Caracterización clínico epidemiológica de la diabetes mellitus tipo 1 en pediatría, Hospital Mario Catarino Rivas / Epidemiological Clinical characterization of diabetes mellitus type 1 in pediatrics, Mario Catarino Rivas Hospital

Antecedentes: Diabetes Mellitus (DM) se consi- dera una enfermedad metabólica con hiperglu- cemia de forma crónica, causada por un déficit parcial o total en la secreción o acción de la in- sulina. El 70-90% de DM1 tienen base autoin- mune. Objetivo: Describir las características clí- nico- epidemiológicas de Diabetes Mellitus I en Pediatría del Hospital Mario Catarino Rivas, San Pedro Sula, Cortés, en el período comprendido entre junio de 2017 - junio de 2019. Pacientes y métodos: Estudio cuantitativo, descriptivo, observacional, realizado en pacientes menores de 18 años que reunieron criterios de inclusión. Los datos se recolectaron mediante encuesta. Re- sultados: El grupo de edad más frecuente fue el escolar de 6-12 años en 49%. Mas frecuente en mujeres en 51%, 29% de los pacientes estudiados presentaron sedentarismo, 17% dislipidemias y sobrepeso, diagnosticadas en el debut de la enfer- medad. Los síntomas más frecuentes fueron po- lifagia en 44%, poliuria en 21%. Conclusiones: Las características socio-demográficas del grupo poblacional estudiado fueron las siguientes, el sexo más afectado fue el femenino y el grupo de edad más frecuente los escolares que se encuen- tran cursando la primaria, la mayoría de los pa- cientes estudiados no presentaban enfermedades asociadas, mientras que solo unos pocos presen- taban sobrepeso y dislipidemias asociado a Dia- betes Mellitus tipo I, se observó un predominio del debut sintomático asociado con la triada de polifagia, polidipsia y poliuria, además visión borrosa y pérdida de peso...(AU)

Síndrome de mano diabetica / Diabetic hand

La diabetes mellitus (DBT) es un desorden metabólico producto de una deficiencia absoluta o relativa de insulina. Este trastorno tiene consecuencias de importancia en varios órganos y sistemas del cuerpo. Es bien conocido que la DBT está asociada con una cantidad de manifestaciones cutáneas y osteoarticulares. La más común de estas características afecta al pie (síndrome de pie diabético); sin embargo, similares lesiones se pueden observar en la mano (síndrome de mano diabética), generalmente asociadas a una larga evolución de la enfermedad, malos controles glicémicos y complicaciones microvasculares. En este artículo se realiza una revisión de la literatura para actualizar el diagnóstico y la terapéutica de manifestaciones musculo-esqueléticas en la mano de pacientes con DBT: movilidad articular limitada, contractura de Dupuytren, tenosinovitis del flexor (dedo en gatillo), infección por síndrome de mano diabética tropical, ulceración neuropática periférica, síndrome del túnel carpiano, neuropatía cubital y neuropatía en piel y uñas.

Diabetes mellitus (DBT) is a metabolic disorder caused by absolute or relative deficiency of insulin. This disorder has importance consequences in various organs and systems. It is well known that DBT is associated with cutaneous and osteoarticular manifestations; the most common of these complications affects the foot (diabetic foot syndrome). However, similar lesions can be observed in the hand (diabetic hand syndrome), usually associated with long standing disease, poor glycemic control and microvascular complications. This article makes a review of the literature to update diagnosis and therapy ofmusculoskeletal manifestations in patients with diabetic hand syndrome: limited joint mobility, Dupuytren’s contracture, trigger finger, tropical diabetic hand, peripheral neuropathic ulceration, carpal tunnel syndrome, cubital neuropathy, and skin and nail changes.

Factors associated with hyperglycemia and low insulin levels in children undergoing cardiac surgery with cardiopulmonary bypass who received a single high dose of methylprednisolone

OBJECTIVES: Administering steroids before cardiopulmonary bypass in pediatric heart surgery modulates systemic inflammatory response syndrome and improves postoperative recovery. However, the use of steroids aggravates hyperglycemia, which is associated with a poor prognosis. Adult patients with systemic inflammatory response syndrome usually evolve with hyperglycemia and high insulin levels, whereas >90% of pediatric patients exhibit hyperglycemia and low insulin levels. This study aims to determine: A) the metabolic and inflammatory factors that are associated with hyperglycemia and low insulin levels in children who underwent cardiac surgery with cardiopulmonary bypass and who received a single high dose of methylprednisolone and B) the best predictors of insulin variation using a mathematical model. METHODS: This preliminary study recruited 20 children who underwent heart surgery with cardiopulmonary bypass and received methylprednisolone (30 mg/kg) immediately after anesthesia. Among the 20 patients initially recruited, one was excluded because of the absence of hyperglycemia and lower insulin levels after surgery. However, these abnormalities were confirmed in the remaining 19 children. The C-peptide, CRP, IL-6, and adrenomedullin levels were measured before surgery, immediately after cardiopulmonary bypass, and on the first, second, and third days after cardiac surgery. RESULTS: IL-6, CRP, and adrenomedullin increments were observed, whereas the C-peptide levels remained within reference intervals. CONCLUSION: The multiple regression model demonstrated that in addition to age and glycemia (two well-known factors that are directly involved in glucose metabolism), adrenomedullin and IL-6 levels were independent factors associated with lower insulin concentrations. These four parameters were responsible for 64.7% of the observed insulin variances. In addition, the fact that C-peptide levels did not fall together with insulin could have grounded the medical decision not to administer insulin to patients.

Lactancia materna en la prevención de la obesidad / Breastfeeding on obesity prevention

El ambiente intrauterino y los primeros años de vida, son fundamentales para la programación de una serie de situaciones en nuestro organismo. Son muchas las teorías que indican que la lactancia materna (LM) puede tener beneficio en la prevención de la obesidad. Esto hace referencia a que la LM posee una serie de componentes hormonales, que favorecen la maduración o la forma de interpretación de ciertas áreas del cerebro, que tienen que ver con los mecanismos de saciedad y hambre. Existen estudios bastante clásicos que demuestran cómo ésta se regula en el niño alimentado con LM, y la impor tancia que el lo representa, en consideración del efecto de la insulina en la formación de tejido adiposo. La variedad metodológica de los estudios sobre LM hace compleja una buena homologación de los resultados, e incluso hasta indicar que la LM es perjudicial. En conclusión, la LM parece disminuir el riesgo de obesidad hacia la vida adulta; sin que los mecanismos biológicos de estas asociaciones estén totalmente definidos; y además del efecto directo de los nutrientes, existen otros mecanismos que podrían explicar esta asociación.

The intrauterine environment and early life are fundamental to programming a series of situations in our body. There are many theories that suggest that breastfeeding (BF) can have benefits in preventing obesity. This refers to the BF has a number of hormonal components that promote maturation or manner of interpretation of certain brain areas, which have to do with the mechanisms of satiety and hunger. There are enough classic studies showing how it is regulated in the BF, and the importance it represents, in consideration of the effect of insulin in adipose tissue formation. The variety methodological studies complicates BF approval good results, and even indicate that the BF is harmful. In conclusion, the BF seems to decrease the risk of obesity into adulthood, but the biological mechanisms of these associations to be fully defined, and in addition to the direct effect of nutrients, there are other mechanisms that could explain this association.

Curso de Reumatologia: aula 2: Importância Clínica da Caquexia Reumatoide / Course of Rheumatology: class 2: Clinical importance of rheumatoid arthistis

A artrite reumatoide é doença autoimune sistêmica de etiologia ainda desconhecida que pode causar destruição de cartilagem e osso. Afeta aproximadamente 1 por cento da população e é duas a três vezes mais frequente nas mulheres do que nos homens. Apesar de agredir predominantemente as articulações, apresenta inúmeras manifestações sistêmicas, entre elas a caquexia - que se manifesta em aproximadamente 66 por cento dos pacientes reumatoides. A caquexia reumatoide é conceituada como perda involuntária de massa celular, predominantemente de músculo esquelético, mas que também ocorre em vísceras e sistema imune. A causa é multifatorial, mas os mecanismos mais importantes são a produção de citocinas, principalmente TNFα e II-1ß, diminuição da ação periférica da insulina e pouca atividade física. Neste artigo discutem-se aspectos relacionados à patogenia, às implicações clínicas e abordagens terapêuticas.

Rheumatoid arthristis is a chronic, systemic, autoimmune disease of unknow etiology that causes destruction of joint cartilage and bone. It affects approximately 1 per cent of the population and predominates among womwn than men. Cachexia, from the Greek "bad condition", generally connotes as state of advanced malnutrition and wasting. However, more recently cachexia has been used to denote the loss of body cell mass which occurs in illness. So rheumatoid cachexia can be defined as an involuntary loss of body cell mass, that predominates in skeletal muscle, and occurs with little or no wegith in the presence of stable or increased fat mass. The etiology is likely multifactorial, and involves excess inflamatory cytokine production, namely excess tumor necrosis factor-α and interleukin-1ß production; reduced peripheral insulin action; and low habitual physical activity. In this article, we evaluate pathogenesis of rheumotoid cachexia, its clinical disclosures and discuss potential therapies.

Insulin 3-like hormone and its role in epididymo-testicular descent

PURPOSE: The role of insulin 3-like (Insl3) hormone signaling in the testicular descent process has been demonstrated. The purpose of the present study was to evaluate epididymal development in Insl3-deficient mice. MATERIALS AND METHODS: Heterozygous and homozygous Insl3 mutants of a mixed CD1 X 129/Sv genetic background were generated by breeding Insl3-/- females with Insl3+/- males, and their genotypes were determined by polymerase chain reaction. On the first postnatal day, newborn males were sacrificed, embedded in paraffin, and cut in 4 µm sections. Sections were stained with hematoxylin/eosin and immunoreacted with anti-± actin antibody. RESULTS: An analysis of stained sections indicated an arrest in the development of the epididymis in all homozygous mice. The cauda and corpus of the epididymis were undersized. Compared to the heterozygous epididymis, the homozygous epididymis had fewer peritubular layers and dwarfish musculature. We confirmed this with immunostaining with monoclonal antibodies against ± -smooth muscle actin. CONCLUSION: Defective development of the smooth musculature in the epididymis of Insl3 homozygous mutant mice, combined with its high intraabdominal undescended position, supports previous observations regarding the importance of intact epididymis morphology and function for descent of the epididymo-testicular unit.

Disfunção autonômica cardiovascular no diabetes mellitus experimental / Cardiovascular autonomic dysfunction in experimental diabetes mellitus

Muitas informações novas têm sido publicadas nos últimos anos a respeito da fisiopatologia da disfunção autonômica cardiovascular em ratos e camundongos diabéticos. Nosso grupo tem estudado o curso temporal das alterações cardiovasculares associadas ao diabetes experimental há alguns anos, obtendo evidências consistentes de grave disautonomia em modelos animais de diabetes. O objetivo deste trabalho foi revisar a contribuição que estudos envolvendo diferentes modelos de deficiência e resistência à insulina têm fornecido para o entendimento, tratamento e prevenção da disfunção autonômica cardiovascular do diabetes.

Much new information has been published in the last few years regarding pathophysiology of cardiovascular autonomic dysfunction in diabetic rats and mice. Our group has been studying the time-course cardiovascular changes associated with experimental diabetes in the last years, and obtained consistent evidences of severe dysautonomia in diabetes animal models. The aim of this manuscript is to review the contribution that studies involving different animal models of insulin deficiency or resistance have given to understand, treat and prevent diabetic cardiovascular autonomic dysfunction.

O manejo da cetoacidose em pacientes com Diabetes Mellitus: subsídios para a prática clínica de enfermagem / Management of diabetic ketoacidosis in Diabetic patients: clinical practice nursing recommendations

A cetoacidose diabética é uma condição aguda e grave que se desenvolve predominantemente em pacientes com Diabetes mellitus do tipo 1 e é induzida pela deficiência relativa ou absoluta de insulina. Ocorre comumente em associação a situações de estresse, que elevam os níveis dos hormônios contra-reguladores e constitui importante emergência clínica, que requer intervenções imediatas e efetivas. Assim, pretende-se, por meio deste artigo, com base na fisiopatologia e nas manifestações clínicas, fornecer subsídios para a prática clínica de enfermagem no manejo da cetoacidose diabética.

Diabetic ketoacidosis is a severeand acute condition in Type 1Diabetes mellitus that is promptedby relative or absolute insulindeficiency. It is frequentlyrelated to stressful situations, inwhich stress hormones are elevated.It is considered a clinicalemergency that requires immediateand effective intervention.This article, based on the physiopathology and the clinical manifestations, aims at providing clinicalpractice nursing recommendationsfor the management ofdiabetic ketoacidosis.

La cetoacidosis diabética es unacondición aguda y grave que sedesarrolla predominantemente enlos pacientes con Diabetes mellitusdel tipo 1 y es inducida por ladeficiencia relativa o absoluta deinsulina. Ocurre generalmenteasociada a situa-ciones de estrés,que elevan los niveles de lashormonas contra-reguladoras,constituyéndose en una importanteemergencia clínica, que requiereintervenciones inmediatasy efectivas. Así, se pretende, pormedio de este artículo, con baseen la fisiopatología y en las manifestaciones clínicas, ofrecer elementos de juicio para la prácticaclínica de enfermería en el manejode la cetoacidosis diabética.

Metabolic emergencies in diabetes.

Hypoglycaemia is the commonest metabolic abnormality faced by diabetic patients on hypoglycaemic therapy including insulin. Diabetic keto-acidosis (DKA) requires prompt diagnosis and all patients arriving emergency with dehydration, shock, coma, severe respiratory difficulty and evidence of any major illness should be tested for capillary blood glucose (CBG) and urinary ketones urgently not to miss DKA. Hyperosmolar non-ketotic state complicates elderly type 2 diabetes with intercurrent infections (respiratory tract infection is commonest) characterised by severe dehydration, severe hyperglycaemia and absence of acidosis and vomiting. Lactic acidosis is extremely rare; may be compounded with comorbidities like tissue hypoxia, septic shock, heart failure--metformin usage inadvertently may precipitate the condition.

Study of some endogenous factors and hormones contributing in the pathogenesis of ketosis in obese versus lean type 2 diabetes mellitus

Diabetic Ketoacidosis [DKA], resulting from severe insulin deficiency, accounts for most hospitalization in type 1 DM. However, the frequency, distinguishing features and pathogenesis of this syndrome in type 2 DM remain to be defined. The study was performed to evaluate the role of some endogenous factors and hormones contributing in the vulnerability of some type 2 DM that developed DKA easily than other. The study was conducted on 80 known type 2 diabetic patients [45 males and 35 females], 48 of them were obese body mass index [BMI] > 30 kg/m[2], admitted to Al-Azhar University Hospitals [emergency department] with manifestations of DKA [group I] from July 2003 to January 2005, and 20 type 2 diabetic patients of the same duration of DM, without history of DKA, [group II] with age and sex matched [12 males and 8 females], 10 of them were obese, as controls. After complete clinical examination and routine laboratory investigations, which confirm the diagnosis of DKA, the following investigations were studied; serum glucagon, C-peptide, glutamic acid decarboxylase antibody [GAD-ab], and C-peptide / glucagon ratio, random blood sugar [RBS], renal and liver function tests, arterial blood gases [bicarbonate and pH], serum electrolyte [sodium, potassium and chloride], lipid profile, CBC, complete urine analysis with special attention to level of ketone bodies Serum levels of glucagon, RBS and urine ketone were significantly higher in-group I than group II, while serum levels of C-peptide, C-peptide / glucagon ratio, sodium, potassium, and bicarbonate were significantly lower in-group I than group II. On the other hand no significant differences in the age, sex, disease duration, GAD abs, lipid profile, blood pH and serum chloride between group I and II. In patients with DKA, the age, disease duration, C-peptide, glucagon and C-peptide / glucagon ratio were significantly lower in lean than obese parents [p<0.05] for all. While serum levels of GAD-abs were significantly higher in lean than obese patients [p<0.05]. Interestingly in patients without DKA, serum levels of C-peptide were significantly lower [p<0.05], while serum levels of GAD-abs were significantly higher in lean than obese patients [p<0.05] and no significant changes in other parameters between them. On the other hand C-peptide correlated negatively with glucagon [r=-650] and GAD abs [r=-684], while serum glucagon correlated positively with GAD-abs [r=644]. It could be concluded that the pathogenesis of ketosis in type 2 diabetes is triggered mainly by deficient endogenous insulin in lean patients [had a criteria of type 1 diabetes such as; younger age of onset of DKA short duration of disease, elevated GAD-abs and low C-peptide / glucagon ratio but still classified as type 2diabetes] and relative increase glucagon level activity in obese patietrts. However, the C-peptide / glucagon ratio is the main denominator or determinant factor for ketosis in type 2 diabetes mellitus

Effects of metformin on spontaneous and clomiphene - induced ovulattion in the polycystic ovary syndrome

The objective of this work was to assess the use of metformin in reducing hyperinsulinemia in order to increase ovulation, whether spontaneously or with the use of clomiphene in obese women with polycystic ovary syndrome. Oral glucose-tolerance tests were done before and after the administration of 500 mg metformin or placebo, 3 times daily for 34 days in 60 obese women with the polycystic ovary syndrome [divided into two equal groups]. Then, women who did not ovulate spontaneously were given 50 mg of clomiphene daily for 5 days while continuing to take metformin or placebo. Serum progesterone was measured on days 35 and 50 and ovulation was presumed to occur if the concentration exceeded 8 ng per milliliter on any of these days. The study concluded that ovulation increased spontaneously and with clomiphene in obese women with polycystic ovary syndrome by decreasing insulin secretion with metformin

Diabetes mellitus: aspectos gerais e neuropatia diabética / Diabetes mellitus: general aspects and diabetic neuropathy

O diabetes mellitus é uma condiçäo patológica caracterizada basicamente por apresentar várias complicaçöes decorrentes de uma disfunçäo branda ou grave do pâncreas, em que este pode sofrer desde um simples mal funcionamento até a perda total de sua capacidade de produçäo de insulina. A ausência de insulina produz alteraçöes no metabolismo dos carboidratos, lipídeos e proteínas. Devido a elevada incidência de pessoas acometidas por diabetes mellitus e o grande grau de acometimento que esta pode ocasionar no organismo, a cada ano surgem várias pesquisas que buscam um maior esclarecimento sobre esta patologia. O presente trabalho teve como objetivo realizar uma revisäo da literatura onde foram abordados aspectos relacionados com as possíveis causas da origem do diabetes mellitus, assim como a fisiopatologia, tipos de diabetes e neuropatia diabética e dentre esta foi enfocada a neuropatia autonômica; como a neuropatia autonômica possui uma larga abrangência, nos detivemos aos distúrbios gastrointestinais.

Hipoinsulinemia em alcoolistas com hepatopatia mínima / Hypoinsulinemia in alcoholics with minimal liver disease

OBJETIVO: Em alcoolistas portadores de lesões hepáticas mínimas avaliar os níveis de glicose e insulina séricas após estímulo com glicose intravenosa. MÉTODOS: Em oito etilistas, portadores de alterações hepáticas mínimas, caracteriza por biópsia hepática, e em 26 controles sadios não-alcoólicos, foram estudados os níveis glicêmicos e insulinêmicos (RIE) nos tempos 1, 3, 5, e 10 minutos após estímulo com glicose intravenosa (0.5g/Kg de peso). RESULTADOS: As médias da insulina sérica dos tempos 1, 3 minutos e resposta integrada total (RIT-10min) após estímulo foram menores no grupo alcoolista em relação ao controle (p < 0,05) apesar de curvas glicêmicas normais. CONCLUSÃO: Etilistas crônicos com lesões hepáticas mínimas, à semelhança do observado anteriormente em etilistas assintomáticos, apresentam níveis diminuídos de insulina sérica, mas com curvas glicêmicas normais, após estímulo com glicose intravenosa, indicando hipofunção de células beta do pâncreas.

Atividade física e metabolismo de proteínas em músculo de ratos diabéticos experimentais / Physical activity and protein metabolism in muscle from experimental diabetic rats

O objetivo deste trabalho foi investigar a influência do exercício físico crônico sobre o metabolismo das proteínas em organismos com deficiência de insulina, utilizando o modelo do "Diabetes Mellitus" experimental em ratos. Foram utilizados ratos machos adultos Wistar, distribuídos em Controle Sedentário (CS), Controle Treinado (CT), Diabético Sedentário (DS) e Diabético Treinado (DT). O diabetes foi induzido por aloxana (30 mg/kg p.c.-i.v.). O treinamento consistiu de nataçäo com sobrecarga equivalente a 2 porcento do peso corporal, a 32 mais ou menos 1 §C, 1h/dia, cinco dias/semana, durante quatro semanas. Ao final do experimento os ratos foram sacrificados por decapitaçäo com coleta de sangue para dosagem de glicose, insulina e hormônio de crescimento (GH) e tecidos para análise de glicogênio, proteínas totais e DNA. O diabetes induziu diminuiçäo nos níveis circulantes de GH (CS = 2,5 mais ou menos 0,3; DS = 1,2 mais ou menos 0,1 ng/ml), nas reservas de glicogênio hepático (CS = 7,4 mais ou menos 0,4; DS = 4,4 mais ou menos 2,6 mg porcento) e muscular (CS = 0,57 mais ou menos 0,03; DS = 0,63 mais ou menos 0,01 mg porcento) no teor de proteínas (CS = 7,16 mais ou menos 1,23; DS = 6,65 mais ou menos 1,0 mg porcento)...

Etiopatogenia do diabetes mellitus do tipo 2 / Etiopathogeny of type 2 diabetes mellitus

O diabetes mellitus do tipo 2, na sua forma habitual, de início tardio, é caracterizado por resistência e deficiência insulínica, que contribuem de maneiras diferentes para a patogenia da doença. A alteração funcional da célula beta se manifesta precocemente, com aumento da relação pró-insulina/insulina. Graus variados de deficiência insulínica (absoluta ou relativa) São observados nos vários grupos étnicos estudados (caucasianos, mexicano-americanos, nipo-americanos, nipo-brasileiros, índios americanos, afro-americanos e asiáticos) onde a grande prevalência do diabetes do tipo 2 está associada à maior ingestão calórica e à redução da atividade física. A obesidade resultante tem um padrão central, visceral-abdominal. Nestas populações, a resistência insulínica é fator inicial e predominante, estanto associada à hiperinsulinemia, e à dislipidemia e ao maior risco de acometimento por doenças cardiovasculares. O papel da obesidade e dos ácidos graxos livres na produção hepática de glicose e na resistência à insulina são abordados, assim como o diagnóstico diferencial com outros tipos de diabetes.

La Dislipidemia en el paciente diabético. Parte I: Bioquímica Patológica / Dyslipidaemia in the diabetic patient. Part I: pathological biochemistry

La hipetrigliceridemia es la dislipidemia más frecuente en el diabético, y la hipercolesterolemia es más frecuente que en las personas no diabéticas. Además, en el diabético se presentan alteraciones estructurales de las lipoproteínas que alteran la función plaquetaria y el sistema inmunológico, todo lo cual tiene en su conjunto un efecto que favorece el proceso aterogénico

Prevalencia de diabetes mellitus no insulinodependiente y factores de riesgo asociados en una población de México, D.F. / Prevalence of non insuline dependent diabetes mellitus and associated risk factors in Mexican population

La diabetes mellitus no insulinodependiente (DMNoID) es una enfermedad crónica, incapacitante, que acorta la esperanza de vida y ocasiona elevados costosos a la comunidad. Su prevalencia varía desde 0 por ciento en Papaú, Nueva Guinea, hasta 34 por ciento en los indios Pima. En México existen pocos estudios sobre prevalencia y se desconoce la fuerza de asociación entre los factores de riesgo conocidos con la ocurrencia de la enfermedad. Se realizó un estudio transversal de prevalencia en 1506 usuarios de una unidad médica de primer nivel; la glicemia capilar se midió con reflectómetro. Se consideraron diabéticos, los sujetos con diagnóstico previo a aquellos con cifras de glicemia capilar iguales o mayores a 200 mg. Se consideró hiperglicemia cuando los valores cayeron entre 121 y 199 mg. La prevalencia global de DMNolD fue de 5.6 por ciento (IC95 por ciento 4.5-6.8), con poca diferencia por sexo. La prevalencia de hiperglicemia fue del 2.9 por ciento (IC 95 por ciento 2.0-3.7)