Clinical Characteristics and Impact of Diabetes Mellitus on Outcomes in Patients with Nonvalvular Atrial Fibrillation

PURPOSE: Studies have shown that diabetes mellitus (DM) is a risk factor for cardiovascular disease, including atrial fibrillation (AF); however, the clinical characteristics and prognostic impact of DM in patients with nonvalvular AF have not been well understood in China. MATERIALS AND METHODS: Included were 1644 consecutive patients with nonvalvular AF. Endpoints included all-cause mortality, cardiovascular mortality, stroke, major bleeding, and combined endpoint events (CEE) during a 1-year follow-up. RESULTS: The prevalence of DM was 16.8% in nonvalvular AF patients. Compared with non-diabetic AF patients, diabetic AF patients were older and tended to coexist with other cardiovascular diseases. Most patients with DM (93.5%) were eligible for anticoagulation, as determined by CHADS2 scores. However, only 11.2% of patients received anticoagulation. During a 1-year follow-up, the all-cause mortality and CEE rate in the DM group were significantly higher than those of the non-DM group, while the incidence of stroke was comparable. After multivariate adjustments, DM was still an independent risk factor for 1-year all-cause mortality [hazard ratio (HR)=1.558; 95% confidence interval (CI) 1.126-2.156; p=0.007], cardiovascular mortality (HR=1.615; 95% CI 1.052-2.479; p=0.028), and CEE (HR=1.523; 95% CI 1.098-2.112; p=0.012), yet not for stroke (HR=1.119; 95% CI 0.724-1.728; p=0.614). CONCLUSION: DM is a common morbidity coexisting with nonvalvular AF and is associated with an increased risk of 1-year all-cause mortality, cardiovascular mortality, and CEE. However, no increased risk of stroke was found during a 1-year follow-up in patients with AF and DM.

Effects of ursolic acid on glucose metabolism, the polyol pathway and dyslipidemia in non-obese type 2 diabetic mice.

Ursolic acid (UA) is a pentacyclic triterpenoid compound that naturally occurs in fruits, leaves and flowers of medicinal herbs. This study investigated the dose-response efficacy of UA (0.01 and 0.05%) on glucose metabolism, the polyol pathway and dyslipidemia in streptozotocin/nicotinamide-induced diabetic mice. Supplement with both UA doses reduced fasting blood glucose and plasma triglyceride levels in non-obese type 2 diabetic mice. High-dose UA significantly lowered plasma free fatty acid, total cholesterol and VLDL-cholesterol levels compared with the diabetic control mice, while LDL-cholesterol levels were reduced with both doses. UA supplement effectively decreased hepatic glucose-6-phosphatase activity and increased glucokinase activity, the glucokinase/glucose-6-phosphatase ratio, GLUT2 mRNA levels and glycogen content compared with the diabetic control mice. UA supplement attenuated hyperglycemia-induced renal hypertrophy and histological changes. Renal aldose reductase activity was higher, whereas sorbitol dehydrogenase activity was lower in the diabetic control group than in the non-diabetic group. However, UA supplement reversed the biochemical changes in polyol pathway to normal values. These results demonstrated that low-dose UA had preventive potency for diabetic renal complications, which could be mediated by changes in hepatic glucose metabolism and the renal polyol pathway. High-dose UA was more effective anti-dyslipidemia therapy in non-obese type 2 diabetic mice.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic evaluation and action of sildenafil citrate

To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function. Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously. A significant increase in urethral pressure was observed during micturition. Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Alloxan diabetes alters the tensile strength, morphological and morphometric parameters of abdominal wall healing in rats

To investigate the effects of alloxan diabetes on the abdominal wall healing of rats undergoing laparotomy. METHODS: Ninety-six male Wistar rats weighing between 200 and 300 grams, divided into two groups: non-diabetic group (G1) and another with untreated diabetes (G2). Three months after diabetes induction, the animals underwent a 5cm-long- laparotomy and 5.0 nylon monofilament suture. After the surgery, 12 animals from each group were euthanized on days 4, 14, 21 and 30 corresponding to the moments M1, M2, M3 and M4. In each moment a fragment of the abdominal wall containing the scar was removed for tensile strength measurement, histological and morphometric study. Clinical and biochemical parameters were also analyzed. RESULTS: G2 animals showed parameters compatible with severe diabetes and decreased plasma levels of insulin. The tensile strength in G2 was significantly smaller in M2 and M4, with a tendency to fall in the other two. Through light microscope, diabetic animals showed more difficulty to increase collagen density and contraction. G2 animals showed high cellularity of fibroblasts in later healing moments, with collagen thinning in M2 and M4. CONCLUSION: The abdominal wound healing in untreated diabetic animals was altered and led to a higher incidence of dehiscence and infections.

Factors Associated with Diabetic Retinopathy and Nephropathy Screening in Korea: The Third and Fourth Korea National Health and Nutrition Examination Survey (KNHANES III and IV)

This cross-sectional study was done to identify and determine the socio-demographic and health-related factors associated with diabetic retinopathy and nephropathy screening in Korea. Participants included 2,660 adults, aged 40 or older, with diabetes. Of the 2,660 adults, 998 (37%) and 1,226 (46.1%) had received a diabetic retinopathy and a nephropathy screening within one year, respectively. Regarding retinopathy, subjects older than 65, living in urban areas, with high educational levels, and with self-reported "unhealthy" status were likely to receive annual screening. Subjects living in urban areas, with higher educational levels, with self-reported "fair" or "unhealthy" status, and with 1 to 2 co-morbidities were likely to receive annual nephropathy screening. The Korea Composite Stock Price Index (KOSPI) continued to rise until 2007 when it started to decline over the subsequent years, following the same curve as the diabetic retinopathy and nephropathy screening rates during that time. Together with the financial matter, lack of patient education proved to be a hindrance to diabetes-related screening. The relatively low screening rates in Korea compared to the Western countries are likely to be due to the difference in the health system, economic situations and national demographics.

Association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina

Diabetes mellitus [DM] is associated with serious complications including macro- and microvascular problems such as diabetic retinopathy. Coronary involvement in diabetic patients is believed to be a consequence of microvascular complications. However, the available data are inconclusive and scarce. This study aimed to evaluate the probable association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina [UA]. In this cross-sectional study, 200 diabetic patients with UA [100 cases with diabetic retinopathy and 100 cases without diabetic retinopathy] were enrolled in a teaching hospital. Left ventricular ejection fraction [LVEF] as well as the frequency of cases with left ventricular dysfunction [LVEF<50%] were compared between the two groups and different degrees of diabetic retinopathy [proliferative and non-proliferative]. Patients' demographic variables were comparable between the two groups. Mean diagnosis time of DM was significantly higher in the patients with diabetic retinopathy [8.40 +/- 6.60 vs. 3.81 +/- 3.58 years; P=0.001]. Mean LVEF was significantly lower in the retinopathy group [50.50 +/- 6.91% vs. 53.07 +/- 4.87%; P=0.003]. Frequency of cases with left ventricular dysfunction was significantly higher in the group with diabetic retinopathy [31% vs. 12%; P=0.001, OR=3.33, 95%CI: 1.58-7.14]. The frequency of cases with left ventricular dysfunction was significantly yet independently higher in patients with proliferative vs. non-proliferative diabetic retinopathy. Left ventricular dysfunction is more common in diabetic patients with unstable angina and diabetic retinopathy compared with their counterparts without diabetic retinopathy

Rhinocerebral zygomycosis in a diabetic patient / Zigomicose rinocerebral em paciente diabética

Rhinocerebral zygomycosis is the most frequent form of fungal infection caused by members of the Zygomycetes class. A fatal case of rhinocerebral zygomycosis caused by Rhizopus (oryzae) arrhizus with histopathological and mycological diagnosis is reported in a diabetic patient.

Zigomicose rinocerebral é a forma mais frequente das infecções fúngicas causadas por membros da classe Zygomicetes. É relatado um caso fatal de zigomicose rinocerebral por Rhizopus (oryzae) arrhizus com diagnóstico histopatológico e micológico, em paciente diabética.

Perfil de pacientes diabéticos em diálise / Profile of diabetic patients in dialysis

Introdução: Atualmente, diabetes mellitus (DM) representa a principal causa mundial de doença renal crônica. No Brasil, aproximadamente 25% dos pacientes em diálise são diabéticos. Objetivo: Este estudo visa a determinar as características clínicas e sociais dos pacientes diabéticos em diálise na cidade de Curitiba, Brasil. Materiais e Métodos: Estudo transversal realizado no período de março a agosto de 2006 na nossa instituição. Foram identificados 97 pacientes diabéticos (46% mulheres; média de 9,4 anos). As informações clínicas e socioeconômicas dos pacientes com idade de ± 58 anos foram obtidas por meio de questionário e revisão de prontuário. Resultados: Hipertensão arterial sistêmica (HAS) foi relatada por 75% dos pacientes e o tabagismo, em 25% das respostas. Renda familiar e nível de escolaridade baixos foram verificados em 85% dos pacientes (1 a 5 salários mínimos/mês). O diagnóstico de DM foi realizado por médico clínico geral em 86% dos casos, e o intervalo entre o diagnóstico de DM e a referência para o nefrologista foi maior que 10 anos (80%). Observou-se também que 48% e 70% dos pacientes em diálise já tinham avaliação prévia, por um endocrinologista e oftalmologista, respectivamente. Entretanto, somente 9% e 35% ainda mantêm acompanhamento regular com esses profissionais. Finalmente, 65% dos pacientes nunca receberam informações sobre cuidados do pé diabético. Conclusão: Diabéticos em diálise apresentam baixa escolaridade e maior prevalência de HAS. Além disso, o treinamento e acompanhamento de uma equipe multidisciplinar poderiam melhorar os cuidados dos pacientes diabéticos em diálise.

Introduction: Currently, diabetes mellitus (DM) represents the main cause of chronic disease worldwide. In Brazil, approximately 25% of dialysis patients are diabetic. Objective: This study was performed to determine the clinical and social characteristics in diabetic dialysis patients in the city of Curitiba, Brazil. Material and Methods: A cross-sectional study was carried out in our institution between March and August 2006. Ninety-seven diabetic (46% female: mean age 58 ± 9.4) patients were identified. Clinical and socialeconomic information was assessed through a questionnaire and by files review. Results: Systemic hypertension (High Blood Pressure HBP) was reported by 75% of patients, and smoking habit was present in 25% of the answers. Low income and low schooling were verified in 85% of the patients (between 1 and 5 minimal wage/month). Moreover, the DM diagnosis was performed by a general physician in 86% of the cases, and the interval between DM diagnosis and referral to the nephrologist was more than 10 years (80%). It has also been observed that 48% and 70% of the patients during dialysis had a previous evaluation by endocrinologist and ophthalmologist, respectively. However, only 9% and 35% of them are still being followed by these professionals regularly. Finally, 65% of the patients never received any information about diabetic foot care. Conclusion: Diabetic patients on dialysis have low income and schooling, with an increased prevalence of HBP. Moreover, management and training of a multiprofessional team could lead to an improvement in diabetes care in diabetic patients on regular dialysis.

[ effect of hesperidin, on cardiac dysfunction of experimental type-I diabetic rats]

Flavonoids are polyphenolic compounds, which are considered as antioxidants due to their ability to scavenge free radicals and inhibit enzymes in oxygen-reduction pathways. Various studies have shown that these products reduce the cardiovascular disease mortalities. Heart failure is one of the main cause of mortality in diabetic patients. It is believed that diabetes has deleterious cardiomyopathic effects, which would lead to heart failure. Several evidences indicate that oxidative stress is an important factor in the pathogenesis of diabetic complications, including cardiomyopathy. The objective of the present study was to examine the effects of hesperidin on cardiac function parameters in experimental diabetes mellitus type 1 [DM1]. Diabetes mellitus was induced in rats by single intraperitoneal injections of streptozotocin [60mg/kg]. diabetic rats were given oral Hesperidin [500 mg/kg] for two months. Afterwards, the animals' hearts were used to study left ventricular systolic pressure [LVSP], rate of rise [+dP/dT] and rate of decrease [-dP/dT] of left ventricular pressure, using Langendorff isolated heart apparatus. Diabetes significantly reduced the LVSP, +dP/dT and -dP/dT compared to the control group p<0.05]. Hesperidin significantly improved all measured parameters in diabetic animals [p<0.05]. These results show that hesperidin can improve diabetic cardiomyopathy in experimental diabetes mellitus

Xantomas eruptivos / Eruptive xantomas

Los xantomas eruptivos son expresión de manifestaciones cutáneas de enfermedades sistémicas, específicamente de hiperlipoproteinemias, entre ellas la hipertrigliceridemia. La enfermedad es poco frecuente, aparece en brotes, se manifiesta por pápulas amarillentas localizadas en nalgas, abdomen, dorso y extremidades y es generalmente asintomática. Afecta a adultos y se asocia a un defecto genético de la lipoprotein-lipasa (LPL) y a un trastorno del metabolismo lipídico. Se presentan 2 casos clínicos de xantomas eruptivos y se realiza una revisión bibliográfica de esta patología y sus posibilidades terapéuticas.

Experiencia en amputaciones en miembros inferiores: Hospital Vargas de Caracas, Servicio de Cirugía Uno / Experience en lower limb amputations: Hospital Vargas de Caracas Servicio de Cirugía 1

Evaluar la experiencia en el tratamiento quirúrgico de las amputaciones de miembros inferiores que ingresaron en nuestro servicio. Estudio retrospectivo- descriptivo de 75 pacientes que ingresaron al Servicio de Cirugía Uno del Hospital de Vargas de Caracas por lesiones en miembros inferiores, en el período comprendido entre enero de 2000 y dicienbre de 2005, y a quienes se les realizó tratamiento quirúrgico. Se estudiaron 75 pacientes con amputaciones. Con una distribución equitativa de géneros, el grupo etario más afectado fue el de 71 a mayores de 76 años, con un 36 por ciento. La lesión que más predominó fue el pie diabético con 78 por ciento. El procedimiento de elección fue la amputación supracondílea en un 54 por ciento, así como en las reintervenciones con un 64 por ciento en 15 pacientes que evolucionaron en forma tórpida. Se observa el poco uso de estudios de imágenes en 39 por ciento de los pacientes. El 100 por ciento de los pacientes egresó con vida después de realizado el procedimiento. Se encontró una frecuencia importante de pie diabético. Los problemas detectados fueron: carencia de ayuda diagnóstica complementaria, falta de aplicacion de procedimientos previos a la amputación y no fueron evaluados integralmente los pacientes. Estos problemas deben ser resueltos para mejorar la calidad de vida y reducir las amputaciones innecesarias.

Ocular involvement in diabetes mellitus.

Diabetes is a worldwide medical problem and is a significant cause of morbidity and mortality. It has considerable impact on both the patient and the society because it typically affects individuals in their most productive years. It is also one of the leading causes of blindness and visual impairment. A person with diabetes has 25 times the risk of blindness compared to a non-diabetic. This article reviews the variety of ways in which the eye and its adnexa can be involved in diabetes mellitus.

Carotid intima media thickness: an independent marker for assessment of macrovascular risk in diabetic patients.

In view of the global epidemic of diabetes with India being the hottest reservoir of the disease, it was tried to identify carotid intima media thickness as a surrogate marker for atherosclerosis in diabetic subjects. The study becomes more relevant because diabetes is now considered a disease of the endothelium and a risk equivalent of coronary atherosclerosis (paradigm shift). The study incorporated 41 normotensive patients of diabetes and 31 age and sex matched controls. Plasma glucose and lipid profiles were assessed in all and the carotid intima media thickness was measured. Results were statistically analysed for significance and correlation coefficient between values of plasma glucose and carotid intima media thickness. Results clearly showed that carotid intima media thickness abnormality can pick up atherosclerosis even if the lipid parameters are nearly normal. So it crystallises from this small study that, as a non-invasive test carotid intima media thickness is a better and early predictor of atherosclerosis in diabetic subjects. It also revealed the linear relationship between both fasting and postprandial blood sugar with carotid intima media thickness.

Achados da fundoscopia e alterações do pé diabético em pacientes do Hospital Universitário Onofre Lopes/UFRN / Fundoscopic alterations and diabetic foot in patients of Hospital Universitário Onofre Lopes/UFRN

OBJETIVO: Trabalho com o objetivo de identificar as alterações do pé diabético causadas pelas lesões microangiopáticas e das lesões do fundo de olho secundárias aretinopatia diabética. MÉTODOS: 76 pacientes com Diabetes Melito tipos 1 e 2atendidos no ambulatório de Oftalmologia e Cirurgia Vascular do HUOL/UFRN, Natal, RN, no período de novembro de 2004 a janeiro de 2005, com queixas relativas a alterações da retinopatia diabéticae/oudo pé diabético. Em todos os pacientes foi realizado exame clínico geral, vascular e oftalmológico. Na avaliação específicado pé diabético deu-se ênfase paraa investigação do status vascular pela Classificação de Fontaine para Doença Arterial Obstrutiva Periférica, biomecânica,e teste do monofilamento de Semmes-Weinstein. O exame oftalmológico constou de refração e fundoscopiaatravés da qual identificou-se as formas clínicas da retinopatia diabética. Os dados foram submetidos à análise estatística das variáveis primárias que consistiu em caracterizar o grupo quanto a idade, tempo de doença, nível de glicose A segunda estratégia da análise dos dados constituiu na realização de testes de associação entrealgumas variáveis secundárias selecionadas. O software utilizado para os testes estatísticos foi o Statistica Versão 5, 1997. RESULTADOS: Dos 76 pacientes diabéticos 97 por cento tinham idade superior a 40 anos. O tempo de doença65 por cento tinham mais de 10 anos. Com relação à glicose 72,72 por cento apresentaram níveis de glicose em jejum acima de 100mg/dl. 55,26 por cento apresentavam algum grau de retinopatia diabética contra 44,74 por cento que não apresentavamesses sinais. Com as alterações do pé diabético, identificou-se 59,93 por cento com lesões com área de predominância isquêmica, enquanto 41,07 por cento tinham ausência de sinais. 58,82 por cento apresentaram área de predominância neuropática, e 41,18 por cento sem sinais de neuropatia. Dos com retinopatia diabética 78,57 por cento tinham comprometimento isquêmico no pé e 47,62 por cento tinham algum grau de neuropatia diabética. Observou-se que a retinopatia diabética não proliferativa, nos seus diversos graus de comprometimento apresentou-se com percentuais em torno de 80 por cento junto às lesões do pé diabético, seja isquêmico ou neuropático. Dos pacientes que tinham retinopatia 60,46 por cento tinham alterações biomecânicas dos pés...