Adalimumab for the Treatment of Non-Infectious Uveitis: A Real Life Experience.

OBJECTIVE: To describe the efficacy and safety of adalimumab for the treatment of non-infectious uveitis (NIU) in four Uveitis Units from tertiary Spanish hospitals. METHODS: Multicenter and retrospective clinical cohort study including all patients with NIU treated with adalimumab from January 2012 to October 2022 in four uveitis units was performed. Efficacy was measured with the number of relapses, ocular inflammation and reduction in immunosuppression and corticosteroid dosage before and after adalimumab use. We collected data regarding adverse effects and examined the immunogenicity of adalimumab. RESULTS: One hundred and twenty-two patients (59% females), with a mean age of 48.6 years (SD = 14.8) accounting for 217 eyes were included. The majority (92.6%) were Caucasian. Uveitis analyzed were predominantly panuveitis (34.7%), bilateral (77.9%), acute (41.5%), and non-granulomatous (90%). Most of them were immune mediated (42.6%), and the main reason to initiate adalimumab was refractory disease (96.7%). The analysis was statistically significant due to the reduction in the number of immunosuppressive drugs as well as the dose of oral corticosteroids and the number of relapses during follow-up (p < 0.001). The decrease in ocular inflammation parameters and the improvement in visual acuity (p < 0.05) were also significant. There were no deaths due to the drug and only one reported case of serious infection. In total, 10.9% of 73 patients tested developed anti-adalimumab antibodies and 4.1% lupus-like. CONCLUSIONS: We consider adalimumab as a leading drug in the treatment of NIU with high safety and efficacy.

Evaluation of brushing efficiency in reducing oral microbiota in mechanically ventilated patients admitted to an intensive care unit.

Background: Patients admitted to the Intensive Care Unit (ICU) are at greater risk of developing nosocomial infections due to their investigations, treatment and changes in the immune system. One of the most prevalent nosocomial infections is respiratory tract infection, such as hospital acquired pneumonia and ventilator-associated pneumonia (VAP). The bacteria commonly found in the oral cavity in the hospital environment are Streptococcus viridians, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., and Klebsiella pneumoniae. There is a need to test and define appropriate standard protocols for oral hygiene in patients undergoing mechanical ventilation in ICUs through the intervention of a dental specialist, preventing the proliferation of microorganisms into the respiratory tract, thus reducing hospitalization time, the use of antibiotics, and increased morbidity/mortality. Objective: This study aimed to evaluate the effectiveness of dental brushing in the reduction of the pathogenic buccal microbiota associated with mechanical ventilation in patients admitted to the Evangelical Hospital from Londrina, Paraná, Brazil. Methodology: The sample consisted of 90 patients (of both sexes), mean age of 65 years, under mechanical ventilation by orotracheal tube and tracheostomized patients, without suspected or confirmed diagnosis of pneumonia. Patients were randomized ∗∗∗. Results: Results showed that oral hygiene using a toothbrush by suction, with chlorhexidine gel 0.12% (Group B), was more effective than conventional hygiene using gauze soaked with chlorhexidine 0.12% (Group A) in reducing pathogenic buccal microbiota. Conclusions: There was a reduction of the pathogenic buccal microbiota in mechanically ventilated patients receiving oral hygiene using a toothbrush by suction with chlorhexidine gel 0.12% (Group B).

Identification of bioactive metabolites from corn silk extracts by a combination of metabolite profiling, univariate statistical analysis and chemometrics.

Corn silk has been widely used as a nutritional and medicinal supplement due to its pharmacological properties, but there is a lack of studies that correlate the extracts' chemical composition with their biological activities. Herein, we performed the large-scale chemical characterization of corn silk extracts and used chemometrics to correlate the chemical composition with the biological activities of the extracts. Twenty-two metabolites were identified by High-Performance Liquid Chromatography coupled to Mass Spectrometry (HPLC-MS), whereas twelve were identified by Gas Chromatography coupled to Mass Spectrometry (GC-MS). Chemometrics allowed us to discriminate extracts obtained in different organic solvents from in natura and commercial product samples and to pinpoint potential candidate metabolites for the antioxidant and anti-glioma activities. Two flavone glycosides (7 and 8), along with a O-methylated anthocyanidin (26) seems to be the main contributors for the biological activities of the corn silk extracts.

Combination of a multiplatform metabolite profiling approach and chemometrics as a powerful strategy to identify bioactive metabolites in Lepidium meyenii (Peruvian maca).

Lepidium meyenii is an edible plant that has been used as a nutritional supplement worldwide due to its medicinal properties. However, most of the studies have focused on the pharmacological activities of the extracts rather than their chemical composition. Herein, we used a combination of a multiplatform metabolite profiling approach and chemometrics to identify bioactive metabolites in L. meyenii. Extracts obtained with ethyl acetate and ethanol showed the promising antioxidant, anti-glioma and antibacterial activities. Sixty metabolites were identified by HPLC-MS, whereas fifteen were identified by GC-MS. Partial least squares discriminant analysis (PLS-DA), hierarchical cluster analysis (HCA), and Variable Importance in Projection (VIP) successfully discriminated extracts obtained in different organic solvents from in natura dry roots and commercial product samples of L. meyenii. Additionally, correlation analysis allowed us to pinpoint potential candidates responsible for each biological activity tested for the extracts, which could be extrapolate for other food-related species.

Atención odontológica a damnificados del terremoto 16 de abril de 2016: impacto en la formación de estudiantes de odontología / Dental care to the victims of the earthquake on April 16, 2016: impact on the formation of dental students

Introducción: los estudiantes y profesores de la carrera de Odontología desarrollaron un proceso de atención a los albergados del terremoto del 16A en Manabí Ecuador. Objetivos: identificar las necesidades de atención odontológica, valorar el grado de consolidación de las competencias profesionales y fomentar valores en el marco de la actividad formativa de los estudiantes. Métodos: se realizó un estudio descriptivo de corte transversal con los estudiantes y pacientes involucrados. Los estudiantes realizaron un diagnóstico de necesidades odontológicas y brindaron atención requerida. Se realizó una encuesta diseñada para valorar el grado de consolidación de las competencias profesionales de los estudiantes. Resultados: la población pediátrica representó el 43 por ciento, la adulta el 57 por ciento El COP-D en población adulta fue de 8,6, el ceo-d fue de 1,56, el índice de higiene oral simplificado fue 1,42. El 60 por ciento de los tratamientos en la población adulta fueron restauraciones, en edad pediátrica se realizaron 344 tratamientos. El 67 por ciento consideró muy útil la consolidación de sus competencias especialmente en el diagnóstico y en actividades de periodoncia. Conclusiones: los estudiantes brindaron atención odontológica a la población albergada después del terremoto e identificaron sus necesidades de salud, lo que permitió fortalecer áreas de competencias, valores de solidaridad, responsabilidad y humanismo(AU)

Introduction: The students and professors of the Dental Surgery major developed a process of attention to the victims of the April 16 earthquake in Manabí Ecuador. Objectives: To identify the needs of dental care, to assess the degree of consolidation of professional skills and to promote values ​​within the framework of the training activity of students. Methods: A descriptive, cross-sectional study was conducted with the students and patients involved. The students made a diagnosis of the dental needs and provided the required attention. A survey was conducted, as designed to assess the degree of consolidation of students' professional competences.Results: The pediatric population represented 43 percent and the adult population, 57 percent. The COP-D in the adult population was 8.6, the CEO-D was 1.56, the simplified oral hygiene index was 1.42. 60 percent of the treatments in the adult population were restorations, in pediatric age there were 344 treatments. 67 percent of the participants considered it very useful to consolidate their skills, especially in diagnosis and periodontal activities. Conclusions: The students provided dental care to the population sheltered after the earthquake and identified their health needs, which allowed to strengthen areas of competence, values ​​of solidarity, responsibility and humanism(AU)

Atención odontológica a damnificados del terremoto 16 de abril de 2016: impacto en la formación de estudiantes de odontología / Dental care to the victims of the earthquake on April 16, 2016: impact on the formation of dental students

Introducción: los estudiantes y profesores de la carrera de Odontología desarrollaron un proceso de atención a los albergados del terremoto del 16A en Manabí Ecuador. Objetivos: identificar las necesidades de atención odontológica, valorar el grado de consolidación de las competencias profesionales y fomentar valores en el marco de la actividad formativa de los estudiantes. Métodos: se realizó un estudio descriptivo de corte transversal con los estudiantes y pacientes involucrados. Los estudiantes realizaron un diagnóstico de necesidades odontológicas y brindaron atención requerida. Se realizó una encuesta diseñada para valorar el grado de consolidación de las competencias profesionales de los estudiantes. Resultados: la población pediátrica representó el 43 por ciento, la adulta el 57 por ciento El COP-D en población adulta fue de 8,6, el ceo-d fue de 1,56, el índice de higiene oral simplificado fue 1,42. El 60 por ciento de los tratamientos en la población adulta fueron restauraciones, en edad pediátrica se realizaron 344 tratamientos. El 67 por ciento consideró muy útil la consolidación de sus competencias especialmente en el diagnóstico y en actividades de periodoncia. Conclusiones: los estudiantes brindaron atención odontológica a la población albergada después del terremoto e identificaron sus necesidades de salud, lo que permitió fortalecer áreas de competencias, valores de solidaridad, responsabilidad y humanismo(AU)

Introduction: The students and professors of the Dental Surgery major developed a process of attention to the victims of the April 16 earthquake in Manabí Ecuador. Objectives: To identify the needs of dental care, to assess the degree of consolidation of professional skills and to promote values ​​within the framework of the training activity of students. Methods: A descriptive, cross-sectional study was conducted with the students and patients involved. The students made a diagnosis of the dental needs and provided the required attention. A survey was conducted, as designed to assess the degree of consolidation of students' professional competences.Results: The pediatric population represented 43 percent and the adult population, 57 percent. The COP-D in the adult population was 8.6, the CEO-D was 1.56, the simplified oral hygiene index was 1.42. 60 percent of the treatments in the adult population were restorations, in pediatric age there were 344 treatments. 67 percent of the participants considered it very useful to consolidate their skills, especially in diagnosis and periodontal activities. Conclusions: The students provided dental care to the population sheltered after the earthquake and identified their health needs, which allowed to strengthen areas of competence, values ​​of solidarity, responsibility and humanism(AU)

Stimulation of the Po-shen and Shen-hun scalp-acupuncture bands modifies levels of inhibitory and excitatory amino acids in the immature rat brain.

OBJECTIVE: In the present study, the effect of stimulation of the Po-shen and Shen-hun scalp-acupuncture bands on tissue amino acid concentrations in several brain regions in awake and pentobarbital-sedated immature rats was evaluated. MATERIALS AND METHODS: Sprague-Dawley rats (aged 15 days) were organized in four groups of at least eight animals: control groups received saline solution 0.9% or sodium pentobarbital at 30mg/kg dosage via intraperitoneal. Experimental groups received saline solution or sodium pentobarbital plus stimulation in Po-shen and Shen-hun scalp-acupuncture bands for one continuous hour during 10 sessions by using scalp-acupuncture. RESULTS: As compared to rats receiving saline solution, scalp-acupuncture produced significant changes in amino acid concentrations, depending on the analyzed region, as follows: in inhibitory amino acids, a GABA increase was observed in amygdala and hippocampus (491 and 184%, respectively), but a decrease in the substantia nigra (80%); glycine showed decrease in all the analyzed regions, except for an increase in brainstem(78%); glutamine presented an increase in hippocampus and cortex (42 and 149%, respectively). In the case of excitatory amino acids, glutamate decreased in all the analyzed regions; whereas aspartate decreased in substantia nigra and brainstem (77.08 and 35%, correspondingly) but increased in hippocampus and cortex (32 and 54%, respectively). The combined treatment of scalp-acupuncture and a GABAergic depressant drug like pentobarbital resulted in almost all changes induced in amino acids for scalp-acupuncture alone being significantly reverted. CONCLUSION: Stimulation of the Po-shen and Shen-hun scalp-acupuncture bands by using scalp-acupuncture alone might produce depressant activity by changes in amino acids, but the combination with a GABAergic tranquilizer like sodium pentobarbital can interfere with this response.

[Evolution of socioeconomic inequalities in infant and child mortality in Brazil, 1993-20]. / Evolução das desigualdades socioeconômicas na mortalidade infantil no Brasil, 1993-2008.

In Brazil, infant and child mortality reveal a downward trend. Few studies have investigated the temporal trends in the inequalities of these deaths, at individual level, according to socio-economic status. The scope of this article was to investigate the temporal trends of the magnitude of inequalities in infant and child mortality, between groups defined by maternal education and household income per capita in the 1993-2008 period in Brazil. Microdata from the National Household Sample Survey were used. The inequality measure was the concentration index (CI). It was calculated for infant and child deaths, according to maternal education and household income per capita. During the 2003-2008 period, there was a reduction in inequalities in infant and child mortality, at individual level, and according to maternal education and household income per capita. In 2008, the concentration of child deaths among children whose mothers had less education was higher than the concentration of infant deaths. The CI according to income had greater variability, but also demonstrated a lower concentration of deaths at the end of the period. The measurement of inequalities in health is important for monitoring the population health situation.

Evolução das desigualdades socioeconômicas na mortalidade infantil no Brasil, 1993-2008 / Evolution of socioeconomic inequalities in infant and child mortality in Brazil, 1993-20

No Brasil, a mortalidade infantil e na infância apresentam tendência decrescente. Poucos estudos investigaram a evolução temporal das desigualdades socioeconômicas nesses óbitos, no nível individual. O objetivo foi investigar a evolução temporal da magnitude das desigualdades na mortalidade infantil e na infância, segundo a escolaridade materna e a renda domiciliar per capita, no período 1993-2008, no Brasil. Foram utilizados microdados das Pesquisas Nacionais por Amostra de Domicílios (PNAD). A medida de desigualdade empregada foi o índice de concentração (IC), calculado para os óbitos infantis e na infância, segundo escolaridade materna e renda domiciliar per capita. No período de 1993 a 2008, houve redução das desigualdades na mortalidade infantil e na infância, no nível individual, segundo a escolaridade materna e a renda domiciliar per capita. Em 2008, a concentração dos óbitos na infância entre crianças cujas mães tinham menor escolaridade era maior do que a concentração dos óbitos infantis. Os IC segundo a renda apresentaram maior variabilidade, mas também demonstraram menor concentração dos óbitos ao final do período. A medição das desigualdades em saúde é importante para o acompanhamento da situação de saúde da população.

In Brazil, infant and child mortality reveal a downward trend. Few studies have investigated the temporal trends in the inequalities of these deaths, at individual level, according to socio-economic status. The scope of this article was to investigate the temporal trends of the magnitude of inequalities in infant and child mortality, between groups defined by maternal education and household income per capita in the 1993-2008 period in Brazil. Microdata from the National Household Sample Survey were used. The inequality measure was the concentration index (CI). It was calculated for infant and child deaths, according to maternal education and household income per capita. During the 2003-2008 period, there was a reduction in inequalities in infant and child mortality, at individual level, and according to maternal education and household income per capita. In 2008, the concentration of child deaths among children whose mothers had less education was higher than the concentration of infant deaths. The CI according to income had greater variability, but also demonstrated a lower concentration of deaths at the end of the period. The measurement of inequalities in health is important for monitoring the population health situation.

In situ and laboratory bioassays using Poecilia reticulata Peters, 1859 in the biomonitoring of an acidic lake at Camaçari, BA, Brazil.

The suitability and viability of acute in situ bioassays were investigated in the biomonitoring program of an acidic lake contaminated with sulphur residues. Responses of organisms observed in laboratory and in situ bioassays were also assessed to determine whether or not they were similar and comparable, regarding accuracy and precision. Newborn Poecilia reticulata were employed as test organisms and exposed to the same water samples under in situ and laboratory conditions. Mortality/immobility was the endpoint assessed and dead/immobile organisms were counted at various time intervals during exposure. The mean calculated LT50 values and 95% confidence intervals were 1.61 (1.36-1.87) h in the laboratory bioassays and 0.72 (0.55-0.89) h in the in situ bioassays. Statistical comparison of these values revealed a significant difference (p<0.05). In situ bioassays were more accurate than those carried out in the laboratory, demonstrating higher sensitivity and better reproduction of what occurs in nature, while laboratory bioassays were more precise.

Compras federais de medicamentos da assistência farmacêutica: evidências recentes

Este trabalho apresenta alguns resultados investigados no âmbito do projeto O uso do poder de compra do governo federal na área de saúde: análise das compras públicas de medicamentos e sugestões de seu aperfeiçoamento. Foi analisada a evolução das compras de medicamentos realizadas pelo Ministério da Saúde para os programas de assistência farmacêutica sob sua responsabilidade, no período de 2005 a 2008. Buscou-se, mesmo que preliminarmente, avaliar a eficiência das compras de medicamentos selecionados, definindo-se eficiência como "redução de custo por mesma quantidade de unidades farmacêuticas adquiridas"