Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines.

OBJECTIVES: This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines. METHODS: A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation. We compared the percentage change in highly satisfied patients per site before and after implementing interventions using a two-proportion Z-test. RESULTS: The urban site had a significant increase in patient satisfaction in 13 survey items, which corresponded to the domains of healthcare availability, service efficiency, technical competency and health communication. The rural site had a significant increase in six survey items, which corresponded to the domains of service efficiency, environment, location, health communication and handling. The remote site had a decrease in patient satisfaction in 10 survey items, with a significant increase in only 4 items under the domains of healthcare availability and handling. CONCLUSION: Our findings support the 'inverse equity hypothesis', where well-resourced urban communities quickly adopt complex health interventions while rural and remote settings experience delays in effectively meeting patient needs and system demands. Extended intervention periods and targeted strategies may be necessary to impact patient satisfaction in underserved areas considerably.

Feasibility, acceptability and impact of a clinical decision support tool among primary care providers in an urban, rural and remote site in the Philippines.

INTRODUCTION: Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses, midwives and community health workers (CHWs). This study aimed to (1) assess the feasibility of using UTD as information source for PCPs in urban, rural and remote settings, (2) determine the acceptability of UTD as an information source for PCPs and (3) examine the impact of UTD access on PCP clinical decision-making. METHODS: Four focus group discussions (FGDs) and two key informant interviews (KII) were conducted to gather insights from 30 PCPs. Thematic analysis through coding in NVivo V.12 was done using the technology acceptance model (TAM) as a guiding framework. RESULTS: All PCPs had positive feedback regarding UTD use because of its comprehensiveness, accessibility, mobility and general design. The participants relayed UTD's benefit for point-of-contact use, capacity-building and continuing professional development. PCPs across the three sites, including CHWs with no formal medical education, were able to provide evidence-based medical advice to patients through UTD. However, external factors in these settings impeded the full integration of UTD in the PCPs' workflow, including poor internet access, unstable sources of electricity, lack of compatible mobile devices and the need for translation to the local language. CONCLUSION: UTD was a feasible and acceptable clinical decision support tool for the PCPs. Factors affecting the feasibility of using UTD include technological and environmental factors (ie, internet access and the lack of translation to the local language), as well as the organisational structure of the primary care facility which determines the roles of the PCPs. Despite the difference in roles and responsibilities of the PCPs, UTD positively impacted decision-making and patient education for all PCPs through its use as a point-of-contact tool and a tool for capacity-building.

Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay.

BACKGROUND: Inequities in health access and outcomes persist in low- and middle-income countries. While strengthening primary care is integral in improving patient outcomes, primary care networks remain undervalued, underfunded, and underdeveloped in many LMICs such as the Philippines. This paper underscores the value of strengthening primary care system interventions in LMICs by examining their impact on job satisfaction and intention to stay among healthcare workers in the Philippines. METHODS: This study was conducted in urban, rural, and remote settings in the Philippines. A total of 36 urban, 54 rural, and 117 remote healthcare workers participated in the study. Respondents comprised all family physicians, nurses, midwives, community health workers, and staff involved in the delivery of primary care services from the sites. A questionnaire examining job satisfaction (motivators) and dissatisfaction (hygiene) factors was distributed to healthcare workers before and after system interventions were introduced across sites. Interventions included the introduction of performance-based incentives, the adoption of electronic health records, and the enhancement of diagnostic and pharmaceutical capabilities over a 1-year period. A Wilcoxon signed-rank test and a McNemar's chi-square test were then conducted to compare pre- and post-intervention experiences for each setting. RESULTS: Among the factors examined, results revealed a significant improvement in perceived compensation fairness among urban (p = 0.001) and rural (p = 0.016) providers. The rural workforce also reported a significant improvement in medicine access (p = 0.012) post-intervention. Job motivation and turnover intention were sustained in urban and rural settings between periods. Despite the interventions introduced, a decline in perceptions towards supply accessibility, job security, and most items classified as job motivators was reported among remote providers. Paralleling this decline, remote primary care providers with the intent to stay dropped from 93% at baseline to 75% at endline (p < 0.001). CONCLUSION: The impact of strengthening primary care on health workforce satisfaction and turnover intention varied across urban, rural, and remote settings. While select interventions such as improving compensation were promising for better-supported settings, the immediate impact of these interventions was inadequate in offsetting the infrastructural and staffing gaps experienced in disadvantaged areas. Unless these problems are comprehensively addressed, satisfaction will remain low, workforce attrition will persist as a problem, and marginalized communities will be underserved.

Evolución de la enfermedad COVID-19 en el municipio Cotorro, año 2020

RESUMEN Introducción: La OMS declaró como Pandemia a la COVID-19 el 11 de marzo de 2020. El municipio Cotorro tuvo su primer caso el 16 de marzo. Objetivo: Examinar la evolución de la COVID-19, marzo-agosto de 2020 en el municipio habanero del Cotorro. Métodos: Investigación descriptiva y transversal, del 16 de marzo al 16 de agosto. Se analizaron historias clínico-epidemiológicas, resultados virológicos, pesquisa domiciliaria y laboral, atención por infección respiratoria aguda en consultorios y policlínicos, y parte diario de la Dirección Municipal de Salud. La información se introdujo en base de datos en Excel. Se realizó análisis estadístico descriptivo. Resultados: La tasa de incidencia fue de 8,59 por 10 000 habitantes; en todos los casos se conoció la fuente de infección, hubo siete pacientes activos y 61 recuperados con alta epidemiológica y 2 fallecidos. La mayoría de los casos sucedieron en personas pertenecientes a los policlínicos Cuatro Caminos y Rafael Valdés. Los más afectados fueron las mujeres, las personas de 41-60 años y los asintomáticos al diagnóstico (60,0 %). Se presentó evento epidemiológico en el Centro Provincial de Protección Social con 92 pacientes; 6 fallecidos, predominio masculino, edades de 50-59 años; prevalecieron los asintomáticos (78,3 %). Conclusiones: La evolución clínico-epidemiológica de la COVID-19 en el municipio Cotorro, en su variabilidad temporal y espacial fue favorable en los cinco meses iniciales de enfrentamiento a la nueva enfermedad, debido a la acción conjunta del sistema único de salud, el trabajo intersectorial y la participación de las organizaciones políticas y de masas.

ABSTRACT Introduction: COVID-19 was declared pandemic by the WHO on 11 March 2020. The municipality of Cotorro had its first case on 16 March. Objective: Examine the evolution of COVID-19 in the municipality of Cotorro, Havana, from March to August 2020. Methods: A descriptive cross-sectional study was conducted from 16 March to 16 August. An analysis was performed of clinical-epidemiological records, virological results, home and workplace screening, acute respiratory infection care in consultation offices and polyclinics, and the daily report by the Municipal Health Division. The information obtained was entered into an Excel database. Descriptive statistical analysis was carried out. Results: The incidence rate was 8.59 per 10 000 inhabitants; in all cases the source of infection was known; seven patients were active, 61 recovered and were epidemiologically discharged, and two died. Most of the cases were from Cuatro Caminos and Rafael Valdés polyclinics. The most affected groups were women, people aged 41-60 years and asymptomatic patients at diagnosis (60.0%). An epidemiological event occurred at the Provincial Social Protection Center with 92 patients: six died, male sex prevailed, age range 50-59 years, and a predominance of asymptomatic patients (78.3%). Conclusions: In spatial and temporal terms, the clinical-epidemiological evolution of COVID-19 in the municipality of Cotorro was favorable during the first five months of the response to the new disease, due to the joint action of the unified health system, intersectoral work and the participation of political and mass organizations.

[Second-line treatment in recurrent urinary incontinence after the use of mid-urethral tapes. Systematic review and metaanalysis of proportions.] / Tratamiento de segunda línea en incontinencia urinaria recurrente posterior al uso de cintas de uretra media. Revisión sistemática y metaanálisis de proporciones.

OBJECTIVE: Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. This study aims to show the cure rate of the second-line management options described in the literature. MATERIAL AND METHOD: Systematic review of the literature with meta-analysis of proportions. Observational and interventional studies were included in which the different types of management of recurrent/persistent urinary incontinence were evaluated in women who had a mid-urethral tape as primary management. RESULTS: 161 studies were identified and screened, including 29 in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity, an estimation of the cure rate for each type of management was performed, with the following results regarding the total combined cure rate: in the implantation of adjustable tapes of 86% ( IC95%: 76.4% -92.1%), the implantation of a second mid urethral tape was 75.1% (95% CI: 68% -81.1%), in the shortening of the previous mid urethral tape was 62.3% (95% CI: 49.1% -73.9%) and finally the implantation of bulking agents was 55.4% (95% CI: 43.2% -67%). We did not find enough studies to perform a quantitative synthesis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. CONCLUSION: The evidence found shows that there may be superiority of the adjustable tapes versus the mid urethral tapes and other included treatments. However, a comparison to statistically corroborate this difference could not be made. These results should be confirmed with multicenter collaborative randomized clinical trials.

OBJETIVO: La incontinencia urinaria femenina tiene una prevalencia hasta del 40%, su tipo más frecuente, con cerca del 50%, es la incontinencia urinaria con esfuerzo. Cuando el manejo primario falla, no se tiene claridad sobre cuál debe ser la conducta. Este estudio pretende mostrar la proporción de curación de las opciones de manejo de segunda línea descritos en la literatura. MATERIAL Y MÉTODO: Revisión sistemática de la literatura con meta-análisis de proporciones. Se incluyeron estudios observacionales y de intervención, en los que se evaluaron los diferentes tipos de manejos de la incontinencia urinaria recurrente/persistente en mujeres que tuvieran una cinta de uretra media como manejo primario. RESULTADOS: Se identificaron y tamizaron 161 estudios, incluyendo 29 en la síntesis cualitativa y 27 en la síntesis cuantitativa. Dada la alta heterogeneidad clínica y metodológica, se realizó una estimación de la proporción de curación para cada uno de los tipos de manejo, con los siguientes resultados con respecto a la proporción de curación total combinada: en la implantación de cintas ajustables de 86% (IC95%: 76,4%-92,1%), en la implantación de una segunda cinta de uretra media fue de 75,1% (IC95%: 68%-81,1%), en el acortamiento de la cinta de uretra media previa fue de 62,3% (IC95%: 49,1%-73,9%) y por último en la implantación de agentes abultantes fue de 55,4% (IC95%: 43,2%-67%). No se encontraron estudios suficientes para poder realizar una síntesis cuantitativa con respecto a: sling pubovaginal, colposuspensión y terapia de piso pélvico, al igual que para los desenlaces secundarios.CONCLUSIÓN: La evidencia encontrada muestra que podría haber superioridad de las cintas ajustables frente a las cintas de uretra media y los otros tratamientos incluidos. Sin embargo, no se pudo realizar una comparación para corroborar estadísticamente dicha diferencia. Estos resultados deben ser corroborados con ensayos clínicos aleatorizados colaborativos multicéntricos.

Tratamiento de segunda línea en incontinencia urinaria recurrente posterior al uso de cintas de uretra media. Revisión sistemática y metaanálisis de proporciones / Second-line treatment in recurrent urinary incontinence after the use of mid-urethral tapes. Systematic review and metaanalysis of proportions

Objetivo: La incontinencia urinaria femenina tiene una prevalencia hasta del 40%, su tipo más frecuente, con cerca del 50%, es la incontinencia urinaria con esfuerzo. Cuando el manejo primario falla, no se tiene claridad sobre cuál debe ser la conducta. Este estudio pretende mostrar la proporción de curación de las opciones de manejo de segunda línea descritos en la literatura. Material y método: Revisión sistemática de la literatura con meta-análisis de proporciones. Se incluyeron estudios observacionales y de intervención, en los que se evaluaron los diferentes tipos de manejos de la incontinencia urinaria recurrente/persistente en mujeres que tuvieran una cinta de uretra media como manejo primario. Resultados: Se identificaron y tamizaron 161 estudios, incluyendo 29 en la síntesis cualitativa y 27 en la síntesis cuantitativa. Dada la alta heterogeneidad clínica y metodológica, se realizó una estimación de la proporción de curación para cada uno de los tipos de manejo, con los siguientes resultados con respecto a la proporción de curación total combinada: en la implantación de cintas ajustables de 86% (IC95%: 76,4%-92,1%), en la implantación de una segunda cinta de uretra media fue de 75,1% (IC95%: 68%-81,1%), en el acortamiento de la cinta de uretra media previa fue de 62,3% (IC95%: 49,1%-73,9%) y por último en la implantación de agentes abultantes fue de 55,4% (IC95%: 43,2%-67%). No se encontraron estudios suficientes para poder realizar una síntesis cuantitativa con respecto a: sling pubovaginal, colposuspensión y terapia de piso pélvico, al igual que para los desenlaces secundarios. Conclusión: La evidencia encontrada muestra que podría haber superioridad de las cintas ajustables frente a las cintas de uretra media y los otros tratamientos incluidos. Sin embargo, no se pudo realizar una comparación para corroborar estadísticamente dicha diferencia. Estos resultados deben ser corroborados con ensayos clínicos aleatorizados colaborativos multicéntricos

Objective: Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. This study aims to show the cure rate of the second-line management options described in the literature. Material and method: Systematic review of the literature with meta-analysis of proportions. Observational and interventional studies were included in which the different types of management of recurrent/persistent urinary incontinence were evaluated in women who had a mid-urethral tape as primary management. Results: 161 studies were identified and screened, including 29 in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity, an estimation of the cure rate for each type of management was performed, with the following results regarding the total combined cure rate: in the implantation of adjustable tapes of 86% ( IC95%: 76.4% -92.1%), the implantation of a second mid urethral tape was 75.1% (95% CI: 68% -81.1%), in the shortening of the previous mid urethral tape was 62.3% (95% CI: 49.1% -73.9%) and finally the implantation of bulking agents was 55.4% (95% CI: 43.2% -67%). We did not find enough studies to perform a quantitative synthesis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. Conclusion: The evidence found shows that there may be superiority of the adjustable tapes versus the mid urethral tapes and other included treatments. However, a comparison to statistically corroborate this difference could not be made. These results should be confirmed with multicenter collaborative randomized clinical trials

Hispanics Coming to the US Adopt US Cultural Behaviors and Eat Less Healthy: Implications for Development of Inflammatory Bowel Disease.

INTRODUCTION: The incidence of inflammatory bowel disease (IBD) among US Hispanics is rising. Adoption of an American diet and/or US acculturation may help explain this rise. AIMS: To measure changes in diet occurring with immigration to the USA in IBD patients and controls, and to compare US acculturation between Hispanics with versus without IBD. Last, we examine the current diet of Hispanics with IBD compared to the diet of Hispanic controls. METHODS: This was a cross-sectional study of Hispanic immigrants with and without IBD. Participants were recruited from a university-based GI clinic. All participants completed an abbreviated version of the Stephenson Multi-Group Acculturation Scale and a 24-h diet recall (the ASA-24). Diet quality was calculated using the Healthy Eating Index (HEI-2010). RESULTS: We included 58 participants: 29 controls and 29 IBD patients. Most participants were Cuban or Colombian. Most participants, particularly those with IBD, reported changing their diet after immigration (72% of IBD and 57% of controls). IBD participants and controls scored similarly on US and Hispanic acculturation measures. IBD patients and controls scored equally poorly on the HEI-2010, although they differed on specific measures of poor intake. IBD patients reported a higher intake of refined grains and lower consumption of fruits, whereas controls reported higher intake of empty calories (derived from fat and alcohol). CONCLUSION: The majority of Hispanics change their diet upon immigration to the USA and eat poorly irrespective of the presence of IBD. Future studies should examine gene-diet interactions to better understand underlying causes of IBD in Hispanics.

Clinical outcomes after switch to mTOR inhibitors in kidney transplant recipients / Resultados clínicos en receptores de trasplante renal posterior a la conversión a ImTOR

Abstract Introduction: mTOR inhibitors Sirolimus and Everolimus are an alternative for inmunosuppression in renal transplant recipients. The aim of the study was to describe the experience of patients with switch to mTOR inhibitors, followed up for more than five years. Materials and methods: Patients with renal transplantation from 1995 to 2013, who had indication of calcineurin inhibitor (CNI) withdrawl after the third month post-transplant were included. All patients underwent renal biopsy prior to conversion. No patient had a diagnosis of chronic nephtopathy, IFTA>40 % or proteinuria >350mg/24h. A descriptive analysis for all variables was devoloped. Kaplan-Meier method was used for the patient's and graft survival and graft rejection incidence. Results: From 1273 renal transplants, the switch from CNI to mTOR inhibitors was performed in 166 (13 %), 78 % (n=129) were switched to Sirolimus. 12,6 % of the patients lost graft function and 4,2 % (n=7) died. 37% had mTOR inhibitors withdrawal, and the major cause was pathologic proteinuria. The incidence of graft rejection after switching to mTOR inhibitors was 9,6 %. The one and five year graf survival was 96,6 % and 83,5 %. The patient survival at one and five years was 98 % and 97 %. Conclusions: The use of mTOR inhibitors drugs appears to be safe in the managgement of specific renal transplant recipients, with a low rejection rate and good survival.

Resumen Introducción: los ImTOR, sirolimus y everolimus son una alternativa de inmunosupresión en personas que han recibido transplantes renales. En este artículo, se describe la experiencia de pacientes que han experimentado una conversión a ImTOR, y a los que se les ha hecho un seguimiento por más de cinco años. Materiales y métodos: se incluyeron pacientes con transplantes renales desde 1995 hasta 2013, quienes tuvieron indicación de suspensión del inhibidor de calcineurina (ICN) después del tercer mes posterior al trasplante. Todos los pacientes fueron sometidos a biopsia renal antes de la administración de ImTOR. Ningún paciente tuvo diagnóstico de nefropatía crónica, IFTA >40 % o proteinuria >350 mg/24h. Se elaboró un análisis descriptivo para todas las variables. Para estudiar la supervivencia del paciente y del injerto, y la incidencia de rechazo agudo, se usó el método de Kaplan-Meier. Resultados: de 1273 trasplantes renales, la conversión de ICN a ImTOR se realizó en 166 casos (13 %). Al 78 % (n=129) se le administró sirolimus. El 13 % de los pacientes perdió la función del injerto y 7 pacientes (4,2 %) fallecieron. En el 37 % de los casos, se retiró el ImTOR. La principal causa de retiro fue el hallazgo de proteinuria patológica. La incidencia de rechazo agudo después del cambio a ImTOR fue de 9,6 %. La supervivencia del injerto tras uno y cinco años fue de 96,6 % y 83,5 %, respectivamente; y la supervivencia del paciente a uno y cinco años fue de 98 % y 97 %, respectivamente. Conclusiones: el uso de inhibidores ImTOR parece ser seguro en este grupo de pacientes trasplantados, pues hubo una baja tasa de rechazo y buena supervivencia del injerto.

Anti-cancer effects of aloe-emodin: a systematic review.

BACKGROUND: Anthraquinones are a possible treatment option for oncological patients due to their anti-cancer properties. Cancer patients often exhaust a plethora of resources that ultimately fail to provide fully curative measures. Alternative treatments are subsequently sought in the hope of finding a therapeutic remedy. Po¬tential regimens include aloe-emodin and its related derivatives. This review therefore summarizes the effects of aloe-emodin and other aloe components in light of their anti-proliferative and anti-carcinogenic properties. METHODS: A systematic search was performed in PubMed for aloe-emodin and cancer in humans. Sixty abstracts of in vitrostudies were selected and reviewed with subsequent screening of the full text. Thirty-eight articles were summarized. RESULTS: Aloe-emodin possesses multiple anti-proliferative and anti-carcinogenic properties in a host of human cancer cell lines, with often multiple vital pathways affected by the same molecule. The most notable effects include inhibition of cell proliferation, migration, and invasion; cycle arrest; induction of cell death; mitochondrial membrane and redox perturbations; and modulation of immune signaling. The effects of aloe-emodin are not ubiquitous across all cell lines but depend on cell type. CONCLUSIONS: On the basis of this systematic review, the multiple consistent effects of aloe-emodin in hu¬man-derived cancer cell lines suggest that aloe-emodin is a potential anti-cancer agent that acts on cancer cells in a pleiotropic manner. RELEVANCE FOR PATIENTS: Cancer patients often utilize alternative therapies as a result of suboptimal efficacy of conventional treatments. Aloe-emodin might become a therapeutic option for cancer patients if the basic research is confirmed in clinical trials.

A double-blind, randomized trial on the effect of a broad-spectrum dietary supplement on key biomarkers of cellular aging including inflammation, oxidative stress, and DNA damage in healthy adults.

Background and Aim: Nutritional approaches that ameliorate cellular senescence may have the potential to counteract the effects of chronic disease. This study will investigate the effect of the Healthycell dietary supplement on markers of inflammation, oxidative stress, and DNA damage. Methods: Thirty adults between the ages of 18 and 55 were enrolled and randomly assigned to one of the two study conditions (n = 15 Healthycell and n = 15 placebo). Subjects participated in a four-week intervention and were assessed at baseline, four weeks, and six weeks (after a two-week washout period). Results: Pro-inflammatory cytokine interleukin (IL)-1α (t = 2.033; mean difference = -3.97 pg/ml; SE = 2.0; 95% CI: -8.0, -0.3; Cohen's d = 0.77; p = 0.05) decreased, while soluble cytokine receptors sTNFR-I (t = 2.057; mean difference = 52.39 pg/mL; SE = 18.5; 95% CI: 5.2, 99.6; Cohen's d = 0.53; p = 0.03) and sTNFR-II (t = 1.739; mean difference = 208.71 pg/ml; SE = 72.0; 95% CI: 24.4, 393.0; Cohen's d = 0.61; p = 0.02) increased in the treatment group versus control. C-reactive protein also rose in the Healthycell group during the trial (t = 2.568; mean difference = 1.41 mg/dL; SE = 0.4; 95% CI: 0.3, 2.5; Cohen's d = 0.66; p < 0.01), without accompanying increases in IL-6 and TNF-α. Additionally, cortisol levels decreased in the Healthycell group (t = 0.575; mean difference = -0.31 ug/dL; SE=0.1; 95% CI: -0.6, -0.03; Cohen's d = 0.88; p = 0.03). When groups were split by age (< 35 years vs. ≥ 35 years), 8-hydroxydeoxyguanosine, a marker of DNA damage, decreased in the older Healthycell group compared to placebo (t = 1.782; mean difference = -7.09 ng/mL; SE = 3.0; 95% CI: -13.3, -0.9; Cohen's d = 0.63; p = 0.03). Significant changes were also found for sTNFR-I, sTNFR-II, and IL-5 in the older group. All results were obtained from t tests by post-hoc analysis. Conclusions: Our findings show an improved inflammatory profile and decreased DNA damage. Additionally, the efficacy of Healthycell was primarily in older adults, where the processes that cause or are associated with cell senescence are more predominant. Relevance for patients: Healthycell may help to counteract the inflammatory effects of aging that lead to both cell senescence and the multitude of age-related chronic diseases.

Double-blind, randomized crossover study of intravenous infusion of magnesium sulfate versus 5% dextrose on depressive symptoms in adults with treatment-resistant depression.

AIM: Treatment-resistant depression patients are more likely to suffer from comorbid physical and mental disorders, experience marked and protracted functional impairment, and incur higher health-care costs than non-affected individuals. Magnesium sulfate is a treatment option that may offer great potential for patients with treatment-resistant depression based on prior work in animals and humans. METHODS: Twelve subjects with mild or moderate treatment-resistant depression were randomized into a double-blind crossover trial to receive an infusion of 4 g of magnesium sulfate in 5% dextrose or placebo infusion of 5% dextrose with a 5-day washout in between the 8-day intervention period. Subjects were assessed before and after the intervention for serum and urine magnesium, lipid panel, the Hamilton Rating Scale for Depression, and the Patient Health Questionnaire-9. RESULTS: We found a difference in serum magnesium from day 2 to 8 (pre-infusion) (P < 0.002) and from baseline to day 8 (P < 0.02). No changes were noted on the Hamilton Rating Scale for Depression or the Patient Health Questionnaire-9 24 h post-treatment, but as serum magnesium increased from baseline to day 7, the Patient Health Questionnaire-9 decreased from baseline to day 7 (P = 0.02). CONCLUSION: Magnesium sulfate did not significantly affect depression 24 h post-infusion, but other results were consistent with the literature. The association between changes in serum magnesium and the Patient Health Questionnaire-9 supports the idea that magnesium sulfate may be used to address treatment-resistant depression, an ongoing medical challenge.

Systematic evaluation of buffer influences on the development of Dictyostelium discoideum.

Development and cell differentiation are key features of the social amoeba Dictyostelium discoideum. Already at early developmental stages, the gene expression profile changes in the amoebae to make the cells aggregation competent. In the laboratory, development starts when the cells are washed free of nutrients. For this purpose, various non-nutrient buffers are used in different laboratories. However, to date, it is not clear if different buffers have different influences on the development of D. discoideum. Therefore, we investigated systematically the influence of six widely used buffers on the development of D. discoideum. Investigation was done at the phenotypical, biochemical, and molecular level. The results show that some of the investigated buffers show clear differences in the phenotypical outcome of the developmental cycle, at a biochemical level as measured in the response to cAMP, and/or at a molecular level as measured in the expression of early developmental marker genes. According to our results buffer compositions should be considered carefully for all developmental experiments with D. discoideum, especially when gene expression will be investigated.

High-intensity, but not moderate-intensity, exercise increases post-exercise rate of fat oxidation in type 2 diabetics.

BACKGROUND: Aerobic exercise is recommended for glycemic and weight control in type 2 diabetes (T2D), but exercise intensity that increase post-exercise fat oxidation has not been established yet. It is expected that high-intensity exercise induce higher absolute oxidations and rates of oxidation of CHO (during) and fat (after) in normoglycemic, but in hyperglycemic it is unclear. AIM: To compare the effects of exercise intensity on CHO and fat oxidation during and after exercise in individuals with T2D. METHODS: Eleven persons with T2D, randomly underwent three experimental sessions 72 hours apart: 1) 20 minute of high-intensity exercise (120% of lactate threshold (LT) - 120%LT), 2) 20 minute of moderate-intensity exercise (80% of LT - 80%LT), and 3) 20 minute of control session (CON) - no exercise was performed and the individuals remained seated during the whole time. Percentages of CHO and fat contribution and CHO and fat oxidation rate (mg/min) were analyzed during and after sessions. RESULTS: The rate of CHO oxidation during exercise was significantly higher during 120%LT in relation to 80%LT and CON (18.2 ± 5.6 vs. 9.5 ± 2.7 vs. 1.1 ± 0.4 mg∙min-1), the absolute rate of fat oxidation was significantly higher in 120%LT compared to 80%LT and CON during exercise (13.5 ± 3.3, 9.5 ± 2.2, and 0.7 ± 0.2 mg∙min-1, respectively, p < 0.05). During the post-exercise oxygen consumption recovery period, only the 120%LT had higher fat oxidation (94.5% vs. 68.1%, p < 0.05), when compared to CON. Both exercise sessions equally elicited a lowered glycaemia during the post-exercise period, but CHO oxidation was lower after 120%LT than CON (0.1 ± 0.2 vs. 0.9 ± 0.5 mg∙min-1, p < 0.05). CONCLUSIONS: Higher intensity elicited an elevated CHO oxidation rate during exercise and a higher percentage of fat utilization during the post-exercise recovery period compared to moderate-intensity exercise and control sessions. RELEVANCE FOR PATIENTS: High-intensity aerobic exercise, even of short duration, may benefit individuals with T2D on the substrate oxidation related to the body fat. Exercise can be an important tool for the prevention and management of T2D due to its effects on carbohydrate and fat metabolism, reduction of body fat, and control of blood glucose.

A cross-sectional assessment of metabolic syndrome in HIV-infected people of low socio-economic status receiving antiretroviral therapy.

BACKGROUND: Metabolic syndrome (MetS) is a constellation of symptoms used as a measure to identify patients at increased risk for cardiovascular disease, type 2 diabetes, and all-cause mortality. The results of prolonged life expectancy and cumulative toxic effects of antiretroviral therapy increase the chance that HIV can cause clinical abnormalities, including MetS. METHODS: We evaluated 89 people living with HIV (PLWH; mean age 48 ± 7 years; mean duration of HIV infection 17 ± 12 years; 47% men; 66% African-American, 22% Hispanic, and 10% non-Hispanic white; and 84% unemployed) enrolled in a community-based exercise training and nutrition education program targeting individuals of low socio-economic status (SES). The prevalence of MetS characteristics and the factors associated with the presence of MetS were analyzed. RESULTS: One in three (33%; 12 men and 17 women) PLWH met ATPIII criteria for MetS. In our cohort, MetS was driven by high waist circumference and elevated blood pressure. In addition, higher use of protease inhibitors, elevated hemoglobin A1c (HbA1c), greater self-reported daily caloric intake and consumption of carbohydrates, sugar, added sugar, and higher glycemic load were found among the individuals with MetS, compared to those without it. Elevated HbA1c and high total sugar consumption were the strongest predictors and accounted for 30% of the occurrence of MetS. CONCLUSIONS: The overall prevalence of MetS in our PLWH cohort receiving antiretroviral therapy is higher than previously reported in the general population and in other PLWH cohorts. Additional work is needed to determine whether MetS is a more disease dependent or lifestyle dependent condition in PLWH.

The effect of exercise training on disease progression, fitness, quality of life, and mental health in people living with HIV on antiretroviral therapy: a systematic review.

BACKGROUND: Exercise has been associated with improvements in adverse physiological and psychological effects of long-term antiretroviral therapy (ART) in people living with HIV (PLWH). AIM: To summarizes the findings on the effects of aerobic or resistance training alone or combined aerobic and resistance exercise training (CARET) on disease progression, fitness, physical functioning, mental health, and quality of life (QOL) in PLWH receiving ART. A systematic search of articles was performed in several databases, and 20 articles that met inclusion criteria were summarized. RELEVANCE FOR PATIENTS: Aerobic exercise was associated with improvements in aerobic capacity, QOL, and depressive symptoms, while resistance training improved strength. CARET was related to improved aerobic fitness, strength, physical functioning, QOL, and self-efficacy. At least one of the exercise interventions resulted in improvements in CD4+ cell count and HIV RNA viral load. Moreover, another study showed that HIV-specific biomarkers remained unchanged in the exercise intervention group, while they significantly worsened in the non-exercise group. In general, in spite of their well-known benefits, exercise programs have not been extensively utilized or widely recognized as viable therapeutic treatment options for this patient population. Knowing the possible health benefits of increasing physical activity level is important to better recommend exercise programs. However, the prescription must be done carefully and on an individual basis. Additional studies investigating the efficiency and effectiveness of different exercise training regimens for PLWH are needed.

A cross-sectional assessment to detect type 2 diabetes with endothelial and autonomic nervous system markers using a novel system.

BACKGROUND: Type 2 diabetes mellitus is frequently unrecognized until complications appear. Diabetic autonomic neuropathy is one of the early complications of type 2 diabetes mellitus, resulting in autonomic nervous system (ANS) dysfunction. The purpose of this study was to determine the validity of ANS function indicators to screen for type 2 diabetes mellitus, as measured by the TM-Oxi and SudoPath system. METHODS: All enrolled participants completed a basic sociodemographic and medical history questionnaire including current medications. Healthy controls (n = 25) underwent a 2-hour oral glucose tolerance test (OGTT) to evaluate glucose, insulin, and insulin C-peptide. Patients with type 2 diabetes mellitus (n = 24) were assessed with fasting plasma glucose (FPG) and glycosylated hemoglobin. The TM-Oxi and SudoPath system evaluation was completed by all subjects. Data were analyzed using SPSS 22. Frequency and descriptive statistics were calculated on all variables. The criterion for statistical significance was α = 0.05. RESULTS: The twenty-five healthy controls had a mean age of 37.0 years. The twenty-four type 2 diabetes mellitus patients currently undergoing standard treatment had a mean age of 48.9 years. Based on the American Diabetes Association guidelines, we detected pre-diabetes in 4 subjects and diabetes in 1 subject, while all other subjects had normal FPG values. At 120 minutes, the correlations between the OGTT and cardiometabolic risk score (CMRS) were: r = 0.56 (p = 0.004) for glucose and r = 0.53 (p = 0.006) for insulin. At 120 minutes, the correlations between the OGTT and photoplethysmography index (PTGi) were: r = -0.56 (p = 0.003) for glucose and r = -0.41 (p = 0.04) for insulin. The CMRS, PTGi, and plethysmography total power index (PTGVLFi) differed significantly between the diabetes patients and healthy participants. The specificity and sensitivity for the CMRS, PTGi, and PTVLFi comparing the diabetes patients with healthy controls were high. CONCLUSION: The TM-Oxi and SudoPath system shows promise as a valid, convenient, and non-invasive screening method for type 2 diabetes mellitus. The ANS function and CMR indicators measured by this system may be useful in guiding diabetes and cardiovascular health screening, treatment, and monitoring.

The mAKAPbeta scaffold regulates cardiac myocyte hypertrophy via recruitment of activated calcineurin.

mAKAPbeta is the scaffold for a multimolecular signaling complex in cardiac myocytes that is required for the induction of neonatal myocyte hypertrophy. We now show that the pro-hypertrophic phosphatase calcineurin binds directly to a single site on mAKAPbeta that does not conform to any of the previously reported consensus binding sites. Calcineurin-mAKAPbeta complex formation is increased in the presence of Ca(2+)/calmodulin and in norepinephrine-stimulated primary cardiac myocytes. This binding is of functional significance because myocytes exhibit diminished norepinephrine-stimulated hypertrophy when expressing a mAKAPbeta mutant incapable of binding calcineurin. In addition to calcineurin, the transcription factor NFATc3 also associates with the mAKAPbeta scaffold in myocytes. Calcineurin bound to mAKAPbeta can dephosphorylate NFATc3 in myocytes, and expression of mAKAPbeta is required for NFAT transcriptional activity. Taken together, our results reveal the importance of regulated calcineurin binding to mAKAPbeta for the induction of cardiac myocyte hypertrophy. Furthermore, these data illustrate how scaffold proteins organizing localized signaling complexes provide the molecular architecture for signal transduction networks regulating key cellular processes.