[Evaluation of a supervised physical exercise program in sedentary patients over 65 years with type 2 diabetes mellitus]. / Evaluación de un programa de ejercicio físico supervisado en pacientes sedentarios mayores de 65 años con diabetes mellitus tipo 2.

OBJECTIVE: To analyze whether an exercise program can modify glycated hemoglobin (HbA1c), blood pressure (BP), body mass index (BMI), lipids, cardiovascular risk profile (CVR), self-perceived health status (SHS), and pharmaceutical expenditure (PE). DESIGN: A randomized, single blind, controlled trial. INTERVENTION: program of supervised aerobic physical exercise. Analysis by intention to treat. LOCATION: Primary Care: 2 rural health areas. Health Area of Navalmoral. Cáceres. Extremadura. Spain. PARTICIPANTS: 100 type 2 diabetic patients, aged 65 to 80 years, sedentary. Distribution: 50% control group (CG) and 50% intervention group (IG). Abandoned 12%. INTERVENTION: monitored aerobic exercise: 40minutes, 2 days/week, 3 months. KEY MEASURES: HbA1c, BP, BMI, lipid, CVR, SHS, PE. Complications during exercise. RESULTS: There were post-intervention differences between groups in HbA1c, BP, BMI, cholesterol and SHS. In the IG, there was a significant decrease in; HbA1c: 0.2±0.4% (95% CI: 0.1 to 0.3), systolic BP: 11.8±8.5mmHg (95% CI: 5.1 to 11.9), BMI: 0.5±1 (95% CI: 0.2 to 0.8), total cholesterol: 14±28.2mg/dl (95% CI: 5.9 to 22.2), LDL: 18.3±28.2mg/dl 95% CI: 10.2 to 26.3), CVR: 6.7±7.7% (95% CI: 4.5 to 8.9), PE: 3.9±10.2 € (95% CI: 0.9 to 6.8), and an increase in SHS; 4.7±5.7 (95% CI: 3 to 6.3). CONCLUSIONS: In diabetics over 65 years, a program of monitored aerobic exercise, of easy implementation, improves HbA1c, BP, cholesterol, CVR, PE, and SHS.

Chemical constituents antioxidant and anticholinesterasic activity of Tabernaemontana catharinensis.

The present work aimed to analyze the alkaloid content of the ethanolic extract of Tabernaemontana catharinensis (Apocynaceae family) and its fractions as well as to evaluate their antioxidant and anticholinesterasic activities. The analyses of the ethanolic extract of T. catharinensis by mass spectrometry allowed identifying the presence of the alkaloids 16-epi-affinine, coronaridine-hydroxyindolenine, voachalotine, voacristine-hydroxyindolenine, and 12-methoxy-n-methyl-voachalotine, as well as an alkaloid with m/z 385.21 whose spectrum suggests a derivative of voacristine or voacangine. The extract and its alkaloid rich fractions showed antioxidant activity, especially those that contain the alkaloid m/z 385.21 or 16-epi-affinine with DPPH scavenging activity (IC50) between 37.18 and 74.69 µg/mL. Moreover, the extract and its fractions exhibited anticholinesterasic activity, particularly the fractions characterized by the presence of 12-methoxy-n-methyl-voachalotine, with IC50 = 2.1 to 2.5 µg/mL. Fractions with 16-epi-affinine combined good antioxidant (IC50 = 65.59 to 74.69 µg/mL) and anticholinesterasic (IC50 = 7.7 to 8.3 µg/mL) activities, representing an option for further studies aimed at treating neurodegenerative diseases.

Average creatinine-urea clearance: revival of an old analytical technique?

Background: Creatinine-based equations such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) are recommended for estimating glomerular filtration rate (eGFR) in clinical practice, but have reduced performance in advanced stages of chronic kidney disease. However, only rarely studies have evaluated the performance of eGFR by measuring the average of the urinary clearances of creatinine and urea (mClUN-cr) compared with the eGFR equations. Methods: This cross-sectional study evaluated the usefulness of mClUN-cr in a population of 855 participants who performed a GFR measurement by urinary inulin clearance. The performance of mClUN-cr was compared with those of CKD-EPI 2009 and CKD-EPI 2021, considering three criteria: bias, precision and accuracy. Results: In the whole sample, the mClUN-cr performed similarly to CKD-EPI equations (2009 and 2021) [precision: 11.5 (95% CI 10.5; 12.5) vs 19.0 (95% CI 17.2; 20.1) and 19.1 (95% CI 17.4; 20.4), and accuracy P30: 97.0 (95% CI 95.8; 98.0) vs 82.0 (95% CI 79.2; 84.4) and 77.2 (95% CI 74.5; 80.0)]. The CKD-EPI equations (2009 and 2021) had the best performance when mGFR was >60 mL/min/1.73 m2. In contrast, the mClUN-cr performed better than others with lowest mGFR values, more noticeable when mGFR was <60 mL/min/1.73 m2. Conclusions: The study described the best performance of mClUN-cr at GFR levels below 60 mL/min/1.73 m2 and a satisfactory result in the overall cohort. The findings point to a role of this tool, especially for estimating GFR in chronic kidney disease patients in developing countries, when reference measurement of GFR is not available.