Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis.

Continuous glucose monitoring (CGM) facilitates the assessment of short-term glucose variability and identification of acute excursions of hyper- and hypo-glycemia. Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in the target glucose range of 70-180 mg/dL (TIR70-180) in <50% of readings was higher for GA (AUC: 0.878; 95% confidence interval (CI): 0.728-0.962) as compared to HbA1c (AUC: 0.682; 95% CI: 0.508-0.825) (p < 0.01). The accuracy of GA (AUC: 0.939; 95% CI: 0.808-0.991) in detecting a time above the target glucose range > 250 mg/dL (TAR>250) in >10% of readings did not differ from that of HbA1c (AUC: 0.854; 95% CI: 0.699-0.948) (p = 0.16). GA (AUC: 0.712; 95% CI: 0.539-0.848) and HbA1c (AUC: 0.740; 95% CI: 0.570-0.870) had a similarly lower efficiency in detecting a time below target glucose range < 70 mg/dL (TBR<70) in >1% of readings (p = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2 ± 17.3% vs. 32.0 ± 7.8%, p < 0.001) and TBR<70 (median (range): 5.6% (0, 25.8) vs. 2.8% (0, 17.9)) were higher during the dialysis-on than during the dialysis-off day. In conclusion, the present study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR70-180 < 50%. However, both biomarkers provided an imprecise reflection of acute excursions of hypoglycemia and inter-day glucose variability.

SGLT-2 inhibitors in Diabetic Kidney Disease: What Lies Behind their Renoprotective Properties?

BACKGROUND: Despite optimal management of diabetic kidney disease (DKD) with intensive glycemic control and administration of agents blocking the renin-angiotensinaldosterone- system, the residual risk for nephropathy progression to end-stage-renal-disease (ESRD) remains high. Sodium-glucose co-transporter type 2 (SGLT-2)-inhibitors represent a newly-introduced anti-diabetic drug class with pleiotropic actions extending above their glucose-lowering efficacy. Herein, we provide an overview of preclinical and clinical-trial evidence supporting a protective effect of SGLT-2 inhibitors on DKD. METHODS: A systematic literature search of bibliographic databases was conducted to identify preclinical studies and randomized trials evaluating the effects SGLT-2 inhibitors on DKD. RESULTS: Preclinical studies performed in animal models of DKD support the renoprotective action of SGLT-2 inhibitors showing that these agents exert albuminuria-lowering effects and reverse glomerulosclerosis. The renoprotective action of SGLT-2 inhibitors is strongly supported by human studies showing that these agents prevent the progression of albuminuria and retard nephropathy progression to ESRD. This beneficial effect of SGLT-2 inhibitors is not fully explained by their glucose-lowering properties. Attenuation of glomerular hyperfiltration and improvement in a number of surrogate risk factors, including associated reduction in systemic blood pressure, body weight, and serum uric acid levels may represent plausible mechanistic explanations for the cardio-renal protection offered by SGLT-2 inhibitors. Furthermore, the tubular cell metabolism seems to be altered towards a ketone-prone pathway with protective activities. CONCLUSION: SGLT-2 inhibition emerges as a novel therapeutic approach of diabetic with anticipated benefits towards cardio-renal risk reduction. Additional research efforts are clearly warranted to elucidate this favorable effect in patients with overt DKD.

Comparison of Glycemic Markers in Chronic Hemodialysis Using Continuous Glucose Monitoring.

BACKGROUND: Glycated hemoglobin A1c (HbA1c) among diabetic hemodialysis patients continues to be the standard of care, although its limitations are well recognized. This study evaluated glycated albumin (GA) and glycated serum protein (GSP) as alternatives to HbA1c in detecting glycemic control among diabetic hemodialysis patients using continuous-glucose-monitoring (CGM)-derived glucose as reference standard. METHODS: A CGM system (iPRO) was applied for 7 days in 37 diabetic hemodialysis patients to determine glycemic control. The accuracy of GA and GSP versus HbA1c in detecting a 7-day average glucose ≥184 mg/dL was evaluated via receiver-operating-characteristic (ROC) analysis. RESULTS: CGM-derived glucose exhibited strong correlation (r = 0.970, p < 0.001) and acceptable agreement with corresponding capillary glucose measurements obtained by the patients themselves in 1,169 time-points over the 7-day-long CGM. The area under ROC curve (AUC) for GA, GSP, and HbA1c to detect poor glycemic control was 0.976 (0.862-1.000), 0.682 (0.502-0.862), and 0.776 (0.629-0.923) respectively. GA levels >20.3% had 90.9% sensitivity and 96.1% specificity in detecting a 7-day average glucose ≥184 mg/dL. The AUC for GA was significantly higher than the AUC for GSP (difference between areas: 0.294, p < 0.001) and the AUC for HbA1c (difference between areas: 0.199, p < 0.01). CONCLUSION: Among diabetic hemodialysis patients, GA is a stronger indicator of poor glycemic control assessed with 7-day-long CGM when compared to GSP and HbA1c.

Peritoneal dialysis-related infections recommendations: 2010 update. What is new?

The International Society of Peritoneal Dialysis (ISPD) 2010 guidelines on PD-related infections reflect the bulk of knowledge acquired over the last 5 years. It includes new information about causative agents of peritonitis, isolation techniques, or therapeutic regimens. Monitoring of infection rates by reporting of peritonitis and exit site infections, isolated microorganism, and presumed etiology is recommended. Furthermore, special focus is given on careful evaluation of each episode of peritonitis in order to determine the route of infection and to reassess patient's training. In this article, we record the changes in the last ISPD (2010) guidelines compared to the previous ones published in March 2005.

Avaliação microbiológica, parasitológica e da rotulagem de hortaliças minimamente processadas comercializadas no município de Ribeirão Preto, SP/Brasil / Microbiological and parasitic quality and labeling adequacy of minimally-processed vegetables, commercialized in Ribeirão Preto, SP/Brasil

O consumo de hortaliças minimamente processadas tem aumentado nos últimos anos no Brasil, principalmente em função da conveniência e da praticidade que o produto oferece. A contaminação microbiológica, a presença de parasitos e os dizeres da rotulagem foram avaliados em 70 amostras de hortaliças folhosas minimamente processadas, adquiridas em supermercados de Ribeirão Preto-SP, no período de janeiro a julho de 2006. Foram pesquisados os microrganismos aeróbios psicrotróficos, cloliformes a 35ºC e 45ºC, salmonella spp. e Escherichia coli. Para a avaliação da rotulagem foram utilizadas as legislações em vigor(Resoluções RDC nº259/2002, 359 e 360/2003, da ANVISA/MS e Lei nº10.674/2003). Das amostras analisadas, 20 estavam em descordo com a legislação em vigor nas análises microbiológicas, 18,6.

Enteroparasitoses em manipuladores de alimentos do município de Ribeirão Preto - SP, Brasil, 2000 / Enteroparasitosis in food handlers in the city of Ribeirão Preto - SP, Brazil, 2000

INTRODUÇÃO: A segurança alimentar vêm adquirindo mundialmente uma importância crescente. As doenças transmitidas por alimentos (DTAS) têm impactos na saúde pública e socioeconômicos, acarretando custos hospitalares em tratamentos e internações. As pessoas envolvidas na produção de alimentos podem ser portadoras de enteroparasitos e vir a contaminar os alimentos, provocando surtos de origem alimentar. OBJETIVOS: Investigar a presença de enteroparasitoses em manipuladores de alimentos do município de Ribeirão Preto, SP, propondo medidas que assegurem a qualidade sanitária dos alimentos. MÉTODOS: Entre julho a dezembro de 2000, 429 manipuladores de alimentos (248 mulheres e 181 homens), com idades entre 16 e 77 anos, foram submetidos ao exame coproparasitológico por ocasião da obtenção ou renovação da carteira de saúde. As amostras de fezes foram examinadas pelos métodos de Kato e da sedimentação espontânea. A pesquisa de oocistos de Cryptosporidium spp foi realizada em 7,0 por cento das amostras de fezes diarréicas através da técnica de concentração pelo formol-éter. RESULTADOS: Foram encontradas enteroparasitoses em 33,1 por cento dos manipuladores, incluindo 20,0 por cento de casos de poliparasitismo. Prevalências mais altas de infecções ocorreram entre os indivíduos envolvidos com atividades de manipulação direta dos alimentos (68 por cento). CONCLUSÕES: Considerando os resultados obtidos, são necessários a educação sanitária e o treinamento dos manipuladores bem como a implementação da metodologia da Análise dos Perigos e Pontos Críticos de Controle (APPCC) em todas as etapas da cadeia de produção dos alimentos, para garantir produtos alimentícios seguros aos consumidores.

INTRODUCTION: Food safety has become increasingly importance worldwide. Food borne diseases have impacts on public health and socioeconomic factors, accounting for hospital costs in treatments and hospitalizations. People involved in food production can be carriers of enteroparasites and contaminate food, causing food borne diseases OBJECTIVE: The aim of this study was to investigate the presence of enteroparasites in food handlers in Ribeirão Preto, SP, proposing measures to ensure the sanitary quality of food. METHODS: From July to December 2000, 429 food handlers (248 women and 181 men), aged between 16 and 77 years, underwent coproparasitological analysis as a mandatory professional requirement. Fecal samples were analyzed by the Kato's and spontaneous sedimentation methods. Cryptosporidium spp oocysts were investigated in 7.0 percent of diarrheic fecal samples using the formalin-ether concentration technique. RESULTS: The results showed enteroparasitosis in 33.1 percent of food handlers, including 20.0 percent cases of multiple parasitic infections. A higher prevalence of infections (68.0 percent) was detected among the individuals involved in direct food handling activities. CONCLUSIONS: Considering these results, it is necessary to provide sanitary education and training to food handlers, and to implement the method of Hazard Analysis and Critical Control Points (HACCP) in all stages of the food chain so as to ensure food safety for consumers.

Ocorrência de Cryptococcus spp e de parasitas de intersse em saúde pública, no excretas de pombos na cidade de Ribeirão Preto, São Paulo, Brasil / Ocurrence of Cryptococcus spp and parasites of interest in public health in pigeons excrement in the city of Ribeirão Preto, SP, Brazil

Os pombos tem sido considerados reservatórios de agentes infecciosos de importância em saúde pública.A decomposição de excretas em áreas públicas pode contaminar o meio ambiente e produtos alimenticios. O objetivo deste estudo..

Relato de nematóides da família Anisakidae em bacalhau comercializado em Ribeirão Preto, SP / Report of nematodes of the Anisakidae family in codfish commercialized in Ribeirão Preto, SP

A anisaquíase é uma parasitose gastrointestinal dos seres humanos, resultante da ingestão acidental de larvas infectantes de nematóides da família Anisakidae. Foram analisadas 11 amostras de bacalhau sendo que 64 por cento estavam em desacordo com a legislação em vigor por conter nematóides da família Anisakidae e, portanto, impróprias para o consumo.

Anisakiasis is a human gastrointestinal parasitosis that results from accidental ingestion of infective larvae belonging to the Anisakidae family. Eleven codfish samples were analyzed and 64 percent did not conform to the present legislation, because they contained nematode larvae from the Anisakidae family and were therefore unfit for consumption.

Ocorrência de parasitas com potencial zoonótico em fezes de cães coletadas em áreas públicas do município de Ribeirão Preto, SP, Brasil / Parasites with zoonotic potential in dog feces collected from public areas of the city of Ribeirão Preto, SP, Brazil

OBJETIVO: Avaliar a ocorrência de parasitos zoonóticos em fezes de cães colhidas em áreas públicas do município de Ribeirão Preto, enfatizando o risco da ocorrência de infecção humana. MÉTODOS: Entre os meses de maio a dezembro de 2003 foram visitadas 78 praças, localizadas em cinco diferentes áreas do município: sudoeste, noroeste, norte, central e sudeste. Foram recolhidos 331 "pools" de material fecal canino, os quais foram processados pela técnica de sedimentação espontânea. RESULTADOS: Em 56,8 por cento "pools" foram observados os parasitos zoonóticos: Ancylostoma spp. (41,7 por cento), Toxocara canis (24,2 por cento), Trichuris vulpis (15,7 por cento), Giardia spp. (10,2 por cento) e Isospora spp. (3,3 por cento). A prevalência de parasitos foi maior nas praças localizadas na área norte do município (70 por cento). CONCLUSÕES: É necessária a adoção de programas de preservação sanitária destes locais, no sentido de prevenir a contaminação ambiental por parasitos potencialmente patogênicos para o homem.

[Report of nematodes of the Anisakidae family in codfish commercialized in Ribeirão Preto, SP]. / Relato de nematóides da família Anisakidae em bacalhau comercializado em Ribeirão Preto, SP.

Anisakiasis is a human gastrointestinal parasitosis that results from accidental ingestion of infective larvae belonging to the Anisakidae family. Eleven codfish samples were analyzed and 64% did not conform to the present legislation, because they contained nematode larvae from the Anisakidae family and were therefore unfit for consumption.

Environmental contamination by Toxocara sp. eggs in Ribeirão Preto, São Paulo State, Brazil.

Toxocariasis is a zoonosis mainly caused by Toxocara canis, an intestinal nematode of dogs. Man acquires the infection through accidental ingestion of viable eggs, and the toxocariasis clinical manifestations may vary from an asymptomatic infection up to the Visceral Larva Migrans syndrome. Seventy eight public squares of Ribeirão Preto, São Paulo, Brazil, including Bonfim Paulista district were visited aiming to evaluate the soil contamination by Toxocara eggs. The squares were divided in five different areas corresponding to the Sanitary Districts of the city. From May to December 2003, soil samples weighting about 250 g each were collected from five distinct sites of each public square. The laboratory analysis was done by centrifugal-flotation techniques in magnesium sulphate solutions with 5% of potassium iodide (d = 1.33) and zinc sulphate (d = 1.20), and by the sedimentation- flotation in conic chalices with zinc sulphate (d = 1.20). Toxocara sp. eggs were found on 16 (20.5%) squares, with the lowest prevalence (12%) at the central area. From these results, it is expected that the legal authority will adopt protection measures for the city public areas, reducing thus the contamination risk by Toxocara sp. eggs.

Environmental contamination by Toxocara sp. eggs in Ribeirão Preto, São Paulo State, Brazil

A toxocaríase é uma zoonose causada principalmente pelo Toxocara canis, nematóide intestinal de cães. O homem adquire a infecção através da ingestão acidental de ovos viáveis, sendo que as manifestações clínicas da toxocaríase podem variar desde uma infecção assintomática à síndrome da Larva Migrans Visceral. Com o objetivo de avaliar a contaminação do solo por ovos de Toxocara sp, foram visitadas 78 praças públicas de Ribeirão Preto, incluindo o distrito de Bonfim Paulista. As praças foram distribuídas em cinco áreas diferentes correspondentes as mesmas dos Distritos Sanitários do município. Entre maio a dezembro de 2003 foram coletadas de cinco pontos de cada praça amostras de solo de aproximadamente 250 gramas. A análise laboratorial foi realizada pelas técnicas da centrífugo-flutuação em soluções de sulfato de magnésio com 5% de iodeto de potássio (d = 1.33) e de sulfato de zinco (d = 1.20) e da flotação-sedimentação em cálice cônico com sulfato de zinco (d = 1.20). Foram encontrados ovos de Toxocara sp. em 16 (20,5%) praças, sendo que a região central apresentou a mais baixa prevalência (12,0%). Espera-se que a partir destes resultados as autoridades competentes adotem medidas de proteção das áreas públicas do município, reduzindo o risco da contaminação por ovos de Toxocara sp.

Contaminação de areias em áreas de recreação infantil por ovos e larvas de Ancylostoma sp no município de Ribeirão Preto, SP, Brasil / Contamination of sandpits by Ancylostoma sp. eggs and larvae in children recreational areas of Ribeirão Preto county, SP, Brazil

As areias de áreas de lazer podem representar um importante ecótopo para a transmissão de várias zoonosesparasitárias, dentre elas a Larva Migrans Cutânea (LMC), causada pela penetração na pele humana das larvas de ancilostomídeos de cães e gatos. Neste estudo investigou-se a contaminação dos tanques de areia por ovos e/ou larvas de Ancylostoma sp. das áreas de recreação infantil existentes em 11 praças públicas do município de Ribeirão Preto. Entre maio a dezembro de 2003, foram coletadas cinco amostras de areia de cada área de recreação. A recuperação das larvas foi realizada pelo método de Baermann, enquanto que para a detecção dos ovos utilizou-se a técnica da centrífugo-flutuação com soluçõessaturadas de sulfato de magnésio contendo 5% de iodeto de potássio (d = 1,33 g/cm3) e de sulfato de zinco(d = 1,20 g/cm3), após um lavado prévio com Tween 80. A presença de larvas foi observada em seis (54%) áreas de recreação, sendo que em quatro (36%) delas foram encontrados ovos de Ancylostoma sp. Estes resultados indicam um risco para a ocorrência da LMC nos usuários destas áreas

Etiology of acute diarrhea among children in Ribeiräo Preto-SP, Brazil

To study the main enteropathogens causing diarrhea in the region of Ribeiräo Preto regarding serogroups and serotypes, the feces of 1836 children under 10 years old, from both sexes, attack of acute gastroenteritis, were analysed during a period of 4 years in Adolfo Lutz Institute - Ribeiräo Preto, SP. The pathogens identified by standard methods were the following: Escherichia coli, Salmonella spp., Shigella spp., Campylobacter spp., Yersinia spp., and Cryptosporidium spp. Positive samples were 22.8 percent (419) with 1.7 percent association of pathogens. Larger isolates were mainly from children 0 to 11 months old. Enteropathogenic E. coli (EPEC) was most frequent (8.7 percent) with predominance of serogroup O119 (40.2 percent), followed by Shigella (6.2 percent), 63.6 percent of which S. sonnei

Encuesta serológica sobre el dengue en Ribeirao Preto, Sao Paulo, Brasil / Dengue serologic survey in Ribeirao Preto, Sao Paulo, Brazil

La ciudad de Riberao Preto sufrió una epidemia de dengue 1 que comenzó en noviembre de 1990 y duró hasta marzo de 1991. Durante septiembre y octubre de 1992 se efectuó una encuesta serológica en dicha ciudad con el fin de detectar anticuerpos IgG contra los cuatro serotipos del dengue y otros flavivirus. En 5,4 por ciento de los participantes en la encuesta se detectaron anticuerpos contra el dengue 1. Los residentes del sector noroeste de Riberao Preto tuvieron una seropositividad considereblemente más alta (9,3 por ciento) que los que vivían en los otros sectores de la ciudad. Se observaron también en el sector noroeste cantidades relativamente elevadas de criaderos del vector Aedes aegypti, el número más alto de casos de dengue notificados y condiciones socieconómicas relativamente bajas. El hecho de que la epidemia se limitara principalmente al sector noroeste quizá fué consecuencia de la intensa lucha antivectorial y las actividades educativas iniciadas en respuesta a la epidemia. En el momento de la encuesta de 1992, la mayor parte de la población de Riberao Preto seguía siendo vulnerable a la infección con dengue 1; además aproximadamente 23 000 personas con anticuerpos contra el dengue 1, estaban expuestas a un riesgo relativamente alto de padecer fiebre hemorrágica/síndrome de choque del dengue si se producía una infección con el dengue 2. Por estas razones se concluyó que sería necesario continuar la educación sobre el dengue y las medidas de lucha antivectórial

Dengue serologic survey in Ribeirao Preto, Sao Paulo, Brazil

The city of Riverao Preto suffered a dengue 1 epidemic that began in November 1990 and ended in 1991. A serologic suvey designed to detect IgG antibodies to the four dengue serotypes and other flaviviruses was carried out in Ribeirao Preto during September and October of 1992. Dengue 1 antibodies were detected in 5.4 percent of the survey participants. Significantly higher seropositivity (9.3 percent) was found among subjects residing in the Northwest Sector of Riberao Preto than among those living in the city's other three sectors. The Northwest Sector also exhibited relatively high levels of breeding sites used by the Aedes aegypti vector, the highest number of reported dengue cases of any sector, and relatively poor socioeconomic conditions. The fact that the epidemic was limited mainly to the Northwest Sector probably resulted mainly from intense vector control and educational measures undertaken in response to the outbreak. As of the 1992 survey, most of the city's population remained vulnerable to dengue 1 infection however an estimated 23 000 with dengue 1 antibodies appeared to be at relatively high risk of developing dengue hemorrhagic fever/dengue shock syndrome in the event of infection with dengue 2. Both of these considerations indicate an ongoing need to maintain dengue education and vector control measures (AU)