Limitations and advances in new treatments and future perspectives of corneal blindness / Limitações e avanços em novos tratamentos e perspectivas futuras na cegueira corneal

ABSTRACT This review is intended to describe the therapeutic approaches for corneal blindness, detailing the steps and elements involved in corneal wound healing. It also presents the limitations of the actual surgical and pharmacological strategies used to restore and maintain corneal transparency in terms of long-term survival and geographic coverage. In addition, we critically review the perspectives of anabolic agents, including vitamin A, hormones, growth factors, and novel promitotic and anti-inflammatory modulators, to assist corneal wound healing. We discuss the studies involving nanotechnology, gene therapy, and tissue reengineering as potential future strategies to work solely or in combination with corneal surgery to prevent or revert corneal blindness.(AU)

RESUMO O presente trabalho traz uma revisão das abordagens terapêuticas para a cegueira da córnea. O estudo detalha as etapas e os elementos envolvidos na cicatrização da córnea. Ele mostra as limitações das estratégias cirúrgicas e farmacológicas usadas para restaurar e manter a transparência da córnea em termos de sobrevida a longo prazo e alcance geográfico. As perspectivas dos agentes anabólicos, incluindo vitamina A, hormônios, fatores de crescimento e novos moduladores pró-mitóticos e anti-inflamatórios para auxiliar a cicatrização da ferida na córnea, são revisadas criticamente. Aqui, apresentamos estudos envolvendo nanotecnologia, terapia gênica e reengenharia de tecidos como possíveis estratégias futuras para atuar de maneira isolada ou combinada com a cirurgia da córnea para prevenir ou reverter a cegueira corneana.(AU)

Evaluation of high-dose vitamin A treatment in postmolar patients with low and plateauing serum human chorionic gonadotropin levels / Avaliação de alta dose de vitamina A em pacientes pósmola hidatiforme, com valores baixos e em platô de gonadotrofina coriônica humana

Abstract Objective To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5IU/L). Methods The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted. Results In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths. Conclusion The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.

Resumo Objetivo Comparar o efeito de alta dose de vitamina A (VitA) no seguimento pósmolar de pacientes com gonadotrofina coriônica humana (hCG) sérica apresentando valoresbaixoseem platô(L&P). Métodos Estudo retrospectivo de série de casos comparando duas coortes não simultâneas. Grupo controle (CG): 34 pacientes com títulos de hCG sérico L&P submetidos a manejo expectante por 6 meses após o esvaziamento uterino, de 1992 a 2010; Grupo de Estudo (SG): de 2011 a 2017, 32 pacientes em condições semelhantes de hCG receberam Vit-A na dose de 200.000 IU por dia, do momento da identificação dohCG em platôate o primeirohCG normaloudiagnóstico de progressão para neoplasia trofoblástica gestacional (NTG). O presente estudo foi aprovado pelo Comitê de Ética da Instituição na qual foi desenvolvido. Resultados Em ambososgrupos, aprevalência de hCGL&P foi < 5%. No SG, os níveis de hCGemplatô forammaiores (CG = 85.5 versus SG = 195 IU/L; p = 0,028), e foram significantemente menores tanto a prevalência de NTG pós-molar (CG = 29.4% versus SG = 6.3%, p = 0,034) como o tempo de seguimento (CG = 14 versus SG = 10 meses, p < 0.001). Na evolução para NTG não houve diferença no estadiamento da Interna tional Federation of Gynecology and Obstetrics (FIGO, na sigla em inglês) ou na agressividade do tratamento. Com altas doses de Vit-A não houve qualquer efeito tóxico relevante. Não houve casos de recidiva de NTG ou de óbito. Conclusão O uso limitado de altas doses de Vit-A parace ser seguro e apresenta efeitos significativos na evolução de pacientes em controle pós-molar com títulos de hCG sérico L&P, e pode diminuir o desenvolvimento de NTG pós-molar nessa população.

Utilização de lente de contato escleral na abordagem terapêutica da úlcera neurotrófica corneana / Use of scleral contact lens in the therapeutic approach of corneal neurotrophic ulcer

Resumo Neste artigo descrevemos como conduzimos com sucesso um caso de úlcera neurotrófica não responsivo à terapia convencional com o uso de lente de contato escleral e as vantagens desta terapêutica.

Abstract In this paper we describe how we successfully conducted a case of neurotrophic ulcer not responsive to conventional therapy using scleral contact lens and the advantages of this therapy.

Vitamin A supplementation reduces the Th17-Treg – Related cytokines in obese and non-obese women

ABSTRACT Objective The objective of the present study was to investigate the effect of vitamin A supplementation on serum Th17 (IL-6, IL-17, IFNγ) and Treg (TGF-β, IL-10) related cytokines in obese and non-obese women. Subjects and methods In a randomized double blind placebo controlled design, 56 obese women were randomly assigned to receive either an oral dose of 25,000 IU retinyl palmitate or placebo per day for 4 months. Twenty eight ages matched non-obese women were also received vitamin A. At the study entry, anthropometric variables were measured and serum Th17 and Treg related cytokine profile were determined at baseline and 4 months after intervention. Results Significantly higher baseline concentrations of IL-6 were observed in obese compared with non-obese women (P < 0.05). However, the initial concentrations of other cytokines were not significantly different between groups. The mean concentrations of IL-17 and TGF-β were significantly decreased after vitamin A supplementation in non-obese and obese women respectively. Positive relationships between IL-17 and IL-10 (r = 0.42, P < 0.001), TGF-β and IL-17 (r = 0.35, P < 0.001) and between IL-10 and IFN-γ (r = 0.41, P = 0.002) in total participants were also observed. Conclusions The results of the present study showed for the first time that vitamin A supplementation reduces serum concentrations of IL-17 and TGF-β in reproductive age women. Further studies are needed to explore the possible underlying mechanisms.

Vitamin A as a key regulator of obesity & its associated disorders: Evidences from an obese rat model.

During the last century, vitamin A has evolved from its classical role as a fat-soluble vitamin and attained the status of para-/autocrine hormone. Besides its well-established role in embryogenesis, growth and development, reproduction and vision, vitamin A has also been implicated in several other physiological processes. Emerging experimental evidences emphasize adipose tissue as an active endocrine organ with great propensity to continuous growth (throughout life). Due to various genetic and lifestyle factors, excess energy accumulates in adipose tissue as fat, resulting in obesity and other complications such as type 2 diabetes, hypertension, and cardiovascular disease. recent in vitro and in vivo studies have shed light on vitamin A metabolites; retinaldehyde and retinoic acid and participation of their pathway proteins in the regulation of adipose tissue metabolism and thus, obesity. In this context, we discuss here some of our important findings, which establish the role of vitamin A (supplementation) in obesity and its associated disorders by employing an obese rat model; WNIN/Ob strain.

Immunisation and Vitamin A Capsule Coverage in a Semi-Urban Area of KwaZulu-Natal Province; South Africa

Background. The Expanded Programme on Immunisation (EPI) in South Africa (SA) has had a large effect on vaccine-preventable illnesses; yet there is little in the literature describing access to and utilisation of the programme beyond 1 year of age. Coverage of vitamin A supplementation is examined through District Health Information System data; but this does not give a fair assessment of the lifetime coverage in a child or provide any correlation with the immunisation status of the child. Objectives. To describe utilisation and dropout rate with the vitamin A and immunisation programmes over the first 6 years of life among children aged 6 - 8 years in a semi-urban population in KwaZulu-Natal (KZN) Province; SA. A secondary objective was to investigate whether access and dropout rates are associated between these two programmes. Methods. A retrospective cohort analysis was performed on 923 anonymised Road-to-Health cards; extracting information on immunisation and vitamin A coverage. Results. Overall; 92.9% (95% confidence interval (CI) 91.2 - 94.6) and 88.5% (95% CI 86.4 - 90.5) of children were fully immunised by 12 months and 18 months of age; respectively. The percentage of children fully immunised by 6 years of age dropped to 44% (95% CI 41.2 - 47.6). The dropout rates for measles; and diphtheria; pertussis and tetanus 1 - 3 vaccination were 2.4% and 1.2%; respectively. Vitamin A had an overall coverage of 34.9% during 6 - 60 months of life for this population; with children receiving; on average; three doses (interquartile range 2 - 5). Conclusion. Despite good immunisation coverage in the first 18 months of life; there was relatively poor vitamin A coverage; suggesting a need for re-evaluation of the current vitamin A capsule distribution programme

Pityriasis Rubra Pilar and hypothyroidism

Pityriasis Rubra Pilaris (PRP) is a chronic and rare papulosquamous disorder. Treatment of Pityriasis Rubra Pilaris is based on empiric evidence because of several doubts regarding its etiology and also because of its relative rarity, making randomized studies difficult to perform. Some factors suggest that the metabolism of vitamin A is involved in pathogenesis. We report a case of Pityriasis Rubra Pilaris associated with autoimmune hypothyroidism which presented rapid and complete response after thyroid hormone replacement, without any association with other systemic treatment. In literature there are only three other reports of significant improvement of the lesions after hormonal correction. Deficiency of thyroid hormone inhibits the conversion of carotene into vitamin A, which would be responsible for the occurrence of Pityriasis Rubra Pilaris in this patient.

Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia / Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia

Objetivo evaluar la costo-efectividad relativa del uso de vitamina a en los niños menores de 5 años en la disminución de eventos de diarrea, malaria y la mortalidad, bajo la perspectiva del sistema de salud colombiano (SGSSS). Materiales y Métodos se construyó unárbol de decisión con muertes evitadas como desenlace. Las probabilidades se extrajeron de la literatura y los costos de fuentes oficiales. El umbral de costo-efectividad fue tres veces el producto interno bruto (PIB) per cápita colombiano de 2012. Se realizaron análisis de sensibilidad determinísticos, probabilísticos y curva de aceptabilidad. Resultados En una cohorte de cien mil niños, la administración de vitamina a, frente no hacerlo, representaría un ahorro en costos de atención médica de $ 340.306.917, debido a que reduce el número de eventos de diarrea (4.268) y de malaria (76), así como los casos en los que se requiere hospitalización. En todos los análisis de sensibilidad se obtuvo un ahorro para el sistema. Conclusión Dentro del sistema de salud colombiano, la suplementación con vitamina a para niños menores de 5 años, comparado con no hacerlo, es la estrategia menos costosa y más efectiva (dominante).

Objective Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). Materials and Methods A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. Results Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. Conclusion Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

Use of retinoids in the treatment of oral leukoplakia: a review / Uso de retinoides no tratamento de leucoplasias bucais: revisão

OBJECTIVE: The purpose of this paper is to review the literature regarding the topical use of the retinoids in the treatment of oral leukoplakia, discussing their mechanisms of action, indications, effectiveness, and adverse effects. DISCUSSION: Leukoplakia is defined as white lesion in oral mucous membrane that cannot be characterized as any other entity and it has potential for malignancy. It does not present specific histological pattern. Due to its potential for malignancy and high prevalence, dentists should know how to diagnose and treat it correctly. The retinoids are chemopreventive agents derived from the vitamin A. They could be either natural or synthetic and their main role is to suppress cellular mitosis. Retinoid derivatives have been used as agents for chemoprevention of malignant transformation of leukoplakias due to its potential effect on the control of the differentiation and proliferation of the epithelial cells, as well as their induction of apoptosis. CONCLUSION: The topical use of retinoids to treat oral leukoplakia is safe, convenient and effective, with minor side effects than the systemic administration.

OBJETIVO: A proposta deste artigo é revisar a literatura referente ao uso de retinoides no tratamento de lecoplasiasbucais e discutir o mecanismo de ação, indicações, efetividade e efeitos adversos. DISCUSSÃO: Leucoplasia é definida como lesão branca na mucosa bucal que não pode ser caracterizada como qualquer outra entidade e tem potencial de malignização. Não apresenta padrão histológico específico e, por causa de seu potencial de malignização e alta prevalência, os cirurgiões-dentistas devem conhecer como diagnosticá-la e tratá-la corretamente. Os retinoidestêm sido usados como agentes quimio-profiláticos para a transformação maligna das leucoplasias por seu efeito potencial no controle da diferenciação e proliferação da células epiteliais, bem como capazes de indução de apoptose. CONCLUSÃO: O uso tópico de retinoides para tratar leucoplasias é seguro, conveniente e efetivo, com efeitos colaterais menores do que na administração sistêmica.

Vitamina A / Vitamin A

A vitamina A é lipossolúvel.A desnutrição é uma das principais causas de carência da vitamina A.As síndromes disabsortivas são causa secundária de carência da vitamina A.No fígado encontra-se a principal reserva de vitamina A do organismo.A vitamina A em dose única não reduz a mortalidade nas crianças com sarampo.

Pityriasis rubra pilaris: presentación de casos / Pityriasis rubra pilaris: presentation of cases

Se realizó una presentación de casos, de dos pacientes con lesiones dermatológicas, donde existe correlación clínico-histopatológica, de Pityriasis rubra pilaris. La intención de este trabajo es que en la práctica dermatológica se piense en esta dermatosis. Para ello se tuvieron como objetivos: viabilizar la comprensión de esta entidad, contribuir a realizar el diagnóstico diferencial con otros cuadros como son dermatitis seborreica, queratodermia palmo-plantar, psoriasis, entre otros. En la dermatosis objeto de estudio, su cuadro histológico es característico, y debe introducirse alimentos en la dieta ricos en vitamina A, beta carotenos y azufre, pues el factor alimenticio juega un papel importante en aquellas afecciones donde la etiología por déficit de las vitaminas u otro oligoelemento está presente. Se revisan aspectos clínicos, asociaciones con otras enfermedades, el tratamiento de esta dermatosis. Se utilizó el método aleatorio, al azar, longitudinal, corroborando el diagnóstico por biopsia de piel de las pacientes. Las pacientes estudiados fueron: ARG, de 5 años, femenina, blanca remitida por el pediatra por lesiones en placas máculo amarillo-hipocrómicas–papulosas, distribuidas en superficie de extensión de brazos y piernas; LSG, de 19 años, femenina, blanca, que es remitida por presentar lesiones en placas máculo-hipocrómico pápulo-escamosas bordes difusos, localizadas en muslo y pierna derechos, se constata alopecia difusa del pelo del cuero cabelludo. El tratamiento local indicado fue una pomada con reductor, ácido salicílico y vaselina, la orientación alimenticia fue dirigida a ingerir alimentos ricos en vitamina A o beta carotenos, y alimentos ricos en azufre, insistiéndoles en esta parte del tratamiento por los antecedentes de ambas pacientes a la no ingestión de estos alimentos. A lo largo de 10 años hemos revisado anualmente la evolución de las pacientes, no existiendo recidivas hasta el momento, manteniendo ambas el régimen dietético orientado.

We presented the cases of two patients with dermatologic lesions, where there it is clinic- histopathologic correlation, of Pityriasis rubra pilaris. The intention of this work is taking into account this dermatosis in the dermatologic practice. To achieve that our objectives were: allowing the comprehension of this entity, contributing to the differential diagnosis with other conditions like seborrheic dermatitis, palmoplantar keratoderma, psoriasis and others. The histological picture of the studied dermatosis is characteristic, and there should be introduced in the diet foods rich in vitamin A, beta carotenes and sulfur, because the alimentary fact plays an important role in those conditions where the etiology by vitamins or other oligo-element deficit is present. We reviewed clinical aspects, the association with other diseases, the treatment of this dermatosis. We used the randomized, longitudinal method, corroborating the diagnostic by patient's skin biopsy. The studied patients were: ARG, white, female, 5-years-old patient send by the podiatrist because she had lesions in yellow macula hypochromic- papular plates, located in extension surfaces of arms and legs; LSG, white, female, 19-years-old patient send presenting lesions in macula- hypochromic papular- squamous plaques with diffuse rims, located in the right thigh and leg, stating diffuse alopecia of the scalp. The indicated treatment was an ointment with reductive, salicylic acid and vaseline. They were advised to eat foods rich in vitamin A or beta carotenes and sulfur, insisting in this part of the treatment because they had antecedents of not eating these foods. We have followed the evolution of these patients for ten years without relapses, having the patients kept the oriented dietetic regime.

Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum / Efecto de la suplementación prenatal con micronutrimentos múltiples en indicadores bioquímicos durante el embarazo y el posparto

Objective. The objective of this analysis was to test the impact of daily supplementation with multiple micronutrients (MM) during pregnancy on Zn, vitamin A and folate status compared to iron only (Fe). Material and Methods. The study was carried out during 1997-2000 in a semi-urban community in Morelos state, Mexico. Women were randomly assigned to MM (n= 249) or Fe (n= 258) and received supplements daily (6 d/wk) under supervision by the field team from recruitment (approximately 9 weeks pregnancy) until delivery. Blood samples were collected on a sub-sample of women at baseline, 32 weeks pregnancy and one month postpartum (1PP) and assessed for serum zinc, retinol and whole blood folate (baseline and 1PP only). A breast milk sample was extracted at 1PP and assessed for retinol content. Result. At baseline there was no significant difference between supplementation groups in mean Zn, retinol or folate concentrations or the prevalence of deficiencies (Zn 12.2%, vitamin A 2.8%, folate 5.3%). Mean change in Zn and retinol concentrations from baseline to 32 weeks pregnancy did not differ between groups or between baseline and 1PP for Zn, retinol or folate. At 1PP, there was a tendency (p= 0.09) towards a lower prevalence of folate deficiency/depletion in the MM group (10.0%) than the Fe group (18.5%). Conclusions. MM supplementation during pregnancy did not improve zinc or vitamin A status compared to Fe only. There is some indication that folate status may have improved with MM supplementation despite low prevalence of deficiency. While lack of response in serum retinol may be explained by generally adequate status, the lack of impact on zinc status requires further exploration.

Objetivo. Evaluar el efecto de la suplementación diaria con múltiples micronutrimentos (MM) durante el embarazo en el estado de zinc, vitamina A y folato comparado con la suplementación sólo con hierro (Fe). Material y métodos. El estudio se realizó en una comunidad semiurbana en el estado de Morelos, México, entre 1997 y 2000. Las mujeres fueron asignadas aleatoriamente a recibir un suplemento de MM (n= 249) o Fe (n= 258) diariamente (6 días/semana), cuyo consumo fue supervisado por personal de campo, desde la evaluación basal (aproximadamente 9 semanas de gestación) hasta el parto. En una submuestra de mujeres participantes, se tomaron muestras de sangre venosa, a las 9 y 32 semanas de embarazo y al mes posparto (1PP). Se midieron las concentraciones séricas de zinc y retinol y la concentración de folato en sangre total, esta última sólo en la evaluación basal y al 1PP. Además se colectó una muestra de leche materna al 1PP, en donde se midió la concentración de retinol. Resultados. En la evaluación basal no hubo diferencias significativas entre grupos en las concentraciones promedio de zinc y retinol, ni en la concentración de folato o en la prevalencia de deficiencias (Zn 12.2%, vitamina A 2.8%, folato 5.3%). El cambio promedio en zinc y retinol de la evaluación basal a la semana 32 de embarazo, no fue diferente entre grupos, tampoco entre la evaluación basal y al 1PP en zinc, retinol o folato. Al 1PP hubo una tendencia (p= 0.09) a menor prevalencia de deficiencia/depleción de folato en el grupo de MM (10.0%) que en el grupo Fe (18.5%). Conclusiones. La suplementación con MM durante el embarazo no mejoró el estado de zinc y vitamina A comparada con la suplementación sólo con Fe. Sin embargo, el estado de folato puede haber mejorado con la suplementación con MM, a pesar de la baja prevalencia de deficiencia de folato. La falta de efecto...

Vitaminas e minerais com propriedades antioxidantes e risco cardiometabólico: controvérsias e perspectivas: [revisão] / Vitamins and minerals with antioxidant properties and cardiometabolic risk: controversies and perspectives: [review]

No processo celular de obtenção de energia, são gerados compostos chamados espécies reativas de oxigênio (ERO) que, em excesso, podem causar danos celulares. Estresse oxidativo resulta do desequilíbrio no estado de óxido-redução a favor da oxidação. Dos mecanismos de defesa antioxidante, participam enzimas endógenas e algumas vitaminas e minerais. A vitamina E encontra-se no plasma e na partícula de LDL, protegendo lipídeos da oxidação. Estudos observacionais relataram associação inversa entre ingestão de vitamina E e risco cardiometabólico (RCM). Entretanto, ensaios clínicos não comprovaram a eficácia de sua suplementação nos desfechos cardiometabólicos. A vitamina C participa do sistema de regeneração da vitamina E, mantendo o potencial antioxidante plasmático. Dados sobre os benefícios de sua suplementação na redução do risco cardiometabólico são inconclusivos. A atividade antioxidante dos carotenoides é responsável, em parte, por seu papel protetor contra doenças cardiovasculares e cânceres. A suplementação desse nutriente também não trouxe resultados consistentes no que se refere à redução do RCM. A participação do zinco e do selênio na defesa antioxidante vem sendo estudada mais recentemente, mas a sua suplementação em indivíduos com níveis séricos normais e ingestão adequada na dieta desses minerais não parece ser necessária. De um modo geral, há muita controvérsia sobre o papel desses micronutrientes no RCM. Estudos epidemiológicos sugerem que o consumo de substâncias antioxidantes provenientes da dieta ou dietas ricas em frutas e hortaliças diminui o RCM. Mais estudos são necessários antes de se recomendar o uso de antioxidantes isolados na forma de suplementos para tal finalidade.

Oxygen reactive species (ROS) are generated during cellular processes. In excess, they may cause damages to the cell. Oxidative stress is an imbalance in the redox state that favors oxidation. Endogenous enzymes and some vitamins and minerals participate in the plasma antioxidant defense. Vitamin E is found in the plasma and in the LDL particle, avoiding lipid peroxidation. Observational studies reported an inverse association between vitamin E consumption and cardiometabolic (CM) risk. However, clinical trials were not able to prove the efficacy of its supplementation on CM endpoints. Vitamin C participates in the vitamin E regeneration system, keeping the plasma's antioxidant potential. Data about beneficial effects of its supplementation in CM risk reduction are inconclusive. The antioxidant activity of carotenoids is partially responsible for its protective role against cardiovascular diseases and cancer. Supplementation of this nutrient did not provide consistent findings in terms of CM risk reduction. Recently, zinc and selenium's participation in the antioxidant defense has been studied, yet its supplementation in individuals with normal levels and adequate ingestion of these nutrients does not seem necessary. In summary, the role of these micronutrients for CM risk is still very controversial. Epidemiological studies suggest that diets rich in antioxidants, or simply in fruit and vegetables intake, can reduce CM risk. Further studies are needed before recommending antioxidant supplements for this purpose.

Atividade quimiopreventiva da tributirina quando administrada isoladamente ou em associação com vitamina A na etapa de promoção da hepatocarcinogênese em ratos / Chemopreventive activity of tributyrin when administrated isolated or in association with vitamin A in promotion phase of hepatocarcinogenesis to rats

No presente estudo avaliou-se a atividade quimiopreventiva da vitamina A (VA), tributirina (TB) e/ou 5-azacitidina (5-AzC) quando administradas isoladamente ou em associação na etapa de promoção do modelo de hepatocarcinogênese. Para tanto, ratos Wistar foram submetidos ao modelo do "hepatócito resistente" (HR), que consistiu na aplicação intraperitoneal de uma dose do agente iniciante dietilnitrosamina (DEN, 20 mg/100 g de p.c.), seguida, 2 semanas após, da aplicação de 4 doses consecutivas de 2- acetilaminofluoreno (2-AAF; 2 mg/100 g de p.c.) e de hepatectomia parcial (HP) a 70 ’POR CENTO’, acrescida de 1 dose de AAF (0,5 mg/100 g de p.c.) 4 dias após a cirurgia. Logo após a aplicação do modelo, os animais receberam VA (1 mg/ 100 g de p.c.) em dias alternados, TB (200 mg/ 100 g de p.c.) todos os dias e /ou 5-AzC (0,25 mg/ 100g de p.c.) duas vezes por semana ou, ainda, óleo de milho, maltodextrina e solução salina (grupo controle) durante cinco semanas. De acordo com a análise macroscópica do fígado, e em comparação ao grupo controle, verificou-se que o grupo tratado com TB isoladamente e o grupo tratado com VA e TB em associação apresentaram menor (p < 0,05) incidência e menor (p < 0,05) número médio de nódulos hepáticos. Em relação à análise morfométrica das lesões pré-neoplásicas (LPN) hepáticas positivas para a enzima glutationa S-transferase forma placentária (GST-P), observou-se que em comparação ao grupo controle os grupos experimentais que receberam 5-AzC apresentaram maior (p < 0,05) número de LPN hepáticas totais (persistentes + remodelação), LPN persistentes e LPN em remodelação, indicando que a 5-AzC teve ação potencializadora da iniciação nesse modelo de hepatocarcinogênese. Além disso, quando comparado ao grupo controle, observou-se que o grupo que recebeu TB isoladamente e o grupo que recebeu TB e nos tamanhos das LPN persistentes. Em comparação aos animais do grupo controle, não...

Chemopreventive activity of vitamin A (VA), tributyrin (TB) and/or 5-azacitidine (5-AzC) when administrated isolated or in association, was evaluated during the promotion phase of the "Resistant Hepatocyte"(RH) model of hepatocarcinogenisis. Rats received one dose of diethylnitrosamine (DEN; 20 mg/100g body weigh [b.w.]) for initiation and two weeks later, the animals received five doses of 2-acetylaminofluorene (AAF, 2 mg/100g b.w.), 4 consecutive doses before partial (2/3) hepatectomy and the remaining one four days after surgery. After 3 days, the animals received vitamin A (1mg/100 g.w.), TB (200 mg/ 100g de b.w.) and /or 5-AzC (0,25 mg/ 100 g de b. w.) or corn oil, maltrodextrin and saline (control goup) during five consecutive weeks. Incidence area of visible hepatocyte nodules/animal were smaller (p < 0,05) in goups that received TB and VA +TB than control group. Number of total (persistant + remodeling), persistent and remodeling hepatic placental glutathione S-transferase (GST-P) positive preneoplastic lesions (PNL) were higher (p < 0,05) in groups that received 5-AzC, indicating that 5-AzC potentiates initiation induced by carcinogens in rat liver. Moreover, the groups that received TB isolated or in association with VA presented mean area of persistent hepatic GST-p positive PNL smaller (p < 0,09) than control group. The animals treated with 5-AzC showed higher (p < 0,05) growth index in PNL than control group. The treatment with VA and TB isolated or in association increased (p < 0,05) the number of apoptotic bodies in PNL when compared to control group. Compared to normal group lower (p < 0,05) hepatic concentrations of retinyl palmitate were observed in control group, indicating that VA metabolism is altered in initial phases of hepatocarcinogenesis. The experimental groups that received VA showed higher concentrations of retinol and retinyl palmitate than control group. Moreover, the animals that received TB showed higher concentration...

Estratégias de combate às microdeficiências no grupo materno-infantil / Strategies to combat the microdeficiencies in the maternal-infantile group / Estrategias del combate a las microdeficiencias en el grupo materno-infantil

As microdeficiências nutricionais, representadas especialmente pelas carências de vitamina A, ferro e ácido fólico, são amplamente reconhecidas como um importante problema de saúde e nutrição entre mulheres e crianças, refletindo de forma negativa na saúde reprodutiva e no desenvolvimento infantil. O presente trabalho objetivou fazer uma revisão da literatura sobre fortificação e suplementação de alimentos como estratégias para o combate às microdeficiências no grupo materno-infantil, com ênfase nos referidos nutrientes, no período de 1986 a 2006. Neste cenário, a suplementação nutricional, a fortificação de alimentos e o estímulo à diversificação alimentar representam estratégias promissoras no combate às carências de micronutrientes. Por outro lado, a suplementação deve ser criteriosa, baseada no limite tolerável para cada faixa etária e em estados fisiológicos, como a gestação. Por fim, o estímulo ao aleitamento materno e à prática da alimentação saudável são importantes aliados na tentativa de combater as deficiências nutricionais de vitaminas e minerais no grupo materno-infantil, em especial, reconhecidamente as de maior magnitude.

Micronutrient deficiencies, especially represented by vitamin A, iron and folic acid deficiencies, are widely recognized as an important health and nutritional problem among women and children reflecting, in a negative way, upon reproductive health and child development. The aim of the present study was to conduct a literature review about food fortification and supplementation as strategies of fighting against micronutrient deficiencies in the mother-child group, emphasizing the referred nutrients, in the period between 1986and 2006. According to the analyzed bibliography, the nutritional supplementation, food fortification and incentive to food diversification represent promising strategies towards fighting against micronutrient deficiencies. On the other hand, the supplementation must be established according to the tolerable limit for each age level and physiological state, like pregnancy. Finally, incentive to breast feeding and healthy eating practices are important allies in the attempt to fight against micronutrient deficiencies of vitamins and minerals in the mother-child group, especially those with greater magnitude.

Las microdeficiencias nutricionales, que son representadas especialmente, por la carencia de Vitamina A, hierro y ácido fólico, son ampliamente reconocidas como un importante problema de salud y nutrición en mujeres y niños, por repercutir negativamente en la salud reproductiva y en el desenvolvimiento infantil. El presente trabajo tuvo como objetivo la revisión de literatura científica que enfocara la fortificación y la suplementación de alimentos como estrategias de lucha contra microdeficiencias, en el grupo maternoinfantil, principalmente en los referidos nutrientes, en el periodo de 1986 a 2006. Eneste contexto, la suplementación nutricional, la fortificación de los alimentos y el estimulo a una alimentación variada, representan estrategias prometedoras de lucha contra las carencias de micronutrientes. Sin embargo, la suplementación debe ser hecha con criterio, basandose en los límites tolerables para cada grupo de edad y los estados fisiológicos, como la gestación. Además, el estimulo al amamantamiento materno y la practica de una alimentación saludable son importantes aliados en la tentativa de combatir, en el grupo materno infantil, las deficiencias nutricionales de vitaminas y de minerales, especialmente de aquellos de reconocida importancia.

Effect of a combination of medium chain triglycerides, linoleic acid, soy lecithin and vitamins A and E on wound healing in rats / Efeito da combinação de triglicerídeos de cadeia média, ácido linoléico, lecitina de soja e vitaminas A e E na cicatrização de ferida em ratos

PURPOSE: The aim of the study was to determine the effect of a combination of medium chain triglycerides (caprylic, capric, caproic and lauric acids), linoleic acid (essential fatty acid), vitamins A and E and soy lecithin, through a morphometric study, on the wound healing kinetics of experimental cutaneous ulcers. METHODS: A total of 45 male Wistar rats were used, in which a skin flap of total thickness with an area of 4 cm² was removed. The animals were divided randomly into 3 groups of 15 rats each, Control, Reference and Test groups, which were treated topically with 0.9 percent NaCl, a preparation of clostebol combined with neomycin sulfate and the test formulation, respectively. The wound areas were measured by digital planimetry at days zero, 3, 7 and 12 postoperative. Based on the wound area, we determined the degree of tissue repair and mean rate of repair at different time intervals. RESULTS: At day 3, an expansion of the wound area was observed in the Reference group and slight contraction in the Control and Test groups. On the subsequent days, the healing process, according to the degree of repair, proceeded in a linear manner, such that, at day 12, the healed area reached 77.95 percent of the initial ulcerated region in the Control group, 78.40 percent in the Reference group and 83.49 percent in the Test group, showing no significant differences. The overall mean rate of repair was equally similar at 12 days of treatment: 25.79 mm²/dia in the Control group, 25.42 mm²/dia in the Reference group and 27.38 mm²/dia in the Test group. CONCLUSION: The test preparation, applied topically on the experimentally induced cutaneous ulcers in rats, did not accelerate the process of tissue repair by secondary union.

OBJETIVO: Avaliar o efeito da associação de triglicerídeos de cadeia média (ácidos caprílico, cáprico, capróico e láurico), ácido linoléico (ácido graxo essencial), vitaminas A e E e lecitina de soja, através de estudo morfométrico, na cinética de reparação de úlceras cutâneas experimentais. MÉTODOS: Utilizaram-se 45 ratos, machos, da linhagem Wistar, nos quais foi removido um retalho cutâneo de espessura total com 4 cm² de área. Os animais foram divididos aleatoriamente em 3 grupos constituídos de 15 ratos, Controle, Referência e Teste, que foram tratados por via tópica respectivamente, com solução salina 0,9 por cento, composto de clostebol associado a sulfato de neomicina e a formulação em teste. As áreas das feridas foram mensuradas por planimetria digital nos dias zero, 3, 7 e 12 de pós-operatório. A partir da área da ferida, calcularam-se ainda o grau de reparação e a taxa média de reparação em intervalo de tempo. RESULTADOS: No 3o dia observou-se uma expansão da área da ferida no grupo referência e uma leve contração nos grupos controle e teste. Nos dias subseqüentes o processo de reparação, medido pela variável grau de reparação, evoluiu de forma linear, de modo que, no 12º dia, a área reparada alcançou 77,95 por cento da região ulcerada inicial no grupo Controle, 78,40 por cento no grupo Referência e 83,49 por cento no grupo Teste, não sendo constatadas diferenças estatisticamente significante. Igualmente semelhantes foram os valores da taxa média de reparação referente aos 12 dias de tratamento: 25,79 mm²/dia no grupo Controle, 25,42 mm²/dia no grupo Referência e 27,38 mm²/dia no grupo Teste CONCLUSÃO: O composto em Teste, aplicado por via tópica em úlceras cutâneas experimentalmente induzidas em ratos, não acelerou o processo de reparação recidual por segunda intenção.

Bebida à base de flocos de abóbora com inulina: características prebióticas e aceitabilidade / Drink based on pumpkin flakes containing insulin: prebiotic characteristics and acceptability

OBJETIVO: Formular bebida para crianças de 4 a 6 anos, à base de flocos de abóbora adicionada de inulina, e caracterizá-la quanto ao valor nutricional, à aceitação e ao efeito prebiótico. MÉTODOS: O valor nutricional da bebida foi avaliado por meio de análise da umidade, de proteínas, lipídeos, cinzas, fibra alimentar, carboidratos e carotenóides. As características microbiológicas foram avaliadas por meio de análises de coliformes a 35ºC e a 45ºC, Staphylococcus aureus, Salmonella ssp, Bacillus cereus, de contagem padrão de aeróbios, bolores e leveduras. A aceitabilidade foi determinada por testes sensoriais, aplicados em duas creches da região metropolitana do Recife (PE), o efeito prebiótico foi avaliado por fermentação in vitro, em meio diferencial para bactérias homefermentativas e heterofermentativas-Ágar, e as análises de ácidos graxos de cadeia curta, foram avaliadas por cromatografia a gás. RESULTADOS: Os resultados físico-químicos demonstram que as formulações pouco diferiram quanto à composição centesimal e que a ingestão 200mL/dia contribui, em média, com 10,8 por cento, 36,0 por cento, 10,2 por cento, 12,6 por cento, 37,1 por cento e 126,4 por cento da Recomendação de Ingestão Diária de energia, proteínas, carboidratos, lipídeos, fibra alimentar e carotenóides, respectivamente. Os resultados microbiológicos comprovaram a inocuidade do produto; os sensoriais que as formulações obtiveram uma aceitação em torno de 70 por cento e os dados da avaliação do efeito prebiótico sugerem maior estudo sobre o tema. CONCLUSÃO: Os resultados permitem concluir que as formulações são nutricionalmente adequadas para pequenas refeições de crianças de 4 a 6 anos, pois, além de prevenir a carência de vitamina A apresentam indícios de efeitos prebióticos.

OBJECTIVE: The objective of this study was to formulate a drink for kids aging from 4 to 6 years based on pumpkin seeds and with insulin, and characterize the drink regarding its nutritional value, acceptance and prebiotic effect. METHODS: The nutritional value of the drink was assessed by determining moisture, proteins, lipids, ash, dietary fiber, carbohydrates and carotenoids. The microbiological characteristics were assessed by coliform analysis at 35ºC and 45ºC, Staphylococcus aureus, Salmonella ssp, Bacillus cereus, standard aerobic organism count, yeasts and molds. Acceptance was determined by sensory tests in two daycare units of the metropolitan region of Recife (PE). The prebiotic effect was assessed by in vitro fermentation in a differential medium for homofermentative and heterofermentative bacteria. Short chain fatty acids were determined by gas chromatography. RESULTS: The physical-chemical results showed that the formulations differed slightly regarding the centesimal composition and that the ingestion of 200mL/day contributes, on average, with 10.8 percent, 36.0 percent, 10.2 percent, 12.6 percent, 37.1 percent and 126.4 percent of the recommended daily intake of energy, proteins, carbohydrates, lipids, dietary fiber and carotenoids respectively. The microbiological results proved that the product is innocuous. The acceptance of the product was of roughly 70 percent. The results of the prebiotic effects showed that more research is necessary. CONCLUSION: The results allow us to conclude that the formulations are nutritionally adequate for small meals of children aging from 4 to 6 years, since the product not only avoids vitamin A deficiency but also presents evidence of some prebiotic effects.