RESUMEN

INTRODUCTION/AIM: Vitamin D plays a crucial role in immune modulation, which may influence the development of graft-versus-host disease (GvHD) in patients undergoing hematopoietic stem cell transplantation (HSCT). This study aims to evaluate the impact of vitamin D levels and supplementation on the incidence of GvHD in HSCT patients. METHODS: A narrative review was conducted across PubMed/Medline, Cochrane Library, CINAHL, and Embase databases. RESULTS: The reviewed studies indicated widespread vitamin D deficiency among HSCT patients, with baseline levels ranging from 12.8 to 29.2 ng/mL. Supplementation protocols varied significantly, with dosages ranging from 1000 IU/day to 60,000 IU/week. Post-supplementation levels improved in some studies. Studies exploring the relationship between vitamin D and GvHD showed mixed results. Lower baseline vitamin D levels were associated with an increased risk of acute GvHD in some studies, while others found no significant correlation. However, a significant association between low levels of vitamin D and the incidence of chronic GvHD was observed. CONCLUSION: Vitamin D deficiency is prevalent in HSCT patients and may influence the risk of developing chronic GvHD. Future research should focus on larger and more rigorous studies to determine the optimal role of vitamin D as an adjuvant therapy in the context of HSCT.

Asunto(s)

RESUMEN

BACKGROUND AND AIM: In patients with Diabetes Mellitus (DM), Enteral Nutrition (EN) is associated with less hyperglycemia and lower insulin requirements compared to Parenteral Nutrition (PN). The primary aim of this study was to assess changes in glycemic control (GC) in DM patients on EN therapy. The secondary objectives included evaluating the impact of the specialized formula on various clinical parameters and the tolerability of the nutritional formula by monitoring potential gastrointestinal side effects. METHODS: We report a case series on the effects of a Diabetes-Specific Formula (DSF) on GC, lipid profile (LP), and renal and hepatic function in a DM cohort receiving EN support. RESULTS: Twenty-two DM subjects with total dysphagia (thirteen men, nine women) on continuous EN were observed. The use of a DSF in EN was associated with an improvement in glycemic indices across all patients studied, leading to a reduction in average insulin demand. No hospitalizations were reported during the study period. CONCLUSION: The study demonstrated that the use of DSFs in a multi-dimensional home care management setting can improve glycemic control, reduce glycemic variability and insulin need, and positively impact the lipid profile of the DM cohort. The metabolic improvements were supported by the clinical outcomes observed.

Asunto(s)

RESUMEN

INTRODUCTION: Type 1 diabetes (T1D) is a disease that primarily occurs in pediatric populations. A school nurse (SN) can provide valuable support in the school setting for minors affected by this condition. METHODS: The main objective of this study was to evaluate the impact of nursing care provided to adolescents and children with T1D using technological devices in school. Qualitative and quantitative outcomes considered in the included studies were collected and discussed. A systematic review was conducted in the PubMed, CINAHL, and Scopus databases and reported thought the PRISMA guidelines. RESULTS: Eleven studies were included. The results showed that SNs need to enhance both their skills and organization to effectively manage young patients with T1D using technology. The response of both the pediatric population and their caregivers to the disease management by a SN has been positive. CONCLUSIONS: The management of chronic diseases is one of the most urgent public health issues, especially for Western healthcare systems. Proper management of patients with T1D at the school level is definitely an aspect that policymakers and healthcare managers should consider to improve the quality of life of this extremely vulnerable population, particularly those using technological management T1D.

RESUMEN

BACKGROUND: COVID-19 infection, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), quickly emerged as the most significant event of the new millennium. A balanced diet seems to ensure the proper functioning of the immune system and plays a fundamental role in the prevention of viral disease, inflammation, or thrombosis. The principal aim of this secondary study was to investigate the relationship between nutrients, lifestyle eating behaviors, and SARS-CoV-2 infection. METHODS: A narrative review was conducted in the PubMed-Medline database, analyzing primary studies. RESULTS: Our review identified 21 relevant studies: 13 focused on vitamins, 1 on omega-3 supplementation, 1 on probiotics, and 6 on lifestyle and dietary behaviors. Vitamin supplementation has shown promise in attenuating COVID-19 symptoms and reducing mortality risk. Specifically, vitamin D has demonstrated efficacy in enhancing immune responses among patients with the disease. While preliminary evidence suggests the potential benefits of omega-3 and probiotic supplementation in improving health outcomes for COVID-19 outpatients, further research is needed to solidify these findings. CONCLUSIONS: The lifestyle changes imposed by lockdown measures have adversely affected psychological well-being and exacerbated health issues associated with reduced physical activity and poor dietary habits.

RESUMEN

Background: Heat burns are a prevalent type of trauma. Rapid and effective treatment is crucial for deep burns to minimize complications. Autologous skin grafting is a highly effective treatment for full-thickness burns. A multidisciplinary team plays a vital role in managing burn patients undergoing skin grafting, from initial contact to outpatient follow-up. Case Summary: This case study involves a 56-year-old patient who suffered burns on 60% of his body following an alcohol explosion on an open flame. The patient underwent autologous skin grafting at a Major Burn Center. Initial symptoms included severe pain and immobility, but the patient remained alert and breathed spontaneously. The diagnosis was a loss of epidermis and dermis with burns covering 60-69% of the total body surface area (TBSA) and third-degree burns covering 10% TBSA. Post-discharge, the patient showed significant improvement, with complete healing of the grafts and partial resolution of other lesions. Six months after the intervention, the patient significantly improved his autonomy and mobility. Conclusions: This case highlights the importance of burn prevention and the critical role of multidisciplinary teams in the entire care pathway of burn patients. Appropriate diagnosis, complete treatment, and continuous multidisciplinary support are essential to prevent complications and ensure recovery.

Asunto(s)

RESUMEN

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a novel class of incretin mimetics for treating type 2 diabetes (T2D). This study evaluated the impact of semaglutide, the first oral GLP-1RA, on glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body composition and anthropometric parameters. Additionally, the effects on cardiovascular risk factors and quality of life (QoL) in T2D patients were assessed. Methods: A prospective observational study with a six-month follow-up was conducted. Clinical parameters, including HbA1c, FPG, anthropometric measurements, blood pressure, cardiovascular risk factors, Diabetes Treatment Satisfaction Questionnaire (DTSQ) responses, and Short Form (36) Health Survey (SF-36) responses, were collected at baseline (T0) and at six months (T1). Results: Sixty-one subjects were enrolled, with there being an average T2D duration of 4.67 ± 3.93 years. Significant decreases were observed in HbA1c (µ = -1.24; SD = 1.33; p < 0.05), FPG (µ = -31.01 mg/dL; SD = 41.71; p < 0.05), body composition and anthropometric parameters (p < 0.05), and cardiovascular risk factors (p < 0.05), with an increase in DTSQ scores (p < 0.05). Conclusions: The administration of 14 mg/day oral semaglutide improved several clinical parameters after six months of treatment. These findings suggest semaglutide is effective in improving glycemic control, weight management, and some cardiovascular risk factors in T2D patients.

RESUMEN

Subcutaneous once-weekly (ow) semaglutide is a recent treatment option for type 2 diabetes (T2D) and obesity, but real-world data on weight loss and associated changes in body composition, nutrients intake, and quality of life are still scarce. This observational, prospective clinical study involved all T2D patients starting ow semaglutide according to routine care between December 2021 and February 2022. Clinical information was collected after 6 months (T6) and 12 months (T12) from semaglutide initiation (T0). Bioelectrical Impedance Analysis (BIA) was performed to measure changes in body composition. Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the 36 - items Short Form Health Survey (SF-36) were administered as patient-reported outcomes (PROs). Changes in continuous endpoints (weight, body composition, nutrients intake, other clinical parameters, and PROs) were assessed using mixed models for repeated measurements. Overall, 90 patients (age 63.0 ± 10.0 years; diabetes duration 7.6 ± 5.9 years; 58.9% men; HbA1c 7.7 ± 1.1%; weight 95.4 ± 19.4 Kg, BMI 34.6 ± 6.4 Kg/m2; 36.7% naïve to diabetes treatment, 43.3% on metformin, 10.0% on dual oral therapy, and 10.0% treated with schemes including insulin) were included in the study. After 6 months from semaglutide initiation, body weight significantly decrease by -4.69 Kg (95%CI -6.19;-3.19) (primary endpoint). After 12 months, body weight was further reduced (-5.38 Kg; 95%CI -7.79;-2.97). At BIA, fat mass was significantly reduced by 2.1 Kg after 6 months but only slightly reduced after 12 months vs. baseline; lean mass was also significantly reduced by over 3 Kg both at 6 and 12 months. Intake of all nutrients declined in the first 6 months of therapy, although only lipids reduction reached the statistical significance (-6.73 g; p=0.02). Statistically significant improvements in BMI, waist circumference, glycemic control, blood pressure and lipid profile were documented. Satisfaction with treatment (DTSQ questionnaire) and mental health (MCS score of SF-36 questionnaire) significantly increased during the follow-up. The study documented real-world benefits of semaglutide for treating obesity in T2D subjects, with important changes on clinical and patient-reported outcomes. Loss of lean mass associated with weight loss warrants attention; parallel strategies to preserve skeletal muscle and improve physical function, i.e. nutritional education and structured exercise, are of great importance.

Asunto(s)

RESUMEN

Background: About one in 11 adults worldwide suffers from diabetic disease with constantly increasing prevalence; from the 529 million patients registered in 2021, the number of people with diabetes was predicted to rise to approximately 1.31 billion in 2050. In Italy, 5.9% of the population is diabetic, with a higher prevalence with increasing age and in the South of the country. Yoga and Mindfulness could represent a valid support for the care of diabetic subjects especially in a stressful caring context such as the Covid-19 pandemic. Study Design: A scoping review was conducted to achieve the goals of the study. Yoga or Mindfulness interventions on diabetic subjects were specifically analyzed and qualitative-quantitative data collected in the selected randomized controlled trials were extensive for possible meta-analysis. Methods: The review was conducted by two independent practitioners and a third one was consulted in case of conflict. The PRISMA method was used for both the selection and reporting of the studies to be included. Specific PICOS and search strategies have been developed on PubMed, Embase and PsycINFO databases. Included in the review were: randomised controlled trials, full dissertation articles and papers in English with a time limit on May 31, 2022. Results: The Review included 22 studies; 12 on Mindfulness, 9 on Yoga and one about both disciplines; among these, one studied patients with Type 1 Diabetes, 14 with Type 2 Diabetes, 6 with both and one with Gestational Diabetes. Only one paper studied adolescent subjects while the other 21 focused on a range of adult subjects. The studies showed that Yoga and Mindfulness have strong potential not only on stress management, but also on clinical-metabolic parameters. Conclusions: The recent Covid-19 pandemic has certainly redesigned a new way of treating and managing chronic diseases, such as diabetes. An increasingly fragile population, and with the growing need to reduce overall stress levels, could find alternative practices in Yoga and Mindfulness to support conventional therapies.

Asunto(s)

RESUMEN

Background: Childhood overweight and obesity represent serious public health concerns in several countries worldwide, including Italy, where the highest prevalence in Europe of overweight and obesity among primary school children was recorded. Among others, primary schools represent suitable social environments for health education projects. In this perspective, to optimize resources and plan successful activities, it is necessary, first of all, to analyze the context of the intervention. Study design: A pilot survey involving children and teachers was conducted in a primary school in Jesi (Le Marche Region, Italy). Methods: A questionnaire was submitted by teachers between May and June 2023 to 104 pupils (aged 6-11) from the five different primary school system classes. A qualitative questionnaire was also filled out by the same teachers (n = 5) who were present while the children were filling the eating/lifestyle questionnaire. Results: Most of the children (96.1%) had breakfast before school, with milk and cereal (51.5%) representing the preferred com-bination. During recess, 59.2% of pupils usually have a sandwich, 23.3% usually have sweet snacks, whereas only 2.9% have a fruit. Over 55% of the sample preferred drinking high-sugar beverages to water, and 15.5% declared going to a fast-food restaurant more than once a week. Over 17% of children did sport only once a week or less often. Over 64% of children habitually played videogames, and 77.6% normally watched TV or played with a tablet/smartphone while eating. Finally, the teachers' interview highlighted that there were no active health-related projects addressed to the pupils, and the school did not normally organize me-etings with health professionals to increase children's and their parents' knowledge and awareness about healthy eating habits. Conclusions: This preliminary investigation analyzed the context for a future health and nutrition education project and will assist researchers in planning successful activities and increasing the efficiency of the intervention.

Asunto(s)

RESUMEN

INTRODUCTION: Diabetes affects 425 million people worldwide (range 20-79 years). Of these, between 87% and 91% are affected by type 2 diabetes mellitus (DM2), and 79% live in medium/low income countries. OBJECTIVES: the main objective of the study was to observe, through the administration of specific questionnaires, the relationship existing between metabolic clinical parameters, quality of life of patients with DM2 and adherence to the MedDiet at first access to Diabetes Center in the period after the COVID-19 pandemic. The secondary objective was to observe the results obtained both qualitatively and quantitatively. MATERIALS AND METHODS: the study was a cross-sectional study. Two types of questionnaires were administered; the first (Medi-Lite) that expresses with specific score the level of "Mediterraneanness" diet while the second concerns the assessment of the SF-36 quality of life. Quantitative data such as biochemical and anthropometric parameters were collected and, through multiple regression, based on the method of least squares (OLS Model) and through the Gretl open source software were analyzed. RESULTS: fifty-two of the 90 patients at first access to the recruiting center in the period considered, met the inclusion criteria and and written consent. None of the estimated coefficients was statistically significant except Diastolic Blood Pressure (DBP), with a p-value < 0.0466. With an improvement in the level of "Mediterraneanness" there is a favorable relationship regarding creatinine, High-Density Lipoprotein (HDL), DBP and glycemia. CONCLUSIONS: The necessary post-COVID-19 territorial management cannot fail to take into consideration this new method of care which puts the patient and the community to which they belong at the center of the complex process of assistance.

Asunto(s)

RESUMEN

INTRODUCTION: the COVID-19 infection, caused by severe Coronavirus 2 syndrome (Sars-Cov-2), immediately appeared to be the most tragic global pandemic event of the twentieth century. Right from the start of the pandemic, diabetic patients treated with metformin experienced a reduction in mortality and complications from COVID-19 compared to those with different treatments or no treatment. Objective The main objective of the study was to observe the effects of metformin in hospitalized subjects infected with COVID-19. Specifically, the outcomes of hospitalization in Intensive Care Units or death were examined. Materials and Methods A specific research PICOS was developed and the Pubmed, Embase and Scopus databases were consulted down to April 30, 2022. To estimate the extent of the metformin effect and risk of severity in SARS-CoV-2 infection, the Odd Ratio (OR) with 95% Confidence Interval (CI) published by the authors of the selected systematic reviews was used. Results from five systematic reviews 36 studies were selected. The final meta-analysis showed that thanks to treatment with metformin, DM2 patients affected by COVID-19 had protection against risk of disease severity, complications (ES 0.80; 95% CI) and mortality (ES 0.69; 95% CI). Conclusions More in-depth studies on the use of metformin, compared to other molecules, may be required to understand the real protective potential of the drug against negative outcomes caused by COVID-19 infection in DM2 patients.

Asunto(s)

RESUMEN

Background: The SARS-CoV-2 pandemic (Severe Acute Respiratory Syndrome Coronavirus 2) and the worldwide health crisis have significantly changed both people's habits and lifestyles. Most of the studies found in the literature were carried out on specific professional categories in the socio-health sector, taking into consideration psychological disorders in relation to work. The purpose of this study was to analyze the psychological impact on a portion of the normal population subjected to lockdown. Methods: A questionnaire was distributed in the period between 23 March 2020 and 18 May 2020 (during Italian lockdown) using an online platform. The scales GAD-7, IES-r, PHQ-9 and MANSA were used to investigate the level of anxiety, the presence of post-traumatic stress disorder, the severity of depression and the perceived quality of life, respectively. Results: Four hundred and eight Italian subjects responded. Females and younger people were more affected by anxiety and depression. Post-traumatic stress disorder affected about 40% of the population sample, significantly young people and women, thus attesting to an important psychopathological response. About one-fifth of the sample population recorded an unsatisfactory quality of life. Conclusions: The results highlight the need to set up preventive interventions (primary and secondary), trying to focus on the most fragile group of subjects from a psychosocial point of view, in order to obtain a significant reduction in psychophysical damage in terms of relapses and outcomes.

Asunto(s)

RESUMEN

BACKGROUND: The recent COVID-19 pandemic has accelerated the treatment process through IT/technological supports, useful in the management of chronic patients such as those affected by type 1 Diabetes Mellitus (T1DM). Specific routes for fragile patients such as those with micro-infusers have been created thanks to the application of "Diabetes Technology," which allows patients to monitor blood glucose quickly and easily. The present pilot study aimed to assess the quality of care provided to patients with micro-infusers in a delicate phase such as a pandemic lockdown. MATERIALS AND METHODS: A mixed-methods approach was used. In the first part, with prior written consent, patients with insulin pumps enrolled voluntarily. In the second part, the focus group discussion (FGD) was carried out with the voluntarily enrolled participants. The FGD data were organized and analyzed by the thematic areas. RESULTS: The number of patients with afferent insulin pumps at the center was 50 individuals. Among them, 20 patients voluntarily joined the first part of the study by completing the PACIC questionnaire, which gave an average result of 3.34 (min. 2.2 and max. 4.2). In the second part, the application of the focus group technique demonstrated that technology is decisive in the management of diabetic pathology, not only in the emergency phase. CONCLUSIONS: At the time of public health crises, alternative strategies such as Tele-Nursing or Telemedicine could be crucial for the management of patients with micro-infuser not only in critical moments, such as lockdown, but also in ordinary health management.

Asunto(s)

RESUMEN

Patients with diabetes mellitus have been reported to be at a high risk of complications from SARS-CoV2 virus infection (COVID-19). In type 2 diabetes, there is a change in immune system cells, which shift from an anti-inflammatory to a predominantly pro-inflammatory pattern. This altered immune profile may induce important clinical consequences, including increased susceptibility to lung infections; and enhanced local inflammatory response. Furthermore, dipeptidyl peptidase 4 (DPP4) enzyme is highly expressed in the lung, and that it may have additional actions besides its effects on glucose metabolism, which might exert profound pro-inflammatory effects. We briefly review the impact on the inflammatory system of DPP4 for its possible detrimental effect on COVID-19 syndrome, and of DPP4 inhibitors (gliptins), currently used as glucose lowering agents, which may have the potential to exert positive pleiotropic effect on inflammatory diseases, in addition to their effects on glucose metabolism. Thanks to these ancillary effects, gliptins could potentially be "repurposed" as salutary drugs against COVID-19 syndrome, even in non-diabetic subjects. Clinical studies should be designed to investigate this possibility.

Asunto(s)

RESUMEN

Il diabete rappresenta una patologia in costante aumento: familiarità, età e stili di vita rappresentano i principali fattori di rischio per questa malattia e per le complicanze ad essa correlate. Considerando l'importanza del regime alimentare per la prevenzione e il trattamento di questa patologia, scopo del presente studio è stato quello di valutare le conoscenze alimentari di pazienti al primo accesso presso un centro di Diabetologia e di indagare sulla loro eventuale influenza su alcuni parametri ematici. È stato somministrato il questionario di Moynihan. La relazione tra i punteggi ottenuti e le variabili emoglobina glicata, BMI, glicemia a digiuno, è stata analizzata attraverso regressione multipla basata sul metodo dei minimi quadrati ordinari (modello OLS). Il response rate è stato del 73,3%. Il punteggio medio totale ottenuto dal questionario è stato di 23,61 ed è stata osservata una correlazione statisticamente significativa (p<0,0473) tra i migliori punteggi del questionario e i valori di Hb1Ac. Questo studio è il primo passo di un'indagine più ampia che verrà condotta nell'ottica di promuovere una formazione del paziente volta a verificare nel tempo le ricadute positive sulle scelte alimentari e sui parametri clinici.

Asunto(s)