Diabetes-specific nutrition algorithm: a transcultural program to optimize diabetes and prediabetes care.

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports.

Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic: Systematic review with network meta-analysis.

BACKGROUND: 5% to 40% of infants cry excessively, usually accompanied by fussiness and excessive of gas. There are no uniform criteria for treatment of infantile colic. Lactobacillus reuteri DSM 17938 has been used with promising results. The objective of this network-meta-analysis (NMA) is to compare the efficacy of L reuteri DSM 17938 with other interventions for infantile colic. METHODS: RCTs, published between 1960 and 2015 for the treatment of infantile colic were included. Primary outcome was duration of crying after 21 to 28 days of treatment. Different databases were searched. Information was analyzed using control group as central axis. A random effect model was used. Hedges standard mean difference (SMD) and odds ratio (OR) were calculated. A SUCRA analysis was performed to evaluate superiority for each intervention. RESULTS: 32 RCTs were analyzed, including 2242 patients. Studies with L reuteri DSM 17938 versus Ctrl., Diet versus Ctrl. and Acupuncture versus Ctrl. were the most influential studies in the NMA. L reuteri DSM 17938 [WMD -51.3 h (CI95% -72.2 to -30.5 h), P .0001] and dietetic approaches [WMD -37.4 h (CI95% -56.1 to -18.7 h), P .0001] were superior compared to the other treatments. CONCLUSIONS: L reuteri DSM 17938 and some dietetic approaches are better to other interventions for treatment of infantile colic.

Pseudoquiste de páncreas, infección primaria por Torulopsis glabrata. Reporte de un caso / Pancreatic pesudocyst, primary infection by Torulopsis glabrata. Report of a case

Antecedentes: T. glabrata es un hongo saprófito, que se ha considerado en los últimos años como un agente patógeno en el pseudoquiste de páncreas. Se han reportado únicamente tres casos en la literatura mundial. objetivo: presentar un nuevo caso de un paciente con pseudoquiste de páncreas cuya causa de infección primaria y sepsis fue T. glabrata; analizar los posibles factores que favorecen la infección, así como revisar la literatura de los casos hasta hoy día registrados. Informe del caso: se presenta la evolución clínica de una paciente posoperada de colecistectomía convencional con exploración de vías biliares y colocación de sonda en T, secundaria a coledocoliatiasis; la cual desarrolló pancreatitis aguda días despu,s de habérsele realizado una CPRE para tratamiento de litiasis residual, después de lo cual recibió manejo con antibióticos de amplio espectro y NPT; posteriormente se complicó con pseudoquiste de páncreas, el cual fue diagnosticado por TAC y manejado de inicio con punción percutánea en que se identificó la T. glabrata. En una recidiva posterior del seudoquiste, con manifestaciones de sepsis se halló el microorganismo descrito como único agente responsable. Conclusiones: la instrumentación del árbol pancreato-biliar, así como la terapia prolongada con antibióticos de amplio espectro y con NPT, fueron los medios que se asociaron como factores de riesgo para la infección por T. glabrata, así como para que este hongo cambiara su comportamiento biológico de comensal a patógeno. Se le deberá considerar como un agente potencialmente patógeno en pacientes que reciban este tipo de terapia y que cursen con pseudoquiste de páncreas, para reconocerlos de forma oportuna e iniciar la terapia conveniente.