Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial

ABSTRACT Objective: The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Materials and methods: Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results: Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion: OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

Regression of orbital brown tumor after surgical removal of parathyroid adenoma

Brown tumors are rare skeletal manifestations that occur in less than 2% of primary hyperparathyroidism (PHPT) cases. Even rarer is the occurrence of brown tumor of the orbit, and few cases have been reported around the world. The rare instance of this benign tumor has prompted us to report the case and treatment of an orbital brown tumor in a patient with PHPT caused by parathyroid adenoma. We present the case of a patient undergoing follow-up at a referral center. The 60-year-old female patient, presented herself with progressive swelling in the nasal region, epistaxis and proptosis, she had noticed seven months prior to our examination. Multiple imaging and laboratory findings revealed parathyroid hormone (PTH)-dependent hypercalcemia (total calcium = 14.3 mg/dL and PTH = 1,573 pg/mL), a nodular lesion in the upper pole of the left thyroid lobe and increased uptake in left upper cervical region. The patient underwent left superior parathyroidectomy in September 2011, which led to the normalization of hypercalcemia and regression of the orbital tumor, as seen on control CT scan. This case highlights the spontaneous regression of the brown tumor after surgical management of the parathyroid adenoma.

Brain hypoperfusion in adolescents dependent of multiple drugs / Hipoperfusão cerebral em adolescentes dependentes de múltiplas drogas

Brain SPECT imaging (BSI) with statistical parametric mapping (SPM) offers a clear and accurate vision of perfusion changes. OBJECTIVE: To study brain perfusion abnormalities in adolescents' dependent of multiple drugs. METHOD: Sixteen male patients (15.1±2.1 years) were submitted to 99mTc-HMPAO BSI with SPM. RESULTS: Cortical hypoperfusion occurred in 7/16 patients (44 percent). There was a significant inverse correlation between the number of hypoperfused regions and the patient's age (p= -0.6737; p=0.004) and with the age when the drug dependence began (p= -0.5616; p=0.023). There was also a tendency towards an inverse correlation between regions of hypoperfusion and the duration of the drug dependence. CONCLUSION: BSI with SPM can help detect hypoperfusion in adolescents dependent on multiple drugs. The younger the patients, the more regions of hypoperfusion are noted. Probably, the neuronal plasticity has an important role in this phenomenon because the highest neural activity occurs in childhood.

SPECT cerebral (SC) com statistical parametric mapping (SPM) oferece uma visão clara e acurada de alterações perfusionais. OBJETIVO: Avaliar anormalidades perfusionais cerebrais em adolescentes usuários de múltiplas drogas. MÉTODO: Dezesseis pacientes masculinos (15,1±2,1 anos) foram submetidos a SC com SPM utilizando-se HMPAO-99mTc. RESULTADOS: Hipoperfusão cortical ocorreu em 7/16 pacientes (44 por cento). Houve uma significativa correlação inversa entre o número de áreas hipoperfundidas e a idade dos pacientes (p= -0,6737; p=0,004) e com a idade quando iniciaram o abuso das drogas (p= -0,5616; p=0,023). Também houve uma tendência para uma correlação inversa entre as áreas de hipoperfusão e a duração do abuso de drogas. CONCLUSÃO: SC com SPM pode auxiliar na detecção de hipoperfusão cortical em adolescentes dependentes de múltiplas drogas. Quanto menor a idade, mais áreas de hipoperfusão são identificadas. Provavelmente a plasticidade neuronal tem importante papel neste fenômeno, pois a maior atividade neuronal ocorre na infância.