To the Editors: As the latest issues of MEDICC Review reveal, the global scientific community is fully engaged in unraveling the mysteries of COVID-19, including its relationship to chronic conditions such as diabetes mellitus (DM), a frequent comorbidity with SARS-CoV-2 infection. Various studies report up to 30% of persons with COVID-19 are diabetic,[1] and such […]
Lower-extremity diabetic ulcers are responsible for 80% of annual worldwide nontraumatic amputations. Epidermal growth factor (EGF) reduction is one of the molecular pillars of diabetic ulcer chronicity, thus EGF administration may be considered a type of replacement therapy. Topical EGF administration to improve and speed wound healing began in 1989 on burn patients as part of an acute-healing therapy. Further clinical studies based on topically administering EGF to different chronic wounds resulted in disappointing outcomes. An analysis of the literature on unsuccessful clinical trials identified a lack of knowledge concerning: (I) molecular and cellular foundations of wound chronicity and (II) the pharmacodynamic requisites governing EGF interaction with its receptor to promote cell response. Yet, EGF intra- and perilesional infiltration were shown to circumvent the pharmacodynamic limitations of topical application. Since the first studies, the following decades of basic and clinical research on EGF therapy for problem wounds have shed light on potential uses of growth factors in regenerative medicine. EGF’s molecular and biochemical effects at both local and systemic levels are diverse: (1) downregulation of genes encoding inflammation mediators and increased expression of genes involved in cell proliferation, angiogenesis and matrix secretion; (2) EGF intervention positively impacts both mesenchymal and epithelial cells, reducing inflammation and stimulating the recruitment of precursor circulating cells that promote the formation of new blood vessels; (3) at the subcellular level, upregulation of the EGF receptor with subsequent intracellular trafficking, including mitochondrial allocation along with restored morphology of multiple organelles; and (4) local EGF infiltration resulting in a systemic, organismal repercussion, thus contributing to attenuation of circulating inflammatory and catabolic reactants, restored reduction-oxidation balance, and decreased toxic glycation products and soluble apoptogenic effectors. It is likely that EGF treatment may rearrange critical epigenetic drivers of diabetic metabolic memory.
KEYWORDS Epidermal Growth Factor, diabetes, diabetes complications, wound healing, diabetic foot, amputation, ulcer, Cuba
Ibraín E. Corrales-Reyes DDS, Yasmany Fornaris-Cedeño, Alberto J. Dorta-Contreras MS PhD, Christian R. Mejia MD MS PhD, Josmel Pacheco-Mendoza DVM MS, Ricardo Arencibia-Jorge PhD
INTRODUCTION The steadily increasing prevalence of diabetes globally has captured researchers’ attention. Cuban production of scientific articles on diabetes has not been studied from a bibliometric perspective.
OBJECTIVE Characterize the production and impact of research and review articles on diabetes by Cuban authors in journals listed in the Scopus bibliographic database, as well as related collaboration among Cuban institutions and between Cuban and non-Cuban institutions.
METHODS A bibliometric analysis was conducted using 2000–2017 data from the Scopus database. The following search strategy was used: descriptor (diabetes), country (Cuba), publication source (journal), article type (original research, review article). Bibliographic indicators of production, visibility, impact and collaboration were examined.
RESULTS Cuba contributed 3.2% of Latin American production and 0.1% of global production related to diabetes. Within Cuba’s scientific production (610 articles, 538 original research and 72 review), 85.9% had a Cuban corresponding author (Cuban leadership). In articles with international collaboration (22.9%), however, most (67.9%) had non-Cuban corresponding authors. A total of 47% (287) were articles involving a single institution. Only 11.1% were published in top-ranked journals, and 14.4% were cited >10 times. Cubans were lead authors on 0.3% of the most frequently cited (top 10%) articles on diabetes in Scopus. A total of 38.4% of this production appeared in low-impact journals and 57.9% in Cuban journals.
Articles published in English accounted for 30% of total and obtained higher impact in terms of citations than articles in Spanish. The strongest networks for scientific collaboration were those that connected Cuban and US researchers.
CONCLUSIONS Cuban scientists conduct research on diabetes, but their work is not highly visible in the peer-reviewed literature, particularly in top-ranked journals. The problem is not simply one of publishing more, but of knowing how and where to publish. It is urgent that Cuban universities training health professionals at all levels include instruction on scientific writing.
KEYWORDS Diabetes, health services research, scientific journals, bibliometrics, Cuba
To the Editors: In his report in the October 2017 issue of MEDICC Review, Vega-Jiménez stressed that the design and integration of a prediabetes (intermediate hyperglycemia) registry would serve as an essential prevention strategy to improve population health outcomes in Cuba.[1] Cuba’s universal health system, with its robust health workforce and established primary care services […]
La población cubana muestra una alta prevalencia de sobrepeso y de enfermedades crónicas no transmisibles asociadas al mismo; la tendencia a ambas prevalencias comienza en la niñez.Además de los aspectos relacionados con la salud de la madre, los factores que contribuyen al aumento excesivo de peso en los niños cubanos son: reducida prevalencia de la lactancia materna exclusiva en lactantes de hasta seis meses de edad, niños que nacen a término con bajo pesoeinadecuado tratamiento nutricional dado a este grupo, alimentación complementaria incorrecta, régimen alimentario que genera obesidad, historia médica familiar y estilos de vida sedentarios. Por ello es importante adoptar estrategias integrales, multisectoriales que promuevan una alimentación adecuada y el control del peso. Esto es particularmente importante para los niños que nacen a término y con bajo peso, que son propensos a almacenar grasa corporal.
PALABRAS CLAVE Bajo peso al nacer, obesidad, diabetes, inflamación, lactancia materna, alimentación, actividad física, estilo de vida, niños, adolescentes, Cuba
The Cuban population exhibits high prevalence of overweight and associated chronic non-communicable diseases, trends that begin in childhood. In addition to factors related to the mother’s health, factors contributing to excess weight gain in Cuban children are: reduced prevalence of exclusive breastfeeding of infants up to six months of age, full-term low birth weight infants and nutritional mismanagement of this group, incorrect complementary feeding, obesogenic diet, family history and sedentary lifestyles. Thus, it is important to adopt comprehensive, multisectoral strategies that promote adequate nutrition and weight control. This is particularly important for full-term low birth weight infants, predisposed to body fat storage.
KEYWORDS Low birth weight, obesity, diabetes, inflammation, breastfeeding, diet, physical activity, lifestyle, children, adolescents, Cuba
INTRODUCTION Diabetes in pregnancy threatens both maternal and neonatal health, with risks of lung immaturity, fetal macrosomia, dystocia and impaired maternal kidney function. Before insulin, diabetes resulted in maternal mortality rates of 30–50% and perinatal mortality rates of 50–60%. Global prevalence estimates vary by population, geographical area and diagnostic criteria. Diabetes accounts for some 90% of endocrine complications in pregnancy.
OBJECTIVES Determine diabetes mellitus prevalence in pregnancy and characterize the population of diabetic women who gave birth in the Isle of Youth Special Municipality in 2008.
METHODS A descriptive retrospective study was carried out from January to December 2008. Clinical records were reviewed of 180 diabetic women who gave birth on the Isle of Youth in 2008, their diagnosis based on WHO criteria modified by municipal health authorities. Study variables were: maternal age, nutritional status, glucose tolerance, gestational age at diagnosis, history of diabetes, and pregnancy outcome; as well as risk factors such as diabetes family history, pregnancy weight gain and comorbidities.
RESULTS Overall prevalence (pregestational and gestational diabetes) among these cases was 17.3%; highest in the group aged ≥35 years. Gestational diabetes was more frequent (96.1% of cases) than pre-gestational diabetes. Multiparity (62.1%), a first-degree family history of diabetes mellitus (26.1%), excess weight before pregnancy (50%) and adequate weight gain during pregnancy (54.4%) were the most frequent conditions found. Among gestational diabetics, diabetes was most frequently detected at 20–28 weeks gestation (31.8%). Fetal macrosomia appeared in 4.4% of cases and a high percentage of deliveries were by Cesarean section (30%). There were no low Apgar scores or congenital abnormalities among neonates.
CONCLUSIONS Despite using modified, more inclusive, WHO diagnostic criteria, the clinical and demographic characteristics of the population studied were comparable to those in other studies of diabetes in pregnancy, except for the low frequency of fetal macrosomia and absence of birth defects present in our study.
KEYWORDS diabetes mellitus, pregnancy, risk factors, diabetes, gestational
