Pharmaceutical targeting of the cannabinoid type 1 receptor impacts the crosstalk between immune cells and islets to reduce insulitis in humans.

AIMS/HYPOTHESIS: Insulitis, a hallmark of inflammation preceding autoimmune type 1 diabetes, leads to the eventual loss of functional beta cells. However, functional beta cells can persist even in the face of continuous insulitis. Despite advances in immunosuppressive treatments, maintaining functional beta cells to prevent insulitis progression and hyperglycaemia remains a challenge. The cannabinoid type 1 receptor (CB1R), present in immune cells and beta cells, regulates inflammation and beta cell function. Here, we pioneer an ex vivo model mirroring human insulitis to investigate the role of CB1R in this process. METHODS: CD4+ T lymphocytes were isolated from peripheral blood mononuclear cells (PBMCs) from male and female individuals at the onset of type 1 diabetes and from non-diabetic individuals, RNA was extracted and mRNA expression was analysed by real-time PCR. Single beta cell expression from donors with type 1 diabetes was obtained from data mining. Patient-derived human islets from male and female cadaveric donors were 3D-cultured in solubilised extracellular matrix gel in co-culture with the same donor PBMCs, and incubated with cytokines (IL-1ß, TNF-α, IFN-γ) for 24-48 h in the presence of vehicle or increasing concentrations of the CB1R blocker JD-5037. Expression of CNR1 (encoding for CB1R) was ablated using CRISPR/Cas9 technology. Viability, intracellular stress and signalling were assayed by live-cell probing and real-time PCR. The islet function measured as glucose-stimulated insulin secretion was determined in a perifusion system. Infiltration of immune cells into the islets was monitored by microscopy. Non-obese diabetic mice aged 7 weeks were treated for 1 week with JD-5037, then euthanised. Profiling of immune cells infiltrated in the islets was performed by flow cytometry. RESULTS: CNR1 expression was upregulated in circulating CD4+ T cells from individuals at type 1 diabetes onset (6.9-fold higher vs healthy individuals) and in sorted islet beta cells from donors with type 1 diabetes (3.6-fold higher vs healthy counterparts). The peripherally restricted CB1R inverse agonist JD-5037 arrested the initiation of insulitis in humans and mice. Mechanistically, CB1R blockade prevented islet NO production and ameliorated the ATF6 arm of the unfolded protein response. Consequently, cyto/chemokine expression decreased in human islets, leading to sustained islet cell viability and function. CONCLUSIONS/INTERPRETATION: These results suggest that CB1R could be an interesting target for type 1 diabetes while highlighting the regulatory mechanisms of insulitis. Moreover, these findings may apply to type 2 diabetes where islet inflammation is also a pathophysiological factor. DATA AVAILABILITY: Transcriptomic analysis of sorted human beta cells are from Gene Expression Omnibus database, accession no. GSE121863, available at https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSM3448161 .

Modificación de conducta en paciente diabética tras educación terapéutica / Behaviour modification in a female diabetic patient after therapeutic education

Según la Organización Mundial de la Salud (OMS), el número de personas diagnosticadas de diabetes ha pasado de ser de 108 millones, en 1980, a 422 millones, en 2014, habiendo aumentado, así mismo, la prevalencia mundial en adultos, mayores de 18 años, del 4,7% en 1980, al 8,5% en 2014. La situación en España es que el 12,6% de la población tiene intolerancia a la glucosa o glucosa basal alterada, situaciones que se consideran prediabéticas. Respecto a la diabetes tipo 1, supone entre el 5 y el 1% del total de personas con diabetes y un 13,8% de los españoles mayores de 18 años tiene diabetes tipo 2. El tratamiento de la diabetes es complejo y exige una participación activa de las personas afectadas, que tienen el derecho y el deber de tomar importantes decisiones sobre sus cuidados y tratamiento. La educación para la salud es esencial en el abordaje terapéutico de las personas con diabetes, ya que mejora el control metabólico y reduce tanto las complicaciones agudas y crónicas como la hospitalización. El objetivo de este artículo es presentar el caso clínico de una paciente diagnosticada de diabetes mellitus tipo 2, que empeoró tras un periodo de incumplimiento de tratamiento. Se elabora el plan de cuidados enfermeros basado en las necesidades básicas descritas por V. Henderson y con el lenguaje taxonómico de Enfermería NANDA-NOC-NIC

According to the World Health Organization (WHO), the number of persons diagnosed with diabetes has increased from 108 million in 1980 to 422 million in 2014; at the same time, the world prevalence in adults >18-year-old has also increased from 4.7% in 1980 to 8.5% in 2014. Currently in Spain, 12.6% of the population presents intolerance to glucose or altered basal glucose levels, situations considered as pre-diabetes. Type 1 diabetes represents between 5 and 1% of all diabetics, while 13.8% of the >18-year-old Spanish population suffers Type 2 diabetes. The treatment for diabetes is complex and demands active involvement by patients, who have the right and the duty to make major decisions about their care and treatment. Health education is essential in their treatment approach, because it will improve metabolic control and reduce both the acute and chronic complications, as well as the need for hospitalization. The objective of this article is to present the case report of a female patient diagnosed with Type 2 diabetes mellitus, who worsened after a period of lack of treatment adherence. The nursing care plan was prepared on the basis of the basic needs described by V. Henderson, and with the NANDA-NOC-NIC nursing taxonomy terminology

Abordaje de un paciente oncológico y su familia / Approach for an oncology patient and her family

Caso clínico de una paciente de 49 años de edad, con oligofrenia y diagnosticada de linfoma de Hodgkin en estado avanzado. El avance de la enfermedad, junto con la situación familiar actual, ha provocado la aparición de un afrontamiento familiar comprometido. Dado que la enfermedad está en progresión se decide incluir a la paciente en el proceso de cuidados paliativos, con un nivel de complejidad media. La paciente, portadora de un catéter venoso central con reservorio subcutáneo (Port-A-Cath®), precisa extracciones sanguíneas continuas, así como transfusiones de repetición. El seguimiento es llevado a cabo tanto por el equipo de cuidados paliativos domiciliarios como por el Servicio Hospitalario de Hematología y el equipo de Atención Primaria (enfermera gestora de casos, enfermera y médico de familia). Puesto que son múltiples los profesionales implicados en este proceso, se precisa de una buena coordinación con el resto de profesionales sanitarios, con el objetivo de que la paciente reciba todos los cuidados necesarios y de que lleve una vida lo más digna posible y libre de sufrimiento

A clinical case of a 49-year-old female patient, mentally handicapped and with a diagnosis of advanced Hodgkin’s Lymphoma. The progression of the disease, together with the current situation of her family, has led to the development of compromised family coping. Given that the disease is progressing, it is decided to include the patient in the palliative care process, with an intermediate level of complexity. The patient has a central venous catheter with subcutaneous reservoir (Port-A-Cath®), requires continuous blood extractions, and also repeat transfusions. Follow-up is conducted by the Home Palliative Care Team as well as by the Hospital Haematology Department and the Primary Care team (nurse case manager, nurse, and GP). The involvement of multiple healthcare professionals in this process requires good coordination between all of them, with the objective of providing all necessary care to the patient, so that she can lead a life as dignified as possible and free of suffering

Gestión en Consulta de Enfermería, en Atención Primaria, del paciente hipertenso y en riesgo cardiovascular. Propuesta de manejo de la MAPA y AMPA / Management in the nursing surgery of primary care for patients with high blood pressure or with a cardiovascular risk. Suggestion for the use the APM and SMAP

Objetivo principal. Analizar la necesidad de crear y gestionar una consulta enfermera en Atención Primaria dirigida exclusivamente a la detección, seguimiento y derivación del paciente en riesgo cardiovascular e hipertenso. Metodología. Haciendo uso de la evidencia científica disponible, considerar las ventajas de la puesta en práctica de un sistema de atención enfermera al paciente en riesgo cardiovascular que contenga los siguientes puntos principales: 1) Valoración del riesgo; 2) Estrategias de intervenciones enfermeras y actividades; 3) Registro correcto en la historia única de salud del usuario; 4) Seguimiento. Resultados principales. Homogeneizar las actividades enfermeras dentro de la práctica clínica del paciente con riesgo cardiovascular en Atención Primaria, evitar la inercia clínica y conseguir un buen seguimiento del paciente con hipertensión arterial. Conclusión principal. La puesta en práctica de un sistema protocolizado y estandarizado enfermero mejora el control y la adherencia al tratamiento del paciente en riesgo cardiovascular e hipertenso (AU)

Objective. Analyze the necessity of creating and managing a nursing surgery in Primary Care focused exclusively on the discovery, following up and derivation in the cardiovascular risk patient. Methods. Making use of the available Scientific evidence, consider the advantages of putting into practice a system for a nurse to attend the necessities of a patient with a cardiovascular risk taking into consideration the following: 1) Estimating the risk; 2) Stratagies for nursing supervision and activities; 3) The correct registration of medical diagnosis of the patient; 4) Monitoring. Results. To enable nurses to treat cardiovascular patients in Primary Care, to reduce the time the patient would have to wait to be attended and to supervise the patient’s progress. Conclusions. Making it possible for nurses to use the same registered standard system for controlling the treatment of cardiovascular patients (AU)

[MANAGEMENT IN THE NURSING SURGERY OF PRIMARY CARE FOR PATIENTS WITH HIGH BLOOD PRESSURE OR WITH A CARDIOVASCULAR RISK. SUGGESTION FOR THE USE OF THE APM AND SMAP]. / Gestión en Consulta de Enfermería, en Atención Primaria, del paciente hipertenso y en riesgo cardiovascular. PROPUESTA DE MANEJO DE LA MAPA Y AMPA.

OBJECTIVE: Analyze the necessity of creating and managing a nursing surgery in Primary Care focused exclusively on the discovery, following up and derivation in the cardiovascular risk patient. METHODS: Making use of the available Scientific evidence, consider the advantages of putting into practice a system for a nurse to attend the necessities of a patient with a cardiovascular risk taking into consideration the following: 1) Estimating the risk; 2) Stratagies for nursing supervision and activities; 3) The correct registration of medical diagnosis of the patient; 4) Monitoring. RESULTS: To enable nurses to treat cardiovascular patients in Primary Care, to reduce the time the patient would have to wait to be attended and to supervise the patient's progress. CONCLUSIONS: Making it possible for nurses to use the same registered standard system for controlling the treatment of cardiovascular patients.