RESUMO
OBJECTIVE: To report the findings and long-term outcome of 76 sport horses with meniscal injury. STUDY DESIGN: Retrospective case series. ANIMALS: Seventy-six horses with 93 meniscal injuries in 85 stifles. METHODS: Medical records of sport horses diagnosed with meniscal injury during arthroscopy were reviewed. Owner follow up was obtained via telephone interview ≥1.5 years postoperatively. Preoperative and intraoperative findings, and postoperative treatments, were analyzed for potential association with return to athletic performance. RESULTS: The medial meniscus was involved in 82.8% of cases, with grade 1 injuries diagnosed in 76.3% of menisci. Overall, 85.5% of horses returned to athletic performance, with 40% returning to their previous level. The grade of meniscal injury was associated with long-term outcome (P = .023). The presence of preoperative radiographic abnormalities (P = .259) or additional joint pathology (P = 1.00) was not associated with long-term outcomes. Fifty-nine stifles were treated with an orthobiologic: autologous conditioned serum, platelet-rich plasma, or marrow-derived mesenchymal stem cells. There was no association between the use of any orthobiologic and long-term outcome (P = .394). CONCLUSION: This is the first report on long-term outcome of sport horses with meniscal injuries following arthroscopic surgery. Overall, the long-term prognosis was fair, with 40% of horses returning to their previous level of use. Severity of the meniscal injury was a prognostic indicator for return to work. The presence of radiographic abnormalities or additional joint pathology, or the use of orthobiologics, was not associated with long-term outcome. CLINICAL SIGNIFICANCE: These findings can help in prognostication for sport horses with meniscal injuries.
Assuntos
Doenças dos Cavalos , Menisco , Lesões do Menisco Tibial , Animais , Artroscopia/veterinária , Doenças dos Cavalos/patologia , Doenças dos Cavalos/cirurgia , Cavalos , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Joelho de Quadrúpedes/patologia , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/veterináriaRESUMO
OBJECTIVE: To provide a comprehensive anatomical description of the normal equine nasolacrimal duct using magnetic resonance imaging, and to develop a practical protocol for performing magnetic resonance dacryocystography (MRD) in horses. ANIMAL STUDIED: The heads of ten fresh horse cadavers with no history of sinonasal or ophthalmologic disorders were used for this study. PROCEDURE: An MRD technique was developed in this study, which consisted of two parts. In the first part, olive oil and gadolinium were compared as contrast medium, using five horses. Two concentrations of gadolinium were used: 0.25 mmol/mL and 0.5 mmol/mL. In the second part, the influence of different head recumbencies using olive oil as the sole contrast medium was studied in the remaining five horses. RESULTS: Injection with olive oil resulted in better distention and a complete filling of the nasolacrimal duct (ND) in all horses. Injection of 0.25 mmol/mL of gadolinium resulted in incomplete filling of the ND, whereas injection of 0.5 mmol/mL of gadolinium resulted in slightly better filling of the duct. The nondependent duct showed better distention compared to the dependent duct when scanning in lateral recumbency. No differences were observed between ducts in a dorsal recumbency. The degree of distention in dorsal recumbency was slightly less than the degree of distention observed in the nondependent ND in lateral recumbency. CONCLUSIONS: Magnetic resonance dacryocystography is a suitable technique for evaluating the nasolacrimal duct and can be performed during a normal magnetic resonance examination.
Assuntos
Cavalos , Aparelho Lacrimal/diagnóstico por imagem , Imageamento por Ressonância Magnética/veterinária , Ducto Nasolacrimal/diagnóstico por imagem , Animais , Cadáver , Meios de Contraste/farmacologia , Gadolínio/farmacologia , Imageamento por Ressonância Magnética/métodos , Azeite de Oliva/farmacologiaRESUMO
OBJECTIVE: To determine the long-term return to performance of horses with impinging and/or overriding dorsal spinous processes (ORDSP) treated with interspinous ligament desmotomy (ISLD) and to determine the prognostic value of radiographic and scintigraphic grades. STUDY DESIGN: Retrospective study. ANIMALS: Seventy-one horses with ORDSP treated with ISLD. METHODS: Medical records were reviewed for signalment, physical examination, gait evaluation, and number of interspinous spaces treated. Preoperative radiographic and scintigraphic images were evaluated with grading scales. Follow-up was obtained with a telephone questionnaire. Prognostic value of the number of affected interspinous spaces, radiographic grading, and scintigraphic grading was tested by using a χ2 test. RESULTS: A median follow-up of 35 months (range, 8-64) was available for 56 horses. Fifty-one of 56 (91.1%) horses returned to some level of performance, with 27 of 51 (52.9%) horses achieving equivalent or higher level of performance. Achieving a lower level of performance was attributed to recurrent back pain in nine of 24 (37.5%) horses and to unassociated lameness in nine of 24 (37.5%) horses. Owners of 44 of 56 (78.6%) horses were satisfied with the postoperative performance level, and owners of 46 of 56 (82.1%) horses would recommend the procedure. None of the variables tested influenced the return to performance. CONCLUSION: Interspinous ligament desmotomy allowed horses with ORDSP to return to some level of performance, although fewer returned to an equivalent or higher level of performance than had previously been reported. CLINICAL SIGNIFICANCE: Interspinous ligament desmotomy allows affected horses to return to some level of performance, regardless of the severity of radiographic and scintigraphic findings.
Assuntos
Dor nas Costas/veterinária , Doenças dos Cavalos/cirurgia , Esportes , Vértebras Torácicas/cirurgia , Animais , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Cavalos , Ligamentos Articulares/patologia , Ligamentos Articulares/cirurgia , Prognóstico , Cintilografia , Estudos RetrospectivosRESUMO
Pain localized to the neck, back, and or pelvis can result in a profound effect on the horse's performance. These conditions can present with a varied and nonspecific set of clinical signs. A careful and thorough examination of these areas by means of physical examination, lameness evaluation both in hand and under saddle, diagnostic anesthesia, and the use of multiple imaging modalities in combination is often necessary to have an accurate prognosis. Medical and surgical management where appropriate of the conditions highlighted in this article are discussed as well as their individual prognosis.
Assuntos
Dor nas Costas/veterinária , Doenças dos Cavalos/diagnóstico , Coxeadura Animal/diagnóstico , Cervicalgia/veterinária , Dor Pélvica/veterinária , Animais , Dor nas Costas/diagnóstico , Cavalos , Cervicalgia/diagnóstico , Dor Pélvica/diagnósticoRESUMO
Angular limb deformities are seen in young foals and are defined as lateral or medial deviations of the limb in the frontal plane distal to a particular joint. Several factors can contribute to the development of an angular limb deformity. Early assessment of the level of ossification of the cuboidal bones is critical to avoid complications long term. Although most deviations self-correct with minimal intervention other than modifications in exercise and hoof trimming, some require surgical intervention in the form of growth acceleration or retardation. This article focuses on growth augmentation techniques, such as hemicircumferential transection and elevation.
Assuntos
Carpo Animal/anormalidades , Casco e Garras/anormalidades , Casco e Garras/cirurgia , Doenças dos Cavalos/terapia , Deformidades Congênitas dos Membros/veterinária , Tarso Animal/anormalidades , Animais , Animais Recém-Nascidos , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/etiologia , Cavalos , Instabilidade Articular/complicações , Instabilidade Articular/veterinária , Deformidades Congênitas dos Membros/complicações , Deformidades Congênitas dos Membros/diagnóstico , Deformidades Congênitas dos Membros/terapia , Osteogênese , Condicionamento Físico Animal , Fatores de Risco , Ossos do Tarso/anormalidades , Ossos do Tarso/patologiaRESUMO
BACKGROUND: Several hematological alterations are associated with altered hemoglobin A1c (Hb A1c). However, there have been no reports of their influence on the rates of exceeding standard Hb A1c thresholds by patients for whom Hb A1c determination is requested in clinical practice. METHODS: The initial data set included the first profiles (complete blood counts, Hb A1c, fasting glucose, and renal and hepatic parameters) of all adult patients for whom such a profile was requested between 2008 and 2013 inclusive. After appropriate exclusions, 21844 patients remained in the study. Linear and logistic regression models were adjusted for demographic, hematological, and biochemical variables excluded from the predictors. RESULTS: Mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) correlated negatively with Hb A1c. Fasting glucose, MCH, and age emerged as predictors of Hb A1c in a stepwise regression that discarded sex, hemoglobin, MCV, mean corpuscular hemoglobin concentration (MCHC), serum creatinine, and liver disease. Mean Hb A1c in MCH interdecile intervals fell from 6.8% (51 mmol/mol) in the lowest (≤27.5 pg) to 6.0% (43 mmol/mol) in the highest (>32.5 pg), with similar results for MCV. After adjustment for fasting glucose and other correlates of Hb A1c, a 1 pg increase in MCH reduced the odds of Hb A1c-defined dysglycemia, diabetes and poor glycemia control by 10%-14%. CONCLUSIONS: For at least 25% of patients, low or high MCH or MCV levels are associated with increased risk of an erroneous Hb A1c-based identification of glycemia status. Although causality has not been demonstrated, these parameters should be taken into account in interpreting Hb A1c levels in clinical practice.
Assuntos
Glicemia/análise , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Eritrócitos/química , Hemoglobinas Glicadas/análise , Hemoglobinas/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Jejum , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Ventral midline hernia formation following abdominal surgery in horses is an uncommon complication; however, it can have serious consequences leading to increased morbidity and mortality. Currently, mesh hernioplasty is the treatment of choice for large ventral midline hernias in horses to allow potential return to normal function. Complications following mesh hernioplasty using polypropylene or polyester mesh in horses can be serious and similar to complications seen in human patients, including persistent incisional drainage, mesh infection, hernia recurrence, intra-abdominal adhesions, mesh or body wall failure, recurrent abdominal pain (colic), and peritonitis. This report describes the use of a novel bioresorbable silk mesh for repair of a large ventral midline incisional hernia in a mature, 600-kg horse. To our knowledge, this is the first report of its kind in the literature. CASE PRESENTATION: A 9-year-old, 600-kg Warmblood mare presented with a ventral midline hernia following emergency exploratory celiotomy 20 months prior. The mare was anesthetized and a hernioplasty was performed using a novel bioresorbable silk mesh (SERI(®) Surgical Scaffold; Allergan Medical, Boston, MA). No complications were encountered either intra- or postoperatively. The mare was discharged from the hospital at 3 days postoperatively in an abdominal support bandage. At 8 and 20 weeks postoperatively, ultrasonographic assessment showed evidence of tissue ingrowth within and around the mesh. The mare was able to be bred 2 years in a row, carrying both foals to full gestation with no complications. Following both foalings, the abdomen has maintained a normal contour with no evidence of hernia recurrence. CONCLUSIONS: Ventral abdominal hernias can be repaired in horses using a bioresorbable silk mesh, which provides adequate biomechanical strength while allowing for fibrous tissue ingrowth. The use of a bioresorbable silk mesh for the repair of ventral hernias can be considered as a realistic option as it potentially provides significant benefits over traditional non-resorbable mesh.
Assuntos
Hérnia/veterinária , Herniorrafia/veterinária , Doenças dos Cavalos/cirurgia , Seda , Telas Cirúrgicas/veterinária , Animais , Feminino , Herniorrafia/instrumentação , CavalosRESUMO
The equine head is an anatomically complex area, therefore advanced tomographic imaging techniques, such as computed tomography or magnetic resonance imaging (MRI), are often required for diagnosis and treatment planning. The purpose of this multicenter retrospective study was to describe MRI characteristics for a large sample of horses with head disorders. Horses imaged over a period of 13 years were recruited. Eighty-four horses met the inclusion criteria, having neurological (n = 65), sinonasal (n = 14), and soft tissue (n = 5) disorders. Magnetic resonance imaging accurately depicted the anatomy and allowed identification of the primary lesion and associated changes. There were good correlations between MRI findings and intraoperative or postmortem results. Magnetic resonance imaging showed the exact localization of the lesions, their size, and relation to surrounding structures. However, in the neurological group, there were 45 horses with no MRI abnormalities, 29 of which had a history of recurrent seizures, related to cryptogenic epilepsy. Magnetic resonance imaging was otherwise a valuable diagnostic tool, and can be used for studying a broad range of head disorders using either low-field or high-field magnets.
Assuntos
Encefalopatias/veterinária , Doenças dos Cavalos/diagnóstico , Imageamento por Ressonância Magnética/veterinária , Animais , Edema Encefálico/veterinária , Neoplasias Encefálicas/veterinária , Meios de Contraste , Encefalocele/veterinária , Epilepsia/veterinária , Feminino , Cavalos , Aumento da Imagem/métodos , Ventrículos Laterais/patologia , Masculino , Doenças Nasais/veterinária , Doenças do Nervo Óptico/veterinária , Doenças dos Seios Paranasais/veterinária , Estudos Retrospectivos , Convulsões/veterinária , Tomografia Computadorizada por Raios X/veterináriaRESUMO
OBJECTIVE: To report surgical management bilateral lateral patellar luxation in a mature alpaca using a combination of trochlear wedge recession (TWR), tibial tuberosity transposition (TTT), and joint capsule imbrication. STUDY DESIGN: Clinical case report. ANIMALS: 9-year-old castrated male Alpaca. METHODS: Bilateral, grade III/IV, lateral patellar luxation was identified by palpation, lameness examination and confirmed with radiography and ultrasonography. Surgical procedures were staged, with the left stifle treated first. Bilateral TWR, TTT, and joint capsule imbrication were performed. Outcome was assessed by radiography and follow up lameness examinations. RESULTS: An immediate improvement in weight bearing occurred after surgery of the left hind limb. Five months after initial surgery, right hind limb patella luxation was corrected. After surgery on the 2nd limb, the alpaca had progressive improvement in weight bearing during hospitalization. At 12 months, there were no signs of lameness and the alpaca had resumed normal activities. CONCLUSIONS: For bilateral lateral patellar luxation, a combination of TWR, TTT, and joint capsule imbrication resulted in excellent long-term outcome.
Assuntos
Camelídeos Americanos/cirurgia , Luxação Patelar/veterinária , Animais , Camelídeos Americanos/lesões , Coxeadura Animal , Masculino , Luxação Patelar/cirurgia , Radiografia , Joelho de Quadrúpedes/diagnóstico por imagem , Joelho de Quadrúpedes/lesões , Joelho de Quadrúpedes/cirurgiaRESUMO
OBJECTIVE: The aim of this study was to describe the use of the locking compression plate (LCP) and locking compression T-plate (LCTP) in cases of carpometacarpal and distal tarsal arthrodesis for the treatment of osteoarthritis and small carpal or tarsal bone fractures, and to document clinical outcomes. STUDY DESIGN: Case records of horses treated with carpometacarpal or distal tarsal arthrodesis via internal fixation using an LCP or LCTP between 2013 and 2021 were reviewed. All cases were evaluated retrospectively. Follow-up information was gained via phone conversation with owners and referring veterinarians. RESULTS: Data were collected for 13 horses that fulfilled the study criteria. A total of eight horses underwent distal tarsal arthrodesis, and five underwent carpometacarpal arthrodesis. Twelve of thirteen horses went back to some level of athletic performance. Eight of 13 returned to the same level, while 4 of 13 returned to a lower level. Minor postoperative complications were recorded in 3 of 13 cases, with all horses suffering manageable short-term complications returning to the same level of work. Two horses suffered a major complication, with one resulting in euthanasia. CONCLUSION: Carpometacarpal and distal tarsal arthrodesis performed using the LCP and LCTP allowed all surviving horses in the study to obtain immediate postoperative comfort and eventual return to use.
Assuntos
Doenças dos Cavalos , Osteoartrite , Articulações Tarsianas , Cavalos/cirurgia , Animais , Resultado do Tratamento , Estudos Retrospectivos , Osteoartrite/veterinária , Artrodese/veterinária , Artrodese/métodos , Placas Ósseas/veterinária , Doenças dos Cavalos/cirurgiaRESUMO
OBJECTIVE: To report repair of a coxofemoral joint luxation in an Alpaca using a toggle-pin technique. STUDY DESIGN: Case report. ANIMALS: An 11-month intact male Alpaca with luxation of the right coxofemoral joint. METHODS: The Alpaca was anesthetized and an open repair and reduction of the luxation was performed using a toggle-pin technique. RESULTS: The luxation was successfully reduced. An Ehmer sling was used for the initial 3 days after surgery and the Alpaca was discharged 7 days postoperatively without complications. Follow-up examinations confirmed maintained reduction of the coxofemoral joint, as well as no evidence of lameness or muscle atrophy. CONCLUSIONS: Coxofemoral joint luxations in Alpacas can be successfully repaired using a toggle-pin technique alone, without the need for other techniques such as capsular reconstruction or greater trochanter transposition. Use of an Ehmer sling for the immediate postoperative period provided additional protection to the repair and was tolerated well.
Assuntos
Pinos Ortopédicos/veterinária , Camelídeos Americanos/cirurgia , Luxação do Quadril/veterinária , Animais , Luxação do Quadril/cirurgia , MasculinoRESUMO
OBJECTIVE: To compare heat generation during insertion, pullout strength, and associated microdamage between a self-tapping positive profile transfixation pin (STTP) and nontapping positive profile transfixation pin (NTTP). SAMPLE POPULATION: 30 pairs of third metacarpal bones (MC3s) from adult equine cadavers. PROCEDURES: One MC3 of each pair was assigned to the STTP group; the other was assigned to the NTTP group. The assigned pin was inserted into the diaphysis in a lateral to medial direction. Bone temperature increase during pilot-hole drilling and pin insertion was recorded at 1 mm from the final thread position with wire thermocouples at cis and trans cortices. Resistance to axial extraction before and after cyclic loading was measured in a material testing device, and microstructural damage caused by transfixation pin insertion was assessed with scanning electron microscopy. RESULTS: The STTP group developed a significant increase in bone temperature, compared with the NTTP group. No significant difference was found between the mean maximal pullout strength of the STTP and the NTTP in both non-cyclic-loaded and cyclic-loaded groups. Microdamage to the bone-pin interface was lower when the STTP versus the NTTP was used, but more bone debris was apparent after inserting the STTP. CONCLUSION AND CLINICAL RELEVANCE: Because of the significant increase in temperature generation and debris accumulation despite similar pullout strengths and lesser microfracture formation, the STTP likely poses a higher risk of bone necrosis and potential loosening than the NTTP. This might be corrected by redesign of the tapping aspect of the STTP.
Assuntos
Pinos Ortopédicos/veterinária , Fraturas Ósseas/veterinária , Metacarpo/cirurgia , Animais , Fenômenos Biomecânicos , Temperatura Corporal , Peso Corporal , Cadáver , Diáfises/cirurgia , Desenho de Equipamento , Eutanásia , Fixadores Externos/veterinária , Fraturas Ósseas/cirurgia , Cavalos , Estresse MecânicoRESUMO
CASE DESCRIPTION: 4 horses with a history of neck pain, abnormal head carriage, and related inability to perform were examined. Cranial nuchal bursitis was diagnosed in 2 horses, and caudal nuchal bursitis was diagnosed in the other 2. CLINICAL FINDINGS: All 4 horses had prominent swelling in the region between the frontal bone and temporal fossa (ie, the poll) and abnormal head carriage. Ultrasonographic examination revealed fluid distention and synovial thickening of the cranial or caudal nuchal bursa in all 4 horses. Ultrasonography-guided aspiration of the affected region was performed successfully in 3 horses. Radiography revealed bony remodeling and mineralization over the dorsal aspect of the atlas in 1 horse and a radiolucency at the axis in another. Nuclear scintigraphy revealed an increase in radioisotope uptake at the level of C2 in 1 horse. Although a septic process was considered among the differential diagnoses in all horses, a septic process could only be confirmed in 1 horse. TREATMENT AND OUTCOME: All horses were refractory to conservative management consisting of intrabursal injection of anti-inflammatory medications. Bursoscopic debridement and lavage of the affected bursae resulted in resolution of the clinical signs in all horses, and they all returned to their intended use. CLINICAL RELEVANCE: Cranial and caudal nuchal bursitis, of nonseptic or septic origin, should be considered as a differential diagnosis in horses with head and neck pain. Horses undergoing surgical intervention consisting of nuchal bursoscopy have the opportunity to return to their original degree of exercise.
Assuntos
Bursite/veterinária , Doenças dos Cavalos/diagnóstico , Lesões do Pescoço/veterinária , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Bursite/diagnóstico , Bursite/terapia , Feminino , Doenças dos Cavalos/terapia , Cavalos , Masculino , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapiaRESUMO
OBJECTIVE: To report outcome of horses after standing pararectal cystotomy for removal of uroliths. STUDY DESIGN: Case series. ANIMALS: Horses (n=9) with cystic calculi. METHODS: Medical records (December 1998-May 2007) of horses with cystic calculi that had standing pararectal cystotomy were reviewed. Signalment; urolith number, size, and type; surgical technique; sedation and analgesia protocols; intra- and postoperative complications and outcome were analyzed. RESULTS: Uroliths (mean diameter, 6.37 cm; median, 6 cm; range, 3-10 cm) were removed intact without need for fragmentation. Eight (89%) horses had no complications and 1 horse (11%) developed persistent drainage from the perineal incision and incisional healing was prolonged. The complications resolved after wound revision, and although cystoscopy showed absence of uroliths, the clinical signs associated with cystitis recurred. CONCLUSIONS: Cystic calculi can be removed safely in standing horses using a pararectal approach. The procedure was well tolerated and no serious complications were encountered. CLINICAL RELEVANCE: Pararectal cystotomy allows removal of cystic calculi in standing sedated horses. The technique may offer an economic advantage over approaches that require general anesthesia.
Assuntos
Cistotomia/veterinária , Doenças dos Cavalos/cirurgia , Cálculos da Bexiga Urinária/veterinária , Animais , Cistotomia/métodos , Cavalos/cirurgia , Masculino , Cuidados Pós-Operatórios/veterinária , Postura , Resultado do Tratamento , Cálculos da Bexiga Urinária/cirurgiaRESUMO
PURPOSE: The aim of this study was to evaluate the effectiveness and safety of combination therapy with a sodium-glucose cotransporter-2 (SGLT2) inhibitor and a glucagon-like peptide-1 receptor agonist (GLP1RA) in patients with inadequately controlled type 2 diabetes. METHODS: A retrospective search of electronic prescriptions of patients undergoing GLP1RA and SGLT2 inhibitor combination therapy was conducted. Once the patients had been identified, demographic data, blood and urine analyses (glycosylated hemoglobin [HbA1c], glucose, renal function, albuminuria, lipid profile, liver enzymes, and uric acid), physical examination (weight, body mass index, and blood pressure), and adverse effects were obtained from their electronic clinical records according to each of the following 3 periods: before the initiation of the combination, the first visit after initiation, and the last available visit. The influence of the duration of diabetes and the drug combination sequence on the effectiveness of the treatment was also analyzed. Statistical analysis was performed with SPSS version 21.0 (IBM SPSS Statistics, IBM Corporation, Armonk, New York). Quantitative variables are presented as mean and SD and were compared by using the Student t test, one-way ANOVA, or repeated measures ANOVA with Bonferroni correction. Categorical variables are expressed as percentages and were compared by using the χ2 test. RESULTS: A total of 212 patients were included, with women accounting for 52.4%. The mean age (SD) of the population was 61.5 (9.6) years. A significant reduction in HbA1c (-12 mmol/mol [-1.1%]) was observed with combined therapy (P < 0.001). The target of HbA1c <53 mmol/mol (<7%) was achieved in 42% of the participants. Mean weight loss was -3.5 kg, and almost 40% of the patients attained the weight loss goal of ≥5% (P < 0.001 in all analyses). Transaminase levels and renal parameters also improved. These benefits persisted over time and bore no relation to the evolution of diabetes. Simultaneous initiation of a combination of a GLP1RA and SGLT2 inhibitor led to faster weight loss and a greater decrease in HbA1c than when they are used sequentially; however, the long-term benefits in terms of metabolic control were similar. Adverse events were rare, and a tendency for a reduced insulin dose was observed. IMPLICATIONS: The findings of this study reveal the combined benefits of a GLP1RA and SGLT2 inhibitor in real-world clinical practice. In general, the combined treatment was well tolerated, and few adverse events were detected.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/antagonistas & inibidores , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Diabetes Mellitus Tipo 2/sangue , Quimioterapia Combinada , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Redução de Peso/efeitos dos fármacosRESUMO
AIMS: To investigate, in a sample of nondiabetic adults from a Spanish community, the differences between prediabetes as defined by HbA1c ("H-prediabetes") and by fasting plasma glucose (FPG) ("F-prediabetes") in regard to prevalence and the influence of potential risk factors, adjusting the latter for confounders. METHODS: A total of 1328 nondiabetic participants aged ≥ 18 years were classified as normoglycemic, H-prediabetic [HbA1c 5.7-6.4% (39-47 mmol/mol)] or F-prediabetic (FPG 5.6-6.9 mmol/L). Multivariable analyses were used to compare the impacts of risk factors on the prevalence of H-prediabetes, F-prediabetes and their conjunctive and disjunctive combinations ("HaF-prediabetes" and "HoF-prediabetes," respectively). RESULTS: Some 29.9% of participants were HoF-prediabetic, 21.7% H-prediabetic, 16.3% F-prediabetic and only 8.1% HaF-prediabetic. Whatever the definition of prediabetes, increasing age, fasting insulin and LDL cholesterol were each a risk factor after adjustment for all other variables. Increasing BMI and decreasing mean corpuscular hemoglobin (MCH) were additional risk factors for H-prediabetes; male sex and increasing uric acid for F-prediabetes and increasing BMI for HaF-prediabetes. The participants satisfying the compound condition "hypertension or hyperlipidemia or obesity or hyperuricemia" (59.9% of the whole study group) included 83.1% of all subjects with HoF-prediabetes. CONCLUSIONS: In this population, the most sensitive risk factor for detection of prediabetes was age, followed by fasting insulin, LDL cholesterol, BMI, MCH, male sex and uric acid, with differences depending on the definition of prediabetes. MCH, an indirect measure of erythrocyte survival, significantly influences the prevalence of HbA1c-defined prediabetes. This study suggests that screening of individuals with selected risk factors may identify a high proportion of prediabetic persons.
Assuntos
Glicemia/análise , Jejum/sangue , Hemoglobinas Glicadas/análise , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Adolescente , Adulto , Idoso , Glicemia/metabolismo , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Prevalência , Características de Residência/estatística & dados numéricos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: There is a growing interest in the pathopysiological consequences of postprandial hyperglycemia. It is well known that in diabetic patients 2 h plasma glucose is a better risk predictor for coronary heart disease than fasting plasma glucose. Data on the glycemic response in healthy people are scarce. OBJECTIVE: To evaluate the effect of macronutrients (carbohydrates, fats, and proteins) and fiber on postprandial glycemic response in an observational study of a non-diabetic adult population. DESIGN: Cross-sectional study. 150 non-diabetic adults performed continuous glucose monitoring for 6 days. During this period they recorded food and beverage intake. The participants were instructed not to make changes in their usual diet and physical exercise.Variables analyzed included clinical parameters (age, sex, body weight, height, body mass index, blood pressure, and waist measurement), meal composition (calories, carbohydrates, fats, proteins, and fiber) and glycemic postprandial responses separated by sexes.The study period was defined from the start of dinner to 6 h later. RESULTS: A total of 148 (51% women) subjects completed all study procedures. Dinner intake was higher in males than in females (824 vs 531 kcal). Macronutrient distribution was similar in both sexes. No significant differences were found in fiber intake between men and women (5.5 g vs 4.5 g).In both sexes, the higher intake of carbohydrates corresponded to a significantly higher glycemic response (p = 0.0001 in women, p = 0.022 in men). Moreover, in women, as fat intake was higher, a flattening of the postprandial glycemic curve was observed (p = 0.003). With respect to fiber, a significantly lower glycemic response was observed in the group of women whose fiber intake at dinner was higher (p = 0.034). CONCLUSIONS: Continuous glucose monitoring provides important information about glucose levels after meals. In this study, the postprandial glycemic response in women was different from that of men, and carbohydrates were the main determinant of elevated postprandial glucose levels.
RESUMO
AIMS: To investigate whether continuous glucose monitoring (CGM) reveals patterns of glycaemic behaviour, the detection of which might improve early diagnosis of dysglycaemia. METHODS: A total 1521 complete days of valid CGM data were recorded under real-life conditions from a healthy sample of a Spanish community, as were matching FPG and HbA1C data. No participant was pregnant, had a history of kidney or liver disease, or was taking drugs known to affect glycaemia. RESULTS: CGM and fingerstick measurements showed a mean relative absolute difference of 6.9⯱â¯2.2%. All subjects were normoglycaemic according to FPG and HbA1C except 21% who were prediabetic. The normoglycaemic subjects had a 24-hour mean blood glucose concentration (MBG) of 5.7⯱â¯0.4â¯mmol/L, spending a median of 97% of their time within the target range (3.9-7.8â¯mmol/L). 73% of them experienced episodes with blood glucose levels above the threshold for impaired glucose tolerance, and 5% levels above the threshold for diabetes. These normoglycaemic participants with episodes of high glycaemia had glycaemic variabilities similar to those of prediabetic subjects with episodes of similar intensity or combined duration. CONCLUSIONS: CGM is a better indicator of possible early dysglycaemia than either FPG or HbA1c.
Assuntos
Automonitorização da Glicemia/métodos , Glicemia/metabolismo , Jejum/sangue , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose/métodos , Hemoglobinas Glicadas/metabolismo , Estado Pré-Diabético/sangue , Adulto , Diagnóstico Precoce , Feminino , Hemoglobinas Glicadas/análise , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine prevalence, clinical findings, and long-term survival rate after surgery associated with incarceration of the small intestine through the gastrosplenic ligament (ISIGL) in horses. DESIGN: Retrospective case series. ANIMALS: 14 horses with ISIGL. PROCEDURES: Medical records of horses with ISIGL examined between January 1994 and December 2006 were reviewed. Signalment, initial physical examination findings, results of abdominal fluid analysis, and clinical laboratory values were recorded, along with surgical findings, including segment of incarcerated intestine and surgical procedures performed. Long-term survival data were obtained through client interviews. RESULTS: Clinical findings included small intestinal distention identified via rectal palpation (10/14 horses) or transabdominal ultrasonography (8/11), nasogastric reflux (4/14), and abnormal abdominal fluid (9/9). All horses required intestinal resection and anastomosis. Postoperative complications included adynamic ileus (5/14 horses), incisional infection (4/14), diarrhea (3/14), and laminitis (1/14). No breed or age predilection was detected, although geldings were at increased risk for ISIGL. Long-term survival rate was 79% (11/14 horses). CONCLUSIONS AND CLINICAL RELEVANCE: ISIGL was an uncommon cause of colicin this hospital population. With appropriate surgical intervention and postoperative management, the long-term prognosis for surgically treated horses was fair to good.