Nitrogenous compounds in the saliva and blood of cirrhotic patients: a cross-sectional study.

OBJECTIVES: Serum increase of nitrogenous compounds (NC) in cirrhotic patients has been associated with the development of hepatic encephalopathy (HE). However, the relation between NC in saliva and HE is unclear. The objective of this study is to measure the levels of nitric oxide and urea in the blood and saliva in 38 cirrhotic patients and correlate them with clinical characteristics and presence and grades of HE. MATERIAL AND METHODS: Automated enzymatic colourimetric assays were performed to determine the levels of NC. Diagnosis and severity of HE were determined based on the West Haven criteria and by using the inhibitory control test. RESULTS: HE was diagnosed in 89.47% of the patients, with the majority (60.50%) presenting covert HE. With regard to the measurement of NC, although nitric oxide is moderately correlated with its amount in blood and saliva (r = 0.630; P < 0.001), only salivary levels were associated with the presence of ascites and ecchymosis (P = 0.013 and P = 0.030, respectively). In patients with HE, the serum levels of urea were higher (P = 0.013) than those in patients without HE or minimal HE. CONCLUSIONS: Nitrogenous compounds in the saliva were correlated with neither the presence nor grades of HE, whereas in the blood, only urea was positively correlated with the severity and presence of HE. CLINICAL RELEVANCE: Saliva is an excellent fluid for diagnosing several diseases, but it does not seem to be able to collaborate with the identification of HE.

Assessment of bone metabolism biomarkers in serum and saliva of cirrhotic patients.

OBJECTIVE: To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs. MATERIALS AND METHODS: Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1ß, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used. RESULTS: Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 ß (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI. CONCLUSION: RANKL, OPG, IL-1ß, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI. CLINICAL RELEVANCE: This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

Plant Spices as a Source of Antimicrobial Synergic Molecules to Treat Bacterial and Viral Co-Infections.

The COVID-19 pandemic exposed the lack of antiviral agents available for human use, while the complexity of the physiological changes caused by coronavirus (SARS-CoV-2) imposed the prescription of multidrug pharmacotherapy to treat infected patients. In a significant number of cases, it was necessary to add antibiotics to the prescription to decrease the risk of co-infections, preventing the worsening of the patient's condition. However, the precautionary use of antibiotics corroborated to increase bacterial resistance. Since the development of vaccines for COVID-19, the pandemic scenario has changed, but the development of new antiviral drugs is still a major challenge. Research for new drugs with synergistic activity against virus and resistant bacteria can produce drug leads to be used in the treatment of mild cases of COVID-19 and to fight other viruses and new viral diseases. Following the repurposing approach, plant spices have been searched for antiviral lead compounds, since the toxic effects of plants that are traditionally consumed are already known, speeding up the drug discovery process. The need for effective drugs in the context of viral diseases is discussed in this review, with special focus on plant-based spices with antiviral and antibiotic activity. The activity of plants against resistant bacteria, the diversity of the components present in plant extracts and the synergistic interaction of these metabolites and industrialized antibiotics are discussed, with the aim of contributing to the development of antiviral and antibiotic drugs. A literature search was performed in electronic databases such as Science Direct; SciELO (Scientific Electronic Library Online); LILACS (Latin American and Caribbean Literature on Health Sciences); Elsevier, SpringerLink; and Google Scholar, using the descriptors: antiviral plants, antibacterial plants, coronavirus treatment, morbidities and COVID-19, bacterial resistance, resistant antibiotics, hospital-acquired infections, spices of plant origin, coronaviruses and foods, spices with antiviral effect, drug prescriptions and COVID-19, and plant synergism. Articles published in English in the period from 2020 to 2022 and relevant to the topic were used as the main inclusion criteria.

Do dental implants installed in different types of bone (I, II, III, IV) have different success rates? A systematic review and meta-analysis.

Purpose: The objective of this systematic review and meta-analysis was to evaluate the survival rate of implants installed in bone type IV (Lekholm and Zarb, 1995) compared to that of implants installed in bone types I, II, and III. Material and methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO International Database of Systematic Reviews (CRD42021229775). The PubMed/MEDLINE, Scopus, and Cochrane databases were searched through July 2021. The PICO question was: "Dental implants installed in type IV bone have a lower success rate when compared to implants installed in type I bone, II and III?". The established inclusion criteria were: 1) controlled and randomized clinical trials (RCT), 2) prospective and retrospective studies with at least 10 participants with dental implants, and 3) patients with dental implants installed in bone tissue types I, II, III, and IV (Lekholm and Zarb, 1985). The minimum followup duration was 1 year. Results: After searching the identified databases, 117 articles were selected for full reading and 68 were excluded. Thus, 49 studies were included for qualitative and quantitative analyses. The total number of participants included was 12,056, with a mean age of 41.56 years and 29,905 implants installed. Bone types I, II, and III exhibit a lower implant failure rate when compared to bone type IV. Conclusion: Dental implants installed in bone types I, II, and III showed significantly higher survival rates than those installed in type IV. The bone type I success rate was not significantly different than that of type II; however, the success rate of bone type I and II was higher than that of type III.

Safety of Empagliflozin: An Individual Participant-Level Data Meta-Analysis from Four Large Trials.

INTRODUCTION: Empagliflozin is a sodium-glucose co-transporter-2 inhibitor used to treat type 2 diabetes (T2D) to improve glycemic control, reduce risk of cardiovascular death in patients with T2D, and treat patients with symptomatic chronic heart failure (HF) and chronic kidney disease (CKD). The safety profile of empagliflozin is well documented, although adverse events (AEs) remain of interest to clinicians. This study provides an up-to-date safety evaluation of empagliflozin. METHODS: Data were pooled from four long-term trials which included: patients with T2D and established cardiovascular disease (EMPA-REG OUTCOME), patients with HF, with/without diabetes (EMPEROR-Reduced and EMPEROR-Preserved), and patients with CKD, with/without diabetes (EMPA-KIDNEY). Since three of the four trials evaluated empagliflozin 10 mg, the meta-analysis was restricted to this dose. RESULTS: Total trial medication exposure was 19,727 patient-years for patients who received empagliflozin (n = 10,472) and 19,447 patient-years for placebo (n = 10,461). The percentages of patients with serious AEs, fatal AEs, and AEs leading to discontinuation were similar for both groups. The incidences of serious urinary tract infection and serious pyelonephritis or urosepsis were similar for both groups but higher for women taking empagliflozin versus placebo. Serious genital infections were not increased with empagliflozin versus placebo. There was a slight increase in ketoacidosis and serious volume depletion in patients who received empagliflozin versus placebo. The occurrence of serious acute kidney injury was lower with empagliflozin versus placebo. Empagliflozin was not associated with an increased incidence of severe hypoglycemia, bone fractures, or lower limb amputations. Empagliflozin is therefore considered safe in people without diabetes, the elderly, patients with very low estimated glomerular filtration rate, low body mass index, and HF. Safety is unaltered by blood pressure, concomitant medication for hypertension, HF, and immunosuppression. CONCLUSION: This meta-analysis of long-term safety data extends current knowledge and confirms the safety and tolerability of empagliflozin.

Empagliflozin is used in adults with type 2 diabetes mellitus (T2D) to improve blood glucose control and in people with T2D and established cardiovascular disease to reduce the risk of death from cardiovascular disease. Also, it is used to treat people with chronic heart failure or chronic kidney disease. Although many clinical trials have shown the effectiveness and safety of empagliflozin, the evaluation of adverse events (AEs) remains of interest. This study further examined the safety of empagliflozin by analyzing four large, long-term clinical trials. These trials included over 20,900 patients with T2D and established cardiovascular disease, patients with heart failure, and patients with chronic kidney disease. Adverse events of interest were pooled and analyzed. Results show the risk of the investigated AEs was similar whether patients had received empagliflozin or placebo. The risk of urinary tract infections, including those that spread to the kidneys, was higher for women taking empagliflozin versus placebo. Ketoacidosis was rare but more frequent in patients taking empagliflozin. A reduction in blood volume was slightly more frequent in people taking empagliflozin versus placebo. The risk of kidney injury was reduced in patients taking empagliflozin versus placebo. The risk of genital infections, hypoglycemia, bone fractures, or lower limb amputations was not increased with empagliflozin. No new safety concerns were raised, including in people who were elderly, had kidney disease, low body weight, T2D, or heart failure. This analysis is consistent with current knowledge of empagliflozin safety in a broad range of patients.

Improving Accessibility to Patients with Interstitial Lung Disease (ILD): Barriers to Early Diagnosis and Timely Treatment in Latin America.

Delayed initiation of effective antifibrotic therapy in patients with interstitial lung diseases (ILD) may influence the progression and outcome of the disease. This study analyzes the differences in the journey of patients with ILD in the Brazilian and Mexican health systems. An evaluative study was conducted in reference centers for interstitial lung diseases in Brazil and Mexico with a panel of four specialists. The patient's journey in both countries begins when the patient seeks medical care after observing a chronic respiratory symptom. In both countries, due to diagnostic complexity, these patients arrive at ILD referral centers at an advanced stage of the disease. Once diagnosis is established, the treatment onset differs between Mexico and Brazil. In Brazil, access to antifibrotic drugs through the public health system has been a significant challenge, and their cost makes them unaffordable for most people. This situation forces medical specialists to provide only supportive care to patients until these drugs can be accessed. In Mexico, antifibrotics have been available in health sectors since 2018. Brazil and Mexico have several similarities regarding the initial journey of the patient due to diagnosis difficulties. Still, the outcome tends to be different due to a difference in access to treatment with antifibrotics. For this reason, advancing health policies that ensure proper treatment for patients with ILD is crucial for the sustainability and reliability of the health system.

Evaluation of Vitamin D isolated or Associated with Teriparatide in Peri-Implant Bone Repair in Tibia of Orchiectomized Rats.

(1) Background: The objective of this study was to evaluate the morphometry of peri-implant bone tissue in orchiectomized rats, treated with vitamin D isolated or associated with teriparatide. (2) Methods: 24 rats were divided into 4 groups: ORQ-orchiectomy, without drug treatment, ORQ+D-orchiectomy, treated with vitamin D, ORQTERI-orchiectomy, treated with teriparatide and ORQTERI+D-orchiectomy, treated with teriparatide + vitamin D. Each animal received an implant in the tibial metaphysis. Euthanasia occurred 60 days after implant surgery. Computed microtomography (micro-CT) was performed to evaluate the parameters of volume and percentage of bone volume (BV, BV/TV), trabecular thickness (Tb.Th), number and separation of trabeculae (Tb.N, Tb.Sp) and percentage of total porosity (Po-tot). Data were subjected to 1-way ANOVA and Tukey post-test, with a significance level of 5%. (3) Results: For the parameters BV, BV/TV, Tb.Th, the ORQTERI+D group showed the highest values in relation to the other groups and for Po-tot, the lowest values were for ORQTERI+D. For Tb.Sp and Tb.N, there was no statistically significant difference when comparing intragroup results (p > 0.05). (4) Conclusions: It was possible to conclude that treatment with vitamin D associated with teriparatide increases bone volume and improves bone quality.

Impact of DNA repair polymorphisms on DNA instability biomarkers induced by lead (Pb) in workers exposed to the metal.

Although the mechanisms of Pb-induced genotoxicity are well established, a wide individual's variation response is seen in biomarkers related to Pb toxicity, despite similar levels of metal exposure. This may be related to intrinsic variations, such as genetic polymorphisms; moreover, very little is known about the impact of genetic variations related to DNA repair system on DNA instability induced by Pb. In this context, the present study aimed to assess the impact of SNPs in enzymes related to DNA repair system on biomarkers related to acute toxicity and DNA damage induced by Pb exposure, in individuals occupationally exposed to the metal. A cross-sectional study was run with 154 adults (males, >18 years) from an automotive batteries' factory, in Brazil. Blood lead levels (BLL) were determined by ICP-MS; biomarkers related to acute toxicity and DNA instability were monitored by the buccal micronucleus cytome (BMNCyt) assay and genotyping of polymorphisms of MLH1 (rs1799977), OGG1 (rs1052133), PARP1 (rs1136410), XPA (rs1800975), XPC (rs2228000) and XRCC1 (rs25487) were performed by TaqMan assays. BLL ranged from 2.0 to 51 µg dL-1 (mean 20 ± 12 µg dL-1) and significant associations between BLL and BMNCyt biomarkers related to cellular proliferation and cytokinetic, cell death and DNA damage were observed. Furthermore, SNPs from the OGG1,XPA and XPC genes were able to modulate interactions in nuclear bud formation (NBUDs) and micronucleus (MNi) events. Taken together, our data provide further evidence that polymorphisms related to DNA repair pathways may modulate Pb-induced DNA damage; studies that investigate the association between injuries to genetic material and susceptibilities in the workplace can provide additional information on the etiology of diseases and the determination of environmentally responsive genes.

Prognostic Factors in Children and Adolescents with Lymphomas and Vertical Transmission of HIV in Rio de Janeiro, Brazil: A Multicentric Hospital-Based Survival Analysis Study.

Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72-50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02-78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81-12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84-13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76-0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil.

Mannheim's peritonitis index in the prediction of postoperative outcome of peritonitis.

OBJECTIVE: evaluate the effectiveness of MPI to predict mortality in patients with peritonitis in Santa Casa de Misericordia de Vitoria Hospital (HSCMV). METHODS: a longitudinal observational cohort retrospectively study, with a sample of 75 patients diagnosed with peritonitis between January 2010 to December 2 of 2015, in HSCMV and with all the necessary criteria for the calculation of IPM. RESULTS: we found a profile of the patients, 33 female and 42 male, mean age 42 years, 11 deaths and 14.67% mortality percentage. Comparing the MPI variables into two groups (survivors and deceased) was found that older than 50 years, presence of malignancy and patients with organ dysfunction have statistical significance for mortality, with p<0.05. The MPI ranged between 4-41 points, with average of 21.2 points. However, among the dead, the score ranged from 23 to 41, with a mean of 32.8. Therefore, the cutoff point of 27 points was established by evaluating the best value of Kappa concordance index, and through it were calculated: 90.90% sensitivity and specificity of 78.13% by the ROC curve. CONCLUSION: based on these results, it was established that the MPI was effective in estimating the risk of death when the index reaches values = 27 points. Categorizing patients into different risk groups helps in determining a better prognosis and defining operative risk, thus contributing to the choice of the surgical procedure nature.

Incidence and Clinical Description of Lymphomas in Children and Adolescents with Vertical Transmission of HIV in Rio de Janeiro, Brazil, in Pre- and Post-Combined Antiretroviral Therapy Eras: A Multicentric Hospital-Based Survival Analysis Study.

The incidence of cancer in children living with HIV (CLWH) is high and lymphomas are the most common type of cancer in this population. The combined antiretroviral therapy (cART) changed the natural history of HIV infection. To determine the incidence and profile of these CLWH malignancies in Rio de Janeiro (RJ), Brazil, we conducted a retrospective and observational study of vertically infected CLWH, ranging from 0−20 incomplete years, from 1995 to 2018, at five reference centers. The study period was divided into three eras in accordance with the widespread use of cART in Brazil. 1306 patients were included. Of the 25 lymphomas found, 19 were AIDS-defining malignancies (ADM); 6 were non-AIDS-defining malignancies (NADM). The incidence rate (IR) of lymphoma developing was 1.70 per 1000 children-year (95% CI 1.09−2.50). ADM development IR decreased from 2.09−1.75−0.19 per 1000 children-year (p < 0.001) through cART eras. Cumulative Nelson−Aalen hazards of developing ADM over a 20-year period were 3.73% in the Early-cART era, 3.07% in the Mid-cART era, and 0.32% in the Late-cART era (p = 0.013). This study demonstrates the IR of lymphoma in CLWH in RJ, Brazil, as well as the benefit of cART in reducing ADM and death occurrence in the Post-cART era.

Acute Toxicity and DNA Instability Induced by Exposure to Low Doses of Triclosan and Phthalate DEHP, and Their Combinations, in vitro.

Triclosan (TCS) is an antimicrobial agent widely used in personal care products (PCP) and the di-(2-ethyl hydroxy-phthalate) (DEHP) is a chemical compound derived from phthalic acid, used in medical devices and plastic products with polyvinyl chloride (PVCs). As result of their extensive use, TCS and DEHP have been found in the environment and previous studies demonstrated the association between their exposure and toxic effects, mostly in aquatic organisms, but there is a shortage in the literature concerning the exposure of TCS and DEHP in human cells. The aim of the present study was to assess the impact of exposure to TCS and DEHP, as well as their combinations, on biomarkers related to acute toxicity and DNA instability, in HepG2 cells, by use of cytokinesis-block micronucleus cytome (CBMNCyt) assay. For that, the cultures were exposed to TCS, DEHP and combinations at doses of 0.10, 1.0, and 10 µM for the period of 4 h and the parameters related to DNA damage (i.e., frequencies of micronuclei (MN) and nuclear buds (NBUDs), to cell division (i.e., nuclear division index (NDI) and nuclear division cytotoxic index (NDCI) and to cell death (apoptotic and necrotic cells) were scored. Clear mutagenic effects were seen in cells treated with TCS, DEHP at doses of 1.0 and 10 µM, but no combined effects were observed when the cells were exposed to the combinations of TCS + DEHP. On the other hand, the combination of the toxicants significantly increased the frequencies of apoptotic and necrotic cells, as well as induced alterations of biomarkers related to cell viability (NDI and NDCI), when compared to the groups treated only with TCS or DEHP. Taken together, the results showed that TCS and DEHP are also able to induce acute toxicity and DNA damage in human cells.

Association Between miR-148a and DNA Methylation Profile in Individuals Exposed to Lead (Pb).

Experimental and epidemiologic studies have shown that lead (Pb) is able to induce epigenetic modifications, such as changes in DNA methylation profiles, in chromatin remodeling, as well as the expression of non-coding RNAs (ncRNAs). However, very little is known about the interactions between microRNAs (miRNAs) expression and DNA methylation status in individuals exposed to the metal. The aim of the present study was to investigate the impact of hsa-miR-148a expression on DNA methylation status, in 85 workers exposed to Pb. Blood and plasma lead levels (BLL and PLL, respectively) were determined by ICP-MS; expression of the miRNA-148a was quantified by RT-qPCR (TaqMan assay) and assessment of the global DNA methylation profile (by measurement of 5-methylcytosine; % 5-mC) was performed by ELISA. An inverse association was seen between miR-148a and % 5-mC DNA, as a function of BLL and PLL (ß = -3.7; p = 0.071 and ß = -4.1; p = 0.049, respectively) adjusted for age, BMI, smoking, and alcohol consumption. Taken together, our study provides further evidence concerning the interactions between DNA methylation profile and miR-148a, in individuals exposed to Pb.

Can children be affected by bisphosphonate-related osteonecrosis of the jaw? A systematic review.

Knowledge of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is mostly based on adult cases, however bisphosphonates are also currently recommended for different paediatric diseases resulting in osteoporosis. The aim of this study was to review the literature on the risk of developing BRONJ in children and adolescents. The PubMed, LILACS, Web of Science, Scopus, and Cochrane databases were searched using the key words "bisphosphonates", "osteonecrosis", "jaw", and "children". Literature reviews, case reports, abstracts, theses, textbooks, and book chapters were excluded. Studies involving children and young adults (younger than 24 years of age) were included. A total of 56 publications were identified. After applying the eligibility criteria, only seven articles remained. Although no cases of osteonecrosis were identified, all studies had weaknesses such as a limited sample size or the absence of risk factors for the development of osteonecrosis. There is general consensus that this subject should be of concern and that further studies should be conducted before any definitive opinion is reached. It is believed that patients with secondary osteoporosis who use bisphosphonates continuously should be followed up during adulthood, since bone turnover decreases over the years.

Prevalence of sublingual varices in patients with cirrhosis and the correlation with nitrogen compounds.

OBJECTIVE: The aim of this study was to verify the presence and severity of sublingual varices in patients with cirrhosis and the correlation between these varices and nitrogen compounds (i.e., ammonia, urea and nitric oxide) in blood and saliva. STUDY DESIGN: This is a case-control observational study of 52 patients with cirrhosis and 52 normoreactive individuals, aimed at assessing the presence (degrees 0 and 1) and severity (mild, moderate, and severe) of sublingual varices. Medical records of the patients with cirrhosis, including complications of cirrhosis, were also obtained. Blood and saliva were collected to evaluate the presence of nitrogen compounds by means of automated enzymatic colorimetric assays. RESULTS: The cirrhosis group had a higher prevalence (n = 39; 75%) compared with controls (n = 22; 42.3%) as well as higher severity (moderate n = 12 [23.1%]; and severe n = 16 [30.0%]) (P = .001 and P < .001, respectively). Of the 39 patients with cirrhosis and sublingual varices, 84.6% had gastroesophageal varices. No correlations were found between the presence/severity of sublingual varices and cirrhotic complications/nitrogen compounds. CONCLUSIONS: The prevalence and severity of varices were higher in the cirrhosis group, but no correlations between the presence/severity of sublingual varices and nitrogen compounds were found.

Mannheim's peritonitis index in the prediction of postoperative outcome of peritonitis / O índice de peritonite de mannheim na predição do desfecho pós-operatório da peritonite

ABSTRACT Objective: evaluate the effectiveness of MPI to predict mortality in patients with peritonitis in Santa Casa de Misericordia de Vitoria Hospital (HSCMV). Methods: a longitudinal observational cohort retrospectively study, with a sample of 75 patients diagnosed with peritonitis between January 2010 to December 2 of 2015, in HSCMV and with all the necessary criteria for the calculation of IPM. Results: we found a profile of the patients, 33 female and 42 male, mean age 42 years, 11 deaths and 14.67% mortality percentage. Comparing the MPI variables into two groups (survivors and deceased) was found that older than 50 years, presence of malignancy and patients with organ dysfunction have statistical significance for mortality, with p<0.05. The MPI ranged between 4-41 points, with average of 21.2 points. However, among the dead, the score ranged from 23 to 41, with a mean of 32.8. Therefore, the cutoff point of 27 points was established by evaluating the best value of Kappa concordance index, and through it were calculated: 90.90% sensitivity and specificity of 78.13% by the ROC curve. Conclusion: based on these results, it was established that the MPI was effective in estimating the risk of death when the index reaches values = 27 points. Categorizing patients into different risk groups helps in determining a better prognosis and defining operative risk, thus contributing to the choice of the surgical procedure nature.

RESUMO Objetivo: avaliar a efetividade do índice de peritonite de Mannheim (IPM) para predizer mortalidade em pacientes com peritonite no Hospital Santa Casa de Misericórdia de Vitória (HSCMV). Método: Coorte longitudinal, observacional retrospectivo, com amostra de 75 pacientes diagnosticados com peritonite entre janeiro de 2010 a 02 de dezembro de 2015 no HSCMV, com todos os critérios necessários para o cálculo do IPM. Resultados: Encontrou-se um perfil dos pacientes, sendo 33 do sexo feminino e 42 do masculino, idade média de 42 anos, 11 óbitos e percentual de mortalidade de 14,67%. Comparando as variáveis do IPM em dois grupos (sobreviventes e falecidos), constatou-se que idade maior do que 50 anos, presença de malignidade e pacientes com disfunção de órgãos tiveram significância estatística para mortalidade, com p<0,05. O IPM variou entre 4 e 41 pontos, com média de 21,2 pontos. No entanto, entre os falecidos o escore variou de 23 a 41 pontos, com média de 32,8. Sendo assim, foi estabelecido o ponto de corte de 27 pontos através da avaliação do melhor valor do Índice Kappa de concordância, e através dele foram calculados: sensibilidade de 90,90% e especificidade de 78,13% através da curva ROC. Conclusão: Com base nesses resultados, foi visto que o IPM foi eficiente em estimar o risco de morte, sendo esse identificado quando o índice atinge valores = 27 pontos.

Altered neutrophil immunophenotypes in childhood B­cell precursor acute lymphoblastic leukemia.

An increasing number of evidences suggest a genetic predisposition in acute lymphoblastic leukemia (ALL) that might favor the occurrence of the driver genetic alterations. Such genetic background might also translate into phenotypic alterations of residual hematopoietic cells. Whether such phenotypic alterations are present in bone marrow (BM) cells from childhood B-cell precursor (BCP)-ALL remains to be investigated. Here we analyzed the immunophenotypic profile of BM and peripheral blood (PB) maturing/matured neutrophils from 118 children with BCP-ALL and their relationship with the features of the disease. Our results showed altered neutrophil phenotypes in most (77%) BCP-ALL cases. The most frequently altered marker was CD10 (53%), followed by CD33 (34%), CD13 (15%), CD15/CD65 (10%) and CD123 (7%). Of note, patients with altered neutrophil phenotypes had younger age (p = 0.03) and lower percentages of BM maturing neutrophils (p = 0.004) together with greater BM lymphocyte (p = 0.04), and mature B-cell (p = 0.03) counts. No significant association was found between an altered neutrophil phenotype and other disease features. These findings point out the potential existence of an altered residual hematopoiesis in most childhood BCP-ALL cases.

Impact of an interdisciplinary approach in children and adolescents with lower urinary tract dysfunction (LUTD).

INTRODUCTION: The lower urinary tract dysfunction (LUTD) corresponds to changes in the filling or emptying of urine caused by neurogenic, anatomical and functional alterations. OBJECTIVE: To evaluate the impact of treatment in children and adolescents with LUTD. METHODS: Historical cohort of 15 year follow-up with the participation of 192 patients (123F, 69M), aged 0.1 to 16.8 years, analyzed at admission (T0) and at final follow-up (T1). Most patients belong to a neurologic bladder dysfunction group (60.4%). The treatment was uroterapy with behavioral and cognitive intervention, timed voiding, oral hydration, laxative diet, biofeedback, sacral nerve stimulation, clean intermittent catheterization (CIC), anticholinergic therapy, rectal enema, treatment of urinary tract infection (UTI) and, in refractory cases, surgical procedures such as continent and incontinent urinary diversion (vesicostomy), bladder augmentation and conduit for performing antegrade colonic enema. RESULTS: The main symptoms were daytime urinary incontinence (82.3%), the non-monosymptomatic nocturnal enuresis (78.6%), fecal incontinence (54.2%) and constipation (47.9%). There was a significant reduction of urinary tract infection (p = 0.0027), daytime urinary incontinence (p < 0.001), nocturnal enuresis (p < 0.001), fecal incontinence (p = 0.010) and of vesicoureteral reflux (p = 0.01). There was significant increase in the use of CIC (p = 0.021), of anticholinergic therapy (p < 0.001) and decrease of chemoprophylaxis (p < 0.001). CONCLUSION: This study showed that treatment of LUTD in children must be individualized, and requires constant monitoring of clinical, laboratory and imaging to minimize the risk of kidney damage.

Avaliação da saúde bucal de pacientes cirróticos em fila de transplante hepático / Assessment of oral health of cirrhotic patients in liver transplant waiting list / Evaluación de la salud bucal de pacientes cirróticos en la lista de espera de trasplante hepático

Objetivo: Avaliar a saúde bucal de pacientes com cirrose hepática em fila de transplante. Materiais e Método: Foram avaliados 103 pacientes cirróticos quanto às características sócio-demográficas e histórico médico da cirrose hepática (etiologia, tempo de inclusão na fila de transplante, valor do MELD - Model for End-Stage Liver Disease, complicações da cirrose e medicações em uso). A avaliação da saúde oral foi feita através do índice de higiene oral simplificado (IHO-S), do índice de cárie dental (CPOD) e da sialometria. Foram realizadas análises descritivas após a tabulação dos dados. Resultados: A população estudada apresentava idade média de 54 anos, o sexo masculino era o mais prevalente e apenas 44% concluíram o ensino fundamental. Hepatite C e cirrose alcoólica foram as etiologias que, com mais frequência, levaram os pacientes a indicação de transplante hepático. Varizes esofágicas, ascite e hipertensão portal foram as complicações mais frequentes. O CPOD médio da população estudada foi considerado alto (23,3). Conclusão: A saúde bucal de pacientes cirróticos em fila de transplante não é satisfatória. Estudos longitudinais são necessários para investigar a relação entre focos de infecção oral e a ocorrência de infecções no pós-transplante hepático.

Objectives: To assess the oral health of patients waiting for a liver transplantation. Material and Methods: A total of 103 cirrhotic patients were evaluated for socio-demographic characteristics and medical history of liver cirrhosis (etiology, time of inclusion in the transplant list, MELD - Model for End Liver Disease - value, complications of cirrhosis and routine medications in use). In addition, simplified oral hygiene index (IHO-S), dental caries index (DMFT) and sialometry were performed to verify oral health. After tabulation of the data, descriptive analyzes were performed. Results: The mean age was 54 years, the male gender was the most prevalent and the elementary school was completed by only 44% of the studied population. Hepatitis C and alcoholic cirrhosis were the etiologies that, more frequently, led the patients to indication for liver transplantation. Esophageal varices, ascites and portal hypertension were the complications of cirrhosis most observed. The mean DMFT of the studied population was considered high (23.3 ). Conclusions: The oral health of cirrhotic patients in the waiting list for transplantation is not satisfactory. Longitudinal studies are needed to investigate the relationship between foci of oral infections and the occurrence of infections post-transplant liver.

Objetivo: Evaluar la salud bucal de pacientes con cirrosis hepática en fila de trasplante. Material y Métodos: Fueron evaluados 103 pacientes cirróticos en cuanto a las características sociodemográficas e historial médico de cirrosis hepática (etiología, tiempo de inclusión en fila de trasplante, valor del MELD - Model for End-Stage Liver Disease, complicaciones de la cirrosis y medicaciones en uso). Así mismo fueron realizados los siguientes índices para evaluación de la salud bucal: índice de higiene oral simplificado (IHO-S), índice de caries dental (CPOD) y sialometría. Fueron realizados análisis descriptivos después de la tabulación de datos. Resultados: La población estudiada presentaba edad media de 54 años, el sexo masculino era el más prevalente y sólo el 44% concluyeran la educacion fundamental. La hepatitis C y la cirrosis alcohólica fueron las etiologias que con más frecuencia, llevaron a los pacientes a indicación de trasplante hepático. Las complicaciones de la cirrosis más observadas fueron várices esofágicas, ascitis e hipertensión portal. El CPOD medio de la población estudiada fue considerado alto, comparado con personas normoreactivas del mismo grupo etáreo (23,3 y 16,75 respectivamente ). Conclusiones: La salud bucal de pacientes cirroticos en fila de trasplante no es satisfactoria. Estudios longitudinales son necesarios para investigar la relación entre focos de infección bucal y la ocurrencia de infecciones en el post transplante hepático.

Passion fruit and apple: from residues to antioxidant, antimicrobial and anti-Alzheimer's potential / Maracujá e maçã: de resíduos ao potencial antioxidante, antimicrobiano e anti-Alzheimer

ABSTRACT: The waste in the fruit production chain, including the juice and pulp industries, produces large quantities of leftover husks, seeds and bagasse. This volume of waste generates huge environmental and economic impact. The objective of this research was to determine the potential of using residues from passion fruit (Passiflora edulis) and apple (Malus domestica) varieties in the production of functional flours. Passion fruit flour showed greater reduction of DPPH (EC50%: 50.4μg/mL) radicals, showing antioxidant potential, as well as a more efficient inhibition of Staphylococcus aureus (71.3±1.2μg/mL), with a modest; however efficient, inhibition of acetylcholinesterase (10%). All Apple flours were good antioxidants and the fuji apple flour stood out inhibiting Pseudomonas aeruginosa (78.6±3.1μg/mL). All the residues showed potential for use as a functional product either as a source of antioxidants, a natural (antimicrobial) preservative for dry foods or supplementary use by patients with Alzheimer's disease.

RESUMO: O desperdício na cadeia produtiva de frutos, incluindo as indústrias de suco e polpa, produz grandes quantidades de resíduos, como cascas, sementes e bagaços. Esse volume de resíduos gera impacto ambiental e econômico. O objetivo deste trabalho foi determinar o potencial de aproveitamento de resíduos de maracujá (Passiflora edulis) e de variedades de maçã (Malus domestica) na produção de farinhas funcionais. A farinha de maracujá apresentou maior redução de radicais DPPH (EC50%: 50,4μg/mL), demonstrando potencial antioxidante, maior inibição de Staphylococcus aureus (71,3±1,2μg/mL) e da acetilcolinesterase (10%). Todas as farinhas de maçã foram boas antioxidantes e a fuji destacou-se inibindo Pseudomonas aeruginosa (78,6±3,1μg/mL). Todos os resíduos mostraram potencial para aproveitamento como produto funcional, seja como fonte de antioxidantes, conservante natural (antimicrobiano) para alimentos secos ou uso suplementar no tratamento de Alzheimer.