Voice, Speech, and Clinical Aspects During Pregnancy: A Longitudinal Study.

BACKGROUND: Pregnancy involves anatomical, physiological, and metabolic changes in a woman's body. However, the effects of these changes on the voice remains unclear, particularly regarding the clinical characteristics. OBJECTIVES: We aimed to evaluate changes in vocal and speech acoustic measures and the relationship between them and clinical aspects in women during pregnancy. METHOD: A prospective, longitudinal study was carried out with 41 low risk, adult, pregnant women, followed for prenatal care. Demographic and anthropometric data as well as lifestyle habits and health conditions were collected. Voice recordings of sustained vowels, and automatic and spontaneous speech were held over each trimester and analyzed by PRAAT®to evaluate acoustic, aerodynamic, and articulatory measures. RESULTS: There were no changes in fundamental frequency, jitter, shimmer, and harmony to noise ratio during pregnancy. Maximum phonation time (MPT), pause rate, and pause duration reduced at the end of pregnancy. MPT was lower in sedentary pregnant women. The fundamental frequency peak rate was higher in eutrophic participants and lower in the third trimester in women with BMI ≥25 kg/m2. Pause rate was higher in pregnant women with BMI ≥25 kg/m2. There was no relationship between sleep quality, reflux, and vocal symptoms and acoustic and aerodynamic measures. CONCLUSIONS: Differences were shown in MPT and temporal pause measurements during pregnancy. Acoustic measurements did not change. There was a relationship between acoustic and aerodynamic measures and clinical variables (BMI, physical activity, and body mass gain).

Prevalence of Peripheral Polyneuropathy Before and After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

PURPOSE: Peripheral polyneuropathy (PPN) can occur in diabetes mellitus (DM), obesity, and after bariatric surgery (BS). We decided to evaluate PPN prevalence before (PreBS-PPN) and after BS (PostBS-PPN) and to look for variables that may be independently associated with both. METHODS: In this cross-sectional study, we evaluated 1467 participants with obesity and without DM before and 10.4 ± 6.8 months after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The Michigan Neuropathy Screening Instrument and the International Physical Activity Questionnaire were used to define the presence of PPN and the Metabolic Equivalent Task (MET) spent per week, respectively. Using Poisson regression models with a robust estimator, the prevalence of PreBS-PPN and PostBS-PPN was analyzed as dependent variables. RESULTS: Prevalence of PostBS-PPN (10.5%) was lower than PreBS-PPN (20.4%, p < 0.001), with a prevalence of 12.7% post-RYGB and 8.4% post-SG (p = 0.072). In the univariate analysis, PreBS-PPN was associated with post-menopausal status (PMS), older age, and taller height. In twelve regression models, we found an independent association of PreBS-PPN with older age, PMS, and taller height. PostBS-PPN prevalence was associated with a higher fasting glycemia and stature, and a lower MET on univariate analysis, and with higher fasting glycemia, stature and RYGB in four multivariate regression models. CONCLUSION: PPN occurs frequently in subjects with obesity without DM and is lower after BS. SG is not likely to be harmful in the development of neuropathy. Studies of PPN incidence and persistence after BS should clarify these factors.

Effect of Bariatric Surgery on High-Density Lipoprotein (HDL) Cholesterol in Non-diabetic Patients with Severe Obesity.

BACKGROUND: This study evaluated changes in serum high-density lipoprotein cholesterol (HDL-C) induced by laparoscopic bariatric surgery (BS) in non-diabetic obese subjects with low (L-HDL-C) or normal (N-HDL-C) levels of HDL-C. We assessed whether increased HDL-C is associated with weight loss, serum non-HDL cholesterol (non-HDL-C), serum triglycerides (TG), and physical activity (PA) before and 6 and 15 months after BS. METHODS: In this prospective cohort study, 71 subjects undergoing BS (42 by Roux-en-Y gastric bypass and 29 by sleeve gastrectomy) were evaluated for the % Excess Weight Loss (%EWL), waist circumference (WC), serum levels of glucose, glycosylated hemoglobin, TG, HDL-C, non-HDL-C, and LDL-C, and the degree, time, and energy expenditure related to PA. The short version of the International Physical Activity Questionnaire was used to assess PA. RESULTS: Levels of HDL-C significantly increased 15 months after BS (p < 0.001) in subjects with low (p < 0.001) or normal (p = 0.017) values at baseline. A similar %EWL, decrease in WC, glucose, non-HDL-C, and LDL-C levels and increase in energy expenditure related to PA, was observed in both groups (L-HDL-C and N-HDL-C) at 15 months after BS. However, the L-HDL-C group presented greater decrease in TG levels compared with N-HDL-C group (p = 0.004). In subjects with increased HDL-C 15 months after BS, there was an association between this increase and the %EWL (p = 0.030), but there was no association with the change in PA. CONCLUSIONS: Irrespective of PA after BS, subjects with low and normal HDL-C levels at baseline showed an increase in HDL-C after BS, and this increase was associated with %EWL induced by BS.

Effects of bovine enterovirus and type 1 diabetes on liver and kidney pyruvate kinase activity in an animal model

Type 1 diabetes (T1D) is an autoimmune disease characterized by the selective destruction of pancreatic beta cells. In addition to genetic factors, enteroviruses have been considered the main environmental factor involved in this pathology. Therefore, the objective of this study was to evaluate the effects of streptozotocin-induced diabetes and bovine enterovirus (BEV) on liver and kidney pyruvate kinase activity in rats. Fourteen male Wistar rats were divided in three groups: control, diabetes and a third group, which was fed with water experimentally contaminated by BEV. Increased blood glucose levels were found in both diabetes and enterovirus groups, whereas there were no alterations in the lipid profile. A reduced pyruvate kinase activity was observed in the liver and kidney of animals from diabetes and enterovirus groups. Under our experimental conditions, the ingestion of water experimentally contaminated by BEV induced alterations in glycaemia, and also interfered in the pyruvate kinase activity in liver and kidney of the rats, which might be one of the possible mechanisms involved in the T1D development.

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors.

BACKGROUND: Obesity and its complications are prevalent in women and increase with age. Polyneuropathy (PNP) is a complication of obesity and bariatric surgery (BS). In subjects with severe (grades II and III) obesity and without DM who are candidates for BS, the prevalence of PNP and associated conditions are not well characterized. The aim of this study was to evaluate the prevalence of PNP in severely obese (SO) women without DM or common nutritional deficiencies in order to determine factors associated with the presence of PNP. METHODS: A cross-sectional study was performed on 450 SO women. They were evaluated with the Michigan Neuropathy Screening Instrument, a Sleep Apnea Questionnaire, and the short form of the International Physical Activity Questionnaire. Data on blood pressure, body mass index, waist circumference, serum glucose, glycated hemoglobin, LDL and HDL cholesterol, triglycerides, vitamin B12, and postmenopausal (PM) status were also collected. Patients with DM and other common causes of PNP were excluded. To evaluate which variables were independently associated with PNP (dependent variable), Poisson regression models were used. RESULTS: The prevalence of PNP was 11.6%. In univariate analysis, PNP was associated with age, PM status, and diagnosis of systemic arterial hypertension (p < 0.001, p < 0.001, and p = 0.016, respectively), and there was a trend toward an association with sleep apnea risk (p = 0.101). In multivariate analysis, PM status (PR = 2.836, 95% CI 1.735-4.636, p = 0.001) and age (PR = 1.0511, 95% CI 1.031-1.071, p = 0.001) were independently associated with PNP diagnosis in two different models. CONCLUSION: Even prior to BS, PNP is highly prevalent and is associated with PM status and age in SO women without diabetes.

Peripheral polyneuropathy in severely obese patients with metabolic syndrome but without diabetes: Association with low HDL-cholesterol.

INTRODUCTION:: The purpose of this study was to evaluate the prevalence of peripheral polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and metabolic syndrome (MetS) but without diabetes and to investigate possible associated factors. METHOD:: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess the presence of PPN. RESULTS:: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol (p=0.057) showed a tendency toward this association. On a Poisson regression analysis, when the three possible associations were included, low HDL-cholesterol (p=0.047) remained independently associated. CONCLUSION:: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI showed a high prevalence and was associated with low levels of HDL-cholesterol. In order to diagnose that complication, neurological evaluation should be performed in these patients.

Peripheral polyneuropathy in severely obese patients with metabolic syndrome but without diabetes: Association with low HDL-cholesterol / Polineuropatia periférica em pacientes obesos graves com síndrome metabólica sem diabetes: associação com baixo HDL-colesterol

Summary Introduction: The purpose of this study was to evaluate the prevalence of peripheral polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and metabolic syndrome (MetS) but without diabetes and to investigate possible associated factors. Method: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess the presence of PPN. Results: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol (p=0.057) showed a tendency toward this association. On a Poisson regression analysis, when the three possible associations were included, low HDL-cholesterol (p=0.047) remained independently associated. Conclusion: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI showed a high prevalence and was associated with low levels of HDL-cholesterol. In order to diagnose that complication, neurological evaluation should be performed in these patients.

Resumo Objetivo: Avaliar a prevalência da polineuropatia periférica (PNP) em indivíduos obesos graus II e III com síndrome metabólica (Ob-II,III,SM) sem diabetes e buscar possíveis fatores associados. Método: Em um estudo transversal, realizado em indivíduos Ob-II,III,SM e sem diagnóstico de diabetes, o Instrumento de Screening de Michigan (MNSI) foi utilizado para avaliar a presença de PNP. Resultados: Um total de 24 de 218 pacientes Ob-II,III,SM e sem diabetes tinham PNP. Quando observamos as associações com PNP em uma análise univariada, níveis séricos de LDL-colesterol (p=0.046) estiveram significativamente associados e houve também uma tendência à associação com níveis séricos de triglicerídeos (p=0.118) e baixo HDL-colesterol (p=0.057). Em uma análise de regressão de Poisson, quando as três possíveis associações foram incluídas, baixo HDL-colesterol (p=0.047) manteve-se independentemente associado. Conclusão: Em pacientes Ob-II,III,SM, mas sem diabetes, a PNP definida pelo MNSI tem uma prevalência elevada e está associada a baixos níveis de HDL-colesterol. Para diagnóstico dessa complicação, recomenda-se realizar o exame neurológico desses pacientes.

Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study.

BACKGROUND: Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. METHODS: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. RESULTS: Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. CONCLUSIONS: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.