Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study.

BACKGROUND: Endovascular treatment (EVT) is part of the usual care for proximal vessel occlusion strokes. However, the safety and effectiveness of EVT for distal medium vessel occlusions remain unclear. We sought to compare the clinical outcomes of EVT to medical management (MM) for isolated distal medium vessel occlusions. METHODS: This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0-2) and excellent (mRS score, 0-1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality. RESULTS: A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95-1.64]; P=0.110), rates of good (mRS score, 0-2; aOR, 1.32 [95% CI, 0.97-1.80]; P=0.075) and excellent (aOR, 1.32 [95% CI, 0.94-1.85]; P=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78-1.85]; P=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21-1.58]; P=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24-0.85]; P=0.013) in the EVT group. CONCLUSIONS: This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.

Heated environment increases blood pressure drop and postural sway during initial orthostasis in healthy subjects.

PURPOSE: We tested the hypothesis that heat stress influences the closed-loop cardio-postural control by an increased blood pressure (BP) drop and postural sway. METHODS: Fourteen healthy individuals (eight women) performed two orthostatic tests under thermal reference (TC; ~ 24 ºC) and HOT (~ 38 ºC) conditions. The center-of-pressure (COP) displacements and the electromyography (EMG) activity of the calf muscles (medial gastrocnemius and tibialis anterior) were recorded during the initial orthostasis (ORT onset) after the supine-to-stand challenge. At the same period, BP (beat-to-beat) was continuously monitored, and supine-to-stand variations (∆%) were calculated. Sublingual temperature (Tsl) was measured as a surrogate of internal temperature. RESULTS: Tsl increased in HOT compared to TC (TC 36.5 ± 0.3 vs. HOT 36.7 ± 0.3 ºC; p < 0.01). COP distance was greater in HOT compared to TC condition (TC 596.6 ± 242.4 vs. HOT 680.2 ± 249.1 mm; p < 0.01). EMG activity of the gastrocnemius decreased in HOT compared to TC condition (TC 95.5 ± 19.8 vs. HOT 78.4 ± 22.8%mV; p = 0.02). EMG of tibialis did not change between TC and HOT (TC 83.5 ± 42.9 vs. HOT 66.1 ± 31.9% mV; p = 0.29). BP showed a greater fall in HOT compared to TC condition (∆%TC - 24.5 ± 13.2 vs. ∆%HOT - 33.2 ± 20.2%; p = 0.01). CONCLUSION: Heat stress causes a greater fall in blood pressure and a reduction in musculoskeletal pump activity during orthostatic onset. These effects could be potential mechanisms that underlie augmented postural instability under a heated environment.

A system for automatic classification of endodontic treatment quality in CBCT.

OBJECTIVES: An evaluation of the effectiveness of a new computational system proposed for automatic classification, developed based on a Siamese network combined with Convolutional Neural Networks (CNNs), is presented. It aims to identify endodontic technical errors using Cone Beam Computed Tomography (CBCT). The study also aims to compare the performance of the automatic classification system with that of dentists. METHODS: One thousand endodontically treated maxillary molars sagittal and coronal reconstructions were evaluated for the quality of the endodontic treatment and the presence of periapical hypodensities by three board-certified dentists and by an oral and maxillofacial radiologist. The proposed classification system was based on a Siamese network combined with EfficientNet B1 or EfficientNet B7 networks. Accuracy, sensivity, precision, specificity, and F1-score values were calculated for automated artificial systems and dentists. Chi-square tests were performed. RESULTS: The performances were obtained for EfficienteNet B1, EfficientNet B7 and dentists. Regarding accuracy, sensivity and specificity, the best results were obtained with EfficientNet B1. Concerning precision and F1-score, the best results were obtained with EfficientNet B7. The presence of periapical hypodensity lesions was associated with endodontic technical errors. In contrast, the absence of endodontic technical errors was associated with the absence of hypodensity. CONCLUSIONS: Quality evaluation of the endodontic treatment performed by dentists and by Siamese Network combined with EfficientNet B7 or EfficientNet B1 networks was comparable with a slight superiority for the Siamese Network. CLINICAL RELEVANCE: CNNs have the potential to be used as a support and standardization tool in assessing endodontic treatment quality in clinical practice.

On the Initialization of Swarm Intelligence Algorithms for Vector Quantization Codebook Design.

Vector Quantization (VQ) is a technique with a wide range of applications. For example, it can be used for image compression. The codebook design for VQ has great significance in the quality of the quantized signals and can benefit from the use of swarm intelligence. Initialization of the Linde-Buzo-Gray (LBG) algorithm, which is the most popular VQ codebook design algorithm, is a step that directly influences VQ performance, as the convergence speed and codebook quality depend on the initial codebook. A widely used initialization alternative is random initialization, in which the initial set of codevectors is drawn randomly from the training set. Other initialization methods can lead to a better quality of the designed codebooks. The present work evaluates the impacts of initialization strategies on swarm intelligence algorithms for codebook design in terms of the quality of the designed codebooks, assessed by the quality of the reconstructed images, and in terms of the convergence speed, evaluated by the number of iterations. Initialization strategies consist of a combination of codebooks obtained by initialization algorithms from the literature with codebooks composed of vectors randomly selected from the training set. The possibility of combining different initialization techniques provides new perspectives in the search for the quality of the VQ codebooks. Nine initialization strategies are presented, which are compared with random initialization. Initialization strategies are evaluated on the following algorithms for codebook design based on swarm clustering: modified firefly algorithm-Linde-Buzo-Gray (M-FA-LBG), modified particle swarm optimization-Linde-Buzo-Gray (M-PSO-LBG), modified fish school search-Linde-Buzo-Gray (M-FSS-LBG) and their accelerated versions (M-FA-LBGa, M-PSO-LBGa and M-FSS-LBGa) which are obtained by replacing the LBG with the accelerated LBG algorithm. The simulation results point out to the benefits of the proposed initialization strategies. The results show gains up to 4.43 dB in terms of PSNR for image Clock with M-PSO-LBG codebooks of size 512 and codebook design time savings up to 67.05% for image Clock, with M-FF-LBGa codebooks with size N=512, by using initialization strategies in substitution to Random initialization.

Automatic Classification System for Periapical Lesions in Cone-Beam Computed Tomography.

Imaging examinations are of remarkable importance for diagnostic support in Dentistry. Imaging techniques allow analysis of dental and maxillofacial tissues (e.g., bone, dentine, and enamel) that are inaccessible through clinical examination, which aids in the diagnosis of diseases as well as treatment planning. The analysis of imaging exams is not trivial; so, it is usually performed by oral and maxillofacial radiologists. The increasing demand for imaging examinations motivates the development of an automatic classification system for diagnostic support, as proposed in this paper, in which we aim to classify teeth as healthy or with endodontic lesion. The classification system was developed based on a Siamese Network combined with the use of convolutional neural networks with transfer learning for VGG-16 and DenseNet-121 networks. For this purpose, a database with 1000 sagittal and coronal sections of cone-beam CT scans was used. The results in terms of accuracy, recall, precision, specificity, and F1-score show that the proposed system has a satisfactory classification performance. The innovative automatic classification system led to an accuracy of about 70%. The work is pioneer since, to the authors knowledge, no other previous work has used a Siamese Network for the purpose of classifying teeth as healthy or with endodontic lesion, based on cone-beam computed tomography images.

Diagnostic accuracy of FDG-PET/MRI versus pelvic MRI and thoracic and abdominal CT for detecting synchronous distant metastases in rectal cancer patients.

PURPOSE: We compared the diagnostic accuracy of detecting distant metastases for baseline rectal cancer staging between PET/MRI and conventional staging (CS). MATERIALS AND METHODS: This prospective study from November 2016 to April 2018 included 101 rectal adenocarcinoma patients for primary staging. These patients underwent whole-body PET/MRI in addition to CS (pelvic MRI and thoracic and abdominal contrast-enhanced CT). Different readers analyzed CS and PET/MRI findings for primary tumor, nodal, and metastatic staging. The presence, number, and location of metastases were recorded according to the organ involved (non-regional lymph nodes (LNs), liver, lungs, or others). Lesions were defined as positive, negative, or indeterminate. The number of lesions per organ was limited to 10. The McNemar test was used to compare the accuracies. RESULTS: PET/MRI exhibited a higher accuracy in detecting metastatic disease than CS in all patients (88.4% vs. 82.6%, p = 0.003) and in patients with extramural vascular invasion (EMVI) (88.9% vs. 85.5%, p = 0.013). The detection rate of PET/MRI was superior to that of CS for all lesions [84.1% vs. 68.9%, p = 0.001], as well as those in the liver (89.2% vs. 84.2%), non-regional LNs (90.0% vs. 36.7%), and lungs (76.4% vs. 66.9%). PET/MRI correctly classified 19/33 (57.5%) patients with indeterminate lesions on CS. CONCLUSION: PET/MRI yields higher accuracy than CS for detecting distant synchronous metastases in the baseline staging of patients with rectal cancer and EMVI. PET/MRI exhibited a higher detection rate than CS for identifying non-regional LNs, hepatic lesions, and pulmonary lesions as well as correctly classifying patients with indeterminate lesions. TRIAL REGISTRATION: NCT02537340.

In vitro pharmacokinetics/pharmacodynamics modeling and efficacy against systemic candidiasis in Drosophila melanogaster of a bisaryloxypropanamine derivative.

The number of deaths due to systemic fungal infections is increasing alarmingly, which is aggravated by the limitations of traditional treatments and multidrug resistance. Therefore, the research and development of new therapeutic options against pathogenic fungi is an urgent need. To evaluate the fungicidal activity of a synthetic compound, 1,3-bis-(3,4-dichlorophenoxy)propan-2-aminium chloride (2j), through time-kill studies and pharmacokinetics/pharmacodynamics (PK/PD) modeling. The protective effect of the compound was also evaluated using the Drosophila melanogaster minihost model of candidiasis. Mathematical modeling of time-kill data of compound 2j was performed to obtain PD characteristics. Additionally, Toll-deficient D. melanogaster flies were infected with a Candida albicans strain and treated with 2j. We observed that compound 2j demonstrated a time- and dose-dependent fungicidal effect against Candida spp. and dermatophytes, even at low concentrations, and rapidly achieved kill rates reaching the maximum effect in less than one hour. The efficacy of the compound against systemic candidiasis in D. melanogaster flies was comparable to that achieved by fluconazole. These results support the potential of compound 2j as a systemic antifungal agent candidate and serve as a starting point for further studies involving mammalian animal models.

Experimental ethology of intensively reared lowland pacas (Cuniculus paca).

The objective of this study was to evaluate and to describe the main behaviors of family groups of lowland pacas (Cuniculus paca) raised in a commercial breeding facility. We used 24 adult pacas, 16 females and 8 males, with a mean live weight of 8.2 kg and age ranging from 2 to 4 years. The animals were kept in groups of two females and one male per enclosure. Cameras were used to monitor the animals. The behaviors identified were divided into five categories (maintenance, exploratory, social interaction, reproductive, and environmental interaction). A completely randomized design in a split-split plot arrangement with three treatment factors was used: sex, period of the day, and season. The frequencies of the maintenance and environmental interaction behavioral categories were significantly higher during the day compared to the nocturnal period (P < 0.05). The duration of each behavioral category differed significantly (P < 0.05) between day and night. The frequencies of the maintenance and reproductive behavioral categories were significantly higher during the dry season compared to the rainy season (P < 0.05) and the relative duration of behaviors of the environmental interaction category was shorter during the dry season (P < 0.05). Females exhibited a significantly higher frequency of maintenance and environmental interaction than males (P < 0.05) and the duration of environmental interaction was shorter (P < 0.05) in females. The present results add to the existing knowledge on the behavior of lowland pacas raised in captivity for production of this wild species which is in the stage of domestication.

Imaging Findings in Transgender Patients after Gender-affirming Surgery.

Gender-affirming surgeries expand the options for physical transition among transgender patients, those whose gender identity is incongruent with the sex assigned to them at birth. Growing medical insight, increasing public acceptance, and expanding insurance coverage have improved the access to and increased the demand for gender-affirming surgeries in the United States. Procedures for transgender women, those patients with feminine gender identity, include breast augmentation using implants and genital reconstruction with vaginoplasty. Some transgender women receive medically unapproved silicone injections for breast augmentation or other soft-tissue contouring procedures that can lead to disfigurement, silicone pulmonary embolism, systemic reactions, and even death. MRI is preferred over CT for postvaginoplasty evaluation given its superior tissue contrast resolution. Procedures for transgender men, patients with a masculine gender identity, include chest masculinization (mastectomy) and genital reconstruction (phalloplasty or metoidioplasty, scrotoplasty, and erectile device implantation). Urethrography is the standard imaging modality performed to evaluate neourethral patency and other complications, such as leaks and fistulas. Despite a sizeable growth in the surgical literature about gender-affirming surgeries and their outcomes, detailed descriptions of the imaging features following these surgeries remain sparse. Radiologists must be aware of the wide variety of anatomic and pathologic changes unique to patients who undergo gender-affirming surgeries to ensure accurate imaging interpretation. Online supplemental material is available for this article. ©RSNA, 2019.

Spontaneous Breathing Trial for Prediction of Extubation Success in Pediatric Patients Following Congenital Heart Surgery: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the usefulness of a spontaneous breathing trial for predicting extubation success in pediatric patients in the postoperative period after cardiac surgery compared with a physician-led weaning. STUDY DESIGN: Randomized, controlled trial. SETTING: PICU of a tertiary-care university hospital. PATIENTS: A population of pediatric patients following cardiac surgery for congenital heart disease. INTERVENTIONS: Patients on mechanical ventilation for more than 12 hours after surgery who were considered ready for weaning were randomized to the spontaneous breathing trial group or the control group. The spontaneous breathing trial was performed on continuous positive airway pressure with the pressure support of 10 cmH2O, the positive end-expiratory pressure of 5 cmH2O, and the fraction of inspired oxygen less than or equal to 0.5 for 2 hours. Patients in the control group underwent ventilator weaning according to clinical judgment. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was extubation success defined as no need for reintubation within 48 hours after extubation. Secondary outcomes were PICU length of stay, hospital length of stay, occurrence rate of ventilator-associated pneumonia, and mortality. One hundred and ten patients with the median age of 8 months were included in the study: 56 were assigned to the spontaneous breathing trial group and 54 were assigned to the control group. Demographic and clinical data and Risk Adjustment for Congenital Heart Surgery-1 classification were similar in both groups. Patients undergoing the spontaneous breathing trial had greater extubation success (83% vs 68%, p = 0.02) and shorter PICU length of stay (median 85 vs 367 hr, p < 0.0001) compared with the control group, respectively. There was no significant difference between groups in hospital length of stay, occurrence rate of ventilator-associated pneumonia, and mortality. CONCLUSIONS: Pediatric patients with congenital heart disease undergoing the spontaneous breathing trial postoperatively had greater extubation success and shorter PICU length of stay compared with those weaned according to clinical judgment.

Costs and benefits of bevacizumab vial sharing for the treatment of retinal diseases.

BACKGROUND: Antiangiogenic therapy has proved to be an important therapeutic tool for many retinal vascular diseases; however, its availability is limited in developing countries. This study sought to describe the bevacizumab vial sharing process and to evaluate the impact of this repackaging system on the costs incurred in a Brazilian public hospital. METHOD: This retrospective study compared the number and costs of intravitreal antiangiogenic injections approved via court order in the first year of the study (2015) to the number and costs of the bevacizumab injections provided through the use of vial sharing in the second year of the study (2016). Vial sharing consists of the traditional process used to repackage bevacizumab; in this case, however, the drug samples used were the residual volume from the preparation of bevacizumab for oncology patients. The hospital adhered to the guidelines established by the Brazilian Health Surveillance Agency (ANVISA). RESULTS: In the first year of the study and using medication obtained through court orders, 550 intravitreal injections were performed in the ophthalmology ambulatory care center. Based on local pricing tables, the total cost of the medication was BRL$1,036,056.25 (USD$267,546.58), and the average cost of each application was BRL$1883.74 (USD$486.45). In the second year of the study, 1081 intravitreal applications were performed at the same hospital using doses obtained through bevacizumab vial sharing. The total cost was BRL$21,942.49 (USD$5663.30) and the per-unit cost was BRL$20.30, or USD$5.23 (a savings of 97.88%). CONCLUSION: This study found that bevacizumab vial sharing led to a significant reduction in public health care costs associated with antiangiogenic treatment and increased the availability of the drug to public health care patients. These results can be extrapolated to other types of drugs and health care systems.

Body fat modulated activity of Gallus gallus domesticus Linnaeus (1758) and Meleagris gallopavo Linnaeus (1758) in association with antibiotics against bacteria of veterinary interest.

In the Northeast of Brazil, ethnoveterinary studies have shown that the body fat from Gallus gallus domesticus and Meleagris gallopavo are used for diseases that affect domestic animals. The objective of this study was to identify the chemical composition and to evaluate the antibacterial activity of the Gallus gallus domesticus (OFGG) and Meleagris gallopavo (OFMG) fixed oils in isolation and in association with antibiotics. The OFGG and OFMG from the poultry's body fat were extracted using hexane as a solvent in Soxhlet. Their composition was indirectly determined using fatty acid methyl esters. The OFGG and OFMG antibacterial and modulatory activities against standard and multi-resistant bacterial strains were performed through the broth microdilution test. In the OFGG chemical composition, 4 constituents were identified. The saturated fatty acid (AGS) and unsaturated fatty acid (AGI) percentages were 35.1% and 64.91% respectively, with linoleic acid being the major component. In the OFMG, 3 constituents were identified. The AGS percentage was 27.71% and 72.29% for AGI, with oleic acid as the most abundant component. The oils did not present antibacterial activity when tested in isolation, presenting Minimum Inhibitory Concentrations (MICs) > 512 µg/mL. However, when associated with antibiotics the OFGG showed synergistic activity with the antibiotics Amikacin, Amoxicillin, Norfloxacin and Oxytetracycline, while the OFMG promoted a synergistic action with the antibiotics Amikacin, Amoxicillin and Norfloxacin.

Optimization of rhein-loaded polymeric nanoparticles using a factorial design and evaluation of the cytotoxic and anti-inflammatory effects.

The aim of the work was to develop rhein loaded polymeric nanoparticles (R-PNPs). Nanoparticles were prepared by three methods, solvent emulsion-evaporation, double emulsion, and nanoprecipitation, by means of experimental design. Additionally, the effects of the best formulation on in vitro cytotoxicity and inflammation were evaluated. The solvent emulsion-evaporation method presented the highest encapsulation efficiency of the three techniques (38.41%), as well as had a mean diameter of 189.33 nm and a polydispersity index of less than 0.1. Despite efforts to optimize the encapsulation of rhein, the drug release from nanoparticles was close to 50% during the first 5 min, followed by a continuous release within 60 min. It was observed that macrophages exposed to the highest concentration of R-PNPs showed cell viability about 80% and at the lowest nanoparticle concentrations was closed to 100%. IL-1ß in cell culture supernatants was decreased in the presence of R-PNPs and TNFα concentrations were lower than the sensitivity of the assay. ROS production was only inhibited with R-PNPs at concentrations of 2.5 and 5 µM. In conclusion, the solvent emulsion-evaporation was the best method evaluated to obtain nanoparticles with the desired specifications. It was possible to assess R-PNPs with low cytotoxicity and anti-inflammatory properties showed by the inhibition of IL-1ß production and a low decrease in ROS production.

Effects of dietary inclusion of macaúba seed cake meal on performance, caecotrophy traits and in vitro evaluations for growing rabbits.

The objective was to evaluate the inclusion of macaúba seed cake (MSC) meal in diets for growing rabbits by assessing their growth and slaughtering performance, haematological traits, nutritional contribution of caecotrophs, in vitro digestibility, degradability and fermentation parameters. A total of 88 rabbits were distributed to four groups with 22 animals each and fed diets containing 0, 50, 100 and 150 g/kg of MSC, respectively. The in vitro assays were conducted employing cecum inoculum on the same dietary treatments. The inclusion of MSC yielded a quadratic effect on in vitro dry matter digestibility (p < 0.001). The maximum amount of produced gas was raised linearly with the inclusion of MSC (p = 0.016). MSC linearly reduced several variables as the nutritional contribution of caecotrophs in dry matter (p = 0.017) and crude protein (p = 0.014), live weight at 51 d (p = 0.024), body weight gain (p = 0.039), average daily feed intake (ADFI) (p = 0.001) and feed conversion ratio (FCR) (p = 0.007) in the first period evaluated (30-50 d); furthermore the ADFI and FCR the second (51-72 d) and whole period (30-72 d) (p < 0.001). MSC addition caused a quadratic effect on white blood cells count (p = 0.026) and a linear decrease of eosinophils (p = 0.045). In conclusion, the inclusion of up to 150 g/kg of MSC improves the in vitro digestibility and fermentation potential of the diets, reflecting on the ADFI and FCR of the animals, although adverse effects are observed on the weight of the commercial carcass and nutritive contribution of the caecotrophs.

Evaluation of the acaricidal activity of thymol incorporated in two formulations for topical use against immature stages of Rhipicephalus sanguineus sensu lato (Latreille, 1806) (Acari: Ixodidae).

The objective of this study was to assess, for the first time, the in vitro acaricidal activity of two topical formulations containing thymol, on immature stages of Rhipicephalus sanguineus sensu lato. For this purpose, two base formulations were prepared: an oil-in-water (O/W) emulsion and a hydroalcoholic solution, containing different thymol concentrations (0.5 to 20 mg/mL). We used the larval packet test for non-engorged larvae and nymphs, and the immersion test for engorged larvae and nymphs. For emulsion, a mortality rate of 94.2% was achieved at 0.75 mg/mL in non-engorged larvae. For engorged larvae, there was 95.0% mortality at 5.0 mg/mL. Non-engorged nymphs showed 83.3% mortality at 2.5 mg/mL, and for engorged nymphs, 86.0% mortality was verified at 5.0 mg/mL. For the hydroalcoholic solution, the mortality found for non-engorged larvae was 88.1% at 2.5 mg/mL. For engorged larvae, the highest mortality was 25.0% at 20 mg/mL; non-engorged nymphs had 91.0% mortality at 1.0 mg/mL and for engorged nymphs; the maximum value verified was 18.3% mortality at 20 mg/mL. Preliminary stability tests were carried, and the hydroalcoholic solution remained stable under all the conditions analyzed. The O/W emulsion showed signs of early instability at the concentration of 5.0 mg/mL. The results obtained indicate that the acaricidal activity of thymol, when included in the proposed formulations, was enhanced against non-engorged larvae with topical treatment in comparison with data in the literature. Although there were variations in toxicity between the different stages, these formulations are promising for future therapeutic use.

Chemical identification and evaluation of the antimicrobial activity of fixed oil extracted from Rhinella jimi.

CONTEXT: The toad Rhinella jimi (Stevaux, 2002) (Bufonidae) is used in traditional medicine to treat a number of illnesses (inflammation, infections, and wounds) in humans as well as animals. OBJECTIVES: The present work examined the antimicrobial actions of the extracted oils from the body fat of R. jimi (ORJ) against fungi and standard and multi-resistant lines of bacteria, as well as their effects when combined with aminoglycosides. MATERIALS AND METHODS: The toads were collected in the municipality of Exu in Pernambuco State, Brazil, and their body fat oils extracted in a Soxhlet apparatus using hexane. A gas chromatograph coupled to a mass spectrometer was used to identify the fatty acids, based on their methyl esters. The antimicrobial activities of the oil were analyzed against standard and multi-resistant lines of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, as well as against fungal lines of Candida albicans and Candida krusei using the broth micro-dilution method. RESULTS: The minimum inhibitory concentrations (MIC) of ORJ were 512 µg/mL for Candida krusei and ≥1024 µg/mL for the other microorganisms. When associated with amikacin, ORJ demonstrated an increase in its ability to inhibit E. coli growth (from 156.25 to 39.06 µg/mL), indicating synergistic interaction. In the same way, when allied with amikacin, gentamicin, and neomycin, the ORJ reduced the MICs meaningly, against P. aeruginosa. CONCLUSIONS: These data will enable searches to be made to obtain new products in combination with antibiotics, enhancing the efficacy of these drugs against drug-resistant microorganisms.

Use of selective serotonin reuptake inhibitors in the treatment of burning mouth syndrome.

BACKGROUND: Patients with burning mouth syndrome (BMS) are frequently treated with antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are increasingly used. Nonetheless, few studies have examined the effects of SSRIs in BMS. OBJECTIVE: We performed a retrospective study to confirm the need for a prospective study on this topic in the future. PATIENTS AND METHODS: 51 patients suffering from primary BMS were included in this study. RESULTS: The frequency of side effects due to SSRIs was low, with mainly digestive side effects. Treatment with SSRIs was more efficient in patients reporting a psychogenic origin for their symptoms. Antidepressants were more frequently stopped when patients did not declare such an origin. CONCLUSIONS: SSRIs appear to be effective and well tolerated. Declaring a psychogenic component may be considered as a potentiating or predictive factor for the efficacy of treatment with SSRIs. These results should be confirmed by a prospective randomised study.

Spatial-temporal variation of parasites in Cnemidophorus ocellifer (Teiidae) and Tropidurus hispidus and Tropidurus semitaeniatus (Tropiduridae) from Caatinga areas in northeastern Brazil.

Parasites are natural regulators of their host populations. Despite this, little is known about variations in parasite composition (spatially or temporally) in environments subjected to water-related periodic stress such as the arid and semiarid regions. The objective of this study was to evaluate the spatial-temporal variation in endoparasite species' abundance and richness in populations of Neotropical Cnemidophorus ocellifer, Tropidurus hispidus, and Tropidurus semitaeniatus lizards in the semiarid northeast of Brazil. The location influenced the abundance of parasites in all analyzed lizard species, while season (dry and rainy) only influenced the total abundance for T. hispidus. In all seasons, males significantly showed more endoparasites than females in all lizard species, although for T. hispidus, this difference was only found in the dry season. Seasonal variations affect the abundance patterns of parasites. Likely, variables include environmental variations such as humidity and temperature, which influence the development of endoparasite eggs when outside of the host. Further, the activity of the intermediate hosts and the parasites of heteroxenous life cycles could be affected by an environmental condition. The variation in the abundance of parasites between the sampling areas could be a reflection of variations in climate and physiochemical conditions. Also, it could be due to differences in the quality of the environment in which each host population lives.

Endothelial, renal and hepatic variables in Wistar rats treated with Vancomycin.

Vancomycin (VCM) is indicated in combat against Gram-positive infections, but it is not considered a first-choice drug because of its adverse effects. It is believed that oxidative stress is the primary mechanism of endothelial injury and the consequent VCM toxicity, which varies from phlebitis to nephrotoxicity. Moreover, dose recommendations, dilution, rates and types of infusion are still controversial. The aim of this study was to determine the effect of different VCM dilutions in endothelial, liver and kidney injuries by biochemical parameters and histopathological analysis. Wistar rats were randomly divided into six groups and subjected to femoral vein cannulation for drug administration. Control groups received 0.9 ml of saline and the others received VCM (10mg/Kg/day) at dilutions of 5.0 and 10.0 mg/mL for 3 and 7 days. Homocysteine, hs-CRP, AST, ALT, GGT, urea, creatinine, lycopene, alpha-tocopherol, beta-carotene and retinol were analyzed. Kidney, liver and cannulated femoral vein fragments were collected.This study showed alterations in ALT which featured hepatotoxicity. However, drug dilutions were not able to show changes in other biochemical parameters. In contrast, kidney and endothelium pathological changes were observed. More studies are needed to characterize VCM induced kidney and endothelium toxicity and biochemical markers able to show such morphological modifications.

Anti-inflammatory potential of zootherapeutics derived from animals used in Brazilian traditional medicine.

CONTEXT: Animals are used for the treatment of diseases caused by inflammatory processes, although few studies evaluate their potential for these purposes. OBJECTIVES: To evaluate the anti-inflammatory potential of zootherapeutic products derived from vertebrates used in Brazilian traditional medicine. MATERIAL AND METHODS: The species analyzed were Tupinambis merianae, Iguana iguana, Crotalus durissus, Boa constrictor, and Euphractus sexcinctus. The methods used in anti-inflammatory assays were ear edema (topical) and paw (systemic). RESULTS: With regard to topical anti-inflammatory activity, the fat from T. merianae, C. durissus, I. iguana, B. constrictor, and E. sexcinctus reduced inflammation, while for systemic anti-inflammatory activity, only the fat and the skin of C. durissus, the skin of I. iguana and the fat from B. constrictor reduced inflammation. CONCLUSIONS: Studies should be conducted to evaluate the mechanisms of action for each product that demonstrated anti-inflammatory activity as well as against other inflammatory processes.