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BackgroundDiabetes prevalence is already high in middle income countries, particularly among older people. Current evidence on diabetes as a risk factor for dementia is limited to cohort studies in high income countries. Few studies carried out fasting glucose assessments to identify undiagnosed cases, and assess diabetes control. We aimed to determine the association between both diagnosed diabetes and total diabetes (including undiagnosed cases) and incident dementia, examining also the impact of glycaemic control on dementia risk.MethodsPopulation-based cohort studies of those aged 65 years and over in sites in Cuba, Dominican Republic, Puerto Rico, Peru, Venezuela, and Mexico. Diagnosed diabetes was assessed through self-reported diagnosis, and undiagnosed diabetes through fasting blood samples (glucose >= 7mmol/L). Blood pressure, smoking, underactivity and waist circumference were assessed from questionnaires and physical examination. Incident 10/66 dementia (and subtypes), and mortality, were ascertained three to five years later.Results12,297 interviews were completed at baseline, with 80-95% responding by site. The ‘at risk’ cohort comprised 10,945 dementia-free individuals, of whom 8,171 (75%) provided blood samples. Mean age varied from 72.0 to 75.1 years by site. Total diabetes prevalence was 43.5% in Puerto Rico, ranging from 11.5% to 27.0% in other sites. Most diabetes cases (50.2% to 68.4%) were not controlled (fasting glucose >7.0 mmol/L). 7,000 participants were followed up for 26,423 person-years with 659 incident dementia cases, and 905 dementia free deaths. Total diabetes was associated with incident 10/66 dementia (pooled meta-analysed adjusted sub-hazard ratio [pASHR] 1.25, 95% CI, 1.05-1.49, I2=48.6%), with a stronger association for uncontrolled (pASHR 1.47, 95% CI 1.19-1.81, I2=49.6%) than controlled cases (pASHR 1.29, 95% CI 0.95-1.74, I2=13.3%). Total diabetes was strongly associated with the incidence of vascular dementia (pASHR 2.25, 95% CI 1.24-4.08, I2=23.7%), but not Alzheimer’s Disease (pASHR 0.99, 95% CI 0.70-1.42, I2=49.0%).ConclusionsDiabetes, particularly when poorly controlled, may increase dementia risk. There is considerable scope for improved detection and control of diabetes among older people in these settings, and hence an opportunity to carry out proof of concept prevention trials. Overlapping epidemics of these age dependent disorders will challenge poorly-resourced health systems in the future.

Introduction Type 2 diabetes mellitus (T2DM) and dementia increase with age. Different studies have explored their association, but the possible relationship between them is still unclear. Methods This is an analysis of the 10/66 Dementia Research Group (DRG) Mexico database; the sample comprised 1193 subjects ≥65 years old followed-up for three years. We calculated the incidence of dementia in subjects with diabetes using three models of analysis. Results T2DM patients have nearly twice the risk of developing dementia (RR 1.9; 95% CI 1.3–2.6) after three years of follow-up. The incidence of dementia is higher in subjects with undiagnosed diabetes. Higher serum glucose levels have a stronger association with dementia. Conclusions It is important to implement early evaluation and monitoring cognitive performance in elders with diabetes to identify minor cognitive impairment and undertake timely interventions to prevent or delay the onset of dementia.

El Cólico Renoureteral es una situación clínica muy dolorosa y requiere de un rápido diagnóstico y tratamiento. Se llevó a cabo un estudio con pacientes a quienes se administraron dos tipos de medicamentos con procedimientos distintos y se realizaron mediciones del dolor. Se obtuvieron datos censurados, considerando como variable de interés el tiempo al cual el paciente manifestó la desaparición del dolor a través de una escala visual análoga. Los métodos de máxima verosimilitud y el análisis de supervivencia proveen métodos útiles para la estimación de funciones paramétricas y la distribución de esta variable. Este estudio permitirá un tratamiento más efectivo, oportuno, de menor costo y adecuado para los pacientes.

Sensory evaluation is the ideal tool for shelf-life determination. With the objective to develop an easy shelf-life indicator, color (L*, a*, b*, chroma and hue angle), total soluble solids (TSS), firmness (F), pH, acidity, and the sensory attributes of appearance, brightness, browning, odor, flavor, texture, color, acidity and sweetness were evaluated in fresh cut mangoes (FCM) stored at 5, 10, 15 and 20 °C. Overall acceptability was evaluated by consumers. Correlation analysis between sensory attributes and physicochemical variables was carried out. Physicochemical cut-off points based on sensory attributes and consumer acceptability was obtained by regression analysis and utilized to estimate FCM shelf-life by kinetic models fitted to each variable. The validation of the model was done by comparing the shelf life estimated by kinetic models and consumers. It was recorded large correlations between appearance, brightness, and color with L*; appearance and color with chroma and hue angle; sweetness and flavor with TSS, and between F and texture. The shelf life estimated based on consumer using a 9 point hedonic scale was in the range of 10–12, 2.3–2.6, 1.3–1.5 and 1.0–1.1 days for 5, 10, 15 and 20 °C. It was recorded large correlation coefficients between the shelf life estimated by consumer acceptability scores and physicochemical variables. Kinetic models based on physicochemical variables showed a tendency to overestimate the shelf life as compared with the models bases on the sensory attributes. It was concluded that physicochemical variables can be used as a tool to estimate the FCM shelf life.