Diabetes self-management education program (DSME) among adolescents with type 1 diabetes mellitus

@#<p style="text-align: justify;">The DSME program is aimed to educate adolescents about diabetes mellitus: disease process, survival skills, exercise management, drug management, diet management, prevent acute and chronic complications and optimize quality of life. This study utilized the quasi experimental pre and post-test design involving 15 adolescent patients with Type 1 Diabetes Mellitus. The DSME materials were composed of five modules that included topics in diabetes awareness, survival skills, exercise, drug and diet management. Knowledge, Fasting Blood Sugar (FBS), Random Blood Sugar (RBS) and waist and hip ratio (WHR) were tested. The Intervention phase was implemented in three months where each module was completed by patients in two weeks. Pre and post-test examinations were done after each module. Participants have very satisfactory knowledge in diabetes awareness, survival skills, exercise, drug management before and after the DSME program. However, participants knowledge in diet management were unsatisfactory before and after the DSME program. FBS were high but RBS levels and WHR were in normal levels before, during and after the DSME program. Knowledge scores were significantly different before and after the implementation of all the modules (Module 1 to Module 5) to the participants. RBS results were significantly different after the implementation of the Module 1- DM awareness and Module 5- diet management. However, no significant differences were obtained in the RBS results of the participants after the implementation of Module 2, 3, 4, and 5. No significant differences were also obtained in the WHR parameters of the participants in each of the implementation of DSME. No significant differences in the FBS results were obtained after the implementation of the DSME modules. The module type DSME is effective in increasing knowledge of the adolescent patients in diabetes and its management. The content of the diet management module needs to be strengthened and be tested again for its effectiveness in increasing knowledge of adolescent patients.</p>

The integration of spiritual practices in nursing care

@#<p style="text-align: justify;">The intent of this study was to describe the integration of spiritual practices in nursing care that could be a basis for developing a framework of nursing care management. The paper utilized a mixed method research design: qualitative approach was used through focused group discussion (FGD) and interviews with staff nurses affiliated with certain tertiary hospitals in Metro Manila selected through purposive sampling. Thematic results from the responses shared by the key informants were processed. These results consisted of the following: (a) Interpersonal relationship with God and personal outlook on values; (b) Caring for the Spirit; (c) Actualization of spiritual care; and, (d) The mission of meaningful service.<br />A spirituality tool was developed based on the emerging themes and was given to each nurse. The tool revolves around seven elements: general manifestation in rendering spiritual care, specific manifestations in rendering spiritual care, recipients of spiritual care, appropriate time in rendering spiritual care, venue for rendering spiritual care, relevance/meaning of spiritual care and institutional support. The statistical treatment of the spirituality tool shows that nurses practice/concur with the spiritual care at all times.<br />The framework on the Integration of Spiritual Practices in Nursing Care points to God's presence in the midst of relational presence, integral presence, spaces of presence and moment presence. Hence, this study puts emphasis</p>

Level of awareness and compliance in diabetes mellitus management among adolescents diagnosed with type-1 diabetes

@#<p style="text-align: justify;">The study aimed to determine the level of awareness and to assess compliance to Diabetes management of adolescents diagnosed with Type-1 Diabetes. A descriptive correlational type of research was utilized to gather information on the level of awareness and compliance of adolescents patients to diet, exercise and drug management suffering from Type-1 diabetes mellitus. The patients (n=20) were recruited from Institute for Studies on Diabetes Foundation Incorporated, Philippines. A purposive sampling was utilized to select twenty adolescents. A researcher-made questionnaire was utilized as the main instrument in gathering data. Focus group discussion was also done to further assess patient's level of awareness and compliance to diabetes management. Results showed that patients have a moderate level of awareness and some extent of compliance to diabetes. Patients have extreme awareness in diet management and moderate awareness in exercise and drug management. In terms of compliance, patients are compliant to some extent only, while drug management has the highest highest level of compliance, followed by exercise and diet. There is a low correlation between level of awareness and compliance in diabetes management (r=.32 p=0.15), indicating that the moderate level of awareness of patients to DM management is not related to their compliance. The results are limited only to the participants of the study. Further study using a larger population and different setting is recommended. Nurses taking care of adolescent patients with diabetes mellitus must understand the importance of health education. Health educations are valuable to increase level of awareness and extent of compliance of adolescents patients with Type-1 diabetes.</p>

FANCD2 Western blot as a diagnostic tool for Brazilian patients with Fanconi anemia

Fanconi anemia is a rare hereditary disease showing genetic heterogeneity due to a variety of mutations in genes involved in DNA repair pathways, which may lead to different clinical manifestations. Phenotypic variability makes diagnosis difficult based only on clinical manifestations, therefore laboratory tests are necessary. New advances in molecular pathogenesis of this disease led researchers to develop a diagnostic test based on Western blot for FANCD2. The objective of the present study was to determine the efficacy of this method for the diagnosis of 84 Brazilian patients with Fanconi anemia, all of whom tested positive for the diepoxybutane test, and 98 healthy controls. The FANCD2 monoubiquitinated isoform (FANCDS+/FANCD2L-) was not detected in 77 patients (91.7 percent). In 2 patients (2.4 percent), there was an absence of both the monoubiquitinated and the non-ubiquitinated proteins (FANCD2S-/FANCD2L-) and 5 patients (5.9 percent) had both isoforms (FANCD2S+/FANCD2L+). This last phenotype suggests downstream subtypes or mosaicism. All controls were diepoxybutane negative and were also negative on the FANCD2 Western blot. The Western blot for FANCD2 presented a sensitivity of 94 percent (79/84) and specificity of 100 percent (98/98). This method was confirmed as an efficient approach to screen Brazilian patients with deleterious mutations on FANCD2 (FANCD2S-/FANCD2L-) or other upstream genes of the FA/BRCA pathway (FANCDS+/FANCD2L-), to confirm the chromosome breakage test and to classify patients according to the level of FA/BRCA pathway defects. However, patients showing both FANCD2 isoforms (FANCD2S+/FANCD2L+) require additional studies to confirm mutations on downstream Fanconi anemia genes or the presence of mosaicism.

Crude ethanol extract from babassu (Orbignya speciosa): cytotoxicity on tumoral and non-tumoral cell lines

Plant-derived substances have been considered as important sources of drugs, including antineoplasic agents. Babassu mesocarp is popularly used in Brazil as a food additive, and in popular medicine against several conditions, such as inflammations, menstrual pains and leukaemia. From babassu Orbignya speciosa (Mart.) Barb. Rodr. [Arecaceae (Palmae)] epicarp/mesocarp, an ethanol extract was prepared and named OSEME, which was tested on the viability,morphology and metabolism of several cell lines, such as the leukaemic cell lines, HL-60, K562 and the latter multidrug resistant counterpart K562-Lucena 1, the human breast cancer cell line MCF-7, the mouse fibroblast cell line 3T3-L1 and fresh human lymphocytes. OSEME promoted a dose-dependent decrease on the viability of all cells. This effect was much more pronounced on the tumoral cell lines than on non-tumoral cells, a phenomenon revealed by the dose of OSEME which promotes half of maximal effect (ID50). The decrease on viability was followed by shrinkage of cells, alteration on their morphology, and a markedly nuclear condensation. Curiously, stimulation of 6-phosphofructokinase activity (6.6-times) was observed on HL-60 cells, treated with OSEME, when compared to control treated with ethanol (vehicle). These results support evidences to suggest OSEME as a promising source of novel antineoplasic agents.

Substâncias derivadas de plantas têm sido usadas como importante fonte de agentes antineoplásicos. O mesocarpo do babaçu é popularmente usado no Brasil como suplemento alimentar e na medicina popular para o tratamento de várias afecções, tais como: inflamações, cólicas menstruais e leucemia. A partir do epicarpo/mesocarpo do babaçu Orbignya speciosa (Mart.) Barb. Rodr. [Arecaceae (Palmae)] foi preparado um extrato etanólico, denominado OSEME, o qual foi incubado com as seguintes linhagens humanas leucêmicas: HL-60, K562 e a sua derivada resistente a múltiplas drogas, K562-Lucena 1; além destas, foram testadas a linhagem humana de câncer de mama, MCF-7; a linhagem de fibroblastos de camundongo, 3T3-L1 e linfócitos humanos de sangue periférico. OSEME promoveu diminuição da viabilidade em todas as linhagens celulares testadas de maneira dose-dependente. Este efeito foi mais pronunciado sobre as linhagens celulares tumorais quando comparado às não tumorais, o que foi revelado pela dose de OSEME capaz de promover metade do efeito máximo (ID50). A diminuição da viabilidade foi acompanhada por danos sobre a morfologia celular com pronunciada condensação citoplasmática e nuclear. Curiosamente, quando a linhagem HL-60 foi tratada com OSEME, foi detectado um aumento de 6,6 vezes da atividade da enzima 6-fosfofrutoquinase, quando comparado ao grupo controle (células tratadas com o veículo etanol). Esses resultados sugerem que OSEME pode ser uma promissora fonte de novos agentes antineoplásicos.

Frequency of Fanconi anemia in Brazil and efficacy of screening for the FANCA 3788-3790del mutation

Fanconi anemia (FA) is an autosomal recessive genetic disease characterized by progressive bone marrow failure, susceptibility to cancer and multiple congenital anomalies. There is important clinical variability among patients and the knowledge of factors which might predict outcome would greatly help the decision making regarding the choices of treatment and the appropriate time to start it. Future studies of the possible correlation between specific mutations with specific clinical presentations will provide the answer to one of these factors. At our Center we standardized a rapid and precise screening test using a mismatch PCR assay for a specific mutation (3788-3790del in exon 38 of gene FANCA) in Brazilian FA patients. We present the results obtained after screening 80 non-consanguineous FA patients referred from all regions of Brazil with a clinical diagnosis of FA supported by cellular hypersensitivity to diepoxybutane. We were able to detect the 3788-3790del allele in 24 of the 80 (30 percent) FA patients studied. Thirteen of the 80 (16.25 percent) were homozygotes and 11 of the 80 (13.75 percent) were compound heterozygotes, thus confirming the high frequency of the FANCA 3788-3790del mutation in Brazilian FA patients. The identification of patients with specific mutations in the FA genes may lead to a better clinical description of this condition, also providing data for genotype-phenotype correlations, to a better understanding of the interaction of this specific mutation with other mutations in compound heterozygote patients, and ultimately to the right choices of treatment for each patient with improvement of the prognosis on future studies.