High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy.

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

Peripheral arterial disease progression and ankle brachial index: a cohort study with newly diagnosed patients with type 2 diabetes.

BACKGROUND: Little is known about the evolution of peripheral arterial disease (PAD) since diagnosis and its association with glycemic and lipid control in patients with Type 2 Diabetes Mellitus (T2DM). OBJECTIVE: Evaluate the actual criteria to start screening PAD with ankle-brachial index (ABI) in T2DM patients and assess its progression and relationship with glycemic and lipid control since diagnosis. METHODS: We performed a 3-year prospective cohort study with two groups: group 1 (978 individuals with T2DM undergoing drug treatment) and group 2 [221 newly diagnosed drug-naive (< 3 months) patients with T2DM]. PAD diagnosis was by ABI ≤ 0.90, regardless any symptoms. RESULTS: As expected, abnormal ABI prevalence was higher in group 1 vs. Group 2 (87% vs. 60%, p < 0.001). However, abnormal ABI prevalence did not differ between patients over and under 50 years in both groups. Our drug-naive group stabilizes ABI (0.9 ± 0.1 vs 0.9 ± 0.1, p = NS) and improved glycemic and lipid control during follow-up [glycated hemoglobin (HbA1c) = 8.9 ± 2.1 vs 8.4 ± 2.3%, p < 0.05; LDL = 132 ± 45 vs 113 ± 38 mg/dL, p < 0.01, respectively]. When compared, patients who evolved with normalization or maintained normal ABI levels at the end [Group A, N = 60 (42%)] with those who decreased ABI to abnormal levels (ABI basal 1.0 ± 0.1 vs final 0.85 ± 0.1, p < 0.001) [Group B, N = 26 (18%)], an improvement in HbA1c (9 ± 2 vs 8 ± 2%, p < 0.05) and a correlation between the final HbA1c with ABI (r = - 0.3, p = 0.01) was found only in the first. In addition, a correlation was found between albuminuria variation and ABI solely in group A (r = - 0.3; p < 0.05). CONCLUSION: Our study suggests that ABI should be measured at diagnosis in T2DM patients, indicating that current criteria to select patients to screen PAD with ABI must be simplified. An improvement in albuminuria and glycemic and lipid control could be related with ABI normalization in newly diagnosed T2DM drug-naive patients.

Health-related quality of life in T1DM patients after high-dose cholecalciferol supplementation: data from a pilot clinical trial.

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) impacts health-related quality of life (HRQoL). Cross-sectional studies suggest that low levels of vitamin D (VD) may impair HRQoL, however, the effect of VD supplementation on quality of life in T1DM patients has not yet been clarified. Our study evaluated the effects of high-dose VD supplementation on HRQoL in T1DM. METHODS: We performed a prospective study with 64 patients receiving cholecalciferol (4000 IU/day for patients with 25-OH-vitamin D [25(OH)D] between 30 and 60 ng/mL, and 10,000 IU/day for those with 25(OH)D below 30 ng/mL) for 12 weeks, as part of a research protocol. HRQoL was assessed with EuroQol instruments (EQ-5D and EQ-VAS). RESULTS: There was an improvement in global EQ-5D index, and analysing specifically the EQ-5D domains, we observed an improvement in mobility (1.3 ± 0.6 versus 1.1 ± 0.3, p < 0.01). Evaluating possible outcome influencing variables, we detected a reduction in albuminuria at the end of the trial, without changes in BMI, lipids, blood pressure, glycemic control and insulin doses. We found correlations between final albuminuria and the dimensions: mobility (r = 0.6; p < 0.01), personal care (r = 0.7; p < 0.01), pain and discomfort (r = 0.6; p < 0.01) and habitual activities (r = 0.6; p < 0.01), suggesting an association between albuminuria reduction and the impact of VD supplementation on HRQoL. CONCLUSION: Our data showed that high doses of cholecalciferol supplementation can improve HRQoL in patients with T1DM, and the reduction of albuminuria seems to be an important factor in this context. TRIAL REGISTRATION: (ISRCTN32601947), 03/06/2017 retrospectively registered.

High-dose Vitamin D Supplementation on Type 1 Diabetes Mellitus Patients: Is there an Improvement in Glycemic Control?

BACKGROUND: Some authors evaluated the effect of VD on hyperglycemia in T1DM, but the results remain controversial. This study aims to analyze the effects of high-dose VD supplementation on T1DM patients' glycemic levels, maintaining stable doses of insulin. METHODS: Prospective, 12-week clinical trial including 67 T1DM patients, supplemented with high doses of cholecalciferol according to participants' VD value. Patients with VD levels below 30 ng/mL received 10,000 IU/day; those with levels between 30-60 ng/mL received 4,000 IU/day. Patients who had not achieved 25(OH)D levels > 30 ng/ml or presented insulin dose variation during the study were not analyzed. RESULTS: Only 46 out of 67 patients accomplished the criteria at the end of the study. There was no general improvement in the glycemic control evaluated by HbA1c (9.4 ± 2.4 vs 9.4 ± 2.6, p=NS) after VD supplementation. However, a post-hoc analysis, based on HbA1c variation, identified patients who had HbA1c reduced at least 0.6% (group 1, N = 13 (28%)). In addition, a correlation between 25(OH)D levels with HbA1c and total insulin dose at the end of the study was observed (r = -0.3, p<0.05; r=-0.4, p<0.05, respectively), and a regression model demonstrated that 25(OH)D was independent of BMI, duration of T1DM and final total insulin dose, being capable of determining 9.2% of HbA1c final levels (Unstandardized B coefficient = -0.033 (CI 95%: -0.064 to -0.002), r2 = 0.1, p <0.05). CONCLUSION: Our data suggest that VD is not widely recommended for glycemic control. Nevertheless, specific patients might benefit from this approach.

Implicações da COVID-19 no Sistema Cardiovascular: uma Revisão de Literatura / Implications of COVID-19 on the Cardiovascular System: a Literature Review

Introdução: O novo coronavírus da Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2), responsável pela Doença do Coronavírus 2019 (COVID-19), é um vírus capaz de causar pneumonia viral, além de complicações extrapulmonares. Revisou-se conceitos básicos sobre a COVID-19, focando nos seus efeitos sobre o sistema cardiovascular. Métodos: Realizou-se revisão de literatura a partir de buscas nas bases de dados PUBMED, Scielo e LILACS entre Janeiro de 2019 a Maio de 2020, com as palavras chaves: "COVID-19" AND "Cardiovascular" e seus correlatos em português e inglês. Foram excluídos estudos repetidos, relatos de caso, estudos experimentais em animais, cartas ao editor, comentários, estudos não disponíveis em inglês ou português e os que limitavam-se à terapêutica da doença. Selecionaram-se estudos observacionais, estudos descritivos, revisões de literatura e revisões sistemáticas. Resultados: A ligação entre a injúria miocárdica e a infecção pelo novo coronavírus é consequência, em grande parte, da sua relação fisiopatológica com o receptor ECA-2, interação capaz de desequilibrar os sistemas imune e cardiovascular. As complicações mais comuns incluem arritmia, lesão cardíaca, miocardite fulminante, insuficiência cardíaca, embolia pulmonar e Coagulação Intravascular Disseminada (CIVD). Ademais, pacientes com condições cardíacas prévias possuem risco aumentado, inclusive para morbimortalidade hospitalar. Conclusão: Conclui-se que a COVID-19 é uma doença com tropismo por vários órgãos, capaz de gerar agressões em diversos sistemas, entre eles, o cardiovascular, cujos danos se devem a mecanismos que afetam tanto a estrutura do miocárdio quanto dos vasos, podendo levar ao óbito. Desta forma, há necessidade de avaliação precoce e monitoramento contínuo dos danos cardíacos.

Association Between 25(OH)Vitamin D, HbA1c and Albuminuria in Diabetes Mellitus: Data From a Population-Based Study (VIDAMAZON).

Background: The effect of glycemic control on diabetic kidney disease (DKD) is well known. Recent evidence has suggested that Vitamin D (VD) may have a nephroprotective effect in diabetes, but the relationship between VD, glycemic control, and albuminuria has yet to be clarified. Objective: Evaluate the relationship between 25-hydroxy-vitamin D [25(OH)D], HbA1c, and albuminuria in Diabetes Mellitus (DM). Patients and Methods: Cross-sectional study with 1576 individuals with DM who had 25(OH)D, HbA1c, and albuminuria levels measured. Patients with abnormal creatinine levels were excluded, in order to avoid interference on VD levels by impaired kidney function. Results: Patients with HbA1c ≥7% had lower 25(OH)D when compared to patients with HbA1c <7% (29.7 ± 10.2 vs 28.1 ± 9.9 ng/ml, p = 0.003) and 25(OH)D levels seems to predict 1.5% of HbA1c behavior. The 25(OH)D concentrations in patients with normoalbuminuria were higher than the levels observed in those with micro or macroalbuminuria (29.8 ± 9.0 vs 26.8 ± 8.6 and 25.1 ± 7.6, respectively, p = 0.001), patients who had 25(OH)D <20 ng/ml and 25(OH)D <30 ng/ml were at a higher risk of presenting albuminuria [OR = 2.8 (95% CI = 1.6 - 4.9), p<0.001, and OR = 2.1 (95% CI = 1.3 - 4.6), p<0.001, respectively]. In our regression model, albuminuria was influenced by HbA1c (r² = 0.076, p<0.00001) and 25(OH)D (r² = 0.018, p = 0.002) independently. Conclusion: Our study found an association between vitamin D levels, HbA1c and DKD. Additionally, our data suggest that the association between urinary albumin excretion and vitamin D levels is independent of glycemic control in patients with diabetes. Even though our patients presented normal creatinine levels, it is necessary further prospective studies to confirm if this association precedes or not the loss of renal function.

Association of Soy and Exclusive Breastfeeding With Central Precocious Puberty: A Case-Control Study.

Introduction: While soy is suggested as a possible risk factor, exclusive breastfeeding (EBF) has a likely protective effect in precocious puberty. Our aim was to evaluate the association between both of these variables with central precocious puberty (CPP). Methods: We performed a retrospective, case-control study. A total of 161 girls were divided into two groups: 84 patients diagnosed with CPP composed the case group and 77 patients without the diagnosis of CPP (had gone through normal onset of puberty) were the control group. Results: Our control group had a higher presence of EBF >6 months, which was an important protective factor for CPP (OR: 0.5; IC 95%: 0.3-0.9, p = 0.05) and also correlated negatively with the presence of it (r = -0.2; p < 0.05). Oppositely, the use of soy was significantly higher in the CPP group, (OR: 3.8; IC 95%: 1.5-6, p < 0.05) and positively correlating (r = 0.2; p < 0.01) with the presence of CPP. Duration of soy intake (years) correlated with bone age (r = 0.415; p < 0.05). A logistic regression was performed to evaluate the effects of EBF duration and soy on CPP. The model was significant (x² (2) = 20,715, p = <0.001) and explained 12.2% (Nagelkerke R2) of the variance, correctly classifying 62.5% of cases. EBF was associated with a reduction of likelihood of having CPP [OR = 0,187 (CI = 0.055-0,635); Wald = 7,222, p = 0.007], while soy intake increased the risk [OR = 3.505 (CI) = 1,688-7,279, Wald = 11,319, p = 0.001]. Conclusion: Our data found the use of soy was associated with CPP. Additionally, EBF was pointed as a protective factor. However, future prospective studies are needed to clarify this issue.

High-dose Cholecalciferol Supplementation Reducing Morning Blood Pressure in Normotensive DM1 Patients.

BACKGROUND: Vitamin D (VD) deficiency has been related to several endocrine metabolic and cardiovascular diseases. The effect of VD supplementation on blood pressure (BP) in patients with diabetes is controversial. OBJECTIVE: The aim of this study was to evaluate high-dose vitamin D supplementation effects on blood pressure of normotensive patients with diabetes mellitus 1 (DM1) patients by 24-hour ambulatory blood pressure monitoring (ABPM). METHODS: We performed a clinical trial including 35 DM1 normotensive patients, who received doses of 4,000 or 10,000 IU/day of cholecalciferol for 12 weeks according to previous VD levels. They underwent 24-hour ABPM, along with glycated hemoglobin, creatine, lipids profile and PCRus dosage before and after VD supplementation. RESULTS: We found an expressive reduction of systolic and diastolic morning blood pressures (117±14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in other pressoric markers. Besides, we noticed a relationship between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). CONCLUSION: Our study suggests an association between supplementation of high doses of vitamin D and the reduction of morning blood pressure in normotensive DM1 patients.

Improvement in Cardiovascular Autonomic Neuropathy After High-Dose Vitamin D Supplementation in Patients With Type 1 Diabetes.

Background: Cardiovascular autonomic neuropathy (CAN) is associated with diabetes mellitus, increasing morbidity and mortality. Some cross-sectional studies associated CAN with low 25-hydroxyvitamin D levels. The aim of our study was to evaluate the effect of high-dose vitamin D (VD) supplementation on CAN in Type 1 Diabetes Mellitus (T1DM) patients. Methods: We performed a prospective study with 23 patients diagnosed with T1DM and CAN. Subjects with VD levels <30 ng/ml received 10,000 IU/day; the ones with VD levels between 30-60 ng/ml were given 4,000 IU/day for 12 weeks. Results: There was an improvement in CAN parameters related to resting heart rate variability, such as time domain parameters [Maximum RR interval (0.77 ± 0.11 vs 0.94 ± 0.51 s, p <0.05), Mean length of regular RR intervals (0.71 ± 0.10 vs 0.76 ± 0.09 s, p <0.05) and Standard deviation of all NN intervals (0.02 ± 0.01 vs 0.03 ± 0.02 s; p <0.01)] and frequency domain parameters [Low Frequency (1.9 ± 0.5 vs 2.5 ± 0.9 s, p < 0.001), Total Power (2.5 ± 0.4 vs 2.8 ± 0.6 s, p <0.05)]. In addition, there was a correlation between absolute VD level variation and posttreatment High Frequency (%), as well as among percent variation in VD level and end-of-study Low Frequency/High Frequency ratio (r=0.6, p<0.01; r= -0.5, p<0.05, respectively). Conclusion: Our pilot study is the first to suggest a strong association between high-dose vitamin D supplementation and improved cardiovascular autonomic neuropathy in T1DM patients. It occurred without any variation in HbA1C, blood pressure levels, lipids, and insulin dose. Clinical Trial Registration: http://www.isrctn.com/ISRCTN32601947, identifier ISRCTN32601947.

Non-ideal behavior of binary aqueous mixtures of some urea derivatives and their capacity to induce lysozyme gelation.

The urea derivatives, namely, ethylurea (EU), 1,3 dimethylurea (1,3-DMU) and 1,1 diethylurea (1,1-DEU), in the limiting regions of their solubilities in water, and tetramethylurea (TMU) at w≥0.65 were investigated in relation to their capacity of inducing hen egg white lysozyme (HEWL) physical (non-covalent) gelation. Protein transparent gels were generated out of TMU/H2O and 1,1-DEU/H2O, respectively, whereas an intensively turbid gel resulted from sol-gel transition taking place in EU/H2O. Oscillatory rheology revealed distinctions in the gels' structural and dynamic characteristics. Hydration patterns of the derivatives in solution, sizes of their non-polar domains and supramolecular symmetry features played a central role in their capacity of gel formation and in the gels' rheological behavior and morphology. Effects on gel characteristics of distinctively positioned ions in the Hofmeister series showed that SCN- disrupted water H-bonding interconnectivity in TMU lysozyme gel, strengthening gel structure, yet maintaining gel transparency. Citrate enhanced system elasticity albeit causing intense turbidity and leading to phase separation. Larger values of the storage modulus, G', were verified for gels generated from binary mixtures containing urea derivatives with higher dipole moments.

Nível de atividade física e aptidão cardiorrespiratória em escolares com sobrepeso/obesidade / Physical activity level and cardiorespiratory fitness in overweight/obese students

Introdução: Obesidade infantil, inatividade física e baixo nível de aptidão física geram consequências precoces na saúde cardiovascular e metabólica. Objetivos: Comparar o nível de atividade física (IPAQ versão curta) com aptidão cardiorrespiratória ( shuttle run test) em escolares com sobrepeso/obesos. Métodos: Realizou-se estudo da prevalência de sobrepeso/obesidade em 334 escolares, divididos posteriormente em dois grupos: G1, com sobrepeso/obesos (n=39), e G2, eutróficos (n=39), para a aplicação do IPAQ versão curta e shuttle run test. Resultados: Classificaram-se 261 escolares como eutróficos; 56 como obesos/com sobrepeso; e 17 com desnutrição/desnutrição severa. Não houve diferença significativa no IPAQ versão curta (p<0,840). No shuttle run test, o G2 apresentou VO2máx por estágios (p<0,004) e por metros (p<0,000) significativamente maiores. Conclusões: IPAQ versão curta apresentou limitações para determinar o nível de atividade física dos escolares estudados, comparado ao shuttle run test, e os resultados do shuttle run test podem ser mais precisos se analisados por metro.

Introduction: Childhood obesity, physical inactivity, and low physical fitness give rise early to consequences for cardiovascular and metabolic health. Objectives: To compare physical activity level (IPAQ short version) with cardiorespiratory fitness (shuttle run test) in overweight/obese children. Methods: We carried out a study in order to analyze the prevalence of overweight/obesity in 334 schoolchildren, who were divided into two groups: G1, overweight / obese (n=39), and G2, normal weight (n=39). The IPAQ short version test and the shuttle run test were applied. Results: A total of 261 students were classified as eutrophic, 56 in obese/overweight, and 17 with malnutrition/severe malnutrition. There was no significant difference in IPAQ short version (p< 0.840). In shuttle run test, G2 showed VO2max by stages (p<0.004) and meters (p <0.000) significantly higher. Conclusions: IPAQ short version was not effective for determining physical activity level of the schoolchildren, compared to the shuttle run test, and the results interpretation of shuttle run test may be more accurate if analyzed by meters.

Educação postural em escolares: existe diferença na aprendizagem entre escolas públicas e privadas? / Educación postural en escolares: ¿hay alguna diferencia en el aprendizaje entre escuelas públicas y privadas? / Postural education in schoolchildren: is there a difference in learning between public and private schools?

Objetivo: Comparar o antes e o depois de uma ação de educação postural sobre o conhecimento relativo ao modo de transportar o material escolar, o modo de se sentar e a posição ao dormir de escolares da rede pública e privada do município de Santa Cruz (RN), Brasil. Métodos: A amostra foi composta por 200 escolares do 1º ao 5º ano, e a ação, de três atividades: palestra sobre hábitos posturais, peça teatral e paródia educativa. Para comparação antes e após as intervenções, foi aplicado um questionário com figuras ilustrativas das diversas posições que poderiam ser adotadas pelo escolar. Na análise estatística, utilizou-se o teste de Mcnemar (??0,05). Resultados: Apenas os alunos da escola privada obtiveram aumento significativo no número de respostas corretas em todas as variáveis observadas: 16% em relação ao transporte do material escolar [55 (67,9%) versus 68 (83,9%)]; 27,5% no modo de sentar [48 (60%) versus 70 (87,5%); ?2=1,905; p<0,001]; e aumento de 18,2% no número de acertos quanto à posição ao dormir [55 (71,4%) versus 69 (89,6%); ?2=0,349; p=0,007]. Conclusão: Esta intervenção de educação postural foi eficaz no aumento do conhecimento dos escolares da rede privada. Entretanto, para a rede pública, as abordagens educacionais utilizadas neste estudo parecem não ter produzido efeito.

Objetivo: Comparar el antes y el después de una acción de educación postural sobre el conocimiento relativo con el modo de cargar los útiles escolares, sentarse y posición de dormir de estudiantes de la red pública y privada en el municipio de Santa Cruz (RN). Métodos: la muestra fue compuesta por 200 estudiantes de 1º a 5º grado, y la acción de tres actividades: una palestra sobre hábitos posturales, obra de teatro y la parodia educativa. Para la comparación antes y después de la intervención, fue aplicado un cuestionario con figuras ilustrativas de las distintas posiciones que podrían ser adoptadas por los estudiantes. En el análisis estadístico, se utilizó el teste de McNemar (??0,05). Resultados: sólo los estudiantes de escuela privada tuvieron un aumento significativo en el número de respuestas correctas en todas las variables observadas: 16% en relación con el transporte del material escolar [55 (67,9%) frente a 68 (83,9%)]; 27 5%, para sentarse [48 (60%) frente a 70 (87,5%), ?2=1,905, p<0,001]; y el 18,2% de aumento en el número de aciertos en relación a la posición de dormir [55 (71,4%) frente a 69 (89,6%), ?2=0,349, p=0,007]. Conclusión: La presente intervención de educación postural fue eficaz para aumentar el conocimiento de los estudiantes de las escuelas privadas. Sin embargo, para las públicas, los abordajes educacionales utilizados parecen haber producido ningún efecto.

Objective: To compare a posture education measure on the knowledge related to the way students carry their school supplies, sit in the desk and their sleeping position at public and private schools in Santa Cruz/RN. Methods: The sample consisted of 200 students from the 1st to the 5th grades and three activities: a lecture on postural habits; a play and an educational parody. For a comparison before and after the interventions, we applied a questionnaire with illustrative figures of the various positions that could be adopted by the school. In the statistical analysis we used the McNemar test (??0.05). Results: Only private school students had a significant increase in the number of correct answers in all the observed variables: 16% regarding the way they carried school supplies [55 (67.9%) versus 68 (83.9%)], 27.5% concerned to the way they sit [48 (60%) versus 70 (87.5%), ?2=1.905, p<0.001] and an increase of 18.2% in the number of correct answers related to the sleeping position [55 (71.4%) versus 69 (89.6%), ?2=0.349, p=0.007]. Conclusion: This postural education intervention was effective in increasing the students? knowledge from private schools. However, for public school students, the educational approaches used in this study did not seem to have produced effects.