Nutritional status and hyperglycemia in the peritransplant period: a review of associations with parenteral nutrition and clinical outcomes

ABSTRACT Hematopoietic stem cell transplantation is an established treatment option for various hematological diseases. This therapy involves complex procedures and is associated with several systemic complications. Due to the toxic effects of the conditioning regimen used in allogeneic transplantations, patients frequently suffer from severe gastrointestinal complications and are unable to feed themselves properly. This complex clinical scenario often requires specialized nutritional support, and despite the increasing number of studies available, many questions remain regarding the best way to feed these patients. Parenteral nutrition has been traditionally indicated when the effects on gastrointestinal mucosa are significant; however, the true benefits of this type of nutrition in reducing clinical complications have been questioned. Hyperglycemia is a common consequence of parenteral nutrition that seems to be correlated to poor transplantation outcomes and a higher risk of infections. Additionally, nutrition-related pre-transplantation risk factors are being studied, such as impaired nutritional status, poorly controlled diabetes mellitus and obesity. This review aims to discuss some of these recent issues. A real case of allogeneic transplant was used to illustrate the scenario and to highlight the most important topics that motivated this literature review.

An assessment of maternal quality of life in the postpartum period in southern Brazil: a comparson of two questionnaires

OBJECTIVES: To assess maternal quality of life (QoL) during the postpartum period and to compare the performance of two QoL questionnaires across a sample of 101 women in southern Brazil. To our knowledge, this is the first study that measures maternal quality of life during the postpartum period in Brazil. INTRODUCTION: There is limited information about postpartum maternal quality of life in Brazil. The are no Portuguese versions of instruments specifically designed to measure quality of life during the postpartum period. METHODS: Research participants completed the Portuguese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and Multicultural Quality of Life Index (MQLI) questionnaires. The correlations between the MQLI and the discrete areas of WHOQOL-BREF were examined using Pearson Product-Moment Correlation Coefficients. RESULTS: We report a significant correlation between the global MQLI and the four domains of the WHOQOL-BREF scores (p < 0.01). An analysis of variance revealed a significant difference in mean scores in the Psychological and Environment domains according to different socio-economic strata: F (3, 97) = 3.81, p = 0.012 and F (3, 97) = 4.03, p = 0.01, respectively. DISCUSSION: The WHOQOL-BREF questionnaire may be more sensitive than the MQLI in detecting the impact of socioeconomic status on the QoL of postpartum women. CONCLUSION: The sample of postpartum women evaluated in this study presented favorable QoL scores according to both the MQLI and WHOQOL-BREF questionnaires. Our results also indicate that the WHOQOL-BREF and the MQLI questionnaires have a significant correlation in terms of their assessments of postpartum mothers.

Patogênese da doença cardiovascular no diabetes / Pathogenesis of cardiovascular disease in diabetes

O diabetes mellitus tipo 2 é uma doença altamente prevalente em todo o mundo. É considerado um problema de saúde pública devido à alta morbidade e mortalidade relacionadas às suas complicações. Entre estas, a doença cardiovascular merece destaque porque é a principal causa de morte entre indivíduos diabéticos. Diversos fatores de risco, como hipertensão arterial, dislipidemia e obesidade, estão presentes no diabetes e associam-se a um maior risco para a ocorrência de eventos cardiovasculares. Entretanto, outros elementos, como a disfunção endotelial, a inflamação e a resistência à insulina, têm sido relacionados ao desenvolvimento da doença aterosclerótica cardiovascular. Este artigo revisa o papel destes e de outros fatores na patogênese da doença cardiovascular no paciente com diabetes.

Fatores associados à interrupção de tratamento anti-retroviral / Factors associated to glycaemic control in patients with type 2 diabetes

OBJETIVO: Avaliar as variáveis que influenciam no controle glicêmico de indivíduos diabéticos tipo 2 que freqüentam um serviço de saúde terciário. MÉTODOS: Estudo retrospectivo realizado através de revisão de prontuários dos pacientes atendidos no Ambulatório de Diabetes da Universidade de Caxias do Sul. Avaliamos os pacientes quanto ao controle glicêmico e metabólico e os subdividimos em compensados e descompensados segundo à hemoglobina glicada no início e no final do período avaliado. Analisamos os fatores associados ao controle glicêmico. RESULTADOS: Incluímos na análise 73 pacientes. Em média, observamos que houve melhora de parâmetros relacionados com o controle glicêmico, pressórico e lipídico no período médio de 20 meses de tratamento. No início do acompanhamento, 25 por cento estavam com hemoglobina glicada < 7 por cento, 22,7 por cento com colesterol LDL < 100 mg/dL e 8,7 por cento com pressão arterial sistólica < 130 mmHg e diastólica < 80 mmHg e nenhum paciente estava com todos os parâmetros dentro das metas preconizadas. Na última consulta, estas proporções foram de 42,3 por cento, 37,5 por cento, 30,2 por cento e 9,6 por cento, respectivamente. Na análise multivariada, menor idade, níveis mais elevados de colesterol LDL e uso de insulina foram fatores associados a um controle glicêmico insatisfatório. CONCLUSÃO: Uma pequena porção dos pacientes atingiu de forma simultânea as metas para controle de glicemia, lipídeos sangüíneos e pressão arterial. Alguns fatores como idade e sexo podem ser determinantes na obtenção de um controle satisfatório do diabetes. Maiores esforços são ainda necessários para atingir as metas de tratamento em pacientes diabéticos tipo 2.

OBJECTIVE: Evaluate the factors influencing blood glucose control of type 2 diabetic patients attended at a tertiary health care center. METHODS: A retrospective study by review of medical records of patients who attended the Diabetes Clinic at the University of Caxias do Sul was carried out. Patients were evaluated for glycaemic and metabolic control and divided according to glycated hemoglobin at the beginning and end of the period in question, in compensated and not compensated. The factors associated with glycaemic control were analyzed. RESULTS: Seventy three patients were included in the analysis. On the average, improvement of parameters related to glycaemic, pressure and lipid control during the average of 20 months of treatment was observed. In the beginning of the follow-up period, 25 percent of patients had glycated hemoglobin < 7 percent, 22.7 percent had LDL cholesterol < 100mg/dL, 8.7 percent had systolic blood pressure < 130 mmHg and diastolic < 80 mmHg and no patients had all parameters meeting the recommended goals. At the last visit the percentages were, 42.3 percent, 37.5 percent, 30.2 percent and 9.6 percent respectively. In the multivariate analysis, younger age, higher levels of LDL cholesterol and insulin use were associated with poor blood glucose control. CONCLUSION: A small part of the sample simultaneously achieved the goals for blood glucose, lipids and blood pressure control. Some factors, such as age and gender can be determinants to achieve control of diabetes. Greater efforts are still needed to achieve the goals for treatment in type 2 diabetic patients.

Avaliação do manejo da pressão arterial em pacientes com diabetes tipo 2 / Evaluation of blood pressure management in patients with type 2 diabetes

Objetivos: Avaliar o tratamento da hipertensão arterial sistêmica em diabéticos tipo 2 atendidos no Ambulatório de Diabetes da Universidade de Caxias do Sul e identificar os fatores relacionados ao alcance das metas de tratamento preconizadas para essa patologia. Metodologia: Estudo retrospectivo com revisão dos prontuários dos pacientes diabé- ticos tipo 2 atendidos no Ambulatório de Diabetes no período de 2001 a 2005 que tiveram um tempo mínimo de acompanhamento de 6 meses. Para análises comparativas, foi utilizado o valor de pressão arterial proposto pela American Diabetes Association (≤ 8804; 130/80 mmHg). Realizou-se análise pareada para verificar mudanças no tratamento e análises bivariada e multivariada para avaliar fatores associados ao alcance da meta de pressão arterial. Resultados: Foram incluídos na análise 73 pacientes. Na análise pareada, observou-se diminuição das médias de pressão arterial, aumento do número de anti-hipertensivos e aumento da proporção de pacientes com a pressão adequadamente controlada entre o início e o fim do período avaliado. Na análise bivariada, menores valores de glicemia de jejum, glicemia pós-prandial e circunferência abdominal em mulheres se associaram ao alcance das metas de PA (P < 0,05). Valores mais baixos de glicemia pós-prandial foi fator independente associado a bom controle da PA (P = 0,05). Conclusões: O manejo da HAS no paciente diabético é insatisfató- rio, estando a minoria dos pacientes dentro das metas preconizadas. Apesar de terem sido obtidas melhoras importantes nos pacientes estudados, maiores esforços são necessários para o alcance das metas de tratamento (AU)

Objectives: To evaluate the treatment of high blood pressure in type 2 diabetic patients assisted in a Diabetes Center at University of Caxias do Sul and to identify the factors related to the achievement of recommended goals of treatment for the disease. Methods: Retrospective study through review of medical records of type 2 diabetic patients assisted from 2001 to 2005 and observed for a minimum time of 6 months. For comparative analysis, the cut-off point of arterial blood pressure used was that proposed by the American Diabetes Association (≤ 8804; 130/80 mmHg). Paired analysis was used to verify changes in treatment and bivariate and multivariate analysis to evaluate the associated factors to the achievement of blood pressure goal. Results: 73 patients were included. In the paired analysis, a decrease in the blood pressure averages, an increase in the number of antihypertensive drugs and an increase in the number of patients with satisfactory blood pressure control were observed. In the bivariate analysis, lower rates of fasting plasma glucose, postprandial glycaemia and abdominal circumference in women were associated with better blood pressure control (P < 0,05). Lower rates of postprandial glycemia were an independent factor associated with good control of blood pressure (P = 0,05). Conclusions: The management of high blood pressure in diabetic patients is unsatisfactory, and only a minority of them achieves the recommended blood pressure targets. Although an important improvement has been reached, more efforts are still necessary for an adequate management of high blood pressure in diabetic patients (AU)