Advanced technologies in water treatment: Chitosan and its modifications as effective agents in the adsorption of contaminants.

Chitosan, derived from the abundant biopolymer chitin, has emerged as a promising option for water treatment due to its intrinsic bioavailability. This review emphasizes the notable characteristics of chitosan, which allow for various modifications, expanding its applications. The polymer's effectiveness in adsorbing contaminants, particularly in advanced water treatment technologies, is highlighted. The review underscores the potential of chitosan-based hybrid materials, including nanocomposites, hydrogels, membranes, films, sponges, nanoparticles, microspheres, and flakes, as innovative alternatives to traditional chemical-based adsorbents. The advantages of using these materials in wastewater treatment, especially in removing heavy metals, dyes, and emerging compounds, are explored. The study delves into the mechanisms involved in wastewater treatment with chitosan, emphasizing the interactions between the polymer and various contaminants. Additionally, the application of chitosan as a contaminant removal agent in a post-pandemic context is addressed, considering the challenges related to waste management and environmental preservation. The analysis highlights the potential contribution of chitosan in mitigating environmental impacts post-pandemic, offering practical solutions for treating contaminated effluents and promoting sustainability. The study addresses current obstacles and prospects for chitosan-based wastewater treatment, emphasizing its promising role in sustainable water management.

Geochemistry and the optics of geospatial analysis as a preposition of water quality on a macroscale.

The water treatment depends exclusively on the identification of residues containing toxic chemical elements accumulated in NPs (nanoparticles), and ultrafine particles sourced from waste piles located at old, abandoned sulfuric acid factories containing phosphogypsum requires global attention. The general objective of this study is to quantify and analyze the hazardous chemical elements present in the leachate of waste from deactivated sulfuric acid factories, coupled in NPs and ultrafine particles, in the port region of the city of Imbituba, Santa Catarina, Brazil. Samples were collected in 2020, 2021, and 2022. Corresponding images from the Sentinel-3B OLCI satellite, taken in the same general vicinity, detected the levels of absorption coefficient of Detritus and Gelbstoff (ADG443_NN) in 443 m-1, chlorophyll-a (CHL_NN (m-3)), and total suspended matter (TSM_NN (g m-3) at 72 points on the marine coast of the port region. The results of inductively coupled plasma atomic-emission spectrometry (ICP-AES) and inductively coupled plasma mass spectrometry (ICP-MS) demonstrate that the leaching occurring in waste piles at the port area of Imbituba was the likely source of hazardous chemical elements (e.g., Mg, Sr, Nd, and Pr) in the environment. These leachates were formed due to the presence of coal pyrite and Fe-acid sulfates in said waste piles. The mobility of hazardous chemical elements potentiates changes in the marine ecosystem, in relation to ADG443_NN (m-1), CHL_NN (m-3), and TSM NN (g m-3), with values greater than 20 g m-3 found in 2021 and 2022. This indicated changes in the natural conditions of the marine ecosystem up to 30 km from the coast in the Atlantic Ocean, justifying public initiatives for water treatment on a global scale.

New and effective cassava bagasse-modified biochar to adsorb Food Red 17 and Acid Blue 9 dyes in a binary mixture.

A promissory technic for reducing environmental contaminants is the production of biochar from waste reuse and its application for water treatment. This study developed biochar (CWb) and NH4Cl-modified biochar (MCWb) using cassava residues as precursors. CWb and MCWb were characterized and evaluated in removing dyes (Acid Blue 9 and Food Red 17) in a binary system. The adsorbent demonstrated high adsorption capacity at all pH levels studied, showing its versatility regarding this process parameter. The equilibrium of all adsorption experiments was reached in 30 min. The adsorption process conformed to pseudo-first-order kinetics and extended Langmuir isotherm model. The thermodynamic adsorption experiments demonstrated that the adsorption process is physisorption, exhibiting exothermic and spontaneous characteristics. MCWb exhibited highly efficient and selective adsorption behavior towards the anionic dyes, indicating maximum adsorption capacity of 131 and 150 mg g-1 for Food Red 17 and Acid Blue 9, respectively. Besides, MCWb could be reused nine times, maintaining its original adsorption capacity. This study demonstrated an excellent adsorption capability of biochars in removing dyes. In addition, it indicated the recycling of wastes as a precursor of bio composts, a strategy for utilization in water treatment with binary systems. It showed the feasibility of the reuse capacity that indicated that the adsorbent may have many potential applications.

Development of a biosponge based on Luffa cylindrica and crosslinked chitosan for Allura red AC adsorption.

A new bioadsorbent from Luffa cylindrica and cross-linked chitosan was proposed in the present study. Luffa was used as a natural support medium for chitosan crosslinked with glutaraldehyde (LCsG) and epichlorohydrin (LCsE). Biosponges were applied to remove Allura red from aqueous solutions. LCsG and LCsE were produced using different concentrations of chitosan (1%, 3% and 5% (m v-1)) and crosslinking agents (0.5%, 1.0% and 1.5% (v v-1)). Based on the FT-IR spectra, functional groups characteristic of chitosan crosslinked with glutaraldehyde and epichlorohydrin confirmed the crosslinking. In addition, the biosorbent revealed highly efficient functional groups and morphology with irregularities favorable for adsorption. It was found that the increase in the percentage of glutaraldehyde and epichlorohydrin increased the sample's swelling degree, and the degree of cross-linking was greater than 80% for all LCsG. The results regarding the degree of swelling and degree of crosslinking corroborated with the evaluation of the biosponge's adsorptive potential. The Sips model predicted the equilibrium isotherms, with a maximum adsorption capacity of 89.05 mg g-1 for LCsG and 60.91 mg g-1 for LCsE. The new procedure was successful. Luffa was excellent support for chitosan, resulting in an attractive, low-cost bioadsorbent, preventing renewable sources.

Identification of hazardous nanoparticles present in the Caribbean Sea for the allocation of future preservation projects.

The deposition of remaining nanoparticles in the Caribbean Sea generates the formation of potentially dangerous elements, which influence at the imbalance of ecosystems. The detection of nanoparticles is not simple and the use of conventional methods is difficult application, which is why we highlight the immediacy and importance of this research for the areas of marine biology, urbanism, engineering and geosciences, applied in the Caribbean Sea. The general objective of this study is to evaluate the use of advanced methods for the determination of toxic nanoparticles, which can directly affect the development of marine organisms in the aquatic ecosystem in waters of the Caribbean Sea, favoring the construction of future international public policies with the elaboration of projects capable of mitigating these levels of contamination. The morphology and structure of nanoparticles were analyzed by emission scanning electron microscope with a high-resolution electron microscope. The nanoparticles smaller than 97 nm were identified in different proportions. The morphological analyses indicated nanoparticles' presence in the form of nanotubes, nanospheres, and nanofibers, which were shown in an agglomerated form. The presence of potentially hazardous elements, such as As, Cd, Pb, Mg, Ni and V were verified. In addition, the presence of asbestos in the form of minerals was confirmed, and that of titanium dioxide was found in large quantities. The results provide new data and emphasize the possible consequences to the in the Caribbean Sea, with the identification of dangerous elements (As, Cb, Pb, Hg, Ni and V), harmful to the marine ecosystem. Therefore, there is a need for strict control to reduce contamination of the Caribbean Sea and avoid risks to the ecosystem and public health, through suggestions of international public policies, through constant monitoring and the application of environmental recovery projects in this marine estuary.

Chitin-psyllium based aerogel for the efficient removal of crystal violet from aqueous solutions.

A new alternative aerogel was prepared from low-cost chitin and psyllium biopolymers to adsorb crystal violet (CV) dye from liquid media and possibly treat effluents containing other dyes. The aerogel was characterized by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM), which demonstrated that aerogel has a typical structure of amorphous materials and presented a randomly interconnected porous structure that resembles an open pore network. 2.5 g L-1 of aerogel was able to remove 86.00% of CV from solutions, and the natural pH of the CV solution was considered the more adequate for adsorption. The pseudo-second-order (PSO) model satisfactorily described the adsorption kinetics, and the Freundlich model was suitable to represent the adsorption equilibrium. The maximum experimental capacity achieved was 227.11 mg g-1, which indicates that aerogel is very efficient and competitive with several adsorbents. Tests using a simulated effluent showed that aerogel has excellent potential to treat real colored effluents.

Soil contamination in Colombian playgrounds: effects of vehicles, construction, and traffic.

The presence of potentially hazardous elements (PHEs) in playground soils is generally associated with anthropogenic sources such as vehicle traffic, industries, construction sites, and biomass burning. Studies indicate that PHEs are harmful to human health and may even be carcinogenic. Therefore, the aim of this study was to evaluate the physicochemical, morphological, and mineralogical properties of soil samples from three public playgrounds located in the cities of Bogota, Medellin, and Barranquilla. Besides, the possible impacts caused by the aerodynamics of particles in Colombian cities were verified. The morphology, composition, and structure of the nanoparticles (NPs) (< 100 nm) present in these soils were evaluated by field emission scanning electron microscopy (FE-SEM) equipped with high-precision field emission (FE) and high-resolution transmission electron microscopy (HR-TEM). Soil samples were predominantly feldspar, quartz, and, to a lesser extent, clay minerals, carbonates, and hematites. The average content of PHEs was anthropogenically enriched in relation to the upper continental crust. As and Sn showed a large spatial variation, indicating the influence of local sources, such as vehicle traffic and industries. There is an inverse relationship between the total concentrations of some elements and their leachable fractions. The accumulation of traffic-derived PHEs has a negative impact on human health and the environment, which is alarming, especially for elements such as Pb, Sb, or As. Therefore, the presence of PHEs should receive greater attention from public health professionals, and limits should be set and exposures controlled. This study includes the construction of a baseline that provides basic information on pollution, its sources, and exposure routes for humans in the vicinity of Colombia's major cities, characterized by their increasing urbanization and industrialization.

Metagenomic analysis reveals mechanisms of atrazine biodegradation promoted by tree species.

Metagenomics has provided the discovery of genes and metabolic pathways involved in the degradation of xenobiotics. Some microorganisms can metabolize these compounds, potentiating phytoremediation in association with plant. This study aimed to study the metagenome and the occurrence of atrazine degradation genes in rhizospheric soils of the phytoremediation species Inga striata and Caesalphinea ferrea. The genera of microorganisms predominant in the rhizospheric soils of I. striata and C. ferrea were Mycobacterium, Conexibacter, Bradyrhizobium, Solirubrobacter, Rhodoplanes, Streptomyces, Geothrix, Gaiella, Nitrospira, and Haliangium. The atzD, atzE, and atzF genes were detected in the rhizospheric soils of I. striata and atzE and atzF in the rhizospheric soils of C. ferrea. The rhizodegradation by both tree species accelerates the degradation of atrazine residues, eliminating toxic effects on plants highly sensitive to this herbicide. This is the first report for the species Agrobacterium rhizogenes and Candidatus Muproteobacteria bacterium and Micromonospora genera as atrazine degraders.

Identification of mercury and nanoparticles in roots with different oxidation states of an abandoned coal mine.

The morphology and composition of roots with different degrees of oxidation as a function of time were evaluated aiming to identify possible hazardous elements and nanoparticles. The roots were obtained from an abandoned coal mine located in the city of Criciúma, Santa Catarina, Brazil. From the roots, analyses were performed to identify nanoparticles (NPs) and ultrafine particles (UFPs), containing possible hazardous elements (PHEs) that cause potential environmental risks and impacts on human health. The identification of nanoscale materials requires greater robustness, so advanced integrated techniques have been used. The characterization of different types of roots was done by using focused ion beam (FIB), to evaluate nano-compound assemblies with high-resolution transmission electron microscopy/energy dispersive spectroscopy (HR-TEM/EDS). The results showed the presence of NPs containing Hg, Co, Cr, Ni, and V. The presence of these elements has increased consistently with the increase of C concentration in the roots, suggesting that the PHEs were gradually released from organic matter and inorganic minerals of coal. However, even with their decrease in roots, it was found that these elements still remained in the soil in significant quantities, even after 15 years of inactivation of the coal mine.

Solid wastes from the enzyme production as a potential biosorbent to treat colored effluents containing crystal violet dye.

Sugarcane bagasse, a largely available waste worldwide, was submitted to solid-state fermentation (SSF) using the fungus Metarhizium anisopliae, aiming to produce enzymes. The solid waste generated from SSF was tested as an alternative biosorbent to treat colored effluents containing crystal violet (CV) dye. The biosorbent, here named BW (bagasse waste), was characterized, and experimental tests were performed to verify the influence of pH and dosage on the CV biosorption. Isotherms and biosorption kinetics were performed, and the biosorption thermodynamic parameters were determined. The potential of BW was also evaluated for the treatment of a simulated textile effluent. The maximum biosorption capacity was 131.2 mg g-1 at 328 K, and the Liu was the most appropriate model to represent equilibrium data. The biosorption was spontaneous and endothermic. The use of BW in the simulated effluent showed that it is an efficient material, reaching color removal values of 85%. Therefore, the sugarcane bagasse generated from SSF can be considered a potential biosorbent to remove CV from textile effluents. This finding is relevant from the total environment viewpoint, since, at the same time, SSF generates enzymes and a solid waste, which in turn can be used as biosorbent to treat colored effluents.

Removal of fluoride from fertilizer industry effluent using carbon nanotubes stabilized in chitosan sponge.

Adsorption of fluoride from fertilizer industry effluent using carbon nanotubes stabilized in chitosan sponge as adsorbent was evaluated. The effluent was produced in the washing of acid gases during the reaction in fertilizer production and all assays were performed using this hazardous material. Adsorbent characterization and ions interactions were elucidated from differential scanning calorimetry, thermal gravimetric analyses, X-ray diffraction, scanning electron microscopy dispersive energy X-ray spectroscopy, atomic force microscopy and X-ray photoelectron spectroscopy. The effluent presented pH 3 and its value not changed in the adsorption assays, maintaining the conditions of the process. The kinetics assays of fluoride from industry effluent were performed in different stirring rates from 100 to 300 rpm. It was observed that adsorption was initially fast reaching the equilibrium at 300 rpm in 20 min. The adsorption capacity was around 975.4 mg g-1, showing the potential of the hybrid material to remove fluoride from a real matrix. The high adsorption capacity was attributed to the chitosan functional groups and the high interaction area promoted by sponge form and the carbon nanotube. Reuse and regeneration of the CNT-CS were investigated and 5 cycles were obtained. The adsorption capacity kept similar values in all cycles.

The Blockade of TACE-Dependent EGF Receptor Activation by Losartan-Erlotinib Combination Attenuates Renal Fibrosis Formation in 5/6-Nephrectomized Rats Under Vitamin D Deficiency.

Chronic kidney disease (CKD) has been considered a major public health issue. In addition to cardiovascular diseases and infections, hypovitaminosis D has been considered a non-traditional aggravating factor for CKD progression. Interstitial fibrosis is a hallmark of CKD strongly correlated with deterioration of renal function. Transforming growth factor ß (TGF-ß) is the major regulatory profibrotic cytokine in CKD. Many injurious stimuli converge on the TGF-ß pathway, which has context-dependent pleiotropic effects and interacts with several related renal fibrosis formation (RFF) pathways. Epidermal growth factor receptor (EGFR) is critically involved in CKD progression, exerting a pathogenic role in RFF associated with TGF-ß-related fibrogenesis. Among others, EGFR pathway can be activated by a disintegrin and a metalloproteinase known as tumor necrosis factor α-converting enzyme (TACE). Currently no effective therapy is available to completely arrest RFF and slow the progression of CKD. Therefore, we investigated the effects of a double treatment with losartan potassium (L), an AT1R antagonist, and the tyrosine kinase inhibitor erlotinib (E) on the alternative pathway of RFF related to TACE-dependent EGFR activation in 5/6-nephrectomized rats under vitamin D deficiency (D). During the 90-day protocol, male Wistar rats under D, were submitted to 5/6 nephrectomy (N) on day 30 and randomized into four groups: N+D, no treatment; N+D+L, received losartan (50 mg/kg/day); N+D+E, received erlotinib (6 mg/kg/day); N+D+L+E received losartan+erlotinib treatment. N+D+L+E data demonstrated that the double treatment with losartan+erlotinib not only blocked the TACE-dependent EGF receptor activation but also prevented the expression of TGF-ß, protecting against RFF. This renoprotection by losartan+erlotinib was corroborated by a lower expression of ECM proteins and markers of phenotypic alteration as well as a lesser inflammatory cell infiltrate. Although erlotinib alone has been emerging as a renoprotective drug, its association with losartan should be considered as a potential therapeutic strategy on the modulation of RFF.

Influence of 2,4-D residues on the soil microbial community and growth of tree species.

The 2,4-D (2,4-dichlorophenoxyacetic acid) has low half-life in the soil, but it is capable of altering the soil microbial community. The objective of this study was to evaluate the influence of 2,4-D residues on the structure of the soil microbial community and the growth of tree species. The tolerance and phytoremediation potential of tree species were evaluated. The microbial analysis was performed by T-RFLP. The 2,4-D herbicide reduced the plant height of K. lathrophyton, number of leaves of C. ferrea and K. lathrophyton and root dry matter allocation for C. brasiliense, I. striata, P. heptaphyllum, and T. guianensis. Cucumis sativus intoxication on soil contaminated with 2,4-D was not significant. The structure of Fungi community in the rhizospheric soils of C. ferrea was altered. The herbicide 2,4-D increased the diversity of Fungi in rhizospheric soils of P. heptahyllum and R. grandis. Most tree species were tolerant, and the evaluation time was sufficient to remedy 2,4-D. The structures of the microbial communities Archaea, Bacteria, and Fungi were little influenced by 2,4-D. The diversity of the Archaea domain was not affected, the diversity of the Bacteria in Inga striata decreased while the fungi increased in Protium heptaphyllum and Richeria grandis with 2,4-D.

Chitosan hydrogel scaffold modified with carbon nanotubes and its application for food dyes removal in single and binary aqueous systems.

This work developed one promising adsorbent based on chitosan hydrogel scaffold modified with carbon nanotubes, for food dye removal in single and binary aqueous systems. The modified hydrogel scaffold was characterized in relation to the gel strength, swelling degree, surface attributes, and infrared spectrum. Adsorption isotherms were performed using dyes, food red 17 (FdR17) and food blue 1 (FdB1), in single and binary aqueous systems. The experimental data were adjusted to the Langmuir model and the thermodynamic parameters were estimated. The kinetic behavior was evaluated and, desorption studies were performed to verify the reuse capacity of the modified hydrogel scaffold. The results showed that maximum adsorption capacities were of 1508 and 1480 mg g-1 for the single system and of 955 and 902 mg g-1 for the binary system, for FdB1 and FbR17, respectively. The thermodynamic parameters indicated that the adsorption was the spontaneous, exothermic and favorable process. The model that best represented the kinetic data was that of Avrami. In desorption, the adsorbent can be used until four times and maintaining the adsorption capacity of the adsorbent in 71% of the initial capacity.

Gene expression analysis identifies hypothetical genes that may be critical during the infection process of Xanthomonas citri subsp. citri

Background: Gene expression analysis via microarray is widely used in phytobacteria to validate differential gene expression associated with virulence or to compare biological profiles of wild type and mutant strains. Here, we employed DNA microarrays to study the early stages of the infection process (24, 72 and 120 h post-inoculation) of Xanthomonas citri subsp. citri (Xac) infecting Citrus sinensis to interrogate the expression profiles of hypothetical genes. Results: Under infective conditions, 446 genes were up- and 306 downregulated. Outstanding among genes upregulated during infection were those involved in synthesizing the Type 3 Secretion System and effectors, xanthan gum and quorum-sensing induction, and flagellum synthesis and regulation. Additionally, 161 hypothetical genes were up- and 100 were downregulated, 49 of which are known to have a significant biological role. To understand hypothetical gene co-regulation or -expression, nine expression profiles including 158 genes were identified during the three infection phases. Of these, 47 hypothetical genes were identified as having expression profiles associated with at least one connected to a gene associated with adaptation and virulence. Conclusions: Expression patterns of six differentially expressed genes were validated by quantitative reverse transcription polymerase chain reaction, thus demonstrating the effectiveness of this tool in global gene expression analysis in Xac.

Separation of anthocyanins extracted from red cabbage by adsorption onto chitosan films.

Anthocyanin pigments are suitable as natural dyes for food, cosmetics and dietary supplements, due to the demand for healthier products and their antioxidant properties. This work aimed to extract the anthocyanin pigments from red cabbage and its separation of the solution by adsorption operation onto chitosan films. The anthocyanin was extracted from red cabbage in water hot at 90 °C by 15 min. Chitosan was obtained from shrimp waste, and its films were produced by casting technique (tensile strength of 25.1 ±â€¯1.9 MPa, elongation of 10.5 ±â€¯3.5% and thicknesses of 103.1 ±â€¯1.3 µm). The anthocyanin adsorption assays were performed in batch, and the highest adsorption capacity was around 140 mg g-1. The equilibrium experimental data were adjusted by Henry, Langmuir and Freundlich models, and all models showed a good fitting (R2 ≥ 0.96 and ARE ≤ 6.5%). The thermodynamic parameters represented endothermic and physical adsorption. The kinetic behavior was evaluated by empirical models, being the pseudo-first order model that showed the best fitting (R2 ≥ 0.97 and ARE ≤ 8.5%). This work presented suitable information about the anthocyanin molecules immobilization onto chitosan films and, these results could be important to the use these pigments with chitosan in different areas.

Synthesis of a bio-based polyurethane/chitosan composite foam using ricinoleic acid for the adsorption of Food Red 17 dye.

A novel bio-based polyurethane/chitosan foam (PU/chitosan) was synthesized using a polyol derived from castor oil and applied to remove Food Red 17 dye (FR17) from aqueous solutions. PU/chitosan foam presented better characteristics and adsorption potential than polyurethane foam (PU). PU/chitosan foam showed a semi-crystalline structure, with several functional groups, high porosity and good mechanical properties. These characteristics are adequate for adsorptive separations. Using identical adsorption conditions, PU/chitosan was able to remove >98% of FR17 dye from the solution, while, PU removed only 40%. The adsorption of FR17 on PU/chitosan composite foam was favored at pH 2. Pseudo-second order model was the most adequate to represent the kinetic data. The equilibrium data followed the Sips model, with a maximum adsorption capacity of 267.24 mg g-1. The adsorption process was spontaneous, favorable and endothermic. The results showed that polyurethane foams are capable to support chitosan, generating an adsorbent with better mechanical characteristics and high potential to remove anionic dyes from aqueous media.

Vitamin D Deficiency Aggravates the Renal Features of Moderate Chronic Kidney Disease in 5/6 Nephrectomized Rats.

The pathogenesis of chronic kidney disease (CKD) involves a very complex interaction between hemodynamic and inflammatory processes, leading to glomerular/vascular sclerosis, and fibrosis formation with subsequent evolution to end-stage of renal disease. Despite efforts to minimize the progression of CKD, its incidence and prevalence continue to increase. Besides cardiovascular diseases and infections, several studies demonstrate that vitamin D status could be considered as a non-traditional risk factor for the progression of CKD. Therefore, we investigated the effects of vitamin D deficiency (VDD) in the course of moderate CKD in 5/6 nephrectomized rats (Nx). Adult male Wistar rats underwent Sham surgery or Nx and were subdivided into the following four groups: Sham, receiving standard diet (Sham); Sham VDD, receiving vitamin D-free diet (VDD); Nx, receiving standard diet (Nx); and VDD+Nx, receiving vitamin D-free diet (VDD+Nx). Sham or Nx surgeries were performed 30 days after standard or vitamin D-free diets administration. After validation of vitamin D depletion, we considered only Nx and VDD+Nx groups for the following studies. Sixty days after surgeries, VDD+Nx rats exhibited hypertension, a greater decline in renal function and plasma FGF-23 levels, renal hypertrophy, as well as higher plasma levels of PTH and aldosterone. In addition, those animals presented more significant chronic tubulointerstitial changes (cortical interstitial expansion/inflammation/fibrosis), higher expression of collagen IV, fibronectin and α-smooth muscle actin, and lower expressions of JG12 and M2 macrophages. Also, VDD+Nx rats had greater infiltration of inflammatory cells (M1 macrophages and T-cells). Such changes were accompanied by higher expression of TGF-ß1 and angiotensinogen and decreased expression of VDR and Klotho protein. Our observations indicate that vitamin D deficiency impairs the renal function and worsens the renovascular and morphological changes, aggravating the features of moderate CKD in 5/6 nephrectomized rats.

Estenose valvular aórtica e o uso de TAVI: revisão narrativa das evidências publicadas e avaliação básica de custos / Aortic valve stenosis and the use of TAVI: narrative review of published evidences and basic costs assessment

Objetivo: Revisar as evidências clínicas da estenose valvular aórtica em suas dimensões médica e econômica, analisando as alternativas de tratamento cirúrgico em pacientes de alto risco cirúrgico com foco na tecnologia do implante transcateter de válvula aórtica (TAVI). Métodos: Foi elaborada uma revisão narrativa das publicações relacionadas à estenose vascular aórtica e às metodologias de tratamento cirúrgico, assim como a comparação entre a metodologia TAVI e as abordagens convencionais (substituição cirúrgica de válvula aórtica por esternotomia, valvuloplastia por balão intra-aórtico e tratamento farmacológico), abordando ainda dados sobre algumas diferentes marcas e gerações de dispositivos de TAVI oferecidas no mercado brasileiro, avaliando a eficácia, a segurança e o custo de tratamento. Resultados: Em pacientes portadores de estenose aórtica grave sintomática e inoperáveis pela abordagem convencional, o uso do TAVI mostrou ser uma alternativa mais segura, eficaz e econômica em comparação aos tratamentos convencionais. Estudos com robustez metodológica mostram que esse procedimento alcança taxas superiores a 80% de sobrevida em um ano e aproximadamente 30% em cinco anos, mesmo em pacientes de alto risco. No entanto, foram observadas diferenças significativas nos desfechos entre diferentes estudos, que podem ser atribuídas não apenas ao desenho e à amostragem, mas às diferenças entre as diversas opções de gerações e marcas de dispositivos para TAVI disponíveis no mercado. Essas opções diferem principalmente na estrutura, via de inserção e modo de expansão. As válvulas de terceira geração vêm apresentando os melhores resultados em termos de eficácia, segurança e facilidade no procedimento, que resultam em mais benefícios aos pacientes e equilibram os custos de tratamento em médio e longo prazos. Conclusões: Estudos com evidências robustas avaliando desfechos representativos para o tratamento da estenose aórtica grave e sintomática mostram que a tecnologia minimamente invasiva TAVI é eficaz, segura no tratamento de pacientes de alto risco ou inoperáveis, com melhorias significativas nos dispositivos de terceira geração.

Objective: To review the clinical evidences of aortic valve stenosis in its medical and economical settings, reviewing the surgical treatment alternatives in patients at high surgical risk focused on the transcatheter aortic valve implantation (TAVI) technology. Methods: A structured review of the publications related to the disease and to the surgical treatment methodologies was conducted, followed by a search for information about the TAVI methodology, with comparisons between this method and conventional approaches (surgical aortic valve replacement by means of sternotomy, valvuloplasty via intra-aortic balloon and pharmacological treatment) and comparisons between different brands and generations of TAVI devices, evaluating the treatment efficacy, safety and cost. Results: In patients with severe symptomatic aortic stenosis who cannot be operated using the conventional approach, the use of TAVI was shown to be a safer, more effective and more economical alternative compared to the conventional treatments. The studies of the best methodology show that this is a safe, effective and curative procedure, reaching rates above 80% in 1-year survival and of approximately 30% in 5-year survival, even in patients at high risk. However, significant differences in the outcomes among different studies were observed, which may be attributed to the design and sampling as well as to the differences among the several options of TAVI devices available on the market. These options differ in structure, insertion route, expansion mode and in the several generations of valves. Third-generation valves have been presenting the best results in terms of efficacy, safety and procedure easiness, which result in more benefits to patients and balance the medium-term and long-term treatment cost. Conclusions: The most robust studies evaluating the TAVI valves show that this minimally invasive technology is effective and safe for the treatment of severe symptomatic aortic stenosis in patients at high risk or who cannot be operated.

Factors that lead to the use of crack cocaine in combination with marijuana in Brazil: a qualitative study.

BACKGROUND: In Brazil, crack cocaine use remains a healthcare challenge due to the rapid onset of its pleasurable effects, its ability to induce craving and addiction, and the fact that it is easily accessible. Delayed action on the part of the Brazilian Government in addressing the drug problem has led users to develop their own strategies for surviving the effects of crack cocaine use, particularly the drug craving and psychosis. In this context, users have sought the benefits of combining crack cocaine with marijuana. Our aim was to identify the reasons why users combine crack cocaine with marijuana and the health implications of doing so. METHODS: The present study is a qualitative study, using in-depth interviews and criteria-based sampling, following 27 crack cocaine users who combined its use with marijuana. Participants were recruited using the snowball sampling technique, and the point of theoretical saturation was used to define the sample size. Data were analyzed using the content analysis technique. RESULTS: The interviewees reported that the combination of crack cocaine use with marijuana provided "protection" (reduced undesirable effects, improved sleep and appetite, reduced craving for crack cocaine, and allowed the patients to recover some quality of life). CONCLUSIONS: Combined use of cannabis as a strategy to reduce the effects of crack exhibited several significant advantages, particularly an improved quality of life, which "protected" users from the violence typical of the crack culture. Crack use is considered a serious public health problem in Brazil, and there are few solution strategies. Within that limited context, the combination of cannabis and crack deserves more thorough clinical investigation to assess its potential use as a strategy to reduce the damage associated with crack use.