Features of patients that died for COVID-19 in a hospital in the south of Mexico: A observational cohort study.

BACKGROUND: Due to the wide spread of SARS-CoV2 around the world, the risk of death in individuals with metabolic comorbidities has dangerously increased. Mexico has a high number of infected individuals and deaths by COVID-19 as well as an important burden of metabolic diseases; nevertheless, reports about features of Mexican individuals with COVID-19 are scarce. The aim of this study was to evaluate demographic features, clinical characteristics and the pharmacological treatment of individuals who died by COVID-19 in the south of Mexico. METHODS: We performed an observational study including the information of 185 deceased individuals with confirmed diagnoses of COVID-19. Data were retrieved from medical records. Categorical data were expressed as proportions (%) and numerical data were expressed as mean ± standard deviation. Comorbidities and overlapping symptoms were plotted as Venn diagrams. Drug clusters were plotted as dendrograms. RESULTS: The mean age was 59.53 years. There was a male predominance (60.1%). The mean hospital stay was 4.75 ± 4.43 days. The most frequent symptoms were dyspnea (88.77%), fever (71.42%) and dry cough (64.28%). Present comorbidities included diabetes (60.63%), hypertension (59.57%) and obesity (43.61%). The main drugs used for treating COVID-19 were azithromycin (60.6%), hydroxychloroquine (53.0%) and oseltamivir (27.3%). CONCLUSIONS: Mexican individuals who died of COVID-19 had shorter hospital stays, higher frequency of shortness of breath, and higher prevalence of diabetes than individuals from other countries. Also, there was a high frequency of off-label use of drugs for their treatment.

Hospitalization and mortality by diabetes mellitus in children: analysis of temporal series.

OBJECTIVE: to analyze the trend of hospitalization rates and mortality due to Diabetes Mellitus in children and adolescents in Brazil. METHOD: temporal series study, hospitalization rates and diabetes mortality in children and adolescents. Data were obtained from the Hospital Information System and Mortality Information System, from 2005-2015, with analysis performed by polynomial regression modeling. RESULTS: 87,100 hospitalizations and 1,120 deaths from diabetes were analyzed. Hospitalizations rates increased for both genders and all age groups, with an increase for adolescents aged 10-14 years. The mortality rate declined, except for the 15-19-year age group. In the overall mortality trend in Brazil, the South and Southeast showed a decrease, whereas for hospitalizations only the Center-West remained constant, while the others increased. CONCLUSION: however, there was a decrease in infant mortality and increase in hospitalizations.

Hospitalization and mortality by diabetes mellitus in children: analysis of temporal series / Interna y mortalidad por diabetes mellitus en la infancia: análisis de series temporais / Internação e mortalidade por diabetes mellitus na infância: análise de séries temporais

ABSTRACT Objective: to analyze the trend of hospitalization rates and mortality due to Diabetes Mellitus in children and adolescents in Brazil. Method: temporal series study, hospitalization rates and diabetes mortality in children and adolescents. Data were obtained from the Hospital Information System and Mortality Information System, from 2005-2015, with analysis performed by polynomial regression modeling. Results: 87,100 hospitalizations and 1,120 deaths from diabetes were analyzed. Hospitalizations rates increased for both genders and all age groups, with an increase for adolescents aged 10-14 years. The mortality rate declined, except for the 15-19-year age group. In the overall mortality trend in Brazil, the South and Southeast showed a decrease, whereas for hospitalizations only the Center-West remained constant, while the others increased. Conclusion: however, there was a decrease in infant mortality and increase in hospitalizations.

RESUMEN Objetivo: analizar la tendencia de las tasas de internación y mortalidad por diabetes mellitus en niños y adolescentes en Brasil. Método: estudio de series temporales, de las tasas de internación y mortalidad por diabetes en niños y adolescentes. Los datos fueron obtenidos del Sistema de Informaciones Hospitalarias y del Sistema de Información sobre Mortalidad, de 2005-2015, con análisis realizado por el modelado de regresión polinomial. Resultados: se analizaron 87.100 internaciones y 1.120 muertes por diabetes. Las tasas de internaciones presentaron aumento para ambos sexos y todas las franjas etarias, con incremento para adolescentes entre 10-14 años. La tasa de mortalidad presentó caída, excepto para el grupo de edad de 15-19 años. A la tendencia de la mortalidad general en Brasil, las regiones Sur y Sudeste presentaron descenso, mientras que para las internaciones, sólo la región Centro-Oeste permaneció constante, mientras que las demás aumentaron. Conclusión: ocurrió decrecimiento de la mortalidad en la infancia, sin embargo, con aumento de las internaciones.

RESUMO Objetivo: analisar a tendência das taxas de internação e mortalidade por Diabetes Mellitus em crianças e adolescentes no Brasil. Método: estudo de séries temporais, das taxas de internação e mortalidade por diabetes em crianças e adolescentes. Os dados foram obtidos do Sistema de Informações Hospitalares e do Sistema de Informações sobre Mortalidade, de 2005-2015, com análise realizada pela modelagem de regressão polinomial. Resultados: foram analisadas 87.100 internações e 1.120 óbitos por diabetes. As taxas de internações apresentaram aumento para ambos os sexos e todas as faixas etárias, com incremento para adolescentes entre 10-14 anos. A taxa de mortalidade apresentou queda, exceto para o grupo etário de 15-19 anos. À tendência da mortalidade geral no Brasil, as regiões Sul e Sudeste apresentaram decréscimo, enquanto que para as internações, apenas a região Centro-Oeste permaneceu constante, enquanto as demais aumentaram. Conclusão: ocorreu decréscimo da mortalidade na infância, porém, com aumento das internações.

Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset.

OBJECTIVE: A common belief is that only a minority of patients with type 1 diabetes (T1D) develop advanced kidney disease and that incidence is higher among men and lower in those diagnosed at a younger age. However, because few patients with T1D survived to older ages until recently, long-term risks have been unclear. RESEARCH DESIGN AND METHODS: We examined the 50-year cumulative kidney complication risk in a childhood-onset T1D cohort diagnosed during 1950-80 (n = 932; mean baseline age 29 years, duration 19 years). Participants comprised 144 who died prior to baseline, 130 followed with periodic surveys, and 658 followed with biennial surveys and a maximum of nine examinations for 25 years. Micro- and macroalbuminuria were defined as an albumin excretion rate of 20-199 and ≥200 µg/min, respectively, and end-stage renal disease (ESRD) was defined as dialysis or kidney transplantation. Cumulative incidence was estimated at 10-year intervals between 20 and 50 years, duration and compared by calendar year of diabetes onset. RESULTS: By 50 years, T1D duration, ESRD affected 60% of the cohort; macroalbuminuria, 72%; and microalbuminuria, 88%. Little evidence existed for declines in cumulative incidence in recent cohorts, except for ESRD (microalbuminuria 3% increase, macroalbuminuria no change; ESRD 45% decrease by 40 years of T1D duration). Onset before age 6 years was associated with the lowest risk; incidence generally did not differ by sex. CONCLUSIONS: Some degree of kidney disease in T1D is virtually universal at long durations and not declining, which has major implications for formulating health care and research strategies. ESRD has declined, but continues to affect >25% of the population by 40 years, duration.

Incidence and Mortality Rates and Clinical Characteristics of Type 1 Diabetes among Children and Young Adults in Cochabamba, Bolivia.

OBJECTIVES: To determine incidence, mortality, and clinical status of youth with diabetes at the Centro Vivir con Diabetes, Cochabamba, Bolivia, with support from International Diabetes Federation Life for a Child Program. METHODS: Incidence/mortality data analysis of all cases (<25 year (y)) diagnosed January 2005-February 2017 and cross-sectional data (December 2015). RESULTS: Over 12.2 years, 144 cases with type 1 diabetes (T1D) were diagnosed; 43.1% were male. Diagnosis age was 0.3-22.2 y; peak was 11-12 y. 11.1% were <5 y; 29.2%, 5-<10 y; 43.1%, 10-<15 y; 13.2%, 15-<20 y; and 3.5%, 20-<25 y. The youngest is being investigated for monogenic diabetes. Measured incidence in Cercado Province (Cochabamba Department) was 2.2/100,000 children < 15 y/y, with ≈80% ascertainment, giving total incidence of 2.7/100,000 children < 15 y/y. Two had died. Crude mortality rate was 2.3/1000 patient years. Clinical data on 141 cases <35 y: mean/median HbA1c was 8.5/8.2% (69/62 mmol/mol), levels higher in adolescents. Three were on renal replacement therapy; four others had substantial renal impairment. Elevated BMI, triglycerides, and cholesterol were common: 19.1%, 18.3%, and 39.1%, respectively. CONCLUSIONS: Bolivia has low T1D incidence. Reasonable glycemic control is being achieved despite limited resources; however, some have serious complications and adverse cardiovascular risk factor profiles. Further attention is needed for complications.

Cause-specific mortality in a cohort of Brazilian patients with type 1 diabetes.

AIMS: To assess cause-specific mortality in a cohort of patients with type 1 diabetes (T1D) followed at an university hospital (tertiary level, Rio de Janeiro city) and an outpatient clinic (secondary level, Bauru city) both in Brazil's southeast, and associations of survival with gender, age at diagnosis, self-reported ethnicity and diabetes duration. METHODS: Our study is based on a cohort of patients with T1D whose vital status was determined as of December 31, 2015. The causes of mortality were determined by death certificates and outpatient clinic records. RESULTS: Among 986 patients, (54.4%) females, (74.8%) Caucasians, 886 (89.9%) were alive, 62 (6.3%) had died, and in 38 (3.9%) the vital status was unknown. Median age at death [interquartile range] and diabetes duration until death were 30.0 [13] and 15.6 [10] years, respectively. Considering those who died (n = 62), most patients (about 70%) died from end-stage renal disease, macrovascular disease or acute complications of diabetes, mainly diabetic ketoacidosis. The other causes of mortality were infections, fatal accidents and non-diabetes-related. The standardized mortality ratio was 3.13 [2.35-4.08] in those aged under 40. In a multivariate Cox model, "age < 40 years" and "year of diagnosis" were the only significant variables with hazard ratios of 6.259 [(3.100-12.639), p < 0.001] and 0.915 [(0.880-0.951), p < 0.001], respectively. CONCLUSIONS: Our study shows that patients with T1D had a threefold increase in mortality. The specific causes of mortality were mainly diabetes-related chronic complications; however, acute complications, especially diabetic ketoacidosis, persisted as an important cause of mortality.

A Contemporary Estimate of Total Mortality and Cardiovascular Disease Risk in Young Adults With Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study.

OBJECTIVE: The degree to which mortality and cardiovascular disease (CVD) incidence remains elevated in young U.S. adults with type 1 diabetes (T1DM) is unclear. We determined contemporary rates for adults <45 years old with long-standing, childhood-onset T1DM from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study. RESEARCH DESIGN AND METHODS: Members of the EDC Study cohort <45 years old during the 1996-2012 follow-up period (n = 502) were studied. Mortality and CVD rates were calculated for those aged 30-39 and 40-44 years. Data from the background Allegheny County, Pennsylvania, population were used to calculate age- and sex-matched standardized mortality (SMR) and incidence rate ratios (IRR). RESULTS: In both age groups, the SMR for total mortality was ∼5 (95% CIs: 30-39-year-olds, 2.8, 7.2; 40-44-year-olds, 3.4, 7.8). CVD mortality SMRs ranged from 19 (95% CI 11, 32) to 33 (95% CI 17, 59). Hospitalized CVD IRR was ∼8 (95% CIs: 30-39-year-olds, 2.5, 18.9; 40-44-year-olds, 4.5, 12.8); revascularization procedures account for much of the increased risk. For all outcomes, the relative risk was larger in women. Participants aged 30-39 years had 6.3% (95% CI 3.8, 9.8) absolute 10-year CVD risk, approaching the American College of Cardiology/American Heart Association-recommended cut point of 7.5% for initiation of statin therapy in older adults. CONCLUSIONS: Total and CVD mortality and hospitalized CVD are all significantly increased in this contemporary U.S. cohort of young adults with long-standing T1DM. These findings support more aggressive risk factor management in T1DM, especially among women.

Intervenciones de enfermería para la detección oportuna, el control y limitación del daño por diabetes mellitus tipo 1 y tipo 2 en la población mayor de 12 años / Nursing interventions for early detection, control and limitation of damage Diabetes Mellitus Type 1 and Type 2, the population over 12 years

Introducción: En México la diabetes mellitus, se encuentra entre las primeras causas de muerte, ocupa el séptimo lugar a escala mundial. 6.4 millones de personas refirieron haber sido diagnosticadas con diabetes. La cifra de diagnóstico previo aumenta después de los 50 años representando un gasto de 3,430 millones de dólares al año en atención y complicaciones. Métodos: Planteamiento de preguntas a responder y conversión a preguntas clínicas estructuradas, búsqueda y revisión sistemática de literatura: recuperación de guías internacionales, meta-análisis, ensayos clínicos aleatorizados y estudios observacionales. Se estableció un algoritmo de búsqueda reproducible en bases de datos electrónicas, encontrando 40 fuentes de utilidad. Se realizó validación por pares clínicos mediante el método Delphi y validación de protocolo de búsqueda así como evaluación de la Calidad de evidencia y fuerza de recomendación, y aprobación por el Comité Nacional de Guías de Práctica Clínica.Resultado: Se plantearon 3 preguntas estructuradas y del análisis de la literatura se obtuvieron 36 evidencias, 40 recomendaciones y 4 puntos de buena práctica lo que contribuirá a disminuir la incidencia, prevalencia, morbilidad y complicaciones de la diabetes mellitus. Conclusiones: Mejorar la efectividad, seguridad y calidad de la atención contribuye al bienestar de las personas y comunidades mediante la monitorización de los niveles de glucosa, estrategias de educación, visitas de seguimiento, asesoramiento, y un programa educativo. Diabetes Mellitus, Educación, Enfermería, Prevención y Control, Diagnóstico y Terapia

Introduction: In Mexico the diabetes mellitus, is among the leading causes of death, ranks seventh worldwide. 6.4 million people reported having been diagnosed with diabetes. The number of previous diagnosis increases after 50 years representing an expenditure of 3,430 million dollars a year in care and complications.Methods: Asking questions to answer and conversion to structured clinical questions, search and systematic review of literature retrieval international guidelines, meta-analyzes, randomized trials and observational studies. Search algorithm was established reproducible in electronic databases and collaborating centers, finding 40 sources of income. Clinical validation pairs was performed using the Delphi method and search protocol validation and evaluation of the quality of evidence and strength of recommendation, and approval by the National Committee on Clinical Practice Guidelines.Result: Three structured questions were established and from the analysis of the literature 36 evidences were raised, 40 recommendations and 4 points of good practice were obtained and will help to reduce the incidence, prevalence, morbidity and complications of diabetes mellitus.Conclusions: To improve the effectiveness, safety and quality of caring contributes to the wellbeing of people and communities by monitoring glucose levels, education strategies, follow-up visits, counseling, and an educational program. Diabetes Mellitus, Education, Nursing, Prevention and Control, Diagnosis and Therapy

As intervenções de enfermagem para detecção precoce, controle e limitação de danos causados por diabetes mellitus tipo 1 e tipo 2 na população acima de 12 anosIntrodução: No diabetes mellitus do México, está entre as principais causas de morte, é o sétimo no mundo. 6,4 milhões de pessoas relataram ter sido diagnosticado com diabetes. O número de aumentos de diagnóstico prévio após 50 anos representando uma despesa de 3.430 milhões de dólares por ano em cuidados e complicações. Métodos: Abordagem de questões clínicas para responder, pesquisar e revisão sistemática de diretrizes internacionais de recuperação de literatura, meta- análise, ensaios clínicos randomizados e estudos observacionais. algoritmo de busca foi estabelecida reprodutível em bases de dados electrónicas, encontrando 40 fontes de renda. pares de validação clínica foi realizada utilizando o método e protocolo de busca de validação Delphi e avaliação da qualidade da evidência e força de recomendação, e aprovação pelo Comitê Nacional de Diretrizes da Prática Clínica. Resultados: 3 estruturadas e análise das questões de literatura foram levantadas 36 provas, 40 recomendações e 4 pontos foram obtidas boas práticas que vão ajudar a reduzir a incidência, prevalência, morbidade e complicações da diabetes mellitus. Conclusões: promover a melhoria da eficácia, segurança e qualidade dos cuidados de contribuir para o bem-estar das pessoas e comunidades, monitorando os níveis de glicose, estratégias de ensino, visitas de acompanhamento, aconselhamento e um programa educacional. Diabetes Mellitus, Educação, Enfermagem, Prevenção e Controle, Diagnóstico e Terapia

Pancreas transplantation: review.

Vascularized pancreas transplantation is the only treatment that establishes normal glucose levels and normalizes glycosylated hemoglobin levels in type 1 diabetic patients. The first vascularized pancreas transplant was performed by William Kelly and Richard Lillehei, to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison Teixeira performed the first isolated segmental pancreas transplant in 1968. Until the 1980s, pancreas transplants were restricted to a few centers of the United States and Europe. The introduction of tacrolimus and mycophenolate mofetil in 1994, led to a significant outcome improvement and consequently, an increase in pancreas transplants in several countries. According to the International Pancreas Transplant Registry, until December 31st, 2010, more than 35 thousand pancreas transplants had been performed. The one-year survival of patients and pancreatic grafts exceeds 95 and 83%, respectively. The better survival of pancreatic (86%) and renal (93%) grafts in the first year after transplantation is in the simultaneous pancreas-kidney transplant group of patients. Immunological loss in the first year after transplant for simultaneous pancreas-kidney, pancreas after kidney, and pancreas alone are 1.8, 3.7, and 6%, respectively. Pancreas transplant has 10 to 20% surgical complications requiring laparotomy. Besides enhancing quality of life, pancreatic transplant increases survival of uremic diabetic patient as compared to uremic diabetic patients on dialysis or with kidney transplantation alone.

Pancreas transplantation: review / Transplante de pâncreas: revisão

ABSTRACT Vascularized pancreas transplantation is the only treatment that establishes normal glucose levels and normalizes glycosylated hemoglobin levels in type 1 diabetic patients. The first vascularized pancreas transplant was performed by William Kelly and Richard Lillehei, to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison Teixeira performed the first isolated segmental pancreas transplant in 1968. Until the 1980s, pancreas transplants were restricted to a few centers of the United States and Europe. The introduction of tacrolimus and mycophenolate mofetil in 1994, led to a significant outcome improvement and consequently, an increase in pancreas transplants in several countries. According to the International Pancreas Transplant Registry, until December 31st, 2010, more than 35 thousand pancreas transplants had been performed. The one-year survival of patients and pancreatic grafts exceeds 95 and 83%, respectively. The better survival of pancreatic (86%) and renal (93%) grafts in the first year after transplantation is in the simultaneous pancreas-kidney transplant group of patients. Immunological loss in the first year after transplant for simultaneous pancreas-kidney, pancreas after kidney, and pancreas alone are 1.8, 3.7, and 6%, respectively. Pancreas transplant has 10 to 20% surgical complications requiring laparotomy. Besides enhancing quality of life, pancreatic transplant increases survival of uremic diabetic patient as compared to uremic diabetic patients on dialysis or with kidney transplantation alone.

RESUMO O transplante vascularizado de pâncreas é o único tratamento que estabelece normoglicemia e normaliza os níveis séricos de hemoglobina glicosilada em pacientes diabéticos tipo 1. O primeiro transplante de pâncreas vascularizado foi realizado para tratar um paciente diabético tipo 1 em dezembro de 1966, por William Kelly e Richard Lillehei. No Brasil, Edison Teixeira realizou o primeiro transplante de pâncreas segmentar isolado em 1968. Até a década de 1980, os transplantes de pâncreas ficaram restritos a poucos centros dos Estados Unidos e da Europa. A introdução dos imunossupressores tacrolimo e micofenolato mofetila, a partir de 1994, propiciou a melhora significativa dos resultados e a consequente realização de transplantes em escala crescente em vários países. Segundo o Registro Internacional de Transplante de Pâncreas, foram realizados, até 31 de dezembro de 2010, mais de 35 mil transplantes de pâncreas. Sobrevida no primeiro ano dos pacientes e dos enxertos pancreáticos excede, respectivamente, 95 e 83%. A melhor sobrevida dos enxertos pancreático (86%) e renal (93%), no primeiro ano pós-transplante, está na categoria de transplante simultâneo de pâncreas e rim. As perdas imunológicas no primeiro ano pós-transplante para transplante simultâneo de pâncreas e rim, transplante de pâncreas após rim e transplante de pâncreas isolado foram, respectivamente, 1,8, 3,7, e 6%. O transplante de pâncreas apresenta de 10 a 20% de complicações cirúrgicas, necessitando laparotomia. O transplante de pâncreas, além de melhorar a qualidade de vida, proporciona o aumento da sobrevida em diabéticos urêmicos, comparados aos diabéticos em diálise ou transplantados renais.

Pancreas transplantation from donors after cardiac death: an update of the UNOS database.

OBJECTIVE: There is reluctance to use donation after cardiac death (DCD) organs for fear of worse outcomes due to increased warm ischemia time. Extensive evidence to confirm the quality of DCD pancreas transplants is not manifest. METHODS: A united network for organ sharing database review of pancreas transplants performed between 1996 and 2012 was conducted. We compared outcomes and all demographic variables between donors after cardiac death and donors after brain death in pancreas transplantation. RESULTS: There were 320 DCD pancreas transplants and 20,448 donation after brain death pancreas transplants performed in the United States between 1996 and 2012. There was no statistically significant difference in graft survival or patient survival in pancreas transplantation in DCD versus donation after brain death donors measured at 1-year, 3-year, 5-year, 10-year, and 15-year intervals. There was no significant difference between donor and recipient age, race, sex, and body mass index (BMI) between the groups. There was no significant difference between the recipient ethnicity or time on wait list between the groups. CONCLUSIONS: Pancreata procured by DCD have comparable outcomes to those procured after brain death. Donation after cardiac death pancreas transplant is a viable method of increasing the donor pool, decreasing wait list mortality, and improving the quality of life for type 1 diabetic patients.

All-cause mortality in a population-based type 1 diabetes cohort in the U.S. Virgin Islands.

OBJECTIVE: Type 1 diabetes remains a significant source of premature mortality; however, its burden has not been assessed in the U.S. Virgin Islands (USVI). As such, the objective of this study was to estimate type 1 diabetes mortality in a population-based registry sample in the USVI. RESEARCH DESIGN AND METHODS: We report overall and 20-year mortality in the USVI Childhood (<19 years old) Diabetes Registry Cohort diagnosed 1979-2005. Recent data for non-Hispanic blacks from the Allegheny County, PA population-based type 1 diabetes registry were used to compare mortality in the USVI to the contiguous U.S. RESULTS: As of December 31, 2010, the vital status of 94 of 103 total cases was confirmed (91.3%) with mean diabetes duration 16.8 ± 7.0 years. No deaths were observed in the 2000-2005 cohort. The overall mortality rates for those diagnosed 1979-1989 and 1990-1999 were 1852 and 782 per 100,000 person-years, respectively. Overall cumulative survival for USVI was 98% (95% CI: 97-99) at 10 years, 92% (95% CI: 89-95) at 15 years and 73% (95% CI: 66-80) at 20 years. The overall SMR for non-Hispanic blacks in the USVI was 5.8 (95% CI: 2.7-8.8). Overall mortality and cumulative survival for non-Hispanic blacks did not differ between the USVI and Allegheny County, PA. CONCLUSIONS: This study, as the first type 1 diabetes mortality follow-up in the USVI, confirmed previous findings of poor disease outcomes in racial/ethnic minorities with type 1 diabetes.

Sepsis-induced acute lung injury (ALI) is milder in diabetic rats and correlates with impaired NFkB activation.

Acute lung injury (ALI) develops in response to a direct insult to the lung or secondarily to a systemic inflammatory response, such as sepsis. There is clinical evidence that the incidence and severity of ALI induced by direct insult are lower in diabetics. In the present study we investigated whether the same occurs in ALI secondarily to sepsis and the molecular mechanisms involved. Diabetes was induced in male Wistar rats by alloxan and sepsis by caecal ligation and puncture surgery (CLP). Six hours later, the lungs were examined for oedema and cell infiltration in bronchoalveolar lavage. Alveolar macrophages (AMs) were cultured in vitro for analysis of IκB and p65 subunit of NFκB phosphorylation and MyD88 and SOCS-1 mRNA. Diabetic rats were more susceptible to sepsis than non-diabetics. In non-diabetic rats, the lung presented oedema, leukocyte infiltration and increased COX2 expression. In diabetic rats these inflammatory events were significantly less intense. To understand why diabetic rats despite being more susceptible to sepsis develop milder ALI, we examined the NFκB activation in AMs of animals with sepsis. Whereas in non-diabetic rats the phosphorylation of IκB and p65 subunit occurred after 6 h of sepsis induction, this did not occur in diabetics. Moreover, in AMs from diabetic rats the expression of MyD88 mRNA was lower and that of SOCS-1 mRNA was increased compared with AMs from non-diabetic rats. These results show that ALI secondary to sepsis is milder in diabetic rats and this correlates with impaired activation of NFκB, increased SOCS-1 and decreased MyD88 mRNA.

[Retrospective study of the maternal, fetal and perinatal outcomes in diabetic women in twenty years of assistance in the Universidade Federal do Triângulo Mineiro School Hospital]. / Estudo retrospectivo das implicações maternas, fetais e perinatais em mulheres portadoras de diabetes, em 20 anos de acompanhamento no Hospital Escola da Universidade Federal do Triângulo Mineiro.

OBJECTIVES: Evaluation of the consequences of diabetes mellitus (DM) on maternal and fetal morbidity and mortality at Universidade Federal do Triângulo Mineiro. MATERIALS AND METHODS: A retrospective review of medical records of pregnant women with diabetes was carried out at the hospital between 1990-2009, focusing on maternal and neonatal data and complications. RESULTS: The last pregnancy of 93 diabetics was evaluated. In thirty-four patients with type 1 diabetes a higher incidence of birth trauma (p = 0.023) and retinopathy (p = 0.023) was observed. Twenty-one type 2 DM subjects required progressively increased insulin therapy (p < 0.01) and showed a higher prevalence of smoking (p = 0.004). Thirty-eight had gestational diabetes. Their diabetic follow-up started at a later gestational age (p < 0.001), had more fetal macrosomia histories (p = 0.028) and cardiovascular risk factors. CONCLUSIONS: Despite improvement of glycemic control during pregnancy neither group attained the glycemic target. However, the majority of DM pregnancies evaluated in our group presented successful outcomes.

Estudo retrospectivo das implicações maternas, fetais e perinatais em mulheres portadoras de diabetes, em 20 anos de acompanhamento no Hospital Escola da Universidade Federal do Triângulo Mineiro / Retrospective study of the maternal, fetal and perinatal outcomes in diabetic women in twenty years of assistance in the Universidade Federal do Triângulo Mineiro School Hospital

OBJETIVOS: Avaliar implicações do diabetes melito (DM) na morbimortalidade materno-fetal, segundo experiência da Universidade Federal do Triângulo Mineiro. MATERIAIS E METODOS: Procedeu-se à análise retrospectiva dos prontuários de gestantes diabéticas assistidas entre 1990 e 2009 focando dados e complicações maternas e neonatais. RESULTADOS: A última gestação de 93 diabéticas foi avaliada, sendo 34 com DM tipo 1, em que se observou maior ocorrência de tocotrauma (p = 0,023) e retinopatia (p = 0,023). Vinte e uma pacientes tinham DM tipo 2; suas necessidades de insulina aumentaram progressivamente (p < 0,01) e observou-se maior prevalência de tabagismo (p = 0,004). Trinta e oito tiveram diabetes gestacional e iniciaram acompanhamento do diabetes em idade gestacional mais tardia (p < 0,001), tiveram mais antecedentes de macrossomia fetal (p = 0,028) e maior prevalência de fatores de risco cardiovascular. CONCLUSÕES: Não obstante melhora do controle glicêmico durante a gestação, nenhum dos grupos atingiu alvos glicêmicos ideais. Ainda assim, a maioria das gestações em diabéticas, conduzidas em nosso meio, evoluiu favoravelmente.

OBJECTIVES: Evaluation of the consequences of diabetes mellitus (DM) on maternal and fetal morbidity and mortality at Universidade Federal do Triângulo Mineiro. MATERIALS AND METHODS: A retrospective review of medical records of pregnant women with diabetes was carried out at the hospital between 1990-2009, focusing on maternal and neonatal data and complications. RESULTS: The last pregnancy of 93 diabetics was evaluated. In thirty-four patients with type 1 diabetes a higher incidence of birth trauma (p = 0.023) and retinopathy (p = 0.023) was observed. Twenty-one type 2 DM subjects required progressively increased insulin therapy (p < 0.01) and showed a higher prevalence of smoking (p = 0.004). Thirty-eight had gestational diabetes. Their diabetic follow-up started at a later gestational age (p < 0.001), had more fetal macrosomia histories (p = 0.028) and cardiovascular risk factors. CONCLUSIONS: Despite improvement of glycemic control during pregnancy neither group attained the glycemic target. However, the majority of DM pregnancies evaluated in our group presented successful outcomes.

[Pancreas and islet transplantation in patients with diabetes mellitus]. / Transplante de pâncreas e ilhotas em portadores de diabetes melito.

Pancreas and kidney transplants have specific indications, benefits and risks. The procedure has become more common and more often as long-term success has improved and risks have decreased. Compared with a patient being on dialysis, simultaneous pancreas-kidney transplant offers a distinct advantage when it comes to mortality, quality of life and diabetic complications. Since there can be a living-donor kidney transplant,, a possibly similar patient and graft survival by 10 years follow-up, this procedure should be considered. Pancreas after kidney transplants, when successful, can improve microvascular complications compared with kidney transplant alone, but immediate mortality may be higher. Solitary pancreas transplantation can improve the quality of life in selected patients, but it may also increase the immediate risk of mortality due to the complexity of the surgery and the risks of immunosupression. The results of Islet transplantation differ from the higher metabolic performance achieved by whole pancreas allotransplantation and its applicability is limited to selected adult diabetic patients.

Transplante de pâncreas e ilhotas em portadores de diabetes melito: [revisão] / Pancreas and islet transplantation in patients with diabetes mellitus: [review]

O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.

Pancreas and kidney transplants have specific indications, benefits and risks. The procedure has become more common and more often as long-term success has improved and risks have decreased. Compared with a patient being on dialysis, simultaneous pancreas-kidney transplant offers a distinct advantage when it comes to mortality, quality of life and diabetic complications. Since there can be a living-donor kidney transplant,, a possibly similar patient and graft survival by 10 years follow-up, this procedure should be considered. Pancreas after kidney transplants, when successful, can improve microvascular complications compared with kidney transplant alone, but immediate mortality may be higher. Solitary pancreas transplantation can improve the quality of life in selected patients, but it may also increase the immediate risk of mortality due to the complexity of the surgery and the risks of immunosupression. The results of Islet transplantation differ from the higher metabolic performance achieved by whole pancreas allotransplantation and its applicability is limited to selected adult diabetic patients.

[Increase in prevalence of diabetes mellitus as a cause of dialytic end-stage renal disease: analysis of 20 years in the west region of Paraná]. / Aumento na prevalência de diabete melito como causa de insuficiência renal crônica dialítica: Análise de 20 anos na região Oeste do Paraná.

UNLABELLED: Diabetic nephropathy (DN) is the main cause of chronic kidney disease (CKD) in developed countries. OBJECTIVE: To observe if there was an increase in the prevalence of diabetes mellitus (DM) of CKD in the last 20 years and to analyze comparatively the survival on dialysis of diabetic and non-diabetic patients. METHODS: Retrospective analysis of patients kept on dialysis in the west region of Paraná State in the period between 1985-2005. Survival analysis was performed using Kaplan-Meier Curves. RESULTS: In the period, 645 patients were admitted to dialysis. In 16.1% DM was the cause of the CKD. It was observed a progressive increase in the prevalence of DM as a cause of CKD. Patient survival was lower in diabetics. CONCLUSIONS: The prevalence of DM as a cause of CKD increased in the last 20 years in our region. The survival rates were lower in diabetic than in non-diabetic patients.

Aumento na prevalência de diabete melito como causa de insuficiência renal crônica dialítica: análise de 20 anos na região Oeste do Paraná / Increase in prevalence of diabetes mellitus as a cause of dialytic end-stage renal disease: analysis of 20 years in the west region of Paraná

A nefropatia diabética (ND) é a principal causa de insuficiência renal crônica terminal (IRCT) nos países desenvolvidos. OBJETIVOS: Observar se ocorreu aumento da prevalência de diabete melito (DM) como causa de IRCT nos últimos 20 anos e comparar a sobrevida em diálise dos diabéticos e não diabéticos. MÉTODOS: Análise retrospectiva dos pacientes mantidos em diálise na região Oeste do Paraná no período de 1985 a 2005. A estimativa de sobrevida foi realizada pela Curva de Sobrevida de Kaplan-Meier. RESULTADOS: Durante este período, foram admitidos em diálise 645 pacientes. Em 16,1 por cento deles o DM foi a causa da IRCT. Observou-se aumento na prevalência de DM como causa de IRCT. A sobrevida dos pacientes em diálise foi inferior nos diabéticos. CONCLUSÕES: A prevalência de DM como causa de IRCT aumentou progressivamente nos últimos 20 anos em nossa região. A sobrevida de pacientes diabéticos em diálise foi menor que a dos não-diabéticos.

Diabetic nephropathy (DN) is the main cause of chronic kidney disease (CKD) in developed countries. OBJECTIVE: To observe if there was an increase in the prevalence of diabetes mellitus (DM) of CKD in the last 20 years and to analyze comparatively the survival on dialysis of diabetic and non-diabetic patients. METHODS: Retrospective analysis of patients kept on dialysis in the west region of Paraná State in the period between 1985­2005. Survival analysis was performed using Kaplan-Meier Curves. RESULTS: In the period, 645 patients were admitted to dialysis. In 16.1 percent DM was the cause of the CKD. It was observed a progressive increase in the prevalence of DM as a cause of CKD. Patient survival was lower in diabetics. CONCLUSIONS: The prevalence of DM as a cause of CKD increased in the last 20 years in our region. The survival rates were lower in diabetic than in non-diabetic patients.