Relationship of advanced glycation end-products in hypertension in diabetic patients: a systematic review.

Diabetes mellitus and arterial hypertension are among the five risk factors that increase mortality in the world. Both are chronic, non-communicable diseases (NCDs), that have a pathophysiological association. Advanced glycation end products (AGEs), produced by the lack of glycemic control in diabetic patients, interact with their AGE receptors (AGER) resulting in increased arterial stiffness, inflammation and endothelial changes - which increases the risk of developing hypertension and other complications. We ran a systematic review in Pubmed, SciELO, Cochrane Library and Web of Science databases using keywords and Boolean operators to optimize the search, with the objective of assessing the mechanism of non-enzymatic glycation of proteins present in patients with diabetes and its correlation with the onset of hypertension, exposing all the endothelial and cellular damage caused by AGEs. We found 719 papers, of which 99 were read in full, and 26 met the eligibility criteria and were included in the present review. AGEs should be considered one of the main cardiometabolic risk factors. Reducing the AGE-AGER interaction will result in cardiovascular protection and increased life expectancy.

Comparação da eficácia da retinografia colorida e da angiografia fluorescente no diagnóstico da retinopatia diabética / Comparing efficacy of fundus photography and fluorescein angiography in the diagnosis of diabetic retinopathy

RESUMO Objetivo: Avaliar a efetividade da retinografia colorida e a da angiografia fluorescente no diagnóstico e no rastreio da retinopatia diabética. Métodos: Estudo retrospectivo, com base na análise de resultados de ambos os exames de 398 pacientes diabéticos. Resultados: Os resultados da angiografia coincidiram com os da retinografia em 77,4% dos casos, e não houve diferença significativa no estadiamento e na identificação da retinopatia pelos dois métodos. Conclusão: Não houve diferença significativa em relação à capacidade diagnóstica da doença pelos métodos descritos, demonstrando não existir benefício em indicar a angiografia como avaliação inicial do paciente diabético.

ABSTRACT Objective: To assess effectiveness of fundus photography and fluorescein angiography in diagnosis and screening of diabetic retinopathy. Methods: A retrospective study of 398 diabetic patients, based on analysis of results of both tests. Results: Results of fluorescein angiography and fundus photography coincided in 77.4% of cases, and there was no significant difference in staging and identification of retinopathy by both methods. Conclusion: There was no significant difference between both methods regarding the capacity to diagnose the disease, showing no benefit in indicating fluorescein angiography as initial assessment of diabetic patients.

Rubeosis faciei diabeticorum is not associated with oxidative stress and skin autofluorescence.

BACKGROUND: Rubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. OBJECTIVE: Examine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . METHODS: Patients diagnosed with Type 2 diabetes mellitus (n=32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. - Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p≤0.05 was considered statistically significant. RESULTS: There was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ=0.398, p=0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. STUDY LIMITATIONS: This is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. CONCLUSIONS: The results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.

Rubeosis faciei diabeticorum is not associated with oxidative stress and skin autofluorescence

Abstract Background Rubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. Objective Examine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . Methods Patients diagnosed with Type 2 diabetes mellitus (n = 32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. - Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p ≤ 0.05 was considered statistically significant. Results There was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ = 0.398, p = 0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. Study limitations This is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. Conclusions The results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.

Modelos constitutivos hiperelásticos del tejido arterial y su valoración para considerar el descontrol metabólico / Hyperelastic constitutive models of arterial tissue and its assessment to consider metabolic uncontrol

Introducción: Las arterias elásticas se caracterizan por un comportamiento hiperelástico anisotrópico, no lineal y cuasi -incompresible, el cual depende de la contribución y distribución de los principales constituyentes. Su evaluación a través de modelos constitutivos junto con enfoques numéricos apropiados puede contribuir potencialmente al estudio de enfermedades como la aterosclerosis, así como al modelado de las intervenciones quirúrgicas o traumas por accidente. Objetivo: Valorar los modelos constitutivos que caracterizan el comportamiento biomecánico de la pared arterial para la identificación del potencial adecuado que permita la correlación de parámetros bioquímicos y mecánicos, en condiciones de daño. Métodos: Se realizó una revisión bibliográfica entre los años 2010-2016 en las bases de datos: Medline, Cochrane Library, Lilacs, así como en el meta-buscador Google. Se consultaron estudios de cohorte, prospectivos, retrospectivos, clínicos, epidemiológicos, revisiones bibliográficas y ensayos clínicos. Resultados: El modelo constitutivo anisotrópico de dos familias de fibras resulta apropiado para obtener nuevas relaciones constitutivas, que aporten más información sobre las propiedades mecánicas de las arterias bajo la influencia del descontrol metabólico generado por la acción de la diabetes mellitus, en los estadios tempranos de la aterosclerosis. Conclusiones: Los cambios en la estructura, composición y propiedades mecánicas que sufre la pared arterial, debido al descontrol metabólico, permite aseverar que la formulación de un modelo adecuado para representar esta realidad es una etapa crucial en la obtención de nuevas relaciones constitutivas, que contribuyan a una solución satisfactoria en el diagnóstico clínico no invasivo de las enfermedades vasculares(AU)

Introduction: The elastic arteries are characterized by a hyper-elastic, anisotropic, non-linear and quasi-incomprehensible behaviour, which depends on the contribution and distribution of the main constituents. Its evaluation through constitutive models together with appropriate numerical approaches can potentially contribute to the study of pathologies such as atherosclerosis, as well as to the modelling of surgical interventions or traumas by accident. Objective: To assess the constitutive models that characterize the biomechanical behavior of the arterial wall for the identification of the adequate potential that allows the correlation of biochemical and mechanical parameters in damage conditions. Methods: A bibliographic review was conducted from 2010 to 2016 in databases such as: Medline, Cochrane Library, Lilacs, as well as in the metasearch engine Google. There were consulted cohort, prospective, retrospective, clinical, epidemiological studies, bibliographic reviews and clinical trials. Results: The constitutive anisotropic model of two families of fibers is appropriate to obtain new constitutive relations, which provide of more information about the mechanical properties of the arteries under the influence of the metabolic decontrol generated by the action of diabetes mellitus, in the early stages of atherosclerosis. Conclusions: The changes in the structure, composition and mechanical properties of the arterial wall as a consequence of the metabolic decontrol allows to assert that the formulation of a suitable model to represent this reality is a crucial stage in obtaining new constitutive relations that contribute to a satisfactory solution in the non-invasive clinical diagnosis of vascular diseases(AU)

A Post-marketing Surveillance Study of Chronic Wounds Treated With a Native Collagen Calcium Alginate Dressing.

Chronic wounds (ie, wounds that fail to progress through a normal, orderly, timely sequence of repair) continue to pose significant clinical and economic burdens. A prospective, descriptive, 3-week post-marketing surveillance study was conducted across 3 wound care centers in the United States to evaluate the effectiveness of a collagen calcium alginate dressing on chronic wounds in conjunction with standard care (SC) practices (eg, offloading, debridement, compression) to support healing. Eligible participants had to be >18 years of age, have at least 1 chronic wound, and no known sensitivity to collagen. Demographic characteristics were recorded at the screening visit on case report forms. At each visit, wound-related pain was assessed using the Visual Analog Scale along with wound characteristics including size (using digital planimetry), wound exudate (minimal, moderate, heavy), and odor (none, mild). Participants were monitored for adverse events as well as infection based on signs and symptoms in and around the local wound bed, the deeper structures, and the surrounding skin. An intention-to-treat approach was used for all analyses. If an observation was missing, the last observation carried forward principle was used. For wounds that healed, pain and exudate were set to 0 (no pain/exudate) at visit 4. Descriptive, paired t tests and the Wilcoxon signed rank test were used to analyze the data. Of the 31 participants (15 men, 16 women, mean age 66.6 years), most (13, 42%) had a diabetic foot ulcer or venous leg ulcer (10, 32%); median duration of all wounds was 148 days. Thirty (30) patients completed the study. The mean number of comorbidities was 10.6 ± 6.3, and patients used a mean of 9.3 ± 5.64 prescription or over-the-counter medications. For all wounds combined, mean wound area was 4.8 ± 8.38 cm2 at baseline. At week 3, a decrease in wound area of 38.1% was noted (median: 45% ± 42.54; P = .006); 3 wounds healed completely. The change in wound exudate level from visit 1 to visit 4 was statistically significant (P = .006). No adverse events or infections occurred. In this population, the use of etiology-appropriate SC and a collagen calcium alginate dressing resulted in a decrease in wound area after 3 weeks of care. Longer-term studies to confirm these observations and controlled clinical studies to compare the effects of this dressing to other nongauze dressing treatments are needed.

Caracterización de pacientes con pie diabético del Hospital General Docente Dr Agostinho Neto, Guantánamo / Characterization of patients with diabetic foot of the Hospital General Docente Dr Agostinho Neto, Guantánamo

Introducción: el pie diabético es un problema de salud, sin embargo, en el Servicio de Angiología y Cirugía Vascular del Hospital General Docente Dr Agostinho Neto se desconocen las características de los pacientes con esta afección. Objetivo: para profundizar en las posibles causas se realizó esta investigación con el objetivo de caracterizar a los pacientes con diagnóstico de pie diabético atendidos en este servicio durante el 2016. Método: se realizó un estudio de tipo observacional, descriptivo, y transversal en el total de pacientes atendidos con esta enfermedad (n=205). Resultados: el pie diabético fue más frecuente en mujeres, entre los 61 y 70 años de edad, con diabetes tipo 2 y más de 16 años de evolución de la enfermedad. Fue más común la forma clínica neuroinfecciosa y fue elevado el porcentaje de pacientes amputados, sobre todo las amputaciones menores. Fallecieron dos pacientes. Conclusiones: se concluyó que dicho padecimiento fue más frecuente en mujeres con edad entre 61 y 70 años, la forma clínica neuroinfecciosa la más común y que se realizaran amputaciones menores. La letalidad en los pacientes con pie diabético fue baja(AU)

Diabetes e lesão cardiovascular - uma consequência inexorável / Diabetes and cardiovascular injury ­ an inexorable consequence

A doença cardiovascular do paciente com diabetes possui múltiplos mecanismos. As manifestações clínicas são variadas, sendo particularmente prevalentes a doença macro e microvascular, a insuficiência cardíaca e a insuficiência renal crônica. Os mecanismos manifestam-se de maneira gradual e diversificada, dependendo do grau de controle glicêmico e de outros fatores de risco associados. A disfunção autonômica, alterações metabólicas glicêmicas e lipídicas, ativação do sistema renina angiotensina aldosterona, disfunção endotelial, comprometimento energético, hipertensão arterial, obesidade e aumento da atividade inflamatória e pró-trombótica têm sido descritos e parecem relacionados ao fenótipo clínico da doença. Uma vez que complicações como doença coronariana, insuficiência cardíaca e renal sejam diagnosticadas, o prognóstico da doença torna-se mais crítico, apesar do notável avanço terapêutico.

The cardiovascular disease in diabetics has multiple mechanisms. The clinical manifestations are diverse, with macro and microvascular disease, heart failure and chronic kidney failure being particularly prevalent. The mechanisms appear gradually and are diverse in form, depending on the degree of glycemic control and other associated risk factors. Autonomic dysfunction, glucose and lipid metabolic abnormalities, renin angiotensin system activation, endothelial dysfunction, energetic impairment, arterial hypertension, obesity and increased inflammatory and prothrombotic activity have been described and appear to be related to the clinical phenotype of the disease. When complications such as coronary heart disease, heart failure or kidney failure are diagnosed, the prognosis of the disease becomes more critical, in spite of notable therapeutic advances.

The Diabetic Foot as a Proxy for Cardiovascular Events and Mortality Review.

PURPOSE OF REVIEW: This article reviewed very recent papers (2016) discussing or bringing clinical evidences of the possible common pathways leading to diabetic foot syndrome (DFS) and increased mortality rates. RECENT FINDINGS: Diabetic patients with diabetic foot syndrome have a mortality rate greater than twofold when compared with non-ulcerated diabetics. In addition, the 5-year mortality rate following amputation is estimated at 39-68%, a life expectancy comparable to aggressive types of cancer or advanced congestive heart failure. The majority of patients with diabetic foot ulcer also present insulin resistance, central obesity, dyslipidemia, and hypertension that characterize the metabolic syndrome that, in turn, is associated with an elevated risk of major cardiovascular events. Sensory neuropathy is the primary cause of more the 60% of diabetic foot ulcer. Diabetic peripheral neuropathy is a microvascular complication of diabetes mellitus and in type 2 diabetes, not only hyperglycemia but also other metabolic alterations and persistent inflammatory status due to adiposity play a major role in axon injury. Elevated triglycerides have been showed to be an independent risk factor for lower extremity amputation in diabetic patients. Also, toxic adiposity, oxidative stress, mitochondrial dysfunction, activation of the polyol pathway, accumulation of advanced glycation end products (AGEs), and elevation of inflammatory markers are also implicated in diabetic vascular disease and neuropathy. The hypotheses that the association between DFS and increased rates of mortality reflects the progression of micro- and macrovascular complications are reinforced by the additional association of DFU to renal failure and retinopathy.

Factores psicosocio-inmunogenéticos en pacientes diabéticos con complicaciones vasculares / Psychological, social and immunogenetic factors observed in diabetic patients with vascular complications

El desarrollo de la medicina, la ciencia y los medios científicos técnicos, permiten explicar de manera didáctica e integral con un enfoque dialéctico-materialista los fenómenos complejos y sus interrelaciones entre sistemas, en diferentes entidades clínicas como la diabetes mellitus, objeto del presente trabajo. Describir la interacción entre factores psicosocio-inmuno-genéticos en pacientes diabéticos con complicaciones vasculares, fue el objetivo de nuestro trabajo. Se trabajó con las bases de datos PubMed, MedLine, SciELO, Ebsco y artículos científicos publicados en revistas cubanas entre 2011-2015. Se revisaron trabajos en español, inglés y francés. Se analizó la interrelación dialéctica e indisoluble de la función integradora del sistema inmune con los sistemas nervioso y endocrino, la que descansa en las relaciones entre los fenómenos psíquicos y orgánicos, y esto solo puede comprenderse completamente cuando se tiene en cuenta la interacción del hombre con el medio social en que se desenvuelve, así como la relación de este con la naturaleza, que es en definitiva el centro de su actividad creadora y transformadora y sobre todo el análisis de las implicaciones prácticas que conlleva para el campo de la clínica y la ciencia. Podemos concluir que el conocimiento de las interacciones entre factores psicosocio-inmuno-genéticos en pacientes diabéticos tipo 2 con complicaciones vasculares, es imprescindible para comprender la dinámica de los fenómenos bioquímicos, así como entre los tres sistemas integradores: neurológico, endocrino e inmune que tienen lugar en estos pacientes, lo que posibilita el tratamiento más adecuado y eficaz y la prevención de la enfermedad hereditaria en familias portadoras(AU)

The development of medicine, science and technical scientific devices allow explaining didactically and comprehensively, with a dialectical-materialist approach, complex phenomena and their interrelationships in different clinical conditions such as diabetes mellitus The objectives of this paper were to describe the interaction among psychological, social, and immunogenetic factors in diabetic patients with vascular complications and to address how these factors are associated with immunosupression state of type 2 diabetic patients. For this purpose, worked with PubMed, MedLine, SciELO, EBSCO databases and scientific articles published in 2011-2015 journals were consulted. A number of papers in Spanish, English and French languages were reviewed. The dialectic and permanent interrelation of the integrative function of the immune system with the nervous and endocrine systems, which is based on the relationship between psychic and phenomena, was analyzed. All this can only be fully understood when one takes into account man's interaction with the social environment as well as his relationship with nature, which is ultimately the core of their creative and transforming activity and particularly, the analysis of the practical implications for the clinical and scientific fields. The knowledge of the interactions among systems is imperative to understand homeostasis and dynamics of biochemical phenomena that occur in humans, both in the relationship between the biological and the psychic areas, and in the biological and the socio environmental areas, thus allowing scientific advances in this field for the development of more effective therapeutic and prevention methods(AU)

Factores psicosocio-inmunogenéticos en pacientes diabéticos con complicaciones vasculares / Psychological, social and immunogenetic factors observed in diabetic patients with vascular complications

El desarrollo de la medicina, la ciencia y los medios científicos técnicos, permiten explicar de manera didáctica e integral con un enfoque dialéctico-materialista los fenómenos complejos y sus interrelaciones entre sistemas, en diferentes entidades clínicas como la diabetes mellitus, objeto del presente trabajo. Describir la interacción entre factores psicosocio-inmuno-genéticos en pacientes diabéticos con complicaciones vasculares, fue el objetivo de nuestro trabajo. Se trabajó con las bases de datos PubMed, MedLine, SciELO, Ebsco y artículos científicos publicados en revistas cubanas entre 2011-2015. Se revisaron trabajos en español, inglés y francés. Se analizó la interrelación dialéctica e indisoluble de la función integradora del sistema inmune con los sistemas nervioso y endocrino, la que descansa en las relaciones entre los fenómenos psíquicos y orgánicos, y esto solo puede comprenderse completamente cuando se tiene en cuenta la interacción del hombre con el medio social en que se desenvuelve, así como la relación de este con la naturaleza, que es en definitiva el centro de su actividad creadora y transformadora y sobre todo el análisis de las implicaciones prácticas que conlleva para el campo de la clínica y la ciencia. Podemos concluir que el conocimiento de las interacciones entre factores psicosocio-inmuno-genéticos en pacientes diabéticos tipo 2 con complicaciones vasculares, es imprescindible para comprender la dinámica de los fenómenos bioquímicos, así como entre los tres sistemas integradores: neurológico, endocrino e inmune que tienen lugar en estos pacientes, lo que posibilita el tratamiento más adecuado y eficaz y la prevención de la enfermedad hereditaria en familias portadoras(AU)

The development of medicine, science and technical scientific devices allow explaining didactically and comprehensively, with a dialectical-materialist approach, complex phenomena and their interrelationships in different clinical conditions such as diabetes mellitus The objectives of this paper were to describe the interaction among psychological, social, and immunogenetic factors in diabetic patients with vascular complications and to address how these factors are associated with immunosupression state of type 2 diabetic patients. For this purpose, worked with PubMed, MedLine, SciELO, EBSCO databases and scientific articles published in 2011-2015 journals were consulted. A number of papers in Spanish, English and French languages were reviewed. The dialectic and permanent interrelation of the integrative function of the immune system with the nervous and endocrine systems, which is based on the relationship between psychic and phenomena, was analyzed. All this can only be fully understood when one takes into account man's interaction with the social environment as well as his relationship with nature, which is ultimately the core of their creative and transforming activity and particularly, the analysis of the practical implications for the clinical and scientific fields. The knowledge of the interactions among systems is imperative to understand homeostasis and dynamics of biochemical phenomena that occur in humans, both in the relationship between the biological and the psychic areas, and in the biological and the socio environmental areas, thus allowing scientific advances in this field for the development of more effective therapeutic and prevention methods(AU)

Resultados y reacciones adversas en pacientes tratados con Heberprot-P® en la comunidad / Results and adverse reactions observed in patients treated with Heberprot-P in the community setting

Introducción: La diabetes mellitus es considerada una epidemia en estos momentos a nivel mundial. Al aumentar la prevalencia de esta enfermedad aumenta la de pie diabético con sus respectivas lesiones. Objetivos: Determinar los resultados y reacciones adversas en pacientes tratados Heberprot-P® en la comunidad. Método: Estudio prospectivo en 17 pacientes con distintas lesiones de pie diabético atendidos en un área de salud entre enero de 2012 y abril de 2013. A todos se les aplicó, de forma ambulatoria, Heberprot-P® (factor de crecimiento epidérmico recombinante humano) hasta la granulación total de las lesiones. Resultados: El 52,94 por ciento de los pacientes tenían pie diabético grado 4 según la clasificación de Wagner. El 100 por ciento de los enfermos mostraron resultados satisfactorios. Las reacciones adversas se presentaron en seis ocasiones y en tres pacientes. Conclusiones: Se alcanzaron buenos resultados con el uso del Heberprot-P® considerados por las pocas reacciones adversas y la ausencia de amputación sobre todo en los pacientes diabéticos con úlceras del pie grado 4 de Wagner. El Heberprot-P® constituye un medicamento a tener en cuenta en la curación de las úlceras del pie diabético con la ventaja de que puede utilizarse de forma ambulatoria(AU)

Introduction: Diabetes mellitus is currently considered as an epidemic worldwide. With the rise of the prevalence of this disease, that of the diabetic foot with its different lesions increases too. Objectives: To determine the results and the adverse reactions in patients treated with Heberprot-P® in the community setting. Method: Prospective study of 17 patients with various diabetic foot lesions, who were seen in a health area from January 2012 to April 2013. They all received an outpatient treatment with Heberprot-P® (human recombinant epidermal growth factor) until complete granulation of lesions. Results: In the group, 52.94 percent of patients had grade 4 diabetic feet according to Wagner´s classification scale. All the treated patients showed satisfactory results and adverse reactions occurred six times in three patients. Conclusions: Good results are achieved with the use of Heberprot-P® due to few adverse reactions and absence of amputation, mainly in diabetics with grade 4-foot ulcers in Wagner´s classification scale. This is a drug to be taken into consideration for curing diabetic foot ulcers since it can also be used in outpatient treatment(AU)

Serum RBP4 and CKD: Association with insulin resistance and lipids.

OBJECTIVE: Serum RBP4 is new adipokine and it has been related to insulin resistance and diabetes risk in animal and clinical studies. However, there is controversy on this relationship among CKD patients. In this study, we evaluated the association of serum RBP4 with insulin resistance and cardiovascular risk factors in CKD. METHODS: Baseline data from the PROGREDIR Study (Sao Paulo, Brazil) comprising 454 participants (mainly stages 3 and 4) was analyzed. RESULTS: In univariable analysis, RBP4 was inversely related to renal function, age and HDL, and positively related to other lipids, insulinemia, HOMA, glycemia, albumin, phosphorus and right hepatic lobe diameter. After adjustment for sex, age and eGFR, HOMA and lipids remained associated to RBP4. In multivariable analysis, eGFR and triglyceride remained significantly associated with RBP4, while HOMA showed no longer a significant positive association. An interaction term between RBP4 and eGFR was significantly related to HOMA. CONCLUSIONS: Renal function is inversely related to serum RBP4. As GFR decreases, the relationship between RBP4 and HOMA is attenuated. On the other hand, triglycerides remained strongly related to RBP4 and this was not affected by eGFR, suggesting that in the CKD population triglycerides may be a better marker of RBP4-associated metabolic effects.

Identificación de los factores de riesgo que conducen al desarrollo de las lesiones neuropáticas ulceradas / Identification of the risk factors for the development of the neuropathic ulcerated wounds

Introducción: el pie diabético es una complicación crónica de la diabetes mellitus, que constituye un problema sanitario por el enorme gasto económico que ocasiona a los servicios de salud y provocar en las personas que lo padecen y su entorno familiar repercusiones sociales y emocionales.Objetivo: identificar la presencia de los factores de riesgo que condujeron al desarrollo de las lesiones neuropáticas ulceradas.Métodos: estudio descriptivo, retrospectivo, en los 109 pacientes diabéticos, sin distinción de sexo y tipo de diabetes, ingresados en el Servicio Provincial de Angiología y Cirugía Vascular, de Matanzas con el diagnóstico de pie diabético neuropático ulcerado en los grados 2 y 3 de Wagner. El período de estudio osciló entre enero de 2010 y mayo de 2014.Resultados: se constató la presencia de neuropatía diabética, existencia de helomas/hiperqueratosis y calzado inadecuado, asociados en más de la mitad de las circunstancias, con un déficit de los cuidados del pie. El número de factores de riesgo por paciente osciló entre seis y siete. En correspondencia con lo anterior, la estratificación de riesgo demostró una elevada frecuencia de pacientes con nivel de riesgo 3.Conclusión: la neuropatía diabética, la presencia de helomas/hiperqueratosis, y el uso de calzado inapropiado constituyen los factores de riesgo más frecuentemente asociados a la aparición de la ulceración neuropática del pie diabético en la población estudiada(AU)

Introduction: the diabetic foot is a chronic complication of diabetes mellitus that represents a health problem due to the high economic cost for the health care services and the social and emotional effects on the people suffering the disease and their family environment.Objective: to identify the risk factors leading to ulcerated neuropathic lesions.Methods: a descriptive and retrospective study conducted in 109 diabetic patients, regardless of sex and type of diabetes, who were diagnosed as 2nd and 3rd degree ulcerated neuropathic diabetic foot according to Wagner classification, and admitted to the Angiology and Vascular Surgery Service of Matanzas province. It was conducted from January 2010 to May 2014.Results: the following risk factors were determined: diabetic neuropathy, callus/hyperkeratosis, wearing wrong shoes; they were mostly associated to inappropriate foot care. The number of risk factors ranged six to seven per patient. In line with the aforementioned, the risk stratification showed a high frequency of patients with risk degree level 3.Conclusions: the presence of diabetic neuropathy, callus/hyperkeratosis, and wearing inappropriate shoes are the most frequent risk factors associated with the occurrence of neuropathic foot ulceration in the studied population(AU)

Riesgo vascular en pacientes diabéticos con obesidad / Vascular risk in diabetic patients with obesity

Un interesante trabajo de Valdés Ramos y Camps Arjona1 sobre las principales complicaciones crónicas en pacientes diabéticos de debut reciente, llama la atención sobre la elevada frecuencia de estas complicaciones. En este comentario me referiré al papel de la obesidad en las complicaciones vasculares, un aspecto insuficientemente tratado en el citado trabajo,1 que amerita un análisis más profundo, aunque se aclara que existen aspectos controversiales y polémicos.La obesidad abdominal asociada a otros factores de riesgo constituye el síndrome metabólico (SM), cuyo rasgo básico es la resistencia a la insulina (RI), caracterizada por dislipidemia, hipertensión arterial, intolerancia a la glucosa y un estado proinflamatorio y protrombótico que incrementan el riesgo de morbilidad y mortalidad por diferentes causas...

Efecto de cohorte al nacer sobre la prevalencia de factores de riesgo asociados a enfermedad coronaria en un país latinoamericano / Birth cohort effect on prevalence of cardiovascular risk factors in coronary artery disease. Experience in a Latin-american country

Antecedentes: La prevalencia de los factores de riesgo tradicionales asociados a enfermedad coronaria ha cambiado con el tiempo. En la actualidad se ha aumentado la frecuencia de dislipidemia, hipertensión y diabetes mellitus, pero disminuido la de tabaquismo. El efecto de cohorte al nacer en sujetos con enfermedad coronaria como aproximación de la verdadera prevalencia en el tiempo no se ha estudiado en Latinoamérica. Objetivo: Determinar la tendencia temporal de la prevalencia de factores de riesgo tradicionales para enfermedad coronaria por efecto de cohorte al nacer en una población de alto riesgo. Métodos: En pacientes con enfermedad coronaria se estimó la prevalencia de: diabetes mellitus, tabaquismo, hipertensión y dislipidemia. Se define como la presencia del efecto de cohorte al nacer la metodología estadística, epidemiológica y sociológica que pretende identificar la influencia del entorno en el transcurso de la vida de acuerdo con la década de nacimiento. Se realizaron análisis ajustados por género. Resultados: Se incluyen 3,056 sujetos. De ellos, el 72% son varones, la mediana de edad fue de 61 años (rango intercuartílico = 53-69). Para toda la población de estudio, la prevalencia de hipertensión fue del 62.3%, diabetes mellitus del 48.8%, tabaquismo activo del 18.8% y dislipidemia del 48.8%. Para diabetes mellitus y dislipidemia se observó un incremento de la prevalencia en cada cohorte según la década de nacimiento, mientras que para la hipertensión se vio una disminución en las mismas décadas de nacimiento. Conclusiones: La prevalencia de los factores de riesgo tradicionales ha cambiado con el tiempo y se evidencia la presencia del efecto del momento al nacer, influido posiblemente por las condiciones sociales del entorno en cada década de la vida.

Background: The prevalence of major risk factors associated to coronary artery disease has changed over time. Today, the frequency of dyslipidemia, hypertension and diabetes mellitus has increased, while smoking has decreased. The birth cohort effect for coronary artery disease in subjects as an approximation of the true prevalence over time has not been studied in Latin-America. Objective: To determine the trends in the prevalence of major risk factors for coronary artery disease by birth cohort effect in a high risk population. Methods: We estimate the prevalence of diabetes mellitus, smoking, hypertension and dyslipidemia from a prospective institutional registry (DREST registry) of patients who underwent percutaneous coronary intervention for acute coronary event. Birth cohort effect was defined as a statistical, epidemiological and sociological methodology to identify the influence of the environment in the lifetime from birth by each decade. Univariate and multivariate analyses were performed adjusted by gender. Results: Out of 3,056 subjects who were enrolled, 72% were male, with a median age of 61 years (interquartile range = 53-69). Hypertension prevalence was 62.3%, for diabetes mellitus it was 48.8%, for smoking it was 18.8% and for dyslipidemia it was 48.8%. We observed an increase in prevalence for diabetes mellitus and dyslipidemia in each cohort according to birth decade, while there was a reduction in prevalence for hypertension in the same decades. Conclusions: The prevalence of major cardiovascular risk factors has changed in time and the presence of time at birth effect is evident, possibly influenced by the environment's social conditions in each decade of life.

[Birth cohort effect on prevalence of cardiovascular risk factors in coronary artery disease. Experience in a Latin-american country]. / Efecto de cohorte al nacer sobre la prevalencia de factores de riesgo asociados a enfermedad coronaria en un país latinoamericano.

BACKGROUND: The prevalence of major risk factors associated to coronary artery disease has changed over time. Today, the frequency of dyslipidemia, hypertension and diabetes mellitus has increased, while smoking has decreased. The birth cohort effect for coronary artery disease in subjects as an approximation of the true prevalence over time has not been studied in Latin-America. OBJECTIVE: To determine the trends in the prevalence of major risk factors for coronary artery disease by birth cohort effect in a high risk population. METHODS: We estimate the prevalence of diabetes mellitus, smoking, hypertension and dyslipidemia from a prospective institutional registry (DREST registry) of patients who underwent percutaneous coronary intervention for acute coronary event. Birth cohort effect was defined as a statistical, epidemiological and sociological methodology to identify the influence of the environment in the lifetime from birth by each decade. Univariate and multivariate analyses were performed adjusted by gender. RESULTS: Out of 3,056 subjects who were enrolled, 72% were male, with a median age of 61 years (interquartile range=53-69). Hypertension prevalence was 62.3%, for diabetes mellitus it was 48.8%, for smoking it was 18.8% and for dyslipidemia it was 48.8%. We observed an increase in prevalence for diabetes mellitus and dyslipidemia in each cohort according to birth decade, while there was a reduction in prevalence for hypertension in the same decades. CONCLUSIONS: The prevalence of major cardiovascular risk factors has changed in time and the presence of time at birth effect is evident, possibly influenced by the environment's social conditions in each decade of life.