Objetivo: Determinar los factores asociados a la comorbilidad DM-TBC en pacientes atendidos en el consultorio de endocrinología del Hospital Nacional Hipólito Unánue en el período enero 2010 - junio 2016. Metodología: Se realizó un estudio de tipo Observacional, analítico, retrospectivo de casos y controles. Formado por 270 pacientes mayores de 15 años, de los cuales 90 pacientes con diagnóstico de diabetes Mellitus y tuberculosis que cumplieron con los criterios de inclusión y exclusión para el estudio constituyeron parte de los casos y 180 pacientes con diagnóstico de diabetes mellitus formaron parte de los controles seleccionados para mantener una relación de 2 a 1 con los casos. Resultados: Los factores asociados o de riesgo estadísticamente significativo para desarrollar la comorbilidad DM-TBC fueron el IMC como el más importante con OR 3,52 (IC 95%: 2,077-5,986 y p. 0, 000), seguido de tener contacto TBC con OR 2, 48 (IC 95%: 1,475-4,183 y p. 0, 001), el sexo que estuvo más asociado fue el masculino con OR 1,92 (IC 95%: 1,152-3,209 y p. 0, 014), también se encontraron asociación con la edad ≥35 años (OR 2,31 con IC 95%: 1,225-4,382 y p. 0, 009), la HbA1c ≥ 7 % (OR: 2,18 con IC 95%: 1,275-3,736 y p. 0, 006) y recibir insulinoterapia (OR: 2,45 con IC 95%: 1,264-4,749 y p. 0, 008). Conclusiones: Los factores asociados a enfermar de diabetes mellitus y tuberculosis fueron el IMC, tener contacto TB, ser varón, tener ≥35 años, tener un mal control glicémico o una HbA1c ≥ 7 % y recibir insulinoterapia.

Objetivo principal: Determinar la relación entre el índice de masa corporal y el pie diabético en pacientes atendidos en el Hospital Vitarte, Enero 2012- Diciembre 2014 Materiales y Métodos: Estudio no experimental, descriptivo, retrospectivo de una muestra de 32 pacientes diabéticos con el diagnóstico de Pie Diabético, mediante la revisión de las historias clínicas, el traslado de datos fue a una ficha de recolección e ingreso de estos al programa de SPSS versión 23.0. Resultados: Del estudio, análisis y discusión de los resultados conseguidos, se ha establecido que de un total de 32 pacientes que fueron atendidos en el Hospital Vitarte durante el periodo de Enero 2012 hasta Diciembre 2014 con diagnóstico de Pie Diabético los principales factores asociados fueron: Hipertensión Arterial con un 43,8% y Dislipidemia con un 31,3%. La edad más frecuente fue entre los 60-66 años con un 34,4%, no se encontró sexo predominante ya que hubo un mismo número de casos tanto de sexo masculino como de sexo femenino. El Índice de Masa Corporal (IMC) con mayor prevalencia fue el del grupo de Preobesidad con el 50% de casos de Pie Diabéticos. El tiempo de enfermedad fue de 2 años con el 25% de casos. El grado de Pie Diabético según Wagner con mayor prevalencia fue el de Ulcera Profunda con absceso u osteomielitis con 46,9%. Se encontró una relación directa entre el Índice de Masa Corporal y el Pie diabético, el tiempo de enfermedad y el Pie Diabético, y edad con la presencia de Pie Diabético. Conclusión: Existe una relación directa entre el Índice de Masa Corporal y el Pie Diabético, a mayor índice de masa corporal, mayor frecuencia de Pie Diabético.

Introducción. Los desórdenes endocrinos más comunes observados en los consultorios de endocrinología son la enfermedad tiroidea y la diabetes mellitus tipo 2. Objetivo. Determinar la frecuencia de la disfunción tiroidea en pacientes con diabetes mellitus tipo 2. Diseño. Investigación de tipo descriptiva observacional. Lugar. El estudio se realizó en el Hospital Nacional Dos de Mayo (HNDM). Participantes. Pacientes adultos con diabetes mellitus tipo 2, según los criterios de la Asociación Americana de Diabetes 2010, asistidos en los consultorios de Endocrinología durante noviembre del 2013 a octubre de 2015. Intervenciones: A partir de 355 historias clínicas de individuos de ambos géneros se recabó mediante una ficha de recolección los datos de género, edad, tipo de disfunción tiroidea, bocio, índice de masa corporal, presión arterial, tiempo de evolución de la diabetes, antecedente familiar de disfunción tiroidea, dislipidemia y autoinmunidad. Resultados. Se encontró que a 355 participantes en este estudio se les realizó pruebas hormonales, de los cuales, el 92.1% presentó disfunción tiroidea. La frecuencia de hipotiroidismo clínico fue 89%, la de hipotiroidismo subclínico 2.7%, la de hipertiroidismo clínico 8.3% y la de bocio 16.9%. Sus características epidemiológicas predominantes fueron mujeres entre los 50 y 59 años de edad. Sus características clínicas fueron: sujetos con hipotiroidismo clínico, sobrepeso, tiempo de evolución de la DM entre 10 a 19 años, normotensa, dislipidemia y se desconoce la presencia de autoinmunidad. Conclusiones. La frecuencia de la disfunción tiroidea en un grupo de diabéticos de tipo 2 del HNDM en quienes se realizó pruebas hormonales para el descarte de enfermedad tiroidea durante noviembre de 2013 y octubre de 2015 fue de 92.1%. En este grupo predomina el hipotiroidismo clínico. Palabras clave. Disfunción tiroidea; Diabetes Mellitus; Bocio; Hipotiroidismo; Hipertiroidismo. / --- Introduction. The most common endocrine disorders observed in endocrinology clinics are thyroid disease and type 2 diabetes mellitus. Objective. To determine the frequency of thyroid dysfunction in patients with type 2 diabetes mellitus. Design. Descriptive observational study. Setting. Dos de Mayo National Hospital. Participants. Adult patients with type 2 diabetes mellitus, according to American Diabetes Association 2010 criteria, and that were assisted in Endocrinology clinics during november 2013 up to october 2015. Intervention: data were analized from 355 clinical histories from patiens of both genders, it was collected using a form data that inclued gender, age, type of thyroid dysfunction, goiter, body mass index, blood pressure, duration of diabetes, family history of thyroid dysfunction, dyslipidemia and autoimmunity . Results. It was found that 355 participants in this study had hormonal tests , of which 92.1 % had the thyroid dysfunction. The frequency of clinical hypothyroidism was 89%; subclinical hypothyroidism was 2.7%, clinical hyperthyroidism was 8.3% and 16.9% of goiter. Its predominant epidemiological characteristics were women between 50 and 59 years old. Their clinical characteristics were : subjects with clinical hypothyroidism , obesity , duration of DM between 10 to 19 years , normotensive , dyslipidemia and the presence of autoimmunity is unknown. Conclusions . The frequency of thyroid dysfunction in a group of type 2 diabetics of HNDM, in whom hormonal test for disposal of thyroid disease was conducted during november 2013 and october 2015 was 92.1 %. In this group predominates clinical hypothyroidism. Keywords. Thyroid Dysfunction; Diabetes Mellitus; Goiter; Hypothyroidism; Hyperthyroidism

El siguiente estudio es de tipo descriptivo, transversal, se realizó con el objetivo de determinar el nivel de conocimiento sobre la atención estomatológica de los pacientes con diabetes mellitus tipo I y II en alumnos de 5to año e internos de odontología. La muestra está constituida de 94 personas entre alumnos (58) e internos (36) de la UNMSM que se encontraban finalizando sus ciclos correspondientes en el año 2015. Para determinar el nivel de conocimiento se realizó una revisión bibliográfica y se elaboró una encuesta/cuestionario que constaba de 25 preguntas cerradas que fue validado mediante juicio de expertos. El instrumento evaluó el nivel de conocimiento de cinco secciones: mitos y creencias, clasificación y fisiopatología; patología bucal; empleo de fármacos y tratamiento odontológico del paciente con diabetes mellitus; y los califico como bajo, regular y alto, según la escala establecida. El 43.6% de los participantes de la investigación tenían un nivel de conocimiento bajo sobre la atención estomatológica del paciente con diabetes mellitus. En el nivel de conocimiento regular, se distribuyó el 54,3% de la población y en el nivel de conocimiento alto, se encontró el 2,1% de la población. Las secciones donde los estudiantes obtuvieron mayor puntaje fueron en mitos y creencias, y clasificación – fisiopatología. En cambio, las secciones de empleo de fármacos y tratamiento odontológico del paciente con diabetes mellitus tipo I y II fue bajo. Con el estudio se concluye que existe un déficit en el conocimiento sobre el manejo estomatológico del paciente con diabetes mellitus tipo I y II ; por lo cual se deben tomar medidas educativas para mejorar los aspectos que muestran necesidades de aprendizaje, debido a la importancia del rol que cumplen los odontólogos en la atención integral de las personas que presentan esta condición sistémica, para así mejorar su calidad de vida y evitar que se presenten complicaciones que podrían afectar la integridad del paciente. Palabras clave: diabetes mellitus, internos, odontología, conocimiento / --- The following study is descriptive, transversal, was conducted to determine the level of knowledge about dental care of patients with diabetes mellitus type I and II in 5th year students and interns dentistry. The sample consists of 94 people among students (58) and internal (36) of San Marcos who were ending their corresponding cycles in 2015. To determine the level of knowledge was conducted a literature review and a survey / questionnaire was developed consisting of 25 closed questions that was validated by expert judgment. The instrument assessed the level of knowledge of five sections: myths and beliefs, classification and pathophysiology; oral pathology; use of drugs and dental treatment of patients with diabetes mellitus; and I qualify as low, regular and high, according to the established scale. 43.6% of the research participants had a low level of knowledge about dental care of patients with diabetes mellitus. In the regular knowledge level, 54.3% of the population was distributed and high knowledge level, 2.1% of the population was found. The sections where students scored highest scores were in myths and beliefs, and classification - pathophysiology. Instead, sections of use of drugs and dental treatment of patients with diabetes mellitus type I and II was low. The study concluded that there is a deficit in knowledge about the stomatological management of patients with diabetes mellitus type I and II; therefore be taken educational measures to improve aspects that show learning needs due to the importance of the role that dentists in the comprehensive care of people with this systemic condition, in order to improve their quality of life and avoid complications that could affect the integrity of the patient are presented.

M.Tech.

PROMOGRAN fördert die Wundheilung durch aktive Modulation des Wundmilieus aller chronischen Wunden auf biochemischer Ebene. Es bindet und deaktiviert überschüssige Proteasen und schützt die Wachstumsfaktoren. PROMOGRAN ist eine gefriergetrocknete Matrix aus oxidierter, regenerierter Cellulose und Kollagen und wird vom Körper vollständig resorbiert. PROMOGRAN besitzt hämostatische Eigenschaften. In dieser Studie sollte die postulierte Wirksamkeit von PROMOGRAN auf drei verschiedenen Wundentitäten überprüft werden. Insgesamt kann PROMOGRAN als eine gute Ergänzung zur Wundbettkonditionierung angesehen werden. Es hat in nahezu allen Fällen dieser Studie wesentlich zu einer schnelleren Wundheilung beigetragen. / PROMOGRAN works at a biochemical level to promote the healing of all chronic wounds by actively modulating the wound environment. It binds and inactivates excess proteases whilst protecting the growth factors. PROMOGRAN consists of a freeze dried matrix composed of oxidised regenerated cellulose and collagen, and is totally absorbed by the body. PROMOGRAN has hemostatic properties. The aim of this study was to investigate the postulated efficacy of PROMOGRAN in the treatment of three different wound entities. PROMOGRAN is seen overall to be an effective adjunct to wound bed conditioning. In nearly all the patients included in this study it contributed to faster wound healing.

In dieser Studie wird das postoperative Outcome von Typ 2 Diabetiker nach Herzbypassoperationen evaluiert. Insgesamt 327 Patienten, 84 insulinpflichtige, 87 nichtinsulinpflichtige und 160 Nicht-Diabetiker, wurden in diese Studie miteinbezogen. Es zeigten sich keine signifikanten Unterschiede im Vergleich von beiden Diabetes-Gruppen. Die Studie stellt dar, dass Patienten mit insulinpflichtigem Typ 2 Diabetes mellitus nach Herzbypassoperationen keine höhere Rate an postoperativen Komplikationen haben. Jedoch Diabetiker im Vergleich zu Nicht-Diabetiker eine deutlich höhere Rate an postoperativen Komplikationen wie Mortalität, renale und respiratorische Insuffizienz und Wundinfektionen, bieten. / This study was done to evaluate the outcome of type 2 diabetic patients after coronary artery bypass grafting. A total of 327 patients, 84 insulin-dependent, 87 non-insulin-dependent and 160 non-diabetic patients, were included in this study. There was no significant difference found in the comparison of both diabetic groups. Our study shows that patients with insulin-dependent type 2 diabetes mellitus who had coronary artery bypass grafting have no significant higher rate of postoperative complications, but diabetic patients in comparison with non-diabetic patients had a higher rate of postoperative complications like mortality, renal and respiratory insufficiency and wound infections.

Die vorliegende Arbeit beschreibt Untersuchungen über die Auswirkungen des P2Y12-Rezeptor-Antagonisten AZD6140 (Ticagrelor) auf die Plättchenfunktionen diabetischer Ratten. AZD6140 ist ein reversibler, direkter, potenter und oraler Inhibitor des P2Y12-Rezeptors. AZD6140 reduziert als Einzeldosis von 5 mg/ kg Körpergewicht verabreicht die Empfindlichkeit der Plättchen hinsichtlich ADP schnell und reversibel. Zudem konnte bereits nach 30 Minuten eine signifikante Hemmung der Plättchenaggregation beobachtet werden. Auch die P-Selektin-Oberflächenexpression und die Plättchenadhäsion wurden nach Einmalgabe von AZD6140 signifikant reduziert. Eine chronische Behandlung diabetischer Ratten mit AZD6140 reduzierte die Plättchenaktivierung in vivo und die Plättchenempfindlichkeit in vitro. Zudem verminderte der P2Y12-Rezeptor-Antagonist nach zweiwöchiger Verabreichung signifikant die Sekretion des pro-inflammatorischen Zytokins RANTES. Der schnelle antithrombozytäre Effekt ist besonders bei Patienten, die für eine PCI vorgesehen sind, von Vorteil, da in solchen Situationen eine effektive, maximale, rasche und vorhersehbare Hemmung der ADP-induzierten Plättchenaggregation notwendig ist, um bessere klinische Ergebnisse erzielen zu können. Die reversible Wirkung von AZD6140 auf die thrombozytären Funktionen ist insbesondere bei vorbehandelten Patienten, die beispielsweise einen koronaren Bypass erhalten sollen, vorteilhaft, da in der Bypasschirurgie über exzessive Blutungsereignisse nach irreversibler antithrombozytärer Therapie berichtet wurde. Im Vergleich zu Clopidogrel ist die Behandlung mit diesem neuen P2Y12-Antagonisten mit einer stärkeren Plättchenhemmung und einer geringeren Variabilität in der Antwort auf die Therapie verbunden. Eine interindividuelle Variabilität in der Wirksamkeit, wie sie bei Clopidogrel zu finden ist, korreliert mit einem erhöhten Risiko unerwünschter kardiovaskulärer Ereignisse, eine Tatsache, die sich besonders gravierend in kardiovaskulären Risikogruppen auswirkt. AZD6140 zeigt eine bessere Wirksamkeit, einen schnelleren Beginn und ein rascheres Ende seiner Wirkung auf die Plättchenfunktionen sowie eine geringere Verlängerung der Blutungszeit im Vergleich zu Clopidogrel. In klinischen Studien wurde das Wirkungsprofil von AZD6140 mit dem von Clopidogrel verglichen. Zuletzt wurde in der Phase III-Studie PLATO die signifikante Überlegenheit in der Wirksamkeit von AZD6140 gegenüber Clopidogrel bestätigt. / The present work describes studies of the effects of the P2Y12 receptor antagonist AZD6140 (ticagrelor) on platelet functions of diabetic rats. AZD6140 is a reversible, direct, and potent oral inhibitor of the P2Y12 receptor. As a single dose of 5 mg / kg body weight AZD6140 reduced the sensitivity of platelets according to ADP quickly and reversibly. Moreover, after 30 minutes, a significant inhibition of platelet aggregation could be observed. The P-selectin surface expression and platelet adhesion were significantly reduced after a single dose of AZD6140. Chronic treatment of diabetic rats with AZD6140 reduced the platelet activation in vivo and the platelet sensitivity in vitro. In addition, after two weeks of administration the P2Y12 receptor antagonist significantly decreased the secretion of pro-inflammatory cytokine RANTES. The rapid antiplatelet effect is particularly beneficial in patients scheduled for PCI, as in such situations as an effective, maximum, rapid and predictable inhibition of ADP-induced platelet aggregation is necessary to achieve better clinical results. The reversible effect of AZD6140 on the platelet functions is especially advantageous in pre-treated patients receiving coronary bypass surgery. In bypass surgery, excessive bleeding after irreversible antiplatelet therapy has been reported. Compared with clopidogrel treatment with this new P2Y12 antagonists is connected with greater platelet inhibition and lower variability in the response to the therapy. An inter-individual variability in the effectiveness, as can be found at clopidogrel, correlates with an increased risk of adverse cardiovascular events, a fact that affects particularly serious in cardiovascular risk groups. AZD6140 shows better efficacy, a faster start and a quick end to its effects on platelet functions and a reduced increase in bleeding time compared to clopidogrel. In clinical trials, the effectivity profile of AZD6140 was compared with clopidogrel. In the phase III PLATO study the significant superiority in efficacy of AZD6140 was confirmed compared with clopidogrel.

The diabetic patient is subject to many complications in the event of poor control of blood glucose or blood pressure. Diabetic nephropathy is the leading cause of kidney dialysis in the developed world. Diabetic retinopathy is one of the leading causes of blindness in the United States. Cardiovascular diseases are the leading cause of morbidity in the United States. There are many different factors that predispose people to developing these conditions. Among these factors in a diabetic patient, hypertension has been shown to be strongly correlated with progression of micro and macrovascular complications. There are several antihypertensive treatment options for lowering blood pressure including angiotensin receptor blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, beta adrenergic receptor blockers, and diuretics among others. By lowering blood pressure in diabetic patients comorbid with hypertension, complications arising from either condition have been shown to be reduced to a greater extent than can be explained with either normal blood pressure or blood glucose levels. However, there is mounting evidence that certain beta-adrenergic receptor blockers cause insulin desensitization, adverse lipid metabolism, and poor carbohydrate metabolism. Furthermore, hypertension is a complex disease process especially when considered from the perspective of the patient with diabetes. There are many possible underlying mechanisms for the hypertension and resulting complications, so it may be important for the prescribing physician to employ a combination of different classes of antihypertensive pharmaceuticals when treating their patients. Although some antihypertensive agents may cause some adverse effects in patients, they are usually very well tolerated, and attempts should be made to incorporate them into a treatment plan for preventing the onset of diabetic complications.

The association between diabetes and coronary artery disease (CAD) has been recognized as a major public health problem in the developed world. While there is an increased prevalence of silent myocardial ischaemia among asymptomatic individuals with diabetes, diabetic individuals with CAD in their larger number are usually asymptomatic, and when they present with signs of disease, there is extensive and severe CAD. It should be noted that amongst black South African, ischemic heart disease (IHD) remains rare, and there is little data linking diabetes mellitus with IHD. However, contrary to early reports that have suggested a low prevalence of CAD in black population in Africa, many studies have indicated a rapid change on the spectrum of CAD in numerous parts of the African continent. Despite the emerging report of high prevalence of risk factors there are only limited data investigating prevalence of CAD in black African with diabetes. The purpose of this thesis was to use myocardial perfusion imaging (MPI) at rest and after stress testing to detect CAD in a group of asymptomatic black patients suffering from diabetes and therefore assess the prevalence of CAD; to assess the changes in myocardial perfusion in asymptomatic diabetic black individuals and compare the differences seen in myocardial perfusion changes between the asymptomatic diabetic black and, the asymptomatic diabetic white and Indian individuals; to include data from symptomatic diabetic patients who were referred for MPI as part of their routine clinical management for possible comparison Consecutive 94 asymptomatic diabetic black patients and 50 asymptomatic diabetic white and Indian patients were recruited from the outpatient diabetic clinic of the Johannesburg hospital. Data from 90 subjects forming a group of symptomatic diabetic patients, 45 blacks and 45 whites and Indians referred for MPI as part of their clinical management were also analyzed. A two-day protocol for SPECT MPI was used in all participants: on the first day the stress testing MPI while the rest MPI was consistently done on the second day. Both exercise and pharmacologic stress testing were used. Technetium-99m methoxy-isobutylisonitrile (MIBI) was used as the myocardial perfusion radiopharmaceutical. Myocardial perfusion was assessed by means of semi-quantitative scoring system to measure the extent and severity of perfusion abnormality. Visual inspection of the reconstructed SPECT MPI images was carried out to assess perfusion deficit where there was a doubt on the extent and severity of perfusion abnormality. The QPS/QGS software allows obtaining resting and post stress left ventricular ejection fraction (LVEF). The means and percentages on study variables were obtained. The Spearmen correlation coefficient was used to calculate correlations between variables. The Kruskal-Wallis test was used to assess differences between black diabetic and white or Indian diabetic patients and Wilcoxon scores (rank sum) two-sided were used to measure differences within these racial groups. There were 123 females (52.6%) and 111 males (47.4%) in total. From the recruited participants, 53 (56.4%) asymptomatic females and 41 (43.6%) asymptomatic males were blacks whereas 24 (48%) asymptomatic females and 26 (52%) asymptomatic males were whites or Indians. The symptomatic group was comprised of 26 (57.8%) female and 19 (42.2%) male black patients and 20 (44.5%) female and 25 (55.5%) male white or Indian patients. Asymptomatic diabetic black participants were younger than the participants from the asymptomatic diabetic white and Indian group with a mean age of 60 (SD±7.2) years Vs 64 (SD±7.7) [p=0.003]. Fourteen percent of asymptomatic black participants had evidence of ischaemia by showing improvement of perfusion on stress testing versus twenty eight percent of white and Indian asymptomatic participants (p=0.62). Perfusion defects that did not change from rest to post stress testing MPI (fixed defects) were also noted in 20% of asymptomatic black and 26% of asymptomatic white and Indian diabetic participants. These fixed perfusion defects are indicative of previous myocardial infarctions and therefore suggestive of CAD. No significant difference was noted on the changes of perfusion that could account either for ischaemia or infract between asymptomatic diabetic black participants and their white and Indian counterparts (p=0.47). The difference on the improvement of perfusion from rest to post-stress MPIs or reversibility of perfusion to suggest only the presence of ischaemia did not also show a significant difference between these two racial groups (p=0.62). Our data demonstrated a high prevalence of CAD in asymptomatic diabetic black participants similar to other racial groups. Our study has demonstrated evidence to recommend screening of asymptomatic diabetic black individuals in equal manner than other races for the detection of CAD. More importantly, stress MPI should be routinely used as a noninvasive investigation in our environment and be utilized more actively in the management of all asymptomatic diabetic patients.