RESUMO
AIMS: To analyse glucose-lowering drug utilization, focusing on the novel glucose-lowering drug groups dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, and the financial burden they entail. METHODS: Crude reimbursed national drug utilization and expenditure data for the entire population of Hungary were obtained from the National Health Insurance Fund for the study period: 2008 to 2017. Data were analysed using the WHO's Anatomical Therapeutic Chemical Classification/defined daily dose system and were expressed in defined daily dose per 1000 inhabitants per day. RESULTS: Total glucose-lowering drug consumption in Hungary showed an 18% increase over the study period, reaching 74.7 defined daily doses per 1000 inhabitants per day, while novel glucose-lowering drug use increased to 11.7 defined daily doses per 1000 inhabitants per day (16% of total glucose-lowering drug use) by 2017. Dipeptidyl-peptidase 4 inhibitor consumption grew to 7.4 defined daily doses per 1000 inhabitants per day by 2017. The most widely used dipeptidyl-peptidase 4 inhibitor was sitagliptin. Glucagon-like peptide-1 receptor agonists were used the least, but by 2017 rose to 1.5 defined daily doses per 1000 inhabitants per day, led by liraglutide. Sodium-glucose co-transporter-2 inhibitors appeared in the utilization data in 2014 and their consumption, mainly empagliflozin, reached 2.8 defined daily doses per 1000 inhabitants per day by 2017. The total expenditure on glucose-lowering drugs increased 94% between 2008 and 2017, and the total cost of novel glucose-lowering drug utilization comprised 44% of the total glucose-lowering drug expenditure in 2017. CONCLUSIONS: Both the use of and the financial burden posed by novel glucose-lowering drugs in Hungary increased steadily between 2008 and 2017. This increase is expected to continue.
Assuntos
Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Custos de Medicamentos/estatística & dados numéricos , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Hungria , Hipoglicemiantes/economia , Estudos Retrospectivos , Fosfato de Sitagliptina/uso terapêuticoRESUMO
AIM OF THE STUDY: Barriers in access to essential care are key determinants of disparities in cancer survival. Breast cancer (BC) is the most common cancer and lead cause of mortality among women, 60 % occurring in low- and middle-income countries (LMs). A quarter of BC are characterized by an over-expression of the epidermal growth factor receptor 2 (HER2). Valuable strategies to diagnose and manage patients with HER2-positive BC have been determined and some considered essential health interventions. ONCOLLEGE-001 is a global survey of availability, accessibility, and affordability of essential HER2 diagnostics and therapeutics. METHOD: A self-administered questionnaire was shared electronically to oncologists, identified from oncology networks. Data were analyzed using descriptive statistics, per income areas and geographic regions. RESULTS: We received 191 responses (84 % response rate). The majority of the responders were from LMs (nâ¯=â¯153) and were physician providers. Immunohistochemistry was the most common HER2 diagnostics available (nâ¯=â¯185). A third of the responders from low/lower-middle and a half of upper-middle income countries had HER2 testing only in the private sector. Trastuzumab was not available for 8 %: when available, 15%-21% reported accessibility only as out-of-pocket expenditure; when not reimbursed, only 10 % of the providers could significantly offer this intervention. Availability of trastuzumab biosimilars was reported in more than a half of the responders (nâ¯=â¯107). CONCLUSION: Stark disparities are reported, with high out-of-pocket expenses for HER2 testing and significant financial barriers to access trastuzumab treatments. Policy solutions are urgently warranted for the selection, prioritization, and reimbursement of essential health interventions, to result in improved population health. POLICY SUMMARY STATEMENT: the inclusion of essential services for cancer management should be assured and financed in the benefit packages of healthcare to all. Prioritizing high-value health interventions, including medicines and medical devices, is critical to deliver impactful programs on population health.
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Medicamentos Biossimilares , Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Custos e Análise de Custo , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Inquéritos e Questionários , Trastuzumab/uso terapêuticoRESUMO
INTRODUCTION: Left ventricular (LV) twist is considered an essential part of LV function due to oppositely directed LV basal and apical rotations. Several factors could play a role in determining LV rotational mechanics in normal circumstances. This study aimed to investigate the relationship between LV rotational mechanics and mitral annular (MA) size and function in healthy subjects. METHODS: The study comprised 118 healthy adult volunteers (mean age: 31.5 ± 11.8 years, 50 males). All subjects had undergone complete two-dimensional (2D) Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE) at the same time by the same echocardiography equipment. RESULTS: The normal mean LV apical and basal rotations proved to be 9.57 ± 3.33 and -3.75 ± 1.98°, respectively. LV apical rotation correlated with end-systolic MA diameter, area, perimeter, fractional area change, and fractional shortening, but did not correlate with any end-diastolic mitral annular morphologic parameters. The logistic regression model identified MA fractional area change as an independent predictor of ≤6° left ventricular apical rotation (P < 0.003). CONCLUSIONS: Correlations could be detected between apical LV rotation and end-systolic MA size and function, suggesting relationships between MA dimensions and function and LV rotational mechanics.
Assuntos
Ecocardiografia Doppler/métodos , Ecocardiografia Tridimensional/métodos , Ventrículos do Coração/fisiopatologia , Valva Mitral/fisiologia , Adulto , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Curva ROC , Rotação , Função Ventricular EsquerdaRESUMO
OBJECTIVE: Modified texture food (MTF), especially pureed is associated with a high prevalence of under-nutrition and weight loss among older adults in long term care (LTC); however, this may be confounded by other factors such as dependence in eating. This study examined if the prescription of MTF as compared to regular texture food is associated with malnutrition risk in residents of LTC homes when diverse relevant resident and home-level covariates are considered. DESIGN: Making the Most of Mealtimes (M3) is a cross-sectional multi-site study. SETTING: 32 LTC homes in four Canadian provinces. PARTICIPANTS: Regular (n= 337) and modified texture food consumers (minced n= 139; pureed n= 68). MEASUREMENTS: Malnutrition risk was determined using the Mini Nutritional Assessment short-form (MNA-SF) score. The use of MTFs, and resident and site characteristics were identified from health records, observations, and standardized assessments. Hierarchical linear regression analyses, accounting for clustering, were performed to determine if the prescription of MTFs is associated with malnutrition risk while controlling for important covariates, such as eating assistance. RESULTS: Prescription of minced food [F(1, 382)=5.01, p=0.03], as well as pureed food [F(1, 279)=4.95, p=0.03], were both significantly associated with malnutrition risk among residents. After adjusting for age and sex, other significant covariates were: use of oral nutritional supplements, eating challenges (e.g., spitting food out of mouth), poor oral health, and cognitive impairment. CONCLUSIONS: Prescription of minced or pureed foods was significantly associated with the risk of malnutrition among residents living in LTC facilities while adjusting for other covariates. Further work needs to consider improving the nutrient density and sensory appeal of MTFs and target modifiable covariates.
Assuntos
Dieta/estatística & dados numéricos , Assistência de Longa Duração , Desnutrição/epidemiologia , Refeições , Redução de Peso , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Avaliação Nutricional , Estado Nutricional , Prevalência , Fatores de RiscoRESUMO
BACKGROUND AND PURPOSE: Assessing the proarrhythmic potential of compounds during drug development is essential. However, reliable prediction of drug-induced torsades de pointes arrhythmia (TdP) remains elusive. Along with QT interval prolongation, assessment of the short-term variability of the QT interval (STV(QT)) may be a good predictor of TdP. We investigated the relative importance of I(Ks) and I(Kr) block in development of TdP together with correlations between QTc interval, QT interval variability and incidence of TdP. EXPERIMENTAL APPROACH: ECGs were recorded from conscious dogs and from anaesthetized rabbits given the I(Kr) blocker dofetilide (DOF), the I(Ks) blocker HMR-1556 (HMR) and their combination, intravenously. PQ, RR and QT intervals were measured and QTc and short-term variability of RR and QT intervals calculated. KEY RESULTS: DOF increased QTc interval by 20% in dogs and 8% in rabbits. HMR increased QTc in dogs by 12 and 1.9% in rabbits. Combination of DOF+HMR prolonged QTc by 33% in dogs, by 16% in rabbits. DOF or HMR given alone in dogs or HMR given alone in rabbits induced no TdP. Incidence of TdP increased after DOF+HMR combinations in dogs (63%) and following HMR+DOF (82%) and DOF+HMR combinations (71%) in rabbits. STV(QT) markedly increased only after administration of DOF+HMR combinations in both dogs and rabbits. CONCLUSION AND IMPLICATIONS: STV(QT) was markedly increased by combined pharmacological block of I(Kr) and I(Ks) and may be a better predictor of subsequent TdP development than the measurement of QTc interval prolongation.
Assuntos
Canais de Potássio de Retificação Tardia/fisiologia , Síndrome do QT Longo/fisiopatologia , Canais de Potássio de Abertura Dependente da Tensão da Membrana/fisiologia , Torsades de Pointes/fisiopatologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Cromanos/administração & dosagem , Cromanos/toxicidade , Canais de Potássio de Retificação Tardia/antagonistas & inibidores , Cães , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Eletrocardiografia/efeitos dos fármacos , Feminino , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Infusões Intravenosas , Síndrome do QT Longo/induzido quimicamente , Masculino , Fenetilaminas/administração & dosagem , Fenetilaminas/toxicidade , Potássio/sangue , Bloqueadores dos Canais de Potássio/administração & dosagem , Bloqueadores dos Canais de Potássio/toxicidade , Canais de Potássio de Abertura Dependente da Tensão da Membrana/antagonistas & inibidores , Coelhos , Sódio/sangue , Especificidade da Espécie , Sulfonamidas/administração & dosagem , Sulfonamidas/toxicidade , Torsades de Pointes/induzido quimicamenteRESUMO
BACKGROUND: Healthy eating perceptions and food group consumption practices of elderly men are largely unexplored. Understanding eating practices of elderly men and how this relates to their quality of life is important for the implementation of practical health promotion strategies. OBJECTIVE: Examine the frequency of food items consumed (daily, most days, or rarely), and the association of self-rated diet and food group consumption of elderly community-dwelling Canadian men. DESIGN: Self-reported nutrition data, obtained via mailed questionnaires in spring 2000, from 1,211 Canadian male respondents (mean age 82 years) participating in the Manitoba Follow-up Study were analyzed. RESULTS: Respondents consumed vegetables/fruit (64%) and grain products (58%) daily, and meat/alternatives (81%) most days. Milk products were equally consumed daily (47%) or most days (47%). Using multiple logistic regression models, controlling for demographic variables, a positive relationship was found between the increasing consumption of vegetables/fruit and grain products and healthier self-rated diets. Daily consumption of vegetables/fruit or grain products significantly predicted healthier self-rated diets compared to men consuming those food categories most days, OR=2.42 (95%CI=1.88, 3.11) and OR=2.18 (95%CI=1.70, 2.79), respectively. Those consuming meat/alternatives or milk products "daily" or "rarely" rated their diets as healthier than those consuming these items "most days". CONCLUSION: Daily consumption of fruits, vegetables, and grain products is viewed as important for overall health and is positively associated with healthier self-rated diets among elderly Canadian men.
Assuntos
Inquéritos sobre Dietas , Dieta/psicologia , Dieta/normas , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Idoso , Idoso de 80 Anos ou mais , Intervalos de Confiança , Grão Comestível , Comportamento Alimentar , Seguimentos , Frutas , Promoção da Saúde , Humanos , Modelos Logísticos , Masculino , Manitoba , Razão de Chances , Qualidade de Vida , Inquéritos e Questionários , VerdurasRESUMO
OBJECTIVES: To identify patterns of nutritional risk among older men over a four-year period and to project their survival rates over the next two and a half years. DESIGN: A prospective longitudinal study. SETTING: Canada. PARTICIPANTS: Three hundred and thirty-six male survivors of the Manitoba Follow-up Study (MFUS) cohort with an average age of 90 years in 2011. MEASUREMENTS: Four years of nutritional risk SCREEN II scores (five waves) from the male survivors of the MFUS cohort. The semi-parametric group-based trajectory approach and survival analysis were used to investigate the trajectories of nutritional risk. RESULTS: Of the participants, 30% lived alone. Five distinct developmental trajectory groups for nutritional risk score were identified. Significant statistical differences were found among the five trajectory groups for SF-36 mental health (p=.02), SF-36 physical health (p=<.001), perception of aging successfully (p=.04) and living alone (p=<.001). Among the five groups, the most pairwise differences were found in appetite, intake of meat and alternatives, and vegetables and fruit, weight change, skipping meals and eating with others. Men in the poorest nutritional risk trajectory group were two times more likely to die within a 2 1/2 year period compared to men in the best nutritional risk trajectory group (hazard rate = 2.33, p=.07). CONCLUSION: Distinct nutritional risk trajectories were found for older men over a four year period. Poor nutritional risk trajectories are associated with higher risk of mortality for very old men over a short period of time. Timely nutritional assessments by health professionals are needed to identify older men at nutritional risk. Subsequent nutrition education and follow-up may be important in preventing further decline.
Assuntos
Envelhecimento , Causas de Morte , Comportamento Alimentar , Avaliação Geriátrica , Nível de Saúde , Desnutrição , Meio Social , Idoso de 80 Anos ou mais , Apetite , Peso Corporal , Dieta , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/etiologia , Manitoba , Saúde Mental , Avaliação Nutricional , Estado Nutricional , Estudos Prospectivos , Risco , Isolamento SocialRESUMO
Introduction Myocardial contractility of the left ventricle (LV) is related to arterial distensibility. Sport activity is frequently associated with changes in both LV and arterial functions. This study aimed to find correlations between three-dimensional speckle-tracking echocardiography-derived segmental LV deformation parameters and echocardiographically assessed aortic stiffness index (ASI) in athletes. This study comprised 26 young elite athletes (mean age: 26.7 ± 8.4 years, nine men). Results Among segmental circumferential strains (CSs), only that of apical anterior (r = 0.40, p = 0.05), septal (r = 0.47, p = 0.01), inferior (r = 0.59, p = 0.001), lateral (r = 0.44, p < 0.05), and midventricular anteroseptal (r = 0.44, p < 0.05) segments correlated with ASI, whereas LV-CS of the midventricular anterior segment showed a correlation tendency. Only longitudinal strain of basal anteroseptal (r = -0.46, p < 0.05) and inferoseptal (r = -0.57, p < 0.01) segments showed correlations with ASI, whereas that of the basal anterior segment had only a tendency to correlate. Some segmental multidirectional strains also correlated with ASI. Conclusions Correlations could be demonstrated between increased aortic stiffness and circular function of the apical and midventricular LV fibers and longitudinal motion of the basal septum and LV anterior wall (part of LV outflow tract) in maintaining circulation in the elite athletes.
Assuntos
Aorta/fisiologia , Contração Miocárdica/fisiologia , Esportes/fisiologia , Volume Sistólico/fisiologia , Rigidez Vascular/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Aorta/diagnóstico por imagem , Ecocardiografia/métodos , Módulo de Elasticidade/fisiologia , Técnicas de Imagem por Elasticidade/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Estatística como AssuntoRESUMO
1. The effects of I(Ks) block by chromanol 293B and L-735,821 on rabbit QT-interval, action potential duration (APD), and membrane current were compared to those of E-4031, a recognized I(Kr) blocker. Measurements were made in rabbit Langendorff-perfused whole hearts, isolated papillary muscle, and single isolated ventricular myocytes. 2. Neither chromanol 293B (10 microM) nor L-735,821 (100 nM) had a significant effect on QTc interval in Langendorff-perfused hearts. E-4031 (100 nM), on the other hand, significantly increased QTc interval (35.6+/-3.9%, n=8, P<0.05). 3. Similarly both chromanol 293B (10 microM) and L-735,821 (100 nM) produced little increase in papillary muscle APD (less than 7%) while pacing at cycle lengths between 300 and 5000 ms. In contrast, E-4031 (100 nM) markedly increased (30 - 60%) APD in a reverse frequency-dependent manner. 4. In ventricular myocytes, the same concentrations of chromanol 293B (10 microM), L-735,821 (100 nM) and E-4031 (1 microM) markedly or totally blocked I(Ks) and I(Kr), respectively. 5. I(Ks) tail currents activated slowly (at +30 mV, tau=888.1+/-48.2 ms, n=21) and deactivated rapidly (at -40 mV, tau=157.1+/-4.7 ms, n=22), while I(Kr) tail currents activated rapidly (at +30 mV, tau=35.5+/-3.1 ms, n=26) and deactivated slowly (at -40 mV, tau(1)=641.5+/-29.0 ms, tau(2)=6531+/-343, n=35). I(Kr) was estimated to contribute substantially more to total current density during normal ventricular muscle action potentials (i.e., after a 150 ms square pulse to +30 mV) than does I(Ks). 6. These findings indicate that block of I(Ks) is not likely to provide antiarrhythmic benefit by lengthening normal ventricular muscle QTc, APD, and refractoriness over a wide range of frequencies.
Assuntos
Coração/efeitos dos fármacos , Bloqueadores dos Canais de Potássio , Potenciais de Ação/efeitos dos fármacos , Animais , Antiarrítmicos/farmacologia , Benzodiazepinas/farmacologia , Separação Celular , Cromanos/farmacologia , Colforsina/farmacologia , Eletrocardiografia , Feminino , Coração/fisiologia , Ventrículos do Coração/efeitos dos fármacos , Técnicas In Vitro , Cinética , Síndrome do QT Longo/fisiopatologia , Masculino , Microeletrodos , Miocárdio/citologia , Músculos Papilares/efeitos dos fármacos , Técnicas de Patch-Clamp , Piperidinas/farmacologia , Piridinas/farmacologia , Coelhos , Sulfonamidas/farmacologiaRESUMO
A case of erythromycin-induced acquired long QT syndrome and "torsades de pointes" ventricular tachycardia is reported. The peculiar ventricular tachyarrhythmia was evoked by orally administered erythromycin (1.5 g/die) in the presence of diuretic (clopamide)-induced hypokalaemia. The pause-dependent "torsades de pointes" was preceded by prolonged QTU interval (560 ms), "particular bigeminy" and "short-long-short" RR interval sequence. The recurrent ventricular tachycardia causing syncopal attacks was abolished by the discontinuation of erythromycin treatment, K+/Mg(2+)-supplementation and oral mexiletine therapy. It is emphasized that the macrolide antibiotic/prokinetic erythromycin, applied in therapeutic dosages, blocks the rapidly activating delayed rectifier potassium current (IKr), and as such, prolongs ventricular repolarization and may be "torsadogenic".
Assuntos
Eritromicina/efeitos adversos , Taquicardia Ventricular/induzido quimicamente , Torsades de Pointes/induzido quimicamente , Clopamida/efeitos adversos , Relação Dose-Resposta a Droga , Eletrocardiografia , Eritromicina/administração & dosagem , Feminino , Humanos , Hipopotassemia/induzido quimicamente , Hipopotassemia/complicações , Hipopotassemia/tratamento farmacológico , Pessoa de Meia-Idade , Potássio/uso terapêuticoRESUMO
The QT dispersion, measured as the interlead variability of QT interval (QTd = QTmax-QTmin), reflects the spatial inhomogeneity of ventricular repolarization times. The authors studied QTd and heart rate-corrected QTd (QTc-d) in 81 patients with diabetes mellitus (IDDM: 39, NIDDM: 42) using Bazett's formula; 20 non-diabetic subjects acted as controls (means +/- SD). QTd (43 +/- 17 ms) and QT c-d (52 +/- 20 ms) were increased (p < 0.05) as compared to the control values (QTd = 32 +/- 17 and, QTc-d = 35 +/- 17 ms, respectively). A significant difference was also observed in QTc-d if the two diabetic groups were compared to the control separately (p < 0.05). Moreover, comparison of the diabetic groups (IDDM vs NIDDM) revealed that type I diabetes mellitus is accompanied by a more pronounced spatial dispersion of ventricular reporlarization (QTd = 49 +/- 16, and QTc-d = 59 +/- 19 ms) as compared to NIDDM (QTd = 38 +/- 16, QTc-d = 46 +/- 20 ms [p < 0.01]). The hypothesis that increased QTd/QTc-d is truly a predictive marker of sudden arrhythmic cardiac death in patients with diabetes mellitus needs further clinical investigation.
Assuntos
Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/fisiopatologia , Feminino , Cardiopatias/complicações , Humanos , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Volume SistólicoRESUMO
The most feared side-effect of long-term amiodarone therapy is progressive alveolitis/pneumonitis leading to pulmonary fibrosis. The case history of a patient is presented who received amiodarone unnecessarily in a high dose (600 mg/day) for 4 years: drug-induced dermatopathy, hypothyroidism and lung fibrosis developed. After cessation of amiodarone treatment the pulmonary complication did not disappear therefore glucocorticoid therapy was introduced. New-onset improductive cough, dyspnea, fever and/or enhanced erythrocyte sedimentation rate may suggest the presence of amiodarone pulmonary toxicity and may form the basis of indication of high-resolution computed tomography (HRCT). Amiodarone-induced pulmonary involvement can be shown by HRCT early, before the appearance of any considerable abnormality of chest radiography.
Assuntos
Amiodarona/efeitos adversos , Fibrose Pulmonar/induzido quimicamente , Amiodarona/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Pessoa de Meia-Idade , Fibrose Pulmonar/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
A study was made of the pathogenic role of gallbladder hypomotility, which is presumably responsible for the high incidence of gallstone disease in long-standing diabetes mellitus. The gallbladder motility of diabetic patients (n = 10) was measured by means of quantitative hepatobiliary scintigraphy, and the severity of concomitant autonomic and sensory polyneuropathy was determined. The presence of marked gallbladder hypomotility was proven, and a positive correlation was observed between the severity of autonomic neuropathy and the contractile disorder. In this group of diabetic patients, a hypaesthetic sensory polyneuropathy too was recognized, the degree of which exhibited a positive correlation with the autonomic neuropathy score. This study underlines the important role of the autonomic neural dysfunction in the development of gallbladder hypomotility accompanying long-term diabetes mellitus.
Assuntos
Neuropatias Diabéticas/etiologia , Doenças da Vesícula Biliar/complicações , Vesícula Biliar/fisiopatologia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Doenças da Vesícula Biliar/fisiopatologia , Humanos , Hungria/epidemiologia , HipocinesiaRESUMO
BACKGROUND: New-onset diabetes after transplantation (NODAT) is one of the most common complications after kidney transplantation. METHODS: Patients were randomly assigned to receive cyclosporine A-based or tacrolimus-based immunosuppression. Fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following 3 groups, on the basis of the results: normal, impaired fasting glucose/impaired glucose tolerance, or NODAT. NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (P = .0002). RESULTS: Albumin levels were similar, but uric acid level (P = .002) and the age of the recipient (P = .003) were significantly different between the diabetic and the normal groups. Evaluation of tissue samples revealed that acute cellular rejection and interstitial fibrosis/tubular atrophy were significantly different in the NODAT group. Changes in the Banff score provided significant difference regarding tubulitis and interstitial inflammation (P = .05). CONCLUSIONS: The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before the development of any sign of functional impairment.
Assuntos
Diabetes Mellitus/patologia , Diagnóstico Precoce , Rejeição de Enxerto/complicações , Transplante de Rim/efeitos adversos , Adulto , Biópsia , Diabetes Mellitus/etiologia , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/patologia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tacrolimo/uso terapêutico , Transplante Homólogo/efeitos adversosRESUMO
OBJECTIVE: To identify longitudinal food group consumption trends and the relationship to perceived changes in diet, health, and functioning. DESIGN: A prospective longitudinal study. SETTING: Canada. PARTICIPANTS: Seven hundred and thirty-six community-dwelling Canadian men (mean age: 2000=79.4 yrs; 2005=84.5 yrs) participating in the Manitoba Follow-up Study. MEASUREMENTS: Self-reported food consumption, self-rated diet and health, life satisfaction, physical and mental functioning from questionnaires completed in 2000 and 2005. RESULTS: The majority of participants did not consume from all four food groups daily, based on Canada's Food Guide recommendations, with only 8% in 2000 and up to 15% in 2005. However, over a five year period, more men improved their consumption in each food group than declined. An association was found between change in the self-rating of the healthiness of their diet and change in consumption of vegetables and fruit, or grain products. Men whose self-rating of the healthiness of their diet remained high or improved between 2000 and 2005, were 2.15 times more likely (95% CI=1.45, 3.17) to also have increased consumption of vegetables and fruit, and 1.71 times more likely (95% CI=1.51, 2.54) to have increased consumption of grain products, relative to men whose self-rating of the healthiness of their diet declined between 2000 and 2005. Men who consumed more food groups daily had better mental and physical component scores. CONCLUSION: Dietary improvements are possible in very old men. Greater daily food group consumption is associated with better mental and physical functioning. Given these positive findings, there is still a need to identify older men who require support to improve their dietary habits as nearly half of the participants consumed two or fewer groups daily.
Assuntos
Envelhecimento , Dieta , Nível de Saúde , Saúde Mental , Satisfação Pessoal , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Estudos de Coortes , Dieta/efeitos adversos , Seguimentos , Idoso Fragilizado/psicologia , Promoção da Saúde , Humanos , Estudos Longitudinais , Masculino , Manitoba , Cooperação do Paciente , Estudos Prospectivos , Autorrelato , Saúde dos VeteranosRESUMO
BACKGROUND: The principal risk factors for cardiovascular mortality posttransplantation are hyperglycemia, hypertriglyceridemia, obesity, and smoking. METHODS: Among 115 patients, we assessed the risk factors for new-onset diabetes (NODM) and dyslipidemia (NODL), and their effects on the function and histopathologic changes in the allografts at 1 year posttransplantation. RESULTS: When evaluating the risk factors and the initial recipient data, we observed a significant difference in age when comparing normal vs NODM patients (P=.004), normal versus NODL patients (P=.002), and normal versus NODL + NODM patients (P=.0001). The difference in body mass index (BMI) was significant when comparing normal with NODM + NODL patients (P=.003). In regard to immunosuppressive therapy, NODM was significantly more frequent among/prescribed tacrolimus (tac; P=.005), whereas subjects who received cyclosporine (CsA) showed a significantly higher incidence of NODL (P=.001). The triglyceride levels were 3.02 ± 1.51 mmol/L among those on CsA versus 2.15 ± 1.57 mmol/L for (P=.004). The difference also proved to be significant for total cholesterol level: 5.43 ± 1.23 mmol/L versus 4.42 ± 1.31 mmol/L respectively (P=.001). In regard to allograft function a significant difference was noted at 1 year after transplantation between the NODM + NODL and the normal group in serum creatinine level (P=.02) as well as the estimated glomerular filtration rate (P=.004). Among diabetic patients, the serum creatinine level measured at posttransplant year 5 was significantly higher than that in 1 year (212.43 vs 147.00 µmol/L; P=.0003). When assessing morphologic changes in the kidney, we observed significantly more frequent interstitial fibrosis/tubular atrophy in all 3 groups compared with normal function patients. CONCLUSION: Our clinical study suggested that at 1 year after transplantation allograft function is already impaired in the presence of both medical conditions (NODM and NODL). However, in regard to morphology, a single condition (NODM or NODL) was sufficient to produce histologic changes in the kidney.
Assuntos
Diabetes Mellitus/etiologia , Dislipidemias/etiologia , Sobrevivência de Enxerto , Transplante de Rim/efeitos adversos , Rim/cirurgia , Adulto , Análise de Variância , Atrofia , Biomarcadores/sangue , Biópsia , Índice de Massa Corporal , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Creatinina/sangue , Ciclosporina/efeitos adversos , Diabetes Mellitus/sangue , Dislipidemias/sangue , Feminino , Taxa de Filtração Glomerular , Hemoglobinas Glicadas/metabolismo , Humanos , Hungria , Imunossupressores/efeitos adversos , Rim/patologia , Rim/fisiopatologia , Lipídeos/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tacrolimo/efeitos adversos , Fatores de Tempo , Resultado do TratamentoAssuntos
Diabetes Mellitus Tipo 1/cirurgia , Nefropatias Diabéticas/prevenção & controle , Neuropatias Diabéticas/prevenção & controle , Retinopatia Diabética/prevenção & controle , Transplante das Ilhotas Pancreáticas , Adulto , Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas/etiologia , Retinopatia Diabética/etiologia , Transplante de Tecido Fetal , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Transplante HomólogoRESUMO
AIMS: To establish the relationships between coronary flow reserve, cardiovascular autonomic function, and insulin resistance characterized by the homeostasis model assessment insulin resistance score in patients with normal carbohydrate metabolism according to the World Health Organization (WHO) and American Diabetes Association (ADA) criteria, and with morphologically normal epicardial coronary arteries. METHODS: Twenty-five patients [12 women and 13 men, mean (sd) age: 53 +/- 11 years] with normal coronary angiography were enrolled into the study. Coronary flow reserve was measured during stress transoesophageal echocardiography. Autonomic dysfunction was assessed by means of five standard cardiovascular reflex tests. The fasting serum glucose and insulin levels were determined and the homeostasis assessment model insulin resistance score was calculated. RESULTS: In patients with normal carbohydrate metabolism, negative correlations were observed between the coronary flow reserve and both the serum insulin level (r = -0.445, P = 0.026) and the homeostasis assessment model insulin resistance score (r = -0.449, P = 0.024). The systolic blood pressure response to standing also correlated with the coronary flow reserve (r = -0.519, P = 0.011). The heart rate response to deep breathing, the Valsalva ratio, the 30/15 ratio and the sustained handgrip test results were not correlated with the coronary flow reserve. CONCLUSIONS: Our data suggest the possible role of insulin resistance and early sympathetic nerve dysfunction in the development of decreased coronary flow reserve in patients without diabetes mellitus or impaired glucose tolerance.
Assuntos
Pressão Sanguínea/fisiologia , Circulação Coronária/fisiologia , Resistência à Insulina/fisiologia , Adulto , Glicemia/metabolismo , Ecocardiografia , Feminino , Homeostase/fisiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Erythromycin is a selective IKr-blocking, action potential duration (APD)-prolonging drug, which may induce early afterdepolarizations (EADs) and torsade de pointes ventricular tachycardia. The successful termination of an erythromycin-induced clinical torsades de pointes by the authors with mexiletine prompted them to investigate in vitro whether erythromycin is able to induce EADs in Purkinje fibers and, if so, whether EADs are suppressible or not by mexiletine. Electrically stimulated canine Purkinje fibers (n = 9) were superfused with erythromycin (200 mg/l) and action potentials were recorded by an intracellular microelectrode technique. Erythromycin induced a pronounced prolongation of APD and the appearance of EADs in all Purkinje preparations (9/9). After the addition of mexiletine (10 mM), a marked shortening of APD and the disappearance of EADs (7/9) were observed. Mexiletine, an inhibitor of the tetrodotoxin-sensitive window Na(+)-current, may prevent IKr-blocking drug-induced torsade de pointes ventricular tachycardia by abolishing APD prolongation and EADs.
Assuntos
Antiarrítmicos/farmacologia , Antibacterianos/farmacologia , Eritromicina/farmacologia , Mexiletina/farmacologia , Ramos Subendocárdicos/efeitos dos fármacos , Torsades de Pointes/prevenção & controle , Potenciais de Ação/efeitos dos fármacos , Animais , Antiarrítmicos/uso terapêutico , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Cães , Estimulação Elétrica , Eritromicina/efeitos adversos , Eritromicina/uso terapêutico , Feminino , Humanos , Técnicas In Vitro , Mexiletina/uso terapêutico , Pessoa de Meia-Idade , Síncope/induzido quimicamente , Torsades de Pointes/induzido quimicamenteRESUMO
Brainstem auditory-evoked potential (BAEP) examinations were performed in 15 patients with long-standing type-1 diabetes mellitus (DM). Cardiovascular reflex tests were applied for assessment of autonomic neuropathy. The aim of our investigation was to compare the BAEP results of this patient group with controls and to look for a possible correlation between the alteration of the auditory brainstem function and the cardiovascular autonomic neuropathy. Analysis of the latencies (waves I, II, III and V) and the inter-peak latencies (waves I-III and I-V) of BAEPs revealed a significant difference between diabetics and healthy controls. The amplitudes of waves I, III and V were definitely lower in comparison with those of healthy controls. A positive correlation was observed between the overall autonomic score and the latencies (waves III and V) and inter-peak latencies (waves I-III and I-V). These data support the hypothesis that long-standing DM and diabetic neuropathy might be related as a cause of certain dysfunctions of the central auditory pathways.