RESUMEN
The COVID-19 pandemic has had overwhelming global impacts with deleterious social, economic, and health consequences. To assess the COVID-19 death toll, researchers have estimated declines in 2020 life expectancy at birth (e0). When data are available only for COVID-19 deaths, but not for deaths from other causes, the risks of dying from COVID-19 are typically assumed to be independent of those from other causes. In this research note, we explore the soundness of this assumption using data from the United States and Brazil, the countries with the largest number of reported COVID-19 deaths. We use three methods: one estimates the difference between 2019 and 2020 life tables and therefore does not require the assumption of independence, and the other two assume independence to simulate scenarios in which COVID-19 mortality is added to 2019 death rates or is eliminated from 2020 rates. Our results reveal that COVID-19 is not independent of other causes of death. The assumption of independence can lead to either an overestimate (Brazil) or an underestimate (United States) of the decline in e0, depending on how the number of other reported causes of death changed in 2020.
Asunto(s)
COVID-19 , Causas de Muerte , COVID-19/complicaciones , COVID-19/mortalidad , Estados Unidos/epidemiología , Brasil/epidemiología , Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias/complicaciones , Neoplasias/mortalidad , Cardiopatías/complicaciones , Cardiopatías/mortalidad , Diabetes Mellitus/mortalidad , Complicaciones de la Diabetes/mortalidad , Causas de Muerte/tendencias , Tablas de Vida , Esperanza de Vida/tendenciasRESUMEN
Introducción: La morbimortalidad por enfermedad renal crónica (ERC) ha presentado en las dos últimas décadas un incremento desconcertante. En Cuba, aunque la mortalidad por esta causa ha tenido un comportamiento estable, la incidencia y la prevalencia se mantienen elevadas. Objetivo: Caracterizar los pacientes fallecidos con ERC según variables demográficas, causas de muerte y otras variables seleccionadas. Material y Métodos: Estudio descriptivo, transversal. El universo de estudio estuvo constituido por todos los fallecidos del país en el período, en cuyos certificados de defunción se incluyó entre una de las causas, la ERC. La información fue obtenida de las bases de datos de mortalidad de la Dirección Nacional de Registros Médicos y Estadísticos de Salud del MINSAP. Procesamiento de forma automatizada (SPSS versión 22.0). Fueron calculadas las frecuencias absolutas y relativas. Resultados: La frecuencia global de pacientes fallecidos se incrementó de forma mantenida y resultó mayor en la provincia La Habana (23,6 por ciento). La media de la edad fue de 70 años. Prevaleció el sexo masculino, el color de piel blanco y el grupo de edad de 80 años y más. Los porcentajes más altos según la causa básica de muerte correspondieron a enfermedad renal hipertensiva y Diabetes Mellitus. Conclusiones: Los fallecidos con ERC son mayormente hombres, de piel blanca, y con edades avanzadas. Las principales causas de muerte son la enfermedad hipertensiva y la Diabetes Mellitus(AU)
Introduction: Chronic kidney disease (CKD) has increased at an alarming rate worldwide over the last two decades. Although mortality due to CKD has registered stable behavior in Cuba, its prevalence and incidence are showing higher rates. Objective: To describe the main demographic features of deceased patients with CKD in Cuba, the causes of death and other variables during the period 2011-2016. Material and Methods: A descriptive cross-sectional study was conducted. The study universe included all deceased patients in Cuba during the period mentioned. CKD was listed on their death certificates as one of the causes of death. The information used was obtained from the mortality database available on the National Directorate of Medical Records and Health Statistics of the Cuban Ministry of Public Health. Data was processed using SPSS version 22.0. Absolute and relative frequencies were calculated. Results: The global frequency of deceased patients showed a steady increase. Havana was the city that presented the highest percentage (23,6 percent). Nonetheless, the rest of the cities showed an increased frequency rate. The median age was 70 years. The male gender prevailed over the female one as well as white ethnicity and the 80 years and over age group. Regarding the cause of death, the highest percentages corresponded to hypertensive kidney disease and Diabetes Mellitus. Conclusions: Most of the deceased patients with CKD are male, white and at advanced ages. The main causes of death are hypertensive disease and Diabetes Mellitus(AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Indicadores de Morbimortalidad , Causas de Muerte/tendencias , Insuficiencia Renal Crónica/mortalidad , Enfermedades Renales , Estadísticas de Salud , Epidemiología Descriptiva , Estudios Transversales , Cuba , Complicaciones de la Diabetes/mortalidadRESUMEN
The present study is aimed to assess the risk factors for mortality in the first 107 rRT-PCR confirmed cases of SARS-CoV-2 infections in Bolivia. For this observational, retrospective and cross-sectional study, the epidemiological data records were collected from the Hospitals and the Ministry of Health of Bolivia, obtaining the clinical and epidemiological data of the COVID-19 cases that were laboratory-diagnosed during March 2-29, 2020. Samples were tested by rRT-PCR to SARS-CoV-2 at the Laboratory of the National Center of Tropical Diseases (CENETROP), following the protocol Charite, Berlin, Germany. The odds ratio (OR) with respective 95% confidence interval (95%CI) for mortality as dependent variable was calculated. When we comparatively analyzed survivors and non-survivors in this first group of 107 cases in Bolivia, we found that at bivariate analyses, age (±60 years old), hypertension, chronic heart failure, diabetes, and obesity, as well as the requirement of ICU, were significantly exposure variables associated with death. At the multivariate analysis (logistic regression), two variables remained significantly associated, age, ±60 years-old (OR=9.4, 95%CI 1.8-104.1) and hypertension (OR=3.3, 95%CI 1.3-6.3). As expected, age and comorbidities, particularly hypertension, were independent risk factors for mortality in Bolivia in the first 107 cases group. More further studies are required to better define risk factors and preventive measures related to COVID-19 in this and other Latin American countries.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Bolivia/epidemiología , COVID-19 , Niño , Intervalos de Confianza , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Complicaciones de la Diabetes/mortalidad , Femenino , Insuficiencia Cardíaca/mortalidad , Humanos , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Obesidad/mortalidad , Oportunidad Relativa , Pandemias , Neumonía Viral/epidemiología , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2 , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: Although most countries face increasing population levels of obesity and diabetes their effect on coronary heart disease (CHD) mortality has not been often studied in small island developing states (SIDs) where obesity rates are among the highest in the world. We estimated the relative contributions of treatments and cardiovascular risk factors to the decline in CHD mortality from 1990 to 2012 in the Caribbean island, Barbados. METHODS: We used the IMPACT CHD mortality model to estimate the effect of increased coverage of effective medical/surgical treatments and changes in major CHD risk factors on mortality trends in 2012 compared with 1990. We calculated deaths prevented or postponed (DPPs) for each model risk factor and treatment group. We obtained data from WHO Mortality database, population denominators from the Barbados Statistical Service stratified by 10-year age group (ages 25-34 up to 85 plus), population-based risk factor surveys, Global Burden of Disease and Barbados' national myocardial infarction registry. Monte Carlo probabilistic sensitivity analysis was performed. RESULTS: In 1990 the age-standardized CHD mortality rate was 109.5 per 100,000 falling to 55.3 in 2012. Implementation of effective treatment accounted for 56% DPPs (95% (Uncertainty Interval (UI) 46%, 68%), mostly due to the introduction of treatments immediately after acute myocardial infarction (AMI) (14%) and unstable angina (14%). Overall, risk factors contributed 19% DPPs (95% UI 6% to 34%) mostly attributed to decline in cholesterol (18% DPPs, 95% UI 12%, 26%). Adverse trends in diabetes: 14% additional deaths(ADs) 95% UI 8% to 21% ADs) and BMI (2% ADs 95%UI 0 to 5% ADs) limited potential for risk factor gains. CONCLUSIONS: Given the significant negative impact of obesity/diabetes on mortality in this analysis, research that explores factors affecting implementation of evidenced-based preventive strategies is needed. The fact that most of the decline in CHD mortality in Barbados was due to treatment provides an example for SIDs about the advantages of universal access to care and treatment.
Asunto(s)
Enfermedad Coronaria/mortalidad , Complicaciones de la Diabetes/mortalidad , Modelos Cardiovasculares , Obesidad/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Barbados/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatías Diabéticas/diagnóstico , Cardiopatías/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/mortalidad , Enfermedades del Sistema Nervioso Autónomo/terapia , Muerte Súbita , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Neuropatías Diabéticas/mortalidad , Neuropatías Diabéticas/terapia , Cardiopatías/mortalidad , Cardiopatías/terapia , Humanos , Pronóstico , Factores de RiesgoRESUMEN
SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.
RESUMO Diabetes é uma das mais frequentes patologias crônicas em todo o mundo, cujo tratamento envolve uma equipe multidisciplinar, médicos generalistas, endocrinologistas, cardiologistas, nefrologistas e oftalmologistas. Pacientes com diabetes mellitus tipo 2 (DMT2) podem apresentar neuropatia autonômica cardíaca (NAC), levando a aumento de mortalidade e morbidade. Nesta revisão, apresentaremos atuais conceitos, características clínicas, diagnóstico, prognóstico e possíveis tratamentos. Novas drogas recentemente desenvolvidas para redução de níveis glicêmicos apresentaram efeito pleiotrópico de redução de morte súbita, sugerindo um potencial uso neste perfil de pacientes.
Asunto(s)
Humanos , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatías Diabéticas/diagnóstico , Cardiopatías/diagnóstico , Pronóstico , Enfermedades del Sistema Nervioso Autónomo/mortalidad , Enfermedades del Sistema Nervioso Autónomo/terapia , Factores de Riesgo , Muerte Súbita , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Neuropatías Diabéticas/mortalidad , Neuropatías Diabéticas/terapia , Cardiopatías/mortalidad , Cardiopatías/terapiaRESUMEN
BACKGROUND: Little is known about diabetes-related major lower extremity amputations (DMLEA) burden in México. AIM OF THE STUDY: To describe DMLEA hospitalization rates, in-hospital survival rates, characteristics associated with all-cause in-hospital mortality and direct costs of hospitalization during the 2005-2015 period, in the two principal Health Institutions in Mexico: the Mexican Institute of Social Security (IMSS) and the Ministry of Health (MoH). METHODS: A secondary data analysis was conducted using hospital discharge information obtained from administrative databases. Non-traumatic DMLEA hospitalizations in adults aged 20 years and over were analyzed. Hospitalization characteristics and in-hospital all-cause mortality risk were also assessed. Direct costs of hospitalization including length of hospital stay, surgical procedure, wound care and medical emergency consultation were accounted in U.S. dollars (USD, 2015). RESULTS: There were 34,051 DMLEA hospitalizations and 1,268 in-hospital deaths. DMLEA hospitalizations rates increase from 4.71-6.12 × 100,000 affiliates during 2005 and 2015 respectively for both institutions together. Females and age ≥60 years were associated with all-cause in-hospital death. The all-period direct costs of hospitalization amounted to $132.51 million USD ($86.30 in the IMSS and $46.21 in the MoH), and showed a sustained increment: from $4.14 million USD in 2005 to $24.84 million USD in 2015 (percentage increase 499.3%). CONCLUSIONS: In-hospital mortality was 3.7%. Female sex and age ≥60 years were characteristics associated with all-cause in-hospital death. The increase in the number of DMLEA hospitalizations and their direct costs, reflects a negative progression of diabetes in the two largest Health Institutions in Mexico.
Asunto(s)
Amputación Quirúrgica/estadística & datos numéricos , Diabetes Mellitus/patología , Hospitalización/economía , Extremidad Inferior/cirugía , Adulto , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/patología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , México , Persona de Mediana Edad , Seguridad Social , Tasa de Supervivencia , Adulto JovenRESUMEN
The objective was to estimate the burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, from 2008 to 2013. A descriptive epidemiological study was performed by calculating disability-adjusted life years (DALY). Burden of disease was high, more than 8,000 DALY in men and women. Disability accounted for 93% of DALY and mortality for 7.5%. The burden in men was 5,580.6 DALY, almost double that in women (2,894.8), and the share of the years lost due to disability (YLD) component in men pushed this rate to 67.6% of total DALY. Men live longer following amputation, so they lose more years of healthy life (65.8%), while mortality is higher in women (61%). DALY rates were not distributed homogeneously across the state. The intensification of evaluation, planning, and development of cost-effective strategies for prevention and health education for diabetic foot should be oriented according to higher male vulnerability.
O objetivo foi estimar a carga da doença para as amputações de membros inferiores atribuíveis ao diabetes mellitus no Estado de Santa Catarina, Brasil, no período de 2008 a 2013. Realizou-se um estudo epidemiológico descritivo, utilizando-se o cálculo de anos de vida perdidos ajustados por incapacidade (DALY - disability-adjusted life years). A carga da doença foi alta, mais de 8 mil DALY, distribuídos entre homens e mulheres. A incapacidade respondeu por 93% do DALY e a mortalidade por 7,5%. A carga dos homens foi 5.580,6 DALY, praticamente o dobro das mulheres (2.894,8), sendo que a participação do componente anos de vida saudável perdidos em virtude de incapacidade (YLD - years lost due to disability) dos homens impulsionou esta taxa para 67,6% do total do DALY. Os homens vivem mais tempo com a amputação, por isto perdem mais anos de vida sadia (65,8%), e a mortalidade é maior entre as mulheres (61%). As distribuições das taxas de DALY no estado não mostraram distribuição homogênea. A intensificação de avaliação, planejamento e desenvolvimento de estratégias custo-efetivas para a prevenção e educação em saúde para o pé diabético deve ser considera a partir da maior vulnerabilidade masculina.
El objetivo fue estimar la carga de enfermedad para las amputaciones de miembros inferiores, atribuibles a la diabetes mellitus en el Estado de Santa Catarina, Brasil, durante el período de 2008 a 2013. Se realizó un estudio epidemiológico descriptivo, utilizándose el cálculo de años de vida ajustados por discapacidad (DALY - disability-adjusted life years). La carga de la enfermedad fue alta, más de 8 mil DALY distribuidos entre hombres y mujeres. La incapacidad supuso un 93% del DALY y la mortalidad un 7,5%. La carga de los hombres fue 5.580,6 DALY, prácticamente el doble de las mujeres (2.894,8), siendo que la participación del componente años de vida saludable perdidos por discapacidad (YLD - years lost due to disability) de los hombres impulsó esta tasa hacia un 67,6% del total del DALY. Los hombres viven más tiempo con la amputación, por ello pierden más años de vida sana (65,8%), y la mortalidad es mayor entre las mujeres (61%). Las distribuciones de las tasas de DALY en el estado no mostraron distribución homogénea. La intensificación de evaluación, planificación y desarrollo de estrategias costo-efectivas para la prevención y educación en salud para el pie diabético debe ser considerada a partir de la mayor vulnerabilidad masculina.
Asunto(s)
Amputación Quirúrgica/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Extremidad Inferior/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/mortalidad , Brasil/epidemiología , Análisis Costo-Beneficio , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Programas Nacionales de Salud , Años de Vida Ajustados por Calidad de Vida , Factores SexualesRESUMEN
Mucormycosis is an emerging infectious disease with high rates of associated mortality and morbidity. Little is known about the characteristics of mucormycosis or entomophthoromycosis occurring in Mexico. A search strategy was performed of literature published in journals found in available databases and theses published online at Universidad Nacional Autónoma de México (UNAM) library website reporting clinical cases or clinical case series of mucormycosis and entomophthoromycosis occurring in Mexico between 1982 and 2016. Among the 418 cases identified, 72% were diabetic patients, and sinusitis accounted for 75% of the reported cases. Diabetes mellitus was not a risk factor for entomophthoromycosis. Mortality rate was 51% (125/244). Rhizopus species were the most frequent isolates (59%, 148/250). Amphotericin B deoxycholate was used in 89% of cases (204/227), while surgery and antifungal management as combined treatment was used in 90% (172/191). In diabetic individuals, this combined treatment approach was associated with a higher probability of survival (95% vs 66%, OR = 0.1, 95% CI, 0.02-0.43' P = .002). The most common complications were associated with nephrotoxicity and prolonged hospitalization due to IV antifungal therapy. An algorithm is proposed to establish an early diagnosis of rhino-orbital cerebral (ROC) mucormycosis based on standardized identification of warning signs and symptoms and performing an early direct microbiological exam and histopathological identification through a multidisciplinary medical and surgical team. In summary, diabetes mellitus was the most common risk factor for mucormycosis in Mexico; combined antifungal therapy and surgery in ROC mucormycosis significantly improved survival.
Asunto(s)
Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Manejo de la Enfermedad , Mucormicosis/diagnóstico , Mucormicosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Niño , Preescolar , Desbridamiento , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , México/epidemiología , Persona de Mediana Edad , Mucorales/clasificación , Mucorales/aislamiento & purificación , Mucormicosis/mortalidad , Mucormicosis/terapia , Prevalencia , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
O objetivo foi estimar a carga da doença para as amputações de membros inferiores atribuíveis ao diabetes mellitus no Estado de Santa Catarina, Brasil, no período de 2008 a 2013. Realizou-se um estudo epidemiológico descritivo, utilizando-se o cálculo de anos de vida perdidos ajustados por incapacidade (DALY - disability-adjusted life years). A carga da doença foi alta, mais de 8 mil DALY, distribuídos entre homens e mulheres. A incapacidade respondeu por 93% do DALY e a mortalidade por 7,5%. A carga dos homens foi 5.580,6 DALY, praticamente o dobro das mulheres (2.894,8), sendo que a participação do componente anos de vida saudável perdidos em virtude de incapacidade (YLD - years lost due to disability) dos homens impulsionou esta taxa para 67,6% do total do DALY. Os homens vivem mais tempo com a amputação, por isto perdem mais anos de vida sadia (65,8%), e a mortalidade é maior entre as mulheres (61%). As distribuições das taxas de DALY no estado não mostraram distribuição homogênea. A intensificação de avaliação, planejamento e desenvolvimento de estratégias custo-efetivas para a prevenção e educação em saúde para o pé diabético deve ser considera a partir da maior vulnerabilidade masculina.
El objetivo fue estimar la carga de enfermedad para las amputaciones de miembros inferiores, atribuibles a la diabetes mellitus en el Estado de Santa Catarina, Brasil, durante el período de 2008 a 2013. Se realizó un estudio epidemiológico descriptivo, utilizándose el cálculo de años de vida ajustados por discapacidad (DALY - disability-adjusted life years). La carga de la enfermedad fue alta, más de 8 mil DALY distribuidos entre hombres y mujeres. La incapacidad supuso un 93% del DALY y la mortalidad un 7,5%. La carga de los hombres fue 5.580,6 DALY, prácticamente el doble de las mujeres (2.894,8), siendo que la participación del componente años de vida saludable perdidos por discapacidad (YLD - years lost due to disability) de los hombres impulsó esta tasa hacia un 67,6% del total del DALY. Los hombres viven más tiempo con la amputación, por ello pierden más años de vida sana (65,8%), y la mortalidad es mayor entre las mujeres (61%). Las distribuciones de las tasas de DALY en el estado no mostraron distribución homogénea. La intensificación de evaluación, planificación y desarrollo de estrategias costo-efectivas para la prevención y educación en salud para el pie diabético debe ser considerada a partir de la mayor vulnerabilidad masculina
The objective was to estimate the burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, from 2008 to 2013. A descriptive epidemiological study was performed by calculating disability-adjusted life years (DALY). Burden of disease was high, more than 8,000 DALY in men and women. Disability accounted for 93% of DALY and mortality for 7.5%. The burden in men was 5,580.6 DALY, almost double that in women (2,894.8), and the share of the years lost due to disability (YLD) component in men pushed this rate to 67.6% of total DALY. Men live longer following amputation, so they lose more years of healthy life (65.8%), while mortality is higher in women (61%). DALY rates were not distributed homogeneously across the state. The intensification of evaluation, planning, and development of cost-effective strategies for prevention and health education for diabetic foot should be oriented according to higher male vulnerability.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Extremidad Inferior/cirugía , Diabetes Mellitus/epidemiología , Amputación Quirúrgica/estadística & datos numéricos , Brasil/epidemiología , Factores Sexuales , Morbilidad , Análisis Costo-Beneficio , Años de Vida Ajustados por Calidad de Vida , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/mortalidad , Amputación Quirúrgica/mortalidad , Programas Nacionales de SaludRESUMEN
BACKGROUND: This study aimed to evaluate mechanical and infectious complications associated with urgent-start peritoneal dialysis (PD) and patients and technique survival in the first 180 days. METHODS: It was a prospective study that evaluated chronic patients who started unplanned PD using high-volume PD (HVPD) right after (<72 h) PD catheter placement. After hospital discharge, patients were treated with intermittent PD on alternate days in a dialysis unit until family training was provided. RESULTS: Fifty-one patients fulfilling the following criteria were included: age was 62.1 ± 15 years, with diabetes as the main etiology of end-stage renal disease (39%), and uremia as the main dialysis indication (76%). Metabolic and fluid controls were achieved after 3 sessions of HVPD, and patients remained in intermittent PD for 23.2 ± 7.2 days. Mechanical complications occurred in 25.7% and peritonitis rate was 0.5 episode/patient-year. In the first 6 months, technique and patients survival rates were 86 and 82.4% respectively. CONCLUSION: The PD modality was a feasible and safe alternative to hemodialysis in the urgent-start dialysis.
Asunto(s)
Complicaciones de la Diabetes , Fallo Renal Crónico , Diálisis Peritoneal , Anciano , Brasil/epidemiología , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Tasa de SupervivenciaRESUMEN
Type 2 diabetes mellitus currently ranks high among indicators used in Global Burden of Disease Studies. The current study estimated the burden of disease attributable to type 2 diabetes mellitus and its chronic complications in Brazil, 2008. We calculated disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) stratified by gender, age bracket, and major geographic region. Type 2 diabetes mellitus accounted for 5% of the burden of disease in Brazil, ranking 3rd in women and 6th in men in the composition of DALYs. The largest share of DALYs was concentrated in the 30-59-year age bracket and consisted mainly of YLDs. The highest YLL and YLD rates were in the Northeast and South of Brazil, respectively. Chronic complications represented 80% of YLDs from type 2 diabetes mellitus. Type 2 diabetes mellitus ranked as a leading health problem in Brazil in 2008, accounting for relevant shares of mortality and morbidity.
Asunto(s)
Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Personas con Discapacidad/estadística & datos numéricos , Adulto , Anciano , Brasil/epidemiología , Enfermedad Crónica , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Femenino , Humanos , Esperanza de Vida , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de VidaRESUMEN
AIMS: To assess cause-specific mortality in a cohort of patients with type 1 diabetes (T1D) followed at an university hospital (tertiary level, Rio de Janeiro city) and an outpatient clinic (secondary level, Bauru city) both in Brazil's southeast, and associations of survival with gender, age at diagnosis, self-reported ethnicity and diabetes duration. METHODS: Our study is based on a cohort of patients with T1D whose vital status was determined as of December 31, 2015. The causes of mortality were determined by death certificates and outpatient clinic records. RESULTS: Among 986 patients, (54.4%) females, (74.8%) Caucasians, 886 (89.9%) were alive, 62 (6.3%) had died, and in 38 (3.9%) the vital status was unknown. Median age at death [interquartile range] and diabetes duration until death were 30.0 [13] and 15.6 [10] years, respectively. Considering those who died (n = 62), most patients (about 70%) died from end-stage renal disease, macrovascular disease or acute complications of diabetes, mainly diabetic ketoacidosis. The other causes of mortality were infections, fatal accidents and non-diabetes-related. The standardized mortality ratio was 3.13 [2.35-4.08] in those aged under 40. In a multivariate Cox model, "age < 40 years" and "year of diagnosis" were the only significant variables with hazard ratios of 6.259 [(3.100-12.639), p < 0.001] and 0.915 [(0.880-0.951), p < 0.001], respectively. CONCLUSIONS: Our study shows that patients with T1D had a threefold increase in mortality. The specific causes of mortality were mainly diabetes-related chronic complications; however, acute complications, especially diabetic ketoacidosis, persisted as an important cause of mortality.
Asunto(s)
Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus Tipo 1/mortalidad , Adolescente , Adulto , Anciano , Brasil/epidemiología , Causas de Muerte , Estudios de Cohortes , Complicaciones de la Diabetes/clasificación , Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética/mortalidad , Femenino , Humanos , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Población Blanca/estadística & datos numéricos , Adulto JovenAsunto(s)
Humanos , Masculino , Femenino , Adulto , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Diabetes Mellitus/patología , Diabetes Mellitus/prevención & control , Diabetes Mellitus/epidemiología , Riesgo a la Salud , Complicaciones de la Diabetes/complicaciones , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/mortalidadAsunto(s)
Humanos , Masculino , Femenino , Adulto , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Diabetes Mellitus/patología , Diabetes Mellitus/prevención & control , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Riesgo a la Salud , Complicaciones de la Diabetes/complicaciones , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/mortalidadRESUMEN
The Global Burden of Disease (GBD) is a methodology that evaluates risks to the population risks when confronted with a disease or injury, such as the entirety of the effects of mortality and disability that these represent for health systems. The chronic kidney disease (CKD) is an entity with high mortality, high disability, and high health-intervention costs. The review of the data generated by the Institute for Health Metrics and Evaluation (IHME), the headquarters of the GBD Study Group, show that at worldwide level, CKD-associated mortality has increased 108% since 1990 to 2015. The main cause that generates death by CKD in Mexico is diabetes mellitus, whose impact on mortality has progressed, being found in 19th place for diabetic nephropathy in 1990 to the 3rd cause of death in 2015, representing a 670% increase. Ages with greatest mortality are situated between 45 and 75 years, generating a greater impact on disability-adjusted death in women. Mexico City has the greatest CKD-related mortality and a greatest number of DALY (Disability-Adjusted Life Years): 1,559.71 per 100 000 inhabitants. The Mexican state with the lower number of deaths is Baja California, and Quintana Roo is the state with the lower number of DALY (766.32 per 100 000 inhabitants).
La carga global de la enfermedad (CGE) es una metodología que evalúa los riesgos poblacionales ante una enfermedad o lesión como el conjunto de los efectos de mortalidad y discapacidad que estos representan para los sistemas de salud. La enfermedad renal crónica (ERC) es una enfermedad con alta mortalidad, discapacidad y altos costos para los sistemas de salud. La revisión de los datos generados por el Instituto para la Medición y Evaluación de la Salud, sede del grupo de estudio de la CGE, muestran que, a nivel global, la mortalidad por ERC se ha incrementado en 108% de 1990 a 2015. La principal causa que genera la muerte por ERC en México es la diabetes mellitus, cuyo impacto en mortalidad ha progresado de encontrarse en el lugar 19 por nefropatía diabética en 1990, a ser la tercera causa de muerte en 2015, representando un incremento de 670%. Las edades con más mortalidad se sitúan entre los 45 a 75 años. La Ciudad de México cuenta con mayor mortalidad por ERC y mayor número de DALYs (Disability-adjusted life years), con 1559.71 por 100 mil habitantes. El estado con menor número de muertes es Baja California, y Quintana Roo es el estado con menor número de DALYs (766.32 por cada 100 000 habitantes).
Asunto(s)
Carga Global de Enfermedades , Insuficiencia Renal Crónica/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Complicaciones de la Diabetes/mortalidad , Femenino , Costos de la Atención en Salud , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/economíaRESUMEN
O diabetes mellitus tipo 2 se destaca, atualmente, na composição dos indicadores dos Estudos de Carga Global de Doença. Este estudo estimou a carga de doença atribuível ao diabetes mellitus tipo 2 e suas complicações crônicas no Brasil, 2008. Foram calculados os anos de vida perdidos ajustados por incapacidade (DALY), anos de vida perdidos por morte prematura (YLL) e os anos de vida perdidos por conta da incapacidade (YLD) estratificados por sexo, faixa etária e região. O diabetes mellitus tipo 2 representou 5% da carga de doença no Brasil, posicionando-se como a 3ª causa mais importante nas mulheres e a 6ª nos homens na construção do DALY. A maioria do DALY se concentrou na faixa etária entre 30 e 59 anos e foi representado majoritariamente pelo YLD. As maiores taxas de YLL e YLD se concentraram nas regiões Nordeste e Sul, respectivamente. As complicações crônicas do diabetes mellitus tipo 2 representaram 80% do YLD. O diabetes mellitus tipo 2 representou um dos principais agravos de saúde no Brasil em 2008, contribuindo com relevantes parcelas de mortalidade e morbidade.
La diabetes mellitus tipo 2 se destaca, actualmente, en la composición de los indicadores de los Estudios de Carga Global de Enfermedad. Este estudio estimó la carga de la enfermedad, atribuible a la diabetes mellitus tipo 2 y sus complicaciones crónicas en Brasil, 2008. Se calcularon los años de vida perdidos, ajustados por incapacidad (DALY), años de vida perdidos por muerte prematura (YLL) y los años de vida perdidos, debido a la incapacidad (YLD), estratificados por sexo, franja de edad y región. La diabetes mellitus tipo 2 representó un 5% de la carga de enfermedad en Brasil, posicionándose como la 3ª causa más importante en las mujeres y la 6ª en los hombres en la construcción del DALY. La mayoría del DALY se concentró en la franja de edad entre 30 y 59 años y fue representado mayoritariamente por el YLD. Las mayores tasas de YLL y YLD se concentraron en las regiones del nordeste y sur, respectivamente. Las complicaciones crónicas de la diabetes mellitus tipo 2 representaron un 80% del YLD. El diabetes mellitus tipo 2 representó uno de los principales agravios de salud en Brasil en 2008, contribuyendo con relevantes cuotas de mortalidad y morbilidad.
Type 2 diabetes mellitus currently ranks high among indicators used in Global Burden of Disease Studies. The current study estimated the burden of disease attributable to type 2 diabetes mellitus and its chronic complications in Brazil, 2008. We calculated disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) stratified by gender, age bracket, and major geographic region. Type 2 diabetes mellitus accounted for 5% of the burden of disease in Brazil, ranking 3rd in women and 6th in men in the composition of DALYs. The largest share of DALYs was concentrated in the 30-59-year age bracket and consisted mainly of YLDs. The highest YLL and YLD rates were in the Northeast and South of Brazil, respectively. Chronic complications represented 80% of YLDs from type 2 diabetes mellitus. Type 2 diabetes mellitus ranked as a leading health problem in Brazil in 2008, accounting for relevant shares of mortality and morbidity.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Personas con Discapacidad/estadística & datos numéricos , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Brasil/epidemiología , Enfermedad Crónica , Esperanza de Vida , Años de Vida Ajustados por Calidad de Vida , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus Tipo 2/mortalidadRESUMEN
OBJECTIVE: The degree to which mortality and cardiovascular disease (CVD) incidence remains elevated in young U.S. adults with type 1 diabetes (T1DM) is unclear. We determined contemporary rates for adults <45 years old with long-standing, childhood-onset T1DM from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study. RESEARCH DESIGN AND METHODS: Members of the EDC Study cohort <45 years old during the 1996-2012 follow-up period (n = 502) were studied. Mortality and CVD rates were calculated for those aged 30-39 and 40-44 years. Data from the background Allegheny County, Pennsylvania, population were used to calculate age- and sex-matched standardized mortality (SMR) and incidence rate ratios (IRR). RESULTS: In both age groups, the SMR for total mortality was â¼5 (95% CIs: 30-39-year-olds, 2.8, 7.2; 40-44-year-olds, 3.4, 7.8). CVD mortality SMRs ranged from 19 (95% CI 11, 32) to 33 (95% CI 17, 59). Hospitalized CVD IRR was â¼8 (95% CIs: 30-39-year-olds, 2.5, 18.9; 40-44-year-olds, 4.5, 12.8); revascularization procedures account for much of the increased risk. For all outcomes, the relative risk was larger in women. Participants aged 30-39 years had 6.3% (95% CI 3.8, 9.8) absolute 10-year CVD risk, approaching the American College of Cardiology/American Heart Association-recommended cut point of 7.5% for initiation of statin therapy in older adults. CONCLUSIONS: Total and CVD mortality and hospitalized CVD are all significantly increased in this contemporary U.S. cohort of young adults with long-standing T1DM. These findings support more aggressive risk factor management in T1DM, especially among women.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/mortalidad , Adulto , Anciano , Estudios de Casos y Controles , Complicaciones de la Diabetes/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Incidencia , Masculino , Persona de Mediana Edad , Pennsylvania/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
La diabetes mellitus, afección frecuente a nivel mundial, tiene gran impacto en la sociedad no solo por su alta prevalencia, sino por sus complicaciones crónicas y su alta mortalidad. Afecta a unos 180 millones de personas en el mundo. La prevalencia de la diabetes (tipos I y II) se estima en el 13 por ciento en pacientes mayores de 60 años. La estructura corneal sufre modificaciones en los pacientes diabéticos; la hiperglucemia afecta la hidratación de la córnea, y con esto varía el espesor corneal y aparecen cambios queratométricos visibles mediante topografía corneal. Las córneas de los pacientes con diabetes presentan alteraciones epiteliales, estromales y endoteliales. Además, existe una disminución de la permeabilidad endotelial durante la fase de hipoxia, que relacionan estos efectos de la diabetes en las células endoteliales. El objetivo de nuestro estudio es abordar las diferentes alteraciones corneales en los pacientes diabéticos(AU)
Diabetes Mellitus, a frequent disease worldwide, has a great impact on the society, not only for their high prevalence, but for their chronic complications and high mortality. It has an effect on 180 million people approximately in the world. The prevalence of diabetes (type I and II) is estimated to be 13 % in patients older than 60 years. The corneal structure undergoes changes in diabetic patients; the hyperglycemia affects the corneal hydration and causes variations in the corneal thickness, with occurrence of visible keratometric changes detected in the corneal topography. The corneas of diabetic patients show epithelial, stromal and endothelial alterations. Additionally, there is decrease in endothelial permeability during the phase of hypoxia that relate these effects of diabetes in the endothelial cells. The objective of our study was to deal with the different corneal alterations in diabetic patients(AU)