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1.
J Clin Endocrinol Metab ; 105(11)2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32797182

RESUMO

INTRODUCTION: New antihyperglycemic medications have been proven to have cardiovascular (CV) and renal benefits in type 2 diabetes mellitus (T2DM); however, an evidence-based decision tree in specific clinical scenarios is lacking. MATERIALS AND METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs), with trial sequential analysis (TSA). Randomized controlled trial inclusion criteria were patients with T2DM from 1 of these subgroups: elderly, obese, previous atherosclerotic CV disease (ASCVD), previous coronary heart disease (CHD), previous heart failure (HF), or previous chronic kidney disease (CKD). Randomized controlled trials describing those subgroups with at least 48 weeks of follow-up were included. Outcomes: 3-point major adverse cardiovascular events (MACE), CV death, hospitalization due to HF, and renal outcomes. We performed direct meta-analysis with the number of events in the intervention and control groups in each subset, and the relative risk of the events was calculated. RESULTS: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) were the only antihyperglycemic agents related to a reduction in CV events in different populations. For obese and elderly populations, GLP-1 RA were associated with benefits in 3-point MACE; for patients with ASCVD, both SGLT2i and GLP-1 RA had benefits in 3-point MACE, while for patients with CHD, only SGLT2i were beneficial. CONCLUSIONS: SGLT2i and GLP-1 RA reduced CV events in selected populations: SGLT2i led to a reduction in events in patients with previous CHD, ASCVD, and HF. GLP-1 RA led to a reduction in CV events in patients with ASCVD, elderly patients, and patients with obesity. Trial sequential analysis shows that these findings are conclusive. This review opens a pathway towards evidence-based, personalized treatment of T2DM. REGISTRATION: PROSPERO CRD42019132807.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Hipoglicemiantes/uso terapêutico , Incretinas/uso terapêutico , Assistência Centrada no Paciente , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Gerenciamento Clínico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Diabetes Res Clin Pract ; 159: 107969, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31805347

RESUMO

INTRODUCTION: Sarcopenia has been discussed as a possible predictor of mortality in the older people, but there are few studies evaluating the relationship between mortality and sarcopenia in the population of patients with type 2 diabetes (T2D), especially after hospital discharge. OBJECTIVE: To evaluate whether coexistence of sarcopenia and T2D predicts mortality after two years of hospital discharge in older patients compared to a control group without diabetes. METHODOLOGY: A prospective study that included patients hospitalized between July 2015 and December 2017. To assess sarcopenia, a Timed Up and Go (TUG) test was performed, muscle strength was measured by handgrip, and muscle mass was measured across the largest calf circumference region. This project was approved by the HCPA Ethics Committee under number 150068. RESULTS: 610 patients were included. The group was stratified according to the presence of diabetes, 306 (51%) patients had TD2. Patients with T2D had lower muscle strength (19.62 ± 7.53 vs. 21.19 ± 7.31p = 0.009), were slower in TUG test (23 vs. 16 s; p < 0.001) than those without T2D, 46.3% being classified as sarcopenic. The mortality rate among T2D was 28%. After adjustment, the coexistence of T2D and sarcopenia was independently associated with mortality after hospital discharge (HR: 1.78; 95% CI: 1.06-2.30). CONCLUSION: Older patients with T2D and sarcopenia had a higher risk of mortality after hospital discharge compared to a control group.


Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Força da Mão/fisiologia , Mortalidade/tendências , Força Muscular/fisiologia , Alta do Paciente/estatística & dados numéricos , Sarcopenia/mortalidade , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Sarcopenia/etiologia , Sarcopenia/patologia , Taxa de Sobrevida
3.
Arch Endocrinol Metab ; 62(1): 47-54, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29694634

RESUMO

Objective The present investigation sought to evaluate the potential association between dietary fiber intake and blood pressure (BP) in adult patients with type 1 diabetes (T1D). Subjects and methods A cross-sectional study was carried out in 111 outpatients with T1D from Porto Alegre, Brazil. Patients were predominantly male (56%) and white (88%), with a mean age of 40 ± 10 years, diabetes duration of 18 ± 9 years, BMI 24.8 ± 3.85 kg/m2, and HbA1c 9.0 ± 2.0%. After clinical and laboratory evaluation, dietary intake was evaluated by 3-day weighed-diet records, whose reliability was confirmed by 24-h urinary nitrogen output. Patients were stratified into two groups according to adequacy of fiber intake in relation to American Diabetes Association (ADA) recommendations: below recommended daily intake (< 14g fiber/1000 kcal) or at/above recommended intake (≥ 14g/1000 kcal). Results Patients in the higher fiber intake group exhibited significantly lower systolic (SBP) (115.9 ± 12.2 vs 125.1 ± 25.0 mmHg, p = 0.016) and diastolic blood pressure (DBP) (72.9 ± 9.2 vs 78.5 ± 9.3 mmHg, p = 0.009), higher energy intake (2164.0 ± 626.0 vs 1632.8 ± 502.0 kcal, p < 0.001), and lower BMI (24.4 ± 3.5 vs 26.2 ± 4.8, p = 0.044). Linear regression modelling, adjusted for age, energy intake, sodium intake, and BMI, indicated that higher fiber intake was associated with lower SBP and DBP levels. No significant between-group differences were observed with regard to duration of diabetes, glycemic control, insulin dosage, or presence of hypertension, nephropathy, or retinopathy. Conclusion We conclude that fiber consumption meeting or exceeding current ADA recommendations is associated with lower SBP and DBP in patients with T1D.


Assuntos
Pressão Sanguínea/fisiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Fibras na Dieta/administração & dosagem , Ingestão de Energia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Recomendações Nutricionais
4.
Arch. endocrinol. metab. (Online) ; 62(1): 47-54, Jan.-Feb. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-887630

RESUMO

ABSTRACT Objective The present investigation sought to evaluate the potential association between dietary fiber intake and blood pressure (BP) in adult patients with type 1 diabetes (T1D). Subjects and methods A cross-sectional study was carried out in 111 outpatients with T1D from Porto Alegre, Brazil. Patients were predominantly male (56%) and white (88%), with a mean age of 40 ± 10 years, diabetes duration of 18 ± 9 years, BMI 24.8 ± 3.85 kg/m2, and HbA1c 9.0 ± 2.0%. After clinical and laboratory evaluation, dietary intake was evaluated by 3-day weighed-diet records, whose reliability was confirmed by 24-h urinary nitrogen output. Patients were stratified into two groups according to adequacy of fiber intake in relation to American Diabetes Association (ADA) recommendations: below recommended daily intake (< 14g fiber/1000 kcal) or at/above recommended intake (≥ 14g/1000 kcal). Results Patients in the higher fiber intake group exhibited significantly lower systolic (SBP) (115.9 ± 12.2 vs 125.1 ± 25.0 mmHg, p = 0.016) and diastolic blood pressure (DBP) (72.9 ± 9.2 vs 78.5 ± 9.3 mmHg, p = 0.009), higher energy intake (2164.0 ± 626.0 vs 1632.8 ± 502.0 kcal, p < 0.001), and lower BMI (24.4 ± 3.5 vs 26.2 ± 4.8, p = 0.044). Linear regression modelling, adjusted for age, energy intake, sodium intake, and BMI, indicated that higher fiber intake was associated with lower SBP and DBP levels. No significant between-group differences were observed with regard to duration of diabetes, glycemic control, insulin dosage, or presence of hypertension, nephropathy, or retinopathy. Conclusion We conclude that fiber consumption meeting or exceeding current ADA recommendations is associated with lower SBP and DBP in patients with T1D.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pressão Sanguínea/fisiologia , Ingestão de Energia , Fibras na Dieta/administração & dosagem , Diabetes Mellitus Tipo 1/fisiopatologia , Estudos Transversais , Recomendações Nutricionais
5.
Diabetes Res Clin Pract ; 116: 205-11, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27321337

RESUMO

BACKGROUND: Adiponectin is a protein secreted by adipose tissue. It plays a key role in insulin resistance and has anti-inflammatory and anti-atherogenic functions. Changes in diet can influence adiponectin levels. Different dietary interventions, especially those altering fatty acid intake, have been reported as possible mediators of adiponectin levels. METHODS: We conducted a cross-sectional study of 122 subjects with type 1 diabetes (T1DM). Dietary intake was evaluated by 3-day weighed-diet records. Adiponectin levels were categorized into tertiles (T1, <10.260µg/mL; T2, 10.261-18.280µg/mL; T3, >18.281µg/mL). RESULTS: Mean age was 38±11years, and mean duration of diabetes was 17±9years. After multiple regression analysis, waist-to-hip ratio (WHR) (r=-0.19, p = 0.03), age (r=-0.22, p=0.01), systolic blood pressure (SBP) (r=-0.27, p=0.002), diastolic blood pressure (DBP) (r=-0.19, p=0.30), total lipid intake (g) (r=-0.20, p=0.02), saturated fatty acid (SFA) intake (r=-0.25, p=0.004), monounsaturated fatty acid (MUFA) intake (r=-0.21, p=0.02), cholesterol intake (mg) (r=-0.20, p=0.021), sodium intake (g) (r=-0.19, p=0.03), and urinary albumin excretion rate (UAE) (µg/24h) (r=0.26, p=0.02) correlated with adiponectin levels. Even after adjustment for age, SBP or DBP, UAE, and WHR in all models, inverse associations between adiponectin levels and intake of total SFA and MUFA and polyunsaturated fatty acid fractions were observed. Subjects in the first and third tertiles of adiponectin exhibited the greatest differences between adiponectin levels, with a trend toward increasing levels with higher SFA intake. CONCLUSIONS: The present study suggests that high SFA intake may be associated with lower adiponectin levels in patients with T1DM.


Assuntos
Adiponectina/sangue , Diabetes Mellitus Tipo 1/metabolismo , Ácidos Graxos/efeitos adversos , Adulto , Estudos Transversais , Dieta , Feminino , Humanos , Masculino
6.
J Hypertens ; 34(7): 1357-63, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27153464

RESUMO

BACKGROUND: Hypertension is associated with increased cardiovascular deaths in patients with acromegaly. OBJECTIVE: To evaluate the accuracy of blood pressure (BP) by 24-h ambulatory blood pressure monitoring (ABPM) and office BP measurements to represent the real BP status in acromegalic patients and its relationship with acromegalic activity and echocardiogram parameters. PATIENTS AND METHODS: Cohort of 37 patients with acromegaly in a tertiary endocrine outpatient service. RESULTS: Twenty-three percent of the patients were considered hypertensive by ABPM versus 32% by office BP measurements (P = 0.006). BP obtained from the ABPM was associated with growth hormone, insulin-like growth factor type 1 levels and echocardiogram parameters of acromegalic myocardiopathy. Nondipper behavior presented a significant association with the hormonal profile. CONCLUSION: BP levels assessed by ABPM were associated with acromegalic activity and echocardiogram parameters. ABPM can correctly identify BP levels and their repercussion on acromegalic patients.


Assuntos
Acromegalia/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Hipertensão/fisiopatologia , Acromegalia/complicações , Adulto , Idoso , Pressão Sanguínea , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Ecocardiografia , Feminino , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/metabolismo , Humanos , Hipertensão/etiologia , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade
7.
Gynecol Endocrinol ; 31(3): 176-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25561184

RESUMO

PURPOSE: The association of pregnancy and Cushing's disease (CD) is rare. Treatment of Cushing's syndrome (CS) is imperative to reduce maternal and fetal morbidity. Ketoconazole is a widely used drug for CS control when the woman is not pregnant but concerns about its teratogenicity and embryotoxicity restricted its use during pregnancy. METHODS AND RESULTS: We describe a case of a CD patient managed with Ketoconazole during the first and second trimester and other cares for her metabolic CS aspects during pregnancy. She delivered a normal female baby. CONCLUSIONS: It is supposed that even with treatment the relatively hypercortisolemic mother could protect her child from the embryotoxicity of ketoconazole as proved in rat fetuses and we suggest that ketoconazole could be an emergency pharmacological therapeutic option for CS management during pregnancy.


Assuntos
Cetoconazol/uso terapêutico , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Adulto , Feminino , Humanos , Gravidez , Resultado da Gravidez , Resultado do Tratamento
8.
Dermatol Surg ; 41 Suppl 1: S110-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25548839

RESUMO

BACKGROUND: Longevity of effects and dose equivalence of different botulinum toxin type A (BoNT-A) preparations need to be better clarified because BoNT-A units are manufacturer-specific. These points are of particular importance for new brands emerging in the market. OBJECTIVE: To assess the field of muscular and anhidrotic effects of 2 commercial preparations of BoNT-A (incobotulinumtoxinA: Xeomin [XEO]; abobotulinumtoxinA: Dysport [DYS]) administered to the upper third of the face. METHODS: Patients were randomized for the side of the forehead (left or right) in which the products were administered. All were treated receiving BoNT-A injections in 10 points (5 on each side) at a dose equivalence of 1.0:2.5 U (XEO:DYS). Clinical assessments and Minor test were performed at baseline and Days 28, 84, 112, and 140. Electromyography was performed at baseline and Days 28 and 140, and ultrasound was performed only at baseline. RESULTS: Eighty patients were enrolled in 2 research centers. Xeomin and DYS presented similar results regarding fields of muscular effects. However, a larger field of anhidrotic effects was found for DYS. There was a positive correlation between the muscle thickness and electromyography results. CONCLUSION: The results of this study suggest that a lower dose equivalence between DYS and XEO could be established.


Assuntos
Toxinas Botulínicas Tipo A/farmacologia , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/fisiologia , Fármacos Neuromusculares/farmacologia , Sudorese/efeitos dos fármacos , Potenciais de Ação/efeitos dos fármacos , Adolescente , Adulto , Método Duplo-Cego , Feminino , Testa , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão/efeitos dos fármacos , Estudos Prospectivos , Envelhecimento da Pele/efeitos dos fármacos , Adulto Jovem
9.
Clin Endocrinol (Oxf) ; 82(6): 793-800, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25376361

RESUMO

OBJECTIVE: To analyse the performance of the desmopressin (DDAVP) test in the diagnosis of Cushing's disease (CD). METHODS: This was a prospective cohort study of 124 patients with suspected hypercortisolism who were recruited from an outpatient endocrinology clinic and investigated for Cushing's syndrome (CS). The ACTH and cortisol responses to the DDAVP test were assessed to determine patient diagnosis and test the procedure's diagnostic accuracy. RESULTS: A total of 68 patients had CD, while 56 had suspected CS. According to ROC analysis, an ACTH peak of 71·8 pg/ml (15·8 pmol/l) following DDAVP administration was able to diagnose CD with a specificity of 94·6% and a sensitivity of 90·8%, a negative predictive value (NPV) of 89·9% and a positive predictive value (PPV) of 95·3%. An absolute ACTH increment ≥37 pg/ml (8·1 pmol/l) over baseline had a sensitivity of 88·0%, specificity of 96·4%, NPV of 87·0% and PPV of 95·3% in diagnosing CD. Only 2 of 56 cases without CD had an absolute ACTH increment ≥37 pg/ml (8·1 pmol/l) over baseline. The DDAVP test was superior to other clinical instruments in diagnosing CS. CONCLUSIONS: The DDAVP test could be a useful additional tool to diagnose CD in patients with suspected CS.


Assuntos
Desamino Arginina Vasopressina/farmacologia , Hormônio Adrenocorticotrópico/sangue , Adulto , Brasil , Estudos de Coortes , Diagnóstico Diferencial , Técnicas de Diagnóstico Endócrino , Feminino , Antagonistas de Hormônios/farmacologia , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Hipersecreção Hipofisária de ACTH/sangue , Hipersecreção Hipofisária de ACTH/diagnóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
10.
Diabetol Metab Syndr ; 6: 66, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25002911

RESUMO

BACKGROUND: Higher intake of dietary fiber is associated with lower risk of coronary heart disease, the leading cause of mortality among people with type 1 diabetes. The protective effect includes the anti-inflammatory properties of some foods. Population-based studies have shown an inverse association between some nutritional habits and high sensitive -C-reactive protein (hs-CRP). This study aimed to ascertain the association between fiber intake and hs-CPR levels in patients with type 1 diabetes. METHODS: This cross-sectional study was conducted with 106 outpatients with type 1 diabetes; age 40 ± 11 years; diabetes duration of 18 ± 8.8 years. Dietary intake was evaluated by 3-day weighed-diet records. Patients were categorized in 2 groups, according to fiber intake (>20 g/day and <20 g/day). RESULTS: The group with fiber intake > 20 g/day had lower hs-CRP levels [median (25(th-)75(th)) 0.7 mg/dl (0.4-2.4) vs. 1.9 mg/dl (1.0-4.4); P = 0.002], than the other group. Controlled for HbA1c and energy intake, an inverse relation was observed between hs-CRP levels and total fiber [ß = - 0.030 (SE: 0.0120), P = 0.02], soluble fiber [ß = - 0.078 (SE: 0.0421), P = 0.06] and insoluble fiber [ß = - 0.039 (SE: 0.01761), P = 0.026]. Even, after additional adjustment fibers remained associated with lower hs-CRP levels. Total fibers were stratified in 4 groups: < 10 g/day, from 10 to < 20 g/day, from 20 to 30 g/day and > 30 g/day. Compared to the group who ingested < 10 g/day of total fiber (referent group), the group who consumed > 30 g/d had significantly lower hs-CRP levels [-2.45 mg/L, P = 0.012] independent of the HbA1c values. CONCLUSIONS: The present study suggests that an increased consumption of dietary fiber > 30 g/day may play a role in reducing inflammation in individuals with type 1 diabetes.

11.
Clin Endocrinol (Oxf) ; 80(3): 411-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23895112

RESUMO

OBJECTIVE: To evaluate the ability of post-transsphenoidal pituitary surgery (TSS) serum cortisol levels (s-cortisol) to predict surgical remission and recurrence of Cushing's disease (CD). DESIGN: One hundred and three patients with CD from a tertiary referral centre were prospectively analysed over 6·0 ± 4·8 years of follow-up. Twenty patients received perioperative glucocorticoids as routine care and had s-cortisol measured 10-12 days after TSS (Protocol I). Eighty-six patients (91 surgeries) had s-cortisol measured at 6, 12, 18, 24, 48 h, and 10-12 days after TSS, and received glucocorticoids only in case of adrenal insufficiency (Protocol II). MAIN OUTCOMES: Remission [clinical signs and symptoms of adrenal insufficiency (or hypocortisolism) plus cortisol <3 µg/dl on the 1-mg overnight test (OT) and/or normal free urinary cortisol] during follow-up. Recurrence was defined as loss of remission criteria at least 1 year after TSS. RESULTS: The remission rate after first TSS was 80%; 8% had recurrence. An s-cortisol nadir ≤3·5 µg/dl within 48 h after TSS had sensitivity of 73%, specificity and positive predictive value (PPV) of 100% and negative predictive value (NPV) of 60% and an s-cortisol nadir ≤5·7 µg/dl within 10-12 days of TSS had specificity and PPV of 100% and sensitivity of 91% NPV of 78% for CD remission. CONCLUSION: At hospital discharge, the s-cortisol nadir within 48 h after TSS was already able to predict surgical remission for some patients, and the s-cortisol nadir within 10-12 days of TSS was able to predict cohort-wide surgical remission.


Assuntos
Hidrocortisona/sangue , Procedimentos Neurocirúrgicos/métodos , Hipersecreção Hipofisária de ACTH/diagnóstico , Hipersecreção Hipofisária de ACTH/cirurgia , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Hipersecreção Hipofisária de ACTH/sangue , Valor Preditivo dos Testes , Recidiva , Indução de Remissão , Seio Esfenoidal/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
JAMA Dermatol ; 149(12): 1386-91, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24108521

RESUMO

IMPORTANCE: This article provides new data on a controversial issue, the influence of doses on the diffusion characteristics of 2 botulinum toxins type A. OBJECTIVE To assess the fields of effect of abobotulinumtoxinA and onabotulinumtoxinA at the same labeled unit dose (1:1 U) comparing sweat gland and muscle activity. DESIGN, SETTING, AND PARTICIPANTS: A prospective, single-center, randomized, double-blind study was conducted at the Brazilian Center for Studies in Dermatology in Porto Alegre, Brazil. The participants included 19 women. INTERVENTIONS: Each patient received 2 U of abobotulinumtoxinA on one side of the forehead and 2 U of onabotulinumtoxinA on the other side. MAIN OUTCOMES AND MEASURES: Horizontal and vertical diameter and area of the fields of anhidrotic effect, the amplitude of evoked compound muscle action potentials, and the 4-point validated Wrinkle Severity Scale were assessed at 28 days. RESULTS: The horizontal and vertical diameters of the fields of effect and the areas were significantly larger for onabotulinumtoxinA than those obtained for abobotulinumtoxinA. There were no significant differences between the products in the Wrinkle Severity Scale scores and Evoked Compound Muscle Action Potentials. OnabotulinumtoxinA had significantly more diffusion than abobotulinumtoxinA when isovolumetric injections of the same labeled unit dose of the products were injected. CONCLUSIONS AND RELEVANCE Although many studies state that diffusion is product dependent and abobotulinumtoxinA diffuses more than onabotulinumtoxinA, findings from the present study confirm that diffusion is dose dependent and the more potent dose tested diffuses more. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01732809.


Assuntos
Toxinas Botulínicas Tipo A/farmacologia , Fármacos Neuromusculares/farmacologia , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/farmacocinética , Brasil , Técnicas Cosméticas , Relação Dose-Resposta a Droga , Método Duplo-Cego , Potenciais Evocados/efeitos dos fármacos , Feminino , Testa , Humanos , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/farmacocinética , Glândulas Sudoríparas/efeitos dos fármacos , Glândulas Sudoríparas/metabolismo
13.
Arq Bras Endocrinol Metabol ; 57(6): 397-405, 2013 Aug.
Artigo em Português | MEDLINE | ID: mdl-24030179

RESUMO

The positive effects of dietary fiber are related, in part, to the fact that a portion of the fermentation of components takes place in the large intestine, which has an impact on the speed of digestion, pH of the colon, and production of by-products with important physiological functions. Individuals with high fiber intake seem to have lower risk of developing coronary artery disease, hypertension, obesity, diabetes, and colon cancer. The increase in fiber intake reduces serum cholesterol, improves blood glucose in patients with diabetes, reduces body weight, and is associated with lower serum ultrasensitive C-reactive protein. Increased fiber intake and intake of more fiber than the currently recommended level (14 g/1,000 kcal) may provide greater health benefits, including reducing low-grade inflammation.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/prevenção & controle , Fibras na Dieta/administração & dosagem , Proteína C-Reativa/análise , Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , Doença Crônica , Constipação Intestinal/prevenção & controle , Humanos , Inflamação/prevenção & controle , Neoplasias Intestinais/prevenção & controle , Intestinos/microbiologia , Intestinos/fisiologia , Obesidade/prevenção & controle
14.
Arq. bras. endocrinol. metab ; Arq. bras. endocrinol. metab;57(6): 397-405, ago. 2013. tab
Artigo em Português | LILACS | ID: lil-685401

RESUMO

Os efeitos positivos da fibra alimentar estão relacionados, em parte, ao fato de que uma parcela da fermentação de seus componentes ocorre no intestino grosso, o que produz impacto sobre a velocidade do trânsito intestinal, sobre o pH do cólon e sobre a produção de subprodutos com importante função fisiológica. Indivíduos com elevado consumo de fibras parecem apresentar menor risco para o desenvolvimento de doença coronariana, hipertensão, obesidade, diabetes e câncer de cólon. O aumento na ingestão de fibras reduz os níveis séricos de colesterol, melhora a glicemia em pacientes com diabetes, reduz o peso corporal e foi associado com menores níveis séricos de proteína C reativa ultrassensível. O maior consumo de fibras e a ingestão de mais fibras do que a atualmente recomendada (14 g/1.000 kcal) poderão trazer maior benefício à saúde, incluindo a redução de processos inflamatórios de baixo grau.


The positive effects of dietary fiber are related, in part, to the fact that a portion of the fermentation of components takes place in the large intestine, which has an impact on the speed of digestion, pH of the colon, and production of by-products with important physiological functions. Individuals with high fiber intake seem to have lower risk of developing coronary artery disease, hypertension, obesity, diabetes, and colon cancer. The increase in fiber intake reduces serum cholesterol, improves blood glucose in patients with diabetes, reduces body weight, and is associated with lower serum ultrasensitive C-reactive protein. Increased fiber intake and intake of more fiber than the currently recommended level (14 g/1,000 kcal) may provide greater health benefits, including reducing low-grade inflammation.


Assuntos
Humanos , Glicemia/metabolismo , Diabetes Mellitus/prevenção & controle , Fibras na Dieta/administração & dosagem , Proteína C-Reativa/análise , Doença Crônica , Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , Constipação Intestinal/prevenção & controle , Inflamação/prevenção & controle , Neoplasias Intestinais/prevenção & controle , Intestinos/microbiologia , Intestinos/fisiologia , Obesidade/prevenção & controle
15.
Dermatol Surg ; 39(7): 1088-96, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23465042

RESUMO

BACKGROUND: Botulinum toxin type A (BoNT-A) injection has become the most popular cosmetic nonsurgical procedure, and it has been suggested that BoNT-A injections may improve emotional states when frown lines are treated. OBJECTIVES: To evaluate symptoms of depression and self-esteem before and after onabotulinumtoxinA (ONA) injections in the glabella in subjects with and without depression. METHODS: Twenty-five subjects with depression were allocated into one group and 25 subjects without depression were matched to those according to demographic characteristics. The Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES) were used to assess depression symptoms and self-esteem, respectively. Patients were assessed up to 12 weeks after the intervention. RESULTS: Patients with depression had significant improvement in depression symptoms after ONA injections. The maximum effect occurred within the first 8 weeks after treatment. A significant reduction from baseline in BDI score and significant improvement in self-esteem were also observed in patients with depression. CONCLUSION: This research presents new data regarding BoNT-A as a potential treatment to improve depression symptoms in patients with Major Depressive Disorder. Self-esteem scores alone cannot explain the improvement in depression symptoms.


Assuntos
Toxinas Botulínicas Tipo A/farmacologia , Transtorno Depressivo Maior/psicologia , Fármacos Neuromusculares/farmacologia , Autoimagem , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Toxinas Botulínicas Tipo A/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , Estudos Prospectivos
16.
Arq Bras Endocrinol Metabol ; 56(3): 159-67, 2012 Apr.
Artigo em Português | MEDLINE | ID: mdl-22666730

RESUMO

Cushing's disease (CD) remains a medical challenge, with many questions still unanswered. Successful treatment of CD patients is closely related to correct approach to syndromic and etiological diagnosis, besides the experience and talent of the neurosurgeon. Pituitary transsphenoidal adenomectomy is the treatment of choice for DC. Assessment of remission after surgery and recurrence in the long term is an even greater challenge. In this regard, special attention should be paid to the role of postoperative serum cortisol as a marker of CD remission. Additionally, the postoperative use of exogenous glucocorticoids only in cases of adrenal insufficiency has been suggested by some authors as an essential practice to enable the use of serum cortisol in this scenario. In this article, we review the forms of evaluation of DC activity, and markers of remission and relapse of CD after transsphenoidal surgery.


Assuntos
Hidrocortisona/sangue , Hipersecreção Hipofisária de ACTH/cirurgia , Insuficiência Adrenal/tratamento farmacológico , Adrenalectomia/métodos , Hormônio Adrenocorticotrópico/sangue , Biomarcadores/sangue , Humanos , Sistema Hipotálamo-Hipofisário/fisiologia , Hipersecreção Hipofisária de ACTH/sangue , Sistema Hipófise-Suprarrenal/fisiologia , Cuidados Pós-Operatórios , Valor Preditivo dos Testes , Recidiva , Resultado do Tratamento
17.
Arq. bras. endocrinol. metab ; Arq. bras. endocrinol. metab;56(3): 159-167, Apr. 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-626266

RESUMO

A doença de Cushing (DC) permanece um desafio médico com muitas questões ainda não respondidas. O sucesso terapêutico dos pacientes com DC está ligado à correta investigação do diagnóstico síndrômico e etiológico, além da experiência e talento do neurocirurgião. A adenomectomia hipofisária transesfenoidal constitui-se no tratamento de escolha para a DC. A avaliação da remissão da doença no pós-operatório e da recorrência em longo prazo constitui um desafio ainda maior. Especial destaque deve ser dado para o cortisol sérico no pós-operatório como marcador de remissão. Adicionalmente, o uso de corticoide exógeno no pós-operatório apenas em vigência de insuficiência adrenal tem sido sugerido por alguns autores como requisito essencial para permitir a correta interpretação do cortisol sérico nesse cenário. Neste artigo, revisamos as formas de avaliação da atividade da DC e os marcadores de remissão e recidiva da DC após a realização da cirurgia transesfenoidal.


Cushing's disease (CD) remains a medical challenge, with many questions still unanswered. Successful treatment of CD patients is closely related to correct approach to syndromic and etiological diagnosis, besides the experience and talent of the neurosurgeon. Pituitary transsphenoidal adenomectomy is the treatment of choice for DC. Assessment of remission after surgery and recurrence in the long term is an even greater challenge. In this regard, special attention should be paid to the role of postoperative serum cortisol as a marker of CD remission. Additionally, the postoperative use of exogenous glucocorticoids only in cases of adrenal insufficiency has been suggested by some authors as an essential practice to enable the use of serum cortisol in this scenario. In this article, we review the forms of evaluation of DC activity, and markers of remission and relapse of CD after transsphenoidal surgery.


Assuntos
Humanos , Hidrocortisona/sangue , Hipersecreção Hipofisária de ACTH/cirurgia , Insuficiência Adrenal/tratamento farmacológico , Adrenalectomia/métodos , Hormônio Adrenocorticotrópico/sangue , Biomarcadores/sangue , Sistema Hipotálamo-Hipofisário/fisiologia , Cuidados Pós-Operatórios , Valor Preditivo dos Testes , Hipersecreção Hipofisária de ACTH/sangue , Sistema Hipófise-Suprarrenal/fisiologia , Recidiva , Resultado do Tratamento
18.
J Am Acad Dermatol ; 67(2): 226-32, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22041253

RESUMO

BACKGROUND: The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE: We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS: In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS: In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS: Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION: At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Neurotoxinas/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/patologia , Potenciais de Ação , Adolescente , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Músculos Faciais/efeitos dos fármacos , Músculos Faciais/inervação , Feminino , Testa , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Glândulas Sudoríparas/efeitos dos fármacos , Resultado do Tratamento , Adulto Jovem
19.
Arq Bras Cardiol ; 97(4): 346-9, 2011 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22011803

RESUMO

BACKGROUND: In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. OBJECTIVE: To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. METHODS: A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). RESULTS: Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95% CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). CONCLUSION: Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.


Assuntos
Doença da Artéria Coronariana/etiologia , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/etiologia , Calcificação Vascular/etiologia , Adulto , Doença da Artéria Coronariana/patologia , Diabetes Mellitus Tipo 1/patologia , Retinopatia Diabética/patologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Calcificação Vascular/patologia
20.
J Cosmet Laser Ther ; 13(6): 297-302, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21981326

RESUMO

Cellulite has a complex and multifactorial etiology. Synergistic action on treating cellulite has gained support in the treatment of cellulite. This study evaluated safety and efficacy of a bipolar radiofrequency, infrared, vacuum and mechanical massage device for cellulite treatment and reduction of body measures. This was a pilot study, which assessed 9 subjects who presented body mass index from 18 to 25 Kg/Kg and at least grade 6 in the Cellulite Severity Scale (CSS). All subjects underwent a 12-session treatment of posterior thighs and buttocks. There was a significant reduction of the hip circumference (p = 0.001), however, no changes in thigh circumferences were observed (p = 0.4). CSS has improved specifically on both buttocks [p = 0.002 (left side) and p = 0.038 (right side)], and no changes were observed on thighs. The studied device demonstrated efficacy in the reduction of cellulite severity and body circumference measures in the buttocks.


Assuntos
Tecido Adiposo , Técnicas Cosméticas/instrumentação , Massagem/métodos , Adulto , Nádegas , Feminino , Humanos , Raios Infravermelhos , Massagem/instrumentação , Pessoa de Meia-Idade , Projetos Piloto , Ondas de Rádio , Coxa da Perna , Resultado do Tratamento , Vácuo , Adulto Jovem
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