Rodrigo Oliveira Moreira

Depression, glycemic control and type 2 diabetes

BackgroundComorbid depression in diabetes has been suggested as one of the possible causes of an inadequate glycemic control. The purpose of this study was to investigate the association between major depression and the glycemic control of type 2 diabetes mellitus (T2DM).MethodsSeventy T2DM patients were evaluated. They underwent a psychiatric examination using the following instruments: Structured Clinical Interview for DSM-IV and Beck Depression Inventory. The diabetes status was assessed in the short-term (glycemia, glycated hemoglobin) clinical control.ResultsThe presence of current depression was observed in 18.6% (13/70). In addition, type 2 diabetes patients who displayed depression evidenced higher levels of glycated hemoglobin (8.6 ± 2.0 vs. 7.5 ± 1.8; p = 0.05) when compared to those who did not exhibit a mood disorder.ConclusionsIn our sample, the presence of depression seems to impact on the short-term control of T2DM. The authors discuss the clinical utility of these findings in the usual treatment of diabetes.

Diabetes mellitus e depressão: uma revisão sistemática

The presence of depression in a patient with diabetes mellitus (DM) seems to be related to changes in the clinical course of the disease. The purpose of this study is to perform a systematic review on the association of DM and depression. A bibliographic search was performed using the MEDLINE and LILACS databases to identify relevant articles, published from 1990 to 2001, which evaluate this relationship. Information concerning prevalence, impact and treatment of depression in DM were analyzed. The prevalence of depression varied from 0 to 60.5%. The presence of depressive symptoms were associated with a poor glycemic control, an increase in the number and severity of clinical complications, a worse quality of life and impairment of social, educational and economic aspects related to DM. The treatment of depression is associated with an improvement in glycemic levels, which may contribute to a better control of several aspects related to DM.

Lean mass as a predictor of bone density and microarchitecture in adult obese individuals with metabolic syndrome

The effects of obesity and metabolic syndrome (MS) on bone health are controversial. Furthermore, the relationship between body composition and bone quality has not yet been determined in this context. The aim of this study was to investigate the correlations between body composition and bone mineral density (BMD) and bone microstructure in obese individuals with MS. This cross-sectional study assessed 50 obese individuals with MS with respect to their body composition and BMD, both assessed using dual X-ray absorptiometry, and bone microarchitecture, assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) of the distal tibia and radius. Several HR-pQCT measurements exhibited statistically significant correlations with lean mass. Lean mass was positively correlated with parameters of better bone quality (r: 0.316-0.470) and negatively correlated with parameters of greater bone fragility (r: -0.460 to -0.310). Positive correlations were also observed between lean mass and BMD of the total femur and radius 33%. Fat mass was not significantly correlated with BMD or any HR-pQCT measurements. Our data suggest that lean mass might be a predictor of bone health in obese individuals with MS.

Sintomas depressivos e qualidade de vida em pacientes diabéticos tipo 2 com polineuropatia distal diabética

OBJECTIVE To investigate the impact of depressive symptoms and neuropathic pain in the quality of life (QL) of diabetic patients with diabetic distal polyneuropathy (DDP). METHODS Two hundred and four patients with type 2 diabetes mellitus were evaluated. The diagnosis of DDP was achieved using the Neuropathy Disability Score and Neuropathy Symptom Score questionnaires. The severity of neuropathic pain was assessed by means of a Visual Analogue Scale (VAS); the severity of depression, by means of the Beck Depression Inventory (BDI); and QL was assessed by means of the World Health Organization Quality of Life Instrument-bref (WHOQOLbref). RESULTS Patients with DDP presented significant higher scores in BDI (12.6 +/- 7.2 versus 9.9 +/- 7.3; p = 0.018) and in VAS (5.0 +/- 2.4 versus 2.6 +/- 2.9; p < 0.001). They also presented significant lower scores in the physical (52.8 +/- 15.5 versus 59.2 +/- 17.0; p = 0.027) and environmental domains (56.6 +/- 12.3 versus 59.6 +/- 13.6; p = 0,045). CONCLUSIONS Diabetic patients with DDP presented a worse QL in the physical and environmental domains of the WHOQOL-bref, probably due to more depressive symptoms and the severity of pain.

Avaliação do efeito da sibutramina sobre a saciedade por escala visual analógica em adolescentes obesos

Inicialmente empregadas para mensuracao de sintomas algicos, as escalas visuais analogicas (EVAs) podem ser tambem um instrumento util para avaliacao da saciedade. O agente antiobesidade sibutramina, ao contrario dos anorexigenos, parece exercer seu efeito de reducao de ingestao alimentar principalmente por estimulo da saciedade. Com o objetivo de avaliar o efeito da sibutramina sobre a saciedade, utilizamos uma EVA em adolescentes obesos que participaram de um estudo duplo-cego randomizado, comparando sibutramina 10mg com placebo. Cada paciente recebeu 13 escalas para serem preenchidas em intervalos de uma hora, num unico dia, das 9 as 21h. Uma dieta com deficit de 500kcal diarias foi dividida em 3 refeicoes, com horarios previamente estipulados: 9:30h, 12:30h, 18:30h. A partir da pontuacao obtida em cada uma das escalas, construiu-se um grafico de linha representativo da pontuacao media de saciedade ao longo do dia. Comparando-se a area sob a curva dos 2 grupos, encontramos 4.609 ± 1.309 para o grupo tratado com sibutramina e 4.141 ± 1.432 para o grupo placebo (p= NS). Desta forma, a sibutramina nao parece apresentar efeito sobre a saciedade de adolescentes obesos, pelo menos quando avaliado atraves de uma EVA.

Relation between insulin resistance and hematological parameters in a Brazilian sample

It has already been demonstrated that insulin resistance (IR) is associated with the stimulation of erythroid progenitors and with increased levels of inflammation markers. Therefore, IR should also be associated with increased red blood cell (RBC) and white blood cell (WBC) count. The aim of this study is to demonstrate that IR is independently associated with altered hematological parameters in a Brazilian sample. We analyzed laboratorial exams from 925 subjects. All data on hematological parameters, insulin resistance (Homeostasis Model Assessment [HOMA]) and lipid levels were included in the analysis. Demographic information included age and gender. HOMA correlated positively with RBC (r= 0.17, p< 0.001), plasma hemoglobin concentrations (r= 0.14, p< 0.001), hematocrit value (r= 0.15, p< 0.001) and WBC (r= 0.17, p< 0.01). Subjects in the upper quartile of IR had higher levels of plasma glucose, fasting insulin, triglycerides, hematocrit, hemoglobin, RBC and WBC count than those in the lower quartile. In conclusion, IR seems to be associated with alterations in several hematological parameters. These hematological alterations may be considered an indirect feature of the IR syndrome.

Perfil lipídico de pacientes com alto risco para eventos cardiovasculares na prática clínica diária

Although there are specific guidelines regarding the treatment of dyslipidemia in highly risk patients, these recommendations are usually inadequately followed. The aim of this study is to investigate risk factors in patients with increased cardiovascular risk currently treated in Brazil and Venezuela. Medical charts of 412 patients were selected in 4 institutions. Patients were divided into groups according to the use of lipid-lowering drugs (LLD), particularly statins. Patients who did not use LLD showed higher levels of total cholesterol (p< 0.001), LDL cholesterol (p< 0,001) and HDL cholesterol (p< 0.001), besides lower levels of triglycerides (p< 0.001). The use of statins was associated with a decrease in levels of total cholesterol (from 251.0 ± 40.0 to 196.0 ± 46.0), LDL cholesterol (from 168.0 ± 36.0 to 116.0 ± 39.0), HDL cholesterol (from 51.0 ± 46.0 to 46.0 ± 12.0) and triglycerides (from 181.0 ± 120.0 to 160.0 ± 79.0). Finally, only a small percentage of patients, even those under treatment with LLD, showed cholesterol levels according to currently available guidelines. Therefore, although the guidelines for the treatment of dyslipidemia are widely known, only a small percentage of patients achieve adequate levels of cholesterol. It is necessary to decrease lipid levels of these patients by increasing the dose of the statins or using a second drug.

The impact of multidrug therapy on the epidemiological pattern of leprosy in Juiz de Fora, Brazil

We investigated the impact of multidrug therapy (MDT) on the epidemiological pattern of leprosy in Juiz de Fora, Brazil, from 1978 to 1995. Evaluation of 1,283 medical charts was performed according to the treatment regimen used in two different periods. Following the introduction of MDT in 1987, prevalence of leprosy decreased from 22 patients/10,000 inhabitants to 5.2 patients/10,000 inhabitants in 1995. Incidence rate of leprosy was lower in period II (1987-1995) than in period I (1978-1986). Decreasing prevalence and incidence appear to be related to drug efficacy rather than decreased case identification, since both self-referred and professionally referred treatment increased markedly from period I to period II. For both periods, multibacillary leprosy was the most frequent clinical form of the disease (+/-68%), and the main infection risk factor identified was household contact. Leprosy is predominantly manifested in adults, but an increase in the number of very old and very young patients was observed in period II. The MDT program has been effective both in combating leprosy and in promoting awareness of the disease.

Perfil epidemiológico do diabetes mellitus auto-referido em uma zona urbana de Juiz de Fora, Minas Gerais

Background: by using data from Juiz de Foras Family Health Program survey, we aimed to assess the epidemiological profile of Diabetes Mellitus (DM) in an urban area in Juiz de Fora, MG, Brazil. Methodology: The source of information was a questionnaire, prepared according to the Primary Health Care Advancement Management Program, for the 12,695 homes visited. 180 students were selected from health courses to make the interviews, after having undergone a methodological training. Data obtained were organized using the software EPI-INFO 6.03 (WHO). Data bank analysis for the population between 30 and 69 years of age has led to the extensive study of DM prevalence and its association with other diseases. Results: Prevalence of self-reported DM was 4.2% (n=861) in general population, reaching 11.6%(n=297) of those between 60 and 69 years old and only 0,9% (n=76) among those between 30 and 39 years old. Irregular or no treatment was reported by 147 diabetics (17.1%). Among men, age did not interfere with compliance; for women there was a correlation between age and adherence to treatment. Other health disturbances were significantly associated with DM: cardiopathy (r=4.8), hypertension (r=4.7), blindness (r=3.1) and walking disabilities (r=3.9). Conclusions: Self-reported DM prevalence was similar to other national surveys. The high prevalence of non-adherence to treatment was significantly associated with low income and younger age in female gender. There was an important association of DM with other health problems, such as cardiopathy, hypertension, blindness and walking disabilities.

Serum TSH levels are associated with cardiovascular risk factors in overweight and obese adolescents

OBJECTIVE To investigate the relationship between serum thyrotropin (TSH), insulin resistance (IR), and cardiovascular risk factors (CRF) in a sample of overweight and obese Brazilian adolescents. METHODS A retrospective, longitudinal analysis of 199 overweight and obese pubescent adolescents was performed. The TSH and free T4 (fT4) levels, anthropometric measurements, and laboratory test results of these patients were analyzed. RESULTS 27 individuals (13.56%) presented with TSH levels above the normal level (subclinical hypothyroidism [SCH]). Their waist circumference (WC) was significantly higher than those of euthyroid individuals. Serum TSH was positively correlated with the homeostasis model assessment of insulin resistance (HOMA-IR) index, triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Using TSH and BMI as independent variables, TSH levels were shown to be independently related to HOMA-IR (p=0.001) and TG (p=0.007). Among euthyroid subjects, individuals with TSH values <2.5mIU/mL exhibited statistically significant decreases in waist-to-hip ratio, HDL-C levels, and HOMA-IR scores and a tendency toward lower WC values. CONCLUSION SCH in overweight and obese adolescents appears to be associated with excess weight, especially visceral weight. In euthyroid adolescents, there appears to be a direct relationship between TSH and some CRF. In conclusion, in the present sample of overweight and obese adolescents, TSH levels appear to be associated with IR and CRF.