The metabolic syndrome and the aggregation of its components were significantly associated with macro- and microvascular complications in Type 2 DM patients.

Diabetic complications are frequent among out patients referring to general hospitals. Almost all patients presented at least one risk factor for cardiovascular disease, justifying the efforts for identification and adequate control.

The peroxisome proliferator-activated receptor ␥2 (PPAR␥2) Pro12Ala polymorphism has been associated with a decreased risk of type 2 diabetes and a lower albumin excretion rate (AER) in patients with established diabetes. We performed a case-control study aiming to evaluate the association between the Pro12Ala polymorphism and diabetic nephropathy. Genomic DNA was obtained from 104 type 2 diabetic patients (case subjects) with chronic renal insufficiency (78 on dialysis and 26 with proteinuria [AER >200 g/min] and serum creatinine >2.0 mg/dl) and 212 normoalbuminuric patients (AER <20 g/min) with known diabetes duration >10 years (control subjects). The genotypic distribution of the PPAR␥2 Pro12Ala polymorphism in these diabetic patients was in Hardy-Weinberg equilibrium, and the Ala allele frequency was 9%. The frequency of Ala carriers (Ala/Ala or Ala/Pro) was 20.3% in control subjects and 10.6% in case subjects (P ‫؍‬ 0.031). The odds ratio of having diabetic nephropathy for Ala carriers was 0. (2) and is responsible for almost half of new ESRD cases. About 80% of these ESRD patients have type 2 diabetes (1,3). It is, therefore, important to identify markers of diabetic nephropathy risk in these patients. A polymorphism in the gene for peroxisome proliferator-activated receptor ␥ (PPAR␥), a nuclear transcription factor involved in adipocyte differentiation, glucose and lipid metabolism, and fatty acid transport (4), has been associated with decreased risk of type 2 diabetes (5,6) and with lower albumin excretion rate (AER) in patients with established type 2 diabetes (7). Here, we evaluated the association between PPAR␥2 Pro12Ala polymorphism and diabetic nephropathy in patients with type 2 diabetes. RESEARCH DESIGN AND METHODSA case-control study was conducted in 316 patients with type 2 diabetes (according to World Health Organization criteria) (8) who were selected from a sample of Ͼ1,200 patients participating in a multicenter research protocol in the Rio Grande do Sul state (Brazil). The aim was to identify the genetic and nongenetic risk factors associated with diabetes complications. All type 2 diabetic patients with proteinuria (AER Ͼ200 g/min) and serum creatinine Ͼ2.0 mg/dl and all patients with normoalbuminuria (AER Ͻ20 g/min) and known diabetes duration of at least 10 years were studied. The 104 proteinuric patients with serum creatinine Ͼ2.0 mg/dl (78 on dialysis) were defined as case subjects, and the 212 normoalbuminuric patients with a known diabetes duration of at least 10 years were defined as control subjects.This study was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre and the corresponding committees at the institutions from which DNA samples were obtained. Written informed consent was obtained from all participants.Patients underwent a standardized clinical and laboratory evaluation that, to summarize, consisted of a questionnaire, physical examination, and blood collection. Sitting blood pressure was measured twice to the nearest 2 mmHg after a 5-min rest ...

Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1% (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95% CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95% CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95% CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95% CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95% CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.

Increased GFR related to single-kidney status confers an increased risk of developing renal disease in the presence of diabetes.

The environment, human, and animals play an important role in the spread of antibiotic-resistant bacteria. Enterococci are members of the gastrointestinal tracts of humans and animals and represent important reservoirs of antibiotic resistance genes. Until today, few studies have examined antibiotic susceptibility in enterococci isolated from primates. Therefore, the present study investigated species distribution, antibiotic susceptibility, and resistance genes in enterococci isolated from wild and captive black capuchins monkeys (Sapajus nigritus) in Rio Grande do Sul, South Brazil. A total of 24 swabs/fecal samples were collected, including 19 from wild monkeys living in two forest fragments [São Sebastião do Caí (SSC) and Santa Cruz do Sul (SCS)], and five in captive [Parque Zoológico da Fundação Zoobotânica (ZOO)], between August 2016 and November 2017. Fifteen colonies were randomly selected from each sample. Enterococci were identified by MALDI-TOF, tested for susceptibility to 12 antibiotics; and screened for tet(S), tet(M), tet(L), msrC, and erm(B) genes by PCR. Two-hundred ninety-six enterococci were isolated (SSC n = 137; SCS n = 86; ZOO n = 73) and differences in Enterococcus species distribution were detected on three monkey groups, with low abundance in SCS (1 - D = 0.2), followed by ZOO (1 - D = 0.68), and SSC (1 - D = 0.73). The enterococci frequently recovered include the following: Enterococcus faecalis (42.6%), E. hirae (29.1%), and E. faecium (15.9%). Antibiotic-nonsusceptible was observed in 202 (67.9%) strains. The rate of non-susceptibility to rifampicin, tetracycline, erythromycin, nitrofurantoin, chloramphenicol, and ampicillin was 46%, 26%, 22% and 19%, 13%, 0.3%, and 0.3%, respectively. All strains were susceptible to vancomycin, streptomycin, gentamycin, and linezolid. Forty-three (14.52%) isolates were identified as multidrug resistant (MDR), and the highest number of MDR enterococci were E. faecium recovered from wild monkeys living close to a hospital and water treatment plant. Elevated rates of antibiotic resistance genes msrC and tet(L) were isolates from ZOO. In conclusion, differences in the frequency of enterococci species, antibiotic-nonsusceptible and antibiotic resistance genes in all groups of monkeys were identified. These data suggest that anthropogenic activities could have an impact in the resistome of primate gut enterococci communities.

A ausência da veia cava inferior, alteração no processo de formação embriológica que ocorre entre a sexta e a oitava semanas de gestação, é uma rara anomalia congênita. Porém, recentemente foi confirmada como sendo um fator de risco importante para o desenvolvimento de trombose venosa profunda, especialmente em jovens. Apresentamos um caso de trombose em veias cava inferior, ilíacas, femorais e poplíteas num jovem de 16 anos com agenesia de um segmento de veia cava infra-renal e veia renal esquerda retroaórtica.

The DD/ID genotypes were associated with incipient or overt DN in patients with DM < or = 10 years.