Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study.

BACKGROUND: Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A1c (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease. OBJECTIVE: This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM. METHODS: The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c≤7.5% with a ≥0.5% reduction in HbA1c at week 24. RESULTS: Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c≤7.5% (64% vs 24%; P=.02) or HbA1c≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed. CONCLUSIONS: The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.

Role of hippocampal NF-κB and GluN2B in the memory acquisition impairment of experiences gathered prior to cocaine administration in rats.

Cocaine can induce severe neurobehavioral changes, among others, the ones involved in learning and memory processes. It is known that during drug consumption, cocaine-associated memory and learning processes take place. However, much less is known about the effects of this drug upon the mechanisms involved in forgetting.The present report focuses on the mechanisms by which cocaine affects memory consolidation of experiences acquired prior to drug administration. We also study the involvement of hippocampus in these processes, with special interest on the role of Nuclear factor kappa B (NF-κB), N-methyl-D-aspartate glutamate receptor 2B (GluN2B), and their relationship with other proteins, such as cyclic AMP response element binding protein (CREB). For this purpose, we developed a rat experimental model of chronic cocaine administration in which spatial memory and the expression or activity of several proteins in the hippocampus were assessed after 36 days of drug administration. We report an impairment in memory acquisition of experiences gathered prior to cocaine administration, associated to an increase in GluN2B expression in the hippocampus. We also demonstrate a decrease in NF-κB activity, as well as in the expression of the active form of CREB, confirming the role of these transcription factors in the cocaine-induced memory impairment.

Influence of Experience on the Thought Process of Clinical Psychologists: An Analysis from the Dual-Process Theories Framework.

In the course of their work, psychologists must make judgments and complex decisions, skills that are part of clinical reasoning. Recent models approach the analysis of such process using the dual-process theories framework. This study provides an assessment of the two systems, System 1 and System 2, in forty-five clinical psychologists with different levels of experience (novices, intermediates and experts) with the purpose of exploring their level of activation and evolution throughout such stages of expertise. According to the results, clinical psychologists mainly activate System 2, M = 70.91, SD = 6.71, than System 1, M = 60.49, SD = 3.78; $ {F}_{\left(1,\kern0.5em 41\right)}=7.99;p<.01;{\upeta}^2=.163, $ when performing their clinical duties. However, no significant changes have been observed regarding the preferential use of thinking Systems 1 or 2 throughout the experience, both systems are used in a similar way in the different levels of expertise analyzed, with an increase of System 2 at the intermediate level of expertise. The results are analyzed in terms of intermediate effect and discussed focusing on the unremitting need for System 2 in psychologist work given the idiosyncratic characteristics of each case requiring treatment in the area of psychology and on the relationship of the two systems in clinical reasoning.

Influence of experience on the thought process of clinical psychologists: an analysis from the dual-process theories framework

In the course of their work, psychologists must make judgments and complex decisions, skills that are part of clinical reasoning. Recent models approach the analysis of such process using the dual-process theories framework. This study provides an assessment of the two systems, System 1 and System 2, in forty-five clinical psychologists with different levels of experience (novices, intermediates and experts) with the purpose of exploring their level of activation and evolution throughout such stages of expertise. According to the results, clinical psychologists mainly activate System 2, M = 70.91, SD = 6.71, than System 1, M = 60.49, SD = 3.78; when performing their clinical duties. However, no significant changes have been observed regarding the preferential use of thinking Systems 1 or 2 throughout the experience, both systems are used in a similar way in the different levels of expertise analyzed, with an increase of System 2 at the intermediate level of expertise. The results are analyzed in terms of intermediate effect and discussed focusing on the unremitting need for System 2 in psychologist work given the idiosyncratic characteristics of each case requiring treatment in the area of psychology and on the relationship of the two systems in clinical reasoning

No disponible

Quality of Life in Patients with Allergic Reactions to Medications: Influence of a Drug Allergy Evaluation.

BACKGROUND: Suspicion of allergic drug reaction can cause important disturbances in the patient's life. OBJECTIVE: We evaluated in a prospective multicenter study the quality of life of patients who suffered a possible allergic drug reaction, and analyzed the effect of a drug allergy evaluation. METHODS: Patients (>18 years old) answered the specific questionnaire twice: before the drug allergy evaluation, and 1 month after it was completed. Statistics were performed using STATA. RESULTS: A total of 360 patients (240, 66.6% female; mean age, 45.4 years; standard deviation [SD], 15.6 years) completed the first questionnaire. After the evaluation, 150 of 346 patients (43.4%) were diagnosed as allergic to the drug (115 of 150 immediate; 35 of 150 delayed) and 196 of 346 patients (56.6%) as nonallergic. The mean value of the first questionnaire was 32.14 (SD, 11.84); patients with anaphylaxis, nonanaphylactic immediate reaction, with more than 1 drug reaction, or a chronic osteoarticular disease, had a statistically significant higher score in Q0 (worse quality of life). After the allergy study, the mean of the second questionnaire was 27.27 (SD, 9.96), showing a global improvement (P < .001). No statistically significant difference was found between drug allergic and non-drug allergic patients (P = .340); however, being >40 years old (P = .030), having a chronic osteoarticular disease (P = .003) and having more than 1 reaction to drugs (P < .001) were associated with a statistically significant worse quality of life after the evaluation. CONCLUSIONS: Having suffered anaphylaxis, more than 1 reported drug allergy or presenting a musculoskeletal disease are factors that worsen the quality of life. Quality of life improved significantly after completing a drug allergy evaluation.

Cocaine promotes oxidative stress and microglial-macrophage activation in rat cerebellum.

Different mechanisms have been suggested for cocaine neurotoxicity, including oxidative stress alterations. Nuclear factor kappa B (NF-κB), considered a sensor of oxidative stress and inflammation, is involved in drug toxicity and addiction. NF-κB is a key mediator for immune responses that induces microglial/macrophage activation under inflammatory processes and neuronal injury/degeneration. Although cerebellum is commonly associated to motor control, muscular tone, and balance. Its relation with addiction is getting relevance, being associated to compulsive and perseverative behaviors. Some reports indicate that cerebellar microglial activation induced by cannabis or ethanol, promote cerebellar alterations and these alterations could be associated to addictive-related behaviors. After considering the effects of some drugs on cerebellum, the aim of the present work analyzes pro-inflammatory changes after cocaine exposure. Rats received daily 15 mg/kg cocaine i.p., for 18 days. Reduced and oxidized forms of glutathione (GSH) and oxidized glutathione (GSSG), glutathione peroxidase (GPx) activity and glutamate were determined in cerebellar homogenates. NF-κB activity, CD68, and GFAP expression were determined. Cerebellar GPx activity and GSH/GSSG ratio are significantly decreased after cocaine exposure. A significant increase of glutamate concentration is also observed. Interestingly, increased NF-κB activity is also accompanied by an increased expression of the lysosomal mononuclear phagocytic marker ED1 without GFAP alterations. Current trends in addiction biology are focusing on the role of cerebellum on addictive behaviors. Cocaine-induced cerebellar changes described herein fit with previosus data showing cerebellar alterations on addict subjects and support the proposed role of cerebelum in addiction.

Technological solution for determining gait parameters using pressure sensors: a case study of multiple sclerosis patients.

This paper describes a study dealing with a technological solution to measure gait quality in people suffering from multiple sclerosis (MS) by selecting objective parameters that focus on their step. Android mobile technology, online services and four wireless pressure sensors are used in concert for this purpose. The objective of this work is the early detection of deterioration of the patient so that a physician can quickly intervene. Tests were carried out on a group of 8 persons with MS, and these results were compared with a control a group of 6 healthy participants. The results indicated a statistical difference in 7 of 40 general step features, with a minimum σ=0.013 and a maximum σ=0.029. These characteristics showed differences between first and fifth metatarsals for each group. It was concluded that these parameters can be used to evaluate gait degeneration in people with MS and that further information could be obtained from measurements with sensors to monitor activities such as bending and inertial sensors.

Shoe-integrated sensors in physical rehabilitation.

This paper presents a shoe-integrated sensor device which collects objective information concerning the gait quality in patients' physical rehabilitation. It involves four pressure sensors, two bending sensors, an ultrasonic sensor and a 9dof IMU, an Inertial Measurement Unit with three accelerometers, three gyroscopes and three magnetometers. The device includes a SDRAMPS with the aim of storing the information for long periods of time. The collected data can be sent to the server for later visualization by the specialist and the patient on a web platform. An interface shows the data in real time, allowing it to verify the connections and to check different movements.

Chronic cocaine effects in retinal metabolism and electrophysiology: treatment with topiramate.

PURPOSE: Cocaine abuse is a major public health problem with multiple-related complications. Indeed, cocaine can affect almost every organ of the human body, but little is known about its effects on the visual system. The main purpose of this work was to study if topiramate was able to reverse changes in retinal metabolism and retinal function induced by chronic cocaine exposure in adult rats. MATERIALS AND METHODS: Sixteen Wistar rats were treated with a daily oral dose of cocaine during 36 days. Sixteen rats receiving NaCl 0.9% served as controls. Eight control and eight cocaine animals were administered topiramate from day 18 to day 36 of the experiment. Malondialdehyde (MDA), glutathione (GSH) and glutamate content, as well as glutathione peroxidase (GPx) activity in retina tissue homogenates were determined. Retinal function was assessed by electroretinogram (ERG). RESULTS: Glutamate concentration was increased in the retinas of cocaine-treated rats. No changes in oxidative stress parameters were observed in the retinas of cocaine-treated rats when compared with the control ones. Cocaine induced a decrease in the a-wave and b-wave ERG amplitude. The administration of topiramate reversed cocaine-induced increase in glutamate concentration and had little effect on a-wave and b-wave ERG amplitude. Topiramate, a drug used during the last decade for the treatment of epileptic seizures, is able to reverse the cocaine-induced alterations observed in retinal glutamate concentration. CONCLUSIONS: We can conclude that retinal glutamate metabolism and function may be affected by exposure to cocaine. We confirm that topiramate, a treatment recently proposed for cocaine dependence, is also able to recover partially cocaine-induced changes in the retina.

Wireless prototype based on pressure and bending sensors for measuring gait [corrected] quality.

This paper presents a technological solution based on sensors controlled remotely in order to monitor, track and evaluate the gait quality in people with or without associated pathology. Special hardware simulating a shoe was developed, which consists of three pressure sensors, two bending sensors, an Arduino mini and a Bluetooth module. The obtained signals are digitally processed, calculating the standard deviation and establishing thresholds obtained empirically. A group of users was chosen with the aim of executing two modalities: natural walking and dragging the left foot. The gait was parameterized with the following variables: as far as pressure sensors are concerned, one pressure sensor under the first metatarsal (right sensor), another one under the fifth metatarsal (left) and a third one under the heel were placed. With respect to bending sensors, one bending sensor was placed for the ankle movement and another one for the foot sole. The obtained results show a rate accuracy oscillating between 85% (right sensor) and 100% (heel and bending sensors). Therefore, the developed prototype is able to differentiate between healthy gait and pathological gait, and it will be used as the base of a more complex and integral technological solution, which is being developed currently.

Algorithms based on CWT and classifiers to control cardiac alterations and stress using an ECG and a SCR.

This paper presents the results of using a commercial pulsimeter as an electrocardiogram (ECG) for wireless detection of cardiac alterations and stress levels for home control. For these purposes, signal processing techniques (Continuous Wavelet Transform (CWT) and J48) have been used, respectively. The designed algorithm analyses the ECG signal and is able to detect the heart rate (99.42%), arrhythmia (93.48%) and extrasystoles (99.29%). The detection of stress level is complemented with Skin Conductance Response (SCR), whose success is 94.02%. The heart rate variability does not show added value to the stress detection in this case. With this pulsimeter, it is possible to prevent and detect anomalies for a non-intrusive way associated to a telemedicine system. It is also possible to use it during physical activity due to the fact the CWT minimizes the motion artifacts.

A stress sensor based on Galvanic Skin Response (GSR) controlled by ZigBee.

Sometimes, one needs to control different emotional situations which can lead the person suffering them to dangerous situations, in both the medium and short term. There are studies which indicate that stress increases the risk of cardiac problems. In this study we have designed and built a stress sensor based on Galvanic Skin Response (GSR), and controlled by ZigBee. In order to check the device's performance, we have used 16 adults (eight women and eight men) who completed different tests requiring a certain degree of effort, such as mathematical operations or breathing deeply. On completion, we appreciated that GSR is able to detect the different states of each user with a success rate of 76.56%. In the future, we plan to create an algorithm which is able to differentiate between each state.

Differential hippocampal response to chronic alcohol consumption of young adult and mature adult rats.

AIMS: Early ethanol consumption could be a risk factor for young brain integrity and its maturation, and also for the development of addictive behaviors in adulthood. Neuronal nitric oxide synthase (nNOS) expressing neurons are specifically located in the subgranular layer (SGL) of dentate gyrus and may be relevant for hippocampal neurogenesis. The focus of this work is aimed to determine local changes in the nNOS-like immunoreactive (nNOS-LIR) cell populations of the SGL after chronic ethanol exposure in young adult and mature adult rats. METHODS: We used the nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase (NADPH-d) reaction as a qualitative marker of nNOS enzyme activity. We also analyzed the nNOS-LIR cell density by the nNOS immunocytochemistry in order to compare these two methods of labeling. Dorsal striatum (CPu) was also analyzed in order to compare two neural areas with high nNOS-LIR cell density. RESULTS: The young adult group showed less hippocampal NADPH-d(+) cell density than the mature adult group. Interestingly, the NADPH-d(+) cell density was increased in the SGL of the young adult ethanol-treated group, whereas it decreased in the mature adult ethanol-treated group, when compared with their respective controls. No change was observed in any of the groups for the hippocampal nNOS-LIR cell density and no differences could be established in CPu for nNOS-LIR and NADPH-d(+) cell densities in any of the groups studied. CONCLUSION: The NADPH-d expression is affected by chronic ethanol exposure in opposite ways between both age groups studied. Further studies are needed to evaluate the relative importance of these findings, especially when considering human subjects.

Cocaine causes memory and learning impairments in rats: involvement of nuclear factor kappa B and oxidative stress, and prevention by topiramate.

Different mechanisms have been suggested for cocaine toxicity including an increase in oxidative stress but the association between oxidative status in the brain and cocaine induced-behaviour is poorly understood. Nuclear factor kappa B (NFkappaB) is a sensor of oxidative stress and participates in memory formation that could be involved in drug toxicity and addiction mechanisms. Therefore NFkappaB activity, oxidative stress, neuronal nitric oxide synthase (nNOS) activity, spatial learning and memory as well as the effect of topiramate, a previously proposed therapy for cocaine addiction, were evaluated in an experimental model of cocaine administration in rats. NFkappaB activity was decreased in the frontal cortex of cocaine treated rats, as well as GSH concentration and glutathione peroxidase activity in the hippocampus, whereas nNOS activity in the hippocampus was increased. Memory retrieval of experiences acquired prior to cocaine administration was impaired and negatively correlated with NFkappaB activity in the frontal cortex. In contrast, learning of new tasks was enhanced and correlated with the increase of nNOS activity and the decrease of glutathione peroxidase. These results provide evidence for a possible mechanistic role of oxidative and nitrosative stress and NFkappaB in the alterations induced by cocaine. Topiramate prevented all the alterations observed, showing novel neuroprotective properties.

Papilomatose confluente reticulada de Gougerot-Carteaud / Confluent and reticulated papillomatosis of Gougerot and Carteaud

Relatamos um caso de papilomatose confluente e reticulada de Gougerot-Carteaud, em uma paciente do sexo feminino, 14 anos de idade com evoluçäo de dois anos