RESUMO
The Dominican Republic has no recent data on type 1 diabetes (T1D) incidence in children. Therefore, a study was undertaken to determine this in persons aged <15 years (y). Data were collected on all new T1D diagnoses between 2010-2019 from the four institutions caring for children with T1D. Diagnosis was made according to standard criteria. No secondary ascertainment source was available. The trend and the effect of age and sex of T1D incidence was analyzed using Poisson regression. A total of 1224 new cases of T1D were diagnosed <15 y; mean ± standard deviation (range) 122 ± 12 (96-135) cases per year. Age at T1D diagnosis was 8.8 ± 3.7 y, with a significant female preponderance (n = 708, 57.8%, p < 0.001). When examined per 5-y age group, cases were consistently highest in 10-14 y, and lowest in 0-4 y in all study years. Mean crude T1D annual incidence was 4.3 (95% CI 3.5-5.1) per 100,000 population. There was no significant difference between incidence across the country's three departments (regions): Southeast (4.4 [3.4-5.7]/100,000 population), North (4.1 [2.9-5.6]), and Southwest (3.9 [2.4-5.9]). Mean standardized annual incidence was 4.1 (4.1-4.2) per 100,000 population, with no significant trend of increase over the study period. The incidence of T1D in children aged <15 y is relatively low in Dominican Republic, but consistent with the limited data from other countries in the region. However, the incidence is eight times higher than the previous estimate during 1995-1999. Ongoing surveillance is warranted.
Assuntos
Diabetes Mellitus Tipo 1 , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , República Dominicana/epidemiologia , Feminino , Humanos , IncidênciaRESUMO
To review the global and regional contributions of the Saint Elian Wound Score System (SEWSS) for the diabetic foot syndrome are the aim of this report. The update includes definitions, classification, diagnosis, treatment, prognosis, and prevention to reduce amputations and mortality. From its local use in Mexico to their global spread as part of the Clinical Practice Recommendations of the Diabetic Foot - International Diabetes Federation-2017, the SEWSS has achieved a significant acceptance for the diabetic foot problem care in Latin America. The concept includes the triage of severity grades system for the five types of Diabetic Foot Attack (DFA) due to ischemia, infection, edema, neuropathy (Charcot), or a mixed combination. Persons with Diabetes Mellitus may progress from the low-risk stage to foot attack that may remite to a high risk stage or conversely, evolve to a major amputation or death. The DFA progressive stages (I-III) are described in this review. The clinical details provided by the assessment of the 10 Saint Elian factors permit a rationale therapeutic approach with relevance in prevention and medical treatment and not focused only on wound care avoiding bias originated by specialty-related preferences.
El propósito de este informe es revisar las contribuciones regionales y mundiales del Sistema de San Elian para el Síndrome del Pie Diabético. Esta actualización incluye definiciones, clasificación, diagnóstico, pronóstico, tratamiento y prevención para reducir las amputaciones y su mortalidad. Desde su aplicación local en Mexico hasta su difusión mundial como parte fundamental de las Recomendaciones de Práctica Clínica del Pie Diabético- Federación Internacional de Diabetes 2017, el sistema ha alcanzado una aceptación significativa para la atención del Pie Diabético en Latinoamérica. El concepto incluye el triage urgente por la diferenciación de la gravedad que proporciona el sistema para los cinco tipos de Ataque Del Pie Diabético (APD): isquemico, infeccioso, edema grave, neuropatia (Charcot) y el mixto. Los pacientes con DM-2 pueden evolucionar desde un pie con bajo riesgo hasta un APD que logre remitir a una etapa de riesgo alto o que finalmente evolucione a amputacion mayor y/o muerte. Se describen las etapas evolutivas (I-III). La detallada evaluación que proporciona los 10 factores de San Elian permiten un abordaje terapéutico racional con relevancia en la prevención y el tratamiento médico sin centrarse erróneamente en el cuidado de heridas.
Assuntos
Diabetes Mellitus , Pé Diabético , Amputação Cirúrgica , Pé Diabético/diagnóstico , Pé Diabético/terapia , Humanos , América Latina/epidemiologia , Prognóstico , TriagemRESUMO
AIM: To identify the demographic and clinical characteristics of Dominican adults admitted to a diabetic foot clinic and compare these characteristics by sex to better characterize and understand the severity of diabetes in the Dominican Republic. METHODS: We conducted a retrospective medical chart review of Dominican adults admitted to the National Institute of Diabetes, Endocrinology, and Nutrition's (INDEN) diabetic foot clinic between January 1st, 2015 and December 31st, 2015. We generated descriptive statistics and compared results by sex. RESULTS: We assessed 447 medical charts of patients admitted in 2015. More men visited the clinic than women (65% vs. 35%). The average duration of diabetes was 14.4⯱â¯8.9 years. Abscess was the most common foot problem (74% in men, 68% in women, pâ¯=â¯0.164). A slightly smaller proportion of men received amputations than women (46% vs. 51%, pâ¯=â¯0.390). Women were older (pâ¯<â¯0.001), less educated (pâ¯=â¯0.004), and less likely to be married (pâ¯<â¯0.001). Women also exhibited higher rates of obesity (pâ¯=â¯0.003), hypertension (pâ¯=â¯0.005), cardiovascular disease (pâ¯=â¯0.011), ischemic foot (pâ¯=â¯0.008), and above the knee amputations (pâ¯=â¯0.002). CONCLUSION: Implementation of diabetes education programs, introduction of proper foot care, and improved resources for lifestyle management are needed to increase awareness and subsequently decrease diabetes and its negative impact on the health and economy of the Dominican Republic. Our findings suggest that various risk factors and comorbidities important to the development of diabetes may be disproportionately affecting women. Interventions should focus on women and their behaviors that increase risk for diabetes.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/epidemiologia , Pé Diabético/patologia , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Demografia , República Dominicana/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
Se realizó un estudio retrospectivo con el fin de conocer la incidencia de úlcera péptica perforada en el Hospital Dr. Luis E. Aybar durante el periodo feb 90-feb 95 en el Hospital Dr. Luis E. Aybar en Santo Domingo, República Dominicana. Encontramos un total de 49 casos en este periodo, de los que obtuvimos los siguientes datos: Mayor incidencia entre la segunda y tercera década de la vida, más frecuente en el sexo masculino, el cuadro clínico evolucionó por mas de 24 horas antes de recibir atención médica, los pacientes no tenían antecedentes de úlcera péptica, ni de haber recibido tratamiento alguno para esta enfermedad. El tratamiento quirúrgico efectuado fue el cierre de Graham modificado en casi todos los casos; la mayoría de los pacientes permaneció en el hospital menos de ocho días