Leveraging the future of diagnosis and management of diabetes: From old indexes to new technologies.

BACKGROUND: Diabetes is a heterogeneous and multifactorial disease. However, glycemia and glycated hemoglobin have been the focus of diabetes diagnosis and management for the last decades. As diabetes management goes far beyond glucose control, it has become clear that assessment of other biochemical parameters gives a much wider view of the metabolic state of each individual, enabling a precision medicine approach. METHODS: In this review, we summarize and discuss indexes that have been used in epidemiological studies and in the clinical practice. RESULTS: Indexes of insulin secretion, sensitivity/resistance and metabolism have been developed and validated over the years to account also with insulin, C-peptide, triglycerides or even anthropometric measures. Nevertheless, each one has their own objective and consequently, advantages and disadvantages for specific cases. Thus, we discuss how new technologies, namely new sensors but also new softwares/applications, can improve the diagnosis and management of diabetes, both for healthcare professionals but also for caretakers and, importantly, to promote the empowerment of people living with diabetes. CONCLUSIONS: In long-term, the solution for a better diabetes management would be a platform that allows to integrate all sorts of relevant information for the person with diabetes and for the healthcare practitioners, namely glucose, insulin and C-peptide or, in case of need, other parameters/indexes at home, sometimes more than once a day. This solution would allow a better and simpler disease management, more adequate therapeutics thereby improving patients' quality of life and reducing associated costs.

Biomass Novel Adsorbents for Phenol and Mercury Removal.

This paper reports the use of activated carbons made from novel agriculture and industrial wastes, namely sunflower, vine shoots, and coffee endocarp, to remove two high-priority contaminants: phenol and mercury species (under different forms) from aqueous solutions. The activated carbons were used as prepared and also modified with nitric acid and triethylenediamine in order to explore additional adsorption mechanisms. The results showed an interesting potential of the materials to be used for water decontamination as indicated by the mercury uptake up to 1104 mg/g for Hg2+, 771 mg/g for [HgCl4]2-, 966 mg/g for HgCl2 and the maximum phenol adsorption capacity of 190 mg/g. The modification with triethylenediamine led to a significant increase in the phenol and mercury adsorption reaching an increment of 85% for phenol and 250% for Hg2+.

Perspectives on a Way Forward to Implementation of Precision Medicine in Patients With Diabetic Kidney Disease; Results of a Stakeholder Consensus-Building Meeting.

Aim: This study aimed to identify from different stakeholders the benefits and obstacles of implementing precision medicine in diabetic kidney disease (DKD) and to build consensus about a way forward in order to treat, prevent, or even reverse this disease. Methods: As part of an ongoing effort of moving implementation of precision medicine in DKD forward, a two-day consensus-building meeting was organized with different stakeholders involved in drug development and patient care in DKD, including patients, patient representatives, pharmaceutical industry, regulatory agencies representatives, health technology assessors, healthcare professionals, basic scientists, and clinical academic researchers. The meeting consisted of plenary presentations and discussions, and small group break-out sessions. Discussion topics were based on a symposium, focus groups and literature search. Benefits, obstacles and potential solutions toward implementing precision medicine were discussed. Results from the break-out sessions were presented in plenary and formed the basis of a broad consensus discussion to reach final conclusions. Throughout the meeting, participants answered several statement and open-ended questions on their mobile device, using a real-time online survey tool. Answers to the statement questions were analyzed descriptively. Results of the open-ended survey questions, the break-out sessions and the consensus discussion were analyzed qualitatively. Results and conclusion: Seventy-one participants from 26 countries attended the consensus-building meeting in Amsterdam, April 2019. During the opening plenary on the first day, the participants agreed with the statement that precision medicine is the way forward in DKD (n = 57, median 90, IQR [75-100]). Lack of efficient tools for implementation in practice and generating robust data were identified as significant obstacles. The identified benefits, e.g., improvement of the benefit-risk ratio of treatment, offer substantive incentives to find solutions for the identified obstacles. Earlier and increased multi-stakeholder collaboration and specific training may provide solutions to alter clinical and regulatory guidelines that lie at the basis of both obstacles and solutions. At the end of the second day, the opinion of the participants toward precision medicine in DKD was somewhat more nuanced (n = 45, median 83, IQR [70-92]) and they concluded that precision medicine is an important way forward in improving the treatment of patients with DKD.

Surface Interactions during the Removal of Emerging Contaminants by Hydrochar-Based Adsorbents.

The aim of this work was to test activated carbons derived from hydrochars produced from sunflower stem, olive stone and walnut shells, as adsorbents for emerging contaminants in aqueous solution, namely fluoxetine and nicotinic acid. The adsorption capacity was determined by the chemical nature of the adsorbents, namely the presence of specific functional groups and their positive or negative ionization in aqueous solutions and also by steric factors. The activated carbons produced by air showed a higher adsorption capacity of fluoxetine, whilst the samples produced by carbon dioxide activation were more useful to remove nicotinic acid. In general, surface acidity was advantageous for fluoxetine adsorption and detrimental for nicotinic acid removal. The adsorption mechanisms involved in each case were discussed and related to the adsorbents characteristics. The maximum adsorption capacity, Q0, given by the Langmuir model was 44.1 and 91.9 mg g-1 for fluoxetine and nicotinic acid adsorption, respectively.

Removal of amitriptyline from simulated gastric and intestinal fluids using activated carbons.

In this work, the adsorption behavior of a tricyclic antidepressant, amitriptyline hydrochloride, onto several activated carbons (ACs) is reported. The adsorption was done using in vitro simulated gastric and intestinal fluid at 37°C to test the performance of the carbons as treatment in overdose cases. The tested materials were one commercial AC (carbomix) and two ACs produced in our laboratory. The highest adsorption capacity was achieved by carbomix, followed by the laboratory-made carbons that still have a very good performance with adsorption capacity up to 120 and 100 mg/g for the gastric and intestinal fluids, respectively.

Influence of preparation conditions in the textural and chemical properties of activated carbons from a novel biomass precursor: the coffee endocarp.

In this work a novel biomass precursor for the production of activated carbons (AC) was studied. The lignocellulosic material used as precursor is the coffee bean endocarp, which constitutes an industrial residue from the Portuguese coffee industry. Activation by carbon dioxide and potassium hydroxide produces activated carbons with small external areas and pore volumes up to 0.22 and 0.43cm3g(-1), respectively, for CO2 and KOH activation. All the AC's produced are very basic in nature with point of zero charge higher than 8. SEM/EDX studies indicate the presence of K, O, Ca and Si. By FTIR it was possible to identify the formation on the AC's surface of several functional groups, namely phenol, alcohol, quinone, lactone, pyrone and ether as well as SiH groups. The tailoring of the porous and chemical structure of the activated carbons produced is possible by selecting the appropriate production conditions.

The art in Abel Salazar's life (1889-1946)--a Portuguese Renaissance spirit of the twentieth century.

Abel Salazar was a true renaissance spirit, scientist, doctor, humanist, artist and writer. His paintings combined realism with a very strong social sense. This article looks at his art and the influence that he had through it on his contemporaries.