RESUMEN
BACKGROUND: Lactobacillus is a genus of Gram-positive non-spore-forming rods usually found in the microbiota of the oral cavity, gastrointestinal tract, and female genitourinary tract. Also, they are commonly used in the food industry as supplements and probiotics. Lactobacilli are normally considered non-pathogenic to the human body, however, under certain circumstances such as immunosuppression, they can cause severe infections, with only a few cases of bacteremia, infective endocarditis, pneumonia, meningitis, and intra-abdominal infections reported. Among these presentations, a pyogenic liver abscess is rather rare. CASE PRESENTATION: We describe the case of a 59-year-old man with a history of diabetes mellitus and multiple abdominal surgeries with the latest being in 2014 presenting with bacteremia and multiple large pyogenic liver abscesses due to Lactobacillus gasseri, which did not appear to be related to the use of probiotics or immunosuppression. CONCLUSIONS: Given the high prevalence of diabetes mellitus and the increased use of probiotics, it is expected that in the future we will see an increase in infections caused by Lactobacilli. Medical management with antibiotics and percutaneous drainage were successful strategies for the treatment of this unusual case of pyogenic liver abscesses and bacteremia caused by Lactobacillus gasseri.
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Bacteriemia/diagnóstico , Lactobacillus gasseri/aislamiento & purificación , Absceso Piógeno Hepático/diagnóstico , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/terapia , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/terapia , Drenaje , Humanos , Lactobacillus gasseri/efectos de los fármacos , Lactobacillus gasseri/patogenicidad , Absceso Piógeno Hepático/complicaciones , Absceso Piógeno Hepático/terapia , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Objective: Diabetes can affect the eye in many ways beyond retinopathy. This study sought to evaluate ocular disease and determine any associations with peripheral neuropathy (PN) or cardiac autonomic neuropathy (CAN) in type 2 diabetes (T2D) and Charcot arthropathy (CA) patients. Design: A total of 60 participants were included, 16 of whom were individuals with T2D/CA, 21 of whom were individuals with T2D who did not have CA, and 23 of whom were healthy controls. Ocular surface evaluations were performed, and cases of dry eye disease (DED) were determined using the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface staining, Schirmer test, and Oculus Keratograph 5M exams. All variables were used to classify DED and ocular surface disorders such as aqueous deficiency, lipid deficiency, inflammation, and ocular surface damage. Pupillary and retinal nerve fiber measurements were added to the protocol in order to broaden the scope of the neurosensory ocular evaluation. PN and CAN were ascertained by clinical examinations involving the Neuropathy Disability Score (for PN) and Ewing's battery (for CAN). Results: Most ocular variables evaluated herein differed significantly between T2D patients and controls. When the controls were respectively compared to patients with T2D and to patients with both T2D and CA, they differed substantially in terms of visual acuity (0.92 ± 0.11, 0.73 ± 0.27, and 0.47 ± 0.26, p=0.001), retinal nerve fiber layer thickness (96.83 ± 6.91, 89.25 ± 10.44, and 80.37 ± 11.67 µm, p=0.03), pupillometry results (4.10 ± 0.61, 3.48 ± 0.88, and 2.75 ± 0.81 mm, p=0.0001), and dry eye symptoms (9.19 ± 11.71, 19.83 ± 19.08, and 24.82 ± 24.40, p=0.03). DED and ocular surface damage also differed between individuals with and without CA, and were associated with PN and CAN. Conclusion: CA was found to be significantly associated with the severity of ocular findings. DED in cases of CA was also associated with PN and CAN. These findings suggest that intrinsic and complex neurosensory impairment in the eyes, peripheral sensory nerves, and the autonomic nervous system are somehow connected. Thus, a thorough ocular evaluation may be useful to highlight neurological complications and the impact of diabetes on ocular and systemic functions and structures.
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Artropatía Neurógena/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Neuropatías Diabéticas/epidemiología , Oftalmopatías/epidemiología , Anciano , Artropatía Neurógena/complicaciones , Brasil/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/etiología , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Retinopatía Diabética/etiología , Síndromes de Ojo Seco/epidemiología , Síndromes de Ojo Seco/etiología , Oftalmopatías/diagnóstico , Oftalmopatías/etiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
SHORT syndrome is a rare developmental disorder frequently associated with growth failure and insulin resistant diabetes mellitus (IRDM). Since GH has a diabetogenic effect, GH therapy has been regarded as a contraindication. We observed a Brazilian girl with SHORT syndrome who received GH therapy from 4 6/12 years of age for SGA short stature. GH dosage was increased from 0.23 to 0.36 mg/kg/week, but statural response to GH therapy remained poor. Her blood HbA1c level, though it remained 5.5-6.0% in childhood, began to elevate with puberty and increased to 9.2% at 10 6/12 years of age, despite the discontinuation of GH therapy at 9 11/12 years of age. Laboratory studies indicated antibody-negative IRDM. She was treated with metformin and canagliflozin (a sodium glucose co-transporter 2 (SGLT2) inhibitor), which ameliorated overt diurnal hyperglycemia and mild nocturnal hypoglycemia and reduced her blood HbA1c around 7%. Whole exome sequencing revealed a de novo heterozygous pathogenic variant (c.1945C>T:p.(Arg649Trp)) in PIK3R1 known as the sole causative gene for SHORT syndrome. Subsequent literature review for patients with molecularly confirmed SHORT syndrome revealed the development of IRDM in 10 of 15 GH-untreated patients aged ≥12 years but in none of three GH-treated and six GH-untreated patients aged ≤10 years. These findings imply a critical role of pubertal development and/or advanced age rather than GH therapy in the development of IRDM, and a usefulness of SGLT2 inhibitor in the treatment of IRDM.
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Diabetes Mellitus/diagnóstico , Trastornos del Crecimiento/complicaciones , Hipercalcemia/complicaciones , Resistencia a la Insulina/fisiología , Enfermedades Metabólicas/complicaciones , Nefrocalcinosis/complicaciones , Brasil , Canagliflozina/administración & dosificación , Niño , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/metabolismo , Quimioterapia Combinada , Femenino , Trastornos del Crecimiento/diagnóstico , Trastornos del Crecimiento/tratamiento farmacológico , Trastornos del Crecimiento/metabolismo , Hormona de Crecimiento Humana/administración & dosificación , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/tratamiento farmacológico , Hipercalcemia/metabolismo , Enfermedades Metabólicas/diagnóstico , Enfermedades Metabólicas/tratamiento farmacológico , Enfermedades Metabólicas/metabolismo , Metformina/administración & dosificación , Nefrocalcinosis/diagnóstico , Nefrocalcinosis/tratamiento farmacológico , Nefrocalcinosis/metabolismo , Pubertad/efectos de los fármacos , Pubertad/metabolismo , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificaciónRESUMEN
Introducción: La COVID-19 se ha caracterizado por un amplio espectro de manifestaciones y formas clínicas que comprenden desde enfermedad ligera hasta la muerte. Es de suma importancia identificar a aquellos con mayores probabilidades de desarrollar las complicaciones. Objetivo: Identificar factores de riesgo para desarrollar complicaciones en los pacientes atendidos con la COVID-19. Métodos: Fueron revisadas las 250 historias clínicas de pacientes ingresados por la COVID-19. Se recopilaron edad, sexo, antecedentes patológicos personales, exámenes de laboratorio y la presencia o no de complicaciones. Se utilizó ji cuadrado para identificar relación entre las complicaciones y el sexo. Fue calculado el Odds Ratio (OR) para complicaciones por grupos de edad, antecedentes patológicos personales y parámetros humorales. Resultados: El distrés respiratorio fue más frecuente en hombres (p = 0,023). Los grupos de edad más afectados fueron de 60 a 79 años y de 80 años y más (OR = 4,85 y 30,53 respectivamente). Fueron factores de riesgo los antecedentes de hipertensión arterial, cardiopatía isquémica, diabetes mellitus, insuficiencia renal crónica y demencia (OR = 4,48; 4,22; 8,75; 17,98 y 10,39 respectivamente). Predispusieron a complicaciones, hematocrito y linfocitos bajo, así como neutrófilos, glucemia, creatinina, ASAT, GGT y LDH altos. Conclusiones: El mayor riesgo de complicaciones lo tuvieron pacientes mayores de 60 años, con enfermedades cardiovasculares, diabetes mellitus, insuficiencia renal y demencia. La presencia de hematocrito y linfocitos bajo, o neutrófilos, glucemia, creatinina, ASAT, GGT y LDH altos, alerta sobre posibles complicaciones(AU)
Introduction: COVID-19 has been characterized by a wide spectrum of manifestations and clinical forms that range from mild illness to death. Identifying those most likely to develop complications is critical. Objective: To identify risk factors for developing complications in patients treated with COVID-19. Methods: 250 medical records of patients admitted for COVID-19 were reviewed. Age, sex, personal pathological history, laboratory tests and the presence or absence of complications were collected. Chi-square was used to identify the relationship between complications and sex. The Odds Ratio (OR) was calculated for complications by age groups, personal pathological history, and humoral parameters. Results: Respiratory distress was more frequent in men (p=0.023). The most affected age groups were 60 to 79 years and 80 years and over (OR=4.85 and 30.53 respectively). Risk factors were the history of arterial hypertension, ischemic heart disease, diabetes mellitus, chronic kidney insufficiency and dementia (OR=4.48, 4.22, 8.75, 17.98 and 10.39 respectively). Low hematocrit and lymphocytes were predisposed to complications, as well as high neutrophils, glycaemia, creatinine, ASAT, GGT and LDH. Conclusions: The highest risk of complications was in patients older than 60 years, with cardiovascular diseases, diabetes mellitus, kidney insufficiency and dementia. The presence of low hematocrit and lymphocytes, or high neutrophils, glycaemia, creatinine, ASAT, GGT and LDH, alerts you to possible complications(AU)
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Humanos , Factores de Riesgo , Isquemia Miocárdica/complicaciones , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Insuficiencia Renal Crónica/complicaciones , HipertensiónRESUMEN
Background and objectives: Diabetes mellitus (DM) stands out among the most important public health problems worldwide since it represents a high burden on health systems and is associated with higher hospitalization rates, and a higher incidence of cardiovascular diseases. Amputations are among the most common complications, leading to disability and increasing care costs. This research aims to analyze the prevalence of DM-related amputations, comorbidities and associated risk factors in the diabetic population residing in the State of Espírito Santo, Brazil. Materials and Methods: This is a quantitative, exploratory, cross-sectional study with a time series design and the use of secondary data registered and followed by the system of Registration and Monitoring of Hypertension and Diabetes-SisHiperdia. Results: The sample consisted of 64,196 diabetic patients, out of them, 3.9% had type 1 DM, 10.9% with type 2 DM, and 85.2% with DM coexisting with hypertension. Most were female (66.6%), aged 40 to 59 years (45.6%), and 60 years and older (45.2%). The prevalence of DM-related amputations in the analyzed sample was 1.2% in type 1 DM, 1.5% in type 2 DM, and 2.2% in concomitant DM and hypertension. Higher amputation rates were observed in males in the age group above 60 years in type 1 DM and type 2 DM and were slightly higher in the age groups up to 29 years in DM with hypertension. A higher prevalence of amputation was related to smoking, physical inactivity, acute myocardial infarction (AMI), stroke, chronic kidney disease (CKD), and diabetic foot (DF) in all types of DM. Conclusions: The present study showed a significant prevalence of DM-related amputations. An increased prevalence was evidenced when correlated with smoking, physical inactivity, AMI, stroke, CKD, and DF with significant statistical associations, except for a sedentary lifestyle in type 1 DM.
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Amputación Quirúrgica/estadística & datos numéricos , Complicaciones de la Diabetes/diagnóstico , Adolescente , Adulto , Anciano , Amputación Quirúrgica/efectos adversos , Amputación Quirúrgica/métodos , Brasil/epidemiología , Distribución de Chi-Cuadrado , Estudios Transversales , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios RetrospectivosRESUMEN
INTRODUCTION: Tuberculosis and diabetes comorbidity remains a challenge for global public health. OBJECTIVE: To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. METHODS: This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. RESULTS: We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). CONCLUSION: The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.
INTRODUÇÃO: A comorbidade tuberculose e diabetes ainda continua um desafio para a saúde pública mundial. OBJETIVO: Analisar o perfil sociodemográfico e as características do diagnóstico e tratamento dos casos de tuberculose com e sem diabetes no Brasil. MÉTODOS: Estudo transversal, com dados do Sistema de Informação de Agravos de Notificação e do Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica, no período de 2007 a 2011. Modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência (RP) e seus respectivos intervalos de confiança. RESULTADOS: A comorbidade estudada foi encontrada em 7,2% dos casos. Modelo hierárquico mostrou maior RP entre indivíduos do sexo feminino (RP = 1,31; intervalo de confiança de 95% - IC95% 1,27 - 1,35); maior associação nas faixas etárias 40-59 anos e ≥ 60 anos (RP = 11,70; IC95% 10,21 - 13,39 e RP = 17,49; IC95% 15,26-20,05) e com resultado positivo da baciloscopia - primeira amostra (RP = 1,40; IC95% 1,35 - 1,47). Reingresso após abandono e abandono foram inversamente associados na comorbidade (RP = 0,66; IC95% 0,57 - 0,76 e RP = 0,79; IC95% 0,72 - 0,87). CONCLUSÃO: Os achados, como a relação inversa do abandono ao tratamento da tuberculose no grupo das pessoas com comorbidade, reforçam a importância de ações integradas nos serviços para mudar o cenário dessa desafiadora comorbidade.
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Complicaciones de la Diabetes/epidemiología , Tuberculosis/complicaciones , Tuberculosis/epidemiología , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Niño , Preescolar , Comorbilidad , Estudios Transversales , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/terapia , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Distribución por Sexo , Factores Socioeconómicos , Tuberculosis/diagnóstico , Tuberculosis/terapia , Adulto JovenRESUMEN
OBJECTIVE: To analyze the characteristics of patients with hypertension and/or diabetes mellitus from Primary Healthcare units. METHODS: This is a retrospective study, with data collected from December 2014 of patients with hypertension and/or diabetes from 13 Primary Healthcare units located in the Southern region of Sao Paulo (SP, Brazil). Patients were compared by sex, diagnosis and cardiovascular risk using student t test, one way analysis of variance (ANOVA), and Mann-Whitney, Kruskal-Wallis and χ2 tests. RESULTS: We evaluated 28,496 patients aged 20 years to 79 years (mean of 57.8 years). Most of patients were women (63.2%) and aged 50 years old or older (74.2%). The participation in the Programa Remédio em Casa (Medicine at Home Program) was higher among women (12.7%), and the proportions of hypertension, diabetes and both diseases were 68.0%, 7.9% and 24.1%, respectively. Patients with hypertension and diabetes had higher participation in Medicine at Home Program (13.3%), and those with diabetes only had higher participation in Programa de Automonitoramento Glicêmico (Self-Monitoring Glucose Program) (20.0%). The proportions of low, moderate, and high cardiovascular risk were 33.0%, 15.5%, and 51.5%, respectively. CONCLUSION: The sample of this study consisted of patients who were mostly women, aged 50 years or older and diagnosed with hypertension. Almost a quarter of patients also had diabetes and approximately one third and half of them were classified as low and high cardiovascular risk.
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Diabetes Mellitus/epidemiología , Hipertensión/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Brasil/epidemiología , Enfermedades Cardiovasculares/complicaciones , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Femenino , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Adulto JovenRESUMEN
ABSTRACT Objective To analyze the characteristics of patients with hypertension and/or diabetes mellitus from Primary Healthcare units. Methods This is a retrospective study, with data collected from December 2014 of patients with hypertension and/or diabetes from 13 Primary Healthcare units located in the Southern region of Sao Paulo (SP, Brazil). Patients were compared by sex, diagnosis and cardiovascular risk using student t test, one way analysis of variance (ANOVA), and Mann-Whitney, Kruskal-Wallis and χ2 tests. Results We evaluated 28,496 patients aged 20 years to 79 years (mean of 57.8 years). Most of patients were women (63.2%) and aged 50 years old or older (74.2%). The participation in the Programa Remédio em Casa (Medicine at Home Program) was higher among women (12.7%), and the proportions of hypertension, diabetes and both diseases were 68.0%, 7.9% and 24.1%, respectively. Patients with hypertension and diabetes had higher participation in Medicine at Home Program (13.3%), and those with diabetes only had higher participation in Programa de Automonitoramento Glicêmico (Self-Monitoring Glucose Program) (20.0%). The proportions of low, moderate, and high cardiovascular risk were 33.0%, 15.5%, and 51.5%, respectively. Conclusion The sample of this study consisted of patients who were mostly women, aged 50 years or older and diagnosed with hypertension. Almost a quarter of patients also had diabetes and approximately one third and half of them were classified as low and high cardiovascular risk.
RESUMO Objetivo Analisar as características de pacientes com hipertensão arterial e/ou diabetes mellitus de unidades de Atenção Primária à Saúde. Métodos Estudo retrospectivo, com dados de dezembro de 2014 de pacientes com hipertensão e/ou diabetes, de 13 unidades de Atenção Primária à Saúde localizadas na região sul da cidade de São Paulo (SP). Os pacientes foram comparados por sexo, diagnósticos e risco cardiovascular, por meio dos testes t de Student, análise de variância de um fator, Mann-Whitney, Kruskal-Wallis e χ2. Resultados Foram avaliados 28.496 pacientes, de 20 anos a 79 anos de idade (média de 57,8 anos), sendo a maioria do sexo feminino (63,2%) e com 50 anos ou mais de idade (74,2%). A participação no Programa Remédio em Casa foi maior no sexo feminino (12,7%) e as proporções de hipertensão, diabetes e de ambas as doenças foram de 68,0%, 7,9% e 24,1%, respectivamente. Os pacientes com hipertensão e diabetes apresentaram maior proporção de participação no Programa Remédio em Casa (13,3%) e aqueles com apenas diabetes apresentaram maior proporção de participação no Programa de Automonitoramento Glicêmico (20,0%). As proporções de risco cardiovascular baixo, moderado e alto foram de 33,0%, 15,5% e 51,5%, respectivamente. Conclusão A amostra deste estudo foi constituída por pacientes em sua maioria do sexo feminino, com 50 anos ou mais de idade e diagnóstico de hipertensão. Cerca de um quarto dos pacientes apresentava também diabetes e aproximadamente um terço e metade deles foram categorizados como risco cardiovascular baixo e alto, respectivamente.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Adulto Joven , Atención Primaria de Salud/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Hipertensión/epidemiología , Brasil/epidemiología , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Enfermedades Cardiovasculares/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Distribución por Edad , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/sangre , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Persona de Mediana EdadRESUMEN
RESUMO: Introdução: A comorbidade tuberculose e diabetes ainda continua um desafio para a saúde pública mundial. Objetivo: Analisar o perfil sociodemográfico e as características do diagnóstico e tratamento dos casos de tuberculose com e sem diabetes no Brasil. Métodos: Estudo transversal, com dados do Sistema de Informação de Agravos de Notificação e do Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica, no período de 2007 a 2011. Modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência (RP) e seus respectivos intervalos de confiança. Resultados: A comorbidade estudada foi encontrada em 7,2% dos casos. Modelo hierárquico mostrou maior RP entre indivíduos do sexo feminino (RP = 1,31; intervalo de confiança de 95% - IC95% 1,27 - 1,35); maior associação nas faixas etárias 40-59 anos e ≥ 60 anos (RP = 11,70; IC95% 10,21 - 13,39 e RP = 17,49; IC95% 15,26-20,05) e com resultado positivo da baciloscopia - primeira amostra (RP = 1,40; IC95% 1,35 - 1,47). Reingresso após abandono e abandono foram inversamente associados na comorbidade (RP = 0,66; IC95% 0,57 - 0,76 e RP = 0,79; IC95% 0,72 - 0,87). Conclusão: Os achados, como a relação inversa do abandono ao tratamento da tuberculose no grupo das pessoas com comorbidade, reforçam a importância de ações integradas nos serviços para mudar o cenário dessa desafiadora comorbidade.
ABSTRACT: Introduction: Tuberculosis and diabetes comorbidity remains a challenge for global public health. Objective: To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. Methods: This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. Results: We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). Conclusion: The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Tuberculosis/complicaciones , Tuberculosis/epidemiología , Complicaciones de la Diabetes/epidemiología , Factores Socioeconómicos , Tuberculosis/diagnóstico , Tuberculosis/terapia , Brasil/epidemiología , Comorbilidad , Prevalencia , Estudios Transversales , Distribución por Sexo , Distribución por Edad , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/terapia , Persona de Mediana EdadRESUMEN
OBJECTIVES: Explore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control. DESIGN: Cross-sectional study. SETTING: Data from the Chilean Health National Survey 2009-2010. PARTICIPANTS: Regular users of primary care services aged 15 or older. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression. RESULTS: 3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8-12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients. CONCLUSIONS: Continuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.
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Continuidad de la Atención al Paciente/estadística & datos numéricos , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Hipertensión/terapia , Atención Primaria de Salud , Factores de Edad , Anciano , Chile , Estudios Transversales , Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Escolaridad , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Examen Físico , Factores SexualesRESUMEN
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).
Asunto(s)
Complicaciones de la Diabetes/complicaciones , Hipertrigliceridemia/etiología , Xantomatosis/etiología , Xantomatosis/patología , Adulto , Biopsia , Dermoscopía , Complicaciones de la Diabetes/diagnóstico , Humanos , Masculino , Piel/patología , Xantomatosis/diagnóstico por imagenRESUMEN
Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatías Diabéticas/diagnóstico , Cardiopatías/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/mortalidad , Enfermedades del Sistema Nervioso Autónomo/terapia , Muerte Súbita , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Neuropatías Diabéticas/mortalidad , Neuropatías Diabéticas/terapia , Cardiopatías/mortalidad , Cardiopatías/terapia , Humanos , Pronóstico , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate the predictive value of epicardial fat thickness (EFT) in CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) score risk groups. METHODS: A total of 158 consecutive patients (75 females, 83 males, mean age 70.8±6.3 years) admitted routinely for cardiologic control were divided into two groups according to their CHA2DS2-VASc scores (scores 0 and 1 were regarded as low risk, and score ≥2 as high risk). One hundred twenty-five of 158 patients had a high-risk score. RESULTS: Mean EFT was significantly higher in the high-risk group than in the low-risk group (4.34±0.62 vs. 5.37±1.0; P<0.001). EFT was positively correlated with CHA2DS2-VASc score (r=0.577, P<0.001). According to receiver operating characteristics (ROC) analysis, EFT value of 4.4 mm was found to be predictive of high risk in CHA2DS2-VASc score with 80% of sensitivity and 79% of specificity (C-statistic = 0.875, P<0.001, 95% confidence interval [CI] = 0.76-0.90). And according to multivariate logistic regression analysis, EFT was an independent predictor of high thromboembolic risk in terms of CHA2DS2-VASc score. CONCLUSION: Our findings suggest that echocardiographic EFT measurement could provide additional information on assessing cardiovascular risks, such as thromboembolic events, and individuals with increased EFT should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.
Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/patología , Enfermedades Cardiovasculares/etiología , Ecocardiografía/métodos , Pericardio/diagnóstico por imagen , Pericardio/patología , Medición de Riesgo/métodos , Factores de Edad , Anciano , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/patología , Complicaciones de la Diabetes/diagnóstico , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/diagnóstico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Factores Sexuales , Estadísticas no Paramétricas , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnósticoRESUMEN
Abstract Objective: To evaluate the predictive value of epicardial fat thickness (EFT) in CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) score risk groups. Methods: A total of 158 consecutive patients (75 females, 83 males, mean age 70.8±6.3 years) admitted routinely for cardiologic control were divided into two groups according to their CHA2DS2-VASc scores (scores 0 and 1 were regarded as low risk, and score ≥2 as high risk). One hundred twenty-five of 158 patients had a high-risk score. Results: Mean EFT was significantly higher in the high-risk group than in the low-risk group (4.34±0.62 vs. 5.37±1.0; P<0.001). EFT was positively correlated with CHA2DS2-VASc score (r=0.577, P<0.001). According to receiver operating characteristics (ROC) analysis, EFT value of 4.4 mm was found to be predictive of high risk in CHA2DS2-VASc score with 80% of sensitivity and 79% of specificity (C-statistic = 0.875, P<0.001, 95% confidence interval [CI] = 0.76-0.90). And according to multivariate logistic regression analysis, EFT was an independent predictor of high thromboembolic risk in terms of CHA2DS2-VASc score. Conclusion: Our findings suggest that echocardiographic EFT measurement could provide additional information on assessing cardiovascular risks, such as thromboembolic events, and individuals with increased EFT should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Pericardio/patología , Pericardio/diagnóstico por imagen , Ecocardiografía/métodos , Enfermedades Cardiovasculares/etiología , Tejido Adiposo/patología , Tejido Adiposo/diagnóstico por imagen , Enfermedades Cardiovasculares/patología , Enfermedades Cardiovasculares/diagnóstico por imagen , Modelos Logísticos , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/diagnóstico , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Factores de Edad , Estadísticas no Paramétricas , Accidente Cerebrovascular/complicaciones , Complicaciones de la Diabetes/diagnóstico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Hipertensión/complicaciones , Hipertensión/diagnósticoRESUMEN
SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.
RESUMO Diabetes é uma das mais frequentes patologias crônicas em todo o mundo, cujo tratamento envolve uma equipe multidisciplinar, médicos generalistas, endocrinologistas, cardiologistas, nefrologistas e oftalmologistas. Pacientes com diabetes mellitus tipo 2 (DMT2) podem apresentar neuropatia autonômica cardíaca (NAC), levando a aumento de mortalidade e morbidade. Nesta revisão, apresentaremos atuais conceitos, características clínicas, diagnóstico, prognóstico e possíveis tratamentos. Novas drogas recentemente desenvolvidas para redução de níveis glicêmicos apresentaram efeito pleiotrópico de redução de morte súbita, sugerindo um potencial uso neste perfil de pacientes.
Asunto(s)
Humanos , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatías Diabéticas/diagnóstico , Cardiopatías/diagnóstico , Pronóstico , Enfermedades del Sistema Nervioso Autónomo/mortalidad , Enfermedades del Sistema Nervioso Autónomo/terapia , Factores de Riesgo , Muerte Súbita , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Neuropatías Diabéticas/mortalidad , Neuropatías Diabéticas/terapia , Cardiopatías/mortalidad , Cardiopatías/terapiaAsunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Ectromelia/diagnóstico , Enfermedades Fetales/diagnóstico , Sindactilia/diagnóstico , Tibia/anomalías , Complicaciones de la Diabetes/diagnóstico , Ecocardiografía , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Embarazo en Diabéticas , Adulto JovenAsunto(s)
Achromobacter denitrificans/aislamiento & purificación , Bacteriemia/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Infecciones por Bacterias Gramnegativas/diagnóstico , Absceso Hepático/diagnóstico , Cirrosis Hepática/complicaciones , Bacteriemia/etiología , Complicaciones de la Diabetes/etiología , Resultado Fatal , Infecciones por Bacterias Gramnegativas/etiología , Humanos , Absceso Hepático/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
Tuberculosis (TB) and diabetes mellitus Type 2 (DM2) are two diseases as ancient as they are harmful to human health. The outcome for both diseases in part depends on immune and metabolic individual responses. DM2 is increasing yearly, mainly due to environmental, genetic and lifestyle habits. There are multiple evidence that DM2 is one of the most important risk factor of becoming infected with TB or reactivating latent TB. Mass spectrometry-based metabolomics is an important tool for elucidating the metabolites and metabolic pathways that influence the immune responses to M. tuberculosis infection during diabetes. We provide an up-to-date review highlighting the importance and benefit of metabolomics for identifying biomarkers as candidate molecules for diagnosis, disease activity or prognosis.
Asunto(s)
Complicaciones de la Diabetes/metabolismo , Diabetes Mellitus Tipo 2 , Metabolómica , Mycobacterium tuberculosis , Tuberculosis , Biomarcadores/metabolismo , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/microbiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/microbiología , Humanos , Pronóstico , Factores de Riesgo , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Tuberculosis/metabolismoRESUMEN
PURPOSE: We aimed to investigate biomarkers and predictive factors for visual and anatomical outcome in patients with naïve diabetic macular edema (DME) who underwent small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling as a first line treatment. DESIGN: Multicenter, retrospective, interventional study. PARTICIPANTS: 120 eyes from 120 patients with naïve DME treated with PPV and ILM peeling with a follow up of 24 months. METHODS: Change in baseline best corrected visual acuity (BCVA) and central subfoveal thickness (CST) 1, 6, 12 and 24 months after surgery. Predictive value of baseline BCVA, CST, optical coherence tomography (OCT) features (presence of subretinal fluid (SRF) and photoreceptor damage), and time between DME diagnosis and surgery. Additional treatment for DME needed. Intra- and post-operative complications (cataract rate formation, increased intraocular pressure). MAIN OUTCOME MEASURES: The correlation between baseline characteristics and BCVA response (mean change from baseline; categorized improvement ≥5 or ≥10; Early Treatment Diabetic Retinopathy Study (ETDRS) letters) 12 and 24 months after surgery. RESULTS: Mean BCVA was 0.66 ± 0.14 logMAR, 0.52 ± 0.21 logMAR, and 0.53 ± 0.21 logMAR (p<0.001) at baseline, 12 and 24 months, respectively. Shorter time from DME diagnosis until PPV (OR: 0.98, 95% CI: 0.97-0.99, p<0.001) was a predictor for good functional treatment response (area under the curve 0.828). For every day PPV is postponed, the patient's chances to gain ≥5 letters at 24 months decrease by 1.8%. Presence of SRF was identified as an anatomical predictor of a better visual outcome, (OR: 6.29, 95% CI: 1.16-34.08, p = 0.033). Safety profile was acceptable. CONCLUSIONS: Our results reveal a significant functional and anatomical improvement of DME 24 months after primary PPV, without the need for additional treatment. Early surgical intervention and presence of SRF predict good visual outcome. These biomarkers should be considered when treatment is chosen.