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1.
J Diabetes Sci Technol ; : 1932296821997179, 2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-33686874

RESUMEN

BACKGROUND: HbA1c result provide information on metabolic control in diabetes mellitus (DM) and could also be used for its diagnosis. For its determination, the laboratory must be certified by the National Glycohemoglobin Standardization Program (NGSP) or the International Federation of Clinical Chemistry (IFCC) and comply with a strict quality control program. AIMS: To determine the correlation and agreement between HbA1c results measured by three analytical methods (enzymatic, turbidimetric, and capillary electrophoresis) versus HPLC. METHODS: Method comparison-1245 samples from equal number of subjects at 45 Association of High Complexity Laboratories (Asociación de Laboratorios de Alta Complejidad-ALAC) centers, centralizing sample processing and operator. Statistical analysis-analysis of variance (ANOVA) and nonparametric Friedman ANOVA test for related samples, means, and medians. Correlation and concordance-Pearson's correlation and linear regression, intraclass correlation coefficient (Passing and Bablock and Bland and Altman). RESULTS: The comparison of mean values obtained by the four methods showed statistically significant, but clinically irrelevant, differences: HbA1c by HPLC versus Electrophoresis 0.06% (0.42 mmol/mol) P = .000 (± 1.96 DS -0.070 -0.047), Enzymatic 0.087% (1 mmol/mol) P = .000 (± 1.96 DS 0.077 0.098), Turbidimetric 0.056% (0.38 mmol/mol) P = 0.000 (± 1.96 DS -0.067 -0.044). Their concordance showed intraclass correlation of single measures of 0.982 P < .001 (95% CI 0.987 - 0.9838). CONCLUSIONS: The three methods present low variability and high correlation versus the HPLC.

3.
Curr Clin Pharmacol ; 2020 09 10.
Artículo en Inglés | MEDLINE | ID: mdl-32914719

RESUMEN

BACKGROUND: Monogenic diabetes (MFD) represents close to 2% of all the cases of dia- betes diagnosed in people younger than 45 years old. Maturity-onset diabetes of the young (MODY), neonatal diabetes, and several syndromic forms of diabetes are included among the most accounts for about typical forms of MDF. MODY is the most frequent type of MFD, with MODY 1, 2, 3, and 5 being the most prevalent forms. The aim of this narrative review is to describe preg- nancy associated changes in the pharmacological profile of the antidiabetic drugs used in women with the most frequent MODY subtypes. METHODS: A comprehensive literature search was carried out to identify eligible studies from MED- LINE/PubMed, EMBASE, and SCIELO databases from 1970 to 2019 first semester. RESULTS: Pregnancy introduces changes in the pharmacodynamic and pharmacokinetic profile of some of the treatments used in MODY. MODY 3 (also known as HNF1-A MODY) is the most fre- quent MDF. MODY 3 patients are highly sensitive to sulfonylureas (SU). This is also the case for MODY pregnant women. This high sensitivity to SU is also registered in patients with MODY 1 (HNF4-A MODY). Pharmacodynamic changes have been proposed to explain this behavior (E- pac2 hyperactivity). However, changes in expression/activity of the metabolizing CYP2C9 cy- tochrome and/or alterations in the drug transporters oatp1 (Slc21a1), Lst-1 (Slc21a6), OATPD (SL- C21A11), and oat2 may better explain, at least in part, this phenomenon by an increase in the con- centration of the active drug. CONCLUSION: The impact of changes in the pharmacological behavior of drugs like SU and other metabolized/transported by mechanisms altered in a pregnancy complicated by MODY is un- known. However, switching-to-insulin recommendation formulated for MODY 1 and 3 seems to be justified. Further research in this field is needed for a better understanding of changes in drug ac- tivity associated with this particular subset of patients with MFD.

4.
Artículo en Inglés | MEDLINE | ID: mdl-32477265

RESUMEN

Proteins to be secreted through so-called "conventional mechanisms" are characterized by the presence of an N-terminal peptide that is a leader or signal peptide, needed for access to the endoplasmic reticulum and the Golgi apparatus for further secretion. However, some relevant cytosolic proteins lack of this signal peptides and should be secreted by different unconventional or "non-canonical" processes. One form of this unconventional secretion was named secretory autophagy (SA) because it is specifically associated with the autophagy pathway. It is defined by ATG proteins that regulate the biogenesis of the autophagosome, its representative organelle. The canonical macroautophagy involves the fusion of the autophagosomes with lysosomes for content degradation, whereas the SA pathway bypasses this degradative process to allow the secretion. ATG5, as well as other factors involved in autophagy such as BCN1, are also activated as part of the secretory pathway. SA has been recognized as a new mechanism that is becoming of increasing relevance to explain the unconventional secretion of a series of cytosolic proteins that have critical biological importance. Also, SA may play a role in the release of aggregation-prone protein since it has been related to the autophagosome biogenesis machinery. SA requires the autophagic pathway and both, secretory autophagy and canonical degradative autophagy are at the same time, integrated and highly regulated processes that interact in ultimate cross-talking molecular mechanisms. The potential implications of alterations in SA, its cargos, pathways, and regulation in human diseases such as metabolic/aging pathological processes are predictable. Further research of SA as potential target of therapeutic intervention is deserved.

5.
Expert Opin Pharmacother ; 20(8): 939-947, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30882259

RESUMEN

INTRODUCTION: The obesity epidemic continues to grow. Bariatric surgery is part of the arsenal to treat the disease. Surgery results in an effective option for patients with severe obesity but also when obesity is associated with significant comorbidities. Weight regain is frequent after bariatric surgery. Consequently, the addition of anti-obesity drugs to prevent and manage weight regain are commonly recommended even when the quality of the evidence supporting this recommendation is relatively weak. cfsda65 AREAS COVERED: The aim of this review is to summarize the available evidence concerning long-term pharmacotherapy of obesity in patients that have undergone bariatric surgery with a focus on pharmacological prevention and management of weight regain. The etiology and epidemiology of weight regain are summarized, as well as the available information about the benefits and risks of long-term pharmacotherapy in the prevention and management of recidivism. EXPERT OPINION: The available information, mainly obtained from observational studies and small trials, is encouraging but calls for a prudent approach in the selection of appropriate agents for each individual patient and a careful follow-up to detect adverse reactions or drug interactions. Results from well-designed trials are upcoming. In the meantime, a cautious, individualized approach is advisable.


Asunto(s)
Fármacos Antiobesidad/uso terapéutico , Cirugía Bariátrica/métodos , Obesidad/tratamiento farmacológico , Humanos , Obesidad/cirugía , Obesidad Mórbida/tratamiento farmacológico , Obesidad Mórbida/cirugía , Aumento de Peso/efectos de los fármacos
6.
Glob Pediatr Health ; 6: 2333794X18821942, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30671496

RESUMEN

The objective of this study was to assess the association between vitamin D and cardiometabolic markers in 2 indigenous communities from similar ethnic backgrounds, but living at different altitudes. A cross-sectional study compared 152 (72 females) indigenous schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 175 (86 females) from Chicoana (CH), 1400 m above sea level, mean age 9 years. Anthropometry, blood pressure, lipids, glucose, insulin, and vitamin D were assessed in spring season. The prevalence of children's overweight/obesity was significantly lower in SAC, 9.2% (13), than in CH, 41.5% (71). There was a significantly higher prevalence of vitamin D deficiency (<20 ng/mL) in SAC (n = 103, 67.7%) than in CH (n = 62, 36.3%). SAC showed an inverse correlation between vitamin D and insulinemia (r = -0.17, P < .05), whereas CH showed an inverse correlation between vitamin D and systolic blood pressure (r = -0.19, P < .05), z-BMI (body mass index; r = -0.25, P < .01), triglycerides (r = -0.15, P < .05), glucose (r = -0.35, P < .05), and insulinemia (r = -0.24, P < .01). Multiple linear regression analysis showed that vitamin D (ß = -.47; R 2 = .21) was significantly associated with SAC location, adjusted for confounding variables. Vitamin D levels were significantly and directly associated with altitude and inversely with metabolic markers, suggesting that populations living at high altitudes are at higher risk for future cardiovascular diseases.

7.
Appl Physiol Nutr Metab ; 44(6): 659-664, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30444642

RESUMEN

The objective was to compare blood pressure (BP) levels in 2 groups of Indigenous Argentine school children from similar ethnic backgrounds but living at different altitudes. One hundred and fifty-two (46.3%) children (age, 4-14 years) from San Antonio de los Cobres (SAC), at 3750 m above sea level, and 176 children (53.7%) from Chicoana (CH), at 1400 m above sea level, participated in this cross-sectional study. Data for children's anthropometry, BP, glucose, lipids, vitamin D, and insulin, as well as mothers' height and weight were assessed. Hypertension was defined as BP ≥ 95th percentile. The prevalence of overweight/obesity among children was significantly lower in SAC (n = 17, 11.2%) than in CH (n = 74, 42%) (body mass index (BMI) > 85th percentile per US Centers for Disease Control and Prevention norms). However, the prevalence of hypertension was significantly higher among children in SAC (n = 15, 9.9%) than among those in CH (n = 2, 1.1%). Children were divided into 4 groups by mean arterial BP quartiles for comparison by ANOVA. As mean arterial BP increased, age, BMI, glucose, triglycerides, triglycerides/high-density lipoprotein cholesterol, and insulin levels increased significantly. Multiple linear regression analyses showed that children's mean arterial BP was significantly associated with altitude adjusted for confounding variables (R2 = 0.42). Furthermore, when mean arterial BP was replaced by systolic BP (R2 = 0.51) or diastolic BP (R2 = 0.33), similar results were obtained. Our results suggest that Indigenous children who live permanently at high altitude have higher levels of BP, adjusted for confounding variables. Routine BP measurements conducted in the SAC community could be essential for the prevention of cardiovascular disease.


Asunto(s)
Altitud , Presión Sanguínea , Grupos Étnicos , Adolescente , Antropometría , Argentina/etnología , Índice de Masa Corporal , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Masculino
8.
Rev. Soc. Argent. Diabetes ; 53(supl.3): 127-138, sept-dic 2019. tab
Artículo en Español | LILACS | ID: biblio-1103236

RESUMEN

Introducción: la incidencia de diabetes mellitus tipo 1 (DM1) aumentó en los últimos años en varias regiones del mundo. Los Estudios Diabetes Mondiale (DiaMond), Europa y Diabetes (EURODIAB) fueron fundamentales para monitorizar el desarrollo de incidencia de DM1 en niños al propiciar pruebas sobre tendencias y prevalencia mundiales. En el Estudio DiaMond, en la provincia de Corrientes, se halló una incidencia de 4,3/100.000 (2,21-7,51) entre los años 1990 a 1999. Objetivos: determinar la incidencia de DM1 en niños <15 años en la provincia de Corrientes entre el 1º de enero de 2009 y el 31 de diciembre de 2016, según edad, sexo y residencia; comparar con el período 1990-1999; calcular la tasa de incidencia 2009-2016; analizar la presencia de factores de riesgo económicos, psicosociales y ambientales. Materiales y métodos: registro de casos de DM1 con población <15 años, que debutó con DM1, entre el 1º de enero de 2009 y el 31 de diciembre de 2016, a través de una ficha epidemiológica. La fuente primaria fueron datos de registros de médicos especializados en diabetes, endocrinólogos y pediatras, y las fuentes secundarias se tomaron de los registros de entrega de insulinas de hospitales, obras sociales y de la Asociación Correntina de Ayuda al Diabético. El método de captura-recaptura se empleó para establecer el grado de eficiencia y estimar el número de casos incidentes. Se calculó la incidencia anual cada 100.000 habitantes en riesgo, agrupados en tres categorías por edad (0-4, 5-9, 10-14). Resultados: casos estimados 104 (IC95% 100-108). Incidencias 6,0/100.000 2009; 2,3/100.000 2010; 3,71/100.000 2011; 3,75/100.000 2012; 5,82/100.000 2013; 5,2/100.000 2014; 2,7/100.000 2015; 5,5/100.000 2016; incidencia general por año 4,4/100.000. Conclusiones: la tasa calculada entre 2009-2016 de 4,4/100.000 fue similar al período 1990-1999 de 6/100.000 y se mantuvo en el rango de tasa intermedia 5-9,99 por 100.000/año


Introduction: Diabetes Mondiale, Europe and Diabetes studies were fundamental to monitor the development of incidence of type 1 diabetes mellitus (DM1) in children, providing evidence on global trends and prevalence, in the Province of Corrientes was found an incidence 4.3/100,000 (2.21-7.51). Objectives: to determine the incidence of DM1 in children <15 years old in the Province of Corrientes between January 1, 2009 and December 31, 2016, according to age, sex and residence; compare with the period 1990-1999, calculate incidence rate 2009 and 2016; analyze the presence of economic, psychosocial and environmental risk factors. Materials and methods: registry of cases of DM1 with population <15 years, which debuted with DM1, between January 1, 2009 and December 31, 2016 through an epidemiological record, being primary source of data records of diabetologists, endocrinologists and pediatricians; secondary sources records of delivery of insulins from hospitals, social eorks and Correntina Association of Diabetic Aid. The capture-recapture method was used to establish the degree of efficiency and estimate the number of incident cases. The annual incidence per 100,000 inhabitants at risk was calculated, grouped into three age categories (0-4, 5-9, 10-14). Results: estimated cases 104 (95%CI 100-108). Incidences 6.0/100,000 2009; 2.3/100,000 2010; 3.71/100,000 2011; 3.75/100,000 2012; 5.82/100,000 2013; 5.2/100,000 2014; 2.7/100,000 2015; 5.5/100,000 2016; general incidence per year 4.4/100,000. Conclusions: the calculated rate between 2009-2016 of 4.4/100,000 was similar to the period 1990-1999 of 6/100,000, keeping in the range of intermediate rate 5-9.99 per 100,000/year


Asunto(s)
Población , Menores , Diabetes Mellitus Tipo 1
9.
Curr Clin Pharmacol ; 13(1): 21-27, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29577863

RESUMEN

BACKGROUND: The liver is the major metabolic clearance organ for chemical agents from the human body. Pregnancy is associated with several physiological changes that may affect one or more of these factors, and also induces changes in the hepatic clearance of certain drugs. The aim of this paper was to review some of the currently available information in the field to provide some insights about the relevance of these changes on the clearance of some drugs. METHODS: A comprehensive literature search was carried out to identify eligible studies from MEDLINE/PubMed, EMBASE and SCIELO databases through 1970 first semester. RESULTS: Gestational Diabetes Mellitus (GDM) is a frequent disease commonly associated with other entities as obesity, hypertension, dyslipidemia, non-alcoholic fatty liver disease, prothrombotic conditions, changes in intestinal microbiome. These entities, together with the glycemic fluctuations associated with GDM might affect the determinants of the hepatic clearance (hepatic blood flow, the unbound fraction of drugs, and the hepatic intrinsic clearance). GDM is frequently associated with multi-drug treatments. While many of these drugs are cleared by the liver, little is known about the clinical relevance of these GDM associated pharmacokinetic changes. CONCLUSION: Considering the frequency of the disease and the effects that these pharmacokinetic changes might have on the mother and child, the need for further research seems advisable. In the meantime, cautious clinical judgment in the management of drug administration in women affected by this disease is recommended.


Asunto(s)
Diabetes Gestacional/fisiopatología , Hígado/metabolismo , Preparaciones Farmacéuticas/metabolismo , Animales , Femenino , Eliminación Hepatobiliar/fisiología , Humanos , Preparaciones Farmacéuticas/administración & dosificación , Farmacocinética , Embarazo
10.
Expert Rev Neurother ; 18(1): 65-82, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29124985

RESUMEN

INTRODUCTION: Stroke is one of the most prevalent neurological diseases worldwide, especially among the elderly population. There are various mechanisms that enhance motor recovery after a stroke. In clinical practice, we have the opportunity to enhance plasticity by designing specific rehabilitation programs. Areas covered: There are a variety of drugs commonly administered to people after the acute phase of a stroke. These drugs may modify motor performance. Herein reviewed is the evidence concerning motor enhancement or decline in stroke patients, produced by drugs commonly used in rehabilitation settings. An extensive review of animal and human studies is performed. Expert commentary: Many of the clinical trials carried out were underpowered. Modest evidence supports the claim that there are agents that can affect motor rehabilitation after a stroke. Amphetamine-like agents, serotonin reuptake inhibitors, and levodopa might improve motor outcomes, while antipsychotics, some antiepileptic drugs, and GABAmimetic drugs could impair the recovery process. To draw definite recommendations, more comprehensive knowledge about the efficacy, long-term effects, and safety of these drugs is required. There are also other interesting molecules that open a promising field for basic and clinical research, in the search for new therapeutic options.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/tratamiento farmacológico , Anfetaminas/uso terapéutico , Animales , Dopaminérgicos/uso terapéutico , Humanos , Levodopa/uso terapéutico , Recuperación de la Función/efectos de los fármacos , Inhibidores de la Captación de Serotonina/uso terapéutico , Accidente Cerebrovascular/fisiopatología
11.
PLoS One ; 12(12): e0190528, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29284058

RESUMEN

The Metabolic Syndrome (MetS) is a cluster of cardiometabolic risk factors, usually accompanied by the presence of insulin resistance (IR) and a systemic subclinical inflammation state. Metabolically healthy obese (MHO) individuals seem to be protected against cardiometabolic complications. The aim of this work was to characterize phenotypically the low-grade inflammation and the IR in MHO individuals in comparison to obese individuals with MetS and control non obese. We studied two different populations: 940 individuals from the general population of Buenos Aires and 518 individuals from the general population of Venado Tuerto; grouped in three groups: metabolically healthy non-obese individuals (MHNO), MHO and obese individuals with MetS (MSO). Inflammation was measured by the levels of hs-CRP (high-sensitivity C reactive protein), and we found that MHO presented an increase in inflammation when compared with MHNO (Buenos Aires: p<0.001; Venado Tuerto: p<0.001), but they did not differ from MSO. To evaluate IR we analyzed the HOMA (Homoeostatic Model Assessment) values, and we found differences between MHO and MSO (Buenos Aires: p<0.001; Venado Tuerto: p<0.001), but not between MHNO and MHO. In conclusion, MHO group would be defined as a subgroup of obese individuals with an intermediate phenotype between MHNO and MSO individuals considering HOMA, hs-CRP and central obesity.


Asunto(s)
Inflamación/metabolismo , Resistencia a la Insulina , Síndrome Metabólico/metabolismo , Obesidad/metabolismo , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Adulto Joven
12.
J Pharm Pract ; 30(5): 549-556, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27194069

RESUMEN

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of heterogeneous drugs largely known for their anti-inflammatory, antipyretic, and analgesic effects, which are met by means of the inhibition of the cyclooxygenase (COX) enzymes. Even when their use in patients with diabetes mellitus is limited due to relevant adverse events, some pharmacological and metabolic effects of NSAIDs have been further studied to be potentially beneficial in the prevention and/or treatment of diabetic subjects. Effects on endogenous glucose production, peripheral insulin resistance, pancreatic islet, and systemic inflammation and the insulin clearance have been reported. In this article, we overview the scientific literature of the last 5 years regarding the potential effects of NSAID treatment on diabetes prevention/treatment. The selected papers showed information in both humans and animal models. Furthermore, we included papers that suggest new areas for further investigation, and we discussed our own suggestions on this matter.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/prevención & control , Animales , Antiinflamatorios no Esteroideos/farmacología , Glucemia/metabolismo , Inhibidores de la Ciclooxigenasa 2/farmacología , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Inflamación/sangre , Inflamación/tratamiento farmacológico , Resistencia a la Insulina/fisiología
13.
Rev. argent. endocrinol. metab ; 53(1): 22-28, mar. 2016. graf, tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-957937

RESUMEN

La obesidad es el principal componente del síndrome metabólico (SM) y determina la progresión de la enfermedad a las complicaciones metabólicas. Los individuos obesos metabólicamente sanos (OMS) parecen estar protegidos contra esas complicaciones. La longitud de los telómeros (LT) es un nuevo marcador del envejecimiento celular, que tiene una relación compleja con el SM. El objetivo principal de este estudio fue investigar por primera vez la LT en OMS y estudiar la asociación entre LT y el número de componentes del SM. Se estudió a 398 mujeres con una edad media de 46,76 ± 15,47 años (rango: 18-86 años), que se agruparon en: individuos con normopeso sin ningún componente del SM (NP0), obesos sin SM (OMS) y de acuerdo con el número de componentes de SM en los grupos sin ningún componentes de SM (0), con uno o 2 componentes (1 + 2) y con SM por la presencia de 3 o más componentes (SM). La LT de los OMS no se diferenció de la de los NP0, pero fue significativamente mayor que la de los individuos con SM (p = 0,032). Se observó una disminución de la LT con el aumento progresivo del número de componentes del SM (p = 0,004), en donde el grupo 0 presentó una LT significativamente mayor que los grupos 1 + 2 (p = 0,027) y SM (p = 0,003). Demostramos por primera vez que las mujeres OMS presentan una LT similar a las mujeres NP0 y más larga que aquellas mujeres con SM. Además, confirmamos que la LT se acorta con el aumento en el número de alteraciones del SM.


Obesity is the principal component in Metabolic Syndrome (MetS) and determines the progression of metabolic complications. Metabolically healthy obese individuals (MHO) seem to be protected against those complications. Telomere length (TL), as a novel marker of cellular aging, has a complex relationship with MetS. The principal aim of this study was to investigate TL in MHO, and to study the association between TL and the number of MetS components. A study was conducted on 398 women (mean age: 46.76 ± 15.47 years; range: 18 - 86 years), grouped according to the number of MetS components (0, 1 + 2, MetS), a group of normal-weight individuals with 0 MetS components (NW0), and a group of obese without MetS (MHO). No differences were found in the TL of the MHO group compared to the NW0, but it was significantly higher than that of individuals with MetS (P = .032). A decrease in TL was observed with a progressive increase in the number of MetS components (P = .004), whereas the group of individuals without MetS components had significantly longer TL than the groups with 1 and 2 components (P = .027), and MetS (P = .003). Shorter TL is not associated with MHO, but is related to MetS and with an increased number of metabolic abnormalities.

14.
Nefrologia ; 36(2): 133-40, 2016.
Artículo en Inglés, Español | MEDLINE | ID: mdl-26873550

RESUMEN

In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation. Results for DM were found in 10 patients according to fasting glucose alone (3.94%; 95% CI: 1.35-6.53%), 11 patients with exclusively the second hour criterion (4.33%; 95% CI: 1.63-7.03%), 15 with both criteria (5.91%; 95% CI: 2.81-9.00%) and 36 patients with at least one criteria (14.17%; 95% CI: 9.69-18.66%). In a multivariate analysis, DM was associated with waist circumference (OR=1.033 per cm; 95% CI, 1.005 to 1.062; P=.019) and with conservative treatment vs. replacement therapy (OR=0.41; 95% CI: 0.19-0.92; P=.028). IGT was evident in 24.6% and 20.3 on conservative vs. replacement therapy, with no statistically significant difference. IFG (ADA criteria) was 19.75 vs. 9.24% in conservative vs. replacement therapy, with a statistically significant difference. OGTT is suggested for all CKD patients since it is able to detect the full range of unknown dysglycaemias, which avoids underdiagnoses and favours performing treatments to prevent progression in DM risk groups (IFG and/or IGT). It also aids in the selection of the most appropriate medication for transplantation or treatment initiation in new cases of undiagnosed DM to decrease morbidity and mortality.


Asunto(s)
Glucemia , Intolerancia a la Glucosa , Insuficiencia Renal Crónica/metabolismo , Adulto , Anciano , Argentina , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad
15.
Thromb J ; 13: 26, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26251639

RESUMEN

AIMS: Although quantitative anti-FXa assays can be used to measure rivaroxaban plasma levels, they are not widely performed or available. We aimed to tentatively determine the cut-off for thromboembolism and bleeding prevention based on the clotting effect of non-rivaroxaban conjugate-activated FX plasma levels in patients with rivaroxaban using a coagulometric method. METHODS AND RESULTS: Rivaroxaban was added in vitro to normal plasma at a range of 0 to 241 µg/L to cover expected peak and trough levels. Rivaroxaban chromogenic (µg/L) and RVV-confirm as a ratio were determined. Patient plasma samples were assayed with the RVV-confirm reagent. The appropriate rivaroxaban plasma concentration to inhibit clotting mechanisms was based on the remaining FXa in plasma, which was expressed as the ratio of patients/normal, R-C. There is a high correlation between R-C in vitro and spiked normal plasma rivaroxaban concentration (R-Square 0.910, linear equation; 0.971 quadratic equation, p < 0.0001 for both) but not with plasma rivaroxaban chromogenic assays. We propose a cut-off R-C value of 1.65 and 4.5 for safety. Based on the proposed therapeutic range, in 158 assays performed in 58 patients, 6.3 % assays were above the level of bleeding tendency at the peak (R-C 5.39 ± 1.01, median 5.13) and 42 % assays were below the prevention cut-off at the trough (R-C 1.31 ± 0.18, median 1.35). CONCLUSIONS: RVVconfirm® is fast and sensitive to measure the effect of rivaroxaban. Clinical studies are needed to establish whether this cut-off is useful for identifying patients at increased risk of hemorrhage or those who exhibit a low level of anticoagulation.

16.
Rev. Soc. Argent. Diabetes ; 49(2): 50-68, 2015.
Artículo en Español | LILACS | ID: lil-774212

RESUMEN

Introducción: la hipertensión arterial (HA) y la diabetes mellitus (DM) son enfermedades crónicas de alta prevalencia que se encuentran frecuentemente asociadas. Objetivos: brindar los conocimientos para la práctica clínica que favorezcan la toma de decisiones diagnósticas y terapéuticas adecuadas, basadas en las evidencias científicas actuales. Materiales y métodos: utilizando la evidencia disponible, los grandes ensayos clínicos publicados en los últimos cuatro años y la adaptación de los recursos diagnósticos y terapéuticos de nuestro país se elaboraron las presentes “Recomendaciones para la Práctica Clínica”. Conclusiones: la HA aumenta la progresión y el desarrollo de las complicaciones crónicas micro y macrovasculares de la DM. El impacto del tratamiento de la HA es significativo en la reducción de la morbimortalidad de las personas con DM. Por ello, el tratamiento debe ser temprano y las metas de objetivo terapéutico deberán ser individualizadas según grupo etario, comorbilidades y daño de órgano blanco. En todas las personas con HA, tengan o no DM y/o enfermedad renal crónica (ERC), el objetivo es alcanzar una PA <140/90 mmHg. Podrán considerarse objetivos más cercanos a 130/80 mmHg en jóvenes, sin comorbilidades, con larga expectativa de vida y menor tiempo de diagnóstico de DM: en quienes tendrían beneficios a nivel renal o en quienes el riesgo de ACV es sustancial, si se logran sin efectos adversos asociados al tratamiento. Los IECA o ARA II son los fármacos de primera elección excepto en casos de intolerancia o contraindicación. Un bajo porcentaje de personas logra el objetivo terapéutico. La educación es una herramienta fundamental para mejorar la adherencia al tratamiento.


Asunto(s)
Diabetes Mellitus , Hipertensión , Terapéutica
17.
Rev. Soc. Argent. Diabetes ; 48(2): 63-69, Jun 2014. graf
Artículo en Español | LILACS | ID: lil-730929

RESUMEN

Objetivos: analizar modalidades terapéuticas en personas con diabetes mellitus tipo 1 (DM1) y su relación con el control glucémico. Métodos: estudio multicéntrico, observacional, transversal en personas con DM1 igual o mayor de 18 años. Realizado en 24 centros por médicos especialistas en Nutrición y/o Diabetes (01/10/2011 a 30/09/2012). Encuesta con datos clínicos, laboratorio y tratamiento habitual. Estadística: Chi2, correlación de Spearman, regresión logística múltiple. Resultados: 514 pacientes, edad 40,6±14,6 años, sexo femenino 55,1%, antigüedad DM1 17,4±12,0 años, media A1C 8,0±1,5%, media glucemia de ayunas 147,2±69,1 mg/dl, frecuencia de automonitoreo 3,3±1,5 veces/día. El 38,8% presentó A1C<7%, mientras el 60,9% tenía A1C <8%. Insulinoterapia intensificada 75,1%; con bomba de infusión 8,6%, realizaba conteo de hidratos, 62,1%. La media de A1C fue 7,8±1,5% en el tratamiento intensificado y 8,4±1,7% en el tratamiento convencional (p=0,001). Presentó hipoglucemias en la última semana el 67%, siendo mayor en el grupo intensificado (p=0,0001). En regresión logística múltiple, el mejor control glucémico correlacionó con la realización de actividad física (p<0,002), conteo de hidratos (p<0,04), respetar horario de comidas (p=0,0001) y mayor frecuencia de automonitoreo (p=0,004). Conclusiones: El 38,8% presentó A1C< 7%. La insulinoterapia intensificada se asoció a mejores niveles de A1C y con mayor frecuencia de hipoglucemias. El mejor control correlacionó conrealización de actividad física, respetar el horario de comidas, el conteo de hidratos y mayor frecuencia de automonitoreo.


Asunto(s)
Glucemia , Diabetes Mellitus Tipo 1
18.
Rev. Soc. Argent. Diabetes ; 48(2): 63-69, Jun 2014. graf
Artículo en Español | BINACIS | ID: bin-131677

RESUMEN

Objetivos: analizar modalidades terapéuticas en personas con diabetes mellitus tipo 1 (DM1) y su relación con el control glucémico. Métodos: estudio multicéntrico, observacional, transversal en personas con DM1 igual o mayor de 18 años. Realizado en 24 centros por médicos especialistas en Nutrición y/o Diabetes (01/10/2011 a 30/09/2012). Encuesta con datos clínicos, laboratorio y tratamiento habitual. Estadística: Chi2, correlación de Spearman, regresión logística múltiple. Resultados: 514 pacientes, edad 40,6±14,6 años, sexo femenino 55,1%, antig³edad DM1 17,4±12,0 años, media A1C 8,0±1,5%, media glucemia de ayunas 147,2±69,1 mg/dl, frecuencia de automonitoreo 3,3±1,5 veces/día. El 38,8% presentó A1C<7%, mientras el 60,9% tenía A1C <8%. Insulinoterapia intensificada 75,1%; con bomba de infusión 8,6%, realizaba conteo de hidratos, 62,1%. La media de A1C fue 7,8±1,5% en el tratamiento intensificado y 8,4±1,7% en el tratamiento convencional (p=0,001). Presentó hipoglucemias en la última semana el 67%, siendo mayor en el grupo intensificado (p=0,0001). En regresión logística múltiple, el mejor control glucémico correlacionó con la realización de actividad física (p<0,002), conteo de hidratos (p<0,04), respetar horario de comidas (p=0,0001) y mayor frecuencia de automonitoreo (p=0,004). Conclusiones: El 38,8% presentó A1C< 7%. La insulinoterapia intensificada se asoció a mejores niveles de A1C y con mayor frecuencia de hipoglucemias. El mejor control correlacionó conrealización de actividad física, respetar el horario de comidas, el conteo de hidratos y mayor frecuencia de automonitoreo.(AU)


Asunto(s)
Diabetes Mellitus Tipo 1 , Glucemia
19.
Thromb J ; 12(1): 7, 2014 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-24656069

RESUMEN

BACKGROUND: New oral anticoagulant (NOAC) drugs are known to influence the results of some routine hemostasis tests. Further data are needed to enable routine assessment of the effects of NOAC on clotting parameters in some special circumstances. METHODS: Following administration of rivaroxaban to patients, at the likely peak and trough activity times, we assessed the effects on prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and clotting time using Russell's viper venom, and in the presence of phospholipids and calcium reagent available as DVVreagent® and DVVconfirm®. The data were used to determine an adequate NOAC plasma level based on anticoagulant activities expressed as a ratio (patients/normal, R-C). RESULTS: DVVconfirm as R-C could be rapidly performed, and the results were reasonably sensitive for rivaroxaban and probably for other FX inhibitors. This assay is not influenced by lupus anticoagulant and heparin, does not require purified NOAC as control, and will measure whole-plasma clotting activity. CONCLUSIONS: We propose a cut-off R-C value of 4.52 ± 0.33 for safety, but clinical studies are needed to establish whether this cut-off is useful for identifying patients at increased risk of hemorrhage or exhibiting low anticoagulation effect. It also seems possible that normal R-C could indicate an absence of anticoagulant activity when rivaroxaban is discontinued due to episodes of uncontrolled bleeding during anticoagulation or for emergency surgery.

20.
Int J Clin Pharmacol Ther ; 52(4): 292-302, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24447650

RESUMEN

INTRODUCTION: Metabolic clearance of isoniazid (INH) may be up to 10 times faster in individuals who are rapid acetylators compared with slow acetylators. In addition, the acetylation phenotype has been suggested to change with age. A better knowledge of the age distribution of the acetylation genotype and phenotype in children requiring INH for tuberculosis treatment or prevention could be important to optimize safety and efficacy of INH use. OBJECTIVES: The aim of the present study was to evaluate the genotype and phenotype of NAT2 in an Argentinean pediatric population rom Buenos Aires. In addition, we wanted to describe genotype-phenotype correlation, as well as its distribution at different ages. METHODOLOGY: NAT2 genotyping was performed by RFLP technique, searching for common polymorphisms. Acetylisoniazid and isoniazid concentrations were measured by HPLC and NAT2 phenotype was defined from the ratio of both concentrations (Metabolic Ratio, MR). RESULTS: Almost half of the patients (46.02%) possessed wild-type haplotype, with 17.05% of individuals having two fully functional alleles, 57.95% one fully functional allele and 25% with no fully functional allele. According to phenotype, most children (96.59%) were classified as fast acetylators, whereas 1.14% of the cases were intermediate and 2.27% slow acetylators. There was a positive association between age and MR (R = 0.52985, p < 0.000001) with a significant MR difference between age categories (p < 0.001). CONCLUSIONS: We found a high proportion of rapid acetylators compared with other populations. Acetylator phenotype showed a positive correlation with age, with a significant change around the 4th year of life.


Asunto(s)
Antituberculosos/farmacocinética , Arilamina N-Acetiltransferasa/genética , Isoniazida/farmacocinética , Adolescente , Distribución por Edad , Argentina , Niño , Preescolar , Genotipo , Humanos , Lactante , Fenotipo , Curva ROC
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