RESUMO
In order to evaluate the performance of a 1-h 75-g oral glucose tolerance test (OGTT) for the diagnosis of gestational diabetes mellitus (GDM), a cohort of 4998 women, 20 years or older, without previous diabetes being treated in prenatal care clinics in Brazil answered a questionnaire and performed a 75-g OGTT including fasting, 1-h and 2-h glucose measurements between their 24th and 28th gestational weeks. Pregnancy outcomes were transcribed from medical registries. GDM was defined according to WHO criteria (fasting: >/=126 mg/dL; 2-h value: >/=140 mg/dL) and macrosomia as a birth weight equal to or higher than 4000 g. Areas under the receiver operator characteristic curve (AUC) were compared and diagnostic properties of various cut-off points were evaluated. The AUCs for the prediction of macrosomia were 0.606 (0.572-0.637) for the 1-h and 0.589 (0.557-0.622) for the 2-h plasma glucose test. Similar predictability was demonstrable regarding combined adverse outcomes: 0.582 (0.559-0.604) for the 1-h test and 0.572 (0.549-0.595) for the 2-h test. When the 1-h glucose test was evaluated against a diagnosis of GDM defined by the 2-h glucose test, the AUC was 0.903 (0.886-0.919). The cut-off point that maximized sensitivity (83%) and specificity (83%) was 141 mg/dL, identifying 21% of the women as positive. A cut-off point of 160 mg/dL, with lower sensitivity (62%), had higher specificity (94%), labeling 8.6% as positive. Detection of GDM can be done with a 1-h 75-g OGTT: the value of 160 mg/dL has the same diagnostic performance as the conventional 2-h value (140 mg/dL). The simplification of the test may improve coverage and timing of the diagnosis of GDM.
Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Adulto , Glicemia/análise , Estudos de Coortes , Feminino , Humanos , Programas de Rastreamento , Valor Preditivo dos Testes , Gravidez , Curva ROC , Sensibilidade e Especificidade , Adulto JovemRESUMO
In order to evaluate the performance of a 1-h 75-g oral glucose tolerance test (OGTT) for the diagnosis of gestational diabetes mellitus (GDM), a cohort of 4998 women, 20 years or older, without previous diabetes being treated in prenatal care clinics in Brazil answered a questionnaire and performed a 75-g OGTT including fasting, 1-h and 2-h glucose measurements between their 24th and 28th gestational weeks. Pregnancy outcomes were transcribed from medical registries. GDM was defined according to WHO criteria (fasting: greater than or equal to 126 mg/dL; 2-h value: greater than or equal to 140 mg/dL) and macrosomia as a birth weight equal to or higher than 4000 g. Areas under the receiver operator characteristic curve (AUC) were compared and diagnostic properties of various cut-off points were evaluated. The AUCs for the prediction of macrosomia were 0.606 (0.572-0.637) for the 1-h and 0.589 (0.557-0.622) for the 2-h plasma glucose test. Similar predictability was demonstrable regarding combined adverse outcomes: 0.582 (0.559-0.604) for the 1-h test and 0.572 (0.549-0.595) for the 2-h test. When the 1-h glucose test was evaluated against a diagnosis of GDM defined by the 2-h glucose test, the AUC was 0.903 (0.886-0.919). The cut-off point that maximized sensitivity (83%) and specificity (83%) was 141 mg/dL, identifying 21% of the women as positive. A cut-off point of 160 mg/dL, with lower sensitivity (62%), had higher specificity (94%), labeling 8.6% as positive. Detection of GDM can be done with a 1-h 75-g OGTT: the value of 160 mg/dL has the same diagnostic performance as the conventional 2-h value (140 mg/dL). The simplification of the test may improve coverage and timing of the diagnosis of GDM.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Glicemia/análise , Estudos de Coortes , Programas de Rastreamento , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Adulto JovemRESUMO
We bacteriologically analyzed 156 species of Enterobacteriaceae, isolated from 138 patients with community-acquired diabetic foot ulcers, in a prospective study made at a diabetic center and at the Federal University of Ceará, Brazil, from March, 2000, to November, 2001. The samples were cultured using selective media, and identification, susceptibility tests and detection of plasmid-mediated-extended-spectrum-beta-lactamase (ESBL) producing strains were made with conventional and automated methods. The most frequently occurring pathogens were K. pneumoniae (21.2%), Morganella morganii (19.9%) and E. coli (15.4%). High resistance rates were noted for ampicillin, first generation cephalosporin, trimethoprim/sulfamethoxazole, tetracycline, amoxicillin-clavulanic acid and chloramphenicol. ESBL-producing strains were detected in 6% of the patients. Resistance among gram-negative bacteria has become increasingly common, even in community-acquired infections.
Assuntos
Antibacterianos/farmacologia , Pé Diabético/microbiologia , Enterobacteriaceae/enzimologia , beta-Lactamases/metabolismo , Diabetes Mellitus Tipo 2/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Humanos , Plasmídeos , Estudos Prospectivos , Resistência beta-LactâmicaRESUMO
We bacteriologically analyzed 156 species of Enterobacteriaceae, isolated from 138 patients with community-acquired diabetic foot ulcers, in a prospective study made at a diabetic center and at the Federal University of Ceará, Brazil, from March, 2000, to November, 2001.The samples were cultured using selective media, and identification, susceptibility tests and detection of plasmid-mediated-extended-spectrum-beta-lactamase (ESBL) producing strains were made with conventional and automated methods. The most frequently occurring pathogens were K. pneumoniae (21.2 percent), Morganella morganii (19.9 percent) and E. coli (15.4 percent). High resistance rates were noted for ampicillin, first generation cephalosporin, trimethoprim/sulfamethoxazole, tetracycline, amoxicillin-clavulanic acid and chloramphenicol. ESBL-producing strains were detected in 6 percent of the patients. Resistance among gram-negative bacteria has become increasingly common, even in community-acquired infections
Assuntos
Humanos , Antibacterianos , beta-Lactamases , Diabetes Mellitus Tipo 2 , Pé Diabético , Enterobacteriaceae , Infecções por Enterobacteriaceae , Resistência beta-Lactâmica , Brasil , Infecções Comunitárias Adquiridas , Enterobacteriaceae , Infecções por Enterobacteriaceae , Testes de Sensibilidade Microbiana , Estudos ProspectivosRESUMO
AIMS: To describe the prevalence of gestational diabetes mellitus (GDM) according to the 1998 WHO provisional recommendations and compare it to that found with previous 1985 WHO criteria. METHODS: A total of 5564 consecutive women aged 20 years or more without diagnosis of diabetes mellitus outside of pregnancy in general prenatal care clinics of the National Health Service in 6 state capitals of Brazil, between their 20th and 28th gestational weeks were enrolled. RESULTS: Of the 5004 women who completed a 75-g oral glucose tolerance test, 379 (7.6%, 95% confidence interval (CI) 6.9% to 8.4%) had GDM by the 1998 criteria (fasting glucose > or = 7.0 mmol/l or 2 h glucose > or = 7.8 mmol/l). Of these 379 cases, only 21 (5.5%) had hyperglycaemia in the range considered diabetes mellitus outside pregnancy (fasting glucose > or = 7.0 mmol/l or 2 h glucose > or = 11.1 mmol/l); the remaining 358 (94.5%) had hyperglycaemia in the impaired glucose tolerance range (fasting glucose < 7.0 and 2 h glucose > or = 7.8 mmol/l and < 11.1 mmol/l). Using the 1985 criteria (fasting or 2 h glucose > or = 7.8 mmol/l), 378 cases of GDM were found, 15 in the diabetes range and 363 in the impaired glucose tolerance range. CONCLUSIONS: Prevalence of GDM is minimally altered by the new WHO definition. Although GDM is a common condition, the vast majority of the cases have hyperglycaemia in the range considered impaired glucose tolerance outside pregnancy.
Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Organização Mundial da Saúde , Adulto , Glicemia/análise , Jejum , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez , Valores de ReferênciaRESUMO
A autora faz uma abordagem da literatura pertinente aos mecanismos geradores da microangiopatia diabetica, focalizando sobretudo a nefropatia e seus aspectos bioquimico-estruturais, no sentido de correlacionar alteracoes de membranas e sensibilidade de receptores. Apresentam tambem um enfoque sobre o controle metabolico dos receptores adrenergicos e suas alteracoes no diabetes mellitus.Conclusoes de seus estudos sobre o receptor vascular adrenergico de rins de coelhos diabeticos sao enfatizados. Uma hipotese e sugerida, na qual alteracoes na sensibilidade do receptor a agonistas adrenergicos poderia ser o sitio primario de um fenomeno mais geral, isto e, a nefropatia diabetica