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2.
Prensa méd. argent ; 107(3): 152-154, 20210000. tab, cuad
Article in English | LILACS, BINACIS | ID: biblio-1359914

ABSTRACT

Este estudio se realizó para caracterizar la frecuencia de aparición, extensión, edad y sexo de la incidencia del eritrasma en pacientes diabéticos según el tipo, la duración y el estado. Estudio transversal y combinado de casos y controles de 200 pacientes diabéticos y 160 grupos no diabéticos que visitaron la consulta externa del Hospital Docente Al-Saddar, Departamento de Medicina y Dermatología, desde el período de diciembre de 2019 a julio de 2020. Dentro del grupo con Diabetes las edades oscilan entre los 12 y los 60 años con una edad media de 37,6 años. 148 pacientes padecían diabetes mellitus tipo no insulinodependiente (NIDDM) y 52 pacientes padecían IDDM. Entre todos los pacientes diabéticos examinados con la lámpara de Wood, para detectar infección por eritrasma, 34 (17%) resultaron afectados, de 26 hombres (76,5% de los afectados) y 8 mujeres (23,5%) se vieron afectados. Entre los 52 pacientes con DMID, 15 (28,8%) se vieron afectados y sólo 19 (12,8%) del resto con DMID se vieron afectados. Se encontró que la incidencia máxima de edad se encuentra en la cuarta década (30-40 años). El sitio de mayor propensión de las lesiones parecía ser la ingle en un 100%. La forma extensa o generalizada se encontró solo en 3 (8,8%) pacientes y el sitio menos afectado fue la membrana de los dedos solo en 2 (5,9%). La presentación de los pacientes fue asintomática en 22 (64,7%) y el cambio de color (marrón rojizo) se encontró en todos los pacientes. En conclusión, la aparición de eritrasma en pacientes diabéticos es más frecuente que su aparición en pacientes no diabéticos. Existe una asociación significativa entre la aparición de eritrasma y la IDDM. La frecuencia de aparición de eritrasma aumenta con la larga duración de la DM y más con la DM incontrolada


This study was conducted to characterize the frequency of occurrence, extent, age, and sex incidence of Erythrasma in diabetic patients according to the type, duration, and state. A cross-sectional and case-control combined study of 200 diabetic patients and 160 non-diabetic groups visiting the outpatient clinic of Al-Saddar Teaching Hospital, Department of Medicine and Dermatology, from the period of December 2019 to July 2020. Among the diabetic group, their ages range from 12-60 years with a mean age of 37.6 years. 148 patients were non-insulin-dependent diabetes mellitus type (NIDDM) and 52 patients were IDDM. Among all the diabetic patients examined by wood's light to detected Erythrasma infection 34(17%) were found to be affected, from 26 males (76.5% of the affected) and 8 females (23.5%) were affected. Among the 52 patients with IDDM, 15(28.8%) were affected and only 19(12.8%) from the remainder with NIDDM affected. The peak age incidence was found to be in the fourth decade (30-40 y). The site of greatest propensity of the lesions appeared to be the groin was 100%. The extensive or generalized form was found only in 3(8.8%) patients and the least affected site was the toe webs only in 2(5.9%). The presentation of the patients was found to be asymptomatic in 22(64.7%), and the color change (red brown) was found in all of the patients. In the conclusion, the occurrence of Erythrasma in diabetic patients is more frequent than its occurrence in non-diabetic patients. There is a significant association between the occurrence of Erythrasma and the IDDM. The frequency of occurrence of Erythrasma increase with the long duration of DM and more with the uncontrolled DM.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Case-Control Studies , Cross-Sectional Studies/statistics & numerical data , Diabetes Mellitus/physiopathology , Erythrasma/physiopathology
4.
Rev. chil. endocrinol. diabetes ; 14(4): 171-177, 2021. tab
Article in Spanish | LILACS | ID: biblio-1348218

ABSTRACT

Los avances en el campo de la fibrosis quística han aumentado la esperanza de vida de estos pacientes, por lo que cada vez es más prevalente la Diabetes Relacionada con la Fibrosis Quística (DRFQ) y sus complicaciones. La DRFQ se asocia a mayor morbimortalidad, deterioro de la función pulmonar y del estado nutricional. Por lo mismo, el manejo óptimo de esta patología depende de un diagnóstico precoz, tratamiento individualizado y vigilancia de las complicaciones diabéticas. El screening de DRFQ debe realizarse anualmente a partir de los 10 años, mediante una Prueba de Tolerancia a la Glucosa Oral (PTGO), lo cual permite el diagnóstico. El manejo de esta patología tiene por objetivo estabilizar y mejorar la función pulmonar y el estado nutricional y metabólico de los pacientes. Actualmente, la insulina es el tratamiento farmacológico de elección para controlar la hiperglicemia y el esquema de uso debe ser individualizado para cada persona. En caso de enfermedades agudas pueden existir mayores requerimientos de insulina. Además, se deben tener consideraciones especiales en cuanto a la dieta y la insuficiencia pancreática exocrina que presentan estos pacientes. Para la vigilancia de complicaciones microvasculares se debe realizar una monitorización anual a partir de los 5 años desde el diagnóstico de DRFQ. Debido a la complejidad de estos pacientes, para alcanzar el mejor cuidado posible se necesita un enfoque multidisciplinario con distintos profesionales de la salud coordinados, incluyendo en la toma de decisiones al paciente y su familia.


Advances made in the field of cystic fibrosis have increased the life expectancy of these patients, which is why Cystic Fibrosis-Related Diabetes (CFRD) and its complications are becoming more and more prevalent. CFRD is associated with increased morbidity and mortality, lower lung function and inadequate weight maintenance. Therefore, the optimal management of this pathology depends on an early diagnosis, individualized treatment and monitoring of diabetic complications. For CFRD, routine screening with an Oral Glucose Tolerance Test (OGTT) should be carried out yearly from the age of 10, which allows to diagnose it. The treatment goals in CFRD are to stabilize and improve lung function and obtain adequate weight gain. Currently, insulin is the pharmacological treatment of choice to control hyperglycemia and the insulin regimen must be personalized for each person. In acute illnesses, there may be higher insulin requirements. In addition, special considerations must be taken regarding diet and exocrine pancreatic insufficiency that these patients present. For the surveillance of microvascular complications, annual monitoring should be carried out 5 years after the diagnosis of CFRD. Due to the complexity of these patients, in order to achieve the best possible care, a multidisciplinary approach is needed with different coordinated health professionals, including the patients and their family in the decision-making process.


Subject(s)
Humans , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Cystic Fibrosis/therapy , Diabetes Mellitus/etiology , Diabetes Mellitus/therapy , Patient Care Team , Mass Screening , Cystic Fibrosis/physiopathology , Nutrition Therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Insulins/therapeutic use , Glucose Tolerance Test , Hypoglycemic Agents/therapeutic use
5.
Rev. méd. Maule ; 35(1): 58-59, oct. 2020.
Article in Spanish | LILACS | ID: biblio-1366686

ABSTRACT

Diabetic patients are at risk of developing unfavorably from SARS-COV19 disease, especially when they have poor glycemic control. On the other hand, in the case of diabetic patients with severe COVID, they evolve with severe hyperglycemia, often difficult to manage. Marked hyperglycemia has also been described in people without a known history of previous diabetes, even there have been reported cases of insulin-dependent diabetes debut in days after the disease. The aim of this review is to analyze possible mechanisms involved in the relationship between COVID-19 and DIABETES.


Subject(s)
Humans , Diabetes Mellitus/epidemiology , COVID-19/epidemiology , Hyperglycemia/complications , Prognosis , Blood Glucose/metabolism , Diabetes Mellitus/physiopathology , COVID-19/physiopathology , COVID-19/virology , Hospitalization/statistics & numerical data , Hyperglycemia/physiopathology
6.
Actual. nutr ; 21(2): 43-49, Abril-Junio de 2020.
Article in Spanish | LILACS | ID: biblio-1282315

ABSTRACT

En las últimas décadas, los cambios en el estilo de vida pro-vocaron un incremento en la prevalencia del síndrome meta-bólico y que la enfermedad por hígado graso no alcohólico (nonalcoholic fatty liver disease, NAFLD sus siglas en inglés) se convierta en la enfermedad hepática crónica más fre-cuente en todo el mundo. Los componentes del síndrome metabólico no son sólo altamente prevalentes en pacientes con hígado graso no alcohólico, sino que a la vez aumentan el riesgo de desarrollarlo. Esta relación bidireccional ha sido claramente establecida. Asimismo se considera que NAFLD podría ser el componente hepático del síndrome metabólico. Aunque NAFLD se considera principalmente una enfermedad benigna, puede progresar a fibrosis hepática grave y carcino-ma hepatocelular (CHC), incluso se encontraría este último en hígados no cirróticos. El objetivo de esta revisión es determinar los procesos fisio-patológicos comunes a estas entidades, cuáles son las estra-tegias diagnósticas recomendadas y cuáles las intervenciones terapéuticas actualmente aprobadas.


Subject(s)
Humans , Male , Female , Carcinoma, Hepatocellular/etiology , Metabolic Syndrome/etiology , Non-alcoholic Fatty Liver Disease/complications , Liver Neoplasms/etiology , Fibrosis/etiology , Fibrosis/physiopathology , Fibrosis/therapy , Risk Factors , Carcinoma, Hepatocellular/physiopathology , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Metabolic Syndrome/diagnosis , Metabolic Syndrome/physiopathology , Metabolic Syndrome/therapy , Diabetes Mellitus/etiology , Diabetes Mellitus/physiopathology , Diabetes Mellitus/therapy , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/physiopathology , Non-alcoholic Fatty Liver Disease/therapy , Liver Neoplasms/physiopathology , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imaging
7.
Article in English | LILACS, BBO | ID: biblio-1101870

ABSTRACT

ABSTRACT The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middle-income country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Diabetes Complications/epidemiology , Diabetes Mellitus/epidemiology , Betacoronavirus , Pneumonia, Viral/physiopathology , Severity of Illness Index , Brazil/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/epidemiology , Comorbidity , Prevalence , Risk Factors , Age Factors , Coronavirus Infections/physiopathology , Diabetes Complications/physiopathology , Diabetes Mellitus/physiopathology , Pandemics , SARS-CoV-2 , COVID-19 , Hypertension/complications , Hypertension/physiopathology , Hypertension/epidemiology , Middle Aged , Obesity/complications , Obesity/physiopathology , Obesity/epidemiology
8.
Rev. chil. endocrinol. diabetes ; 13(4): 170-176, 2020. tab
Article in Spanish | LILACS | ID: biblio-1123624

ABSTRACT

La diabetes mellitus ha sido asociado a una mayor probabilidad de enfermedad más grave por Covid-19. Los estudios epidemiológicos evidencian que los pacientes diabéticos tienen un riesgo mayor de un cuadro grave que requiera UCI, ventilación mecánica y probabilidad de morir. Un buen control metabólico parece fundamental para disminuir este riesgo. En el caso del manejo ambulatorio es importante asegurar la continuidad de los tratamientos crónicos, medir los niveles de glicemia capilar y minimizar la posibilidad de infección. En caso de infección por SARS-Cov2 el paciente diabético deberá hacer los ajustes necesarios en su tratamiento tanto para lograr un control glicémico adecuado como para disminuir los riesgos de algunos fármacos antidiabéticos. El uso de telemedicina constituye una excelente herramienta para facilitar el logro de los objetivos terapéuticos. En caso de requerir hospitalización, se ha evidenciado que los pacientes diabéticos tienen altos requerimientos de insulina y rápida tendencia a producir cetosis. Considerando la situación actual de pandemia las metas intrahospitalarias pueden ser más laxas y seguras, en especial en pacientes no críticos. En caso de pacientes críticos idealmente se debe mantener las metas glicémicas entre 140-180 mg/dL.


Diabetes mellitus has been associated with a higher probability of severe disease due to Covid-19. Epidemiological studies show that diabetic patients have an increased risk of a serious condition requiring ICU, mechanical ventilation and of course the probability of dying. Good metabolic control seems essential to reduce this risk. In the case of outpatient management, it is very important to ensure the continuity of chronic treatments, measure capillary blood glucose levels and minimize the possibility of infection. In case of SARS-Cov2 infection, the diabetic patient should make the necessary adjustments in their treatment, both to achieve adequate glycemic control and to reduce the risks of some antidiabetic drugs. Telemedicine is an excellent tool to facilitate the achievement to therapeutic goals. In case of requiring hospitalization, it has been shown that diabetic patients have high insulin requirements and rapid tendency to produce ketosis. Considering the current situation of a pandemic, intrahospital goals may be laxer and safer, especially in non-critically ill patients. In the case of critically ill patients, the glycemic goals should ideally be maintained between 140-180 mg/dL.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Outpatients , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Risk , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Diabetes Mellitus/physiopathology , Diabetes Mellitus/therapy , Hospital Care , Pandemics , Ambulatory Care , Betacoronavirus , Inpatients
9.
Int. braz. j. urol ; 45(6): 1204-1208, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056338

ABSTRACT

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.


Subject(s)
Humans , Male , Adult , Aged , Risk Assessment/methods , Erectile Dysfunction/diagnosis , Erectile Dysfunction/physiopathology , Reference Values , Anthropometry , Cross-Sectional Studies , Reproducibility of Results , Risk Factors , Age Factors , Statistics, Nonparametric , Stroke/physiopathology , Diabetes Mellitus/physiopathology , Heart Failure/physiopathology , Hypertension/physiopathology , Middle Aged
10.
Rev. Assoc. Med. Bras. (1992) ; 65(8): 1067-1073, Aug. 2019. graf
Article in English | LILACS | ID: biblio-1041054

ABSTRACT

SUMMARY OBJECTIVE Diabetes is a risk factor for acute kidney injury (AKI). However, its mechanism of pathogenesis has not been elucidated. The aim of the study was to investigate the role of inflammation and the toll-like receptor 7 (TLR7) in ischemic AKI for diabetes. METHODS A high glucose hypoxia-reoxygenation model of human renal tubular epithelial (HK-2) cells was used to generate AKI induced by ischemia-reperfusion in diabetes. The activity of cells was measured by CCK-8 assay and LDH activity. Inflammatory cytokines were assessed by ELISA. TLR7, MyD88, and NF-κB expressions were examined by western blotting. Apoptosis was evaluated by flow cytometry. RESULTS The high glucose group and low glucose group were subjected to hypoxia-reoxygenation. The low glucose group developed only mild cell damage, apoptosis, and inflammatory response. In contrast, an equivalent hypoxia-reoxygenation injury provoked severe cell damage, apoptosis, and inflammatory response in the high glucose group. Expression of TLR7 and its related proteins were measured in the high glucose group before and after hypoxia-reoxygenation. The high glucose group exhibited more significant increases in TLR7 expression following hypoxia-reoxygenation than the low glucose group. In addition, the expression of TLR7 and its related proteins after hypoxia-reoxygenation were higher in the high glucose group than in the low glucose group. Inhibition of TLR7 provides significant protection against ischemic injury in diabetes. CONCLUSION Our results suggest that diabetes increases the vulnerability to ischemia-induced renal injury. This increased vulnerability originates from a heightened inflammatory response involving the TLR7 signal transduction pathway.


RESUMO OBJETIVO O diabetes é um fator de risco para a lesão renal aguda (LRA). No entanto, seu mecanismo de patogênese não foi elucidado. O objetivo do estudo foi investigar o papel da inflamação e do receptor Toll-like 7 (TLR7) na LRA isquêmica no diabetes. MÉTODOS Um modelo de hipóxia-reoxigenação de células epiteliais tubulares renais humanas (HK-2) na presença de concentrações altas de glicose foi utilizado para gerar LRA induzida por isquemia-reperfusão em diabetes. A atividade das células foi medida pelo ensaio Cell Counting Kit-8 (CCK-8) e pela atividade da lactato desidrogenase (LDH). As citocinas inflamatórias foram avaliadas por ensaio imunoenzimático (Elisa). A expressão de TLR7, do fator de diferenciação mieloide 88 (MyD88) e do fator de transcrição nuclear-κB (NF-κB) foi examinada por Western blotting. A apoptose foi avaliada por citometria de fluxo. RESULTADOS Os grupos glicose alta e glicose baixa foram submetidos à hipóxia-reoxigenação. O grupo de baixa glicose desenvolveu apenas danos celulares ligeiros, apoptose e uma resposta inflamatória. Em contraste, no grupo de alta glicose, uma lesão equivalente de hipóxia-reoxigenação provocou danos celulares graves, apoptose e uma resposta inflamatória. A expressão de TLR7 e suas proteínas relacionadas foi medida no grupo de alta glicose antes e após a hipóxia-reoxigenação. O grupo de alta glicose exibiu maiores aumentos na expressão de TLR7 após hipóxia-reoxigenação do que o grupo de baixa glicose. Além disso, a expressão de TLR7 e suas proteínas relacionadas após a hipóxia-reoxigenação foi maior no grupo com alto nível de glicose do que no grupo com baixo nível de glicose. A inibição do TLR7 fornece proteção significativa contra a lesão isquêmica no diabetes. CONCLUSÃO Nossos resultados sugerem que o diabetes aumenta a vulnerabilidade à lesão renal induzida por isquemia. Essa vulnerabilidade acrescida tem por origem uma resposta inflamatória aumentada envolvendo a via de transdução de sinal do TLR7.


Subject(s)
Humans , Diabetes Mellitus/metabolism , Toll-Like Receptor 7/metabolism , Acute Kidney Injury/metabolism , Ischemia/metabolism , Transfection , Signal Transduction , Cells, Cultured , RNA, Small Interfering , Diabetes Mellitus/physiopathology , Toll-Like Receptor 7/physiology , Acute Kidney Injury/physiopathology , Flow Cytometry , Ischemia/physiopathology
11.
Geriatr., Gerontol. Aging (Impr.) ; 13(2): 118-120, abr-jun.2019. ilus
Article in Portuguese | LILACS | ID: biblio-1096825

ABSTRACT

O diabetes e suas complicações constituem as principais causas de mortalidade precoce na maioria dos países. O envelhecimento da população e a crescente prevalência da obesidade e do sedentarismo, além dos processos de urbanização, são considerados os principais fatores responsáveis pelo aumento da incidência e da prevalência do diabetes mellitus (DM) em todo o mundo. Este relato de caso objetiva descrever a presença de distúrbio do movimento em idoso por conta do estado hiperosmolar não cetótico. A combinação de hemicoreia-hemibalismo, hiperglicemia não cetótica e envolvimento dos gânglios da base em exames de imagem é considerada uma síndrome única. Os distúrbios do movimento em estado hiperosmolar não cetótico apresentam resposta terapêutica satisfatória com o uso de neurolépticos e controle glicêmico adequado. A escassez de trabalhos publicados proporciona subdiagnósticos clínico e laboratorial, interferindo no prognóstico e no acompanhamento dos pacientes.


Diabetes mellitus (DM) and its complications constitute the leading causes of early mortality in most countries. Population aging and the growing prevalence of obesity and sedentary lifestyles, in addition to spreading urbanization, are considered the main drivers of the increasing incidence and prevalence of DM worldwide. This case report describes the acute onset of movement disorder in an older woman secondary to hyperosmolar hyperglycemic state (HHS). The combination of hemichorea­hemiballismus, HHS, and evidence of basal ganglia involvement on neuroimaging is considered a unique syndrome. Movement disorders secondary to HHS respond satisfactorily to administration of neuroleptic agents and proper glycemic control. The lack of published studies on this pathologic entity may lead to clinical and laboratory underdiagnosis, with negative impacts on patient prognosis and follow-up.


Subject(s)
Humans , Female , Aged , Chorea/drug therapy , Chorea/diagnostic imaging , Hyperglycinemia, Nonketotic/complications , Dyskinesias/drug therapy , Dyskinesias/diagnostic imaging , Diabetes Complications , Psychotropic Drugs/therapeutic use , Diabetes Mellitus/physiopathology , Hypoglycemic Agents , Movement Disorders/diagnosis
12.
Arq. bras. cardiol ; 112(4): 453-460, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001278

ABSTRACT

Abstract Coronary artery disease (CAD) is one of the leading causes of mortality. High circulating levels of low-density lipoprotein (LDL) in the blood are associated with cardiovascular mortality, whether through an etiological role or through its association with the progression of CAD per se. Randomized clinical trials have shown that, when LDL levels are reduced, cardiovascular risk is also reduced, which reinforces this association. The first major trial involving a hypolipidemic agent of the statin family, the Scandinavian Simvastatin Survival Study (4S), was published in 1994 and found a significant reduction in mortality in patients at high cardiovascular risk. However, even in subsequent studies with different statins, a residual risk persisted, and this seems not to have changed over time; it is speculated that this risk may be due to statin intolerance. In this scenario, the potential exists for novel hypolipidemic agents to drive a true revolution in the therapy of dyslipidemia. The recent discovery of PCSK9 inhibitors (PCSK9i), a class of hypolipidemic monoclonal antibodies, is extremely promising. PCSK9 inhibition is capable of promoting a mean LDL reduction of up to 60%, with potential for very significant clinical repercussions, as every 38 mg/dL reduction in LDL appears to be associated with a 22% reduction in cardiovascular risk. This review addresses a brief history of PCSK9i, major trials of these drugs, cardiovascular outcomes, and aspects related to their efficacy and safety. Finally, the molecular mechanisms and possible pleiotropic effects of PCSK9i are also discussed.


Resumo A doença arterial coronariana (DAC) é uma das principais causas de mortalidade. Níveis circulantes elevados de lipoproteína de baixa densidade (LDL) no sangue estão associados com mortalidade cardiovascular, seja por um papel etiológico ou por sua associação com a progressão da DAC em si. Estudos clínicos randomizados mostram que, quando os níveis de LDL são reduzidos, o risco cardiovascular também é reduzido, o que reforça tal associação. O primeiro ensaio importante envolvendo um agente hipolipemiante da família da estatina, o estudo Scandinavian Simvastatin Survival Study (4S), foi publicado em 1994 e encontrou uma redução significativa na mortalidade de pacientes com risco cardiovascular elevado. Contudo, mesmo em estudos subsequentes com diferentes estatinas, observou-se um risco residual persistente, o qual aparentemente não mudou ao longo dos anos. Especula-se que esse risco se deve à intolerância às estatinas. Nesse cenário, existe um potencial para novos agentes hipolipemiantes que levem a uma verdadeira revolução no tratamento das dislipidemias. A descoberta recente dos inibidores de PCSK9 (PCSK9i), uma classe de anticorpos monoclonais, é extremamente promissora. A inibição da PCSK9 é capaz de promover uma redução média nos níveis de LDL de até 60%, com potencial para repercussões clínicas muito significativas, já que para cada redução de 38 mg/dL, parece haver uma redução de 22% no risco cardiovascular. Esta revisão aborda uma breve história dos PCSK9i, os principais ensaios envolvendo esses medicamentos, desfechos cardiovasculares, e aspectos relacionados a sua eficácia e segurança. Finalmente, os mecanismos moleculares e possíveis efeitos pleiotrópicos dos PCSK9i são também discutidos.


Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Proprotein Convertase 9/antagonists & inhibitors , Hypercholesterolemia/drug therapy , Cholesterol, LDL/drug effects , Anticholesteremic Agents/therapeutic use , Cardiovascular Diseases/etiology , Reproducibility of Results , Risk Factors , Risk Assessment , Diabetes Mellitus/physiopathology , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal, Humanized/pharmacology , Hypercholesterolemia/complications , Cholesterol, LDL/blood , Anticholesteremic Agents/pharmacology
13.
Rev. Soc. Bras. Clín. Méd ; 17(1): 15-20, jan.-mar. 2019. tab., graf.
Article in Portuguese | LILACS | ID: biblio-1025963

ABSTRACT

Objetivo: Demonstrar a prevalência da hipovitaminose D em trabalhadores de turno de uma empresa de mineração e verificar se, nesta população, há correlação entre as variáveis glicêmicas (hemoglobina glicada e glicemia de jejum) e os níveis séricos de vitamina D. Métodos: Estudo transversal observacional realizado por 2 anos consecutivos com trabalhadores de turno. No primeiro ano, foram analisados os níveis séricos de vitamina D (25(OH)D) e glicemia de jejum, excluindo indivíduos que realizavam tratamento para controle glicêmico, suplementação de vitamina D e/ou participantes do sexo feminino, totalizando 548 trabalhadores. No ano seguinte, foram selecionados da amostra anterior apenas os indivíduos que apresentaram hipovitaminose D (25(OH) D<30ng/mL). Nestes, foram analisados os níveis de 25(OH)D, glicemia de jejum e hemoglobina glicada. Foram aplicados o teste de normalidade Kolmogorov-Smirnov e a correlação de Spearman. Resultados: A idade média dos participantes foi de 38,2 anos. No primeiro ano, 80,8% dos trabalhadores apresentaram hipovitaminose D e 10,8% apresentavam glicemia de jejum fora dos níveis de normalidade. Dentre a amostra do ano seguinte, 81,1% permaneceram com hipovitaminose D, 18,2% apresentaram glicemia de jejum fora dos níveis de normalidade e 15,8% apresentaramhemoglobina glicada alterada. Não foram encontradas correlações significativas entre a 25(OH)D e a glicemia de jejum e hemoglobina glicada. Conclusão: Foi observada alta prevalência de hipovitaminose nos trabalhadores de turno. Diferentemente de outros estudos, não foram encontradas correlações significativas entre as variáveis glicêmicas e a concentração sérica da vitamina D. (AU)


Objective: To demonstrate the prevalence of hypovitaminosis D in shift workers of a mining company, and to check whether, in this population, there is a correlation between glycemic variables (glycosylated hemoglobin and fasting plasma glucose)- and serum levels of vitamin D. Methods: These are cross-sectional observational studies performed in two consecutive years with shift workers. In the first year, the serum levels of vitamin D (25(OH)D) and fasting plasma glucose were analyzed, with people who underwent treatment for glycemic control, vitamin D supplementation, and/or female participants being excluded, totalizing 548 workers. In the following year, only those individuals who presented hypovitaminosis D (25 (OH) D <30 ng/dL) were selected from the previous sample. The levels of 25 (OH) D, fasting plasma glucose, and HbA1C of these individuals were analyzed. The Kolmorogov-Smirnov normality test and the Spearman correlation were applied. Results: Th e m ean a ge o f participants was 38.2 years. In the first year, 80.8% (n=442) of the workers presented hypovitaminosis D, and 10.8% had fasting plasma glucose out of normal levels. Among the sample of the following year, 81.1% remained with hypovitaminosis D, 18.2% (n=51) had fasting glycemia out of normal levels, and 15.8% (n=44) had altered glycosylated hemoglobin. Conclusion: A high prevalence of hypovitaminosis in shift workers was observed. Differently from other studies, no significant correlations were found between glycemic variables and serum vitamin D concentration. (AU)


Subject(s)
Humans , Male , Adult , Middle Aged , Vitamin D Deficiency/epidemiology , Glycemic Index/physiology , Miners/statistics & numerical data , Shift Work Schedule/statistics & numerical data , Vitamin D/blood , Vitamin D Deficiency/diagnosis , Blood Glucose/analysis , Glycated Hemoglobin A/analysis , Prevalence , Cross-Sectional Studies , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology
14.
Clinics ; 74: e560, 2019. tab, graf
Article in English | LILACS | ID: biblio-989632

ABSTRACT

OBJECTIVE: To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS: We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS: The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS: The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.


Subject(s)
Humans , Male , Female , Middle Aged , Body Composition , Obesity, Morbid/diet therapy , Weight Loss/physiology , Diet, Reducing/methods , Bariatric Surgery , Obesity, Morbid/surgery , Preoperative Care/methods , Body Mass Index , Sex Factors , Prospective Studies , Age Factors , Diabetes Mellitus/diet therapy , Diabetes Mellitus/physiopathology , Waist Circumference , Hip/anatomy & histology , Hospitalization/statistics & numerical data , Neck/anatomy & histology
15.
Med. interna (Caracas) ; 35(1): 3-9, 2019.
Article in Spanish | LILACS, LIVECS | ID: biblio-1000244

ABSTRACT

El uso de dosis baja de aspirina en prevención primaria de eventos cardiovasculares (CV) en sujetos sanos o aparentemente sanos es un tópico ampliamente debatido. Muchos argumentos indican que la "prevención primaria" es solo una definición convencional y que la transición a la prevención secundaria representa un continuo de elevación de valores del riesgo CV. Aunque no hay pruebas consistentes de la eficacia de la aspirina en diferentes niveles de riesgo CV, en las poblaciones de riesgo bajo parece ser menos eficiente. Esta revisión de los tres nuevos estudios aleatorios señalan que tanto los adultos aparentemente sanos y los pacientes con diabetes obtienen muy poco beneficio protector de la aspirina considerando el incremento en el riesgo de eventos de sangrado severo.(AU)


The use of low-dose aspirin in primary prevention of cardiovascular (CV) events in healthy or apparently healthy people is a widely debated topic. Many arguments indicate that "primary prevention" is only a conventional definition and that the transition from primary to secondary prevention represents a continuum of increasing levels of CV risk. Although there are no consistent proofs of efficacy of aspirin at different CV risk levels, in low-risk population aspirin appear to be less efficient. This review of three new randomized trials indicated that both the apparently healthy adults and patients with diabetes would derive little protective benefit from aspirin considering the increased risk of severe bleeding events(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Blood Coagulation/drug effects , Coronary Thrombosis/diagnosis , Aspirin/administration & dosage , Diabetes Mellitus/physiopathology , Primary Prevention , Cardiovascular Diseases , Stroke
17.
In. Negrão, Carlos Eduardo; Pereira-Barretto, Antônio Carlos; Rondon, Maria Urbana Pinto Brandão. Cardiologia do exercício: do atleta ao cardiopata / Exercise cardiology: from athlete to heart disease. São Paulo, Manole, 4ª; 2019. p.335-383.
Monography in Portuguese | LILACS | ID: biblio-1015678
18.
Rev. bras. enferm ; 72(supl.2): 30-35, 2019. tab
Article in English | LILACS, BDENF | ID: biblio-1057636

ABSTRACT

ABSTRACT Objective: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. Method: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. Results: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). Conclusion: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.


RESUMEN Objetivo: evaluar los factores asociados al riesgo de diabetes mellitus en ancianos cuidadores. Método: se trata de un estudio transversal, en el cual participaron 326 ancianos cuidadores registrados en Unidades de Salud de la Familia. Se utilizó en la recolección de datos un cuestionario de caracterización sociodemográfica, de informaciones clínicas y del cuidado, y en la evaluación del riesgo de desarrollo de la diabetes el Finnish Diabetes Risk Score. Resultados: el 35,5% de los cuidadores presentaron un alto riesgo de desarrollo de diabetes. Los factores asociados al riesgo de desarrollo fueron: el uso de medicamentos (OR = 3,88), la evaluación de la salud como regular o negativa (OR = 1,72) y ser del sexo femenino (OR = 0,48). Conclusión: más de un tercio de los los ancianos cuidadores presentaron un alto riesgo de desarrollo de diabetes. Por lo tanto, el hecho de ser del sexo femenino, residir con más personas, hacer uso de medicamentos y tener una evaluación negativa de la salud son los factores asociados al aumento de ese riesgo.


RESUMO Objetivo: avaliar os fatores associados ao risco de diabetes mellitus em idosos cuidadores. Método: trata-se de um estudo transversal, realizado com 326 idosos cuidadores cadastrados em Unidades de Saúde da Família. Para a coleta de dados utilizou-se um questionário de caracterização sociodemográfica, informações clínicas e do cuidado, e o Finnish Diabetes Risk Score para a avaliação do risco de desenvolvimento de diabetes. Resultados: dos cuidadores, 35,5% apresentaram alto risco de desenvolvimento de diabetes. Os fatores associados ao risco de desenvolvimento foram o uso de medicamentos (OR = 3,88), a avaliação da saúde regular ou negativa (OR = 1,72) e ser do sexo feminino (OR = 0,48). Conclusão: mais de um terço dos idosos cuidadores apresentam alto risco de desenvolvimento de diabetes. Portanto, ser do sexo feminino, residir com mais pessoas, fazer uso de medicamentos e ter uma avaliação negativa da saúde são fatores associados ao aumento desse risco.


Subject(s)
Humans , Male , Female , Adult , Aged , Caregivers/statistics & numerical data , Diabetes Mellitus/diagnosis , Socioeconomic Factors , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Caregivers/classification , Diabetes Mellitus/physiopathology , Middle Aged
19.
Actual. osteol ; 14(3): 205-218, sept. - dic. 2018. ilus., graf.
Article in Spanish | LILACS | ID: biblio-1052695

ABSTRACT

La diabetes es una enfermedad crónica asociada con importantes comorbilidades. El sistema esquelético parece ser un objetivo adicional de daño mediado por diabetes. Se acepta que la diabetes tipo 1 y tipo 2 se asocian con un mayor riesgo de fractura ósea. Varios estudios han demostrado que los cambios metabólicos causados por la diabetes pueden influir en el metabolismo óseo disminuyendo la calidad y la resistencia del hueso. Sin embargo, los mecanismos subyacentes no se conocen por completo pero son multifactoriales y, probablemente, incluyen los efectos de la obesidad, hiperglucemia, estrés oxidativo y acumulación de productos finales de glicosilación avanzada. Estos darían lugar a un desequilibrio de varios procesos y sistemas: formación de hueso, resorción ósea, formación y entrecruzamiento de colágeno. Otros factores adicionales como la hipoglucemia inducida por el tratamiento, ciertos medicamentos antidiabéticos con un efecto directo sobre el metabolismo óseo y mineral, así como una mayor propensión a las caídas, contribuirían al aumento del riesgo de fracturas en pacientes con diabetes mellitus. Esta revisión tiene como objetivo describir los mecanismos fisiopatológicas subyacentes a la fragilidad ósea en pacientes diabéticos. (AU)


Diabetes is a chronic disease associated with important comorbidities. The skeletal system seems to be an additional target of diabetes mediated damage. It is accepted that type 1 and type 2 diabetes are associated with an increased risk of bone fracture. Several studies have shown that metabolic changes caused by diabetes can influence bone metabolism by decreasing bone quality and resistance. However, the underlying mechanisms are not completely known but they are multifactorial and probably include the effects of obesity, hyperglycemia, oxidative stress and accumulation of advanced glycosylation end products. These would lead to an imbalance of several processes and systems: bone formation, bone resorption, formation and collagen crosslinking. Other additional factors such as treatment-induced hypoglycemia, certain antidiabetic medications with a direct effect on bone and mineral metabolism, as well as an increased propensity for falls, would contribute to the increased risk of fractures in patients with diabetes mellitus. This review aims to describe the pathophysiological mechanisms underlying bone fragility in diabetic patients. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Osteogenesis Imperfecta/physiopathology , Diabetes Mellitus/physiopathology , Osteogenesis Imperfecta/metabolism , Osteogenesis Imperfecta/drug therapy , Osteoporosis/diagnosis , Bone and Bones/metabolism , Glycosylation , Risk Factors , Oxidative Stress , Diabetes Mellitus/metabolism , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Fractures, Bone/complications , Fractures, Bone/prevention & control , Hyperglycemia/complications , Hypoglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Obesity/complications
20.
Rev. méd. Chile ; 146(11): 1317-1324, nov. 2018.
Article in Spanish | LILACS | ID: biblio-985705

ABSTRACT

The 2017 Guidelines on hypertension of the American College of Cardiology and American Heart Association, which proposed values of 130/80 mmHg as the cutoff points for the onset of hypertension, aroused great interest. This recommendation is based in the SPRINT study (The Systolic Pressure Intervention Trial), which included hypertensive patients over 50 years of age, non-diabetic, without a history of stroke and with a low representation of subjects with a history of coronary artery disease (16%). A group with intensive anti-hypertensive therapy (pressure achieved 121.5 mmHg) achieved a significantly lower cardiovascular risk as compared with a group with standard therapy (pressure achieved 134.6 mmHg). The Guide proposes immediate pharmacological therapy in diabetic hypertensive patients, in those with stage 3 chronic kidney disease or with persistent albuminuria, and in patients with atherosclerotic disease. The Guideline does not include the management of isolated systolic hypertension of the elderly and did not consider studies that show an increased risk when pressure is reduced below 130/80 mmHg in patients with coronary disease, peripheral vascular disease, diabetes mellitus or chronic renal failure. The new classification of hypertension would increase the number of hypertensive patients in our country by more than one million, would increase the risk associated with diastolic pressure reductions in older adults and ignores the evidence indicating a risk associated with reductions below 130/80 mmHg in patients with diabetes, with chronic renal failure or with atherosclerotic disease. Therefore, it is advisable to maintain a threshold of 140/90 mmHg and perform a careful and gradual management of blood pressure in the latter group of hypertensive patients.


Subject(s)
Humans , Practice Guidelines as Topic/standards , Hypertension/physiopathology , Hypertension/therapy , Reference Values , Cardiovascular Diseases/physiopathology , Risk Factors , Coronary Disease/physiopathology , Diabetes Mellitus/physiopathology , Renal Insufficiency, Chronic/physiopathology , Hypertension/classification
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