Using dynamic pupillometry as a simple screening tool to detect autonomic neuropathy in patients with diabetes: a pilot study

<p>Abstract</p> <p>Background</p> <p>Autonomic neuropathy is a common and serious complication of diabetes. Early detection is essential to enable appropriate interventional therapy and management. Dynamic pupillometry has been proposed as a simpler and more sensitive tool to detect subclinical autonomic dysfunction. The aim of this study was to investigate pupil responsiveness in diabetic subjects with and without cardiovascular autonomic neuropathy (CAN) using dynamic pupillometry in two sets of experiments.</p> <p>Methods</p> <p>During the first experiment, one flash was administered and the pupil response was recorded for 3 s. In the second experiment, 25 flashes at 1-s interval were administered and the pupil response was recorded for 30 s. Several time and pupil-iris radius-related parameters were computed from the acquired data. A total of 24 diabetic subjects (16 without and 8 with CAN) and 16 healthy volunteers took part in the study.</p> <p>Results</p> <p>Our results show that diabetic subjects with and without CAN have sympathetic and parasympathetic dysfunction, evidenced by diminished amplitude reflexes and significant smaller pupil radius. It suggests that pupillary autonomic dysfunction occurs before a more generalized involvement of the autonomic nervous system, and this could be used to detect early autonomic dysfunction.</p> <p>Conclusions</p> <p>Dynamic pupillometry provides a simple, inexpensive, and noninvasive tool to screen high-risk diabetic patients for diabetic autonomic neuropathy.</p

pH effect on the synthesis of different size silver nanoparticles evaluated by DLS and their size-dependent antimicrobial activity

This paper reports citrate-stabilized silver nanoparticles (AgNPs) synthesized by nitrate ion chemical reduction with sodium borohydride, at different pHs (2–9). The AgNPs synthesized by this method exhibited size distribution from 5 to 249 nm, depending on pH, as determined by dynamic light scattering, and morphology spherical, as determined by transmission electron microscopy. In pH range 3–7 occurred aggregation of the nanoparticles. The size distribution depending on pH was determined by dynamic light scattering. The zeta potential was determined, and the colloidal stability was correlated with nanoparticles aggregation at different pHs. The size-dependent antimicrobial activity was evaluated for two solutions, wherein both samples exhibited antimicrobial activity, although the smallest AgNPs without agglomeration have enhanced antimicrobial properties.Keywords: Silver Nanoparticles, Zeta Potential, Dynamic Light Scattering, Size Distribution, Antimicrobial Activity

An update on the distribution of the Brazilian Funnel-eared Bat, Natalus macrourus (Gervais, 1856) (Mammalia, Chiroptera), with new records from the Brazilian Northeastern

We present data on the geographic distribution, morphology, and biology of the Brazilian funnel-eared bat, Natalus (Gervais, 1856), with new records for the Brazilian state of Sergipe, filling a gap of approximately 800 km in the distribution of the species in Brazilian Northeast

Tendência temporal da mortalidade por câncer de laringe no Brasil e regiões, no período de 1980 a 2019

Objetivo: analisar a tendência da mortalidade por câncer de laringe no Brasil e regiões no período de 1980 a 2019. Metodologia: trata-se de um estudo ecológico de série temporal. Os dados foram provenientes do SIM/DATASUS, e foram estratificados segundo faixa etária, ano, local e sexo. Foi calculada a taxa padronizada de mortalidade (TPM) e utilizada para análise de tendência, por intermédio do modelo JoinPoint. Resultados: foi possível observar que o Brasil apresentou alto número de mortes em toda série temporal com cerca de 112.693 óbitos. No tocante as suas regiões destacaram-se o Sudeste, seguido do Sul com 62.111 e 23.356 mortes pelo agravo, respectivamente. Dentre as faixas etárias analisadas, o grupo de 60-79 anos apresentou predominância em ambos os sexos, com 56.947 ocorrências. Já para o sexo, o masculino apresentou mais de 98 mil mortes em detrimento de mais de 13 mil para o feminino, uma diferença 85,6%. Avaliando a tendência, o Brasil apresentou estabilidade em boa parte da série temporal, com diminuição significativa a partir de 2009 (APC -1,6). Nas regiões, o Nordeste apresentou a maior tendência de crescimento (AAPC 2,7) e o Norte também demonstrou crescimento a partir de 1990 (APC 1,8), as demais apresentaram redução considerável e significativa, exceto Centro-oeste que não apresentou JoinPoints. Conclusão: ressalta-se a importância da revisão, melhoria e até implementação de novas políticas de rastreamento a fim de aumentar o quantitativo de diagnóstico precoce e evitar, a longo prazo, a mortalidade

Modelo Estatístico para a Determinação do Número Ótimo de Iterações do Filtro de Difusão Anisotrópica Aplicado à Redução de Ruído de Imagens de Ressonância Magnética do Cérebro

Apesar do grande sucesso dos filtros de difusão anisotrópica na redução de ruídos de imagens médicas, uma limitação dessa abordagem iterativa é a determinação automática do número correto de iterações do algoritmo,  visto que um número grande de iterações pode causar um borramento excessivo das bordas entre as estruturas anatômicas, enquanto um número  pequeno pode não ser suficiente para remover completamente o ruído da imagem. Portanto, este trabalho propõe um modelo estatístico para  a determinação automática do número ótimo de iterações do filtro de  difusão anisotrópica aplicado à redução de ruído de imagens médicas.  O modelo é determinado "off-line" por meio da maximização do  índice de similaridade estrutural, o qual é usado neste trabalho como  uma função objetivo para avaliar quantitativamente a qualidade das  imagens resultantes após cada iteração do filtro. Após a determinação  dos parâmetros do modelo, o número ótimo de iterações do algoritmo  necessário para remover o ruído da imagem e, ao mesmo tempo preservar as bordas entre as estruturas anatômicas, é facilmente obtido. Resultados aplicados à imagens 3D de ressonância magnética do cérebro são apresentados  para ilustrar a eficácia do método proposto

Surgical Mask to Prevent Influenza Transmission in Households: A Cluster Randomized Trial

Facemasks and respirators have been stockpiled during pandemic preparedness. However, data on their effectiveness for limiting transmission are scarce. We evaluated the effectiveness of facemask use by index cases for limiting influenza transmission by large droplets produced during coughing in households.A cluster randomized intervention trial was conducted in France during the 2008-2009 influenza season. Households were recruited during a medical visit of a household member with a positive rapid influenza A test and symptoms lasting less than 48 hours. Households were randomized either to the mask or control group for 7 days. In the intervention arm, the index case had to wear a surgical mask from the medical visit and for a period of 5 days. The trial was initially intended to include 372 households but was prematurely interrupted after the inclusion of 105 households (306 contacts) following the advice of an independent steering committee. We used generalized estimating equations to test the association between the intervention and the proportion of household contacts who developed an influenza-like illness during the 7 days following the inclusion. Influenza-like illness was reported in 24/148 (16.2%) of the contacts in the intervention arm and in 25/158 (15.8%) of the contacts in the control arm and the difference between arms was 0.40% (95%CI: -10% to 11%, P = 1.00). We observed a good adherence to the intervention. In various sensitivity analyses, we did not identify any trend in the results suggesting effectiveness of facemasks.This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.clinicaltrials.gov NCT00774774

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.