This study was based on the hypothesis that IL-1β and its central regulator, the inflammasome, may play a role in the inflammatory condition exhibited by placental tissues from mothers with different gestational hyperglycemia levels. Pregnant women were classified according to the glycemic reference as non-diabetic (n = 15), mild gestational hyperglycemia (n = 15), gestational diabetes mellitus (n = 15) and type 2 diabetes mellitus (n = 15). We investigated levels of pro-inflammatory factors in maternal plasma and placental tissues (by ELISA or immunohistochemistry) and, NFKB activity (by electrophoretic mobility shift assay) and inflammasome protein expression (by Western blot) in chorionic villous. Maternal plasma and placental levels of inflammatory factors (IL-1β, IL-6, and MCP-1) were increased during all hyperglycemic conditions. Villous stroma cells showed strong immunoreactivity to CD68. In addition, with syncytiotrophoblast, the villous stroma cells were also stained to detect iNOS, MCP-1, TLR2, and TLR4. Although the levels of protein had fluctuated in the groups, NLRP1, NLRP3, ASC, and Caspase 1 were up-regulated in all hyperglycemic groups suggesting the inflammasome may be assembled in these pregnant women. The NFKB activity also exhibited higher levels in hyperglycemic groups, which might imply in pro-inflammatory cytokines production. In summary, increased maternal glucose levels during pregnancy changed systemic and placental inflammatory patterns, which occurred in parallel with the expression of inflammasome factors and processing and secretion of the pro-inflammatory cytokine IL-1β. These results suggest an inflammatory condition in all gestational hyperglycemic conditions, even in hyperglycemia that is less severe than gestational or overt diabetes, likely associated with inflammasome activation and inflammatory cytokine secretion. Inflammasome activation as a possible source of inflammatory factors may be an important target to be considered while managing hyperglycemia and preventing adverse pregnancy outcomes.
Background: Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis. Methods: We prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from "The Study of Stroke Mortality and Morbidity" (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level). Results: We found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype. Conclusions: For ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.
Introdu��o: O Diabetes mellitus tipo 1 (DM1) � uma disfun��o cr�nica do metabolismo de carboidratos, lip�dios e prote�nas, ocasionada pela morte das c�lulas � do p�ncreas, culminando na aus�ncia da produ��o de insulina e consequente hiperglicemia. Para manter a qualidade de vida, este paciente deve administrar an�logos de insulina humana, via intrad�rmica, o que culmina em diversos efeitos colaterais. Dentre as insulinas mais modernas no mercado, a Degludeca (IDeg) � um an�logo de a��o ultralonga, promissor no tratamento de pacientes acometidos por DM1. Objetivo: Realizar uma revis�o integrativa sobre os efeitos da IDeg no paciente portador de DM1. M�todo: Foram pesquisados os efeitos metab�licos dos principais tipos de insulinas administradas no organismo de portadores do Diabetes Mellitus do tipo I, atrav�s de revis�o bibliogr�fica por e-books e artigos cient�ficos dos �ltimos 5 anos, escolhidos e selecionados em bancos de dados. Resultados: � poss�vel observar grande efic�cia dos efeitos da IDeg em pacientes DM1. Pode-se destacar a redu��o significativa da hipoglicemia noturna e diminui��o da dose aplicada, com faixa terap�utica superior a outros an�logos, al�m da diminui��o dos n�veis de HbA1c. Conclus�o: Moderna e promissora, a IDeg promove o controle glic�mico ideal e adequado para efic�cia no tratamento de pacientes DM1.
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