Relationship of irisin expression with metabolic alterations and cardiovascular risk in type 2 diabetes mellitus: a preliminary study

OBJECTIVE

The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity.

METHODS

A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood.

RESULTS

Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression.

CONCLUSION

The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.

Expression of TNFR1, VEGFA, CD147 and MCT1 as early biomarkers of diabetes complications and the impact of aging on this profile

Hyperglycemia leads to microvascular lesions in various tissues. In diabetic nephropathy-DN, alterations in usual markers reflect an already installed disease. The study of new biomarkers for the early detection of diabetic complications can bring new prevention perspectives. Rats were divided into diabetic adult-DMA-or elderly-DME and control sham adult-CSA-or control sham elderly-CSE. Blood and urine samples were collected for biochemical analysis. Bulbar region, cardiac, hepatic and renal tissues were collected for target gene expression studies. As result, DMA showed decreased TNFR1, MCT1 and CD147 expression in the bulbar region, TNFR1 in the heart, VEGFA and CD147 in the kidney and TNFR1 in blood. Positive correlations were found between TNFR1 and MCT1 in the bulbar region and HbA1c and plasma creatinine, respectively. DME showed positive correlation in the bulbar region between TNFR1 and glycemia, in addition to negative correlations between CD147 in the heart versus glycemia and urea. We concluded that the initial hyperglycemic stimulus already promotes changes in the expression of genes involved in the inflammatory and metabolic pathways, and aging alters this profile. These changes prior to the onset of diseases such as DN, show that they have potential for early biomarkers studies.

Survivin expression as a prognostic marker for breast cancer

OBJECTIVE

Due to the speed of development observed in breast cancer, several studies aimed at discovering new biomarkers have been carried out in order to arrive at an early diagnosis. As survivin plays a fundamental role in the evasion of apoptosis in tumor cells, the aim of this study was to verify the expression profile of the survivin gene in paraffin-embedded breast tumor samples and associate it with the clinical characteristics of the patients.

METHODS

This is a cross-sectional study, for which 100 tumor samples were obtained from cancer patients treated throughout the year 2019 at Instituto de Mama do Cariri (Juazeiro do Norte, in the state of Ceará). This study included women over 30 years old who had confirmed breast cancer through anatomopathological examination but excluded those with non-neoplastic breast comorbidities, other neoplasms, or chronic diseases. Survivin gene expression was assessed by quantitative polymerase chain reaction.

RESULTS

The expression of survivin is associated with the lack of expression of estrogen (p=0.027) and progesterone (p>0.0005) receptors. It means that survivin expression is higher in patients in which labeling was absent for estrogen receptor and progesterone receptor.

CONCLUSION

Our data reinforce that survivin expression is higher in estrogen receptor-patients, thus representing an additional prognostic tool.

COVID-19 compromises iron homeostasis: Transferrin as a target of investigation

IMPORTANCE

Since the beginning of the COVID-19 pandemic, numerous metabolic alterations have been observed in individuals with this disease. It is known that SARS-CoV-2 can mimic the action of hepcidin, altering intracellular iron metabolism, but gaps remain in the understanding of possible outcomes in other pathways involved in the iron cycle.

OBJECTIVE

To profile iron, ferritin and hepcidin levels and transferrin receptor gene expression in patients diagnosed with COVID-19 between June 2020 and September 2020.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study that evaluated iron metabolism markers in 427 participants, 218 with COVID-19 and 209 without the disease.

EXPOSURES

The primary exposure was positive diagnose to COVID-19 in general population of Santo André and São Bernardo cities. The positive and negative diagnose were determinate through RT-qPCR.

MAIN OUTCOMES AND MEASURES

Devido a evidências de alterações do ciclo do ferro em pacientes diagnosticados com COVID-19 e devido a corregulação entre hepcidina e receptor de transferrina, uma análise da expressão gênica deste último, poderia trazer insights sobre o estado de ferro celular. A hipótese foi confirmada, mostrando aumento da expressão de receptor de transferrina concomitante com redução do nível de hepcidina circulante.

RESULTS

Serum iron presented lower values in individuals diagnosed with COVID-19, whereas serum ferritin presented much higher values in infected patients. Elderly subjects had lower serum iron levels and higher ferritin levels, and men with COVID-19 had higher ferritin values than women. Serum hepcidin was lower in the COVID-19 patient group and transferrin receptor gene expression was higher in the infected patient group compared to controls.

CONCLUSIONS AND RELEVANCE

COVID-19 causes changes in several iron cycle pathways, with iron and ferritin levels being markers that reflect the state and evolution of infection, as well as the prognosis of the disease. The increased expression of the transferrin receptor gene suggests increased iron internalization and the mimicry of hepcidin action by SARS-CoV-2, reduces iron export via ferroportin, which would explain the low circulating levels of iron by intracellular trapping.

Preclinical Effects Of Melatonin On The Development Of Ehrlich's Tumor: A Biochemical, Cognitive, And Molecular Approach

BACKGROUND

It has already been shown that melatonin is an antitumoral molecule that affects malignant cells via some mechanisms. The benefit played by this hormone on cancer is due to its antioxidant effects.

OBJECTIVE

This study aimed to evaluate the preclinical effects of melatonin in mice with the Ehrlich ascites tumor.

METHODS

Twenty Balb/ c male mice with Ehrlich tumor were treated with different melatonin doses. Their inflammatory and oxidative stress were accessed by gene expression. Hepatotoxicity and hematological parameters were also evaluated through biochemical analyses. Animal welfare was analysed weekly from the categories guided by the NC3Rs.

RESULTS

Gene expression analyses have shown that only Tnfα and Sod1 were expressed in all groups studied. Only the M-3 group showed increased Tnfα expression compared to the control. All groups treated with melatonin showed decreased Sod1 expression compared to the control. No signs of hepatotoxicity were caused by any of the melatonin doses used in the treatment.

CONCLUSION

In animals with Ehrlich´s tumor treated with melatonin, a decrease in oxidative stress, an amelioration in welfare and in cognitive tasks could be observed, even if the treatment has not reduced the size of the tumor itself. In parallel with the already patented use of melatonin in the treatment of sleep disorders or chronic kidney disease, our results propose its use to improve the general well-being of breast cancer patients.

A Cross-Sectional Study of p66Shc Gene Expression in Liquid Biopsy of Diabetic Patients. Is it Possible to Predict the Onset of Renal Disease?

Background: Diabetic nephropathy (DN) is a disorder affecting glomerular function that, histologically, is due to the presence of glomerulosclerosis accompanied with endothelial dysfunction of the afferent and efferent renal arterioles. Insulin resistance in diabetic patients is known to be one of the causes of endothelial dysfunction because it increases oxidative stress, and one of the main genes regulating the production pathways of reactive oxygen species is p66Shc. The aim of this study was to evaluate the p66Shc gene expression as a precocious biomarker of renal dysfunction in diabetic patients, using liquids samples of urine sediment and peripheral blood. Methods: 29 diabetic patients and 37 healthy donors were recruited from the Centro Universitário FMABC outpatient clinic. The RT-gPCR technique was applied to evaluate p66Shc gene expression in urine and peripheral blood samples from diabetic patients, which were compared with healthy donors. Results: There was no significant expression of p66Shc gene in samples from diabetic patients compared with healthy donors. However, p66Shc expression in the blood samples of diabetics (0.02417±0.078652-ΔCT, n=29) was 3.6 times higher than in healthy participants (0.00689±0.01758, n=37) while in the urine samples, it was 1.48 times higher in diabetics group (0.02761±0.05412-ΔCT) than in CTL group (0.0186±0.02199). Conclusion: There was no significant p66Shc gene expression in peripheral blood and urine samples of diabetic patients without kidney injury compared with healthy donors, although there is a tendency for this gene to participate in the oxidative imbalance present in diabetes.

Yellow fever vaccination in hemodialysis patients: A systematic review

Introduction:

Yellow fever is an infectious disease endemic to Africa, and Central and South America with a significant impact on public health, causing outbreaks and epidemics. Clinical manifestations can vary from asymptomatic to more severe and lethal disease outcomes. The primary prevention of yellow fever occurs through the vaccination of individuals, which confers immunity for life. Patients with chronic kidney disease, especially those undergoing dialysis, have low vaccination and seroconversion rates. As mentioned above, this research aimed to perform a systematic review of the yellow fever vaccination protocol in hemodialysis patients

Methods:

A systematic review on vaccination against yellow fever in hemodialysis patients using databases, PubMed and Biblioteca Virtual em Saúde (BVS), was performed. For data collection, combinations were made using the following descriptors: protocols, vaccination, yellow fever, kidney dialysis, chronic kidney failure, chronic kidney disease, and group risk included in the title and abstract description. Articles with no subject related to the search were excluded and also if they were duplicated.

Results:

In this review, 90 scientific articles were identified in both databases. After applying exclusion criteria, a total of 3 articles were selected.

Conclusion:

We recommend carefully assessing the risk-benefit and contraindications for the patient, emphasizing the risk groups. There is an evident lack of studies on the subject, and there is a need to broaden investigations related toimmunization for patients on dialysis. The review is registered in the PROSPERO system with the number 323550.

Use of Saliva to Assess the Adherence to Treatment with Oral Hypoglycemic Agents in Patients with Type 2 Diabetes

BACKGROUND

The diagnosis of Type 2 Diabetes Mellitus (T2DM) is made by demonstrating the hypoglycemic condition, which involves the determination of plasma glucose, and the follow-up of hypoglycemic treatment is performed by assessing the glycated hemoglobin (HbA1c) concentration.

AIM

The aim of this study was to evaluate the saliva as an alternative sample in assessing the adherence to treatment with oral hypoglycemic agents in patients with Type 2 Diabetes.

METHODS

We selected 68 patients with T2DM, who were subjected to venous blood and saliva collection, in addition to answering a standardized questionnaire on adherence to hypoglycemic treatment. Laboratory tests performed on saliva, whole blood, serum or plasma included assessment of glycemia, urea, creatinine, uric acid, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, and glycated hemoglobin.

RESULTS

It was concluded that 82% of the patients adhered to hypoglycemic treatment based on glycated hemoglobin concentration (cut-off value of 7.0%). Comparing the groups that adhered to hypoglycemic treatment and those that did not adhere, statistical differences (P<0,05) were observed in the glucose, HDL-cholesterol, triglycerides, and insulin use (insulin therapy) parameters. Plasma glucose and urea serum concentration showed positive correlations when compared to saliva samples. Regarding the questionnaire, it was found that 35% of the patients presented positive screening for belief barriers and 83% positive score for recall barriers, and the positive screening correlated with glycated hemoglobin.

CONCLUSION

Data have shown that it is possible to use saliva as an alternative sample to the laboratory assessment of hypoglycemic treatment adherence in T2DM patients.

Ophthalmic Manifestations Among Patients Surviving COVID-19

Background and Aim

To identify ocular findings related to SARS-CoV-2 infection in patients after the resolution of COVID-19 using complete ocular examinations and optical coherence tomography (OCT).

Methods

In this cross-sectional study, conducted from May 30 to October 30, 2020, patients who recovered from various stages COVID-19 underwent eye examination and multimodal retinal imaging (Retinographies and Spectral-OCT).

Results

We included 50 patients, 29 (58%) males, median age of 46.5 [standard deviation 15.8]. Of these, 42% (21) had mild, 18% (9) had severe and 40% (20) had critical disease. The median time interquartile range (IQR) between symptom onset and ocular examination was 55 days [IQR 39-71]. Seven patients (14%) reported ophthalmic symptoms, transitory low visual acuity (6%) and retroocular pain (8%). On OCT, one patient without comorbidities had sectoral retinal pallor suggestive of acute retinal ischaemia and oedema of the retina's inner layers and atrophy. All findings progressively and spontaneously improved months after resolution of COVID-19.

Conclusion

Patients with COVID-19 present findings compatible with the general population depending on age and comorbidities; nevertheless, acute retinal findings associated with the disease may be present, such as caused either by the direct effects of retinal SARS-CoV-2 infection, by indirect effects of the cytokine storm or by the pro-thrombotic state associated with COVID-19. Therefore, retinal involvement in patients with COVID-19 remains subject to considerable discussion and study.

Quantification of Vitamin D at Different Levels of Clinical Worsening of COVID-19

INTRODUCTION AND AIM

Vitamin D is the name given to a group of lipid-soluble steroidal substances of physiological importance in the body, especially in bone metabolism. The active form of vitamin D is believed to have immunomodulatory effects on immune system cells, especially T lymphocytes, as well as on the production and action of several cytokines and on the expression of potent antimicrobial peptides in epithelial cells that line the respiratory tract, playing an important role in protecting the lung from infections. The aim of this study was to assess vitamin D levels in patients with COVID-19 in healthcare service and to verify that these levels are adequate to protect the progression of this infection.

METHODS

The aim of this observational study was to evaluate the serum concentration of vitamin D in 300 patients suspected of being infected with COVID-19, treated at Basic Health Units (BHUs) and at the Hospital Complex in the municipality of São Bernardo do Campo.

RESULTS

294 patients were included, 195 (66%) of which tested positive for COVID-19 and 99 (34%) negative for COVID-19. Among the patients in the positive group, 163 patients were in the mild group (84%); 22 patients in the moderate group (11%); 8 patients in the severe group (4%), and 2 patients in the deceased group (1%).

CONCLUSION

For the patients in this study, no association was observed for the protective factor of vitamin D against COVID-19 infection, and its role in controlling the clinical staging of the disease was not verified.

Relationship between Lifestyle and Residence Area with 25(OH)D Levels in Older Adults

The aim of this study was to investigate whether the habitat of older adults living in the urban and rural areas is a contributing factor to altered serum 25(OH)D levels. An analytical, cross-sectional research with a quantitative approach was conducted in the upper backwoods of Paraíba with older adults registered at the Reference Center for Social Assistance (CRAS), addressing residents of both rural area (n = 41) and urban area (n = 43) who were randomly chosen to participate in the study. Data collection took place between January and February 2020. Higher rates of handgrip strength were observed in rural older adults (29.22 ± 8.92 Kgf) with serum 25(OH)D levels in the range of 30 to 40 ng/mL when compared to older adults with concentrations below 30 ng/mL (21.82 ± 5.00 Kgf) and above 40 ng/mL (23.47 ± 6.88 Kgf). Older people living in the urban area, with 25(OH)D levels above 40 ng/mL, presented a lower muscle power index when compared to individuals with vitamin levels from 21 to 29 ng/mL (17.40 ± 6.34 s; 15.33 ± 2.00 s). The urbanization associated with 25(OH)D levels can cause changes in skeletal and respiratory muscle strength, because the habitat associated with 25(OH)D levels affects the parameters of muscle strength of the upper limbs for older adults living in a rural area and the muscle strength of the lower limbs for those living in an urban area.

A profile of the knowledge and use of generic drugs by a population from the metropolitan region of São Paulo

Objectives: To evaluate the acceptance of generic drugs in the population of Diadema, and identify factors that interfere in their choice, aiming at an improvement in assistance for these patients. Materials and methods: 203 participants were interviewed through a questionnaire containing 23 questions. The interviews were performed in Diadema city/São Paulo - Brazil. Data was expressed inpercentages; however, Chi-square test was also used for some associations and a 95% confidence interval was considered. Results: Most interviewees declared having satisfactory knowledge about generic drugs and reported previous use of it. Eighty-one point three percent of interviewed people reported that generic drugs had present the expected therapeutic effect, and 85.7% informed they believed in the safety of these drugs. The pharmacy/drugstore was the principal mean of communication to transmit information about generic medications, and a relation was observed between socioeconomic conditions and knowledge/use of these drugs. Conclusion: The studied population showed good acceptance and satisfactory knowledge about generic drugs and most of them believe in its safety. The price, the level of education, and the value of income of the population, and the low frequency of prescription, demonstrated to influence the consumption of generic drugs. Implementation of programs encouraging the prescription of these drugs and campaigns to enlighten information about generic drugs for the population could be beneficial for a better knowledge and use of them, ensuring access to health by all populations.

Effect of Subchronic Selenium Treatment in the Liver of BALB/C Mice with Transplantable Ehrlich Tumor

Selenium has an anti-inflammatory, antioxidant, and possibly antitumoral action. Thus, we hypothesized that this element could be an ally in cancer treatment. We evaluated the effect of chelated selenium treatment of BALB/c mice with Erhlich Tumor on tumor size, histology, and biochemical parameters of the liver. A total of 96 male mice were treated for 7, 15, and 30 days with different doses of chelated selenium. During the 7 days of treatment, livers presented mild hydropic degeneration; after 15 days, the livers presented mild hydropic degeneration, inflammatory infiltrate, and steatosis, which was intensified in the animals treated for 30 days. Biochemical analysis showed an increase of the alanine transaminase enzyme in those animals, indicating hepatotoxicity. At the beginning of treatment, selenium was able to inhibit tumor growth. After 30 days of treatment, however, hepatotoxicity could be seen.

Biochemical markers and anthropometric profile of children enrolled in public daycare centers

OBJECTIVE

The nutritional status resultant from dietary habits along with socioeconomic conditions and the school environment are directly related to the individual's health condition not only in their childhood but also throughout adulthood. The aim of this study was to evaluate the effects of socioeconomic factors on the anthropometric profile and to analyze a probable association between this profile and biochemical markers in children attending public daycare centers.

METHODS

It is a transversal study developed in a probability sample of clusters of children from 6 months to 5 years old. Anthropometric and socioeconomic data were gathered at the CMEIs, questionnaires on the nutritional status were applied and blood was collected at the Family Health Units (USFs).

RESULTS

Female children are three times more likely to be underweight; in families with five members, it is 1/3 more likely that children of higher-educated parents are overweight. Among the results of the biochemical tests, hypervitaminosis A was a relevant aspect, positively correlating with copper (p=0.005) and zinc (p=0.008).

CONCLUSION

Therefore, since the influence of the family is an important predictor of overweight and its future outcomes related to nutritional deficiencies and inadequate dietary intake, educational interventions are vital as a way to pave the path to prevention.

Expression of DNA repair genes in association with ionizing radiation

BACKGROUND AND AIM

DNA repair systems are functionally essential for the maintenance of life and among these, we can highlight the MutS system, subdivided into MutSα (hMSH2 and hMSH6) and MutSβ (hMSH2 and hMSH3). The objective of this study was to analyze the expression of hMSH2 and hMSH6 repair genes in radiology technicians exposed to low radiation doses.

METHODS

Thirty workers occupationally exposed to ionizing radiation and twenty-five non-exposed were included in this study. Gene expression was analyzed by qPCR. Peripheral blood samples were collected from both groups for total RNA isolation.

RESULTS

It was observed a five-fold increase (p=0.006) in the hMSH2 repair gene expression in those exposed to radiation and a weak but significant correlation (p=0.041) with the hMSH6 genes when we associated the number of hours of exposure with gene expression.

CONCLUSIONS

The longer the exposure time, the greater the activation of this component of the repair system.

APPLICATION TO PRACTICE

Blood count parameters could did not alter with radiation exposure. X-rays used by radiology technicians in imaging tests can damage the DNA to the point of activating the MutS repair system and that there is a greater tendency of expression of this system in professionals that had undergone longer exposure.

[Variabilidad del ritmo cardíaco en pediatría: aspectos metodológicos y aplicaciones clínicas]

La variabilidad del ritmo cardíaco (VRC) corresponde a las variaciones temporales de la frecuencia cardíaca o del intervalo latido-latido. Este parámetro refleja el estado de los mecanismos autonómicos de control cardiovascular. Los cambios propios del ciclo vital de las personas, el sedentarismo y diversos procesos de enfermedad han mostrado inducir cambios en la VRC y desplazar el balance autonómico hacia una mayor influencia simpática o parasimpática sobre el corazón. Estos antecedentes apoyan el uso de los índices de VRC para el diagnóstico y seguimiento de diversas entidades nosológicas en el adulto. Sin embargo, en la población pediátrica ha existido un limitado avance en el estudio de las variaciones temporales del ritmo cardíaco. Este artículo tiene por objetivo describir los aspectos fisiológicos y técnicos de la VRC en población pediátrica. El propósito es aportar antecedentes que permitan optimizar la aplicación de estos parámetros en este grupo etario.

Does nebivolol have renoprotective action in patients with chronic kidney disease conditions? An integrative review

Systemic arterial hypertension (SAH) is a chronic disease of multifactorial origin and one of the main risk factors for major adverse cardiovascular events (MACE), which are the leading causes of morbidity and mortality worldwide. The pharmacological treatment of SAH involves five main classes of drugs, and Nebivolol (NEB) is one of those drugs, belonging to the class of third generation β1-adrenoceptors selective blockers. NEB is composed of a racemic mixture of two enantiomers: d-nebivolol, which exerts antagonist effects on β₁-adrenoceptors, and l-nebivolol, a vascular β₃ receptor agonist. There are several studies that report different actions of NEB, not only for the treatment of SAH, but also as an antioxidant agent or even as a protector of renal damage. The aim of this systematic review was to investigate the available evidence regarding the effects of NEB on kidney diseases, evaluating its possible renoprotective action.

Diagnostic potential of hypoxia-induced genes in liquid biopsies of breast cancer patients

In tumor cells, higher expression of glucose transporter proteins (GLUT) and carbonic anhydrases (CAIX) genes is influenced by hypoxia-induced factors (HIF).Thus, we aimed to study the expression profile of these markers in sequential peripheral blood collections performed in breast cancer patients in order to verify their predictive potential in liquid biopsies. Gene expressions were analyzed by qPCR in tumor and blood samples from 125 patients and 25 healthy women. Differential expression was determined by the 2(−ΔCq) method. Expression of HIF-1α and GLUT1 in the blood of breast cancer patients is significantly higher (90–91 and 160–161 fold increased expression, respectively; p < 0.0001) than that found in healthy women. Their diagnostic power was confirmed by ROC curve. CAIX is also more expressed in breast cancer women blood, but its expression was detected only in a few samples. But none of these genes could be considered predictive markers. Therefore, evaluation of the expression of HIF-1α and GLUT1 in blood may be a useful laboratory tool to complement the diagnosis of breast cancer, in addition to being useful for follow-up of patients and of women with a family history of breast cancer.

Kidney Diseases: The Age of Molecular Markers

Kidney diseases are conditions that increase the morbidity and mortality of those afflicted. Diagnosis of these conditions is based on parameters such as the glomerular filtration rate (GFR), measurement of serum and urinary creatinine levels and equations derived from these measurements (Wasung, Chawla, Madero. Clin Chim Acta 438:350-357, 2015). However, serum creatinine as a marker for measuring renal dysfunction has its limitations since it is altered in several other physiological situations, such as in patients with muscle loss, after intense physical exercise or in people on a high protein diet (Riley, Powers, Welch. Res Q Exerc Sport 52(3):339-347, 1981; Juraschek, Appel, Anderson, Miller. Am J Kidney Dis 61(4):547-554, 2013). Besides the fact that serum creatinine is a marker that indicates glomerular damage, it is necessary the discovery of new biomarkers that reflect not only glomerular damage but also tubular impairment. Recent advances in Molecular Biology have led to the generation or identification of new biomarkers for kidney diseases such as: Acute Kidney Failure (AKI), chronic kidney disease (CKD), nephritis or nephrotic syndrome. There are recent markers that have been used to aid in diagnosis and have been shown to be more sensitive and specific than classical markers, such as neutrophil gelatinase associated lipocalin (NGAL) or kidney injury molecule-1 (KIM-1) (Wasung, Chawla, Madero. Clin Chim Acta 438:350-357, 2015; George, Gounden. Adv Clin Chem 88:91-119, 2019; Han, Bailly, Abichandani, Thadhani, Bonventre. Kidney Int 62(1):237-244, 2002; Fontanilla, Han. Expert Opin Med Diagn 5(2):161-173, 2011). However, early diagnostic biomarkers are still necessary to assist the intervention and monitor of the progression of these conditions.

Side effects of 1% cyclopentolate hydrochloride in children and adolescents attended at Centro Universitário FMABC

Introduction: It is known that vision disorders are within the context of public health problems. In childhood, during the neuropsychomotor development phase, visual changes are crucial, since there is a strong correlation between poor school performance and changes in acuity. For these reasons, ophthalmological examination in children, including refraction, is extremely important, aiming at the early diagnosis of diseases and possible refractive errors that may compromise the child's life and development. 1% cyclopentolate hydrochloride eye drops are the most used during ophthalmic clinical evaluation as a cycloplegic and mydriatic agent to assist in refractive examination. Objective: The ocular and systemic side effects of 1% cyclopentolate hydrochloride eye drops were studied in patients who underwent static refractive examination in the strabismus sector of the Ophthalmology Discipline of the Centro Universitário FMABC. Methods: A drop of 1% cyclopentolate is instilled in both eyes of each patient and the possible ocular and systemic signs and symptoms presented were observed after 40 minutes and 24 hours after instillation. Results: we expect to find ocular side effects more evident than systemic symptoms in the two evaluation times (40 minutes and 24 hours after instillation). All symptoms (ocular and systemic) are reversed spontaneously. Conclusion: The present study aims to show that the side effects observed by the topical (ocular) use of cyclopentolate eye drops 1% are few and present spontaneous reversal both from an eye point of view, as well as from a systemic point of view.

Post-operative complications of penetrating corneal keratoplasty in patients with anterior segment toxic syndrome secondary to cataract surgery

Introduction: Toxic Anterior Segment Syndrome (TASS) after cataract surgery may cause severe corneal decompensation that compromises corneal transparency and may require penetrating corneal keratoplasty to improve visual acuity. Objective: We evaluated the postoperative complications of patients who underwent penetrating corneal transplantation for severe corneal decompensation secondary to TASS after cataract surgery, such as persistent epithelial defect, glaucoma, and primary and secondary transplant button failure. We will also evaluate pre- and postoperative visual acuity, graft survival time, and the presence of anterior chamber disorganization. Methods: Retrospective observational study in which a review of medical records of 9 patients diagnosed with TASS after cataract surgery who underwent penetrating corneal keratoplasty will occur. Results: In the present study all operated patients had glaucoma after penetrating corneal transplantation, and this presence of glaucoma was not correlated with graft survival time and with any other parameter evaluated. The presence of persistent epithelial defect correlated negatively with visual acuity. Conclusion: Postoperative complications of penetrating corneal transplantation in patients with TASS were frequent, such as glaucoma, primary and secondary button failure and persistent epithelial defect. The only complication that compromised visual acuity was the persistent epithelial defect. All patients evolved with glaucoma.

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

Introduction: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. Objective: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). Methods: The incidence of sub-clinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. Results: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. Conclusion: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Dexamethasone intravitreal implant for macular edema: a pilot study in a public health center

Introduction: Macula edema consists in one of the most common causes of visual impairment. Objective: To evaluate the safety and efficacy of continuous release of 0.7 mg dexamethasone (using implantable device) for treatment of macular edema. Methods: Cross-sectional observational study of 16 patients treated with 0.7 mg dexamethasone intraocular implant. Visual acuity, intraocular pressure and central macular thickness were recorded at baseline, 1-month and 3-month follow-up. Results: 15 eyes of 13 patients were included. Most eyes (n=9) improve visual acuity from baseline at 1-month follow-up; this improvement persisted through 3-monyh follow-up in six eyes. The central macular thickness decreased in the majority of the subjects at 1-month (n=12) and at 3-month (n=10) follow-up. Three eyes presented with elevated intraocular pressure. Conclusion: Dexamethasone implant can both reduce the risk of vision loss and improve anatomical features of macular edema due to several pathologies studied. This implant may be used safely and should be considered a therapeutic option to Brazilian Public Health System.

Diabetic macular edema: a literature review

Diabetic Macular Edema is a major cause of visual impairment in economically active population, being responsible for a significant impact in quality of life in the affected population, as well as high costs to the health care system. Over decades, some studies have compared treatments using Laser, Anti-VEGF and intravitreous corticosteroids, establishing protocols to reach effectives therapies. Thus, it is essential an entire understanding of available therapies to reach the goal of disease control, in an individual basis and in a collective health care system, as efficient as possible.

Liquid biopsy in cancer using the Z-scan technique: a new approach to discover biomarkers in cancer

AIM

Biomarkers have been broadly studied as a tool for the diagnosis and prognosis for different types of cancer. Z-scan is a kind of measurement technique that generates a nonlinear refractive index (n2). Today, Z-scan has been used in oncology to discriminate between solid tumors and to identify tumor circulating cell-free DNA in liquid samples.

MATERIALS & METHODS

According to the inclusion and exclusion criteria defined in this review, 35 articles were selected.

CONCLUSION

The use of this technique for this kind of measurement will allow for a rapid and precise diagnosis of different types of tumor and may lead to better therapeutic approaches.

Retinal findings in hospitalised patients with severe COVID-19

AIM

To identify retinal findings using dilated eye examination, which are possibly related to SARS-CoV-2 infection in hospitalised patients with confirmed severe COVID-19.

METHODS

In this cross-sectional study, hospitalised patients with confirmed severe COVID-19 in a single referral centre for the treatment of COVID-19, in Santo André, São Paulo Metropolitan Area, Brazil, underwent dilated eye examination of both eyes performed by a retina specialist. Findings were recorded using a portable digital fundus camera. Retinographies were analysed by two retina specialists. Medical records were reviewed for assessment of patient demographics, baseline comorbidities and clinical data.

RESULTS

There were a total of 18 patients, nine (50%) male, median IQR age of 62.5 (12) years. Ten of the 18 patients (55.6%; 95% CI 33.7 to 75.4) had abnormalities on dilated eye examination. The main findings were flame-shaped haemorrhages (N=4; 22.2%; 95% CI 9.0 to 45.2) and ischaemic pattern lesions (cotton wool spots and retinal sectorial pallor) (N=4; 22.2%; 95% CI 9.0 to 45.2), with one patient having both cotton wool spots and flame-shaped haemorrhages.

CONCLUSION

These findings suggest that patients with severe COVID-19 have acute vascular lesions of the inner retina including flame-shaped haemorrhages and cotton wool spots. Further studies controlling for confounding factors are necessary to properly assess these findings so as to increase the understanding of COVID-19 pathophysiology and to identify new therapies.

Effects of Intravitreal Bevacizumab Therapy in Patients with Proliferative Diabetic Retinopathy

INTRODUCTION

Diabetes mellitus (DM) stands out as one of the chronic diseases with the highest morbidity and mortality rates worldwide. Among the many complications of DM, diabetic retinopathy (DR) is one of the causes of blindness in patients aged between 20 and 64 years. At least 90% of the new cases showed to have the retinal structure and function restored when proper treatment was provided.

AIM

To evaluate the efficacy of the antiangiogenic bevacizumab in the treatment of DR according not only to the clinical laboratory parameters for glycated hemoglobin (HbA1C) and capillary glycemia but also to the ophthalmological parameters for optical coherence tomography (OCT) and best-corrected visual acuity (BCVA).

PATIENTS AND METHODS

A total of 11 individuals were included and followed up for 12 months after 3 administrations of bevacizumab.

RESULTS

Upon associating the ophthalmological and laboratory variables throughout the treatment, no significant alterations could be seen regarding the analyzed variables. However, it was observed that HbA1c values and the total leukocyte count negatively interfered with the treatment response.

CONCLUSION

The current study showed that HbA1c values and the amount of leukocytes negatively interfere with the therapeutic response. Therefore, laboratory analyses of these parameters are recommended for diabetic patients undergoing the above-mentioned treatment.

Role of hypoxia-inducible factor 1α as a potential biomarker for renal diseases-A systematic review

Renal cells need oxygen for homeostasis; it is known for adjusting cellular functioning and the energy obtainment have a broad relationship with cellular respiration, through the O₂ bioavailability. O₂ homeostasis regulation in the kidney is mediated by hypoxia-inducible factors (HIFs). HIF is divided into three α isoforms, represented by HIF-1α, HIF-2α, and HIF-3α in addition to three paralogs of HIF-1β; these are involved in some metabolic processes, as well as in the pathogenesis of several diseases. Renal biopsy analyses of patients and experimental animal models aim to understand the relationship between HIF and protection against developing renal diseases or the induction of their onset, being thus this molecule can be considered a potential biomarker of renal disease. We carried out a systematic review to which we included studies on HIF-1α and renal disease in the last 5 years (2013-2018) in researches with humans and/or animal model through searches in three databases: LILACS, PubMed, and SciELO by two researchers. We obtained 22 articles that discussed the relationship with HIF as inductor or protector against renal disease and no relation between HIF and renal. We observed controversies remain regarding the relation between of HIF with renal diseases; this may be related to the different intracellular pathways mediated by HIF-1α, thereby determining differentiated cellular responses.

The role of Survivin as a biomarker and potential prognostic factor for breast cancer

SUMMARY Breast cancer (BC) is one of the primary health problems worldwide. As the most common cancer in women in the world and in Brasil, behind only non-melanoma skin cancer, this neoplasm corresponds to approximately 28% of new cases per year in the country. BC also affects men, although the incidence corresponds to only 1% of total cases. Currently, most of the chemotherapeutic agents used in BC treatment are extremely toxic and cause long-term side effects. There is also a need to obtain earlier diagnoses, more accurate prognoses and make new therapies available that are more selective and effective in order to improve the current scenario. Therefore, this work sought to evaluate the importance of the biomarker survivin (Sur) in relation to BC, through the detailing of the role of Sur as a biomarker, the correlation between this protein and the prognosis of BC patients, and a summary of therapeutic strategies that target Sur for the development of new anticancer therapies.

Physical exercise alters hepatic morphology of low-density lipoprotein receptor knockout ovariectomized mice

To explore the effects of physical exercise on the liver of animals in menopause, we analyzed the histomorphometric parameters of the hepatic tissue in ovariectomized and dyslipidemic female mice. The animals were distributed in six groups (n = 5): sedentary control (SC), sedentary ovariectomized control (SOC), trained ovariectomized control (TOC), sedentary LDL knockout (LDL-S), sedentary ovariectomized LDL knockout (LDL-SO), and trained ovariectomized LDL knockout (LDL-TO). At the end of the experiment, the liver and the visceral adipose tissue (VAT) of animals were removed for morphometric and stereological studies. In the LDL-S and LDL-SO animals, both sedentary, results showed reduction in the area (µm²) and major and minor diameters (µm) of hepatocytes and reduction in the portions of large hepatocytes, and increase in the percentage of Kupffer cells. The trained group showed a tendency of increase in the area and diameter and in the percentage of hepatocytes, as well significant reduction in the percentage of Kupffer cells and interstitial tissue. We suggested that training can prevent cell and tissue damage caused by the process of increase in hepatic fat, lipoperoxidation, and tissue inflammation in animals with privation of estrogen and dyslipidemia, apparently reflecting a better metabolic response of the hepatic tissue in organisms undergoing training.

Obstructive sleep apnea syndrome and sleep quality in hypertensive patients

INTRODUCTION

Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients.

OBJECTIVE

To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives.

METHOD

A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment.

RESULTS

Group I (using up to two antihypertensive agents - 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs - 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS.

CONCLUSION

Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

Digitoxin improves cardiovascular autonomic control in rats with heart failure

The effects of chronic treatment with digitoxin on arterial baroreceptor sensitivity for heart rate (HR) and renal sympathetic nerve activity (rSNA) control, cardiopulmonary reflex, and autonomic HR control in an animal model of heart failure (HF) were evaluated. Wistar rats were treated with digitoxin, which was administered in their daily feed (1 mg/kg per day) for 60 days. The following 3 experimental groups were evaluated: sham, HF, and HF treated with digitoxin (HF + DIG). We observed an increase in rSNA in the HF group (190 ± 29 pps, n = 5) compared with the sham group (98 ± 14 pps, n = 5). Digitoxin treatment prevented an increase in rSNA (98 ± 14 pps, n = 7). Therefore, arterial baroreceptor sensitivity was decreased in the HF group (−1.24 ± 0.07 bpm/mm Hg, n = 8) compared with the sham group (−2.27 ± 0.23 bpm/mm Hg, n = 6). Digitoxin did not alter arterial baroreceptor sensitivity in the HF + DIG group. Finally, the HF group showed an increased low frequency band (LFb: 23 ± 5 ms2, n = 8) and a decreased high frequency band (HFb: 77 ± 5 ms2, n = 8) compared with the sham group (LFb: 14 ± 3 ms2; HFb: 86 ± 3 ms2, n = 9); the HF+DIG group exhibited normalized parameters (LFb: 15 ± 3 ms2; HFb: 85 ± 3 ms2, n = 9). In conclusion, the benefits of decreasing rSNA are not directly related to improvements in peripheral cardiovascular reflexes; such occurrences are due in part to changes in the central nuclei of the brain responsible for autonomic cardiovascular control.