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1.
Arq. ciências saúde UNIPAR ; 26(1): 23-32, Jan-Abr. 2022.
Article in Portuguese | LILACS | ID: biblio-1362667

ABSTRACT

O descarte inadequado de medicamentos pode levar a impactos ambientais negativos e deve ser considerado um problema de saúde pública. O presente estudo teve como objetivo levantar dados quantitativos e qualitativos relacionados ao perfil dos medicamentos descartados no município de Governador Valadares - MG. O trabalho foi desenvolvido nas UAPS/ESF que possuíam farmácias, e também na Farmácia Central/Policlínica Municipal. Nesses locais, foi realizada uma análise dos medicamentos descartados no período de julho de 2017 a maio de 2018. Por meio dos dados obtidos nesse período foi possível perceber que as principais classes de medicamentos descartadas foram os inibidores da enzima conversora de angiotensina, antagonistas da angiotensina II, agentes betabloqueadores, diuréticos, hipoglicemiantes, contraceptivos hormonais e agentes modificadores de lipídeos. Além disso, foi realizada uma ação de educação em saúde e aplicado um questionário semiestruturado aos usuários participantes dos grupos operativos. Dos 34 usuários respondentes do questionário, 23 (69,70%) não tinham acesso a informação sobre o local correto de descarte e armazenamento de medicamentos. Após a ação de educação em saúde verificou-se um aumento no quantitativo de medicamentos descartados pelos usuários nas UAPS/ESF Mãe de Deus I e II, Altinópolis III e IV, Santa Rita II, São Pedro I e II e Esperança e Nossa Senhora das Graças. O trabalho desenvolvido permitiu apresentar dados relevantes para a gestão municipal demonstrando a importância do farmacêutico no cuidado em saúde e o caráter epidemiológico local da prevalência das doenças crônico não transmissíveis.


The inadequate disposal of drugs can lead to negative environmental impacts and should be treated as a public health problem. This study aimed at surveying quantitative and qualitative data related to the profile of drugs discarded in the city of Governador Valadares - MG. The work was developed in the UAPS / ESF that had pharmacies, and also in the Central Pharmacy/Municipal Polyclinic. In these locations, an analysis of the drugs discarded between July 2017 and May 2018 was carried out. Through the data obtained in this period, it was possible to notice that the main classes of drugs discarded were angiotensin-converting enzyme inhibitors, angiotensin II antagonists, beta-blocking agents, diuretics, hypoglycemic agents, hormonal contraceptives, and lipid-modifying agents. In addition, a health education action was carried out and a semi-structured questionnaire was applied to users participating in the operating groups. From the 34 users who responded the questionnaire, 23 (69.70%) did not have access to information on the correct place to dispose and store medicines. After the health education action, there was an increase in the amount of drugs discarded by users in the UAPS/ESF Mãe de Deus I and II, Altinópolis III and IV, Santa Rita II, São Pedro I and II, and Esperança and Nossa Senhora das Graças. The work carried out made it possible to present relevant data for municipal management, demonstrating the importance of the pharmacist in health care and the local epidemiological character of the prevalence of chronic non-communicable diseases.


Subject(s)
Humans , Male , Female , Pharmacies/supply & distribution , Pharmaceutical Preparations , Patients , Pharmacists/supply & distribution , Tablets/supply & distribution , Angiotensin-Converting Enzyme Inhibitors/supply & distribution , Health Centers , Public Health/education , Health Education , Municipal Management/legislation & jurisprudence , Delivery of Health Care , Diabetes Mellitus/drug therapy , Drug Storage , Environment , Hypertension/drug therapy , Hypoglycemic Agents/supply & distribution , Lipids/supply & distribution
3.
Rev. medica electron ; 43(5): 1191-1208, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1352105

ABSTRACT

RESUMEN Introducción: la diabetes mellitus es un trastorno metabólico caracterizado por hiperglucemia crónica con alteraciones en carbohidratos, grasas y proteínas. Debido al aumento de la morbimortalidad por diabetes, esta constituye un problema de salud en el mundo, en Cuba y en el contexto matancero. Objetivo: determinar la prevalencia de diabéticos controlados con la hemoglobina glicosilada (HbA1c), los factores asociados, y las barreras para una intervención posterior. Materiales y métodos: estudio epidemiológico, transversal, analítico a una cohorte de 601 diabéticos tipo 2 mayores de 18 años, en dos policlínicos, estudiados anteriormente. Se encuestaron y procesaron en el programa Epi-Info 7. Se obtuvieron frecuencias y proporciones de variables, prevalencia de diabéticos controlados con la hemoglobina HbA1c, los factores asociados, las comorbilidades con el OR, y las diferencias de variables entre los dos policlínicos, con el Chi2 y p < 0,05 %. Resultados: la prevalencia de diabéticos controlados fue de un 69,3 %. Las variables demográficas, comorbilidades y factores del estilo de vida no tuvieron diferencias estadísticamente significativas. Todas las variables (presencia y ausencia del factor) presentaron un control por encima del 64 %. El peso saludable, sobrepeso, enfermedades del corazón y respiratorias crónicas, ingestión de bebidas azucaradas y alimentación inadecuada, presentaron diferencias estadísticamente significativas entre los dos policlínicos. Conclusiones: No existieron diferencias entre las variables de diabéticos controlados y no controlados. Se identificaron las barreras para mejorar el control de los pacientes para una postintervención y mejorar su calidad de vida, pues un 30 % de los diabéticos no controlados presentaron algunos de los factores de riesgo estudiados (AU).


ABSTRACT Introduction: diabetes Mellitus is a metabolic disorder characterized by chronic hyperglycemia with alterations in carbohydrates, fats and proteins. Due to the increase of the morbidity and mortality rates, this is a health problem in the world, in Cuba and the province of Matanzas. Objective: to determine the prevalence of diabetics controlled with glycosylated hemoglobin (HbA1c), associated factors, and barriers to further intervention. Materials and method: an epidemiological, cross-sectional, analytical study was carried out in a cohort of 601 previously studied, type 2 diabetics over 18 years of age, in two polyclinics. The patients were surveyed and data processed in the Epi-Info 7 program. Frequencies and proportions of variables, prevalence of diabetics controlled by hemoglobin HbA1c, associated factors, comorbidities with odds ratio, as well as differences of variables between the two polyclinics were calculated by using Chi2 and p value <0.05 %. Results: the prevalence of controlled diabetics was 69.3 %. There were no statistically significant differences between demographic variables, co-morbidities and associated life style risk factors. All variables (presence and absence of the factor) showed control above 64 %. Healthy weight, overweight, heart and chronic respiratory diseases, sweet beverages intake and inadequate diet revealed statistically significant differences between the two polyclinics. Conclusions: there were no differences between the variables controlled and non-controlled diabetics. Barriers to improve patients control were identified for the sake of performing a subsequent intervention and improving their life quality, because 30 % of uncontrolled diabetic patients had some of the studied risk factors (AU).


Subject(s)
Humans , Male , Female , Glycated Hemoglobin A/therapeutic use , Diabetes Mellitus/prevention & control , Patients , Comorbidity/trends , Prevalence , Diabetes Mellitus/drug therapy
4.
Rev. urug. cardiol ; 36(2): e401, ago. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1289997

ABSTRACT

La diabetes mellitus, la insuficiencia cardíaca y la enfermedad renal crónica tienen alta prevalencia en la población. Asimismo, estas patologías están comprendidas en un "círculo vicioso" porque comparten mecanismos fisiopatológicos que predisponen a su coexistencia en un mismo paciente, incrementando significativamente el riesgo de eventos cardiovasculares. Recientemente se han agregado al arsenal terapéutico las gliflozinas, un grupo de fármacos con beneficios en las tres enfermedades mencionadas. Saber cómo se desarrolló la investigación con estos fármacos y sus mecanismos de acción es fundamental para optimizar el tratamiento de los pacientes.


Diabetes mellitus, heart failure, and chronic kidney disease are highly prevalent in the population. Likewise, these pathologies are included in a "vicious circle" because they share pathophysiological mechanisms that predispose to their coexistence in the same patient, significantly increasing the risk of cardiovascular events. Gliflozins, a group of drugs with benefits in the three mentioned pathologies, have recently been added to the therapeutic arsenal. Knowing how research with these drugs and its mechanisms of action is essential to optimize the treatment of patients.


Diabetes mellitus, insuficiência cardíaca e doença renal crônica são altamente prevalentes na população. Estas patologias fazem parte de um "círculo vicioso", compartilhando mecanismos fisiopatológicos que predispõem à coexistência no mesmo paciente, e aumentando significativamente o risco de eventos cardiovasculares. As gliflozinas, são un grupo de drogas com benefícios das três patologias citadas, foram adicionadas recentemente ao arsenal terapêutico. Saber como foram desenvolvidas as pesquisas com esses medicamentos e seus mecanismos de ação é essencial para otimizar o tratamento dos pacientes.


Subject(s)
Humans , Diabetes Mellitus/drug therapy , Renal Insufficiency, Chronic/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/pharmacology , Heart Failure/drug therapy , Hypoglycemic Agents/pharmacology , Treatment Outcome
5.
Rev. urug. cardiol ; 36(1): e36104, abr. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1252413

ABSTRACT

La diabetes mellitus es una de las principales causas de morbilidad y mortalidad a nivel mundial. Este grupo de pacientes generalmente representa una población con alto o muy alto riesgo cardiovascular, razón por la cual se realiza una estratificación precoz del riesgo, buscando enfocarse objetivamente en el abordaje farmacológico y no farmacológico con una estrategia intensiva. La enfermedad cardiovascular representa la principal causa de mortalidad, pero en los últimos años se han producido avances en la terapéutica que han demostrado reducir los eventos cardiovasculares mayores. Este artículo revisa la interacción entre diabetes, enfermedades cardiovasculares y su tratamiento.


Diabetes mellitus is one of the main causes of morbidity and mortality worldwide. This group of patients generally represents a population with high or very high cardiovascular risk, that is the reason for an early stratification of risk, seeking to objectively focus on pharmacological and non-pharmacological approach with an intensive strategy. Cardiovascular disease represents the main cause of mortality, but in recent years there have been advances in therapeutics that have been shown to reduce major cardiovascular events. This article reviews the interaction between diabetes, cardiovascular diseases and their treatment.


A diabetes mellitus é uma das principais causas de morbimortalidade em todo o mundo. Esse grupo de pacientes geralmente representa uma população com alto ou muito alto risco cardiovascular, razão pela qual se estratifica precocemente o risco, buscando enfocar objetivamente a abordagem farmacológica e não farmacológica com estratégia intensiva. A doença cardiovascular representa a principal causa de mortalidade, mas nos últimos anos houve avanços na terapêutica que mostraram reduzir os eventos cardiovasculares maiores. Este artigo analisa a interação entre diabetes, doenças cardiovasculares e seu tratamento.


Subject(s)
Humans , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/drug therapy , Diabetes Complications , Diabetes Mellitus/diagnosis , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/adverse effects , Biomarkers , Cardiovascular Diseases/etiology , Risk Assessment , Diabetes Mellitus/epidemiology
6.
Femina ; 49(4): 251-256, 20210430.
Article in Portuguese | LILACS | ID: biblio-1224096

ABSTRACT

O diabetes mellitus gestacional (DMG) é uma complicação que atinge o metabolismo da gestante, resultando em intolerância à glicose e consequente hiperglicemia, originada pela insuficiência de insulina materna. Este estudo tem como objetivo identificar os tratamentos disponíveis e mais utilizados para o DMG. Trata-se de um uma revisão de literatura, feita a partir de 22 referências, acerca dos tratamentos para o DMG. As bases de dados escolhidas foram Google Acadêmico, UpToDate, SciELO e o acervo da Universidade do Planalto Catarinense. Estudos apontam a insulina humana ­ NPH e regular ­ como a principal escolha, quando comparada aos seus análogos, apesar de ainda existirem muitas controvérsias quanto ao início do tratamento, o esquema terapêutico e os ajustes das doses. Pesquisas têm demonstrado bons resultados sobre a eficácia e a segurança dos hipoglicemiantes orais ­ gliburida e metformina ­ no tratamento de gestantes diabéticas, mas é evidente a necessidade de mais estudos para confirmar a efetividade deles e garantir um bom desenvolvimento do concepto. Concluiu-se que o controle dietético e o exercício físico são a primeira opção de tratamento para o DMG. Todavia, caso a euglicemia não seja atingida, opta-se pelo tratamento medicamentoso por meio da insulinoterapia ou hipoglicemiantes orais, o que possibilita a redução da incidência dos efeitos adversos ao binômio materno-fetal.(AU)


Gestational diabetes mellitus (DMG) is a complication that affects the pregnant woman's metabolism, resulting in glucose intolerance and consequent hyperglycemia, caused by insufficient maternal insulin. This study aims to identify the available and most used treatments for DMG. This is a literature review, based on 22 references, about treatments for Gestational Diabetes; the databases chosen were Google Scholar, UpToDate, SciELO and the collection of the Universidade do Planalto Catarinense. Studies point to human insulin ­ NPH and regular ­ as the main choice when compared to its analogues, although there are still many controversies about the beginning of treatment, therapeutic scheme and dose adjustments. Researches have shown good results on the efficacy and safety of oral hypoglycemic agents ­ glyburide and metformin ­ in the treatment of diabetic pregnant women, but it is evident the need for further studies to confirm their effectiveness and to guarantee a good development of the fetus. It was concluded that dietary control and physical exercise are the first treatment option for DGM. However, if euglycemia is not achieved, drug treatment is chosen through insulin therapy or oral hypoglycemic agents, which makes it possible to reduce the incidence of adverse effects to the maternal-fetal binomial.(AU)


Subject(s)
Humans , Female , Pregnancy , Diabetes, Gestational/diet therapy , Diabetes, Gestational/drug therapy , Diabetes, Gestational/therapy , Diabetes Mellitus/drug therapy , Exercise , Databases, Bibliographic , Glyburide/adverse effects , Glyburide/therapeutic use , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Metformin/adverse effects , Metformin/therapeutic use
7.
Femina ; 49(3): 177-182, 20210331.
Article in Portuguese | LILACS | ID: biblio-1224087

ABSTRACT

O diabetes mellitus gestacional (DMG) é um distúrbio metabólico por déficit na produção e/ou ação insulínica. Tem relação direta com um constante estado catabólico associado com maior resistência à ação da insulina. Doença de difícil controle, implica risco materno-fetal elevado. O objetivo é estudar a eficácia das drogas antidiabéticas orais sobre o controle glicêmico no DMG e sua segurança quanto aos desfechos gestacionais e perinatais. Trata-se de revisão de literatura descritiva baseada em dados de artigos, livros-texto e guidelines emitidos nos últimos cinco anos. O antidiabético oral pode ser uma boa alternativa no controle do DMG em fase inicial da doença, na presença de distúrbio metabólico e como complemento da terapia com insulina. Entretanto, por causa de sua passagem placentária, há preocupações com seus efeitos fetais e perinatais. Estudos comparativos destacam a metformina no manejo do DMG, considerando principalmente a segurança materno-fetal.(AU)


Gestational diabetes mellitus (GDM) is a metabolic disorder caused by deficit in production and/or insulin action. It is directly related to a constant catabolic state associated with greater resistance to insulin action. Disease difficult to control, implies high maternal-fetal risk. To study the efficacy of oral antidiabetic drugs on glycemic control in GDM and its safety regarding gestational and perinatal outcomes. Descriptive literature review based on data from articles, textbooks and guidelines issued in the last five years. Oral antidiabetic can be a good alternative in the control of GDM in the initial phase of the disease, in the presence of metabolic disorder and as a complement to insulin therapy. However, there are concerns about its placental passage and perinatal effects. Comparative studies highlight metformin in the management of DMG considering mainly maternal-fetal safety.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/drug therapy , Diabetes, Gestational/drug therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Administration, Oral , Risk Factors , Glyburide/therapeutic use , Acarbose/therapeutic use , Metformin/therapeutic use
8.
Arq. bras. cardiol ; 116(2): 229-235, fev. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1153018

ABSTRACT

Resumo Fundamento A dupla antiagregação plaquetária (DAP) é o tratamento fundamental do infarto agudo do miocárdio (IAM). Objetivo O presente estudo visou investigar a eficácia e a segurança da tripla antiagregação plaquetária (TAP) em pacientes femininas idosas com diabetes e infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST), que foram submetidas à intervenção coronária percutânea ICP. Métodos Trata-se se de um estudo randomizado e mono-cego. O grupo controle A (97 pacientes idosos do sexo masculino com diabetes e STEMI, cujos escores CRUSADE foram < 30) recebeu aspirina, ticagrelor e tirofibana. Um total de 162 pacientes femininas idosas com diabetes e IAMCSST foram divididas aleatoriamente em dois grupos de acordo com o escore CRUSADE. O grupo B (69 pacientes com escore CRUSADE > 31) recebeu aspirina e ticagrelor. O grupo C (93 pacientes com escore CRUSADE < 30) recebeu aspirina, ticagrelor e tirofibana. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Após a PCI, o fluxo sanguíneo grau 3 Thrombolysis in Myocardial Infarction (TIMI) e a perfusão miocárdica TIMI grau 3 foram significativamente menos prevalentes no grupo B, em comparação com o grupo A (p < 0,05). Quando comparada aos grupos A e C, a incidência de complicações adversas maiores foi significativamente maior no grupo B (p < 0,05). Conclusão A TAP pode efetivamente reduzir a incidência de complicações maiores em pacientes idosas com diabetes e IAMCSST. No entanto, atenção cuidadosa deve ser dada à hemorragia em pacientes que recebem TAP. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Dual antiplatelet therapy (DAPT) is the cornerstone treatment of acute myocardial infarction (AMI). Objective The present study aimed to investigate the efficacy and safety of triple antiplatelet therapy (TAPT) in elderly female patients with diabetes and ST segment elevation myocardial infarction (STEMI), who had undergone percutaneous coronary intervention (PCI). Methods We designed a randomized, single-blind study. Control group A (97 elderly male patients with diabetes and STEMI, whose CRUSADE scores were < 30) received aspirin, ticagrelor, and tirofiban. A total of 162 elderly female patients with diabetes and STEMI were randomly divided into two groups according to CRUSADE score. Group B (69 patients with CRUSADE score > 31) received aspirin and ticagrelor. Group C (93 patients with CRUSADE score < 30) received aspirin, ticagrelor and tirofiban. P values < 0.05 were considered statistically significant. Results Compared to the findings in group A, post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow and TIMI myocardial perfusion grade 3 were significantly less prevalent in group B (p < 0.05). When compared to groups A and C, the incidence of major adverse complications was significantly higher in group B (p < 0.05). Conclusion TAPT could effectively reduce the incidence of major complications in elderly female patients with diabetes and STEMI. However, close attention should be paid to hemorrhage in patients receiving TAPT. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Male , Female , Aged , Diabetes Mellitus/drug therapy , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Myocardial Infarction/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Single-Blind Method , Treatment Outcome
9.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 57-64, jan.-dez. 2021. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1146077

ABSTRACT

Objetivo: analisar o perfil de utilização de medicamentos por hipertensos e/ou diabéticos de uma Estratégia de Saúde da Família do Sul de Mato Grosso. Métodos: trata-se de uma pesquisa quantitativa e transversal com usuários cadastrados em uma Unidade Básica de Saúde. Os dados foram coletados em visitas domiciliares. Resultados: os usuários consumiram uma média de 2,9 medicamentos. Não houve diferença estatística no consumo médio de medicamentos entre homens e mulheres. Os idosos utilizavam mais medicamentos. Os fármacos que atuam no sistema cardiovascular foram os mais consumidos. Conclusão: os resultados apontam para a necessidade da promoção do uso racional de medicamentos, sobretudo na população idosa


Objective: to analyze the profile of drug use by hypertensive and diabetic people from a Family Health Strategy of Southern Mato Grosso. Methods: this is a quantitative and cross-sectional research with users registered at a Basic Health Unit. The data were collected in home visits. Results: the users consumed an average of 2.9 drugs. There was no statistical difference in the mean consumption between men and women. The elders used more drugs. The most used drugs were the ones that work in the cardiovascular system. Conclusion: the results show the need for promoting the rational use of drugs, especially in the elderly population


Objetivo: analizar el perfil de utilización de medicamentos por hipertensos y/o diabéticos de una Estrategia de Salud de la Familia del Sur de Mato Grosso. Métodos: se trata de una investigación cuantitativa y transversal con usuarios registrados en una Unidad Básica de Salud. Los datos fueron colectados en visitas domiciliarias. Resultados: los usuarios consumieron una media de 2,9 medicamentos. No habia diferencia estadística en el consumo medio de medicamentos entre hombres y mujeres. Los ancianos utilizaban más medicamentos. Los fármacos que actúan en el sistema cardiovascular fueron los más consumidos. Conclusión: los resultados apuntan a la necesidad de la promoción del uso racional de medicamentos, sobre todo en la población anciana


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Family Health Strategy , Diabetes Mellitus/drug therapy , Drug Utilization/statistics & numerical data , Hypertension/drug therapy , Epidemiologic Studies , House Calls , Hypertension
10.
Journal of Integrative Medicine ; (12): 478-492, 2021.
Article in English | WPRIM | ID: wpr-922526

ABSTRACT

Angiotensin-converting enzyme (ACE) inhibitors are antihypertensive medications often used in the treatment of diabetes-related complications. Synthetic ACE inhibitors are known to cause serious side effects like hypotension, renal insufficiency, and hyperkalaemia. Therefore, there has been an intensifying search for natural ACE inhibitors. Many plants or plant-based extracts are known to possess ACE-inhibitory activity. In this review, articles focusing on the natural ACE inhibitors extracted from plants were retrieved from databases like Google Scholar, PubMed, Scopus, and Web of Science. We have found more than 50 plant species with ACE-inhibitory activity. Among them, Angelica keiskei, Momordica charantia, Muntingia calabura, Prunus domestica, and Peperomia pellucida were the most potent, showing comparatively lower half-maximal inhibitory concentration values. Among the bioactive metabolites, peptides (e.g., Tyr-Glu-Pro, Met-Arg-Trp, and Gln-Phe-Tyr-Ala-Val), phenolics (e.g., cyanidin-3-O-sambubioside and delphinidin-3-O-sambubioside), flavonoids ([-]-epicatechin, astilbin, and eupatorin), terpenoids (ursolic acid and oleanolic acid) and alkaloids (berberine and harmaline) isolated from several plant and fungus species were found to possess significant ACE-inhibitory activity. These were also known to possess promising antioxidant, antidiabetic, antihyperlipidemic and anti-inflammatory activities. Considering the minimal side effects and lower toxicity of herbal compounds, development of antihypertensive drugs from these plant extracts or phytocompounds for the treatment of diabetes-associated complications is an important endeavour. This review, therefore, focuses on the ACE inhibitors extracted from different plant sources, their possible mechanisms of action, present status, and any safety concerns.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors , Antihypertensive Agents , Diabetes Complications/drug therapy , Diabetes Mellitus/drug therapy , Humans , Peptides
11.
Article in Chinese | WPRIM | ID: wpr-878939

ABSTRACT

The evaluation standard of LEAD animal model was established according to the understanding of the etiology and pathogenesis of diabetic lower extremity vascular disease based on Chinese and Western medicine. The consistency between the existing LEAD animal model and the clinical characteristics of traditional Chinese and Western medicine was analyzed and evaluated. The advantages and disadvantages of the existing model were compared,the application scope of different models was considered,and the possible improvement methods of the existing model were proposed,so as to provide impetus for the improvement of LEAD animal model.We should reflect more characteristics of traditional Chinese medicine syndromes in the process of model improvement and development,making the LEAD animal model to get closer to clinical features of traditional Chinese and Western medicine.


Subject(s)
Animals , China , Diabetes Mellitus/drug therapy , Drugs, Chinese Herbal , Lower Extremity , Medicine , Medicine, Chinese Traditional
12.
Braz. J. Pharm. Sci. (Online) ; 57: e181060, 2021. tab
Article in English | LILACS | ID: biblio-1350238

ABSTRACT

The purpose of this study is to describe the frequency of potential drug prescribing omissions (PPOs) for elderly patients at the time of hospital discharge and to compare the frequency PPOs among different medical specialities. This cross-sectional study examined data from elderly patients when they were admitted for >24 h to a northeastern Brazil teaching hospital during June-December 2016. Were included in the study 227 patients, of whom 36.9% had at least one PPO. The highest number of PPOs was identified among those with at least 5 prescribed drugs. In total, 153 PPOs were identified at hospital discharge. In most cases (78.4%), patients were not evaluated by the specialist physician.The most commonly identified PPOs on discharge were: the omission of statin therapy in cases of diabetes mellitus plus one or more cardiovascular-associated factor; calcium and vitamin D supplements in patients with known osteoporosis; and angiotensin converting enzyme inhibitors in cases of chronic heart failure. The results of this study suggest that the frequency of prescribing omissions PPOs during patient discharge was high. This can be avoided by the careful evaluation by prescribers with experience in certain specialties where several prescribed omissions would be common.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Patient Discharge/standards , Patient Discharge/statistics & numerical data , Physicians , Drug Prescriptions/standards , Prescription Drug Misuse/statistics & numerical data , Potentially Inappropriate Medication List/classification , Health Services for the Aged/supply & distribution , Health Services for the Aged/ethics , Hospitals , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Patient Safety/standards , Geriatrics/classification
13.
Braz. J. Pharm. Sci. (Online) ; 57: e19187, 2021. graf
Article in English | LILACS | ID: biblio-1350232

ABSTRACT

Propolis from stingless bees (Heterotrigona itama) is a resinous compound that exhibits antihyperglycaemia, free radical scavenging, and cardioprotective properties. The effect of propolis on diabetic vessels has not been investigated. Thus, this research aimed to determine the effect of propolis supplementation on the level of antioxidants and its mechanism of action in the aorta of diabetic rats. Male Sprague-Dawley rats were divided into five groups (n=8/group): healthy (control), untreated diabetes (DM), metformin-treated diabetes (DM+M, 300 mg/kg/day metformin), propolis-treated diabetes (DM+P, 300 mg/kg/day propolis extract) and diabetes with combined treatment (DM+M+P, dosage as former). Oral supplementation was conducted for four weeks immediately upon successful induction of diabetes by streptozotocin (60 mg/kg, intraperitoneal injection). At the end of the study, the rats were euthanised, and thoracic aorta was processed into tissue homogenates to determine the levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase-1 (GPx-1) and soluble receptor for advanced glycation end-products (sRAGE). Aorta segments were harvested to examine their relaxation response towards graded concentration of acetylcholine (Ach; 10-8-10-4) M following precontraction with phenylephrine (PE; 10-6 M). Vasorelaxation towards a cumulative dose of propolis (0.01-1.00%) using PE-precontracted healthy aorta (n=6/experiments) was investigated under various simulated conditions: physiological buffer, L-NAME (10-4 M), methylene blue (10-5 M), indomethacin (10-5 M) and elevated glucose (25 mM). Propolis maintained antioxidative enzymes and sRAGE decoy molecules in the aortic tissue of the diabetic rats. The amelioration of diabetes-induced impairment of endothelium-dependent relaxation by propolis was mediated through the nitric oxide(NO)-cyclic guanosine monophosphate (cGMP) pathway. This non-clinical study reports vasoprotective property of propolis in diabetes mellitus.


Subject(s)
Animals , Male , Rats , Propolis/analysis , Bees/anatomy & histology , Rats, Sprague-Dawley/classification , Diabetes Mellitus/drug therapy , Endothelium/abnormalities , Nitric Oxide/adverse effects , Aorta/abnormalities , Relaxation , Vasodilation , Antioxidants/pharmacology
14.
Rev. bras. cir. cardiovasc ; 35(6): 859-868, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1144000

ABSTRACT

Abstract Introduction: This study aimed to determine the effect of preoperative aspirin administration on early and long-term clinical outcomes in patients suffering from diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG). Methods: In this observational study, a total of 315 patients were included and grouped according to the time interval between their last aspirin dose and the time of surgery; patients who had been continued aspirin intake with last administered dose ≤ 24-hours before CABG (n=144) and those who had been given the last dose of aspirin between 24 to 48 hours before CABG (n=171). Results: Multivariable analysis showed that the continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of 30-day major adverse cardiac and cerebral events (MACCE) (P=0.004) as well as reduced incidence of composite 30-day mortality/MACCE (P=0.012). During mean follow-up of 37±17.5 months, the unadjusted hazard ratio (HR) showed that aspirin ≤ 24 hours prior CABG in patients with DM significantly reduced the incidence of MACCE and composite of mortality/MACCE during follow-up (HR: 0.50; 95% confidence interval [CI]: 0.29-0.87; P=0.014 and HR: 0.61; 95% CI: 0.38-0.97; P=0.039, respectively). However, after propensity score (PS) matching, the PS-adjusted HR showed a non-significant trend towards the reduction of MACCE during follow-up (HR: 0.58; 95% CI: 0.31-1.06; P=0.081). Conclusion: Continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of early MACCE, but without significant influence on long-term outcomes.


Subject(s)
Humans , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Coronary Artery Bypass , Diabetes Mellitus/drug therapy , Percutaneous Coronary Intervention , Coronary Artery Disease/surgery , Retrospective Studies , Treatment Outcome , Propensity Score
15.
Arq. bras. oftalmol ; 83(6): 526-534, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1153085

ABSTRACT

ABSTRACT Purpose: To compare visual acuity, macular thickness, and the area of active neovascularization based on fluorescein angiography outcomes associated with standard single-spot panretinal photocoagulation in the Early Treatment Diabetic Retinopathy Study (ETDRS) pattern combined with intravitreal ranibizumab injection versus multiple-spot full scatter (PASCAL) panretinal photocoagulation combined with intravitreal ranibizumab injection versus intravitreal injection alone in patients with proliferative diabetic retinopathy. Methods: Patients with proliferative diabetic retinopathy and no prior laser treatment were randomly assigned to receive three different types of treatment. Panretinal photocoagulation in the ETDRS group was administered in two sessions (weeks 0 and 2), and panretinal photocoagulation in the PASCAL group was administered in one session (week 0). Intravitreal injection of ranibizumab was administered at the end of the first laser session in both the ETDRS and PASCAL groups and at week 0 in the intravitreal injection group. Comprehensive ophthalmic evaluations were performed at baseline and every 4 weeks through week 48. Results: Thirty patients (n=40 eyes) completed the 48-week study period. After treatment, best-corrected visual acuity was significantly (p<0.05) improved at all follow-up visits in the group receiving intravitreal injection alone, at all but week 4 in the ETDRS group, and at all but weeks 4 and 8 for the PASCAL group. A significant decrease in central subfield macular thickness was observed in the PASCAL group at weeks 4, 8, and 48; only at week 48 in the intravitreal injection group; and never in the ETDRS group. There was no significant difference among the three treatment groups with respect to change from baseline to week 48 in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization. Conclusions: Intravitreal injection alone or combined with single- or multiple-spot panretinal photocoagulation yielded similar outcomes with respect to mean change in best-corrected visual acuity, central subfield macular thickness, and fluorescein leakage from active neovascularization at up to one-year of follow-up. All subjects provided written informed consent to participate (NCT02005432 in clinicaltrials.gov).


RESUMO Objetivo: Comparar as medidas de acuidade visual, espessura macular central e área de neovasos ativos na an­giofluoresceinografia submetidos a panfotocoagulação retiniana padrão ETDRS associado a injeção intravítrea de ranibizumabe versus panfotocoagulação padrão PASCAL associado a injeção intravítrea de ranibizumabe versus somente injeção intravítrea de ranibizumabe em pacientes com retinopatia diabética pro­liferativa. Métodos: Pacientes com retinopatia diabética proliferativa e virgens de tratamento, randomicamente divididos nas três diferentes terapias retinianas. Panfotocoagulação no grupo ETDRS em 2 sessões (semanas 0 e 2) e no grupo PASCAL, na semana 0. Injeção intravítrea de ranibizumabe realizado ao fim da primeira sessão de laser em ambos os grupos: ETDRS e PASCAL, e na semana 0 no grupo injeção intravítrea de ranibizumabe. Avaliações oftalmológicas, tomografia de coerência óptica e angiofluoesceinografia realizados na visita basal e a cada 4 semanas por 48 semanas. Resultados: Trinta pacientes (n=40 olhos) completaram as 48 semanas de seguimento. Após o tratamento, a acuidade visual melhorou significantemente em todas a visitas no grupo injeção intravítrea de ranibizumabe (p<0,05); em todas exceto na semana 4 no grupo ETDRS, em todas exceto nas semanas 4 e 8 no grupo PASCAL. Redução significativa na espessura do subcampo central foi evidenciada no grupo PASCAL nas semanas 4, 8 e 48; somente na semana 48 no grupo injeção intravítrea de ranibizumabe, e em nenhuma visita no grupo ETDRS. Redução também na área de neovasos ativos em todas as visitas em todos os grupos. Não houve diferença significante entre os três grupos com relação a mudança media na medidas de acuidade visual, espessura macular central ou área de neovasos ativos da visita inicial para a semana 48. Conclusões: Somente IVB ou este associado a panfotocoagulação ETDRS ou PASCAL, apresentaram efeitos semelhantes em relação a medidas de acuidade visual, espessura do subcampo central e área de neovasos ativos no decorrer de 48 semanas de seguimento.


Subject(s)
Humans , Angiogenesis Inhibitors/therapeutic use , Diabetes Mellitus , Diabetes Mellitus/drug therapy , Diabetic Retinopathy , Diabetic Retinopathy/surgery , Diabetic Retinopathy/drug therapy , Treatment Outcome , Laser Coagulation , Intravitreal Injections , Ranibizumab/therapeutic use
16.
Rev. cuba. endocrinol ; 31(3): e250, sept.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156399

ABSTRACT

Introducción: Los medicamentos inhibidores del cotransportador sodio-glucosa actúan inhibiéndose de forma selectiva y reversible a nivel renal. A través de este mecanismo, reducen la reabsorción de glucosa, la cual pasa a excretarse por la orina y de esta forma, contribuyen a normalizar la glucemia. Objetivo: Describir la función de los inhibidores del cotransportador sodio-glucosa tipo 2 en el tratamiento de la diabetes mellitus. Métodos: Se utilizó como buscador de información científica a Google Académico, Google, Pubmed y SciELO. Se evaluaron artículos de revisión, de investigación y páginas Web, que en general, tenían menos de 10 años de publicados, en idioma español, portugués o inglés. Fueron excluidos los artículos que no cumplieron con estos requisitos. Esto permitió el estudio de 98 artículos, de los cuales 75 fueron referenciados. Conclusiones: La administración de los inhibidores del cotransportador sodio-glucosa induce cambios favorables en la hemoglobina glucosilada, el peso corporal y la presión arterial, además de presentar un bajo riesgo de hipoglucemia. Aunque constituyen un grupo farmacológico que puede ser utilizado como monoterapia, con mayor frecuencia son usados como coadyuvantes en el tratamiento de los pacientes con diabetes mellitus, que reciben tratamiento farmacológico con otros medicamentos normo o hipoglucemiantes y que no han alcanzado las metas de control. Se debe estar alerta ante la aparición de posibles efectos secundarios o reacciones adversas, para descontinuar el tratamiento y tomar las medidas correspondientes(AU)


Introduction: Sodium-glucose co-transporter inhibitors´ drugs (SGLT) work by selectively and reversiblely inhibiting at the renal level. Through this mechanism, they reduce glucose reabsorption, which is excreted through urine and thus contribute to normalizing blood glucose. Objective: Describe the role of sodium-glucose co-transporter inhibitors 2 in the treatment of diabetes mellitus. Methods: There were used as search engines for scientific information : Google Scholar, Google, Pubmed and SciELO. The keywords used were: Glyphozines, sodium-glucose co-transporter inhibitors, diabetes mellitus, treatment and weight loss. Review articles, research articles and web pages were assessed, which generally had less than 10 years of publication, and were in Spanish, Portuguese or English language. Items that did not meet these requirements were excluded. This allowed the study of 98 articles, of which 75 were referenced. Conclusions: Administration of sodium-glucose co-transporter inhibitors induces favorable changes in glycosylated haemoglobin, body weight and blood pressure, as well as a low risk of hypoglycaemia. Although they are a pharmacological group that can be used as monotherapy, they are mostly used as adjuvants in the treatment of patients with diabetes mellitus who receive drug treatment with other normo or hypoglycemic medications and who have not met control goals. It is important to be alert to possible side effects or adverse reactions to discontinue treatment and take appropriate action(AU)


Subject(s)
Humans , Diabetes Mellitus/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Hypoglycemic Agents/therapeutic use , Review Literature as Topic , Search Engine/methods
17.
Ciênc. Saúde Colet ; 25(11): 4615-4622, nov. 2020. tab, graf
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1133035

ABSTRACT

Resumo Objetivou-se verificar a associação entre a prática de atividade física em diferentes domínios e o uso de insulina em adultos e idosos. Trata-se de um estudo transversal de base populacional com dados do inquérito Vigilância de fatores de risco e proteção para doenças crônicas por Inquérito Telefônico (VIGITEL 2013). A amostra foi composta por indivíduos com idade ≥18 anos, residentes nas 27 capitais do Brasil e com diagnóstico de diabetes. A prática de atividade física no deslocamento, domicílio, lazer e trabalho, e o uso de insulina foram por autorrelato. Empregou-se regressão logística binária em análises bruta e ajustada para fatores sociodemográficos. Dos 4.593 indivíduos com diabetes, uso de insulina foi relatado por 16,2% e 25,5% dos adultos e idosos, respectivamente. A prática de atividade física no domicílio (RO: 0,61; IC95%: 0,40; 0,94) no trabalho (RO: 0,38; IC95%: 0,18; 0,78) estiveram associadas ao menor uso de insulina em idosos. Houve tendência de redução do uso de insulina à medida que se aumentou a quantidade de domínios fisicamente ativos em idosos (p = 0,003). Conclui-se que, em idosos, a atividade física praticada de forma isolada ou de forma acumulada em diferentes domínios teve associação com o menor uso de insulina.


Abstract The scope of this paper was to verify the association between the practice of physical activity of different types and the use of insulin in adults and the elderly. This is a cross-sectional population-based study with data from the survey entitled Surveillance of risk factors and protection for chronic diseases by telephone (VIGITEL 2013). The sample consisted of individuals aged ≥18 years, living in the 27 Brazilian capitals and diagnosed with diabetes. The practice of physical activity in commuting, the home, leisure, work and the use of insulin were self-reported. Binary logistic regression was used in crude and adjusted analyses for sociodemographic factors. Of the 4,593 subjects with diabetes, insulin use was reported by 16.2% and 25.5% of adults and the elderly, respectively. The practice of physical activity in the home (OR: 0.61, 95%CI: 0.40; 0.94) and at work (OR: 0.38, 95%CI: 0.18; 0.78) were associated with the lowest use of insulin among the elderly. There was a tendency to reduce insulin use as the number of physically active domains increased among the elderly (p = 0.003). The conclusion drawn was that physical activity practiced alone or in a cumulative way in different domains was associated with lower insulin use among the elderly.


Subject(s)
Humans , Adolescent , Adult , Aged , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Insulin , Socioeconomic Factors , Brazil , Exercise , Cross-Sectional Studies , Leisure Activities
18.
Rev. bras. cir. cardiovasc ; 35(5): 666-674, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137347

ABSTRACT

Abstract Objective: To describe insulin use and postoperative glucose control in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: We examined 2,390 patients with and without diabetes enrolled in the Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) Study who underwent CABG surgery (01/2004 - 06/2005) to describe postoperative insulin use, variation in insulin use across different hospitals, and associated in-hospital complications and clinical outcomes. Logistic regression was used to assess the adjusted relationship between insulin use and clinical outcomes. Results: Overall, insulin was used in 82% (n=1,959) of patients, including 95% (n=1,203) with diabetes (n=1,258) and 67% (n=756) without diabetes (n=1,132). Continuous insulin was used in 35.5% of patients in the operating room and in 56% in the intensive care unit. Continuous insulin use varied significantly among centers from 8-100% in patients with diabetes. When compared with all patients not receiving insulin, insulin use in patients without diabetes was associated with a higher rate of death or major complication (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI] 1.15-2.04; P=0.003). In patients with diabetes, insulin use was not associated with a higher risk of adverse outcomes (adjusted OR=1.01; 95% CI 0.52-1.98; P=0.98). Conclusion: The postoperative use of insulin is high among CABG patients in the United States of America. Insulin use in patients without diabetes was associated with worse clinical outcomes compared to patients (both with and without diabetes) who did not receive insulin. Further investigation is needed to determine the optimal use of postoperative insulin after CABG.


Subject(s)
Humans , Male , Coronary Artery Bypass , Insulin/therapeutic use , United States , Logistic Models , Risk Factors , Treatment Outcome , Diabetes Mellitus/drug therapy
19.
Revista Digital de Postgrado ; 9(1): e202, 2020.
Article in Spanish | LILACS, LIVECS | ID: biblio-1095048

ABSTRACT

La diabetes mellitus (DM) se considera como un conjunto de trastornos metabólicos relacionados con la hiperglucemia, que requiere cambios en estilos de vida, en virtud de que no solo se afecta el estado físico, sino que requiere cambios que pueden influir en el estado emocional y psicosocial. Las personas con diabetes requieren de cuidados continuos orientados al control metabólico centrados en el empoderamiento, autocuidado y en la educación terapéutica para alcanzar metas y resultados orientados a minimizar la aparición de las complicaciones crónicas. Objetivo: analizar la importancia de la educación terapéutica en los pacientes con trastornos afectivos como depresión y ansiedad, asociados a la diabetes. Conclusión: la educación terapéutica como parte integral del tratamiento de la DM ha demostrado mejorar los síntomas asociados a depresión y ansiedad, lo cual podría adquirir un valor importante en el manejo de este grupo de pacientes(AU)


Diabetes mellitus (DM) is considered as a set of metabolic disorders related to hyperglycemia, which requires changes in lifestyle, because not only physical condition is affected, but it also requires changes that can influence emotional state and psychosocial. People with diabetes require continuous care oriented to metabolic control focused on empowerment, self-care and therapeutic education to achieve goals and results aimed at minimizing the occurrence of chronic complications. Objective: to analyze the importance of therapeutic education in patients with affective disorders such as depression and anxiety, associated with diabetes. Conclusion: therapeutic education as an integral part of the treatment of DM has been shown to improve symptoms associated with depression and anxiety, which could acquire an important value in the management of this group of patients(AU)


Subject(s)
Humans , Diabetes Mellitus/pathology , Diabetes Mellitus/prevention & control , Diabetes Mellitus/drug therapy , Diabulimia/pathology , Hypoglycemia/etiology , Anxiety , Therapeutics , Affective Symptoms , Depression
20.
Evid. actual. práct. ambul ; 23(2): e002058, 2020. tab
Article in Spanish | LILACS | ID: biblio-1103846

ABSTRACT

Ciertos hallazgos preclínicos generaron preocupación en la comunidad científica y en la población general sobre el uso de inhibidores de la enzima convertidora de angiotensina (IECA) y los antagonistas del receptor de la angiotensina II (ARAII), y los posibles desenlaces adversos asociados con relación a la infección por el nuevo Coronavirus (SARS-Cov-2).Por este motivo, nos planteamos como objetivo proveer de recomendaciones dinámicas (living recommendations) para el tratamiento con fármacos IECA o ARA II en pacientes con riesgo o documentación de infección por SARS-CoV-2 (en todo su espectro de gravedad). Se utilizó como metodología la adaptación/adopción de guías de práctica clínica bajo el enfoque GRADE, actualizando la evidencia al 7 de abril de 2020 mediante búsquedas en múltiples bases de datos y consultando a un panel multidisciplinario libre de conflictos de interés. Como resultado de este proceso se arribó a la siguiente afirmación: se recomienda, en contexto de la pandemia de COVID-19, en personas que se encuentran en tratamiento con IECA/ARAII, mantener el tratamiento sin cambios por sobre suspenderlo o reemplazarlo por otros fármacos (Recomendación fuerte a favor - calidad de evidencia baja). (AU)


Certain preclinical findings raised concerns in the scientific community and in the general population about the use ofangiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) and the possible adverse outcomes associated with the infection with the new Coronavirus (SARS-Cov-2). For this reason, our objective is to provide living recommendations for treatment with ACEI or ARA in patients with risk or documentation of SARS-CoV-2 infection (inall its severity spectrum). The adaptation/adoption of clinical practice guidelines under the GRADE approach was used as a methodology, updating the evidence as of April 7, 2020, by searching multiple databases and consulting a multidisciplinary panel free of conflicts of interest. As a result of this process, the following statement was reached: it is recommended, in the context of the COVID-19 pandemic, in people who are undergoing treatment with ACEI/ARA, to maintain the treatment unchanged instead of its suspension or replacement with other drugs (Strong recommendation in favor - low quality ofevidence). (AU)


Subject(s)
Humans , Male , Female , Adult , Young Adult , Pneumonia, Viral/complications , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Coronavirus Infections/complications , Angiotensin II Type 2 Receptor Blockers/pharmacology , Antihypertensive Agents/pharmacology , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Cardiovascular Diseases/drug therapy , Surveys and Questionnaires , Practice Guidelines as Topic , Risk Assessment , Evidence-Based Medicine , Diabetes Mellitus/drug therapy , Renal Insufficiency, Chronic/drug therapy , Angiotensin II Type 2 Receptor Blockers/adverse effects , Pandemics , Clinical Decision-Making , Betacoronavirus/drug effects , GRADE Approach , Antihypertensive Agents/adverse effects
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