Effectiveness of an educational intervention on the management of type 2 diabetic patients hospitalized in Internal Medicine: results from the FADOI-DIAMOND study

Appropriate management of hyperglycemia is crucial for patients with type 2 diabetes. Aim of the FADOI-DIAMOND study was to evaluate real-world management of type 2 diabetic patients hospitalized in Internal Medicine wards (IMW) and the effects of a standardized educational intervention for IMW staff. DIAMOND has been carried out in 53 Italian IMW, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase). In PRE phase, each center reviewed the charts of the last 30 hospitalized patients with known type 2 diabetes. An educational program was conducted in each center by means of the “outreach visit,” a face-to-face meeting between IMW staff and a trained external expert. Six months after, each center repeated the data collection (POST phase), specular to the PRE. A total of 3,167 patients were enrolled (1,588 PRE and 1,579 POST). From PRE phase to POST, patients with registered anthropometric data (54.1 vs. 74.9 %, p < 0.001) and in-hospital/recent measurement of glycated hemoglobin (48.2 vs. 61.4 %, p < 0.005) increased significantly. After educational program, more patients received insulin during hospitalization (68.3 vs. 63.6 %, p = 0.005). A more relevant variation in glycemia during hospitalization was observed in POST phase than PRE (?22.2 vs. ?15.5 mg/dL, p < 0.001), without differences as for occurrence of hypoglycemia (12.3 vs. 11.9 %). A one-shot educational intervention led to persistent improvement in the management of hospitalized patients with type 2 diabetes and to significant better glycemic control. Further studies might evaluate the effectiveness of a more aggressive educational program, on both management and outcomes.     

Keggin-structure heteropolyacid supported on alumina to be used in trans/esterification of high-acid feedstocks

Heteropolyacids (HPA) with Keggin structures, such as H₃PMo₁₂O₄₀ (H₃PMo), have been described as efficient catalysts in trans/esterification reactions due to their tolerance to water and free fatty acids contents, with particularly well-suited characteristics of high proton mobility and stability. The versatile array of HPA is considerably increased when such catalysts are supported onto solid matrices. In this sense, Al₂O₃ was assessed as support for H₃PMo to be used in trans/esterification reactions to produce biodiesel from high-acid feedstocks. The catalyst structure was characterized and applied on trans/esterification reaction of acid oils using ethanol as acyl acceptor. A face centered composite design was employed to conduct the experimental design and results analysis, taking macaw palm oil as study model. The process achieved an optimum level of 99.8% ester content and 4.1 mm² s⁻¹ viscosity under the following reaction conditions: 190 °C reaction temperature, 50 : 1 ethanol-to-oil molar ratio and 13.0% catalyst concentration. Other tested feedstocks (fungal single cell oil and residual frying oil) were also tested promoting satisfactory results, though the parameters were found to be slightly outside the limits set by the USA (ASTM D6715) standard. The H₃PMo/Al₂O₃ catalyst presented good regeneration and can be reused for up to four reaction cycles and requires lower ethanol-to-oil ratio, temperature, and catalyst concentration in comparison with other data from the literature.

Heteropolyacids (HPA) with Keggin structures, such as H₃PMo₁₂O₄₀ (H₃PMo), have been described as efficient catalysts in trans/esterifications of high-acid feedstocks due to their tolerance to water and free fatty acids contents.     

Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period

Background:

Physiotherapy in the plastic surgery post-operative (PO) is essential to provide means for an adequate and fast recovery as it restores function through the use of physiotherapeutic procedures.

Aim:

The aim of the following study is to verify the effects of the association between the manual lymphatic drainage and the therapeutic ultrasound on pain, oedema and the tissue fibrosis in liposuction and lipoabdominoplasty PO.

Design:

This is a clinical trial prospective.

Materials and Methods:

Eighteen women aged between 18 and 60 years participated in this study, in the late PO period following lipoabdominoplasty or liposuction in the abdomen, flanks and lower trunk, which showed tissue fibrosis of the flanks and abdomen regions. They were divided into two groups: Liposuction group and lipoabdominoplasty group. A total of twelve sessions of therapeutic ultrasound followed by the manual lymphatic drainage were performed. The patients were assessed with regard to pain, oedema and tissue fibrosis in different moments: Initial assessment, during assessment and final assessment through the application of the protocol of evaluation of cysts fibrosis levels.

Statistical Analysis:

The test of equality for two proportions and the confidence interval test for mean to evaluate the distribution of variables. The significance level adopted for statistical tests was 5% (P < 0.05).

Results:

There was a statistically significant reduction of pain, swelling and tissue fibrosis in both groups.

Conclusion:

the association between manual lymphatic drainage and the therapeutic ultrasound reduced the swelling and the tissue fibrosis and made pain disappear in liposuction and lipoabdominoplasty PO period.KEY WORDS: Oedema, lipectomy, lymphatic system, plastic, surgery, ultrasound therapy     

Tobacco use and smoking cessation among third‐year dental students in southern Brazil

The aim of the present cross‐sectional study was to assess tobacco use and smoking cessation among third‐year dental students in southern Brazil. The Global Health Professions Student Survey questionnaire was used in eight dental schools in Rio Grande do Sul state, Brazil. Of the 663 eligible students, 576 (87%) participated. The prevalence of current smoking was 19.1% [95% confidence interval (CI): 12.9–25.3%], and 61.6% (95% CI: 54.9–68.3%) of students reported having smoked at least once in their lifetime. The prevalence of dental students who had smoked ≥100 cigarettes in their lifetime was 17.1% (95% CI: 12.5–21.7%). Being frequently exposed to other smokers at home or in other places (second‐hand smoke) increased the likelihood of current smoking by two‐ to threefold. Approximately 6.1% (95% CI: 3.5–8.7%) of the students reported that they currently wanted to stop smoking and 7.5% (95% CI: 5.3–9.6%) had tried to stop smoking in the last year. Friends and family were the most frequent sources of help or counselling, and only a limited proportion of students received help from health professionals. Tobacco use and exposure to second‐hand smoking is widespread among dental students in southern Brazil. Smoking‐cessation initiatives targeting health care students are urgently needed.     

Is There a Positive Effect of Smoking Cessation on Periodontal Health? A Systematic Review

Background: Although the detrimental effects of tobacco on the periodontal tissues have been reported extensively, little is known about the potential beneficial effect of smoking cessation on periodontal health. The aim of this systematic review is to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy. Methods: Two independent reviewers completed the review process through title (n = 118), abstract (n = 24), and whole‐paper selection (n = 5). Sources include Medline and EMBASE databases (up to December 2012) and a reference list of selected studies. Prospective studies comparing progression rates of periodontitis between smokers and quitters and clinical trials evaluating the effect of smoking‐cessation programs, alone or in combination with periodontal treatment, were included. At least 1 year of follow‐up was required for inclusion. Results: Of 331 potentially relevant publications, five studies fulfilled the inclusion criteria. Because of heterogeneity of the studies, a meta‐analysis could not be performed. One study reported that the progression of clinical attachment loss (AL) ≥3 mm during a 6‐year period was approximately three times higher among smokers than quitters (P <0.001). Two studies (10 and 20 years of follow‐up) observed a decrease in radiographic bone loss of ≈30% among quitters when compared with smokers. Among individuals receiving non‐surgical periodontal treatment, quitters were more likely to have periodontal probing depth reductions (P <0.05) than non‐quitters/oscillators. No differences in AL were observed. Conclusion: Based on the limited available evidence, smoking cessation seems to have a positive influence on periodontitis occurrence and periodontal healing.     

Efficacy of red and infrared lasers in treatment of temporomandibular disorders — a double-blind,randomized, parallel clinical trial

Aim:

Low-level laser therapy has still not been well established, and it is important to define a standardized protocol for the treatment of temporomandibular disorders (TMDs) using low level laser. There is no consensus on controlled clinical trials concerning the best option for laser therapy with regard to wavelength. The aim of this study was to evaluate the efficacy of red and infrared laser therapy in patients with TMD, using a randomized parallel-group double-blind trial.

Methodology:

Each hemiface of 19 subjects was randomized to receive intervention, in a total of 116 sensitive points. Pain was measured at baseline and time intervals of 24 hours, 30 days, 90 days, and 180 days after treatment. Irradiation of 4 J/cm² in the temporomandibular joints and 8 J/cm² in the muscles was used in three sessions.

Results:

Both treatments had statistically significant results (P<0·001); there was statistical difference between them at 180 days in favor of the infrared laser (P?=?0·039). There was improvement in 24 hours, which extended up to 180 days in both groups.

Conclusion:

Both lasers are effective in the treatment and remission of TMD symptoms.     

Cluster of SARS-CoV-2 Gamma Variant Infections,Parintins, Brazil,March 2021

High case counts after the Gamma (P. 1) variant of severe acute respiratory syndrome coronavirus 2 emerged in Brazil raised concerns that previously infected persons might become reinfected. Investigation of a cluster of coronavirus disease cases in Parintins, in the Brazilian Amazon, suggested household transmission but did not identify high rates of reinfection.     

Plasma miRNA-based signatures in CRC screening programs

Colorectal cancer (CRC) screening programs help diagnose cancer precursors and early cancers and help reduce CRC mortality. However, currently recommended tests, the fecal immunochemical test (FIT) and colonoscopy, have low uptake. There is therefore a pressing need for screening strategies that are minimally invasive and consequently more acceptable to patients, most likely blood based, to increase early CRC identification. MicroRNAs (miRNAs) released from cancer cells are detectable in plasma in a remarkably stable form, making them ideal cancer biomarkers. Using plasma samples from FIT-positive (FIT+) subjects in an Italian CRC screening program, we aimed to identify plasma circulating miRNAs that detect early CRC. miRNAs were initially investigated by quantitative real-time PCR in plasma from 60 FIT+ subjects undergoing colonoscopy at Fondazione IRCCS Istituto Nazionale dei Tumori, then tested on an internal validation cohort (IVC, 201 cases) and finally in a large multicenter prospective series (external validation cohort [EVC], 1121 cases). For each endoscopic lesion (low-grade adenoma [LgA], high-grade adenoma [HgA], cancer lesion [CL]), specific signatures were identified in the IVC and confirmed on the EVC. A two-miRNA-based signature for CL and six-miRNA signatures for LgA and HgA were selected. In a multivariate analysis including sex and age at blood collection, the areas under the receiver operating characteristic curve (95% confidence interval) of the signatures were 0.644 (0.607–0.682), 0.670 (0.626–0.714) and 0.682 (0.580–0.785) for LgA, HgA and CL, respectively. A miRNA-based test could be introduced into the FIT+ workflow of CRC screening programs so as to schedule colonoscopies only for subjects likely to benefit most.