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- Avaliação das Anomalias do Metabolismo da Glicose Após a Gravidez Complicada por Diabetes GestacionalPublication . Matos, C; Pereira, Mntroduction: Gestational Diabetes Mellitus (GDM) is associated with an increased risk of maternal Diabetes Mellitus (DM). Our objective was to analyse post-partum reclassification anomalies, and its relation with maternal history, pregnancy data and neonatal outcomes. Methods: Retrospective analysis of women with gestational diabetes between the year 2000 to 2007, aged from 16 to 45 years old; 47.2% had positive familiar history of DM and 9.1% had past history of GDM. Other maternal and gestational characteristics were collected; newborn weight and morbidity and reclassification results were evaluated. Statistical analysis was based on descriptive methods and Spearman correlation, Kruskal-Wallis, Mann-Whitney, Qui-square and Fisher tests, and multivariate analysis by logistic regression. Results: 424 women; 69.6% underwent reclassification; 6.1% were diagnosed impaired fasting glucose, 12.5% impaired glucose tolerance and 3.7% DM. A relation was established, between progression to impaired glucose metabolism and family history of diabetes, elevated BMI before pregnancy, earlier gestational age at diagnosis and need for insulin therapy. Discussion: Only elevated BMI before pregnancy seems to predict progression to altered glucose metabolism. Therefore, it is important to develop preventive strategies for obesity and be aware that every woman with GDM undergoes reclassification tests.
- 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.
- Carência de Vitamina D numa População Hospitalar: Uma Fotografa pela Perspetiva LaboratorialPublication . Santos, MJ; Fernandes, V; Garcia, FMNTRODUCTION: Although vitamin D deficiency is increasingly recognized around the world, there are few studies on the Portuguese reality. This study aims to analyse vitamin D levels in the assays performed in our hospital and their relationship with age, genre, requesting specialty and moment of sample collection. MATERIAL AND METHODS: Cross-sectional study of measurements of 25(HO)D performed in our Hospital between June 2012 and November 2014. Included variables: gender, age, requesting specialty, month of sample collection. Vitamin D status classified as: 'Deficiency' (≤ 20 ng/mL), 'Insufficiency' (21 - 29 ng/ml) and 'Sufficiency' (≥ 30 ng/mL). RESULTS: We included 5 439 assays; 55.0% from women; the median age was 64.0 years. Sixty per cent had 'Deficiency', 20.7% 'Insufficiency' and 18.9% 'Sufficiency'. We found a negative correlation between age and vitamin D level (p < 0.001). We didn't find differences in vitamin D levels between genres. Nine specialties requested 98% of the assays, namely Nephrology (56.2%). We found differences between specialties based on age and vitamin D level (p < 0.001). Vitamin D levels changed throughout the year, with higher levels in the summer, followed by autumn, spring and winter (p < 0.001). Despite this seasonal fluctuation, vitamin D sufficiency was only present in a minority of assays (27.8% in summer and 9.2% in winter). DISCUSSION: Vitamin D deficiency is prevalent in this population, affects individuals of all ages and is not offset by the seasonal variation of sunlight. CONCLUSION: Vitamin D deficiency is a real and prevalent problem in our population that needs further attention and action, given its clinical implications.
- De encefalopatia e orelhas duras ao síndrome de Sheehan: caso clínicoPublication . Machado, A; Ferreira, C; Lopes, M; Pereira, T; Pardal, F
- Design of cationic lipid nanoparticles for ocular delivery: Development, characterization and cytotoxicityPublication . Fangueiro, JF; Andreani, T; Egea, MA; Garcia, ML; Souto, SB; Silva, AM; Souto, EBIn the present study we have developed lipid nanoparticle (LN) dispersions based on a multiple emulsion technique for encapsulation of hydrophilic drugs or/and proteins by a full factorial design. In order to increase ocular retention time and mucoadhesion by electrostatic attraction, a cationic lipid, namely cetyltrimethylammonium bromide (CTAB), was added in the lipid matrix of the optimal LN dispersion obtained from the factorial design. There are a limited number of studies reporting the ideal concentration of cationic agents in LN for drug delivery. This paper suggests that the choice of the concentration of a cationic agent is critical when formulating a safe and stable LN. CTAB was included in the lipid matrix of LN, testing four different concentrations (0.25%, 0.5%, 0.75%, or 1.0%wt) and how composition affects LN behavior regarding physical and chemical parameters, lipid crystallization and polymorphism, and stability of dispersion during storage. In order to develop a safe and compatible system for ocular delivery, CTAB-LN dispersions were exposed to Human retinoblastoma cell line Y-79. The toxicity testing of the CTAB-LN dispersions was a fundamental tool to find the best CTAB concentration for development of these cationic LN, which was found to be 0.5wt% of CTAB.
- 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.
- Diabetes e hiperglicemia: factores de prognóstico na pneumonia adquirida na comunidade – estudo retrospectivo em doentes admitidos no Hospital de BragaPublication . Fernandes, V; Ramalho, J; Santos, MJ; Oliveira, N; Pereira, M
- Diabetes e hiperglicemia: fatores de prognóstico na pneumonia adquirida na comunidadePublication . Fernandes, V; Ramalho, J; Santos, MJ; Oliveira, N; Lopes-Pereira, MBackground: Community acquired pneumonia (CAP) is a common condition and a major cause of morbidity. Diabetes mellitus (DM) increases the risk and complications of infectious diseases. However, the role of DM and glycemia at the time of presentation as prognostic factors in patients with CAP remains to be clarified. Aims: To evaluate the relationship between DM/glycemia at the time of presentation and complications, length of stay and mortality in patients with CAP, and the relationship between glycemic control and complications in patients with diabetes.Methods: Observational, analytical and retrospective study of adults admitted to our hospital between October/2011 and March/2012, with CAP. Electronic clinical data were analyzed and telephone calls were done to assess mortality at 30 and 90 days. The chi-square test, Mann-Whitney and Kruskal-Wallis tests, and logistic regression were used. Results: Of the 440 included patients, 51.1% were women, 83.1% elderly and 29.3% had diagnosis of DM. Of these, 48.8% had HbA1c measured (median 6.8%, IQR: 6.3-7.8%). The median glucose was 134 mg/dL (IQR: 111-176 mg/dL). Patients with DM were older (p = 0.002), had higher severity of pneumonia (p = 0.025), more complications (p = 0.001) and longer hospital stay (p = 0.001). DM proved to be a predictor of complications (p = 0.008). No association between DM and mortality was found, nor between HbA1c levels and complications, length of stay and mortality. Higher glucose levels at admission were associated with longer hospital stay (p = 0.016) and patients with hyperglycemia on admission had more complications (no statistically significant). However, no association between glucose levels on admission and mortality was found. Conclusion: DM and hyperglycemia on admission are associated with adverse outcome in CAP. Both are associated with longer hospital stay and DM predicts complications from CAP.
- Diabetes e o futuro do tratamento.Publication . Medina, JL; Souto, S; Ferreira, J
- Diabetes Gestacional: Avaliação dos Desfechos Maternos, Fetais e NeonataisPublication . Miranda, A; Fernandes, V; Marques, M; Castro, L; Fernandes, O; Pereira, MLIntrodução: Apesar dos progressos na vigilância e tratamento da diabetes gestacional (DG), os resultados obstétricos e neonatais ainda não igualaram os da gravidez sem esta complicação. Este estudo pretendeu caracterizar uma população de grávidas com DG comparando-a com uma população obstétrica com rastreio de DG negativo. Material e Métodos: Realizámos um estudo observacional e retrospetivo, através da consulta de processos clínicos de 201 grávidas com DG e 201 grávidas com rastreio de DG negativo, com seguimento e parto no nosso hospital. Resultados: As grávidas com DG apresentaram idade mais avançada (33 vs 31 anos, p = 0,001) e maior prevalência de hipertensão gestacional (6% vs 2%, p = 0,041). O grupo da DG registou uma taxa de cesariana mais elevada (40,3% vs 24,4%, p = 0,001), sendo a incompatibilidade céfalo-pélvica o principal motivo de cesariana (32,9%). Não se verificaram diferenças entre os grupos relativamente ao peso fetal ao nascimento. Recém-nascidos de mães com DG tiveram mais distócia de ombros (3% vs 0%, p = 0,014) e foram mais frequentemente admitidos da Unidade de Cuidados Intensivos Neonatais (14,9% vs 8,5%, p = 0,044), principalmente por hipoglicemia. Não foram encontrados fatores de risco para este desfecho. Discussão: Grávidas com DG eram mais velhas, apresentaram maior incidência de hipertensão gestacional, parto por cesariana e morbilidade neonatal relativamente ao grupo controlo. Conclusão: No presente estudo, a ocorrência de DG condicionou um aumento da morbilidade obstétrica e, sobretudo, neonatal.