RESUMO
Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the "Brazilian Diabetes Study" cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables.
Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Letramento em Saúde , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Transversais , BrasilRESUMO
Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the "Brazilian Diabetes Study" cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables.
RESUMO
INTRODUÇÃO: A dissecção de aorta é um evento cardiovascular com elevada taxa de mortalidade, caso ocorra atraso no seu diagnóstico e tratamento, e que possui como diagnóstico diferencial as síndromes coronarianas agudas. Aponta-se uma incidência de 5 a 30 casos por milhão de pessoas por ano, sendo necessário um alto nível de suspeita clínica para o seu diagnóstico. O avanço da técnica operatória e a intervenção precoce são apontados como fatores essenciais na melhora dos resultados do tratamento cirúrgico no que se refere às taxas de mortalidade. DESCRIÇÃO DO CASO: Esse trabalho teve como objetivos a descrição de um caso típico de dissecção de aorta que se destacou pela gravidade da sua apresentação clínica e rapidez na investigação diagnóstica. Além disso, busca-se, através desse relato, realizar a revisão dessa importante patologia em diversos aspectos. Relatou-se o caso de um paciente do sexo masculino, 49 anos, tabagista, que se apresentou com dor torácica, sem irradiação, associada a dispneia e que foi tratado, inicialmente, como um caso de edema agudo de pulmão, evoluindo com instabilidade clínica e necessidade de intubação orotraqueal e início de noradrenalina. O paciente foi avaliado, posteriormente, com ecocardiograma e angiotomografia de tórax e de abdome, sendo confirmado o diagnóstico de dissecção de aorta que complicou com insuficiência valvar aórtica e foi iniciado o tratamento clínico. O início da dissecção era no bulbo e essa se estendia até a bifurcação da aorta e pela artéria ilíaca comum esquerda. O paciente evolui, novamente, com instabilidade hemodinâmica, durante a internação, porém houve resposta ao tratamento cirúrgico, com remissão dos sintomas. O caso descrito se apresentou como uma síndrome de insuficiência respiratória e edema agudo de pulmão, refratário ao tratamento clínico inicial, com uma dor típica associada, o que motivou a investigação diagnóstica. Buscou-se, inicialmente, o controle do duplo produto do paciente com o esmolol e foi indicado, posteriormente, o tratamento cirúrgico, com correção da insuficiência aórtica, para o paciente, após a estabilização do quadro. CONCLUSÕES: Percebe-se que a dissecção de aorta é uma condição de elevada gravidade, que possui uma diversidade de fatores de risco e de apresentações clínicas. A agilidade no diagnóstico e tratamento dependem da suspeita dessa condição. Destaca-se a importância do diagnóstico dessa condição e do reconhecimento das indicações cirúrgicas, pois está comprovado seu impacto na sobrevida do paciente.
Assuntos
Diagnóstico Diferencial , Dissecção Aórtica , Insuficiência da Valva Aórtica , Síndrome Coronariana AgudaRESUMO
BACKGROUND: Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D. METHODS: In a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records. RESULTS: Of the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta - 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively). CONCLUSIONS: This study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients.
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BACKGROUND AND AIMS: Macrophages derived from monocytes play an important role in atherosclerosis progression. Subpopulations of circulating classical, intermediate, and non-classical monocytes possess distinct functions and phenotypes, and participate in the pathogenesis of disease. The aim of this study was to compare the quantity and phenotypes of circulating monocyte subpopulations in patients with established atherosclerosis and healthy control individuals. Additionally, the study aimed to provide insight into the functional activity of monocytes against a heat shock protein (HSP60). METHODS: Chemokine and pattern recognition receptors in monocyte subsets obtained from peripheral blood of acute and chronic coronary artery disease patients and controls were quantified by flow cytometry. Furthermore, monocytes from healthy controls were stimulated in vitro with HSP60, and the cytokines produced by them were evaluated by flow cytometry. RESULTS: Eighteen controls (C), 34 individuals with risk factors for cardiovascular disease (RF), 32 patients with stable angina (SA), and 16 patients with unstable angina (UA) were enrolled in the study. The absolute count of intermediate monocytes was found to be increased in patients of the UA group; high frequencies of the chemokine receptors CCR2, CCR5, and CX3CR1 were also observed in this subpopulation. Moreover, the pattern recognition receptors TLR2 and TLR4 were more frequent in intermediate monocytes from the UA group. Furthermore, the intermediate monocytes from healthy individuals produced IL-12p70 after stimulation with HSP60. CONCLUSIONS: Our results show that intermediate monocytes of UA patients exhibited an enhanced expression of the receptors involved in the recognition of damage-associated molecular patterns (DAMPs) and enhancement of the migratory function. Hence, they might contribute to the propagation and progression of inflammation observed in atherosclerosis, especially in the acute setting.
Assuntos
Angina Instável/metabolismo , Quimiocinas/metabolismo , Monócitos/metabolismo , Receptores de Reconhecimento de Padrão/metabolismo , Receptor 1 de Quimiocina CX3C/metabolismo , Chaperonina 60/metabolismo , Feminino , Humanos , Interleucina-12/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores CCR2/metabolismo , Receptores CCR5/metabolismo , Receptor 2 Toll-Like/metabolismo , Receptor 4 Toll-Like/metabolismoRESUMO
INTRODUCTION: Cholesterol undergoes oxidation via both enzymatic stress- and free radical-mediated mechanisms, generating a wide range of oxysterols. In contrast to oxidative stress-driven metabolites, enzymatic stress-derived oxysterols are scarcely studied in their association with atherosclerotic disease in humans. METHODS: 24S-hydroxycholesterol (24S-HC), 25-hydroxycholesterol (25-HC), and 27-hydroxycholesterol (27-HC) were assessed in plasma and arteries with atherosclerotic plaques from 10 patients (54-84 years) with severe peripheral artery disease (PAD) as well as arteries free of atherosclerotic plaques from 13 individuals (45-78 years, controls). RESULTS: Plasma 25-HC was higher in PAD individuals than in controls (6.3[2] vs. 3.9[1.9] ng/mgCol; p = 0.004). 24S-HC and 27-HC levels were, respectively, five- and 20-fold higher in the arterial tissue of PAD individuals than in those of the controls (p = 0.016 and p = 0.001). Plasma C-reactive protein correlated with plasma 24-HC (r = 0.51; p = 0.010), 25-HC (r = 0.75; p < 0.001), 27-HC (r = 0.48; p = 0.015), and with tissue 24S-HC (r = 0.4; p = 0.041) and 27-HC (r = 0.46; p = 0.023). CONCLUSION: Arterial intima accumulation of 27-HC and 24S-HC is associated with advanced atherosclerotic disease and systemic inflammatory activity in individuals with severe PAD.