Obinutuzumab-Induced Inflammatory Bowel Disease-Like Pancolitis: A First Case Report.

Introduction: Obinutuzumab is a type II anti-CD20 monoclonal antibody associated with a higher rate of toxicity when compared to rituximab. Gastrointestinal side-effects have been reported but data is still sparse. Case Presentation: A 47-year-old female with medical history of stage IV follicular non-Hodgkin lymphoma under chemotherapy presented with chronic bloody diarrhea and iron deficiency anemia. Endoscopic and histologic features resembled inflammatory bowel disease (IBD), imposing a thorough differential diagnosis. The diagnosis of obinutuzumab-induced pancolitis was made and the drug was suspended with subsequent clinical improvement. Conclusion: This is the first case report of obinutuzumab-induced pancolitis. The challenging differential diagnosis of IBD required a multidisciplinary approach with subsequent outcome and management implications.

Introdução: Obinutuzumab é um anticorpo monoclonal anti-CD20 tipo II, com aparente maior taxa de toxicidade relativamente ao rituximab. Alguns efeitos adversos gastrointestinais têm sido reportados, no entanto, a evidência científica mantém-se escassa. Caso Clínico: Mulher de 47 anos, com antecedentes de linfoma não-Hodgkin folicular estádio IV sob quimioterapia, apresenta-se com diarreia crónica sanguinolenta e anemia ferropénica. Os achados endoscópicos e histológicos assemelham-se a uma doença inflamatória intestinal (DII), impondo um diagnóstico diferencial exaustivo. Foi diagnosticada com uma pancolite induzida por obinutuzumab, tendo este sido suspenso, com melhoria clínica subsequente. Conclusão: Este é o primeiro caso documentado de pancolite induzida por obinutuzumab. A apresentação com aspetos sugestivos de DII obrigou a uma abordagem holística e multidisciplinar com implicações na abordagem e seguimento da doente.

Presbyvestibulopathy, Comorbidities, and Perception of Disability: A Cross-Sectional Study.

Objective: To assess the perception of disability in patients with presbyvestibulopathy and to determine the factors (demographic, balance test scores, and comorbidities) that determine higher levels of disability. Material and Methods: This was a cross-sectional study conducted in a tertiary university hospital. There were 103 patients who fulfilled the diagnostic criteria for presbyvestibulopathy and were included. Dizziness Handicap Inventory (DHI) score was the main variable used to quantify disability. Influence on DHI score, sex, age, time of evolution, equilibriometric parameters (posturographic scores and timed up and go test), history of falls, comorbidities (high blood pressure, diabetes, and dyslipidemia), psychotropic drug use, tobacco or alcohol use, living environment (urban or rural), and active lifestyle were analyzed. Results: Most of the DHI scores showed a moderate (46 patients, 44.7%) or severe (39 participants, 37.9%) handicap. DHI scores were higher in women (59.8 vs. 36.1, p < 0.001), patients with obesity (58.92 vs. 48.68; p = 0.019), benzodiazepine (59.9 vs. 49.1, p = 0.008) or other psychotropic drug (60.7 vs. 49.2, p = 0.017) users, and fallers (57.1 vs. 47.3, p = 0.048). There was also a significant positive correlation between DHI score, time (Rho coefficient: 0.371, p < 0.001), and steps (Rho coefficient: 0.284, p = 0.004) used in the TUG and with the short FES-I questionnaire (a shortened version of the Falls Efficacy Scale-International) score (Rho coefficient: 0.695, p < 0.001). DHI scores were lower in alcohol consumers than in non-drinkers (46.6 vs. 56, p = 0.048). No significant correlation was found between DHI scores and age, time of evolution, posturographic scores, comorbidities, environment (rural or urban), or active lifestyle. Conclusion: Most patients with presbyvestibulopathy show an important subjective perception of disability in relation to their symptoms. This perception is substantially higher in women than in men. The most influential factors are difficulties in walking, fear of falling, and obesity. Unique Identifier: NCT03034655, www.clinicaltrials.gov.

First international descriptive and interventional survey for cholesterol and non-cholesterol sterol determination by gas- and liquid-chromatography-Urgent need for harmonisation of analytical methods.

Serum concentrations of lathosterol, the plant sterols campesterol and sitosterol and the cholesterol metabolite 5α-cholestanol are widely used as surrogate markers of cholesterol synthesis and absorption, respectively. Increasing numbers of laboratories utilize a broad spectrum of well-established and recently developed methods for the determination of cholesterol and non-cholesterol sterols (NCS). In order to evaluate the quality of these measurements and to identify possible sources of analytical errors our group initiated the first international survey for cholesterol and NCS. The cholesterol and NCS survey was structured as a two-part survey which took place in the years 2013 and 2014. The first survey part was designed as descriptive, providing information about the variation of reported results from different laboratories. A set of two lyophilized pooled sera (A and B) was sent to twenty laboratories specialized in chromatographic lipid analysis. The different sterols were quantified either by gas chromatography-flame ionization detection, gas chromatography- or liquid chromatography-mass selective detection. The participants were requested to determine cholesterol and NCS concentrations in the provided samples as part of their normal laboratory routine. The second part was designed as interventional survey. Twenty-two laboratories agreed to participate and received again two different lyophilized pooled sera (C and D). In contrast to the first international survey, each participant received standard stock solutions with defined concentrations of cholesterol and NCS. The participants were requested to use diluted calibration solutions from the provided standard stock solutions for quantification of cholesterol and NCS. In both surveys, each laboratory used its own internal standard (5α-cholestane, epicoprostanol or deuterium labelled sterols). Main outcome of the survey was, that unacceptably high interlaboratory variations for cholesterol and NCS concentrations are reported, even when the individual laboratories used the same calibration material. We discuss different sources of errors and recommend all laboratories analysing cholesterol and NCS to participate in regular quality control programs.

Recém-nascidos com risco de toxoplasmose congênita, revisão de 16 anos / Newborns at risk for congenital toxoplasmosis, review of 16 years

OBJETIVOS: Analisar os dados de gestações com risco de toxoplasmose congênita e investigar a evolução dos recém-nascidos, em um hospital de nível II em Portugal. MÉTODOS: Um estudo transversal retrospetivo incluiu recém-nascidos com risco de toxoplasmose congênita e suas mães, cujo parto ocorreu entre janeiro de 2000 e dezembro de 2015. Os critérios de inclusão foram mãe com soroconversão para toxoplasmose durante a gestação ou primeira amostra sérica com IgM e IgG específicas positivas. O diagnóstico de toxoplasmose congênita foi definido por IgM específica positiva ao nascimento e/ou reação em cadeia da polimerase positiva no líquido amniótico e/ou persistência de IgG específica até os 12 meses de vida. A toxoplasmose congênita foi definida como sintomática quando os achados clínicos foram atribuídos à doença. Os testes Qui-quadrado ou Exato de Fisher foram usados para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05. RESULTADOS: Ocorreram 39.585 nascimentos vivos no período em estudo e foram identificados 98 casos com risco de toxoplasmose congênita, dos quais 89 completaram o seguimento. A prevalência de IgG para T. gondii nas gestantes foi de 26% (intervalo de confiança [IC] 95% 24-27%). Foram confirmados 22 casos de toxoplasmose congênita (5,6 por 10.000 nascidos vivos, IC95% 3,5-8,5 por 10.000). Dos 22 recém-nascidos, 18 (82%, IC95% 61-93%) eram sintomáticos. Os achados clínicos mais frequentes foram calcificação intracraniana (64%), hepatomegalia e/ou elevação das transaminases (32%) e retinocoroidite (14%). As lesões cerebrais foram mais frequentes quando a infeção materna foi documentada no primeiro e segundo trimestres em comparação com o terceiro (p=0,018). Em 31 casos (35%), as gestantes foram tratadas desde o momento do diagnóstico até o parto com espiramicina, não se tendo encontrado diferenças relativamente à taxa de transmissão vertical ou ao aparecimento de manifestações clínicas entre os recém-nascidos de mães tratadas e não tratadas. CONCLUSÕES: A prevalência de toxoplasmose congênita foi superior à reportada em outros países da Europa. A prevalência de calcificações intracranianas foi maior do que a descrita na literatura, enquanto que a de retinocoroidite e estrabismo foi menor. As alterações cerebrais nos recém-nascidos foram mais frequentes nas infecções de primeiro e segundo trimestre. Não houve diferença na taxa de transmissão vertical e na ocorrência de manifestações clínicas entre os recém-nascidos cujas mães receberam espiramicina na gestação ou não receberam tratamento.

AIMS: To analyze the data on pregnancies with risk of congenital toxoplasmosis and to investigate the newborns' outcome, in a level II hospital in Portugal. METHODS: A cross-sectional retrospective study included newborns at risk for congenital toxoplasmosis and their mothers, whose delivery occurred between January 2000 and December 2015. The inclusion criteria were mother with seroconversion to toxoplasmosis during pregnancy or first serum sample with positive specific IgM and IgG. The diagnosis of congenital toxoplasmosis was defined by positive specific IgM at birth and/or polymerase chain reaction positive in amniotic fluid and/or persistence of specific IgG up to 12 months of life. Congenital toxoplasmosis was defined as symptomatic when clinical findings were attributed to the disease. Chi-square or Fisher's exact tests were used to test associations between variables, assuming statistical significance when p<0.05. RESULTS: There were 39,585 live births in the study period and 98 cases with risk of congenital toxoplasmosis were identified, of which 89 completed the follow-up. The prevalence of anti-T. gondii IgG in the pregnant women was 26% (95% confidence interval [CI] 24-27%). Twenty-two cases of congenital toxoplasmosis (5.6 per 10,000 live births, 95%CI 3.5-8.5 per 10,000) were confirmed. Of the 22 newborns, 18 (82%, 95%CI 61-93%) were symptomatic. The most frequent clinical findings were intracranial calcification (64%), hepatomegaly and / or elevation of transaminases (32%) and retinochoroiditis (14%). Cerebral lesions were more frequent when maternal infection was documented in the first and second trimester compared to the third trimester (p=0.018). In 31 cases (35%), the pregnant women were treated from the time of diagnosis until delivery with spiramycin, and no differences were found regarding the rate of vertical transmission or the appearance of clinical manifestations among the newborns of treated and non-treated mothers treated. CONCLUSIONS: The prevalence of congenital toxoplasmosis was higher than that reported in other European countries. The prevalence of intracranial calcifications was higher than that described in the literature, whereas retinochoroiditis and strabismus occurrence was lower. Brain lesions in newborns were more frequent in first- and second-trimester infections. There was no difference in the rate of vertical transmission and in the occurrence of clinical manifestations among newborns whose mothers received spiramycin during gestation and those whose mothers did not receive treatment.

Avaliação da contaminação microbiológica em resinas compostas utilizadas nas clínicas odontológicas da Universidade Regional de Blumenau

Objetivo: foi avaliar a contaminação de resinas compostasutilizadas nas clínicas do curso de Odontologia daUniversidade Regional de Blumenau (FURB). Materiais emétodo: foram avaliados os tubetes das resinas: Z 350®,Z 250®, opallis®, charisma® e vit-l-escense®, divididosem grupo I, composto por resinas que, após o uso na clínica,foram armazenadas em geladeira, e grupo II, compostopor resinas analisadas logo após o uso. Ainda foramidentificados os grupos controle negativo, contendoresinas novas, controle zero, contendo o meio de culturaBrain Heart Infusion (BHI) HIMEDIA®, e controle positivo,contendo material coletado da mucosa bucal. Forampreparados 160 tubos de ensaio com BHI. As amostrasdos grupos I e II foram fracionadas, retirando-se 2 mm deresina e introduzindo em tubos de ensaios, assim sistematicamente,até o total de 8 mm, totalizando 144 tubosde ensaios. A turvação foi identificada em uma amostrado grupo I e em duas do grupo II e no grupo controlepositivo. As amostras dos grupos I e II com turvamentoforam submetidas à coloração de Gram e à detecção decatalase, identificando cocos gram-positivos com contaminaçãopor Staphylococcus sp. Os resultados foramsubmetidos ao teste Qui-Quadrado de Pearson, não mostrandoresultados estatisticamente significativos para acontaminação bacteriana das RC (p=0,560). Conclusão:as resinas compostas utilizadas não estavam contaminadas,indicando a eficácia nas técnicas de manutenção dacadeia asséptica empregada; entretanto, casos isoladosde contaminação sugerem a importância de coibir açõesque levem à contaminação.

Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial.

Balance becomes more precarious with age, and even without pathological disorders, the physiological decline in balance that occurs with age is a factor that also favors falls. So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation, compared to a control group, in improving balance in elderly patients with postural instability. 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computer dynamic posturography (CDP) training, optokinetic stimulus, exercises at home, or control group. Patients were assessed with objective and subjective outcome measures. The individuals that trained using CDP improved significantly more than the control group on the average balance score (p < 0.001) and reducing the number of falls in the sensorial organization test (p < 0.001). In addition, the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group (p < 0.001). In our present study, supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment. An increased age did not affect the potential for improvement after training. So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls, mainly injuries and psychological consequences due to fear of falling again.

Motor development of preterm and term infants in the fundamental movement phase: a cross-sectional study / Desenvolvimento motor de crianças nascidas pré-termo e a termo na fase motora fundamental: um estudo transversal

Abstract Introduction: Motor development is a continuous process of motor behavior changes throughout life, allowing for movement control. Premature birth can affect this process, with a greater risk of delays in acquiring these skills. Objective: Compare motor development during the fundamental movement phase of preterm infants submitted to early stimulation and full-term babies. Methods: An analytical cross-sectional study with convenience sampling, performed with twenty 3-year-old children of both sexes, distributed into two groups: the preterm group (n = 10), which received physical therapy in the first months of life, and the term group (n = 10). Motor development stages were assessed between January and April 2013, using the Motor Development Scale (Escala de Desenvolvimento Motor - EDM) developed by Francisco Rosa Neto, with an average execution time of thirty minutes. Statistical analysis was performed using BioEstat 5.0 software, and the Shapiro-Wilk test was applied to verify data normality. A significance level of p ≤ 0.05 was adopted, analyzed using the Mann-Whitney test. Results: The term group exhibited significant differences in relation to the preterm group for the variables Fine and Gross Motor Skills, and Spatial and Temporal Awareness, with no differences in Balance and Body Scheme. Conclusion: Only the premature infants submitted to early intervention achieved normal levels of Balance and Body Scheme on the EDM Scale.

Resumo Introdução: Desenvolvimento motor é um processo contínuo de alterações do comportamento motor ao longo da vida, permitindo controle de movimentos. O nascimento prematuro pode ser um evento que acarrete implicações ao processo, com maior risco para atrasos na aquisição das habilidades. Objetivo: Comparar o desenvolvimento motor de crianças nascidas prematuras estimuladas precocemente e crianças nascidas a termo, na fase motora fundamental. Métodos: Estudo transversal analítico, de conveniência, realizado com 20 crianças na faixa etária de 03 anos, de ambos os sexos, distribuídas em dois grupos, grupo pré-termo (n = 10) o qual, durante os primeiros meses receberam intervenção fisioterapêutica e grupo a termo (n = 10). As fases do desenvolvimento motor foram avaliadas através da Escala de Desenvolvimento Motor (EDM), desenvolvida por Francisco Rosa Neto, com execução média de trinta minutos, entre janeiro e abril de 2013. A análise estatística dos resultados foi realizada através do pacote BioEstat 5.0 e para verificar a normalidade entre os dados utilizou-se o Teste de Shapiro-Wilk. Em relação ao padrão de significância adotou-se o valor de p ≤ 0,05, analisado por meio do teste de Mann-Whitnney. Resultados: O grupo a termo demonstrou diferenças significativas quando comparado com o grupo pré-termo nas variáveis Motricidade Fina e Global, na Organização Espacial e Temporal, não apresentando discrepância de valores nas variáveis Equilíbrio e Esquema Corporal. Conclusão: Somente os prematuros que receberam a intervenção precoce conseguiram alcançar níveis estabelecidos como normais nas variáveis Equilíbrio e Esquema Corporal da Escala EDM.

Efeito da suplementação de proteína isolada do leite ou da soja na prevenção da perda de massa muscular em idosos saudáveis: uma revisão / Effect of whey or soy protein isolates on the prevention of muscle mass loss in the healthy elderly population: a literature review

Sarcopenia is defined as a multifactor syndrome that induces age-related loss of skeletal muscle mass. The causes of sarcopenia include altered endocrine function, inflammation, disuse, insulin resistance, chronic diseases, and protein-energy deficiency. Different strategies are under investigation to counteract this loss and promote muscle anabolism in the elderly population, including increased intake of protein and amino acids. Objective: The purpose of present review is to compare and analyze studies related to muscle preservation or gain and the supplementation of whey or soy protein isolates in elderly healthy subjects. Data source: The present review analyzed original articles published in English between 2005 and 2013 tracked by the following key words: whey protein, soy protein, aging, elderly, supplementation, sarcopenia, and muscle wasting. Data synthesis: The content of essential amino acids in milk proteins has been described to be significantly higher than in soy proteins. Soy protein supplementation causeshigher liver deamination and nitrogen retention in the splanchnic tissue, causing weaker synthesis signaling in the muscle tissue. Conclusion: Supplementation with protein and amino acids may be beneficial; however, more studies are needed to establish proper type, dose and distribution, and to quantify improvement in the muscle function and quality of life in the elderly population.

A sarcopenia é uma síndrome complexa, relativa à idade e, em última instância, resulta em perda de massa muscular. Suas causas são multifatoriais e podem incluir alterações endócrinas, inflamações, desuso, resistência à insulina, doenças crônicas e deficiências nutricionais, em especial deficiência proteico-calórica. Diversas estratégias têm sido propostas a fim de preservar ou promover ganho de massa muscular do idoso, comoaumento da ingestão de proteína, aminoácidos essenciais associadas ou não à prática regular de exercício físico. Objetivo: A presente revisão tem como objetivo analisar estudos com a suplementação de proteína derivada da soja ou do leite, com relação ao ganho de massa muscular em idosos saudáveis. Fonte de dados: Foram utilizados artigos originais em inglês, realizados entre os anos 2005 e 2013. O critério para seleção dos artigos foram as palavras-chave: whey protein, soy protein, aging, elderly, supplementation,sarcopenia, muscle wasting. Síntese dos dados: A quantidade de aminoácidos essenciais encontrada na proteína derivada do leite é maior que na proteína derivada da soja. A desaminação de aminoácidos pelo fígado e retenção de nitrogênio no pool de aminoácidos esplâncnicos é maior com a suplementação de proteína de soja, causando assim menorsinalização anabólica no músculo esquelético. Conclusão: A suplementação de proteína e aminoácidos parece ser benéfica, porém mais estudos são necessários a fim de se estabelecer o melhor tipo, dose e distribuição, além de quantificar a real melhora na qualidade de vida de idosos sarcopênicos.

Is there a relationship between objective and subjective assessment of balance in elderly patients with instability?

To assess whether a subjective questionnaire that measures the disability caused by balance disorders in daily life activities is correlated to objective assessment of balance in elderly patients with age-related instability. We included 37 subjects aged 65 years or more who presented balance disorders induced solely by age. Balance assessment was through the sensory organisation test and limits of stability of computerised dynamic posturography, the SwayStar system and the modified timed up and go test. The patients also completed the dizziness handicap inventory (DHI) questionnaire. The SwayStar balance control index (BCI) was most significantly correlated to the DHI score and the score of its different scales. When we divided the patients into subgroups according to DHI score, we only found statistically significant differences in the BCI and number of falls. In our population of elderly patients with instability, there is practically no correlation between the DHI and the static balance assessment. However, there is greater correlation with the BCI, which could show that dynamic balance is perceived as more disabling for these patients. In this case, when designing a rehabilitation protocol we should focus more on dynamic activities such as gait.

Blood shizonticidal activities of phenazines and naphthoquinoidal compounds against Plasmodium falciparum in vitro and in mice malaria studies.

Due to the recent advances of atovaquone, a naphthoquinone, through clinical trials as treatment for malarial infection, 19 quinone derivatives with previously reported structures were also evaluated for blood schizonticide activity against the malaria parasite Plasmodium falciparum. These compounds include 2-hydroxy-3-methylamino naphthoquinones (2-9), lapachol (10), nor-lapachol (11), iso-lapachol (12), phthiocol (13) and phenazines (12-20). Their cytotoxicities were also evaluated against human hepatoma and normal monkey kidney cell lines. Compounds 2 and 5 showed the highest activity against P. falciparum chloroquine-resistant blood-stage parasites (clone W2), indicated by their low inhibitory concentration for 50% (IC50) of parasite growth. The therapeutic potential of the active compounds was evaluated according to the selectivity index, which is a ratio of the cytotoxicity minimum lethal dose which eliminates 50% of cells and the in vitro IC50. Naphthoquinones 2 and 5, with activities similar to the reference antimalarial chloroquine, were also active against malaria in mice and suppressed parasitaemia by more than 60% in contrast to compound 11 which was inactive. Based on their in vitro and in vivo activities, compounds 2 and 5 are considered promising molecules for antimalarial treatment and warrant further study.

Blood shizonticidal activities of phenazines and naphthoquinoidal compounds against Plasmodium falciparum in vitro and in mice malaria studies

Due to the recent advances of atovaquone, a naphthoquinone, through clinical trials as treatment for malarial infection, 19 quinone derivatives with previously reported structures were also evaluated for blood schizonticide activity against the malaria parasite Plasmodium falciparum. These compounds include 2-hydroxy-3-methylamino naphthoquinones (2-9), lapachol (10), nor-lapachol (11), iso-lapachol (12), phthiocol (13) and phenazines (12-20). Their cytotoxicities were also evaluated against human hepatoma and normal monkey kidney cell lines. Compounds 2 and 5 showed the highest activity against P. falciparum chloroquine-resistant blood-stage parasites (clone W2), indicated by their low inhibitory concentration for 50% (IC50) of parasite growth. The therapeutic potential of the active compounds was evaluated according to the selectivity index, which is a ratio of the cytotoxicity minimum lethal dose which eliminates 50% of cells and the in vitro IC50. Naphthoquinones 2 and 5, with activities similar to the reference antimalarial chloroquine, were also active against malaria in mice and suppressed parasitaemia by more than 60% in contrast to compound 11 which was inactive. Based on their in vitro and in vivo activities, compounds 2 and 5 are considered promising molecules for antimalarial treatment and warrant further study.

Impact of subject's position and acoustic stimulus type on vestibular evoked myogenic potentials (VEMPs) in normal subjects.

Vestibular evoked myogenic potentials (VEMPs) are currently considered a diagnostic tool for studying the vestibular system, specifically the saccule and inferior vestibular nerve. This prospective study aimed at evaluating the impact of patient position and type of acoustic stimulus on VEMPs results using 60 healthy subjects who underwent otoscopy, pure tone audiometry and VEMPs in different conditions affecting their position and the type of acoustic stimulus. Corrected amplitude is significantly greater when the patient is seated and latency difference and amplitude asymmetry do not change with either patient position or type of stimulus. The results obtained in different test conditions are not comparable. Being seated is the most appropriate position for the test.

Anti-malarial activity of indole alkaloids isolated from Aspidosperma olivaceum.

BACKGROUND: Several species of Aspidosperma (Apocynaceae) are used as treatments for human diseases in the tropics. Aspidosperma olivaceum, which is used to treat fevers in some regions of Brazil, contains the monoterpenoid indole alkaloids (MIAs) aspidoscarpine, uleine, apparicine, and N-methyl-tetrahydrolivacine. Using bio-guided fractionation and cytotoxicity testing in a human hepatoma cell line, several plant fractions and compounds purified from the bark and leaves of the plant were characterized for specific therapeutic activity (and selectivity index, SI) in vitro against the blood forms of Plasmodium falciparum. METHODS: The activity of A. olivaceum extracts, fractions, and isolated compounds was evaluated against chloroquine (CQ)-resistant P. falciparum blood parasites by in vitro testing with radiolabelled [3H]-hypoxanthine and a monoclonal anti-histidine-rich protein (HRPII) antibody. The cytotoxicity of these fractions and compounds was evaluated in a human hepatoma cell line using a 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay, and the SI was calculated as the ratio between the toxicity and activity. Two leaf fractions were tested in mice with Plasmodium berghei. RESULTS: All six fractions from the bark and leaf extracts were active in vitro at low doses (IC50 < 5.0 µg/mL) using the anti-HRPII test, and only two (the neutral and basic bark fractions) were toxic to a human cell line (HepG2). The most promising fractions were the crude leaf extract and its basic residue, which had SIs above 50. Among the four pure compounds evaluated, aspidoscarpine in the bark and leaf extracts showed the highest SI at 56; this compound, therefore, represents a possible anti-malarial drug that requires further study. The acidic leaf fraction administered by gavage to mice with blood-induced malaria was also active. CONCLUSION: Using a bio-monitoring approach, it was possible to attribute the anti-P. falciparum activity of A. olivaceum to aspidoscarpine and, to a lesser extent, N-methyl-tetrahydrolivacine; other isolated MIA molecules were active but had lower SIs due to their higher toxicities. These results stood in contrast to previous work in which the anti-malarial activity of other Aspidosperma species was attributed to uleine.

An overview of amines as nutritional supplements to counteract cancer cachexia.

Cancer cachexia is a complex multifactorial syndrome characterized by loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Recently, some amino acids and other amine dietary supplements have been highlighted in medical field due to positive effects upon diseases evolving skeletal muscle atrophy. Therefore, the aim of this brief review is to discuss the putative application of amines as dietary supplements to counteract skeletal muscle wasting on cancer cachexia. Specifically, we focus in two nutritional supplements: (1) branched-chain amino acids (BCAAs) and (2) creatine. Both BCAAs and creatine may attenuate proteolysis and enhance proteins synthesis in skeletal muscle. Although more experimental studies and clinical trials are still necessary to elucidate this therapeutic application, several evidences have demonstrated that amines supplementation is a promising coadjuvant treatment to cancer cachexia.

Correlation between bithermal caloric test results and vestibular evoked myogenic potentials (VEMPs) in normal subjects.

UNLABELLED: Bithermal caloric testing and vestibular evoked myogenic potentials (VEMPs) are both diagnostic tools for the study of the vestibular system. The first tests the horizontal semicircular canal and the second evaluates the saccule and lower vestibular nerve. The results of these two tests can therefore be expected to be correlated. The aim of this study was to compare bithermal caloric test results with VEMP records in normal subjects to verify whether they are correlated. MATERIAL AND METHOD: A prospective study was conducted in 60 healthy subjects (30 men and 30 women) who underwent otoscopy, pure tone audiometry, bithermal caloric testing and VEMPs. From the caloric test, we assessed the presence of possible vestibular hypofunction, whether there was directional preponderance and reflectivity of each ear (all based on both slow phase velocity and nystagmus frequency). The analysed VEMPs variables were: p1 and n1 latency, corrected amplitude, interaural p1 latency difference and p1 interaural amplitude asymmetry. We compared the reflectivity, hypofunction and directional preponderance of the caloric tests with the corrected amplitudes and amplitude asymmetries of the VEMPs. No correlations were found in the different comparisons between bithermal caloric testing results and VEMPs except for a weak correlation (p = 0.039) when comparing preponderance based on the number of nystagmus in the caloric test and amplitude asymmetry with 99 dB tone burst in the VEMPs test. The results indicate that the two diagnostic tests are not comparable, so one of them cannot replace the other, but the use of both increases diagnostic success in some conditions.

Alkali soluble fluoride deposits on bovine dental enamel after treatment with a mouthwash containing fluoride and chlorhexidine / Deposição de fluoreto solúvel em álcali no esmalte dental bovino após tratamento com um enxaguatóriocontendo fluoreto e clorexidina

Aim: The aim of this in vitro study was to determine whether the addition of chlorhexidine (CHX)to a mouthwash containing fluoride (F) diminishes the concentration of soluble F and its reactivity withbovine dental enamel. Materials and Methods: First, the concentration of F found in mouthwashs wasdetermined by an ion-specific electrode. To test their reactivity, 30 slabs of bovine dental enamel (5 x 5mm)were distributed into three groups (n = 10), according to the treatment applied, for 30 seconds: controlgroup (distilled deionized water); NaF group (0.05% sodium fluoride); NaF + CHX group (Noplak Max®:0.05% sodium fluoride + 0.12% chlorhexidine digluconate). After, the slabs were washed with distilleddeionized water and individually immersed in artificial saliva for 30 minutes. They were dried and thenindividually immersed in 0.5 mL of 1M KOH for 24 hours, under agitation. After buffering the samples withHCI containing TISAB II, the concentration of F present in the KOH solutions was determined be means ofan ion-specific electrode. Results: No significant difference in the concentration of soluble F in the studiedmouthwashs (NaF and NaF+CHX; Student’s t-test, p > 0.05) could be observed. Furthermore, no differencecould be identified among the alkali soluble fluoride deposits from the NaF and NaF+CHX groups, andboth groups presented higher deposit levels than did the control group (Kruskal-Wallis and Dunn´s method,p < 0.05). Conclusion: The addition of CHX to a mouthwash containing F did not decrease its soluble Fconcentration, nor its reactivity to bovine dental enamel.

Correcão estética dos dentes anteriores com resina composta nanoparticulada / Anterior teeth esthetic correction with nanofill resin composite

A realização de facetas estéticas diretas em resina composta permite a recuperação estética de forma conservadora de dentes com tratamento endodôntico que apresentam alteração cromática e não respondem às técnicas de clareamento dental. Este trabalho relata caso clínico de paciente que apresentava descontentamento com a cor escurecida do dente 21 e com o tamanho dos dentes adjacentes. O escurecimento ocorreu após trata- mento endodôntico e se manteve inalterado após realização de clareamento interno. Após anamnese, diagnóstico clínico e radiográfico, foi indicado à realização de faceta direta com resina composta nanoparticulada no dente 21. As resinas com nanopartículas apresentam à incorporação de partículas de carga com tamanho nanométrico entre 20 e 75 nanômetros, a matriz orgânica tendo como vantagens as propriedades estéticas das resinas de micro- partículas e propriedades de resistência similar às resinas híbridas, sendo um composto de indicação de uso universal. Após a realização da faceta, foi feito o recontorno cosmético nos dentes adjacentes com discos de lixa, usados em ordem decrescente de granulação. Obteve-se melhora na estética do sorriso recuperando a cor e alinhamento dentário.

The use of direct nanofill resin composite veneer allows an esthetic recovery of stained endodontically-treated teeth when dental bleaching techniques failure. This study shows a clinical case of an unsatisfied patient that complied about the tooth colored central incisor (21) and the shape of the others anterior teeth. The darkness appeared after the endo- dontic treatment and left unchanged after the use of walking-bleaching technique. After anamnesis, clinical and radiographic diagnosis, the use of direct nanofiller resin composite veneer was indicated for central incisor (21), and that cosmetic recountouring was made in the other teeth. A new class of dental composites, the nanofill resin composite has been developed with a nanometer-sized particles; averaging 20 and 75 nanometers in size the resin matrix, showed high translucency and polish retention similar to those of microfill, while maintaining physical properties and wear resistance equivalent to those of several hybrid composites, universal restorative is one. The patient got a better smile and recovered the color and alignment of anterior teeth.

Trypanosoma cruzi: blood parasitism kinetics and their correlation with heart parasitism intensity during long-term infection of Beagle dogs

The goals of the present study were to evaluate the kinetics of blood parasitism by examination of fresh blood, blood culture (BC) and PCR assays and their correlation with heart parasitism during two years of infection in Beagle dogs inoculated with the Be-78, Y and ABC Trypanosoma cruzi strains. Our results showed that the parasite or its kDNA is easily detected during the acute phase in all infected animals. On the other hand, a reduced number of positive tests were verified during the chronic phase of the infection. The frequency of positive tests was correlated with T. cruzi strain. The percentage of positive BC and blood PCR performed in samples from animals inoculated with Be-78 and ABC strains were similar and significantly larger in relation to animals infected with the Y strain.Comparison of the positivity of PCR tests performed using blood and heart tissue samples obtained two years after infection showed two different patterns associated with the inoculated T. cruzi strain: (1) high PCR positivity for both blood and tissue was observed in animals infected with Be-78 or ABC strains; (2) lower and higher PCR positivity for the blood and tissue, respectively, was detected in animals infected with Y strains. These data suggest that the sensitivity of BC and blood PCR was T. cruzi strain dependent and, in contrast, the heart tissue PCR revealed higher sensitivity regardless of the parasite stock.