Prediabetes and Cardiometabolic Risk: The Need for Improved Diagnostic Strategies and Treatment to Prevent Diabetes and Cardiovascular Disease.

The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes.

Robotic transanal surgery: initial experience in a developing country / Cirugía robótica transanal: experiencia inicial en un país en vías de desarrollo

Background: Transanal minimally invasive surgery (TAMIS) is a surgical technique used for the excision of rectal neoplasia that gained popularity during the last decade. Due to the technical difficulty (non-articulated instruments, reduced workspace) and the long learning curve associated with this technique, the use of robotic platforms to improve resection results has been suggested and reported, at the same time that the learning curve decreases and the procedure is facilitated. Materials and Methods: From March 2017 to December 2019, all patients with rectal lesions eligible for TAMIS were offered the possibility to receive a robotic TAMIS (RTAMIS). We used a transanal GelPoint Path (Applied Medical Inc., Santa Margarita, CA, USA) in the anal canal to be able to do the Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform docking, which we used to perform the excision of the rectal lesion as well as the resection site defect. Results: Five patients between 34 and 79 years of age underwent R-TAMIS. The mean distance to the anal verge was 8.8 cm. There were no conversions. The mean surgery time was 85 minutes, and the mean docking time was 6.6minutes. Conclusions: Robotic TAMIS is a feasible alternative to TAMIS, with a faster learning curve for experienced surgeons in transanal surgery and better ergonomics. Further studies are needed to assess the cost-benefit relationship. (AU)

Introdução: A cirurgia transanal minimamente invasiva (TAMIS, na sigla em inglês) é uma técnica que se tornou popular na última década para a excisão local de neoplasias no reto. Devido à dificuldade técnica (instrumentos não articulados, espaço de trabalho reduzido) e à longa curva de aprendizado representada por essa técnica, o uso de plataformas robóticas para melhorar os resultados da ressecção tem sido sugerido e relatado, aomesmo tempo emque a curva de aprendizado diminui e o procedimento é facilitado. Materiais e Métodos: De março de 2017 a dezembro de 2019, foi oferecida aos pacientes comlesões retais candidatos aoTAMIS a possibilidade de ressecção transanal robótica (R-TAMIS). Foi utilizada uma porta de acesso transanal GelPoint Path (Applied Medical Inc. Santa Margarita, CA, EUA), que foi introduzida no canal anal para posteriormente criar pneumoperitônio e realizar o acoplamento do sistema robótico Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, EUA) para realizar a ressecção e o fechamento do defeito por robótica. Resultados: Cinco pacientes entre 79 e 34 anos foram submetidos à R-TAMIS. A distânciamédia àmargemanal foi de 8,8 cm. Não houve conversões. O tempo cirúrgico médio foi de 85 minutos, e o tempo médio de acoplamento foi de 6,6 minutos. Conclusões: A R-TAMIS é uma alternativa à TAMIS convencional, com menor curva de aprendizado para cirurgiões experientes em cirurgia transanalminimamente invasiva e melhor ergonomia para ressecção e fechamento. Outros estudos são necessários para avaliar a relação custo-benefício. (AU)

Control of differential-drive mobile robots for soft object deformation.

The aim of this work is a control scheme implementation to deform a nonrigid object in which deformation dynamics are modeled by the finite element method. The deformation of a soft object is highly difficult to model because of its non-linearity, time-dependency, and material-response characteristics. Thus, the control implementation for Differential Drive Mobile Robots (DDMR) to deform an elastic object, is a challenge. The proposed steps to solve it are: Position-control designed over DDMR kinematics. Alignment-control applied for DDMRs orientation. The desired shape of the object is achieved using two contact points as the control nodes. A centralized vision algorithm was employed in each stage to obtain positions. To show the usefulness of the proposed scheme, numerical simulation, and real-time implementation were carried out.

Paciente adulto con diabetes mellitus tipo 1: múltiples factores para lograr un control adecuado. Reporte de caso / Adult patient with type 1 diabetes mellitus: multiple factors to achieve an adequate control

RESUMEN La diabetes mellitus tipo 1 (DM1) es una de las enfermedades crónicas más comunes de la infancia; sin embargo, un gran número de pacientes adultos viven con esta condición. La terapia con insulina es el pilar del tratamiento. Otros aspectos importantes son fomentar un estilo de vida saludable y lograr la adherencia a la medicación. Se presenta el caso de una mujer de 29 años con diagnóstico de diabetes mellitus tipo 1 hace 15 años. Describimos el manejo y evolución de los últimos 5 años y destacamos la importancia de las nuevas tecnologías, como el monitoreo continuo de glucosa, además de factores como la adherencia al tratamiento y el soporte familiar, los cuales fueron particularmente importantes para el control de la enfermedad de la paciente.

ABSTRACT Type 1 diabetes mellitus (T1DM) is one of the most common chronic childhood diseases. However, a large number of adult patients live with this condition. Insulin therapy is the cornerstone of diabetes treatment. Other important aspects are the promotion of a healthy lifestyle and the adhesion to medications. This is the case of a 29-year-old woman with a fifteen- year diagnosis of T1DM. Medical treatment and evolution over the last five years are described. The importance of new technologies such as continuous glucose monitoring and other factors such as adherence to treatment and family support were particularly important for the patient's adequate disease control.

A novel approach for rectal trauma. The use of a transanal platform to repair a combined high-velocity rectal gun fire wound / Uma nova abordagem para trauma retal. Uso de uma plataforma transanal para reparo de ferimento retal combinado por disparo de arma de fogo de alta velocidade

Abstract Up to 80 % of the rectal injuries reported in US trauma centers occur secondary to firearm injuries. Rectal gunshot wounds are associated with significant morbidity and mortality. Diverse surgical approaches and techniques have been described; however, controversy persists regarding the best management for these complex injuries. Nowadays, no single approach has proven to provide optimal results when dealing with these injuries. We present a case of a young male that suffered a combined (intra-extraperitoneal) gun shot gun to the rectus and the use of a transanal platform to repair it.

Resumo Até 80 % das lesões retais relatadas nos centros de trauma dos EUA ocorrem secundariamente às lesões por armas de fogo. Ferimentos retais por arma de fogo estão associados a significativa morbimortalidade. Foram descritas diversas abordagens e técnicas cirúrgicas; no entanto, ainda há controvérsias quanto qual é o melhor tratamento para essas lesões complexas. Atualmente, nenhuma abordagem isolada provou ótimos resultados ao lidar com essas lesões. Apresentamos um caso de um jovem do sexo masculino que sofreu um ferimento de pistola combinada (intra-extraperitoneal) no reto e o uso de uma plataforma transanal para repará-la.

Correction to: Atypical hyperglycemia presentation suggests considering a diagnostic of other types of diabetes: first reported GCK-MODY in Perú.

[This corrects the article DOI: 10.1186/s40842-019-0091-x.].

Atypical hyperglycemia presentation suggests considering a diagnostic of other types of diabetes: first reported GCK-MODY in Perú.

BACKGROUND: Prevalence of maturity-onset diabetes of the young (MODY) is estimated between 1 and 2% of all diabetes cases. In Latin-America little information has been described about the frequency of the disease, perhaps due to limited access to genetic studies. CASE PRESENTATION: We present the case of a male patient with a history of two years of fatigue, mild hyperglycemia and intermittent polyuria, accompanied by a recent history of weight loss. He was diagnosed initially as type 2 diabetes, but in the follow-up as a patient with type 1 diabetes. He required relatively low doses of insulin and was evaluated in the endocrinology service at a hospital in Lima. The results of glucose, insulin and C-peptide in the oral glucose tolerance test (OGTT) performed were not consistent with a type 1 diabetes. Moreover, the age of the patient and the clinical characteristics did not strongly suggest a diagnosis of type 2 diabetes either. These clinical features had prompted us to carry out the genetic study. The genetic test performed with a genetic MODY panel through a massive sequencing. Heterozygous pathogenic for a variant in GCK gene was found (c.629 T > C, p.Met210Thr.). His parents were negative for this variant after performed the genetic test. CONCLUSIONS: This is the first case of MODY for a pathogenic variant in the GCK gene reported in Perú. The genetic evaluation of a clinical suspicion of MODY is important to confirm the diagnosis and establish an adequate treatment in patients.

Síndrome metabólico: concepto y aplicación práctica / Metabolic syndrome: concept and practical application

El síndrome metabólico (SM) es un conjunto de anormalidades metabólicas consideradas como un factor de riesgo para desarrollar enfermedad cardiovascular y diabetes. Los componentes del SM se han definido según diferentes guías y consensos. Las definiciones propuestas por el National Cholesterol Education Program Adult Treatment Panel III (ATP III) y la International Diabetes Federation (IDF) son las más utilizadas en las diferentes publicaciones; sin embargo, se han realizado actualizaciones para diferentes poblaciones según la etnia y ubicación geográfica, como es el caso de la Asociación Latinoamericana de Diabetes (ALAD), que define un perímetro abdominal determinado para la región América Latina. En el año 2009, la publicación Harmonizing the Metabolic Syndrome sugirió un consenso para el diagnóstico de SM tratando de unificar los criterios de las diferentes organizaciones. Respecto a la fisiopatología del SM, la resistencia a insulina ha sido considerada como base del desarrollo del conjunto de anormalidades que lo conforman, sugiriendo a la obesidad abdominal o central como responsable del desarrollo de la insulino resistencia. Las adipoquinas producidas por el tejido adiposo abdominal actuarían directa o indirectamente en el desarrollo de los componentes del síndrome. Es importante mencionar que el síndrome metabólico ha sido considerado un equivalente diagnóstico de prediabetes, por ser predictor de diabetes. El incremento en la prevalencia del SM a nivel mundial le ha otorgado una gran importancia en la prevención y control de riesgo de la enfermedad cardiovascular y la diabetes. En el presente artículo revisaremos importantes aspectos sobre la definición y diagnóstico del síndrome metabólico.

The metabolic syndrome (MS) is a cluster of metabolic abnormalities considered risk factors for developing cardiovascular disease and diabetes. MS components are defined according to different guidelines and consensus. The definition proposed by the National Cholesterol Education Program Adult Treatment Panel III (ATPIII) and the International Diabetes Federation (IDF) are the most commonly used in the different publications. These definitions have been updated in some populations according to ethnicity and geographical location, such as the Latin American Diabetes Association (ALAD) that defines a specific abdominal perimeter for Latin-Americans. In 2009 the publication Harmonizing the Metabolic Syndrome suggested a consensus on the application of unified diagnostic criteria for MS. Regarding the pathophysiology of MS, insulin resistance has been considered the main factor for development of the abnormalities associated with this syndrome; the abdominal or central obesity would be responsible for the development of insulin resistance. Adipokines produced in the abdominal fat would play a direct or indirect role in the development of MS components. It is important to consider the metabolic syndrome as equivalent to prediabetes because is also predicts diabetes. The rise in MS prevalence worldwide has increased the importance of this syndrome in the prevention and control of cardiovascular disease risk and diabetes. In the present article we review important aspects of the metabolic syndrome.

Hipotiroidismo subclínico y estimación de su frecuencia en síndrome metabólico y obesidad en un grupo poblacional urbano de Lima, Perú / Subclinical hypothyroidism and estimation of its prevalence in metabolic syndrome and obesity in an urban population group in Lima, Peru

El hipotiroidismo subclínico (HSC) es una condición relativamente frecuente en la población adulta, siendo escasos los reportes al respecto en nuestro medio. El síndrome metabólico (SM) y la obesidad han incrementado su prevalencia en la población mundial, habiendo sido descrita en algunos reportes su coexistencia con el HSC. Objetivo: Evaluar la prevalencia de HSC, además de estimar su frecuencia en SM y obesidad en un grupo poblacional. Métodos: Estudio descriptivo transversal. Un total de 69 trabajadores del Hospital Municipal del distrito de Comas en Lima-Perú, sin antecedente de enfermedad cardiovascular, enfermedad tiroidea o gestantes y sin medicación que altere los valores de hormonas tiroideas fueron incluidos en el estudio. Variables: HSC, SM, obesidad, además del índice de masa corporal (IMC), colesterol total, colesterol LDL e hipotiroidismo subclínico límite superior elevado (HSC-Lse) fueron evaluados. El diagnóstico de HSC fue definido como una condición de elevación de hormona estimulante de la tiroides (TSH) y niveles normales de tiroxina Libre (T4L). Resultados: La edad promedio fue de 32ñ11,7 años, 54 fueron mujeres y 15 varones. La prevalencia de HSC fue de 14,5% (10 mujeres y 3 varones). La prevalencia de SM fue de 18,8% y de obesidad 8,6%. La frecuencia de HSC en SM fue de 10% y de 16% en los que no tenían SM, mientras que la frecuencia de HSC en obesidad fue de 16,7% y de 14,3% en sujetos no obesos. No se encontró diferencia significativa al evaluar la media de los componentes de SM, IMC, colesterol total y colesterol LDL en los grupos con y sin HSC. Conclusiones: La prevalencia de HSC fue elevada. La prevalencia de SM y obesidad fue similar a la descrita en otras series. La frecuencia de sujetos con HSC en los grupos con SM y obesidad fue baja, adem s de no existir una variación significativa en la media de los componentes de SM, IMC y lípidos entre los grupos con y sin HSC.

Subclinical hypotiroidism (SCH) is a relatively common condition among the adult population, but there are insufficient studies in Peru. Metabolic syndrome (MS) and obesity have increased their prevalence in the world, and many times coexists with SCH. Objective: To study the prevalence of SCH, and its frequency in MS and obesity in a specific population. Methods: Descriptive cross-sectional study. A total of 69 workers from “Hospital Municipal” at Comas district in Lima- Peru, with no past history of cardiovascular disease, thyroid disease or pregnacy, and on no medication that could change thyroid hormone profile were included in our study. Variables: SCH, MS, obesity and also body mass index (BMI), total cholesterol, LDL cholesterol and elevated upper limit subclinical hypothyroidism were evaluated. The diagnosis of SCH was defined as a condition of high thyroid stimulating hormone (TSH) with normal levels of free thyroxin (Ft4). Results: The mean age was 32ñ11.67, with 54 females and 15 males. The prevalence of SCH was 14% (10 females and 3 males). The prevalence of MS was 18,8% and of obesity 8,6%. The frequencies of SCH in MS were 10% and 16% in the group without MS. We did not find significant differences in the mean levels of the MS components: BMI, total cholesterol and LDL cholesterol in groups with and without SCH. Conclusion: The prevalence of SCH was high. The prevalence of MS and obesity were similar as in other reports. The frequency of subjects with SCH in the group with MS and obesity were low, also we did not find significant variation in the mean of the components of MS, BMI and lipids in the groups with and without SCH.

HL7 in personal health system component's integration for mental health treatment / HL7 como componente de integração em Sistema de PEP para tratamento em Saúde Mental

Help4Mood is a project inside 7th European Framework Programme (FP7) for developing a computational distributed system to support remotely the treatment of patients with major depression at home. Core components are integrated with Health Level Seven (HL7) standard. One of the main goals of this system is to use the paradigm of a Virtual Agent to support the first symptoms of clinician alert of a patient, to interact with him an to prevent some causes of relapse. The system processes inputs from different devices (to monitor sleeping, eating and motor activity) in a decision support system, and the Virtual Agent interacts with the patient before clinical support from hospital is needed. The technical framework is using the open source HL7-standard-based healthcare integration engine, Mirth Connect, to interact with the different subsystems, analyze data and give different priorities for messages in queues. Particularly, the use of standard HL7 will contribute to interest in the project results and the potential impact through the development, dissemination and use, as stated in the analysis of the European commission.

Help4Mood é um projeto do 7 º Programa de Framework Europeu (FP7) para desenvolvimento de um sistema computacional distribuído para apoio remoto de tratamento domiciliar de pacientes com depressão. Os principais componentes são integrados com o padrão Health Level Seven (HL7). Um dos objetivos principais deste sistema é a utilização do paradigma de um agente virtual para apoiar os primeiros sintomas de alerta clínico de um paciente, interagirindo com ele de forma a impedir que algumas ocorrências de recaída. O sistema processa as entradas de dispositivos diferentes (para monitorar a dormir, comer e atividade motora) em um sistema de apoio à decisão, e o Agente Virtual interage com o paciente antes que o atendimento clínico hospitalar seja necessário. O framework usa o código-fonte ?open source? como motor de integração baseado no padrão HL7, chamado ?Mirth Connect? a fim de interagir com os diferentes subsistemas, analisar os dados, e dar prioridades diferentes para as mensagens enviadas. A utilização do padrão HL7, por certo, contribuirá para os resultados do projeto e o impacto potencial através do desenvolvimento, difusão e utilização, como referenciado na análise da Comissão Europeia do programa.

Prevalencia de síndrome metabólico en una población de estudiantes de Lima / Prevalence of metabolic syndrome in a population of students in Lima

El objetivo del presente trabajo es describir la prevalencia de síndrome metabólico (SM) y la relación de los componentes de SM con el índice de masa corporal (IMC) y la talla, en una población de estudiantes de Lima. La muestra fue de 185 estudiantes de un instituto superior tecnológico, en quienes se evaluó índice de masa corporal, perímetro abdominal, control de glucosa en ayunas, colesterol HDL y triglicéridos. Los criterios utilizados para el diagnóstico de SM fueron los de la federación Internacional de Diabetes. El criterio de talla baja se basó en la descripción del documento Norma Oficial Mexicana NOM-174-SSA1-1998, para el manejo integral de la obesidad. El IMC se basó en los parámetros de sobrepeso y obesidad regidos por la OMS. La prevalencia de SM fue de 4% en la población estudiada. La prevalencia de glucosa de ayuno alterada (mayor de 100 mg%) fue de 3,8%. Respecto a los componentes de SM, promedio de obesidad central, triglicéridos y presión arterial, no se hallaron valores alterados. Sin embargo, el promedio de valor de HDL hallado, resultó inferior al valor mínimo normal descrito. Las personas de talla baja presentaron un prevalencia de HDL bajo, a pesar de presentar un IMC normal, a diferencia del grupo de la talla no baja.

The objective of the following paper is to describe the prevalence of Metabolic Syndrome (MS), and the relation of its components with Body Mass Index (BMI), and with height a student population in Lima. The sample consisted of 185 students of a Superior Institute of Technology who were measured for BMI, abdominal perimeter, fasting glucose control, HDL cholesterol. And triglycerides. The implemented criteria for the diagnose of MS was that used by the International Diabetes Federation (IDF). The height criterion was based on the description of the document Norma Oficial Mexicana NOM-174-SSA1-1998, para el manejo integral de la obesidad. The BMI was based on parameters of overweight and obesity dictated by the WHO. The prevalence of MS was of 4% in the sample population. The prevalence of altered fasting glucose (greater than 100 mg%) was 3,8%. In respect to the MS components, the average of central obesity, triglycerides, and arterial pressure; no altered values were found. Nevertheless, the average value of the HDL found was lower than the minimum value described. People of a lower height showed a low prevalence of HDL even though they showed a normal BMI as opposed to the group of a taller height.

Chemometrics-assisted UV-spectroscopic strategies for the determination of theophylline in syrups.

Two spectrophotometric methods, assisted by chemometric tools, were developed for the determination of theophylline in syrups: derivative spectroscopy (DS) and partial least-squares regression (PLS), the latter using both artificial and natural calibration sets. HPLC technique was employed to apply a reference method in order to achieve a complete assessment of performance. Calibrations presented excellent analytical figures of merits (i.e. LOD ranged from 0.03 to 0.4 mg L(-1) and analytical sensitivity ranged from 1.7 to 8.3 L mg(-1)). The intermediate precision presented pooled coefficients of variation ranged between 0.54 and 1.08%. Accuracy was studied trough an elliptical joint confidence region test (EJCR) comparing the obtained values when analysing spiked real samples by the HPLC and the studied methodologies. Both studied methods can be considered acceptable for the pharmaceutical quality assurance of theophylline in syrup samples.