Tratamiento quirúrgico de pie diabético basado en clasificación Wagner / Surgical treatment of diabetic foot based on Wagner classification

Se realizó un estudio que caracterizó a los pacientes que reciben tratamiento quirúrgico en el Hospital Roosevelt por pie diabético según la Clasificación Wagner. El objetivo era determinar el tratamiento quirúrgico brindado al paciente con pie diabético, basado en la clasificación Wagner, en el Departamento de Cirugía del Hospital Roosevelt durante el período de enero a octubre 2015. Se realizó un estudio descriptivo estudiando a los pacientes con diagnóstico de pie diabético, con una muestra de 81 pacientes. Se encontró que 56% presentaron grado IV, edad de 56-65 años en 38%, de sexo masculino 65%. 134 procedimientos quirúrgicos realizados, más común lavado y desbridamiento en 38%. Principalmente diagnóstico de Diabetes mellitus tipo II, con tiempo diagnóstico mayor a 10 años en 51%. Uso de hipoglucemiantes orales 49%. De los estudiados, 41% no presentaba ninguna comorbilidad. Se concluyó que el tratamiento quirúrgico más frecuente para Pie diabético Wagner II y III fue el lavado y desbridamiento, grado IV amputación de dedos y grado V las amputaciones femorales supracondíleas. Caracterizados como pacientes en rango de edad entre los 56-65 años, de sexo masculino, que padece Diabetes mellitus tipo II, clasificado como pie diabético Wagner IV, ameritando tratamiento quirúrgico como amputación de dedos seguido de amputaciones radicales descritas como amputación supracondílea, con tiempo de diagnóstico mayor a 10 años, con tratamiento de hipoglucemiantes orales, y sin ninguna comorbilidad médica asociada. (AU)

A study was conducted that characterized patients receiving surgical treatment at Roosevelt Hospital for diabetic foot according to the Wagner Classification. The objective was to determine the surgical treatment provided to the patient with diabetic foot, based on the Wagner classification, in the Department of Surgery at Roosevelt Hospital during the period from January to October 2015. A descriptive study was carried out studying patients with a diagnosis of diabetic foot, with a sample of 81 patients. It was found that 56% had grade IV, age 56-65 years in 38%, male 65%. 134 surgical procedures performed, the most common was lavage and debridement in 38%. Mainly diagnosis of type II diabetes mellitus, with a diagnosis time greater than 10 years in 51%. Use of oral hypoglycemic agents 49%. Of those studied, 41% did not present any comorbidity. The conclusion was that the most frequent surgical treatment for Wagner II and III was lavage and debridement, grade IV finger amputation and grade V supracondylar femoral amputations. Characterized as patients in the age range between 56-65 years, male, suffering from type II diabetes mellitus, classified as Wagner IV diabetic foot, meriting surgical treatment such as amputation of fingers followed by radical amputations described as supracondylar amputation, with time of diagnosis greater than 10 years, with treatment of oral ypoglycemic agents, and without any associated medical comorbidity. (AU)

Tuberculose e diabetes: associação com características sociodemográficas e de diagnóstico e tratamento. Brasil, 2007-2011 / Tuberculosis and diabetes: association with sociodemographic characteristics and diagnosis and treatment of tuberculosis. Brazil, 2007-2011

RESUMO: Introdução: A comorbidade tuberculose e diabetes ainda continua um desafio para a saúde pública mundial. Objetivo: Analisar o perfil sociodemográfico e as características do diagnóstico e tratamento dos casos de tuberculose com e sem diabetes no Brasil. Métodos: Estudo transversal, com dados do Sistema de Informação de Agravos de Notificação e do Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica, no período de 2007 a 2011. Modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência (RP) e seus respectivos intervalos de confiança. Resultados: A comorbidade estudada foi encontrada em 7,2% dos casos. Modelo hierárquico mostrou maior RP entre indivíduos do sexo feminino (RP = 1,31; intervalo de confiança de 95% - IC95% 1,27 - 1,35); maior associação nas faixas etárias 40-59 anos e ≥ 60 anos (RP = 11,70; IC95% 10,21 - 13,39 e RP = 17,49; IC95% 15,26-20,05) e com resultado positivo da baciloscopia - primeira amostra (RP = 1,40; IC95% 1,35 - 1,47). Reingresso após abandono e abandono foram inversamente associados na comorbidade (RP = 0,66; IC95% 0,57 - 0,76 e RP = 0,79; IC95% 0,72 - 0,87). Conclusão: Os achados, como a relação inversa do abandono ao tratamento da tuberculose no grupo das pessoas com comorbidade, reforçam a importância de ações integradas nos serviços para mudar o cenário dessa desafiadora comorbidade.

ABSTRACT: Introduction: Tuberculosis and diabetes comorbidity remains a challenge for global public health. Objective: To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. Methods: This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. Results: We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). Conclusion: The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.

Cardiovascular autonomic neuropathy in type 2 diabetic patients

SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.

RESUMO Diabetes é uma das mais frequentes patologias crônicas em todo o mundo, cujo tratamento envolve uma equipe multidisciplinar, médicos generalistas, endocrinologistas, cardiologistas, nefrologistas e oftalmologistas. Pacientes com diabetes mellitus tipo 2 (DMT2) podem apresentar neuropatia autonômica cardíaca (NAC), levando a aumento de mortalidade e morbidade. Nesta revisão, apresentaremos atuais conceitos, características clínicas, diagnóstico, prognóstico e possíveis tratamentos. Novas drogas recentemente desenvolvidas para redução de níveis glicêmicos apresentaram efeito pleiotrópico de redução de morte súbita, sugerindo um potencial uso neste perfil de pacientes.

Efectos renales y nefroprotección inducidos por el inhibidor del SGLT2 Empagliflozina en pacientes con diabetes mellitus: revisión de la literatura / Renal effects and nephroprotection induced by SGLT2 inhibitor Empagliflozin in patients with Diabetes Mellitus: a literature review

La insuficiencia renal es una comorbilidad frecuente en pacientes con diabetes mellitus (DM) e incrementa en ellos el riesgo cardiovascular; la hiperglucemia crónica en pacientes con DM induce una gran cantidad de alteraciones directas e indirectas en la estructura y la función renal, y constituye el principal factor para el desarrollo de la nefropatía diabética y la enfermedad renal terminal. En la presente revisión, se exponen los resultados de los estudios en los que se ha demostrado la alta tolerabilidad de empagliflozina en pacientes diabéticos con insuficiencia renal concomitante en estadios I a III. Empagliflozina, mediante la inhibición de SGLT2, ofrece una terapia novedosa con efectos benéficos no sólo sobre el control glucémico, sino también beneficios cardiovasculares y renales, los cuales han sido demostrados en el estudio EMPA-REG OUTCOME y continúan en evaluación en otros estudios

Chronic kidney disease is a frequent comorbidity in patients with diabetes mellitus (DM) and it increases their cardiovascular risk; chronic hyperglycemia in patients with DM leads to direct and indirect disorders in kidney's structure and function, and it is the principal risk factor for the development of diabetic nephropathy and end-stage renal disease. In the current review, results of studies are exposed in which high tolerability of empagliflozin is exposed in diabetic patients with kidney disease. Empagliflozin by inhibiting SGLT2 provides a novel therapy with benefic effects, not only in glycemic control, but it also has cardiovascular and renal benefits, which they have been demonstrated in the EMPA-REG OUTCOME trial, and continue in evaluation in other studies

First line management of adult diabetic ketoacidosis patients

BackgroundiDiabetic Ketoacidosis [DKA] is a hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. It is a medical emergency with a significant morbidity and mortality. It is however a potentially reversible condition in case an emergency and immediate medical attention, prompt recognition, diagnosis and treatment were provided

Aim of the Study: was to leverage the current research data in order to construct a treatment guideline for diabetic ketoacidosis in the emergency department

Methods:A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL,Embase and the Cochrane Library. Databases using [diabetic ketoacidosis] as a MeSH heading and as textword. High yield journals were also hand searched

Findings: The initial treatment phase aims to restore circulating volume, reduce blood glucose levels, to correct any electrolyte imbalances and to reduce ketone levels which in turn corrects the acidosis. Evidence also showed that there is no need for insulin bolus prior to starting an insulin drip in the treatment of diabetic ketoacidosis. Also, using beta-hydroxybutyrate at presentation can expedite diagnosis and therefore treatment. Implementing treatment guidelines into the emergency department may help expedite diagnosis and treatment

Conclusion: Prompt first line management of DKA is the most critical stage to profoundly reduce morbidity and mortality rates of this potentially fatal crisis. It's therefore crucial to follow the evidence-based guidelines and DKA protocol in the emergency department to expedite diagnosis, guide treatment, and improve continuity of care between the emergency department and the ICU as well as improving the clinical outcomes of patients with DKA. Initially, this will improve outcomes by decreasing the delay until treatment is initiated andprovide a continuum of treatment between the emergency department and the intensive care unit

Furthermore, the healthcare providersmust ensure that they have the ability to provide support and education to people at risk of developing DKA and those that have had an episode of DKA by spreading awareness and education to help reduce both the initial occurrence and recurrence of this often preventable life-threatening condition

Diarrea crónica en el diabético: Una revisión de la literatura / Chronic diarrhea in the diabetic: A review of the literature

Desde hace más de 70 años se conoce la asociación de diarrea con diabetes mellitus. En pacientes diabéticos su prevalencia es de alrededor del 20%. Sus manifestaciones clínicas son diversas, y representa un reto diagnóstico y terapéutico. Existen ciertos diagnósticos de mayor prevalencia en pacientes diabéticos que en la población general. Las distintas etiologías relacionadas pueden ser diagnosticadas adecuadamente a través de la historia clínica y pruebas diagnósticas complementarias. Los medicamentos utilizados por el paciente diabético para el manejo de su enfermedad, frecuentemente causan diarrea crónica, por lo que se debe profundizar en los antecedentes farmacológicos al momento de estudiar la diarrea. Los pacientes diabéticos pueden presentar otras condiciones patológicas asociadas, como enfermedad celíaca o colitis microscópica, cuya molestia única es la diarrea. La función del páncreas exocrino puede estar disminuida en el paciente diabético, frecuentemente llevando a insuficiencia pancreática exocrina. Factores dietarios, como los edulcorantes libres de azúcar y otros agentes, pueden causar diarrea en el paciente diabético. La presencia de condiciones como la neuropatía autonómica y neuropatía periférica secundarias a la diabetes mellitus, pueden explicar desordenes como la disfunción anorrectal y la incontinencia fecal. Finalmente, la enteropatía diabética per se o con sobrecrecimiento bacteriano asociado, puede causar diarrea. Lograr un control glicémico adecuado constituye el pilar del tratamiento de la diarrea en el diabético, después de esto existen medidas adicionales que se aplican según el contexto especifico del paciente. En el presente artículo se revisan las causas de mayor incidencia diarrea en el paciente diabético y los mecanismos fisiopatológicos implicados

The association of diarrhea with diabetes mellitus has been known for more than 70 years. In diabetic patients its prevalence is around 20%.Its clinical manifestations are diverse, and represents a diagnostic and therapeutic challenge.There are certain diagnoses of higher prevalence in diabetic patients than in the general population.The different related etiologies can be adequately diagnosed through the clinical history and complementary diagnostic tests.The medications used by the diabetic patient to manage their disease often cause chronic diarrhea, so the pharmacological background should be studied at the time of the study of diarrhea.Diabetic patients can present other associated pathological conditions, such as celiac disease or microscopic colitis, which only discomfort is diarrhea.Exocrine pancreatic function may be decreased in the diabetic patient, frequently leading to exocrine pancreatic insufficiency. Dietary factors, such as sugar-free sweeteners and other agents, can cause diarrhea in the diabetic patient.The presence of conditions such as autonomic neuropathy and peripheral neuropathy secondary to diabetes mellitus may explain disorders such as anorectal dysfunction and faecal incontinence. Finally, diabetic enteropathy alone or with associated bacterial overgrowth can cause diarrhea.Achieving adequate glycemic control is the pillar of the treatment of diarrhea in the diabetic, after which there are additional measures that are applied according to the specific context of the patient.This article reviews the causes of higher diarrhea incidence in the diabetic patient and the pathophysiological mechanisms involved

Glaucoma neovascular, complicación de la isquemia retiniana / Neovascular glaucoma, a retinal ischemia complication

Introducción: el glaucoma neovascular es un tipo de glaucoma secundario frecuente en los pacientes diabéticos, se produce por la formación de una membrana fibrovascular a nivel del ángulo camerular, como consecuencia de un estímulo angiogénico producido por enfermedades que generan isquemia ocular. Los pacientes con retinopatía diabética proliferativa pueden sufrir esta enfermedad de difícil tratamiento para el oftalmólogo, y que constituye una amenaza para la visión del paciente. Objetivo: revisar aspectos clínicos, patogenia, métodos para el diagnóstico y tratamiento terapéutico del glaucoma neovascular con vistas a prevenir o reducir la pérdida visual. Desarrollo: el glaucoma neovascular es una complicación de la diabetes mellitus y de otras enfermedades generales, que provoca una disminución importante de la visión, y en muchas ocasiones, ceguera. Las enfermedades oculares que con más frecuencia lo producen son la oclusión de la vena central de la retina, la retinopatía diabética proliferativa y el síndrome isquémico ocular, generando isquemia retiniana y coroidea con la consecuente formación de neovasos. Conclusiones: la educación al paciente diabético y el adecuado tratamiento terapéutico de la retinopatía diabética es importante para prevenir la aparición del glaucoma neovascular(AU)

Introduction: neovascular glaucoma is the type of secondary glaucoma common in diabetic patients; it is caused by the formation of fibrovascular membrane at the camerular angle as a result of angiogenic stimulus due to ocular ischemia-generating diseases. The proliferative diabetic retinopathy patients may suffer this difficult-to-treat disease that represents a threat to the vision of a patient. Objective: to review clinical aspects, pathogenenesis, diagnosis methods and treatment of the neovascular glaucoma with a view to preventing or reducing the vision loss. Development: neovascular glaucoma is a complication of diabetes mellitus and of other general diseases, which brings about significant reduction of vision and often blindness. The most frequent eye diseases responsible for this are central retinal vein occlusion, proliferative diabetic retinopathy and ocular ischemic syndrome, leading to retinal and choroid ischemia with resulting formation of neovessels. Conclusions: education aimed at diabetic patient and the adequate therapeutic treatment of the diabetic retinopathy is important to prevent the occurrence of neovascular glaucoma(AU)

Relato de um caso de tratamento homeopático de portadora de gastroparesia diabética / Report of a case of homeopathic treatment of patients with diabetic gastroparesis

O presente trabalho consiste num estudo descritivo baseado em coleta e análise de dados de prontuário. Trata do caso de uma paciente diabética, com gastroparesia internada no Hospital Público Regional de Betim, Minas Gerais. Reconheceu-se, na base da doença, específico desequilíbrio de saúde, susceptível de ser tratado com Silicea terra. Recorreu-se a memória sintética experimental, que compreende timidez, sensibilidade à contradição, conscienciosidade, antecipação, transtornos por separação, acne e intolerância a corpos estranhos. Após dose única do medicamento na diluição 30cH, observaram-se rápida melhora de sensação de doença, processos exonerativos e exercícios de vitalidade. Apesar do ambiente hospitalar enfatizar a paliação da doença, consegue-se demonstrar a efetividade da homeopatia neste nível de atenção médica e de ensino, auxiliando na simplificação terapêutica. Conclui-se que a homeopatia pode integrar o conjunto de alternativas médicas disponíveis para a atenção hospitalar, com finalidades de ensino, e pode auxiliar na simplificação terapêutica, a partir da cura de sensação de doença.

The present is a descriptive study based on collection and analysis of data from medical records. It concerns the case of a diabetic patient with gastroparesis admitted to Public Regional Hospital, Betim, Minas Gerais, Brazil. At the bottom of her disease we detected a specific health imbalance likely to respond to Silicea terra. We had resource to an experimental synthetic memory comprising: timidity; sensitivity to contradiction; consciousness; anticipation; ailments from separation; acne; and intolerance to foreign bodies. Following a single dose of Sil 30cH the patient exhibited fast improvement of her feeling of illness, exoneration symptoms and exercise of vitality. While the hospital setting prioritized the palliation of disease, the effectiveness of homeopathy also in this level of medical care and teaching might be demonstrated, contributing to the simplification of treatment. We conclude that homeopathy can be included among the medical alternatives available for inpatient care and teaching, and that it might contribute to the simplification of treatments based on the cure of the feeling of illness.

Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?

PURPOSE: The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (alpha-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). MATERIALS AND METHODS: A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. RESULTS: Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95+/-2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage. CONCLUSIONS: Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.

Pacientes diabéticos hospitalizados en un servicio de medicina interna: características, causas de hospitalización y control metabólico / Diabetic patients hospitalized in a service of internal medicine: characteristics, reasons of hospitalization and metabolic control

Most of patients that present hyperglycemia during hospitalization still have the condition when they are discharged. A good level of metabolic control for hospitalized patients was set at a glycemic value between 70 and 180 mg/dl, taking into account that no statistics exist for the studied population. Aim: To describe reasons for hospitalization and glycemic control of patients with Diabetes Mellitus (DM) hospitalized in the Internal Medicine UNIT (SMI) of Hospital San Martin of Quillota (HSMQ). Patients and methods: Descriptive study of serial cases that included all patients of the SMI of HSMQ during July and August 2014. The information was obtained by daily census, analysis of nursing data, and interviews with patients. The information included general characteristics of the population and in patient management. Results: Of a total of 353 patients, 55 (15.6 percent) corresponded to diabetic patients, of them 92.7 percent had DM type 2. The average duration of hospitalization for not DM was 7 days where as for the DM it was 13.4 days. The principal reason for hospitalization for DM patients was infection: 23.6 percent (13/55). During hospitalization, most of patients’ care was controlled by means of "sliding scale" (28/55), but the schemes were quite variable, predominantly resulting in normal glycemia (63.8 percent) followed by hyperglycemia (33.7 percent). Conclusion: We found a significant percentage of patients with hyperglycemia and a great variability in the managing of DM in this sample, which indicates the importance of implementing a protocol for managing these cases...

Necrobiosis lipoídica en paciente diabético tipo 1: reporte de un caso / Necrobiosis lipodica in a type 1 diabetic patient: case report

La necrobiosis lipoídica es una enfermedad crónica granulomatosa de la piel de origen desconocido, que se caracteriza por placas inflamatorias amarronadas con bordes indurados y centro atrófico. Dos tercios de los casos se reportan en pacientes diabéticos, con predominio en el sexo femenino. Se describe el caso de una mujer de 18 años de edad con diagnóstico de diabetes tipo 1 de más de 15 años de evolución, en tratamiento con insulina detemir 88 U/día, con inadecuada adherencia al tratamiento y mal control metabólico. Presentó lesiones hipotróficas en cara anterior de ambas piernas (región pretibial derecha y antepié izquierdo), de centro ulcerado, no dolorosas, con bordes indurados, de meses de evolución. Se realizó diagnóstico de necrobiosis lipoídica mediante biopsia de piel. La paciente mejoró con tratamiento local de las lesiones (corticoides intralesionales y antibióticos tópicos) y adecuado control de la glucemia. En la literatura se discuten numerosas opciones de tratamiento, pero no existen recomendaciones terapéuticas firmes basadas en estudios controlados.

Necrobiosis lipoidica is a chronic granulomatous skin disease of unknown origin characterized by inflammatory plaques with indurated edges and brownish atrophic center. Two thirds of cases are reported in diabetic patients, with a predominance in females. The case of a 18-year-old woman with type 1 diabetes for 15 years is described; she was on insulin detemir 88 U/day, with inadequate adherence to treatment and poor metabolic control. She presented painless hypotrophic dermic lesions in the anterior aspect of both legs and in the left forefoot; they had ulcerated center and indurated edges; the evolution was chronic (several months). Diagnosis of necrobiosis lipoidica was made by skin biopsy. The patient improved with local treatment of lesions (intradermic steroids and topical antibiotics) and adequate glycemic control. In the literature many treatment options are discussed, but there are no firm therapeutic recommendations based on controlled studies.

Analysis of treatment of comorbidities and the profile of medical consultations for diabetes mellitus / Análise do tratamento das comorbidades e do perfil de consultas médicas do diabetes mellitus

The scope of this paper was to analyze the profile of medical consultations and drugs used for the treatment of comorbidities in patients with diabetes attended in the Brazilian Unified Health System. This was a pharmaco-epidemiological cross-sectional study conducted between March 2006 and February 2007 All patients with diabetes attended in the western sanitary district of Ribeirao Preto in the state of São Paulo were included in the study. The types of medical attendance (primary, secondary and emergency care) and the drugs prescribed for the treatment of comorbidities were analyzed. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System and 3,198 patients were identified. The mean age was 60.4 years and more than 55% of the patients were 60 years or older. The cardiovascular drugs most used were captopril or enalapril (60%). About 40.6% of the patients used acetylsalicylic acid in platelet antiaggregant doses. The patients had an average of 5.1 medical consultations per year (primary care, secondary care and emergency care). The utilization of statins and acetylsalicylic acid was less than that reported in the literature and the data indicate a high prevalence of admission to emergency care.

Analisar o perfil de consultas médicas e de medicamentos para o tratamento de comorbidades em pacientes com diabetes atendidos no Sistema Único de Saúde. Estudo farmacoepidemiológico e transversal realizado de mar/2006 a fev/2007. Foram incluídos no estudo portadores de diabetes atendidos no Distrito Sanitário Oeste de Ribeirão Preto (SP), sendo analisadas as consultas médicas realizadas na atenção primária, secundária e emergência, além dos medicamentos prescritos para tratamento de comorbidades associadas ao diabetes. Foram identificados 3.198 pacientes, com idade média de 60,4 anos e aproximadamente 55,0% idosos. Os medicamentos do sistema cardiovascular foram os mais prescritos, sendo que 60,0% dos pacientes utilizavam captopril ou enalapril. Além disso, 40,6% dos pacientes faziam uso de ácido acetilsalicílico em dose antiagregante plaquetário. Em relação às consultas médicas, os pacientes apresentaram média de 5,1 visitas ao ano, na atenção primária, na atenção secundária e no atendimento de emergência. A utilização de ácido acetilsalicílico e estatina foram menores do que a relatada na literatura e os dados indicam uma alta prevalência de admissão no atendimento de emergência.

Efecto del extracto acuoso de la raíz de Ruellia Tuberosa L. sobre el daño renal en la diabetes. Papel del estrés oxidativo / Effect of the aqueous extract of the root of Ruellia Tuberosa L. on kidney damage in diabetes. Role of oxidative stress

La diabetes es una de los principales problemas de la salud pública mundial, en parte debido a su asociación con otras enfermedades cardiometabólicas. Las complicaciones tisulares de la diabetes es su principal causa de muerte, siendo la nefropatía diabética la que lidera la lista de daños inducidos por la hiperglicemia crónica. Se conocen varios mediadores celulares de la nefropatía: la angiotensina II, los productos de glicosilación avanzada, las kinasas activadas por mitógenos, las especies reactivas de oxígeno y nitrógeno, entre otras, cuya activación traen como consecuencia el aumento de la síntesis de proteínas de la matriz extracelular, el ensanchamiento del glomérulo, el daño tubular y la fibrosis. Esto se traduce en insuficiencia renal crónica, caracterizada por la proteinuria, el aumento de la diuresis, el desequilibrio electrolítico, el incremento de creatinina plasmática y del nitrógeno ureico en sangre (BUN), los cuales son considerados marcadores clínicos del daño renal en la diabetes. Muchos grupos de investigación están enfocados en la búsqueda de fármacos que sean capaces de abolir, disminuir o prevenir la nefropatía diabética. En el campo de la etnobotánica, la etnomedicina y la etnofarmacología existen diversos estudios que han aportado nuevas especies, fitofármacos y productos naturales para el tratamiento no sólo de la diabetes, sino también de sus complicaciones. Existen alrededor de 1200 plantas antidiabéticas en el mundo. En Venezuela son muy pocas las especies que han sido estudiadas, a pesar que goza de gran biodiversidad vegetal. Ruellia tuberosa L. (yuquilla) es una de estas plantas de uso etnomédico, la cual pertenece a la familia Acanthaceae y está distribuida en todo el país. Las partes aéreas de esta especie han sido estudiadas de manera exhaustiva, encontrándose actividad: antidiabética, antioxidante, antiinflamatoria y analgésica. Sin embargo, su raíz ha sido muy poco estudiada. Recientemente, reportamos la actividad analgésica y antiinflamatoria del extracto acuoso de la raíz de R. tuberosa (RT) en animales de experimentación. Con el fin de validar su uso tradicional como antidiabético y de conocer la capacidad protectora ante las complicaciones de la diabetes, en este trabajo se evaluó el efecto del RT sobre el daño renal en un modelo de ratas con diabetes inducida por la estreptozotocina (ETZ) e in vitro en células de epitelio renal (células Vero) sometidas a altas concentraciones de glucosa. Asimismo, se evaluó la relación de la actividad protectora del RT con su potencial antioxidante y con la inhibición de la vía de señalización de la PKC-NF-κB. Para ello fueron evaluadas las modificaciones de la glicemia, de los marcadores de daño renal, el daño oxidativo renal, el sistema antioxidante renal, la proliferación y muerte de las células de epitelio renal, en los modelos experimentales bajo diferentes condiciones de estrés. Asimismo la expresión del NF-κB inducida por un activador de la PKC (PMA) en células de cáncer de cuello uterino (HeLa), la actividad antioxidante y el contenido de polifenoles del extracto. Los resultados muestran que el RT contiene compuestos polifenólicos y que produce un efecto atrapador del anión superóxido, estableciéndose así su capacidad antioxidante. El RT disminuyó la glicemia, la proteinuria, la diuresis, el BUN la creatinina plasmática y la pérdida de peso en los animales diabéticos; disminuyó el contenido de grupos carbonilos en las proteínas, de malonildialdehido, de proteínas totales en la corteza renal y suprimió el incremento del peso del riñón en las ratas con diabetes inducida por la ETZ; contrarrestó el decremento de la actividad de la CAT, SOD total, CuZn-SOD, GPx y GR inducida por la glucosa in vivo e in vitro; protegió a las células Vero de la glucotoxicidad, del estrés oxidativo y del estrés nitrosativo, inducido por la alta glucosa, por el peróxido de hidrógeno y por el nitroprusiato de sodio respectivamente. Sin embargo, el peróxido, el nitroprusiato así como el PMA disminuyeron el efecto protector del RT sobre la glucotoxicidad. Este extracto previno el incremento de la actividad del NF-κB inducido por el PMA en las células HeLa. Todos estos hallazgos establecen al RT como un antioxidante con efecto protector sobre el daño renal en la diabetes, tanto in vivo como in vitro, a través de un mecanismo que involucra la disminución de la glicemia, del estrés oxidativo, del estrés nitrosativo, y de la vía de señalización de la PKC-NF-kB. Esto aporta, por primera vez, información acerca de los efectos farmacológicos de la especie, a la vez que contribuye tanto a la validación de su uso tradicional como a la caracterización farmacológica de su género, sentado así las bases para el estudio fitoquímico y tecnológico de este potencial fitofármaco.

Manifestações musculoesqueléticas em diabetes mellitus / Musculoskeletal disorders in diabetes mellitus

O diabetes mellitus está associado a uma grande variedade de manifestações musculoesqueléticas. Muitas delas são subclínicas e correlacionadas com tempo de evolução e controle inadequado da doença, e devem ser reconhecidas e adequadamente tratadas, pois sua abordagem melhora a qualidade de vida desses pacientes. Nesta revisão são discutidas as principais manifestações musculoesqueléticas encontradas em diabetes mellitus.

Diabetes mellitus is associated with a great variety of musculoskeletal manifestations, many of which are subclinical and correlated with disease duration and its inadequate control. They should be recognized and treated properly, because their management improves the patients' quality of life. This review discusses the major musculoskeletal manifestations found in diabetes mellitus.

Resultados de la implantación de la cámara no midriática sobre la población diabética / Results of non-mydriatic fundus camera screening in a diabetic population

Objetivo: Determinar el impacto de la implantación de sistemas de cribado de retinopatía diabética (RD) mediante cámara no midriática (CNM) en una población con diabetes mellitus (DBT). Métodos: Estudio prospectivo de 6 años de duración, sobre el cribado oportunístico de una población de 12 801 pacientes con DBT. Resultados: Se revisaron 10 047 pacientes con DBT, un 78.48% de los individuos con DBT censados. En 86 (0.86%) pacientes no se pudo interpretar la imagen y debieron ser referidos a las consultas de oftalmología. Un total de 1 908 pacientes (19%) requirió dilatación pupilar. A los 6 años se detectó RD en 1 410 pacientes, con una incidencia anual del 6.15%; la forma leve fue la más frecuente, con un 77.94% de casos. La incidencia de edema macular diabético fue del 4.84% anual. Se verificó la presencia de otras enfermedades en 995 pacientes (9.91%). Conclusiones: Podemos extraer que el cribado mediante CNM es altamente útil para poder acceder a una gran parte de la población diabética, en especial aquella que acude con escasa frecuencia al oftalmólogo, lo que nos permite diagnosticar un número importante de individuos susceptibles de tratamiento láser para evitar que presenten ceguera.