RESUMO
Objective: Screen time (ST) has shown negative effects on physical and mental health, with an increase in the prevalence of overweight, metabolic syndrome (MetS), and obesity. The time spent in front of the screens was also associated with higher odds of selecting indicators of cardiometabolic disease in adulthood. In view of this, the aim of this study was to identify the risk of MetS and type 2 diabetes mellitus (T2DM) in healthy young males and relate it to ST and sleep time. Methods: We evaluated physical and laboratory characteristics, dichotomous diagnosis criteria, and continuous scores to assess MetS and Finnish Diabetes Risk Score questionnaire to measure the T2DM risk. Results: The means of MetS dichotomous and continuous severity criteria, among individuals with <7 hr of sleep, were higher than those with adequate sleep. We did not observe a direct impact of ST on the risk of MetS; nevertheless, >8 hr of ST increased 1.22 points in the T2DM risk. Conclusion: Excessive ST increased the risk of T2DM, but not of MetS. Moreover, sleeping <7 hr was associated with a higher mean of dichotomous and continuous severity criteria for MetS.
Assuntos
Diabetes Mellitus Tipo 2 , Síndrome Metabólica , Tempo de Tela , Sono , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/complicações , Sono/fisiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Adulto Jovem , Adulto , Fatores de Risco , Fatores de Tempo , Estudos Transversais , Medição de Risco , Adolescente , Finlândia/epidemiologia , Voluntários Saudáveis , Inquéritos e Questionários , PrevalênciaRESUMO
INTRODUCTION: posterior urethral valves represent an important cause of childhood chronic kidney disease. The identification of biomarkers that indicate early kidney damage and even adequate clearance could reduce how many patients head towards kidney failure. OBJECTIVE: this study evaluated how this easy-analysis biomarker (CA 19-9) could help identifying potential renal damage and adequate clearance in obstructive uropathies. METHODS: 46 female Wistar rats were divided into 5 groups, with different patterns of partial urinary tract obstruction: group control; group OIV: infravesical obstruction; group OIVd: infravesical obstruction with reversion, obstruction relief 7 postoperative days later; group OUu: unilateral ureteral obstruction; group OUb: bilateral ureteral obstruction. The CA 19-9s performance was compared to another biomarker: Ngal. Determination of basal CA 19-9 and Ngal in urine and blood and serum creatinine levels was performed in the rats prior to surgery (T0) and after 14 days (T1). Group OIVd underwent intermediate (Ti) collection before clearance. RESULTS: the urinary concentration of CA 19-9 increased in groups OIV, OIVd and OUb; elevation at T1 and Ti, reached statistical significance compared to the T0 value (p<0,05). Changes in urinary CA 19-9 were more expressive in infravesical obstruction groups (AUC 0.81). Obstruction relief in group OIVd promoted significant urinary CA 19-9 reduction (p<0,05) in the final evaluation. CONCLUSIONS: CA 19-9 urinary concentration increased in partial urinary tract obstruction. Its best performance was in the bladder neck obstruction group, in which the elevation was detected early (6 days after infravesical obstruction) and the CA19-9 urinary concentration declined after clearance.
Assuntos
Obstrução Ureteral , Animais , Antígeno CA-19-9/urina , Feminino , Lipocalina-2 , Prognóstico , Ratos , Ratos Wistar , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/cirurgia , Obstrução Ureteral/urinaRESUMO
ABSTRACT Introduction: posterior urethral valves represent an important cause of childhood chronic kidney disease. The identification of biomarkers that indicate early kidney damage and even adequate clearance could reduce how many patients head towards kidney failure. Objective: this study evaluated how this easy-analysis biomarker (CA 19-9) could help identifying potential renal damage and adequate clearance in obstructive uropathies. Methods: 46 female Wistar rats were divided into 5 groups, with different patterns of partial urinary tract obstruction: group control; group OIV: infravesical obstruction; group OIVd: infravesical obstruction with reversion, obstruction relief 7 postoperative days later; group OUu: unilateral ureteral obstruction; group OUb: bilateral ureteral obstruction. The CA 19-9s performance was compared to another biomarker: Ngal. Determination of basal CA 19-9 and Ngal in urine and blood and serum creatinine levels was performed in the rats prior to surgery (T0) and after 14 days (T1). Group OIVd underwent intermediate (Ti) collection before clearance. Results: the urinary concentration of CA 19-9 increased in groups OIV, OIVd and OUb; elevation at T1 and Ti, reached statistical significance compared to the T0 value (p<0,05). Changes in urinary CA 19-9 were more expressive in infravesical obstruction groups (AUC 0.81). Obstruction relief in group OIVd promoted significant urinary CA 19-9 reduction (p<0,05) in the final evaluation. Conclusions: CA 19-9 urinary concentration increased in partial urinary tract obstruction. Its best performance was in the bladder neck obstruction group, in which the elevation was detected early (6 days after infravesical obstruction) and the CA19-9 urinary concentration declined after clearance.
RESUMO Introdução: a válvula de uretra posterior representa uma importante causa de doença renal crônica na infância. A identificação de biomarcadores que monitorem danos renais precoces e o sucesso da desobstrução do trato urinário podem reduzir o número de pacientes que evoluem para insuficiência renal. Objetivo: avaliar o desempenho do biomarcador antígeno carboidrato CA 19-9 nas obstruções parciais do trato urinário. Método: 46 ratas Wistar foram divididas em 5 grupos: grupo controle; grupo OIV: obstrução infravesical; grupo OIVd: obstrução infravesical com alívio da obstrução após 7 dias; grupo OUu: obstrução ureteral unilateral; grupo OUb: obstrução ureteral bilateral. O desempenho do CA 19-9 foi comparado a outro biomarcador, a Ngal. A dosagem de CA 19-9 e Ngal na urina e no sangue, e os níveis de creatinina sérica foram avaliados nas ratas antes da cirurgia (T0) e após 14 dias (T1). O grupo OIVd foi submetido a uma coleta intermediária (Ti). Resultados: a concentração urinária de CA19-9 aumentou nos grupos OIV, OIVd e OUb; a elevação em T1 e Ti alcançou significância estatística em relação ao valor de T0 (p<0,05). As alterações no CA 19-9 urinário foram mais expressivas nos grupos de obstrução infravesical (AUC 0,81). O alívio da obstrução no grupo OIVd promoveu redução do CA 19-9 urinário (p<0,05). Conclusões: a concentração urinária de CA19-9 aumentou na obstrução parcial do trato urinário. Seu melhor desempenho foi no grupo de obstrução infravesical, no qual a elevação foi detectada precocemente (6 dias de pós-operatório) com queda após a retirada do fator obstrutivo.
RESUMO
BACKGROUND AND AIMS: Abnormalities in lipid metabolism, accumulation of uremic toxins and advanced glycation end products may contribute to worsening atherosclerosis. This study characterized the glycation and carbamoylation profile of serum albumin isolated from individuals with diabetic kidney disease and its influence on cholesterol efflux. MATERIAL AND METHODS: 49 patients with type 2 diabetes (T2DM) and different eGFR evaluated glycation and carbamoylation profile by measurement of carboxymethyl lysine (CML) and carbamoylated proteins (CBL) in plasma by ELISA, homocitrulline (HCit) in plasma by colorimetry. In the isolated albumins, we quantified CBL (ELISA) and total AGE and pentosidine by fluorescence. Macrophages were treated with albumin isolated, and 14C-Cholesterol efflux mediated by HDL2 or HDL3 was measured. Kruskal-Wallis test, Jonckheere-Terpstra test and Brunner's posttest were used for comparisons among groups. RESULTS: Determination of CML, HCit, CBL in plasma, as total AGE and pentosidine in albumins, did not differ between groups; however, CBL in the isolated albumins was higher in the more advanced stages of CKD (p=0.0414). There was reduction in the 14C-cholesterol efflux after treatment for 18h with albumin isolated from patients with eGFR<60mL/min/1.73m2 compared with control group mediated by HDL2 (p=0.0288) and HDL3 (p<0.0001), as well as when compared with eGFR ≥60mL/min/1.73m2 per HDL2 (p=0.0001) and HDL3 (p<0.0001). Treatment for 48h showed that eGFR<15mL/min/1.73m2 had a lower percentage of 14C-cholesterol efflux mediated by HDL2 compared to control and other CKD groups (p=0.0274). CONCLUSIONS: Albumins isolated from individuals with T2DM and eGFR<60mL/min/1.73m2 suffer greater carbamoylation, and they impair the cholesterol efflux mediated by HDL2 and HDL3. In turn, this could promote lipids accumulation in macrophages and disorders in reverse cholesterol transport.
Assuntos
Colesterol/metabolismo , Nefropatias Diabéticas/metabolismo , Macrófagos , Insuficiência Renal Crônica , Albumina Sérica , Diabetes Mellitus Tipo 2/complicações , Humanos , Macrófagos/metabolismo , Carbamilação de Proteínas , Insuficiência Renal Crônica/metabolismo , Albumina Sérica/metabolismo , Toxinas UrêmicasRESUMO
BACKGROUND AND AIM: 11ß-Hydroxysteroid dehydrogenase 1 has been implicated in insulin resistance (IR) in the setting of metabolic disorders, and single nucleotide polymorphisms (SNPs) in its encoding gene (HSD11B1) have been associated with type 2 diabetes and metabolic syndrome. In type 1 diabetes (T1D), IR has been related to the development of chronic complications. We investigated the association of HSD11B1 SNPs with microvascular complications and with IR in a Brazilian cohort of T1D individuals. MATERIALS AND METHODS: Five SNPs were genotyped in 466 T1D individuals (57% women; median of 37 years old, diabetes duration of 25 years and HbA1c of 8.4%). RESULTS: The minor allele T of rs11799643 was nominally associated with diabetic retinopathy (OR = 0.52; confidence interval [CI] 95% = 0.28-0.96; P = .036). The minor allele C of rs17389016 was nominally associated with overt diabetic kidney disease (DKD) (OR = 1.90; CI 95% = 1.07-3.37; P = .028). A follow-up study revealed that 29% of the individuals lost ≥5 mL min-1 × 1.73 m2 per year of the estimated glomerular filtration rate (eGFR). In these individuals (eGFR decliners), C allele of rs17389016 was more frequent than in non-decliners (OR = 2.10; CI 95% = 1.14-3.89; P = .018). Finally, minor allele T of rs846906 associated with higher prevalence of arterial hypertension, higher body mass index and waist circumference, thus conferring risk to a lower estimated glucose disposal rate, a surrogate marker of insulin sensitivity (OR = 1.23; CI 95% = 1.06-1.42; P = .004). CONCLUSION: SNPs in the HSD11B1 gene may confer susceptibility to DKD and to IR in T1D individuals.
Assuntos
11-beta-Hidroxiesteroide Desidrogenase Tipo 1 , Diabetes Mellitus Tipo 1 , Nefropatias Diabéticas , Resistência à Insulina , 11-beta-Hidroxiesteroide Desidrogenase Tipo 1/genética , Adulto , Diabetes Mellitus Tipo 1/genética , Nefropatias Diabéticas/genética , Feminino , Predisposição Genética para Doença , Humanos , Resistência à Insulina/genética , Masculino , Polimorfismo de Nucleotídeo ÚnicoRESUMO
OBJECTIVE: To investigate the association between inadequate functional health literacy, considering the Short Assessment of Health Literacy for Portuguese-speaking Adults, and glycemic control in elderly patients with type 2 diabetes, and to examine this association in low social support settings, according to Medical Outcomes Study . METHODS: Cross-sectional study conducted at the diabetes referral center of a university hospital. Participants were recruited among type 2 diabetes patients aged 60 years or older, between May 2013 and November 2014. The primary outcome was the most recent glycated hemoglobin value measured within the last 6 months. RESULTS: A total of 398 elderly patients with type 2 diabetes were evaluated. Of these, 232 were not eligible to participate. The final sample comprised 166 participants. Hierarchical multiple linear regression was performed. The following variables were entered in three blocks: sociodemographic characteristics, clinical variables and health literacy scores. Regression analysis of the interaction between health literacy and social support as a determinant of glycemic control was also performed. Mean age of subjects was 68.0 years (standard deviation of 5.9). Mean glycated hemoglobin value was 8.5% (standard deviation of 1.4). Short assessment of health literacy for Portuguese speaking adults score was independently associated with glycated hemoglobin (B=-0.059; p=0.043). The interaction between social support and health literacy score (p=0.003) was a determinant of glycemic control. CONCLUSION: Health literacy is associated with glycemic control. Social support may modify the relation between health literacy and glycemic control.
Assuntos
Diabetes Mellitus Tipo 2 , Letramento em Saúde , Idoso , Glicemia , Estudos Transversais , Hemoglobinas Glicadas/análise , Controle Glicêmico , Humanos , Pessoa de Meia-Idade , Apoio SocialRESUMO
BACKGROUND AND AIM: A low-grade inflammation is associated with cardiac autonomic neuropathy (CAN) and increased concentration of leukotriene B4 (LTB4) was found in individuals with type 1 diabetes and definitive CAN. This cross-sectional study evaluated plasma concentration of LTB4 and of other inflammatory mediators, namely, tumor necrosis factor (TNF), interleukin (IL)1B, and IL10 in individuals with type 2 diabetes (T2D) and different degrees of CAN, and correlated these inflammatory mediators with the degree of glycemic control and with a surrogate marker of insulin resistance. METHODS: TNF, IL1B, IL10 and LTB4 plasma concentrations were measured in 129 T2D subjects (62% women with [median] age of 63 years, disease duration of 8 years and HbA1c of 7.3%) with or without CAN. The Lipid accumulation product index was used as a surrogate marker of insulin resistance. RESULTS: LTB4 concentration was significantly higher in those presenting incipient CAN (69.7 ± 16.6 pg mL-1) and definitive CAN (71.5 ± 15.7 pg mL-1) versus those without CAN (57.0 ± 13.9 pg mL-1). The groups without CAN and with incipient CAN were pooled (group without definitive CAN) and compared to those with definitive CAN. LTB4 concentration was higher in the latter group, as well as TNF concentration, while IL10 concentration was lower in this group. After adjustment for confounding variables, only LTB4 concentration remained significantly different between the groups with and without definitive CAN. Plasma concentration of LTB4 did not correlate with the degree of glycemic control. After sorting the participants by sex, a borderline weak correlation was found between LTB4 and the Lipid accumulation product index in women. CONCLUSION: In the T2D setting, circulating LTB4 concentration seems to be associated with cardiovascular dysautonomia.
RESUMO
AIMS: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. METHODS: This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. RESULTS: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. CONCLUSIONS: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. Daily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision.
Assuntos
Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Fotografação/métodos , Retina/diagnóstico por imagem , Telemedicina/métodos , Adulto , Idoso , Brasil , COVID-19 , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico por imagem , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Encaminhamento e Consulta , Smartphone , Telemedicina/instrumentaçãoRESUMO
AIMS: Given the participation of oxidative stress in the pathogenesis of diabetic complications, we evaluated, in type 1 diabetes (T1D) individuals, the association between diabetic retinopathy (DR) and functional single nucleotide polymorphisms (SNPs) in regulatory regions of two genes belonging to the antioxidant glutathione (GSH) system: rs17883901 in GCLC and rs713041 in GPX4. METHODS: A cross-sectional case-control study included 288 individuals (61% women, 34[±11] years old, diabetes duration of 22[±9] years, mean [±SD]) sorted according to DR stages: absence of DR (ADR), non-proliferative DR (NPDR) and proliferative DR (PDR). SNPs were genotyped by real-time PCR using fluorescent labelled probes. Logistic regression models with adjustment for confounding covariates were employed. RESULTS: The presence of at least one T-allele of rs17883901 in GCLC was an independent risk factor for PDR (OR 4.13, 95% CI 1.38-13.66, pâ¯=â¯0.014) in a polytomous regression model (PDR versus ADR). The presence of at least one T-allele of rs713041 in GPX4 conferred protection against PDR (OR 0.30, 95% CI 0.11-0.80, pâ¯=â¯0.017) in female T1D individuals. CONCLUSION: The functional SNPs rs17883901 and rs713041 modulate the risk for PDR in the studied population of T1D individuals, widening the spectrum of candidate genes for this complication.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/genética , Glutamato-Cisteína Ligase/genética , Glutationa Peroxidase/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idade de Início , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 1/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fosfolipídeo Hidroperóxido Glutationa Peroxidase , Adulto JovemRESUMO
Cardiac autonomic neuropathy is a neglected diabetic chronic complication for which genetic predictors are rarely reported. Oxidative stress is implicated in the pathogenesis of microvascular complications, and glutathione peroxidase 4 is involved in the detoxification of peroxides and of reactive oxygen species. Thus, the association of a functional variant in the gene encoding glutathione peroxidase 4 (rs713041) with this diabetic complication was investigated in 341 individuals with type 1 diabetes evaluated for cardiac autonomic neuropathy status (61.7% women, 34 [27-42] years old; diabetes duration: 21 [15-27] years; HbA1c: 8.3% [7.4-9.4]; as median [interquartile interval]). Cardiac autonomic neuropathy was present in 29% of the participants. There was an inverse association of the minor T allele of rs713041 with cardiac autonomic neuropathy (odds ratio = 0.39; 95% confidence interval = 0.17-0.90; p = 0.0271) after adjustment for potential confounders. The functional glutathione peroxidase 4 variant rs713041 modulated the risk for cardiac autonomic neuropathy in the studied population with type 1 diabetes.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus Tipo 1/genética , Neuropatias Diabéticas/genética , Glutationa Peroxidase/genética , Polimorfismo de Nucleotídeo Único , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/enzimologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/enzimologia , Neuropatias Diabéticas/fisiopatologia , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Masculino , Fenótipo , Fosfolipídeo Hidroperóxido Glutationa Peroxidase , Medição de Risco , Fatores de RiscoRESUMO
AIMS/INTRODUCTION: Epigenetics participate in the pathogenesis of metabolic memory, a situation in which hyperglycemia exerts prolonged deleterious effects even after its normalization. We tested the hypothesis that genetic variants in an epigenetic gene could predispose to diabetes complications. MATERIAL AND METHODS: We assessed the frequency of five single-nucleotide polymorphisms in the gene encoding deoxyribonucleic acid methytransferase 1 (DNMT1; rs8112895, rs7254567, rs11085721, rs17291414 and rs10854076), and their associations with diabetic kidney disease, retinopathy, distal polyneuropathy and autonomic cardiovascular neuropathy in 359 individuals with long-term type 1 diabetes. RESULTS: None of the single-nucleotide polymorphisms studied was significantly associated with the presence of chronic complications in the overall population. However, after sex stratification, the minor allele C of rs11085721 conferred risk for cardiovascular neuropathy in women after adjustment for confounding variables (odds ratio 2.32; 95% confidence interval 1.26-4.33; P = 0.006). CONCLUSIONS: The fact that heterozygous mutations in DNMT1 are associated with hereditary sensory autonomic neuropathy provides plausibility to the present finding. If confirmed in independent samples, it suggests that genetic variants in epigenetic genes might predispose to more or fewer epigenetic changes in the face of similar metabolic derangements triggered by hyperglycemia, constituting the "genetics of epigenetics" for microvascular diabetes complications.
Assuntos
Sistema Nervoso Autônomo/patologia , Biomarcadores/análise , DNA (Citosina-5-)-Metiltransferase 1/genética , Diabetes Mellitus Tipo 1/complicações , Cardiomiopatias Diabéticas/etiologia , Neuropatias Diabéticas/etiologia , Polimorfismo de Nucleotídeo Único , Adulto , Sistema Nervoso Autônomo/metabolismo , Cardiomiopatias Diabéticas/genética , Cardiomiopatias Diabéticas/patologia , Neuropatias Diabéticas/genética , Neuropatias Diabéticas/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , PrognósticoRESUMO
Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.
Assuntos
Doença Celíaca/psicologia , Diabetes Mellitus Tipo 1/psicologia , Adaptação Psicológica , Adolescente , Atitude Frente a Saúde , Brasil , Doença Celíaca/complicações , Doença Celíaca/dietoterapia , Doença Celíaca/enfermagem , Criança , Comorbidade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/enfermagem , Dieta para Diabéticos/psicologia , Dieta Livre de Glúten/psicologia , Emoções , Feminino , Humanos , Insulina/uso terapêutico , Relações Interpessoais , Entrevistas como Assunto , Masculino , Cooperação do Paciente , Pesquisa Qualitativa , Ajustamento SocialRESUMO
RESUMO Objetivo Compreender a experiência de crianças e adolescentes que convivem com diabetes mellitus tipo 1 e doença celíaca. Método Estudo qualitativo, exploratório e descritivo. A coleta de dados ocorreu entre janeiro e setembro de 2012, com 3 crianças e 2 adolescentes, em um ambulatório de diabetes do Hospital das Clinicas da FMUSP ou na residência dos participantes na cidade de São Paulo, por meio de entrevistas semiestruturadas. Utilizou-se a Análise de Conteúdo como método de tratamento dos dados. Resultados A dieta aparece como foco da experiência dos participantes, porém com diferentes significados. As crianças têm dificuldade em seguir a dieta, enquanto os adolescentes referem que os aspectos sociais e afetivos são os mais afetados. Conclusão Reforça-se a importância do enfermeiro buscar estratégias em parceria com as crianças, os adolescentes e suas famílias a fim de minimizar as dificuldades encontradas principalmente no manejo da dieta imposta por ambas as doenças.
RESUMEN Objective Comprender la experiencia de los niños y adolescentes que viven con diabetes tipo 1 y la enfermedad celíaca. Método Estudio cualitativo exploratorio y descriptivo, se incluyeron 3 niños y 2 adolescentes; los datos fueron colectados de enero a septiembre de 2012, en la clínica de diabetes del Hospital de Clínicas de la Facultad de Medicina de la Universidad de São Paulo o en la residencia de los participantes en São Paulo, a través de entrevistas semi-estructuradas. Para el tratamiento de los datos se utilizó la técnica de Análisis de Contenido. Resultados La dieta es el foco de la experiencia de los participantes, pero con diferentes significados. Los niños tienen dificultad para seguir la dieta, mientras que los adolescentes reportan que los aspectos sociales y afectivos son los más afectados. Conclusión Los resultados refuerzan la importancia de la enfermera buscar estrategias en colaboración con los niños, adolescentes y sus familias para minimizar dificultades encontradas principalmente en la gestión de la dieta impuesta por ambas enfermedades.
ABSTRACT Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Doença Celíaca/psicologia , Diabetes Mellitus Tipo 1/psicologia , Ajustamento Social , Brasil , Adaptação Psicológica , Atitude Frente a Saúde , Comorbidade , Doença Celíaca/complicações , Doença Celíaca/dietoterapia , Doença Celíaca/enfermagem , Entrevistas como Assunto , Cooperação do Paciente , Pesquisa Qualitativa , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/enfermagem , Dieta para Diabéticos/psicologia , Emoções , Dieta Livre de Glúten/psicologia , Insulina/uso terapêutico , Relações InterpessoaisRESUMO
Celiac crisis, an acute severe onset of celiac disease, is a rare and life-threatening manifestation. We report a 30-year-old woman with type 1 diabetes mellitus who arrived at our service with one-month history of severe acute watery diarrhea associated with nausea, vomiting, abdominal pain, and weight loss of 9 kg. The diagnostic hypothesis of celiac crisis was reached based on profuse diarrhea leading to dehydration, severe metabolic and electrolyte abnormalities, and subsequent improvement after introduction of a gluten-free diet.
Assuntos
Doença Celíaca/complicações , Diabetes Mellitus Tipo 1/complicações , Adulto , Doença Celíaca/dietoterapia , Diarreia/etiologia , Dieta Livre de Glúten , Feminino , HumanosRESUMO
Celiac crisis, an acute severe onset of celiac disease, is a rare and life-threatening manifestation. We report a 30-year-old woman with type 1 diabetes mellitus who arrived at our service with one-month history of severe acute watery diarrhea associated with nausea, vomiting, abdominal pain, and weight loss of 9 kg. The diagnostic hypothesis of celiac crisis was reached based on profuse diarrhea leading to dehydration, severe metabolic and electrolyte abnormalities, and subsequent improvement after introduction of a gluten-free diet.
A crise celíaca é uma manifestação rara e grave da doença celíaca. Relatamos um caso de uma paciente de 30 anos de idade, com antecedente de diabetes melito tipo 1 e história de um mês de diarreia aquosa aguda, associada a náuseas, vômitos, dor abdominal e perda de peso de 9 kg. A hipótese diagnóstica de crise celíaca foi realizada, baseada no quadro de diarreia profusa, desidratação e distúrbios hidroeletrolíticos e ácido-básicos que melhorou após a introdução de dieta enteral sem glúten.
Assuntos
Adulto , Feminino , Humanos , Doença Celíaca/complicações , Diabetes Mellitus Tipo 1/complicações , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Diarreia/etiologiaRESUMO
PURPOSE: To assess the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and to compare it with the separate use of each treatment. METHODS: After systemic clinical control, thirty patients with diffuse diabetic macular edema were divided into 3 treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow-up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity, central macular thickness, total macular volume and intraocular pressure. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness or the total macular volume. On the other hand, this reduction was statistically significant in the other two groups. All groups improved their mean visual acuity, however, the group that received both treatments had a higher percentage of patients that gained 10 or more letters. CONCLUSION: The simultaneous administration of grid photocoagulation with intravitreal triamcinolone can be considered an option for the treatment of diffuse diabetic macular edema.
Assuntos
Retinopatia Diabética , Glucocorticoides/uso terapêutico , Fotocoagulação a Laser , Edema Macular , Triancinolona Acetonida/uso terapêutico , Terapia Combinada/métodos , Interpretação Estatística de Dados , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/cirurgia , Feminino , Seguimentos , Humanos , Injeções , Pressão Intraocular/efeitos dos fármacos , Pressão Intraocular/fisiologia , Edema Macular/tratamento farmacológico , Edema Macular/fisiopatologia , Edema Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos , Acuidade Visual/fisiologia , Corpo VítreoRESUMO
OBJETIVO: Avaliar a eficácia do uso intravítreo da triancinolona acetonida associada a fotocoagulação com laser no tratamento do edema macular difuso diabético. Comparar esta associação terapêutica com o uso isolado de cada tratamento. MÉTODOS: Após controle clínico sistêmico, trinta pacientes portadores de edema macular difuso diabético foram divididos em 3 grupos de tratamento: (1) fotocoagulação macular em grade com laser de argônio; (2) aplicação intravítrea de 4 mg de triancinolona acetonida; (3) associação dos itens anteriores. O seguimento foi realizado em intervalos predeterminados de um dia, uma semana e mensalmente, até completar 6 meses. Foram analisados os parâmetros: acuidade visual corrigida LogMAR, espessura macular central, volume macular total e pressão intra-ocular. RESULTADOS: A fotocoagulação com laser não reduziu de forma estatisticamente significativa a espessura macular central e o volume macular total. Esta redução foi significativa e estatisticamente semelhante nos outros dois grupos. Todos os grupos apresentaram melhora da acuidade visual, entretanto, o grupo que recebeu a associação do laser com a triancinolona intravítrea obteve maior porcentagem de pacientes com ganho de 10 ou mais letras de visão. CONCLUSÃO: O uso simultâneo da fotocoagulação com a triancinolona intravítrea pode ser considerado uma opção terapêutica para o edema macular difuso diabético.
PURPOSE: To assess the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and to compare it with the separate use of each treatment. METHODS: After systemic clinical control, thirty patients with diffuse diabetic macular edema were divided into 3 treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow-up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity, central macular thickness, total macular volume and intraocular pressure. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness or the total macular volume. On the other hand, this reduction was statistically significant in the other two groups. All groups improved their mean visual acuity, however, the group that received both treatments had a higher percentage of patients that gained 10 or more letters. CONCLUSION: The simultaneous administration of grid photocoagulation with intravitreal triamcinolone can be considered an option for the treatment of diffuse diabetic macular edema.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retinopatia Diabética , Glucocorticoides/uso terapêutico , Fotocoagulação a Laser , Edema Macular , Triancinolona Acetonida/uso terapêutico , Terapia Combinada/métodos , Interpretação Estatística de Dados , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/cirurgia , Seguimentos , Injeções , Pressão Intraocular/efeitos dos fármacos , Pressão Intraocular/fisiologia , Edema Macular/tratamento farmacológico , Edema Macular/fisiopatologia , Edema Macular/cirurgia , Resultado do Tratamento , Corpo Vítreo , Acuidade Visual/efeitos dos fármacos , Acuidade Visual/fisiologiaRESUMO
As proteínas desacopladoras de prótons (UCPs) pertencem à família dos transportadores mitocondriais H+/ácidos graxos. A UCP1 é responsável pela termogênese, mas o exato papel fisiológico da UCP2 e UCP3 ainda não está estabelecido. Ratos foram induzidos ao hipertireoidismo, através da administração de LT3, associado ou não à captopril, propranolol ou clenbuterol. O tratamento com LT3 resultou em aumento estatisticamente significativo do mRNA da UCP3 em miocárdio e músculo esquelético e esse efeito não foi alterado por nenhuma das medicações usadas concomitantemente, nem quando o LT3 foi administrado conjuntamente ao clenbuterol. Os efeitos do hormônio tireoideano sobre a expressão da UCP3, não são dependentes da angiotensina II, nem do sistema β-adrenérgico, refletindo uma ação direta do T3 sobre a expressão da UCP3 / Thyroid hormones stimulate UCP3 expression in skeletal muscle. We examined whether thyroid hormone-induced changes in UCP3 mRNA expression are related to directs effects of T3 or reflect secondary effects of the hormone through stimulation of renin-angiotensin or -adrenergic systems. Hyperthyroidism was produced by injections of T3 with or without concomitant treatment with either captopril, propranolol or clenbuterol. T3 resulted in a significant increase in the relative abundance of UCP3 in heart and skeletal muscle (P < 0.05), and the effect was not altered by captopril or propanolol. There was no synergistic or additive effect of T3 and clenbuterol on UCP3 mRNA expression in skeletal muscle. We conclude that the effect of T3 on UCP3 expression in cardiac and skeletal muscle is not dependent on either angiotensin II or the -adrenergic system and probably reflects a direct action of the hormone on UCP3 gene expression...