RESUMEN
SGLT2 inhibitors are new antihyperglycaemic agents whose ability to lower glucose is directly proportional to GFR. Therefore, in chronic kidney disease (CKD) the blood glucose lowering effect is reduced. Unlike many current therapies, the mechanism of action of SGLT2 inhibitors is independent of insulin action or beta-cell function. In addition, the mechanism of action of SGLT2 inhibitors is complementary and not alternative to other antidiabetic agents. SGLT2 inhibitors could be potentially effective in attenuating renal hyperfiltration and, consequently, the progression of CKD. Moreover, the reductions in intraglomerular pressure, systemic blood pressure, and uric acid levels induced by SGLT inhibition may potentially be of benefit in CKD subjects without diabetes. However, at present, only few clinical studies were designed to evaluate the effects of SGLT2 inhibitors in CKD. Consequently, safety and potential efficacy beyond blood glucose lowering should be better clarified in CKD. In this paper we provide an updated review of the use of SGLT2 inhibitors in clinical practice, with particular attention on subjects with CKD.
Asunto(s)
Hipoglucemiantes/uso terapéutico , Insuficiencia Renal Crónica/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Animales , Canagliflozina/efectos adversos , Canagliflozina/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/fisiopatología , Tasa de Filtración Glomerular , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemiantes/efectos adversos , Insuficiencia Renal Crónica/fisiopatología , Transportador 2 de Sodio-Glucosa , Sorbitol/efectos adversos , Sorbitol/análogos & derivados , Sorbitol/uso terapéuticoRESUMEN
BACKGROUND: Sex hormones and adipokines seem to differently interact in both genders at different ages. AIM: To comparatively evaluate the serum level of adipokines and sex hormones in healthy non-pharmacologically treated premenopausal women, post-menopausal women, and elderly women, and in age-matched men. SUBJECTS: From the historical cohort of the Brisighella Heart Study we selected 199 adult healthy subjects (males: 89; females: 110), aged 62.5±12.4 yr. Men and women included in the age-class subgroups were matched for body mass index (BMI), waist circumference, blood pressure, heart rate, fasting plasma glucose, plasma lipids. RESULTS: Leptin did not differ among various age classes in men, while pre-menopausal women displayed significantly lower serum leptin than post-menopausal women (-6.7 ± 2.2 pg/ml, p=0.036). Post-menopausal women had significantly greater serum leptin when compared with age-matched men (+13.1 ± 2.0 pg/ml, p<0.001); the same was observed for elderly women when compared with elderly men (+11.2 ± 2.3 pg/ml, p<0.001). At any age, women had significantly lower serum testosterone/estrone ratio than age-matched men (p<0.01). Serum DHEAS was inversely proportional to age in both genders. The main predictors of adiponectin level are age in men (p=0.027) and BMI in women (p=0.003). The main predictors of leptin level are BMI and the testosterone/estrone ratio in both sexes (p<0.05). The testosterone/estrone ratio is also the main predictor of ghrelin levels in women (p=0.006). CONCLUSION: Sex hormones and adipokines show specific interactions in the two genders and in different age-classes in a representative sample of adult healthy subjects.
Asunto(s)
Adipoquinas/sangre , Hormonas Esteroides Gonadales/sangre , Posmenopausia/sangre , Premenopausia/sangre , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Leptina/sangre , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores SexualesRESUMEN
High-volume hemofiltration (HVHF) and coupled plasma filtration adsorption (CPFA) have shown potential to improve the treatment of sepsis in animals, but there have been no studies comparing these two treatments in humans. Our aim was to compare the hemodynamic effects of HVHF and CPFA in septic shock patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). We performed a cross-over study enrolling patients with septic shock and AKI who were receiving CRRT. Patients were treated with pulse HVHF and continuous veno-venous hemofiltration (CVV H) on day 1 and CPFA and CVV H on day 2 or vice versa. HVHF was performed for 8-10 hours with a replacement fluid rate of 85 mL/kg/h. CPFA was performed for 8-10 hours with a plasma flow rate of 15%. CVV H was performed for the rest of the day with a replacement fluid rate of 35 mL/kg/h. The primary endpoints were changes in mean arterial pressure, vasopressor requirement (expressed as vasopressor score, VS), and noradrenaline dose after pulse HVHF and CPFA. The two treatments were compared using nonparametric tests. We enrolled 8 patients (median age 70.5 years, SOFA 12.5, SAPS II 69.5). There was a trend towards a reduction in VS with HVHF and CPFA (HVHF p=0.13, CPFA p<0.05). There was no significant difference between the two treatments in terms of percentage change in VS score (p=0.22). The data from this pilot study provide no evidence for a difference in hemodynamic effects between pulse HVHF and CPFA in patients with septic shock already receiving CRRT. A larger sample size is needed to adequately explore this issue.
Asunto(s)
Hemofiltración/métodos , Choque Séptico/terapia , Adsorción , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios ProspectivosRESUMEN
Pasteurella multocida infections can be caused by scratches or bites of many animals including pets. An unrecognized infection can lead to severe complications such as arthritis, osteomyelitis, respiratory infections and even meningitis or endocarditis. We present the case of a woman affected by soft tissue infection caused by Pasteurella multocida complicated by bacteremia and pneumonia.
Asunto(s)
Bacteriemia , Enfermedad por Rasguño de Gato/complicaciones , Infecciones por Pasteurella , Pasteurella multocida , Neumonía Bacteriana , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/etiología , Infecciones Comunitarias Adquiridas , Femenino , Humanos , Ofloxacino/uso terapéutico , Infecciones por Pasteurella/diagnóstico , Infecciones por Pasteurella/tratamiento farmacológico , Pasteurella multocida/aislamiento & purificación , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/etiología , Radiografía Torácica , Factores de Tiempo , Resultado del TratamientoRESUMEN
A school-based nutrition education programme aimed at the control of coronary risk factor rise during childhood was started in 1983 for 150 boys and girls aged 6-7 years. The study was performed in a rural area of central Italy, where adult obesity represents a major health problem. Preventive treatment was based on general health education in schools towards healthy lifestyles. Nutritional intervention was mainly focused on the adoption of the 'prudent diet'. School-teachers received specific training on how to teach 'good nutrition'. The nutrition curriculum was taught by teachers throughout the school year. Several meetings were organised to actively involve the children's parents. Practical recommendations for changes in food selection and preparation were also given. After a five-year follow up, a strong 'tracking phenomenon' for body mass index was observed, suggesting a great stability over time of lifestyles and dietary habits leading to the development of obesity during childhood. We conclude that a school-delivered programme of general nutrition education for the control of risk factors does not appear to be able to control child obesity.