Joana Rodrigues Dantas

Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study

IntroductionThe aim of this study was to evaluate the performance of five general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation II and III-J, the Simplified Acute Physiology Score II, and the Mortality Probability Models at admission and at 24 hours of intensive care unit [ICU] stay), and to validate a specific score – the ICU Cancer Mortality Model (CMM) – in cancer patients requiring admission to the ICU.MethodsA prospective observational cohort study was performed in an oncological medical/surgical ICU in a Brazilian cancer centre. Data were collected over the first 24 hours of ICU stay. Discrimination was assessed by area under the receiver operating characteristic curves and calibration was done using Hosmer–Lemeshow goodness-of-fit H-tests.ResultsA total of 1257 consecutive patients were included over a 39-month period, and 715 (56.9%) were scheduled surgical patients. The observed hospital mortality was 28.6%. Two performance analyses were carried out: in the first analysis all patients were studied; and in the second, scheduled surgical patients were excluded in order to better compare CMM and general prognostic scores. The results of the two analyses were similar. Discrimination was good for all of the six studied models and best for Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation III-J. However, calibration was uniformly insufficient (P < 0.001). General scores significantly underestimated mortality (in comparison with the observed mortality); this was in contrast to the CMM, which tended to overestimate mortality.ConclusionNone of the model scores accurately predicted outcome in the present group of critically ill cancer patients. In addition, there was no advantage of CMM over the other general models.

Should thyroid-stimulating hormone goals be reviewed in patients with type 1 diabetes mellitus? Results from the Brazilian Type 1 Diabetes Study Group.

To investigate if thyroid‐stimulating hormone (TSH) levels are associated with any differences in glycaemic control or diabetes‐related complications in individuals with Type 1 diabetes.

Anti-parietal cell antibodies and pernicious anemia in patients with type 1 diabetes mellitus and multiethnic background

Anti-parietal cell (APC) antibodies and pernicious anemia (PA) were evaluated in patients with type 1 diabetes (n=75) and in controls. A higher frequency of APC (13.3%) and PA (4%) was found in cases than in controls (p=0.003), associated with other autoimmune diseases (p=0.003), but not with insulin or PTPN22 polymorphisms.

Low triglyceride levels are associated with a better metabolic control in patients with type 1 diabetes

BackgroundAlthough it is well known in the literature that high triglyceride serum (TG) levels can jeopardize the metabolic control, little is known about the influence of low TG on type 1 diabetes patients (T1D). The aim of this study is to investigate the distribution of TG serum levels in individuals with T1D and its relationship with metabolic control.FindingsWe reviewed the medical charts of 180 patients with T1D, who were classified in groups according to TG levels: 1) low (below 50 mg/dL); 2) normal (50-150 mg/dL); 3) high (above 150 mg/dL). TG were low in 21.1% (n = 38; group 1), normal in 68.6% (n = 123; group 2) and high in 10.6% (n = 19; group 3). High TG was associated with a poor metabolic control (p < 0.001). Patients with TG lower than 50 mg/dL had a lower HbA1c than those with TG between 50 and 150 mg/dL (7.41+/-1.50% vs 8.56%+/-1.94%; p = 0.002).ConclusionTG lower than 50 mg/dL was common and might be associated with a better metabolic control in patients with T1D, although it is not clear whether the former is the cause or consequence for the latter.

Avaliação da função pancreática em pacientes com diabetes melito tipo 1 de acordo com a duração da doença

Patients with type 1 diabetes (T1D) may exhibit some residual insulin secretion for many years after their diagnosis. This has been associated with a more favorable prognosis. OBJECTIVE: To analyze insulin secretion in individuals with T1D using C-peptide (CP) response to glucagon and comparing patients with recent onset ( 5 years -Group 2). METHODS: Subjects with T1D had their blood sampled before (fasting) and 6 minutes after glucagon infusion for CP, HbA1c and anti-GAD measurement. RESULTS: Forty-three individuals were evaluated, 22 in Group 1 and 21 in Group 2. Preserved insulin secretion (CP >1.5 ng/mL) was observed in 6 (13.9%) and in 8 (18.6%) patients before (CP 1) and after (CP 2) glucagon stimulus, respectively, showing no difference between the groups (p=0.18 and 0.24). CP 1 and CP 2 were detectable (>0.5 ng/dL) in 13 (30.2%) and 18 (41.9%) patients, respectively. Both were more frequent in Group 1 than in Group 2 (p=0.45 for CP1/p=0.001 for CP 2). Similar serum levels where seen between the groups, both before and after stimulus (1.4±0.8 vs. 1.2±1.0; p=0.69 and 1.8±1.5 vs. 1.7±0.8; p=0.91). Group 1 presented an inverse correlation between disease duration and CP 2 (R=-0.58; p=0.025). CONCLUSION: A significant number of patients with T1D have detectable residual insulin secretion, especially in the first 5 years of disease. These subjects are an ideal population for clinical trials that target the prevention of β cell function loss in T1D.

Zinc transporter 8 autoantibodies in patients with type 1 diabetes from a multiethnic population and their first degree relatives

OBJECTIVE Zinc transporter 8 autoantibodies (ZnT8A) have been poorly studied in non-Caucasian individuals. We aimed to investigate the prevalence of ZnT8 autoantibodies in patients with T1D and their first degree relatives (FDR) from a multiethnic population, as well as its relation with the insulin (INS) or the protein tyrosine phosphatase non-receptor 22 (PTPN22) gene polymorphisms. SUBJECTS AND METHODS ZnT8A were analyzed in sera from T1D patients (n = 72, mean age of 30.3 ± 11.4 years) of variable duration (15.7 ± 11.8 years) and their FDR (n = 78, mean age of 18.3 ± 9.1 years) by a triple mix Radioligand Binding Assay (RBA) for the ZnT8 autoantibody (ZnT8-RWQ) variants. SNP (single nucleotide polymorphism) for INS and PTPN22 were genotyped. RESULTS The prevalence of ZnT8A was higher in T1D patients than FDR, for ZnT8TripleA (24% vs. 4%,p = 0.001), ZnT8RA (24% vs. 4%, p < 0.001) and ZnT8QA (15% vs. 3%, p = 0.004). All FDR with ZnT8A (n = 3) had at least another positive antibody. Heterozygosis for PTPN22 was associated with a higher frequency of ZnT8TripleA (p = 0.039) and ZnT8RA (p = 0.038). CONCLUSIONS ZnT8A is observed in non-Caucasian patients with T1D, even years after the disease onset, as well as in their FDR. In those, there was an overlap between ZnT8A and other T1D antibodies. ZnT8A was associated with PTPN22 polymorphisms. Further longitudinal studies are necessary to elucidate the importance of these findings in the natural history of T1D patients with multiethnic background.

Continuous C-peptide loss in patients with type 1 diabetes and multiethnic background.

C peptide (CP) was evaluated in 88 individuals with type 1 diabetes, variable disease duration and multiethnic background. Initially, 28 patients had detectable CP, which persisted in 46.2% after 17.4±4 months. CP decline was associated with ethnicity, HbA1c and baseline CP, but not with GADA, PTPN22 or insulin gene polymorphisms.

Residual C-peptide in patients with Type 1 diabetes and multiethnic backgrounds.

OBJECTIVE: To evaluate serum C-peptide in 88 patients from a multiethnic population with Type-1 diabetes and variable disease durations. METHOD: Eighty-eight patients with a mean disease duration of 8.1±7.6 years were included and underwent C-peptide measurement before and after glucagon stimulation. Chi-squared and Mann Whitney U-tests were used to compare the variables between groups (all two-tailed, α  = 0.05). Spearmańs correlation coefficient was used to test the association between the continuous variables. Logistic regression was used for the multivariate analysis. Twenty-eight (31.8%) individuals had significantly detectable C-peptide levels after stimuli, particularly those with a shorter disease duration (p<0.001). RESULTS: Patients with detectable C-peptide levels required lower insulin doses (p<0.009) and had similar HbA1C results (p = 0.182) and fewer chronic complications (p = 0.029). CONCLUSION: C-peptide detection was common in Type-1 diabetics, particularly shortly after being diagnosed. This result may have clinical implications.

The impact of sustained hyperglycemia, metabolic memory and hba1c variability in the development of chronic complications in patients with type 1 diabetes

Objectives To assess if there is an association between the development of chronic complications (retinopathy-DR, nephropathy-DN, peripheral neuropathy– PN and cardiac autonomic neuropathy-CAN) in patients with T1D and 1) the mean glycated Haemoglobin during their followup since diabetes onset (mHbA1c); 2) the standard deviation (SD) of HbA1c over this period, 3) the HbA1c in the first 3 yrs. of disease (1st 3 yr.) and 4) the current HbA1c.

High normal TSH is associated with retinopathy and increased albumin excretion in euthyroid type 1 diabetic patients

Background Patients with Type 1 diabetes (T1D) have an increased risk of autoimmune diseases, especially thyroid disease, and untreated thyroid disease may interfere in the insulin sensitivity and glycemic control. Subclinical hypothyroidism and high levels of TSH have been associated with high risk of cardiovascular disease and chronic complications in type 2 diabetic (T2D) patients. TSH levels have also been linked to diabetic retinopathy and renal dysfunction in patients with T1D.