Quasi-experimental study of effects of lighting on rest, activity and melatonin in postpartum women

Objectives: to compare the parameters of the activity/rest cycle of early postpartum breastfeeding women under a controlled and uncontrolled long wavelength ray light regimen. Methods: quasi-experimental study with breastfeeding women and their babies during postnatal rooming-in, São Paulo, Brazil. Participants were allocated to either an experimental (intervention) or a comparison group. The intervention involved exposure of the woman in a controlled room with artificial long wavelength ray light at night. Each woman’s level of 6-sulfatoxymelatonin at 24 hours and activity/rest times was analyzed. Results: the mean activity/rest times of women in the experimental and comparison groups were similar. The mean percentages of total load of 6-sulfatoxymelatonin during the day and night were similar (p=0.09). At 24 hours, the experimental group presented a significantly lower mean percentage of total load compared to the comparison group (p=0.04). Conclusions: women who stayed in the room with long-wavelength artificial light showed no difference in activity/rest and 6-sulfatoxymelatonin levels in the early postpartum period

Melanopsin System Dysfunction in Smith-Magenis Syndrome Patients

PURPOSE: Smith-Magenis syndrome (SMS) causes sleep disturbance that is related to an abnormal melatonin profile. It is not clear how the genomic disorder leads to a disturbed synchronization of the sleep/wake rhythm in SMS patients. To evaluate the integrity of the intrinsically photosensitive retinal ganglion cell (ipRGC)/melanopsin system, the transducers of the light-inhibitory effect on pineal melatonin synthesis, we recorded pupillary light responses (PLR) in SMS patients. METHODS: Subjects were SMS patients (n = 5), with molecular diagnosis and melatonin levels measured for 24 hours and healthy controls (n = 4). Visual stimuli were 1-second red light flashes (640 nminsignificant direct ipRGC activation), followed by a 470-nm blue light, near the melanopsin peak absorption region (direct ipRGC activation). Blue flashes produce a sustained pupillary constriction (ipRGC driven) followed by baseline return, while red flashes produce faster recovery. RESULTS: Pupillary light responses to 640-nm red flash were normal in SMS patients. In response to 470-nm blue flash, SMS patients had altered sustained responses shown by faster recovery to baseline. SMS patients showed impairment in the expected melatonin production suppression during the day, confirming previous reports. CONCLUSIONS: SMS patients show dysfunction in the sustained component of the PLR to blue light. It could explain their well-known abnormal melatonin profile and elevated circulating melatonin levels during the day. Synchronization of daily melatonin profile and its photoinhibition are dependent on the activation of melanopsin. This retinal dysfunction might be related to a deficit in melanopsin-based photoreception, but a deficit in rod function is also possible.Sao Paulo Research Foundation (FAPESP) [2014/26818-2, 2014/50457-0, 2016/04538-3, 2014/06457-5, 2015/22227-2, 2016/22007-5]National Council for Scientific and Technological Development (CNPq) [480428/2013-4, 470785/2014-4, 404239/2016-1]CAPES [3263/2013]Janos Bolyai Scholarship of the Hungarian Academy of SciencesUniv Sao Paulo, Dept Expt Psychol, Inst Psychol, Sao Paulo, BrazilSemmelweis Univ, Dept Ophthalmol, Budapest, HungaryUniv Sao Paulo, Dept Neurol, Fac Med, Sao Paulo, BrazilBudapest Univ Technol & Econ, Dept Mechatron Opt & Engn Informat, Budapest, HungaryUniv Texas San Antonio, Dept Cellular & Struct Biol, San Antonio, TX USAUniv Fed Sao Paulo, Dept Physiol, Sao Paulo, BrazilUniv Sao Paulo, Dept Physiol & Biophys, Inst Biomed Sci, Av Lineu Prestes 1524, BR-05508000 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Physiol, Sao Paulo, BrazilFAPESP [2014/26818-2, 2014/50457-0, 2016/04538-3, 2014/06457-5, 2015/22227-2, 2016/22007-5]CNPq [480428/2013-4, 470785/2014-4, 404239/2016-1]CAPES [3263/2013]Web of Scienc

Environmental control of biological rhythms: effects on development, fertility and metabolism

Internal temporal organisation properly synchronised to the environment is crucial for health maintenance. This organisation is provided at the cellular level by the molecular clock, a macromolecular transcription-based oscillator formed by the clock and the clock-controlled genes that is present in both central and peripheral tissues. In mammals, melanopsin in light-sensitive retinal ganglion cells plays a considerable role in the synchronisation of the circadian timing system to the daily light/dark cycle. Melatonin, a hormone synthesised in the pineal gland exclusively at night and an output of the central clock, has a fundamental role in regulating/timing several physiological functions, including glucose homeostasis, insulin secretion and energy metabolism. As such, metabolism is severely impaired after a reduction in melatonin production. Furthermore, light pollution during the night and shift work schedules can abrogate melatonin synthesis and impair homeostasis. Chronodisruption during pregnancy has deleterious effects on the health of progeny, including metabolic, cardiovascular and cognitive dysfunction. Developmental programming by steroids or steroid-mimetic compounds also produces internal circadian disorganisation that may be a significant factor in the aetiology of fertility disorders such as polycystic ovary syndrome. Thus, both early and late in life, pernicious alterations of the endogenous temporal order by environmental factors can disrupt the homeostatic function of the circadian timing system, leading to pathophysiology and/or disease.This work was supported by grants 1110220 from FONDECYT and ACT1116 from CONICYT, Chile (to HGR); Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Desenvolvimento Tecnológico e Científico (CNPq; Brazil, to AMC, FGA and JCN); Pro-Reitoria de Pesquisa Universidade Federal de Minas Gerais, Brazil (to MOP); fellowship 21120472 from CONICYT (Chile) to (NM) and an NIEHS sponsored Pilot Grant from the Department of Environmental Medicine at the University of Rochester School of Medicine to MTS

Doença de Kawasaki - aspectos epidemiológicos, fisiopatológicos, manejo terapêutico e correlação a COVID-19

A Doença de Kawasaki (DK) é uma vasculite que afeta predominantemente os vasos sanguíneos de médio porte, especialmente as artérias coronárias do coração. Nos últimos anos, tornou-se uma crescente preocupação de saúde pública, devido ao aumento notável de casos, tornando-se a causa mais comum de doença cardíaca pediátrica adquirida em países desenvolvidos, como Japão, Coréia e Estados Unidos da América (EUA). A causa exata da DK ainda é incerta, mas suspeita-se de uma combinação de fatores genéticos e infecciosos. Estudos sugerem que agentes virais podem desempenhar um papel desencadeante, pois a frequência da doença mostra correlação com a sazonalidade de infecções respiratórias comuns. Os sintomas característicos da DK incluem febre persistente, congestão ocular bilateral não exsudativa, eritema e edema de língua, lábios e mucosa oral, além de alterações nas extremidades e linfadenomegalia cervical. Embora não existam testes específicos para diagnóstico, a ecocardiografia do coração e dos grandes vasos sanguíneos é um exame importante para avaliar o envolvimento coronariano. Ademais, o tratamento padrão para DK envolve o uso precoce de imunoglobulina intravenosa e ácido acetilsalicílico (AAS), o que reduz significativamente o risco de desenvolvimento de aneurismas coronarianos, uma complicação grave da doença. Outrossim, o diagnóstico diferencial é crucial devido à semelhança de sintomas com outras infecções virais comuns em crianças pequenas. Além disso, a infecção por COVID-19 em crianças pode se manifestar de forma assintomática ou leve, mas casos graves podem levar à síndrome inflamatória multissistêmica (MIS-C), que compartilha características clínicas e patológicas com a DK. Portanto, a possibilidade de MIS-C deve ser considerada em crianças com sintomas sugestivos e histórico de exposição ao SARS-CoV-2

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Pineal melatonin production in Streptozotocin-diabetic rats: mechanisms and microdialysis daily profile.

A pineal participa da sincronização do organismo pela síntese de melatonina. Diabetes é um distúrbio metabólico caracterizado por hiperglicemia. Diante da controvérsia sobre a síntese de melatonina em animais diabéticos, esse trabalho objetivou avaliar as alterações da glândula pineal mediante o diabetes induzido por STZ (60mg/kg, i.p.). Ratos wistar (250-280g, 12h/12h claro/escuro) foram utilizados em todos os procedimentos que envolveram técnicas de FACS, microdiálise, HPLC, radiometria da atividade enzimática e qPCR. Os resultados mostraram que o diabetes causa diminuição (50%) e perda do perfil mono/bifásico da síntese pineal de melatonina, que não é causada por necrose ou apoptose dos pinealócitos e reflete um desarranjo no metabolismo pineal, evidenciado pela diminuição na atividade da AANAT (55%). Observou-se também um desbalanço rítmico de fatores determinantes como a expressão do receptor ß1 e a atividade e expressão das enzimas TPH1 e HIOMT. A menor concentração de melatonina circulante pode ser um fator contribuinte para o desenvolvimento da doença.The gland is involved in the organism synchronization via its hormone melatonin. Diabetes involves hyperglicemia and insulin synthesis/signaling impairment. The aim of this work was to evaluate the pineal melatonin synthesis in STZ-diabetic rats (60mg/kg, i.p.). Male wistar rats (250-280g, 12h/12h light/dark) were used as the animal model and FACS, microdialysis, HPLC, enzyme activity assay and qPCR were the techniques used to evaluate the pineal phisiology. The results show a decrease in pineal melatonin (50%) and a circadian profile impairment that were not due to necrosis or apoptosis. This finding reflects an important impairment in the pineal metabolism that was related to a decrease in AANAT activity (55%). An alteration in the rhthmicity of important factors, such as the ß1-adrenergic receptor expression and the TPH1 and HIOMT activity and expression, was also observed. This decrease in circulating melatonin may be of fundamental importance to the establishment and maintenance of diabetes

A brief review about melatonin, a pineal hormone

ABSTRACT Melatonin is a ubiquitous molecule in nature, being locally synthesized in several cells and tissues, besides being a hormone that is centrally produced in the pineal gland of vertebrates, particularly in mammals. Its pineal synthesis is timed by the suprachiasmatic nucleus, that is synchronized to the light-dark cycle via the retinohypothalamic tract, placing melatonin synthesis at night, provided its dark. This unique trait turns melatonin into an internal synchronizer that adequately times the organism's physiology to the daily and seasonal demands. Besides being amphiphilic, melatonin presents specific mechanisms and ways of action devoted to its role as a time-giving agent, being widely spread in the organism. The present review aims to focus on melatonin as a pineal hormone with specific mechanisms and ways of action, besides presenting the clinical syndromes related to its synthesis and/or function disruptions

Rs4862705 in the melatonin receptor 1A gene is associated with renal function decline in type 1 diabetes individuals

AimThe pathogenesis of chronic diabetes complications has oxidative stress as one of the major elements, and single-nucleotide polymorphisms (SNPs) in genes belonging to antioxidant pathways modulate susceptibility to these complications. Considering that melatonin is a powerful antioxidant compound, our aim was to explore, in a longitudinal cohort study of type 1 diabetes (T1D) individuals, the association of microvascular complications and SNPs in the gene encoding melatonin receptor 1A (MTNR1A).MethodsEight SNPs in MTNR1A were genotyped in 489 T1D individuals. Besides cross-sectional analyses of SNPs with each one of the microvascular complications (distal polyneuropathy, cardiovascular autonomic neuropathy, retinopathy, and diabetic kidney disease), a longitudinal analysis evaluated the associations of SNPs with renal function decline in 411 individuals followed up for a median of 8 years. In a subgroup of participants, the association of complications with urinary 6-sulfatoxymelatonin (aMT6s) concentration was investigated.ResultsThe group of individuals with a renal function decline ≥ 5 mL min−1 1.73 m−2 year−1 presented a higher frequency of the A allele of rs4862705 in comparison with nondecliners, even after adjustment for confounding variables (OR = 1.84, 95% CI = 1.20–2.82; p = 0.0046). No other significant associations were found.ConclusionsThis is the first study showing an association between a variant in a gene belonging to the melatonin system and renal function decline in the diabetic setting