Factores asociados al éxito de la cirugía revascularizadora en diabéticos con isquemia crítica crónica de las extremidades / Factors associated with the success of revascularization surgery in diabetic patients with chronic critical limb ischemia

Introducción: La cirugía revascularizadora es una de las estrategias fundamentales para el tratamiento de la isquemia crítica crónica de los miembros inferiores. Objetivo: Identificar los factores asociados al éxito de la cirugía revascularizadora de los miembros inferiores en diabéticos con isquemia crítica crónica. Métodos: Se realizó un estudio descriptivo, prospectivo y de tipo cohorte en pacientes diabéticos sometidos a una cirugía revascularizadora, por presentar isquemia crítica crónica de la extremidad. Estos fueron seguidos durante seis meses en el Instituto Nacional de Angiología y Cirugía Vascular entre septiembre de 2019 y enero de 2021. La variable principal de salida resultó los factores pronosticadores del éxito de la cirugía, la cual se consideró exitosa cuando el paciente permaneció vivo y sin una amputación mayor. Resultados: Se incluyeron 50 pacientes con una edad promedio de 64 ± 10,21 años y un 24 por ciento de mujeres. El 88 por ciento fueron fumadores; y el 78 por ciento, hipertensos. La efectividad global de la cirugía resultó del 64 por ciento (IC al 95 por ciento 50 por ciento-78 por ciento). Solamente el sexo femenino, con una probabilidad de 0,053 y un Odds Ratio de 4,23; el antecedente de enfermedad cerebrovascular (p: 0,13 y OR: 6,98); y la infección (p: 0,18 y OR: 2,7) mostraron una tendencia a asociarse de forma estadísticamente significativa con el éxito de la cirugía. Conclusiones: El sexo femenino, el antecedente de enfermedad cerebrovascular y la presencia de infección fueron los principales candidatos para estudiarse como variables pronosticadoras del éxito de la cirugía revascularizadora(AU)

Introduction: Revascularizing surgery is one of the fundamental strategies for the treatment of chronic critical ischemia of the lower limbs. Objective: To identify the factors associated with the success of lower limb revascularization surgery in diabetics with chronic critical ischemia. Methods: A descriptive, prospective, cohort-type study was conducted in diabetic patients undergoing revascularization surgery due to chronic critical limb ischemia. The patients were followed for six months at the National Institute of Angiology and Vascular Surgery from September 2019 to January 2021. The primary endpoint variable was the predictor of the success of surgery, which was considered successful when the patient remained alive and without major amputations. Results: 50 patients with an average age of 64 ± 10.21 years and 24 percent women were included. 88 percent of the patients were smokers; and 78 percent hypertensive ones. The overall effectiveness of surgery was 64 percent (95 percent CI 50 percent-78 percent). Only the female sex, with a probability of 0.053 and an Odds Ratio of 4.23, history of cerebrovascular disease (p: 0.13 and OR: 6.98); and infection (p: 0.18 and OR: 2.7) showed a tendency to be statistically, significantly associated with the success of surgery. Conclusions: Female sex, history of cerebrovascular disease and presence of infection were the main candidates as prognostic variables of the success of revascularizing surgery(AU)

Perfil epidemiológico de pacientes atendidos en la consulta de pie diabético / Epidemiological profile of patients attended in the diabetic foot consultation

Introducción: El pie diabético tiene etiología multifactorial, con una prevalencia mundial de entre 1,3-4,8 por 100 mil habitantes. Objetivo: Identificar las principales características epidemiológicas de los pacientes con pie diabético. Métodos: Se realizó un estudio observacional descriptivo, de tipo serie de casos, en el Policlínico Docente "Área Este" de Camagüey, para analizar el quinquenio 2017-2021. Del universo de 301 pacientes fue seleccionada una muestra de 250. Se estudiaron las variables: grupo etario, sexo, años de evolución de la enfermedad, tipo de lesión desencadenante, factores de riesgo, tipo de úlceras y derivación a la atención secundaria. Para el procesamiento de los datos se empleó SPSS y los resultados se expresaron en valores absolutos y porcentajes. Resultados: Se obtuvo predominio del grupo etario 60 años y más (47,6 por ciento), y del sexo masculino (52,8 por ciento), con diabetes mellitus de evolución de 15 años y más (40,8 por ciento), heridas como lesión desencadenante (27,2 por ciento), hiperglucemia (70 por ciento), hipertensión arterial (81,2 por ciento), úlcera neuropática (48,0 por ciento), con necesidad de atención secundaria y necrectomía (48,4 por ciento). Conclusiones: En la serie estudiada se identificó un predominio del sexo masculino, la edad avanzada, y el antecedente de diabetes de larga evolución y de haber sufrido herida en el pie al momento de presentar hiperglucemia(AU)

Introduction: Diabetic foot has multifactorial etiology, with a worldwide prevalence of 1.3-4.8 per 100 000 inhabitants. Objective: To identify the main epidemiological characteristics of patients with diabetic foot. Methods: A descriptive observational study of case series type was carried out in the "East Area" Teaching Polyclinic of Camagüey, to analyze the five-year period 2017-2021. From the universe of 301 patients, a sample of 250 was selected. The following variables were studied: age group, sex, years of disease evolution, type of triggering lesion, risk factors, type of ulcers and referral to secondary care. SPSS was used for data processing and the results were expressed in absolute values and percentages. Results: There was a predominance of the age group 60 years and older (47.6 percent), and of the male sex (52.8 percent), diabetes mellitus with evolution of 15 years and more (40.8 percent), wounds as triggering lesion (27.2 percent), hyperglycemia (70 percent), hypertension (81.2 percent), neuropathic ulcer (48.0 percent), and with need for secondary care and necroctomy (48.4 percent). Conclusions: In the series studied, a predominance of male sex, advanced age, and a history of long-term diabetes and having suffered a foot injury at the time of hyperglycemia were identified(AU)

Achados tomográficos incidentais de calcificações coronarianas: um estudo de prevalência na região sul do Brasil / Incidental tomographic findings of coronary artery calcifications: a prevalence study in southern Brazil

Fundamento: As calcificações de artérias coronárias (CAC) mostram-se como fator preditivo de doenças cardiovasculares (DCV). A tomografia computadorizada (TC) de tórax com protocolo de aquisição de baixa dose apresenta acurácia na identificação de CAC e propicia achados incidentais dessas calcificações, que são comumente negligenciados. Este estudo analisará a prevalência de achados incidentais de calcificação em artérias coronárias em indivíduos não cardiopatas submetidos à TC de tórax. Métodos: Estudo transversal consecutivo de caráter analítico e descritivo. Foram incluídos indivíduos de ambos os sexos que realizaram TC de tórax por encaminhamento, acima de 18 anos e não cardiopatas. A coleta de dados foi realizada por meio de prontuários e ficha de anamnese auto aplicada. As variáveis referentes às CAC e à extensão do comprometimento foram obtidas a partir da reavaliação das imagens de TC de tórax disponíveis no sistema da instituição. Os exames foram anonimizados e avaliados por dois médicos radiologistas experientes. Considerou-se como estatisticamente significativo p≤0,05. Resultados: Foram analisados 397 exames. Encontrou-se prevalência de calcificações em 176 (44%) dos casos. A existência dessas calcificações coronárias está relacionada à idade (p<0,001). As calcificações possuem relação com o sexo (p = 0,03) com maior razão de chance de desenvolvimento em homens (odds ratio [OR] = 1,55). O tabagismo (p<0,001), o sedentarismo (p<0,001), a hipertensão arterial sistêmica (p<0,001), o diabetes mellitus (p = 0,04) e as dislipidemias (p<0,001) mostraram associação positiva. Conclusão: A prevalência de achados incidentais de CAC foi de 44%; variam em maior número entre leve e grave; maior razão de chance no sexo masculino e aumento da prevalência com a idade. Portanto, a TC de tórax mostra-se um efetivo método para avaliar as CAC, e juntamente com a história clínica do paciente pode ser utilizada para medir os fatores de risco para doenças cardiovasculares e intervir no desfecho do quadro.(AU)

Introduction: Coronary artery calcifications (CAC) are shown to be a predictive factor of cardiovascular diseases. Computed tomography (CT) of the chest with a low-dose acquisition protocol is accurate in identifying CAC and provides incidental findings of these calcifications, which are commonly overlooked. This study will analyze the prevalence of incidental findings of calcification in coronary arteries in non-cardiac individuals undergoing chest CT. Methods: Consecutive cross-sectional study of an analytical and descriptive nature. Individuals of both genders who underwent chest CT by referral, over 18 years of age and without heart disease were included. Data collection was carried out using medical records and a self-applied anamnesis form. The variables referring to the CAC and the extension of the impairment were obtained from the reassessment of the chest CT images available in the institution's system. The exams were anonymized and evaluated by two experienced radiologists. P≤0.05 was considered statistically significant. Results: 397 exams were analyzed. A prevalence of calcifications was found in 176 (44%) of the cases. The existence of these coronary calcifications is related to age (p<0.001). Calcifications are related to gender (p = 0.03) with a higher odds ratio of development in men (odds ratio [OR] = 1.55). Smoking (p<0.001), sedentary lifestyle (p<0.001), systemic arterial hypertension (p<0.001), Diabetes Mellitus (p = 0.04), and dyslipidemia (p<0.001) showed a positive association. Conclusion: The prevalence of incidental CAC findings was 44%; vary in greater numbers between mild and severe; higher odds ratio in males and increased prevalence with age. Therefore, chest CT proves to be an effective method to assess CAC, and together with the patient's clinical history, it can be used to measure risk factors for CVD and intervene in the outcome of the condition.(AU)

Sex- and age-specific impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus in the development of disabling dementia in a Japanese population

BACKGROUND@#Sex- and age-specific impacts of cardiovascular risk factors on the development of dementia have not been well evaluated. We investigated these impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus on the risk of disabling dementia.@*METHODS@#The study participants were 25,029 (10,134 men and 14,895 women) Japanese aged 40-74 years without disabling dementia at baseline (2008-2013). They were assessed on smoking status (non-current or current), overweight/obesity (body mass index ≥25 kg/m2 and ≥30 kg/m2, respectively), hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or any antihypertensive medication use), and diabetes mellitus (a fasting serum glucose ≥126 mg/dL, non-fasting glucose ≥200 mg/dL, hemoglobin A1c ≥6.5% by the National Glycohemoglobin Standardization Program or glucose-lowering medication use) at baseline. Disabling dementia was identified as the level of care required ≥1 and cognitive disability grade ≥IIa according to the National Long-term Care Insurance Database. We used a Cox proportional regression model to estimate hazard ratios and 95% confidence intervals (95% CIs) of disabling dementia according to the cardiovascular risk factors and calculated the population attributable fractions (PAFs).@*RESULTS@#During a median follow-up of 9.1 years, 1,322 (606 men and 716 women) developed disabling dementia. Current smoking and hypertension were associated with a higher risk of disabling dementia in both sexes, whereas overweight or obesity was not associated with the risk in either sex. Diabetes mellitus was associated with a higher risk only in women (p for sex interaction = 0.04). The significant PAFs were 13% for smoking and 14% for hypertension in men and 3% for smoking, 12% for hypertension, and 5% for diabetes mellitus in women. The total PAFs of the significant risk factors were 28% in men and 20% in women. When stratified by age, hypertension in midlife (40-64 years) was associated with the increased risk in men, while diabetes mellitus in later-life (65-74 years) was so in women.@*CONCLUSIONS@#A substantial burden of disabling dementia was attributable to smoking, and hypertension in both sexes and diabetes mellitus in women, which may require the management of these cardiovascular risk factors to prevent dementia.

Características clínicas y epidemiológicas de la COVID-19 en personas con diabetes / Clinical and epidemiological characteristics of COVID-19 in people with diabetes

Introducción: En diciembre de 2019, el nuevo coronavirus (SARS-CoV-2), causante de la enfermedad conocida como COVID-19, fue identificado en Wuhan, China. La diabetes es una de las comorbilidades más frecuentes en personas con COVID-19, al reportar una prevalencia entre 7 por ciento y 30 por ciento. Objetivo: Describir las características clínicas y epidemiológicas de la COVID-19 en personas con diabetes. Métodos: Se realizó un estudio descriptivo-retrospectivo de corte transversal en 54 personas con diabetes mellitus, egresados de la Sala "Elpidio Sosa", perteneciente al Instituto Nacional de Angiología y Cirugía Vascular, con el diagnóstico de COVID-19 confirmado por PCR-RT durante los meses desde enero hasta octubre de 2021. Se procedió a la revisión de las historias clínicas y se obtuvieron las variables grupos de edad, sexo, color de la piel, comorbilidades asociadas en las personas diabéticas y manifestaciones clínicas de la COVID-19. Resultados: Predominaron las personas del grupo de edad 70 años y más con 19 casos para un 35,2 por ciento, fundamentalmente del sexo femenino (64,8 por ciento) y color de la piel blanca (72,2 por ciento). Las comorbilidades asociadas más frecuentes fueron la hipertensión arterial con 40 casos (74,07 por ciento) y la cardiopatía isquémica (12 pacientes) para un 22,2 por ciento. Sobresalieron como manifestaciones clínicas de la COVID-19, la tos seca (51,85 por ciento), la fiebre (29,6 por ciento) y el decaimiento (25,9 por ciento). Conclusiones: Prevalecieron las personas diabéticas con manifestaciones clínicas floridas de la COVID-19 y múltiples comorbilidades asociadas(AU)

Introduction: In December 2019, the new coronavirus (SARS-CoV-2), which causes the disease known as COVID-19, was identified in Wuhan, China. Diabetes is one of the most frequent comorbidities in people with COVID-19, reporting a prevalence between 7% and 30%. Objective: To describe the clinical and epidemiological characteristics of COVID-19 in people with diabetes. Methods: A cross-sectional descriptive-retrospective study was conducted in 54 people with diabetes mellitus discharged from "Elpidio Sosa" Room, belonging to the National Institute of Angiology and Vascular Surgery, with the diagnosis of COVID-19 confirmed by PCR-RT from January to October 2021. The medical records were reviewed and the following variables were obtained: age groups, sex, skin color, associated comorbidities in diabetic people and clinical manifestations of COVID-19. Results: People aged 70 years and over predominated with 19 cases for 35.2 percent, mainly female (64.8 percent) and white skin color (72.2 percent). The most frequent associated comorbidities were arterial hypertension with 40 cases (74.07 percent) and ischemic heart disease (12 patients) for 22.2 percent. Dry cough (51.85 percent), fever (29.6 percent) and decay (25.9 percent) stood out as clinical manifestations of COVID-19. Conclusions: Diabetic people with varied clinical manifestations of COVID-19 and multiple associated comorbidities prevailed(AU)

Microbiota conjuntival preoperatoria de pacientes diabéticos candidatos a cirugía de catarata / Preoperative Conjunctival Microbiota of Diabetic Patients who are Candidates for Cataract Surgery

Introducción: La microbiota conjuntival en pacientes con catarata puede afectar el posoperatorio, lo que se puede hacer más complejo en pacientes con diabetes mellitus. Objetivos: Determinar la microbiota conjuntival en los pacientes diabéticos de la línea preoperatoria pendiente a cirugía de catarata en el Instituto Cubano Oftalmología "Ramón Pando Ferrer" desde septiembre de 2018 hasta diciembre de 2019. Método: Se realizó una investigación observacional, descriptiva, de corte transversal con 45 pacientes diabéticos diagnosticados de catarata senil, que fueran atendidos en el período y hospital antes mencionado. A todos los pacientes se les realizó hisopado conjuntival en cultivo correspondiente. Se realizó anamnesis para recoger datos sobre la diabetes. Los datos obtenidos (matriz en Excel) se analizaron con software SPSS 21, y los resultados se presentan en tablas de frecuencias. Se utilizó ji cuadrado para la correlación entre variables. Resultados: De los 45 pacientes, predominaron las mujeres (57,8 por ciento), con edades de 60 años y más (68,9 por ciento), y sin antecedentes patológicos oculares (82,2 por ciento). Hubo crecimiento bacteriano en el 66,7 por ciento (p < 0,002). El germen más frecuente fue Staphylococcus coagulasa negativa (48,3 por ciento). Conclusiones: El estudio de la microbiota conjuntival preoperatoria garantiza, en parte, el éxito de la cirugía de catarata(AU)

Introduction: The conjunctival microbiota in cataract patients may affect the postoperative course, which may become more complex in patients with diabetes mellitus. Objectives: To determine the conjunctival microbiota in diabetic patients in the preoperative line pending cataract surgery at the Cuban Ophthalmology Institute "Ramón Pando Ferrer" from September 2018-2019. Methods: An observational, descriptive, cross-sectional, descriptive research was conducted, 45 diabetic patients, diagnosed with senile cataract, who were treated in the period and hospital mentioned above. All patients underwent conjunctival swabbing and corresponding culture. Anamnesis was performed to collect data on diabetes. The data obtained (matrix in Excel) were analyzed with SPSS 21 software, and the results were presented in frequency tables. Chi-square was used for correlation between variables. Results: Out of the 45 patients, women predominated (57.8 percent), aged 60 years and older (68.9 percent), and with no ocular pathological history (82.2 percent). There was bacterial growth in 66.7 percent (p < 0.002). The most frequent germ was coagulase-negative Staphylococcus (48.3 percent). Conclusions: The study of the preoperative conjunctival microbiota, guarantees, in part, the success of cataract surgery(AU)

Fatores desencadeantes para limitações sociais e saúde mental em diabéticos / Triggering factors for social limitations and mental health in diabetics / Factores desencadenantes de limitaciones sociales y salud mental en diabéticos

Introdução:A Diabetes Mellitus é caracterizada como uma síndrome de múltiplas etiologias, que ocorre pela falta de insulina, ou resistência do organismo à mesma, estando relacionada à diversas complicações que demandam ao paciente adaptações no modo de viver e que podem ser geradores de sofrimento psicológico. Objetivo:Identificar os principais fatores desencadeantes para a ocorrência de limitações sociais e suas consequências na saúde mental de pacientes convivendo com diabetes. Metodologia:O estudo configura-se como revisão integrativa da literatura. Utilizou-se como critérios de inclusão: artigos completos, publicados de 2015 a 2020, nos idiomas inglês, português e espanhol. Foram excluídos: documentos de editoriais, revisões, resenhas, capítulos de livros e artigos que não atendessem ao objetivo proposto. A busca dos estudos se deu entre os meses de outubro a novembro de 2020 nas bases de dados: PubMed,CinahleEmbase. Foram utilizados descritores controlados identificados nos Descritores em CiênciasdaSaúde (DECs), Medical Subject Headings (MESH) e EMBASEEmtree, resultando em 2.063 estudos na identificação, passando por triagem e permanecendo 718, após a elegibilidade resultou em 12, dando origem a 9 estudos na amostra final. Resultados:A amostra final resultou na criação de eixos temáticos que trazem o aumento do sofrimento psicológico em pessoas com diabetes ocasionados pelas mudanças no estilo de vida, na falta de apoio familiar e social, na inatividade física, no impacto do gênero e da cultura, e no aumento dos sintomas de complicações e de comprometimento funcional, sendo desencadeantes para a ocorrência de limitações sociais. Conclusões:A diabetes e o seu tratamento geram limitações sociais na vida dos pacientes, pela necessidade de mudanças no estilo devida que demandam muita dedicação e tempo, tais fatores são considerados preditores para aumento dos riscos de sofrimento psicológico nesses pacientes (AU).

Introduction:Diabetes Mellitus is characterized by being a syndrome of multiple etiologies, which occurs due to the lack of insulin or the body's resistance to it, being related to various complications that require the patient to adapt their lifestyle and that can generate psychological suffering.Objective:Identify the main triggering factors for the occurrence of social limitations and their consequences on the mental health of patients living with diabetes.Method:This study is configured as an integrative review of the literature. The inclusion criteria were full articles, published from 2015 to 2020, in English, Portuguese and Spanish.Editorial documents, reviews, book chapters and articles that did not meet theproposed objective were excluded.The compilation of studies was carried out from October and November 2020 in the databases:PubMed, CinahlandEmbase. In addition, controlled descriptors identified in the Descriptors in Health Sciences (DECs), MESH and EMBASE Emtree were used, which resulted in 2,063 studies identified, submitted for selection, remaining 718, and 12 after the eligibility process, resulting in 9 studies in the final sample.Results:The final sample resulted in the creation of thematic axes that bring an increase in psychological suffering in people with diabetes caused by changes in their lifestyle, lack of family and social support, physical inactivity, impact of gender and culture, and the increase in symptoms of complications and functional impairment, triggering the occurrence of social limitations.Conclusion:Diabetes and its treatment generate social limitations in the lives of patients, due to the need for changes in their lifestyle that require a lot of dedication and time, such factors are considered predictors to increase the risks of psychological suffering in these patients (AU).

Introducción:La Diabetes Mellitus se caracteriza por ser un síndrome de múltiples etiologías, que se presenta por la falta de insulina o por la resistencia del organismo a esta, estando relacionada con diversas complicaciones que requieren del paciente adaptaciones ensumodo de vida y que pueden generar sufrimientopsicológico.Objetivo:Identificar los principales factores desencadenantes parala ocurrenciade limitaciones sociales y sus consecuencias enla salud mental de los pacientes que viven con diabetes.Metodología:Esteestudio se configura como una revisión integradora de la literatura. Se incluyeron: artículos completos, publicados de 2015 a 2020, en inglés, portugués y español.Se excluyeron: documentos editoriales, reseñas, capítulos de libros y artículos que no cumplieron con el objetivo propuesto.El compilado de estudiosse realizóde octubre y noviembre de 2020 en las bases de datos:Medline (PubMed®), CINAHL yEMBASE.Se utilizaron descriptores controlados identificados en los Descriptores enCiencias de la Salud (DECs), MESH y EMBASE Emtree, lo que resultó en 2.063 estudios identificados, sometidos a selección, quedando 718,y resultando, luego del procesode elegibilidad,en 12, dando lugar a 9 estudios en la muestrafinal. Resultados:La muestra final resultó en la creación de ejes temáticos que traen un aumento del sufrimiento psicológico en las personas con diabetes provocado por cambios en suestilo de vida, la falta de apoyo familiar y social, inactividad física, impacto del género y la cultura, y el aumento de los síntomas de complicaciones y deterioro funcional, desencadenando la ocurrencia de limitaciones sociales.Conclusiones:La diabetes y su tratamiento generan limitaciones sociales en la vida de los pacientes, debido a la necesidad de cambios en suestilo de vida que requieren mucha dedicación y tiempo, tales factores se consideran predictores para aumentar los riesgos de sufrimiento psicológico en estos pacientes (AU).

Enfermedad coronaria: factores de riesgo y supervivencia a 10 años en la cirugía coronaria / Risk factors associated with 10-year survival after coronary artery bypass grafting

Background: Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. Aim: To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. Material and Methods: Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. Results: Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. Conclusions: These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Excursão sistólica do anel tricúspide e do anel mitral: correlação com função diastólica ventricular esquerda / Tricuspid annular plane systolic excursion and mitral annular systolic excursion: correlation with left ventricular diastolic function

Introdução: A excursão sistólica do anel tricúspide e a do anel mitral são parâmetros utilizados para se avaliar a função contrátil do ventrículo direito e do ventrículo esquerdo, respectivamente. Pouco se conhece sobre sua relação com a função diastólica ventricular esquerda. Objetivo: Avaliar se os valores de excursão sistólica do anel tricúspide e do anel mitral se correlacionam com parâmetros utilizados na avaliação da função diastólica ventricular esquerda. Métodos: Estudo observacional transversal. Foram selecionados 219 indivíduos, sendo 116 mulheres, com função sistólica preservada de ambos os ventrículos. As análises foram feitas separadamente para os sexos masculino e feminino, por meio dos coeficientes de correlação de Pearson e de Sperman. Foram obtidos: excursão sistólica do anel tricúspide, excursão sistólica do anel mitral, volumes atriais e medidas relacionadas à avaliação da função diastólica do ventrículo esquerdo ao ecocardiograma transtorácico. Resultados: No sexo feminino, a excursão sistólica do anel mitral se correlacionou positivamente com o e' lateral (coeficiente de correlação de Sperman de 0,22; p=0,016) e a excursão sistólica do anel tricúspide se correlacionou positivamente com a relação E/A (coeficiente de correlação de Sperman de 0,23, p=0,037), com o e' lateral (coeficiente de correlação de Sperman de 0,28; p=0,012), com o e' septal (coeficiente de correlação de Sperman de 0,28; p=0,012) e negativamente com a relação E/e' (coeficiente de correlação de Pearson de -0,27; p=0,018) e onda A (coeficiente de correlação de Pearson de -0,29; p= 0,009). No sexo masculino, apenas a excursão sistólica do anel mitral se correlacionou positivamente com a onda E (coeficiente de correlação de Pearson de 0,21; p=0,037), e' lateral (coeficiente de correlação de Sperman de 0,34; p <0,001) e e' septal (coeficiente de correlação de Sperman de 0,26; p=0,008). Não houve correlação entre excursão sistólica do anel mitral e do anel tricúspide e volumes atriais. A presença de hipertensão arterial sistêmica e diabetes melito influenciou nos valores de excursão sistólica do anel tricúspide e do anel mitral correlacionados a ondas E e A, relação E/A, ondas e' septal e lateral e relação E/e'. Conclusão: No presente estudo, os valores da excursão sistólica do anel mitral e do anel tricúspide apresentaram correlação significativa com algumas variáveis da função diastólica ventricular esquerda com maior evidência no sexo feminino.(AU)

Introduction: Tricuspid annular plane systolic excursion and mitral annular systolic excursion are parameters used to assess the systolic function of the right ventricle and left ventricle, respectively. Little is known about its relationship with left ventricular diastolic function. Objective: To assess whether the values of mitral annular systolic excursion and tricuspid annular plane systolic excursion correlate with parameters used in the evaluation of left ventricular diastolic function. Method: Observational cross-sectional study. Two hundred nine individuals were selected, 116 women, with both ventricles normal systolic function. The analyzes were performed for men and women, through Pearson correlation coefficient and Sperman correlation coefficient. Tricuspid annular plane systolic excursion, mitral annular systolic excursion, atrial volumes and left ventricular diastolic function parameters on transthoracic echocardiogram were obtained. Results: In women, mitral annular systolic excursion was positively correlated with lateral e '(Sperman correlation coefficient of 0.22; p=0.016) and tricuspid annular plane systolic excursion was positively correlated with E / A ratio (Sperman correlation coefficient of 0.23; p=0.037), lateral e' (Sperman correlation coefficient of 0.28; p=0.012), and septal e' (Sperman correlation coefficient of 0.28; p=0.012), and negatively with the E/e' ratio (Pearson correlation coefficient of -0.27; p=0.018), and A wave (Pearson correlation coefficient of -0.29; p=0.009). In men, only mitral annular systolic excursion correlated positively with E wave (Pearson correlation coefficient of 0.21; p=0.037), lateral e' (Sperman correlation coefficient of 0.34; p <0.001) and the septal e' (Sperman correlation coefficient of 0.26; p=0.008). There was no correlation between mitral annular systolic excursion E and tricuspid annular plane systolic excursion and atrial volumes. Hypertension and diabetes mellitus influenced tricuspid annular plane systolic excursion and mitral annular systolic excursion values correlated to E and A waves, E/A ratio, septal and lateral e' waves, and E/e' ratio. Conclusion: In the present study, mitral annular systolic excursion and tricuspid annular plane systolic excursion values showed a significant correlation with some parameters of left ventricular diastolic function, with stronger evidence on female sex.(AU)

Tasa de mortalidad de personas con pie diabético en La Habana durante el periodo 2010-2015 / Mortality for Diabetic Foot in People with Diabetes Mellitus in Havana during the 2010-2015 Period

Introducción: Se define como pie diabético toda infección, úlcera o destrucción tisular del pie asociada a neuropatía y/o enfermedad vascular periférica de miembros inferiores en personas con diabetes. Objetivo: Determinar la tasa de mortalidad en personas con pie diabético en La Habana durante el período 2010-2015, así como las causas y las variables sociodemográficas de los fallecidos. Método: Estudio observacional, descriptivo y retrospectivo. Se revisó el registro de fallecidos por diabetes mellitus en La Habana como causa básica de muerte de los años comprendidos del 2010 al 2015, Se analizaron las variables edad, sexo, causa básica de muerte, amputaciones y municipio de procedencia. Los resultados se expresaron en frecuencias absolutas, relativas y tasas por 100 000 habitantes. Resultados: La tasa de mortalidad en personas con pie diabético fue de 3,07/105 habitantes. El año de mayor mortalidad fue el 2010 (10,41 por ciento) y el de menor fue el 2011 (7,34 por ciento). Predominaron las mujeres (56 por ciento) y los mayores de 70 años (66,5 por ciento). En el 48,5 por ciento de los casos se reportaron amputaciones. Las causas directas de muerte más frecuente fueron: la sepsis (34,5 por ciento), el tromboembolismo pulmonar (32,2 por ciento) y la bronconeumonía (21,1 por ciento). Los municipios con menores tasas de fallecidos fueron La Habana Vieja y Arroyo Naranjo. Conclusiones: La tasa de mortalidad en personas con pie diabético en el período 2010-2015 tuvieron una tendencia a la disminución. Las cifras más elevadas se observaron en la edad y en el sexo femenino. Las infecciones, el tromboembolismo pulmonar y la bronconeumonía fueron las causas de muerte directa más importantes(AU)

Introduction: Mortality due to diabetes mellitus may rise due to an increase in its prevalence and the risk of chronic complications. Objective: To determine the mortality rate in people with diabetic foot in Havana during the 2010-2015 period, as well as the causes and sociodemographic variables of the deceased. Methods: Observational, descriptive and retrospective study. The registry of deaths from diabetes mellitus as the basic cause of death from 2010 to 2015 was reviewed. The variables age, sex, basic cause of death, amputations and municipality of origin were analyzed. The results were expressed in absolute and relative frequencies, as well as in rates per hundred thousand inhabitants. Results: The mortality rate in people with diabetic foot was 3.07/105 inhabitants. The year with the highest mortality was 2010 (10.41 percent) and the year with the lowest value was 2011 (7.34 percent). Women (56 percent) and those aged over seventy years (66.5 percent) predominated. In 48.5 percent of the cases accounted for amputations. The most frequent direct causes of death were sepsis (34.5 percent), pulmonary thromboembolism (32.2 percent) and bronchopneumonia (21.1 percent). The municipalities with the lowest death rates were La Habana Vieja and Arroyo Naranjo. Conclusions: Mortality rates in people with diabetic foot in the 2010-2015 period tended to decrease. The highest figures were observed in geriatric ages and among women. Infections, pulmonary embolism and bronchopneumonia were the most important direct causes of death(AU)

Infecciones asociadas a la atención sanitaria en el Instituto Nacional de Angiología y Cirugía Vascular / Infections associated with health care at the National Institute of Angiology and Vascular Surgery

Introducción: Las infecciones asociadas a la asistencia sanitaria constituyen un problema de salud. Objetivo: Caracterizar las infecciones asociadas a la asistencia sanitaria en los tres servicios del Instituto Nacional de Angiología y Cirugía Vascular durante 2019. Métodos: Estudio longitudinal de epidemiología clínica en 89 pacientes ingresados en 2019, a los que se les diagnosticó una infección asociada a la asistencia sanitaria. Las variables de estudio fueron: edad, sexo, meses del año, servicio asistencial, enfermedades asociadas, gérmenes más frecuentes y principales localizaciones. Se calcularon las frecuencias absolutas y relativas. Resultados: Se encontró una tasa porcentual acumulada de 6,6 por cada 100 egresos, con predominio del sexo masculino y mayor frecuencia en los pacientes de la quinta década de vida. La herida quirúrgica contribuyó con 43 casos de los 89 reportados, seguida por la bronconeumonía bacteriana con 18. La principal enfermedad asociada fue la diabetes mellitus y los gérmenes más frecuentes aislados resultaron Stafilococus aureus, Pseudomona sp y Acinetobacter bawmani. Conclusiones: La tasa de incidencia de infecciones asociadas a la asistencia sanitaria en el Instituto Nacional de Angiología y Cirugía Vascular durante 2019 no difiere de las presentadas en años anteriores y se corresponden con los reportes internacionales(AU)

Introduction: Health care associated infections are a health problem. Objective: Characterize healthcare associated infections in the three services of the National Institute of Angiology and Vascular Surgery during 2019. Methods: Longitudinal study of clinical epidemiology in 89 patients admitted in 2019, who were diagnosed with an infection associated with health care. The study variables were: age, sex, months of the year, care service, associated diseases, more frequent germs and main locations. Absolute and relative frequencies were calculated. Results: A cumulative percentage rate of 6.6 per 100 discharges was found, with male predominance and higher frequency in patients in the fifth decade of life. The surgical wound was present in 43 of the 89 cases reported, followed by bacterial bronchopneumonie with 18. The main associated disease was diabetes mellitus and the most common isolated germs were Stafilococus aureus, Pseudomonasp and Acinetobacter baumannii. Conclusions: The incidence rate of healthcare associated infections at the National Institute of Angiology and Vascular Surgery during 2019 does not differ from those presented in previous years and corresponds to international reports(AU)

Enfermedad cardiovascular aterosclerótica según el sexo en personas de edad mediana con diabetes mellitus / Atherosclerotic cardiovascular disease according to sex in middle-aged people with diabetes mellitus

Introducción: El sexo influye en la susceptibilidad de las personas de ambos géneros con relación a la mayoría de las enfermedades comunes, incluidas la diabetes mellitus y la aterosclerosis. Objetivo: Identificar si existen diferencias en la presentación de la enfermedad cardiovascular aterosclerótica entre hombres y mujeres de edad mediana con diabetes mellitus. Métodos: Se realizó un estudio descriptivo de corte transversal en 1449 pacientes con diabetes mellitus en edad mediana (40 a 59 años) que ingresaron en el Centro de Atención al Diabético de Bayamo, Granma, desde el año 2010 al 2019. Se empleó la prueba de Chi Cuadrado para comprobar la relación entre las variables cualitativas, y T de Student para comparar los valores promedio de las variables cuantitativas. Resultados: La proporción de enfermedad cardiovascular aterosclerótica en el sexo masculino fue similar a la del femenino (51,4 por ciento x 48,6 por ciento, p=0.2328). No hubo discrepancias importantes en el porcentaje de la enfermedad, entre ambos sexos, en los diferentes grupos etarios. El riesgo de enfermedad cardiovascular aterosclerótica en los hombres fue mayor que en las mujeres premenopausicas (OR=2,19, IC: 1,4-3,3 p=0,0002), pero inferior respecto a las posmenopáusicas. (OR=1.12, IC: 0.8-1.4, p=0.4129). El análisis multivariado mostró al tiempo de la diabetes >10 años y a la hipertensión arterial como riesgo de enfermedad cardiovascular aterosclerótica en ambos sexos. Asimismo, se evidenció en la edad mayor de 45 años en los hombres (OR=2.5, IC: 1.4-4.6) y la menopausia en las mujeres (OR=1.8, IC: 1.1-3.07). Conclusiones: La frecuencia de la enfermedad cardiovascular aterosclerótica en las personas de edad mediana con diabetes mellitus es similar en ambos sexos. El sexo masculino tiene mayor riesgo de enfermarse que las mujeres premenopausicas, pero menor que las posmenopáusicas. La hipertensión arterial y el tiempo de la diabetes son factores de riesgo comunes para uno y otro sexo(AU)

Introduction: Sex influences the susceptibility of people of both genders to most common diseases, including diabetes mellitus (DM) and atherosclerosis. Objective: Identify if there are differences in the presentation of atherosclerotic cardiovascular disease between middle-aged men and women with diabetes mellitus. Methods: A descriptive cross-sectional study was conducted in 1449 patients with DM in middle age (40 to 59 years) who were admitted to the Diabetic´s Care Center of Bayamo, Granma province, from 2010 to 2019. The Chi-Square test was used to check the relation between the qualitative variables, and the T Student test to compare the average values of the quantitative variables. Results: The proportion of atherosclerotic cardiovascular disease in males was similar to that of females (51.4 percent x 48.6 percent, p=0.2328). There were no major discrepancies in the percentage of atherosclerotic cardiovascular disease, between both sexes, in the different age groups. The risk of atherosclerotic cardiovascular disease in men was higher than in pre-menopausal women (OR=2.19, CI: 1.4-3.3 p=0.0002), but lower than in post-menopausal women. (OR=1.12, CI: 0.8-1.4, p=0.4129). Multivariate analysis showed diabetes >10 years and arterial hypertension as a risk of atherosclerotic cardiovascular disease in both sexes. It was also evidenced in ages over 45 years in men (OR=2.5, CI: 1.4-4.6) and menopause in women (OR=1.8, CI: 1.1-3.07). Conclusions: The frequency of atherosclerotic cardiovascular disease in middle-aged people with diabetes mellitus is similar in both sexes. Males have a higher risk of atherosclerotic cardiovascular disease than pre-menopausal women, but lower than post-menopausal women. High blood pressure and diabetes time are common risk factors for both sexes(AU)

Los cuestionarios como herramienta en la medición de la actividad física en personas con diabetes mellitus y obesidad en la población cubana / Questionnaires as a tool to measure physical activity in people with diabetes mellitus and obesity in the Cuban population

Introducción: Los cuestionarios son instrumentos estandarizados que se utilizan en la vigilancia global de la actividad física en las personas con diabetes mellitus y obesidad. Estos constituyen una técnica costo-efectiva más viable pero menos precisa en comparación con los métodos objetivos que se utilizan para medir la actividad física a nivel poblacional. Sin embargo, son la herramienta más empleada por los especialistas por su interacción directa con los pacientes que se incluyen en las investigaciones sobre la diabetes y la obesidad. Objetivos: Identificar los cuestionarios como una opción factible en Cuba para medir el nivel de actividad física en estudios epidemiológicos en personas con diabetes mellitus y obesidad. Métodos: Se realizó una revisión integradora de la bibliografía durante el periodo 2013-2020, a partir de los criterios de inclusión. La búsqueda se efectuó a través de PubMed, Cochrane, LILIACS y SciELO. Las palabras o criterios empleados fueron: actividad física, actividad física/cuestionarios, actividad física/técnicas de medición, enfermedades no transmisibles, diabetes mellitus y obesidad. Se identificaron 68 artículos, de los cuales fueron seleccionados 29 que contribuyeron al resultado final. Conclusiones: Las nuevas evidencias expuestas propician elementos sólidos para identificar los cuestionarios validados por sensores de movimiento como una opción factible que debe ser utilizada en Cuba para medir el nivel de actividad física en estudios epidemiológicos en personas con diabetes mellitus y obesidad(AU)

Introduction: The questionnaires are standardized instruments, which are used in full monitoring of physical activity in people with diabetes mellitus and obesity. They are a more viable cost-effect technique, but less precise in comparison with the objective methods that are used to measure physical activity in the population level. However, they are the most used tool by the specialists due to its direct interaction with patients included in researches on diabetes and obesity. Objectives: Identify the questionnaires as a feasible option in Cuba to measure the level of physical activity in epidemiological studies in people with diabetes mellitus and obesity. Methods: An integrative review of the bibliography was carried out from the inclusion criteria during the period 2013-2020. The search was carried out through PubMed, Cochrane, LILACS and SciELO to answer the question of the review: What is the physical activity´s measurement technique that can be used in people with diabetes mellitus and obesity in the Cuban population, taking into account the new empirical evidence on the subject? Physical activity, physical activity / questionnaires, physical activity / measurement techniques, non-communicable diseases, diabetes mellitus and obesity; were the words or criteria used. 68 articles were identified, and 29 of them were selected so, they contributed to the final result. Conclusions: The new evidences presented provide solid elements to identify the questionnaires validated by motion sensors as a feasible option that should be used in Cuba to measure the level of physical activity in epidemiological studies of people with diabetes mellitus and obesity(AU)

¿Por qué asociar la enfermedad periodontal inmunoinflamatoria crónica con el descontrol metabólico del paciente diabético? / Why to link the chronic immune-mediated inflammatory disease with the absence of metabolic control of a patient suffering from diabetes?

Introducción: La asociación entre la diabetes mellitus y las periodontopatías se ha reportado en numerosos estudios. Se acepta que la interrelación entre ambas es bidireccional. Un alto porcentaje de los estudios epidemiológicos, así como de los estudios en animales de experimentación, sugieren que la presencia de una condición tiende a aumentar el riesgo y la severidad de la otra. Objetivo: Consolidar núcleos teóricos y evidencias clínicas que esclarezcan la relación entre la enfermedad periodontal inmunoinflamatoria crónica y el descontrol metabólico del paciente diabético. Métodos: Se realizó una revisión de la literatura disponible a través de la búsqueda automatizada en las bases de datos: PubMed, Scielo y Google Académico, en el período de enero - junio de 2020. La estrategia de búsqueda se realizó a nivel de título, resumen y palabras clave de los artículos, con el uso de conectores lógicos. Se evaluaron artículos de revisión, de investigación, metaanálisis, de autores cubanos e internacionales que hicieran referencia específicamente al tema de estudio a través del título. Resultados: Fueron seleccionados 29 textos científicos, escritos en idioma español e inglés, publicados entre el año 2005 y el 2019, de los cuales 27 eran artículos científicos de revistas y 2 libros de texto. Conclusiones: La mayor parte de las publicaciones revisadas sobre el tema, avalan la relación entre enfermedad periodontal y descontrol metabólico diabético, basados en estudios clínicos y hemoquímicos. Existen investigadores que sugieren continuidad de estudios para perfeccionar metodologías, esclarecer teorías y sobredimensionamiento de la asociación. La valoración de las periodontopatías, como factor de riesgo para el descontrol metabólico del diabético, debe pasar de una interrogante a una estrategia promocional, preventiva y terapéutica(AU)

Introduction: The association between Diabetes Mellitus and periodontopathies has been reported in numerous studies. It is accepted that the interrelation between the two is bidirectional. A high percentage of epidemiological studies, as well as studies in experimental animals, suggest that the presence of one condition tends to increase the risk and severity of the other. Objective: Consolidate theoretical nuclei and clinical evidence that clarify the relationship between chronic immune-mediated inflammatory periodontal disease and the metabolic decontrol of the diabetic patient. Methods: A review of the available literature was performed through the automated search in the following databases: PubMed, Scielo and Google Scholar, in the period January-June 2020. The search strategy was carried out through the title, abstract and keywords levels of the articles, with the use of logic connectors. Review, research and meta-analysis articles and by Cuban and international authors ones were assessed and that make specific reference to the studied topic through the title. Results: 29 scientific texts were selected; those were written in Spanish and English, published between 2005 and 2019, of which 27 were articles from a scientific journal and 2 were textbooks. Conclusions: Most of the publications reviewed on the subject endorse the relation between periodontal disease and diabetic metabolic decontrol, based on clinical and hemochemical studies. There are researchers who suggest continuity of studies to improve methodologies, clarify theories and oversize the association. The evaluation of periodontopathies as a risk factor for the metabolic decontrol of the diabetic must go from a question to a promotional, preventive and therapeutic strategy(AU)

Diabetes de inicio precoz en pacientes con fibrosis quística, a propósito de 3 casos / Early-onset diabetes in patients with cystic fibrosis, about 3 cases

INTRODUCCIÓN. La diabetes es la complicación extrapulmonar más frecuente en adultos con fibrosis quística. Existen escasas publicaciones de diabetes relacionada a la fibrosis quística en preescolares a nivel mundial. En Chile se desconoce su prevalencia. MÉTODO. Reportamos una serie de tres casos de niños con fibrosis quística (FQ) y diagnóstico de diabetes a muy temprana edad. RESULTADOS. Caso 1: Niño de 8 años, con diagnóstico de fibrosis quística a los 3 meses de vida por test de sudor y estudio genético p.Phe508del /-. Presenta hiperglicemia no cetósica desde los 6 meses de edad, con colonización traqueal de Staphylococcus Aureus (SA) y Pseudomona Aeruginosa (PA) y debut de diabetes a los 2 años 1 mes. Caso 2: Niño de 16 años, a los 7 meses de vida se diagnostica FQ por test de sudor y estudio genético p.Phe508del /-. Presenta colonización traqueal por SA y múltiples infecciones por PA. A los 5 años 7 meses se diagnostica diabetes presentando cetosis al debut. Caso 3: Niño de 13 años, con diagnóstico de FQ a los 7 meses de vida mediante test de sudor y estudio genético p.Phe508del/-. Presenta colonización traqueal por SA y múltiples infecciones por PA, se realiza diagnóstico de diabetes a los 2 años 7 meses de edad. DISCUSIÓN: La diabetes asociada a fibrosis quística es una complicación frecuente en adultos con fibrosis quística, pero puede presentarse desde edades tempranas. Se debe tener alto nivel de sospecha para el diagnóstico oportuno y óptimo manejo.

INTRODUCTION: Diabetes is the most common extra pulmonary complication in adults with cystic fibrosis (CF). There are few reports of diabetes related to (CF) in preschool children worldwide. Prevalence in Chile is unknown. MÉTODO: We report ta serie of three cases of children with CF and diagnosis of diabetes at an early age. Case 1: Boy 8 year old, CF diagnosed at the age of 3 months by sweat test and genetic study p.Phe508del/-. He presented non-ketotic hyperglycemia since he was 6 months old, with tracheal colonization of Staphylococcus Aureus (SA) and Pseudomona Aeruginosa (PA) , and diagnosis of diabetes at the age of 2 years 1 month. Case 2: Boy patient, 16 years old, with diagnosis of CF at the of age 7 months by sweat test and genetic study p.Phe508del/-. He presents tracheal colonization by SA and multiple PA infections. At the age 5 years 7 months, diabetes is diagnosed, presenting ketosis at the beginning. Case 3: Boy 13 years diagnosed with CF at the age of 7 months, presented sweat test and genetic study p.Phe508del/-. He presents tracheal colonization by SA and multiple infections. DISCUSSION: CF related diabetes is common in adults with cystic fibrosis, but it can be diagnosed in early childhood. A high level of suspicious is required for a proper and timely diagnosis

Factores de riesgo cardiovasculares asociados a enfermedad arterial periférica de miembros inferiores en sus estadios iniciales / Cardiovascular risk factors associated with peripheral arterial disease of lower limbs in their initial stages

Introducción: La enfermedad arterial periférica en la actualidad se considera una verdadera epidemia. Se estima que puede afectar al 10 por ciento de los individuos mayores de 55 años. El principal problema de la enfermedad radica en su infravaloración diagnóstica y terapéutica, debido a la modificación de los factores de riesgo, el uso de fármacos antiplaquetarios y el tratamiento de los síntomas. Objetivo: Identificar los factores de riesgo cardiovasculares en pacientes ambulatorios con enfermedad arterial periférica de los miembros inferiores en sus estadios iniciales. Métodos: Se realizó un estudio descriptivo-retrospectivo de corte transversal en una muestra de 57 pacientes con diagnóstico de enfermedad arterial periférica de miembros inferiores en sus estadios iniciales, atendidos en consulta externa de Arteriología durante dos años. Las variables estudiadas fueron: clínicas y de laboratorio, y algunos de los factores de riesgo cardiovasculares como: edad, sexo, diabetes mellitus, hábito de fumar, hiperlipemia y micro albuminuria. Resultados: Se encontró un predominio del sexo masculino (57,8 por ciento). El 100 por ciento de los pacientes fumaban. Se evidenció la presencia de variables de laboratorio elevadas, lo que justificó la presencia de factores de riesgo cardiovasculares desde etapas tempranas de la enfermedad. Conclusiones: Se logró identificar a los pacientes ambulatorios en sus estadios iniciales y la presencia de algunos factores de riesgo cardiovasculares en etapas tempranas de la enfermedad(AU)

Introduction: Peripheral arterial disease is currently considered a true epidemic. Estimates indicate that it can affect 10 percent of individuals over 55 years of age. The main problem of the disease is its diagnostic and therapeutic underestimation, due to the modification of risk factors, the use of antiplatelet drugs, and the treatment of symptoms. Objective: To identify the cardiovascular risk factors in ambulatory patients with peripheral arterial disease of lower limbs in its initial stages. Methods: A cross-sectional descriptive-retrospective study was carried out in a sample of 57 patients with diagnosis of peripheral arterial disease of lower limbs in its initial stages and who attended an outpatient department of arteriology for two years. The variables studied included clinical ones and of laboratory, as well as some cardiovascular risk factors, such as age, sex, diabetes mellitus, smoking, hyperlipidemia, and microalbuminuria. Results: A predominance of the male sex was found (57.8 percent). 100 percent of the patients smoked. The presence of elevated laboratory variables was evidenced, a fact consistent with the presence of cardiovascular risk factors from the early stages of the disease. Conclusions: In the initial stages of the disease, ambulatory patients were identified, as well as some cardiovascular risk factors in early stages of the disease(AU)

Moringa oleifera: un producto natural con posibilidades para ser usado en pacientes con diabetes mellitus / Moringa oleifera: a natural product with chances of being used in patients with diabetes mellitus

Introducción: La búsqueda de nuevos fármacos o de productos naturales que mejoren la calidad de la atención y los resultados en el tratamiento de la diabetes mellitus continúan. La Moringa oleifera tiene variados usos y es uno de los productos naturales que desde hace años se evalúa con este fin, por sus sustanciales propiedades curativas. Objetivo: Evaluar los efectos de la Moringa oleifera como un producto natural con posibilidades de ser usado en pacientes con diabetes mellitus. Método: Se utilizaron como buscadores de información científica a SciELO, PubMed, Google y a Google Académico. La estrategia de búsqueda incluyó los siguientes términos como palabras claves: Moringa oleifera, diabetes mellitus, propiedades antidiabéticas, reacciones adversas. Se evaluaron artículos de revisión, de investigación y páginas Web que, en general, tenían menos de 10 años de publicados, en idioma español, portugués e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Esto permitió evaluar 120 artículos, de los cuales 64 fueron referenciados. Conclusiones: La Moringa oleifera es una planta que constituye un producto natural con propiedades nutracéuticas y funcionales. Puede usarse como un coadyuvante en los tratamientos convencionales indicados para el tratamiento de la diabetes mellitus, lo cual dependería de los resultados de ensayos clínicos rigurosos, que permitan dilucidar si realmente es capaz de contribuir a lograr en el humano, un control glucémico eficaz, sin efectos secundarios importantes e incluso ayudar a mejorar algunas de las complicaciones y comorbilidades que habitualmente acompañan a la diabetes mellitus(AU)

Introduction: The search of new drugs or natural products that improve the quality of care and the results of diabetes mellitus treatment continue. Moringa oleifera has different uses and is one of the natural products that have been assessed through the years with that purpose, due to its considerable curative properties. Objective: Assess the effects of Moringa oleifera as a natural product with chances of being used in patients with diabetes mellitus. Methods: There were used as scientific information searchers ScieELO, PubMed, Google and Google Scholar. The search strategy included the following terms as keywords: Moringa oleifera, diabetes mellitus, anti-diabetic properties, adverse reactions. Review articles, research articles and web pages were assessed; in general terms, those had less than 10 years of being published, were in Spanish, Portuguese and English languages, and were making specific reference in the title to the studied subject. This allowed assessing 120 articles, of which 64 were quoted. Conclusions: Moringa oleifera is a plant that constitutes a natural product with nutraceutical and functional properties. It can be used as a contributory agent in conventional treatments indicated for diabetes mellitus, which will depend on the results of strict clinical trials that allow to clarify if it is actually capable of contributing to achieve an efficient glycemic control in humans, without relevant side effects, or even to help improving some of the complications and comorbidities that usually accompany diabetes mellitus(AU)

Prevalencia de la discapacidad visual en el adulto diabético en Cuba / Prevalence of visual impairment among adult diabetics in Cuba

Objetivo: Describir la discapacidad visual del diabético de 50 años y más de edad y la cobertura de la atención oftalmológica en Cuba durante el año 2016. Métodos: Se realizó una investigación epidemiológica, descriptiva y transversal que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016, la cual incluyó la retinopatía diabética validada por la Organización Mundial de la Salud. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos donde se tomaron todos los diabéticos conocidos o no con discapacidad visual. Resultados: La prevalencia de cualquier tipo de discapacidad visual en el diabético es de 25,4 por ciento (21,8-28,9). El riesgo de desarrollar discapacidad visual moderada, grave y ceguera es de 19,4 por ciento (16,5-22,3), 2,8 por ciento (1,0-4,6) y 3,2 por ciento (1,5-4,8) respectivamente. La catarata es la primera causa de discapacidad. El riesgo de discapacidad visual en el diabético es similar para uno y otro sexo y se incrementa con la edad. Las coberturas de tratamiento son bajas. Conclusiones: En Cuba, alrededor de un cuarto de los diabéticos tienen algún riesgo de discapacidad visual. El diabético tiene mayor riesgo de discapacidad visual moderada; sin embargo, el riesgo de discapacidad visual grave y de ceguera es el mismo para toda la población de 50 años y más de edad. La catarata y la retinopatía diabética son las causas más frecuentes de discapacidad visual en el diabético. Se evidencian dificultades con la atención oftalmológica, que incluye el examen y la cobertura de tratamiento de la catarata y del láser para la retinopatía diabética(AU)

Objective: Describe visual impairment among diabetics aged 50 years and over, and the coverage of ophthalmological care in Cuba in the year 2016. Methods: A descriptive cross-sectional epidemiological study was conducted based on the Rapid Assessment of Avoidable Blindness survey developed in Cuba in the year 2016, which included diabetic retinopathy with validation by the World Health Organization. The data obtained from the questionnaires were transferred to a database of visually impaired known and unknown diabetics. Results: Prevalence of any sort of visual impairment among diabetics is 25.4 percent (21.8-28.9). Risk of developing moderate visual impairment, severe visual impairment or blindness is 19.4 percent (16.5-22.3), 2.8 percent (1.0-4.6) and 3.2 percent (1.5-4.8), respectively. Cataract is the leading cause of impairment. Risk of visual impairment among diabetics is similar in the two sexes and increases with age. Treatment coverage is low. Conclusions: In Cuba, about one fourth of the diabetics are at some risk of visual impairment. Diabetics are at a higher risk of moderate visual impairment. However, the risk of severe visual impairment and blindness is the same as for the population aged 50 years and over. Cataract and diabetic retinopathy are the most common causes of visual impairment among diabetics. Difficulties were found in ophthalmological care, including examination and treatment coverage for cataract and laser therapy for diabetic retinopathy(AU)

Prevalência de hiperglicemia de estresse em uma unidade de terapia intensiva / Prevalence of stress hyperglycemia in an intensive care unit

Objetivo: Avaliar a prevalência e o manejo da hiperglicemia de estresse em pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo retrospectivo, realizado de janeiro a junho de 2018. Os dados foram obtidos a partir de 582 prontuá- rios eletrônicos, considerando os valores glicêmicos durante a hospitalização, história prévia ou não de diabetes mellitus, causas do internamento, tempo de permanência na unidade de terapia intensiva, presença de complicações durante o internamento e conduta utilizada em caso de hiperglicemia de estresse. Resulta- dos: Dos 582 pacientes internados na unidade de terapia intensi- va, 579 tiveram sua glicemia indicada nos prontuários analisados; 341 (58,9%) apresentaram hiperglicemia em algum momento da internação, sendo a hiperglicemia de estresse caracterizada em 200 pacientes (35%). A duração média de internamento desses pacientes foi de 8,39±10,9 dias, e a causa mais frequente de inter- namento foi devido a pós-operatório por diversas causas, somando 148 indivíduos (74%). Dentro os pacientes, 72 (36%) apresenta- ram alguma complicação. Além disso, 13 casos (6,5%) evoluíram para óbito. Conclusão: Estudos disponíveis sobre alvos de gli- cose em pacientes críticos das unidades de terapia intensiva apresentam difícil interpretação devido às diferenças subs- tanciais no grupo de populações e aos protocolos de gestão de pacientes utilizados em vários centros. Todavia, a prevalência da hiperglicemia de estresse encontrada nesta amostra é se- melhante à de outras casuísticas estudadas. O índice eleva- do de complicações enfatiza a necessidade de padronização nos critérios para diagnóstico e tratamento da hiperglicemia de estresse objetivando melhor prognóstico desses pacientes independentemente da causa do internamento.

Objective: To evaluate the prevalence and management of stress hyperglycemia in patients hospitalized in anintensive care unit. Methods: Retrospective study, carried out from January to June 2018. Data were obtained from 582 electronic medical records, considering glycemic values during hospitalization, existence of previous history of Diabetes Mellitus, causes of hospitalization, length of stay in the intensive care unit, presence of complications during hospitalization, and behavior used in case of stress hyper- glycemia. Results: Of the 582 patients admitted in the ICU, 579 had their glycemia indicated in the charts analyzed: 341 (58,9%) had hyperglycemia in a certain moment of hospitalization, with stress hyperglycemia being present in 200 patients (35%). The average duration of hospitalization of these patients was 8,39 ± 10,9 days, and the most frequent cause of hospitalization was postoperative for various causes, totaling 148 individuals (74%). Of the patients, 72 (36%) presented some type of complication and 13 patients (6,5%) died. Conclusion: Available studies on glucose targets in critical intensive care unit patients are difficult to be interpre- ted because of substantial differences in the study populations and of patient management protocols used at various centers. However, the prevalence of stress hyperglycemia found in this sample is similar to that of other study groups. The high com- plication rate emphasizes the need for standardization of the criteria for diagnosis and treatment of stress hyperglycemia aiming at a better prognosis of these patients regardless of the cause of hospitalization.

Diabetes relacionada con la fibrosis quística / Cystic fibrosis-related diabetes

Los avances en el campo de la fibrosis quística han aumentado la esperanza de vida de estos pacientes, por lo que cada vez es más prevalente la Diabetes Relacionada con la Fibrosis Quística (DRFQ) y sus complicaciones. La DRFQ se asocia a mayor morbimortalidad, deterioro de la función pulmonar y del estado nutricional. Por lo mismo, el manejo óptimo de esta patología depende de un diagnóstico precoz, tratamiento individualizado y vigilancia de las complicaciones diabéticas. El screening de DRFQ debe realizarse anualmente a partir de los 10 años, mediante una Prueba de Tolerancia a la Glucosa Oral (PTGO), lo cual permite el diagnóstico. El manejo de esta patología tiene por objetivo estabilizar y mejorar la función pulmonar y el estado nutricional y metabólico de los pacientes. Actualmente, la insulina es el tratamiento farmacológico de elección para controlar la hiperglicemia y el esquema de uso debe ser individualizado para cada persona. En caso de enfermedades agudas pueden existir mayores requerimientos de insulina. Además, se deben tener consideraciones especiales en cuanto a la dieta y la insuficiencia pancreática exocrina que presentan estos pacientes. Para la vigilancia de complicaciones microvasculares se debe realizar una monitorización anual a partir de los 5 años desde el diagnóstico de DRFQ. Debido a la complejidad de estos pacientes, para alcanzar el mejor cuidado posible se necesita un enfoque multidisciplinario con distintos profesionales de la salud coordinados, incluyendo en la toma de decisiones al paciente y su familia.

Advances made in the field of cystic fibrosis have increased the life expectancy of these patients, which is why Cystic Fibrosis-Related Diabetes (CFRD) and its complications are becoming more and more prevalent. CFRD is associated with increased morbidity and mortality, lower lung function and inadequate weight maintenance. Therefore, the optimal management of this pathology depends on an early diagnosis, individualized treatment and monitoring of diabetic complications. For CFRD, routine screening with an Oral Glucose Tolerance Test (OGTT) should be carried out yearly from the age of 10, which allows to diagnose it. The treatment goals in CFRD are to stabilize and improve lung function and obtain adequate weight gain. Currently, insulin is the pharmacological treatment of choice to control hyperglycemia and the insulin regimen must be personalized for each person. In acute illnesses, there may be higher insulin requirements. In addition, special considerations must be taken regarding diet and exocrine pancreatic insufficiency that these patients present. For the surveillance of microvascular complications, annual monitoring should be carried out 5 years after the diagnosis of CFRD. Due to the complexity of these patients, in order to achieve the best possible care, a multidisciplinary approach is needed with different coordinated health professionals, including the patients and their family in the decision-making process.