Treating Diabetes and Hypertension in the Obese Patient

Obesity is an independent risk factor for coronary heart disease and it is associated with insulin resistance, which contributes to the development of dyslipidemia, hypertension, and type 2 diabetes. The coexistence of hypertension and diabetes increases the risk for macrovascular and microvascular complications, predisposing patients to congestive heart failure, coronary heart disease, cerebral and peripheral vascular diseases, nephropathy, and retinopathy. In obese diabetic patients, body weight reduction, as well as metiformin therapy, increase insulin sensitivity and enhance blood pressure and glicemic control. Antihypertensive treatment in diabetic patients decreases cardiovascular mortality and delays the decline of the glomerular function. Pharmacological treatment should consider the effects of the antihypertensive agents on insulin sensitivity and lipid profile. Diuretics and b-blockers are reported to reduce insulin sensitivity, whereas calcium channel blockers are metabolically neutral and ACE inhibitors increase insulin sensitivity and confer additional renal and vascular protection to diabetic patients. Angiotensin II antagonists has shown similar effects.A obesidade é um fator de risco independente para doença coronariana. A resistência à insulina associada à obesidade contribui para o desenvolvimento de dislipidemia, hipertensão arterial e diabetes tipo 2. A coexistência de hipertensão e diabetes aumenta o risco para complicações micro e macrovasculares, predispondo os indivíduos à insuficiência cardíaca congestiva, doença coronariana e cerebrovascular, insuficiência arterial periférica, nefropatia e retinopatia. Em pacientes diabéticos obesos a redução do peso, bem como o uso de metiformina, melhoram a sensibilidade à insulina, o controle da glicemia e da pressão arterial. O tratamento anti-hipertensivo em diabéticos reduz a mortalidade cardiovascular e retarda o declínio da função glomerular. Deve-se considerar os efeitos dos agentes anti-hipertensivos sobre a sensibilidade à insulina e o perfil lipídico. Diuréticos e b-bloqueadores podem reduzir a sensibilidade à insulina, enquanto bloqueadores de canais de cálcio são metabolicamente neutros e os iECA aumentam a sensibilidade à insulina, além de conferir proteção adicional cardiovascular e renal para diabéticos. O bloqueio da angiotensina II tem mostrado benefícios semelhantes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

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

Genetically engineered silk-based composite biomaterials functionalized with fibronectin type-II that promote cell adhesion

[Excerpt] Recombinant protein-based polymers (rPBPs) are an emerging class of biopolymers inspired by Nature and produced by synthetic protein biotechnology approaches. Due to their exceptional physical-chemical and biological characteristics, as well as their ability to be customized for specific applications, rPBPs have been explored for the development of advanced biomaterials [1]. Within rPBPs, silk-like polymers (SLP) are being utilized in a range of studies in materials science [2]. [...]This work was supported by FCT Funded Project “Chimera” (PTDC/EBB-EBI/109093/2008), by FCT/MEC through Portuguese funds (PIDDAC) – PEst-OE/BIA/UI4050/2014, by the strategic programme UID/BIA/04050/2013 (POCI-01-0145-FEDER-007569) funded by national funds through the FCT I.P. and by the ERDF through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI). TC is thankful to the FCT for its support through Investigador FCT 2015. ARibeiro thanks FCT for the SFRH/BPD/98388/2013 grant. RMachado and AdaCosta acknowledge FCT for SFRH-BPD/86470/2012 and SFRH/BD/75882/2011 grants, respectively

Corrigendum to ‘‘Silk-based biomaterials functionalized with fibronectin type II promotes cell adhesion” [Acta Biomater. 47 (2017) 50–59]

The authors regret that Telma C. Bernardo was inadvertently omitted in the author line-up. The correct authorship order should be as follows: Ana Margarida Pereira, Raul Machado, André da Costa, Artur Ribeiro, Telma C. Bernardo, Tony Collins, Andreia C. Gomes, Isabel B. Leonor, David L. Kaplan, Rui L. Reis, Margarida Casal. Telma C. Bernardo participated in recombinant 6mer+FNII production and purification. The authors regret the error and would like to apologize for any inconvenience caused.- (undefined

Major discrepancy between clinical diagnosis of death and anatomopathological findings in adolescents with chronic diseases during 18-years

Objectives: To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study including a sample of adolescents’ autopsies who died in a pediatric and adolescent tertiary hospital over&nbsp;18&nbsp;consecutive years. During this period, there were n&nbsp;=&nbsp;2912 deaths, and n&nbsp;=&nbsp;581/2912(20%) occurred in adolescents. Of these, n&nbsp;=&nbsp;85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes&nbsp;I&nbsp;or&nbsp;II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n&nbsp;=&nbsp;26) and Goldman classes&nbsp;III, IV or&nbsp;V (low or no disagreement between these two parameters, n&nbsp;=&nbsp;59). Results: Median age at death (13.5&nbsp;[10‒19] vs. 13&nbsp;[10‒19] years, p&nbsp;=&nbsp;0.495) and disease duration (22&nbsp;[0‒164]&nbsp;vs.&nbsp;20&nbsp;[0‒200] months, p&nbsp;=&nbsp;0.931), and frequencies for males (58%&nbsp;vs.&nbsp;44%, p&nbsp;=&nbsp;0.247) were similar between class I/II&nbsp;vs.&nbsp;class&nbsp;III/IV/V. The frequency of pneumonia (73%&nbsp;vs.&nbsp;48%, p&nbsp;=&nbsp;0.029), pulmonary abscess (12%&nbsp;vs.&nbsp;0%, p&nbsp;=&nbsp;0.026), as well as isolation of yeast (27%&nbsp;vs.&nbsp;5%, p&nbsp;=&nbsp;0.008), and virus (15%&nbsp;vs.&nbsp;2%, p&nbsp;=&nbsp;0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class&nbsp;I/II compared to those with Goldman class&nbsp;III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4%&nbsp;vs.&nbsp;25%, p&nbsp;=&nbsp;0.018). Conclusion: This study showed that&nbsp;30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies

Ranking protected areas in the Azores using standardised sampling of soil epigean arthropods

Copyright © Springer 2005.Nineteen areas in seven of the nine Azorean islands were evaluated for species diversity and rarity based on soil epigean arthropods. Fifteen out of the 19 study areas are managed as Natural Forest Reserves and the remaining four were included due to their importance as indigenous forest cover. Four of the 19 areas are not included in the European Conservation network, NATURA 2000. Two sampling replicates were run per study area, and a total of 191 species were collected; 43 of those species (23%) are endemic to the archipelago and 12 have yet to be described. To produce an unbiased multiple-criteria index (importance value for conservation, IV-C) incorporating diversity and rarity based indices, an iterative partial multiple regression analysis was performed. In addition, an irreplaceability index and the complementarity method (using both optimisation and heuristic methods) were used for priority-reserves analyses. It was concluded that at least one well-managed reserve per island is absolutely necessary to have a good fraction of the endemic arthropods preserved. We found that for presence/absence data the suboptimal complementarity algorithm provides solutions as good as the optimal algorithm. For abundance data, optimal solutions indicate that most reserves are needed if we want that at least 50% of endemic arthropod populations are represented in a minimum set of reserves. Consistently, two of the four areas not included in the NATURA 2000 framework were considered of high priority, indicating that vascular plants and bird species used to determine NATURA 2000 sites are not good surrogates of arthropod diversity in the Azores. The most irreplaceable reserves are those located in older islands, which indicates that geological history plays an important role in explaining faunal diversity of arthropods in the Azores. Based both on the uniqueness of species composition and high species richness, conservation efforts should be focused on the unmanaged Pico Alto region in the archipelago’s oldest island, Santa Maria

Advanced silk-based genetic polymers with improved cell adhesion properties

[Excerpt] Recombinant protein-based polymers (rPBPs) are an emerging class of genetic polymers inspired by Nature and produced by synthetic protein biotechnology approaches. Due to their exceptional physical-chemical and biological characteristics, as well as their ability to be customized for specific applications, rPBPs have been explored for the development of advanced biomaterials [1]. Most of the polymers used as biomaterials thus far have been chemically synthesized, originating random copolymers with diverse and uncontrolled distribution of molecular weight (MW) and composition. However, advances in recombinant DNA technology allow the biological synthesis of fine-tuned rPBPs with precise control of their composition, polymer size and structure [2]. Furthermore, with the development of recombinant protein engineering and biotechnology, it is now possible to design new bioactive rPBPs by combining active peptides/domains from different natural proteins in the same fusion protein. [...

Guidelines for the management and treatment of periodic fever syndromes Cryopyrin-associated periodic syndromes (cryopyrinopathies – CAPS)

AbstractObjectiveTo establish guidelines based on cientific evidences for the management of cryopyrin associated periodic syndromes.Description of the evidence collection methodThe Guideline was prepared from 4 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation.Results1215 articles were retrieved and evaluated by title and abstract; from these, 42 articles were selected to support the recommendations.Recommendations1. The diagnosis of CAPS is based on clinical history and clinical manifestations, and later confirmed by genetic study. CAPS may manifest itself in three phenotypes: FCAS (mild form), MWS (intermediate form) and CINCA (severe form). Neurological, ophthalmic, otorhinolaryngological and radiological assessments may be highly valuable in distinguishing between syndromes; 2. The genetic diagnosis with NLRP3 gene analysis must be conducted in suspected cases of CAPS, i.e., individuals presenting before 20 years of age, recurrent episodes of inflammation expressed by a mild fever and urticaria; 3. Laboratory abnormalities include leukocytosis and elevated serum levels of inflammatory proteins; and 4. Targeted therapies directed against interleukin-1 lead to rapid remission of symptoms in most patients. However, there are important limitations on the long-term safety. None of the three anti-IL-1β inhibitors prevents progression of bone lesions