Background: Severe neurological involvement in systemic lupus erythematosus (NPSLE) is one of the most dreadful complications of the disease. Objective: To identify the best drug, dose, and ...treatment. Patients and methods: The study was a controlled clinical trial at two tertiary care centres of patients with SLE according to the ACR criteria, with incident (no more than 15 days) onset of severe NP manifestations such as seizures, optic neuritis, peripheral or cranial neuropathy, coma, brainstem disease, or transverse myelitis. Induction treatment with 3 g of IV methylprednisolone (MP) followed by either IV monthly cyclophosphamide (Cy) versus IV MP bimonthly every 4 months for 1 year and then IV Cy or IV MP every 3 months for another year. The primary end point was response to treatment: at least 20% improvement from basal conditions on clinical, laboratory, or specific neurological testing variables. Results: Overall, a response rate of 75% was observed. Of the 32 patients studied, 18/19 receiving Cy and 7/13 receiving MP responded to treatment (p<0.03). Conclusions: Cy seems to be more effective than MP in the treatment of acute, severe NPSLE.
El vértigo y su relación con el síndrome metabólico Vázquez-Pérez; Ylhuicatzi-Rodríguez, AC; Ariza-Andraca, CR
Revista de la Asociación de Medicina Interna de México,
04/2017, Letnik:
33, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Resumen La relación entre el vértigo y el síndrome metabólico se ha estudiado poco. Se han descrito diversas alteraciones moleculares, estructurales y funcionales que pueden explicar la existencia de ...vértigo en estos pacientes. En este artículo se analiza la epidemiología y la fisiopatología del vértigo en los pacientes con síndrome metabólico. Habrá que tener presente e indagar de manera propositiva las alteraciones del aparato vestibular en los pacientes con este síndrome.
Steroid induced diabetes (SDM) has been known for a long time, but its pathophysiological mechanisms as well as its predisposing factors remain unknown.
In order to investigate the different factors ...related to the development of steroid diabetes (SDM) in patients with rheumatic diseases, we studied 27 patients with SDM, and 27 age- and sex-matched controls who also received therapy with glucocorticoids. In every case, family history of DM, body mass index, associated treatment, steroid dose and treatment duration were studied; fasting serum insulin, "C" peptide, growth hormone and glucagon levels were measured.
All of the patients received prednisone. Cumulated prednisone dose was the only factor significantly associated with the development of SDM. Patients with SDM had a cumulated dose of 26.6 +/- 28 g (M +/- SD), while the control group received 11.6 +/- 11 g (p < 0.02) (odds ratio, 6.35). Serum insulin levels were not significantly different, but insulin/glucose ratio was lower in SDM (0.104 +/- 0.05) than in the control group (0.163 +/- 0.07) (p < 0.05).
These findings suggest that high cumulated prednisone dose may induce DM regardless of another hereditary or personal predisposing factor.
To develop and validate a specific instrument to measure lifestyle of type 2 diabetes mellitus (DM2) patients.
A longitudinal, observational, prospective study was conducted between March 2001 and ...April 2002 at family medicine healthcare units of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security (MISS)) in Mexico State's East District. A self-administered instrument (instrument to measure diabetic lifestyles, IMEVID) was designed to measure the lifestyles of diabetic patients. It was submitted for review by a multidisciplinary group of experts who assessed its logical and content validity to measure the lifestyle in DM2 patients. The instrument was administered on two different days to 412 adult subjects with DM2. Some items were excluded on the basis of the frequency with which their answer choices were selected, as well as the item-total correlation, and the item's significant loads in several domains in factorial analysis.
The sample population consisted of 389 (94.7% response) subjects who completed the study. Intraclass correlation coefficients for logical and content validity were 0.91 and 0.95 respectively. After depuration of items, the instrument had 25 closed items grouped in 7 domains: nutrition, physical activity, tobacco consumption, alcohol consumption, information on diabetes, emotions, and therapeutic adherence. The global rating of the questionnaire had a Cronbach's alpha of 0.81 and a test-retest correlation coefficient of 0.84.
The specific questionnaire IMEVID is the first to measure the lifestyle in subjects with DM2. It has logical validity, content validity, and a good level of consistency.
To evaluate construct validity of an instrument to measure lifestyle in patients with type 2 diabetes mellitus (IMEVID questionnaire)
Comparative cross-sectional study.
Six family medicine units ...(primary care).
412 adults with type 2 diabetes.
The IMEVID was applied by self-administration and the following metabolic control parameters values were measured: body mass index (BMI), waist/hip index (WHI), hemoglobin A1C (HbA1C), total cholesterol (TC), triglycerides (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the average of fasting plasma glucose in the last three months (FG). The test hypothetic construct was that higher total scores in the IMEVID (better lifestyle) would be associated with lower values in the metabolic control parameters. Three groups of subjects were formed based on the total score: group one (<quartile 25), group two (among quartile 25 and 75) and group three (>quartile 75). Differences on these parameters between groups were researched.
389 subjects completed the study, 69,2% were women. Seven IMEVID domains had weak correlations at least with two of eight parameters (r between 0.22 and 0.16; P<.05). The total score had correlation with six of eight parameter (r between 0.18 and 0.10; P< or =.05). The group three subjects had lower levels of BMI, WHI, HbA1C, FG, TC and TGL than group one subjects (P<.05).
IMEVID has construct validity to measure the lifestyle in subjects with DM2. Its total score discriminates outstanding clinical characteristics in these patients.
Delayed insulin absorption due to subcutaneous edema Ariza-Andraca, C R; Altamirano-Bustamante, E; Frati-Munari, A C ...
Archivos de investigacion medica,
1991 Apr-Jun, Letnik:
22, Številka:
2
Journal Article
A prospective study to determine if subcutaneous edema interferes with insulin absorption was performed. Forty-six patients entered the study. Three groups were formed. Twenty patients with ...generalized edema (Group 1), ten of them with non-insulin dependent diabetes mellitus (NIDDM). Twenty patients without edema (Group II). 10 of them with NIDDM; and six patients with mild edema (Group III). The disappearance of I125-insulin was measured throughout 360 minutes. The rate of absorption in group I was significantly lower and delayed than in group II. The amount of insulin absorbed at 360 minutes was 3 to 4 fold lower in group I than in group II (p 0.001). Group III had intermediate values. The peak of plasma I125-insulin level was 3 to 4 fold lower in group I than group II. The impairment of insulin absorption in subjects with edema was more evident in those with NIDDM. In conclusion, this study demonstrates that subcutaneous edema impairs insulin absorption. Insulin absorption from subcutaneous tissue varies due to several conditions, resulting in a difficult glycemic control. Previous studies have shown that insulin absorption is affected by several factors as the site of injection, room and skin temperature, physical exercise, the thickness of adipose tissue, local massage, and local degradation of insulin. Edema due to chronic complications such as nephropathy and cardiopathy often occurs in long-standing diabetic subjects. However, the effects of edema of the skin and subcutaneous tissue on insulin absorption has not been previously examined. The aim of this study was to assess if edema affects the absorption of insulin.
The objective of this study was to determine the role of atrial natriuretic peptide (ANP) in autonomic neuropathy and to learn the effect of saline solution infusion on ANP. Twenty one subjects were ...distributed in three groups: 1) control group, 2) diabetic patients with autonomic neuropathy, and 3) diabetic patients without autonomic neuropathy. The levels of ANP, renin, aldosterone and cortisol were determined at baseline and 30, 60, and 75 min after saline infusion. At baseline ANP was lower in diabetic patients with autonomic neuropathy (32.9 +/- 13) than control group (34 +/- 15). ANP increased statistically significantly at 30 min after solution administration in control group (60 +/- 35, F = 4, p < 0.05), but it did not change in diabetic patients (Group II: 34.3 +/- 9.3 and Group III 34.6 +/- 10.7). Sixty and 75 min after saline infusion ANP returned to basal levels in control group, but they did not change in diabetic patients. A delayed response of renin, aldosterone and cortisol to saline solution administration was observed in diabetic patients. There was no correlation between ANP levels and alteration of autonomic tests. It is concluded that independent of autonomic neuropathy, the levels of ANP did not increase with saline infusion in diabetic patients.
To develop and validate a diagnostic-therapeutic guideline (DTG) for the management of hospitalized diabetic patients, and apply it to a sample of medical files.
The DTG was constructed and then ...validated by a consensus of internist physicians, afterwards it was applied to a sample of 97 randomly selected medical files of diabetic patients discharged from a internal medicine service. Hospitalization time, studies requested, average glycemia, glycemic prior to the discharge, time for to achieve glycemic control and mortality were compared at different percentages of the DTG's application. The results were analyzed by U of Mann-Whitney and ANOVA of Kruskal-Wallis.
The intra-class correlation coefficient among the physicians for the guide validation was 0.94, with minimal modifications of content and format. The time, in hours, to achieve glycemic control was minor with a higher application percentage of the complete guide, p < 0.001, and also of the therapeutic domain, p = 0.05. The last glycemic prior to the discharge was lower with a higher application than 75% of the diagnostic domain, p < 0.001. A higher application percentage of the entire guide was found in living subjects more than in deceased subjects, p = 0.001, and also of the therapeutic domain, p = 0.008, and of the diagnostic domain p = 0.05.
A higher level of application of the DTG is associated with a shorter time to achieve glycemic control, lower glycemic prior to the discharge and lower mortality.
To assess the effect of different doses of Plantago psyllium mucilage on glucose tolerance test, four oral glucose tolerance tests were performed to eight healthy volunteers. Glucose load (75 g) was ...mixed with 0 (control test), 10.20 and 30 g of mucilage. Serum glucose levels were measured at 0, 30, 60, 120 and 180 minutes. Maximum peak of glucose at 30 minutes, and the area under the curve of glucose were significantly lower in the test with 20 and 30 g of mucilage than the tests with 0 and 10g. There was a significant relationship (r = 0.44 p less than 0.025) between the dose of P. psyllium mucilage and its attenuating effect of hyperglycemia.
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