The role of intermittent continuous glucose monitoring in a successful outpatient transition from insulin to glibenclamide in a patient with transient neonatal diabetes

SUMMARY Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes occurring mainly in the first 6 months of life. Approximately 30% of transient NDM (TNDM) cases will have an activating mutation in the KATP channel genes ABCC8 and KCNJ11. The majority of the patients with KCNJ11 mutations who are receiving insulin treatment can be transferred to treatment with sulfonylurea (SU), with an improvement in metabolic control and quality of life. Intermittent continuous glucose monitoring (iCGM) is used to assess the current and retrospective interstitial glucose, providing information such as hypo/hyperglycemia tendency and time on target. This case report describes the use of iCGM in the transition from insulin treatment to glibenclamide in a patient with TNDM caused by a pathogenic variant of KCNJ11. This is the first report of a successful outpatient transition from insulin to glibenclamide, in a Brazilian child with TNDM using iCGM (FreeStyle Libre@). The remote monitoring and online management allowed the patient to safely stay at home during the transition from insulin to SU, especially important in the context of the COVID-19 pandemic. We conclude that iCGM is a helpful tool in cases of NDM and should be used to increase safety and speed up dose adjustments in outpatient transition from insulin to glibenclamide.

The role of intermittent continuous glucose monitoring in a successful outpatient transition from insulin to glibenclamide in a patient with transient neonatal diabetes.

Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes occurring mainly in the first 6 months of life. Approximately 30% of transient NDM (TNDM) cases will have an activating mutation in the KATP channel genes ABCC8 and KCNJ11. The majority of the patients with KCNJ11 mutations who are receiving insulin treatment can be transferred to treatment with sulfonylurea (SU), with an improvement in metabolic control and quality of life. Intermittent continuous glucose monitoring (iCGM) is used to assess the current and retrospective interstitial glucose, providing information such as hypo/hyperglycemia tendency and time on target. This case report describes the use of iCGM in the transition from insulin treatment to glibenclamide in a patient with TNDM caused by a pathogenic variant of KCNJ11. This is the first report of a successful outpatient transition from insulin to glibenclamide, in a Brazilian child with TNDM using iCGM (FreeStyle Libre@). The remote monitoring and online management allowed the patient to safely stay at home during the transition from insulin to SU, especially important in the context of the COVID-19 pandemic. We conclude that iCGM is a helpful tool in cases of NDM and should be used to increase safety and speed up dose adjustments in outpatient transition from insulin to glibenclamide.

Um estudo ator-rede para o brinquedo artesanal: herança que se traduz em Minas / An actor-net study of the artisan toy: heritage that is translated in Minas

Este artigo apresenta uma revisão crítica de literatura que teve como objetivo contextualizar, em uma região de Minas Gerais, a pesquisa sobre os brinquedos e jogos tradicionais que, passando de grupo em grupo, foram assumindo versões particulares na produção artesanal. Tendo como suporte teórico-metodológico a Teoria Ator-Rede, defendemos a realização desta investigação no campo da Psicologia Social num movimento de mapear, registrar e preservar objetos que, em sua mistura de materialidade e socialidade, fazem parte da memória e da identidade dos grupos de brincantes. Nesta primeira etapa do projeto, para seguir o traçado deixado por estes artefatos, foi realizado este estudo no sentido de fundamentar a nossa entrada no campo para a verificação das práticas artesanais vigentes na região.(AU)

This article presents a critical review of literature that aims at contextualizing, in a region of Minas Gerais, the research about toys and traditional games that, passing from group to group, have been assuming particular versions in the artisan production. Having the Actor-Net Theory as a theoretical-methodological support, we defend the accomplishment of this investigation in the field of Social Psychology in a movement of mapping, registering, and preserving objects that, in their mixture of materiality and sociality, are part of the memory and identity of the playful groups. In this first stage of the project, taking into consideration that we intend to follow the traces left by these devices, this study was conducted in order to fundament our entrance in the field for the verification of the effective artisan practice in the region.(AU)

L-DOPA accessibility in culture medium increases melanin expression and virulence of Sporothrix schenckii yeast cells.

Melanin is a complex polymer widely distributed in nature and has been described as an important virulence factor in several pathogenic fungi, including Sporothrix schenckii. The aim of the present work was to investigate the presence of melanin on the surface of S. schenckii yeast cells which showed differences in their virulence depending on the culture conditions under which they were grown. Yeast cells were cultivated in brain heart infusion (BHI) broth from Difco and Oxoid. BHI from these two vendors are different in their brain and heart infusion contents. Yeasts cultivated in the medium containing the higher brain infusion content were highly virulent as ascertained by the mice mortality rate, CFU and histopathology. Transmission electron microscopy revealed a higher expression of electron dense granules on the fungal cell wall of the most virulent yeast cells. Flow cytometry analysis, with anti-melanin antibodies, confirmed that this pigment was melanin. Furthermore, spectrophotometric analysis showed a higher concentration of this polymer on NaOH and cell wall extracts of the most virulent yeast cells. These results suggest that differences in the relative content of brain and heart infusion in the culture medium modulated melanin expression on the surface of S. schenckii yeast cells and, as a consequence, virulence. A new pathway of melanin biosynthesis in S. schenckii is proposed which involves the use of phenolic compounds from rich brain medium as melanin substrate.