Effects of Weight Loss and Interaction with Physical Activity on Risks of Cardiovascular Outcomes in Individuals with Type 2 Diabetes

Background@#This study investigated the effects of weight loss during follow-up on cardiovascular outcomes in a type 2 diabetes cohort and tested interactions with clinical and laboratory variables, particularly physical activity, that could impact the associations. @*Methods@#Relative weight changes were assessed in 651 individuals with type 2 diabetes and categorized as ≥5% loss, <5% loss, or gain. Associations between weight loss categories and incident cardiovascular outcomes (total cardiovascular events [CVEs], major adverse cardiovascular events [MACEs], and cardiovascular mortality) were assessed using multivariable Cox regression with interaction analyses. @*Results@#During the initial 2 years, 125 individuals (19.2%) lost ≥5% of their weight, 180 (27.6%) lost <5%, and 346 (53.1%) gained weight. Over a median additional follow-up of 9.3 years, 188 patients had CVEs (150 MACEs) and 106 patients died from cardiovascular causes. Patients with ≥5% weight loss had a significantly lower risk of total CVEs (hazard ratio [HR], 0.52; 95% confidence interval, 0.33 to 0.89; P=0.011) than those who gained weight, but non-significant lower risks of MACEs or cardiovascular deaths. Patients with <5% weight loss had risks similar to those with weight gain. There were interactions between weight loss and physical activity. In active individuals, ≥5% weight loss was associated with significantly lower risks for total CVEs (HR, 0.20; P=0.004) and MACEs (HR, 0.21; P=0.010), whereas in sedentary individuals, no cardiovascular protective effect of weight loss was evidenced. @*Conclusion@#Weight loss ≥5% may be beneficial for cardiovascular disease prevention, particularly when achieved with regular physical activity, even in high-risk individuals with long-standing type 2 diabetes.

Reflex cardioinhibitory syncope potentially related to SARS-CoV-2 infection: a case report / Síncope cardioinibitória reflexa potencialmente relacionada à infecção por SARS-CoV-2: um relato de caso

Autonomic dysfunction related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is increasingly described in the literature. We report the case of a 30-year-old male with a background of asthma and migraine who experienced a second episode of SARS-CoV-2 infection characterized by mild respiratory symptoms. Twenty-four days after the symptom onset, he developed acute syncope. A tilt test revealed a neuromediated cardioinhibitory response with asystole (Vasovagal Syncope International Study ­ VASIS type 2B). The temporal association between SARS-CoV-2 infection and syncope seems to indicate a probable causal relationship, which requires corroboration by future studies.

Disfunção autonômica relacionada à infecção por coronavírus-2 da síndrome respiratória aguda grave (SARS-CoV-2) vem sendo cada vez mais descrita na literatura. Relatamos o caso de um homem de 30 anos de idade, com histórico de asma e enxaqueca, que apresentou um segundo episódio de infecção por SARS-CoV-2 caracterizado por sintomas respiratórios leves. Vinte e quatro dias após o início dos sintomas, desenvolveu um quadro agudo de síncope. Um teste de inclinação revelou uma resposta cardioinibitória neuromediada com assistolia (Vasovagal Syncope International Study ­ VASIS tipo 2B). A associação temporal entre infecção por SARS-CoV-2 e síncope parece indicar uma provável relação causal, a qual requer corroboração por estudos futuros.

Prenatally programmed hypertension: role of maternal diabetes

Epidemiological and experimental studies have led to the hypothesis of the fetal origin of adult diseases, suggesting that some adult diseases might be determined before birth by altered fetal development. Maternal diabetes subjects the fetus to an adverse environment that has been demonstrated to result in metabolic, cardiovascular and renal impairment in the offspring. The growing amount of obesity in young females in developed and some developing countries should contribute to increasing the incidence of diabetes among pregnant women. In this review, we discuss how renal and extrarenal mechanisms participate in the genesis of hypertension induced by a diabetic status during fetal development.

Effect of D-alpha-tocopherol on tubular nephron acidification by rats with induced diabetes mellitus

The objective of the present study was to determine if treatment of diabetic rats with D-alpha-tocopherol could prevent the changes in glomerular and tubular function commonly observed in this disease. Sixty male Wistar rats divided into four groups were studied: control (C), control treated with D-alpha-tocopherol (C + T), diabetic (D), and diabetic treated with D-alpha-tocopherol (D + T). Treatment with D-alpha-tocopherol (40 mg/kg every other day, ip) was started three days after diabetes induction with streptozotocin (60 mg/kg, ip). Renal function studies and microperfusion measurements were performed 30 days after diabetes induction and the kidneys were removed for morphometric analyses. Data are reported as means ± SEM. Glomerular filtration rate increased in D rats but decreased in D + T rats (C: 6.43 ± 0.21; D: 7.74 ± 0.45; D + T: 3.86 ± 0.18 ml min-1 kg-1). Alterations of tubular acidification observed in bicarbonate absorption flux (JHCO3) and in acidification half-time (t/2) in group D were reversed in group D + T (JHCO3, C: 2.30 ± 0.10; D: 3.28 ± 0.22; D + T: 1.87 ± 0.08 nmol cm-2 s-1; t/2, C: 4.75 ± 0.20; D: 3.52 ± 0.15; D + T: 5.92 ± 0.19 s). Glomerular area was significantly increased in D, while D + T rats exhibited values similar to C, suggesting that the vitamin prevented the hypertrophic effect of hyperglycemia (C: 8334.21 ± 112.05; D: 10,217.55 ± 100.66; D + T: 8478.21 ± 119.81æm²). These results suggest that D-alpha-tocopherol is able to protect rats, at least in part, from the harmful effects of diabetes on renal function.

Plasmaféresis indicada por enfermedad neurológica: experiencia de 140 procedimientos en 47 pacientes / Plasmapheresis in neurological diseases: experience in 140 procedures in 47 patients

Background: Plasmapheresis can be useful in myasthenia gravis, Guillain BarrÚ syndrome and chronic demyelinating inflamatory polyradiculoneuritis. Aim: To report our experience with plasmapheresis in patients with neurological diseases. Material and methods: Retrospective review of plasmapheresis procedures done between 1995 and 2001, in a public hospital. Indications criteria, clinical results and technical yield were analyzed. Results: One hundred fifty nine procedures were reviewed. One hundred forty (88 percent) were indicated for neurological diseases (44 percent for Guillain BarrÚ syndrome and 29 percent for myasthenia gravis). Clinical improvement or eventual complications were avoided in 70 percent of patients with Guillain BarrÚ syndrome and 100 percent of patients with myasthenia gravis. Hypotension in 10 percent and paresthesias in 7 percent were observed. All complications were successfully controlled with crystalloid or fresh plasma infusions or citrate management. In 11 cases, the procedure was interrupted due to obstruction of the venous access, that was peripheral in eight of these. The most common difficulties of the procedure were delay in performing it in 50 percent of patients and insufficient exchange volumes in 30 percent. Conclusions: Plasmapheresis was safe and useful in patients with myasthenia gravis and Guillain BarrÚ syndrome. The drawbacks of the procedure are its costs and requirement of special equipment (Rev MÚd Chile 2004; 132: 295-8).

Algas marinas de Baja California Sur, México: valor nutrimental / Marine algae of Baja California Sur, Mexico: nutritional value

The Baja California Peninsula is one of the richest regions of seaweed resources in México. The objective of this study was to determine the chemical composition of some marine algae species of Baja California Sur, with an economical potential due to their abundance and distribution, and to promote their use as food for human consumption and animal feeding. The algae studied were Green (Ulva spp., Enteromorpha intestinalis, Caulerpa sertularoides, Bryopsis hypnoides), Red (Laurencia johnstonii, Spyridia filamentosa, Hypnea valentiae) and Brown (Sargassum herporizum, S. sinicola, Padina durvillaei, Hydroclathrus clathrathus, Colpomenia sinuosa). The algae were dried and ground before analysis. In general, the results showed that algae had a protein level less than 11 per cent, except L. johnstonii with 18 per cent and low energy content. The ether extract content was lower than 1 per cent. However, the algae were a good source of carbohydrates and inorganic matter.

Malnutrition as an additional risk factor to gentamicin nephrotoxicity / Desnutrição como um fator de risco adicional na nefrotoxidade à gentamicina

A relação entre a desnutrição e as doenças infecciosas tem sido descrita há algum tempo. A gentamicina é um antibiótico aminoglicosídeo muito utilizado no tratamento de infecções graves por gram-negativos, apesar de sua nefrotoxidade. Estudos experimentais e clínicos também mostraram alterações importantes na função renal durante a desnutrição. Assim sendo, o objetivo do presente estudo foi verificar se o uso da gentamicina (G) em ratos submetidos à restrição alimentar (R) pode interferir no desenvolvimento da nefrotoxidade à gentamicina. Ratos Wistar machos com dois meses de idade foram submetidos à restrição alimentar (50 porcento) durante 30 dias. Nos 10 últimos dias, eles foram tratados com soro fisiológico ou gentamicina (40mg/kg/dia intraperitoneal). Os grupos estudados foram: C)- ratos com alimentação ad libitum + soro fisiológico, G)- alimentação ad libitum + gentamicina, R)- restrição alimentar + soro fisiológico, RG)- restrição alimentar + gentamicina. Uma queda significativa na taxa de filtração glomerular (TFG) foi observada nos grupos R (5,69 ± 0,22) e G (5,31 ± 0,27) se comparados ao grupo C (7,17 ± 0,42 ml.min kg). No grupo RG, a diminuição a TFG foi mais evidente do que nos grupos G ou R, (4,42 ± 0,24 ml.min-1.kg-1). Em todos os grupos experimentais, a diminuição da TFG ocorreu paralelamente à diminuição do fluxo plasmático renal (FPR), de modo que a fração de filtração (FF porcento) foi mantida. Um declínio na proporção inulina urina/plasma foi observado em ambos os grupos tratados com gentamicina e também no grupo com restrição alimentar. Apesar de G e R "per se" causarem um aumento na excreção de Na elevado a +, os valores mais altos foram obtidos no grupo RG. Apesar do nosso estudo ter sido realizado num modelo experimental, se extrapolado a protocolos humanos pode-se sugerir que o uso de antibióticos aminoglicosídeos nos pacientes desnutridos deve ser feito com cautela, especialmente devido a função renal e considerando o risco aumentado potencial exibido por estes pacientes.

Effects of dietary lipids on renal function of aged rats

Normal aging is accompanied by renal functional and morphological deterioration and dietetic manipulation has been used to delay this age-related decline. We examined the effects of chronic administration of diets containing 5 percent lipid-enriched diet (LD, w/w) on renal function of rats at different ages. Three types of LD were tested: canola oil, fish oil and butter. Mean systemic tail-cuff blood pressure and glycemia remained within the normal range whatever the age and the diet of the animals. Proteinuria began to rise from the 8th month in the groups ingesting LD, while in the control group it increased significantly (above 10 mg/24 h) only after the 10th month. With age, a significant and progressive decline in glomerular filtration rate (GFR) and renal plasma flow was observed in the LD groups but after 6 months of lipid supplementation, the decline in these parameters was more marked in the butter and fish oil groups. By the 18th month, the lowest GFR level was observed in the group ingesting the butter diet (2.93 + or - 0.22 vs 5.01 + or - 0.21 ml min-1 kg-1 in control, P<0.05). Net acid excretion, evaluated in 9- and 18-month-old rats, was stimulated in the fish oil group when compared both to control and to the other two LD groups. These results suggest that even low levels of LD in a chronic nutritional regimen can modify the age-related changes in renal function and that the impact of different types of lipid-supplemented diets on renal function depends on the kind of lipid present in the diet

Effect of thyroparathyroidectomy on urinary acidification in diabetic rats

In previous studies we have shown stimulation of renal acid excretion in the proximal tubules of rats with diabetes of short duration, with no important alterations in glomerular hemodynamics; on the other hand, in thyroparathyroidectomized rats (TPTX model), a significant decrease in renal acid excretion, glomerular filtration rate (GFR) and renal plasma flow (RPF) was detected. Since important changes in the parathyroid hormone-vitamin D-Ca axis are observed in the diabetic state, the present study was undertaken to investigate the renal repercussions of thyroparathyroidectomy in rats previously made diabetic by streptozotocin (45 mg/kg). Four to 6 days after the induction of diabetes (DM), a group of rats were thyroparathyroidectomized (DM + TPTX). Renal functional parameters were evaluated by measuring the inulin and sodium para-aminohippurate clearance on the tenth day. The decrease in the GFR and RPF observed in TPTX was not reversed by diabetes since the same alterations were observed in DM + TPTX. Net acid (NA) excretion was unchanged in DM (6.19 ± 0.54), decreased in TPTX (3.76 ± 0.25) and returned to normal levels in DM + TPTX (5.54 ± 0.72) when compared to the control group (6.34 ± 0.14 µmol min-1 kg-1). The results suggest that PTH plays an important vasodilator role regarding glomerular hemodynamics, since in its absence the impairment in GFR and RPF was not reversed by the diabetic state. However, with respect to acid excretion, the presence of diabetes was able to overcome the negative stimulus represented by TPTX

La cobertura de la vacuna de Fiebre Amarilla en Santa Cruz - Bolivia entre 1980 y 1999 / The covering of the vaccine against the Yellow Fever, in Santa Cruz - Bolivia, between 1980 and 1997

La prevencion mas afectiva contra la fiebre amarilla es la vacunacion y la estrategia con mayor costo beneficio para lograr coberturas eficaces es la vacunacion sistematica de la poblacion en riesgo y de futuras generaciones mediante el programa ampliado de Inmunizacion (PAI). Como en otros paises en Africa y America Latina, Bolivia no logro implementar esta estrategia por falta de vacunas. Del otro lado de Bolivia cuenta con una ciudad como Santa Cruz de la Sierra con 1 millon de habitantes en alto riesgo. A fin de estimar la cobertura de vacunacion actual contra la fiebre amarilla en la ciudad de Santa Cruz, se revisaron la literatura cientifica, las estadisticas nacioales y los informes de encuestas realizada a partir del 1980 y se entrevisto a personas claves. La mayoria de las campaña de vacunacion en el Dpto. de Santa Cruz fueron organizadas para contrarrestar brotes de fiebre amarilla selvatica. con la campaña masiva en 1982 en la ciudad de Santa Cruz se llego a una cobertura de 87 por ciento (IC 95 por ciento 81-93) de la poblacion urbana. Los esfuerzos de vacunacion posteriores fueron limitados y no lograron compensar el crecimiento de mas de 200 por ciento de la poblacion. La cobertura bajo a 35 por ciento (IC95 por ciento 31-39) en 1990 y la mejor estimacion de la proteccion inmunitaria para 1997 es de 41 por ciento 41 por ciento (IC 95 por ciento 35-47) para los mayores. Los niños y residentes de zonas perifericas de la ciudad tienen una cobertura menor. La informacion mas confiable proviene de seroencuestas. Los datos obtenido mediante entrevista sobreestiman la cobertura y la falta de datos rutinarios desglosados por ciudad y zona rural junto con el problema de la revacunacion impiden el calculo de la cobertura. Los datos recolectados demuestran que la cobertura actual es insuficiente para proteger la poblacion de la ciudad. Se estima la necesidad de vacunas para una campaña entre 500,000 y 650,000 y se recomienda priorizar los barrios perifericos, los migrantes y todas las personas nacidas despues de 1982 y posteriormente integrar la vacuna contra la fiebre amarilla en el PAI

Renal effect of gentamicin in diabetic rats

To evaluate the protective effect of diabetes mellitus (DM) on renal function of rats treated with gentamicin (GM), male Wistar-EPM rats (250-350 g) were treated with streptozotocin (SZ; 45 mg/kg) and starting 10 days after induction of diabetes, GM was given for ten consecutive days at a daily dose of 40 mg/kg. In the GM-treated group (G), a significant fall in inulin and sodium-p-aminohippurate clearance was obtained (3.57 + or - 0.16 and 12.59 + or - 0.61 ml min-1kg-1 vs 6.43 + or - 0.21 and 17.98 + or - 0.47 ml min-1 kg-1 in control rats (C), respectively) while in the animals previously injected with SZ (diabetic + gentamicin, DG group) these changes injected with SZ (diabetic + gentamicin, DG group) these changes were not observed. The diabetic (D), g and DG group showed a significant rise in urinary flow compared to C (0.165 + or - 0.009, 0.145 + or - 0.007 and 0.173 + or - 0.009 ml min-1kg-1 vs 0.109 + or - 0.003 ml min-1kg-1, respectively); however, only in G was the U/P inulin ration significantly decreased when compared to C. The fractional excretion (FE) of sodium and postassium was significantly augmented in G when compared to C, D and DG. Thus, diabetes protected against gentamicin nephrotoxicity at both the glomerular and tubular level, although it did not promote a reduction in urinary flow

Function and morphometric evaluation of intrauterine undernutrition on kidney development of the progeny

Renal function and renal morphometry of the progeny of rats submitted to 50% dietary restriction (pairfed with control group) throughout pregnancy (Rtgroup), during the first half of pregnancy (R1 group) or during the second half of pregnancy (R2 group) were studied 3 months after birth. Glomerular filtration rate (GFR) and renal plasma flow (RPF) decrease significantly in all groups when compared to control (C) (GFR, 4.44 ñ 0.12, 4.04 ñ 0.18, and 4.00 ñ 0.16 vs 6.87 ñ 0.17, and RPF, 19.06 ñ0.57, 17.00 ñ 1.14, and 13.31 ñ0.50 vs 22.57 ñ 0.67, respectively). Urinary osmolality tended to be lower in the R2 and Rt groups (887.1 ñ 42.36 and 868.0 ñ 42.36 vs 975.1 ñ 38.31 in C), and the net acid excretion calculated per ml of GFR was either maintained or stimulated (R1 group). A significant decline in the number of glomeruli occurred in R1, R2 and Rt rats (79.84 ñ 2.08, 62.30 ñ 2.07, and 58.16 ñ 2.32 vs 99.77 ñ 2.28 in C repectively). The results show that intrauterine undernutrition actually caused a deleterious effect on the number of functional nephrons

Effects of parathyroid hormone on urinary acidification in the rat

To evaluate the effects of parathyroid hormone (PTH) on urinary acidification parameters, thyroparathyroidectomy was performed in normal (TPTX) and in calcium-supplemented rats (TPTX+Ca2**). Both groups were supplemented with thyroxin. Glomerular filtration rate (GFR) fell from 7.79 ñ 0.33 in the control group (C) to 4.88 ñ 0.26 ml min**-1Kg**-1 in TPTX, while net acid excretion fell from 5.65 ñ 0.22 in C to 3.76 ñ 0.26 µmol min**1Kg in TPTX. Kinetic dat of urinary acidification obtained by microperfusion techniques in proximal tubules showed that the half-time of acidification (t/2) rose from 4.75 ñ 0.24 s in C to 8.97 ñ 0.64s in TPTX and persisted elevated in TPTx +Ca**2+ (7.40 ñ 0.43s); in the latter group, stationary pH was not significantly different from that of the control group. Bicarbonate reabsorption (J**HCO3) fell from 2.18 ñ 0.15 in C to 0.823 ñ 0.082 in TPTX and was 1.53 ñ 0.073 nmol s**-1 cm**-2 in TPTX+Ca**2+. These suggest that normal pH gradients depend on normal calcium levels, but acidification half-times are dependent on PTH, which also contributes keeping glomerular hemodynamics and acidification rates at normal levels

Effects of intrauterine undernutrition on the renal function of the progeny

The progency of rats submitted to 50% food restriction during a) the first 11 days of pregnancy (R1 group) and b) the entire period of pregnancy (RT group) was studied for renal function. After birth, the litter was left with the mother for 28 days and allowed free access to food and water until the experimental time, which occurred 3 months after birth. Glomerular filtration rate (GFR), renal plasma flow (RPF) and urinary flow (V) decreased significantly in both the Rl and RT groups when compared to control rats (C) (GFR = 4.44 + or 0 0.12 and 4.26 + or - 0.17 vs 6.95 + or - 0.25, and RPF = 19.06 + or - 0.57 and 12.59 + or - 0.60 vs 24.64 + or - 1.18). However, net acid excretion calculated per ml GFR was maintained or even stimulated (AB = 12.63 + or - 0.44 and 8.31 + or - 0.29 vs 7.97 + or - 0.85). The results show that a definite impairment of glomerular hemodynamics is demonstrable 3 months after birth in the progeny of mothers submitted to severe food restriction during pregnancy, even when the progeny have been on a normal diet for 2 months after suckling

The renal effects of kainic acid

the respone of juvenile cultivated Piaractus mesopotamicus to handling stress, whthout anesthesia, was determined over 3-5 min (T1), 1 h (T2) and 6 h (T3) afeter capture. Plasma cortisol, glucose and total cholesterol were measured. Hyperglycemia present at T2 continued to rise until T3 while plasma cortisol levels increased but were similar at T2 and T3. Total plasma cholesterol was altered only at T3. Hyperglycemic changes were greater in fish without than stomach contents during the T2-T3 period. These differences in hyperglycemic changes may reflect the role of hormones other than cortisol in the regulation of glucose release in these fish

Evaluation of distal tubular function in aminoglycoside induced nephropathy

Acute metabolic acidosis potentiates the nephrotixicity of aminoglycosides by impairing the adequate excretion of ammonium and titratable acidity. The present study assesses distal tubular function after aminoglycoside administration in the rat. Two aminoglycosides, gentamicin and netilmicin were given to rats either in low doses equivalent to those used clinically (BG4 and BN5 groups) or in doses ten times higher (BG40 and BN50). The rats were subjected to acute metabolic alkalosis and the pCO2 of urine was continuously evaluated. the regression lines obtained by plotting the differences between urine and blood pCO2 as a function of urinary HCO3 in low dose models were simsilar to those obtained for the control group. However, the slopes obtained for BG40 and BN50 were significantly different from the control, suggesting an impairment of H+ secretion

Cetoacidosis alcoholica. Informe de un caso y consideraciones fisiopatologicas. / Alcoholic ketoacidosis. Report of a case and physiopathological considerations

Se informa un caso de cetoacidosis alcoholica en el que las determinaciones de glucosa, betahidroxibutirato y cortisol en suero resultaron elevadas. La medicion de hormona del crecimiento fue normal y la de insulina baja relativa al nivel de glucosa correspondiente. Aunque no se observo aumento del lactato, la relacion lactato/piruvato estuvo elevada. El tratamiento fue con bolo unico de 10 u. de insulina regular y liquidos intravenosos glucosados. La curva de tolerancia a la glucosa realizada despues del evento agudo fue normal.Por lo anterior y dentro de ciertos limites, se puede descartar que el sujeto fuera diabetico. Se revisan ademas los conceptos actuales de la fisiopatologia en la cetoacidosis alcoholica