Integrating Nursing–Teleophthalmology Improves Diabetic Retinopathy Screening in Primary Healthcare, Reducing Unnecessary Referrals to Specialist Healthcare Jacira Xavier de Carvalho, Fernando K. Malerbi, Silvia Ferreira Bortoto, Mozania Reis de Matos, Cristiane das Graças Dias Cavalcante, et al. International Journal of Nursing Practice, 2025 AimThis work aimed to evaluate the use of teleophthalmology by a primary healthcare nursing team for the diagnosis and referral for diabetic retinopathy to specialized healthcare in relation to numbers referred for specialized healthcare.MethodsIn this quantitative, cross‐sectional service evaluation study, participants with type 2 diabetes mellitus underwent a fundoscopy examination between February and June 2020. Using a portable retinal camera attached to a smartphone, nurses acquired fundus images that were stored on a cloud platform, enabling remote reading by a retinal specialist. The study was conducted at a primary healthcare urban centre on the outskirts of São Paulo, Brazil.ResultsThe study enrolled 779 participants, of whom 150 were identified as having diabetic retinopathy present; in another 434, evidence of diabetic retinopathy was absent, and 195 individuals (25%) were classified as having ungradable images. In total, 345 participants were referred for specialized appraisal, 150 of whom due to evidence of diabetic retinopathy and for another 195 participants owing to ungradable images. Thus, more than half of the imaged participants (56%) were not eligible for referral to specialist healthcare and remained treated in primary care.ConclusionsNursing–teleophthalmology integration reduced specialized healthcare referral numbers by more than half. This approach contributed to better triage with a more robust evaluation for diabetic retinopathy diagnostic suspicion, reducing unnecessary referral.
Screen Time and Hours of Sleep Influence the Estimate Risk of Diabetes Mellitus and Metabolic Syndrome in Healthy Young Males Carolina Costa-Santos, Gabriella Guarilha Costa Dias Mattar, Ronan Antonio Fuziwara, Jorge Alexandre de Araújo Peres, Márcia Silva Queiroz Metabolic Syndrome and Related Disorders, 2024 Objective: Screen time (ST) has shown negative effects on physical and mental health, with an increase in the prevalence of overweight, metabolic syndrome (MetS), and obesity. The time spent in front of the screens was also associated with higher odds of selecting indicators of cardiometabolic disease in adulthood. In view of this, the aim of this study was to identify the risk of MetS and type 2 diabetes mellitus (T2DM) in healthy young males and relate it to ST and sleep time. Methods: We evaluated physical and laboratory characteristics, dichotomous diagnosis criteria, and continuous scores to assess MetS and Finnish Diabetes Risk Score questionnaire to measure the T2DM risk. Results: The means of MetS dichotomous and continuous severity criteria, among individuals with <7 hr of sleep, were higher than those with adequate sleep. We did not observe a direct impact of ST on the risk of MetS; nevertheless, >8 hr of ST increased 1.22 points in the T2DM risk. Conclusion: Excessive ST increased the risk of T2DM, but not of MetS. Moreover, sleeping <7 hr was associated with a higher mean of dichotomous and continuous severity criteria for MetS.
Advances in separation methods for the use of platelet-rich fibrin in tissue repair: an integrative review General Dentistry, 2023
Could CA 19-9 be a useful biomarker in the diagnosis, prognosis, and prediction of adequate relief in lower urinary tract obstructions? MARCIA EMILIA FRANCISCO SHIDA, HUMBERTO DELLÊ, MARCIA SILVA QUEIROZ Revista do Colegio Brasileiro De Cirurgioes, 2022 Introduction: posterior urethral valves represent an important cause of childhood chronic kidney disease. The identification of biomarkers that indicate early kidney damage and even adequate clearance could reduce how many patients head towards kidney failure. Objective: this study evaluated how this easy-analysis biomarker (CA 19-9) could help identifying potential renal damage and adequate clearance in obstructive uropathies. Methods: 46 female Wistar rats were divided into 5 groups, with different patterns of partial urinary tract obstruction: group control; group OIV: infravesical obstruction; group OIVd: infravesical obstruction with reversion, obstruction relief 7 postoperative days later; group OUu: unilateral ureteral obstruction; group OUb: bilateral ureteral obstruction. The CA 19-9s performance was compared to another biomarker: Ngal. Determination of basal CA 19-9 and Ngal in urine and blood and serum creatinine levels was performed in the rats prior to surgery (T0) and after 14 days (T1). Group OIVd underwent intermediate (Ti) collection before clearance. Results: the urinary concentration of CA 19-9 increased in groups OIV, OIVd and OUb; elevation at T1 and Ti, reached statistical significance compared to the T0 value (p<0,05). Changes in urinary CA 19-9 were more expressive in infravesical obstruction groups (AUC 0.81). Obstruction relief in group OIVd promoted significant urinary CA 19-9 reduction (p<0,05) in the final evaluation. Conclusions: CA 19-9 urinary concentration increased in partial urinary tract obstruction. Its best performance was in the bladder neck obstruction group, in which the elevation was detected early (6 days after infravesical obstruction) and the CA19-9 urinary concentration declined after clearance.
Serum albumin modified by carbamoylation impairs macrophage cholesterol efflux in diabetic kidney disease Aécio Lopes de Araújo Lira, Monique de Fátima Mello Santana, Raphael de Souza Pinto, Carlos André Minanni, Rodrigo Tallada Iborra, et al. Journal of Diabetes and Its Complications, 2021 BACKGROUND AND AIMS Abnormalities in lipid metabolism, accumulation of uremic toxins and advanced glycation end products may contribute to worsening atherosclerosis. This study characterized the glycation and carbamoylation profile of serum albumin isolated from individuals with diabetic kidney disease and its influence on cholesterol efflux. MATERIAL AND METHODS 49 patients with type 2 diabetes (T2DM) and different eGFR evaluated glycation and carbamoylation profile by measurement of carboxymethyl lysine (CML) and carbamoylated proteins (CBL) in plasma by ELISA, homocitrulline (HCit) in plasma by colorimetry. In the isolated albumins, we quantified CBL (ELISA) and total AGE and pentosidine by fluorescence. Macrophages were treated with albumin isolated, and 14C-Cholesterol efflux mediated by HDL2 or HDL3 was measured. Kruskal-Wallis test, Jonckheere-Terpstra test and Brunner's posttest were used for comparisons among groups. RESULTS Determination of CML, HCit, CBL in plasma, as total AGE and pentosidine in albumins, did not differ between groups; however, CBL in the isolated albumins was higher in the more advanced stages of CKD (p=0.0414). There was reduction in the 14C-cholesterol efflux after treatment for 18h with albumin isolated from patients with eGFR<60mL/min/1.73m2 compared with control group mediated by HDL2 (p=0.0288) and HDL3 (p<0.0001), as well as when compared with eGFR ≥60mL/min/1.73m2 per HDL2 (p=0.0001) and HDL3 (p<0.0001). Treatment for 48h showed that eGFR<15mL/min/1.73m2 had a lower percentage of 14C-cholesterol efflux mediated by HDL2 compared to control and other CKD groups (p=0.0274). CONCLUSIONS Albumins isolated from individuals with T2DM and eGFR<60mL/min/1.73m2 suffer greater carbamoylation, and they impair the cholesterol efflux mediated by HDL2 and HDL3. In turn, this could promote lipids accumulation in macrophages and disorders in reverse cholesterol transport.
