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1.
J Diabetes Res ; 2019: 5158308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886279

RESUMO

Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.

2.
Vnitr Lek ; 65(7-8): 475-482, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487990

RESUMO

INTRODUCTION: Acute pulmonary embolism, usually caused by thromboembolism is still a serious medical problem in spite of technical progress in diagnostics, as well as the enhancements in prophylactic and therapeutic options. AIM: The evaluation of characteristic, incidence, diagnostic, treatment and mortality rate of patients with pulmonary embolism hospitalized at the 1st Internal Clinic, University Hospital in Martin, within the years 1996-2017. METHODS: The authors offer retrospective analysis of 699 (359 men) patients with pulmonary embolism. Diagnosis was confirmed by angiography, perfusion scan or computed tomography. The data of patients were collected continuously and they are archived at the workplace of the authors. RESULTS: Patients with explicitly confirmed pulmonary embolism created 1.01 % of all hospitalized patients with average age 60.2. The average age of men was lower compared to women (56.6 vs 65.9). As high-risk pulmonary embolism presented 14.88 %, intermediate-risk 40.77 % and low-risk 44.34 % patients with pulmonary embolism. The source of pulmonary embolism was detected in 46.35 % and risk factors were detected in 52.79 % patients with pulmonary embolism. With thrombolytic therapy were treated 23.18 % of all patient with pulmonary embolism and intracranial bleeding occurred in 0.28 % of them. Early mortality rate was 7.58 % of all patients with pulmonary embolism. CONCLUSION: The authors detected increasing occurrence of patients with pulmonary embolism and from 2005 increasing occurrence of non-provoked pulmonary embolism. An average age in the patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary was lower in men (53.5 vs 60.9) as well in women (56 vs 67.7). Patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary were more frequent hospitalized because acute coronary syndrome (5.03 % vs 2.91 %) as well ischemic stroke (7.16 % vs 5.61 %) within one year after pulmonary embolism.


Assuntos
Embolia Pulmonar , Angiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica
3.
J Diabetes Complications ; 33(4): 315-322, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30755355

RESUMO

INTRODUCTION: Sex differences are defined as biology-linked differences between women and men that occur through the sex chromosomes and their effects on organ systems. MATERIAL AND METHODS: The objective of this prospective study was to determine risk factors for post-transplant diabetes mellitus (PTDM) in men and women. RESULTS: A total of 417 patients (271 men and 146 women) were included in the monitored group. Age at the time of kidney transplantation (KT) >60 years and hypovitaminosis D at the time of KT (<20 µg/l) were identified as independent risk factors for PTDM in both men and women. It was further confirmed as an independent risk factor for men a waist circumference at the time of KT >94 cm, C-peptide at the time of KT >5 ng/ml, HOMA-IR >2 and triacylglycerols at the time of KT >1.7 mmol/l. In case of women, the dominant factor was BMI at the time of KT >30 kg/m2 and menopause at the time of KT. A significant decrease in C-peptide was recorded in women with PTDM. CONCLUSION: It was confirmed that there are gender differences with regard to the development of PTDM after KT. Women show pancreas ß cell dysfunction, whereas insulin resistance and metabolic syndrome are dominant in men.

4.
Obes Facts ; 11(6): 454-464, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30537756

RESUMO

BACKGROUND: To report changes in body composition and biochemical parameters in patients with type 1 diabetes mellitus (T1D) after switching from multiple daily injection (MDI) to continuous subcutaneous insulin infusion (CSII). METHODS: 31 patients switched over from MDI to CSII. Body composition, biochemical parameters, glycaemic variability (GV) and level of physical activity were evaluated before and 6 months on CSII. RESULTS: In both sexes, we found an increase in skeletal muscle mass (SMM), (p = 0.008; 0.008). In men, there was mainly a decrease in visceral fat area (VFA), (p = 0.028) and in women there was decrease of total body fat (TBF), (p = 0.020) and non-significant decrease of VFA (p = 0.098). SMM inversely correlated with VFA in men (p = -0.001) and with TBF in women (p = -0.005 ). GV was decreased generally and correlated inversely with TBF in men only (p = -0.026). Physical activity was increased and correlated inversely with VFA in men (p = -0.002) and in women (p = -0.006). CONCLUSIONS: Using CSII in T1D leads to a significant increase of SMM in both sexes to a decrease of VFA in men and to a non-significant decrease of VFA in women. Changes in adipose tissue and SMM were also related to increased physical activity and to decreased GV.


Assuntos
Tecido Adiposo/efeitos dos fármacos , Distribuição da Gordura Corporal , Diabetes Mellitus Tipo 1/tratamento farmacológico , Grelina/sangue , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Leptina/sangue , Músculo Esquelético/efeitos dos fármacos , Tecido Adiposo/metabolismo , Adulto , Idoso , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Composição Corporal/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/patologia , Feminino , Hemoglobina A Glicada/efeitos dos fármacos , Hemoglobina A Glicada/metabolismo , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Tamanho do Órgão/efeitos dos fármacos , Circunferência da Cintura
5.
Vnitr Lek ; 62(6): 442-8, 2016.
Artigo em Tcheco | MEDLINE | ID: mdl-27485841

RESUMO

BACKGROUND: Diabetes mellitus is the most common cause of end stage kidney disease in the developed countries. Chronic kidney disease-mineral and bone disorder (CKD-MBD) develops with deteriorating of the renal functions. Diabetic patients on hemodialysis are characterized by low bone turnover, higher prevalence of severe and progressive vascular calcification with increased cardiovascular morbidity and mortality. The main factor which causes vascular calcification in patients with diabetic kidney disease (DKD) is poor glycemic control. The recent trial findings describe an inverse correlation between intact parathyroid hormone (iPTH) serum levels and glycemic control in a group of diabetic patients on hemodialysis. AIM: The objective of the proposed project is to access the difference of the laboratory markers MBD in the group of patients with 3rd stage DKD depending on glycemic control. We focused on the relationship between the glycemic compensation of diabetes (HbA1c) and iPTH serum level. PATIENTS AND METHOD: Ninety one patients with 3rd stage DKD were investigated. There were 46 women (50.5 %) and 45 men (49.5 %), average age of patients was 71.2 ± 7.0 years, with creatinine level 128 ± 30 µmol/l and estimated glomerular filtration (eGF, MDRD) 0.82 ± 0.16 ml/s. There were 60 patients with better glycemic control of diabetes (HbA1c < 7 %) vs 29 patients with poorly controlled diabetes (HbA1c > 7 %). MBD markers were compared in both groups. Patients were further stratified into subgroups based on the serum level of iPTH (iPTH < 35 pg/ml vs iPTH > 35 pg/ml) and MBD markers compared. Statistical analysis was performed using and Mann-Whitney test. RESULTS: We have found the statistical significance in the serum phosphate and proteinuria levels in between groups with HbA1c < 7 % vs patients with HbA1c > 7 %. Diabetics with better glycemic control had significant reduction in serum phosphate level (1.14 ± 0.20 vs 1.23 ± 0.18 mmol/l, p = 0.038) and in 24 hrs proteinuria level (0.56 ± 1.35 vs 1.30 ± 1.61 g/day, p = 0.007). In the group of presumed low bone turnover (iPTH < 35 pg/ml) we have found the trend towards increased serum calcium level (2.49 ± 0.12 vs 2.43 ± 0.10 mmol/l, p = 0.063) and increased HbA1c value (7.5 ± 1.8 vs 6.4 ± 1.6 %, p = 0.023). CONCLUSION: Our results suggest the closer relationship between glycemic control of diabetes and mineral-bone disorder in earlier stages of DKD. KEY WORDS: diabetes mellitus type 2 (DM2T) - chronic kidney disease (CKD) - mineral and bone disorder (MBD).


Assuntos
Biomarcadores/análise , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Nefropatias Diabéticas/diagnóstico , Idoso , Glicemia/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Masculino
6.
Vnitr Lek ; 62(4): 256-62, 2016 Apr.
Artigo em Tcheco | MEDLINE | ID: mdl-27250602

RESUMO

BACKGROUND: To assess the relationship of parameters of obesity in relationship to coronary angiography findings with correlation of epicardial fat (EF) thickness in uppermentioned context. METHODS: There were 80 patients examined (43 males, 37 postmenopausal females) undergoing elective coronary angiography. We examined the regular obesity parameters - BMI, waist circumference (WC), neck circumference (NC), total body fat (TBF), and visceral fat (VF) using bioimpedance. We assessed the echocardiographically measured EF thickness. We added examination of lipidogram, glycaemia, HOMA-IR (insulin resistance index) and AIP (aterogenic index of plasma). The set was divided into group with coronarographically proved stenosis or stenoses (withCS), and a group without finding of quantifiable stenosis or stenoses (withoutCS). RESULTS: The average thickness of EF in withCS group was 6.3 vs 5.6 mm in group withoutCS (p < 0.025). The differences in the thickness of EF in mentioned groups were 6.5 vs 5.2 mm in males (p < 0.025, = 20 %) and 6.1 vs 6.0 mm in females (p < 0.025, = 1.64 %). In males in withCS group, there was a dominant fat increase in epicardial region and TBF, and in females in withCS group, the fat deposits were increased in general. BMI was not a dominant parameter of adiposity in neither group (males in withCS group 31.11 vs withoutCS 30.41 kg/m(2); females in withCS group 31.40 vs withoutCS 31.20 kg/m(2)). EF was correlated the most by WC in males (r = 0.488; p < 0.005), and in females too (r = 0.564, p < 0.005). The patients in withCS group had increased HOMA-IR 4.75 vs 3.56 in withoutCS group, and AIP 0.22 vs 0.17. CONCLUSION: Thickness of EF in males and VT in females could be considered obesity parameters in assessment of pre-clinical stages of coronary atherosclerosis and prediction of risk of coronary heart disease. In adipose parameters, EF thickness was correlated the most by WC. Risk stratification of coronary artery disease is supplemented by increased HOMA-IR and AIP.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Obesidade/complicações , Pericárdio/ultraestrutura , Índice de Massa Corporal , Angiografia Coronária , Feminino , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Medição de Risco , Ultrassonografia , Circunferência da Cintura
7.
Diabetes Res Clin Pract ; 81(2): 238-42, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18495284

RESUMO

BACKGROUND: Slovakia is a country with high prevalence of diabetes mellitus (DM) and coronary heart disease (CHD), but the reason of west-east gradient prevalence in Europe is not clear. METHODS: We analyzed 1517 subjects responding to structure of Slovak adult population according to age, sex and regions. Self-reporting CHD risk factors, waist circumference, body mass index (BMI), blood pressure, levels of fasting and 2h glucose, triglycerides, and HDL cholesterol were examined. Impaired fasting glucose (IFG) and DM were diagnosed according to American Diabetes Association (ADA) criteria and the metabolic syndrome (MS) according to NCEP/ATP III and International Diabetes Federation (IDF) criteria. RESULTS: We confirmed 7.0% DM prevalence, including 5.3% of known DM, 1.2% of new DM according to the ADA criteria, and 0.5% of additional new DM cases after oral glucose test (oGTT) in subjects with IFG. Prevalence of MS according to NCEP/ATP III criteria were 20.1% (15.9% in males and 23.9% in females) and 38.1% according to IDF criteria (39.7% in males and 36.6% in females). Low HDL was the most common MS component in the Slovak population (56% total, 45% in male and 66% in female subjects). CONCLUSIONS: DM prevalence in Slovakia is higher than in West European countries and equal to the Mediterranean countries. MS prevalence and its components are equal to European population with the exception of low HDL, which is one of the highest in Europe.


Assuntos
Diabetes Mellitus/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Eslováquia/epidemiologia , Inquéritos e Questionários
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