Quality of life associated with treatment adherence in patients with type 2 diabetes: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Despite certain contradictions, an association has been identified between adherence to drug treatment and the quality of life in patients with type 2 diabetes. The contradictions observed emphasize the importance of using different methods to measure treatment adherence, or the association of psychological precursors of adherence with quality of life. For this reason, we have used an indirect method to measure adherence (pill count), as well as two adherence behaviour precursors (attitude and knowledge), to assess the association between adherence and the quality of life in type 2 diabetes patients.</p> <p>Methods</p> <p>A cross-sectional comparative study on a random sample of 238 type 2 diabetic patients was carried out over one year in four family medicine units of the Mexican Institute of Social Security (IMSS) in Aguascalientes, Mexico. Treatment adherence was measured using the indirect method of pill count to assess adherence behaviour, obtaining information at two home visits. In the first we recorded the medicine prescribed and in the second, we counted the medicine remaining to determine the proportion of the medicine taken. We also assessed two adherence behaviour precursors: the patients' knowledge regarding their medical prescription measured through a structured questionnaire; and attitudes to treatment adherence using a Likert scale. Quality of life was measured through the WHOQOL-100 (the WHO Quality of Life questionnaire). Information concerning both knowledge and attitude was obtained through interviews with the patients. A multiple linear regression model was constructed to establish the relationship between each quality of life domain and the variables related to adherence, controlling for covariates.</p> <p>Results</p> <p>There was no association between quality of life and treatment adherence behaviour. However, the combination of strong knowledge and a positive attitude was associated with five of the six quality of life domains.</p> <p>Conclusion</p> <p>The results suggest that it is important to explore psychological precursors of treatment adherence behaviour in type 2 diabetic patients. Indeed, we consider that it will be useful to carry out interventions that change negative attitudes towards treatment adherence and that promote medical prescription knowledge, which may help to improve the quality of life of such patients.</p

Static response in disk packings

We present experimental and numerical results for displacement response functions in packings of rigid frictional disks under gravity. The central disk on the bottom layer is shifted upwards by a small amount, and the motions of disks above it define the displacement response. Disk motions are measured with the help of a still digital camera. The responses so measured provide information on the force-force response, that is, the excess force at the bottom produced by a small overload in the bulk. We find that, in experiments, the vertical-force response shows a Gaussian-like shape, broadening roughly as the square root of distance, as predicted by diffusive theories for stress propagation in granulates. However, the diffusion coefficient obtained from a fit of the response width is ten times larger than predicted by such theories. Moreover we notice that our data is compatible with a crossover to linear broadening at large scales. In numerical simulations on similar systems (but without friction), on the other hand, a double-peaked response is found, indicating wave-like propagation of stresses. We discuss the main reasons for the different behaviors of experimental and model systems, and compare our findings with previous works.Fil: Moukarzel, Cristian Fernando. CENTRO DE INVESTIGACIÓN Y DE ESTUDIOS AVANZADOS ; INSTITUTO POLITÉCNICO NACIONAL; . Universidad Nacional de San Luis; ArgentinaFil: Pacheco Martínez, Hector. CENTRO DE INVESTIGACIÓN Y DE ESTUDIOS AVANZADOS ; INSTITUTO POLITÉCNICO NACIONAL; . Universidad Nacional de San Luis; ArgentinaFil: Ruiz-Suarez, J. C.. Universidad Nacional de San Luis; Argentina. CENTRO DE INVESTIGACIÓN Y DE ESTUDIOS AVANZADOS ; INSTITUTO POLITÉCNICO NACIONAL;Fil: Vidales, Ana Maria. Universidad Nacional de San Luis; Argentina. CENTRO DE INVESTIGACIÓN Y DE ESTUDIOS AVANZADOS ; INSTITUTO POLITÉCNICO NACIONAL; . Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Phenomenological methodology for assessing the influence of flow conditions on the acoustic response of exhaust aftertreatment systems

[EN] The increasing limits of standards on aerosol and gaseous emissions from internal combustion engines have led to the progressive inclusion of different exhaust aftertreatment systems (EATS) as a part of the powertrain. Regulated emissions are generally abated making use of devices based on monolithic structures with different chemical functions. As a side effect, wave transmission across the device is affected and so is the boundary at the exhaust line inlet, so that the design of the latter is in turn affected. While some models are available for the prediction of these effects, the geometrical complexity of many devices makes still necessary in many cases to rely on experimental measurements, which cannot cover all the diversity of flow conditions under which these devices operate. To overcome this limitation, a phenomenological methodology is proposed in this work that allows for the sound extrapolation of experimental results to flow conditions different from those used in the measurements. The transfer matrix is obtained from tests in an impulse rig for different excitation amplitudes and mean flows. The experimental coefficients of the transmission matrix of the device are fitted to Fourier series. It allows treating the influence of the flow conditions on the acoustic response, which is manifested on changes in the characteristic periods, separately from the specific properties of every device. In order to provide predictive capabilities to the method, the Fourier series approach is coupled to a gas dynamics model able to account for the sensitivity of propagation velocity to variations in the flow conditions. (C) 2017 Elsevier Ltd. All rights reserved.This work has been partially supported by the Spanish Ministerio de Economia y Competitividad through Grant no. TRA2013-40853-R. Additionally, the Ph.D. student E.J. Sanchis has been funded by a grant from Universitat Politecnica de Valencia with reference FPI-2016-S2-1355. These supports are gratefully acknowledged by the authors. Finally, the authors wish also to acknowledge the suggestions of the referees, which have resulted in a considerable improvement of the text.Torregrosa, AJ.; Arnau Martínez, FJ.; Piqueras, P.; Sanchis-Pacheco, EJ.; Tartoussi, H. (2017). Phenomenological methodology for assessing the influence of flow conditions on the acoustic response of exhaust aftertreatment systems. Journal of Sound and Vibration. 396:289-306. https://doi.org/10.1016/j.jsv.2017.02.03328930639

Fasciola hepatica induces eosinophil apoptosis in the migratory and biliary stages of infection in sheep

The aim of the present work was to evaluate the number of apoptotic eosinophils in the livers of sheep experimentally infected with Fasciola hepatica during the migratory and biliary stages of infection. Four groups (n = 5) of sheep were used; groups 1–3 were orally infected with 200 metacercariae (mc) and sacrificed at 8 and 28 days post-infection (dpi), and 17 weeks post-infection (wpi), respectively. Group 4 was used as an uninfected control. Apoptosis was detected using immunohistochemistry with a polyclonal antibody against anti-active caspase-3, and transmission electron microscopy (TEM). Eosinophils were identified using the Hansel stain in serial sections for caspase-3, and by ultrastructural features using TEM. At 8 and 28 dpi, numerous caspase-3+ eosinophils were mainly found at the periphery of acute hepatic necrotic foci. The percentage of caspase -3+ apoptotic eosinophils in the periphery of necrotic foci was high (46.1–53.9) at 8 and 28 dpi, respectively, and decreased in granulomas found at 28 dpi (6%). Transmission electron microscopy confirmed the presence of apoptotic eosinophils in hepatic lesions at 8 and 28 dpi. At 17 wpi, apoptotic eosinophils were detected in the infiltrate surrounding some enlarged bile ducts containing adult flukes. This is the first report of apoptosis induced by F. hepatica in sheep and the first study reporting apoptosis in eosinophils in hepatic inflammatory infiltrates in vivo. The high number of apoptotic eosinophils in acute necrotic tracts during the migratory and biliary stages of infection suggests that eosinophil apoptosis may play a role in F. hepatica survival during different stages of infection.This work was supported by EU grants (FPVII-265862-PARAVAC, H2020-635408-PARAGONE) and the Spanish Ministry of Science grant AGL2009-08726. TEM studies were carried out by the Central Services for Research of the University of Córdoba (SCAI)Veterinari

Apoptosis of peritoneal leucocytes during early stages of Fasciola hepatica infections in sheep

Several immunomodulatory properties have been described in Fasciola hepatica infections. Apoptosis has been shown to be an effective mechanism to avoid the immune response in helminth infections. The aim of the present work was to study apoptosis in peritoneal leucocytes of sheep experimentally infected with F. hepatica during the early stages of infection. Five groups (n = 5) of sheep were used. Groups 2–5 were orally infected with 200 metacercariae (mc) and sacrificed at 1, 3, 9 and 18 days post-infection (dpi), respectively. Group 1 was used as the uninfected control (UC). Apoptosis was detected using three different methods 1) immunocytochemistry (ICC) with a polyclonal antibody anti-active caspase-3; 2) an annexin V flow cytometry assay using the Annexin V-FITC/propidium iodide (PI); and 3) transmission electron microscopy (TEM). The differential leucocyte count revealed that the majority of peritoneal granulocytes were eosinophils, which increased significantly at 9 and 18 dpi with respect to the uninfected controls. The ICC study revealed that the percentage of caspase-3+ apoptotic peritoneal leucocytes increased significantly from 3 dpi onwards with respect to the uninfected controls. The flow cytometry annexin V assay detected a very significant (P < 0.001) increase of apoptotic peritoneal macrophages, lymphocytes and granulocytes, which remained higher than in the UC until 18 dpi. Transmission electron microscopy studies also confirmed the presence of apoptosis in peritoneal eosinophils at 18 dpi. This is the first report of apoptosis induced by F. hepatica in the peritoneal leucocytes of sheep in vivo. The results of this work suggest the importance of apoptosis induction for the survival of the juvenile parasites in the peritoneal migratory stages of infection.This work was supported by EU grants (H2020-635408-PARAGONE) and the Spanish Ministry of Science grant AGL2015-67023-C2-1-R. The TEM studies were carried out by the Central Research Services (SCAI) of the University of CórdobaAccepted manuscriptVeterinari

Distribution of Foxp3+ T cells in the liver and hepatic lymph nodes of goats and sheep experimentally infected with Fasciola hepatica

Foxp3 regulatory T cells (Tregs) are now considered to play a key role in modulation of immune responses during parasitic helminth infections. Immunomodulation is a key factor in Fasciola hepatica infection; however, the distribution and role of Foxp3+ Tregs cells have not been investigated in F. hepatica infected ruminants. The aim of this study was to evaluate the presence of Foxp3+ Tregs in the liver and hepatic lymph nodes from experimentally infected sheep and goats during acute and chronic stages of infection. Three groups of goats (n=6) and three groups of sheep (n=6) were used in this study. Goats in groups 1-2 and sheep in groups 4-5 were orally infected with metacercarie of ovine origin. Groups 1 and 4 were killed during the acute stage of the infection, at nine days post infection (dpi); groups 2 and 5 were killed during the chronic stage, at 15 and19 weeks post infection respectively (wpi). Groups 3 (goats) and 6 (sheep) were left as uninfected controls. Fluke burdens and liver damage were assessed and the avidin-biotin-complex method was used for the immunohistochemical study. At nine dpi in acute hepatic lesions, the number of both Foxp3+ and CD3+ T lymphocytes increased significantly in goats and sheep. In the chronic stages of infection (15-19wpi), the number of Foxp3+ and CD3+ T lymphocytes were also significantly increased with respect to control livers, particularly in portal spaces with severely enlarged bile ducts (response to adult flukes) while the increase was lower in granulomas, chronic tracts and smaller portal spaces (response to tissue damage). Foxp3+ Tregs were increased in the cortex of hepatic lymph nodes of sheep (chronic infection) and goats (acute and chronic infection). The estimated proportion of T cells which were Foxp3+ was significantly increased in the large bile ducts and hepatic lymph node cortex of chronically infected goats but not sheep. This first report of the expansion of Foxp3+ Tregs in acute and chronic hepatic lesions in ruminants suggests that these cells may be involved in both parasite survival and modulation of hepatic damage. Future studies should be focused on the investigation of parasite molecules and cytokines involved in this process.This work was supported by EU grants (H2020-635408-PARAGONE) and the Spanish Ministry of Science grant AGL2015-67023-C2-1-R. TM receives funding from the Scottish Government.Accepted manuscriptVeterinari

Short-period volcanic gas precursors to phreatic eruptions: Insights from Poás Volcano, Costa Rica

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Antimicrobial Susceptibility and Characterization of Resistance Mechanisms of Corynebacterium urealyticum Clinical Isolates

Corynebacterium urealyticum is a non-diphtherial urease-producing clinically relevant corynebacterial, most frequently involved in urinary tract infections. Most of the C. urealyticum clinical isolates are frequently resistant to several antibiotics. We investigated the susceptibility of 40 C. urealyticum isolated in our institution during the period 2005-2017 to eight compounds representative of the main clinically relevant classes of antimicrobial agents. Antimicrobial susceptibility was determined by the Epsilometer test. Resistance genes were searched by PCR. All strains were susceptible to vancomycin whereas linezolid and rifampicin also showed good activity (MICs90 = 1 and 0.4 mg/L, respectively). Almost all isolates (39/40, 97.5%) were multidrug resistant. The highest resistance rate was observed for ampicillin (100%), followed by erythromycin (95%) and levofloxacin (95%). Ampicillin resistance was associated with the presence of the blaA gene, encoding a class A ?-lactamase. The two rifampicin-resistant strains showed point mutations driving amino acid replacements in conserved residues of RNA polymerase subunit ? (RpoB). Tetracycline resistance was due to an efflux-mediated mechanism. Thirty-nine PFGE patterns were identified among the 40 C. urealyticum, indicating that they were not clonally related, but producing sporadic infections. These findings raise the need of maintaining surveillance strategies among this multidrug resistant pathogen.This research was funded by Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI) D16/0016/0007 and RD16/0016/0008), and co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014-2020