Carbohydrate counting and insulin analogs to treat type 1 diabetes mellitus. How to improve metabolic control?

Abstract Objectives: Clinical-laboratory comparison of a population of children and adolescents with DM1 followed at a Brazilian outpatient university clinic, at two different periods (2014 and 2020), regarding changes made both to the insulin therapy scheme and to the nutritional approach to carbohydrate counting. Methods: The data of patients with DM1 aged 0-19 years enrolled in the service in 2014 and 2020 were collected. Student's t-test was performed to compare the means of HbA1c and the variables of interest. Results: NPH + regular insulin was predominantly used in 2014 (49.1%), while in 2020, the predominance shifted to insulin analogs (48.4%). Pump use tripled from 1.3% in 2014 to 4.4% in 2020, and the percentage of patients performing carbohydrate counting reduced from 28.3% to 17.8%. Regarding HbA1c, the 2014 group of patients had a mean of 9.8%, while the 2020 group had a mean of 9.6% (p = 0.49). Conclusion: The change in treatments between 2014 and 2020 did not result in a significant improvement in HbA1c levels. However, it was identified the importance of carbohydrate counting and the use of insulin analogs to improve metabolic control in this population at both times.

Carbohydrate counting and insulin analogs to treat type 1 diabetes mellitus. How to improve metabolic control?

OBJECTIVES: Clinical-laboratory comparison of a population of children and adolescents with DM1 followed at a Brazilian outpatient university clinic, at two different periods (2014 and 2020), regarding changes made both to the insulin therapy scheme and to the nutritional approach to carbohydrate counting. METHODS: The data of patients with DM1 aged 0-19 years enrolled in the service in 2014 and 2020 were collected. Student's t-test was performed to compare the means of HbA1c and the variables of interest. RESULTS: NPH + regular insulin was predominantly used in 2014 (49.1%), while in 2020, the predominance shifted to insulin analogs (48.4%). Pump use tripled from 1.3% in 2014 to 4.4% in 2020, and the percentage of patients performing carbohydrate counting reduced from 28.3% to 17.8%. Regarding HbA1c, the 2014 group of patients had a mean of 9.8%, while the 2020 group had a mean of 9.6% (p = 0.49). CONCLUSION: The change in treatments between 2014 and 2020 did not result in a significant improvement in HbA1c levels. However, it was identified the importance of carbohydrate counting and the use of insulin analogs to improve metabolic control in this population at both times.

Continuous interstitial glucose monitoring for term newborns: analysis of the first day of life.

OBJECTIVE: Glycaemia in newborns changes significantly after birth; however, little is known about these changes. The objective was to describe continuous interstitial glucose values in term newborns who were exclusively breast fed on the first day of life. DESIGN: We studied 159 newborns with appropriate weights for gestational age, who were exclusively breast fed on the first day of life, using a continuous glucose monitoring device that calculates interstitial glucose every 5 min. The device was removed after 24 hours, and the results were analysed using the R program, which provides the minimum, maximum, median and a standard curve with centiles. RESULTS: At the second hour of life, the moment in which the sensor started to identify the newborn's glycaemia, interstitial glucose levels were 2.59-4.43 mmol/L (46.7-79.9 mg/dL). The median interstitial glucose level of the newborns during the first day of life was 3.33±0.48 mmol/L (60±8.6 mg/dL). Interstitial glucose levels dropped until the sixth hour of life, reaching 2.19-3.95 mmol/L (39.5-71.1 mg/dL), and then increased again. The maximum values were found at the 20th and 21st hours of life, which were 2.81-4.64 mmol/L (50.6-83.6 mg/dL). CONCLUSION: The interstitial glucose during the first 24 hours of life declined until the sixth hour of life, then increased around the 20th hour and remained stable until the end of the first day of life.

Cardiac involvement in patients recovered from COVID-19 identified using left ventricular longitudinal strain.

INTRODUCTION: Coronavirus disease-19 (COVID-19) has been associated with subclinical myocardial dysfunction during its acute phase and a recurring pattern of reduced basal left ventricular longitudinal strain on speckle-tracking echocardiography (STE) in hospitalized patients. But a question still remains unanswered: speckle-tracking echocardiography might also be suitable to detect residual myocardial involvement after acute stage of COVID-19? METHODS AND RESULTS: We studied 100 patients recovered from COVID-19 with STE to evaluate global (GLS) and segmentar longitudinal strain (LS) and compared with a control group of 100 healthy individuals. STE was performed at a median of 130.35 ± 76.06 days after COVID-19 diagnostic. Demographic and echocardiographic parameters are similar in both groups. Left ventricular ejection faction (LVEF) and GLS were normal in COVID-19 patients (66.20 ± 1.98% and - 19.51 ± 2.87%, respectively). A reduction in mean LS for the basal segments was found in COVID-19 (16.48 ± 5.41%) when compared to control group (19.09 ± 4.31%) (p < 0.001). CONCLUSION: The present study suggests that COVID-19-induced cardiac involvement could persist after recovery of the disease and may be detected by deformation abnormalities using STE. COVID-19-induced myocardial involvement often shows specific LV deformation patterns due to pronounced edema and/or myocardial damage in basal LV segments.

Data-Texts in the Sciences: The Evidence-Explanation Continuum.

Grounded within current reform recommendations and built upon Giere's views (1986, 1999) on model-based science, we propose an alternative approach to science education which we refer to as the Evidence-Explanation (EE) Continuum. The approach addresses conceptual, epistemological, and social domains of knowledge, and places emphasis on the epistemological conversations about data acquisitions and transformations in the sciences. The steps of data transformation, which we refer to as data-texts, we argue, unfold the processes of using evidence during knowledge building and reveal the dynamics of scientific practices. Data-texts involve (a) obtaining observations/measurements to become data; (b) selecting and interpreting data to become evidence; (c) using evidence to ascertain patterns and develop models; and (d) utilizing the patterns and models to propose and refine explanations. Throughout the transformations of the EE continuum, there are stages of transition that foster the engagement of learners in negotiations of meaning and collective construction of knowledge. A focus on the EE continuum facilitates the emergence of further insights, both by questioning the nature of the data and its multiple possibilities for change and representations and by reflecting on the nature of the explanations. The shift of emphasis to the epistemics of science holds implications for the design of learning environments that support learners in developing contemporary understandings of the nature and processes of scientific practices.

A educação crítica e cidadã no PET economia/UFES / The critical education and citizen in PET economics/UFES

O objetivo deste artigo é apresentar o funcionamento e algumas das atividades desenvolvidas pelo PET Economia/UFES, ao longo de sua existência, que contribuíram e contribuem para o desenvolvimento de uma Educação Tutorial crítica e cidadã no seio de nosso grupo. Para tanto, apresentaremos, inicialmente, um pouco da construção histórica do grupo para em um segundo momento descrever algumas de nossas atividades que constituem o eixo ensino, pesquisa e extensão.

The objective of this paper is to present the functioning and some of the activities that are undertaken by the PET Economia/UFES throughout its existence, these activities have contributed and still contribute to the development of a tutorial education critical and citizenship within our group. Therefore, we will initially present a bit of the historical formation of the group and, in a second moment, we wil describe some of our activities that constitute the axis of teaching, research and extension.

Aferição da glicemia capilar na clínica odontológica - rastreamento de casos de Diabete tipo II / Measurement of blood glucose in the dental clinic - tracking cases of Type II Diabetes

Estimativas mostram que, no ano de 2025, a população brasileira atingirá 228 milhões de habitantes. A Diabete tipo 2 foi a terceira causa de morte no Brasil e a primeira causa de morte entre os 40 e 49 anos (Censo 2010). Em 2025, serão 11 milhões de diabéticos no país, representando um aumento de mais de 100% em relação aos 5 milhões do ano 2000. Este trabalho propõe o rastreamento de casos suspeitos através do teste de aferição da glicemia capilar pós-prandial. Avaliamos 69 mulheres e 34 homens, um percentual de 8% de casos suspeitos os quais apresentaram glicemia capilar média pós-prandial além de duas horas de 232,75mg/dl e a máxima de 412mg/dl em concordância com o Ministério da Saúde.

Estimates show that in 2025, the Brazilian population is expected to reach 228 million. The type 2 Diabetes was the third leading cause of death in Brazil (Censo 2010). By 2025, should be about 11 million diabetics in the country, representing an increase of over 100 % compared to 5 million in 2000,. This study aims to track possible cases through benchmarking test postprandial blood glucose. The evaluation of 69 women and 34 men showed a percentage of 8% possible cases which had mean postprandial blood glucose of more than two hours of 232.75 mg/dl and a maximum of 412mg/dl in agreement with Ministry of Health studies.

Chromosome painting in three-toed sloths: a cytogenetic signature and ancestral karyotype for Xenarthra.

BACKGROUND: Xenarthra (sloths, armadillos and anteaters) represent one of four currently recognized Eutherian mammal supraorders. Some phylogenomic studies point to the possibility of Xenarthra being at the base of the Eutherian tree, together or not with the supraorder Afrotheria. We performed painting with human autosomes and X-chromosome specific probes on metaphases of two three-toed sloths: Bradypus torquatus and B. variegatus. These species represent the fourth of the five extant Xenarthra families to be studied with this approach. RESULTS: Eleven human chromosomes were conserved as one block in both B. torquatus and B. variegatus: (HSA 5, 6, 9, 11, 13, 14, 15, 17, 18, 20, 21 and the X chromosome). B. torquatus, three additional human chromosomes were conserved intact (HSA 1, 3 and 4). The remaining human chromosomes were represented by two or three segments on each sloth. Seven associations between human chromosomes were detected in the karyotypes of both B. torquatus and B. variegatus: HSA 3/21, 4/8, 7/10, 7/16, 12/22, 14/15 and 17/19. The ancestral Eutherian association 16/19 was not detected in the Bradypus species. CONCLUSIONS: Our results together with previous reports enabled us to propose a hypothetical ancestral Xenarthran karyotype with 48 chromosomes that would differ from the proposed ancestral Eutherian karyotype by the presence of the association HSA 7/10 and by the split of HSA 8 into three blocks, instead of the two found in the Eutherian ancestor. These same chromosome features point to the monophyly of Xenarthra, making this the second supraorder of placental mammals to have a chromosome signature supporting its monophyly.

Cuidado de enfermagem a famílias de crianças hospitalizadas por doença crônica / Nursing care to families of children hospitalized with cronic disease / Atención de enfermería a la familia de niños con enfermidade crónica hospitalizados

O estudo objetivou investigar o cuidado de enfermagem a famílias de crianças com doença crônica hospitalizadas. Constitui-se de uma pesquisa exploratório-descritiva com abordagem qualitativa, desenvolvida em um hospital público do município de João Pessoa-PB com nove famílias no período de agosto a outubro de 2010, por meio de entrevista semiestruturada. Para a análise do material empírico foi empregada a técnica do Discurso do Sujeito Coletivo. Foi possível apreender duas ideias centrais: 1) o cuidado que recebemos da equipe de enfermagem durante a permanência no hospital tem sido o aconselhamento, o diálogo e a escuta; 2) o importante para os familiares é que cuidem do seu filho. O Discurso do Sujeito Coletivo evidenciou que alguns elementos estão presentes no cuidado de enfermagem às famílias, como o diálogo, aconselhamento e escuta, que são considerados relevantes para o fortalecimento de pessoas fragilizadas. Por outro lado, as famílias apresentam uma forte dimensão sociocultural na qual suas demandas são relegadas em favor do filho. A enfermagem deve ter sensibilidade para perceber que as famílias de crianças com doenças crônicas, mesmo que não exteriorizem a necessidade de cuidar, internamente estão clamando para serem atendidas em seus aspectos psicológicos, sociais e biológicos.

This study aimed to investigate the nursing care to families of hospitalized children with chronic condition. An exploratory and descriptive research, with qualitative approach, was developed in a public hospital in João Pessoa, PB, with nine families from August to October 2010 through semi-structured interviews. For the empirical analysis we used the technique of the Discourse of Collective Subject. It was possible to identify two main ideas: the care they receive from the nursing staff during their stay in hospital has been through counseling, dialogue and listening; the importance for the families to have their children taken care of. The Discourse of the Collective Subject showed that some elements are present in nursing care to families, such as dialogue, counseling and listening, in which they were considered relevant to strengthen the most vulnerable people. However, families have a strong socio-cultural dimension in which their demands are relegated in favor of their children. Nurses should be sensitive to realize that the children's relatives with chronic diseases, even if they do not expand their need for care, they are internally clamoring to be addressed in their psychological, social and biological aspects.

El estudio objetiva investigar el cuidado de la enfermería a la familia del niño hospitalizado en condición crónica. Investigación exploratoria descriptiva, con enfoque cualitativo, desarrollada en un hospital público del municipio de João Pessoa-PB con nueve familias en el período de Agosto a Octubre de 2010, por medio de entrevista semiestructurada. Para el análisis del material empírico fue empleada la técnica del Discurso del Sujeto Colectivo. Fue posible aprehender dos ideas centrales: el cuidado que recibimos del equipo de enfermería durante la permanencia en el hospital ha sido el aconsejamiento, el diálogo y la escucha: "lo importante para el familia es que cuiden de su hijo". El Discurso del Sujeto Colectivo evidenció que algunos elementos están presentes en el cuidar de la enfermería a las familias, como el diálogo, aconsejamiento y escucha, siendo considerados relevantes para el fortalecimiento de personas débiles. Además, las familias presentan una fuerte dimensión sociocultural cuyas demandas son relegadas en favor del hijo. La enfermería debe tener sensibilidad para percibir que las familias de niños con enfermedades crónicas, aun que no exterioricen la necesidad de cuidar, internamente ruegan por ser atendidas en sus aspectos psicológicos, sociales y biológicos.