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The important role of academic leagues (extensions) in Brazilian medical education
(Source: Revista da Associacao Medica Brasileira)
Source: Revista da Associacao Medica Brasileira - March 19, 2019 Category: General Medicine Source Type: research

Central role of obesity in endothelial cell dysfunction and cardiovascular risk
SUMMARY Atherosclerosis is the leading cause of mortality in the contemporary world. The critical role of the endothelial cells (EC) in vascular homeostasis, the metabolic changes that take place when the cell is activated, and the elements involved in these processes have been widely explored over the past years. Obesity and its impact, promoting a rise in blood levels of free fatty acids (FAs) are often associated with atherosclerosis and cardiovascular mortality. However, the mechanisms that promote cardiovascular structural changes and adaptive changes in the ECs, particularly in the context of obesity, are little know...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Inhibition of the sodium-glucose co-transporter 2 in the elderly: clinical and mechanistic insights into safety and efficacy
SUMMARY The prevalence of type 2 diabetes mellitus (T2DM) in the elderly grew sharply over the last decade. Reduced insulin sensitivity and secretory capacity, weight gain, sarcopenia, and elevated adiposity are all common metabolic and body changes in the aging population that favor an increased risk of hypoglycemia, frailty syndrome, falls, and cognitive dysfunction. First line antidiabetic therapy is frequently not safe in older individuals because of its high risk of hypoglycemia and prevalent co-morbid diseases, such as chronic kidney disease, osteoporosis, cardiovascular disease, and obesity. Sodium-glucose cotranspo...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Diabetic cardiomyopathy: factual or factoid?
SUMMARY Although long ago described, there is no established consensus regarding the real existence of Diabetic Cardiomyopathy (CMPDM). Due to its complex pathophysiology, it has been difficult for clinical and experimental research to establish clear connections between diabetes mellitus (DM) and heart failure (HF), as well as to solve the mechanisms of the underlying myocardial disease. However, the epidemiological evidence of the relationship of these conditions is undisputed. The interest in understanding this disease has intensified due to the recent results of clinical trials evaluating new glucose-lowering drugs, su...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Cardiovascular autonomic neuropathy in type 2 diabetic patients
SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at ...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels
CONCLUSION Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.RESUMO CONTEXTO E OBJETIVO A defici ência de vitamina D não é apenas associada ao metabolismo ósseo, mas também ao diabetes mellitus. Procurou-se estudar a possível associação entre os níveis de concentração do soro de vitamina D e de Hb...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Consumption of animal-based and processed food associated with cardiovascular risk factors and subclinical atherosclerosis biomarkers in men
CONCLUSIONS A diet with high consumption of animal products has a higher correlation with cardiovascular risk factors; the opposite is true for the consumption of plant-based food, associated with the profile of more favorable biomarkers for cardiovascular health and better biochemical and structural parameters.RESUMO OBJETIVO Avaliar a frequ ência do consumo alimentar de indivíduos homens aparentemente saudáveis e a associação desta com fatores de risco cardiovascular e biomarcadores de aterosclerose subclínica. MÉTODOS Neste estudo observacional, 88 homens tiveram o padrão alimentar obtido por meio do questi...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Diabetes control could through platelet-to-lymphocyte ratio in hemograms
CONCLUSION As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.RESUMO OBJETIVO A associa ção entre diabetes mellitus tipo 2 e inflamação está bem estabelecida. Pretendemos estudar a relação plaquetária com linfócitos (PLR), um novo índice inflamatório derivado do hemograma, em pacientes diabéticos e comparar com aqueles em voluntários saudáveis. MÉTODOS Foram registrado s e analisados dados médicos de diabéticos de tipo 2 que apare...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

The efficacy of saxagliptin in T2DM patients with non-alcoholic fatty liver disease: preliminary data
CONCLUSION For T2DM combined with NAFLD patients, the saxagliptin treatment could not only effectively control blood glucose but also attenuate insulin resistance and inflammatory injury of the liver to improve fatty liver further.RESUMO OBJETIVO Investigar a efic ácia clínica e os possíveis mecanismos da saxagliptina no tratamento do diabetes mellitus tipo 2 (DM2) associado à doença hepática gordurosa não alcoólica (DHGNA). MÉTODOS Um total de 95 DM2 combinados com pacientes com DHGNA foram aleatoriamente divididos em grupo A (grupo saxagliptina), grupo B (grupo glimepirida) e grupo C (glimepirida combinado...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Intensive treatment of hyperglycemia in the acute phase of myocardial infarction: the tenuous balance between effectiveness and safety – a systematic review and meta-analysis of randomized clinical trials
CONCLUSION This meta-analysis suggests that there may be a tenuous line between the effectiveness and safety of reducing blood glucose in the acute phase of MI. The targets must not exceed a reduction greater than 36 mg/dL in relation to estimated average blood glucose.RESUMO INTRODU ÇÃO No infarto agudo do miocárdio (IAM), cada incremento de 18 mg/dl (1 mmol/L) se associa a um aumento de 3% na mortalidade. As estratégias de redução da glicemia tentadas até o momento, entretanto, não trouxeram resultados animadores. METODOLOGIA Foram pesquisadas nas bases de dados Medli ne (PubMed) e Cochrane Library os ensaios c...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Clinical registry of cardiovascular surgeries in a university hospital
CONCLUSION The importance of a database maintenance with international standards that can be reproducible was evidenced, allowing the evaluation of techniques and assistance and the integration of data among health institutions.RESUMO OBJETIVO Criar e implantar um registro cl ínico informatizado para verificar mortalidade e incidência de desfechos cirúrgicos maiores em pacientes adultos submetidos a cirurgias cardiovasculares a curto, médio e longo prazo. METODOLOGIA Trata-se de um estudo observacional do tipo Registro, prospectivo, que visa documentar as caracterí sticas dos pacientes submetidos à cirurgia cardiov...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus
CONCLUSION We suggest utilization of UHR in diagnosis of MS as a novel criteria. Nevertheless, prospective studies with larger population may make a better scientific evidence in that issue.RESUMO CONTEXTO E OBJETIVO A s índrome metabólica (SM) é uma entidade clínica associada ao aumento do risco de diabetes mellitus tipo 2 (DM) e doenças cardiovasculares. Os níveis séricos de ácido úrico estão correlacionados com os critérios estabelecidos de EM. Uma vez que DM tipo 2 e MS são distúrbios metabólicos, nós hipotetizamos se uma relação ácido úrico para HDL-colesterol (UHR) poderia predizer a regulação...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Prevalence, treatment, and control of dyslipidemia in diabetic participants of two brazilian cohorts: a place far from heaven
CONCLUSIONS The data in our study have shown that the dyslipidemia control in diabetic patients is inadequate and there is a tendency of direct association between lack of blood glucose control and lack of dyslipidemia control, in addition to the association with other cardiovascular risk factors, such as diastolic hypertension and smoking. This worsened control might be related to the plateau in the descending curve of mortality, and investments in this regard can improve the cardiovascular health in diabetic patients.RESUMO OBJETIVO O diabetes é importante causa de mortalidade cardiovascular. Nos últimos anos, a mor...
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Diabetes and premature death
(Source: Revista da Associacao Medica Brasileira)
Source: Revista da Associacao Medica Brasileira - February 7, 2019 Category: General Medicine Source Type: research

Posterior L5-S1 transdiscal screws for high grade spondylolisthesis - a systematic review
CONCLUSIONS: Our review concludes, with limited level of evidence that PTD fixation is a safe and efficient technique for treating HGLS patients. It is technically less demanding than a circumferential fusion, even though proper screw insertion is more demanding than conventional pedicle screw fixation.RESUMO OBJETIVOS: O tratamento cir úrgico das listeses de alto grau da coluna lombar (LAGCL) é complexo, objetivando alcançar uma fusão sólida capaz de suportar o estresse biomecânico da junção lombo-sacra, bem como descompressão do tecido neural. Realizamos revisão sistemática da literatura para avaliar a segura...
Source: Revista da Associacao Medica Brasileira - December 17, 2018 Category: General Medicine Source Type: research