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Background/Objective: Myasthenia Gravis (MG) is an autoimmune disorder characterized by pathogenic autoantibodies (AAbs) targeting nicotinic acetylcholine receptors (AChR), disrupting neuromuscular communication. RadioImmunoPrecipitation Assay (RIPA) is recommended to detect AChR AAbs, but its complexity and radioactive requirements limit widespread use. We compare non-RIPA anti-AChR immunoassays, including Cell-Based Assay (CBA) and two ELISA kits, against the gold standard RIPA. Methods/Results: 145 samples were included with medical indication for anti-AChR testing. By the RIPA method, 63 were negative (RIPA-Neg <â0.02 nmol/L), 18 were classified as Borderline (≥0.02 -1 nmol/L), and 64 were positive (RIPA-Posâ>â1 nmol/L). The competitive ELISA showed poor agreement with RIPA (Kappaâ=â0.216). The indirect ELISA demonstrated substantial agreement with RIPA (Kappaâ=â0.652), with â¼76% sensitivity and â¼94% specificity for MG diagnostic. The CBA, where fixed cells expressing clustered AChR were used as substrate, exhibited almost perfect agreement with RIPA (Kappaâ=â0.984), yielding â¼98% sensitivity and 96% specificity for MG. In addition, a semiquantitative analysis showed a strong correlation between CBA titration, indirect ELISA, and RIPA levels (râ=â0.793 and râ=â0.789, respectively). Conclusions: The CBA displayed excellent analytical performance for MG diagnostic when compared to RIPA, making it a potential replacement for RIPA in clinical laboratories. Some solid-phase assays (such as the indirect ELISA applied here), as well as CBA titration, offer reliable options to estimate anti-AChR AAb levels after confirming positivity by the CBA.â¥.
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Autoanticorpos , Ensaio de Imunoadsorção Enzimática , Miastenia Gravis , Ensaio de Radioimunoprecipitação , Humanos , Ensaio de Imunoadsorção Enzimática/métodos , Miastenia Gravis/imunologia , Miastenia Gravis/diagnóstico , Sensibilidade e Especificidade , Receptores Colinérgicos/imunologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Adulto JovemRESUMO
AIMS: To investigate whether a specific endothelium-derived microparticles (EMPs) phenotype could be associated with birth weight and microvascular endothelial function in children. MATERIALS AND METHODS: A total of 95 children aged 6-14 years were recruited. Anthropometric measurements, blood pressure measurement, microvascular endothelial function testing, and biochemical profile analyses were performed. Standardized flow cytometry methods were used to identify and quantify the circulating CD144+, CD31+/annexin V+, and CD62E+ EMPs. KEY FINDINGS: The circulating number of CD31+/annexin V+ EMPs and CD144+ EMP levels were correlated with birth weight, systolic blood pressure, microvascular endothelial function, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) level. In the multivariable logistic regression models, we identified strong evidence of a higher risk of microvascular endothelial dysfunction among children with low birth weight (LBW) and increased levels of both CD31+/annexin V+ EMPs and LDL-C; LBW and elevated LDL-C levels were independent predictors of high circulating numbers of CD31+/annexin V+ and CD144+ > 75th percentile EMPs. SIGNIFICANCE: Our data provide evidence that children with LBW values showed greater numbers of circulating CD31+/annexin V+ and CD144+ EMPs. In addition, LBW and high levels of CD31+/annexin V+ and LDL-C were significant risk factors for the presence of microvascular endothelial dysfunction.
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Micropartículas Derivadas de Células , Anexina A5 , Peso ao Nascer , LDL-Colesterol , Endotélio Vascular , HumanosRESUMO
BACKGROUND: Obesity perturbs endothelium integrity, leading to endothelial activation, which predisposes the release of endothelium-derived microparticles (EMP). We measured the CD31+/annexin V+ and CD62E+ EMP levels to improve our understanding of their contribution to endothelial damage in children with overweight/obesity. SUBJECT AND METHODS: In this cross-sectional study, 107 children with normal weight and 35 children with overweight/obesity were evaluated. Anthropometric measurement, blood pressure, biochemical profile was performed. Standardized flow cytometry methods were used to identify and quantify circulating CD31+/annexin V+ and CD62E+ EMP. RESULTS: Children with overweight/obesity had significantly higher circulating levels of CD31+/annexin V+ (750 [600]) and CD62E+ (1400 [700]) EMP than those with normal weight (P < 0.001 for both). We found that EMP levels were positively correlated with body mass index (BMI), waist circumference, blood pressure, total cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides. The multivariable logistic regression model revealed that the risks of having high EMP levels (> 75th percentile) were high in children with both large waist circumference and elevated LDLc level. Receiver operating characteristic (ROC) curves demonstrated that the LDLc levels showed significantly greater discrimination than waist circumference for both CD31+/annexin V+ (P = 0.031) as CD62E+ EMPs (P = 0.041). CONCLUSIONS: Children with overweight/obesity have high circulating CD31+/annexin V+ and CD62E+ EMP levels, which may be an early sign of endothelial apoptosis and inflammatory activation in response to injury. These EMP levels were positively associated with several cardiometabolic risk factors. Our data underscore the negative influence of high-risk metabolic profiles on endothelial integrity in the early stages of childhood obesity.
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Sobrepeso , Obesidade Infantil , Anexina A5/metabolismo , Criança , LDL-Colesterol , Estudos Transversais , Endotélio Vascular , Humanos , Sobrepeso/complicações , Sobrepeso/metabolismo , Obesidade Infantil/complicaçõesRESUMO
RESUMEN Objetivo: evaluar la calidad de atención en servicios de internación psiquiátrica de hospitales generales desde los enfoques de derechos y comunitario. Métodos: estudio multicéntrico, observacional descriptivo. Se seleccionaron cuatro servicios de internación psiquiátrica de hospitales generales ubicados en centros urbanos de distinta población en Argentina. En cada uno de ellos se analizaron los registros estadísticos, se realizaron observaciones no participantes y se entrevistó a gestores, trabajadores y usuarios. La guía de observación y entrevista se elaboró a partir de la revisión de instrumentos de la OMS y del proyecto Idea. Los resultados se analizaron a partir de las categorías de enfoque de derechos y orientación comunitaria de los servicios. Resultados: respecto del enfoque de derechos se observa que el que requiere mayor desarrollo es el de capacidad jurídica. En relación a la orientación comunitaria, se observa un mayor desarrollo de esta perspectiva a través de la implementación de diversas estrategias y el trabajo con las familias como la más común. Conclusiones: en términos de procesos y resultados de la atención se observan algunas diferencias entre los servicios que cuentan con sala especializada y los que no, y que estos últimos requieren de otros estudios para poder ser analizados.
ABSTRACT Objective: To evaluate, based on the human rights and community care frameworks, the quality of hospitalization psychiatric services in general hospitals. Methods: Multisite, descriptive observational study. There were analyzed four psychiatric hospitalization services, located in general hospitals of urban districts with different sizes in Argentina. Data collection included analysis of statistical records, non-participant observations of services, and interviews with service managers, service staff and users. The observation and interview guides were based on two international tools: Idea project interview guide, and QRTK of the WHO. Results were analyzed using two main categories: human rights-based care approach and community orientation of care delivery. Results: Regarding human rights-based care, legal capacity is the right that requires more improvement in services. About community orientation of care, different strategies were observed, with the work with the families as the most common. Conclusions: One aspect that requires further research is the specific type of psychiatric hospitalization service in the general hospital, given the fact that some differences in process and results were observed between general and specialized wards.
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Introduction: The indirect immunofluorescence assay on HEp-2 cells (HEp-2/IFA) is used worldwide for screening for autoantibodies to cellular antigens. Cell culture and fixation methods influence the cell distribution of autoantigens and the preservation of epitopes. Therefore, discrepancy of results obtained using different HEp-2/IFA kits (interkit nonreproducibility) is a common phenomenon in the clinical laboratory routine. Objective: This study evaluated the interkit nonreproducibility of HEp-2/IFA results using samples from patients with systemic autoimmune disease (SAD), nonautoimmune diseases (NAD), and healthy blood donors (HBD). Methods: Serum from 275 SAD patients, 293 NAD patients, and 300 HBD were processed at 1:80 dilution using four HEp-2 kits according to the manufacturers' instructions. Interkit reproducibility was determined for positive/negative results and patterns. The agreement of positive/negative results among kits for each sample was determined as the reactivity agreement score (RAS). The pattern reproducibility score (PRS) in each sample was calculated as a function of the number of kits showing equivalent patterns. Qualitative variables and ordinal variables were analyzed by the Chi-square and Mann-Whitney U tests, respectively. Results: A total of 402 samples were nonreactive in all kits and were considered devoid of autoantibodies. Further analysis included the 466 reactive samples (238 SAD, 119 NAD, 109 HBD). Reactivity to the nucleus had the highest interkit reproducibility (RAS = 83.6), followed by the metaphase plate (RAS = 78.9), cytoplasm (RAS = 77.4), and nucleolus (RAS = 72.4). Interkit reproducibility was higher in SAD (RAS = 78.0) than in NAD (RAS = 70.6) and HBD (RAS = 71.3) groups. Samples with strong reactivity (++++/4 and +++/4) had higher interkit reproducibility than those with weak reactivity (+/4). In the SAD group, RAS for nuclear reactivity was 87.5% for strongly reactive samples as opposed to 4.4% for weakly reactive samples, and the same was observed for NAD and HBD samples. The most robust patterns were the centromere AC-3 (PRS = 78.4), multiple nuclear dots AC-6 (PRS = 73.6), nuclear coarse speckled AC-5 (PRS = 71.3), nuclear homogeneous AC-1 (PRS = 67.9), and the reticular cytoplasmic AC-21 (PRS = 68.6). Conclusion: Interkit nonreproducibility in HEp-2/IFA is prevalent and occurs with the highest frequency with weakly reactive samples. International initiatives with the engagement of in vitro diagnostic industry are encouraged to promote the harmonization of the properties and performance of HEp-2/IFA commercial kits.
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Anticorpos Antinucleares/imunologia , Autoanticorpos/imunologia , Doenças Autoimunes/imunologia , Técnica Indireta de Fluorescência para Anticorpo/métodos , Kit de Reagentes para Diagnóstico/normas , Anticorpos Antinucleares/sangue , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Linhagem Celular Tumoral , Humanos , Kit de Reagentes para Diagnóstico/classificação , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Costa Rica is a candidate to eliminate malaria by 2020. The remaining malaria transmission hotspots are located within the Huétar Norte Region (HNR), where 90% of the country's 147 malaria cases have occurred since 2016, following a 33-month period without transmission. Here, we examine changes in transmission with the implementation of a supervised seven-day chloroquine and primaquine treatment (7DCPT). We also evaluate the impact of a focal mass drug administration (MDA) in January 2019 at Boca Arenal, the town in HNR reporting the greatest local transmission. We found that the change to a seven-day treatment protocol, from the prior five-day program, was associated with a 98% reduction in malaria transmission. The MDA helped to reduce transmission, keeping the basic reproduction number, RT, significantly below 1, for at least four months. However, following new imported cases from Nicaragua, autochthonous transmission resumed. Our results highlight the importance of appropriate treatment delivery to reduce malaria transmission, and the challenge that highly mobile populations, if their malaria is not treated, pose to regional elimination efforts in Mesoamerica and México.
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Background The objective of the study was to determine whether the staining pattern and titer of indirect immunofluorescence assay on HEp-2 cells (HEp-2 IFA) are associated with systemic lupus erythematosus (SLE) disease activity. Methods A total of 269 consecutive patients meeting the ACR and SLICC criteria for SLE were classified into three groups according to the SLE Disease Activity Index 2000 (SLEDAI2K): Remission (SLEDAI2K = 0; n = 47); Intermediate (SLEDAI2K = 1-5; n = 111); Active (SLEDAI2K ≥ 6; n = 111). All subjects were assessed for HEp-2 IFA titer and staining pattern and nine traditional parameters of SLE disease activity. After a 6 to 12-month interval, 101 of the 269 patients were reassessed. Results HEp-2 IFA homogeneous nuclear pattern (AC-1) occurred more frequently in the Active Group compared to the Remission Group (p < 0.001). Fine speckled nuclear pattern (AC-4) tended to occur more frequently in the Remission Group compared to the Active Group (p = 0.054). Subjects with AC-1 pattern had higher SLEDAI (8.8 ± 7.6) than those with AC-4 (4.8 ± 5.2) (p < 0.001). HEp-2 IFA titer and anti-nuclear antibody by enzyme-linked immunosorbent assay (ANA-ELISA) values were lower in the Remission Group compared to the other two groups (p < 0.001). Multivariate analyses identified only ELISA anti-dsDNA as an independent variable associated with disease activity. In follow-up analysis, HEp-2 IFA titer decreased significantly in the 33 subjects with decreased disease activity (p = 0.002). Receiver operator characteristic (ROC) curve analysis for determination of disease activity showed equivalent areas under the curve (AUC) for HEp-2 IFA titer and traditional disease activity parameters. Conclusions HEp-2 IFA pattern and titer can reflect SLE disease activity and may be considered in conjunction with other laboratory and clinical parameters in the assessment of SLE disease activity.
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Anticorpos Antinucleares/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Lúpus Eritematoso Sistêmico/imunologia , Adulto , Linhagem Celular , DNA/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/sangue , Masculino , Pessoa de Meia-Idade , Nucleossomos/imunologia , Estudos ProspectivosRESUMO
Smart conductive materials are developed in regenerative medicine to promote a controlled release profile of charged bioactive agents in the vicinity of implants. The incorporation and the active electrochemical release of the charged compounds into the organic conductive coating is achieved due to its intrinsic electrical properties. The anti-inflammatory drug dexamethasone was added during the polymerization, and its subsequent release at therapeutic doses was reached by electrical stimulation. In this work, a Poly (3,4-ethylenedioxythiophene): κ-carrageenan: dexamethasone film was prepared, and κ-carrageenan was incorporated to keep the electrochemical and physical stability of the electroactive matrix. The presence of κ-carrageenan and dexamethasone in the conductive film was confirmed by µ-Raman spectroscopy and their effect in the topographic was studied using profilometry. The dexamethasone release process was evaluated by cyclic voltammetry and High-Resolution mass spectrometry. In conclusion, κ-carrageenan as a doping agent improves the electrical properties of the conductive layer allowing the release of dexamethasone at therapeutic levels by electrochemical stimulation, providing a stable system to be used in organic bioelectronics systems.
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Carragenina/química , Dexametasona/administração & dosagem , Polímeros/química , Polissacarídeos/química , Dexametasona/química , Dexametasona/farmacologia , Liberação Controlada de Fármacos , Estabilidade de Medicamentos , Condutividade Elétrica , Técnicas Eletroquímicas , Eletrodos , Análise EspectralRESUMO
Costa Rica is near malaria elimination. This achievement has followed shifts in malaria health policy. Here, we evaluate the impacts that different health policies have had on malaria transmission in Costa Rica from 1913 to 2018. We identified regime shifts and used regression models to measure the impact of different health policies on malaria transmission in Costa Rica using annual case records. We found that vector control and prophylactic treatments were associated with a 50% malaria case reduction in 1929-1931 compared with 1913-1928. DDT introduction in 1946 was associated with an increase in annual malaria case reduction from 7.6% (1942-1946) to 26.4% (1947-1952). The 2006 introduction of 7-day supervised chloroquine and primaquine treatments was the most effective health policy between 1957 and 2018, reducing annual malaria cases by 98% (2009-2018) when compared with 1957-1968. We also found that effective malaria reduction policies have been sensitive to natural catastrophes and extreme climatic events, both of which have increased malaria transmission in Costa Rica. Currently, outbreaks follow malaria importation into vulnerable areas of Costa Rica. This highlights the need to timely diagnose and treat malaria, while improving living standards, in the affected areas.
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Política de Saúde/história , Malária/história , Costa Rica , Política de Saúde/legislação & jurisprudência , História do Século XX , História do Século XXI , Malária/prevenção & controle , Malária/transmissãoRESUMO
The rheological behavior, thermogravimetric analysis (TGA), and atomic force microscopy (AFM) of the Pereskia aculeata Miller (OPN) mucilage treated with sodium chloride (NaCl), calcium chloride (CaCl2), and sucrose were evaluated. The experimental design was divided in a fractional factorial 25-1 for the screening of factors (OPN, sucrose, NaCl, CaCl2, and pH) and then in a 5â¯×â¯3â¯×â¯3 full factorial (OPN, sucrose, and NaCl). The model solutions used for the screening of factors presented shear-thinning behavior and the OPN mucilage concentrations were the factors that had significant effect on the apparent viscosity. Sucrose addition increased the thermal stability of the OPN mucilage solutions. OPN mucilage, sucrose, and NaCl were the variables with significant effect on thermogravimetric responses. The samples presented Newtonian behavior in 0-1.25% OPN mucilage concentrations and non-Newtonian behavior adjusted by power-law in 2.50-5.00% OPN mucilage concentrations with predominance of elastic behavior, contributing to the formation of stronger gels. The presence of sucrose in the systems containing OPN mucilage changed their rheological properties and salt additions caused reduction in viscosity. The AFM results provided a better understanding of the mechanism of OPN mucilage interactions in different solutions that justify the changes in viscosities.
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Mucilagem Vegetal/química , Reologia , Sais/química , Estreptófitas/química , Sacarose/química , Microscopia de Força Atômica , Estrutura Molecular , Mucilagem Vegetal/análise , Cloreto de Sódio/química , Temperatura , TermogravimetriaRESUMO
INTRODUCTION: Genetically engineered monoclonal antibodies and fusion proteins directed against cytokines or their receptors represent a breakthrough in the treatment of various chronic immune-inflammatory diseases. Areas covered: Studies show high remission rates in several diseases, but clinical practice shows a significant percentage of individuals who do not exhibit the desired response. Loss of therapeutic benefit after initial successful response is designated secondary failure. Immune-biological agents are not self-antigens and are therefore potentially immunogenic. Secondary failure is frequently caused by antibodies against immune-biologicals, known as anti-drug antibodies (ADA). ADA that neutralize circulating immune-biologicals and/or promote their clearance can reduce treatment efficacy. Furthermore, ADA can induce adverse events by diverse immunological mechanisms. This review provides a comprehensive overview of ADA in rheumatoid arthritis patients treated with anti-TNF immune-biologicals, and explores the concept of therapeutic drug monitoring (TDM) as an effective strategy to improve therapeutic management. Expert opinion: Monitoring circulating ADA and therapeutic immune-biological drugs is helpful when evaluating patients with secondary failure. However, immunological tests for ADA vary considerably regarding their ability to detect different types of ADA. Several assays are not designed to determine ADA-induced drug neutralizing capacity, and they may report clinically non-relevant data, especially if drug is present in test samples.
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Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Animais , Anticorpos/imunologia , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/imunologia , Antirreumáticos/farmacologia , Artrite Reumatoide/imunologia , Fatores Biológicos/imunologia , Fatores Biológicos/farmacologia , Fatores Biológicos/uso terapêutico , Monitoramento de Medicamentos/métodos , Humanos , Inflamação/tratamento farmacológico , Inflamação/imunologia , Falha de TratamentoRESUMO
Argentina está en un proceso de transformación de la atención en salud mental, lo que implica el desarrollo de nuevos dispositivos de atención y el fortalecimiento de aquellos consonantes con la reforma, entre los que se encuentran los servicios de internación psiquiátrica en hospitales generales. La situación de dichos servicios en el país es heterogénea cuantitativa y cualitativamente, y son pocos los estudios al respecto. A partir de lo anterior, el objetivo general de este estudio fue evaluar la calidad de la atención de servicios de salud mental con internación psiquiátrica en hospitales generales, desde los ejes de la orientación comunitaria y el respeto y salvaguarda de derechos. Se realizó un estudio observacional, enmarcado en la investigación evaluativa y en la investigación-acción, en cuatro servicios ubicados en diferentes provincias del país. Se realizó análisis documental de datos estadísticos de los servicios, y entrevistas con el responsable, trabajadores y usuarios de los servicios. El análisis de los datos fue mixto. Los resultados indican que los derechos de los usuarios tienden a ser respetados durante la internación, en especial la conservación de los vínculos. En cuanto a la información sobre el diagnóstico y tratamiento, aún se requiere afianzar lo referido al consentimiento informado formal (escrito). Sobre la toma de decisiones, éstas tienden a incluir a los usuarios, aunque se desconocen las decisiones anticipadas. Los usuarios por su parte desconocen sus derechos, y las asociaciones que los nuclean. La orientación comunitaria se desarrolla mediante diversas estrategias como el trabajo con redes (formales e informales), la preparación para el alta, y las acciones para motivar el mantenimiento de los vínculos sociales y afectivos. Se observa un reconocimiento sobre la importancia y utilidad de la evaluación, pero la insuficiencia de herramientas para implementarla. Los datos estadísticos tienden a ser de baja calidad
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Unidade Hospitalar de Psiquiatria , Qualidade da Assistência à Saúde , Avaliação em Saúde , Saúde Mental , Hospitais GeraisRESUMO
Cortes cilíndricos de melões (Cucumis melo var. inodorus Naudin tipo amarelo) foram submetidos à impregnação com soluções de cloreto de cálcio (0,5 g.100 mL-1 de solução), adicionadas de amido gelatinizado (0, 5 e 10 g.100 mL-1 de solução) e glicose (0, 10 e 20 g.100 mL-1 de solução), com pressão de vácuo (84,4; 50,5 e 16,6 kPa) controlada. Foram feitas medidas do teor de sólidos solúveis totais, perda ou incorporação de componentes e textura de pedaços dos melões antes e após impregnação a vácuo. As variações desses parâmetros foram calculadas em relação aos do fruto original. Alterações na viscosidade das soluções devido aos processamentos também foram quantificadas. A existência de processos sinergísticos entre os fluxos de solutos do fruto e da solução pode ser constatada e analisada através de superfícies de resposta para as diferentes pressões, em função das concentrações de amido gelatinizado e de glicose nas soluções. A mobilidade molecular dos componentes do fruto e da solução em relação à viscosidade foi discutida.
Cylindrical cuts of melon (Cucumis melo var inodorus Naudin, yellow type) were submitted to impregnation with calcium chloride solutions (0.5 g.100 mL-1 of solution) added with gelatinized starch (0. 5 and 10 g.100 mL-1 of solution) and glucose (0. 10 and 20 g.100 mL-1 of solution) with controlled vacuum pressure (84.4; 50.5 and 16.6 kPa). Measurements of the total soluble solids, incorporation or loss components (turgidity) and texture of melon slices were made before and after vacuum impregnation. Quality parameter variations were calculated in relation to the original fruit. Alterations in the viscosity of the solutions during the processing had been also quantified. The existence of synergistic processes between the solute flows from the fruit and from the solution was evident and could be analyzed using response surfaces for the different pressures as a function of the glucose and gelatinized starch concentrations in the solutions. The molecular mobility of components of the fruit and the solution related to viscosity was discussed.
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Bee stings are a health concern in the Americas, where fatal envenomings due to massive attacks by Africanized honeybees have been documented in the last decades. Most studies on the toxic effects of honeybee venom in experimental animals have been performed using the intravenous or intraperitoneal injection routes. The aim of this study was to develop a mouse model that would better resemble a massive honeybee attack by using the subcutaneous (s.c.) route to induce a severe, sublethal systemic envenoming. An array of acute venom effects were characterized, including biochemical, hematological, histological, and inflammatory alterations, after the s.c. injection of 0.5 median lethal dose of venom. Rapid increases in serum alanine (ALT) and aspartate (AST) transaminases, creatinine, urea nitrogen, uric acid, sodium and chloride electrolytes, and creatine kinase (CK) were recorded, indicating damage to liver, kidneys, and skeletal muscle. Also, coagulation disturbances (fibrinogen decrease, and moderate delay in prothrombin and partial thromboplastin times) were demonstrated. Circulating platelet and leukocyte numbers remained unaltered, but a hemoconcentration effect (hematocrit and hemoglobin increase) was observed. This effect might be related to the marked edema induced by the venom. In addition, this inflammatory response included a systemic increase in cytokines (IL-1 beta, IL-6, TNF-alpha), together with an elevation of serum malondialdehyde and nitric oxide. The myotoxic effects of venom, melittin, and phospholipase A(2) were demonstrated after injection by s.c. route. No synergistic myotoxicity between melittin and PLA(2) was observed. Moreover, these two components, when injected at equivalent concentrations to those present in venom, induced a lower increase in serum CK than venom, suggesting that other components also contribute to its strong systemic toxicity towards skeletal muscle. The model here presented may be useful in preclinical studies to assess therapeutic antivenoms developed to cope with the problem of massive bee attacks.
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Venenos de Abelha/toxicidade , Abelhas/fisiologia , Mordeduras e Picadas de Insetos/fisiopatologia , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/fisiologia , Citocinas/sangue , Modelos Animais de Doenças , Sinergismo Farmacológico , Feminino , Injeções Subcutâneas , Mordeduras e Picadas de Insetos/sangue , Mordeduras e Picadas de Insetos/etiologia , Dose Letal Mediana , Masculino , Meliteno/toxicidade , Camundongos , Camundongos Endogâmicos , Miosite/induzido quimicamente , Miosite/patologia , Estresse Oxidativo/efeitos dos fármacos , Fosfolipases A2/toxicidadeRESUMO
OBJECTIVE: To analyze mortality due to Hymenoptera stings in Costa Rica during 1985-2006. METHODS: Records of deaths due to Hymenoptera stings in 1985-2006 were retrieved from Instituto Nacional de Estadística y Censos (National Statistics and Census Institute). Mortality rates were calculated on the basis of national population reports, as of 1 July of each year. Information for each case included age, gender, and the province in which the death occurred. In addition, reports of Hymenoptera sting accidents received by the Centro Nacional de Intoxicaciones (National Poison Center, CNI) in 1995-2006 were obtained to assess exposure to these insects. RESULTS: Over the 22-year period analyzed, 52 fatalities due to Hymenoptera stings were recorded. Annual mortality rates varied from 0-1.73 per 1 million inhabitants, with a mean of 0.74 (95% confidence interval: 0.46-0.93). The majority of deaths occurred in males (88.5%), representing a male to female ratio of 7.7:1. A predominance of fatalities was observed in the elderly (50 years of age and older), as well as in children less than 10 years of age. The province with the highest mortality rate was Guanacaste. The CNI documented 1,591 reports of Hymenoptera stings (mostly by bees) in 1995-2006, resulting in an annual average of 133 cases, with only a slight predominance of males over females (1.4:1). CONCLUSIONS: Stings by Hymenoptera, mostly by bees, constitute a frequent occurrence in Costa Rica that can be life-threatening in a small proportion of cases, most often in males and the elderly. The annual number of fatalities fluctuated from 0-6, averaging 2.4 deaths per year. Awareness should be raised not only among the general population, but also among health care personnel that should consider this risk in the clinical management of patients stung by Hymenoptera.
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Himenópteros , Mordeduras e Picadas de Insetos/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Costa Rica/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: To analyze mortality due to Hymenoptera stings in Costa Rica during 1985-2006. METHODS: Records of deaths due to Hymenoptera stings in 1985-2006 were retrieved from Instituto Nacional de Estadística y Censos (National Statistics and Census Institute). Mortality rates were calculated on the basis of national population reports, as of 1 July of each year. Information for each case included age, gender, and the province in which the death occurred. In addition, reports of Hymenoptera sting accidents received by the Centro Nacional de Intoxicaciones (National Poison Center, CNI) in 1995-2006 were obtained to assess exposure to these insects. RESULTS: Over the 22-year period analyzed, 52 fatalities due to Hymenoptera stings were recorded. Annual mortality rates varied from 0-1.73 per 1 million inhabitants, with a mean of 0.74 (95 percent confidence interval: 0.46-0.93). The majority of deaths occurred in males (88.5 percent), representing a male to female ratio of 7.7:1. A predominance of fatalities was observed in the elderly (50 years of age and older), as well as in children less than 10 years of age. The province with the highest mortality rate was Guanacaste. The CNI documented 1 591 reports of Hymenoptera stings (mostly by bees) in 1995-2006, resulting in an annual average of 133 cases, with only a slight predominance of males over females (1.4:1). CONCLUSIONS: Stings by Hymenoptera, mostly by bees, constitute a frequent occurrence in Costa Rica that can be life-threatening in a small proportion of cases, most often in males and the elderly. The annual number of fatalities fluctuated from 0-6, averaging 2.4 deaths per year. Awareness should be raised not only among the general population, but also among health care personnel that should consider this risk in the clinical management of patients stung by Hymenoptera.
OBJETIVO: Analizar la mortalidad por picaduras de himenópteros en Costa Rica en el período de 1985 a 2006. MÉTODOS: Se obtuvieron los registros de picaduras de himenópteros entre 1985 y 2006 del Instituto Nacional de Estadísticas y Censos. Las tasas de mortalidad se calcularon a partir de los datos de la población nacional para el 1 de julio de cada año. La información de cada caso abarcaba la edad, el sexo y la provincia en la que ocurrió la muerte. Además, para evaluar la exposición a estos insectos se contó con las notificaciones de accidentes por picaduras de himenópteros del Centro Nacional de Intoxicaciones (CNI) de 1995 a 2006. RESULTADOS: En el período de 22 años analizado se registraron 52 muertes por picaduras de himenópteros. La tasa anual de mortalidad varió entre 0 y 1,73 por millón de habitantes, con una media de 0,74 (intervalo de confianza de 95 por ciento: 0,46 a 0,93). La mayoría de las muertes correspondieron a hombres (88,5 por ciento), con una razón hombre:mujer de 7,7:1. Predominaron los casos letales en adultos mayores (50 años o más) y niños menores de 10 años. La provincia con la mayor mortalidad fue Guanacaste. El CNI documentó 1 591 casos de picaduras de himenópteros (principalmente abejas) entre 1995 y 2006, para un promedio anual de 133 casos, con un ligero predominio de hombres sobre mujeres (1,4:1). CONCLUSIONES: Las picaduras de himenópteros, principalmente de abejas, son sucesos frecuentes en Costa Rica que pueden amenazar la vida en una reducida proporción de casos, principalmente hombres y adultos mayores. El número anual de muertes varió entre 0 y 6, con un promedio de 2,4 muertes anuales. Se debe fomentar la conciencia no solo en la población general sino también en el personal especializado de salud, quienes deben tomar en cuenta este riesgo al atender a los pacientes con picaduras de himenópteros.
Assuntos
Humanos , Animais , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Himenópteros , Mordeduras e Picadas de Insetos/mortalidade , Costa Rica/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Although several tools have been designed to assess quality of life (QoL) among middle-aged women their capacity to specifically assess sexual dysfunction (SD) remains uncertain. Moreover, if SD impairs QoL within this population, then sexual assessment becomes a key issue. OBJECTIVES: To evaluate the accuracy of the Menopause Rating Scale (MRS) in diagnosing SD among climacteric women. METHODS: In this cross-sectional study 370 women aged 40-59 years filled out the MRS and the Female Sexual Functioning Index (FSFI) simultaneously. SD among surveyed women was defined as those obtaining a total FSFI score of