RESUMO
Resumen Objetivo: el síndrome coronario agudo es una importante causa de morbimortalidad en Colombia, con una alta carga en calidad de vida, muertes, impacto social y costos para el sistema. El control subóptimo de las dislipidemias tiene múltiples causas, entre ellas el uso inadecuado de las estatinas, la inercia terapéutica, la baja difusión y la adopción de las guías y protocolos de manejo, adicional a las barreras de acceso a la atención y a los medicamentos, y la falta de trazabilidad en la atención a partir del evento isquémico agudo. El proyecto "Ruta de atención y manejo de los lípidos en el paciente con síndrome coronario agudo" busca identificar las brechas en la atención clínica y el manejo de la dislipidemia en los pacientes con síndrome coronario agudo en Colombia, y plantear soluciones para cerrarlas. Materiales y método: se realizaron 178 encuestas a profesionales médicos en instituciones de todo el país, para conocer las pautas de manejo de los pacientes con dislipidemia en el paciente con síndrome coronario agudo. Un panel de 17 expertos analizó los resultados y definió las brechas entre la práctica clínica, la evidencia disponible y el manejo recomendado, y planteó recomendaciones para cerrarlas. Resultados y Conclusiones: este artículo muestra las principales brechas detectadas en el manejo de la dislipidemia en pacientes con síndrome coronario agudo en Colombia, y emite recomendaciones de manejo de la dislipidemia, coherentes con las necesidades y características del Sistema de Salud colombiano.
Abstract Objective: acute coronary syndrome (ACS) is an important cause of morbidity and mortality in Colombia, imposing a heavy burden in terms of quality of life, deaths, social impact, and costs to the system. Suboptimal control of dyslipidemia, associated with inadequate statin use, therapeutic inertia, and low rate of dissemination and adoption of the management protocols and guidelines are clinical and healthcare-related factors that contribute to this situation. This is compounded by barriers that hinder access to care and medications, and the lack of care traceability after the acute ischemic event. The "Care Pathway and lipid management in patients with Acute Coronary Syndrome" project seeks to identify gaps in clinical care and the management of dyslipidemia in patients with acute coronary syndrome in Colombia and propose solutions to bridge those gaps. Materials and method: to gain insights into the management of dyslipidemia in patients with ACS, 178 surveys were sent to medical professionals working in different institutions throughout the country. A panel of 17 experts analyzed the results and identified gaps in terms of clinical practice, available evidence, recommended management, and proposed recommendations to bridge those gaps. Results and conclusions: this paper describes the main gaps related to the management of dyslipidemia in patients with ACS in Colombia and offers recommendations by the needs and characteristics of the Colombian Health System.
RESUMO
La neuropatía diabética se presenta hasta en el 60 % de los pacientes diabéticos. La neuropatía diabética periférica es la causa más común de neuropatía en el mundo. La fisiopatología de la neuropatía diabética involucra daño periférico nervioso por acumulación de productos tóxicos derivados de la hiperglicemia. El sistema nervioso central se ve posteriormente involucrado a través de sensibilización, disminución de la función del sistema inhibitorio y aumento en la excitabilidad del sistema de facilitación. La clínica más común se manifiesta de manera simétrica afectando fibras sensitivas pequeñas y grandes, aunque se han encontrado formas atípicas de presentación. Las pruebas diagnósticas confirmatorias se reservan para la duda diagnóstica, casos de síntomas atípicos o investigación. El consenso en cuanto a tratamiento es el uso de gabapentinoides, antidepresivos tricíclicos e inhibidores de recaptura de serotonina y noradrenalina. Estas tres familias se consideran como primera línea de tratamiento.
Diabetic neuropathy occurs in up to 60% of diabetic patients. Diabetic peripheral neuropathy is the most common cause of neuropathy in the world. The pathophysiology of diabetic neuropathy involves peripheral nerve damage due to the accumulation of toxic products derived from hyperglycemia. The central nervous system is subsequently involved through sensitization, decreased function of the inhibitory system, and increased excitability of the facilitative system. The most common symptoms manifest symmetrically, affecting small and large sensory fibers, although atypical forms of presentation have been found. Confirmatory diagnostic tests are reserved for diagnostic doubt, atypical symptoms, or research. The consensus regarding treatment is the prescription of gabapentinoids, tricyclic antidepressants, and serotonin and norepinephrine reuptake inhibitors. These three families are considered the first line.
RESUMO
BACKGROUND: Cognitive impairment is twice more frequent in elderly with type 2 diabetes mellitus (DM). This study was conducted to determine the association between glycemic control and cognitive performance among community-dwelling elderly persons in Mexico. METHODS: Cross-sectional study conducted in individuals aged 60 years or elderly participating in the 2012 Mexican Health and Aging Study. Type 2 DM participants were classified in 3 groups according to their glycated hemoglobin levels (HbA1c): < 7% (intensive control), 7-7.9% (standard control) or ≥ 8% (poor control), and cognitive performance: low (CCCE ≤44 points), intermediate (44.1-59.52 points), or high (≥59.53 points). Multinomial logistic regression models were constructed to determine this association. RESULTS: Two hundred sixteen community-dwelling adults aged 60 and older with type 2 diabetes were selected. Subjects in the low cognitive performance group were older (69.7 ± 6.6 vs 65.86 ± 5.18 years, p < .001) and had a lower educational level (2.5 ± 2.6 vs 7.44 ± 4.15 years, p < .000) when compared to the high cognitive performance participants. HbA1c ≥ 8% was associated with having low (Odds Ratio (OR) 3.17, 95% CI 1.17-8.60, p = .024), and intermediate (OR 3.23, 95% CI 1.27-8.20, p = .014) cognitive performance; this trend was not found for HbA1c 7.0-7.9% group. The multinomial regression analysis showed that the presence of HbA1c ≥ 8% (poor glycemic control) was associated with low (OR 3.17, 95% CI = 1.17-8.60, p = .024), and intermediate (OR 3.23, 95% CI = 1.27-8.20, p = .014) cognitive performance. After adjusting for confounding variables. CONCLUSIONS: Glycemic control with a HbA1c ≥ 8% was associated with worse cognitive performance.
Assuntos
Diabetes Mellitus Tipo 2 , Idoso , Envelhecimento , Glicemia , Cognição , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Controle Glicêmico , Humanos , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: It has been proposed that Vitamin D helps reduce the accumulation of cerebral ß-amyloid-42 by innate immune stimulation and phagocytosis activation. An association between low Vitamin D levels and Alzheimer's dementia (AD) has been established. We determined the association between Vitamin D, mild cognitive impairment (MCI), and AD in older Mexican adults (> 65 years). METHODS: Cross-sectional study conducted at the memory clinic in a tertiary-level hospital in Mexico City. We evaluated subjects with MCI, AD, and normal cognition (NC) with available serum Vitamin D [25(OH)D] levels (past 6 months). Three categories were assigned according to 25(OH)D levels: sufficiency (> 30 ng/mL), insufficiency (21-29 ng/mL), and deficiency (≤ 20 ng/mL). Descriptive statistics, means and standard deviations were used. Logistic regression analyses adjusted by age, sex, and educational level were performed. RESULTS: We evaluated 208 patients. Mean age was 79 ± 1 year, 65% (n = 136) were female; and mean educational level was 6.7 ± 2.3 years. Thirty-one subjects (14%) had NC; 42% (n = 88) had MCI; and 43% (n = 89) had AD. Prevalence of Vitamin D deficiency was 54%, more frequent in the AD group (64%) followed by the MCI (59%) and NC (13%) (p < 0.001) groups. In the multivariate logistic regression analysis, Vitamin D deficiency was associated with MCI (HR 25.02 [confidence interval 95% 4.48-139]; p < 0.001) and AD (HR 41.7 [5.76-301]; p < 0.001) after adjusting for confounders. CONCLUSIONS: Serum Vitamin D deficiency was associated with MCI and dementia; low levels produced a greater effect over executive functions.
Assuntos
Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/epidemiologia , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/sangue , Cognição , Disfunção Cognitiva/sangue , Estudos Transversais , Demência/sangue , Demência/etiologia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , México , Centros de Atenção Terciária , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologiaRESUMO
ABSTRACT Background It has been proposed that Vitamin D helps reduce the accumulation of cerebral β-amyloid-42 by innate immune stimulation and phagocytosis activation. An association between low Vitamin D levels and Alzheimers dementia (AD) has been established. We determined the association between Vitamin D, mild cognitive impairment (MCI), and AD in older Mexican adults (> 65 years) Methods Cross-sectional study conducted at the memory clinic in a tertiary-level hospital in Mexico City. We evaluated subjects with MCI, AD, and normal cognition (NC) with available serum Vitamin D [25(OH)D] levels (past 6 months). Three categories were assigned according to 25(OH)D levels: sufficiency (> 30 ng/mL), insufficiency (21-29 ng/mL), and deficiency (≤ 20 ng/mL). Descriptive statistics, means and standard deviations were used. Logistic regression analyses adjusted by age, sex, and educational level were performed Results We evaluated 208 patients. Mean age was 79 ± 1 year, 65% (n = 136) were female; and mean educational level was 6.7 ± 2.3 years. Thirty-one subjects (14%) had NC; 42% (n = 88) had MCI; and 43% (n = 89) had AD. Prevalence of Vitamin D deficiency was 54%, more frequent in the AD group (64%) followed by the MCI (59%) and NC (13%) (p < 0.001) groups. In the multivariate logistic regression analysis, Vitamin D deficiency was associated with MCI (HR 25.02 [confidence interval 95% 4.48-139]; p < 0.001) and AD (HR 41.7 [5.76-301]; p < 0.001) after adjusting for confounders Conclusions Serum Vitamin D deficiency was associated with MCI and dementia; low levels produced a greater effect over executive functions.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Vitamina D/análogos & derivados , Deficiência de Vitamina D/complicações , Doença de Alzheimer/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Estudos Transversais , Cognição , Demência/etiologia , Demência/sangue , Função Executiva/fisiologia , Doença de Alzheimer/sangue , Disfunção Cognitiva/sangue , Disfunção Cognitiva/epidemiologia , Centros de Atenção Terciária , MéxicoRESUMO
Background: Frailty, a state of increased vulnerability, could play a role in the progression of vascular dementia. We aim to describe the changes in cerebrovascular reactivity of older adults with frailty and vascular-type mild cognitive impairment (MCIv). Methods: This was a cross-sectional study. A comprehensive geriatric assessment, neuropsychological evaluation, and transcranial Doppler ultrasound (TCD) was performed on 180 participants who were allocated into four groups: healthy (n = 74), frail (n = 40), MCIv (n = 35), and mixed (frail + MCIv) (n = 31). ANOVA and Kruskal-Wallis tests were used for the analysis of continuous variables with and without normal distribution. Multinomial logistic regression was constructed to identify associated covariates. Results: Subjects in the mixed group, compared to healthy group, were older (75.0 ± 5.9 vs 70.3 ± 5.9 years; p < 0.001), showed lower education (9.3 ± 6.4 vs 12.2 ± 4.0 years; p = 0.054), greater frequency of diabetes (42% vs 12%; p = 0.005), worse cognitive performance (z = -0.81 ± 0.94), and reduced left medial-cerebral artery cerebrovascular reactivity (0.43 ± 0.42 cm/s). The mixed group was associated with age (odds ratio (OR) 1.16, 95% Confidence Interval (CI) = 1.06-1.27; p < 0.001), diabetes (OR 6.28, 1.81-21.84; p = 0.004), and Geriatric Depression Scale (GDS) score (OR 1.34, 95% CI = 1.09-1.67; p = 0.007). Conclusions: Frailty among older adults was associated with worse cognitive performance, diabetes, and decreased cerebral blood flow.