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1.
Nutr. clín. diet. hosp ; 42(1): 115-125, Abr. 2022. tab
Artículo en Portugués | IBECS | ID: ibc-204595

RESUMEN

Introdução: O controle glicêmico e o estado nutricionaladequados são aliados no tratamento e promoção da saúdedos portadores de diabetes mellitus tipo 1 (DM1). Objetivo: Investigar associação de fatores relacionados àalimentação e ao tratamento do DM1 com controle glicêmicoe estado nutricional em usuários de sistema de infusão contí-nua de insulina (SICI). Materiais e Métodos: Estudo transversal com 61 pacien-tes do Ceará. Por meio da ferramenta REDCap, coletaram-sedados socioeconômicos, de controle glicêmico, antropométricos e relacionados à alimentação e ao tratamento do diabe-tes. Também foi realizado o upload dos dados dos SICI’s edos sensores de glicose. Aplicaram-se os testes Qui-Quadradode Pearson, Exato de Fisher e correlação de Spearman, comnível de significância de 5%. Resultados: Excesso de peso associouse à dificuldadepara esperar o tempo de ação da insulina antes da alimentação (p=0,048) e à menor dificuldade na falta de fornecimentodos insumos (p=0,040). Não ter excesso ponderal associou-se à prática de exercício físico (p<0,001), a crer menos que ainsulina contribui para o ganho ponderal (p<0,001) e a me-nos preocupação com isso (p=0,024). Aqueles com hemoglobina glicada e variabilidade glicêmica segundo o desvio pa-drão da glicose (DP) adequadas compareceram mais aonutricionista (p=0,041; p=0,007), quem possuía variabilidadeglicêmica adequada segundo o coeficiente de variação (CV)tinha mais de 10 anos de doença (p=0,001) e quem possuíaDP e CV adequados tinha menos dificuldade para realizar bo-lus em público (p=0,044; p=0,001) e aferia glicemia quatroou mais vezes diariamente (p=0,033; p=0,030). Conclusão: O estado nutricional e o controle glicêmico as-sociaram-se a fatores individuais dos pacientes, evidenciandoa importância do entendimento e manejo desses fatores pe-los profissionais de saúde.(AU)


Introduction: Adequate glycemic control and nutritionalstatus are allies in the treatment and health promotion of pa-tients with type 1 diabetes mellitus (T1DM). Objective: To investigate the association between factorsrelated to food and T1DM treatment with glycemic controland nutritional status in patients using insulin pumps. Materials and Methods: Crosssectional study with 61patients from Ceará. Through the REDCap tool, socioeconomic, glycemic control, anthropometric and diabetes-relateddata, treatment and diet were collected. Data from SICI’s andglucose sensors were also uploaded. Pearson’s Chi-Square, Fisher’s Exact and Spearman’s correlation tests were applied,with a significance level of 5%. Results: Overweight was associated with difficulty to wait-ing for the insulin action time before feeding (p=0.048) andless difficulty with lack of supply of inputs (p=0.040). Not be-ing overweight was associated with physical exercise(p<0.001), less belief that insulin contributes to weight gain(p<0.001), and less concern about it (p=0.024). Those withadequate glycated hemoglobin and glycemic variability according to the standard deviation of glucose (SD) attendedthe nutritionist more often (p=0.041; p=0.007), those withan adequate glycemic variability according to the coefficientof variation (CV) had more than 10 years of disease(p=0.001) and those with an adequate PD and VC, had lessdifficulty in performing bolus in public (p=0.044; p=0.001)and measured blood glucose four or more times daily(p=0.033; p=0.030). Conclusion: Nutritional status and glycemic control areassociated with individual patient factors, highlighting the importance of health professionals’ understanding and manage-ment of these factors.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 1/terapia , Insulina , Glucemia , Estado Nutricional , Factores Socioeconómicos , Antropometría , Nutrición, Alimentación y Dieta , Estudios Transversales , 52503 , Interpretación Estadística de Datos , Brasil
2.
J Matern Fetal Neonatal Med ; : 1-9, 2022 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-35341453

RESUMEN

OBJECTIVE: To evaluate whether ultrasound abdominal fat measurements in the first and second trimesters can predict adverse gestational outcomes, particularly gestational diabetes mellitus (GDM), and identify early patients at higher risk for complications. METHODS: A prospective cohort study of 126 pregnant women at 11-14 and 20-24 weeks of gestation with normal fasting glucose levels during early pregnancy. From 126 participants with complete data, 13.5% were diagnosed with GDM, based on the cutoffs established for the peripherical blood glucose. Subcutaneous, visceral, and maximum preperitoneal abdominal fat were measured using ultrasound techniques. GDM status was determined by oral glucose tolerance test (OGTT) with 75 g glucose overload, and the following values were considered abnormal: fasting glucose ≥92 mg/dl and/or 1 h after overload ≥180 mg/dl and/or 2 h after overload ≥153 mg/dl. The receiver operator characteristic (ROC) curve was used to determine the optimal threshold to predict GDM. RESULTS: Maximum preperitoneal fat measurement was predictive of GDM, and subcutaneous and visceral abdominal fat measurements did not show significant differences in the prediction of GDM. According to the ROC curve, a threshold of 45.25 mm of preperitoneal fat was identified as the optimal cutoff point, with 87% sensitivity and 41% specificity to predict GDM. The raw and adjusted odds ratios for age and pre-pregnancy body mass index were 0.730 (95% confidence interval [CI], 0.561-0.900) and 0.777 (95% CI, 0.623-0.931), respectively. CONCLUSION: The use of a 45.25 mm threshold for maximum preperitoneal fat, measured by ultrasound to predict the risk of GDM, appears to be a feasible, inexpensive, and practical alternative to incorporate into clinical practice during the first trimester of pregnancy.

3.
J Matern Fetal Neonatal Med ; 35(11): 2216-2226, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32567410

RESUMEN

OBJECTIVE: Studies of subcutaneous and visceral abdominal fat thickness evaluated by ultrasound as a predictor of gestational diabetes mellitus (GDM) have been published, but the best technique and standardization are unknown. To identify, critically evaluate, and analyze studies using subcutaneous and visceral abdominal fat as a model for predicting GDM in the first and second trimesters of pregnancy and evaluate their methodological quality. METHODS: PubMed, Scopus, and Web of Science databases were searched from May to July 2019. We included studies of any sample size performed for any duration and in any configuration. Model development and validation studies were eligible for inclusion. Two authors independently performed the eligibility assessment of the studies by reviewing the titles and abstracts. Data on study design, gestational age, diagnostic criteria for GDM, device, ultrasound fat measurement technique, and cutoff point for GDM prediction were extracted. RESULTS: The electronic search resulted in 1331 articles, of which 14 were eligible for systematic review. Different criteria for diagnosing GDM and fat measurement techniques were used. The cutoff point for subcutaneous, visceral, and total abdominal fat for predicting GDM in the first and second trimesters varied between the studies. CONCLUSION: No study validated the model for predicting GDM using subcutaneous and visceral abdominal fat measurements. External validation studies are recommended to improve the generalization of this GDM predictor in clinical practice.


Asunto(s)
Diabetes Gestacional/diagnóstico , Grasa Intraabdominal/diagnóstico por imagen , Grasa Subcutánea/diagnóstico por imagen , Diabetes Gestacional/diagnóstico por imagen , Femenino , Edad Gestacional , Humanos , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Ultrasonografía
4.
Artículo en Inglés | MEDLINE | ID: mdl-34574647

RESUMEN

Congenital Generalized Lipodystrophy (CGL) is a rare syndrome characterized by the almost total absence of subcutaneous adipose tissue due to the inability of storing lipid in adipocytes. Patients present generalized lack of subcutaneous fat and normal to low weight. They evolve with severe metabolic disorders, non-alcoholic fatty liver disease, early cardiac abnormalities, and infectious complications. Although low body weight is a known risk factor for osteoporosis, it has been reported that type 1 and 2 CGL have a tendency of high bone mineral density (BMD). In this review, we discuss the role of bone marrow tissue, adipokines, and insulin resistance in the setting of the normal to high BMD of CGL patients. Data bases from Pubmed and LILACS were searched, and 113 articles published until 10 April 2021 were obtained. Of these, 76 were excluded for not covering the review topic. A manual search for additional literature was performed using the bibliographies of the studies located. The elucidation of the mechanisms responsible for the increase in BMD in this unique model of insulin resistance may contribute to the understanding of the interrelationships between bone, muscle, and adipose tissue in a pathophysiological and therapeutic perspective.


Asunto(s)
Resistencia a la Insulina , Lipodistrofia Generalizada Congénita , Adipoquinas , Densidad Ósea , Médula Ósea , Humanos
5.
Diabetol Metab Syndr ; 13(1): 65, 2021 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-34130736

RESUMEN

BACKGROUND: A new strain of human coronavirus (HCoV) spread rapidly around the world. Diabetes and obesity are associated with a worse prognosis in these patients. Congenital Generalized Lipodystrophy (CGL) patients generally have poorly controlled diabetes and require extremely high doses of insulin. There is no documentation in the literature of cases of COVID in CGL patients. Thus, we aimed to evaluate the prevalence of SARS-CoV-2 infection in CGL patients, and the association of their clinical and metabolic characteristics and outcomes. METHODS: This is a cross-sectional study carried out between July and October 2020. Clinical data collected were respiratory or other flu-like symptoms, need of hospitalization in the last three months, CGL comorbidities, and medications in use. Cholesterol, triglycerides, glycohemoglobin A1c levels, anti-SARS-CoV-2 antibodies and nasopharyngeal swab for RT-qPCR were also obtained in all CGL patients. Mann-Whitney U test was used to analyze the characteristics of the participants, verifying the non-adherence of the data to the Gaussian distribution. In investigating the association between categorical variables, we used Pearson's chi-square test and Fisher's exact test. A significance level of 5% was adopted. RESULTS: Twenty-two CGL patients were assessed. Eight subjects (36.4%) had reactive anti-SARS-CoV-2 antibodies. Only one of these, also presented detectable RT-qPCR. Five individuals (62.5%) were women, median age of 13.5 years (1 to 37). Symptoms like fever, malaise, nausea, diarrhea and chest pain were present, and all asymptomatic patients were children. All subjects had inadequate metabolic control, with no difference between groups. Among positive individuals there was no difference between those with AGPAT2 (75%) and BSCL2 gene mutations (25%) (p > 0.05). No patient needed hospitalization or died. CONCLUSIONS: We described a high prevalence of SARS-CoV-2 infection in CGL patients with a good outcome in all of them. These findings suggest that at least young CGL patients infected by SARS-COV-2 are not at higher risk of poor outcome, despite known severe metabolic comorbidities.

6.
Diabetes Metab Syndr Obes ; 14: 565-573, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33603422

RESUMEN

Type 1 diabetes mellitus (T1DM) results from the immune cell-mediated destruction of functional pancreatic ß-cells. In the presymptomatic period, T1DM is characterized by the presence of two or more autoantibodies against the islet cells in patients without glycemic decompensation. Therapeutic strategies that can modify the autoimmune process could slow the progression of T1DM. Dipeptidyl peptidase-4 (DPP-4) or CD26, a multifunctional serine protease with a dual function (regulatory protease and binding protein), can modulate inflammation and immune cell-mediated ß-cell destruction. CD26 is involved in T-cell co-stimulation, migration, memory development, thymic maturation, and emigration patterns. DPP-4 degrades the peptide hormones GLP-1 and GIP. In addition to regulating glucose metabolism, DPP-4 exerts anti-apoptotic, regenerative, and proliferative effects to promote ß-cell mass expansion. GLP-1 receptor signaling may regulate murine lymphocyte proliferation and maintenance of peripheral regulatory T-cells. In patients with T1DM, the serum DPP-4 activity is upregulated. Several studies have suggested that the upregulated DPP-4 activity is correlated with T1DM pathophysiology. DPP-4, which is preferentially expressed on the Th1 surface, can promote the polarization of Th1 immunity, a prerequisite for T1DM development. CD26 inhibition can suppress T-cell proliferation and Th1 cytokine production and stimulate tumor growth factor beta-1 (TGF-ß1) secretion, which plays an important role in the regulation of autoimmunity in T1DM. Studies on humans or animal models of T1DM have suggested that DPP-4 inhibitors can improve ß-cell function and attenuate autoimmunity in addition to decreasing insulin dependence. This review summarizes the emerging roles of DPP-4 inhibitors in potentially delaying the progression of T1DM.

7.
Arch Endocrinol Metab ; 64(4): 337-348, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32813762

RESUMEN

A literature review on the clinical, laboratory, and treatment features of type B insulin resistance syndrome (TBIRS). Data from PubMed, the Virtual Health Library and Cochrane database were selected and analyzed using the REDCap application and R statistical program. From 182 papers, 65 were selected, which assessed 119 clinical cases, 76.5% in females and 42.9% in African-Americans, with an average age of 44 years. A common feature of TBIRS is co-occurrence of autoimmune diseases, such as systemic lupus erythematosus (most frequently reported). Hyperglycemia of difficult control was the mostly reported condition. Tests for anti-insulin receptor antibodies were positive in 44.2% of the cases. Disease management comprised fractional diet, insulin therapy (maximum dose given was 57 600 IU/day), plasmapheresis and immunosuppression with several classes of drugs, mainly glucocorticoids. Remission occurred in 69.7% of cases, in 30.3% of these spontaneously. The mortality rate was 15.38%. There was an inverse relationship between anti-insulin antibodies and remission (p = 0.033); and a positive correlation between combined immunosuppressive therapy and remission (p = 0.002). Relapse occurred in 7.6% of the cases. This rare syndrome has difficult-to-control diabetes, even with high doses of insulin, and it is usually associated with autoimmune diseases. Therapeutic advances using immunomodulatory therapy have led to significant improvements in the rate of remission.


Asunto(s)
Enfermedades Autoinmunes , Diabetes Mellitus , Resistencia a la Insulina , Adulto , Autoanticuerpos , Femenino , Humanos , Masculino , Receptor de Insulina
8.
Diabetes Metab Syndr ; 14(5): 1217-1224, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32682310

RESUMEN

BACKGROUND AND AIMS: Metabolic Syndrome (MS) is increasing in developing countries. Different definitions of MS lead to discrepancies in prevalence estimates and applicability. We assessed the prevalence of MS as defined by the International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Plan III (Modified NCEP) and Joint Interim Statement (JIS); compared the diagnostic performance and association of these definitions of MS with pre-diabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. METHODS: A total of 714 randomly selected subjects from Northeastern Brazil were investigated in a cross-sectional study. Sociodemographic, anthropometric, and clinical data were recorded. Diagnostic test performance measures assessed the ability of the different MS definitions to identify those with pre-diabetes, T2DM and increased CVD risk. RESULTS: The adjusted prevalence of MS was 36.1% applying the JIS criteria, 35.1% the IDF and 29.5% Modified NCEP. Women were more affected by MS according to all definitions. MS was significantly associated with pre-diabetes, T2DM and CVD risk following the three definitions. However, the JIS and IDF definitions showed higher sensitivity than the Modified NCEP to identify pre-diabetes, T2DM and CVD risk. The odds ratios for those conditions were not significantly different when comparing the definitions. CONCLUSIONS: MS is highly prevalent in Brazil, particularly among those with pre-diabetes, T2DM, and high CVD risk. The IDF and JIS criteria may be better suited in the Brazilian population to identify pre-diabetes, T2DM and CVD risk. This may also signify the importance of the assessment of MS in clinical practice.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/fisiopatología , Síndrome Metabólico/fisiopatología , Estado Prediabético/fisiopatología , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores de Riesgo , Adulto Joven
9.
Diabetol Metab Syndr ; 12: 28, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32280377

RESUMEN

BACKGROUND: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by the near-total loss of subcutaneous adipose tissue soon after birth, resulting in ectopic fat deposition and severe metabolic disturbances. Most cases are caused by AGPAT2 or BSCL2 gene mutations. We aimed to report two unrelated CGL patients with a novel frameshift mutation in AGPAT2 (p.Leu124Serfs*26). METHODS: Clinical features and laboratory were obtained by medical interview and medical records review. DNA was extracted, amplified and sequenced. Mutation Taster was used to estimate the potential biological impact of the AGPAT2 mutations on the protein function. RESULTS: Patient 1: a 30-year-old woman with lipodystrophy phenotype at birth and diagnosis of diabetes at age 13 presented with severe hypertriglyceridemia and pancreatitis at age 17, hypertension and albuminuria at age 18, proliferative diabetic retinopathy with visual loss at age 25, and an acute myocardial infarction due to multivessel coronary disease during a hospitalization for forefoot amputation at age 29. At this time, she required hemodialysis due to end-stage renal disease. Patient 2: a 12-year-old girl with lipodystrophy phenotype and hypertriglyceridemia detected in the first year of life and abnormalities in the global longitudinal strain, evaluated by speckle-tracking echocardiography last year. Molecular analysis identified a c.369_372delGCTC (p.Leu124Serfs*26) AGPAT2 mutation in both unrelated patients, a compound heterozygous mutation in Patient 1, and homozygous mutation in Patient 2. CONCLUSION: We describe two unrelated patients with type 1 CGL due to Leu124Serfs*26, a novel AGPAT2 frameshift mutation, presenting as early cardiovascular disease. These findings suggest an association between Leu124Serfs*26 and a more aggressive phenotype.

10.
Clin Biochem ; 80: 1-7, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32209332

RESUMEN

BACKGROUND: Interleukin-18 (IL-18), a proinflammatory and proatherogenic cytokine, has been associated with type 2 diabetes, metabolic syndrome, stroke and coronary artery disease. Some studies have indicated that the IL-18 promoter -137 G/C polymorphism seems to be associated with changes in the IL-18 expression and may contribute to the development of cardiovascular disease (CVD). The aim of this study was to evaluate the association between -137 G/C polymorphism and the levels of IL-18, biochemical markers for cardiovascular disorders, anthropometric profile and cardiovascular disease in Brazilian patients with type 2 diabetes (T2DM). DESIGN & METHODS: Study subjects comprised 125 T2DM patients undergoing follow-up at a reference endocrinology service in northeastern Brazil. The -137G/C polymorphism in the IL-18 gene and serum IL-18 levels were determined by using allele-specific polymerase chain reaction (PCR) and enzyme-linked immune assay (ELISA), respectively. The anthropometric parameters were assessed using a Body Composition Monitor with Scale, and the laboratory data were measured using an automatic analyzer as well as spectrophotometric analysis. RESULTS: The genotype distribution of IL-18 -137 G/C genetic polymorphism was significantly different among T2DM patients with and without CVD. The results show an association between the CC genotype of -137G/C polymorphism and CVD in T2DM patients (p < 0.001). Serum levels of IL-18 were significantly higher in CC carriers (843.1 pg/mL) compared with GG or GC carriers (303.6 pg/mL and 292.0 pg/mL, respectively). In addition, the present study showed that carriers of the CC genotype also had significantly higher concentrations of creatinine and albuminuria than carriers of the GG or GC genotypes (p < 0.05 in both). CONCLUSION: These results suggest that Brazilian T2DM patients with the CC genotype seem to show a predisposition to CVD, as well as an elevation in markers of renal function.


Asunto(s)
Enfermedades Cardiovasculares/genética , Diabetes Mellitus Tipo 2/genética , Interleucina-18/genética , Regiones Promotoras Genéticas , Insuficiencia Renal/genética , Adulto , Anciano , Biomarcadores/sangre , Brasil/epidemiología , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Insuficiencia Renal/epidemiología
11.
Diabetes Metab Syndr Obes ; 13: 107-115, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32021357

RESUMEN

PURPOSE: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by the absence of functional adipocytes resulting in ectopic lipid storage, metabolic disorders and early cardiovascular disease. Two-dimensional speckle-tracking (2D-STE) allows the detection of early abnormalities in myocardial function. We aimed to evaluate myocardial deformation in a large sample of CGL patients using 2D-STE. PATIENTS AND METHODS: A cross-sectional study of 22 patients with CGL and 22 healthy subjects, matched for sex and age, was conducted from 2013 to 2018. All participants had undergone standard conventional echocardiography (ECHO) and 2D-STE. Determination of blood glucose, lipids, insulin, and leptin were performed in all CGL patients. RESULTS: In the CGL group the mean age was 14.6±10.7 years where 68.2% (n=15) were younger than 18 years old. All the patients had hypoleptinemia, 95.4% (21/22) low HDL-c, 86.4% (19/22) hypertriglyceridemia, 68.2% (15/22) diabetes, 50% (11/22) hepatic steatosis, 41% (9/22) insulin resistance, 41% (9/22) hypercholesterolemia, and 18.2% (4/22) hypertension. ECHO showed that 36.6% (8/22) of CGL patients presented diastolic dysfunction, 31.8% (7/22) left ventricular hypertrophy (LVH), 27.3% (6/22) increased left atrial volume index (LAVI), and 18.2% (4/22) increased left ventricular systolic diameter (LVDS) but normal ejection fraction (EF), whether using 2D-STE, 68.2% (15/22) of CGL patients showed abnormal global longitudinal strain (GLS) (p<0.01), and in almost LV segments. Positive association between abnormal GLS and A1c (r=0.57, p=0.005), glucose (r=0.5, p=0.018) and basal insulin (r= 0.69, p= 0.024), and negative association with leptin (r = -0.51, p = 0.005) were found in these patients. CONCLUSION: The 2D-STE revealed precocious left ventricular systolic dysfunction in a young CGL population with normal systolic function by ECHO. Early exposure to common metabolic abnormalities as insulin resistance, hyperglycemia, and hypoleptinemia must be involved in myocardial damage in these patients.

12.
Diabetol Metab Syndr ; 11: 53, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31303898

RESUMEN

Background: Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by the absence of subcutaneous adipose tissue, severe insulin resistance, diabetes mellitus, and cardiovascular complications, including cardiac autonomic neuropathy (CAN), left ventricular hypertrophy (LVH), and atherosclerosis. The present study aimed to access the association between CAN parameters and cardiovascular abnormalities in CGL patients. Methods: A cross-sectional study was conducted with 10 CGL patients and 20 healthy controls matched for age, sex, BMI, and pubertal stage. We evaluated clinical, laboratory, and cardiovascular parameters-left ventricular mass index (LVMI), interventricular septum thickness (IVS), systolic and diastolic function determined by two-dimensional transthoracic echocardiography; carotid intimal media thickness (cIMT); and cQT interval. Heart rate variability (HRV) was evaluated by spectral analysis components-high frequency (HF), low frequency (LF), very low frequency (VLF), LF/HF ratio, and total amplitude spectrum (TAS)-and cardiovascular reflexes tests (postural hypotension test, respiratory, orthostatic and Valsalva coefficients). Results: In CGL group, four patients (40%) had LVH and diastolic dysfunction. HF component (parasympathetic control) was lower in LVH patients. CGL patients presented higher values of cIMT and cQT interval than heathy subjects. Inverse association between LVMI and LF (p = 0.011), IVS and LF (p = 0.007), and cIMT and leptin (p < 0.001) were observed, even after adjustments by HOMA-IR, A1c, and blood pressure. In CGL group, there were associations between LMVI and HF component (IC95%: - 1.000; - 00.553), LVMI and TAS (IC95%: - 1.000; - 0.012), and IVS and HF component (IC95%: - 1.000; - 0.371). Conclusion: The association between increased LV mass and parameters of HRV provides possible speculations about the involvement of CAN in the pathophysiology of the cardiac complications, including LVH, in patients with CGL.

13.
Transplant Proc ; 51(6): 1956-1961, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31303408

RESUMEN

BACKGROUND: New-onset diabetes after transplant is a severe complication that can present in liver transplant recipients, negatively impacting quality of life and graft survival. It also contributes to increased risk of infection, cardiovascular disease, and rejection, which are the main causes of death among liver transplant recipients. The aim of the present study was to assess the risk factors associated with new-onset diabetes after transplant. METHOD: This was a case control study based on the data from 146 liver transplant patients at a reference hospital. The data from the charts were collected using a 2-part form: Part I (sociodemographic variables) and Part II (clinical variables). RESULTS: Multiple analysis showed that pre-existing systemic arterial hypertension (odds ratio [OR], 2.65; 95% CI, 1.12-6.28) and the use of sodium mycophenolate associated with tacrolimus (OR, 2.68; 95% CI, 1.02-7.06) increased the risk of new-onset diabetes after transplant. On comparing the anthropometric variables, lipid panel, and blood glucose levels of liver transplant patients with and without diabetes, higher glycemic levels were found in the group with diabetes (P < .001). CONCLUSION: Pre-existing systemic arterial hypertension and the associated use of sodium mycophenolate and tacrolimus increased the risk of new-onset diabetes after transplant.


Asunto(s)
Diabetes Mellitus/etiología , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Glucemia/análisis , Estudios de Casos y Controles , Femenino , Humanos , Hipertensión/complicaciones , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/efectos adversos , Periodo Preoperatorio , Factores de Riesgo , Tacrolimus/efectos adversos
14.
Arch Endocrinol Metab ; 63(1): 79-83, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30864635

RESUMEN

Thyroid carcinoma (TC) is rare in children, particularly in those aged < 10 years. Several studies have demonstrated a correlation between neoplasms and hyperinsulinemia and insulin resistance, which are often associated with a higher risk for and/or aggressiveness of the neoplasm. Congenital generalized lipodystrophy (CGL) with autosomal recessive inheritance is a rare disease and is characterized by the lack of adipose tissue, severe insulin resistance, and early metabolic disturbances. Here, we reported a rare case of a type 2 CGL in a girl who presented with a papillary TC (PTC) at the age of 7 years. She had no family history of TC or previous exposure to ionizing radiation. She had a generalized lack of subcutaneous fat, including the palmar and plantar regions, muscle hypertrophy, intense acanthosis nigricans, hepatomegaly, hypertriglyceridemia, severe insulin resistance, and hypoleptinemia. A genetic analysis revealed a mutation in the BSCL2 gene (p.Thr109Asnfs* 5). Ultrasound revealed a hypoechoic solid nodule measuring 1.8 × 1.0 × 1.0 cm, and fine needle aspiration biopsy suggested malignancy. Total thyroidectomy was performed, and a histopathological examination confirmed PTC with vascular invasion and parathyroid lymph node metastasis (pT3N1Mx stage). This is the first report to describe a case of differentiated TC in a child with CGL. Severe insulin resistance that is generally observed in patients with CGL early in life, especially in those with type 2 CGL, may be associated with this uncommon presentation of aggressive PTC during childhood.


Asunto(s)
Lipodistrofia Generalizada Congénita/diagnóstico , Cáncer Papilar Tiroideo/complicaciones , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/diagnóstico , Niño , Femenino , Humanos , Lipodistrofia Generalizada Congénita/complicaciones , Lipodistrofia Generalizada Congénita/genética , Cáncer Papilar Tiroideo/diagnóstico , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/genética
15.
Rev. bras. med. fam. comunidade ; 14(41): e1818, fev. 2019. tab, ilus
Artículo en Portugués | LILACS, Coleciona SUS | ID: biblio-996066

RESUMEN

Introdução: A visita domiciliar permite ao profissional de saúde romper com o modelo centrado na doença, voltando-se para uma abordagem centrada no indivíduo. No entanto, observa-se uma grande deficiência na organização e gestão destas, o que muitas vezes dificulta a priorização mais adequada destes pacientes. Objetivo: Apresentar a experiência de uma equipe ao utilizar uma nova ferramenta para avaliação e classificação de risco que visa otimizar a gestão da agenda das visitas domiciliares. Métodos: Trata-se de um relato de experiência de uma equipe de saúde da família, na periferia de uma capital no Nordeste do Brasil, que aplicou esta ferramenta aos pacientes de visita domiciliar entre os meses de junho e novembro de 2017. Resultados: Os dados coletados foram analisados, sendo possível classificar os pacientes quanto ao risco e vulnerabilidade. Esta ferramenta favoreceu o fortalecimento e estruturação do registro, planejamento, avaliação e monitoramento das visitas realizadas nos território. Além disso, deve ser ressaltada sua fácil aplicação e a reprodutibilidade em diferentes cenários da atenção primária. Conclusão: O uso de instrumentos adequados permite identificar pacientes em situação de risco e vulnerabilidade, além de possibilitar a organização da agenda, a identificação das necessidades das pessoas, o acompanhamento das doenças crônicas, propor estratégias, e planejar intervenções futuras.


Introduction: The home visit allows the health professional to break the disease-centered model, turning to an individual-centered approach. However, there is a great deficiency in the organization and management of these, which often makes it more difficult to prioritize these patients. Objective: To present the experience of a team when using a new risk evaluation and classification tool that aims to optimize the management of the home visits schedule. Methods: This is an report of the experience of a family health team, in a peripheric neighborhood of a capital city in the northeast of Brazil, that applied this tool with patients who applied this tool to home visiting patients in the period between June and November 2017. Results: The data collected were analyzed and it was possible to classify the patients regarding risk and vulnerability. This tool favored the strengthening and structuring of the registration, planning, evaluation and monitoring of the visits made in the territory. In addition, its easy application and reproducibility in different primary care settings should be emphasized. Conclusion: The use of appropriate instruments allows the identification of patients at risk and vulnerability, besides organizing the agenda, identifying people's needs, monitoring chronic diseases, proposing strategies, and planning for future interventions


Introducción: La visita domiciliaria permite al profesional de la salud romper con el modelo centrado en la enfermedad, volviéndose hacia un enfoque centrado en el individuo. Sin embargo, se observa una gran deficiencia en la organización y gestión de éstas, lo que a menudo dificulta la priorización más adecuada de estos pacientes. Objetivo: Presentar la experiencia de un equipo en la utilización de una nueva herramienta de evaluación y clasificación de riesgo que visa optimizar la gestión de la agenda de visitas domiciliarias. Métodos: Tratase de un relato de experiencia de un equipo de salud de la familia en la periferia de una capital en el Nordeste de Brasil, donde se aplicó esta herramienta con pacientes asistidos en domicilio entre los meses de junio y noviembre de 2017. Resultados: Los dados obtenidos fueron analizados, siendo posible clasificar según el riesgo y la vulnerabilidad. Esta herramienta favoreció el fortalecimiento y estructuración de registro, planificación, evaluación y monitoreo de las visitas realizadas en el territorio. Además, llamamos la atención a su fácil aplicabilidad y reproductibilidad en diferentes escenarios de la atención primaria a la salud. Conclusión: El uso de instrumentos adecuados permite identificar pacientes en situación de riesgo y vulnerabilidad, además de posibilitar la organización de la agenda, la identificación de las necesidades de las personas, el seguimiento de las enfermedades crónicas, proponer estrategias, y planificar intervenciones futuras


Asunto(s)
Humanos , Organización y Administración , Atención Primaria de Salud , Evaluación en Salud , Servicios de Atención de Salud a Domicilio
16.
Arch. endocrinol. metab. (Online) ; 63(1): 79-83, Jan.-Feb. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-989300

RESUMEN

SUMMARY Thyroid carcinoma (TC) is rare in children, particularly in those aged < 10 years. Several studies have demonstrated a correlation between neoplasms and hyperinsulinemia and insulin resistance, which are often associated with a higher risk for and/or aggressiveness of the neoplasm. Congenital generalized lipodystrophy (CGL) with autosomal recessive inheritance is a rare disease and is characterized by the lack of adipose tissue, severe insulin resistance, and early metabolic disturbances. Here, we reported a rare case of a type 2 CGL in a girl who presented with a papillary TC (PTC) at the age of 7 years. She had no family history of TC or previous exposure to ionizing radiation. She had a generalized lack of subcutaneous fat, including the palmar and plantar regions, muscle hypertrophy, intense acanthosis nigricans, hepatomegaly, hypertriglyceridemia, severe insulin resistance, and hypoleptinemia. A genetic analysis revealed a mutation in the BSCL2 gene (p.Thr109Asnfs* 5). Ultrasound revealed a hypoechoic solid nodule measuring 1.8 × 1.0 × 1.0 cm, and fine needle aspiration biopsy suggested malignancy. Total thyroidectomy was performed, and a histopathological examination confirmed PTC with vascular invasion and parathyroid lymph node metastasis (pT3N1Mx stage). This is the first report to describe a case of differentiated TC in a child with CGL. Severe insulin resistance that is generally observed in patients with CGL early in life, especially in those with type 2 CGL, may be associated with this uncommon presentation of aggressive PTC during childhood.


Asunto(s)
Humanos , Femenino , Niño , Neoplasias de la Tiroides/diagnóstico , Lipodistrofia Generalizada Congénita/diagnóstico , Cáncer Papilar Tiroideo/complicaciones , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/genética , Lipodistrofia Generalizada Congénita/complicaciones , Lipodistrofia Generalizada Congénita/genética , Cáncer Papilar Tiroideo/diagnóstico
17.
Arch Endocrinol Metab ; 62(5): 566-570, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30462811

RESUMEN

Insulin autoimmune syndrome (IAS, Hirata's disease) is a rare hypoglycemic disorder characterized by spontaneous hypoglycemia associated with extremely high circulating insulin levels and positive anti-insulin antibody results. Thus far, most cases have been reported in Asian countries, notably Japan, with few cases reported in western countries. As a possible cause, it is associated with the use of drugs containing sulfhydryl radicals, such as captopril. This report refers to a 63-year-old female Brazilian patient with a history of postprandial hypoglycemia. After extensive investigation and exclusion of other causes, her hyperinsulinemic hypoglycemia was considered to have likely been induced by captopril. Most cases of IAS are self-limiting. However, dietary management, corticosteroids, plasmapheresis, and rituximab have already been used to treat patients with IAS. In our case, after discontinuation of captopril, an initial decrease in insulin autoantibody levels was observed followed by improvement in episodes of hypoglycemia. Although it is a rare disease, IAS should be considered in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia. Patients with suspected IAS must be screened for autoimmunity-related drugs for insulin. Initial clinical suspicion of IAS can avoid unnecessary costs associated with imaging examinations and/or invasive surgical procedures.


Asunto(s)
Antihipertensivos/efectos adversos , Enfermedades Autoinmunes/inducido químicamente , Captopril/efectos adversos , Hipoglucemia/inducido químicamente , Hipoglucemia/inmunología , Anticuerpos Insulínicos/efectos de los fármacos , Enfermedades Autoinmunes/etnología , Enfermedades Autoinmunes/inmunología , Glucemia/análisis , Brasil , Femenino , Humanos , Hipoglucemia/etnología , Anticuerpos Insulínicos/inmunología , Persona de Mediana Edad , Síndrome
18.
Arch. endocrinol. metab. (Online) ; 62(5): 566-570, Oct. 2018. tab, graf
Artículo en Inglés | LILACS | ID: biblio-983788

RESUMEN

SUMMARY Insulin autoimmune syndrome (IAS, Hirata's disease) is a rare hypoglycemic disorder characterized by spontaneous hypoglycemia associated with extremely high circulating insulin levels and positive anti-insulin antibody results. Thus far, most cases have been reported in Asian countries, notably Japan, with few cases reported in western countries. As a possible cause, it is associated with the use of drugs containing sulfhydryl radicals, such as captopril. This report refers to a 63-year-old female Brazilian patient with a history of postprandial hypoglycemia. After extensive investigation and exclusion of other causes, her hyperinsulinemic hypoglycemia was considered to have likely been induced by captopril. Most cases of IAS are self-limiting. However, dietary management, corticosteroids, plasmapheresis, and rituximab have already been used to treat patients with IAS. In our case, after discontinuation of captopril, an initial decrease in insulin autoantibody levels was observed followed by improvement in episodes of hypoglycemia. Although it is a rare disease, IAS should be considered in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia. Patients with suspected IAS must be screened for autoimmunity-related drugs for insulin. Initial clinical suspicion of IAS can avoid unnecessary costs associated with imaging examinations and/or invasive surgical procedures.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedades Autoinmunes/inducido químicamente , Captopril/efectos adversos , Hipoglucemia/inducido químicamente , Hipoglucemia/inmunología , Anticuerpos Insulínicos/efectos de los fármacos , Antihipertensivos/efectos adversos , Enfermedades Autoinmunes/etnología , Enfermedades Autoinmunes/inmunología , Síndrome , Glucemia/análisis , Brasil , Hipoglucemia/etnología , Anticuerpos Insulínicos/inmunología
19.
Cad. Esp. (Ceará) ; 12(1)jan.-jun. 2018.
Artículo en Portugués | Coleciona SUS | ID: biblio-967190

RESUMEN

A partir de 2011, os Ministérios da Saúde e da Educação instituíram programas para prover e fixar os profissionais médicos na atenção primária do Brasil. Este artigo tem como objetivo trazer um relato da implantação destes programas no Ceará a partir de 2012. Trata-se de um estudo descritivo, realizado através de análise documental e coleta de dados que relata a experiência da implantação e implementação dos programas de provimento no estado do Ceará, compreendendo o período entre 2012 e 2016. O Ceará possui, atualmente, 2.352 equipes de saúde da família implantadas, sendo que mais da metade destas são vinculadas aos programas de provimento. Observou-se que 69% dos médicos trabalham nos municípios classificados como G100 e Pobreza. Por meio deste relato de experiência, pode-se considerar a possibilidade de ampliação do número de equipes de saúde da família, capacitando a oportunidade do provimento de médicos para municípios classificados como de extrema pobreza e vulnerabilidade no interior do estado, além de promover a longitudinalidade do cuidado.(AU)


As of 2011, the Ministries of Health and Education have instituted programs to provide and fix medical professionals in primary care in Brazil. This article aims to provide an account of the implementation of these programs in Ceará from 2012. This is a descriptive study, conducted through documentary analysis and data collection that reports on the experience of the implementation of the state's welfare programs of Ceará, comprising the period between 2012 to 2016. Ceará currently has 2,352 family health teams implanted, more than half of which are linked to the provision programs. It was observed that 69% of doctors work in municipalities classified as G100 and Poverty. Through this experience report, it is possible to consider the possibility of expanding the number of family health teams, enabling the provision of doctors to municipalities classified as extreme poverty and vulnerability within the state, in addition to promoting longitudinality of care.(AU)


Asunto(s)
Atención Primaria de Salud , Política Pública , Distribución de Médicos , Equidad en Salud , Programas Nacionales de Salud , Brasil
20.
BMC Cardiovasc Disord ; 18(1): 6, 2018 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-29329523

RESUMEN

BACKGROUND: Metabolic abnormalities in congenital generalized lipodystrophy (CGL) are associated with microvascular complications. However, the evaluation of different types of neuropathy in these patients, including the commitment of cardiovascular autonomic modulation, is scarce. The objective of the present study was to determine the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with CGL compared with individuals with type 1 diabetes and healthy subjects. METHODS: Ten patients with CGL, 20 patients with type 1 diabetes and 20 healthy subjects were included in the study. Controls were paired 1:2 for age, gender, BMI and pubertal stage. Heart rate variability (HRV) was analyzed using cardiovascular autonomic reflex tests, including postural hypotension test, Valsalva (VAL), respiratory (E/I) and orthostatic (30/15) coefficients, and spectral analysis of the HRV, determining very low (VLF), low (LF) and high (HF) frequencies components. The diagnosis of CAN was defined as the presence of at least two altered tests. RESULTS: CAN was detected in 40% of the CGL patients, 5% in type 1 diabetes patients and was absent in healthy individuals (p < 0.05). We observed a significant reduction in the E/I, VLF, LF and HF in CGL cases vs. type 1 diabetes and healthy individuals and lower levels of 30/15 and VAL in CGL vs. healthy individuals. A significant positive correlation was observed between leptin and 30/15 coefficient (r = 0.396; p = 0.036) after adjusting for insulin resistance and triglycerides. Autonomic cardiovascular tests were associated with HbA1c, HOMA-IR, triglycerides and albumin/creatinine ratio in CGL cases. CONCLUSIONS: We observed a high prevalence of CAN in young patients with CGL, suggesting that insulin resistance, hypertriglyceridemia and hypoleptinemia, may have been involved in early CAN development. Additional studies are needed to evaluate the role of leptinemia in the physiopathogenesis of the condition.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Sistema Nervioso Autónomo/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Sistema Cardiovascular/inervación , Frecuencia Cardíaca , Lipodistrofia Generalizada Congénita/fisiopatología , Adolescente , Adulto , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/epidemiología , Biomarcadores/sangre , Glucemia/metabolismo , Brasil/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Niño , Creatinina/sangre , Estudios Transversales , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/fisiopatología , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/fisiopatología , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Insulina/sangre , Resistencia a la Insulina , Leptina/sangre , Lipodistrofia Generalizada Congénita/diagnóstico , Lipodistrofia Generalizada Congénita/epidemiología , Masculino , Prevalencia , Albúmina Sérica Humana/análisis , Triglicéridos/sangre
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