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Unconventional food plants, popularized in Brazil as PANC, remain underutilized globally. In that sense, this study aims to explore the nutritional and functional properties of taioba (Xanthosoma sagittifolium), a plant with edible leaves and tubers, and to investigate its potential for industrial-scale application as a source of starch. A systematic review was carried out and meta-analysis following the PRISMA guidelines was conducted based on a random effects synthesis of multivariable-adjusted relative risks (RRs). The searches were carried out in seven search sources, among which were Web of Science, Elsevier's Science Direct, Wiley Online Library, Springer Nature, Taylor & Francis, Hindawi, Scielo, ACS-American Chemical Society, and Google Scholar. The systematic review was guided by a systematic review protocol based on the POT strategy (Population, Outcome, and Types of studies), adapted for use in this research. Mendeley was a resource used for organization, to manage references, and to exclude duplicates of studies selected for review. The findings revealed that taioba leaves are abundant in essential nutrients, proteins, vitamins, and minerals. Additionally, the tubers offer rich starch content along with vitamins and minerals like iron, potassium, and calcium, making them an ideal substitute for conventional sources on an industrial scale. This research highlights the significance of studying the functionalities, applicability, and integration of this PANC in our diets, while also emphasizing its capability as a substitute for traditional starch varieties. Moreover, exploiting this plant's potential adds value to Amazonian resources, reduces import costs, and diversifies resource utilization across multiple industrial sectors.
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The Brazilian superfruit called Açaí or Assaí has gained interested from researcher and consumers worldwide, due to its health-related properties. In this context, this pioneering study aimed to compare the physicochemical, nutritional, and thermal properties of vegetable oils obtained from two varieties of açaí (Euterpe oleracea), purple and white. Both açaí oils from white (WAO) and purple (PAO) varieties were obtained by using the conventional solid-liquid extraction, which resulted in oil yields ranging from 52 to 61%. WAO and PAO were analyzed by their edibility quality parameters given the recommendations from Codex Alimentarius; their nutritional functionality indices and their composition of fatty acids and triglycerides content were estimated. Both oils showed low levels of acidity and peroxides, <1.8 mg KOH g-1 and < 1.7 mEq kg-1, respectively, which are good indicators of their preservation status, agreeing with the food regulations. PAO and WAO showed differences among the composition of fatty acids, mainly related to the content of monounsaturated fatty acids (MUFAs), which were 62.5 and 39.5%, respectively, mainly oleic acid. Regarding the polyunsaturated fatty acids (PUFAs), the WAO showed up to 23% of linoleic acid, whereas the PAO exhibited up to 11% of it. These differences reflect on the values of the nutritional functionality indices, atherogenic (AI), thrombogenic (IT), and hypocholesterolemic/hypercholesterolemic ratio (H/H). Both PAO and WAO showed low levels of AI and TI and superior values of H/H than other oilseeds from the literature. These results indicate the nutritional properties of açaí oils regarding a potential cardioprotective effect when included in a regular dietary intake. The thermogravimetric behavior and the evaluation of oxidation status by infrared spectroscopy (FTIR) were also studied. Both açaí oils demonstrated higher thermal stability (with an onset temperature ranging from 344 to 350 °C) and low indications of oxidation status, as no chemical groups related to it were noted in the FTIR spectrum, which agrees with the determined acidity and peroxide content. Moreover, the FTIR analysis unveiled characteristic chemical groups related to fatty acids and triglycerides, agreeing with the literature reports. These findings collectively contribute to a deeper comprehension of the nutritional and functional properties between white and purple açaí oils, offering valuable insights into their potential health, food, and industrial applications.
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Epidemiological studies have shown that a diet rich in bioactive components significantly reduces cardiovascular disease incidence and mortality. In this sense, there is a need for meta-analytical research that confirms this phenomenon and increases specific knowledge about certain bioactive compounds such as carotenoids. Thus, this systematic review and meta-analysis aim to disseminate knowledge about the sources of carotenoids in fruit consumed in the north of Brazil which are outside the Brazilian trade balance. A systematic review and a meta-analysis following the PRISMA guidelines were conducted based on a random effects synthesis of multivariable-adjusted relative risks (RRs). Searches of seven sources were carried out, including PubMed, Science Direct from Elsevier, Web of Science, Scielo, Eric Research and Google Scholar databases. The systematic review was guided by a systematic review protocol based on the POT strategy (population, outcome and type of study) adapted for use in this research. Mendeley was a resource used to organize and manage references and exclude duplicates of studies selected for review. In this review, we present the potential bioactive compounds concentrated in little-known fruit species from the Amazon and their benefits. Consuming fruits that are rich in notable constituents such as carotenoids is important for the prevention of chronic non-communicable diseases through anti-inflammatory and anticoagulant properties, as well as antivirals, immunomodulators and antioxidants agents that directly affect the immune response.
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Carotenoides , Frutas , Humanos , Antioxidantes/química , Antioxidantes/farmacología , Brasil/epidemiología , Carotenoides/química , Conducta Alimentaria , Frutas/química , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & controlRESUMEN
The physical and functional interaction between transient receptor potential channel ankyrin 1 (TRPA1) and neuronal calcium sensor 1 (NCS-1) was assessed. NCS-1 is a calcium (Ca2+) sensor found in many tissues, primarily neurons, and TRPA1 is a Ca2+ channel involved not only in thermal and pain sensation but also in conditions such as cancer and chemotherapy-induced peripheral neuropathy, in which NCS-1 is also a regulatory component.We explored the interactions between these two proteins by employing western blot, qRT-PCR, co-immunoprecipitation, Ca2+ transient monitoring with Fura-2 spectrophotometry, and electrophysiology assays in breast cancer cells (MDA-MB-231) with different levels of NCS-1 expression and neuroblastoma cells (SH-SY5Y).Our findings showed that the expression of TRPA1 was directly correlated with NCS-1 levels at both the protein and mRNA levels. Additionally, we found a physical and functional association between these two proteins. Physically, the NCS-1 and TRPA1 co-immunoprecipitate. Functionally, NCS-1 enhanced TRPA1-dependent Ca2+ influx, current density, open probability, and conductance, where the functional effects depended on PI3K. Conclusion: NCS-1 appears to act not only as a Ca2+ sensor but also modulates TRPA1 protein expression and channel function in a direct fashion through the PI3K pathway. These results contribute to understanding how Ca2+ homeostasis is regulated and provides a mechanism underlying conditions where Ca2+ dynamics are compromised, including breast cancer. With a cellular pathway identified, targeted treatments can be developed for breast cancer and neuropathy, among other related diseases.
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Neoplasias de la Mama , Proteínas Sensoras del Calcio Neuronal , Neuropéptidos , Canal Catiónico TRPA1 , Femenino , Humanos , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Calcio/metabolismo , Señalización del Calcio , Línea Celular Tumoral , Proteínas Sensoras del Calcio Neuronal/metabolismo , Proteínas Sensoras del Calcio Neuronal/genética , Neuronas/metabolismo , Neuronas/efectos de los fármacos , Neuropéptidos/metabolismo , Neuropéptidos/genética , Fosfatidilinositol 3-Quinasas/metabolismo , Transducción de Señal , Canal Catiónico TRPA1/metabolismo , Canal Catiónico TRPA1/genéticaRESUMEN
ABSTRACT The genus Curicta Stål comprises aquatic insects commonly known as water scorpions and typically occurs in habitats associated with marginal mud. It is exclusively distributed in the New World, with 17 species recorded in the Neotropical Region, including 12 in Brazil. In the state of Maranhão, only one species, Curicta montei De Carlo, has been documented to date. Thus, this study aims to explore the diversity of Curicta in the state of Maranhão. A total of 124 specimens were collected, representing three species: Curicta granulosa De Carlo, C. johnpolhemi Keffer, and C. montei. Notably, C. johnpolhemi and C. granulosa are reported here as new distribution records for the state of Maranhão. Previously described based solely on a single female, our investigation of C. johnpolhemi enabled the description of the male, providing additional taxonomic insights for the species. Photographs of one specimen from each species are provided and diagnostic features are illustrated.
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Introduction: Long-term pulmonary dysfunction (L-TPD) is one of the most critical manifestations of long-COVID. This lung affection has been associated with disease severity during the acute phase and the presence of previous comorbidities, however, the clinical manifestations, the concomitant consequences and the molecular pathways supporting this clinical condition remain unknown. The aim of this study was to identify and characterize L-TPD in patients with long-COVID and elucidate the main pathways and long-term consequences attributed to this condition by analyzing clinical parameters and functional tests supported by machine learning and serum proteome profiling. Methods: Patients with L-TPD were classified according to the results of their computer-tomography (CT) scan and diffusing capacity of the lungs for carbon monoxide adjusted for hemoglobin (DLCOc) tests at 4 and 12-months post-infection. Results: Regarding the acute phase, our data showed that L-TPD was favored in elderly patients with hypertension or insulin resistance, supported by pathways associated with vascular inflammation and chemotaxis of phagocytes, according to computer proteomics. Then, at 4-months post-infection, clinical and functional tests revealed that L-TPD patients exhibited a restrictive lung condition, impaired aerobic capacity and reduced muscular strength. At this time point, high circulating levels of platelets and CXCL9, and an inhibited FCgamma-receptor-mediated-phagocytosis due to reduced FcγRIII (CD16) expression in CD14+ monocytes was observed in patients with L-TPD. Finally, 1-year post infection, patients with L-TPD worsened metabolic syndrome and augmented body mass index in comparison with other patient groups. Discussion: Overall, our data demonstrated that CT scan and DLCOc identified patients with L-TPD after COVID-19. This condition was associated with vascular inflammation and impair phagocytosis of virus-antibody immune complexes by reduced FcγRIII expression. In addition, we conclude that COVID-19 survivors required a personalized follow-up and adequate intervention to reduce long-term sequelae and the appearance of further metabolic diseases.
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PURPOSE: Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated. METHODS: All patients were selected prospectively from a multicenter registry of adults hospitalized with confirmed COVID-19. Cases had hypertension and myocardial injury, defined by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantified and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury. RESULTS: The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fluorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38-cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR-CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated significantly with myocardial injury. CONCLUSION: Our findings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.
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Linfocitos T CD8-positivos , COVID-19 , Adulto , Humanos , ADP-Ribosil Ciclasa 1 , COVID-19/complicaciones , Antígenos HLA-DR , Biomarcadores , Activación de LinfocitosRESUMEN
The development of biobased antioxidant active packaging has been valued by the food industry for complying with environmental and food waste concerns. In this work, physicochemical properties for chitosan composite films as a potential active food packaging were investigated. Chitosan films were prepared by solution casting, plasticized with a 1:2 choline chloride: glycerol mixture as a deep eutectic solvent (DES) and incorporated with 0-10% of optimized açaí oil polyelectrolyte complexes (PECs). Scanning electron microscopy and confocal laser scanning microscopy revealed that the chitosan composite films were continuous and contained well-dispersed PECs. The increased PECs content had significant influence on the thickness, water vapor permeability, crystallinity (CrD) and mechanical and dynamic behavior of the films, as well as their antioxidant properties. The tensile strength was reduced in the following order: 11.0 MPa (control film) > 0.74 MPa (5% DES) > 0.63 MPa (5% DES and 5% PECs). Films containing 2% of PECs had an increased CrD, ~6%, and the highest elongation at break, ~104%. Films with 1% of PECs displayed the highest antioxidant properties against the ABTS and DPPH radicals, ~6 and ~17 mg TE g-1, respectively, and highest equivalent polyphenols content (>0.5 mg GAE g-1). Films with 2% of particles were not significantly different. These results suggested that the chitosan films that incorporated 1-2% of microparticles had the best combined mechanical and antioxidant properties as a potential material for food packaging.
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Quitosano , Eliminación de Residuos , Antioxidantes/química , Quitosano/química , Embalaje de Alimentos/métodos , Disolventes Eutécticos Profundos , Cápsulas , Alimentos , PermeabilidadRESUMEN
In utero hematopoietic cell transplantation (IUHCT) is an experimental treatment for congenital hemoglobinopathies, including Sickle cell disease and thalassemias. One of the principal advantages of IUHCT is the predisposition of the developing fetus toward immunologic tolerance. This allows for engraftment across immune barriers without immunosuppression and, potentially, decreased susceptibility to graft-versus-host disease (GVHD). We demonstrate fetal resistance to GVHD following T cell-replete allogeneic hematopoietic cell transplantation compared with the neonate. We show that this resistance is associated with elevated fetal serum interleukin-10 conducive to the induction of regulatory T cells (Tregs). Finally, we demonstrate that the adoptive transfer of Tregs from IUHCT recipients to neonates uniformly prevents GVHD, recapitulating the predisposition to tolerance observed after fetal allotransplantation. These findings demonstrate fetal resistance to GVHD following hematopoietic cell transplantation and elucidate Tregs as important contributors.
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Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Humanos , Recién Nacido , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/prevención & control , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Tolerancia Inmunológica , Feto , Linfocitos T ReguladoresRESUMEN
Biofilms are complex tri-dimensional structures that encase microbial cells in an extracellular matrix comprising self-produced polymeric substances. The matrix rich in extracellular polymeric substance (EPS) contributes to the unique features of biofilm lifestyle and structure, enhancing microbial accretion, biofilm virulence, and antimicrobial resistance. The role of the EPS matrix of biofilms growing on biotic surfaces, especially dental surfaces, is largely unravelled. To date, there is a lack of a broad overview of existing literature concerning the relationship between the EPS matrix and the dental implant environment and its role in implant-related infections. Here, we discuss recent advances in the critical role of the EPS matrix on biofilm growth and virulence on the dental implant surface and its effect on the etiopathogenesis and progression of implant-related infections. Similar to other biofilms associated with human diseases/conditions, EPS-enriched biofilms on implant surfaces promote microbial accumulation, microbiological shift, cross-kingdom interaction, antimicrobial resistance, biofilm virulence, and, consequently, peri-implant tissue damage. But intriguingly, the protagonism of EPS role on implant-related infections and the development of matrix-target therapeutic strategies has been neglected. Finally, we highlight the need for more in-depth analyses of polymicrobial interactions within EPS matrix and EPS-targeting technologies' rationale for disrupting the complex biofilm microenvironment with more outstanding translation to implant applications in the near future.
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Antiinfecciosos , Implantes Dentales , Humanos , Biopelículas , Matriz Extracelular , Matriz Extracelular de Sustancias PoliméricasRESUMEN
Após um longo e acidentado percurso, perfilado pelas repercussões de um período pandêmico (uma situação de crise planetária), coloca-se à disposição essa coletânea de escritos produzidos a partir do convite para compartilhar experiências de atenção a pessoas em situação de crise, na perspectiva da Atenção Psicossocial, em territórios do semiárido nordestino, mais especificamente, no Vale do Médio São Francisco. Este livreto, chamado assim por intuito afetivo e jamais por uma avaliação de sua qualidade ou mesmo tamanho, ganhou um nome que busca expressar seu eixo de sustentação: a (re)afirmação da potência do encontro para produzir caminhos de abertura e de expansão de vida na produção do cuidado Encontro e acolhimento em territórios vivos: narrativas para repensar tecnologias de cuidado a pessoas em crise na Atenção Psicossocial. Trata-se de uma produção coletiva, visceralmente polifônica, germinada a partir do desejo compartilhado de fazer circular outras narrativas e vozes em torno do cuidado a pessoas em situação de crise. Assume-se como um fruto de agenciamentos coletivos diversos, em um país em que as atualizações da colonização sofrida (e jamais devidamente reparada) são vívidas, inclusive nos modos de pensar e produzir saúde. Destaca-se, assim, sua intencionalidade de contribuir para reposicionar ou mesmo extrapolar a captura do campo da saúde pela racionalidade biomédica, reconhecendo seus limites e efeitos iatrogênicos, especialmente em um contexto contemporâneo, marcado brutalmente pela medicalização da vida. Como destacado por Sandra Fagundes, no prefácio do livreto: "No correr dos contos, como no Grande Sertão Veredas, de Guimaraes Rosa, a vida embrulha tudo. A vida é assim, esquenta e esfria, aperta e daí afrouxa, sossega e depois desinquieta. O que ela quer da gente é coragem. O cuidado em liberdade, o que requer é ancoragem: suporte para o insuportável, impensável, indizível e para a potência".
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Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Autocuidado , Intervención en la Crisis (Psiquiatría) , Rehabilitación Psiquiátrica , TelerrehabilitaciónRESUMEN
BACKGROUND: Contemporary living conditions present opportunities that promote obesity. In addition, traditional nutritional intervention have been considered inefficient, and there is a demand for the development and evaluation of strategies not based on the traditional paradigm of diets. AIM: The aim of this study is to describe the Food and Nutrition Education Program with Sensory and Cognitive Exercises (PESC), which seeks to promote consciousness of eating experience and body signals appreciation to adult women and thus to make them less vulnerable to food consumption stimuli. METHOD: This protocol outlines a randomized study that will include 60 adult women. PESC is based on the sensory influence for eating behavior and on the Triple-Aspect Monism theory of consciousness. It is composed of exercises that explore sensory, cognitive and emotional aspects of food experience in order to promote it into a conscious process. The program consists of four weekly workshops that explore themes related to the current obesogenic environment problematic. The intervention group (n=30) will be evaluated at the beginning of the first workshop and after the last one. The control group (n=30) will not participate on the workshops and will be evaluated twice, with a one-month interval. CONCLUSIONS: This study will contribute substantially to the development of nutritional interventions based on sensory aspects and consciousness of food experience. Therefore, PESC is considered an innovative approach with regard to improving individuals' eating behavior. TRIAL REGISTRY: This clinical trial was registered with the Brazilian Registry of Clinical Trials (ReBEC), http://www.ensaiosclinicos.gov.br/rg/RBR-4qgpg5/,numberRBR-4qgpg5.
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Estado de Conciencia , Alimentos , Adulto , Ejercicio Físico , Conducta Alimentaria/psicología , Femenino , Educación en Salud/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Chitosan is a versatile biomolecule with a broad range of applications in food and pharmaceutical products. It can be obtained by the alkaline deacetylation of chitin. This biomolecule can be extracted using conventional or green methods from seafood industry residues, e.g., shrimp shells. Chitin has limited applications because of its low solubility in organic solvents. Chitosan is soluble in acidified solutions allowing its application in the food industry. Furthermore, biological properties, such as antioxidant, antimicrobial, as well as its biodegradability, biocompatibility and nontoxicity have contributed to its increasing application as active food packaging. Nevertheless, some physical and mechanical features have limited a broader range of applications of chitosan-based films. Green approaches may be used to address these limitations, leading to well-designed chitosan-based food packaging, by employing principles of a circular and sustainable economy. In this review, we summarize the properties of chitosan and present a novel green technology as an alternative to conventional chitin extraction and to design environmentally friendly food packaging based on chitosan.
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Quitosano , Quitina/química , Embalaje de Alimentos , Residuos Industriales , Alimentos MarinosRESUMEN
Polymicrobial infection is the main cause of dental implant failure. Although numerous studies have reported the ability of titanium (Ti) surface modifications to inhibit microbial adhesion and biofilm accumulation, the majority of solutions for the utilization of Ti antibacterial surfaces have been testedin in vitro and animal models, with only a few developed surfaces progressing into clinical research. Motivated by this huge gap, we critically reviewed the scientific literature on the existing antibacterial Ti surfaces to help understand these surfaces' impact on the "puzzle" of undesirable dental implant-related infections. This manuscript comprises three main sections: (i) a narrative review on topics related to oral biofilm formation, bacterial-implant surface interactions, and on how implant-surface modifications can influence microbial accumulation; (ii) a critical evidence-based review to summarize pre-clinical and clinical studies in an attempt to "fit pieces into the puzzle" to unveil the best way to reduce microbial loads and control polymicrobial infection around dental implants showed by the current in vivo evidence; and (iii) discussion and recommendations for future research testing emerging antibacterial implant surfaces, connecting basic science and the requirements for future clinical translation. The findings of the present review suggest no consensus regarding the best available Ti surface to reduce bacterial colonization on dental implants. Smart release or on-demand activation surface coatings are a "new piece of the puzzle", which may be the most effective alternative for reducing microbial colonization on Ti surfaces, and future studies should focus on these technologies.
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Coinfección , Implantes Dentales , Animales , Adhesión Bacteriana , Biopelículas , Propiedades de Superficie , TitanioRESUMEN
The higher cariogenicity of human milk when compared with bovine milk is still a debatable subject. Therefore, we evaluated the effect of human or bovine milk exposure on biofilm composition and enamel demineralization using a validated cariogenic biofilm model. Streptococcus mutans UA159 biofilms (n = 8) were grown on human saliva-coated bovine enamel slabs of known surface hardness. The biofilms were exposed 8×/day to 0.9% NaCl (negative control), human milk, bovine milk, 7.0% lactose (active human milk control), 4.5% lactose (active bovine milk control), or 10% sucrose (positive control). The culture medium was changed twice daily, and the pH was analyzed as an indicator of biofilm acidogenicity. After 120 h of growth, biofilms were harvested to evaluate viable cells, and soluble and insoluble extracellular polysaccharides (EPS). Enamel demineralization was assessed by the percentage of surface hardness loss (%SHL). Data were analyzed by one-way ANOVA/Tukey's test (α = 5%). In terms of %SHL, negative control (7.7 ± 3.1), human milk control (13.3 ± 7.5), bovine milk control (15.3 ± 8.2), human milk (7.5 ± 5.0), and bovine milk (8.7 ± 6.3) did not differ among them (p > 0.05) but differed (p < 0.05) from sucrose (55.1 ± 5.4). The findings of enamel demineralization (%SHL) were statistically supported by the data of biofilm acidogenicity, bacterial counts and EPS biofilm composition. This experimental study suggests that human and bovine milk have low cariogenic potential to provoke caries lesions in enamel.
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Caries Dental , Desmineralización Dental , Animales , Biopelículas , Bovinos , Esmalte Dental , Humanos , Leche , Streptococcus mutans , Sacarosa/efectos adversosRESUMEN
The cefazolin inoculum effect (CzIE) has been associated with therapeutic failures and mortality in invasive methicillin-susceptible Staphylococcus aureus (MSSA) infections. A diagnostic test to detect the CzIE is not currently available. We developed a rapid (â¼3 h) CzIE colorimetric test to detect staphylococcal-ß-lactamase (BlaZ) activity in supernatants after ampicillin induction. The test was validated using 689 bloodstream MSSA isolates recovered from Latin America and the United States. The cefazolin MIC determination at a high inoculum (107 CFU/ml) was used as a reference standard (cutoff ≥16 µg/ml). All isolates underwent genome sequencing. A total of 257 (37.3%) of MSSA isolates exhibited the CzIE by the reference standard method. The overall sensitivity and specificity of the colorimetric test was 82.5% and 88.9%, respectively. Sensitivity in MSSA isolates harboring type A BlaZ (the most efficient enzyme against cefazolin) was 92.7% with a specificity of 87.8%. The performance of the test was lower against type B and C enzymes (sensitivities of 53.3% and 72.3%, respectively). When the reference value was set to ≥32 µg/ml, the sensitivity for isolates carrying type A enzymes was 98.2%. Specificity was 100% for MSSA lacking blaZ The overall negative predictive value ranged from 81.4% to 95.6% in Latin American countries using published prevalence rates of the CzIE. MSSA isolates from the United States were genetically diverse, with no distinguishing genomic differences from Latin American MSSA, distributed among 18 sequence types. A novel test can readily identify most MSSA isolates exhibiting the CzIE, particularly those carrying type A BlaZ. In contrast to the MIC determination using high inoculum, the rapid test is inexpensive, feasible, and easy to perform. After minor validation steps, it could be incorporated into the routine clinical laboratory workflow.
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Cefazolina , Infecciones Estafilocócicas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Cefazolina/farmacología , Pruebas Diagnósticas de Rutina , Humanos , América Latina , Meticilina , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/genéticaRESUMEN
Importance: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Objective: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. Design, Setting, and Participants: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020). Interventions: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. Main Outcomes and Measures: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression. Results: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). Conclusions and Relevance: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04364893.