RESUMO
Trypanosoma cruzi is the etiologic agent of Chagas disease, a parasitic disease of great medical importance on the American continent. Trypomastigote infection's initial step in a mammalian host is vital for the parasite's life cycle. A trypomastigote's surface presents many molecules, some of which have been proposed to be involved in the infection process, including a glycoprotein family called mucin-associated surface proteins (MASPs). This work describes a 49-kDa molecule (MASP49) that belongs to this family and is expressed mainly on the surfaces of amastigotes and trypomastigotes but can be found in extracts and the membrane-enriched fractions of epimastigotes. This protein is partially GPI-anchored to the surface and has a role during the internalization process, since its blockade with specific antibodies decreases parasite entry into Vero cells by 62%. This work shows that MASP49 binds to peritoneal macrophages and rat cardiomyocytes, undergoes glycosylation via galactose N-acetylgalactosamine, and can attach to the macrophage murine C-type lectin receptor (mMGL). These results suggest that MASP49 can be considered a virulence factor in T. cruzi, and a better understanding of its role in the infection process is necessary.
RESUMO
UNLABELLED: Long term diabetes self-management behaviors, and strict glycemic control are difficult to achieve in clinical practice. OBJECTIVE: Asesss two different reinforcement strategies for diabetes selfcare management, psychological distress and glycemic control in a one year follow up study. METHODS: 70 consecutive type 2 diabetic patients, were recruited and randomly assigned to three study groups. Subjects in the control group (CG) continued with their normal treatment schedule. The second group received a reinforcement course at 6 months (RCG) and in the third group, patients were contacted monthly by phone (PHCG) to promote self-management attitudes and address problems as they arose. A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up. RESULTS: At one year follow-up, the three groups significantly increased their diabetes-related knowledge. Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan (p=0.06 and 0.003). In addition, the PHCG significantly increased (p<0.0001) their adherence to pharmacological treatment. No significant differences were observed in glycemic control, prevalence of depression or diabetes related distress. CONCLUSIONS: Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors. Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Autocuidado , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pobreza , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate the psychosocial barriers to insulin use in low-income, type 2 diabetic patients; the clinical characteristics of these patients; and the possible causes of nonadherence to insulin regimens months after prescription. METHODS: We studied a prospective cohort of low-income patients with type 2 diabetes mellitus, aged 45 to 75 years, attending a tertiary health care center in Mexico City, Mexico. Patients were eligible if their diabetes was not controlled with oral agents, and they were excluded if they had type 1 diabetes mellitus, a secondary cause of diabetes, had been admitted to the hospital within the month before study commencement, had been previously treated with insulin, had severe diabetic complications, or had a chronic or disabling medical illness. All patients were prescribed 6 to 10 units of neutral protamine Hagedorn insulin before bedtime and received a referral to visit with a diabetes nurse educator. The main outcome was adherence or nonadherence to insulin therapy, and it was correlated with several variables including attitudes toward insulin, diabetes self-management, diabetes-related knowledge, depression, and diabetes-related distress. Brief medical history, complete battery of questionnaires, and laboratory workup were obtained at baseline and 1 to 3 months after insulin prescription. RESULTS: Twenty-nine consecutive patients were included. Mean age (+/- standard deviation) was 59 +/- 8 years, 18 (62%) were women, mean diabetes duration was 14 +/- 9 years, and mean hemoglobin A1c level was 10.8 +/- 1.4%. Negative attitudes toward insulin were very common, particularly in patients with less education and poorer diabetes-related knowledge (odds ratio, 6.2; 95% confidence interval, 1.04-47.3; P = .02). Even when they received precise recommendations, 12 patients (41%) did not adhere to insulin treatment. Patients who did not adhere to therapy were most commonly women and were depressed (P = .05). Improved adherence was significantly associated with the additional support of a diabetes nurse educator (odds ratio, 6.6; 95% confidence interval, 1.0-55.7; P = .02). CONCLUSIONS: Improving patient perception and acceptance of insulin with the help of diabetes educators can facilitate earlier and more aggressive intervention and thus optimize glycemic control.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adesão à Medicação/psicologia , Cooperação do Paciente/psicologia , Pobreza/psicologia , Idoso , Atitude Frente a Saúde , Estudos de Coortes , Depressão/psicologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Adesão à Medicação/etnologia , México , Pessoa de Meia-Idade , Cooperação do Paciente/etnologia , Pobreza/etnologia , Estudos Prospectivos , Estudos Retrospectivos , Autoimagem , Apoio Social , Inquéritos e QuestionáriosRESUMO
Antecedentes: Es difícil establecer conductas apropiadas de autocuidado y cumplir los objetivos terapéuticos en pacientes con diabetes tipo 2. El objetivo de esta investigación fue evaluar el impacto de dos estrategias de reforzamiento en el autocuidado de la diabetes, variables psicosociales y control glucémico a un año de seguimiento. Métodos: Se incluyeron 70 pacientes con diabetes tipo 2 asignados en forma aleatoria a tres grupos de estudio: grupo control (GC) que continuó con el programa habitual de tratamiento; un segundo grupo (GCR), que recibió un curso educativo después de seis meses; un tercer grupo (GRT), asignado a recibir llamadas telefónicas mensuales para promover conductas de autocuidado e intentar detectar y solucionar problemas. Se practicaron diversos cuestionarios y análisis de laboratorio al inicio y un año después. Resultados: Al año de seguimiento, los tres grupos mejoraron en forma significativa sus conocimientos en diabetes. Ambos grupos experimentales mejoraron su adherencia al plan de alimentación (p=0.06 y 0.003). El GRT también mejoró su adherencia al tratamiento farmacológico (p<0.0001). No se observaron cambios significativos en el control glucémico, prevalencia de depresión o disfunción emocional asociada a la diabetes. Conclusiones: Las estrategias de reforzamiento mejoran el autocuidado de la diabetes. Se requieren estudios a largo plazo para demostrar el impacto de estos beneficios en la calidad de vida y el logro de los objetivos terapéuticos.
Long term diabetes self-management behaviors, and strict glycemic control are difficult to achieve in clinical practice. OBJECTIVE: Asesss two different reinforcement strategies for diabetes selfcare management, psychological distress and glycemic control in a one year follow up study. METHODS: 70 consecutive type 2 diabetic patients, were recruited and randomly assigned to three study groups. Subjects in the control group (CG) continued with their normal treatment schedule. The second group received a reinforcement course at 6 months (RCG) and in the third group, patients were contacted monthly by phone (PHCG) to promote self-management attitudes and address problems as they arose. A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up. RESULTS: At one year follow-up, the three groups significantly increased their diabetes-related knowledge. Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan (p=0.06 and 0.003). In addition, the PHCG significantly increased (p<0.0001) their adherence to pharmacological treatment. No significant differences were observed in glycemic control, prevalence of depression or diabetes related distress. CONCLUSIONS: Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors. Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , /terapia , Educação de Pacientes como Assunto/métodos , Cooperação do Paciente , Autocuidado , Projetos Piloto , Pobreza , Estudos ProspectivosRESUMO
To examine the relationship between demographic, clinical and psychosocial variables and diabetes self-care management in Mexican type 2 diabetic patients. Cross-sectional study of 176 consecutive patients with type 2 diabetes aged 30-75 years, attending a tertiary health-care center in Mexico City. A brief medical history and previously validated questionnaires were completed. The study group consisted of 64 males/112 females, aged 55 +/- 11 years, mean diabetes duration of 12 +/- 8 years and HbA1c of 9.0 +/- 2.0%, 78.4% reported following the correct dose of diabetes pills or insulin, 58% ate the recommended food portions, and 44.3% did exercise three or more times per week. A good adherence to these three recommendations was observed in only 26.1% of the patients. These patients considered as a group were characterized by a greater knowledge about the disease (P < 0.00001), regular home blood glucose monitoring (P < 0.01), an inner perception of better diabetes control (P = 0.007), good health (P = 0.004) and better communication with their physician (P < 0.02). A poor adherence to two or the three main diabetes care recommendations was associated with a depressive state (OR 2.38, 95% CI 1.1-4.9, P < 0.01) and a history of excessive alcohol intake (OR 4.03, 95% CI 1.1-21.0, P = 0.03). Poor adherence to standard diabetes care recommendations is frequently observed in patients with type 2 diabetes attending a specialized health care center in Mexico City. Depression must be identified and treated effectively.