Abstract Purpose: To analyze diabetes mellitus (DM) in a multifactorial manner with the consumption of sugar-sweetened beverages (SSB) and variables like nutritional status, sex, genetic predisposition, age and ethnicity; in order to determine the relationship between BGA and DM in the Mazahua Otomí (MO) community. Methodological design: This quantitative survey on social and nutritional variables was designed, validated and applied. A logistic model was developed to find the relationship of DM in relation to the variables: SSB consumption, sex, genetic predisposition, age, body mass index and ethnicity. Results: The Mazahua otomi community has a monthly family income below the extreme poverty line; they do not have disease control: 68% are obese or overweight and SSB consumption is medium to high in 90% of the population. In a multifactorial manner and according to the model, there is a probability of manifesting DM depending on the variables mentioned above; while, with the exception of nutritional status and age, the others are the most significant. In taste and preferences, 52% opt for the Coca-Cola SSB brand. Research limitations: The results found should be complemented in other case studies in communities with similar characteristics and a broader probabilistic population sample. Finding: In the MO community there is a relationship between BGA consumption and DM and there is no control of the disease. This work contributes to the design of public policies to prevent health damage because of excessive consumption of SSB and its relationship with DM; likewise, those policies that rescue and promote good nutritional practices of the communities of indigenous peoples.

Resumen Objetivo: Analizar en forma multifactorial la diabetes mellitus (DM) con el consumo de las bebidas gaseosas azucaradas (BGA) y de las variables estado nutricional, sexo, predisposición genética, edad y etnia, para determinar la relación de las BGA y la DM en la comunidad Mazahua Otomí (MO). Diseño Metodológico: El estudio fue cuantitativo. Se diseñó, validó y aplicó una encuesta estructurada sobre variables sociales y nutricionales. Se elaboró un modelo logístico para encontrar la relación de DM con las variables: consumo de BGA, sexo, predisposición genética, edad, índice de masa corporal y etnia. Resultados: En la comunidad MO que se investigó un padre de familia promedio tiene un ingreso mensual por debajo de la línea de pobreza extrema y no existe control de la enfermedad de estudio: 68% tiene obesidad o sobrepeso y el consumo de BGA es entre medio y alto en 90% de la población. En forma multifactorial, hay probabilidad de manifestar la DM en función de las variables antes señaladas; mientras que, a excepción de estado nutricional y la edad, las demás son las más significativas. En gustos y preferencias, 52% opta por la marca de BGA Coca-Cola. Limitaciones de la investigación: Los resultados encontrados deberán complementarse con estudios de caso en comunidades con características similares y una muestra poblacional probabilística más amplia. Hallazgos: En la comunidad MO existe una relación entre el consumo de BGA y la DM y no hay control de la enfermedad. Este trabajo aporta al diseño de políticas públicas de prevención del daño a la salud por el consumo excesivo de BGA y su relación con la DM. De igual manera aquellas políticas públicas que rescaten y fomenten las buenas prácticas nutritivas entre las comunidades de los pueblos originarios.

RESUMEN Introducción: Paraguay asumió el reto de lograr cobertura universal mediante redes basadas en Atención Primaria de la Salud con Unidades de Salud de la Familia (USF) en el primer nivel de atención. Un desafío es la atención integral ante enfermedades no transmisibles, principal causa de mortalidad en el país. Objetivo: analizar la capacidad de las USF para la atención de personas con hipertensión arterial y diabetes en el sistema nacional de salud. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Metodología: Incluyó a 761 USF de 12 regiones sanitarias agrupados en 4 ejes territoriales. Se adaptó el método de evaluación SARA de la OMS con 75 variables, aplicando un cuestionario a profesionales de salud entre noviembre y diciembre de 2022. Se calculó índices de disponibilidad y preparación así como un índice que los integra. La medida continua de estos índices se categorizó en 3 grupos: suficiente >0,75 a 1; intermedio 0,5 a 0,75 y bajo <0,5. Resultados: Solo en el 38 % de las USF el índice de disponibilidad fue suficiente, en el 31,5 % para el índice de preparación y en el 31,1 % para el índice integrador SARA DM/HTA. El desempeño se asoció de forma significativa con el eje territorial no así con el área ni con la cobertura a población indígena Discusión: las USF presentaron limitaciones para la atención de personas con diabetes e hipertensión en estas regiones del país.

ABSTRACT Introduction: Paraguay assumed the challenge of achieving universal coverage through networks based on Primary Health Care with Family Health Units (USF) at the first level of care. One challenge is comprehensive care for non-communicable diseases, the main cause of mortality in the country. Objective: to analyze the capacity of the USF to care for people with high blood pressure and diabetes in the national health system. The design was non-experimental, quantitative, cross-sectional, descriptive with an analytical component. Methods: It included 761 USF from 12 health regions grouped into 4 territorial axes. The WHO SARA evaluation method was adapted with 75 variables, applying a questionnaire to health professionals between November and December 2022. Availability and preparation indices were calculated as well as an index that integrates them. The continuous measurement of these indices was categorized into 3 groups: sufficient >0.75 to 1; intermediate 0.5 to 0.75 and low <0.5. Results: Only in 38.0% of the USF the availability index was sufficient, in 31.5% for the readiness index and in 31.1% for the SARA DM/HTA integrating index. The performance was significantly associated with the territorial axis, but not with the area or with the coverage of the indigenous population. Discussion: the USF presented limitations for the care of people with diabetes and hypertension in these regions of the country.

RESUMEN Introducción: la necrosis pancreática se presenta entre 10 y 20 % de los pacientes con pancreatitis aguda, tiene una mortalidad de 10 a 25 % y si se agrega infección a la necrosis entre 40 y 70 %. Objetivo: describir el manejo clínico quirúrgico de la necrosis pancreática infectada en el Servicio de Cirugía General del Hospital Nacional entre el periodo 2021-2022. Metodología: estudio observacional descriptivo de corte temporal transversal. En pacientes internados en el Servicio de Cirugía General del Hospital Nacional por pancreatitis aguda grave con necrosis pancreática infectada. Resultados: se analizaron un total de 30 pacientes. La media de edad fue de 39 años. Predominó en nuestra población pacientes de sexo masculino en el 56.67 %. En cuanto a las comorbilidades asociadas un 33.3 % los pacientes presentaron principalmente Diabetes mellitus tipo 2 e Hipertensión arterial; en menor medida Obesidad en un 23.3 %. De la población en estudio 76.6 % recibieron tratamiento quirúrgico y 23.33% tratamiento médico principalmente antibiótico terapia. De los pacientes sometidos a tratamiento quirúrgico 9 fueron a necrosectomia abierta, 7 a drenaje percutáneo, y en menor medida drenaje biliar y endoscópico. En cuanto a la mortalidad por necrosis pancreática infectada encontramos un 10 % de mortalidad. Discusión: la mayor parte de los pacientes con pancreatitis aguda grave sufren de necrosis pancreática; la necrosis pancreática infectada se asocia con mayor riesgo de mortalidad y en su mayoría requieren tratamientos invasivos. Conclusión: el manejo mínimamente invasivo en el tratamiento inicial de la necrosis pancreática infectada podría resolver la mayoría de los casos sin necesidad de realizar necrosectomia; reservando esta última solo a los que fracasan en el tratamiento inicial.

ABSTRACT Introduction: pancreatic necrosis occurs between 10 and 20 % of patients with pancreatitis, has a mortality of 10 to 25 % and if infection is added to the necrosis between 40 and 70 %. Objective: to describe the surgical and clinical management of infected necrotizing pancreatitis in patients admitted to the General Surgery Service of the Hospital Nacional between the period 2021-2022. Methodology: this was an observational, descriptive and cross-section study with a temporal cut. We included patients admitted to the general surgery service of the National Hospital with severe acute pancreatitis with infected necrotizing pancreatitis. Results: a total of 30 patients were included. The mean age was 39 years. Male patients prevailed in our population in 56.67 %. Regarding the associated comorbidities, 33.3 % of the patients presented mainly type 2 diabetes mellitus and arterial hypertension; to a lesser extent Obesity in 23.3 %. In the study population, 76.6 % received surgical treatment and 23.33 % medical treatment, mainly antibiotic therapy. Of the patients who underwent surgical treatment, 9 were open necrosectomy, 7 had percutaneous drainage, and to a lesser extent biliary and endoscopic drainage. Regarding mortality due to infected necrotizing pancreatitis, we found a 10% mortality. Discussion: most of the patients with severe acute pancreatitis suffer from necrotizing pancreatitis; infected necrotizing pancreatitis is associated with increased risk of mortality and most require invasive treatment. Conclusion: minimally invasive management in the initial treatment of infected necrotizing pancreatitis, which could resolve most cases without the need to perform necrosectomy; the latter should be reserved for those who fail the initial treatment.

RESUMEN Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

ABSTRACT Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

RESUMEN Introducción: las crisis hiperglicémicas agudas son las emergencias endocrinológicas más frecuentes en la práctica clínica y junto a la hipoglucemia se las describe como las complicaciones metabólicas agudas graves del paciente diabético. Objetivo: identificar las causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico - Hospital Nacional. Metodología: estudio observacional, descriptivo, de corte transversal de pacientes internados en el Centro Médico Hospital Nacional, durante el periodo de mayo 2021 a octubre del 2023. Los datos fueron obtenidos con la revisión de las fichas clínicas. Resultados: de los 100 pacientes evaluados, la crisis hiperglicémica aguda más frecuente fue la Cetoacidosis diabética (CAD) 53 %, seguida del Estado hiperosmolar hiperglicémico (EHH) 25 % y el estado mixto 22 %. Los desencadenantes más frecuentes fueron el abandono del tratamiento, debut de la enfermedad e infecciones. La mortalidad global fue del 12 %. Conclusión: la causa más frecuente de descompensación fueron el abandono del tratamiento, la diabetes de novo y procesos infecciosos.

ABSTRACT Introduction: hyperglycemic crises are the most frequent endocrinological emergencies in clinical practice and, along with hypoglycemia, are described as serious acute metabolic complications in diabetic patients. Objective: to identify the precipiting causes of acute hyperglycemic crisis in hospitalized patients in the Centro Médico Nacional - Hospital National. Methodology: this was an observational, descriptive, cross -sectional study of patients hospitalized at the Centro Médico Nacional - Hospital National, from May 2021 to October 2023. The data were obtained from a review of the clinical records. Results: Of the 100 patients evaluated, the most frequent acute hyperglycemic crisis was diabetic ketoacidosis (CAD) 53 %, followed by the hyperglycemic hyperosmolar state (EHH) 25 % and the mixed state 22 %. The most frequent triggers were the abandonment of treatment, disease debut and infections. Global mortality was 12 %. Conclusion: the most frequent causes of decompensations were abandoning treatment, novo diabetes and infectious processes.

RESUMEN Introducción: Educación y autocuidado son pilares en el tratamiento de la Diabetes Mellitus (DM) y prevención de complicaciones como la enfermedad del pie relacionada a la diabetes (EPRD). Objetivo: Determinar el nivel de conocimiento de DM y el autocuidado de los pies en pacientes con DM tipo 2. Materiales y métodos: Estudio observacional descriptivo, prospectivo, corte transversal; realizado en pacientes adultos con DM tipo 2, que acudieron a consulta endocrinológica y podológica en Hospital Central del Instituto de Previsión Social, en un periodo de 9 meses, desde setiembre 2022 a junio 2023. Tras al menos 2 consultas en cada especialidad, se solicitó el llenado de los cuestionarios DKQ24 y APD-UMA para evaluar conocimiento sobre DM y autocuidado de los pies respectivamente. Resultados: Se incluyó a 103 pacientes, 57% mujeres, 63±11 años de Diabetes, 14±8,45; 29% educación primaria, índice de masa corporal 30,56±5,31, hipertensión arterial 83,5%, 11,6% tabaquistas, retinopatía 35,9%, pérdida de la sensibilidad protectora (PSP) en pies 53,4%, enfermedad arterial periférica 20,4%, deformidades 49,5% y lesiones previas 27,2% en pies; amputación menor 2,9%, amputación mayor 1 %. HBA1c media 8% (±1,3), clearence de creatininia 78,2 mg/dL/m2 (±21,42). Niveles de conocimiento: bueno 68 (66%), regular 34 (33%) y escasos 1(1%). Autocuidado de los pies: promedio de respuestas entre muy adecuadas y adecuadas: 87,4 (84,8%), regular: 9,4 (9,2%); entre inadecuadas y muy inadecuadas 7 (6,8%). Conclusión: Los pacientes con DM2 que acuden a consulta multidisciplinaria tienen un alto conocimiento sobre su patología y autocuidado de los pies, lo que ayudaría a la prevención de complicaciones, teniendo en cuenta que son un grupo de riesgo para EPRD.

ABSTRACT Introduction: Education and self-care are pillars in the treatment of Diabetes Mellitus (DM) and prevention of complications such as diabetes-related foot disease (DPERD). Objetive: Determine the level of knowledge of DM and foot self-care in patients with type 2 DM. Materials and methods: Descriptive, prospective, cross-sectional observational study; performed in adult patients with type 2 DM, who attended an endocrinological and podiatric consultation at the Central Hospital of the Institute of Social Security, in a period of 9 months, from September 2022 to June 2023. After at least 2 consultations in each specialty, a filling out the DKQ24 and APD-UMA questionnaires to evaluate knowledge about DM and foot self-care respectively. Results: 103 patients were included, 57% women, 63±11 years of Diabetes, 14±8.45; 29% primary education, body mass index 30.56±5.31, high blood pressure 83.5%, 11.6% smokers, retinopathy 35.9%, loss of protective sensitivity (PSP) in feet 53.4%, peripheral arterial disease 20.4%, deformities 49.5% and previous injuries 27.2% in the feet; minor amputation 2.9%, major amputation 1%. HBA1c mean 8% (±1.3), creatinine clearance 78.2 mg/dL/m2 (±21.42). Knowledge levels: good 68 (66%), regular 34 (33%) and poor 1 (1%). Foot self-care: average of responses between very adequate and adequate: 87.4 (84.8%), regular: 9.4 (9.2%); between inadequate and very inadequate 7 (6.8%). Conclusion: Patients with DM2 who attend multidisciplinary consultation have an elevated level of knowledge about their foot pathology and self-care, which would help prevent complications, considering that they are a risk group for EPRD.

RESUMEN Introducción: El cáncer de vesícula biliar (CVB) es la neoplasia más frecuente de las vías biliares, su diagnóstico suele hacerse de forma tardía llevando a una reducción en las opciones terapéuticas y alta mortalidad. La importancia de hacer un diagnóstico oportuno es la mejoría en el pronóstico debido a mayores opciones terapéuticas e incluso curación de la enfermedad, lo que hace muy relevante conocer la prevalencia de CVB en pacientes colecistectomizados. Objetivos: Determinar la prevalencia del cáncer de vesícula en la anatomía patológica de pacientes colecistectomizados en el Hospital General de Barrio Obrero en el año de 2021. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y de corte transversal, con datos colectados de los expedientes clínicos: edad, sexo, motivo de consulta, antecedentes patológicos personales y patologías basales, hallazgo operatorio y resultados de anatomía patológica. Los datos fueron cargados en una planilla Excel y analizados estadísticamente. Resultados: Se diagnosticaron 2 carcinomas mal diferenciados (3,5%) de todas las colecistectomías. El promedio de edad fue de 39a (DS +/- 14;16), sexo femenino (63%). Las comorbilidades más frecuentes fueron obesidad (58,7%), hipertensión arterial (33,8%), diabetes y dislipidemia (12,8% cada). Conclusión: El cáncer de vesícula biliar tiene una alta prevalencia regional, debido a factores de riesgo relacionados al estilo de vida y dieta. El hallazgo más llamativo fue encontrar con una mayor prevalencia en el grupo de edad entre 31-50 años en lugar de mayores a 60 años.

ABSTRACT Introduction: Gallbladder cancer (CVB) is the most common neoplasm of the bile ducts; its diagnosis is usually made late, leading to a reduction in therapeutic options and high mortality. The importance of making a timely diagnosis is the improvement in prognosis due to greater therapeutic options and even cure of the disease, which makes it very relevant to know the prevalence of CVB in cholecystectomized patients. Objectives: Determine the prevalence of gallbladder cancer in the pathological anatomy of cholecystectomized patients at the Barrio Obrero General Hospital in the year 2021. Materials and methods: Observational, descriptive, retrospective and cross-sectional study, with data collected from clinical records: age, sex, reason for consultation, personal pathological history and baseline pathologies, operative finding and pathological anatomy results. The data were loaded into an Excel spreadsheet and analyzed statistically. Results: 2 poorly differentiated carcinomas were diagnosed (3.5%) of all cholecystectomies. The average age was 39 years (SD +/- 14;16), female (63%). The most frequent comorbidities were obesity (58.7%), high blood pressure (33.8%), diabetes and dyslipidemia (12.8% each). Conclusion: Gallbladder cancer has a high regional prevalence, due to risk factors related to lifestyle and diet. The most striking finding was a higher prevalence in the age group between 31-50 years rather than those over 60 years of age.

RESUMEN La mastitis linfocítica o mastitis diabética es una patología benigna rara, caracterizada por una inflamación fibrótica de la mama, causando gran preocupación por la simulación de un carcinoma. Está asociada por lo general a la diabetes tipo 2, aunque pueden presentarse en otras patologías autoinmunes y además en pacientes sin comorbilidades. Se presenta en caso clínico de una paciente joven sin comorbilidades que consulto en consultorio de patología mamaria por tumor mamario. Se realizó una biopsia percutánea por trucut con confirmación histológica de mastitis linfocítica, se realizó control cercano observándose remisión clínica e imagenológica de la lesión en 6 meses de seguimiento. Se presenta el caso a fin de recalcar la importancia del diagnóstico histológico percutáneo de la lesión para determinar la naturaliza de la misma, constatándose una patología benigna que no requiere resección, evitando así causar deformidades que podrían afectar psicológicamente a la paciente.

ABSTRACT Lymphocytic mastitis or diabetic mastitis is a rare benign pathology, characterized by fibrotic inflammation of the breast, causing great concern due to the simulation of carcinoma. It is generally associated with type 2 diabetes, although it can occur in other autoimmune pathologies and also in patients without comorbidities. The clinical case of a young patient without comorbidities who consulted in the breast pathology clinic due to a breast tumor. A percutaneous trucut biopsy was performed with histological confirmation of lymphocytic mastitis, close control was performed, observing clinical and imaging remission of the lesion in 6 months of follow-up. The case is presented in order to emphasize the importance of percutaneous histological diagnosis of the lesion, to determine its nature, confirming a benign pathology that does not require resection, thus avoiding causing deformities that could psychologically affect the patient.

RESUMEN El riesgo de amputaciones en pacientes con diabetes es 10 a 20 veces más frecuente en comparación con no diabéticos. El equipo biotecnológico desarrollado por ROKIT Healthcare, Inc., de procedencia surcoreana: Dr. INVIVO, es un equipo de biotecnología que ofrece una terapia eficaz para el tratamiento del pie diabético, con una plataforma de regeneración de órganos hiperpersonalizados que mediante la inteligencia artificial, escanea la lesión para así, fabricar un parche que contiene células madres autólogas, matriz extracelular y materiales específicos de tejido, para posteriormente aplicarla a la herida, y con esto, lograr la cicatrización y regeneración completa. El propósito del presente reporte apunta a demostrar la efectividad del tratamiento en úlceras en pie diabético y exponer los resultados de 3 casos clínicos con extensas lesiones posteriores a amputaciones de miembros inferiores, atendidos en el Hospital Distrital de Ñemby, Paraguay, utilizando esta tecnología.

ABSTRACT The risk of amputations in patients with diabetes is 10 to 20 times more frequent compared to non-diabetics. The biotechnological team developed by ROKIT Healthcare, Inc., of South Korean origin: Dr. INVIVO, is a biotechnology team that offers an effective therapy for the treatment of diabetic foot, with a hyper-personalized organ regeneration platform that, through artificial intelligence, scan the injury in order to manufacture a patch that contains autologous stem cells, extracellular matrix and specific tissue materials, to later apply it to the wound, and with this, achieve complete healing and regeneration. The purpose of this report aims to demonstrate the effectiveness of treatment in diabetic foot ulcers and present the results of 3 clinical cases with extensive injuries after lower limb amputations, treated at the District Hospital of Ñemby, Paraguay, using this technology.

BACKGROUND: Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes. OBJECTIVES: To describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia. METHODS: This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models. RESULTS: Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP >140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol >3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p<0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c <7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management CONCLUSION: Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD.

ABSTRACT Introduction: diabetes mellitus is a non-communicable disease with high comorbidity and especially linked to chronic kidney disease. Characterization of diabetic patients according to epidemiological variables and knowledge of their chronic kidney disease must precede the clinical assessment and educational intervention aimed at modifying lifestyles as part of primary health care. Objectives: to characterize diabetic patients from Santa Clara Polyclinic according to selected epidemiological variables as well as the comorbidity linked to chronic kidney disease. Methods: a descriptive exploratory study was carried out on diabetic patients belonged to the 16-11 doctor’s office in Santa Clara Polyclinic from October 2019 to June 2022. The population was made up of 79 diabetic patients and 60 formed the sample according to inclusion and exclusion criteria. Statistical analysis techniques such as descriptive statistics, simple frequency analysis and the Chi- square independence test were used. Results: males, age group 55-59 years, type 2 diabetes mellitus and high blood pressure levels correlated with diabetes predominated. Besides, a low level of knowledge on chronic kidney diseases was identified. Conclusions: the obtained results confirm the relevance of this type of studies to raise the level of knowledge on the relationship between diabetes mellitus and chronic kidney disease in order to contribute to the improvement of the quality of life of this population group through a previously oriented educational intervention.

RESUMEN Introducción: La diabetes mellitus es una enfermedad no transmisible con una elevada comorbilidad, sobre todo, vinculada a la enfermedad renal crónica. La caracterización del paciente diabético, según variables epidemiológicas y los conocimientos de la enfermedad renal crónica que presentan, deben preceder a la valoración clínica y a la intervención educativa dirigida a modificar estilos de vida como parte de la atención primaria de salud. Objetivos: Caracterizar a pacientes diabéticos del Policlínico Santa Clara, según variables epidemiológicas seleccionadas, y la comorbilidad vinculada con la enfermedad renal crónica. Métodos: Se realizó un estudio descriptivo-exploratorio a los pacientes diabéticos en el consultorio médico de la familia 16-11 del Policlínico Santa Clara, de octubre del 2019 a junio del 2022. La población estuvo conformada por 79 pacientes diabéticos y la muestra por 60, según criterios de inclusión y exclusión. Se utilizaron técnicas de análisis estadístico: análisis de frecuencias simples, estadística descriptiva y la prueba de independencia de Chi cuadrado. Resultados: Predominó el sexo masculino; grupo etario de 55-59; diabetes mellitus tipo 2 y cifras elevadas de tensión arterial correlacionadas con la diabetes. Además, existió un nivel bajo de conocimientos acerca de las enfermedades renales crónicas. Conclusiones: Los resultados obtenidos permiten confirmar la relevancia de este tipo de estudios para elevar el nivel de conocimientos sobre la relación entre el padecimiento de diabetes mellitus y la enfermedad renal crónica, para contribuir a mejorar la calidad de vida de este grupo poblacional a través de una intervención educativa previamente orientada.

Abstract Background: Malnutrition is more common in diabetic patients, and this can influence the severity of the diabetic foot due to impaired healing. Objective: To describe the characteristics of hospitalized patients due to diabetic foot, their nutritional status, their stage, and look for correlations between them. Method: Retrospective and analytical study of the Dr. Carlos Macgregor Sánchez Navarro Regional General Hospital from April to July 2023. Sample of 23 patients with diabetic foot with medical records and complete procedures. Demographic, clinical and laboratory data were collected and evaluated with the CONUT and WIFI scales. Results: Average of 61.5 years and an average duration of diabetes of 9.1 years, advanced lesions in the foot, with absent pulses, deformities and claudication. All with anemia and suboptimal glycemic control. Protein ratio suggests inflammation, metabolic stress and malnutrition. WIFI and CONUT scales: advanced injuries and malnutrition. No statistically significant association was found between nutritional status and injury severity. Conclusions: In older patients with long-term diabetes, the diabetic foot is complex. Optimal glucose control and multidisciplinary care are essential. Nutritional status should be evaluated and improved for better clinical outcomes and quality of life.

Resumen Antecedentes: La desnutrición es más común en pacientes diabéticos y esto puede influir en la severidad del pie diabético debido a la alteración en la cicatrización Objetivo: Describir las características de los pacientes hospitalizados por pie diabético, su estado nutricional, su estadio y buscar correlaciones entre ellas. Método: Estudio retrospectivo y analítico del Hospital General Regional Dr. Carlos Macgregor Sánchez Navarro de abril a julio de 2023. Muestra de 23 pacientes con pie diabético con registros médicos y de los procedimientos completos. Se recopilaron datos demográficos, clínicos y laboratoriales, se evaluaron con las escalas CONUT y WIFI. Resultados: Promedio de 61.5 años y una duración promedio de diabetes de 9.1 años, lesiones avanzadas en el pie, con pulsos ausentes, deformidades y claudicación. Todos con anemia y control glucémico subóptimo. La relación proteica sugiere inflamación, estrés metabólico y desnutrición. Escalas WIFI y CONUT: lesiones avanzadas y desnutrición. No se encontró asociación estadísticamente significativa entre el estado nutricional y la gravedad de las lesiones. Conclusiones: En pacientes mayores con diabetes de larga duración, el pie diabético es complejo. Es esencial un buen control de glucosa y atención multidisciplinaria. Se debe evaluar y mejorar el estado nutricional para mejores resultados clínicos y calidad de vida.

Abstract Background: In Mexico, 29% of mortality resulting from SARS-CoV-2 was associated with one or more comorbidities. Diabetes mellitus was one of the most frequently increasing in-hospital mortality. Objective: This study was aimed at determining the impact of nosocomial infections in diabetic patients diagnosed with COVID-19. Materials and methods: An analysis of 930 patients with SARS-CoV-2 was performed, grouping data from April 2020 to December 2021. Survival, hospital stay, causative agents, antimicrobial resistance, and comorbidities were the variables of interest. Results: About 30% of patients had diabetes mellitus, which presented a greater number of concomitant comorbidities such as arterial hypertension in 50%, and chronic kidney disease in 13%. The survival function was higher in patients without diabetes mellitus. Conclusions: The association between nosocomial infections and diabetes mellitus increased hospital length of stay and mortality, which is why multidisciplinary teams are important to carry out prevention programs and establish hospital sanitation measures.

Resumo Introdução: Os inibidores do co-transportador de sódio-glicose 2 (iSGLT2) são fármacos cada vez mais utilizados no tratamento da diabetes mellitus tipo 2 (DM2) por apresentarem benefícios em doentes com comorbilidades como doença renal crónica e insuficiência cardíaca. Existe evidência que suporta a relação entre a terapêutica com iSGLT2 e o aumento do risco de infeções genitais. Em relação à sua associação com infeções do trato urinário (ITU) existem algumas incongruências na literatura. Objetivos: Avaliar se os utentes com DM2 medicados com iSGLT2 estão em risco aumentado de terem ITU e infeções genitais, numa amostra de doentes com DM2 seguidos numa Unidade de Saúde e Familiar (USF), em comparação com utentes sob terapêutica com outros grupos farmacológicos de antidiabéticos, que não os iSGLT2. Métodos: Estudo caso-controlo, com uma população com DM2 inscritos numa USF do Norte de Portugal. Foram comparados os registos, do ano de 2021, de ocorrência de cistite, pielonefrite/ pielite, balanite, prostatite, vaginite, candidíases e tricomoníase em utentes medicados com iSGLT2 com um grupo não medicado com estes fármacos (variável grupo: caso ou com iSGLT2 vs controlo ou sem iSGLT2). Foram efetuados modelos de regressão logística (simples e múltiplos) de forma a estudar a associação entre a terapêutica com iSGLT2 e as infeções mencionadas. Resultados: Amostra final: 953 utentes. Para a ocorrência de cistite, o grupo iSGLT2 mostrou-se protetor para este outcome, com um OR de 0,47 [0,24; 0,90]. Quando a variável grupo foi ajustada para os fatores de risco potencialmente confundidores perdeu a significância no modelo final 0,54 [0,27; 1,07]. Para o desenvolvimento de pielonefrite, balanite, vaginite e tricomoníase, a variável grupo não se mostrou significativamente associada. Conclusão: Este estudo parece favorecer a segurança a nível de infeções urinárias e genitais na utilização dos iSGLT2 que possam limitar a prescrição destes fármacos.

Abstract Introduction: Sodium-glucose co-transporter 2 inhibitor (iSGLT2) drugs are being increasingly used in type 2 diabetes mellitus (DM2), due to their benefit in chronic kidney disease and heart failure - frequent comorbidities in patients with DM2. Evidence has been found linking iSGLT2 usage to an increased risk of genital infections. Regarding iSGLT2’s association with urinary tract infections (UTI), the findings are inconsistent. Aim: Determine in a sample taken from a primary care center, to determine whether DM2 patients treated with iSGLT2 are at an increased risk of UTI and genital infections when compared to DM2 patients treated only with other antidiabetic drugs. Methods: A case-control study, of a population of DM2 patients from a primary care center in the north of Portugal. Records from the year 2021 of cystitis, pyelonephritis/pyelitis, balanitis, prostatitis, vaginitis, candidiasis, and trichomoniasis, of iSGLT2 medicated DM2 patients were compared to those without this treatment (group variable: case with iSGLT2 vs control without iSGLT2). Logistic regression models were utilized to derive the association between iSGLT2 usage and previously mentioned infections. Results: Final sample: 953 patients. The group iSGLT2 was protective of the outcome cystitis, with an OR=0.47 [0.24; 0.90]. After adjusting for potential confounding factors this association was no longer significant - OR=0.54 [0.27; 1.07]. There was no significant association found between iSGLT2 usage and pyelonephritis/pyelitis, balanitis, prostatitis, vaginitis, candidiasis, and trichomoniasis. Conclusion: The present study seems to favor iSGLT2 safety regarding urinary and genital infections that may limit the prescription of these drugs.

Resumo Objetivo: Avaliar a efetividade dos medicamentos inibidores da SGLT2 (iSGLT2) no controlo de pessoa com diabetes tipo 2 (PDM2) pelos valores de hemoglobina A1c (HbA1c), índice de massa corporal (IMC) e perímetro abdominal (PA) após cinco anos de seguimento. Métodos: Estudo observacional de coorte retrospetiva multicêntrica, de 2017 a 2022, efetuado em 2023. Analisaram-se os dados fornecidos pela Administração Regional de Saúde (ARS) do Centro de PDM2 (classificação T90 da ICPC-2) dos Agrupamentos de Centros de Saúde (ACeS) Baixo Mondego e Dão Lafões, de PMD2 escolhidas aleatoriamente e medicadas em 2017 com iSGLT2. Dados de PDM2 em 2017 e 2022, para a data mais próxima do fim do respetivo ano para HbA1c, IMC e PA. Controlo de DM2 para valores de HbA1c: ≤7% e ≤8%. Resultados: Amostra de n=264 pessoas, 59,0% (n=156) homens. Verificaram-se variações de 2017 para 2022 na HbA1c de 7,62±1,21 para 7,56±1,12 (Δ=-0,009) (p=0,951), no IMC de 31,65±8,72 para 29,90±4,56 (Δ=-0,056) (p<0,001) e no PA de 104,90±13,64 para 105,58±11,11 (Δ=+0,007) (p=0,424). Frequência de PMD2 controladas, para HbA1c ≤7% e <65 anos, de 31,1% em 2017 e de 27,1% em 2022, Δ=-12,9 (p>0,05) e para HbA1c ≤8% de 74,8% em 2017 e de 73,3% em 2022, Δ=-0,02 (p=0,002). Discussão: Comparando com valores de um estudo prévio, com seguimento a dois anos, verificaram-se reduções em HbA1c e IMC e aumento do PA, provavelmente pelo facto de a sarcopenia reduzir o IMC, que o aumento do PA não contrabalança. A prescrição de iSGLT2 não reduziu a prevalência de PMD2. Conclusão: Verificou-se efetividade dos iSGLT2 na redução da HbA1c e do IMC, ao contrário do PA e da percentagem de PMDM2 controladas pelo valor de HbA1c.

Abstract Objective: To ascertain the five-year effectiveness of SGLT2 inhibitor (iSGLT2) medicines on Type 2 Diabetes Mellitus Persons (T2DMP) on haemoglobin (HbA1c), body mass index (BMI) and abdominal perimeter (AP) values. Methods: Observational multicentric retrospective cohort study, in 2022, analysing data provided by the Regional Health Administration Authority (RHA) of Central for T2DMP (ICPC-2 - T90 classification) of Baixo Mondego and Dão Lafões, Portuguese NHS Primary Care Units clusters, medicated in 2017 with SGLT2i and re-studied in 2022, for closest date to the end of the year. Two values of HbA1c were taken as control cut-offs: ≤7% and ≤8%. Results: A sample of n=264, 59.0% (n=156) male was studied. From 2017 to 2022: HbA1c, 7.62±1.21 to 7.56±1.12 (Δ=-0.8) (p=0.951); BMI, 31.65±8.72 to 29.90±4.56 (Δ=-5.5) (p<0.001); and AP, 104.90±13.64 to 105.58± 11.11(Δ=+0.6) (p=0.424). The prevalence of controlled PMD2 under 65 years for HbA1c ≤7% in 2017 was 34.0% and in 2022 of 32.1%, Δ=-5.50; and for HbA1c ≤8% for older ones than 65 years of 74.8% in 2017 and of 743.3% in 2022, Δ=-0.02. Discussion: Comparing these values with previous ones, an improvement in HbA1c and BMI, and worsening of AP was verified, sarcopenia possibly reducing BMI not balanced by the AP increase. Conclusion: The effectiveness of iSGLT2 in the reduction of HbA1c and BMI was verified, unlike the AP and the frequency of controlled PDM2.