Characteristics of the clinical treatment of Brazilian and French older adults with diabetes.

OBJECTIVE: The study aimed to compare the drug therapy profile between French older adults with diabetes of the GERODIAB cohort and Brazilian older adults with diabetes assessed in a cross-sectional study conducted in Brazil. METHOD: This quantitative cross-sectional study was conducted with a sample of 246 Brazilian people aged 65 and over receiving care through the Unified Health System in the city of Fortaleza, Northeastern Brazil, who were compared to a sample of 987 French people aged 70 and over receiving care the Rouen University Center in France. RESULTS: The French participants treated for type 2 diabetes (T2D) with insulin alone, insulin + oral hypoglycemic agent (OHA) or OHA/GLP-1 analogue were older and presented higher mean values for body mass index, waist circumference and duration of diabetes in years. The French reported more episodes of hypoglycemia in all treatment modalities. These episodes occurred more frequently in the older adults treated with insulin alone and less frequently in those treated with OHA or GLP-1 analogues. The percentage of Brazilian and French older adults who monitored capillary blood glucose differed significantly in all treatment modalities. CONCLUSION: The significant differences relating to the drug therapy modalities used by Brazilian and French older adults with diabetes point to the importance of understanding the therapeutic objective of drug therapy with older adults with diabetes. Adapting the therapy to the patient's clinical conditions can prevent the worsening of comorbidities that influence the loss of autonomy and frailty.

Expressão do simportador sódio-iodo (NIS) nos tumores tireoidianos benignos e malignos através de estudo imunohistoquímico e da quantificação do RNA mensageiro / Expression of the sodium iodide symporter (NIS) in benign and malignant thyroid tumors using immunohistochemistry and mesenger RNA quantification

O transporte de iodo para tireóide é mediado pelo simportador sódio-iodo (NIS), glicoproteína de 643 aminoácidos localizada na região basolateral da célula folicular que acopla a entrada de sódio e iodo para o interior da célula. A clonagem do gene NIS em 1996 foi o primeiro passo na investigação dos mecanismos moleculares responsáveis pela diminuição da captação do radioiodo nos tumores benignos e malignos da tireóide. Estudos prévios sobre a expressão do gene NIS baseados em quantificação do transcrito e/ou análise imuno-histoquímica da proteína, mostraram resultados bastante divergentes. A maioria dos estudos com RT-PCR mostrou redução ou até ausência do transcrito do NIS. Os estudos mais recentes de imunohistoquímica, no entanto, mostraram aumento da expressão da proteína NIS, ao invés de diminuição. Poucos foram os estudos que fizeram análise do transcrito e da proteína concomitantemente nas mesmas amostras. Este estudo teve como objetivo quantificar o RNAm do gene NIS e avaliar a expressão e localização celular da proteína NIS, através das técnicas de RT-PCR em tempo real e exame imunohistoquímico, respectivamente. Foram estudadas 30 amostras de nódulos de tireóide, sendo 14 nódulos benignos e 16 nódulos malignos, sempre pareados com o tecido não-tumoral do mesmo paciente. Através de exame cintilográfico, verificou-se que 100% dos nódulos malignos e 85,7% dos benignos eram hipocaptantes. Houve diminuição da expressão gênica do NIS em 78,6% dos nódulos benignos, em 81,2% dos carcinomas utilizando o gene PSMC6 como controle interno e em 100% dos carcinomas com o gene GAPDH como controle interno. O exame imunohistoquímico da proteína NIS revelou positividade da proteína NIS no citoplasma em 100% dos tecidos não-tumorais, 100% dos nódulos benignos e 93,75% dos nódulos malignos, não sendo estatisticamente diferentes entre si. A positividade na membrana basolateral ocorreu em 23,3% das amostras não-tumorais, em 14,3%...

The iodide uptake by epithelial thyroid cells requires the expression of sodium iodide symporter (NIS), a transmembrane glycoprotein of 643 amino acids. NIS is located at basolateral plasma membrane of the thyroid follicular cells and couples the transport of iodide and sodium to this cells. NIS gene was cloned in 1996, being the first step of investigation of the mechanisms responsible for the lower uptake of radioiodide by benign and malignant thyroid tumors. Previous studies about expression of NIS gene based in quantification by RT-PCR and/or immunohistochemistry analysis showed divergent data. The majority of RT-PCR studies showed reduction or even absence of transcript of NIS in malignant tumors. Recent studies of immunostaining showed that many tumors overexpress rather than under express NIS. Only a few studies have made the analysis of the transcript and the protein at the same time in the same samples. The objective of this study was to investigate NIS transcript levels and the presence and location of NIS protein, using real time RT-PCR and immunohistochemistry, respectively. It was included 30 samples of thyroid tumors, 14 benign and 16 malignant ones, always compared to adjacent non-tumoral samples. Scintigraphic findings showed that 100% of malignant tumors and 87.5% of benign ones were ?cold?. RT-PCR data revealed lower gene expression in 78.6% of the benign tumors, 81.2% of the carcinomas using PSMC6 as a housekeeping gene and 100% of the carcinomas using GHPDH as a housekeeping gene, when paired to the normal tissue samples. Immunohistochemical staining revealed presence of NIS protein in 100% of the nontumoral samples, 100% of the benign tumors and 93.75% of the malignant tumors. No statistical differences were detect in this data. NIS protein was identified at basolateral membrane in 23.3% of non-tumoral samples, 14.3% of benign tumors and 12.5% of malignant tumors. No statistical differences were detect in this data...