Diagnosis and treatment strategy of periodontitis with diabetes / 中华口腔医学杂志

The number of diabetic patients visiting stomatology for periodontal disease is increasing, and the symptoms are relatively severe, and often complications increase the complexity of periodontal treatment. This article briefly describes the research progress and clinical manifestations of the epidemiology and related pathological mechanisms of periodontitis with diabetes, focusing on the treatment and providing reference for stomatologists in the clinical diagnosis and treatment of patients with diabetic periodontitis.

Knowledge about the disease and adherence to treatment in patients with diabetes

Introduction: Glycemic decompensation in diabetes is one of the major factors for the development of chronic disease complications. Factors involved in the adequate control of diabetes include adherence to pharmacological treatment and knowledge about the disease.Methods: Cross-sectional study on the factors associated with adherence to drug treatment and knowledge about diabetes in diabetic patients treated at Hospital Universitário de Santa Maria between 2018 and 2019, based on the validated Morisky-Green test and on the Diabetes Knowledge Questionnaire.Results: A total of 201 patients diagnosed with diabetes were included, the majority (85.6%) of which had type 2 diabetes and were white (75.6%), with a mean age of 59.4 years. An association between insufficient knowledge about diabetes and patients with type 2 diabetes was observed. An association was found between patients with type 2 diabetes using insulin and non-adherence to drug treatment compared with patients with type 2 diabetes who did use insulin. The research also showed that non-adherence to drug treatment was associated with higher occurrence of hypoglycemia compared with patients who adhered to drug treatment.Conclusion: The data obtained in our study allows us to conclude that non-adherence to pharmacological treatment makes diabetes therapy more complicated and worsens the prognosis.

Avaliação imunológica promovida pelo consumo de kombucha em camundongos diabéticos / Immunologic evaluation promoted by the consumption of kombucha in diabetic mice

O kombucha é uma bebida fermentada tradicional, originária da China, preparada pela fermentação de chá preto adoçado com cultura mista de bactérias e leveduras chamada Simbiotic Culture of Bacteria and Yeast (SCOBY). Tem sido alegado que o mesmo possui propriedades funcionais, tais como recuperação ou manutenção de peso corporal, atividade antihiperglicêmica, entre outras. Por não existirem estudos suficientes que as comprovem, este trabalho teve por objetivo avaliar a influência do consumo de kombucha como tratamento alternativo para amenizar e/ou retardar sintomas e complicações do Diabetes Mellitus e identificar as possíveis modificações metabólicas, morfológicas e imunológicas ocorridas em camundongos com diabetes tipo 1. De acordo com os resultados obtidos, observou-se que, apesar de ter havido recuperação de massa corpórea próxima daquela que se tinha antes da indução da diabetes, esse efeito não foi exclusivo do kombucha e, embora a influência no controle glicêmico tenha sido maior nos camundongos normoglicêmicos que diabéticos, acredita-se que a administração por um período prolongado pudesse indicar melhores resultados, uma vez que as avaliações histológicas e morfométricas do intestino demonstraram resultados satisfatórios quanto ao aumento da superfície de mucosa e diminuição do infiltrado inflamatório, favorecendo a modulação imunológica. Logo, considera-se necessária a realização de mais trabalhos para comprovação da capacidade funcional do kombucha e elucidação de sua eficácia enquanto tratamento exclusivo e/ou complementar do diabetes

Kombucha is a traditional Chinese fermented beverage prepared by fermenting sweetened black tea with mixed bacterial and yeast culture called Simbiotic Culture of Bacteria and Yeast (SCOBY). It has been claimed that it has functional properties such as body weight recovery or maintenance, antihyperglycemic activity, among others. Because there are not enough studies to prove them, this study aimed to evaluate the influence of kombucha consumption as an alternative treatment to alleviate and/or delay symptoms and complications of Diabetes Mellitus and to identify possible metabolic, morphological and immunological changes in mice with type 1 diabetes. According to the results obtained, it was observed that, although there was a recovery of body mass close to the one obtained before diabetes induction, this effect was not unique to kombucha, and although the influence on glycemic control was greater in normoglycemic rather than diabetic mice, it is believed that administration over a prolonged period could indicate better results, since histological and morphometric evaluations of the intestine showed satisfactory results in terms of mucosal surface enlargement and decreased inflammatory infiltrate, favoring immune modulation. . Therefore, further work is considered necessary to prove the functional capacity of kombucha and to elucidate its effectiveness as an exclusive and / or complementary treatment of diabetes

Diabetes mellitus asociada a pancreatitis autoinmune: caso clínico / Autoimmune pancreatitis associated with diabetes mellitus: report of one case

Autoimmune pancreatitis is uncommon, responds to steroids and is usually associated with diabetes mellitus. We report a 73 year-old male who, two months after a diagnosis of diabetes mellitus, presented with obstructive jaundice and weight loss. Abdominal magnetic resonance imaging was suggestive of an autoimmune pancreatitis and serum IgG4 was 339 mg/dl (normal range 3-201). The patient was treated with prednisone 40 mg/day with a good clinical and laboratory response. During outpatient care, the dose of prednisone was tapered.

Associação entre a periodontite apical e o diabetes mellitus: uma revisão da literatura / Association between apical periodontitis and diabetes mellitus: a literature review

Objetivo: realizar uma revisão de literatura para verificar a relação entre o diabetes mellitus e a periodontite apical (PA). Revisão da literatura: a PA caracteriza-se por uma perda óssea na região do ápice dental, que decorre principalmente da contaminação do sistema de canais radiculares. Embora a PA seja um processo inflamatório local, na região do periápice radicular, sua progressão pode ser influenciada por patologias sistêmicas, como o diabetes. O diabetes melittus é uma patologia crônica na qual há alteração na produção de insulina ou resistência à ação desta, esse hormônio auxilia a manter a concentração normal de glicose sanguínea. O quadro de hiperglicemia crônica presente no paciente diabético descompensado ocasiona alterações fisiológicas, que permitem suspeitar de uma relação entre o diabetes e a progressão de lesões periapicais. Considerações finais: a literatura estudada sugere uma associação positiva entre a presença do diabetes e a progressão de lesões periapicais. Porém, apesar de os estudos apontarem que existe uma maior prevalência de periodontite apical em diabéticos, ainda são poucas as evidências científicas sobre o assunto. (AU)

Objective: the present study aims to review the lit-erature to verify the relationship between diabetes mellitus and apical periodontitis (AP). Literature Review: the AP is characterized by bone loss in the tooth apex region, mainly resulting from the contamination of the root canal system. Although AP is a local inflammatory process in the root peri-apex region, its development may be affected by systemic pathologies such as diabetes. Diabetes mellitus is a chronic condition that causes chang-es in insulin production or the resistance to its action, considering this hormone helps maintain-ing the normal concentration of blood glucose. The chronic hyperglycemia condition in decom-pensated diabetic patients causes physiological changes that allow establishing a relationship be-tween diabetes and the development of the peri-apical lesions. Final considerations: the literature studied suggests a positive association between the presence of diabetes and the development of periapical lesions. However, although studies in-dicate a higher prevalence of apical periodontitis in diabetics, there is still little scientific evidence on the subject. (AU)

Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema

OBJECTIVES: This study was conducted to investigate the risk factors for pulmonary abscess-related empyema by investigating the clinical characteristics and chest computed tomography imaging features of patients with pulmonary abscesses. METHODS: We retrospectively analyzed the chest computed tomography findings and clinical features of 101 cases of pulmonary abscess, including 25 cases with empyema (the experimental group) and 76 cases with no empyema (the control group). The potential risk factors for pulmonary abscess-related empyema were compared between the groups by using univariate and multivariate logistic regression analyses. RESULTS: The incidence of pulmonary abscess-related empyema was 24.8% (25/101). Univariate analysis showed that male gender, diabetes, pleuritic symptoms, white blood cells >10×109/L, albumin level <25 g/L, and positive sputum cultures were potential clinical-related risk factors and that an abscess >5 cm in diameter and transpulmonary fissure abscesses were potential computed tomography imaging-related risk factors for pulmonary abscess-related empyema. Multivariate logistic regression analysis showed that transpulmonary fissure abscesses (odds ratio=9.102, p=0.003), diabetes (odds ratio=9.066, p=0.003), an abscess >5 cm in diameter (odds ratio=8.998, p=0.002), and pleuritic symptoms (odds ratio=5.395, p=0.015) were independent risk factors for pulmonary abscess-related empyema. CONCLUSIONS: Transpulmonary fissure abscesses, diabetes, giant pulmonary abscesses, and pleuritic symptoms increased the risk of empyema among patients with pulmonary abscesses.

An umbrella review on the effects of diabetes on implant failure and peri-implant diseases

Abstract The aim of this review is to summarize the evidence on associations between diabetes mellitus (DM) and complications around dental implants. Electronic database searches of MEDLINE, EMBASE, JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews and the PROSPERO register were performed from 1990 up to and including May 2018, using MeSH terms and other keywords. Systematic reviews and meta-analyses investigating the associations of DM and implant complications (failure, survival, bone loss, peri-implant diseases, and post-surgery infection) were eligible. The quality of the included reviews was determined using the Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2). Twelve systematic reviews were included. Implant survival rates ranged from 83.5% to 100%, while implant failure rates varied from 0% to 14.3% for subjects with DM. The three meta-analyses performed for event "implant failure" reported no statistically significant differences between diabetic and non-diabetic subjects. An apparently increased risk of peri-implantitis is reported in patients with DM. According to the AMSTAR 2 classification, 50% of the reviews were classified as being of "critically low", 25% as of "low" and 25% as of "moderate" quality. Evidence indicates high levels of survival and low levels of failure of implants inserted in patients with DM. However, DM was assessed as a whole in the majority of studies and, the actual influence of hyperglycemia on implant survival/failure is still uncertain. DM/hyperglycemia seems to be associated with a high risk of peri-implantitis. However, this conclusion is based on a limited number of systematic reviews.

Family Health Strategies: Profile/quality of life of people with diabetes / Estrategias Salud de la Familia: perfil/calidad de vida de personas con diabetes / Estratégias Saúde da Família: perfil/qualidade de vida de pessoas com diabetes

ABSTRACT Objective: To evaluate the quality of life and to analyze the epidemiological profile of people with diabetes treated in Family Health Strategies. Method: A cross-sectional study carried out with 350 people with diabetes. Results: Most people with diabetes are women, elderly, married, white, with low educational level, retired/pensioners, family income of up to two minimum wages. As the time of people with the disease increases, their quality of life decreases. People with complications from diabetes have a lower quality of life, with a statistically significant difference. Conclusion: Knowledge of the sociodemographic characteristics, clinical evaluation and quality of life of people with diabetes can improve the care process provided to this population.

RESUMEN Objetivo: Evaluar la calidad de vida y analizar el perfil epidemiológico de las personas con diabetes atendidas en Estrategias Salud de la Familia. Método: Estudio transversal, realizado con 350 personas con diabetes. Resultados: Las personas con diabetes, en su mayoría, son mujeres, ancianas, casadas, blancas, con bajo nivel instruccional, jubiladas/pensionistas, renta familiar de hasta dos salarios mínimos. A medida que aumenta el tiempo de las personas con la enfermedad, disminuye su calidad de vida. Las personas que tienen complicaciones derivadas de la diabetes tienen una calidad de vida menor, con diferencia estadística significativa. Conclusión: El conocimiento de las características sociodemográficas, de evaluación clínica y de la calidad de vida de las personas con diabetes puede mejorar el proceso de cuidado prestado a esta población.

RESUMO Objetivo: Avaliar a qualidade de vida e analisar o perfil epidemiológico de pessoas com diabetes atendidas em Estratégias Saúde da Família. Método: Estudo transversal, realizado com 350 pessoas com diabetes. Resultados: As pessoas com diabetes, em sua maioria, são mulheres, idosas, casadas, brancas, com baixo nível instrucional, aposentadas/pensionistas, renda familiar de até dois salários mínimos. À medida que aumenta o tempo das pessoas com a doença, diminui a sua qualidade de vida. As pessoas que possuem complicações decorrentes do diabetes possuem uma qualidade de vida menor, com diferença estatística significativa. Conclusão: O conhecimento das características sociodemográficas, de avaliação clínica e da qualidade de vida das pessoas com diabetes pode melhorar o processo de cuidado prestado a esta população.

Effects of diabetes mellitus and systemic arterial hypertension on elderly patients' hearing / Effects of diabetes mellitus and systemic arterial hypertension on elderly patients' hearing

Abstract Introduction: Chronic diseases can act as an accelerating factor in the auditory system degeneration. Studies on the association between presbycusis and diabetes mellitus and systemic arterial hypertension have shown controversial conclusions. Objective: To compare the initial audiometry (A1) with a subsequent audiometry (A2) performed after a 3 to 4-year interval in a population of elderly patients with diabetes mellitus and/or systemic arterial hypertension, to verify whether hearing loss in these groups is more accelerated when compared to controls without these clinical conditions. Methods: 100 elderly individuals participated in this study. For the auditory threshold assessment, a previous complete audiological evaluation (A1) and a new audiological evaluation (A2) performed 3-4 years after the first one was utilized. The participants were divided into four groups: 20 individuals in the diabetes mellitus group, 20 individuals in the systemic arterial hypertension group, 20 individuals in the diabetes mellitus/systemic arterial hypertension group and 40 individuals in the control group, matching them with each study group, according to age and gender. ANOVA and Kruskal-Wallis statistical tests were used, with a significance level set at 0.05. Results: When comparing the mean annual increase in the auditory thresholds of the A1 with the A2 assessment, considering each study group and its respective control, it can be observed that there was no statistically significant difference for any of the frequencies for the diabetes mellitus group; for the systemic arterial hypertension group, significant differences were observed after 4 kHz. For the diabetes mellitus and systemic arterial hypertension group, significant differences were observed at the frequencies of 500, 2 kHz, 3 kHz and 8 kHz. Conclusion: It was observed that the systemic arterial hypertension group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing.

Resumo: Introdução: Doenças crônicas podem atuar como fator de aceleração na degeneração do sistema auditivo. Os estudos sobre a associação da presbiacusia com o diabetes mellitus e com a hipertensão arterial sistêmica mostraram conclusões controversas. Objetivo: Comparar a audiometria inicial (A1) com uma audiometria sequencial (A2) feita com um intervalo de três a quatro anos em uma população de idosos portadores de diabetes mellitus e/ou hipertensão arterial sistêmica, a fim de saber se a perda de acuidade auditiva nesses grupos é mais acelerada comparados com controles sem essas condições clínicas. Método: Participaram deste estudo 100 idosos. Para a análise dos limiares auditivos, foram usadas: uma avaliação audiológica completa feita anteriormente (A1) e uma nova avaliação audiológica (A2) feita após três a quatro anos da primeira. Os participantes foram distribuídos em quatro grupos: 20 indivíduos no grupo com diabetes mellitus, 20 no grupo hipertensão arterial sistêmica, 20 no grupo diabetes mellitus/hipertensão arterial sistêmica e 40 indivíduos no grupo controle, foram pareados com cada grupo de estudo, de acordo com as características referentes a idade e sexo. Foram usados os testes estatísticos Anova e Kruskal-Wallis, com nível de significância de 0,05. Resultados: Na comparação da média de aumento anual dos limiares auditivos da avaliação A1 com a avaliação A2, considerando cada grupo estudo e seu respectivo controle, pode-se observar que para o grupo diabetes mellitus não houve diferença estatisticamente significante para qualquer das frequências; para o grupo hipertensão arterial sistêmica foram observadas diferenças significantes a partir de 4 kHz. Já para o grupo diabetes mellitus/hipertensão arterial sistêmica foram observadas diferenças significantes nas frequências de 500, 2k, 3k e 8 kHz. Conclusão: Verificou-se que o grupo hipertensão arterial sistêmica foi o que apresentou maior queda dos limiares auditivos no segmento estudado, quando comparado com os outros grupos, sugeriu que entre as três condições estudadas a hipertensão parece ser a que teve maior influência sobre a audição.

The Prognostic Value and Clinical Use of Myocardial Perfusion Scintigraphy in Asymptomatic Patients after Percutaneous Coronary Intervention / O Valor Prognóstico e o uso Clínico da Cintilografia de Perfusão Miocárdica em Pacientes Assintomáticos após Intervenção Coronariana Percutânea

Abstract Background: The role of myocardial perfusion scintigraphy (MPS) in the follow-up of asymptomatic patients after percutaneous coronary intervention (PCI) is not established. Objectives: To evaluate the prognostic value and clinical use of MPS in asymptomatic patients after PCI. Methods: Patients who underwent MPS consecutively between 2008 and 2012 after PCI were selected. The MPS were classified as normal and abnormal, the perfusion scores, summed stress score (SSS), and summed difference score (SDS) were calculated and converted into percentage of total perfusion defect and ischemic defect. The follow-up was undertaken through telephone interviews and consultation with the Mortality Information System. Primary endpoints were death, cardiovascular death, and nonfatal acute myocardial infarction (AMI), and secondary endpoint was revascularization. Logistic regression and COX method were used to identify the predictors of events, and the value of p < 0.05 was considered statistically significant. Results: A total of 647 patients were followed for 5.2 ± 1.6 years. 47% of MPS were normal, 30% were abnormal with ischemia, and 23% were abnormal without ischemia. There were 61 deaths, 27 being cardiovascular, 19 non-fatal AMI, and 139 revascularizations. The annual death rate was higher in those with abnormal perfusion without ischemia compared to the groups with ischemia and normal perfusion (3.3% × 2% × 1.2%, p = 0.021). The annual revascularization rate was 10.3% in the ischemia group, 3.7% in those with normal MPS, and 3% in those with abnormal MPS without ischemia. The independent predictors of mortality and revascularization were, respectively, total perfusion defect greater than 6%, and ischemic defect greater than 3%. Forty-two percent of the patients underwent MPS less than 2 years after PCI, and no significant differences were observed in relation to those who underwent it after that period. Conclusion: Although this information is not contemplated in guidelines, in this study MPS was able to predict events in asymptomatic after PCI patients, regardless of when they were performed.

Resumo Fundamentos: O papel da cintilografia de perfusão miocárdica (CPM) no seguimento de pacientes assintomáticos após intervenção coronariana percutânea (ICP) não está estabelecido. Objetivos. Avaliar o valor prognóstico e o uso clínico da CPM em pacientes assintomáticos após ICP. Métodos: Foram selecionados pacientes que realizaram CPM consecutivamente entre 2008 e 2012 após ICP. As CPM foram classificadas em normais e anormais, os escores de perfusão, escore somado do estresse (SSS) e escore somado da diferença (SDS) foram calculados e convertidos em porcentagem de defeito perfusional total e de defeito isquêmico. O seguimento foi por meio de entrevistas telefônicas e consulta ao Sistema de Informação de Mortalidade. Desfechos primários foram morte, morte cardiovascular e infarto agudo do miocárdio (IAM) não fatal e desfecho secundário foi revascularização. Regressão logística e método de COX foram utilizados para identificar os preditores de eventos e o valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: 647 pacientes foram acompanhados por 5,2 ± 1,6 anos. 47% das CPM foram normais, 30% anormais com isquemia e 23% anormais sem isquemia. Ocorreram 61 mortes, 27 cardiovasculares, 19 IAM não fatais e 139 revascularizações. A taxa anual de óbitos foi superior naqueles com perfusão anormal sem isquemia comparada aos grupos com isquemia e perfusão normal (3,3% × 2% × 1,2%, p = 0,021). A taxa anual de revascularização foi 10,3% no grupo com isquemia, 3,7% naqueles com CPM normal e 3% naqueles com CPM anormal sem isquemia. Foram preditores independentes de mortalidade e revascularização, respectivamente, defeito perfusional total maior que 6% e defeito isquêmico maior que 3%. Quarenta e dois por cento dos pacientes realizaram CPM menos de 2 anos após ICP e não foram observadas diferenças relevantes em relação aos que realizaram após esse período. Conclusão: Embora esta informação não esteja contemplada em diretrizes, neste estudo a CPM foi capaz de predizer eventos em pacientes assintomáticos após ICP, independente do momento de realização.

Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction / Diferenças por Sexo na Ansiedade e Depressão após Infarto Agudo do Miocárdio

Abstract Background: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Both depression and anxiety play a significant role in cardiovascular disease progression and are acknowledged to be independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. Objective: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. Methods: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). Conclusions: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women.

Resumo Fundamento: Os pacientes com doença cardíaca, depressão e transtornos de ansiedade são altamente prevalentes e persistentes. A depressão e a ansiedade desempenham um papel significativo na progressão da doença cardiovascular e são reconhecidas como fatores de risco independentes. No entanto, há muito pouca análise relacionada ao gênero em relação às doenças cardiovasculares e transtornos emocionais. Objetivo: Avaliar os níveis de depressão e ansiedade em pacientes com infarto do miocárdio (IM) no primeiro mês após o IM e avaliar a relação entre os fatores de risco para doença cardiovascular, indicadores demográficos e distúrbios emocionais, bem como determinar se existem diferenças ou semelhanças baseadas no sexo do paciente. Métodos: Esta pesquisa incluiu questões demográficas, características clínicas, questões sobre fatores de risco de doença cardiovascular e a Escala Hospitalar de Ansiedade e Depressão [HADS]. Todos os testes estatísticos foram bilaterais, e valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Determinou-se que 71,4% dos pacientes do sexo feminino e 60,4% dos pacientes do sexo masculino apresentavam sintomatologia concomitante de ansiedade e/ou depressão (p = 0,006). Utilizando os homens como o ponto de referência, as mulheres mostraram um risco elevado de apresentar qualquer distúrbio psiquiátrico (odds ratio, 2,86, p = 0,007). O escore da HADS-D foi notavelmente maior nas mulheres (8,66 ± 3,717) do que nos homens (6,87 ± 4,531, p = 0,004). Foi determinado que os pacientes do sexo masculino que desenvolveram depressão eram em média mais jovens do que aqueles sem depressão (p = 0,005). Conclusões: As mulheres demonstraram risco mais elevado de apresentar distúrbio de ansiedade e/ou depressão em comparação aos homens. Além disso, a gravidade da depressão aumentou com a idade entre os homens, enquanto o gravidade da ansiedade diminuiu. Em contraste, a gravidade da depressão e ansiedade foram semelhantes para mulheres de todas as idades após o IM. Um maior escore de depressão foi associado com diabetes e inatividade física, e o maior escore de ansiedade foi associado ao tabagismo nos homens. A hipercolesterolemia foi associada tanto aos maiores escores de ansiedade e depressão, enquanto um maior escore de depressão foi associado à inatividade física entre mulheres.

Dietary intake of non-dialysis chronic kidney disease patients: the PROGREDIR study. A cross-sectional study

ABSTRACT BACKGROUND: Despite evidence that diet is very important in relation to chronic kidney disease (CKD) progression, studies in this field are scarce and have focused only on some specific nutrients. We evaluated the energy, macronutrient and micronutrient intakes and dietary patterns of non-dialysis CKD participants in the PROGREDIR study. DESIGN AND SETTING: Cross-sectional study; CKD cohort, São Paulo, Brazil. METHODS: Baseline data on 454 participants in the PROGREDIR study were analyzed. Dietary intake was evaluated through a food frequency questionnaire. Dietary patterns were derived through principal component analysis. Energy and protein intakes were compared with National Kidney Foundation recommendations. Linear regression analysis was performed between energy and nutrient intakes and estimated glomerular filtration rate (eGFR), and between sociodemographic and clinical variables and dietary patterns. RESULTS: Median energy and protein intakes were 25.0 kcal/kg and 1.1 g/kg, respectively. In linear regression, protein intake (β = -3.67; P = 0.07) was related to eGFR. Three dietary patterns (snack, mixed and traditional) were retained. The snack pattern was directly associated with male gender (β = 0.27; P = 0.006) and inversely with diabetes (β = -0.23; P = 0.02). The traditional pattern was directly associated with male gender (β = 0.27; P = 0.007) and schooling (β = 0.40; P < 0.001) and inversely with age (β = -0.01; P = 0.001) and hypertension (β = -0.34; P = 0.05). CONCLUSIONS: We identified low energy and high protein intake in this population. Protein intake was inversely related to eGFR. Dietary patterns were associated with age, gender, schooling level, hypertension and diabetes.

Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs / Fatores de risco para tuberculose: diabetes, tabagismo, álcool e uso de outras drogas

ABSTRACT Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.

RESUMO A tuberculose continua a ser um importante problema de saúde para a humanidade. Embora os esforços para controlar a epidemia tenham reduzido sua mortalidade e incidência, há vários fatores predisponentes a ser controlados a fim de reduzir a carga da doença. Este artigo de revisão aborda alguns dos fatores de risco associados à infecção por tuberculose, como diabetes, tabagismo, uso de álcool e uso de outras drogas, que podem também contribuir para maus resultados do tratamento da tuberculose. A tuberculose pode levar a complicações no curso e no manejo de outras doenças, como o diabetes. Portanto, é importante identificar essas comorbidades em pacientes com tuberculose a fim de assegurar um manejo adequado de ambas as condições.

Retinal changes in solid organ and bone marrow transplantation patients / Alterações retinianas em pacientes de um programa de transplante de órgãos sólidos e de medula óssea

ABSTRACT Objective To evaluate retinal changes in patients who underwent solid organ or bone marrow transplantation. Methods A retrospective analysis of medical records of patients evaluated from February 2009 to December 2016. All patients included underwent funduscopy. Clinical and demographic data regarding transplantation and ophthalmological changes were collected. Results A total of 126 patients were analyzed; of these, 108 underwent transplantation and 18 were in the waiting list. Transplantation modalities were heart, lung, kidney, liver, pancreas, combined pancreas and kidney and bone marrow transplantation. The main pre-transplantation comorbidities were diabetes and arterial hypertension. Of the 108 transplanted patients, 82 (76%) had retinal changes. All patients who underwent pancreas or combined pancreas and kidney transplantation had diabetic retinopathy. The main retinal changes found were diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusions, chorioretinal infections and central serous chorioretinopathy. Conclusion Retinal changes were either related to preexisting conditions, mainly diabetic retinopathy, or developed postoperatively as a complication of the surgical procedure, or as an infection related to the immunosuppressive status, or due to drug toxicity. These patients may present with complex ophthalmological changes and should be carefully evaluated prior to surgery and further followed by an ophthalmologist skilled in the management of diabetic retinopathy and posterior pole infections.

RESUMO Objetivo Analisar as alterações retinianas de pacientes submetidos a transplantes de órgãos sólidos ou de medula óssea. Métodos Análise de prontuário dos pacientes avaliados no período de fevereiro de 2009 a dezembro de 2016. Todos os pacientes incluídos foram submetidos à avaliação fundoscópica. Foram coletados dados demográficos e clínicos, referentes ao transplante e às alterações oftalmológicas encontradas. Resultados Foram avaliados 126 pacientes, sendo 108 submetidos a transplantes e 18 que aguardavam o procedimento. Foram avaliados pacientes submetidos a transplantes de coração, pulmão, rim, fígado, pâncreas, pâncreas-rim e medula óssea. As principais comorbidades pré-transplante foram diabetes e hipertensão arterial. Dos 108 pacientes transplantados, 82 (76%) apresentaram alterações retinianas. Todos os pacientes submetidos ao transplante de pâncreas ou pâncreas-rim apresentaram alterações retinianas relacionadas ao diabetes. As principais alterações retinianas detectadas foram retinopatia diabética, retinopatia hipertensiva, oclusões vasculares retinianas, infecções coriorretinianas e coriorretinopatia serosa central. Conclusão As alterações retinianas estavam relacionadas a doenças preexistentes, principalmente à retinopatia diabética, ou surgiram após o transplante, como complicação do procedimento cirúrgico, ou como complicação infecciosa associada à imunossupressão, ou ainda por toxicidade medicamentosa. Tais pacientes podem apresentar alterações oculares complexas, devendo ser submetidos à avaliação retiniana pré-operatória cuidadosa e ao acompanhamento pós-operatório por oftalmologista especializado no manejo da retinopatia diabética e de doenças infecciosas do segmento posterior ocular

Diabetes mellitus and the skin

Abstract: Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.

Frecuencia de síndrome metabólico en niños y adolescentes del Paraguay / Frequency of metabolic syndrome in children and adolescents in Paraguay

La intención de la elección del tema de Síndrome Metabólico surge a raíz de la epidemia mundial de obesidad en la infancia y adolescencia observada en las últimas décadas, y que ha supuesto la aparición en pediatría de alteraciones hasta ahora más propias de la edad adulta, como el Síndrome Metabólico (SM) y que generen día a día numerosas complicaciones de salud como las Enfermedades Cardiovasculares (ECV) y Diabetes tipo 2. Se tienen como objetivo determinar la frecuencia de SM en niños y adolescentes del Paraguay y sus componentes. Se ha encontrado que el sobrepeso y la obesidad abdominal son los factores principales que contribuyen a las manifestaciones del Síndrome Metabólico en niños y adolescentes del Paraguay, por ese motivo corren mayor riesgo de sufrir enfermedades cardiovasculares y diabetes tipo 2 en el futuro y de forma más precoz. Se ha visto en estudios realizados en América que los componentes más prevalentes fueron la obesidad y la dislipidemia, mientras que; alrededor del 7% con hiperglucemia y síndrome metabólico de manera general. Según estudios realizados en Paraguay, se vio que la frecuencia de sobrepeso y obesidad es muy alta al igual que la incidencia del síndrome metabólico

The purpose of the choice of the Metabolic Syndrome issue arises from the worldwide epidemic of obesity in infancy and adolescence observed in the last decades, and which has led to the appearance in pediatrics of alterations that have hitherto been more typical of adulthood, Such as Metabolic Syndrome (MS) and that generate daily complications of health such as Cardiovascular Diseases (CVD) and Type 2 Diabetes. Its objective is to determine the frequency of MS in children and adolescents in Paraguay and its components. It has been found that overweight and abdominal obesity are the main factors that contribute to the manifestations of the Metabolic Syndrome in children and adolescents of Paraguay, for that reason they are at greater risk of suffering cardiovascular diseases and type 2 diabetes in the future and in a more early. It has been seen in studies carried out in America that the most prevalent components were obesity and dyslipidemia, whereas; around 7% with hyperglycemia and metabolic syndrome in general. According to studies in Paraguay, it was found that the frequency of overweight and obesity is very high, as is the incidence of the metabolic syndrome

Infecciones en cirugía bariátrica / Bariatric surgery infections

Las infecciones de sitio operatorio son eventos adversos frecuentes en cirugía, su presencia determina una mayor morbimortalidad, además de estancia hospitalaria y costos económicos para los afectados. La obesidad constituye un factor de riesgo para dicha enfermedad por aspectos multifactoriales. Considerando la epidemia occidental del sobrepeso y la obesidad, así como la masificación de la cirugía bariátrica, es importante mantener conceptos actualizados. La obesidad determina un estado de respuesta inflamatorio sistémico basal, el cual puede ser descompensado por segundas injurias, dicha descompensación puede determinar en una mayor tasa de infecciones asociadas a la intervención quirúrgica. Existe evidencia que no logra demostrar significación estadística con relación a la presencia de diabetes o H. pylori como factor de riesgo. De forma complementaria, algunos paradigmas como la mayor tasa de infecciones pulmonares o la necesidad de uso de antibiótico-profilaxis en cirugía bariátrica se mantiene.

Surgical site infections are frequent adverse events in surgery, its presence determines increased morbidity and mortality plus hospital stay and economic costs for those affected. Obesity is a risk factor for this disease by multifactorial aspects. Considering the Western epidemic overweight and obesity, as well as the massification of bariatric surgery, it is important to keep updated concepts. Obesity determines a state of basal systemic inflammatory response, which can be decompensated by a second hit, this decompensation can determine a higher rate of infections associated to surgery. There is evidence that fails to demonstrate statistical significance in relation to the presence of diabetes or H. pylori infection as a risk factor. As a complement, some paradigms as the highest rate of lung infections or the need for antibiotic prophylaxis use in bariatric surgery remains.

Diabetes mellitus and drug abuse during pregnancy and the risk for orofacial clefts and related abnormalities / La diabetes mellitus, el abuso de drogas durante el embarazo y el riesgo de malformaciones craneofaciales y anomalías relacionadas / Diabetes mellitus e uso de drogas durante a gravidez e o risco de fissuras orofaciais e anomalias relacionadas

Abstract Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized.

Resumen Objetivos: esta investigación estableció la prevalencia de diabetes mellitus (DM) y el abuso de drogas en madres de niños con malformaciones creaneofaciales (MCF). Métodos: 325 mujeres que tuvieron hijos (0-3 años) con malformaciones fueron entrevistadas. Se obtuvieron datos referentes a: tipo de diabetes; uso de drogas lícitas o ilícitas durante el embarazo; circunferencia de la cintura; y, glucemia en ayunas en la primera consulta prenatal. Resultados: el veintisiete por ciento de las mujeres tenían DM. Entre estas, el 89% tuvieron DM gestacional, el 5,5% DM tipo 1 y el 5,5% DM tipo 2. La prevalencia de DM en madres de hijos con MCF fue de 27%. Esto es significativamente más alto que el promedio de la población brasileña afectada por esa enfermedad, que es de 7,6% (p<0.01) (OR=4,5, 95%IC=3,5-5,8). Observando el abuso de drogas durante el embarazo, el 32% de las madres había utilizado drogas y una correlación positiva significativa fue observada entre el abuso de drogas y la ocurrencia de hendiduras y otras malformaciones craneofaciales (p=0,028) (OR=2,87; 95%IC=1,1-7,4). Conclusiones: la DM y el abuso de drogas durante el embarazo aumentan el riesgo de MCF y de anomalías relacionadas; se enfatiza la importancia del diagnóstico precoz de DM y la prevención del abuso de drogas, especialmente entre las mujeres embarazadas.

Resumo Objetivos: avaliar a prevalência de diabetes mellitus (DM) e o uso de drogas em mães de crianças com fissuras orofaciais (FOF). Método: 325 mulheres que tiveram filhos (0-3 anos) com fissuras foram entrevistadas. Os dados referentes tipo de diabetes, uso de drogas lícitas / ilícitas durante a gravidez, circunferência abdominal e glicemia em jejum na primeira consulta pré-natal foram coletados. Resultados: vinte e sete por cento das mulheres tinham DM. Destes, 89% tinham DM gestacional, 5,5% DM tipo 1 e 5,5% DM tipo 2. A prevalência de DM em mães de crianças com FOF foi de 27%, significativamente mais elevado que a média da população brasileira que é de 7,6% (p <0,01) (OR = 4,5, IC de 95% = 3,5-5,8). Com relação ao uso de drogas, 32% das mães eram usuárias drogas durante a gravidez e uma correlação positiva foi observada entre o uso de drogas e a ocorrência de FOF e anomalias relacionadas (p = 0,028) (OR = 2,87; IC95% = 1,1-7,4). Conclusões: DM e uso de drogas durante a gravidez aumentam o risco de FOF e anomalias relacionadas e o diagnóstico precoce de DM e a prevenção do uso de drogas, especialmente em mulheres grávidas, devem ser enfatizados.