[Lifestyle: physical activity and training as prevetion and therapy of type 2 diabetes mellitus (Update 2019)]. / Lebensstil: körperliche Aktivität und Training in der Prävention und Therapie des Typ 2 Diabetes mellitus (Update 2019).

Lifestyle in general and particularly health enhancing physical activity is known to be an important component in the prevention and therapy of type 2 diabetes mellitus.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. Additionally, inactivity should be recognised as health hazard and prolonged episodes of sitting should be avoided.Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Supervised exercise classes are well known to be attractive for adults to reach a sufficient level of health enhancing physical activity. The potential of regional, standardised exercise programmes could have been shown, although existing barriers to entry must be reduced. To tackle this public health challenge and based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

Cardiovascular safety of metformin and sulfonylureas in patients with different cardiac risk profiles.

OBJECTIVES/BACKGROUND: Based on previous experiences, the Food and Drug Administration and the European Medicines Agency recommend that clinical trials for novel antidiabetic drugs are powered to detect increased cardiovascular risk. In this context, data concerning licensed drugs such as metformin and sulfonylureas are conflicting. The influence of baseline cardiovascular risk on any treatment effect appears obvious but has not been formally proven. We therefore evaluated association of metformin and sulfonylureas with cardiovascular events in patients with different cardiovascular risk profiles indicated by N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) levels. METHODS: 2024 patients with diabetes mellitus were included in this observational study. The primary endpoint was defined as a combination of cardiovascular events and death. Association of metformin and sulfonylureas was assessed using Cox regression models. Possible differences of these associations in patients with different NT-proBNP levels were studied by stratifying and through interaction analysis. RESULTS: During a median follow-up of 60 months, the primary endpoint occurred in 522 (26%) of patients. The median age was 63 years. A Cox regression analysis was adjusted for site of treatment, concomitant medication, age, gender, body mass index, glycated haemoglobin, duration of diabetes, glomerular filtration rate, cholesterol, and history of smoking and cardiac disease. Metformin was associated with a decreased risk in the cohort with elevated NT-proBNP ≥300 pg/mL (HR 0.70, p=0.014) and a similar association was found for the interaction between metformin and NT-proBNP (p=0.001). There was neither an association for sulfonylureas nor a significant interaction between sulfonylureas and NT-proBNP. CONCLUSIONS: Metformin is associated with beneficial cardiovascular outcomes in patients with diabetes only when (sub)clinical cardiovascular risk defined by NT-proBNP levels is present.

[The diabetic foot]. / Diabetischer Fuß.

These are the guidelines for preventive care, diagnosis and treatment of the diabetic foot syndrome. Diabetic periphery neuropathy, peripheral vascular disease, bone deformity and altered biomechanics are foot-related risk conditions. The position statement is focused on screening methods and recommendations for clinical care for diabetics, who currently have no foot ulcers. A decision pathway is offered with respect to diagnosis and management of diabetic patients at an increased risk or manifest injuries.

[Physical activity and exercise training in the prevention and therapy of type 2 diabetes mellitus]. / Körperliche Aktivität und Training in der Prävention und Therapie des Typ 2 Diabetes mellitus.

Lifestyle in general (nutrition, exercise, smoking habits), besides the genetic predisposition, is known to be a strong predictor for the development of diabetes. Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

Estudo comparativo entre duas plataformas para realização de Lasik personalizado para correção de miopia e astigmatismo: Alcon CustomCornea® versus Bausch & Lomb Zyoptix® / Wavefront-Guided Lasik for low to moderate myopia: CustomCornea® versus Zyoptix®

OBJETIVO: Comparar os resultados obtidos após o Lasik personalizado utilizando duas plataformas diferentes. MÉTODOS: Estudo prospectivo, randomizado com 50 pacientes míopes submetidos a cirurgia refrativa em ambos os olhos. Foram selecionados para o estudo, pacientes com equivalente esférico semelhante entre os olhos. Todos foram submetidos a Lasik bilateral e simultâneo, sendo que um olho foi operado pela plataforma CustomCornea® e o outro pela Zyoptix®. Acuidade visual sem e com correção, refração dinâmica e estática, medida das aberrações oculares, teste de sensibilidade ao contraste foram realizados no período pré-operatório e pós-operatório de 1, 3 e 6 meses. RESULTADOS: No período pré-operatório a média do equivalente esférico era de -3,29 ± 1,56 D no grupo CustomCornea® e de -3,22 ± 1,50 D no Zyoptix® (p=0,267). No sexto mês de pós-operatório, a média do equivalente esférico no grupo CustomCornea® era de -0,077 ± 0,23 D e -0,282 ± 0,30 D no Zyoptix® (p<0,001*). Acuidade visual sem correção > 20/20 foi alcançada em 86 por cento dos olhos no grupo CustomCornea® e 70 por cento no grupo Zyoptix® (p=0,094). Nenhum paciente perdeu duas ou mais linhas da melhor acuidade visual corrigida. Cem por cento dos olhos CustomCornea® e 88 por cento dos Zyoptix® ficaram entre ± 0,50 D da emetropia (p=0,014*). Melhora da sensibilidade ao contraste em todas as frequências espaciais testadas foi observada em ambos os grupos. A aberração esférica apresentou aumento em ambos os grupos, porém este foi estatisticamente maior na plataforma Zyoptix® (p<0,001). CONCLUSÃO: Não foram observadas diferenças entre os grupos quanto à eficácia e segurança. O tratamento com a plataforma Zyoptix® consumiu menor quantidade de estroma. Melhor previsibilidade da correção cirúrgica foi obtida pelo grupo CustomCornea®, bem como menor indução de aberração esférica.

PURPOSE: To compare the visual and clinical outcomes of Wavefront-guided laser in situ keratomileusis (Lasik) with Alcon CustomCornea® and Zyoptix® systems. METHODS: A prospective, randomized, masked and bilateral study was conducted. Fifty patients with preoperative spherical equivalent ranging from -1.00 to -6.50 D were enrolled for customized ablation in both eyes. All of them were submitted to Lasik CustomCornea® treatment in one eye and Zyoptix® in the other eye. Uncorrected visual acuity, best correct visual acuity (BCVA), manifest refraction, wavefront measurements, and contrast sensitivity testing were performed preoperatively and postoperatively at 1, 3 and 6 months. RESULTS: Preoperatively manifest refractive spherical equivalent was -3.29 ± 1.56 D in the CustomCornea® group and -3.22 ± 1.50 D in the Zyoptix® group. At 6 months, 86 percent of CustomCornea® eyes and 70 percent of Zyoptix® eyes had UCVA > 20/20. One hundred percent of the CustomCornea® group and 88 percent of the eyes in the Zyoptix® were within 0.50 D of emmetropia. In both groups, the contrast sensitivity improved. Spherical aberration increased in both groups, with the CustomCornea® group showing lower levels (p<0,001). CONCLUSION: There were no differences between the systems according to safety and effectiveness. The Zyoptix® platform showed greater spherical aberration.

Comparison of topographic corneal irregularity after LASIK and intrastromal corneal ring segments in the same patients.

PURPOSE: To retrospectively compare the irregularity of the corneal surfaces of 14 patients after LASIK in 1 eye and placement of intrastromal corneal ring segments (ICRS) in the other eye. METHODS: In a within-patient comparison, Orbscan corneal topography was used to retrospectively compare the corneal surface irregularity of LASIK-treated and ICRS-treated eyes at an outpatient tertiary-care ophthalmology clinic in Sao Paulo, Brazil. For the anterior corneal surface, irregularity measurements were compared for both the central and peripheral areas of the cornea. The differences between each group were analyzed for statistical significance. RESULTS: The corneal surfaces of eyes treated with ICRS were found to be more irregular than the corneal surfaces of eyes treated with LASIK, the mean irregularity being 1.91 for LASIK-treated eyes and 3.12 for ICRS-treated eyes in the anterior corneal surface and 0.51 for LASIK-treated eyes and 0.87 for ICRS-treated eyes in the posterior corneal surface. A statistically significant difference was noted only in the posterior surfaces. CONCLUSIONS: When measured with Orbscan topography, ICRS-treated eyes show more corneal surface irregularity than LASIK-treated eyes. The difference in outcome for the two types of treatment may be due to the mechanical effect of the ICRS on the shape of the cornea.

Primeiro censo brasileiro em cirurgia refrativa / First Brazilian refractive surgery survey

OBJETIVO: Realizar o primeiro censo brasileiro de cirurgia refrativa. MÉTODOS: Entre agosto de 2001 e fevereiro de 2002 foram enviados questionários para 7.890 oftalmologistas brasileiros, com questões sobre aspectos demográficos, tendências, padrões de práticas, instrumentos, cuidados pré-operatórios e mercado da cirurgia refrativa. RESULTADOS: Novecentos e vinte questionários (11,67 por cento) foram devidamente respondidos. O laser in situ ceratomileuse é a técnica preferida para correção de dioptrias entre +5,00 e -7,00 D. O excimer laser mais utilizado é o Nidek® EC 5000 e o microceratótomo mais freqüente é o Hansatome. Outros aspectos como: demográficos, procedimentos, técnicas, tendências, volume cirúrgico, cuidados pré-operatórios e mercado também foram analisados. CONCLUSÃO: A partir desta pesquisa, pode-se observar e monitorar aspectos demográficos, padrões de práticas, tendências, tecnologia e mercado da cirurgia refrativa no Brasil e compará-las com outras pesquisas semelhantes em outras partes do mundo.

[First Brazilian refractive surgery survey]. / Primeiro censo brasileiro em cirurgia refrativa.

PURPOSE: To perform the first Brazilian refractive surgery survey. METHODS: Between August 2001 and February 2002, a questionnaire was mailed to 7890 Brazilian ophthalmologists. The questionnaire presented questions about demographic aspects, technology, instruments, market, trends, practice patterns and cost of refractive surgery. RESULTS: Nine hundred and twenty questionnaires (11.67%) were answered. LASIK is the preferred technique for correction between +5.00 and -7.00 D. The mostly used excimer laser is Nidek EC 5000, and Hansatome is the mostly used microkeratome. Others aspects like: demographic, techniques, practice patterns, trends, market, and pre-, intra- and postoperative care, were analyzed. CONCLUSION: With this survey, the Brazilian ophthalmologists can observe and monitor these aspects of refractive surgery in Brazil, and compare them with others surveys.

Low level laser therapy in primary Raynaud's phenomenon--results of a placebo controlled, double blind intervention study.

OBJECTIVE: To assess the efficacy of low level laser therapy in patients with primary Raynaud's phenomenon and predict the success of laser therapy by clinical characteristics. METHODS: Forty-eight patients were included in a randomized placebo controlled, double blind crossover study. Laser and sham therapy each were applied 5 days a week for 3 weeks. Clinical symptoms, exposure to triggers, and frequency and intensity of attacks were recorded in diaries. Results of infrared thermography before onset and at the end of both irradiation sequences were evaluated. Primary endpoint was the average intensity of attacks; secondary endpoints were average number of attacks and thermography results. Age, sex, duration of symptoms, age at onset of symptoms, evoking conditions other than cold, maximum temperature drop after cold provocation, and rewarming time after cold provocation were tested as potential predictors. RESULTS: Number of attacks and their intensity were significantly reduced during laser therapy compared to sham treatment. Thermographic parameters did not reach statistical significance. In a stepwise multiple regression analysis, evoking conditions other than cold (stress, wetness as additional triggers), rewarming time, and temperature decrease after cold provocation were significant predictors of therapeutic efficacy. CONCLUSION: Low level laser therapy reduces frequency and severity of Raynaud attacks. The effect is most pronounced in patients with signs of decreased threshold for vasospasm and less effective in patients with delayed hyperemia.

Degree of atherosclerosis predicts short-term commitment for smoking cessation therapy.

BACKGROUND: Only little is known about factors that influence the smokers' propensity to start smoking cessation therapy and stay within such programs. METHODS: One hundred fifteen subjects that were current smokers and presented at the angiologic outpatient unit were enrolled in a prospective cohort study. All patients were invited to take part in a smoking cessation program. Patients' history, noninvasive vascular, cardiac, and pulmonary parameters, state of atherosclerotic disease (SMART-score), smoking history, and Fagerström index were obtained and the carbon monoxide breathing test was performed. RESULTS: Lower age and heavy smoking were associated with less propensity to start smoking cessation therapy. The degree of atherosclerosis significantly predicted short-term commitment to smoking cessation therapy (relative risk for discontinuation: 0.82; 95% CI: 0.70-0.96). Single factors predictive for staying within the therapy were peripheral arterial occlusive disease and hyperlipidemia, while neither prior myocardial infarction nor pulmonary function was associated with compliance. Fifty-four percent of patients that completed 3 months of therapy quit smoking. CONCLUSIONS: Counseling in smokers with preexistent or newly diagnosed atherosclerotic diseases or risk factors should include their specific vascular condition and information on positive consequences on the progress of these conditions. Counseling for initiation of smoking cessation therapy should apply different strategies as used in the maintenance phase of therapy.

Cell cycle regulators at the ocular surface.

The ocular surface provides an outstanding model to examine the regulation of the proliferative cell cycle. Cells within the cornea and conjunctiva exhibit a wide range of proliferative abilities ranging from the rapidly proliferating cells in the basal cell layer of the epithelium to the quiescent keratocytes and endothelial cells. In this review, dedicated to Dr David Maurice, we will discuss four families of proteins known to regulate the cell cycle. These families include: (1) the cyclins; (2) the CIP/KIP family of cell cycle inhibitors--consisting of p21, p27, and p57; (3) the INK4 family of cell cycle inhibitors--including p16, p15, p18, and p19; and (4) the retinoblastoma family--consisting of pRb, p107, and p130. Members of all of these families have been localized in various cells in the ocular surface. We will discuss how these proteins are involved in regulating cell proliferation both in normal homeostasis and during wound healing.

Resultados a curto prazo de ceratotomia lamelar pediculada (LASIK) para correção de hipermetropia com o sistema Ladar Vision de excimer laser / Short-term results of hyperopic laser in situ keratomileusis (LASIK) with the Ladar Vision excimer laser system

OBJETIVO: Avaliar a eficácia e a segurança do LASIK (ceratotomia lamelar pediculada) hipermetrópico utilizando-se o sistema Ladar Vision de excimer laser. MÉTODOS: Foram analisados, retrospectivamente, 28 olhos de 17 pacientes com hipermetropia de +1,00 a +3,00 D (grupo 1) e 29 olhos de 18 pacientes com hipermetropia de + 3,25 a + 6,00 D (grupo 2), submetidos à cirurgia de LASIK, com o Sistema Ladar Vision de excimer laser. Acuidade visual sem correção, melhor acuidade visual corrigida e refração sob cicloplegia foram avaliadas em um, três e seis meses de pós-operatório. RESULTADOS: No grupo 1, o equivalente esférico médio pré-operatório, sob cicloplegia, era de + 2,14 ± 0,64 D, passando para + 0,44 ± 0,38 D no sexto mês de pós-operatório. No grupo 2, o equivalente esférico médio pré-operatório era de +4,26 ± 0,75 D, diminuindo para +1,14 ± 0,63 D no sexto mês de pós-operatório. 3,4 por cento dos olhos do grupo 2 perderam três linhas de visão no primeiro mês de pós-operatório. No grupo 1, não houve perda de duas ou mais linhas de visão. CONCLUSÕES: O LASIK hipermetrópico com o sistema Ladar Vision mostrou-se procedimento eficaz e seguro. Pacientes do grupo 2 parecem estar sob maior risco de perda de linhas de melhor acuidade visual corrigida no pós-operatório.

Ferrara intrastromal corneal ring segments for severe keratoconus.

PURPOSE: Intrastromal Ferrara ring segments were inserted in eyes with severe keratoconus to evaluate safety and efficacy of this procedure. METHODS: Intrastromal Ferrara ring segments were placed in 36 eyes of 35 patients with severe keratoconus, who were evaluated after 12 months of follow-up. All patients had highly disabling visual acuity, contact lens intolerance, and a previous indication for penetrating keratoplasty. Statistical analysis included preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity, manifest refraction, anterior chamber depth, keratometry, and pachymetry. RESULTS: No patient had a loss of visual acuity. Uncorrected visual acuity improved in 28 eyes (77.78%) and best spectacle-corrected visual acuity improved in 29 eyes (80.56%). Spherical equivalent refraction decreased from -7.29 +/- 3.12 D to -4.80 +/- 3.04 D at 12 months after Ferrara intrastromal ring segment implantation. Corneal topography and ultrasound biomicroscopy showed corneal flattening, demonstrated by thinning of the central cornea and a reduction in anterior chamber depth. Segment decentration occurred in one eye (2.7%), asymmetric positioning of the segments in two eyes (5%), inadequate depth in two eyes (5%), migration of the segments in two eyes (5%), segment extrusion in five eyes (13.8%), conjunctivitis in one eye (2.7%), bacterial keratitis in one eye (2.7%), and hydrops in one eye (2.7%). CONCLUSIONS: With these early results, Ferrara intrastromal ring segments appear to be an alternative for the treatment of severe keratoconus.

Padröes de expressäo e localizaçäo das família das proteínas do gene do retinoblastoma e do fator de transcriçäo E2F durante o desenvolvimento e diferenciaçäo celular da córnea: estudo in situ / Expression and localization patterns of retinoblastoma and E2F family proteins during corneal development and cell differentiation: in situ study

0 objetivo deste trabalho é determinar in situ os padroes de expressao e localizaçao das famílias do gene do retinoblastoma e do fator de transcriçao E2F nos epitélios corneano e limbar, bem como nos ceratócitos da córnea, durante seu desenvolvimento e diferenciaçao. E também correlacionar a localizaçao das proteínas reguladoras do ciclo celular com o estado de proliferaçao das células epiteliais e dos ceratócitos. Para este experimento foram preparadas secçoes por meio de criopreservaçao de córneas de ratos neonatos, jovens e adultos. As células epiteliais do limbo e da córnea, e os ceratócitos do estroma foram examinados e localizados por microscopia imunofluorescente indireta, usando anticorpos comerciais contra a proteína do retinoblastoma e seus membros familiares próximos, a proteína p107 e a p130; os membros da família dos fatores de transcriçao E2F; E2F-1, E2F-2, e E2F-4; e o antígeno de proliferaçao Ki67 um marcador de células que estao ativamente ciciando. A transcriçao reversa da reaçao em cadeia da polimerase foi usada para determinar se o ácido ribonucléico mensageiro para a proteína do retinoblastoma, a p107, a p130, o E2F-1, o E2F-2, o E2F-3, o E2F-4, e o E2F-5 estavam presentes no epitélio comeano adulto. 0 Ki67 foi localizado na camada basal corneana e no epitélio limbar com o maior número de células marcadas entre o décimo terceiro e o décimo nono dias. Alguns ceratócitos estromais foram marcados até o décimo nono dia, porém em maior número no segundo dia. Em córneas de adultos, nenhum Ki67 foi descoberto nos ceratócitos ou nas células suprabasais do epitélio. A análise da transcriçao reversa da reaçao em cadeia da polimerase indicou que o ácido ribonucléico mensageiro para todos os membros das famílias da pRb e do E2F estava presente no epitélio corneano adulto. A pRb e o E2F-2 foram localizados em todas as células das córneas neonatas, jovens e adultas, inclusive nas suprabasais do epitélio que sao terminalmente diferenciadas. A p130 exibiu uma localizaçao citoplásmica difusa até o período entre nove e 11...(au)

Ceratoplastia lamelar profunda com viscodissecçäo da membrana de Descemet / Deep lamellar keratoplasty with viscodissection of Descemet's membrane

Objetivo: Avaliar a eficácia da técnica de ceratoplastia lamelar profunda preservando a membrana de Descemet e as células endoteliais do paciente, com a utilizaçäo de botäo esclero-corneano. Métodos: Foram realizadas 14 ceratoplastias lamelares com viscodissecçäo da membrana de Descemet do receptor usando sulfato de condroitina 4 por cento e hialuronato de sódio 3 por cento. Dez (10) pacientes apresentavam ceratocone avançado, 3 tinham leucoma por herpes simples eem 1 havia irregularidade corneana pós-ceratotomia radial. O acompanhamento pós-operatório variou de 12 a 48 meses (média 24 ñ10,5 meses). Resultados: Após a retirada de todas as suturas a média do equivalente esférico no último exame oftalmológico foi de -2,0 ñ 3,6 dioptrias (D) (-10,3 D a +4,74 D). O astigmatismo final variou de -6,0 DC a-0,75 DC com média de -3,3 ñ 1,9 DC. Dos 14 pacientes 12 apresentaram na visita final acuidade visual com correçäo de 20/40 ou melhor. Todos os pacientes ganharam linha de visäo pela tabela de Snellen. Näo houve presença de edema corneano, descompensaçäo endotelial ou rejeiçäo. Nenhuma opacidade ou depósito na interface foi observado. Dois pacientes apresentaram dobras na membrana de Descemet com baixa da acuidade visual. Conclusäo: Apesar das dificuldades técnicas relacionadas à ceratoplastia lamelar e viscodissecçäo da membrana de Descemet, acreditamos que este seja um procedimento de escolha em pacientes cuja populaçäo de células endoteliais esteja preservada. Esta técnica resulta em melhor acuidade visual final quando comparada ao transplante lamelar tradicional e menor reaçäo imunológica quando comparada a ceratoplastia penetrante. Independentemente da qualidade do tecido doador, conseguimos córneas transparentes como resultado, pois o endotélio do receptor foi preservado.

Ceratite não específica da interface pós laser in situ ceratomileusis - lasik / Nonspecific diffuse intralamellar keratitis (nsdik) after laser in situ keratomileusis - lasik

Objetivos: Relatar a ocorrência de ceratite não específica da interface (CNEI) em pacientes submetidos a laser in situ ceratomileusis (LASIK) e descrever a evolução dessa entidade. Tipo de estudo: Estudo prospectivo de série de casos. Participantes: 11 pacientes (11 olhos) que desenvolveram CNEI pós LASIK. Local: Trabalho realizado na Eye Clinic Day Hospital. Métodos: Lasik foi realizado em 03 olhos utilizando-se o VISX 20/20 B e em 08 olhos o Chiron Technolas PlanoScan 217-C. Os pacientes foram avaliados no 1º e 7º dias de pós-operatório (PO), e no 1º, 3º e 6º meses de PO. Variáveis Analisadas: Acuidade visual com correção (AVCC) e acuidade visual sem correção (AVSC), refração subjetiva e videoceratoscopia computadorizada. Resultados: A CNEI foi diagnosticada entre o 1º e 5º dia de PO, sendo classificada segundo Hatsis em grau II (1 paciente) e III (10 pacientes). Na ocasião do diagnóstico foi aumentada a freqüência de aplicação do corticóide tópico. No 6º mês todos os pacientes apresentavam AVCC de 20/30 ou melhor (7 com AVCC de 20/20). Nove pacientes evoluíram com EE hipermetrópico e 2 pacientes EE miópico. As alterações da topografia corneana representadas por astigmatismo irregular e descentralização reduziram-se durante o seguimento dos pacientes. Conclusão: O diagnóstico precoce favorecido pelo exame biomicroscópico no 1º PO e a intensificação de corticoterapia tópica pode ter contribuído para atenuação de seqüelas relacionadas à CNEI.