Probiotics, prebiotics, and synbiotics in childhood diarrhea.

Acute diarrhea is the second leading cause of morbidity and mortality attributed to infections in children under five years of age worldwide, with 1.7 million annual estimated cases and more than 500,000 deaths. Although hydroelectrolytic replacement is the gold standard in treating diarrhea, it does not interfere with the restoration of the intestinal microbiota. Several studies have searched for an adequate alternative in restructuring intestinal homeostasis, finding that treatments based on probiotics, prebiotics, and synbiotics are effective, which made such treatments increasingly present in clinical practice by reducing illness duration with minimal side effects. However, there are still controversies regarding some unwanted reactions in patients. The diversity of strains and the peculiarities of the pathogens that cause diarrhea require further studies to develop effective protocols for prevention and treatment. Here, we provide a descriptive review of childhood diarrhea, emphasizing treatment with probiotics, prebiotics, and synbiotics.

Probiotics, prebiotics, and synbiotics in childhood diarrhea

Abstract Acute diarrhea is the second leading cause of morbidity and mortality attributed to infections in children under five years of age worldwide, with 1.7 million annual estimated cases and more than 500,000 deaths. Although hydroelectrolytic replacement is the gold standard in treating diarrhea, it does not interfere with the restoration of the intestinal microbiota. Several studies have searched for an adequate alternative in restructuring intestinal homeostasis, finding that treatments based on probiotics, prebiotics, and synbiotics are effective, which made such treatments increasingly present in clinical practice by reducing illness duration with minimal side effects. However, there are still controversies regarding some unwanted reactions in patients. The diversity of strains and the peculiarities of the pathogens that cause diarrhea require further studies to develop effective protocols for prevention and treatment. Here, we provide a descriptive review of childhood diarrhea, emphasizing treatment with probiotics, prebiotics, and synbiotics.

Intra-myocardial dissecting hematoma: late complication of cocaine-induced myocardial infarction

Intra-myocardial dissecting hematoma (IDH) is a rare and unusual form of myocardial rupture that can be secondary to complicate acute myocardail infarction (MI). It is usually caused by a hemorrhagic dissection between the layers of myocardial fibers that can occur during the acute injury or the remodeling process. This case demonstrates a patient with a history of cocaine-induced ischemic cardiomyopathy complicated with an extensive IDH. Case description A 38-year-old man with a past medical history of hypertension, heart failure with reduced ejection fraction (HFrEF), and cocaine abuse disorder, presents to the emergency department complaining of worsening shortness of breath. Six months before the current hospitalization, the patient had been diagnosed with acute myocardial infarction, left heart Cath showed a severe three-vessel coronary artery disease, but it was non-suitable for revascularization. The transthoracic echocardiogram (TTE) showed significant left ventricular dysfunction with an ejection fraction of 28% and a thrombus in the left ventricle. Four days before the current admission, the patient started complaining of worsening exertional dyspnea, orthopnea, and peripheral edema. His vital signs were BP 90 x 62mmhg, HR 104 bpm, SatO2 90% and afebrile. His physical examination revealed an increased jugular venous pressure, significant symmetric peripheral edema (3+/4), and cold extremities. Cardiac auscultation revealed a regular rhythm, S3, without murmrs. A pulmonary exam revealed bilateral crackles on the inferior 1/3 of the lungs. EKG showed sinus tachycardia and prior inferior necrosis. Renal function was normal, but lactate acid was elevated (2.6mg/dL). The patient was started with noninvasive ventilation, along with IV diuretic therapy, vasopressor, and inotropic support (dobutamine). A TTE was performed which showed an intra-myocardial dissecting hematoma in the inferior left ventricle (LV) wall, along with a large thrombus in the LV chamber and severe biventricular dysfunction (ejection fraction was 23%). Our patient responded well to the medical treatment. Due to his severely reduced left ventricular ejection fraction (LVEF), the IDH was managed conservatively. He was discharged on standard medication for HFrEF and oral anticoagulation. Discussion this case demonstrates IDH as a late complication following a cocaine-induced MI. Two-dimensional echocardiography is useful in the diagnosis of IDH as well as in ruling out potential differential diagnoses. Conservative treatment is a viable option, especially for those patients not suitable for cardiac revascularization with severely reduced left ventricular ejection.

Síncope cardioinibitória 2b com pausa de 48 segundos em paciente com síndrome de down e defeito do septo av corrigido: descrição do caso e do plano terapêutico / Cardioinhibitory syncope 2b with a 48-second pause in a patient with down syndrome and corrected AV septal defect: case description and therapeutic plan

INTRODUÇÃO: Os quadros de Síncope habitualmente se iniciam na adolescência. Aproximadamente 20% da população experimenta o primeiro episódio de desmaio entre 10 e 20 anos. Apesar de extremamente angustiantes estes nem sempre são investigados. Apenas 25 a 50% dos pacientes são avaliados nos serviços de saúde. Entretanto alguns casos merecem tratamento pelo risco de eventos e necessitam de acompanhamento especializado, inclusive para monitorização da indicação de dispositivos de marcapasso (MP) em caso de refratariedade ao tratamento clínico. Isto ocorre em alguns caos de síncope de padrão neuromediado do tipo cardioinibitória com pausa (Síncope cardioinibitória 2b ao Teste de Inclinação) OBJETIVO: Descrever o caso de uma paciente púbere pós com Síndrome de Down e síncopes de repetição de início recente com teste de inclinação (TI) positivo (resposta 2b). DESCRIÇÃO DO CASO: Paciente 13 anos feminina, Síndrome de Down portadora de defeito do septo AV total em fase pós operatória de correção total com bom resultado cirúrgico. Iniciou concomitante a menarca quadro de sincope recorrente com pródromos (dor abdominal e palidez). Apresenta Holter sem alterações arrítmicas e ecocardiograma com FEVD no limite inferior da normalidade. Analise do ECG com sinais de bloqueio divisional ântero superior direito. Foi submetido a avaliação por TI. Realizou protocolo de inclinação passivo a 70 graus não sensibilizado. Após 5 minutos de repouso foi inclinada e se manteve estável por 7 minutos e no oitavo minuto de inclinação apresentou dor abdominal, seguida de sincope com resposta cardioinibitória 2b e pausa de 48 segundos (fig 1) apesar do retorno a posição de Trendelenburgo (-30 graus). Houve retorno dos batimentos cardíacos com recuperação imediata do nível de consciência. Iniciado tratamento clínico com orientação de aumento da ingesta hídrica, suspender fatores desencadeantes (ortostase prolongada, ambientes quentes por exemplo) e mantido a monitorização rigorosa com intuito de avaliar a refratariedade e a necessidade de indicação de MP. CONCLUSÃO: 1) Os quadros de síncope neuromediada são particularmente frequentes durante a adolescência, principalmente após o estirão do crescimento 2) As respostas cardioinibitórias podem se instalar subitamente e serem de grande repercussão. Apesar deste fato o tratamento clínico deve ser sempre priorizado; 3) O paciente deve ser monitorizado quanto as recorrências e refratariedade ao tratamento clínico para indicação precisa de MP em pacientes com síncope cardioinibitória 2b com grandes pausas refratária à medidas gerais.

Development and characterization of microsatellite loci for Ocotea species (Lauraceae) threatened with extinction.

The Atlantic rainforest species Ocotea catharinensis, Ocotea odorifera, and Ocotea porosa have been extensively harvested in the past for timber and oil extraction and are currently listed as threatened due to overexploitation. To investigate the genetic diversity and population structure of these species, we developed 8 polymorphic microsatellite markers for O. odorifera from an enriched microsatellite library by using 2 dinucleotide repeats. The microsatellite markers were tested for cross-amplification in O. catharinensis and O. porosa. The average number of alleles per locus was 10.2, considering all loci over 2 populations of O. odorifera. Observed and expected heterozygosities for O. odorifera ranged from 0.39 to 0.93 and 0.41 to 0.92 across populations, respectively. Cross-amplification of all loci was successfully observed in O. catharinensis and O. porosa except 1 locus that was found to lack polymorphism in O. porosa. Combined probabilities of identity in the studied Ocotea species were very low ranging from 1.0 x 10-24 to 7.7 x 10-24. The probability of exclusion over all loci estimated for O. odorifera indicated a 99.9% chance of correctly excluding a random nonparent individual. The microsatellite markers described in this study have high information content and will be useful for further investigations on genetic diversity within these species and for subsequent conservation purposes.

Short-term effects of air pollution on respiratory morbidity at Rio de Janeiro--Part II: health assessment.

The effects of air pollution on health have been studied worldwide. Given that air pollution triggers oxidative stress and inflammation, it is plausible that high levels of air pollutants cause higher number of hospitalisations. This study aimed to assess the impact of air pollution on the emergency hospitalisation for respiratory disease in Rio de Janeiro, Brazil. The study was divided in two parts: Part I specifically addressing the air pollution assessment and Part II addressing the health assessment. Accordingly, this Part II aimed to estimate the association between the concentrations of PM10, SO2 and CO observed in Rio de Janeiro and the number of emergency hospitalisations at a central hospital due to respiratory diseases. The pollutant concentrations were measured at two different sites in Rio de Janeiro, but the excess relative risks were calculated based on the concentrations observed at one of the sites, where limits were generally exceeded more frequently, between September 2000 and December 2005. A time series analysis was performed using the number of hospitalisations, divided in three categories (children until 1 year old, children aged between 1 and 5 years old and elderly with 65 years old or more) as independent variable, the concentrations of pollutants as dependent variables and temperature, relative humidity, long term trend, and seasonality as confounders. Data were analysed using generalised additive models with smoothing for some of the dependent variables. Results showed an excess risk of hospitalisation for respiratory disease higher than 2% per 10 µg m⁻³ increase in PM10 concentrations for children under 5 years old, of 2% per 10 µg m⁻³ increase in SO2 for elderly above 65 years old and around 0.1% per 10 µg m⁻³ increase in CO for children under 1 year and elderly. Other studies have found associations that are in agreement with the results achieved in this study. The study suggests that the ambient levels of air pollutants experienced in Rio de Janeiro between 2000 and 2005 were linked to the number of hospitalisations for respiratory diseases among children and elderly.

Short-term effects of air pollution on respiratory morbidity at Rio de Janeiro--PART I: Air pollution assessment.

Exposure to air pollution has been related with the most varied adverse health outcomes. This study aims to assess the impact of air pollution on the emergency hospitalization for respiratory disease in Rio de Janeiro, Brazil. The study was divided in two parts: Part I specifically addressing the air pollution assessment and Part II addressing the health assessment. Accordingly, this Part I aims to: i) evaluate the concentrations of PM(10), SO(2) and CO at two sites in Rio de Janeiro and compare them; ii) analyse the concentrations observed according to the national and international standards; and iii) analyse the air pollutants behaviour, namely, annually, seasonally, daily and considering weekdays/weekends variations. The pollutant concentrations were measured at two different sites in Rio de Janeiro and the analysis was performed for the period between September 2000 and December 2005. Results showed that PM(10) concentrations in Rio de Janeiro exceeded the daily and annual standards imposed by the European Union, the Brazilian legislation and WHO guidelines. Regarding SO(2) and CO, concentrations were, generally, below both European and Brazilian standards. Nevertheless, considering WHO guidelines, SO(2) threshold for daily concentrations (20 µg m(-3)) was exceeded around 150 times. Behaviour assessment showed that the influence of traffic is a major factor affecting the air pollution in Rio de Janeiro. Considering the results achieved and the proven health effects of air pollution, strategies should be defined for its reduction, particularly concerning particulate matter, and consequently contribute to the protection of public health.

Protective effect of rPb40 as an adjuvant for chemotherapy in experimental paracoccidioidomycosis.

The conventional treatment for the most prevalent mycosis in Latin America, paracoccidioidomycosis (PCM), involves long periods of therapy that results in side effects and a high frequency of relapses. The search for a new, alternative treatment is necessary. Pb40 is an antigenic protein from P. brasiliensis fraction F0. This fraction has already been shown to have significant protective activity when used as a PCM vaccine in experimental models. The complete cDNA sequence corresponding to Pb40 was cloned into a pET-21a plasmid, expressed in E. coli with a his-tag and purified by affinity chromatography. The predicted protein sequence exhibited nearly 100% homology to a fragment of the hypothetical EF-hand domain containing protein of P. brasiliensis. Immunization with this recombinant protein was used together with chemotherapy in an attempt to improve PCM treatment. The combined drug/rPb40 treatment exhibited long-lasting control of PCM in the liver and spleen and largely preserved the tissue structures of these organs. Despite the lack of a reduction in CFUs in the group that received the combined treatment, there was a significant reduction in the size of the lesions in the lungs after 70 days of infection. At the same time, the IL-10 levels were higher in the treated mice than in the infected-only mice. Moreover, significant levels of rPb40-specific IgG antibodies were detected in the sera of immunized mice. Thus, the treatment protocol consisting of rPb40 immunization in addition to fluconazole chemotherapy showed an additive protective effect after intratracheal challenge, preventing fungal dissemination to other sites of infection and preventing relapses. These results provide new prospects for PCM immunotherapy.

Protective immunity induced by rPb27 of Paracoccidioides brasiliensis.

A cDNA coding for an antigenic protein (rPb27) from the pathogenic fungus Paracoccidioides brasiliensis was cloned and its protective activity was determined against paracoccidioidomycosis (PCM). The cDNA sequence contained an open reading frame (ORF) of 660 base pairs encoding a protein of 219 amino acids with a predicted molecular weight of 25kDa. The deduced amino acid sequence exhibited 100% identity to the 27kDa P. brasiliensis hypothetic protein (access number AA49615). The complete coding cDNA was cloned into a pGEX 4T-2 plasmid and expressed in Escherichia coli as a glutathione-S-transferase-tagged (GST) recombinant protein. Mice immunized with purified rPb27 were able to develop high levels of IgG2b, moderate levels of IgG1 and low levels of IgG2a. At the same time the levels of TGF-beta and IFN-gamma were high while a very low production of IL-10 was verified. Using confocal microscopy with anti-rPb27 mouse serum against P. brasiliensis yeast forms, surface and cytosolic staining pattern were observed. Moreover, immunization of mice with this antigen induced a significant degree of protection in the lungs (93%), liver (93%) and spleen (100%) at 60 days after challenge with infection. Thus, the granulomatous lesions revealed a greater degree of compaction and organization, with few lesions in the lungs and no dissemination of the fungus to other organs. These results showed that a recombinant protein of P. brasiliensis (rPb27) promoted acquired protection against infection with P. brasiliensis yeast forms, suggesting the use of this protein for future development as a prophylactic vaccine for PCM.

Exposure to volatile organic compounds in an ethanol and gasoline service station.

The present study was conducted to determine the VOCs concentrations in a service station located in a residential and commercial area in the city of Rio de Janeiro. This is, to our knowledge, the first published determination in Brazil, where both ethanol and ethanol-blended gasoline are used. Electro polished, stainless steel, evacuated canisters were used for sampling. The analysis was performed by gaschromatography with flame ionization detection (CG-FID) and by gas chromatography-mass spectrometry (CG-MS). A total of 80 and 56 compounds were determined in samples collected at the service station and control location, respectively. The most abundant compounds at the service station were in order of decreasing concentration (units: microg m(-3)): 2-methylbutane (1,715.7), 2-methylbut-1-ene (1,043.2), isobutene (758.8), 2-methylprop-1-ene (703.7), 2-methylpentane (492.1), pentadi-1,3-ene (189.7), toluene (157.0), benzene (144.5), but-2-ene (126.3) and m,p-xylene (123.2). A mean concentration of 144.5 microg m(-3) was determined for benzene, this value is about ten times the concentration determined in the control location in this work and about 70 times the value determined in other locations of Rio de Janeiro using charcoal cartridges for the sampling. The mean benzene/toluene ratios are 0.92 and 0.31 in the service station and control location, respectively. Since in Brazil service station workers are employed to fill customer's cars (self-service is not commonly used) the possible risk of cancer of these workers should be evaluated in a future study.