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OBJECTIVE: To evaluate the association between inflammatory markers and abdominal fat assessed by ultrasound in prepubertal children with and without excess weight. METHODS: A cross-sectional study involving 241 prepubertal children, 156 with obesity, 37 with overweight, and 48 with normal weight, aged five to ten years, who were followed at a research unit on Childhood Obesity from a teaching hospital belonging to a public health system. The concentration of interleukin-6, tumor necrosis factor-α and C-reactive protein were assessed and regression analyses, considering outcome variables such as abdominal wall and intra-abdominal fat thickness measured by ultrasound, were performed. RESULTS: The findings highlighted an association between abdominal fat and inflammatory markers, even in children at this young age group. Subcutaneous fat showed a stronger association with inflammatory biomarkers compared to intra-abdominal fat when performing logistic regression, with a positive association between tumor necrosis factor-α and abdominal wall thickness equal to or greater than the 75th percentile in adjusted logistic regression (OR: 18.12; CI 95 %: 1.57: 209.55). CONCLUSIONS: Abdominal wall fat, in contrast to what is often observed in adults, appears to have a greater impact on chronic inflammation related to excessive weight in very young children.
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Gordura Abdominal , Biomarcadores , Proteína C-Reativa , Interleucina-6 , Fator de Necrose Tumoral alfa , Ultrassonografia , Humanos , Criança , Masculino , Estudos Transversais , Feminino , Pré-Escolar , Biomarcadores/sangue , Biomarcadores/análise , Proteína C-Reativa/análise , Gordura Abdominal/diagnóstico por imagem , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/análise , Interleucina-6/sangue , Interleucina-6/análise , Obesidade Infantil , Inflamação/sangue , Índice de Massa Corporal , Gordura Intra-Abdominal/diagnóstico por imagem , SobrepesoRESUMO
Schistosomiasis, a widespread parasitic disease caused by the blood fluke of the genus Schistosoma, affects over 230 million people, primarily in developing countries. Praziquantel, the sole drug currently approved for schistosomiasis treatment, demonstrates effectiveness against patent infections. A recent study highlighted the antiparasitic properties of amiodarone, an anti-arrhythmic drug, exhibiting higher efficacy than praziquantel against prepatent infections. This study assessed the efficacy of amiodarone and praziquantel, both individually and in combination, against Schistosoma mansoni through comprehensive in vitro and in vivo experiments. In vitro experiments demonstrated synergistic activity (fractional inhibitory concentration index ≤0.5) for combinations of amiodarone with praziquantel. In a murine model of schistosomiasis featuring prepatent infections, treatments involving amiodarone (200 or 400 mg/kg) followed by praziquantel (200 or 400 mg/kg) yielded a substantial reduction in worm burden (60%-70%). Given the low efficacy of praziquantel in prepatent infections, combinations of amiodarone with praziquantel may offer clinical utility in the treatment of schistosomiasis.
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Amiodarona , Praziquantel , Schistosoma mansoni , Esquistossomose mansoni , Amiodarona/farmacologia , Amiodarona/uso terapêutico , Animais , Praziquantel/farmacologia , Praziquantel/uso terapêutico , Schistosoma mansoni/efeitos dos fármacos , Camundongos , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/parasitologia , Feminino , Anti-Helmínticos/farmacologia , Anti-Helmínticos/uso terapêutico , Sinergismo Farmacológico , Quimioterapia Combinada , Masculino , Modelos Animais de DoençasRESUMO
Peri-implant mucositis is characterised by inflammation of soft tissues surrounding a dental implant without associated bone loss beyond initial remodelling. Early detection and timely intervention are critical to prevent its progression to peri-implantitis. This paper focuses on various treatment options for treating peri-implant mucositis. The cornerstone of professional treatment lies in the mechanical disruption and removal of microbial biofilms around the implant. This can be achieved through careful use of manual or powered instruments, such as ultrasonic scalers or air polishing devices. However, there is a need for further research to determine the most effective single approach for treating peri-implant mucositis. Current evidence does not support the combination of mechanical debridement with locally administered antibiotics. Contrarily, evidence strongly supports the removal, cleaning, and modifications of prostheses to improve both self-performance and professional cleanability. The use of adjunctive therapies like photodynamic therapy and diode laser, in conjunction with mechanical instrumentation, is not currently recommended due to the limited strength of available evidence. Preventive measures emphasise the importance of comprehensive oral hygiene care, encompassing professional guidance and at-home practices, to manage biofilms effectively. This encompasses oral hygiene instruction, regular debridement, and maintenance care. Supporting peri-implant therapy is also vital for ongoing implant monitoring, preventing the recurrence of mucositis, and halting its progression to peri-implantitis. This multifaceted approach is key to effectively managing and treating peri-implant mucositis.
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Biofilmes , Implantes Dentários , Peri-Implantite , Estomatite , Humanos , Implantes Dentários/efeitos adversos , Peri-Implantite/terapia , Peri-Implantite/prevenção & controle , Estomatite/terapia , Estomatite/prevenção & controle , Estomatite/etiologia , Tomada de Decisão Clínica , Higiene Bucal/métodos , Desbridamento/métodos , Antibacterianos/uso terapêuticoRESUMO
This study aimed to analyze the application of the Phytoplankton Community Index-PCI and Functional Groups-FG in determining the water quality of the Guamá River (Pará, Amazônia, Brazil). Samplings occurred monthly for analyses of phytoplankton and physical and chemical parameters, for two years, at the station where water was collected for human supply consumption. Seasonality influenced electrical conductivity, total suspended solids, dissolved oxygen, transparency, winds, true color, and N-ammoniacal. The ebb tide showed high turbidity and suspended solids. The density varied seasonally with the highest values occurring in September and December (61.1 ind mL-1 and 60.2 ind mL-1, respectively). Chlorophyll-a was more elevated in December (21.0 ± 4.7 µg L-1) and chlorophyll-c higher in relation to clorophyll- b indicated the dominance of diatoms. Functional Group P prevailed in the study months. Through the PCI índex the waters of Guamá River varied from reasonable to excellent and the TSI ranged from oligo to mesotrophic. The use of Functional Groups proved to be a promising tool in the determination of water quality since it covered the most abundant species in the Environment, but the PCI is not adequate to characterize Amazonian white-waters rivers, which have diatoms as the leading dominant group.
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Diatomáceas , Intervenção Coronária Percutânea , Humanos , Fitoplâncton , Rios/química , Brasil , Clorofila/análise , Estações do Ano , Monitoramento AmbientalRESUMO
The jabuticaba bark is rich in anthocyanins and fibers, and its use may be of industrial interest. In the food sector, its used as an ingredient in the production of fermented products, liqueurs or enriched flours. It also has pharmaceutical and cosmetic applications. The objective was to evaluate the effect of pretreatment and fresh use of jabuticaba peels in the extraction of total phenolic compound (TPC) and total anthocyanin (TA) contents with and without ultrasound assistance and in the sequential extraction of pectin from the residue. In the TPC and TA extraction, a 3x2 factorial design was used. For conventional anthocyanin extraction (CAE), occurred in an incubator under agitation. For ultrasound-assisted anthocyanin extraction (UAE) was utilized an ultrasonic homogenizer with probe (20 kHz, 160 W). The extracts were quantified (TPC, TA, antioxidant activity and color). The residues were characterized and used for sequential pectin extraction, which was quantified and characterized. The results were subjected to analysis of variance. Fresh jabuticaba peel is a residue that can be used to sequentially extract phenolic compounds, particularly anthocyanins and pectin. The use of ultrasound (UAE) was less efficient than CAE for extracting TPC and TA or performing sequential extraction on all pretreatment peels.
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Antocianinas , Pectinas , Pectinas/química , Antocianinas/análise , Fenóis/análise , Antioxidantes/análise , Extratos Vegetais/químicaRESUMO
Background: The high burden of drug-resistant tuberculosis (TB) is a problem to achieve the goals of the End TB Strategy by 2035. Whether isoniazid monoresistance (Hr) affects anti-TB treatment (ATT) outcomes remains unknown in high-burden countries. Methods: We evaluated determinants of ATT outcome among pulmonary TB cases reported to the National Notifiable Disease Information System (SINAN) between June 2015 and June 2019, according to drug sensitivity testing (DST) results. Binomial logistic regression models were employed to evaluate whether Hr was associated with an unfavorable ATT outcome: death or failure, compared to cure or treatment completion. Results: Among 60 804 TB cases reported in SINAN, 21 197 (34.9%) were included in the study. In this database, the frequency of unfavorable outcomes was significantly higher in those with Hr in contrast to isoniazid-sensitive persons with pulmonary TB (9.1% vs 3.05%; P < .001). Using a binomial logistic regression model, Hr was independently associated with unfavorable outcomes (odds ratio, 3.34 [95% confidence interval, 2.06-5.40]; P < .001). Conclusions: Hr detected prior to ATT was predictive of unfavorable outcomes at the national level in Brazil. Our data reinforce the need for high-TB-burden countries to prioritize DST to detect Hr. Effective treatment regimens for Hr-TB are needed to improve outcomes.
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BACKGROUND: The comprehension of the interests of Internet users regarding their health-related searches may reveal the community's demands about oral health. The study aimed to characterize the interests of Google users related to mouthwash in Australia, Brazil, Chile, Japan, Mexico, Russia, the United Kingdom, the United States, Saudi Arabia and South Africa applying the Google Trends. METHODS: This longitudinal retrospective study analysed the mouthwash-related interest of Google users from January 2004 to December 2020. The monthly variation of relative search volume (RSV) and the main queries related were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for mouthwash for additional 12 months. Auto-correlation plots and a general additive model (GAM) were used to diagnose trends and seasonality in RSV curves. In addition, the influence of social isolation related to the outbreak of COVID-19 were analysed. RESULTS: The RSVs curves showed a considerable increase in searches related to mouthwash to AUS, BRA, JAP, MEX, GBR and USA (RSV > 25), while the growth was slight to CHI, KSA, RSA and RUS (RSV < 25) over the years, without influence of monthly seasonality. All countries showed a significant increase in mouthwash interest after the outbreak of COVID-19, except for KSA and RUS. The mouthwash-related searches were associated to specific brands or chemical compositions, treatments, whitening agents, homemade mouthwash and indications for the 'best mouthwash'. CONCLUSIONS: In general, there was an increasing interest of Google users in mouthwash-related topics between 2004 and 2020. In addition, in most countries, there was an expansion in searches during the social isolation of the COVID-19 pandemics.
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COVID-19 , Antissépticos Bucais , Humanos , Estados Unidos , Antissépticos Bucais/uso terapêutico , Estudos Retrospectivos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Brasil , Saúde BucalRESUMO
OBJECTIVE: To analyze bibliometrics, characteristics, and the risk of bias of randomized controlled trials (RCTs) on dental implants published in six high-impact factor journals and to identify factors contributing to citation number. MATERIALS AND METHODS: A systematic electronic search was conducted in four databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) to identify RCTs on dental implants published in six dental journals between 2016 and 2017. Twenty-five bibliometric variables and paper characteristics were extracted to evaluate their contribution to the citation count. Risk of bias analysis was performed using the RoB2 tool. Negative binomial regression was used to examine the effects of predictor variables on the Citation count. Significance level was set to 5%. RESULTS: A total of 150 RCTs included received a cumulative citation count of 3452 until July 2022. In the negative binomial regression analysis, open-access RCTs exhibited 60% more citations, and RCTs that presented statistical significance received 46% more citations. Conversely, first author affiliations from Africa, Asia and Oceania continents showed 49% fewer citations than publications from Europe. Regarding the risk of bias, 73.3% of the RCTs had some concerns, while 26% were deemed to have a high risk of bias. Only one RCT (0.07%) showed a low risk of bias. CONCLUSION: Within the limitation of the study, factors such as open access, statistically significant results, and country influence the number of citations received by the RCTs on dental implants.
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Bibliometria , Implantes Dentários , Ensaios Clínicos Controlados Aleatórios como Assunto , HumanosRESUMO
A Bacille Calmette-Guérin (BCG) is still the only licensed vaccine for the prevention of tuberculosis, providing limited protection against Mycobacterium tuberculosis infection in adulthood. New advances in the delivery of DNA vaccines by electroporation have been made in the past decade. We evaluated the safety and immunogenicity of the DNA-hsp65 vaccine administered by intramuscular electroporation (EP) in cynomolgus macaques. Animals received three doses of DNA-hsp65 at 30-day intervals. We demonstrated that intramuscular electroporated DNA-hsp65 vaccine immunization of cynomolgus macaques was safe, and there were no vaccine-related effects on hematological, renal, or hepatic profiles, compared to the pre-vaccination parameters. No tuberculin skin test conversion nor lung X-ray alteration was identified. Further, low and transient peripheral cellular immune response and cytokine expression were observed, primarily after the third dose of the DNA-hsp65 vaccine. Electroporated DNA-hsp65 vaccination is safe but provides limited enhancement of peripheral cellular immune responses. Preclinical vaccine trials with DNA-hsp65 delivered via EP may include a combination of plasmid cytokine adjuvant and/or protein prime-boost regimen, to help the induction of a stronger cellular immune response.
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The use of beneficial microorganisms is an important strategy to improve rice production in a sustainable way. The study was carried out to determine the effect of single and combined beneficial microorganism on the development of upland rice. The experiment was performed in greenhouse and arranged in a completely randomized design with 29 treatments and 4 replications. Treatments consisted of rice seeds cultivar BRS A501 CL treated with single and combined multifunctional microorganisms (1 (Serratia marcescens), 2 (Bacillus toyonensis), 3 (Phanerochaete australis), 4 (Trichoderma koningiopsis), 5 (Azospirillum brasilense), 6 (Azospirillum sp.), 7 (Bacillus sp.), 8 to 28 (combination of all these microorganisms in pairs) and 29 (control)). Inoculation of upland rice with sole and combined microorganism on upland rice increased the roots and shoots development, yield components and grain yield of upland rice. The combinations of Bacillus sp. (BRM 63573) and A. brasilense (AbV5), Azospirillum sp. (BRM 63574) + B. toyonensis (BRM 32110) and Phanerochaete australis (BRM 62389) + Serratia marcenscens (BRM 32114) led to improved roots and shoots development; increased number of panicles and grains per pot, 1000 grains weight and grain yield of rice plants. Besides, the combinations allow helped in increased accumulation of nutrients in roots, shoots and grains of rice plants.
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Oryza , Phanerochaete , Raízes de Plantas , SementesRESUMO
BACKGROUND: Oral care regimens can be explored to improve oral health in patients with gingivitis. This study aimed to evaluate the efficacy of a multicomponent oral care regimen with a dual zinc plus arginine (DZA) toothpaste and cetylpyridinium chloride with zinc lactate (CPC + Zn) mouthwash in reducing gingival bleeding in patients with gingivitis. METHODS: This randomized clinical trial included 94 participants with gingivitis who were randomized into two groups: the DZA/CPC + Zn group, which used a 1450-ppm fluoride toothpaste containing 0.96% zinc plus 1.5% arginine and a fluoride-containing mouthwash with 0.075% CPC and 0.28% zinc lactate, and the control group, which used a 1450-ppm fluoride toothpaste and a placebo mouthwash for 6 months. All participants were examined by a blinded examiner who measured the gingival index, plaque index, and gingival severity index. Data were analyzed using paired t test, independent t test, and analysis of covariance (ANCOVA). RESULTS: Both groups presented statistically significant reductions in all clinical parameters compared to baseline. The DZA/CPC + Zn group exhibited significantly greater reductions in gingival index, gingival severity index, proximal gingival index, plaque index and proximal plaque index compared to the control group at 1, 3, and 6 months. Furthermore, DZA/CPC + Zn significantly decreased the percentage of patients with generalized gingivitis over a 6-month follow-up period. However, differences between the DZA/CPC + Zn and the control groups were not maintained after both groups established similar regimens with fluoride toothpaste. CONCLUSION: The multicomponent oral care regimen consisting of DZA toothpaste and CPC + Zn mouthwash is effective in reducing gingival inflammation and supragingival biofilm in patients with gingivitis.
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Schistosomiasis is a parasitic disease that afflicts approximately 250 million people worldwide. There is an urgent demand for new antiparasitic agents because praziquantel, the only drug available for the treatment of schistosomiasis, is not universally effective and may derail current progress toward the WHO goal of eliminating this disease as a public health problem by 2030. Nifuroxazide (NFZ), an oral nitrofuran antibiotic, has recently been explored to be repurposed for parasitic diseases. Here, in vitro, in vivo, and in silico studies were conducted to evaluate the activity of NFZ on Schistosoma mansoni. The in vitro study showed significant antiparasitic activity, with 50% effective concentration (EC50) and 90% effective concentration (EC90) values of 8.2 to 10.8 and 13.7 to 19.3 µM, respectively. NFZ also affected worm pairing and egg production and induced severe damage to the tegument of schistosomes. In vivo, a single oral dose of NFZ (400 mg/kg of body weight) to mice harboring either prepatent or patent S. mansoni infection significantly reduced the total worm burden (~40%). In patent infection, NFZ achieved a high reduction in the number of eggs (~80%), but the drug caused a low reduction in the egg burden of animals with prepatent infection. Finally, results from in silico target fishing methods predicted that serine/threonine kinases could be one of the potential targets for NFZ in S. mansoni. Overall, the present study revealed that NFZ possesses antischistosomal properties, mainly in terms of egg burden reduction in animals with patent S. mansoni infection. IMPORTANCE The increasing recognition of the burden imposed by helminthiasis, associated with the limited therapeutic arsenal, has led to initiatives and strategies to research and develop new drugs for the treatment of schistosomiasis. One of these strategies is drug repurposing, which considers low-risk compounds with potentially reduced costs and shorter time for development. In this study, nifuroxazide (NFZ) was evaluated for its anti-Schistosoma mansoni potential through in vitro, in vivo, and in silico studies. In vitro, NFZ affected worm pairing and egg production and induced severe damage to the tegument of schistosomes. In vivo, a single oral dose of NFZ (400 mg/kg) to mice harboring either prepatent or patent S. mansoni infection significantly reduced the total worm burden and egg production. In silico investigations have identified serine/threonine kinases as a molecular target for NFZ. Collectively, these results implied that NFZ might be a potential therapeutic candidate for the treatment of schistosomiasis.
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Nitrofuranos , Esquistossomose mansoni , Esquistossomose , Esquistossomicidas , Animais , Camundongos , Esquistossomicidas/farmacologia , Esquistossomicidas/uso terapêutico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/parasitologia , Schistosoma mansoni , Nitrofuranos/farmacologia , Nitrofuranos/uso terapêutico , Treonina/farmacologia , Treonina/uso terapêutico , SerinaRESUMO
OBJECTIVES: To develop alginate nanoparticles functionalized with polysorbate 80 (P80) as miltefosine carriers for brain targeting in the oral treatment of cryptococcal meningitis. METHODS: Miltefosine-loaded alginate nanoparticles functionalized or not with P80 were produced by an emulsification/external gelation method and the physicochemical characteristics were determined. The haemolytic activity and cytotoxic and antifungal effects of nanoparticles were assessed in an in vitro model of the blood-brain barrier (BBB). A murine model of disseminated cryptococcosis was used for testing the efficacy of oral treatment with the nanoparticles. In addition, serum biomarkers were measured for toxicity evaluation and the nanoparticle biodistribution was analysed. RESULTS: P80-functionalized nanoparticles had a mean size of â¼300 nm, a polydispersity index of â¼0.4 and zeta potential around -50 mV, and they promoted a sustained drug release. Both nanoparticles were effective in decreasing the infection process across the BBB model and reduced drug cytotoxicity and haemolysis. In in vivo cryptococcosis, the oral treatment with two doses of P80 nanoparticles reduced the fungal burden in the brain and lungs, while the non-functionalized nanoparticles reduced fungal amount only in the lungs, and the free miltefosine was not effective. In addition, the P80-functionalization improved the nanoparticle distribution in several organs, especially in the brain. Finally, treatment with nanoparticles did not cause any toxicity in animals. CONCLUSIONS: These results support the potential use of P80-functionalized alginate nanoparticles as miltefosine carriers for non-toxic and effective alternative oral treatment, enabling BBB translocation and reduction of fungal infection in the brain.
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Criptococose , Meningite Criptocócica , Nanopartículas , Camundongos , Animais , Meningite Criptocócica/tratamento farmacológico , Polissorbatos/uso terapêutico , Alginatos/uso terapêutico , Distribuição Tecidual , Encéfalo , Criptococose/tratamento farmacológico , Portadores de Fármacos/uso terapêuticoRESUMO
BACKGROUND: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. METHODS: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. CONCLUSION: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.
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Anti-Infecciosos , Infecções Pneumocócicas , Criança , Adulto , Idoso , Humanos , Lactente , Adolescente , Pré-Escolar , Sorogrupo , Estudos Retrospectivos , Pacientes Internados , Brasil/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Hospitais de Ensino , Vacinas ConjugadasRESUMO
BACKGROUND: Sepsis and septic shock still represent great challenges in critical care medicine. Sildenafil has been largely used in the treatment of pulmonary arterial hypertension, but its effects in sepsis are unknown. The aim of this study was to investigate the hypothesis that sildenafil can attenuate endotoxin-induced pulmonary hypertension in a porcine model of endotoxemia. METHODS: Twenty pigs were randomly assigned to Control group (n.ß=.ß10), which received saline solution; or to Sildenafil group (n.ß=.ß10), which received sildenafil orally (100.ßmg). After 30.ßminutes, both groups were submitted to endotoxemia with intravenous bacterial lipopolysaccharide endotoxin (LPS) infusion (4.ß..g.kg-1.h-1) for 180.ßminutes. We evaluated hemodynamic and oxygenation functions, and also lung histology and plasma cytokine (TNF.., IL-1.., IL6, and IL10) and troponin I response. RESULTS: Significant hemodynamic alterations were observed after 30.ßminutes of LPS continuous infusion, mainly in pulmonary arterial pressure (from Baseline 19.ß...ß2.ßmmHg to LPS30 52.ß...ß4.ßmmHg, p.ß<.ß0.05). There was also a significant decrease in PaO2/FiO2 (from Baseline 411.ß...ß29 to LPS180 334.ß...ß49, p.ß<.ß0.05). Pulmonary arterial pressure was significantly lower in the Sildenafil group (35.ß...ß4.ßmmHg at LPS30, p.ß<.ß0.05). The Sildenafil group also presented lower values of systemic arterial pressure. Sildenafil maintained oxygenation with higher PaO2/FiO2 and lower oxygen extraction rate than Control group but had no effect on intrapulmonary shunt. All cytokines and troponin increased after LPS infusion in both groups similarly. CONCLUSION: Sildenafil attenuated endotoxin-induced pulmonary hypertension preserving the correct heart function without improving lung lesions or inflammation.
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Endotoxemia , Hipertensão Pulmonar , Animais , Suínos , Citrato de Sildenafila/farmacologia , Hipertensão Pulmonar/induzido quimicamente , Hipertensão Pulmonar/tratamento farmacológico , Endotoxinas/farmacologia , Lipopolissacarídeos/farmacologia , HemodinâmicaRESUMO
Chagas disease (CD) is caused by the flagellate protozoan Trypanosoma cruzi. It is endemic in Latin America. Nowadays around 6 million people are affected worldwide, and 75 million are still at risk. CD has two evolutive phases, acute and chronic. The acute phase is mostly asymptomatic, or presenting unspecific symptoms which makes it hard to diagnose. At the chronic phase, patients can stay in the indeterminate form or develop cardiac and/or digestive manifestations. The two trypanocide drugs available for the treatment of CD are benznidazole (BZ) and nifurtimox (NFX), introduced in the clinic more than five decades ago. WHO recommends treatment for patients at the acute phase, at risk of congenital infection, for immunosuppressed patients and children with chronic infection. A high cure rate is seen at the CD acute phase but better treatment schemes still need to be investigated for the chronic phase. There are some limitations within the use of the trypanocide drugs, with side effects occurring in about 40% of the patients, that can lead patients to interrupt treatment. In addition, patients with advanced heart problems should not be treated with BZ. This is a neglected disease, discovered 114 years ago that still has no drug effective for their chronic phase. Multiple social economic and cultural barriers influence CD research. The high cost of the development of new drugs, in addition to the low economical return, results in the lack of investment. More economic support is required from governments and pharmaceutical companies on the development of more research for CD treatment. Two approaches stand out: repositioning and combination of drugs, witch drastically decrease the cost of this process, when compared to the development of a new drug. Here we discuss the progress of the clinical trials for the etiological and pathophysiological treatment for CD. In summary, more studies are needed to propose a new drug for CD. Therefore, BZ is still the best option for CD. The trials in course should clarify more about new treatment regimens, but it is already possible to indicate that dosage and time of treatment need to be adjusted.
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ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.
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Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. Keywords: Antimicrobial resistance; Chronic diseases; Comorbidity; Invasive pneumococcal diseases; Pneumococcal conjugate vaccine; Pneumococcal serotypes; Pneumococcal vaccine.
Assuntos
Asma , Streptococcus pneumoniae , HIV , Vacinas Conjugadas , MeningiteRESUMO
Leptospirosis is a zoonosis that can infect buffaloes and other mammalians, and it's caused by Gram-negative bacteria of the genus Leptospira spp. The infection occurs through contact with urine or a contaminated environment with the mucous membranes of the animals, and the disease has two phases: leptospiremia and leptospiruria. The objective of this study was to determine the frequency of leptospirosis in buffaloes in the state of Paraná, Brazil, as well as the main serovars present in this area. A total of 276 blood samples were collected from buffaloes from 18 properties located in different cities and mesoregions of Paraná state. A microscopic agglutination test (MAT) was performed to detect the presence of anti-Leptospira spp. antibodies and to identify its serovars. The prevalence was 77.17% (213/276) of buffaloes seropositive for at least one serovar. The most frequent serovar was Icterohaemorrhagiae, followed by the Pomona serovar and serovar Hardjo. This study seems to be the first to determine the frequency of buffaloes with leptospirosis in the state of Paraná. Prevention and control measures are important to control the disease in herds.
Leptospirose é uma zoonose que infecta búfalos e outros mamíferos e é causada por bactérias Gram-negativas do gênero Leptospira spp. A infecção ocorre por meio do contato com a urina ou ambiente contaminado com as membranas mucosas dos animais e a doença possui duas fases: leptospiremia e leptospirúria. O objetivo deste trabalho foi determinar a frequência da leptospirose em bubalinos provenientes do estado do Paraná, assim como determinar os principais sorovares presentes no estado. Um total de 276 amostras de sangue foram coletados de búfalos provenientes de 18 propriedades localizadas em 14 municípios de diferentes mesorregiões do estado do Paraná. O teste de soroaglutinação microscópica (SAM) foi realizado para detecção da presença de anticorpos anti-Leptospira spp. e identificação dos respectivos sorovares. A prevalência de búfalos soropositivos para ao menos um sorovar foi de 77,17% (213/276). O sorovar mais frequente identificado nestes búfalos foi o Icterohaemorrhagiae, seguido pelos sorovares Pomona e Hardjo. Este é o primeiro estudo a determinar a frequência de búfalos com leptospirose no estado do Paraná. Medidas de controle e prevenção são importantes para o controle do agente nos rebanhos.
Assuntos
Animais , Búfalos , Leptospira/imunologia , Leptospirose/epidemiologia , Brasil/epidemiologia , Leptospira interrogans serovar icterohaemorrhagiae , Leptospira interrogans serovar pomonaRESUMO
OBJECTIVE: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculosis treatment outcomes. METHODS: This was a longitudinal study involving 140 patients diagnosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the patients were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes mellitus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglobin levels (< 5.7%, 5.7%-6.4%, and ≥ 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure). RESULTS: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%). CONCLUSIONS: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.