Reverse Potts for the Treatment of Severe Idiopathic Pulmonary Hypertension in Children

ABSTRACT Idiopathic pulmonary arterial hypertension is a rare and progressive disease with poor prognosis. Many patients progressively worsen even when using combinations of specific drugs for its treatment. Herein, we present our experience in the management of three children with severe pulmonary arterial hypertension refractory to clinical treatment who underwent Potts surgery in addition to clinical treatment.

Propolis effects in periodontal disease seem to affect coronavirus disease: a meta-analysis

Abstract This meta-analysis aimed to investigate the effects of propolis on the severity of coronavirus disease symptoms by reducing periodontal disease. PubMed, EMBASE, SciELO, Web of Science, and SCOPUS databases were systematically searched. Studies have been conducted analyzing propolis's effects on COVID-19 and periodontitis. The study was conducted according to the PRISMA statement and registered in PROSPERO. Risk of Bias (RoB) assessment and meta-analysis of clinical studies were performed (Review Manager 5, Cochrane). The certainty of the evidence was assessed using GradePro (GDT). Studies have shown propolis flavonoids inhibit viral replication in several DNA and RNA viruses, including coronaviruses. Propolis components have an aminopeptidase inhibitor activity that can inhibit the main proteases of SARS viruses and seem to inhibit protein spikes, which are sites of most mutations in SARS-CoV strains. The meta-analysis showed favorable results with the use of propolis on probing depth (95%CI: 0.92; p < 0.001), clinical attachment level (95%CI: 1.48; p < 0.001), gingival index (95%CI: 0.14; p = 0.03), plaque index (95%CI: 0.11; p = 0.23), and blending on probing (95%CI: 0.39; p < 0.001). The antibacterial activity of propolis could be mediated through its direct action on microorganisms or the stimulation of the immune system, activating natural defenses. Thus, propolis inhibits the replication of SARS-CoV-2 as well as its bacterial activity. Treatment with propolis improves general health and facilitates the activation of the immune system against coronavirus.

Analysis of practical prices in the acquisition of medicines by the health consortia compared to municipal institutions in the period from 2017 to 2018

Objective: To identify whether the drug purchases made by the Health Consortia were more efficient, in economic terms, than the purchases made individually by the Municipal Institutions, for the years 2017 and 2018. Methods: Descriptive analysis of the sample, using the trend measures central, economic analysis and calculation of the economic percentage. Results: The values obtained showed efficiency in consortium purchases, reflected in the greater quantity acquired and the lower price practiced, for most of the items analyzed in the reference period. Conclusions: Purchases by Health Consortia provided more savings compared to purchases made by Municipal Institutions, proving to be an option to obtain economic resources for health.

Análise de preços praticados nas aquisições de medicamentos pelos consórcios de saúde em comparação com as instituições municipais para o período de 2017 a 2018 / Analysis of practical prices in the acquisition of medicines by the health consortia compared to municipal institutions in the period from 2017 to 2018

Objetivo: Identificar se as aquisições de medicamentos realizadas pelos Consórcios de Saúde foram mais eficientes, em termos econômicos, que as compras realizadas individualmente pelas Instituições Municipais, para os anos de 2017 e 2018. Métodos: Análise descritiva da amostra, empregando as medidas de tendência central, análise econômica e cálculo do percentual econômico. Resultados: Os valores obtidos mostraram eficiência nas compras dos consórcios, refletidos na maior quantidade adquirida e no menor preço praticado, para a maioria dos itens analisados no período de referência. Conclusão: As compras pelos Consórcios de Saúde proporcionaram mais economia em comparação com as compras realizadas pelas Instituições Municipais, mostrando-se como uma opção para obter economicidade dos recursos destinados à saúde.

Objective: To identify whether the drug purchases made by the Health Consortia were more efficient, in economic terms, than the purchases made individually by the Municipal Institutions, for the years 2017 and 2018. Methods: Descriptive analysis of the sample, using the trend measures central, economic analysis and calculation of the economic percentage. Results: The values obtained showed efficiency in consortium purchases, reflected in the greater quantity acquired and the lower price practiced, for most of the items analyzed in the reference period. Conclusion: Purchases by Health Consortia provided more savings compared to purchases made by Municipal Institutions, proving to be an option to obtain economic resources for health.

Estudo observacional transversal de pacientes submetidos à oclusão percutânea de forame oval patente: uma avaliação retrospectiva de 20 anos / Cross-sectional observational study of patients submitted to percutaneous occlusion of patent foramen ovale: a 20-year retrospective analysis

Introdução: A possibilidade de shunt da direita para esquerda pelo forame oval é causa potencial de embolia paradoxal. A presença de forame oval entre os pacientes com acidente vascular cerebral isquêmico criptogênico em mais de 40% dos casos despertou interesse em avaliar o impacto de seu fechamento na redução de recidiva da doença. O estudo objetiva relatar a experiência de 20 anos com fechamento percutâneo de forame oval realizado por um único operador. Métodos: Foram submetidos a fechamento percutâneo de forame oval associado a shunt da direita para esquerda 527 pacientes com acidente vascular cerebral isquêmico. Resultados: O procedimento foi realizado com sucesso em todos os pacientes. A média da idade foi de 48 anos (9 a 72 anos), sendo 57% do sexo masculino. Foram implantadas prótese Amplatzer® em 295 pacientes (56%) e Occlutech® em 232 (44%). Não houve mortalidade, e ocorreram as seguintes complicações: hematoma no local da punção em três pacientes (0,6%); fístula arteriovenosa femoral em dois (0,4%) com resolução espontânea; tamponamento cardíaco em dois (0,4%) com resolução após punção e drenagem; arritmia supraventricular transitória em três (0,6%); cefaleia em 27 (5,1%); fibrilação atrial em dois (0,4%); shunt residual grande com necessidade de segunda prótese em dois pacientes (0,4%); recorrência de acidente vascular cerebral isquêmico em seguimento em 5 anos em quatro (0,8%) e hipersensibilidade ao níquel em uma paciente (0,2%). Conclusão: A oclusão de forame oval como prevenção de recorrência de acidente vascular cerebral isquêmico nessa série se mostrou segura, eficaz e com baixo índice de recidiva em 5 anos de seguimento.

Background: Left-to-right shunting via the foramen ovale is a potential cause of paradoxical embolism. The presence of patent foramen ovale in more than 40% of patients with idiopathic ischemic stroke has led to deeper investigation of the impact of its closure on decreasing stroke recurrence rates. This study describes 20 years of experience with percutaneous patent foramen ovale occlusion performed by a single operator. Methods: This sample comprised 527 patients with ischemic stroke submitted to percutaneous occlusion of patent foramen ovale associated to left-to- right shunting. Results: The procedure was successful in all cases. The mean age was 48 years (range of 9 to 72 years), and 57% were male. Amplatzer® and Occlutech® prostheses were implanted in 295 and 232 patients (56% and 44%, respectively). There were no deaths, and complications were as follows: hematoma at the puncture site (three patients, 0.6%), femoral arteriovenous fistula with spontaneous resolution (two patients, 0.4%), cardiac tamponade resolved after puncture and drainage (two patients, 0.4%), transient supraventricular arrhythmia (22 patients, 4.2%), headache (27 patients, 5.1%), atrial fibrillation (two patients, 0.4%), large residual shunt requiring a second prosthesis (two patients, 0.4%), recurrence of ischemic stroke within 5 years (four patients, 0.8%) and hypersensitivity to nickel (one patient, 0.2%). Conclusion: In this series, patent foramen ovale occlusion was a safe and effective alternative for prevention of recurrent ischemic stroke. Recurrence rates over the course of 5 years were low.

Aplasia pura adquirida crônica da série vermelha secundária à quimioterapia em paciente com adenocarcinoma endometrioide invasivo / Chronic acquired pure aplasia of the red series secondary to chemotherapy in a patient with invasive endometrioid adenocarcinoma

O presente relato de caso descreve a apresentação atípica de uma paciente com adenocarcinoma endometrioide invasivo que evoluiu com aplasia pura adquirida crônica da série vermelha secundária à quimioterapia. Paciente de 71 anos, sexo feminino, procurou atendimento médico por quadro de metrorragia com três meses de evolução. A curetagem uterina evidenciou adenocarcinoma endometrioide invasor moderadamente diferenciado. Iniciou-se uma abordagem com esquema quimioterápico composto por Carboplatina e Paclitaxel interrompido ao quinto ciclo para evitar progressão de aplasia medular constatada por biópsia de medula óssea. A possível hematotoxicidade do protocolo Paclitaxel e Carboplatina foi observada na conduta terapêutica da paciente, por sua progressão para uma apresentação atípica de aplasia pura adquirida crônica da série vermelha após administração desta associação de drogas.

The present case report describes the atypical presentation of a patient with invasive endometrioid adenocarcinoma that evolved with chronic acquired pure aplasia of the red series secondary to chemotherapy. A seventy-one-yearold patient, female, sought medical care for a three-month-old metrorrhagia evolution. The uterine curettage showed moderately differentiated invasive endometrioid adenocarcinoma. It was initiated an approach with chemotherapy regimen consisting of Carboplatin and Paclitaxel interrupted at the fifth cycle to prevent progression of spinal aplasia found by bone marrow biopsy. The possible hematoxicity of the patient, for its progression to an atypical presentation of chronic acquired aplasia of the red series after administration of this combination of drugs.

Muscle activation in pelvic anteversion and retroversion / Ativação muscular durante a anteversão e retroversão pélvica

Abstract Introduction: The inability to maintain good pelvic stability has been attributed to inefficient muscle coordination and deconditioning of the stabilizing muscles. Despite this, little is known about the role of the pelvic muscles in anteversion and retroversion movements. Objective: To compare the neuromuscular activity of the tensor fascia lata, gluteus medius, upper and lower portions of the gluteus maximus, and multifidus in pelvic anteversion and retroversion. Methods: The neuromuscular activity of 17 healthy young adults (aged 25.3 ± 4.6 years) was assessed during five repetitions of the pelvic anteversion and retroversion movements. The Vicon-Nexus system (10 cameras) was used for the kinematic analysis of the pelvis in the sagittal plane (anteversion and retroversion), and the TeleMyo DTS Desk Receiver electromyograph and the Myomuscle v. 3.8 software to measure neuromuscular activity. The paired samples t-test was used to compare muscle activity between pelvic anteversion and retroversion movements using the Statistica v.8 software with a significance level of p < 0.05. Results: The comparison of the movements showed greater muscle activity in the inferior gluteus maximus in retroversion and greater activity in the multifidus in pelvic anteversion. The upper portion of the gluteus maximus showed relevant activation in both movements. Conclusion: There was more pronounced activity of the lower portion of the gluteus maximus in retroversion, while the upper gluteus maximus showed relevant activation level in both movements. The multifidi were more active in retroversion.

Resumo Introdução: A incapacidade de manter uma boa estabilidade pélvica tem sido atribuída à coordenação muscular ineficiente e ao descondicionamento dos músculos estabilizadores. Apesar disso, pouco se sabe sobre a função dos músculos pélvicos nos movimentos de anteversão e retroversão. Objetivo: Comparar a atividade neuromuscular do tensor da fáscia lata, glúteo médio, porções inferior e superior do glúteo máximo e multífidos durante a anteversão e retroversão pélvica. Métodos: A atividade neuromuscular de 17 adultos jovens saudáveis (25,3 ± 4,6 anos) foi avaliada durante cinco repetições dos movimentos de anteversão e retroversão pélvica. Utilizou-se o sistema Vicon-Nexus (10 câmeras) para a análise cinemática da pelve no plano sagital (anteversão e retroversão), e o eletromiógrafo TeleMyo DTS Desk Receiver e o software MyoMuscle v. 3.8 para mensurar a atividade neuromuscular. Testes t pareados foram conduzidos para comparar a atividade muscular entre os movimentos de anteversão e retroversão pélvica, utilizando-se o software Statistica v.8 com nível de significância de p < 0,05. Resultados: Quando comparados os movimentos, maior atividade muscular foi observada para o glúteo máximo inferior durante a retroversão e maior atividade para os multífidos durante a anteversão pélvica. A porção superior do glúteo máximo apresentou ativação relevante em ambos os movimentos. Conclusão: Houve atividade mais pronunciada da porção inferior do glúteo máximo na retroversão enquanto o glúteo máximo superior apresentou nível relevante de ativação em ambos os movimentos; os multífidos se mostraram mais ativos na retroversão.

Composição química e atividade antibacteriana do óleo essencial dos frutos da Pimenta dioica / Chemical composition and antibacterial activity of essential oil from fruits of Pimenta dioica

RESUMO Neste estudo descrevemos a extração, composição química e a atividade antibacteriana do óleo essencial extraído dos frutos da Pimenta dioica. Para isso, extraímos o óleo por hidrodestilação; identificamos os compostos por cromatografía gasosa acoplada ao espectrómetro de massa (CG/EM); quantificamos o componente majoritário por espectrometria UV-vis e voltametria; e determinamos a atividade antibacteriana contra Escherichia coli, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa e Serratia odorifera pelo método de difusão em disco. Os resultados mostraram que o óleo é composto em sua maioria por eugenol e sua quantidade está em, aproximadamente, 78,15%, cuja classe predominante foi a dos monoterpenos. Além disso, as bactérias testadas com o óleo essencial apresentaram halos de inibição, variando de 11 a 21 mm. Portanto, o óleo é um potencial agente antibacteriano.

SUMMARY In this study we describe the extraction, chemical composition, and antibacterial activity of the essential oil extracted from fruits of Pimenta dioica. For this, we extracted the oil by hydrodistillation; we identified the compounds by Gas Chromatography coupled to the Mass Spectrometer (CG/MS); we quantified the major component by vis-UV Spectrometry and Voltammetry; and we determined the antibacterial activity against Escherichia coli, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and Serratia odorifera, using the disk diffusion method. The results showed that the oil is composed mostly of eugenol and its quantity is approximately 78.15%, whose predominant class was that of monoterpenes. In addition, the bacteria tested with the essential oil showed inhibition halos, ranging from 11 to 21 mm. Therefore, the oil is a potential antibacterial agent.

Recomendações para cirurgia de emergência durante a pandemia do COVID-19 / Recommendations for emergency surgery during the COVID-19 pandemic

Introdução: a pandemia provocada pelo 2019 Novel Coronavírus (COVID-19) provocou um desafio global de saúde pública, com repercussões em diversos setores da sociedade. As práticas médicas necessitaram adaptar-se no atendimento ao doente portador do COVID-19 ou suspeito. Métodos: realizou-se pesquisa bibliográfica de publicações e de diretrizes de sociedades médicas em relação às abordagens cirúrgicas de emergência nesta atual pandemia. Resultados: o material bibliográfico ainda é escasso, indefinido e de baixa evidência, mas são adequados neste momento inicial de enfrentamento do COVID-19 no Brasil. Conclusão: para reduzir o risco de contaminação dos profissionais de saúde, as técnicas e decisões cirúrgicas precisam adaptar-se ao cenário de pandemia do COVID-19.(AU)

Introduction: the pandemic caused by the 2019 Novel Coronavirus (COVID-19) has caused a global public health challenge, with repercussions in several sectors of society. Medical practices needed to adapt in the care of patients with or suspected of having COVID-19. Methods: Bibliographic research of publications and guidelines of medical societies regarding emergency surgical approaches in this current pandemic was carried out. Results: the bibliographic material is still scarce, undefined and of low evidence, but which are adequate in this initial moment of coping with COVID-19 in Brazil. Conclusion: to reduce the risk of contamination of health professionals, surgical techniques and decisions need to adapt to the pandemic scenario of COVID-19.(AU)

Hip morphology and its relationship with hip strength, mobility and lower limb biomechanics: a systematic review in adults / Relação da morfologia do quadril com força, mobilidade e biomecânica dos membros inferiores: uma revisão sistemática em adultos

Abstract This systematic review (PROSPERO registration n.43640) aimed to summarise and determine the quality of evidence relating hip bone morphology to (i) hip strength, (ii) mobility and (iii) lower limb biomechanics during functional activities. A standardized search on MEDLINE/PubMed, Web of Science, ScienceDirect and Scopus resulted in 17 papers that met inclusion criteria: i) original investigations with a minimal sample of n=10, ii) studies on humans and iii) presence of at least one quantitative hip morphological parameter and one hip functional (i.e. strength and mobility) and/or one lower limb biomechanical parameter. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool with adaptations. Sixteen out of the 17 included studies showed high risk of bias. We observed that primary evidence pointed to the influence of hip morphology on hip mobility in the transverse plane. Specifically, positive correlations between femoral anteversion angle and range of internal hip rotation in physical examination were observed. Regarding biomechanical parameters, no clear evidence of association between hip morphology, and kinematic and kinetic parameters were found. Our results point to a field that is currently under explored and future studies with low risk of bias addressing these relationships are required.

Resumo Essa revisão sistemática (PROSPERO registro no 43640) tem por objetivo sintetizar e determinar a qualidade da evidência que relaciona morfologia do quadril à (i) força do quadril, (ii) mobilidade e (iii) biomecânica dos membros inferiores durante atividades funcionais. Uma busca padronizada no MEDLINE/PubMed, Web of Science, ScienceDirect e Scopus resultou em 17 artigos em acordo com os critérios de inclusão: i) estudos originais com amostra mínima de n=10; ii) estudos em humanos e iii) presença de no mínimo um parâmetro quantitativo da morfologia do quadril e um parâmetro funcional do quadril (ex.: mobilidade e força) e/ou um parâmetro biomecânico do membro inferior. A avaliação do risco de viés foi realizada através da ferramenta Quality Assessment of Diagnostic Accuracy Studies (QUADAS) com adaptações. Dezesseis dos 17 estudos incluídos apresentaram alto risco de viés. Observamos que a evidência primária aponta para influência da morfologia do quadril em sua mobilidade no plano transverso. Foram observadas, especificamente, correlações positivas entre o ângulo de anteversão femoral e a mobilidade de rotação interna do quadril durante o exame físico. Em relação aos parâmetros biomecânicos, não foram encontradas evidências claras sobre associação entre morfologia do quadril e parâmetros cinemáticos e cinéticos. Nossos resultados apontam para um campo atualmente subexplorado e investigações futuras com baixo risco de viés que avaliem essas relações são necessárias.

Insect (Hexapoda) diversity in the oceanic archipelago of Fernando de Noronha, Brazil: updated taxonomic checklist and new records

ABSTRACT Hexapods, commonly known as insects, are a neglected taxonomic group in the Fernando de Noronha archipelago, with unanswered questions about their species richness and the ecological processes in which they are involved (e.g., colonization, introduction, establishment, and extinction). Herein, we provide an updated Hexapod checklist with current nomenclatural combinations. The entomofauna of the Fernando de Noronha archipelago is currently composed of 453 species in 21 orders. The orders, and their respective number of species, are: Blattaria (9), Coleoptera (118), Collembola (29), Dermaptera (3), Diplura (1), Diptera (134), Embioptera (1), Hemiptera (29), Hymenoptera (59), Isoptera (2), Lepidoptera (25), Mantodea (1), Neuroptera (3), Odonata (5), Orthoptera (11), Phasmatodea (1), Phthiraptera (6), Psocoptera (3), Siphonaptera (1), Thysanoptera (10), and Zygentoma (2). The archipelago has 263 new taxon records (family + genera + species). Thirty-eight species (3.39%) were described from local specimens and most of them are likely endemic species. This study more than doubles our knowledge (from the previous 190 records) of the entomofauna in this large Brazilian archipelago. This study also provides a baseline for studies on its conservation status and for implementing future environmental management programs.

Infectious diarrhea in autologous stem cell transplantation: high prevalence of coccidia in a South American center

ABSTRACT Background: Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. Methods: The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria. Results: Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (p-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarrhea (p-value = 0.06). Conclusions: The high frequency of diarrhea caused by coccidia shows the importance of investigating and correctly identifying etiological agents and highlights the possible varieties of intestinal infections in patients who undergo autologous stem cell transplantation.

Caenorhabditis elegans as an indicator of toxicity of Bacillus thuringiensis strains to Meloidogyne incognita race 3 / Caenorhabditis elegans como indicador de toxicidade de estirpes de Bacillus thuringiensis a Meloidogyne incognita raça 3

ABSTRACT: The cotton plant (Gossypium hirsutum) is affected by several diseases of economic importance, among them root-knot nematode (Meloidogyne incognita races 3 and 4). Methods to control this disease include the application of nematicides, solarization, deep plowing, crop rotation and use of antagonistic microorganisms. Among species of Bacillus, there are strains that act as bioregulators and antagonists of several pathogens. Tests to identify these strains are hampered by the difficulty of obtaining large populations of the pathogen and by the time of execution of the in vivo tests that should be conducted for about 90 days. The objective of this research was to compare the toxicity of B. thuringiensis strains to two nematodes, M. incognita and Caenorhabditis elegans, evaluating the possibility of using C. elegans as an indicator for the selection of strains with biocontrol potential against M. incognita. Therefore, the toxicity of nine B. thuringiensis strains on C. elegans and M. incognita was evaluated under laboratory and greenhouse conditions. Most strains toxic to C. elegans in vitro were also toxic to M. incognita, and three of them (S906, S1192, S2036) significantly reduced the populations of the two nematodes. The toxic effect of B. thuringiensis strains on C. elegans was like that reported for the same bacterial isolates on M. incognita in vivo. These results suggested that it is plausible to use C. elegans as an indicator of toxicity for selection of B. thuringiensis strains toxic to M. incognita.

RESUMO: O algodoeiro (Gossypium hirsutum) é acometido por várias doenças de importância econômica, dentre as quais a meloidoginose (Meloidogyne incognita raças 3 e 4). Entre os métodos de controle dessa doença, destacam-se as aplicações de nematicidas, a solarização, a aração profunda, a rotação de culturas e o uso de microrganismos antagonistas. Dentre as espécies do gênero Bacillus, existem estirpes que atuam como biorreguladores e antagonistas de vários patógenos. Os testes para identificação dessas estirpes são prejudicados pela dificuldade de se obter grandes populações do patógeno e pelo tempo de execução dos testes in vivo que devem ser conduzidos por cerca de 90 dias. Diante disso, o presente trabalho teve como objetivo comparar a toxicidade de estirpes de B. thuringiensis a dois nematoides, M. icognita e Caenorhabditis elegans, verificando a possibilidade de empregar C. elegans como indicador para a seleção de estirpes com potencial de biocontrole contra M. incognita. Para tanto, a toxicidade de nove estirpes de B. thuringiensis para C. elegans e M. incognita foi avaliada em laboratório e em casa de vegetação. A maioria das estirpes tóxicas ao C. elegans in vitro, também foi tóxica ao M. incognita, sendo que três delas (S906, S1192, S2036) reduziram significativamente as populações dos dois nematoides. O efeito tóxico apresentado pelas estirpes de B. thuringiensis contra C. elegans foram similares aos apresentados pelos mesmos isolados contra M. incognita in vivo. Esses resultados sugerem que é plausível o uso do C. elegans como indicador de toxicidade para seleção de estirpes de B. thuringiensis tóxicas a M. incognita.

Ingesta de hierro y gen HFE en varones adultos de Buenos Aires / Iron intake and HFE gen in male adults from Buenos Aires

El consumo excesivo de hierro (Fe) en portadores de mutaciones en el gen HFE puede resultar en sobrecarga. Para evaluar el riesgo de sobrecarga de Fe fueron investigados 166 varones adultos donantes de sangre de la ciudad de Buenos Aires. Se estimó la ingesta diaria de Fe (IFe), de Fe hemínico y de Fe proveniente de harinas enriquecidas con SO4Fe. Se determinó ferritina sérica y porcentaje de saturación de transferrina (criterio de sobrecarga de Fe: ferritina sérica > 300 ng/ml y saturación de transferrina ≥ 50%). Las mutaciones C282Y, H63D y S65C fueron investigadas en sangre mediante PCR-RFLP. Todos los participantes cubrieron ampliamente el requerimiento estimado promedio de Fe (6 mg Fe/día) y 3.0% superó el máximo tolerable (45 mg Fe/día). El Fe hemínico correspondió al 9.4% de la IFe y el de harinas enriquecidas al 47.7%. Se observó una asociación entre el aumento de IFe y el de ferritina sérica (p = 0.0472), y el 2.3% de los donantes presentaron ferritina sérica > 300 ng/ml y saturación de transferrina ≥ 50%. El 29.3% de los donantes eran portadores de los genotipos H63D, S65C o C282Y, asociados a hemocromatosis hereditaria, y tenían valores de saturación de transferrina significativamente mayores a los de los donantes wild type (p = 0.0167). Si bien la incidencia clínica de hemocromatosis hereditaria fue baja en el grupo estudiado (1.2%), el consumo excesivo de Fe plantea un riesgo potencial para la salud de individuos que ignoran sus antecedentes familiares de sobrecarga de Fe.

Excess iron (Fe) intake in subjects carrying certain mutations in the HFE gene may result in Fe overload. To estimate risk of Fe overload, 166 male blood donors (19-65 years) from Buenos Aires city were investigated. Daily Fe intake (FeI), hem Fe intake, and Fe intake from SO4Fe enriched flours were estimated (SARA Computer Program and Food Composition Table, USDA). Serum ferritin and transferrin saturation were determined; criteria for Fe overload was serum ferritin > 300 ng/ml and transferrin saturation ≥ 50%. HFE genotypes C282Y, H63D and S65C were analyzed by PCR-RFLP in blood samples. No participant presented FeI lower than the estimated average requirement (6 mg Fe/day) and 3.0% was over the upper level (45 mg Fe/day). Hem Fe and Fe from flour enrichment were 9.4% and 47.7% of daily Fe intake, respectively. A significant association was observed between the increase in serum ferritin (ng/ml) and the increase in FeI (p = 0.0472); 2.3% of the donors presented serum ferritin > 300 ng/ml and transferrin saturation ≥ 50%. Genotypes associated with hereditary hemochromatosis (H63D, S65C and C282Y) were found in 29.3% of the donors. The percentage of transferrin saturation was higher in subjects carrying mutation than in wild type subjects (p = 0.0167). Although penetrance of hereditary hemochromatosis in the studied group was only 1.2%, an excessive Fe intake could enhance adverse effects in individuals unaware of any family history of Fe overload.

Influence of dexamethasone and levamisole on macrophage recruitment, giant cell formation and blood parameters in the tropical fish Piaractus mesopotamicus / Influência da dexametasona e levamisol no recrutamento de macrófagos, formação de células gigantes e parâmetros hematológicos no peixe tropical Piaractus mesopotamicus

The aim of this study was to evaluate the effect of parenteral administration of dexamethasone and levamisole on the accumulation of macrophages and formation of giant cells in chronic inflammation by foreign body and blood parameters in pacu (Piaractus mesopotamicus). It was used 50 mg/kg of levamisole and 2.0 mg/kg of dexamethasone and the combination of both drugs. Coverslips were implanted under the skin. After 2, 7, and 15 days postimplantation (DPI), fish were anesthetized for removal of coverslips and the number of macrophages and giant cells were count. It was also collected blood from the caudal vessel to evaluate: red blood cell count, hematocrit, hemoglobin concentration, leukocytes count, thrombocytes count, MCV, and MCHC. We observed that dexamethasone affects negatively the formation of giant cells in the chronic inflammation for foreign body. Levamisole, despite being immunostimulatory in several species, showed limited action. However, it was enough to counteract the effect of dexamethasone; the association of the drugs did not interfere significantly in erythrocyte and leukocyte number in most of the treatments and times studied. In dexamethasone group there was a reduction in the number of erythrocytes and hemoglobin associated with increased mean corpuscular volume, suggesting slight macrocytic anemia. At 15 DPI, most groups showed the recovery of hematologic response. As in mammals, dexamethasone affects negatively the inflammatory response. Levamisole showed little effect by itself. However, in some parameters the association of both drugs causes similar response to control and naïve groups, showing the antagonistic effect of these drugs.

O objetivo deste estudo foi avaliar o efeito da administração parenteral de dexametasona e levamisol na acumulação de macrófagos e formação de células gigantes na inflamação crônica por corpo estranho e avaliação de parâmetros sanguíneos em pacu (Piaractus mesopotamicus). Utilizou-se 50 mg/kg de levamisol e 2,0 mg / kg de dexametasona e a combinação de ambos fármacos. As lamínulas foram implantadas sob a pele. Depois de 2, 7 e 15 dias pós-implantação (DPI), os peixes foram anestesiados para a remoção das lamínulas e contagem do número de macrófagos e células gigantes. Foi coletado sangue da veia caudal para realizar contagem de células vermelhas, leucócitos, trombócitos, concentração de hemoglobina, MCV e MCHC. Observou-se que a dexametasona afeta negativamente a formação de células gigantes na inflamação crónica por corpo estranho. O levamisol, apesar de ser considerado imunoestimulante em várias espécies, mostrou ação limitada. No entanto, foi suficiente para neutralizar o efeito da dexametasona; a associação das drogas não interferiu significativamente no número de eritrócitos e de leucócitos na maioria dos tratamentos e períodos estudados. No grupo da dexametasona, houve redução do número de eritrócitos e concentração de hemoglobina associado ao aumento do volume corpuscular médio sugerindo leve anemia macrocítica. Aos 15 DPI, a maioria dos grupos mostrou recuperação na resposta hematológica. Como em mamíferos, a dexametasona afeta negativamente a resposta inflamatória. O levamisol mostrou pouco efeito por si só. No entanto, em alguns parâmetros a associação das duas drogas provoca resposta similar ao grupo controle e naive, mostrando o efeito antagonista de estas drogas.

Wound healing in Piaractus mesopotamicus supplemented with chromium carbochelate and Saccharomyces cerevisiae / Cicatrização cutânea em Piaractus mesopotamicus suplementados com carboquelato de cromo e Saccharomyces cerevisiae

Wound healing and tissue repair are necessary to ensure survival and health of any organism. The aim of this study was to investigate the impact of supplementation with chromium carbochelate (CC) and Saccharomyces cerevisiae (SC) on wound healing in tropical teleost fish Piaractus mesopotamicus. Thus, fish were distributed into four groups: a) control (without supplementation); b) supplemented with 18 mg/kg of chromium carbochelate; c) supplemented with 0.3% of S. cerevisiae and d) supplemented with an association of both supplements. After 105 days of feeding, full-thickness skin incisions (2.0 x 1.0 x 0.25 cm) were performed removing epidermis and dermis. Macroscopic and histologic observations were carried out at 1, 3, 7, 14, 21, 28, and 35 days after wounding to monitor the healing rate. Opposing fronts advanced gradually and faster each day demonstrating a progressive increase in the healing process over time. The inflammatory process was exacerbated and expansive, with an increase in mucous cells and chromatophores. Although no significant differences were observed between groups on wound retraction and microscopic parameters, fish supplemented with CC and SC showed faster re-epithelialization, greater degree of organization of collagen fibers, and higher neovascularization. We concluded that supplementation with S. cerevisiae and chromium carbochelate improves specific aspects of cutaneous healing process in pacu.(AU)

A cicatrização e reparação de tecidos são mecanismos essenciais para garantir a sobrevivência e saúde de qualquer indivíduo. O objetivo deste trabalho foi avaliar o impacto da suplementação com carboquelato de cromo (CC) e Saccharomyces cerevisiae (SC) sobre a cicatrização no peixe tropical Piaractus mesopotamicus. Para isto, os peixes foram distribuídos em quatro grupos: controle (sem tratamento), suplementados com 18 mg/kg de carboquelato de cromo, 0,3% de S. cerevisiae e associação de ambos os suplementos. Após 105 dias de alimentação, foram realizadas incisões na pele de espessura completa (2,0 x 1,0 x 0,25 cm) removendo epiderme e derme. Avaliações macroscópicas e microscópicas foram realizadas 1, 3, 7, 14, 21, 28 e 35 dias após a indução das feridas, para monitorar a taxa de cicatrização. As bordas opostas das feridas avançaram gradualmente a cada dia, demonstrando o aumento progressivo do processo de cicatrização ao longo do tempo. O processo inflamatório foi exacerbado e expansivo, com aumento no número de células mucosas e cromatóforos. Apesar deste processo, não foram observadas diferenças significativas na retração das feridas e nos parâmetros microscópicos entre os grupos. Peixes suplementados com CC ou Sc apresentaram rápida reepitelização, maior grau de organização de fibras colágenas e de neovascularização inicial. Concluiu-se que a suplementação com S. cerevisiae ou carboquelato de cromo melhora aspectos específicos do processo cicatricial no pacu.(AU)

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis / Cirurgia com tela para correção de prolapso de parede anterior: metanálise

Abstract Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6- 8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used,with or without the use of vaginalmeshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.

Resumo Introdução Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comumo anterior. Para tratamento são utilizadas cirurgias, comou semtelas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): "Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)". Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p 1 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado.

Clinical relevance of rhinovirus infections among adult hospitalized patients

Human rhinovirus (HRV) is an emerging viral pathogen. Aim: To characterize a group of patients admitted due to infection by this agent in a general hospital in Chile. Methods: Cases were identified by RT-PCR for 1 year through active surveillance of patients admitted with severe respiratory illness. Diagnosis was not available during hospitalization. Thirty-two cases were identified, 90% were ≥60 years old or had co-morbid conditions. Human rhinovirus-related admissions represented 23.7% of hospitalization due to severe acute respiratory infections among adults and ranked second to influenza (37.8%). Patients presented with pneumonia (68.8%), decompensated chronic lung conditions (21.9%), heart failure or influenza-like illness (6.3% each). Admission to intensive or intermediate care units was required by 31.2% and in-hospital mortality reached 12.5%. A CURB-65 score ≥3 was significantly associated to in-hospital mortality (p < 0.05). Most patients received antibiotics (90%). Conclusions: Human rhinovirus infections in elderly patients with co-morbid conditions are associated with hospitalizations, requiring critical or semi-critical antibiotics use. A high CURB-65 score was associated to in-hospital mortality. .