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1.
Khirurgiia (Mosk) ; (9): 75-79, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33030005

RESUMEN

Surgical treatment of post-traumatic right-sided phrenic hernia is associated with certain technical difficulties due to topographic and anatomical features. Morbid obesity combined with diabetes mellitus type II is one of the main factors complicating any surgical thoracic or abdominal surgery and further rehabilitation. We report simultaneous surgery for complicated post-traumatic right-sided phrenic hernia in a patient with morbid obesity and diabetes mellitus type II. Surgical correction of giant phrenic hernia facilitated further effective treatment of morbid obesity and concomitant diabetes mellitus type II.


Asunto(s)
Diabetes Mellitus Tipo 2 , Herniorrafia , Obesidad Mórbida , Diabetes Mellitus Tipo 2/complicaciones , Hernia/complicaciones , Humanos , Obesidad Mórbida/complicaciones , Resultado del Tratamiento
2.
Medicine (Baltimore) ; 99(35): e21558, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871871

RESUMEN

BACKGROUND: As indicated by numerous studies, there exists a relationship between the polymorphism of methylenetetrahydrofolate reductase (MTHFR) and susceptibility to diabetic nephropathy (DN) in various populations; nonetheless, the findings remain inconsistent. Therefore, we carried out a meta-analysis to determine the relationship between the MTHFR gene polymorphism and DN susceptibility. MATERIALS AND METHOD: Related studies were identified from PubMed, Cochrane Library, EMBASE, and the China National Knowledge Infrastructure database (time period: from building the library to October 2019). The strength of the association was examined using odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: The findings illustrated that the C677T gene polymorphism was significantly associated with an enhanced susceptibility to DN compared to that with diabetes mellitus in allelic (OR = 1.64, 95% CI = 1.34-2.00, P < .001), dominant (OR = 1.85, 95% CI = 1.40-2.46, P < .001), codominant (heterozygote: OR = 1.67, 95% CI = 1.27-2.21, P < .001; homozygote: OR = 2.55, 95% CI = 1.82-3.57, P < .001), and recessive (OR = 1.89, 95% CI = 1.50-2.38, P < .001) models of the overall population. Moreover, as compared with the healthy controls, a significantly augmented susceptibility to DN was found in all 5 genetic comparison models (allelic: OR = 2.06, 95% CI = 1.58-2.67, P < .001; dominant: OR = 2.52, 95% CI = 1.73-3.69, P < .001; codominant: OR = 3.78, 95% CI = 2.50-5.70, P < .001; recessive: OR = 2.41, 95% CI = 1.96-2.97, P < .001). Furthermore, stratifying data by ethnicity revealed substantially augmented vulnerability to DN in not only Caucasian but also Asian populations. CONCLUSION: The present study suggests that the C677T polymorphism was associated with an augmented susceptibility to DN.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/epidemiología , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo de Nucleótido Simple/genética , Alelos , Grupo de Ascendencia Continental Asiática/genética , Estudios de Casos y Controles , China/epidemiología , Diabetes Mellitus Tipo 2/genética , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/genética , Grupo de Ascendencia Continental Europea/genética , Predisposición Genética a la Enfermedad , Humanos , Factores de Riesgo
3.
Ann Ital Chir ; 91: 273-276, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32877380

RESUMEN

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.


Asunto(s)
Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Betacoronavirus/aislamiento & purificación , Implantación de Prótesis Vascular/métodos , Infecciones por Coronavirus/prevención & control , Procedimientos Endovasculares/métodos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Anestesia Local , Aneurisma Disecante/complicaciones , Profilaxis Antibiótica , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Aneurisma de la Aorta Torácica/complicaciones , Contraindicaciones de los Procedimientos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/transmisión , Darunavir/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Quimioterapia Combinada , Enoxaparina/uso terapéutico , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Complicaciones Intraoperatorias/prevención & control , Intubación Intratraqueal/efectos adversos , Persona de Mediana Edad , Nasofaringe/virología , Quirófanos , Aislamiento de Pacientes , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/transmisión , Ritonavir/uso terapéutico , Isquemia de la Médula Espinal/prevención & control , Arteria Vertebral/cirugía
4.
Medicine (Baltimore) ; 99(33): e20978, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32871975

RESUMEN

BACKGROUND: The number of people with diabetes is growing exponentially.Human studies have shown that vitamin D supplementation is beneficial for type 2 diabetic microangiopathy. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, in order to determine whether vitamin D supplementation is effective and safe in type 2 diabetic microangiopathy, it is necessary to conduct a meta-analysis of high-quality clinical trials. METHODS: We will search each database from the built-in until March 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieval clinical registration tests and grey literatures. In this study, only the clinical randomized controlled trials were selected to evaluate the efficacy and safety of vitamin D in the treatment of type 2 diabetic microangiopathy. The two researchers independently conducted literature selection, data extraction and quality assessment. Statistical heterogeneity among studies will be evaluated using the Cochran Q test (x) and the I statistical value. We will utilize the Review Manage software V5.3.0 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Copenhagen, Denmark) to statistically analyze all data. ETHICS AND DISSEMINATION: Ethics and dissemination: This study is a systematic review of vitamin D supplementation as a treatment of type 2 diabetic microangiopathy. RESULTS: This study will provide high-quality synthesis of effectiveness and safety of vitamin D supplementation for type 2 diabetic microangiopathy. CONCLUSION: This systematic review aims to provide new options for vitamin D treatment of type 2 diabetic microangiopathy in terms of its efficacy and safety. REGISTRATION NUMBER: LNPLASY202050055.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/terapia , Suplementos Dietéticos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto , Vitamina D/uso terapéutico , Diabetes Mellitus Tipo 2/terapia , Humanos , Vitamina D/efectos adversos
5.
Medicine (Baltimore) ; 99(33): e21143, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32871982

RESUMEN

BACKGROUND: The impact of vitamin K in ameliorating diabetes-associated complications, especially those linked with platelet activation and coagulation remains unclear. The current study aims to systematically explore and discuss the available evidence on the impact of vitamin K on the diabetes-cardiovascular disease (CVD)-associated complications. METHODS: A systematic review of studies published on the MEDLINE (PubMed), EMBASE, and Google Scholar electronic database will be conducted. The review will include studies published from inception until May 25, 2020, reporting on the effect of vitamin K on CVD-related markers, especially coagulation factors and platelet activation in type 2 diabetes mellitus. Before the full-text screening, all studies will be screened by title, abstract, and keywords. The Downs and Black checklist will be used to assess the quality of the studies. Additionally, the Cochrane collaboration tool will also be used to evaluate the risk of bias across the included studies. Kappa Cohen's calculator will be used to assess the level of agreement between the authors. DISCUSSIONS: This systematic review will not require ethical approval, and the results will be distributed through conference and peer-reviewed publications. Our results will assist current and future research scientists on the potential use of vitamin K as a protective therapy against CVD-related complications. SYSTEMATIC REVIEW REGISTRATION: This protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42020151667.


Asunto(s)
Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/terapia , Diabetes Mellitus Tipo 2/complicaciones , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto , Vitamina K/uso terapéutico , Diabetes Mellitus Tipo 2/terapia , Suplementos Dietéticos , Humanos
6.
BMJ Case Rep ; 13(9)2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32948531

RESUMEN

We are reporting a middle-aged male patient with polycythaemia vera comorbidity. The patient was exhibiting symptoms including fever, cough and shortness of breath and was found to have acute pulmonary embolism. He was diagnosed with SARS-CoV-2. This case suggests that a high index of suspicion should be taken into consideration for thromboembolic events, when treating patients with COVID-19 with breathing difficulty and low oxygen saturation levels, especially in those who have underlying predisposing conditions for coagulopathy.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Policitemia Vera/complicaciones , Embolia Pulmonar/etiología , Betacoronavirus , Angiografía por Tomografía Computarizada , Infecciones por Coronavirus/sangre , Diabetes Mellitus Tipo 2/complicaciones , Ecocardiografía , Fibrinolíticos/uso terapéutico , Heparina/uso terapéutico , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Policitemia Vera/sangre , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía Computarizada por Rayos X , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología
7.
Nat Commun ; 11(1): 4592, 2020 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-32929089

RESUMEN

Prediabetes is a state of glycaemic dysregulation below the diagnostic threshold of type 2 diabetes (T2D). Globally, ~352 million people have prediabetes, of which 35-50% develop full-blown diabetes within five years. T2D and its complications are costly to treat, causing considerable morbidity and early mortality. Whether prediabetes is causally related to diabetes complications is unclear. Here we report a causal inference analysis investigating the effects of prediabetes in coronary artery disease, stroke and chronic kidney disease, complemented by a systematic review of relevant observational studies. Although the observational studies suggest that prediabetes is broadly associated with diabetes complications, the causal inference analysis revealed that prediabetes is only causally related with coronary artery disease, with no evidence of causal effects on other diabetes complications. In conclusion, prediabetes likely causes coronary artery disease and its prevention is likely to be most effective if initiated prior to the onset of diabetes.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Estado Prediabético/complicaciones , Glucemia/metabolismo , Enfermedades Cardiovasculares/genética , Intervalos de Confianza , Enfermedad de la Arteria Coronaria/complicaciones , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Ayuno/sangre , Humanos , Persona de Mediana Edad , Estudios Observacionales como Asunto , Oportunidad Relativa , Estado Prediabético/sangre , Estado Prediabético/genética , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo , Accidente Cerebrovascular/complicaciones
9.
PLoS Med ; 17(9): e1003316, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32946450

RESUMEN

BACKGROUND: Lifetime glycemic exposure and its relationship with age at diagnosis in type 2 diabetes (T2D) are unknown. Pharmacologic glycemic management strategies for young-onset T2D (age at diagnosis <40 years) are poorly defined. We studied how age at diagnosis affects glycemic exposure, glycemic deterioration, and responses to oral glucose-lowering drugs (OGLDs). METHODS AND FINDINGS: In a population-based cohort (n = 328,199; 47.2% women; mean age 34.6 and 59.3 years, respectively, for young-onset and usual-onset [age at diagnosis ≥40 years] T2D; 2002-2016), we used linear mixed-effects models to estimate the association between age at diagnosis and A1C slope (glycemic deterioration) and tested for an interaction between age at diagnosis and responses to various combinations of OGLDs during the first decade after diagnosis. In a register-based cohort (n = 21,016; 47.1% women; mean age 43.8 and 58.9 years, respectively, for young- and usual-onset T2D; 2000-2015), we estimated the glycemic exposure from diagnosis until age 75 years. People with young-onset T2D had a higher mean A1C (8.0% [standard deviation 0.15%]) versus usual-onset T2D (7.6% [0.03%]) throughout the life span (p < 0.001). The cumulative glycemic exposure was >3 times higher for young-onset versus usual-onset T2D (41.0 [95% confidence interval 39.1-42.8] versus 12.1 [11.8-12.3] A1C-years [1 A1C-year = 1 year with 8% average A1C]). Younger age at diagnosis was associated with faster glycemic deterioration (A1C slope over time +0.08% [0.078-0.084%] per year for age at diagnosis 20 years versus +0.02% [0.016-0.018%] per year for age at diagnosis 50 years; p-value for interaction <0.001). Age at diagnosis ≥60 years was associated with glycemic improvement (-0.004% [-0.005 to -0.004%] and -0.02% [-0.027 to -0.0244%] per year for ages 60 and 70 years at diagnosis, respectively; p-value for interaction <0.001). Responses to OGLDs differed by age at diagnosis (p-value for interaction <0.001). Those with young-onset T2D had smaller A1C decrements for metformin-based combinations versus usual-onset T2D (metformin alone: young-onset -0.15% [-0.105 to -0.080%], usual-onset -0.17% [-0.179 to -0.169%]; metformin, sulfonylurea, and dipeptidyl peptidase-4 inhibitor: young-onset -0.44% [-0.476 to -0.405%], usual-onset -0.48% [-0.498 to -0.459%]; metformin and α-glucosidase inhibitor: young-onset -0.40% [-0.660 to -0.144%], usual-onset -0.25% [-0.420 to -0.077%]) but greater responses to other combinations containing sulfonylureas (sulfonylurea alone: young-onset -0.08% [-0.099 to -0.065%], usual-onset +0.06% [+0.059 to +0.072%]; sulfonylurea and α-glucosidase inhibitor: young-onset -0.10% [-0.266 to 0.064%], usual-onset: 0.25% [+0.196% to +0.312%]). Limitations include possible residual confounding and unknown generalizability outside Hong Kong. CONCLUSIONS: In this study, we observed excess glycemic exposure and rapid glycemic deterioration in young-onset T2D, indicating that improved treatment strategies are needed in this setting. The differential responses to OGLDs between young- and usual-onset T2D suggest that better disease classification could guide personalized therapy.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Adulto , Factores de Edad , Anciano , Glucemia , Estudios de Cohortes , Diabetes Mellitus Tipo 2/complicaciones , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Femenino , Glucosa/uso terapéutico , Hemoglobina A Glucada/análisis , Hong Kong/epidemiología , Humanos , Hipoglucemiantes , Masculino , Metformina/administración & dosificación , Persona de Mediana Edad
10.
Lancet ; 396(10254): 819-829, 2020 09 19.
Artículo en Inglés | MEDLINE | ID: mdl-32877652

RESUMEN

BACKGROUND: Both DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin) trials showed that sodium-glucose co-transporter-2 (SGLT2) inhibition reduced the combined risk of cardiovascular death or hospitalisation for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) with or without diabetes. However, neither trial was powered to assess effects on cardiovascular death or all-cause death or to characterise effects in clinically important subgroups. Using study-level published data from DAPA-HF and patient-level data from EMPEROR-Reduced, we aimed to estimate the effect of SGLT2 inhibition on fatal and non-fatal heart failure events and renal outcomes in all randomly assigned patients with HFrEF and in relevant subgroups from DAPA-HF and EMPEROR-Reduced trials. METHODS: We did a prespecified meta-analysis of the two single large-scale trials assessing the effects of SGLT2 inhibitors on cardiovascular outcomes in patients with HFrEF with or without diabetes: DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin). The primary endpoint was time to all-cause death. Additionally, we assessed the effects of treatment in prespecified subgroups on the combined risk of cardiovascular death or hospitalisation for heart failure. These subgroups were based on type 2 diabetes status, age, sex, angiotensin receptor neprilysin inhibitor (ARNI) treatment, New York Heart Association (NYHA) functional class, race, history of hospitalisation for heart failure, estimated glomerular filtration rate (eGFR), body-mass index, and region (post-hoc). We used hazard ratios (HRs) derived from Cox proportional hazard models for time-to-first event endpoints and Cochran's Q test for treatment interactions; the analysis of recurrent events was based on rate ratios derived from the Lin-Wei-Yang-Ying model. FINDINGS: Among 8474 patients combined from both trials, the estimated treatment effect was a 13% reduction in all-cause death (pooled HR 0·87, 95% CI 0·77-0·98; p=0·018) and 14% reduction in cardiovascular death (0·86, 0·76-0·98; p=0·027). SGLT2 inhibition was accompanied by a 26% relative reduction in the combined risk of cardiovascular death or first hospitalisation for heart failure (0·74, 0·68-0·82; p<0·0001), and by a 25% decrease in the composite of recurrent hospitalisations for heart failure or cardiovascular death (0·75, 0·68-0·84; p<0·0001). The risk of the composite renal endpoint was also reduced (0·62, 0·43-0·90; p=0·013). All tests for heterogeneity of effect size between trials were not significant. The pooled treatment effects showed consistent benefits for subgroups based on age, sex, diabetes, treatment with an ARNI and baseline eGFR, but suggested treatment-by-subgroup interactions for subgroups based on NYHA functional class and race. INTERPRETATION: The effects of empagliflozin and dapagliflozin on hospitalisations for heart failure were consistent in the two independent trials and suggest that these agents also improve renal outcomes and reduce all-cause and cardiovascular death in patients with HFrEF. FUNDING: Boehringer Ingelheim.


Asunto(s)
Compuestos de Bencidrilo/efectos adversos , Glucósidos/efectos adversos , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Volumen Sistólico/efectos de los fármacos , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Compuestos de Bencidrilo/uso terapéutico , Índice de Masa Corporal , Estudios de Casos y Controles , Causas de Muerte/tendencias , Ensayos Clínicos como Asunto , Muerte , Diabetes Mellitus Tipo 2/complicaciones , Quimioterapia Combinada , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Tasa de Filtración Glomerular/fisiología , Glucósidos/uso terapéutico , Insuficiencia Cardíaca/clasificación , Insuficiencia Cardíaca/fisiopatología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neprilisina/antagonistas & inhibidores , Evaluación del Resultado de la Atención al Paciente , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico
11.
JAMA ; 324(9): 879-887, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32870301

RESUMEN

Importance: Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with these conditions choose to undergo bariatric surgery. Summaries of the expanding evidence for both the benefits and risks of bariatric surgery are needed to better guide shared decision-making conversations. Observations: There are approximately 252 000 bariatric procedures (per 2018 numbers) performed each year in the US, of which an estimated 15% are revisions. The 1991 National Institutes of Health guidelines recommended consideration of bariatric surgery in patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 40 or higher or 35 or higher with serious obesity-related comorbidities. These guidelines are still widely used; however, there is increasing evidence that bariatric procedures should also be considered for patients with type 2 diabetes and a body mass index of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes. Substantial evidence indicates that surgery results in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions, regardless of the type of procedures used. The 2 most common procedures used currently, the sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes and similar safety through at least 5-year follow-up. However, emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable weight loss and glycemic control. Although safety is a concern, current data indicate that the perioperative mortality rates range from 0.03% to 0.2%, which has substantially improved since early 2000s. More long-term randomized studies are needed to assess the effect of bariatric procedures on cardiovascular disease, cancer, and other health outcomes and to evaluate emerging newer procedures. Conclusions and Relevance: Modern bariatric procedures have strong evidence of efficacy and safety. All patients with severe obesity-and especially those with type 2 diabetes-should be engaged in a shared decision-making conversation about the risks and benefits of surgery compared with continuing usual medical and lifestyle treatment, and the decision about surgery should be driven primarily by informed patient preferences.


Asunto(s)
Cirugía Bariátrica , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias , Pérdida de Peso , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Diabetes Mellitus Tipo 2/complicaciones , Dislipidemias/etiología , Femenino , Gastrectomía , Humanos , Hipertensión/etiología , Masculino , Obesidad Mórbida/complicaciones , Síndromes de la Apnea del Sueño/etiología
12.
Internist (Berl) ; 61(10): 1094-1105, 2020 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-32897404

RESUMEN

BACKGROUND: The early detection and treatment of diabetic nephropathy (DN) is of crucial importance as patients with diabetes mellitus represent the largest proportion of patients on dialysis, with the highest morbidity and mortality. Currently, the first clinical sign of incipient DN is microalbuminuria, but its precision is not optimal. Many studies now report that proteins and peptides are new biomarkers in urine that primarily depict the pathophysiology of DN and thus allow for improved diagnosis of DN. OBJECTIVES: The presentation of new concepts for the early detection and treatment of DN for better patient management. MATERIAL AND METHODS: A systematic literature search was carried out. RESULTS: Many potential markers have been described in the search for new biomarkers to diagnose DN by urinary proteome analysis. However, many of these studies were not meaningful due to the small number of samples. This limitation led to inadequate validation of proteins that could not be confirmed as markers. However, the diagnostic benefit of CKD 273, a multimarker of 273 protein fragments, was sustainably demonstrated for the early diagnosis of DN. This multi-marker shows significant advantages in the precision of diagnosis and prognosis compared to albuminuria. Furthermore, many of its peptide markers map the molecular pathophysiology of DN. CONCLUSIONS: Clinical urinary proteome analysis shows great benefits and is already an appropriate tool for the early detection of incipient DN.


Asunto(s)
Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/orina , Proteoma/análisis , Proteómica/métodos , Albuminuria/diagnóstico , Albuminuria/orina , Biomarcadores/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/orina , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/orina , Diagnóstico Precoz , Humanos
13.
Niger J Clin Pract ; 23(9): 1194-1200, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32913156

RESUMEN

Aim: This retrospective analysis aims to evaluate the correlation between blood glucose fluctuation (BGF) and heart rate variability (HRV) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). Subjects and Methods: In total, 210 patients with CHD and T2DM from January 2014 to January 2019 admitted to Wenling Hospital of Traditional Chinese Medicine were enrolled in this study. Based on whether BGF existed, patients were allocated to BG control group and BG fluctuation group. The HRV parameters, frequency of adverse events, and Gensini score between groups were recorded and Pearson analysis was performed. Results: Results displayed that no significant differences in age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), alcohol consumption history, drinking history, or serum lipid were found between groups (P > 0.05 for all items). However, the BGF parameters were significantly higher while the HRV parameters were significantly lower in BG fluctuation group, compared with BG control group (P < 0.05 for all items). Pearson analysis showed that despite mean blood glucose (MBG) and mean amplitude of glycemic excursions (MAGE) both correlated with a standard deviation of NN intervals (SDNN) level, the correlation coefficient of MAGE-SDNN was much higher (-0.705 vs -0.185). Additionally, the frequencies of adverse events and Gensini scores were also significantly higher in the BG fluctuation group than the BG control group. Conclusions: It suggests that BGF strongly correlated with HRV in patients with CHD and T2DM. It also provides experimental instructions for clinical practice.


Asunto(s)
Glucemia/análisis , Enfermedad Coronaria/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Glucosa/metabolismo , Frecuencia Cardíaca/fisiología , Adulto , Anciano , Índice de Masa Corporal , Enfermedad Coronaria/sangre , Enfermedad Coronaria/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
BMJ ; 370: m3342, 2020 09 23.
Artículo en Inglés | MEDLINE | ID: mdl-32967856

RESUMEN

OBJECTIVE: To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. DESIGN: Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-analysis. SETTING: Canadian Network for Observational Drug Effect Studies (CNODES), with administrative healthcare databases from seven Canadian provinces and the United Kingdom, 2013-18. POPULATION: 209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time conditional propensity score and followed for a mean of 0.9 years. MAIN OUTCOME MEASURES: The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. Cox proportional hazards models were used to estimate site specific adjusted hazards ratios and 95% confidence intervals, comparing use of SGLT2 inhibitors with use of DPP-4 inhibitors in an as treated approach. Site specific results were pooled using random effects meta-analysis. RESULTS: Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1 v 6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9 v 7.7; 0.60, 0.54 to 0.67), heart failure (3.1 v 7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7 v 17.3; 0.60, 0.54 to 0.67). SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6 v 3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with canagliflozin (0.79, 0.66 to 0.94), dapagliflozin (0.73, 0.63 to 0.85), and empagliflozin (0.77, 0.68 to 0.87). CONCLUSIONS: In this large observational study conducted in a real world clinical practice context, the short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939624.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido , Adulto Joven
15.
Medicine (Baltimore) ; 99(37): e21687, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925714

RESUMEN

BACKGROUND: Increased risk and cancer-related mortality is observed in pancreatic cancer (PC) patients with diabetes mellitus (DM). Whether using metformin as glucose-lowering therapy can result in survival benefit in this group of patients is still unclear. METHODS: A meta-analysis of 21 studies that including 38,772 patients was performed to investigate the association between metformin and overall survival in patients with PC and concurrent DM. RESULTS: A significant survival benefit was observed in metformin treatment group compared with non-metformin group (hazard ratio [HR] = 0.83, 95% confidence interval [CI]: 0.74-0.91). These associations were observed in both subgroups of Asian countries (HR = 0.69, 95% CI: 0.60-0.79) and Western countries (HR = 0.86, 95% CI: 0.76-0.95), the former was more obvious. Survival benefit was gained for patients at early stage (HR = 0.75, 95% CI: 0.64-0.85) and mixed stage (HR = 0.81, 95% CI: 0.70-0.91), but not for patients at advanced stage (HR = 0.99, 95% CI: 0.74-1.24). Similarly, survival benefit was also observed in patients receiving surgery (HR = 0.82, 95% CI: 0.69-0.94) and comprehensive treatment (HR = 0.85, 95% CI: 0.77-0.93), but not in chemotherapy group (HR = 0.99, 95% CI: 0.67-1.30). No obvious benefit was suggested when pooled by time-varying COX model (HR = 0.94, 95% CI: 0.86-1.03). CONCLUSIONS: These results suggest that metformin is associated with survival benefit in patients with PC and concurrent DM. Further randomized controlled trials and prospective studies with larger sample sizes are required to confirm our findings.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Neoplasias Pancreáticas/mortalidad , Anciano , Ensayos Clínicos como Asunto , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/complicaciones , Modelos de Riesgos Proporcionales , Tasa de Supervivencia
16.
J Wound Ostomy Continence Nurs ; 47(5): 445-449, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32925589

RESUMEN

BACKGROUND: Prior to the COVID-19 pandemic, the Cardiovascular Surgery (CV) service of an academic medical center conducted a quality improvement project to decrease readmissions to the hospital from 2 rehabilitation facilities using telehealth via video calling. This initiative became of great importance with the COVID-19 pandemic because it helped the CV service better navigate and more efficiently meet the patient care needs associated with patient care restrictions. The CV service had to quickly evaluate and implement measures to reduce the rate of transmission of the coronavirus, which included adapting the clinic workflow to comply with state and federal recommendations. To minimize the interruption of clinical services and the associated revenue, a rapid transition from outpatient clinic visits to telehealth visits was implemented. CASES: Two cases reports of patients with wounds managed with 2 different telehealth platforms are described. Doxy.me platform allows the provider to e-mail or text a link to their personal waiting room for patients to join the video call. The second platform is Cisco Jabber platform to connect directly to the nursing unit at a skilled nursing or rehabilitation facility. CONCLUSION: Health care systems have had to adjust the manner in which they triage, evaluate, and care for patients using telehealth platforms that do not rely on in-person clinic visits during the COVID-19 pandemic. There are multiple telehealth platforms that require careful planning and treatment implementation. Each health care agency needs to choose the one or ones that function the best in their care setting.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/patología , Pie Diabético/terapia , Neumonía Viral/epidemiología , Telemedicina/organización & administración , Anciano , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Pie Diabético/etiología , Femenino , Humanos , Masculino , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión
17.
Value Health ; 23(9): 1163-1170, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32940234

RESUMEN

OBJECTIVES: The cardiovascular outcomes challenge examined the predictive accuracy of 10 diabetes models in estimating hard outcomes in 2 recent cardiovascular outcomes trials (CVOTs) and whether recalibration can be used to improve replication. METHODS: Participating groups were asked to reproduce the results of the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) and the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program. Calibration was performed and additional analyses assessed model ability to replicate absolute event rates, hazard ratios (HRs), and the generalizability of calibration across CVOTs within a drug class. RESULTS: Ten groups submitted results. Models underestimated treatment effects (ie, HRs) using uncalibrated models for both trials. Calibration to the placebo arm of EMPA-REG OUTCOME greatly improved the prediction of event rates in the placebo, but less so in the active comparator arm. Calibrating to both arms of EMPA-REG OUTCOME individually enabled replication of the observed outcomes. Using EMPA-REG OUTCOME-calibrated models to predict CANVAS Program outcomes was an improvement over uncalibrated models but failed to capture treatment effects adequately. Applying canagliflozin HRs directly provided the best fit. CONCLUSIONS: The Ninth Mount Hood Diabetes Challenge demonstrated that commonly used risk equations were generally unable to capture recent CVOT treatment effects but that calibration of the risk equations can improve predictive accuracy. Although calibration serves as a practical approach to improve predictive accuracy for CVOT outcomes, it does not extrapolate generally to other settings, time horizons, and comparators. New methods and/or new risk equations for capturing these CV benefits are needed.


Asunto(s)
Modelos Económicos , Evaluación de Resultado en la Atención de Salud/métodos , Compuestos de Bencidrilo/uso terapéutico , Calibración , Canagliflozina/uso terapéutico , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/uso terapéutico , Humanos , Medición de Riesgo , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico
18.
J Clin Endocrinol Metab ; 105(12)2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-32979271

RESUMEN

PURPOSE: Coronavirus disease 2019 (COVID-19) has become a topic of concern worldwide; however, the impacts of type 2 diabetes mellitus (T2DM) on disease severity, therapeutic effect, and mortality of patients with COVID-19 are unclear. METHODS: All consecutive patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were included in this study. RESULTS: A total of 663 patients with COVID-19 were included, while 67 patients with T2DM accounted for 10.1% of the total. Compared with patients with COVID-19 without T2DM, those with T2DM were older (aged 66 years vs 57 years; P < 0.001) and had a male predominance (62.7% vs 37.3%; P = 0.019) and higher prevalence of cardiovascular diseases (61.2% vs 20.6%; P < 0.001) and urinary diseases (9% vs 2.5%; P = 0.014). Patients with T2DM were prone to developing severe (58.2% vs 46.3%; P = 0.002) and critical COVID-19 (20.9% vs 13.4%; P = 0.002) and having poor therapeutic effect (76.1% vs 60.4%; P = 0.017). But there was no obvious difference in the mortality between patients with COVID-19 with and without T2DM (4.5% vs 3.7%; P = 0.732). Multivariate logistic regression analysis identified that T2DM was associated with poor therapeutic effect in patients with COVID-19 (odd ratio [OR] 2.99; 95% confidence interval [CI], 1.07-8.66; P = 0.04). Moreover, having a severe and critical COVID-19 condition (OR 3.27; 95% CI, 1.02-9.00; P = 0.029) and decreased lymphocytes (OR 1.59; 95% CI, 1.10-2.34; P = 0.016) were independent risk factors associated with poor therapeutic effect in patients with COVID-19 with T2DM. CONCLUSIONS: T2DM influenced the disease severity and therapeutic effect and was one of the independent risk factors for poor therapeutic effect in patients with COVID-19.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Hipoglucemiantes/uso terapéutico , Neumonía Viral/mortalidad , Anciano , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/virología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/virología , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
19.
Medicine (Baltimore) ; 99(31): e20707, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32756077

RESUMEN

INTRODUCTION: There is a risk of cognitive impairment in diabetic patients. Some studies have shown that dipeptidyl peptidase-4 inhibitors (DPP-4) inhibitors can play a protective role in controlling blood glucose and blocking the DPP-4 to attach antibody glucagon-like peptide -1 degradation and prolong antibody glucagon-like peptide -1, promoting the growth of neurites and the formation of synapses. The purpose of this study is to explore the effect of the DPP-4 inhibitor on cognitive impairment in diabetic patients by meta-analysis. METHODS: The system review plan will strictly follow the Systematic Review and Meta-Analysis Protocols entry for reporting. PubMed, EMBASE, Cochrane Library, Clinicaltrials(clinicaltrials.gov), Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Databases will be systematically searched, and all randomized controlled trials comparing DPP-4 inhibitors with placebo or other hypoglycemic drugs to study cognitive impairment in type 2 diabetic patients will be included. The inclusion, evaluation and data extraction of the literature will be conducted by 2 persons independently, and the dispute will be resolved by a third person. All the meta-analysis of the included literature and the research progress of the existing research are analyzed as the main results. ETHICS AND DISSEMINATION: It is to evaluate and analyze the completed research, so there is no ethical problem. The research results will be published in a peer-reviewed journal. REGISTRATION: The protocol of this systematic review and meta-analysis was registered on International Platform of Registered Systematic Review and Meta-analysis Protocols (https://inplasy.com/) (number. 202040185).


Asunto(s)
Disfunción Cognitiva/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Hipoglucemiantes/uso terapéutico , Disfunción Cognitiva/etiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos
20.
N Engl J Med ; 383(8): 721-732, 2020 08 20.
Artículo en Inglés | MEDLINE | ID: mdl-32813948

RESUMEN

BACKGROUND: Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss. METHODS: We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles. RESULTS: Weight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 µmol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 µmol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) µmol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5±15.9 to 61.6±13.0 µmol per kilogram of fat-free mass per minute in the diet group and from 29.4±12.6 to 54.5±10.4 µmol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group. CONCLUSIONS: In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02207777.).


Asunto(s)
Diabetes Mellitus Tipo 2/metabolismo , Derivación Gástrica , Obesidad/dietoterapia , Obesidad/cirugía , Pérdida de Peso/fisiología , Adulto , Glucemia/análisis , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/cirugía , Femenino , Técnica de Clampeo de la Glucosa , Humanos , Insulina/metabolismo , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Prospectivos , Inducción de Remisión
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