Metabolic control of diabetic patients assisted by private and public health care systems during the COVID-19 pandemic: A retrospective cohort study.

AIMS: We sought to analyze the impacts of social restriction measures imposed by the pandemic COVID-19 on the control of metabolic parameters in diabetic patients. METHODS: We accessed the medical records of patients who underwent clinical follow-up in the public and private health systems between July 2019 and June 2021. The sample consisted of 288 patients (111 adults and 177 older individuals). A two-way ANOVA mixed model was used to test the effects of intra- (time: baseline and after 24 months) and inter-subject factors. Linear regression analysis was used to predict the difference in body weight considering age, sex, HbA1c, health care system and insulin use. RESULTS: Among adults, we observed an increase in body weight and LDL-c levels, especially for insulin users (p ≤ 0.05). Adults assisted by the public health care system showed higher HbA1c levels (p = 0.001). Among older individuals using insulin, blood glucose levels decreased (p = 0.019). Body weight decreased in those assisted by the private system (p = 0.005), while glycemia decreased for patients assisted by both health care systems (p = 0.043). The linear regression model confirmed that the increase in body weight was more pronounced in adults than in older individuals. CONCLUSION: The social restriction measures imposed by the pandemic affected the metabolic control of diabetic patients, especially adults assisted by the public health care system.

Espironolactone improves flow-mediated vasodilatation in subjects with the metabolic syndrome.

INTRODUCTION: The role of aldosterone in the pathophysiology of the metabolic syndrome (MS)-related endothelial dysfunction has been the subject of recent research. OBJECTIVE: To evaluate the effects of aldosterone blockade on flow-mediated vasodilation (FMD) and on renal and metabolic parameters of patients with the MS. METHODS: 19 MS subjects underwent clinical examination, laboratory work-up (serum lipid profile, glucose and insulin; creatinine clearance; microalbuminuria investigation), ambulatory blood pressure monitoring (ABPM), and FMD analysis before and after 16 weeks of aldosterone blockade with spironolactone. RESULTS: After the treatment period, FMD increased from 7.6 ± 5.63% to 15.0 ± 6.10% (p < 0.001), associated with a non-significant decrease of blood pressure (from 142.2 ± 16.37 mmHg to 138.8 ± 16.67 mmHg, and from 84.3 ± 10.91 mmHg to 82.7 ± 9.90 mmHg, respectively). HDL-cholesterol significantly increased, microalbuminuria showed a decreasing trend and creatinine clearance did not change after treatment. CONCLUSION: Aldosterone blockade in patients with the MS improved FMD without interfering with metabolic and renal parameters.

Espironolactona melhora a vasodilatação fluxo mediada em indivíduos com síndrome metabólica / Espironolactone improves flow-mediated vasodilatation in subjects with the metabolic syndrome

INTRODUÇÃO: O papel da aldosterona na fisiopatologia da disfunção endotelial relacionada à síndrome metabólica (SM) tem sido objeto de estudos. OBJETIVO: Avaliar o bloqueio da aldosterona sobre a vasodilatação fluxo mediada (VDFM) e sobre parâmetros renais e metabólicos em indivíduos com SM. MÉTODOS: Dezenove indivíduos com SM foram submetidos a exame clínico; exames complementares: glicose, insulina, lipidograma, depuração da creatinina, microalbuminúria e a monitorização ambulatorial da pressão arterial (MAPA) e análise da VDFM antes e após 16 semanas do uso de espironolactona. RESULTADOS: Após o tratamento, observou-se aumento da VDFM, de 7,6 ± 5,63 por cento para 15,0 ± 6,10 por cento (p < 0,001), com redução não significante da pressão sistólica e diastólica (142,2 ± 16,37 mmHg para 138,8 ± 16,67 mmHg e 84,3 ± 10,91 mmHg para 82,7 ± 9,90 mmHg, respectivamente). O colesterol HDL (High-density lipoprotein - lipoproteína de alta densidade) aumento de modo significante, a microalbuminúria apresentou tendência à redução, enquanto a depuração da creatinina não variou significativamente com o tratamento. CONCLUSÃO: O bloqueio da aldosterona em pacientes com SM melhorou a VDFM, sem induzir alterações no perfil metabólico e em parâmetros renais.

INTRODUCTION: The role of aldosterone in the pathophysiology of the metabolic syndrome (MS)-related endothelial dysfunction has been the subject of recent research. OBJECTIVE: To evaluate the effects of aldosterone blockade on flow-mediated vasodilation (FMD) and on renal and metabolic parameters of patients with the MS. METHODS: 19 MS subjects underwent clinical examination, laboratory work-up (serum lipid profile, glucose and insulin; creatinine clearance; microalbuminuria investigation), ambulatory blood pressure monitoring (ABPM), and FMD analysis before and after 16 weeks of aldosterone blockade with spironolactone. RESULTS: After the treatment period, FMD increased from 7.6 ± 5.63 percent to 15.0 ± 6.10 percent (p < 0.001), associated with a non-significant decrease of blood pressure (from 142.2 ± 16.37 mmHg to 138.8 ± 16.67 mmHg, and from 84.3 ± 10.91 mmHg to 82.7 ± 9.90 mmHg, respectively). HDL-cholesterol significantly increased, microalbuminuria showed a decreasing trend and creatinine clearance did not change after treatment. CONCLUSION: Aldosterone blockade in patients with the MS improved FMD without interfering with metabolic and renal parameters.

Perfil dos usuários do ambulatório de dermatologia antroposófica - HU/CAS- UFJF, Juiz de Fora - MG / The patient´s profile of the anthroposophic dermatology service - HU/CAS - UFJF, Juiz de Fora - MG

Este trabalho busca demonstrar o perfil do usuário da Medicina Antroposófica (MA) no Ambulatório de Dermatologia do Hospital Universitário ? Centro de Atenção à Saúde da Universidade Federal de Juiz de Fora (HU/CAS-UFJF), assim como avaliar sua aceitação pela comunidade.O ambulatório surgiu dentro de uma visão mais abrangente da Medicina, em conformidade com a Organização Mundial de Saúde, que vem estimulando o uso da Medicina Tradicional e Complementar/Alternativa nos Sistemas de Saúde de forma integrada às técnicas modernas da medicina ocidental; e visa difundir a prática Médica Antroposófica em Juiz de Fora demonstrando sua eficácia e qualidade.Para tal feito, foi realizado um estudo retrospectivo, quali-quantitativo, através da coleta de dados, a partir de prontuários de 2008 e 2009 do HU/CAS-UFJF, seguida da análise das informações.O resultado demonstrou que a MA foi eficaz em mais de 75% dos tratamentos propostos, com média de cura/melhora completa em 40% dos casos analisados. Discute-se então, sobre os resultados encontrados e percebe-se que têm semelhanças com os da literatura em relação à frequência das doenças dermatológicas. As conclusões são positivas e contribuem para a legitimidade da Medicina Antroposófica.

This paper seeks to demonstrate the patients’ profile of the Anthroposophical Medicine (AM) in the Dermatology Clinic of the Hospital Undergraduate / Secondary Service Center, Federal University of Juiz de Fora - MG (HU / CAS-UFJF) as well as evaluate its acceptance by the community. This Clinic of AM emerged within a more comprehensive vision of medicine in accordance with the World Health Organization which has encouraged the use of Traditional Medicine and Complementary / Alternative Systems in an integrated manner with the modern Western medicine techniques, and aims to spread the Anthroposophical Medicine experience in Juiz de Fora and demonstrate its effectiveness and quality. For this, it was performed a retrospective study and quali-quantitative data collection made in the period of June- December 2009 from medical files of the HU/ CAS - UFJF, followed by analysis of the collected data. The findings were that the AM was effective in more than 75% of the proposed treatments, with healing / improvement average of 100% in 40% of cases. It is argued then about the results and perceives that has similarities with the literature in relation to frequency. The conclusions are positive and contribute to the legitimacy of Medicine Antroposófica.