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Although adult spontaneous (non-diabetic) hypoglycaemia is rare, its recognition is important for the preventative or curative treatment of the underlying cause. Establishing Whipple’s triad—low blood glucose, neuroglycopaenia and resolution of neuroglycopaenia on increasing blood glucose levels to normal or above—is essential to verify hypoglycaemia. Awareness that hypoglycaemia may occur in severely ill patients is important for its prevention. Further investigation in such cases is unnecessary unless another cause of hypoglycaemia is suspected. Patients are often asymptomatic and normoglycaemic at review. Their history of medication, self-medication, access to hypoglycaemic drugs, alcohol use and comorbidity may provide aetiological clues. The investigation involves obtaining blood samples during symptoms for laboratory glucose measurement or provoking fasting or postprandial hypoglycaemia as directed by symptoms. If confirmed, insulin, c-peptide, proinsulin and beta-hydroxybutyrate are analysed in hypoglycaemic samples. These will classify hypoglycaemia due to non-ketotic hyperinsulinaemia, non-ketotic hypoinsulinaemia and ketotic hypoinsulinaemia, and direct investigations to identify the underlying cause. There are, however, many pitfalls that may mislabel healthy individuals as “hypoglycaemic” or misdiagnose treatable or preventable causes of spontaneous hypoglycaemia. Clinical acumen and appropriate investigations will mostly identify hypoglycaemia and its cause.

Determinar las concentraciones de proteína de unión a los ácidos grasos cardíaca (HFABP) en pacientes con insuficiencia cardíaca con fracción de eyección reducida (ICFEr) y su potencial valor pronóstico.

O rugby é caracterizado pelo contato fí­sico intenso, exigindo força e estabilidade central. Déficits na estabilidade central resultam em técnicas ineficientes, deixando o atleta suscetí­vel a lesões. O objetivo do presente estudo foi analisar os efeitos de um programa de estabilização central sobre a flexibilidade, estabilidade do CORE e equilí­brio em atletas de rugby feminino. Participaram do estudo 10 atletas, submetidas a um programa de exercí­cios de 10 sessões. Como instrumentos de avaliação foram utilizados: Eight Hop Test (EHT) e Side Hop Test (SHT) para o equilí­brio; abaixamento da perna estendida para a estabilidade do CORE e o teste de sentar e alcançar no banco de Wells para a flexibilidade. Foram realizadas três avaliações: a primeira um dia antes do iní­cio do protocolo de exercí­cios, a segunda no dia seguinte a última sessão do programa e a terceira no oitavo dia após o término da intervenção. As atletas apresentaram melhora no EHT após a intervenção (p

O objetivo do presente estudo foi apontar as compensações comuns durante a realização do Overhead Squat (OS) em atletas de rugby, a fim de indicar exercí­cios corretivos para estas compensações A amostra foi composta por 28 atletas de rugby, sendo 19 homens (21,11 + 4,54 anos) e 9 mulheres (26,37 + 6,33 anos), com treinamento regular e sem lesões pregressas. O agachamento foi realizado, de forma padronizada, na maior amplitude de movimento possí­vel, mantendo os cotovelos estendidos com o bastão mantido acima da cabeça e a parte superior do corpo elevada o tempo todo, o exercí­cio foi filmado nos planos frontal e sagital. Para avaliar o movimento foram observadas as seguintes regiões corporais no plano frontal: pés e joelhos; e no sagital: calcanhares, quadris/coxas, tronco e braços. A pontuação foi atribuí­da da seguinte forma: 0 para execução falha ou não adequada e 1 para execução adequada, tendo como pontuação máxima 6 pontos. Os resultados indicam que os sujeitos apresentaram mediana de 4 pontos, sendo que dois atletas obtiveram pontuação máxima. Ademais, 84,7% da amostra apresentou ao menos 2 compensações, 67,9% apresentam inclinação do tronco fora da base de sustentação e 53,6% apresentam incapacidade de chegar a uma posição de coxa paralela ao solo. Os resultados indicam que a capacidade limitada de mobilidade no tornozelo e estabilidade de joelhos pode comprometer a profundidade do agachamento, assim como o encurtamento dos gastrocnêmicos e o déficit de força em glúteo máximo induzindo à inclinação excessiva do tronco durante a realização do OS.

To determine concentrations of heart-type fatty acid-binding protein (HFABP) in patients with heart failure with reduced ejection fraction (HFrEF) and its potential value for prognostic assessment.

Pénuries d’eau, inondations violentes, ruissellements intenses : face aux changements globaux, les territoires évoluent vers des trajectoires parfois en rupture avec celles du passé. Des informations fiables sont nécessaires pour le renouvellement des connaissances et la définition des politiques de prévention et de remédiation. Comment diversifier et multiplier les relais de terrain ? Les observations participatives, ne relevant plus uniquement de l’implication de professionnels, mais aussi de celle de citoyens novices, peuvent y contribuer.

We review the recent advance in the understanding of the optoelectronic properties of hexagonal boron nitride (hBN) in the deep ultraviolet. The comparison between bulk hBN and monolayer hBN highlights some of their major differences such the bandgap nature, the excitonic binding energy and the phonon-assisted broadening of the excitonic lines. Perspectives point out the relevance of addressing the regime of hBN samples made of a very few number of monolayers, including twisted hBN monolayers in the context of twistronics.

Objetivou-se caracterizar o perfil antropométrico e de desempenho fí­sico de duas categorias distintas da base de um clube de futebol. Compuseram a amostra 29 atletas da categoria sub-20 (17,89±1,69 anos de idade), e 22 atletas sub-17 (16,00±0,69 anos de idade). Para a caracterização antropométrica, foram aferidos valores de estatura, massa corporal, í­ndice de massa corporal (IMC) e percentual de gordura corporal (%GC). Para a avaliação de desempenho fí­sico, foram realizados testes de resistência aeróbia (Yo-Yo Intermittent Recovery), altura de salto sem (squat jump; SJ) e com contramovimento (countermovement jump; CMJ), e máxima velocidade em sprint de 10m (S10) e 20m (S20). As médias de estatura e massa corporal dos grupos sub-20 e sub-17 foram, respectivamente, 171,6+33,8 cm e 174,6+7,4 cm; e de 73,3+7,2 kg e 70,5+7,8 kg. Referente ao %GC, o grupo sub-20 apresentou média 8,8+3,04%, e de 10,1+2,67% para o sub-17. Quanto à altura de salto, no teste de SJ o grupo sub-20 apresentou média de 28,7+7,65 cm, e o grupo sub-17 de 28,0+7,24 cm. Já para o CMJ, a categoria sub-20 apresentou média de 32,6+7,14 cm, e a sub-17 de 30,0+6,02 cm. Em relação à resistência aeróbia máxima, sub-20 e sub-17 apresentaram, respectivamente, 3023,6+269,4 m, e 2946,3+249,4 m. No S10, o grupo sub-20 teve desempenho médio de 1,69+0,07s e o grupo sub-17 de 1,55+0,51s. No S20, valores semelhantes, com valores de 2,98+0,12s, para sub-20, e 2,99+0,09s para sub-17. Conclui-se que a categoria sub-20 apresentou valores superiores nas variáveis de massa corporal, IMC, SJ, CMJ, resistência aeróbia e S10.

Abstract Background Genotyping is a powerful tool for investigating outbreaks of infectious diseases and it can provide useful information such as identifying the source and route of transmission, and circulating strains involved in the outbreak. Genotyping techniques based on variable number of tandem repeats (VNTR) are instrumental in detecting heterogeneity in Mycobacterium ulcerans (MU) and also for discriminating MU from other mycobacteria species. Here, we describe and map the distribution of MU genotypes in Buruli ulcer (BU) endemic communities of the Nyong valley in Cameroon. We also tested the hypothesis of whether the suspected animal reservoirs of BU that share the human microhabitat are shedding contaminated fecal matters and saliva into their surrounding environments. Methods Environmental samples from suspected MU-risk factors and lesion swabs from human patients were sampled in BU-endemic communities and tested for the presence of MU by qPCR targeting three independent sequences (IS2404, IS2606, KR-B). Positive samples to MU were further genotyped by VNTR with confirmation by sequencing of four loci (MIRU1, Locus 6, ST1, Locus 19). Results MU was detected in environmental samples including water bodies (23%), biofilms (14%), detritus (10%), and in human patients (73%). MU genotypes D, W, and C were found both in environmental and human samples. The micro geo-distribution of MU genotypes from communities showed that genotype D is found both in environmental and human samples, while genotypes W and C are specific to environmental samples and human lesions, respectively. No obvious focal grouping of MU genotypes was observed at the community scale. An additional survey in the human microhabitat suggests that domestic and wild animals do not shed MU in their saliva and feces in sampled communities. Conclusions VNTR typing uncovered different MU genotypes circulating in the endemic communities of the Akonolinga district. A MU environmental genotype was found in patients, yet the mechanism of contamination remains to be investigated; and recovering MU in culture from the environment remains key priority to enable a better understanding of the mode of transmission of BU. We also conclude that excretions from suspected animals are unlikely to be major sources of MU in the Nyong Valley in Cameroon.

Deforestation for conventional farming has affected soil quality (SQ) worldwide. The goal of our study was to evaluate the impact of land use change, from forest to subsistence farming, on SQ in Benin. Composite soils from forest, horticultural, agricultural, fallow, and degraded lands were collected to analyze for chemical and physical properties. Using inductive additive approach and principal component analysis (PCA), generalized (SQIg) and minimum dataset SQ (SQIMDS) indices were calculated. Results showed that upon conversion of forest, total organic carbon (TOC) decreased by more than 2 folds in fallow and degraded soils. A similar impact was observed on total nitrogen (TN). Soil cation exchange capacity (CEC) and base saturation (BS) were significantly higher under horticulture than in degraded lands. In contrast, carbon protection capacity (CPC) was significantly higher by 12-41% in forest soils compared to the lowest in degraded soils. Among the land uses, aggregate stability index (ASI) was, by far, the lowest (3.2%) in degraded soils and highest (7.5%) in horticulture soils. Soils under fallow and degraded lands had SQIg decreased by 5 to 16%, when compared with forest, indicating a significant SQ degradation. In contrast, SQIg under horticulture increased by 5%, suggesting a similar or even an improvement in SQ comparable to the forest. The PCA-based SQIMDS significantly and positively accounted for 70% of the variability in SQIg with a non-significant biasness (6 ± 3.8% at p

BACKGROUND AND OBJECTIVES: Culturally diverse informal caregivers of community-dwelling persons with dementia face challenges in accessing dementia care resources due to language barriers and cultural stigmas surrounding dementia. This study presents the perceived intervention experiences of a home-based approach which considers the cultural and linguistic needs of diverse family caregivers in dementia care. The intervention model includes home visits by trained bilingual, non-licensed community health workers (CHWs) whose cultural histories and understandings reflect that of the caregivers. The purpose of the present study was to understand family caregivers experience in caregiving and their feedback on the intervention, which includes caregiver support through education and skill development. METHODS: The present study thematically analyzed qualitative data from exit interviews with caregivers who participated in a CHW-led, 12-week home visit-based intervention program. RESULTS: Among 57 caregivers (mean age = 63.5, SD = 14.3) who participated in the 3-month home-visit intervention and completed the exit interviews, 33% were Korean Americans, 28% Vietnamese Americans, 21% non-Hispanic Whites, and 17.5% Latino/Hispanic. The majority were females (81%) and spouses (51%). Main themes include, (a) Individual Level: Improvements in Caregiving Self-efficacy and Self-care Awareness, (b) Relational Level: Enhanced Communications and Relationships with Persons with Dementia, and (c) Community Level: Connection and Access to Community Resources and Support. CONCLUSION: Interview data show that the culturally and linguistically tailored program supported diverse caregivers by increasing self-care awareness, improving knowledge about dementia and dementia care, strengthening communication skills, and facilitating access to community resources. Strong rapport between CHWs and caregivers enhanced the effectiveness of the intervention. Future approaches can focus on supporting caregivers with especially limited resources.