Changed Diabetic Treatment from Multiple Daily Injection (MDI), Dulaglutide to Xultophy

The patient is a 56-year old (yo) female with type 2 diabetes mellitus (T2DM). Medical histories include persisting T2DM from 35yo, renal stone at 43yo, hypertension from 45yo, photocoagulation for retinopathy on 54yo. An incidentaloma was found in the left adrenal gland, where endocrinological exams were negative for functional tumor. Her diabetic control situation became worse with HbA1c > 10%, then the treatment has been changed from multiple daily injection (MDI), Dulaglutide to Xultophy which is combined agents of degludec and liraglutide (IDegLira). It was provided 10-18 doses daily, and then glucose variability profile was improved satisfactory, suggesting the dual synergistic effects

Current topics of possible pharmacotherapy for chronic kidney disease (CKD) and diabetes

The authors and colleagues have been involved in Non-Communicable Diseases (NCDs), especially including diabetes, chronic kidney disease (CKD) and hemodialysis. Some topics are described as possible therapy for CKD. (i) Metformin has inhibitory effect on cardiovascular events, and has an evidence for safe administration in mild to moderate renal impairment. (ii) Canagliflozin reduced moderately cardiovascular and renal outcomes across the primary and secondary prevention groups, from mega studies of CANVAS and CREDENCE. (iii) erythropoiesis stimulating agent (ESA) has been effective for improving anemia in HD for years. Some hypoxia-inducible factor (HIF) seems to be applied for clinical practice soon

Recent Topics on Various Clinical Problems Related with Diabetic Neuropathy

Diabetes has been a crucial disease worldwide, and authors have continued diabetic practice and research. Recent topics on neuropathy are described. For diabetic patients, common symptoms of dysesthesia and loss of protective sensation (LOPS) should be checked annually. Diabetic peripheral neuropathy (DPN) has been treated by pregabalin, duloxetine, gabapentin and tapentadol. Autonomic Neuropathy (AN) includes Orthostatic Hypotension (OH), Cardiac Autonomic Neuropathy (CAN), gastroparesis and genitourinary disturbances. Diabetic foot may be related with Peripheral Arterial Disease (PAD), Diabetic Foot Infection (DFI), diabetic foot osteomyelitis (DFO) and amputation. For those, Hyperbaric Oxygen Therapy (HBOT) may be effective with continuing discussion

Percepciones docentes sobre la comprensión de lectura

Este estudio tuvo como objetivo conocer las percepciones docentes sobre el proceso de enseñanza y aprendizaje de la comprensión lectora en el marco de la implementación de un programa de lectura. Por un lado, se buscó conocer sus percepciones sobre las condiciones que dificultan el desarrollo de la lectura y, por otro, describir sus percepciones respecto a las condiciones que han contribuido a mejorar la comprensión de lectura de los alumnos. Partiendo de un enfoque cualitativo, se realizaron entrevistas y observaciones de aula a seis docentes de dos escuelas públicas de Lima Metropolitana. Complementariamente, se realizaron entrevistas a las dos subdirectoras de las escuelas. Los hallazgos indican que los docentes de una escuela tienen percepciones más elaboradas sobre la lectura y muestran mayor claridad y coherencia entre sus percepciones y sus prácticas pedagógicas. No obstante, casi el total de docentes coinciden en identificar un punto de quiebre en la enseñanza de la lectura que tiene lugar con el desarrollo de estrategias de lectura. Estas son descritas por los participantes como pautas que van a guiar a los alumnos en el proceso lector y que van a permitir que mejoren su comprensión. El grupo de docentes menciona la falta del hábito de lectura y el poco apoyo de los padres como factores que dificultan el proceso de enseñanza de la lectura. Finalmente, como factores facilitadores, identifican algunos elementos del programa tales como la calidad de los materiales y capacitaciones brindadas así como las relaciones interpersonales establecidas con los promotores del programa.The aim of this study was to identify teachers’ perceptions about reading comprehension in the context of a reading program implementation. On the one hand, this research seeks to identify teachers’ perceptions about the conditions that contribute to reading comprehension improvement. On the other hand, it looks for the conditions that make reading comprehension difficult. This qualitative research consisted of classroom observations and interviews to 6 teachers and 2 principals of two public schools in Lima Metropolitana to collect information about theirs perceptions. The findings indicated that in one school teachers have more elaborated perceptions about reading than in the other school, and show more clarity and coherence between their perceptions and teaching practices. Nevertheless, most of the teachers agree to identify teaching of reading strategies as a breaking point in reading comprehension teaching. The strategies are described as guidelines that direct students in the reading process contributing to reading improvement. Teachers claimed that lack of reading habits and the absence of parental support are factors that make teaching of reading comprehension difficult. Finally, as the factors that contribute to improve reading comprehension, they identify some program components like the quality of the materials, training characteristics as well as the good treatment given.Tesi

Phenotypic analysis of a temperature sensitive mutant in the large subunit of the vaccinia virus mRNA capping enzyme

AbstractThe heterodimeric vaccinia virus mRNA capping enzyme is a multifunctional enzyme, encoded by genes D1R and D12L. Published biochemical experiments demonstrate that, in addition to mRNA capping, the enzyme is involved in early viral gene transcription termination and intermediate viral gene transcription initiation. This paper presents the phenotypic characterization of Dts36, a temperature sensitive mutant in the large subunit of the mRNA capping enzyme (G705D), encoded by gene D1R. At the non-permissive temperature, Dts36 displays decreased steady state levels of some early RNAs, suggesting a defect in mRNA capping. Mutant infections also show decreased steady state levels of some early proteins, while DNA replication and post-replicative gene expression are absent. Under non-permissive conditions, the mutant directs synthesis of longer-than-normal early mRNAs from some genes, demonstrating that early gene transcription termination is defective. If mutant infections are initiated at the permissive temperature and shifted to the non-permissive temperature late during infection, steady state levels of intermediate gene transcripts decrease while the levels of late gene transcripts remain constant, consistent with a defect in intermediate gene transcription initiation. In addition to its previously described role in mRNA capping, the results presented in this study provide the first in vivo evidence that the vaccinia virus mRNA capping enzyme plays a role in early gene transcription termination and intermediate gene transcription

Clearer Image of Computed Tomography by Reconstruction Analysis Method

Computed tomography (CT) has been widely used for long. In recently years, the useful application of CT would be the method of the reconstruction images. Historically speaking, reconstruction images were conducted so far by algebraic reconstruction technique (ART), filtered back projection (FBP), iterative reconstruction (IR) algorithms and so on. There are various effects of reconstruction image of CT in clinical practice. Two cases with such beneficial experiences were reported. Case 1 is 74-year-man with hypertension. He was diagnosed to have abdominal aortic aneurysm (AAA). By reconstruction images, the general shape and details were clearly observed including regulating background data. Case 2 is 48-year-female without history of low back pain. When she received abdominal CT, she was pointed out to have lumbar disc herniation between L4 and L5. The diagnosis was done from the lateral tomography of lumbar vertebrae. By reconstruction images with colored modification, the detail status of herniation was clearly observed. Consequently, reconstruction image method of CT would be useful and effective. Further evolution of CT apparatus and development of computer analysis would be expected for better clinical practice and research in the future

CONOCIMIENTO, ACTITUDES Y LA CREENCIA DE PROFESIONALES DE LA SALUD DE MARINGÁ FRENTE A LA VIOLENCIA DE LA FAMILIA CONTRA EL NIÑO Y EL ADOLESCENTE

It is a descriptive-exploratory study of quali-quantitative nature, developed with 32 professionals. The data were collected in the months of January to June of 2000 through semi-structured interview. The results demonstrated that the subject of the domestic violence was not approached in the basic formation of most of the interviewees (65%), however, in the professional practice the enfrentamento of real cases had already been esperiencied by 90% of them, and in a general way and, in percentage terms, the attitudes dont correspond to referred ones in the hypothetical situation, especially when the victim is a child. It is concluded that in spite of the importance and the healths professionals of health paper in the diagnosis, prevention and intervention in situations of domestic violence, most of the time these ones neither receive formation nor feel prepared for an effective performance, be in the sense of supporting and to qualifying the victim to face the situation or to notice the aggressor as somebody that needs help to solve the problem.Es un estudio descriptivo-exploratorio de la naturaleza quali-cuantitativa, desarrollado con 32 profesionales. Los datos fueron recogidos en los meses de enero a junio de 2000 atraves de entrevista semiestructurada. Los resultados demostraram que el tema violencia doméstica no fue abordado en la formación básica de la mayoría de los entrevistados (65%), sin embargo, en la práctica profesional, el enfrentamento de casos verdaderos ya fue experimentado por 90%, y de manera general, en porcentaje, las actitudes no correspondem a lo que uno referiram en una situación hipotética, especialmente cuando la víctima es un niño. En conclusion, a pesar de la importancia y el papel de los profesionales de la salud en el diagnostico, prevención y intervención en situaciones de violencia doméstica, en mayoría del tiempo este uno no recibe formación ni sente prepararados para uno eficaz funcionamiento, sea en sentido de apoyo y calificar víctima para hacer frente a la situación o percibir el agresor como alguien que necesita de ayuda para solucionar el problema.Trata-se de um estudo descritivo-exploratório de natureza quali-quantitativa, desenvolvido junto a 32 profissionais da área da saúde. Os dados foram coletados nos meses de janeiro a junho de 2000 através de entrevista semi-estruturada. Os resultados demonstraram que a questão da violência doméstica não foi abordada na formação básica da maioria dos entrevistados (65%), no entanto, na prática profissional o enfrentamento de casos reais já foi vivenciada por 90% deles, sendo que de forma geral e, em termos percentuais, as atitudes tomadas não correspondem às referidas na situação hipotética, especialmente quando a vítima é criança. Conclui-se que à despeito da importância e do papel dos profissionais de saúde no diagnóstico, prevenção e intervenção em situações de violência doméstica, na maioria das vezes estes não recebem formação e nem se sentem preparados para uma atuação eficaz, seja no sentido de apoiar e capacitar a vítima para enfrentar a situação ou para perceber o agressor como alguém que precisa de ajuda para vencer o problema

七田式トレーニング法による健常高齢者の認知機能への影響（2）

2017年度に報告した七田式いきいき脳開発プログラム（以下七田式脳トレ）の効果１）について再検証を行った。65-90歳の健常高齢者25名が七田式脳トレを実施した。8ヵ月間28回のうち25回以上，24回以下の2群にて，七田式脳トレ開始時，開始から4ヵ月時，開始から8ヵ月時に，MMSE，HDS-R，FAB，Apathy 指数，うつ指標の測定を行った。群別に開始から4ヵ月と4ヵ月から8ヵ月及び全期の差を解析した。また，脳トレ開始時，開始から4ヵ月時，開始から8ヵ月時のMMSE，HDS-R，FAB検査値とうつ指標の相関を解析した。七田式脳トレは，25回以上群において4ヵ月の継続でMMSE［合計］が有意に上昇し， 8ヵ月の継続でMMSE［合計］が初回検査値に比べ有意に上昇した。MMSE，HDS-R，FAB検査値とうつ指標の相関は3時点の検査いずれにおいても認められなかった。七田式脳トレは，4ヵ月の継続で認知機能を高める効果を示し，継続することで認知機能を保つことが出来ることが示唆された

Carnitine for Body Composition in Hemodialysis Patients

Background: Authors and colleagues have continued clinical research for hemodialysis patients. Currently, a pilot study presents intervention of carnitine for changes of the body composition. Subjects and Methods: Subjects were six patients on hemodialysis with intervention of carnitine (group 1). Average data were 74.3 years, 65.4 kg, 22.6 in BMI. As levocarnitine, L-Cartin FF injection 1000 mg was administered three times a week for six months. Group 2 has six control patients for age-, sex-, body weight, BMI-matched (group 2). Body composition of muscle and fat tissues were measured by InBody 770 on 0 and 6 months. Results: In group 1, muscle volume and skeletal muscle showed increasing tendency without statistical significance. In contrast, there were significant decreases of body fat volume (22.3 kg vs 20.5 kg, 39.0% vs 35.8%) (p<0.05). No significant differences were found in hemoglobin, total protein, albumin and Cardio-Thoracic Ratio (CTR) of chest X-ray. Group 2 showed no significant changes. Discussion and Conclusion: Hemodialysis patients often have muscular reduction. Previous reports showed improved lean body mass by carnitine administration, which may support our result. These results from current pilot study would be expected to become useful reference data in the pathophysiological investigation in patients on hemodialysis