isiXhosa versions of the GDM Knowledge Questionnaire (GDMKQ). METHODS: A prospective, observational study was conducted at a high-risk antenatal clinic in South Africa. Pregnant women ≥ 18 years with GDM were consecutively sampled. Semantic equivalence between the original and adapted versions was assessed. Face and content validity, internal consistency and test-retest reliability were evaluated. RESULTS: The three SA-GDMKQ versions demonstrated good face and content validity. For internal consistency, Cronbach's alpha values were 0.534 for the Afrikaans version, 0.434 for the English version and 0.621 for the isiXhosa version. Test-retest reliability found kappa (standard error [s.e.]) values ranged between −0.03 (0.18) and 0.89 (0.13) for the English version, between −0.07 (0.18) and 0.53 (0.13) for the Afrikaans version and between 0.28 (0.18) and 0.87 (0.17) for the isiXhosa version. All versions of the SA-GDMKQ had a statistically significant (p < 0.001) positive linear correlation between the total scores. CONCLUSION: The English, Afrikaans and isiXhosa SA-GDMKQ versions were found to be feasible and easy to comprehend, although lower internal consistency and test-retest reliability were displayed. Further validation of the psychometric properties of the English, Afrikaans and isiXhosa versions of the SA-GDMKQ among larger sample groups is however warranted. CONTRIBUTION: This study adds to the knowledge around developing and using culturally appropriate questionnaires and outcome measures in research and clinical practice.

Abstract This review aimed to identify the impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus. It followed the Joanna Briggs Institute and the PRISMA-ScR Checklist. The search was conducted in the Cochrane Library, Embase, Virtual Health Library, PubMed/MEDLINE, Scopus, and Web of Science databases. The strategy included the descriptors “Diabetes mellitus,” “Diabetes Melito,” “Diabetes,” “Diabetes Melito,” “Model ECHO,” “Project ECHO,” and “Extension for Community Healthcare Outcomes.” Two independent reviewers selected the studies using the Rayyan-Intelligent Systematic Review management software. Nine of the 151 studies initially identified were selected, and one study was identified through gray literature. The ten studies were published in English between 2012 and 2022. Improvements were found in the professionals’ knowledge and self-confidence, besides decreased glycated hemoglobin levels, hospital admissions, and hospitalization costs among people with diabetes. The conclusion is that the ECHO® Model positively impacted the monitoring of people with diabetes mellitus, especially in vulnerable communities.

Resumo A presente revisão teve como objetivo identificar o impacto do modelo ECHO® no acompanhamento de pessoas com diagnóstico de diabetes mellitus. O trabalho foi desenvolvido de acordo com as recomendações do Joanna Briggs Institute e do Checklist PRISMA-ScR, cujas buscas foram realizadas nas bases de dados Cochrane Library, Embase, Biblioteca Virtual em Saúde, PubMed/MEDLINE, Scopus e Web of Science, por meio de estratégias compostas pelos descritores “Diabetes mellitus”, “Diabete Melito”, “Diabetes”, “Diabetes Melito”, “model ECHO”, “Project ECHO” e “Extension for Community Healthcare Outcomes”. A seleção dos estudos contou com dois revisores trabalhando de forma independente através do software de gestão Rayyan-Intelligent Systematic Review. Dos 151 trabalhos identificados, nove foram selecionados. Um estudo foi identificado na literatura cinzenta. Os dez estudos incluídos foram publicados em inglês, entre os anos de 2012 a 2022. Observou-se melhorias no conhecimento e na autoconfiança dos profissionais, além de diminuição da hemoglobina glicada, redução de hospitalizações e de gastos com internações das pessoas com diabetes. Conclui-se que este trabalho expõe um impacto positivo do Modelo ECHO® no acompanhamento de pessoas com diabetes mellitus, principalmente em comunidades de maior vulnerabilidade.

Resumen La presente revisión tuvo como objetivo identificar el impacto del modelo ECHO® en el seguimiento de personas diagnosticadas con diabetes mellitus. El trabajo se desarrolló de acuerdo con las recomendaciones del Instituto Joanna Briggs y el PRISMA-ScR Checklist, cuyas búsquedas se realizaron en las bases de datos Cochrane Library, Embase, Biblioteca Virtual de Salud (BVS), PubMed/MEDLINE, Scopus y Web of Science, mediante estrategias compuestas por los descriptores “Diabetes mellitus”, “Diabete Melito”, “Diabetes”, “Diabetes Melito”, “model ECHO”, “Project ECHO” y “Extension for Community Healthcare Outcomes”. La selección de estudios incluyó a dos revisores que trabajaron de forma independiente utilizando el software de gestión Rayyan-Intelligent Systematic Review. Se seleccionaron nueve de las 151 obras identificadas y se identificó un estudio por medio de la literatura gris. Los diez estudios incluidos fueron publicados en inglés entre 2012 y 2022. Se observaron mejoras en el conocimiento y la confianza en sí mismos de los profesionales, además de una reducción de la hemoglobina glucosilada, de las hospitalizaciones y de los costos de hospitalización de las personas con diabetes. Se concluye que este trabajo expuso un impacto positivo del Modelo ECHO® en el seguimiento de personas con diabetes mellitus, especialmente en comunidades más vulnerables.

ABSTRACT Objective: To evaluate the association between food anxiety and glycosylated hemoglobin (Hb) among adults with type 2 diabetes mellitus (T2DM) treated at a medical center in Lima in 2023. Materials and methods: This was a quantitative, non-experimental, cross-sectional, correlational-causal study conducted in 2023. The sample consisted of 122 participants, comprising adults of both sexes, aged between 40 and 59 years, diagnosed with T2DM, who had undergone laboratory tests for glycosylated Hb within the past three months and who signed an informed consent. Those who had other comorbidities or were undergoing psychological treatment were excluded. Food anxiety was assessed using the Food Cravings Questionnaire-Trait instrument, which categorizes food anxiety into two levels: low (≤ 126 points) and high (> 126 points). Glycosylated Hb levels were measured through laboratory tests and classified into controlled, moderate, high, very high and critical. A descriptive analysis was performed using frequency measures such as numbers, percentages, median and interquartile range (IQR), while the association between variables was assessed using the chi-square test. Results: Evidence showed that 1.1 % had controlled glycosylated Hb, 13.2 % had moderate glycosylated Hb, 29.7 % had high glycosylated Hb, 33 % had very high glycosylated Hb and 23.1 % had critical glycosylated Hb. Almost all patients lacked adequate control of glycosylated Hb, while 53 % and 38 % had high and low levels of food anxiety, respectively. Participants with a high level of food anxiety exhibited higher values of glycosylated Hb. Food anxiety was more pronounced in men, who also had higher levels of glycosylated Hb (high, very high and critical). Conclusions: An association was found between food anxiety and glycosylated Hb.

RESUMEN Objetivos: Evaluar la asociación entre ansiedad por la comida y la hemoglobina (Hb) glicosilada en adultos con diabetes mellitus tipo 2 (DM2) atendidos en un centro clínico de Lima en el 2023. Materiales y métodos: Se realizó un estudio de enfoque cuantitativo, diseño no experimental, transversal y correlacional-causal durante el año 2023. La muestra estuvo conformada por 122 participantes. Se incluyeron a adultos de ambos sexos, con edades comprendidas entre 40 y 59 años con diagnóstico de DM2, que contaban con análisis de laboratorio correspondientes a la Hb glicosilada tomada en un periodo no mayor a tres meses de antigüedad y que firmaron el consentimiento informado. Se excluyeron a aquellos que cursaban con otras comorbilidades o llevaban algún tratamiento psicológico. La ansiedad por la comida se determinó mediante el instrumento Food Cravings Questionnaire-Triat, que categoriza la ansiedad por la comida en dos niveles: nivel bajo (≤ 126 puntos) y nivel alto (> 126 puntos). La Hb glicosilada se evaluó mediante análisis de laboratorio y se clasificó en controlada, moderada, alta, muy alta y crítica. Para el análisis descriptivo se utilizaron medidas de frecuencia, como números, porcentajes, mediana y rango intercuartil (RIQ); la asociación entre variables se evaluó con la prueba estadística ji al cuadrado. Resultados: Se evidenció un 1,1 % con Hb glicosilada controlada, un 13,2 % con Hb glicosilada moderada, un 29,7 % con Hb glicosilada alta, un 33 % con Hb glicosilada muy alta y un 23,1 % con Hb glicosilada crítica. Casi la totalidad de los pacientes no tuvieron un control adecuado de la Hb glicosilada. Un 53 % de participantes presentaron niveles altos de ansiedad por la comida y el 38 %, niveles bajos. Los participantes con un nivel alto de ansiedad por la comida presentaron mayores valores de Hb glicosilada. La ansiedad por la comida fue mayor en hombres, quienes presentaron mayores niveles de Hb glicosilada (alta, muy alta y crítica). Conclusiones: Se encontró asociación entre ansiedad por la comida y la hemoglobina glicosilada.

ABSTRACT Objective: To identify the factors associated with dengue with warning signs among the insured population of the department of La Libertad in 2023. Materials and methods: This descriptive cross-sectional study analyzed a population comprising the entire universe of dengue patients with warning signs (n = 252). The sample consisted of 249 cases recorded from January to June 2023. The dependent variable was dengue with warning signs, while the independent variables were age (categorized by life stages), sex, history of dengue and comorbidities such as type 2 diabetes mellitus, hypertension, obesity, asthma, cancer (acute and chronic lymphoblastic leukemia, prostate cancer, breast cancer, stomach cancer, rectal cancer and non-Hodgkin’s lymphoma), chronic kidney disease and human immunodeficiency virus (HIV) infection. The bivariate analysis involved calculating absolute and relative frequencies, while the multivariate analysis employed binomial logistic regression to identify variables associated with dengue with warning signs. The research received approval by the Research and Ethics Committee of Red Asistencial La Libertad (La Libertad Healthcare Network). Results: Dengue with warning signs was slightly more prevalent among women (55.42 %). In the binomial logistic regression, the odds ratio (OR) revealed that hypertension, obesity and cancer were significantly associated with dengue with warning signs, while age, sex, history of dengue, type 2 diabetes mellitus, asthma, chronic kidney disease and HIV infection were not statistically significant factors. Conclusions: The factors associated with dengue with warning signs were comorbidities including hypertension, obesity and cancer. Factors such as age, sex, history of dengue, asthma, chronic kidney disease and HIV infection were not identified as significant contributors to this severity level of dengue.

RESUMEN Objetivo: Identificar los factores asociados al dengue con signos de alarma en la población asegurada del departamento de La Libertad durante el año 2023. Materiales y métodos: El estudio es descriptivo de corte transversal. La población estuvo constituida por el universo de pacientes con dengue con signos de alarma, es decir, 252; la muestra fue de 249 casos desde el mes de enero al mes de junio de 2023. La variable dependiente fue dengue con signos de alarma; las variables independientes fueron edad, incluidas las etapas de vida, sexo, antecedente de dengue y las comorbilidades de diabetes mellitus tipo 2, hipertensión arterial, obesidad, asma, cáncer (leucemia linfoblástica aguda y crónica, cáncer de próstata, cáncer de mama, cáncer de estómago, cáncer rectal y linfoma no Hodgkin), enfermedad renal crónica e infección por el virus de inmunodeficiencia humana (VIH). El análisis bivariado consistió en calcular las frecuencias absolutas y relativas; el análisis multivariado se centró en aplicar regresión logística binomial para identificar las variables asociadas al dengue con signos de alarma. La investigación contó con la aprobación del Comité de Investigación y Ética de la Red Asistencial La Libertad. Resultados: Los casos de dengue con signos de alarma fueron ligeramente mayores en las mujeres (55,42 %); el odds ratio de la regresión logística binomial fue significativo para hipertensión arterial, obesidad y cáncer, mas no para la edad, el sexo, el antecedente de dengue, la diabetes mellitus tipo 2, el asma, la enfermedad renal crónica y la infección por el VIH. Conclusiones: Los factores que estuvieron asociados a dengue con signos de alarma fueron las comorbilidades de hipertensión arterial, obesidad y cáncer; la edad, el sexo, el antecedente de dengue, el asma, la enfermedad renal crónica y la infección por VIH no se identificaron como factores de dengue con esta severidad.

ABSTRACT Although rare, secondary adrenal insufficiency represents a serious complication in patients receiving treatment with mTOR inhibitors, such as everolimus. This drug is commonly used to prevent organ transplant rejection and to treat certain cancer types, but its impact on adrenal function is not always apparent. In the case presented, a 74-year-old man with a history of liver transplant and type 2 diabetes mellitus attended his routine medical check-up with no symptoms related to adrenal insufficiency. Despite his asymptomatic state, the medical team decided to study adrenal function because of the prolonged duration of everolimus treatment. The diagnostic tests included the measurement of 24-hour urine cortisol, which revealed low cortisol levels, thus confirming adrenal insufficiency. This finding is significant, as adrenal insufficiency can result in adrenal crises that, if not properly managed, can be potentially fatal. This case highlights the importance of endocrine surveillance in immunosuppressed patients, where the absence of symptoms should not lead to complacency. A proactive approach to evaluating adrenal function is crucial for identifying complications before they become emergencies. Early detection and appropriate treatment of adrenal insufficiency can significantly improve clinical outcomes and the quality of life for these patients. Therefore, it is recommended that physicians remain vigilant to the risks associated with the use of mTOR inhibitors and conduct regular adrenal function evaluations in this patient group.

RESUMEN La insuficiencia suprarrenal secundaria, aunque poco común, representa una complicación seria en pacientes que reciben tratamiento con inhibidores de mTOR, como el everolimus. Este medicamento se utiliza comúnmente en la prevención del rechazo en trasplantes de órganos y en el tratamiento de ciertos tipos de cáncer, pero su impacto en la función suprarrenal no siempre es evidente. En el caso presentado, un hombre de 74 años con antecedentes de trasplante hepático y diabetes mellitus tipo 2 asistió a su control médico rutinario sin manifestar síntomas relacionados con la insuficiencia suprarrenal. A pesar de su estado asintomático, el equipo médico decidió investigar la función suprarrenal, dada la duración del tratamiento con everolimus. Las pruebas diagnósticas incluyeron la medición de cortisol en orina de 24 horas, la cual reveló niveles bajos, confirmando así la insuficiencia suprarrenal. Este hallazgo es significativo, ya que la insuficiencia suprarrenal puede llevar a crisis adrenal que, si no se maneja adecuadamente, puede ser potencialmente mortal. Este caso destaca la importancia de la vigilancia endocrina en pacientes inmunosuprimidos, donde la ausencia de síntomas no debe llevar a la complacencia. Un enfoque proactivo para evaluar la función suprarrenal es esencial para identificar complicaciones antes de que se conviertan en emergencias. La detección temprana y el tratamiento adecuado de la insuficiencia suprarrenal pueden mejorar significativamente los resultados clínicos y la calidad de vida de estos pacientes. Por lo tanto, se recomienda que los médicos estén alertas a los riesgos asociados con el uso de inhibidores de mTOR y realicen una evaluación regular de la función adrenal en este grupo de pacientes.

Abstract Aim To evaluate the clinical effectiveness of ozonated sunflower oil (Oz) as an adjunctive of non-surgical periodontal therapy in patients with type 2 diabetes mellitus (DM2), on fibroblast cell viability and migration and the effectiveness of Oz on a Candida albicans (C. albicans) culture. Methodology In total, 32 sites in 16 DM2 with moderate to advanced periodontal disease with periodontal pocket depths ≥5mm were selected. The treatments were divided into two groups: control, saline solution (SS) as an adjunctive of scaling and root planing (SRP+SS), and test, Oz as an adjunctive of SRP (SRP+Oz). Hematological [fasting glucose level (FGL) and hemoglobin A1c (HbA1c)] and microbiological samples were collected from the participants at baseline and three months after periodontal treatment and the microbiological samples were analyzed by PCR. C. albicans was previously tested by the agar diffusion test. The effect of Oz was tested on cell viability and fibroblast migration. Results The groups showed no statistically significant differences (paired t-test-p>0.05) regarding hematological parameters, FGL (median - baseline 171.41, 3 months 164mg/dL), and HbA1c (baseline 8%, 3 months 7.5%) (Kruskal-Wallis One-Way Nonparametric-p>0.05) after periodontal therapy. The groups showed statistical differences for periodontal parameters between baseline and three months (paired t-test-p<0.05). PCR analysis showed a reduction in the percentage of C. albicans in the SRP+Oz group after three months (McNemar’s test-p=0.002). Cell viability was lower in the high glucose Dulbecco’s modified Eagle’s medium (4500 mg/L) than in low glucose (1000 mg/L) (RM-ANOVA-p<0.0001). The wound healing test showed reduced fibroblast migration (one-way ANOVA with Dunnett’s post-test-p<0.01). Oz showed high C. albicans antifungal inhibition (Kruskal-Wallis test-p=0.0001). Conclusions SRP+Oz effectively reduced C. albicans in-vitro and in-vivo but showed no clinical improvements compared to the control. Cell viability and wound healing of fibroblasts showed no improvements.

Objetivo analisar a situação vacinal de pessoas com diabetes mellitus tipos 1 e 2 na Atenção Primária à Saúde. Método estudo transversal, analítico, realizado em 25 equipes de Saúde da Família com 274 pessoas com diabetes. Foram avaliadas as variáveis sociodemográficas e clínicas e esquema vacinal completo para cada vacina recomendada pelo Programa Nacional de Imunizações, por meio de análise bivariada e regressão logística. Resultados das pessoas com diabetes mellitus, 69,1% não tinham esquema vacinal completo contra hepatite B; 64,6%, contra difteria e tétano; 74,3%, contra febre amarela; 87,9%, contra pneumococo; 87,9%, contra varicela; 24,5%, contra influenza; e 0,7%, contra a covid-19. Entre os motivos referidos para o esquema incompleto, estão não conhecer a importância de vacinar e não ser informado por profissional de saúde. Houve associação estatística significativa entre o perfil sociodemográfico e clínico em relação ao esquema vacinal completo da vacina da influenza e a idade e renda; covid-19 e idade, tipo de diabetes e tempo convivendo com o diabetes. Conclusão pessoas com diabetes mellitus tipos 1 e 2 apresentaram baixa completude vacinal no contexto da Atenção Primária à Saúde, o que é preocupante devido à situação de maior vulnerabilidade a infecções imunopreveníveis e mortalidade nesse grupo.

Objective to analyze the vaccination status of individuals with type 1 and type 2 diabetes in Primary Healthcare. Method cross-sectional, analytical study conducted in 25 Family Health teams with 274 individuals with diabetes. Sociodemographic and clinical variables were evaluated, as well as the full vaccination schedule for each vaccine recommended by the National Immunization Program, through bivariate analysis and logistic regression. Results among individuals with diabetes mellitus, the following incomplete vaccination rates were found: 69.1% for hepatitis B; 64.6% for diphtheria and tetanus; 74.3% for yellow fever; 87.9% for pneumococcus; 87.9% for varicella; 24.5% for influenza; and 0.7% for COVID-19. The reported reasons for low vaccination rates included not knowing the importance of vaccination and not being informed by healthcare providers. A statistically significant association was found between sociodemographic and clinical profile regarding the full vaccination schedule between the influenza vaccine and age and income; COVID-19 and age, type of diabetes and duration of diabetes. Conclusion individuals with type 1 and type 2 diabetes treated in Primary Healthcare showed low vaccination rates, which is concerning due to increased vulnerability to vaccine-preventable infections and mortality within this group.

Objetivo analizar la situación vacunal de personas con diabetes mellitus tipos 1 y 2 en la atención primaria de salud. Método estudio transversal, analítico, realizado en 25 equipos de Salud de la Familia con 274 personas con diabetes. Se evaluaron las variables sociodemográficas, clínicas y el esquema vacunal completo para cada vacuna recomendada por el Programa Nacional de Inmunizaciones mediante un análisis bivariado y regresión logística. Resultados de las personas con diabetes mellitus, el 69,1% no contaba con el esquema vacunal completo contra la hepatitis B; el 64,6% contra la difteria y el tétanos; el 74,3% contra la fiebre amarilla; el 87,9% contra el neumococo; el 87,9% contra la varicela; el 24,5% contra influenza y el 0,7% contra la COVID-19. Entre los motivos aludidos para el esquema vacunal incompleto, figuran no conocer la importancia de vacunarse y no haber sido informado por el profesional de la salud. Hubo asociación estáticamente significante entre el perfil sociodemográfico y clínico con relación al esquema vacunal completo entre la vacuna contra la influenza y la edad y los ingresos; COVID-19 y edad, tipo de diabetes y tiempo viviendo con diabetes. Conclusión las personas con diabetes mellitus tipos 1 y 2 presentaron baja completitud de las vacunas en el contexto de la Atención Primaria de Salud, lo que es preocupante debido a la situación de mayor vulnerabilidad a infecciones inmunoprevenibles y mortalidad en este grupo.

ABSTRACT Purpose: This prospective study aimed to identify risk factors associated with progression to stage 3 chronic kidney disease (CKD) and the occurrence of kidney stone formation or growth following nephrectomy for urolithiasis. Materials and methods: From January 2006 to May 2013, patients undergoing nephrectomy for urolithiasis were enrolled. Renal function was assessed using estimated glomerular filtration rate (eGFR) via the Chronic Kidney Disease Epidemiology Collaboration equation, while kidney stone events were detected using computed tomography. Results: Among 107 patients followed for an average of 83.5 months, type 2 diabetes mellitus (T2DM) significantly increased the risk of progression to stage 3 CKD by 34.79-fold (p=0.004). Age was associated with a 15% increase in the odds of developing stage 3 CKD per year (p=0.01), while higher preoperative eGFR was protective (OR=0.84, p<0.01). DMSA-99mTc values below 15% were less likely to lead to renal function deterioration. New kidney stone formation occurred in 15.9% of patients and stone growth observed in 12.1%. Contralateral kidney stones (p<0.01) and hypercalciuria (p=0.03) were identified as risk factors for kidney stone events. Conclusions: T2DM and age were predictors of CKD progression, while higher preoperative eGFR was protective. Hypercalciuria and contralateral kidney stones increased the risk of kidney stone formation and/or growth post-nephrectomy for urolithiasis.

Objetivo: mapear as evidências disponíveis acerca das características da coordenação do cuidado entre a Atenção Primária à Saúde e a Atenção Especializada Ambulatorial aos usuários com diabetes e hipertensão. Método: trata-se de uma revisão de escopo que teve 40 artigos como amostra final avaliados por meio de Análise de Conteúdo, do tipo temático - categorial, com auxílio de ferramenta tecnológica. Resultados: a coordenação do cuidado foi definida por meio de oito categorias: informação e comunicação, integração do cuidado, melhoria e qualidade, gestão do cuidado, compartilhamento do cuidado, atributo fundamental, profissionais da saúde e usuários dos serviços de saúde, com concentração dos resultados dos artigos principalmente em quatro categorias, destacando-se a informação e comunicação, seguida da categoria de gestão do cuidado e da categoria de compartilhamento do cuidado, em paralelo com melhoria e qualidade. Conclusão: ferramentas tecnológicas são um primeiro passo na garantia da coordenação do cuidado, mostrando-se uma característica significativa, com ênfase nos estudos sobre o compartilhamento de informações entre os serviços de saúde por meio de prontuários eletrônicos. No entanto, apesar dessa tecnologia se mostrar vantajosa para o sistema de saúde, com bons resultados, não é o único meio de se garantir a coordenação do cuidado.

Objective: to map the available evidence on the characteristics of care coordination between Primary Health Care and Specialized Outpatient Care for users with diabetes and hypertension. Method: this is a scoping review with 40 articles as the final sample, evaluated by means of Content Analysis, of the thematic-categorical type, with the aid of a technological tool. Results: care coordination was defined by means of eight categories: information and communication, integration of care, improvement and quality, care management, care sharing, fundamental attribute, health professionals and health service users, with the results of the articles concentrating mainly on four categories, with information and communication standing out, followed by the category of care management and the category of care sharing, in parallel with improvement and quality. Conclusion: technological tools are a first step in ensuring the coordination of care, proving to be a significant feature, with emphasis on studies on the sharing of information between health services through electronic medical records. However, although this technology has proved to be advantageous for the health system, with good results, it is not the only means of ensuring the coordination of care.

Objetivo: mapear las evidencias disponibles acerca de las características de la coordinación del cuidado entre la Atención Primaria de Salud y la Atención Especializada Ambulatoria para los usuarios con diabetes e hipertensión. Método: se trata de una revisión de alcance que tuvo 40 artículos como muestra final, evaluados mediante Análisis de Contenido, del tipo temático-categorial, con el auxilio de una herramienta tecnológica. Resultados: la coordinación del cuidado se definió mediante ocho categorías: información y comunicación, integración del cuidado, mejora y calidad, gestión del cuidado, compartición del cuidado, atributo fundamental, profesionales de la salud y usuarios de los servicios de salud, con una concentración de los resultados de los artículos principalmente en cuatro categorías, destacándose la información y comunicación, seguida por la categoría de gestión del cuidado y la categoría de compartición del cuidado, en paralelo con mejora y calidad. Conclusión: las herramientas tecnológicas son un primer paso en la garantía de la coordinación del cuidado, demostrando ser una característica significativa, con énfasis en los estudios sobre la compartición de información entre los servicios de salud mediante historiales clínicos electrónicos; sin embargo, a pesar de que esta tecnología se muestra ventajosa para el sistema de salud, con buenos resultados, no es el único medio para garantizar la coordinación del cuidado.