A bullous variant of central serous chorioretinopathy treated with oral spironolactone / Uma variante bolhosa da coriorretinopatia serosa central tratada com espironolactona oral

ABSTRACT We report the case of a 39-year-old male patient who presented with visual loss in the right eye for 6 weeks. The best-corrected visual acuity was counting fingers in the right eye and 20/30 in the left eye. The fundus examination demonstrated a right retinal detachment inferiorly extending to the fovea and a left macular serous detachment. After multimodal imaging study, the patient was diagnosed as having a bullous variant of central serous chorioretinopathy and treated with oral spironolactone associated with adjuvant laser photocoagulation. The retinal changes resolved after 6 months. The final visual acuity was 20/20 in both eyes.

RESUMO Relatamos o caso de um homem de 39 anos apresentando perda visual no olho direito há seis semanas. A melhor acuidade visual corrigida foi conta-dedos no olho direito e 20/30 no esquerdo. A fundoscopia demonstrou descolamento de retina direito inferiormente com extensão à fóvea e descolamento macular seroso à esquerda. Após estudos de imagem multimodal, o paciente foi diagnosticado com uma variante bolhosa de coriorretinopatia serosa central e tratado com espironolactona oral associada à fotocoagulação a laser adjuvante. As alterações retinianas resolveram após seis meses. A acuidade visual final foi 20/20 em ambos os olhos.

Utilización precoz de tocilizumab en pacientes internados con COVID-19 grave y crítica: un estudio multicéntrico en la Provincia de Buenos Aires / Early use of tocilizumab in hospitalized patients with severe and critical COVID-19 in the Province of Buenos Aires: a multicentric study

Resumen Introducción: El objetivo principal del estudio fue evaluar la mortalidad en los pacientes con COVID-19 graves y críticos, que recibieron tocilizumab (TCZ) -un antagonista monoclonal del receptor de IL-6- de forma temprana vs. tardía. Métodos: Cohorte retrospectiva multicéntrica de pacientes >18 años internados con COVID-19 desde el 1/7/2021-1/8/2022, con 5-7 puntos de gravedad inicial (GI) según Escala de la OMS. Se consideró adminis tración temprana o tardía a la infusión de TCZ ≤ ó > a 48 h del ingreso. Las variables de resultado fueron mortalidad a 28 días y cambio de la GI. Los factores relacionados con la mortalidad fueron evaluados con regresión de Cox. Resultados: Se incluyeron 266 pacientes, 159(60%) varones; edad 58(± 15); con hipertensión arterial (43%), obesidad (37%) y diabetes (27%);70 presentaban GI = 5 (oxígeno suplementario), 143 GI = 6 (ventilación no inva siva o cánula nasal de alto flujo) y 53 GI = 7 (ventilación mecánica invasiva). La mortalidad a 28 días fue 42%, asociada independientemente a: edad, obesidad, GI, días entre la internación y administración del TCZ, y días entre la fecha de inicio de síntomas y el TCZ. La mortalidad para GI 5, 6 y 7 fue 26%, 39% y 72%, respectivamente; 76% y 62% de los pacientes permanecieron estables o mejoraron la GI a los días 3 y 7 de la infusión de TCZ. La mortalidad a 28 días fue 39% (TCZ temprano) vs. 57% (TCZ tardío); p = 0.02; HR = 0.63[0.41-0.99, p = 0.05]). Discusión: Estos resultados apoyan la administración temprana de TCZ en pacientes con COVID-19 grave y crítica.

Abstract Introduction: Tocilizumab (TCZ), an IL-6 receptor antagonist monoclonal antibody is warranted in severe and critically-ill COVID-19 patients. The objective was to evaluate 28-day mortality of patients with severe or critical COVID-19 treated with early vs delayed TCZ. Methods: Multicenter, retrospective cohort study in cluding patients>18 years hospitalized between 7/1/2021- 8/1/2022 with confirmed COVID-19, with 5, 6 and 7 points of WHO Ordinal Initial Severity Scale [SS]. Early or late administration was considered if TCZ was administered before or after 48 hours from admission. Outcomes were28-day mortality and change of SS. Factors related to 28-day mortality were evaluated with Cox regression. Results: 266 patients were included, 159(60%) male; aged 58(± 15); frequent comorbidities were hypertension (42%), obesity (37%) and diabetes (27%). Seventy patients had a SS = 5 (Supplemental O2), 143 had SS = 6 (NIV/ HFNC), and 53 had SS = 7 (IMV). 28-day mortality was 42%(112/266); predictors were age, obesity, higher SS, days between hospitalization and TCZ administration, and fewer days between symptoms onset and TCZ. Mortality of SS 5, 6 and 7 was 26%, 39% and 72% respectively. Com pared with baseline SS points, 76% and 62% of patients remained stable or improved on days 3 and 7 since TCZ administration. 28-day mortality was lower when TCZ was administered before 48 hours (39% vs 57%; p = 0.02; HR = 0.63;[0.41-0.99, p = 0.05]). Discussion: This study supports the early use of TCZ in patients with severe or critical COVID-19.

Corifollitropin Alfa for Controlled Ovarian Stimulation in Assisted Reproductive Technologies: State of the Art / Alfacorifolitropina para estimulação ovariana controlada em tecnologias de reprodução assistida: Estado da arte

Abstract Physical and emotional burdens during the journey of infertile people through assisted reproductive technologies are sufficient to justify the efforts in developing patient-friendly treatment strategies. Thus, shorter duration of ovarian stimulation protocols and the need for less injections may improve adherence, prevent mistakes, and reduce financial costs. Therefore, the sustained follicle-stimulating action of corifollitropin alfa may be the most differentiating pharmacokinetic characteristic among available gonadotropins. In this paper, we gather the evidence on its use, aiming to provide the information needed for considering it as a first choice when a patient-friendly strategy is desired.

Resumo O desgaste físico e emocional durante a jornada de pessoas inférteis pelas tecnologias de reprodução assistida é suficiente para justificar esforços no desenvolvimento de estratégias de tratamento compassivas. Desta forma, a menor duração dos protocolos de estimulação ovariana e a necessidade de menos injeções podem melhorar a adesão, prevenir erros e reduzir custos financeiros. Portanto, a estimulação folicular sustentada da alfacorifolitropina parece ser a característica farmacocinética que melhor a diferencia das gonadotrofinas atualmente disponíveis no mercado. No presente artigo, reunimos evidências sobre seu uso, com o objetivo de fornecer as informações necessárias para considerá-la como primeira escolha quando se deseja uma estratégia amigável ao paciente.

Nueva evidencia en el tratamiento de la enfermedad renal diabética: ¿qué aporta la finerenona?

Contexto: la enfermedad renal diabética (ERD) es la primera causa a nivel mundial de enfermedad renal crónica (ERC) e impacta directamente en el riesgo cardiovascular y mortalidad de los pacientes con diabetes mellitus (DM). La finerenona, un antagonista selectivo del receptor mineralocorticoide (ARM), ha sido descrito en diversos estudios recientes como un fármaco que contribuye a la reducción de la progresión de la ERD y la disminución del riesgo cardiovascular, con un adecuado perfil de seguridad. Objetivo: realizar una revisión de la literatura sobre el impacto de la finerenona en la progresión del daño renal y el riesgo cardiovascular en los pacientes con ERD. Metodología: se realizó una búsqueda sistemática en diversas fuentes: PubMed (Medline, Biblioteca del Congreso de los Estados Unidos), Science Direct, Scopus, Embase y Lilacs; la búsqueda fue restringida a referencias en idioma español e inglés, sin límites en la fecha de publicación. Se utilizaron las siguientes palabras clave en el idioma inglés: diabetic renal disease, chronic kidney disease, diabetes mellitus, spironolactone, eplerenone, finerenone, mineralocorticoid receptor antagonist y sus correspondientes versiones en español. Resultados: Las referencias encontradas en la búsqueda fueron revisadas entre los diferentes autores para, posteriormente, proceder a realizar la elaboración del documento. Conclusiones: la finerenona es un medicamento que brinda cardio y nefroprotección en pacientes con ERD de fenotipo albuminúrico.

Background: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) worldwide and has a direct impact on cardiovascular risk and mortality in patients with diabetes mellitus (DM). Finerenone, a selective mineralocorticoid receptor (MRA) antagonist, has been described in several recent studies as a drug that contributes to slowing the progression of CKD and reducing cardiovascular risk, with an adequate safety profile. Purpose: To carry out a review of the literature on the impact of finerenone on the progression of renal damage and cardiovascular risk in patients with DKD. Methodology: A systematic search were carried out in various sources: PubMed (Medline, United States Library of Congress), Science Direct, Scopus, Embase and Lilacs; the search was restricted to references in Spanish and English, with no limits on publication date. The following keywords in the English language were used: diabetic renal disease, chronic kidney disease, diabetes mellitus, spironolactone, eplerenone, finerenone, mineralocorticoid receptor antagonist and their corresponding Spanish versions. Results: The references found in the search were reviewed among the different authors to subsequently proceed to prepare the document. Conclusions: Finerenone is a drug that provides cardio and nephroprotection in patients with DKD albuminuric phenotype.

Characterization and survival of broad-spectrum biocontrol agents against phytopathogenic fungi / Caracterización y supervivencia de agentes de control biológico de amplio espectro frente a hongos fitopatógenos

Resumen Este estudio tuvo como objetivo aislar, caracterizar e identificar bacterias de control biológico que poseen actividad antifúngica de amplio espectro de la filosfera de diferentes cultivos, incluidos el maíz, el trigo y la papa, así como evaluar su actividad en la promoción del crecimiento. En este estudio, 14/113 bacterias de control biológico mostraron actividad antifúngica. Los aislamientos bacterianos M11 y M33 (de maíz), del total de 113, fueron reseleccionados debido a su fuerte actividad antifúngica de amplio espectro (más del 50%) después de su evaluación contra cuatro hongos fitopatógenos que afectan cultivos de alta importancia económica, entre ellos, Alternaría alternata, Rhizoctonia solani, Fusarium oxysporum y Fusarium verticillioides. Los aislamientos se evaluaron, adicionalmente, para determinar los rasgos que promueven el crecimiento de las plantas, es decir, producción de ácido indolacético, solubilización de fosfato, producción de celulasa, compuestos orgánicos volátiles microbianos, cianuro de hidrógeno y sideróforos. Las 14 cepas aisladas mostraron resultados positivos para la producción de la hormona ácido indolacético y la enzima celulasa; 10 cepas fueron positivas para la producción de cianuro de hidrógeno. Además, se observó producción de sideróforos en el caso de 7 cepas, mientras que 5 pudieron solubilizar fosfato inorgánico. Los compuestos orgánicos volátiles microbianos solo fueron sintetizados por los aislamientos M11 y M33, que fueron identificados como Bacillus amyloliquefaciens y Bacillus subtilis, respectivamente, mediante secuenciación del gen ARNr 16S. El estudio de supervivencia mostró que las bacterias de control biológico, es decir, B. amyloliquefaciens y B. subtilis, tienen la capacidad de sobrevivir sobre un sustrato a base de melasa, por un período de tres meses.

Prevention of Premature Ovulation by Administration of Gonadotropin Releasing Hormone Antagonist the day After Ovulation Triggering in Diminished Ovarian Reserve Patients / Prevenção da ovulação prematura por meio da administração de antagonismo de liberação de gonadotropismo no dia seguinte à ovulação

Abstract Objective The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes. Methods This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2nd or 3rd day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection. Results The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p=0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) (p=0.013), the oocyte maturity rate (79.42 versus 47.87%) (p=0.041), the fertilization rate (65.68 versus 34.54%) (p=0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) (p=0.003) were higher in the GnRH antagonist group than in the control group. Conclusion The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.

Resumo Objetivo O objetivo do presente estudo retrospectivo foi investigar a eficácia da administração do antagonista do hormônio liberador da gonadotrofina (GnRH) em dose única no dia seguinte ao desencadeamento da gonadotrofina coriônica humana (hCG) para a maturação final do oócito, na prevenção da luteinização prematura em pacientes com diminuição do ovário reserva em ciclos de fertilização in vitro (FIV). O objetivo secundário do estudo foi pesquisar o efeito deste protocolo nos resultados da gravidez. Métodos Trata-se de um estudo retrospectivo incluindo 267 pacientes inférteis que apresentam um único folículo antral visto por ultrassonografia no 2° ou 3° dia do ciclo menstrual antes de iniciar o tratamento de FIV. Nós randomizamos os pacientes em dois grupos. Os pacientes que receberam injeção de antagonista de GnRH em dose única no dia seguinte ao desencadeamento do hCG formaram o grupo caso, e os pacientes que receberam o regime de tratamento padrão formaram o grupo controle. Em ambos os grupos, os oócitos foram coletados 36 horas após a injeção de hCG. Resultados A taxa de ovulação prematura foi significativamente baixa no grupo caso em comparação com o grupo controle (6,86 versus 20,6% por ciclo programado) (p=0,022). Além disso, a taxa de recuperação de oócitos (93,14 versus 67,87% por ciclo programado) (p=0,013), a taxa de maturidade do oócito (79,42 versus 47,87%) (p=0,041), a taxa de fertilização (65,68 versus 34,54%) (p=0,018) e a taxa de transferência de embriões por ciclo programado (44,11 versus 18,78%) (p=0,003) foram maiores no grupo antagonista de GnRH do que no grupo controle. Conclusão A administração de antagonista de GnRH, no dia seguinte ao desencadeamento de hCG em tratamentos de FIV de pacientes com reserva ovariana diminuída permitiu uma redução significativa na taxa de ovulação precoce,mas não teve efeito na taxa de nascidos vivos.

Alternativas de control biorracionales sobre Phytophthora infestans, fitopatógeno causante de la gota en papa / Biorational control alternatives on Phytophthora infestans, phytopathogen causing gout in potatoes

Resumen La gota de la papa o tizón tardío es una de las enfermedades más agresivas que atacan los cultivos de papa y en poco tiempo los destruye, ocasionando enormes pérdidas económicas, es producida por el fitopatógeno Phytophthora infestans, oomyceto que ha tomado gran importancia debido a sus efectos devastadores y las dificultades para lograr su erradicación. Los fungicidas de naturaleza química representan un problema debido al uso inadecuado, lo que hace muy difícil eliminar la enfermedad por la aparición de nuevas especies resistentes. Existen nuevas alternativas para su control, basadas en el uso de sustancias de naturaleza vegetal, y la aplicación de nuevas herramientas capaces de realizar edición de genes, reprogramar o eliminar secuencias de ADN/ARN, favoreciendo así, la obtención de cultivos libres de sustancias tóxicas. En esta revisión, se presentan los métodos existentes de biocontrol: como aceites esenciales, metabolitos microbianos, herramientas moleculares y el uso de sustancias biodegradables que favorecen el manejo y prevención de plagas, que ayudan a mitigar la problemática ambiental generada por el uso de fungicidas de naturaleza química.

Abstract The drop of the potato or late blight is one of the most aggressive diseases that attack the potato crops and in a short time destroys them, causing great economic losses, it is produced by the phytopathogen Phytophthora infestans, oomyceto that has taken great importance due to its devastating effects and difficulties in achieving its eradication. Fungicides of a chemical nature represent a problem due to the affected use, which makes it very difficult to eliminate the disease due to the appearance of new resistant species. There are new alternatives for its control, based on the use of substances of the plant nature, and the application of new specific tools to perform gene editing, reprogram or eliminate DNA / RNA sequences, thus favoring the obtaining of cultures free of toxic substances . In this review, specific biocontrol methods are presented, such as essential oils, microbial metabolites, molecular tools and the use of biodegradable substances that favor the management and prevention of pests, which help mitigate the environmental problems generated by the use of fungicides from chemical nature.

Anestesia intravenosa contínua com cetamina racêmica ou dextrocetamina e detomidina em cadelas / [Continuous intravenous anesthesia with racemic ketamine or dextroketamine and detomidine in female dogs]

Objetivou-se com este estudo comparar a associação de detomidina e cetamina ou dextrocetamina, por via intravenosa contínua, em oito cadelas submetidas a dois protocolos: GCD - indução anestésica com 5mg/kg e infusão intravenosa contínua de 20mg/kg/h de cetamina; e GDD - indução com 3,5mg/kg e infusão de 14mg/kg/h de dextrocetamina. Associou-se detomidina, 30µg/kg/h, em ambos os grupos. Registraram-se frequência cardíaca (FC), pressão arterial (PA), frequência respiratória (f), temperatura (TC), miorrelaxamento, analgesia, hemogasometria e eletrocardiograma, antes e 15 minutos após a MPA (Mbasal e Mmpa); após o início da infusão (Mic); a cada 10 minutos até 90 minutos (M10, M20, M30, M40, M50, M60, M70, M80 e M90); e 30 minutos após o fim da infusão (M120). Foi observada bradicardia em Mmpa no GCD e de Mmpa a M10 no GDD. Ocorreu hipotensão em Mmpa e hipertensão a partir de Mic. A f diminuiu de M10 a M30. Foram observados: onda T de alta amplitude, bloqueios atrioventriculares e parada sinusal. Ocorreu acidose respiratória. O período de recuperação foi de 219,6±72,3 minutos no GCD e de 234,1±96,8 minutos no GDD. A cetamina e a dextrocetamina, associadas à detomidina por infusão contínua, causam efeitos cardiorrespiratórios e anestésicos similares.(AU)

The combination of detomidine and ketamine or dextrocetamine for continuous intravenous infusion was compared in eight female dogs submitted to two protocols: GCD - 5mg/kg of anesthetic induction and continuous intravenous infusion of ketamine 20mg/kg/h; and GDD - induction with 3.5mg/kg and infusion of 14mg/kg/h of dextrocetamine. Detomidine, 30µg/kg/h was associated in both groups. Heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature (CT), myorelaxation, analgesia, blood gas analysis and electrocardiogram were recorded before and 15 minutes after MPA (Mbasal and Mmpa); after the start of infusion (Mic); every 10 minutes to 90 minutes (M10, M20, M30, M40, M50, M60, M70, M80 and M90); and 30 minutes after the end of infusion (M120). Bradycardia was observed in Mmpa in GCD and from Mmpa to M10 in GDD. There was hypotension in Mmpa and hypertension from Mic. The RR decreased from M10 to M30. High amplitude T wave, atrioventricular blocks and sinus arrest were observed. Respiratory acidosis occurred. The recovery period was 219.6±72.3 minutes in GCD and 234.1±96.8 minutes in GDD. Ketamine and S+ ketamine associated with detomidine for continuous infusion cause cardiorespiratory and similar anesthetic effects.(AU)

Complicações precoces em próteses parciais fixas implantossuportadas de zircônia monolítica e bicamada: estudo prospectivo, randomizado, de boca dividida / Early complications in fixed partial prosthesis implants supported with monolithic and bilayer zirconia: a prospective, randomized, split-mouth study

As coroas de cerâmica pura estão ganhando força na odontologia uma vez que as exigências estéticas e mecânicas são cada vez mais evidentes, uma vez que as próteses metal free do tipo bicamada, não raramente, apresentam lascamento da cerâmica de cobertura como a principal falha a longo prazo, então iniciou-se o uso de próteses monolíticas. Paralelamente é crescente a busca e o uso de implantes osseointegráveis para suportar as reabilitações parciais, sendo a primeira opção para as reabilitações orais de áreas edêntulas. Logo, o objetivo deste estudo clínico prospectivo, randomizado de boca dividida é avaliar o desempenho clínico e a previsibilidade, caracterizando o número e o tipo de complicações e falhas precoces como desgaste do antagonista, perda óssea, inflamação gengival e falhas mecânicas que possam ocorrer em PPFs de três elementos implantossuportadas com retenção mista em região posterior de mandíbula em zircônia monolítica e infraestrutura de zircônia com cerâmica de cobertura, além de avaliar a percepção estética e satisfação do paciente com cada uma delas. Os pacientes selecionados (N=2) passarão por procedimentos cirúrgicos para instalação de dois implantes na região posterior de mandíbula, sendo dois de cada lado. Após três a quatro meses os cicatrizadores serão instalados e a moldagem será realizada para confecção das próteses seguindo a aleatorização do lado da mandíbula. Serão avaliados desgaste das próteses e dos antagonistas por meio de microscopia eletrônica de varredura; perda óssea periimplantar utilizando radiografias periapicais em três períodos, imediatamente após a instalação das próteses, uma semana após e três meses depois, percepção estética e alteração de cor utilizando o método de escala visual analógica pelo paciente. As hipóteses deste estudo são resistência à fratura e lascamento será semelhante nos grupos avaliados, todos os grupos serão esticamente aceitáveis, o desgaste do antagonista e das próteses será semelhante entre os grupos e a manutenção periodontal e nível de perda óssea será semelhante para os grupos(AU)

The pure ceramic crowns have been gaining strength in dentistry since the aesthetic and mechanical requirements are increasingly evident. Since free metal dentures of the bilayer type, not infrequently, show sputtering of the ceramic cover as the main long-term failure, the use of monolithic prostheses was started. At the same time, the search for and use of osseointegratable implants to support partial rehabilitation is increasing, being the first option for oral rehabilitation of edentulous areas. Therefore, the purpose of this prospective, randomized, split-mouth clinical study is to assess clinical performance and predictability, characterizing the number and type of early complications and failures such as antagonist wear, bone loss, gingival inflammation, and mechanical failures that may occur in PPFs of three implant - supported elements with mixed retention in posterior region of mandible in monolithic zirconia, zirconia infrastructure with covering ceramics and metaloceramics, besides evaluating aesthetic perception and patient satisfaction with each one. Patients selected (n = 8) will undergo surgical procedures to install two implants in the posterior mandible, two on each side. After three to four months the healing will be installed and the molding will be performed to make the prosthesis following the randomization of both the patients and the side of the jaw. Wear of prostheses and antagonists will be assessed by scanning electron microscopy and profilometry; bone loss peri-implant using periapical radiographs in seven periods, immediately after the implant installation, 7 days after surgery, before the installation of the healers, at the installation of the prosthesis, 21 days after, six and twelve months later, aesthetic perception and color change using the method of visual analog scale by the patient and an intraoral spectophotometer. The hypotheses of this study are resistance to fracture and chipping will be similar in the evaluated groups, all groups will be ethically acceptable, the wear of the antagonist and the prostheses will be similar between groups and the periodontal maintenance and level of bone loss will be similar for the groups(AU)

Atividade antagonista in vitro de bactérias ácido láticas isoladas de queijo de coalho artesanal do Sertão paraibano frente a microrganismos indicadores / Antagonist activity in vitro of lactic acid bacteria isolated from coalho cheese from Sertão paraibano front microorganisms indicators

Bactérias ácido láticas (BAL) produzem substâncias inibitórias de patógenos e deteriorantes de alimentos e isso tem despertado interesse sobre seu uso na preservação e na segurança sanitária desses produtos. Assim, o estudo foi realizado com o objetivo de avaliar a atividade inibitória de Streptococcus infantarius subsp. infantarius isoladas de queijo de coalho artesanal do Sertão da Paraíba frente a microrganismos indicadores. A avaliação do potencial antagônico foi realizada pela técnica de difusão em disco frente à estirpe reveladora Escherichia coli, isolada das mesmas amostras de queijos e frente ao patógeno de referência Escherichia coli ATCC 3539. Das 11 estirpes analisadas, 81,8% foram capazes de inibir o microrganismo indicador isolado dos mesmos queijos de coalho, enquanto 36,4% das bactérias láticas apresentaram inibição frente ao patógeno de referência. Conclui-se que as cepas Streptococcus infantarius subsp. infantarius isoladas de queijos de coalho do Sertão da Paraíba apresentam potencial antagônico e podem assegurar a qualidade microbiológica de alimentos fermentados, inclusive o queijo de coalho.(AU)

Lactic acid bacteria (BAL) produce pathogen inhibiting and food damaging substances and this has raised interest in their use in the preservation and health safety of these products. Thus, the study was carried out with the objective of evaluating the inhibitory activity of Streptococcus infantarius subsp. infantarius isolated from artisanal coalho cheese from Sertão da Paraíba against indicator microorganisms. The evaluation of the antagonistic potential was performed using the disk diffusion technique against the Escherichia coli revealing strain, isolated from the same cheese samples and against the reference pathogen Escherichia coli ATCC 3539. Of the 11 strains analyzed, 81.8% were able to inhibit the indicator microorganism isolated from the same coalho cheeses, while 36.4% of the lactic acid bacteria showed inhibition compared to the reference pathogen. It is concluded that the strains Streptococcus infantarius subsp. infantarius isolated from coalho cheeses from Sertão da Paraíba have antagonistic potential and can ensure the microbiological quality of fermented foods, including coalho cheese.(AU)

Actinomicetos con actividad anti-candida aisladas de hormigas cortadoras de hojas Atta cephalotes (Formicidae: Myrmicinae: Attini) / Actinomyces with anti-candida activity isolated from leaf-cutting ants Atta cephalotes (Formicidae: Myrmicinae: Attini)

RESUMEN Objetivos. Aislar, seleccionar e identificar actinomicetos asociados a hormigas cortadoras de hojas Atta cephalotes (Linnaeus, 1758), que presenten mayor actividad anti-Candida. Materiales y métodos. Estudio transversal realizado en hormigas recolectadas de una localidad de Huánuco, Perú, a partir de las cuales se aislaron cepas de actinomicetos que fueron evaluadas mediante pruebas in vitro para determinar su capacidad antagonista frente a especies de Candida. Los actinomicetos de mayor antagonismo fueron seleccionados y cultivados en agitación, luego se obtuvieron los metabolitos extracelulares con solventes orgánicos y finalmente se evaluaron los extractos crudos para determinar cuantitativamente la concentración mínima inhibitoria (CMI). Resultados. Se logró aislar 30 actinomicetos, de los cuales el 47 % presentaron actividad antagonista a Candida albicans (C. albicans) ATCC 7516, el 43 % a Candida parapsilosis ATCC 7307, el 37% a Candida tropicalis ATCC 7206 y C. albicans ATCC 10231 y el 30% a C. albicans ATCC 98028. Extractos orgánicos de las cepas HAA-16 y HAA-17 presentaron marcada actividad anti-Candida; siendo el extracto de acetato de etilo de la cepa HAA17 el de mejor rendimiento por tener mayor espectro de actividad y presentar una CMI de 3,25 mg/ml frente a C. albicans ATCC 7516 y Candida parapsilosis ATCC 7307. Los actinomicetos seleccionados se identificaron mediante técnicas moleculares como miembros del género Streptomyces. Conclusiones. Los actinomicetos asociados a Atta cephalotes son excelentes productores de compuestos bioactivos, capaces de inhibir el crecimiento de levaduras patógenas del género Candida y con potencial aplicación en el desarrollo de nuevos productos naturales de interés biomédico.

ABSTRACT Objectives. To isolate, select and identify actinomyces associated to leaf-cutting ants Atta cephalotes (Linnaeus, 1758), that present a greater anti-Candida activity. Materials and Methods. Cross-sectional study made with ants collected at a location in Huánuco, Peru, from which strands of actinomyces were isolated and later evaluated by in vitro testing in order to determine its antagonistic capacity against species of Candida. The actinomyces with greater antagonism were selected and cultured by agitation, then the reliable extracellular metabolites were obtained with organic solvents, and finally the crude extracts were evaluated to determine quantitatively the minimum inhibiting concentration (MIC). Results. Thirty (30) actinomyces were isolated, of which 47% exhibited antagonistic activity against Candida albicans (C. albicans) ATCC 7516, 43% to Candida parapsilosis ATCC 7307, 37% to Candida tropicalis ATCC 7206 and C. albicans ATCC 10231, and 30% to C. albicans ATCC 98028. Organic extracts of the HAA-16 and HAA-17 strands exhibited noticeable anti-Candida activity, being the ethyl acetate extract of the HAA-17 strand the one with the highest performance thanks to a wider activity spectrum of MIC 3.25 mg/mL against C. albicans ATCC 7516 and Candida parapsilosis ATCC 7307. The selected actinomyces were identified by means of molecular techniques as members of the Streptomyces genus. Conclusions. Actinomyces associated to Atta cephalotes are excellent producers of bioactive compounds, being able to inhibit the growth of pathogenic mold of the Candida genus and with potential for application in the development of new natural products for the biomedical field.

Evaluación de la estrategia de terapia antitrombótica posterior al cambio valvular aórtico con válvulas biológicas en pacientes de bajo riesgo trombótico / Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis

Resumen De acuerdo a las guías actuales, aún es materia de debate el uso de anticoagulación en los primeros 3 meses en pacientes de bajo riesgo trombótico sometidos a cambio valvular aórtico con prótesis biológicas. En base a la evidencia actual, la aspirina a dosis bajas es razonable como alternativa a los antagonistas de la vitamina K (AVK) durante el posquirúrgico temprano en pacientes con prótesis biológicas en posición aórtica. Se comparó la incidencia de complicaciones trombóticas o hemorrágicas de acuerdo a la estrategia de terapia antitrombótica en los pacientes de bajo riesgo trombótico sometidos a cambio valvular aórtico con válvulas biológicas en el Instituto Nacional de Cardiología Ignacio Chávez. La hipótesis: la aspirina como monoterapia antitrombótica tiene un efecto benéfico comparado con los AVK. Se estudiaron los pacientes de bajo riesgo trombótico sometidos a cambio valvular aórtico con válvulas biológicas en el Instituto Nacional de Cardiología Ignacio Chávez. Se incluyeron los pacientes operados del año 2011 al 2015. Se identificó en el seguimiento a un año la presencia de complicaciones trombóticas o hemorrágicas y si se manejaron con cualquiera de las siguientes: aspirina únicamente, AVK solo y la combinación aspirina más AVK. Se analizaron 231 pacientes. Solo se presentó una complicación hemorrágica en un paciente tratado con AVK. No hubo complicaciones trombóticas. No se presentaron complicaciones trombóticas en pacientes que no recibieron anticoagulación oral formal durante los primeros 3 meses posquirúrgicos, lo que indica que es seguro el uso de aspirina como monoterapia en estos pacientes de bajo riesgo trombótico.

Abstract According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period.

Tasa acumulada de embarazo clínico y en curso en ciclos de inseminación intrauterina y análisis de los ciclos según la edad, conteo de folículos maduros y estimulación con antagonista de GnRH / Clinical and ongoing cumulative pregnancy rates in cycles of intrauterine insemination and analysis of the cycles according to age, follicular count and GnRH antagonist use

Resumen Objetivo: Determinar la tasa acumulada de embarazo clínico en ciclos de inseminación intrauterina en pacientes estimuladas con gonadotropinas según el número de folículos maduros desarrollados y edad, así como la influencia de los antagonistas de GnRH en su desarrollo y en la tasa de embarazo. Materiales y métodos: Estudio analítico, retrospectivo, en el que se evaluaron ciclos de inseminación intrauterina de pacientes con diferentes protocolos de gonadotropinas en un periodo de dos años. La muestra se dividió en grupos: menores de 35 y más o menos mayores de 35 años y uso o no de antagonista de GnRH. Resultados: Se evaluaron 229 ciclos de inseminación intrauterina en 172 pacientes; de éstas 64% eran menores de 34 años (grupo 1) y 36% mayores de 35 años. El 50% de las pacientes desarrolló de 2 a 3 folículos maduros y 10% de 4 a 6, con una tendencia en aumento de la tasa de embarazo con el desarrollo de hasta 4 folí culos maduros. El antagonista de GnRH no parece relacionarse con mejores tasas de embarazo clínico o en curso en ciclos con más de un folículo maduro. La tasa acumulada de embarazo clínico en tres ciclos fue de 40.6%, mientras que la tasa acumulada de embarazo en curso fue 26.1%. Conclusiones: Hubo relación proporcional entre el número de folículos maduros desarrollados y la tasa de embarazo clínico y en curso. La edad no parece haber tenido influencia en las tasas de em barazo y no pudo demostrarse la eficacia del antagonista en ciclos con desarrollo multifolicular.

Abstract Objective: To determine the cumulative clinical pregnancy rate in cycles of intrauterine insemination with gonadotropin stimulation in relation to number of mature follicles and age and the use of GnRH antagonist on its development. Materials and methods: Analytical, retrospective study in which intrauterine insemination cycles of patients with different gonadotropin protocols were evaluated over a period of two years. The patients were divided in two groups: <35 and ≥35 years old and the use of GnRH antagonist. Results: We evaluated 229 cycles of intrauterine insemination in 172 patients; Of these 64% were under 34 years old (group 1) and 36% over 35 years. The use of antGnRH did not appear to have relation with better clinical and ongoing pregnancy rates in cycles with more than one mature follicle. The cumulative pregnancy rate in three cycles was 40.6%, and cumulative ongoing pregnancy rates was 26.1%. Conclusions: The more mature follicle developed the higher clinical and ongoing pregnancy rates. The age did not appear to have influence in the pregnancy rates, there is no better pregnancy rates with use of antGnRH in cycles with multifolicular developed.

Tasas de embarazo en el primer ciclo de inseminación intrauterina en pacientes estimuladas con gonadotropinas según el desarrollo folicular y edad / Pregnancy rates in the first cycle of intrauterine insemination with gonadotropin stimulation in relation to number of follicles and age

Resumen OBJETIVO: conocer la tasa de embarazo clínico en el primer ciclo de inseminación intrauterina en pacientes estimuladas con gonadotropinas, según la cantidad de folículos maduros desarrollados y la edad, así como la influencia de los antagonistas de GnRH en su desarrollo y en la tasa de embarazo. MATERIALES Y MÉTODOS: estudio analítico y retrospectivo efectuado para evaluar el primer ciclo de inseminación intrauterina en las pacientes atendidas en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes entre enero de 2015 y diciembre de 2016, con diferentes protocolos de gonadotropinas. La muestra se dividió en grupos: menores de 35 y mayores de esta edad e indicación o no de antagonista de GnRH. RESULTADOS: se estudiaron 171 pacientes; 60.4% menores de 35 años (grupo 1) y 65.1% mayores de esta edad (grupo 2) que desarrollaron de 2 a 4 folículos maduros. La tasa de embarazo clínico en el grupo 1 fue de 27.7 y 28.5% en el grupo 2. Con 1 (54.5%) y 4 (57.4%) folículos maduros desarrollados y relación proporcional entre el número de éstos y la tasa de embarazo. La tasa de embarazo en curso fue de 19.8% en el grupo 1 y 13.3% en el grupo 2. El uso de antagonista de GnRH no parece relacionarse con mejores tasas de embarazo en ciclos con más de un folículo maduro. CONCLUSIONES: se encontró asociación entre la cantidad de folículos maduros desarrollados y la tasa de embarazo clínico y en curso, pero sin diferencia significativa al momento de asociar estas variables con la edad o con el uso de un antagonista de GnRH. Sin embargo, sí se encontró una tendencia clara de mejores tasas de embarazo en las pacientes tratadas con antagonista de GnRH.

Abstract OBJECTIVE: To determine the clinical pregnancy rate in the first cycle of intrauterine insemination with gonadotropin stimulation in relation to number of mature follicles and age and the use of GnRH antagonist on its development. MATERIALS AND METHODS: Analytic, retrospective study, we evaluated the first IUI cycle in 171 women stimulated with different protocols of ovarian stimulation in a period of two years. The patients were divided into two groups: <35 and ≥35 years old and the use of GnRH antagonist. RESULTS: 60.4 and 65.1% of patients <35 and ≥35 years old respectively, developed 2 to 4 mature follicles; the clinical pregnancy rate <35 and ≥35 years old was 27.7 y 28.5% and 54.5 and 57.4% with 1 and 4 mature follicles developed, we found a proportional relation between mature follicles and pregnancy rates. The ongoing pregnancy rates was 19.8 y 13.3% in <35 y ≥35 years respectively. The use of antGnRH does not appear to be related to better pregnancy rates in cycles with more than one mature follicle. CONCLUSIONS: we found a proportional relation between mature follicles and pregnancy rates. The use of antGnRH does not appear to be related to better pregnancy rates in cycles with more than one mature follicle. The target in ovarian stimulation and IUI must be the development of 2 or 3 matures follicles.

Factores de riesgo asociados con el aumento de progesterona el día de la aplicación de hCG en protocolos de estimulación con un antagonista para fertilización in vitro / Risk factors associated with increased progesterone on the day of hCG application in stimulation protocols with an antagonist for in vitro fertilization

Resumen ANTECEDENTES: se ha reportado el efecto adverso de la elevación prematura de las concentraciones de progesterona durante la fase folicular de un ciclo de fertilización in vitro. Hasta el momento no existen estudios que evalúen los factores de riesgo asociados con esta elevación. OBJETIVO: evaluar los factores de riesgo asociados con la elevación prematura de las concentraciones de progesterona durante la fase folicular en ciclos de estimulación ovárica para fertilización in vitro con un fármaco antagonista en esquema flexible. MATERIALES Y METODOS: estudio retrospectivo, observacional y transversal de ciclos de fertilización in vitro, efectuado en el Centro Mexicano de Fertilidad del CEPAM, de enero de 2009 a febrero de 2014. Criterios de inclusión: pacientes que recibieron un protocolo de estimulación ovárica con un antagonista de GnRH en esquema flexible. RESULTADOS: se analizaron 469 ciclos de fertilización in vitro. Las principales variables relacionadas con las concentraciones de progesterona el día de la aplicación de hCG fueron: IMC (r=-0.96), estradiol basal (r=0.94), edad de la mujer (r= -0.7) y pico máximo de estradiol (r=0.89). No se encontró correlación con las concentraciones de FSH y LH basales, ni con la dosis total de gonadotropinas. CONCLUSION: las pacientes de menor edad e IMC, además de concentraciones basales elevadas y pico máximo de estradiol suelen tener concentraciones altas de progesterona el día de la aplicación de hCG.

Abstract BACKGROUND: It is well known that premature luteinization has a deletereous efecto on the outcome of IVF cycles however there are no reports that evaluate associated risk factor. OBJECTIVE: To evaluate factors associated to premature luteinization during folicular phase of IVF cycles under antagonist stimulation protocol. MATERIAL AND METHODS: This is a comparative, retrospective, observational study. 469 IVF flexible-antagonist protocol cycles were included from January 2009 to February 2014. RESULTS: We registered 469 IVF cycles. The IMC, basal estradiol, age and estradiol on trigger date showed correlation with premature luteinization. There were no association with basal FSH and LH nor total gonadotropin dose. CONCLUSION: Lowe age and IMC and higher estradio levels are associated to a higer level of progesterone on trigger date.

Utilidad del score SAMe-TT2R2 en el control de la anticoagulación oral con warfarina en pacientes con fibrilación auricular no valvular / Usefulness of the SAMe-TT2R2 score in the control of oral anticoagulation with warfarin in patients with non-valvular atrial fibrillation

Antecedentes: la prevención de eventos tromoboembólicos mediante anticoagulación oral es uno de los principales objetivos en el tratamiento de la fibrilación auricular (FA) no valvular, pudiendo utilizarse tanto fármacos antivitamina K (AVK), como warfarina y anticoagulantes orales directos (ACOD). La warfarina ofrece su mayor eficacia y seguridad cuando el porcentaje de tiempo en rango terapéutico (TTR) es mayor de 65%-70%. El score SAMe-TT2R2 fue desarrollado como herramienta para intentar predecir la respuesta al tratamiento anticoagulante con fármacos AVK. Los pacientes con un puntaje favorable (0-1 punto) tendrían una buena respuesta al tratamiento y por lo tanto un TTR adecuado, mientras que un puntaje desfavorable (2 puntos) permitiría predecir un TTR inadecuado, identificando pacientes que requieren intervenciones adicionales para optimizar la calidad de anticoagulación o que serían mejores candidatos a ACOD. Objetivo: evaluar la utilidad del score SAMe-TT2R2 en el control de la anticoagulación oral con warfarina en pacientes portadores de FA no valvular. Método: estudio retrospectivo de 115 pacientes ambulatorios con FA no valvular, anticoagulados con warfarina entre el 1° de junio de 2012 y el 31 de junio de 2014. Las variables analizadas fueron: edad, sexo, fracción de eyección del ventrículo izquierdo (FEVI), comorbilidades, fármacos concomitantes, score CHA2DS2-VASc y HAS-BLED. Se calculó el TTR individual mediante método de Rosendaal y se calculó el score SAMe-TT2R2. Se utilizó el test de t para comparación de medias y el test de chi² para análisis de variables categóricas. Se consideró significativo un valor p<0,05. Resultados: la media de edad fue de 71,0±9,8 años, sexo masculino 52,2%. Comorbilidades asociadas fueron: hipertensión arterial (HTA) 82,6%, cardiopatía isquémica 24,3%, diabetes mellitus 18,3%, ataque cerebrovascular previo 10,4%, tabaquismo 6,1% y ex tabaquista 30,4%, consumo concomitante de tres o más fármacos 87,0%. La media de FEVI fue de 48,3±12,4%, score CHA2DS2-VASc 3,6±1,2 puntos y score HAS-BLED 1,8±0,9 puntos. La media de TTR calculada fue de 54,9±21,6% y solamente 37 pacientes (32,2%) tuvieron un TTR 65%. El score SAMe-TT2R2 tuvo una media de 1,8±1,0 puntos, 45 pacientes (39,1%) tuvieron un puntaje favorable a warfarina (0-1 punto) y 70 pacientes (60,9%) un puntaje desfavorable (2 puntos). No hubo diferencia significativa en la media de TTR según la categoría de SAMe-TT2R2 (53,0±23,7% vs 56,2±20,2%, p=0,447). Tampoco se encontró asociación entre un score SAMe-TT2R2 favorable a warfarina y un TTR 65% (33,3% vs 31,4%, p=0,831). Conclusión: en la población estudiada no hubo diferencia en la calidad de la anticoagulación oral con warfarina entre las categorías (favorable y desfavorable) del score SAMe-TT2R2.

Background: prevention of thromboembolic events is the main objective of oral anticoagulation treatment in non-valvular atrial fibrillation (AF) and either oral anticoagulation with vitamin K antagonists (VKA), like warfarin, or direct oral anticoagulants (ACOD) can be used. When warfarin is used, a time in therapeutic range (TTR) >65- 70% offers the best efficacy and safety. The SAMe-TT2R2 score has been developed as a tool to predict the response to VKA. A favorable SAMe-TT2R2 score (0-1 point) can identify patients that respond adequately to VKA and will have a better TTR, whilst a not favorable SAMe-TT2R2score (2 points) associates with poor TTR, needing additional therapies to optimize anticoagulation quality control or would be better candidates to direct oral anticoagulants (ACOD) Objective: assess SAMe-TT2R2 score value in anticoagulation quality control of patients with non-valvular AF treated with warfarin. Method: retrospective study of 115 ambulatory patients with non-valvular AF receiving oral anticoagulation treatment with warfarin, from June 1st 2012 to June 31st 2014. Analyzed variables were age, sex, left ventricle ejection fraction (LVEF), comorbidities, number of concomitant drugs, CHA2DS2-VASc and HAS-BLED scores. Rosendaal method was used to calculate the individual TTR. Student T test was used to compare mean values and X2 test for categorical variables. P < 0.05 was considered statistically significant. Results: mean age was 71.0 ± 9.8 years, 52.2% were male, most frequent comorbidities were: hypertension 82.6%, ischemic heart disease 24.3%, diabetes mellitus 18.3%, cerebrovascular disease 10.4%, smoking 6.1% and former smoking 30.4%, concomitant use of 3 or more drugs 87%. Mean LVEF was 48.3 ± 12.5 %, CHA2DS2-VASc Score 3.6 ± 1.2 points and HAS-BLED Score 1.8 ± 0.9 points. Mean TTR was 54.9 ± 21.6% and only 37 patients (32.2%) had a TTR  65%. Mean SAMe-TT2R2 score was 1.8 ± 1.0 points, a warfarin-favorable score (0-1 point) was found in 45 patients (39.1%) and 70 patients (60.9%) had a non-favorable score (2 points). No significant mean TTR difference was found among SAMe-TT2R2 categories (53.0 ± 23.7% vs. 56.2 ± 20.2%, p=0.447). No association between a favorable SAMe-TT2R2 Score and a high TTR (65%) was found (33.3 vs. 31.4%, p=0.831). Conclusion: no difference in anticoagulation quality control was found among favorable and non-favorable SAMe-TT2R2 score categories.

Influence of preoperative propranolol on cardiac index during the anhepatic phase of liver transplantation / Influência do propranolol pré-operatório no índice cardíaco durante a fase anepática do transplante hepático / Influencia del propranolol preoperatorio en el índice cardíaco durante la fase anhepática del trasplante hepático

INTRODUCTION: Liver transplantation is the best therapeutic option for end-stage liver disease. Non-selective beta-blocker medications such as propranolol act directly on the cardiovascular system and are often used in the prevention of gastrointestinal bleeding resulting from HP. The effects of propranolol on cardiovascular system of cirrhotic patients during liver transplantation are not known. OBJECTIVE: Evaluate the influence of propranolol used preoperatively on cardiac index during the anhepatic phase of liver transplantation. METHOD: 101 adult patients (73 male [72.2%]) who underwent cadaveric donor orthotopic liver transplantation by piggyback technique with preservation of the retrohepatic inferior vena cava performed at Hospital das Clinicas, Federal University of Minas Gerais were evaluated. There was no difference in severity between groups by the MELD system, p = 0.70. The preoperative use of propranolol and the cardiac index outcome were compared during the anhepatic phase of liver transplantation in 5 groups (I: increased cardiac index, II: cardiac index reduction lower than 16%, III: cardiac index reduction equal to or greater than 16% and less than 31%, IV: cardiac index reduction equal to or greater than 31% and less than 46%, V: cardiac index reduction equal to or greater than 46%). RESULTS: Patients in group I (46.4%) who received propranolol preoperatively were statistically similar to groups II (60%), III (72.7%), IV (50%) and V (30.8%), p = 0.57. CONCLUSION: The use of propranolol before transplantation as prophylaxis for gastrointestinal bleeding may be considered safe, as it was not associated with worsening of cardiac index in anhepatic phase of liver transplantation. .

INTRODUÇÃO: O transplante hepático (TH) é a melhor opção terapêutica para doença hepática em estágio terminal (DHET). As medicações betabloqueadoras não seletivas, como o propranolol, atuam diretamente no sistema cardiovascular (SCV) e são frequentemente usadas na prevenção de hemorragia digestiva decorrente da HP. Os efeitos do propranolol no SCV de cirróticos durante o TH não são conhecidos. OBJETIVO: Avaliar a influência do uso pré-operatório do propranolol no índice cardíaco (IC) durante a fase anepática do TH. MÉTODO: Avaliaram-se 101 pacientes adultos (73 homens, 72,2%) submetidos a transplante ortotópico de fígado doador cadáver, pela técnica de piggyback com preservação da veia cava inferior retro-hepática, feito no Hospital das Clínicas da Universidade Federal de Minas Gerais. Não houve diferença de gravidade pelo sistema MELD entre os grupos, p = 0,70. Foram comparados o uso pré-operatório de propranolol com o desfecho do IC durante a fase anepática do TH em cinco grupos (I: aumento do IC; II: redução do IC inferior a 16%; III: redução do IC igual a ou maior do que 16% e menor do que 31%; IV: redução do IC igual a ou maior do que 31% e menor do que 46%;V: redução do IC igual a ou maior do que 46%). RESULTADOS: Pacientes que fizeram uso pré-operatório de propranolol no grupo I (46,4%) foram estatisticamente semelhantes aos dos grupos II (60%), III (72,7%), IV (50%) e V (30,8%), p = 0,57. CONCLUSÃO: O propranolol no pré-transplante, como profilaxia para hemorragia digestiva, pode ser considerado seguro, pois não se associou à pioria do IC na fase anepática do TH. .

INTRODUCCIÓN: El trasplante hepático (TH) es la mejor opción terapéutica para la enfermedad hepática en estado terminal. Los betabloqueantes no selectivos, como el propranolol, actúan directamente en el sistema cardiovascular y a menudo son usadas en la prevención de la hemorragia digestiva proveniente de la hipertensión portal. Los efectos del propranolol en el sistema cardiovascular de cirróticos durante el TH no se conocen. OBJETIVO: Evaluar la influencia del uso preoperatorio del propranolol en el índice cardíaco (IC) durante la fase anhepática del TH. MÉTODO: Se estudiaron 101 pacientes adultos (73 hombres [72,2%]) sometidos a trasplante ortotópico de hígado de donante cadáver, por la técnica de piggyback con preservación de la vena cava inferior retrohepática, en el Hospital das Clínicas de la Universidad Federal de Minas Gerais. No hubo diferencia respecto a la gravedad por el sistema Meld entre los grupos (p = 0,70). Se comparó el uso preoperatorio del propranolol con el resultado del IC durante la fase anhepática del TH en 5 grupos (i: aumento del IC; ii: reducción del IC < 16%; iii: reducción del IC ≥ 16% y < 31%; iv: reducción del IC ≥ 31% y < 46%;v: reducción del IC ≥ 46%). RESULTADOS: El número de pacientes que usaron el propranolol en el preoperatorio en el grupo i (46,4%) fue estadísticamente similar a los grupos ii (60%), iii (72,7%), iv (50%) y v (30,8%), p = 0,57. CONCLUSIÓN: El propranolol en el pretrasplante, como profilaxis para la hemorragia digestiva, puede ser considerado seguro porque no se asoció con el empeoramiento del IC en la fase anhepática del TH. .

Lesiones preneoplásicas gástricas en pacientes colombianos: asociación de polimorfismos genéticos interleucinas 1B-511, 1RN, 10-819, 10-1082, factor de necrosis tumoral-&alpha -308 y anticuerpos inmunoglobulina G hacia cagA de Helicobacter pylori / Pre-cancerous gastric lesions in Colombian patients: association with IL-1B-511, IL-1RN, IL-10-919, IL-10-1082, TNF-&alpha -308 genes polymorphisms, and anti-Helicobacter pylori cagA IgG antibodies

Objetivo: Evaluar la asociación de los polimorfismos de alguna de las citocinas más estudiadas en relación con el cáncer gástrico (IL-1B-511, IL-1RN intron-2-VNTR, TNF-α-308, IL-10-819 e IL-10- 1082) y la presencia de anticuerpos hacia la proteína cagA de Helicobacter pylori con las lesiones preneoplásicas gástricas en pacientes colombianos. Materiales y métodos: Se estudiaron 185 pacientes con lesiones preneoplásicas (gastritis atrófca, metaplasia intestinal y displasia), y 154 controles (gastritis no atrófica), provenientes de hospitales de una zona de riesgo alto y otra de riesgo bajo para cáncer gástrico. Se obtuvieron biopsias gástricas y muestras de sangre; la genotipificación de los polimorfismos se hizo por discriminación alélica usando PCR en tiempo real y por PCR convencional y electroforesis en agarosa (VNTR del intron 2 de IL-1RN); la serología de Helicobacter pylori y Helicobacter pylori cagA se determinó por ELISA. Se utilizó regresión logística multinomial en el análisis estadístico. Resultados: El genotipo IL-1B-511TT (odds ratio = 4,05; intervalo de confianza 95% 1,35-12,10) se asoció a metaplasia intestinal; no se observaron otras asociaciones entre los diferentes polimorfismos y las lesiones preneoplásicas. La infección por Helicobacter pylori cagA positivo se asoció a gastritis atrófica, metaplasia intestinal y displasia (OR = 2,66; 13,70; 40,29, respectivamente). Conclusión: Los resultados sugieren que entre los genotipos proinflamatorios el genotipo IL-1B-511TT estaría asociado a la metaplasia intestinal, y la serología de Helicobacter pylori cagA positivo sería un biomarcador útil para intervenir y prevenir la presencia de lesiones preneoplásicas. Se necesitan otros estudios con población colombiana que evalúen la asociación hallada de IL1B-511 con la metaplasia intestinal.

Objective: To evaluate the relationship of some of the most studied cytokines (IL-1B-511, IL-1RN intron-2-VNTR, TNF-a-308, IL-10-819, and IL-10-1082) with gastric cancer, as well as the presence of anti-Helicobacter pylori cagA IgG antibodies with pre-cancerous lesions in Colombian patients. Materials and methods: A study was conducted on 185 patients with pre-cancerous lesions (atrophic gastritis, intestinal metaplasia and dysplasia), and 154 controls (non-atrophic gastritis), seen in hospitals in a high risk area, and another in a low risk area, for gastric cancer. Gastric biopsy specimens and blood samples were obtained. The genotyping of the polymorphisms was performed by allelic discrimination using real-time PCR, conventional PCR, and agarose electrophoresis (VNTR of IL-1RN intron 2). The serology of Helicobacter pylori and Helicobacter pylori cagA was determined by ELISA. A multinomial logistic regression was used in the statistical analysis. Results: The IL-1B-511TT genotype was associated with intestinal metaplasia (OR=4.05; 95% CI; 1.35-12.10). No other relationships were observed between the different polymorphisms and preimg/revistas/rcc/cancerous lesions. Infection due to a positive Helicobacter pylori cagA was associated with atrophic gastritis, intestinal metaplasia and dysplasia (OR=2.66; 13.70; 40.29, respectively). Conclusion: The results suggest that, among the pro-inflammatory genotypes, the IL-1B-511TT would be associated with intestinal metaplasia, and that a positive Helicobacter pylori cagA serology could be a useful biomarker for the intervention and prevention of pre-cancerous lesions. Further studies are required in the Colombian population in order to evaluate the relationship found between IL1B-511 and intestinal metaplasia.

Antimicrobial activity of the Nisin Z producer Lactococcus lactis subsp. lactis Lc08 against Listeria monocytogenes in skim milk / Atividade antimicrobiana de Lactococcus lactis subsp. lactics Lc08 produtor de Nisina Z contra Listeria monocytogenes em leite desnatado

The presented study aimed to verify the effect of different pH values, enzyme solutions and heat treatments on the antimicrobial activity of the bacteriocinogenic strain Lactococcus lactis subsp. lactis Lc08 and to test their antimicrobial activity against Listeria monocytogenes in reconstituted skim milk at refrigeration temperatures. This strain was previously described as a nisin Z producer and capable of inhibiting L. monocytogenes growth in in vitro tests. The antimicrobial activity of the bacteriocin cell-free supernatant of Lc08 was sensitive to enzyme treatments (except papain). The pH values and heating (65ºC for 30min, 75ºC for 15s) had no apparent effect on the antimicrobial activity of the bacteriocin produced by Lc08. Only treatment at autoclave conditions result in loss of their antimicrobial activity. Lc08 presented antimicrobial activity against L. monocytogenes in the milk system after 12h at 25ºC. No effect was found at 7ºC. The results show the application viability of the Lc08 in food systems as a biopreservative against L. monocytogenes.

O presente estudo teve como objetivo verificar o efeito de diferentes valores de pH, soluções enzimáticas e tratamentos térmicos na atividade antimicrobiana da cepa bacteriocinogênica Lactococcus lactis subsp. lactis Lc08 e testar sua atividade antagonista contra Listeria monocytogenes em leite desnatado reconstituído em diferentes temperaturas de estocagem. Essa cepa já foi descrita como produtora de nisina Z e capaz de inibir o desenvolvimento de L. monocytogenes em testes in vitro. A atividade antimicrobiana do sobrenadante de Lc08 contendo a bacteriocina produzida e livre de células foi sensível ao tratamento pelas enzimas testadas (exceto papaína). A aplicação de diferentes valores de pH e o tratamento térmico (65ºC por 30 min, 75ºC por 15s) não influenciaram na atividade antimicrobiana da bacteriocina produzida por Lc08. Apenas o tratamento em autoclave resultou em perda da sua capacidade em inibir o desenvolvimento de L. monocytogenes. A cepa Lc08 apresentou atividade antagonista contra L. monocytogenes em leite após período de estocagem de 12h a 25ºC. Não foi observado efeito a 7ºC. Os resultados mostram a viabilidade de aplicação da cultura Lc08 ou de sua bacteriocina em produtos lácteos como bioconservador contra L. monocytogenes.