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1.
Rev. cuba. med. mil ; 49(4): e918, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156512

ABSTRACT

Introducción: La COVID-19 se ha caracterizado por un amplio espectro de manifestaciones y formas clínicas que comprenden desde enfermedad ligera hasta la muerte. Es de suma importancia identificar a aquellos con mayores probabilidades de desarrollar las complicaciones. Objetivo: Identificar factores de riesgo para desarrollar complicaciones en los pacientes atendidos con la COVID-19. Métodos: Fueron revisadas las 250 historias clínicas de pacientes ingresados por la COVID-19. Se recopilaron edad, sexo, antecedentes patológicos personales, exámenes de laboratorio y la presencia o no de complicaciones. Se utilizó ji cuadrado para identificar relación entre las complicaciones y el sexo. Fue calculado el Odds Ratio (OR) para complicaciones por grupos de edad, antecedentes patológicos personales y parámetros humorales. Resultados: El distrés respiratorio fue más frecuente en hombres (p = 0,023). Los grupos de edad más afectados fueron de 60 a 79 años y de 80 años y más (OR = 4,85 y 30,53 respectivamente). Fueron factores de riesgo los antecedentes de hipertensión arterial, cardiopatía isquémica, diabetes mellitus, insuficiencia renal crónica y demencia (OR = 4,48; 4,22; 8,75; 17,98 y 10,39 respectivamente). Predispusieron a complicaciones, hematocrito y linfocitos bajo, así como neutrófilos, glucemia, creatinina, ASAT, GGT y LDH altos. Conclusiones: El mayor riesgo de complicaciones lo tuvieron pacientes mayores de 60 años, con enfermedades cardiovasculares, diabetes mellitus, insuficiencia renal y demencia. La presencia de hematocrito y linfocitos bajo, o neutrófilos, glucemia, creatinina, ASAT, GGT y LDH altos, alerta sobre posibles complicaciones(AU)


Introduction: COVID-19 has been characterized by a wide spectrum of manifestations and clinical forms that range from mild illness to death. Identifying those most likely to develop complications is critical. Objective: To identify risk factors for developing complications in patients treated with COVID-19. Methods: 250 medical records of patients admitted for COVID-19 were reviewed. Age, sex, personal pathological history, laboratory tests and the presence or absence of complications were collected. Chi-square was used to identify the relationship between complications and sex. The Odds Ratio (OR) was calculated for complications by age groups, personal pathological history, and humoral parameters. Results: Respiratory distress was more frequent in men (p=0.023). The most affected age groups were 60 to 79 years and 80 years and over (OR=4.85 and 30.53 respectively). Risk factors were the history of arterial hypertension, ischemic heart disease, diabetes mellitus, chronic kidney insufficiency and dementia (OR=4.48, 4.22, 8.75, 17.98 and 10.39 respectively). Low hematocrit and lymphocytes were predisposed to complications, as well as high neutrophils, glycaemia, creatinine, ASAT, GGT and LDH. Conclusions: The highest risk of complications was in patients older than 60 years, with cardiovascular diseases, diabetes mellitus, kidney insufficiency and dementia. The presence of low hematocrit and lymphocytes, or high neutrophils, glycaemia, creatinine, ASAT, GGT and LDH, alerts you to possible complications(AU)


Subject(s)
Humans , Risk Factors , Myocardial Ischemia/complications , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Diabetes Complications/diagnosis , Renal Insufficiency, Chronic/complications , Hypertension
2.
Einstein (Säo Paulo) ; 18: eAO4483, 2020. tab
Article in English | LILACS | ID: biblio-1056068

ABSTRACT

ABSTRACT Objective To analyze the characteristics of patients with hypertension and/or diabetes mellitus from Primary Healthcare units. Methods This is a retrospective study, with data collected from December 2014 of patients with hypertension and/or diabetes from 13 Primary Healthcare units located in the Southern region of Sao Paulo (SP, Brazil). Patients were compared by sex, diagnosis and cardiovascular risk using student t test, one way analysis of variance (ANOVA), and Mann-Whitney, Kruskal-Wallis and χ2 tests. Results We evaluated 28,496 patients aged 20 years to 79 years (mean of 57.8 years). Most of patients were women (63.2%) and aged 50 years old or older (74.2%). The participation in the Programa Remédio em Casa (Medicine at Home Program) was higher among women (12.7%), and the proportions of hypertension, diabetes and both diseases were 68.0%, 7.9% and 24.1%, respectively. Patients with hypertension and diabetes had higher participation in Medicine at Home Program (13.3%), and those with diabetes only had higher participation in Programa de Automonitoramento Glicêmico (Self-Monitoring Glucose Program) (20.0%). The proportions of low, moderate, and high cardiovascular risk were 33.0%, 15.5%, and 51.5%, respectively. Conclusion The sample of this study consisted of patients who were mostly women, aged 50 years or older and diagnosed with hypertension. Almost a quarter of patients also had diabetes and approximately one third and half of them were classified as low and high cardiovascular risk.


RESUMO Objetivo Analisar as características de pacientes com hipertensão arterial e/ou diabetes mellitus de unidades de Atenção Primária à Saúde. Métodos Estudo retrospectivo, com dados de dezembro de 2014 de pacientes com hipertensão e/ou diabetes, de 13 unidades de Atenção Primária à Saúde localizadas na região sul da cidade de São Paulo (SP). Os pacientes foram comparados por sexo, diagnósticos e risco cardiovascular, por meio dos testes t de Student, análise de variância de um fator, Mann-Whitney, Kruskal-Wallis e χ2. Resultados Foram avaliados 28.496 pacientes, de 20 anos a 79 anos de idade (média de 57,8 anos), sendo a maioria do sexo feminino (63,2%) e com 50 anos ou mais de idade (74,2%). A participação no Programa Remédio em Casa foi maior no sexo feminino (12,7%) e as proporções de hipertensão, diabetes e de ambas as doenças foram de 68,0%, 7,9% e 24,1%, respectivamente. Os pacientes com hipertensão e diabetes apresentaram maior proporção de participação no Programa Remédio em Casa (13,3%) e aqueles com apenas diabetes apresentaram maior proporção de participação no Programa de Automonitoramento Glicêmico (20,0%). As proporções de risco cardiovascular baixo, moderado e alto foram de 33,0%, 15,5% e 51,5%, respectivamente. Conclusão A amostra deste estudo foi constituída por pacientes em sua maioria do sexo feminino, com 50 anos ou mais de idade e diagnóstico de hipertensão. Cerca de um quarto dos pacientes apresentava também diabetes e aproximadamente um terço e metade deles foram categorizados como risco cardiovascular baixo e alto, respectivamente.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Primary Health Care/statistics & numerical data , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Brazil/epidemiology , Blood Glucose Self-Monitoring/statistics & numerical data , Cardiovascular Diseases/complications , Retrospective Studies , Risk Factors , Sex Distribution , Age Distribution , Diabetes Complications/diagnosis , Diabetes Complications/blood , Diabetes Complications/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/blood , Home Care Services/statistics & numerical data , Hypertension/complications , Hypertension/diagnosis , Middle Aged
3.
Rev. bras. epidemiol ; 23: e200009, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1092617

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Tuberculosis/complications , Tuberculosis/epidemiology , Diabetes Complications/epidemiology , Socioeconomic Factors , Tuberculosis/diagnosis , Tuberculosis/therapy , Brazil/epidemiology , Comorbidity , Prevalence , Cross-Sectional Studies , Sex Distribution , Age Distribution , Diabetes Complications/diagnosis , Diabetes Complications/therapy , Middle Aged
4.
Rev. bras. cir. cardiovasc ; 34(1): 41-47, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985234

ABSTRACT

Abstract Objective: To evaluate the predictive value of epicardial fat thickness (EFT) in CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) score risk groups. Methods: A total of 158 consecutive patients (75 females, 83 males, mean age 70.8±6.3 years) admitted routinely for cardiologic control were divided into two groups according to their CHA2DS2-VASc scores (scores 0 and 1 were regarded as low risk, and score ≥2 as high risk). One hundred twenty-five of 158 patients had a high-risk score. Results: Mean EFT was significantly higher in the high-risk group than in the low-risk group (4.34±0.62 vs. 5.37±1.0; P<0.001). EFT was positively correlated with CHA2DS2-VASc score (r=0.577, P<0.001). According to receiver operating characteristics (ROC) analysis, EFT value of 4.4 mm was found to be predictive of high risk in CHA2DS2-VASc score with 80% of sensitivity and 79% of specificity (C-statistic = 0.875, P<0.001, 95% confidence interval [CI] = 0.76-0.90). And according to multivariate logistic regression analysis, EFT was an independent predictor of high thromboembolic risk in terms of CHA2DS2-VASc score. Conclusion: Our findings suggest that echocardiographic EFT measurement could provide additional information on assessing cardiovascular risks, such as thromboembolic events, and individuals with increased EFT should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pericardium/pathology , Pericardium/diagnostic imaging , Echocardiography/methods , Cardiovascular Diseases/etiology , Adipose Tissue/pathology , Adipose Tissue/diagnostic imaging , Cardiovascular Diseases/pathology , Cardiovascular Diseases/diagnostic imaging , Logistic Models , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnosis , Multivariate Analysis , Prospective Studies , Risk Factors , Age Factors , Statistics, Nonparametric , Stroke/complications , Diabetes Complications/diagnosis , Heart Failure/complications , Heart Failure/diagnosis , Hypertension/complications , Hypertension/diagnosis
5.
Rev. Assoc. Med. Bras. (1992) ; 65(1): 56-60, Jan. 2019.
Article in English | LILACS | ID: biblio-985002

ABSTRACT

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


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


Subject(s)
Humans , Autonomic Nervous System Diseases/diagnosis , Diabetes Complications/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Diabetic Neuropathies/diagnosis , Heart Diseases/diagnosis , Prognosis , Autonomic Nervous System Diseases/mortality , Autonomic Nervous System Diseases/therapy , Risk Factors , Death, Sudden , Diabetes Complications/mortality , Diabetes Complications/therapy , Diabetes Mellitus, Type 2/mortality , Diabetes Mellitus, Type 2/therapy , Diabetic Neuropathies/mortality , Diabetic Neuropathies/therapy , Heart Diseases/mortality , Heart Diseases/therapy
6.
Rev. Assoc. Med. Bras. (1992) ; 64(1): 85-92, Jan. 2018. tab, graf
Article in English | LILACS | ID: biblio-896416

ABSTRACT

Summary Diabetic nephropathy is the main cause of chronic kidney disease, and represents the most common and serious complication of diabetes. The exact pathogenesis is complex and not elucidated. Several factors and mechanisms contribute to the development and outcome of diabetic nephropathy. An early diagnosis and intervention may slow down disease progression. A variety of biological markers associated with diabetic nephropathy were found in recent years, which was important for predicting the occurrence and development of the disease. Therefore, this article provides an overview of early biomarkers that are associated with diabetic nephropathy.


Subject(s)
Humans , Diabetic Nephropathies/diagnosis , Biomarkers/analysis , Risk Factors , Early Diagnosis , Diabetes Complications/diagnosis , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/etiology , Renal Insufficiency, Chronic
7.
Rev. med. interna Guatem ; 22(1): 31-40, 2018 ene.mar. tab
Article in Spanish | LILACS, LIGCSA | ID: biblio-1052723

ABSTRACT

La detección de micro albuminuria permite el rápido diagnóstico de nefropatía incipiente, predecir desarrollo de proteinuria y aumento de mortalidad; siendo la medición en orina de 24 horas Gold standard para su diagnóstico. En sepsis el aumento de permeabilidad vascular favorece paso de sustancias como albúmina y con ello producir micro albuminuria, cuya medición es pronostica de mortalidad en unidad de terapia intensiva. Diseño: estudio descriptivo transversal donde se evaluaron 27 pacientes ingresados en unidad de terapia intensiva de adultos del hospital general de enfermedades debiendo cumplir con: antecedentes de hipertensión arterial y/o diabetes mellitus, tener diagnóstico de choque hipovolémico o séptico, medición de escalas pronosticas de mortalidad y tener examen de orina de 24 horas para evaluar presencia de micro albuminuria, posteriormente se evaluó la condición de egreso como vivo o muerto. Métodos: Se realizó cálculo de Chi2 de homogeneidad o Test Exacto de Fisher para variables categóricas. La normalidad de variables numéricas se determinó con Shaphiro Wilk; si era normal se realizó t de Student de Muestras independientes y de lo contrario U de Mann Whitney. Resultados: Edad media de 50.29 años, principalmente hombres con antecedente de diabetes y diagnóstico de choque séptico. Obteniéndose una media para micro albuminuria en 31.93 mg/dl en pacientes vivos y para fallecidos 58.69 mg/dl. Las escalas pronosticas de mortalidad fueron estadísticamente significativas (p =0.03) para SOFA y (p =0.010) para escala APACHE, así también se obtuvo (p =0.03) para presencia de Micro albuminuria. Conclusiones: La cuantificación de Micro albuminuria en orina de 24 horas en pacientes con estado de choque en unidadde terapia intensiva es un factor pronóstico de mortalidad al ingreso del paciente.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Albuminuria/urine , Kidney Diseases/diagnosis , Kidney Diseases/mortality , Shock/mortality , Shock, Septic/complications , Diabetes Complications/diagnosis , Hypertension/complications
8.
Rev. guatemalteca cir ; 23(1): [71-75], ene-dic,2017. graf
Article in Spanish | LILACS | ID: biblio-884891

ABSTRACT

Los liposarcomas son tumores poco frecuentes, de comportamiento clínico silencioso y evolución variable dependiendo del tipo histológico, la recurrencia local y las metástasis a distancia. El tratamiento de elección es la resección quirúrgica total del tumor. Se presenta el caso de paciente femenina de 57 años de edad que consultó por tumor retroperitoneal cuyo diagnóstico por patología fue de liposarcoma bien diferenciado. Se reseca la totalidad el tumor, preservando el riñón derecho. Conclusión. La cirugía en caso de liposarcoma retroperitoneal es el tratamiento de elección donde la radioterapia y la quimioterapia juegan un papel controversial.


Liposarcomas are rare tumours, of silent clinical behavior and variable evoluton depending on histological type, local recurrence and distant metastases. Treatment of choice is tumors' complete surgical resecton. We hereby report the case of a 57-year-old female patent with a retroperitoneal tumor, whose fnal diagnosis was well-diferentated liposarcoma. The entre tumor was resected, preserving the right kidney. Conclusion. For Retroperitoneal Liposarcoma, surgery is the treatment of choice


Subject(s)
Humans , Female , Liposarcoma/diagnosis , Diabetes Complications/diagnosis , Tomography, X-Ray Computed/statistics & numerical data
9.
J. bras. nefrol ; 39(4): 481-485, Oct.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-893806

ABSTRACT

ABSTRACT Hyporeninemic hypoaldosteronism, despite being common, remains an underdiagnosed entity that is more prevalent in patients with diabetes mellitus. It presents with asymptomatic hyperkalemia along with hyperchloraemic metabolic acidosis without significant renal function impairment. The underlying pathophysiological mechanism is not fully understood, but it is postulated that either aldosterone deficiency (hyporeninemic hypoaldosteronism) and/or target organ aldosterone resistance (pseudohypoaldosteronism) may be responsible. Diagnosis is based on laboratory parameters. Treatment strategy varies according to the underlying pathophysiological mechanism and etiology and aims to normalize serum potassium. Two clínical cases are reported and the relevant literature is revisited.


RESUMO Apesar de comum, o hipoaldosteronismo hiporeninêmico continua a ser uma entidade sub-diagnosticada, com maior prevalência em pacientes com diabetes mellitus. A doença cursa com hipercalemia assintomática acompanhada de acidose metabólica hiperclorêmica sem disfunção renal significativa. O mecanismo fisiopatológico subjacente não é entendido em sua totalidade, mas postula-se que a deficiência de aldosterona (hipoaldosteronismo hiporeninêmico) e/ou a resistência à aldosterona no órgão-alvo (pseudo-hipoaldosteronismo) possam ser responsáveis. O diagnóstico é fundamentado em parâmetros laboratoriais. A estratégia terapêutica varia de acordo com o mecanismo fisiopatológico subjacente e a etiologia, mas seu objetivo é normalizar o potássio sérico. O presente artigo relata dois casos e analisa a literatura relevante sobre o assunto.


Subject(s)
Humans , Male , Middle Aged , Hypoaldosteronism/diagnosis , Diabetes Complications/diagnosis , Hyperkalemia/diagnosis , Hypoaldosteronism/complications , Hyperkalemia/complications
10.
Rev. méd. Chile ; 145(5): 564-571, mayo 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-902513

ABSTRACT

Background: Diabetic retinopathy is the first cause of blindness during working years. Aim: Provide knowledge of screening coverage, prevalence and level of diabetic retinopathy in patients that belong to the Cardiovascular Health Program in primary care. Material and Methods: Analysis of retinographies performed to 9076 diabetic patients aged 61 ± 13 years (61% women) adscribed to a Cardiovascular Health program in primary care centers of South-East Metropolitan Santiago. The examination was carried out by the evaluation of retinographies by trained optometrists. Results: The coverage of the screening program was 21%. The prevalence of sight threatening diabetic retinopathy was 3,1%. The prevalence of these entities was 45% higher in people aged between 18 and 44 years than in older people. Their prevalence in urban communities was 32% higher than in rural locations. Conclusions: The coverage of the screening program is low. Diabetic patients aged 18 to 44 years and those coming from urban communities have a higher prevalence of severe non-proliferative and proliferative diabetic retinopathy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Mass Screening/methods , Blindness/etiology , Diabetes Complications/diagnosis , Diabetic Retinopathy/diagnosis , Primary Health Care , Severity of Illness Index , Program Evaluation , Chile/epidemiology , Blindness/prevention & control , Blindness/epidemiology , Prevalence , Diabetes Complications/epidemiology , Diabetic Retinopathy/complications , Diabetic Retinopathy/epidemiology
12.
Clinics ; 72(1): 5-10, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-840031

ABSTRACT

OBJECTIVES: Although several studies have investigated the effects of diabetes on hearing loss, the relationship between these two conditions remains unclear. Some studies have suggested that diabetes may cause sensorineural hearing loss, whereas others have failed to find an association. The biggest challenge in investigating the association between diabetes and hearing loss is the presence of confounding variables and the complexity of the auditory system. Our study investigated the association between diabetes and sensorineural hearing loss. We evaluated the influence of time from diabetes diagnosis on this association after controlling for age, gender, and hypertension diagnosis and excluding those subjects with exposure to noise. METHODS: This cross-sectional study evaluated 901 adult and elderly Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participants from São Paulo, Brazil who underwent audiometry testing as part of ELSA-Brasil’s baseline assessment. RESULTS: Hearing thresholds and speech test results were significantly worse in the group with diabetes than in the group without diabetes. However, no significant differences were found between participants with and without diabetes after adjusting for age, gender, and the presence of hypertension. Hearing thresholds were not affected by occupational noise exposure in the groups with and without diabetes. In addition, no association between the duration of diabetes and hearing thresholds was observed after adjusting for age, gender, and hypertension. CONCLUSION: We found no association between the duration of diabetes and worse hearing thresholds after models were adjusted for age, gender, and the presence of hypertension.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Auditory Threshold/physiology , Diabetes Complications/diagnosis , Diabetes Mellitus/physiopathology , Hearing Loss, Sensorineural/etiology , Audiometry, Pure-Tone , Time Factors , Cross-Sectional Studies , Longitudinal Studies , Diabetes Complications/physiopathology , Hearing Loss, Sensorineural/diagnosis
13.
Rev. med. interna Guatem ; 19(1): 32-39, ene-abr. 2015. tab
Article in Spanish | LILACS | ID: biblio-982106

ABSTRACT

En la actualidad hay una creciente aumento de diabetes mellitus tipo II y casos de mujeres en edad reproductiva, hay ciertos elementos a tomar en cuenta para abordar la consejería en la preconcepción. El artículo toca esos elementos a tomar en cuenta para ese tema para llevar a un felíz término el embarazo en dichos casos con un adecuado control.


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Diabetes, Gestational/diagnosis , Diabetes, Gestational/prevention & control , Diabetes Complications/diagnosis , Insulin/therapeutic use
14.
Rev. Soc. Bras. Clín. Méd ; 13(1)abr. 2015. tab
Article in Portuguese | LILACS | ID: lil-749218

ABSTRACT

OBJETIVO: Diabetes mellitus é uma doença crônica prevalente, associada a inúmeras complicações. A neuropatia periférica diabética é a mais comum, acometendo 50% dos diabéticos, mas muitas vezes não é diagnosticada. Por cursar com insensibilidade distal e alterações arquiteturais dos pés, predispõe a úlceras, podendo culminar no pé diabético com risco de amputação. O diabetes mellitus é responsável por 70% das amputações de membros, que poderiam ser prevenidas com o diagnóstico precoce da neuropatia periférica diabética. Sugere-se avaliar o grau de neuropatia em diabéticos por meio de escores, visando homogeneizar o diagnóstico, quantificar a prevalência e promover medidas preventivas. MÉTODOS: Realizou-se entrevista, exame físico e coleta de dados de diabéticos atendidos ambulatorialmente, para pontuação e qualificação no Escore de Sintomas Neuropáticos e no Escore de Comprometimento Neuropático, validados na língua portuguesa para avaliar neuropatia periférica diabética, além de análise das características clínicas e epidemiológicas associadas. RESULTADOS: Foram incluídos 116 pacientes, constatando-se neuropatia periférica diabética em 31,9%. Houve correlação significativa de neuropatia periférica diabética coma idade dos pacientes, mas não com as demais variáveis clínicas e laboratoriais. Os pacientes avaliados apresentaram médias de idade de 55±15 anos e tempo de diabetes de 14,8±10,9 anos, sendo predominantemente caucasianos, mulheres e portadores de diabetes mellitus tipo 2. Eram hipertensos 67,2% e 42,2%, obesos. CONCLUSÃO: A prevalência encontrada corrobora a literatura, embora poucos estudos tenham utilizado critérios similares para diagnosticar neuropatia periférica diabética. Empregando os escores padronizados, de baixo custo e fácil aplicação possibilitamos o diagnóstico precoce e embasado dessa entidade, sendo possível, com isso, reduzir a prevalência de graves complicações do pé diabético e disseminar informações a respeito.


OBJECTIVE: Diabetes mellitus is a prevalent chronic disease, associated with numerous complications. Diabetic peripheral neuropathy is the most common, affecting 50% of diabetics, although is often not diagnosed. Presenting with distal numbness and architectural alterations of the feet, it predisposes ulcers and may culminate in diabetic foot at risk for amputation. Diabetes mellitus is responsible for 70% of limb amputations, which could be prevented with early diagnosis of diabetic peripheral neuropathy. This study aims to evaluate the degree of neuropathy in diabetics through validated scores, in order to standardize the diagnosis, quantify the prevalence and promote preventive actions. METHODS: We performed an interview, physical examination and data collection of diabetic outpatients, for rating in the Neuropathy Symptom Score and the Neuropathy Disability Score, validated in Portuguese, to assess diabetic peripheral neuropathy, in addition to analysis of clinical and epidemiological associated characteristics. RESULTS: We included 116 patients and diabetic peripheral neuropathy was found in 31.9%. There was significant correlation diabetic peripheral neuropathy with age, but not with other clinical and laboratory variables. The mean age was 55±15 years, diabetes duration was 14.8±10.9 years and patients were predominantly Caucasian, women and had type 2 diabetes mellitus. Of the patients, 67.2 % were hypertensive and 42.2% obese. CONCLUSION: The prevalence found is supported by previous data, although few studies have used similar criteria to diagnose diabetic peripheral neuropathy. Employing the standard scores, of low cost and easy implementation, we enable early and accurate diagnosis of this condition, allowing to reduce the prevalence of severe diabetic foot complications and spread information about it.


Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Complications/diagnosis , Diabetes Mellitus , Peripheral Nervous System Diseases/diagnosis , Practice Guidelines as Topic , Diabetic Foot/diagnosis
15.
Braz. dent. j ; 25(1): 69-72, Jan-Feb/2014. graf
Article in English | LILACS | ID: lil-709406

ABSTRACT

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.


A fasceíte necrotizante cervical (FNC) é uma infecção rara de tecidos moles, potencialmente fatal, caracterizada por necrose no tecido subcutâneo e fascia com progressão rápida. Um caso de FNC de origem odontogênica em um paciente diabético, complicado por dependência alcoólica e abuso de tabaco, é relatado junto a uma revisão da literatura. O procedimento de emergência compreendeu hidratação, administração de colóide, controle glicêmico e antibioticoterapia de amplo espectro, seguido de debridamento cirúrgico agressivo. Necrose no músculo platisma foi verificada por análise histopatológica. Cirurgia reconstrutiva foi feita após resolução da infecção e a ferida foi fechada com enxerto dérmico autógeno. O paciente teve um longo período de internação hospitalar, em parte devido ao abuso de substâncias, o que levou a uma recuperação difícil. Os princípios de diagnóstico imediato, debridamento cirúrgico agressivo, antibioticoterapia de amplo espectro e cuidados em terapia intensiva no tratamento da FNC foram confirmados no presente caso. Foi concluído que diante da ocorrência de FNC na presença de diabetes mellitus e de abuso de substâncias como álcool e tabaco, o profissional assistente deve considerar uma resposta mais difícil ao tratamento e maior tempo de internação.


Subject(s)
Aged , Humans , Male , Diabetes Complications/diagnosis , Fasciitis, Necrotizing/diagnosis , Neck , Substance-Related Disorders/complications , Tooth Diseases/diagnosis , Fasciitis, Necrotizing/etiology , Tooth Diseases/complications
16.
Article in English | WPRIM | ID: wpr-141033

ABSTRACT

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.


Subject(s)
Causality , Comorbidity , Diabetes Complications/diagnosis , Elastic Modulus , Elasticity Imaging Techniques/methods , End Stage Liver Disease/epidemiology , Fatty Liver/epidemiology , Female , Humans , Image Interpretation, Computer-Assisted/methods , Incidence , Liver/physiopathology , Liver Cirrhosis/epidemiology , Male , Middle Aged , Reproducibility of Results , Republic of Korea/epidemiology , Risk Factors , Sensitivity and Specificity
17.
Article in English | WPRIM | ID: wpr-141032

ABSTRACT

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.


Subject(s)
Causality , Comorbidity , Diabetes Complications/diagnosis , Elastic Modulus , Elasticity Imaging Techniques/methods , End Stage Liver Disease/epidemiology , Fatty Liver/epidemiology , Female , Humans , Image Interpretation, Computer-Assisted/methods , Incidence , Liver/physiopathology , Liver Cirrhosis/epidemiology , Male , Middle Aged , Reproducibility of Results , Republic of Korea/epidemiology , Risk Factors , Sensitivity and Specificity
18.
Rev. cuba. med. gen. integr ; 29(2): 121-131, abr.-jun. 2013.
Article in Spanish | LILACS | ID: lil-689646

ABSTRACT

La caracterización clínica de las personas con diabetes es esencial para efectuar su evaluación de forma integral y ofrecer un tratamiento médico individualizado. Objetivo: identificar las características clínicas y la frecuencia de complicaciones crónicas en personas con Diabetes Mellitus tipo 2 de diagnóstico reciente en la provincia Granma. Métodos: se realizó un estudio transversal y descriptivo con pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre enero de 2011 a julio de 2012. El universo estuvo constituido por los 683 pacientes que ingresaron durante esa etapa en la institución. Representaron la muestra los 150 diabéticos tipo 2 que tenían menos de 6 meses de padecer la enfermedad. Resultados: la edad media fue de 49,2 años. Predominaron los diabéticos con antecedentes familiares de Diabetes Mellitus (60,6 por ciento), con sobrepeso y obesidad (90 por ciento) e hipertensos (62 por ciento). Al momento del diagnóstico 43 (28,7 por ciento) casos presentaron complicaciones crónicas: 9 (6 por ciento) retinopatía diabética, 16 (10,6 por ciento) polineuropatía diabética, 11 (7,3 por ciento) cardiopatía isquémica, 4 (2,6 por ciento) ictus y 13 (8,6 por ciento) enfermedad arterial periférica. A 7 pacientes se les diagnosticó más de una complicación. Conclusiones: la Diabetes Mellitus tipo 2 frecuentemente se presenta en nuestro medio en personas mayores de 45 años, con antecedentes familiares de diabetes y asociada a la obesidad y la hipertensión arterial. Las complicaciones crónicas de la diabetes están presentes en un porcentaje elevado de casos al momento del diagnóstico inicial de dicha enfermedad...


Clinical characterization of people with diabetes mellitus is essential to carry out its comprehensive evaluation and indicate an individualized medical treatment. Objective: to identify the clinical characteristics and the frequency of chronic complications in people with newly diagnosed Type 2 Diabetes Mellitus in Granma Province. Methods: a descriptive cross-sectional study was conducted in patients with Type 2 Diabetes Mellitus who were admitted to The Diabetes Care Center in Bayamo, Granma, from January 2011 to July 2012. The universe was composed of the 683 patients who were admitted to this institution during this period of time. The sample was represented by the 150 Type 2 diabetics who have been suffering from this disease for less than 6 months. Results: the mean age was 49, 2 years. The diabetics who had family antecedents of Diabetes Mellitus (60, 6 percent), the ones who were overweight and obese (90 percent) and the hypertensive ones (62 percent), predominated in the study. At the moment of the diagnosis, 43 cases (28,7 percent) presented the following chronic complications: 9 had diabetic retinopathy (6 percent), 16 had diabetic polyneuropathy (10, 6 percent), 11 had ischemic heart disease (7,3 percent), 4 suffered from stroke (2,6 percent) and 13 presented peripheral arterial disease (8,6 percent). 7 patients were diagnosed with more than one complication. Conclusions: type 2 Diabetes Mellitus frequently occurs in people over 45 years, with family antecedents of diabetes mellitus associated to obesity and hypertension. Chronic complications of diabetes are present in a high percent of cases at the moment of the initial diagnosis of the disease...


Subject(s)
Humans , Male , Female , Stroke/etiology , /complications , Hypertension/etiology , Myocardial Ischemia/etiology , Diabetic Neuropathies/etiology , Obesity/etiology , Diabetic Retinopathy/etiology , Cross-Sectional Studies , Diabetes Complications/diagnosis , Epidemiology, Descriptive
19.
Med. interna (Caracas) ; 29(1): 43-51, 2013. tab, graf
Article in Spanish | LILACS | ID: lil-753323

ABSTRACT

La polineuropatía diabética es la más común de las complicaciones microvasculares de la diabetes mellitus, siendo causa importante de morbilidad y mortalidad asociada a la enfermedad. Evaluar el efecto del ácido tióctico en los cambios clínicos, neuroconductivos e histopatológicos en la neuropatía diabética sensitivo motora distal. Estudio prospectivo, longitudinal, de intervención terapéutica, en pacientes que acudieron a la consulta externa y unidad cardiometabólica del Servicio de Medicina Interna del Hospital Militar “Dr. Carlos Arvelo”, a quien se les realizó historia clínica con evaluación del score sensitivo-motor, pruebas de neuroconducción y biopsia de piel, con evaluación a la semana n° 1, 4,12, 18 y 24. 30 pacientes diabéticos con criterio clínico de neuropatía diabética sensitivo motora distal. Se observó mejoría de las parestesias a partir de la semana 12 (p <0.05) de la administración del ácido tióctico a dosis de 600mg/día por vía oral. En la neuroconducción hubo aumento de la velocidad de conducción durante el post tratamiento (p<0,05). Se realizaron 12 biopsias de piel: 2 fueron positivas (16,7%) previo tratamiento y 10 negativas (83,3%) con anticuerpo PGP 9,5. En la semana 24 post tratamiento 7 positivas (58,3%) y 5 negativas (41,7%) (p<0,05). Se demostró que el tratamiento con ácido tióctico es efectivo en mejorar los síntomas y la neuroconducción en los pacientes diabéticos con neuropatía sensitivo motora distal.


Diabetic neuropathy is the most common microvascular complication of diabetes mellitus, and a major cause of morbidity and mortality. To evaluate the effect of thioctic acid in the clinical, histopathological neuroconductive and sensory motor diabetic distal neuropathy. Prospective, longitudinal, therapeutic intervention, in patients attending the outpatient and cardiometabolic consultation Internal Medicine; an assessment of sentitivo-motor score was performed and blood chemistry was measured as well as HbA1c. Neuroconduction and skin biopsy with assessment at weeks 1, 4.12, 18 and 24 were done. 30 diabetic patients with clinical criteria of distal motor sensory neuropathy were included. The clinical symptom was paresthesia, which was present from week 12 and showed improvement (p <0.05) at weeks 18 and 24 (p<0.05). Neuroconduction was measured by increased conduction velocity post treatment (p <0.05). Biopsieswere performed in 12 patients; two were positive (16.7%) after treatment and 10 negative (83.3%) for PGP 9.5 antibody. At week 24 of treatment, 7 were positive (58.3%) and 5 negative (41.7%) (p<0.05). We demonstrated effectiveness of thioctic acid after week 12 of treatment.


Subject(s)
Humans , Male , Female , Thioctic Acid/therapeutic use , Diabetes Complications/diagnosis , Neural Conduction/physiology , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/therapy , Internal Medicine
20.
Article in English | WPRIM | ID: wpr-159644

ABSTRACT

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.


Subject(s)
Age Factors , Aged , Alzheimer Disease/diagnosis , Brain/diagnostic imaging , Cross-Sectional Studies , Dementia/pathology , Diabetes Complications/diagnosis , Female , Humans , Hyperlipidemias/complications , Hypertension/complications , Interviews as Topic , Male , Middle Aged , Odds Ratio , Periodontal Diseases/complications , Predictive Value of Tests , Risk Factors , Stroke/pathology , Tomography, X-Ray Computed , Tooth Loss
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