Desmopressin was able to stimulate the pituitary-adrenal axis in patients with Cushing's disease and, like corticotrophin releasing hormone, it may prove useful in the differential diagnosis of Cushing's syndrome.
This study aimed to analyze costs for treating patients with diabetic foot cared by the public Brazilian Health System (SUS), comparing the estimated cost with the amount of SUS reimbursement. A cohort prospective study carried out in hospitals that provide services for the Unified Health System in Sergipe, involving 109 hospitalization episodes of patients with diabetes and foot ulcers. We follow these patients day by day and estimated the hospital direct cost and the SUS reimbursement. All patients had type 2 diabetes and the majority of ulcers (64.2%) were classified as Wagner 4 or 5. Forty-three (39.4%) healed without amputation and fifty-two (47.7%) healed with amputation. Fourteen (12.8%) patients died. Hospital direct cost ranged from R$ 943.72 to R$ 16,378.85; with an average of R$ 4,461.04. The SUS reimbursement varied from R$ 96.95 to R$ 2,410.18, with an average of R$ 633.97, usually seven times low. Smaller difference between costs occurred in patients from the Beneficent hospital and higher rates occurred in those treated with minor amputation.
Our data suggest that in the short and middle terms, high fructose and sucrose diets do not adversely affect glycemia, lipemia, or insulin and C-peptide secretion in well-controlled type II diabetic subjects.
Our model shows that the social and economic impact of diabetic foot disease in Brazil is high. Government decision makers should reflect on the current situation and provide organized foot care throughout the whole country.
There is a very well known correlation between diabetes and cardiovascular disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious cardiovascular diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and cardiovascular disease: Glicemic Control, Cardiovascular Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology.
The Brazilian Diabetes Society is starting an innovative project of quantitative assessment of medical arguments of and implementing a new way of elaborating SBD Position Statements. The final aim of this particular project is to propose a new Brazilian algorithm for the treatment of type 2 diabetes, based on the opinions of endocrinologists surveyed from a poll conducted on the Brazilian Diabetes Society website regarding the latest algorithm proposed by American Diabetes Association /European Association for the Study of Diabetes, published in January 2009.An additional source used, as a basis for the new algorithm, was to assess the acceptability of controversial arguments published in international literature, through a panel of renowned Brazilian specialists. Thirty controversial arguments in diabetes have been selected with their respective references, where each argument was assessed and scored according to its acceptability level and personal conviction of each member of the evaluation panel.This methodology was adapted using a similar approach to the one adopted in the recent position statement by the American College of Cardiology on coronary revascularization, of which not only cardiologists took part, but also specialists of other related areas.
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