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OBJECTIVE: To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS: A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS: A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION: Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.
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Introducción: La avulsión de la espina tibial posterior en el adulto representa una forma infrecuente de compromiso del ligamento cruzado posterior (LCP), más común de ver en la población pediátrica. La posibilidad de consolidación de esta lesión, con el tratamiento adecuado en forma temprana, depende de un diagnóstico precoz. Caso: reportamos el caso de una paciente de veintisiete años con una lesión multiligamentaria de rodilla con inestabilidad medial y posterior, por trauma de alta energía tras sufrir un accidente de tránsito en moto. Fue tratada mediante una fijación abierta con técnica de "pull-out". Discusión: en países asiáticos es una lesión frecuente por la alta prevalencia de accidentes en moto, pero menos común en nuestro medio. Si bien el manejo quirúrgico temprano muestra mejores resultados, no existe consenso actual en cuanto a la técnica. Dos tipos de resolución (abierta y artroscópica) muestran resultados similares a largo plazo, con un mayor porcentaje de artrofibrosis en el último grupo. Conclusión: al existir controversia sobre su manejo quirúrgico, creemos que la combinación de las ventajas de ambas técnicas (abierta y artroscópica) constituye una opción reproducible, de bajo costo y con bajo índice de complicaciones.
Introduction: Avulsion of the posterior tibial spine in adults represents an infrequent form of compromise of the posterior cruciate ligament (PCL), more common to see in the pediatric population. The possibility of consolidation of this lesion, with adequate treatment early, depends on an early diagnosis.Case: we report the case of a 27-year-old patient with a multiligamentary knee injury with medial and posterior instability, due to high-energy trauma after suffering a motorcycle traffic accident. Which was treated with an open fixation with a "pull-out" technique. Discussion: in Asian countries it is a frequent injury due to the high prevalence of motorcycle accidents, being less common in our continent. Although early surgical management shows better results, there is no current consensus regarding the optimal technique. Both types of resolution (open and arthroscopic) show similar long-term results, with a higher risk of arthrofibrosis in the last group. Conclusion: as there is controversy over its surgical management, we believe that the combination of the advantages of both techniques (open and arthroscopic) constitutes a reproducible, low-cost option with a low rate of complications.
Assuntos
Adulto , Tíbia/lesões , Acidentes de Trânsito , Fratura Avulsão , Traumatismos do Joelho , Articulação do Joelho/cirurgiaRESUMO
La presente recomendación busca brindar un marco de seguridad para la prescripción de actividad física en niños, niñas y adolescentes con diabetes mellitus tipo 1 (DM1), considerando la evaluación de las situaciones que puedan presentarse antes, durante y después de su práctica. Incluye las estrategias terapéuticas sobre el tipo de ejercicio, el control glucémico capilar (o mediante el uso de monitoreo continuo de glucosa, MCG) y la adecuación de la insulinoterapia y de la ingesta de hidratos de carbono. Se prioriza que, para optimizar los beneficios del ejercicio como parte del tratamiento de la DM1, es importante una completa y constante educación diabetológica para el paciente y sus cuidadores brindada por un equipo interdisciplinario entrenado en el manejo integral de niños, niñas y adolescentes con DM1.
These recommendations seek to provide a safety framework for the prescription of physical activity in children and adolescents with DM1, considering the evaluation of the situations that may arise before, during and after the practice of physical activity. It includes therapeutic strategies on the type of exercise, intensive capillary glycemic control or through the use of continuous glucose monitoring (CGM) and the adequacy of insulin therapy and carbohydrate intake. It is prioritized that to optimize the benefits of exercise as part of the treatment of DM1, a complete and constant diabetes education is important, provided by an interdisciplinary team trained in the comprehensive management of children and adolescents with DM1
Assuntos
Diabetes Mellitus Tipo 1 , Esportes , Carboidratos , Exercício Físico , Controle Glicêmico , Glucose , InsulinaRESUMO
Resumen La presente recomendación busca brindar un marco de seguridad para la prescripción de actividad física en niños, niñas y adolescentes con diabetes mellitus tipo 1 (DM1), considerando la evaluación de las situaciones que puedan presentarse antes, durante y después de su práctica. Incluye las estrategias terapéuticas sobre el tipo de ejercicio, el control glucémico capilar(o mediante el uso de monitoreo continuo de glucosa, MCG) y la adecuación de la insulinoterapia y de la ingesta de hidratos de carbono. Se prioriza que, para optimizar los beneficios del ejercicio como parte del tratamiento de la DM1, es importante una complete y constant educación diabetológica para el paciente y sus cuidadores brindada por un equipo interdisciplinario entrenado en el manejo integral de niños, niñas y adolescentescon DM1.
Abstract These recommendations seek to provide a safety framework for the prescription of physical activity in children and adolescents with DM1, considering the evaluation of the situations that may arise before, during and after the practice of physical activity. It includes therapeutic strategies on the type of exercise, intensive capillary glycemic control or through the use of continuous glucose monitoring (CGM) and the adequacy of insulin therapy and carbohydrate intake. It is prioritized that to optimize the benefits of exercise as part of the treatment of DM1, a complete and constant diabetes education is important, provided by an interdisciplinary team trained in the comprehensive management of children and adolescents with DM1.
