RESUMEN
INTRODUCTION: To assess the intention of actual pregnancy and its influence on glycated hemoglobin (HbA1c) profile before and during the pregnancy of women with previous diabetes mellitus (DM). METHODS: Prospective cohort study included pregnant women with previous DM assisted from October/2018 to October/2019. Data were collected with standardized questionnaire and from medical records. Comparisons of variables of interest (Student's t test, Mann-Whitney or chi-square test) were performed between the group of women who did or denied report having interest to become pregnant. And a logistic regression analysis were performed considering prematurity or fetal/neonatal complication as dependent variables. RESULTS: Sixty patients were included, with HbA1c mean of pre-pregnancy, first and third trimesters of 9.3, 8.1 and 6.8%, respectively. 7.7% women had HbA1c ≤ 6.5% in pre-pregnancy and 16.7% in first trimester. 83.3% reported having received guidance on the importance of glucose control and contraception before their current pregnancy. Although 28.3% reported the intention to become pregnant, only 28.3% reported regular use of any contraceptive method before it, none of which had HbA1c in the recommended goal for pregnancy. Glycemic control did not differ between groups intending or not to become pregnant. Women with adequate glycemic control in first trimester had a lower frequency of prematurity (p = 0.015) and fetal complications (p = 0.001), and better control at the end of pregnancy. DISCUSSION: Although most of these women reported having had information about the importance of a planned pregnancy, adequate glycemic control of women with diabetes before and during the pregnancy is still not a reality nowadays. It might be necessary to improve medical communication in pregnancy planning.
Asunto(s)
Diabetes Mellitus Tipo 1 , Embarazo en Diabéticas , Recién Nacido , Embarazo , Femenino , Humanos , Masculino , Diabetes Mellitus Tipo 1/complicaciones , Hemoglobina Glucada , Control Glucémico , Estudios ProspectivosRESUMEN
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
RESUMEN
Turner Syndrome (TS) is associated with an increased risk of cardiovascular and metabolic complications. Furthermore, TS women need hormone replacement therapy (HRT), of which progestins can influence body weight. We aimed to analyze the metabolic and weight profile in a cohort of 111 TS women. They started receiving estrogen at 15.8 (±3.6) years old, with no change in hypertension, dysglycemia, and dyslipidemia incidence but with a tendency to increase overweight (p = 0.054). As the first used type of progestin, most had received cycles of 10 days per month of medroxyprogesterone (MPA) or levonorgestrel (LNG), then shifted to micronized progesterone (MP), which has currently become the most used one. By multiple linear regression analysis, we found that the prolonged use of MPA, LNG, or MP showed no metabolic change except for weight gain. The percentage of annual BMI increment was positive for all progestins used in TS women (MPA 2.2 ± 2.2; LNG 0.2 ± 1.2; and MP 2.2 ± 2.6 kg/m2), but LNG seemed to best prevent on weight gain over time (p < 0.05). In conclusion, metabolic comorbidities are prevalent in TS even before the HRT regimen, and LNG performed better on less weight gain than MPA and MP in our cohort of the TS population.
Asunto(s)
Agentes Anticonceptivos Hormonales/administración & dosificación , Terapia de Reemplazo de Estrógeno/métodos , Levonorgestrel/administración & dosificación , Síndrome de Turner/tratamiento farmacológico , Aumento de Peso/efectos de los fármacos , Adolescente , Adulto , Índice de Masa Corporal , Agentes Anticonceptivos Hormonales/farmacología , Estudios Transversales , Femenino , Humanos , Levonorgestrel/farmacología , Medroxiprogesterona/administración & dosificación , Medroxiprogesterona/farmacología , Progestinas/administración & dosificación , Progestinas/farmacología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Gonadal sex determination is a complex genetic process by which an embryonic primordium is driven to form an ovary or a testis, which requires a delicate dosage balance involving many genes. Disruption in this molecular pathway can lead to differences of sex development (DSD). Although some genetic mechanisms leading to 46,XY DSD have been elucidated, little is known about copy-number variation (CNV) causing testicular or ovotesticular 46,XX DSD. We describe a 20-year natural history of a man with SRY-negative 46,XX who was born with atypical male external genitalia, aortic coarctation, and bilateral blepharophimosis-ptosis. The molecular study identified a de novo heterozygous 3-Mb 15q26.2 deletion, a gene-poor locus containing NR2F2, which encodes the nuclear receptor COUP-TFII that is highly expressed in ovary and cardiac arteries. Immunohistochemistry confirmed the low COUP-TFII expression on his ovotestis tissue. Monosomy of 15q26.2, encompassing the NR2F2 gene, may act as a Z-factor regulating the male sex determination negatively. This finding supports a novel type of CNV resulting in DSD in an individual who developed male puberty spontaneously.
RESUMEN
CONTEXT: Otitis is common in patients with Turner syndrome (TS) and may be misdiagnosed in the presence of other causes of otalgia. OBJECTIVE: We hypothesized that stylohyoid ligament calcification (SLC), named Eagle syndrome (ES), is a common cause of otalgia in TS. DESIGN: Cohort of 1-year data collection. SETTING: We analyzed all consecutive women with Turner syndrome (TW). PATIENTS: Ninety-six TW and 55 age-paired normal control women (CW). INTERVENTION: Participants were asked about current or past otalgia and had bilateral tonsillar palatine palpated by the same physician. MAIN OUTCOME MEASURES: When otalgia or cervicalgia plus painful palatine tonsil palpation was positive, participants underwent facial X-ray or three-dimensional cranial CT. If SLC was >25 mm, ES was confirmed. RESULTS: Thirty-four TW (35%) had clinical signs and 27/34 (79%) had radiologically confirmed ES. Of the TW with confirmed ES (27/96; 28%), 14 (51.9%) were inadvertently treated for recurrent otitis as a presumed cause of otalgia. Eleven of the TW with ES (26.1%) were below age 21. There was no association with karyotype, age, body mass index, or growth hormone use. Ten CW (18.2%) complained of symptoms of ES, but only 4 (7.3%) were radiologically confirmed (CW vs TW, P < 0.01), and none were <21 years old. ES occurred more at younger ages in TW (P < 0.002). CONCLUSION: ES is more prevalent in TW than in controls and occurs at younger ages. ES must be assessed as a common comorbidity of TS at any age, especially during childhood, as a differential diagnosis of otalgia.
RESUMEN
ABSTRACT Objectives We aimed to measure the quality of life (QoL) of patients with Turner syndrome (PTS) and determine the extent to which their clinical or laboratory alterations influence QoL compared to reference women (RW) of the same age range. Subjects and methods From Dec-2013 to Dec-2014, 90 participants were recruited. They were 18 years and older: 48 with Turner syndrome (TS) (PTS) and 42 without (RW). Recruited subjects completed the Portuguese version of Short Form 36 (SF-36) questionnaire, and blood was drawn to measure LH, FSH, oestradiol (E2), progesterone (P4), SHBG, and SDHEA (by ECLIA) and testosterone (by LC MS/MS). Results Age and schooling were similar between groups. The most common occupations for PTS were health worker, administration and education, and health worker or cashier for RW. Most participants were Catholic or Evangelical. Eighty-one percent (39/48) of cases used Hormonal Replacement Therapy (HRT), mostly transdermal (23/39). RW and PTS scored similarly on the SF-36 questionnaire. RW had higher oestradiol (p = 0,01), lower FSH (p = 0,01) and higher testosterone (p = 0,01) than PTS. Concentrations of P4, LH, SHBG or SDHEA were similar. Significant associations were found among QoL and hormones (E2 with Vitality and LH with Physical Role) only in the PTS group. Conclusions PTS do not consider that TS affects their QoL as measured by domains on the SF-36. Oestradiol was related with QoL, emphasising the importance of HRT.
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Calidad de Vida , Síndrome de Turner/psicología , Terapia de Reemplazo de Hormonas/psicología , Testosterona/sangre , Síndrome de Turner/sangre , Brasil , Estudios de Casos y Controles , Encuestas y Cuestionarios , Estradiol/sangreRESUMEN
OBJECTIVES: We aimed to measure the quality of life (QoL) of patients with Turner syndrome (PTS) and determine the extent to which their clinical or laboratory alterations influence QoL compared to reference women (RW) of the same age range. SUBJECTS AND METHODS: From Dec-2013 to Dec-2014, 90 participants were recruited. They were 18 years and older: 48 with Turner syndrome (TS) (PTS) and 42 without (RW). Recruited subjects completed the Portuguese version of Short Form 36 (SF-36) questionnaire, and blood was drawn to measure LH, FSH, oestradiol (E2), progesterone (P4), SHBG, and SDHEA (by ECLIA) and testosterone (by LC MS/MS). RESULTS: Age and schooling were similar between groups. The most common occupations for PTS were health worker, administration and education, and health worker or cashier for RW. Most participants were Catholic or Evangelical. Eighty-one percent (39/48) of cases used Hormonal Replacement Therapy (HRT), mostly transdermal (23/39). RW and PTS scored similarly on the SF-36 questionnaire. RW had higher oestradiol (p = 0,01), lower FSH (p = 0,01) and higher testosterone (p = 0,01) than PTS. Concentrations of P4, LH, SHBG or SDHEA were similar. Significant associations were found among QoL and hormones (E2 with Vitality and LH with Physical Role) only in the PTS group. CONCLUSIONS: PTS do not consider that TS affects their QoL as measured by domains on the SF-36. Oestradiol was related with QoL, emphasising the importance of HRT.
Asunto(s)
Terapia de Reemplazo de Hormonas/psicología , Calidad de Vida , Síndrome de Turner/psicología , Adolescente , Adulto , Brasil , Estudios de Casos y Controles , Estradiol/sangre , Femenino , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Testosterona/sangre , Síndrome de Turner/sangre , Adulto JovenRESUMEN
Post-menopause hyperandrogenism is a condition that needs careful evaluation. Aromatase inhibitors (AI), which are important in the management of positive estrogen breast cancer, and chronic kidney disease (CKD) can puzzle the evaluation of this condition. A postmenopause female with type-2 diabetes and advanced CKD was attended due to progressive virilization, which has started after the introduction of an AI for breast cancer 5 years earlier. Clinical and radiological investigation has confirmed a pure Leydig cell tumor as source of hyperandrogenism. Re-evaluation of the breast tumor immunohistochemistry has shown positive androgen receptor expression and negative expression for estrogen, progesterone and HER-2 receptors. Even though an ovarian tumor was the source of androgen excess, we discuss that AI could exert a slight contribution to patient's virilization by reducing estradiol counterbalance. Also, although the onset of hyperandrogenic symptoms was unclear, we could not exclude that the ovarian tumor had produced enough androgens to play a role in breast tumor progression. This case report supports the literature regarding the possible association between Leydig cell tumor and androgen-receptor-positive breast cancer development. Finally, progressive hyperandrogenic symptoms in postmenopause, even under AI therapy or the presence of advanced CKD, impose a more detailed investigation.
Asunto(s)
Neoplasias de la Mama/patología , Tumor de Células de Leydig/patología , Neoplasias Ováricas/patología , Anciano , Inhibidores de la Aromatasa/efectos adversos , Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Humanos , Hiperandrogenismo/etiología , Tumor de Células de Leydig/complicaciones , Neoplasias Ováricas/complicaciones , Posmenopausia , Virilismo/etiologíaRESUMEN
Obese men may present hypogonadothrofic hypogonadism, mainly related to higher insulinemia and aromatase activity. Our objectives were to evaluate the relationship of sex-hormones profiles and frequency of depressive symptoms in 43 obese men, in a cross-sectional study. They had 19-60 years, and body mass index 30-50 kg/m(2). LH, total and free testosterone (TT and FT), estradiol (E2), sex hormone binding globulin, estradiol/total testosterone ratio (E2/T) were analyzed. Depressive symptoms were evaluated by "beck depression inventory" (BDI), and significant depression was considered if BDI ≥ 16.Thirty-four (80%) presented low TT levels, but only 4 (14%) had low free testosterone and hypogonadism symptoms; 12 of 43 (28%) presented increased E2. Forty five (56%) presented depressive symptoms, but 16 (28% of the 45) had significant depression. BDI correlated positively with E2 (r = 0.407; p = 0.001) and E2/T (r = 0.473; p = 0.001), but not TT or FT. Patients with significant depressive showed higher levels of estradiol (136 ± 48 versus 103 ± 48 pg/ml, p = 0.02) and E2/T (16.0 ± 9.9 versus 9.8 ± 4.6; p = 0.002) (mean ± SD).In conclusion, obese men may present relatively excess of estradiol and deficiency in testosterone, leading to an imbalance between these two hormones. The greater this imbalance, the more depressive symptoms had our patients.
Asunto(s)
Depresión/etiología , Estradiol/sangre , Obesidad/psicología , Globulina de Unión a Hormona Sexual/análisis , Testosterona/sangre , Adulto , Estudios Transversales , Depresión/sangre , Depresión/fisiopatología , Estradiol/fisiología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/fisiopatología , Escalas de Valoración Psiquiátrica , Globulina de Unión a Hormona Sexual/fisiología , Testosterona/fisiología , Adulto JovenRESUMEN
The aim of this study was to develop new strategies based on virtual reality that can provide additional information to clinicians for the rehabilitation assessment. Virtual reality system Toyra has been used to record kinematic information of 15 patients with cervical spinal cord injury (SCI) while performing evaluation sessions using the mentioned system. Positive correlation, with a moderate and very strong association, has been found between clinical scales and kinematic data, considering only the subscales more closely related to the upper limb function. A set of metrics was defined combining these kinematic data to obtain parameters of reaching amplitude, joint amplitude, agility, accuracy, and repeatability during the evaluation sessions of the virtual reality system Toyra. Strong and moderate correlations have been also found between the metrics reaching and joint amplitude and the clinical scales.
Asunto(s)
Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Extremidad Superior/fisiopatología , Interfaz Usuario-Computador , Adulto , Fenómenos Biomecánicos , Demografía , Femenino , Humanos , Articulaciones/fisiopatología , Masculino , AutocuidadoRESUMEN
Upper limb function impairment is one of the most common sequelae of central nervous system injury, especially in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring small changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We developed a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neuroretation system.
RESUMEN
Pancreas transplantation is an invasive procedure that can restore and maintain normoglycemic level very successfully and for a prolonged period in DM1 patients. The procedure elevates the morbimortality rates in the first few months following the surgery if compared to kidney transplants with living donors, but it offers a better quality of life to patients.Although controversial, several studies have shown the stabilization or the improvement of some of the chronic complications related to diabetes, as well as the extra number of years of life that patients submitted to a double pancreas-kidney transplantation may gain.Recent studies have demonstrated clashing outcomes regarding isolated pancreas transplantations, a fact which reinforces the need for a more discerning selection of patients for this procedure.
RESUMEN
Pancreas and kidney transplants have specific indications, benefits and risks. The procedure has become more common and more often as long-term success has improved and risks have decreased. Compared with a patient being on dialysis, simultaneous pancreas-kidney transplant offers a distinct advantage when it comes to mortality, quality of life and diabetic complications. Since there can be a living-donor kidney transplant,, a possibly similar patient and graft survival by 10 years follow-up, this procedure should be considered. Pancreas after kidney transplants, when successful, can improve microvascular complications compared with kidney transplant alone, but immediate mortality may be higher. Solitary pancreas transplantation can improve the quality of life in selected patients, but it may also increase the immediate risk of mortality due to the complexity of the surgery and the risks of immunosupression. The results of Islet transplantation differ from the higher metabolic performance achieved by whole pancreas allotransplantation and its applicability is limited to selected adult diabetic patients.
Asunto(s)
Diabetes Mellitus Tipo 1/cirugía , Trasplante de Islotes Pancreáticos/métodos , Trasplante de Riñón/métodos , Trasplante de Páncreas/métodos , Adulto , Enfermedad Crónica , Diabetes Mellitus Tipo 1/mortalidad , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/mortalidad , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/mortalidad , Neuropatías Diabéticas/etiología , Neuropatías Diabéticas/mortalidad , Rechazo de Injerto , Humanos , Terapia de Inmunosupresión , Trasplante de Islotes Pancreáticos/efectos adversos , Trasplante de Islotes Pancreáticos/mortalidad , Trasplante de Riñón/efectos adversos , Páncreas/irrigación sanguínea , Trasplante de Páncreas/efectos adversos , Trasplante de Páncreas/mortalidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.
Pancreas and kidney transplants have specific indications, benefits and risks. The procedure has become more common and more often as long-term success has improved and risks have decreased. Compared with a patient being on dialysis, simultaneous pancreas-kidney transplant offers a distinct advantage when it comes to mortality, quality of life and diabetic complications. Since there can be a living-donor kidney transplant,, a possibly similar patient and graft survival by 10 years follow-up, this procedure should be considered. Pancreas after kidney transplants, when successful, can improve microvascular complications compared with kidney transplant alone, but immediate mortality may be higher. Solitary pancreas transplantation can improve the quality of life in selected patients, but it may also increase the immediate risk of mortality due to the complexity of the surgery and the risks of immunosupression. The results of Islet transplantation differ from the higher metabolic performance achieved by whole pancreas allotransplantation and its applicability is limited to selected adult diabetic patients.
Asunto(s)
Adulto , Humanos , Diabetes Mellitus Tipo 1/cirugía , Trasplante de Islotes Pancreáticos/métodos , Trasplante de Riñón/métodos , Trasplante de Páncreas/métodos , Enfermedad Crónica , Diabetes Mellitus Tipo 1/mortalidad , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/mortalidad , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/mortalidad , Neuropatías Diabéticas/etiología , Neuropatías Diabéticas/mortalidad , Rechazo de Injerto , Terapia de Inmunosupresión , Trasplante de Islotes Pancreáticos/efectos adversos , Trasplante de Islotes Pancreáticos/mortalidad , Trasplante de Riñón/efectos adversos , Trasplante de Páncreas/efectos adversos , Trasplante de Páncreas/mortalidad , Páncreas/irrigación sanguínea , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Diabetes mellitus is associated with an increased incidence of cardiovascular events and microvascular complications. Serum amyloid A (SAA), a HDL apolipoprotein is a risk marker for cardiovascular disease. A permanent increase in SAA plasma levels is observed in diabetics. Because SAA acts on leukocytes, we evaluated whether the synthesis of proinflammatory cytokines and migration of neutrophils and monocytes induced by SAA is affected in diabetics. Cells, isolated from human blood, were cultured in the presence of SAA. TNF-alpha, IL-1beta, IL-8 and IL-1ra levels were measured by ELISA in the culture supernatants and in serum of subjects. Neutrophils and monocytes migration were followed in a chemotaxis chamber. We make the novel observation that neutrophils and monocytes of diabetics are more responsive to SAA for the induction of the proinflammatory cytokine IL-1beta and the proangiogenic and chemotactic protein IL-8. Incremental TNF-alpha production was also found to occur when monocytes were stimulated with SAA. Cell migration was also increased. The increased production of cytokines and increased migration of leukocytes from diabetics in response to SAA may contribute to a sustained accumulation and activation of inflammatory cells in the disease. Accordingly, the hyper-responsiveness of leukocytes to SAA may be relevant to the proinflammatory conditions associated to vascular complications in diabetic patients.
Asunto(s)
Angiopatías Diabéticas/etiología , Leucocitos/efectos de los fármacos , Proteína Amiloide A Sérica/farmacología , Adulto , Anciano , Movimiento Celular/efectos de los fármacos , Células Cultivadas , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patología , Femenino , Humanos , Proteína Antagonista del Receptor de Interleucina 1/sangre , Proteína Antagonista del Receptor de Interleucina 1/metabolismo , Interleucina-1beta/sangre , Interleucina-1beta/metabolismo , Interleucina-8/sangre , Interleucina-8/metabolismo , Leucocitos/metabolismo , Leucocitos/patología , Masculino , Persona de Mediana Edad , Modelos Biológicos , Monocitos/efectos de los fármacos , Monocitos/metabolismo , Monocitos/patología , N-Formilmetionina Leucil-Fenilalanina/farmacología , Neutrófilos/efectos de los fármacos , Neutrófilos/metabolismo , Neutrófilos/patología , Proteína Amiloide A Sérica/análisis , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
To evaluate the role of vasopressin (AVP) on blood pressure (BP) in diabetic patients with autonomic neuropathy (AN), 10 patients were studied on a fixed sodium and potassium diet. On days 4 and 7, a 24-h BP monitoring, as well as blood and urine samples for sodium, potassium, creatinine, and osmolality determinations were obtained for every 4-h period; either placebo or an AVP-V1-antagonist (d(CH2)5Tyr(me)AVP; 0.5 mg; AVPi) were given iv at 1 PM. On placebo, systolic BP (SBP) showed a progressive elevation during the day, declining after 12 PM (8 AM to 12 AM 122+/-9; 12 AM to 4 PM 125+/-11; 4 PM to 8 PM 134+/-14; 8 PM to 12 PM 136+/-14; 12 PM to 8 AM 131+/-17 mm Hg). On AVPi this rise in SBP was blunted: 8 AM to 12 AM 125+/-122; 12 AM to 4 PM 121+/-21; 4 PM to 8 PM 126+/-16; 8 PM to 12 PM 129+/-14; 12 PM to 8 AM 124+/-12 mm Hg. Creatinine clearance and diureses were greater during the night, both with placebo and AVPi. Plasma osmolality did not change on either day, although serum sodium decreased after AVPi, reaching the lowest values at 4 PM to 8 PM period (137+/-4.7 v 131+/-3.8 mEq/L; P < .05). With placebo, fractional excretion of sodium (FENa) increased from 0.43%+/-0.32% during 12 h of orthostasis to 0.92%+/-1.05% during 12 h of recumbency (P < .02). With AVPi, the FENa on orthostasis did not differ from that with placebo, although BP values were lower and did not increase with recumbency (0.58+/-0.57 v 0.73%+/-0.49%; NS). In conclusion, our results show that in diabetic patients with AN, vasopressin participates in BP control by stimulating vascular and renal V1 receptors, which results in vasoconstriction and sodium reabsorption.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/fisiología , Ritmo Circadiano/fisiología , Neuropatías Diabéticas/fisiopatología , Vasopresinas/fisiología , Adulto , Aldosterona/sangre , Arginina Vasopresina/administración & dosificación , Arginina Vasopresina/análogos & derivados , Presión Sanguínea/efectos de los fármacos , Femenino , Antagonistas de Hormonas/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Concentración Osmolar , Renina/sangre , Sodio/sangre , Sodio/orina , Vasopresinas/antagonistas & inhibidores , Equilibrio Hidroelectrolítico/efectos de los fármacos , Equilibrio Hidroelectrolítico/fisiologíaRESUMEN
RESUMO - I INFLUÊNCIA DA NEUROPATIA AUTONÔMICA NA DISFUNÇÃO DO VENTRÍCULO ESQUERDO EM DIABÉTICOS INSULINO DEPENDENTES Neste estudo foram analisadas as interrelações entre neuropatia autonômica (NA), o ritmo da pressão arterial (PA) e a disfunção ventricular esquerda em pacientes diabéticos do tipo 1. Dezenove pacientes foram submetidos aos testes para avaliação de neuropatia autonômica, à monitorização ambulatorial da PA por 24 horas e realizaram um ecocardiograma. Os pacientes foram então divididos pela presença (NA+) ou não (NA-) de NA. No grupo NA+ (n=8), a razão E/A ao ecocardiograma foi menor que no grupo NA - (n=11) (1,1ñ0,3 vs. 1,6ñ0,3; pAsunto(s)
Monitores de Presión Sanguínea
, Cardiomiopatías
, Diabetes Mellitus
, Neuropatías Diabéticas
, Vasopresinas
RESUMEN
Context: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease. Objective: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1). Patients: OSAD (n=17)and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 + 8.2 and 13.2 + 5.9 years, respectively) and metabolic control (HbA1c: 6.4 + 1.9 and 6.8 + 1.4 per cent). Main Outcome Measures: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. Results: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 + 2.5 vs. 17.3 + 9.2 mug/min; p<0.05). Nephropathy was detected in 12 per cent of the OSAD (none of them macroproteinuric) and in 39 per cent of the iDM1. The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p<0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29 per cent of the OSAD and in 46 per cent of the iDM1. Conclusions. OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1, the increase in UAE of OSAD was not associated with reductions in GFR.
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Poliendocrinopatías Autoinmunes/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Angiopatías Diabéticas , Distribución Aleatoria , Estudios Retrospectivos , Angiopatías Diabéticas/epidemiologíaRESUMEN
Monitorizaçäo pressórica de 24 horas (MP24h) tem sido usada no estudo de complicaçöes crônicas do diabetes pelo seu potencial de identificar distúrbios nao evidenciáveis às mediçöes ambulatoriais. Comparamos 1) a pressäo arterial (PA) de 24h de 23 indivíduos com diabetes insulino-dependente sem nefropatia (normoalbuminúricos ou "Normo"), com 14 portadores de microalbuminúria ("Micro") e com grupo näo-diabético ("NI") (n=10); 2) parâmetros eco-cardiográficos entre os diabéticos. Além de PA e frequência cardíaca (FC), as cargas sistólicas (percentual de registros de PA sistólica > 140 mmHg no período diurno e >120 mmHg no noturno) e diastólicas (valores de corte: 90 e 80 mmHg) foram obtidas e os descensos noturnos da PA calculados. Os grupos diabéticos näo diferiram quanto à dose de insulina e controle glicêmico. A PA sistólica diurna dos diabéticos foi maior que a dos NI, näo diferindo entre Normo e Micro (119+7 vs 126+8 e 130+8 mmHg; NI, Normo e Micro, respectivamente, p<0,01), padräo este observado também para a PA sistólica noturna (103+7 vs 109+8 e 116+13 mmHg; p<0,05). Näo houve diferença entre os grupos quanto às PA diastólicas. As PA médias diurnas (91+4 vs 98+4 mmHg) e noturnas (76+5 vs 85+9 mmHg) foram menores no NI do que nos Micro (p<0,05). A FC näo diferiu entre os grupos. Todos tiveram queda da PA e FC à noite com o sono. A carga sistólica diurna foi maior nos Micro do que nos NI, näo havendo diferença estatística entre Normo e Micro (Mi=0,8 vs 4,5 e 17,8 por cento; NI, Normo e Micro, p<0,01), embora nítida a tendência dos últimos a cargas mais altas. A carga diastólica diurna foi menor nos NI do que nos Micro, sem diferença entre os grupos diabéticos (Mi=2,3 vs 8,1 e 20,8 por cento; p<0,02). As cargas noturnas dos 3 grupos foram similares. O descenso noturno da PA média dos NI foi maior em comparaçäo com os grupos diabéticos (Mi=20,6 vs 14,8 e 14,8 por cento; p<0,05). O índice de massa de ventrículo esquerdo (MVE), dentro da faixa normal, näo diferiu entre Normo e Micro (82,8+23,6 e 89,5+21,3 g/m2). Näo houve correlaçäo entre albuminúria, descenso noturno e MVE. A MP24h revelou que o estado diabético, independente da presença de nefropatia, se associa a aumento da PA. Nesta amostra näo foi possível separar diabéticos Micro e Normo, usando parâmetros como cargas pressóricas e descenso noturno no PA. A MVE näo mostrou utilidade para reconhecer precocemente o dano renal, se comparada à albuminúria. Outras disfunçöes próprias da doença...
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/etiología , Presión Arterial/fisiología , Albuminuria , Diabetes Mellitus Tipo 1/fisiopatología , Monitoreo Fisiológico/métodos , Nefropatías Diabéticas/fisiopatología , Factores de TiempoRESUMEN
As síndromes poliglandulares auto-imunes (SPAs) caracterizam-se pela associaçäo de duas ou mais endocrinopatias auto-imunes no mesmo indivíduo. A relaçäo cronológica entre o aparecimento das tiroidopatias auto-imunes (moléstia de Basedow Graves e tiroidite de Hashimoto) e do diabetes mellitus tipo I nas SPAs näo está bem estabelecida. A fim de melhor avaliar essa seqüência de eventos, analisamos 44 portadores de diabetes mellitus do tipo I e quadro clínico e/ou laboratorial de outra endocrinopatia ou doença auto-imune associada (SPA), sendo 38 mulheres e seis homens, com idades variando entre 10 e 73 anos. Observamos que nesses pacientes, o diabetes incide predominantemente na quarta década de vida e, em 93 por cento dos casos está associado a uma tiroidopatia auto-imune. A moléstia de Basedow Graves usualmente precede o desenvolvimento do diabetes diferentemente da tiroidite de Hashimoto (p=0,002). Esses dados enfatizam a importância da pesquisa de diabetes mellitus do tipo I em portadores de moléstia de Basedow Graves, assim como da investigaçäo de tiroidite de Hashimoto em portadores de diabetes mellitus do tipo I, através da avaliaçäo da funçao dos órgäos-alvo e/ou verificaçäo de marcadores imunológicos.