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Browsing HB - EDM - Artigos by Author "Alves, M"
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- Cardiovascular safety of type 2 diabetes medications: Review of existing literature and clinical implicationsPublication . Paredes, S; Matta-Coelho, C; Monteiro, AM; Brás, A; Marques, O; Alves, M; Ribeiro, LType 2 diabetes mellitus (T2DM), cardiovascular disease (CVD) and the cardiovascular effect of antidiabetic drugs are today critical medical issues, with the prevalence of T2DM in particular showing a steep increase worldwide, mainly due to unhealthy lifestyle habits. T2DM in association with obesity and other cardiovascular risk factors, results in the development of CVD, the leading cause of morbidity and mortality in patients with T2DM. Thus, treatment of T2DM is an individualized and complex challenge in which targeting cardiovascular risk factors is an important component in the decision making. Given the cardiovascular adverse events associated with rosiglitazone, both the Food and Drug Administration and the European Medicines Agency currently require the demonstration of cardiovascular safety of new antidiabetic drugs. Consequently, clinical trials to guarantee their cardiovascular safety are now obligatory. This review aims to summarize the available evidence on the cardiovascular effects and safety of the major drugs used in T2DM treatment and also to provide an overview of upcoming and ongoing clinical trials in this field. Our belief is that this review will be of substantial assistance to all medical doctors who are treating diabetic patients, namely primary care physicians, internal medicine doctors, endocrinologists, diabetologists and less well experienced personnel such as young doctors in training.
- Diabetes e cirurgia de ambulatório – protocolo de atuação no período perioperatórioPublication . Monteiro, AM; Alves, M; Marques, OA diabetes mellitus é uma doença crónica de elevada prevalência em todo o mundo. Dado que os procedimentos cirúrgicos em regime de ambulatório têm aumentado significativamente, surge a necessidade de elaboração de um protocolo para o controlo glicémico destes doentes neste contexto. A avaliação cuidadosa pré‐operatória é fundamental e permite antecipar alterações no controlo glicémico e evitar complicações perioperatórias. Existe evidência crescente de que a otimização do controlo glicémico no período perioperatório se associa a diminuição da morbilidade e mortalidade. Com este artigo pretende‐se divulgar um protocolo atualizado, como proposta de atuação no controlo glicémico de pessoas com diabetes submetidas a procedimentos cirúrgicos em unidades de ambulatório. Abstract Diabetes mellitus is a chronic disease highly prevalent throughout the world. Since outpatient surgical procedures have significantly increased, there is a need to formulate a protocol for glycemic control of these patients in this context. Careful preoperative evaluation is crucial and allows us to anticipate changes in glycemic control and avoid perioperative complications. There is growing evidence that the optimization of glycemic control in the perioperative period is associated with decreased morbidity and mortality. With this article we intend to publish an updated protocol as an acting proposal on glycemic control in diabetic patients undergoing surgical procedures in outpatient units.
- Hipopituitarismo Pós-abortamento: a propósito de um caso clínicoPublication . Monteiro, AM; Alves, M; Marques, O
- Iron Deficiency and Obesity - Are we Diagnosing with Appropriate Indicators?Publication . Monteiro, AM; Fernandes, V; Matta-Coelho, C; Paredes, Sílvia; Pereira, ML; Marques, O; Alves, MINTRODUCTION: We aim to define the iron deficiency prevalence and eventual differences between obese patients with and without metabolic syndrome. MATERIAL AND METHODS: Analysis of patients evaluated at multidisciplinary consultation of obesity in our institution between 2013 and 2015 (n = 260). Iron deficiency: ferritin levels < 15 ng/mL. EXCLUSION CRITERIA: prior bariatric surgery; lack of ferritin or hemoglobin determinations. RESULTS: We analyzed data from 215 patients (84.2% female) with a mean age of 42.0 ± 10.3 years. The median body mass index was 42.5 (40.0 - 46.8) kg/m2 and 52.1% had metabolic syndrome. Iron deficiency was present in 7.0%, with no differences between genders or between patients with or without metabolic syndrome. Hypertension was associated with lower prevalence of iron deficiency. Type 2 diabetes and hypertension patients had higher levels of ferritin. The multivariate analysis showed that metabolic syndrome and increasing body mass index were predictive of higher risk of iron deficiency while hypertension predicted lower odds of iron deficiency. DISCUSSION: The prevalence of iron deficiency was similar in other published studies. Iron deficiency may be underdiagnosed if based only on ferritin concentrations. In our study, diabetes and hypertension appear to contribute to the increase in ferritin levels described in obesity. CONCLUSION: Ferritin may not be a reliable index for evaluating iron stores in obese patients, particularly when associated with comorbidities such as type 2 diabetes and hypertension. Further studies are needed to guide the diagnosis and iron supplementation in these patients.
- Management and Treatment of Glucocorticoid-Induced HyperglycemiaPublication . Paredes, S; Alves, MINTRODUCTION: Glucocorticoids have been associated to several side effects, specially a diabetogenic action, the most common and representative effect. Glucocorticoid-induced hyperglycemia is a common medical condition, with general associated morbidity and mortality. MATERIAL AND METHODS: It was performed a literature review about the management and treatment of glucocorticoid-induced hyperglycemia. RESULTS: Through numerous not quite fully understood mechanics, glucocorticoids promote hyperglycemia in non-diabetic patients and worsen diabetes control in diabetic individuals. Glucocorticoid-induced hyperglycemia presents key patterns, enhanced in the postprandial period and scheduled-dependent. Despite the existence of guidelines for hyperglycemia treatment in non-critic hospitalized and non-hospitalized patients, there are no guidelines respecting glucocorticoid-induced hyperglycemia. Nevertheless, it is known that glucocorticoid-induced hyperglycemia is complex and demanding, requiring a specific approach. Indeed, glucocorticoid-induced hyperglycemia treatment depends on the glucocorticoid used, its dose, frequency and schedule. Furthermore, the scheme of treatment previously used by diabetic individuals also influences the choice of the new scheme. DISCUSSION AND CONCLUSION: The authors reviewed the glucocorticoid induced-hyperglycemia thematic and propose strategies to approach and treat glucocorticoid induced-hyperglycemia in diabetic and non-diabetic individuals. This review is expected to be useful in different settings and crosswise to all medical specialties.