Aortic Intima-Media Thickness and Mean Platelet Volume in Children With Type 1 Diabetes Mellitus

Background: Diabetes mellitus type 1 is the most common endocrine metabolic disorder occurring in childhood and adolescence due to the autoimmune destruction of pancreatic beta cells as a result of various environmental factors interacting with an underlying genetic predisposition. Diabetes is a risk factor for early onset atherosclerosis, and the high mortality rate seen in these patients is partially related to cardiovascular diseases. Objectives: This study was conducted to compare mean platelet volume as a marker of early atherosclerosis with aortic intima-media thickness in children with type 1 diabetes and to identify its correlation with known cardiovascular risk factors. Patients and Methods: The study included 27 patients between age range of 6 and 17 years that were diagnosed with type 1 diabetes and 30 healthy children of the same age range who did not have any chronic disease. In both groups, we used the color Doppler ultrasound to measure children’s aortic intima-media thickness and identify their mean platelet volumes. Results: There was no significant difference between the groups regarding gender distribution, age, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels (P > 0.05). Also no significant difference could be documented between the patient and control groups regarding the aortic intima-media thickness and mean platelet volume (P > 0.05). However, there was a significant correlation between aortic intima-media thickness and mean platelet volume (r = 0.351; P < 0.05). Conclusions: In the present study, there was no evidence of early atherosclerosis in children with type 1 diabetes. However, mean platelet volume having a significant correlation with aortic intima-media thickness may be useful as an early marker of atherosclerosis.

Effect of Playing Interactive Computer Game on Distress of Insulin Injection Among Type 1 Diabetic Children

Background: Diabetic children and their families experience high level stress because of daily insulin injection. Objectives: This study was conducted to investigate the impact of an interactive computer game on behavioral distress due to insulin injection among diabetic children. Patients and Methods: In this clinical trial, thirty children (3-12 years) with type 1 diabetes who needed daily insulin injection were recruited and allocated randomly into two groups. Children in intervention groups received an interactive computer game and asked to play at home for a week. No special intervention was done for control group. The behavioral distress of groups was assessed before, during and after the intervention by Observational Scale of Behavioral Distress–Revised (OSBD-R). Results: Repeated measure ANOVA test showed no significantly difference of OSBD-R over time for control group (P = 0.08), but this changes is signification in the study group (P = 0.001). Comparison mean score of distress were significantly different between two groups (P = 0.03). Conclusions: According to the findings, playing interactive computer game can decrease behavioral distress induced by insulin injection in type 1 diabetic children. It seems this game can be beneficial to be used alongside other interventions.

Analysis of contributions of herpes simplex virus type 1 UL43 protein to induction of cell-cell fusion

Purpose: To investigate whether UL43 protein, which is highly conserved in alpha- and gamma herpes viruses, and a non-glycosylated transmembrane protein, is involved in virus entry and virus-induced cell fusion. Methods: Mutagenesis was accomplished by a markerless two-step Red recombination mutagenesis system implemented on the Herpes simplex virus 1 (HSV-1) bacterial artificial chromosome (BAC). Growth properties of HSV-1 UL43 mutants were analyzed using plaque morphology and one-step growth kinetics. SDS-PAGE and Western blot was employed to assay the synthesis of the viral glycoproteins. Virus-penetration was assayed to determine if UL43 protein is required for efficient virus entry. Results: Lack of UL43 expression resulted in significantly reduced plaque sizes of syncytial mutant viruses and inhibited cell fusion induced by gBΔ28 or gKsyn20 (p < 0.05). Deletion of UL43 did not affect overall expression levels of viral glycoproteins gB, gC, gD, and gH on HSV-1(F) BAC infected cell surfaces. Moreover, mutant viruses lacking UL43 gene exhibited slower kinetics of entry into Vero cells than the parental HSV-1(F) BAC. Conclusion: Thus, these results suggest an important role for UL43 protein in mediating virus-induced membrane fusion and efficient entry of virion into target cells.

Le traitement nutritionnel des épisodes d'hypoglycémie dans le diabète de type 1

Les patients atteints de diabète de type 1 (DbT1) semblent sur-traiter leurs hypoglycémies par rapport aux recommandations des Lignes directrices Canadiennes en diabète. Objectifs : 1) Décrire les habitudes des patients DbT1 pour le traitement des hypoglycémies et estimer les impacts sur le profil de risque cardio-métabolique et 2) explorer les excursions glycémiques suite à un traitement d’hypoglycémie qui respecte les recommandations. Méthodologie (analyses secondaires) : Objectif 1 : 121 patients DbT1 ont complété un journal alimentaire et de glycémies de 48 h. Des variables cardio-métaboliques ont été mesurées et un questionnaire sur la peur des hypoglycémies a été complété. Objectif 2 : 57 patients DbT1 ont complété les bras contrôles de notre programme sur le pancréas artificiel (traitement des hypoglycémies standardisé). Les valeurs de glycémie étaient disponibles aux 5 minutes. Résultats : Projet 1 : Les patients ont fait en moyenne 1,45 hypoglycémies/jour et 73% sur-traitaient avec une consommation moyenne de glucides de 32 ± 24 g. Ce sur-traitement est associé avec un plus jeune âge et une peur des hypoglycémies plus importante, mais pas avec un profil de risque cardio-métabolique plus défavorable. Projet 2 : Dans 20% des cas, traiter une hypoglycémie avec 15 g de glucides était efficace pour ramener la glycémie ≥ 4,0 mmol/L en 15 minutes, le temps moyen étant de 24 ± 12 minutes. La proportion d’insuline basale, le temps depuis le dernier repas et la pratique d’activité physique sont les éléments qui semblent avoir le plus d’impact sur l’efficacité du traitement. Conclusion : L’éducation entourant le traitement des hypoglycémies a besoin d’être renforcée et d’autres études sont nécessaires afin de valider les recommandations.

Le traitement nutritionnel des épisodes d'hypoglycémie dans le diabète de type 1

Les patients atteints de diabète de type 1 (DbT1) semblent sur-traiter leurs hypoglycémies par rapport aux recommandations des Lignes directrices Canadiennes en diabète. Objectifs : 1) Décrire les habitudes des patients DbT1 pour le traitement des hypoglycémies et estimer les impacts sur le profil de risque cardio-métabolique et 2) explorer les excursions glycémiques suite à un traitement d’hypoglycémie qui respecte les recommandations. Méthodologie (analyses secondaires) : Objectif 1 : 121 patients DbT1 ont complété un journal alimentaire et de glycémies de 48 h. Des variables cardio-métaboliques ont été mesurées et un questionnaire sur la peur des hypoglycémies a été complété. Objectif 2 : 57 patients DbT1 ont complété les bras contrôles de notre programme sur le pancréas artificiel (traitement des hypoglycémies standardisé). Les valeurs de glycémie étaient disponibles aux 5 minutes. Résultats : Projet 1 : Les patients ont fait en moyenne 1,45 hypoglycémies/jour et 73% sur-traitaient avec une consommation moyenne de glucides de 32 ± 24 g. Ce sur-traitement est associé avec un plus jeune âge et une peur des hypoglycémies plus importante, mais pas avec un profil de risque cardio-métabolique plus défavorable. Projet 2 : Dans 20% des cas, traiter une hypoglycémie avec 15 g de glucides était efficace pour ramener la glycémie ≥ 4,0 mmol/L en 15 minutes, le temps moyen étant de 24 ± 12 minutes. La proportion d’insuline basale, le temps depuis le dernier repas et la pratique d’activité physique sont les éléments qui semblent avoir le plus d’impact sur l’efficacité du traitement. Conclusion : L’éducation entourant le traitement des hypoglycémies a besoin d’être renforcée et d’autres études sont nécessaires afin de valider les recommandations.

Adherence to therapeuthic regimen and metabolic control of type 1 diabetes

Abstract Objectives: To assess the adherence to therapeutic regimen; to determine the Hemoglobin Glycation Index (HbA1c); to analyse the relationship that exists between the adherence to therapeutic regimen and metabolic control. Design: correlational analytical study, carried out according to a cross-sectional perspective. Participants: A non-probabilistic sample of 266 people with type 1 diabetes aged between 18 and 78 years old (mean M = 51.02 ± SD = 18.710), attending follow-up diabetes consultations. Mostly male individuals (51.88%), with low schooling level (50.75% had only inished elementar school). Measuring Instruments: We used the following data collection tools: a questionnaire on clinical and socio-demographic data, blood analysis of venous blood to determine the glycated hemoglobin level (HbA1c).Three self-report scales were used: Accession to Diabetes Treatment (Matos, 1999), Self-perception Scale (Vaz Serra, 1986) and Social Support Scale (Matos & Rodrigues, 2000). Results: In a sample in which the mean disease duration is 12.75 years, 69.17% of the sample run glycemic control tests between once a day and four times a year and 42.86% of them undergo insulin treatment. In the last 3 weeks, 26.32% of these people have experienced an average of 4.22 to 44.36%, hypoglycemic crises and experienced an average of 6.18 hyperglycemic crises. 57% of the individuals have showed a poor metabolic control (mean HbA1c higher than 7.5% (HbA1c mean M ≥ 7.50%). The mean psychosocial proile revealed individuals who show a decent self-esteem (M = 70.81) and acceptable social support (M = 58.89). Conclusions: The results suggest we should develop a kind of investigation that could be used to monitor the strenght of the mediation effect effect of the psychosocial predictive dimension of the adherence, since it has become essential to support a multidisciplinary approach which center lays in the promotion of a co-responsible self-management from the person who suffers from diabetes. This will enable a better quality of life; fewer years of people’s lives lost prematurely and a better health with less economical costs for citizens and healthcare systems.

Design et synthèse d’inhibiteurs d’une ectonucléotide pyrophosphatase/phosphodiestérase de type 1 (ENPP1) et leur activité anticancéreuse

La calcification de la valve aortique (CVA) est une maladie cardiovasculaire de plus en plus répandue, particulièrement en Amérique du Nord. Elle cause le rétrécissement de la valve aortique et le seul traitement actuellement disponible est le remplacement chirurgical. Des études menées par le Dr Patrick Mathieu (Institut de Cardiologie et de Pneumologie de Québec) ont montré qu’une surexpression d’une ectonucléotide pyrophosphatase/phosphodiestérase de type 1 (ENPP1) est à l’origine de cette sténose. Une solution à cette maladie serait donc de trouver un inhibiteur d’ENPP1. Inspirées des travaux du groupe de Pfizer visant ENPP1 pour le traitement de la chondrocalcinose articulaire et l’ostéoarthrite, quelques familles d’inhibiteurs de type quinazoline-4-pipéridine sulfamides (QPS) ont été synthétisés et testées in vitro. Une étude en modélisation moléculaire sur le site potentiel de liaison des inhibiteurs sur ENPP1 est en cours, en collaboration avec le Pr Patrick Lagüe (Université Laval, Département de biochimie, microbiologie et bio-informatique) et son équipe pour optimiser le design de la structure des composés. Les composés d’une des familles, les QPS-pyrimidine, ont été testés in vitro sur quelques lignées cellulaires cancéreuses (HT-1080, HT-29, M21 et MCF-7) pour mesurer leur activité antiproliférative. Ces composés ont une inhibition de croissance médiane (IC50) de l’ordre du micromolaire et représentent donc un point de départ intéressant pour la mise au point de nouveaux traitements anticancéreux.

Anxiety, stress and depression in young adults with type 1 Diabetes

Introdução: A vida dos jovens adultos com diabetes tipo 1 (DM1) tem muitas exigências e as consequências psicológicas da adesão contínua aos aspetos do tratamento pode afetar a qualidade de vida. Objetivos: Conhecer o suporte social, satisfação com a vida, ansiedade, stresse e depressão nos jovens adultos com DM1. Material e Métodos: Estudo quantitativo realizado com 278 jovens adultos com DM1 (18 - 35 anos). Resultados: Os jovens consideram ter bom suporte social. A média de satisfação com a vida é 6,6 ±1,7 (escala 0-10). A maior parte dos jovens não apresenta estados persistentes de ansiedade e de excitação e tensão (stresse), pelo que têm resistência à frustração e desilusão. A maioria dos jovens não apresenta sintomas de depressão, revelando auto-estima, sentimentos positivos, motivação, entusiasmo e perceção da probabilidade de alcançar objetivos de vida que sejam significativos. A análise fatorial das escalas de ansiedade, stresse e depressão permitiu encontrar 3 fatores que explicam 50% da variância total: stresse (36%), ansiedade (8%), depressão (6%). Conclusões: Os jovens adultos com DM1 têm bom suporte social e satisfação com a vida. A maior parte dos jovens não revela sintomas de ansiedade, stresse e depressão. O suporte social e a satisfação com a vida poderão contribuir para uma boa saúde mental.

Socio-demographic and epidemiological characteristics associated with human immunodeficiency virus type I (HIV-1) infection in HIV-1-explosed but uninfected individuals, and in HIV-1-infected patients from a southern brasilian population

The ability to control human immunodeficiency virus type 1 (HIV-1) infection and progression of the disease is regulated by host and viral factors. This cross-sectional study describes the socio-demographic and epidemiological characteristics associated with HIV-1 infection in 1,061 subjects attended in Londrina and region, south of Brazil: 136 healthy individuals (Group 1), 147 HIV-1-exposed but uninfected individuals (Group 2), 161 HIV-1-infected asymptomatic patients (Group 3), and 617 patients with AIDS (Group 4). Data were obtained by a standardized questionnaire and serological tests. The age of the individuals ranged from 15.1 to 79.5 years, 54.0% and 56.1% of the Groups 3 and 4 patients, respectively, were men. The major features of groups 2, 3, and 4 were a predominance of education level up to secondary school (55.8%, 60.2% and 62.4%, respectively), sexual route of exposure (88.4%, 87.0% and 82.0%, respectively), heterosexual behavior (91.8%, 75.2% and 83.7%, respectively), and previous sexually transmitted diseases (20.4%, 32.5%, and 38.1%, respectively). The patients with AIDS showed the highest rates of seropositivity for syphilis (25.6%), of anti-HCV (22.3%), and anti-HTLV I/II obtained by two serological screening tests (6.2% and 6.8%, respectively). The results documenting the predominant characteristics for HIV-1 infection among residents of Londrina and region, could be useful for the improvement of current HIV-1 prevention, monitoring and therapeutic programs targeted at this population.

The use of botulinum toxin type A in the treatment of HTLV-1-associated overactive bladder refractory to conventional therapy

Urinary symptoms occur in 19% of human T-cell lymphotropic virus type 1 (HTLV-1)-infected patients who do not fulfill criteria for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and in almost 100% of HAM/TSP patients. Few studies have evaluated therapies for overactive bladder (OAB) caused by HTLV-1 infection. This case report describes the effect of onabotulinum toxin A on the urinary manifestations of three patients with HAM/TSP and OAB symptoms. The patients were intravesically administered 200 units of Botox&#174;. Their incontinence episodes improved, and their OAB symptoms scores (OABSS) reduced significantly. These data indicate that Botox&#174; should be a treatment option for OAB associated with HTLV-1 infection.

Multibacillary leprosy patients with high and persistent serum antibodies to leprosy IDRI diagnostic-1/LID-1: higher susceptibility to develop type 2 reactions

Leprosy inflammatory episodes [type 1 (T1R) and type 2 (T2R) reactions] represent the major cause of irreversible nerve damage. Leprosy serology is known to be influenced by the patientR17;s bacterial index (BI) with higher positivity in multibacillary patients (MB) and specific multidrug therapy (MDT) reduces antibody production. This study evaluated by ELISA antibody responses to leprosy Infectious Disease Research Institute diagnostic-1 (LID-1) fusion protein and phenolic glycolipid I (PGL-I) in 100 paired serum samples of 50 MB patients collected in the presence/absence of reactions and in nonreactional patients before/after MDT. Patients who presented T2R had a median BI of 3+, while MB patients with T1R and nonreactional patients had median BI of 2.5+ (p > 0.05). Anti-LID-1 and anti-PGL-I antibodies declined in patients diagnosed during T1R (p < 0.05). Anti-LID-1 levels waned in MB with T2R at diagnosis and nonreactional MB patients (p < 0.05). Higher anti-LID-1 levels were seen in patients with T2R at diagnosis (vs. patients with T1R at diagnosis, p = 0.008; vs. nonreactional patients, p = 0.020) and in patients with T2R during MDT (vs. nonreactional MB, p = 0.020). In MB patients, high and persistent anti-LID-1 antibody levels might be a useful tool for clinicians to predict which patients are more susceptible to develop leprosy T2R.

Molecular cloning of a novel human I-mfa domain-containing protein that differently regulates human T-cell leukemia virus type I and HIV-1 expression.

Regulation of viral genome expression is the result of complex cooperation between viral proteins and host cell factors. We report here the characterization of a novel cellular factor sharing homology with the specific cysteine-rich C-terminal domain of the basic helix-loop-helix repressor protein I-mfa. The synthesis of this new factor, called HIC for Human I-mfa domain-Containing protein, is controlled at the translational level by two different codons, an ATG and an upstream non-ATG translational initiator, allowing the production of two protein isoforms, p32 and p40, respectively. We show that the HIC protein isoforms present different subcellular localizations, p32 being mainly distributed throughout the cytoplasm, whereas p40 is targeted to the nucleolus. Moreover, in trying to understand the function of HIC, we have found that both isoforms stimulate in T-cells the expression of a luciferase reporter gene driven by the human T-cell leukemia virus type I-long terminal repeat in the presence of the viral transactivator Tax. We demonstrate by mutagenesis that the I-mfa-like domain of HIC is involved in this regulation. Finally, we also show that HIC is able to down-regulate the luciferase expression from the human immunodeficiency virus type 1-long terminal repeat induced by the viral transactivator Tat. From these results, we propose that HIC and I-mfa represent two members of a new family of proteins regulating gene expression and characterized by a particular cysteine-rich C-terminal domain.

Gene transfer of a soluble IL-1 type 2 receptor-Ig fusion protein improves cardiac allograft survival in rats.

OBJECTIVE: Interleukin-1 (IL-1) mediates ischemia-reperfusion injury and graft inflammation after heart transplantation. IL-1 affects target cells through two distinct types of transmembrane receptors, type-1 receptor (IL-1R1), which transduces the signal, and the non-signaling type-2 receptor (IL-1R2), which acts as a ligand sink that subtracts IL-1beta from IL-1R1. We analyzed the efficacy of adenovirus (Ad)-mediated gene transfer of a soluble IL-1R2-Ig fusion protein in delaying cardiac allograft rejection and the mechanisms underlying the protective effect. METHODS: IL-1 inhibition by IL-1R2-Ig was tested using an in vitro functional assay whereby endothelial cells preincubated with AdIL-1R2-Ig or control virus were stimulated with recombinant IL-1beta or tumor necrosis factor-alpha (TNF-alpha), and urokinase-type plasminogen activator (u-PA) induction was measured by zymography. AdIL-1R2-Ig was delivered to F344 rat donor hearts ex vivo, which were placed in the abdominal position in LEW hosts. Intragraft inflammatory cell infiltrates and proinflammatory cytokine expression were analyzed by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR), respectively. RESULTS: IL-1R2-Ig specifically inhibited IL-1beta-induced u-PA responses in vitro. IL-1R2-Ig gene transfer reduced intragraft monocytes/macrophages and CD4(+) cell infiltrates (p<0.05), TNF-alpha and transforming growth factor-beta (TGF-beta) expression (p<0.05), and prolonged graft survival (15.6+/-5.7 vs 10.3+/-2.5 days with control vector and 10.1+/-2.1 days with buffer alone; p<0.01). AdIL-1R2-Ig combined with a subtherapeutic regimen of cyclosporin A (CsA) was superior to CsA alone (19.4+/-3.0 vs 15.9+/-1.8 days; p<0.05). CONCLUSIONS: Soluble IL-1 type-2 receptor gene transfer attenuates cardiac allograft rejection in a rat model. IL-1 inhibition may be useful as an adjuvant therapy in heart transplantation.

Copolymer 1 induces T cells of the T helper type 2 that crossreact with myelin basic protein and suppress experimental autoimmune encephalomyelitis

The synthetic amino acid copolymer copolymer 1 (Cop 1) suppresses experimental autoimmune encephalomyelitis (EAE) and is beneficial in multiple sclerosis. To further understand Cop 1 suppressive activity, we studied the cytokine secretion profile of various Cop 1-induced T cell lines and clones. Unlike T cell lines induced by myelin basic protein (MBP), which secreted either T cell helper type 1 (Th1) or both Th1 and Th2 cytokines, the T cell lines/clones induced by Cop 1 showed a progressively polarized development toward the Th2 pathway, until they completely lost the ability to secrete Th1 cytokines. Our findings indicate that the polarization of the Cop 1-induced lines did not result from the immunization vehicle or the in vitro growing conditions, but rather from the tendency of Cop 1 to preferentially induce a Th2 response. The response of all of the Cop 1 specific lines/clones, which were originated in the (SJL/J×BALB/c)F1 hybrids, was restricted to the BALB/c parental haplotype. Even though the Cop 1-induced T cells had not been exposed to the autoantigen MBP, they crossreacted with MBP by secretion of interleukin (IL)-4, IL-6, and IL-10. Administration of these T cells in vivo resulted in suppression of EAE induced by whole mouse spinal cord homogenate, in which several autoantigens may be involved. Secretion of anti-inflammatory cytokines by Cop 1-induced suppressor cells, in response to either Cop 1 or MBP, may explain the therapeutic effect of Cop 1 in EAE and in multiple sclerosis.