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Alejandra Monserrat Rodríguez-Ramírez, María Teresa Alcántara-Garcés, Sergio Hernández-Jiménez, Ana Cristina García-Ulloa, Denise Arcila-Martínez, Héctor Velázquez-Jurado, Rodrigo Eduardo Arizmendi-Rodríguez On behalf of the study group CAIPaDiCentro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoCorrespondence: María Teresa Alcántara-Garcés, Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI Tlalpan, Mexico City, 14080, Mexico, Tel +1 52 55 54870900 (5045), Email teresa.alcantarag@incmnsz.mxIntroduction: Anxiety disorders (AXD) are among the most prevalent mental health conditions in patients with type 2 diabetes (T2D). Previous data have established an association of other psychiatric conditions with poor metabolic control and increased odds of diabetes-related complications. Nonetheless, follow-up information about the effects of AXD on the metabolic control of patients with TD2 is still limited.Objective: Evaluate the effects of AXD on the metabolic parameters of patients with T2D over 12 months of follow-up in a multidisciplinary comprehensive care model.Methods: Prospective study of T2D subjects enrolled in a comprehensive care program with follow-up at 3 and 12 months of treatment. Patients were assessed using the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale (HADS). We registered clinical and metabolic characteristics from each visit. Metabolic parameters over time were analyzed with a mixed model of repeated measures using AXD and time as interaction variables.Results: Our sample included 2703 patients at baseline, and 1161 (43%) subjects continued the follow-up at 12 months. The AXD group had more females, lower age, and fewer years of formal education compared with subjects without AXD at baseline, 3 and 12 months. Patients with AXD also reported higher mean fasting glucose at three months, and higher HbA1c at three and 12 months. Our MMRM for HbA1c reported significant differences over time in subjects with and without AXD. The differences in means between groups increased from 0.17% at three months to 0.31% at 12 months. The variables from the HADS anxiety score, sex, age, years of diagnosis, and insulin treatment were also associated with HbA1c parameters over time.Conclusion: Patients with AXD had the worst glycemic control at 3 and 12 months of follow-up. HbA1c differences in patients with AXD compared with non-AXD subjects increases over time in association with anxiety symptoms.Keywords: diabetes care, psychiatric comorbidity, anxiety, glycemic control

Los aneurismas gigantes de las arterias coronarias son una entidad rara (afectan a aproximadamente el 0.02% de la población), de causa diversa (en su mayoría se asocian a aterosclerosis, aunque se asocian también a distintas vasculitis y enfermedades del tejido conectivo). En muchas ocasiones son un hallazgo incidental, aunque a veces comportan riesgos importantes (síndromes coronarios agudos por embolización, fístulas, taponamiento cardiaco o muerte súbita). El manejo a seguir en estos casos es aún controvertido por la falta de evidencia dada la rareza del cuadro, tendiéndose a individualizar en cada caso según distintos factores, como las características del paciente, la causa subyacente del aneurisma o el tamaño del mismo y el crecimiento del mismo a lo largo del seguimiento.

Ana C García Ulloa,1 Maria S Tron-Gómez,2 Michelle Díaz-Pineda,1 Diana Hernández-Juárez,1 María V Landa-Anell,1 Marco A Melgarejo-Hernández,1 Sergio Hernández-Jiménez1 On behalf of the CAIPaDi Study Group1Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; 2Faculty of Health Sciences, Universidad Anáhuac México Norte, Huixquilucan, MexicoCorrespondence: Sergio Hernández-Jiménez, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Centro de Atención Integral del Paciente con Diabetes, Vasco de Quiroga No. 15, Belisario Domínguez, Colonia Sección XVI, Tlalpan, Mexico City, 14080, Mexico, Tel +1 52 55 54870900 (5045) ; +1 52 55 55737378, Email sergio.hernandezj@incmnsz.mxIntroduction: In 2020, several countries established a global emergency state. Lockdowns restricted people’s lifestyles and daily activities to prevent coronavirus spread. These measures hindered diabetes mellitus control and lifestyle changes. This study aims to evaluate if attending a multidisciplinary program before the pandemic helped maintain a good metabolic state, lifestyle modifications, and mental health in patients with diabetes mellitus during the COVID-19 lockdown.Methods: Patients included in this study attended a multidisciplinary program, with < 5 years of diagnosis of type 2 diabetes, without disabling complications, between 18– 70 years old. The complete lockdown occurred from February 27, 2020, to May 31, 2020. The first patient (non-COVID) to return to the center for face-to-face consultation was in March 2021. Consultations in 2019 were face-to-face and changed to a virtual modality during 2020. We analyzed metabolic, lifestyle, mental health, and diabetes education parameters.Results: A total of 133 patients with type 2 diabetes mellitus were included with complete information in visits before and during the lockdown. Metabolic parameters and self-care measures (nutrition plan, foot evaluation, and self-glucose monitoring) evaluated on our patients had no change during the lockdown. We found a significant increase in the time patients spent sitting during the day (p< 0.05). Barriers to exercise increased during lockdown, being joint pain (3.8% to 12.0%, p< 0.01) and lack of time to exercise (4.5% to 7.5%, p=0.33) being the most common. There was no significant difference in symptoms of anxiety and depression, quality of life, and empowerment.Conclusion: A multidisciplinary diabetes mellitus program, including diabetes education for self-care activities, positively impacts patients, maintaining good outcomes despite lockdown difficulties.Keywords: multidisciplinary care, lifestyle, self-care, mental health, type 2 diabetes, COVID-19 pandemics

Resumen Introduccion y objetivos La estenosis aortica (EA) es la valvulopatia mas frecuente en los paises occidentales, por ser fundamentalmente degenerativa asociada a la edad. La EA representa cada ano un mayor numero de estudios diagnosticos, ingresos hospitalarios y procedimientos intervencionistas. El retraso diagnostico, una alta comorbilidad o fragilidad acompanante empeoran el pronostico y pueden afectar al tratamiento. El objetivo de este trabajo fue establecer la prevalencia de EA en poblacion anciana de ambito comunitario y conocer los niveles de comorbilidad y fragilidad de dichos sujetos afectados. Metodos Se incluyo a pacientes ≥ 65 anos remitidos para vacunacion antigripal, sin antecedentes de EA o reemplazo de valvula aortica. Resultados Participaron un total de 522 individuos, con una edad media de 78,7 anos. El 61% fueron mujeres. La EA aparecio en el 4,2% de la muestra, con una prevalencia dependiente de la edad (12,8% de los mayores de 85 anos). La mayoria de los pacientes (72,7%; n = 16) presentaron comorbilidad. Sin embargo, la fragilidad no se describio con frecuencia (13,6%; n = 3) y el riesgo quirurgico fue generalmente bajo (54,5%, n = 12). Conclusiones La carga de EA no conocida en la poblacion general de ancianos es mas alta que la indicada previamente. Aunque los sujetos con EA no diagnosticados presentan la mayoria de las veces comorbilidades, rara vez son fragiles y la mayoria muestra un bajo riesgo quirurgico.

Objective: To evaluate misconceptions about diabetes in people who attend the first visit at the CAIPaDi program, as well as its association with metabolic and psychological variables at short and long term. Methods and Analysis: The frequency of misconceptions in diabetes was determined through a true/false survey. We compared sociodemographic, metabolic and psychological variables between people with and without misconceptions at baseline, at 3 months and 1 year after a multidisciplinary educational program. Results: 902 participants answered the survey, with an age of 50 ±10 years old, 54.3% were women, with 1 (0-5) years living with type 2 diabetes. At baseline, 53% of the participants had at least 1 misconception, being more frequent in women (p=0.045) and in population with lower educational level (p

Purpose: First-degree family members of patients with type 2 diabetes have a higher risk of developing diabetes. Attendance in a diabetes prevention program is essential to implement prevention strategies. However, many relatives drop out. Identifying the causes behind the program abandonment is necessary to improve attendance adherence. Methods: We reviewed six different databases for causes of treatment abandonment in prevention programs for type 2 diabetes published between 1980 and 2020. Eleven articles met inclusion criteria and varied in sample size, ethnicity, gender, age of the participating patients, and length of follow-up. Causes of abandonment were categorized into social, biological, lifestyle, and emotional. Results: Sample sizes of the selected studies ranged from 143 to 128,520 subjects. The main barriers were age, economic difficulties, ignorance about risk factors, family history of diabetes, living in public housing, marital status, comorbidities, and low consumption of fruits and vegetables. Physicians' attitudes toward prediabetes screening were also a barrier. Conclusion: People at risk of developing diabetes face multiple barriers to preventing the development of this disease. During the research, the variety of reasons causing dropouts in prevention programs was great and diverse.

This paper reports the treatment of gaseous hydrogen sulfide, H2S, in a biotrickling filter (BTF) under extreme acidic pH conditions (≈ 1.2). The effect of adding thiosulfate (Na2S2O3.5H2O) to promote biomass growth, feeding low concentrations of ozone to control excess biomass, and the carbon dioxide, CO2, consumption by the chemolithoautotrophic consortium were evaluated. The results showed a global removal efficiency over 98.0% with loads of H2S > 50 g m−3 h−1 (at 639 ppmv) and a linear relation between H2S elimination capacity with the CO2 consumption rate of around 0.1 gCO2/gH2S. Supplementing sulfur in the medium with 2 g L−1 thiosulfate resulted in negative effect performance. Respirometry tests proved that the consortium could not utilize this sulfur form at this pH. Additionally, continuous and intermittent O3 feeding to the BTF in gaseous concentrations of 98 ± 5.4 mg m−3 caused a slight decreased in the performance but the biomass activity in the BTF was only slightly affected allowing a quick performance recovery once O3 addition was suspended.

En este trabajo se aborda el tema de la distribución de cine independiente en nuestro país, a través del caso de estudio del documental mexicano Vatreni y su relativo éxito en los circuitos de exhibición europeos en contraste con su escasa exhibición en los canales de distribución mexicanos. Con base en investigación documental y de campo, se esboza una propuesta tendiente a mejorar el intrincado periplo de la distribución y exhibición de cine independiente en México. Videoabstract Te invitamos a ver la explicacion del artículo en palabras de los autores. Da click en la imagen para abrir el reproductor de video.

Background and aims: Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients’ acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors. Methods: The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019. Results: During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week ( p Conclusion: The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.

Background: Diabetes educators are an important element in the multidisciplinary treatment team of diabetes. Diabetes education interventions are recommended throughout the course of the disease since they have a favorable impact in glucose control. Objective: The objective of the study was to evaluate the baseline status and at follow-up of patients participating in diabetes education sessions. Methods: Retrospective cohort study based on the review of clinical records of patients from a National Health Institute in Mexico. A total of 153 subjects that attended individual sessions were included in the study. Changes were assessed in 48 participants that had a second evaluation. The outcomes included clinical, anthropometric, and biochemical parameters, along with variables related to diabetes education. Results: The knowledge about tools for diabetes self-management was poor. Significant changes were found in different components that promote self-management of diabetes including knowing glycemic targets, performing an adequate insulin injection, and practicing self-monitoring of blood glucose. Conclusions: The knowledge of patients with diabetes about their disease is inadequate. Interventions related to diabetes education could promote better adherence to self-care behaviors in patients with diabetes.

Background . There is controversy regarding the association between hypovitaminosis D and COVID-19 outcomes. Aim of the study . We assessed the association between 25-hydroxyvitamin D levels and COVID-19 outcomes in hospitalized subjects with severe SARS-CoV-2 infection. Methods . Retrospective cohort study. Serum 25-hydroxyvitamin D levels of subjects with severe COVID-19 pneumonia were measured at hospital admission, between March 17th, 2020, and March 1st, 2021. Results . Out of 2,908 patients, 571 (19.6%) had vitamin D deficiency (defined as a serum 25-hydroxyvitamin D level

Whole body vibration (WBV) has been suggested as improving skin and blood flow. This study aimed to determine the effect of exposure to WBV on levels of partial transcutaneous oxygen pressure (TcPO2) in the foot of patients with type 2 diabetes (T2D) within the metabolic control goals. A block randomized, open, two-arm, parallel and controlled clinical trial was conducted. Participants recruited from the Center of Comprehensive Care for the Patient with Diabetes were assessed at the National Institute of Rehabilitation, Mexico City. Control group underwent multidisciplinary care for T2D; experimental group, in addition to the comprehensive diabetes care, was exposed to WBV through an exercise program, attending three times a week for a period of 3 months. TcPO2 was measured in the feet of the participants at baseline and after 12 weeks. A sample of 50 volunteers with recently-diagnosed T2D and similar baseline characteristics (demographic, cardiovascular risk, presence of diabetic polyneuropathy, and indicators of glycemic control and TcPO2) was recruited. The experimental group (n=27) showed a mean value of 47.7±6.1 mmHg in TcPO2, significantly higher (p=0.028) than the 44.3±7.5 mmHg of control group (n=23), at the end of intervention. In conclusion, exposure to WBV promoted an increase and a significant 3 mmHg difference in the foot TcPO2 levels between those subjects with T2D that underwent the 12-week exercise program and those not exposed to the treatment.

Background: Post-COVID-19 patients may incur myocardial involvement secondary to systemic inflammation. Our aim was to detect possible oedema/diffuse fibrosis using cardiac magnetic resonance imaging (CMR) mapping and to study myocardial deformation of the left ventricle (LV) using feature tracking (FT). Methods: Prospective analysis of consecutively recruited post-COVID-19 patients undergoing CMR. T1 and T2 mapping sequences were acquired and FT analysis was performed using 2D steady-state free precession cine sequences. Statistical significance was set to p

To evaluate the effectiveness of a comprehensive care program to achieve and maintain goals in patients with type 2 diabetes.The CAIPaDi program includes 9 interventions delivered in 7 h. It seeks to achieve metabolic goals, identify and resolve barriers that would make implementation difficult, and provide self-efficacy and empowerment to patients by identifying personal profiles to establish individualized strategies. The program consists of a 4 intervention visits (1, 2, 3, and 4 months) and two follow up visits (12 and 24 months). Outcomes are compared between every visit. Main outcome was the attainment of the USA National Committee for Quality Assurance treatment goals.1104 patients completed the first 4 visits, 545 the 12 month evaluation, and 218 the 24 month evaluation. After the conclusion of the four monthly sessions, 80.6% had HbA1c7%, 72.1% had BP130/80 mmHg and 71.6% had LDL- cholesterol100 mg/dl. After twelve months, the percentage of goals achieved were 65.9%, 67.7% and 43.3% respectively (p 0.001). For the 2-year evaluation the percentages were 61.0%, 70.6%, and 40.8% respectively (p 0.001). All patients had renal, eye, foot and dental evaluations. Empowerment and quality of life showed significant changes; anxiety and depression scores remained low at annual follow-ups.The CAIPaDI program results in sustained improvement and maintenance of treatment goals.

CONTEXT Patients with a body mass index (BMI) ≥35 kg/m2 have lower benefits with intensive treatments and metabolic control goals are more difficult to reach. OBJECTIVE Evaluate the effect of a comprehensive care program in patients with a BMI ≥35 kg/m2. DESIGN Prospective cohort study. SETTING Comprehensive Care Center in a National Institute of Health. PATIENTS Patients with type 2 diabetes, ≤5 years of diagnosis, without disabling complications, nonsmokers, and a BMI

We compared the completeness of data captured by physicians in a diabetes outpatient clinic using a general electronic health record system versus one that was specifically geared to diabetes. Use of a diabetes-oriented data system was found to allow for greater capture of crucial variables required for diabetes care than a general electronic record and was well accepted by health care providers.

To evaluate the use of the electronic integral monitoring system (SMID) to identify factors associated to glycemic control and its impact in the quality of care in patients with type 2 diabetes (T2D).T2D patients registered in SMID were analyzed. Biochemical, clinical and lifestyle variables were recorded. Factors associated to HbA1c ≤7% were explored. Quality of care of the clinic was measured according to the National Committee for Quality Assurance Criteria (NCQA) that requires a score of 75 to achieve a good quality of care.511 patients were included. Prescription of basal insulin, SGLT-2 inhibitors and barriers to follow nutritional plan were associated with decreased probability of having adequate glycemic control. Patients in the maintenance stage of motivation had higher probability of having HbA1c ≤7%. According to NCQA evaluation 60 points were achieved. Glucose goals were not met; 35.9% had HbA1c ≥9% and 17% HbA1c7%. While foot evaluation, smoking approach, blood pressure and lipids goals were accomplished; eye and renal evaluations were borderline.Glycemic control in patients with long standing T2D and multiple comorbidities is challenging, which directly impacts in the quality of care. Professionals should focus in reinforcing non-pharmacological interventions to optimize glycemic targets.

ObjectiveTo determine the prevalence of diabetic retinopathy (DR) and diabetic macular oedema (DME) and their associated risk factors in patients recently diagnosed with type 2 diabetes.Methods and analysisWe carried out a cross-sectional study from April 2014 to August 2017. We included patients aged ≥18 years. Diabetes was defined as fasting plasma glucose of >7.8 mmol/L or 2-hour postload plasma glucose of >11.1 mmol/L. Non-mydriatic fundus examination with a digital-fundus camera was performed. Three images centred in the macula, optic disc and temporal to the macula were obtained and graded according to the Scottish Scale Classification of Diabetic Retinopathy.Results1232 patients (mean age 51.5 years) with a diabetes duration of 0–5 years were examined. Age-adjusted and sex-adjusted prevalence of DR and DME was 17.4% (95% CI 15.3% to 19.6%) and 6.6% (95% CI 5.4% to 8.2%), respectively. DR was associated with diabetes duration (OR per year=1.20, pConclusionOur study contributes to the evidence of progressive increase in DR and DME risk in early stages of diabetes, supporting the urgent need for early screening.

Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMICs). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMICs is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMICs were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 18 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies do not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients’ characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowing linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMICs. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.

It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.

This paper reports the treatment of gaseous hydrogen sulfide, H

Highlights • Indigenous origin conferred lower probability of prediabetes and type 2 diabetes. • Social determinants were associated with lower probability of type 2 diabetes. • Family history of diabetes was associated with prediabetes and type 2 diabetes., Aims In this research we assessed the prevalence of prediabetes and type 2 diabetes and its association with social determinants such as indigenous origin and residence area in population from Comitan, Chiapas, Mexico. Methods The Comitan Study is a population-based study carried out from 2010 to 2012 that included 1844 participants aged ≥ 20 years, 880 indigenous and 964 nonindigenous participants. Ethnicity was ascertained by self-report and speaking an indigenous language was also recorded. Prediabetes was defined as fasting serum glucose 5.6–6.9 mmol/l or 2-hour post load serum glucose 7.8–11.0 mmol/l. Type 2 diabetes was defined as fasting serum glucose ≥ 7.0 mmol/l or 2-h post load serum glucose ≥ 11.1 mmol/l or previous clinical diagnosis. Results Age-sex-adjusted prevalence of prediabetes and type 2 diabetes was 18.0% (95%CI 15.3–20.6) and 11.0% (95%CI 8.9–131.1) in nonindigenous and 10.6% (95%CI 8.4–12.7) and 4.7% (95%CI 3.3–6.1) in indigenous individuals, respectively. After stratifying by ethnicity, in both indigenous and nonindigenous participants the probability of prediabetes and type 2 diabetes increased with age and BMI. In both indigenous and nonindigenous participants the probability of type 2 diabetes was lower in those living in rural compared with urban areas. Conclusions The prevalence of prediabetes and type 2 diabetes was significantly lower in indigenous than in nonindigenous participants. Also, the prevalence of type 2 diabetes was lower in those living in rural areas. Health benefits of a traditional lifestyle may partially account for these differences.

Introduction Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. Objective To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. Methods A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8 ± 9.1 years (55.9% women), BMI 29.2 ± 4.4 kg/m2, and time since the diagnosis 1 (0–5) years were included in the study. Results At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were “Lack of information on an adequate diet” (24.7%), “I eat away from home most of the time” (19.7%), and “Denial or refusal to make changes in my diet” (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p 7% (24.7%) and triglyceride levels >150 mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p Conclusions Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes.

IntroductionLipid control is essential in type 2 diabetes mellitus (T2DM). The aim of this study is to investigate factors associated with lipid therapy adherence and achievement of goals in real-life setting among patients with recently diagnosed T2DM.Research design and methodsThis is a longitudinal analysis in a center of comprehensive care for patients with diabetes. We include patients with T2DM, 2) and completed 2-year follow-up. The comprehensive diabetes care model includes 9 interventions in 4 initial visits and annual evaluations. Endocrinologists follow the clinic’s guideline and adapt therapy to reach risk-based treatment goal. The main outcome measures were the proportion of patients meeting low-density lipoprotein cholesterol (c-LDL) (ResultsWe included 288 consecutive patients (54±9 years, 53.8% women), time since T2DM diagnosis 1 (0–5) year. Baseline, 10.8% patients were receiving statin therapy (46.5% moderate-intensity therapy and 4.6% high-intensity therapy), 8.3% fibrates and 4.2% combined treatment. The proportion of patients with combined treatment increased to 41.6% at 3 months, decreased to 20.8% at 1 year and increased to 38.9% at 2 years of evaluation. Patients receiving treatment met LDL and triglycerides goals at 3 months (17% vs 59.7%, relative ratio (RR)=0.89, 95% CI 0.71 to 1.12), at 1 year (17% vs 26.7%, RR=0.62, 95% CI 0.41 to 0.95) and at 2 years (17% vs 29.9%, RR=0.63, 95% CI 0.43 to 0.93). Main reasons for medication suspension: patient considered treatment was not important (37.5%) and other physician suspended treatment (31.3%).Conclusion88.2% of patients with T2DM required lipid-lowering drugs. Education for patients and physicians is critical to achieve and maintain diabetes goals.Trial registration numberNCT02836808.

Evidence based medicine has changed the manner in which medicine is practiced and learned. Epidemiological studies, meta-analyses and systematic reviews have been used to create algorithms for the treatment of hyperglycemia in patients with type 2 diabetes. Recently, several randomized controlled trials (i.e. ACCORD, ADVANCE, VADT) have generated new and valuable information regarding the benefits and risks of achieving optimal glucose control. As a result, guidelines and algorithms have been updated. However, many aspects remain controversial. In this article, the clinical implications of the existing guidelines are critically analyzed. The limitations of the current guidelines include the lack of applicability to relevant diabetic subgroups, the exclusion of important factors that modify the therapeutic response to glucose-lowering agents and the limited recognition of the importance of the socioeconomic situation on treatment efficacy. Many subgroups of patients have not been included in the studies used to generate recommendations. There is insufficient evidence to support the use of current treatment recommendations in patients with early onset type 2 diabetes, patients with advanced microvascular complications, and the elderly with or without chronic complications. The characteristics of the candidates for conservative or intensive treatment are poorly defined. Interventions are recommended without considering clinical variables (i.e. obesity, time since diagnosis or prolonged exposure to hyperglycemia) that may modify treatment efficacy and the occurrence of side effects. Finally, no consideration is given to the socioeconomic context of the population in which the guidelines are to be applied. In summary, this manuscript highlights the key areas which require further work. If these issues are adequately addressed, the guidelines for the management of type 2 diabetes will be relevant and applicable to all diabetic groups.

BACKGROUND: An alkaline mineral medium (pH ≈10) was used in a previous study to enhance the absorption rate of hydrogen sulfide in a biofiltration process where an alkaliphilic sulfo-oxidizing bacterial consortium was deployed. In this work the same mineral media and bacterial consortium were used to assess a biotrickling filter performance during the treatment of low gaseous concentrations of carbon disulfide and ethanethiol. RESULTS: The alkalinity of the mineral medium increased the solubility of carbon disulfide and ethanethiol by around 50% and 80%, respectively. The oxidation activity of the microorganisms resulted in a lower value compared to other reported results. The maximum elimination capacities reached using alkaline biotrickling filtration were between 2.3 and 3.5 g m -3 h -1 with removal efficiencies around 50%. A conceptual model for biotrickling filtration of ethanethiol was developed and validated using experimental data under dynamic conditions. CONCLUSION: Alkaline conditions enhance the absorption rates of sulfur compounds in a biotrickling filter, but the elimination capacity of the system was limited by the low oxidation activities of the alkaliphilic microorganisms. It is necessary to continue exploring the biodiversity in order to find a microorganism adapted to the consumption of volatile sulfur compounds.

Benzene, toluene, ethyl benzene and xylenes, known collectively as BTEX, are widespread contaminants, commonly found in soil, aquifers, and the atmosphere. BTEX degradation was evaluated as separate substrates and in mixtures, in liquid culture, and in packed biofilters with the filamentous fungus Paecilomyces variotii CBS115145. BTEX were differentially utilized by P. variotii: toluene was completely degraded, followed by ethyl benzene; benzene was partially assimilated (45%), similarly to m- and p-xylenes, while o-xylene was only 30% metabolized in liquid culture. Carbon recoveries as CO2 were 48, 40, and 53% for toluene, benzene, and ethyl benzene, respectively. Initial toluene addition allowed complete elimination of m-xylene in 12 days. In mixtures of toluene–benzene and ethyl benzene–benzene, the toluene degradation rate (0.27 mg l−3 h−1) was lower than the rate obtained with only toluene (0.37 mg l−3 h−1), while for ethyl benzene the rate was 0.15 mg l−3 h−1 as single substrate and 0.10 mg l−3 h−1 in the ethyl benzene–benzene mixture. Benzene degradation was also negatively affected by both toluene and ethyl benzene. Enzymatic analyses showed benzene oxidation activity. In biofiltration experiments average total carbon elimination capacities (TCECs) of 70 gC m−3 h−1 and a maximum of around 110 gC m−3 h−1 for the BTEX mixture were attained. Toluene, ethyl benzene, and benzene ECs were around 70 gC m−3 h−1, 40 gC m−3 h−1, and 10 gC m−3 h−1, respectively.

Peripheral neuropathy affects about 30% of people with diabetes mellitus. Between 16% and 26% of diabetes patients experience chronic pain. This may be referred to as diabetic neuropathic pain (DNP) or diabetic peripheral neuropathic pain (DPNP). Minimum requirements for diagnosis of DPNP should include assessment of pain and symptoms and neurological examination, with the accent on sensory examination. Given that depression and other co-morbidities are commonly associated with this condition, a broad approach to management is essential. Lifestyle intervention and optimisation of glycaemic control are recommended as initial steps in management. An evidence-based treatment algorithm for DPNP has been proposed, recommending initial use of either a tri-cyclic antidepressant, selective serotonin noradrenaline re-uptake inhibitor or alpha-2-delta agonist, depending on patient co-morbidities and contra-indications. Addition of an opioid agonist may be required in the event of inadequate pain control. Irrespective of which treatment is offered, only about one third of patients are likely to achieve more than 50% pain relief. Further research to improve the diagnosis and management of DPNP is needed.

To examine the relationship between demographic, clinical and psychosocial variables and diabetes self-care management in Mexican type 2 diabetic patients. Cross-sectional study of 176 consecutive patients with type 2 diabetes aged 30-75 years, attending a tertiary health-care center in Mexico City. A brief medical history and previously validated questionnaires were completed. The study group consisted of 64 males/112 females, aged 55 +/- 11 years, mean diabetes duration of 12 +/- 8 years and HbA1c of 9.0 +/- 2.0%, 78.4% reported following the correct dose of diabetes pills or insulin, 58% ate the recommended food portions, and 44.3% did exercise three or more times per week. A good adherence to these three recommendations was observed in only 26.1% of the patients. These patients considered as a group were characterized by a greater knowledge about the disease (P0.00001), regular home blood glucose monitoring (P0.01), an inner perception of better diabetes control (P = 0.007), good health (P = 0.004) and better communication with their physician (P0.02). A poor adherence to two or the three main diabetes care recommendations was associated with a depressive state (OR 2.38, 95% CI 1.1-4.9, P0.01) and a history of excessive alcohol intake (OR 4.03, 95% CI 1.1-21.0, P = 0.03). Poor adherence to standard diabetes care recommendations is frequently observed in patients with type 2 diabetes attending a specialized health care center in Mexico City. Depression must be identified and treated effectively.