RESUMO
In 2016, meetings of groups of physicians and paediatricians with a special interest in lipid disorders and familial hypercholesterolaemia were held to discuss several domains of management of familial hypercholesterolaemia in adults and children in Hong Kong. After reviewing the evidence and guidelines for the diagnosis, screening, and management of familial hypercholesterolaemia, consensus was reached on the following aspects: clinical features, diagnostic criteria, screening in adults, screening in children, management in relation to target plasma low-density lipoprotein cholesterol levels, detection of atherosclerosis, lifestyle and behaviour modification, and pharmacotherapy.
Assuntos
Anticolesterolemiantes/uso terapêutico , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Adulto , Doenças Cardiovasculares/prevenção & controle , Criança , Consenso , Gerenciamento Clínico , Humanos , Guias de Prática Clínica como AssuntoRESUMO
AIMS: Diabetic kidney disease independently predicts cardiovascular disease and premature death. We examined the burden of chronic kidney disease (CKD, defined as an estimated GFR < 60 ml/min/1.73 m(2) ) and quality of care in a cross-sectional survey of adults (age ≥ 18 years) with Type 2 diabetes across Asia. METHODS: The Joint Asia Diabetes Evaluation programme is a disease-management programme implemented using an electronic portal that systematically captures clinical characteristics of all patients enrolled. Between July 2007 and December 2012, data on 28 110 consecutively enrolled patients (China: 3415, Hong Kong: 15 196, India: 3714, Korea: 1651, Philippines: 3364, Vietnam: 692, Taiwan: 78) were analysed. RESULTS: In this survey, 15.9% of patients had CKD, 25.0% had microalbuminuria and 12.5% had macroalbuminuria. Patients with CKD were less likely to achieve HbA1c < 53 mmol/mol (7.0%) (36.0% vs. 42.3%) and blood pressure < 130/80 mmHg (20.8% vs. 35.3%), and were more likely to have retinopathy (26.2% vs. 8.7%), sensory neuropathy (29.0% vs. 7.7%), cardiovascular disease (26.6% vs. 8.7%) and self-reported hypoglycaemia (18.9% vs. 8.2%). Despite high frequencies of albuminuria (74.8%) and dyslipidaemia (93.0%) among CKD patients, only 49.0% were using renin-angiotensin system inhibitors and 53.6% were on statins. On logistic regression, old age, male gender, tobacco use, long disease duration, high HbA1c , blood pressure and BMI, and low LDL cholesterol were independently associated with CKD (all P < 0.05). CONCLUSIONS: The poor control of risk factors, suboptimal use of organ-protective drugs and high frequencies of hypoglycaemia highlight major treatment gaps in patients with diabetic kidney disease in Asia.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Sistema de Registros , Insuficiência Renal Crônica/epidemiologia , Fatores Etários , Idoso , Albuminúria/epidemiologia , Albuminúria/metabolismo , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Ásia/epidemiologia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/metabolismo , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/etiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Feminino , Taxa de Filtração Glomerular , Hemoglobinas Glicadas/metabolismo , Hong Kong/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/uso terapêutico , Índia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Análise Multivariada , Filipinas/epidemiologia , Qualidade da Assistência à Saúde , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/metabolismo , República da Coreia/epidemiologia , Fatores Sexuais , Taiwan/epidemiologia , Uso de Tabaco/epidemiologia , Vietnã/epidemiologiaRESUMO
BACKGROUND CONTEXT: Anterior lumbar surgery is a common procedure for anterior lumbar interbody fusion and disc replacement but the impact of obesity on this procedure has not been determined. PURPOSE: To assess the perioperative outcomes of anterior retroperitoneal lumbar surgery in obese versus non-obese patients. STUDY DESIGN/SETTING: Prospective review of patients with anterior retroperitoneal lumbar disc procedures PATIENT SAMPLE: Seventy-four patients with anterior retroperitoneal lumbar disc procedures performed were evaluated. OUTCOME MEASURES: Access-related parameters included tissue depth (skin-to-fascia and fascia-to-spine depths), length of incision, estimated blood loss during the anterior procedure, the duration of the anterior exposure, and the duration of the entire anterior procedure. Outcome measures included complications attributable to the anterior procedure, analgesic use, length of time to ambulation, and length of hospitalization. METHODS: Seventy-four anterior retroperitoneal lumbar disc procedures were prospectively analyzed. Patient age, sex, body mass index, comorbidities, diagnosis, and operative parameters were collected. Access-related parameters and outcome measures were compared between obese and non-obese patients. Obesity was defined as body mass index greater than or equal to 30. RESULTS: There were 35 males and 39 females. Mean age was 46.6 years. The main diagnosis (63.5%) was discogenic back pain. Forty-one (55%) patients were non-obese and 33 were obese. The two patient groups were comparable in terms of age, sex, diagnosis, mean number of anterior levels operated, and previous abdominal surgery (all p>.05). In obese patients, there were two iliac vein lacerations (major complication rate, 6.1%), one superficial infection, and one urinary tract infection (minor complication rate, 6.1%). In non-obese patients, there were two iliac vein lacerations, one intestinal serosal tear (major complication rate, 7.3%), and two urinary tract infections (minor complication rate, 4.9%). There was no significant difference in the complication rates between obese and non-obese patients (p=.6). Obese patients have significantly longer duration of anterior exposure, duration of entire anterior surgery, longer length of anterior incision, and more depth from skin to fascia and from fascia to spine compared with non-obese patients. However, obesity does not affect blood loss, analgesic use, length of time to ambulation, and length of hospitalization. CONCLUSION: Perioperative outcomes in obese and non-obese patients were comparable and obesity is not related to an increased risk of morbidity in anterior lumbar surgery.
Assuntos
Vértebras Lombares/cirurgia , Obesidade/complicações , Fusão Vertebral , Adulto , Índice de Massa Corporal , Feminino , Humanos , Complicações Intraoperatórias , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/estatística & dados numéricos , Tempo , Resultado do TratamentoRESUMO
We report the genetic characteristics of a family with familial paraganglioma syndrome. The index patient was diagnosed with carcinoid tumour of the bronchus at the age of 30 years then later diagnosed with bilateral phaeochromocytoma. His sister had bilateral carotid body tumours. Mutational analyses of succinate dehydrogenase B and SDHD on the index patient showed him to be heterozygous for the M1I mutation of the SDHD gene. A genetic analysis revealed that his sister also had succinate dehydrogenase deficiency with the same mutation. Pre-symptomatic testing confirmed the genetic diagnosis, and led to a clinical diagnosis in an otherwise asymptomatic sibling. Comparison with other known cases of M1I mutation suggests that this is a founder mutation in the Chinese population. Genetic analysis of the succinate dehydrogenase genes can provide a specific diagnosis and allow for genetic screening of at-risk individuals.
Assuntos
Paraganglioma Extrassuprarrenal/genética , Succinato Desidrogenase/genética , Adolescente , Neoplasias das Glândulas Suprarrenais/genética , Adulto , Idoso , Povo Asiático/genética , Neoplasias Brônquicas/genética , Tumor Carcinoide/genética , Análise Mutacional de DNA , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Linhagem , Succinato Desidrogenase/deficiência , SíndromeRESUMO
There is a paucity of data on the effects of overt nephropathy and moderate renal impairment on endothelial function in diabetic patients. A total of 26 type II diabetic (DM) patients with nephropathy (DMN+) (mean +/- s.d. age: 63.7 +/- 6.3 years), 32 diabetic patients without nephropathy (DMN-) (59.4 +/- 10.1 years), and 52 non-diabetic subjects (54.9 +/- 8.2 years) were recruited. High-resolution ultrasound scan was used to measure carotid intima media thickness (IMT) and flow-mediated dilation (FMD) of the brachial artery. Endothelium-independent dilation was determined by maximal vascular dilation after sublingual nitroglycerine (glyceryl trinitrate (GTN)-induced dilation). The mean carotid IMT increased progressively from non-DM to DMN- to DMN+ groups (0.74 +/- 0.23 vs 0.80 +/- 0.25 vs 1.03 +/- 0.38 mm; P=0.001 for trend) whereas FMD- (4.3 +/- 2.5 vs 3.9 +/- 1.7 vs 1.9 +/- 2.0%, P<0.001 for trend) and GTN-induced dilation (14.7 +/- 4.0 vs 14.5 +/- 3.9 vs 10.3 +/- 3.2%; P<0.001 for trend) declined in an opposite manner. On multivariate analysis, age (beta=0.257, P=0.009), glomerular filtration rate (beta=-0.364, P<0.001), and smoking (beta=0.25, P=0.013) were independently associated with carotid IMT (F=15.76, R(2)=0.340, P<0.001). After adjustment for baseline brachial arterial diameter, history of smoking (beta=-0.039, P<0.001), fasting plasma glucose (beta=-0.033, P=0.002), and total cholesterol (beta=-0.023, P=0.024) were independently associated with vessel diameter after FMD (F=2446.5, R(2)=0.992, P<0.001); whereas age (beta=-0.069, P=0.001) and urinary albumin excretion (beta=-0.048, P=0.018) were independently associated with vessel diameter after GTN (F=851.6, R(2)=0.967, P<0.001). Type II diabetic patients with overt nephropathy and moderate renal impairment had both structural and functional vascular abnormalities beyond the endothelium.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/patologia , Endotélio Vascular/patologia , Insuficiência Renal/patologia , Idoso , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/patologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Estudos de Casos e Controles , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/patologia , Nefropatias Diabéticas/etiologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Rim/irrigação sanguínea , Rim/patologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nitroglicerina/farmacologia , Insuficiência Renal/etiologia , Fatores de Risco , Túnica Íntima/patologia , Túnica Íntima/fisiopatologia , Túnica Média/parasitologia , Túnica Média/patologia , Ultrassonografia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologiaRESUMO
In this report, we aimed to examine the impact of the new International Diabetes Federation (IDF) definition on the prevalence and clinical characteristics of subjects with metabolic syndrome (MES). Data were obtained from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population. There were 1513 subjects well representing all occupational groups from managers to general laborers [910 (60.1%) men and 603 (39.9%) women (mean age 37.5+/-9.2, median 37.0, range 18-66 years)]. The crude prevalence of MES defined by the IDF criterion was 7.4% (compared to other criteria: NCEP, 9.6%; WHO, 13.4% and EGIR, 8.9%). The age-standardized prevalence of MES by the IDF criterion was 8.8% in women and 7.3% in men. Subjects with MES defined by IDF criterion had higher body mass index and waist compared to those with MES defined by NCEP or WHO criteria, and lower triglyceride compared to those with MES defined by NCEP criterion after adjustment for age, gender and smoking. Non-MES subjects defined by IDF criterion had higher 2h glucose and insulin resistance compared to non-MES subjects defined by WHO. In conclusion, the new IDF criterion for MES is easy to implement in clinical practice. It may be potentially more 'specific' in identifying subjects with MES although compared to the NCEP criterion, it may have missed a proportion of subjects, especially men, who have metabolic derangement. Prospective and interventional studies are needed to validate the prognostic values of this new definition in comparison with other existing definitions.
Assuntos
Síndrome Metabólica/epidemiologia , Adolescente , Adulto , Idoso , Povo Asiático , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Síndrome Metabólica/classificação , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , PrevalênciaRESUMO
AIM: The aim of this study is to investigate the prevalence of metabolic syndrome (MES) in type 2 diabetic patients and the predictive values of the World Health Organization (WHO) and National Cholesterol Education Programme (NCEP) definitions and the individual components of the MES on total and cardiovascular mortality. METHODS: A prospective analysis of a consecutive cohort of 5202 Chinese type 2 diabetic patients recruited between July 1994 and April 2001. RESULTS: The prevalence of the MES was 49.2-58.1% depending on the use of various criteria. There were 189 deaths (men: 100 and women: 89) in these 5205 patients during a median (interquartile range) follow-up period of 2.1 (0.3-3.6 years). Of these, 164 (87%) were classified as cardiovascular deaths. Using the NCEP criterion, patients with MES had a death rate similar to those without (3.51 vs. 3.85%). By contrast, based on the WHO criteria, patients with MES had a higher mortality rate than those without (4.3 vs. 2.4%, p = 0.002). Compared to patients with neither NCEP- nor WHO-defined MES, only the group with MES defined by the WHO, but not NCEP, criterion had significantly higher mortality rate (2.6 vs. 6.8%, p < 0.001). Using Cox regression analysis, only age, duration of diabetes and smoking were identified as independent factors for cardiovascular or total death. Among the various components of MES, hypertension, low BMI and albuminuria were the key predictors for these adverse events. CONCLUSIONS: In Chinese type 2 diabetic patients, the WHO criterion has a better discriminative power over the NCEP criterion for predicting death. Among the various components of the MES defined either by WHO or NCEP, hypertension, albuminuria and low BMI were the main predictors of cardiovascular and total mortality.
Assuntos
Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/epidemiologia , Síndrome Metabólica/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Albuminúria/complicações , Albuminúria/epidemiologia , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Causas de Morte , Diabetes Mellitus Tipo 2/complicações , Feminino , Hong Kong/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Resistência à Insulina , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Distribuição por Sexo , Fumar/epidemiologiaRESUMO
BACKGROUND: To examine the lipid profile in Chinese type 2 diabetic patients and their relationship with anthropometric parameters, glycaemic control and cardiovascular mortality. METHODS: A consecutive cohort of 562 newly referred patients with type 2 diabetes to a hospital-based diabetes centre were examined in 1996. Subjects treated with lipid lowering drugs at the time of referral were excluded. A total of 517 subjects were followed up over a mean (+/-SD) period of 4.6 +/- 0.9 years. Glycated haemoglobin (HbA1c), fasting insulin and lipid profile and anthropometric parameters were documented at the time of recruitment. Cardiovascular mortality, mainly due to coronary heart disease and stroke, was ascertained using death registry and review of hospital case notes in 2001. RESULT: Of the 517 subjects (mean age of 54.0 +/- 14.0 years), 42.6% were men. In this cohort, 63.3% of subjects were either overweight (BMI > or = 23 kg/m2) or obese (BMI > or = 25 kg/m2) using Asian criteria. The mean (+/-SD) total cholesterol (TC), LDL-Cholesterol (LDL-C), HDL-Cholesterol (HDL-C) and geometric mean (x// antilog SD) of triglycerides (TG) were 5.6 +/- 1.3 mmol/L, 3.6 +/- 1.1 mmol/L, 1.3 +/- 0.3 mmol/L and 1.46x//1.90 mmol/L respectively. TC and LDL-C correlated positively with HbA1c, HDL-C negatively with BMI and WC (waist circumference), while TG positively with HbA1c, BMI, WC and HOMA (insulin resistance estimated using the homeostasis model assessment). During the 4.6 years follow-up period, there were 61 deaths giving a total mortality rate of 11.4%, of which 15 (25%) were because of cardiovascular events. Apart from age and disease duration, logarithm of TG was significantly associated with increased risk of cardiovascular mortality (p = 0.049, relative risk = 2.97, 95% CI 1.00-8.77). CONCLUSIONS: Chinese type 2 diabetic patients had a lower prevalence of obesity, lower TG and higher HDL-C than Caucasian patients. Despite the low incidence of cardiovascular death, TG, which was closely associated with obesity indexes, was significantly associated with cardiovascular death in these patients.
Assuntos
Diabetes Mellitus Tipo 2/sangue , Hipertrigliceridemia/sangue , Obesidade/sangue , Triglicerídeos/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/mortalidade , China , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Hong Kong , Humanos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/tratamento farmacológico , Hipertrigliceridemia/mortalidade , Hipolipemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Valor Preditivo dos Testes , Análise de Regressão , Fatores de Risco , Fumar , Análise de SobrevidaRESUMO
A 39-year-old entertainer was referred in November 2000 for suspected secondary hypothroidism found during a routine insurance check. Thyroid stimulating hormone (TSH) was 0.30 mIU/L (NR 0.47-4.68 mIU/L) and total T4 was 21.6 nmol/l (NR 57.9-154.4 nmol/l). She had enjoyed good past health and gave birth to a baby girl at 32 weeks gestation in July 2000. She was clinically euthyroid and there was no goiter. Menses was regular with oral contraception. Thyroid function was rechecked with free T4 7.9 pmol/1 (NR 10.2-19.6 pmol/1) and TSH 5.44 mIU/l (NR 0.3-4 mIU/l). Further inquiry revealed that she had been taking a weight reducing drug since December 1999 for fear of potential weight gain during pregnancy. This was identified to be Tri-iodothyroacetic acid (Triac). Serial thyroid function tests showed gradual recovery of thyroid function after Triac was stopped.
Assuntos
Fármacos Antiobesidade/efeitos adversos , Doenças da Glândula Tireoide/induzido quimicamente , Tireotropina/metabolismo , Tiroxina/metabolismo , Tri-Iodotironina/análogos & derivados , Tri-Iodotironina/efeitos adversos , Adulto , Feminino , Humanos , Hipopituitarismo/diagnóstico , Gravidez , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea , Redução de Peso/efeitos dos fármacosRESUMO
A 30-year-old woman presented in March 2000 with a six-year history of oligomenorrhoea followed by amenorrhoea. She was a known hepatitis B carrier and received interferon-alpha therapy from 1994 to 1997. She developed oligomenorrhoea three months after commencing interferon therapy. Endocrine investigation showed panhypopituitarism. Magnetic resonance (MR) imaging showed a 2 x 3 mm cyst at the posterior aspect of the anterior pituitary gland. She was treated with cortisol, thyroxine and sex hormone replacement. Repeat MR imaging 10 months later showed the same pituitary cyst with no interval change. In conclusion, a case of irreversible panhypopituitarism, associated with interferon-alpha therapy, is reported.
Assuntos
Antivirais/efeitos adversos , Hipopituitarismo/induzido quimicamente , Interferon-alfa/efeitos adversos , Adulto , Portador Sadio/tratamento farmacológico , Feminino , Hepatite B/prevenção & controle , HumanosRESUMO
Diabetes is associated with an increased risk of cardiovascular disease (CVD). We studied risk factors for CVD in a cohort of Chinese type 2 diabetic patients recruited between July 1994 and August 1998. Ischemic heart disease (IHD) was defined as a history of: (i) confirmed coronary artery disease (with typical electrocardiographic changes or a positive exercise tolerance test) in patients under care of a cardiologist; (ii) documented myocardial infarction; or (iii) coronary interventions such as angioplasty or coronary artery bypass graft. Cerebrovascular accident (CVA) was defined as any definite cerebral vascular event with or without residual neurological deficit. CVD was defined as a history of IHD or CVA. The study enrolled 3333 patients, including 1370 men (41.1%) and 1963 women (58.9%) of mean age 55.9+/-13.3 years (range, 16-91 years; median, 57 years). A total of 279 patients (8.4%) had CVD (including 4.1% with CVA, 4.9% with IHD, and 0.6% with both CVA and IHD). Men had an overall higher rate of CVD than women (10.1% vs. 7.1%, p=0.002). All cardiovascular diseases showed a progressive increase in prevalence with increasing age with the peak among those aged
Assuntos
Albuminúria , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Complicações do Diabetes , Angiopatias Diabéticas/epidemiologia , Triglicerídeos/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The relationship between diabetes and Helicobacter pylori (HP) infection is controversial. In this study, we examined the possible relationship between HP infection and type 2 diabetes in Chinese subjects. Sixty-three Chinese type 2 diabetic patients (mean age +/- SD: 49.9 +/- 12.0 years; range: 17-76 years) were recruited irrespective of the duration of diabetes or type of therapy. Twenty-nine (46%) of them had upper gastrointestinal symptoms and the other 34 (54%) did not. Another 55 age- and sex-matched non-diabetic subjects (mean age +/- SD: 45.6 +/- 15.6 years, p=0.098; range 18-79 years) with dyspepsia indicated for upper endoscopy were recruited as a comparison group. Upper endoscopy was performed with antral mucosal biopsy specimens taken for rapid urease test (CLO test). HP infection was considered to be present if the rapid urease test was positive. The rates of HP infection of the diabetic and non-diabetic individuals were 50.8% and 56.4% respectively (p: NS). The rate of HP infection was similar between the 2 groups of diabetic patients with or without gastrointestinal symptoms (42.9% vs. 56.3%, p: NS). Using logistic regression analysis (forward stepwise) with age, sex, glycaemic control, duration of diabetes and upper gastrointestinal symptoms as independent variables to predict the risk of HP infection in diabetic patients, none of the parameters enter into the model. In conclusion, the rate of HP infection in Hong Kong Chinese subjects with type 2 diabetes is around 50%, which is similar to control subjects. No association was found between HP infection, glycaemic status, and duration of diabetes and upper gastrointestinal symptoms in these diabetic subjects.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori , Adolescente , Adulto , Idoso , Biópsia , Glicemia/análise , Feminino , Mucosa Gástrica/microbiologia , Gastroenteropatias/microbiologia , Gastroscopia , Hemoglobinas Glicadas/análise , Hong Kong , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , UreaseRESUMO
We examined the determinants of glycaemic control in a consecutive cohort of 562 newly-referred Chinese type 2 diabetic patients (57% women) during a 12-month period. All patients underwent a structured assessment with documentation of clinical and biochemical characteristics. Pancreatic beta-cell function was assessed by fasting plasma C-peptide concentration. Insulin deficiency was defined as fasting plasma C-peptide <0.2 pmol/ml. Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA) based on a product of fasting plasma glucose and insulin concentrations. Treatment was considered appropriate when insulin-deficient patients were treated with insulin and non-insulin-deficient patients were treated with oral agents or diet. Mean (+/-SD) age was 54.3+/-13.8 years (range 17-87 years) and disease duration was 5.0+/-5.9 years. At the time of referral, 70.5% (n=396) were on drug therapy (9% on insulin and 62.8% on oral agents), 20.6% (n=116) were on diet and 9% (n=50) had not received any form of treatment. The mean HbA(lc) was 8.4+/-2.3%. The geometric mean (x// antilog SD) of IR was 4.62x//2.51 (range 0. 63-162.7) and correlated only with waist : hip ratio (WHR, p=0.008). The geometric mean of plasma C peptide was 0.47x//2.89 nmol/l and correlated with BMI (p<0.001). Glycated haemoglobin was correlated positively with age (p=0.013), disease duration (p<0.001), IR (p<0. 001) and negatively with BMI (p<0.001). Glycated haemoglobin was lower in patients who had seen a dietitian (7.9% vs. 8.7%, p<0.001) or diabetes nurse (7.8% vs. 8.7%, p<0.001) or who performed self blood glucose monitoring (7.9% vs. 8.6%, p=0.001) and higher among smokers (8.9% vs. 8.2%, p=0.003). Compared to insulin-deficient patients (n=118), non-insulin-deficient patients (n=413) had features resembling that of the Metabolic Syndrome with increased WHR (p=0.005), blood pressure (p<0.001), BMI (p=0.001) and were older (p=0.04). Amongst the insulin-deficient patients, 27% were treated with oral agents or diet. Patients receiving appropriate therapy (n=362) had a lower HbA(lc) than those treated inappropriately (n=173) (8.2% vs. 8.7%, p=0.02). On multivariate analysis, short disease duration (p<0.001), low IR (p<0.001), high BMI (p=0.001), diabetes education (p<0.001), lack of smoking (p=0. 014) and choice of appropriate treatment (p=0.009) were the independent determinants of good glycaemic control.
Assuntos
Glicemia/metabolismo , Peso Corporal , Diabetes Mellitus Tipo 2/metabolismo , Ilhotas Pancreáticas/metabolismo , Educação de Pacientes como Assunto , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Automonitorização da Glicemia , Pressão Sanguínea , Peptídeo C/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Análise MultivariadaRESUMO
We report a patient with a biochemically and radiologically confirmed parathyroid adenoma, which underwent spontaneous resolution by necrosis. The patient was followed-up over the subsequent two years during which time the tumour and hypercalcaemia recurred. Sequential radiological and biochemical changes at the time of diagnosis, spontaneous necrosis and recurrence are documented fully.
Assuntos
Adenoma/diagnóstico por imagem , Biomarcadores Tumorais/sangue , Regressão Neoplásica Espontânea , Neoplasias das Paratireoides/diagnóstico por imagem , Adenoma/sangue , Adenoma/patologia , Idoso , Feminino , Seguimentos , Humanos , Necrose , Recidiva Local de Neoplasia , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/patologia , Tomografia Computadorizada por Raios XRESUMO
AIMS: To examine and compare gastrointestinal (GI) symptoms in Hong Kong Chinese Type 2 diabetic outpatients and non-diabetic control subjects. METHODS: A total of 149 Chinese Type 2 diabetic patients (66 men and 83 women, age (mean +/- SD) 46.8+/-11.1 years) newly referred to the diabetes clinic of the Prince of Wales Hospital, Hong Kong were examined. Sixty-five age and sex-matched non-diabetic subjects were recruited from the community as controls (22 men and 43 women, age (mean +/- SD) 46.5+/-6.6 years, P = 0.820). All patients were interviewed regarding GI symptoms over the past year, using a questionnaire that covered 14 items. A scoring system from 0 to 4 was used to grade severity. RESULTS: Diabetic patients had higher blood pressure, fasting plasma glucose and glycated haemoglobin and were more often smokers than control subjects. Of the 149 diabetic subjects, 105 (70.5+/-45.8%) had GI symptoms while only 20 (30.8%) of the 65 control subjects had GI symptoms (P<0.001). The respective percentages of upper and lower GI symptoms in diabetic and normal subjects were 44.3% vs. 24.6% (P = 0.006) and 54.4% vs. 13.9% (P<0.001). The three commonest GI symptoms in diabetic patients were diarrhoea (34.9%), constipation (27.5%) and epigastric fullness (16.8%). After adjustment for age, sex, duration of diagnosed diabetes and smoking, patients with or without metformin had similar percentages or scores for GI symptoms. On multivariate analysis using age, body mass index, fasting plasma glucose, glycated haemoglobin, duration of diagnosed diabetes and presence of peripheral neuropathy as independent variables, duration of diabetes was the only independent parameter associated with total score for GI symptoms (beta = 0.116, P = 0.003), for upper GI symptoms (beta = 0.073, P = 0.005) and for lower GI symptom (beta = 0.043, P = 0.020). CONCLUSIONS: Up to 70% of the Chinese Type 2 diabetic outpatients have GI symptoms, which is a much higher rate than in non-diabetic control subjects. Duration of diabetes is the most important factor associated with the presence of such GI symptoms.
Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Adulto , Povo Asiático , Glicemia/análise , Pressão Sanguínea , China/etnologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Gastroenteropatias/classificação , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Inquéritos e QuestionáriosRESUMO
The association between gynaecomastia and thyrotoxicosis is well recognised. However, the reported frequency of the association is variable, partly depending upon the defining criteria used. Here we report two patients with thyrotoxicosis in whom gynaecomastia was the presenting feature. Both patients had other contributing factors, which are assumed to have predisposed to gynaecomastia. In both patients, the gynaecomastia resolved with successful treatment of the thyrotoxicosis. When gynaecomastia is a presenting, or prominent feature of thyrotoxicosis, the possibility of additional underlying pathology should be considered.
Assuntos
Ginecomastia/etiologia , Tireotoxicose/complicações , Adulto , Biomarcadores/sangue , Hormônios Esteroides Gonadais/sangue , Ginecomastia/sangue , Ginecomastia/tratamento farmacológico , Humanos , Masculino , Tireotoxicose/sangueRESUMO
Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent. Four cases of rectal carcinoma presenting during pregnancy are reported. In the first or second trimester of pregnancy, it is possible to resect the tumour with preservation of pregnancy, and in the third trimester, it is best to bring the pregnancy to term before removing the tumour. Unfortunately, the prognosis for such rectal cancer is poor.