Liver disease, transplant, and exercise

Introdução: A Diabetes Mellitus tipo 1 é uma doença crónica cuja incidência tem vindo a aumentar ao longo dos anos e em idades cada vez mais jovens. Deste modo, é de extrema importância conhecer, reconhecer e saber tratar atempadamente as suas complicações agudas, visto ocorrerem com alguma frequência. As principais complicações são a hipoglicémia e a cetoacidose diabética. Ambas ocorrem em função de alterações bruscas dos níveis de glicemia, quer por aumento exagerado, quer por queda acentuada e, constituem, duas possíveis situações de emergência em Endocrinologia. Objectivos: O fundamento deste trabalho consiste em abordar os mecanismos etiológicos e fisiopatológicos destas duas situações graves e frequentes (em especial a hipoglicémia) e, também, pesquisar o melhor método terapêutico a ser aplicado em cada caso, numa perspectiva clínica. Desenvolvimento: Um controlo glicémico apertado é fundamental para minimizar o aparecimento das complicações crónicas da Diabetes e, para tal, um tratamento agressivo com insulina é crucial. No entanto, a hipoglicémia surge com muita frequência nestes doentes, limitando a optimização da sua aplicação. Todos os diabéticos, assim como os seus familiares, devem saber reconhecer os sinais e sintomas iniciais de uma crise hipoglicémica, de modo a poder agir prontamente com a ingestão de alimentos açucarados ou administração de glucagon, podendo mesmo ser necessário recorrer ao Serviço de Urgência. Para tal é fundamental uma boa educação e aconselhamento médico, assim como uma monitorização apertada dos níveis da glicémia.A cetoacidose diabética, caracterizada por hiperglicémia, cetonémia e acidose metabólica, é outra complicação aguda frequente da Diabetes Tipo 1. Está muitas vezes associada a quadros infecciosos, assim como ao não cumprimento do esquema terapêutico 5 com insulina. O quadro clínico associado a esta condição também deve ser explicado ao diabético para que este possa detectar, quer o aumento da glicémia, quer a presença de corpos cetónicos, podendo administrar insulina antes da deterioração do estado geral. O tratamento consiste fundamentalmente na reposição de fluidos e insulinoterapia sendo, por vezes, necessária a correcção dos distúrbios hidro-electrolíticos. Conclusão: o objectivo deste trabalho consiste numa revisão dos conceitos de hipoglicémia e cetoacidose e uma breve discussão sobre o melhor tratamento para cada caso. No entanto, é de salientar que o melhor método ‘terapêutico’ é, sem dúvida, a prevenção e, para tal, é muito importante uma boa articulação médico-doente, de modo a conseguir diminuir a frequência destas complicações.Introduction: Type 1 Diabetes Mellitus is a chronic disease whose incidence has been increasing over the years and even in younger people. Thus, it is extremely important to know, recognize and treat promptly the acute complications, as they occur with some frequency. The main complications are hypoglycemia and ketoacidosis. They both occur due to sudden changes in blood glucose levels, either by an increase or reduction and are two possible emergencies in Endocrinology. Objectives: The foundation of this work is to address the etiological and pathophysiological mechanisms of these two serious and frequent conditions (especially hypoglycemia), and also search for the best therapeutic method to be applied in each case, in a clinical perspective. Development: A tight glycemic control is essential to minimize the emergence of chronic complications of diabetes and to this end, an aggressive treatment with insulin is crucial. However, hypoglycemia appears quite often in these patients, limiting its optimal 6 implementation. All diabetics and their relatives should recognize the early symptoms of a hypoglycemic crisis, in order to act promptly with the intake of sugary foods or administration of glucagon, and going to de Emergency Room if necessary. For this to happen is necessary a good basic education and medical advice, as well as close monitoring of blood glucose levels.Diabetic ketoacidosis is characterized by hyperglycemia, ketonemia and metabolic acidosis, and is another common acute complication of Type 1 Diabetes. It is often associated with infection, as well as with poor compliance of the insulin regimen. The clinical figure associated with this condition must also be explained to the diabetics so that they can detect either the increase in blood sugar or the ketone bodies, so they can administer insulin before the deterioration of the general condition. The treatment consists primarily in fluid replacement and insulin therapy, and sometimes is necessary to correct the hydro-electrolytic disturbance. Conclusion: The aim of this work is to review the concepts of hypoglycemia and ketoacidosis and a brief discussion about the best treatment for each case. However, it is noteworthy that the best ‘therapeutic’ method is undoubtedly the prevention and, for this to happen, it is very important a good doctor-patient relationship in order to be able to reduce the frequency of these complications

Upper extremity bioimpedance before and after treadmill testing in women post breast cancer treatment

Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is limited in women with breast cancer-related lymphedema (BCRL). The aim of this study was to compare changes in UE volume immediately following a symptom-limited CR treadmill test in women with and without BCRL. As part of a cross-sectional study, 133 women post unilateral BC treatment completed symptom-limited treadmill testing. Bioimpedance spectroscopy (BIS) was used to measure UE resistance before and immediately following treadmill testing. Resistance ratios >1 (unaffected side/affected side) indicate greater volume in the affected limb. T-tests and repeated measures ANOVA were performed to evaluate differences between and within groups. Mean age was 56.2 years (SD 9.4); BMI was 26.13 kg m(-2) (SD 5.04). For women with previously diagnosed BCRL (n = 63), the resistance ratio was 1.116 (SD 0.160) pre-treadmill and 1.108 (SD 0.155) post-treadmill. For women without BCRL (n = 70), the resistance ratio was 0.990 (SD 0.041) pre-treadmill and 1.001 (SD 0.044) post-treadmill. Resistance ratios for women with BCRL were higher than those for women without BCRL at both time points (main effect of group: p < 0.001). No main effects were found for time (p = 0.695). A statistically significant effect was found for the time-by-group interaction (p = 0.002). 78% of the women with BCRL wore a compression garment during testing. Following testing, the women with BCRL demonstrated a non-statistically significant decrease in the resistance ratio, suggesting an immediate decrease in interlimb volume difference. The women without BCRL demonstrated an increase in the resistance ratio

Age, sex, race, initial fitness and response to training : the HERITAGE family study

Effets de l'âge, de la race, du sexe et de la condition physique initiale sur la puissance maximale aérobie de 633 sujets soumis à un test sur ergocycle. Comparaison et analyse des résultat

Age, sex, race, initial fitness and response to training : the HERITAGE family study

Effets de l'âge, de la race, du sexe et de la condition physique initiale sur la puissance maximale aérobie de 633 sujets soumis à un test sur ergocycle. Comparaison et analyse des résultat

Reciprocal relations between physical disability, subjective health, and atrial fibrillation:The Framingham Heart Study

<p>Background Atrial fibrillation (AF)-related symptoms and physical performance are relied upon to guide therapeutic management of patients with AF. We sought to understand whether AF predisposes to or is a result of physical disability and poor subjective health in the community.</p><p>Methods We studied relations between physical disability (Rosow-Breslau Functional Health Scale), subjective health (self-report) and incident AF, and the converse, in the Framingham Heart Study.</p><p>Results In 3,609 participants (age 73 +/- 8 years, 59% women), a subset of 861 participants (24%) had prevalent physical disability at baseline. During 5.8 +/- 1.8 years of follow-up, 555 participants (10-year age-and sex-adjusted incidence rate 13%) developed incident AF. Prevalent physical disability was related to incident AF (multivariable-adjusted hazard ratio 1.25, 95% CI 1.02-1.54, P =.03). In 3,525 participants, prevalent poor subjective health (n = 333) also was related to incident AF (n = 552, multivariable-adjusted hazard ratio 1.31, 95% CI 1.00-1.70, P =.048). Conversely, in 2,080 participants (age 69 +/- 6 years, 55% women), interim AF (n = 106) was associated with newly reported physical disability (n = 573) at a follow-up examination (multivariable-adjusted odds ratio 1.58, 95% CI 1.08-2.31, P =.01). In 1,954 participants, interim AF (n = 96) likewise was related to newly reported poor subjective health (n = 224, multivariable-adjusted odds ratio 1.83, 95% CI 1.10-3.02, P = .02).</p><p>Conclusions Physical disability and poor subjective health were related to incident AF in a community-based cohort. Conversely, interim AF was related to newly reported physical disability and poor subjective health. Because AF guidelines incorporate symptoms, it is essential to clarify the temporality and mechanisms linking physical disability, subjective health, and AF.</p>