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Amidst the COVID-19 pandemic, hydroxychloroquine (HCQ) was widely administered despite limited data on its safety and efficacy. This study assesses the acute and chronic impacts of HCQ on electrocardiography (ECG) parameters alongside the effects of azithromycin and levofloxacin coadministration in patients with COVID-19. A comprehensive analysis was conducted on 109 COVID-19 patients receiving HCQ, with or without Azithromycin and/or Levofloxacin, and 51 long-term HCQ-treated Sjogren's syndrome (SS) patients. ECG parameters, including QTc interval, were meticulously evaluated against a control group of 109 COVID-19 patients without HCQ treatment. HCQ monotherapy, in combination with Levofloxacin, significantly prolonged the QTc interval in COVID-19 patients compared to controls. Notably, the combination of HCQ and Azithromycin demonstrated a mitigated impact on QTc prolongation. Long-term HCQ use in SS patients did not significantly affect QTc intervals, illustrating a distinct safety profile from short-term use in COVID-19 treatment. HCQ's impact on QTc prolongation is influenced by therapeutic context, coadministered drugs, and patient demographics. The findings underscore the necessity of cautious HCQ use, particularly in acute settings like COVID-19, where monitoring and consideration of drug interactions and patient-specific factors are critical.
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Azitromicina , Tratamento Farmacológico da COVID-19 , Eletrocardiografia , Hidroxicloroquina , Síndrome do QT Longo , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Hidroxicloroquina/administração & dosagem , Eletrocardiografia/efeitos dos fármacos , Feminino , Masculino , Pessoa de Meia-Idade , Azitromicina/uso terapêutico , Azitromicina/efeitos adversos , Azitromicina/administração & dosagem , Síndrome do QT Longo/induzido quimicamente , Idoso , Síndrome de Sjogren/tratamento farmacológico , Quimioterapia Combinada , Levofloxacino/uso terapêutico , Levofloxacino/administração & dosagem , Levofloxacino/efeitos adversos , Adulto , SARS-CoV-2 , COVID-19RESUMO
INTRODUCTION: Obesity, type 1 diabetes mellitus (T1DM), and type 2 diabetes mellitus (T2DM) are metabolic diseases that continue to be a global problem. Testosterone levels in men are affected by several factors, including obesity and DM. Although the relationship between diabetes and testosterone is not fully understood, oxidative stress is thought to play a major role. The aim of this study was to compare serum testosterone levels and oxidative stress markers [total antioxidant status (TAS), total oxidant capacity (TOS), oxidative stress index (OSI), and ischaemic modified albumin (IMA)] among the control group and experimentally induced obese, T1DM, and T2DM rats. MATERIAL AND METHODS: The study included 28 male Sprague-Dawley rats divided into 4 groups: the obesity group were fed a high-fat diet (HFD), the T2DM group received a HFD plus a single dose of streptozocin (STZ), the T1DM group received only STZ, and there was a control group. Serum testosterone, TAS, TOS, OSI, and IMA were analysed. RESULTS: Serum testosterone levels were lower in the T1DM and T2DM groups compared to the control and obesity groups. The TOS levels were highest in the T2DM group, followed by the T1DM group, the obesity group, and finally the control group. No significant difference was found between the obesity group and the control group in terms of TOS levels. Regarding TAS levels, the order observed was control group > obesity group > T2DM > T1DM. Testosterone was positively correlated with TAS and negatively correlated with TOS and OSI. CONCLUSIONS: Increased oxidative stress in diabetes may be an important factor that decreases serum testosterone levels.
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Obesidade , Estresse Oxidativo , Testosterona , Masculino , Animais , Testosterona/sangue , Obesidade/sangue , Glicemia/análise , Ratos Sprague-Dawley , Distribuição Aleatória , Dieta Hiperlipídica , Lipídeos/sangueRESUMO
BACKGROUND: To evaluate the impact of concomitant use of probiotic BB-12 in metformin-treated patients with type 2 diabetes or prediabetes on glycemic control, metformin-related gastrointestinal side effects, and treatment compliance. METHODS: A total of 156 patients (mean [standard deviation] age: 50.9 [9.9 years], 74.4% females) with newly diagnosed type 2 diabetes or prediabetes were randomly assigned to receive either metformin alone (n = 84, MET group) or metformin plus Bifidobacterium animalis subsp. lactis (BB-12) probiotic (n = 72, MET-PRO group). Data on body mass index (kg/m2), fasting blood glucose (mg/dL), blood lipids, and glycated hemoglobin (HbA1c) levels were recorded at baseline and at the third month of therapy. Data on gastrointestinal intolerance symptoms and treatment noncompliance were also recorded during post-treatment week 1 to week 4. RESULTS: MET-PRO versus MET therapy was associated with a significantly higher rate of treatment compliance (91.7% vs 71.4%, P = .001), greater reduction from baseline HbA1c values (0.9 [0.4-1.6] vs 0.4 [0-1.6] %, P < .001) and lower likelihood of gastrointestinal intolerance symptoms, including abdominal pain (P = .031 to <.001), diarrhea (P = .005 to <.001) and bloating (P = .010 to <.001). Noncompliance developed later (at least 15 days after the therapy) in a significantly higher percentage of patients in the MET group (P = .001 for 15-21 days and P = .002 for 22-28 days). CONCLUSION: In conclusion, the present study proposes the benefit of combining probiotics with metformin in the treatment of patients with T2D or prediabetes in terms of improved glycemic control and treatment adherence rather than correction of dyslipidemia or weight reduction.
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Bifidobacterium animalis , Diabetes Mellitus Tipo 2 , Metformina , Estado Pré-Diabético , Probióticos , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Metformina/efeitos adversos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/uso terapêutico , Estado Pré-Diabético/induzido quimicamente , Estado Pré-Diabético/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Controle Glicêmico , Glicemia/análise , Cooperação do Paciente , Probióticos/efeitos adversos , Quimioterapia Combinada , Método Duplo-CegoRESUMO
ABSTRACT Objectives: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Subjects and methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusions: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.
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Objective: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusion: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.
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BACKGROUND: To evaluate the changes in the peripapillary, macular and choriocapillaris microvasculatures in the eyes of patients with Behçet's disease (BD) without ocular involvement by optical coherence tomography angiography (OCT-A) and to investigate the relationship with systemic vascular involvement (SVI). METHODS: The study included 56 eyes of 33 patients with non-ocular BD and 61 eyes of 33 healthy subjects. The macular microvascular (MMV) vessel densities (VDs), FAZ parameters, Choriocapillaris flow area (CCFA), radial peripapillary capillary (RPC) VDs and optic nerve head (ONH) analyses were performed with OCT-A. MMV, RPC, ONH, and CCFA measurements were compared between the non-ocular BD patients and healthy controls. Then, the patient group was divided into two subgroups according to the presence of SVI. MMV, RPC, and CCFA measurements of these subgroups were compared with the healthy controls. RESULTS: While deep capillary plexus VD and foveal density decreased in MMV analysis in the BD group compared to the control group, CCFA was not different. In the RPC and ONH analysis, the VDs of the inside-disc small vessels and the VDs of the inside-disc all vessels were decreased while the cup/disk area ratio and cup volume were increased in the BD group compared to the healthy controls. Furthermore, the VDs of the inside-disc vessels were reduced in patients without SVI compared to those with SVI and healthy controls. CONCLUSIONS: The RPC network, ONH and MMV architecture analysis by OCT-A revealed changes in the MMV, RPC, and ONH structures in non-ocular BD patients. Moreover, the decrease in RPC VDs and MMV VDs in patients without SVI suggested that the patients with BD without SVI had subclinical ocular involvement even in the absence of clinical ocular findings.
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Síndrome de Behçet , Fotoquimioterapia , Síndrome de Behçet/diagnóstico por imagem , Corioide/diagnóstico por imagem , Angiofluoresceinografia/métodos , Humanos , Microvasos/diagnóstico por imagem , Fotoquimioterapia/métodos , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodosRESUMO
OBJECTIVE: Ocular involvement in systemic sclerosis (SSc) has been documented; however it cannot be distinguished from secondary changes due to concomitant hypertension.Therefore, the aim of this prospective cross-sectional study was to demonstrate the direct effects of Ssc on retinal and choroidal microvasculature in patients without hypertension. METHODS: 47 SSc patients and 44 age- and sex-matched healthy control subjects were enrolled in this study. In fundus examination: Increased vascular tortitis, focal or general arteriolar narrowing, arteriovenous notch, severe exudation, microhemorrhage, and pigment epithelial changes in the retina of SSc patients without hypertension were investigated. Patients with at least two of the above findings were considered to have retinopathy After that, patients were divided into two groups according to the presence of retinopathy in this study. Retinal and choroidal microvasculature were evaluated using optical coherence tomography angiography. RESULTS: There was a significant decrease in SSc patients with retinopathy in both superficial capillary plexus vessel density (SCP VD) and deep capillary plexus vessel density (DCP VD) compared to the control group. Full avascular zone (FAZ) evaluation tool variables (FAZ area, FAZ perimeter, foveal density) were significantly lower in all Ssc patients than in the healthy control group. It was found that the flow in the 1 mm and 3 mm circular area (Outer Retina 1-3 mm Flow Area) increased significantly in Ssc patients with retinopathy. Choroidal flow (Choriocapillaries 1 mm Flow Area) was statistically lower in Ssc patients with retinopathy. CONCLUSIONS: We have showed an increase in the outer retina 1-3 mm flow area (circular area of the outer retina fold covering the fovea) despite the decrease in vascular density and choroidal thickness in scleroderma patients with retinopathy. Hence, we first demonstrated that Ssc itself may have an effect on retinal and choroidal microvasculature, independent of hypertension.
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Corioide/irrigação sanguínea , Microcirculação , Microvasos/diagnóstico por imagem , Doenças Retinianas/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Escleroderma Sistêmico/fisiopatologia , Adulto , Angiografia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Densidade Microvascular , Microvasos/fisiopatologia , Pessoa de Meia-Idade , Imagem de Perfusão , Valor Preditivo dos Testes , Estudos Prospectivos , Doenças Retinianas/diagnóstico por imagem , Vasos Retinianos/fisiopatologia , Escleroderma Sistêmico/diagnóstico por imagem , Tomografia de Coerência ÓpticaRESUMO
BACKGROUND/AIMS: Several studies have shown that a change in microbiota plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Furthermore, with the emergence in recent studies of differences according to the subtype of IBD and whether the disease is active or in remission, there has started to be research into the relationship between IBD and several microorganisms. Blastocystis hominis is primary among these organisms. The aim of the present study was to determine the role of B. hominis in the acute flare-up of ulcerative colitis (UC). MATERIALS AND METHODS: A total of 114 patients with UC were included in the study, with 52 in the active phase. The Mayo scoring system was used for the activity index. Patients determined with a flare-up agent other than B. hominis were excluded from the study. Fecal samples of the patients were examined by the polymerase chain reaction method for the presence of B. hominis. RESULTS: B. hominis positivity was determined in 37 (34%) patients with UC. Of the patients, 17 (32.6%) were in the acute flare-up phase, and 20 (32.2%) were in remission (p=0.961). In 11 (64.7%) of the B. hominis positive patients, the disease severity was determined as mild-moderate (p<0.001). CONCLUSION: The results of the present study showed that while there was no difference between the active and remission phases in respect of B. hominis presence, there was milder involvement in those determined with B. hominis.
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Infecções por Blastocystis/complicações , Blastocystis hominis , Colite Ulcerativa/parasitologia , Exacerbação dos Sintomas , Adulto , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
BACKGROUND: Malnutrition results in functional changes in the liver and pancreas that negatively affect carbohydrate metabolism. The aim of this study was to evaluate whether insulin hormone and glycated hemoglobin A1c (HbA1c) could serve as predictors of hunger-related malnutrition/undernutrition without disease in adults. METHODS: The Malnutrition Universal Screening Tool (MUST) was used to assess malnutrition in this single-center, cross-sectional study. The malnourished group (n = 67) comprised patients with a MUST score of ≥ 2, and the control group (n = 31) included subjects with a MUST score of 0 - 1. Serum albumin, prealbumin, C-reactive protein (CRP), fasting glucose, fasting insulin, hemoglobin and HbA1c levels, body mass index (BMI), and homoeostatic model for insulin resistance (HOMA-IR) scores were compared between the two groups. RESULTS: No significant difference was determined between the control and malnourished groups in respect of age or gender. HbA1c [5.5% (5 - 6.2) vs. 5.2% (3.9 - 6.7), p = 0.001], insulin levels [7.37 (2.36 - 52.16) vs. 3.91(1.17 - 30.08) µIU/mL, p < 0.001], and BMI [21.7 (14.1 - 34.0) vs. 17.8 (12.0 - 26.6) kg/m2, p < 0.001] were significantly lower in the malnourished group. Logistic regression analysis revealed that BMI was the only significant parameter (odds ratio [95% confidence interval] 0.680 [0.543 - 0.852]). CONCLUSIONS: Plasma insulin and HbA1c levels were significantly decreased in young adult malnourished patients without disease who had normal fasting glucose levels. These two parameters are known to be unaffected by inflammatory states, and therefore warrant further research on larger and different age sub-populations to assess if they might be early predictors of hunger-related malnutrition without disease.
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Hemoglobinas Glicadas/análise , Fome , Insulina/sangue , Desnutrição/sangue , Adolescente , Adulto , Idoso , Glicemia/análise , Proteína C-Reativa/análise , Estudos Transversais , Jejum/sangue , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Albumina Sérica/análise , Adulto JovemRESUMO
BACKGROUND: Proton pump inhibitor (PPI) induced hypomagnesemia is a completely unexplained issue and cases are still being reported. Long-term use is the main factor, but there are a few articles stating that it may also emerge with short-term use. We aimed to evaluate the changes of serum and urine magnesium levels during shortterm high dose pantoprazol treatment. METHODS: The serum and 24-hour urine magnesium levels of 58 patients were evaluated during the course of 2 days. Of 58 patients, 25 were allowed oral intake on the 3rd day of hospitalization and thus, 24-hour urine for 3 days was collected from 33 patients. RESULTS: There were no significant differences in the mean levels of serum magnesium and the median levels of urine magnesium. When the magnesium levels were evaluated by age over and under 60 years, the baseline serum magnesium level was significantly higher than the 1st level in patients aged ≥ 60 years (p = 0.029). The 3rd day serum magnesium level was significantly higher than the baseline and 1st day levels in those aged < 60 years (p = 0.049). CONCLUSIONS: We showed that plasma levels and urinary excretion of magnesium did not change significantly during high-dose pantoprazol treatment. It can be hypothesized that magnesium levels are not affected by PPIs in short-term usage. Age and other contributing factors may have more impact on PPI induced hypomagnesemia. Patients aged over 60 years might be handled carefully under proton pump inhibitors treatment.
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Hospitalização/estatística & dados numéricos , Magnésio/sangue , Magnésio/urina , Pantoprazol/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/urina , Humanos , Hipercalciúria/sangue , Hipercalciúria/diagnóstico , Hipercalciúria/urina , Masculino , Pessoa de Meia-Idade , Nefrocalcinose/sangue , Nefrocalcinose/diagnóstico , Nefrocalcinose/urina , Pantoprazol/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/uso terapêutico , Erros Inatos do Transporte Tubular Renal/sangue , Erros Inatos do Transporte Tubular Renal/diagnóstico , Erros Inatos do Transporte Tubular Renal/urina , Fatores de TempoRESUMO
The conformation and heterogeneity of lambda-carrageenan, a sulphonated galactan from red seaweed, solubilised in aqueous solvent with the assistance of microwave irradiation, has been assessed by a combination of analytical ultracentrifugation, size-exclusion chromatography, light scattering and capillary viscometry. Preparations appeared generally unimodal on the basis of sedimentation coefficient distributions from sedimentation velocity although at the highest concentrations a shoulder appears with a sedimentation coefficient approximately 1.1 times greater than that of the main component. Even under conditions commensurate with charge suppression simple linear regression was insufficient to represent non-ideal concentration dependence and the extraction of the Grálen concentration dependence parameter ks. A more general fitting algorithm was therefore employed. Mark-Houwink-Kuhn-Sakurada analysis of the change in intrinsic viscosity [η] with molecular weight, together with the Wales-van Holde ratio (combination of ks with [η]) point to an extended flexible conformation for lambda-carrageenan in the (weight average) molecular weight range Mw=340,000-870,000g/mol. The origin of the larger sedimentation coefficient component appearing at the higher concentrations is considered.