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1.
Ugeskr Laeger ; 182(29)2020 07 13.
Artigo em Dinamarquês | MEDLINE | ID: mdl-32734864

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by infection with severe acute respiratory syndrome corona virus 2. High age, hypertension, diabetes, and obesity are risk factors for severe COVID-19 with increased mortality. In this review, we discuss potential mechanisms by which diabetes and obesity modulate the host viral interactions and host-immune response. Glucose levels should be monitored rigorously, and patient-tailored aggressive treatment of hyperglycaemia is recommended, often with the use of insulin. Persons with diabetes and obesity are susceptible to severe outcomes from COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Diabetes Mellitus/virologia , Interações entre Hospedeiro e Microrganismos , Obesidade/complicações , Pneumonia Viral/complicações , Betacoronavirus , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/metabolismo , Diabetes Mellitus/metabolismo , Sistema Endócrino , Humanos , Hiperglicemia/tratamento farmacológico , Insulina/uso terapêutico , Obesidade/metabolismo , Obesidade/virologia , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/metabolismo , Fatores de Risco
3.
Medicine (Baltimore) ; 99(27): e21016, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629722

RESUMO

We evaluated the statewide burden of obesity and its complications among government and state funded programs (Medicare and Medicaid) and commercial insurance.We calculated the prevalence of obesity and the prevalence of relevant comorbidities among different demographic groups and based on health insurance, among adults (18-65 years old) who visited a statewide health network in the state of Rhode Island, in 2017.The overall prevalence of obesity among 74,089 individuals was 38.88% [Asians 16.77%, Whites 37.49%, Hispanics 44.23%, and Blacks 48.44%]. Medicare or Medicaid beneficiaries were 26% and 27%, respectively, more likely to have obesity than those who had commercial insurance (Odds Ratio:1.26, 95% confidence interval [CI]:1.20-1.32; Odds Ratio:1.27, 95%CI:1.22-1.32). Moreover, Medicaid and Medicare beneficiaries with obesity had a higher prevalence of diabetes compared with privately insured with obesity (10.58% and 10.44% vs 4.45%). Medicare beneficiaries with obesity had a statistically higher prevalence of ischemic heart disease (4.34%, 95%CI: 3.77-4.91) than privately insured (3.21%, 95%CI: 2.94-3.47).Based on statewide data among 18 to 65 years old adults, Medicare and Medicaid provide health coverage to 40% of individuals with obesity and 46% of those with the obesity-related comorbidities and complications. State and federal health care programs need to support and expand obesity-related services and coverage.


Assuntos
Demografia/tendências , Cobertura do Seguro/economia , Obesidade/economia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade , Efeitos Psicossociais da Doença , Estudos Transversais , Demografia/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Medicaid/economia , Medicare/economia , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/etnologia , Prevalência , Rhode Island/epidemiologia , Estados Unidos , Adulto Jovem
4.
Rev Bras Epidemiol ; 23: e200075, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32638853

RESUMO

BACKGROUND: From 2006 to 2017, the Brazilian federal government provided free of charge traditional insulins for diabetes treatment. This involved public tendering by the Department of Health Logistics of the Ministry of Health (DLOG-MOH) and the reimbursement after direct contracting for supply with commercial private retailers (Brazilian Popular Pharmacy Program - PFPB). OBJECTIVE: We aim to describe the budget of the Brazilian federal government committed to for the acquisition of insulin, as well as corresponding prices and treatment availability from 2009 to 2017. METHODS: Insulin volume and expenditure data were obtained in official administrative databases and in the Electronic System of the Information Service to Citizens. Data were analyzed according to the total provision by the federal government, DLOG-MOH and PFPB. Moreover, data were presented according to insulin type. Volumes were calculated in number of defined daily doses (DDD)/1,000 inhabitants/day. RESULTS: Budgetary commitments due to insulin over nine years amounted to U$1,027 billion in 2017, with an approximate average of U$114.1 million per year. DLOG-MOH was the main insulin provider, despite the increase in PFPB provision along period. DLOG-MOH and PFBP together provided an average of 6.08 DDD/1000 inhabitants/day for nine years. Average prices in PFPB were higher than those in the DLOG series, with a downward trend over the years, narrowing to 2.7 times in 2017, when compared to 2009. CONCLUSIONS: Brazil evidenced a moderately sustainable and effective, albeit imperfect, policy for public provision of traditional insulins in the period preceding mandatory free supply of insulin analogues. Future studies must address treatment availability and financial sustainability in the new scenario.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Financiamento Governamental/estatística & dados numéricos , Insulina/economia , Brasil , Gastos em Saúde/estatística & dados numéricos , Humanos , Insulina/uso terapêutico
5.
Nursing ; 50(8): 32-38, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32639268

RESUMO

Several nutrition strategies and eating patterns can help support self-management among persons with diabetes. This article details the effectiveness of popular eating patterns and nutrition strategies, as well as the role of nurses in facilitating informed patient choices and decisions.


Assuntos
Diabetes Mellitus/dietoterapia , Diabetes Mellitus/enfermagem , Comportamento Alimentar/psicologia , Autocuidado , Comportamento de Escolha , Humanos , Papel do Profissional de Enfermagem , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto
6.
Cardiovasc Diabetol ; 19(1): 114, 2020 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690029

RESUMO

In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.


Assuntos
Betacoronavirus/patogenicidade , Glicemia/efeitos dos fármacos , Infecções por Coronavirus/terapia , Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Unidades de Terapia Intensiva , Pneumonia Viral/terapia , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Glicemia/metabolismo , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Dislipidemias/tratamento farmacológico , Dislipidemias/mortalidade , Interações Hospedeiro-Patógeno , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Hipoglicemiantes/efeitos adversos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
15.
Braz J Med Biol Res ; 53(9): e9360, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32696822

RESUMO

Diabetic nephropathy (DN) has been identified as the major cause of end-stage renal disease (ESRD) in most developed countries. MicroRNA-770-5p depletion could repress high glucose (HG)-triggered apoptosis in podocytes, and downregulation of E2F transcription factor 3 (E2F3) could facilitate podocyte injury. Nevertheless, whether E2F3 is involved in miR-770-5p knockdown-mediated improvement of DN is still unclear. The expression levels of miR-770-5p and E2F3 were detected in HG-treated podocytes by RT-qPCR. The expression levels of E2F3, apoptosis-related proteins Bcl-2 related X protein (Bax), B-cell lymphoma-2 (Bcl-2), Bad, apoptotic peptidase activating factor 1 (APAF1), C-caspase3, C-caspase7, and C-caspase9 were detected by western blot assay. The effects of miR-770-5p and E2F3 on HG-treated podocytes proliferation and apoptosis were detected by CCK-8 and flow cytometry assays. The interaction between miR-770-5p and E2F3 was predicted by Targetscan, and then verified by the dual-luciferase reporter assay. MiR-770-5p was upregulated and E2F3 was downregulated in HG-treated podocytes. MiR-770-5p inhibited proliferation and promoted apoptosis and E2F3 promoted proliferation and suppressed apoptosis in HG-treated podocytes. E2F3 is a target gene of miR-770-5p and it partially abolished the effect of miR-770-5p in HG-triggered proliferation and apoptosis of podocytes. MiR-770-5p deficiency blocked HG-induced APAF1/caspase9 pathway via targeting E2F3 in podocytes. We firstly confirmed that E2F3 was a target of miR-770-5p in podocytes. These findings suggested that miR-770-5p expedited podocyte injury by targeting E2F3, and the miR-770-5p/E2F3 axis might represent a pathological mechanism of DN progression.


Assuntos
Diabetes Mellitus , Nefropatias Diabéticas , MicroRNAs , Podócitos , Apoptose , Fator de Transcrição E2F3 , Glucose , Humanos
16.
Int J Med Sci ; 17(12): 1744-1750, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32714077

RESUMO

Many studies have reported the risk factors for exacerbations in patients with 2019 novel coronavirus (2019-nCoV). This study aims to perform the meta-analysis of risk factors for the exacerbation of the novel coronavirus-infected pneumonia (NCIP). PubMed, Embase and Google scholar have been searched. We included the cohort studies involving risk factors for the exacerbation of NCIP. This meta-analysis compared the risk factors of patients between intensive care (ICU) group and non-ICU group. Two cohort studies were included in this study. After comparing the patients between intensive care (ICU) group and non-ICU group, several important factors were found to significantly increase the risk of exacerbations in patients with NCIP, and they included hypertension (RR=2.34; 95% CI=1.21 to 4.51; P=0.01), cardiovascular diseases (RR=2.28; 95% CI=1.13 to 4.58; P=0.02), COPD (RR=7.65; 95% CI=1.24 to 47.13; P=0.03), dyspnea (RR=2.89; 95% CI=2.05 to 4.08; P<0.00001), myalgia or fatigue (RR=1.24; 95% CI=1.01 to 1.52; P=0.04), but several factors such as gender, Huanan Seafood Wholesale Market exposure, diabetes, chronic liver disease, malignancy, fever, cough, expectoration, headache and diarrhoea appeared to have no obvious effect on the exacerbation of pneumonia. In addition, as the exacerbation of pneumonia, some complications had the high probability to occur according to the meta-analysis of acute respiratory distress syndrome (ARDS) (RR=13.95; 95% CI=6.20 to 31.41; P<0.00001), shock (RR=24.29; 95% CI=4.66 to 126.69; P=0.0002), acute cardiac injury (RR=10.32; 95% CI=3.05 to 34.96; P=0.0002) and acute kidney injury (RR=5.90; 95% CI=1.32 to 26.35; P=0.02) between two groups. Several risk factors were confirmed to significantly improve the risk of exacerbation in patients with NCIP, which was very important for the exacerbation prediction and treatment of these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Adulto , Idoso , China/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dispneia/epidemiologia , Dispneia/etiologia , Exposição Ambiental , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Fatores de Risco , Choque/epidemiologia , Choque/etiologia , Avaliação de Sintomas
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