Is Diabetes a Risk Factor for a Severe Clinical Presentation of Dengue? - Review and Meta-analysis

Background

The mean age of acute dengue has undergone a shift towards older ages. This fact points towards the relevance of assessing the influence of age-related comorbidities, such as diabetes, on the clinical presentation of dengue episodes. Identification of factors associated with a severe presentation is of high relevance, because timely treatment is the most important intervention to avert complications and death. This review summarizes and evaluates the published evidence on the association between diabetes and the risk of a severe clinical presentation of dengue.

Methodology/Findings

A systematic literature review was conducted using the MEDLINE database to access any relevant association between dengue and diabetes. Five case-control studies (4 hospital-based, 1 population-based) compared the prevalence of diabetes (self-reported or abstracted from medical records) of persons with dengue (acute or past; controls) and patients with severe clinical manifestations. All except one study were conducted before 2009 and all studies collected information towards WHO 1997 classification system. The reported odds ratios were formally summarized by random-effects meta-analyses. A diagnosis of diabetes was associated with an increased risk for a severe clinical presentation of dengue (OR 1.75; 95% CI: 1.08–2.84, p = 0.022).

Conclusions/Significance

Large prospective studies that systematically and objectively obtain relevant signs and symptoms of dengue fever episodes as well as of hyperglycemia in the past, and at the time of dengue diagnosis, are needed to properly address the effect of diabetes on the clinical presentation of an acute dengue fever episode. The currently available epidemiological evidence is very limited and only suggestive. The increasing global prevalence of both dengue and diabetes justifies further studies. At this point, confirmation of dengue infection as early as possible in diabetes patients with fever if living in dengue endemic regions seems justified. The presence of this co-morbidity may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue.     

Isolation of Pseudobutyrivibrio ruminis and Pseudobutyrivibrio xylanivorans from rumen of Creole goats fed native forage diet

We isolated and identified functional groups of bacteria in the rumen of Creole goats involved in ruminal fermentation of native forage shrubs. The functional bacterial groups were evaluated by comparing the total viable, total anaerobic, cellulolytic, hemicellulolytic, and amylolytic bacterial counts in the samples taken from fistulated goats fed native forage diet (Atriplex lampa and Prosopis flexuosa). Alfalfa hay and corn were used as control diet. The roll tubes method increased the possibility of isolating and 16S rDNA gene sequencing allowed definitive identification of bacterial species involved in the ruminal fermentation. The starch and fiber contents of the diets influenced the number of total anaerobic bacteria and fibrolytic and amylolytic functional groups. Pseudobutyrivibrio ruminis and Pseudobutyrivibrio xylanivorans were the main species isolated and identified. The identification of bacterial strains involved in the rumen fermentation helps to explain the ability of these animals to digest fiber plant cell wall contained in native forage species.     

Mouse transient receptor potential channel 6: role in hemostasis and thrombogenesis

Although changes in the intracellular levels of calcium (Ca(2+)) are a central step in platelet activation, the underlying mechanism of Ca(2+) entry is still unclear. Previous studies have demonstrated that TRPC6, a member of the canonical transient receptor potential channel (TRPC) family is expressed in platelets in a significant amount, and is predominantly found on the plasma membrane. Based on these considerations, we hypothesized that TRPC6 plays a critical role in platelet function. To characterize the role of TRPC6 in platelet function in vivo, we employed a genetic approach, subjecting TRPC6 knockout mice to the tail bleeding time test and a carotid artery injury thrombosis model. We found that TRPC6-deficient animals displayed a prolonged bleeding time, and an increased time for occlusion of the injured carotid artery, compared to their wild-type littermates. Taken together, our data demonstrate for the first time, that TRPC6 deletion in mice results in defects in hemostasis and protection against thrombogenesis, suggesting a vital role in platelet function. Furthermore, TRPC6 may define a new therapeutic target for managing multiple thrombosis-based disorders.     

Apotransferrin decreases the response of oligodendrocyte progenitors to PDGF and inhibits the progression of the cell cycle

In the CNS, transferrin (Tf) is expressed by the oligodendroglial cells (OLGcs) and is essential for their development. We have previously shown that apotransferrin (aTf) accelerates maturation of OLGcs in vivo as well as in vitro. The mechanisms involved in this action appear to be complex and have not been completely elucidated. The aim of this study was to investigate if Tf participates in the regulation of the cell cycle of oligodendroglial progenitor cells (OPcs). Primary cultures of OPcs were treated with aTf and/or with different combinations of mitogenic factors. Cell cycle progression was studied by BrdU incorporation, flow cytometry and by the expression of cell cycle regulatory proteins. Apotransferrin decreased the number of BrdU+ cells, increasing the cell cycle time and decreasing the number of cells in S phase. The cell cycle inhibitors p27kip1, p21cip1 and p53 were increased, and in agreement with these results, the activity of the complexes involved in G1-S progression (cyclin D/CDK4, cyclin E/CDK2), was dramatically decreased. Apotransferrin also inhibited the mitogenic effects of PDGF and PDGF/IGF on OPcs, but did not affect their proliferation rate in the presence of bFGF, bFGF/PDGF or bFGF/IGF. Our results indicate that inhibition of the progression of the cell cycle of OPcs by aTf, even in the presence of PDGF, leads to an early beginning of the differentiation program, evaluated by different maturation markers (O4, GC and MBP) and by morphological criteria. The modulation by aTf of the response of OPcs to PDGF supports the idea that this glycoprotein might act as a key regulator of the OLGc lineage progression.     

Growth, soluble carbohydrates, and aloin concentration of Aloe vera plants exposed to three irradiance levels

Research was conducted on Aloe vera, a traditional medicinal plant, to investigate the effects of light on growth, carbon allocation, and the concentrations of organic solutes, including soluble carbohydrates and aloin. The plants were vegetatively propagated and grown under three irradiances: full sunlight, partial (30% full sunlight), and deep shade (10% full sunlight) for 12-18 months. After 1 year of growth, five plants from each treatment were harvested to determine total above- and below ground dry mass. Four plants from the full sunlight and the partial shade treatments were harvested after 18 months to assess the soluble carbohydrate, organic acid and aloin concentrations of the clear parenchyma gel and the yellow leaf exudate, separately. Plants grown under full sunlight produced more numerous and larger axillary shoots, resulting in twice the total dry mass than those grown under partial shade. The dry mass of the plants grown under deep shade was 8.6% that of plants grown under full sunlight. Partial shade increased the number and length of leaves produced on the primary shoot, but leaf dry mass was still reduced to 66% of that in full sunlight. In contrast, partial and deep shade reduced root dry mass to 28 and 13%, respectively, of that under full sunlight, indicating that carbon allocation to roots was restricted under low light conditions. When plants were sampled 6 months later, there were only minor treatment effects on the concentration of soluble carbohydrates and aloin in the leaf exudate and gel. Soluble carbohydrate concentrations were greater in the gel than in the exudate, with glucose the most abundant soluble carbohydrate. Aloin was present only in the leaf exudate and higher irradiance did not induce a higher concentration. Limitation in light availability primarily affected total dry mass production and allocation, without substantial effects on either primary or secondary carbon metabolites.     

Morphological changes of myelin sheaths in rats intracranially injected with apotransferrin

Previous findings from our laboratories indicate that the intracranial injection of apotransferrin (aTf) in neonatal rats produces an accelerated oligodendrocyte maturation and an enhanced production and deposition of myelin membranes in the brain. To evaluate the anatomical distribution and the morphological characteristics of the myelin in these rats, we analyzed the optic nerves, cerebellum, and selected areas of brain sections from aTf-treated and control rats by both light and electron microscopy. Microscopic identification of myelin using a specific staining procedure, showed that in aTf-injected rats, in coincidence with previous biochemical studies, there was an increased deposition of myelin in selected areas of the nervous system. Qualitative and quantitative analysis of electron micrographs from areas showing increased myelinaton, such as the optic nerves and the corpus callosum, showed that among other changes, the intracranial treatment with aTf produces ultrastructural evidences of myelin decompaction, consisting of an enlargement in the distance between adjacent major dense lines, a decreased density of the intraperiod line, and an increased electron density of the major dense line, accompanied by a significant increase in its width. The intracranial administration of aTf induces an increased deposition of myelin by oligodeudroglial cells (OLGc), and these myelin membranes, in spite of the changes in composition and in morphology, appear to function normally. Apotransferrin can be considered as a differentiation factor that could be used to stimulate remyelination in cases in which myelin has been destroyed by various pathological processes.     

Lipid and temperature dependence of the kinetic and thermodynamic parameters for active amino acid transport in Escherichia coli K1060

The influence of membrane physical state on the kinetic and thermodynamic parameters for the active transport systems for two amino acids has been investigated in Escherichia coli K1060, an unsaturated fatty acid auxotrophic mutant. The apparent Michaelis constant (Km) for the uptake of L-[14C]glutamine (0.05 to 0.08 microM) or L-[14C]proline (1 microM approx.) is invariant with temperature for this mutant grown on elaidate (18:1t), palmitelaidate (16:1t), oleate (18:1c), palmitoleate (16:1c) and linoleate (18:2c,c). Arrhenius plots of the maximum velocities (Vmax) for L-glutamine transport in cells grown on 16:1t, 18:1c and 16:1c are biphasic within a limited temperature range peculiar to each UFA supplementation. Above an upper temperature limit also displayed by 18:1t and 18:2c,c-cells, Vmax decreases with temperature. A characteristic temperature (Tb) marks the point of intersection of the biphasic slope of the Arrhenius plots, and activation energy (Ea) is lower above than below Tb. Differential thermal analysis considered with membrane lipid fatty acyl profiles indicates that the upper temperature limit is governed by both membrane lipid acyl chain fluidity and heterogeneity, while Tb is governed by fluidity alone. Data on L-proline transport Vmax are similar, but the upper temperature limit and Tb are each shifted to lower temperatures relative to L-glutamine. We suggest that membrane defects related to energy-coupling and caused by abnormal fluidity and physical state are responsible for the peculiar temperature dependences of Vmax for these active transport processes.     

Membrane-bound succinate dehydrogenase of Bacillus pumilus strain 5: effects of modulators of monoelectron transfer

The membrane-bound succinate dehydrogenase (SDH; EC 1.3.99.1) of Bacillus pumilus strain 5 was investigated as succinate:ferricyanide oxidoreductase activity at 27 degrees C. A Km of 8.3 x 10(-3) M was obtained, and the Vmax was 1.8 x 10(-6) mole succinate dehydrogenated min-1 mg-1 membrane protein, at a substrate (succinate) concentration below 40 x 10(-3) M. Above this succinate concentration the Km was 102 x 10(-3) M and the Vmax was 3.7 x 10(-6) mole succinate min-1 mg-1 membrane protein. Para-benzoquinone or 2,4-dinitrophenylhydrazine, in micromolar amounts inhibited the enzyme by serving as an electron sink. Hydroxyl radical (OH.) scavengers, mannitol and benzoate, activated the enzyme, while superoxide dismutase (SOD) had no effect on the enzyme. Thus, the mechanism of electron transfer from succinate to Fe(CN)3-(6) through SDH does not involve superoxide (O2-) as a rate-limiting intermediate.