Acerola processing waste: Convective drying with ethanol as pretreatment.

The acerola seed is an agro-industrial waste. It is a high moisture content product, rich in bioactive compounds. Drying is an alternative to make this waste available in a safe condition. The use of ethanol as a pretreatment could improve the drying process besides reducing the operation time. This study aimed to investigate the influence of ethanol pretreatment (ET) on the content of bioactive compounds, cell wall thickness, and color. The drying kinetics was studied, and the influence of external and internal resistance was discussed. The samples were immersed in ethanol for 2 min with subsequent convective drying (40 °C and 60 °C; 1 m s-1) until they reached the equilibrium condition. The ET reduced the drying time up to 36.36 %. The external and mixed control of mass transfer were identified as the governing regimes for drying this material, depending on the use of ethanol. ET led to an increase in effective diffusivity, a reduction in cell wall thickness, and preservation of the color of the dried waste. The ET positively impacted the conservation of ascorbic acid compared to untreated dried samples but was not relevant to phenolic compounds, carotenoids, and antioxidant activity. The drying process increased the bioactivity of the anthocyanins. The best condition was drying at 60 °C, pretreated with ethanol.

Chagas disease deaths detected among garbage codes registered in mortality statistics in Brazil: a study from the buRden of ChAgas dISEase in the contemporary world (RAISE) project.

OBJECTIVES: The objective of this study was to identify Brazil's most critical garbage codes (GCs) reclassified to Chagas disease (ChD) in mortality data and their proportions. We also estimated the potential impact of misclassification on the number of deaths attributed to ChD. STUDY DESIGN: Population-based descriptive study. METHODS: We used the Mortality Information System (SIM; in Portuguese) data before and after routine GC investigation in 2015-2019 to evaluate ChD deaths detected among them. We identified priority GCs, which contributed more than 0.1 % to the percentage of total ChD deaths registered. Spearman's correlation was used to evaluate the association between the reclassification of priority GCs and ChD prevalence. Then, we applied the GC correction factors to estimate the number of deaths attributed to ChD. RESULTS: 22,154 deaths were reported as ChD in the study period. Among them, 1004 deaths originally listed as priority GCs were deaths reclassified to ChD after an investigation in the SIM final database. Unspecific cardiomyopathy (10.2 %), unspecific heart diseases (4.7 %), and heart failure (2.8 %) were GCs with the highest proportions of reclassification to ChD in Brazil. Higher ChD prevalence at the state level was associated with a higher proportion of GC deaths reclassified as ChD. When applying correction factors identified after investigation, we estimated an increase of 26.4 % in registered ChD deaths, mostly in states with higher endemicity. CONCLUSIONS: GCs might conceal deaths due to ChD, particularly in Brazil's states with higher endemicity. The approach suggested in this study may offer an alternative method for estimating ChD-related deaths in endemic countries.

Cardiovascular mortality in Brazil during the COVID-19 pandemic: a comparison between underlying and multiple causes of death.

OBJECTIVES: The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death. STUDY DESIGN: Ecological time-series study. METHODS: An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated. RESULTS: Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11). CONCLUSIONS: During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.

Anesthesia or seizure-like behavior? The effects of two Amazonian plants, Acmella oleracea and Piper alatabaccum in zebrafish (Danio rerio).

Currently, available fish anesthetics can produce important side effects, including respiratory arrest and distress. Easy-to-implement alternatives with low toxicity are needed to ensure fish health as well as to help artisanal fisheries and fish sellers in handling and transporting fishes, and native plants seems to be the best alternative. We aimed to implement an anesthetic protocol using crude ethanolic extracts from flowers and leaves of two Amazonian plants, the Acmella oleracea and Piper alatabaccum. We first tested the extracts for anesthesia, using the zebrafish as model. Even though in some treatments the animals apparently entered deep anesthesia, many of them presented aberrant behaviors and even died. Thus, we performed new experiments testing the extracts effects on seizure-like behaviors of the fish. Only the leaf extract of A. oleracea has potential effects for fish anesthesia. Both the flower extract from this plant and the leaf extract from P. alatabaccum induced seizure-like behavior in the animals. In conclusion, besides bringing a possible new anesthetic protocol for fish, our work draws attention for the neurotoxic effects the anesthetic solutions may cause, since several studies defend other Piper species as anesthetic for fish and A. oleracea flowers' extract was already pointed as fish anesthetic.

Anthelmintic intoxication in goats and sheep: A systematic review.

The objective of this study was to conduct research of the literature available in electronic media on anthelmintic intoxication in sheep and goats. The search for primary studies was carried out in five electronic databases: ScienceDirect, PubMed, Scopus, Web of Science, and SciELO. The search terms used were (antihelmintic OR antiparasitic OR vermifuge) AND (poisoning OR toxicity OR overdose OR intoxication) AND (goat OR sheep). A total of 2361 articles were identified from the five databases: Science Direct (n = 1869), PubMed (n = 434), Scopus (n = 37), Web of Science (n = 16), and SciELO (n = 5). As 111 articles were found in duplicates, 2250 were left for review of the title and abstracts, of which 115 were read in full, and 28 were included in the systematic review. Of the 28 articles, 16 involved sheep, 9 involved goats, and 3 involved both species. Twelve drugs were identified in intoxication reports: albendazole (2), closantel (14), disophenol (1), ivermectin (1), levamisole (2), moxidectin (1), netobimin (1), nitroxinil (1), oxfendazole (2), parbendazole (2), tetramizole (1), and thiabendazole (1). The most prevalent symptoms of anthelmintic intoxication reported were showed involvement of the nervous, locomotor, and renal systems, as well as teratogenic influences. Data from this review underscore the need of the care required in the control of parasitic infections through the safe use of antiparasitic drugs to avoid cases of intoxication.

Effect of salivary CYP4EM1 and CYP4EM2 gene silencing on the life span of Chagas disease vector Rhodnius prolixus (Hemiptera, Reduviidae) exposed to sublethal dose of deltamethrin.

Control of Chagas disease in endemic countries is primarily accomplished through insecticide spraying for triatomine vectors. In this context, pyrethroids are the first-choice insecticide, and the evolution of insect resistance to these insecticides may represent an important barrier to triatomine control. In insects, cytochrome P450s are enzymes involved in the metabolism of xenobiotics and endogenous chemicals that are encoded by genes divided into different families. In this work, we evaluated the role of three Rhodnius prolixus CYP4EM subfamily genes during blood meal and after deltamethrin exposure. CYP4 gene members were expressed in different insect organs (integument, salivary glands (SGs), midgut, fat body and malpighian tubules) at distinct transcriptional levels. CYP4EM1 gene was highly expressed in the SG and was clearly modulated after insect blood meal. Injection of CYP4EM1dsRNA promoted significant reduction in mRNA levels of both CYP4EM1 and CYP4EM2 genes and induced deleterious effects in R. prolixus nymphs subsequently exposed to sublethal doses of deltamethrin (3.4 or 3.8 ng/nymph treated). The higher dose reduced the survival over time and increased susceptibility of R. prolixus nymphs to deltamethrin. A better understanding of this mechanism can help in developing of more efficient strategies to reduce Trypanosoma cruzi vector transmission in Americas.

Castleman disease. Interaction with dermatopathy: Case report.

INTRODUCTION: Castleman disease (CD) is a lymphoproliferative disorder with lymph node hypertrophy. In the unicentric form (UCD), it affects one lymph node or chain of lymph nodes. In the multicentric form (DCM), there is hypertrophy of several lymph node chains with the formation of tumor masses, causing compressive symptoms. This case report showed a case of CD in a different location(inguinal region) associated to a multiple skin lesions. PRESENTATION OF THE CASE: We reported a UCD in a 43-year-old female patient with no previous comorbidities. Since January 2016, this patient developed erysipelas lesions of the left leg (LL) from the thigh root to the foot. Concomitantly, a tumor mass appeared in the inguinal region. In 2019 we performed a biopsy that revealed changes characteristic of CD. Due to extremely poor trophic conditions, the skin area with erysipelas was resected, and the raw surface was grafted. DISCUSSION: As an inference, the erysipelas may have been responsible for the subsequent lymphangitis, lymphedema and lymph node hypertrophy. CONCLUSION: Resection of the diseased skin and lymph node excision constitute the treatment of UCD and result in improvement of the clinical picture. Nevertheless, further study of the inflammatory reaction and of markers such as interleukin-6 and the presence of skin disorders in DC is needed.

Impacto tardio da hipertensão pulmonar e da insuficiência tricúspide após troca transcateter de valva aórtica / Late impact of pulmonary hypertension and tricuspid regurgitation after transcatheter aortic valve replacement

INTRODUÇÃO: Troca transcateter de valva aórtica (TAVR) é cada vez mais utilizada no tratamento da estenose aórtica (EA) senil. EA é comumente associada a hipertensão pulmonar (HP) e insuficiência tricúspide (IT). Nosso OBJETIVO foi avaliar o impacto tardio no curso da HP e IT. MÉTODOS: Pacientes submetidos a TAVR foram acompanhados quanto aos dados ecocardiográficos da HP e da IT por 24 meses. Todos os ecocardiogramas foram realizados em centro único. Foram divididos em grupos de acordo com IT e HP após 24 meses (pressão sistólica da artéria pulmonar = or < 45 mmHg) com follow-up de até 96 meses. Resultados clínicos e mortalidade foram comparados. RESULTADOS: 156 e 151 pacientes foram selecionados para acompanhamento da HP e da IT respectivamente. Média de follow-up foi de 42,23±17,53 meses e 42,60±17,67 meses para grupos de HP e IT. HP se reduziu após o TAVR (32,7% pre-TAVR vs. 20,5% pos-TAVR, p<0,001), mas não foi encontrada mudança significativa na IT (11,9% pre-TAVR vs. 10,6% pos-TAVR). Aumento de átrio esquerdo (AE) foi associado a manutenção de HP (p=0,002). Além disso, o aumento do diâmetro do AE (p=0,015) e EuroSCORE II elevado (p=0,041) foram correlacionados ao surgimento de nova HP. Na análise multivariada, surgimento de nova HP (HR 6,17, 95% CI 1,71­22,29,p=0,005), disfunção diastólica tipo II ou III (HR 1,06, 95% CI 1,06-1,11, p=0,036) e diâmetro de AE (HR 1,11, 95% CI 1,02­1,21, p=0,02) foram preditores independentes de mortalidade. CONCLUSÃO: TAVR foi capaz de reduzir a gravidade da HP, mas não da IT. Além disso, a sobrevida a longo prazo foi afetada pela HP, disfunção diastólica e tamanho do AE.

Treatment with Bifidobacterium longum 51A attenuates intestinal damage and inflammatory response in experimental colitis.

This study evaluated the effects of Bifidobacterium longum 51A on the intestinal mucosa and inflammatory response in experimental colitis. Colitis was induced by administration of 3.5% dextran sodium sulphate (DSS) solution for 7 days. Two periods of administration were performed: treatment (T) group, mice received Bifidobacterium only during disease induction (7 days); total treatment (TT) group, mice received Bifidobacterium for 10 days before and during disease induction. The probiotic effects on intestinal permeability, inflammatory infiltrate, histological analysis, cytokines, chemokines and sIgA were evaluated. Bifidobacterium administration in the T group showed reduction in intestinal permeability and lower IL-1ß, myeloperoxidase, and eosinophil peroxidase levels compared to those in the colitis group (P<0.05). Bifidobacterium administration in the TT group attenuated severe lesions in the colon and reduced eosinophil peroxidase level (P<0.05). B. longum 51A treatment modality was more effective than total treatment and reduced the inflammatory response and its consequences on intestinal epithelium.

Long-term analysis of pulmonary hypertension and tricuspid regurgitation after transcatheter aortic valve replacement

INTRODUCTION: transcatheter aortic valve replacement (TAVR) is increasingly utilized in treatment of aortic stenosis (AS). AS is commonly associated to pulmonary hypertension (PH) and tricuspid regurgitation (TR). We aimed to evaluate the long-term post-TAVR course of PH and TR. METHODS: Patients undergoing TAVR were screened for 24-month echocardiographic data on PH and TR. All echocardiograms were performed by a sing le team. Patients were divided in groups according to TR and PH (pulmonary systolic pressure ≥ or < 45 mmHg) grading at 24 months with follow-up of up to 96 months. Standardized clinical outcomes and survival were compared. RESULTS: 156 and 151 patients were se le cted for PH and TR follow-up, respectively. Mean follow-up was 42.23±17.53 months and 42.60±17.67 months for PH and TR groups. Maximum follow-up was 96 months. PH was reduced post-TAVR (32.7% pre-TAVR vs. 20.5% post-TAVR, p<0.001), but no significant difference in TR was found (11.9% pre-TAVR vs. 10.6% post-TAVR). Increased le ft atrial (LA) diameter (p = 0.002) was associated to maintenance PH. Moreover, increased LA diameter (p=0.015) and increased EuroSCORE II (p=0.041) were correlated to new onset PH. On a multivariab le Cox regression model, new onset PH (HR 6.17, 95% CI 1.71­22.29, p=0.005), diastolic dysfunction type II or III (HR 1.06, 95% CI 1.06-1.11, p=0.036) and LA diameter (HR 1.11, 95% CI 1.02­1.21, p=0.02) were independent predictors of long-term mortality. CONCLUSIONS: TAVR was ab le to reduce the severity of PH, but not TR, in this cohort. Additionally, long-term survival was affected by PH, diastolic dysfunction and LA sizing.

Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review.

BACKGROUND: A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. METHODS: A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records. RESULTS: There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55-95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively. CONCLUSIONS: Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.

Adrenergic receptor ß3 is involved in the memory consolidation process in mice.

Attention and emotion have a positive impact on memory formation, which is related to the activation of the noradrenergic system in the brain. The hippocampus and amygdala are fundamental structures in memory acquisition, which is modulated by noradrenaline through the noradrenergic receptors. Pharmacological studies suggest that memory acquisition depends on the action of both the ß3 (ß3-AR) and ß2 (ß2-AR) receptor subtypes. However, the use of animal models with specific knockout for the ß3-AR receptor only (ß3-ARKO) allows researchers to more accurately assess its role in memory formation processes. In the present study, we evaluated short- and long-term memory acquisition capacity in ß3-ARKO mice and wild-type mice at approximately 60 days of age. The animals were submitted to the open field test, the elevated plus maze, object recognition, and social preference. The results showed that the absence of the ß3-AR receptor caused no impairment in locomotion and did not cause anxious behavior, but it caused significant impairment of short- and long-term memory compared to wild-type animals. We also evaluated the expression of genes involved in memory consolidation. The mRNA levels for GLUT3, a glucose transporter expressed in the central nervous system, were significantly reduced in the amygdala, but not in the hippocampus of the ß3-ARKO animals. Our results showed that ß3-AR was involved in the process of acquisition of declarative memory, and its action may be due to the facilitation of glucose absorption in the amygdala.

First Report of the Lesion Nematodes: Pratylenchus Brachyurus and Pratylenchus Delattrei on Tomato (Solanum Lycopersicum L.) Plants in Cape Verde.

Roots of Solanum lycopersicum L. were collected in growing season of year 2015, on the island of Santiago in Cape Verde. Morphological, morphometric and molecular (18S rDNA and 28S rDNA) studies revealed the presence of Pratylenchus brachyurus and P. delattrei in root systems and root zones of tomato plants. To our knowledge, this is the first record of the occurrence of these nematode species in Cape Verde.

Hypothermia indices among severely injured trauma patients undergoing urgent surgery: A single-centred retrospective quality review and analysis.

BACKGROUND: Hypothermia (<36°C) exacerbates trauma-induced coagulopathy and worsens morbidity and mortality among severely injured trauma patients; there is a paucity of published data describing how well trauma centres adhere to standards regarding measurement of temperature, and best practices for preventing and treating hypothermia. METHODS: We completed a retrospective quality audit of all severely injured trauma patients (Injury Severity Score (ISS≥20)) who had urgent surgery at Sunnybrook Health Sciences Centre (SHSC) between 2010 and 2014. Information regarding temperature monitoring was evaluated over the course of the initial resuscitation and admission. Independent risk factors for in-hospital mortality were elucidated through a multivariable regression analysis. RESULTS: Out of a total of 4492 trauma patients, 495 were severely-injured and went to the operating room (OPR) after being treated in the trauma bay (TB) at SHSC between 2010 and 2014. The majority of the patients were male (n=384, 77.6%) and had a blunt mechanism of injury (n=391, 79.0%). The median ISS score was 29 (interquartile range (IQR) 26, 35). Eighty-nine (17.9%) patients died; 26 (5.2%) of these patients died intra-operatively. Less than one fifth of patients (n=82,16.6%) received a temperature measurement during pre-hospital transport phase. Upon arrival to the TB, almost two-thirds (n=301, 60.8%) of patients had their temperature recorded and a similar proportion (n=175, 58.1%) of those patients were hypothermic (<36°C). In the OPR, close to 80% (n=389, 78.6%) of patients had their temperature measured on both arrival; almost 60% (n=223, 57.3%) were hypothermic on arrival. Almost all patients had their temperature measured upon arrival to the ICU or specialized ward (n=450, 98.3%). Warming initiatives were documented in only 36 (7.3%) patients in the TB, yet documented in almost all patients in OR (n=464, 93.7%). An increased risk of in-hospital mortality was correlated with not taking a temperature measurement in the TB (Odds Ratio (OR) 2.86 (95% Confidence Interval (CI) [1.64-4.99]) or OPR (OR 4.66 (95% CI [2.50-8.69]). CONCLUSIONS: A majority of severely injured trauma patients are hypothermic well into the perioperative period after initial admission. An absence of having temperature measurement during initial hospitalization is associated with increased in-hospital mortality amongst this patient group. Quality improvement initiatives should aim to strive for ongoing temperature measurement as a key performance indicator and early prevention and treatment of hypothermia during initial resuscitation.

Adrenergic receptor ß3 is involved in the memory consolidation process in mice

Attention and emotion have a positive impact on memory formation, which is related to the activation of the noradrenergic system in the brain. The hippocampus and amygdala are fundamental structures in memory acquisition, which is modulated by noradrenaline through the noradrenergic receptors. Pharmacological studies suggest that memory acquisition depends on the action of both the β3 (β3-AR) and β2 (β2-AR) receptor subtypes. However, the use of animal models with specific knockout for the β3-AR receptor only (β3-ARKO) allows researchers to more accurately assess its role in memory formation processes. In the present study, we evaluated short- and long-term memory acquisition capacity in β3-ARKO mice and wild-type mice at approximately 60 days of age. The animals were submitted to the open field test, the elevated plus maze, object recognition, and social preference. The results showed that the absence of the β3-AR receptor caused no impairment in locomotion and did not cause anxious behavior, but it caused significant impairment of short- and long-term memory compared to wild-type animals. We also evaluated the expression of genes involved in memory consolidation. The mRNA levels for GLUT3, a glucose transporter expressed in the central nervous system, were significantly reduced in the amygdala, but not in the hippocampus of the β3-ARKO animals. Our results showed that β3-AR was involved in the process of acquisition of declarative memory, and its action may be due to the facilitation of glucose absorption in the amygdala.

Establishment and cryptic transmission of Zika virus in Brazil and the Americas.

Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 2016) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 2016). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus.

Evaluation of colonisation resistance in stool of human donors using ex vivo, in vitro and in vivo assays.

The indigenous microbiota is the population of microorganisms normally present on the surface and mucosa of an individual, where it performs essential health functions, including the colonisation resistance (CR) against pathogens. To identify the bacteria responsible and the mechanisms involved in the CR, the germ-free (GF) animal model has been used, because in vitro studies cannot always be extrapolated to what occurs in vivo. In this study, ex vivo antagonism assays against seven enteropathogenic bacteria using stools from 15 healthy human donors confirmed that the CR showed individual variation. Using in vitro antagonism assays, 14 strains isolated from dominant faecal microbiota of donors with elevated CR were selected for mono-association in GF mice to test the in vivo antagonism against Salmonella enterica ser. Typhimurium. Mice mono-associated with Enterococcus hirae strain 8.2, Bacteroides thetaiotaomicron strain 16.2 and Lactobacillus ruminis strain 18.1 had significant reductions in faecal counts of the pathogen during the challenge. After five days of infection, the group associated with E. hirae 8.2 showed a reduction in the translocation of S. Typhimurium to the spleen, while the group associated with L. ruminis 18.1 presented an increased translocation to the liver. The histological data confirmed these results and revealed that the mice associated with E. hirae 8.2 showed fewer lesions on ileum and liver, compared to the damage caused by S. Typhimurium alone, while in mice associated with L. ruminis 18.1 there was significantly worse lesions. Concluding, from the dominant faecal microbiota from healthy human with high CR, through ex vivo, in vitro and in vivo assays, a bacterium was characterised for its high CR potential, being a candidate for probiotic use.

Fibrinogen in the initial resuscitation of severe trauma (FiiRST): a randomized feasibility trial.

BACKGROUND: Decreased plasma fibrinogen concentration shortly after injury is associated with higher blood transfusion needs and mortality. In North America and the UK, cryoprecipitate transfusion is the standard-of-care for fibrinogen supplementation during acute haemorrhage, which often occurs late during trauma resuscitation. Alternatively, fibrinogen concentrate (FC) can be beneficial in trauma resuscitation. However, the feasibility of its early infusion, efficacy and safety remain undetermined. The objective of this trial was to evaluate the feasibility, effect on clinical and laboratory outcomes and complications of early infusion of FC in trauma. METHODS: Fifty hypotensive (systolic arterial pressure ≤100 mm Hg) adult patients requiring blood transfusion were randomly assigned to either 6 g of FC or placebo, between Oct 2014 and Nov 2015 at a tertiary trauma centre. The primary outcome, feasibility, was assessed by the proportion of patients receiving the intervention (FC or placebo) within one h of hospital arrival. Plasma fibrinogen concentration was measured, and 28-day mortality and incidence of thromboembolic events were assessed. RESULTS: Overall, 96% (43/45) [95% CI 86-99%] of patients received the intervention within one h; 95% and 96% in the FC and placebo groups, respectively (P=1.00). Plasma fibrinogen concentrations remained higher in the FC group up to 12 h after admission with the largest difference at three h (2.9 mg dL - 1 vs. 1.8 mg dL - 1; P<0.01). The 28-day mortality and thromboembolic complications were similar between groups. CONCLUSIONS: Early infusion of FC is feasible and increases plasma fibrinogen concentration during trauma resuscitation. Larger trials are justified.

Cryoprecipitate therapy.

Cryoprecipitate, originally developed as a therapy for patients with antihaemophilic factor deficiency, or haemophilia A, has been in use for almost 50 yr. However, cryoprecipitate is no longer administered according to its original purpose, and is now most commonly used to replenish fibrinogen levels in patients with acquired coagulopathy, such as in clinical settings with haemorrhage including cardiac surgery, trauma, liver transplantation (LT), or obstetric haemorrhage. Cryoprecipitate is a pooled product that does not undergo pathogen inactivation, and its administration has been associated with a number of adverse events, particularly transmission of blood-borne pathogens and transfusion-related acute lung injury. As a result of these safety concerns, along with emerging availability of alternative fibrinogen preparations, cryoprecipitate has been withdrawn from use in a number of European countries. Compared with the plasma from which it is prepared, cryoprecipitate contains a high concentration of coagulation factor VIII, coagulation factor XIII, and fibrinogen. Cryoprecipitate is usually licensed by regulatory authorities for the treatment of hypofibrinogenaemia, and recommended for supplementation when plasma fibrinogen levels decrease below 1 g litre(-1); however, this threshold is empiric and is not based on solid clinical evidence. Consequently, there is uncertainty over the appropriate dosing and optimal administration of cryoprecipitate, with some guidelines from professional societies to guide clinical practice. Randomized, controlled trials are needed to determine the clinical efficacy of cryoprecipitate, compared with the efficacy of alternative preparations. These trials will allow the development of evidence-based guidelines in order to inform physicians and guide clinical practice.

Força muscular respiratória e pico de fluxo expiratório de pacientes com bronquiectasia submetidos à reabilitação respiratória / Respiratory muscle strength and peak expiratory flow in patients with bronchiectasis underwent pulmonary rehabilitation / La fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria

Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo ®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia(AU)

Objetivo. Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia

Objective. This research aimed to evaluate the respiratory muscle strength and peak expiratory flow in patients with bronchiectasis undergoing respiratory rehabilitation. Method. Clinical trial where, after scrutiny of inclusion and exclusion criteria, the sample was divided randomly into experimental group (EG, n = 13, age = 60 ± 14.86 years) - who underwent treatment with respiratory rehabilitation twice week, lasting 40 minutes per session, at 12 weeks and control group (CG, n = 13, age = 58 ± 13.90 years) - patients with conservative clinical follow-up without therapy during the period of research because they were part of a waiting list for care. The dependent variables of the study were respiratory muscle strength (maximal inspiratory pressure - MIP- expiratory pressure - MEP) and peak expiratory flow (PEF), measured by the manometer and the peak flow®, respectively. The level of significance was set at p < 0.05. Results. In within groups comparison, there was a significant increase only in the EG variables, namely: MIP (Δ = 18.08 cm H2O, p < 0.001) and MEP (cmH2O Δ = 12.31, p < 0.001) and PEF (Δ = 26.77 l / min, p = 0.016). In the between groups comparison, increased satisfactory post-test, GE, compared to GC in MIP and MEP (p = 0.005). Conclusion. it appears that physical therapy influences the proposed increase in respiratory muscle strength and peak expiratory flow in patients with bronchiectasis(AU)