Treatment of erectile dysfunction by intracavernosal administration of mesenchymal stem cells in patients with diabetes mellitus

ABSTRACT Erectile dysfunction is observed in about 50% of men. It has been found that diabetes mellitus increases its prevalence to 19-86.3%, necessitating attention to a therapeutic strategy. Among the available treatment methods, intracavernosal injections of mesenchymal stem cells have proven to be particularly effective. Objective The purpose of study is to assess and analyse the effectiveness of their use in the treatment of erectile dysfunction in patients with diabetes mellitus. Materials and Methods The literature search was conducted using systematic methods and analysis in databases such as Web of Science, Scopus, PubMed, Elsevier, and Springer, with 41 sources included for further review. Results The study highlights microangiopathic and neuropathic links as key factors in erectile dysfunction development in diabetic patients, stemming from endothelial dysfunction and conductivity disturbances. Mesenchymal stem cell therapy from bone marrow, adipose tissue, and umbilical cord mitigates pathogenic impact through regenerative and anti-apoptotic effects. Due to this, most studies indicate high efficacy of the treatment and rapid therapeutic action through intracavernosal administration. Some studies suggest an increase in the body's receptor sensitivity to other drugs, such as sildenafil. Conclusion From the perspective of further research on this issue, standardising the preparation of stem cells and the treatment method using a large sample size is essential to introduce such a method as an extremely promising therapy for this delicate issue in men into practical medicine. The practical value of the study lies in the systematisation of information on different sources of mesenchymal stem cells for treating erectile dysfunction.

Treatment of erectile dysfunction by intracavernosal administration of mesenchymal stem cells in patients with diabetes mellitus.

Erectile dysfunction is observed in about 50% of men. It has been found that diabetes mellitus increases its prevalence to 19-86.3%, necessitating attention to a therapeutic strategy. Among the available treatment methods, intracavernosal injections of mesenchymal stem cells have proven to be particularly effective. OBJECTIVE: The purpose of study is to assess and analyse the effectiveness of their use in the treatment of erectile dysfunction in patients with diabetes mellitus. MATERIALS AND METHODS: The literature search was conducted using systematic methods and analysis in databases such as Web of Science, Scopus, PubMed, Elsevier, and Springer, with 41 sources included for further review. RESULTS: The study highlights microangiopathic and neuropathic links as key factors in erectile dysfunction development in diabetic patients, stemming from endothelial dysfunction and conductivity disturbances. Mesenchymal stem cell therapy from bone marrow, adipose tissue, and umbilical cord mitigates pathogenic impact through regenerative and anti-apoptotic effects. Due to this, most studies indicate high efficacy of the treatment and rapid therapeutic action through intracavernosal administration. Some studies suggest an increase in the body's receptor sensitivity to other drugs, such as sildenafil. CONCLUSION: From the perspective of further research on this issue, standardising the preparation of stem cells and the treatment method using a large sample size is essential to introduce such a method as an extremely promising therapy for this delicate issue in men into practical medicine. The practical value of the study lies in the systematisation of information on different sources of mesenchymal stem cells for treating erectile dysfunction.

Elementos precondicionantes de complicaciones cardiacas en el paciente diabético con infarto agudo de miocardio / Preconditioning elements of cardiac complications among patients with diabetes and acute myocardial infarction

RESUMEN Objetivo: Identificar factores de riesgo, basados en los parámetros clínicos, ecocardiográficos y terapéuticos, para predecir complicaciones cardiacas en pacientes diabéticos con infarto agudo de miocardio (IAM). Materiales y métodos: Se realizó un estudio observacional, analítico, de casos y controles en el Centro de Cirugía Cardiovascular y Cardiología Santiago de Cuba, adjunto al Hospital Provincial Saturnino Lora, durante el periodo comprendido entre los años 2019 y 2021. La muestra quedó constituida por 266 pacientes, elegidos por muestreo aleatorio simple 1:2. Las variables de estudio se agruparon en demográficas, clínico-ecocardiográficas y terapéuticas. Se realizó el análisis multivariado con todas las variables que constituyeron factores de riesgo; se empleó el análisis de la varianza unidireccional y la regresión logística binaria. Resultados: Las complicaciones más frecuentes fueron la fibrilación auricular y la insuficiencia cardiaca en un 12 %, aproximadamente. Las cifras de control metabólico mostraron alteración al ingreso (OR = 6,92; LI: 2,61; LS: 18,32; p = 0,001). El análisis univariado demostró que diez factores incrementaron el riesgo de presentar complicaciones, entre ellos, el diagnóstico de diabetes mellitus ≥10 años (OR = 2,50; LI: 1,14; LS: 5,45; p = 0,020); además, el análisis multivariado reveló que la edad ≥60 años (OR = 5,624; IC = 1,607-19,686; p = 0,007), el control metabólico al ingreso alterado (OR = 5,245; IC = 1,491-18,447; p = 0,010), la no aplicación de terapia trombolítica (OR = 5,74; IC = 1,46-22,586; p = 0,012), la FEVI ≤ 40 % (OR = 5,245; IC = 1,17-23,433; p = 0,030), la presión de la aurícula izquierda ≥15 mmHg (OR = 12,335; IC = 3,45-44,08; p = 0,001) y la motilidad ≥1,5 puntos (OR = 4,702; IC = 1,258-17,575; p = 0,021) incrementaron el riesgo de forma independiente. Conclusiones: El estudio demostró el valor de seis factores de riesgo de complicaciones cardiacas en el paciente diabético con IAM, donde sobresale el control glucémico al ingreso, la fracción de eyección disminuida del ventrículo izquierdo, la presión de la aurícula izquierda aumentada y la no terapia de reperfusión coronaria.

ABSTRACT Objective: To identify the risk factors based on clinical, echocardiographic and therapeutic parameters which predict the development of cardiac complications among patients with diabetes and acute myocardial infarction (AMI). Materials and methods: An observational, analytical, case-control study was conducted at Centro de Cardiología y Cirugía Cardiovascular de Santiago de Cuba, attached to Hospital Provincial Saturnino Lora, from 2019 to 2021. The sample consisted of 266 patients, chosen by simple random sampling 1:2. The study included demographic, clinical- echocardiographic and therapeutic variables. A multivariate analysis was performed with all the variables considered as risk factors; one-way analysis of variance and binary logistic regression were used. Results: The most frequent cardiac complications were atrial fibrillation and heart failure (approximately 12 %). A metabolic control analysis on admission yielded altered results (OR = 6.92; LI: 2.61; LS: 18.32; p = 0.001). The univariate analysis showed that ten factors increased the risk of complications, including the diagnosis of diabetes mellitus ≥ 10 years (OR = 2.50; LI: 1.14; LS: 5.45; p = 0.020). On the other hand, the multivariate analysis revealed six factors that predict the development of cardiac complications: age ≥ 60 years (OR = 5.624; CI = 1.607-19.686; p = 0.007), altered metabolic control on admission (OR = 5.245; CI = 1.491-18.447; p = 0.010), lack of use of thrombolytic therapy (OR = 5.74; CI = 1.46-22.586; p = 0.012), left ventricular ejection fraction (LVEF) ≤ 40 % (OR = 5.245; CI = 1.17-23.433; p = 0.030), left atrial pressure ≥ 15 mmHg (OR = 12.335; CI = 3.45-44.08; p = 0.001) and motility ≥ 1.5 points (OR = 4.702; CI = 1.258-17.575; p = 0.021). Conclusions: The study demonstrated the value of six risk factors of cardiac complications among patients with diabetes and AMI, where glycemic control on admission, decreased LVEF, increased left atrial pressure and no reperfusion therapy stand out.

Prevalence and associated factors of diabetic retinopathy in Latin American countries: a scoping review / Prevalência e fatores associados à retinopatia diabética em países da América Latina: uma revisão de escopo

ABSTRACT Objective To gather the available evidence in the literature on the prevalence and associated factors of diabetic retinopathy (DR) in Latin America. Methods This scoping review was developed according to the PRISMA-ScR. Prevalence data were summarized by weighted mean, considering the type of DM and country. For the analysis of associated factors, meta-analyses were performed with the most homogeneous studies, and the ORs and their 95%CIs were calculated. Results Forty-two articles published between 2004 and 2020 were included in this study. The mean prevalence of DR ranged from 15.0% in Costa Rica to 32.7% in Brazil. Conclusion This variation may be related to the diagnostic method, age of the studied population, duration of disease, glycemic control, or other associated factors such as the presence of diabetic nephropathy or hypertension. This review discloses an important burden of DR in Latin America and highlights the need for further in-country studies.

RESUMO Objetivo O objetivo desta revisão foi reunir as evidências disponíveis na literatura sobre a prevalência e os fatores associados à retinopatia diabética na América Latina. Métodos Esta é uma revisão de escopo desenvolvida de acordo com o PRISMA-ScR. Os dados de prevalência foram resumidos por média ponderada, considerando o tipo de diabetes mellitus e o país. Para a análise dos fatores associados, foram realizadas metanálises com os estudos mais homogêneos e calculados as razões de chance e seus intervalos de confiança de 95%. Resultados Foram publicados 42 artigos entre 2004 e 2020, os quais foram incluídos neste estudo. A prevalência média de retinopatia diabética variou de 15,0%, na Costa Rica, a 32,7%, no Brasil. Conclusão Essa variação pode estar relacionada ao método de diagnóstico, à idade da população estudada, à duração da doença, ao controle glicêmico ou a outros fatores associados, como a presença de nefropatia diabética ou hipertensão. Esta revisão revelou um ônus importante da retinopatia diabética na América Latina e destaca a necessidade de mais estudos nos países.

Perfil clínico-metabólico de pacientes pé diabéticos frequentadores de uma Unidade Básica de Saúde de Altamira, Pará, Brasil / Clinical-metabolic profile of diabetic foot patients attendinga Basic Health Unit in Altamira, Pará, Brazil

Introdução: o pé diabético é de origem neuropática e representa uma das complicações do diabetes mellitus, abrange várias condições patológicas, que incluem neuropatia, doença arterial periférica, neuroartropatia de Charcot, ulceração do pé e, em alguns casos, amputação. Objetivo: descrever o perfil clínico-metabólico de pacientes pé diabéticos frequentadores de uma Unidade Básica de Saúde (UBS). Material e Método: trata-se de um estudo descritivo exploratório com abordagem quantitativa. Foram avaliados 15 pacientes portadores de úlceras do pé diabético atendidos em uma Unidade Básica de Saúde de Altamira, estado do Pará, Brasil. Os dados foram submetidos à análise de acordo com os indicadores dos perfis investigados. Resultados: todos os pacientes possuem diabetes tipo II, baixos níveis de renda familiar e escolaridade. O Índice de Massa Corpórea (IMC) foi de 92%, circunferência abdominal 93%, proteína C reativa ultrassensível, interleucina-6 e hemoglobina glicada estavam superiores ao normal em mais da metade dos doentes, assim como a vitamina D estava deficiente em mais da metade dos pacientes. Conclusões: há barreiras ao manejo adequado dos portadores de pé diabético na atenção básica da cidade de Altamira que podem contribuir para o desenvolvimento de complicações macro e microvasculares. Recomendações técnicas direcionadas aos gestores locais contribuem para a atenção básica na região.

Introduction: the diabetic foot is of neuropathic origin and represents one of the complications of diabetes mellitus, encompasses several pathological conditions, including neuropathy, peripheral arterial disease, Charcot neuroarthropathy, foot ulceration, osteomyelitis and, in some cases, amputation. Objective: to describe the clinical-metabolic profile of diabetic foot patients attending a Basic Health Unit (BHU). Material and Method: this is a descriptive exploratory study with a quantitative approach. Fifteen patients with diabetic foot ulcers treated at the Basic Health Unit in Altamira, state of Pará, Brazil, were evaluated. The data were submitted to analysis according to the indicators of the investigated profiles. Results: all patients have Type 2 Diabetes, low level of family income and education. The Body Mass Index (BMI) was 92%, abdominal circumference (93%), Ultrasensitive C-Reactive Protein, Interleukin-6 and glycated hemoglobin were higher than normal in more than half of the patients, as well as vitamin D was deficient in more of half of the patients. Conclusions: there are barriers to the proper management of patients with diabetic foot in primary care in the city of Altamira that can contribute to the development of macro and microvascular complications. Technical recommendations directed at local managers contribute to primary care in the region.

Comparação da eficácia da retinografia colorida e da angiografia fluorescente no diagnóstico da retinopatia diabética / Comparing efficacy of fundus photography and fluorescein angiography in the diagnosis of diabetic retinopathy

RESUMO Objetivo: Avaliar a efetividade da retinografia colorida e a da angiografia fluorescente no diagnóstico e no rastreio da retinopatia diabética. Métodos: Estudo retrospectivo, com base na análise de resultados de ambos os exames de 398 pacientes diabéticos. Resultados: Os resultados da angiografia coincidiram com os da retinografia em 77,4% dos casos, e não houve diferença significativa no estadiamento e na identificação da retinopatia pelos dois métodos. Conclusão: Não houve diferença significativa em relação à capacidade diagnóstica da doença pelos métodos descritos, demonstrando não existir benefício em indicar a angiografia como avaliação inicial do paciente diabético.

ABSTRACT Objective: To assess effectiveness of fundus photography and fluorescein angiography in diagnosis and screening of diabetic retinopathy. Methods: A retrospective study of 398 diabetic patients, based on analysis of results of both tests. Results: Results of fluorescein angiography and fundus photography coincided in 77.4% of cases, and there was no significant difference in staging and identification of retinopathy by both methods. Conclusion: There was no significant difference between both methods regarding the capacity to diagnose the disease, showing no benefit in indicating fluorescein angiography as initial assessment of diabetic patients.

From Endothelial Dysfunction to Arterial Stiffness in Diabetes Mellitus.

Prevalence of diabetes mellitus has increased drastically over time, especially in more populous countries such as the United States, India, and China. Patients with diabetes have an increased risk of major cardiovascular events such as acute myocardial infarction, cerebrovascular disease, and peripheral vascular disease. Arterial stiffness is a process related to aging and vascular, metabolic, cellular and physiological deterioration. In recent years, it has been described as an independent predictor of cardiovascular mortality and coronary artery disease. Additionally, it plays an important role in the measurement of chronic disease progression. Recent studies have suggested a strong relationship between diabetes mellitus and arterial stiffness since they share a similar pathophysiology involving endothelial dysfunction. The literature has shown that microvascular and macrovascular complications in diabetic patients could be screened and measured with arterial stiffness. Additionally, new evidence proposes that there is a relationship between blood glucose levels, microalbuminuria, and arterial stiffness. Moreover, arterial stiffness predicts cardiovascular risk and is independently associated with mortality in diabetic patients. Abnormal arterial stiffness values in diabetic patients should alert the clinician to the presence of vascular disease, which merits early study and treatment. We await more studies to determine if arterial stiffness could be considered a routine useful non-invasive tool in the evaluation of diabetic patients. There is enough evidence to conclude that arterial stiffness is related to the progression of diabetes mellitus.

Rubeosis faciei diabeticorum is not associated with oxidative stress and skin autofluorescence.

BACKGROUND: Rubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. OBJECTIVE: Examine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . METHODS: Patients diagnosed with Type 2 diabetes mellitus (n=32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. - Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p≤0.05 was considered statistically significant. RESULTS: There was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ=0.398, p=0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. STUDY LIMITATIONS: This is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. CONCLUSIONS: The results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.

Rubeosis faciei diabeticorum is not associated with oxidative stress and skin autofluorescence

Abstract Background Rubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. Objective Examine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . Methods Patients diagnosed with Type 2 diabetes mellitus (n = 32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. - Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p ≤ 0.05 was considered statistically significant. Results There was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ = 0.398, p = 0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. Study limitations This is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. Conclusions The results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.

Associação entre doença celíaca e complicações do diabetes em pacientes com diabetes mellitus tipo 1: revisão sistemática / Association of celiac disease and complications of diabetes in type 1 diabetes mellitus patients: sistematic review

Devido à genética comum e à interação entre fatores ambientais e imunológicos, os pacientes com diabetes mellitus tipo 1 possuem um maior risco de desenvolverem outras doenças autoimunes, como a doença celíaca. O objetivo do trabalho foi avaliar a associação entre a doença celíaca e a presença de complicações do diabetes em pacientes com diabetes mellitus tipo 1. Foi realizada uma revisão sistemática da literatura, empregando as bases de dados PubMed, Web of Science, SciELO e LILACS. Foram estabelecidos como critérios de elegibilidade: estudos observacionais originais redigidos em português, inglês ou espanhol, que avaliaram a associação entre a doença celíaca e a presença de complicações do diabetes em pacientes com diabetes mellitus tipo 1. O processo de busca resultou em 3.651 artigos, e 13 foram incluídos no estudo. As principais complicações do diabetes avaliadas nos estudos selecionados foram nefropatia (34,8%) e retinopatia (26,1%), seguidas de hipoglicemia (13,0%), níveis reduzidos de HDL-colesterol (8,7%), neuropatia periférica (4,3%), aterosclerose subclínica (4,3%), doença cardiovascular (4,3%) e cetoacidose (4,3%). Para os níveis reduzidos de HDL-colesterol, doença cardiovascular, aterosclerose subclínica e neuropatia periférica, 100% dos estudos encontraram associação entre a doença celíaca e a presença destas complicações do diabetes. Com relação à retinopatia, nefropatia e hipoglicemia, 50%, 37,5% e 33,3% dos estudos encontraram associação, respectivamente, enquanto que nenhum estudo encontrou associação entre a doença celíaca e a cetoacidose. Portanto, foi verificada associação entre a doença celíaca e a presença de complicações do diabetes em pacientes com diabetes mellitus tipo 1.(AU)

Due to common genetics, and to interaction between environmental and immunologic factors, patients with type 1 diabetes mellitus have a higher risk to develop other autoimmune diseases, such as celiac disease. The aim of this study was to evaluate the association between celiac disease and the presence of complications of diabetes in patients with type 1 diabetes mellitus. A systematic review of literature was performed, using PubMed, Web of Science, Scielo and Lilacs databases. Eligibility criteria were: original observational studies written in Portuguese, English or Spanish, which evaluated the association between celiac disease and the presence of diabetes complications in patients with type 1 diabetes mellitus. The research resulted in 3651 papers, and from these, 13 were included in the study. The main complications of diabetes evaluated in the studies selected were nephropathy (34.8%) and retinopathy (26.1%), followed by hypoglycemia (13.0%), lower levels of HDL cholesterol (8.7%), peripheral neuropathy (4.3%), subclinical atherosclerosis (4.3%), cardiovascular disease (4.3%), and ketoacidosis (4.3%). Regarding lower levels of HDL cholesterol, cardiovascular disease, subclinical atherosclerosis, and peripheral neuropathy, 100% of the studies found an association between celiac disease and the presence of these complications of diabetes. Regarding retinopathy, nephropathy and hypoglycemia, 50%, 37.5% and 33.3% of the studies found some association, respectively, while none of the studies detected any association between celiac disease and ketoacidosis. Therefore, an association between celiac disease and the presence of diabetes complications in patients with type 1 diabetes mellitus was observed.(AU)

Resultados del uso de la triamcinolona intravítrea en pacientes con rubeosis de iris / Results of the use of the intravitreous triamcinolone in patients with rubeosis iridis

Fundamento: la rubeosis del iris se asocia generalmente con diferentes enfermedades que producen falta de oxígeno en la retina. La falta de oxígeno hace que se liberen sustancias que estimulan la formación de nuevos vasos sanguíneos (angiogénesis) en un intento del organismo por solucionar la isquemia. La rubeosis de iris es la complicación más frecuente y precoz de muchas enfermedades vasculares del segmento posterior, que conlleva a una pérdida irreversible de la visión si no se diagnostica y se trata oportunamente. Objetivo: describir el comportamiento de la rubeosis de iris luego del tratamiento con triamcinolona intravítrea. Métodos: se realizó un estudio descriptivo de corte longitudinal, en pacientes con rubeosis de iris que acudieron a la consulta de retina del Centro Oftalmológico Carlos J Finlay, desde junio 2013 a junio 2014. El universo de estudio estuvo constituido por 25 pacientes y la muestra no probabilística estuvo formada por 30 ojos que cumplieron los criterios de inclusión, se les aplicó un formulario para recoger los datos. Los resultados se relacionaron con las siguientes variables: tensión ocular, síntomas, enfermedades que provocaron rubeosis de iris, grados de rubeosis. Resultados: la tensión ocular se estabilizó con el tratamiento empleado, el síntoma más frecuente fue el dolor. La retinopatía diabética proliferativa fue la afección más frecuente en el 40 % de los pacientes, seguido de la trombosis de la vena central de la retina. El estado de la rubeosis mejoró en más de la mitad de los pacientes, algunos con regresión completa. Conclusiones: la tensión intraocular mejoró después del tratamiento con triamcinolona intravítrea. Los síntomas desaparecieron en más de la mitad de los pacientes. La retinopatía diabética proliferativa fue la enfermedad más frecuente que provocó rubeosis de iris. Este signo desapareció en más de la mitad de los pacientes después del tratamiento.

Background: rubeosis iridis is generally associated to different diseases that produce lack of oxygen in the retina. It is the most frequent and early complication of many vascular diseases of the posterior segment that causes irreversible loss of vision if it is not early diagnosed and treated. Objective: to describe the behavior of rubeosis iridis after the treatment with intravitreous triamcinolone. Method: a descriptive, longitudinal study was conducted in patients with rubeosis iridis who came to the retina consultation of Carlos J. Finlay Ophthalmology Center from June 2013 to June 2014. The universe of the study was composed of 25 patients and the non-probabilistic sample by 30 eyes that matched the inclusion criteria. A form was applied to collect the data. The results were related to the following variables: ocular tension, symptoms, diseases that cause rubeosis iridis and rubeosis degrees. Results: ocular tension stabilized with the treatment applied. The most frequent symptom was pain. Proliferative diabetic retinopathy was the most frequent disease in the 40 % of the patients, followed by thrombosis of the central retinal vein. More than the half of the patients improved their condition, some of them with a complete regression. Conclusions: intraocular tension improved after the treatment with intravitreous triamcinolone. Symptoms disappeared in more than the half of the patients. Proliferative diabetic retinopathy was the most frequent disease that caused rubeosis iridis. This sign disappeared in more than the half of the patients after the treatment.

Complicaciones microvasculares en niños con diabetes mellitus tipo I / Microvascular complications in children with type I diabetes mellitus

Introducción: la diabetes mellitus (DM1) es la enfermedad crónica endocrinológica más frecuente en pediatría y de mayor repercusión sanitaria por la gravedad de sus complicaciones. Dentro de estas complicaciones tienen especial relevancia la afectación de la microvasculatura, que causa retinopatía, neuropatía y nefropatía. Estas complicaciones, si bien se manifiestan durante la edad adulta, comienzan a desarrollarse en la niñez. Existen normas internacionales para su identificación. Se citan factores de riesgo que favorecen su desarrollo. Objetivos: determinar la prevalencia de complicaciones microvasculares en niños y adolescentes portadores de DM1; evaluar si las recomendaciones internacionales para su búsqueda se cumplen; describir la presencia de factores de riesgo asociados a su desarrollo. Material y método: estudio descriptivo retrospectivo, en base a la revisión de historias clínicas de pacientes menores de 15 años con diagnóstico de DM1, asistidos en el Centro Hospitalario Pereira Rossell en el período comprendido entre el 1/1/2000 y el 31/12/2009

Complicaciones microvasculares en niños con diabetes mellitus tipo I / Microvascular complications in children with type I diabetes mellitus

Introducción: la diabetes mellitus (DM1) es la enfermedad crónica endocrinológica más frecuente en pediatría y de mayor repercusión sanitaria por la gravedad de sus complicaciones. Dentro de estas complicaciones tienen especial relevancia la afectación de la microvasculatura, que causa retinopatía, neuropatía y nefropatía. Estas complicaciones, si bien se manifiestan durante la edad adulta, comienzan a desarrollarse en la niñez. Existen normas internacionales para su identificación. Se citan factores de riesgo que favorecen su desarrollo. Objetivos: determinar la prevalencia de complicaciones microvasculares en niños y adolescentes portadores de DM1; evaluar si las recomendaciones internacionales para su búsqueda se cumplen; describir la presencia de factores de riesgo asociados a su desarrollo. Material y método: estudio descriptivo retrospectivo, en base a la revisión de historias clínicas de pacientes menores de 15 años con diagnóstico de DM1, asistidos en el Centro Hospitalario Pereira Rossell en el período comprendido entre el 1/1/2000 y el 31/12/2009. Resultados: en el período analizado se identificaron192 pacientes; con una media de edad al debut de 7,5años, con un promedio de 5,8 años de evolución deDM1. El 73,4% tenía mal control metabólico, casi 18%tenía sobrepeso, 2,1% presentaba obesidad, 22,6%tenía dislipemia y 17% eran sedentarios. Se habíasolicitado albuminuria al 39,6% y fondo de ojo al 77%de los que deberían haber sido estudiados, deacuerdo a pautas internacionales.

Introduction: type 1 diabetes mellitus (DM1) is themost common chronic endocrine pediatric disease. Ithas a greater impact by the severity of it chroniccomplications. Among these complications areparticularly relevant microvasculature involvement,causing retinopathy, neuropathy and nephropathy.These complications, although manifested inadulthood begin to develop in childhood. There areinternational standards for identification. Risk factorsthat favor its development are mentioned.Objectives: to determine the prevalence ofmicrovascular complications in children andadolescents with DM1; assess whether internationalrecommendations for the search are met; describe thepresence of risk factors associated with theirdevelopment.Methods: retrospective descriptive study, based on areview of medical records of patients younger than 15years diagnosed with DM1, assisted in the PereiraRossell Hospital in the period between 1/1/2000 and31/12/2009. Results: during the reporting period 192 patients wereidentified, with a mean age at onset of 7,5 years, withan average of 5,8 years of evolution of DM1. 73,4% hadpoor metabolic control, almost 18% were overweight,2,1% were obese, 22,6% had dyslipidemia, and 17%were sedentary...

Relación entre características antropométricas y variables de riesgo vascular en diabéticos tipo 2 / Relationship between anthropometric characteristics and its repercussion in Type-2 Diabetes Mellitus

La interrelación existente entre obesidad y diabetes mellitus tipo 2 tiene gran importancia clínico-epidemiológica. Se propone como objetivo evaluar en diabéticos tipo 2 la relación entre las características antropométricas y el nivel de riesgo de variables clínicas y bioquímicas. Se estudiaron 120 pacientes, edades 40 a 79 años, de la consulta de diabetes del Hospital "Hermanos Ameijeiras¨, entre octubre del 2009 y septiembre del 2010. Se evaluaron antecedentes, complementarios, y se realizó examen clínico general. Se determinaron índice de masa corporal (IMC), circunferencia abdominal (CA), tensión arterial (TA), parámetros glucémicos (glucemia en ayunas, postprandial, hemoglobina glucosilada), lípidicos (colesterol, triglicéridos, HDL-C, LDL-C), así como ácido úrico y microalbuminuria y se clasificaron según riesgo vascular en bajo, moderado y alto. Se consideró alto riesgo la obesidad (IMC = de 30 kg/m²sc) y CA aumentada (CAA hombres >102 cm y mujeres > 88) y se relacionaron con el nivel de riesgo predeterminado para el resto de las variables. Los resultados se analizaron estadísticamente con significación de p < 0.05. Prevalecieron la obesidad (48,3 %) y la CAA (67,5 %). El 93,1 % de obesos con CAA y el 61,5 % de los sobrepesos. Tanto en los obesos como en CAA, en relación al resto, hubo diferencias significativas con el mayor riesgo del conjunto de variables y con el riesgo alto de cada variable, sin diferencias entre ellos. Se concluyó que los diabéticos tipo 2 con obesidad y aumento de grasa abdominal tienen mayor riesgo vascular.

The interrelation between obesity and type-2 diabetes mellitus is very important from the clinical and epidemiological view points. This study was aimed at assessing the association between vascular risk and anthropometric variables in patients with type-2 diabetes mellitus, where the body-mass index and the abdominal size were evaluated in relation to the presence of chronic vascular complications in these patients. One hundred twenty (120) patients from 40 to 79 years old, attending to the diabetes mellitus office at “Hermanos Ameijeiras” University Hospital from October 2009 to September 2010 were included in the study considering the medical history, complementary and general clinical examinations. Body-mass index, abdominal size (AS), insulinemia and C-peptide were also determined; (IMC ≥ de 30 kg/m2 sc) was taken as obesity risk and the augmented abdominal size (in men >102 cm and in women > 88) and these values were related to vascular complications together with C-peptide and insulinemia on empty stomach. Results were statistically analyzed having a significance of p<0.05. Obesity (48,3%) and abdominal size (67,5%) prevailed. Both, the obese ones and those presenting high C-peptide values and insulinemia showed no differences among them. Vascular chronic complications prevailed in type-2 diabetic patients and in those with augmentation of the abdominal fat.

Relación entre características antropométricas y su repercusión en diabéticos tipo 2 / Relation between anthropometric characteristics and its repercussion in Diabetes Type-2

La interrelación existente entre obesidad y diabetes mellitus tipo 2 tiene gran importancia clínico-epidemiológica. Con el objetivo de evaluar en pacientes diabéticos tipo 2 la asociación entre el nivel de riesgo vascular de las variables antropométricas, índice de masa corporal y circunferencia abdominal con relación a la presencia de complicaciones crónicas vasculares en éstos. Se estudiaron 120 pacientes, de 40 a 79 años, que asistieron a la consulta de diabetes mellitus del "Hospital "Hermanos Ameijeiras", de octubre de 2009 a septiembre del año 2010. Se evaluaron antecedentes, complementarios, y se realizó examen clínico general. Se determinaron índice de masa corporal y circunferencia abdominal, insulinemia y péptido C. Se consideró alto riesgo la obesidad (IMC= de 30 kg/m² sc) y CA aumentada (CAA Hombres>102 cm y Mujeres>88) y se relacionaron con las complicaciones vasculares y los niveles de péptido C e insulinemia en ayunas. Los resultados se analizaron estadísticamente con significación de p<0.05. Prevalecieron la obesidad (48,3 %) y la CAA (67,5 %). Tanto en los obesos como en pacientes con CAA tuvieron valores elevados de péptido C e insulinemia, sin diferencias entre ellos. Se concluyó que en los diabéticos tipo 2 con obesidad y aumento de grasa abdominal predominaron las complicaciones crónicas vasculares.

The interrelation between obesity and type-2 diabetes mellitus is very important from the clinical and epidemiological view point. This study was aimed at assessing the association between the vascular risk and the anthropometric variables in patients with type-2 diabetes mellitus, where the body-mass index and the abdominal size were evaluated in relation to the presence of chronic vascular complications in these patients. One hundred twenty (120) patients from 40 to 79 years old, attending to the diabetes mellitus office at "Hermanos Ameijeiras" University Hospital from October 2009 to September 2010 were included in the study considering the medical history, complementary and general clinical examinations. Body-mass index, abdominal size (AS), insulinemia and C-peptide were also determined; (IMC ? de 30 kg/m² sc) was taken as obesity risk and the augmented abdominal size (in men >102 cm and in women > 88) and these values were related to vascular complications together with C-peptide and insulinemia on empty stomach. Results were statistically analyzed having a significance of p<0.05. Obesity (48,3%) and abdominal size (67,5%) prevailed. Both, the obese ones and those presenting high C-peptide values and insulinemia showed no differences among them. Vascular chronic complications prevailed in type-2 diabetic patients and in those with augmentation of the abdominal fat.

Complicações microvasculares e disfunção autonômica cardíaca em pacientes com diabete melito tipo 1 / Microvascular complications and cardiac autonomic dysfunction in patients with diabetes mellitus type 1 / Complicaciones microvasculares y disfunción autonómica cardíaca en pacientes con diabetes mellittus tipo 1

FUNDAMENTO: A presença de neuropatia autonômica cardíaca (NAC) em pacientes com diabete melito (DM) está associada a aumento da mortalidade e a complicações crônicas microvasculares do diabete. OBJETIVO: Investigar uma possível associação entre achados sugestivos de NAC durante a realização do teste ergométrico (TE) e nefropatia e retinopatia em pacientes com DM tipo 1. MÉTODOS: Realizamos um estudo transversal com 84 pacientes com DM tipo 1. Todos os pacientes foram submetidos à avaliação clínica e laboratorial e realizaram TE, sendo que aqueles que apresentaram achados sugestivos de isquemia miocárdica foram excluídos da análise dos dados (n = 3). A avaliação de complicações microvasculares (retinopatia e nefropatia) foi realizada na amostra. RESULTADOS: Os pacientes com nefropatia e aqueles com retinopatia atingiram uma frequência cardíaca (FC) durante o pico de exercício (FC máxima) menor e apresentaram aumento menor da FC em relação ao repouso (ΔFC pico) quando comparados com aqueles sem estas complicações. Esses pacientes também apresentaram menor redução da FC no segundo e 4º minutos após o final do teste (ΔFC recuperação dois e 4 minutos). Após realização de análise multivariada com controle para os possíveis fatores de confusão, os ΔFC recuperação em dois e 4 minutos, FC máxima e o ΔFC pico permaneceram significativamente associados à retinopatia; e os ΔFC recuperação no segundo e 4º minutos permaneceram associados à presença de nefropatia. CONCLUSÃO: O TE pode ser considerado um instrumento adicional para a detecção precoce de NAC e para identificar pacientes em maior risco para complicações microvasculares do diabete.

BACKGROUND: The presence of cardiac autonomic neuropathy (CAN) in patients with diabetes mellitus (DM) is associated with increased mortality and chronic microvascular complications of diabetes. OBJECTIVE: To investigate a possible association between specific findings of CAN during exercise testing (ET) and nephropathy and retinopathy in patients with type 1 DM. METHODS: We conducted a cross-sectional study of 84 patients with type 1 DM. All patients underwent clinical laboratory evaluation and performed ET, and those who presented findings suggesting myocardial ischemia were excluded from data analysis (n = 3). The assessment of microvascular complications (retinopathy and nephropathy) was performed in the sample. RESULTS: Patients with nephropathy and those with retinopathy achieved a lower heart rate (HR) at peak exercise (HR max) and smaller increase in HR in relation to rest (Peak ΔHR) compared with those without these complications. These patients also had a smaller reduction in HR in the second and 4th minutes after the end of the test (ΔHR recovery 2 and 4 minutes). After performing a multivariate analysis with control for possible confounding factors, the ΔHR recovery in two and four minutes, maximum HR and Peak ΔHR remained significantly associated with retinopathy; and ΔHR recovery in the second and 4th minutes remained associated with the presence of nephropathy. CONCLUSION: The ET can be considered an additional tool for early detection of CAN and to identify patients at increased risk for microvascular complications of diabetes.

BACKGROUND: LA presencia de neuropatía autonómica cardíaca (NAC) en pacientes con diabetes mellittus (DM) está asociada a aumento de la mortalidad y a complicaciones crónicas microvasculares de diabetes. OBJECTIVE: Investigar una posible asociación entre hallazgos sugestivos de NAC durante la realización de la prueba ergométrica (PE) y nefropatía y retinopatía en pacientes con DM tipo 1. METHODS: Realizamos un estudio transversal con 84 pacientes con DM tipo 1. Todos los pacientes fueron sometidos a evaluación clínica y laboratorial y llevaron a cabo PE, siendo que aquellos que presentaron hallazgos sugestivos de isquemia miocárdica fueron excluidos del análisis de los datos (n = 3). La evaluación de complicaciones microvasculares (retinopatía y nefropatía) se realizó en la muestra. RESULTS: Los pacientes con nefropatía y aquellos con retinopatía alcanzaron una frecuencia cardíaca (FC) durante el nivel máximo de ejercicio (FC máxima) menor y presentaron aumento menor de FC con relación al reposo (ΔFC pico) cuando comparados con aquellos sin estas complicaciones. Estos pacientes también presentaron una menor reducción de la FC en el segundo y 4º minutos tras el final de la prueba (ΔFC recuperación 2 y 4 minutos). Tras la realización de análisis multivariado con control para los posibles factores de confusión, los ΔFC recuperación en dos y 4 minutos, FC máxima y el ΔFC pico permanecieron significativamente asociados a la retinopatía; y los ΔFC recuperación en el segundo y 4º minutos permanecieron asociados a la presencia de nefropatía. CONCLUSION: Se puede considerar la PE como un instrumento adicional para la detección precoz de NAC y para identificar pacientes en un mayor riesgo para complicaciones microvasculares de la diabetes.

Caracterização de pacientes com diabetes mellitus tipo 1 do sul do Brasil: complicações crônicas e fatores associados / Characterization of patients with type 1 diabetes mellitus in southern Brazil: chronic complications and associated factors

OBJETIVO: Avaliar a prevalência de complicações crônicas vasculares e fatores associados em pacientes com diabetes mellitus (DM) tipo 1. MÉTODOS: Estudo transversal com pacientes DM tipo 1 atendidos no Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre. Os pacientes foram avaliados quanto à presença de complicações crônicas vasculares. RESULTADOS: Avaliamos 573 pacientes, idade média de 33 anos. A presença de retinopatia diabética (RD) foi observada em 43,3 por cento, o tempo de DM [RC: 1,07; IC95 por cento 1,03-1,11; P < 0,001], presença de nefropatia diabética (ND) [RC 3,40; IC95 por cento 1,89 - 6,13; P <0,001] e presença de hipertensão (HAS) [RC:2,12; IC95 por cento 1,16 - 3,87; P = 0,014] foram associados com RD. A ND esteve presente em 34,5 por cento e foi associada à presença de HAS [RC: 1.93; IC95 por cento (1,16-3,21); P = 0,001] e colesterol total [RC: 1,0; IC 95 por cento (1,0-1,01); P = 0,05]. Sete pacientes apresentaram doença macrovascular. Apenas 22 por cento atingiram níveis de HbA1c <7,0 por cento. A prevalência de HAS foi 33 por cento, sendo que 48 por cento estavam com a PA <130/80 mm Hg e 45 por cento dos pacientes apresentaram valores de LDL >100 mg/dl. CONCLUSÃO: Observamos elevadas prevalências de complicações microvasculares e de HAS. A duração do DM, HAS e presença de ND foram associados à RD. HAS e dislipidemia foram associados à ND. A maioria dos pacientes encontrava-se fora dos alvos desejados de controle glicêmico, pressórico e lipídico. Maiores esforços são necessários para intensificar o controle metabólico e pressórico de pacientes com DM tipo 1.

OBJECTIVE: To evaluate the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus (DM). METHODS: Cross sectional study with type 1 DM patients attending the Endocrine Division, Hospital de Clinicas de Porto Alegre. Patients were evaluated for presence of chronic vascular complications. RESULTS: We evaluated 573 patients, mean age of 33 years. The presence of diabetic retinopathy (DR) was observed in 43.3 percent, diabetes duration [OR: 1.07, 95 percent CI: 1.03 to 1.11, P <0001], the presence of diabetic nephropathy (DN) [OR: 3.40; CI 95 percent: 1.89 to 6.13, P <0001] and hypertension (HPT) [OR: 2.12, 95 percent CI: 1.16 to 3.87, P = 0014] were associated with DR. The DN was present in 34.5 percent and was associated with HPT [OR: 1.93, 95 percent CI: 1.16 to 3.21, P = 0001] and total cholesterol [OR: 1.0, 95 percent CI: 1.0-1.01, P = 0.05]. Seven patients had macrovascular disease. Only 22 percent achieved an A1c of <7.0 percent. HPT was 33 percent and 48 percent had levels <130/80 mm Hg and 45 percent of patients had values for LDL> 100 mg/dl. CONCLUSION: We observed a high prevalence of microvascular complications and HPT. Duration of DM, HPT and presence of DN were associated with DR. HPT and dyslipidemia were associated with DN. Most patients did not meet the desired glycemic control, blood pressure and lipid targets. Greater efforts are needed to intensify the pressure and metabolic control of patients with type 1 DM.

Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients / Estudo histológico comparativo das lesões ateroscleróticas e alterações microvasculares em membros inferiores amputados de pacientes diabéticos e não-diabéticos

OBJETIVE: To perform a comparative analysis of atherosclerotic lesions and capillaries changes in diabetic and nondiabetic patients. METHODS: Leg arteries and skin of 57 amputated lower limbs of diabetic (47.3 percent) and nondiabetic patients were histologically examined. The percentage of arterial stenosis of infrapopliteal arteries and the histological classification of atherosclerotic lesions were determined. Capillary thickening was classified into four categories. RESULTS: Diabetic group showed more than 75 percent stenosis in 57 percent (vs. 56 percent in nondiabetic) of the anterior tibial; 78 percent (vs. 68 percent) of the posterior tibial; 58 percent (vs. 50 percent) of the peroneal leg arteries. Diabetic and nondiabetic patients have predominance of type VI atherosclerotic lesions. The comparison of both groups showed no significant differences in atherosclerotic lesions. Diabetic patients had significantly more PAS positive capillary thickening (63 percent vs. 23 percent). CONCLUSIONS: There were no differences in histological characteristics of atherosclerosis between the two groups. Capillary thickening has been more observed in diabetics.

OBJETIVO: Comparar as lesões ateroscleróticas das extremidades de diabéticos e não-diabéticos, estudando a ocorrência de espessamento capilar. MÉTODOS: Examinou-se segmentos arteriais e da derme de 57 membros inferiores amputados de diabéticos (47,3 por cento) e não-diabéticos. Analisou-se a porcentagem de estenose das artérias infra-poplíteas e a classificação histológica da placa. A presença de espessamento capilar foi classificada em quatro categorias. RESULTADOS: Entre os diabéticos 57 por cento (versus 56 por cento dos não-diabéticos) apresentavam estenose maior que 75 por cento da artéria tibial anterior; 78 por cento (versus 68 por cento) da tibial posterior; 58 por cento (versus 50 por cento) da fibular. Houve predominância em ambos de lesões ateroscleróticas do tipo VI. Comparando os grupos, não houve diferença significante na porcentagem de obstrução arterial ou na classificação da placa aterosclerótica. Os diabéticos apresentaram significativamente mais espessamento capilar (63 por cento versus 23 por cento). CONCLUSÕES: Não houve diferença nas características das lesões ateroscleróticas em diabéticos e não-diabéticos. O espessamento capilar foi mais prevalente entre os diabéticos.

Caso para diagnóstico? / Case for diagnosis?

Os autores relatam caso clínico de paciente do sexo masculino, diabético do tipo II insulinodependente, que apresentava lesões eritêmato-acastanhadas no abdômen e nas coxas, com ligeira atrofia assintomática. O exame histopatológico das lesões revelou a combinação de angiopatia e alterações leves do colágeno, compatíveis com o diagnóstico de dermopatia diabética.

The authors report the case of a patient with insulin-dependent type II diabetes, who presented asymptomatic and atrophic reddish brown patches on his abdomen and thighs. The histopathological features of the lesions showed a combination of vascular disease and minor collagen changes, compatible with the diagnosis of diabetic dermopathy.