Interpretación del monitoreo continuo de glucosa: una visión práctica

Contexto: las herramientas para el monitoreo de glucosa a nivel capilar, como intersticial, han evolucionado en precisión y exactitud. Puntualmente, los sistemas de monitoreo continuo de glucosa han permitido alcanzar las metas de control en pacientes con diabetes de una manera más fácil. Aunque la literatura médica recomienda que la información obtenida de estos dispositivos debe estar organizada y resumida, el proceso estructurado de interpretación no está estandarizado. Objetivo: describir desde una perspectiva práctica, sencilla e intuitiva, la interpretación de los datos del sistema de monitoreo continuo de glucosa.   Metodología: se realizó una búsqueda descriptiva de la literatura en la base de datos PubMed y se seleccionaron artículos pertinentes a los objetivos propuestos. A través de reuniones periódicas presenciales y virtuales, se diseñó un esquema de interpretación de los registros de monitorización continua de glucosa, teniendo en cuenta las recomendaciones de la literatura y la experiencia personal de los autores para llegar a un consenso práctico. Resultados: los objetivos de interpretación se resumieron en 4 pasos: 1) Determinar si el estudio es confiable; 2) Definir el problema; 3) Determinar dónde está el problema; 4) identificar la etiología del problema. Conclusiones: la interpretación de la información de los sistemas de monitoreo continuo de glucosa deben de ser sencillas, intuitivas y prácticas

Type 2 diabetes and urinary incontinence: A scoping review and position statement

Context: Urinary incontinence (UI) is a highly prevalent and disabling condition among older adults and women with type 2 diabetes (T2D), yet it remains underrecognized in clinical guidelines. The global rise in diabetes and population aging amplifies its burden. Objective: This position statement aims to raise clinical awareness about urinary incontinence in individuals with diabetes and provide evidence-based recommendations for its management. A multidisciplinary consensus process identified key barriers, challenges, and care priorities to guide healthcare professionals in delivering more comprehensive and person-centered care. Methods: A scoping review was conducted to examine the clinical literature on urinary incontinence and its association with type 2 diabetes, following the Joanna Briggs Institute Reviewer’s Manual and PRISMA-ScR guidelines. The Nominal Group Technique was also used to obtain insights from a multidisciplinary panel of experts, including endocrinologists, geriatricians, nurses, and pelvic floor specialists. Results: The review included 32 peer-reviewed articles and informed structured discussions on the epidemiology, clinical impact, treatment strategies, and lived experiences related to urinary incontinence in people with type 2 diabetes. The expert panel generated 57 ideas; 23 were considered critically important and incorporated into the final position statement. Conclusions: Urinary incontinence remains underdiagnosed and undertreated among older adults and postmenopausal women with type 2 diabetes. Contributing factors include fragmented care, limited provider awareness, and financial barriers. Multidisciplinary strategies focusing on metabolic control, patient education, and improved healthcare accessibility are essential for advancing the quality of care and reducing the burden of urinary incontinence in this vulnerable population

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Interpretación del monitoreo continuo de glucosa: una visión práctica

Contexto: las herramientas para el monitoreo de glucosa a nivel capilar, como intersticial, han evolucionado en precisión y exactitud. Puntualmente, los sistemas de monitoreo continuo de glucosa han permitido alcanzar las metas de control en pacientes con diabetes de una manera más fácil. Aunque la literatura médica recomienda que la información obtenida de estos dispositivos debe estar organizada y resumida, el proceso estructurado de interpretación no está estandarizado. Objetivo: describir desde una perspectiva práctica, sencilla e intuitiva, la interpretación de los datos del sistema de monitoreo continuo de glucosa.   Metodología: se realizó una búsqueda descriptiva de la literatura en la base de datos PubMed y se seleccionaron artículos pertinentes a los objetivos propuestos. A través de reuniones periódicas presenciales y virtuales, se diseñó un esquema de interpretación de los registros de monitorización continua de glucosa, teniendo en cuenta las recomendaciones de la literatura y la experiencia personal de los autores para llegar a un consenso práctico. Resultados: los objetivos de interpretación se resumieron en 4 pasos: 1) Determinar si el estudio es confiable; 2) Definir el problema; 3) Determinar dónde está el problema; 4) identificar la etiología del problema. Conclusiones: la interpretación de la información de los sistemas de monitoreo continuo de glucosa deben de ser sencillas, intuitivas y prácticas.</jats:p

Cadeira turca primária vazia: estudo retrospectivo

Introduction: Primary empty sella (PES) consists of herniation of the suprasellar subarachnoid space within the sella turcica in patients with no history of sellar pathology. Diagnosis is mostly made incidentally. Objective: Describe the characteristics of patients with PES. Methods: Patients with PES from 6 Argentine centers specialized in Neuroendocrinology in Buenos Aires diagnosed between 1997-2021 were included. Diagnosis was based in sellar magnetic resonance, pituitary functional evaluation by baseline hormonal measurement and visual function assessed by neuro-ophthalmological evaluation and campimetry. Results: Sixty-three patients with a mean age of 52.3 ± 13.2 years and a predominance of female gender (79%, 4:1 ratio) were included. The average BMI was 32.7 ± 8.13 kg/m2 and 68% were overweight or obese. HTA was also found in 59%. Among women, the parity frequency was 78%: 92% had multiple pregnancies. The diagnosis was incidental in 22%. In symptomatic patients (n= 49), the reasons for consultation were headache in 61%, symptoms of endocrine dysfunction in 51% and visual disturbances in 33%: 43% of the patients presented multiple symptoms. MRI showed partial PES in 63% and total PES in 37% of the patients. In the biochemical evaluation, hypopituitarism was observed in 46%. Conclusions: Although the diagnosis of PES can be made incidentally, in our series most of the patients presented symptoms. Most of them were multiparous women, obese and hypertensive patients. Biochemical evaluation should be carried out to investigate isolated or multiple pituitary deficits in order to indicate the corresponding replacement treatment.Introducción: La silla turca vacía primaria (STVP) consiste en la herniación del espacio subaracnoideo supraselar dentro de la silla turca en pacientes sin antecedentes de patología selar. El diagnóstico se realiza mayoritariamente de forma incidental. Objetivos: Describir las características de pacientes con STVP. Métodos: Pacientes de 6 centros argentinos especializados en Neuroendocrinología con STVP entre 1997-2021. El diagnóstico fue realizado mediante resonancia magnética selar (RM), la evaluación funcional hipofisaria por medición hormonal basal y la función visual mediante evaluación neuro-oftalmológica y campimetría. Resultados: Se incluyeron 63 pacientes con una edad promedio de 52.3± 13.2 años y predominio femenino (79%; 4:1).  El IMC promedio fue de 32.7 ± 8.13 kg/m2 y un 68% presentaron sobrepeso u obesidad. El 59% presentaba HTA. Entre las mujeres, la frecuencia de paridad fue 78 %: 92% tuvieron embarazos múltiples. El diagnóstico fue incidental en 22% de los pacientes. En los pacientes sintomáticos (n= 49), los motivos de consulta fueron cefalea en el 61%, síntomas de disfunción endocrina en 51% y alteraciones visuales 33% . El 43% presentó más de un síntoma. La RM evidenció STV parcial en 63% y STV total en 37% de los pacientes. En el 46% se observó hipopituitarismo. Conclusiones: En nuestra serie la mayoría de los pacientes presentaron sintomatología.  Se observó un claro predominio en mujeres multíparas, y en pacientes obesos e hipertensos. Debe instrumentarse la evaluación bioquímica para pesquisar el déficit pituitario aislado o múltiple e indicar el correspondiente tratamiento sustitutivo.Introdução: A sela vazia primária (SFE) consiste na herniação do espaço subaracnóideo suprasselar dentro da sela turca em pacientes sem histórico de patologia selar. O diagnóstico é feito principalmente de forma incidental. Objetivo: Descrever as características dos pacientes com PES. Métodos: Foram incluídos pacientes com PES de 6 centros argentinos especializados em Neuroendocrinologia em Buenos Aires, diagnosticados entre 1997-2021. O diagnóstico foi baseado na ressonância magnética selar, avaliação funcional hipofisária por dosagem hormonal basal e função visual avaliada por avaliação neuro-oftalmológica e campimetria. Resultados: Foram incluídos 63 pacientes com idade média de 52,3 ± 13,2 anos e predominância do sexo feminino (79%, proporção 4:1). O IMC médio foi de 32,7 ± 8,13 kg/m2 e 68% estavam com sobrepeso ou obesidade. ATS também foi encontrada em 59%. Entre as mulheres, a frequência de paridade foi de 78%: 92% tiveram gestações múltiplas. O diagnóstico foi incidental em 22%. Nos pacientes sintomáticos (n= 49), os motivos de consulta foram cefaleia em 61%, sintomas de disfunção endócrina em 51% e distúrbios visuais em 33%: 43% dos pacientes apresentavam sintomas múltiplos. A ressonância magnética mostrou PES parcial em 63% e PES total em 37% dos pacientes. Na avaliação bioquímica foi observado hipopituitarismo em 46%. Conclusões: Embora o diagnóstico de SEP possa ser feito incidentalmente, em nossa série a maioria dos pacientes apresentou sintomas. A maioria eram mulheres multíparas, obesas e hipertensas. Avaliação bioquímica deve ser realizada para investigação de déficits hipofisários isolados ou múltiplos, a fim de indicar o tratamento substitutivo correspondente

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally