Microbial Diversity in Children with Gastroenteritis in the Amazon Region of Brazil: Development and Validation of a Molecular Method for Complete Sequencing of Viral Genomes.

INTRODUCTION: Metagenomic sequencing is a powerful tool that is widely used in laboratories worldwide for taxonomic characterization of microorganisms in clinical and environmental samples. In this study, we utilized metagenomics to investigate comprehensively the microbial diversity in fecal samples of children over a four-year period. Our methods were carefully designed to ensure accurate and reliable results. MATERIAL AND METHODS: Validated and analyzed were metagenomic data obtained from sequencing 27 fecal samples from children under 10 years old with gastroenteritis over a four-year period (2012-2016). The fecal specimens were collected from patients who received care at public health facilities in the northern region of Brazil. Sequencing libraries were prepared from cDNA and sequenced on the Illumina HiSeq. Kraken-2 was utilized to classify bacterial taxonomy based on the 16S rRNA gene, using the Silva rRNA database. Additionally, the Diamond program was used for mapping to the non-redundant protein database (NR database). Phylogenomic analyses were conducted using Geneious R10 and MEGA X software, and Bayesian estimation of phylogeny was performed using the MrBayes program. The results indicate significant heterogeneity among norovirus strains, with evidence of recombination and point mutations. This study presents the first complete genome of parechovirus 8 in the region. Additionally, it describes the bacterial populations and bacteriophages present in feces, with a high abundance of Firmicutes and Proteobacteria, including an increased proportion of the Enterobacteriaceae family. The presented data demonstrate the genetic diversity of microbial populations and provide a comprehensive report on viral molecular characterization. These findings are relevant for genomic studies in gastrointestinal infections. The metagenomic approach is a powerful tool for investigating microbial diversity in children with gastroenteritis. However, further studies are imperative to conduct genomic analysis of identified bacterial strains and thoroughly analyze antimicrobial resistance genes.

Mitochondrial Stress Links Environmental Triggers with Pro-Inflammatory Signaling in Crohn's Disease.

Inflammatory Bowel Diseases (IBD) are a group of chronic, inflammatory disorders of the gut. The incidence and activity of IBD are determined by both genetic and environmental factors. Among these factors, polymorphisms in genes related to autophagy and the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) have been consistently associated with IBD. We show that NSAIDs induce mitochondrial stress and mitophagy in intestinal epithelial cells. In an altered mitophagy context simulating that observed in IBD patients, NSAID-induced mitochondrial stress leads to the release of mitochondrial components, which act as Danger Associated Molecular Patterns with pro-inflammatory potential. Furthermore, colonic organoids from Crohn's disease patients and healthy donors show activation of the mitochondrial Unfolded Protein Response (UPRmt) upon treatment with ibuprofen. Finally, colon biopsies from Crohn's disease patients in remission or with low-to-moderate activity also show expression of genes involved in UPRmt, while patients with severe activity show no increase compared to healthy donors. Our results suggest the involvement of mitochondria in the mechanisms triggering inflammation in IBD after NSAID use. Moreover, our results highlight the clinical relevance of mitochondrial stress and activation of the UPRmt pathway in the pathophysiology of Crohn's disease.

Maternal and child predictors associated with loss to follow-up in the newborn hearing screening program: a cohort study in maternity hospitals in northeastern Brazil.

PURPOSE: Analyze maternal and child predictors associated with loss to follow-up in the newborn hearing screening program at maternity hospitals in northeastern Brazil. METHODS: Retrospective cohort study, including secondary data from infants (n=604) referred to the newborn hearing screening program in two maternity hospitals for monitoring and/or diagnosis. The predictors evaluated included socioeconomic factors, such as maternal age, marital status, income, schooling, place of residence, number of children and number of prenatal visits. In addition, maternal and child health factors, such as smoking and drug intake during pregnancy, consanguinity, congenital infections, craniofacial malformations, use of ototoxic drugs, syndromes and a history of hearing loss in the family. Statistical analysis was performed based on binary logistic regression models, using the stepwise method. RESULTS: The logistic regression model containing the number of prenatal visits and the history of hearing loss in the family was significant [χ2(2) =34.271; p<0.001]. The number of prenatal visits (OR = 2.343; 95% CI = 1.626 - 3.376) and family history of hearing loss (OR = 2.167; 95% CI = 1.507 - 3.115) were significant predictors. The other predictors were not significant. CONCLUSION: The results reveal that newborns whose mothers had ≤ 5 prenatal visits and those with a family history of hearing loss increased their likelihood of loss to follow-up by 2.3 and 2.1 times, respectively. It is important to provide subsidies for public health improvements in order to help advise, guide and educate mothers, especially during prenatal care.

Percepção de enfermeiras sobre a identificação do paciente como segurança na assistência a criança hospitalizada / Percepción del personal de enfermería de la identificación del paciente como medida de seguridad en la atención a los niños hospitalizados / Perception of nurses on patient identification as safety in the care of hospitalized child

Objetivo: identificar a percepção de enfermeiras que atuam em unidade pediátrica sobre medidas de segurança do paciente. Método: estudo qualitativo, descritivo e exploratório, realizado em um hospital público de Pernambuco, Brasil. Participaram seis enfermeiras atuantes na pediatria. A coleta de dados foi realizada entre novembro e fevereiro de 2021 mediante entrevistas semiestruturadas, a análise dos dados foi realizada por meio da investigação do conteúdo. Resultados: identificou-se três categorias a partir da análise dos resultados, sendo elas a percepção das enfermeiras sobre segurança do paciente, as barreiras de identificação do paciente na unidade pediátrica e a pulseiras de identificação: estratégia para mitigar erros na unidade pediátrica. Considerações finais: foi possível perceber que as enfermeiras acreditam na importância da identificação dos pacientes como uma estratégia para minimizar a ocorrência de erros relacionados a medicamentos e enfatizam que esse ato proporciona uma segurança maior aos profissionais durante a execução dos procedimentos.

Objetivo: identificar la percepción de las enfermeras que trabajan en una unidad pediátrica sobre las medidas de seguridad del paciente. Método: estudio cualitativo, descriptivo y exploratorio, realizado en un hospital público de Pernambuco, Brasil. Participaron seis enfermeras que trabajaban en la unidad pediátrica. La recogida de datos se llevó a cabo entre noviembre y febrero de 2021 mediante entrevistas semiestructuradas, el análisis de datos se realizó mediante investigación de contenido. Resultados: se identificaron tres categorías a partir del análisis de los resultados, siendo éstas la percepción de las enfermeras sobre la seguridad del paciente, las barreras de identificación del paciente en la unidad pediátrica y las barreras de identificación: estrategia para mitigar los errores en la unidad pediátrica. Consideraciones finales: Fue posible notar que las enfermeras creen en la importancia de la identificación del paciente como estrategia para minimizar la ocurrencia de errores relacionados a la medicación y destacan que este acto proporciona mayor seguridad a los profesionales durante la ejecución de los procedimientos.

Objective to identify the perception of nurses who work in a pediatric unit about patient safety measures. Method: qualitative, descriptive and exploratory study, conducted in a public hospital in Pernambuco, Brazil. Six pediatric nurses participated. Data collection was conducted between November and February 2021 through semi-structured interviews; data analysis was conducted through content investigation. Results: three categories were identified from the analysis of the Results: nurses' perception of patient safety, patient identification barriers in the pediatric unit, and identification wristbands: a strategy to mitigate errors in the pediatric unit. Final considerations: it was possible to realize that nurses believe in the importance of patient identification as a strategy to minimize the occurrence of medication-related errors and emphasize that this act provides greater safety to professionals during the execution of procedures.

Maternal and child predictors associated with loss to follow-up in the newborn hearing screening program: a cohort study in maternity hospitals in northeastern Brazil / Preditores maternos e infantis associados a perda de seguimento do programa triagem auditiva neonatal: estudo de coorte em maternidades do nordeste do Brasil

ABSTRACT Purpose Analyze maternal and child predictors associated with loss to follow-up in the newborn hearing screening program at maternity hospitals in northeastern Brazil. Methods Retrospective cohort study, including secondary data from infants (n=604) referred to the newborn hearing screening program in two maternity hospitals for monitoring and/or diagnosis. The predictors evaluated included socioeconomic factors, such as maternal age, marital status, income, schooling, place of residence, number of children and number of prenatal visits. In addition, maternal and child health factors, such as smoking and drug intake during pregnancy, consanguinity, congenital infections, craniofacial malformations, use of ototoxic drugs, syndromes and a history of hearing loss in the family. Statistical analysis was performed based on binary logistic regression models, using the stepwise method. Results The logistic regression model containing the number of prenatal visits and the history of hearing loss in the family was significant [χ2(2) =34.271; p<0.001]. The number of prenatal visits (OR = 2.343; 95% CI = 1.626 - 3.376) and family history of hearing loss (OR = 2.167; 95% CI = 1.507 - 3.115) were significant predictors. The other predictors were not significant. Conclusion The results reveal that newborns whose mothers had ≤ 5 prenatal visits and those with a family history of hearing loss increased their likelihood of loss to follow-up by 2.3 and 2.1 times, respectively. It is important to provide subsidies for public health improvements in order to help advise, guide and educate mothers, especially during prenatal care.

RESUMO Objetivo Analisar preditores maternos e infantis associados a perda de seguimento do programa de triagem auditiva neonatal em maternidades em maternidades do nordeste do Brasil. Método Estudo de coorte retrospectivo, incluindo dados secundários de lactentes (n=604) que foram encaminhados para o monitoramento e/ou diagnóstico do programa de triagem auditiva neonatal, em duas maternidades do nordeste do Brasil. Preditores avaliados incluíram fatores socioeconômicos, como, idade materna, estado civil, renda, escolaridade, local de residência, número de filhos e número de pré-natais; E fatores de saúde materno e infantil, como, fumo e drogas durante a gestação, consanguinidade, infecções congênitas, malformações craniofaciais, uso de drogas ototóxicas, síndromes e história de perda auditiva na família. Foi realizado análise estatística baseada em modelos de regressão logística binária, método stepwise. Resultados O modelo de regressão logística contendo o número de pré-natais e a história de perda auditiva na família foi significativo [χ2(2) =34,271; p<0,001]. Foram preditores significativos, o número de pré-natais (OR = 2,343; IC 95%= 1,626 - 3,376) e a história de perda auditiva na família (OR =2,167; IC 95% = 1,507 - 3,115), os demais preditores, não apresentaram significância neste estudo. Conclusão Os resultados demonstram que estão associados e aumentam as chances de perda de seguimento do programa, recém-nascidos cuja mães realizaram ≤ 5 pré-natais com 2,3 vezes mais chances e história de perda auditiva na família aumentando os riscos em 2,1 vezes a mais. É importante fornecer subsídios para que sejam implementadas melhorias na saúde pública que visem aconselhar, orientar e conscientizar as mães, principalmente durante os pré-natais.

Recreational Drugs and the Risk of Hepatocellular Carcinoma.

Recreational or aesthetic drug use is a distinctive behavior of humans, principally attested in the last century. It is known that recreational and illegal drugs are major contributors to the universal morbidity rate worldwide. Many of these substances have a well-established hepatotoxic potential, causing acute or chronic liver injury, liver fibrosis and cirrhosis, but their implications for hepatocellular carcinoma or other varieties of liver tumors are little known. In this article, we perform an extensive literature review, aiming to provide updated information about recreational drug use and the risk of developing liver tumors. Khat use and pyrrolizidine alkaloid consumption (present in some natural plants) have been linked to liver cirrhosis. Kava intake is associated with different liver tumors in animal models but not in humans. Cannabis' potential to accelerate liver fibrosis in chronic hepatitis is controversial according to the existing data. Cigarette smoking is an important contributor to hepatocellular carcinoma, and anabolic androgen steroids are well-defined causes of a variety of liver cancers and other hepatic tumors. Long-term follow-up studies of subjects who have developed injuries in association with the use of recreational drugs are warranted so as to better define the risk of developing hepatocellular carcinoma in association with these substances and, thus, to implement health care policies to combat this preventable cause of cancer.

N-Acetylcysteine for Preventing Acetaminophen-Induced Liver Injury: A Comprehensive Review.

Aims: N-Acetylcysteine (NAC) is used as an antidote in acetaminophen (APAP) overdose to prevent and mitigate drug-induced liver injury (DILI). Our objective was to systematically review evidence of the use of NAC as a therapeutic option for APAP overdose and APAP-related DILI in order to define the optimal treatment schedule and timing to start treatment. Methods: Bibliographic databases (PubMed, Web of Science, Embase, and MEDLINE) were searched for retrospective and prospective cohort studies, case series, and clinical trials. The prespecified primary outcomes were DILI-related mortality, hepatotoxicity, and adverse events (AEs). Results: In total, 34 studies of NAC usage in APAP-related DILI cases with 19,580 patients were identified, of which 2,376 patients developed hepatotoxicities. The mortality rate across different studies ranged from 0 to 52%. Large variability of NAC regimens was found, i.e., intravenous (I.V.) (100-150 mg/kg) and oral (70-140 mg/kg), and length of treatment varied-12, 24, or 48 h for I.V. regimen and 72 h for oral administration. The timing of initiation of NAC treatment showed different results in terms of occurrence of hepatotoxicity and mortality; if started within 8 h and no more than 24 h from APAP overdose, either intravenously or orally, NAC administration was efficacious in terms of mortality. The most frequent AEs reported were anaphylactic reactions, followed by cutaneous AEs for the IV route and intestinal AEs for the oral one. Conclusion: NAC improves hepatotoxicity and reduces mortality. Timing of treatment, ranging from 8 to 24 h from APAP overdose, regardless of the regimen or route of administration, is important to prevent or minimize liver damage, particularly in children and in elderly and obese patients.

Identification of New Toxicity Mechanisms in Drug-Induced Liver Injury through Systems Pharmacology.

Among adverse drug reactions, drug-induced liver injury presents particular challenges because of its complexity, and the underlying mechanisms are still not completely characterized. Our knowledge of the topic is limited and based on the assumption that a drug acts on one molecular target. We have leveraged drug polypharmacology, i.e., the ability of a drug to bind multiple targets and thus perturb several biological processes, to develop a systems pharmacology platform that integrates all drug-target interactions. Our analysis sheds light on the molecular mechanisms of drugs involved in drug-induced liver injury and provides new hypotheses to study this phenomenon.

Floristic survey of a Caatinga area of high biological importance in the Mesoregion of Paraíba backlands, Northeast Brazil / Levantamento florístico de uma área de Caatinga de alta importância biológica na Mesorregião do Sertão Paraibano, Nordeste do Brasil

The Caatinga occupies an area of ​​approximately 912,529 km², being one of the most distinct phytogeographic regions of the Brazilian territory. It has a vegetation that varies according to its distribution and relationship with the geography of each area. This study aimed to carry out a floristic survey of ABA farm, located in the municipality of Passagem, mesoregion of the Paraíba backlands. For four years, fortnightly botanical collections were carried out in all the plant's physiognomies on the farm, following a standard botanical protocol of floristic survey and herborization techniques. The results of this research brought up an important floristic list, consisting of 322 species from 194 genera belonging to 62 botanical families. Among these families, the ones with the higher number of species were Fabaceae (48 spp.), Euphorbiaceae (23 spp.), Convolvulaceae (21 spp.), Malvaceae (19 spp.) and Asteraceae (15 spp.). The habits were herbs (108 spp.), trees (59 spp.), subshrubs (56 spp.), shrubs (46 spp.), lianas (46 spp.), epyphytes and parasites (four spp.) In addition, 38 new species records were registered for the Paraíba State.

A Caatinga ocupa uma área de aproximadamente 912.529 km², sendo umas das regiões fitogeográficas mais distintas do território brasileiro. Possui uma vegetação que varia conforme a sua distribuição e relação com a geografia de cada área. Este trabalho teve como objetivo fazer um levantamento florístico da Fazenda ABA, localizada no município de Passagem, mesorregião do sertão paraibano. Durante quatro anos foram realizadas coletas botânicas quinzenais em todas as fitofisionomias da Fazenda ABA, obedecendo a um protocolo botânico padrão de técnicas de levantamento florístico e herborização de exsicatas. Os resultados desta pesquisa geraram uma lista florística importante, constituída de 322 espécies de 194 gêneros pertencentes a 62 famílias botânicas, dentre estas as famílias que mais se destacaram em número de espécies temos Fabaceae (48 spp.), Euphorbiaceae (23 spp.), Convolvulaceae (21 spp.), Malvaceae (19 spp.) e Asteraceae (15 spp.). Os hábitos foram o herbáceo (108 spp.), arbóreo (59 spp.), subarbustivo (56 spp.), arbustivo (46 spp.), lianas (46 spp.), epífitas e parasitas (quatro spp.). Além disso foram apontados 38 novos registros de espécies para o Estado da Paraíba.   

Methionine Cycle Rewiring by Targeting miR-873-5p Modulates Ammonia Metabolism to Protect the Liver from Acetaminophen.

Drug-induced liver injury (DILI) development is commonly associated with acetaminophen (APAP) overdose, where glutathione scavenging leads to mitochondrial dysfunction and hepatocyte death. DILI is a severe disorder without effective late-stage treatment, since N-acetyl cysteine must be administered 8 h after overdose to be efficient. Ammonia homeostasis is altered during liver diseases and, during DILI, it is accompanied by decreased glycine N-methyltransferase (GNMT) expression and S-adenosylmethionine (AdoMet) levels that suggest a reduced methionine cycle. Anti-miR-873-5p treatment prevents cell death in primary hepatocytes and the appearance of necrotic areas in liver from APAP-administered mice. In our study, we demonstrate a GNMT and methionine cycle activity restoration by the anti-miR-873-5p that reduces mitochondrial dysfunction and oxidative stress. The lack of hyperammoniemia caused by the therapy results in a decreased urea cycle, enhancing the synthesis of polyamines from ornithine and AdoMet and thus impacting the observed recovery of mitochondria and hepatocyte proliferation for regeneration. In summary, anti-miR-873-5p appears to be an effective therapy against APAP-induced liver injury, where the restoration of GNMT and the methionine cycle may prevent mitochondrial dysfunction while activating hepatocyte proliferative response.

Efecto citotóxico de diterpenos derivados del ácido ent-kaureno aislados de Coespeletia moritziana (Sch. Bip. ex Wedd.) Cuatrec / Cytotoxic effect of ent-kaurene acid-derived diterpenes isolated from Coespeletia moritziana (Sch. Bip. Ex Wedd.) Cuatrec

The objective of the work was to study the cytotoxic effect of ent-kaurene acid derivatives obtained from Coespeletia moritziana (Sch. Bip. Ex Wedd.) Cuatrec., After analysis by GC/MS, IR and NMR. Isolating: kaurenic acid (I), grandifloric acid (II), 15-α-hydroxy kaurenic acid (III), 15 α-acetoxy-kaur 16-en-19-oic acid (IV), Kaurenol (V); and by hemisynthesis: 15,16-epoxy-17-acetoxy-kauran 19-oic acid (VI), 15-oxo-ent-kaur-16-en-19-oic acid (VIII), ester 2,3,4,6 -15-oxo-kaur-16-en-19-oic acid acetyl α-D-pyranosyl tetra-tetra (VII). Cytotoxicity was tested in human cancer cell lines: uterus (HeLa), lung (A-549), breast (MCF-7), African green monkey kidney non-tumor line (Vero) and human peripheral blood mononuclear cells (CMPS). Compound (I) was active against HeLa, A-549 and Vero. Compounds (II and VIII) showed moderate and good (IC50 ≤ 9 µM) cytotoxicity, respectively, against the five cell lines. Compound (V) showed moderate activity against A-549 and compound (VII), slight cytotoxicity against HeLa and A-549. Results that show the cytotoxic specificity of the isolated kaurenes and derivatives of Coespeletia moritzianaand their therapeutic potential.

El objetivo del trabajo fue estudiar el efecto citotóxico de derivados del ácido ent-kaureno obtenidos de Coespeletia moritziana (Sch. Bip. ex Wedd.) Cuatrec., previo análisis mediante GC/MS, IR y RMN. Aislandose: ácido kaurénico(I), ácido grandiflorénico (II), ácido 15-α-hidroxi kaurénico(III), ácido 15 α-acetoxi-kaur 16-en-19-oico (IV), Kaurenol (V); y por hemisíntesis: ácido 15,16-epoxi-17-acetoxi-kauran 19-oico (VI), ácido15-oxo-ent-kaur-16-en-19-oico (VIII), éster 2,3,4,6-tetra acetil α-D-piranosilo del ácido 15-oxo-kaur-16-en-19-oico (VII). La citotóxicidad fue ensayada en líneas celulares cancerosas humanas: útero (HeLa), pulmón(A-549), mama (MCF-7), línea no tumoral de riñón de mono verde africano (Vero) y células mononucleares humanas de sangre periférica (CMPS). El compuesto (I) resultó activo frente a HeLa, A-549 y Vero. Los compuestos (II y VIII), mostraron moderada y buena (IC50≤9µM) citotoxicidad respectivamente, frente a las cinco líneas celulares. El compuesto (V) presentó moderada actividad frente a A-549 y el (VII), leve citotoxicidad frente a HeLa y A-549. Resultados que evidencian la especificidad citotóxica de los kaurenos aislados y derivados de Coespeletia moritzianay su potencial terapéutico.

Effectiveness and Safety of Attic Exposition-Antrum Exclusion versus Canal Wall-Up in Patients with Acquired Stage Ib and II Cholesteatoma Affecting the Attic and Tympanic Cavity.

This study aims to test the effectiveness and safety of exteriorization surgery comprising atticotomy and obliteration of the additus ad antrum, also referred to as attic exposition-antrum exclusion (AE-AE) surgery. This surgery combines otoendoscopy with surgical microscopy for the treatment of acquired pars flaccida cholesteatoma in stages Ib and II (according to the classification of the Japan Otological Society) present in the attic and the tympanic cavity. We reviewed a historical cohort of 65 patients. Of the total, 21 were treated with canal wall-up tympanomastoidectomy (CWU). Patients in whom the AE-AE technique was performed had residual and recurrence rates of 0% and 9.1%, respectively, compared with 28.6% and 9.5%, respectively, for those treated with CWU. In the AE-AE procedure, surgery is performed in one stage compared with the two stages in CWU, to address the risk of residual cholesteatoma. Auditory thresholds were higher in the CWU group compared with the AE-AE group in the pre-surgery (53 ± 16 vs. 44 ± 15 dB; p = 0.039) and post-surgery (52 ± 18 vs. 42 ± 16 dB; p = 0.042) evaluations but not in pre-post-surgery comparisons for either the AE-AE technique (p = 0.89) or the CWU technique (p = 0.96). We conclude that AE-AE is an effective and safe technique for the treatment of acquired stage Ib and II cholesteatoma present in the attic and tympanic cavities.

Retrospective molecular analysis of norovirus recombinant strains in the amazon region, Brazil.

BACKGROUND: Noroviruses are enteric viruses that cause acute gastroenteritis worldwide. Over two decades, GII.4 genotype was responsible for most cases. However, recombinant strains have emerged and changed the epidemiological context of these infections. OBJECTIVES: The aim of this study was to identify the recombinant genetic strains of norovirus causing gastroenteritis in Brazilian children from the Amazon region. METHODS: We analyzed 534 cases of gastroenteritis between 2015 and 2016. Genotypic characterization was performed by partial sequencing of ORF1 and ORF2. Evolutionary history was inferred by Bayesian inference using MrBayes. Recombinant strains were confirmed by Simplot and RDP4 analysis. FINDINGS: We performed viral detection tests and identified a norovirus frequency of 31.8% (175/534). Based on viral RdRp and VP1 genes, nine genotypes were identified: GIIP31/GII.4, GII·P16/GII.4, GII·P7/GII.6, GII·P21/GII.13, GII·P33/GII.1, GII·P17/GII.17, GI·P7/GI.7, GII·P4/NT, and GII.7/NT. The phylogenetic tree showed evolutionary relationships among the genotypes, including the recombinant strains. This is the first description of GII·P33/GII.1 and GII·P21/GII.13 genotypes in Brazil. CONCLUSION: Norovirus evolution has been characterized by the continuous replacement of variants that have new antigenic properties. In recent years, recombinant strains have displaced GII.4, improving the viral fitness and influencing the viral transmissibility and pathogenicity.

Cinesioterapia aplicada à fadiga oncológica / Kinesiotherapy applied to oncological fatigue

Buscou-se na literatura estudos que façam uso da cinesioterapia para tratar, atenuar e melhorar a fadiga em pacientes oncológicos além de identificar qual melhor intervenção para prática clínica com esse grupo de pacientes. Métodos: Realizou-se uma revisão integrativa da literatura acompanhada com avaliação de qualidade metodológica. Iniciaram-se as buscas no período de 7 de maio de 2020 a 15 de setembro de 2020, nas bases de dados PEDro, Pubmed e Scielo. Foram encontrados 146 artigos, porém apenas 12 foram selecionados e analisados de acordo com os critérios de inclusão e a qualidade metodológica da escala PEDro. Resultados: Os estudos encontrados apresentam diversas condutas fisioterapêuticas para a fadiga em pacientes com idade entre 18 e 94 anos de curto a longo prazo, sendo no mínimo 3 meses e no máximo 2 anos de intervenção em níveis ambulatoriais e domiciliares, com protocolos de exercícios terapêuticos aeróbicos, ativos, resistidos e funcionais que proporcionaram resultados positivos aos pacientes com fadiga oncológica. Conclusão: O uso da fisioterapia com exercícios cinesioterapêuticos é essencial para reabilitação desses pacientes, fazendo-se necessário mais pesquisas com ensaios clínicos incluindo a aplicação da fisioterapia com exercícios cinesioterapêuticos. (AU)

A simple method for obtaining human albumin and its use for in vitro interaction assays with indole-thiazole and indole-thiazolidinone derivatives.

This work aimed to develop a simple and low-cost method to obtain human serum albumin (HSA) and its consequent application for in vitro drug interaction assays. The HSA was purified by classic principles of plasma precipitation and thermocoagulation, using a multiple-stage fractionation. The quality of the final product was assessed by electrophoresis, protein dosage by the Lowry method and the pharmacopeial thermal stability. At the end, an isotonic solution of HSA with a total protein concentration of 2.7 mg·mL-1 was obtained, which was visualized as a single band corresponding to the molecular weight of 66 kDa. After the thermal stability test, there was no indication of turbidity or color change of the solution. Finally, the HSA was useful for interaction assays with indole-thiazole and indole-thiazolidinone derivatives through UV-vis absorption and fluorescence spectroscopic studies, as well as by docking molecular analysis. Derivatives quenched the intrinsic fluorescence of HSA, disrupted the tryptophan residues microenvironment, and probably bind at Sudlow's site I. Therefore, the simplified methodology developed in this work proved to be effective in obtaining HSA that can be applied to research goals including drug interaction assays.

Serological and molecular epidemiology of the Dengue, Zika and Chikungunya viruses in a risk area in Brazil.

BACKGROUND: The co-circulation of types of arbovirus in areas where they are endemic increased the risk of outbreaks and limited the diagnostic methods available. Here, we analyze the epidemiological profile of DENV, CHIKV and ZIKV at the serological and molecular level in patients with suspected infection with these arboviruses in the city of Juazeiro do Norte, Ceará, Brazil. METHODS: In 2016, the Central Public Health Laboratory (LACEN) of Juazeiro do Norte received 182 plasma samples from patients who visited health facilities with symptoms compatible with arbovirus infection. The LACEN performed serological tests for detection of IgM/IgG to DENV and CHIKV. They then sent these samples to the Retrovirology Laboratory of the Federal University of São Paulo and Faculty of Medical of the ABC where molecular analyses to confirm the infection by DENV, ZIKV and CHIKV were performed. The prevalence of IgM/IgG antibodies and of infections confirmed by RT-qPCR were presented with 95% confidence interval. RESULTS: In serologic analysis, 125 samples were positive for antibodies against CHIKV and all were positive for antibodies against DENV. A higher prevalence of IgG against CHIKV (63.20% with 95% CI: 45.76-70.56) than against DENV (95.05% with 95% CI: 78.09-98.12) was observed. When the samples were submitted to analysis by RT-qPCR, we observed the following prevalence: mono-infection by ZIKV of 19.23% (95% CI: 14.29-34.82) patients, mono-infection by CHIKV of 3.84% (95% CI: 2.01-5.44) and co-infection with ZIKV and CHIKV of 1.09% (95% CI: 0.89-4.56). CONCLUSION: The serologic and molecular tests performed in this study were effective in analyzing the epidemiological profile of DENV, CHIKV and ZIKV in patients with suspected infection by these arboviruses in the city of Juazeiro do Norte, Ceará/Brazil.

New sources of botanical acaricides from species of Croton with potential use in the integrated management of Tetranychus urticae / Nuevas fuentes de acaricidas botánicos de especies de Croton con uso potencial en el manejo integrado de Tetranychus urticae

Essential oils from the leaves and stems of Croton adenocalyx, C. grewioides, C. heliotropiifoliusand C. blanchetianus obtained through hydrodistillation were analyzed by GC-MS. We then investigated the lethal and sublethal effects of the Croton oils and 15 major constituents against Tetranychus urticae. ß-Caryophyllene was the major component in the leaf and stem oils from C. heliotropiifolius and C. adenocalyx. Spathulenol and (E)-anethole were the major constituents identified in the leaf and stem oils of C. blanchetianus and C. grewioides, respectively. The oil with the greatest lethal and sublethal effects was those from C. adenocalyx. Among the constituents ß-caryophyllene and spatulenol were the most toxic to the mite, where as eugenol and methyl eugenol were the most repellent. The toxicity and repellency of the Croton oils, particularly the oils from C. adenocalyx, demonstrate that these oils constitute a promising alternative to synthetic acaricides for use in the control of T. urticae.

Los aceites esenciales de las hojas y tallos de Croton adenocalyx, C. growioides, C. heliotropiifolius y C. blanchetianus obtenidos mediante hidrodestilación fueron analizados a través de GC-MS. Se investigaron los efectos letales y subletales de los aceites de Croton y 15 componentes principales contra Tetranychus urticae. El ß-cariofileno fue el componente principal en los aceites de hojas y tallos de C. heliotropiifolius y C. adenocalyx. El espatulenol y el (E)-anetol fueron los principales componentes identificados en los aceites de hojas y tallos de C. blanchetianus y C. growioides, respectivamente. El aceite con los mayores efectos letales y subletales fue el de C. adenocalyx. Entre los componentes, el ß-cariofileno y el espatulenol fueron los más tóxicos para el ácaro, mientras que el eugenol y el metil eugenol fueron los más repelentes. La toxicidad y la repelencia de los aceites de Croton, particularmente los aceites de C. adenocalyx, demuestran que estos aceites constituyen una alternativa prometedora respecto a los acaricidas sintéticos para uso en el control de T. urticae.

Profile of herbal and dietary supplements induced liver injury in Latin America: A systematic review of published reports.

Hepatotoxicity related to HDS is a growing global health issue. We have undertaken a systematic review of published case reports and case series from LA from 1976 to 2020 to describe the clinical features of HDS related hepatotoxicity in this region. We search in PubMed, Web of Science, Scopus and specific LA databases according to PRISMA guidelines. Only HILI cases published in LA that met criteria for DILI definition were included. Duplicate records or reports that lacked relevant data that precluded establishing causality were excluded. Finally, 17 records (23 cases) were included in this review. Centella asiatica, Carthamus tinctorius, and Herbalife® were the most reported HDS culprit products, the main reason for HDS consumption was weight loss. The clinical characteristics of HDS hepatotoxicity in our study were compared to those of other studies in the USA, Europe and China showing a similar signature with predominance of young females, hepatocellular damage, a high rate of ALF and mortality, more frequent inadvertent re-challenge and chronic damage. This study underscores the challenge in causality assessment when multi-ingredients HDS are taken and the need for consistent publication practice when reporting hepatotoxicity cases due to HDS, to foster HDS liver safety particularly in LA.

A relação entre hipertensão arterial, ansiedade e estresse: uma revisão integrativa da literatura / La relación entre hipertensión arterial, ansiedad y estrés: una revisión bibliográfica integrativa / The relationship of high blood pressure, anxiety and stress: an integrative literature review

RESUMO. Este estudo teve por objetivo realizar uma revisão integrativa de literatura para verificar o que os estudos têm abordado sobre a relação entre estresse e ansiedade em pessoas hipertensas. Para tanto, o levantamento dos estudos foi realizado nas bases PsycINFO, Portal da Capes, Scielo e Medline BVS-PSI, utilizando os descritores 'hipertensão arterial' and 'estresse' and 'ansiedade', e seus correspondentes na língua inglesa 'arterial hypertension' and 'stress' and 'anxiety' e espanhola 'hipertensión' and 'estrés' and 'ansiedad', considerando os últimos seis anos (2013 a 2018). Foram selecionados 14 estudos. Os resultados foram agrupados em três categorias: a) o impacto causado pelo diagnóstico de doenças crônicas não transmissíveis, b) fatores psicológicos associados à hipertensão arterial e c) relação saúde física versus saúde mental: uma questão também de método. Os resultados mostraram que ansiedade e estresse, além da depressão podem apresentar-se como aspectos moduladores da hipertensão arterial. Portanto, considera-se necessária a desmistificação da lógica cartesiana entre mente e corpo, para que sejam efetivadas ações de cuidado integral dos sujeitos e de promoção à saúde. Espera-se que os resultados obtidos reafirmem a importância de considerar os aspectos psicológicos e emocionais nas doenças crônicas e que estudos futuros com diferentes delineamentos sejam desenvolvidos na área da psicologia.

RESUMEN. Este estudio tuvo como objetivo realizar una revisión bibliográfica integradora para verificar lo que los estudios han abordado sobre la relación entre estrés y ansiedad en personas hipertensas. Para ello, el levantamiento de los estudios fue realizado en las bases PsycINFO, Portal da Capes, Scielo y Medline BVS-PSI, utilizando los descriptores 'hipertensión arterial' y 'estrés' y 'ansiedad', y sus correspondientes en la lengua inglesa 'arterial hipertension' y 'ansiedad' y 'ansiedad', considerando los últimos seis años (2013 a 2018). Se seleccionaron 14 estudios. Los resultados fueron agrupados en tres categorías: a) el impacto causado por el diagnóstico de enfermedades crónicas no transmisibles, b) factores psicológicos asociados a la hipertensión arterial y c) Relación entre salud física y mental: una cuestión también de método. Los resultados mostraron que la ansiedad y el estrés, además de la depresión pueden presentarse como aspectos moduladores de la arterial hipertension. Por lo tanto, se considera necesaria la desmistificación de la lógica cartesiana entre mente y cuerpo, para que se efectúen acciones de cuidado integral de los sujetos y de promoción a la salud. Se espera que los resultados obtenidos reafirmen la importancia de considerar los aspectos psicológicos y emocionales en las enfermedades crónicas, y que estudios futuros con diferentes delineamientos se desarrollen en las demas áreas de salud, ademas del área médica.

ABSTRACT The objective of this study was to conduct an integrative literature review to verify which studies addressed the relationship between stress and anxiety in hypertensive patients. To do so, the study was carried out at the bases PsycINFO, Portal da Capes, Scielo and Medline BVS-PSI, using the descriptors 'arterial hypertension' and 'stress' and 'anxiety', and their correspondents in the English language 'arterial hypertension' and 'stress' and 'anxiety' and Spanish 'hypertension' and 'anxiety', considering the last six years (2013 to 2018). The results were grouped into three categories: a) The impact caused by the diagnosis of chronic non communicable diseases, b) Psychological factors associated with arterial hypertension and c) Deconstructing the dichotomy: physical health vs. mental health. The search resulted in the inclusion of 14 empirical studies. The results showed that anxiety and stress, in addition to depression, may present as modulatory aspects of arterial hypertension. Therefore, it is considered necessary the demystification of the cartesian logic between mind and body, so that actions of integral care of the subjects and promotion of health are carried out. It is hoped that the results obtained reaffirm the importance of considering the psychological and emotional aspects in chronic diseases, and that future studies with different designs be developed in the other areas of health, besides the medical area.

Diversity of Loricariidae (Actinopterygii: Siluriformes) assemblages in two Conservation Areas of the Middle Xingu River, Brazilian Amazon, and their suitability for sustainable ornamental fisheries

The Xingu River has one of the most diverse fish faunas in the Amazon region. Loricariidae stands out as the most diverse family in the basin, comprising more than 60 species distributed over 26 genera. Species of Loricariidae are some of the most economically valued in the ornamental market worldwide. The loss of fishing environments in Altamira region due to dam impacts is driving a shift of ornamental fishing to areas upstream, among which are included the Xingu River and Iriri River Extractive Reserve Areas. Thus, the objective of this work was to inventory fish species with ornamental potential in these extractive reserves to serve as a baseline to help guide the future management of ornamental fishing in those areas. Thirty-two species of Loricariidae were collected in these reserves through either free diving or diving with compressed air. The composition of species varied according to the sampling method and area. The majority of species found in the reserves are also found in the impacted areas of Belo Monte near Altamira. The study areas showed high diversity of fish species in rapids environments, suggesting that this area could serve as an additional source of income for the residents of these reserves.(AU)

O rio Xingu possui umas das mais diversas ictiofaunas da região Amazônica. Loricariidae destaca-se como a família mais diversa nessa bacia, compreendendo mais de 60 espécies distribuídas em 26 gêneros. As espécies de Loricariidae estão entre as mais valorizadas economicamente no mercado ornamental mundial. A perda de ambientes de pesca na região de Altamira devido aos impactos das barragens está provocando uma mudança da pesca ornamental para áreas a montante, entre as quais estão incluídas as áreas das Reservas Extrativistas do Rio Xingu e do Rio Iriri. Assim, o objetivo deste trabalho foi o de inventariar espécies de peixes com potencial ornamental nestas reservas extrativistas para servir de linha de base para ajudar a orientar o gerenciamento futuro da pesca ornamental nestas áreas. Trinta e duas espécies de Loricariidae foram coletadas nestas reservas através de mergulho livre ou mergulho com ar comprimido. A composição das espécies variou de acordo com o método de amostragem e a área de conservação. A maioria das espécies encontradas nas reservas também são encontradas nas áreas impactadas de Belo Monte, perto de Altamira. As áreas de estudo mostraram grande diversidade de espécies de peixes em ambientes rápidos, sugerindo que esta área poderia servir como uma fonte adicional de renda para os residentes destas reservas.(AU)