The impact of time-restricted eating on beta-cell function in adults with type 2 diabetes: a randomized cross-over trial.

OBJECTIVE: Time-restricted eating (TRE) which consists of restricting the eating window to typically 4-8h (while fasting for the remaining hours of the day) has been proposed as a non-pharmacological strategy with cardio-metabolic benefits but little is known about its metabolic impact in type 2 diabetes (T2DM). We evaluated whether TRE can improve pancreatic beta-cell function and metabolic status in overweight individuals with early T2DM. RESEARCH DESIGN AND METHODS: In a randomized cross-over trial, 39 participants [mean 2.9 years of diabetes duration, baseline glycated hemoglobin (HbA1c) 6.6% ± 0.7% and body mass index (BMI) 32.4 ± 5.7 kg/m2] were randomized to either an initial intervention consisting of 6-weeks of TRE (20h-fasting/4h-eating) or standard lifestyle. The primary outcome of beta-cell function was assessed by Insulin Secretion-Sensitivity Index-2 (ISSI-2) derived from an oral glucose tolerance test. Trial registration: clinicaltrials.gov NCT05717127. RESULTS: As compared to standard lifestyle, TRE induced a 14% increase in ISSI-2 (+14.0 ± 39.2%, p = 0.03) accompanied by 14% reduction of hepatic insulin resistance as evaluated by HOMA-IR [-11.6% (-49.3-21.9), p = 0.03]. Fasting glucose did not differ between interventions, but TRE yielded a significant reduction in HbA1c (-0.32 ± 0.48%, p <0.001). These metabolic improvements were coupled by a reduction of body weight of 3.86% (-3.86 ± 3.1%, p <0.001) and waist circumference of 3.8 cm (-3.8 ± 7.5 cm, p = 0.003). CONCLUSION: TRE improved beta-cell function and insulin resistance in overweight patients with early diabetes, accompanied by beneficial effects on adiposity.

Laughter as medicine: A systematic review and meta-analysis of interventional studies evaluating the impact of spontaneous laughter on cortisol levels.

OBJECTIVES: Laughter as an expression of humor has been recognized as good medicine for centuries. The health benefits of humor-induced well-being remain unclear and thus we conducted a systematic review and meta-analysis of interventional studies to evaluate the impact of spontaneous laughter on stress response as measured by cortisol levels. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE/PubMed, EMBASE, PsycINFO, Scopus, and Clinicaltrials.gov. ELIGIBILITY CRITERIA: Interventional studies, which could be either randomized placebo-controlled trials (RCTs) or quasi-experimental studies, conducted in adults that compared any spontaneous laughter intervention to a controlled setting and reported changes in cortisol levels were selected. DATA EXTRACTION AND SYNTHESIS: We examined the impact of laughter on percentage change in cortisol levels by calculating pooled estimates of the absolute differences between arithmetic means before and after interventions as compared to control using random-effects model. RESULTS: Eight studies (315 participants; mean age 38.6) met our inclusion criteria; four were RCTs and four were quasi-experiment studies. Five studies evaluated the impact of watching a humor/comedy video, two studies evaluating laughter sessions administered by a trained laughter therapist, and one study evaluating a self-administered laughter program. Pooling these data showed a significant reduction in cortisol levels by 31.9% (95%CI -47.7% to -16.3%) induced by laughter intervention compared to control group with no evidence of publication bias (P = 0.66). Sensitivity analyses demonstrated that even a single laughter session induced a significant reduction of 36.7% in cortisol (95%CI -52.5% to -20.8%). In addition, analyses including the four RCTs reinforced these results by demonstrating a significant reduction in cortisol levels promoted by laughter as compared to the placebo arm [-37.2% (95%CI -56.3% to -18.1%)]. CONCLUSIONS: Current evidence demonstrates that spontaneous laughter is associated with greater reduction in cortisol levels as compared with usual activities, suggesting laughter as a potential adjunctive medical therapy to improve well-being. TRIAL REGISTRATION: Registration number: CRD42021267972.

Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies.

BACKGROUND: Thyroid nodules are a common finding in the general population, and their detection is increasing with the widespread use of ultrasound (US). Thyroid cancer is found in 5-15% of cases depending on sex, age, and exposure to other risk factors. Some US parameters have been associated with increased risk of malignancy. However, no characteristic seems sufficiently reliable in isolation to diagnose malignancy. The objective of this meta-analysis was to evaluate the diagnostic performance of US features for thyroid malignancy in patients with unselected thyroid nodules and nodules with indeterminate fine-needle aspiration (FNA) cytology. METHODS: Electronic databases were reviewed for studies published prior to July 2012 that evaluated US features of thyroid nodules and reported postoperative histopathologic diagnosis. A manual search of references of review and key articles, and previous meta-analyses was also performed. A separate meta-analysis was performed including only nodules with indeterminate cytology. Analyzed features were solid structure, hypoechogenicity, irregular margins, absence of halo, microcalcifications, central vascularization, solitary nodule, heterogeneity, taller than wide shape, and absence of elasticity. RESULTS: Fifty-two observational studies (12,786 nodules) were included. Nine studies included nodules with indeterminate cytology as a separate category, comprising 1851 nodules. In unselected nodules, all US features were significantly associated with malignancy with an odds ratio varying from 1.78 to 35.7, and microcalcifications, irregular margins, and a taller than wide shape had high specificities (Sp; 87.8%, 83.1%, 96.6%) and positive likelihood ratios (LHR; 3.26, 2.99, 8.07). Absence of elasticity was the single feature with the best diagnostic performance (sensitivity 87.9%, Sp 86.2%, and positive LHR 6.39). The presence of central vascularization was the most specific US feature in nodules with indeterminate cytology (Sp 96% and positive LHR 2.13). CONCLUSIONS: US features in isolation do not provide reliable information to select nodules that should have a FNA performed. A combination of US characteristics with higher likelihood ratios and consequently with higher post-test probabilities of malignancy-microcalcifications, or a taller than wide shape, or irregular margins, or absence of elasticity-will probably identify nodules with an increased risk for malignancy. Further studies are required to standardize elastography techniques and evaluate outcomes, especially in nodules with an indeterminate cytology.

Emerging parameters of the insulin and glucose response on the oral glucose tolerance test: reproducibility and implications for glucose homeostasis in individuals with and without diabetes.

AIMS: Recent studies have suggested that novel parameters of the insulin and glucose response on the oral glucose tolerance test (OGTT) can provide metabolic insight beyond glucose tolerance, but have not evaluated their reproducibility. Thus, our aim was to evaluate the reproducibility of these parameters and, if confirmed, characterize their clinical/pathophysiologic relevance in healthy and diabetic individuals. METHODS: Thirty healthy adults each underwent 3 replicate OGTTs, enabling assessment of the reproducibility of the following 5 parameters: time to insulin peak, shape of the glucose curve, glucose nadir below baseline, 1-h post-challenge glucose, and time to glucose peak. The only reproducible parameter was then further evaluated in 63 patients with early type 2 diabetes (T2DM) before and after 4-weeks of intensive insulin therapy (IIT) designed to improve beta-cell function (measured by Insulin Secretion-Sensitivity-Index-2 (ISSI-2)). RESULTS: Of the five parameters, only time to glucose peak displayed reliable reproducibility on replicate testing (κ=0.76). Over 80% of controls had their glucose peak at 30-min post-load, whereas all but one of the diabetic patients had their peak at 60-min or later. ISSI-2 was lower in T2DM patients with peak at ≥90-min than in those with peak at ≤60-min (P=0.012). In patients in whom IIT improved beta-cell function by ≥20% from baseline, 39.1% had glucose peak on the post-therapy OGTT shift to an earlier timepoint, as compared to 15.4% with similar shift in those without such improvement(P=0.03). CONCLUSION: Time to glucose peak is a reproducible characteristic on the OGTT and associated with beta-cell function in early T2DM.

Determinants of reversibility of ß-cell dysfunction in response to short-term intensive insulin therapy in patients with early type 2 diabetes.

Short-term intensive insulin therapy (IIT) can improve pancreatic ß-cell function when administered early in the course of type 2 diabetes mellitus (T2DM). However, the degree of improvement in response to this therapy varies between patients. Thus, we sought to characterize the determinants of improvement in ß-cell function in response to short-term IIT in early T2DM. Sixty-three patients with mean 3.0 ± 2.1 yr duration of T2DM and Hb A1c of 6.8 ± 0.8% underwent 4 wk of IIT consisting of basal insulin detemir and premeal insulin aspart, with oral glucose tolerance test administered at baseline and 1 day post-IIT. ß-Cell function before and after IIT was assessed by Insulin Secretion Sensitivity Index-2 (ISSI-2). Reversibility of ß-cell dysfunction was defined as percentage change in ISSI-2 of ≥25%. Overall, the study population experienced an increase in ISSI-2 from baseline to post-IIT (P = 0.01), with one-third of participants achieving ≥25% improvement in ISSI-2. Compared with their peers, those with increases in ISSI-2 of ≥25% had greater decrements in fasting glucose (P < 0.0001), Hb A1c (P = 0.001), ALT (P = 0.04), AST (P = 0.02), and HOMA-IR (P < 0.0001). On logistical regression analysis, baseline Hb A1c (OR = 2.83, 95% CI 1.16-6.88, P = 0.02) and change in HOMA-IR (OR = 0.008, 95%CI 0.0004-0.16, P = 0.001) emerged as independent predictors of reversibility of ß-cell dysfunction. Indeed, reversibility of ß-cell dysfunction was achieved in only those participants in whom IIT yielded an improvement in HOMA-IR. In conclusion, decline in HOMA-IR may be a key determinant of improvement of ß-cell function in response to short-term IIT, suggesting a fundamental contribution of insulin resistance to the reversible component of ß-cell dysfunction in early T2DM.

Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: Studies have shown that, when implemented early in the course of type 2 diabetes mellitus, treatment with intensive insulin therapy for 2-3 weeks can induce a glycaemic remission, wherein patients are able to maintain normoglycaemia without any anti-diabetic medication. We thus did a systematic review and meta-analysis of interventional studies to assess the effect of short-term intensive insulin therapy on the pathophysiological defects underlying type 2 diabetes mellitus (pancreatic ß-cell dysfunction and insulin resistance) and identify clinical predictors of remission. METHODS: We identified studies published between 1950 and Nov 19, 2012, which assessed the effect of intensive insulin therapy on ß-cell function or insulin resistance, or both, or assessed long-term drug-free glycaemic remission in adults aged 18 years or older with newly diagnosed type 2 diabetes mellitus. We calculated pooled estimates by random-effects model. This study is registered with International Prospective Register of Systematic Reviews, number CRD42012002829. FINDINGS: We identified 1645 studies of which seven fulfilled inclusion criteria (n=839 participants). Five studies were non-randomised. A pooled analysis of the seven studies showed a post-intensive insulin therapy increase in Homeostasis Model Assessment of ß-cell function as compared with baseline (1·13, 95% CI 1·02 to 1·25) and a decrease in Homeostasis Model Assessment of Insulin Resistance (-0·57, -0·84 to -0·29). In the four studies that assessed glycaemic remission (n=559 participants), the proportion of participants in drug-free remission was about 66·2% (292 of 441 patients) after 3 months of follow-up, about 58·9% (222 of 377 patients) after 6 months, about 46·3% (229 of 495 patients) after 12 months, and about 42·1% (53 of 126 patients) after 24 months. Patients who achieved remission had higher body-mass index than those who did not achieve remission (1·06 kg/m(2), 95% CI 0·55 to 1·58) and lower fasting plasma glucose (-0·59 mmol/L, 95% CI -1·11 to -0·07) at baseline. INTERPRETATION: Short-term intensive insulin therapy can improve the underlying pathophysiology in early type 2 diabetes mellitus, and thus might provide a treatment strategy for modifying the natural history of diabetes. FUNDING: None.

Pituitary gland metastasis from renal cell carcinoma presented as a non-functioning macroadenoma.

Metastatic tumors involving the pituitary gland are an uncommon finding and occur in up to 1% of all pituitary tumor resections. A 74-year-old man had progressive vision deterioration, over the 30 days prior to consultation. He did not complain of headache or polyuria, but referred to intestinal constipation. Five years ago, he underwent a right radical nephrectomy for renal cell carcinoma, followed by chemotherapy and radiotherapy for lung and parotid metastases. On ophthalmologic examination, there was a left abducens nerve palsy and bitemporal hemianopia. Magnetic resonance imaging demonstrated a sellar mass with suprasellar cistern extension compressing the optic chiasm. Endocrinological evaluation revealed central adrenal and gonadal insufficiencies. The patient underwent a transsphenoidal tumor resection that revealed renal cell carcinoma. This case illustrates that metastatic pituitary lesions can mimic typical symptoms and signs of pituitary macroadenoma. Furthermore, clinical diabetes insipidus, a common finding of pituitary metastases, can be absent.

Pituitary gland metastasis from renal cell carcinoma presented as a non-functioning macroadenoma / Metástase de carcinoma de células renais para hipófise simulando macroadenoma não funcionante

Metastatic tumors involving the pituitary gland are an uncommon finding and occur in up to 1 percent of all pituitary tumor resections. A 74-year-old man had progressive vision deterioration, over the 30 days prior to consultation. He did not complain of headache or polyuria, but referred to intestinal constipation. Five years ago, he underwent a right radical nephrectomy for renal cell carcinoma, followed by chemotherapy and radiotherapy for lung and parotid metastases. On ophthalmologic examination, there was a left abducens nerve palsy and bitemporal hemianopia. Magnetic resonance imaging demonstrated a sellar mass with suprasellar cistern extension compressing the optic chiasm. Endocrinological evaluation revealed central adrenal and gonadal insufficiencies. The patient underwent a transsphenoidal tumor resection that revealed renal cell carcinoma. This case illustrates that metastatic pituitary lesions can mimic typical symptoms and signs of pituitary macroadenoma. Furthermore, clinical diabetes insipidus, a common finding of pituitary metastases, can be absent.

Metástases de neoplasias para hipófise são incomuns e ocorrem em até 1 por cento dos tumores de hipófise. Apresentamos o caso de um homem de 74 anos de idade com progressiva deterioração visual nos 30 dias que antecederam seu atendimento. Ele negava cefaleia ou poliúria e queixava-se de constipação intestinal. O paciente havia sido submetido à nefrectomia radical para carcinoma de células renais cinco anos antes, seguida de quimioterapia e radioterapia por metástases pulmonares e parotídea. Ao exame oftalmológico, apresentava paralisia do nervo abducente esquerdo e hemianopsia bitemporal. A ressonância magnética demonstrou uma massa selar com extensão suprasselar comprimindo o quiasma óptico. Na avaliação endocrinológica apresentava insuficiência adrenal e gonadal centrais. O paciente foi submetido à ressecção transesfenoidal da lesão que, ao exame anatomopatológico, se revelou como carcinoma de células renais. Esse caso demonstra que a presença de lesões metastáticas na hipófise pode mimetizar sinais e sintomas de macroadenoma não funcionante e que o diabetes insípido central, comum nas lesões metastáticas para hipófise, pode estar ausente.

Transplante de ilhotas pancreáticas humanas: revisão da literatura e implantação de um laboratório de isolamento de ilhotas pancreáticas / Human pancreatic islet transplantation: literature review and establishment of a pancreatic islet isolation laboratory

O diabetes melito tipo 1 (DM1) está associado ao desenvolvimento de complicações crônicas de elevada morbi-mortalidade em indivíduos jovens em idade produtiva. A terapia intensiva com insulina comprovadamente diminui o aparecimento das complicações crônicas da doença. Entretanto, essa terapia ainda está associada ao aumento da incidência de hipoglicemia. Em pacientes com “DM1 lábil”, os quais apresentam hipoglicemias graves sem sintomas de alerta, o transplante de ilhotas pancreáticas humanas é uma das melhores alternativas para restaurar a secreção de insulina e a percepção da hipoglicemia. Cerca de 80% dos pacientes que receberam transplante de ilhotas de mais de um doador, submetidos ao tratamento imunossupressor do protocolo de Edmonton, adquiriram independência de insulina após 1 ano do transplante. Porém, apenas 10% destes pacientes permaneceram livres de insulina após 5 anos. Entretanto, mesmo aqueles pacientes que necessitaram utilizar novamente insulina tiveram a normalização da homeostase glicêmica e da percepção da hipoglicemia, com prevenção da hipoglicemia grave. Sendo assim, o transplante de ilhotas é capaz de diminuir os níveis de glicose plasmática e HbA1c, reduzir a ocorrência de hipoglicemias graves e melhorar a qualidade de vida dos pacientes. O objetivo deste artigo foi fazer uma breve revisão da literatura sobre o isolamento e transplante de ilhotas pancreáticas humanas e relatar a implantação de um laboratório de isolamento de ilhotas humanas no Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre.

Type 1 diabetes mellitus (DM1) is associated with chronic complications of high morbidity and mortality in young adults in a productive age. Insulin therapy has proved to reduce the chronic complications of diabetes. However, this therapy is still associated to an increased incidence of hypoglycemia. In patients with “brittle DM1”, who have severe hypoglycemia without any symptoms (hypoglycemia unawareness), the pancreatic islet transplantation is one of the best alternatives for restoring insulin secretion and hypoglycemia perception. About 80% of the patients who received islet transplantation from more than one donor, on immunosuppressive treatment with the Edmonton’s protocol, maintained insulin independence 1 year after transplantation. Nevertheless, only 10% of these patients remained free of insulin after 5 years post-transplantation. However, even those patients who returned to insulin treatment had a normalization of the glucose homeostasis and hypoglycemia perception. Therefore, islet transplantation is able to diminish plasmatic glucose and HbA1c levels, to reduce the occurrence of severe hypoglycemia, and to improve the quality of life of the patients. The purpose of this paper is to briefly review islet isolation and transplantation process, and report the establishing of a human islet isolation laboratory in the Endocrine Service at Hospital de Clínicas de Porto Alegre.

Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation.

The main risk factors for the development and progression of diabetic retinopathy (DR) are chronic hyperglycemia, disease duration and systemic blood pressure. So far chronic hyperglycemia is the strongest evidence concerning the risk of developing DR. However there are some patients with poor metabolic control who never develop this diabetic complication. We present a case of a 73-year-old woman with type 1 diabetes mellitus, diagnosed 69 years ago. The patient is 73 years old, with no evidence of DR, despite poor glycemic control and several risk factors for DR. This case suggests the presence of a possible protection factor, which could be genetic.

Risk factors for micro and macrovascular disease in black and white patients with type 2 diabetes mellitus.

BACKGROUND: The prevalence of chronic complications in type 2 diabetes mellitus (DM) is higher in black patients. The reason for this finding is still unknown. The objective of this study was to analyze the micro and macrovascular risk factor profile of type 2 DM patients without advanced diabetic nephropathy according to ethnicity. METHODS: A cross-sectional multicentric regional study was conducted evaluating 780 patients. All patients were submitted to clinical and laboratory evaluation. Ethnicity was self-reported as white (n = 585) or black (n = 195). RESULTS: Black patients had lower triglycerides [115 (35-892) vs. 152 (34-1236) mg/dl; P <0.001] and higher HDL-cholesterol levels than whites (48.3 +/- 13.5 vs. 44.8 +/- 12.1 mg/dl; P = 0.002).White and black patients did not differ regarding fasting plasma glucose, A1c test, total and LDL cholesterol, blood pressure levels, insulin and HOMA-IR. There were no differences between groups regarding medication in use (statin: 18.5 vs. 19.3%, P = 1.000; fibrates: 1.5 vs. 0.7%, P = 0.680; angiotensin converting enzyme inhibitors: 39.5 vs. 43.8%, P = 0.375; acetylsalicylic acid: 29.9 vs. 27.7%, P = 0.673). CONCLUSIONS: There were no differences in the prevalence of the classic micro and macrovascular risk factors between ethnic groups. The study of non-conventional risk factors and genetic factors is essential to understand determinants of the worst outcomes presented by the African-Brazilian population.

Serum uric acid levels improve prediction of incident type 2 diabetes in individuals with impaired fasting glucose: the Rancho Bernardo Study.

OBJECTIVE: To determine whether serum uric acid predicts incident type 2 diabetes by glucose tolerance status in older community-dwelling adults. RESEARCH DESIGN AND METHODS: Participants without diabetes at baseline were evaluated for incident type 2 diabetes 13 years later. Baseline glucose tolerance status was defined as normoglycemia, impaired fasting glucose, and impaired postchallenge glucose tolerance. RESULTS: A total of 566 participants were included (mean age 63.3 +/- 8.6 years; 41% men). Regression models adjusted for age, sex, BMI, diuretic use, and estimated glomerular filtration rate showed that for each 1 mg/dl increment in uric acid levels, incident type 2 diabetes risk increased by approximately 60%. When analyses were stratified by glucose status, uric acid levels independently predicted incident type 2 diabetes among participants who had impaired fasting glucose (odds ratio 1.75, 95% CI 1.1-2.9, P = 0.02). CONCLUSIONS: Uric acid may be a useful predictor of type 2 diabetes in older adults with impaired fasting glucose.

Late afternoon blood pressure increase is associated with diabetic retinopathy in normotensive type 2 diabetes mellitus patients.

AIMS: To identify if the variability of blood pressure (BP) is associated with diabetic retinopathy (DR) in normotensive type 2 DM patients. METHODS: Sixty-five normotensive type 2 DM patients that had 24-h ambulatory BP monitoring (ABPM) were grouped according any degree of DR. RESULTS: Fourteen (21%) patients had DR. Office BP and 24-h BP parameters did not differ between groups. At late afternoon period, patients with DR had higher increment in both systolic (11.3+/-12.7mmHg vs. 1.0+/-11.4mmHg, P=0.006) and diastolic (6.7+/-8.6mmHg vs. -0.73+/-10.0mmHg, P=0.017) BP levels than those without. Multivariate logistic analyses were performed with DR as a dependent variable. Each 1mmHg increment in systolic BP at the late afternoon period was associated with a 10.2% increase in DR prevalence [OR 1.102 (CI 95% 1.011-1.202, P=0.027)], after adjustments for A1C test, DM duration, age, albuminuria and current smoking. CONCLUSIONS: In conclusion, in normotensive type 2 DM patients, BP increase at late afternoon is associated to DR independently from confounder factors or other ABPM parameters.

Risk factors for micro and macrovascular disease in black and white patients with type 2 Diabetes mellitus / Comparação de fatores de risco para complicações micro e macrovasculares em pacientes com Diabetes mellitus tipo 2 negros e brancos

BACKGROUND: The prevalence of chronic complications in type 2 diabetes mellitus (DM) is higher in black patients. The reason for this finding is still unknown. The objective of this study was to analyze the micro and macrovascular risk factor profile of type 2 DM patients without advanced diabetic nephropathy according to ethnicity. METHODS: A cross-sectional multicentric regional study was conducted evaluating 780 patients. All patients were submitted to clinical and laboratory evaluation. Ethnicity was self-reported as white (n = 585) or black (n = 195). RESULTS: Black patients had lower triglycerides [115 (35-892) vs. 152 (34-1236) mg/dl; P <0.001] and higher HDL-cholesterol levels than whites (48.3 ± 13.5 vs. 44.8 ± 12.1 mg/dl; P = 0.002).White and black patients did not differ regarding fasting plasma glucose, A1c test, total and LDL cholesterol, blood pressure levels, insulin and HOMA-IR. There were no differences between groups regarding medication in use (statin: 18.5 vs. 19.3 percent, P = 1.000; fibrates: 1.5 vs. 0.7 percent, P = 0.680; angiotensin converting enzyme inhibitors: 39.5 vs. 43.8 percent, P = 0.375; acetylsalicylic acid: 29.9 vs. 27.7 percent, P = 0.673). CONCLUSIONS: There were no differences in the prevalence of the classic micro and macrovascular risk factors between ethnic groups. The study of non-conventional risk factors and genetic factors is essential to understand determinants of the worst outcomes presented by the African-Brazilian population.

OBJETIVO: A prevalência das complicações crônicas do Diabetes mellitus (DM) é maior nos negros. A razão para esse achado é desconhecida. O objetivo desse estudo é analisar os fatores de risco para doença micro e macrovascular em pacientes com DM tipo 2 de acordo com a etnia. MÉTODOS: Foi realizado estudo transversal avaliando 780 pacientes. Todos pacientes realizaram avaliação clinico/ laboratorial. A etnia foi autoreferida em branca (n = 585) ou negra (n = 195). RESULTADOS: Os pacientes negros apresentaram níveis menores de triglicerídeos [115 (35-892) vs. 152 (34-1236) mg/dl; P <0.001] e maiores de HDL colesterol que os brancos (48.3 ± 13.5 vs. 44.8 ± 12.1 mg/dl; P = 0.002). Não houve diferença entre os grupos quanto à glicemia de jejum, teste A1c, LDL e colesterol total, níveis pressóricos, insulina e Homa-ir. Não houve diferença no uso de medicações (estatinas: 18.5 vs. 19.3 por cento, P = 1.000; fibratos: 1.5 vs. 0.7 por cento, P = 0.680; inibidores da enzima conversora da angiotensina: 39.5 vs. 43.8 por cento, P = 0.375; acido acetilsaliscílico: 29.9 vs. 27.7 por cento, P = 0.673). CONCLUSÃO: Não houve diferença na prevalência dos fatores de risco convencionais para doença micro e macrovascular entre os grupos étnicos. O estudo de fatores não-convencionais e genéticos é essencial para a elucidação dos determinantes dos piores desfechos apresentados pela população diabética afrobrasileira.

Nefropatia induzida por contraste: medidas de prevenção: [revisão] / Contrast-induced nephropathy: prevention strategies: [review]

A nefropatia do contraste é definida como piora na função renal que se segue à administração de contraste intravenoso, tendo sido excluídas outras causas. A nefropatia do contraste manifesta-se, usualmente, como uma insuficiência renal aguda não oligúrica. Por definição, deve haver um aumento na creatinina basal de 25-50% ou um aumento superior a 0,5 mg/dl em 24-48 horas após o uso intravenoso de contraste, na ausência de outras causas de piora da função renal. As medidas de prevenção são baseadas na correção dos fatores que levam ao desenvolvimento da nefropatia do contraste e dividem-se em: escolha de agentes de contraste menos nefrotóxicos (não-iônicos) e utilização de doses menores; melhora no estado clínico do paciente com hidratação; uso de drogas que reduzam vasoconstrição renal e estresse oxidativo; e suspensão temporária de drogas com potencial nefrotóxico ou prejudiciais no caso de diminuição da filtração glomerular. A instituição de um protocolo com medidas preventivas em pacientes em risco e, especialmente, em diabéticos submetidos a contraste potencialmente nefrotóxico poderá reduzir a morbidade e custos associados ao seu desenvolvimento. A presente revisão tem o objetivo de descrever a definição e patogênese de nefropatia do contraste, enfatizando as principais recomendações de manejo para prevenir sua ocorrência.

Contrast-induced nephropathy is defined as worsening in renal function after administration of intravenous contrast and exclusion of other causes. Contrast-induced nephropathy is usually manifested as an acute non-oliguric renal failure. Cases of contrast-induced nephropathy are usually defined by a fixed (0.5 mg/dl) or proportionate (25-50%) rise in serum creatinine levels 24-48 hours after exposure to the contrast medium, in the absence of other causes of renal function impairment. Prevention strategies are based on the correction of factors leading to the development of contrast-induced nephropathy and are divided into choice of less nephrotoxic contrast (non-ionic); improvement in the patient’s clinical status through hydration; use of drugs that reduce renal vasoconstriction and oxidative stress; and temporary suspension of drugs with nephrotoxic potential or that are harmful in case of reduced glomerular filtration. The development of a protocol with preventive strategies for risk patients, especially in diabetics submitted to potentially nephrotoxic contrast can reduce morbidity and associated costs to its development. This review aims at describing the definition and pathogenesis of contrast-induced nephropathy, focusing on the main management recommendations to prevent its occurrence.

Association between systemic lupus erythematosus, rheumatoid arthritis, hyperprolactinemia and thyroid autoantibodies.

BACKGROUND: Hyperprolactinemia (hyperPRL) has been associated with autoimmune rheumatic disorders and the presence of thyroid autoantibodies (tAb). The interrelation between these variables was the focus of this prospective study. METHODS: The study assessed six groups of individuals: 26 with systemic lupus erythematosus (SLE), 20 with rheumatoid arthritis (RA), 28 with tAb (tAb+), 14 with untreated hyperprolactinemia (hyperPRL), 10 with treated hyperPRL, and a control group (n = 28). Prolactin (PRL), free thyroxin, TSH, antibodies against thyroglobulin (TgAb), thyroid microsomal antigen (MsAb) and/or thyroid peroxidase (TPOAb) were determined in all patients. Those with hyperPRL had macroprolactin investigated by the polyethylene glycol (PEG) precipitation method. RESULTS: PRL (ng/mL) levels in the SLE, RA, and tAb+ groups were, respectively, 21.3 +/- 12.6, 11.5 +/- 7.4, and 12.5 +/- 8.6, and were significantly greater in the SLE group (p = 0.006) than in the controls (12.5 +/- 6.5) and in the other groups. Five patients had hyperPRL: three with SLE, one with RA, and one with tAb+. Macroprolactinemia was detected in three of the untreated hyperprolactinemic patients and in the hyperprolactinemic patient of the tAb+ group. Positivity for any of the tAb was 15% in the SLE, 15% in the RA, 57.1% in the untreated hyperPRL, 10% in the hyperPRL on treatment, and 3.6% in the control group. The presence of antibodies was significantly more frequent in the untreated hyperPRL group than in the control group (p = 0.001). CONCLUSIONS: The results indicate that the PRL level is higher in SLE patients and that in the presence of hyperPRL there is increased prevalence of antithyroid antibodies, evidencing the association of PRL and autoimmunity and pointing to the appropriateness of assessing and monitoring the progress of these markers in patients affected by these disorders.

A erradicação do Helicobacter pylori em pacientes com úlcera duodenal provoca maior incidência de esofagite de refluxo? / Does eradication of helicobacter pylori in patients with duodenal ulcer cause higher incidence of reflux esophagitis?

Os autores propuseram-se avaliar a relação entre a erradicação do helicobacter pylori (HP) em pacientes com úlcera duodenal (UD) e o desenvolvimento de esofagite de refluxo. Para tanto, avaliaram prospectivamente, com duas endoscopias realizadas com intervalo de seis meses cada, 29 pacientes comUD e Hp positivo, tratados com esquema tríplice de antibióticos. No final do seguimento de 12 meses observou-se incidência de esofagite péptica em 25por cento dos casos. Concluiu-se, a despeito do pequeno número de casos e do curto seguimento, que a incidência de esofagite endoscópica é elevada em pacientes com UD após tratamento eo HP.