Oral L-Arginine (5 g/day) for 14 Days Improves Microcirculatory Function in Healthy Young Women and Healthy and Type 2 Diabetes Mellitus Elderly Women.

OBJECTIVE: The aim of this study was to investigate the effect of oral supplementation with L-arginine on serum biochemical profile, blood pressure, microcirculation, and vasoreactivity/endothelial function in young controls, and elderly women with and without type 2 diabetes mellitus (T2DM). METHODS: Healthy young (n = 25), healthy elderly (n = 25), and elderly women with type 2 diabetes mellitus (T2DME, n = 23, glycated Hb ≥6.4% and mean of 7.7 years for duration of the disease), aged 18-30 and older than 65 years, respectively, were included in the study. All patients underwent biochemical analysis (fasting glycemia and lipidogram), arterial blood pressure, nailfold videocapillaroscopy (capillary diameters, functional capillary density [FCD], peak red blood cell velocity [RBCVmax] after 1 min ischemia, time to reach peak RBCV [TRBCVmax]), and venous occlusion plethysmography (vasoreactivity), before and after 14 days of oral supplementation with L-arginine (5 g/day). RESULTS: L-Arginine did not change fasting glycemia and lipidogram, but it decreased systolic, diastolic, and mean arterial pressure in elderly women, increased RBCVmax in all groups, and did not decrease TRBCVmax in T2DME. Capillary diameters and FCD remained unchanged in all groups. L-Arginine improved vasoreactivity during reactive hyperemia and after sublingual nitroglycerin (0.4 mg) in all groups. CONCLUSION: L-Arginine supplementation (5g/day during 14 days) was able to improve vascular/microvascular health in the elderly women with or without T2DM.

Ozonoterapia sistémica en pacientes diabéticos insulinodependientes con dolor neuropático / Systemic ozone therapy in insulin-dependent diabetic patients with neuropathic pain

Introducción: Con frecuencia, los pacientes diabéticos presentan dolor neuropático como complicación de su enfermedad. Objetivo: Identificar las ventajas de la ozonoterapia sistémica en pacientes diabéticos insulinodependientes con dolor neuropático. Métodos: Se realizó un estudio descriptivo en diabéticos insulinodependientes con dolor neuropático que acudieron a la Clínica del Dolor del Hospital Clínico Quirúrgico Hermanos Ameijeiras entre febrero de 2014 hasta enero de 2019. A todos se les cuantificó el dolor, la presencia de parestesias, la fuerza muscular, el reflejo aquiliano y la hemoglobina glicosilada. Se administraron 15 sesiones de ozono vía rectal y 6 de autohemoterapia mayor. Se compararon los resultados de la primera sesión y en la última (8 semanas de tratamiento). Resultados: El 45,3 por ciento tenían 60 años o más, 59 por ciento eran del sexo femenino y 89,3 por ciento tenían 15 o más años de evolución de la diabetes. En la primera consulta la intensidad del dolor en 100 por ciento osciló entre 7 y 10 de la escala numérica verbal y todos presentaron parestesias. En 59,3 por ciento existió disminución de la fuerza muscular, 62 por ciento presentó reflejo aquiliano disminuido y 88 por ciento hemoglobina glicosilada mayor o igual a 12 por ciento. Estos síntomas mejoraron a las ocho semanas. Conclusiones: Las probadas propiedades analgésicas y antiinflamatorias del ozono lo convierten en la actualidad en una herramienta terapéuticas de las más eficientes para el control del dolor crónico en pacientes diabéticos insulinodependientes(AU)

Introduction: Frequently, diabetic patients present neuropathic pain as a complication of their disease. Objective: To identify the advantages of systemic ozone therapy for insulin-dependent diabetic patients with neuropathic pain. Methods: A descriptive study was carried out with insulin-dependent diabetic patients with neuropathic pain who attended the Pain Clinic of Hermanos Ameijeiras Clinical-Surgical Hospital between February 2014 until January 2019. All of them were quantified pain, the presence of paresthesias, muscle strength, ankle jerk reflex, and glycosylated hemoglobin. The patients received fifteen sessions of rectal ozone and six sessions of major self-hemotherapy. We compared the outcomes after the first session and after the last one (eight weeks). Results: 45.3 percent were 60 years or older, 59 percent were female, and 89.3 percent had a natural history of diabetes of 15 years or more. In the first hospital visit, the intensity of 100 percent pain ranged between 7 and 10 according to the verbal numeric scale, and all presented paresthesias. In 59.3 percent, there was a decrease in muscle strength, 62 percent had decreased ankle jerk reflex, and 88 percent had glycosylated hemoglobin higher than or equal to 12 percent. These symptoms improved at week eight. Conclusions: The proven analgesic and anti-inflammatory properties of ozone make it currently a therapeutic tool among the most efficient for controlling chronic pain in insulin-dependent diabetic patients(AU)

Mhc: polimorfimoos genéticos en autoinmunidad

Las enfermedades autoinmunes se caracterizan por inflamación, así como por el desarrollo y mantenimiento de anticuerpos y linfocitos T dirigidos contra antígenos propios (autoantígenos). Aunque la etiología de estas enfermedades es desconocida, poseen mecanismos en común. Existe una fuerte asociación genética entre ciertas enfermedades autoinmunes como la artritis reumatoide, esclerosis múltiple y diabetes mellitus insulino-dependiente y algunos alelos y/o haplotipos del complejo principal de histocompatibilidad. La explicación actual para este tipo de asociaciones propone que las moléculas del complejo principal de histocompatibilidad que se han encontrado asociadas, unen de manera eficiente autoantígenos envueltos en la patofisiología de la enfermedad, lo cual resulta en una respuesta inmune periférica mediada por células T contra autoantígenos y las secuelas autoinmunes. La susceptibilidad individual en autoinmunidad puede estar determinada por una combinación de polimorfismos específicos de genes que codifican para múltiples citocinas, antígenos del complejo principal de histocompatibilidad, moléculas de adhesión y proteínas celulares. Esta condición puede conducir a la expresión anormal de moléculas inmunorreguladoras y finalmente resultar en el desarrollo o exacerbación de la enfermedad. Recientemente también se ha estudiado el papel de las secuencias virales en la patogénesis de autoinmunidad, principalmente involucradas en mimetismo molecular.

Autoimmune diseases are characterized by inflammation and by the development and maintenance of antibodies and T lymphocytes against "self" antigens. Although the etiology of these diseases is unknown, they have a number of cellular and molecular mechanisms in common. A strong genetic association exists between a number of autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, and insulin-dependent diabetes mellitus (IDDM) and the expression of certain alleles or haplotypes of the major histocompatibility complex (MHC). The current explanation for this association proposes that disease-associated MHC molecules efficiently bind autoantigens involved in the pathophysiology of the disease. This results in a peripheral T cell-mediated immune response to the autoantigens and autoimmune sequelae. Individual susceptibility to autoimmune diseases may be determined by a combination of specific polymorphisms of genes encoding multiple cytokines, MHC antigens, adhesion molecules, and cellular proteins. This condition may lead to abnormal expression of immunoregulatory molecules and finally result in the development or exacerbation of the disease. Recently, the role of viral sequences in the pathogenesis of autoimmunity has been discussed, mainly involved in molecular mimicry.

Adaptação transcultural e validação do "Diabetes Quality of Life for Youts" de Ingersoll e Marrero / Cross-cultural adaptation and validation of the "Diabetes Quality of Life for Youths" of Ingersoll and Marrero

A avaliação da qualidade de vida tem sido considerada, na atualidade, como um parâmetro fundamental na compreensão do impacto causado pelo diabetes mellitus do tipo 1, no cotidiano dos adolescentes. Na realidade brasileira não existem instrumentos específicos validados que possibilitem essa avaliação. Assim sendo, este estudo teve como objetivos fazer a adaptação transcultural e validação "Diabetes Quality of Life for Youths"(DQOLY) de Ingersoll e Marrero e, analisar as relações entre a variáveis sócio demográficas, clínicas e a questão da autopercepção do estado de saúde e os escores obtidos pela aplicação do instrumento. O DQOLY é composto por 53 itens agrupados nos domínios: satisfação, impacto e preocupação. O processo de adaptação transcultural incluiu as etapas: tradução para o português, back translation, revisão pelos juízes e pré-teste. O instrumento adaptado, foi aplicado a 124 adolescentes com diabetes mellitus tipo 1, para a análise de suas propriedades psicométricas(confiabilidade e validade). A adaptação transcultural gerou uma versão brasileira do instrumento que na análise da consistência interna, apresentou valores de Alpha de Cronbach de 0, 8695 para o domínio Satisfação, 0, 8658 para o Impacto, 0, 8387 para o Preocupação e 0, 9333 para o total, com a exclusão de três itens inconsistentes no domínio Impacto e portanto, o instrumento gerado ficou constituído por 48 itens. No teste-reteste não houve diferenças significativas(p>0, 05) --------------------------------------|a entre duas aplicações do instrumento aos mesmos sujeitos, o que demonstrou a estabilidade temporal do mesmo. Na análise de validade de conteúdo, a concordância entre os juízes não foi unânime somente quando envolveu a avaliação de um deles. A validade convergente foi configurada pelas correlações positivas e significativas entre os escores total e por domínios do instrumento em estudo e da escala de Autoestima(p<0,001). (continuação) A validade fatorial não confirmou os três domínios. Nas comparações dos escores do instrumento entre adolescentes com controle metabólico adequado e não adequado, houve diferença significativa para os domínios impacto, preocupação e total(p<0, 05), o que determinou a validade discriminante. Os escores do instrumento foram relacionados às variáveis sócio demográficas, clinicas e a autopercepção do estado de saúde e os resultados demonstraram correlação positiva e significativa(p<0,05) entre o maior número de episódios de hiperglicemia relatadas e todos os escores do instrumento, indicando que quanto maior o número de hiperglicemias relatadas, pior a qualidade de vida. O domínio satisfação se correlacionou negativamente com a maior frequência das monitorizações domiciliares da glicemia, mostrando que o maior número de testes correlaciona-se com melhor qualidade de vida neste domínio. Todos os domínios do instrumento e o total tiveram correlação positiva e estatisticamente significativa com o relato de melhor percepção do estado de saúde(p<0, 001). Este estudo indica que o DQOLY adaptado para a cultura brasileira é um instrumento confiável e válido para utilização em nosso meio.

The quality of life evaluation has been considered, nowadays, as a fundamental parameter on comprehension of diabetes type 1's impact on adolescent's lifestyle. In the Brazilian reality, there are no validated specific instruments that permit this evaluation. Hence, the goals of this study were to cross-culturally adapt and validate the Ingersoll and Marrero's "Diabetes Quality of Life for Youths" (DQOLY) instrument and to analyze the relations among social demographics, clinical variables, self perceived health status and the scores obtained through the adapted instrument application. The DQOLY is composed of 53 items arranged by domains: satisfaction, impact, worries. The cross-cultural adaptation process included the stages: translation into portuguese, back translation, committee review and pre- testing. The adapted instrument was applied to 124 type 1 diabetes adolescents in order to assess the psychometric properties(reliability and validity). The cross-cultural adaptation originated the Brazilian version, in which, internal consistency evaluated by Conbach's Apha scored 0.8695 for satisfaction domain, 0.8658 for impact, 0.8387 for worries and 0.9333 for total, the exclusion of three inconsistent items on Impact domain generated a 48- item instrument. Regarding the test-retest, there were no significant differences(p>0.05) between two instrument appliances on the same subjects, which demonstrated its temporal stability. In the case of content validity, the agreement between the judges was the rule, except when it just involved the evaluation of one of them. The convergent validity was demonstrated by positive and significant correlation among the instrument's total and domains scores and the self esteem scale(p<0.001). The factorial validity did not confirm the three domains. In the regard to instrument scores comparisons among adolescents with and without adequate metabolic control, (continue) (continuation)there were significant differences on impact, worries domains and total(p<0.05), which demonstrated the discriminant validity. The instrument scores were related to socio- demographics and clinical variables. The self- perceived health status and the results indicated significant positive correlation(p<0.05) among the larger number of hyperglycemic episodes referred and all instrument's scores, indicating that the higher is the number of related hyperglycemia's episodes, the worse is the quality of life. The satisfaction domain was negatively correlated to the higher frequency of home monitoring blood glucose, demonstrating that the higher are the frequencies of the tests , the better is the quality of life in this domain. All instrument's domains and total had positive and significant correlation with self- perceived health status(p<0.001). This study indicates that adaptacion of the DQOLY into Brazilian culture is a reliable and valid instrument for utilization in our reality.

Perfil lipídico, microalbuminúria e pressão arterial sistêmica em pacientes com diabetes insulino-dependente / Lipids, Microalbuminuria and Systemic Blood Pressure in Patients with InsulinDependent Diabetes Mellitus

PURPOSE: To determine the association between lipids, microalbuminuria and systemic blood pressure. Urinary albumin excretion rate (AER) was determined in timed overnight urine samples by radioimmunoassay. Microalbuminuria was defined when two out of three urine samples had AER ranging 20-200 micrograms/min. Lipids were determined by colorimetric methods (total cholesterol, HDL cholesterol and triglycerides). METHODS: Fifty patients with insulin dependent diabetes mellitus (28 females, 22 males) aged 21.9 +/- 7 years and with diabetes duration of 6.8 +/- 5.8 years attending the outpatients diabetes clinic were studied cross-sectionally. RESULTS: Microalbuminuria was present in 12of our patients. A high systolic blood pressure (SBP) was found in microalbuminuric patients (p = 0.003). No difference concerning serum lipids were found in comparison between normo and microalbuminuric patients, although 20of all patients had increased cholesterol and LDL cholesterol and 4had high HDL cholesterol and triglycerides levels. Stepwise multiple regression analysis showed that SBP was the only significant independent variable to influence AER (r = 0.42 r2 = 0.18 p = 0.002). CONCLUSION: Although in our study, microalbuminuria was associated only with SBP, the independent alteration of lipids in young IDDM patients must be considered as a possible additional risk factor for cardiovascular disease.

Diabetes mellitus durante la gestación y morbimortalidad perinatal / Gestacional diabetes and perinatal morbimortality in Medellín, Colombia

El análisis retrospectivo de 166 pacientes embarazadas y con diagnóstico de diabetes mellitus, atendidas en el Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, permite apreciar un registro inadecuado de la información, lo que le resta confiabilidad, y la carencia de protocolos apropiados de manejo. La diabetes gestacional (DMG) se presentó en 81 pacientes (48.8 por ciento), seguida por la diabetes mellitus no insulino dependiente (DMNID) (69 pacientes; 41.5 por ciento) y por último la diabetes insulina dependiente (DMID) en 16 pacientes (9.6 por ciento). Se halló una tasa de morbilidad perinatal del 52.2 por ciento (72 casos de los 138 en que se dispuso de información), inaceptable para esta población, distribuida así por entidades: macrosomía (16 casos; 22.2 por ciento), sufrimiento fetal agudo (15 casos; 20.8 por ciento), sufrimiento fetal crónico (10 casos; 13.9 por ciento), polihidramnios (9 casos; 12.5 por ciento), hipoglicemia (8 casos; 11.1 por ciento), trauma fetal (6 casos; 8.3 por ciento), síndrome de dificultad respiratoria (5 casos; 6.9 por ciento) hiperbilirrubinemia (5 casos; 6.9 por ciento) e hipocalcemia (1 caso). Cabe resaltar que las entidades potencialmente prevenibles (macrosomía, sufrimiento fetal agudo y crónico, polihidramnios, trauma fetal y síndrome de dificultad respiratoria ) fueron más frecuentes en la población de DMNID y DMG, lo que refleja un manejo clínico inadecuado. La mortalidad fetal fue del 3.6 por ciento (5 casos) y en tres de ellos se asoció a hipertensión materna. Se puso en evidencia la urgente necesidad de un protocolo interdisciplinarlo de manejo clínico, con el cual se puedan establecer un registro adecuado y pautas de manejo conforme a las necesidades de la población de riesgo que atiende esta Institución de referencia

Retrospective analysis of 166 pregnant women with gestational diabetes mellitus, at San Vicente de Paúl Hospital, Medellín, Colombia, evidenced inadequate registration of information and lack of clinical management protocols, despite the fact that this is a reference institution. Gestational diabetes mellitus (GDM) was found in 81 patients (48.8%), non-insulin-dependent diabetes mellitus (NIDDM) in 69 (41.5%) and insulin-dependent diabetes mellitus (IDDM) in 16 (9.6%). Perinatal morbidity rate was 52.2% (72 cases among the 138 in which information was available), distributed as follows: macrosomy (16 cases; 22.2%), acute fetal distress (15 cases; 20.8%), chronic fetal distress (10 cases; 13.9%), polyhydramnios (9 cases; 12.5%), hypoglycemia (8 cases; 11.1 %) and delivery fetal trauma (6 cases; 8.3%). It was remarkable that the potentially preventable entities (macrosomy, acute and chronic fetal distress, polyhydramnios, fetal trauma and respiratory failure syndrome) were more frequent in NIDDM and GDM groups, indicating an inadequate clinical management; fetal mortality was 3.6% (5 patients) mostly associated to maternal hypertension. These results point out to the urgent need of establishing in this third level hospital an interdisciplinary management protocol of gestational diabetes, with apropriate registration of information and clear clinical guides