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Muzy J, Campos MR, Emmerick I, Sabino R. Supply and demand of procedures related to diabetes mellitus and its complications in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:1653-1667. [PMID: 35475843 DOI: 10.1590/1413-81232022274.05612021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
This article aims to present a methodology for monitoring the procedures recommended in the care protocol for diabetic patients, based on the indicator of the ratio between supply and demand for exams, according to Brazil, macro-regions, federative units (FUs), and municipalities. The prevalence of diabetes mellitus (DM) and its complications were estimated using a multinomial model. The offer of DM procedures was obtained from the Ambulatory Information System (SIA/SUS) and the demand from the number of tests defined in the protocol as necessary per year, according to disease risk categories. Based on this, the supply-demand ratio indicator was created. The innovation here consists of analyzing the demand for diabetic care according to established parameters and the supply of health services together. The connection between the recommended treatment protocol and the existence of the service offered concerning the demand for care based on the prevalence of the disease provides a key monitoring tool. And, when analyzed together with the indicator of the ratio between supply and demand for procedures, these measures become a proxy for the quality of prevention and care for patients with the disease.
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Affiliation(s)
- Jéssica Muzy
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480 Manguinhos, 21041-210. Rio de Janeiro RJ Brasil.
| | - Monica Rodrigues Campos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480 Manguinhos, 21041-210. Rio de Janeiro RJ Brasil.
| | - Isabel Emmerick
- University of Massachusetts Medical School. Massachusetts USA
| | - Raulino Sabino
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480 Manguinhos, 21041-210. Rio de Janeiro RJ Brasil.
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Rashad NM, Sherif MH, El-Shal AS, Abdelsamad MAE. The expression profile of circANKRD36 and ANKRD36 as diagnostic biomarkers of chronic kidney disease in patients with type 2 diabetes mellitus. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2021. [DOI: 10.1186/s43042-021-00165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The molecular mechanisms for chronic kidney disease (CKD) remain largely unknown and appear to be multifactorial. In the current study, we aimed to study the circulatory levels of circular ankyrin repeat domain 36 (circANKRD36) and ANKRD36 in Egyptian patients with type 2 diabetes mellitus (T2DM) and CKD and to explore their associations with the progression of CKD. This cross-sectional controlled study enrolled 60 patients with T2DM and 40 controls. Real-time polymerase chain reaction (RT-PCR) and real-time quantitative PCR (RT-qPCR) analyses were used to detect the expression levels of circANKRD36 and ANKRD36.
Results
Our results detected that the relative expression levels of circANKRD36 and ANKRD36 were significantly higher in patients with T2DM compared to controls. CircANKRD36 and ANKRD36 were significantly overexpressed in patients with macroalbuminuria (0.2316±0.096, 0.0086±0.0035, respectively) compared microalbuminuria (0.1347±0.032, 0.0037±0.0008, respectively) as well as normoalbuminuria (0.1261±0.018, 0.0027±0.0004, respectively), p˂0.001*.
Conclusion
The relative expression levels of circANKRD36 and ANKRD36 were significantly increased in patients with T2DM more specifically in patients with diabetic nephropathy (DN) and macroalbuminuria.
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Osman WM, Jelinek HF, Tay GK, Khandoker AH, Khalaf K, Almahmeed W, Hassan MH, Alsafar HS. Clinical and genetic associations of renal function and diabetic kidney disease in the United Arab Emirates: a cross-sectional study. BMJ Open 2018; 8:e020759. [PMID: 30552240 PMCID: PMC6303615 DOI: 10.1136/bmjopen-2017-020759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Within the Emirati population, risk factors and genetic predisposition to diabetic kidney disease (DKD) have not yet been investigated. The aim of this research was to determine potential clinical, laboratory and reported genetic loci as risk factors for DKD. RESEARCH DESIGN AND METHODS Four hundred and ninety unrelated Emirati nationals with type 2 diabetes mellitus (T2DM) were recruited with and without DKD, and clinical and laboratory data were obtained. Following adjustments for possible confounders, a logistic regression model was developed to test the associations of 63 single nucleotide polymorphisms (SNPs) in 43 genetic loci with DKD (145 patients with DKD and 265 without DKD). Linear regression models, adjusted for age and gender, were then used to study the genetic associations of five renal function traits, including 83 SNPs with albumin-to-creatinine ratio, 92 SNPs with vitamin D (25-OH cholecalciferol), 288 SNPs with estimated glomerular filtration rate (eGFR), 363 SNPs with serum creatinine and 73 SNPs with blood urea. RESULTS Patients with DKD, as compared with those without the disease, were mostly men (52%vs38% for controls), older (67vs59 years) and had significant rates of hypertension and dyslipidaemia. Furthermore, patients with DKD had T2DM for a longer duration of time (16vs10 years), which in an additive manner was the single factor that significantly contributed to the development of DKD (p=0.02, OR=3.12, 95% CI 1.21 to 8.02). Among the replicated associations of the genetic loci with different renal function traits, the most notable included SHROOM3 with levels of serum creatinine, eGFR and DKD (Padjusted=0.04, OR=1.46); CASR, GC and CYP2R1 with vitamin D levels; as well as WDR72 with serum creatinine and eGFR levels. CONCLUSIONS Associations were found between several genetic loci and risk markers for DKD, which may influence kidney function traits and DKD in a population of Arab ancestry.
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Affiliation(s)
- Wael M Osman
- Center of Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
- Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Guan K Tay
- Center of Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- School of Health and Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Western Australia, Australia
- Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ahsan H Khandoker
- Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Institute of Cardiac Science, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Mohamed H Hassan
- Medical Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Habiba S Alsafar
- Center of Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
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Dellamea BS, Leitão CB, Friedman R, Canani LH. Nitric oxide system and diabetic nephropathy. Diabetol Metab Syndr 2014; 6:17. [PMID: 24520999 PMCID: PMC3928920 DOI: 10.1186/1758-5996-6-17] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 02/04/2014] [Indexed: 01/09/2023] Open
Abstract
About 30% of patients with type 2 diabetes mellitus develop clinically overt nephropathy. Hyperglycemia is necessary, but not sufficient, to cause the renal damage that leads to kidney failure. Diabetic nephropathy (DN) is a multifactorial disorder that results from interaction between environmental and genetic factors. In the present article we will review the role of the nitric oxide synthase (NOS) in the pathogenesis of DN.Nitric oxide (NO) is a short-lived gaseous lipophilic molecule produced in almost all tissues, and it has three distinct genes that encode three NOS isoforms: neuronal (nNOS), inducible (iNOS) and endothelial (eNOS).The correct function of the endothelium depends on NO, participating in hemostasis control, vascular tone regulation, proliferation of vascular smooth muscle cells and blood pressure homeostasis, among other features. In the kidney, NO plays many different roles, including control of renal and glomerular hemodynamics. The net effect of NO in the kidney is to promote natriuresis and diuresis, along with renal adaptation to dietary salt intake.The eNOS gene has been considered a potential candidate gene for DN susceptibility. Three polymorphisms have been extensively researched: G894T missense mutation (rs1799983), a 27-bp repeat in intron 4, and the T786C single nucleotide polymorphism (SNP) in the promoter (rs2070744). However, the potential link between eNOS gene variants and the induction and progression of DN yielded contradictory results in the literature.In conclusion, NOS seems to be involve in the development and progression of DN. Despite the discrepant results of many studies, the eNOS gene is also a good candidate gene for DN.
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Affiliation(s)
| | - Cristiane Bauermann Leitão
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rogério Friedman
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis Henrique Canani
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Bertoldi AD, Kanavos P, França GVA, Carraro A, Tejada CAO, Hallal PC, Ferrario A, Schmidt MI. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Global Health 2013; 9:62. [PMID: 24299125 PMCID: PMC4220809 DOI: 10.1186/1744-8603-9-62] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/11/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. METHODS A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. RESULTS From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment. CONCLUSIONS Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Panos Kanavos
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Giovanny V A França
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - André Carraro
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas, RS, Brazil
| | | | - Pedro C Hallal
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Alessandra Ferrario
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Maria Inês Schmidt
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Teixeira CRDS, Nakanish MK, Becker TAC, Zanetti ML, Kusumota L, Landim CAP. Diagnóstico de enfermagem Eliminação urinária prejudicada em pessoas com Diabetes Mellitus. Rev Bras Enferm 2010; 63:908-12. [DOI: 10.1590/s0034-71672010000600006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 10/17/2010] [Indexed: 11/21/2022] Open
Abstract
Estudo exploratório descritivo com o objetivo de descrever os diagnósticos de enfermagem em pessoas com diabetes mellitus que apresentaram diagnóstico de enfermagem Eliminação urinária prejudicada. Os dados foram obtidos através do exame físico e a técnica de entrevista dirigida. Após a coleta de dados, procedeu-se a identificação dos diagnósticos de enfermagem nomeados de acordo com a Taxonomia II da NANDA, utilizando o processo de raciocínio diagnóstico de Risner. Das 31 pessoas entrevistadas, identificou-se 10 (32%) sujeitos que apresentaram o diagnóstico de enfermagem eliminação urinária prejudicada. Conhecer os fatores relacionados e as caracteristicas definidoras desse diagnóstico possibilita que o enfermeiro trace intervenções de enfermagem que preservem a função renal, e consequentemente a nefropatia diabética.
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Carpena MP, Rados DV, Sortica DA, Souza BMD, Reis AF, Canani LH, Crispim D. Genetics of diabetic nephropathy. ACTA ACUST UNITED AC 2010; 54:253-61. [PMID: 20520954 DOI: 10.1590/s0004-27302010000300002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 02/26/2010] [Indexed: 01/08/2023]
Abstract
The increasing prevalence of diabetes mellitus has led to a growing number of chronic complications including diabetic nephropathy (DN). In addition to its high prevalence, DN is associated with high morbidity and mortality especially due to cardiovascular diseases. It is well established that genetic factors play a role in the pathogenesis of DN and genetically susceptible individuals can develop it after being exposed to environmental factors. DN is probably a complex, polygenic disease. Two main strategies have been used to identify genes associated to DN: analysis of candidate genes, and more recently genome-wide scan. Great efforts have been made to identify these main genes, but results are still inconsistent with different genes associated to a small effect in specific populations. The identification of the main genes would allow the detection of those individuals at high risk for DN and better understanding of its pathophysiology as well.
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Murussi M, Murussi N, Campagnolo N, Silveiro SP. [Early detection of diabetic nephropathy]. ACTA ACUST UNITED AC 2009; 52:442-51. [PMID: 18506269 DOI: 10.1590/s0004-27302008000300004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 12/17/2007] [Indexed: 11/22/2022]
Abstract
Due to the unfavorable prognosis of advanced stages of diabetic nephropathy (DN), the ideal approach is to identify renal involvement as early as possible. It is recommended to measure urinary albumin excretion (UAE) annually, in random urine samples, in order to detect the stages of DN [microalbuminuria (UAE 17-174 mg/l or 30-300 mg albumin/g of creatinine) and macroalbuminuria (> 174 mg/l or > 300 mg/g)]. However, it has been suggested that UAE levels below the threshold of consensus could already signal the risk for DN progression and increased mortality, indicating the need to revise cutoff values. As a substantial amount of UAE (the immunounreactive fraction), is not detected by conventional methods, HPLC would be more sensitive to identify the presence of damage by measuring total UAE (immunoreactive + immunounreactive). Another recent observation is that diminished glomerular filtration rates (GFR) occurs in the presence of normoalbuminuria. Therefore, besides evaluating UAE, it is recommended to estimate GFR with equations employing creatinine; such as the Modification of Diet in Renal Disease (MDRD) study, available at www.mdrd.com. Owing to the known limitations of creatinine, alternative endogenous markers are being studied, and cystatin-C is a promising marker under investigation. Finally, new strategies that could detect DN even earlier, include biomarkers such as proteomics, defining a profile of urinary protein excretion able to identify the subsequent risk of renal disease.
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Affiliation(s)
- Marcia Murussi
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Lenardt MH, Hammerschmidt KSDA, Borghi ÂCDS, Vaccari É, Seima MD. O idoso portador de nefropatia diabética e o cuidado de si. TEXTO & CONTEXTO ENFERMAGEM 2008. [DOI: 10.1590/s0104-07072008000200013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Trata-se de pesquisa qualitativa convergente assistencial, cujo objetivo é descrever ações de cuidados de si, alicerçadas nos hábitos de cuidado do idoso renal crônico portador de nefropatia diabética, em tratamento hemodialítico. Coletaram-se dados e aplicaram-se escalas de avaliação funcional concomitante aos cuidados de enfermagem, junto a sete idosos, no período de 26 de abril a 31 de junho de 2006. Para ordenação e análise das informações empregou-se proposição metodológica do Discurso do Sujeito Coletivo. Emergiram oito idéias centrais: obedecer parcialmente ao que é explicado; cuidados com açúcar, doces e uso de adoçante; obedecer à prescrição médica e alternar local da aplicação; dependência para aplicação da insulina; manter o braço livre de qualquer esforço; dependência pelo déficit visual e desconhecimento dos medicamentos; controle alimentar, distração e tranqüilidade; tendência ao isolamento. O desafio para o cuidado de si está na construção da independência e nas possibilidades de diálogos abertos e produtivos entre os idosos e familiares.
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Trentini M, Cubas MR. [Nursing actions in nephrology: a theoretical referral expanded beyond the biologicist health conception]. Rev Bras Enferm 2006; 58:481-5. [PMID: 16514960 DOI: 10.1590/s0034-71672005000400020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article focuses ways of nursing performance in nephrology in the health promotion programs. Therefore, we present a theoretical referral formed by concepts of health promotion, health education and technologies. The conception of health promotion is anchored in the First International Conference documents about the subject, which took place in Ottawa, Canada in 1986. Health education is based on the empowerment paradigm, seen as a social action process that promotes people's participation in controlling their lives and health. The concept of technologies is presented in accordance with Merhy's conception, classifying them as hard technologies, light-hard and light ones. This referral will surely represent a new challenge for nurses in nephrology.
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