Oral condition as a predictor of risk for malnutrition during hospitalization: A cross-sectional study.

BACKGROUND: Malnutrition and poor oral health are common conditions in patients in the hospital. Both conditions are associated with poor systemic health. The present study aimed to assess the relationship between the oral condition and the nutrition status of individuals admitted to a large tertiary hospital. METHODS: This cross-sectional study evaluated 364 patients who received a comprehensive dental examination at their hospital bed. An examiner recorded visible plaque index, gingival bleeding index, plaque retentive factors, probing depth, clinical attachment loss, bleeding on probing, number of existing teeth, and prosthesis use. Medical status was assessed by the Charlson Comorbidity Index. The nutrition status was evaluated by the Subjective Global Assessment. Crude and adjusted prevalence ratios were estimated by Poisson regression analysis with robust variance. RESULTS: Patients with moderate to severe malnutrition presented worse oral hygiene (55.83 ± 25.16 vs 64.90 ± 24.28; P < 0.001), more gingival inflammation (24.31 ± 24.13 vs 33.43 ± 27.36; P < 0.001), higher levels of attachment loss (4.22 ± 1.81 vs 4.80 ± 1.83; P < 0.001), and a lower mean number of teeth (14.58 ± 7.45 vs 10.94 ± 6.85; P < 0.001) than patients without malnutrition. In the multivariable analysis, the number of teeth and higher comorbidity index were associated with malnutrition. CONCLUSIONS: Poor oral health and medical condition were associated with malnutrition in this single-institution study, and oral condition may be considered an indicator of malnutrition in patients in the hospital. The implications of this study include the need to raise awareness among health professionals of the importance of oral health and nutrition status in adults.

Newest Diabetes-Related Technologies for Pediatric Type 1 Diabetes and Its Impact on Routine Care: a Narrative Synthesis of the Literature.

Purpose of Review: This review aims to address the actual state of the most advanced diabetes devices, as follows: continuous subcutaneous insulin infusions (CSII), continuous glucose monitoring systems (CGM), hybrid-closed loop (HCL) systems, and "Do-it-yourself" Artificial Pancreas Systems (DIYAPS) in children, adolescents, and young adults. This review has also the objective to assess the use of telemedicine for diabetes care across three different areas: education, social media, and daily care. Recent Findings: Recent advances in diabetes technology after integration of CSII with CGM have increased the popularity of this treatment modality in pediatric age and shifted the standard diabetes management in many countries. We found an impressive transition from the use of CSII and/or CGM only to integrative devices with automated delivery systems. Although much has changed over the past 5 years, including a pandemic period that precipitated a broader use of telemedicine in diabetes care, some advances in technology may still be an additional burden of care for providers, patients, and caregivers. The extent of a higher rate of "auto-mode" use in diabetes devices while using the HCL/DIYAPS is essential to reduce the burden of diabetes treatment. Summary: More studies including higher-risk populations are needed, and efforts should be taken to ensure proper access to cost-effective advanced technology on diabetes care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-021-00248-7.

Pens versus syringes to deliver insulin among elderly patients with type 2 diabetes: a randomized controlled clinical trial.

BACKGROUND: Diabetes mellitus (DM) is a prevalent disease among elderly population. As the disease progresses, insulin may become necessary. The use of pens application seems to be more practical. However, the influence of this method on glycemic control needs to be defined in elderly people. METHODS: Randomized clinical trial comparing pens and syringes for insulin application among patients with type 2 DM over 60 years old and Glycated Hemoglobin > 8.5% at baseline. The follow-up was 24 weeks, with monthly medical visits to adjust the treatment. All patients received insulin NPH and, if necessary, insulin Regular. We assessed glycemic control, adherence to treatment, hypoglycemia occurrence, need for adjustment in treatment and impact on quality of life, RESULTS: We included 121 patients with mean age of 65.75 years. Sixty-one were randomized for pen group (PG) and 60 patients for syringe group (SG). At baseline, mean HbA1c was 10.34 ± 1.66% and 9.90 ± 1.25% (p = 0.103) in PG and SG respectively. Mean HbA1c was 8.39 ± 1.28% in PG and 8.85 ± 1.74% in SG (p = 0.101) at 24 weeks. However, there was a more significant reduction in PG (- 1.94 ± 1.93% in PG and - 1.04 ± 1.46% in SG, p < 0.05) during follow-up. We found no difference in treatment adherence rates, hypoglycemia, greater need for insulin doses or oral medication, and progression to basal-bolus insulin scheme. We also found no difference in the impact of the disease on quality of life between groups. CONCLUSION: Although we did not find any difference in the impact on quality of life, frequency of hypoglycemia or adherence, the PG showed a reduction in HbA1c higher in 24 weeks of follow-up. CLINICAL TRIAL REGISTRATION: NCT02517242.

Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis.

AIMS: Systematic review and meta-analysis to evaluate the effect of Self-Monitoring of Blood Glucose (SMBG) on glycemic control in patients with type 2 Diabetes (T2D). METHODS: We searched the Medline, Embase, Cochrane Central, and ClinicalTrials.gov databases up to 20 July 2017. We also performed a manual search of abstracts from recent meetings of the American Diabetes Association and the European Association for the Study of Diabetes. STUDY SELECTION: randomized controlled trials (RCTs) conducted in patients with T2D comparing any kind of SMBG to a control group. Two independent reviewers assessed the eligibility of references. Influence of SMBG in glycated hemoglobin (HbA1c) was aggregated as weighted mean difference accessed by direct random effect meta-analyses at 12, 24 weeks and 1 year. Sub-analyses were made to assess the effects of previous glycemic control and number of tests performed. RESULTS: SMBG was associated with a reduction of HbA1c at 12 weeks (-0.31%; 95% CI: -0.57 to -0.05) and 24 weeks (-0.34%; 95%CI: -0.52 to -0.17), but no difference was found for 1 year. Subgroup analysis including studies with baseline HbA1c greater than 8% showed a higher reduction of HbA1c: -0.83% (95% CI: -1.55 to -0.11) at 12 weeks, and -0.48% (95% CI: -0.77 to -0.19) at 24 weeks, with no difference for 1 year nor for the stratification for number the tests. CONCLUSION: SMBG seems to lead to a slightly better glycemic control in the short term in patients with T2D. Patients decompensated at baseline appear to have the greatest benefit. PROSPERO register: CRD42016033558.

A comparative study of the anatomy of adipose tissue in areas with and without raised lesions of cellulite using magnetic resonance imaging.

BACKGROUND: Cellulite is considered a noninflammatory phenomenon characterized by alterations to the skin surface, with depressed and raised lesions. Few studies have evaluated subcutaneous fat in patients with cellulite, and there is no information about the anatomy of raised lesions. METHODS: Sixty women with raised cellulite lesions were evaluated using magnetic resonance imaging (MRI). Cellulite grade was evaluated using the Cellulite Severity Scale (CSS). Raised cellulite lesions were marked and compared with control areas on the opposite side of the body (buttocks, abdomen, and upper thighs). RESULTS: Mean age was 39.3 ± 11.0 years and average body mass index (BMI) was 25.4 ± 4.1 kg/m(2) . There were no differences between the raised lesions and the control areas in the anatomy of the fat lobes and their size. CSS scores were higher in older patients and in those with higher BMI. Patients with higher BMI had more fat lobes. CONCLUSIONS: The anatomy of subcutaneous fat was similar in raised and control areas for shape, size, and thickness. Higher CSS scores were found in older patients and those with higher BMI.

Avaliação dos aspectos psicológicos, psiquiátricos e comportamentais de pacientes com celulite: estudo-piloto / Assessment of psychological, psychiatric, and behavioral aspects of patients with cellulite: a pilot study

Introdução: Cerca de 50% da população refere algum tipo de insatisfação com a aparência. Os hábitos comportamentais que motivam os pacientes a procurar tratamentos cosméticos ainda não estão completamente entendidos. Objetivos: Avaliar os aspectos comportamentais, psicológicos e psiquiátricos de pacientes com celulite. Métodos: Estudo transversal observacional descritivo. Na primeira etapa, 46 voluntárias responderam a questionário autoaplicável e, na segunda etapa, um psiquiatra aplicou o questionário Mini. Resultados: A maioria das entrevistadas referiu o início das lesões de celulite após o início da puberdade. Os ambientes que mais causaram desconforto quanto à celulite foram praia (87%) e piscina (67,4%). Quase metade das pacientes referiu já ter recebido algum tipo de comentário constrangedor em razão da sua celulite e 78,3% delas sentem-se pressionadas a procurar tratamentos. Distúrbios de alimentação apresentados incluíram uso de drogas, ingestão compulsiva de alimentos, culpa após as refeições e indução de vômitos. O transtorno emocional específico mais encontrado foi ansiedade generalizada. Conclusões: Pacientes com celulite podem apresentar desconforto emocional e sentimentos negativos em situações comuns do dia a dia. Alterações em hábitos comportamentais específicos e presença de comorbidades psicológicas ou psiquiátricas podem estar presentes em algumas pacientes.

Introduction: About 50% of the population reports some kind of dissatisfaction related to their physical appearance. Patients' motivations for seeking cosmetic treatment are not yet fully understood. Objectives: To evaluate the behavioral, psychological, and psychiatric characteristics of patients with cellulite. Methods: In the first phase of this cross-sectional, descriptive and observational study, forty-six volunteers answered a self-administered questionnaire. In the second phase, a psychiatrist administered the M.I.N.I. questionnaire. Results: Most interviewees described the forthcoming of cellulite during puberty. Discomfort caused by cellulite was mainly felt at the beach (87%) and pool (67,4%). Almost half of patients reported having been subject to an embarrassing comment related to their cellulite, while 78.3% felt pressure to seek treatment. The eating disorders described included the use of drugs, compulsive ingestion of food, feeling guilty after eating, and self-induced vomiting. The most frequently found specific emotional disorder was generalized anxiety. Conclusions: Patients with cellulite can experience emotional distress and negative feelings in everyday situations. Changes in specific behaviors and the presence of psychological and psychiatric comorbidities can be present in some patients.

Hypertension-related factors in patients with active and inactive acromegaly.

INTRODUCTION: There are several complications of the cardiovascular system caused by acromegaly, especially hypertension. OBJECTIVES: To evaluate hypertension characteristics in patients with cured/controlled acromegaly and with the active disease. PATIENTS AND METHODS: Cross-sectional study of the follow-up of forty-four patients with acromegaly submitted to clinical evaluation, laboratory tests and cardiac ultrasound. Patients with cured and controlled disease were evaluated as one group, and individuals with active disease as second one. RESULTS: Forty-seven percent of the patients had active acromegaly, and these patients were younger and had lower blood pressure levels than subjects with controlled/cured disease. Hypertension was detected in 50% of patients. Subjects with active disease showed a positive correlation between IGF-1 and systolic and diastolic blood pressure levels (r = 0.48, p = 0.03; and r = 0.42, p = 0.07, respectively), and a positive correlation between IGF-1 and urinary albumin excretion (UAE) rates. In patients with active disease, IGF-1 was a predictor of systolic blood pressure, although it was not independent of UAE rate. For individuals with cured/controlled disease, waist circumference and triglycerides were the predictors associated with systolic and diastolic blood pressure. CONCLUSIONS: Blood pressure (BP) levels in patients with active acromegaly dependent of the GH excess. However, once thedisease becomes controlled and IGF-1 levels decrease, their blood pressure levels are depend on the other cardiovascular riskfactors [corrected].

Diabetes mellitusin a cohort of patients with acromegaly / Diabetes melito em uma coorte de pacientes com acromegalia

OBJECTIVES: To evaluate the presence of diabetes mellitus (DM) in a cohort of patients with acromegaly. METHODS: This was a cross sectional study. RESULTS: Fifty-eight acromegalic patients were assessed. Only 29 percent met the criteria for cure, and 27 percent had the disease controlled. Twenty-two had DM; HbA1c was equal to 7.34 ± 2.2 percent. Most of the diabetic patients (18 out of 22, 82 percent) did not meet criteria for cure. They were more often hypertensive [16/22 (73 percent) vs. 17/36 (46 percent), p = 0.04], and used statins more frequently [14/22 (64 percent) vs. 8/36 (21 percent), p = 0.004]. After regression analysis, hypertension was associated with diabetes [odds ratio (OR): 9.28 (95 percent CI: 1.59 - 54.00), p = 0.01], and cured/ controlled acromegaly was associated with protection against the presence of diabetes [OR: 0.17 (95 percent CI: 0.03 - 0.78), p = 0.02]. CONCLUSIONS: The presence of DM was associated with active acromegaly and presence of hypertension. However, absolute levels of GH and IGF-1 did not differ between patients with and without diabetes.

OBJETIVOS: Avaliar a presença de diabetes melito (DM) em uma coorte de acromegálicos. MÉTODOS: Este é um estudo transversal. RESULTADOS: Cinquenta e oito pacientes acromegálicos foram analisados. Apenas 29 por cento preencheram critérios de cura e 27 por cento estavam com a doença controlada. Vinte e dois pacientes (38 por cento) apresentaram DM, HbA1c 7,34 ± 2,2 por cento. Destes, 18 não preencheram critérios de cura. Pacientes com DM foram mais frequentemente hipertensos [16/22 (73 por cento) vs. 17/36 (46 por cento), p = 0,04] e usavam mais estatina [14/22 (64 por cento) vs.8/36 (21 por cento), p = 0,004]. Após regressão múltipla, hipertensão foi associada a DM [razão de chances (RC): 9,28 (95 por cento CI: 1,59 - 54,00), p = 0,01], e acromegalia curada/controlada foi fator protetor para presença de diabetes [OR: 0,17 (95 por cento CI: 0,03-0,78), p = 0,02]. CONCLUSÕES: A presença de DM esteve associada com acromegalia ativa e com a presença de hipertensão. No entanto, os níveis absolutos de GH e IGF-1 não diferiram entre aqueles com e sem diabetes.

Hypertension-related factors in patients with active and inactive acromegaly / Fatores implicados com a hipertensão em pacientes com acromegalia ativa e inativa

INTRODUCTION: There are several complications of the cardiovascular system caused by acromegaly, especially hypertension. OBJECTIVES: To evaluate hypertension characteristics in patients with cured/controlled acromegaly and with the active disease. PATIENTS AND METHODS: Cross-sectional study of the follow-up of forty-four patients with acromegaly submitted to clinical evaluation, laboratory tests and cardiac ultrasound. Patients with cured and controlled disease were evaluated as one group, and individuals with active disease as second one. RESULTS: Forty-seven percent of the patients had active acromegaly, and these patients were younger and had lower blood pressure levels than subjects with controlled/cured disease. Hypertension was detected in 50 percent of patients. Subjects with active disease showed a positive correlation between IGF-1 and systolic and diastolic blood pressure levels (r = 0.48, p = 0.03; and r = 0.42, p = 0.07, respectively), and a positive correlation between IGF-1 and urinary albumin excretion (UAE) rates. In patients with active disease, IGF-1 was a predictor of systolic blood pressure, although it was not independent of UAE rate. For individuals with cured/controlled disease, waist circumference and triglycerides were the predictors associated with systolic and diastolic blood pressure. CONCLUSIONS: Our findings suggest that blood pressure levels in patients with active acromegaly are very similar, and depend on excess GH. However, once the disease becomes controlled and IGF-1 levels decrease, their blood pressure levels will depend on the other cardiovascular risk factors.

INTRODUÇÃO: Existem várias complicações no sistema cardiovascular causadas pela acromegalia, especialmente a hipertensão. OBJETIVOS: Avaliar as características da hipertensão em pacientes com acromegalia curada/controlada e com doença ativa. PACIENTES E MÉTODOS: Estudo transversal com 44 pacientes com acromegalia seguidos em nosso serviço. Eles foram submetidos a avaliação clínica, exames laboratoriais e ecocardiograma. Pacientes com doença curada/controlada foram avaliados como um grupo único e os indivíduos com doença ativa como outro grupo. RESULTADOS: Quarenta e sete por cento dos pacientes apresentaram acromegalia ativa. Esses indivíduos foram mais jovens e apresentaram níveis mais baixos de pressão arterial que os indivíduos com doença controlada/curada. A hipertensão foi detectada em 50 por cento da amostra. Indivíduos com doença ativa mostraram uma correlação positiva entre os níveis de IGF-1 e os níveis de pressão arterial sistólica e de pressão arterial diastólica (r = 0,48, p = 0,03; e r = 0,42, p = 0,07, respectivamente) e também apresentaram uma correlação positiva entre IGF-1 e excreção urinária de albumina (EUA). Em pacientes com doença ativa, o IGF-1 foi um preditor da pressão arterial sistólica, embora não tenha sido independente da taxa de EUA. Para indivíduos com doença curada/controlada, a circunferência da cintura e os triglicérides foram os preditores associados aos níveis de pressão arterial sistólica e diastólica. CONCLUSÕES: Nossos resultados sugerem que os níveis pressóricos em pacientes com acromegalia ativa dependem do excesso de GH. No entanto, uma vez que a doença torna-se controlada e os níveis de IGF-1 reduzem, os níveis de pressão arterial dependerão de outros fatores de risco cardiovasculares.

Diabetes mellitus in a cohort of patients with acromegaly.

OBJECTIVES: To evaluate the presence of diabetes mellitus (DM) in a cohort of patients with acromegaly. METHODS: This was a cross sectional study. RESULTS: Fifty-eight acromegalic patients were assessed. Only 29% met the criteria for cure, and 27% had the disease controlled. Twenty-two had DM; HbA1c was equal to 7.34 ± 2.2%. Most of the diabetic patients (18 out of 22, 82%) did not meet criteria for cure. They were more often hypertensive [16/22 (73%) vs. 17/36 (46%), p = 0.04], and used statins more frequently [14/22 (64%) vs. 8/36 (21%), p = 0.004]. After regression analysis, hypertension was associated with diabetes [odds ratio (OR): 9.28 (95% CI: 1.59 - 54.00), p = 0.01], and cured/ controlled acromegaly was associated with protection against the presence of diabetes [OR: 0.17 (95% CI: 0.03 - 0.78), p = 0.02]. CONCLUSIONS: The presence of DM was associated with active acromegaly and presence of hypertension. However, absolute levels of GH and IGF-1 did not differ between patients with and without diabetes.

Family history of type 2 diabetes is associated with metabolic syndrome in obese female subjects / História familiar de diabetes tipo 2 está associada com síndrome metabólica em indivíduos obesos do sexo feminino

The aim of this study was to evaluate the association between the family history (FH) of type 2 diabetes and metabolic syndrome (MetS) in a group of non-diabetic obese female subjects. A cross-sectional study was conducted in 239 female patients with obesity, regularly attending the Internal Medicine Division’s outpatient clinic (Hospital de Clínicas de Porto Alegre, Brazil). The inclusion criteria were patients with body mass index /30 kg/m2 and absence of type 2 diabetes. The FH was considered positive if a first degree relative had a diagnosis of diabetes. Seventy-four of 239 patients evaluated (30%) had a positive FH for type 2 diabetes. Patients with positive FH had higher waist/hip ratio and MetS more often than patients with negative FH. FH of type 2 diabetes was associated with MetS in this sample of nondiabetic obese female patients. Waist/hip ratio and fasting plasma glucose, markers of insulin resistance, were also associated with FH of type 2 diabetes. The simple question: “Do you have a FH of type 2 diabetes?” may help to identify the obese patients that should be better evaluated and intensively treated with the objective of preventing type 2 diabetes.

O objetivo deste estudo foi avaliar a associação entre história familiar (HF) de diabetes melito tipo 2 (DM2) e síndrome metabólica (SM) em um grupo de mulheres obesas não-diabéticas. Conduzimos um estudo transversal com 239 mulheres com obesidade, regularmente atendidas no ambulatório de medicina interna do Hospital de Clínicas de Porto Alegre, Brasil. Os critérios de inclusão foram pacientes com índice de massa corporal /30 kg/m2 e ausência de DM2. A HF de DM2 foi considerada positiva se um familiar de primeiro grau tivesse o diagnóstico de diabetes. Setenta e quatro das 239 pacientes avaliadas (30%) tiveram uma HF positiva de DM2. Pacientes com HF positiva tiveram maior razão cintura/quadril e mais frequentemente a presença de SM que as pacientes com HF negativa. A HF de DM2 foi associada com SM nesta amostra de pacientes femininas obesas não-diabéticas. A razão cintura/quadril e a glicemia de jejum, ambos marcadores de resistência à ação da insulina, foram também associadas com HF de DM2. A simples pergunta: “Você tem uma HF de DM2”? pode ajudar a identificar pacientes obesos que devem ser mais bem avaliados e intensamente tratados com o objetivo de prevenção do DM2.