Luciana Pavan Antoniolli

24-hour blood pressure homeostasis and renal function in subjects with and without metabolic syndrome

Materials and methods We designed a cross-sectional study of consecutive individuals (n=108; females 74%; 52.8±12.7 yrs.; mean±SD) from the Diabetes Clinic of a university hospital. MS was defined by the International Diabetes Federation criteria. BP was measured at office and its circadian variation was determined by 24-h ambulatory BP monitoring, after withdrawal from anti-hypertensive medications. Patients were classified according to their BP behavior: normotension (NT; n=29), white-coat hypertension (WCH; n=19) and ambulatory hypertension (AHT; n=57). Fasting and 2h-plasma glucose levels, lipid profile, creatinine and 24-h urinary albumin excretion (UAER) were measured. Glomerular filtration rate (GFR) was estimated by the CKD-EPI equation. A two-sided P value <0.05 was considered significant. Results Estimated GFR (EGFR) was lower in subjects with MS than in those without MS (Mean±SD; 90±20 vs 98.8±16.5; P=0.047). EGFR was related to age (r=-0.666; P<0.001), fasting glucose (r=0.223; P=0.021), and 24-h systolic BP (r=-0.196; P=0.044), but not to diastolic BP. EGFR was inversely related to sleep-time BP (r=-0.224; P=0.021), morning systolic BP (r=-0.224; P=0.030) and pulse pressure (r=-0.233; P=0.170). Subjects with WCH and AHT compared to those with NT had lower EGFR (Mean±SD; 89.3±18 vs 89.6±26.3 vs 100.2±14.8; P=0.036) and higher UAER (Median [P25-75]; 1 [0-5.3] vs 6.1 [1-19] vs 6.3 [1-16.8]; P=0.031).

Accuracy of insulin resistance indices for metabolic syndrome in a population with different degrees of glucose tolerance

Background Insulin resistance has been associated with the development of metabolic syndrome (MS), which is an interrelated cluster of risk factors for cardiovascular disease and type 2 diabetes (T2D). Several equations derived from the oral glucose tolerance test (OGTT) have been developed as surrogates for the euglycemic hyperinsulinemic clamp technique to estimate insulin resistance and insulin sensitivity.

Cryptococcal Meningitis: A Retrospective Cohort of a Brazilian Reference Hospital in the Post-HAART Era of Universal Access

Objective Cryptococcus neoformans is a common opportunistic infection in adults with acquired immunodeficiency syndrome worldwide. However, limited data exist for HIV-infected patients in the post-HAART (highly active antiretroviral therapy) era in Brazil. The aim of this study was to describe the clinical characteristics and outcomes of cryptococcosis in a cohort of patients attending a teaching tertiary care hospital in southern Brazil after the introduction of HAART in Brazil. Patients and Methods A retrospective study was conducted in tertiary care hospital in southern Brazil. Detailed data on risk factors, clinical manifestations, diagnosis methods, treatment, and prognosis of patients with meningeal cryptococcosis were evaluated from January 2009 to December 2016. Results Seventy-nine cases of cryptococcal meningitis were identified. Most of the patients presented positive CSF (cerebrospinal fluid) cultures for Cryptococcus neoformans (96%). The prevalence of males and females with meningeal cryptococcosis was similar. The age of the patients ranged from 5 to 67 years. The median time of hospitalization was 28 days. The most common underlying disease was HIV (82%), followed by solid transplant (10%). Fever, nausea, vomiting, headache, and altered mental status were the most common clinical manifestations. Initial opening intracranial pressures varied from 30 to 130 cm H2O. CNS imaging abnormalities include hydrocephalus and hypodensities. Widened Virchow–Robin spaces were described in only 2 patients (2.5%). Induction treatment of the majority of the patients consisted of amphotericin B and flucytosine (67%) followed by amphotericin B and fluconazole (19%). Multivariate analysis of Cox regression identified headache at presentation, mechanical ventilation, CSF glucose <20 mg/dL, and CSF cryptococcal antigen ≥1 : 1000 for independent risk factors for death. All-cause 30-day and 60-day mortalities were 19% and 24%, respectively. Conclusions Meningeal cryptococcosis mostly caused by C. neoformans continues to occur predominantly in HIV-infected adults despite HAART being widely distributed in Brazil. Cryptococcosis remains a significant opportunistic infection in solid organ transplant recipients. Despite adequate antifungal treatment and management of intracranial hypertension in a reference tertiary care hospital, mortality was high. Identification of risk factors and additional treatment modalities, especially for intracranial hypertension, are necessary to improve care for patients with cryptococcal meningitis.

Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study

BackgroundThe shapes of the plasma glucose concentration curve during the oral glucose tolerance test are related to different metabolic risk profiles and future risk of type 2 DM. We sought to further analyze the relationship between the specific shapes and hyperglycemic states, the metabolic syndrome and hormones involved in carbohydrate and lipid metabolism, and to isolate the effect of the shape by adjusting for the area under the glucose curve.MethodsOne hundred twenty one adult participants underwent a 2-h oral glucose tolerance test and were assigned to either the monophasic (n = 97) or the biphasic (n = 24) group based upon the rise and fall of their plasma glucose concentration. We evaluated anthropometric measures, blood pressure, lipid profile, high-sensitivity C-reactive protein, glycated hemoglobin, insulin sensitivity, beta-cell function, C-peptide, glucagon, adiponectin and pancreatic polypeptide.ResultsSubjects with monophasic curves had higher fasting and 2-h plasma glucose levels, while presenting lower insulin sensitivity, beta-cell function, HDL cholesterol, adiponectin and pancreatic polypeptide levels. Prediabetes and metabolic syndrome had a higher prevalence in this group. Glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein and glucagon were not significantly different between groups. After adjusting for the area under the glucose curve, only the differences in the 1-h and 2-h plasma glucose concentrations and HDL cholesterol levels between the monophasic and biphasic groups remained statistically significant.ConclusionsRates and intensity of metabolic dysfunction are higher in subjects with monophasic curves, who have lower insulin sensitivity and beta-cell function and a higher prevalence of prediabetes and metabolic syndrome. These differences, however, seem to be dependent on the area under the glucose curve.

BK Virus Encephalitis in HIV-Infected Patients: Case Report and Review

Encephalitis and meningitis due to BKPyV are unusual and emerging condition. Only a few cases of BKPyV encephalitis have been reported in hematopoietic stem cell transplant recipients, with the majority of cases presenting with concurrent hemorrhagic cystitis and HIV-infected patients. The authors report two HIV-infected patients with the diagnosis of BKPyV encephalitis and discuss the main clinical, diagnostic, and therapeutic aspects of this infection in patients with AIDS. Physicians should be aware to recognize the main clinical features and diagnose BKPyV central nervous infection in the setting of AIDS.

Waist-to-height ratio as a predictor of metabolic syndrome in a population with different degrees of glucose tolerance

Waist-to-height ratio as a predictor of metabolic syndrome in a population with different degrees of glucose tolerance Tassia Cividanes Pazinato, Barbara Limberger Nedel, Anize Delfino von Frankenberg, Vanessa Piccoli, Luciana Pavan Antoniolli, Mayara Abichequer Beer, Leticia Maria Tedesco Silva, Rodrigo Soares de Souza Marques, Leonardo de Andrade Mesquita, Monique de Moura Machado, Andre Fernandes Reis, Fernando Gerchman

Association of pulse pressure with fasting and 2-h plasma glucose in subjects with different degrees of glucose tolerance

Materials and methods In a cross-sectional study, 128 subjects (53.1±12.3 y, females 72%) were submitted to a 75-g OGTT (measurement of glucose and insulin) and divided according to glucose tolerance status (normal glucose tolerance [NGT; n=38], prediabetes [PDM; n=53] and diabetes [DM; n=37]). 24-h ABPM was performed. Mean 24h PP was calculated as the difference between mean systolic and diastolic blood pressure (BP), obtained through 24-h ABPM. Fasting C-peptide and A1c were collected. Body size (BMI) and central obesity (waist circumference) were assessed. Insulin sensitivity index (ISI Stumvoll), insulin resistance (HOMA-IR) and b-cell function (insulinogenic index; ΔIns30′-0′/ΔGli30′-0′) were estimated. A two-sided P value < 0.05 was considered significant. Results By ABPM, 24-hour PP progressively increased from NGT to DM (mean±SD; NGT 45.9±8.5 vs PDM 51.9±10.4 vs DM 57.8±11.1 mmHg; P<0.001). 24-hour PP was positively related to age (r=0.316; P<0.001), waist circumference (r=0.263; P=0.003), BMI (r=0.35; P<0.001), A1C (r=0.438; P<0.001), 2-h glucose level (r=0.424; P<0.001), C-peptide (r=0.286; P=0.001), HOMA-IR (r=0.155; P=0.085) and it was inversely related to ISI Stumvoll (r=-0.474; P <0.001) and to insulinogenic index (r=-0.184; P=0.048). While adjusting for age and waist circumference, pulse pressure was independently associated with 2 hour plasma glucose (R=0.287; P=0.002) and A1c (R=0.241; P=0.010).