Erradicación de diabetes en Guatemala: Un sueño posible

Diabetes is a health problem with social and economic consequences. The worldwide prevalence of diabetes is raising; by 1985 there were 30 million of people with diabetes, 177 million by the year 2000 and it is estimated that in 2030 there will be around 438 million people with diabetes. The prevalence of diabetes in Guatemala it’s around 8% of the population, however it is unknown the prevalence of the underdiagnosed and pre-diabetes. Guatemala has high obesity, overweight and sedentary index which increase the risk of diabetes. Worldwide every 6 seconds somebody dies as a consequence of diabetes and in Guatemala represents the third cause in general mortality. The analysis is made about type 2 diabetes which represents 90% of all diabetes and in general is preventable. The author proposes 3 moments in the diabetes natural history: (1) healthy patients that will become diabetics, (2) diabetics who will have a complication related to the disease and (3) complicated patients who will decease. During these three moments there are interventions to be done, however there are non-preventable programs and the inefficiency of the public assistant system. The author proposes possible solutions in base of scientific evidence to stop the raising of diabetes, lowering micro and macro vascular complications and overall to generate a preventive culture in Guatemala.La diabetes mellitus es un problema de salud con alcances económicos y sociales. La prevalencia mundial está aumentando: se estima que para 1985 habí­a 30 millones de personas con diabetes, 177 millones en el año 2000 y se estima que para el año 2030 habrá 438 millones de diabéticos. En Guatemala el 8% de la población tiene diabetes y se desconoce el porcentaje no diagnosticado y en pre-diabetes; además el paí­s tiene í­ndices de obesidad, sobrepeso y sedentarismo altos, situación que predispone a la aparición de la enfermedad. En el mundo cada 6 segundos muere alguien a causa de complicaciones relacionadas con diabetes y en Guatemala ocupa la tercera causa de mortalidad general. Existen varios tipos de diabetes, sin embargo, el ensayo se enfoca en la diabetes tipo 2 debido a que representa el 90% de los casos pero sobre todo por que es prevenible. Para el autor existen tres momentos importantes de los pacientes diabéticos: (1) paciente sano y con riesgo qué enfermará de diabetes, (2) paciente diabético que tendrá complicaciones y (3) pacientes con complicaciones que morirán. En los tres momentos se puede intervenir directamente, sin embargo, existen deficiencias como la ausencia de programas de prevención y la ineficiencia del sistema asistencial público. El autor propone posibles soluciones en base a evidencia cientí­fica para detener el aumento de casos de diabetes mellitus, disminuir las complicaciones micro y macro vasculares en los pacientes y principalmente, generar una cultura preventiva en Guatemala

Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system’s quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala’s National Healthcare System were included. These represent six out of the country’s eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student’s t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2–24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival. (C) 2021 The Authors. Published by Elsevier Ltd

A dream to achieve: diabetes erradication in Guatemala

Diabetes is a health problem with social and economic consequences. The worldwide prevalence of diabetes is raising; by 1985 there were 30 million of people with diabetes, 177 million by the year 2000 and it is estimated that in 2030 there will be around 438 million people with diabetes. The prevalence of diabetes in Guatemala it’s around 8% of the population, however it is unknown the prevalence of the underdiagnosed and pre-diabetes. Guatemala has high obesity, overweight and sedentary index which increase the risk of diabetes. Worldwide every 6 seconds somebody dies as a consequence of diabetes and in Guatemala represents the third cause in general mortality. The analysis is made about type 2 diabetes which represents 90% of all diabetes and in general is preventable. The author proposes 3 moments in the diabetes natural history: (1) healthy patients that will become diabetics, (2) diabetics who will have a complication related to the disease and (3) complicated patients who will decease. During these three moments there are interventions to be done, however there are non-preventable programs and the inefficiency of the public assistant system. The author proposes possible solutions in base of scientific evidence to stop the raising of diabetes, lowering micro and macro vascular complications and overall to generate a preventive culture in Guatemala