Cachexia: Pathophysiology and Ghrelin Liposomes for Nose-to-Brain Delivery.

Cachexia, a severe multifactorial condition that is underestimated and unrecognized in patients, is characterized by continuous muscle mass loss that leads to progressive functional impairment, while nutritional support cannot completely reverse this clinical condition. There is a strong need for more effective and targeted therapies for cachexia patients. There is a need for drugs that act on cachexia as a distinct and treatable condition to prevent or reverse excess catabolism and inflammation. Due to ghrelin properties, it has been studied in the cachexia and other treatments in a growing number of works. However, in the body, exogenous ghrelin is subject to very rapid degradation. In this context, the intranasal release of ghrelin-loaded liposomes to cross the blood-brain barrier and the release of the drug into the central nervous system may be a promising alternative to improve its bioavailability. The administration of nose-to-brain liposomes for the management of cachexia was addressed only in a limited number of published works. This review focuses on the discussion of the pathophysiology of cachexia, synthesis and physiological effects of ghrelin and the potential treatment of the diseased using ghrelin-loaded liposomes through the nose-to-brain route.

Analysis of the adaptive multilevel splitting method on the isomerization of alanine dipeptide.

We apply the adaptive multilevel splitting (AMS) method to the C eq → C ax transition of alanine dipeptide in vacuum. Some properties of the algorithm are numerically illustrated, such as the unbiasedness of the probability estimator and the robustness of the method with respect to the reaction coordinate. We also calculate the transition time obtained via the probability estimator, using an appropriate ensemble of initial conditions. Finally, we show how the AMS method can be used to compute an approximation of the committor function. © 2019 Wiley Periodicals, Inc.

Insertion and Anchoring of HIV-1 Fusion Peptide into Complex Membrane Mimicking Human T-cell.

A fundamental understanding of how HIV-1 envelope (Env) protein facilitates fusion is still lacking. The HIV-1 fusion peptide, consisting of 15 to 22 residues, is the N-terminus of the gp41 subunit of the Env protein. Further, this peptide, a promising vaccine candidate, initiates viral entry into target cells by inserting and anchoring into human immune cells. The influence of membrane lipid reorganization and the conformational changes of the fusion peptide during the membrane insertion and anchoring processes, which can significantly affect HIV-1 cell entry, remains largely unexplored due to the limitations of experimental measurements. In this work, we investigate the insertion of the fusion peptide into an immune cell membrane mimic through multiscale molecular dynamics simulations. We mimic the native T-cell by constructing a 9-lipid asymmetric membrane, along with geometrical restraints accounting for insertion in the context of gp41. To account for the slow timescale of lipid mixing while enabling conformational changes, we implement a protocol to go back and forth between atomistic and coarse-grained simulations. Our study provides a molecular understanding of the interactions between the HIV-1 fusion peptide and the T-cell membrane, highlighting the importance of conformational flexibility of fusion peptides and local lipid reorganization in stabilizing the anchoring of gp41 into the targeted host membrane during the early events of HIV-1 cell entry. Importantly, we identify a motif within the fusion peptide critical for fusion that can be further manipulated in future immunological studies.

Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial.

BACKGROUND: Pain Neuroscience Education (PNE) consists of an educational strategy that seeks to understand the biological processes of pain and how to control it. The main objective of this study will be to evaluate the impact of PNE on outcomes related to the postoperative period. The hypothesis is that the intervention may positively influence postoperative recovery, contributing to pain control, clinical indications, acceptance and consumption of analgesics and other pharmacological drugs that contribute to its control, as well as psychological aspects, such as anxiety, depression and pain catastrophising. METHODS AND ANALYSIS: This will be an open, parallel, multicentre and randomised controlled clinical trial. A total of 100 participants aged between 18 and 59 years of age, of both genders, who are going to have elective general surgery will be evaluated. The intervention group will participate in a preoperative pain neuroscience educational session and also receive usual preoperative care, while the control group receives usual preoperative care as well. The educational session will last 30 min and consists of a video (5:20 min), a questionnaire about the content, time for participants to express their beliefs, thoughts and doubts. Participants will be evaluated preoperatively and there will be one postintervention evaluation. The intensity and characteristics of pain and anxiety are evaluated as primary outcomes. As secondary outcomes, pain catastrophising and depression are taken into account. ETHICS AND DISSEMINATION: The project was approved by the Research Ethics Committee of the Faculty of Ceilandia, the Research Ethics Committee of the Institute of Strategic Health Management of the Federal District and the Research Council of the Hospital of Brasília-Rede Dasa (CAAE: 28572420.3.0000.8093). Recruitment began in June of 2023. All participants were included in the study only after their written consent. All data obtained will be analysed and distributed through publication in journals and at scientific events. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (ReBEC) (RBR-23mr7yy).

Germline pathogenic variants in patients with early-onset neuroendocrine neoplasms.

Neuroendocrine neoplasms (NENs) are a rare group of cancers with heterogeneous behaviour and mostly of unknown aetiology. Excluding some infrequent hereditary cancer syndromes, the extent and clinical significance of mutations in other cancer predisposing genes (CPGs) are not known. We aimed to investigate the frequency of pathogenic and likely germline pathogenic variants (GPVs) in known CPGs in young adults with NEN and the clinical and molecular characteristics of these patients. We recruited 108 patients with lung or digestive NEN diagnosed between 18 and 50 years and performed targeted sequencing of 113 CPGs on germline DNA. For some patients, tumour features such as loss of heterozygosity (LOH), tumour mutation burden and microsatellite instability were evaluated. GPVs were detected in 17 patients (15.7%). Median age, sex, stage at diagnosis, family history of NENs or any personal history of neoplasm were similar between patients with or without GPVs. GPV carriers had more gastric (P = 0.084), functioning NEN (P = 0.041), positive family history of cancer (P = 0.015) and exclusively well-differentiated histology. Genes affected were mostly involved in DNA repair (CHEK2, ERCC2, ERCC3, XPC, MSH6, POLE and SLX4), with most GPVs found in MUTYH (four cases). LOH was performed in eight tumours and detected only in an SLX4-positive case. Overall, our findings indicate a role of inherited genetic alterations, particularly in DNA repair genes, in NEN carcinogenesis in young adults. These patients more often had a family history of cancer and functioning NENs.

Vibrational and electronic spectroscopy of neutral antimony coordination compounds of the 1,3-dithiole-2-thione-4,5-dithiolate (dmit).

The S 1s X-ray absorption near edge structure (XANES) and X-ray photoelectron spectra (XPS) of the neutral complexes [SbL(dmit)] (L = Br or I; dmit =1,3-dithiole-2-thione-4,5-dithiolate) have been measured using tunable synchrotron radiation. The valence shell electronic excitation by ultraviolet-visible (UV-vis) spectroscopy and the infrared vibrational spectra are presented and analyzed. The UV-vis results lead to an assignment of bands at 400 nm as π(Sm) → π*(C═S), where S(m) is the thiolate sulfur. The corresponding S 1s → π*(C═S) transition was identified at 2468.3 eV. Ab initio calculations, within the improved virtual orbital (IVO) method, carried out with the GSCF3 program, were applied to establish a complete and accurate spectral assignment. It has been the first attempt to apply such methodology for dmit coordination compounds, and very consistent results were obtained.

Human Learning for Molecular Simulations: The Collective Variables Dashboard in VMD.

The Collective Variables Dashboard is a software tool for real-time, seamless exploration of molecular structures and trajectories in a customizable space of collective variables. The Dashboard arises from the integration of the Collective Variables Module (also known as Colvars) with the visualization software VMD, augmented with a fully discoverable graphical interface offering interactive workflows for the design and analysis of collective variables. Typical use cases include a priori design of collective variables for enhanced sampling and free energy simulations as well as analysis of any type of simulation or collection of structures in a collective variable space. A combination of those cases commonly occurs when preliminary simulations, biased or unbiased, reveal that an optimized set of collective variables is necessary to improve sampling in further simulations. Then the Dashboard provides an efficient way to intuitively explore the space of likely collective variables, validate them on existing data, and use the resulting collective variable definitions directly in further biased simulations using the Collective Variables Module. Visualization of biasing energies and forces is proposed to help analyze or plan biased simulations. We illustrate the use of the Dashboard on two applications: discovering coordinates to describe ligand unbinding from a protein binding site and designing volume-based variables to bias the hydration of a transmembrane pore.

NIH stroke scale and unfavourable outcomes in acute ischaemic stroke: retrospective study.

OBJECTIVES: To evaluate the determining factors of severe functional impairment (SFI) outcome at discharge and in-hospital mortality in patients who had an acute ischaemic stroke and thus favouring early implementation of primary palliative care (PC). METHODS: A retrospective descriptive study by the analysis of 515 patients who had an acute ischaemic stroke admitted at stroke unit, aged≥18 years, from January 2017 to December 2018. Previous clinical and functional status data, National Institute of Health Stroke Scale (NIHSS) on admission, and data related to the evolution during hospitalisation were evaluated, relating them to the SFI outcome at discharge and death. The significance level was set at 5%. RESULTS: Of 515 patients included, 15% (77) died, 23.3%(120) had an SFI outcome and 9.1% (47) were evaluated by the PC team. It was observed that NIHSS Score≥16 is responsible for a 15.5-fold increase in the occurrence of death outcome. The presence of atrial fibrillation was responsible for a 3.5-fold increase in the risk of this outcome. CONCLUSION: NIHSS Score is an independent predictor of in-hospital death and SFI outcomes at discharge. Knowledge about the prognosis and risk of developing unfavourable outcomes is important for planning the care of patients affected by a potentially fatal and limiting acute vascular insult.

The (un)shared responsibility in the reverse logistics of portable batteries: A Brazilian case.

The Brazilian National Solid Waste Policy (BNSWP) determines that reverse logistics (RL) of waste batteries is mandatory and adopts the principle of shared responsibility among stakeholders. In this work, we sought to diagnose the current state of the RL chain for batteries in Vale do Aço, Brazil, and identify challenges and potentialities related to its improvement. Data were obtained by means of questionnaires sent to the main stakeholders involved in the batteries RL chain and by consultation of official Brazilian databases. The results showed that the main obstacles to the implementation of the RL of portable batteries in the region are: the lack of information by consumers and retailers regarding the BNSWP and management of waste batteries; the existence of few collection and consolidation points in the region; lack of municipal waste management plans; and lack of sustainability of waste picker organizations. The identified potentialities were: the good receptivity of environmental education actions by the population; the possibility of taking advantage of direct logistics of local retail chains to collect waste; the existence of a special waste management and transportation company in the region; and the existence of waste picker organizations interested in integrating the RL system. Finally, by a SWOT analysis, strategies for the implementation of a more effective RL system were drawn up. This work can serve as a basis for the structuring and implementation of the batteries RL system at the Metropolitan Region of Vale do Aço (MRVA) and can be a reference for other settings.

A rare cause of monogenic cerebral small vessel disease and stroke: Cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL).

BACKGROUND: Cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL) is a rare monogenic cause of cerebral small vessel disease. To date, fewer than 15 patients with CARASAL have been described, all of common European ancestry. METHODS: Clinical and imaging phenotypes of two patients are presented. Genetic variants were identified using targeted Sanger and focused exome sequencing, respectively. RESULTS: Both patients carried the same pathogenic p.Arg325Cys mutation in CTSA. One patient of Chinese ethnicity presented with migraine, tinnitus and slowly progressive cognitive impairment with significant cerebral small vessel disease in the absence of typical cardiovascular risk factors. She later suffered an ischaemic stroke. A second patient from Brazil, of Italian ethnicity developed progressive dysphagia and dysarthria in his 50s, he later developed hearing loss and chronic disequilibrium. Magnetic resonance imaging in both cases demonstrated extensive signal change in the deep cerebral white matter, anterior temporal lobes, thalami, internal and external capsules and brainstem. CONCLUSIONS: CARASAL should be considered in patients with early onset or severe cerebral small vessel disease, particularly where there are prominent symptoms or signs related to brainstem involvement, such as hearing dysfunction, tinnitus or dysphagia or where there is significant thalamic and brainstem involvement on imaging.

Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Plant phenological asynchrony and community structure of gall-inducing insects associated with a tropical tree species.

The dynamics of occurrence of target organs in plant populations produces windows of opportunity that directly and indirectly affect the structure of herbivore communities. However, mechanisms that drive herbivore specialization between resource patches are still poorly known. In this study, we tested three hypotheses related to variation in host plant phenology and community structure (i.e., composition, richness, and abundance) of gall-forming species: (a) plants with early leaf-flushing in the season will have greater vegetative growth and high contents of secondary chemical compounds; (b) gall-inducing insect community structure changes among temporary resource patches of the host; and (c) interspecific competition is a probable mechanism that drives gall-inducing insect community structure on Copaifera langsdorffii. We monitored daily a total of 102 individuals of the super-host C. langsdorffii from August 2012 to May 2013, to characterize the leaf flushing time of each host plant. The leaf flushing time had a positive relationship with the number of folioles per branch and a negative relationship with branch growth. We sampled a total of 4,906 galls belonging to 24 gall-inducing insect species from 102 individuals of C. langsdorffii. In spite of some gall-inducing species presented high abundance on early leaf-flushing plants, direct and indirect effects of plant phenology on galling insect abundance was species dependent. At the community level, our study revealed that the quality and quantity of plant resources did not affect the richness and abundance of gall-inducing insects associated with C. langsdorffii. However, the richness and composition of gall-inducing species varied according to the variation in leaf flushing time of the host plant. The results of null model analysis showed that galls co-occurrence on C. langsdorffii trees differ more than expected by chance and that interspecific competition can be one potential mechanism structuring this gall-inducing insect community.

Avaliação do conhecimento em Oftalmologia na Graduação Médica / Evaluation of Ophthalmology knowledge in Medical Graduation

Objetivo: avaliar o nível de conhecimento oftalmológico dos estudantes de medicina sobre achados do fundo de olho e alterações da retinopatia diabética, assim como o interesse destes alunos por um maior aprendizado sobre o assunto. Materiais e Métodos: A amostra foi constituída por alunos do curso de medicina do Centro Universitário Christus (Unichristus), na cidade de Fortaleza ­ Ceará ­ Brasil, durante os meses de novembro e dezembro de 2018. Eles responderam a um questionário composto por 20 questões de múltipla escolha, com quatro itens cada, contendo apenas um único item correto, com assuntos relacionados à fundoscopia e à retinopatia diabética. Foram escolhidos o quinto semestre (s5), por ter finalizado recentemente o módulo de oftalmologia, e o sétimo semestre (s7), para avaliação da retenção de conteúdo após um ano do término da disciplina. O questionário também abordou o interesse dos alunos em obter maior aprendizado sobre o assunto. Resultados: o questionário foi aplicado em 120 alunos (62 alunos do s5 e 58 alunos do s7). Houve um maior número de acertos no s5, com média de 57,2% de acertos, em relação ao s7, cuja média de acertos foi de 49,9%. Conclusão: Diante de uma média de acertos abaixo do desejável, e do interesse da maioria dos alunos em obter maior aprendizado, fica clara a demanda por uma maior inserção da disciplina de oftalmologia na graduação médica, por meio das instituições de ensino, dando a devida relevância ao tema, oferecendo aos seus alunos suporte para um aprendizado concreto e contínuo.

Objective: to evaluate the level of ophthalmological knowledge of medical students about fundus findings and changes in diabetic retinopathy, as well as the interest of these students in greater learning on the subject. Materials and Methods: The sample consisted of medical students from the Centro Universitário Christus (Unichristus), in the city of Fortaleza - Ceará - Brazil, during the months of November 2018 and December 2018. They answered a questionnaire composed of 20 multiple-choice questions, with four items each, containing only one correct item, with subjects related to fundus findings and changes in diabetic retinopathy. The fifth semester (s5) was chosen, for having recently completed the ophthalmology module, and the seventh semester (s7), to assess content retention one year after the end of the course. The questionnaire also addressed the students' interest in obtaining greater learning on the subject. Results: the questionnaire was applied to 120 students (62 students from s5 and 58 students from s7). There was a greater number of correct answers in s5, with an average of 57.2% of correct answers, compared to s7, whose average of correct answers was 49.9%. Conclusion: Given an average of hits below the desirable, and the interest of most students to obtain greater learning, it is clear the demand for a greater insertion of the discipline of ophthalmology in medical graduation, through educational institutions, giving due importance to the theme, offering its students support for learning concrete and continuous.

Brazilian practice guidelines for stroke rehabilitation: part II / Diretrizes brasileiras para reabilitação no acidente vascular cerebral: parte II

Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Ophthalmological profile of patients with thyroid diseases in Fortaleza, Ceará, Brazil: glaucoma investigation / Perfil oftalmológico de pacientes com tireoidopatias em Fortaleza, Ceará, Brasil: investigação de glaucoma

Objetivo: avaliar a prevalência de glaucoma entre os portadores de patologias tireoidianas, acompanhados na Clínica Escola de Saúde (CES) do núcleo de Medicina do Centro Universitário Christus (UNICHRISTUS), Fortaleza ­ Ceará ­ Brazil. Métodos: estudo transversal e descritivo de prontuários de pacientes diagnosticados com hipotireoidismo ou hipertiroidismo pelo Código Internacional de Doenças (CID-10) no sistema eletrônico da CES, entre 2013 e 2018. Pacientes triados foram convidados a realizar um exame oftalmológico na Fundação Leiria de Andrade (FLA). Resultados: dos 499 prontuários triados, 22,8% (114) possuíam diagnóstico confirmado para tireoidopatias, sendo 85,9% (98) com hipotireoidismo, e 14,0% (16) com hipertireoidismo. Desses, 72,0% (101) eram mulheres e 28,0% (13) homens. A faixa etária mais prevalente foi entre 41 a 60 anos de idade, correspondendo a 46,4% (53), sendo 65,7% (75) de Fortaleza ­ Ceará ­ Brasil. As principais comorbidades associadas às tireoidopatias foram hipertensão arterial sistêmica, representando 43,8% (50), seguida de dislipidemia, 26,3% (30) e diabetes mellitus tipo 2 em 13,1% dos pacientes (15). Do total, 25 pacientes foram encaminhados à FLA, 84,0% (21) relataram doenças oculares prévias, 4,0% (1) diagnosticado com escavação aumentada constitucional e 12,0% (3) com diagnóstico de glaucoma primário de ângulo aberto. Conclusão: apesar da hipótese de associação entre o glaucoma e as tireoidopatias, o tamanho amostral não possibilitou inferências sobre o risco aumentado de sua correlação, assim como em outros estudos preexistentes na literatura, sendo necessários mais estudos para elucidar com maior precisão essa associação relevante. Palavras-chave: Glaucoma; Tireoide; Hipotireoidismo; Hipertireoidismo; Pressão Intraocular. Resumo Objective: To evaluate the prevalence of ophthalmological pathologies, between thyroidopathies, for early diagnosis of glaucoma in patients seen at the Clínica Escola de Saúde (CES) of the Medicine Center of the Centro Universitário Christus (UNICHRISTUS), Fortaleza ­ Ceará ­ Brazil. Methods: A cross-sectional study and descriptive analysis of medical records of patients diagnosed with hypothyroidism or hyperthyroidism by the International Classification of Diseases (ICD-10) on the CES electronic system, between 2013 and 2018. Screened patients were invited to perform an eye examination at Fundação Leiria de Andrade (FLA). Results: Of the 499 medical records screened, 22.8% (114) had a confirmed diagnosis for thyroid disorders, 85.9% (98) with hypothyroidism, and 14.0% (16) with hyperthyroidism. Of these, 72.0% (101) were women and 28.0% (13) men. The most prevalent age group was between 41 and 60 years old, corresponding to 46.4% (53), being 65.7% (75) from Fortaleza - Ceará. The main comorbidities associated with thyroid diseases were systemic arterial hypertension, 43.8% (50), followed by dyslipidemia, 26.3% (30), and type 2 diabetes mellitus in 13.1% of patients (15). Of the total, 25 patients were referred to the FLA, 84.0% (21) reported previous eye diseases, 4.0% (1) diagnosticated with increased constitutional excavation, and 12.0% (3) with a diagnosis of primary open-angle glaucoma. Conclusion: Despite the hypothesis of an association between glaucoma and thyroidopathy, the sample size didn't allow inferences about the increased risk of its correlation, as well as in other pre-existing studies in the literature, requiring further studies to elucidate this relevant association.

Objetivo: avaliar a prevalência de glaucoma entre os portadores de patologias tireoidianas, acompanhados na Clínica Escola de Saúde (CES) do núcleo de Medicina do Centro Universitário Christus (UNICHRISTUS), Fortaleza ­ Ceará ­ Brazil. Métodos: estudo transversal e descritivo de prontuários de pacientes diagnosticados com hipotireoidismo ou hipertiroidismo pelo Código Internacional de Doenças (CID-10) no sistema eletrônico da CES, entre 2013 e 2018. Pacientes triados foram convidados a realizar um exame oftalmológico na Fundação Leiria de Andrade (FLA). Resultados: dos 499 prontuários triados, 22,8% (114) possuíam diagnóstico confirmado para tireoidopatias, sendo 85,9% (98) com hipotireoidismo, e 14,0% (16) com hipertireoidismo. Desses, 72,0% (101) eram mulheres e 28,0% (13) homens. A faixa etária mais prevalente foi entre 41 a 60 anos de idade, correspondendo a 46,4% (53), sendo 65,7% (75) de Fortaleza ­ Ceará ­ Brasil. As principais comorbidades associadas às tireoidopatias foram hipertensão arterial sistêmica, representando 43,8% (50), seguida de dislipidemia, 26,3% (30) e diabetes mellitus tipo 2 em 13,1% dos pacientes (15). Do total, 25 pacientes foram encaminhados à FLA, 84,0% (21) relataram doenças oculares prévias, 4,0% (1) diagnosticado com escavação aumentada constitucional e 12,0% (3) com diagnóstico de glaucoma primário de ângulo aberto. Conclusão: apesar da hipótese de associação entre o glaucoma e as tireoidopatias, o tamanho amostral não possibilitou inferências sobre o risco aumentado de sua correlação, assim como em outros estudos preexistentes na literatura, sendo necessários mais estudos para elucidar com maior precisão essa associação relevante

Anatomia e etiologia do ombro doloroso / Painful shoulder anatomy and etiology

O ombro doloroso tem etiologia multifatorial, e suas causas são traumas, instabilidades ou lesões degenerativas. Podem ser classificadas como intra-articulares, extra-articulares ou à distância. O objetivo deste estudo foi descrever a anatomia do ombro nas principais doenças, baseado em revisão bibliográfica da literatura recente e de livros-texto de anatomia. Em conclusão, o conhecimento da anatomia é fundamental para compreensão das várias doenças que afetam o ombro doloroso para seu correto diagnóstico e tratamento.

The painful shoulder has a multifactorial etiology, and its causes are trauma, instability or degenerative lesions. They can be classified as intra-articular, extraarticular or at a distance. The aim of this study was to describe the anatomy of the shoulder in major diseases, based on review of recent literature and anatomy textbooks. In conclusion, knowledge of anatomy is essential for understanding the various diseases that affect the painful shoulder for its correct diagnosis and treatment.

Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital.

OBJECTIVE: To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil. METHOD: A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG) (n = 36) received standard care, patients in the intervention group (IG) (n = 34) received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires. RESULTS: Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group. CONCLUSION: The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy.

The role of enteric hormone GLP-2 in the response of bone markers to a mixed meal in postmenopausal women with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2D) is a complex disease associated with several chronic complications, including bone fragility and high fracture risk due to mechanisms not yet fully understood. The influence of the gastrointestinal tract and its hormones on bone remodeling has been demonstrated in healthy individuals. Glucagon-like peptide 2 (GLP-2), an enteric hormone secreted in response to nutrient intake, has been implicated as a mediator of nutrient effects on bone remodeling. This study aimed to analyze the dynamics of bone resorption marker C-terminal telopeptide of type I collagen (CTX), bone formation marker osteocalcin, and GLP-2 in response to a mixed meal in diabetic postmenopausal women. METHODS: Forty-three postmenopausal women with osteopenia or osteoporosis (20 controls - group CO - and 23 diabetic - group T2D) were subjected to a standard mixed meal tolerance test, with determination of serum CTX, plasma osteocalcin and serum GLP-2 concentrations at baseline and 30, 60, 120 and 180 minutes after the meal. RESULTS: T2D women had higher body mass index as well as higher femoral neck and total hip bone mineral density. At baseline, luteinizing hormone, follicle-stimulating hormone, osteocalcin and CTX levels were lower in group T2D. In response to the mixed meal, CTX and osteocalcin levels decreased and GLP-2 levels increased in both groups. The expected CTX suppression in response to the mixed meal was lower in group T2D. CONCLUSIONS: Bone turnover markers were significantly reduced in T2D women at baseline. Confirming the role of nutrient intake as a stimulating factor, GLP-2 increased in response to the mixed meal in both groups. Importantly, CTX variation in response to the mixed meal was reduced in T2D women, suggesting abnormal response of bone remodeling to nutrient intake in T2D.