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Article in Korean | WPRIM (Western Pacific) | ID: wprim-811256


PURPOSE: Diabetic nephropathy is one of the most important diabetic complications prompted by chronic hyperglycemia, characterized by glomerulosclerosis, tubular fibrosis, and it eventually causes kidney failure. Nobiletin is a polymethoxyflavone present in tangerine and other citrus peels, and has anti-cancer and anti-inflammatory effects. This study investigated the effects of nobiletin on glomerular fibrosis through inhibition of the transforming growth factor (TGF)-β1-Src-caveolin-1 pathway.METHODS: Human renal mesangial cells (HRMC) were incubated in media containing 33 mM glucose with or without 1–20 uM nobiletin for 3 day. The cellular expression levels of fibrogenic collagen IV, fibronectin, connective tissue growth factor (CTGF), TGF-β1, Src and caveolin-1 were all examined. In addition, TGF-β1, Src and caveolin-1 proteins were screened to reveal the relationship among TGF-β1-Src-caveolin-1 signaling in glomerular fibrosis.RESULTS: High glucose promoted the production of collagen IV, fibronectin and CTGF in HRMC, which was inhibited in a dose dependent manner by 1–20 uM nobiletin. The Western blot data showed that high glucose elevated the expression of TGF-β1, Src, caveolin-1 and Rho GTPase. When nobiletin was treated to the HRMC exposed to high glucose, the expression of TGF-β1-Src-caveolin-1 was dampened. Finally, TGF-β1-Src-caveolin-1 signaling pathway was activated in high glucose-exposed HRMC, and such activation was encumbered by nobiletin.CONCLUSION: These result demonstrated that nobiletin blunted high glucose-induced extracellular matrix accumulation via inhibition of the TGF-β1-Src-caveolin-1 related intracellular signaling pathway. Nobiletin may be a potent renoprotective agent to counteract diabetes-associated glomerular fibrosis that leads to kidney failure.

Blotting, Western , Caveolin 1 , Citrus , Collagen , Connective Tissue Growth Factor , Diabetes Complications , Diabetic Nephropathies , Extracellular Matrix , Fibronectins , Fibrosis , Glucose , GTP Phosphohydrolases , Humans , Hyperglycemia , Mesangial Cells , Renal Insufficiency , Transforming Growth Factors
An. bras. dermatol ; 94(6): 691-697, Nov.-Dec. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1054897


Abstract Background: Different strategies have been proposed for the cardiovascular risk management of patients with psoriasis. Objective: To estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy. Methods: A retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed. Results: A total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1-27.0%) and 1.9% (IQR 0.4-5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively. Study limitations: This was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis. Conclusion: This population with psoriasis was mostly classified at moderate-high risk and the statin therapy indication was similar when applying the two strategies evaluated.

Humans , Male , Female , Adult , Middle Aged , Aged , Psoriasis/prevention & control , Cardiovascular Diseases/prevention & control , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Anticholesteremic Agents/therapeutic use , Psoriasis/complications , Triglycerides/blood , Cardiovascular Diseases/etiology , Sex Factors , Cholesterol/blood , Retrospective Studies , Risk Factors , Practice Guidelines as Topic , Risk Assessment , Diabetes Complications
Nursing (Säo Paulo) ; 22(257): 3226-3233, out.2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1026097


Objetivo: analisar a taxa de internação por Diabetes mellitus no Pará. Método: Estudo analítico, de abordagem quantitativo. Os dados das internações hospitalares do período de 2008 a 2017 foram extraídos do Sistema de Informação Hospitalar do Sistema Único de Saúde, por meio do programa Tabwin. Para análise foram utilizados os programas Bioestat, Tabwin e Excel. Resultados: Foram registradas 53.954 internações e 1.950 óbitos ocorridos durante a internação pela doença. O maior risco de óbito na internação pela doença foi associado aos homens, pessoas com idade acima de 70 anos, e nas complicações agudas e de longo prazo. A taxa de internação ao longo de todo o período foi crescente nas Regiões de Saúde do Marajó I, II e Araguaia. Conclusão: Houve um crescimento das taxas de internação e mortalidade durante a internação por Diabetes Mellitus até o ano de 2015 no Pará e variação entre as regiões de saúde.(AU)

Objective: analyze the hospitalization rate for Diabetes mellitus in Pará. Method: Analytical study, with a quantitative approach. Data from hospital admissions from 2008 to 2017 were extracted from the Hospital Information System of the Unified Health System, through the Tabwin program. For the analysis, the programs Bioestat, Tabwin and Excel were used. Results: There were 53,954 hospitalizations and 1,950 deaths during hospitalization. The highest risk of death in hospitalization for the disease was associated with men, people over 70 years of age, and in acute and long-term complications. The hospitalization rate throughout the period was increasing in the Health Regions of Marajó I, II and Araguaia. Conclusion: There was an increase in hospitalization rates and mortality during hospitalization for Diabetes mellitus up to 2015 in Pará and variation among health regions.(AU)

Objetivo: analizar la tasa de internación por Diabetes mellitus en Pará. Método: Estudio analítico, de abordaje cuantitativo. Los datos de las internaciones hospitalarias del período de 2008 a 2017 fueron extraídos del Sistema de Información Hospitalaria del Sistema Único de Salud, a través del programa Tabwin. Para el análisis se utilizaron los programas Bioestat, Tabwin y Excel. Resultados: Se registraron 53.954 internaciones y 1.950 muertes ocurridas durante la internación por la enfermedad. El mayor riesgo de muerte en la internación por la enfermedad fue asociado a los hombres, personas mayores de 70 años, y en las complicaciones agudas ya largo plazo. La tasa de internación a lo largo de todo el período fue creciente en las Regiones de Salud del Marajó I, II y Araguaia. Conclusión: Hubo un crecimiento de las tasas de internación y mortalidad durante la internación por Diabetes Mellitus hasta el año 2015 en Pará y variación entre las regiones de salud.(AU)

Humans , Risk Factors , Diabetes Complications , Diabetes Mellitus/mortality , Hospitalization
Rev. chil. endocrinol. diabetes ; 12(3): 170-174, jul. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1006512


Objetivo: El objetivo del estudio fue describir las características y evolución de los pacientes que acudieron a las urgencias de nuestro hospital y fueron diagnosticados de cetoacidosis diabética (CAD) utilizando la novedosa herramienta de Big Data Savana. Método: Estudio retrospectivo descriptivo de los pacientes atendidos en urgencias del Hospital Universitario Infanta Leonor durante los años 2011 al 2016 con diagnóstico de CAD. La búsqueda se realizó con Savana Manager. Resultados: Se diagnosticaron 95 episodios de CAD en 68 pacientes. Del total de episodios de CAD, 57 fueron en diabéticos tipo 1 (de ellos 4 LADA), 25 en diabéticos tipo 2, 2 en diabéticos postpancreatectomía y 12 fueron debuts diabéticos. Del total, 61 (64,2%) requirieron ingreso hospitalario, de ellos 23 (24,2%) ingresaron en UCI. La media de HbA1c fue de 10,6 ± 2,1%. Tres pacientes requirieron reingreso tras el alta. La mortalidad fue muy baja con el fallecimiento en 1 paciente diagnosticado simultáneamente de cáncer pulmonar. Los desencadenantes de la CAD fueron: 35 casos (36,8%) falta de adherencia al tratamiento, 31 (32,6%) infecciones, 12 (12,6%) debuts, 8 (8,4%) varias causas y 9 (9,5%) no se pudo determinar la causa. Se clasificaron como CAD de gravedad leve un 28%, un 38% como de gravedad moderada y 34% como graves. La duración del ingreso no se relacionó con la severidad de la cetoacidosis. Conclusiones: La CAD es una complicación grave que afecta tanto a diabéticos tipo 1 como a tipo 2 con elevado porcentaje de ingresos hospitalarios y en UCI, aunque con baja mortalidad en nuestro medio. La duración de los ingresos no se relaciona con la severidad del cuadro.

Objective: the study was designed to describe the clinical features and evolution of the diabetic patients attended in our hospital emergency department with diabetic ketoacidosis (DKA) using the novel Big Data tool Savana. Method: Retrospective descriptive study of the patients attended in the emergency room of the Infanta Leonor University Hospital during the years 2011 to 2016 with diagnosis of CAD. The search was made with Savana. Results: 95 episodes of DKA were diagnosed in 68 patients. Of the total episodes of CAD 57 were in type 1 diabetics (of which 4 were LADA), 25 in type 2 diabetics, 2 in diabetics postpancreatectomy and 12 were new onset of diabetes. Of the total, 61 (64.2%) required hospital admission, of which 23 (24.2%) were admitted to the intensive care unit (ICU). The mean HbA1c was 10.6 ± 2.1%. Three patients required readmission after discharge. Mortality was very low with death in 1 patient simultaneously diagnosed of lung cancer. The triggers of CAD were: 35 cases (36,8%) lack of adherence to treatment, 31 (32.6%) infections, 12 (12.6%) new onset, 8 (8,4%) various causes and 9 (9.5%) the cause could not be determined. They were classified as mild DKA 28%, 38% as moderate and 34% as severe. The duration of admission was not related to the severity of ketoacidosis. Conclusions: DKA is a serious complication that affects both, type 1 and type 2 diabetics patients, with a high percentage of hospital and ICU admissions, although with low mortality in our environment. The lenght of the stay in hospital is not related to the severity of the DKA.

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Diabetic Ketoacidosis/epidemiology , Diabetes Complications/epidemiology , Spain/epidemiology , Medical Informatics , Epidemiology, Descriptive , Retrospective Studies , Diabetic Ketoacidosis/etiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Emergency Service, Hospital , Hyperglycemia/complications , Hyperglycemia/epidemiology
Rev. cuba. angiol. cir. vasc ; 20(1)ene.-jun. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-991044


Introducción: Las cirugías arteriales en los pacientes diabéticos permiten disminuir las frecuencias de amputaciones que se realizan en estos pacientes. Objetivo: Exponer los principales tipos de cirugías arteriales en los miembros inferiores que se realizan en pacientes diabéticos y sus resultados. Métodos: Estudio de búsqueda y síntesis bibliográfica en el que consultaron y tamizaron 162 documentos (artículos, registros médicos y tesis) publicados en las bases de datos de sistemas referativos MEDLINE, PubMed y SciELO e indexadas en la Web of Sciencies, Scopus, Redalyc y Latindex, con la utilización de descriptores: cirugía revascularizadora, permeabilidad arterial, pie diabético, cirugía endovascular, endarterectomía, angioplastia transluminal percutánea. Esto generó que se seleccionara 43 artículos y tres registros médicos. Resultados: La técnica en la revascularización del sector aortoiliaco incluye la cirugía derivativa anatómica [by-passaorto-femoral (bi o uni)]y la extraanatómica [by-pass (axilo-femoral, fémoro-femoral), la endarterectomía y la cirugía endovascular en el sector iliaco. Las técnicas quirúrgicas a aplicar en el sector femoropoplíteo y distal son el by-pass secuencial, endarterectomía, simpatectomía, tratamiento endovascular. Es importante tener en cuenta las características de los pacientes por separado para la decisión del tipo de cirugía. Conclusiones: Las cirugías arteriales en el paciente diabético son diversas y para su éxito es necesario valorar siempre el riesgo quirúrgico y la anatomía de las lesiones de cada paciente(AU)

Introduction: Arterial surgeries in diabetic patients allow reducing the frequency of amputations that are performed in these patients. Objective: To show the main types of arterial surgery in the lower limbs performed in diabetic patients and their results. Methods: Bibliographic search and synthesis study in which 162 materials (articles, medical records and theses) published in the MEDLINE, PubMed and SciELO reference databases were searched and indexed in the Web of Sciencies, Scopus, Redalyc and Latindex, using as descriptors: revascularization surgery, arterial permeability, diabetic foot, endovascular surgery, endarterectomy, percutaneous transluminal angioplasty. This led to the quoting of 43 articles and three medical records. Results: The technique in the revascularization of the aorto iliac sector includes the anatomical derivative surgery [aorto-femoral by-pass (bi or uni)] and extra-anatomical [by-pass (axillo-femoral, femoro-femoral), endarterectomy and endovascular surgery in the iliac sector. The surgical techniques to be applied in the femoro popliteal and distal sectors are the sequential by-pass, endarterectomy, sympathectomy, and endovascular treatment. It is important to consider the characteristics of patients separately to decide the type of surgery. Conclusions: The arterial surgeries in the diabetic patient are diverse and for the success of them it is necessary to always assess the surgical risk and the anatomy of the lesions of each patient(AU)

Humans , Capillary Permeability , Diabetes Complications , Peripheral Arterial Disease/surgery , Peripheral Arterial Disease/epidemiology , Cuba
Managua; s.n; jun. 2019. 81 p. ilus, tab, graf.
Thesis in Spanish | LILACS (Americas) | ID: biblio-1015445


OBJETIVO: Determinar los conocimientos, actitudes y prácticas, con respecto a la RD, de los pacientes diabéticos, que acuden a la consulta oftalmológica en el CENAO, Managua, Nicaragua, Febrero 2019. METODOLOGÍA: Estudio descriptivo transversal a través de una encuesta CAP. Esta se basaba en las siguientes agrupaciones de datos: características sociodemográficas, características clínicas, conocimientos, actitudes y prácticas. Participaron 47 pacientes diabéticos mayores de 18 años que asistieron a la consulta oftalmológica en el CENAO durante el tiempo de investigación. RESULTADOS: El 76,6% (36) de los pacientes eran mayores de 50 años, El 47% (22) no sabían el tipo de diabetes que padecían y el 70,2% (33) aún no tenían RD. El 94% (44) de los pacientes tenían buenas actitudes, el 63% (30) tenían buenas prácticas y solamente el 5% (3) tenían buenos conocimientos sobre la RD. CONCLUSIONES: La mayoría de los pacientes diabéticos no solamente tenían buenas actitudes con respecto al chequeo ocular anual y a la importancia de visitar a un oftalmólogo en caso de que sea necesario, sino que también tenían buenas prácticas con respecto a este tema. No obstante, la gran mayoría de los pacientes diabéticos tenían un nivel de conocimientos, sobre la RD, que se considera deficiente. Esto permitió la existencia de una discrepancia significativa entre el nivel de conocimientos, las actitudes y las prácticas, con respecto a la RD, de los pacientes diabéticos

Humans , Ophthalmology , Diabetes Complications , Diabetes Mellitus , Diabetic Retinopathy , Epidemiology, Descriptive , Health Administration
J. bras. nefrol ; 41(2): 176-184, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012539


Abstract Introduction: The aim of the study was to report the implementation of a functional network for the early diagnosis of chronic kidney disease (CKD) in patients with risk factors and the coordinated work between primary and specialized care in social security in Perú. Material and methods: A cross-sectional analysis of the data of patients evaluated in a health network in the city of Lima (2013 to 2016), older than 18 years, with risk factors for CKD, evaluated with serum creatinine and creatine albumin ratio in random urine (ACR). A multivariate logistic regression analysis was performed to evaluate the factors associated with the finding of CKD. Results: The implementation included training in renal health, installation of a digital database, organization of laboratories, and empowerment of primary care. We evaluated 42,746 patients of which 41.8% were men, with median age 69.2 years. The most frequent cause of detection was hypertension (HBP): 23,921 (55.9%). The prevalence of CKD was 12,132 (28.4%), the most frequent stage of CKD was 3a: 4735 (39.0%). Of the total, 6214 (14.5%) patients had microalbuminuria and 1335 (3.1%), macroalbuminuria. The risk of CKD increased 2.5 times (95% CI: 2.3-2.7) in patients with diabetes (DM) and HBP, in men (OR 1.2, 95% CI: 1.2-1.3) and as age increased (> 77 years: OR 2.7, 95% CI: 2.5-2.8). The identification of the disease in the primary care setting is 60% less likely than in specialized care. Conclusions: One of every four patients are diagnosed with CKD, and the simultaneous diagnosis of DM and HBP and old age are the most important factors.

Resumo Introdução: O objetivo do presente estudo foi descrever a implementação de uma rede funcional para o diagnóstico precoce de doença renal crônica (DRC) em pacientes com fatores de risco e o coordenar os trabalhos entre atenção primária e especializada no sistema de seguridade social peruano. Material e métodos: Análise transversal dos dados de pacientes maiores de 18 anos com fatores de risco para DRC avaliados em uma rede de saúde na cidade de Lima (2013 a 2016) por meio de creatinina sérica e relação albumina/creatinina (RAC) em amostra aleatória de urina. Análise de regressão logística multivariada foi executada para avaliar os fatores associados à presença de DRC. Resultados: A implementação incluiu treinamento em saúde renal, instalação de um banco de dados digital, organização de laboratórios e empoderamento da atenção primária. Foram avaliados 42.746 pacientes, dos quais 41,8% eram homens, com idade mediana de 69,2 anos. A causa mais comum de detecção foi hipertensão, observada em 23.921 indivíduos (55,9%). A prevalência de DRC foi de 12.132 (28,4%), com estágio 3A sendo o mais frequente com 4735 casos (39,0%). Do total, 6214 (14,5%) pacientes apresentavam microalbuminúria e 1335 (3,1%) macroalbuminúria. O risco de DRC foi 2,5 vezes maior (IC 95%: 2,3-2,7) nos pacientes com diabetes e hipertensão, em homens (OR 1,2, IC 95%: 1,2-1,3) e idosos (> 77 anos: OR 2,7, IC 95%: 2,5-2,8). A identificação da doença no cenário da atenção primária é 60% menos provável do que na atenção especializada. Conclusões: Um em cada quatro pacientes é diagnosticado com DRC. Idade avançada e diagnóstico simultâneo de DM e hipertensão são os fatores mais relevantes.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Primary Health Care , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Ambulatory Care Facilities , Peru/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Creatinine/blood , Early Diagnosis , Diabetes Complications , Albuminuria , Renal Insufficiency, Chronic/etiology , Hypertension/complications
ABCS health sci ; 44(1): 75-79, 02 maio 2019. tab
Article in English | LILACS (Americas) | ID: biblio-995057


INTRODUCTION: Tropical pyomyositis is an infectious disease that affects skeletal muscle and may appear as a diffuse inflammation or a rapidly progressive myonecrotic process. The predisposition of this disease in diabetics is already mentioned in several studies. The pathogenesis is possibly related to changes in neutrophils and the reversal of the immune response pattern that occurs in situations such as parasitic diseases. Staphylococcus aureus is the most common microorganism, accounting for 90% of cases of tropical pyomyositis. The diagnosis is sometimes late because patients usually do not seek care by the first symptoms, and because it is a rare disease and physicians are not very familiar with it. CASE REPORT: A 42-year-old male patient with diabetes mellitus, hypothyroidism, anemia, thrombocytopenia, and hypoalbuminemia developed tropical pyomyositis with multiple muscle abscesses in quadriceps, soleus and anterior tibial, triceps and biceps brachialis and pronator round, requiring prolonged antibiotic therapy and surgical drainage. CONCLUSION: Pyomyositis is a little known disease and if not diagnosed early can be fatal.

INTRODUÇÃO: A piomiosite tropical é uma doença infecciosa que afeta o músculo esquelético, aparecendo como uma inflamação difusa ou um processo mionecrótico rapidamente progressivo. A predisposição desta enfermidade em diabéticos já é referida em vários estudos. A patogênese possivelmente está relacionada a alterações nos neutrófilos e na inversão do padrão de resposta imune que acontece em situações como parasitoses. Staphylococcus aureus é o microorganismo mais comum, representando 90% dos casos de piomiosite tropical. O diagnóstico pode ser tardio porque os pacientes geralmente não buscam cuidados com os primeiros sintomas e, por ser uma doença rara, pode surpreender um médico ainda não familiarizado com esta entidade clínica. RELATO DE CASO: Paciente do sexo masculino com 42 anos de idade com diabetes mellitus, hipotireoidismo, anemia, trombocitopenia e hipoalbuminemia que desenvolveu piomiosite tropical com múltiplos abscessos musculares em quadríceps, sóleo e tibial anterior, tríceps e bíceps braquial e pronador redondo, necessitando de antibioticoterapia prolongada e drenagem cirúrgica. CONCLUSÃO: A piomiosite não é uma doença bem conhecida e pode ser fatal se não for diagnosticada precocemente.

Humans , Male , Adult , Diabetes Complications/microbiology , Pyomyositis/microbiology , Staphylococcal Infections , Abscess
J. bras. nefrol ; 41(1): 48-54, Jan.-Mar. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1002416


ABSTRACT Aim: To determine the prevalence of chronic kidney disease (CKD) and the epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients. Methods: Cross-sectional study. We included 274 patients with HIV/AIDS. CKD was defined by the estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2 assessed by CKD-EPI) and albuminuria criteria from KDIGO guidelines. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without CKD. The factors associated with CKD were assessed by logistic regression analysis. Results: The mean age was 41±11 years, and 72.3% of the patients were men. The global prevalence of CKD was 11.7% (n = 32); 7.2% (n = 20) were defined by eGFR criterion; 7.6% (n = 21), by the albuminuria criterion; and 3.2% (n = 9), by both CKD criteria. The most frequently observed stages of CKD were KDIGO G3A1 stage with 4.7% (n = 13), KDIGO G1A2 stage with 3.6% (n = 10) and KDIGO G3A2 stage with 1.7% (n = 5). The factors associated with CKD were use of abacavir/lamivudine (OR 3.2; 95% CI 1.1-8.9; p = 0.03), a CD4 lymphocyte count < 400 cells/µL (OR 2.6; 95% 1.03-6.4, p = 0.04), age (OR 1.1; 95% CI 1.04-1.2, p = 0.001) and albuminuria (OR 19.98; 95% CI: 5.5-72.2; p < 0.001). Conclusions: CKD was a frequent complication in HIV-infected patients. These findings confirm the importance of screening and the early detection of CKD, as well as the importance of identifying and treating traditional and non-traditional risk factors associated with CKD.

RESUMO Objetivo: Determinar a prevalência de doença renal crônica (DRC) e os fatores epidemiológicos, clínicos e laboratoriais associados à DRC em pacientes mexicanos infectados pelo HIV. Métodos: Estudo transversal. Incluímos 274 pacientes com HIV/AIDS. A DRC foi definida pela taxa de filtração glomerular estimada (TFGe < 60 mL/min/1,73 m2, avaliada pelo CKD-EPI) e pelos critérios de albuminúria das diretrizes do KDIGO. As características clínicas, epidemiológicas e laboratoriais foram comparadas entre pacientes com e sem DRC. Os fatores associados à DRC foram avaliados por análise de regressão logística. Resultados: A média da idade foi de 41 ± 11 anos e 72,3% dos pacientes eram homens. A prevalência global de DRC foi de 11,7% (n = 32); 7,2% (n = 20) foram definidos pelo critério TFGe; 7,6% (n = 21), pelo critério da albuminúria; e 3,2% (n = 9), pelos dois critérios para DRC. Os estágios mais frequentemente observados da DRC foram o estágio KDIGO G3A1 com 4,7% (n = 13); estágio KDIGO G1A2 com 3,6% (n = 10) e estágio KDIGO G3A2 com 1,7% (n = 5). Os fatores associados à DRC foram o uso de abacavir/lamivudina (OR 3,2; IC95% 1,1-8,9; p = 0,03), contagem de linfócitos CD4 < 400 células/µL (OR 2,6; 95% 1,03-6,4, p = 0,04), idade (OR 1,1; IC95% 1,04-1,2, p = 0,001) e albuminúria (OR 19,98; IC95%: 5,5-72,2; p < 0,001). Conclusões: A DRC foi uma complicação frequente em pacientes infectados pelo HIV. Esses achados confirmam a importância do rastreamento e da detecção precoce da DRC, bem como a importância de identificar e tratar os fatores de risco tradicionais e não tradicionais associados à DRC.

Humans , Male , Female , Adult , Middle Aged , HIV Infections/complications , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/epidemiology , Dideoxynucleosides/adverse effects , Logistic Models , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Age Factors , CD4 Lymphocyte Count , Lamivudine/adverse effects , Anti-HIV Agents/adverse effects , Diabetes Complications , Albuminuria , Glomerular Filtration Rate , Hypertension/complications , Mexico/epidemiology
Rev. salud pública ; 21(1): 89-93, ene.-feb. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1058871


RESUMEN Objetivo Evaluar la autopercepción del estado de salud (APES) de los pensionados por complicaciones de la diabetes mellitus, y que características sociodemográficas, familiares, laborales y clínicas de éstos están asociadas a dichas variables. Métodos Estudio transversal analítico en un universo 240 pensionados que aceptaron participar. Se evaluó la APES con el Cuestionario EuroQol-5D en español, y se incluyeron variables sociodemográficas, familiares, laborales y clínicas. Resultados Se estudiaron 240 pensionados con edad media 53,43 ± 8,16 años, 94,3% masculinos y 5,7% femeninos. Se encontró que el 53,4% refiere una APES regular, mala o muy mala. Se halló asociación significativa entre mala APES y vida laboral ≤30 años OR=6,00 (IC95% 1,27, 28,26) e insuficiencia renal crónica OR=7,00 (IC95% 1,39,35,35). No se encontraron modelos explicativos mediante regresión logística. Conclusiones La frecuencia de APES mala fue elevada en la muestra de pensionados por complicaciones de la diabetes mellitus. Se requieren estudios con muestras más amplias para mejores conclusiones.(AU)

ABSTRACT Objective To evaluate self-perception of health status (APES by its Spanish acronym) of people retired due to complications of diabetes mellitus, and what socio-demographic, family, work and clinical characteristics are associated to these variables. Materials and Methods Analytical, cross-sectional study in a universe of 240 pensioners who agreed to participate. The APES was evaluated with the EuroQol-5D questionnaire in Spanish, and socio-demographic, family, work and clinical variables were included. Results 240 pensioners with a mean age of 53.43 ± 8.16 years (94.29% male and 5.71% female) were studied. It was found that 53.4% reported regular, poor or very poor APES. A significant association between poor APES and work life ≤30 years (OR=6.00; 95%CI: 1.27, 28.26) and chronic renal failure (OR=7.00; 95%CI: 1.39, 35.35) was found. No explanatory models were found through logistic regression. No explanatory models were found by logistic regression. Conclusion The frequency of poor APES was high in the sample of patients with diabetes. Studies with larger samples are required for better conclusions.(AU)

Humans , Quality of Life , Health Status , Insurance, Disability/statistics & numerical data , Diabetes Complications/epidemiology , Cross-Sectional Studies/instrumentation , Analytical Epidemiology
REME rev. min. enferm ; 23: e-1186, jan.2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1008366


Objetivo: apreender o conhecimento de professores sobre o diabetes mellitus e seu manejo no ambiente escolar. Métodos: estudo exploratório qualitativo que utilizou como base conceitual o Programa Saúde na Escola. Os dados foram coletados no período de outubro a dezembro de 2016, com 31 professores do ensino fundamental, utilizando um roteiro com questões abertas e subjetivas, que foram submetidas à análise de conteúdo. Resultados: emergiram duas categorias ­ conhecimento limitado sobre a doença e cuidados preventivos adotados e limitações na identificação e manejo de descompensações glicêmicas. Os professores reconhecem a importância de capacitação nessa área e de uma boa comunicação dos familiares com os profissionais da educação para melhor cuidado da criança no ambiente escolar. Conclusão: numerosos são os desafios no cuidado às crianças com diabetes mellitus no contexto escolar, sendo necessário repensar ações articuladas entre família, escola e o setor saúde.(AU)

Objective: to seize the knowledge of teachers about diabetes mellitus and its management in the school environment. Methods: exploratory and qualitative study that used the Brazilian Programa Saúde na Escola as a conceptual basis. Data was collected from October to December 2016, with 31 elementary school teachers, using a script with open and subjective questions that were submitted to content analysis. Results: two categories emerged ­ limited knowledge about the disease and the preventive care adopted, and limitations in the identification and management of glycemic decompensations. Teachers recognize the importance of training in this area and of a good communication between family members and education professionals for better child care in the school environment. Conclusion: there are numerous challenges in the care of children with diabetes mellitus in the school context, and it is necessary to rethink articulated actions among family, school and the health sector.(AU)

Objetivo: comprender el conocimiento de profesores sobre la diabetes mellitus y cómo se manejan en el ambiente escolar. Método: estudio exploratorio cuantitativo en base al programa Salud en la Escuela. Los datos se recogieron entre octubre y diciembre de 2016 con 31 profesores de enseñanza fundamental por medio de cuestiones abiertas y subjetivas. Las respuestas se analizaron segun su contenido. Resultados: se establecieron dos categorías ­ 1) conocimiento limitado sobre la enfermedad y los cuidados preventivos adoptados y 2) limitaciones en la identificación y manejo de descompensaciones glucémicas. Los profesores reconocen la importancia de la...(AU)

Humans , Child , Adolescent , School Health Services , Child Health , Diabetes Complications , Diabetes Mellitus
Enferm. foco (Brasília) ; 10(1): 65-70, jan. 2019. tab
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1028056


Objetivo: Detectar a prevalência do Diabetes Mellitus tipo 2, ocorrência de fatores de risco e complicações em uma subpopulação do estado de Sergipe. Metodologia: Trata-se de um estudo transversal, descritivo e quantitativo, realizado por meio de formulário contemplando dados sociodemográficos e clínicos do paciente. A amostra foi obtida por conveniência, com 307 pacientes. As variáveis categóricas foram avaliadas pelo Teste Qui-Quadrado e Exato de Fisher e adotada significância estatística para p-valor de 5% (0,05). Resultados: A prevalência de diabetes foi 38,1%. O fator de risco que apresentou associação foi à hipertensão. Lesão nos pés esteve presente em 69,3%. Conclusão: As condições socioeconômicas e educacionais da população são fatores dificultadores para promoção da saúde e prevenção do diabetes e suas complicações.

Objective: To detect the prevalence of Type 2 Diabetes Mellitus, the occurrence of risk factors and complications in a subpopulation of the state of Sergipe. Methodology: This is a cross-sectional, descriptive and quantitative study, carried out by means of a form containing sociodemographic and clinical data of the patient. The sample was obtained for convenience, with 307 patients. Categorical variables were assessed by Chi-square and Fisher’s exact test and adopted a statistical significance for p-value of 5% (0.05). Results: The prevalence of diabetes was 38.1%. The risk factor that presented association was hypertension. Foot injury was present in 69.3%. Conclusion: The socioeconomic and educational conditions of the population are factors that make it difficult to promote health and prevent diabetes and its complications.

Objetivo: Detectar la prevalencia de la Diabetes Mellitus tipo 2, ocurrencia de factores de riesgo y complicaciones en una subpoblación del estado de Sergipe. Metodología: Se trata de un estudio transversal, descriptivo y cuantitativo, realizado por medio de formulario contemplando datos sociodemográficos y clínicos del paciente. La muestra fue obtenida por conveniencia, con 307 pacientes. Las variables categóricas fueron evaluadas por el Test Qui-cuadrado y Exacto de Fisher y se adoptó significancia estadística para p-valor del 5% (0,05). Resultados: La prevalencia de la diabetes fue del 38,1%. El factor de riesgo que presentó asociación fue a la hipertensión. La lesión en los pies estuvo presente en el 69,3%. Conclusión: Las condiciones socioeconómicas y educativas de la población son factores dificultadores para la promoción de la salud y prevención de la diabetes y sus complicaciones.

Male , Female , Humans , Diabetes Complications , Diabetes Mellitus , Chronic Disease , Epidemiology , Prevalence
Biociencias ; 14(1): 41-50, 2019.
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-1006765


Objetivo: Evaluar la calidad del sueño nocturno y la somnolencia diurna en pacientes con diagnóstico de diabetes mellitus e hipertensión arterial.Métodos:Se realizó un estudio transversal, prospectivo, en pacientes mayores de 18 años con diagnóstico de diabetes Mellitus e hipertensión Arterial, según la ADA2016 y ESH/ESC, que asistena la consulta de medicina interna del Hospital "Dr. Miguel Pérez Carreño" enel periodo comprendido deenero a juliodel 2017.Resultados: Se evaluó 263,con predominiofemenino con 63,1 %; con un rango de edad de 19-92 años, una media de 61 años ± 13. Se aplicó el cuestionario de Berlín para estimar el riesgo de SAOS, evidenciando 56,27 % bajo riesgo y 43,7 % alto riesgo; los pacientes con sobrepeso tenían un 27 % y los obesos un 21,7 % con alto riesgo. Se observó mala calidad de sueño en el 79,8% de los pacientes hipertensosy 95,5 % en pacientes diabéticos. La somnolencia diurna en hipertensos fue de47,2 %, y endiabéticos el 45,4 %. Se presentóAlto riesgo de SAOS en hipertensos 47,9 %, en diabéticos 40,9 %.Se determinó que no hubo relación entre HTA y DM con mala calidad de sueño (p = 0,186), somnolencia diurna (0,627) y SAOS (p = 0,208). Conclusiones: La mala calidad de sueño estuvo presente en la mayoría de la población y la presencia de somnolencia diurna fue menor. Hubo alto riesgo de SAOS en relación conel índice de masa corporal y el hábitoalcohólico.

Objective:To evaluate the quality of nocturnal sleep and daytime sleepiness in patients diagnosed with diabetes mellitus and arterial hypertension. Methods: A prospective, cross-sectional study was conducted in patients older than 18 years diagnosed with diabetes mellitus and arterial hypertension, according to the ADA 2016 and ESH / ESC, who attend the internal medicine clinic of the "Dr. Miguel Pérez Carreño "in the period from January to July 2017.Results:263 were evaluated, with female predominance with 63.1%; with an age range of 19-92 years, an average of 61 years ± 13. The Berlin questionnaire was applied to estimate the risk of OSAS, evidencing 56.27% low risk and 43.7% high risk; overweight patients had 27% and obese patients 21.7% at high risk. Poor sleep quality was observed in 79.8% of hypertensive patients and 95.5% in diabetic patients. Daytime sleepiness in hypertensive patients was 47.2%, and in diabetics 45.4%. There was a high risk of OSAS in hypertensive patients, 47.9%, in diabetics, 40.9%. It wasdetermined that there was no relationship between hypertension and DM with poor sleep quality (p = 0.186), daytime sleepiness (0.627) and OSAS (p = 0.208). Conclusions:The poor quality of sleep was present in the majority of the population and the presence of daytime sleepiness was lower. There was a high risk of OSAS in relation to body mass index and alcohol habit.

Humans , Diabetes Mellitus , Diabetes Complications
Article in English | WPRIM (Western Pacific) | ID: wprim-742357


PURPOSE: To compare the improving effects of diabetic erectile dysfunction with two anti-glycemic agents; phlorizin and insulin. MATERIALS AND METHODS: Sixty Sprague-Dawley rats were divided into four groups (n=15 in each group): normal control (C), untreated diabetic rats (D), and diabetic rats treated by phlorizin (P) or insulin (I). Ten weeks after the diabetic induction using an injection of streptozotocin (55 mg/kg), four weeks of diabetic control was conducted. Erectile response, Western blot, and immunohistochemistry were assessed. RESULTS: During the experiment, the C-group showed continuous weight gain, while the other groups suffered from weight loss. After start of diabetic control, the body weight of I-group was increased; whereas, there was no meaningful change in the P-group. Meanwhile, comparable blood glucose levels were achieved in the P- and I-groups. The erectile response was markedly decreased in the D-group, whereas the P- and I-groups were similar as good as the C-group. In addition, D-group showed the significant decrease in the cavernosal smooth muscle content and increased apoptosis. Platelet endothelial cell adhesion molecule-1 protein expression, phosphorylation of endothelial nitric oxide synthase and myosin phosphatase target subunit 1 were significantly distorted in the D-group, while the P- and I-groups were comparable with the C-group. CONCLUSIONS: Phlorizin treatment resulted in the improvement of erectile function as same as insulin despite the lack of anabolic weight gains. These results suggest that control of blood glucose level rather than a type of anti-glycemic agents is more important for the prevention and treatment of diabetic erectile dysfunction

Animals , Platelet Endothelial Cell Adhesion Molecule-1 , Apoptosis , Blood Glucose , Blotting, Western , Body Weight , Diabetes Complications , Erectile Dysfunction , Immunohistochemistry , Insulin , Male , Muscle, Smooth , Myosin-Light-Chain Phosphatase , Nitric Oxide Synthase Type III , Phlorhizin , Phosphorylation , Rats , Rats, Sprague-Dawley , Streptozocin , Weight Gain , Weight Loss
Article in Korean | WPRIM (Western Pacific) | ID: wprim-787431


BACKGROUND: Diabetic patients are known to have unusually high mean intraocular pressure (IOP); attributable to autonomic dysfunction and genetic factors. A recent study reported that diabetic complications occur in not only diabetes but also prediabetes. We performed this study to analyze the relationship between glycated hemoglobin A1c (HbA1c) levels and IOP in non-diabetics using electronic medical records at the health screening center of Soon Chun Hyang University Seoul Hospital.METHODS: We considered 16,643 individuals who visited the health screening center of Soon Chun Hyang University Seoul Hospital between November 2015 and September 2017. In total, 3,029 subjects were included in the study. Exclusion criteria included a history of hypertension, diabetes, stroke, cardiovascular disease, hepatitis (A-C), cancer, other disease, fasting blood glucose of 126 mg/dL or higher, HbA1c of 6.5% or higher, and individuals whose binocular IOP could not be measured. We categorized subjects into two groups; those with HbA1c less than or equal to 5.6%, and those with HbA1c greater than 5.6% and less than 6.5%. The mean IOP of each group was compared by gender.RESULTS: After adjusting for factors affecting IOP, analysis of variance was performed to analyze the relationship between HbA1c and IOP. There was no statistically significant difference between the HbA1c groups in males. However, there was a significant difference in IOP between females in the the higher and lower HbA1c groups.CONCLUSION: There was a statistically significant relationship between mean IOP and HbA1c in females without diabetes. Further research is needed with prospective and extensive data collection.

Blood Glucose , Data Collection , Diabetes Complications , Diabetes Mellitus , Electronic Health Records , Fasting , Female , Health Promotion , Glycated Hemoglobin A , Hepatitis , Humans , Hypertension , Intraocular Pressure , Male , Mass Screening , Myocardial Infarction , Prediabetic State , Prospective Studies , Seoul , Telescopes
Article in English | WPRIM (Western Pacific) | ID: wprim-739790


BACKGROUND: Sarcopenic obesity (SO) is a serious public health concern, few studies have examined the clinical implications of SO in newly-diagnosed type 2 diabetes mellitus (T2DM) patients. We evaluated the prevalence of the newly diagnosed, drug-naïve T2DM patients with low muscle mass with abdominal obesity and its association with insulin resistance and other diabetic complications. METHODS: We classified 233 drug-naïve T2DM subjects into four groups according to abdominal obesity (waist circumference ≥90 cm in men and ≥85 cm in women) and low muscle mass status (appendicular skeletal muscle <7.0 kg/m² for men and <5.4 kg/m² for women). RESULTS: The proportion of the subjects with low muscle mass and abdominal obesity among the newly diagnosed, drug-naïve T2DM patients was 8.2%. Homeostasis model assessment of insulin resistance (HOMA-IR) increased linearly according to body composition group from normal to abdominal obesity to both low muscle mass and abdominal obesity. The multiple logistic regression analysis indicated that subjects with low muscle mass and abdominal obesity (odds ratio [OR], 9.39; 95% confidence interval [CI], 2.41 to 36.56) showed a higher risk for insulin resistance, defined as HOMA-IR ≥3, than those with abdominal obesity (OR, 5.36; 95% CI, 2.46 to 11.69), even after adjusting for other covariates. However, there were no differences in lipid profiles, microalbuminuria, or various surrogate markers for atherosclerosis among the four groups. CONCLUSION: Subjects with both low muscle mass and abdominal obesity had a higher risk of insulin resistance than those with low muscle mass or abdominal obesity only.

Atherosclerosis , Biomarkers , Body Composition , Diabetes Complications , Diabetes Mellitus, Type 2 , Homeostasis , Humans , Insulin Resistance , Logistic Models , Male , Muscle, Skeletal , Obesity , Obesity, Abdominal , Prevalence , Public Health
Article in English | WPRIM (Western Pacific) | ID: wprim-739216


BACKGROUND: To investigate the effects of dipeptidyl peptidase-4 (DPP-4) inhibitors on renal outcomes in patients with type 2 diabetes. METHODS: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials (RCTs) of DPP-4 inhibitors from inception to September 2017. We selected eligible RCTs comparing DPP-4 inhibitors with placebo or other antidiabetic agents and reporting at least one renal outcome. A meta-analysis was conducted to calculate standardized mean differences, weighted mean differences (WMDs), relative risks (RRs), and 95% confidence intervals (CIs) for each renal outcome. RESULTS: We included 23 RCTs with 19 publications involving 41,359 patients. Overall changes in urine albumin-to-creatinine ratio were comparable between DPP-4 inhibitors and controls (P=0.150). However, DPP-4 inhibitors were associated with significantly lower risk of incident microalbuminuria (RR, 0.89; 95% CI, 0.80 to 0.98; P=0.022) and macroalbuminuria (RR, 0.77; 95% CI, 0.61 to 0.97; P=0.027), as well as higher rates of regression of albuminuria (RR, 1.22; 95% CI, 1.10 to 1.35; P<0.001) compared with controls. Although DPP-4 inhibitors were associated with small but significantly lower estimated glomerular filtration rate (WMD, −1.11 mL/min/1.73 m2; 95% CI, −1.78 to −0.44; P=0.001), there was no difference in the risk of end-stage renal disease between two groups (RR, 0.93; 95% CI, 0.76 to 1.14; P=0.475). CONCLUSION: DPP-4 inhibitors had beneficial renal effects mainly by reducing the risk of development or progression of albuminuria compared with placebo or other antidiabetic agents.

Albuminuria , Diabetes Complications , Diabetes Mellitus, Type 2 , Diabetic Nephropathies , Dipeptidyl-Peptidase IV Inhibitors , Glomerular Filtration Rate , Humans , Hypoglycemic Agents , Kidney Failure, Chronic
Anatomy & Cell Biology ; : 176-182, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-782306


Macrovascular diabetes complications are generally caused by a process called atherosclerosis. Evidences suggest that to initiate atherosclerosis, oxidated low-density lipoprotein (oxLDL) has to promote the expression of adhesion molecule. Several studies have evidenced the relevance of oxidative stress and atherosclerosis. However, the protective effect of alpha-lipoic acid (ALA) at atherosclerosis still needs to be explored. This study is aimed at investigating the concentration of plasma oxLDL and the expression of adhesion molecule of type 2 diabetes mellitus (DM) using rat model. Eighteen male rats were segregated into three groups labeled as control group, DM group and DM+ALA group. Type 2 diabetes was induced by intraperitoneal injection of streptozotocin (50 mg/kg) followed by nicotinamide (110 mg/kg). ALA was administered at a dose of 60 mg/kg body weight/day throughout the feeding period of 3 weeks. Plasma oxLDL concentration was measured by enzyme-linked immunosorbent assays and expression of vascular cell adhesion molecule-1 (VCAM-1) was measured by immunohistochemistry. Expression of abdominal aortic adhesion molecule was assessed by calculation with Adobe Photoshop CS3. Analysis of variance test was used to compare the concentration of plasma oxLDL and expression of adhesion molecule. A P-value of 0.05 was considered statistically significant. Plasma oxLDL was lower in diabetic rat+ALA compared with the diabetic rat. Percentage of area VCAM-1 in DM+ALA group was lower than DM group. There were no significant differences between groups in intensity of VCAM-1. In conclusion, ALA showed protective effects against early atherosclerosis in diabetic rats.

Animals , Atherosclerosis , Diabetes Complications , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Enzyme-Linked Immunosorbent Assay , Humans , Immunohistochemistry , Injections, Intraperitoneal , Lipoproteins , Male , Models, Animal , Niacinamide , Oxidative Stress , Plasma , Rats , Streptozocin , Thioctic Acid , Vascular Cell Adhesion Molecule-1
Article in English | WPRIM (Western Pacific) | ID: wprim-719637


Oxidative stress is considered a major contributor in the pathogenesis of diabetic neuropathy and in diabetes complications, such as nephropathy and cardiovascular diseases. Diabetic neuropathy, which is the most frequent complications of diabetes, affect sensory, motor, and autonomic nerves. This study aimed to investigate whether 7,8-dihydroxyflavone (7,8-DHF) protects SH-SY5Y neuronal cells against high glucose-induced toxicity. In the current study, we found that diabetic patients exhibited higher lipid peroxidation caused by oxidative stress than healthy subjects. 7,8-DHF exhibits superoxide anion and hydroxyl radical scavenging activities. High glucose-induced toxicity severely damaged SH-SY5Y neuronal cells, causing mitochondrial depolarization; however, 7,8-DHF recovered mitochondrial polarization. Furthermore, 7,8-DHF effectively modulated the expression of pro-apoptotic protein (Bax) and anti-apoptotic protein (Bcl-2) under high glucose, thus inhibiting the activation of caspase signaling pathways. These results indicate that 7,8-DHF has antioxidant effects and protects cells from apoptotic cell death induced by high glucose. Thus, 7,8-DHF may be developed into a promising candidate for the treatment of diabetic neuropathy.

Antioxidants , Autonomic Pathways , Cardiovascular Diseases , Cell Death , Diabetes Complications , Diabetic Neuropathies , Glucose , Healthy Volunteers , Humans , Hydroxyl Radical , Lipid Peroxidation , Neurons , Oxidative Stress , Superoxides