Prevalence of diabetic retinopathy in Brazil: a systematic review with meta-analysis.

AIMS: To evaluate the prevalence of diabetic retinopathy (DR) in Brazilian adults with diabetes mellitus via a systematic review with meta-analysis. METHODS: A systematic review using PubMed, EMBASE, and Lilacs was conducted, searching for studies published up to February 2022. Random effect meta-analysis was performed to estimate the DR prevalence. RESULTS: We included 72 studies (n = 29,527 individuals). Among individuals with diabetes in Brazil, DR prevalence was 36.28% (95% CI 32.66-39.97, I2 98%). Diabetic retinopathy prevalence was highest in patients with longer duration of diabetes and in patients from Southern Brazil. CONCLUSION: This review shows a similar prevalence of DR as compared to other low- and middle-income countries. However, the high heterogeneity observed-expected in systematic reviews of prevalence-raises concerns about the interpretation of these results, suggesting the need for multicenter studies with representative samples and standardized methodology.

The power of the placebo effect in diabetes: A systematic review and meta-analysis.

This review aims to identify the magnitude of the placebo effect in people with type 2 diabetes mellitus. Literature research was conducted Medline, Embase and Virtual Health Library for studies published between the date of inception and June 2021. The eligibility criteria included randomized controlled trials, showing comparison to placebo, having participants with type 2 diabetes mellitus, and having glycated hemoglobin (HbA1c) as the primary outcome. Meta-analysis was conducted with the effect of changing HbA1c in relation to the baseline. Exploration of heterogeneity was performed.The meta-analysis showed an increase in the average of HbA1c compared to the baseline of 0.14% (95% CI: 0.07-0.21). There was a significant difference between follow-up times (p = 0.03) and between administration routes (p = 0.01), with an increase in HbA1c in the oral route [0.15% (95% CI: 0.07-0.23)]. The meta-regression of the year of publication showed a significant downward trend (p = 0.01) of the increase in HbA1c compared to the baseline.In this study, the expected placebo effect of Hba1c reduction was not found; instead, higher Hba1c levels were observed in the control groups, although this effect was reduced over the years. Registration: PROSPERO ID CRD42020172797.

Ectonucleotidase activities are altered in serum and platelets of L-NAME-treated rats.

It is well known that hypertension is closely associated to the development of vascular diseases and that the inhibition of nitric oxide biosynthesis by administration of Nomega-Nitro-L-arginine methyl ester hydrochloride(L-NAME) leads to arterial hypertension. In the vascular system, extracellular purines mediate several effects;thus, ADP is the most important platelet agonist and recruiting ag ent, while adenosine, an end product of nucleotide metabolism, is a vasodilator and inhibitor of platelet activation and recruitment. Members of several families of enzymes, known as ectonucleotidases, including E-NTPDases (ecto-nucleoside triphosphate diphosphohydrolase), E-NPP (ecto-nucleotide pyrophosphatase/phosphodiesterase) and 5'-nucleotidase are able to hydrolyze extracellular nucleotides until their respective nucleosides. We investigated the ectonucleotidase activities of serum and platelets from rats made hypertensive by oral administration of L-NAME (30 mg/kg/day for 14 days or 30 mg/kg/day for 14 days plus 7 days of L-NAME washout, in the drinking water) in comparison to normotensive control rats. L-NAME promoted a significant rise in systolic blood pressure from 112 +/- 9.8 to 158 +/- 23 mmHg. The left ventricle weight index (LVWI) was increased in rats treated with L-NAME for 14 days when compared to control animals. In serum samples, ATP, ADP and AMP hydrolysis were reduced by about 27%, 36% and 27%, respectively. In platelets, the decrease in ATP, ADP and AMP hydrolysis was approximately 27%, 24% and 32%, respectively. All parameters recovered after 7 days of L-NAME washout. HPLC demonstrated a reduction in ADP, AMP and hypoxanthine levels by about 64%, 69% and 87%,respectively. In this study, we showed that ectonucleotidase activities are decreased in serum and platelets from L-NAME-treated rats, which should represent an additional risk for the development of hypertension. The modulation of ectonucleotidase activities may represent an approach to antihypertensive therapy via inhibition of spontaneous platelet activation and recruitment, as well as thrombus formation.

Impact of distance education on academic performance in a pharmaceutical care course.

The objective of this study was to compare the performance of pharmacy students from a Pharmaceutical Care course, taught in both distance education (DE) and campus-based formats using active methodologies. For two semesters, students (n = 82) taking the course studied half the subject in the distance education format and half in person. Questionnaires were applied at the beginning of the semester aimed to outline the demographic profile of the students. Their grade in the course was evaluated to determine their performance. The Module 1 (Information on Medication) average on the campus-based was 7.1225 and on DE was 7.5519, (p = 0.117). The Module 2 (Pharmaceutical Services) average on the campus-based was 7.1595 and on distance education was 7.7025, (p = 0.027*). There was a difference in learning outcomes in the Pharmaceutical Care Course between face-to-face and distant education. Therefore, the student performance was better in the distance education module, indicating distance education can be satisfactorily used in Pharmacy Programs.

Estudo comparativo da metodologia ativa "gincana" nas modalidades presencial e à distância em curso de graduação de farmácia / Comparative study of "scavenger hunt" active methodology betweenface-to-face and distance learning in pharmacy undergraduate course

INTRODUÇÃO: O crescimento da educação a distância (EaD) no Brasil tem sido cada vez mais intenso, inclusive em cursos da saúde. OBJETIVOS: Realizar análise comparativa da "Gincana" nas modalidades presencial e a distância. Em 2012, a "Gincana" foi desenvolvida a distância, sendo denominada "Gincana Virtual". MÉTODOS: Equipes foram formadas e tarefas eram formuladas e trocadas entre elas, sendo avaliadas a construção da tarefa, factibilidade, pertinência de conteúdo e resposta. A gincana foi aplicada na modalidade a distância no primeiro semestre 2012 (n=40) e presencial no segundo semestre do mesmo ano (n=42). Foi respondido um questionário final de avaliação, considerando: Metodologia, Material, Tarefas e Considerações. Ainda foi avaliado o desempenho entre as modalidades. RESULTADOS: A "Gincana" apresentou diferença significativa, sendo preferida pelos alunos na modalidade presencial. Conforme os comentários dos alunos, o uso do Fórum síncrono como forma de interação é inovador, porém pode dificultar a interação e o dinamismo da atividade. Por outro lado, incentiva a participação da turma, devido ao fato da EaD diminuir a exposição do aluno. Houve um melhor desempenho acadêmico, na média, na modalidade presencial. CONCLUSÃO: As gincanas promovem um aumento da atenção e da concentração dos estudantes por conta da competição, portanto, a ferramenta de interação da "Gincana Virtual" deve ser interativa e dinâmica, assim como ocorre no presencial.

INTRODUCTION: The growth of distance education (DE) in Brazil has been increasingly intense, including in health courses. OBJECTIVE: To do a comparative analysis between the modalities about assessment of activity and academic performance. "Scavenger Hunt" was developed in Distance Learning (DL) mode in 2012, called "Virtual Scavenger Hunt". METHODS: The "Scavenger Hunt" was applied in DL mode in the first 2012 semester (n=40) and face-to-face in the second semester (n=42). The class was divided into two teams, for the first time the teams formulated tasks and the second time the tasks were exchanged between them. The students answered a final discipline assessment survey, considering Methodology, Collateral, Tasks and Considerations. Yet was assessed the academic performance between the two modes. RESULTS: "Scavenger Hunt", as the Methodology andthe Task was a significant difference, with a preference for the face-to-face kind. As for the comments of the students, the use of synchronous Forum as a means of interaction is innovative, but can cause confusion and slow to update, hindering the interaction and dynamism of activity. On the other hand, it makes the Class participation higher because DL reduces exposure of the student. There was a better academic performance, on average, in the face-to-face mode. CONCLUSION: The educational games promotes increasing students' attention and concentration because of the competition, so the interaction tool "Virtual Scavenger Hunt" should be interactive and dynamic, as well as in the face-to-face class.

L-NAME-treatment alters ectonucleotidase activities in kidney membranes of rats.

AIMS: To investigate the effect of N(omega)-Nitro-L-arginine methyl ester (l-NAME) treatment, known to induce a sustained elevation of blood pressure, on ectonucleotidase activities in kidney membranes of rats. MAIN METHODS: L-NAME (30 mg/kg/day) was administered to Wistar rats for 14 days in the drinking water. Enzyme activities were determined colorimetrically and their gene expression patterns were analyzed by semi-quantitative RT-PCR. The metabolism of ATP and the accumulation of adenosine were evaluated by HPLC in kidney membranes from control and hypertensive rats. PKC phosphorylation state was investigated by Western blot. KEY FINDINGS: We observed an increase in systolic blood pressure from 115+/-12 mmHg (control group) to 152+/-18 mmHg (l-NAME-treated group). Furthermore, the hydrolysis of ATP, ADP, AMP, and p-Nph-5'TMP was also increased (17%, 35%, 27%, 20%, respectively) as was the gene expression of NTPDase2, NTPDase3 and NPP3 in kidneys of hypertensive animals. Phospho-PKC was increased in hypertensive rats. SIGNIFICANCE: The general increase in ATP hydrolysis and in ecto-5'-nucleotidase activity suggests a rise in renal adenosine levels and in renal autoregulatory responses in order to protect the kidney against the threat presented by hypertension.