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1.
Rev. Soc. Argent. Diabetes ; 54(supl. 2): 107-122, mayo - ago. 2020. ilus, tab
Artículo en Español | LILACS, BINACIS | ID: biblio-1122964

RESUMEN

Los eventos cardiovasculares representan la mayor complicación de la diabetes. La evidencia sugiere que la metformina mejora los resultados cardiovasculares en pacientes con diabetes, especialmente en el United Kingdom Prospective Diabetes Study (UKPDS) y otros estudios posteriores, por distintos mecanismos. Hay pocos estudios de seguridad cardiovascular para sulfonilureas aunque no tendrían un perfil seguro a este nivel. La gliclazida parece ser la de mejor performance de las drogas de este grupo. Algo similar ocurre con las meglitinidas, para las cuales los datos indican que no aumentarían el riesgo pero tampoco mejorarían la incidencia de eventos cardiovasculares. Las tiazolidinedionas son las drogas más cuestionadas, aunque los estudios y metaanálisis son contradictorios no habría dudas que aumentan el riesgo de insuficiencia cardíaca. Los inhibidores de la DPPIV mostraron resultados neutros a excepción de saxagliptina que aumentaría el riesgo de internación por insuficiencia cardíaca. Existen datos convincentes que los inhibidores de los receptores SGLT-2 a nivel renal y los análogos del GLP-1 intestinal tienen efectos positivos a nivel cardiovascular, con algunas diferencias entre los integrantes de esta familia. En cuanto a las insulinas, los estudios sugieren que tanto los análogos lentos como rápidos tendrían un mejor perfil cardiovascular, ligado principalmente a la menor incidencia de hipoglucemias severas, que insulina NPH y regular respectivamente.


Cardiovascular events represent the greatest complication of diabetes. Evidence suggests that metformin improves CV outcomes in patients with diabetes, especially in the United Kingdom Prospective Diabetes Study (UKPDS) and other subsequent studies, by different mechanisms. There are few cardiovascular safety studies for sulfonylureas although they would not have a safe profile at this level. Gliclazide appears to be the best performing drug in this group. Something similar occurs with meglitinides for which the data indicates that they would not increase the risk but neither would they improve the incidence of cardiovascular events. Thiazolidinediones are the most questioned drugs, although the studies and meta-analyzes are contradictory, there would be no doubt that they increase the risk of heart failure. DPPIV inhibitors showed neutral results except for saxagliptin, which would increase the risk of hospitalization for heart failure. There is convincing data that SGLT-2 receptor inhibitors at the renal level and intestinal GLP-1 analogues have positive effects at the cardiovascular level with some differences between the members of these families. Regarding insulins, studies suggest that both slow and fast analogues would have a better cardiovascular profile, mainly linked to the lower incidence of severe hypoglycemia, than NPH and regular insulin, respectively


Asunto(s)
Humanos , Diabetes Mellitus , Insuficiencia Cardíaca , Insulina
2.
Mult Scler Relat Disord ; 40: 101960, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32032843

RESUMEN

BACKGROUND: Heart Rate Recovery (HRR) after a physical exercise has been poorly investigated in people with multiple sclerosis (PwMS). OBJECTIVE: To evaluate the kinetics of HRR and its autonomic modulation in PwMS and to elucidate the interplay between HRR and subjective fatigue. METHODS: ECG was digitally acquired during rest (5 min), submaximal exercise (4 min at 10 W of upper limb cycling) and recovery (3 min) in 17 PwMS (EDSS: 5.9 ± 1.2, mean±standard deviation) and 17 healthy control (HC) subjects. Short-term (first 30 s) and long-term (up to180 s) validated indices of HRR were calculated. The time course of the parasympathetic index of heart rate variability RMSSD (Root Mean Square of Successive Differences) was computed every 30 s of recovery. Subjective fatigue was evaluated by the Borg scale applied to breathing and upper limbs. RESULTS: In comparison with HC, the short-term HRR indices were significantly slower (P < 0.05) in PwMS, whereas the long-term ones did not. The time course of RMSSD was significantly different in PwMS (P < 0.05). HRR and HRV indexes did not correlate with fatigue perception and baseline HRV values. CONCLUSION: The cardiac parasympathetic reactivation from a submaximal exercise was blunted in PwMS, thereby slowing the short-term phase of HRR. This may contribute to the higher cardiovascular risk in PwMS, but the mechanism needs further investigation. The parasympathetic impairment during post-exercise HR reactivation cannot be predicted by baseline HRV values and may therefore be revealed only by an appropriate provocative low-intensity physical test.

3.
Int J Rehabil Res ; 42(4): 300-308, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31524664

RESUMEN

Rehabilitation treatments have been proven to be a viable way to reduce fatigue and upper limb impairments in people with multiple sclerosis (PwMS). Our aim was to examine which treatment has better short-term and carryover effects on fatigue and manual dexterity in multiple sclerosis population. Twenty PwMS participated in a 16-week randomized crossover study composed of 20 sessions. The participants were divided into two groups (group A and group B). Sessions containing combined arm cycling and task-oriented exercises were administered by a physical therapist in hospital setting. Each group received 20 sessions of aerobic training and task-oriented exercises and then an 8-week rest period or vice versa with group A receiving sessions first. Fatigue was assessed by using the Modified Fatigue Impact Scale (MFIS) and Motor Fatigability Index (MFI), which was assessed using an engineered glove during a fatiguing finger tapping task. To measure manual dexterity, the nine hole peg test (NHPT) and a rate of tapping at maximum velocity task (RATE-MV) were utilized. Treatment effects were assessed by t-test or Mann-Whitney test at the end of both periods checking for carryover effects. After treatment the combined (Groups A and B) between-period differences were MFIS: 5.2 (10.7) points, P = 0.05; MFI: -0.007 (<0.001)Hz/s, P = 0.05 and RATE-MV: 0.2 (0.4) Hz/s, P = 0.05 in favor of the treatment period. No statistically significant between-period differences were found for the NHPT: 3.6 (25.0) s, P = 0.63. No carryover effects (P > 0.05) were observed. In conclusion, sessions of arm cycling and tailored task-oriented exercises have shown to be a viable resource for treating manual dexterity and fatigue in PwMS.


Asunto(s)
Terapia por Ejercicio/métodos , Fatiga/rehabilitación , Esclerosis Múltiple/rehabilitación , Adulto , Estudios Cruzados , Evaluación de la Discapacidad , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desempeño Psicomotor , Extremidad Superior
4.
Mult Scler J Exp Transl Clin ; 5(2): 2055217319843673, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31019725

RESUMEN

Background: Persons with multiple sclerosis may benefit from hospital-based multidisciplinary rehabilitation. Objectives: To investigate the effects of hospital-based multidisciplinary rehabilitation and to identify their potential predictors in a large sample of persons with multiple sclerosis. Methods: From the charts of 655 persons with multiple sclerosis consecutively admitted to our unit, disease profiles, modified Barthel index, Expanded Disability Status Scale (EDSS), pain numerical rating score and type of interventions were retrospectively collected. We defined an improvement at discharge as follows: modified Barthel index increase of at least 5 points, EDSS decrease of 1.0 if baseline score was 5.5 or less and of 0.5 if baseline score was greater than 5.5; any numerical rating score decrease. Results: After a median admission period of 36 days, at discharge 65%, 22% and 89% of persons with multiple sclerosis improved for modified Barthel index, EDSS and numerical rating score, respectively. The modified Barthel index improvement was associated with shorter disease duration, lower EDSS at baseline and with access to psychological counselling. EDSS improvement was associated with shorter disease duration, relapsing-remitting course, female gender and longer duration of the admission period. Conclusions: Inpatient multidisciplinary rehabilitation was associated with improved autonomy in activities of daily living in a relevant proportion of persons with multiple sclerosis. The effect seems to be more evident in individuals with shorter multiple sclerosis duration and relapsing-remitting disease course.

5.
Mult Scler Relat Disord ; 24: 85-90, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29982110

RESUMEN

BACKGROUND: People with multiple sclerosis (PwMS) often develop an autonomic dysfunction (AD), which onset should be assessed early at a subclinical level, as it may interfere with pharmacological treatments and exercise. OBJECTIVE: To evaluate basal cardiac autonomic tone, its modulations during sit-to-stand, sub-maximal exercise and recovery in PwMS without clinical overt AD and its relationships with fatigue perception. METHODS: Twenty-three PwMS (55 ±â€¯8 yrs [mean ±â€¯SD]; EDSS score 5.7 ±â€¯1.3) and 20 age-matched healthy controls (HC; 55 ±â€¯8yrs) were enrolled. ECG was digitally acquired during:1) sitting at rest (low sympathetic activation); 2) standing (light sympathetic activation); and 3) during light exercise (moderate sympathetic activation) and recovery. Parasympathetic and sympatho-vagal parameters of heart rate (HR) variability in time and frequency domains were calculated from beat series. RESULTS: HR was slightly but not significantly higher in PwMS compared to HC in all experimental conditions. Parasympathetic indexes were significantly lower (p < 0.05) in PwMS compared to HC during baseline sitting and post-exercise recovery, whereas sympathovagal parameters were similar in both groups. No correlation between autonomic tone and perceived fatigue was observed. CONCLUSION: Parasympathetic tone appears to be impaired in PwMS basal and post-exercise conditions, but not during postural challenge and exercise. In addition, AD does not affect perceived fatigue.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Corazón/fisiopatología , Esclerosis Múltiple/fisiopatología , Postura/fisiología , Estudios Transversales , Ejercicio Físico/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
J Neurol ; 265(6): 1393-1401, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29627940

RESUMEN

BACKGROUND: Rehabilitation seems to promote brain plasticity, but objective measures of efficacy are lacking and there is a limited understanding of the mechanisms underlying functional recovery. OBJECTIVE: To study functional and structural brain changes induced by gait rehabilitation. METHODS: We enrolled MS inpatients (EDSS 4.5-6.5) undergoing a 4-week neurorehabilitation. Several clinical measures were obtained, including: 2-min walk test (2MWT), dynamic gait index (DGI), Berg balance scale (BBS). Furthermore, motor-task functional MRI (fMRI) of plantar dorsiflexion, resting state fMRI, and regional diffusion tensor imaging (DTI) metrics were obtained. All the assessments were performed at baseline (T0), after the end of the rehabilitation period (T1) and 3 months later (T2). RESULTS: Twenty-nine patients were enrolled at T0, 26 at T1, and 16 completed all timepoints. At T1, there was a significant improvement of 2MWT, DGI, and BBS scores, along with a reduced extent of the widespread activation related to the motor task at the fMRI and an increased functional connectivity in the precentral and post-central gyrus, bilaterally. None of these changes were maintained at T2. CONCLUSIONS: Our findings show a short-term beneficial effect of motor rehabilitation on gait performances in MS, accompanied by brain functional reorganization in the sensory-motor network.


Asunto(s)
Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Marcha , Esclerosis Múltiple/rehabilitación , Rehabilitación Neurológica , Imagen de Difusión Tensora , Femenino , Marcha/fisiología , Hospitalización , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Actividad Motora/fisiología , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/fisiopatología , Vías Nerviosas/diagnóstico por imagen , Vías Nerviosas/fisiopatología , Plasticidad Neuronal , Equilibrio Postural , Descanso , Resultado del Tratamiento
7.
Front Neurol ; 8: 491, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28974941

RESUMEN

A 48-year-old woman with multiple sclerosis (MS), treated with natalizumab for more than one year without clinical and magnetic resonance imaging (MRI) signs of disease activity, was diagnosed with definite progressive multifocal leukoencephalopathy (PML). She presented with subacute motor deficit of the right upper limb (UL), followed by involvement of the homolateral leg and urinary urgency. The patient was treated with steroids and plasma exchange. On follow-up MRI scans, the PML lesion remained stable and no MS rebounds were observed, but the patient complained of a progressive worsening of the right UL motor impairment, becoming dependent in most activities of daily living. A cycle of multidisciplinary rehabilitation (MDR) was then started, including daily sessions of UL robot therapy and occupational therapy. Functional MRI (fMRI) was acquired before and at the end of the MDR cycle using a motor task which consisted of 2 runs: in one run the patient was asked to observe while the second one consisted of hand grasping movements. At the end of the rehabilitation period, both the velocity and the smoothness of arm trajectories during robot-based reaching movements were significantly improved. After MDR, compared with baseline, fMRI showed significantly increased functional activation within the sensory-motor network in the active, motor task, while no significant differences were found in the observational task. MDR in MS, including robot-assisted UL training, seems to be clinically efficacious and to have a significant impact on brain functional reorganization on a short-term, even in the presence of superimposed tissue damage provoked by PML.

8.
Sci Total Environ ; 605-606: 482-497, 2017 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-28672237

RESUMEN

Urban watersheds are significantly anthropogenically-altered landscapes. Most previous studies cover relatively short periods, without addressing concentrations, loads, and yields in relation to annual climate fluctuations, and datasets on Ag, Se, PBDEs, and PCDD/Fs are rare. Intensive storm-focused sampling and continuous turbidity monitoring were employed to quantify pollution at two locations in the Guadalupe River (California, USA). At a downstream location, we determined loads of suspended sediment (SS) for 14yrs., mercury (HgT), PCBs, and total organic carbon (TOC) (8yrs), total methylmercury (MeHgT) (6yrs), nutrients, and trace elements including Ag and Se (3yrs), DDTs, chlordanes, dieldrin, and PBDEs (2yrs), and PCDD/Fs (1yr). At an upstream location, we determined loads of SS for 4yrs. and HgT, MeHgT, PCBs and PCDD/Fs for 1yr. These data were compared to previous studies, climatically adjusted, and used to critically assess the use of small datasets for estimating annual average conditions. Concentrations and yields in the Guadalupe River appear to be atypical for total phosphorus, DDTs, dieldrin, HgT, MeHgT, Cr, Ni, and possibly Se due to local conditions. Other pollutants appear to be similar to other urban systems. On average, wet season flow varied by 6.5-fold and flow-weighted mean (FWM) concentrations varied 4.4-fold, with an average 7.1-fold difference between minimum and maximum annual loads. Loads for an average runoff year for each pollutant were usually less than the best estimate of long-term average. The arithmetic average of multiple years of load data or a FWM concentration combined with mean annual flow was also usually below the best estimate of long-term average load. Mean annual loads using sampled years were also less than the best estimate of long-term average by a mean of 2.2-fold. Climatic adjustment techniques are needed for computing estimates of long-term average annual loads.

9.
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
10.
Salud(i)ciencia (Impresa) ; 19(2): 142-147, jun. 2012. graf
Artículo en Español | LILACS | ID: lil-675017

RESUMEN

La diabetes afecta aproximadamente al 10% de la población adulta, por lo que constituye la etiología más frecuente de enfermedad renal entre los pacientes que requieren hemodiálisis. La hipertensión está frecuentemente asociada con la diabetes tipo 2, en la que se presenta como diagnóstico previo, concomitante o posterior, y a la diabetes tipo 1, como consecuencia de la nefropatía. La hipertensión incrementa el riesgo cardiovascular y acelera la progresión de la nefropatía, en tanto que su tratamiento retrasa los eventos cardiovasculares y renales. Los mecanismos principalmente involucrados en la hipertensión y progresión de la nefropatía son la expansión secundaria a la reabsorción incrementada de sodio y la sobreestimulación del sistema renina-angiotensina-aldosterona, y la vasoconstricción por desregulación de los moduladores de la resistencia vascular. Los objetivos generales del tratamiento antihipertensivo en el paciente con diabetes son lograr una presión arterial sistólica < 130 mm Hg y diastólica < 80 mm Hg, y menores en el paciente proteinúrico (< 125/75 mm Hg). Para alcanzar estos objetivos debe restringirse la ingesta de sodio a < 2 000 mg/día, considerándose los inhibidores del sistema renina-angiotensina como las drogas de elección inicial para retrasar la disminución del filtrado glomerular. El algoritmo del tratamiento antihipertensivo sugiere la modificación de los hábitos de vida y asociaciones farmacológicas orientadas fisiopatológicamente para alcanzar los objetivos


Asunto(s)
Hipertensión/clasificación , Hipertensión/terapia , Impactos en la Salud , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/rehabilitación , Nefropatías Diabéticas/terapia , Insuficiencia Renal Crónica
11.
Salud(i)cienc., (Impresa) ; 19(2): 142-147, jun. 2012. graf
Artículo en Español | BINACIS | ID: bin-128771

RESUMEN

La diabetes afecta aproximadamente al 10% de la población adulta, por lo que constituye la etiología más frecuente de enfermedad renal entre los pacientes que requieren hemodiálisis. La hipertensión está frecuentemente asociada con la diabetes tipo 2, en la que se presenta como diagnóstico previo, concomitante o posterior, y a la diabetes tipo 1, como consecuencia de la nefropatía. La hipertensión incrementa el riesgo cardiovascular y acelera la progresión de la nefropatía, en tanto que su tratamiento retrasa los eventos cardiovasculares y renales. Los mecanismos principalmente involucrados en la hipertensión y progresión de la nefropatía son la expansión secundaria a la reabsorción incrementada de sodio y la sobreestimulación del sistema renina-angiotensina-aldosterona, y la vasoconstricción por desregulación de los moduladores de la resistencia vascular. Los objetivos generales del tratamiento antihipertensivo en el paciente con diabetes son lograr una presión arterial sistólica < 130 mm Hg y diastólica < 80 mm Hg, y menores en el paciente proteinúrico (< 125/75 mm Hg). Para alcanzar estos objetivos debe restringirse la ingesta de sodio a < 2 000 mg/día, considerándose los inhibidores del sistema renina-angiotensina como las drogas de elección inicial para retrasar la disminución del filtrado glomerular. El algoritmo del tratamiento antihipertensivo sugiere la modificación de los hábitos de vida y asociaciones farmacológicas orientadas fisiopatológicamente para alcanzar los objetivos (AU)


Asunto(s)
Hipertensión/clasificación , Hipertensión/terapia , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/terapia , Nefropatías Diabéticas/rehabilitación , Insuficiencia Renal Crónica , Impactos en la Salud
12.
Medicina (B.Aires) ; 56(2): 183-94, 1996. ilus, tab
Artículo en Español | LILACS | ID: lil-172303

RESUMEN

La hipertensión se asocia a alteraciones metabólicas vinculables a hiperinsulinemia, como posibles resultantes de nuestros hábitos de vida. Las relaciones entre obesidad central, hiperinsulinemia, actividad simpática, dislipemia, aterosclerosis, retención de sodio, reactividad vascular alterada e hipertensión, permiten estabelecer nexos fisiopatológicos que no son exhaustivamente comprendidos en la actualidad, pero con probable implicación etiológica. Aun sin estabelecer un puente entre la obesidad y la hipertensión a través de la hiperinsulinemia, el síndrome metabólico condiciona incremento tanto del riesgo vascular como de la presión arterial, y nos hace reconsiderar la definición esencial en estos pacientes.


Asunto(s)
Humanos , Hipertensión/metabolismo , Hiperinsulinismo/metabolismo , Obesidad/metabolismo , Hipertensión/complicaciones , Hiperinsulinismo/complicaciones , Insulina/farmacología , Obesidad/complicaciones , Resistencia a la Insulina/fisiología , Factores de Riesgo , Sistema Nervioso Simpático , Síndrome
13.
Medicina [B.Aires] ; 56(2): 183-94, 1996. ilus, tab
Artículo en Español | BINACIS | ID: bin-22369

RESUMEN

La hipertensión se asocia a alteraciones metabólicas vinculables a hiperinsulinemia, como posibles resultantes de nuestros hábitos de vida. Las relaciones entre obesidad central, hiperinsulinemia, actividad simpática, dislipemia, aterosclerosis, retención de sodio, reactividad vascular alterada e hipertensión, permiten estabelecer nexos fisiopatológicos que no son exhaustivamente comprendidos en la actualidad, pero con probable implicación etiológica. Aun sin estabelecer un puente entre la obesidad y la hipertensión a través de la hiperinsulinemia, el síndrome metabólico condiciona incremento tanto del riesgo vascular como de la presión arterial, y nos hace reconsiderar la definición esencial en estos pacientes. (AU)


Asunto(s)
Humanos , Hipertensión/metabolismo , Hiperinsulinismo/metabolismo , Obesidad/metabolismo , Hipertensión/complicaciones , Hiperinsulinismo/complicaciones , Obesidad/complicaciones , Resistencia a la Insulina/fisiología , Insulina/farmacología , Sistema Nervioso Simpático , Síndrome , Factores de Riesgo
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