Maria Helena de Melo Lima

Topical insulin accelerates wound healing in diabetes by enhancing the AKT and ERK pathways: a double-blind placebo-controlled clinical trial.

Background Wound healing is impaired in diabetes mellitus, but the mechanisms involved in this process are virtually unknown. Proteins belonging to the insulin signaling pathway respond to insulin in the skin of rats. Objective The purpose of this study was to investigate the regulation of the insulin signaling pathway in wound healing and skin repair of normal and diabetic rats, and, in parallel, the effect of a topical insulin cream on wound healing and on the activation of this pathway. Research Design and Methods We investigated insulin signaling by immunoblotting during wound healing of control and diabetic animals with or without topical insulin. Diabetic patients with ulcers were randomized to receive topical insulin or placebo in a prospective, double-blind and placebo-controlled, randomized clinical trial (NCT 01295177) of wound healing. Results and Conclusions Expression of IR, IRS-1, IRS-2, SHC, ERK, and AKT are increased in the tissue of healing wounds compared to intact skin, suggesting that the insulin signaling pathway may have an important role in this process. These pathways were attenuated in the wounded skin of diabetic rats, in parallel with an increase in the time of complete wound healing. Upon topical application of insulin cream, the wound healing time of diabetic animals was normalized, followed by a reversal of defective insulin signal transduction. In addition, the treatment also increased expression of other proteins, such as eNOS (also in bone marrow), VEGF, and SDF-1α in wounded skin. In diabetic patients, topical insulin cream markedly improved wound healing, representing an attractive and cost-free method for treating this devastating complication of diabetes. Trial Registration ClinicalTrials.gov NCT01295177

Characterization of the insulin-signaling pathway in lacrimal and salivary glands of rats

Purpose. Insulin has been acknowledged as a mediator of several physiological events in lacrimal and salivary glands. We investigated the presence of insulin receptors and of insulin-induced autophosphorylation of the insulin receptor and activation of elements involved in the early steps of insulin signaling in lacrimal and salivary glands of rats. Methods. Lacrimal and salivary glands of Wistar rats were removed and processed for immunohistochemistry using anti-insulin receptor and anti-IGF-1 receptor antibodies. The activation of insulin receptors following insulin treatment, and the involvement of insulin receptor substrates-1 and -2, Shc, JAK-2 and STAT-1, were analyzed by immunoprecipitation, followed by SDS-PAGE and immunoblotting of rat lacrimal and salivary glands after exposure to insulin. Results. Insulin and IGF-1 receptors were present in rat lacrimal and salivary glands and were located predominantly in the cytoplasm and plasma membrane. Functional studies demonstrated that insulin induced a dose-dependent phosphorylation of the insulin receptor, IGF-1R, insulin receptor substrates-1 and -2, Shc, and STAT-1. In rats with streptozotocin-induced diabetes mellitus there was a significant reduction in insulin-induced insulin receptor and STAT-1 phosphorylation in the lacrimal gland but not in the salivary gland; there was no influence on Shc phosphorylation in either tissue. Conclusions. The present results indicate that insulin and IGF-1 receptors are expressed in lacrimal and salivary glands, and that insulin can induce the phosphorylation of its receptor and activate elements involved in the early steps of insulin signaling in both tissues.

Intervenção educativa para o autocuidado de indíviduos com diabetes mellitus

OBJECTIVE: To assess the knowledge, attitudes and practices of self-care in individuals with diabetes mellitus (DM) in a specialized health service in Belo Horizonte - MG, Brazil. METHODS: The research was a case study with a qualitative approach. Data were collected by conducting focus groups with the participation of 12 individuals with diabetes and who attended three sessions of the educational program developed in this health service. RESULTS: Data were analyzed using thematic analysis, which allowed the identification of the following categories: experiences; feelings; practical education for self-care associated with food and physical activity; perceived barriers to the pursuit of a healthy lifestyle; and expectations. CONCLUSION: The results of the study showed the importance of education and health communication guided the dialogical relations and appreciation of popular knowledge, by reorienting the educational practices for self care, in order to establish strategies for prevention and disease control.OBJETIVO: Analizar conocimientos, actitudes y practicas del autocuidado de individuos con Diabetes mellitus (DM) en un servicio especializado de salud de Belo Horizonte - MG, Brasil. METODOS: Investigacion de tipo estudio de caso con abordaje cualitativo. Los datos fueron recolectados por medio de la realizacion de grupos focales con la participacion de 12 individuos con DM y que asistieron a tres sesiones del programa educativo desarrollado en ese servicio de salud. RESULTADOS: Los datos, analizados segun el enfoque del analisis tematico, posibilitaron la identificacion de las siguientes categorias: Experiencias; Sentimientos; Practica educativa para el autocuidado, asociada a la alimentacion y a la actividad fisica; Barreras percibidas para la busqueda de un estilo de vida saludable; y Expectativas. CONCLUSION: Los resultados del estudio mostraron la importancia de la educacion y de la comunicacion en salud basadas en las relaciones dialogicas y en la valorizacion del saber popular, al reorientar las practicas educativas para el autocuidado, de forma a estabelecer estrategias de prevencion y control de la enfermedad.

Regulation of IRS-1/SHP2 interaction and AKT phosphorylation in animal models of insulin resistance.

Insulin stimulates tyrosine kinase activity of its receptor, resulting in phosphorylation of its cytosolic substrate, insulin receptor substrate-1, which, in turn, associates with proteins containing SH2 domains, including phosphatidylinositol 3-kinase (Pl 3-kinase) and the phosphotyrosine phosphatase SHP2. The regulation of these associations in situations of altered insulin receptor substrate-1 (IRS-1) phosphorylation was not yet investigated. In the present study, we investigated insulin-induced IRS-1/SHP2 and IRS-1/PI 3-kinase associations and the regulation of a downstream serine-kinase AKT/PKB in liver and muscle of three animal models of insulin resistance: STZ diabetes, epinephrine-treated rats, and aging, which have alterations in IRS-1 tyrosine phosphorylation in common. The results demonstrated that insulin-induced IRS-1/PI 3-kinase association has a close correlation with IRS-1 tyrosine phosphorylation levels, but insulin-induced IRS-1/SHP2 association showed a modulation that did not parallel IRS-1 phosphorylation, with a tissue-specific regulation in aging. The integration of the behavior of IRS-1/PI 3-kinase and with IRS-1/SHP2 associations may be important for insulin signaling downstream as AKT phosphorylation. In conclusion, the results of the present study demonstrated that insulin-induced IRS-1/SHP2 association can be regulated in insulin-sensitive tissues of animal models of insulin resistance and may have a role in the control of AKT phosphorylation, which may be implicated in the control of glucose metabolism.

PGC1α gene Gly482Ser polymorphism predicts improved metabolic, inflammatory and vascular outcomes following bariatric surgery

Aims/Hypothesis:Bariatric surgery is currently employed as an effective approach to treat class III obesity and class II obesity with co-morbidities. Unfortunately, the general anthropometric and metabolic outcomes of the surgery are not homogeneous, and defining the eligibility criteria that allow for a more precise prediction of the outcomes of this invasive procedure will refine the selection of patients. Here we tested the hypothesis that the Gly482Ser polymorphism of the ppargc1a gene would predict different outcomes following bariatric surgery.Methods:Fifty-five patients (26 Gly/Gly and 29 Gly/Ser+Ser/Ser) selected for the Roux-en-Y gastric bypass according to the National Institutes of Health Consensus Statement criteria were followed up for 1 year, monitoring their anthropometric, metabolic and inflammatory parameters.Results:Patients with the Gly482Ser polymorphism had significantly improved reductions in the waist/hip ratio, fasting blood glucose, C-reactive protein, blood leukocyte count, serum interleukin-6 and intima–media thickness of the carotid artery, as compared with Gly/Gly patients.Conclusions/Interpretation:Thus, the Gly482Ser polymorphism may predict a more favorable metabolic and inflammatory outcome for obese patients submitted to bariatric surgery, leading to a reduced atherosclerotic risk.

Associação entre flebite e retirada de cateteres intravenosos periféricos

The objective of this prospective study is to verify the incidence of phlebitis among patients with peripheral intravenous catheters and to identify possible relations between this complication and catheter-related variables. Seventy-six adult patients hospitalized in a Brazilian university hospital were evaluated, using charts with patient-related variables, peripheral intravenous catheters, and pharmacological therapy. Phlebitis was evaluated based on Infusion Nurses Society proposed classification. Inferential and descriptive statistics have been used. We observed 25.8% incidence of phlebitis, from which 40% presented pain occurrences, with erythema and edema. Among patients with phlebitis, 60% developed a complication episode, and the average period of permanence of peripheral intravenous catheters with phlebitis was 3.10 days. We observed phlebitis associations to adverse occurrences during the removal of peripheral intravenous catheters (p<0.001). Educational actions and professional training for nursing personnel are necessary for dealing with intravenous therapy, mainly on what is related to early detection of phlebitis. dESCRIpTORS: Intravenous infusions. Phlebitis. Nursing. Nursing care. Peripheral catheterization.Se trata de un estudio prospectivo para determinar la incidencia de flebitis en pacientes con cateter intravenoso periferico e identificar posibles asociaciones de esta complicacion con las variables relacionadas con el cateter intravenoso periferico. Se evaluaron setenta y seis pacientes adultos hospitalizados en el sector de enfermeria de un hospital universitario, mediante un formulario que contiene las variables relacionadas con los pacientes, el cateter intravenoso periferico y la terapia farmacologica. La flebitis fue evaluada de acuerdo a la clasificacion propuesta por la Infusion Nurses Society. Se utilizo la estadistica descriptiva e inferencial. La incidencia de flebitis fue del 25,8%, de los cuales, el 40% presento sintomas clinicos de dolor, con eritema y/o edema. Entre los pacientes con flebitis, el 60% desarrollo un episodio de complicacion, y el tiempo medio de permanencia del cateter intravenoso periferico con flebitis fue 3,10 dias. Se observo una relacion de la flebitis con la retirada de cateter intravenoso periferico por eventos adversos (p<0,001). Se necesitan acciones educativas y capacitacion del personal de enfermeria para el manejo de la terapia intravenosa, especialmente en lo que respecta a la deteccion temprana de flebitis.

Planejamento da alta hospitalar do paciente diabético: construção de uma proposta

The acute and chronic complications that patients with diabetes and their families have to deal with after hospital discharge may be a consequence of the deficiencies in the educational process across hospitalization and the formal preparation for discharge. The objective of this study is to present a proposal of the plan for hospital discharge of adult patients with diabetes. A literature review on the hospital discharge of the assessed population was performed, including articles published between 2004 and February 2009. Taking the literature into consideration, a flier was created to guide the discharge process. The flier lists the information that should be collected and worked with the patient during the first four days of hospitalization, considering their individual needs and the Ineffective self health management. The discharge must be inserted in the Nursing Process, as nurses have an essential role in identifying the needs of patients and their families. The flier helps to identify the patients needs and the actions to be performed by the team.The acute and chronic complications that patients with diabetes and their families have to deal with after hospital discharge may be a consequence of the deficiencies in the educational process across hospitalization and the formal preparation for discharge. The objective of this study is to present a proposal of the plan for hospital discharge of adult patients with diabetes. A literature review on the hospital discharge of the assessed population was performed, including articles published between 2004 and February 2009. Taking the literature into consideration, a flier was created to guide the discharge process. The flier lists the information that should be collected and worked with the patient during the first four days of hospitalization, considering their individual needs and the Ineffective self health management. The discharge must be inserted in the Nursing Process, as nurses have an essential role in identifying the needs of patients and their families. The flier helps to identify the patients needs and the actions to be performed by the team.

Educational intervention for self-care of individuals with diabetes mellitus

OBJECTIVE: To assess the knowledge, attitudes and practices of self-care in individuals with diabetes mellitus (DM) in a specialized health service in Belo Horizonte - MG, Brazil. METHODS: The research was a case study with a qualitative approach. Data were collected by conducting focus groups with the participation of 12 individuals with diabetes and who attended three sessions of the educational program developed in this health service. RESULTS: Data were analyzed using thematic analysis, which allowed the identification of the following categories: experiences; feelings; practical education for self-care associated with food and physical activity; perceived barriers to the pursuit of a healthy lifestyle; and expectations. CONCLUSION: The results of the study showed the importance of education and health communication guided the dialogical relations and appreciation of popular knowledge, by reorienting the educational practices for self care, in order to establish strategies for prevention and disease control.OBJETIVO: Analizar conocimientos, actitudes y practicas del autocuidado de individuos con Diabetes mellitus (DM) en un servicio especializado de salud de Belo Horizonte - MG, Brasil. METODOS: Investigacion de tipo estudio de caso con abordaje cualitativo. Los datos fueron recolectados por medio de la realizacion de grupos focales con la participacion de 12 individuos con DM y que asistieron a tres sesiones del programa educativo desarrollado en ese servicio de salud. RESULTADOS: Los datos, analizados segun el enfoque del analisis tematico, posibilitaron la identificacion de las siguientes categorias: Experiencias; Sentimientos; Practica educativa para el autocuidado, asociada a la alimentacion y a la actividad fisica; Barreras percibidas para la busqueda de un estilo de vida saludable; y Expectativas. CONCLUSION: Los resultados del estudio mostraron la importancia de la educacion y de la comunicacion en salud basadas en las relaciones dialogicas y en la valorizacion del saber popular, al reorientar las practicas educativas para el autocuidado, de forma a estabelecer estrategias de prevencion y control de la enfermedad.

Influence of cyclosporine on the occurrence of nephrotoxicity after allogeneic hematopoietic stem cell transplantation: a systematic review

Cyclosporine, a drug used in immunosuppression protocols for hematopoietic stem cell transplantation that has a narrow therapeutic index, may cause various adverse reactions, including nephrotoxicity. This has a direct clinical impact on the patient. This study aims to summarize available evidence in the scientific literature on the use of cyclosporine in respect to its risk factor for the development of nephrotoxicity in patients submitted to hematopoietic stem cell transplantation. A systematic review was made with the following electronic databases: PubMed, Web of Science, Embase, Scopus, CINAHL, LILACS, SciELO and Cochrane BVS. The keywords used were: “bone marrow transplantation” OR “stem cell transplantation” OR “grafting, bone marrow” AND cyclosporine OR cyclosporin OR “risk factors” AND “acute kidney injury” OR “acute kidney injuries” OR “acute renal failure” OR “acute renal failures” OR “nephrotoxicity”. The level of scientific evidence of the studies was classified according to the Oxford Centre for Evidence Based Medicine. The final sample was composed of 19 studies, most of which (89.5%) had an observational design, evidence level 2B and pointed to an incidence of nephrotoxicity above 30%. The available evidence, considered as good quality and appropriate for the analyzed event, indicates that cyclosporine represents a risk factor for the occurrence of nephrotoxicity, particularly when combined with amphotericin B or aminoglycosides, agents commonly used in hematopoietic stem cell transplantation recipients.

Relation between phlebitis and peripheral intravenous catheter removal

The objective of this prospective study is to verify the incidence of phlebitis among patients with peripheral intravenous catheters and to identify possible relations between this complication and catheter-related variables. Seventy-six adult patients hospitalized in a Brazilian university hospital were evaluated, using charts with patient-related variables, peripheral intravenous catheters, and pharmacological therapy. Phlebitis was evaluated based on Infusion Nurses Society proposed classification. Inferential and descriptive statistics have been used. We observed 25.8% incidence of phlebitis, from which 40% presented pain occurrences, with erythema and edema. Among patients with phlebitis, 60% developed a complication episode, and the average period of permanence of peripheral intravenous catheters with phlebitis was 3.10 days. We observed phlebitis associations to adverse occurrences during the removal of peripheral intravenous catheters (p<0.001). Educational actions and professional training for nursing personnel are necessary for dealing with intravenous therapy, mainly on what is related to early detection of phlebitis. dESCRIpTORS: Intravenous infusions. Phlebitis. Nursing. Nursing care. Peripheral catheterization.Se trata de un estudio prospectivo para determinar la incidencia de flebitis en pacientes con cateter intravenoso periferico e identificar posibles asociaciones de esta complicacion con las variables relacionadas con el cateter intravenoso periferico. Se evaluaron setenta y seis pacientes adultos hospitalizados en el sector de enfermeria de un hospital universitario, mediante un formulario que contiene las variables relacionadas con los pacientes, el cateter intravenoso periferico y la terapia farmacologica. La flebitis fue evaluada de acuerdo a la clasificacion propuesta por la Infusion Nurses Society. Se utilizo la estadistica descriptiva e inferencial. La incidencia de flebitis fue del 25,8%, de los cuales, el 40% presento sintomas clinicos de dolor, con eritema y/o edema. Entre los pacientes con flebitis, el 60% desarrollo un episodio de complicacion, y el tiempo medio de permanencia del cateter intravenoso periferico con flebitis fue 3,10 dias. Se observo una relacion de la flebitis con la retirada de cateter intravenoso periferico por eventos adversos (p<0,001). Se necesitan acciones educativas y capacitacion del personal de enfermeria para el manejo de la terapia intravenosa, especialmente en lo que respecta a la deteccion temprana de flebitis.