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: 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.

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: 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.

Vaccination is key to eliminating hepatitis B virus infection in South Africa (SA). Despite introducing immunisation in 1995, as part of the expanded programme of immunisation (EPI), hepatitis B virus infection remains endemic, and EPI vaccine coverage is incomplete. In addition to infants, non-immune adults at risk of infection through their occupation or with behavioural risk factors should receive vaccination. SA has many individuals with diabetes mellitus (a prevalence of almost 13%), obesity, HIV (8.45 million) or older age (5 million >60 years old), associated with a poorer vaccine response. Recently two new hepatitis B vaccines have been licensed: HEPLISAV-B includes an adjuvant that improves immunogenicity and has shown improved vaccine response in individuals with HIV, old age or diabetes mellitus. PreHevbrio, which includes three hepatitis B surface protein domains, instead of one, may also be more immunogenic, although clinical study data are still limited. These two novel vaccines have not yet been investigated in children and licensed in SA. Should HEPLISAV-B become available in SA, it may be particularly valuable to target high-risk groups in the country, such as people living with HIV, who show a poor response to the currently licensed vaccine.

Abstract Background: There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. Objectives: To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. Methods: Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. Results: In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls.

RESUMEN Inicialmente desarrollados como medicamentos para la diabetes mellitus, los agonistas GLP-1 han ganado mucha popularidad en el tratamiento de la obesidad y la pérdida de peso. El presente caso describe a una mujer de 69 años con antecedente de úlcera péptica y consumo de AINES, quien cursó con dolor abdominal e intolerancia oral refractaria al manejo convencional, por lo que se realizó una endoscopía digestiva alta, diagnosticándose gastroparesia severa. Al ampliar la anamnesis, se reveló el uso subrepticio de semaglutida. Se continuó con terapia de soporte y los síntomas remitieron espontáneamente. El presente reporte de caso tiene como objetivo advertir los riesgos potenciales del uso de análogos de GLP-1 en el contexto de una endoscopía con sedación.

ABSTRACT Initially developed as medications for diabetes mellitus, GLP-1 agonists have gained much popularity in the treatment of obesity and weight loss. The present case describes a 69-yearold woman with a history of peptic ulcer and use of NSAIDs, who presented with abdominal pain and oral intolerance refractory to conventional management, for which an upper digestive endoscopy was performed, diagnosing severe gastroparesis. Asking more about the story, revealed surreptitious use of semaglutide. She continued with supportive therapy and the symptoms resolved spontaneously. The present case report aims to warn of the potential risks of the use of GLP-1 analogues in the context of endoscopy with sedation.

ABSTRACT Objective: To identify the influence of carbohydrate (CHO) intake on oxidative status among women with and without gestational diabetes mellitus (GDM). Materials and methods: A cross-sectional, observational and comparative study was carried out with two groups of 21 women each with and without GDM in the city of Toluca, Mexico, from January to December 2022. The sociodemographic parameters were determined by administering the patients a medical history questionnaire; anthropometric parameters such as body weight and height were measured; and biochemical parameters including total cholesterol (TC) and triglycerides (TG) were calculated. The oxidant/antioxidant status was assessed as follows: malondialdehyde (MDA) as oxidative stress marker; and catalase (CAT), superoxide dismutase (SOD) and total antioxidant capacity (TAC) as antioxidants. Dietary habits were evaluated through a 24-hour reminder in both groups of women to obtain the macronutrient classes, i.e., proteins, fats and CHOs. Based on the total carbohydrates (TCHOs), complex (CCHOs) and simple carbohydrates (SCHOs) such as sucrose were calculated. SCHOs per day were measured using the list of foods with sucrose content per 100 grams according to the Mexican Food Equivalence System (SMAE). The NutriKcal VO program was used for the dietary analysis. Statistical tests such as Student’s t test and Mann-Whitney U test were performed for the independent samples and nonhomogeneous variables, respectively, and Spearman’s rank correlation coefficient (p < 0.05) was determined using the IBM SPSS Statistics V19. Results: The results showed that the difference between the levels of TC (p < 0.029), TG (p < 0.029), enzymes CAT (p < 0.011) and SOD (p < 0.013), as well as MDA (p < 0.039) was significantly higher among patients in the group with GDM compared to that in the group without GDM. In addition, the group with GDM consumed a higher proportion of sucrose. Conclusions: Women with GDM have an imbalance in the oxidant/antioxidant status, influenced by the type of CHO they consume, particularly SCHOs such as sucrose.

RESUMEN Objetivo: Identificar la influencia del consumo de hidratos de carbono (HCO) sobre el estado oxidante en mujeres con y sin diabetes mellitus gestacional (DMG). Materiales y métodos: Se realizó un estudio transversal, observacional y comparativo a dos grupos de 21 mujeres con y sin DMG, respectivamente, en la ciudad de Toluca, México, de enero a diciembre del 2022. Para evaluar parámetros sociodemográficos, se les aplicó un cuestionario de historia clínica; en cuanto a los parámetros antropométricos, se les midió peso corporal y estatura; y respecto a los parámetros bioquímicos, colesterol total (CT) y triglicéridos (TG). Para evaluar el estado oxidante/antioxidante se cuantificaron, como marcador oxidante, el malondihaldeído (MDA), y como antioxidantes, catalasa (cat), superóxido dismutasa (SOD) y capacidad antioxidante total (CAT). Los hábitos dietéticos se evaluaron a través de un recordatorio de 24 horas, en ambos grupos de mujeres, para obtener los macronutrientes: proteínas, lípidos e HCO. A partir de los hidratos de carbono totales (HCOT), se calcularon los hidratos de carbono complejos (HCOC) e hidratos de carbono simples (HCOS) como la sacarosa. Para el cálculo de HCOS por día, se usó la lista de alimentos con contenido de sacarosa por cada 100 gramos de consumo que emplea el Sistema Mexicano de Equivalentes; para el análisis de dieta, se utilizó el programa Nutrikcal VO. Se usaron las pruebas estadísticas t de Student para muestras independientes, U de Mann-Whitney para las variables no homogéneas y se realizó la correlación de Spearman (p < 0,05) en el programa SPSS, versión 19. Resultados: Los resultados mostraron que la diferencia entre los valores de CT (p < 0,029), TG (p < 0,029), las enzimas: cat (p < 0,011), SOD (p < 0,013), así como el MDA (p < 0,039), fueron significativamente mayores en las pacientes del grupo con DMG en comparación con el grupo sin DMG. Además, el grupo con DMG consumió mayor proporción de sacarosa. Conclusiones: Las mujeres con DMG tienen un desequilibrio en el estado oxidante/antioxidante influenciado por el tipo de HCO que consumen, en particular los HCOS como la sacarosa.

Resumo Diabetes mellitus (DM) é uma síndrome endócrina caracterizada por níveis elevados de glicose no sangue devido à atividade anulada da insulina. Os tratamentos existentes para o DM têm efeitos colaterais e vários graus de eficácia. Portanto, é fundamental que novas abordagens sejam desenvolvidas para aprimorar o manejo do DM. As plantas terapêuticas foram acreditadas como tendo eficácia comparativamente alta com menos efeitos adversos. O presente estudo visa elucidar o perfil fitoquímico, efeitos anti-hiperlipidêmicos e antidiabéticos do extrato metanólico de D. salicifolia (folhas) em camundongos diabéticos induzidos por aloxana. Alloxan foi injetado por via intraperitoneal (150 mg kg-1, b.w), para induzir diabetes em camundongos. Os camundongos foram divididos em três grupos (n = 10). Grupo 1 (controle normal) recebeu ração normal e água purificada, Grupo II (controle diabético) recebeu ração regular e água limpa, e o grupo III (tratamento diabético) recebeu extrato metanólico da planta (300 mg kg-1) por 28 dias com uma dieta típica e água limpa durante todo o experimento. Amostras de sangue foram coletadas para verificar a glicose sérica e a concentração de LDL, TC, TG. O extrato demonstrou atividade anti-hiperglicêmica significativa (P <0,05), enquanto melhorias no peso corporal e no perfil lipídico dos camundongos foram observadas após o tratamento com o extrato. Este estudo estabelece que o extrato tem alta eficácia com comparativamente menos toxicidade e pode ser usado para o controle do DM.

Abstract Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P<0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

Resumo O objetivo principal deste estudo foi descobrir uma possível associação entre grupos sanguíneos ABO ou Rh e diabetes mellitus (DM) na população local de oito (8) diferentes cidades de Karachi, Paquistão. Para tanto, foi realizado um levantamento em Karachi para observação prática dessas cidades durante o período de 9 meses de junho de 2019 a fevereiro de 2020.De dezoito (18) cidades de Karachi, as amostras (N = 584) foram coletadas de apenas oito (8) cidades de Karachi e deram um número-código para cada cidade. A amostra do grupo de diabéticos foi (n1 = 432) e a amostra de pré-diabetes foi (n2 = 152). Um glicômetro padrão da Abbot Company para testes de açúcar no sangue aleatório (RBS) e açúcar no sangue em jejum (FBS), antissoros de sangue padrão foram usados para o tipo de sangue ABO / Rh. As técnicas de avaliação de saúde foram realizadas de forma ética, tomando o consentimento informado de todos os indivíduos registrados. Finalmente, os dados foram analisados pelo SPSS versão 20.0.No presente estudo, foi realizada a comparação das frequências dos grupos sanguíneos ABO entre diabéticos e pré-diabéticos. Os valores percentuais do sangue do Grupo-B são dados como: (32% em DM vs. 31% em pré-diabéticos), seguido pelo sangue do Grupo-O como: (18% em DM vs. 11% em pré-diabéticos). Ao contrário dos Grupos “B” e “O”, sangue do Grupo-A e Grupo-AB tiveram distribuição percentual maior de pré-diabéticos em comparação com pacientes com DM, dado como: Grupo-A (32% em pré-diabéticos vs. 26% em DM) e Grupo AB (26% em pré-diabéticos vs. 24% em pacientes diabéticos). Além disso, também foi calculada a distribuição percentual do sistema Rh, no qual o Grupo Rh + ve foi elevado e mais comum em pacientes com DM em comparação aos pré-diabéticos; dados numericamente como: Grupo Rh + ve (80% em DM vs. 72% em pré-diabéticos). Diferentes visões e dimensões do tema de pesquisa foram estudadas com o suporte da literatura, alguns não encontraram nenhuma associação e alguns estabeleceram uma associação positiva, embora alguns não estivessem claros em fazer uma conclusão sólida. Conclui-se que o DM tem correlação positiva com os grupos sanguíneos ABO, e as pessoas com o Grupo B têm maior suscetibilidade à doença DM.

Abstract The main purpose of this study was to find out a possible association between ABO blood groups or Rh and diabetes mellitus (DM) in the local population of eight (8) different towns of Karachi, Pakistan. For this purpose a survey was carried out in Karachi to have a practical observation of these towns during the period of 9 months from June 2019 to Feb. 2020. Out of eighteen (18) towns of Karachi, samples (N= 584) were collected from only eight (8) Towns of Karachi and gave a code-number to each town. Diabetic group sample was (n1=432) & pre-diabetes sample was (n2 =152). A standard Abbot Company Glucometer for Random Blood Sugar (RBS) and Fasting Blood Sugar (FBS) tests, standard blood anti sera were used for ABO/Rh blood type. Health assessment techniques were performed ethically by taking informed consent from all registered subjects. Finally data was analyzed by SPSS version 20.0. In our current study, the comparison of ABO blood groups frequencies between diabetic and pre-diabetic individuals were carried out. The percentage values of blood Group-B as given as: (32% in DM vs. 31% in pre-diabetics), followed by blood Group-O as: (18% in DM vs. 11% in pre-diabetics). Contrary to Group-“B” & “O”, blood Group-A and Group-AB were distribution percentage higher pre-diabetic as compared to DM patients, as given as: Group-A (32% in pre-diabetics vs. 26% in DM) & Group-AB (26% in pre-diabetics vs. 24% in diabetic’s patients). In addition, percentage distribution of Rh system was also calculated, in which Rh+ve Group was high and more common in DM patients as compared to pre-diabetics; numerically given as: Rh+ve Group (80% in DM vs. 72% in pre-diabetics). Different views and dimensions of the research topic were studied through literature support, some have found no any association and some established a positive association still some were not clear in making a solid conclusion. It is concluded that DM has a positive correlation with ABO blood groups, and people with Group-B have increased susceptibility to DM disease.