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3.
Rev Med Suisse ; 11(462): 450-2, 454-5, 2015 Feb 18.
Artigo em Francês | MEDLINE | ID: mdl-25915986

RESUMO

For patients with type I diabetes, transition from pediatric to adult care is a challenge due to complex treatment requirements and the physical, psychological and social changes of adolescence. Members of the care team must recognize that while these emerging adults need to develop self-management skills, this may conflict at times with the developmentally appropriate desire for increasing autonomy. The role of nursing in coordinating a successful transition is critical for maintaining continuity of patient-centered care that responds to the specific needs of these young adults.


Assuntos
Diabetes Mellitus , Transição para Assistência do Adulto , Adolescente , Diabetes Mellitus/terapia , Humanos , Modelos Teóricos , Suíça , Transição para Assistência do Adulto/organização & administração , Adulto Jovem
4.
Mucosal Immunol ; 8(6): 1324-38, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25850656

RESUMO

Central to inflammatory bowel disease (IBD) pathogenesis is loss of mucosal barrier function. Emerging evidence implicates extracellular adenosine signaling in attenuating mucosal inflammation. We hypothesized that adenosine-mediated protection from intestinal barrier dysfunction involves tissue-specific signaling through the A2B adenosine receptor (Adora2b) at the intestinal mucosal surface. To address this hypothesis, we combined pharmacologic studies and studies in mice with global or tissue-specific deletion of the Adora2b receptor. Adora2b(-/-) mice experienced a significantly heightened severity of colitis, associated with a more acute onset of disease and loss of intestinal epithelial barrier function. Comparison of mice with Adora2b deletion on vascular endothelial cells (Adora2b(fl/fl)VeCadCre(+)) or intestinal epithelia (Adora2b(fl/fl)VillinCre(+)) revealed a selective role for epithelial Adora2b signaling in attenuating colonic inflammation. In vitro studies with Adora2b knockdown in intestinal epithelial cultures or pharmacologic studies highlighted Adora2b-driven phosphorylation of vasodilator-stimulated phosphoprotein (VASP) as a specific barrier repair response. Similarly, in vivo studies in genetic mouse models or treatment studies with an Adora2b agonist (BAY 60-6583) recapitulate these findings. Taken together, our results suggest that intestinal epithelial Adora2b signaling provides protection during intestinal inflammation via enhancing mucosal barrier responses.


Assuntos
Colite/patologia , Células Epiteliais/metabolismo , Mucosa Intestinal/patologia , Receptor A2B de Adenosina/metabolismo , Transdução de Sinais , Doença Aguda , Animais , Western Blotting , Colite/metabolismo , Modelos Animais de Doenças , Células Epiteliais/patologia , Citometria de Fluxo , Imunofluorescência , Marcação In Situ das Extremidades Cortadas , Mucosa Intestinal/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Transdução de Sinais/fisiologia
5.
Rev Med Suisse ; 9(389): 1192-6, 1198-9, 2013 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-23798189

RESUMO

In developed countries, 12-25 % of the aged population (>65 years old) have diabetes. Treatment of the old diabetic patients is less well studied compared to younger patients although diabetic and geriatric medical associations have issued specific treatment and priority guidelines for these patients. Treatment and targets of glycemic control must be adapted to the functional condition of the patients, prevent symptoms and complications of the geriatric syndrome. Prevention and screening of chronic complication of diabetes have to be integrated in the overall care of aged diabetic patients to optimize their quality of life and health state.


Assuntos
Diabetes Mellitus/terapia , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Avaliação Geriátrica/métodos , Humanos , Modelos Biológicos
6.
Rev Med Suisse ; 7(316): 2166-9, 2011 Nov 09.
Artigo em Francês | MEDLINE | ID: mdl-22164672

RESUMO

Severe hypoglycemia is a feared complication of treatment in older diabetic patients (> 75 years) and a limiting factor for good glycemic control. Its real incidence is not well studied and probably underestimated. Cognitive impairment, malnutrition and/or cachexia, polypharmacy and a recent hospitalization are risk factors for severe hypoglycemia specific for older patients. Cognitive impairment screening can identify patients unable to manage their treatment. Simplification of treatment and/or transferring its execution to relatives must then be considered. Prevention also involves the detection of malnutrition and comorbidities, Age-adjusted therapeutic targets (HbA1c 7-8%) are important to avoid an exceedingly strict glycemic control. However, giving up on good glycemic control is not an adequate prevention strategy in itself.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hipoglicemia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Humanos , Hipoglicemia/etiologia , Fatores de Risco
7.
Diabetes Metab ; 37(2): 131-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21273106

RESUMO

AIMS: We aimed to characterize the determinants and characteristics of renal disease in very old diabetic patients in geriatric care. METHODS: Consecutive diabetic patients (96 women, 38 men) admitted to a geriatric service were studied. Glomerular filtration rate (GFR), albuminuria, vascular and general comorbidities, glycaemic control, malnutrition (using the Mini-Nutritional Assessment [MNA], serum albumin and cholesterol levels), haemoglobin and inflammation (CRP levels) were assessed. RESULTS: (a) 51.2 and 12.4% patients had moderate or severe renal insufficiency. The prevalence of normo-, micro- and macroalbuminuria was 45.0, 38.9 and 16.0% in the whole population, and was similar in patients with or without moderate renal insufficiency. Renal insufficiency was associated with previous stroke (P=0.024), heart failure (P=0.024), and atrial fibrillation (P=0.008), and possibly myocardial infarction (P=0.059, Mann-Whitney test). (b) Albuminaemia was associated with albuminuria, MNA scores, haemoglobin, total and HDL-cholesterol and CRP. However, in multiple linear regression analysis CRP was the only robust determinant of albuminaemia (P<0.0001). (c) Renal insufficiency was not associated with the MNA, serum albumin, haemoglobin and cholesterol levels. CONCLUSION: Renal insufficiency often occurs without albuminuria, suggesting aetiologies distinct from classical diabetic nephropathy, and is strongly associated with vascular comorbidities. Hypoalbuminaemia is more strongly associated with inflammation than with albuminuria and malnutrition. Malnutrition, hypoalbuminaemia, low cholesterol levels and anaemia are not associated with renal insufficiency, likely due to the very high prevalence of these abnormalities in the whole population. These features must be taken into account when organizing the global care of elderly diabetic patients.


Assuntos
Nefropatias Diabéticas/epidemiologia , Hospitalização , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/epidemiologia , Fibrilação Atrial/complicações , Glicemia/análise , Proteína C-Reativa , HDL-Colesterol/sangue , Comorbidade , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/complicações , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/epidemiologia , Masculino , Desnutrição/complicações , Desnutrição/epidemiologia , Infarto do Miocárdio/complicações , Insuficiência Renal/fisiopatologia , Acidente Vascular Cerebral/complicações , Doenças Vasculares/complicações , Doenças Vasculares/epidemiologia
8.
Diabet Med ; 27(8): 918-24, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20653750

RESUMO

BACKGROUND: Type 2 diabetes usually occurs in the context of obesity and associated insulin resistance. Current treatment recommendations are based on lifestyle modifications and incremental drug therapy. However, this approach could lead to inappropriate priorities upon ageing, when diabetes may be compounded by malnutrition and reduced insulin resistance. METHODS: We prospectively evaluated glycaemic and nutritional parameters in 146 consecutive diabetic patients (age 82.5 +/- 7.3 years, mean +/- sd) admitted to our geriatric service. We also implemented nutritional support therapy and a drug therapy adjustment protocol. Oral hypoglycaemic agent withdrawal was attempted in cases of good glycaemic control (HbA(1c) < 7.5% (<47 mmol/mol) or fasting blood glucose < 7.5 mmol/l). RESULTS: Mean BMI and HbA(1c) were 29.6 +/- 7.1 kg/m(2) and 6.9 +/- 1.2% (52 +/- 9 mmol/mol), respectively. Of the patients, 51.4% were taking 1-3 oral hypoglycaemic agents, 30.8% were on insulin and 9.6% on were on insulin and oral hypoglycaemic therapy. Low Mini Nutritional Assessment scores and serum marker levels indicated a high prevalence of malnutrition and/or chronic disease, even in obese patients. Mini Nutritional Assessment scores were positively associated with HbA(1c) values. Among patients treated by oral hypoglycaemic agents, complete drug withdrawal was achieved in 65.8%, much more often than new treatments were added (P = 0.002). Glycaemic control did not worsen after approximately 30 days, despite in-hospital nutritional therapy. Successful oral hypoglycaemic therapy withdrawal was associated with lower Mini Nutritional Assessment scores. CONCLUSIONS: Malnutrition is highly prevalent in elderly diabetic inpatients and, paradoxically, contributes to 'good' glycaemic control. Malnutrition should be screened for in these patients and, when present, should prompt a revision in diet and drug therapy. In particular, the possibility of reducing unnecessary drug therapy should be considered.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas/metabolismo , Hipoglicemiantes/uso terapêutico , Resistência à Insulina/fisiologia , Insulina/uso terapêutico , Desnutrição/epidemiologia , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Avaliação Geriátrica , Humanos , Masculino , Desnutrição/sangue , Prevalência
9.
J Chromatogr A ; 1217(25): 4109-19, 2010 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-19939397

RESUMO

For doping control, analyses of samples are generally achieved in two steps: a rapid screening and, in the case of a positive result, a confirmatory analysis. A two-step methodology based on ultra-high-pressure liquid chromatography coupled to a quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) was developed to screen and confirm 103 doping agents from various classes (e.g., beta-blockers, stimulants, diuretics, and narcotics). The screening method was presented in a previous article as part I (i.e., Fast analysis of doping agents in urine by ultra-high-pressure liquid chromatography-quadrupole time-of-flight mass spectrometry. Part I: screening analysis). For the confirmatory method, basic, neutral and acidic compounds were extracted by a dedicated solid-phase extraction (SPE) in a 96-well plate format and detected by MS in the tandem mode to obtain precursor and characteristic product ions. The mass accuracy and the elemental composition of precursor and product ions were used for compound identification. After validation including matrix effect determination, the method was considered reliable to confirm suspect results without ambiguity according to the positivity criteria established by the World Anti-Doping Agency (WADA). Moreover, an isocratic method was developed to separate ephedrine from its isomer pseudoephedrine and cathine from phenylpropanolamine in a single run, what allowed their direct quantification in urine.


Assuntos
Anabolizantes/urina , Cromatografia Líquida de Alta Pressão/métodos , Dopagem Esportivo/prevenção & controle , Espectrometria de Massas/métodos , Detecção do Abuso de Substâncias/métodos , Humanos
10.
J Chromatogr A ; 1216(20): 4423-33, 2009 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-19342059

RESUMO

The general strategy to perform anti-doping analyses of urine samples starts with the screening for a wide range of compounds. This step should be fast, generic and able to detect any sample that may contain a prohibited substance while avoiding false negatives and reducing false positive results. The experiments presented in this work were based on ultra-high-pressure liquid chromatography coupled to hybrid quadrupole time-of-flight mass spectrometry. Thanks to the high sensitivity of the method, urine samples could be diluted 2-fold prior to injection. One hundred and three forbidden substances from various classes (such as stimulants, diuretics, narcotics, anti-estrogens) were analysed on a C(18) reversed-phase column in two gradients of 9min (including two 3min equilibration periods) for positive and negative electrospray ionisation and detected in the MS full scan mode. The automatic identification of analytes was based on retention time and mass accuracy, with an automated tool for peak picking. The method was validated according to the International Standard for Laboratories described in the World Anti-Doping Code and was selective enough to comply with the World Anti-Doping Agency recommendations. In addition, the matrix effect on MS response was measured on all investigated analytes spiked in urine samples. The limits of detection ranged from 1 to 500ng/mL, allowing the identification of all tested compounds in urine. When a sample was reported positive during the screening, a fast additional pre-confirmatory step was performed to reduce the number of confirmatory analyses.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Dopagem Esportivo , Espectrometria de Massas/métodos , Detecção do Abuso de Substâncias/métodos , Urina/química , Diuréticos/urina , Entorpecentes/urina
11.
Rev Med Suisse ; 3(107): 994-1000, 2007 Apr 18.
Artigo em Francês | MEDLINE | ID: mdl-17526373

RESUMO

The incidence of diabetes type I has increased considerably in young children with an annual increase in Switzerland of 23,8% over the last ten years. The development of rapid acting and long acting analogues allowed a significant progress in treatment. Multiple daily insulin injections together with carbohydrate counting as well as continuous subcutaneous insulin infusion (CSII) improved the quality of life and led to an increased daily flexibility. The incidence of severe hypoglycaemic events has decreased at the same time metabolic control improved. The development of interstitial glucose measurement (online) coupled to the insulin pump represents a step further towards the artificial pancreas. The new therapeutic strategies of immunomodulation will hopefully lead to secondary and tertiary prevention of diabetes.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Esquema de Medicação , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/metabolismo , Hemoglobinúria/etiologia , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , Hipoglicemiantes/classificação , Bombas de Infusão Implantáveis , Injeções Subcutâneas , Insulina/administração & dosagem , Sistemas de Infusão de Insulina , Monitorização Ambulatorial , Qualidade de Vida , Resultado do Tratamento
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