RESUMO
BACKGROUND: We aimed to assess the long-term outcomes of biliopancreatic diversion (BPD) surgery on glycemic control, insulin sensitivity (IS), and beta cell function using complementary oral and intravenous dynamic tests. METHODS: A total of 57 women were divided into three groups: 19 lean, 18 obese (both groups with normal glucose tolerance (NGT)), and 20 obese with type 2 diabetes who underwent BPD and were reassessed 12 months after the procedure. OGTTs and hyperglycemic clamps (HG) were performed. Mathematical modeling was used to analyze IS, beta cell function, and delayed time of beta cell response. The basal, dynamic (first phase/steps of insulin secretion), and static (second phase/steps of insulin secretion) disposition indexes were calculated. RESULTS: After surgery, the patients exhibited improvements in glycemic control and 15 patients achieved diabetes remission. The surgical patients demonstrated normalized IS in OGGT and HG tests compared to the control groups. The basal beta cell function was improved but remained impaired compared to the Lean NGT group. The stimulated beta cell function parameters showed marked improvements regarding the intravenous stimulus and the second phase/distal steps of insulin secretion. The delay time markedly decreased and became normalized in both dynamic tests. CONCLUSIONS: The common physiopathology features of type 2 diabetes, i.e., impaired IS and beta cell dysfunction, were demonstrated to be primarily functional and were likely to be reversible to some degree after the BPD. The marked long-term improvement in glycemic control after BPD was closely related to IS improvement and mainly by the recovery of several beta cell physiological features.
Assuntos
Desvio Biliopancreático , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/cirurgia , Resistência à Insulina/fisiologia , Células Secretoras de Insulina/metabolismo , Obesidade/cirurgia , Adulto , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Glucose/metabolismo , Teste de Tolerância a Glucose , Humanos , Insulina/metabolismo , Pessoa de Meia-Idade , Obesidade/metabolismoRESUMO
OBJECTIVE: Accumulation of epicardial (EAT) adipose tissue is associated with the development of an unfavorable metabolic risk profile. Gold standard methods used to assess this fat depot are not routinely applicable in the clinic. Anthropometric measures, including the sagittal abdominal diameter (SAD), have emerged as surrogate markers of visceral obesity. We determined the relationship between EAT measurement and cardiometabolic risk parameters and the potential use of the SAD, compared with other anthropometric parameters, as a practical estimation of EAT. MATERIALS/METHODS: Sixty-seven premenopausal women were evaluated. The anthropometric parameters that were measured included waist circumference, SAD, body mass index and waist-to-hip ratio. EAT was determined by echocardiogram. Visceral adipose tissue (VAT) was determined by abdominal ultrasound. Insulin sensitivity was assessed by the hyperglycemic clamp. RESULTS: The accumulation of EAT was correlated with impaired insulin sensitivity and decreased adiponectin. All of the anthropometric measurements were correlated with EAT. Interestingly, EAT was most significantly correlated with the SAD. From the ROC analysis, we found that the SAD measurements were very accurate, presenting the highest area under the curve for EAT (0.81; p<0.01) when compared with the other measurements. In the multiple linear regression analysis, EAT was moderately predicted by the SAD (R²=0.25; p<0.001). CONCLUSION: SAD, a simple anthropometric measure, accurately estimated EAT and thus represents a clinically useful non-invasive marker that can identify patients with EAT accumulation.
Assuntos
Abdome/patologia , Tecido Adiposo Branco/patologia , Adiposidade , Obesidade/patologia , Pericárdio/patologia , Abdome/diagnóstico por imagem , Adiponectina/sangue , Tecido Adiposo Branco/diagnóstico por imagem , Adulto , Biomarcadores , Índice de Massa Corporal , Tamanho Corporal , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Resistência à Insulina , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/patologia , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/diagnóstico por imagem , Obesidade Abdominal/sangue , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/diagnóstico por imagem , Obesidade Abdominal/patologia , Pericárdio/diagnóstico por imagem , Valor Preditivo dos Testes , Pré-Menopausa , Curva ROCRESUMO
Jaundice related to thyrotoxicosis and not as an effect of antithyroid drugs is a rare complication that usually occurs in the presence of heart failure (HF) or hepatitis. We report a case of a 54-year-old white woman with hyperthyroidism caused by Graves's disease and jaundice despite methimazole suspension. Bilirubin fluctuated at high values, between 30.0 and 52.3 mg/dL, transaminases were slightly increased, on admission ALT = 46 U/L and AST = 87 U/L; coagulation indices and serum proteins were on the lower limit of the normal range with PT 68% and albumin = 2.5 g/dL. Serology for hepatitis was negative. After the first radioiodine therapy (RT), bilirubin reached its maximum, which coincided with the worst period of HF exacerbation. Bilirubin normalized 4 weeks after the second RT, with the stabilization of HF and normalization of thyroid hormones. We discuss the possible etiologies of severe jaundice in hyperthyroid patients, as well as the difficult anticoagulant therapy with warfarin.
Assuntos
Cardiomiopatias/complicações , Icterícia/etiologia , Trombose/complicações , Tireotoxicose/complicações , Antitireóideos/uso terapêutico , Feminino , Átrios do Coração , Humanos , Metimazol/uso terapêutico , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tireotoxicose/tratamento farmacológicoRESUMO
Icterícia relacionada à tireotoxicose, e não como efeito das drogas antitireoidianas, é uma complicação rara que, em geral, ocorre na presença de insuficiência cardíaca (IC) ou hepatite. Apresentamos o caso de mulher de 54 anos de idade, branca, diagnóstico de hipertireoidismo por doença de Graves com icterícia associada a despeito da suspensão prévia de metimazol. A bilirrubina oscilava em valores elevados entre 30,0 e 52,3 mg/dL, as transaminases eram pouco elevadas com valores de ALT, na admissão, de 46 U/I e AST de 87 U/I; coagulograma e proteínas encontravam-se no limite inferior da normalidade, sendo TAP 68% e albumina = 2,5 g/dL. Sorologias para hepatites foram negativas. Após a primeira dose de radioiodoterapia (RT), a bilirrubina atingiu seu valor máximo, que coincidiu com período de pior exacerbação da IC. A bilirrubina normalizou-se após quatro semanas da segunda dose de RT com a estabilização da IC e a normalização dos hormônios tireoidianos. Discutimos as possíveis etiologias de icterícia severa em pacientes hipertireoideos, assim como a difícil terapia anticoagulante com varfarina.
Jaundice related to thyrotoxicosis and not as an effect of antithyroid drugs is a rare complication that usually occurs in the presence of heart failure (HF) or hepatitis. We report a case of a 54-year-old white woman with hyperthyroidism caused by Graves's disease and jaundice despite methimazole suspension. Bilirubin fluctuated at high values, between 30.0 and 52.3 mg/dL, transaminases were slightly increased, on admission ALT = 46 U/L and AST = 87 U/L; coagulation indices and serum proteins were on the lower limit of the normal range with PT 68% and albumin = 2.5 g/dL. Serology for hepatitis was negative. After the first radioiodine therapy (RT), bilirubin reached its maximum, which coincided with the worst period of HF exacerbation. Bilirubin normalized 4 weeks after the second RT, with the stabilization of HF and normalization of thyroid hormones. We discuss the possible etiologies of severe jaundice in hyperthyroid patients, as well as the difficult anticoagulant therapy with warfarin.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Cardiomiopatias/complicações , Icterícia/etiologia , Trombose/complicações , Tireotoxicose/complicações , Antitireóideos/uso terapêutico , Átrios do Coração , Metimazol/uso terapêutico , Índice de Gravidade de Doença , Tireotoxicose/tratamento farmacológicoRESUMO
The TyG index was evaluated as a surrogate method for estimation of insulin resistance (IR). TyG index correlated with adiposity, metabolic and atherosclerosis markers related to IR and presented a moderate degree of agreement with hyperglycemic clamp. TyG index represents an accessible tool for assessment of IR in clinical practice.
Assuntos
Glicemia/metabolismo , Jejum/sangue , Técnica Clamp de Glucose , Triglicerídeos/sangue , Adiposidade/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Apresentamos o caso de um paciente com baqueteamento digital e artrite que foi diagnosticado como tendo osteoartropatia hipertrófica primária. Essa é uma doença rara e benigna. Entretanto, artralgia e alterações cutâneas podem reduzir significativamente a qualidade de vida do paciente. Além de um breve resumo da doença, apresentamos o caso e a revisão da literatura, enfatizando o tratamento dessa condição para os clínicos em geral.
We report the case of a patient with clubbing of the digits and arthritis who was diagnosed as having primary hipertrophic osteoarthropathy. This is a rare, benign disease. However, the arthralgia and skin changes can significantly impair the quality of life of the patient. In addition to a brief description of the disease, we present the case and a review of the literature regarding the treatment of this condition to the general practitioner.