Influence of a family history of type 2 diabetes, demographic and clinical data on carotid intima-media thickness in patients with type 1 diabetes: a cross-sectional study

BACKGROUND: Intima-media thickness (IMT) of the common carotid artery is a surrogate end point of cardiovascular disease (CVD). Identifying the factors associated with a higher IMT may contribute to the identification of subjects with higher CVD risk. Our objective was to compare the common carotid IMT of type 1 diabetes patients to healthy control subjects. The secondary objective was to determine factors associated with a higher carotid IMT. METHODS: We conducted a cross-sectional study between March 2009 and October 2013, comprising 127 type 1 diabetes patients and 125 control subjects matched by age, gender and body mass index (BMI). Carotid IMT was measured using semi-automated edge detection software. RESULTS: Type 1 diabetes patients had a higher median IMT compared with control subjects (0.538; IQR: 0.500-0.607 vs 0.513 mm; IQR: 0.481-0.557, respectively p = 0.001). Women with type 1 diabetes had a higher median IMT difference compared to the control group (0.537; IQR: 0.495-0.596 vs 0.502 mm; IQR: 0.472-0.543, respectively p = 0.003) than did men with type 1 diabetes (0.547; IQR: 0.504-0.613 vs 0.528 mm; IQR: 0.492-0.575, respectively p = 0.2). Age and diabetes duration had an additive effect on the IMT of type 1 diabetes patients. Multivariate gamma regression model analysis showed that in type 1 diabetes patients, the IMT was associated with age (Exp (β) = 1.006, p < 0.001), duration of diabetes (Exp (β) = 1.004, p = 0.001), BMI (Exp (β) = 1.005, p = 0.021), family history of type 2 diabetes (Exp (β) = 1.044, p = 0.033), total cholesterol (Exp (β) = 0.999, p = 0.001) and creatinine clearance (Exp (β) = 1.000, p = 0.043). CONCLUSIONS: Patients with type 1 diabetes have increased IMT, a marker of subclinical atherosclerosis. The CVD risk may be similar between men and women with type 1 diabetes, suggesting a loss of gender protection. Also, CVD risk may be higher in those with a family history of type 2 diabetes. Prospective studies are needed to confirm the predictive value of these findings and the causal effect between IMT and CVD in patients with type 1 diabetes

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Study of the intima-media thickening in carotid arteries of healthy elderly with high blood pressure and elderly with high blood pressure and dyslipidemia

Elizabete Viana de Freitas, Andr&eacute;a Ara&uacute;jo Brand&atilde;o, Roberto Pozzan, Maria Eliane Magalh&atilde;es, M&aacute;rcia Castier, Airton Pires Brand&atilde;oCardiology Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, BrazilObjective: The objective of this study was to assess the mean intima-media thickening of carotid arteries of elderly subjects, and its relationship with age, anthropometric measurements, high systolic blood pressure and dyslipidemia.Methods: In this investigation, 129 subjects were enrolled between 1995 and 1998, age ranging from 29 to 94 years. They were assigned to one of 4 groups, including 2 control groups (group I, of healthy younger subjects; group II of healthy elderly subjects). Groups III and IV included those who presented with isolated systolic hypertension (ISH), and ISH and dyslipidemia, respectively. All subjects were submitted to a medical interview, lab tests with measurement of cholesterol levels, electrocardiogram, and carotid ultrasound. The ultrasound included measurement of the intima-media thickening (IMT) of the carotid arteries, the right carotid artery (RCA) and left carotid artery (LCA), and assessment of the presence of plaques. Blood fat and glucose were measured by a standard method. The results were compared among the groups through statistical tests. The tests employed were: Chi-Square, Pearson&rsquo;s and Likelihood Ratio, Student&rsquo;s t, Mann-Whitney; ANOVA followed by Tukey&rsquo;s test, Kruskal-Wallis nonparametric test, and test for multiple comparisons and Odds Ratio determination (OR).Results: In this investigation, a positive association was observed between aging and IMT. In relation to systolic hypertension, a significant association was observed with IMT (IMT-RCA p = 0.0034; IMT-LCA p = 0.0196; IMT-RLCA p = 0.0299), and with the presence of plaques (PlaqueR p = 0.0110; PlaqueL p = 0.0294; PlaqueRL p = 0.0040).Conclusion: This investigation evidenced the important role of aging in IMT, and of systolic hypertension in the IMT and presence of plaque. However, further studies are needed for a better understanding of the actual role of risk factors in aging.Keywords: aging, elderly, carotid arteries, high blood pressur

Experimental and DFT Approach on the Determination of Natural Gas Hydrate Equilibrium with the use of Excess N2 and Choline-Chloride Ionic Liquid as an Inhibitor

This work presents the characterization of hydrate-forming conditions of a Qatari natural gas-type mixture, QNG-S1, obtained using two different experimental methods, namely, a benchtop reactor and a gas hydrate autoclave. The obtained experimental results were found to be in agreement with each other. Another mixture in which the QNG-S1 sample was diluted with nitrogen (N2) in a 1:1 ratio was also characterized for hydrate dissociation conditions using a rocking cell apparatus only. The thermodynamic hydrate inhibition effect of a biocompatible ionic liquid, choline chloride (ChCl), was tested for both QNG-S1 and QNG-S1+N2 at two concentrations (1 and 5 wt %) using the rocking cell apparatus. It was found that the ChCl shows a typical classical thermodynamic inhibitor behavior for both tested mixtures QNG-S1 and QNG-S1+N2 by shifting the hydrate equilibrium toward lower temperature and higher pressure. Likewise, the interaction between ChCl and model hydrate cages was analyzed using density functional theory to characterize the ionic liquid inhibition mechanism at the nanoscopic level. 2016 American Chemical Society.Scopu

O tratamento das doenças sistêmicas reumatológicas: uma análise crítica do uso dos AINHs, considerando o risco cardiovascular

Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):74-80doi:10.12957/rhupe.2013.7085Os anti-inflamatórios não esteroidais (AINEs) são medicamentos usados com elevada frequência em todo o mundo, particularmente entre as mulheres após os 45 anos com manifestações articulares e em muitas oportunidades por períodos prolongados, principalmente os AINEs que apresentam seletividade para a isoenzima ciclo-oxigenase (COX-2). Os efeitos adversos mais conhecidos desses agentes ocorrem no trato gastrointestinal (GI) e incluem, sobretudo, a doença péptica e a hemorragia digestiva. São ainda frequentemente relatadas a insuficiência renal aguda, a hipertensão arterial, a doença arterial coronariana aguda (IAM) e a insuficiência cardíaca, cuja mortalidade foi superior às causadas por câncer cervical. Nas últimas décadas, eventos adversos cardiovasculares têm sido descritos mais frequentemente com o emprego dos agentes COX-2 seletivos. Dessa forma, a identificação de fatores de risco cardiovascular (CV) nos pacientes para os quais um AINE venha a ser prescrito tornou‑se mandatória em nossos dias. O principal mecanismo de ação desses agentes é a inibição da síntese das prostaglandinas (PG), que agindo predominantemente sobre uma ou outra isoforma da COX inibe ou favorece os mecanismos vaso-oclusivos. Assim, a inibição seletiva da COX-2, que participa da formação da prostaciclina (PGI2) e cuja ação é eminentemente antitrombótica, vasodilatadora e de promoção da redução da agregação e adesão de plaquetas, contribui para o desencadeamento dos eventos adversos cardiovasculares. O uso de AINE em pacientes com artrite reumatoide sejam COX-2 seletivos ou clássicos, demonstraram maior risco para eventos cardiovasculares quando comparados ao placebo. Na população geral, AINE com seletividade parcial para a COX-2, podem determinar aumento do risco de morte de causa cardiovascular e maior frequência de acidente vascular encefálico (AVE). O conjunto desses achados com medicamentos usados tão amplamente reforça a necessidade de uma análise crítica de seus riscos a cada paciente para os quais esses agentes forem prescritos.Descritores: Anti-inflamatórios não esteroides; Efeitos adversos; Doenças cardiovasculares; Risco.Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):74-80doi:10.12957/rhupe.2013.7085Non steroidal anti-inflammatory drugs (NSAID) are widely used throughout the world and particularly among women with rheumatic complaints and older than 45 years of age. Those ciclo-oxigenase (COX-2) selective agents are often used for long periods. The most widely known adverse events occur within the gastrointestinal system and include peptic ulcer disease and upper digestive haemorrhage. However acute renal insufficiency, arterial hypertension and acute ischemic coronary disease (MI) and congestive heart failure which have all been largely reported, have higher mortality rates than those caused by cervical cancer. During the last few decades, cardiovascular adverse events are being more frequently described mainly with the COX-2 selective agents use. This way, the identification of cardiovascular risk factors (CV) in patients for whom an NSAID may be prescribed became mandatory today. The main mechanism of action of these agents is the inhibition of prostaglandin (PG), however and depending on which isoform of this enzyme is inhibited; vaso-occlusive mechanisms may be stimulated. Thus, selective COX-2 inhibition, which is involved in prostacyclin (PGI2) formation, whose action is essentially antithrombotic, vasodilating promotion, platelet adhesion and aggregation reduction, contributes to the onset of adverse cardiovascular events. The use of NSAIDs among patients with rheumatoid arthritis including COX-2 selectives or classic agents, were found to be more associated with cardiovascular events compared with placebo. In the general population, NSAID with partial COX-2 selectivity may increase the risks of cardiovascular death and frequency of cerebrovascular accident (CVA). The combination of these findings put together with the wide use of these drugs reinforces the need for a critical analysis of their risks to each patient for whom these agents are prescribed.Keywords: Anti-inflammatory agents, non­Steroidal; Adverse effects; Cardiovascular diseases; Risk

Bronchodilation induced by PGE2 is impaired in Group-III pulmonary hypertension

BACKGROUND AND PURPOSE: In patients with pulmonary hypertension (PH) associated with lung disease and/or hypoxia (Group III), a reduction of pulmonary vascular tone and tissue hypoxia are considered therapeutically beneficial. Prostaglandin (PG) E2 and PGI2 induce potent relaxation of human bronchi from non-PH (control) patients via EP4 and IP receptors, respectively. However, the effects of PGE2 /PGI2 and their mimetics on human bronchi from PH-patients are unknown. Our aim was to compare the relaxant effects of several PGI2 -mimetics approved for treating PH-Group I with several PGE2 -mimetics in bronchial preparations derived from PH-Group III and control patients. EXPERIMENTAL APPROACH: Using an organ bath system, the tone of bronchial muscle was investigated in tissue from either control or PH-Group III patients. Expression of prostanoid receptors were analyzed by Western blot and real-time PCR and endogenous PGE2 , PGI2 and cAMP levels were determined by ELISA. KEY RESULTS: Maximal relaxations induced by different EP4 agonists (PGE2 , L-902688, ONO-AE1-329) were significantly decreased in human bronchi from PH-patients versus controls. In contrast, the maximal relaxations produced by PGI2 -mimetics (iloprost, treprostinil, beraprost) were similar for both groups of patients. Both EP4 and IP receptor protein and mRNA expressions were significantly lower in human bronchi from PH-patients. cAMP levels significantly correlated with PGI2 but not with PGE2 levels. CONCLUSION AND IMPLICATIONS: This study shows that PGI2 -mimetics have preserved maximal bronchodilation in PH-Group III patients. The decreased bronchodilation induced by EP4 agonists suggests that restoration of EP4 expression in airways of PH-patients with respiratory diseases could bring additional therapeutic benefit