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BACKGROUND: Occupational therapy (OT) is an effective evidence-based intervention that positively influences stroke patients'independence recovery, leading to new opportunities for better quality of life outcomes. OBJECTIVES: To explore the effectiveness of an early OT intervention program (EOTIPS) in the process of hospital to home discharge after stroke in Spain. MATERIAL AND METHODS: We conducted a prospective, randomized controlled clinical trial that included 60 adults who suffered a stroke and were discharged home. Participants assigned to the experimental group (n = 30) were included in EOTIPS and compared with a control group (n = 30). Evaluations assessed quality of life (Stroke and Aphasia Quality of Life Scale [SAQOL-39]), functional independence (Modified Rankin Scale [mRS], Barthel Index [BI] and Stroke Impact Scale-16 [SIS-16]), perceptual-cognitive skills (Montreal Cognitive Assessment [MoCA]), upper limb function (Fugl Meyer Assessment [FMA]), mobility (Berg Balance Scale [BBS] and Timed Up & Go [TUG]), communication skills (Communicative Activity Log [CAL]) and mood disorders (Beck Depression Inventory-II [BDI-II] and Hamilton Anxiety Scale [HAM-A]); they were completed within two weeks post-stroke and after three months follow-up. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. RESULTS: Participants in the intervention group showed a significant better evolution in the main outcome measure of quality of life (SAQOL-39 p = .029), as well as for independence (mRSp = .004), perceptual-cognitive skills (MoCA p = .012)and symptoms of depression (BDI-II p = .011) compared to the control group. CONCLUSIONS: EOTIPS was effective in improving quality of life, as well as enhancing perceptual-cognitive skills, independence and reducing levels of depression for patients who suffered a stroke in a Spanish cohort and could be considered as an applicable non-pharmacologic therapeutic tool that can lead to patients' positive outcomes after stroke. This study was registered on ClinicalTrials.gov with the identifier NCT04835363.
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Terapia Ocupacional , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Terapia Ocupacional/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/psicologia , Estudos Prospectivos , Espanha , Resultado do TratamentoRESUMO
We compare the social determinants of health (SDOH) and the social determination of health (SDET) from the school of Latin American Social Medicine/Collective Health. Whereas SDET acknowledges how capitalist rule continues to shape global structures and public health concerns, SDOH proffers neoliberal solutions that obscure much of the violence and dispossession that influence contemporary migration and health-disease experiences. Working in simultaneous ethnographic teams, the researchers here interviewed Honduran migrants in their respective sites of Honduras, Mexico, and the United States. These interlocutors connected their experiences of disaster and health-disease to lack of economic resources and political corruption. Accordingly, we provide an elucidation of the liberal and dehumanizing foundations of SDOH by relying on theorizations from Africana philosophy and argue that the social determination of health model better captures the intersecting historical inequalities that structure relationships between climate, health-disease, and violence.
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Antropologia Médica , Determinantes Sociais da Saúde , Humanos , Determinantes Sociais da Saúde/etnologia , México/etnologia , Estados Unidos , Mudança Climática , Honduras/etnologia , Migrantes , Masculino , Feminino , Violência/etnologiaRESUMO
Recovery of rare earth elements (REEs) with trace amount in environmental applications and nuclear energy is becoming an increasingly urgent issue due to their genotoxicity and important role in society. Here, highly efficient recovery of low-concentration REEs from aqueous solutions by an enhanced chemisorption and electrosorption process of oxygen-doped molybdenum disulfide (O-doped MoS2) electrodes is performed. All REEs could be extremely recovered through a chemisorption and electrosorption coupling (CEC) method, and sorption behaviors were related with their outer-shell electrons. Light, medium, and heavy ((La(III), Gd(III), and Y(III)) rare earth elements were chosen for further investigating the adsorption and recovery performances under low-concentration conditions. Recovery of REEs could approach 100% under a low initial concentration condition where different recovery behaviors occurred with variable chemisorption interactions between REEs and O-doped MoS2. Experimental and theoretical results proved that doping O in MoS2 not only reduced the transfer resistance and improved the electrical double layer thickness of ion storage but also enhanced the chemical interaction of REEs and MoS2. Various outer-shell electrons of REEs performed different surficial chemisorption interactions with exposed sulfur and oxygen atoms of O-doped MoS2. Effects of variants including environmental conditions and operating parameters, such as applied voltage, initial concentration, pH condition, and electrode distance on adsorption capacity and recovery of REEs were examined to optimize the recovery process in order to achieve an ideal selective recovery of REEs. The total desorption of REEs from the O-doped MoS2 electrode was realized within 120 min while the electrode demonstrated a good cycling performance. This work presented a prospective way in establishing a CEC process with a two-dimensional metal sulfide electrode through structure engineering for efficient recovery of REEs within a low concentration range.
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Wastewater treatment plants produce solid and semi-solid sludge, which treatment minimises secondary environmental pollution because of wastewater treatment and obtaining new bioproducts. For this reason, in this paper, the co-pyrolysis of biogenic biomasses recovered from a biological reactor with immobilised fungal and bacterial biomass and a tertiary reactor with Chlorella sp. used for dye-contaminated wastewater treatment was carried out. Biogenic biomasses mixed with pine bark allowed the production and characterisation of two types of biochar. The raw material and biochar were on the "in vitro" germination of Lolium sp. seeds, followed by adsorption studies for malachite green (MG) dye using the raw material and the biochar. Results showed that using 60 mg L-1 of a cationic coagulant at pH 6.5 allowed for the recovery of more than 90% of the microalgae after 50 min of processing. Two biochar resulted: BC300, at pH 5.08 ± 0.08 and BC500, at pH 6.78 ± 0.01. The raw material and both biochars were co-inoculated with growth-promoting bacteria; their viabilities ranged from 1.7 × 106 ± 1.0 × 101 to 7.5 × 108 ± 6.0 × 102 CFU g-1 for total heterotrophic, nitrogen-fixing and phosphate-solubilising bacteria. Re-use tests on Lolium sp. seed germination showed that with the post-coagulation effluent, the germination was 100%, while with the biochar, with and without beneficial bacteria, the germination was 98 and 99%, respectively. Finally, BC500 adsorbed the highest percentage of malachite green at pH 4.0, obtaining qecal values of 0.5249 mg g-1 (R2: 0.9875) with the pseudo-second-order model. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-023-03766-x.
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BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer's disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD. OBJECTIVE: We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia. METHODS: We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (nâ=â40) that received three times a week one session per day of 20 minutes in the NSC and a control group (nâ=â37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis. RESULTS: Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, pâ=â0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, pâ=â0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, pâ=â0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, pâ=â0.003). CONCLUSIONS: The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.
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Doença de Alzheimer , Demência , Humanos , Método Simples-Cego , Demência/diagnóstico , Doença de Alzheimer/diagnóstico , Casas de Saúde , Sintomas Comportamentais/etiologia , Sintomas Comportamentais/terapia , Sintomas Comportamentais/diagnósticoRESUMO
Introducción: La pandemia de la COVID-19 ha generado problemas de salud física y mental en los universitarios. Objetivos: Determinar la relación entre nivel de actividad física y estado de ánimo en estudiantes universitarios durante el confinamiento por la COVID-19. Métodos: Participaron 215 estudiantes universitarios, edad 22,09 ± 2,61 (108 mujeres y 107 hombres) durante el confinamiento por la COVID-19. Fueron aplicados instrumentos en formato digital durante el mes de junio del año 2020. El nivel de actividad física se evaluó utilizando el Cuestionario Internacional de Actividad Física (IPAQ), forma corta, y el estado de ánimo se evaluó con la Escala de Valoración del Estado de Ánimo (EVEA). Resultados: Estado de ánimo alegría presentó una correlación positiva significativa con todas las variables de actividad física, excepto con tiempo sentado. Estado de ánimo tristeza-depresión presentó una correlación negativa con equivalente metabólico de actividad física vigorosa (r -0,201; p= 0,003) y equivalente metabólico total (r -0,172; p= 0,011). Estado de ánimo ansiedad se correlacionó negativamente con equivalente metabólico de actividad física vigorosa (r -0,163; p= 0,017) y equivalente metabólico total (r -0,162; p= 0,018). Conclusiones: El nivel de actividad física se relaciona positivamente con el estado de ánimo, principalmente con el nivel de alegría, sin embargo, estas correlaciones presentan un tamaño del efecto pequeño(AU)
Introduction: The COVID-19 pandemic has generated physical and mental health problems in university students. Objectives: To determine the relationship between physical activity level and mood in university students during COVID-19 confinement. Methods: 215 university students aged 22.09 ± 2.61 (108 women and 107 men) participated during the confinement due to the COVID-19 pandemic. Instruments in digital format were applied during the month of June 2020. Physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ) short form and mood was assessed using the Mood Rating Scale (EVEA). Results: Mood joy presents a significant positive correlation with all variables of physical activity, except with sitting time. Sadness-depression mood showed a negative correlation with metabolic equivalent of vigorous physical activity (r -0.201; p= 0.003) and total metabolic equivalent (r -0.172; p= 0.011). Mood anxiety was negatively correlated with metabolic equivalent of vigorous physical activity (r -0.163; p= 0.017) and total metabolic equivalent (r -0.162; p= 0.018). Conclusions: The level of physical activity is positively related to mood, mainly with the level of joy, however, these correlations have a small effect size(AU)
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Humanos , Masculino , Feminino , Adulto , Exercício Físico , Quarentena/métodos , Saúde Mental , Afeto , Estudantes , Estudos Transversais , Estudo Observacional , COVID-19RESUMO
BACKGROUND: Older people achieve lower levels of antibody titers than younger populations after Covid-19 vaccination and show a marked waning humoral immunity over time, likely due to the senescence of the immune system. Nevertheless, age-related predictive factors of the waning humoral immune response to the vaccine have been scarcely explored. In a cohort of residents and healthcare workers from a nursing home that had received two doses of the BNT162b2 vaccine, we measured specific anti-S antibodies one (T1), four (T4), and eight (T8) months after receiving the second dose. Thymic-related functional markers, including thymic output, relative telomere length, and plasma thymosin-α1 levels, as well as immune cellular subsets, and biochemical and inflammatory biomarkers, were determined at T1, and tested for their associations with the magnitude of the vaccine response (T1) and the durability of such response both, at the short- (T1-T4) and the long-term (T1-T8). We aimed to identify age-related factors potentially associated with the magnitude and persistence of specific anti-S immunoglobulin G (IgG)-antibodies after COVID-19 vaccination in older people. RESULTS: Participants (100% men, n = 98), were subdivided into three groups: young (< 50 years-old), middle-age (50-65 years-old), and older (≥65 years-old). Older participants achieved lower antibody titers at T1 and experienced higher decreases in both the short- and long-term. In the entire cohort, while the magnitude of the initial response was mainly associated with the levels of homocysteine [ß (95% CI); - 0.155 (- 0.241 to - 0.068); p = 0.001], the durability of such response at both, the short-term and the long-term were predicted by the levels of thymosin-α1 [- 0.168 (- 0.305 to - 0.031); p = 0.017, and - 0.123 (- 0.212 to - 0.034); p = 0.008, respectively]. CONCLUSIONS: Higher plasma levels of thymosin-α1 were associated with a lower waning of anti-S IgG antibodies along the time. Our results suggest that plasma levels of thymosin-α1 could be used as a biomarker for predicting the durability of the responses after COVID-19 vaccination, possibly allowing to personalize the administration of vaccine boosters.
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The genus Metarhizium has an increasingly important role in the development of Integrated Pest Control against Tephritid fruit flies in aerial sprays targeting adults and soil treatments targeting preimaginals. Indeed, the soil is considered the main habitat and reservoir of Metarhizium spp., which may be a plant-beneficial microorganism due to its lifestyle as an endophyte and/or rhizosphere-competent fungus. This key role of Metarhizium spp. for eco-sustainable agriculture highlights the priority of developing proper monitoring tools not only to follow the presence of the fungus in the soil and to correlate it with its performance against Tephritid preimaginals but also for risk assessment studies for patenting and registering biocontrol strains. The present study aimed at understanding the population dynamics of M. brunneum strain EAMb 09/01-Su, which is a candidate strain for olive fruit fly Bactrocera oleae (Rossi, 1790) preimaginal control in the soil, when applied to the soil at the field using different formulations and propagules. For this, strain-specific DNA markers were developed and used to track the levels of EAMb 09/01-Su in the soil of 4 field trials. The fungus persists over 250 days in the soil, and the levels of the fungus remained higher when applied as an oil-dispersion formulation than when applied as a wettable powder or encapsulated microsclerotia. Peak concentrations of EAMb 09/01-Su depend on the exogenous input and weakly on environmental conditions. These results will help us to optimize the application patterns and perform accurate risk assessments during further development of this and other entomopathogenic fungus-based bioinsecticides.
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I address the privatization of public health care services in Honduras by focusing on one family's experiences using both private and public health services. I juxtapose their increasing use of private health care services, over public services, against sustained and consistent episodes of health sector reform culminating in protests against decrees that sought to further restructure the Ministry of Health during early 2019. By complementing the concept of "privatization by attrition" with "institutional bad faith," I argue that the increased use of private health care may be understood as privatization by coercion.
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Reforma dos Serviços de Saúde , Privatização , Humanos , Honduras , Antropologia Médica , Atenção à SaúdeRESUMO
BACKGROUND: Older patients managed with intensive antidiabetic therapy are more likely to be harmed. Our study's primary endpoint was to analyze the safety and efficacy of linagliptin in combination with basal insulin versus basal-bolus insulin in patients with 75 years of age or older hospitalized in medicine and surgery departments in real-world clinical practice. METHODS: We retrospectively enrolled non-critically patients ≥75 years with type 2 diabetes admitted to medicine and non-cardiac surgery departments with admission glycated hemoglobin <8%, admission blood glucose <240 mg/dL, and without at-home injectable therapies managed with our hospital's antihyperglycemic protocol (basal-bolus or linagliptin-basal regimens) between January 2016 and December 2018. To match each patient who started on the basal-bolus regimen with a patient who started on the linagliptin-basal regimen, a propensity matching analysis was used. RESULTS: Postmatching, 198 patients were included in each group. There were no significant differences in mean daily blood glucose levels after admission (P=0.203); patients with mean blood glucose 100-140mg/dL (P=0.134), 140-180mg/dL (P=0.109), or >200mg/dL (P=0.299); and number and day of treatment failure (P=0.159 and P=0.175, respectively). The total insulin dose and the number of daily injections were significantly lower in the linagliptin-basal group (both, P<0.001). Patients on the basal-bolus insulin regimen had more total hypoglycemic events than patients on the linagliptin-basal insulin regimen (P<0.001). CONCLUSIONS: The linagliptin-basal insulin regimen was an effective alternative with fewer hypoglycemic events and daily insulin injections than intensive basal-bolus insulin in very old patients with type 2 diabetes with mild-to-moderate hyperglycemia treated at home without injectable therapies.
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Diabetes Mellitus Tipo 2 , Hipoglicemia , Humanos , Linagliptina/efeitos adversos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glicemia , Estudos Retrospectivos , Hipoglicemia/induzido quimicamente , Hipoglicemia/tratamento farmacológico , Resultado do Tratamento , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêuticoRESUMO
The motion of colloidal species on an out-of-thermal equilibrium surface is studied experimentally by optical microscopy. Water droplets of size in the micrometer range, spontaneously formed at a spherical-like interface between water and oil, are the colloidal species. The interface appears as a convex meniscus when putting water on oil with an added nonionic surfactant. Since the water density is greater than that of oil, the interface is produced into the oil. The spontaneously formed water droplets move attached to the interface while still growing from submicrometer sizes to a few micrometers. Although the dynamic nature of the process, with both the interface and the particles still changing, produces heterogeneities in the system, anomalous diffusion was not observed. The motion of the droplets has a well-identified Brownian component with a Gaussian distribution of steps due to the thermal agitation of the media surrounding the droplets and a drift component due to the effect of gravity.
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Stroke is one of the main causes of disability in adulthood. Its rehabilitation is a complex process that requires a multidisciplinary team of specialised professionals. The main goal of this review was to determine the impact of occupational therapy intervention post-stroke on the home discharge process. A systematic search was carried out of the following databases: Pubmed, Web of Science, PsycINFO, Scopus, Otseeker, and Dialnet. A screening was performed taking into account the type of article, including exclusively RCT, and type of intervention, only including interventions within the scope of occupational therapy that take place during the process of hospital discharge post-stroke. A total of 2285 citations were identified in the search from which 13 articles met the inclusion criteria. Comparisons of the groups indicated that early occupational therapy intervention during the process of hospital discharge can be effective in terms of functional recovery and can lead to the caregiver seeing improvements in self-efficacy and fatigue. In addition, the inclusion of a caregiver in the intervention influences the patient's adherence to treatment, leading to a reduction in the cost of treatment and rehabilitation.
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In this work, we report measurements of the mean squared angular and translational displacements of a colloidal dumbbell immersed in a viscoelastic fluid using digital microscopy. From the mean squared displacements, we obtain the mechanical properties of the media. Both angular and translational motions provide the same viscoelastic complex modulus and agree with that obtained from the translational motion of a spherical probe particle.
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Using two plays written by girls and boys, I discuss how children from low-income urban neighborhoods in Honduras reflected on the slow process of privatization of the Honduran national health system. The children peppered their narratives with motifs suggestive of ongoing processes of material and social deterioration under capitalism, while paying attention to the different social mechanisms through which care could be mobilized. The plays speak to the value of incorporating children's perspectives on topics of health-disease processes that circle political, economic, and social tensions, and the importance of incorporating new ways of producing knowledge through artistic mediums.
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Capitalismo , Pobreza , Antropologia Médica , Criança , Feminino , Humanos , Masculino , Narração , Características de ResidênciaRESUMO
Cells are dynamic systems with complex mechanical properties, regulated by the presence of different species of proteins capable to assemble (and disassemble) into filamentous forms as required by different cells functions. Giant unilamellar vesicles (GUVs) of DMPC (1,2-dimyristoyl-sn-glycero-3-phosphocholine) are systems frequently used as a simplified model of cells because they offer the possibility of assaying separately different stimuli, which is no possible in living cells. Here we present a study of the effect of acting protein on mechanical properties of GUVs, when the protein is inside the vesicles in either monomeric G-actin or filamentous F-actin. For this, rabbit skeletal muscle G-actin is introduced inside GUVs by the electroformation method. Protein polymerization inside the GUVs is promoted by adding to the solution MgCl2 and the ion carrier A23187 to allow the transport of Mg+2 ions into the GUVs. To determine how the presence of actin changes the mechanical properties of GUVs, the vesicles are deformed by the application of an AC electric field in both cases with G-actin and with polymerized F-actin. The changes in shape of the vesicles are characterized by optical microscopy and from them the bending stiffness of the membrane are determined. It is found that G-actin has no appreciable effect on the bending stiffness of DMPC GUVs, but the polymerized actin makes the vesicles more rigid and therefore more resistant to deformations. This result is supported by evidence that actin filaments tend to accumulate near the membrane.
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Actinas/química , Dimiristoilfosfatidilcolina/química , Eletricidade , Lipossomas Unilamelares/química , Citoesqueleto de Actina/química , Actinas/metabolismo , Animais , Calcimicina/química , Cloreto de Magnésio/química , Cloreto de Magnésio/metabolismo , Microscopia , Músculo Esquelético/metabolismo , Coelhos , Tensão Superficial , Lipossomas Unilamelares/metabolismo , ViscosidadeRESUMO
BACKGROUND: Sarcopenia is defined as the loss of muscle mass and strength. Despite the seriousness of this disease, a single diagnostic criterion has not yet been established. Few studies have reported the prevalence of sarcopenia globally, and there is a high level of heterogeneity between studies, stemmed from the diagnostic criteria of sarcopenia and the target population. The aims of this systematic review and meta-analysis were (i) to identify and summarize the diagnostic criteria used to define sarcopenia and severe sarcopenia and (ii) to estimate the global and region-specific prevalence of sarcopenia and severe sarcopenia by sociodemographic factors. METHODS: Embase, MEDLINE, and Web of Science Core Collections were searched using relevant MeSH terms. The inclusion criteria were cross-sectional or cohort studies in individuals aged ≥18 years, published in English, and with muscle mass measured using dual-energy x-ray absorptiometry, bioelectrical impedance, or computed tomography (CT) scan. For the meta-analysis, studies were stratified by diagnostic criteria (classifications), cut-off points, and instruments to assess muscle mass. If at least three studies reported the same classification, cut-off points, and instrument to measure muscle mass, they were considered suitable for meta-analysis. Following this approach, 6 classifications and 23 subgroups were created. Overall pooled estimates with inverse-variance weights obtained from a random-effects model were estimated using the metaprop command in Stata. RESULTS: Out of 19 320 studies, 263 were eligible for the narrative synthesis and 151 for meta-analysis (total n = 692 056, mean age: 68.5 years). Using different classifications and cut-off points, the prevalence of sarcopenia varied between 10% and 27% in the studies included for meta-analysis. The highest and lowest prevalence were observed in Oceania and Europe using the European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2, respectively. The prevalence ranged from 8% to 36% in individuals <60 years and from 10% to 27% in ≥60 years. Men had a higher prevalence of sarcopenia using the EWGSOP2 (11% vs. 2%) while it was higher in women using the International Working Group on Sarcopenia (17% vs. 12%). Finally, the prevalence of severe sarcopenia ranged from 2% to 9%. CONCLUSIONS: The prevalence of sarcopenia and severe sarcopenia varied considerably according to the classification and cut-off point used. Considering the lack of a single diagnostic for sarcopenia, future studies should adhere to current guidelines, which would facilitate the comparison of results between studies and populations across the globe.
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Sarcopenia , Absorciometria de Fóton , Adolescente , Adulto , Idoso , Impedância Elétrica , Feminino , Força da Mão , Humanos , Masculino , Prevalência , Sarcopenia/diagnóstico , Sarcopenia/epidemiologiaRESUMO
BACKGROUND: There is little evidence on the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in older patients with heart failure. This work analyzed the clinical efficacy and safety of empagliflozin continuation in very old patients with type 2 diabetes hospitalized for acute decompensated heart failure. METHODS: We conducted a real-world observational study between September 2015 and June 2021. Patients ≥80 years were grouped by antihyperglycemic regimen: (1) continuation of preadmission empagliflozin combined with basal insulin regimen and (2) conventional basal-bolus insulin regimen. A propensity score matching analysis matched patients in both groups in a 1:1 manner. The primary outcome was differences in clinical efficacy measured by the visual analogue scale dyspnea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints such as adverse events, worsening heart failure, discontinuation of empagliflozin, length of hospital stay, and in-hospital deaths were also analyzed. RESULTS: After propensity score matching, 79 patients were included in each group. At discharge, the N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were lower in the empagliflozin continuation group than in the insulin group (1699 ± 522 vs. 2303 ± 598 pg/ml, p = 0.021). Both the diuretic response and cumulative urine output were greater in patients treated with empagliflozin than in patients with basal-bolus insulin during the hospitalization (at discharge: -0.14 ± -0.06 vs. -0.24 ± -0.10, p = 0.044; and 16,100 ± 1510 vs. 13,900 ± 1220 ml, p = 0.037, respectively). No differences were observed in safety outcomes. CONCLUSIONS: In very old patients with type 2 diabetes hospitalized for acute heart failure, continuing preadmission empagliflozin reduced NT-proBNP levels and increased diuretic response and urine output compared to a basal-bolus insulin regimen. The empagliflozin regimen also showed a good safety profile.
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Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Insulinas , Inibidores do Transportador 2 de Sódio-Glicose , Idoso , Compostos Benzidrílicos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diuréticos/uso terapêutico , Glucosídeos , Insuficiência Cardíaca/tratamento farmacológico , Hospitalização , Humanos , Insulinas/uso terapêutico , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversosRESUMO
Background: Dysbiosis and mucin depletion are related with intestinal barrier dysfunction and seems to be an early pathophysiological event in inflammatory bowel disease (IBD). The objective of this work is to study these parameters in the natural history of colitis in IL-10 deficient mice (IL-10-/-). Methods: Wild type (WT) and IL-10-/-. mice were followed until sacrifice at 3, 5, 10, 20, 57, and 70 weeks. Body weight, colonic weight/length ratio and in vivo intestinal permeability were registered. Expression of inflammatory and adhesion molecules in the colon was explored by qPCR as Mucin-2 (MUC-2) and molecules involved in goblet cell maturation Interleukin-18 (IL-18) and WAP Four-Disulfide Core Domain 2 (WFDC2), the endoplasmic reticulum stress markers X-box-binding protein (Xbp-1) and Reticulon-4B (RTN-4B). Bacterial composition in feces and colonic mucosa was determined by massive sequencing of the V3-V4 regions of 16S rDNA gene. Results: IL-10-/- mice showed histological inflammation at weeks 20 and 57, but most notably the intestinal permeability was significantly higher from week 10. Concordantly, the number of goblet cells and expression of MUC-2, IL-18, WFDC2 and Xbp-1 were significantly lower in KO from week 10. Nevertheless, no significant differences were found in the mRNA expression of MUC-2 or Xbp-1 between both groups-derived colon organoids. Significant bacterial differences began at week 5, being the Akkermansia deficiency in KO the most relevant result. Conclusion: Gut microbiota alterations and mucin depletion are associated with early intestinal barrier dysfunction and precede overt gut inflammation in this animal model of IBD.