Glucose metabolism disorders and vestibular manifestations: evaluation through computerized dynamic posturography / Distúrbios do metabolismo da glicose e manifestações vestibulares: avaliação pela posturografia dinâmica computadorizada

ABSTRACT INTRODUCTION: Global sugar consumption has increased in the past 50 years; its abusive intake is responsible for peripheral insulin resistance, which causes the metabolic syndrome - obesity, diabetes mellitus, hypertension, and coronary heart disease. OBJECTIVE: To evaluate the effect of a fractionated diet without glucose as treatment for labyrinthine disorders associated with glucose-insulin index. METHODS: The study design was a prospective randomized controlled trial. Fifty-one patients were divided into two groups: the diet group (DG), which comprised subjects treated with a fractionated diet with glucose restriction, and the control group (CG), in which individuals were not counseled regarding diet. Patients underwent computerized dynamic posturography (CDP) and visual analog scale (VAS) on the first and 30th days of the study. RESULTS: There was improvement in the assessed posturographic conditions and VAS self-assessment in the DG group after 30 days when compared to the control group. CONCLUSION: The fractionated diet with glucose restriction was effective for the treatment of vestibular dysfunction associated with glucose metabolism disorders.

Resumo Introdução: O consumo mundial de açúcar triplicou nos últimos 50 anos e a sua ingesta abusiva é responsável pela resistência periférica à insulina que origina a síndrome metabólica-obesidade, diabetes mellitus, hipertensão arterial e doenças coronarianas. Objetivo: Avaliar de forma objetiva o efeito da dieta fracionada e sem glicose como forma de tratamento dos distúrbios labirínticos associados às alterações da curva glicoinsulinêmica. Método: Trata-se de um ensaio clínico controlado randomizado prospectivo. Estudo realizado com 51 pacientes divididos em dois grupos: Grupo Dieta composto por indivíduos tratados com dieta fracionada com restrição de glicose e Grupo Controle no qual os indivíduos não foram orientados em relação à dieta. Os pacientes realizaram Posturografia Dinâmica Computadorizada e Escala Análogo Visual no primeiro e trigésimo dias do estudo. Resultados: Foi observada melhora nas condições posturográficas avaliadas e melhora clínica do grupo dieta na análise da escala análogo visual quando comparados grupo dieta e grupo controle. Conclusão: A dieta fracionada e restritiva de glicose mostrou-se eficaz no tratamento das disfunções vestibulares associadas aos distúrbios do metabolismo da glicose.

Thyroid volume in patients with glucose metabolism disorders / Volume da tiroide em pacientes com alterações do metabolismo da glicose

Objective Thyroid volume and the prevalence of thyroid nodules are higher in patients with insulin resistance. A relationship between thyroid volume and glucose metabolism disorders (GMD) has not as yet been clarified. The present retrospective study aimed to investigate the association between GMD and thyroid volume. Subjects and methods: We investigated the data of 2,630 patients who were evaluated for thyroid biopsy in our hospital. The study population included 602 patients with GMD, 554 patients with diabetes mellitus (DM) and 1,474 patients with normal glucose metabolism as a control group. We obtained the levels of serum thyroid stimulating hormone (TSH) and the thyroid volumes of those patients retrospectively. Results The median ages for the control group, GMD group and DM group were 55 (15‐91) years, 60 (27‐97) years, and 65 (27‐91) years respectively and there was a statistically significant difference between the groups with regard to age and gender (p<0.001). Levels of TSH were similar in all groups. The median total thyroid volumes for patients with DM and GMD were significantly higher than that of the control group [22.5 (3‐202) mL, 20.2 (4‐190) mL, and 19.2 (3‐168) mL respectively, p≤0.001 for all parameters]. Also the median total thyroid volume for patients with DM was significantly higher than that of the GMD group (p<0.001). According to the correlation analysis, thyroid volume was significantly correlated with age (r=0.92, p<0.001) and TSH (r=0.435, p<0.001). Age, gender, TSH levels, GMD and DM diagnosis were independently correlated with thyroid volume. Conclusion The thyroid gland is one of the target tissues of metabolic disorders. We reported a positive correlation between GMD/type 2 DM and thyroid volume. Further controlled, prospective, randomized studies on this subject are required to gain more information. .

Objetivo O volume da tiroide e a prevalência de nódulos tiroidianos são mais altos em pacientes com resistência à insulina. A relação entre o volume da tiroide e os transtornos do metabolismo da glicose (TMG) ainda não foi elucidada. O objetivo do presente estudo retrospectivo foi investigar a associação entre os TMG e o volume da tiroide. Sujeitos e métodos: Analisamos os dados de 2.630 pacientes que foram avaliados para biópsia de tiroide em nosso hospital. A população estudada incluiu 602 pacientes com TMG, 554 pacientes com diabetes melito (DM) e 1.474 pacientes com metabolismo normal da glicose, como grupo controle. As concentrações de hormônio tireoestimulante (TSH) e os volumes da tiroide para esses pacientes foram obtidos de forma retrospectiva. Resultados As idades medianas para o grupo controle, grupo TMG e grupo DM foram 55 (15‐91), 60 (27‐97) e 65 (27‐91) anos, respectivamente, e houve diferença estatisticamente significativa entre os grupos com relação à idade e ao gênero (p<0,001). Os níveis de TSH foram similares em todos os grupos. A mediana do volume total da tiroide para pacientes com DM e TMG foi significativamente maior do que para os pacientes do grupo controle [22,5 (3‐202) mL, 20,2 (4‐190) mL, e 19,2 (3‐168) mL, respectivamente, p≤0,001 para todos os parâmetros]. Além disso, a mediana do volume total da tiroide para pacientes com DM foi significativamente maior do que no grupo TMG (p<0,001). De acordo com a análise de correlação, o volume da tiroide foi significativamente correlacionado com a idade (r=0,92; p<0,001) e TSH (r=0,435; p<0,001). A idade, o gênero, a concentração de TSH e o diagnóstico de TMG e DM se correlacionaram com o volume da tiroide de forma independente. Conclusão A tiroide ...

Sensação subjetiva do zumbido pré e pós intervenção nutricional em alterações metabólicas / Tinnitus sensation pre and post nutritional intervention in metabolic disorders

BACKGROUND: different etiologies are related to tinnitus including metabolic disorders (blood glucose and lipids). AIM: the aim of this study was compare tinnitus severity by self-report measures pre and post nutritional intervention, using the Tinnitus Handicap Inventory. METHOD: participants of this study were twenty one male and female subjects, with ages ranging from 40 to 82 years. Inclusion criteria involved the presence of tinnitus and metabolic disorder diagnosed by laboratory exams. All subjects were submitted to a nutritional intervention program. Audiological evaluation and the Tinnitus Handicap Inventory were applied pre and post intervention. RESULTS: when comparing the presence of tinnitus pre and post intervention, data analysis indicates statistical difference concerning tinnitus sensation - 71.5 percent of the individuals referred less impact of tinnitus in daily activities. CONCLUSION: an important difference was observed concerning tinnitus influence in subject's life by self-report measures. A direct relation between tinnitus and metabolic disorders in cases related with this symptom was verified.

TEMA: diferentes etiologias estão relacionadas com a presença de zumbido, incluindo doenças metabólicas (glicêmicas e lipídicas). OBJETIVO: comparar o grau de severidade do zumbido por meio de medidas de auto-análise em sujeitos com alterações metabólicas pré e pós-intervenção nutricional, utilizando o Questionário de Gravidade do Zumbido. MÉTODO: vinte e um sujeitos, homens e mulheres, com idade entre 40 e 82 anos, participaram deste estudo. Critérios de inclusão abrangeram a presença de zumbido e de alteração metabólica diagnosticada por meio de exames laboratoriais. Todos os sujeitos foram submetidos a um programa de intervenção nutricional. A avaliação audiológia e o questionário de gravidade de zumbido foram aplicados pré e pós-intervenção. RESULTADOS: comparando os resultados pré e pós-intervenção os dados mostram uma diferença estatisticamente significante com relação à sensação do zumbido em 71,5 por cento dos sujeitos, os quais referiram menor impacto do zumbido nas atividades diárias. CONCLUSÃO: uma importante diferença foi observada com relação à influência do zumbido na vida do sujeito quando utilizadas as medidas de auto-análise. Verificou-se uma relação direta entre zumbido e alterações metabólicas em casos relacionados a estes sintomas.

Síndrome metabólico en niños y adolescentes: [revisión] / Metabolic syndrome in children and adolescents: [review]

La obesidad es uno de los componentes del síndrome metabólico. Este último diagnóstico pudiese implicar en algunos casos mayor riesgo de desarrollo de complicaciones cardio-metabólicas en la edad adulta, más frecuentes en los niños y adolescentes obesos con antecedentes familiares, los cuales mejoran con el manejo adecuado del peso. esta situación constituye un motivo de preocupación para el pediatra, por la mayor probabilidad de persistencia en la edad adulta y porque constituye un factor de riesgo en la aparición de enfermedades crónicas no transmisibles del adulto (ECNT): hipertensión, perfil lipídico anormal, diabetes tipo 2, síndrome metabólico y enfermedad cardiovascular ateroesclerótica. El síndrome metabólico (SM) consiste en la asociación de un conjunto de indicadores antropométricos, bioquímicos y fisiológicos que implican mayor riesgo para el desarrollo de enfermedad cardio-metabólica. Aún existen controversias en cuanto a los criterios diagnósticos y a los valores límite para su clasificación (puntos de corte), la prevalencia es mayor en niños, niñas y adolescentes obesos que en aquellos con peso normal. Esta discrepancia en los criterios ha ocasionado confusión, dificultad al comparar estudios y poblaciones, y para establecer las implicaciones clínicas del síndrome. En el presente artículo se revisan los aspectos epidemiológicos, factores de riesgo, algunos componentes del síndrome (obesidad, dislipidemia, presión arterial alta y resistencia a la insulina) y los criterios actuales para el diagnóstico en niños y adolescentes.

Obesity is one of the components of metabolic syndrome. This diagnosis in some cases may involve greater risk of developing cardiometabolic complications in the adult age, more common in obese children and adolescents with family history, which improve with proper handling of weight. This situation is a matter of concern to the pediatrician for the likelyhood to persist into adulthood and because it constitutes a risk factor of the onset of chronic non-communicable diseases in adults, such as hypertension, abnormal lipid profile, diabetes type 2, metabolic syndrome and atherosclerotic cardiovascular disease. The metabolic syndrome (MS) is the association of a set of anthropometric, biochemical and physiological signs that involve higher risk for developing cardio-metabolic disease. Although there are some controversies regarding the diagnostic criteria and cut-off points, the prevalence is higher in obese children and adolescents than in those with normal weight. This discrepancy in the criteria has caused confusion, difficulty in comparing studies and populations, and also to establish the clinical implications of the syndrome. In this article will review the epidemiological aspects, risk factors, some components of the syndrome (obesity, dyslipidemia, high blood pressure and insulin resistance) and the current criteria for diagnosis in children and adolescents.

Congenital glucose galactose malabsorption complicated with rickets and nephrogenic diabetes insipidus

Congenital Glucose Galactose malabsorption [CGGM] is a rare disorder with limited data from the Arab world. We report the first case of CGGM in Oman. B.S.A two years old female who presented with chronic osmotic diarrhea since birth with hypernatraemic dehydration. B.S was found to have Glucose Galactose Malabsorption based on clinical trial of ORS and elemental formula. Symptoms resolved on introduction of Carbohydrate free formula. The patient developed many complications while on TPN including rickets and nephrogenic diabetes insipidus. These complications have not been reported earlier in CGGM

[Serum iron, hepatic iron deposition, and inflammatory hepatic necrosis/fibrosis in chronic hepatitis C]

We studied the effects of serum iron level, hepatic iron deposition and other metabolic disorders i.e., insulin resistance in hepatic fibrosis development. Among 60 patients with chronic hepatitis C, we measured serum iron, ferritin and transferring level. Meanwhile, hepatic biopsies were obtained from 43 patients for whom iron deposition, inflammatory necrosis/fibrosis score and steatosis were determined. Hepatic iron deposition was significantly associated with waist circumference, ferritin level >200ng/ml, fasting C-peptide >1.9ng/ml, AST/ALT ratio >1, and fasting triglyceride >200mg/dl. On the other hand, it was not correlated with the following: grading, preportal-precital hepatitis [A], necrosis [b], focal lytic necrosis [C], focal apoptosis [C], and portal inflammation [D]. Our findings suggested an interaction between hepatic iron deposition and waist circumference, ferritin, fasting C-peptide, AST/ALT, and fasting triglyceride