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Lederman C, Ferreira JFM, de Albuquerque CP, de Lima ACP, Barroso LP, de Souza JCM, de Lima VHV, de Castro GJ, Luduvice NZ, Morais LCC, Perdigao MDL, Freitas RMVD, Teixeira ML, Waldvogel BC, Mansur AJ. Mortality after discharge from a public tertiary cardiovascular referral hospital. Medicine (Baltimore) 2023; 102:e33627. [PMID: 37083767 PMCID: PMC10118353 DOI: 10.1097/md.0000000000033627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
It is critically important for stakeholders with distinct foci of attention on healthcare to understand patient evolution in the presence of an established diagnosis or with a suspected diagnosis of various diseases, specially considering death as an outcome. To study the long-term mortality of patients at a cardiovascular referral hospital. Deterministic binding (selection of pairs of registers from the hospital electronic health records and the mortality records of São Paulo state) from 2002 to 2017 was performed. Studied variables were: age, sex, hospital treatment unit where the first visit occurred (Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostics Services), treatment type, elapsed time between the first visit and death, diagnosis at first and last visits and variables related to death. Statistical Methods: descriptive, survival (with Kaplan-Meier method), correspondence and competitive risks analyses; in case of nonoccurrence of death until the end of 2017, the patients were considered alive. Statistical significance was set at values of P < .05. Median age at the first visit to the Hospital was 51.9 years. Birth locations included 4496 cities, 17.33% in São Paulo, 0.41% in Rio de Janeiro, 0.40% in Osasco, 24.04% in other cities. Sex included females (46.7%), males (44.2%), not defined (6.3%), and other (2.8%). We observed an association between diseases in ICD-10 Chapter 16 (certain conditions originating in the perinatal period) and Chapter 17 (congenital malformations, deformations, and chromosomal abnormalities), both as diagnoses and underlying causes of death, as well as between neoplasms as diagnoses and as the underlying cause of death. In this sample, there was an association between admission diagnoses and underlying causes of death, such as neoplasms, cardiovascular diseases, and congenital heart malformations. Additionally, patients who underwent a cardiac intervention had a smaller less mortality rate than those who were not operated on. There were also differences in cardiovascular mortality between distinct treatment units of the hospital ((Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostic Services).
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Affiliation(s)
- Carlos Lederman
- Instituto do Coração (InCor) – Hospital das Clínicas HCFMUSP, Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - João Fernando Monteiro Ferreira
- Instituto do Coração (InCor) – Hospital das Clínicas HCFMUSP, Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cicero Piva de Albuquerque
- Instituto do Coração (InCor) – Hospital das Clínicas HCFMUSP, Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Lucia Pereira Barroso
- Departamento de Estatística, Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
| | | | - Victor Hugo Vieira de Lima
- Departamento de Estatística, Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Jordan de Castro
- Departamento de Estatística, Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
| | - Nicole Zukowski Luduvice
- Departamento de Estatística, Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Alfredo José Mansur
- Instituto do Coração (InCor) – Hospital das Clínicas HCFMUSP, Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
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Barreto APA, Barreto Filho MA, Duarte LC, Cerqueira-Silva T, Camelier A, Tavares NM, Barral-Netto M, Boaventura V, Lima MCC. Metabolic disorders and post-acute hospitalization in black/mixed-race patients with long COVID in Brazil: A cross-sectional analysis. PLoS One 2022; 17:e0276771. [PMID: 36315558 PMCID: PMC9621406 DOI: 10.1371/journal.pone.0276771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although low-middle income countries have been disproportionately affected by the COVID-19 pandemic, there is scarce information about the impact of long COVID on their population. This study aimed to evaluate long COVID symptomatology, complications (hospital readmission and metabolic disorders), and main clinical features that impact Quality of Life (QoL). METHODS This cross-sectional study provides a detailed clinical and laboratory picture of individuals who presented residual symptoms after mild to severe acute COVID-19. Between Aug-2020 to Sep-2021, long COVID patients were evaluated in a reference center for long COVID in Bahia State, Brazil. The EQ-5D-5L questionnaire accessed QoL. RESULTS A total of 1164 (52 ±13.4 years, 57% female, 88% black/mixed-race) were evaluated 2.3 [IQR = 1.6-3.7] months after mild (n = 351, 30.2%), moderate (338, 29.0%) or severe (475, 40.8%) acute illness. Dyspnea (790, 67.9%), fatigue (738, 63.5%), and chest pain (525, 42.9%) were the most frequent residual symptoms regardless of acute severity, affecting the QoL of 88.9% of patients (n/N-826/925), mainly the domains of anxiety/depression and pain/discomfort. High levels of HbA1c were detected for 175 out of 664 patients (26.6%), 40% of them without a previous diagnosis of diabetes mellitus. Of note, hospital admission one-to-three months after the acute phase of disease was required for 51 (4.4%) patients. CONCLUSION In this majority-black/mixed-race population, long COVID was associated with post-acute hospitalization, newly diagnosed diabetes mellitus, and decreased QoL, particularly in women and regardless of disease severity of acute infection, suggesting important implications for health care system.
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Affiliation(s)
- Ana Paula Andrade Barreto
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Marcio Andrade Barreto Filho
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Lucimeire Cardoso Duarte
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz (Fiocruz-Bahia), Salvador, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Aquiles Camelier
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Fundação Maria Emília Freire de Carvalho (FME), Salvador, Brazil
| | | | - Manoel Barral-Netto
- Instituto Gonçalo Moniz (Fiocruz-Bahia), Salvador, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Viviane Boaventura
- Instituto Gonçalo Moniz (Fiocruz-Bahia), Salvador, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, Brazil
- * E-mail:
| | - Marcelo Chalhoub Coelho Lima
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Universidade Salvador, (UNIFACS), Salvador, Brazil
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Malerbi FK, Andrade RE, Morales PH, Stuchi JA, Lencione D, de Paulo JV, Carvalho MP, Nunes FS, Rocha RM, Ferraz DA, Belfort R. Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera. J Diabetes Sci Technol 2022; 16:716-723. [PMID: 33435711 PMCID: PMC9294565 DOI: 10.1177/1932296820985567] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Portable retinal cameras and deep learning (DL) algorithms are novel tools adopted by diabetic retinopathy (DR) screening programs. Our objective is to evaluate the diagnostic accuracy of a DL algorithm and the performance of portable handheld retinal cameras in the detection of DR in a large and heterogenous type 2 diabetes population in a real-world, high burden setting. METHOD Participants underwent fundus photographs of both eyes with a portable retinal camera (Phelcom Eyer). Classification of DR was performed by human reading and a DL algorithm (PhelcomNet), consisting of a convolutional neural network trained on a dataset of fundus images captured exclusively with the portable device; both methods were compared. We calculated the area under the curve (AUC), sensitivity, and specificity for more than mild DR. RESULTS A total of 824 individuals with type 2 diabetes were enrolled at Itabuna Diabetes Campaign, a subset of 679 (82.4%) of whom could be fully assessed. The algorithm sensitivity/specificity was 97.8 % (95% CI 96.7-98.9)/61.4 % (95% CI 57.7-65.1); AUC was 0·89. All false negative cases were classified as moderate non-proliferative diabetic retinopathy (NPDR) by human grading. CONCLUSIONS The DL algorithm reached a good diagnostic accuracy for more than mild DR in a real-world, high burden setting. The performance of the handheld portable retinal camera was adequate, with over 80% of individuals presenting with images of sufficient quality. Portable devices and artificial intelligence tools may increase coverage of DR screening programs.
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Affiliation(s)
- Fernando Korn Malerbi
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
- Fernando Korn Malerbi, Federal University of
São Paulo, Rua Botucatu, 822. São Paulo, SP 04039-032, Brazil.
| | - Rafael Ernane Andrade
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Hospital de Olhos Beira Rio, Itabuna,
BA, Brazil
| | - Paulo Henrique Morales
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
| | | | | | | | | | | | | | - Daniel A. Ferraz
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
- NIHR Biomedical Research Centre for
Ophthalmology, Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of
Ophthalmology, London, UK
| | - Rubens Belfort
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
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Abstract
Background: The global economic burden of Diabetes mellitus (DM) is expected to reach US$ 745 billion in 2030. The growing prevalence of the disease, mainly type 2 diabetes, is the result of population aging, nutritional transition, which include growing rates of obesity and consumption of foods high in sugar and fat. Brazil is the fourth country in the number of patients with diabetes globally and follows the global trends, with a continuous increase in prevalence. Objectives: To estimate the economic burden of DM in Brazil, including all direct and indirect costs. Methods: We used a cost-of-illness approach to calculate the total economic burden of DM. We used official healthcare-related statistics referring to 2016. Findings: We estimated the Brazilian economic burden to reach US$ 2.15 billion in 2016, of which 70.6% are indirect costs related to premature deaths, absenteeism, and early retirement. We estimate that if the rate of growth of diabetes prevalence remains in Brazil, direct and indirect costs of diabetes will more than double by 2030 (an increase of 133.4% or 6.2% per year). Conclusion: Our results are in accordance with the literature that shows that indirect costs are more relevant in low- and middle-income countries due to poorer access to health care, which result in higher mortality rates from non-communicable diseases. However, due to the potentially underestimated prevalence of diabetes in Brazil and the lack of access to nationwide private healthcare costs, we estimate costs of diabetes in Brazil to be higher than the conservative results we found. The onset of the COVID-19 pandemic is likely to result in even greater costs than what we estimated.
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Alathari BE, Cruvinel NT, da Silva NR, Chandrabose M, Lovegrove JA, Horst MA, Vimaleswaran KS. Impact of Genetic Risk Score and Dietary Protein Intake on Vitamin D Status in Young Adults from Brazil. Nutrients 2022; 14:1015. [PMID: 35267990 PMCID: PMC8912678 DOI: 10.3390/nu14051015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 01/27/2023] Open
Abstract
Given the relationship between vitamin D deficiency (VDD) and adverse outcomes of metabolic diseases, we investigated the interplay of dietary and genetic components on vitamin D levels and metabolic traits in young adults from Brazil. Genetic analysis, dietary intake, and anthropometric and biochemical measurements were performed in 187 healthy young adults (19−24 years). Genetic risk scores (GRS) from six genetic variants associated with vitamin D (vitamin D-GRS) and 10 genetic variants associated with metabolic disease (metabolic-GRS) were constructed. High vitamin D-GRS showed a significant association with low 25(OH)D concentrations (p = 0.001) and high metabolic-GRS showed a significant association with high fasting insulin concentrations (p = 0.045). A significant interaction was found between vitamin D-GRS and total protein intake (g/day) (adjusted for non-animal protein) on 25(OH)D (pinteraction = 0.006), where individuals consuming a high protein diet (≥73 g/d) and carrying >4 risk alleles for VDD had significantly lower 25(OH)D (p = 0.002) compared to individuals carrying ≤4 risk alleles. Even though our study did not support a link between metabolic-GRS and vitamin D status, our study has demonstrated a novel interaction, where participants with high vitamin D-GRS and consuming ≥73 g of protein/day had significantly lower 25(OH)D levels. Further research is necessary to evaluate the role of animal protein consumption on VDD in Brazilians.
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Affiliation(s)
- Buthaina E. Alathari
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Harry Nursten Building, Pepper Lane, Reading RG6 6DZ, UK; (B.E.A.); (J.A.L.)
- Department of Food Science and Nutrition, Faculty of Health Sciences, The Public Authority for Applied Education and Training, P.O. Box 14281, AlFaiha 72853, Kuwait
| | - Nathália Teixeira Cruvinel
- Nutritional Genomics Research Group, Faculty of Nutrition, Federal University of Goiás (UFG), Goiânia 74690-900, Brazil; (N.T.C.); (N.R.d.S.)
| | - Nara Rubia da Silva
- Nutritional Genomics Research Group, Faculty of Nutrition, Federal University of Goiás (UFG), Goiânia 74690-900, Brazil; (N.T.C.); (N.R.d.S.)
| | - Mathurra Chandrabose
- Department of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading RG6 6ES, UK;
| | - Julie A. Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Harry Nursten Building, Pepper Lane, Reading RG6 6DZ, UK; (B.E.A.); (J.A.L.)
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AH, UK
- Institute of Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6AA, UK
| | - Maria A. Horst
- Nutritional Genomics Research Group, Faculty of Nutrition, Federal University of Goiás (UFG), Goiânia 74690-900, Brazil; (N.T.C.); (N.R.d.S.)
| | - Karani S. Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Harry Nursten Building, Pepper Lane, Reading RG6 6DZ, UK; (B.E.A.); (J.A.L.)
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AH, UK
- Institute of Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6AA, UK
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Abstract
Increasing rates of non-communicable diseases (NCDs) (obesity, type 2 diabetes, and dental caries) are positively associated with the consumption of added sugars, particularly in sugar-sweetened beverages (SSB). Governments worldwide have implemented SSB taxes to reduce the consumption of sugars added to beverages to reduce the prevalence of NCDs. There is a tax on manufactured products, including SSBs in Brazil. However, in 2016 and 2018, the Brazilian federal government decreased the tax rate, bucking global trends. The SSB industry has criticised such policies, and current tax levels are too low to reduce consumption sufficiently to prevent harm. Research supports positive public health impact potential for a higher SSB tax in Brazil. Sharing experience among countries and complementary policies (nutrition education and front of pack labelling) could increase the positive impacts of an SSB tax. We describe the history of SSB taxes in Brazil and the rationale it provides for specific SSB taxes across the country.
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Martins RB, Ordaz-Briseño SA, Flores-Hernández S, Bós ÂJG, Baptista-Rosas RC, Mercado-Sesma AR. Comparison of prevalence of diabetes complications in Brazilian and Mexican adults: a cross-sectional study. BMC Endocr Disord 2021; 21:48. [PMID: 33726717 PMCID: PMC7962221 DOI: 10.1186/s12902-021-00711-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Type 2 diabetes is more frequent in Latin American people than in non-Hispanic whites due to a combination of genetic and lifestyle risk factors. Brazil and Mexico are the most populous countries in Latin America. The present study aimed to compare the results of the National Health Survey "PNS" in Brazil and the National Survey Health and Nutrition "ENSANUT" in Mexico regarding the prevalence, complications and healthcare issues of diabetes in both countries. METHODS A cross-sectional study was conducted with data from the National Health Survey (PNS) of 2013 in Brazil and the National Survey of Health and Nutrition (ENSANUT) of 2018 in Mexico. The prevalence of diabetes, complications and risk factors related to developing diabetes were considered. RESULTS The respondents included 3636 individuals in Brazil and 4555 individuals in Mexico. There were significant differences in age and time living with diabetes between the two countries. Mexican people had twice as likely as Brazilian people to have a complication (p < 0.0001). The principal risk factor (OR 2.47; p ≤ 0.0001) for developing any diabetic complication was living with diabetes for more than 15 years. Visual impairment was the most frequent complication in both countries, but it was more prevalent in Mexico (p ≤ 0.001). CONCLUSIONS Diabetes complications are important health problems in Brazil and Mexico. Visual impairment was the principal complication in both countries. Several factors, such as access to and type of health system, living in a rural area, treatment, BMI and performing preventive actions, affected the risk of developing a complication. However, living with diabetes for more than 15 years was the principal risk factor. National health surveys have added significant information on the impact of diabetes in these Latin American populations. This comparison of data could provide valuable information to guide national policies and program decisions in both countries.
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Affiliation(s)
- Renata Breda Martins
- Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Ângelo José Gonçalves Bós
- Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raúl C Baptista-Rosas
- Departamento de Salud Enfermedad como proceso individual, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, Mexico
- Multidisciplinary Health Research Center, Centro Universitario de Tonalá/Universidad de Guadalajara (México), 45425, Tonalá, Jalisco, Mexico
| | - Arieh Roldán Mercado-Sesma
- Departamento de Salud Enfermedad como proceso individual, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, Mexico.
- Multidisciplinary Health Research Center, Centro Universitario de Tonalá/Universidad de Guadalajara (México), 45425, Tonalá, Jalisco, Mexico.
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Pre-pregnancy BMI is associated with offspring body composition in adulthood before adiposity-related disorders: a retrospective cohort. Public Health Nutr 2020; 24:1296-1303. [PMID: 33357251 DOI: 10.1017/s1368980020005285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the association between maternal pre-pregnancy BMI and offspring body composition in adulthood. DESIGN Retrospective cohort. Undergraduates of nutrition or nutritionists were recruited at the baseline of the Nutritionists' Health Study between 2014 and 2017. Maternal pre-pregnancy BMI and current life aspects were self-reported through online questionnaires. Three body compartments were dual-energy x-ray absorptiometry-determined. The following variables were obtained: body fat (%), fat mass index (FMI) (kg/m2), android-to-gynoid fat ratio, visceral adipose tissue (VAT) (cm3), appendicular skeletal muscle mass index (ASMI) (kg/m2), total bone and femur mineral content (g) and density (g/cm2). Linear regression adjusted according to directed acyclic graphs recommendation was performed. SETTING São Paulo, Brazil. PARTICIPANTS Healthy non-pregnant women (aged 20-45 years) (n 150). RESULTS Median age and BMI were 22 years (IQR = 20, 29) and 22·3 kg/m2 (IQR = 20·4, 25·3), respectively. Pre-pregnancy BMI ≥ 25 kg/m2 was reported by 14·7 % of mothers. In fully adjusted models, maternal pre-pregnancy BMI was associated with their daughters' body fat % (β = 0·31; 95 % CI 0·0004, 0·63), FMI (β = 0·17; 95 % CI 0·03, 0·30), android-to-gynoid ratio (β = 0·01; 95 % CI 0·004, 0·02) and VAT (β = 0·09; 95 % CI 0·02, 0·16), but not with total bone density (β = 0·001; 95 % CI -0·003, 0·006) and content (β = 7·13; 95 % CI -4·19, 18·46). Direct association with ASMI was also detected, but lost statistical significance when participants whose mothers were underweight were excluded. CONCLUSIONS Maternal pre-pregnancy BMI was directly associated with offspring general and visceral adiposity but seems not to be associated with bone mass. Results reinforce importance of avoiding excess of maternal adiposity, as an attempt to break the vicious cycle of obesity transmission.
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Queiroz MS, de Carvalho JX, Bortoto SF, de Matos MR, das Graças Dias Cavalcante C, Andrade EAS, Correa-Giannella ML, Malerbi FK. Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera. Acta Diabetol 2020; 57:1493-1499. [PMID: 32748176 PMCID: PMC7398859 DOI: 10.1007/s00592-020-01585-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. METHODS This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. RESULTS A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. CONCLUSIONS A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. Daily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision.
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Affiliation(s)
- Márcia Silva Queiroz
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo, 01504-001, Brazil
| | - Jacira Xavier de Carvalho
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180, Brazil
| | - Silvia Ferreira Bortoto
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo, 01504-001, Brazil
| | - Mozania Reis de Matos
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180, Brazil
| | | | | | - Maria Lúcia Correa-Giannella
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo, 01504-001, Brazil
| | - Fernando Korn Malerbi
- Programa de Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, Sao Paulo, 01504-001, Brazil.
- Departamento de Oftalmologia, Universidade Federal de São Paulo, Rua Botucatu 822, São Paulo, 04039-032, Brazil.
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Monteiro RL, Ferreira JS, Silva ÉQ, Donini A, Cruvinel-Júnior RH, Verissímo JL, Bus SA, Sacco IC. Feasibility and Preliminary Efficacy of a Foot-Ankle Exercise Program Aiming to Improve Foot-Ankle Functionality and Gait Biomechanics in People with Diabetic Neuropathy: A Randomized Controlled Trial. SENSORS 2020; 20:s20185129. [PMID: 32916792 PMCID: PMC7570556 DOI: 10.3390/s20185129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023]
Abstract
Foot-ankle strengthening and mobility exercises are part of international guideline recommendations for people at risk of diabetic foot disease. We examined the feasibility and preliminary efficacy of a 12-week foot-ankle exercise program on clinical, functional and biomechanical outcomes in people with diabetic neuropathy (DPN). We randomly allocated 30 people with DPN to usual care (control) or usual care plus a supervised exercise program (intervention). For feasibility, we assessed recruitment rate and participant adherence and satisfaction. For program efficacy, we assessed baseline to 12-week changes in daily physical activity level, gait speed, tactile sensitivity, ankle range of motion, DPN symptoms, quality of life, foot health and functionality, foot strength and plantar pressure during gait, using paired t-tests (p < 0.05). In 52 weeks, we recruited 45 eligible participants (0.90/week). Program adherence was 80% and participants’ satisfaction had a mean (SD) of 4.57 (0.70) out of 5. The intervention group significantly improved on toes strength, contact time during gait and DPN symptoms, and peak forefoot pressures increased over time; controls showed significantly increased heel peak pressures and force. The exercise program was feasible, based on a moderate recruitment rate and an adherent and satisfied population, and the intervention showed several positive preliminary effects over time compared to usual care.
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Affiliation(s)
- Renan L. Monteiro
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
- Department of Physical Therapy, Federal University of Amapá, Rod. Juscelino Kubitschek, km 02 - Jardim Marco Zero, Macapá, AP 68903-419, Brazil
| | - Jane S.S.P. Ferreira
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Érica Q. Silva
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Asha Donini
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Ronaldo H. Cruvinel-Júnior
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Jady L. Verissímo
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Sicco A. Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Isabel C.N. Sacco
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
- Correspondence: ; Tel.: +55-11-3091-8426; Fax: +55-11-3091-7462
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Gómez EJ. The international and domestic politics of type 2 diabetes policy reform in Brazil. BMJ Glob Health 2020; 5:bmjgh-2020-002457. [PMID: 32873596 PMCID: PMC7467506 DOI: 10.1136/bmjgh-2020-002457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Understanding the international and domestic political factors influencing the evolution of type 2 diabetes policies and primary care institutions is a new area of scholarly research. This article contributes to this area of inquiry by illustrating how a government’s shifting foreign policy aspirations, that is, to establish the government’s reputation as an internationally recognised leader in type 2 diabetes policy, and presidential electoral incentives provide alternative insights into the evolution of type 2 diabetes treatment policies and primary care institutional reforms. Methods I conduct a single-case study analysis with the usage of qualitative data; quantitative statistical data on epidemiological trends and government policy spending is also provided as supportive evidence. Results The case of Brazil illustrates how a reduction in foreign policy commitment to international reputation building in health as well as presidential electoral incentives to use diabetes policy as an electoral strategy account for a decline in sustaining policy and primary care institutional innovations in response to type 2 diabetes. Conclusion Future scholars interested in understanding the lack of sustainability and effectiveness in type 2 diabetes programmes should consider investigating the complex international and domestic political factors influencing political interests, incentives and commitment to reform.
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Affiliation(s)
- Eduardo J Gómez
- College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
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Camargo CP, Weschenfelder RHN, Fonseca GMD, Sousa AADC, Gemperli R. A non-inferiority study to compare daily fast-acting insulin versus twice a week slow-acting insulin-moderate diabetes mode. Acta Cir Bras 2020; 35:e202000704. [PMID: 32813772 PMCID: PMC7412997 DOI: 10.1590/s0102-865020200070000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Given the high prevalence of diabetes (D), several animal models have been analyzed. In the literature, most of the animal models have studied severe D. However, in clinical practice, most patients have moderate disease. Therefore, the present study aimed to describe a moderate D condition. Methods We analyzed 20 Wistar rats, age eight-weeks, weight between 200g-250g. All animals received an intravenous injection of Streptozotocin (55mg/kg weight). On the 15th day after D induction, the animals were divided into two groups: Group I – animals receiving a single daily dose of fast-acting insulin (FAIG) NPH (1UI,SC) for partial glycemic control, and Group II - animals receiving slow-acting insulin(SAIG) twice a week. We measured glycemia, weight, and adverse events every week during two months. Results Of the total of animals analyzed in the study, three animals died in the FAIG and two animals died in the SAIG. Regarding the glycemic level, results were 339.5 ± 125.4mg/dL (95CI 302.3402 to 376.6842) in the FAIG, and 367.8 ± 66.1mg/dL (95IC 333.7607 to 401.8978) in the SAIG. There was no difference between groups as to weight during the study. Conclusion The use of slow-acting-insulin is not inferior to the use of fast-acting-insulin in the management of partially insulin-controlled moderate diabetes in rats.
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Cespedes C, Montaña-Jimenez LP, Lasalvia P, Aschner P. Changes in the incidence of diabetes mellitus type 1 in children under the age of 15 in the city of Bogotá, Colombia. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2020; 67:289-291. [PMID: 31767509 DOI: 10.1016/j.endinu.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Camila Cespedes
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | | | - Pieralessandro Lasalvia
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia; NeuroEconomix, Bogotá, Colombia
| | - Pablo Aschner
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia; Asociación Colombiana de Diabetes, Bogotá, Colombia
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Wartchow KM, Rodrigues L, Lissner LJ, Federhen BC, Selistre NG, Moreira A, Gonçalves CA, Sesterheim P. Insulin-producing cells from mesenchymal stromal cells: Protection against cognitive impairment in diabetic rats depends upon implant site. Life Sci 2020; 251:117587. [PMID: 32224027 DOI: 10.1016/j.lfs.2020.117587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) is a serious public health problem and can cause long-term damage to the brain, resulting in cognitive impairment in these patients. Insulin therapy for type 1 DM (DM1) can achieve overall blood glucose control, but glycemic variations can occur during injection intervals, which may contribute to some complications. Among the additional therapies available for DM1 treatment is the implantation of insulin-producing cells (IPCs) to attenuate hyperglycemia and even reverse diabetes. Here, we studied the strategy of implanting IPCs obtained from mesenchymal stromal cells (MSCs) from adipose tissue, comparing two different IPC implant sites, subcapsular renal (SR) and subcutaneous (SC), to investigate their putative protection against hippocampal damage, induced by STZ, in a rat DM1 model. Both implants improved hyperglycemia and reduced the serum content of advanced-glycated end products in diabetic rats, but serum insulin was not observed in the SC group. The SC-implanted group demonstrated ameliorated cognitive impairment (evaluated by novel object recognition) and modulation of hippocampal astroglial reactivity (evaluated by S100B and GFAP). Using GFP+ cell implants, the survival of cells at the implant sites was confirmed, as well as their migration to the pancreas and hippocampus. The presence of undifferentiated MSCs in our IPC preparation may explain the peripheral reduction in AGEs and subsequent cognitive impairment recovery, mediated by autophagic depuration and immunomodulation at the hippocampus, respectively. Together, these data reinforce the importance of MSCs for use in neuroprotective strategies, and highlight the logistic importance of the subcutaneous route for their administration.
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Affiliation(s)
- Krista Minéia Wartchow
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil
| | - Leticia Rodrigues
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil
| | - Lílian Juliana Lissner
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil
| | - Barbara Carolina Federhen
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil
| | - Nicholas Guerini Selistre
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil
| | - Aline Moreira
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil
| | - Carlos-Alberto Gonçalves
- Federal University of Rio Grande do Sul (UFRGS), Biochemistry Post-Graduate Program, Porto Alegre, Brazil.
| | - Patrícia Sesterheim
- Institute of Cardiology of Rio Grande do Sul, Experimental Center, Porto Alegre, Brazil
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Franco DR, Perez-Nieves M, Ivanova JI, Cao D, Vaz MSC. Basal insulin persistence in Brazilian participants with T2DM. ACTA ACUST UNITED AC 2019; 65:1254-1264. [PMID: 31721957 DOI: 10.1590/1806-9282.65.10.1254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Real-world effectiveness of basal insulin therapy is affected by poor treatment persistence, often occurring soon after initiation. This analysis is part of an international cross-sectional study conducted in T2DM patients and is intended to describe the reasons behind non-persistence to insulin therapy in Brasil. METHODS Responders to an online survey in seven countries were classified as continuers (no gap of ≥7 days), interrupters (interrupted therapy for ≥7 days within first 6 months, then restarted), and discontinuers (terminated therapy for ≥7 days within first 6 months, and did not start it again before the survey). We present the results from the Brazilian cohort. RESULTS Of 942 global respondents, 156 were from Brasil, with a mean age of 34 years and a mean of 5.8 years since T2DM diagnosis. Reasons contributing to insulin continuation (n=50) were improved glycemic control (82%) and improved physical feeling (50%). Common reasons for interruption (n=51) or discontinuation (n=55) were, respectively, weight gain (47.1%, 43.6%), hypoglycemia (45.1%, 38.2%), and pain from injections (39.2%, 49.1%). However, not all patients who reported weight gain and hypoglycemia as a reason for interruption or discontinuation experienced these: 16/24 (66.7%) and 22/24 (91.7%) participants had weight gain, and 13/23 (56.5%) and 15/21 (71.4%) had hypoglycemia, respectively. The most important reason for possible re-initiation for interrupters and discontinuers, respectively, was persuasion by the physician/HCP (80.4%, 72.7%). CONCLUSION The benefits of basal insulin therapy motivated continuers to persist with the treatment; experienced or anticipated side effects contributed to interruption and discontinuation. Physician and patient training is key in the treatment of diabetes.
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Ferraz ÁAB, de Sá VCT, Santa-Cruz F, Siqueira LT, Silva LB, Campos JM. Roux-en-Y gastric bypass for nonobese patients with uncontrolled type 2 diabetes: a long-term evaluation. Surg Obes Relat Dis 2019; 15:682-687. [PMID: 31005458 DOI: 10.1016/j.soard.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is growing evidence that the impact of Roux-en-Y gastric bypass (RYGB) on type 2 diabetes (T2D) occurs regardless of the amount of weight loss. Taking this background into consideration, it is plausible to study this procedure in individuals with lower body mass index (BMI) under clinical treatment failure for uncontrolled T2D. OBJECTIVES To elucidate the long-term impact of RYGB on T2D regression in a non-obese population. SETTING Hospital das Clínicas, Federal University of Pernambuco, Brazil. METHODS Twelve patients with BMI 25 to 30 kg/m2 and inadequately controlled T2D underwent RYGB and were followed up for 6 years. Fasting plasma glucose, glycated hemoglobin, BMI, and the use of insulin and/or oral hypoglycemic agents were assessed. Each variable was analyzed in 3 distinct moments: preoperative evaluation, 2-year postoperative follow-up (2-PO), and 6-year postoperative follow-up (6-PO). RESULTS There were no cases of early or late mortality. Mean BMI at preoperative evaluation, 2-PO, and 6-PO were 28.1 ± 1.2; 23.2 ± 2.4; and 24.7 ± 3.1, respectively. The lowest BMI at 6-PO was 19.1 kg/m2. Complete remission of T2D was achieved in 16.7%, partial remission in another 16.7%, glycemic control in 25%, and glycemic improvement in 25% of the sample at 6-PO; 16.7% did not present positive glycemic outcomes. Only 1 patient needed to resume insulin administration between 2-PO and 6-PO. CONCLUSIONS RYGB was found to be safe and effective in treating uncontrolled T2D in non-obese patients, providing improvements in the glycemic patterns in 83.4% of our sample.
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Affiliation(s)
- Álvaro A B Ferraz
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Vladimir C T de Sá
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Luciana T Siqueira
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | - Lyz B Silva
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
| | - Josemberg M Campos
- Department of Surgery, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil
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Malvezzi MAPN, Pereira HABS, Dionizio A, Araujo TT, Buzalaf NR, Sabino-Arias IT, Fernandes MS, Grizzo LT, Magalhães AC, Buzalaf MAR. Low-level fluoride exposure reduces glycemia in NOD mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 168:198-204. [PMID: 30388537 DOI: 10.1016/j.ecoenv.2018.10.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 06/08/2023]
Abstract
UNLABELLED Water fluoridation is the most widespread measure to prevent dental caries but its relationship with the development of type-1 diabetes (T1D), which has been increasing by 2-5% worldwide, is not quite well understood. AIM This study evaluated if fluoride (F) administered in the drinking water can prevent or reduce the development of T1D in non-obese diabetic (NOD) mice, as well as to explore the underlying mechanisms. MATERIALS AND METHODS Twenty-four weaning NOD mice received water containing 0, 10 or 50 ppm F for 21 days. Plasma glucose and insulin were analyzed. Quantitative proteomic analysis was conducted in the liver and gastrocnemius muscle. RESULTS Animals treated with 10 ppm F had significantly lower glucose levels than the control group, but there was no significant difference among the groups in relation to insulin. The % of β-cell function was significantly higher in the 10 ppm F group. Changes in the proteomic profile of muscle and liver were seen among the groups. In the muscle, the 10 ppm F group presented, when compared with control, increased expression of proteins involved in energy metabolism. The 50 ppm F group, compared with control, presented increased expression of proteins related to muscle contraction, differentiation of brown adipose tissue and apoptosis. For the liver, the 10 ppm F group had increase in proteins involved in energy metabolism and protein synthesis, in respect to control. There was also an increase in isoforms of Glutathione S transferase, which was confirmed by Western blotting. In the group treated with 50 ppm F, proteins related to ROS metabolism and energetic metabolism were altered. CONCLUSION Increased expression of antioxidant proteins by treatment with low F concentration may possibly help to explain protection against the development of T1D, which should be better explored in future mechanistic studies.
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Affiliation(s)
- Maria Aparecida Pereira Nunes Malvezzi
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Heloisa Aparecida Barbosa Silva Pereira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Aline Dionizio
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Tamara Teodoro Araujo
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Nathalia Rabelo Buzalaf
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Isabela Tomazini Sabino-Arias
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Mileni Silva Fernandes
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Larissa Tercilia Grizzo
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil
| | - Marilia Afonso Rabelo Buzalaf
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, São Paulo, Brazil.
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Political party ambitions and type-2 diabetes policy in Brazil and Mexico. HEALTH ECONOMICS POLICY AND LAW 2018; 15:261-276. [PMID: 30394254 DOI: 10.1017/s1744133118000415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the Americas, next to the United States, Brazil and Mexico have the highest prevalence of type-2 diabetes. In contrast to most studies, this article compares and analyzes the politics behind the implementation of type-2 diabetes self-care management programs (DSM), which is a new area of scholarly research. This article claims that Brazil outpaced Mexico with respect to the implementation of effective DSM programs, the product of positive policy spillover effects associated with the president and governing political party's popular anti-poverty programs, and the enduring legacy of centralized ministry of health financial and human resource assistance to primary care programs in a context of decentralization. Brazil also benefited from having a strong partnership with international health agencies. None of these factors was present in Mexico. Findings suggest that more research needs to go into understanding the complex political and inter-governmental contexts facilitating DSM program implementation, which is a neglected area of research.
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Arrifano GPF, Alvarez-Leite JI, Souza-Monteiro JR, Augusto-Oliveira M, Paraense R, Macchi BM, Pinto A, Oriá RB, do Nascimento JLM, Crespo-Lopez ME. In the Heart of the Amazon: Noncommunicable Diseases and Apolipoprotein E4 Genotype in the Riverine Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1957. [PMID: 30205523 PMCID: PMC6165059 DOI: 10.3390/ijerph15091957] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
The Amazon River basin is the largest tropical forest in the world. Most of the Amazon belongs to Brazil, a developing country that currently faces huge challenges related to the consolidation of its universal healthcare system. Noncommunicable diseases (NCDs) are the leading cause of death in Brazil, accounting for 74% of all deaths, and NCDs are probably underestimated in Amazonian population because of their geographical isolation and the precariousness of riverine communities. Important risk factors, such as genetic susceptibility, remain undetermined in the riverine population. This study performed fasting blood sugar (FBS) and blood pressure measurements and investigated the presence of the ε4 allele of apolipoprotein E (APOE4) to determine the prevalence of diabetes, hypertension and the genetic risk of NCDs. FBS and APOE4 were measured in blood samples from 763 participants using spectrometry and real-time PCR; 67.5% showed altered measurements, and 57.9% had never been diagnosed or treated. Altered FBS was found in 28.3% of the participants, hypertension in 57.6% and APOE4 in 32.0%. The health profile of the riverine population appears to differ from that of urban population in the Amazon. Additional risk factors for NCDs, such as environmental contamination and nutritional transition, may contribute more than increased genetic susceptibility to the prevalence of altered FBS and hypertension. Our results will help guide the development of preventive strategies and governmental actions for more effective management of NCDs in the Amazon area.
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Affiliation(s)
- Gabriela P F Arrifano
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Jacqueline I Alvarez-Leite
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-90, Brazil.
| | - José Rogério Souza-Monteiro
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Marcus Augusto-Oliveira
- Laboratório de Investigações em Neurodegeneração e Infecção (Hospital Universitário João de Barros Barreto), Universidade Federal do Pará, Belém 66063-023, Brazil.
| | - Ricardo Paraense
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Barbarella M Macchi
- Laboratório de Neuroquímica e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - André Pinto
- Laboratório de Análises Clínicas, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Reinaldo B Oriá
- Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Departamento de Morfologia e Instituto de Biomedicina, Escola de Medicina, Universidade Federal do Ceará, Fortaleza 60430-160, Brazil.
| | - José Luiz Martins do Nascimento
- Laboratório de Neuroquímica e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Maria Elena Crespo-Lopez
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
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Arrifano GPF, Martín-Doimeadios RCR, Jiménez-Moreno M, Fernández-Trujillo S, Augusto-Oliveira M, Souza-Monteiro JR, Macchi BM, Alvarez-Leite JI, do Nascimento JLM, Amador MT, Santos S, Ribeiro-Dos-Santos Â, Silva-Pereira LC, Oriá RB, Crespo-Lopez ME. Genetic Susceptibility to Neurodegeneration in Amazon: Apolipoprotein E Genotyping in Vulnerable Populations Exposed to Mercury. Front Genet 2018; 9:285. [PMID: 30100920 PMCID: PMC6073741 DOI: 10.3389/fgene.2018.00285] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/10/2018] [Indexed: 01/24/2023] Open
Abstract
Human exposure to mercury is a serious problem of public health in Amazon. As in other vulnerable populations throughout the world, Amazonian riverine populations are chronically exposed to this metal and some symptoms of mercury intoxication were already detected in these populations. However, studies on the genetic susceptibility to mercury toxicity in the Amazon are scarce, and they tested a limited number of individuals. In this context, apolipoprotein E gene (APOE) is a key element with a well-established association among their alleles and the neurodegenerative consequences of mercury intoxication. However, no studies have addressed APOE genotyping in Amazonian exposed populations. Additionally, epidemiological studies with APOE genotyping in Amazon have been restricted to indigenous populations. Therefore, this work analyzed for the first time the genotypic and allelic profiles of APOE in Amazonian riverine populations chronically exposed to mercury. Eight hundred and twenty three individuals were enrolled in our study donating blood (794) and/or hair (757). APOE genotyping was analyzed by real-time PCR. Total mercury and mercury species were quantified by ICP-MS and GC-pyro-AFS, respectively. Genomic ancestry markers were evaluated by multiplex-PCR reaction, separated by capillary electrophoresis on the ABI 3130 Genetic Analyzer instrument and analyzed on GeneMapper ID v3.2. The 𝜀3 and 𝜀3/𝜀3 were the most frequent allele and genotype, respectively, followed by 𝜀4 allele and 𝜀3/𝜀4 genotype. Only 𝜀2/𝜀2 genotype was not found, suggesting that the absence of this genotype is a generalized phenomenon in Amazon. Also, our data supported an association between the presence of APOE4 and the Amerindian origin in these populations. Fifty-nine individuals were identified at maximum risk with levels of mercury above 10 μg/g and the presence of APOE4. Interestingly, among individuals with high mercury content, APOE4-carriers had high mercury levels than APOE2-carriers, pointing to a different heavy metal accumulation according to the APOE allele. These data suggest that APOE4, in addition to a possible pharmacodynamic effect, may influence pharmacokinetically the mercury exposure causing its higher accumulation and leading to worse deleterious consequences. Our results may aid in the development of prevention strategies and health policy decision-making regarding these at-risk vulnerable populations.
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Affiliation(s)
- Gabriela P F Arrifano
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Rosa C R Martín-Doimeadios
- Department of Analytical Chemistry and Food Technology, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - María Jiménez-Moreno
- Department of Analytical Chemistry and Food Technology, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - Sergio Fernández-Trujillo
- Department of Analytical Chemistry and Food Technology, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - Marcus Augusto-Oliveira
- Laboratório de Investigações em Neurodegeneração e Infecção (Hospital Universitário João de Barros Barreto), Universidade Federal do Pará, Belém, Brazil
| | - José R Souza-Monteiro
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Barbarella M Macchi
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | | | - José L M do Nascimento
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil.,Neuroscience Research Group, CEUMA University, São Luís, Brazil
| | - Marcos T Amador
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Sidney Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Ândrea Ribeiro-Dos-Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | | | - Reinaldo B Oriá
- Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Departamento de Morfologia e Instituto de Biomedicina, Escola de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Maria E Crespo-Lopez
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
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22
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A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil. BMC Health Serv Res 2017; 17:32. [PMID: 28086870 PMCID: PMC5237239 DOI: 10.1186/s12913-016-1968-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/22/2016] [Indexed: 12/30/2022] Open
Abstract
Background Rates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil. Methods Nineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients’ reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients’ reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs’ fidelity to and experiences with the intervention. Results Patients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/−19) to 68 (+/−21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (−16.1 mg/dL, p = .005) and triglyceride levels (−38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium- or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many described a shift from advice-giving to encouraging patients to define their own goals. Conclusion In resource-scarce settings, it is essential to fully utilize existing primary care resources to stem the epidemic of diabetes and other NCDs. Our pilot results support the potential of training CHAs to incorporate effective diabetes self-management support into their routine patient encounters. Trial registration NCT02994095 12/14/2016 Registered retrospectively.
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23
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Nieto-Martínez R, González-Rivas JP, Florez H, Mechanick JI. Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale. Endocrinol Metab Clin North Am 2016; 45:967-1009. [PMID: 27823615 DOI: 10.1016/j.ecl.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Av. Andrés Bello con Av. Libertador, Apartado 516, Barquisimeto, Venezuela; Department of Physiology, School of Medicine, University of Panamá, Vía Transísmica, Apartado 0824, Estafeta Universitaria, Panamá, República de Panamá.
| | - Juan P González-Rivas
- The Andes Clinic of Cardio-Metabolic Studies, Av. Miranda entre calles Bermúdez y Arismendi, Apartado 3112, Timotes, Venezuela
| | - Hermes Florez
- Miami Veterans Affairs Medical Center, University of Miami Miller School of Medicine, 1201 Northwest 16th Street, CLC 207, Miami, FL 33125, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, 1192 Park Avenue, New York, NY 10128, USA
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