Myeloperoxidase as a biomarker for intestinal-brain axis dysfunction induced by malnutrition and Cryptosporidium infection in weanling mice

Abstract Cryptosporidiosis is a waterborne protozoal infection that may cause life-threatening diarrhea in undernourished children living in unsanitary environments. The aim of this study is to identify new biomarkers that may be related to gut-brain axis dysfunction in children suffering from the malnutrition/infection vicious cycle is necessary for better intervention strategies. Myeloperoxidase (MPO) is a well-known neutrophil-related tissue factor released during enteropathy that could drive gut-derived brain inflammation. We utilized a model of environmental enteropathy in C57BL/6 weanling mice challenged by Cryptosporidium and undernutrition. Mice were fed a 2%-Protein Diet (dPD) for eight days and orally infected with 107-C. parvum oocysts. C. parvum oocyst shedding was assessed from fecal and ileal-extracted genomic DNA by qRT-PCR. Ileal histopathology scores were assessed for intestinal inflammation. Prefrontal cortex samples were snap-frozen for MPO ELISA assay and NF-kb immunostaining. Blood samples were drawn by cardiac puncture after anesthesia and sera were obtained for serum amyloid A (SAA) and MPO analysis. Brain samples were also obtained for Iba-1 prefrontal cortex immunostaining. C. parvum-infected mice showed sustained stool oocyst shedding for six days post-infection and increased fecal MPO and inflammation scores. dPD and cryptosporidiosis led to impaired growth and weight gain. C. parvum-infected dPD mice showed increased serum MPO and serum amyloid A (SAA) levels, markers of systemic inflammation. dPD-infected mice showed greater MPO, NF-kB expression, and Iba-1 immunolabeling in the prefrontal cortex, an important brain region involved in executive function. Our findings suggest MPO as a potential biomarker for intestinal-brain axis dysfunction due to environmental enteropathy.

Off-label drug use in an adult intensive care unit of a Brazilian hospital

Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice

Hereditary breast cancer ­ what we have learned in the last decade

This literature review aims to inform and assist physicians and other health professionals in managing all information related to hereditary breast cancer, which is in constant and rapid growth, allowing for improvement in patient care and assistance. In addition, we seek to better identify which patients are eligible for the clinical criteria of association with risk of hereditary breast cancer, based on international recommendations and highlighting the main high and moderate penetrance genes that make up the multigenic panels for germline investigation in breast cancer, as well as the possibilities of clinical management that must be considered when complex decisions are required in clinical practice. Nowadays, there is more interest in population screening, in a greater supply of genetic tests, more genes included in multigene panels ­ allowing the search for genetic counseling ­, apart from the need for clinical-decision support.

Avaliação do índice de vulnerabilidade clínico-funcional em idosos / Evaluation of the clinical-functional vulnerability index in older adults

OBJETIVO:Avaliar o índice de vulnerabilidade clínico-funcional (IVCF) em idosos e sua relação com indicadores socioeconômicos, comportamentais e clínico-terapêuticos. MÉTODO: Estudo epidemiológico transversal de desenho quantitativo com 318 idosos vinculados à Estratégia Saúde da Família e aleatoriamente sorteados. Os dados foram coletados por meio do questionário IVCF-20 e a análise subsidiada pela estatística descritiva, bivariada e multivariada, considerando significância quando o p-valor <0,05. RESULTADO: A maior parte dos idosos (59,1%) é considerada frágil ou potencialmente frágil. Entre os grupos estudados, houve diferença estatisticamente significativa do IVCF com relação às variáveis faixa etária (p<0,001), alfabetização funcional (p=0,001), consumo de álcool (p<0,001), prática de exercícios físicos (p<0,001), problemas de saúde autorreferidos (p<0,001) e uso de medicamentos (p<0,001), além de correlação positiva com o estresse (r=0,135; p=0,016). No modelo de regressão linear múltipla, o conjunto de variáveis preditoras sociodemográficas explicam a fragilidade de idosos em 30,4% (R2=0,304).CONCLUSÃO: O avançar da idade, enquanto variável não controlável, aponta a necessidade de estimular a manutenção da funcionalidade na velhice a partir da proposição de estratégias de atenção à saúde de modo a prolongar a longevidade com segurança, autonomia e vitalidade. AU

OBJECTIVE: To evaluate the clinical-functional vulnerability index (CFVI) of older adults and its relationship with socioeconomic, behavioral, clinical and therapeutic indicators. METHOD: A cross-sectional epidemiological study with a quantitative design was performed with 318 randomly drawn older adults registered with the Family Health Strategy. Data were collected through the CFVI-20 questionnaire and analysis was supported by descriptive, bivariate and multivariate statistics, with results with p-value <0.05 considered significant. RESULT: most older adults (59.1%) were considered frail or potentially frail. Among the groups studied, there was a statistically significant difference in the CFVI for the variables age group (p<0.001), functional literacy (p=0.001), alcohol consumption (p<0.001), physical exercise (p<0.001), self-reported health problems (p<0.001) and medication use (p<0.001), as well as a positive correlation with stress (r=0.135; p=0.016). In the multiple linear regression model, the set of sociodemographic predictor variables explained the frailty of the elderly by 30.4% (R2=0.304).CONCLUSION: The advancement of age, as a non-controllable variable, indicates a need to encourage the maintenance of functionality in old age, based on the health care strategies that prolong longevity with safety, autonomy and vitality.

Molecular diagnosis of diarrheagenic Escherichia coli isolated from Psittaciformes of illegal wildlife trade / Diagnóstico molecular de Escherichia coli diarreiogênicas isoladas de Psittaciformes do tráfico ilegal de animais silvestres

Diarrheagenic Escherichia coli (DEC) are considered one of the major causes of human diarrhea in developing countries. Some studies have pointed wild birds as important reservoirs for these pathogens. However, scarce species from the Psittaciformes order have been investigated. This study aimed to evaluate the presence of DEC strains in Psittaciformes from illegal wildlife trade. A total of 78 E. coli strains isolated from cloacal swab samples of 167 Psittaciformes in the Ceará State, Brazil, were evaluated regarding the presence of the following DEC virulence genes by polymerase chain reaction (PCR): eaeA and bfpA genes (Enteropathogenic E. coli - EPEC); stx1 and stx2 (Shiga toxin-producing E. coli - STEC); estA and eltB (Enterotoxigenic E. coli - ETEC); ipaH (Enteroinvasive E. coli - EIEC); aatA and aaiC (Enteroaggregative E. coli - EAEC). Positive strains for eaeA and bfpA genes were considered typical EPEC, while strain positive exclusively for the eaeA gene were classified as atypical EPEC. The eaeA gene was identified in 20 E. coli strains and bfpA in 22 isolates. In addition, 11 and 9 belonged to tEPEC and aEPEC, respectively. No strain was positive for stx1 or stx2. A total of 47 (60.3%) strains and a total of 136 birds (81.4%) were negative for the remaining DEC pathotypes investigated. In conclusion, psittacine from illegal wildlife trade in Ceará State, Brazil, presented a relevant prevalence of typical and atypical EPEC, potentially playing a role as reservoirs of DEC strains in the environment. Thus, proper control measures must be adopted to block the spread of these pathogens.(AU)

Escherichia coli diarreiogênicas (DEC) são consideradas uma das causas mais importantes de diarreia em países em desenvolvimento. Alguns estudos têm apontado aves silvestres como importantes reservatórios destes patógenos, entretanto, poucas espécies da ordem Psittaciformes têm sido investigada. O objetivo deste estudo foi analisar a presença de cepas de E. coli diarreiogênicas em Psittaciformes do tráfico de animais silvestres. Um total de 78 amostras de E. coli isoladas de suabes cloacais provenientes de 167 de Psittaciformes do Ceará, Brasil, foram avaliadas quanto a presença dos seguintes genes de virulência DEC por meio de reação em cadeia de polimerase (PCR): eaeA e bfpA (E. coli Enteropatogênica - EPEC); stx1 e stx2 (E. coli produtora de Shiga - STEC); estA e eltB (E. coli Enterotoxigênica - ETEC); ipaH (E. coli Enteroinvasiva - EIEC); aatA e aaiC (E. coli Enteroagregativa - EAEC). As cepas positivas para os genes eaeA e bfpA foram consideradas EPEC típicas, enquanto que as positivas exclusivamente para o gene eaeA foram classificadas como EPEC atípicas. O gene eaeA foi identificado em 20 cepas de E. coli e o gene bfpA em 22 dos isolados. Adicionalmente, 11 e 9 cepas foram classificadas como EPEC típicas e atípicas, respectivamente. Nenhuma cepa foi positiva para os genes stx1 e stx2. Um total de 47 cepas (60,3%) e um total de 136 aves (81,4%) foram negativas para os demais patotipos DEC pesquisados. Em conclusão, psitacídeos provenientes do tráfico de aves silvestres do estado do Ceará, Brasil, apresentaram relevante prevalência de EPEC típicas e atípicas, potencialmente participando como reservatórios de cepas DEC no ambiente. Portanto, medidas de controle devem ser adotadas para inibir a disseminação destes patógenos.(AU)

Clinical evaluation, biochemistry and genetic polymorphism analysis for the diagnosis of lactose intolerance in a population from northeastern Brazil

OBJECTIVE: This work aimed to evaluate and correlate symptoms, biochemical blood test results and single nucleotide polymorphisms for lactose intolerance diagnosis. METHOD: A cross-sectional study was conducted in Fortaleza, Ceará, Brazil, with a total of 119 patients, 54 of whom were lactose intolerant. Clinical evaluation and biochemical blood tests were conducted after lactose ingestion and blood samples were collected for genotyping evaluation. In particular, the single nucleotide polymorphisms C>T-13910 and G>A-22018 were analyzed by restriction fragment length polymorphism/polymerase chain reaction and validated by DNA sequencing. RESULTS: Lactose-intolerant patients presented with more symptoms of flatulence (81.4%), bloating (68.5%), borborygmus (59.3%) and diarrhea (46.3%) compared with non-lactose-intolerant patients (p<0.05). We observed a significant association between the presence of the alleles T-13910 and A-22018 and the lactose-tolerant phenotype (p<0.05). After evaluation of the biochemical blood test results for lactose, we found that the most effective cutoff for glucose levels obtained for lactose malabsorbers was <15 mg/dL, presenting an area under the receiver operating characteristic curve greater than 80.3%, with satisfactory values for sensitivity and specificity. CONCLUSIONS: These data corroborate the association of these single nucleotide polymorphisms (C>T-13910 and G>A-22018) with lactose tolerance in this population and suggest clinical management for patients with lactose intolerance that considers single nucleotide polymorphism detection and a change in the biochemical blood test cutoff from <25 mg/dL to <15 mg/dL.

Genetic analysis of mecA gene and detection of homologue pbpD in Stahylococcus sciuri group

Oxacillin/methicillin-resistance is related to the mecA and its regulatory genes mecR1 and mecI. Its origin is still unknown, although evidences support that it is related to CNS, once mecA and a homologue gene, pbpD, were both detected in Staphylococcus sciuri species group. The present work evaluated 210 samples of skin and ear swabs from rodents and 60 nasal swabs from equines of Army Biologic Institute, Rio de Janeiro. Pheno- and genotypic characterization provided 59.52% (25/42) and 78.57% (11/14) S. lentus and S. sciuri, respectively. It was observed that although all S. sciuri isolates tested positive for pbpD, there was no correlation with oxacillin-resistance. On the other hand, isolates tested positive for mecA gene also presented phenotypic oxacillin-resistance in at least one assay. The alignment of the mecA gene showed that the nucleotide sequences were sorted into 2 different groups, one comprising the bovine strains and the other containing human and equine strains.

Mucormicose (zigomicose) rino cerebral: apresentaçäo de dois casos com sobrevida / Mucomycosis (zygomycosis) rhinocerebral: report of two cases with prognosis

Säo relatados dois casos de mucormicose rinocerebral em jovens diabéticos. Num paciente, a micose teve curso arrastado e apesar do envolvimento sino-órbito-cerebral, a sintomatologia refletiu apenas o comprometimento órbito-ocular. No outro paciente, a doença teve curso agudo nasal e palatina, seios paranasais, tecidos periorbitários, olho e nervos cranianos, porém sem acometimento cerebral. Houve sobrevida de ambos os pacientes, porém, em apenas um deles o diagnóstico foi completo pelo isolamento do agente