Mixed Fungal Biofilms: From Mycobiota to Devices, a New Challenge on Clinical Practice.

Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that allow the evaluation of fungal morphology and the identification of the etiologic agent of mycosis. Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that enable the examination of the fungi for further identification of the etiological agent of the mycosis. The isolation of fungi from pure cultures is typically recommended, as when more than one species is identified, the second agent is considered a contaminant. Fungi mostly survive in highly organized communities that provoke changes in phenotypic profile, increase resistance to antifungals and environmental stresses, and facilitate evasion from the immune system. Mixed fungal biofilms (MFB) harbor more than one fungal species, wherein exchange can occur that potentialize the effects of these virulence factors. However, little is known about MFB and their role in infectious processes, particularly in terms of how each species may synergistically contribute to the pathogenesis. Here, we review fungi present in MFB that are commensals of the human body, forming the mycobiota, and how their participation in MFB affects the maintenance of homeostasis. In addition, we discuss how MFB are formed on both biotic and abiotic surfaces, thus being a significant reservoir of microorganisms that have already been associated in infectious processes of high morbidity and mortality.

Rhodotorula sp. and Trichosporon sp. are more Virulent After a Mixed Biofilm.

Rhodotorula spp. and Trichosporon spp. are opportunistic pathogens, and although an association between these two species in the same infection appears to be uncommon, it has been reported. This is the first study that aimed to evaluate the pathogenesis of a co-infection by R. mucilaginosa and T. asahii, using a new in vivo model, the Zophobas morio larvae. Suspensions from planktonic and biofilm-recovered cells were injected in the larvae as in monospecies as mixed (a ratio of 1:1 for both agents of a of 105 inoculum). Individual and mixed biofilms of R. mucilaginosa and T. asahii were produced for 24 and 48 h, and they were partially characterized by crystal violet and reduction of tetrazolium salt. When evaluating the impact of the planktonic suspension in vivo we verified that the fungi in monoculture were more able to kill the larvae than those from planktonic mixed suspension. On the other hand, regarding biofilm-recovered cells, there was an increase in the death of larvae infected for mixed suspensions. Moreover, the death rate was more pronounced when the larvae were infected with 48 h biofilm-recovered cells than the 24 h ones. T. asahii was the best producer of total biomass, mainly in 48 h. The metabolic activity for both yeasts organized in biofilm maintained the same pattern between 24 and 48 h. The present study proves a synergistic interaction between R. mucilaginosa and T. asahii after an experience in a mixed biofilm. Our results suggest that both species were benefited from this interaction, acquiring a greater potential for virulence after passing through the biofilm and this ability was acquired by the cells released from the biofilm.

First Study of Naturally Formed Fungal Biofilms on the Surface of Intragastric Balloons.

BACKGROUND: Intragastric balloon (IGB) is a medical device used in the endoscopic treatment of pre-obesity and obesity. The involvement of IGB with biofilms has been previously reported; however, little is still known. We determine the frequency of biofilms naturally formed on the external surface of IGB, as well as some variables related to IGB types and patients features, species of fungi involved, and biofilm evidence. METHODS: A retrospective study was conducted based on endoscopies and medical records of patients with explanted IGB between 2015 and 2018, which had masses strongly adhered to the surface of the balloon, suspecting the presence of a biofilm. From 2018, the samples of those masses were investigated seeking biofilm characterization based on mycological and structural aspects. RESULTS: A total of 149 endoscopies were surveyed; 27 IGBs (18.12%) showed signs suggesting biofilm formation. There was no significant difference between biofilm involvement in IGB and the anthropometric and demographic profile of the patients. On the other hand, there was a significant difference regarding the IGB type, 24.05% of the adjustable IGB were compromised by biofilm, while in non-adjustable IGB, it was 11.43% (p = 0.04; OR 2.45; 95% CI, 0.98-6.12). Candida glabrata was the most isolated fungal species from the well-organized fungal biofilm. CONCLUSIONS: The frequency of fungal biofilm naturally formed on the external surface of IGB was elevated. The risk of biofilm formation was increased for the adjustable IGB, but it did not relate to the demographic data and anthropometric patient profile.

High prevalence of dengue antibodies and the arginine variant of the FcγRIIa polymorphism in asymptomatic individuals in a population of Minas Gerais State, Southeast Brazil.

Dengue is the most prevalent arthropod-borne viral illness in humans worldwide. Single-nucleotide polymorphisms (SNPs) in genes involved in the immune response, such as dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN), IgG Fc receptor II-A (FcγRIIa), vitamin D receptor (VDR), and tumor necrosis factor alpha (TNF-α), were previously reported to be associated with susceptibility to dengue disease in different human populations. Therefore, due to the relevant association of host immune and genetic status with disease susceptibility/severity of dengue, this work aims to verify the frequency of anti-dengue virus antibodies and some dengue-associated risk SNPs in a population in Minas Gerais State, Southeast Brazil. A total of 1560 individuals were genotyped for polymorphisms in DC-SIGN (rs4804803), FcγRIIa (rs1801274), VDR (rs7975232), and TNF-α (rs1800629). The presence of anti-dengue antibodies (IgM and/or IgG) in these samples was also assayed. Anti-dengue antibodies were detected at an overall frequency of 16.86%, indicating a virus infection in asymptomatic individuals. The genotypic frequencies of all SNPs studied did not differ between the asymptomatic and control groups. Regarding the allelic frequencies of the four SNPs analyzed, a higher frequency was detected of the G allele of FcγRIIa/rs1801274 in the asymptomatic individuals when compared to that in the control group (p = 0.03). Therefore, the results showed a high prevalence of asymptomatic individuals in Minas Gerais State, with a potential association between the presence of the G allele of FcγRIIa/rs1801274 and protection against symptomatic disease.

Bem-estar espiritual e coping religioso/espiritual em pessoas com insuficiência renal crônica / Spiritual well-being and spiritual/religious coping in people with chronic kidney disease

Resumo Objetivo: Avaliar a variação temporal e a correlação entre o bem-estar espiritual e coping religioso/espiritual de pessoas com insuficiência renal crônica em tratamento hemodialítico. Metodologia: Estudo descritivo, analítico e longitudinal. A amostra inicial contou com 118 participantes com perda de 31 ao final das coletas, o que reduziu a amostra final para 87 participantes. Foram aplicados, por meio de entrevista, o questionário sociodemográfico e clínico, a Escala de Coping Religioso/Espiritual Breve (CRE-Breve) e a Escala de Bem-estar Espiritual (EBE) em três coletas distintas, realizadas a cada dois meses. Resultados: Verificou-se que as pessoas com insuficiência renal crônica em hemodiálise fazem uso do enfrentamento religioso e espiritual. A média do CRE positivo foi 3,34, que reflete um escore alto. O EBE total e o EBE religioso associaram-se significativamente à importância dada à religião/espiritualidade (p < 0,001). Conclusão: Os pacientes com insuficiência renal crônica em tratamento hemodialítico entrevistados neste estudo utilizam o coping religioso/espiritual de forma positiva e significativa, da mesma forma que consideram importante a religião/espiritualidade em suas vidas.

Resumen Objetivo: Evaluar la variación temporal y la correlación entre el bienestar espiritual y el afrontamiento religioso/espiritual en personas con insuficiencia renal crónica sometidas a hemodiálisis. Metodología: Estudio descriptivo, analítico y longitudinal. La muestra inicial contó con 118 participantes, pero al final de la recopilación de datos hubo una pérdida de 31, lo que redujo la muestra a 87. Se aplicaron mediante entrevistas el cuestionario sociodemográfico y clínico, la Escala de Coping Religioso/Espiritual Breve (CRE-Breve) y la Escala de Bem-estar Espiritual (EBE). La recopilación de datos se realizó en tres etapas, con intervalos frecuentes de dos meses. Resultados: Se encontró que las personas con insuficiencia renal crónica sometidas a hemodiálisis suelen recurrir al afrontamiento religioso y espiritual. La media positiva de CRE fue de 3,34, lo que reflejó una alta puntuación. Por su parte, el EBE total y el EBE religioso se asociaron significativamente con la importancia que se le da a la religión/espiritualidad (p < 0,001). Conclusiones: Los pacientes con insuficiencia renal crónica sometidos a hemodiálisis utilizan el afrontamiento religioso/espiritual de manera positiva y significativa; así mismo, consideran importante la religión/ espiritualidad en sus vidas.

Abstract Objective: To assess temporal variation and correlation between spiritual well-being and spiritual/religious coping in people with chronic kidney disease on hemodialysis. Methodology: Longitudinal, descriptive and analytical study. Initial sample was composed of 118 participants, but at the end of data collection, there was a loss of 31 participants, which is why the sample was reduced to 87. A socio-demographic and clinical questionnaire, the Brief Spiritual/ Religious Coping Scale (Brief-SRCOPE Scale), and The Spiritual Well-Being Scale (SWB) were applied using interviews. Data collection were carried out in three stages, at two-month frequent intervals. Results: It was found that people with chronic kidney disease on hemodialysis tend to resort spiritual and religious coping. The spiritual/religious coping mean positive was 3.34, reflecting a high score. On the other hand, total SWB and the religious SWB were significantly associated with the importance given to spirituality/religion (p < 0.001). Conclusions: Patients with chronic kidney disease on hemodialysis make use of spiritual/religious coping positively and significantly; likewise, they regard religion/spirituality as important in their lives.

Effects of prayer on the vital signs of patients with chronic kidney disease: randomized controlled trial.

OBJECTIVE: To assess the effect of prayer on blood pressure, heart rate and respiratory rate in patients with chronic kidney disease and learn their perception of the intervention. METHOD: A randomized controlledtrial, double blind with a sample of volunteers, randomized into an intervention group (n=42) and a control group (n=37). Questionnaires addressing socio-demographic, clinical and spiritual characteristics and the Duke University Religious Index were applied. Blood pressure, heart rate and respiratory rate were measured. The prayer was conducted at three different moments on alternating weeks. The qualitative data were organized and analyzed through Thematic Analysis. RESULTS: The sample consisted of 95 randomized volunteers. In the intra-group analysis, a statistically significant reduction (P<0001) of blood pressure, heart rate and respiratory rate was observed in all evaluations of the people who were prayed for. The qualitative analysis resulted in the themes Prayer in a "Place of Suffering" and Positive Evaluation and in the sub-themes Relief from Suffering, Hope for Improvement, and Coping with Hemodialysis. CONCLUSIONPrayer reduced blood pressure, heart rate and respiratory rate in patients who suffer from chronic kidney disease, and the volunteers' evaluation of the intervention was positive.BrazilianClinicalTrials Registry: RBR-2zv39y. OBJETIVO: Avaliar o efeito da prece sobre a pressão arterial, a frequência cardíaca e respiratória em paciente com insuficiência renal crônica e conhecer sua percepção a respeito da intervenção. MÉTODO: Ensaio clínico controlado, randomizado, duplo cego com uma amostra de voluntários, randomizados em grupo intervenção (n=42) e grupo controle (n=37). Foram aplicados, por meio de entrevista, um questionário de características sociodemográficas, clínicas e espirituais e o Índice de Religiosidade da Universidade de Duke, além da mensuração da pressão arterial, frequência cardíaca e respiratória. A prece foi ministrada em três momentos diferentes, durantes semanas alternadas. Os dados qualitativos foram organizados e analisados por meio da Análise Temática. RESULTADOS: A amostra totalizou 95 voluntários randomizados.Na análiseintragruposfoi observada uma redução estatisticamente significativa (P<0001) dos valores de pressão arterial, frequência cardíaca e respiratória em todas as análises das pessoas que receberam a prece. Aanálise qualitativa resultou nos temasA Prece em um "Lugar de Sofrimento" e Avaliação Positiva e nos subtemas Alívio do Sofrimento, Esperança de Superação, Enfrentamento do Tratamento Hemodialítico. CONCLUSÃO: A prece reduziu os valores da pressão arterial, frequência cardíaca e respiratória de pacientes com insuficiência renal crônica e a avaliação dos voluntários em relação à intervenção foi positiva. Registro Brasileiro de Ensaios Clínicos: RBR-2zv39y.

Complexation of oxethazaine with 2-hydroxypropyl-ß-cyclodextrin: increased drug solubility, decreased cytotoxicity and analgesia at inflamed tissues.

OBJECTIVES: Oxethazaine (OXZ) is one of the few local anaesthetics that provides analgesia at low pH, but presents poor solubility, cytotoxicity and no parenteral formulations. To address these issues, we aimed to prepare OXZ host-guest inclusion complex with hydroxypropyl-beta-cyclodextrin (HP-ß-CD). METHODS: The inclusion complex was formed by co-solubilization, followed by a job plot analysis to determine stoichiometry of complexation and dialysis equilibrium analysis (based on UV/VIS absorption and fluorescence profiles of OXZ). Complex formation was confirmed by phase-solubility data, X-ray, Scanning Electron Microscopy and DOSY-1 H-NMR experiments. In vitro cytotoxicity was analysed by MTT test in 3T3 fibroblasts. In vivo analgesia was tested by Von Frey test (inflammatory wounds - rats). KEY FINDINGS: Oxethazaine complexed (1 : 1 molar ratio) with HP-ß-CD, as indicated by loss of OZX crystalline structure (X-ray) and strong host: guest interaction (NMR, K = 198/M), besides increased solubility. In vitro cell survival improved with the complex (IC50 OXZ = 28.9 µm, OXZ : HP-ß-CD = 57.8 µm). In addition, the complex (0.1% OXZ) promoted in vivo analgesia for the same time that 2% lidocaine/epinephrine did. CONCLUSION: Our results show that complexation improved physicochemical and biological properties of OXZ, allowing its application to inflamed tissues by parenteral routes.

Effects of prayer on the vital signs of patients with chronic kidney disease: randomized controlled trial / Efectos de la plegaria en los parámetros vitales de pacientes con insuficiencia renal crónica: ensayo clínico randomizado / Efeitos da prece nos parâmetros vitais de pacientes com insuficiência renal crônica: ensaio clínico randomizado

Abstract OBJECTIVE To assess the effect of prayer on blood pressure, heart rate and respiratory rate in patients with chronic kidney disease and learn their perception of the intervention. METHOD A randomized controlledtrial, double blind with a sample of volunteers, randomized into an intervention group (n=42) and a control group (n=37). Questionnaires addressing socio-demographic, clinical and spiritual characteristics and the Duke University Religious Index were applied. Blood pressure, heart rate and respiratory rate were measured. The prayer was conducted at three different moments on alternating weeks. The qualitative data were organized and analyzed through Thematic Analysis. RESULTS The sample consisted of 95 randomized volunteers. In the intra-group analysis, a statistically significant reduction (P<0001) of blood pressure, heart rate and respiratory rate was observed in all evaluations of the people who were prayed for. The qualitative analysis resulted in the themes Prayer in a "Place of Suffering" and Positive Evaluation and in the sub-themes Relief from Suffering, Hope for Improvement, and Coping with Hemodialysis. CONCLUSIONPrayer reduced blood pressure, heart rate and respiratory rate in patients who suffer from chronic kidney disease, and the volunteers' evaluation of the intervention was positive.BrazilianClinicalTrials Registry: RBR-2zv39y.

Resumen OBJETIVO Evaluar el efecto de la plegaria sobre la presión arterial, la frecuencia cardiaca y respiratoria en paciente con insuficiencia renal crónica y conocer su percepción respecto de la intervención. MÉTODO Ensayo clínico controlado, randomizado, doble ciego con una muestra de voluntarios aleatorizados en grupo de intervención (n=42) y grupo control (n=37). Fueron aplicados, por medio de encuesta, un cuestionario de rasgos sociodemográficos, clínicos y espirituales y el Índice de Religiosidad de la Universidad de Duke, además de la medición de la presión arterial, frecuencia cardiaca y respiratoria. La plegaria fue impartida en tres momentos distintos, durante semanas alternadas. Los datos cualitativos fueron organizados y analizados mediante el Análisis Temático. RESULTADOS La muestra totalizó 95 voluntarios randomizados. En el análisis intragrupos se observó una reducción estadísticamente significativa (P<0001) de los valores de presión arterial, frecuencia cardiaca y respiratoria en todos los análisis de las personas que recibieron la plegaria. El análisis cualitativo resultó los temas La Plegaria en un "Lugar de Sufrimiento" y Evaluación Positiva y los subtemas Alivio del Sufrimiento, Esperanza de Superación, Enfrentamiento del Tratamiento Hemodialítico. CONCLUSIÓN La plegaria redujo los valores de la presión arterial, frecuencia cardiaca y respiratoria de paciente con insuficiencia renal crónica, y la evaluación de los voluntarios con relación a la intervención fue positiva. Registro Brasileño de Ensayos Clínicos: RBR-2zv39y.

Resumo OBJETIVO Avaliar o efeito da prece sobre a pressão arterial, a frequência cardíaca e respiratória em paciente com insuficiência renal crônica e conhecer sua percepção a respeito da intervenção. MÉTODO Ensaio clínico controlado, randomizado, duplo cego com uma amostra de voluntários, randomizados em grupo intervenção (n=42) e grupo controle (n=37). Foram aplicados, por meio de entrevista, um questionário de características sociodemográficas, clínicas e espirituais e o Índice de Religiosidade da Universidade de Duke, além da mensuração da pressão arterial, frequência cardíaca e respiratória. A prece foi ministrada em três momentos diferentes, durantes semanas alternadas. Os dados qualitativos foram organizados e analisados por meio da Análise Temática. RESULTADOS A amostra totalizou 95 voluntários randomizados.Na análiseintragruposfoi observada uma redução estatisticamente significativa (P<0001) dos valores de pressão arterial, frequência cardíaca e respiratória em todas as análises das pessoas que receberam a prece. Aanálise qualitativa resultou nos temasA Prece em um "Lugar de Sofrimento" e Avaliação Positiva e nos subtemas Alívio do Sofrimento, Esperança de Superação, Enfrentamento do Tratamento Hemodialítico. CONCLUSÃO A prece reduziu os valores da pressão arterial, frequência cardíaca e respiratória de pacientes com insuficiência renal crônica e a avaliação dos voluntários em relação à intervenção foi positiva. Registro Brasileiro de Ensaios Clínicos: RBR-2zv39y.