Hyperglycemia and nocturnal systolic blood pressure are associatedwith left ventricular hypertrophy and diastolic dysfunction in hypertensive diabetic patients

BACKGROUND: The aim of this study was to determine if hypertensive type 2 diabetic patients, when compared to patients with essential hypertension have an increased left ventricular mass index (LVMI) and a worse diastolic function, and if this fact would be related to 24-h pressoric levels changes. METHODS: Ninety-one hypertensive patients with type 2 diabetes mellitus (DM) (group-1 [G1]), 59 essential hypertensive patients (group-2 [G2]) and 26 healthy controls (group-3 [G3]) were submitted to 24-h Ambulatory Blood Pressure Monitoring (ABPM) and echocardiography (ECHO) with Doppler. We calculated an average of fasting blood glucose (AFBG) values of G1 from the previous 4.2 years and a glycemic control index (GCI) (percentual of FBG above 200 mg/dl). RESULTS: G1 and G2 did not differ on average of diurnal systolic and diastolic BP. However, G1 presented worse diastolic function and a higher average of nocturnal systolic BP (NSBP) and LVMI (NSBP = 132 ± 18 vs 124 ± 14 mmHg; P < 0.05 and LVMI = 103 ± 27 vs 89 ± 17 g/m(2); P < 0.05, respectively). In G1, LVMI correlated with NSBP (r = 0.37; P < 0.001) and GCI (r = 0.29; P < 0.05) while NSBP correlated with GCI (r = 0.27; P < 0.05) and AFBG (r = 0.30; P < 0.01). When G1 was divided in tertiles according to NSBP, the subgroup with NSBP≥140 mmHg showed a higher risk of LVH. Diabetics with NSBP≥140 mmHg and AFBG>165 mg/dl showed an additional risk of LVH (P < 0.05; odds ratio = 11). In multivariate regression, both GCI and NSBP were independent predictors of LVMI in G1. CONCLUSION: This study suggests that hyperglycemia and higher NSBP levels should be responsible for an increased prevalence of LVH in hypertensive patients with Type 2 DM

A influência da espiritualidade no cuidado do paciente

Espiritualidade e religiosidade são palavras e conceitos que, apesar de possuírem significados próprios, correlacionam-se no ambiente hospitalar no contexto do cuidado com o paciente. As crenças religiosas, sejam elas quais forem, proporcionam bem-estar e contribuem para uma mudança atitudinal, suavizando as vivências traumáticas relacionando-as ao processo do cuidado com pacientes em estado grave, são também elementos que auxiliam o processo de cura. Objetivo: analisar como a fé pode ser um fator contribuinte para o tratamento dos pacientes. Metodologia: trata-se de um estudo bibliográfico qualitativo exploratória onde foram coletados artigos acerca do tema da espiritualidade no cuidado do paciente nos anos de 2010 a 2021. Resultados: observou-se que os pacientes tiveram uma melhora significativa durante os cuidados após se apoiaram na espiritualidade, embora não haja um consenso entre as equipes de cuidados de que a espiritualidade influencie positivamente na melhora. Conclusão: conclui-se que os pacientes tiveram melhora significativa com o uso da fé, seja ela no processo de aceitação, relacionamento com a equipe ou até mesmo no processo de cura

Enhancing Network Slicing Architectures with Machine Learning, Security, Sustainability and Experimental Networks Integration

Network Slicing (NS) is an essential technique extensively used in 5G networks computing strategies, mobile edge computing, mobile cloud computing, and verticals like the Internet of Vehicles and industrial IoT, among others. NS is foreseen as one of the leading enablers for 6G futuristic and highly demanding applications since it allows the optimization and customization of scarce and disputed resources among dynamic, demanding clients with highly distinct application requirements. Various standardization organizations, like 3GPP's proposal for new generation networks and state-of-the-art 5G/6G research projects, are proposing new NS architectures. However, new NS architectures have to deal with an extensive range of requirements that inherently result in having NS architecture proposals typically fulfilling the needs of specific sets of domains with commonalities. The Slicing Future Internet Infrastructures (SFI2) architecture proposal explores the gap resulting from the diversity of NS architectures target domains by proposing a new NS reference architecture with a defined focus on integrating experimental networks and enhancing the NS architecture with Machine Learning (ML) native optimizations, energy-efficient slicing, and slicing-tailored security functionalities. The SFI2 architectural main contribution includes the utilization of the slice-as-a-service paradigm for end-to-end orchestration of resources across multi-domains and multi-technology experimental networks. In addition, the SFI2 reference architecture instantiations will enhance the multi-domain and multi-technology integrated experimental network deployment with native ML optimization, energy-efficient aware slicing, and slicing-tailored security functionalities for the practical domain.Comment: 10 pages, 11 figure

Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course