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.

Manejo intraparto del tabique vaginal longitudinal / Intrapartum management of a longitudinal vaginal septum

RESUMEN El tabique vaginal congénito longitudinal (TVCL) es un defecto que puede asociarse a dispareunia o distocia durante el parto. Se presenta el caso de una mujer secundigesta nulípara de 20 años en quien se identificó un TVCL durante trabajo de parto. En el tacto vaginal se palpó una estructura elástica de aproximadamente 2 cm por detrás del introito vaginal. Durante la segunda etapa del trabajo de parto, se realizó una sección medial del tabique permitiendo el nacimiento de un producto vivo. En conclusión, un examen físico exhaustivo es suficiente para evidenciar la presencia de un tabique vaginal; sin embargo, existe la probabilidad de un diagnóstico intraparto de TVCL donde la formación médica ginecológica es necesaria para minimizar los riesgos asociados al parto.

ABSTRACT The longitudinal congenital vaginal septum (LCVS) is a defect that can be associated with dyspareunia or dystocia during childbirth. We present a case of a 20 year old woman in whom a LCVS was identified during labor. In the pelvic examination, an elastic structure was felt about 2 cm behind the vaginal intro. During the second stage of labor, a medial section of the septum was made allowing the birth of a live female product. In conclusion, a thorough physical examination is enough to show the presence of a vaginal septum. However, there is a probability of an intrapartum diagnosis of LCVS therefore gynecological medical training is necessary to minimize the risks associated with childbirth.