Organizational intervention to improve access to retinopathy screening for patients with diabetes mellitus: health care service improvement project in a tertiary public hospital.

INTRODUCTION: The aim of this study was to improve the access to diabetic retinopathy (DR) screening with retinographies in a tertiary care center through a process conducted by an interdisciplinary group driven by a nurse. MATERIALS AND METHODS: This is a quality improvement study that evaluated the flow for DR screening conducted by an interdisciplinary group using the Plan-Do-Study-Act methodology. As a result measure, we assessed the quantity of retinographies performed after the project implementation, the proportion of patients who presented abnormal retinographies, and the proportion of patients referred to a specialist. RESULTS: The new patient screening flow and the reinforcement of available human resources led to an increase in the number of retinographies performed and screened patients. A total of 1184 retinographies were conducted, and it was possible to observe DR alterations in 37.8 % patients, of which only 6 % needed to be referred to the DR reference center. CONCLUSIONS: This study showed a significant increase in the number of retinographies performed. The Plan-Do-Study-Act methodology was an important tool to improve the flow of patient access to fundus images, helping to consistently and continuously improve these processes.

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.

A Study on the Anti-NF-κB, Anti-Candida, and Antioxidant Activities of Two Natural Plant Hormones: Gibberellin A4 and A7.

INTRODUCTION: Gibberellins (GA) are terpenoids that serve as important plant hormones by acting as growth and response modulators against injuries and parasitism. In this study, we investigated the in vitro anti-NF-κB, anti-Candida, and antioxidant activity of gibberellin A4 (GA4) and A7 (GA7) compounds, and further determined their toxicity in vivo. METHODS: GA4 and GA7 in vitro toxicity was determined by MTT method, and nontoxic concentrations were then tested to evaluate the GA4 and GA7 anti-NF-κB activity in LPS-activated RAW-luc macrophage cell culture (luminescence assay). GA4 in silico anti-NF-κB activity was evaluated by molecular docking with the software "AutoDock Vina", "MGLTools", "Pymol", and "LigPlot+", based on data obtained from "The Uniprot database", "Protein Data Bank", and "PubChem database". The GA4 and GA7 in vitro anti-Candida effects against Candida albicans (MYA 2876) were determined (MIC and MFC). GA7 was also evaluated regarding the viability of C. albicans preformed biofilm (microplate assay). In vitro antioxidant activity of GA4 and GA7 was evaluated against peroxyl radicals, superoxide anions, hypochlorous acid, and reactive nitrogen species. GA4 and GA7 in vivo toxicity was determined on the invertebrate Galleria mellonella larvae model. RESULTS: Our data show that GA4 at 30 µM is nontoxic and capable of reducing 32% of the NF-κB activation on RAW-luc macrophages in vitro. In vitro results were confirmed via molecular docking assay (in silico), since GA4 presented binding affinity to NF-κB p65 and p50 subunits. GA7 did not present anti-NF-κB effects, but exhibited anti-Candida activity with low MIC (94 mM) and MFC (188 mM) values. GA7 also presented antibiofilm properties at 940 mM concentration. GA4 did not present anti-Candida effects. Moreover, GA4 and GA7 showed antioxidant activity against peroxyl radicals, but did not show scavenging activity against the other tested radicals. Both compounds did not affect the survival of G. mellonella larvae, even at extremely high doses (10 g/Kg). CONCLUSION: Our study provides preclinical evidence indicating that GA4 and GA7 have a favorable low toxicity profile. The study also points to GA4 and GA7 interference with the NF-κB via, anti-Candida activity, and a peroxyl radical scavenger, which we argue are relevant biological effects.

Early neurovascular retinal changes detected by swept-source OCT in type 2 diabetes and association with diabetic kidney disease.

PURPOSE: To evaluate retinal thickness and capillary density in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD) using swept-source optical coherence tomography (SS-OCT). METHODS: A cross-sectional study was conducted with T2D patients with mild or no diabetic retinopathy (DR) and nondiabetic controls. Inner retinal layer thickness was measured with SS-OCT. Retinal capillary density and the foveal avascular zone (FAZ) were measured with SS-OCT angiography (OCTA). SS-OCT parameters were compared in patients with and without diabetic kidney disease (DKD) and nondiabetic controls. RESULTS: 131 DKD eyes showed decreased ganglion cell layer plus (GCL+) (p = 0.005 TI; p = 0.022 I), retinal nerve fiber layer (RNFL) (p = 0.003), and central retinal thickness (CRT) (p = 0.032), as well as foveal avascular zone (FAZ) enlargement (p = 0.003) and lower capillary density in the superficial vascular plexus (p = 0.016, central quadrant), compared to controls. No statistically significant changes were found between diabetic patients without significant DKD and controls. CONCLUSION: Our findings suggest early neurovascular damage in patients with T2D; these changes were more significant in patients with DKD. Larger longitudinal studies are warranted to determine the role of early neurovascular damage in the pathophysiology of severe DR.

Forest fires and deforestation in the central Amazon: Effects of landscape and climate on spatial and temporal dynamics.

Forest fires and deforestation are the main threats to the Amazon forest. Extreme drought events exacerbate the impact of forest fire in the Amazon, and these drought events are predicted to become more frequent due to climate change. Fire escapes into the forest from agriculture and pasture areas. We assessed the potential drivers of deforestation and forest fires in the central Brazilian Amazon and show that over a period of 31 years (1985-2015) forest fires occurred only in years of extreme drought induced by El Niño (1997, 2009 and 2015). The association of forest fires with strong El Niños shows the vulnerability of forest to climate change. The areas deforested were closely associated with navigable rivers: 62% of the total deforestation from 2000 to 2018 was located within the 2 km of rivers. There was a notable increase in deforestation and forest fire during the 2015 El Niño in comparison to previous years. Only a small part of the forest that burned was deforested in the years following the wildfires: 7% (1997), 3% (2009) and 1.5% (2015). Forest close to roads, rivers and established deforestation is susceptible to deforestation and fire since these areas are attractive for agriculture and pasture. Indigenous land was shown to be important in protecting the forest, while rural settlement projects attracted both forest fire and deforestation. Of the total area in settlement projects, 40% was affected by forest fires and 17% was deforested. Rivers are particularly important for deforestation in this part of Amazonia, and efforts to protect forest along the rivers are therefore necessary. The ability to predict where deforestation and fires are most likely to occur is important for designing policies for preventative actions.

Wildfires as a major challenge for natural regeneration in Atlantic Forest.

The natural regeneration management is a good strategy of ecological restoration of the Atlantic Forest, one of the most devastated biomes on the planet. However, the frequent occurrence of wildfires is one of the challenges to the success of this method. The objective of this study was to evaluate the effects of wildfires on forest dynamics in Atlantic Forest. The studied area was explored during the coffee cycle when plantations replaced primary forests. We used remote sensing data to analyze the forest dynamics over a period of 50 years (1966-2016). We used the INPE burn database to find the occurrence of hot spots from 1998 to 2016. During this period, we selected the years most affected by the fires for the identification of fire scars using the Normalized Burn Ratio spectral index. From this set of information, we used the methodology of weights of evidence to relate forest dynamics and wildfire events with biophysical and anthropic variables. The results showed that in 1966 the forest area accounted for 8.01% of the land cover, and in 2016 this number rose to 18.55% due to the spontaneous natural regeneration process. The regenerating areas were mainly related to the proximity of the remaining fragments and the portions of the landscape receiving the least amount of global solar radiation. The proximity to urban areas, roads and highways, damaged regeneration and favored both deforestation and wildfire events. Fire scars preferentially occur where there is greater sun exposure. It is possible to observe a negative correlation between the natural regeneration process and the fire scars. We concluded that fire severity is one of the factors that shape the landscape of the region while slowing the regeneration process in preferential areas.