Situational diagnosis of the popular use of medicinal plants in pediatrics / Diagnóstico situacional do uso popular de plantas medicinais em pediatria

Abstract This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.

Resumo O objetivo deste estudo foi descrever o uso de plantas medicinais para alívio e tratamento de patologias em pediatria realizado por pais de crianças cadastradas em uma Unidade Básica de Saúde. Trata-se de um estudo transversal, observacional e analítico, que ocorreu nos meses de março a maio de 2016, com a participação de 176 indivíduos, utilizando como instrumento de investigação um questionário semiestruturado. Para análise dos dados aplicou-se a estatística descritiva, com uso da distribuição de frequências e o teste do qui-quadrado. Das 177 indicações de uso medicinal de plantas na infância, considerando a parte da planta utilizada e sua forma de uso, 61,6% convergiram com os dados científicos, 21,5% divergiram e 16,9% foram novas indicações, sem registro semelhante na literatura. Esses resultados, ao mesmo tempo em que respaldam o uso popular de plantas medicinais, apontam a necessidade de maior conscientização sobre o uso racional da fitoterapia e estimulam a investigação científica, pois trazem novos elementos sobre o potencial terapêutico de diferentes espécies.

Situational diagnosis of the popular use of medicinal plants in pediatrics.

This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.

IDO, COX and iNOS have an important role in the proliferation of Neospora caninum in neuron/glia co-cultures.

Central nervous system (CNS) is the main site for encystment of Neospora caninum in different animal species. In this tissue, glial cells (astrocytes and microglia) modulate responses to aggression in order to preserve homeostasis and neuronal function. Previous data showed that when primary cultures of glial cells are infected with N. caninum, they develop gliosis and the immune response is characterized by the release of TNF and IL-10, followed by the control of parasite proliferation. In order to elucidate this control, three enzymatic systems involved in parasite-versus-host interactions were observed on a model of neuron/glia co/cultures obtained from rat brains. Indoleamine 2,3-dioxygenase (IDO), induced nitric oxide synthase (iNOS) responsible for the catabolism of tryptophan and arginine, respectively, and cycloxigenase (COX) were studied comparing their modulation by respective inhibitors with the number of tachyzoites or the immune response measured by the release of IL-10 and TNF. Cells were treated with the inhibitors of iNOS (1.5 mM L-NAME), IDO (1 mM 1-methyl tryptophan), COX-1 (1 µM indomethacin) and COX-2 (1 µM nimesulide) before infection with tachyzoites of N. caninum (1:1 cell: parasite). After 72 h of infection, immunocytochemistry showed astrogliosis and a significant increase in the number and length of neurites, compared with uninfected co-cultures, while an increase of IL-10 and TNF was verified. N. caninum did not change iNOS activity, but the inhibition of the basal levels of this enzyme stimulated parasite proliferation. Additionally, a significant increase of about 40% was verified in the IDO activity, whose inhibition caused 1.2-fold increase in parasitic growth. For COX-2 activity, infection of cultures stimulated a significant increase in release of PGE2 and its inhibition by nimesulide allowed the parasitic growth. These data indicate that iNOS, IDO and COX-2 control the proliferation of N. caninum in this in vitro model. On the other hand, the release of IL-10 by glia besides modulating the inflammation also allow the continuity of parasitism.

Situational diagnosis of the popular use of medicinal plants in pediatrics

Abstract This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.

Resumo O objetivo deste estudo foi descrever o uso de plantas medicinais para alívio e tratamento de patologias em pediatria realizado por pais de crianças cadastradas em uma Unidade Básica de Saúde. Trata-se de um estudo transversal, observacional e analítico, que ocorreu nos meses de março a maio de 2016, com a participação de 176 indivíduos, utilizando como instrumento de investigação um questionário semiestruturado. Para análise dos dados aplicou-se a estatística descritiva, com uso da distribuição de frequências e o teste do qui-quadrado. Das 177 indicações de uso medicinal de plantas na infância, considerando a parte da planta utilizada e sua forma de uso, 61,6% convergiram com os dados científicos, 21,5% divergiram e 16,9% foram novas indicações, sem registro semelhante na literatura. Esses resultados, ao mesmo tempo em que respaldam o uso popular de plantas medicinais, apontam a necessidade de maior conscientização sobre o uso racional da fitoterapia e estimulam a investigação científica, pois trazem novos elementos sobre o potencial terapêutico de diferentes espécies.

A space-time model for carbapenemase-producing Klebsiella pneumoniae (KPC) cluster quantification in a high-complexity hospital.

A retrospective space-time permutation model with non-Euclidean distance criteria was applied within a high-complexity hospital setting to quantitatively explore cluster patterns of 273 patients infected with or colonized by carbapenemase-producing Klebsiella pneumoniae during 4 years. Results were compared to standard nosocomial active-surveillance methods. Two clusters were identified in the period, suggesting that space-time strategies for cluster quantification within confined environments may be useful.

Phytocannabinoids and epilepsy.

WHAT IS KNOWN AND OBJECTIVE: Antiepileptic drugs often produce serious adverse effects, and many patients do not respond to them properly. Phytocannabinoids produce anticonvulsant effects in preclinical and preliminary human studies, and appear to produce fewer adverse effects than available antiepileptic drugs. The present review summarizes studies on the anticonvulsant properties of phytocannabinoids. METHODS: Literature search using the PubMed database to identify studies on phytocannabinoids and epilepsy. RESULTS AND DISCUSSION: Preclinical studies suggest that phytocannabinoids, especially cannabidiol and cannabidivarin, have potent anticonvulsant effects which are mediated by the endocannabinoid system. Human studies are limited in number and quality, but suggest that cannabidiol has anticonvulsant effects in adult and infantile epilepsy and is well tolerated after prolonged administration. WHAT IS NEW AND CONCLUSION: Phytocannabinoids produce anticonvulsant effects through the endocannabinoid system, with few adverse effects. Cannabidiol and cannabidivarin should be tested in randomized, controlled clinical trials, especially in infantile epileptic syndromes.

Salvinorin a and related compounds as therapeutic drugs for psychostimulant-related disorders.

Pharmacological treatments are available for alcohol, nicotine, and opioid dependence, and several drugs for cannabis-related disorders are currently under investigation. On the other hand, psychostimulant abuse and dependence lacks pharmacological treatment. Mesolimbic dopaminergic neurons mediate the motivation to use drugs and drug-induced euphoria, and psychostimulants (cocaine, amphetamine, and methamphetamine) produce their effects in these neurons, which may be modulated by the opioid system. Salvinorin A is a κ-opioid receptor agonist extracted from Salvia divinorum, a hallucinogenic plant used in magico-ritual contexts by Mazateca Indians in México. Salvinorin A and its analogues have demonstrated anti-addiction effects in animal models using psychostimulants by attenuating dopamine release, sensitization, and other neurochemical and behavioral alterations associated with acute and prolonged administration of these drugs. The objective of the present article is to present an overview of the preclinical evidence suggesting anti-addictive effects of salvinorin A and its analogues.

Scintigraphy in postoperative follow-up of osteosynthesis of the femur with a bridge plate associated with an intramedullary pin in rabbits / Cintilografia no acompanhamento pós-operatório de osteossíntese do fêmur com placa em ponte associada ao pino intramedular em coelhos

The objective of this work was to monitor the consolidation of the femur after osteosynthesis with a bridge plate associated with the intramedullary pin using scintigraphy. We used seven New Zealand breed male rabbits, at 4 months of age, with a mean weight of 3.5 kg. We performed a three-phase bone scintigraphy with technetium-labeled methylene diphosphonate (99mTc-MDP) before and after surgery, and 20, 50 and 90 days postoperatively. The activity index (AI) was calculated by dividing the average number of uptake counts in the region of the osteotomy by the average number of counts in the corresponding region in the contralateral limb. Radiography was performed before surgery, after surgery, and 15, 30, 45, 60 and 90 days postoperatively. We found a direct relationship between the activity index and progress of bone scintigraphy in the evaluation sequence over the period of observation. Scintigraphy allows monitoring of bone metabolism and measurement of vascularization and/or bone or tissue perfusion. The images obtained in the blood pool and static phases are the most appropriate for assessing bone metabolism in the context of this study. The bridge plate associated with the intramedullary pin promotes osteosynthesis with sufficient stability to allow bone consolidation.

A cintilografia foi empregada no acompanhamento da consolidação de osteotomia experimental do fêmur após osteossíntese com placa em ponte associada ao pino intramedular. Foram usados sete coelhos machos, raça Nova Zelândia, com massa corporal de 3,5kg e idade média de quatro meses. A cintilografia óssea trifásica com metilenodifosfonato marcado com tecnécio-99m (MDP-99mTc) foi obtida antes e após a cirurgia, e nos dias 20, 50 e 90 do pós-operatório.O índice de atividade (IA) foi calculado por meio do quociente da média do número de contagens na região da osteotomia pela média do número de contagens na região correspondente, no membro contralateral normal. Paralelamente ao estudo cintilográfico, foram realizadas radiografias antes dos procedimentos cirúrgicos e aos 15, 30, 45, 60 e 90 dias após, para acompanhamento do processo de cura óssea. Encontrou-se relação direta entre o índice de atividade e a evolução do processo de consolidação óssea na avaliação cintilográfica sequencial ao longo do período de observação. A cintilografia óssea trifásica permite acompanhar o metabolismo ósseo, avaliar e mensurar a vascularização e perfusão tecidual. As imagens obtidas na fase de pool sanguíneo e na fase óssea são as mais adequadas para avaliação do metabolismo ósseo. A placa em ponte associada com o pino intramedular promove osteossíntese com estabilidade suficiente para permitir a consolidação ossea.

A new record of whale shark Rhincodon typus in Brazilian waters: a report of association with Caranx crysos.

In May 2011, a Rhincodon typus was sighted on the continental shelf of the central Brazilian coast, in the vicinity of a gas platform. During the video record, an interspecific following association was observed between a Caranx crysos school and the R. typus.

Single-balloon enteroscopy for treating Roux-en-Y choledochojejunostomy stenosis after liver transplantation: a case report.

Endoscopic treatment of biliary tract complications after Roux-en-Y surgery is still a challenge. With balloon enteroscopy, we can reach previously inaccessible areas changing the management of biliopancreatic diseases in patients with surgically altered anatomy. We report a case of single-balloon enteroscopy plus endoscopic retrograde cholangiopancreatography for the treatment of a pinpoint stricture in a hepaticojejunal anastomosis after liver transplantation.

Tumor cytotoxicity of leucurolysin-B, a P-III snake venom metalloproteinase from Bothrops leucurus

Although it has been demonstrated that venoms and toxins from some snakes are able to influence the growth of tumor cells, few antitumoral compounds from Bothrops leucurus venom have been characterized. Leucurolysin-B (leuc-B) is a metalloproteinase class P-III isolated from B. leucurus which possesses an ECD-disintegrin domain. Both ECD-disentegrin and RGD-disintegrin are able to bind to cell surface integrins and inhibit their adherence to their natural ligands. In the present study, the potential efficacy and the cytotoxic effects of leuc-B on glioblastoma, breast cancer and melanoma cell lines were analyzed. The effect of leuc-B on cancer cell survival was evaluated and its 50 percent inhibitory concentration (IC50) was determined. Morphological alterations were monitored by contrast phase and fluorescent microscopy. The results demonstrated that leuc-B has potent cytotoxic effect in a micromolar range against all evaluated cancer cell lines. Morphologically, dying cells showed fragmentation, condensation of their contents concomitant with shrinkage and appearance of vacuoles. This study reports for the first time the cytotoxic effect of leuc-B from B. leucurus snake venom on tumor cells.

Reef fish structure and distribution in a south-western Atlantic Ocean tropical island.

The community structure of the reef fish fauna of Trindade Island, a volcanic oceanic island located 1160 km off the coast of Brazil, is described based on intensive visual censuses. Seventy-six species were encountered in 252 censuses, with mean ± S.E. of 99 ± 3 individuals and 15.7 ± 0.3 species 40 m(-2) transect. The average fish biomass, calculated from length-class estimation, was 22.1 kg 40 m(-2) transect. The species contributing most to biomass were, in decreasing order, Melichthys niger, Cephalopholis fulva, Kyphosus spp., Holocentrus adscensionis, Sparisoma amplum, Sparisoma axillare, Acanthurus bahianus and Epinephelus adscensionis. Carnivorous fishes were the largest trophic group in terms of biomass, followed by omnivores and roving herbivores. The two predominant types of reef habitat, fringing reefs built by coralline algae and rocky reefs made of volcanic boulders, showed significant differences in the biomass and the abundance of the trophic guilds. Within each habitat type, significant differences in species richness, density and biomass were detected among crest, slope and interface zones. Although similar in overall species composition to coastal reefs in Brazil, the fish fauna of Trindade Island shares certain characteristics, such as a high abundance of planktivores, with other Brazilian oceanic islands. Despite comparatively high fish biomass, including the macro-carnivorous species habitually targeted by fisheries, signs of overfishing were evident. These findings highlight the urgency for a conservation initiative for this isolated, unique and vulnerable reef system.

Liver transplantation in bearers of hepatitis B associated or not with delta hepatitis in the age of the new antiviral drugs: is hyperimmune globulin still necessary?

Hepatitis B (HBV) is a public health problem worldwide; one-third of the population has already been in contact with HBV, and 350 million people are chronic carriers of virus. The appearance of hyperimmune gamma globulin and antiviral drugs has allowed that group to undergone hepatic transplantation, achieving satisfactory results to prevent a relapse. But the use of hyperimmune gamma globulin has an extremely high cost, and combined therapies with new antiviral drugs seem to be a therapeutic alternative. We analyzed 21 patients with hepatitis B associated or not with Delta hepatitis over a mean follow-up period of 19.5 months, concluding that use of only nucleotide analogues has sufficient to achieve satisfactory results.

Crotalus durissus terrificus venom as a source of antitumoral agents

The basic knowledge on neoplasms is increasing quickly; however, few advances have been achieved in clinical therapy against tumors. For this reason, the development of alternative drugs is relevant in the attempt to improve prognosis and to increase patients' survival. Snake venoms are natural sources of bioactive substances with therapeutic potential. The objective of this work was to identify and characterize the antitumoral effect of Crotalus durissus terrificus venom (CV) and its polypeptide, crotoxin, on benign and malignant tumors, respectively, pituitary adenoma and glioblastoma. The results demonstrated that CV possess a powerful antitumoral effect on benign (pituitary adenoma) and malignant (glioblastoma multiforme) tumors with IC50 values of 0.96 ± 0.11 µg/mL and 2.15 ± 0.2 µg/mL, respectively. This antitumoral effect is cell-cycle-specific and dependent on extracellular calcium, an important factor for crotoxin phospholipase A2 activity. The CV antitumoral effect can be ascribed, at least partially, to the polypeptide crotoxin that also induced brain tumor cell death. In spite of the known CV nephrotoxicity and neurotoxicity, acute treatment with its antitumoral dose established in vitro was not found to be toxic to the analyzed animals. These results indicate the biotechnological potential of CV as a source of pharmaceutical templates for cancer therapy.

Effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in Santo Daime members.

The use of the hallucinogenic brew ayahuasca, obtained from infusing the shredded stalk of the malpighiaceous plant Banisteriopsis caapi with the leaves of other plants such as Psychotria viridis, is growing in urban centers of Europe, South and North America in the last several decades. Despite this diffusion, little is known about its effects on emotional states. The present study investigated the effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in members of the Santo Daime, an ayahuasca-using religion. Standard questionnaires were used to evaluate state-anxiety (STAI-state), trait-anxiety (STAI-trait), panic-like (ASI-R) and hopelessness (BHS) in participants that ingested ayahuasca for at least 10 consecutive years. The study was done in the Santo Daime church, where the questionnaires were administered 1h after the ingestion of the brew, in a double-blind, placebo-controlled procedure. While under the acute effects of ayahuasca, participants scored lower on the scales for panic and hopelessness related states. Ayahuasca ingestion did not modify state- or trait-anxiety. The results are discussed in terms of the possible use of ayahuasca in alleviating signs of hopelessness and panic-like related symptoms.

Molecular characterization of a neutralizing murine monoclonal antibody against Tityus serrulatus scorpion venom.

Monoclonal antibodies (mAbs) against Tityus serrulatus venom were obtained by the fusion of SP2/0 murine myeloma cells and spleen cells from BALB/c mice immunized with a toxic fraction (TstFG50) of the Tityus venom (this G50 chromatography fraction represents most of the toxicity of the crude venom) conjugated to bovine serum albumin (BSA) with glutaraldehyde. From the initial screening of over 200 hybridoma fusion wells, a panel of 9 anti-TstFG50 secreting hybridomas was established. The capacity of mAbs to neutralize the TstFG50 toxic fraction toxic was determined by in vitro neutralization assays and by inhibition of the binding of 125I-TsVII to its site on rat brain synaptosomes. Only mAbTs1 neutralized 50% of the toxic effects produced by scorpion venom and showed 35% inhibition of the binding of 125I-TsVII at 10(-7) M. To map the epitope recognized by the protective mAbTs1, we prepared a comprehensive series of overlapping 15-mer synthetic peptides covering the amino acid sequences of the four Tityus proteins. MAbTs1 reacted with peptide 26 of TsIV (KKSKDKKADSGYSYW), peptide 30 of TsVII (KKGSSGYSAWPASYS) and peptide 31 of TsNTxP (KKGSSGYSAWPASYS). MAbTs1 was not reactive with any peptide from TsII. The N-terminal lysine residue from the epitope was found to be critical for mAbTs1 binding. The epitope was positioned on the available three-dimensional structure of TsVII together with the recently identified residues from the pharmacophore of beta-scorpion toxins. The neutralizing properties of mAbTs1 might be explained by spatial vicinity of epitope residues with pharmacophore residues.

Fulminant hepatic failure: Wilson's disease or autoimmune hepatitis? Implications for transplantation.

Fulminant hepatic failure (FHF) accounts for 10-15% of pediatric liver transplants in the USA annually. Because the onset of FHF may be the first presentation of Wilson's disease (WD) and autoimmune hepatitis (AIH) in previously asymptomatic adolescents, determination of the etiology of FHF is critical as treatment and prognosis differ between these two entities. Patients with AIH may be salvaged by medical treatment. On the contrary, liver transplantation is currently the only life saving therapeutic option available for patients with WD who present with fulminant liver failure. To establish the diagnosis of WD and AIH in the setting of FHF remains challenging for diagnosticians and decisions regarding liver transplantation may be necessary before a diagnosis is firmly established. We report a previously asymptomatic patient who presented with FHF and clinical and laboratory features suggestive of both WD and AIH and who underwent successful therapeutic liver transplantation before the diagnosis of WD could be confirmed.

The relationship between child temperament and early childhood caries.

PURPOSE: Among the potential risk factors associated with nursing caries/baby bottle tooth decay--a subset of Early Childhood Caries (ECC)--is a "strong-tempered" behavioral style in the child. However, the few empirical studies that have investigated this description remain controversial. The research goal of this study was to operationalize the "strong-tempered" profile and investigate its association to parental feeding practices and ECC levels. METHODS: In an observational-correlational study design, 58 children (ASA I), ages 18 to 70 months (M = 43 months, SD = 17), were reliably assessed for ECC levels by a clinical evaluator. A second evaluator, blind to ECC status, interviewed parents using a demographic survey, a feeding practices measure, and the EAS Temperament Survey for Children. RESULTS: Multiple regression analyses indicated that none of the four temperament factors (Emotionality, Activity, Sociability, and Shyness) significantly predicted duration of feeding habit defined as the length of time in months that the child breast or bottle fed, whichever lasted the longest. However, the combination of greater duration of feeding habit and higher levels of Shyness predicted all three measures of ECC: the presence or absence of caries (r2 = .19, P < .001), the number of carious teeth (r2 = .23, P < .001) and the number of carious surfaces (r2 = .21, P < .001). Furthermore, the addition of Native status significantly increased the predictive value of all of three models (r2 = .37, r2 = .43, r2 = .29, respectively, Ps < .0001). CONCLUSION: Temperament did not predict the duration of feeding habit but together, shyness and duration of feeding habit was associated with ECC.

Binding sites and actions of Tx1, a neurotoxin from the venom of the spider Phoneutria nigriventer, in guinea pig ileum.

Tx1, a neurotoxin isolated from the venom of the South American spider Phoneutria nigriventer, produces tail elevation, behavioral excitation and spastic paralysis of the hind limbs after intracerebroventricular injection in mice. Since Tx1 contracts isolated guinea pig ileum, we have investigated the effect of this toxin on acetylcholine release, as well as its binding to myenteric plexus-longitudinal muscle membranes from the guinea pig ileum. [125I]-Tx1 binds specifically and with high affinity (Kd = 0.36 +/- 0.02 nM) to a single, non-interacting (nH = 1.1), low capacity (Bmax 1.1 pmol/mg protein) binding site. In competition experiments using several compounds (including ion channel ligands), only PhTx2 and PhTx3 competed with [125I]-Tx1 for specific binding sites (K0.5 apparent = 7.50 x 10(-4) g/l and 1.85 x 10(-5) g/l, respectively). PhTx2 and PhTx3, fractions from P. nigriventer venom, contain toxins acting on sodium and calcium channels, respectively. However, the neurotoxin PhTx2-6, one of the isoforms found in the PhTx2 pool, did not affect [125I]-Tx1 binding. Tx1 reduced the [3H]-ACh release evoked by the PhTx2 pool by 33%, but did not affect basal or KCl-induced [3H]-ACh release. Based on these results, as well as on the homology of Tx1 with toxins acting on calcium channels (omega-Aga IA and IB) and its competition with [125I]-omega-Cono GVIA in the central nervous system, we suggest that the target site for Tx1 may be calcium channels.