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2.
Nurs Res ; 70(1): 15-23, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32991530

RESUMEN

BACKGROUND: Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality. OBJECTIVES: This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed. METHODS: Data from hospitalizations of patients who experienced hypoglycemia (<70 mg/dl) and met inclusion criteria 1 year prior to intervention and 3 years postintervention were extracted, including demographics, glycemic control medications, diagnostic-related group, length of stay, and Charlson comorbidity index. For clarity and to determine if any significant change was sustained, the analysis compared data from 1 year prior to intervention to the second-year postintervention. RESULTS: A total of 7,895 unique hypoglycemic events in 3,819 patients experiencing 20,094 hypoglycemic measures were included in the analysis. Patients were primarily adult, female, and White. Only 58.7% of the sample had diabetes; the median Charlson comorbidity index was 6. Results demonstrated improvement postintervention to registered nurse hypoglycemia protocol adherence regardless of age category or hypoglycemia severity. There was a significant reduction in median time from the first hypoglycemia measure to the second measure. In addition, there was a significant difference in the number of treatment interventions and reduction in time from the first hypoglycemia measure to return of patient to a blood glucose of ≥70 mg/dl. DISCUSSION: These study results support that the use of a standardized hypoglycemia protocol and appropriate nurse workflows enables nurses to manage hypoglycemia promptly and effectively in most acute and critically ill hospitalized patients. Results also supported a differentiation in nurse workflow for patients with mild versus severe hypoglycemia. Implementing these interventions may result in avoidance or mitigation of the potential consequences of severe and/or sustained hypoglycemia.


Asunto(s)
Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/fisiopatología , Hospitalización/estadística & datos numéricos , Hipoglucemia/inducido químicamente , Hipoglucemia/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/análisis , Niño , Preescolar , Enfermedad Crítica/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
3.
Acta Pharm ; 71(2): 175-184, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33151168

RESUMEN

Recently, an outbreak of a fatal coronavirus, SARS-CoV-2, has emerged from China and is rapidly spreading worldwide. Possible interaction of SARS-CoV-2 with DPP4 peptidase may partly contribute to the viral pathogenesis. An integrative bioinformatics approach starting with mining the biomedical literature for high confidence DPP4-protein/gene associations followed by functional analysis using network analysis and pathway enrichment was adopted. The results indicate that the identified DPP4 networks are highly enriched in viral processes required for viral entry and infection, and as a result, we propose DPP4 as an important putative target for the treatment of COVID-19. Additionally, our protein-chemical interaction networks identified important interactions between DPP4 and sitagliptin. We conclude that sitagliptin may be beneficial for the treatment of COVID-19 disease, either as monotherapy or in combination with other therapies, especially for diabetic patients and patients with pre-existing cardiovascular conditions who are already at higher risk of COVID-19 mortality.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Dipeptidil Peptidasa 4/efectos de los fármacos , Inhibidores de la Dipeptidil-Peptidasa IV/farmacología , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Fosfato de Sitagliptina/farmacología , Fosfato de Sitagliptina/uso terapéutico , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/tratamiento farmacológico , Biología Computacional , Infecciones por Coronavirus/complicaciones , Cristalografía por Rayos X , Minería de Datos , Complicaciones de la Diabetes/tratamiento farmacológico , Sistemas de Liberación de Medicamentos , Reposicionamiento de Medicamentos , Redes Reguladoras de Genes , Humanos , Estructura Molecular , Pandemias , Neumonía Viral/complicaciones
4.
Probl Endokrinol (Mosk) ; 66(1): 35-46, 2020 08 04.
Artículo en Ruso | MEDLINE | ID: mdl-33351311

RESUMEN

BACKGROUND: Data on the national level and worldwide show a higher rate of mortality in patients with diabetes mellitus (DM) due to COVID-19, which determines the high relevance of risk factor analysis for outcomes in DM patients to substantiate the strategy for this category of patients. AIM: To assess the effect of clinical and demographic parameters (age, gender, body mass index (BMI), glycemic control (HbA1c), and antidiabetic and antihypertensive drugs, including ACE inhibitors and ARBs) on clinical outcomes (recovery or death) in patients with type 2 DM. MATERIALS AND METHODS: A retrospective analysis of the Russian Register of Diabetes database was performed, including patients with type 2 DM (n=309) who suffered pneumonia/COVID-19 in the period from 01.02.2020 to 27.04.2020 and the indicated outcome of the disease (recovery or death) RESULTS: The percentage of lethality was determined to be 15.2% (47 of 309 people). The degree of lethality was found to be significantly higher in males (OR=2.08; 95% CI 1.1–3.9; p=0.022) and in patients on insulin therapy (OR=2.67; 95% CI; 1.42–5.02; p=0.002), while it was significantly lower in patients with an age <65 years (OR=0.34; 95% CI 0.18–0.67; p=0.001) and in patients receiving metformin (OR=0.26; 95% CI 0.14–0,5; p<0.0001), antihypertensive therapy (OR=0.43; 95% CI 0.22–0.82; p=0.009), β-blockers (OR=0.26; 95% CI 0.08–0.86; p=0.018), diuretics (OR=0.4; 95% CI 0.17–0.93; p=0.028) and renin-angiotensin system blockers (ACE inhibitors or ARBs) (OR=0.36; 95% CI 0.18–0.74; p=0.004). A tendency to an increase in lethality at higher rates of HbA1c and BMI was present, but it did not reach a statistical significance. Differences between patients receiving insulin therapy and those who were not receiving the insulin therapy were observed as follows: a significantly longer duration of type 2 DM (13.4 vs. 6.8 years, respectively; p<0.0001), worse overall glyacemic control (HbA1c: 8.1% vs. 7.0%, resp.; p<0.0001), and three times more frequent failure to achieve the HbA1c goal by more than 2.5% (14.7% vs. 5.9%, resp.; p=0.04). CONCLUSION: The identified risk factors for lethality in patients with type 2 DM indicate that good glycemic control and previous treatment with metformin and antihypertensive drugs (including RAS blockers) could reduce the frequency of deaths. In patients on insulin therapy, a higher lethality degree was associated with worse glycemic control.


Asunto(s)
/mortalidad , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/mortalidad , Hipertensión/mortalidad , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , /tratamiento farmacológico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/virología , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/virología , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/virología , Insulina/metabolismo , Masculino , Metformina/efectos adversos , Metformina/uso terapéutico , Federación de Rusia/epidemiología , /patogenicidad
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(10): 650-657, dic. 2020. tab, graf
Artículo en Inglés | IBECS | ID: ibc-197677

RESUMEN

BACKGROUND: There are few data available in the literature on the prevalence of diabetes mellitus (DM) in patients with home enteral nutrition (HEN) via tube feeding. The objective was to analyze the prevalence of DM in patients receiving HEN, as well as evaluating the complications, the prescribed antidiabetic treatments and the nutrition regimen selected. DESIGN: This was a retrospective, single-center, observational study reviewing clinical histories. The population consisted of patients over 18 years of age who started HEN by tube between January 2016 and January 2018. Sociodemographic variables were recorded, as well as variables related to HEN. Additional variables were recorded in patients with DM. RESULTS: In the 198 study patients, followed up for a median of 104 days, the prevalence of DM was 31.8%, and patients with DM were older (71.3±11.5 vs. 64.2±15.8; p = 0.002) than those without DM. There were no differences between patients with and without DM as regards the prescription of HEN, its route and form of administration, and its complications. One hundred and thirty-two patients (66.7%) died during follow-up. The presence of DM did not increase the risk of death during follow-up (after adjusting for age, gender, and diagnosis). More than 85% of patients with DM received a specific formula for diabetes, and 84.1% of these patients received drug treatment. CONCLUSION: The prevalence of DM was high in patients receiving HEN, most of whom were prescribed specific enteral nutrition formulas. The presence of DM was not associated with greater morbidity and mortality or with differences in HEN regimens or indications


INTRODUCCIÓN: Existen pocos datos en la literatura sobre la prevalencia de la diabetes mellitus (DM) en los pacientes con nutrición enteral domiciliaria (NED) por sonda. El objetivo es analizar la prevalencia de los pacientes con DM en NED, las complicaciones, el tratamiento antidiabético y las pautas nutricionales escogidas. DISEÑO: Estudio observacional retrospectivo unicéntrico con revisión de historias clínicas. Población: pacientes mayores de 18 años que iniciaron NED y ambulatoria mediante sonda desde enero de 2016 a enero de 2018. Se recogieron variables sociodemográficas y relacionadas con la NED. En personas con DM se recogieron otras variables adicionales. RESULTADOS: Ciento noventa y ocho pacientes con una mediana de seguimiento de 104 días. La prevalencia de la DM fue del 31,8%, con mayor edad (71,3±11,5 vs. 64,2±15,8; p = 0,002) que los no DM. No encontramos diferencias entre personas con DM y sin ella respecto a la indicación de la NED, vía y forma de administración ni complicaciones mecánicas o infecciosas. Fallecieron 132 pacientes (66,7%) durante el seguimiento. La presencia de diabetes no incrementó el riesgo de fallecer durante el seguimiento (ajustado por la edad, el género y el diagnóstico). Más del 85% de los pacientes con DM recibieron una fórmula específica para diabetes. El 84,1% de los pacientes con DM recibieron tratamiento farmacológico. CONCLUSIÓN: En pacientes con NED por sonda, la prevalencia de DM fue elevada, y los pacientes recibieron mayoritariamente fórmulas nutricionales específicas. La presencia de diabetes no se asoció con una mayor morbimortalidad o diferencias en las pautas o indicaciones de la NED


Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Diabetes Mellitus/dietoterapia , Diabetes Mellitus/epidemiología , Nutrición Parenteral en el Domicilio/métodos , Nutrición Parenteral en el Domicilio/instrumentación , Complicaciones de la Diabetes/tratamiento farmacológico , Estudios Retrospectivos , Hipoglucemiantes/uso terapéutico
6.
Medicine (Baltimore) ; 99(45): e23086, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157977

RESUMEN

BACKGROUND: Diabetic gastroparesis (DGP) is one of the common complications of diabetes. Accumulated evidences have shown that acupoint injection is beneficial for the clinical treatment of diabetic gastroparesis. However, there is currently no systematic review to assess this therapy. This program aims to evaluate the effectiveness and safety of this therapy for the patients with DGP. METHODS AND ANALYSIS: Literature search will be conducted via following electronic bibliographic databases from inception to Aug 2020: the Cochrane Library, PubMed, MEDLINE, Web of Science, EMBASE, Springer, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Chinese Scientific Journal Database (VIP), Wan-Fang Database. All randomized controlled trials published in English or Chinese related to acupoint injection for DGP will be included. The primary outcome is the total effective rate. The secondary outcomes are the change of motilin and gastrin levels before and after the treatment. Two researchers will be responsible for the selection of study, extraction of data, and assessment of study quality independently. RevMan V5.3 Software will be used for assessing the risk of bias and synthesizing data. RESULTS: This study will provide a high-quality synthesis of current available evidence for the treatment of DGP with this therapy clinically. CONCLUSION: The conclusions of our study will provide new evidence to judge whether acupoint injection is an effective intervention for patients suffered from DGP. OSF REGISTRATION NUMBER:: osf.io/ms58j.


Asunto(s)
Puntos de Acupuntura , Complicaciones de la Diabetes/tratamiento farmacológico , Gastroparesia/tratamiento farmacológico , Metaanálisis como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Humanos , Inyecciones/efectos adversos , Inyecciones/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
7.
Medicine (Baltimore) ; 99(41): e22592, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031311

RESUMEN

BACKGROUND: DM is a common chronic metabolic disease. COVID-19 is a large-scale infectious disease. Some studies have shown that DM is an independent risk factor that increases COVID-19 mortality or other adverse outcomes. There is currently no specific and effective drug treatment. More and more people realize that DPP-4 inhibitors may play a huge role in fighting COVID-19 combined with diabetes. However, there is no evidence-based medicine to confirm the effectiveness and safety of DPP-4 inhibitors in the treatment of COVID-19 patients with diabetes. Therefore, we will conduct a systematic review and meta-analysis to synthesize the existing clinical evidence. METHODS AND ANALYSIS: Electronic databases include CNKI, Wanfang, VIP, CBM database, Cochrane Library, PubMed, Web of Science, EMBASE, etc. We will retrieve each database from December 2019 to September 2020. At the same time, we will look for clinical trial registration and gray literature. This study only included clinical randomized controlled trials. The reviewers independently conduct literature selection, data analysis, quality analysis, and evaluation. The primary outcomes include mortality rate, morbidity, interleukin-6, tumor necrosis factor-alpha, clinical improvement, symptoms improvement, fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, fasting insulin, adverse reactions, etc. Finally, we will conducted a meta-analysis through Review Manager Software version 5.3. RESULTS: The results will be published in peer-reviewed journals and presented at a relevant conference. CONCLUSION: This study will explore the effectiveness and safety of DPP-4 inhibitors in the treatment of COVID-19 patients with diabetes. It will provide evidence-based medical evidence for DPP-4 inhibitors in the treatment of diabetes with COVID-19. REGISTRATION NUMBER: INPLASY202090015.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Complicaciones de la Diabetes/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Betacoronavirus , Humanos , Metaanálisis como Asunto , Pandemias , Revisiones Sistemáticas como Asunto
9.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 36(3): 193-196, 2020 May.
Artículo en Chino | MEDLINE | ID: mdl-32981270

RESUMEN

Objective: To investigate the protective effect of spermine (Sp) on diabetic cardiomyopathy (DCM) and high glucose-induced cardiac fibroblasts (CFs), and to explore its mechanism.Methods: ①Animal experiments: 24 male Wistar rats were randomly divided into control group, type 1 diabetes group (TID) and spermine group (TID+Sp, each group n=8). TID rats were induced by streptozocin (STZ, 60 mg/kg), and TID+Sp rat were pretreated with spermine (Sp, 5 mg/(kg·d)) for 2 weeks before STZ injection. After 12 weeks of modeling, blood glucose, insulin levels, ejection fraction (EF) and shortening fraction (FS) were measured, and Masson staining and Sirius red staining were performed in the rat cardiac tissues. ②Cell experiments: primary CFs were extracted from newborn (1-3 d) Wistar rat hearts, and were randomly divided into control group, high-glucose group (HG) and HG+Sp group (n=6 per group). HG group was treated with 40 mmol/L glucose, and the HG+Sp group was pretreated with 5 µmol/L Sp for 30 min before HG treatment. The cell viability of CFs was detected by CCK8, the content of collagen in culture medium was analyzed by ELISA, and protein expressions of cell cycle related proteins (PCNA, CyclinD1 and P27) were detected by Western blot. Results: Compared with control group, the blood glucose and collagen content were increased, and the insulin level and heart function were decreased in the T1D group. Meanwhile, HG induced an increasing of the cell viability, the collagen content in the medium and the expressions of PCNA and CyclinD1, while the expression of P27 was down-regulated. Spermine could reduce the above changes, manifested as improving the cardiac function, regulating the expression of cyclin and reducing the level of myocardial fibrosis. Conclusion: Spermine can alleviate myocardial fibrosis in diabetic cardiomyopathy, which mechanism is related to the regulation of cell cycle.


Asunto(s)
Ciclo Celular , Complicaciones de la Diabetes , Cardiomiopatías Diabéticas , Fibrosis , Espermina , Animales , Glucemia/análisis , Glucemia/efectos de los fármacos , Ciclo Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Complicaciones de la Diabetes/inducido químicamente , Complicaciones de la Diabetes/tratamiento farmacológico , Cardiomiopatías Diabéticas/inducido químicamente , Cardiomiopatías Diabéticas/complicaciones , Cardiomiopatías Diabéticas/tratamiento farmacológico , Fibroblastos/efectos de los fármacos , Fibrosis/tratamiento farmacológico , Fibrosis/etiología , Glucosa/toxicidad , Corazón/efectos de los fármacos , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar , Espermina/farmacología , Espermina/uso terapéutico
10.
Diab Vasc Dis Res ; 17(7): 1479164120942119, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32744067

RESUMEN

Type 2 diabetes mellitus is a type of metabolic disorder characterized by hyperglycaemia with multiple serious complications, such as diabetic neuropathies, diabetic nephropathy, diabetic retinopathy, and diabetic foot. Platelet-derived growth factors are growth factors that regulate cell growth and division, playing a critical role in diabetes and its harmful complications. This review focused on the cellular mechanism of platelet-derived growth factors and their receptors on diabetes development. Furthermore, we raise some proper therapeutic molecular targets for the treatment of diabetes and its complications.


Asunto(s)
Complicaciones de la Diabetes/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Receptores del Factor de Crecimiento Derivado de Plaquetas/metabolismo , Animales , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemiantes/uso terapéutico , Factor de Crecimiento Derivado de Plaquetas/antagonistas & inhibidores , Factor de Crecimiento Derivado de Plaquetas/uso terapéutico , Receptores del Factor de Crecimiento Derivado de Plaquetas/antagonistas & inhibidores , Transducción de Señal
11.
J Diabetes Res ; 2020: 1652403, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32851093

RESUMEN

Background: Since December 2019, novel coronavirus- (SARS-CoV-2) infected pneumonia (COVID-19) has rapidly spread throughout China. This study is aimed at describing the characteristics of COVID-19 patients in Wuhan. Methods: 199 COVID-19 patients were admitted to Wuhan Red Cross Hospital in China from January 24th to March 15th. The cases were divided into diabetic and nondiabetic groups according to the history of taking antidiabetic drugs or by plasma fasting blood glucose level at admission, and the difference between groups were compared. Results: Among 199 COVID-19 patients, 76 were diabetic and 123 were nondiabetic. Compared with nondiabetics, patients with diabetes had an older age, high levels of fasting plasma glucose (FPG), D-dimer, white blood cell, blood urea nitrogen (BUN) and total bilirubin (TBIL), lower levels of lymphocyte, albumin and oxygen saturation (SaO2), and higher mortality (P < 0.05). The two groups showed no difference in clinical symptoms. Diabetes, higher level of D-dimer at admission, and lymphocyte count less than 0.6 × 109/L at admission were associated with increasing odds of death. Antidiabetic drugs were associated with decreasing odds of death. Treatment with low molecular weight heparin was not related to odds of death. Conclusion: The mortality rate of COVID-19 patients with diabetes was significantly higher than those without diabetes. Diabetes, higher level of D-dimer, and lymphocyte count less than 0.6 × 109/L at admission were the risk factors associated with in-hospital death.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/mortalidad , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Anciano , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Estudios de Casos y Controles , China/epidemiología , Técnicas de Laboratorio Clínico/métodos , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Hipoglucemiantes/uso terapéutico , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , ARN Viral/análisis , Estudios Retrospectivos , Factores de Riesgo
12.
BMC Infect Dis ; 20(1): 614, 2020 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-32811466

RESUMEN

BACKGROUND: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. CASE PRESENTATION: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. CONCLUSION: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.


Asunto(s)
Complicaciones de la Diabetes/microbiología , Mucorales/genética , Mucormicosis/complicaciones , Enfermedades Orbitales/complicaciones , Rinitis/complicaciones , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Biopsia , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/cirugía , Resultado Fatal , Humanos , Huésped Inmunocomprometido , Masculino , Maxilar/microbiología , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Mucormicosis/cirugía , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/cirugía , ARN Ribosómico 28S/genética , Rinitis/tratamiento farmacológico , Rinitis/microbiología , Rinitis/cirugía
13.
Med Hypotheses ; 143: 110111, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32721805

RESUMEN

Patients with SARS-CoV-2 infections experience lymphopenia and inflammatory cytokine storms in the severe stage of the disease, leading to multi-organ damage. The exact pattern of immune system changes and their condition during the disease process is unclear. The available knowledge has indicated that the NF-kappa-B pathway, which is induced by several mediators, has a significant role in cytokine storm through the various mechanisms. Therefore, identifying the state of the immune cells and the dominant mechanisms for the production of cytokines incorporated in the cytokine storm can be a critical step in the therapeutic approach. On the other hand, some studies identified a higher risk for diabetic patients. Diabetes mellitus exhibits a close association with inflammation and increases the chance of developing COVID-19. Patients with diabetes mellitus have shown to have more virus entry, impaired immunity response, less viral elimination, and dysregulated inflammatory cytokines. The parallel analysis of COVID-19 and diabetes mellitus pathogenesis has proposed that the control of the inflammation through the interfering with the critical points of major signaling pathways may provide the new therapeutic approaches. In recent years, the role of Dipeptidyl Peptidase 4 (DPP4) in chronic inflammation has been proved. Numerous immune cells express the DPP4 protein. DPP4 regulates antibody production, cytokine secretion, and immunoglobulin class switching. DPP4 inhibitors like sitagliptin reduce inflammation intensity in different states. Following the accumulating data, we hypothesize that sitagliptin might reduce COVID-19 severity. Sitagliptin, an available DPP4 inhibitor drug, showed multidimensional anti-inflammatory effects among diabetic patients. It reduces the inflammation mostly by affecting on NF-kappa-B signaling pathway. Under the fact that inflammatory mediators are active in individuals with COVID-19, blocking the predominant pathway could be helpful.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Complicaciones de la Diabetes/tratamiento farmacológico , Inflamación/fisiopatología , Neumonía Viral/complicaciones , Fosfato de Sitagliptina/farmacología , Infecciones por Coronavirus/tratamiento farmacológico , Citocinas , Complicaciones de la Diabetes/virología , Diabetes Mellitus/tratamiento farmacológico , Dipeptidil Peptidasa 4/metabolismo , Humanos , Resistencia a la Insulina , Modelos Teóricos , Subunidad p50 de NF-kappa B/metabolismo , Pandemias , Neumonía Viral/tratamiento farmacológico , Transducción de Señal
15.
Am Heart J ; 225: 88-96, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32485329

RESUMEN

Intensive lipid management is critical to reduce cardiovascular (CV) risk for patients with diabetes mellitus (DM). METHODS: We performed an observational study of 7628 patients with (n = 2943) and without DM (n = 4685), enrolled in the Provider Assessment of Lipid Management (PALM) registry and treated at 140 outpatient clinics across the United States in 2015. Patient self-estimated CV risk, patient-perceived statin benefit and risk, observed statin therapy use and dosing were assessed. RESULTS: Patients with DM were more likely to believe that their CV risk was elevated compared with patients without DM (39.1% vs 29.3%, P < .001). Patients with DM were more likely to receive a statin (74.2% vs 63.5%, P < .001) but less likely to be treated with guideline-recommended statin intensity (36.5% vs 46.9%, P < .001), driven by the low proportion (16.5%) of high risk (ASCVD risk ≥7.5%) primary prevention DM patients treated with a high intensity statin. Patients with DM treated with guideline-recommended statin intensity were more likely to believe they were at high CV risk (44.9% vs 38.4%, P = .005) and that statins can reduce this risk (41.1% vs 35.6%, P = .02), compared with patients treated with lower than guideline-recommended statin intensity. Compared with patients with an elevated HgbA1c, patients with well-controlled DM were no more likely to be on a statin (77.9% vs 79.3%, P = .43). CONCLUSIONS: In this nationwide study, the majority of patients with DM were treated with lower than guideline-recommended statin intensity. Patient education and engagement may help providers improve lipid therapy for these high-risk patients.


Asunto(s)
Actitud Frente a la Salud , Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus , Adhesión a Directriz , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Anciano , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Diabetes Mellitus/sangre , Femenino , Hemoglobina A Glucada/análisis , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Sistema de Registros , Factores de Riesgo , Estados Unidos
16.
J Mycol Med ; 30(3): 101002, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32507472

RESUMEN

INTRODUCTION: Rhino-orbital-aspergillosis (ROA) is a rare but serious disease in immunocompetent patients. Diagnosis is often delayed due to the absence of specific clinical symptoms. We describe the case of a patient who presented initially with ROA which spread progressively to the right ethmoid-sphenoid sinuses and then to the brain. OBSERVATION: A 61-year-old patient with a history of well-controlled diabetes presented with a sudden severe decrease in right visual acuity. Cerebral MRI showed the presence of an infiltrate in the right orbital apex extending to the homolateral cavernous sinus without any cerebral involvement. A diagnosis of right orbital myositis was made and corticosteroid therapy was started. His symptoms worsened progressively leading to quasi-blindness. A new MRI showed the development of right sphenoid-ethmoid osteolytic lesions. A fungal aetiology was suspected and tests for fungal biomarkers found a ß-(1-3)-D-glucan level of 99pg/ml but negative galactomannan. An ethmoid biopsy was performed for histological and mycological investigations, including the detection of Aspergillus DNA by qPCR. qPCR was positive and culture resulted in the isolation of multi-sensitive Aspergillus fumigatus. Treatment was initiated with voriconazole. Due to persistence of blindness and the appearance of a lesion extending to the right frontal lobe, surgical excision was performed followed by antifungal treatment for a total duration of 1year. The patient is currently stable, but has persistence of blindness in the right eye. CONCLUSION: Invasive ROA is a rare but serious disease in immunocompetent patients which should be evoked in the differential diagnosis of a tumour or vasculitis. Early diagnosis is essential for optimal management.


Asunto(s)
Aspergilosis/diagnóstico , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Inmunocompetencia , Infecciones Fúngicas Invasoras/diagnóstico , Rinitis/microbiología , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Aspergillus fumigatus/aislamiento & purificación , Ceguera/diagnóstico , Ceguera/microbiología , Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/microbiología , Infecciones Fúngicas del Ojo/complicaciones , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Humanos , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/microbiología , Masculino , Persona de Mediana Edad , Neuroaspergilosis/complicaciones , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/tratamiento farmacológico , Neuroaspergilosis/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Rinitis/complicaciones , Rinitis/diagnóstico , Rinitis/tratamiento farmacológico , Voriconazol/uso terapéutico
17.
Sci Rep ; 10(1): 7238, 2020 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-32350374

RESUMEN

Acute kidney injury (AKI) predicts poor prognosis in patients with acute myocardial infarction (MI) and diabetes mellitus (DM) is an independent risk factor of AKI. Recent clinical studies have shown the beneficial effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on cardiovascular and renal outcomes in patients with DM. We recently reported that canagliflozin normalized susceptibility of diabetic rats to AKI after acute MI via ß-hydroxybutyrate-mediated suppression of NOX expression. Here we examined whether the same renoprotective effect is shared by empagliflozin. Serum creatinine levels were not changed by MI induced by coronary artery occlusion in LETO, non-diabetic control rats, and OLETF, obese type 2 diabetic rats. However, immunohistochemistry revealed that MI increased renal expression of NGAL and KIM-1, early markers of tubular injury, by 3.2-fold and 2.6-fold, respectively, in OLETF. These increases in injury markers were not observed in LETO. Pretreatment with empagliflozin of OLETF for 2 weeks improved hyperglycemia, increased blood ß-hydroxybutyrate level, and suppressed MI-induced expression of NGAL and KIM-1. Empagliflozin suppressed upregulation of NOX2 and NOX4 in the kidney of OLETF. Taken together with the results of our previous study, it was concluded that treatment with the SGLT2 inhibitor protects the diabetic kidney from MI-induced AKI.


Asunto(s)
Lesión Renal Aguda , Compuestos de Bencidrilo/farmacología , Complicaciones de la Diabetes , Diabetes Mellitus Experimental , Glucósidos/farmacología , Riñón , Infarto del Miocardio , Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/etiología , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/patología , Animales , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/metabolismo , Complicaciones de la Diabetes/patología , Diabetes Mellitus Experimental/tratamiento farmacológico , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patología , Riñón/metabolismo , Riñón/patología , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Ratas
18.
Complement Ther Med ; 50: 102391, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32444053

RESUMEN

OBJECTIVE: The purpose of this up-to-date comprehensive systematic review was to evaluate and summarize all research studies in the field in order to clarify the magnitude of Nigella sativa (N. sativa) effects on the management of Diabetes mellitus (DM) and its complications. METHODS: A systematic review was conducted in a Cochrane style and in accordance PRISMA checklist using the published studies in PubMed/MEDLINE, SCOPUS, and EMBASE databases that were searched up to January 2019. Abstracts that met PICO criteria for qualitative studies underwent dual review for data extraction to evaluate study quality and details. RESULTS: Dietary supplementation with N. sativa preparations can improve various secondary complications of diabetic patients. N. sativa preparations possess antidiabetic, hypoglycemic, anti-hyperlipidemic, antihypertensive, and anti-obesity effects. Beneficial effects of N. sativa preparations include the restoration of the antioxidant defense systems, the increase in the activity of antioxidant enzymes, the decrease of inflammatory biomarkers, the suppression of the production pro-inflammatory mediators, improvement of endothelial dysfunction, and hepatic, kidney, heart and immune system functions. They have key roles in managing diabetes-induced inflammation and oxidative stress in diabetic patients. CONCLUSION: N. sativa preparations have key roles in herbal medicine as an adjuvant in the treatment and management of patients with DM and its complications. Moreover, the beneficial effects of N. sativa preparations were differently based on dosage forms, active ingredients, and duration of intervention. The best dosage to improve glycemic indices and lipid and lipoprotein profiles is 2 g daily powdered N. sativa for at least 12 weeks.


Asunto(s)
Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Suplementos Dietéticos , Nigella sativa , Preparaciones de Plantas/uso terapéutico , Animales , Modelos Animales de Enfermedad , Humanos , Fitoterapia , Semillas
19.
Sci Rep ; 10(1): 7702, 2020 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-32382160

RESUMEN

In this retrospective study, we investigated the impact of diabetes mellitus (DM) on patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT). We analyzed the demographic and clinical characteristics, treatment tolerance, and toxicities of patients with HNC undergoing primary or adjuvant CCRT with or without DM between 2007 and 2016. Of the 556 patients undergoing CCRT, 84 (15.1%) had DM. Compared with patients without DM, patients with DM were significantly older (56.2 ± 11.2 vs. 51.9 ± 9.5 years, P < 0.001), received lower doses of cisplatin (adjuvant CCRT: 175.30 ± 84.03 vs. 214.88 ± 68.25, P = 0.014; primary CCRT: 142.84 ± 79.49 vs. 187.83 ± 76.19, P < 0.001), and experienced higher rates of infection (adjuvant CCRT: 52% vs. 30.5%, P = 0.042; primary CCRT: 45.8% vs. 22.9%, P < 0.001). Among patients undergoing primary CCRT, compared with those without DM, the patients with DM experienced significantly higher rates of hematologic toxicity (65.7% vs. 39.3%, P = 0.004) and treatment-related deaths (10.2% vs. 3.5%, P = 0.051); and a greater weight loss (-6.17 ± 9.27% vs. -4.49 ± 6.84, P = 0.078). Patients with HNC and DM undergoing CCRT, compared with patients without DM, experienced higher rates of infection and hematotoxicity, loss of body weight, and higher treatment-related mortality.


Asunto(s)
Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/radioterapia , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Anciano , Quimioradioterapia/métodos , Cisplatino/administración & dosificación , Complicaciones de la Diabetes/patología , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/patología , Diabetes Mellitus/radioterapia , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad
20.
J Diabetes ; 12(9): 659-667, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32401405

RESUMEN

The antimalarial drug hydroxychloroquine (HCQ) has long been used as a disease-modifying antirheumatic drug for the treatment of several inflammatory rheumatic diseases. Over the last three decades, various studies have shown that HCQ also plays a role in the regulation of glucose homeostasis. Although the mechanisms of action underlying the glucose-lowering properties of HCQ are still not entirely clear, evidence suggests that this drug may exert multifaceted effects on glucose regulation, including improvement of insulin sensitivity, increase of insulin secretion, reduction of hepatic insulin clearance, and reduction of systemic inflammation. Preliminary studies have shown the safety and efficacy of HCQ (at a dose ranging from 400 to 600 mg/day) in patients with type 2 diabetes over a short-term period. In 2014, HCQ has been approved in India as an add-on hypoglycemic agent for patients with uncontrolled type 2 diabetes. However, large randomized controlled trials are needed to establish the safety and efficacy profile of HCQ in patients with type 2 diabetes over a long-term period. With regard to the COVID-19 pandemic, several medications (including HCQ) have been used as off-label drugs because of the lack of proven effective therapies. However, emerging evidence shows limited benefit from HCQ use in COVID-19 in general. The aim of this manuscript is to comprehensively summarize the current knowledge on the antihyperglycemic properties of HCQ and to critically evaluate the potential risks and benefits related to HCQ use in patients with diabetes, even in light of the current pandemic scenario.


Asunto(s)
Infecciones por Coronavirus , Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hidroxicloroquina/efectos adversos , Hidroxicloroquina/uso terapéutico , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Pandemias , Neumonía Viral , Antivirales , Infecciones por Coronavirus/tratamiento farmacológico , Humanos
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