Body composition and sexual hormones for the glucose control of autoimmune diabetes in males: are they necessary to predict diabetes-related complications?

BackgroundGlucose control in diabetes is essential for avoiding diabetes-related complications.AimTo determine the impact of body composition and sexual hormones in glucose control and diabetes-related complications, in males with autoimmune diabetes.Patients and methodsThirty-nine patients with autoimmune diabetes and flash glucose monitoring were included. A morphofunctional nutritional evaluation with bioelectrical impedance vector analysis (BIVA), abdominal adipose tissue ultrasound, rectus femoris ultrasound and biochemical parameters, was performedResultsStrong, positive correlations were observed between body composition parameters, biochemical variables and sexual hormones (p<0.05). Adipose tissue measured by BIVA and ultrasound was more significantly associated with glucose control (including time in range >70%, glucose variability <36% determined by flash glucose monitoring; p<0.05) and the presence of microvascular/macrovascular complications (p<0.05) than lean mass. After adjusting by the duration of diabetes, BMI, abdominal circumference, fat mass and phase angle increased the risk for microvascular complications (OR 1.32(1.00 – 1.73), OR 1.06(1.00 – 1.12), OR 1.14(1.01 – 1.20), 0R 0.3(0.10 – 0.91) respectively; for macrovascular complications: BMI OR 1.38(1.04 – 1.84) and fat mass OR 1.26(1.00 – 1.58)]. Sexual hormone levels did not influence on glucose control or the development of diabetes-related complications.ConclusionAnthrpometric parameters, especially adipose tissue, were associated with glucose control and variability determined by flash glucose monitoring. Furthermore, changes in fat and lean mass were associated with the presence of microvascular and macrovascular complications. Thus, a comprehensive nutritional evaluation might be useful for the evaluation of males with autoimmune diabetes, in order to identify patients with increased risk of complications

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Hiperlipidemia durante la diabetes gestacional, complicaciones maternas y para la descendencia.

lipid profile suffers adaptive changes during pregnancy due to estrogen stimulation and insulin resistance. Several relations have been suggested between maternal lipid profile, glucose tolerance, endothelial cell dysfunction and long-term cardiovascular risk; the effects of maternal lipid profile metabolism in fetal growth are also inconclusive. Since a regular evaluation and follow-up of lipid profile during pregnancy has not been established yet, we aimed to evaluate the incidence of dyslipidemia in patients with gestational diabetes (GDM) and analyze some putative relations with pregnancy, offspring complications and maternal metabolic syndrome parameters determined three and twelve months after delivery. two hundred and fifty patients with GDM were included. Full medical history, offspring characteristics, lipid profile and maternal variables of metabolic syndrome were evaluated during pregnancy and three- and twelve-months after delivery. The incidence of dyslipidemia during pregnancy was determined using two different classifications. lower plasma HDL and hypertriglyceridemia were the most current disorders; prematurity or birth weight were not correlated with dyslipidemia. During pregnancy, the lipid-related parameter that better predicted the risk of offspring macrosomia was triglycerides (TG). High TG three months after delivery were correlated to macrosomia and metabolic syndrome variables before and after pregnancy (three and twelve months). TG during pregnancy is the parameter that best predicts the risk of macrosomia and is related to increased metabolic risk after delivery. The evaluation of lipid profile and other metabolic variables during pregnancy and after delivery is required to early diagnose cardiovascular risk factors, especially in high risk population

Diabetes mellitus : proceso asistencial integrado. 2ª ed

Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados). Este proceso reemplaza a la 1ª edición, editada en 2011YesLa Gestión por Procesos Asistenciales Integrados (PAIs) se inició con el I Plan de Calidad y se ha mantenido en el sistema sanitario público andaluz hasta la fecha actual, como parte integrante del III Plan de Calidad del SSPA. A través de esta estrategia se pretende y consigue disminuir la variabilidad en las actuaciones clínicas, se reordenan los flujos de trabajo, se identifican las actuaciones que aportan valor añadido y se facilita la tarea de los profesionales, con el fin último de mejorar la calidad de la asistencia y la satisfacción de los ciudadanos con la atención recibida. Los PAIs se identifican por tanto como herramientas facilitadoras de la práctica clínica y de la continuidad de la atención al paciente. La definición de las actuaciones y los profesionales que intervienen en ellas a través del análisis de la mejor evidencia disponible se complementa en los PAIs actuales con la identificación de aquéllas que no aportan valor, una oportunidad de contribuir desde la práctica clínica diaria a la sostenibilidad de nuestro SSPA. La diabetes, por su elevada prevalencia e impacto sanitario y social, constituye una de las enfermedades crónicas en las que esta estrategia cobra todo su sentido. El análisis de resultados en salud elaborado en el año 2016 como parte de la actualización del Plan Integral de Diabetes ha demostrado una mejoría de los resultados en morbimortalidad en diabetes en nuestra comunidad y consolida esta metodología de trabajo. El PAI Diabetes actualizado que presentamos, además de revisar y renovar las características de calidad del proceso diagnóstico-terapéutico de la persona con diabetes ya incluido en el previo, incorpora además contenidos específicos en la atención a la mujer gestante, la infancia o el paciente hospitalizado y sistematiza la educación terapéutica, como un elemento transversal a lo largo de todo el proceso

Diabetes mellitus : proceso asistencial integrado. 3ª ed

YesLa Gestión por Procesos Asistenciales Integrados (PAIs) se inició con el I Plan de Calidad y se ha mantenido en el sistema sanitario público andaluz hasta la fecha actual, como parte integrante del III Plan de Calidad del SSPA. A través de esta estrategia se pretende y consigue disminuir la variabilidad en las actuaciones clínicas, se reordenan los flujos de trabajo, se identifican las actuaciones que aportan valor añadido y se facilita la tarea de los profesionales, con el fin último de mejorar la calidad de la asistencia y la satisfacción de los ciudadanos con la atención recibida. Los PAIs se identifican por tanto como herramientas facilitadoras de la práctica clínica y de la continuidad de la atención al paciente. El PAI Diabetes actualizado que presentamos, además de revisar y renovar las características de calidad del proceso diagnóstico-terapéutico de la persona con diabetes ya incluido en el previo, incorpora además contenidos específicos en la atención a la mujer gestante, la infancia o el paciente hospitalizado y sistematiza la educación terapéutica, como un elemento transversal a lo largo de todo el proceso

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation

Notes for genera – Ascomycota

Knowledge of the relationships and thus the classification of fungi, has developed rapidly with increasingly widespread use of molecular techniques, over the past 10--15 years, and continues to accelerate. Several genera have been found to be polyphyletic, and their generic concepts have subsequently been emended. New names have thus been introduced for species which are phylogenetically distinct from the type species of particular genera. The ending of the separate naming of morphs of the same species in 2011, has also caused changes in fungal generic names. In order to facilitate access to all important changes, it was desirable to compile these in a single document. The present article provides a list of generic names of Ascomycota (approximately 6500 accepted names published to the end of 2016), including those which are lichen-forming. Notes and summaries of the changes since the last edition of `Ainsworth Bisby's Dictionary of the Fungi' in 2008 are provided. The notes include the number of accepted species, classification, type species (with location of the type material), culture availability, life-styles, distribution, and selected publications that have appeared since 2008. This work is intended to provide the foundation for updating the ascomycete component of the ``Without prejudice list of generic names of Fungi'' published in 2013, which will be developed into a list of protected generic names. This will be subjected to the XIXth International Botanical Congress in Shenzhen in July 2017 agreeing to a modification in the rules relating to protected lists, and scrutiny by procedures determined by the Nomenclature Committee for Fungi (NCF). The previously invalidly published generic names Barriopsis, Collophora (as Collophorina), Cryomyces, Dematiopleospora, Heterospora (as Heterosporicola), Lithophila, Palmomyces (as Palmaria) and Saxomyces are validated, as are two previously invalid family names, Bartaliniaceae and Wiesneriomycetaceae. Four species of Lalaria, which were invalidly published are transferred to Taphrina and validated as new combinations. Catenomycopsis Tibell Constant. is reduced under Chaenothecopsis Vain., while Dichomera Cooke is reduced under Botryosphaeria Ces. De Not. (Art. 59)