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1.
BMC Infect Dis ; 20(1): 145, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066406

RESUMO

BACKGROUND: Pyogenic liver abscess (PLA) is an inflammatory disease with increasing incidence. When it occurs with diabetes mellitus (DM), the risk of recurrence and mortality may increase. However, the effect of DM on the short-term prognosis of PLA patients after hospitalization remained unknown. METHODS: Two hundred twenty-seven PLA patients who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to January 2018 were retrospectively enrolled. They were divided into two groups as the DM group (n = 61) and the Non-DM group (n = 166). In the DM group, HbA1C level < 7% was considered to be good-control of glycaemia (n = 23). The clinical characteristics and overall short-term survival were analyzed. RESULTS: The proportion of PLA patients with DM was 26.87%. In the DM group, there was a higher incidence of hypertension and Candida spp. infection. Conservative administration and percutaneous drainage were mainly used in patients with good- (60.87%) and poor-control (60.53%) of glycaemia, respectively. During follow-up, 24 (10.57%) died due to uncontrolled systemic infections and other serious complications. Compared with PLA patients without DM, patients in the DM group had significantly increased 6-month mortality rate after discharge (Log-Rank test, P = 0.021). Poor-control of glycaemia did not reduce the six-month survival, while the recurrence rate of PLA within 3 months showed an almost 3-fold increase (13.16% vs. 4.35%). Further multivariate analyses found that DM was the only independent risk factor for the PLA six-month survival (odds ratio [OR]: 3.019, 95% confidence interval [CI]: 1.138-8.010, P = 0.026). However, the blood glucose level had no significant effect on the short-term survival of PLA patients with DM (Log-Rank test, P = 0.218). CONCLUSIONS: In PLA patients, DM aggravated short-term mortality and blood glucose levels should be well controlled.


Assuntos
Complicações do Diabetes/complicações , Complicações do Diabetes/epidemiologia , Abscesso Hepático Piogênico/complicações , Abscesso Hepático Piogênico/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia , Criança , Complicações do Diabetes/mortalidade , Feminino , Hospitalização , Humanos , Abscesso Hepático Piogênico/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
2.
Angiology ; 71(5): 411-416, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32030991

RESUMO

Acute stent thrombosis is an important complication of stent implantation. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age between 65 and 74 years, female gender) score incorporates important cardiovascular (CV) risk factors and predicts prognosis in various CV conditions. We evaluated the value of the CHA2DS2-VASc score in predicting acute stent thrombosis (ie, thrombosis during 24 hours after stent placement) in patients undergoing primary percutaneous intervention for ST-segment elevated myocardial infarction. Patients with intraprocedural stent thrombosis and complications were excluded; 48 (2.1%) of 2732 patients had acute stent thrombosis according to our definition. Median CHA2DS2-VASc score was significantly higher in this stent thrombosis group. Cumulative acute stent thrombosis rates were 0.51% for CHA2DS2-VASc score ≤1, 1.55% for ≤2, 1.80% for ≤3, 2.00% for ≤4, 2.17% for ≤5, and 2.19% for ≤6. The CHA2DS2-VASc score (odds ratio = 1.390, 95% confidence interval = 1.118-1.728; P = .003) was an independent predictor of acute stent thrombosis. The CHA2DS2-VASc score ≤1 predicted the absence of the acute stent thrombosis with 91% specificity and 36% sensitivity. Further studies are needed to establish the value of this finding in the context of current clinical practice.


Assuntos
Intervenção Coronária Percutânea , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Stents/efeitos adversos , Trombose/diagnóstico , Trombose/etiologia , Doença Aguda , Fatores Etários , Idoso , Complicações do Diabetes/complicações , Feminino , Insuficiência Cardíaca/complicações , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/complicações , Doenças Vasculares/complicações
3.
PLoS One ; 14(12): e0226866, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869391

RESUMO

INTRODUCTION: Proteinuria is a potent predictor of adverse events in general, although a few large studies have reported a J-shaped association between proteinuria and mortality in individuals with glomerular filtration rate <30 ml/min/1.73m2. However, this association has not been specifically evaluated among incident dialysis patients. METHODS: Among 1,380 Japanese patients who initiated dialysis, we quantified the association of pre-dialysis dipstick proteinuria (negative/trace, 1+, 2+, and ≥3+) with mortality using Cox models adjusting for potential confounders, such as age, gender, clinical history of hypertension, diabetes, and cardiovascular disease. RESULTS: Mean age of study participants was 67.4 (SD 13.0) years, and 67.6% were men. The most common dipstick proteinuria category was ≥3+ (55.4%), followed by 2+ (31.2%), 1+ (9.9%), and negative or trace (3.5%). Patients with lower proteinuria level were older than those with higher proteinuria. Lower proteinuria was significantly associated with a higher risk of all-cause mortality, even after accounting for potential confounders (p for trend <0.001). In those with negative/trace dipstick proteinuria compared to those with dipstick proteinuria ≥3+, the adjusted hazard ratio was 2.60 [95% CI: 1.62-4.17] in the fully adjusted model. Similar findings were observed when analyses were restricted to patients older than 70 years, and when cardiovascular mortality and non-cardiovascular mortality were analyzed separately. CONCLUSIONS: In incident dialysis patients, pre-dialysis proteinuria was inversely associated with mortality risk. Although future studies are needed to identify mechanisms, our findings suggest the need to carefully interpret proteinuria in patients with incident dialysis.


Assuntos
Proteinúria/diagnóstico , Diálise Renal/mortalidade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Estudos de Coortes , Complicações do Diabetes/complicações , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Proteinúria/complicações , Diálise Renal/efeitos adversos , Fatores de Risco
4.
Artigo em Inglês | MEDLINE | ID: mdl-31881760

RESUMO

: Type 1 diabetes mellitus (T1DM) has been linked to many autoimmune problems. The association between T1DM and urticaria warrants investigation. Data were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Participants with T1DM were recruited as the case group, and that group was matched by sex and age at a ratio of 1:4 to the control group comprising those without T1DM. The study period was 1998-2011. All participants were followed up to the diagnosis of urticaria, withdrawal from the insurance program, death, or the end of the study. A multivariable Cox proportional hazard model was used to calculate the adjusted and crude hazard ratios for urticaria. A total of 5895 participants (1179 in the case group and 4716 in the control group) were followed up in the study. The total incidence rate of urticaria in patients with type 1 DM was 26.6 per 1000 person-years, and that in controls was 6.85 per 1000 person-years. Compared with the control group, the hazard ratio of urticaria in the case group was 2.84 (95% CI = 2.27-3.56). Compared with age-matched participants without T1DM, patients with type 1 DM aged <18 years had a 3.62-fold higher risk of urticaria (95% CI = 2.85-4.59). The hazard ratio in patients with an adjusted Diabetes Complications Severity Index (aDCSI) score of 1.01-2.00 per year was 2.57 (95% CI = 1.18-5.57), and that in patients with an aDCSI score of >2.00 per year was 4.47 (95% CI = 2.68-7.47). T1DM patients aged <18 years had an increased risk of urticaria, but a similar phenomenon was not observed among T1DM patients older than 18 years.


Assuntos
Bases de Dados Factuais , Complicações do Diabetes/complicações , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Urticária/etiologia , Adolescente , Estudos de Casos e Controles , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
5.
Angiol Sosud Khir ; 25(4): 28-33, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855198

RESUMO

BACKGROUND: Diabetes mellitus a commonly encountered pathology in the whole world and has a tendency towards steady growth of morbidity and development of vascular complications. The presence of haemostatic disorders and genetic susceptibility to thrombosis in patients with diabetes mellitus increases the risk for the development of thrombotic complications. AIM: The purpose of the study was to determine the incidence rate of thrombophilic conditions (TC) and thrombosis-associated gene carrier status (TAGCS) in patients suffering from neuroischaemic form of diabetic foot. PATIENTS AND METHODS: The study enrolled a total of 38 patients undergoing treatment at the Department of Vascular Surgery for critical ischaemia of lower limbs combined with diabetes mellitus during the period from 2016 to 2018. There were 29 (76.3%) men and 9 (23.7%) women. The mean age amounted to 58.9±7.3 years. The diagnosis of TC and TAGCS was made based on the study for the presence of the markers of antiphospholipid syndrome, level of homocysteine and antithrombin III, proteins C and S, as well as comprehensive genetic study in order to reveal gene polymorphisms (prothrombin, Leiden mutation, MTHFR gene, MTR gene and others). Based on the obtained findings we calculated the incidence rate of TC and TAGCS, as well as their combinations in the examined patients. RESULTS: In the studied group of patients we revealed various incidence of TC and TAGCS, and, most importantly, that of a combination of these conditions. All cases of thrombophilias were combined with TAGCS. Hyperhomocysteinemia was most commonly combined with the MTRR 66 A>G gene mutation, the presence of lupus anticoagulant - with PAI-1 675 5G>4G, whereas thrombophilic conditions - with MTRR 66 A>G and PAI-I - 675 5G>4G. Two patients were found to be carriers of the factor V Leiden mutation. CONCLUSION: The examined patients were diagnosed as having TC or TAGCS, as well as their combinations in one form or another, thus increasing the risk for the development of thromboses and embolisms in such patients.


Assuntos
Complicações do Diabetes/complicações , Pé Diabético/etiologia , Tromboembolia/etiologia , Trombofilia/complicações , Idoso , Complicações do Diabetes/genética , Pé Diabético/genética , Feminino , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tromboembolia/genética , Trombofilia/genética
6.
Rev Med Chil ; 147(5): 668-672, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31859901

RESUMO

Autoimmune pancreatitis is uncommon, responds to steroids and is usually associated with diabetes mellitus. We report a 73 year-old male who, two months after a diagnosis of diabetes mellitus, presented with obstructive jaundice and weight loss. Abdominal magnetic resonance imaging was suggestive of an autoimmune pancreatitis and serum IgG4 was 339 mg/dl (normal range 3-201). The patient was treated with prednisone 40 mg/day with a good clinical and laboratory response. During outpatient care, the dose of prednisone was tapered.


Assuntos
Pancreatite Autoimune/complicações , Pancreatite Autoimune/tratamento farmacológico , Complicações do Diabetes , Diabetes Mellitus , Glucocorticoides/uso terapêutico , Prednisona/uso terapêutico , Idoso , Pancreatite Autoimune/diagnóstico por imagem , Complicações do Diabetes/complicações , Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico , Imunoglobulina G/sangue , Insulina/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Resultado do Tratamento
7.
BMC Health Serv Res ; 19(1): 981, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856797

RESUMO

BACKGROUND: Cancer increases the risk of developing one or more chronic conditions, yet little research describes the associations between health care costs, utilization patterns, and chronic conditions in adults with cancer. The objective of this study was to examine the treated prevalence of chronic conditions and the association between chronic conditions and health care expenses in US adults with cancer. METHODS: This retrospective observational study used US Medical Expenditure Panel Survey (MEPS) Household Component (2010-2015) data sampling adults diagnosed with cancer and one or more of 18 select chronic conditions. The measures used were treated prevalence of chronic conditions, and total and chronic condition-specific health expenses (per-person, per-year). Generalized linear models assessed chronic condition-specific expenses in adults with cancer vs. without cancer and the association of chronic conditions on total health expenses in adults with cancer, respectively, by controlling for demographic and health characteristics. Accounting for the complex survey design in MEPS, all data analyses and statistical procedures applied longitudinal weights for national estimates. RESULTS: Among 3657 eligible adults with cancer, 83.9% (n = 3040; representing 16 million US individuals per-year) had at least one chronic condition, and 29.7% reported four or more conditions. Among those with cancer, hypertension (59.7%), hyperlipidemia (53.6%), arthritis (25.6%), diabetes (22.2%), and coronary artery disease (18.2%) were the five most prevalent chronic conditions. Chronic conditions accounted for 30% of total health expenses. Total health expenses were $6388 higher for those with chronic conditions vs. those without (p < 0.001). Health expenses associated with chronic conditions increased by 34% in adults with cancer vs. those without cancer after adjustment. CONCLUSIONS: In US adults with cancer, the treated prevalence of common chronic conditions was high and health expenses associated with chronic conditions were higher than those without cancer. A holistic treatment plan is needed to improve cost outcomes.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Múltiplas Afecções Crônicas/economia , Neoplasias/economia , Adulto , Estudos Transversais , Complicações do Diabetes/complicações , Complicações do Diabetes/economia , Complicações do Diabetes/epidemiologia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Hipertensão/complicações , Hipertensão/economia , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Neoplasias/complicações , Neoplasias/terapia , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
8.
Acta Chir Orthop Traumatol Cech ; 86(5): 358-361, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748112

RESUMO

PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.


Assuntos
Artrite Infecciosa/cirurgia , Artrodese/instrumentação , Articulações dos Dedos/cirurgia , Idoso , Artrite Infecciosa/complicações , Artrodese/métodos , Fios Ortopédicos , Complicações do Diabetes/complicações , Fixadores Externos , Feminino , Humanos , Masculino , Resultado do Tratamento
9.
Diabetes Res Clin Pract ; 158: 107905, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676331

RESUMO

AIMS: The purpose of this study was to investigate the risk factors for major amputation in patients hospitalized with diabetic forefoot ulcers. METHODS: Between January 2003 and December 2018, a total of 1792 diabetic patients were admitted to the diabetic wound center for the management of diabetic foot ulcers. Among the patients, 1032 diabetic patients with forefoot ulcers were included in this study. Nine hundred and eighty-three patients (95%) healed without major amputations while 49 patients (5%) healed after major amputations. Data related to 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology, and serology were collected from the patients in these two groups for comparison. RESULTS: Among the 88 potential risk factors, 34 showed statistically significant differences between the two groups. In the univariate analysis of 88 risk factors, 33 showed statistically significant differences. In stepwise multiple logistic regression analysis, four of the 33 risk factors remained statistically significant. The multivariate-adjusted odds ratios for gender, magnesium levels, platelet levels, and glycated hemoglobin (HbA1c) levels were 8.216, 2.480, 1.009, and 0.570, respectively. CONCLUSION: Risk factors for major amputation in patients hospitalized with diabetic forefoot ulcers include male gender, increased magnesium, increased platelet levels, and low levels of HbA1c.


Assuntos
Amputação/métodos , Complicações do Diabetes/complicações , Pé Diabético/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
10.
BMC Infect Dis ; 19(1): 973, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730464

RESUMO

BACKGROUND: Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. METHODS: A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study. RESULTS: A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. CONCLUSIONS: Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Complicações do Diabetes/diagnóstico , Pneumonia/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/complicações , Comorbidade , Complicações do Diabetes/complicações , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Atenção Primária à Saúde , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha
11.
Medicine (Baltimore) ; 98(39): e17273, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574841

RESUMO

BACKGROUND: Previous study has reported that Fuyuan Xingnao Decoction (FYXND) can be utilized for the treatment of patients with diabetes mellitus (DM) combined cerebral infarction (CI) effectively. METHODS: We will search from the following databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Global Health, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All databases will be searched from the inception to the present without language limitation. Two independent authors will perform literature selection, information collection, and methodological quality assessment. Statistical analysis will be carried out using RevMan 5.3 software. RESULTS: This study will provide accurate results on the effectiveness and safety of FYXND on DM and CI through primary and secondary outcomes. The primary outcome is neurological deficit. The secondary outcomes consist of fasting blood glucose, hemoglobin Alc, fasting insulin, quality of life, and adverse effects. CONCLUSIONS: This well-designed study will establish high quality evidence of the effectiveness and safety of FYXND for DM and CI to facilitate the clinical practice and guideline development.


Assuntos
Infarto Cerebral/tratamento farmacológico , Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Infarto Cerebral/etiologia , Complicações do Diabetes/sangue , Complicações do Diabetes/complicações , Diabetes Mellitus/sangue , Humanos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
12.
Braz Oral Res ; 33(suppl 1): e070, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576954

RESUMO

The aim of this review is to summarize the evidence on associations between diabetes mellitus (DM) and complications around dental implants. Electronic database searches of MEDLINE, EMBASE, JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews and the PROSPERO register were performed from 1990 up to and including May 2018, using MeSH terms and other keywords. Systematic reviews and meta-analyses investigating the associations of DM and implant complications (failure, survival, bone loss, peri-implant diseases, and post-surgery infection) were eligible. The quality of the included reviews was determined using the Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2). Twelve systematic reviews were included. Implant survival rates ranged from 83.5% to 100%, while implant failure rates varied from 0% to 14.3% for subjects with DM. The three meta-analyses performed for event "implant failure" reported no statistically significant differences between diabetic and non-diabetic subjects. An apparently increased risk of peri-implantitis is reported in patients with DM. According to the AMSTAR 2 classification, 50% of the reviews were classified as being of "critically low", 25% as of "low" and 25% as of "moderate" quality. Evidence indicates high levels of survival and low levels of failure of implants inserted in patients with DM. However, DM was assessed as a whole in the majority of studies and, the actual influence of hyperglycemia on implant survival/failure is still uncertain. DM/hyperglycemia seems to be associated with a high risk of peri-implantitis. However, this conclusion is based on a limited number of systematic reviews.


Assuntos
Complicações do Diabetes/complicações , Peri-Implantite/etiologia , Implantes Dentários/efeitos adversos , Falha de Restauração Dentária , Humanos , Falha de Prótese , Fatores de Risco , Falha de Tratamento
13.
J Diabetes Res ; 2019: 4583895, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565656

RESUMO

Aim: (1) To quantify the invisible variations of facial erythema that occur as the blood flows in and out of the face of diabetic patients, during the blood pulse wave using an innovative image processing method, on videos recorded with a conventional digital camera and (2) to determine whether this "unveiled" facial red coloration and its periodic variations present specific characteristics in diabetic patients different from those in control subjects. Methods: We video recorded the faces of 20 diabetic patients with peripheral neuropathy, retinopathy, and/or nephropathy and 10 nondiabetic control subjects, using a Canon EOS camera, for 240 s. Only one participant presented visible facial erythema. We applied novel image processing methods to make the facial redness and its variations visible and automatically detected and extracted the redness intensity of eight facial patches, from each frame. We compared average and standard deviations of redness in the two groups using t-tests. Results: Facial redness varies, imperceptibly and periodically, between redder and paler, following the heart pulsation. This variation is consistently and significantly larger in diabetic patients compared to controls (p value < 0.001). Conclusions: Our study and its results (i.e., larger variations of facial redness with the heartbeats in diabetic patients) are unprecedented. One limitation is the sample size. Confirmation in a larger study would ground the development of a noninvasive cost-effective automatic tool for early detection of diabetic complications, based on measuring invisible redness variations, by image processing of facial videos captured at home with the patient's smartphone.


Assuntos
Complicações do Diabetes/complicações , Complicações do Diabetes/diagnóstico , Eritema/etiologia , Face/irrigação sanguínea , Idoso , Cor , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade
14.
Rev Lat Am Enfermagem ; 27: e3197, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618390

RESUMO

OBJECTIVE: to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital. METHOD: this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation). RESULTS: 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days). CONCLUSION: this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.


Assuntos
Hospitalização/estatística & dados numéricos , Ataque Isquêmico Transitório/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Fatores Etários , Idoso , Correlação de Dados , Complicações do Diabetes/complicações , Feminino , Humanos , Hipertensão/complicações , Ataque Isquêmico Transitório/complicações , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Pneumonia/complicações , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Infecções Urinárias/complicações
15.
Diabetes Res Clin Pract ; 157: 107869, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31560962

RESUMO

AIMS: There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control. METHODS: We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol), ≥9% to 12% (108 mmol/mol), ≥12%). RESULTS: Mean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c ≥12% were more likely to be Black and lack insurance. CONCLUSIONS: YA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled diabetes. Many already had comorbidities and diabetes complications, high use of acute care services and low use of diabetes specialty services. YA characteristics varied by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially impacting healthcare utilization patterns and medication adherence, and leading to DKA/HHS admissions.


Assuntos
Complicações do Diabetes/complicações , Testes Diagnósticos de Rotina/métodos , Adolescente , Adulto , Emergências , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Hospitais Urbanos , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
16.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(3): 282-288, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31496160

RESUMO

OBJECTIVE: To determine the effect of trimetazidine on cardiac function and exercise tolerance in primary hypertension patients with type 2 diabetic. METHODS: In this randomized, double-blind, placebo-controlled prospective study, 60 primary hypertensive patients with diabetic were equally assigned into two groups, patients received trimetazidine (20 mg, 3 times a day) or placebo for 1 year. Echocardiography, cardiopulmonary exercise testing were performed; and the plasma N terminal pro B type natriuretic peptide (NT-ProBNP), hr-CRP, TNF-α, angiotensin Ⅱ and endothelin concentration were determined before and after treatment. RESULTS: In trimetazidine group, the left ventricular mass index, the mitral flow velocity E wave to A wave ratio (E/A), the peak early diastolic velocity (VE) to late diastolic velocity (VA) ratio (VE/VA) and the peak systolic velocity (Vs) were significantly improved, the plasma NT-ProBNP level was significantly decreased, and the exercise time, metabolic equivalent, maximal oxygen uptake and anaerobic threshold were significantly increased (all P<0.05); plasma concentration of hr-CRP, TNF-α, angiotensin Ⅱ and endothelin were significantly reduced after trimetazidine treatment, compared with baseline (all P<0.05) and with placebo (all P<0.05). There were no significant differences in any of above parameters after treatment in placebo group (all P>0.05). No severe adverse reaction was observed in both groups. CONCLUSIONS: For patients with both hypertension and diabetes, trimetazidine can improve cardiac function and increase exercise tolerance.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Tolerância ao Exercício , Coração , Hipertensão , Trimetazidina , Complicações do Diabetes/complicações , Diabetes Mellitus/tratamento farmacológico , Método Duplo-Cego , Tolerância ao Exercício/efeitos dos fármacos , Coração/efeitos dos fármacos , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Peptídeo Natriurético Encefálico/sangue , Estudos Prospectivos , Resultado do Tratamento , Trimetazidina/farmacologia , Trimetazidina/uso terapêutico , Vasodilatadores/farmacologia , Vasodilatadores/uso terapêutico
17.
Skinmed ; 17(3): 200-202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496478

RESUMO

A 32-year-old man presented to the dermatology department with generalized asymptomatic yellowish papules on an erythematous base, arms, thighs, and buttocks. These lesions had appeared in the previous month (Figure 1). Dermoscopy revealed a homogeneous yellow color, corresponding to dermal xanthomatous deposits, with interconnected fine and dotted vessels (Figure 2). The laboratory findings showed extremely high levels of triglycerides (4.842 mg/dL; normal <150), as well as increased total cholesterol (576 mg/dL; normal <200), fasting blood glucose (294 mg/dL), and glycated hemoglobin 12.3% (normal range 4% to 6%). A skin biopsy demonstrated foamy cells, with extracellular lipid between collagen bundles in the dermis (Figure 3).


Assuntos
Complicações do Diabetes/complicações , Hipertrigliceridemia/etiologia , Xantomatose/etiologia , Xantomatose/patologia , Adulto , Biópsia , Dermoscopia , Complicações do Diabetes/diagnóstico , Humanos , Masculino , Pele/patologia , Xantomatose/diagnóstico por imagem
18.
Eur J Clin Microbiol Infect Dis ; 38(12): 2215-2220, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31385146

RESUMO

The aim of this study was to describe the epidemiology of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia in a diabetic and a non-diabetic population of the University Hospital of Charleroi and to analyze medical outcomes, including risk of metastatic infection and mortality. Descriptive and multivariable analyses were performed using MedCalc 18.9 (MedCalc Software bvba, Ostend, Belgium). A total of 248 patients with MSSA bacteremia were identified between 1st January 2012 and 28th June 2017 out of which 32.7% were diabetic. Within the diabetic patients, we observed more prolonged hospital duration of stay (p = 0.034), more secondary bacteremia of cutaneous sources (including cellulitis, diabetic foot and ulcer) (p = 0.037), and more metastatic infection (p = 0.002). The overall 30-day mortality was 24.2% with no difference between the two groups. With a logistic regression analysis, it was demonstrated that age ≥ 60 years (odds ratio (OR), 2.20 (95% CI, 1.03-4.67)) and Charlson Comorbidity Index (CCI) ≥ 3 (OR, 2.95 (95% CI, 1.51-5.79)) were the only independent risk factors of mortality, while removal of the primary site of infection was a protective factor (OR, 0.27 (95% CI, 0.12-0.62)). Risk of developing metastatic infection was increased with diabetes (OR, 2.08 (95% CI, 1.12-3.90)), while early empirical antibiotic therapy (OR, 0.38 (95% CI, 0.20-0.71)) decreased this risk. Diabetes was not associated with increased 30-day mortality after MSSA bacteremia. However, diabetes increased significantly the risk of metastatic infection. An aggressive treatment of MSSA bacteremia seems crucial to improve the outcome of diabetic patients.


Assuntos
Bacteriemia/epidemiologia , Complicações do Diabetes/epidemiologia , Meticilina/farmacologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Idoso , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/terapia , Bélgica/epidemiologia , Complicações do Diabetes/complicações , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação
19.
J Hand Surg Asian Pac Vol ; 24(3): 317-322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438802

RESUMO

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.


Assuntos
Complicações do Diabetes/complicações , Mãos , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Desbridamento , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Cicatrização , Infecção dos Ferimentos/diagnóstico , Adulto Jovem
20.
Expert Rev Gastroenterol Hepatol ; 13(8): 711-721, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31314613

RESUMO

Introduction: Gastroparesis is a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction. Diabetes is the most commonly known cause of gastroparesis. Management of diabetic gastroparesis involves lifestyle modifications, glycemic control, pharmacological drugs, and for refractory cases surgical treatments. Metoclopramide remains the only drug approved by the Food and Drug Administration for diabetic gastroparesis. The aim of this article is to provide a concise review of the pharmacology, clinical efficacy and tolerability of metoclopramide. Areas covered: We searched PubMed using the key words 'metoclopramide', 'diabetic gastroparesis', and 'gastric emptying'. The relevant articles and their bibliography were reviewed. Metoclopramide acts on several different receptors; primarily as a dopamine receptor antagonist, both peripherally improving gastric emptying, and centrally resulting in an anti-emetic effect. Metoclopramide side effects, mostly related to its ability to cross the blood-brain barrier, include drowsiness, restlessness, hyperprolactinemia, and tardive dyskinesia (TD), a movement disorder that may be irreversible. Expert opinion: Metoclopramide carries a black box warning for use >12 weeks due to the risk of TD. However, gastroparesis patients experience chronic symptoms often requiring prolonged treatments. Physicians and patients look forward to FDA approval of new agents for gastroparesis with better efficacy and safety profile.


Assuntos
Complicações do Diabetes/complicações , Antagonistas dos Receptores de Dopamina D2/uso terapêutico , Esvaziamento Gástrico/efeitos dos fármacos , Gastroparesia/tratamento farmacológico , Metoclopramida/uso terapêutico , Trato Gastrointestinal Superior/efeitos dos fármacos , Antagonistas dos Receptores de Dopamina D2/efeitos adversos , Antagonistas dos Receptores de Dopamina D2/farmacologia , Gastroparesia/etiologia , Humanos , Metoclopramida/efeitos adversos , Metoclopramida/farmacologia , Resultado do Tratamento , Trato Gastrointestinal Superior/inervação
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