Effectiveness of a flash glucose monitoring systems implementation program through a group and telematic educational intervention in adults with type 1 diabetes

OBJECTIVES

Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes.

PATIENTS AND METHODS

Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla.

RESULTS

Eighty-eight participants were included (men: 46.6%; mean age (years) 38.08, SD: 9.38); years of DM1 evolution: 18.4 (SD: 10.49); treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was -0.45% (95% CI [-0.6, -0.25], P < 0.01), increasing to -1.08% in the group that started with HbA1c ≥ 8% (P < 0.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of -6.5 points was observed (P < 0.01). In the global score of the Spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was -8.44 points (P < 0.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in + 4 points (P < 0.01).

CONCLUSIONS

The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice.

Peritoneal tuberculosis due to Mycobacterium caprae

The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.

Human tuberculosis due to Mycobacterium bovis and M. caprae in Spain, 2004-2007

OBJECTIVE

To identify the characteristics associated with human tuberculosis (TB) caused by Mycobacterium bovis and M. caprae in Spain.

DESIGN

Retrospective study covering all M. bovis and M. caprae isolates identified at the National Mycobacterial Reference Laboratory (NRL) from 2004 to 2007. We studied the microbiological and epidemiological characteristics of patients and performed a genetic analysis of isolates.

RESULTS

The study covered 110 isolates (89 M. bovis and 21 M. caprae) that accounted for respectively 1.9% and 0.3% of the M. tuberculosis complex isolates available at the NRL. Data on risk of exposure to M. bovis or to M. caprae were available in 82 (74%) of the 110 cases, with 60 (73%) registering a probable or possible risk of exposure and 22 (27%) registering no risk. Probable exposure mainly included crop and livestock farmers, and possible exposure included patients born in countries with a high prevalence of bovine TB. Spoligotyping of strains yielded 36 different patterns, with SB0121, SB0134 and SB0157 being predominant.

CONCLUSIONS

In Spain, cases of human TB due to M. bovis and M. caprae represent a small proportion of all TB cases, and for a high percentage of cases this is linked to occupational exposure and coming from countries endemic for bovine TB.

Short- and long-term modulation of the lutein epoxide and violaxanthin cycles in two species of the Lauraceae: sweet bay laurel (Laurus nobilis L.) and avocado (Persea americana Mill.)

Short- and long-term responses of the violaxanthin (V) and lutein epoxide (Lx) cycles were studied in two species of Lauraceae: sweet bay laurel (Laurus nobilis L.) and avocado (Persea americana L.). The Lx content exceeded the V content in shade leaves of both species. Both Lx and V were de-epoxidised on illumination, but only V was fully restored by epoxidation in low light. Violaxanthin was preferentially de-epoxidised in low light in L. nobilis. This suggests that Lx accumulates with leaf ageing, partly because its conversion to lutein is limited in shade. After exposure to strong light, shade leaves of avocado readjusted the total pools of alpha- and beta-xanthophyll cycles by de novo synthesis of antheraxanthin, zeaxanthin and lutein. This occurred in parallel with a sustained depression of F(v)/F(m). In Persea indica, a closely related but low Lx species, F(v)/F(m) recovered faster after a similar light treatment, suggesting the involvement of the Lx cycle in sustained energy dissipation. Furthermore, the seasonal correlation between non-reversible Lx and V photoconversions and pre-dawn F(v)/F(m) in sun leaves of sweet bay supported the conclusion that the Lx cycle is involved in a slowly reversible downregulation of photosynthesis analogous to the V cycle.

Comparison of GenoType MTBC with RFLP-PCR and multiplex PCR to identify Mycobacterium tuberculosis complex species

The aims of the work presented here were to evaluate a commercial system based on DNA hybridization technology on nitrocellulose strips (GenoType MTBC; Hain Diagnostika, Nehren, Germany) for identifying Mycobacterium tuberculosis complex isolates to the species level and to compare the results with those obtained using the RFLP-PCR and multiplex PCR molecular techniques, biochemical tests and susceptibility testing. The commercial system correctly identified 102 of 103 (99.03%) strains studied, indicating it is capable of discriminating among the tuberculosis complex species.

Systematic molecular characterization of multidrug-resistant Mycobacterium tuberculosis complex isolates from Spain

We used spoligotyping and restriction fragment length polymorphism (RFLP) of the IS6110-insertion sequence to study the molecular epidemiology of multidrug-resistant (MDR) tuberculosis in Spain. We analyzed 180 Mycobacterium tuberculosis complex isolates collected between January 1998 and December 2000. Consecutive isolates from the same patients (n = 23) always had identical genotypes, meaning that no cases of reinfection occurred. A total of 105 isolates (58.3%) had unique RFLP patterns, whereas 75 isolates (41.7%) were in 20 different RFLP clusters. Characterization of the katG and rpoB genes showed that 14 strains included in the RFLP clusters did not actually cluster. Only 33.8% of the strains isolated were suggestive of MDR transmission, a frequency lower than that for susceptible strains in Spain (46.6%). We found that the Beijing/W genotype, which is prevalent worldwide, was significantly associated with immigrants. The 22 isolates in the largest cluster corresponded to the Mycobacterium bovis strain responsible for two nosocomial MDR outbreaks in Spain.

Gas exchange characteristics of a Canarian laurel forest tree species (Laurus azorica) in relation to environmental conditions and leaf canopy position

Diurnal courses of gas exchange were measured over a 1-year period in fully expanded current-year leaves in the upper (sun-exposed, 18 m above ground) and the lower (shaded, 12 m above ground) canopy of Laurus azorica (Seub.) Franco, a major canopy species of the Canarian laurel forest in Tenerife, Canary Islands, Spain. Laurus azorica exhibited high leaf plasticity in gas exchange characteristics, with a maximum carbon assimilation rate (Amax) of shade leaves about 50% that of sun leaves. This difference reflects the high leaf area index (LAI) of the stand and the correspondingly sharp light attenuation with increasing canopy depth. In sun leaves, Amax peaked at about 11 micromol m-2 s-1 and maximum transpiration (E) was about 8 mmol m-2 s-1, which corresponded with a maximum stomatal conductance (gs) of about 650 mmol m-2 s-1. Mean maximum instantaneous water-use efficiency (WUE) was 1.5 mmol mol-1 and the mean maximum A/gs was 20-35 micromol mol-1. Mean minimum internal CO2 concentration (Ci) was 225 micromol mol-1. Although high air vapor pressure deficit (VPD) caused a small decrease in gs, it remained high enough to maintain relatively high A and E. These gas exchange characteristics indicate a non-conservative use of water, which is appropriate for a species subject to droughts that are mild or of short duration. In this respect, Laurus azorica differs from its congener, L. nobilis L., of the Mediterranean region and other shrubs growing in Mediterranean-type climates in California and Chile that have to withstand more severe or more prolonged droughts.

In vitro susceptibilities of rapidly growing mycobacteria to telithromycin (HMR 3647) and seven other antimicrobials

The antimicrobial activities of telithromycin (HMR 3647) and seven other antimicrobials against 94 strains of rapidly growing mycobacteria were determined. Telithromycin at a concentration of 1 microg/ml inhibited Mycobacterium peregrinum (100%), Mycobacterium chelonae (80%), Mycobacterium abscessus-Mycobacterium mucogenicum (44.4%), and Mycobacterium fortuitum (2.1%). All or most strains of M. peregrinum, M. fortuitum, and M. mucogenicum were inhibited by 2 microg of quinolones per ml.

Identification by spoligotyping of a caprine genotype in Mycobacterium bovis strains causing human tuberculosis

We have used spoligotyping to characterize 18 Mycobacterium bovis strains isolated from cattle and 23 M. bovis strains isolated from goats. The spoligotypes revealed that caprine strains form a separate and well-differentiated group that we refer to hereafter in this abstract as the caprine genotype. To evaluate the importance of this genotype as a cause of tuberculosis in other animal species, including humans, we applied the spoligotyping method to 112 strains, including to all isolates identified as M. bovis by a Mycobacterial National Reference Laboratory (Majadahonda, Madrid) from 1994 to 1996. Eighty-three of these strains were identified in human isolates. In addition to being identified in three goat isolates and two sheep isolates, the caprine genotype was also found in three isolates causing human tuberculosis. Evidence to support the argument that there is a zoonotic risk of caprine tuberculosis was presented by the identification of the caprine genotype in an isolate from a veterinary worker with a recent history of contact with tuberculous goats.

Generalised tuberculosis in a patient with acquired immunodeficiency syndrome

We describe a heroin addict who presented with cellular immunodeficiency, generalised tuberculosis, and pneumonia caused by Pneumocystis carinii, and discuss the risk of these associations.