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[SciELO Preprints] - Hepatic Insulin Resistance: A liver-specific type 2 diabetes
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Andrade, Luis Jesuino de Oliveira
Oliveira, Gabriela Correia Matos de
Bittencourt , Alcina Maria Vinhaes
Xavier , Isabela Pimenta
Oliveira, Luís Matos de
Introduction: The liver plays a critical role in glucose and lipid homeostasis. Insulin resistance (IR) has been increasingly recognized as a primary etiological factor in metabolic disorders. Hepatic insulin resistance (HIR) is a specific manifestation of IR characterized by the liver's reduced responsiveness to insulin despite elevated circulating insulin levels. Objective: This review aims to elucidate the role of HIR in the pathogenesis of metabolic disorders, focusing on its relationship with metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM). Methods: A comprehensive literature search was conducted to explore the underlying mechanisms of HIR, its clinical implications, and its association with MAFLD and T2DM. Results: HIR is characterized by impaired insulin-mediated glucose uptake and increased hepatic glucose output. This metabolic dysfunction contributes to the development of hepatic steatosis, dyslipidemia, and insulin resistance in peripheral tissues. The interplay between HIR and lipogenesis is important in the progression of MAFLD and its association with T2DM, and could be described as a hepatic equivalent of T2DM. Conclusion: The understanding of a T2DM-like condition in the liver is decisive for developing more targeted and effective treatments.
Introdução: O fígado desempenha um papel crítico na homeostase da glicose e lipídios. A resistência à insulina (RI) tem sido cada vez mais reconhecida como um fator etiológico primário em distúrbios metabólicos. A resistência à insulina hepática (RIH) é uma manifestação específica da RI caracterizada pela redução da resposta hepática à insulina, apesar dos níveis elevados de insulina circulante. Objetivo: Este manuscrito visa avaliar o papel da RIH na patogênese dos distúrbios metabólicos, com foco em sua relação com a doença hepática gordurosa associada à disfunção metabólica (DHGDM) e o diabetes mellitus tipo 2 (DMT2). Métodos: Foi realizada uma busca abrangente na literatura para explorar os mecanismos subjacentes da RIH, suas implicações clínicas e sua associação com a DHGDM e o DMT2. Resultados: A RIH é caracterizada pela redução da captação de glicose mediada pela insulina e pelo aumento da produção hepática de glicose. Essa disfunção metabólica contribui para o desenvolvimento de esteatose hepática, dislipidemia e RI em tecidos periféricos. A interação entre RIH e lipogênese é importante na progressão da DHGDM e sua associação com o DMT2, podendo ser descrita como um equivalente hepático do DMT2. Conclusão: A compreensão de uma condição semelhante ao DMT2 no fígado é decisiva para o desenvolvimento de tratamentos mais direcionados e eficazes.
2.
Brain insulin resistance and Alzheimer’s disease: a systematic review Alzheimers Alzheimer s disease
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Andrade, Luis Jesuino de Oliveira
; Oliveira, Luís Matos de
; Bittencourt, Alcina Maria Vinhaes
; Lourenço, Letícia Góes de Carvalho
; Oliveira, Gabriela Correia Matos de
.
RESUMO. A incapacidade das células de reagir à insulina, ocasionando intolerância à glicose e hiperglicemia, é chamada de resistência à insulina. Essa condição clínica, que tem sido bem pesquisada em órgãos como tecido adiposo, músculo e fígado, tem sido associada às doenças neurodegenerativas como a doença de Alzheimer (DA) quando ocorre no cérebro. Objetivo: O objetivo dos autores foi reunir os dados da literatura atual sobre a resistência insulínica cerebral (RIC) e sua provável repercussão em doenças neurodegenerativas, mais especificamente na DA, por meio de uma revisão sistemática da literatura. Métodos: Foi realizada uma pesquisa abrangente em vários bancos de dados médicos, incluindo o Cochrane Central Register of Controlled Trials, EMBASE, Medical Literature Analysis and Retrieval System Online (Medline) e PubMed, empregando os descritores: “resistência à insulina”, “resistência insulínica cerebral”, “doença de Alzheimer”, “neurodegeneração” e “cognição”. Os autores concentraram sua busca em estudos no idioma inglês publicados entre 2000 e 2023 que investigaram a influência da RIC em distúrbios neurodegenerativos ou ofereceram insights sobre os mecanismos subjacentes da RIC. Dezessete estudos que atenderam aos critérios de inclusão foram selecionados. Resultados: Os resultados demonstram que a RIC é um fenômeno observado em uma variedade de doenças neurodegenerativas, incluindo a DA. Estudos sugerem que a utilização e captação prejudicadas de glicose, a produção reduzida de trifosfato de adenosina (ATP) e as alterações na plasticidade sinápticas causadas pela RIC estão ligadas a problemas cognitivos. No entanto, foram observados resultados conflitantes com relação à associação entre DA e RIC, com alguns estudos sugerindo nenhuma associação. Conclusão: Com base nos estudos avaliados, pode-se concluir que a associação entre DA e RIC ainda é inconclusiva, e pesquisas adicionais são necessárias para elucidar essa relação. RESUMO insulina hiperglicemia clínica adiposo fígado (DA cérebro Objetivo (RIC Métodos médicos Trials EMBASE Medline (Medline PubMed descritores , insulina” cerebral, cerebral” Alzheimer, Alzheimer” neurodegeneração “neurodegeneração cognição. cognição . “cognição” 200 202 selecionados Resultados ATP (ATP cognitivos entanto Conclusão avaliados podese pode se inconclusiva “cognição 20 2
ABSTRACT. The disability of cells to react to insulin, causing glucose intolerance and hyperglycemia, is referred to as insulin resistance. This clinical condition, which has been well-researched in organs such as adipose tissue, muscle, and liver, has been linked to neurodegenerative diseases like Alzheimer’s disease (AD) when it occurs in the brain. Objective: The authors aimed to gather data from the current literature on brain insulin resistance (BIR) and its likely repercussions on neurodegenerative disorders, more specifically AD, through a systematic review. Methods: A comprehensive search was conducted in multiple medical databases, including the Cochrane Central Register of Controlled Trials, EMBASE, Medical Literature Analysis and Retrieval System Online (Medline), and PubMed®, employing the descriptors: “insulin resistance”, “brain insulin resistance”, “Alzheimer’s disease”, “neurodegeneration”, and “cognition”. The authors focused their search on English-language studies published between 2000 and 2023 that investigated the influence of BIR on neurodegenerative disorders or offered insights into BIR’s underlying mechanisms. Seventeen studies that met the inclusion criteria were selected. Results: The results indicate that BIR is a phenomenon observed in a variety of neurodegenerative disorders, including AD. Studies suggest that impaired glucose utilization and uptake, reduced adenosine triphosphate (ATP) production, and synaptic plasticity changes caused by BIR are linked to cognitive problems. However, conflicting results were observed regarding the association between AD and BIR, with some studies suggesting no association. Conclusion: Based on the evaluated studies, it can be concluded that the association between AD and BIR remains inconclusive, and additional research is needed to elucidate this relationship. ABSTRACT hyperglycemia condition wellresearched well researched tissue muscle liver Alzheimers Alzheimer s (AD Objective (BIR review Methods databases Trials EMBASE Medline, Medline , (Medline) PubMed PubMed® descriptors resistance, resistance” disease, disease” neurodegeneration, neurodegeneration “neurodegeneration” cognition. cognition . “cognition” Englishlanguage English language 200 202 BIRs mechanisms selected Results uptake ATP (ATP production problems However Conclusion inconclusive relationship (Medline “neurodegeneration “cognition 20 2
3.
Decoding the relationship between cow’s milk proteins and development of type 1 diabetes mellitus cows cow s
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Andrade, Luís Jesuino de Oliveira
; Oliveira, Gabriela Correia Matos de
; Oliveira, Luísa Correia Matos de
; Bittencourt, Alcina Maria Vinhaes
; Baumgarth, Yvana
; Oliveira, Luís Matos de
.
ABSTRACT Objective To analyze in silico the evidence of molecular mimicry between human beta-cell autoantigens and cow’s milk proteins as a potential type 1 diabetes mellitus (T1DM) trigger. Materials and methods The in silico analysis was performed using bioinformatics tools to compare the amino acid sequences of cow’s milk proteins (bovine serum albumin [BSA] and beta-lactoglobulin [BLG]) and human beta-cell autoantigens (glutamic acid decarboxylase-65 [GAD-65], insulin, and zinc transporter 8 [ZnT8]). The structural and functional characteristics of the proteins were analyzed to identify potential molecular mimicry mechanisms. Results The results of the in silico analysis showed significant sequence similarity between BSA/BLG and GAD-65/human insulin/ZnT8, ranging from 19.64% to 27.27%. The cow’s milk proteins evaluated shared structural features with the beta-cell antigens selected for comparison, indicating a potential for molecular mimicry between these proteins. Conclusion The findings of this study provide further evidence for a potential role of cow’s milk proteins in triggering T1DM. The in silico analysis suggests that molecular mimicry mechanisms between cow’s milk proteins and human beta-cell antigens may contribute to the autoimmune response leading to T1DM. betacell beta cell cows cow s T1DM TDM T DM (T1DM trigger bovine BSA [BSA betalactoglobulin lactoglobulin BLG [BLG] glutamic decarboxylase65 decarboxylase 65 decarboxylase-6 GAD65, GAD65 GAD , [GAD-65] insulin ZnT8. ZnT8 ZnT . [ZnT8]) BSABLG GAD65/human GAD65human GADhuman 65/human insulinZnT8 insulinZnT insulin/ZnT8 1964 19 64 19.64 2727 27 27.27% comparison [BLG decarboxylase6 6 decarboxylase- GAD6 [GAD-65 [ZnT8] 65human insulin/ZnT 196 19.6 272 2 27.27 [GAD-6 [ZnT8 19. 27.2 [GAD- [ZnT 27. [GAD
4.
Ingestive behavior, volatile fatty acids, blood biochemical and hormonal variables of dairy goats supplemented with glycerin behavior acids
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Freire, Luís Flávio da Silva
; Cruz, George Rodrigo Beltrão da
; Ribeiro, Neila Lidiany
; Costa, Roberto Germano
; Silva, Gislaine Ferreira
; Salviano, Giullyann de Oliveira
; Chiodi, John Edson
; Leite, José Aparecido de Oliveira
; Matos Júnior, Joab Jorge Leite de
; Leite, Jackson Rômulo de Sousa
.
ABSTRACT. The objective of this research was to determine the ingestive behavior, volatile fatty acids, and blood biochemical and hormonal variables of goats consuming a diet with 15% glycerin. Feed efficiency (FE) and rumination (ER) of dry matter intake (DMI) and neutral detergent fiber (NDFI) of dairy goats supplemented with glycerin (0 and 15%) were not influenced by treatments (p > 0.05). The specific activities of defecation, urination and drinking had a significant effect (p < 0.05) in relation to the treatments with glycerin in the diet of dairy goats. The occasional activities (defecation, urinating and drinking water) decreased with the addition of 15% of glycerin in the goats’ diet. Lactic acid had a significant effect (p < 0.001) with the addition of 15% glycerin. Diets for dairy goats with 15% glycerin did not change the consumption of dry material, neutral detergent fiber, nor did they change the ingestive behavior of these animals. The levels of globulin, protein, albumin/globulin, glucose, cholesterol, urea, triglycerides, cortisol, and T4 variables were significantly influenced (p < 0.05) by the addition of glycerin in the diet. ABSTRACT acids 15 FE (FE ER (ER DMI (DMI NDFI (NDFI 0 ( p 0.05. 005 0.05 . 05 defecation (defecation water 0.001 0001 001 material animals globulin protein albuminglobulin albumin albumin/globulin glucose cholesterol urea triglycerides cortisol T 1 00 0.0 0.00 000 0.
5.
Challenges in the conservation and management of legal reserve areas in Brazilian grassland and savanna ecosystems in the face of global climate change
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Tomas, Walfrido Moraes
; Baggio, Rodrigo
; Berlinck, Christian Niel
; Camilo, André Restel
; Cunha, Cátia Nunes da
; Damasceno-Junior, Geraldo
; Durigan, Giselda
; Dutra-Silva, Rodrigo
; Fidélis, Alessandra
; Garcia, Letícia Couto
; Herrera, Heitor Miraglia
; Libonati, Renata
; Marengo, José Antonio
; Oliveira, Maxwell da Rosa
; Overbeck, Gerhard Ernst
; Pereira, Alexandre de Matos Martins
; Pillar, Valério De Patta
; Pivello, Vânia Regina
; Ribeiro, Danilo Bandini
; Ribeiro, José Felipe
; Sampaio, Alexandre Bonesso
; Santos Júnior, Antonio dos
; Schmidt, Isabel Belloni
; Soriano, Balbina Maria Araújo
; Tiepolo, Liliani Marília
; Timo, Thiago Philipe de Camargo e
; Urbanetz, Cátia
; Vieira, Daniel Luis Mascia
; Walter, Bruno Machado Teles
.
Resumo As áreas de reserva legal (ARLs) são parte fundamental da estratégia brasileira de conservação, juntamente com as áreas de preservação permanente. As ARLs são destinadas à manutenção da biodiversidade e podem ser manejadas de forma sustentável. Quando essas áreas abrigam ecossistemas dependentes de fogo e pastejo, como os campos nativos e as savanas, devem ser adotadas práticas de manejo adequadas à sua conservação e ao enfrentamento dos efeitos das mudanças climáticas globais. No entanto, esse assunto ainda é pouco discutido no Brasil, e as políticas públicas não são claras a esse respeito. Este artigo de revisão descreve os ecossistemas campestres e savânicos no Brasil, os aspectos legais relacionados com o manejo das ARLs, os cenários climáticos atuais e futuros, e a relação entre clima e risco de incêndios. Também apresenta uma revisão sobre o uso do fogo e do pastejo em ecossistemas campestres e savânicos, os desafios legais relativos à sua aplicação nas ARLs e o uso de geotecnologias no monitoramento destas práticas. Conclui-se que o pastejo e o fogo, como instrumentos de manejo, são adequados às funções das ARLs, desde que praticados segundo normas legais e cientificamente embasadas para evitar os efeitos negativos do seu uso equivocado. (ARLs permanente sustentável savanas globais entanto Brasil respeito futuros incêndios Concluise Conclui se equivocado
Abstract Legal reserve areas (LRAs) are a fundamental part of the Brazilian conservation strategy, together with permanent preservation areas. The LRAs are intended to maintain biodiversity and can be managed sustainably. When these areas are home to ecosystems that depend on fire and grazing, such as native grasslands and savannas, management practices that are suitable for their conservation and for dealing with the effects of global climate change should be adopted. However, this subject is still poorly discussed in Brazil, and public policies are not clear on this matter. This review article describes the grassland and savanna ecosystems in Brazil, the legal aspects related to the management of LRAs, the current and future climate scenarios, and the relationship between climate and fire risk. It also presents a review about the use of fire and grazing in grassland and savanna ecosystems, the legal challenges related to their application in LRAs, and the use of geotechnologies to monitor these practices. The conclusion is that grazing and fire, as management tools, are adequate for LRA functions, as long as they are practiced in accordance with legal and scientifically based standards to avoid the negative effects of their incorrect use. (LRAs strategy sustainably savannas adopted However Brazil matter scenarios risk tools functions
6.
THE CONNECTION BETWEEN BILE ACIDS AND TYPE 2 DIABETES MELLITUS - A REVIEW
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RESUMO Contexto: Os ácidos biliares (ABs) são moléculas esteróides sintetizadas exclusivamente no fígado, sendo produtos finais do catabolismo do colesterol. Os ABs são conhecidos por estarem envolvidos em várias alterações metabólicas, incluindo a síndrome metabólica e o diabetes mellitus tipo 2 (DM2). A DM2 é uma doença crônica degenerativa caracterizada pela resistência insulínica, deficiência de insulina devido à produção insuficiente de células ß pancreáticas e hiperglicemia levando a múltiplas complicações. Objetivo: O objetivo deste estudo é investigar o papel dos ABs na fisiopatologia da DM2, destacando as possibilidades no desenvolvimento de procedimentos terapêuticos visando os ABs como uma via opcional no tratamento da DM2. Métodos: A pesquisa foi realizada por meio de revisão narrativa e publicações sobre a relação entre ABs e DM2. As bases de dados usadas para a pesquisa incluem PubMed, Scopus e Web of Science. As palavras-chave usadas para a pesquisa incluíram: ácidos biliares, diabetes mellitus tipo 2, síndrome metabólica e distúrbios metabólicos. Resultados: Os estudos relataram o envolvimento dos ABs na fisiopatologia da DM2. Os ABs atuam como ligantes para o receptor nuclear farnesoide X, regulando o metabolismo da glicose, metabolismo lipídico e produção de energia celular. Além disso, os ABs regulam a produção, eliminação e mobilização de ABs através do receptor farnesoide X. Os ABs também atuam como uma via de sinalização através do receptor acoplado à proteína G Takeda 5, contribuindo ainda mais para a regulação metabólica. Esses achados sugerem que o ABs pode oferecer uma nova abordagem terapêutica no tratamento da DM2. Conclusão: Este estudo destaca o papel importante do ABs na DM2, especificamente por meio de suas interações com vias metabólicas-chave. O redirecionamento ao ABs pode representar uma abordagem inovadora e eficaz para o tratamento da DM2. Contexto (ABs fígado colesterol metabólicas DM . (DM2) insulínica complicações Objetivo Métodos PubMed Science palavraschave palavras chave incluíram metabólicos Resultados X glicose celular disso 5 Conclusão metabólicaschave. metabólicaschave chave. metabólicas-chave (DM2 (DM
ABSTRACT Background: Bile acids (BAs) are steroid molecules synthesized exclusively in the liver, being end products of cholesterol catabolism. BAs are known to be involved in several metabolic alterations, including metabolic syndrome and type 2 diabetes mellitus (DM2). DM2 is a chronic degenerative disease characterized by insulin resistance, insulin deficiency due to insufficient production of pancreatic ß-cells, and elevated serum glucose levels leading to multiple complications. Objective: The objective of this study is to investigate the role of BAs in the pathophysiology of DM2, highlighting the possibilities in the development of therapeutic procedures targeting BAs as an optional pathway in the treatment of DM2. Methods: The research was carried out through narrative review and publications on the relationship between BAs and DM2. The databases used for the search include PubMed, Scopus, and Web of Science. The keywords used for the search include bile acids, type 2 diabetes mellitus, metabolic syndrome, and metabolic disorders. Results: The studies have reported the involvement of BAs in the pathophysiology of DM2. BAs act as a ligand for the nuclear farnesoid X receptor, regulating glucose metabolism, lipid metabolism, and cellular energy production. Additionally, BAs modulate the production, elimination, and mobilization of BAs through the farnesoid X receptor. BAs also act as a signaling pathway through Takeda G protein-coupled receptor 5, further contributing to metabolic regulation. These findings suggest that targeting BAs may offer a novel therapeutic approach in the treatment of DM2. Conclusion: This study highlights the important role of BAs in DM2, specifically through their interactions with key metabolic pathways. Targeting BAs may represent an innovative and effective approach to the treatment of DM2. Background (BAs liver catabolism alterations DM . (DM2) resistance ßcells, ßcells ß cells, cells ß-cells complications Objective Methods PubMed Scopus Science disorders Results metabolism Additionally elimination proteincoupled protein coupled 5 regulation Conclusion pathways (DM2 (DM
7.
ASSOCIATION BETWEEN NONALCOHOLIC FATTY PANCREATIC DISEASE AND TRIGLYCERIDE/GLUCOSE INDEX TRIGLYCERIDEGLUCOSE TRIGLYCERIDE GLUCOSE
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ANDRADE, Luis Jesuino de Oliveira
; OLIVEIRA, Luis Matos de
; BITTENCOURT, Alcina Maria Vinhaes
; BAPTISTA, Gustavo Magno
; OLIVEIRA, Gabriela Correia Matos de
.
RESUMO Contexto: A doença pancreática gordurosa não alcoólica (DPGNA) é um aumento de gordura pancreática, e tem uma importante associação com a resistência à insulina (RI) e com diabetes mellitus tipo 2. Pesquisas confirmaram que o índice triglicérides/glicemia (TyG) determina a RI tanto quanto a avaliação da clamp hiperinsulinêmico-euglicêmico como o teste do modelo de homeostasia da RI (HOMA-IR). Objetivo: Avaliar a associação entre o grau de DPGNA e o índice TyG. Métodos: Em 72 pacientes submetidos a ultrassonografia do abdome com diagnóstico de DPGNA, foram avaliados os níveis de insulina, glicose e triglicérides. Os índices HOMA-IR e TyG foram usados como referência para RI. Os graus de DGPNA e o índice TyG foram apresentados através da curva ROC com o objetivo de avaliar a associação entre diferentes graus de DPGNA, e a correlação do DGPNA com o HOMA-IR também foi avaliada. Resultados: Houve uma correlação estatisticamente significativa entre o grau de DPGNA e o índice TyG. A curva AUROC para o índice TyG para prever o grau do NADPD foi 0,855 (0,840-0,865). As probabilidades ajustadas de intensidade do grau de NAFPD foram mais fortemente associadas aos valores de TyG quando comparadas com o HOMA-IR. Conclusão: Neste estudo, o índice TyG correlacionou-se positivamente com o grau de DPGNA, tendo um desempenho melhor que o índice HOMA-IR. Contexto (DPGNA (RI 2 triglicéridesglicemia triglicérides glicemia (TyG hiperinsulinêmicoeuglicêmico hiperinsulinêmico euglicêmico HOMAIR. HOMAIR HOMA IR . (HOMA-IR) Objetivo Métodos 7 avaliada Resultados 0855 0 855 0,85 0,8400,865. 08400865 0,840 0,865 840 865 (0,840-0,865) IR. Conclusão estudo correlacionouse correlacionou se (HOMA-IR 085 85 0,8 8400 0,8400,865 0840086 0840 0,84 0865 0,86 84 86 (0,840-0,865 08 8 0, 0,8400,86 084008 084 086 (0,840-0,86 0,8400,8 08400 (0,840-0,8 0,8400, (0,840-0, 0,8400 (0,840-0 (0,840- (0,840 (0,84 (0,8 (0, (0 (
ABSTRACT Background: Nonalcoholic fatty pancreatic disease (NAFPD) is an increase of fat in the pancreas, and has an important association with insulin resistance (IR) and type 2 diabetes mellitus. Research has confirmed that the triglyceridemia/glycemia (TyG) index determines IR as much as does the hyperinsulinemic-euglycemic clamp assessment as the homeostasis model testing of IR (HOMA-IR). Objective: To evaluate the association between degree of NAFPD and TyG index. Methods: In 72 patients undergoing ultrasound of abdomen with a diagnosis of NAFPD, insulin, glucose, and triglycerides levels were evaluated. The HOMA-IR and TyG indexes were used as a reference for IR. The degrees of NAFPD and the TyG index were presented through the receiver operating characteristics (ROC) curves in order to evaluate the association between different degrees of NAFPD, and the correlation of NAFPD with HOMA-IR was also evaluated. Results: There was a statistically significant correlation between the degree of NAFPD and the TyG index. The AUROC curve for the TyG index for predicting the degree of NADPD was 0.855 (0.840-0.865). The intensity-adjusted probabilities of the degree of NAFPD were more strongly associated with TyG values when compared with HOMA-IR. Conclusion: In this study the TyG index correlated positively with the degree of NAFPD, performing better than HOMA-IR. Background (NAFPD pancreas (IR mellitus triglyceridemiaglycemia triglyceridemia glycemia (TyG hyperinsulinemiceuglycemic hyperinsulinemic euglycemic HOMAIR. HOMAIR HOMA . (HOMA-IR) Objective Methods 7 glucose evaluated ROC (ROC Results 0855 0 855 0.85 0.8400.865. 08400865 0.840 0.865 840 865 (0.840-0.865) intensityadjusted intensity adjusted Conclusion (HOMA-IR 085 85 0.8 8400 0.8400.865 0840086 0840 0.84 0865 0.86 84 86 (0.840-0.865 08 8 0. 0.8400.86 084008 084 086 (0.840-0.86 0.8400.8 08400 (0.840-0.8 0.8400. (0.840-0. 0.8400 (0.840-0 (0.840- (0.840 (0.84 (0.8 (0. (0 (
8.
[SciELO Preprints] - The Connection Between Bile Acids and Type 2 Diabetes Mellitus
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Andrade, Luis Jesuino de Oliveira
Oliveira, Luis Matos de
Bittencourt , Alcina Maria Vinhaes
Oliveira, Gabriela Correia Matos de
Resumo:
En
Bile acids (BAs) are steroid molecules that have a hydrophilic and a hydrophobic end, and are synthesized exclusively in the liver, being end product of cholesterol catabolism. Type 2 diabetes mellitus (DM2) is a chronic degenerative disease, with a pathophysiology characterized by insulin resistance (IR), insulin deficiency due to insufficient production of pancreatic ß-cells, and elevated serum glucose levels leading to multiple complications. BAs are related to several metabolic alterations, including metabolic syndrome and DM2. It is currently known that BAs act as a ligand for the nuclear farnesoid X receptor, a receptor with an important role in glucose metabolism, lipids and cellular energy production, as well as in the regulation of production, elimination and mobilization of BAs. BAs have also been reported to act as a signaling pathway through of Takeda G protein-coupled receptor 5. In this manuscript, we describe the interface between BAs and metabolic disorders, in particular DM2, including discussing possibilities in the development of therapeutic procedures targeting BAs as an optional pathway in the treatment of DM2.
9.
Estimated average blood glucose level based on fructosamine level
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de Oliveira Andrade, Luis Jesuino
; Bittencourt, Alcina Maria Vinhaes
; de Brito, Luiz Felipe Moreno
; de Oliveira, Luís Matos
; de Oliveira, Gabriela Correia Matos
.
Archives of Endocrinology and Metabolism
- Métricas do periódico
ABSTRACT Objective: To define the mathematical relationship between fructosamine levels and average glucose values. Subjects and methods: The study comprised laboratory data of 1,227 patients with type 1 or 2 diabetes mellitus. Fructosamine levels measured at the end of a 3-week period were compared against the average blood glucose levels of the previous 3 weeks. Average glucose levels were determined by the weighted average of the daily fasting capillary glucose results performed during the study period, and the plasma glucose measured in the same sample collected for fructosamine measurement. Results: In total, 9,450 glucose measurements were performed. Linear regression analysis between fructosamine levels and average glucose levels showed that for each 1.0 µmol/L increase in fructosamine level there was a 0.5 mg/dL increase in average glucose level, as estimated by the equation Mean glucose level = (0.5157 x Fructosamine) – 20. The coefficient of determination (r2 = 0.353492, p < 0.006881) allowed the calculation of the estimated average glucose based on fructosamine level. Conclusion: Our study demonstrated a linear correlation between fructosamine level and mean blood glucose level, suggesting that fructosamine levels can be a proxy for the average glucose level in assessing the metabolic control of patients with diabetes. Objective values methods 1227 227 1,22 mellitus 3week week weeks measurement Results total 9450 9 450 9,45 10 0 1. µmolL µmol L 05 5 0. mgdL mg dL 0.5157 05157 5157 (0.515 20 r2 r (r 0353492 353492 0.353492 0.006881 0006881 006881 Conclusion 122 22 1,2 945 45 9,4 0.515 0515 515 (0.51 035349 35349 0.35349 0.00688 000688 00688 12 1, 94 4 9, 0.51 051 51 (0.5 03534 3534 0.3534 0.0068 00068 0068 (0. 0353 353 0.353 0.006 0006 006 (0 035 35 0.35 0.00 000 00 ( 03 0.3 0.0
10.
Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study
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Reis, Flavio Pola dos
; Fernandes, Lucas Matos
; Abdalla, Luis Gustavo
; Campos, Silvia Vidal
; Camargo, Priscila Cilene Leon Bueno de
; Santos, Samuel Lucas dos
; Aguiar, Ivana Teixeira de
; Pires, Juliana Patricia
; Costa, Andre Nathan
; Carraro, Rafael Medeiros
; Teixeira, Ricardo Henrique de Oliveira Braga
; Pêgo-Fernandes, Paulo Manuel
.
ABSTRACT BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients’ demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.
11.
[SciELO Preprints] - Myocardial Insulin Resistance
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de Oliveira Andrade, Luis Jesuino
Santos Padilha, Ingrid Silva
Matos de Oliveira, Luís
Matos de Oliveira, Gabriela Correia
Resumo:
En
Background:
The low available of Glut-4 transporters in sarcolemma of the cardiac cells is what characterizes the myocardial insulin resistance (MIR), which is triggered separately of generalized insulin resistance. Insulin receptors are quite evident in the heart muscle and vessels, and mitochondrial activity performs a significant function in MIR preserving cellular homeostasis by cell reproduction, cells livelihoods, and energy generation.
Objective:
To evaluate the MIR mechanism and through the signaling pathway design.
Methods:
PubMed database was employed to search for reviews publications with MIR. The referenced data of the signaling pathway was chosen aggregating references of the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. A signaling pathway was designed based on MIR research manuscripts, where we show several mechanisms included in the MIR. The KEGG server was employed to exploit the interrelationship protein-protein, and elaborate signaling pathway diagram. The signaling pathway mapping was carried out with PathVisio software.
Results:
We selected 42 articles from a total of 450 articles in the PubMed database that presented a significant association between the terms "insulin resistance myocardial" AND "signaling pathway". Founded on database-validated research papers, we choose well-founded pathways and we succeeded representative description of these pathways. The reproduction contigs taken from the KEGG database designed the signaling pathway of the bio-molecules that lead to MIR. Thus, the acting among multiple mechanisms releases factors that participate of the development of MIR.
Conclusion:
The interaction among various mechanisms and molecular interactions are important factors in development of MIR.
12.
Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021
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Nicolau, José Carlos
; Feitosa Filho, Gilson Soares
; Petriz, João Luiz
; Furtado, Remo Holanda de Mendonça
; Précoma, Dalton Bertolim
; Lemke, Walmor
; Lopes, Renato Delascio
; Timerman, Ari
; Marin Neto, José A.
; Bezerra Neto, Luiz
; Gomes, Bruno Ferraz de Oliveira
; Santos, Eduardo Cavalcanti Lapa
; Piegas, Leopoldo Soares
; Soeiro, Alexandre de Matos
; Negri, Alexandre Jorge de Andrade
; Franci, Andre
; Markman Filho, Brivaldo
; Baccaro, Bruno Mendonça
; Montenegro, Carlos Eduardo Lucena
; Rochitte, Carlos Eduardo
; Barbosa, Carlos José Dornas Gonçalves
; Virgens, Cláudio Marcelo Bittencourt das
; Stefanini, Edson
; Manenti, Euler Roberto Fernandes
; Lima, Felipe Gallego
; Monteiro Júnior, Francisco das Chagas
; Correa Filho, Harry
; Pena, Henrique Patrus Mundim
; Pinto, Ibraim Masciarelli Francisco
; Falcão, João Luiz de Alencar Araripe
; Sena, Joberto Pinheiro
; Peixoto, José Maria
; Souza, Juliana Ascenção de
; Silva, Leonardo Sara da
; Maia, Lilia Nigro
; Ohe, Louis Nakayama
; Baracioli, Luciano Moreira
; Dallan, Luís Alberto de Oliveira
; Dallan, Luis Augusto Palma
; Mattos, Luiz Alberto Piva e
; Bodanese, Luiz Carlos
; Ritt, Luiz Eduardo Fonteles
; Canesin, Manoel Fernandes
; Rivas, Marcelo Bueno da Silva
; Franken, Marcelo
; Magalhães, Marcos José Gomes
; Oliveira Júnior, Múcio Tavares de
; Filgueiras Filho, Nivaldo Menezes
; Dutra, Oscar Pereira
; Coelho, Otávio Rizzi
; Leães, Paulo Ernesto
; Rossi, Paulo Roberto Ferreira
; Soares, Paulo Rogério
; Lemos Neto, Pedro Alves
; Farsky, Pedro Silvio
; Cavalcanti, Rafael Rebêlo C.
; Alves, Renato Jorge
; Kalil, Renato Abdala Karam
; Esporcatte, Roberto
; Marino, Roberto Luiz
; Giraldez, Roberto Rocha Corrêa Veiga
; Meneghelo, Romeu Sérgio
; Lima, Ronaldo de Souza Leão
; Ramos, Rui Fernando
; Falcão, Sandra Nivea dos Reis Saraiva
; Dalçóquio, Talia Falcão
; Lemke, Viviana de Mello Guzzo
; Chalela, William Azem
; Mathias Júnior, Wilson
.
Arquivos Brasileiros de Cardiologia
- Métricas do periódico
https://doi.org/10.36660/abc.20210180
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13.
[SciELO Preprints] - SARS-CoV-2/COVID and Type 1 Diabetes Mellitus: An immunoinformatics approach
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Andrade, Luis Jesuino de Oliveira
Bittencourt , Alcina Maria Vinhaes
Oliveira , Luís Matos de
Oliveira , Luisa Correia Matos de
Oliveira , Gabriela Correia Matos de
Contact with viruses which have an aminoacid (AA) sequence simile to that of the auto-antigens can lead to autoimmune diseases in genetically susceptible individuals. SARS-CoV-2 has been implied as a possible causer of new-onset type 1 diabetes mellitus (DM1), however, no consistent evidence yet that SARS-CoV-2 take to DM1 on your own initiative. Objective: Evaluate the possible similarity between the AA sequences of human insulin and human glutamic acid decarboxylase-65 (GAD65) with SARS-CoV-2/COVID proteins, to explain the possible trigger of DM1. Methods: AA sequences of the human insulin (4F0N), GAD65 (2OKK), and SARS-CoV-2 (SARS-Cov2 S protein at open state (7DDN), SARS-Cov2 S protein at close state (7DDD), SARS CoV-2 Spike protein (6ZB5), Crystal structure of SARS-CoV-2 nucleocapsid protein N-terminal RNA binding domain (6M3M), Crystal structure of SARS-CoV-2 nucleocapsid protein C-terminal RNA binding domain (7DE1), Crystal Structure of NSP1 from SARS-CoV-2 (7K3N), and SARS-CoV-2 S trimer (7DK3)) available in the Protein Data Bank were compared using the Pairwise Structure Alignment. Results: Sequence identity percentage (SI%) and sequence similarity percentage (SS%) were found among the 4F0N, 2OKK and SARS-CoV-2. The SI% between the 4F0N and SARS-CoV-2 ranged from 4.76% to 14.29% and SS% ranged from 5.00% to 45.45%, distributed like this: 4F0N and 7DDN = SI% 4.76 and SS% 28.57; 4F0N and 7DDD = SI% 14.39 and SS% 23.81; 4F0N and 6ZB5 = SI% 4.76 and SS% 28.57; 4F0N and 6M3M = SI% 5.00 and SS% 5;00; 4F0N and 7DE1 = SI% 4.76 and SS% 9.21; 4F0N and 7K3N = SI% 9.09 and SS% 45.45; 4F0N and 7DK3 = SI% 4.76 and SS% 28.57. The SI% between the between the 2OKK and SARS-CoV-2 ranged from 3.19% to 6,70% and SS% ranged from 10.45 % to 22.22%, distributed like this: 2OKK and 7DDN = SI% 6.70 and SS% 15.64; 2OKK and 7DDD = SI% 7.53 and SS% 18.84; 2OKK and 6ZB5 = SI% 6.68 and SS% 17.38; 2OKK and 6M3M = SI% 4.48 and SS% 10.45; 2OKK and 7DE1 = SI% 6.67 and SS% 22.22; 2OKK and 7K3N = SI% 3.19 and SS% 15.97; 2OKK and 7DK3 = SI% 3.95 and 17.98. Conclusion: Immunoinformatics data suggest a potential pathogenic link between DM1 and SARS-CoV-2/COVID. Thus, by means of molecular mimicking we check that sequences similarity among SARS-CoV-2/COVID and human insulin and human glutamic acid decarboxylase-65 may lead to production of an immune cross-response to self-antigens, with breakage of self-tolerance that can trigger DM1.
O contato com vírus que têm uma sequência de aminoácidos (AA) semelhante à dos autoantígenos podem desencadear doenças autoimunes em indivíduos geneticamente suscetíveis. SARS-CoV-2 foi sugerido como um possível causador de diabetes mellitus tipo 1 de início recente (DM1), no entanto, não há evidências consistentes de que o SARS-CoV-2 possa desencadear DM1. Objetivo: Avaliar a possível semelhança entre as sequências AA da insulina humana e da descarboxilase-65 do ácido glutâmico humano (GAD65) com as proteínas SARS-CoV-2 / COVID, para explicar o possível desencadeamento do DM1. Métodos: Sequências de AA da insulina humana (4F0N), GAD65 (2OKK) e SARS-CoV-2 SARS-Cov2 S protein at open state (7DDN), SARS-Cov2 S protein at close state (7DDD), SARS CoV-2 Spike protein (6ZB5), Crystal structure of SARS-CoV-2 nucleocapsid protein N-terminal RNA binding domain (6M3M), Crystal structure of SARS-CoV-2 nucleocapsid protein C-terminal RNA binding domain (7DE1), Crystal Structure of NSP1 from SARS-CoV-2 (7K3N), and SARS-CoV-2 S trimer (7DK3)) nbsp;disponíveis no Protein Data Bank foram comparadas utilizando o Pairwise Structure Alignment. Resultados: O percentual de identidade de sequências (SI%) e o percentual de similaridade de sequências (SS%) foram encontrados entre o 4F0N, 2OKK e o SARS-CoV-2. O SI% entre o 4F0N e o SARS-CoV-2 variou de 4,76% a 14,29% e o SS% variou de 5,00% a 45,45%, assim distribuídos: 4F0N e 7DDN = SI% 4,76 e SS% 28,57; 4F0N e 7DDD = SI% 14,39 e SS% 23,81; 4F0N e 6ZB5 = SI% 4,76 e SS% 28,57; 4F0N e 6M3M = SI% 5,00 e SS% 5; 00; 4F0N e 7DE1 = SI% 4,76 e SS% 9,21; 4F0N e 7K3N = SI% 9,09 e SS% 45,45; 4F0N e 7DK3 = SI% 4,76 e SS% 28,57. O SI% entre o 2OKK e o SARS-CoV-2 variou de 3,19% a 6,70% e o SS% variou de 10,45% a 22,22%, assim distribuídos: 2OKK e 7DDN = SI% 6,70 e SS% 15,64; 2OKK e 7DDD = SI% 7,53 e SS% 18,84; 2OKK e 6ZB5 = SI% 6,68 e SS% 17,38; 2OKK e 6M3M = SI% 4,48 e SS% 10,45; 2OKK e 7DE1 = SI% 6,67 e SS% 22,22; 2OKK e 7K3N = SI% 3,19 e SS% 15,97; 2OKK e 7DK3 = SI% 3,95 e 17,98. Conclusão: Os dados de imunoinformática sugerem uma potencial ligação patogênica entre SARS-CoV-2 / COVID e o DM1. Assim, por meio de mimetização molecular, verificamos que a similaridade das sequências de AA entre SARS-CoV-2 / COVID e insulina humana e a descarboxilase-65 do ácido glutâmico humano pode levar à produção de uma resposta cruzada imunológica para autoantígenos, com quebra de auto-tolerância, podendo desencadear o DM1.
14.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
Revista Brasileira de Terapia Intensiva
- Métricas do periódico
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
15.
[SciELO Preprints] - “Incidentalormones” - Macro-hormones
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Resumo:
En
Introduction: Complexes of monomeric hormone molecules immunoglobulin-associated lead to the formation of macro-complexes biologically inactive that are called macro-hormones. Patients’ presenting unexpectedly elevated hormones values indicates the need that the existence of macro-hormones must be researched.
Objective: To describe the macro-hormones discovered incidentally in laboratory tests, which we refer to as "incidentalormones".
Methods: An integrative review was conducted, and data was gathered from the published articles in medical database. The different forms of macro-hormones are reviewed; the biochemical significance and laboratory assays of macro-hormones are also revised within the ambit of current laboratory medicine. We discussed diagnostic difficulty encountered in patients with "incidentalormones”, as well as methods of macro-hormone detection, immunoglobulin involved, clinical significance and associations with other diseases.
Conclusion: The presence of macro-hormones, often guides us to intervention in laboratory trials, and could result in false-positive diagnosis with inadequate therapy. Laboratories should follow a diagnostic algorithm to carefully recognize and examine possible immunoassay interferences.
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