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Resumen Objetivo: Estimar la prevalencia de diabetes en atención ambulatoria y describir sus características epidemiológicas, comorbilidades y complicaciones vasculares relacionadas. Método: Corte transversal que incluyó la totalidad de adultos afiliados a la prepaga del Hospital Italiano de Buenos Aires en marzo de 2019, Argentina. Resultados: La prevalencia global de diabetes resultó del 8.5% con intervalo de confianza del 95% (IC95%): 8.3-8.6 (12,832 de un total de 150,725 afiliados). El estrato etario con mayor prevalencia fue el grupo entre 65 y 80 años, con un 15.7% (IC95%: 15.3-16.1). Las personas con diabetes presentaban una media de edad de 70 años (desviación estándar: 14), el 52% eran mujeres, y los factores de riesgo cardiovasculares más frecuentemente asociados fueron: dislipidemia (88%), hipertensión arterial (74%) y obesidad (55%). En relación con el control metabólico, el 60% tenía al menos una hemoglobina glucosilada medida en el último año, siendo el 70% de estas menores al 7%. Casi el 80% tiene medido el colesterol vinculado a lipoproteínas de baja densidad (c-LDL) al menos una vez en los últimos dos años, de ellos el 55% presentaba un valor de c-LDL igual o menor a 100 mg/dl. Las complicaciones macrovasculares presentes en orden de frecuencia fueron: infarto agudo de miocardio (11%), accidente cerebrovascular (8%) y enfermedad vascular periférica (4%); mientras que las complicaciones microvasculares resultaron ser neuropatía diabética (4%) y retinopatía (2%). El 7% tuvo pie diabético, con menos del 1% de amputaciones. Conclusiones: La diabetes representa un problema prevalente, incluso en pacientes ancianos. Esta población sigue presentando un elevado riesgo cardiovascular, con escaso cumplimiento de objetivos terapéuticos.
Abstract Objective: To estimate prevalence of diabetes in outpatient care and to describe its epidemiological characteristics, comorbidities, and related vascular complications. Methods: Observational cross-sectional study which included all adults affiliated from a private insurance health plan on March 2019, at Hospital Italiano de Buenos Aires, from Argentina. Results: The global prevalence of diabetes resulted in 8.5% with 95% CI 8.3-8.6 (12,832 out of a total of 150,725 affiliates). The age stratum with the highest prevalence was the group between 65 and 80 years old with 15.7% (95% CI 15.3-16.1). People with diabetes had a mean age of 70 years (SD 14), 52% were women, and the most frequently associated cardiovascular risk factors were: dyslipidaemia (88%), arterial hypertension (74%) and obesity (55%). In relation to metabolic control, 60% had at least one glycosylated hemoglobin measured in the last year, 70% of which were less than 7%. Almost 80% have LDL measured at least once in the last 2 years, 55% of them had an LDL value equal to or less than 100 mg/dl. The macrovascular complications present in order of frequency were: acute myocardial infarction (11%), cerebrovascular accident (8%) and peripheral vascular disease (4%); while the microvascular complications were found to be diabetic neuropathy (4%) and retinopathy (2%). 7% had diabetic foot, with less than 1% amputations. Conclusion: Diabetes represents a prevalent problem, even in elderly patients. This population continues to present a high cardiovascular risk, with little compliance with therapeutic goals.
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OBJECTIVE: To estimate prevalence of diabetes in outpatient care and to describe its epidemiological characteristics, comorbidities, and related vascular complications. METHODS: Observational cross-sectional study which included all adults affiliated from a private insurance health plan on March 2019, at Hospital Italiano de Buenos Aires, from Argentina. RESULTS: The global prevalence of diabetes resulted in 8.5% with 95% CI 8.3-8.6 (12,832 out of a total of 150,725 affiliates). The age stratum with the highest prevalence was the group between 65 and 80 years old with 15.7% (95% CI 15.3-16.1). People with diabetes had a mean age of 70 years (SD 14), 52% were women, and the most frequently associated cardiovascular risk factors were: dyslipidaemia (88%), arterial hypertension (74%) and obesity (55%). In relation to metabolic control, 60% had at least one glycosylated hemoglobin measured in the last year, 70% of which were less than 7%. Almost 80% have LDL measured at least once in the last 2 years, 55% of them had an LDL value equal to or less than 100 mg/dl. The macrovascular complications present in order of frequency were: acute myocardial infarction (11%), cerebrovascular accident (8%) and peripheral vascular disease (4%); while the microvascular complications were found to be diabetic neuropathy (4%) and retinopathy (2%). 7% had diabetic foot, with less than 1% amputations. CONCLUSION: Diabetes represents a prevalent problem, even in elderly patients. This population continues to present a high cardiovascular risk, with little compliance with therapeutic goals.
OBJETIVO: Estimar la prevalencia de diabetes en atención ambulatoria y describir sus características epidemiológicas, comorbilidades y complicaciones vasculares relacionadas. MÉTODO: Corte transversal que incluyó la totalidad de adultos afiliados a la prepaga del Hospital Italiano de Buenos Aires en marzo de 2019, Argentina. RESULTADOS: La prevalencia global de diabetes resultó del 8.5% con intervalo de confianza del 95% (IC95%): 8.3-8.6 (12,832 de un total de 150,725 afiliados). El estrato etario con mayor prevalencia fue el grupo entre 65 y 80 años, con un 15.7% (IC95%: 15.3-16.1). Las personas con diabetes presentaban una media de edad de 70 años (desviación estándar: 14), el 52% eran mujeres, y los factores de riesgo cardiovasculares más frecuentemente asociados fueron: dislipidemia (88%), hipertensión arterial (74%) y obesidad (55%). En relación con el control metabólico, el 60% tenía al menos una hemoglobina glucosilada medida en el último año, siendo el 70% de estas menores al 7%. Casi el 80% tiene medido el colesterol vinculado a lipoproteínas de baja densidad (c-LDL) al menos una vez en los últimos dos años, de ellos el 55% presentaba un valor de c-LDL igual o menor a 100 mg/dl. Las complicaciones macrovasculares presentes en orden de frecuencia fueron: infarto agudo de miocardio (11%), accidente cerebrovascular (8%) y enfermedad vascular periférica (4%); mientras que las complicaciones microvasculares resultaron ser neuropatía diabética (4%) y retinopatía (2%). El 7% tuvo pie diabético, con menos del 1% de amputaciones. CONCLUSIONES: La diabetes representa un problema prevalente, incluso en pacientes ancianos. Esta población sigue presentando un elevado riesgo cardiovascular, con escaso cumplimiento de objetivos terapéuticos.
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Assistência Ambulatorial , Diabetes Mellitus , Angiopatias Diabéticas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Ambulatorial/estatística & dados numéricos , Argentina/epidemiologia , Comorbidade , Estudos Transversais , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/terapia , Hemoglobinas Glicadas/análise , Fatores de Risco de Doenças Cardíacas , Hipertensão/epidemiologia , Seguro Saúde/estatística & dados numéricos , Prevalência , Fatores de RiscoRESUMO
ABSTRACT BACKGROUND: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications (other than venous thromboembolism) are sparse. OBJECTIVE: To investigate the vascular complications in severely ill patients hospitalized with COVID-19 and their association with all-cause mortality. DESIGN AND SETTING: This cohort study was conducted at the Universidade Federal de São Paulo, Brazil. METHODS: All 305 consecutive patients diagnosed with COVID-19 and hospitalized in the intensive care unit (ICU) of a tertiary university hospital from April 2 to July 17, 2021, were included and followed up for 30 days. RESULTS: Of these, 193 (63.3%) were male, and the mean age was 59.9 years (standard deviation = 14.34). The mortality rate was 56.3% (172 patients), and 72 (23.6%) patients developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivors (28.5%) than in the survivors (17.3%) group and included disseminated intravascular coagulation (DIC, 10.8%), deep vein thrombosis (8.2%), acrocyanosis (7.5%), and necrosis of the extremities (2%). DIC (adjusted odds ratio (aOR) 2.30, 95% confidence interval (CI) 1.01-5.24, P = 0.046) and acrocyanosis (aOR 5.21, 95% CI 1.48-18.27, P = 0.009) were significantly more prevalent in the non-survivors than in the survivors group. CONCLUSION: Vascular complications in critically ill COVID-19 patients are common (23.6%) and can be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of the management of COVID-19. REGISTRATION: RBR-4qjzh7 (https://ensaiosclinicos.gov.br/rg/RBR-4qjzh7).
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The development of type 2 diabetes mellitus (T2DM) vascular complications (VCs) is associated with oxidative stress and chronic inflammation and can result in endothelial dysfunctions. Circulating microRNAs play an important role in epigenetic regulation of the etiology of T2DM. We studied 30 healthy volunteers, 26 T2DM patients with no complications, and 26 T2DM patients with VCs, to look for new biomarkers indicating a risk of developing VCs in T2DM patients. Peripheral blood samples were used to determine redox state, by measuring the endogenous antioxidant defense system (superoxide dismutase, SOD; catalase, CAT; glutathione reductase, GRd; glutathione peroxidase, GPx; and glucose-6-phosphate dehydrogenase, G6DP) and markers of oxidative damage (advanced oxidation protein products, AOPP; lipid peroxidation, LPO). Additionally, inflammatory marker levels (IL-1, IL-6, IL-18, and TNF-α), c-miR-21, and c-miR-126 expression were analyzed. T2DM patients showed the highest oxidative damage with increased GSSG/GSH ratios, LPO, and AOPP levels. In both diabetic groups, we found that diminished SOD activity was accompanied by increased CAT and decreased GRd and G6PD activities. Diabetic patients presented with increased relative expression of c-miR-21 and decreased relative expression of c-miR-126. Overall, c-miR-21, SOD, CAT, and IL-6 had high predictive values for diabetes diagnoses. Finally, our data demonstrated that IL-6 exhibited predictive value for VC development in the studied population. Moreover, c-miR-21 and c-miR-126, along with GPx and AOPP levels, should be considered possible markers for VC development in future studies.
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Splanchnic vein thrombosis is an unusual manifestation of venous thromboembolism and includes portal vein thrombosis, mesenteric veins thrombosis, splenic vein thrombosis, and the Budd-Chiari syndrome. The most common risk factors include hematologic and autoimmune disorders, hormonal therapy, liver cirrhosis, solid abdominal cancer, recent abdominal surgery, and abdominal infections or inflammatory conditions, such as pancreatitis. Splanchnic vein thrombosis in acute pancreatitis is most commonly associated with the severe form of the disease and pancreatic necrosis. This report describes a case of splanchnic vein thrombosis as a complication of necrotizing acute pancreatitis in a pediatric patient. Splanchnic vein thrombosis was incidentally detected on contrast-enhanced computed tomography to assess the pancreas. There was no evidence of prior risk factors for the thrombotic condition. The patient was treated with anticoagulation and showed complete resolution after recovery from necrotizing acute pancreatitis, at a 16-month follow-up. The complication of necrotizing acute pancreatitis with splanchnic vein thrombosis in pediatric age is a rare presentation.
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BACKGROUND: Percutaneous retrieval of intravascular foreign bodies has recently increased as a treatment option. PURPOSE: To report our single-center experience of the percutaneous retrieval of 14 intravascular embolized catheter fragments in children and to conduct a literature review. MATERIAL AND METHODS: MEDLINE databases were searched for case reports and series including children and iatrogenic catheter fragments or guidewires retrieved through percutaneous techniques. We also conducted a retrospective analysis of 14 cases from our institution over a 14-year period. A total of 27 studies were selected comprising 74 children, plus our 14 unpublished cases. Statistical analyses were performed using Microsoft Excel version 2016. RESULTS: Port catheter fragments and peripherally inserted central catheters (PICCs) were the most embolized foreign bodies and the pulmonary artery was the most common site of embolization in 44.1% of cases. Analysis of the retrieval technique demonstrated a preference for extraction through the femoral vein (81.7%) and using snare techniques (93.5%). The success rate of percutaneous retrieval was 96.6% with only 1.1% of procedure-related complications. Patients were asymptomatic in 77.2% of cases, presented septic complications in 2.3%, and no deaths were reported. Median fluoroscopy time was 10 min (range = 1.7-80 min) and median procedure length was 60 min (range = 35-208 min). CONCLUSION: Percutaneous retrieval of intravascular foreign bodies is a feasible, safe, and efficient technique in children and should be considered the preferred treatment option.
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Cateterismo Periférico , Corpos Estranhos , Cateteres de Demora/efeitos adversos , Criança , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/métodos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos , Projetos de Pesquisa , Estudos RetrospectivosRESUMO
Introducción: El pie diabético se considera un problema de salud a escala mundial, debido al alto número de ingresos en los servicios hospitalarios. Objetivo: Caracterizar a los pacientes con pie diabético isquémico sometidos a cirugía revascularizadora en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se llevó a cabo un estudio descriptivo y retrospectivo en 24 pacientes que ingresaron en el Servicio de Angiopatía Diabética del Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de pie diabético isquémico, a los cuales se les realizó cualquier tipo de cirugía revascularizadora durante el período comprendido entre abril de 2018 y abril de 2019. Las variables estudiadas fueron: edad, sexo, factores de riesgo ateroscleróticos y enfermedades asociadas, patrón topográfico, clasificación de Fontaine, clasificación hemodinámica según la American College of Cardiology Foundation (ACCF) y técnicas quirúrgicas utilizadas. Se calcularon las frecuencias absolutas y relativas para las variables cualitativas. Resultados: Más del 95 por ciento de los pacientes eran mayores de 50 años. Hubo un predominó del sexo masculino (79,2 por ciento). La hipertensión arterial y el hábito de fumar resultaron los factores de riesgo de mayor frecuencia con igual porcentaje (79,8 por ciento). El patrón oclusivo predominante fue el fémoro-poplíteo (75 por ciento) y la técnica quirúrgica más utilizada resultó el bypass fémoro-poplíteo con prótesis sintética en la primera porción de la poplítea (54,1 por ciento). No se necesitó la amputación después de la cirugía en el 83 por ciento de los enfermos. Conclusiones: Los pacientes se caracterizaron por ser en su mayoría adultos mayores, fumadores e hipertensos. A estos se les realizaron, preferentemente, técnicas quirúrgicas convencionales sobre los procederes endovasculares(AU)
Introduction: Diabetic foot is considered a global health problem, due to the high number of hospital admissions. Objective: Characterize patients with ischemic diabetic foot undergoing revascularization surgery at the National Institute of Angiology and Vascular Surgery. Methods: A descriptive and retrospective study was carried out in 24 patients who were admitted in the Diabetic Angiopathy Service of the National Institute of Angiology and Vascular Surgery with the diagnosis of ischemic diabetic foot, whom underwent any kind of revascularization surgery during the period from April 2018 to April 2019. The variables studied were: age, sex, atherosclerotic risk factors and associated diseases, topographic pattern, Fontaine classification, hemodynamic classification according to the American College of Cardiology Foundation (ACCF) and surgical techniques used. Absolute and relative frequencies for qualitative variables were calculated. Results: More than 95 percent of patients were over 50 years of age. There was a predominance of the male sex (79.2 percent). High blood pressure and smoking habit resulted in the most common risk factors with the same percentage (79.8 percent). The predominant occlusive pattern was the femoro-popliteal (75 percent) and the most commonly used surgical technique was the femoro-popliteal bypass with synthetic prosthetics in the first portion of the popliteal (54.1 percent). No amputation was needed after surgery in 83 percent of patients. Conclusions: Patients were characterized by being mostly older adults, smokers and hypertensive ones. Preferably conventional surgical techniques on endovascular proceedings were performed to these patients(AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Fatores de Risco , Pé Diabético , Angiopatias Diabéticas , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
BACKGROUND: Anterior lumbar interbody fusion (ALIF) is a good alternative for the surgical treatment of lumbar degenerative disc disease. The primary vascular complications regarding this intervention involve the common iliac vein bifurcation complex (CIVC). Currently, no classification system allows defining which patients are more prone to these complications. We aimed to perform a retrospective study evaluating the anatomy of the common iliac CIVC at the L5-S1 disc proposing a novel classification system as it relates to the ALIF difficulty. METHODS: 91 consecutive patients who underwent ALIF at the L5-S1 level were included. We categorize the CIVC at the L5-S1 disc space into four types according to the veins position along the disc space. The patient records were reviewed for demographic information, surgical characteristics, and complications. The surgical difficulty was rated at the end of the procedure. RESULTS: 54% of the patients were women. The mean age was 52.5 ± 14.8 years. Mean surgical bleeding was 152 ml (range 20ml -3000 ml), and mean surgical time was 79 ± 13.3 minutes. Berbeo-Diaz-Vargas (BDV) classification type 4 was found in 43.9% of the patients. The surgical complexity was associated with the bleeding magnitude and surgical time spent (p<0.01), not being related to the corporal mass index or sacral slope. Bleeding magnitude, surgical time, and surgical complexity were significantly related to the BDV classification system (p<0.01). Weighted Cohen´s kappa index for the BDV scale was 0.89 (95% IC 0.822 - 0.974). CONCLUSIONS: BDV scale is a reliable and reproducible tool for the classification of CIVC significantly related to a higher incidence of bleeding, prolonged operating time, and increased perceived difficulty by the surgeon.
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BACKGROUND: The upper limb approach utilizing transradial access for combined left and right heart catheterization (CLRHC) and ultrasound-guided antecubital venous access for isolated right heart catheterization (IRHC) are strategies that may reduce risks, especially in anticoagulated patients. combined left and right heart catheterization. OBJECTIVES: To assess safety and feasibility of upper limb approach for IRHC or CLRHC in anticoagulated versus non-anticoagulated patients. METHODS: Ninety-three patients who underwent IRHC or CLRHC with ultrasound-guided antecubital venous access and transradial arterial access were prospectively enrolled. The primary outcome was a composite of procedure failure and incidence of immediate vascular complications. RESULTS: Of the 93 patients, 44 (47%) were on anticoagulation and 49 (53%) were not. Mean age was 54 ± 17 and 53 ± 15 years, respectively. Atrial fibrillation (39% vs 15%) and chronic kidney disease (21% vs 6%) were more common in anticoagulated patients. The main indication for anticoagulation was deep vein thrombosis/pulmonary thromboembolism in 22 patients (50%). The primary outcome occurred in 4 (8%) patients in the non-anticoagulated group as compared with 0 in the anticoagulated group (p = 0.12). Procedure failure occurred in two patients (4%) and immediate vascular complications in two patients (4%) in the non-anticoagulated group (p = 0.3 for all). There was no difference between groups regarding duration of the procedure, radiation dose, fluoroscopy time, post-procedure recovery room time and median time to venous or arterial hemostasis. CONCLUSIONS: The upper limb approach for heart catheterization had similar rates of procedure failure and immediate vascular complications in anticoagulated patients when compared to non-anticoagulated patients.
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Cateterismo Cardíaco , Artéria Radial , Adulto , Idoso , Cateterismo Cardíaco/efeitos adversos , Estudos de Viabilidade , Humanos , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Extremidade Superior , VeiasRESUMO
OBJECTIVES: The use of monitored anesthesia care (MAC) for transcatheter aortic valve replacement (TAVR) is gaining favor in the United States, although general anesthesia (GA) continues to be common for these procedures. Open surgical cutdown for transfemoral TAVR has been a relative contraindication for TAVR with MAC at most centers. The objective of this study was to review the authors' results of transfemoral TAVR performed in patients with open surgical cutdown with the use of MAC. DESIGN: Retrospective study design from a prospectively recorded database. SETTING: Tertiary academic (teaching) hospital. PARTICIPANTS: Two hundred eighty-two patients undergoing transfemoral TAVR with open surgical cutdown under MAC from 2015 to 2017. INTERVENTIONS: Transfemoral TAVR under MAC with surgical cutdown for femoral vascular access. MEASUREMENTS AND MAIN RESULTS: The study cohort consisted of 282 patients with severe aortic stenosis (mean area 0.65 [± 0.16] cm2, mean gradient of 48.9 [±13.3] mmHg, and mean age of 82.7 [± 7.31] years). Eleven (3.9%) patients required conversion to GA. First postoperative pain score (0-10) was 2.9 and highest postoperative pain score was 4.6. Major and minor vascular complications occurred in 2 (0.7%) and 6 (2.1%) patients, respectively. Twenty-nine (10.3%) patients were readmitted within 30 days, and 6 (2.1%) patients had in-hospital mortality. CONCLUSIONS: Open surgical cutdown for transfemoral TAVR can be performed safely using MAC and ilioinguinal block with low rates of conversion to general anesthesia and acceptable postoperative outcomes and pain scores.
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Anestesia Geral/métodos , Estenose da Valva Aórtica/cirurgia , Cateterismo Periférico/métodos , Sedação Consciente/efeitos adversos , Contraindicações de Procedimentos , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Feminino , Artéria Femoral , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Transcatheter aortic valve implantation (TAVI) is a relatively new medical intervention. Research on dedicated TAVI devices is an exciting and dynamic field to be explored by professionals involved in technological innovation. The authors describe in this article the first engineering concept and part of the US Patent of a new valve prosthesis. Divided into two pieces to be separately implanted using a single catheter by means of an innovative technique, this device aims at reducing prosthesis and delivery catheter profile. Miniaturization of the valve and delivery system is probably the best solution to reduce the morbidity and mortality that derive from vascular complications associated with TAVI.
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Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/métodos , Humanos , Desenho de Prótese , Fatores de RiscoRESUMO
O Diabetes mellitus (DM) é uma síndrome multifatorial cujas complicações matam 5% da população mundial todo o ano. A hiperglicemia crônica característica do DM promove disfunção endotelial e o desenvolvimento de complicações microvasculares, como nefropatia, retinopatia e neuropatia, e macrovasculares como o acidente vascular cerebral e infarto agudo do miocárdio (IAM). O DM é uma patologia com altas taxas de morbidade e mortalidade, o que torna relevante a realização de estudos epidemiológicos para investigar suas características. O objetivo deste trabalho foi analisar o perfil clínico-laboratorial e a presença de complicações vasculares em pacientes com DM tipo 2 (DM2). Foram selecionados 300 pacientes com DM2 atendidos no Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). Dados clínico-laboratoriais foram coletados e analisados a partir do prontuário médico e do banco de dados do laboratório de análises clínicas do HC-UFPR. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Setor de Ciências da Saúde da UFPR (número CAAE: 01038112.0.0000.0102). Os participantes tinham média de idade de 62 anos, eram na maioria mulheres (73%), apresentavam obesidade, hipertensão e dislipidemia. Concentrações de hemoglobina glicada >7%, indicando mal controle glicêmico, foram detectadas em 60,3% dos pacientes com DM2 neste estudo. E 40,7% dos participantes apresentaram ao menos uma complicação vascular. Os dados encontrados reforçam as estatísticas que pacientes com DM2 apresentam hipertensão, dislipidemias e obesidade, e estão em maior risco para complicações vasculares que podem causar morbidade e mortalidade.
Diabetes mellitus (DM) is a multifactorial syndrome with complications that kill 5% of the global population per year. Chronic hyperglycemia promotes endothelial dysfunction and the development of microvascular complications such as nephropathy, retinopathy and neuropathy, as well as macrovascular complications, such as stroke and acute myocardial infarction (AMI). DM is a disease with high morbidity and mortality, which makes it relevant to conduct epidemiological studies to investigate its features. The aim of this study was to evaluate clinical and laboratory profile and the presence of vascular complications in patients with type 2 DM (DM2). A total of 300 patients with DM2 treated at the Endocrinology and Metabolism Service at the Clinical Hospital of Federal University of Parana (HC-UFPR) were selected. Clinical and laboratory data were collected and analyzed from the medical records and laboratory database of HC-UFPR. This study was approved by the Research Ethics Committee of the UFPR Health Sciences Sector (CAAE number: 01038112.0.0000.0102). The mean age of participants was 62 years, with mostly women (73%) presenting obesity, high blood pressure and dyslipidemia. Glycated hemoglobin concentrations >7%, indicating poor glycemic control, was detected in 60.3% of DM2 patients in this study, with 40.7% participants presenting at least one vascular complication. These results confirm the fact that DM2 patients have hypertension, dyslipidemia and obesity, and are at increased risk for vascular complications associated with high morbidity and mortality.
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Humanos , Diabetes Mellitus Tipo 2 , Hiperglicemia , Biomarcadores , Angiopatias Diabéticas , Neuropatias Diabéticas , Retinopatia Diabética , Dislipidemias , Hipertensão , Nefropatias , ObesidadeRESUMO
As complicações crônicas do diabetes mellitus (DM) são decorrentes principalmente do controle inadequado, do tempo de evolução e de fatores genéticos da doença. As complicações crônicas microvasculares englobam a nefropatia diabética, a retinopatia diabética e a neuropatia diabética. As complicações crônicas macrovasculares, como o próprio nome diz, são resultantes de alterações nos grandes vasos e causam infarto agudo do miocárdio, acidente vascular cerebral e doença vascular periférica. O risco relativo de morte devido a complicações vasculares é três vezes maior nos pacientes com DM do que na população restante com as doenças cardiovasculares (DCVs), sendo responsáveis por até 80% dos óbitos em portadores de DM. Nesses pacientes o risco de infarto agudo do miocárdio (IAM) é semelhante àquele observado em pessoas sem DM que já tiveram um IAM prévio...
The complications from chronic diabetes mellitus (DM) are resulting from inadequate control, time evolution and disease genetics factors. The chronic microvascular complications include diabetic nephropathy, diabetic retinopathy and diabetic neuropathy. The chronic microvascular complications, as name says itself, are resulting from large-vessels adjustments and it causes acute myocardial infarction, cerebrovascular accident and peripheral arterial disease as well. The relative risk of death due vascular complications is three times bigger in patients with DM than in remaining people with cardiovascular diseases (CVDs) which are responsible for until 80% of obituaries in DM carriers. In these patients, the risk of acute myocardial infarction (AMI) is similar to that observed in people who do not have DM and who had previous IAM...
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Humanos , Masculino , Feminino , Complicações do Diabetes/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Acidente Vascular Cerebral/etiologia , Angiopatias Diabéticas/prevenção & controle , Diabetes Mellitus/genética , Doenças Vasculares Periféricas/etiologia , Infarto do Miocárdio/etiologia , Nefropatias Diabéticas/etiologia , Neuropatias Diabéticas/etiologia , Retinopatia Diabética/etiologia , Fatores de TempoRESUMO
Objetivo: determinar con qué frecuencia se indica la insulina a personas con diabetes mellitus tipo 2 de la provincia Granma y los factores asociados a la indicación de este tratamiento.Métodos: estudio descriptivo transversal con 520 pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, entre septiembre de 2011 y junio de 2013. Los pacientes se dividieron en 2 grupos: con tratamiento insulínico y sin él.Resultados: 308 pacientes (59,2 por ciento), llevaban tratamiento con insulina. De ellos, 156 (30 por ciento) la utilizaban de forma permanente y 152 (29,2 por ciento) de manera transitoria. El porcentaje de pacientes con tratamiento insulínico se incrementó significativamente a medida que aumentaba el tiempo de evolución de la diabetes (p= 0,0000). Los casos con tratamiento insulínico tenían un índice de masa corporal significativamente menor que aquellos que no la utilizaban (p= 0,0000). La presencia de complicaciones microvasculares de la diabetes se asoció notoriamente al uso de insulina (p= 0,0000).Conclusiones: la mayoría de los diabéticos tipo 2 en nuestro medio necesita insulina para su control y su uso está estrechamente relacionado con el tiempo de evolución de la diabetes, el índice de masa corporal, los niveles de glucemia y la presencia de complicaciones vasculares de esta enfermedad....
Objective: to determine how often insulin for people with type 2 diabetes mellitus is indicated in Granma province, and to determine the associated factors with the indication for this treatment. Methods: a cross-sectional descriptive study of 520 type 2 diabetic patients admitted to the Diabetic Care Center of Bayamo, Granma, from September 2011 to June 2013. Patients were divided into two groups: those with insulin therapy with and those with no insulin therapy. Results: 308 patients (59.2 percent) had insulin treatment. 156 (30 percent) out of them used it continuously and 152 (29.2 percent) had it briefly. The percentage of patients with insulin treatment significantly increased, increasing the duration of diabetes (p= 0.0000) as well. Cases with insulin treatment had a significantly lower body mass rate than those who did not use it (p= 0.0000). The presence of microvascular complications of diabetes is notoriously associated with the use of insulin (p= 0.0000). Conclusions: the majority of type 2 diabetics in our country need insulin to control it and its use is closely related to the duration of diabetes, body mass index, blood glucose levels, and the presence of vascular complications of this disease...
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Humanos , /tratamento farmacológico , Insulina/uso terapêutico , Índice de Massa Corporal , Estudos Transversais , Epidemiologia DescritivaRESUMO
Spontaneous pseudoaneurysm regression is a rare event. In particular, the spontaneous regression of a splenic artery pseudoaneurysm has, to our knowledge, been previously documented in only two case reports. Furthermore, the pathophysiological mechanism of this event remains unclear. However, it is fully known that this vascular complication is potentially life-threatening and presents a high mortality rate if untreated. We report the case of a 49-year-old man affected by acute pancreatitis. Computed tomography was performed, and showed a pseudoaneurysm of the splenic artery. This patient underwent endoscopic retrograde cholangiopancreatography to treat the pancreatitis, while the vascular complication was managed with a careful and conservative treatment. On day 6 of hospitalization, a second computed tomography scan was performed and revealed complete regression of the pseudoaneurysm. This case describes the diagnosis and management of splenic artery pseudoaneurysm following acute pancreatitis and its spontaneous regression.
RESUMO
INTRODUÇÃO: A trombose de veia porta foi considerada contraindicação ao transplante de fígado no passado em razão da elevada morbi-mortalidade. Diversos avanços permitiram melhora dos resultados. OBJETIVO: Revisão dos avanços e das estratégias cirúrgicas utilizadas para realização do transplante de fígado na vigência de trombose de veia porta. MÉTODO: Revisão da literatura nas bases de dados Medline, Scielo, Lilacs cruzando os descritores: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Foram estudados a epidemiologia, fatores de risco, classificação, diagnóstico, estratégias cirúrgicas e resultados. CONCLUSÃO: A trombose de veia porta deixou de ser contraindicação para o transplante hepático. O cirurgião dispõe atualmente de uma série de estratégias para realização do transplante, variando conforme o grau da trombose. Apesar de implicar em maior morbidade e taxas de re-trombose, os resultados do transplante na presença de trombose portal são semelhantes aos observados nas séries habituais.
BACKGROUND: Portal vein thrombosis was considered a contraindication for liver transplantation in the past because of the high morbidity and mortality rates. Many advances made the results better. AIM: Review the advances and surgical strategies for liver transplantation in presence of portal vein thrombosis. METHOD: Survey of publications in Medline, Scielo and Lilacs databases. Headings crossed: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Data analyzed were epidemiology, risk factors, classification, diagnosis, surgical strategies and outcomes. CONCLUSION: Portal vein thrombosis is not a contraindication for liver transplantation anymore. There are many strategies to perform the liver transplantation in this condition, depending on portal vein thrombosis grade. Regardless higher morbidity and re-trhombosis rates, the outcomes of liver transplantation in portal vein thrombosis are similar to series without portal vein thrombosis.
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Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Veia Porta , Trombose Venosa/complicaçõesRESUMO
O Diabetes Mellitus (DM) é uma síndrome de etiologia múltipla, decorrente da falta de insulina e/ou da incapacidade de a insulina exercer adequadamente seus efeitos. Caracteriza-se por hiperglicemia crônica, com distúrbios do metabolismo dos carboidratos, lipídios e proteínas. Constitui-se um importante problema de saúde pública, devido à sua elevada prevalência, ao desenvolvimento decomplicações crônicas incapacitantes e ao alto custo econômico gerado pelo seu tratamento. A hiperglicemia é um dos fatores mais importantes para o aparecimento e progressão das complicações vasculares do DM. A elevação persistente nas concentrações da glicose provoca mudanças na estrutura e na função de proteínas plasmáticas e tissulares, com efeitos indesejáveis sobre a saúde do portador de diabetes. O aumento da via dos polióis, glicosilação não-enzimática, com a produção dos produtos finais da glicação avançada (AGEs); estresseoxidativo, gerando o aumento de radicais livres e alteração da proteína kinase C, levando à disfunção endotelial e à aterogênese, são alguns dos mecanismos que tentam explicar o dano vascular induzido pela hiperglicemia. O objetivo desta revisão bibliográfica é discutir os mecanismos pelos quais a hiperglicemia pode desencadear as disfunções vasculares associadas com o DM.
Diabetes Mellitus (DM) is a variable aetiology syndrome due to the lack of insulin and/or its incapacity to achieve its actions. DM is characterized by chronic hyperglycemia, disturbances of carbohydrate, protein and fat metabolism. The disease is an importantpublic health matter because of its high prevalence, development of chronic disabling complications and high economical cost generated by its treatment. Hyperglycemia is one of the most important factors for the emergence and progression of the vascular complications of DM. The persistent elevation of the glucose concentrations provokes changes in the structure and function of plasma and tissue proteins with undesirable effects on the diabetics health. The increase of the polyol pathway, non-enzymatic glycosilation with the production ofadvanced glycation end products (AGEs), oxidative stress causing the increase in free radicals and alteration of protein kinase C leading to atherogenesis and endothelial dysfunction are some of the mechanisms trying to explain the vascular damage induced by hyperglycemia. The purpose of this bibliographic review is to discuss the mechanisms through which hyperglycemia may trigger the vascular dysfunctions linked to DM.
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Diabetes Mellitus , Angiopatias Diabéticas , Hiperglicemia , Hiperglicemia/sangue , SorbitolRESUMO
Objetivo: O objetivo do estudo é apresentar as complicações vasculares arteriais e venosas observadas em um serviço de transplante hepático universitário brasileiro. Métodos: Os prontuários de todos os pacientes submetidos a transplante hepático no período de setembro de 1991 a janeiro de 2000 foram analisados para determinar as complicações vasculares e correlacioná-las a dados clínicos e do procedimento cirúrgico. Resultados:Foram realizados 169 transplantes, sendo quatro inter vivos e nove retransplantes. Um total de 24 complicações vasculares (14,3%) foi identificado em 22 pacientes (13,0%). A complicação vascular mais comum foi atrombose da artéria hepática (15 casos), seguido da trombose da veia porta (quatro casos). Complicações da veia cava inferior infra ou supra-hepática foram incomuns, ocorrendo em um total de três casos (1,8%). As complicações vasculares foram mais freqüentes nas crianças (26,06%) do que em adultos (13,14%) (p<0,05). Dos pacientes com trombose da artéria hepática, um foi submetido à angioplastia, um a trombectomia, oito a retransplante e cinco evoluíram para o óbito enquanto aguardavam retransplante. Dos quatro casos de trombose da veia porta, dois foram a óbito, um foi submetido à colocação percutânea de prótese e um a tratamento conservador. Os pacientescom estenose da veia porta e da veia cava inferior infra e supra-hepática foram submetidos a tratamento conservador, com boa evolução clínica. Conclusões: que as complicações vasculares são freqüentes após o transplante hepático, principalmente em crianças, e são associadas à elevada morbidade, mortalidade e retransplante.
Background: The authors present the vascular complications observed in an academic Brazilian hepatic transplantation division. Methods: Hospital charts of all patients who were submitted to a liver transplantation between of September 1991 and January 2000, were evaluated to determine vascular complications and to correlated them to clinical data and surgical procedures. Results: Of a total of 169 tranplantations performed, four were from living related donors and 9 retransplantations. Twenty-four vascular complications (14,3%) were identified in 22 patients (13,0%), the most common being hepatic artery thrombosis (15 cases) and portal vein thrombosis (4 cases). Complications of the infra and suprahepatic vena cava were observed in three cases (1,8%). Vascular complications were more common in children (26,06%) than in adults (13,14%) (p<0,05). From the patients with hepatic artery thrombosis, one was submitted to an angioplasty, one to a thrombectomy, while eight underwent retransplantation and five died waiting for retransplantation. Of the patients with portal vein thrombosis, two died, one submitted to an endovascular stent placement, and one to conservative treatment. Patients with stenosis of the portal vein and of the infra and suprahepatic inferior vena cava received a conservative treatment, with good clinical recovery. Conclusion: Vascular complications are frequent after liver transplantation, mainly withchildren. They are associated with an elevated rate of morbidity, mortality and retransplantation.