Postural performance assessment in aging people with diabetes and diabetic peripheral neuropathy using a Wii balance board.

PURPOSE: To determine the effect of sensory perturbations on static postural control in older people with type 2 diabetes mellitus by comparing postural outcomes of people with and without diabetic neuropathy using a Wii Balance Board (WBB). MATERIALS AND METHODS: Static postural balance assessments were performed in 31 participants: nine with type 2 diabetes mellitus; 12 with diabetic neuropathy; and 10 non-diabetic controls. Participants stood on the WBB under sensory perturbations (visual and proprioceptive). Body balance was analysed using centre of pressure ellipse area, mean velocity, and sample entropy. The effects of within-participant factors, sensory perturbations and the between-participants factor 'group' on outcomes were analysed using a multivariate analysis of variance model. RESULTS: Type 2 diabetes mellitus participants with and without neuropathy showed altered postural performance under sensory perturbations compared to non-diabetic participants. Moreover, participants with diabetic neuropathy showed impaired postural performance when one perceptual system was disturbed. Finally, participants with type 2 diabetes mellitus without neuropathy decreased their postural performance when both sensory disturbances were present. CONCLUSIONS: The Wii Balance Board can be a useful alternative for balance impairment screening related to diabetic neuropathy and contribute as an affordable source of insight in early interventions in integral diabetes care.Implications to rehabilitationOlder people with diabetic peripheral neuropathy depend on visual and somatosensory cues to keep their static postural balance.Static balance assessment using the Wii Balance Board allows the identification of alterations in postural performance in participants with diabetes.This low-cost method used can be considered as a complement to integral diabetes care.

Diabetic Foot Infections: Bacterial Isolates From the Centers and Hospitals of Latin American Countries.

Diabetic foot infections (DFIs) are one of the most important reasons for lower limb amputations. An adequate approach to the management of DFI implies control of infection using strategies of tissue debridement and empirical antibiotic treatment based on local microbiology. The aim of this study was to determine the bacterial isolates profile and antibiotic susceptibility patterns in samples from DFI from Latin American centers, on the premise that microbiology of this region differs from that of other continents and influences antimicrobial election. Three hundred and eighty-two samples from soft tissue and bone were studied from 17 centers of 4 countries. Three hundred and seven (80.4%; 95% confidence interval = 75.9-84.2) were positive. Gram negatives (GN) were isolated in 43.8% of all samples, not only in severe but also in mild infections, 51% in bone samples, more frequently in presence of ischemia (47% vs 38%; P = .07) and in wounds with longer duration of the lesion (30-20 days; P < .01). Staphylococcus aureus was the most frequent single germ (19.9%). Gram positives were isolated more frequently in patients without ischemia (53% vs 40%; P = .01). Enterococcus faecalis was the most frequent germ in bone samples (16.8%). Ciprofloxacin and trimethoprim-sulfamethoxazole were the oral antimicrobials most effective against GN. Trimethoprim-sulfamethoxazole and rifampicin were the oral antimicrobials most effective against Staphylococcus. Because of GN high antibiotic resistance patterns, patients treated in an ambulatory setting have to be controlled early after starting empiric treatment to assess response to therapy and hospitalize for parenteral antibiotics if oral treatment fails.

HIV and SARS-CoV-2: points to consider to face this new pandemic. / VIH y SARS-CoV-2: aspectos a considerar para enfrentar esta nueva pandemia.

In December 2019, a new species of pneumonia-causing betacoronavirus was identified in Wuhan, China, which was later identified as SARS-CoV-2. This RNA virus presents certain similarities with other viruses of the same genetic material. It has been seen that infection by human immunodeficiency virus resembles the infection by SARS-CoV-2 in various aspects. In this comment, we present some of the virological, immunological, clinical, and pharmacological similarities between HIV and SARS-CoV-2, which could allow us to understand the immunopathogenesis of COVID-19 better, as well as make some decisions in regarding antiviral management.

En diciembre de 2019 una nueva especie de ß-coronavirus causante de neumonía fue identificada en la ciudad China de Wuhan, el cual posteriormente fue denominado SARS-CoV-2. Este virus de ácido ribonucleico presenta ciertas similitudes con otros virus del mismo material genético, dentro de ellos se ha visto que la infección por virus de la inmunodeficiencia humana se asemeja en diversos aspectos a la infección por SARS-CoV-2. En este comentario presentamos algunas de las similitudes virológicas, inmunológicas, clínicas y farmacológicas entre estos dos virus, las cuales podrían permitirnos entender de mejor manera la inmunopatogenia de COVID-19, así como también tomar algunas decisiones en cuanto al manejo antiviral.

VIH y SARS-CoV-2: aspectos a considerar para enfrentar esta nueva pandemia / HIV and SARS-CoV-2: points to consider to face this new pandemic

En diciembre de 2019 una nueva especie de ß-coronavirus causante de neumonía fue identificada en la ciudad China de Wuhan, el cual posteriormente fue denominado SARS-CoV-2. Este virus de ácido ribonucleico presenta ciertas similitudes con otros virus del mismo material genético, dentro de ellos se ha visto que la infección por virus de la inmunodeficiencia humana se asemeja en diversos aspectos a la infección por SARS-CoV-2. En este comentario presentamos algunas de las similitudes virológicas, inmunológicas, clínicas y farmacológicas entre estos dos virus, las cuales podrían permitirnos entender de mejor manera la inmunopatogenia de COVID-19, así como también tomar algunas decisiones en cuanto al manejo antiviral.

In December 2019, a new species of pneumonia-causing betacoronavirus was identified in Wuhan, China, which was later identified as SARS-CoV-2. This RNA virus presents certain similarities with other viruses of the same genetic material. It has been seen that infection by human immunodeficiency virus resembles the infection by SARS-CoV-2 in various aspects. In this comment, we present some of the virological, immunological, clinical, and pharmacological similarities between HIV and SARS-CoV-2, which could allow us to understand the immunopathogenesis of COVID-19 better, as well as make some decisions in regarding antiviral management.

Pie diabético en pacientes internados en hospitales de Latinoamérica / Diabetic foot among hospitalized patients in Latin America

El pie diabético es una afección compleja. En su evolución puede demandar atención de primer nivel al inicio, atención de tercer nivel cuando aparecen complicaciones más graves, y con frecuencia internación para procedimientos complejos de diagnóstico y tratamiento. El conocimiento de la frecuencia de este cuadro entre los pacientes internados en hospitales de Latinoamérica permite hacer un diagnóstico de situación, la toma de decisiones y la programación de políticas de salud sobre la base de información concreta. Presentamos un estudio descriptivo, transversal, que consistió en analizar información colectada de 11 357 pacientes internados en 135 centros de diferente nivel de complejidad localizados en 9 países de Latinoamérica con el objetivo de determinar la prevalencia de diabetes mellitus, la tasa de pie diabético y parámetros relacionados. La prevalencia de diabetes mellitus en la internación fue 18.6% (IC 95%; 14.1-15.4), la tasa de pie diabético fue 14.8% (IC 95%; 14.1-15.4) y la de pie diabético con lesiones clasificadas como Wagner ≥ 1 fue 5.2% (IC 95%; 4.8-5.6). El pie diabético fue el motivo de internación en el 3.7% del total de internados y en el 20% de aquellos con diabetes mellitus. En nuestro conocimiento, nuestro estudio es el primero de esta envergadura en Latinoamérica, y sienta las bases para nuevos trabajos de investigación que permitirán un diagnóstico acabado de diferentes aspectos relacionados al pie diabético en la Región.

The diabetic foot is a complex condition. Along its course, it may require primary health care at the beginning, tertiary health care when more severe complications arise, and hospitalization when specialized management involving complex diagnostic and therapeutic procedures becomes peremptory. Determining frequencies of diabetic foot in hospitalized patients provides baseline data on the status of this condition aiming to an effective decision making process at the public health level. This transversal study consisted in analyzing data of 11 357 inpatients from 135 health centers in 9 Latin American countries in order to assess the prevalence of diabetes mellitus, the frequency of diabetic foot and related parameters in hospitalized patients in the region. The prevalence of diabetes mellitus was 18.6% (IC 95%; 14.1-15.4). The rate of diabetic foot was 14.8% (IC 95%; 14.1-15.4) and that of diabetic foot classified as Wagner ≥ 1 was 5.8% (IC 95%; 4.8-5.6). Diabetic foot was the reason for admission for 3.7% of all inpatients and for 20% of those who were diabetic. In our knowledge, this study is the largest in Latin America, and lays the foundation for further advances in the knowledge of the burden of diabetic foot.

Carbapenemase producing Klebsiella pneumoniae in Peru: a case report and antimicrobial resistance discussion. / Klebsiella pneumoniae productora de carbapenemasas en Perú: reporte de caso y discusión de la resistencia a los antimicrobianos.

Carbapenemases are one of the major mechanisms of antimicrobial resistance, usually due to the indiscriminate use of antibiotics. The expansion of this mechanism of resistance at world level is imminent and control measures are limited. In the region of the Central Sierra of Peru - Huancayo, we report a case of carbapenemase-producing Klebsiella pneumoniae, with the purpose of discussing the problems related to this emerging mechanism of antibiotic resistance.

Las carbapenemasas son uno de los mecanismos enzimáticos de resistencia antimicrobiana, que compromete la mayor parte de los antibióticos betalactámicos. Por lo general, su producción se debe al uso indiscriminado de antimicrobianos. A nivel mundial, la expansión de este mecanismo de resistencia es inminente y las medidas de control son limitadas. Con el objeto de discutir los problemas relacionados a este mecanismo emergente de resistencia, reportamos un caso de Klebsiella pneumoniae productora de carbapenemasas en Huancayo, la Región de la Sierra Central de Perú.