The association of diabetic peripheral neuropathy with cardiac autonomic neuropathy in individuals with diabetes mellitus: A systematic review.

This systematic review aimed to explore the relationship between diabetic peripheral neuropathy (DPN) and cardiac autonomic neuropathy (CAN) in individuals with type 1 and 2 diabetes mellitus (DM). METHODS: The systematic review follow the protocol registered in Prospero (CRD42020182899). Two authors independently searched the PubMed, Scopus, Embase, Cochrane, and Web of Science databases. Discrepancies were resolved by a third author. The review included observational studies investigating the relationship between CAN and DPN in individuals with DM. RESULTS: Initially, out of 1165 studies, only 16 were selected, with 42.8 % involving volunteers with one type of diabetes, 14.3 % with both types of diabetes and 14.3 % not specify the type. The total number of volunteers was 2582, mostly with type 2 DM. It was analyzed that there is a relationship between CAN and DPN. It was observed that more severe levels of DPN are associated with worse outcomes in autonomic tests. Some studies suggested that the techniques for evaluating DPN might serve as risk factors for CAN. CONCLUSION: The review presents a possible relationship between DPN and CAN, such as in their severity.

Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis.

AIMS: To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. METHODS: A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023. RESULTS: We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators. CONCLUSIONS: This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level.

Benefits of Sebastiania hispida (Euphorbiaceae) extract and photobiomodulation therapy as potentially adjunctive strategies to be explored against snake envenoming.

The purpose of this study was to assess the topic use of Sebastiania hispida extract and low-level gallium-arsenide laser irradiation (GaAs, 904 nm) to reduce the local myonecrosis and edema of Bothrops moojeni snake venom-injected gastrocnemius. Wistar rats receiving intramuscular venom injection (VBm) were compared with saline control (S) and envenomed rats receiving local exposure to plant extract (VExt) or laser irradiation (VL). The phytochemistry and thin-layer chromatography of S. hispida extract indicated the presence of phenolic compounds like gallic acid and flavonoids including quercetin. Gastrocnemius of VExt and VL groups had a significant reduction of edema and creatine kinase (CK) activities and a greater Myogenin (MyoG) expression compared to VBm group, with the plant extract efficacy better than laser exposure. Reduction of edema and serum CK activities reflects a lessening of muscle damage, whereas the increase of MyoG indicates myoblast differentiation and acceleration of muscle repair. The S. hispida richness in phenolic compounds and flavonoids, such as the light modulatory ability to triggering a multitude of cell signalings likely underlie the positive outcomes. Our findings suggest both treatments as potential auxiliary tools to be explored in clinical trials in combination with anti-venom therapy after Bothropic snakebites.

Avaliação do comportamento cardiovascular de gestantes durante o repouso e na fase de relaxamento de um protocolo aquático terapêutico de moderada intensidade / Evaluation of pregnant women's cardiovascular behaviour during rest and in the relaxation phase of an aquatic therapeutic protocol

Objetivo: Avaliar o comportamento cardiovascular de gestantes, durante o repouso e fase de relaxamento de um protocolo aquático terapêutico de moderada intensidade. Métodos: Foram estudadas 10 gestantes, com média de 21,8 ± 4,0 semanas de gestação. Antes e após o protocolo foram aferidas a pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD), e posicionado o cardiofrequencímetro para coleta das oscilações cardíacas dos intervalos RR. Em seguida, as gestantes permaneceram em repouso, por um período de 5 minutos, e foram submetidas a um protocolo de exercícios aquático terapêutico composto por aquecimento, alongamento, fortalecimento e relaxamento. Resultados: Completaram o estudo 10 participantes, com idade média de 23,8 ± 5,2 anos. Não houve diferenças significativas (p < 0,05) entre os valores de PAS e PAD em repouso e pós-protocolo. Em relação aos índices da variabilidade de frequência cardíaca-VFC (Mean RR, Mean HR, RMSSD, SD1) também não foi observado diferença significativa ao comparar o período de repouso e a fase de relaxamento. Conclusão: Dessa forma, os resultados do estudo e achados disponíveis atualmente sugerem que a prática de exercício físico em intensidade moderada no meio aquático é segura, visto que as gestantes apresentaram respostas autonômicas eficientes nas fases de pós-exercício. (AU)

Objective: To evaluate pregnant women's cardiovascular behaviour, during rest and in the relaxation phase of an aquatic therapeutic protocol of moderate intensity. Methods: 10 pregnant women were studied, with an average of 21,8 ± 4,0 weeks of pregnancy. Before and after the protocol, Systolic Blood Pressure (SBP) and Diastolic Blood pressure (DBP) were assessed and the heart rate monitor (Polar ­ model V800) was positioned to gather the heart oscillations of the RR breaks. Then, the pregnant women remained at rest, for a period of 5 minutes, and were submitted to a protocol of aquatic therapeutic exercise, composed by warming-up, stretching, strengthening and relaxation. After the protocol, SBP and DBP were checked again. Results: 10 participants completed the study, with the average ages of 23,8 ± 5,2 years old. We did not point significant differences (p < 0,05) between the results of SBP and DBP in rest and post-protocol, neither in relation to the Heart Rate Variability indexes (Mean RR, Mean HR, RMSSD, SD1), when compared the resting period to the relaxation phase of the protocol. Conclusion: Therefore, the results from the present study and the recent research available suggests that the practice of moderate intensity physical activity in the aquatic environment is safe, seeing that the pregnant women exhibited efficient autonomic responses in the post-exercise phases. (AU)

Acute effects of low-level laser therapy (660 nm) on oxidative stress levels in diabetic rats with skin wounds.

BACKGROUND: Laser therapy influences oxidative stress parameters such as the activity of antioxidant enzymes and the production of reactive oxygen species. OBJECTIVE: To analyze the effects of low-level laser therapy on oxidative stress in diabetics rats with skin wounds. METHODS: Thirty-six animals were divided into 4 groups: NDNI: non-diabetic rats with cutaneous wounds that not received laser therapy; NDI: non-diabetic rats with cutaneous wounds that received laser therapy; DNI: diabetic rats with skin wounds who did not undergo laser therapy; DI: rats with diabetes insipidus and cutaneous wounds and received laser therapy. The animals were treated with LLLT (660 nm, 100 mW, 6 J/cm, spot size 0.028 cm). On the day of killing the animals, tissue-wrapped cutaneous wounds were collected and immediately frozen, centrifuged, and stored to analyze malondialdehyde (MDA) levels. RESULTS: Significant difference was observed within the groups of MDA levels (ANOVA, p = 0.0001). Tukey's post-hoc test showed significantly lower values of MDA in irradiated tissues, both in diabetic and non-diabetic rats. ANOVA of the diabetic group revealed a significant difference (p &#60; 0.01) when all groups, except NDI and DI, were compared. CONCLUSIONS: LLLT was effective in decreasing MDA levels in acute surgical wounds in diabetic rats.

Effects of photobiomodulation therapy on Bothrops moojeni snake-envenomed gastrocnemius of mice using enzymatic biomarkers.

Bothropic venom contains a range of biologically active substances capable of causing severe local and systemic envenoming symptomatology within its victims. The snake anti-venom is effective against systemic effects but has no neutralizing effect against the fast developing local effects. Herein, mice gastrocnemius injected with Bothrops moojeni venom (40 µg/kg) or saline solution were irradiated with HeNe (632.8 nm) and GaAs (904 nm) lasers (daily energy density of 4 J/cm2; 0.03/0.21 power density; 0.07/0.16 spot size; 1.2/0.04 total energy, 1 cm off contact, for HeNe and GaAs lasers, respectively) and euthanized in periods ranging from 3 h to 21 days. Blood biochemistry for creatine kinase (CK), alkaline phosphatase (ALP), acid phosphatase (AP), lactate dehydrogenase (LDH), aspartate transaminase (AST), and myoglobin and histopathological analysis, for assessing the degree of myonecrosis and regeneration of gastrocnemius, were done at every time interval. GaAs laser promoted faster photobiomodulation therapy (PBMT) effects, and the GaAs group exhibited a better clinical outcome than the HeNe group. Within the GaAs group, the serum levels of CK, LDH, AP, AST, and myoglobin, which were increased by the physiological effects of the venom, were reduced to initial baseline before snake envenomation in less time than those irradiated by the HeNe laser. However, the group receiving irradiation from the HeNe laser returned the levels of ALP activity to baseline faster than those of the GaAs group. Histopathological analysis revealed enhanced muscle regeneration in mice groups treated with both lasers. PBM promoted by GaAs and HeNe showed well-developed centrally nucleate regenerating cells and an increased number of newly formed blood vessels when compared to unirradiated muscle. We therefore suggest that GaAs had the best outcomes likely derived from a deeper penetrating longer wavelength. We conclude that PMBT is a promising, non-invasive approach to be further tested in pre-clinical studies with a goal to further its clinical use in skeletal muscle recovery in snakebite victims.

Spatial distribution and environmental factors associated to phlebotomine fauna in a border area of transmission of visceral leishmaniasis in Mato Grosso do Sul, Brazil.

BACKGROUND: Mato Grosso do Sul has been undergoing a process of urbanization which results in loss of native vegetation. This withdrawal makes vectors of man and domestic animals closer, causing changes in the epidemiology of diseases such as American Visceral Leishmaniasis. The aim of the study was to evaluate the phlebotomine fauna and environmental issues related to the transmission of AVL in Ponta Porã, Mato Grosso do Sul, between 2009 and 2010. METHODS: Vegetation of the urban area was evaluated by Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI) and Soil Adjusted Vegetation Index (SAVI). RESULTS: The results showed that the phlebotomine fauna of the city consists of five species, especially Lutzomyia longipalpis (Lutz and Neiva, 1912), the vector of Leishmania (Leishmania) infantum. Predominance of males was observed. The insects were captured in greater quantity in the intradomicile. Lu. longipalpis was the most frequent and abundant species, present throughout the year, with a peak population after the rainy season. Vectors can be found in high amounts in forest and disturbed environments. CONCLUSIONS: The finding of Lu. longipalpis in regions with little vegetation and humidity suggests that the species is adapted to different sorts of environmental conditions, demonstrating its close association with man and the environment it inhabits. The tourist feature of Ponta Porã reinforces its epidemiological importance as a vulnerable city. The geographical location, bordering Paraguay through dry border, makes possible the existence of a corridor of vectors and infected dogs between the two countries.

Effects of pre- or post-exercise low-level laser therapy (830 nm) on skeletal muscle fatigue and biochemical markers of recovery in humans: double-blind placebo-controlled trial.

OBJECTIVES: The purpose of this study was to investigate the effect of low-level laser therapy (LLLT) before and after exercise on quadriceps muscle performance, and to evaluate the changes in serum lactate and creatine kinase (CK) levels. METHODS: The study was randomized, double blind, and placebo controlled. PATIENTS: A sample of 27 healthy volunteers (male soccer players) were divided into three groups: placebo, pre-fatigue laser, and post-fatigue laser. The experiment was performed in two sessions, with a 1 week interval between them. Subjects performed two sessions of stretching followed by blood collection (measurement of lactate and CK) at baseline and after fatigue of the quadriceps by leg extension. LLLT was applied to the femoral quadriceps muscle using an infrared laser device (830 nm), 0.0028 cm(2) beam area, six 60 mW diodes, energy of 0.6 J per diode (total energy to each limb 25.2 J (50.4 J total), energy density 214.28 J/cm(2), 21.42 W/cm(2) power density, 70 sec per leg. We measured the time to fatigue and number and maximum load (RM) of repetitions tolerated. Number of repetitions and time until fatigue were primary outcomes, secondary outcomes included serum lactate levels (measured before and 5, 10, and 15 min after exercise), and CK levels (measured before and 5 min after exercise). RESULTS: The number of repetitions (p=0.8965), RM (p=0.9915), and duration of fatigue (p=0.8424) were similar among the groups. Post-fatigue laser treatment significantly decreased the serum lactate concentration relative to placebo treatment (p<0.01) and also within the group over time (after 5 min vs. after 10 and 15 min, p<0.05 both). The CK level was lower in the post-fatigue laser group (p<0.01). CONCLUSIONS: Laser application either before or after fatigue reduced the post-fatigue concentrations of serum lactate and CK. The results were more pronounced in the post-fatigue laser group.

Effect of laser therapy (660 nm) on recovery of the sciatic nerve in rats after injury through neurotmesis followed by epineural anastomosis.

The aim of this study was to analyze the influence of aluminum gallium arsenide (AlGaAs) laser (660 nm) on the myelin sheath and functional recovery of the sciatic nerve in rats. The sciatic nerves of 12 Wistar rats were subjected to injury through neurotmesis and epineural anastomosis, and the animals were divided into two groups: group 1 was the control and group 2, underwent low-level laser therapy (LLLT). After the injury, AlGaAs laser at 660 nm, 4 J/cm(2), 26.3 mW and beam area of 0.63 cm(2) was administered to three equidistant points on the injury for 20 consecutive days. In the control group the mean area of the myelin impairment was 0.51 (+/- 0.11) on day 21 after the operation, whereas this value was 1.31 (+/- 0.22) in the LLLT group. Student's t-test revealed a P value = 0.0229 for the mean area values of the myelin sheath between the LLLT and control groups. Comparison of the sciatic functional index (SFI) showed that there was no significant difference between the pre-lesion value in the laser therapy group and the control group. The use of AlGaAs laser (660 nm) provided significant changes to the morphometrically assessed area of the myelin sheath, but it did not culminate in positive results for functional recovery in the sciatic nerve of the rats after injury through neurotmesis.