Achados ao ecocardiograma transtorácico em pacientes hospitalizados com COVID- 19: resultados do registro brasileiro de ecocardiografia durante a pandemia de COVID-19 (ECOVID) / Transthoracic echocardiography findings of hospitalized patients with COVID-19: results from the brazilian echocardiography registry during the COVID-19 Pandemic (ECOVID)

Fundamento: A ecocardiografia transtorácica (ETT) pode desempenhar um papel crucial na avaliação das manifestações cardíacas da COVID-19. Objetivo: Nosso objetivo foi relatar a prevalência das principais anormalidades ecocardiográficas em pacientes hospitalizados com COVID-19. Métodos: Realizou-se estudo observacional multicêntrico prospectivo com pacientes com COVID-19 submetidos a ETT durante a internação. Pacientes com insuficiência cardíaca prévia, doença arterial coronariana ou fibrilação atrial foram classificados como portadores de doença cardiovascular (DCV) prévia. Foram coletados dados clínicos e ecocardiográficos da estrutura e da função cardíaca. Resultados: Avaliamos 310 pacientes com COVID-19, com 62±16 anos de idade, 61% homens, 53% com hipertensão arterial, 33% com diabetes e 23% com DCV prévia. No total, 65% dos pacientes necessitaram de suporte em unidade de terapia intensiva. As alterações ecocardiográficas mais prevalentes foram hipertrofia do ventrículo esquerdo (VE) (29%), hipertensão pulmonar (25%), disfunção sistólida do VE (16,5%), disfunção sistólica do ventrículo direito (VD) (15,9%), disfunção diastólica do VE grau II/III (11%) e alteração da contratilidade regional do VE (11%). Derrame pericárdico foi incomum (7%). Hipertrofia do VE (25 vs. 45%, p=0,001), disfunção sistólica do VE (11 vs. 36%, p<0,001), alterações da contratilidade regional (6 vs. 29%, p<0,001), disfunção diastólica do VE grau II/III (9 vs. 19%, p=0,03) e hipertensão pulmonar (22 vs. 36%, p=0,019) foram menos comuns nos pacientes sem do que com DCV prévia. A disfunção sistólica do VD mostrou-se semelhante em pacientes sem e com DCV prévia (13 vs. 25%, p=0,07). Conclusões: Entre os pacientes hospitalizados com COVID-19, os achados ecocardiográficos anormais foram comuns, porém menos encontrados naqueles sem DCV. A disfunção sistólica do VD pareceu afetar de forma semelhante pacientes com e sem DCV prévia. (AU)

Background: Transthoracic echocardiography (TTE) may play a crucial role in the evaluation of cardiac manifestations of coronavirus disease 2019 (COVID-19). Objective: We aimed to report the prevalence of the main echocardiographic abnormalities of hospitalized COVID-19 patients. Methods: We performed a prospective multicenter observational study in patients with COVID-19 who underwent TTE during hospitalization. Patients with pre-existing heart failure, coronary artery disease, or atrial fibrillation were categorized as having previous cardiovascular disease (CVD). Clinical and echocardiographic data about cardiac structure and function were collected. Results: We evaluated 310 patients with COVID-19 (mean age, 62±16 years; 61% men; 53% with arterial hypertension; 33% with diabetes; and 23% with previous CVD). Overall, 65% of the patients required intensive care unit support. The most prevalent echocardiographic abnormalities were LV hypertrophy (29%), pulmonary hypertension (25%), left ventricular (LV) systolic dysfunction (16.5%), right ventricular (RV) systolic dysfunction (15.9%), grade II/III LV diastolic dysfunction (11%), and LV regional wall motion abnormality (11%). Pericardial effusion was uncommon (7% of cases). LV hypertrophy (25% vs. 45%, p=0.001), LV systolic dysfunction (11% vs. 36%, p<0.001), regional wall motion abnormalities (6% vs. 29%, p<0.001), grade II/III LV diastolic dysfunction (9% vs. 19%, p=0.03), and pulmonary hypertension (22% vs. 36%, p=0.019) were less common in patients without previous CVD. RV systolic dysfunction occurred at similar frequencies in patients with versus without previous CVD (13% vs. 25%, p=0.07). Conclusions: Among patients hospitalized with COVID-19, abnormal echocardiographic findings were common, but less so among those without previous CVD. RV systolic dysfunction appeared to affect similar proportions of patients with versus without previous CVD. (AU)

Historia de la diabetes y embarazo en Cuba después de 1959 / History of diabetes and pregnancy in Cuba after 1959

En 1959 surgió en Cuba lo que se conoce hoy como la Actividad de Diabetes y Embarazo. El objetivo de este informe es describir su origen y desarrollo. Esta labor tuvo su inicio en el Hospital General Calixto García, por quien puede considerarse el pionero en este campo, el Dr. Antonio Márquez Guillén. En 1970, se fundó en el Hospital Ramón González Coro la primera sala hospitalaria destinada a atender específicamente a mujeres embarazadas con diabetes. Esta sala ha estado funcionando bajo la égida del Dr. Lemay Valdés Amador. La atención preconcepcional a la mujer con diabetes se estableció en 1992 en el Instituto Nacional de Endocrinología y uno de sus adeptos más genuinos fue el Dr. Jacinto Lang Prieto. A partir del 2001 la actividad de diabetes y embarazo inició un proceso de consolidación, que tuvo como punto de partida la fundación de un programa nacional y terminó con la realización en 2007 del I Consenso Cubano de Diabetes y Embarazo. El proyecto de colaboración con la Fundación Mundial de la Diabetes, iniciado en el 2007, contribuyó a la extensión de esta actividad a todo el país y a evidenciar los logros de Cuba en la atención de embarazadas diabéticas, lo que motivó que la Federación Internacional de Diabetes nombrara Centro de Excelencia en la atención a la mujer embarazada con Diabetes y Embarazo al Servicio de Diabetes y Embarazo del Hospital Ramón González Coro. Recién en 2017, se realizó el II Consenso Cubano de Diabetes y Embarazo, y se continúa trabajando para mantener los logros alcanzados(AU)

In 1959 arose in Cuba what is known today as the Activity of Diabetes and Pregnancy. The objective of this report is to describe its origin and development. This work had its beginning in General Calixto García Hospital by who can be regarded as a pioneer in this field, Dr. Antonio Márquez Guillén. In 1970, it was founded in Ramón González Coro Hospital the first hospital room designed to attend specifically pregnant women with diabetes. This room has been operated under the aegis of Dr. Lemay Valdés Amador. The preconceptional care to women with diabetes was established in 1992 at the National Institute of Endocrinology and one of its most genuine supporters was Dr. Jacinto Lang Prieto. From 2001, the activity of diabetes and pregnancy began a process of consolidation, which took as its starting point the foundation of a national program and ended with the execution in 2007 of the First Cuban Consensus of Diabetes and Pregnancy. The collaborative project with the World Diabetes Foundation initiated in 2007 contributed to the extension of this activity throughout the country and to demonstrate the achievements of Cuba in the care of pregnant women with diabetes, which prompted that the International Diabetes Federation appointed the service of Diabetes and Pregnancy of Ramón González Coro Hospital as a Center of Excellence in the attention to pregnant women with Diabetes and Pregnancy. Recently in 2017, the Second Cuban Consensus of Diabetes and Pregnancy was carried out, and the work to maintain the achievements continues(AU)

Papel do receptor nuclear PPAR-gamma na redução do número e reatividade de mastócitos observada em animais diabéticos / Role of the peroxisome proliferator-actived receptor (PPAR)-gamma in the reduction of mast cell number and reactivity observed in diabetic animals

O estado diabético está associado à redução no número e ao comprometimento da funcionalidade de mastócitos. A partir disso, este trabalho foi realizado com intuito de investigar o papel do receptor ativado por proliferadores de peroxissomos (PPAR)-gamma na redução do número e reatividade de mastócitos em ratos diabéticos. O efeito da ativação do PPAR-gamma sobre a apoptose dos mastócitos também foi avaliada. A diabetes foi induzida através de uma injeção única de aloxana (40 mg/Kg) em animais que se encontravam em jejum. Após três dias da indução da diabetes, o ligante agonista de PPAR-gamma rosiglitazona (0,5 mg/Kg) e/ou o antagonista específico do mesmo receptor GW9662 (0,5 mg/Kg) foram administrados uma vez ao dia durante 18 dias consecutivos. A taxa de apoptose dos mastócitos e os níveis hormonais foram determinados pela análise da fragmentação de DNA e por radioimunoensaio, respectivamente. O tratamento com rosiglitazona restaurou o número de mastócitos na cavidade torácica e no tecido mesentérico dos ratos diabéticos. Além disso, o tratamento dos animais diabéticos com rosiglitazona restabeleceu a liberação normal de histamina dos mastócitos após estimulação antigênica in vitro, avaliada por fluorimetria. O aumento da apoptose dos mastócitos em animais diabéticos foi inibida com a rosiglitazona. Observamos ainda que o aumento nos níveis circulantes de corticosterona associado com a disfunção mastocitária em ratos diabéticos é sensível ao tratamento com o agonista de PPAR-gamma. Em adição, o bloqueio do receptor PPAR-gamma com GW9662 suprimiu a capacidade da rosiglitazona em normalizar os níveis de glicocorticóides bem como restaurar o número de mastócitos.

Utilizando imunohistoquímicas, constatamos que a ativação do PPAR-gamma no eixo hipotálamo-pituitária-adrenal (HPA) de animais diabéticos reduziu a expressão do receptor do hormônio adrenocorticotrófico (ACTH) MC2-R, bem como do receptor de glicocorticóides (GR), nas adrenais e hipófise, respectivamente, desses animais. Finalmente, nós mostramos que o aumento nos níveis de ACTH no plasma dos animais diabéticos foi reduzido pelo tratamento com rosiglitazona. Como conclusão, nossos achamos mostram que a rosiglitazona restaura o número e reatividade dos mastócitos de animais diabéticos, acompanhado pela redução da apoptose dessas células, em paralelo com a atenuação da elevada secreção de glicocorticóides, indicando que o PPAR-gamma tem um papel importante nesse fenômeno.

Glimpses of the history of insulin.

The discovery of the insulin which took place at Toronto, Canada in 1921-22 is one of the most important medical discoveries of the modern age. For this miracle, Prof. John James Macleod and Frederic Grant Banting were Jointly awarded the Nobel Prize in 1923 for Physiology or Medicine. Frederick Sanger a British biochemist discovered the structure of insulin in 1958 and was awarded Nobel prize for chemistry. Diabetes mellitus is called Madhumeha in ancient Indian Ayurvedic medicine. Egyptians and Greeks knew about it. Greek physician Aretaeus of Capadocia first suggested the term "Diabetes" and described it. Though insulin was discovered about 80 years ago research interest in it still continues unabated. This paper also gives case details of the first patient on whom Insulin was first tried and chronology of research on pancreas and Insulin.

Screening of Madhumehaghna (anti diabetic) plants in Vrihattrayee.

The three texts written by Charak, Sushrut and Vagbhat are considered as Vrihattrayee because of their original contributions to the basic tenants of Ayurveda and innovative uses of plants and medicine. But despite the possibility of exploring efficacious for mulations from among these classics, not much attempts have been made in this direction, due to the fact that now most of them are not in vogue in practice by majority of Ayurvedic physicians. As such, a glossary of plants as described in those texts for the management of prameha including diabetes has been collected which would be useful for studying these drugs from different angles.

Yugi's pramegam and diebetes mellitus: an analogue.

Yugimahamuni was one among the greatest siddhars and has matchless contribution towards enrichment of Siddha system. In his Vaidya Chinthamani-800, he has written clearly about 4448 names of the diseases, its signs, symptoms and prognosis. Under the heading - "Meganoikal," he has elaborated twenty varieties of the urinary disorders based on the physical characters of urine. But the general signs and symptoms of 'Meganoikal' described by Yugi clearly indicate that many of these characteristics are of diabetic in nature. Under the sub-heading 'avasthaikal', Yugi accurately described certain sufferings experienced by the patients of 'Meganoikal'. It is quite interesting to note that those ten types of sufferings he has listed out, starting from obesity ending in Tuberculosis are comparable with the acute and long term complications of diabetics, and hence this analogue.