Comparación entre la morbilidad y la mortalidad por COVID-19, asociada a factores de riesgo metabólicos en población no indígena e indígena de México / Comparison between morbidity and mortality from COVID-19, associated with metabolic risk factors in non-indigenous and indigenous populations of Mexico

Introducción. La investigación sobre la pandemia de COVID-19, se ha estudiado en tiempo real, ha sido y sigue siendo reveladora. Objetivo. Analizar la morbilidad y la mortalidad por COVID-19, asociadas a factores de riesgo metabólicos en población no indígena e indígena de México. Materiales y métodos. Utilizamos la Base Nacional de Datos COVID-19, durante los años críticos 2020-2021- 2022. Se trabajó con 5.380.247 casos que representaron la población total de positivos al SARS-CoV-2. Se analizaron las discrepancias entre las prevalencias de población no indígena, población indígena, defunción y no defunción. Se definió población indígena, con la clasificación oficial de auto-identificación. Se aplicó el modelo de regresión logística para determinar el riesgo de morir para cada variable: enfermedades cardiovasculares, hipertensión, diabetes, obesidad, sexo, edad y condición indígena. El análisis de multicolinealidad se analizó a través de la prueba de asociación Phi para variables dicotómicas y a través del ajuste de Nagelkerke. Resultados. En los positivos totales 99,2% fue población no indígena y 0,8% indígenas, mientras su porcentaje de letalidad fue de 5,8% y 11,1% respectivamente. En ambos grupos, murieron más hombres (61,5%) que mujeres (38,5%) y las edades de mayor defunción fueron 60 a 79 años. La mortalidad por enfermedades cardiovasculares fue la de mayor incidencia, 26,6% en población general y 32,3% en indígena; por diabetes 22,1% y 27,9%; hipertensión 20,0% y 26,7%y la obesidad 11, 3% y 17,4% respectivamente. Los análisis de regresión logística se ajustaron por sexo, edad y condición indígena. El condicionante de mayor riesgo de muerte, fueron las comorbilidades metabólicas y el de menor riesgo, la condición indígena. Conclusiones. El impacto de la pandemia por COVID-19 fue más grave cuando hubo padecimientos metabólicos tanto en la población no indígena como en la indígena(AU)

Introduction. Research on the COVID-19 pandemic, studied in real time, has been and continues to be revealing. Objective. To analyze morbidity and mortality from COVID-19, associated with metabolic risk factors in non-indigenous and indigenous populations of Mexico. Materials and methods. We use the National COVID-19 Database, during the critical years 2020-2021-2022. We worked with 5,380,247 cases that represented the total population of SARS-CoV-2 positives. The discrepancies between the prevalence of non-indigenous population, indigenous population, death and non-death were analyzed. The indigenous population was defined, with the official self-identification classification. The logistic regression model was applied to determine the risk of dying for each variable: cardiovascular diseases, hypertension, diabetes, obesity, sex, age and indigenous status. The multicollinearity analysis was analyzed through the Phi association test for dichotomous variables and through the Nagelkerke adjustment. Results. Of the total positives, 99.2% were non-indigenous people and 0.8% were indigenous, while their fatality percentage was 5.8% and 11.1% respectively. In both groups, more men (61.5%) than women (38.5%) died and the ages of greatest death were 60 to 79 years. Mortality from cardiovascular diseases was the one with the highest incidence, 26.6% in the general population and 32.3% in the indigenous population; due to diabetes 22.1% and 27.9%; hypertension 20.0% and 26.7% and obesity 11.3% and 17.4% respectively. Logistic regression analyzes were adjusted for sex, age, and indigenous status. The condition with the highest risk of death was metabolic comorbidities and the lowest risk was indigenous status. Conclusions. The impact of the COVID-19 pandemic was more serious when there were metabolic disorders in both the non-indigenous and indigenous populations(AU)

Cirugía bariátrica y evolución de COVID-19 / Bariatric surgery and evolution of COVID-19

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

Tendencia de consejerías en actividad física y enfermedades cardiometabólicas en el Maule, Chile: estudio previo a pandemia por COVID-19 entre 2012 y 2019 / Trend in Physical Activity Counseling and Cardiometabolic Diseases in Maule, Chile: COVID-19 Pre-Pandemic Study between 2012 and 2019

BACKGROUND: Physical activity (PA) practice reduces the adverse effects of COVID-19. PA counseling promotes healthy lifestyles and prevents cardiometabolic diseases. AIM: To assess the trend in cases of PA counseling and the cardiometabolic disease between 2012 and 2019 (before COVID-19) in a southern Chilean region. MATERIAL AND METHODS: Records of Maule Region Health Service for 731.163 men, and 829.097 women aged < 10 to ≥ 65 years were analyzed. The average annual percentage change (AAPC) during the study period and the annual percentage change (APC) during intermediate periods, were calculated. RESULTS: There was a significant decrease in PA counseling in women in the study period (AAPC: −13.6%). In the 2012-2017 period a significant decrease in counseling for total, men and women were observed (APC: −18.1, −16.5 and −19.1%, respectively). Obesity increased significantly in total, men and women in the 2012-2019 period (AAPC: 10.1, 8.5 and 10.7%, respectively). The same trend was observed for hypertension (AAPC: 8.1, 8.5 and 7.6% respectively) and elevated blood glucose (AAPC: 10, 11.5 and 9.6%, respectively). CONCLUSIONS: In the study period PA counseling decreased along with an increase in obesity, hypertension and high blood glucose. Increasing PA counseling is a mainstay in the prevention of cardiometabolic diseases and probably to prevent contagion and complement the treatment of COVID-19.

Activación de sensores del estrés del retículo endoplásmico por dietas asociadas a enfermedades metabólicas y COVID-19 / Activation of endoplasmic reticulum stress sensors by metabolic disease-associated diets and COVID-19

El retículo endoplásmico es un organelo abundante, dinámico y sensor de energía. Sus abundantes membranas, rugosa y lisa, se encuentran distribuidas en diferentes proporciones dependiendo del linaje y requerimiento celular. Su función es llevar a cabo la síntesis de proteínas y lípidos, y es el almacén principal de Ca2+ intracelular. La sobrecarga calórica y la glucolipotoxicidad generada por dietas hipercalóricas provoca la alteración del retículo endoplásmico, activando la respuesta a proteínas mal plegadas (UPR, Unfolded Protein Response, por sus siglas en inglés) como reacción al estrés celular relacionado con el retículo endoplásmico y cuyo objetivo es restablecer la homeostasis del organelo al disminuir el estrés oxidante, la síntesis de proteínas y la fuga de Ca2+. Sin embargo, durante un estrés crónico, la UPR induce formación de especies reactivas de oxígeno, inflamación y apoptosis, exacerbando el estado del retículo endoplásmico y propagando un efecto nocivo para los demás organelos. Es por ello que el estrés del retículo endoplásmico se ha considerado un inductor del inicio y desarrollo de enfermedades metabólicas, incluido el agravamiento de COVID-19. Hasta el momento, existen pocas estrategias para reestablecer la homeostasis del retículo endoplásmico, las cuales son dirigidas a los sensores que desencadenan la UPR. Por tanto, se justifica con urgencia la identificación de nuevos mecanismos y terapias novedosas relacionadas con mitigar el impacto del estrés del retículo endoplásmico y las complicaciones asociadas.

The endoplasmic reticulum is an abundant, dynamic and energy-sensing organelle. Its abundant membranes, rough and smooth, are distributed in different proportions depending on the cell lineage and requirement. Its function is to carry out protein and lipid synthesis, and it is the main intracellular Ca2+ store. Caloric overload and glycolipotoxicity generated by hypercaloric diets cause alteration of the endoplasmic reticulum, activating the Unfolded Protein Response (UPR) as a reaction to cellular stress related to the endoplasmic reticulum and whose objective is to restore the homeostasis of the organelle by decreasing oxidative stress, protein synthesis and Ca2+ leakage. However, during chronic stress, the UPR induces reactive oxygen species formation, inflammation and apoptosis, exacerbating the state of the endoplasmic reticulum and propagating a deleterious effect on the other organelles. This is why endoplasmic reticulum stress has been considered an inducer of the onset and development of metabolic diseases, including the aggravation of COVID-19. So far, few strategies exist to reestablish endoplasmic reticulum homeostasis, which are targeted to sensors that trigger UPR. Therefore, the identif ication of new mechanisms and novel therapies related to mitigating the impact of endoplasmic reticulum stress and associated complications is urgently warranted.

Complicações metabólicas relacionadas à terapia de nutrição parenteral em pacientes hospitalizados / Metabolic complications related to parenteral nutrition therapy in hospitalized patients

Investigar as complicações metabólicas relacionadas à administração da terapia nutricional parenteral (TNP) e sua relação com o desfecho clínico de pacientes hospitalizados. Métodos: Estudo longitudinal retrospectivo realizado com pacientes internados em hospital público referência no atendimento de urgências e emergências da cidade de Goiânia no período de setembro de 2020 a fevereiro de 2021. A coleta de dados foi realizada por meio de consulta aos prontuários eletrônicos. As informações foram coletadas após o primeiro dia de uso da NP até o desfecho clínico -alta, óbito ou descontinuidade da NP. Resultados: A amostra foi constituída por 28 pacientes em uso de nutrição parenteral no hospital durante a etapa de coleta dedados. Desses pacientes a maioria era do sexo masculino, com média de idade de 46,78 anos. As indicações mais frequentes para o uso da terapia nutricional parenteral foram: repouso,abdome agudo e pós-operatório. As complicações mais prevalentes foram a hipocalemia, hipomagnesemia, uremia e a hiponatremia e o desfecho clínico mais frequente foi o óbito. Encontrou-se relação entre desfecho clínico e presença de hipernatremia (p=0,010), ocorrendo a alta hospitalar exclusivamente naqueles pacientes que não apresentaram hipernatremia. E ainda houve relação marginal (p=0,053) entre desfecho clínico e local da internação, sendo que foi mais frequente o óbito naqueles admitidos na unidade de terapia intensiva. Conclusão: Não houve associação entre a TNP e as complicações metabólicas. Todavia, observou-se relação entre hipernatremia e mortalidade, sendo esta mais prevalente em pacientes internados nas unidades de terapia intensiva (UTIs). Nessa amostra, a complicação metabólica mais observada foi a hipocalemia

To investigate the metabolic complication related to administration of the Parenteral Nutrition Therapy (PNT) and their relation to the clinical outcome of hospitalized patients. Methods: retrospective longitudinal study carried with interned patients at a public hospital of standart in the urgency and emergency care from the Goiânia city during the period from september2020 to february 2021. The data capture was realized through consultation to the electronic record. The information was collected after the first day use of NP to clinical outcome -discharge, death or discontinuation of NP. Results: The sample was composed by 28 patients in use of parenteral nutrition at hospital during the data capture. The majority of these patients were male, with mean age of 46-78 anos. The indications more frequent to the use of parenteral nutrition therapy were: rest, acute abdomen and pos-operative. The complications more prevalent were hypokalemia, hypomagnesemia, uremia and hyponatremia. And the clinical outcome more frequent was death. A relationship between clinical outcome and hypernatremia presence (p=0,010) was found, occurring the hospitalar discharge exclusively in those patients which did not submit to hypernatremia. And there was still a marginal relationship (p=0,053) between clinical outcome and hospitalization, which was more frequent the death in those admitted in intensive care units. Conclusion: There was no association between the PNT and the metabolic complications. However, there was an observed relationship between hypernatremia and mortality, while more prevalent in patients staying in the intensive care unit (ICU). In this sample, the metabolic complication most observed was hypokalemia

Mortalidad por COVID-19 en México y las enfermedades metabólicas durante el año crítico de la pandemia / COVID-19 mortality in Mexico and metabolic diseases during a critical pandemic year

Conocer la asociación específica de las enfermedades metabólicas en la mortalidad por COVID-19, ocurrida en México durante el año crítico de la pandemia de marzo 2020 a marzo 2021. Método. Se utilizó la base nacional de COVID-19 de la Dirección General de Epidemiología. Se analizaron los casos positivos que presentaron las enfermedades metabólicas: cardiovasculares, hipertensión, diabetes y obesidad. Se realizó un análisis descriptivo para conocer la distribución de los casos fallecidos y no fallecidos. Se empleó la prueba de ji cuadrada para la diferencia de las proporciones. Se utilizaron análisis de regresión logística para conocer la asociación entre las enfermedades metabólicas y la mortalidad por COVID-19 en personas positivas al virus SARS-CoV-2. Los datos fueron ajustados por edad y sexo. Resultados. Se observó la asociación de las enfermedades metabólicas en la mortalidad. La diabetes tuvo mayor porcentaje de letalidad 18,4%. Cuando se conjuntaron las enfermedades cardiovasculares y diabetes el porcentaje de letalidad subió a 31,5%; la conjunción de las enfermedades cardiovasculares, con hipertensión y diabetes fue la de mayor porcentaje de letalidad 38,7%. La obesidad fue la que tuvo menor incidencia. Conclusiones. Las enfermedades metabólicas en México son un problema de salud pública que afectó la mortalidad por covid-19. Es prioritario atender con políticas públicas preventivas y efectivas en favor de un modelo de consumo alimentario sano, acorde con las necesidades nutrimentales de la población(AU)

To know the specific association of metabolic disease on COVID-19 mortality, occurred during the critical year of the pandemic, from march 2020 to march 2021. Method: The Covid-19 national base of the General Directorate of Epidemiology was used. Positive cases of metabolic diseases were analyzed: cardiovascular disease, hypertension, diabetes and obesity. A descriptive analysis was carried out to find out the distribution of deceased and non-deceased cases. The chi-square test was used for the difference in proportions. Logistic regression analysis was used to understand the association between metabolic diseases and COVID 19 mortality in people who tested positive for the SARS-CoV-2 virus. The data were adjusted for age and gender. Results: The association of metabolic diseases on mortality was observed. Diabetes had a higher percentage of lethality 18,4%. When cardiovascular disease and diabetes were combined, the fatality rate rose to 31,5%; the combination of cardiovascular diseases, with hypertension and diabetes was the highest percentage of lethality 38,7%. Obesity had the least incidence. Conclusions: Metabolic diseases in México are a public health problem that affected COVID-19 mortality. It is a priority to deal with preventive and effective public policies in favor of a healthy food consumption model, in line with the nutritional needs of the population(AU)

Análise de componentes principais dos fatores de risco em adolescentes com excesso de peso antes e após um programa de intervenção / Analysis of principal components of risk factors in overweight adolescents before and after an intervention program

O objetivo do estudo é verificar o agrupamento dos fatores de risco cardiometabólicos e as possíveis mudanças deste, após um programa de intervenção interdisciplinar realizado com adolescentes com sobrepeso/obesidade. Os sujeitos foram alocados em dois grupos: grupo intervenção e grupo controle. O grupo intervenção participou de um programa com a duração de seis meses, com sessões três vezes por semana, que incluiu sessões com exercícios físicos, orientações nutricionais e psicológicas. Foram realizadas avaliações antropométricas, pressão arterial, aptidão cardiorrespiratória e coleta sanguínea para avaliação da glicose e perfil lipídico, antes e após o período de intervenção. Análise de componentes principais foi realizada para verificar o agrupamento dos fatores de risco nos períodos pré e pós-intervenção. A análise fatorial agrupou os componentes em três fatores no momento pré-intervenção, no grupo intervenção, que representou 83,88% da variância total do modelo. Já, no grupo controle, no período pré e pós-intervenção, e na avaliação pós-intervenção do grupo intervenção, os componentes foram agrupados em dois fatores centrais, que explicam, respectivamente, 68,38%, 71,23%, 75,19% da variância total do modelo. O grupo intervenção apresentou mudanças no agrupamento das variáveis nos resultados pós-intervenção, em comparação com o pré-teste. Nenhum componente central, que inter-relacionasse todos os demais fatores, nas quatro análises realizadas, foi encontrado. Entretanto, as variáveis antropométricas aparecem como os componentes de maior carga fatorial, agrupadas no fator 1, em todas as análises realizadas, fator que explica a maior variância total em torno das variáveis iniciais. (AU)

The objective of the study is to verify the grouping of cardiometabolic risk factors and their possible changes after an interdisciplinary intervention program performed with overweight/obese adolescents. The subjects were allocated in two groups: the intervention group and the control group. The intervention group participated in a program lasting six months, with sessions three times a week, which included sessions with physical exercises, nutritional and psychological orientations. Anthropometric evaluations, blood pressure, cardiorespiratory fitness, and blood collection were performed for evaluation of glucose and lipid profile before and after the intervention period. Main component analysis was performed to verify the grouping of risk factors in the pre-and post-intervention periods. The factorial analysis grouped the components into three factors at the pre-intervention time, in the intervention group, which represented 83.88% of the total variance of the model. In the control group, in the pre-and post-intervention period, and in the post-intervention evaluation of the intervention group, the components were grouped into two central factors, which explain, respectively, 68.38%, 71.23%, 75, 19% of the total variance of the model. The intervention group presented changes in the grouping of the variables in the post-intervention results, compared to the pre-test. No central component, which interrelated all the other factors, was found in the four analyzes. However, the anthropometric variables appear as the components of higher factor load, grouped in factor 1, in all the analyzes performed, a factor that explains the largest total variance around the initial variables. (AU)

Glycemic safety of a maximum aerobic test in type 1 diabetics and their correlation with health parameters / Segurança glicêmica de um teste aeróbico máximo em pessoas com diabetes tipo 1 e sua correlação com parâmetros de saúde

To verify the glycemic safety of a maximal cardiorespiratory test (V̇ O2max) in T1DM patients and correlate the maximum cardiorespiratory values with metabolic control parameters such as glycemia, glycated hemoglobin, time of diagnosis (TD), and fat (body [GC] and visceral [GV]). The cross-sectional study evaluated ten T1DM patients (age 24.9 ± 7.5 years; time of diagnosis 11.5 ± 7.4; body mass index 22 ± 2 kg/m2 ). Metabolic glycemic control variables (before and after), glycated hemoglobin (HbA1c), time since diagnosis and total and visceral fat were collected. The CENESP maximum test protocol was used on the treadmill with direct maximal oxygen uptake (V̇ O2max). Normality test, paired t-test and correlations (p <0.05) were performed. In the results, blood glucose pre 189 ± 67 mg/dL vs. post 172 ± 66 mg/dL (p = 0.140). The V̇ O2max with a regular average score for men and women (37.4 ± 6.6 ml.kg.min-1). There was a negative and almost perfect correlation with TD, GC and GV (p = 0.028, p <0.000, and p <0.000). We conclude that is possible to perform a CENESP maximal with glycemic safe in T1DM. However, TD, GC, and GV negatively interfere with cardiorespiratory fitness and should be verified before the test. (AU)

Verificar a segurança glicêmica de um teste cardiorrespiratório máximo (V̇ O2max) em pacientes com diabetes mellitus tipo 1 (DM1) e correlacionar os valores com parâmetros de controle metabólico como glicemia, hemoglobina glicada, tempo de diagnóstico (DT) e gordura (corporal[GC] e visceral[GV]). O estudo transversal avaliou dez DM1 (idade 24,9 ± 7,5 anos; tempo de diagnóstico 11,5 ± 7,4; índice de massa corporal 22 ± 2 kg/m2). Foram coletadas variáveis de controle glicêmico metabólico (antes e depois), hemoglobina glicada (HbA1c), tempo de diagnóstico e gordura total e visceral. O protocolo de teste máximo do CENESP foi utilizado na esteira com consumo máximo direto de oxigênio (V̇ O2max). Teste de normalidade, teste t pareado e correlações (p<0,05) foram realizados. Nos resultados, glicemia pré 189 ± 67 mg/dL vs. pós 172 ± 66 mg/dL (p = 0,140). O V̇ O2max com pontuação média regular para homens e mulheres (37,4 ± 6,6 ml.kg.min-1). Houve correlação negativa e quase perfeita com DT, GC e GV (p = 0,028; p < 0,000 e p < 0,000). Concluímos que é possível realizar um CENESP máximo com segurança glicêmica no DM1. No entanto, DT, GC e GV interferem negativamente na aptidão cardiorrespiratória e devem ser verificados antes do teste.

Niveles séricos de interleucina-6 en pacientes con diabetes tipo 2 y su correlación con el perfil lipídico / Serum levels of interleukin-6 in patients with type 2 diabetes and its correlation with the lipid profile

La diabetes mellitus es una enfermedad metabólica caracterizada por hiperglucemia, a consecuencia de defectos en la producción, secreción y/o acción de la insulina, produciendo alteraciones en el metabolismo de los hidratos de carbono, lípidos y proteínas; asociado a un proceso inflamatorio crónica en un plazo variable, que provocara lesiones macro y microvasculares. Objetivo: Evaluar los niveles séricos de interleucina-6 (IL-6) en pacientes diabéticos tipo 2 y su correlación con el perfil lipídico. Métodos: Se realizó estudio descriptivo analítico y transversal, comprendido por 60 adultos de ambos sexos entre 30 a 60 años, con diabetes mellitus tipo 2 que acudieron a consulta de Endocrinología del Hospital Militar Universitario Dr. Carlos Arvelo. Se les determino glucemia basal, interleucina-6, perfil lipídico, resultados relacionados con parámetros antropométricos, composición corporal, la edad y tiempo de evolución de la diabetes. Resultados: La edad promedio de 51,60 años ± 6,51, donde el 71,6% correspondieron al sexo femenino y el 28,3% al masculino, tiempo de evolución de la diabetes entre 1 mes y 37 años, con un promedio de 10,97 años. Se presentó correlación positiva baja y estadísticamente significativa entre interleucina 6 y los parámetros de triglicéridos, VLDL y no-HDL Conclusión: Se encontró valores elevados de IL-6 en todos los pacientes diabéticos tipo 2, así como una correlación positiva entre IL-6 y las lipoproteínas ricas en triglicéridos. Esto respalda la idea de que la hipertrigliceridemia puede causar cambios inflamatorios en pacientes diabéticos y esto elevaría el riesgo cardiovascular de estos pacientes(AU)

Disfunções metabólicas e vertigem: apresentação e revisão dos métodos diagnósticos / Metabolic dysfunctions and vertigo: presentation and review of diagnostic methods

Contexto: A tontura é um sintoma de alta prevalência e as labirintopatias de causas metabólicas destacam-se como uma das mais frequentes em nosso meio. Distúrbios do metabolismo glicêmico, disfunções tireoidianas e dislipidemias são as principais. Objetivos: Os objetivos deste estudo são descrever a porcentagem das principais disfunções metabólicas nos pacientes com vertigem e revisar os métodos diagnósticos. Desenho e local: Estudo observacional de pacientes atendidos no setor de Otoneurologia do Instituto Penido Burnier. Métodos: Avaliação de 506 pacientes com vertigem por meio da análise do hormônio tireoestimulante, glicemia de jejum, hemoglobina glicada, insulina de jejum, curvas glicoinsulinêmica de três horas, colesterol total e suas frações (lipoproteína de alta densidade [HDL] e lipoproteína de baixa densidade [LDL]) e triglicerídeos. Foi feita a comparação entre os sexos e com os dados encontrados na população geral. Resultados: Níveis de HDL, triglicerídeos e glicemia de jejum foram mais alterados no sexo masculino e o colesterol total foi mais elevado no sexo feminino. A elevação do HOMA (homeostatic model assessment) foi a alteração mais significante encontrada no grupo em estudo comparando com a população geral, entretanto as curvas glicoinsulinêmicas mostraram mais alterações em comparação ao HOMA. Discussão: A análise do HOMA e da curva glicoinsulinêmica mostrou que a porcentagem de alteração é diferente entre os métodos, não havendo concordância entre eles. O HOMA não substitui as curvas na investigação dos pacientes com vertigem e suspeita de distúrbios do metabolismo glicêmico. Conclusão: É alta a porcentagem das disfunções metabólicas na população com vertigem, justificando a investigação laboratorial neste grupo de pacientes.

Factores asociados al autocuidado de la salud en los pacientes diabéticos / Factors associated with self-care in diabetic patients

La diabetes es una enfermedad que afecta a la población mundial, y los adultos mayores son los más propenso a padecerla, como consecuencia a los niveles de estrés y malos hábitos alimenticios que llevaron a lo largo de su vida productiva. Es por ello, que el: Objetivo de esta investigación es, describir los factores asociados al autocuidado de la salud en los pacientes diabéticos. Materiales y métodos: Investigación documental. Se incluyeron estudios de cohortes que analizaron diagnóstico y tratamiento oportuno en el autocuidado de pacientes diabéticos en bases de datos electrónicas, como lo son Porta Scielo, PubMed, Medline PLUS, Embase, Scopus y Web of Science, del 2015 al 2020. Las medidas de autocuidado son habilidades que los individuos practican para el mantenimiento de su salud, sobre todo cuando hay una patología de base que ponga en riesgo el estado de salud y el bienestar en general. Resultado: La diabetes es una enfermedad complicada, requiere vigilancia constante, conocimiento de la enfermedad y del apoyo de varios especialistas en salud, la mayor parte del cuidado y control debe prevenir del paciente mismo. Es importante que los pacientes no solo perciban los daños o la severidad de la ausencia de autocuidado, lo que puede influir en el adecuado control de la diabetes mellitus, sino que se le proporcione mediante la educación para la salud, estrategias que faciliten en ellos el aprendizaje de habilidades que le permitan percibir los beneficios de la adopción de estilos de vida saludables. Conclusiones: el equipo básico de salud desempeña un rol importante en la realización de acciones que faciliten el autocuidado en los pacientes diabéticos, lo que puede constituir una vía para que las personas tomen decisiones serias respecto al mantenimiento de un adecuado estado de su salud. Por ende, es necesario que se realicen programas que desarrollen el ajuste adecuado de expectativas, objetivos definidos, el manejo adecuado del refuerzo, el incremento del sentimiento de autoeficacia, el autocontrol, y que brinden alternativas que favorezcan un autocuidado óptimo(AU)

Diabetes is a disease that affects the world population, and older adults are the most prone to suffer from it, as a consequence of the levels of stress and poor eating habits that they led throughout their productive lives. That is why the: Objective of this research is to describe the factors associated with self-care of health in diabetic patients. Materials and methods: Documentary research. Cohort studies that analyzed diagnosis and timely treatment in the self-care of diabetic patients were included in electronic databases, such as Porta Scielo, PubMed, Medline PLUS, Embase, Scopus and Web of Science, from 2015 to 2020. The measures of Self-care are skills that individuals practice to maintain their health, especially when there is an underlying pathology that puts the state of health and well-being in general at risk. Result: Diabetes is a complicated disease, it requires constant vigilance, knowledge of the disease and the support of various health specialists, most of the care and control must be prevented by the patient himself. It is important that patients not only perceive the damage or the severity of the absence of self-care, which can influence the adequate control of diabetes mellitus, but that it is provided through health education, strategies that facilitate in them the learning skills that allow you to perceive the benefits of adopting healthy lifestyles. Conclusions: the basic health team plays an important role in carrying out actions that facilitate self-care in diabetic patients, which can constitute a way for people to make serious decisions regarding the maintenance of an adequate state of their health. Therefore, it is necessary to carry out programs that develop the adequate adjustment of expectations, defined objectives, the adequate management of reinforcement, the increase of the feeling of self-efficacy, self-control, and that provide alternatives that favor a more optimal self-care(AU)

Milk yield and composition in dairy cows with post-partum disorders / [Produção e composição do leite em vacas com desordens no pós-parto]

This study aimed to determine the impact of different post-partum disorders on milk yield and composition. One hundred and fifteen Holstein cows from a commercial dairy farm located in the state of Rio Grande do Sul in southern Brazil were monitored up to 62 days post-partum. During this period, body condition score evaluation and animal clinical examination were conducted. Percentages of fat, protein, and lactose, as well as somatic cells score, were determined in milk samples. The AST activity and concentrations of NEFA, calcium, and BHBA, were analyzed in blood samples. The occurrence of clinical disorders was identified in 30 (26%) cows. Subclinical disorders were identified in 64 (56%) cows. Only 21 (18%) cows did not suffer any kind of disorder within the studied period. In this study, no significant differences were found in milk production, protein, and somatic cell count in clinical, subclinical, and healthy cows. Milk fat and the fat: protein quotient (F:P) were higher in cows with clinical disorders and the 6 to 21 days in milk, and lactose were lower in cows with clinical disorders and the 22 to 42 days in milk (P<0.05).(AU)

O objetivo deste estudo foi determinar o impacto de diferentes distúrbios após o parto na produção de leite e em sua composição. Cento e quinze vacas Holandesas de uma fazenda de gado leiteiro, localizada em estado da região Sul do Brasil, foram monitoradas até 62 dias após o parto. Durante esse período, foram realizadas avaliações do escore de condição corporal e exame clínico nos animais. As porcentagens de gordura, proteína e lactose, bem como o escore de células somáticas, foram determinadas nas amostras de leite. A atividade do AST e as concentrações de NEFA, cálcio e BHBA foram analisadas em amostras de sangue. A ocorrência de distúrbios clínicos foi identificada em 30 (26%) vacas, os distúrbios subclínicos foram identificados em 64 (56%) vacas. Apenas 21 (18%) vacas não sofreram nenhum tipo de distúrbio ao longo do período estudado. Neste estudo, não foram encontradas diferenças significativas na produção do leite, proteína e na contagem de células somáticas em vacas com doenças clínicas, subclínicas e saudáveis. No leite, a gordura e o quociente gordura e proteína (G:P) foram maiores em vacas com doença clínica no período de seis a 21 dias de lactação, e a lactose foi menor em vacas com doença clínica no período de 22 a 42 dias de lactação (P<0,05).(AU)

Prevalencia en diabetes y factores de riesgo en enfermedades discapacitantes / Prevalence in diabetes and risk factors in disabling diseases / Prevalência em diabetes e fatores de risco em doenças incapacitantes

La diabetes es una de las principales enfermedades metabólicas en la cual los niveles de glucosa se ven afectados debido a que el cuerpo no produce insulina suficiente, para controlar la glucosa proveniente de los alimentos, lo que deriva o desencadena en los distintos tipos de diabetes, como la diabetes mellitus tipo 1 (DM1) y la diabetes mellitus tipo 2 (DM2). OBJETIVO: determinar la prevalencia de diabetes y factores de riesgo en enfermedades discapacitantes METODOLOGIA: el trabajo de investigación tuvo un alcance descriptivo, corte transversal y un enfoque cuantitativo. Se utilizó el instrumento RFT5-33 como principal material de apoyo para la recolección de datos. RESULTADOS: se determinó que la prevalencia de diabetes fue de 23,6% dejando como muestra 172 familias, de las cuales se observó como factores de riesgo que el 70,6% realiza una escasa actividad física; el consumo de alcohol representa el 14,1% y en base a la alimentación se constató que el 14% se alimenta menos de 3 veces al día y el 15,1% no desayunan. CONCLUSION: los factores de riesgo que más afectaron a la comunidad San Eduardo fueron el sedentarismo, consumo de alcohol y mala nutrición.(AU)

Diabetes is one of the major metabolic diseases level are affected because the body does not produce enough insulin to control glucose from food, which derives or triggers different types of diabetes such as one or two. OBJECTIVE: determine the prevalence of diabetes and risk factors in disabled diseases. METHODOLOGY: the research work had a descriptive scope, nonexperimental design and a quantitative approach. The RFT 5-33 instrument was used as the main supporting material for data collection. RESULTS: the prevalence of diabetes was determined in 23.6%, leaving 172 families, of which 70.6% were observed as rick factors performing low physical activity; alcohol consumption was 14.1% and 14% were found to be fed less than 3 times a day and 15.1% were not eating breakfast. CONCLUSION: the risk factors that most affected the San Eduardo community were sedentarism, alcohol consumption, and poor nutrition.(AU)

O diabetes é uma das principais doenças metabólicas em que os níveis de glicose são afetados porque o corpo não produz insulina suficiente para controlar a glicose dos alimentos, o que leva ou desencadeia diferentes tipos de diabetes, como diabetes mellitus tipo 1 (DM1) e diabetes tipo 2 mellitus (DM2). OBJETIVO: determinar a prevalência de diabetes e os fatores de risco em doenças incapacitantes METODOLOGIA: o trabalho de pesquisa teve um escopo descritivo, transversal e com abordagem quantitativa. O instrumento RFT5-33 foi utilizado como principal material de apoio para a coleta de dados. RESULTADOS: constatou-se que a prevalência de diabetes foi de 23,6%, deixando como amostra 172 famílias, das quais se observou como fatores de risco que 70,6% realizam pouca atividade física; O consumo de álcool representa 14,1% e com base na alimentação, verificou-se que 14% comem menos de 3 vezes ao dia e 15,1% não tomam café da manhã. Conclusão: Os fatores de risco que mais afetaram a comunidade San Eduardo foram o sedentarismo, o consumo de álcool e a má alimentação. (AU)

Calidad de vida de personas con Diabetes Mellitus monitoreadas por la Unidad Básica de Salud / Qualidade de vida de pessoas com Diabetes Mellitus acompanhadas pela Unidade Básica de Saúde / Quality of Life in People with Diabetes Mellitus Followed by the Basic Health Unit

Introducción: La diabetes mellitus es una enfermedad metabólica que afecta a la población y requiere la evaluación de la calidad de vida para la formulación de estrategias de atención específicas y así minimizar o prevenir su deterioro. Objetivo: Evaluar la calidad de vida de personas con diabetes mellitus monitoreadas por la Unidad Básica de Salud. Métodos: Estudio transversal realizado con 82 diabéticos en una Unidad Básica de Salud. Se utilizaron cuestionarios que contenían variables sociodemográficas y clínicas y las áreas clínica y Problem Areas in Diabetes para la evaluación evaluar de la calidad de vida. En el análisis de datos, se utilizaron la prueba de Kruskal-Wallis, la prueba U de Mann-Whitney, la prueba t de Student y el analysis of variance. La mayoría de los participantes fueron mujeres, ancianas, casadas, con educación primaria completa, morenas, jubiladas, con su propio hogar, con un ingreso familiar de hasta un salario mínimo, diabéticos tipo 2, no fumadores, que usan antidiabéticos orales como una forma de tratamiento, sedentarios, no alcohólico, con dos comorbilidades asociadas a diabetes y entre seis y 10 años de diagnóstico. La puntuación total mostró un promedio de 32,36, lo que indica una buena calidad de vida para la mayoría de los participantes, y aquellos que sufren un impacto negativo presentan el factor emocional más afectado. Conclusión: Los datos obtenidos con este estudio permitirán la planificación de acciones específicas dirigidas a esta población para promover una mejor adherencia a las prácticas que influyen positivamente en la calidad de vida(AU)

Introdução: O Diabetes mellitus é uma doença metabólica que acomete a população, sendo necessária a avaliação da qualidade de vida para a formulação de estratégias de cuidado específicas para minimizar ou prevenir o seu comprometimento. Objetivo: Avaliar a qualidade de vida de pessoas com Diabetes Mellitus acompanhados pela Unidade Básica de Saúde. Métodos: Estudo transversal realizado com 82 diabéticos em uma Unidade Básica de Saúde. Utilizou- se questionários contendo variáveis sociodemográficas e clínicas e o Problem Areas in Diabetes para avaliação da qualidade de vida. Na análise dos dados, utilizaram-se os testes Kruskal-Wallis, U de Mann-Whitney, teste t de Student e Analysis of variance. Resultados: A maioria dos participantes são mulheres, idosas, casadas, com ensino fundamental completo, pardas, aposentadas, com casa própria, com renda familiar de até um salário mínimo, diabéticos tipo 2, não fumantes, que utilizam os antidiabéticos orais como forma de tratamento, sedentários, não etilistas, com duas comorbidades associadas ao diabetes e entre seis a 10 anos de diagnóstico. O escore total apresentou média de 32,36 , indicando boa qualidade de vida para a maioria dos participantes, e aqueles que sofrem impacto negativo apresentam o fator emocional como domínio mais acometido. Conclusão: Os dados obtidos com este estudo possibilitará o planejamento de ações específicas voltadas a essa população de modo a promover melhor adesão a práticas que influenciem positivamente na qualidade de vida(AU)

Introduction: Diabetes mellitus is a metabolic disease that affects population health and requires quality of life assessment to formulate specific care strategies to minimize or prevent its deterioration. Objective: To assess the quality of life of people with diabetes mellitus monitored by the basic health unit. Methods: Cross-sectional study carried out with 82 diabetic patients in a basic health unit. Questionnaires containing sociodemographic and clinical variables, as well as the problem areas in diabetes, were used to assess quality of life. In the data analysis, the Kruskal-Wallis test, the Mann-Whitney U test, the Student's t test and variance analysis were used. Results: Most of the participants were women, elderlies and had black skin. They were nonsmokers and nonalcoholic patients, had completed primary education and were retired. They had their own homes and a family income of up to a minimum wage. They had type 2 diabetes, apart from two comorbidities associated with diabetes, and between six and ten years of diagnosis. They used oral antidiabetics as a sedentary form of treatment. The total score showed an average of 32.36, which indicates a good quality of life for most of the participants, while those who suffered a negative impact had the emotional factor as the most affected domain. Conclusion: The data obtained from this study will allow planning specific actions targeted at this population to promote better adherence to practices that positively influence quality of life(AU)

Indicadores de desigualdad y mortalidad por enfermedades cardiometabólicas en Guatemala / Inequality indicators and cardiometabolic diseases mortality in Guatemalahttps

La medición de las desigualdades en salud al interior de los países de ingresos bajos y medios es necesaria para la planificación, monitoreo y evaluación de intervenciones de salud pública, especialmente para problemas que contribuyen altamente a la carga de enfermedad, como las enfermedades cardiometabólicas. El objetivo de este estudio fue caracterizar los patrones de desigualdad de las tasas de mortalidad para las principales causas cardiometabólicas en Guatemala. Se usó datos del Censo Nacional de Población, y estadísticas oficiales de de-función de 2018 para calcular tasas crudas de mortalidad para diabetes (DM), infarto agudo de miocardio (IAM), y accidente cerebrovascular (ACV). Se calcularon indicadores simples y complejos de desigualdad absoluta y relativa (diferencia, razón, índice de pendiente, índice de concentración, distancia de la media, índice de Theil, riesgo atribuible poblacional, y porcentaje de riesgo atribuible poblacional) para seis dimensiones de desigualdad: sexo, pueblo de pertenencia, nivel educativo, tipo de ocupación, departamento y municipio. Se documentaron 6,445 muertes por DM, 5,761 por IAM, y 3,218 por ACV. Los indicadores mostraron marcadas desigualdades para las seis dimensiones estudiadas. El patrón de desigualdad predominante para sexo, pueblo de pertenencia y departamento fue de privación masiva. Para nivel educativo y ocupación predominó un patrón de incrementos escalonados. Se identificó exclusión marginal superpuesta en nivel educativo, ocupación y municipio. Se concluye que los patrones de desigualdad de las tasas de mortalidad para estas tres enfermedades sugieren la superposición de patrones de privación masiva, incrementos escalonados, y exclusión marginal.

Measuring health inequalities within low- and middle-income countries is needed for planning, monitoring, and evaluation of public health interventions, especially for problems that represent a high burden of disease, like cardio metabolic diseases. The goal of this study was to characterize inequality patterns in mortality rates from cardio metabolic causes in Guatemala. Data from the 2018 National Population Census, and official vital statistics were used to estimate crude mortality rates for diabetes (DM), acute myocardial infarction (IAM), and stroke (ACV). Simple and complex indicators of absolute and relative inequality (difference, ratio, slope index, concentration index, distance from the mean, Theil index, population attributable risk, and percentage of popula-tion attributable risk) were calculated for six dimensions of inequality: sex, race/ethnicity, education level, type of occupation, department, and municipality. A total of 6,445 DM deaths, 5,761 IAM deaths, and 3,218 ACV deaths were documented. Indicators showed marked inequalities for the six dimensions studied. Massive deprivation was the predominant inequality pattern for sex, race/ethnicity, and department. Staggered increments were iden-tified for education level and type of occupation. Overlapping marginal exclusion was found for education level, occupation, and municipality. We conclude that inequality patterns found for the three causes of death suggest overlapping patterns of mass deprivation, staggered increments, and marginal exclusion.

Riesgo cardiometabólico del sedentarismo / Cardiometabolic risk of sedentary lifestyle

Sedentary behavior is spreading among society, especially since the rise of technology and progress. The sedentary lifestyle habits are being transmitted to young people, who increase the time they spend in sedentary activities like video games or TV. It has been demonstrated that both sedentary behavior and physical inactivity have negative cardiometabolic consequences for the health, and they become a serious problem for public health, as it has been claimed in several studies and by scientific statements. This review intent to make a call of attention to this problem that will have profound impact in the near future in many countries in Latin America. (AU)

Bases para el diseño de una política pública para la educación nutricional en enfermedades cardiometabólicas en el Municipio Maracaibo, Estado Zulia / Bases for the design of a public policy for nutritional education in cardiometabolic diseases in the municipality of Maracaibo, Zulia state

Las enfermedades cardiometabólicas son de alta prevalencia en edades donde existe una mayor productividad. Esta condición representa un problema público que implica su análisis en el ámbito de las políticas públicas localizadas en contextos específicos como el caso del Municipio Maracaibo del Estado Zulia en Venezuela. El estudio propone elaborar el diseño de una política pública relativa a la educación nutricional, mediante la gestión de proyectos estratégicos para prevenir, educar y controlar las referidas enfermedades. El estudio fue desarrollado durante el período 2019-2020. En lo metodológico se fundamentó en el enfoque de marco lógico que permiten cuestionar y analizar la realidad estudiada, a través de la organización de un diseño de investigación estructurado en un nivel prospectivo-estratégico que implica la sistematización del problema público. El resultado plantea un proyecto didáctico de intervención comunitaria orientado a disminuir la prevalencia de enfermedades cardiometabólicas en esta región del país, mediante un programa de educación nutricional para promocionar estilos de vida saludables. Se concluye que la definición de las enfermedades cardiometabólicas como problema estructurado en el ámbito social, es un prerrequisito para el diseño de una política pública, asociado a proyectos de educación nutricional que contribuyan a atenuar esta condición en la población(AU)

Cardiometabolic diseases are highly prevalent at ages where there is greater productivity. This condition represents a public problem that implies its analysis in the field of public policies located in specific contexts, such as the Maracaibo Municipality of the Zulia State - Venezuela. The study proposes to develop the design of a public policy related to nutritional education, through the management of strategic projects to prevent, educate and control the referred diseases. The study was developed during the 2019- 2020 period. Methodologically, it was based on the logical framework approach that allows questioning and analyzing the reality studied, through the organization of a structured research design at one level; prospective - strategic, and implies the systematization of the public problem. The result proposes a didactic community intervention project aimed at reducing the prevalence of cardiometabolic diseases in this region of the country, through a nutritional education program to promote healthy lifestyles. It is concluded that the definition of cardiometabolic diseases as a structured problem in the social sphere is a prerequisite for the design of a public policy, associated with nutritional education projects that contribute to mitigating this condition in the population(AU)