Objectives This study aimed to evaluate the frequencies of the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) and methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphisms in obese patients with and without type 2 diabetes mellitus (T2DM). Subjects and methods These polymorphisms were analyzed by polymerase chain reaction in 125 patients with obesity, 47 (T2DM) and 78 (Control Group). Results No significant difference was found on comparing the T2DM and Control Groups in respect to the genotypic frequencies of the polymorphisms - (II: 13.3% vs. 12.0%; ID: 37.8% vs. 37.3; DD: 48.9% vs. 50.7%; CC: 36.2% vs. 39.0%; CT: 46.8% vs. 49.3%; TT: 17.0% vs. 11.7%), and alleles (I: 32.2% vs. 30.7%; D: 67.8% vs. 69.3%; C: 59.6% vs. 63.6%; T: 40.4% vs. 36.4%) and their synergisms in the pathophysiology of T2DM. On analyzing the T2DM Group, there were no significant differences in the presence of complications. In this population of Brazilian obese patients, no correlation was found between the ACE and MTHFR polymorphisms in the development of T2DM. Conclusion Analyzing only the group with diabetes, there was also no relationship between these polymorphisms and comorbidities.
ObjectiveThe incidence of adverse events in myeloablative transplant protocols is high in refractory Crohn’s disease; this study used low doses of cyclophosphamide. Fourteen patients were submitted to non-myeloablative autologous hematopoietic stem cell transplantation.ResultsThe average number of days of anemia (hemoglobin < 10 g/dL) was 5.4 ± 4.2 and 14 ± 2.4 in the mobilization and conditioning phases, respectively. The mean number of days of neutropenia (neutrophils < 0.5 × 109/L) in the mobilization phase was 1.7 ± 1.5 while it was 7.6 ± 1.4 in the conditioning phase. When comparing the conditioning and mobilization phases, there was an increased number days of leukopenia (white blood cells < 1.0 × 109/L), lymphocytopenia (lymphocytes < 0.5 × 109/L) and thrombocytopenia (platelets < 25 × 109/L). Crohn’s Disease Activity Index values before the transplant ranged from 155 to 450.5 (mean 281.2 ± 79.0) and at 30 days after the procedures they ranged from 45.4 to 177 (mean 95.8 ± 35.4). Moreover, the procedure improved in overall quality of life of patients. Non-myeloablative autologous hematopoietic stem cell transplantation with lower doses of cyclophosphamide leads to lower rates of hematological toxicity and adverse events compared to protocols described in the literature. Trial registration NCT 03000296: Date 9 December 2016Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2824-1) contains supplementary material, which is available to authorized users.
Arterial pulmonary hypertension (PAH) is a rare complication in patients with metabolic syndrome. A good glycemic control is related to a better prognosis in diabetic patients with PAH. The presence of GLP-1 receptors in the lungs and the fact that this incretin promotes vasorelaxation in the pulmonary artery, place the incretin-based therapy as a possible treatment in patients with PAH. This case report will show the effect of vildagliptin -a DPP4 inhibitor -on the improvement of pulmonary symptoms and hemodynamic patterns in a patient with type 2 diabetes mellitus and PAH.
Studies show that at least half the adult population is overweight in most countries. Recent case reports have shown the important metabolic potential of the pathophysiology of PAH. Many cases of PAH, etiologically classified as idiopathic, present an important interaction with insulin resistance, glucose intolerance and adiponectin deficiency. However, very little of these effects is operated GLP1 link receiver in his lung. About 20 years it is known of the presence of GLP1R lung and also the statement of GLP1 in vasorelaxation of pulmonary artery in animal models but few papers relating this incretin in the pathophysiology and treatment of PAH. The mimic incretins hypoglycemic drugs -the iDPP4 and GLP1a -would have a great therapeutic potential in diabetic patients with PAH. More studies are needed to evaluate the benefit of these medications in the treatment of PAH as well as its effectiveness of these effects in non-diabetic patients.
A diabetes mellitus tipo 2 (DM2) é uma síndrome heterogênea que resulta de deficiência na secreção de insulina pelas células beta do pâncreas ou de hiperglicemia por aumento da resistência à insulina nos tecidos periféricos. Os principais exames de controle glicêmico são a hemoglobina glicada (HbA1c) e glicemia basal, peso corporal e níveis de lipídios séricos (colesterol total e triglicerídeos). Publicações mostram que a intervenção da dieta low carb (DLC) melhorou esses parâmetros de controle glicêmico. O objetivo desta revisão sistemática foi analisar como a DLC pode trazer benefícios para o tratamento de pacientes diabéticos do tipo 2. Foram utilizados artigos publicados na base de dados Scielo, Pubmed, Sociedade Brasileira de Diabetes e Diretrizes da Sociedade Brasileira de Diabetes. Incluiu-se os estudos que consideravam a DLC em pacientes com diabetes tipo 2 e os efeitos dessa dieta em relação ao controle da glicemia glicada, peso e níveis de lipídeos séricos. A meta-análise é a primeira a avaliar a eficácia da DLC no manejo da diabetes tipo 2. Nove RCTs com 734 participantes foram incluídos na análise. Os achados dessa metanálise sugerem que a intervenção da LCD teve um efeito positivo na HbA1c, triglicerídeos e concentração de HDL-c. Em conclusão, esse tipo de dieta tem efeito benéfico na melhora da HbA1c, o que sugere que essa pode ser efetiva para o manejo da diabetes tipo 2. Além disso, a intervenção com essa dieta pode ser benéfica em fatores de risco para o desenvolvimento de doenças cardiovasculares.
According to epidemiological data on type 2 diabetes (T2DM) represents about 95 % of cases of diabetes diagnosed, with projected to exceed 480 million in 2030. In addition, pulmonary arterial hypertension (PAH) has an estimated prevalence of 30 to 50 cases per million population, affects women more often than men, and PAH and T2DM are medical conditions that presents statistical correlation. The aim of this study was to evaluate the treatment in patients with diabetic that despite age, reported no episodes of hypoglycemia during the case study. Larger studies are needed to assess whether the same results are reproducible in diabetics and also euglycemic patients with PAH. Case 1, SPLM, patient 63-year-old female with a previous diagnosis of T2DM, obesity, hypertension and dyslipidemia forwarded to endocrine evaluation for better glycemic control and weight loss. Case 2, HFC, patient 74-year-old female with a previous diagnosis of T2DM about three years, obesity, hypertension, dyslipidemia osteopenia, vitamin D deficiency and pulmonary hypertension. In the present study, this is the first description in humans that use a iDDP4 may be a treatment option for patients with PAH by the presence of receptor GLP-1R in the lung. It was concluded that in the first case there was weight loss and improved glycemic level. In the second case, both the glucose level of the weight remained. In both cases, using vildagliptin, there was a decrease in systolic pressure of right ventricle pointed out that the relaxation of pulmonary artery has a more beneficial effect would be mediated by NO and activation of vascular potassium channels, further of the effect direct by increasing GLP1, since the IRS1 less inhibited increases the activation of kinases, which in turn increases the stimulus for nitric oxide production in endothelial cells, reducing pulmonary arterial pressure.
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