Prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to assess the prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean. METHODS: We searched Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed/Medline and Embase databases until January 16, 2023. We meta-analyzed prevalences according to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). RESULTS: Forty-three prevalence studies (47 585 participants) and one incidence study (436 participants) were included. The overall prevalence of retinopathy in patients with T1DM was 40.6% (95% CI: 34.7 to 46.6; I2: 92.1%) and in T2DM was 37.3% (95% CI: 31.0 to 43.8; I2: 97.7), but the evidence is very uncertain (very low certainty of evidence). In meta-regression, we found that age (T1DM) and time in diabetes (T2DM) were factors associated with the prevalence. On the other hand, one study found a cumulative incidence of diabetic retinopathy of 39.6% at 9 years of follow-up. CONCLUSIONS: Two out of five patients with T1DM or T2DM may present diabetic retinopathy in Latin America and the Caribbean, but the evidence is very uncertain. This is a major public health problem, and policies and strategies for early detection and opportunely treatment should be proposed.

Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis.

AIMS: To determine the overall prevalence of diabetic foot at risk according to the International Working Group on the Diabetic Foot stratification. MATERIALS AND METHODS: We searched PubMed/Medline, Scopus, Web of Science, and Embase. We included cross-sectional studies or cohorts from 1999 to March 2022. We performed a meta-analysis of proportions using a random-effects model. We assessed heterogeneity through subgroup analysis by continent and other characteristics. RESULTS: We included 36 studies with a total population of 11,850 people from 23 countries. The estimated overall prevalence of diabetic foot at risk was 53.2% (95% CI: 45.1-61.3), I2 = 98.7%, p < 0.001. In the analysis by subgroups, South and Central America had the highest prevalence and Africa the lowest. The factors explaining the heterogeneity were the presence of chronic kidney disease, diagnostic method for peripheral arterial disease, and quality. The estimates presented very low certainty of evidence. CONCLUSIONS: The overall prevalence of diabetic foot at risk is high. The high heterogeneity between continents can be explained by methodological aspects and the type of population. However, using the same classification is necessary for standardization of the way of measuring the components, as well as better designed general population-based studies.

Green space exposure and type 2 diabetes mellitus incidence: A systematic review.

INTRODUCTION: Epidemiological studies have suggested that exposure to green spaces is associated with a lower prevalence of diabetes. The aim of this systematic review was to summarize the evidence on green spaces and diabetes mellitus II (T2DM) in longitudinal studies. METHODS: We searched PubMed, SCOPUS, Web of Science (WoS)/Core Collection, WoS/MEDLINE, and EMBASE until February 2023. We included cohort studies that assessed the incidence of T2DM according to the level of exposure to green spaces. Two authors independently performed study selection, data extraction, and analysis of risk of bias. No meta-analysis was performed due to clinical heterogeneity between studies. RESULTS: We included 13 cohort studies with a sample size ranging from 1700 to 1 922 545 participants. Studies presented different ways of defining (quartiles, percentages) and measuring (tools, buffers) green spaces. Similarly, the definition of T2DM was heterogeneous (self-reports, medical records, clinical criteria). Twelve studies showed that individuals with higher exposure to green spaces had a decreased incidence of T2DM. Out of these 12 studies, 10 revealed statistically significant differences. All studies were of high methodological quality, except for one. CONCLUSION: Our findings suggest that exposure to green space could be a protective factor for the development of T2DM. Promoting policies to preserve and increase green space could help to reduce T2DM at the community level. More standardization of green space exposure definition is needed in studies on green space and T2DM.

Control metabólico y su relación con enfermedad arterial periférica en sujetos con diabetes mellitus tipo 2: Estudio caso-control pareado

Objetivo : Evaluar la relación entre control metabólico y enfermedad arterial periférica (EAP) en pacientes con diabetes mellitus tipo 2 (DM2) del hospital María Auxiliadora (HMA). Material y métodos : Estudio caso-control pareado para sexo, de un análisis secundario basado en datos del servicio de endocrinología del HMA, Lima-Perú. Los casos con EAP, fueron aquellos con índice tobillo-brazo (ITB) < 0,9. Los controles fueron aquellos con ITB entre 0,9 y 1,3 en una relación 4:1 con respecto a los casos. Se definió como mal control metabólico si presentaron al menos uno de las siguientes: hemoglobina glicosilada ≥ 7 %, presión arterial sistólica ≥ 140 mm Hg, presión arterial diastólica ≥ 90 mm Hg, colesterol HDL< 40 mg/dl (varón) o < 50 mg/dl (mujer), colesterol LDL ≥ 100 mg/dl y triglicéridos ≥ 150 mg/dl. Se calculó el Odds ratio (OR) de mal control metabólico, tanto crudo como ajustado, según presencia de EAP mediante regresión logística. Resultados : Incluimos a 39 casos y 157 controles. Un 94,9 % y 82,2 % de los casos y controles presentaron mal control metabólico respectivamente (p<0,05). Al ajustar a edad, tiempo de diabetes, índice de masa corporal y antecedente de tabaco, los pacientes con mal control metabólico presentaron un OR de 5,45; (IC 95 % 1,17 - 25,2); p=0,030 de presentar enfermedad arterial periférica definido por ITB<0,9. Conclusión : El mal control metabólico presenta una relación independiente con EAP en pacientes con DM2 del Hospital María Auxiliadora. Metas terapéuticas centradas solo en la glicemia, elevarían la carga de enfermedad de complicaciones macrovasculares.

Objective : To assess the relationship between metabolic control and peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (DM2) in Maria Auxiliadora Hospital (MAH). Material and methods : This is a sex-matched case control study with a secondary analysis based on data from the endocrinology service of MAH, Lima, Peru. Cases with PAD were defined as those with 50 mg/dL (females), LDL cholesterol ≥100 mg/dL and triglycerides ≥150 mg/dL. Odds ratio values for poor metabolic control were calculated, both crude and adjusted, according to the presence or PAD, by using logistic regression. Results : We included 39 cases and 157 controls. A great majority of cases (94.9%) and of controls (82.2%) had poor metabolic control, respectively (p<0.05). When adjusting for age, time with diabetes, body mass index, and history of tobacco use, patients with poor metabolic control had OR at 5.45 (95% CI: 1.17 - 25.2) and p= 0.030 for having peripheral arterial disease, as defined by ATAI <0.9. Conclusion : Poor metabolic control showed and independent relationship with PAD in DM2 patients in Maria Auxiliadora Hospital. If therapy was only centered in glycemic control, it would increase the burden of disease of macrovascular complications.

Prevalence of Foot At-Risk and its Associated Characteristics among Outpatients with Diabetes Mellitus in a Peruvian Public Hospital.

OBJECTIVE: To assess the prevalence of patients at risk of developing diabetic foot complications(i.e.foot at-risk) and its clinical components according to the updated International Working Group on Diabetic Foot (IWGDF) criteria and to describe demographic and diabetes-related characteristics. METHODS: We conducted a cross-sectional study at María Auxiliadora Hospital between 2017 and 2018. The criteria for foot at-risk in the IWGDF 2019 risk stratification system are classified into four risk categories, R0-R3, ranging from no peripheral arterial disease (PAD) and no peripheral neuropathy (PN) to the presence of PAD or PN in combination with previous foot ulcer, amputation, or end- stage renal disease (R3). According to this system, we obtained prevalence ratios (PR) of foot at-risk categories dependent on sex, age, diabetes duration, and Total Symptom Score. A sample size of 402 subjects was included in the study. RESULTS: Subjects included had a mean age of 61 years, and 66% were female. There were no patients with type 1 diabetes, and 59% percent had a diabetes duration of less than ten years. The prevalence of foot at-risk was 54.3% defined by the IWGDF 2019 criteria, which gave prevalence17% higher than that defined with the previous 1999 criteria. PN and PAD frequency was 37.3% and 30.1%, respectively. Foot at-risk prevalence was 40% higher in those with severe Total Symptom Score (PR 1.40, 95% CI 1.09-1.80) and also 39% higher in men than in women (PR 1.39, 95% CI 1.17-1.64). Likewise, diabetes duration of more than ten years had a 25% higher prevalence of foot at-risk (PR 1.25, 95% CI 1.05-1.49), and those older than 60 years had a 20% higher presence of this condition (PR 1.20, 95% CI 1.0011.43). CONCLUSIONS: Our hospital faces a substantial burden of diabetic foot risk in men, patients with long diabetes duration, and those with painful neuropathy. More initiatives are required at primary or hospital level to detect this critical condition. Likewise, reference centers with multidisciplinary teams to apply prevention and therapeutic interventions are urgently needed.

Association Between the Diabetes mellitus Duration and the Severity of Diabetic Foot Disease in Hospitalized Patients in Latin America.

The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America.Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders.Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 (p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 (p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer.We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.

Relación entre anemia del primer trimestre y bajo peso al nacer en cuatro Centros de Salud Materno-Infantiles de Lima Sur durante el 2019 / Relationship between first trimester anemia and low birth weight in four mother-and-child health centers in Lima Sur during 2019

RESUMEN Objetivo: Determinar la relación entre la anemia materna del primer trimestre y el bajo peso al nacer de cuatro centros de salud maternos de Lima-Sur durante el 2019. Materiales y métodos: Se realizó un estudio cohorte retrospectivo de una base de datos secundaria donde se incluyeron gestantes atendidas en cuatro Centros de Salud con nivel de complejidad I-4 de Lima-Sur; cuyos partos se registraron durante el 2019, excluyendo a los recién nacidos pretérmino. Una hemoglobina del primer trimestre <11 g/dl se definió como anemia y un peso <2500 g como bajo peso al nacer. Se calculó la incidencia acumulada según anemia y se halló el riesgo relativo (RR) ajustado a potenciales confusores. Resultados: Se incluyó 221 gestantes y el 76 % tuvo una edad entre 18 a 35 años. Un 42 % fue primigesta, un 52 % presentó exceso de peso y el 60 % realizó 6 o más controles prenatales. Un 23,5 % de gestantes presentó anemia en el primer trimestre y se halló una incidencia de 2,7 % casos con bajo peso al nacer. La anemia del primer trimestre elevó en 11 veces la incidencia de recién nacidos con bajo peso, independiente de la edad, índice de masa corporal y paridad (RR ajustado = 11,1; IC 95 % 1,3 - 97,2; p=0,029). Conclusiones: De la muestra estudiada, una de cada cuatro gestantes presenta anemia durante el primer trimestre incrementando la incidencia acumulada de tener un neonato con bajo peso hasta en 11 veces.

ABSTRACT Objective: To determine the relationship between maternal anemia in the first trimester of pregnancy and low birth weight in four mother-and-child-health centers in Southern Lima during 2019. Material and methods: A retrospective cohort study from a secondary database was performed, where pregnant women from 4 middle-complexity Health Centers from Southern Lima were included. Deliveries took place during 2019, excluding preterm newborns. First trimester hemoglobin concentration <11 g/dL was defined as anemia and birth weight <2500 g was defined as low birth weight. Cumulative incidence for anemia was calculated, and relative risk (RR) adjusted for potential confounders was also calculated. Results: Two hundred and twenty one pregnant women were included. Seventy-six per cent were between 18 and 35 years old. Forty-two percent were primigravida, fifty-two percent had excess body weight, and sixty percent had six or more prenatal control visits. Nearly one quarter (23,5%) of all pregnant women had anemia during the first trimester, and there were 2,7% cases of low birth weight. Anemia during the first trimester of pregnancy increased 11 times the frequency of newborns with low birth weight, independently of age, body mass index, and parity (adjusted RR = 11,1; 95% CI: 1,3-97,2; p= 0,029). Conclusions: In the studied sample, one out of four pregnant women had anemia during the first trimester of pregnancy, increasing up to 11 times the cumulative incidence for having a neonate with low birth weight.

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis.

AIMS: The objective of this systematic review and meta-analysis is to estimate the prevalence and incidence of diabetic peripheral neuropathy (DPN) in Latin America and the Caribbean (LAC). MATERIALS AND METHODS: We searched MEDLINE, SCOPUS, Web of Science, EMBASE and LILACS databases of published observational studies in LAC up to December 2020. Meta-analyses of proportions were performed using random-effects models using Stata Program 15.1. Heterogeneity was evaluated through sensitivity, subgroup, and meta-regression analyses. Evidence certainty was performed with the GRADE approach. RESULTS: Twenty-nine studies from eight countries were included. The estimated prevalence of DPN was 46.5% (95%CI: 38.0-55.0) with a significant heterogeneity (I2 = 98.2%; p<0.01). Only two studies reported incidence, and the pooled effect size was 13.7% (95%CI: 10.6-17.2). We found an increasing trend of cumulative DPN prevalence over time. The main sources of heterogeneity associated with higher prevalence were diagnosis criteria, higher A1c (%), and inadequate sample size. We judge the included evidence as very low certainty. CONCLUSION: The overall prevalence of DPN is high in LAC with significant heterogeneity between and within countries that could be explained by population type and methodological aspects. Significant gaps (e.g., under-representation of most countries, lack of incidence studies, and heterogenous case definition) were identified. Standardized and population-based studies of DPN in LAC are needed.

Nationwide prevalence and clinical characteristics of inpatient diabetic foot complications: A Peruvian multicenter study.

OBJECTIVE: To evaluate the burden of diabetic foot complications amongst inpatients in Peru. MATERIALS AND METHODS: Cross-sectional multicenter study, performed in public hospitals, in one-day enrollment between October and December 2018. RESULTS: We included 8346 patients from 39 national hospitals. Diabetic foot (DF) inpatient point prevalence was 2.8% (CI 95% 2.4-3.1), and DF point prevalence among Diabetes Mellitus (DM) inpatients was 18.9% (CI 95% 16.7-21.1). DF prevalence was higher in jungle and coastal hospitals than highlands ones, and there was no difference according to its care complexity level. Of the 234 patients with DF, 73% were males, age average was 62 ± 12 years, with DM mean time duration of 15 ± 9.9 years. Regarding to DF etiology, 91% and 68% had some degree of peripheral neuropathy and peripheral artery disease, respectively. According to the Infectious Diseases Society of America criteria, 61% presented moderate to severe infections, and 40% had bone involvement. Debridement within 48 h was performed in 36% of sepsis cases. CONCLUSION: Peru has a substantial burden of DF disease, with a greater share of that burden falling on less equipped hospitals in the country's jungle and coastal regions. Interdisciplinary teams and pathways may improve the time of surgical debridement in the highest risk patients.

Asociación entre conocimiento y prácticas sobre la infección por VIH en mujeres peruanas: análisis secundario de encuesta nacional

Resumen Introducción: Las mujeres en edad reproductiva podrían considerarse como una población vulnerable a contraer la infección por VIH. La relación entre conocimiento y prácticas no está descrita en un contexto donde los conocimientos, actitudes y prácticas sobre el VIH son inadecuados. Objetivo: Determinar la asociación entre conocimientos y prácticas sobre la infección por VIH en mujeres peruanas en edad reproductiva. Material y Métodos: Análisis de Encuesta Demográfica y de Salud Familiar 2019, cuya muestra fue probabilística, estratificada y bietápica. El análisis consideró a mujeres en edad reproductiva sexualmente activas. Se definió "conocimientos adecuados" a los puntajes superiores al tercil superior de las observaciones al responder 18 preguntas y se determinó la asociación con cada una de las cinco prácticas. Se utilizó estadística descriptiva e inferencial -bivariada y multivariada- con regresión de Poisson para análisis poblacionales. Resultados: La media de respuestas correctas fue 12,6 (IC95%: 12,5-12,7). El 19,2% había usado preservativo en su última relación sexual. Un nivel de conocimientos adecuado estuvo asociado al uso de preservativo en la última relación sexual (RPa: 1,20; IC95%: 1,06-1,36), haber tenido una infección de transmisión sexual y con haberse realizado una prueba diagnóstica para infección por VIH. Conclusiones: Considerando una baja prevalencia de uso de preservativo en la última relación sexual de mujeres peruanas en edad reproductiva, los conocimientos generales adecuados sobre la infección por VIH se asocian con haber realizado esta práctica.

Abstract Background: Reproductive-age women are a vulnerable population for HIV infection. The relationship between knowledge and practices is not well described in a context where levels of knowledge, attitudes, and practices about HIV infection are inadequate. Aim: To determine the association between knowledge and practices about HIV infection in Peruvian reproductive-age women. Methods: Analysis of secondary data from the 2019 Demographic and Family Health Survey. It got a probabilistic, stratified, and two-stage sample. We included reproductive-age and actively sexual women. Scores above the upper tertile of the observations were defined as "adequate knowledge" by answering 18 questions. Then, we determined the association between adequate knowledge with each of the five practices. Descriptive and inferential statistics -bivariate and multivariate- were used with the Poisson regression for survey analysis. Results: The mean of correct answers was 12.6 (95% CI: 12.5 - 12.7). 19.2% of Peruvian women had used a condom in the last sexual relationship. An adequate level of knowledge was associated with the use of condoms in the last sexual intercourse (PRa: 1.20; 95% CI:1.06 - 1.36), with having a sexually transmitted infection in the last year, and with having a diagnostic test for HIV infection. Conclusions: Considering a low prevalence of condom use in the last sexual intercourse of Peruvian women of reproductive age, adequate general knowledge about HIV infection has associated with the accomplishment of this practice.

Prevalence of Diabetes Mellitus and Its Associated Unfavorable Outcomes in Patients With Acute Respiratory Syndromes Due to Coronaviruses Infection: A Systematic Review and Meta-Analysis.

INTRODUCTION: Only 3 types of coronavirus cause aggressive respiratory disease in humans (MERS-Cov, SARS-Cov-1, and SARS-Cov-2). It has been reported higher infection rates and severe manifestations (ICU admission, need for mechanical ventilation, and death) in patients with comorbidities such as diabetes mellitus (DM). For this reason, this study aimed to determine the prevalence of diabetes comorbidity and its associated unfavorable health outcomes in patients with acute respiratory syndromes for coronavirus disease according to virus types. METHODS: Systematic review of literature in Pubmed/Medline, Scopus, Web of Science, Cochrane, and Scielo until April of 2020. We included cohort and cross-sectional studies with no restriction by language or geographical zone. The selection and extraction were undertaken by 2 reviewers, independently. The study quality was evaluated with Loney's instrument and data were synthesized by random effects model meta-analysis. The heterogeneity was quantified using an I 2 statistic. Funnel plot, Egger, and Begg tests were used to evaluate publication biases, and subgroups and sensitivity analyses were performed. Finally, we used the GRADE approach to assess the evidence certainty (PROSPERO: CRD42020178049). RESULTS: We conducted the pooled analysis of 28 studies (n = 5960). The prevalence analysis according to virus type were 451.9 diabetes cases per 1000 infected patients (95% CI: 356.74-548.78; I 2 = 89.71%) in MERS-Cov; 90.38 per 1000 (95% CI: 67.17-118.38) in SARS-Cov-1; and 100.42 per 1000 (95% CI: 77.85, 125.26 I 2 = 67.94%) in SARS-Cov-2. The mortality rate were 36%, 6%, 10% and for MERS-Cov, SARS-Cov-1, and SARS-Cov-2, respectively. Due to the high risk of bias (75% of studies had very low quality), high heterogeneity (I 2 higher than 60%), and publication bias (for MERS-Cov studies), we down rate the certainty to very low. CONCLUSION: The prevalence of DM in patients with acute respiratory syndrome due to coronaviruses is high, predominantly with MERS-Cov infection. The unfavorable health outcomes are frequent in this subset of patients. Well-powered and population-based studies are needed, including detailed DM clinical profile (such as glycemic control, DM complications, and treatment regimens), comorbidities, and SARS-Cov-2 evolution to reevaluate the worldwide prevalence of this comorbidity and to typify clinical phenotypes with differential risk within the subpopulation of DM patients.

Incidence of COVID-19 infection and prevalence of diabetes, obesity and hypertension according to altitude in Peruvian population.

To investigate the cumulative incidence and mortality of COVID-19 and the prevalence of comorbidities such as diabetes, obesity and hypertension in regions with different altitude levels ranging from sea level to high altitude. METHODOLOGY: Analytical study in which we correlated secondary data obtained from reports of the Ministry of Health and National Institute for Statistics and Informatic. The cumulative incidence and mortality of COVID-19 in 25 peruvian regions is reported, together with its relationnship with altitude levels during March-July 2020 using Pearsons correlation. We also aiming to assess the prevalence of diabetes, obesity and hypertension with altitude according to the ENDES 2018 data using Gamma statistics. RESULTS: COVID-19 maintained an inverse correlation with higher rates in the coastal regions and lower rates with increasing altitude in the cumulative incidence (Pearson = -0.8, p < 0.000) and mortality (Pearson = -0.77, p < 0.000), adjusted gender and age. The prevalence of diabetes and obesity showed the same inverse correlation trend with altitude (Gamma p < 0.000) but not hypertension (Gamma p = 0.13) CONCLUSIONS: The data in Peru it is suggested that physiological adaptation in a hypoxic environment at high altitude may protect persons from the severe impact of acute infection caused by SARS-CoV-2. The reduction in cumulative incidence and mortality rates with increasing altitude is the main finding. Possible mechanisms such as a decreased expression of angiotensin-converting enzyme 2 (ACE2) and a lower virulence because of a high altitude environment, may explain this epidemiological features. In addition, the lower prevalence of diabetes, obesity and hypertension may establish a protective epidemiology against these disease.

[Association between knowledge and practices on HIV infection in Peruvian women: secondary analysis of national survey]. / Asociación entre conocimiento y prácticas sobre la infección por VIH en mujeres peruanas: análisis secundario de encuesta nacional.

BACKGROUND: Reproductive-age women are a vulnerable population for HIV infection. The relationship between knowledge and practices is not well described in a context where levels of knowledge, attitudes, and practices about HIV infection are inadequate. AIM: To determine the association between knowledge and practices about HIV infection in Peruvian reproductive-age women. METHODS: Analysis of secondary data from the 2019 Demographic and Family Health Survey. It got a probabilistic, stratified, and two-stage sample. We included reproductive-age and actively sexual women. Scores above the upper tertile of the observations were defined as "adequate knowledge" by answering 18 questions. Then, we determined the association between adequate knowledge with each of the five practices. Descriptive and inferential statistics -bivariate and multivariate- were used with the Poisson regression for survey analysis. RESULTS: The mean of correct answers was 12.6 (95% CI: 12.5 - 12.7). 19.2% of Peruvian women had used a condom in the last sexual relationship. An adequate level of knowledge was associated with the use of condoms in the last sexual intercourse (PRa: 1.20; 95% CI:1.06 - 1.36), with having a sexually transmitted infection in the last year, and with having a diagnostic test for HIV infection. CONCLUSIONS: Considering a low prevalence of condom use in the last sexual intercourse of Peruvian women of reproductive age, adequate general knowledge about HIV infection has associated with the accomplishment of this practice.

Resistencia bacteriana y factores asociados en pacientes con pie diabético infectado sin desenlace de amputación mayor en un hospital nacional peruano / Bacterial resistance and associated factors in patients with infected diabetic foot with no major amputation outcomes in a Peruvian national hospital

RESUMEN Objetivo: Determinar la resistencia bacteriana y factores asociados en pacientes con pie diabético infectado sin desenlace de amputación mayor. Materiales y métodos: Estudio transversal, analítico, de revisión de historias clínicas de pacientes con pie diabético infectado del 2010-2014 en el Hospital Nacional Edgardo Rebagliati Martins. Según protocolo, las muestras de cultivo consistieron en tejidos que se obtuvieron después de desbridar la zona afectada. Sólo se usaron medios aerobios. Resultados: Se incluyeron 88 pacientes, aislándose 128 bacterias. El 81,8% fue varón con edad promedio de 60,6 años. El 76% tenía tiempo de diabetes >10 años y el 18,7% presentó Hba1c <7,0%. Según clasificación Wagner, 39,8% fue grado 3 y 40,9% grado 4. La infección grado moderada, según IDSA, fue la más frecuente (80,7%), al igual que la isquemia moderada (65,9%) y 44% tuvo infección previa por pie diabético. El 42% de los cultivos fue polimicrobiano, las bacterias aisladas más frecuentes fueron Escherichia coli (23,4%); Enterococcus faecalis (14,1%) y Staphylococcus aureus (13,3%). El 33% de las Enterobacterias fueron productores de betalactamasa de Espectro Extendido (BLEE). Se halló asociación de BLEE con infección previa por pie diabético, mayor PCR y fascitis necrotizante por LRINEC. El 71% de los S. aureus fue meticilino resistente (SAMR), hallándose asociación sólo con PCR alto. Conclusiones: En pacientes con pie diabético sin desenlace de amputación mayor, se encontró una elevada frecuencia de Enterobacterias BLEE positivas y SAMR. Infección previa, PCR alto y LRINEC >8 estuvo asociado a la presencia de BLEE y sólo PCR alto a SAMR

Objective: To determine bacterial resistance and its associated factors in patients with infected diabetic foot with no major amputation outcomes. Materials and methods: This is a cross-sectional analytical study, which consisted in reviewing clinical records from patients with infected diabetic foot seen during the period 2010-2014 in the Edgardo Rebagliati- Martins Hospital. According to the protocol, samples for culture consisted in tissues that were obtained after debriding the affected areas. Only aerobic media for cultures were used. Results: Eighty-eight patients were included, and 128 bacterial isolates were obtained. Most of the subjects (81.8%) were male, and their average age was 60.6 years. Three-fourths of all patients (76%) had diabetes for more than 10 years, and 18.7% had Hba1c <7.0%. According to the Wagner classification, 39.8% were grade 3 and 40.9% were grade 4. Moderated grade infections, according to the IDSA, were the most frequent instances (80.7%), as well as moderate ischemia (65.9%) , and 44% of patients had a previous infection on their diabetic foot. Only 42% of all cultures were polymicrobial, and most frequently isolated microorganisms were Escherichia coli (23.4%), Enterococcus faecalis (14.1%), and Staphylococcus aureus (13.3%). One-third (33%) of Enterobacteriaceae were Extended-Spectrum Beta-lactamase (ESBL) producers. There was an association of having ESBL microorganisms with previous diabetic foot infections, higher CRP values and necrotizing fasciitis according to LRINEC. Most S. aureus strains (71%) were methicillin-resistant (MRSA), and this was associated with high CRP values. Conclusions: In patients with diabetic foot with no major amputation outcomes, there was a high frequency of ESBL Enterobacteriaceae and MRSA. The occurrence of a previous infection, high CRP values and LRINEC >8 were associated with the presence of ESBL, and only high CRP values were associated with MRSA

Clasificación de pie en riesgo de ulceración según el Sistema IWGDF y factores asociados en pacientes con diabetes mellitus tipo 2 de un hospital peruano / Classification of foot at risk of ulceration following the IWGDF classification and associated factors in type 2 diabetic patients in a Peruvian hospital

Objetivos: Determinar la frecuencia de pie en riesgo de ulceración según el Sistema International Working Group on the Diabetic Foot (IWGDF) y los factores asociados en pacientes con diabetes mellitus tipo 2 de un hospital general de Lima-Perú. Material y Métodos: Estudio descriptivo, transversal de información secundaria. Se revisaron 382 fichas de pacientes con diabetes mellitus tipo 2, recopiladas por el servicio de endocrinología del Hospital María Auxiliadora desde enero de 2013 a diciembre de 2015. La ficha contenía datos demográficos y examen físico que incluía evaluación de monofilamento, diapasón 128 Hz y examen de pulsos. Se utilizó el IWGDF: Grado 0 no Neuropatía Periférica (NP), Grado 1 NP; Grado 2 Enfermedad arterial periférica (EAP) y/o deformación del pie y Grado 3 antecedente de úlcera. Se analizaron los datos mediante estadística descriptiva e inferencial. Resultados: El 73,9% fueron mujeres, la edad promedio fue 60,3 años. El 61% tenía Hba1c >7% y el 55% tenía más de 5 años de tiempo de enfermedad. Según la clasificación IWGDF, el 22% tuvo riesgo 0; 8%, riesgo 1; 64%, riesgo 2 y 6,5%, riesgo 3. El 54,3% presentó deformación biomecánica, el 39% EAP, el 35,5% NP, y el 6,5% antecedente de úlcera o amputación. En el análisis multivariado se halló asociación directa entre presentar mayor edad y tener pie en riesgo, grados 2 y 3 OR 1,02 (IC95% 1,001 - 1,05). Conclusiones: Cerca del 70% de la población estudiada presentó alto y muy alto riesgo de ulceración. Predominaron la deformación biomecánica y la enfermedad arterial periférica como hallazgos en la evaluación. (AU)

Objectives: To determine the frequency of foot at risk of ulceration following the international working group diabetic foot classification and associated factors in type 2 diabetic patients in a general Peruvian hospital in Lima. Methods: cross sectional study using secondary data. We reviewed 382 medical charts of type 2 diabetic patients gathered by the endocrinology service of Hospital Maria Auxiliadora from January 2013 to December 2015. Each medical chart had demographic data, and physical examination information that included monofilament, diapason 128Hz and peripheral pulse evaluations. The IWGDF was used: grade 0 means no peripheral neuropathy (PN), grade 1 means PN, grade 2 means peripheral arterial disease (PAD) and/or foot deformity and grade 3 means history of foot ulcer. Descriptive and inferential statistics were used. Results: 73.9% were females; mean age was 60.3 years; 61% had Hba1c>7% and 55% had more than 5 years of illness. Based on IWGDF, 22% had grade 0, 8% grade 1, 64% grade 2 and 6.5% grade 3. Biomechanical deformity was seen in 54.3%, 39% had PAD, 35.5% had PN and 6.5% had history of an ulcer or amputation. The multivariate analysis found that older age and having grades 2 and 3 of the IWGDF classification were independently associated with foot at risk of ulceration [OR 1.02 (95%CI 1.001-1.05). Conclusions: Almost 70% of the study population had high and very high risk for foot ulceration. Biomechanical deformities and PAD predominated as the most significant findings in this study. (AU)