Blood glucose related adverse drug reaction of antitumor monoclonal antibodies: a retrospective analysis using Vigibase

Abstract On the increasing prevalence of using mAbs (monoclonal antibodies) in cancer therapy and the severe risk of hyperglycemia, we aimed to analyze the main clinical ADRs of mAbs, with a focus on adverse hyperglycemic events associated with currently clinically used mAbs. mAbs as well as target information were selected from Martinadale book and published articles. Drug approving information was collected from each government website, and ADR statistic data were collected from VigibaseR, comparing with Adverse Event Reporting System of US FDA. Top 10 mAbs were classified within listing in total ADR records, ADRs per year, hyperglycemic ADR records. Vigibase data were updated onto 15 Feb 2019. 20 mAbs were analyzed with 263217 ADR reports, wherein 16751 records on Metabolism and nutrition disorders and 1444 records on Glucose metabolism disorders. The geographic, age, gender distributions and annual ADR report numbers were listed respectively. Of the top 10, Rituximab, Bevacizumab and Nivolumab were on the top 3 in total ADR record and hyperglycemic record. Top 3 record results were similar in Vigibase and FDA database. It is of increasing importance for clinicians to be aware of early detection, patient management, or drug selection strategies when using mAbs, particularly within the high glycemic risk-reported mAbs, to improve the efficacy and tolerability of mAbs regiment and optimize patient outcomes.

Nutritional factors and metabolic biomarkers: impact in risk and survival of women with breast cancer / Fatores nutricionais e biomarcadores metabólicos: impacto no risco e sobrevida de mulheres com câncer de mama

Breast cancer (BC) is the most common cause of cancer and the leading cause of death in women. BC is a complex disease and distributes in distinct molecular subtypes regarding the expression of estrogen receptor (ER), progesterone receptor (PR), receptor tyrosine-protein kinase erbB-2 (HER2), and Ki67 protein status. Although BC is multifactorial evidence indicates that nutritional factors are relevant during steps of carcinogenesis, recurrence, and survival. We aim to assess the role of nutrition status and metabolic biomarkers in women with BC. This is a case-control study between May 2011 and August 2012. In the case group, there was a follow-up until April 2019, characterizing a cohort study. From these groups, different manuscripts were structured with different study designs according to each hypothesis. Manuscript 1 - cohort based on the follow-up of the BC group, Manuscript 2 - a cross-sectional study with women with Luminal A BC (ER positive, PR positive/negative, HER2 negative, Ki67 low) and Manuscript 3 - a cross-sectional case-control study. Data were obtained by medical records, interviews and anthropometric parameters with electrical impedance. Blood samples were collected after 12-hour fasting to analyze serum glucose, glycated hemoglobin, insulin growth factor 1 (IGF-1), insulin growth factor binding protein (IGFBP-3), insulin and adipokines, thiobarbituric acid reactive substances (TBARS), non-esterified fatty acids (NEFA), DNA oxidative damage (8-OH-dG) and lipoproteins (total cholesterol - TC, Low-density lipoprotein cholesterol - LDL-c, high-density lipoprotein cholesterol - HDL-c and triacylglycerols) and fatty acid profile of erythrocyte membrane. All statistical tests were performed using Statistical Package for Social Sciences® (SPSS), version 21.0. Statistical significance was set at p < 0.050. The main results of the study showed that premenopausal women with BC and clinical staging (CS) between II and III had a more atherogenic lipid profile characterized by the decrease in HDL-c, increase in LDL-c, non-HDL-C and apolipoprotein B (Apo B). We highlight that women with BC and high LDL-c and non-HDL-c had increase odd of having larger tumor size whereas HDL-c was associated with a decreased risk. Premenopausal women with BC had an increased level of TBARS and NEFA at diagnosis and had a lower survival probability. Additionally, women with Luminal A BC had higher serum levels of glucose, IGF-1, IGFBP-3, IL1ß, IL6, and lower IL10 compared to its matching controls. Also, women with increased serum levels of TBARS, glucose, and insulin increased risk of Luminal A BC, and higher levels of adiponectin decrease the risk of developing Luminal A BC when controlled by menopause status and BMI. Women with BC presented impaired IGF-1/insulin axis, sustained by overweight/obesity and higher central adiposity. Increased levels of serum glucose, insulin, and IGF-1 showed higher odds to developing BC. In conclusion, our results demonstrate the relevant impact of metabolic biomarkers on risk of developing BC and in survival outcomes. This study reinforces the relevance to increase prevention strategies regarding lifestyle and nutrition to decrease incidence and improve outcome of BC.

Câncer de mama (CM) é a causa mais comum de câncer no mundo e a principal causa de morte em mulheres. O CM é uma doença complexa e é classificada em tipos moleculares de acordo com a expressão do receptor de estrogênio (RE), receptor de progesterona (RP), receptor tyrosine-protein kinase erbB-2 (HER2) e proteína Ki67. Embora o CM seja multifatorial, há evidências científicas que indicam que componentes nutricionais podem ser relevantes durante as diversas etapas da carcinogênese, recidiva e sobrevivência. O objetivo deste estudo foi avaliar o papel do estado nutricional e marcadores metabólicos em mulheres com CM. Trata-se de um estudo caso-controle realizado entre maio 2011 e agosto 2012. O grupo caso foi acompanhado até abril 2019, caracterizando um estudo de coorte. A partir destes grupos foram estruturados diversos manuscritos com delineamentos diferentes, segundo cada hipótese levantada, a saber: Manuscrito 1 - Coorte baseada no seguimento do grupo CM, Manuscrito 2 - Estudo transversal baseado em mulheres com CM Luminal A (RE positivo, RP positivo/negativo, HER2 negativo, Ki67 baixo) e; Manuscrito 3 - estudo transversal do tipo caso-controle. Os dados foram obtidos através de prontuários médicos, entrevista e avaliação antropométrica com uso de bioimpedância elétrica. As amostras de sangue foram coletadas após jejum de 12 horas e a partir dessas foram analisadas glicemia, hemoglobina glicada (HbA1c), insulina, fator de crescimento semelhante à insulina 1 (IGF-1), proteína 3 de ligação ao fator de crescimento semelhante a insulina (IGFBP-3), substâncias reativas ao ácido tiobarbitúrico (TBARS), ácidos graxos não esterificados (NEFA), dano oxidativo ao DNA (8-OH-dG), perfil lipídico (colesterol total - CT, colesterol associado à lipoproteína de baixa densidade - LDL-c, colesterol associado à lipoproteína de alta densidade - HDL-c e triacilgliceróis) e perfil de ácidos graxos incorporados às membranas eritrocitárias. Todos os testes estatísticos foram realizados no programa Statistical Package for Social Sciences® (SPSS), versão 21.0. Significância estatística foi considerada em p < 0,050. Os principais resultados do estudo mostram que mulheres com CM na pré-menopausa e com estadiamento clínico II e III tiveram um perfil lipídico mais aterogênico caracterizado pela diminuição do HDL-c, aumento do LDL-c, nãoHDL-c e apolipoproteína B (Apo B). Destaca-se que mulheres com CM e LDL-c e nãoHDL-c aumentados apresentaram maior chance de tumores maiores, enquanto mulheres com CM com maior HDL-c apresentaram menor risco. Mulheres com CM na pré-menopausa que apresentaram maior conteúdo de TBARS e NEFA no momento do diagnóstico tiveram menor sobrevida. Adicionalmente, mulheres com CM e tumores do tipo Luminal A tiveram maiores concentrações de glicose, IGF-1, IGFBP-3, IL1ß, IL6 e menores de IL10 comparadas com o grupo controle. Mulheres com com concentrações mais elevadas de TBARS, glicose e insulina apresentaram maior risco de CM Luminal A, enquanto aquelas com concentrações mais elevadas de adiponectina apresentaram menor risco de desenvolver CM Luminal A, mesmo quando controlados pelo estado de menopausa e IMC. Mulheres com CM apresentaram alterações no eixo IGF-1/insulina que foi sustentada no sobrepeso/obesidade e no aumento da adiposidade central. Observou-se que mulheres com concentrações mais elevadas de glicose, insulina e IGF-1 tiveram maior chance de desenvolver CM. Em conclusão, os resultados demonstram o relevante impacto dos marcadores metabólicos no risco de desenvolver CM e o seu impacto na sobrevida. Este estudo reforça a relevância das estratégias de prevenção relacionadas ao estilo de vida e nutrição a fim de diminuir incidência e melhorar a sobrevida de mulheres com CM.

Repercussões metabólicas: quais, como e por que investigar? / Metabolic repercussions: which ones, how and why investigate?

A síndrome dos ovários policísticos (SOP) é frequentemente acompanhada de distúrbio metabólico, principalmente dos carboidratos e dos lipídeos, aumentando o risco de síndrome metabólica. Por essa razão, alguns investigadores ainda denominam a SOP de síndrome metabólica-reprodutiva. O objetivo deste capítulo é descrever as principais repercussões metabólicas, bem como como investigá-las e saber como suas consequências podem ser deletérias para a saúde da mulher. Esta é uma revisão narrativa mostrando a implicação do metabolismo dos carboidratos e dos lipídeos nas dislipidemias, bem como da síndrome metabólica sobre o sistema reprodutor, e o risco cardiovascular da mulher com SOP. Conclui-se que o manejo adequado dos distúrbios metabólicos na SOP é benéfico a curto e a longo prazo tanto para o sistema reprodutor quanto para o cardiovascular.(AU)

Prediabetic state and dyslipidemia in freshmen in Health Sciences campus of a Mexican University / Prediabetes y dislipidemia en estudiantes de Nuevo ingreso al campus de Ciencias de la Salud de una universidad Mexicana

Objective: given the dramatic increase of diabetes in the world, the objective of this research was to analyze the values of blood glucose in a university population again income to support strategies for detection and preventive management of pre-diabetes and diabetes. Materials and methods: this is an observational, analytical,cross-sectional, non-probabilistic study to analyze biochemical markers in two freshman populations in a School of Medicine, 367 students enrolled in 2011 and 430 enrolled in 2016. The study variables were glycemia, triglyceridemia, and cholesterolemia.Statistical measures of central tendency, dispersions, and correlations for the groups,and applied Chi-square to clinical categories was analiced. Results: it was found significant increases in women in glycemia between 2011 and 2016: t = -4.582 (p = 0.0001) and cholesterolemia t = -9.124 (p = 0.0001). Men had significant increases in glycemia with t = -6.428 (p = 0.0001) and cholesterolemia with t = -9.499 (p = 0.0001).There was a higher prevalence of prediabetes and total cholesterol in borderline levels and risks in the 2016-population. We found correlation in men and women regarding glucose-triglycerides, glucose-cholesterol, and cholesterol-triglycerides in both populations. Conclusions: in the sample of 2016 there was increase in young adults at risk of developing type 2 diabetes mellitus and atherosclerosis by what is needed to develop strategies to improve lifestyle..(AU)

Objetivo: a nivel global se ha observado un desplazamiento hacia la derecha los promedios de glucosa y colesterol en sangre. Esto aumenta la probabilidad de desarrollar enfermedades no transmisibles. Por ello el objetivo fue analizar la prevalencia de anomalías en adultos jóvenes. Materiales y métodos: es un estudio observacional,analítico, transversal, no probabilistico. Se realizó en el Centro Clínico de una Escuela de Medicina en el sureste de México. Participaron poblaciones de nuevo ingreso a una facultad de medicina, 367 jóvenes en 2011, y 430 en 2016. Mediciones principales.Glucemia, trigliceridemia y colesterolemia en ayuno. Se analizaron estadísticos de tendencia central, dispersiones y correlaciones para los grupos. También Chi2 para categorías clínicas. Resultados: se encontraron incrementos significativos en mujeres de glucemia entre 2011 y 2016, t = -4.582 (p = 0.0001) y colesterolemia, t = -9.124 (p= 0.0001). Los hombres también tuvieron incrementos significativos en glucemia con t= -6.428 (p = 0.0001) y colesterolemia con t = -9.499 (p = 0.0001). Hubo mayor revalencia de prediabetes y colesterol total en niveles mayores al deseable en la población de 2016. Se encontró correlación en mujeres y hombres entre glucosa-triglicéridos, glucosa-colesterol y colesterol triglicéridos en ambas poblaciones. Conclusiones: en 2016 hubo incremento en la proporción de individuos en riesgo de desarrollar diabetes de tipo 2 y aterosclerosis..(AU)

Ginsenoside Rg1 inhibits dietary-induced obesity and improves obesity-related glucose metabolic disorders

Obesity and its consequent type 2 diabetes are significant threats to global health. Emerging evidence indicates that ginsenosides from ginseng (Panax ginseng) have anti-diabetic activity. We hypothesized that ginsenosides Rg1 could suppress dietary-induced obesity and improve obesity-related glucose metabolic disorders. Our results showed that ginsenoside Rg1 attenuated dietary-induced body weight gain and fat accumulation in white adipocyte tissue of mice fed a high-fat diet. Furthermore, we found that ginsenosides Rg1 not only decreased fasting glucose concentration and the 2-h postprandial glucose concentration, but also improved insulin resistance and glucose intolerance in those mice. Ginsenoside Rg1 also activated the AMPK pathway in vitro and in vivo and increased plasma membrane translocation of GLUT4 in C2C12 skeletal muscle cells. In conclusion, our observations suggested that ginsenoside Rg1 inhibited dietary-induced obesity and improved obesity-related insulin resistance and glucose intolerance by activation of the AMPK pathway.

Evaluación de tres metodologías para la predicción del riesgo de alteraciones del metabolismo de la glucosa en sujetos con sobrepeso y obesidad / Evaluation of three methodologies for risk prediction of impaired glucose metabolism in overweighed and obese subjects

Introducción: en la actualidad, en Cuba no existe una estrategia establecida para la pesquisa de las alteraciones del metabolismo de la glucosa. Objetivo: evaluar la capacidad diagnóstica de tres metodologías para predecir el riesgo de alteraciones del metabolismo de la glucosa en sujetos con sobrepeso y obesidad. Métodos: se realizó un estudio de evaluación diagnóstica longitudinal, con los datos de 90 sujetos con edades comprendidas entre 25 y 70 años, analizados 2,5 años después de la evaluación inicial. Se obtuvo la edad, el sexo, los antecedentes patológicos personales, los medicamentos empleados, el peso, la talla, el perímetro de cintura y la tensión arterial, así como las concentraciones de glucosa al inicio y a los 2,5 años ulteriores, la insulina y los triglicéridos, además de calcular la resistencia a la insulina en la evaluación inicial. Se utilizó un modelo de puntaje-riesgo para la diabetes tipo 2. Resultados: la frecuencia de alteraciones del metabolismo de la glucosa (glucemia alterada en ayuna y diabetes tipo 2) a los 2,5 años ulteriores, de acuerdo con la presencia previa o no en los sujetos de glucemia alterada en ayunas, resistencia a la insulina y riesgo moderado/alto de diabetes tipo 2, fue superior en los sujetos con glucemia alterada en ayuna previa (72,4 por ciento [21/29]), con resistencia a la insulina al inicio (65,6 por ciento [40/61]) y con riesgo moderado/alto (54,4 por ciento [43/79]), en relación con aquellos sin glucemia alterada en ayuna, sin resistencia a la insulina y con riesgo bajo de diabetes (41,0 por ciento [25/61], p= 0,005; 20,7 por ciento [6/29], p= 0,006 y 27,3 por ciento [3/11], p< 0,0001 respectivamente). La resistencia a la insulina y el riesgo de diabetes tipo 2 moderado/alto mostraron una elevada sensibilidad para identificar sujetos con alteraciones del metabolismo de la glucosa (87,0 y 93,5 por ciento respectivamente), por el contrario de la glucemia alterada en ayunas, que mostró una baja sensibilidad (45,7 por ciento). De los 19 sujetos que desarrollaron diabetes tipo 2 a los 2,5 años, el 100 por ciento presentó riesgo de diabetes tipo 2 moderado/alto y 94,7 por ciento resistencia a la insulina al inicio. Conclusiones: la resistencia a la insulina y el riesgo de diabetes tipo 2 podrían ser de gran utilidad en la identificación de individuos con alto riesgo para padecer diabetes(AU)

Introduction: at present, there is no set strategy in Cuba for the screening of impaired glucose metabolism. Objective: to evaluate the diagnostic capacity of three methodologies to predict the risk of impaired glucose metabolism in overweighed and obese individuals. Methods: a longitudinal diagnostic evaluation study was carried out using data from 90 subjects aged 25 to 70 years, which were analyzed two and a half years after the initial assessment. Information about age, sex, personal pathological history, used medication, weight, height, waist circumference and blood pressure as well the glucose concentrations at the beginning and two and a half years later, insulin and triglyceride indexes was collected in addition to estimating the insulin-resistance index in the initial evaluation. A risk-score model for type 2 diabetes was also used. Results: the frequency of impaired glucose metabolism (impaired fasting glycemia and type 2 diabetes) after two and a half years, according to the previous existence or not of impaired fasting glycemia, insulin resistance and moderate/high risk of type 2 diabetes, was higher in subjects with previous impaired fasting glycemia (72,4 percent [21/29]), with insulin resistance at the beginning (65.6 percent [40/61]) and with moderate/high risk (54,4 percent [43/79]) than in those individuals without impaired fasting glycemia, insulin resistance and with low diabetes risk (41.0 percent [25/61], p= 0,005; 20.7 percent [6/29], p= 0.006 and 27.3 percent [3/11], p< 0.0001, respectively). Insulin resistance index and moderate/high risk of type 2 diabetes showed high sensitivity to identify subjects with impaired glucose metabolism (87.0 and 93.5 percent, respectively), in contrast to impaired fasting glucose whose sensitivity was low (45.7 percent). Of 19 individuals who developed type 2 diabetes two and a half years later, 100 percent had moderate/high risk of type 2 diabetes and 94.7 percent had insulin resistance at the beginning. Conclusions: insulin resistance and risk of type 2 diabetes could be very useful in detecting individuals with high risk of developing diabetes(AU)

Glucose metabolism disorders and vestibular manifestations: evaluation through computerized dynamic posturography / Distúrbios do metabolismo da glicose e manifestações vestibulares: avaliação pela posturografia dinâmica computadorizada

ABSTRACT INTRODUCTION: Global sugar consumption has increased in the past 50 years; its abusive intake is responsible for peripheral insulin resistance, which causes the metabolic syndrome - obesity, diabetes mellitus, hypertension, and coronary heart disease. OBJECTIVE: To evaluate the effect of a fractionated diet without glucose as treatment for labyrinthine disorders associated with glucose-insulin index. METHODS: The study design was a prospective randomized controlled trial. Fifty-one patients were divided into two groups: the diet group (DG), which comprised subjects treated with a fractionated diet with glucose restriction, and the control group (CG), in which individuals were not counseled regarding diet. Patients underwent computerized dynamic posturography (CDP) and visual analog scale (VAS) on the first and 30th days of the study. RESULTS: There was improvement in the assessed posturographic conditions and VAS self-assessment in the DG group after 30 days when compared to the control group. CONCLUSION: The fractionated diet with glucose restriction was effective for the treatment of vestibular dysfunction associated with glucose metabolism disorders.

Resumo Introdução: O consumo mundial de açúcar triplicou nos últimos 50 anos e a sua ingesta abusiva é responsável pela resistência periférica à insulina que origina a síndrome metabólica-obesidade, diabetes mellitus, hipertensão arterial e doenças coronarianas. Objetivo: Avaliar de forma objetiva o efeito da dieta fracionada e sem glicose como forma de tratamento dos distúrbios labirínticos associados às alterações da curva glicoinsulinêmica. Método: Trata-se de um ensaio clínico controlado randomizado prospectivo. Estudo realizado com 51 pacientes divididos em dois grupos: Grupo Dieta composto por indivíduos tratados com dieta fracionada com restrição de glicose e Grupo Controle no qual os indivíduos não foram orientados em relação à dieta. Os pacientes realizaram Posturografia Dinâmica Computadorizada e Escala Análogo Visual no primeiro e trigésimo dias do estudo. Resultados: Foi observada melhora nas condições posturográficas avaliadas e melhora clínica do grupo dieta na análise da escala análogo visual quando comparados grupo dieta e grupo controle. Conclusão: A dieta fracionada e restritiva de glicose mostrou-se eficaz no tratamento das disfunções vestibulares associadas aos distúrbios do metabolismo da glicose.

Preeclampsia - eclampsia: factor de riesgo para síndrome metabólico / Preeclampsia-eclampsia: risk factor for metabolic syndrome

La historia de Preeclampsia-Eclampsia ha sido documentada como factor de riesgo para SM. Objetivo: evaluar la relación entre el antecedente del Síndrome Preeclampsia-Eclampsia y el diagnóstico del SM actual. Método: Un estudio de casos, descriptivo y retrospectivo de pacientes mayores de 35 años, con historia de Preeclampsia ­ Eclampsia por lo menos 20 años antes. Procedimiento: Recolección de datos en las consultas y hospitalización del Hospital Hernández, Los Magallanes, Caracas, Venezuela entre los meses de septiembre a noviembre del 2012, y se evaluó el 100% de las mujeres atendidas en la consulta creada para ese fin. A estas pacientes se les realizó una historia médica integral y se evaluaron los criterios diagnósticos del SM. Tratamiento estadístico: Las variables se registraron en una hoja de recolección de datos y se vaciaron en una base de datos Excel 2010. Se evaluaron desde el punto de vista descriptivo, las variables numéricas fueron tratadas con promedios y medidas de tendencia central y las cualitativas con proporciones y/o porcentaje. Las comparaciones intergrupales se realizaron a través de la prueba de chi cuadrado modificado para el tamaño de la muestra(AU)

It has been documented that a history of Preeclampsia - Eclampsia is a risk factor for metabolic syndrome. Objective: To evaluate the relationship between a history of preeclampsiaeclampsia syndrome and diagnosis of the current metabolic syndrome. Method: A case study, descriptive and retrospective patients in women older than 35 years, with a history of preeclampsia - Eclampsia at least 20 years earlier. Procedure: a data collection was used in ambulatory and hospitalization area of the Hospital José Gregorio Hernández between the months of September to November 2012, and assessed 100% of women are addressed in the query created for that purpose. These patients had a comprehensive medical history and diagnostic criteria of MS were evaluated. Statistics: Variables were recorded on a sheet of data collection and emptied in a database Excel 2010 data. They were evaluated from the descriptive point of view, numeric variables were treated with averages and measures of central tendency and qualitative proportions and / or percentage. Intergroup comparisons were carried out by the modified chi-square test for sample size(AU)

Prevalencia de los principales trastornos metabólicos en niños entre las edades de 2 a 18 años con diagnóstico de obesidad de la consulta externa de endocrinología del Hospital Nacional de Niños Benjamín Bloom durante el periodo 2012-2014 / Prevalence of the main metabolic disorders in children between the ages of 2 to 18 years with a diagnosis of obesity in the endocrinology outpatient clinic of the Benjamín Bloom National Children's Hospital during the period 2012-2014

El estudio es Descriptivo de tipo Transversal, Observacional, Retrospectivo. Se determinó la prevalencia de Hiperinsulinemia, Dislipidemias, y Diabetes Mellitus Tipo 2, se tomó como universo aquellos niños de la consulta externa de endocrinología del Hospital de Niños Benjamín Bloom diagnosticados con Obesidad según su índice de masa corporal, se utilizó el muestreo aleatorio simple tomando en cuenta los criterios de inclusión y exclusión establecidos. Los trastornos metabólicos más frecuentes en los niños obesos de la consulta externa de endocrinología de Hospital de niños Benjamin Bloom fueron en primer lugar la Hiperinsulinemia con un 68.5% (37 pacientes), En segundo lugar tenemos a Dislipidemia con un 29.6% (16 pacientes), hallazgos importantes como Acantosis Nigricans fueron encontrados en 66.7% de la población estudiada. Apenas 1.9% de los pacientes en nuestro estudio presentaron el Diagnostico de Diabetes Mellitus tipo 2. El principal trastorno metabólico en niños con diagnóstico de obesidad de la consulta externa de endocrinología de Hospital de Niños Benjamín Bloom es la Hiperinsulinemia con un 68.5% (37 pacientes)

Incidencias de pacientes con diabetes descompensada en la Unidad de Cuidados Intensivos del Hospital Regional Miguel Ángel Mariscal Llerena Ayacucho - 2016 / Incidences of the patients with decompensated diabetes in the Intensive Care Unit at the Regional Hospital Miguel Angel Llerena Mariscal, Ayacucho - 2016

La diabetes es un trastorno metabólico que se ha convertido en los últimos años en un problema de salud global y alarmante constituyendo la principal causa de enfermedad y muerte temprana en los adultos. Estudios realizados señalan que esta enfermedad cada vez se manifiesta en edades más tempranas y su evolución está asociada al desarrollo de complicaciones cuyo costo social y sanitario es alto. En esta perspectiva, es que se realizado la presente investigación cuyo título es "Incidencia de pacientes con diabetes descompensada en la unidad de cuidados intensivos del hospital regional Miguel Ángel Mariscal Llerena - Ayacucho". Objetivo: Determinar la incidencia de la diabetes descompensada en los pacientes mayores de 15 años ingresados en la unidad de cuidados intensivos. Metodología: El estudio es de tipo cuantitativo, nivel aplicativo, método descriptivo de corte transversal. Población: Pacientes mayores de 15 años que ingresaron a la unidad de Cuidados Intensivos, del Hospital Regional de Ayacucho, que cumpla con los criterios de inclusión; la técnica fue la observación y se utilizó como instrumento un cuestionario. Resultados: Del 100 por ciento (34) de pacientes diabéticos hospitalizados, el 59 por ciento (20) tienen diabetes descompensada y el 41 por ciento (14) tuvieron diabetes no descompensada. Conclusión: Hay un elevado porcentaje de diabetes descompensada.

Diabetes is a metabolic disorder that has become in recent years an alarming problem overall health and the main cause of disease and early death in adults. Studies indicate that this disease is manifested in increasingly younger ages and their evolution is associated with the development of social and health complications whose cost is high. In this perspective, it is that this research titled "Incidence of patients with decompensated diabetes in the intensive care unit of regional hospital Miguel Angel Mariscal Llerena - Ayacucho" is performed. Objective: To determine the incidence of diabetes decompensated patients older than 15 years admitted to the intensive care unit. Methodology: The study is quantitative, application level, descriptive method of cross section. Population: Patients older than 15 years who were admitted to the Intensive Care Unit of the Regional Hospital of Ayacucho, who meets the inclusion criteria; the technique was observation and was used as instrument a questionnaire. Results: Of 100 per cent (34) of diabetic patients hospitalized, 59 per cent (20) have decompensated diabetes and 41 per cent (14) had not decompensated diabetes. Conclusion: There is a high percentage of diabetes decompensated.

Emergências glicêmicas / Glycemic emergencies

Emergências glicêmicas são complicações frequentes na prática do emergencista, constituindo importante causa de morbimortalidade. Este capítulo objetiva abordar de forma prática o diagnóstico e o manejo das emergências glicêmicas mais comuns em sala de emergência.

Glycemic emergencies are frequent complications in the practice of the emergencist physician, and it is an important cause of morbidity and mortality. This chapter aims to approach in a practical way the diagnosis and management of the most common glycemic emergencies in the emergency room.

Relation between sleep quality and metabolic syndrome among university students / Relación entre calidad del sueño y síndrome metabólico en estudiantes universitarios / Relação entre qualidade do sono e síndrome metabólica em universitários

This transversal study aimed to analyze the relationship between poor sleep quality and metabolic syndrome among university students. The sleep quality and the components of metabolic syndrome of 701 university students from Fortaleza, Brazil, were evaluated during 2011 and 2012. In the evaluation of the scale of the associations, robust Poisson regression was used, adjusted for sex and age. The prevalence of metabolic syndrome and poor quality sleep was 1.7% and 95.3% respectively. There was an increase in risk of 5% of developing metabolic syndrome among those university students who slept poorly (p=0.013). It is concluded that the university students in the sample who were poor sleepers present a greater probability of presenting metabolic syndrome.

Estudio cuantitativo, transversal, con el objetivo de analizar la relación entre la calidad del sueño de los pobres y el síndrome metabólico en estudiantes universitarios. Durante 2011 y 2012 se evaluaron la calidad del sueño y los componentes del síndrome metabólico de 701 estudiantes universitarios en Fortaleza, Brasil. En la evaluación de la magnitud de las asociaciones se utilizó robusto de regresión de Poisson ajustado por edad y sexo. La prevalencia del síndrome metabólico y la mala calidad del sueño fue de 1,6% y 95,3% respectivamente. Hubo un aumento del 5% de riesgo de desarrollar el síndrome metabólico entre los universitarios malos durmientes (p=0,013). Se puede concluir en la investigación que los estudiantes universitarios clasificados como malos durmientes eran más propensos a tener el síndrome metabólico.

Estudo de corte transversal, cujo objetivo foi analisar a relação entre má qualidade do sono e síndrome metabólica em universitários. Foram avaliados a qualidade do sono e os componentes da síndrome metabólica de 701 universitários de Fortaleza, Brasil durante 2011 e 2012. Na avaliação da magnitude das associações foi utilizada a regressão de Poisson robusta ajustada para sexo e idade. A prevalência de síndrome metabólica e má qualidade do sono foi de 1,7% e 95,3% respectivamente. Houve um aumento do risco de 5% para o desenvolvimento de síndrome metabólica entre os universitários maus dormidores (p=0,013). Pode-se concluir que os universitários da amostra maus dormidores apresentaram mais chance de apresentar síndrome metabólica.

Thyroid volume in patients with glucose metabolism disorders / Volume da tiroide em pacientes com alterações do metabolismo da glicose

Objective Thyroid volume and the prevalence of thyroid nodules are higher in patients with insulin resistance. A relationship between thyroid volume and glucose metabolism disorders (GMD) has not as yet been clarified. The present retrospective study aimed to investigate the association between GMD and thyroid volume. Subjects and methods: We investigated the data of 2,630 patients who were evaluated for thyroid biopsy in our hospital. The study population included 602 patients with GMD, 554 patients with diabetes mellitus (DM) and 1,474 patients with normal glucose metabolism as a control group. We obtained the levels of serum thyroid stimulating hormone (TSH) and the thyroid volumes of those patients retrospectively. Results The median ages for the control group, GMD group and DM group were 55 (15‐91) years, 60 (27‐97) years, and 65 (27‐91) years respectively and there was a statistically significant difference between the groups with regard to age and gender (p<0.001). Levels of TSH were similar in all groups. The median total thyroid volumes for patients with DM and GMD were significantly higher than that of the control group [22.5 (3‐202) mL, 20.2 (4‐190) mL, and 19.2 (3‐168) mL respectively, p≤0.001 for all parameters]. Also the median total thyroid volume for patients with DM was significantly higher than that of the GMD group (p<0.001). According to the correlation analysis, thyroid volume was significantly correlated with age (r=0.92, p<0.001) and TSH (r=0.435, p<0.001). Age, gender, TSH levels, GMD and DM diagnosis were independently correlated with thyroid volume. Conclusion The thyroid gland is one of the target tissues of metabolic disorders. We reported a positive correlation between GMD/type 2 DM and thyroid volume. Further controlled, prospective, randomized studies on this subject are required to gain more information. .

Objetivo O volume da tiroide e a prevalência de nódulos tiroidianos são mais altos em pacientes com resistência à insulina. A relação entre o volume da tiroide e os transtornos do metabolismo da glicose (TMG) ainda não foi elucidada. O objetivo do presente estudo retrospectivo foi investigar a associação entre os TMG e o volume da tiroide. Sujeitos e métodos: Analisamos os dados de 2.630 pacientes que foram avaliados para biópsia de tiroide em nosso hospital. A população estudada incluiu 602 pacientes com TMG, 554 pacientes com diabetes melito (DM) e 1.474 pacientes com metabolismo normal da glicose, como grupo controle. As concentrações de hormônio tireoestimulante (TSH) e os volumes da tiroide para esses pacientes foram obtidos de forma retrospectiva. Resultados As idades medianas para o grupo controle, grupo TMG e grupo DM foram 55 (15‐91), 60 (27‐97) e 65 (27‐91) anos, respectivamente, e houve diferença estatisticamente significativa entre os grupos com relação à idade e ao gênero (p<0,001). Os níveis de TSH foram similares em todos os grupos. A mediana do volume total da tiroide para pacientes com DM e TMG foi significativamente maior do que para os pacientes do grupo controle [22,5 (3‐202) mL, 20,2 (4‐190) mL, e 19,2 (3‐168) mL, respectivamente, p≤0,001 para todos os parâmetros]. Além disso, a mediana do volume total da tiroide para pacientes com DM foi significativamente maior do que no grupo TMG (p<0,001). De acordo com a análise de correlação, o volume da tiroide foi significativamente correlacionado com a idade (r=0,92; p<0,001) e TSH (r=0,435; p<0,001). A idade, o gênero, a concentração de TSH e o diagnóstico de TMG e DM se correlacionaram com o volume da tiroide de forma independente. Conclusão A tiroide ...

Serum uric acid and disorders of glucose metabolism: the role of glycosuria

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4±12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

Estratégias de prevención: diabetes mellitus / Prevention strategies: diabetes mellitus

La diabetes mellitus tipo 2 es un trastorno metabólico multifactorial que afecta el metabolismo de lípidos, proteínas y carbohidratos con complicaciones crónicas que alteran la calidad de vida del individuo, altos costos por morbilidad, mortalidad y discapacidad. Existen múltiples estudios que describen estrategias farmacológicas y no farmacológicas para detener o retrasar la progresión a diabetes; en este artículo se pretende analizar los estudios publicados en el área de prevención con el fin de poder determinar cuál es la estrategia óptima. Como método los autores realizaron una búsqueda y revisión de la literatura nacional e internacional en buscadores médicos especializados a saber: Centro Cochrance Iberoamericano, PubMed, Medscape, la base de datos de las revistas de la ALAD, New England Journal of Medicine, Lancet, The British Journal of Medicine y Diabetes Care. En los resultados se evidenció que las intervenciones se realizaron en pacientes con alto riesgo y alteraciones en la glicemia en ayuno o curva de tolerancia glucosada. Las intervenciones en el estilo de vida (dieta+ ejercicio) de manera continua han demostrado ser altamente efectivos en reducción de riesgo; del mismo modo, algunos fármacos como la metformina, acarbosa y rosiglitazona pero con efectos secundarios relevantes. Conclusiones: El tamizaje para detectar a la población de alto riesgo para desarrollar diabetes mellitus y ulterior aplicación de estrategias individualizadas con intervenciones en el estilo de vida para minimizar los factores de riesgo, son herramientas efectivas a la hora de hacer prevención en diabetes tipo 2(AU)

Diabetes mellitus type 2 is a multifactorial metabolic disorder involving the metabolism of lipids, proteins and carbohydrates with chronic complications affecting the quality of life of the individual, high costs due morbidity, mortality and disability. Many studies describe pharmacological and non-pharmacological strategies to halt or delay the progression to diabetes; this article analyzes the studies so far published on the subject of prevention in order to determine the optimal strategy. As a method the authors conducted a search and review of national and international literature in specialized medical search engines namely Latin American Center Cochrance, PubMed, Medscape, the database ALAD magazines, The New England Journal of Medicine, Lancet, The British Journal of Medicine and Diabetes Care. The results evidence that the interventions were performed in patients at high risk and impaired fasting glucose or glucose tolerance curve. Interventions in lifestyle (diet plus exercise) continuously have proven highly effective in reducing risk, similarly some drugs such as metformin, acarbose and rosiglitazone but with side effects as product of their use. Conclusions: screening should be performed to detect people at high risk for diabetes mellitus in this group later to implement individualized strategies, interventions should begin with lifestyle and patients with multiple risk factors may include drug treatment(AU)

Microbiota intestinal e risco cardiometabólico: mecanismos e modulação dietética / Intestinal microbiota and cardiometabolic risk: mechanisms and diet modulation

A microbiota intestinal, adquirida no período pós-natal, é composta por grande diversidade de bactérias que desempenham diferentes funções no hospedeiro humano, entre elas a absorção de nutrientes, proteção contra patógenos e modulação do sistema imune. O conteúdo bacteriano intestinal ainda não é totalmente conhecido, mas sabe-se que é influenciado por fatores internos e principalmente externos que modulam sua composição e função. Estudos indicam que a microbiota intestinal difere em indivíduos magros e obesos e ainda naqueles que mantêm hábitos alimentares diferentes. Há evidências de que as relações entre dieta, inflamação, resistência à insulina e risco cardiometabólico são em parte mediadas pela composição de bactérias intestinais. Conhecimentos sobre a microbiota poderão reverter em diferentes estratégias para manipular as populações bacterianas e promover saúde. Esta revisão aborda a relevância do conhecimento sobre o papel de fatores ou padrões alimentares na composição da microbiota, assim como mecanismos fisiopatológicos de doenças metabólicas crônicas e as potencialidades de prebióticos e probióticos sobre o perfil de risco cardiometabólico.

The gut microbiota obtained after birth is composed of a large range of bacteria that play different roles in the human host, such as nutrient uptake, protection against pathogens and immune modulation. The intestinal bacterial content is not completely known, but it is influenced by internal, and mainly by external factors, which modulate its composition and function. Studies indicate that the gut microbiota differs in lean and obese individuals, and in individuals with different food habits. There is evidence that the relationship between diet, inflammation, insulin resistance, and cardiometabolic risk are, in part, mediated by the composition of intestinal bacteria. Knowledge about the gut microbiota may result in different strategies to manipulate bacterial populations and promote health. This review discusses the relevance of understanding the role of dietary factors or patterns in the composition of the microbiota, as well as pathophysiological mechanisms of chronic metabolic diseases, and the potential of prebiotics and probiotics on the cardiometabolic risk profile.