Prevalence of autoimmune diseases in an admixed population of patients with type 1 diabetes: a multicenter study in Brazil.

BACKGROUND/OBJECTIVES: The primary aim of this study was to evaluate the prevalence of autoimmune diseases (AIDs) and its associated factors in an admixed Brazilian population of patients with type 1 diabetes (T1D). The secondary one was to determine the relationship between AIDs and the occurrence of diabetes-related chronic complications (DRCC). METHODS: This cross-sectional, nationwide survey was conducted in 13 public clinics in 11 Brazilian cities. Overall, 1,760 patients were included; 967 females (55.9%), 932 (54%) Caucasians, aged 29.9 ± 11.9 years, age at diagnosis 14.8 ± 8.9 years, diabetes duration 15.5 ± 9.3 years and 12.2 ± 3.8 years of school attendance. AIDs were retrieved from medical records or self-report and stratified as follows: absence of AIDs, only autoimmune thyroid disease (AITD), and other AIDs including the combination with AITD (hyper or hypothyroidism). RESULTS: The prevalence of AIDs was 19.5% being AITDs (16.1%), the most frequently found. A higher prevalence of hypertension, dyslipidemia and overweight or obesity was found in patients who had exclusively AITDs. A higher prevalence of diabetic retinopathy (DR) was observed in patients with AITDs and patients with other AIDs in combination with AITDs. Chronic kidney disease (CKD) was more prevalent in patients with only AITDs. Lower levels of HbA1C, were observed in patients with isolated AITDs or with other AIDs, regardless of the presence of AITD. Hierarchical multivariate analysis, showed that AIDs were associated with female gender, older age, and longer diabetes duration, self-reported color-race (White and Brown), geographic region (Brazilian North/Northeast region) and higher anti-TPO levels (≥ 35 UI/ml). CONCLUSIONS: In conclusion, Brazilian patients with T1D, belonging to a highly ethnically admixed population, had an important prevalence of AIDs, mostly AITDs, that was associated with female gender, self-reported color-race, older age and longer diabetes duration. Moreover, these patients also had a higher prevalence of DRCC. Even though we highlight the importance of investigating the presence of AIDs at diagnosis and at regular intervals, it is unclear whether screening and early detection of additional AIDs may improve the clinical outcomes in individuals with T1D. Future prospective studies are necessary to establish the interplay between T1D, AIDs and DRCC.

Prevalence of overweight/obesity and its relationship with metabolic syndrome and fatty liver index in adult patients with type 1 diabetes. A Brazilian multicenter study.

AIMS: To determine the prevalence of overweight/obesity and its relationship with metabolic syndrome (MS), fatty liver index (FLI), cardiovascular risk factors (CVRF), and diabetes-related chronic complications (DRCC) in adult patients with type 1 diabetes (T1D). METHODS: This study was conducted in 14 Brazilian public clinics in ten cities, with 1,390 patients: 802 females (57.7%), 779 (56.0%) Caucasians, aged 33.6 ± 10.8 years, age at diagnosis, 16.2 ± 9.2 years, diabetes duration, 17.4 ± 9.2 years, and HbA1c 8.8 ± 2.0%. RESULTS: Overall, 825 patients (59.4%) had normal weight, and 565 had overweight/obesity; ( 429 (30.9%) presented overweight and 136 (9.8%) presented obesity). After adjustments, overweight/obesity was associated with age, family history of overweight/obesity, total daily insulin dose, hypertension, adherence to diet, type of health care insurance, use of metformin, levels of C-reactive protein, triglycerides, uric acid and HDL-cholesterol. These patients also presented a higher prevalence of MS, FLI ≥ 60, and CVRF than patients without overweight/obesity. Overweight/obesity was not associated with DRCC and with HbA1c levels. CONCLUSIONS: Patients with T1D with overweight/obesity presented traditional risk factors for DRCC, cardiovascular diseases, MS, and non-alcoholic fatty liver disease; most of these risk factors are modifiable and can be avoided with interventions that prevent overweight/obesity.

Osteohistological characterization of notosuchian osteoderms: Evidence for an overlying thick leathery layer of skin.

Osteoderms are mineralized structures embedded in the dermis, known for nonavian archosaurs, squamates, xenarthrans, and amphibians. Herein, we compared the osteoderm histology of Brazilian Notosuchia of Cretaceous age using three neosuchians for comparative purposes. Microanatomical analyses showed that most of them present a diploe structure similar to those of other pseudosuchians, lizards, and turtles. This structure contains two cortices (the external cortex composed of an outer and an inner layers, and the basal cortex) and a core in-between them. Notosuchian osteoderms show high bone compactness (>0.85) with varying degrees of cancellous bone in the core. The neosuchian Guarinisuchus shows the lowest bone compactness with a well-developed cancellous layer. From an ontogenetic perspective, most tissues are formed through periosteal ossification, although the mineralized tissues observed in baurusuchid LPRP/USP 0634 suggest a late metaplastic development. Histology suggests that the ossification center of notosuchian osteoderm is located at the keel. Interestingly, we identified Sharpey's fibers running perpendicularly to the outer layer of the external cortex in Armadillosuchus arrudai, Itasuchus jesuinoi, and Baurusuchidae (LPRP/USP 0642). This feature indicates a tight attachment within the dermis, and it is evidence for the presence of an overlying thick leathery layer of skin over these osteoderms. These data allow a better understanding of the osteohistological structure of crocodylomorph dermal bones, and highlight their structural diversity. We suggest that the vascular canals present in some sampled osteoderms connecting the inner layer of the external cortex and the core with the external surface may increase osteoderm surface and the capacity of heat transfer in terrestrial notosuchians.

Overweight/obesity in adolescents with type 1 diabetes belonging to an admixed population. A Brazilian multicenter study.

BACKGROUND: To determine the prevalence of overweight/obesity and associated risk factors in Brazilian adolescents with type 1 diabetes (T1D) and its association with diabetic retinopathy (DR) and chronic kidney disease (CKD). METHODS: This study was performed in 14 Brazilian public clinics in ten cities, with 1,760 patients. 367 were adolescents (20.9%):184 females (50.1%), 176 (48.0%) Caucasians, aged 16.4 ± 1.9 years, age at diagnosis 8.9 ± 4.3 years, diabetes duration 8.1 ± 4.3 years, school attendance 10.9 ± 2.5 years and HbA1c 9.6 ± 2.4%. RESULTS: 95 (25.9%) patients presented overweight/obesity, mostly females. These patients were older, had longer diabetes duration, higher levels of total and LDL-cholesterol, higher prevalence of family history of hypertension, hypertension, undesirable levels of LDL-cholesterol, and metabolic syndrome compared to eutrophic patients. No difference was found regarding ethnicity, HbA1c, uric acid, laboratorial markers of non-alcoholic fatty liver disease (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase). CONCLUSIONS: Almost one quarter of our patients presented overweight/obesity. These patients had higher prevalence of traditional risk factors for micro and macrovascular diabetes-related chronic complications such as diabetes duration, hypertension, high levels of LDL-cholesterol and metabolic syndrome. The majority of the patients with or without overweight/obesity presented inadequate glycemic control which is also an important risk factor for micro and macrovascular diabetes-related chronic complications. No association was found between overweight/obesity with diabetic CKD, DR and laboratorial markers of non-alcoholic fatty liver disease. The above-mentioned data point out that further prospective studies are urgently needed to establish the clinical prognosis of these young patients.

The first Jurassic theropod from the Sergi Formation, Jatobá Basin, Brazil.

Archosaur osteological remains are abundant in Brazil, particularly from the Triassic and Cretaceous strata, but in Jurassic, the record is predominantly represented by ichnofossils. The Upper Jurassic archosaur records comprise the Paralligatoridae Batrachomimus pastosbonensis, from the Pastos Bons Formation (Parnaíba Basin), remains of Mesoeucrocodylia from the Aliança Formation (Jatobá Basin), and fragments of Dinosauria from the Brejo Santo Formation (Araripe Basin) with a dubious assignment. Here, we present the first undoubted Dinosauria record for the Jurassic of Brazil, MCT 2670-LE, a middle to distal caudal vertebra belonging to a theropod. MCT 2670-LE was excavated in the 60s by prof. Ignacio Machado Brito, being primarily attributed to strata of the Aliança Formation but the rock matrix involving the specimen allows us to correlate MCT 2670-LE to Sergi Formation, marking this specimen as the first archosaur record of this unit. The caudal vertebra is assigned to Carcharodontosauria based on the hourglass shaped centrum and the deep and narrow ventral groove. The specimen provides new data to the paleogeographic distribution of carcharodontosaurians before the South America-Africa break-up, as well as understanding the theropod faunal turnover of paleoenvironments during the Jurassic-Cretaceous transition in Brazil.

Human Leukocyte Antigens class II (HLA II) gene profile from an admixed population of patients with type 1 diabetes with severe diabetic retinopathy: a nested case-control study in Brazil.

BACKGROUND: Although the well-established role of the HLA genes on the predisposition of type 1 diabetes (T1D), its contribution to the development and progression of diabetic retinopathy is still unclear, especially in admixed populations. We aimed to study the relationship between HLA alleles and severe diabetic retinopathy in a highly admixed population of T1D patients. METHODS: This was a nested case-control study based on a cross-sectional, nationwide survey conducted in Brazil. We included 117 patients with severe diabetic retinopathy and 117 random controls composed of T1D patients without retinopathy, matched for diabetes duration. HLA-class II genes (HLA-DRB1, -DQA1, and -DQB1) were genotyped using the SSO and NGS methods. RESULTS: Haplotypes HLA-DRB1*04:05 ~ DQA1*03:01 g ~ DQB1*03:02 (OR 1.75, CI 0.97-3.16, p value 0.058) and HLA-DRB1*13:02 ~ DQA1*01:02 ~ DQB1*06:04 (OR 5.18, CI 1.12-23.09, p value 0.019) were more prevalent on the severe DR group but they did not present statistically difference after Bonferroni correction. The most frequent haplotype on both groups was HLA-DRB1*03:01 ~ DQA1*05:01 g ~ DQB1*02:01 (29.6% on severe DR and 33.33% on the control group). CONCLUSIONS: Our study showed no influence of HLA genes on the development of DR. Further longitudinal data is needed to better understand the role of genetic factors on this multifactorial significant microvascular complication.

Diabetes-related chronic complications in Brazilian adolescents with type 1 diabetes. A multicenter cross-sectional study.

AIMS: To investigate the prevalence of diabetes-related chronic complications (DRCCs) and its associated factors in Brazilian adolescents with type 1 diabetes (T1D). METHODS: This nationwide study was conducted in 14 public clinics in 10 cities, with 1,760 patients, 367 adolescents, with 328 eligible for this study. Evaluated DRCCs were retinopathy (DR), chronic kidney disease (CKD), peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). RESULTS: Among eligible patients, 184 were females (50.1%), age range 13-19 years, HbA1c 9.6% ± 2.4, aged 8.9 ± 4.3 years at diagnosis and diabetes duration of 8.1 ± 4.3 years. 103 (31.4%) patients presented any type of DRCC. CKD was found in 46 (14.0%), CAN in 41(12.5%), DR in 28 (8.5%) and DPN in 16 (4.9%) patients. One, two or three DRCCs were observed in 79 (24.1%), 19 (5.8%) and 5 (1.5%) patients, respectively, and were associated with longer diabetes duration, higher HbA1c and diastolic blood pressure levels (dBP), use of renin angiotensin inhibitors and lower adherence to diet. CONCLUSIONS: A high percentage of patients presented some kind of DRCC, associated with diabetes duration, glycemic control, dBP, adherence to diet. Educational programs should start from the diagnosis to avoid DRCCs in this young population.

The first notosuchian crocodyliform from the Araçatuba Formation (Bauru Group, Paraná Basin), and diversification of sphagesaurians.

The mesoeucrocodylian record from the Bauru Group (Paraná Basin, Brazil) comes from three formations: Adamantina (Late Turonian-Early Maastrichtian), Presidente Prudente (Early Campanian-Early Maastrichtian) and Marília (Maastrichtian). These records are restricted to the Early Coniacian-Early Maastrichtian. Here, we report a new crocodyliform record from the Bauru Group, which was the first of the Araçatuba Formation, from a new locality of Coronel Goulart district, in Álvares Machado municipality. Coronelsuchus civali gen. nov. et sp. nov. comprises two related specimens - FFP PG 13 and FFP PG 14 recovered close to each other and on the same muddy sandstone level. We perform a phylogenetic analysis with 392 characters (five new added) and 88 taxa. Our analyses supported the new clades: Sphagesauria, Sphagesaurinae and Caipirasuchinae. Our phylogenetic results suggest C. civali as a basal Sphagesauria. Regarding the Crocodyliform Assemblage Zones (CAZ), the new species is correlated to the CAZ 1, together with small sphagesaurians, Caryonosuchus and itasuchids. The C. civali reveals an older appearing (pre-Turonian) and diversification of Sphagesauria. The specimens also expand the stratigraphic range for Notosuchia in the Bauru Group.

Thermal favorability for the Oidium caricae and Asperisporium caricae in areas of edaphoclimatic aptitude for the Carica papaya.

Objective this study aimed to determine the thermal favorability for the oidium (Oidium caricae) and early blight (Asperisporium caricae) in areas of edaphoclimatic aptitude for the papaya (Carica papaya) in the Espírito Santo state, Brazil. The edaphoclimatic zoning was based on the overlapping of maps that characterize the average annual air temperature obtained by multiple linear regression, annual water deficiency calculated by the Thornthwaite and Matter method (1955) and favorable soil classes to the development of papaya. The results indicated that as regards the edaphoclimatic zoning for the papaya crop it was observed that 71.70% of the area is classified as apt for its development. In relation to agrometeorological favorability for the occurrence of fungal diseases, there was a favorability of 7.64% for the development without restrictions of the oidium and a predominance of 64,56% of favorability with thermal restriction. For the early blight fungus, it was observed that the zones of favorability without restriction correspond to 11.66% of the area apt for the papaya cultivation and that 55.13% of the area has favorability with restriction of humidity. The edaphoclimatic zoning for the papaya crop showed compatibility with the most productive areas of this crop in the state of Espírito Santo. The zoning of thermal favorability for the occurrence of papaya fungal diseases proved to be a valuable tool for studies of plant diseases, allowing the establishment of plans for the allocation of resistant varieties, in order to minimize the risks of loss of crop productivity due to the disease. This methodology presents potential to be used in other areas, cultures and phytopathological diseases.

Relationship between Proliferative Diabetic Retinopathy and Inflammatory Markers in Patients with Type 1 Diabetes in Brazil: A Nested Case Control Study.

INTRODUCTION: This study examined the relationship between proliferative diabetic retinopathy (PDR) and serum levels of C-reactive protein, VEGF, TNF-α, and IL-6 inflammatory biomarkers, related to the pathophysiology of diabetic retinopathy. METHODS: This cross-sectional, case control study comprised 240 patients with type 1 diabetes (80 cases with PDR and 160 controls without diabetic retinopathy) who were matched for gender and duration of diabetes. RESULTS: C-reactive protein was the only inflammatory biomarker that was positively related to PDR (OR 1.96; 95% CI 1.01-3.78, p = 0.0045). We also noted an association between high glycated hemoglobin levels, the use of angiotensin-converting enzyme inhibitor, low glomerular filtration rate, and PDR. CONCLUSION: Patients with higher levels of C-reactive protein are more likely to present with PDR. We did not find a link between serum levels of VEGF, TNF-α, or IL-6 and PDR. The function of inflammatory biomarkers in PDR must be addressed in further studies.

Genomic ancestry as a risk factor for diabetic retinopathy in patients with type 1 diabetes from an admixed population: a nested case-control study in Brazil.

AIMS: The influence of genetic factors on the development and progression of diabetic retinopathy is still unclear. Previous studies showed controversial results. We aimed to characterize the relationship between genomic ancestry and self-reported color/race with severe diabetic retinopathy in patients with type 1 diabetes belonging to a highly admixed population. METHODS: This study was a nested case-control based on data collected from a large cross-sectional, nationwide survey conducted in clinics from all five geographic regions of Brazil. For the present study, we included 414 individuals. Cases (n = 176) were considered if they had severe non-proliferative or proliferative diabetic retinopathy, and controls (n = 238) were type 1 diabetes patients without retinopathy, matched for diabetes duration by a range of 5 years. Indirect ophthalmoscopy was performed, and individual genomic ancestry was inferred using a panel of 46 ancestry informative markers. RESULTS: The backward stepwise logistic regression analysis showed that African genomic ancestry (OR 3.9, p = 0.045), HbA1c (OR 1.24, p = 0.001), glomerular filtration rate (OR 0.98, p < 0.001) and hypertension (OR 2.52, p < 0.001) were associated with severe diabetic retinopathy after adjusting for clinical and demographic data. Self-reported color/race was not statistically associated with diabetic retinopathy. CONCLUSIONS: Genomic ancestry, as well as clinical variables such as hypertension, impaired glomerular filtration rate and poor diabetes control (HbA1c), was important risk factor for the development of severe diabetic retinopathy. Further studies are needed, especially in highly admixed populations, to better understand the role of genomic ancestry and possible genes that might be associated with the development and/or progression of diabetic retinopathy.

Diabetic Retinopathy May Indicate an Increased Risk of Cardiovascular Disease in Patients With Type 1 Diabetes-A Nested Case-Control Study in Brazil.

Objective: Cardiovascular disease, the leading cause of death worldwide, and diabetic retinopathy, the main cause of blindness in economically active populations, share clinical risk factors, and pathophysiological features. The aim of this study is to examine the association between diabetic retinopathy, cardiovascular disease, and common risk factors in patients with type 1 diabetes. Design and Methods: This nested case-control study was performed in patients from the Brazilian Type 1 Diabetes Study Group, a nationwide survey that was conducted in Brazil and enrolled 1,760 patients with type 1 diabetes. A total of 342 patients were selected (57 cases with macrovascular disease and 285 controls who were matched for duration of diabetes and gender). Results: In the exploratory analysis, stratified by cardiovascular disease, the following variables were statistically significant: age (p=0.037), hypertension (p=0.035), high BMI (p = 0.046), diabetic retinopathy (p = 0.003), and chronic kidney disease (p = 0.026). By multivariate logistic regression, patients with diabetic retinopathy were more likely to develop cardiovascular disease (OR 2.16, 95% CI 1.16-4.02, p = 0.015). Although to a lesser extent than diabetic retinopathy, higher BMI levels were also related to an increase in the risk of cardiovascular disease of 1.08 (95% CI 1.01-1.15, p = 0.024). Conclusion: The presence of diabetic retinopathy indicates a greater risk for cardiovascular disease in Brazilian patients with type 1 diabetes. Further studies are warranted to determine whether a noninvasive exam, such as fundoscopy, could help identify patients who show an increased risk for cardiovascular disease.

Reassessment of the enigmatic crocodyliform "Goniopholis" paulistanus Roxo, 1936: Historical approach, systematic, and description by new materials.

The Crocodyliformes are the most represented vertebrate clade in the Upper Cretaceous sequences of the Bauru Group, Paraná Basin. However, some of the species described have an uncertain taxonomic status and phylogenetic position. For instance, "Goniopholis" paulistanus has been assigned as a nomem dubium, due to its description being based on scarce material. The "G". paulistanus specimens (i.e. teeth and a left tibia) were discovered in two different localities in São Paulo state: Mirandópolis and Valparaíso municipalities; where the upper interval of the Adamantina Formation (Early Maastrichtian of Bauru Group) crops out. Revisiting these specimens, we observed multicrenulated teeth in middle dentary toot- row, a remarkable feature only shared with teleosaurids Machimosaurus hugii (Upper Jurassic of Laurasia) and M. rex (Lower Cretaceous of Tunisia). This apomorphy was also recognized in new material from the Alfredo Marcondes municipality (Presidente Prudente Formation), which are here also referred to "G". paulistanus. We recognized the teeth of "G." paulistanus as the lectotype, however the tibia cannot be assigned to a species as it was not collected in association with the teeth. We performed a phylogenetic analysis with a data matrix composed of 388 characters and 86 taxa, analyzed in TNT. The strict consensus tree recovered Neosuchia and Ziphosuchia (Notosuchia + Sebecia) within Mesoeucrocodylia. The species "G" paulistanus is valid, as a distinct and new genus within Sebecia, in a polytomy with Barreirosuchus, Pepesuchus, Itasuchus and Peirosaurus, forming the clade Itasuchidae. Stolokrosuchus is the sister taxon to Itasuchidae, the sister group of all other Sebecia (Peirosauridae (Mahajangasuchidae + Sebecidae and taxa affinis)). The clades Ziphosuchia, Sebecia and Itasuchidae are here redefined, and we find the last two clades to be more closely related to terrestrial notosuchids than to semiaquatic neosuchians.

Current epidemiology of diabetic retinopathy in patients with type 1 diabetes: a national multicenter study in Brazil.

BACKGROUND: Diabetic retinopathy is the leading cause of blindness in economically active populations. The aims of this study were to estimate the prevalence and to identify risk factors for diabetic retinopathy in patients with type 1 diabetes in Brazil. METHODS: This was a nationwide, cross-sectional study conducted between August 2010 and August 2014. The study included 1760 patients with type 1 diabetes. Patients underwent a standard questionnaire, clinical and laboratory analyses and were screened for diabetic retinopathy. To analyze the risk factors related to diabetic retinopathy, two models of logistic regression models were performed, one considering vision-threatening cases and the other with any diabetic retinopathy cases as dependent variables. The group with vision-threatening included patients with severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and macular edema. RESULTS: In total, 1644 patients (mean age, 30.1± 12.0 years; duration of diabetes, 15.3 ± 9.3 years; female, 55.8%) were studied. 35.7% presented diabetic retinopathy and 12% presented vision-threatening diabetic retinopathy. Three risk factors associated with diabetic retinopathy were in common to both groups: longer diabetes duration (OR 1.07; 95% CI, 1.05-1.09), higher levels of HbA1c (OR 1.24; CI, 1.17-1.32) and higher levels of serum uric acid (OR 1.22; CI, 1.13-1.31) (p < 0.001 for all comparisons). CONCLUSION: The higher rate of vision-threatening retinopathy found in our study highlights the need to improve access to eye care and screening programs for diabetic retinopathy in Brazil. In addition to traditional risk factors, we found an association between serum uric acid levels and diabetic retinopathy. Further studies are needed to address this association.

Regional differences in the prevalence of diabetic retinopathy: a multi center study in Brazil.

BACKGROUND: Diabetic retinopathy has a significant impact in every healthcare system. Despite that fact, there are few accurate estimates in the prevalence of DR in Brazil's different geographic regions, particularly proliferative DR and diabetic macular edema. This study aims to determine the prevalence of diabetic retinopathy in Brazil's five continental regions and its determinant factors. METHODS: This multi center, cross-sectional, observational study, conducted between August 2011 and December 2014, included patients with type 1 diabetes from the 5 Brazilian geographic regions (South, Southeast, North, Northeast and Midwest). During a clinical visit, a structured questionnaire was applied, blood sampling was collected and each patient underwent mydriatic binocular indirect ophthalmoscopy evaluation. RESULTS: Data was obtained from 1644 patients, aged 30.2 ± 12 years (56.1% female, 54.4% Caucasian), with a diabetes duration of 15.5 ± 9.3 years. The prevalence of diabetic retinopathy was 242 (36.1%) in the Southeast, 102 (42.9%) in the South, 183 (29.9%) in the North and Northeast and 54 (41.7%) in the Midwest. Multinomial regression showed no difference in the prevalence of non-proliferative diabetic retinopathy in each geographic region, although, prevalence of proliferative diabetic retinopathy (p = 0.022), and diabetic macular edema (p = 0.003) was higher in the Midwest. Stepwise analyses reviled duration of diabetes, level of HbA1c and hypertension as independent variables. CONCLUSIONS: The prevalence of non proliferative diabetic retinopathy in patients with type 1 diabetes was no different between each geographic region of Brazil. The Midwest presented higher prevalence of proliferative diabetic retinopathy and diabetic macular edema. Duration of DM and glycemic control is of central importance to all. Hypertension is another fundamental factor to every region, at special in the South and Southeast. Glycemic control and patients in social and economic vulnerability deserves special attention in the North and Northeast of Brazil.

Comparison between binocular indirect ophthalmoscopy and digital retinography for diabetic retinopathy screening: the multicenter Brazilian Type 1 Diabetes Study.

BACKGROUND: Diabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries. Diabetic retinopathy screening is effective in preventing blindness and can be performed through various diagnostic methods. Our objective is to compare binocular indirect ophthalmoscopy (BIO) to telemedicine protocols of digital retinography for diabetic retinopathy screening in a large and heterogenous type 1 diabetes population in a developing country. METHODS: Data from 1266 Type 1 Diabetes Mellitus patients from a Brazilian multicenter study were analyzed. Patients underwent BIO and digital retinography, non-mydriatic and mydriatic. Images were sent to a reading center in a telemedicine protocol. Agreement between the different methods was calculated with kappa statistic for diabetic retinopathy and maculopathy classification. Clinical outcome was either observation or referral to specialist. RESULTS: Agreement between BIO and mydriatic retinography was substantial (kappa 0.67-0.74) for diabetic retinopathy observation vs referral classification. Agreement was fair to moderate (kappa 0.24-0.45) between retinography and BIO for maculopathy. Poor mydriasis was the main obstacle to image reading and classification, especially on the non-mydriatic strategy, occurring in 11.9 % of right eyes and 16.9 % of left eyes. CONCLUSION: Mydriatic retinography showed a substantial agreement to BIO for diabetic retinopathy observation vs referral classification. A significant amount of information was lost on the non-mydriatic technique because of poor mydriasis. We recommend a telemedicine-based diabetic retinopathy screening strategy with digital mydriatic retinography, preferably with 2 fields, and advise against non-mydriatic retinography in developing countries.

Dual-color control of nucleotide polymerization sensed by a fluorescence actuator.

Spatial and temporal control of molecular mechanisms can be achieved using photolabile bonds that connect biomolecules to protective caging groups, which can be cleaved upon irradiation of a specific wavelength, releasing the biomolecule ready-to-use. Here we apply and improve a previously reported strategy to tightly control in vitro transcription reactions. The strategy involves two caging molecules that block both ATP and GTP nucleotides. Additionally, we designed a molecular beacon complementary to the synthesized mRNA to infer its presence through a light signal. Upon release of both nucleotides through a specific monochromatic light (390 and 325 nm) we attain a light signal indicative of a successful in vitro transcription reaction. Similarly, in the absence of irradiation, no intense fluorescence signal was obtained. We believe this strategy could further be applied to DNA synthesis or the development of logic gates.

A new sebecid from the paleogene of Brazil and the crocodyliform radiation after the K-Pg boundary.

A new crocodyliform, Sahitisuchus fluminensis gen. et sp. nov., is described based on a complete skull, lower jaw and anterior cervical vertebrae collected in the São José de Itaboraí Basin of Rio de Janeiro, Brazil. The specimen is one of the best preserved crocodyliforms from Paleocene deposits recovered so far and represents a sebecosuchian, one of the few clades that survived the Cretaceous-Paleogene biotic crisis. The new taxon is found in the same deposit as an alligatoroid, a group that experienced large diversification in the Paleogene. The sebecosuchian record suggests that after the Cretaceous-Paleogene biotic crisis, the less specialized members of this clade characterized by a higher number of teeth compared to the baurusuchid sebecosuchians survived, some having terrestrial habits while others developed a semi-aquatic life style (e.g., Lorosuchus). Starting in the Eocene, sebecid sebecosuchians became specialized with a more accentuated oreinirostry as observed in Sebecus and in Langstonia, but not showing the typical reduced dentition developed by the Cretaceous baurusuchid sebecosuchians. The basal position of Barinasuchus arveloi, a high-snouted Miocene sebecid, indicates the occurrence of an independent lineage sometime after the K-Pg biotic crisis that developed accentuated oreinirostry, suggesting a more complex history of the post-K-Pg crocodyliform radiation.

Marcadopres de obesidade e risco cardiovascular em mulheres com síndrome dos ovários policísticos / Obesity and cardiovascular risk markers in women with polycystic ovary syndrome

Fundamentos: A obesidade é muito frequente em mulheres portadoras de síndrome dos ovários policísticos (SOP) e está associada ao aumento do risco cardiovascular. Objetivo: Associar medidas antropométricas: índice de massa corpórea (IMC), circunferência da cintura(CC), relação cintura-estatura (RCEST), relação cintura quadril (RCQ), percentual de gordura corporal (%GC)a fatores de risco cardiovascular (FRCV): pressão arterial elevada, perfil lipídico e glicemia de jejum alterados, em mulheres com SOP. Métodos: Estudo transversal realizado com 78 mulheres portadoras de SOP, diagnosticadas pelo critério de Rotterdam. Foram mensurados: colesterol total (CT), triglicerídeos (TG), LDL-colesterol (LDL-c), HDL-colesterol (HDL-c), glicemia de jejum e pressão arterial (PA) em todas as pacientes, bem como as variáveis antropométricas. Resultados: A prevalência de obesidade foi elevada, tanto avaliada pelo IMC (34,6%), quanto avaliada pelo %GC (61,5%). A alteração do perfil lipídico foi relevante na amostra, especialmente a diminuição do HDL-c observada em 34,6% das mulheres. O IMC, CC e RCEST apresentaram correlação positiva significativa com todos os FRCV analisados neste estudo. Conclusões: A presença de FRCV foi elevada na amostra estudada. Os indicadores antropométricos utilizados apresentaram boa correlação com o risco cardiovascular em mulheres com SOP. Isso sugere a viabilidade do uso desses indicadores na avaliação clínica, com vistas à detecção do risco cardiovascular nessas pacientes.

Background: Obesity is very frequent in women with polycystic ovary syndrome (PCOS) and is associated with the increased cardiovascular risk. Objective: To associate anthropometric measurements body mass index (BMI), waist circumference (WC),waist to height ratio (WHtR), waist hip ratio (WHR), body fat percentage (BF%) with the following cardiovascular risk factors (CVRF): high blood pressure, lipid profile and fasting glucose changes among women with PCOS. Methods: Cross-section study conducted with 78 women with PCOS, diagnosed according to the Rotterdam Consensus. The following were measured: total cholesterol (TC), triglycerides (TG), LDL cholesterol (LCL-c) HDL cholesterol (HDL-c), fasting glucose and blood pressure (BP) in all patients, as well as anthropometric variables. Results: The prevalence of obesity was high when assessed by BMI (34.6%) and BF% (61.5%). The lipid profile was relevant in the sample, especially the decrease in HDL-c noted in 34.6% of the women. The BMI, WC and WHtR showed significant positive correlation with all CVRF analyzed in this study. Conclusions: The presence of cardiovascular risk : factors was high in the sample studied. The anthropometric indicators used in this study showed a good correlation to cardiovascular risks among women with PCOS. This suggests the feasibility of using these indicators in clinical evaluations in order to detect cardiovascular risks among these patients.