Desfecho clínico de pessoas com diabetes infectadas pelo SARS-CoV-2 que desenvolveram Síndrome Respiratória Aguda Grave, Brasil / Clinical outcomes of SARS-CoV-2 infected people with diabetes who developed Severe Acute Respiratory Syndrome in Brazil

Objetivo: Comparar os desfechos clínicos de pessoas com e sem Diabetes Mellitus tipo 2 (DM 2), infectadas pelo SARS-CoV-2, que desenvolveram Síndrome Respiratória Aguda Grave (SRAG) no Brasil. Métodos: Trata-se de um estudo transversal realizado a partir de análise da ficha de notificação compulsória de Síndrome Respiratória Aguda Grave Hospitalizado, obtidas no DATASUS. Foram analisados homens e mulheres com e sem DM2, infectados pelo SARS-CoV-2 e notificados como SRAG no período de fevereiro de 2020 a maio de 2021. Foram identificados os desfechos: hospitalização, admissão em Unidade de Terapia Intensiva (UTI) e óbito. Em seguida, a porcentagem de cada desfecho entre pessoas com DM2 foi comparada com a de pessoas não-diabéticas infectadas no mesmo período, utilizando o teste de Qui-Quadrado, com intervalo de confiança de 95%. Resultados: De um total de 384.805 pacientes, 111.046 eram diabéticos e 273.759 não diabéticos. Entre os diabéticos, 98.2% foram hospitalizados, 43.7% admitidos em UTI e 44.6% evoluíram a óbito. Enquanto entre os não-diabéticos, 97.3% necessitaram de hospitalização, 37.2% foram admitidos em UTI e 35.7% evoluíram a óbito. Após a análise com o teste de Qui-Quadrado, nos desfechos analisados foi encontrada uma diferença estatística significante (p<0.001) entre os grupos. Conclusão: A presença de DM 2 esteve associada a um pior prognóstico da COVID-19, quando comparada a pessoas sem DM2 na população brasileira. Entretanto, são necessários mais estudos para estabelecer a causalidade e elucidar a fisiopatologia dessa associação (AU)

Objective: Compare the clinical outcomes of people with and without Type 2 Diabetes Mellitus (DM2), infected by SARS-CoV-2, who developed Severe Acute Respiratory Syndrome (SARS) in Brazil. Methodology: This is a cross-sectional study. The research was carried out by analyzing the compulsory notification form Severe Acute Respiratory Syndrome of hospitalized patients, obtained from DATASUS. Type 2 diabetic and non-diabetic men and women infected with SARS-CoV-2 and notified as SARS in the period February 2020 to May 2021 were analyzed. The outcomes were identified as: hospitalization, Intensive Care Unit (ICU) admission, and death. The percentage of each outcome among diabetic patients was compared with that of the infected non-diabetic patients in the same period using the Chi-square test, with a 95% confidence interval. Results: From a total of 384,805 patients, 111,046 were diabetic and 273,759 non-diabetic. Among the diabetic patients, 98.2% were hospitalized, 43.7% were admitted to the ICU, and 44.6% died. While among non-diabetics, 97.3% required hospitalization, 37.2% were admitted to the ICU, and 35.7% died. After the analysis with the Chi-square test, a statistically significant difference was found between the groups (p<0.001). Conclusion: The presence of DM2 was associated with a worse prognosis for COVID-19 compared to people without DM2, in the Brazilian population. However, further studies are needed to establish causality and elucidate the pathophysiology of this association (AU)

Protective effect of tert-butylhydroquinone on retinal morphology and function in early diabetic rats and its mechanism / 中华实验眼科杂志

Objective:To investigate the protective effects of an antioxidant tert-butylhydroquinone (tBHQ) on the morphology and function of retina in early-stage experimental diabetic rats, and to explore the mechanism of its protective effect.Methods:Forty-five healthy SD rats of clean degree were randomized into normal control group, diabetes model group and tBHQ intervention group, with 15 rats in each group according to a random number table.The diabetes model was established via a single intraperitoneal injection of streptozotocin (STZ) in diabetes model group and tBHQ intervention group.Normal control group was intraperitoneally administered with an equal-volume injection of sodium citrate buffer.Rats in the tBHQ intervention group maintained a diet with 1% tBHQ for 2 weeks before the STZ injection, and the other two groups were fed with normal rat food only.Blood from tail vein was collected to assay the blood glucose level at 72 hours, 2 weeks and 4 weeks following modeling.Rat electroretinogram (ERG) was detected at 4 weeks after modeling.Morphological changes of rat retina were observed by hematoxylin and eosin staining.The apoptosis of retinal cells in different layers was detected by TUNEL assay.The expression of protein kinase B (Akt), p-Akt, endothelial nitric oxide synthase (eNOS) and p-eNOS was detected by Western blot.Müller cell line rMC-1 cells cultured in vitro were divided into 5 groups, including normal control group (72-hour culturing in normal medium), mannitol control group (72-hour culturing in medium containing 5.5 mmol/L glucose and 24.5 mmol/L mannitol), high glucose group (72-hour culturing in high-glucose medium), tBHQ intervention group (24-hour culturing in normal-glucose medium containing 5 μmol/L tBHQ, 72-hour culturing in high-glucose medium containing 5 μmol/L tBHQ), and phosphoinositide 3-kinase (PI3K) inhibitor group (6-hour culturing in normal medium containing 5 μmol/L LY294002, 24-hour culturing in normal-glucose medium containing 5 μmol/L LY294002 and 5 μmol/L tBHQ, 72-hour culturing in high-glucose medium containing 5 μmol/L LY294002 and 5 μmol/L tBHQ). The expression of Akt, p-Akt, eNOS and p-eNOS in the cells was detected by western blot.The use and care of animals complied with Regulations for the Administration of Laboratory Animals in Southwest Medical University.The study protocol was approved by the Animal Ethics Committee of Southwest Medical University (No.201711189). Results:The blood glucose level at 72 hours, 2 weeks and 4 weeks after modeling was higher in diabetic model group than tBHQ intervention group and normal control group (all at P<0.01). Four weeks after modeling, the scotopic ERG a-wave and b-wave amplitudes of diabetic model group were lower than those of normal control group and tBHQ intervention group (all at P<0.05). With edema and thickening of inner plexiform layer, thinning of inner nuclear layer and outer nuclear layer, as well as loosely arrangement and disorder of retinal layers, the number of retinal ganglion cells was decreased in diabetic model group in comparison with normal control group, all of which were improved in tBHQ intervention group in comparison with diabetic model group.There were more apoptotic retinal cells in diabetic model group than normal control group and tBHQ intervention group (both at P<0.05), which mainly existed in the outer nuclear layer.The relative expressions of p-Akt/Akt and p-eNOS/eNOS in rat retina of normal control group, diabetic model group and tBHQ intervention group were 0.76±0.11 and 0.83±0.06, 0.52±0.10 and 0.52±0.08, 1.14±0.31 and 1.03±0.13, respectively.The relative expressions of p-Akt/Akt and p-eNOS/eNOS in diabetic model group were lower than those of normal control group and tBHQ intervention group (all at P<0.01). The relative expressions of p-Akt/Akt and p-eNOS/eNOS in normal glucose group, mannitol control group, high glucose group, tBHQ intervention group and PI3K inhibitor group were 0.95±0.38 and 0.86±0.11, 0.94±0.27 and 0.74±0.29, 0.33±0.25 and 0.45±0.29, 1.32±0.37 and 1.28±0.22, 0.24±0.09 and 0.73±0.29, respectively.The relative expressions of p-Akt/Akt and p-eNOS/eNOS were significantly lower in high glucose group than those in normal glucose group and tBHQ intervention group (all at P<0.05), which were significantly lower in PI3K inhibitor group compared with tBHQ intervention group (both at P<0.01). Conclusions:tBHQ has protective effects on the morphology and function of retina in early diabetic rats, and the mechanism may be related to the activation of Akt/eNOS signaling pathway.

Prevalência de hipertensão arterial sistêmica e diabetes mellitus em indivíduos com covid-19: um estudo retrospectivo de óbitos em pernambuco, brasil / Prevalence of systemic arterial hypertension and diabetes mellitus in individuals with covid-19: a retrospective study of deaths in pernambuco, brazil

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

Diabetic macular edema: a literature review

Diabetic Macular Edema is a major cause of visual impairment in economically active population, being responsible for a significant impact in quality of life in the affected population, as well as high costs to the health care system. Over decades, some studies have compared treatments using Laser, Anti-VEGF and intravitreous corticosteroids, establishing protocols to reach effectives therapies. Thus, it is essential an entire understanding of available therapies to reach the goal of disease control, in an individual basis and in a collective health care system, as efficient as possible.

Attention to Cardiovascular and Renal Complications in Diabetes – how to prevent them?

@#It is a well-established fact that patients with diabetes mellitus are at high risk of cardiovascular and renal complications in the course of their lifetime. Much effort has been invested in understanding the pathobiology of this as well as in developing an effective strategy to reduce the morbidity and mortality associated with it. Metabolic control together with mitigating other known risk factors for the cardiovascular and renal disease has been the basis of improving the outcomes of all patients with diabetes. Ongoing scientific discoveries continue to provide physicians and patients with better means of treatment over the years. Each is a step forward, and with the addition of new classes of therapeutics, we will need to reconstruct the management pathway that is best for each patient given their risk profiles and characteristics.

Kidney Disease in Diabetes Mellitus: Cross-Linking between Hyperglycemia, Redox Imbalance and Inflammation / Doença Renal do Diabetes: Cross-Linking entre Hiperglicemia, Desequilíbrio Redox e Inflamação

Abstract Chronic hyperglycemia is the key point of macro- and microvascular complications associated with diabetes mellitus. Excess glucose is responsible for inducing redox imbalance and both systemic and intrarenal inflammation, playing a critical role in the pathogenesis of diabetic kidney disease, which is currently the leading cause of dialysis in the world. The pathogenesis of the disease is complex, multifactorial and not fully elucidated; many factors and mechanisms are involved in the development, progression and clinical outcomes of the disease. Despite the disparate mechanisms involved in renal damage related to diabetes mellitus, the metabolic mechanisms involving oxidative/inflammatory pathways are widely accepted. The is clear evidence that a chronic hyperglycemic state triggers oxidative stress and inflammation mediated by altered metabolic pathways in a self-perpetuating cycle, promoting progression of cell injury and of end-stage renal disease. The present study presents an update on metabolic pathways that involve redox imbalance and inflammation induced by chronic exposure to hyperglycemia in the pathogenesis of diabetic kidney disease.

Resumo A hiperglicemia crônica é o ponto-chave das complicações macro e microvasculares associadas ao diabetes mellitus. O excesso de glicose é responsável por induzir desequilíbrio redox e inflamação sistêmica e intra-renal, desempenhando um papel crítico na patogênese da doença renal do diabetes, configurada atualmente como a principal causa de doença renal dialítica em todo o mundo. A patogênese da doença é complexa, multifatorial e, não totalmente elucidada, estando vários fatores e mecanismos associados ao seu desenvolvimento, progressão e desfechos clínicos. Apesar dos mecanismos díspares envolvidos nos danos renais durante o diabetes, os caminhos metabólicos pela via oxidativa/inflamatória são amplamente aceitos e discutidos. As evidências acentuam que o estado hiperglicêmico crônico desencadeia o estresse oxidativo e a inflamação mediada por diversas vias metabólicas alteradas em um ciclo-vicioso de autoperpetuação, promovendo aumento da injúria celular e progressão para a doença renal dialítica. O presente artigo traz, portanto, uma atualização sobre os caminhos metabólicos que envolvem o desequilíbrio redox e a inflamação induzidos pela exposição crônica à hiperglicemia na patogênese da doença renal do diabetes.

Protection of polysaccharides of dendrobium candidum on blood-retinal barrier in diabatic rats and its mechanism / 中华实验眼科杂志

Background The pathogenesis of diabetic retinopathy (DR) involves a variety of biological pathways.Recently,inflammation factor has been thought to paly an important role in the pathogenesis of DR.Studies show that the concent of tumor necrosis factor-α (TNF-α) is increased in high-glucose environment,which leads to the abnormality of tight junction protein and follows by blood-retinal barrier (BRB) damage.Polysaccharides of dendrobium candidum (PDC) can inhibit the overexpression of TNF-α,but its effect on TNF-α in early DR procedure has been unelucidated.Objective This study was to investigate the effects of PDC on permeability of BRB and its mechanism in daibetic rats.Methods Fifty clear adult SD rats were divided into normal control group,diabetic model group and low-(100 mg/[kg · d]),moderate-(200 mg/[kg · d]) and high-dose (300 mg/[kg · d]) PDC groups,10 rats for each group.Streptozotocin was intraperitoneally injected to establish diabetic model in 40 rats,expect for normal control group.PDC at the concentrations of 100,200 and 300 mg/(kg · d) was intragastrically administered in the low-,moderate-and high-dose groups respectively at 6 weeks after modeling,and normal saline solution was used at the same way in the normal control group and diabetic model group.Evans blue was perfused via cardic chamber and eyes were obtained.Evants blue leakage was measured to evaluate the BRB permeability.The relative expressions of TNF-α,zonula occludens-1 (ZO-1),occludin and claudin-5 proteins were detected by Western blot;TNF-α contents in the retina and serum of the rats were detected by ELISA.Results The leakage concents of Evans blue in the retinas were (12.68±1.30),(30.45±2.60),(22.12±1.15),(17.99±1.00) and (21.49±1.00) in the normal control group,diabetic model goup and low-,moderate-and high-dose PDC groups,respectively,and the retinal leakage concents in the diabetic model group were significantly higher than those in the normal control group,and the retinal leakage contents in the low-,moderate-and high-dose PDC groups were lower than those in the diabetic model group (all at P ＜ 0.01).Western blot showed that the relative expression level of retinal TNF-α was significantly higher in the diabetic model group compared with the normal control group(1.12±0.10 vs.0.27±0.03),and that in the diabetic model group was significantly higher than that in the normal control group;while the relative expression levels of retinal TNF-α in different doses PDC groups were significantly lower,and the relative expression levels of retinal ZO-1,occludin and claudin-5 were significantly higher than those in the diabetic model group (all at P＜0.05).ELISA showed that the concentrations of retinal and serum TNF-α were higher in the diabetic model group compared with the normal control group,and those in the different doses of PDC groups were lower than those in the diabetic model group (all at P＜0.05).No significant differences were found among various doses of PDC groups (all at P＞0.05).Conclusions PDC can improve the permeability of BRB by down-regulating the expression of TNF-α and up-regulating the expressions of tight junction proteins in the retina of diabetic rats,which is probably related to suppressing the development of early DR.

Association analysis of advanced glycation end-products in lens with diabetic retinopathy severity / 中华实验眼科杂志

Background The deposition of advanced glycation end products (AGEs) in lens is the risk factor of diabetic complications.Researches revealed that AGEs has autofluorescence.Crystallin is a longevity protein.AGEs accumulation is probably associated with diabetic retinopathy (DR).Objective This study was to evaluate the association of AGEs autofluorescence intensity with diabetes and with DR.Methods A cross-sectional study was carried out under the approval of Ethic Committee of Shenyang He Eye Hospital and informed consent of each patient.One hundred eyes of 100 patients with age-related cataract aged 50-70 years were included in He Eye Hospital from September to December 2015.The patients were divided into non-diabetes group (40 patients) and diabetes group (60 patients),and then the patients in diabetes group were subdivided into non-DR (NDR) group,non-proliferating DR (NPDR) group and proliferating DR (PDR) group according to the DR grading criteria,20 patients for each.Glycosylated henoglobin A1c (HbA1c) and fasting plasma glucose (FPG) were detected for each subject,and the lens autofluorescence was assayed with lens fluorescence biomicroscope (Clearpath DS120).The association of lens autofluorescence intensity with serum HbA1c level or DR severity was analyzed.Results The age and diabetes course were matched among the non-diabetes group,NDR group,NPDR group and PDR group (F=2.587,2.899,both at P＞0.05),and the FBS and HbA1c level were evidently higher in the NDR group,NPDR group and PDR group than those in the non-diabetes group (all at P＜0.01).The autofluorescence intensity of lens was (0.159±0.032),(0.256±0.024),(0.319 ±0.013) and (0.394±0.035) cd in the non-diabetes group,NDR group,NPDR group and PDR group,respectively,showing a significant difference among the groups (F =90.265,P =0.000).The autofluorescence intensity of lens in the NDR group,NPDR group and PDR group was significantly increased in comparison with the non-diabetes group and the autofluorescence intensity of lens was gradually increased with the severity of DR (all at P＜0.01).A positive linear correlation was found between autofluorescence intensity of lens and serum HbA1 c level in diabetes patients (r =0.654,P ＜ 0.05).Conclusions The autofluorescence intensity of AGEs in lens appears to be associated with the severity of DR and HbA1 c.The autofluorescence intensity of AGEs in the lens of diabetes patient is probably one of the evaluation indexes of early stage of DR.

Relationship of serum S100A8/A9 complex and retinal inflammation in patients with diabetic retinopathy / 中华实验眼科杂志

Background Inflammation is one of the most popular aspects in the studies of diabetic retinopathy (DR) mechanisms.Researches showed that S100A8/A9 participate in the inflammatory procedure of many diseases,however,the relationship between S100A8/A9 complex and retinal inflammation of DR needs to be researched.Objective This study was to detect the serum S100A8/A9 level of diabetes mellitus (DM) and DR patients,and explore its role in DM an DR development.Methods A cases-controlled study was carried out.The DR patients,type 2 DM patients without retinal change and heathy controls were enrolled in Shanghai Xuhui Central Hospital from January to June 2014,and 30 patients for each group.The DR patients were subgrouped to non-proliferative DR (NPDR) group and proliferative DR (PDR) group.The periphery blood was collected to isolate the serum,and serum S100A8/A9 complex level was detected by ELISA.Serum high-sensitivity C-reactive protein (hsCRP) and glycosylated hemoglobin A1C (HbAlc) level was assayed by immunity turbidimetry and immune agglutination respectively.Results Serum S100A8/A9 complex levels in the DR group,DM group and normal control group were (9.74±0.59),(11.41 ±0.64) and (6.46 ±0.62) μg/L,respectively,and the serum S100A8/A9 complex level in the DM group and DR group was significantly higher than that in the normal control group,and the serum S100A8/A9 complex level in the DM group raised in compared with the DR group (all at P＜0.01).Serum hsCRP levels in the DR group,DM group and normal control group were (1.40±0.34),(1.27±0.13) and (1.11 ± 0.12)mg/L,respectively,with the highest value in the DR group and the lowest value in the normal control group (all at P=0.00).The serum HbAlc levels were higher in the DR group and DM group than those in the normal control group (both at P =0.00),while no significant difference was found in the serum HbAlc level between DR group and DM group (P =0.12).There was no significant differece in the serum S100A8/A9,hsCRP and HbAlc levels between NPDR group and PDR group (t=-0.10,P =0.92;t =-0.17,P =0.87;t =0.66,P =0.51).A weak positive correlation was seen between serum S100A8/A9 level and serum hsCRP level (r =0.36,P =0.00).Conclusions As an inflammatory marker,S100A8/A9 complex might play an important role in the pathogenesis and development of DR.Intensive control of glycemia can alleviate retinal inflammation in DM patients.

Clinical features of diabetic patients with dry eye disease in a community in Maceio: a cross-sectional study / Características clínicas de pacientes diabéticos com olho seco em uma comunidade de Maceió: estudo transversal

ABSTRACT Objective: This study was carried out in order to assess the epidemiological profile of symptomatic dry eye in diabetic patients. Methods: Two hundred and twenty-one diabetic patients were evaluated using a specific questionnaire about other diseases and drugs. Of these, 58 who classified as having moderate to severe dry eye were included. Results: In this study, 58 of the 221 diabetic patients had moderate to severe dry eye (26.2%). Of the 58 patients, dry eye was more prevalent at age 61.46 ± 14.18 years for men, and 61.09 ± 10.64 for women (p<0.005). Dry eye was more common in women (75.9%) (p=0.456). Of the 58 patients, 15 (25.9%) had at least one ocular disease.The most common was diabetic retinopathy (13 of 15 patients, 86.7%, 95% CI 69.46-103.87). A total of 19 patients used eye drops (32.8%); and most (14 of the 19 individuals, 73.7%) used lubricants (95%CI 53.88-93.48). Hypertension was the most prevalent associated comorbidity (56.9%) and the most commonly used medications were hypoglycemic agents (98 %, 95%CI 94.00 - 101.92) and angiotensin converting enzyme inhibitors (53.1%, 95%CI 53.06 39.09 - 67.04). Conclusion: Further epidemiologic studies need to be done to establish a real etiologic relationship between diabetes and dry eye, and its correlation to other risk factors. In spite of these limitations, we have strong evidence of this relationship, and in clinical practice, examination for dry eye should be part of the assessment of diabetic disease.

RESUMO Objetivo: O estudo foi realizado para descrever o perfil epidemiológico de pacientes diabéticos com olho seco sintomático. Métodos: Duzentos e vinte e um pacientes diabéticos foram avaliados por meio de questionário específico sobre outras doenças e medicamentos. Destes, 58 foram diagnosticados com olho seco moderado a severo e foram incluídos no estudo. Resultados: Neste estudo, 58 dos 221 pacientes diabéticos tinham olho seco moderado a severo (26,2%). Dos 58 pacientes, o olho seco, foi mais prevalente na faixa etária de 61,46 ± 14,18 anos para os homens e 61,09 ± 10,64 para as mulheres (p <0,005). O olho seco foi mais comum em mulheres (75,86%) (p = 0,456). Dos 58 pacientes, 15 (25,9%) tinham pelo menos uma doença ocular. A mais comum foi a retinopatia diabética (13 de 15 pacientes, 86,7%, IC de 95% 69,46-103,87). Um total de 19 pacientes utilizavam colírios (3,8%); lubrificantes foram os mais usados (14 dos 19 indivíduos, 73, 7%, (IC de 95%, 53,88-93,48). A hipertensão foi a doença mais prevalente associada (56.9%) e os medicamentos mais utilizados foram hipoglicemiantes orais (98%, IC 95% 94,00 - 10,92) e inibidores da enzima conversoras da angiotensina (53,1%, IC 95%, 53,06 39,09 - 67,04). Conclusão: Novos estudos epidemiológicos devem ser feitos para avaliar a real relação etiológica entre olho seco e diabetes e sua correlação com outros fatores de risco. Apesar das limitações, temos fortes evidências da relação entre olho seco e diabetes. Na prática clínica, o exame de olho seco deve ser parte da avaliação dos diabéticos.

Choice of current approaches to the management of diabetic macular edema / 中华实验眼科杂志

Diabetic macular edema (DME) is the most common reason for visual impairment in diabetic eye diseases.DME is easy to relapse and the treatment outcome is beyond satisfied.Anti-vascular endothelial growth factor (anti-VEGF) therapy has been proposed to be a first-line or key treatment regimen in the management guideline for DME.However,in clinical practice,there still are many ambiguous and controversial views in the choice and implement of different managing paradigms,including the therapeutical goal,the assessment of treatment effectiveness,the explanation of the guidelines,the regimen of anti-VEGF therapy,the value evaluation of laser photocoagulation,the use of steroids and the management of recurrent DME.Recently,the researches of treating drugs for DME are developing and making a great progress,so eye doctors should track the research results,improve the therapeutical regimen,fully understand the advantages and disadvantages of different treating methods and standardize the treatment process in order to release the best treatment effects on DME.

Intervenciones de enfermería para la prevención de complicaciones crónicas en pacientes con diabetes mellitus en el primer nivel de atención / Nursing interventions for the prevention of chronic complications in patients with diabetes mellitus in primary care

Introducción. Diabetes Mellitus es una enfermedad crónica que requiere asistencia médica continua, la Federación Internacional de Diabetes, calcula que 246 millones de personas en el mundo padecen esta enfermedad. En México se ha incrementado, siendo de las primeras causas de muerte en el país, la Encuesta Nacional de Salud y Nutrición, identifico a 6.4 millones de mexicanos con diabetes, estimando que el 9.2% de los adultos, tienen el diagnóstico de diabetes, favoreciendo el desarrollo de complicaciones crónicas, con disminución de la calidad de vida, incrementando los costos en las tasas de hospitalización y de atención hospitalaria. Métodos. Se realizó esta guía de práctica clínica, con la elaboración de preguntas clínicas estructuradas, protocolos de búsquedas en base de datos electrónicas específicas, PubMed (internacional), Artemisa (nacional) y en otros sitios Web, retrospectivo a 5 años, en idiomas inglés y español, utilizando términos MESH, revisando sistémicamente la literatura, seleccionando las evidencias científicas de mayor puntaje obtenido en escalas de gradación Shekelle, SING y ADA. Resultados. Obtuvieron 70 resultados, 13 fueron útiles para responder lo relacionado a la prevención de complicaciones crónicas de diabetes mellitus. Conclusiones. Basados en la revisión sistemática realizada, se obtuvieron evidencias y recomendaciones para la práctica de enfermería, que impacten en la identificación de factores de riesgo, prevención de las complicaciones crónicas, en pacientes con diabetes mellitus en el primer nivel de atención

Introduction. Diabetes Mellitus is a chronic disease that requires ongoing medical care, the International Diabetes Federation estimates that 246 million people worldwide suffer from this disease. In Mexico has increased, being one of the leading causes of death in the country, the National Survey of Health and Nutrition, was identified to 6.4 million Mexicans with diabetes, estimating that 9.2% of adults are diagnosed with diabetes, promoting the development of chronic complications, with decreased quality of life, increasing costs in rates of hospitalization and hospital care. Methods. This clinical practice guideline, with the development of structured clinical questions, was conducted protocols searches based on specific electronic databases, PubMed (international), Artemis (national) and other Web sites, retrospective to 5 years in English and Spanish, using MeSH terms, systemically reviewing the literature, selecting the scientific evidence obtained higher scores on scales of gradation Shekelle, SING and ADA. Results. 70 results, 13 were helpful in answering related to the prevention of chronic complications of diabetes mellitus. Conclusions. They based systematic review, evidence and recommendations for nursing practice that impact on identifying risk factors, prevention of chronic complications in patients with diabetes mellitus at the primary care level were obtained.

Diabetes Mellitus é uma doença crônica que requer cuidados médicos contínuos, a Federação Internacional de Diabetes estima que 246 milhões de pessoas em todo o mundo sofrem desta doença. No México tem aumentado, sendo uma das principais causas de morte no país, a Pesquisa Nacional de Saúde e Nutrição, foi identificado para 6,4 milhões de mexicanos com diabetes, estimando-se que 9,2% dos adultos são diagnosticadas com diabetes, promover o desenvolvimento de complicações crônicas, com a diminuição da qualidade de vida, aumentando os custos das taxas de hospitalização e cuidados hospitalares.Métodos. Esta orientação prática clínica, com o desenvolvimento de questões clínicas estruturadas, foi realizado protocolos pesquisas com base em bancos de dados eletrônicos específicos, PubMed (internacional), Artemis (nacional) e outros sites, retrospectiva de 5 anos em Inglês e Espanhol, usando termos de malha, sistemicamente revisão da literatura, selecionando as evidências científicas obtiveram escores mais altos em escalas de gradação Shekelle, cantar e ADA. Resultados. 70 resultados, 13 eram úteis para responder relacionadas com a prevenção das complicações crônicas do diabetes mellitus. Conclusões. Eles basearam revisão sistemática, provas e recomendações para a prática de enfermagem que têm impacto sobre a identificação de fatores de risco, prevenção das complicações crônicas em pacientes com diabetes mellitus no nível de atenção primária foram obtidas.

Avaliação das práticas preventivas do pé diabético / Evaluation of preventive practices for the diabetic foot

Objetivo - O objetivo deste trabalho foi de avaliar o conhecimento de portadores de diabetes sobre as medidas preventivas do pé diabético. Métodos - Este foi um estudo descritivo, quantitativo, tipo inquérito por entrevista. A população estudada foi composta por 100 portadores de diabetes, cadastrados em uma Unidade Básica de Saúde do município de Campinas, São Paulo. Resultados - Dos entrevistados, 58% tinham 60 anos ou mais, 70% eram do sexo feminino e 80% alfabetizados. Destes, 51% tinha mais de dez anos de diagnóstico de doença e 62% alguma complicação relacionada, sendo as visuais (41,9%) e o pé diabético (37,1%) as mais frequentes. Um grande percentual (80%) relatou ter conhecimento sobre a doença e 94% consultavam o médico regularmente. Bom conhecimento em relação ao autocuidado com os pés foi observado em 62% da população, 89% realizavam inspeção dos pés diariamente, 64% não andavam descalços, 88% usavam sapatos adequados, 57% usavam meias com os sapatos. Dos entrevistados 64% receberam orientação sobre a doença e cuidados com os pés e 46% participaram das atividades oferecidas pela unidade. O enfermeiro (47%) foi o profissional mais envolvido com as ações de educação em saúde. Conclusão - Grande parte da população tinha conhecimento sobre as práticas preventivas do pé diabético. Ressalta-se o papel da unidade de saúde neste contexto, em especial o do enfermeiro e seu envolvimento com as atividades de promoção de saúde e prevenção deste agravo e que é necessária, para o desenvolvimento das ações, a co-responsabilidade da população, principalmente no que concerne ao autocuidado.

Objective - The aim of this study was to assess knowledge of patients with diabetes about preventive diabetic foot. Methods - This was a descriptive study, quantitative type interview survey. The study population comprised 100 patients with diabetes, enrolled in Basic Health Unit, Campinas, São Paulo. Results - Of those interviewed, 58% was 60 years or more, female (70%) and 80% were illiterate. 51% of the population had more than ten years of disease diagnosis, 62% some complication, visual complications (41.9%) and diabetic foot (37.1%) the most frequently. 80% of respondents reported having knowledge of the disease and 94% consulted the doctor regularly. Of the population studied 62% had good knowledge about self-care with their feet, 89% performed inspection of the feet daily, 64% did not walk barefoot, 88% wore appropriate shoes, 57% wore socks with his shoes. Of survey participants 64% received orientation about the disease and 46% participated in the activities offered by unit. The nurse was most involved the health professional in the actions of health education (47%). Conclusion - Much of the population was aware of the preventive diabetic foot. It is emphasized the role of the unit and particularly the role nurse and his involvement with the activities of health promotion and prevention of the disease, which is necessary for the development of actions, co-responsibility of the population, especially in respect to self-care.

Consideraciones anestesicas en el paciente diabético con neuropatía autonómica

Introducción: La neuropatía autonómica o disautonomía diabética, es una complicación de la diabetes mellitus que se caracteriza por disminución de la función del sistema nervioso autónomo periférico expresada a través del órgano efector, en pacientes diabéticos. Objetivo: Realizar una puesta al día sobre la disautonomía diabética y sus implicaciones anestésicas. Desarrollo: Se señalan los signos y síntomas de la neuropatía autonómica, como complicaciones de la diabetes mellitus. Se analizaron las consideraciones preoperatorias en este tipo de pacientes y sus consecuencias de acuerdo a la respuesta fisiológica, las implicaciones de las diferentes técnicas anestésicas y las posibles complicaciones, así como el tratamiento a utilizar. Conclusiones: La diabetes mellitus es un complejo desorden metabólico y la neuropatía autonómica una complicación que requiere consideraciones específicas durante el tratamiento anestésico quirúrgico. Diagnosticar y tratar las complicaciones es un deber del anestesiólogo moderno. Prevenir y mejorar su pronóstico una obligación.

Introduction: Autonomic neuropathy or diabetic non-autonomy is a complication of diabetes mellitus characterized by a decrease of peripheral autonomic nervous system function by means of the effector organ in diabetic patients. Objective: To made an update on diabetic non-autonomy and its anesthetic implications. Development: Signs and symptoms of autonomic neuropathy are considered as diabetes mellitus complications. In this type of patient preoperative considerations are analyzed and their consequences according to the physiologic response, implications of the different anesthetic techniques and the potential complications as well as the treatment to be applied. Conclusions: Diabetes mellitus is a complex metabolic disorder and the autonomic neuropathy is a complication requiring specific considerations during the surgical anesthetic treatment. To diagnose and to treat the complications is a duty of trendy anesthesiologist. To prevent and to improve its prognosis is a duty.

Relation between diabetes mellitus and male fertility / Relação entre diabetes mellitus e fertilidade masculina

Objective: The objective of the present study was to verify if there is any relation between diabetes mellitus and male infertility. Methods: the spermograms of 43 non-diabetic subjects and 12 diabetic patients (type 1 and 2) aged 20-60 years were compared. Spermiological findings in diabetic patients were compared with those of normal individuals of the same age. Serum testosterone, prolactin, follicle-stimulant hormone, luteinizing hormone, glucose and glycosilated hemoglobin were assayed in diabetic patients. Results: Six diabetic patients (four type 1 and two type 2) presented chronic complications attributed to neuropathy and vascular insufficiency. No difference was observed in the semen characteristics (odor, color, viscosity and pH) between the control group and the diabetic patients. There were no differences between seminal concentrations and percentage of motile spermatozoa during the first hour of observation in the two groups (p < 0.05). Impotence was reported by four diabetic patients (33.3%). Erectile failure was associated with diabetic microangiopathy and neuropathy. There were no controls with impotence. No significant hormonal changes were found in the diabetic patients. Conclusions: The present results suggest that neuropathy and vascular insufficiency may be implicated in sexual dysfunction in type 1 and 2 diabetic patients, without significantly affecting the hypothalamic-pituitary-gonadal axis.

Objetivo: O objetivo do presente estudo foi verificar se há relação entre diabetes mellitus e infertilidade masculina. Métodos: Foi estudado espermograma de 43 indivíduos não-diabéticos e 12 diabéticos (tipo I e tipo II) com idade variando entre 20 e 60 anos. Os diabéticos também foram submetidos à dosagem hormonal de testosterona, prolactina, hormônio folículo-estimulante e hormônio luteinizante, além da e glicemia de jejum e hemoglobina glicosilada. Resultados: Foram encontrados seis pacientes diabéticos (quatro tipo I e dois pacientes tipo II) com complicações crônicas decorrentes da vásculo- e neuropatia diabéticas. A análise do líquido seminal dos voluntários, não-diabéticos e diabéticos, não mostrou diferenças entre as características dos sêmens: odor, cor, viscosidade e pH. Também não houve diferença entre as concentrações seminais e a porcentagem de espermatozoides móveis durante a primeira hora de observação entre os dois grupos (p > 0,05). Foi relatada impotência por quatro diabéticos (33,3%) com complicações crônicas do diabetes, secundárias à neuropatia e à angiopatia diabética. Não foi encontrada impotência em nenhum paciente do grupo não-diabético. Não foram encontradas alterações hormonais significativas nos diabéticos. Conclusões: Os resultados sugerem que a neuropatia e insuficiência vascular podem estar relacionadas à disfunção sexual em pacientes diabéticos tipo I e II, sem, entretanto, comprometimento do eixo hipotálamo-hifofisário-gonadal.