Resumen Desde una perspectiva de la estructura y la agencia, el artículo analiza la crítica y la crisis en Nicaragua durante el gobierno de Ortega (2007-2020). Ello muestra que los “juicios singulares” de sectores sociales para frenar el autoritarismo y el capitalismo neoliberal, interpretados por el gobierno como enemigos del progreso (2007- marzo 2018), transitaron a un “juicio general” de sectores sociales y empresariales que, representados en la Alianza Cívica y observando los crímenes de lesa humanidad, critican el autoritarismo y la injusticia, lo que el gobierno evalúa como un intento de golpe de Estado (abril 2018- 2020). El conflicto entre juicios llevó a un diálogo nacional con decisiones parciales, mientras la crisis sociopolítica y económica se profundiza. El análisis devela la necesidad de promover democracia con justicia social.

Abstract From a structure and agency perspective, this article analyzes the criticism and crisis in Nicaragua during the Ortega administration (2007-2020). It shows that the "singular trials" of social sectors to curb authoritarianism and capitalism, interpreted by the government as enemies of progress (2007- March 2018), went through a "general judgment" of social and business sectors represented in the Alianza Cívica that, witnessing crimes against humanity, criticize authoritarianism and injustice, which the government evaluates as an attempted coup (April 2018-2020). The conflict between trials led to a national dialogue with partial decisions, while the socio-political and economic crisis deepens. The analysis reveals the need for promoting democracy with social justice.

Background: Complications increase treatment costs of diabetes mellitus (DM). An adequate metabolic control of the disease could reduce these costs. Aim: To evaluate the costs of medical care for a cohort of patients with DM, according to their degree of metabolic compensation. Material and Methods: All diabetic patients attended in a regional hospital from 2005 to 2010 were analyzed. A correlational study between costs of individual healthcare and levels of glycosylated hemoglobin (HbA1c), was performed in a series of annual cross-sectional measurements. Results: The study comprised 1,644 diabetic patients. During the study period the average cost of healthcare per patient increased from $878,000 to more than $1,000,000 Chilean pesos (CLP) during the study period. The percentage of patients with HbA1c levels below 7.0% varied between 43.0% and 54.9%. Costs for patients with HbA1c levels between 7 and 8.9% were 1.3 to 1.5 times greater. For the group of patients with HbA1c levels between 9 and 10.9% the costs increased 1.4 to 1.6 times. For patients with HbA1c levels greater than 11.0%, healthcare costs doubled. Conclusions: Healthcare expenditure varied according to metabolic control, which is consistent with international findings. This study was limited by its selected population, incomplete information on health expenditures, and the inclusion of only direct costs to the health system. If all patients would achieve metabolic compensation, the yearly savings would be CLP $308,000,000 (or USD $657,000).