RESUMO
The purpose of this study was to look at the determinants of the unsteady walking (UW) symptom in patients with type 2 diabetes mellitus (T2DM) by defining if UW and/or the Diabetic Neuropathy Symptoms Score (DNSS) are associated with positive scores in Beck's Depression Inventory (BDI) and with a positive Michigan Neuropathy Screening Instrument score (MNSI). We evaluated 203 T2DM patients without visible gait disturbances. They were divided into UW (+) and UW (-) or DNSS (+) and DNSS (-) according to symptoms. We found a prevalence of 48.3% for UW (+) and of 63% for DNSS (+) in our sample. In univariate analysis, the presence of UW was significantly associated with waist circumference (P=0.024), number of comorbidities (P=0.012), not practicing physical exercise (P=0.011), positive BDI score (P=0.003), presence of neuropathic symptoms by the MNSI questionnaire (P<0.001), and positive diabetic neuropathy screening by MNSI (P=0.021). In multivariate analysis, UW (used as a dependent variable) was independently associated with a positive BDI score (P<0.001; 95%CI=1.01-1.03), T2DM duration (P=0.023; 95%CI=1.00-1.03), number of co-morbidities (P=0.032; 95%CI=1.01-1.37), and a sedentary lifestyle (P=0.025; 95%CI=1.06-2.5). The UW symptom and a positive DNSS are more closely related to a positive score for depression than to presence of neuropathy in T2DM.
Assuntos
Depressão/psicologia , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/complicações , Comportamento Sedentário , Transtornos de Sensação/etiologia , Caminhada/fisiologia , Estudos Transversais , Neuropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de DoençaRESUMO
The purpose of this study was to look at the determinants of the unsteady walking (UW) symptom in patients with type 2 diabetes mellitus (T2DM) by defining if UW and/or the Diabetic Neuropathy Symptoms Score (DNSS) are associated with positive scores in Beck's Depression Inventory (BDI) and with a positive Michigan Neuropathy Screening Instrument score (MNSI). We evaluated 203 T2DM patients without visible gait disturbances. They were divided into UW (+) and UW (−) or DNSS (+) and DNSS (−) according to symptoms. We found a prevalence of 48.3% for UW (+) and of 63% for DNSS (+) in our sample. In univariate analysis, the presence of UW was significantly associated with waist circumference (P=0.024), number of comorbidities (P=0.012), not practicing physical exercise (P=0.011), positive BDI score (P=0.003), presence of neuropathic symptoms by the MNSI questionnaire (P<0.001), and positive diabetic neuropathy screening by MNSI (P=0.021). In multivariate analysis, UW (used as a dependent variable) was independently associated with a positive BDI score (P<0.001; 95%CI=1.01-1.03), T2DM duration (P=0.023; 95%CI=1.00-1.03), number of co-morbidities (P=0.032; 95%CI=1.01-1.37), and a sedentary lifestyle (P=0.025; 95%CI=1.06-2.5). The UW symptom and a positive DNSS are more closely related to a positive score for depression than to presence of neuropathy in T2DM.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Depressão/psicologia , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/complicações , Comportamento Sedentário , Transtornos de Sensação/etiologia , Caminhada/fisiologia , Estudos Transversais , Neuropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/psicologia , Programas de Rastreamento , Prevalência , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To evaluate the efficacy of a single prophylactic dose of actinomycin D (Act-D) in the reduction of postmolar gestational trophoblastic neoplasia (GTN) in adolescents with high-risk hydatidiform mole (Hr-HM). METHODS: In a retrospective study, 60 adolescents with Hr-HM were selected from a cohort of patients with gestational trophoblastic disease (GTD) followed at Santa Casa, Porto Alegre, Brasil. Twenty-nine received a single dose of Act-D at the time of uterine evacuation as prophylactic chemotherapy (P-chem) (study group) and 31 patients with the same risk factors did not received P-chem (control group). Patient follow-up was the same in both groups. Each group was analyzed for number of adolescents with postmolar GTN, morbidity associated with postmolar GTN, and reproductive outcomes. RESULTS: Postmolar GTN was diagnosed in two (6.9%) adolescents (95% CI, 0.0-16.1) in the study group and in 9 (29.0%) patients (95% CI, 13-45) in the control group. The reduction of postmolar GTN with a single dose of Act-D used as P-chem was 76% (relative risk = 0.24; 95% CI, 0.06-0.99). Adverse effects of P-chem were minor. In the follow-up, when postmolar GTN were diagnosed, severity of disease was not increased, compliance with follow-up was not reduced, and reproductive outcomes after discharge were similar. CONCLUSIONS: P-chem with a single dose of Act-D reduced postmolar GTN in 76% during follow-up of adolescents with Hr-HM. Since this regimen may reduce treatment costs, without affecting compliance with follow-up, it can be adopted by any Trophoblastic Disease Center.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Dactinomicina/uso terapêutico , Doença Trofoblástica Gestacional/prevenção & controle , Mola Hidatiforme/cirurgia , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Gravidez , Reprodução , Estudos RetrospectivosRESUMO
Streptozotocin (STZ)-induced diabetes in rats is characterized by cardiovascular dysfunction beginning 5 days after STZ injection, which may reflect functional or structural autonomic nervous system damage. We investigated cardiovascular and autonomic function, in rats weighing 166 ± 4 g, 5-7, 14, 30, 45, and 90 days after STZ injection (N = 24, 33, 27, 14, and 13, respectively). Arterial pressure (AP), mean AP (MAP) variability (standard deviation of the mean of MAP, SDMMAP), heart rate (HR), HR variability (standard deviation of the normal pulse intervals, SDNN), and root mean square of successive difference of pulse intervals (RMSSD) were measured. STZ induced increased glycemia in diabetic rats vs control rats. Diabetes reduced resting HR from 363 ± 12 to 332 ± 5 bpm (P < 0.05) 5 to 7 days after STZ and reduced MAP from 121 ± 2 to 104 ± 5 mmHg (P = 0.007) 14 days after STZ. HR and MAP variability were lower in diabetic vs control rats 30-45 days after STZ injection (RMSSD decreased from 5.6 ± 0.9 to 3.4 ± 0.4 ms, P = 0.04 and SDMMAP from 6.6 ± 0.6 to 4.2 ± 0.6 mmHg, P = 0.005). Glycemia was negatively correlated with resting AP and HR (r = -0.41 and -0.40, P < 0.001) and with SDNN and SDMMAP indices (r = -0.34 and -0.49, P < 0.01). Even though STZ-diabetic rats presented bradycardia and hypotension early in the course of diabetes, their autonomic function was reduced only 30-45 days after STZ injection and these changes were negatively correlated with plasma glucose, suggesting a metabolic origin.
Assuntos
Animais , Masculino , Ratos , Sistema Nervoso Autônomo/fisiopatologia , Bradicardia/fisiopatologia , Diabetes Mellitus Experimental/fisiopatologia , Hiperglicemia/fisiopatologia , Glicemia , Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Ratos Wistar , Estreptozocina , Fatores de TempoRESUMO
Streptozotocin (STZ)-induced diabetes in rats is characterized by cardiovascular dysfunction beginning 5 days after STZ injection, which may reflect functional or structural autonomic nervous system damage. We investigated cardiovascular and autonomic function, in rats weighing 166 +/- 4 g, 5-7, 14, 30, 45, and 90 days after STZ injection (N = 24, 33, 27, 14, and 13, respectively). Arterial pressure (AP), mean AP (MAP) variability (standard deviation of the mean of MAP, SDMMAP), heart rate (HR), HR variability (standard deviation of the normal pulse intervals, SDNN), and root mean square of successive difference of pulse intervals (RMSSD) were measured. STZ induced increased glycemia in diabetic rats vs control rats. Diabetes reduced resting HR from 363 +/- 12 to 332 +/- 5 bpm (P < 0.05) 5 to 7 days after STZ and reduced MAP from 121 +/- 2 to 104 +/- 5 mmHg (P = 0.007) 14 days after STZ. HR and MAP variability were lower in diabetic vs control rats 30-45 days after STZ injection (RMSSD decreased from 5.6 +/- 0.9 to 3.4 +/- 0.4 ms, P = 0.04 and SDMMAP from 6.6 +/- 0.6 to 4.2 +/- 0.6 mmHg, P = 0.005). Glycemia was negatively correlated with resting AP and HR (r = -0.41 and -0.40, P < 0.001) and with SDNN and SDMMAP indices (r = -0.34 and -0.49, P < 0.01). Even though STZ-diabetic rats presented bradycardia and hypotension early in the course of diabetes, their autonomic function was reduced only 30-45 days after STZ injection and these changes were negatively correlated with plasma glucose, suggesting a metabolic origin.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Bradicardia/fisiopatologia , Diabetes Mellitus Experimental/fisiopatologia , Hiperglicemia/fisiopatologia , Animais , Glicemia , Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Masculino , Ratos , Ratos Wistar , Estreptozocina , Fatores de TempoRESUMO
Increased expression of transforming growth factor beta-1 (TGF-beta 1) and glucose transporter (GLUT1) has been implicated in the genesis of diabetic nephropathy. The aim of this study was to evaluate GLUT1 protein levels in the renal cortex of a rat model of diabetes as well as its relationship to urinary albumin and TGF-beta1. Streptozotocin-injected rats (n = 13) and controls (n = 13) were compared for their urinary albumin, and TGF-beta 1 and for renal cortical and medullar GLUT1 protein abundance. GLUT1 protein content was determined by optical densitometry after Western blotting using an anti-GLUT1 antibody; urinary albumin was measured using electroimmunoassay, urinary TGF-beta 1 using ELISA. Forty-five days of diabetes resulted in increased albuminuria (p < 0.05), urinary TGF-beta 1 (p < 0.05) and GLUT1 protein abundance (p < 0.05). There was a positive correlation between urinary TGF-beta 1 and plasma glucose levels (r = 0.65, p < 0.05) and albuminuria (r = 0.72, p < 0.05). We concluded that 45 days of diabetes result in incipient diabetic nephropathy and increased cortical GLUT1 protein abundance. We speculate that the higher cortical GLUT1 protein levels in diabetes may amplify the effects of hyperglycemia in determining higher intracellular glucose in mesangial cells, thereby contributing to diabetes-related kidney damage.
Assuntos
Diabetes Mellitus Experimental/metabolismo , Nefropatias Diabéticas/metabolismo , Proteínas de Transporte de Monossacarídeos/biossíntese , Fator de Crescimento Transformador beta/urina , Albuminúria/urina , Animais , Glicemia/metabolismo , Western Blotting , Peso Corporal , Diabetes Mellitus Experimental/urina , Nefropatias Diabéticas/urina , Transportador de Glucose Tipo 1 , Córtex Renal/metabolismo , Masculino , Proteínas de Transporte de Monossacarídeos/urina , Ratos , Ratos Wistar , Fator de Crescimento Transformador beta/biossínteseRESUMO
Incidentalomas of the thyroid are common small nodules found occasionally during imaging procedures. Their pathological nature is generally benign, but about 4% may harbour malignant tissue. Most current studies only suggest clinical follow-up, but there are no data about the natural history of malignant incidentalomas. The authors describe a patient with multiple incidentaloma of the thyroid submitted to fine-needle aspiration biopsy because his larger nodule grew 50% in 3 months at ultrasonographic follow-up. The cytological examination suggested thyroid malignancy in this nodule and surgical pathology showed multicentric papillary carcinoma. This case suggests that the larger diameter of a malignant incidentaloma may change rapidly. If more time had been spent before repeating the ultrasonography, the volume could have changed even more and the prognosis could have been changed as indicated by most prognostic score indexes.
Assuntos
Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Adulto , Biópsia por Agulha , Carcinoma Papilar/cirurgia , Terapia Combinada , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Prognóstico , Neoplasias da Glândula Tireoide/cirurgia , UltrassonografiaRESUMO
A field trial was carried out during summer 1996 in a commercial beef cattle farm located in the central area of Argentina (30 degrees 16'S, 60 degrees 30'W) to evaluate the efficacy of a new insect growth regulator material (dicyclanil) in the prevention of myiosis caused by screwworm (Cochliomyia hominivorax) larvae. Forty bull calves (Bos indicus x Bos taurus), 5 to 6 months old were allocated by ranked paris to a control (G.1) and a treated group (G.2) of the same number of animals. On day 0, all experimental animals were surgically castrated and calves of group 2 were treated topically with 20 ml as a single dose of a ready-to-use formulation containing 5% w/v dicyclanil. Inspections for screwworm larva infestation were carried out on days 4, 8, 12, 16, 19, 23 and 25 after castration. The incidence of egg masses on the scrotal wounds evidenced a similar challenge for all groups (P > 0.05 chi(2)). However, 16 animals of G.1 (80%) and only one of G.2 (5%) developed active myiosis, respectively. This difference was significant (P=0.003 X(2)).
Assuntos
Doenças dos Bovinos/prevenção & controle , Hormônios Juvenis/uso terapêutico , Orquiectomia/veterinária , Infecção por Mosca da Bicheira/veterinária , Infecção da Ferida Cirúrgica/veterinária , Administração Tópica , Animais , Argentina , Bovinos , Doenças dos Bovinos/parasitologia , Dípteros/efeitos dos fármacos , Dípteros/fisiologia , Hormônios Juvenis/administração & dosagem , Hormônios Juvenis/farmacologia , Masculino , Orquiectomia/efeitos adversos , Contagem de Ovos de Parasitas/veterinária , Infecção por Mosca da Bicheira/parasitologia , Infecção por Mosca da Bicheira/prevenção & controle , Infecção da Ferida Cirúrgica/parasitologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
Autonomic neuropathy is a frequent complication of diabetes associated with higher morbidity and mortality in symptomatic patients, possibly because it affects autonomic regulation of the sinus node, reducing heart rate (HR) variability which predisposes to fatal arrhythmias. We evaluated the time course of arterial pressure and HR and indirectly of autonomic function (by evaluation of mean arterial pressure (MAP) variability) in rats (164.5 + 1.7 g) 7, 14, 30 and 120 days after streptozotocin (STZ) injection, treated with insulin, using measurements of arterial pressure, HR and MAP variability. HR variability was evaluated by the standard deviation of RR intervals (SDNN) and root mean square of successive difference of RR intervals (RMSSD). MAP variability was evaluated by the standard deviation of the mean of MAP and by 4 indices (P1, P2, P3 and MN) derived from the three-dimensional return map constructed by plotting MAPn x [(MAPn+1) - (MAPn)] x density. The indices represent the maximum concentration of points (P1), the longitudinal axis (P2), and the transversal axis (P3) and MN represents P1 x P2 x P3 x 10(-3), STZ induced increased urinary glucose in diabetic (D) rats compared to controls (C). Seven days after STZ, diabetes reduced resting HR from 380.6 + 12.9 to 319,2 + 19.8 bpm, increased HR variability, as demonstrated by increased SDNN, from 11.77 + 1.67 to 19.87 + 2.60 ms, did not change MAP, and reduced P1 from 61.0 + 5.3 to 51.5 + 1.8 arbitrary units (AU), P2 from 41.3 + 0.3 to 29.0 + 1.8 AU, and MN from 171.1. + 30.2 to 77.2 + 9.6 AU of MAP. These indices, as well as HR and MAP, were similar for D and C animals 14, 30 and 120 days after STZ. Seven-day rats showed a negative correlation of urinary glucose with resting HR (r=-0.76, P=0.03) as well as with the MN index (r=-0.83, P=0.01). We conclude that rats with short-term diabetes mellitus induced by STZ presented modified autonomic control of HR and MAP which was reversible. The metabolic control may influence the results, suggesting that insulin treatment and a better metabolic control in this model may modify arterial pressure, HR and MAP variability.
Assuntos
Ratos , Animais , Masculino , Pressão Sanguínea , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/fisiopatologia , Modelos Animais de Doenças , Frequência Cardíaca , Insulina/farmacologia , Ratos Wistar , Estreptozocina/farmacologiaRESUMO
The objectives of the present study were 1) to compare results obtained by the traditional manual method of measuring heart rate (HR) and heart rate response (HRR) to the Valsalva maneuver, standing and deep breathing, with those obtained using a computerized data analysis system attached to a standard electrocardiograph machine; 2) to standardize the responses of healthy subjects to cardiovascular tests, and 3) to evaluate the response to these tests in a group of patients with diabetes mellitus (DM). In all subjects (97 healthy and 143 with DM) we evaluated HRR to deep breathing. HRR to standing, HRR to the Valsalva maneuver, and blood pressure response (BPR) to standing up and to a sustained handgrip. Since there was a strong positive correlation between the results obtained with the computerized method and the traditional method, we conclude that the new method can replace the traditional manual method for evaluating cardiovascular responses with the advantages of speed and objectivity. HRR and BPR of men and women did not differ. A correlation between age and HRR was observed for standing (r = -0.48, P < 0.001) and deep breathing (r = -0.41; P < 0.002). Abnormal BPR to standing was usually observed only in diabetic patients with definite and severe degrees of autonomic neuropathy.