65 research outputs found
Diabetic ketoacidosis and hyperosmolar hyperglycemic state
Diabetic ketoacidosis is acute hyperglycaemic complication of DM type 1 patients and this situation of metabolic disturbances develops in a milieu of severe insulin deficiency,usually associated to stress conditions that increase the counterregulatory hormones.Hyperosmolar Hypergycemic state is a specific complication of the DM type 2 patients with predominance of the effects of hyperosmolarity and dehydration, specially involving the central nervous system. Precipitating factors, clinical presentation, basic pathophysiology and treatment of these diabetic hyperglycaemic emergencies are analysed in this review.A cetoacidose diabética é uma complicação aguda, típica dos pacientes com DM tipo I ou insulinodependentes, um conjunto de distúrbios metabólicos, que se desenvolvem em uma situação de deficiência insulínica grave, comumente associada a condições estressantes, que levam a aumento dos hormônios contra-reguladores. O estado hiperglicêmico hiperosmolar é uma complicação aguda, característica do diabético tipo II ou não insulinodependente, quando predominam os efeitos da hiperosmolaridade e desidratação, principalmente envolvendo o sistema nervoso central. Fatores precipitantes, quadro clínico, fisiopatologia básica e tratamento dessas emergências médicas são analisados nesta revisão
DIABETES MELLITUS E INTOLERÂNCIA À GLICOSE EM PACIENTES COM ACROMEGALIA
Acromegaly is a disease caused by growth hormone (GH) overproduction. In this state, carbohydrate metabolism disturbance often occurs. Diabetes mellitus prevalence has been demonstrated between 19 and 56%, and impaired glucose tolerance prevalence between 5 and 46% in many groups of patients with acromegaly. The present study was designed to estimate diabetes mellitus and impaired glucose tolerance prevalence in a group of acromegalic patients assisted in the Endocrinology/Metabology Division of University Hospital of School of Medicine of Ribeirão Preto, São Paulo University (HCFMRP), attempting to also analyze their endocrine and metabolic characteristics. The patients were studied before any therapeutic intervention and were divided in three groups: diabetics, with impaired glucose tolerance and nondiabetics/non impaired glucose tolerance patients. We studied 55 acromegalic patients assisted in HCFMRP. We determined age, sex, weight, height, time of typical acromegalic symptoms upset, and blood GH and glucose during oral glucose tolerance test (oGTT): 0, 30, 60, 90 and 120 minutes. In 19 patients (39,5%) the basal insulin levels were determined in the first sample of the oGTT. Using this data, we calculated body mass index (BMI = weight (kg), divided by square height (meters)), and areas under curves of mean values of GH and glucose in blood during oGTT. Statistical analyzes were processed by Kruskal-Wallis, Mann Whitney and Spearman correlation tests.Among the 55 acromegalic patients studied, 15 (27,3%) were diabetics (DM), 9(16,4%) had impaired glucose tolerance (IG), and 31 (56,4%) did not have blood glucose disturbances (NL). Females were more frequent in DM and IG groups (66,7% in both groups), while women were minority in NL group (29%). DM and IG groups show similar age distribution (45,8+13,1 and 46,3+10,6 years, respectively), and significantly higher age than NL group (36,4+11,1 years; p<0,05). Between the 19 patients whose basal insulin level were obtained, 4 were of the DM group, 6 of the IG group and 9 of the NL group. Mean basal serum insulin level in acromegalic patients, even from the DM, IG or the NL group, was higher than that seen in normal adult population. There was no correlation between areas under GH and glucose curves during oGTT. We did not see statistical differences among the three groups in BMI, activity acromegaly time and area under GH curves during oGTT. In conclusion, we verified increased prevalence of glucose metabolism alterations among our acromegalic patients, associated with female gender, older age, and higher levels of basal serum insulin.A acromegalia é uma doença insidiosa, causada pela secreção excessiva de hormônio do crescimento (GH). Nela, destaca-se a ocorrência freqüente de alteração do metabolismo dos carboidratos, tendo-se verificado, anteriormente, prevalência de diabetes mellitus entre 19 e 56% e de intolerância à glicose entre 5 e 46% em vários grupos populacionais. Neste estudo, objetivamos definir a freqüência de diabetes mellitus e intolerância à glicose em um grupo de pacientes acromegálicos, atendidos na Divisão de Endocrinologia/Metabologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Universidade de São Paulo (HCFMRP), no início do atendimento de cada paciente, antes, portanto da aplicação de qualquer medida terapêutica, procurando também analisar as características endocrinometabólicas desses pacientes, que foram subdivididos em três categorias: diabéticos, intolerantes à glicose e não diabéticos/não intolerantes.Foram analisados os dados de 55 pacientes acromegálicos, atendidos no HCFMRP. Foram registrados os dados de idade, sexo, peso, estatura, tempo do surgimento de sintomas típicos da acromegalia, e níveis sanguíneos de GH e glicemia durante o teste oral de tolerância à glicose (oGTT): aos 0, 30, 60, 90 e 120 min. Em 19 pacientes (39,5%), foi dosado o nível de insulina plasmática na amostra basal do oGTT. A partir dos valores obtidos, calculamos o índice de massa corporal (IMC = peso, em quilogramas, dividido pelo quadrado da estatura, em metros), e as áreas sob as curvas das médias de GH e glicemia no oGTT. As análises estatísticas foram feitas pelos testes de Kruskal-Wallis, de Mann Whitney e de correlação de Spearman, fixando-se intervalo de confiança de 95%.Dos 55 pacientes acromegálicos, estudados, 15 (27,3%) eram diabéticos (DM), 9 (16,4%) apresentavam intolerância à glicose (IG), e 31 (56,4%) não apresentavam alterações dos níveis glicêmicos (NL). Nos grupos DM e IG, predominam indivíduos do sexo feminino (66,7% são mulheres em ambos os grupos), enquanto no grupo NL, as mulheres são minoria (29%). Os grupos DM e IG apresentam distribuição de idades semelhante (45,8±13,1 e 46,3±10,6 anos, respectivamente), e significativamente mais alta do que a do grupo NL (36,4±11,1 anos; p<0,05). Dos 19 pacientes em que foi dosada a insulinemia basal, 4 eram do grupo DM, 6 do grupo IG e 9 do grupo NL. O nível sérico médio de insulina nos pacientes acromegálicos, tanto nos grupos alterados (DM e IG) quanto no grupo NL, é mais elevada do que a encontrada na população adulta normal. Não há correlação entre áreas sob curvas de GH e de glicemia no oGTT. Com relação ao IMC, duração da acromegalia e área sob curvas de GH durante o oGTT, não foram encontradas diferenças estatísticas significativas entre os três grupos. Foi possível observar, portanto, prevalência aumentada dos distúrbios do metabolismo de glicose nos acromegálicos, assim como a associação desses distúrbios com o sexo feminino e com idade mais avançada, além de aumento dos níveis de insulinemia basal
Controle de hiperglicemia intra-hospitalar em pacientes críticos e não-críticos
Hiperglicemia é uma condição frequente encontrada no ambiente intra-hospitalar. Quando presente em pacientes críticos internados pode levar a maior morbi-mortalidade, comprometendo o tratamento da doença de base. Essa revisão tem por objetivo padronizar a conduta terapêutica na hiper e hipoglicemias nos pacientes internados em ambiente hospitalar, de forma a reduzir tempo de internação e mortalidadeHyperglycemia is a common condition found in-hospital environment. When present in critically ill patients admitted can lead to increased morbidity and mortality, affecting the treatment of the underlying disease. This protocol aims to standardize the therapeutic approach in hyper-and hypoglycemia in patients admited to hospital in order to reduce length of stay and mortality.
Management of hypercalcemia and hypocalcemia
No ser humano normal, os níveis de cálcio sérico são mantidos dentro de uma estreita faixa de variação, independentemente do estado alimentar e da atividade física. Desta forma, é possível manter adequadamente as funções intra e extra-celular deste cátion divalente, que incluem: a) estabilidade de membrana, b) participação na cascata de coagulação, c) manutenção do produto iônico, mineral, requerido para o processo de mineralização, d) participação nos processos de excitabilidade e contração do músculo cardíaco e esquelético, e) secreção hormonal, f) segundo mensageiro, mediando a mensagem produzida pela interação de diversos hormônios com seus receptores. O controle dos níveis séricos de cálcio é realizado, principalmente, pelo PTH e 1,25 (OH2 D, que atuam em seus orgãos-alvo, o rim, o tecido ósseo e o trato gastrintestinal. Felizmente, a hipocalcemia e a hipercalcemia graves são ocorrências incomuns, mas, quando presentes, associam-se a elevado índice de morbimortalidade. No entanto, seu pronto reconhecimento e adequado tratamento reduz significativamente os riscos envolvidos e são determinantes para que ocorra uma boa evolução do quadro. Abaixo, descrevemos, de forma objetiva, a avaliação e o tratamento da hipercalcemia e hipocalcemia em sala de urgência.
In the normal human being, the serum calcium levels are kept inside of a narrow range of variation independently of the alimentary state and of physical activity. Therefore, it is possible to maintain the physiological intra and extra-cellular role of this divalent cation which include: a) the stability of membrane, b) participation in the coagulation cascade, c) maintenance of the required mineral ionic product for the mineralization process, d) participation in the excitation and contraction in all forms of skeletal and cardiac muscle, e) hormonal secretion, f) second messenger, mediating the signal induced by the interaction of diverse hormones with their receptors. The regulation of serum calcium levels is maintained by the PTH and 1,25 (OH2 D which control calcium influx and efflux in bone, intestine and kidney. Fortunately, severe hypocalcemia/hypercalcemia are uncommon occurrences, but when are diagnosed are associated with high index of morbidity and mortality. However, its early recognition and introduction of adequate treatment reduces significantly the involved risks and are fundamental for therapeutic success. Below, we describe a practic guide for evaluation and treatment of hypercalcemia and hipocalcemia in emergency room.
 
Obesity and its relationship with cardiovascular risk factors in a Japanese-Brazilian population
OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2% da primeira e 30,8% da segunda geração), com idade > 20 anos, correspondendo a 66,8% da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6% entre os homens e de 25,6% entre as mulheres e a de obesidade foi de 46,3% entre os homens e de 39,0% entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6% e entre as mulheres de 20,8%. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.OBJECTIVE: To describe associations of weight excess and abdominal obesity with cardiovascular risk factors in a Japanese-Brazilian population from Mombuca, Guatapará, SP. METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69.2% first and 30.8% second generation), aged 20 years or more, corresponding to 66.8% of the resident population from this age group. Data were collected through standardized questionnaires and laboratory and physical examinations were performed. RESULTS: Prevalence of overweight and obesity was 29.6% and 46.3% in men and 25.6% and 39.0% in women, respectively. The prevalence of abdominal obesity was 55.6% in men and 20.8% in women. Body mass index was independently associated with triglycerides, waist circumference and age; systolic blood pressure with waist circumference. CONCLUSIONS: Data from the present survey highlight the necessity of interventions to prevent obesity in the Japanese-Brazilian population from Mombuca
Resonance between Noise and Delay
We propose here a stochastic binary element whose transition rate depends on
its state at a fixed interval in the past. With this delayed stochastic
transition this is one of the simplest dynamical models under the influence of
``noise'' and ``delay''. We demonstrate numerically and analytically that we
can observe resonant phenomena between the oscillatory behavior due to noise
and that due to delay.Comment: 4 pages, 5 figures, submitted to Phys.Rev.Lett Expanded and Added
Reference
Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola
<p>Abstract</p> <p>Background</p> <p>To determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a rural community (Bengo) of Angola.</p> <p>Methods</p> <p>A random sample of 421 subjects aged 30 to 69 years (30% men and 70% women) was selected from three villages of Bengo province. This cross-sectional home survey was conducted using a sampling design of stage conglomerates. First, clinical and anthropometric data were obtained and fasting capillary glucose level was determined. Subjects who screened positive (fasting capillary glucose ≥ 100 mg/dl and < 200 mg/dl) and each sixth consecutive subject who screened negative (fasting capillary glucose < 100 mg/dl) were submitted to the second phase of survey, consisting of the 75-g oral glucose tolerance test. Data was analyzed by the use of SAS statistical software.</p> <p>Results</p> <p>The prevalence rates of diabetes mellitus and IGT were 2.8% and 8.1%, respectively. The age group with the highest prevalence of diabetes was 60 to 69 years (42%). Impaired glucose tolerance prevalence was 38% in the 40 to 49 year age group and it increased with age, considering that the 50 to 59 and 60 to 69 year age groups as a whole represent 50% of all subjects with impaired glucose tolerance. The prevalence of diabetes mellitus did not differ significantly between men (3.2%) and women (2.7%) (p = 0.47). On the other hand, the prevalence of impaired glucose tolerance among women showed almost twice that found in men (9.1% vs. 5.6%, respectively). Overweight was present in 66.7% of the individuals with diabetes mellitus and 26.5% of individuals with impaired glucose tolerance showed overweight or obesity.</p> <p>Conclusions</p> <p>Although the prevalence of diabetes mellitus was low, the prevalence of impaired glucose tolerance is considered to be within an intermediary range, suggesting a future increase in the frequency of diabetes in this population.</p
Prevalence of the metabolic syndrome using two proposed definitions in a Japanese-Brazilians community
Metabolic Syndrome (MetS) is associated with increased risk of morbi-mortality, thus the characterization of the population magnitude of this syndrome is critical for allocating health care. However, prevalence estimates of MetS in the same population could differ depending on the definition used. Therefore, we compared the prevalence of the MetS using definitions proposed by: National Cholesterol Education Panel Revised (NCEP) and International Diabetes Federation (IDF) 2009 in a Japanese-Brazilians community (131 individuals, age 57 ± 16 years, 1st and 2nd generation). All individuals went through a clinical and laboratorial evaluation for assessment of weigh, height, waist circumference, blood pressure, triglycerides, HDL-cholesterol and fasting plasma glucose. The prevalence of MetS was 26.7% (n = 35) and 37.4% (n = 49) under the NCEP and IDF definitions, respectively. Despite higher blood pressure measurements, waist circumference and serum triglyceride levels and lower HDL cholesterol levels (p < 0.01), individuals identified with MetS did not show increased blood glucose levels. IDF definition classified 14 individuals (10.7%) with MetS that were not classified under the NCEP and 35 individuals were identified with MetS by both criteria. We observed, in this group, more severe lipid disorders, compared to individuals identified only under the IDF definition, and the BMI and waist circumference (p = 0.01; p = 0.006, respectively) were lower. In conclusion, the IDF revised criteria, probably because of the ethnic specific values of waist circumference, was able to identify a larger number of individuals with MetS. However, our data suggesting that additional studies are necessary to define best MetS diagnostic criteria in this population.We are grateful to patients participating in this study and to Sebastiao L. Brandao Filho for technical assistance.This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sector
Endoplasmic reticulum stress activation in adipose tissue induces metabolic syndrome in individuals with familial partial lipodystrophy of the Dunnigan type
Multiprofessional care of patients with diabetes mellitus at the endocrinology outpatient clinic of the university hospital of the Ribeirão Preto school of medicine (HCFMRP-USP)
The present study describes the flow of care delivery and activities with patients carriers of diabetes mellitus by a health multiprofessional team from the Endocrinology Outpatient Clinic of the University Hospital of the Ribeirão Preto School of Medicine. This program, according to the proposal of the America’s Declaration about Diabetes, aims at assuring to diabetes carriers conditions to acquire knowledge and skills regarding self-care.O presente estudo descreve o fluxo de atendimento e as atividades desenvolvidas pela equipe multiprofissional de saúde do Ambulatório de Endocrinologia e Metabologia do HCFMRPUSP, junto aos pacientes com diabetes mellitus. Este programa, em consonância aos propósitos da Declaração das Américas sobre Diabetes, visa assegurar que os pacientes com diabetes estejam em condições de adquirir conhecimentos e aptidões para o autocuidado
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