Prevention of gestational diabetes mellitus in overweight or obese pregnant women: A network meta-analysis

Aims: Several interventions have been implemented to prevent the development of gestational diabetes mellitus (GDM) in obese pregnant women, including physical exercise programs, and administration of metformin, vitamin D and probiotics. The aim of this network meta‐analysis was to compare the efficiency of these interventions and identify the optimal. Materials: A network meta-analysis of randomized trials was performed comparing the different interventions for the development of GDM in overweight or obese women, either to each other or placebo/no intervention. A search was conducted in four electronic databases and grey literature sources. The primary outcome was the development of GDM; secondary outcomes were other complications of pregnancy. Results: The meta-analysis included 23 studies (4237 participants). None of the interventions was superior compared with placebo/no intervention for the prevention of GDM. Metformin and physical exercise were superior to placebo/no intervention for gestational weight gain (MD −1.21, 95% CI −2.14 to −0.28 and MD −0.96, 95% CI −1.69 to −0.22, respectively). Metformin was superior to placebo/no intervention for caesarean sections and admission to NICU. Conclusions: Interventions aiming to prevent the development of GDM in overweight/obese women are not effective, when applied during pregnancy. © 2019 Elsevier B.V

Cytokine profile and proviral load among Japanese immigrants and non-Japanese infected with HTLV-1 in a non-endemic area of Brazil

Submitted by Sandra Infurna ([email protected]) on 2017-07-06T10:57:14Z No. of bitstreams: 1 louise_zanella_etal_IOC_2017.pdf: 2111205 bytes, checksum: 46a343e352837e56495a852d5ad4fffd (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-07-06T11:14:43Z (GMT) No. of bitstreams: 1 louise_zanella_etal_IOC_2017.pdf: 2111205 bytes, checksum: 46a343e352837e56495a852d5ad4fffd (MD5)Made available in DSpace on 2017-07-06T11:14:44Z (GMT). No. of bitstreams: 1 louise_zanella_etal_IOC_2017.pdf: 2111205 bytes, checksum: 46a343e352837e56495a852d5ad4fffd (MD5) Previous issue date: 2017Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ. Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil / Fundação Oswaldo Cruz. Campo Grande, MS, Brasil.Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil / Fundação Oswaldo Cruz. Campo Grande, MS, Brasil.The lifetime risk of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) development differs among ethnic groups. To better understand these differences, this prospective cohort study was conducted to investigate the cytokine profile and the HTLV-1 proviral load (PVL) in Japanese and non-Japanese populations with HAM/TSP and asymptomatic carriers (ACs). The serum IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α, and IFN-γ levels were quantified using the Cytometric Bead Array in 40 HTLV-1-infected patients (11 HAM/TSP and 29 ACs) and 18 healthy controls (HCs) in Brazil. Among ACs, 15 were Japanese descendants and 14 were non-Japanese. Of 11 patients with HAM/TSP, only one was a Japanese descendant. The HTLV-1 PVL was quantified by real-time PCR. The HTLV-1 PVL was 2.7-fold higher in HAM/TSP patients than ACs. Regardless of the clinical outcome, the PVL was significantly higher in patients younger than 60 years than older patients. The HAM/TSP and ACs had higher IL-10 serum concentrations than that of HCs. The ACs also showed higher IL-6 serum levels than those of HCs. According to age, the IL-10 and IL-6 levels were higher in ACs non-Japanese patients older than 60 years. HAM/TSP patients showed a positive correlation between IL-6 and IL-17 and a negative correlation between the PVL and IL-17 and IFN-γ. In the all ACs, a significant positive correlation was observed between IL-2 and IL-17 and a negative correlation was detected between IL-10 and TNF-α. Only 6.25% of the Japanese patients were symptomatic carriers, compared with 41.67% of the non-Japanese patients. In conclusion, this study showed that high levels of HTLV-1 PVL was intrinsicaly associated with the development of HAM/TSP. A higher HTLV-1 PVL and IL10 levels found in non-Japanese ACs over 60 years old, which compared with the Japanese group depicts that the ethnic background may interfere in the host immune status. More researches also need to be undertaken regarding the host genetic background to better understand the low frequency of HAM/TSP in Japanese HTLV-1-infected individuals

HTLV-1 proviral load according to clinical outcome and age in the study population.

<p>HTLV-1 proviral load according to clinical outcome and age in the study population.</p

Serum concentration of HTLV-1 proviral load and cytokines in asymptomatic carriers according to age and race.

<p>Serum concentration of HTLV-1 proviral load and cytokines in asymptomatic carriers according to age and race.</p