Particularidades no manejo do diabetes em crianças e idosos

A presente revisão tem por objetivo apresentar e discutir as particularidades no manejo do diabetes em duas populações distintas de pacientes, as crianças e os idosos, através da revisão das principais diretrizes na área, além de revisão da literatura, abordando aspectos importantes de cada grupo etário que tenham impacto nas decisões terapêuticas. O manejo do diabetes em crianças e idosos apresenta alguns pontos em comum. Ambas são populações com características clínicas e psicossociais bastante heterogêneas, nas quais a individualização do tratamento é crucial para a obtenção de sucesso terapêutico. São populações vulneráveis ao risco de hipoglicemia e hiperglicemia extremas e que na grande maioria dos casos o suporte social e familiar é determinante para o tratamento adequado. As metas terapêuticas em crianças preconizadas pela International Society of Pediatric and Adolescent Diabetes (ISPAD) e seguidas pela Sociedade Brasileira de Diabetes são nível de hemoglobina glicada (A1c) < 7,5% para todos com menos de 18 anos, porém sempre se ressaltando a necessidade de evitar hipoglicemias graves e garantir crescimento e desenvolvimento normais. O tratamento consiste de dieta, atividade física e insulinoterapia exclusiva desde o diagnóstico, para os casos de DM1, ou metformina associada ou não à insulinoterapia, para os casos de diabetes tipo 2. Para idosos, os objetivos e metas de tratamento são variáveis, dependendo da presença de comorbidades, da fragilidade, do deficit cognitivo, da expectativa de vida e do suporte social/familiar do idoso. Sendo assim, as metas de A1c podem variar de 6,5% a 8,5-9,0% devendo sempre ser individualizadas. Para a escolha da medicação, devemos considerar o tempo de duração do diabetes, o peso do paciente, sintomas, níveis de glicemia e de HbA1c, o potencial da droga em reduzir a glicemia, seus efeitos extraglicêmicos, seu perfil de segurança, tolerabilidade, posologia e custo. Descritores: Crianças; Diabetes mellitus; Idoso; Terapêutica

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Strong magneto-optical responses of an ensemble of defect-bound excitons in aged WS2_{2} and WSe2_{2} monolayers

Transition metal dichalcogenide (TMD) monolayers present a singular coupling in their spin and valley degrees of freedom. Moreover, by applying an external magnetic field it is possible to break the energy degeneracy between their K and $-$K valleys. Thus, this analogous valley Zeeman effect opens the possibility of controlling and distinguishing the spin and valley of charge carriers in TMDs by their optical transition energies, making these materials promising for the next generation of spintronic and photonic devices. However, the free excitons of pristine TMD monolayer samples present a moderate valley Zeeman splitting, which is measured by their g-factor values that are approximately $-4$. Therefore, for application purposes it is mandatory alternative excitonic states with higher magnetic responses. Here we investigate the valley Zeeman effect in aged WS$_{2}$ and WSe$_{2}$ grown monolayers by magneto-photoluminescence measurements at cryogenic temperatures. These samples present a lower energy defect-bound exciton emission related to defects adsorbed during the aging process. While the free excitons of these samples exhibit g-factors between $-3$ and $-4$, their defect-bound excitons present giant effective g-factor values of $-(25.0 \pm 0.2)$ and $-(19.1 \pm 0.2)$ for WS$_{2}$ and WSe$_{2}$ aged monolayers, respectively. In addition, we observe a significant spin polarization of charge carriers in the defective mid gap states induced by the external magnetic fields. We explain this spin polarized population in terms of a spin-flip transition mechanism, which is also responsible for the magnetic dependent light emission of the defect-bound exciton states. Our work sheds light in the potential of aged TMDs as candidates for spintronic based devices

Attenuation of motor deficits by hydroethanolic extract of Poincianella pyramidalis in a Parkinson's disease model

The present study aimed to evaluate the possible neuroprotective effect of the hydroethanolic extract of Poincianella pyramidalis (EFIPp) (Tul.) L. P. Queiroz (Fabaceae), an endemic plant found in Northeastern Brazil, commonly used in folk medicine, on the motor deficits induced by repeated treatment with reserpine (RES) in rats. Adult male Wistar rats received 10 s.c. injections of 0.1 mg/kg RES or vehicle (VR), every 48 h, and daily i.p. injections daily of HEPp (25 mg/kg) or vehicle (VE). Throughout treatment, catalepsy behavior and oral movements were scored. After behavioral tests, superoxide dismutase (SOD) and catalase (CAT) activities were evaluated in the prefrontal cortex, hippocampus and striatum. RES treatment induced a progressive increase of catalepsy time in the treated group compared to control groups starting at day 15. RES also increased the number of vacuous chewing movements, tongue protrusions and duration of facial twitching. Treatment with HEPp attenuated the motor deficit in the catalepsy test and delayed the onset of oral movements induced by RES. No significant changes were observed in the antioxidant assay. Taken together, these results show a beneficial effect of HEPp on motor deficits induced by reserpine, suggesting a neuroprotective effect in a rat model of PD.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Fundação de Apoio a Pesquisa e a Inovação Tecnologica do Estado de Sergipe (FAPITEC)Pro-reitoria de Pesquisa da Universidade Federal de Sergipe (POSGRAP/UFS)Univ Fed Sergipe, Dept Physiol, Sao Cristovao, SE, BrazilUniv Massachusetts, Neurosci & Behav Program, Amherst, MA 01003 USAMinist Educ, CAPES Fdn, BR-70040020 Brasilia, DF, BrazilUniv Fed Sao Paulo, Dept Biosci, Santos, SP, BrazilUniv Fed Sao Paulo, Dept Pharmacol, Sao Paulo, SP, BrazilUniv Fed Sergipe, Dept Biosci, Itabaiana, SE, BrazilUniv Fed Sao Paulo, Dept Biosci, Santos, SP, BrazilUniv Fed Sao Paulo, Dept Pharmacol, Sao Paulo, SP, BrazilWeb of Scienc

Chemotherapy-induced neuropathy in monomethyl Auristatin E treatment:prevention by lithium

BACKGROUND: The increasing number of cancer survivors, thanks to improved cancer treatments, has escalated the prevalence of adverse effects, especially chemotherapy-induced peripheral neuropathy (CIPN) and chemotherapy-induced cognitive impairment (CICI). New drug classes, including antibody-drug conjugates (ADCs), are being developed to target cancer cells and avoid noxious effects. Despite the efforts, ADCs present a high prevalence of neuropathy. A drug often employed in approved ADCs is Monomethyl Auristatin E (MMAE), a microtubule-based agent. The aim of this study was to investigate the sensory and cognitive effects of MMAE in a mouse model and test the potential use of lithium to alleviate MMAE-induced neuropathy.METHODS: We developed a model of MMAE-induced CIPN and CICI and used behavior and sensory tests to analyze these conditions. We also evaluated calcium signaling and protein levels in neuropathic tissues and tumor progression upon treatments with lithium and MMAE.RESULTS: MMAE administration leads to loss of peripheral sensitivity and cognitive impairment and lithium prevents both central and peripheral neuropathies induced by chemotherapy, without affecting the antitumor activity of MMAE.CONCLUSION: This study shows that strategies including lithium pretreatment can prevent both central and peripheral neuropathies induced by chemotherapy to improve quality of life of cancer survivors.</p

Atenuación de deficiencias motoras por el extracto hidroalcohólico de Poincianella pyramidalis en un modelo de la enfermedad de Parkinson

The present study aimed to evaluate the possible neuroprotective effect of the hydroethanolic extract of Poincianella pyramidalis (EHPp) (Tul.) L. P. Queiroz (Fabaceae), an endemic plant found in Northeastern Brazil, commonly used in folk medicine, on the motor deficits induced by repeated treatment with reserpine (RES) in rats. Adult male Wistar rats received 10 s.c. injections of 0.1 mg/kg RES or vehicle (VR), every 48 h, and daily i.p. injections daily of HEPp (25 mg/kg) or vehicle (VE). Throughout treatment, catalepsy behavior and oral movements were scored. After behavioral tests, superoxide dismutase (SOD) and catalase (CAT) activities were evaluated in the prefrontal cortex, hippocampus and striatum. RES treatment induced a progressive increase of catalepsy time in the treated group compared to control groups starting at day 15. RES also increased the number of vacuous chewing movements, tongue protrusions and duration of facial twitching. Treatment with HEPp attenuated the motor deficit in the catalepsy test and delayed the onset of oral movements induced by RES. No significant changes were observed in the antioxidant assay. Taken together, these results show a beneficial effect of HEPp on motor deficits induced by reserpine, suggesting a neuroprotective effect in a rat model of PD.El presente estudio tuvo como objetivo evaluar el posible efecto neuroprotector del extracto hidroalcohólico de Poincianella pyramidalis (EHPp) (Tul.) L. P. Queiroz (Fabaceae), en los déficits motores inducidos por el tratamiento repetido con reserpina (RES) en ratas. Ratas Wistar machos adultos recibieron 10 inyecciones (s.c.) de 0,1 mg/kg de RES o vehículo (VR) a cada 48 h, y inyecciones (i.p.) diarias de EHPp (25 mg/kg) o vehículo (VE). Durante todo el tratamiento se observó el comportamiento de la catalepsia y movimientos orales. Después de análisis de comportamientos, fueron evaluados el superóxido dismutasa (SOD) y las actividades de catalasa (CAT) en la corteza prefrontal, el hipocampo y el cuerpo estriado. El tratamiento con EHPp atenuó el déficit motor en el ensayo de catalepsia y el retraso en el comienzo de los movimientos orales inducidos por RES. No se observaron cambios significativos en el ensayo antioxidante. Estos resultados muestran un efecto beneficioso de EHPp en déficits motores inducidos por RES, sugiriendo un efecto neuroprotector en un modelo de enfermedad de Parkinson

Transition Metals Doped Nanocrystals: Synthesis, Characterization, and Applications

Doping is a technique that makes it possible to incorporate substitutional ions into the crystalline structure of materials, generating exciting properties. This book chapter will comment on the transition metals (TM) doped nanocrystals (NCs) and how doping and concentration influence applications and biocompatibility. In the NCs doped with TM, there is a strong interaction of sp-d exchange between the NCs’ charge carriers and the unpaired electrons of the MT, generating new and exciting properties. These doped NCs can be nanopowders or be embedded in glass matrices, depending on the application of interest. Therefore, we show the group results of synthesis, characterization, and applications of iron or copper-doped ZnO nanopowders and chromium-doped Bi2S3, nickel-doped ZnTe, and manganese-doped CdTe quantum dots in the glass matrices

Determination of the strong coupling and its running from measurements of inclusive jet production

The value of the strong coupling S is determined in a comprehensive analysis at next-to-next-to-leading order accuracy in quantum chromodynamics. The analysis uses double-differential cross section measurements from the CMS Collaboration at the CERN LHC of inclusive jet production in proton-proton collisions at centre-of- mass energies of 2.76, 7, 8, and 13 TeV, combined with inclusive deep-inelastic data from HERA. The value $_S$($_Z$ ) = 0.1176 $^{+0.0014}_{-0.0016}$ is obtained at the scale of the Z boson mass. By using the measurements in different intervals of jet transverse momentum, the running of $_S$ is probed for energies between 100 and 1600 GeV

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio