The Effect of Plantago major on Wound Healing in Preclinical Studies: A Systematic Review.

BACKGROUND: Plantago major is a medicinal plant that has been used for centuries to treat various health conditions including wounds. PURPOSE: To investigate the effectiveness of the topical use of P major in healing skin wounds in animal models. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted. Seven (7) electronic databases (Virtual Health Library, Public/Publisher MEDLINE, Scopus, Web of Science, Embase, Cumulative Index of Nursing and Allied Health Literature, and CAB Direct) were searched for controlled studies published in English from January 2006 to March 2020. The Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies tools guided the evaluation of the studies and determined their quality. The Systematic Review Center for Laboratory Animal Experimentation was used to assess the risk of bias. RESULTS: Of the 176 publications identified, 4 met the inclusion criteria. Studies included 20 to 100 animals and varying concentrations of P major. There were no reports of losses during research. Wound healing was assessed between 17 and 21 days following wounding. The best response in terms of wound contraction rate occurred with 10%, 20%, and 50% concentrations when compared with control groups. One (1) study did not have an animal ethics committee review. All studies had a high risk of bias and a lack of methodological rigor. CONCLUSION: The results of this review did not find evidence about the in vivo effectiveness of P major for wound healing. More rigorous preclinical studies with adequate sample sizes are required to identify the best concentrations and formulations as well as increase understanding about the mechanisms of action of P major in wound healing.

Association between self-efficacy and sociodemographic and clinical variables in patients with Diabetes Mellitus / Associação entre autoeficácia e variáveis sociodemográficas e clínicas em pacientes com Diabetes Mellitus

Model of study: A cross-sectional study was conducted. Objective: to evaluate the association between self-efficacy and socio-demographic and clinical variables in patients with type 2 diabetes mellitus (T2DM). Method: The sample was composed by 111 patients with T2DM in use of insulin, in primary health care units and outpatient setting in the southeast region of São Paulo state, Brazil. Sociodemographic data were gathered using validated questionnaire and clinical data were obtained from medical and health records. Self-efficacy was assessed by the Brazilian version of Insulin Management Diabetes Self-Efficacy Scale (IMDSES). The data were submitted to descriptive and comparative analyses using Mann-Whitney and Kruskal-Wallis to verify association between socio-demographic/clinical variables and self-efficacy. Results: Self-efficacy was associated with schooling level and presence of comorbidities, such as coronary artery disease, dyslipidemia, obesity, peripheral arterial disease and peripheral neuropathy. Conclusion: The findings provide support to the design some specifics interventions aimed at improving the selfefficacy of patients with T2DM on insulin use. (AU)

Modelo do estudo: Foi conduzido um estudo transversal. Objetivo: verificar a associação entre autoeficácia e variáveis sociodemográficas e clínicas em pacientes com diabetes mellitus. Métodos: A amostra foi composta por 111 pacientes com diabetes mellitus tipo 2 em uso de insulina em unidade básica de saúde e em ambulatório de hospital universitário da região sudeste do Estado de São Paulo, Brasil. Os dados sociodemográficos foram coletados usando questionário validado e os dados clínicos foram obtidos dos prontuários do hospital e da unidade básica de saúde. A medida da autoeficácia foi obtida por meio da aplicação da Insulin Management Diabetes Self-Efficacy Scale ­ IMDSES. Para verificar a associação entre as variáveis sociodemográficas / clínicas e a autoeficácia foram utilizados os testes de Mann-Whitney e Kruskal-Wallis. Resultados: A autoeficácia foi associada à escolaridade, presença de comorbidades e complicações do DM, como doença arterial coronária, obesidade, doença arterial periférica e neuropatia periférica. Conclusão: Os achados subsidiam o delineamento de intervenções para otimizar a autoeficácia em pacientes com diabetes mellitus em uso de insulina. (AU)

Psychometric performance of the Brazilian version the "Insulin Management Diabetes Self-Efficacy Scale" for patient with Type 2 Diabetes Mellitus / Propriedades psicométricas da versão brasileira "Escala de auto-eficácia no manejo da insulina" em pacientes com diabetes mellitus tipo 2

Model of study: Validation study. Objective: To evaluate the psychometric performance of the Brazilian version of the Insulin Management Diabetes Self-Efficacy Scale - IMDSES. Methodology: Reliability (internal consistency - Cronbach's α), convergent and criterion validity were assessed. Data were gathered from 127 patients with type 2 diabetes mellitus (T2DM) in use of insulin through the application of sociodemographic and clinical instruments and the Brazilian versions of the Summary of Diabetes Self-Care Activities Measures - SDSCA and the IMDSES. Results: It was observed "ceiling effect" in Insulin domain. Reliability was confirmed in all IMDSES domains and Total Score (α=0.87). The convergent construct validity was supported by significant negative moderate to weak magnitude correlations between the scores of IMDSES domains and the scores of SDSCA domains. Criterion validity was partially supported by the weak magnitude correlation between the General Managements domain and the Total Score of IMDSES and serum levels of glycated hemoglobin (r=0.22; p=0.02). Conclusion: The Brazilian version of IMDSES presented satisfactory psychometric measures and may be useful to evaluate the effectiveness of nursing interventions aimed at optimizing the selfefficacy of the T2DM patient in the management of his treatment. (AU)

Modelo de estudo: estudo de validação. Objetivo: Avaliar o desempenho psicométrico da versão brasileira "Escala de Auto-eficácia no manejo da insulina" - IMDSES. Metodologia: A confiabilidade (consistência interna - α Cronbach), a validade convergente e a validade de critério foram avaliadas. Os dados foram coletados de 127 pacientes com diabetes mellitus tipo 2 (DM2) em uso de insulina por meio da aplicação de instrumentos sociodemográficos e clínicos e as versões brasileiras "Summary of Diabetes Self-Care Activities Measures" - SDSCA and the IMDSES. Resultados: Observou-se "efeito de teto" no domínio da insulina. A confiabilidade foi confirmada em todos os domínios do IMDSES obtendo pontuação total satisfatória (α=0,87). A validade convergente de constructo foi confirmada por correlações negativas significativas de magnitude moderada a fraca entre os escores dos domínios do IMDSES e os escores de domínio da SDSCA. A validade de critério foi parcialmente confimada por correlação de magnitude fraca entre o domínio de Gerenciamento Geral e o escore total do IMDSES e níveis de hemoglobina glicada (r=0.22; p=0.02). Conclusão: A versão brasileira do IMDSES apresentou medidas psicométricas satisfatórias e pode ser útil para avaliar a efetividade das intervenções de enfermagem que visam otimizar a autoeficácia do paciente com DM2 no manejo do tratamento. (AU)

A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol.

BACKGROUND: Non-adherence to oral antidiabetics drugs (OADs) has been a common problem and may contribute to poor glycemic control. AIM: To describe an experimental study protocol that aims at implementing and evaluating the effect of the "action planning and coping planning" interventions on medication adherence to OADs in patients with type 2 diabetes mellitus (T2DM) in follow-up at primary care services. DESIGN: A randomized controlled trial. METHODS: Two groups (intervention and control) will be followed over a period of 105 days. The intervention group will receive a combination of the "action planning" and "coping planning" intervention strategies. There will be in-person meetings and phone calls to reinforce the intervention. The control group will receive the usual care from the health unit. CONCLUSIONS: It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence.

Evaluating the Effect of 3% Papain Gel Application in Cutaneous Wound Healing in Mice.

While the US Food and Drug Administration has not approved the use of 3% papain gel in the United States, the authors feel this study adds to the literature regarding its use. INTRODUCTION: The aim of this study was to evaluate the effect of 3% papain gel on wounds in mice. MATERIALS AND METHODS: Thirty healthy C57BL mice (25-30 g) aged 10 weeks were randomly divided into 2 groups: mice treated with 3% papain gel and mice treated with placebo gel. Skin incisions were performed with a 6-mm metallic punch with a cutting blade edge. On days 3 and 7 after creating the lesion, the mice were euthanized and lesion samples were collected. The lesion samples were processed and sectioned into 3 fragments of skin to be stained with 3 types of dye: hematoxylin and eosin, Picrosirius red, and Weigert. In addition, immunohistochemical analysis (α-SM actin and Ki67) followed by real-time polymerase chain reaction (PCR) protocol was performed on the samples. RESULTS: On gross examination, the 3% papain-treated group took less time to heal the wounds compared with the control. On day 7, microscopic examination showed the 3% papain-treated group had lower numbers of inflammatory cells, increased neovascularization, and improved organization of collagen and elastic fibers. Using PCR analysis, the 3% papain-treated group showed a significant increase in transforming growth factor beta and interleukin-6 expression compared with the control (P < .05). CONCLUSION: Due to a reduced local inflammatory response, increased angiogenesis, and improved organization of collagen deposition, these findings demonstrate 3% papain gel can improve cutaneous wound healing in mice.

Prevalence and clinical significance of potential drug-drug interaction in hematopoietic stem cell transplantation.

Patients undergoing hematopoietic stem cell transplantation (HSCT) are at risk of developing potential drug-drug interactions (PDDIs). The aim of this study was to assess the prevalence of PDDIs that occur in HSCT patients on the day of hematopoietic stem cell infusion. We performed a cross-sectional study based on the evaluation of prescriptions to HSCT patients on the day of infusion (day 0). The PDDIs were analyzed using the DRUG-REAX(®) system and classified according to the severity level, available scientific evidence, time of onset, and potential clinical impact. Forty patients undergoing HSCT were included in this study; 33 patients (82.5%) were exposed to at least one major and one contraindicated PDDI in a concomitant manner. All patients exposed to PDDIs had an increased risk of cardiotoxicity. Most cases of PDDIs were classified as being of major severity (80.9%), with time of onset not specified (61.9%), and with good or excellent scientific evidence (52.4%). HSCT patients have a high prevalence of clinically significant PDDIs. The management of PDDIs requires an approach that includes biochemical tests, installation of cardiac monitors, periodic electrocardiograms, implementation of electronic prescriptions with a PDDI alert system, and availability of the PDDI databases.

Regulation of IRS-1/SHP2 interaction and AKT phosphorylation in animal models of insulin resistance.

Insulin stimulates tyrosine kinase activity of its receptor, resulting in phosphorylation of its cytosolic substrate, insulin receptor substrate-1, which, in turn, associates with proteins containing SH2 domains, including phosphatidylinositol 3-kinase (PI 3-kinase) and the phosphotyrosine phosphatase SHP2. The regulation of these associations in situations of altered insulin receptor substrate-1 (IRS-1) phosphorylation was not yet investigated. In the present study, we investigated insulin-induced IRS-1/SHP2 and IRS-1/PI 3-kinase associations and the regulation of a downstream serine-kinase AKT/PKB in liver and muscle of three animal models of insulin resistance: STZ diabetes, epinephrine-treated rats, and aging, which have alterations in IRS-1 tyrosine phosphorylation in common. The results demonstrated that insulin-induced IRS-1/PI 3-kinase association has a close correlation with IRS-1 tyrosine phosphorylation levels, but insulin-induced IRS-1/SHP2 association showed a modulation that did not parallel IRS-1 phosphorylation, with a tissue-specific regulation in aging. The integration of the behavior of IRS-1/PI 3-kinase and with IRS-1/SHP2 associations may be important for insulin signaling downstream as AKT phosphorylation. In conclusion, the results of the present study demonstrated that insulin-induced IRS-1/SHP2 association can be regulated in insulin-sensitive tissues of animal models of insulin resistance and may have a role in the control of AKT phosphorylation, which may be implicated in the control of glucose metabolism.