Ruy Lyra

Prevenção do diabetes mellitus tipo 2

Type 2 Diabetes mellitus (DM2) is a complex, multifactorial and worldwide metabolic disease that affects quality and lifestyle of patients. Patients with diabetes can have a 15-year or more reduction of lifetime and the high mortality is due to cardiovascular (CV) complications. Effective strategies for the reduction of the impact of DM2 on CV disorders for the next years and attention concerning to strategies of prevention, mainly for the populations with larger risk of developing the disease, are essential. In that context, impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) must suffer intervention strategies in order to minimize the risk for diabetes. Behavior modification (diet therapy and physical activity) must be stimulated, and pharmacological agents have to be used when indicated. Studies worldwide have been confirming the effectiveness of lifestyle strategies and even the use of pharmacological agents for the prevention of DM2.

Cushing's syndrome in pregnancy: an overview

Cushings syndrome (CS) during pregnancy is a rare condition with fewer than 150 cases reported in the literature. Adrenal adenomas were found to be the commonest cause, followed by Cushings disease. The gestation dramatically affects the maternal hypothalamic-pituitary-adrenal axis, resulting in increased hepatic production of corticosteroid-binding globulin (CBG), increased levels of serum, salivary and urinary free cortisol, lack of suppression of cortisol levels after dexamethasone administration and placental production of CRH and ACTH. Moreover, a blunted response of ACTH and cortisol to exogenous CRH may also occur. Therefore, the diagnosis of CS during pregnancy is much more difficult. Misdiagnosis of CS is also common, as the syndrome may be easily confused with preeclampsia or gestational diabetes. Because CS during pregnancy is usually associated with severe maternal and fetal complications, its early diagnosis and treatment are critical. Surgery is the treatment of choice for CS in pregnancy, except perhaps in the late third trimester, with medical therapy being a second choice. There does not seem to be a rationale for supportive treatment alone.

Treatment of type 2 diabetes in Latin America: a consensus statement by the medical associations of 17 Latin American countries

Latin America is undergoing a remarkable epidemiological transformation. Diabetes and other chronic, nontransmissible diseases are now the leading health problems. Despite the

Atualização sobre hemoglobina glicada (HbA1C) para avaliação do controle glicêmico e para o diagnóstico do diabetes: aspectos clínicos e laboratoriais

Universidade Federal de Sao Paulo (UNIFESP) Hospital do Rim e Hipertensao Centro Integrado de Hipertensao e Metabologia Cardiovascular

Consenso Brasileiro sobre antipsicóticos de segunda geração e distúrbios metabólicos

Resumo Objetivo: Discutir os aspectos atuais do tratamento com os antipsicoticos, levando-se em consideracao o perfil de efeitos metabolicos, tais como ganho de peso, diabetes, dislipidemias e sindrome metabolica. Tais fatores aumentam o risco de doenca cardiovascular, que e a principal causa de morte nos portadores de esquizofrenia. Metodo: Foi realizada uma reuniao de consenso com psiquiatras especialistas em esquizofrenia e endocrinologistas, os quais, com base nas evidencias provenientes de ampla revisao da literatura, elaboraram um documento com recomendacoes que auxiliam a pratica clinica. Resultados e conclusoes: A avaliacao periodica dos efeitos adversos metabolicos em pacientes que fazem uso de antipsicoticos e fundamental para a pratica clinica, especialmente nos caso de antipsicoticos de segunda geracao. O equilibrio entre eficacia e tolerabilidade deve ser cuidadosamente considerado em todas as etapas do tratamento.

A luta continua

For trade unions in Southern Africa, there was hardly a more appropriate time to remember the famous Mozambican revolutionary slogan “a luta continua” (the struggle continues) than now. Twenty years after the independence of the last colony in the region (Namibia) and fifteen years after the end of apartheid in South Africa, Southern African workers face a host of monumental challenges. These range from organisational challenges, to socio-economic inequalities and political repression. This article aims to sketch the state of labour and the possibilities for rising to the current challenges.

The Role of Isotretinoin Therapy for Cushing's Disease: Results of a Prospective Study.

Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushings disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6–12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6–12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism.

Eficácia da cabergolina no tratamento da acromegalia

We evaluated in a prospective non-randomized study the effect of cabergoline administration (1-1.5mg twice weekly, for 2-4 months) on GH and IGF-1 levels in 9 acromegalic patients. Normalization of GH and IGF-1 levels occurred in 3 out of the 9 patients (33%) who were evaluated, in 3 out of 5 patients (60%) with GH/prolactin-cosecreting pituitary adenomas but in none without associated hyperprolactinemia. The best responses were observed in patients with pre-treatment GH and IGF-1 levels below 20ng/mL and 750ng/mL, respectively. Our results suggest that cabergoline may be an effective therapy for acromegalic patients with cosecreting GH/prolactin adenomas, particularly for those with moderately elevated plasma IGF-1 and GH levels.