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Sex disparity in the management and outcomes of dyslipidemia of diabetic patients in the Arabian Gulf: findings from the CEPHEUS study
No full textAbstract\ud
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Background\ud
Little is known about sex gap in the management and outcomes of dyslipidemia among diabetics in the Arabian Gulf. The aim if this study was to determine sex differences in the management and outcomes of dyslipidemia in diabetic patients in the Arabian Gulf.\ud
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Methods\ud
This study was derived from the Centralized Pan-Middle-East Survey on the management of hypercholesterolemia. Patients recruited were aged ≥18 years on lipid lowering drugs for ≥3 months (stable medication for ≥6 weeks). Outcomes were based on the joint Consensus Statement of the American Diabetes Association and American College of Cardiology Foundation. Analyses were performed using univariate and multivariate logistic regression techniques.\ud
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Results\ud
The mean age of the cohort (n = 3336) was 57 ± 11 years and 45% (n = 1486) were females. Females were less likely to be on rosuvastatin (7.6% vs 12%; P < 0.001), atorvastatin (41% vs 46%; P = 0.005) and combination hypolipidemic therapy (5.6% vs 2.8%; P < 0.001) but more likely to be on simvastatin (51% vs 39%; P < 0.001) than males. Females, especially those with very high atherosclerotic cardiovascular disease (ASCVD) risk status, were also less likely to achieve LDL-cholesterol [adjusted odds ratio (aOR), 0.58; 95% confidence interval (CI): 0.40–0.86; P = 0.006], non-HDL-cholesterol [aOR, 0.68; 95% CI: 0.46–0.99; P = 0.048] and apolipoprotein B [aOR, 0.64; 95% CI: 0.44–0.92; P = 0.016] lipid targets.\ud
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Conclusions\ud
Diabetic women were less likely to be on optimal hypolipemic therapy and consequently less likely to attain lipid goals compared to men. This shows a sex gap on dyslipidemia treatment in the region. Diabetic women with very high ASCVD risk status need to be aggressively treated to lower their risk of cardiovascular events.The CEPHEUS project was sponsored by AstraZeneca. The sponsor had no involvement in the study conception or design; analysis, or interpretation of data; writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication
Correction to: High-fat diet or low-protein diet changes peritoneal macrophages function in mice
No full textAbstract\ud
The original version of this article [1], published on 28 June 2016, contains a mistake. The part labels in Fig. 1 are missing. The corrected version of Fig. 1 is given below
Diabetic retinopathy among Brazilian Xavante Indians
No full textAbstract\ud
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Background\ud
To describe the frequency of diabetic retinopathy (DR) and its associated variables in Brazilian Xavante Indians.\ud
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Methods\ud
A population-based survey carried out in two Xavante Reservations between 2008 and 2012, included 948 Indians aged 20 years or more, identified 246 individuals with type 2 diabetes. A non-probabilistic cluster sample of 140 diabetic individuals were submitted to ophthalmologic examination. Due to operational conditions and to optimize the field work, only the larger Xavante villages were included. Ophthalmologic examinations were performed during one trip to each reservation, in their villages and consisted of measurement visual acuity, anterior segment biomicroscopy, applanation tonometry, and direct and indirect ophthalmoscopy.\ud
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Results\ud
The frequency of DR was 19.3%, distributed as follows: mild non-proliferative retinopathy in nine (33.3%) subjects, moderate in nine (33.3%), severe in six (22.3%), very severe in two (7.4%), and high-risk proliferative DR in one (3.7%). The occurrence of DR was higher among those with a longer duration of diabetes, higher levels of glycated hemoglobin (HbA1c) and fasting glucose, papillary excavation ≥ 0.5, and among individuals in older age group. Using the log-binomial regression model, diabetes duration > 24 months and HbA1c ≥ 6.5% were significantly associated with the occurrence of DR.\ud
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Conclusions\ud
The presence of DR (19.3%) in Xavante Indians is an alert for health care providers for this population, since diabetes is a new disease among them. Its association with disease duration, high levels of HbA1c and blood glucose calls attention for the necessity of more actions to improve diabetes control in this recently contacted ethnic group that needs particular attention.This study was supported by the Fundação de Amparo à Pesquisa do Estado\ud
de São Paulo-FAPESP (proc. 2010/05634-0) and the Conselho Nacional de\ud
Desenvolvimento Científco e Tecnológico-CNPq (proc. 476347/2007-6)
A cross-sectional study of associations between kinesiophobia, pain, disability, and quality of life in patients with chronic low back pain
No full textAbstract\ud
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Background\ud
Low back pain is a significant health problem condition due to high prevalence among the general population. Emotions and physical factors are believed to play a role in chronic low back pain. Kinesiophobia is one of the most extreme forms of fear of pain due to movement or re-injury.\ud
The purpose of this study was to investigate the association between kinesiophobia and pain intensity, disability and quality of life in people with chronic low back pain.\ud
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Methods\ud
The study included 132 individuals with chronic back pain, with ages between 18 and 65 years old. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia, pain intensity was measured using the Numeric Rating Scale with a cut-off more than 3 for inclusion in the study, disability was assessed using the Roland Morris questionnaire, quality of pain was assessed using the McGill questionnaire, and quality of life was assessed using the Quality of Life questionnaire SF-36.\ud
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Results\ud
The results are statistically significant, but with weak associations were found between kinesiophobia and pain intensity (r = 0.187), quality of pain (sensory, r = 0.266; affective, r = − 0.174; and total r = 0.275), disability (r = 0.399) and physical quality of life (emotional r = − 0.414).\ud
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Conclusion\ud
Kinesiophobia is an important outcome to assess in patients with chronic low back pain. The results suggest that correlations between kinesiophobia and disability and quality of life are statistically significant
Improving oral sentence production in children with cochlear implants: effects of equivalence-based instruction and matrix training
No full textAbstract\ud
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Children who use cochlear implants (CI) and who are readers usually produce more accurate speech in response to text than to pictures. Equivalence-based instruction (EBI) can be a route to establish functional interdependence between these verbal operants. The present study investigated whether children with CI who read would improve speech accuracy when tacting pictures of scenes after EBI that included dictated sentences, pictures of scenes, and printed sentences. This study evaluated whether teaching verbal relations to diagonal sentences from a matrix with subject-verb-object combinations promoted recombinative generalization to untrained sentences. Participants were three children with CI with a more accurate speech when reading print than when tacting pictures of scenes. They were taught to select pictures of scenes in response to dictated sentences (AB) by matching-to-sample (MTS) and to construct printed sentences in response to dictated sentences (AE) by constructed-response-matching-to-sample (CRMTS). Speech production in response to print (CD) and in response to pictures of scenes (BD) were probed for both trained and untrained sentences, using a multiple baseline design across participants. All participants learned the trained relations, showed emergence of derived relations, and improved speech accuracy when tacting pictures of scenes. They were able to recombine sentence components and tact novel pictures using untrained sentences from the matrix. These results indicate that speech accuracy and generative sentence production can be improved in children with CI from interventions that incorporate EBI and matrix training.\ud
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Trial registration\ud
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CAAE#01454412.0.0000.5441\ud
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registered 01/29/2013.This study was funded by the State of São Paulo Research Foundation\ud
(FAPESP#2012/05696-0)
TCF7L2 correlation in both insulin secretion and postprandial insulin sensitivity
No full textAbstract
Background
The TCF7L2 rs7903146 variant is strongly associated with type 2 diabetes mellitus (T2DM). However, the mechanisms involved in this association remain unknown and may include extrapancreatic effects. The aim of this study was to perform a metabolic characterization of T2DM patients with and without the TCF7L2 rs7903146 risk T allele and analyze some influences of the TCF7L2 genotype on glucose metabolism.
Methods
Patients with T2DM (n = 162) were genotyped for the TCF7L2 rs7903146 single nucleotide polymorphism. Individuals with CT/TT and CC genotypes were compared regarding basal serum levels of glucose, glycosylated hemoglobin A1C, HDL, uric acid, insulin, and C-peptide. A subset of 56 individuals was evaluated during a 500-calorie mixed-meal test with measurements of glucose, insulin, proinsulin, C-peptide and glucagon. Additional secondary assessments included determination of insulinogenic index (IGI30), and insulin sensitivity (%S) and resistance (IR) by Homeostatic model assessment (HOMA).
Results
Patients with the CT/TT genotype showed lower baseline plasma concentrations of C-peptide when compared with those with the CC genotype. Of the 56 individuals who participated in the mixed-meal test, 26 and 30 had the CC and CT/TT genotypes, respectively. CT/TT subjects, compared with CC individuals, had higher post prandial plasma levels of insulin and C-peptide at 30–120 min (p < 0.05) and proinsulin at 45–240 min (p < 0.05). Interestingly CT/TT individuals presented at baseline higher %S (p = 0.021), and lower IR (p = 0.020) than CC individuals. No significant differences in IGI30 values were observed between groups.
Conclusions
The T2DM individuals carrying the rs7903146 T allele of the TCF7L2 gene presented higher IR pattern in response to a mix-meal test, different of beta cell function at baseline assessed by C-peptide levels which was lower, and Homa-IR was lower when comparing with non-carriers
Epidemiology of gastrointestinal symptoms in young and middle-aged Swiss adults: prevalences and comorbidities in a longitudinal population cohort over 28 years
No full textAbstract
Background
Although subacute and chronic gastrointestinal symptoms are very common in primary care, epidemiological date are sparse. The aim of the study was to examine and quantify the prevalence of subacute and chronic gastrointestinal symptoms and their associations with somatic and mental disorders in the general population.
Methods
Data were collected prospectively between 1981 (age m = 22, f = 23) and 2008 (age 49/50) from the Zurich Cohort Study (n = 292 men, 299 women), a representative general population survey. The participants were assessed using a semi-structured interview, the “Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology” (SPIKE). Prevalence rates were computed to be representative of the general population aged 22–50. Associations were quantified by odds ratios (ORs) and their 99% confidence intervals (CI).
Results
The prevalences of intestinal and of gastric symptoms were significantly higher among women in all categories examined. For example, any gastric symptoms: f. 26.4% vs m.15.2%; any intestinal symptoms: 27.6% vs 14.6%; nausea/vomitus: 19.1% vs 4.5%; constipation: 15.8% vs 6.5% (all p < 0.001). Strong associations (all p < 0.0001) were found between fatigue (1 month) and chronic stomach (OR = 9.96, 99%-CI: 5.53–17.94) and chronic intestinal symptoms (OR = 9.02, 99%-CI: 4.92–16.54). Panic attacks were associated with subacute intestinal symptoms (OR = 4.00, 99%-CI: 2.43–6.59). Anxiety was more strongly associated with subacute intestinal symptoms (OR = 3.37, 99%-CI: 2.23–5.08) than with subacute stomach symptoms (OR = 1.85, 1.20–2.86). Bipolar disorders were associated with subacute stomach symptoms (OR = 1.83, 1.18–2.17) and unipolar depression with subacute intestinal symptoms (OR = 2.05, 1.34–3.15).
Conclusions
Remarkably high prevalence rates of gastric and intestinal complaints were observed in women (over 1/4; men 1/7). Fatigue/neurasthenia was the strongest co-factor in both conditions. Various syndromes related to anxiety, phobia, and panic disorders showed further significant associations. The integration of psychiatric and/or psychological treatment could help address the functional part of gastric and intestinal syndromes
Similarity testing for role-based access control systems
No full textAbstract\ud
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Context\ud
Access control systems demand rigorous verification and validation approaches, otherwise, they can end up with security breaches. Finite state machines based testing has been successfully applied to RBAC systems and enabled to obtain effective test cases, but very expensive. To deal with the cost of these test suites, test prioritization techniques can be applied to improve fault detection along test execution. Recent studies have shown that similarity functions can be very efficient at prioritizing test cases. This technique is named similarity testing and assumes the hypothesis that resembling test cases tend to have similar fault detection capabilities. Thus, there is no gain from similar test cases, and fault detection ratio can be improved if test diversity increases.\ud
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Objective\ud
In this paper, we propose a similarity testing approach for RBAC systems named RBAC similarity and compare to simple dissimilarity and random prioritization. RBAC similarity combines the dissimilarity degree of pairs of test cases with their relevance to the RBAC policy under test to maximize test diversity and the coverage of its constraints.\ud
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Method\ud
Five RBAC policies and fifteen test suites were prioritized using each of the three test prioritization techniques and compared using the Average Percentage Faults Detected metric.\ud
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Results\ud
Our results showed that the combination of the dissimilarity degree to the relevance of a test case to RBAC policies in the RBAC similarity can be more effective than random prioritization and simple dissimilarity, by itself, in most of the cases.\ud
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Conclusion\ud
The RBAC similarity criterion is suitable as a test prioritization criteria for test suites generated from finite state machine models specifying RBAC systems.Carlos Diego Nascimento Damasceno’s research project was supported by the National Council for Scientific and Technological Development (CNPq), process number 132249/2014-6
Peptidomic investigation of Neoponera villosa venom by high-resolution mass spectrometry: seasonal and nesting habitat variations
No full textAbstract\ud
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Background\ud
Advancements in proteomics, including the technological improvement in instrumentation, have turned mass spectrometry into an indispensable tool in the study of venoms and toxins. In addition, the advance of nanoscale liquid chromatography coupled to nanoelectrospray mass spectrometry allows, due to its high sensitivity, the study of venoms from species previously left aside, such as ants. Ant venoms are a complex mixture of compounds used for defense, predation or communication purposes. The venom from Neoponera ants, a genus restricted to Neotropical regions, is known to have cytolytic, hemolytic, antimicrobial and insecticidal activities. Moreover, venoms from several Neoponera species have been compared and differences in their toxicity related to nesting habitat variation were reported. Therefore, the present study aimed to perform a deep peptidomic analysis of Neoponera villosa venom and a comparison of seasonal and nesting habitat variations using high-resolution mass spectrometry.\ud
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Methods\ud
Specimens of N. villosa ants were captured in Panga Natural Reserve (Uberlândia, MG, Brazil) from arboreal and ground-dwelling nests during summer and winter time. The venom glands were dissected, pooled and disrupted by ultra-sonic waves. The venom collected from different habitats (arboreal and ground-dwelling) and different seasons (summer and winter) was injected into a nanoACQUITY ULPC hyphened to a Q-Exactive Orbitrap mass spectrometer. The raw data were analyzed using PEAKS 7.\ud
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Results\ud
The results showed a molecular diversity of more than 500 peptides among these venoms, mostly in the mass range of 800–4000 Da. Mutations and post-translational modifications were described and differences among the venoms were observed. Part of the peptides matched with ponericins, a well-known antimicrobial peptide family. In addition, smaller fragments related to ponericins were also identified, suggesting that this class of antimicrobial peptide might undergo enzymatic cleavages.\ud
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Conclusion\ud
There are substantial differences among the venom of N. villosa ants collected in different seasons and from different nest habitats. The venom composition is affected by climate changes that influence prey availability and predator presence. Clearly, nano-LC-MS boosted the knowledge about ant venom, a rich source of unexplored and promising bioactive compounds.This work was supported by the São Paulo Research Foundation (FAPESP – grant n. 2015/18432-0; and scholarships to CTC, n. 2013/26200-6 and n. 2015/17466-8), the National Council for Scientific and Technological Development (CNPq – grant n. 449960/2014-5)
Challenges of interpreting epidemiologic surveillance pertussis data with changing diagnostic and immunization practices: the case of the state of São Paulo, Brazil
No full textAbstract\ud
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Background\ud
A significant increase in pertussis incidence occurred in Brazil, from 2011 to 2014, despite high coverage of childhood immunization with whole-cell-pertussis (wP) containing vaccines. This study presents pertussis surveillance data from São Paulo state and discusses the challenges to interpret them considering pertussis cyclic epidemic behavior, the introduction of new diagnostic techniques and new vaccination strategies, and enhanced disease awareness during epidemics.\ud
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Methods\ud
Observational study including pertussis cases reported to the Surveillance System in São Paulo state, from January 2001 to December 2015. Pertussis cases data were retrieved from the National Notifiable Diseases Information System (SINAN) website and from São Paulo state Epidemiological Surveillance Center (CVE/SP) database. Vaccination coverage and homogeneity data were collected from the Unified Health System Department of Informatics (DATASUS). We presented cases distribution by year, age group and diagnostic criteria and calculated pertussis incidence rates. The proportions of cases among different age groups were compared using chi-square test for trend.\ud
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Results\ud
Infants less than 1 year of age were the most affected during the whole period, but the proportions of cases in this age group had a significant decreasing trend, with significant increase in the proportions of cases reported among older age groups (1–4, 5–10 and ≥20 years). Cases among infants aged less than 6 months represented ≥90% of all cases in children less than 1 year of age in all but 2 years (2012 and 2015). A non-significant decrease in the proportion of cases among infants aged < 2 months was observed in parallel to a significant increase in the proportion of cases in infants aged 6–11 months.\ud
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Conclusions\ud
A pertussis outbreak has occurred in a state with universal use of wP vaccine. The disease cyclic behavior has probably had a major role in the increased incidence rates registered in São Paulo state, from 2011 to 2014, as well as in the decreased incidence in 2015. Maternal vaccination cannot explain the drop in the number of cases among all age groups, in 2015, as herd protection is not expected, but may have had an impact on the number of cases in infants aged < 2 months