Can Antidiabetic Drugs Improve Male Reproductive (Dys)Function Associated with Diabetes?

The alarming increase in the number of diabetic patients worldwide raises concerns regarding the impact of the disease on global health, not to mention on social and economic aspects. Furthermore, the association of this complex metabolic disorder with male reproductive impairment is worrying, mainly due to the increasing chances that young individuals, at the apex of their reproductive window, could be affected by the disease, further contributing to the disturbing decline in male fertility worldwide. The cornerstone of diabetes management is glycemic control, proven to be effective in avoiding, minimizing or preventing the appearance or development of disease-related complications. Nonetheless, the possible impact of these therapeutic interventions on male reproductive function is essentially unexplored. To address this issue, we have made a critical assessment of the literature on the effects of several antidiabetic drugs on male reproductive function. While the crucial role of insulin is clear, as shown by the recovery of reproductive impairments in insulin-deficient individuals after treatment, the same clearly does not apply to other antidiabetic strategies. In fact, there is an abundance of controversial reports, possibly related to the various study designs, experimental models and compounds used, which include biguanides, sulfonylureas, meglitinides, thiazolidinediones/glitazones, bile acid sequestrants, amylin mimetics, as well as sodiumglucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP1), α-glucosidase inhibitors and dipeptidyl peptidase 4 (DPP4) inhibitors. These aspects constitute the focus of the current review.

A partnership between a local public health unit and schools to end female genital mutilation

Key messages

There is potential for a closer collaboration with schools to try to end female genital mutilation and to address other health topics. Local public health units should establish and mobilise local networks of institutions and community partners to tackle complex public health problems.

Migration and integration: the case of health literacy (HLS-EU-PT) as a foundation to promote cultural sensitiveness

Background

Portugal has experienced trough-out his recent history successive migration patterns. Lately, with instability in Syria and the Mediterranean routes of migration between Africa and Europe, new challenges have emerged. One of them is related to migrants’ health and their navigation of health care system. In order to better understand cultural patterns of migrants, this research aims to explore their health literacy (HL) in the context of the European Health Literacy Survey framework (HLS-EU).

Methods

A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores <30). In order to access the migrant condition, a proxy variable considered the participant’s parents origin: at least one of the parents was born in a foreign country.

Results

Out of the 748 participants, 4.1% (n = 31) were considered migrants. Of the migrant participants, 6.9% have inadequate, 51.7% problematic, 24.1% sufficient and 17.2% excellent HL (HLS-EU-PT). Migrants have lower levels of HL when compared with nationals in this sample (respectively 58.6% and 45.8% for insufficient HL) but this difference is not statistically significant.

Conclusions

Although results didn’t show an association between being migrant and lower levels of HL (when compared with nationals), it is nevertheless relevant to consider that more than 1 in every two migrants (58.6%) have insufficient HL levels. Special consideration should be given to this group to promote HL levels and further research is needed to better understand how HL and cultural sensitiveness may work for a better integration of migrants.

Benefits from a tabletop exercise in a Heat-Health Action Plan in Amadora, Portugal

Issue

National guidelines for Heat-Health Action Plans (HHAP) in Portugal exist since 2004. These guidelines are further developed and implemented at Local Public Health Units (LPHU) together with local partners. Tabletop exercises are a useful tool to improve preparedness. Despite the long experience with HHAP there has not been any tabletop exercise in Amadora.

Description

Amadora’s LPHU organized a tabletop exercise with local partners to improve HHAP preparedness (12th July 2018). It included: LPHU, city hall, civil protection services, local social services, primary healthcare services, local public hospital, and firefighters. The exercise hypothesized a scenario of an unprecedented increase of temperature for an extended period of time, activating the highest level of warning (red) and action in the HHAP.

Results

During the exercise several issues were identified. Some partners were not clear about the pathway established for red warnings and partners were not aware of relevant HHAP activities. Also, from the 8 sites listed as climate shelters, only 2 were deemed as adequate for using in this scenario, even though they have been listed for several HHAP. Due to the exercise, it was possible to conduct an inspection of said shelters, which hadn’t took place yet due to the lack of resources. It was possible to find out that only one shelter was fit for purpose. Additional private facilities were identified as desirable shelter locations during the exercise. A few weeks later, a red warning was issued and clarification arising from the tabletop exercise was useful to properly implement measures.

Lessons

Despite the perceived frequent and good communication among partners of the HHAP, several issues - mainly regarding the adequacy of shelters - were identified with a tabletop exercise. It also improved preparedness for the following HHAP warning. As such, tabletop exercises should be promoted within HHAP.

Key messages

Despite developing heat-health action plans for several years, with the involvement of community partners, unidentified constraints existed in Amadora, Portugal. Tabletop exercises should be used more frequently, as we were able to identify and solve constraints within our heat-health action plan using one.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Twelve years of Lyell's Syndrome in the burn unit of São João Hospital Centre

Stevens-Johnson syndrome (SSJ) and toxic epidermal necrolysis (TEN) correspond to an acute and rare life-threatening mucocutaneous reaction. We describe the etiology, length of stay, comorbidities and mortality of TEN in our hospital in a retrospective study of 12 years. Twenty-one patients were included in the study. The mean age was 66 years: 57.1% were females. One third had mucosal surface involvement. Median TBSA of epidermal detachment was 66% on day 1. Forty-two per cent had a SCORTEN at admission of 3 and 28.6% had a SCORTEN of 4, which performs 70.6% with SCORTEN ≥5. The most common causes of SJS/TEN in this study were antibiotics. There were a total of 15 deaths (71.4%). All the patients in the antibiotic group died. Patients who needed invasive ventilation had higher mortality (91%) than the non-invasive ventilation group (50%) and the group on spontaneous ventilation (42.8%). The most common complications were sepsis (53%) and renal failure (23%). Highest mortality due to sepsis was in the antibiotic group. When SCORTEN score was calculated for each patient, statistical evaluation showed an increase in mortality with increasing final score. The most crucial interventions are discontinuation of the causative drug and immediate referral to a burn unit, which helps in early diagnosis and decreases mortality. Our study provides insights into the confirmation of the risk of SJS/TEN as well as its treatment. When SSJ/TEN is caused by antibiotics, the suspicion of developing fatal sepsis should be high regardless of the patient's medical condition.

Classifying different Iberian pig genetic lines by applying chemical-instrumental parameters of dry-cured Iberian shoulders

Iberian pigs are an autochthonous porcine breed mainly bred in southwestern of Iberian Peninsula, this herd traditionally feeds on acorn and pasture, in an extensive production system. In this study, the main objective was for classifying Iberian shoulders from different genetic lines of pigs and their crossed genetic lines. For that, morphology parameters, fatty acid profile and volatile compounds were determined on two batches of dry-cured Iberian shoulders. The samples were acquired from the same place of the dry-cured Iberian shoulders. From these data, two databases were created, for training and validation purpose. Results on this study, firstly demonstrate the capability of data mining techniques in order to classify shoulder as function as Iberian pig genetic lines by using of different quality characteristics. Four classification models were developed and tested in the training database and all models achieved a percentage of correct classification higher than 75%. Then, the same four classification models were performed in the validation database and the model of J48 decision tree and fatty acid profile reached the highest correct classification percentage (91.67%), and from Retinto genetic line (95.65%). From this classification model, a software application was developed in order to determine in a semi-automatic way the genetic line of the dry-cured Iberian shoulder. This application could be used in the meat industries for determining relationships between genetic line and meat quality or performance of noble parts.

Papilar topografy and morphology of the tongue in the E. sexcinctus

Introduction: The Six-banded armadillo (Euphractussexcintus) belongs to Cigunlata order, has diverse feeding habits and masticatory apparatus developed. The tongue, one of the major components of this equipment, has the mucosa papillae, taste buds and tongue glands. Materials and Methods: Six-banded armadillo were submitted to an anesthetic protocol with Tiletamine and zolazepan (Telazol®, Fortdotge, Brazil) and Sodium Thiopental (Thiopentax®, Cristália, Brazil), we proceeded to euthanasia using Potassium Chloride 19.1%, to then fix them in a 10% formaldehyde solution. The tongues were dissected and identified structures. For microscopic processing, segments from different parts of the tongue were subjected to histological routine and stained with hematoxylin-eosin and Masson. Results: The tongue of the six-banded armadillo presents three types of papillae: filiform, fungiform and vallate, with no conical buds and foliate. Still in the tongue mucosa, was observed mucous glands and various taste corpuscles. Some data differ from those same found in other wild animals that have been studied, but are similar to those of the same phylogenetic. Conclusion: The morphological characteristics of the six-banded armadillo's tongue are adapted to the difficulties faced by him during chewing, requiring the tongue, structures that provide you mobility, strength and sensitivity.