Prevention of Caries in Cancer Patients: A Systematic Review on the Effectiveness of Dental Materials.

This study aims to identify dental materials and their effectiveness in preventing caries in patients after chemotherapy and radiotherapy for the head and neck. The electronic search was performed in PubMed, Science Direct, Embase and Scopus. All 653 articles found passed through a double-blinded screening process. The exclusion of articles by reading titles and abstracts selected 16 articles for full reading, of which 4 were included into the study. A risk of bias analysis for non-randomized and randomized articles was performed using respectively the ROBINS I and ROB II tools. The data extraction suggested that the casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), in association with fluorine, is able to form harder surfaces compared to the control group, the intraoral fluoride-releasing system (IFRS) effectiveness is similar to the fluorine in gel and a mouthwash composed of natural enzymes (Oral7) did not demonstrate effectiveness in the prevention dental caries. New randomized controlled clinical trials are necessary to evaluate the effectiveness of prevention when applying dental materials in patients after treatment of head and neck cancer.

Surface Characteristics and Microbial Adhesion in Polymethylmethacrylate for Denture Base Submitted to Antimicrobial Agents and Cleaning Agents: A Systematic Review.

This review aimed to identify the influence of antimicrobial and cleaning agents on surface characteristics such as surface free energy (SFE) and wettability, and microbial adhesion in polymethylmethacrylate (PMMA) for denture base. The review question, based on PICO, was: "Does intervention with antimicrobial and cleaning agents in PMMA influence the surface free energy, wettability, and consequently the microbial adhesion?" and the protocol was registered in Open Science Framework (osf. io/v3xgn). The search was performed in PubMed, Lilacs, Embase, Scopus, and Science Direct databases, using the terms: ("acrylic resin" OR PMMA) AND (antimicrobial OR antibacterial) AND ("electrostatic interaction" OR surface free energy) AND (biofilm OR "bacteria adhesion"), and resulted in 462 articles, of which 7 were included. The antimicrobials polypara-xylylene, carboxybetaine methacrylate, ethylene glycol methacrylate phosphate, and deposition of F and Ag ions in PMMA influenced the SFE and wettability. Denture cleaners reduced microbial adhesion. Five of the included studies evaluated the microbial adhesion, however, only two observed a direct relationship between SFE, wettability, and microbial adhesion. It was concluded that the intervention with antimicrobial and cleaning agents in PMMA can interfere in SFE and surface wettability, but no correlation was observed between microbial adhesion and these surface characteristics in PMMA.

Structural, thermal, electronic, vibrational, magnetic, and cytotoxic properties of chloro(glycinato-N,O)(1,10-phenanthroline-N,N')­copper(II) trihydrate coordination complex.

Chloro(glycinato-N,O)(1,10-phenanthroline-N,N')­copper(II) trihydrate complex was synthesized through the slow evaporation method. The crystal's structural, thermal, magnetic, and vibrational properties were obtained by X-ray powder diffraction (XRPD), thermal analyses, magnetization, Raman, and Fourier-transform infrared (FT-IR) spectroscopy. XRPD results showed that the crystalline complex belongs to a monoclinic system (P21/n). Thermal analyses revealed that around 333 K, the material undergoes a thermodynamically irreversible process. Magnetic data showed a paramagnetic behavior with weak ferromagnetic interactions. Moreover, all the Raman- and infrared-active bands were assigned from computational calculations based on the density functional theory (DFT) to analyze intra-molecular vibrational modes. In addition, the cytotoxic assay on colorectal cancer cells was performed to evaluate the antitumor activity of this ternary compound. Therefore, the antineoplastic activity of [Cu(1,10-phenanthroline)(glycine)Cl]•3H2O complex in HCT-116 cells was confirmed, showing a potent cytotoxic effect.

Species diversity, novel interactions and absence of well-supported host-guided phylogenetic groupings of Neotropical Alternaria isolates causing foliar lesions in Solanaceae.

AIM: To report the characterization of 120 Alternaria isolates inducing early blight-like foliar lesions in nine species of five Solanaceae genera collected across all macrogeographical Brazilian regions. MATERIAL AND RESULTS: Phylogenetic relationships were assessed via analyses of the Alternaria alternata allergenic protein-coding, glyceraldehyde-3-phosphate dehydrogenase and the calmodulin gene sequences. Most of the tomato isolates were placed into the Alternaria linariae cluster, whereas most of the potato isolates were grouped with Alternaria grandis. Novel host-pathogen interactions were also reported. Seventeen isolates were selected for morphometrical characterization, and a subsample of 13 isolates was employed in pathogenicity assays on tomato, potato, eggplant, scarlet eggplant, Capsicum annuum, Datura stramonium, Physalis angulata and Nicotiana tabacum. Eleven isolates were able to induce foliar lesions in tomatoes but none in C. annuum. Potato was susceptible to a subgroup of isolates but displayed a subset of isolate-specific interactions. Morphological traits were in overall agreement with molecular and host range data. CONCLUSION: Alternaria linariae and A. grandis were confirmed as the major causal agents of tomato and potato early blight, respectively. However other Alternaria species are also involved with early blight in solanaceous hosts in Brazil. SIGNIFICANCE AND IMPACT OF THE STUDY: The diversity and host-specific patterns of the Alternaria isolates from Solanaceae may have practical implications in establishing effective early blight genetic resistance and cultural management strategies especially for tomato and potato crops.

Uso de la toxina botulínica en el tratamiento de sonrisa gingival / Use of botulinum toxin in the treatment of gummy smile

El objetivo es abordar la importancia del uso de la toxina botulínica para corregir la sonrisa gingival, demostrando la satisfacción del paciente, aunque el efecto sea temporal y reversible, evitando procedimientos invasivos. Se realizó un levantamiento bibliográfico en las bases de datos PubMed, LILACS y Bireme, los términos utilizados en la investiga- ción fueron: sonrisa gingival y toxina botulínica o sonrisa gingival y estética. Los criterios de inclusión fueron una revisión de literatura de casos clínicos de pacientes con sonrisa gingival publicados entre 2015 y mayo de 2019. Esta revisión aborda la aplicación de la toxina botulínica para devolver una sonrisa armoniosa y hermosa al paciente, ya que es una alternativa viable, eficiente, menos invasiva y segura. La práctica de la aplicación de toxina botulínica puede ser un complemento útil para mejorar la estética y mejorar la satisfacción del paciente en relación a la sonrisa gingival sin realizar procedimientos invasivos, es decir, cuando está debidamente indicado, pudiendo reemplazar o agregar procedimientos quirúrgicos.

The objective was to address the importance of using botulinum toxin to correct gummy smile, showing patient satisfaction even if the effect is temporary and reversible, avoiding invasive procedures. A bibliographic survey was carried out in the databases PubMed, LILACS and Bireme, the terms used in the research were gummy smile and botulinum toxin or gummy smile and aesthetic. The inclusion criteria were a review of the literature of clinical cases of patients with with a gummy smile published between 2015 and May 2019. This review addressed the application of botulinum toxin to give the patient a beautiful and harmonious smile, as it is a viable, efficient, less invasive and safe alterna- tive. The practice of applying botulinum toxin can be a useful complement to improve patient satisfaction with a gummy smile without undergoing invasive procedures, that is, when well indicated, being able to replace or complement surgical procedures.

Differentiation of canine adipose mesenchymal stem cells into insulin-producing cells: comparison of different culture medium compositions.

The aim of this study was to differentiate canine adipose-derived mesenchymal stem cells (ADMSCs) into insulin-producing cells by using culture media with different compositions to determine the most efficient media. Stem cells isolated from the fat tissues close to the bitch uterus were distributed into 6 groups: (1) Dulbecco's modified Eagle medium (DMEM)-high glucose (HG), ß-mercaptoethanol, and nicotinamide; (2) DMEM-HG, ß-mercaptoethanol, nicotinamide, and exendin-4; (3) DMEM-HG, ß-mercaptoethanol, nicotinamide, exendin-4, B27, nonessential amino acids, and l-glutamine; (4) DMEM-HG, ß-mercaptoethanol, and nicotinamide (for the initial 8-d period), and DMEM-HG, ß-mercaptoethanol, nicotinamide, exendin-4, B27, nonessential amino acids, l-glutamine, and basic fibroblast growth factor (for the remaining 8-d period); (5) DMEM-HG and fetal bovine serum; and (6) DMEM-low glucose and fetal bovine serum (standard control group). Adipose-derived mesenchymal stem cells from groups 1 to 5 gradually became round in shape and gathered in clusters. These changes differed between the groups. In group 3, the cell clusters were apparently more in numbers and gathered as bigger aggregates. Dithizone staining showed that groups 3 and 4 were similar in terms of the mean area of each aggregate stained for insulin. However, only in group 4, the number of insulin aggregates and the total area of aggregates stained were significantly bigger than in the other groups. The mRNA expression of PDX1, BETA2, MafA, and Insulin were also confirmed in all the groups. We conclude that by manipulating the composition of the culture medium it is possible to induce canine ADMSCs into insulin-producing cells, and the 2-staged protocol that was used promoted the best differentiation.

Caracterização fenotípica de vacas F1 Holandês x Zebu de diferentes bases maternas / [Phenotypic characterization of Holsteins x Zebu F1 cows from different maternal bases]

Caracterizaram-se fêmeas F1 Holandês x Zebu de diferentes bases maternas quanto às pelagens, despigmentações e características morfométricas. Foram utilizadas 266 fêmeas F1, progênies do cruzamento de 26 touros da raça Holandesa com fêmeas de composição genética zebuínas: Gir, Nelore, Guzonel, Nelogir. Foram aplicadas análise de distribuição de frequência para características qualitativas e medidas de dispersão e tendência central para características morfométricas, e as médias foram comparadas pelo teste de Tukey a 5% de probabilidade. Acima de 60,0% dos animais foram de pelagem preta. As vacas que tiveram origem na raça Gir apresentaram comprimento de cabeça 2,8cm maior (P<0,05) que as fêmeas da raça Nelore. O comprimento da orelha variou (P<0,05) conforme a base materna utilizada. As vacas com genes da raça Nelore são 5,0cm mais altas (P<0,05). O perímetro torácico foi a característica morfométrica que teve correlação fenotípica de elevada magnitude com o peso, acima de 0,70, para as fêmeas das bases maternas Gir, Nelore e Nelogir. A pelagem não é indicativa da base materna utilizada. As vacas F1 de base materna Gir tiveram estrutura corporal menor que as fêmeas que portam genes da raça Nelore.(AU)

F1 Holstein x Zebu females from different maternal bases were characterized regarding coat, depigmentation and morphometric characteristics. A total of 266 F1 female progenies from the crossbreeding of 26 Holstein bulls with females of Zebu genetic composition were used: Gir, Nellore, Guzonel, Nellogir. Frequency distribution analysis was applied for qualitative characteristics and dispersion measures and central tendency for morphometric characteristics, and means were compared by Tukey test at 5% probability. Over 60.0% of the animals had a black coat. The cows that originated from the Gir breed had a head length of 2.8cm (P<0.05) higher than the Nellore females. Ear length varied (P<0.05) according to the maternal base used. Cows with Nelore genes were 5.0cm taller (P<0.05). The thoracic perimeter was the morphometric characteristic that had a high magnitude phenotypic correlation with weight, above 0.70, for the females of the Gir, Nellore and Nellogir maternal bases. The coat is not indicative of the maternal base used. F1 Gir-based cows had a smaller body structure than females with Nellore genes.(AU)

Comparative transcriptome analysis of the human endocervix and ectocervix during the proliferative and secretory phases of the menstrual cycle.

Despite extensive studies suggesting increased susceptibility to HIV during the secretory phase of the menstrual cycle, the molecular mechanisms involved remain unclear. Our goal was to analyze transcriptomes of the endocervix and ectocervix during the proliferative and secretory phases using RNA sequencing to explore potential molecular signatures of susceptibility to HIV. We identified 202 differentially expressed genes (DEGs) between the proliferative and secretory phases of the cycle in the endocervix (adjusted p < 0.05). The biofunctions and pathways analysis of DEGs revealed that cellular assembly and epithelial barrier function in the proliferative phase and inflammatory response/cellular movement in the secretory phase were among the top biofunctions and pathways. The gene set enrichment analysis of ranked DEGs (score = log fold change/p value) in the endocervix and ectocervix revealed that (i) unstimulated/not activated immune cells gene sets positively correlated with the proliferative phase and negatively correlated with the secretory phase in both tissues, (ii) IFNγ and IFNα response gene sets positively correlated with the proliferative phase in the ectocervix, (iii) HIV restrictive Wnt/ß-catenin signaling pathway negatively correlated with the secretory phase in the endocervix. Our data show menstrual cycle phase-associated changes in both endocervix and ectocervix, which may modulate susceptibility to HIV.

Enfermedad de paget mamaria. presentación de un caso / Mammary paget disease. case report

RESUMEN: La enfermedad de Paget mamaria es una patología poco común de la mama que tiene una gran importancia por su alta asociación a carcinoma mamario y por requerir de un alto índice de sospecha para arribar a su diagnóstico. Se presenta el caso de una mujer de 65 años de edad, con diagnóstico de enfermedad de Paget mamaria asociada a carcinoma ductal infiltrante de mama izquierda con compromiso ganglionar axilar homolateral. Se realizó la revisión bibliográfica de esta patología, con especial énfasis en la clínica, diagnóstico, estadificación, tratamientoy pronóstico.

ABSTRACT: Paget's disease of the breast is a rare pathology in the breast, however, it is very important because of its high association with mammary carcinoma and because it requires a high index of suspicion. We present the case of a 65-year-old woman with Paget's disease of the breast associated with an infiltrating ductal carcinoma of the left breast with homolateral axillary lymph node involvement. A bibliographic review of this pathology was carried out, with special emphasis on the clinic, diagnosis, staging, treatment and prognosis.

African swine fever virus evasion of host defences.

African swine fever virus causes a haemorrhagic fever in domestic pigs and wild boar. The continuing spread in Africa, Europe and Asia threatens the global pig industry. The lack of a vaccine limits disease control. To underpin rational strategies for vaccine development improved knowledge is needed of how the virus interacts with and modulates the host's responses to infection. The virus long double-stranded DNA genome codes for more than 160 proteins of which many are non-essential for replication in cells but can have important roles in evading the host's defences. Here we review knowledge of the pathways targeted by ASFV and the mechanisms by which these are inhibited. The impact of deleting single or multiple ASFV genes on virus replication in cells and infection in pigs is summarised providing information on strategies for rational development of modified live vaccines.

Direct inhibitory effect of caffeine on viability, synthesis activity and gene expression in cultures of chondrocytes extracted from the articular cartilage of rats / Efeito inibidor direto da cafeína sobre a viabilidade, atividade de síntese e expressão gênica em culturas de condrócitos da cartilagem articular de ratos

The aim of this study was to evaluate the effect of concentrations of caffeine on the viability, synthesis activity and gene expression in cultures of chondrocytes. Extracted articular cartilage from the femurs and tibias of 15 Wistar rats at three days old to isolate chondrocytes. Chondrocytes were cultured in chondrogenic medium (control) or supplemented with caffeine (0.5, 1.0, 2.0mM). Cell viability, alkaline phosphatase activity and collagen synthesis were assessed using colorimetric assays at 7, 14, 21 days. The chondrocyte cultures of all groups grown under coverslips were stained with hematoxylin-eosin to determine the percentage of cells/field and with PAS, safranin O, alcian blue to determine the percentage of matrix chondrogenic/field at 21 days. The expressions of gene transcripts for aggrecan, collagen-II, Sox-9, Runx-2 and alkaline phosphatase were also evaluated by RT-PCR at 21 days. The means were compared using Student-Newman-Keuls. Caffeine significantly reduced the conversion of MTT to formazan, percentage of cells/field, collagen synthesis, alkaline phosphatase activity, synthesis of PAS+, safranin O+ and alcian blue+ chondrogenic matrix, and the expression of aggrecan, Sox-9 and II collagen. It is concluded that caffeine at concentrations of 0.5, 1.0, 2.0mM has a direct inhibitory effect on chondrogenesis in cultures of chondrocytes from rats.(AU)

O objetivo deste estudo foi avaliar o efeito direto de concentrações de cafeína sobre a viabilidade, atividade de síntese e expressão gênica em culturas de condrócitos de ratos. As cartilagens dos fêmures e tíbias de 15 ratos Wistar com três dias foram extraídas para isolamento de condrócitos. Os condrócitos foram cultivados em meio condrogênico (controle) ou em meio acrescido de diferentes concentrações de cafeína (0,5, 1,0, 2,0mM). Foram avaliadas a viabilidade celular, a atividade da fosfatase alcalina e a síntese de colágeno por ensaios colorimétricos aos sete, 14 e 21 dias. Condrócitos cultivados sob lamínulas foram corados pela hematoxilina e eosina, para se determinar a porcentagem de células/campo, e pelo PAS, safranina O, alcian Blue, para se determinar a porcentagem de matriz condrogênica/campo aos 21 dias. Foi avaliada a expressão de transcriptos gênicos para Sox-9, Runx-2, agrecano, colágeno-II e fosfatase alcalina por qRT-PCR, aos 21 dias. As médias foram comparadas pelo Student-Newman-Keuls. A cafeína reduziu significativamente o MTT em cristais de formazan, a porcentagem de células/campo, a síntese de colágeno, a atividade da fosfatase alcalina e a síntese de matriz condrogênica PAS+, safranina O+, alcian blue+ e expressão de Sox-9 e colágeno-II. Conclui-se que a cafeína, nas concentrações de 0,5, 1,0, 2,0mM, apresenta efeito inibidor direto sobre a condrogênese em culturas de condrócitos de ratos.(AU)

The smokeless tobacco habit and DNA damage: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review was to evaluate the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. MATERIAL AND METHODS: We searched PubMed, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE. We also surveyed gray literature. We included only clinical trials that compare the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. Quality assessments of the selected trials were evaluated by two independent reviewers, using the Effective Public Health Practice Project - (EPHPP) with modifications. RESULTS: After the database screening and removal of duplicates, 2574 studies were identified. After title screening, 172 studies remained, and this number was reduced to 25 after careful examination of the abstracts. The standardized mean difference of the frequency of micronuclei between groups was 1.88, with a 95% confidence interval of 1.40 to 2.36 (p < 0.00001). In all analyses heterogeneity was detected. CONCLUSIONS: Despite the heterogeneity of studies, the frequency of micronuclei was significant bigger in adults who have the smokeless tobacco habit when compared to those not have this habit. The same occurred with the frequency of binucleated cells, karyolisis and karyorrhexis.

Inflammation-induced glycolytic switch controls suppressivity of mesenchymal stem cells via STAT1 glycosylation.

Mesenchymal stem cells (MSCs) represent key contributors to tissue homeostasis and promising therapeutics for hyperinflammatory conditions including graft-versus-host disease. Their immunomodulatory effects are controlled by microenvironmental signals. The MSCs' functional response towards inflammatory cues is known as MSC-"licensing" and includes indoleamine 2,3-dioxygenase (IDO) upregulation. MSCs use tryptophan-depleting IDO to suppress T-cells. Increasing evidence suggests that several functions are (co-)determined by the cells' metabolic commitment. MSCs are capable of both, high levels of glycolysis and of oxidative phosphorylation. Although several studies have addressed alterations of the immune regulatory phenotype elicited by inflammatory priming metabolic mechanisms controlling this process remain unknown. We demonstrate that inflammatory MSC-licensing causes metabolic shifts including enhanced glycolysis and increased fatty acid oxidation. Yet, only interfering with glycolysis impacts IDO upregulation and impedes T-cell-suppressivity. We identified the Janus kinase (JAK)/signal transducer and activator of transcription (STAT)1 pathway as a regulator of both glycolysis and IDO, and show that enhanced glucose turnover is linked to abundant STAT1 glycosylation. Inhibiting the responsible O-acetylglucosamine (O-GlcNAc) transferase abolishes STAT1 activity together with IDO upregulation. Our data suggest that STAT1-O-GlcNAcylation increases its stability towards degradation thus sustaining downstream effects. This pathway could represent a target for interventions aiming to enhance the MSCs' immunoregulatory potency.

Analgesic efficacy of ketorolac associated with a tramadol/acetaminophen combination after third molar surgery - a randomized, triple-blind clinical trial.

BACKGROUND: This study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery. MATERIAL AND METHODS: A randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects. RESULTS: Significant differences in pain intensity were observed in the different times (p < 0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p < 0.001), the need of antiemetic were greater in Group K+T+A (p < 0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A. CONCLUSIONS: The current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant.

COPD exacerbations: management and hospital discharge.

Chronic Obstructive Pulmonary Disease (COPD) is a serious pulmonary condition. Many patients experience exacerbations and some require Emergency Room visits and hospitalization. In Portugal, hospitalizations due to COPD between 2009 and 2016 decreased by 8%, but they still represented 8049 hospitalized patients in 2016. Appropriate management of COPD exacerbations presents a clinical challenge and, in order to guide therapy, it is important to identify the underlying cause; however, this is not possible in about a third of severe COPD exacerbations. There are several diagnostic tools that can be used to assess an exacerbation and its severity, which will in turn guide treatment, and prognostic scores should be used to predict the risk of future exacerbations. After an exacerbation is appropriately managed, a suitable discharge plan should be prepared. This should generally include reclassification of the patient according to GOLD criteria, optimization of pharmacological therapy, management of comorbidities, patient (or caregiver) education on the correct use of medications, referral to a Pulmonology Outpatient Clinic, if they are not already attending one, and a smoking cessation and respiratory rehabilitation program. In this paper, we will focus on the pharmacological strategies for the management of COPD exacerbations, risk stratification and a hospital discharge plan proposal.

Cytokine expression in response to root repair agents.

AIM: To evaluate the expression of TNF-α, IL-6, IFN-γ, TGF-ß, IL-4, IL-10, RANKL, RANK and OPG on mouse calvarial bone treated with MTA, Geristore® and Emdogain® . METHODOLOGY: Bone wounds were made on the heads of C57BL/6 mice, breaking the periosteum and the cortical surface of the calvaria. Each repair agent was inserted into sectioned Eppendorf microtubes and placed on the bone wound, and soft tissues were sutured. At 14 and 21 days, animals were sacrificed and the treated region was dissected. The calvaria bone was removed, and RNA was extracted. mRNA expression of the aforementioned cytokines was assessed using real-time PCR. Data were analysed by nonparametric methods, including the Mann-Whitney and Kruskal-Wallis tests (P < 0.05). RESULTS: Following treatment with Emdogain® and MTA, mRNA expression of RANKL, RANK and OPG increased significantly (P < 0.05) between days 14 to 21. Geristore® did not alter the basal expression of these mediators during the same period of evaluation. Whilst treatment with Emdogain® did cause a significant increase in TNF-α mRNA expression between days 14 and 21 (P < 0.05), treatment with MTA did not alter the basal expression of this cytokine at either experimental time point. However, TNF-α mRNA expression was down-regulated significantly at day 21 (P < 0.05) when Geristore® was applied. A significant increase in the mRNA expression of IL-6, TGF-ß, IL-10, IL-4 and IFN-γ was observed with Emdogain® and MTA treatment between days 14 to 21, whereas Geristore® reduced significantly the expression of IL-6, TGF-ß and IL-4 (P < 0.05). CONCLUSION: The clinical indication of these repair agents depends on the root resorption diagnosis. Whilst MTA and Emdogain® induce a pro- and anti-inflammatory response early and late, respectively, Geristore® was not associated with an inflammatory reaction when compared with both repair agents.

Potential drug-drug interactions and polypharmacy in institutionalized elderly patients in a public hospital in Brazil.

WHAT IS KNOWN ON THE SUBJECT?: Older individuals constitute an increasing proportion of the population, and therefore, are the major consumers of drugs. The elderly, especially those with mental disabilities, frequently develop chronic diseases and start using numerous drugs. Drug-drug interactions (DDIs) are a major clinical problem in the elderly population, and previous studies have focused only on antidepressants and others types of drugs used to treat mental health conditions. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: This study shows that in hospitalized elderly patients with mental disorders (aged 60-69 years), polypharmacy (≥5 drugs) and the use of drugs that act on the cardiovascular, respiratory and nervous systems can lead to potential drug-drug interactions. Moreover, it was reported that the prevalence of drug-drug interactions in elderly patients with mental disorders was high during their hospitalization in a public hospital in Brazil. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should know the factors associated with drug-drug interactions in hospitalized elderly patients with mental disorders to choose appropriate strategies for avoiding treatment failure and adverse events in patients. ABSTRACT: Introduction Despite the impact on patient safety and the fact that prevalence is higher in older patients, previous research did not analyse drug-drug interactions (DDIs) in view of nursing care of elderly psychiatric patients. Aim To identify potential drug-drug interactions and polypharmacy in prescriptions of aged inpatients with psychiatric disorders and analyse associated factors. Methods In this retrospective cross-sectional study, we analysed the medical records of institutionalized patients diagnosed with psychiatric disorders (n = 94), aged >60 years, and prescribed multiple medications. Drug prescriptions were checked at admission, midway through and the last prescription. Factors associated with DDI occurrence were assessed using multivariable logistic regression analysis. Results A DDI prevalence potential of 67.0%, 74.5% and 80.8% occurred in patients at admission, midway through hospitalization and the last prescription, respectively. Most of the prescribed drugs were nervous system agents. A high percentage of serious and contraindicated potential DDIs occurred. Age between 60 and 69 years, use of cardiovascular and respiratory system drugs, and the number of medications contributed significantly to DDI. Implications for mental health nursing Knowledge on the factors associated with DDIs in patients with mental disorders can contribute to the improvement of effectiveness and safety of nursing care.

Killing two birds with one stone? Association between tobacco and alcohol consumption.

OBJECTIVES: Tobacco and excessive alcohol consumption are addictive behaviours, listed among the 10 leading risk factors that cause death and disability in the world, and health consequences are greater if their consumption is combined. There is sparse empirical evidence on the variables that influence the simultaneous consumption of tobacco and alcohol. This study aims to identify the variables that influence the joint decision to consume alcohol and tobacco, and that encourage drinkers to smoke. STUDY DESIGN: The sample includes Portuguese adults, mainly aged 50 years and over, extracted from the Survey of Health, Ageing and Retirement in Europe, covering the year 2011. METHODS: We propose a bivariate probit model, which allows us to model simultaneously the two goods, accounting for potential correlation between smoking and drinking decisions. RESULTS: We identified the variables that influence joint consumption, and tobacco consumption among drinkers, which could be used as policy instruments to develop concerted policies. Prevention policies should focus on males, younger and more educated individuals, as well as on individuals with unhealthy eating habits, because these variables were statistically significant and increased joint consumption. In addition, these characteristics also should be regarded if we want to control tobacco consumption among alcohol consumers. CONCLUSIONS: The analysis of the interdependence between alcohol and tobacco use presented in this article may allow reducing their consumption with a common intervention, enabling policymakers to 'kill two birds with one stone' and to achieve extended health and economic gains.

Evidence for genetic overlap between adult onset Still's disease and hereditary periodic fever syndromes.

OBJECTIVE: Adult onset Still's disease (AOSD) is a severe, autoimmune disease that can be challenging to treat with conventional therapeutics and biologicals in a considerable number of cases. Therefore, there is a high need to understand its pathogenesis better. As major clinical symptoms overlap between AOSD and hereditary periodic fever syndromes (HPFS), we analysed four known HPFS genes in AOSD. METHODS: We performed Sanger sequencing and quantitative analysis of all coding regions of MEFV, TNFRSF1A, MVK and NLRP3 in 40 AOSD patients. All rare coding variants (n = 6) were evaluated for several aspects to classify them as benign to pathogenic variants. Statistical analysis was performed to analyse whether variants classified as (likely) pathogenic were associated with AOSD. RESULTS: We identified three rare variants in MEFV, one previously not described. Association to the three likely pathogenic MEFV variants was significant (p c = 2.34E- 03), and two of the three carriers had a severe course of disease. We observed strong evidence for significant association to mutations in TNFRSF1A (p c = 2.40E- 04), as 5% of patients (2/40) carried a (likely) pathogenic variant in this gene. Both of them received a biological for treatment. CONCLUSION: Our results indicate TNFRSF1A as a relevant gene in AOSD, especially in patients with a more challenging course of disease, while causal variants remain to be identified in the majority of patients.

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil.

OBJECTIVES: We aimed to report the first 54 cases of pregnant women infected by Zika virus (ZIKV) and their virologic and clinical outcomes, as well as their newborns' outcomes, in 2016, after the emergence of ZIKV in dengue-endemic areas of São Paulo, Brazil. METHODS: This descriptive study was performed from February to October 2016 on 54 quantitative real-time PCR ZIKV-positive pregnant women identified by the public health authority of São José do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiologic data collected before and after birth. Adverse outcomes in newborns were analysed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by reverse transcription PCR (RT-PCR). RESULTS: A total of 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis confirmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited adverse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though a broad clinical spectrum of outcomes, including lenticulostriate vasculopathy, subependymal cysts, and auditory and ophthalmologic disorders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes. CONCLUSIONS: Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or nonexistent in this study. The clinical presentation the newborns we studied was mild compared to other reports, suggesting that there is significant heterogeneity in congenital Zika infection.