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1.
Life Sci ; 240: 117138, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809715

RESUMO

Pyroptosis is a form of cell death mediated by gasdermin D (GSDMD); it is characterised by NLRP3 inflammasome activation, caspase activation, cell membrane pore formation, and the release of interleukin-1ß and interleukin-18. NLRP3 inflammasome activation plays a central role in pyroptosis. Recent research has suggested that NLRP3 inflammasome activation may be involved in the occurrence and development of diabetes mellitus and its associated complications. This finding provided the impetus for us to clarify the significance of pyroptosis in diabetes. In this review, we summarise the current understanding of the molecular mechanisms involved in pyroptosis, as well as recent advances in the role of NLRP3 inflammasome activation and pyroptosis in the development of diabetes and diabetic complications.


Assuntos
Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/genética , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/genética , Inflamassomos/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Piroptose/genética , Animais , Complicações do Diabetes/patologia , Diabetes Mellitus/patologia , Humanos , Inflamassomos/efeitos dos fármacos , Piroptose/efeitos dos fármacos
2.
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
/complicações , Complicações do Diabetes , Diabetes Mellitus , Glucocorticoides/uso terapêutico , Prednisona/uso terapêutico , Idoso , 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
3.
Life Sci ; 239: 117011, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31669241

RESUMO

Diabetes mellitus (DM) is a multifaceted and costly disease, which requires serious attention. Finding a cheaper anti-diabetic alternative that can act on multiple disease-related targets and pathways is the ultimate treatment goal for DM. Nanotechnology has offered some exciting possibilities in biomedical and drug delivery applications. Zinc oxide nanoparticles (ZnO-NPs), a novel agent to deliver zinc, have great implications in many disease therapies including DM. This review summarizes the pharmacological mechanisms by which ZnO-NPs alleviate DM and diabetic complications. Research implications and future perspectives were also discussed.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Nanopartículas Metálicas/uso terapêutico , Óxido de Zinco/uso terapêutico , Animais , Complicações do Diabetes/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Humanos , Hipoglicemiantes/farmacologia , Óxido de Zinco/farmacologia
4.
Medicine (Baltimore) ; 98(47): e18067, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764838

RESUMO

Osteoporosis is a complication of type 2 diabetes mellitus (T2DM). Blockade of receptor activator of nuclear factor kappa-B ligand (RANKL) improves osteoporosis, but might also improve glucose tolerance through reduction of hepatic insulin resistance. However, the effect of denosumab (a human monoclonal antibody of RANKL) upon glycemic and metabolic parameters is controversial. We revealed the effect of denosumab upon glycemic and metabolic parameters for 52 weeks. We evaluated 20 individuals diagnosed with both osteoporosis (male and female: postmenopausal) and T2DM. We measured glycemic and metabolic parameters before and 26/52 weeks after administration of denosumab (60 mg per 26 weeks) without changing any other medication each patient was taking. All patients completed the study without complications and the T-score (lumbar spine and femoral neck) improved significantly from baseline to 52 weeks after denosumab administration (P < .001, .001, respectively). None of the glycemic parameters changed significantly from baseline to 26 weeks after denosumab administration, but levels of glycated hemoglobin and homeostasis model assessment of insulin resistance improved significantly from baseline to 52 weeks after administration (P = .019, .008, respectively). The levels of liver enzymes did not change significantly from baseline to 26 weeks after denosumab administration, but levels of aspartate transaminase and alanine aminotransferase improved significantly from baseline to 52 weeks after administration (P = .014, .004, respectively). None of the markers of lipid metabolism and body mass index changed significantly from baseline to 26/52 weeks after denosumab administration. These data demonstrated that denosumab is useful for T2DM patients with osteoporosis for glycemic control via improvement of insulin resistance. Also, the effect of denosumab might be due to improvement of hepatic function.


Assuntos
Glicemia/efeitos dos fármacos , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Denosumab/farmacologia , Denosumab/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Osteoporose/metabolismo , Idoso , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Osteoporose/etiologia , Ligante RANK/imunologia
5.
J Diabetes Res ; 2019: 8712492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583254

RESUMO

Testicular structural and functional impairment is a serious complication in male diabetes mellitus (DM) patients that leads to impaired fertility in adulthood. In contrast to other endocrine therapies, islet transplantation (IT) can effectively prevent and even reverse diabetic nephropathy and myocardial damage. However, whether IT can alleviate diabetes-induced testicular injury remains unclear. In this study, we sought to investigate the effect of IT on diabetes-induced testicular damage. A diabetic rat model was established by streptozotocin injection. DM, IT, and insulin treatment (INS) groups were compared after 4 weeks of respective treatment. We confirmed that IT could effectively attenuate diabetes-induced testicular damage and recover sperm counts more extensively compared with INS in diabetic rats. In addition, significantly higher levels of superoxide dismutase (SOD) activity and lower contents of malondialdehyde (MDA) were detected in the testes of the IT group versus diabetic rats. Mechanism studies revealed that IT significantly activates the expression of Nrf-2, HO-1, and NQO-1 and inhibits upregulation of the NF-κB expression in response to DM, while INS only exhibit slight impact on the protein expression. Therefore, we speculate that IT may prevent the progression of testicular damage by downregulating oxidative stress and inhibiting inflammation via Nrf-2/HO-1 and NF-κB pathways.


Assuntos
Complicações do Diabetes/cirurgia , Diabetes Mellitus Experimental/cirurgia , Inflamação/metabolismo , Transplante das Ilhotas Pancreáticas , Estresse Oxidativo/fisiologia , Transdução de Sinais/fisiologia , Doenças Testiculares/cirurgia , Testículo/metabolismo , Animais , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/metabolismo , Complicações do Diabetes/patologia , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patologia , Heme Oxigenase (Desciclizante)/metabolismo , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Inflamação/patologia , Insulina/farmacologia , Insulina/uso terapêutico , Masculino , Malondialdeído/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , NF-kappa B/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Contagem de Espermatozoides , Doenças Testiculares/tratamento farmacológico , Doenças Testiculares/metabolismo , Doenças Testiculares/patologia , Testículo/efeitos dos fármacos , Testículo/patologia
6.
JAMA ; 322(13): 1294-1304, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573641

RESUMO

Importance: Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death. Observations: Defined as a persistent abnormality in kidney structure or function (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3 months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is most commonly attributed to diabetes and hypertension. However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies. Optimal management of CKD includes cardiovascular risk reduction (eg, statins and blood pressure management), treatment of albuminuria (eg, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers), avoidance of potential nephrotoxins (eg, nonsteroidal anti-inflammatory drugs), and adjustments to drug dosing (eg, many antibiotics and oral hypoglycemic agents). Patients also require monitoring for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Those at high risk of CKD progression (eg, estimated GFR <30 mL/min/1.73 m2, albuminuria ≥300 mg per 24 hours, or rapid decline in estimated GFR) should be promptly referred to a nephrologist. Conclusions and Relevance: Diagnosis, staging, and appropriate referral of CKD by primary care clinicians are important in reducing the burden of CKD worldwide.


Assuntos
Insuficiência Renal Crônica , Complicações do Diabetes/tratamento farmacológico , Progressão da Doença , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Prognóstico , Encaminhamento e Consulta , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Medição de Risco
7.
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 , Revisão Sistemática como Assunto , Resultado do Tratamento
8.
J Pak Med Assoc ; 69(9): 1394-1395, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511734

RESUMO

This review presents the dynamic and fast growing concept of precision medicine in a simple and succinct manner. It describes the potential of precision medicine in diabetes praxis, under three headings: diagnosis of type of diabetes, choice of pharmacotherapy for glucose lowering, and management of complications of diabetes. This review should make the scope of precision medicine easy to understand for the practicing physician.


Assuntos
Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Medicina de Precisão , Diabetes Mellitus/genética , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos
9.
Life Sci ; 235: 116823, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31476307

RESUMO

AIMS: Advanced glycation end products (AGEs) trigger intracellular reactive oxygen species (ROS) generation, activation of receptor for AGEs (RAGE) expression/functionality and RAGE-associated signalling pathways which influence the diabetic-cum-atherosclerotic complications, whereas, the atherosclerosis progression is greatly influenced by hepatic ß-Hydroxy-ß-methyl-glutaryl-Co-A reductase (HMG-R) activity. The present report was premeditated to uncover the regulatory role of HMG-R inhibitors and ezetimibe (EZ) in attenuating the LDL-AGEs-induced pathogenicity via targeting cellular-ROS and RAGE-associated signalling in HEK-293 cells. MAIN METHODS: The MTT assay was used to assess either the cytotoxic or cytoprotective impact of each HMG-R inhibitors, EZ, and LDL-AGEs, whereas, quantification of ROS was performed by DCFDA method. The qRT-PCR was used to detect the mRNA level of RAGE, neuropilin-1 (NRP-1) and other RAGE-associated genes like MMP-2, NF-κB, and TGFß-1. KEY FINDINGS: The HMG-R inhibitors do not exert any cytotoxicity in HEK-293 cells, whereas, and LDL-AGEs negatively affected the cell viability of HEK-293 cells. However, viability of LDL-AGEs-treated HEK-293was markedly retained after simultaneous treatment with our test inhibitors. Further, DCFDA staining showed that LDL-AGEs-induced ROS was also suppressed upon treatment with our test inhibitors in HEK-293 cells. qRT-PCR analysis reflected that these inhibitors suppress the RAGE, NF-κB, TGFß-1, and MMP-2 expression, whereas, the NRP-1 was up-regulated by these compounds in LDL-AGEs-exposed HEK-293 cells. SIGNIFICANCE: The above pharmacological effects signify that HMG-R inhibitors and EZ (alone or in combination) may implied in the treatment of AGEs-induced oxidative stress and tissue damage in diabetic complications via targeting intracellular-ROS, NRP-1 functionality and RAGE-associated genes i.e. NF-κB, TGFß-1, and MMP-2.


Assuntos
Ezetimiba/farmacologia , Produtos Finais de Glicação Avançada/metabolismo , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Lipoproteínas LDL/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Anticolesterolemiantes/farmacologia , Apoptose , Complicações do Diabetes/tratamento farmacológico , Células HEK293 , Humanos , NF-kappa B/metabolismo
12.
Molecules ; 24(18)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31514313

RESUMO

This review aimed to provide a general view of catalpol in protection against diabetes and diabetic complications, as well as its pharmacokinetics and safety concerns. The following databases were consulted with the retrieval of more than 100 publications through June 2019: PubMed, Chinese National Knowledge Infrastructure, WanFang Data, and web of science. Catalpol exerts an anti-diabetic effect in different animal models with an oral dosage ranging from 2.5 to 200 mg/kg in rats and 10 to 200 mg/kg in mice. Besides, catalpol may prevent the development of diabetic complications in kidney, heart, central nervous system, and bone. The underlying mechanism may be associated with an inhibition of inflammation, oxidative stress, and apoptosis through modulation of various cellular signaling, such as AMPK/PI3K/Akt, PPAR/ACC, JNK/NF-κB, and AGE/RAGE/NOX4 signaling pathways, as well as PKCγ and Cav-1 expression. The pharmacokinetic profile reveals that catalpol could pass the blood-brain barrier and has a potential to be orally administrated. Taken together, catalpol is a well-tolerated natural compound with promising pharmacological actions in protection against diabetes and diabetic complications via multi-targets, offering a novel scaffold for the development of anti-diabetic drug candidate. Further prospective and well-designed clinical trials will shed light on the potential of clinical usage of catalpol.


Assuntos
Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Glucosídeos Iridoides/farmacocinética , Glucosídeos Iridoides/uso terapêutico , Animais , Modelos Animais de Doenças , Humanos , Glucosídeos Iridoides/efeitos adversos , Glucosídeos Iridoides/química , Especificidade de Órgãos
13.
Cutan Ocul Toxicol ; 38(4): 401-405, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31438736

RESUMO

Purpose: The aim of this study is to compare the efficacy of intravitreal injection of aflibercept and dexamethasone implant in the early treatment period of naive diabetic macular edema (DME) with serous retinal detachment (SRD). Materials and methods: In this retrospective comparative study, medical records of patients who received treatment for naive DME with SRD and underwent three monthly intravitreal aflibercept (IVA) injections (2 mg) or one intravitreal dexamethasone implant (IDI) injection (0.7 mg) were reviewed. The best corrected visual acuity (BCVA), central macular thickness (CMT), and presence and height of SRD were compared three months after IDI injection and one month after the third IVA injection. Results: A total of 57 eyes of 49 patients were included in the study. The IVA group consisted of 32 eyes of 27 patients, whereas the IDI group consisted of 25 eyes of 22 patients. Both groups were similar in terms of gender, baseline intraocular pressure, HbA1c levels, types of diabetes, BCVA, CMT, and height of SRD (p = 0.469, p = 0.089, p = 0.889, p = 0.461, p = 0.072, p = 0.073, and p = 0.064, respectively). The mean CMT changes were 228.6 ± 109.8 µm and 168.5 ± 106.4 µm in the IDI and IVA groups, respectively (p < 0.001 for both groups). The change in CMT was statistically significantly greater in IDI group than in IVA group (p = 0.041). The mean SRD changes were 162.7 ± 106.9 µm and 110.7 ± 51.9 µm in the IDI and IVA groups, respectively (p < 0.001 for both groups), and the change in SRD height was statistically significantly greater in IDI group than in IVA group (p = 0.019). SRD completely resolved in 92% and 91.2% of the patients in IDI and IVA groups, respectively (p = 0.856). Moreover, BCVA was significantly increased after the injections in both groups (p < 0.001 for both groups), and the change in BCVA was comparable between the groups (p = 0.245). Conclusions: Fewer injections of dexamethasone implant demonstrated better morphological results than aflibercept in the early treatment period of naive diabetic macular edema (DME) with serous retinal detachment (SRD).


Assuntos
Inibidores da Angiogênese/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Dexametasona/administração & dosagem , Complicações do Diabetes/tratamento farmacológico , Edema Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Descolamento Retiniano/tratamento farmacológico , Adulto , Idoso , Implantes de Medicamento , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade
14.
Food Funct ; 10(9): 5350-5360, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31393485

RESUMO

Diabetic osteoporosis (DOP) is a systemic endocrine-metabolic osteopathy which has the characteristics of bone mineral density (BMD) reduction and bone microstructural destruction. Although anthocyanin-rich extract from black rice (AEBR) was reported to have a beneficial effect on diabetic rats, no studies have been performed on whether black rice anthocyanins are beneficial for diabetic osteoporosis. Therefore, in this study, a streptozotocin-induced diabetic rat model was established to investigate the protective effect of AEBR on diabetes-induced osteoporosis and its possible mechanism. AEBR at three doses (0.5, 1.0, and 2.0 g kg-1 d-1) were administered by oral gavage to diabetic rats for 8 weeks. The blood glucose, BMD, bone histomorphometry parameters, serum bone turnover biomarkers, bone marrow adipocyte numbers, as well as osteoprotegerin (OPG), runt-related transcription factor 2 (RUNX 2), and receptor activator of nuclear factor-κ B ligand (RANKL) protein expression in bone and serum were detected. The results indicated that AEBR dose-dependently decreased the blood glucose, increased the BMD, and decreased the serum bone turnover markers. The bone microstructure and osteoclast numbers in bone tissues returned to normal in the high AEBR dosage group; at the same time, the AEBR dose-dependently suppressed bone marrow adipogenesis. The RUNX 2 as well as the OPG/RANKL ratio in diabetic rats' bone tissues increased significantly in the AEBR treatment group. Our results indicate that AEBR administration can ameliorate bone loss caused by diabetes; this is mainly attributed to its inhibition of bone turnover, suppression of bone marrow adipogenesis, and up-regulation of RUNX 2 and the OPG/RANKL expression ratio.


Assuntos
Antocianinas/administração & dosagem , Complicações do Diabetes/tratamento farmacológico , Oryza/química , Osteoporose/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Animais , Antocianinas/análise , Glicemia/metabolismo , Densidade Óssea/efeitos dos fármacos , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Complicações do Diabetes/genética , Complicações do Diabetes/metabolismo , Complicações do Diabetes/fisiopatologia , Feminino , Humanos , Osteoclastos/citologia , Osteoclastos/metabolismo , Osteoporose/genética , Osteoporose/metabolismo , Osteoporose/fisiopatologia , Osteoprotegerina/genética , Osteoprotegerina/metabolismo , Ligante RANK/genética , Ligante RANK/metabolismo , Ratos , Ratos Sprague-Dawley
15.
BMC Infect Dis ; 19(1): 603, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291896

RESUMO

BACKGROUND: This study aims to investigate the pathogen distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection. METHODS: From August 2015 to December 2017, 172 pathogenic bacterial strains from patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection in our hospital were identified, and the drug sensitivity was analyzed. RESULTS: Among these 172 strains of pathogenic bacteria, gram negative bacteria was the main cause of pulmonary infection in hospitalized patients with acute cerebral infarction, accounting for 75.6% of all pathogens. Furthermore, 80% of diabetic patients with cerebral infarction had lung infection induced by gram negative bacteria, which was significantly higher than that in non-diabetic patients (72.2%). Moreover, the drug resistance rate in the diabetic group (68.3%) was significantly higher than that in the non-diabetic group (54.3%). Gram positive bacteria accounted for 19.1% of all pathogenic bacteria. The infection rate of gram-positive bacteria in diabetic patients with cerebral infarction was 14.7%, which was lower than that in the non-diabetic group (22.6%). The drug-resistance rate was higher in the diabetic group (45.5%) than in the non-diabetic group (28.2%). Furthermore, the fungal infection rate in patients with lung infection in these two groups was 5.3 and 5.2%, respectively, and fungi presented with high sensitivity to commonly used antifungal agents. CONCLUSION: In patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection, the majority of pathogens are multidrug-resistant gram negative bacilli. Pathogen culture should be conducted as soon as possible before using antibiotics, and antimicrobial agents should be reasonably used according to drug sensitivity test results.


Assuntos
Infarto Cerebral/complicações , Infecção Hospitalar/microbiologia , Complicações do Diabetes/microbiologia , Resistência Microbiana a Medicamentos , Pneumonia/microbiologia , Doença Aguda , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/microbiologia , Infecção Hospitalar/tratamento farmacológico , Complicações do Diabetes/tratamento farmacológico , Feminino , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pneumonia/tratamento farmacológico
16.
Medicina (Kaunas) ; 55(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315312

RESUMO

Diabetic kidney disease affects up to forty percent of patients with diabetes during their lifespan. Prevention and treatment of diabetic kidney disease is currently based on optimal glucose and blood pressure control. Renin-angiotensin aldosterone inhibitors are considered the mainstay treatment for hypertension in diabetic patients, especially in the presence of albuminuria. Whether strict blood pressure reduction entails a favorable renal outcome also in non-albuminuric patients is at present unclear. Results of several clinical trials suggest that an overly aggressive blood pressure reduction, especially in the context of profound pharmacologic inhibition of the renin-angiotensin-aldosterone system may result in a paradoxical worsening of renal function. On the basis of this evidence, it is proposed that blood pressure reduction should be tailored in each individual patient according to renal phenotype.


Assuntos
Anti-Hipertensivos/uso terapêutico , Nefropatias Diabéticas/tratamento farmacológico , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/etiologia , Complicações do Diabetes/fisiopatologia , Nefropatias Diabéticas/fisiopatologia , Humanos , Hipertensão/fisiopatologia
17.
Am J Med Sci ; 358(2): 121-126, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331449

RESUMO

BACKGROUND: Multiple studies have addressed ethnic diabetes mellitus (diabetes) care inequalities. But few have assessed whether ethnicity influences patient perceptions of diabetic quality-of-life (QOL). The authors therefore designed a cross-sectional study to quantify the overall QOL associated with diabetes in consecutive white (Caucasian) and black (African-American) participants. MATERIAL AND METHODS: A validated, time tradeoff utility instrument was consecutively administered by interview to 518 white and 92 African-American, adult, diabetic participants in an ambulatory setting. The instrument calculates QOL by quantifying a utility associated with their condition, with utility anchors of 1.00 (perfect health for that condition permanently) and 0.00 (death). Utility acquisition as used herein, first requires asking participants to estimate their theoretical remaining time of life, then subtracting from 1.00 the maximum proportion of their estimated remaining time of life they would be willing to hypothetically trade-if any-to permanently cure their condition (diabetes). Thus, a diabetic participant estimating 20 remaining years of life who will theoretically trade 3 of those years to cure their diabetes, has a diabetes-associated utility of [1.00 - (3/20) =)] 0.85. The closer the utility is to 1.00, the better the QOL associated with a condition, while the closer it is to 0.00, the poorer the associated QOL. RESULTS: The mean diabetes utility (QOL) for the white, diabetic participant cohort was 0.87, while that for the black cohort was 0.86 (P = 0.95). The ethnic cohorts were matched for age (P = 0.70), sex (P = 0.64), level of education (P = 0.29), known years of having diabetes (P = 0.10), insulin use (P = 0.23), type of diabetes (P = 0.27) and the number of associated comorbidities (P = 0.23). There was no difference between the cohorts for the presence and severity of the individual, diabetes-related comorbidities of retinopathy (P = 0.15), nephropathy (P = 0.24), neuropathy (P = 0.52), depression (P = 0.23) and heart disease (P = 0.32). Multiple linear regression integrating both cohorts revealed no effect of ethnicity upon diabetes utility (P = 0.60). CONCLUSIONS: Diabetes-related QOL was similar in matched cohorts of adult white and black participants with diabetes mellitus. This study suggests utilities for diabetes mellitus can be used in economic analyses without adjustment for white and black ethnicity.


Assuntos
Afro-Americanos , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu , Qualidade de Vida/psicologia , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/etnologia , Complicações do Diabetes/psicologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Insulina/administração & dosagem , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
18.
ACS Appl Mater Interfaces ; 11(33): 29604-29618, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361112

RESUMO

Diabetes and its complications have become a global challenge of public health. Herein, we aimed to develop a long-acting delivery system of lixisenatide (Lixi), a glucose-dependent antidiabetic peptide, based on an injectable hydrogel for the synchronous treatment of type 2 diabetes mellitus (T2DM) and associated complications. Two triblock copolymers, poly(ε-caprolactone-co-glycolic acid)-poly(ethylene glycol)-poly(ε-caprolactone-co-glycolic acid) and poly(d,l-lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(d,l-lactic acid-co-glycolic acid) possessing temperature-induced sol-gel transitions, were synthesized by us. Compared to the two single-component hydrogels, their 1/1 mixture hydrogel not only maintained the temperature-induced gelation but also exhibited a steadier degradation profile in vivo. Both in vitro and in vivo release studies demonstrated that the mixture hydrogel provided the sustained release of Lixi for up to 9 days, which was attributed to balanced electrostatic interactions between the positive charges in the peptide and the negative charges in the polymer carrier. The hypoglycemic efficacy of Lixi delivered from the mixture hydrogel after a single subcutaneous injection into diabetic db/db mice was comparable to that of twice-daily administrations of Lixi solution for up to 9 days. Furthermore, three successive administrations of the abovementioned gel system within a month significantly increased the plasma insulin level, lowered glycosylated hemoglobin, and improved the pancreatic function of the animals. These results were superior or equivalent to those of twice-daily injections of Lixi solution for 30 days, but the number of injections was markedly reduced from 60 to 3. Finally, an improvement in hyperlipidemia, augmentation of nerve fiber density, and enhancement of motor nerve conduction velocity in the gel formulation-treated db/db mice indicated that the sustained delivery of Lixi arrested and even ameliorated diabetic complications. These findings suggested that the Lixi-loaded mixture hydrogel has great potential for the treatment of T2DM with significant improvements in the health and quality of life of patients.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Peptídeos/administração & dosagem , Peptídeos/uso terapêutico , Animais , Varredura Diferencial de Calorimetria , Dicroísmo Circular , Preparações de Ação Retardada , Complicações do Diabetes/sangue , Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Hidrogéis/química , Rim/efeitos dos fármacos , Rim/metabolismo , Masculino , Camundongos , Qualidade de Vida , Ratos
19.
Diabetes Metab Syndr ; 13(2): 1225-1229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336468

RESUMO

BACKGROUND AND OBJECTIVES: The present review shows a list of anti-glycation plants with their anti-glycation activity mechanisms that can attract the attention of pharmacologist for further scientific research towards finding better remedy for diabetic complications. MATERIALS: Google scholar, Pubmed, Web of Science and Scopus were searched. The terms were advanced glycation end products (AGEs), medicinal plants, antiglycation products. RESULTS: plants that studied in this review inhibit glycation in several possible mechanisms. Some of these plants inhibit the production of shiff base and amadori products. The others inhibit the generation of amadori products in the advanced phase. Some others blocked the aggregation of AGEs and some plants have antioxidant activity and reduce AGEs formation by preventing oxidation of amadori product and metal-catalyzed glucoxidation. CONCLUSION: This review can help pharmacologist to find antiglycation natural substance that can be useful in treatment of diabetic complications.


Assuntos
Complicações do Diabetes/tratamento farmacológico , Produtos Finais de Glicação Avançada/antagonistas & inibidores , Fitoterapia , Plantas Medicinais/química , Glicosilação , Humanos
20.
Mater Sci Eng C Mater Biol Appl ; 103: 109741, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349480

RESUMO

Wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) biofilm represent a high risk in patients with diabetes. Nitric oxide (NO) has shown promise in dispersing biofilm and wound healing. For an effective treatment of MRSA biofilm-infected wounds, however, NO needs to be supplied to the biofilm matrix in a sustainable manner due to a short half-life and limited diffusion distance of NO. In this study, polyethylenimine/diazeniumdiolate (PEI/NONOate)-doped PLGA nanoparticles (PLGA-PEI/NO NPs) with an ability to bind to the biofilm matrix are developed to facilitate the NO delivery to MRSA biofilm-infected wound. In simulated wound fluid, PLGA-PEI/NO NPs show an extended NO release over 4 days. PLGA-PEI/NO NPs firmly bind to the MRSA biofilm matrix, resulting in a greatly enhanced anti-biofilm activity. Moreover, PLGA-PEI/NO NPs accelerate healing of MRSA biofilm-infected wounds in diabetic mice along with complete biofilm dispersal and reduced bacterial burden. These results suggest that the biofilm-binding NO-releasing NPs represent a promising NO delivery system for the treatments of biofilm-infected chronic wounds.


Assuntos
Antibacterianos/farmacologia , Complicações do Diabetes/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Nanopartículas/química , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Ferimentos e Lesões/tratamento farmacológico , Animais , Antibacterianos/química , Antibacterianos/metabolismo , Compostos Azo/química , Biofilmes/efeitos dos fármacos , Complicações do Diabetes/microbiologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/microbiologia , Liberação Controlada de Fármacos , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos ICR , Óxido Nítrico/farmacocinética , Polietilenoimina/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Infecções Cutâneas Estafilocócicas/complicações , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/microbiologia , Ferimentos e Lesões/patologia
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