Influencia de la seropositividad contra adenovirus-36 sobre riesgo de obesidad y resistencia a la insulina en población infanto-juvenil de la Región de la Araucanía / Influence of adenovirus 36 seropositivity on the risk of obesity and insulin resistance in a population of children and adolescents from the Región de la Araucanía

La infección previa por el adenovirus-36 (Ad-36) se ha asociado con el proceso adipogénico y el control glicémico en modelos experimentales de cultivos celulares y animales. En humanos, la presencia de anticuerpos contra Ad-36 ha mostrado aumentar el riesgo de obesidad y, paradójicamente, mejorar el control glicémico en diferentes poblaciones. Se evaluó la influencia de la seropositividad contra Ad-36 sobre riesgo de obesidad, el perfil lipídico y glicémico en una población de niños en edad escolar. Métodos: Doscientos ocho individuos de entre 9 y 13 años se agruparon según estado nutricional como normopeso (IMC z-score de -1 a +1), con sobrepeso (IMC z-score de +1 a +2) y con obesidad (IMC z-score > +3). Se evaluaron medidas antropométricas, desarrollo puberal según Tanner y parámetros bioquímicos (perfil lipídico, glucemia e insulina) y la seropositividad contra Ad-36. Se determinó la resistencia a la insulina (RI) según criterio para la población infantil chilena. La seropositividad contra Ad-36 se determinó mediante ELISA. Resultados: Hubo una alta prevalencia de sobrepeso/obesidad en la población de estudio. La seropositividad contra Ad-36 fue del 5,4% en el grupo total, pero no se observó una asociación con el estado nutricional. No se encontró correlación entre la seropositividad contra Ad-36 y los parámetros del perfil lipídico. La insulina y la HOMA-RI fueron significativamente más bajas en el grupo Ad-36 (+) (p<0,001), no habiendo sido reportados casos de RI en el grupo Ad-36 (+) en nuestra población. Conclusiones: Nuestros resultados sugieren que la infección previa por el adenovirus-36 afecta la secreción de insulina y la resistencia a la insulina, como se ha descrito anteriormente, sin embargo, no se observa correlación con el desarrollo de la obesidad infantil en la población pediátrica del sur de Chile.

Previous infection with Adenovirus-36 (Ad-36) has been associated with adipogenic process and glycemic control in experimental models of cell culture and animals. In humans, the presence of antibodies against Ad-36 has been shown to increase the risk of obesity and, paradoxically, improve glycemic control in different populations. The influence of Ad-36 seropositivity on obesity risk, lipid and glycemic profile was evaluated in a population of school-age children. Methods: Two hundred eight individuals aged 9 to 13 years were grouped according to their nutritional status as normal weight (BMI z-score from -1 to +1), overweight (BMI z-score from +1 to +2) or obese (BMI z-score from -1 to +1). z-score > +3). Anthropometric measurements, pubertal development according to Tanner stage, biochemical parameters (lipid profile, glycemia and insulin) and seropositivity against Ad-36 were evaluated. Insulin resistance (IR) was determined according to criteria for the Chilean child population. Seropositivity against Ad-36 was determined by ELISA. Results: There was a high prevalence of overweight/obesity in the study population. Seropositivity against Ad-36 was 5.4% in the total group, but no association with nutritional status was observed. No correlation was found between Ad-36 seropositivity and lipid profile parameters. Insulin and HOMA-RI were significantly lower in the Ad-36 (+) group (p<0.001), and no cases of RI were reported in the Ad-36 (+) group in our population. Conclusions: Our results suggest that previous adenovirus-36 infection affects insulin secretion and insulin resistance, as previously described, however, no correlation is observed with the development of childhood obesity in the pediatric population. from southern Chile.

The effect of fruit consumption time on glucose regulation in pregnancy with gestational diabetes / O efeito do tempo de consumo de fruta na regulação da glicose na gravidez com diabetes gestacional

ABSTRACT Objective This study aims to determine the effect of fruit consumption time on blood glucose regulation in pregnant women with gestational diabetes. Methods The study was carried out with 64 volunteer participants diagnosed with gestational diabetes. Participants who were directed to the Department of Nutrition and Dietetics were divided into two groups according to the order of application; Group 1 was included in the nutrition treatment program for a week, consuming fruit for the main meal and Group 2 for the snack. During this process, the participants were applied a personalized nutrition plan that was adjusted equally for macronutrients of all meals containing isocaloric 3 main and 4 snacks. In this process, blood glucose values were measured six times a day by the participants and the blood glucose results of both groups before starting the nutrition therapy and on the seventh day after starting the medical nutrition therapy were compared. Results The mean age of the women participating in the study was 33.50±4.95 years and 32.28±5.18 years for the 1st and 2nd groups, respectively, and the groups were similar in terms of anthropometric measurements. The post-diet average of postprandial blood glucose levels in the morning within each group dropped from 180mg/d to 115mg/dL (p<0,001) for Group 1 and from 185mg/dL to 110mg/dL (p<0,001) for Group 2. There was a decrease in the fasting plasma glucose and postprandial blood glucose levels measured in the morning, noon and evening before and after the medical nutrition therapy of the groups, but no statistically significant difference was found between the groups (p>0.05). All participants on the gestational diabetes diet had normal blood sugar levels without the need for insulin. A statistically significant decrease was observed in the postprandial blood glucose-fasting plasma glucose difference levels of the pregnant women in the group that consumed fruit for snacks (Group 2) on the seventh day of the study (p<0,001). There was no significant difference in the pre-diet and post-diet morning fasting plasma glucose values of both groups (p>0,05). Conclusion This study found that medical nutrition therapy in pregnant women with gestational diabetes led to a decrease in blood glucose levels, but consuming fruits as a snack or at the main meal did not make a significant difference on fasting plasma glucose and postprandial blood glucose. It was concluded that the type and amount of carbohydrates consumed daily in gestational diabetes are determinative on blood glucose level.

RESUMO Objetivo O objetivo deste estudo é determinar o efeito do tempo de consumo de fruta na regulação da glucose no sangue em mulheres grávidas com diabetes gestacional. Métodos Este estudo foi realizado com 64 participantes voluntários diagnosticados com diabetes gestacional. Os participantes que foram encaminhados para o Departamento de Nutrição e Dietética foram divididos em dois grupos, de acordo com a ordem da sua aplicação. O grupo 1 foi incluído no programa de tratamento médico nutricional durante uma semana, consumindo fruta para a refeição principal e o grupo 2 para os lanches. Neste processo, foi aplicado aos participantes um plano de nutrição personalizado, com isocalórico, 3 refeições principais e 4 lanches, os macronutrientes de todas as refeições foram ajustados igualmente. Neste processo, os valores de glicemia foram medidos seis vezes por dia pelos participantes, e foram comparados os resultados da glicemia de ambos os grupos antes de se iniciar a terapia nutricional médica e no sétimo dia após o início da terapia nutricional médica. Resultados A idade média das mulheres que participaram no estudo foi de 33,50±4,95 e 32,28±5,18 anos para o 1º e 2º grupos, respetivamente, e não houve diferença entre os grupos em termos de medidas antropométricas. A glicemia média pós-prandial de manhã após terapia nutricional médica dentro dos grupos variou entre 180mg/d a 115mg/dL (p<0,001) para o Grupo 1, e de 185mg/dL a 110mg/dL para o Grupo 2 (p<0,001). Houve uma diminuição nos níveis de glicemia em jejum e glicemia média pós-prandial medidos de manhã, meio-dia e noite antes e depois da terapia nutricional médica dos grupos, mas não houve diferença estatisticamente significativa entre os grupos (p>0,05). Os níveis de açúcar no sangue de todos os participantes na dieta diabetes gestacional baixaram para níveis normais sem necessidade de terapia com insulina. Uma diminuição estatisticamente significativa foi observada no sétimo dia do estudo nos níveis de diferença do glicemia média pós-prandial-glicemia em jejum das mulheres grávidas do grupo que consumiram fruta como aperitivo (Grupo 2). (p<0.001). Não houve diferença significativa nos valores de glicemia em jejum matinal de ambos os grupos antes e depois da dieta (p>0,05). Conclusão Como resultado deste estudo, verificou-se que a terapia nutricional levou a uma diminuição do açúcar no sangue em mulheres grávidas com diabetes gestacional, mas o consumo de fruta como lanche ou refeição principal não fez uma diferença significativa no jejum e na glucose do sangue pós-prandial. Concluiu-se que o tipo e a quantidade de hidratos de carbono consumidos diariamente na diabetes gestacional são determinantes para o nível de glicose no sangue.

Effect of strength training versus raloxifene on bone weight, blood glucose, lipid and antioxidant profile in ovariectomized rats

We compared the effect of the treatment with strength training (ST) and raloxifene (RALOX) on bone weight, blood glucose, lipid, and antioxidant profile in ovariectomized rats. Twenty-four Wistar rats were distributed into four groups: ovariectomy + VEHICLE (control); ovariectomy + RALOX; ovariectomy + ST; ovariectomy + RALOX + ST. Thirty days after ovariectomy, the animals underwent the treatment with RALOX (750 µcg day-1) and/or ST (three sessions week-1). Thirty days after, all groups were scarified, tibia and femur were weighed, and the blood was collected for analysis of the lipid profile, glucose, and antioxidants catalase (CAT) and glutathione (GSH). The ST group showed greater femur weight (0.82 ± 0.18 g) and RALOX + ST had greater tibia weight (0.61± 0.17 g) than CONTROL with femur weight of 0.65 ± 0.08 g and tibia of 0.49 ± 0.08 g with no differences between treatments (p > 0.05). ST group showed significantly higher catalase (181.7 ± 15.4 µM g-1) compared to the other groups. In contrast, the GSH value was lower in ST group (89.2 ± 8.1 µM g-1) compared to RALOX (175.9 ± 17.1 µM g-1) and RALOX + ST (162.8 ± 12.1 µM g-1), but the values of these two groups did not differ from CONTROL(115.3 ± 21.1 µM g-1). Total cholesterol did not differ between groups (p > 0.05), but exercise alone(54.3 ± 2.5 mg dL-1) or with RALOX (53.0 ± 1.5 mg dL-1) resulted in higher HDL cholesterol than CONTROL (45.5 ± 2.5 mg dL-1). Only RALOX+ST presented lower glucose (140.3 ± 9.7 mg dL-1) values than CONTROL (201.7 ± 30.6 mg dL-1). In conclusion, ST promotes similar benefits on bone and metabolic parameters compared to pharmacological treatment in ovariectomized rats.(AU)

Associations between glycated hemoglobin and glucose indicators in adults in areas at different altitude in China / 中华流行病学杂志

Objective: To explore the associations of glycated hemoglobin (HbA1c) with FPG and oral glucose tolerance test 2-hour (OGTT-2 h) in areas at different altitude in China. Methods: Subjects who participated in 2018-2019 China Chronic Disease and Risk Factor Surveillance and had no prior type 2 diabetes diagnosis were included. Subsequently, they were categorized into three groups based on altitude of living area (<2 000, 2 000- and ≥3 000 m). With adjustment for intracluster correlation, multivariable linear regression analysis was performed to evaluate the associations of HbA1c with FPG and OGTT-2 h in the context of HbA1c was normal (<5.7%) or abnormal (≥5.7%). Furthermore, the shape of relationships between HbA1c and glucose indicators was examined using restricted cubic spline. Finally, receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA1c for diabetes. Results: A total of 157 277 subjects were included in the analysis. While FPG and OGTT-2 h levels gradually decreased with increase of altitude, HbA1c level was similar among the three groups. When HbA1c was <5.7%, its association with FPG and OGTT-2 h was weak and no obvious difference was observed among the three groups. When HbA1c was ≥5.7%, the FPG and OGTT-2 h increased by 15.45% (95%CI:14.71%- 16.18%) and 24.54% (95%CI:23.18%-25.91%) respectively per one standard deviation increase in HbA1c in group in area at altitude <2 000 m. However, the FPG and OGTT-2 h increased by 13.08% (95%CI:10.46%-15.76%) and 21.72% (95%CI:16.39%-27.31%), respectively, in group in area at altitude 2 000- m, and increased by 11.41% (95%CI:9.32%-13.53%) and 20.03% (95%CI:15.38%- 24.86%), respectively, in group of altitude ≥3 000 m. The restricted cubic spline indicated that the curve showing the association of HbA1c with FPG and OGTT-2 h was flat when HbA1c was <5.7%, but showed a positive linear relationship when HbA1c was ≥5.7%. The area under curve for detecting diabetes was 0.808 (95%CI:0.803-0.812) in group of altitude <2 000 m and 0.728 (95%CI:0.660-0.796, P=0.022) in group of altitude ≥3 000 m. The relevant optimal cutoff value of HbA1c was 5.7%, with a sensitivity of 65.4% and a specificity of 83.0%, and 6.0%, with a sensitivity of 48.3% and a specificity of 93.7%, respectively. Conclusions: When HbA1c was ≥5.7%, the association between HbA1c and glucose indicators became weaker as the increase of altitude. In the area at altitude ≥3 000 m, it may not be appropriate to use HbA1c in the diagnosis of diabetes.

Comparación de los valores de glucosa en caninos obtenidos con glucómetros portátiles y la prueba estándar de laboratorio / Comparação dos valores de glicose em caninos obtidos com glicômetros portáteis e o teste laboratorial padrão / Comparison of glucose values in dogs obtained with portable glucometers and the standard laboratory test

La medición de glucosa en caninos es un procedimiento habitual en la clínica diaria, actualmente este valor se puede obtener mediante dispositivos portátiles y pruebas laboratoriales. Se realizó esta investigación con el fin de aportar mayor conocimiento sobre la importancia de la medición de glucosa, ya que en los últimos años ha perdido valor entre las pruebas hematológicas a considerar debido a que solo se relaciona con determinadas patologías como la diabetes u otras enfermedades metabólicas. El presente trabajo tiene como objetivo comparar los valores de glucosa en caninos obtenidos mediante un glucómetro portátil de uso humano (Accu-chek® Active, Roche Diagnostic, Mannheim, Alemania); veterinario (aLcose® Vet Glu, jjPlus Corporation, New Taipei, Taiwán) y la prueba estándar de laboratorio, esto nos indicará la fiabilidad de los resultados obtenidos mediante estos métodos. Se realizó la toma de muestras de sangre de 50 caninos clínicamente sanos, de los cuales se obtuvo el resultado de glucemia mediante estos tres métodos. Los resultados de nuestra investigación evidenciaron que las tres formas de evaluación de la glucosa sanguínea en perros brindaban resultados estadísticamente diferentes (p < 0.05). Se obtuvo valores de glucosa diferentes entre los tres métodos de medición, teniendo como promedios finales 84.14 mg/dL, 101.12 mg/dL y 91.12 mg/dL correspondientes al glucómetro portátil de uso humano, veterinario y a la prueba estándar de laboratorio respectivamente. En conclusión, los glucómetros portátiles de uso humano subestiman los valores reales de glucosa, mientras que los de uso veterinario lo sobreestiman, comparados con la prueba estándar de laboratorio.

A medição de glicose nos cães é um procedimento habitual realizado no atendimento clínico. Atualmente este valor pode ser obtido por meio de dispositivos portáteis e testes laboratoriais. Esta pesquisa foi realizada com a finalidade de destacar a importância da medição de glicose, visto que nos últimos anos esta avaliação não tem sido muito valorada entre os testes hematológicos, sendo considerada relevante apenas em relação a patologias como a diabetes e outras doenças metabólicas. O presente estudo teve como objetivo comparar os valores de glicose em cães obtidos com glicômetro portátil de uso humano; veterinário e o teste padrão de laboratório. Esta comparação poderá indicar a confiabilidade dos resultados obtidos mediante os métodos avaliados. Foi realizada a amostragem do sangue de 50 caninos clinicamente sadios os quais foram submetidos a avaliação de glicose mediante os três métodos. Os resultados de nossa investigação evidenciaram que as três formas de avaliação da glicose sanguínea têm resultados estatisticamente diferentes (p < 0,05). Os valores de glicose tiveram medias finais de 84,14 mg/dL, 101,12 mg/dL e 91,12 mg/dL para o glicômetro portátil de uso humano (Accu-chek® Active, Roche Diagnostic, Mannheim, Alemanha), veterinário (aLcose® Vet Glu, jjPlus Corporation, Nova Taipei, Taiwan) e o teste padrão de laboratório, respectivamente. Ao concluir, os glicômetros portáteis de uso humano subestimam os valores reais de glicose e os de uso veterinário os superestimam quando comparados com o teste padrão de laboratório.

The measurement of glucose in canines is a common procedure in daily clinical practice. Currently this value can be obtained by use of portable devices and laboratory tests. This research was carried out in order to provide more knowledge about the importance of glucose measurement, since in recent years it has lost value among the hematological tests to be considered because it is only related to certain pathologies such as diabetes or other metabolic diseases. The present study aimed to compare the glucose values in dogs obtained with a portable glucometer for human use, veterinarian use, and the standard laboratory test. This comparison may indicate the reliability of the results obtained through the evaluated methods. A blood sampling of 50 clinically healthy canines was taken and submitted to glucose evaluation using the three methods. Our investigation showed that the three ways of assessing blood glucose have statistically different results (p < 0.05). Glucose values had final averages of 84.14 mg/dL, 101.12 mg/dL, and 91.12 mg/dL for the portable glucometer for human use (Accu-chek® Active, Roche Diagnostic, Mannheim, Germany), veterinary (aLcose® Vet Glu, jjPlus Corporation, New Taipei, Taiwan) and the standard laboratory test, respectively. In conclusion, portable glucometers for human use underestimate the glucose values, and those for veterinary use overestimate them compared to the standard laboratory test.

Effect of volume of participation in exercise programs on biochemical parameters of women / Efeito do volume de participação em programas de exercícios nos parâmetros bioquímicos de mulheres

The aim of the study was to evaluate the effect of the volume of participation in exercise programs offered in Primary Health Care (PHC), for 24 weeks on blood biochemical parameters of adult women. Three Basic Health Units in Rio Claro City (São Paulo) were selected and 2 exercise inter-ventions were implemented with different volumes (3 weekly sessions, 90 minutes each; 2 weekly sessions, 60 minutes each). In total, 53 participants remained until the end of the interventions. Regardless of their number of absences, they were divided into 4 groups, according to the volume of participation (calculated individually according to the duration of sessions and the number of classes held), forming groups according to quartiles: Low Volume Group (LVG; 57.62 ± 9.97 years-old), Low Medium Volume Group (LMVG; 56.31 ± 12.18 years-old), High Medium Volume Group (HMVG; 53.00 ± 10.25 years-old), and High-Volume Group (HVG; 59.69 ± 7.66 years-old). Blood biochemical parameters were dosed using the ELISA method. The Generalized Estimation Equa-tion Model was used to compare the biochemical parameters (time, group, and interaction; p ≤ 0.05). The analysis showed significant and positive time effect for low-density lipoproteins (LDL) and glycemia in all groups and for total cholesterol (TC) in LVG, LMVG and HMVG; a significant group effect for HVG on TC (higher levels compared to all other groups) and LDL (higher levels compared to LVG and LMVG). It is concluded that the physical exercise programs offered in the PHC contributed to a significant reduction in LDL and blood glucose levels, regardless of the vol-ume of participation of individuals in the programs

O objetivo do presente estudo foi avaliar o efeito do volume de participação em programas de exercícios, ofer-tados na Atenção Primária à Saúde (APS), durante 24 semanas, nos parâmetros bioquímicos sanguíneos de mulheres adultas. Foram selecionadas 03 Unidades Básicas de Saúde de Rio Claro-São Paulo e implementa-das 2 intervenções de exercícios com diferentes volumes (3 sessões/semana, 90 minutos cada; 2 sessões/semana, 60 minutos cada). No total, 53 participantes se mantiveram até o final das intervenções, independentemente do número de faltas foram divididos em 4 grupos, de acordo com o volume de participação (calculado con-forme a duração das sessões e a quantidade de aulas realizadas de forma individual), formando os grupos segundo os quartis: Grupo Baixo Volume (GBV; 57,62 ± 9,97 anos), Grupo Baixo Médio Volume (GBMV; 56,31 ± 12,18 anos), Grupo Médio Alto Volume (GMAV; 53,00 ± 10,25 anos) e Grupo Alto Volume (GAV; 59,69 ± 7,66 anos). Os parâmetros bioquímicos sanguíneos foram dosados pelo método ELISA. Foi utilizado o Modelo de Equações de Estimações Generalizadas para a comparação dos parâmetros bioquímicos (tempo, grupo e interação; p ≤ 0,05). A análise evidenciou efeito significativo favorável do tempo para lipoproteínas de baixa densidade (LDL) e glicemia em todos os grupos e para colesterol total (CT) no GVB, GBMV e GMAV; e efeito significativo do grupo para GAV no CT (maiores níveis comparado a todos os grupos) e LDL (maiores níveis comparados ao GBV e GBMV ). Conclui-se que o programa de exercício físico ofertado na APS contribuiu para a redução significativa dos níveis de LDL e glicemia, independentemente do volume de participação dos indivíduos nos programas

Análisis comparativo de respuesta glicémica y de péptido C, tras la ingesta de estevia y D-tagatosa, según habitualidad de consumo de edulcorantes no nutritivos y preferencias alimentarias reportadas por mujeres con resistencia a la insulina / Comparative analysis of glicemic response and c peptide, after comsumption of stevia and d tagatosa, according to regular compsumtion of not nutritive sweeteners andnourish preferences reported by woman with insuline resistance

INTRODUCCIÓN: El consumo de edulcorantes no nutritivos (ENN) ha ido en aumento. A pesar de ello, se desconoce el efecto entre el consumo habitual de ENN y las preferencias alimentarias con parámetros bioquímicos en pacientes con resistencia a la insulina. OBJETIVO: Comparar la respuesta glicémica y de péptido C, según habitualidad de consumo de edulcorantes y preferencias alimentarias reportados por mujeres con resistencia a la insulina tras la ingesta de estevia y D-tagatosa. MÉTODOS: Treinta y tres mujeres con RI se sometieron a una encuesta de opción múltiple sobre preferencias alimentarias y ETCC modificada de edulcorantes. Aleatoriamente recibieron una precarga de control o experimental (estevia y D-tagatosa) donde se midió glicemia y péptido C en los tiempos -10, 30, 60, 90, 120, 180. RESULTADOS: Se encontró un ABC de péptido C más alto después de la ingesta de D-tagatosa (p = 0,02) en pacientes que prefieren alimentos ricos en proteínas en comparación con aquellos que prefieren alimentos ricos en grasas o en carbohidratos simples. Se observó un mayor ABC de péptido C (p = 0,04) para la prueba control en quienes prefieren el sabor salado y consumen menor cantidad de ENN, sin diferencias significativas entre quienes prefirieron sabor dulce. CONCLUSIONES: Al comparar las respuestas glicémicas e insulinémicas entre habitualidad de consumo de edulcorantes y preferencias alimentarias reportados por las pacientes tras la ingesta de agua, estevia y D-Tagatosa, no se obtuvieron diferencias significativas. Salvo en quienes preferían alimentos ricos en proteínas tras la ingesta de D- tagatosa y quienes preferían sabor salado con menor consumo habitual de ENN tras ingesta control.

INTRODUCTION: The consumption of non-nutritive sweeteners (NNS) has been increasing. Despite this, the effect between the habitual consumption of ENN and food preferences with biochemical parameters in patients with insulin resistance is unknown. OBJECTIVE: To compare the glycemic and C-peptide response, according to the habitual consumption of sweeteners and food preferences reported by women with insulin resistance after ingesting stevia and D-tagatose. METHODS: Thirty-three women with IR underwent a multiple choice survey on food preferences and modified ETCC for sweeteners. They randomly received a control or experimental preload (stevia and D-tagatose) where glycemia and peptide C were measured at times -10, 30, 60, 90, 120, 180. RESULTS: A higher C-peptide AUC was found after ingestion of D-tagatose (p = 0.02) in patients who prefer foods rich in protein compared to those who prefer foods rich in fat or simple carbohydrates. A higher AUC of peptide C (p = 0.04) is performed for the control test in those who prefer a salty taste and consume a lower amount of ENN, without significant differences between those who prefer a sweet taste. CONCLUSION: When comparing the glycerol and insulin responses between the habitual consumption of sweeteners and the food preferences reported by the patients after the ingestion of water, stevia and D-Tagatose, no significant differences were obtained. Except in those who prefer foods rich in protein after ingesting D-tagatose and those who prefer salty taste with less habitual consumption of NNS after control intake.

Adiposidad abdominal y resistencia a la insulina al finalizar el primer trimestre de la gestación / Abdominal Adiposity and Insulin Resistance at the End of the First Trimester of Gestation

Introducción: La adiposidad central como factor desencadenante de resistencia a la insulina precoz constituye una amenaza potencial de riesgo metabólico y cardiovascular en el embarazo. Objetivo: Determinar la capacidad discriminante de las grasas abdominales sobre la resistencia a la insulina, diagnosticada por el índice triglicéridos/glucosa-IMC al finalizar el primer trimestre del embarazo. Métodos: Se realizó un estudio observacional analítico de 526 gestantes con embarazo simple y edad gestacional entre 12 y 13 semanas, entre los años 2016 y 2020. Se estudió el test de triglicéridos/glucosa-IMC y las grasas abdominales por ultrasonido. Se utilizaron las curvas ROC (Receiver operating characteristic Curve) para discriminar la resistencia a la insulina al finalizar el primer trimestre de la gestación, cuando aumentan las grasas abdominales. Resultados: La grasa subcutánea fue la que presentó mayor área bajo la curva en la discriminación de la resistencia a la insulina, con un nivel de sensibilidad y especificidad aceptable. Conclusiones: La grasa subcutánea, aunque con bajo valor discriminativo, puede considerarse como augurio de resistencia a la insulina y de diabetes gestacional. Se requiere profundizar en el estudio de las grasas abdominales dado el conocimiento de su impacto en los desórdenes metabólicos en el curso avanzado de la gestación(AU)

Introduction: Central adiposity as a triggering factor for early insulin resistance is a potential threat of metabolic and cardiovascular risk in pregnancy. Objective: To determine the discriminating capacity of abdominal fat over insulin resistance, diagnosed by the triglyceride/glucose-BMI index at the end of the first trimester of pregnancy. Methods: An analytical and observational study was carried out with 526 pregnant women of singleton pregnancy and gestational age between twelve and thirteen weeks, between 2016 and 2020. The triglyceride/glucose-BMI test was studied, together with abdominal fats by ultrasound. ROC (receiver operating characteristic) curves were used to discriminate insulin resistance at the end of the first trimester of gestation, when abdominal fats increase. Results: Subcutaneous fat presented the highest area under the curve in the discrimination of insulin resistance, with an acceptable level of sensitivity and specificity. Conclusions: Subcutaneous fat, although with low discriminative value, can be considered as a harbinger of insulin resistance and gestational diabetes. Further study of abdominal fat is required, given the knowledge of its impact on metabolic disorders in late gestation(AU)

The relationship between fasting blood glucose level and thromboembolism events in patients with non-valvular atrial fibrillation / 中华心血管病杂志

Objective: To explore the relationship between fasting blood glucose level and thromboembolism events in patients with non-valvular atrial fibrillation (NVAF). Methods: This was an observational study based on data from a multicenter, prospective Chinese atrial fibrillation registry cohort, which included 18 703 consecutive patients with atrial fibrillation (AF) in 31 hospitals in Beijing from August 2011 to December 2018. Patients were divided into 5 groups according to status of comorbid diabetes and fasting glucose levels at admission: normal blood glucose (normal glucose group), pre-diabetes group, strict glycemic control group, average glycemic control group and poor glycemic control group. Patients were followed up by telephone or outpatient service every 6 months. The primary follow-up endpoint was thromboembolic events, including ischemic stroke and systemic embolism. The secondary endpoint was the composite endpoint of cardiovascular death and thromboembolic events. Kaplan-Meier survival analysis and multifactorial Cox regression were used to analyze the correlation between fasting glucose levels and endpoint events. Results: The age of 18 703 patients with NVAF was (63.8±12.0) years, and there were 11 503 (61.5%) male patients. There were 11 877 patients (63.5%) in normal blood glucose group, 2 023 patients (10.8%)in pre-diabetes group, 1 131 patients (6.0%) in strict glycemic control group, 811 patients in average glycemic control group and 2 861 patients(4.3%) in poor glycemic control group. Of the 4 803 diabetic patients, 1 131 patients (23.5%) achieved strict glycemic control, of whom 328 (29.0%) were hypoglycemic (fasting blood glucose level<4.4 mmol/L at admission). During a mean follow-up of (51±23) months (up to 82 months), thromboembolic events were reported in 984 patients (5.3%). The survival curve analysis of Kaplan Meier showed that the incidence rates of thromboembolic events in normal glucose group, pre-diabetes group, strict glycemic control group, average glycemic control group and poor glycemic control group were 1.10/100, 1.41/100, 2.09/100, 1.46/100 and 1.71/100 person-years, respectively (χ²=53.0, log-rank P<0.001). The incidence rates of composite endpoint events were 1.86/100, 2.17/100, 4.08/100, 2.58/100, 3.16/100 person-years (χ²=72.3, log-rank P<0.001). The incidence of thromboembolic events and composite endpoint events in the other four groups were higher than that in the normal blood glucose group (P<0.001). Multivariate Cox regression analysis showed that compared with normal glucose group, the risk of thromboembolism increased in pre-diabetes group(HR=1.23, 95%CI 1.00-1.51, P=0.049), strict glycemic control group(HR=1.32, 95%CI 1.06-1.65, P=0.013) and poor glycemic control group(HR=1.26, 95%CI 1.01-1.58, P=0.044). Conclusion: Both high or low fasting glucose may be an independent risk factor for thromboembolic events in patients with NVAF.

Blood glucose related adverse drug reaction of antitumor monoclonal antibodies: a retrospective analysis using Vigibase

Abstract On the increasing prevalence of using mAbs (monoclonal antibodies) in cancer therapy and the severe risk of hyperglycemia, we aimed to analyze the main clinical ADRs of mAbs, with a focus on adverse hyperglycemic events associated with currently clinically used mAbs. mAbs as well as target information were selected from Martinadale book and published articles. Drug approving information was collected from each government website, and ADR statistic data were collected from VigibaseR, comparing with Adverse Event Reporting System of US FDA. Top 10 mAbs were classified within listing in total ADR records, ADRs per year, hyperglycemic ADR records. Vigibase data were updated onto 15 Feb 2019. 20 mAbs were analyzed with 263217 ADR reports, wherein 16751 records on Metabolism and nutrition disorders and 1444 records on Glucose metabolism disorders. The geographic, age, gender distributions and annual ADR report numbers were listed respectively. Of the top 10, Rituximab, Bevacizumab and Nivolumab were on the top 3 in total ADR record and hyperglycemic record. Top 3 record results were similar in Vigibase and FDA database. It is of increasing importance for clinicians to be aware of early detection, patient management, or drug selection strategies when using mAbs, particularly within the high glycemic risk-reported mAbs, to improve the efficacy and tolerability of mAbs regiment and optimize patient outcomes.

Verificación y transferencia de intervalos de referencia de variables bioquímicas de rutina / Verification and transfer of reference intervals of routine biochemical variables

Introducción. El correcto análisis en la interpretación de los resultados de cualquier analito biológico es esencial para la salud del paciente y está fuertemente ligado a contrastar dichos resultados con los intervalos biológicos referenciales que estén acorde a la población que está siendo analizada diariamente. El objetivo de este artículo, fue establecer intervalos referenciales (IR) en adultos para glicemia, urea, creatinina, ácido úrico, colesterol total y triglicéridos en un laboratorio clínico y comparar los valores obtenidos con los incluidos en los insertos para ese rango de edad. Metodología. La población fue de 561 adultos de ambos sexos, aparentemente sanos, que acudieron a Biomasterclin Laboratorio en Valencia, Venezuela, y cuyas edades fueron de 57,1±18,1 años. Resultados. Los IR obtenidos fueron glicemia 63,0-108,8 mg/dL, urea 17,7-54,9 mg/dL, creatinina 0,60-1,41 mg/dL, ácido úrico 0,89-7,26 mg/dL, colesterol total 78,5-251,1 mg/dL y triglicéridos 39,5-176,0 mg/dL. Los IR propuestos por la casa comercial empleada para la determinación de la glicemia y la creatinina pudieron ser transferidos a la población evaluada, mientras que el resto de los IR no. Conclusión. Debido a las diferencias que se presentan entre los IR en los estuches comerciales comparados con los de la población de individuos que acuden a los laboratorios clínicos, se hace necesario establecer IR para ser empleados en cada laboratorio clínico

The correct analysis in the interpretation of the results of any biological analyte is essential for the health of the patient and it is strongly linked to comparing those results with reference ranges that are in accordance with the population that is being analyzed on a daily basis. The objective of this study was to establish reference ranges in adults for glycemia, urea, creatinine, uric acid, total cholesterol and triglycerides in a clinical laboratory and compare the values obtained with those included in the inserts for the corresponding age group. Methodology. The population consisted of 561 apparently healthy adults of both sexes that attended Biomasterclin Laboratorio in Valencia, Venezuela, whose ages were 57.1±18.1 years. Results. The reference ranges obtained for glycemia were 63.0- 108.8 mg/dL, urea 17.7-54.9 mg/dL, creatinine 0.60-1.41 mg/dL, uric acid 0.89- 726 mg/dL, total cholesterol 78.5-251.1 mg/dL and triglycerides 39.5-176.0 mg/ dL. The reference ranges proposed by the commercial kits used for the determination of glycemia and creatinine could be transferred to the evaluated population, while the rest of the reference ranges could not. Conclusion. Due to the differences that occur between the reference ranges in commercial kits compared to those of the population of individuals who attend clinical laboratories, it is necessary to establish reference values in each clinical laboratory

Comparación de dos sistemas de medición de glucosa en sangre en pacientes adultos internados en una unidad de cuidados intensivos / Comparison of two blood glucose measurement systems in adult patients hospitalised in an intensive care unit

Resumen El desempeño analítico de la determinación de glucosa es crucial para el manejo del paciente crítico. El objetivo del presente estudio fue establecer si los valores de glucosa determinados por un sistema point of care (POC) eran comparables con el sistema de uso habitual del laboratorio. Se analizaron 60 muestras de pacientes críticamente enfermos. La medición de la glucosa en suero y sangre entera se realizó en el analizador modular Cobas c 501 y, en el POC, Cobas b 221, respectivamente. Se estudió la correlación y concordancia entre los métodos, se compararon los resultados con requerimientos de calidad internacionales y se realizó el análisis de exactitud clínica en planillas de vigilancia de errores (Surveillance Error Grid). La glucemia media en el equipo Cobas b 221 fue 149,96 mg/dL, mientras que la glucemia media en suero en el equipo Cobas c 501 fue 148,37 mg/dL. El coeficiente de correlación obtenido fue 0,95. Mediante el análisis de concordancia se observó que un 5% de los valores superaban las 2 desviaciones estándar. En base a las especificaciones de los requerimientos internacionales, los resultados obtenidos no alcanzaron el desempeño óptimo. El análisis mediante planillas de vigilancia de errores determinó que el 90% de las mediciones se encontraron en la clasificación de grado de riesgo A, y el resto en grado de riesgo B. El analizador Cobas b 221 presenta las características metrológicas adecuadas para suplir al sistema de referencia en situaciones de urgencia o avería.

Abstract The analytical performance of glucose determination is crucial for the management of critical patients. The objective of this research was to establish whether the glucose values determined by a point of care (POC) system were comparable with the laboratory's usual use system. Sixty samples from critically ill patients were analysed. The measurement of serum glucose and whole blood was performed on the Cobas c 501 modular analyser and, at the POC, Cobas b 221, respectively. The correlation and agreement between the different methods was studied and the results compared with the international quality requirements. The analysis of clinical accuracy was performed in ways to monitor errors (Surveillance Error Grid). The average blood glucose in the Cobas b 221 was 149.96 mg/dL, while the average blood glucose in the Cobas c 501 was 148.37 mg/dL. The correlation coefficient obtained was 0.95. The concordance analysis showed that 5% of the values exceeded the two standard deviations. Based on the specifications of the international requirements, the results obtained did not reach the optimum performance. The analysis using error monitoring forms determined that 90% of the measurements were in the classification of risk grade A, while the rest were in risk grade B. The Cobas b 221 analyser presents the appropriate clinical characteristics to be used to replace in case of emergency in relation to the Cobas c 501 measurement system.

Resumo O desempenho analítico da determinação da glicose é crucial para o manejo do paciente crítico. O objetivo da presente pesquisa foi estabelecer se os valores de glicose determinados por um sistema point of care (POC) eram comparáveis com o sistema de uso habitual do laboratório. Foram analisadas 60 amostras de pacientes criticamente doentes. A medição da glicose em soro e sangue total foi realizada no analisador modular Cobas c 501 e no POC Cobas b 221, respectivamente. A correlação e concordância entre os diferentes métodos foram estudadas, os resultados foram comparados com os requisitos de qualidade internacionais. A análise de precisão clínica foi realizada em formulários de monitoramento de erros (Surveillance Error Grid). A glicemia média no equipamento Cobas b 221 foi de 149,96 mg/dL, enquanto que a glicemia sérica média no equipamento Cobas c 501 foi de 148,37 mg/dL. O coeficiente de correlação obtido foi de 0,95. A análise de concordância mostrou que 5% dos valores superavam os dois desvios-padrão. Com base nas especificações dos requisitos internacionais, os resultados obtidos não atingiram o desempenho ideal. A análise por meio de formulários de monitoramento de erros determinou que 90% das medições foram encontradas na classificação do grau de risco A, enquanto que o restante estava no grau de risco B. O analisador Cobas b 221 apresenta as características metrológicas apropriadas para suprir o sistema de referência em situações de emergência ou avaria.

Antioxidant capacity, reproductive response and glucose concentration and insulin of ewes supplemented prior to insemination with orange residue / [Capacidade antioxidante, resposta reprodutiva e concentração de glicose e insulina de ovelhas suplementadas antes da inseminação com resíduo de laranja]

The objective was to evaluate the antioxidant capacity, glucose and insulin concentration and reproductive performance of ewes supplemented with orange residue prior to insemination. Fifty-five multiparous ewes were divided into two corrals, and 15 unbred ewes were kept individually to measure feed consumption. Two integral diets were administered; T0: control treatment and T1: with 20% of dry matter of orange residue. Ten days after the start of supplementation, the ewes were synchronized. Supplementation was finalized prior to artificial insemination, then, a blood sample was taken to measure the antioxidant capacity and glucose and insulin concentration. An analysis of variance was made to evaluate the effect of treatment on the antioxidant capacity, glucose and insulin; and to analyze the response to estrus, percentage of gestation and prolificity a ji squared test was performed. Of 9 antioxidant compounds found in the orange residue, hesperidin (7.44%), chlorogenic acid (0.50%) and protocatechuic acid had the highest concentration. Feed intake, estrus response, percentage of gestation, antioxidant capacity, and glucose and insulin concentration were not affected by the treatment. It is concluded that inclusion of 20% of orange residue in the diet prior to insemination in ewes is possible.(AU)

O objetivo deste estudo foi avaliar a capacidade antioxidante, a concentração de glicose e insulina e o comportamento reprodutivo de ovelhas suplementadas com resíduo de laranja antes da inseminação. Cinquenta e cinco ovelhas multíparas foram divididas em dois currais e 15 ovelhas sem raça foram mantidas individualmente para se medir o consumo de ração. Duas dietas integrais foram administradas; T0: tratamento controle e T1: dieta com 20% de resíduo de laranja seco. Dias após o início da suplementação, as ovelhas foram sincronizadas. A suplementação foi finalizada antes da inseminação artificial e, em seguida, foi coletada uma amostra de sangue para medir a capacidade antioxidante e a concentração de glicose e insulina. Uma análise de variância foi feita para avaliar o efeito do tratamento sobre a capacidade antioxidante, a glicose e a insulina, e um teste do ji quadrado foi realizado para analisar a resposta ao estro, a porcentagem de gestação e de prolificidade. Dos nove compostos antioxidantes encontrados no resíduo laranja, a hesperidina (7,44%), o ácido clorogênico (0,50%) e o ácido protocatecuico foram os de maior concentração. O consumo alimentar, a resposta ao estro, a porcentagem de gestação, a capacidade antioxidante, a concentração de glicose e a insulina não foram afetados pelo tratamento. Conclui-se que é possível a inclusão de 20% de resíduos de laranja na dieta antes da inseminação em ovelhas.(AU)

The effect of physical exercise on blood sugar control in diabetic patients / O efeito do exercício físico no controle do açúcar no sangue em pacientes diabéticos / El efecto del ejercicio físico sobre el control del azúcar en sangre en pacientes diabéticos

ABSTRACT Introduction Diabetes is a metabolic disease characterized by hyperglycemia. It is a metabolic syndrome in which blood sugar levels increase due to defects in insulin secretion or impaired function, or even both defects. Object To understand the effect of diabetic patients in controlling blood sugar through physical exercise, the paper analyzes the correlation between the exercise status and physiological indicators of diabetic patients in our hospital. Methods We randomly selected 41 diabetic patients and monitored their exercise. At the same time, we check the physiological indicators of the patients after the exercise is completed and analyze the control of blood sugar by sports. Results After healthy physical exercise, the blood sugar level of diabetic patients tended to stabilize, and the glycosylated hemoglobin level decreased. The blood sugar levels of patients who did not participate in healthy physical exercises were not stable, and their glycosylated hemoglobin levels did not improve. Conclusion Healthy sports is a simple, easy, safe and effective adjuvant therapy for the prevention and treatment of diabetes, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução O diabetes é uma doença metabólica caracterizada por hiperglicemia. É uma síndrome metabólica em que os níveis de açúcar no sangue aumentam devido a defeitos na secreção de insulina ou função prejudicada, ou mesmo ambos os defeitos. Objetivo Para compreender os pacientes diabéticos no controle da glicemia por meio do exercício físico, o artigo analisa a correlação entre o estado de exercício e os indicadores fisiológicos de pacientes diabéticos em nosso hospital. Métodos Selecionamos aleatoriamente 41 pacientes diabéticos e monitoramos seus exercícios. Ao mesmo tempo, verificamos os indicadores fisiológicos dos pacientes após a realização do exercício e analisamos o controle da glicemia pelo esporte. Resultados Após exercícios físicos saudáveis, o nível de açúcar no sangue de pacientes diabéticos tendeu a se estabilizar e o nível de hemoglobina glicosilada diminuiu. Os níveis de açúcar no sangue dos pacientes que não praticavam exercícios físicos saudáveis não foram estáveis e os níveis de hemoglobina glicosilada não melhoraram. Conclusão O esporte saudável é uma terapia adjuvante simples, fácil, segura e eficaz para a prevenção e tratamento do diabetes e merece divulgação clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción la diabetes es una enfermedad metabólica caracterizada por hiperglucemia. Es un síndrome metabólico en el que los niveles de azúcar en sangre aumentan debido a defectos en la secreción de insulina o función alterada, o incluso a ambos defectos. Objeto Para comprender a los pacientes diabéticos en el control de la glucemia a través del ejercicio físico, el trabajo analiza la correlación entre el estado de ejercicio y los indicadores fisiológicos de los pacientes diabéticos en nuestro hospital. Métodos Seleccionamos aleatoriamente a 41 pacientes diabéticos y monitoreamos su ejercicio. Al mismo tiempo, verificamos los indicadores fisiológicos de los pacientes una vez finalizado el ejercicio y analizamos el control del azúcar en sangre mediante los deportes. Resultados Después de un ejercicio físico saludable, el nivel de azúcar en sangre de los pacientes diabéticos tendió a estabilizarse y el nivel de hemoglobina glicosilada disminuyó. Los niveles de azúcar en sangre de los pacientes que no participaron en ejercicios físicos saludables no fueron estables y sus niveles de hemoglobina glicosilada no mejoraron. Conclusión El deporte saludable es una terapia adyuvante simple, fácil, segura y eficaz para la prevención y el tratamiento de la diabetes y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Feedback of biochemical indexes of blood sugar control by swimming exercise / Feedback dos índices bioquímicos de controle de açúcar no sangue por exercícios de natação / Feedback de los índices bioquímicos del control del azúcar en sangre mediante el ejercicio de natación

ABSTRACT Introduction: According to the metabolic characteristics of ultra-long-distance swimming and the characteristics of energy utilization and absorption during exercise, we have formulated a nutritional supplement plan for crossing to study the influence of swimming sports on blood sugar and give biochemical feedback indicators. Objective: To lay a foundation for studying the nutrition supplement rules during long-term exercise by taking the athletes' blood after training to determine the changes in blood sugar, adjusting and determining the nutritional supplement plan during training. Methods: We monitor athletes' physical function changes and biochemical indicators during training and study the changes of these biochemical indicators and athletes' physical functions after long-term swimming exercises to scientifically arrange the exercise intensity and load during the training period. Results: The urine indexes after exercise did not change much, reflecting the exercise load's low intensity. The changes in blood lactic acid and blood urea indexes after exercise also confirmed this. During the training period, the athletes' hemoglobin and red blood cell parameters are in the ideal range, indicating that the athlete's physical function is in good condition. During the training period, the training load intensity and load are reasonable according to ultra-long-distance swimming's energy supply characteristics. After training, the changes in blood glucose indicators reflect that the nutritional supplement program we formulated for athletes is reasonable and feasible. Conclusions: By monitoring the blood sugar and biochemical indicators of swimmers, it can help athletes to arrange exercise intensity scientifically and load during the training period, to better carry out open water competitions in China, and to arrange training and scientific nutrition during the training period scientifically. Lay the foundation for the establishment of nutrition supplement theory and training theory for super long-time sports. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMEN Introducción: De acuerdo con las características metabólicas de la natación de ultra larga distancia y las características de utilización y absorción de energía durante el ejercicio, hemos formulado un plan de complementos nutricionales para estudiar la influencia de los deportes de natación en el azúcar en sangre y dar indicadores de retroalimentación bioquímica. Objetivo: Sentar las bases para el estudio de las reglas de los suplementos nutricionales durante el ejercicio a largo plazo mediante la extracción de sangre de los atletas después del entrenamiento para determinar los cambios en el azúcar en sangre, ajustando y determinando el plan de suplementos nutricionales durante el entrenamiento. Métodos: monitoreamos los cambios en la función física de los atletas y los indicadores bioquímicos durante el entrenamiento y estudiamos los cambios de estos indicadores bioquímicos y las funciones físicas de los atletas después de ejercicios de natación de larga distancia para organizar científicamente la intensidad y la carga del ejercicio durante el período de entrenamiento. Resultados: Los índices de orina después del ejercicio no cambiaron mucho, lo que refleja la baja intensidad de la carga de ejercicio. Los cambios en los índices de ácido láctico y urea en sangre después del ejercicio también lo confirmaron. Durante el período de entrenamiento, los parámetros de hemoglobina y glóbulos rojos de los atletas están en el rango ideal, lo que indica que la función física del atleta está en buenas condiciones. Durante el período de entrenamiento, la intensidad de la carga de entrenamiento y la carga son razonables de acuerdo con las características de suministro de energía de la natación de ultra larga distancia. Después del entrenamiento, los cambios en los indicadores de glucosa en sangre reflejan que el programa de suplementos nutricionales que formulamos para los atletas es razonable y factible. Conclusiones: monitorear los indicadores bioquímicos y de azúcar en sangre de los nadadores, puede ayudar a los atletas a organizar científicamente la intensidad del ejercicio y la carga durante el período de entrenamiento, a realizar mejor las competiciones en aguas abiertas en China y a organizar el entrenamiento y la nutrición científica durante el período de entrenamiento. Sentar las bases para el establecimiento de la teoría de los suplementos nutricionales y la teoría del entrenamiento para deportes de larga duración. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

RESUMO Introdução: De acordo com as características metabólicas da natação de ultra longa distância e as características de utilização e absorção de energia durante o exercício, formulamos um plano de suplemento nutricional para estudar a influência dos esportes de natação no açúcar no sangue e fornecer indicadores de feedback bioquímico. Objetivo: Estabelecer as bases para o estudo das regras de suplementos nutricionais durante exercícios de longa duração, retirando sangue de atletas após o treinamento para determinar as mudanças na glicemia, ajustando e determinando o plano de suplementação nutricional durante o treinamento. Métodos: monitoramos as mudanças na função física e nos indicadores bioquímicos dos atletas durante o treinamento e estudamos as mudanças nesses indicadores bioquímicos e nas funções físicas dos atletas após exercícios de natação de longa distância para organizar cientificamente a intensidade e a carga do exercício durante o período de treinamento. Resultados: As taxas de urina após o exercício não mudaram muito, refletindo a baixa intensidade da carga de exercício. Alterações nos índices de uréia e ácido láctico no sangue após o exercício também confirmaram isso. Durante o período de treinamento, os parâmetros de hemoglobina e hemácias dos atletas estão na faixa ideal, indicando que a função física do atleta está em boas condições. Durante o período de treinamento, a intensidade da carga de treinamento e a carga são razoáveis de acordo com as características da fonte de alimentação da natação de ultra longa distância. Após o treinamento, as mudanças nos indicadores de glicose no sangue refletem que o programa de suplementos nutricionais que formulamos para atletas é razoável e viável. Conclusões: monitorar os indicadores bioquímicos e de açúcar no sangue de nadadores pode ajudar os atletas a organizar cientificamente a intensidade e carga do exercício durante o período de treinamento, conduzir melhor competições em águas abertas na China e organizar treinamento e nutrição científica durante o período de treinamento. Estabelecendo as bases para o estabelecimento da teoria dos suplementos nutricionais e da teoria do treinamento para esportes de longa duração. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial

ABSTRACT Objective: The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Materials and methods: Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results: Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion: OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

Conocimiento de los médicos generales sobre complicaciones obstétricas asociadas a riesgo cardiovascular subsecuente / General practitioners’ knowledge about pregnancy complications associated with long-term cardiovascular risk

Resumen Introducción: La enfermedad cardiovascular (ECV) constituye la principal causa de mortalidad en mujeres; la preeclampsia (PE) y la diabetes mellitus gestacional (DMG) están asociadas a incremento en el riesgo de ECV. Objetivo: Evaluar el conocimiento de los médicos generales (MG) sobre complicaciones obstétricas asociadas a ECV. Métodos: Se envió a los MG un cuestionario electrónico anónimo basado en casos, diseñado para evaluar el entendimiento de la influencia de la historia obstétrica en el riesgo cardiovascular a largo plazo y el conocimiento general sobre riesgo de ECV. Resultados: La tasa de respuesta fue de 35 % (161/465). Los participantes reconocieron que la PE y la DMG son factores de riesgo para ECV (98 y 83 %, respectivamente) y reportaron las siguientes estrategias de tamizaje de ECV en mujeres con historial de PE y DMG: monitoreo de presión arterial (PE 100 %, DMG 46 %), cálculo de índice de masa corporal (PE 68 %, DMG 57 %), evaluación del perfil de lípidos (PE 71 %, DMG 57 %), hemoglobina glucosilada (PE 26 %, DMG 92 %) y glucosa en ayuno (PE 28 %, DMG 91 %). Conclusión: Las estrategias de tamizaje para identificar ECV en mujeres con antecedentes de PE y DMG reportadas por los MG fueron variables.

Abstract Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in women; preeclampsia (PE) and gestational diabetes mellitus (GDM) are associated with an increased risk of CVD. Objective: To evaluate general practitioners (GP) knowledge about complicated pregnancies and their association with CVD. Methods: An anonymous case-based electronic questionnaire designed to assess the level of understanding on the influence of a history of pregnancy complications on long-term cardiovascular risk and general knowledge about CVD risk was sent to GPs. Results: The response rate was 35 % (161/465). The participants recognized that PE and GDM are risk factors for CVD (98 and 83 %, respectively), and reported the following CVD screening strategies in women with a history of PE and GDM: blood pressure monitoring (PE 100 %, GDM 46 %), body mass index calculation (PE 68 %, GDM 57 %), lipid profile evaluation (PE 71 %, GDM 57 %), glycated hemoglobin (PE 26 %, GDM 92 %), and fasting glucose (PE 28 %, GDM 91 %). Conclusion: GP-reported screening strategies to identify CVD in women with a history of PE and GDM were variable.

Effects of blood flow restriction in large and small muscle groups / Efeitos da restrição do fluxo sanguíneo em grupamentos musculares grandes e pequenos / Efectos de la restricción del flujo sanguíneo en grupos musculares grandes y pequeños

ABSTRACT Introduction It is known that strength training brings improvements in health and sports performance by causing muscle hypertrophy and increased strength, as well as modifying some hemodynamic and physiological factors. Several strength training methodologies have been developed, one of which is vascular occlusion. There are few studies with large muscle groups due to poor adherence to the training style and the fact that vascular occlusion of large muscle groups is more difficult. Objective To verify and compare the hemodynamic effects of exercise with and without vascular occlusion in different muscle groups. Methods Quantitative crossover study, with cross-sectional and field procedures. The sample consisted of 10 physically active healthy male and female subjects between 18 and 30 years of age. With the cross-over design, all the volunteers participated in 3 groups: intervention with vascular occlusion, intervention without vascular occlusion and the control group. Results Overall, lactate and cholesterol remained elevated after 15 minutes of recovery and blood glucose and blood pressure did not vary among the groups. Conclusion Vascular occlusion training is an effective method for manipulating hemodynamic variables. Evidence level II; Clinical study.

RESUMO Introdução Sabe-se que o treino de força traz melhorias para a saúde e o desempenho esportivo, por ocasionar hipertrofia muscular e aumento de força, além de modificar alguns fatores hemodinâmicos e fisiológicos. Foram desenvolvidos vários métodos de treinamento de força, entre eles, a oclusão vascular. Porém, existem poucos estudos com grandes grupamentos musculares, devido à pouca adesão ao estilo de treino e ao fato de a oclusão vascular de grandes grupos musculares ser mais difícil. Objetivo Verificar e comparar os efeitos hemodinâmicos do exercício com e sem oclusão vascular em diferentes grupamentos musculares. Métodos Estudo quantitativo, cruzado, com procedimentos transversais e de campo. A amostra foi composta por 10 indivíduos saudáveis e fisicamente ativos do sexo masculino e feminino, na faixa etária de 18 a 30 anos. Com o desenho cruzado, todos os voluntários participaram de 3 grupos: intervenção com oclusão vascular, intervenção sem oclusão vascular e grupo controle. Resultados De forma geral, entre grupos, o lactato e o colesterol se mantiveram elevados depois de 15 minutos de recuperação, a glicemia e as pressões arteriais não variaram. Conclusão O treinamento com oclusão vascular é um método eficaz para manipular as variáveis hemodinâmicas. Nível de evidência II; Estudo clínico.

RESUMEN Introducción Se sabe que el entrenamiento de fuerza trae mejoras para la salud y el desempeño deportivo, por causar hipertrofia muscular y aumento de fuerza, además de modificar algunos factores hemodinámicos y fisiológicos. Fueron desarrollados varios métodos de entrenamiento de fuerza, entre ellos, la oclusión vascular. Sin embargo, existen pocos estudios con grandes grupos musculares, debido a la poca adhesión al estilo de entrenamiento y al hecho de que la oclusión vascular de grandes grupos musculares grandes es más difícil. Objetivo Verificar y comparar los efectos hemodinámicos del ejercicio con y sin oclusión vascular en diferentes grupos musculares. Métodos Estudio cuantitativo, cruzado, con procedimientos transversales y de campo. La muestra fue compuesta por 10 individuos saludables y físicamente activos del sexo masculino y femenino, en el grupo de edad de 18 a 30 años. Con el diseño cruzado, todos los voluntarios participaron en 3 grupos: intervención con oclusión vascular, intervención sin oclusión vascular y grupo control. Resultados De forma general, entre los grupos, el lactato y el colesterol se mantuvieron elevados después de 15 minutos de recuperación, la glucemia y las presiones arteriales no variaron. Conclusión El entrenamiento de oclusión vascular es un método eficaz para manipular las variables hemodinámicas. Nivel de evidencia II; Estudio clínico.

Prevalência de hiperglicemia de estresse em uma unidade de terapia intensiva / Prevalence of stress hyperglycemia in an intensive care unit

Objetivo: Avaliar a prevalência e o manejo da hiperglicemia de estresse em pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo retrospectivo, realizado de janeiro a junho de 2018. Os dados foram obtidos a partir de 582 prontuá- rios eletrônicos, considerando os valores glicêmicos durante a hospitalização, história prévia ou não de diabetes mellitus, causas do internamento, tempo de permanência na unidade de terapia intensiva, presença de complicações durante o internamento e conduta utilizada em caso de hiperglicemia de estresse. Resulta- dos: Dos 582 pacientes internados na unidade de terapia intensi- va, 579 tiveram sua glicemia indicada nos prontuários analisados; 341 (58,9%) apresentaram hiperglicemia em algum momento da internação, sendo a hiperglicemia de estresse caracterizada em 200 pacientes (35%). A duração média de internamento desses pacientes foi de 8,39±10,9 dias, e a causa mais frequente de inter- namento foi devido a pós-operatório por diversas causas, somando 148 indivíduos (74%). Dentro os pacientes, 72 (36%) apresenta- ram alguma complicação. Além disso, 13 casos (6,5%) evoluíram para óbito. Conclusão: Estudos disponíveis sobre alvos de gli- cose em pacientes críticos das unidades de terapia intensiva apresentam difícil interpretação devido às diferenças subs- tanciais no grupo de populações e aos protocolos de gestão de pacientes utilizados em vários centros. Todavia, a prevalência da hiperglicemia de estresse encontrada nesta amostra é se- melhante à de outras casuísticas estudadas. O índice eleva- do de complicações enfatiza a necessidade de padronização nos critérios para diagnóstico e tratamento da hiperglicemia de estresse objetivando melhor prognóstico desses pacientes independentemente da causa do internamento.

Objective: To evaluate the prevalence and management of stress hyperglycemia in patients hospitalized in anintensive care unit. Methods: Retrospective study, carried out from January to June 2018. Data were obtained from 582 electronic medical records, considering glycemic values during hospitalization, existence of previous history of Diabetes Mellitus, causes of hospitalization, length of stay in the intensive care unit, presence of complications during hospitalization, and behavior used in case of stress hyper- glycemia. Results: Of the 582 patients admitted in the ICU, 579 had their glycemia indicated in the charts analyzed: 341 (58,9%) had hyperglycemia in a certain moment of hospitalization, with stress hyperglycemia being present in 200 patients (35%). The average duration of hospitalization of these patients was 8,39 ± 10,9 days, and the most frequent cause of hospitalization was postoperative for various causes, totaling 148 individuals (74%). Of the patients, 72 (36%) presented some type of complication and 13 patients (6,5%) died. Conclusion: Available studies on glucose targets in critical intensive care unit patients are difficult to be interpre- ted because of substantial differences in the study populations and of patient management protocols used at various centers. However, the prevalence of stress hyperglycemia found in this sample is similar to that of other study groups. The high com- plication rate emphasizes the need for standardization of the criteria for diagnosis and treatment of stress hyperglycemia aiming at a better prognosis of these patients regardless of the cause of hospitalization.

Análise do perfil clínico e epidemiológico de pacientes com artrite psoriásica em ambulatório de reumatologia na Região Amazônica / Clinical and epidemiological profile analysis of patients with psoriatic arthritis in a rheumatology clinic in the Amazon Region

Objetivo: Conhecer o perfil clínico e epidemiológico de pacien- tes portadores de artrite psoriásica de uma região brasileira. Método: Pesquisa observacional, transversal, epidemiológica e documental, baseada na coleta de dados obtidos a partir da análise de 53 prontuários de pacientes cadastrados do Ambu- latório de Reumatologia da Universidade do Estado do Pará, na Região Amazônica. Resultados: Houve predominância do padrão do tipo poliartrite simétrica, sem distinção entre os sexos, com a presença de manifestações extra-articulares, pso- ríase em placas, em uso de metotrexato em doses médias. Con- clusão: Apesar da etiopatogenia da doença ser dependente de fatores genéticos, ambientais e imunológicos e da população amazônica ser muito particular, de uma miscigenação entre eu- ropeus, ameríndios e negros, o perfil clínico e epidemiológicos dos pacientes do Ambulatório de Reumatologia da Universidade do Estado do Pará é semelhante ao das literaturas nacional e internacional.

Objective: To know the clinical and epidemiologic profile of pso- riatic arthritis patients of a Brazilian region. Method: This is an observational, cross-sectional, epidemiological, and documental study, based on the data obtained from the analysis of the medi- cal records of 53 patients registered on the Rheumatology Cli- nic of the Universidade do Estado do Pará, in the Amazon area. Results: There was a predominance of the symmetrical polyar- ticular pattern, with no sexual distinction, extra articular invol- vement, plaque psoriasis, and treatment withn methotrexate, in medium doses. Conclusion: Despite the etiopathogenesis being dependent on genetic, environmental, and immunological fac- tors, and the population of the Amazon being a mix of Europeans, Amerindians, and black people, the clinical and epidemiological profile of the patients of the Rheumatology clinic of the Univer- sidade do Estado do Pará is similar to the ones described on the national and international literature.