This study provides a safe and low-cost in-house protocol for RT-qPCR-based detection of SARS-CoV-2 using mouthwash–saliva self-collected specimens to achieve clinical and epidemiological surveillance in a real-time web environment applied to ambulatory populations. The in-house protocol comprises a mouthwash–saliva self-collected specimen, heat virus inactivation, and primers to target virus N-gene region and the human RPP30-gene. Aligning with 209 SARS-CoV-2 sequences confirmed specificity including the Alpha variant from the UK. Development, validation, and statistical comparison with official nasopharyngeal swabbing RT-qPCR test were conducted with 115 specimens of ambulatory volunteers. A web–mobile application platform was developed to integrate a real-time epidemiological and clinical core baseline database with mouthwash–saliva RT-qPCR testing. Nine built-in algorithms were generated for decision-making on testing, confining, monitoring, and self-reports to family, social, and work environments. Epidemiological and clinical follow-up and SARS-CoV-2 testing generated a database of 37,351 entries allowing individual decision-making for prevention. Mouthwash–saliva had higher sensitivity than nasopharyngeal swabbing in detecting asymptomatic and mild symptomatic cases with 720 viral copy number (VCN)/mL as the detection limit (Ct = 37.6). Cycling threshold and viral loading were marginally different (p = 0.057) between asymptomatic (35 Ct ± 2.8; 21,767.7 VCN/mL, range 720–77,278) and symptomatic (31.3 Ct ± 4.5; 747,294.3 VCN/mL, range 1433.6–3.08 × 106). We provided proof-of-concept evidence of effective surveillance to target asymptomatic and moderate symptomatic ambulatory individuals based on integrating a bio-safety level II laboratory, self-collected, low-risk, low-cost detection protocol, and a real-time digital monitoring system. Mouthwash–saliva was effective for SARS-CoV-2 sampling for the first time at the community level.

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Objetivo. Comparar el control glucémico entre pacientes con diabetes mellitus tipo 2 prepandemia vs pandemia de Covid-19 que acudieron a unidades de salud de primer nivel de atención de la Ciudad de México. Material y métodos. Se analizaron los registros de 23 912 pacientes con diabetes; 78.7% fueron del grupo prepandemia (2016 a 2020) y 21.3% del grupo pandemia (marzo 2020 a julio 2021). Se calcularon medidas de tendencia central y de dispersión, pruebas t de Student y se ajustó un modelo de regresión logística múltiple. Resultados. La mayoría de los pacientes con diabetes fueron mujeres (66.6 y 62.6%) con edad promedio de 59 y 58 años, respectivamente, y con hemoglobina glucosilada (HbA1) final de 7.7 vs el grupo pandemia (8.0). Las variables asociadas con el descontrol glucémico incluyeron periodo, nivel de HbA1, sobrepeso, obesidad, antecedente de padres con diabetes, número de medicamentos y tipo de insulina. Conclusiones. La mayoría de los pacientes con diabetes en ambos grupos tuvieron descontrol glucémico. Los pacientes del grupo pandemia tuvieron mayor descontrol glucémico de HbA1 comparados con los del grupo prepandemia. Después de recibir atención médica en ambos grupos, los pacientes mejoraron su control glucémico.

Diabetes burden is greater in low- middle-income countries, where large gaps exist in achieving diabetes care goals. We examined a quality initiative multicomponent integrated care (MIC) program (DIABEMPIC, DIABetes EMPowerment and Improvement of Care) on diabetes care goals in adults with type 2 diabetes (T2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-month empowerment-based program that includes an interdisciplinary case management team, diabetes self-management education, shared medical appointments, a patient-centered approach, and audit and feedback. At the end of the program patients continue routine care in public primary care units. We report the effect of the intervention on diabetes care goals at the end of the program and 18 months after the initial recruitment (long-term evaluation). Results: 704 patients with T2D completed the program, and 182 already have a long-term evaluation. The mean (SD) age of this subgroup was 57 (10.9) years, 67% female, 61% had elementary or less education, 68% had medium-low or lower socioeconomic status, mean diabetes duration was 13 (8) years, and mean A1c was 9.5% (2.2). After the program (n=182) systolic and diastolic blood pressure (-11, -4 mmHg respectively), A1c (-2.6%), and non-HDL cholesterol (-29 mg/dl) decreased significantly (p<0.0001). Clinical benefits persisted in long-term evaluation in systolic and diastolic blood pressure (-9, -3 mmHg respectively, p<0.0001), A1c (-1.4%, p<0.0001), and non-HDL cholesterol (-11 mg/dl, p=0.018). Conclusions: This quality-of-care initiative had valuable short and long-term effects on diabetes care goals in a real-world setting. The long-term impact is smaller than the impact observed at the end of the intervention. This work suggests further replication of the intervention and enhances the need to improve routine follow-up in primary health units after the participation in MIC programs. Disclosure R. Silva-tinoco: None. A. Gallardo-hernández: None. J. Ochoa-moreno: None. V. Delatorre-saldaña: None. T. Cuatecontzi-xochitiotzi: None. A. Gonzalez-cantu: None. C. Castillo-galindo: None. B. Pimentel-hernández: None. M. Romero-ibarguengoitia: None. A. Núñez-rodríguez: None. F. Orozco-gutiérrez: None.