Understanding the barriers and improving care in type 2 diabetes: Brazilian perspective in time to do more in diabetes

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Type 2 diabetes mellitus (T2DM) is a complex disease, particularly in a continental country like Brazil. We attempted to understand and evaluate the perceptions and routines of Brazilians with T2DM and physicians, compared with other countries. METHODS: We compared the results from a 20-min online survey in Brazil with simultaneously collated data from India, Japan, Spain, UK and USA. RESULTS: In total, 652 adults with T2DM and 337 treating physicians were enrolled, of whom 100 patients and 55 physicians were from Brazil. The numbers of primary care physicians from the five countries were 221 versus 43 in Brazil, diabetes specialists were 61 versus 12. There was disconnect between the opinions of physicians and people with diabetes globally. Further, there were differences between clinical practices in Brazil versus the rest of the world, in many areas Brazilians were performing better. CONCLUSIONS: Communication between patients and physicians should be clearer. There is an urgent need to identify the deficits in education, in order to address the clinical inertia within the diabetes management team. There is a necessity to understand the specific requirements of the Brazilian population in order to contextualise international guidelines and implement local changes in practice.The online survey was supported by Novarti

Cartas entre os Jarawara : um estudo da apropriação da escrita

Orientador: Tania Maria AlkminDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Estudos da LinguagemResumo: A presente dissertação relata a experiência do povo Jarawara com a escrita. Embora sendo uma sociedade de tradição oral, os Jarawara, com uma população de 153 pessoas que vivem na região do médio Purus, Amazonas, solicitaram a escrita e, em apenas quatro anos (1989 a 1992) alcançaram completo domínio sobre ela. Inicialmente os Jarawara assumiram o controle do processo de escolarização adaptando-o à espontaneidade própria de sua cultura. Em seguida mudaram a função da escrita através da substituição do livro didático Jarawara, pessoal e em constante elaboração. Além disso, criaram a CARTA JARAWARA, tendo como principal característica o fato de ser escrita para uma pessoa em particular mas lida por todos. O mais surpreendente na experiência Jarawara com a escrita é a rapidez com que o povo assumiu o controle do novo conhecimento: tendo recebido a escrita em 1989, apenas quatro anos depois, em 1992, a escola e a escrita Jarawara já eram realidade. A experiência Jarawara demonstra, portanto, que as pessoas podem agir sobre a escrita, transformando-a e lhe dando a forma desejada.Abstract: Not informedMestradoMestre em Linguístic

Clinical Differential Diagnosis between Nonodontogenic and Endodontic Radiolucent Lesions in Periapical Location: A Critical Review

In endodontics, accurate diagnoses are important for the selection of appropriate and successful therapy. Several nonendodontic entities in periapical location may resemble those of inflammatory endodontic origin and impact therapeutic approaches. The aim of this study was to review noninflammatory entities mimicking dentoalveolar abscesses or apical periodontitis and to discuss clinical and pathological features. In this review study, the authenticated search engine in PubMed (MEDLINE) database was used to find articles by using “Nonvital Pulp Dentoalveolar Abscess”, “Nonvital Pulp And Apical Periodontitis”, “Periapical Abscess“, “Chronic Dentoalveolar Abscess”, “Chronic Apical Periodontitis”, “Periapical Granuloma”, And “Radicular Cyst”. Each of these predefined keywords were combined with the terms “Misdiagnosed”, “Mimicking”, “Masquerading”, or “Simulating” to search for reported cases indexed from 1978 to 2020. All case reports fulfilling the selection criteria were reviewed to identify radiolucent nonendodontic periapical lesions focused on the questions: “Which pathological entities mimick radiolucent endodontic lesions in periapical location? Based on endodontic clinical parameters, what are the contrasting features?” Out of 426 articles, 111 were relevant to the subject, including a series of cases and case reports. Only well-documented English and recent papers were considered. A total of 30 noninflammatory entities appeared clinically as radiolucent endodontic lesion in periapical location. Lesions simulating chronic apical periodontitis represented 83.3% and dentoalveolar abscess 16.7%. Interestingly, primary malignancies and metastasis counted 43.3% and pain was a typical symptom. Swelling was a noncontributory clinical feature in distinguishing periapical lesions. Lack of pulp response was registered in 68.4% of nonedodontic lesions. A flowchart was generated to summarize clinicopathological aspects of radiolucent nonendodontic entities appearing as dentoalveolar abscesses or apical periodontitis In relation to clinical practice, it is very important for us to note that, a group of pathological entities may simulate radiolucencies of endodontic origin in periapical location, especially malignancies and non-inflammatory odontogenic lesions

Periodontal disease and oral hygiene benefits in HIV seropositive and AIDS patients

Objectives: The frequency of gingival and periodontal disease in HIV-seropositive and AIDS patients was investigated in order to evaluate the oral hygiene benefits of using mechanical therapy. Study design: thirty-two consenting HIV-positive patients were examined. Their gingival and periodontal status were evaluated using the Gingival Index and the Simplified Oral Hygiene Index. The data were assessed at baseline, after three months and after six months. Subjects received mechanical therapy, which included calculus removal, scaling and root planning, tooth polishing and oral hygiene instructions. The maintenance of oral hygiene was performed weekly. HIV staging and CD4 counts were also investigated. Results: At the baseline, gingival and periodontal disease was present in 71.9% of all subjects. Chronic gingivitis (43.8%) was the most frequent in all subjects. A clear improvement in gingival health was registered in 78.2% of subjects after six months of mechanical therapy. No association was registered between CD4 count and gingival/periodontal status or attachment loss with HIV staging. Conclusions: Chronic gingivitis was the most frequent disease in HIV infected and AIDS patients. Oral hygiene using mechanical therapy improves the gingival condition, suggesting that it is an important step in the maintenance of periodontal health

A importância das equipes multidisciplinares para o juízo da infância e juventude no estado do Tocantins

This research seeks to demonstrate the importance of multidisciplinary teams to Children and Juvenile Court in Tocantins State. The exploratory documental method was the most appropriate for this research. The data were collected through doctrinaires and normatives researches done besides statistical survey. All the Brazilian Courts were consulted with the purpose to inform about the structure of Children and Juvenile Court, about the multidisciplinary teams as though about the the operation and constitutional of Children and Juveniles Coordination. The verification of a procedural standardization concerning to the social educational attendance by multidisciplinary teams happened through the manual analysis of the courts. The doctrinaire and jurisprudential survey concerning to the multidisciplinary teams regulation was done by researching books, articles, courts and electronic sites. In this view, the subject discussed, the documental survey searched data not only from the trial courts, but specially from Conselho Nacional de Justiça - CNJ, responsible to instigate the Law formatted in the courts. This survey was done with the laws and judiciary researches carried out by CNJ and by other organizations and authorities. Researching quantitative it was surveyed statistical data from the Tribunal de Justiça do Tocantins about the distribution and the most relevant judgments pertaining children and juvenile, as adoptions, social educational lawsuit, measures of protection and suspension or lost of the custody. Besides this survey from Trial Courts data, it also was surveyed data from the Segunda Vara Civel, Família e Sucessões, Infância e Juventude e Precatórias Cíveis of Paraiso do Tocantins analyzing the procedure of lawsuits before mentioned demonstrating the time gap among the ones which had a multidisciplinary team and the ones that did not have. Besides this research confirm the importance of multidisciplinary teams it was evident in the statistical data surveyed this conclusion that was exhaustively demonstrated.Dissertação propositiva que teve por objetivo demonstrar a importância das equipes multidisciplinares para o Juízo da Infância e Juventude no estado do Tocantins. O método exploratório documental apresentou-se o mais adequado para os fins a que se destinava esta pesquisa. Os dados foram coletados por meio de pesquisas doutrinárias e normativas realizadas, além de levantamentos estatísticos. Os tribunais de justiça de todo o País foram consultados a fim de informarem a respeito da estrutura das varas da infância e juventude, no que diz respeito às equipes multidisciplinares, assim como sobre o funcionamento e constituição das Coordenadorias da infância e juventude. A verificação de uma padronização procedimental referente ao atendimento socioeducativo por equipes multidisciplinares se deu pela análise dos manuais de procedimentos dos tribunais que os possuem. O levantamento doutrinário e jurisprudencial a respeito da regulamentação das equipes multidisciplinares deuse por meio de consultas a livros, artigos, tribunais e páginas da internet. Nesse mesmo sentido, em razão da matéria tratada, o levantamento documental buscou dados não somente nos tribunais de justiça, mas também, especialmente, no Conselho Nacional de Justiça (CNJ), responsável por fomentar os dispositivos legais dormitados nos tribunais. Esse levantamento se deu com a consulta tanto às normas quanto às pesquisas judiciárias realizadas pelo CNJ, assim como por outros órgãos e entidades. Ainda buscando elementos quantitativos, foram levantados dados estatísticos do Tribunal de Justiça do Estado do Tocantins no que se refere à distribuição e aos julgamentos das ações mais relevantes da infância e juventude, como adoções, ações socioeducativas, medidas de proteção e suspensão ou perda de poder familiar. Além deste levantamento no banco de dados do tribunal de justiça, também foram levantados dados na 2ª Vara Cível, Família e Sucessões, Infância e Juventude e Precatórias Cíveis de Paraíso do Tocantins, analisando o andamento das ações retromencionadas, demonstrando o lapso temporal de julgamento entre as que possuíam equipe multidisciplinar e as que não as contemplavam. Além de a pesquisa confirmar, doutrinária e normativamente, a importância e essencialidade das equipes multidisciplinares, evidenciou-se, nos dados estatísticos levantados, esta conclusão, o que ficou demonstrado exaustivamente

Procedimento Operacional Padrão (POP) em Serviço Social: um relato de experiência na UTI Adulto.

The present work is the final product of the experience of a resident in the Multiprofessional Residency in Health. The theme of the research is the importance of social service “operacional proceedings” in the professional experience of the social worker in the field of practice “Adult Intensive Care Unit ” at the Hospital of Clinics at the Federal University of Uberlândia, analysis period from February to June 2019. Based on a bibliographic recovery plus an account of analytical experience, the objective was to discuss the relevance of the “operacional proceedings”of Social Service in the Unit. Exposure and comparison with other procedures of other institutions were carried out, in analysis of the procedures performed and observed by the author in the reality of the hospital. Based on the author's observations, it was intended to bring collaborations to the team's debate on Social Service SOPs in the Adult Intensive Care Unit of Hospital of Clinics.O presente trabalho é produto final da experiência de uma residente na Residência Multiprofissional em Saúde. A pesquisa possui como tema, a importância dos Procedimentos Operacionais Padrão (POPs) de Serviço Social na experiência profissional da assistente social no campo de prática “Unidade de Terapia Intensiva- Adulto” do Hospital de Clínicas da Universidade Federal de Uberlândia, período de análise de fevereiro a junho de 2019. Baseando-se em uma recuperação bibliográfica acrescida de um relato de experiência analítico o objetivo foi discutir a relevância do POP de Serviço Social na Unidade. Realizou-se a exposição e comparação com outros procedimentos de outras instituições, em análise aos procedimentos feitos e observados pela autora na realidade do hospital. A partir das observações da autora, pretendeu-se trazer colaborações ao debate da equipe sobre os POPs do Serviço Social na Unidade de Terapia Intensiva-Adulto do Hospital de Clínicas

Simcluster: clustering enumeration gene expression data on the simplex space

Transcript enumeration methods such as SAGE, MPSS, and sequencing-by-synthesis EST "digital northern", are important high-throughput techniques for digital gene expression measurement. As other counting or voting processes, these measurements constitute compositional data exhibiting properties particular to the simplex space where the summation of the components is constrained. These properties are not present on regular Euclidean spaces, on which hybridization-based microarray data is often modeled. Therefore, pattern recognition methods commonly used for microarray data analysis may be non-informative for the data generated by transcript enumeration techniques since they ignore certain fundamental properties of this space.

Here we present a software tool, Simcluster, designed to perform clustering analysis for data on the simplex space. We present Simcluster as a stand-alone command-line C package and as a user-friendly on-line tool. Both versions are available at: http://xerad.systemsbiology.net/simcluster.

Simcluster is designed in accordance with a well-established mathematical framework for compositional data analysis, which provides principled procedures for dealing with the simplex space, and is thus applicable in a number of contexts, including enumeration-based gene expression data

Exploring early combination strategy in Latin American patients with newly diagnosed type 2 diabetes : a sub-analysis of the VERIFY study

Background Patients with type 2 diabetes mellitus (T2DM) from Latin American countries face challenges in access to healthcare, leading to under-diagnosis, under-achievement of glycemic target, and long-term complications. Early diagnosis and treatment initiation are of paramount importance in this population due to the high prevalence of risk factors such as obesity and metabolic syndrome. The VERIFY study in patients with newly diagnosed T2DM (across 34 countries), assessed the normoglycemic durability (5 years), with early combination (EC) therapy approach versus the traditional stepwise approach of initiating treatment with metformin monotherapy (MET). Here we present the results from the VERIFY study for participants from eight countries in Latin America. Methods Newly diagnosed adult patients with T2DM, HbA1c 6.5-7.5% and body-mass index (BMI) of 22-40 kg/m(2) were enrolled. The primary endpoint was time to initial treatment failure (TF; HbA1c >= 7.0% at two consecutive scheduled visits 13 weeks apart). Time to second TF was evaluated when patients in both groups were receiving and failing on the vildagliptin combination. Safety and tolerability were also assessed for both treatment approaches during the study. Results A total of 537 eligible patients (female, 58.8%) were randomly assigned to receive either EC (n = 266) or MET (n = 271). EC significantly reduced the relative risk of time to initial TF by 47% versus MET [HR (95% CI) 0.53 (0.4, 0.7) p < 0.0001]. Overall, 46.4% versus 66.3% of patients achieved the primary endpoint in the EC and MET groups, with a median [interquartile range (IQR)] time to TF of 59.8 (27.5, not evaluable) and 33.4 (12.2, 60.1) months, respectively. The risk for time to second TF was 31% lower with EC (p < 0.0092). A higher proportion of patients receiving EC maintained durable HbA1c < 7.0%, < 6.5%, and < 6.0%. Both treatment approaches were well tolerated, and only 3.2% of participants discontinued the study due to adverse events. All hypoglycemic events (EC: n = 7 and MET: n = 3) were single, mild episodes and did not lead to study discontinuation. Conclusion Similar to the global population, long-term clinical benefits were achieved more frequently and without tolerability issues with EC versus standard-of-care MET in this Latin American sub-population. This study is registered with ClinicalTrials.gov, NCT01528254.Peer reviewe

ProbCD: enrichment analysis accounting for categorization uncertainty

As in many other areas of science, systems biology makes extensive use of statistical association and significance estimates in contingency tables, a type of categorical data analysis known in this field as enrichment (also over-representation or enhancement) analysis. In spite of efforts to create probabilistic annotations, especially in the Gene Ontology context, or to deal with uncertainty in high throughput-based datasets, current enrichment methods largely ignore this probabilistic information since they are mainly based on variants of the Fisher Exact Test. We developed an open-source R package to deal with probabilistic categorical data analysis, ProbCD, that does not require a static contingency table. The contingency table for&#xd;&#xa;the enrichment problem is built using the expectation of a Bernoulli Scheme stochastic process given the categorization probabilities. An on-line interface was created to allow usage by non-programmers and is available at: http://xerad.systemsbiology.net/ProbCD/. We present an analysis framework and software tools to address the issue of uncertainty in categorical data analysis. In particular, concerning the enrichment analysis, ProbCD can accommodate: (i) the stochastic nature of the high-throughput experimental techniques and (ii) probabilistic gene annotation