Avaliação do perfil glicêmico de pacientes com cirrose por meio de monitoramento ambulatorial contínuo por sistema flash

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2022.O monitoramento do Diabetes Mellitus (DM) em pacientes com cirrose pode ser desafiador. A hemoglobina glicada A1c (HbA1c) frequentemente subestima o controle glicêmico nessa população, enquanto a automonitoramento da glicemia capilar falha em verificar de forma adequada as flutuações da glicose ao longo do dia. Nos propomos a avaliar o uso do monitoramento ambulatorial contínuo de glicose por sistema flash (FCGM) em pacientes com cirrose hepática (CH). Estudo observacional analítico incluindo 30 pacientes com CH (Child-Pugh B/C): 10 sem DM (G1), 10 com diagnóstico recente de DM pelo teste oral de tolerância a glicose (TOTG) (G2), 10 com diagnóstico prévio de DM (G3). O monitoramento da glicose foi realizado com FCGM durante 56 dias (4 sensores por paciente). Foi calculado o indicador de gestão de glicose (GMI) pela média de glicose dos 56 dias, o qual corresponde aos níveis de HbA1c estimado pelo FCGM. O tempo no alvo (TIR) foi determinado pela porcentagem de tempo em que os valores de glicose permaneceram entre 70?180mg/dL. Exames laboratoriais, incluindo a HbA1c e frutosamina foram realizados no início do estudo (D0) e após 28 e 56 dias. A idade foi maior no G3 (67,20±3,82) vs. G1 (50,80±11,34) e G2 (54,60±8,90). Porém não houve diferença entre os grupos em relação ao IMC, sexo, peptídeo-C, HOMA-IR e variáveis associadas a gravidade da doença hepática. Comparações entre os grupos no D0 mostraram diferenças significativas de HbA1c (4,75±0,43, 5,39±0,95, 6,79±1,41% respectivamente, p=0,000), frutosamina (275,90±36,90, 297.90±24.95, 365,59±76,19mcmol/L, p=0,004) e glicemia de jejum (94,10±10.05, 107,20±21,99, 148,50±37,98mg/dL, p=0,001). Comparações entre os grupos quanto aos parâmetros do FCGM após 56 dias, mostraram diferenças significativas de GMI (5,28±0,17, 6,03±0,59, 6,86±1,08%, p=0,000), glicose média (82,79±7,06, 113,39±24,32, 149,14±45,31mg/dL, p=0,000), TIR (70,89±9,76, 80,2±13,55, 57,96±17,96%, p=0,006) e variabilidade glicêmica (26,1±5,0, 28,21±5,39, 35,31±6,85%, p=0,004). Nos pacientes com DM, GMI teve correlação com HbA1C, de forma mais significativa no G3 (r=0,827, p=0,003), do que em G2 (r=0,618, p=0,057). Entretanto, houve discordância entre os valores de GMI e HbA1c em todos os grupos, G1 e G2, sendo a maior diferença encontrada no G2 0,69% (95% IC 0,45-1,33). Quanto ao TIR, G1, G2 e G3 permaneceram 30,95, 11,38 e 12,48% do tempo abaixo do alvo, 69,05, 80,20 e 57,96% do tempo no alvo e 0, 8,42 e 29,56% do tempo acima do alvo, respectivamente. Foram encontradas discordâncias entre HbA1c e GMI em pacientes com CH. O FCGM foi capaz de detectar anormalidades no controle glicêmico que não seriam detectadas pelo acompanhamento com o uso da HbA1c. Apesar de novos estudos serem necessários, esse estudo piloto sugere que o FCGM seja uma forma melhor de avaliação do controle glicêmico de pacientes com CH.Abstract: Managing diabetes (DM) in patients with liver cirrhosis (LC) is challenging. Glycated Hemoglobin (HbA1c) frequently underestimates glycemic control in this population, while self-monitoring of blood glucose fails to adequately check for glucose fluctuations throughout the day. We aimed to evaluate the use of flash glucose monitoring (FGMS) in patients with LC. Analytical observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without DM (G1), 10 newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous diagnosis of DM (G3). Glucose levels were monitored using FGMS for 56 days (4 sensors/patient). We calculated the 56-day average Glucose Management Indicator (GMI), which is the expected level of HbA1c based on the average of glucose measurements by FGMS. Time in range (TIR) was determined as the percent of time spent with glucose values within 70-180 mg/dL. Blood tests including HbA1c and fructosamine were performed at baseline, after 28 and 56 days. Age was higher in G3 (67,20±3,826yo) vs. G1 (50,80±11,34yo) and G2 (54,60±8,90yo). Although no differences between groups was found regarding to BMI, gender, c-peptide, HOMA-IR and variables associated with LC severity. Comparisons of FGMS parameters between groups at 56 days showed significant differences in GMI (5,28±0,17, 6,03±0,59, 6,86±1,08%, p=0,000), average glucose (82,79±7,06, 113,39±24,32, 149,14±45,31mg/dL, p=0,000), TIR (70,89±9,76, 80,2±13,55, 57,96±17,96%, p=0,006) and glucose variability (26,01±5,0, 28,21±5,39, 35,31±6,85%, p=0,004). The 56-day HbA1c average for G1, G2 and G3 were 4,82±0,39, 5,34±1,26, 6,97±1,47%, respectively. There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0,35% (95% IC 0,07-0,63). In G1, the mean difference was 0,46% (95% IC 0,19-0,73) and in G2 0,69% (95% IC 0,45-1,33). However, there was concordance between values of GMI and HbA1c in G3, with a mean difference of -0,10% (95% IC -0,59-0,38). Regarding TIR, G1, G2 and. G3 remained 30,95, 11,38 and 12,48% of the time below range, 69,05, 80,20 and 57,96% in target and 0, 8,42 and 29,56% above range, respectively. Disagreements were found between GMI and HbA1c in patients with LC. FGMS was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c. Although further studies are needed, this pilot study suggests that FGMS is a better way to assess glycemic control in patients with LC

EFEITO DA INFESTAÇÃO DOS PERCEVEJOS Dichelops melacanthus e Nezara viridula (HETEROPTERA: PENTATOMIDAE) EM FEIJOEIRO

A cultura do feijão é uma das mais importantes. Os danos causados por percevejos em semente de feijão sobre a sua qualidade têm sido destacados por vários pesquisadores, havendo necessidade de estudos sobre o real efeito da alimentação dos percevejos na cultura do feijão e o seu potencial em causar danos ou não. Assim, o presente trabalho teve como objetivo avaliar a resposta da infestação de N. viridula e D. melacanthus com dois e quatro percevejos por quatro plantas de feijoeiro, avaliando os componentes de produção, como peso de grãos e peso de mil sementes, massa seca da parte aérea, massa seca de raiz e altura de planta, além de análise visual de dano nos diferentes tratamentos, sendo cinco tratamentos (entre eles uma testemunha) e 12 repetições. Os dados foram agrupados, procedeu-se a análise da variância e as médias foram comparadas pelo teste de Tukey a 5% de significância. Foi verificado que  a presença de percevejos no feijoeiro afetou o rendimento da cultura, visto que todos os tratamentos com percevejos apresentaram menor valor do peso de grãos e peso de mil sementes, com exceção do tratamento com dois percevejos N. viridula, que apresentou peso de mil sementes igual ao da testemunha. O componente massa seca da parte aérea teve um maior valor para o tratamento N. viridula com quatro percevejos, diferindo para a variável massa seca de raiz. A testemunha e o tratamento N. viridula com dois percevejos apresentaram os maiores valores. Logo, dos tratamentos com percevejos, o N. viridula, em geral, representou menor dano à cultura. Na análise visual de dano, o tratamento D. melacanthus com quatro percevejos apresentou danos mais severos.Palavras-chave: Injúrias. Danos. Feijão. Percevejo-verde. Percevejo-barriga-verde. Componentes da produção

Association of the fibronectin type III domain–containing protein 5 rs1746661 single nucleotide polymorphism with reduced brain glucose metabolism in elderly humans

Fibronectin type III domain–containing protein 5 (FNDC5) and its derived hormone, irisin, have been associated with metabolic control in humans, with described FNDC5 single nucleotide polymorphisms being linked to obesity and metabolic syndrome. Decreased brain FNDC5/irisin has been reported in subjects with dementia due to Alzheimer’s disease. Since impaired brain glucose metabolism develops in ageing and is prominent in Alzheimer’s disease, here, we examined associations of a single nucleotide polymorphism in the FNDC5 gene (rs1746661) with brain glucose metabolism and amyloid-β deposition in a cohort of 240 cognitively unimpaired and 485 cognitively impaired elderly individuals from the Alzheimer’s Disease Neuroimaging Initiative. In cognitively unimpaired elderly individuals harbouring the FNDC5 rs1746661(T) allele, we observed a regional reduction in low glucose metabolism in memory-linked brain regions and increased brain amyloid-β PET load. No differences in cognition or levels of cerebrospinal fluid amyloid-β42, phosphorylated tau and total tau were observed between FNDC5 rs1746661(T) allele carriers and non-carriers. Our results indicate that a genetic variant of FNDC5 is associated with low brain glucose metabolism in elderly individuals and suggest that FNDC5 may participate in the regulation of brain metabolism in brain regions vulnerable to Alzheimer’s disease pathophysiology. Understanding the associations between genetic variants in metabolism-linked genes and metabolic brain signatures may contribute to elucidating genetic modulators of brain metabolism in humans

Calidad de vida de los trabajadores en una institución de larga estancia para mayores: revisión del alcance

Objetivo: analisar os fatores que influenciam a qualidade de vida dos trabalhadores de instituições de longa permanência para idosos. Métodos: revisão de escopo com seleção de artigos sobre o tema nas bases SciELO, Pubmed e CINAHL, no período de agosto a outubro de 2020. Foram incluídos estudos com trabalhadores de instituições de longa permanência para idosos. Para a análise dos dados, utilizou-se um instrumento no Excel para categorizar e melhor visualizar o relatório dos elementos essenciais. Resultados: conforme a busca nas bases de dados foram encontrados 143 artigos, sendo incluídos 8 artigos. Os dados foram classificados em três categorias: caracterização dos trabalhadores, fatores que influenciam na qualidade de vida dos trabalhadores de instituição de longa permanência para idosos e estratégias de enfrentamento. Conclusão: conclui-se que esta pesquisa é relevante e contribui tanto para o trabalhador quanto para os idosos das instituições de longa permanência, no momento em que trará o olhar das demandas e dificuldades encontradas no seu exercício profissional.Objective: to analyze the factors that influence the quality of life of workers in long-stay institutions for the elderly. Methods: scope review with selection of articles on the subject in the SciELO, Pubmed and CINAHL databases, from August to October 2020. Studies with workers from long-stay institutions for the elderly were included. For data analysis, an Excel instrument was used to categorize and better visualize the essential elements report. Results: according to the search in the databases, 143 articles were found, including 8 articles. Data were classified into three categories: characterization of workers, factors that influence the quality of life of workers in a long-term care institution for the elderly, and coping strategies. Conclusion: it is concluded that this research is relevant and contributes to both the worker and the elderly in long-stay institutions, at a time when it will bring a look at the demands and difficulties encountered in their professional practiceObjetivo: analizar los factores que influyen en la calidad de vida de los trabajadores en instituciones de larga estancia para ancianos. Métodos: revisión de alcance con selección de artículos sobre el tema en las bases de datos SciELO, Pubmed y CINAHL, de agosto a octubre de 2020. Se incluyeron estudios con trabajadores de instituciones de larga estancia para ancianos. Para el análisis de datos se utilizó un instrumento Excel para categorizar y visualizar mejor el reporte de elementos esenciales. Resultados: de acuerdo con la búsqueda en las bases de datos, se encontraron 143 artículos, incluidos 8 artículos. Los datos se clasificaron en tres categorías: caracterización de los trabajadores, factores que influyen en la calidad de vida de los trabajadores en una institución de atención a largo plazo para ancianos y estrategias de afrontamiento. Conclusión: se concluye que esta investigación es relevante y aporta tanto al trabajador como al anciano en instituciones de larga estancia, en un momento en el que traerá una mirada a las demandas y dificultades encontradas en su práctica profesional

Antidepressant-like effects of chronic guanosine in the olfactory bulbectomy mouse model

Major depressive disorder (MDD) leads to pervasive changes in the health of afflicted patients. Despite advances in the understanding of MDD and its treatment, profound innovation is needed to develop fast-onset antidepressants with higher effectiveness. When acutely administered, the endogenous nucleoside guanosine (GUO) shows fast-onset antidepressant-like effects in several mouse models, including the olfactory bulbectomy (OBX) rodent model. OBX is advocated to possess translational value and be suitable to assess the time course of depressive-like behavior in rodents. This study aimed at investigating the long-term behavioral and neurochemical effects of GUO in a mouse model of depression induced by bilateral bulbectomy (OBX). Mice were submitted to OBX and, after 14 days of recovery, received daily (ip) administration of 7.5 mg/kg GUO or 40 mg/kg imipramine (IMI) for 45 days. GUO and IMI reversed the OBX-induced hyperlocomotion and recognition memory impairment, hippocampal BDNF increase, and redox imbalance (ROS, NO, and GSH levels). GUO also mitigated the OBX-induced hippocampal neuroinflammation (IL-1, IL-6, TNF-α, INF-γ, and IL-10). Brain microPET imaging ([18F]FDG) shows that GUO also prevented the OBX-induced increase in hippocampal FDG metabolism. These results provide additional evidence for GUO antidepressant-like effects, associated with beneficial neurochemical outcomes relevant to counteract depression

Evaluation of yeast-based additives, as an alternative to ionophores, on rumen fermentation of ruminant diets using an in vitro gas production system

IntroductionThe study aimed to assess yeast-based additives' effects, as monensin alternatives, on rumen fermentation parameters, greenhouse gas emissions, and ruminal kinetics of ruminant diets using an in vitro system. Three experiments were conducted, each individually evaluating escalating levels of three yeast-based additives.MethodsThree experiments were designed: Experiment 1 evaluated prebiotic blend 1—yeast culture [Saccharomyces cerevisiae (Scer)], beta-glucans, fructooligosaccharides, galactooligosaccharides, and mannanoligosaccharides; Experiment 2 investigated prebiotic blend 2—beta-glucan fractions and mannanoligosaccharides from Scer; Experiment 3 examined yeast cells—hydrolyzed, inactivated, and spray-dried yeast (Scer) cells. Uniform experimental design and procedures were employed across the three experiments. Each experiment had six treatments: monensin (Rumensin®, 25 mg/kg DM) as positive control, and yeast additive levels (0, 533, 1,067, 1,600, and 2,133 mg/kg on DM basis) added to ruminant diets (60% corn silage and 40% concentrate). An in vitro gas production (GP) system with 50 AnkomRF bottles assessed total GP (at 24 and 48 hours), kinetics, fermentation profiles, methane (CH4), and carbon dioxide (CO2) concentrations. Comparison with monensin utilized Dunnett’s test (5%). Yeast additive levels were analyzed for linear and quadratic responses.ResultsIn Experiment 1, the 1,600 mg/kg yeast additive had lower concentrations of propionate, isobutyrate, valerate, and branched-chain volatile fatty acids (BCVFAs), and a higher acetate concentration and acetate-to-propionate ratio than monensin. In Experiment 2, the 1,600 mg/kg yeast additive led to lower total VFA and isovalerate concentrations than monensin. Additionally, compared to the 1,067 mg/kg yeast additive, monensin showed lower isovalerate concentration and higher NH3-N concentration. In Experiment 3, the 533 mg/kg yeast additive resulted in lower valerate and BCVFA concentrations, and higher CH4 and CO2 concentrations than monensin. Monensin had lower total VFA, butyrate, and acetate-to-propionate ratio, and higher propionate concentration compared to the 2,133 mg/kg yeast additive.DiscussionCollectively, these findings suggest yeast-based additives could be monensin alternatives, enhancing animal nutrient utilization efficiency and contributing to improved livestock sustainability

Vascular flora of the Legado das Águas, Reserva Votorantim, municipalities of Tapiraí, Miracatú and Juquiá, São Paulo, Brazil

We present  a list of vascular plants found in Legado das Águas, Reserva Votorantim, a private reserve having an area of approximately 35,000 ha that spans the municipalities of Tapiraí, Miracatú, and Juquiá, in the state of São Paulo, Brazil. The reserve is part of a complex of state-protected areas including Alto Ribeira Touristic State Park, Intervales State Park , Carlos Botelho State Park, Jurupará State Park, and Serra do Mar State Park. Together, these form an important and large area of continuous and well-preserved forest. Our study, which involved two main floristic surveys in March/April 2013 and April 2014, recorded 768 species, representing 131 families and 432 genera. The majority of species were angiosperms (619) representing 106 families and 370 genera. There were also two species of gymnosperms belonging to two genera in separate families; 147 species of ferns and lycophytes belonging to 23 families and 60 genera. In demonstrating the presence of almost 800 species of plants, of which 16 are threatened, our study highlights the importance of floristic surveys and the critical role of private protected areas in managing and preserving native flora

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Efeitos da cirurgia bariátrica no hipogonadismo masculino associado à obesidade

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Florianópolis, 2018.Introdução: A prevalência de obesidade vem aumentando exponencialmente nas últimas décadas. Estudos associam a obesidade masculina com alterações do eixo gonadal, levando a um hipogonadismo funcional. A cirurgia bariátrica proporciona perda de peso expressiva e, normalmente, sustentada, além de melhora metabólica que se associa a aumento nos androgênios circulantes. Objetivos: Avaliar o eixo gonadal masculino e o perfil metabólico de indivíduos obesos no pré e pós-operatório de cirurgia bariátrica, comparando-os com grupo de IMC normal. Métodos: Estudo de coorte retrospectivo, onde foram analisados 29 homens obesos que realizaram cirurgia bariátrica (sleeve ou bypass em Y-Roux) entre 2012 e 2016 no Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC) e 29 homens com IMC normal, pareados por idade. Foram avaliados dados referentes ao pré-operatório e seis meses pós-cirurgia, comparados com o grupo controle (GC). Resultados: Grupo do estudo (G1) apresentou média de idade, peso e IMC de 42,8 ± 9,5 anos; 155,2 ± 25,8 kg e 50,6 ± 7,1 kg/m2, respectivamente. Observou-se diferença nos valores pré- operatórios de testosterona total (TT) do G1 em relação ao GC (229,5 ± 96,4 x 461,5 ± 170,8 ng/dL, p < 0,01), enquanto a testosterona livre calculada (TLC) não mostrou diferença entre os grupos (5,3 ± 1,9 x 6,1 ± 2,1 ng/dL, p = 0,13). A média de perda de peso absoluta pós-operatória foi 39,2 ± 13,8 kg, e observou-se aumento da TT pós-operatória (229,5 ± 96,4 x 388,3± 160,9 ng/dL, p < 0,01) e da SHBG (23,9 ± 11,6 x 51,3 ± 27,6 nmol/L,p < 0,01), independentemente do tipo de cirurgia realizada. A média de perda de peso no pós-operatório foi 25,1 ± 6,9% e o aumento médio da TT foi 158,8± 130,6 ng/dL. Após o procedimento, o G1 não apresentou diferença de TT em relação ao GC (388,3 ± 160,9 x 461,5 ± 170,8 ng/dL, p = 0,09). A cirurgia bariátrica promoveu melhora do perfil metabólico de forma estatisticamente significativa nos níveis de glicemia de jejum, HbA1c, colesterol total, HDL e triglicerídeos. Conclusão: Hipogonadismo funcional é prevalente em homens com obesidade e devemos estar atentos a este diagnóstico. Embora faltem estudos para definir os melhores parâmetros diagnósticos e a indicação de reposição hormonal adequada, identificamos em nosso estudo importante aumento dos níveis de TT nos primeiros 6 meses pós-cirurgia bariátrica. Estudos anteriores reforçam que a função gonadal pode normalizar após melhora metabólica.Abstract : Introduction: The prevalence of obesity has been growing exponentially in the last decades. Research links the male obesity to changes on the gonadal axis, wich induces a functional hypogonadism. The bariatric surgery provides an expressive and, usually sustained weight loss and a metabolic improvement that is associated with an increasing of the circulating androgens. Objectives: Retrospective cohort study, to evaluate the male s gonadal axis and the metabolic profile of obese individuals in the bariatric preoperative and postoperative period comparing them to a normal BMI group. Methods: 29 obese men undergoing bariatric surgery (sleeve or Roux-en-y gastric bypass) between 2012 and 2016 at University Hospital of Universidade Federal de Santa Catarina (HU-UFSC) and a control group (CG) of age-matched 29 men with normal BMI were analyzed. The data of preoperative and the six months post surgery were compared with the CG. Results: The study group (G1) presented respectively the average age, weight and BMI of 42,8 ± 9,5 years old; 155,2 ± 25,8 kg and 50,6 ± 7,1 kg/m2. The total testosterone (TT) preoperative values of G1 were different than values of CG (229,5 ± 96,4 x 461,5 ± 170,8 ng/dL, p < 0,01) while the calculated free testosterone (TLC) did not present differences between the groups (5,3 ± 1,9 x 6,1 ± 2,1 ng/dL, p = 0,13). The postoperative mean of the absolute weight loss was 39,2 ± 13,8 kg, and it was observed an increase of postoperative TT (229,5 ± 96,4 x 388,3 ± 160,9 ng/dL, p < 0,01) and SHBG (23,9 ± 11,6 x 51,3 ± 27,6 nmol/L, p < 0,01) regardless of the type of surgery performed. The mean weight loss in the postoperative period was 25,1 ± 6,9% and the increase of the TT was 158,8 ± 130,6 ng/dL. After the procedure, G1 did not show difference in TT when compared to the CG (388,3 ± 160,9 x 461,5 ± 170,8 ng/dL, p = 0,09). Bariatric surgery promoted a statistically significant improvement in the metabolic profile for fasting blood glucose levels, HbA1c, total cholesterol, HDL and triglycerides. Conclusion: The functional hypogonadism is prevalent in obese men and we must be alert to this diagnosis. Although studies are lacking to define the best diagnostic parameters and indication of an adequate hormone replacement, increase in the TT levels in the first 6 months after the bariatric surgery were identified in our study. Previous studies have shown that gonadal function can normalize after metabolic improvement