THE COMBINATORY EFFECTS OF ESSENTIAL OIL FROM Lippia macrophylla ON MULTIDRUG RESISTANT Acinetobacter baumannii CLINICAL ISOLATES.

To assess the antibacterial effectiveness of Lippia macrophylla essential oil (LMEO) against multidrug-resistant Acinetobacter baumannii isolates, both as a standalone treatment and in combination with conventional antibiotics. LMEO demonstrated a significant inhibitory effect on the growth of A. baumannii, with a minimum inhibitory concentration (MIC) below 500µg/mL. Notably, LMEO was capable of reversing the antibiotic resistance of clinical isolates or reducing their MIC values when used in combination with antibiotics, showing synergistic (FICI ≤ 0.5) or additive effects. The combination of LMEO and imipenem was particularly effective, displaying synergistic interactions for most isolates. Ultrastructural analyses supported these findings, revealing that the combination of LMEO + ceftazidime compromised the membrane integrity of the Acb35 isolate, leading to cytoplasmic leakage and increased formation of Outer Membrane Vesicles (OMVs). Taken together our results point for the use of LMEO alone or in combination as an antibacterial agent against A. baumannii. These findings offer promising avenues for utilizing LMEO as a novel antibacterial strategy against drug-resistant infections in healthcare settings, underscoring the potential of essential oils in enhancing antibiotic efficacy.

Improving pharmaceutical practice in diabetes care using point-of-care glycated haemoglobin testing in the community pharmacy.

OBJECTIVES: To evaluate the use of point-of-care testing to detect new cases of diabetes mellitus at a Brazilian public community pharmacy. METHODS: This cross-sectional study included individuals without a previous diagnosis of diabetes mellitus who met the criteria for screening according to the Brazilian Diabetes Society, which were identified during their presence at a Brazilian public community pharmacy. The measurements of HbA1c were performed using a Cobas b101 device (Roche Diagnostics) and were categorized according to the following classification established by the Brazilian Society of Diabetes: HbA1c <5.7%, normal; HbA1c between 5.7% and 6.4%, pre-diabetes; and HbA1c >6.4%, new diagnosis of T2DM. KEY FINDINGS: One hundred and eight users met the inclusion criteria. The patients' mean age was 54.4 (± 15.4) years old, ranging from 22 to 80 years old. Eighty (74.1%) participants presented with glycated haemoglobin levels over the standard threshold, of which 58 (72.5%) were in the pre-diabetes range (glycated haemoglobin levels between 5.7% and 6.4%), and 22 (27.5%) had glycated haemoglobin levels >6.4%, which corresponds to a new diagnosis of type 2 diabetes mellitus. CONCLUSIONS: The use of point-of-care glycated haemoglobin testing allowed community pharmacists at a Brazilian public community pharmacy to identify health system users with glycated haemoglobin alterations that corresponded to the pre-diabetes state or a new diagnosis of type 2 diabetes mellitus. This presented a good opportunity to refer these users to diabetes diagnosis and treatment services.

Comparative transcriptomics analysis of multidrug-resistant Acinetobacter baumannii in response to treatment with the terpenic compounds thymol and carvacrol.

Acinetobacter baumannii is a gram-negative opportunistic bacterium that has become a major public health concern and a substantial medical challenge due to its ability to acquire multidrug resistance (MDR), extended-drug resistance, or pan-drug resistance. In this study, we evaluated the antibacterial activity of thymol and carvacrol alone or in combination against clinical isolates of MDR A. baumannii. Additionally, we used RNA-sequency to perform a comparative transcriptomic analysis of the effects of carvacrol and thymol on the Acb35 strain under different treatment conditions. Our results demonstrated that thymol and carvacrol alone, effectively inhibited the bacterial growth of MDR A. baumannii isolates, with a minimum inhibitory concentration (MIC) lower than 500 µg/mL. Furthermore, the combination of thymol and carvacrol exhibited either synergistic (FICI ≤ 0.5) or additive effects (0.5 < FICI ≤ 4), enhancing their antibacterial activity. Importantly, these compounds were found to be non-cytotoxic to Vero cells and did not cause hemolysis in erythrocytes at concentrations that effectively inhibited bacterial growth. Transcriptomic analysis revealed the down-regulation of mRNA associated with ribosomal subunit assemblies under all experimental conditions tested. However, the up-regulation of specific genes encoding stress response proteins and transcriptional regulators varied depending on the experimental condition, particularly in response to the treatment with carvacrol and thymol in combination. Based on our findings, thymol and carvacrol demonstrate promising potential as chemotherapeutic agents for controlling MDR A. baumannii infections. These compounds exhibit strong antibacterial activity, particularly in combination and lower cytotoxicity towards mammalian cells. The observed effects on gene expression provide insights into the underlying mechanisms of action, highlighting the regulation of stress response pathways.

Sexualidade: implicações no cotidiano de pessoas com lesão medular / Sexuality: implications for the daily lives of people with spinal cord injury

A lesão medular altera funções motoras e sensitivas, podendo causar limitações de atividades e restrição de participação. Nesse contexto, é frequente a presença de alterações da sexualidade, relacionadas a diminuição da função sexual, libido, baixa autoestima e aceitação social. Apesar disso, a sexualidade e seus desdobramentos têm sido pouca integrada no processo de reabilitação dessas pessoas. Objetivo: Compreender a sexualidade da pessoa com lesão medular, suas vivências e estratégias utilizadas, bem como a atuação de profissionais de saúde nessa área a partir da percepção de pessoas com lesão medular. Método: Estudo descritivo de análise qualitativa, que incluiu 12 pessoas com lesão medular, de idades entre 23 e 56 anos, usuários do Projeto Praia Para Todos, Rio de Janeiro. A coleta de dados foi realizada através de entrevista gravada por telefone. Os instrumentos utilizados foram Ficha de identificação sociodemográfica, roteiro de entrevista semiestruturado e Quociente Sexual. A inferência e interpretação dos dados foram realizados após transcrição das entrevistas na íntegra. Resultados: A lesão medular acarretou mudanças na vivência da sexualidade em aspectos físicos, psicossociais e ambientais. As principais estratégias utilizas foram mudança de hábitos, utilização de equipamentos, técnicas, medicamentos e busca por rede de suporte social. Embora o processo de reabilitação tenha se dado através de equipe multidisciplinar, foi identificado ausência de abordagem da sexualidade. Conclusão: Sugere-se mais estudos que visem identificar as limitações, barreiras e estratégias utilizadas por pessoas com lesão medular e outras deficiências, bem como o esclarecimento a profissionais de saúde sobre a importância da atuação nesse campo.

Spinal cord injury alters motor and sensory functions, which may cause activity limitations and participation restriction. In this context, the presence of changes in sexuality is frequent, related to decreased sexual function, libido, low self-esteem and social acceptance. Despite this, sexuality and its consequences have been poorly integrated in the rehabilitation process. Objective: Comprehend the spinal cord injured person's sexuality, their experiences and strategies used, as well as the action of healthcare professionals in this area. Method: Descriptive study of qualitative analysis, which included 12 people with spinal cord injury, aged between 23 and 56 years; they were users of the Praia Para Todos Project, Rio de Janeiro. Data were collected through recorded phone interviews. The instruments used were a sociodemographic identification form, a semi-structured interview script and the Sexual Quotient Questionnaire. The inference and interpretation of data were performed after transcribing the interviews in full. The inferring and interpretation data were performed after the transcription of the full interview. Results: Spinal cord injury caused changes in the experience of sexuality in physical, psychosocial and environmental aspects. The main strategies used were changing habits, using equipment, techniques, medications and seeking a social support network. Although the rehabilitation process happened through a multidisciplinary team, an absence of approach to sexuality was identified. Conclusion: Further studies are suggested that aim to identify limitations, barriers and application by people with spinal cord injury and other disabilities, as well as clarification to health professionals about the importance of working in this field.

The Effect of Resistance Training on Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis.

Resistance training (RT) has been considered an intervention with effective stimulus on bone mineral formation and is, therefore, recommended to decrease the rate of bone morpho-functional proprieties loss with aging. Thus, this meta-analysis aimed to analyze the effectiveness of RT protocols in promoting changes in bone mineral density (BMD) in older adults. The systematic reviews and meta-analysis followed the PRISMA guidelines (PROSPERO CRD42020170859). The searches were performed in the electronic databases using descriptors according to the PICO strategy. The methodological quality and risk of bias were assessed with the PEDro scale, and the magnitude of the results was determined by Hedges' g. Seven studies involving 370 elderlies, with the RT planned as a unique exercise mode of intervention, showed designs with four to five exercises for upper- and lower-limbs musculature, two to three sets per exercise, eight to twelve repetitions to failure at 70-90% 1 RM, 60-120 s of rest between sets, and executed three times per week for 12-52 weeks. The RT protocols were classified between good and excellent and evidenced a positive effect on the BMD at the hip (0.64%) and spine (0.62%) but not in the femoral neck (-0.22%) regardless of the intervention length. The narrow range of either positive or negative changes in the BMD after the RT intervention support, at best, a preventive effect against the increasing risk of bone frailty in an older population, which is evident beyond 12 weeks of RT practice engagement.

Mudanças percebidas pelos usuários durante o tratamento no serviço de Psicologia e Psiquiatria em uma Unidade Básica de Saúde no município de São Paulo / Changes perceived by users during treatment in the Psychology and Psychiatry service in a Basic Health Unit in the city of São Paulo

Introdução: produzir cuidados em saúde mental é oferecer possibilidades para que os usuários em sofrimento psíquico se percebam não apenas como coadjuvantes, mas, como protagonista do seu processo de transformação. A Atenção Primária à Saúde enquanto porta de entrada para o Sistema Único de Saúde deve acolher as necessidades das pessoas em sofrimento psíquico e produzir medidas resolutivas para essas demandas. A mesma se configura como campo importante de produção de cuidados em saúde mental e vem sendo solicitada desde a implantação da Rede de Atenção Psicossocial. Objetivo: Analisar as mudanças percebidas pelos usuários durante o tratamento no serviço de psicologia e psiquiatria em uma Unidade Básica de Saúde do município de São Paulo. Método: pesquisa quantitativa, transversal, descritiva e exploratória, conduzida em uma Unidade Básica de Saúde do Município de São Paulo. A amostra de conveniência foi constituída por 120 usuários com idade superior a 18 anos e em tratamento nos serviços de Psicologia e Psiquiatria de no mínimo 12 meses. A coleta foi realizada de 16 de março a 17 de abril de 2020. Foi utilizada a Escala de Mudanças Percebidas e questionário sociodemográfico e clínico. As variáveis dependentes foram: problemas pessoais, humor, estabilidade emocional, confiança, interesse pela vida, capacidade de suportar situações difíceis, convivência com a família, convivência com amigos, com outras pessoas, interesse por trabalhar as mudanças percebidas com o serviço de saúde, obtidas através do cálculo médio da EMP após o início de tratamento na UBS (para o caso de análise univariada e múltipla de correlação com a mudança percebida); as variáveis independentes foram: características do perfil sociodemográfico e clínico dos usuários atendidos na UBS, tempo de tratamento, histórico de internação, quantidade de internações, uso de psicotrópicos, tratamentos em outros equipamentos de saúde, no serviço de psicologia e psiquiatria da UBS, acompanhamento por outras especialidade de saúde, existência de outras doenças além do transtorno psiquiátrico, participação em atividades de promoção em saúde, frequência de consultas e retornos da psicologia. Realizou-se análise descritiva, univariada e múltipla por meio de Regressão Linear Múltipla com nível de significância de 5%. A suposição acerca da normalidade da variável dependente foi comprovada por teste de Normalidade de Kolmogorov-Smirnov. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo (Protocolo: N.º 3.389.518). Resultados: Da amostra (n=120) são do sexo feminino (70%), casada (3,5%), ensino médio completo (42,5%) e média de idade de 55,9 anos. As variáveis independentes número de filhos (p=0,021) e viver com outros (p= 0,042) apresentaram correlação com a mudança percebida. Pela análise múltipla, a variável que corresponde à vive atualmente com outros (0,197) tem maior percepção de mudança. Viver com o cônjuge (-0,146) não se considera preparado para alta do serviço de psiquiatria (-0,231), às vezes segue a prescrição médica (-0,166), tem familiares com sofrimento psíquico ou transtorno mental (-0,293), com destaque para o fato de que todas as variáveis têm menor percepção de mudança. A distribuição de normalidade mostrou que há pouca mudança percebida em relação aos processos de tratamentos (r2=0,212), ou seja, 21,2% dos entrevistados apresentaram mudança percebida. Conclusão: As variáveis que contribuem positivamente para melhor percepção de mudança são não fazer uso de psicotrópico, viver com outras pessoas, não ter histórico de tratamento psiquiátrico e psicológico, não ter familiares em sofrimento psíquico/transtorno mental, não passar em tratamento psiquiátrico e fazer apenas tratamento psicológico; e as que contribuem para menor percepção de mudança foram viver com cônjuges, não se sentir preparado para alta psiquiátrica, não seguir e/ou às vezes seguir a prescrição médica e ter familiares em sofrimento psíquico/transtorno mental.

HERisk: An improved spatio-temporal human health risks assessment software.

Risk assessment is considered an essential tool to assist in the management and mitigation of polluted areas, especially those associated with economic activities that significantly degrade the environment, such as mining. However, most of the methodologies of risk assessment adopt the deterministic approach of using a fixed value for ascertaining the hazards derived from exposure to chemical pollutants. However, this is not the case of the Human, Ecological and Radiological Risk (HERisk) code, which allows space-time assessments of ecological, radiological, and human health risks. Indeed, this work aims to describe this new software (enhanced version of HHRISK), which not only improves the performance of the code but also increases its applicability and versatility. To showcase its usefulness in evaluating ecological pollution and human health risk were studied the contents of potentially toxic elements (Co, Cu, Fe, Mn, Ni, Pb, and Zn) in soils and surface waters from the nickel mining area in the municipality of Itagibá (Bahia, Brazil). The obtained results showed that metals are non-homogeneous distributed, suggesting the presence of local enrichment sources, mainly related to human activities. The statistical analyses carried out revealed that mining and agricultural activities are possibly responsible for the contents of these pollutants in both soils and surface waters. The calculated ecological indices of pollution confirmed anthropogenic pollution around the mining area, especially in the locations closest to sterile waste piles. The results of the human health risk assessment revealed that the ingestion of meat and contaminated water are the main routes for entering the potentially toxic elements to the human body and that Co is the chemical specie that poses the highest risk in the entire region. The hazard index (HI) values indicated that the whole area around the mine should be considered as a high risk for human health.

Assessment of water resources pollution associated with mining activity in a semi-arid region.

Mining, although relevant and indispensable for human socioeconomic development, is considered one of the most polluting anthropogenic activities. Water resources are the most vulnerable environmental compartment to the direct impacts of mining, especially in the semi-arid regions. In these regions, mining activity constitutes an important challenge in the management of water resources; since its impacts can be maximized by the adverse meteorological conditions. This study aimed to assess the level of contamination in water resources of three important mining areas in a semi-arid region, where approximately 70,000 people live. The concentrations of eleven heavy metals in sediment, surface and groundwater samples were determined by ICP OES. The results obtained for water samples indicated significant contamination by Cd, Pb, and U, based on the limits established by Brazilian and international regulatory legislation. In the case of sediment samples, higher concentrations of Cr, Cu, Ni, and V were observed. Pollution indices (PLI, CF and Igeo) revealed moderate to extreme contamination mainly along the Jacaré and Contas rivers. The Pearson correlation, Principal Component, and Hierarchical Cluster analyses were performed to identify patterns in the distribution of elements and common sources of pollution. The results suggested that the concentrations of Co, Cr, Cu, Fe, Mn, Ni, and V were mainly related to mining activities and, to a lesser extent, natural sources. In the case of Cd and Pb, contamination may have an important contribution from fertilizers use, whereas Zn has a mixed source of both lithogenic and anthropogenic origin. On the other hand, the high concentrations of U, specifically in groundwater samples, were associated with geogenic causes. Although the potential ecological risk values indicated a low ecological risk; other sediment quality indices (TEL, PEL, ΣTU, and PEL-Q) revealed that there is 25% of the probability that the content of heavy metals in water resources near the mining areas induces adverse toxic effects on aquatic organisms.

Evaluation of the use of antivenom sera in the emergency service of a regional public hospital in Vitória da Conquista (BA), Brazil. / Avaliação do uso de soros antivenenos na emergência de um hospital público regional de Vitória da Conquista (BA), Brasil.

This study aims to characterize the epidemiological profile of victims of scorpion and snakebite envenomations and to evaluate the adequacy of antivenom sera prescriptions. This is a cross-sectional study whose data sources were the envenomation notification information sheets of the Notifiable Diseases Information System in the city of Vitória da Conquista (BA), Brazil. We included information on scorpion or snakebite envenomations attended in the municipality in the period between July 2016 and June 2017. The data obtained and the variables of interest were analyzed according to the questions of this study. In the observed period, 293 victims of envenomations were treated. Of these, 149 (50.9%) were men, and 114 (38.9%) were 20-59 years old. In total, 235 (80.9%) cases of scorpionism and 58 (19.1%) of ophidism were reported. Of these, 203 (69.3%) were classified as mild, and in 200 (68.5%) cases, serum therapy was prescribed for the patients. Regarding the adequacy of the prescriptions, 172 (59.7%) were considered inadequate, and of these, the use of some vials above than indicated was the most frequent. The inappropriate prescription of antivenom sera occurred in approximately 60% of the evaluated cases. Despite this, most accidents were classified as mild - in young men.

O presente estudo tem como objetivo caracterizar o perfil epidemiológico de vítimas de acidentes escorpiônicos e ofídicos e avaliar a adequação das prescrições de soros antivenenos. Estudo transversal cujas fontes de dados foram as fichas de notificação de acidentes por animais peçonhentos do Sistema de Informação de Agravos de Notificação no município de Vitória da Conquista (BA), Brasil. Foram incluídas as informações de acidentes escorpiônicos ou ofídicos no período entre julho de 2016 e junho de 2017 atendidos no município. Os dados obtidos e as variáveis de interesse foram analisadas de acordo com as perguntas deste estudo. No período observado foram atendidas 293 vítimas de acidentes por animais peçonhentos. Destas, 149 (50,9%) foram homens e 114 (38,9%) possuíam entre 20 a 59 anos. Foram 235 (80,9%) casos de escorpionismo e 58 (19,1%) de ofidismo. Destes, 203 (69,3%) foram classificados como leves e em 200 (68,5%) casos foi prescrita soroterapia para estes pacientes. Quanto à adequação das prescrições, 172 (59,7%) foram julgadas inadequadas e destas, o uso de número de ampolas acima do indicado foi a mais frequente. A prescrição inapropriada de soros antivenenos ocorreu em aproximadamente em 60% dos casos avaliados. Apesar disso, a maioria dos acidentes foi classificada como leve, em homens jovens.

Avaliação do uso de soros antivenenos na emergência de um hospital público regional de Vitória da Conquista (BA), Brasil / Evaluation of the use of antivenom sera in the emergency service of a regional public hospital in Vitória da Conquista (BA), Brazil

Resumo O presente estudo tem como objetivo caracterizar o perfil epidemiológico de vítimas de acidentes escorpiônicos e ofídicos e avaliar a adequação das prescrições de soros antivenenos. Estudo transversal cujas fontes de dados foram as fichas de notificação de acidentes por animais peçonhentos do Sistema de Informação de Agravos de Notificação no município de Vitória da Conquista (BA), Brasil. Foram incluídas as informações de acidentes escorpiônicos ou ofídicos no período entre julho de 2016 e junho de 2017 atendidos no município. Os dados obtidos e as variáveis de interesse foram analisadas de acordo com as perguntas deste estudo. No período observado foram atendidas 293 vítimas de acidentes por animais peçonhentos. Destas, 149 (50,9%) foram homens e 114 (38,9%) possuíam entre 20 a 59 anos. Foram 235 (80,9%) casos de escorpionismo e 58 (19,1%) de ofidismo. Destes, 203 (69,3%) foram classificados como leves e em 200 (68,5%) casos foi prescrita soroterapia para estes pacientes. Quanto à adequação das prescrições, 172 (59,7%) foram julgadas inadequadas e destas, o uso de número de ampolas acima do indicado foi a mais frequente. A prescrição inapropriada de soros antivenenos ocorreu em aproximadamente em 60% dos casos avaliados. Apesar disso, a maioria dos acidentes foi classificada como leve, em homens jovens.

Abstract This study aims to characterize the epidemiological profile of victims of scorpion and snakebite envenomations and to evaluate the adequacy of antivenom sera prescriptions. This is a cross-sectional study whose data sources were the envenomation notification information sheets of the Notifiable Diseases Information System in the city of Vitória da Conquista (BA), Brazil. We included information on scorpion or snakebite envenomations attended in the municipality in the period between July 2016 and June 2017. The data obtained and the variables of interest were analyzed according to the questions of this study. In the observed period, 293 victims of envenomations were treated. Of these, 149 (50.9%) were men, and 114 (38.9%) were 20-59 years old. In total, 235 (80.9%) cases of scorpionism and 58 (19.1%) of ophidism were reported. Of these, 203 (69.3%) were classified as mild, and in 200 (68.5%) cases, serum therapy was prescribed for the patients. Regarding the adequacy of the prescriptions, 172 (59.7%) were considered inadequate, and of these, the use of some vials above than indicated was the most frequent. The inappropriate prescription of antivenom sera occurred in approximately 60% of the evaluated cases. Despite this, most accidents were classified as mild - in young men.

Impact of untreated dental caries on the quality of life of Brazilian children: population-based study.

BACKGROUND: The assessment of oral health should consider clinical and biopsychosocial aspects. AIM: To evaluate the impact of untreated dental caries on the quality of life of children. DESIGN: A cross-sectional study was conducted with 647 Brazilian children. The Child Perceptions Questionnaire (CPQ8-10 ) and the 'oral health' global indicator were administered to the children and used as the outcomes. Parents answered a general questionnaire, and oral clinical examinations were performed. Data analysis involved descriptive statistics, chi-squared test, Mann-Whitney test, and Poisson's regression analysis (α = 5%). The psychometric properties of the CPQ8-10 were tested for younger age group (6/7 years). RESULTS: Untreated caries was a predictor of impact on quality of life for the following items: 'pain in teeth/mouth' (PR = 1.69; 95% CI: 1.41-2.04), 'difficulty biting/chewing hard foods' (PR = 1.28; 95% CI: 1.05-1.56), 'difficulty eating what you wanted to eat' (PR = 1.61; 95% CI: 1.29-2.02), 'trouble sleeping' (PR = 1.64; 95% CI: 1.27-2.13), 'missed school' (PR = 1.62; 95% CI: 1.24-2.12), 'trouble doing homework' (PR = 1.61; 95% CI: 1.12-2.31), and 'difficulty paying attention in class' (PR = 1.41; 95% CI: 1.01-1.96). CONCLUSION: Children with untreated dental caries feel greater negative impacts on quality of life than children without untreated caries.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases.

Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases / O que o reumatologista deve saber sobre as manifestações orofaciais das doenças reumáticas autoimunes

ABSTRACT Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

RESUMO Manifestações orofaciais ocorrem com frequência nas doenças reumáticas e, comumente, representam sinais iniciais ou de atividade da doença que ainda são negligenciados na prática clínica. Entre as doenças reumáticas autoimunes com possíveis manifestações orais, incluem-se a artrite reumatoide (AR), miopatias inflamatórias (MI), esclerose sistêmica (ES), lúpus eritematoso sistêmico (LES), policondrite recidivante (PR) e síndrome de Sjögren (SS). Sinais e sintomas orofaciais como hipossalivação, xerostomia, disfunções temporomandibulares, lesões na mucosa bucal, doença periodontal, disfagia e disfonia podem ser a primeira expressão dessas doenças reumáticas. Esse artigo revisa as principais manifestações orofaciais das doenças reumáticas que podem ser de interesse do reumatologista, para diagnóstico e acompanhamento das doenças reumáticas autoimunes.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. / O que o reumatologista deve saber sobre as manifestações orofaciais das doenças reumáticas autoimunes.

Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.

Saccharomyces cerevisiae and non-Saccharomyces yeasts in grape varieties of the São Francisco Valley.

The aims of this work was to characterise indigenous Saccharomyces cerevisiae strains in the naturally fermented juice of grape varieties Cabernet Sauvignon, Grenache, Tempranillo, Sauvignon Blanc and Verdejo used in the São Francisco River Valley, northeastern Brazil. In this study, 155 S. cerevisiae and 60 non-Saccharomyces yeasts were isolated and identified using physiological tests and sequencing of the D1/D2 domains of the large subunit of the rRNA gene. Among the non-Saccharomyces species, Rhodotorula mucilaginosa was the most common species, followed by Pichia kudriavzevii, Candida parapsilosis, Meyerozyma guilliermondii, Wickerhamomyces anomalus, Kloeckera apis, P. manshurica, C. orthopsilosis and C. zemplinina. The population counts of these yeasts ranged among 1.0 to 19 × 10(5) cfu/mL. A total of 155 isolates of S. cerevisiae were compared by mitochondrial DNA restriction analysis, and five molecular mitochondrial DNA restriction profiles were detected. Indigenous strains of S. cerevisiae isolated from grapes of the São Francisco Valley can be further tested as potential starters for wine production.

Saccharomyces cerevisiae and non-Saccharomyces yeasts in grape varieties of the São Francisco Valley

The aims of this work was to characterise indigenous Saccharomyces cerevisiae strains in the naturally fermented juice of grape varieties Cabernet Sauvignon, Grenache, Tempranillo, Sauvignon Blanc and Verdejo used in the São Francisco River Valley, northeastern Brazil. In this study, 155 S. cerevisiae and 60 non-Saccharomyces yeasts were isolated and identified using physiological tests and sequencing of the D1/D2 domains of the large subunit of the rRNA gene. Among the non-Saccharomyces species, Rhodotorula mucilaginosa was the most common species, followed by Pichia kudriavzevii, Candida parapsilosis, Meyerozyma guilliermondii, Wickerhamomyces anomalus, Kloeckera apis, P. manshurica, C. orthopsilosis and C. zemplinina. The population counts of these yeasts ranged among 1.0 to 19 x 10(5) cfu/mL. A total of 155 isolates of S. cerevisiae were compared by mitochondrial DNA restriction analysis, and five molecular mitochondrial DNA restriction profiles were detected. Indigenous strains of S. cerevisiae isolated from grapes of the São Francisco Valley can be further tested as potential starters for wine production.

Acometimento hepático na síndrome sulfona dapsona-induzida durante tratamento de hanseníase / Hepatic involvement in sulfone dapsone-induced syndrome during treatment of leprosy

A hanseníase é uma doença endêmica no Brasil e constitui grave problema de saúde pública. Em números absolutos, o Brasil é o segundo país que mais registra novos casos da doença por ano no mundo. O tratamento da hanseníase compreende: quimioterapia específica, supressão dos surtos reacionais, prevenção de incapacidades físicas, reabilitação física e psicossocial. A síndrome sulfona é uma condição multissistêmica potencialmente grave que pode ocorrer durante o tratamento de algumas dermatoses, entre elas a hanseníase. Relatamos um caso de síndrome de hipersensibilidade à dapsona (SHD) em um paciente masculino, de 32 anos, ocorrida durante o tratamento de hanseníase multibacilar...

Acute kidney injury risk in patients with ST-segment elevation myocardial infarction at presentation to the ED.

INTRODUCTION: Acute kidney injury (AKI) is common in acute myocardial infarction (AMI) patients and has serious prognostic implications. The early identification of patients at risk of developing AKI at the emergency department (ED) can reduce its incidence. METHODS: Patients with ST-segment elevation myocardial infarction (STEMI) at the ED were included. Associated factors playing a role at ED presentation and during hospitalization were collected, and independent risk factors of developing AKI were assessed. RESULTS: Mean age among patients (n = 406, 69.7% male) was 62.5 ± 12.5 years. At ED admission, the mean glomerular filtration rate (GFR) was 70.5 ± 28.1 mL/min per 1.73 m(2), and 140 (34.5%) patients had a GFR <60 mL/min per 1.73 m(2). Eighty-three patients (20.4%) developed AKI: 47 (11.6%) with stage 1, 26 (6.4%) with stage 2 and 10 (2.5%) with stage 3. Mortality was 11.8% and was higher in patients with AKI (34.9% vs 5.9%, P < .0001). Univariate analysis disclosed age, reduced GFR at presentation, severe Killip class, heart rate and longer door-to-needle time as risk factors to develop AKI. Moreover, these patients received less ß-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the ED. Multivariate analysis revealed that age, Killip class, heart rate, door-to-needle time, and ß-blocker non-use were independent factors associated with AKI. These factors provided the ED physician with good accuracy in identifying patients at high risk of developing AKI. CONCLUSION: Factors associated with AKI in STEMI patients allowed physicians to identify patients at high risk in the ED. Moreover, reduced door-to-needle time and ß-blocker use were associated with renal protection in AMI patients.