Access to health care levels and quality of life for women with fibromyalgia during the COVID-19 pandemic: cross-sectional study / Acesso aos níveis de atenção à saúde e à qualidade de vida de mulheres com fibromialgia durante a pandemia da COVID-19: estudo observacional transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a clinical condition that presents generalized and chronic musculoskeletal pain. With the COVID-19 pandemic, factors such as social distancing and a reduction in the search for and supply of care for chronic diseases may have contributed to worsening the quality of life (QoL) of people with fibromyalgia. The aim of this study was to investigate the relationship between access to health care and the QoL of women with fibromyalgia during the COVID-19 pandemic. METHODS: This was a descriptive cross-sectional observational study of 30 women diagnosed with fibromyalgia, with a mean age of 56.3±10.4 years, who took part in group therapy promoted by the Fibro Dance (Dança Fibro) extension project at the Trairi Health Science Faculty of the Federal University of Rio Grande do Norte (Faculdade de Ciência da Saúde do Trairi da Universidade Federal do Rio Grande do Norte - FACISA/ UFRN). QoL was evaluated using the Short Form 36 Health Survey (SF-36) and access to health care was investigated using a questionnaire developed by the researchers, which also included sociodemographic questions and questions about health conditions. Descriptive and inferential statistics were used to analyze the data. The Shapiro-Wilk normality test was used to check the distribution of the data, and the t-test was used to compare the means of the variables with normally distributed data, while the Mann-Whitney non-parametric test was used for the variables without normal distribution. A 5% significance level was adopted for the inferential analysis. RESULTS: 66.7% of the participants received care in primary care, while 36.7% and 26.7% received care in specialized care and hospitals, respectively. As for QoL, the domains that showed the greatest impairment, with the lowest mean score, were limitation of physical aspects (9.2; 95%CI: 1.6; 16.7), limitation of emotional aspects (11.1; 95%CI: 0.6; 21.6), pain (29.9; 95%CI: 23.9;35.8), general state of health (35.8; 95%CI: 32.2; 39.4) and vitality (38.7; 95%CI: 31.9; 45.4). In the inferential analysis, there was no statistically significant difference in QoL between the group of women who received primary care or hospital care compared to the group who did not receive care at these levels (p > 0.05). On the other hand, there were statistically significant differences when the comparison was analyzed in specialized care. In the functional capacity domain (p = 0.005), the average score for the group that received specialized care was higher than the score for the group that did not, 38.2 and 24.2, respectively. For the social aspects domain (p = 0.045), the average score was 54.5 for those who received care and 37.5 for the group who did not receive care at the level of care in question. CONCLUSION: This study concluded that access to specialized care during the COVID-19 pandemic contributed to women with fibromyalgia showing better results in QoL domains such as functional capacity and social aspects.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma condição clínica que apresenta dor musculoesquelética generalizada e crônica. Com a pandemia da COVID-19, fatores como distanciamento social e redução na busca e oferta por cuidados para as doenças crônicas podem ter contribuído para piorar a qualidade de vida (QV) das pessoas com fibromialgia. O objetivo deste estudo foi investigar a relação entre o acesso aos níveis de atenção à saúde e a QV de mulheres com fibromialgia durante a pandemia da COVID-19. MÉTODOS: Trata-se de um estudo observacional transversal descritivo com 30 mulheres diagnosticadas com fibromialgia, apresentando média de idade de 56,3±10,4 anos, que participaram da terapia em grupo promovida pelo projeto de extensão Dança Fibro, da Faculdade de Ciência da Saúde do Trairi da Universidade Federal do Rio Grande do Norte (FACISA/UFRN). A QV foi avaliada usando o Short Form 36 Health Survey (SF-36) e o acesso aos níveis de atenção à saúde foi investigado por meio de um questionário desenvolvido pelos pesquisadores, que também contemplou questões sociodemográficas e sobre condições de saúde. Para a análise de dados, foram usadas a estatística descritiva e a inferencial, sendo aplicado o teste de normalidade de Shapiro-Wilk para verificação da distribuição dos dados, e o teste t para comparar as médias das variáveis que apresentaram os dados normalmente distribuídos, enquanto que para as variáveis que não apresentaram distribuição normal, foi utilizado o teste não paramétrico de Mann-Whitney. Na análise inferencial, foi adotado um nível de significância de 5%. RESULTADOS: Foi observado que 66,7% das participantes receberam cuidados na atenção básica, enquanto que 36,7% e 26,7% foram assistidas na atenção especializada e hospitalar, respectivamente. No que diz respeito à QV, os domínios que apresentaram maior comprometimento, com menor escore médio, foram limitação dos aspectos físicos (9,2; IC95%: 1,6; 16,7), limitação dos aspectos emocionais (11,1; IC95%: 0,6; 21,6), dor (29,9; IC95%: 23,9;35,8), estado geral de saúde (35,8; IC95%: 32,2; 39,4) e vitalidade (38,7; IC95%: 31,9; 45,4). Na análise inferencial, não foi observada diferença estatisticamente significativa na QV entre o grupo de mulheres que foram assistidas na atenção básica ou na atenção hospitalar em comparação com o grupo que não recebeu assistência nestes níveis de atenção (p > 0,05). Em contrapartida, constatou-se diferenças estatisticamente significativas quando a comparação foi analisada no âmbito da atenção especializada. No domínio capacidade funcional (p = 0,005), o escore médio para o grupo que recebeu cuidados na atenção especializada foi superior ao escore do grupo que não recebeu, 38,2 e 24,2, respectivamente. Para o domínio aspectos sociais (p = 0,045), o escore médio foi de 54,5 para aquelas que foram assistidas e de 37,5 para o grupo que não recebeu assistência no nível de atenção em questão. CONCLUSÃO: Este estudo concluiu que o acesso à atenção especializada durante a pandemia da COVID-19 contribuiu para que as mulheres com fibromialgia apresentassem melhores resultados nos domínios da QV, tais como capacidade funcional e aspectos sociais.

Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling: A randomised clinical trial

Background: Melasma is an acquired dyschromia with several histologic alterations in the epidermis, basement membrane and upper dermis. The treatment of melasma is challenging due to the irregular response and chronicity of the disease. To date, there are no curative strategies, largely due to the limited understanding of the intrinsic effects of each treatment. Objectives: The objective of the study was to evaluate the histological changes promoted by triple combination cream, with or without complementary treatment with microneedling and oral tranexamic acid, in the treatment of melasma. Methods: A factorial, randomised, controlled and evaluator-blinded clinical trial was performed involving 64 women with facial melasma, divided in four groups, who underwent 60 days of treatment with triple combination cream alone (control group) or combined with two monthly microneedling sessions (microneedling group), TA 250 mg twice daily (tranexamic acid group), or both tranexamic acid group and microneedling group. The participants underwent biopsy of the area with melasma at inclusion (D1) and D60. The primary outcomes were the variation (D1 × D60) between the variables: Thickness of the epidermis and stratum corneum, stratum corneum compaction and solar elastosis; melanin density in the epidermis and upper dermis; proportion between the extension of the nonintact and intact basement membrane zone; mast cell count in the upper dermis; melanocyte count in the basal layer, pendulum melanocyte count and melanocyte area; immunostaining density of vascular endothelial growth factor; stem cell factor and keratinocyte growth factor. Results: One participant in the TG discontinued tranexamic acid due persistent headache; and herpes simplex occurred in three patients after microneedling. The groups showed a 24% (CI95%: 17–35%; P < 0.01) reduction in epidermal melanin density. There was no change in dermal melanin density or the area of melanocytes after treatment. There was an overall 25% (CI95%: 7–42%; P < 0.01) reduction in the number of pendulum melanocytes, especially in the microneedling and tranexamic acid group, that presented a 41% (CI95%: 7–73%; P < 0.01) reduction. The extension of the nonintact basal membrane relative to the intact basal membrane decreased after treatment, especially in microneedling group and microneedling and tranexamic acid group. There was an increase of 13% (CI95%: 5–21%; P = 0.02) in epidermal thickness and 6% (CI95%: 0–22%; P = 0.04) thinning of the stratum corneum in the groups. All groups showed stratum corneum compaction. Solar elastosis improved only in the microneedling group and microneedling and tranexamic acid group. Vascular endothelial growth factor immunostaining increased 14% (CI95%: 4–24%; P = 0.03) in the groups; and stem cell factor increased only in microneedling group. There was no change in the number of mast cells, CD34 and keratinocyte growth factor immunostaining. Limitations: The site of biopsy may not represent all of the facial melasma and the immunohistochemical sensitivity of the cytokines does not have a stoichiometric relationship with proteins. Conclusion: A greater thickness of the epidermis is associated with melasma bleaching. Dermal melanin seems to have no impact on melasma prognosis. Damage to the skin barrier and stimulus of angiogenesis should be avoided in the treatment of melasma. Microneedling complements the topical treatment of melasma by improving patterns of skin photoaging. Oral tranexamic acid complements the topical treatment of melasma by inhibiting the stem cell factor.

Bioassay-guided isolation of α-glucosidase inhibitors from Byrsonima garcibarrigae Cuatrec

SUMMARY Introduction: Byrsonima garcibarrigae is an endemic tree of Amazonas state, Brazil, with pharmacological and chemical knowledge poorly understood. Aim: To investigate the antidiabetic potential of the B. garcibarrigae stem bark. Methods: The stem bark was sequentially extracted by maceration with hexane (EHBG), ethyl acetate (EABG), and methanol (EMBG). The antioxidant capacity, α-glucosidase inhibitory potentials and anti-glycation capacities were evaluated. A bio-guided fractionation gave compounds that were characterized by MS and NMR. Results: 8 compounds were identified by HPLC-MS. EMBG showed the highest α-glucosidase inhibitory activity (1.09±0.32 µg/mL), antioxidant activity (9.2±0.23 µg/mL) and phenolic compounds content (61.43±0.50%), thus was fractionated producing hexane (FHX), chloroform (FCL) and hydromethanolic (FHM) fractions. After additional anti- α-glucosidase assays, FHM (1.02±0.49 µg/mL) was fractionated giving quercitrin and epicatechin. The anti-glycation assay showed that EMBG, FHM and quercitrin presented higher activities in comparison to the positive control, amino-guanidine. Conclusions: B. garcibarrigae displayed antidiabetic potential since inhibited α-glucosidase, as well as presented expressive antioxidant and anti-glycation activities were recorded.

Introducción: Byrsonima garcibarrigae es un árbol endémico del estado de Amazonas, Brasil, con poco conocimiento farmacológico y químico. Objetivo: investigar el potencial antidiabético de la corteza del tallo de B. garcibarrigae. Métodos: la corteza del tallo se extrajo secuencialmente mediante maceración con hexano (EHBG), acetato de etilo (EABG) y metanol (EMBG). Se evaluó la capacidad antioxidante, los potenciales inhibidores de la α-glucosidasa y las capacidades anti-glicación. Un fraccionamiento bioguiado dio compuestos que se caracterizaron por MS y NMR. Resultados: se identificaron 8 compuestos mediante HPLC-MS. EMBG mostró la mayor actividad inhibidora de α-glucosidasa (1,09 ± 0,32 µg/mL), actividad antioxidante (9,2±0.23 µg/mL) y contenido de compuestos fenólicos (61,43 ± 0.50%), por lo que se fraccionó produciendo hexano (FHX), cloroformo (FCL) e hidrometanólicas (FHM). Después de ensayos adicionales de anti- α-glucosidasa, se fraccionó FHM (1,02 ± 0,49 µg/mL) dando quercitrina y epicatequina. El ensayo antiglicación mostró que EMBG, FHM y quercitrina presentaron actividades más altas en comparación con el control positivo, aminoguanidina. Conclusiones: B. garcibarrigae mostró potencial antidiabético ya que se registró una inhibición de la α-glucosidasa, así como también presentó actividades expresivas antioxidantes y antiglicación.

Introdução: Byrsonima garcibarrigae é uma árvore endêmica do estado do Amazonas, Brasil, com pouco conhecimento farmacológico e químico. Objetivo: investigar o potencial antidiabético da casca do caule de B. garcibarrigae. Métodos: a casca do caule foi extraída sequencialmente por maceração com hexano (EHBG), acetato de etila (EABG) e metanol (EMBG). A capacidade antioxidante, potencial inibibitório de α-glicosidase e capacidade antiglicação foram avaliadas. Um fracionamento bioguiado isolou compostos que foram caracterizados por MS e RMN. Resultados: 8 compostos foram identificados por HPLC-MS. O EMBG apresentou a maior atividade inibitória de α-glicosidase (1,09 ± 0,32 µg/mL), atividade antioxidante (9,2±0,23 µg/mL) e teor de compostos fenólicos (61,43 ± 0,50%), por isso foi fracionado produzindo hexano (FHX), clorofórmio (FCL) e hidrometanólico (FHM). Após ensaios anti- α-glicosidase adicionais, FHM (1,02 ± 0,49 µg/mL) foi fracionado, originando a quercitrina e epicatequina. O ensaio de antiglicação mostrou que EMBG, FHM e quercitrina exibiram atividades mais altas em comparação com o controle positivo, aminoguanidina. Conclusões: B. garci-barrigae apresentou potencial antidiabético, uma vez que foi registrada inibição da α-glicosidase, bem como expressiva atividade antioxidante e antiglicação.

Acute kidney injury and renal replacement therapy: terminology standardization / Injúria renal aguda e métodos de suporte: padronização da nomenclatura

Abstract The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.

Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.

Anti-inflammatory effects and acute oral toxicity of Copaifera spp. essential oil-loaded nanoemulsion / Efectos antiinflamatorios y toxicidad oral aguda de nanoemulsión cargada de aceite esencial de Copaifera spp

Copaifera spp. essential oil (EOC) was extracted by hydrodistillation of Copaifera oleoresin (COR). The EOC was characterized by GC/MS and a novel EOC-loaded nanoemulsion was developed to enhance the EOC solubility and to evaluate its utility as antinflammatory. EOC contain 14 volatile compounds (including ß-caryophyllene: 51.52%) having a required HLB of 11. The Surfactant: EOC: Water ratio of 13:15:75 (%, w:w:w) produced the optimal formulation (particle size: 94.47 nm). The EOC-loaded nanoemulsion presented a pseudoplastic/thixotropic behavior with excellent shelf stability for 6 months. The anti-inflammatory effect of the nanoemulsion was more potent than that of the EOC, and statistically equal to diclofenac (50 mg/kg). The EOC-loaded nanoemulsion showed no oral acute toxicity (in mice) at 2000 mg/kg; hence, it is considered a nontoxic product. The development of the EOC-loaded nanoemulsion added value to both the COR and the EOC by providinga suitable formulation that could be used as an anti-inflammatory product.

El aceite esencial (EOC) fue extraído por hidrodestilación de oleoresina de Copaifera spp. El EOC fue caracterizado químicamente por GC/MS. Se formuló una nanoemulsión con EOC para mejorar la solubilidad del EOC y evaluar su utilidad como antiinflamatorio. El EOC contiene 14 compuestos volátiles (incluido el ß-cariofileno: 51,52%) con un HLB requerido de 11. La relación Tensioactivo: EOC: Agua de 13:15:75 (%, p:p:p) produjo la formulación óptima (tamaño de partícula: 94,47 nm).. La nanoemulsión cargada con EOC presentó un comportamiento pseudoplástico/tixotrópico con una excelente estabilidad en almacenamiento durante 6 meses. El efecto antiinflamatorio de la nanoemulsión fue más potente que el del EOC y estadísticamente igual al diclofenaco (50 mg/kg). La nanoemulsión cargada con COE no mostró toxicidad aguda oral (en ratones) a 2000 mg/kg; por lo tanto, se considera un producto no tóxico. El desarrollo de la nanoemulsión cargada con EOC agregó valor tanto al COR como al EOC al proporcionar una formulación adecuada que podría usarse como un producto antiinflamatorio.

Effect of açai supplementation (Euterpe Oleracea Mart) associated with exercise in animals and human: a scoping review / Efeitos da suplementação com açaí (Euterpe Oleracea Mart) associada ao exercício físico em animais e humanos: revisão de escopo

ABSTRACT Objective This scoping review aimed to map evidence on açai supplementation combined with exercise in animal and/or human experimental studies. Methods The search considered six electronic databases and screening of relevant references. The selection process and data extraction were performed by two independent authors. The study characteristics, and AS (e.g., form, intervention time, amount ingested) and exercise (e.g., types, intensity, and duration) strategies were summarized, as well as their reported results. Results From an initial total of 342 studies identified; 11 (5 with animal and 6 with human models) were eligible. In animals, açai supplementation and exercise led to benefits in exercise tolerance and improvements in several hemodynamic parameters, as well as significant improvements in liver markers and glucose metabolism. In humans, açai supplementation indicated positive results in increasing exhaustion time to 90% of VO2max and increasing intensity at the anaerobic threshold. Conclusion We conclude that future research involving animals and humans should examine açai supplementation and exercise with (a) obesity models to test the effect of adiponectin on body composition with analysis of histological and histochemical parameters; (b) eccentric injury protocols with the incorporation of muscle quality variables to assess recovery; (c) chronic açai supplementation and strength training; (d) comparison of different forms of açai supplementation in exercise protocols.

RESUMO Objetivo Esta revisão de escopo teve como objetivo mapear evidências sobre a suplementação com açaí combinada com exercícios físicos em estudos experimentais em animais e / ou humanos. Métodos A busca considerou seis bases de dados eletrônicas além da triagem de referências relevantes. O processo de seleção e extração de dados foi realizado por dois autores independentes. As características do estudo, estratégias de suplementação de açaí (forma, tempo de intervenção, e quantidade ingerida) e exercícios (tipos, intensidade e duração), seus resultados foram resumidos. Resultados Um total de 342 estudos foram inicialmente alcançados e somente 11 foram elegíveis (5 com animais e 6 com humanos). Em animais, a suplementação de açaí e os exercícios indicaram benefícios na tolerância ao exercício e melhorias em vários parâmetros hemodinâmicos, bem como melhorias significativas nos marcadores hepáticos e no metabolismo da glicose. Em humanos, a suplementação de açaí indicou resultados positivos no aumento do tempo de exaustão para 90% do VO2máx e no aumento da intensidade correspondente ao limiar anaeróbio. Conclusão Concluiu-se que pesquisas futuras envolvendo animais e humanos devem examinar a suplementação de açaí e exercícios com (a) modelos de obesidade para testar o efeito da adiponectina na composição corporal por meio de parâmetros histológicos e histoquímicos (b) protocolos de dano muscular excêntrico com incorporação de variáveis de qualidade muscular para avaliação da recuperação; (c) suplementação crônica de açaí e treinamento de força; (d) comparação das diferentes formas de suplementação de açaí em protocolos de exercícios.

Oxidative stress induction by crude extract of Xylaria sp. triggers lethality in the larvae of Aedes aegypti (Diptera: Culicidae)

ABSTRACT Background: Aedes aegypti is currently controlled with synthetic larvicides; however, mosquitoes have become highly resistant to these larvicides and difficult to eradicate. Studies have shown that insecticides derived from fungal extracts have various mechanisms of action that reduce the risk of resistance in these mosquitoes. One possible mechanism is uncontrolled production of reactive oxygen species (ROS) in the larvae, which can cause changes at the cellular level. Thus, the crude extract of Xylaria sp. was evaluated to investigate the oxidative effect of this extract in A. aegypti larvae by quantifying the oxidative damage to proteins and lipids. Methods: The larvicidal potential of the crude extract of Xylaria sp. Was evaluated, and the extract was subsequently tested in human lung fibroblasts for cytotoxicity and ROS production. ROS level was quantified in the larvae that were killed following exposure to the extract in the larvicide test. Results: The crude extract of Xylaria sp. Caused cytotoxicity and induced ROS production in human lung fibroblasts and A. aegypti larvae, respectively. In the larvicide trial, the extract showed an LC50 of 264.456 ppm and an LC90 of 364.307 ppm, and was thus considered active. The extract showed greater oxidative damage to lipids and proteins, with LC90 values of 24.7 µmol MDA/L and 14.6278 ×10-3 nmol carbonyl/ mg protein, respectively. Conclusions: Crude extracts of Xylaria sp. induced oxidative stress that may have caused the mortality of A. aegypti larvae.

Physicochemical characterization and cosmetic applications of Passiflora nitida Kunth leaf extract

Abstract Passiflora nitida Kunth, an Amazonian Passiflora species, is little studied, although the specie's high biological potential. Herein the plant's pharmacognostic characterization, extract production, antioxidant potential evaluation, and application of this extract in cosmetic products is reported. The physical chemical parameters analyzed were particle size by sieve analysis, loss through drying, extractive yield, total ash content, laser granulometry, specific surface area and pore diameter (SBET), differential scanning calorimetry, thermogravimetry (TG), and wave dispersive X-Ray fluorescence (WDXRF). Total phenol/flavonoid content, LC-MS/MS analysis, DPPH and ABTS antioxidant radical assays, cytotoxicity, melanin, and tyrosinase inhibition in melanocytes test provided evidence to determine the content of the major constituent. P. nitida dry extract provided a fine powder with mesopores determined by SBET, with the TG curve showing five stages of mass loss. The antioxidant potential ranged between 23.5-31.5 mg∙mL-1 and tyrosinase inhibition between 400-654 µg∙mL-1. The species presented an antimelanogenic effect and an inhibitory activity of cellular tyrosinase (26.6%) at 25 µg/mL. The LC-MS/MS analysis of the spray-dried extract displayed the main and minor phenolic compounds constituting this sample. The results indicate that P. nitida extract has promising features for the development of cosmetic formulations

Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit / Impacto do desenvolvimento de lesão renal aguda em pacientes internados na unidade de terapia intensiva pediátrica

Abstract Objective: To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit. Materials and methods: Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members. Results: A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit. Conclusion: Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.

Resumo Objetivo: Identificar os fatores de risco para o desenvolvimento de lesão renal aguda, mortalidade a curto e em longo prazo de pacientes com lesão renal aguda após internação em Unidade de Terapia Intensiva Pediátrica. Materiais e métodos: Análise retrospectiva de pacientes internados em unidade de terapia intensiva pediátrica de janeiro de 2004 a dezembro de 2008. Lesão renal aguda foi definida pelo critério KDIGO. Fatores de risco para lesão renal aguda, mortalidade hospitalar e em longo prazo foram obtidos através de análise multivariada por regressão logística. Mortalidade em longo prazo (até 2011) foi obtida através de busca no banco de dados da instituição e contato telefônico com parentes dos pacientes. Resultados: Foram avaliados 434 pacientes e a incidência de lesão renal aguda foi de 64%. A maioria dos episódios de lesão renal aguda (78%) ocorreu nas primeiras 24 horas após internação na Unidade de Terapia Intensiva Pediátrica. Os fatores de risco para o desenvolvimento de lesão renal aguda encontrados foram: baixo volume de diurese, menoridade, uso de ventilação mecânica, droga vasoativa, diurético e anfotericina. Menor peso, balanço hídrico positivo, lesão renal aguda, uso de dopamina e ventilação mecânica foram fatores de risco independentes para mortalidade hospitalar. A mortalidade em longo prazo foi de 17,8%. Pressão arterial sistólica, escore PRISM, baixo volume de diurese e ventilação mecânica foram fatores de risco independentes associados à mortalidade em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica. Conclusão: Lesão renal aguda foi um evento frequente, precoce e esteve associada à mortalidade hospitalar e em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica.

The selective obtaining of amyrins from Amazonian Protium oleoresins / La obtención selectiva de amirinas a partir de oleorresinas de Protium amazónicas

SUMMARY The oleoresin produced by species of genus Protium sp. is rich in alpha and betaamyrins, two triterpenes with many pharmacogical activities. Considering the need to make the improved obtainment of these products feasible, this study sought to optimize techniques for the extraction and isolation of amyrins from resin. Two methods of extraction (maceration and sonication) with different solvents were compared to direct isolation from crude resin. The isolation of triterpenes was performed by chromatographic columns and the yields of extracts and fractions were analyzed by analysis of variance. The best extraction solvent for amyrins was hexane for both maceration and sonication methods (38.16±2.06% and 37.67±8.21%, respectively). There was no statistical difference between these methods and the direct method (32.05±2.40%). Additionally, the direct method is cheaper and more environmentally friendly. Thus, this study showed that it is possible to obtain a large quantity of amyrins by means of cheap, fast and ecological methods.

RESUMEN La oleorresina producida por especies del género Protium sp. es rica en amirinas alfa y beta, dos triterpenos con muchas actividades farmacológicas. Esta investigación buscó optimizar las técnicas de extracción y aislamiento de amirinas de la resina para hacer factible la obtención mejorada de esos productos. Se compararon dos métodos de extracción (maceración y sonicación) con diferentes solventes con aislamiento directo de la resina cruda. El aislamento de los triterpenos se realizó mediante columnas cromatográficas y los rendimientos de extractos y fracciones fueron hechos mediante análisis de varianza. El mejor solvente para la extracción de amirinas fue el hexano para ambos métodos de maceración y sonicación (38,16±2,06% y 37,67±8,21%, respectivamente). No hubo diferencia estadística entre estos métodos y el método directo (32,05±2,40%). Además, el método directo es más barato y ecológico. De este modo, esta investigación demostró que es posible obtener una gran cantidad de amirinas a través de métodos rápidos, baratos y ecológicos.

Technical note and clinical instructions for Acute Kidney Injury (AKI) in patients with Covid-19: Brazilian Society of Nephrology and Brazilian Association of Intensive Care Medicine / Nota técnica e orientações clínicas sobre a Injúria Renal Aguda (IRA) em pacientes com Covid-19: Sociedade Brasileira de Nefrologia e Associação de Medicina Intensiva Brasileira

ABSTRACT We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.

RESUMO Este documento foi desenvolvido para trazer informações pertinentes à prática nefrológica em relação ao conhecimento sobre o acometimento renal da COVID-19, conduta frente aos casos de injúria renal aguda e orientações práticas sobre a provisão do suporte dialítico.Como as informações sobre a COVID-19 evoluem a uma velocidade jamais vista na ciência médica, as orientações apresentadas, embora baseadas em evidências científicas recentes, referem-se ao momento presente. Essas orientaços poderão ser atualizadas à medida que dados publicados e outras informações relevantes venham a ser disponibilizadas.

Ocotea (Lauraceae) Amazonian essential oils chemical composition and their tyrosinase inhibition to use in cosmetics / Ocotea (Lauraceae) composición química de aceites esenciales amazónicos y su inhibición de la tirosinasa para usar en cosméticos

This study presents analyses on the chemistry, biology, pharmacology and chromatography of essential oils extracted from three species of the Ocotea genus: O. minor, O. ceanothifolia and O. leucoxylon. Leaves and stems, as well as the bark of O. minor, were processed using a modified Clevenger apparatus. Seven essential oils were obtained and analyzed using GC-FID and GC-MS, and their chemical compositions were determined. Assays of cytotoxicity, antioxidant and free radical scavenging activity, as well as tyrosinase and elastase inhibition were performed. In total, 25 constituents were identified, the principal being sesquiterpenes, such as spathulenol caryophyllene and its oxide. The oils did not present cytotoxicity using a hemolytic model, but also did not show antioxidant activity in the DPPH assay. Essential oil from stems of O. ceanothifolia, rich in spathulenol and caryophyllene oxide, demonstrated the capacity to inhibit 49.08% of tyrosinase activity at a concentration of 100 µg/mL. This research contributes to the chemical profile analysis of the three species of Ocoteathrough chemical investigations and biological activity, which are reported for the first time here in this study.

Este trabajo realiza un estudio químico, biológico, farmacológico y cromatográfico de aceites esenciales extraídos de tres especies del género Ocotea: O. minor, O. ceanothifoliay O. leucoxylon. Las hojas y tallos, así como la corteza de O. minor, se procesaron utilizando un aparato Clevenger modificado. Se obtuvieron siete aceites esenciales y se analizaron usando GC-FID y GC-MS, y se determinaron sus composiciones químicas. Se realizaron ensayos de citotoxicidad, actividad antioxidante y de atrapamiento de radicales libres, así como inhibición de tirosinasa y elastasa. En total, se identificaron 25 componentes, siendo los principales sesquiterpenos, como el spathulenol cariofileno y su óxido. Los aceites no presentaron citotoxicidad en un modelo hemolítico y tampoco mostraron actividad antioxidante en el ensayo con DPPH. El aceite esencial de tallos de O. ceanothifolia, rico en espatulenol y óxido de cariofileno, mostró capacidad para inhibir el 49.08% de la actividad de tirosinasa a una concentración de 100 µg/mL. Esta investigación contribuye al análisis del perfil químico de las tres especies de Ocotea a través de investigaciones químicas y actividad biológica la cual se informan por primera vez.

Phenolic compounds from Virola venosa (Myristicaceae) and evaluation of their antioxidant and enzyme inhibition potential / Compostos fenólicos de Virola venosa (Myristicaceae) e avaliação de seu potencial antioxidante e de inibição enzimática

Virola venosa, popularly known in Brazil as ucuuba-da-mata, occurs naturally in the Amazon region and has potential to provide useful natural compounds, as already known for other Virola species. Therefore, the objective of this study was to determine the chemical composition of bark and leaf extracts of V. venosa, and to test the antioxidant capacity and α-glucosidase inhibition potential of their compounds. Polar extracts showed to be more active in both assays, therefore a bioactivity-guided fractionation was performed to identify the compounds that were responsible for the recorded activities. Using a combination of LC-MS/MS analysis and isolation with NMR identification, eight phenolic compounds were identified. Assays with pure compounds of the active fraction revealed that ferulic acid was the main contributor compound to the observed bioactivity in the crude extracts. (AU)

Virola venosa, popularmente conhecida como ucuuba-da-mata, ocorre naturalmente na região amazônica e tem potencial para fornecer compostos naturais úteis, como já foi mostrado para outras espécies de Virola. Por isso, o objetivo deste estudo foi determinar a composição química dos extratos do tronco e das folhas de V. venosa e os possíveis potenciais antioxidantes e de inibição contra α-glucosidase de seus compostos. Os extratos polares mostraram-se mais ativos em ambos os testes, portanto, um fracionamento guiado por bioatividade foi realizado para designar os compostos responsáveis pelas atividades registradas. Através da combinação de análise CL-EM/EM e isolamento com identificação por RMN, foram identificados oito compostos fenólicos. Testes com os compostos puros principais das frações mais ativas indicaram o ácido ferúlico como o principal contribuinte das atividades biológicas observadas para os extratos brutos, e, consequentemente, o princípio ativo principal de V. venosa.(AU)

Dietary supplementation with camu-camu and continuous exercises in the treatment of obesity / Suplementação dietética com camu-camu e exercícios contínuos no tratamento da obesidade

ABSTRACT Objective The goal of this study were to investigate the effects of continuous exercise with/or without the ingestion the Camu-camu pulp in a rat model of obesity. Methods Neonate male Wistar rats, receiving monosodium glutamate, subcutaneously were separated into foour groups: sedentary group S (no treatment), exercise group E (continuous swimming training), Camu-camu group C (25mL of pulp of Camu-camu/day) and exercise and Camu-camu group EC (25mL of pulp of Camu-camu/day, continuous swimming). After 12 weeks, the animals were received euthanasia. Results The exercise program was conducted for five days for 12 weeks and the effects of supplementation with or without Camu-camu in obese rats were analyzed, showing that the relative levels of the variables cholesterol, triglycerides, glucose, High Density Lipoprotein and Low Density Lipoprotein and in all groups there was a significant reduction (.<0.001), except for the control group. Body weight and feed intake, epididymal and visceral fat deposits were not significantly different between the means of groups C and E, but these groups showed a significant difference when compared to the EC group (.<0.001). Conclusion The results demonstrate the effectiveness of continuous exercise and diet supplemented with Camu-camu fruit pulp to control obesity.

RESUMO Objetivo O objetivo deste estudo foi investigar os efeitos do exercício contínuo, com ou sem a ingestão da polpa de camu-camu, em um modelo de ratos obesos. Métodos Ratos machos neonatos Wistar receberam glutamato monossódico subcutaneamente e foram separados em três grupos. grupo de exercício E (treinamento de natação contínuo); grupo exercitado e suplementado com camu-camu - EC (natação contínua e administração de camu-camu); e grupo sedentário S (sem tratamento), como controle. Concluído o experimento, os animais sofreram eutanásia. Resultados O experimento teve a duração de doze semanas. O protocolo de exercício de natação (120min) e a ingestão da suplementação com camu-camu de polpa (25mL) tiveram a mesma duração e foram feitas simultaneamente cinco vezes por semana. Os resultados apontaram redução significativa (p<0,001) dos níveis relativos das variáveis colesterol, triglicérides, glicose, High Density Lipoprotein e Low Density Lipoprotein nos dois primeiros grupos, quando comparados ao grupo controle. Quanto a peso corporal e consumo de ração, depósitos de gordura epididimal e visceral, não houve diferença significativa entre as médias dos grupos C e E - porém, estes grupos apresentaram diferença significativa quando comparados ao grupo suplementado com camu-camu (p<0,001). Conclusão Os resultados demonstraram a efetividade do exercício contínuo e da dieta suplementada com a polpa de camu-camu para o controle da obesidade.

Investigação sobre o uso do ácido retinoico a 3% e a 5% em soluções para peeling como agente para drug delivery após indução percutânea de colágeno com agulhas (IPCA®): perfil de segurança e protocolo de uso / Investigation on the use of 3% and 5% retinoic acid in peeling solutions as a drug delivery agent after percutaneous induction of collagen with needles (IPCA®): safety profile and application protocol

Introdução: O ácido retinoico em solução para peelings é amplamente usado no tratamento do fotoenvelhecimento. Até o presente momento não conhecemos o grau de esterilidade dessas soluções ou a segurança de seu uso em peles cuja integridade tenha sido perdida por intervenções com microagulhas. Objetivos: Avaliar o potencial bactericida do ácido retinoico 3% e 5% em soluções para peelings com e sem tonalizante, bem como a segurança e tolerância de sua administração imediatamente após o tratamento com microagulhas. Metódos: Amostras de solução de ácido retinoico 3% e 5%, com e sem tonalizante, oriundas de duas farmácias de manipulação (A e B) foram expostas a colônias de Pseudomonas aeruginosa e Staphylococcus aureus. Essas soluções foram usadas como drug delivery após indução percutânea de colágeno com agulhas. Resultados: As amostras avaliadas em D0, D30, D60 e D90 mostraram capacidade bactericida sobre os agentes testados. O uso das soluções após a intervenção com microagulhas foi bem tolerado e apresentou resultados satisfatórios. Conclusão: A solução de ácido retinoico para peelings pode ser utilizada com segurança após procedimentos que levem à perda da integridade da barreira cutânea. A ausência de efeitos adversos e os bons resultados do procedimento permite sugerir a associação de microagulhamento e peeling de ácido retinoico como uma proposta inovadora, reproduzível e segura.

Introduction: Retinoic acid in peeling solution is widely used in the treatment of photoaging. To date, the degree of sterility of these solutions or the safety of their use in skins whose integrity has been lost through microneedling interventions is unknown. Objectives: To evaluate the bactericidal potential of 3% and 5% retinoic acid in peeling solution, with and without a colored vehicle, as well as the safety and tolerance to its administration immediately after application with microneedles. Methods: Samples of 3% and 5% retinoic acid solution, with and without a colored vehicle, prepared by two dispensing pharmacies (A and B) were exposed to Pseudomonas aeruginosa and Staphylococcus aureus colonies. These solutions were used as drug delivery agents after percutaneous induction of collagen with needles. Results: The samples evaluated in D0, D30, D60 and D90 indicated the presence of bactericidal capacity of the tested agents. The use of the solutions following intervention with microneedles was well tolerated and yielded satisfactory results. Conclusion: The retinoic acid peeling solution can be safely used following procedures that lead to a loss of integrity of the skin barrier. The absence of adverse effects and good results yielded by the procedure suggest that the association of microneedling and retinoic acid peeling is an innovative, reproducible and safe proposal.

Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial

OBJECTIVES: Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease. METHODS: This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906. RESULTS: A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5). CONCLUSIONS: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.

Indução percutânea de colágeno com agulhas (IPCA®) associada a radiofrequência pulsada com multiagulhas (RFPM®) na condução de cicatrizes de acne deprimidas: protocolo de tratamento / Percutaneous induction of collagen with needles (IPCA®) associated with Pulsed radiofrequency with multineedles (RFPM®) in the management of depressed acne scars: treatment protocol

Introdução: As cicatrizes de acne deprimidas apresentam-se sempre como um desafio terapêutico. Lasers fracionados, abordagens cirúrgicas e peelings químicos têm tentado oferecer resultados cosméticos aceitáveis, mas continua difícil a escolha do tratamento ideal. Objetivo: Avaliar a eficácia da indução percutânea de colágeno com agulhas associada a radiofrequência pulsada com multiagulhas em cicatrizes de acne deprimidas. Métodos: Estudo retrospectivo da segurança e efetividade da técnica mediante avaliação dos resultados por aplicação de questionário de satisfação aos pacientes e julgamento clínico e fotográfico pelo dermatologista. Resultados: Foram avaliados 13 pacientes com idade entre 21 e 37 anos, submetidos à associação, 100% dos quais relataram satisfação com os resultados, enquanto na avaliação comparativa das fotografias o índice de melhora foi de 50% em dois pacientes e de 70% em seis pacientes. Conclusão: Essa nova proposta terapêutica se apresenta como alternativa ao tratamento de cicatrizes de acne deprimidas.

Introduction: Depressed acne scars always arise as a therapeutic challenge. Fractional lasers, surgical approaches and chemical peels have attempted to offer acceptable aesthetic results, however it is still difficult to determine the ideal treatment. Objective: To evaluate the efficacy of Percutaneous Collagen Induction with needles (IPCA®) associated with Pulsed Radiofrequency with Multineedles (RFPM®) in depressed acne scars. Methods: Retrospective study of the safety and effectiveness of the technique through the evaluation of results based on a satisfaction questionnaire answered by the patients and the clinical and photographic assessment carried out by a dermatologist. Results: Thirteen patients (aged between 21 and 37 years) who had undergone the combination treatment were evaluated. All (100%) reported satisfaction with the outcomes, while in the comparative evaluation of photographs yielded an improvement rate of 50% in 2 patients and of 70% in 6 patients. Conclusion: This new therapeutic proposal arises as an alternative in the treatment of depressed acne scars.

Indução percutânea de colágeno com agulhas em cicatrizes após acidentes automobilísticos: correção cosmética e funcional / Percutaneous collagen induction with needles in scars developed after automobile accidents: esthetical and functional correction

Introdução: A utilização de técnicas com microagulhas vem adquirindo importância crescente na correção de cicatrizes. Objetivo: Estudo retrospectivo, descritivo e unicêntrico, avaliando os resultados da indução percutânea de colágeno com agulhas em cicatrizes desenvolvidas após acidentes automobilísticos. Métodos: Foram considerados registros em prontuários e fotografias padronizadas feitas antes e três meses depois de sessão única de microagulhamento, de nove pacientes com diagnóstico de cicatrizes pós-traumáticas tratados pelo mesmo protocolo. As avaliações clínica e fotográfica do tratamento, de acordo com escala de categorias − muito bom, bom, razoável, ruim −, foram realizadas pelo investigador três meses após o procedimento, quando também foram aplicados questionários de satisfação aos pacientes. Resultados: Na avaliação clínica e por meio de fotografias, o autor considerou cinco pacientes com resultados muito bons e quatro com resultados bons. 100% dos pacientes relataram satisfação com os resultados. Conclusões: Observam-se bons resultados cosmético e funcional em cicatrizes após trauma acidental com a utilização da indução percutânea de colágeno com agulha. Não se observaram efeitos adversos, o que nos permite sugerir que o procedimento apresentou bom perfil de segurança.

Introduction: The use of microneedling techniques has become increasingly important in the correction of scars. Objective: To evaluate the results of percutaneous induction of collagen with needles in scars developed after automobile accidents. Methods: A retrospective, descriptive and monocentric study analyzed medical records containing standardized photographs taken at baseline and 3 months after a single microneedling session, in 9 patients diagnosed with post-traumatic scars who were treated using the same protocol. Clinical and photographic evaluations of the treatment were performed by the investigator 3 months after the procedure according to a category scale (very good, good, reasonable, poor). Patient satisfaction questionnaires were also applied at this experimental timepoint. Results: The clinical and photographic evaluation classified 5 patients as very good and 4 as good regarding the results achieved. All patients reported satisfaction with the outcomes. Conclusions: The use of needle-induced percutaneous collagen yielded good esthetical and functional results in scars developed following accidental trauma. Adverse effects were not observed, which suggests that the described procedure has a good safety profile.

Radiofrequência pulsada com multiagulhas (RFPM®) no tratamento do envelhecimento do lóbulo da orelha / Pulsed radiofrequency with multineedles for earlobe aging treatment

Introdução: Várias técnicas vêm sendo descritas para o tratamento do envelhecimento do lóbulo da orelha. Métodos cirúrgicos e não cirúrgicos, como peelings, laser fracionado de CO2, e preenchedores vêm sendo propostos com o intuito de produzir remodelamento de colágeno dessa região. Objetivo: O objetivo deste estudo clínico retrospectivo foi avaliar a eficácia da radiofrequência pulsada com multiagulhas (RFPM®) no rejuvenescimento do lóbulo da orelha. Métodos: Estudo retrospectivo da segurança e efetividade da técnica mediante avaliação dos resultados por aplicação de questionário de satisfação aos pacientes e julgamento dos resultados clínicos por dermatologistas independentes. Resultados: Foram avaliados 12 pacientes com idade entre 48 e 67 anos, submetidos à técnica, 100% dos quais relataram satisfação com os resultados, enquanto na avaliação comparativa das fotografias por dois dermatologistas independentes o índice de melhora foi de 75% em quatro pacientes e 100% em oito pacientes. A hiperpigmentação pós-inflamatória foi observada entre dez e 15 dias após o tratamento em cinco pacientes, tendo sido revertida após tratamento clínico. Conclusão: Esse novo procedimento se apresenta como alternativa ao tratamento do envelhecimento do lóbulo da orelha.

Introduction: Numerous techniques have been described to treat the earlobe aging. Surgical and nonsurgical methods as peelings, CO2 laser and fillings have been proposed to produce collagen remodeling. Objective: The objective of this retrospective clinical study was to evaluate the effectiveness of microneedling assisted radiofrequency for earlobe aging. Methods: Retrospective study of the technique's safety and effectiveness through the evaluation of the results with the application of a satisfaction questionnaire to patients and of the analysis of clinical outcomes by independent dermatologists. Results: Twelvy patients aged between 48 and 67 years who underwent the technique were evaluated. One hundred percent of the patients reported satisfaction with the results, whereas in the comparative evaluation of the photographs carried out by two independent dermatologists the rate of improvement was 75% in four patients, 100% in eigth patients. Post-inflammatory hyperpigmentation was observed ten to 15 days after the treatment in five patients, though it was reversed after clinical treatment. Conclusion: This new procedure emerges as an alternative treatment for earlobe aging.