HeberFERON en el tratamiento de pacientes con carcinoma basocelular de la oreja / HeberFERON in the treatment of patients with basal cell carcinoma of the ear

Fundamento: El carcinoma basocelular de la región auricular es considerado uno de los más agresivos y con peor pronóstico, suele ser destructivo y mutilante por lo que el tratamiento conservador, como es el uso de los interferones, es importante en la práctica médica habitual. Objetivo: Evaluar los resultados de la aplicación del HeberFERON en una serie de pacientes con carcinoma basocelular en la región auricular. Metodología: Se realizó un estudio observacional, descriptivo y longitudinal en una serie de casos con diagnóstico clínico, dermatoscópico e histopatológico de carcinoma basocelular de la oreja que recibieron tratamiento con HeberFERON en el Policlínico Centro de la ciudad Sancti Spíritus, durante el período del 20 de febrero de 2017 a 20 de diciembre de 2022. En total se incluyeron 29 pacientes. Se realizó una evaluación inicial, durante y 16 semanas después del tratamiento; se les inyectó 10.5 UI de HeberFERON 3 veces por semana perilesional e intradérmico hasta completar 9 dosis. Las variables fueron la respuesta al tratamiento y presencia o no de eventos adversos. Resultados: Predominó el sexo masculino, la localización en la concha de la oreja, subtipo clínico nódulo ulcerativo y el histológico sólido, con respuesta completa en la mayoría de los pacientes. Como eventos adversos más comunes se presentaron dolor en el sitio de inyección, fiebre, edema y eritema perilesional. Conclusiones: La respuesta al tratamiento fue favorable en la mayoría de los pacientes y los eventos adversos que se observaron fueron los descritos en la literatura sin cambio en la actitud farmacológica.

Background: Basal cell carcinoma of the auricular region is one of the most aggressive cancers and with the worst prognosis, is usually destructive and mutilating, therefore conservative treatment, such as the use of interferons, is important in routine medical practice. Objective: To evaluate the results of HeberFERON application in a series of patients with basal cell carcinoma in the auricular region. Methodology: An observational, descriptive and longitudinal study was conducted on a series of cases with clinical, dermoscopic and histopathologic diagnosis of basal cell carcinoma of the ear treated with HeberFERON at the Center Polyclinic in Sancti Spíritus city, during the period from February 20, 2017 through December 20, 2022. A total of 29 patients were included in the study. An evaluation was conducted at the start of treatment, during treatment, and 16 weeks after treatment; the patients were treated with 10.5 IU of HeberFERON by perilesional and intradermal injections three times a week until completing nine doses. The variables were the response to the treatment and the presence or absence of any adverse events. Results: The male sex predominated, location in the ear turbinate, clinical subtype ulcerative nodule and solid histologic subtype, with a complete response in the majority of patients. The most common adverse events were injection site pain, fever, edema, and perilesional erythema. Conclusions: The response to treatment was favorable in most patients, and the adverse events observed were those described in the literature, with no change in pharmacologic attitude.

Chitosan microparticles loaded with essential oils inhibit duo-biofilms of Candida albicans and Streptococcus mutans

Abstract Oral candidiasis is a common fungal infection that affects the oral mucosa, and happens when Candida albicans interacts with bacteria in the oral microbiota, such as Streptococcus mutans, causing severe early childhood caries. C. albicans and S. mutans mixed biofilms are challenging to treat with conventional antimicrobial therapies, thus, new anti-infective drugs are required. Objective This study aimed to test a drug delivery system based on chitosan microparticles loaded with geranium and lemongrass essential oils to inhibit C. albicans and S. mutans mixed biofilms. Methodology Chitosan microparticles loaded with essential oils (CM-EOs) were obtained by spray-drying. Susceptibility of planktonic were performed according CLSI at 4 to 2,048 µg/mL. Mixed biofilms were incubated at 37ºC for 48 h and exposed to CM-EOs at 256 to 4,096 µg/mL. The antimicrobial effect was evaluated using the MTT assay, with biofilm architectural changes analyzed by scanning electron microscopy. RAW 264.7 cell was used to evaluate compound cytotoxicity. Results CM-EOs had better planktonic activity against C. albicans than S. mutans. All samples reduced the metabolic activity of mixed C. albicans and S. mutans biofilms, with encapsulated oils showing better activity than raw chitosan or oils. The microparticles reduced the biofilm on the slides. The essential oils showed cytotoxic effects against RAW 264.7 cells, but encapsulation into chitosan microparticles decreased their toxicity. Conclusion This study demonstrates that chitosan loaded with essential oils may provide an alternative method for treating diseases caused by C. albicans and S. mutans mixed biofilm, such as dental caries.

Foeniculum vulgare (hinojo): alternativa terapéutica femenina / Foeniculum vulgare (fennel): female therapeutic alternative

INTRODUCCIÓN: el Foeniculum vulgare es una planta medicinal de gran importancia por sus propiedades y valor nutricional. Los extractos del hinojo poseen propiedades terapéuticas ante cambios endocrinos, perturbaciones psicológicas, malestares y sintomatología presente en el ciclo vital de la mujer. OBJETIVOS: analizar información sobre las diferentes propiedades y efectos terapéuticos del F. vulgare en las distintas etapas del ciclo vital de la mujer. METODOLOGÍA: se realizó una búsqueda crítica y analítica del tema por medio de lenguaje controlado recopilado del MeSH y DeCs en metabuscadores científicos. RESULTADOS: el desarrollo de esta revisión fue viable debido a la variedad de literatura, estudios y ensayos clínicos internacionales de libre acceso de información relevante al tema. CONCLUSIÓN: esta planta puede ser empleada como tratamiento, prevención y como fuente de nutrientes; y sus extractos tienen un efecto importante en el ciclo vital de la mujer dependiendo se encuentre en menstruación, menopausia o postmenopausia.

INTRODUCTION: foeniculum vulgare is a medicinal plant of great importance for its properties and nutritional value.Fennel extracts possess therapeutic properties against endocrine changes, psychological disturbances, discomfort and symptomatology present in the vital cycle of women. OBJECTIVES: analyze information on the different properties and therapeutic effects of F. vulgare in the different stages of the life cycle of women. METHODOLOGY: a critical and analytical search of the topic was performed ,by means of controlled language compiled from MeSH and DeCs in scientific meta-search engines. RESULTS: the development of this review was feasible due to the variety of freely available international literature, studies and clinical trials of information relevant to the topic. CONCLUSIÓN: this plant can be used as a treatment, prevention and as a source of nutrients; and its extracts have an important effect on the vital cycle of the woman depending on whether she is in menstruation, menopause or postmenopause.

Ocular surface toxicity of depatuxizumab mafoditin (ABT-414): case reports / Toxicidade do depatuxizumabe mafodotina (ABT-414) na superfície ocular: relatos de casos

ABSTRACT The purpose of this study is to report the clinical features and outcomes of ocular surface toxicity following depatuxizumab mafoditin (ABT-414) therapy for unresectable glioblastoma. Ocular signs and symptoms of three patients treated with ABT-414 during a phase III trial for glioblastoma multiforme were evaluated. Both eyes of all patients were damaged during the week after the first infusion of the ABT-414 molecule. In all patients, mild-to-moderate keratitis could be ascertained, along with decreased visual acuity and blurred vision, as well as foreign-body sensation and redness. Symptoms and visual acuity improved 4 weeks. In conclusion, ABT-414 therapy may cause transient ocular surface toxicity. The initiation of artificial tears and lubricant ointment was enough to control the ocular surface signs and symptoms. A multidisciplinary approach, complete ophthalmologic monitorization, and elaboration of protocols are required to adequately manage these patients.

RESUMO Nosso objetivo é relatar as características clínicas e os resultados da toxicidade na superfície ocular após a terapia com depatuxizumabe mafodotina (ABT-414) para glioblastoma irressecável. Os sinais e sintomas oculares de três pacientes que foram tratados com ABT-414 durante um estudo de fase III para glioblastoma multiforme foram avaliados. Ambos os olhos de todos os pacientes foram danificados durante a semana após a primeira infusão da molécula ABT-414. Em todos os pacientes, uma ceratite de leve a moderada pode ser verificada, juntamente com uma diminuição da acuidade visual e visão turva, bem como sensação de corpo estranho e vermelhidão. Os sintomas e a acuidade visual melhoraram em um período de 4 semanas. Em conclusão, a terapia com ABT-414 pode causar toxicidade transitória na superfície ocular. A iniciação com lágrimas artificiais e pomada lubrificante foi suficiente para controlar os sinais e sintomas na superfície ocular. Uma abordagem multidisciplinar, com acompanhamento oftalmológico completo e a elaboração de protocolos são necessários para o manejo adequado desses pacientes.

Evaluación de la eficacia de la tintura de manzanilla al 20 % en la estomatitis aftosa / Evaluation of the efficacy of 20 % chamomile tincture in aphthous stomatitis

RESUMEN Fundamentación: En el tratamiento tradicional de la estomatitis aftosa no se incluye la tintura de manzanilla al 20 %, sin embargo, sus propiedades justifican su posible utilización. Objetivo: Evaluar la eficacia de la tintura de manzanilla al 20 % como alternativa de tratamiento en pacientes con estomatitis aftosa en la disminución de la intensidad del dolor. Metodología: Se realizó un estudio experimental abierto, controlado y aleatorizado en el municipio Sancti Spíritus entre septiembre de 2019 y marzo de 2021. Se seleccionaron 39 pacientes con estomatitis aftosa mayores de 12 años de edad; mediante asignación aleatoria, se conformaron 2 grupos al azar: 1 de estudio aplicando tintura de manzanilla al 20 % y otro de control utilizando triamcinolona al 0.1 %. La variable de resultado principal del estudio utilizada fue la eficacia. Resultados: Predominó el sexo femenino para ambos grupos. En el grupo estudio, la edad más representativa fue de 24 a 35 años (25 %) y en el grupo control predominaron las edades de 36 a 47 años (26.3 %). Al comparar la intensidad del dolor en los diferentes momentos de evolución no existieron diferencias significativas entre ambos grupos. Se observó un predominio de pacientes sin reacciones adversas, estas se presentaron en un número muy reducido, 1 paciente en cada grupo. Conclusiones: La tintura de manzanilla al 20 % como alternativa de tratamiento de los pacientes con estomatitis aftosa, resultó de eficacia similar a la triamcinolona al 0.1 %.

ABSTRACT Background: Traditional treatment of aphthous stomatitis does not include 20 % chamomile tincture, however its properties justify its possible use. Objective: To evaluate the efficacy of 20 % chamomile tincture as an alternative treatment in patients with aphthous stomatitis for the reduction of pain intensity. Methodology: An exposed, controlled and randomized experimental study was conducted in Sancti Spíritus municipality between September 2019 and March 2021. Thirty-nine patients with aphthous stomatitis older than 12 years of age were selected; by random assignment, 2 groups were randomly formed: 1 study group applying chamomile tincture at 20 % and another control group using triamcinolone at 0.1 %. Efficiency was the main outcome study variable. Results: Female sex predominated in both groups. In the study group, the most representative age was 24 to 35 years (25 %) in the control group the predominant age was 36 to 47 years (26.3 %). When comparing the pain intensity at different times of evolution there were no significant differences between the two groups. A patients' prevalence without adverse reactions was observed, these occurred in a very small number, 1 patient in each group. Conclusions: The efficacy of chamomile tincture at 20 %, as an alternative treatment for patients with aphthous stomatitis, was similar to that of triamcinolone at 0.1 %.

Kounis Syndrome: Case Report in Goiânia/BR

Abstract 22-year-old male patient with no heart disease, who was given an ambulatory medication with analgesics due to an acute renal crisis. After the drug administration, the patient presented dyspnea, cyanosis, and hemoptysis. There was suspicion of anaphylactic shock, which was treated, but there was no improvement in the clinical condition. The patient was referred to the Intensive Care Unit, where tests were performed showing elevated cardiac enzymes and Immunoglobulin E and Computed Tomography of Thoracic revealed alveolar hemorrhage. He developed clinical worsening and died after sepsis. The final diagnosis was of kounis syndrome due to the hypersensitivity reaction to the analgesics introduced in the patient, generating an acute coronary syndrome (ACS). The purpose of this case report was to highlight a syndrome that is little reported because it is not part of the differential diagnosis routines of ACS, but it generates important complications.

Prevalence of xerostomia and its association with systemic diseases and medications in the elderly: a cross-sectional study

ABSTRACT BACKGROUND: Dry mouth syndrome or xerostomia is defined as decreased salivary flow or hypofunction of salivary glands. Its origins are multicausal and might be the result of a change in the salivary glands or a systemic imbalance. OBJECTIVE: To ascertain the prevalence of self-reported xerostomia and to identify associated factors. DESIGN AND SETTING: Cross-sectional study on the entire population of 293 elderly people over 60 years of age living in a Brazilian municipality. METHODS: Data were gathered from a questionnaire that asked about demographic data, chronic diseases and use of continuous medications, and which used the Xerostomia Inventory (XI) to evaluate dry mouth sensation. Our analysis consisted of multivariate regression and estimation of odds ratios (OR) and their respective 95% confidence intervals (CI) in binary logistic regression models. RESULTS: The prevalence of self-reported xerostomia was 19.1%. Elderly people with diabetes had higher odds of having self-reported xerostomia (OR: 3.59; 95% CI: 1.48-8.68; P < 0.001) as did those who had chronic diseases and used continuous medication (OR: 2.3; 95% CI: 1.19-4.67; P = 0.009). Elderly people who used continuous medication for the gastrointestinal tract were more likely to have xerostomia (OR: 2.14; 95% CI: 1.03-1.44; P = 0.030). CONCLUSIONS: Elderly people with diabetes and chronic diseases who were using continuous medication were more likely to have dry mouth. Use of continuous medications for the gastrointestinal tract led to a greater chance of having self-reported xerostomia.

La tintura de manzanilla al 20 % como alternativa de tratamiento para la estomatitis aftosa / Chamomile tincture at 20 % as an alternative treatment for aphthous stomatitis

RESUMEN Fundamento: Las aftas son causa de consultas frecuentes entre las urgencias estomatológicas. La tintura de manzanilla, resulta muy efectiva por su propiedad analgésica, antiinflamatoria, protectora, reparadora de membrana y reepitelizante. Objetivo: Ilustrar los resultados de la tintura de manzanilla al 20 % como alternativa de tratamiento en una paciente con estomatitis aftosa Presentación de caso: Paciente de 66 años de edad, femenina, con antecedentes de salud, fumadora, sometida a estrés, que acudió a consulta por lesiones aftosas dolorosas en el borde lateral izquierdo y dorso de la lengua. Conclusiones: La paciente con estomatitis aftosa, tratada con tintura de manzanilla al 20 %, mostró moderación del dolor a los 3 días, evolución general satisfactoria y cicatrización de las lesiones a los 5 días de la primera aplicación.

ABSTRACT Background: Aphthous ulcers are a frequent cause of assistance at the stomatology emergencies. Chamomile tincture (Matricaria Chamomilla) is very effective due to its analgesic, anti-inflammatory, protective, membrane-repairing and re-epithelialising properties. Objective: To illustrate the results of chamomile tincture at 20 % as an alternative treatment in a patient with aphthous stomatitis. Case report: A 66-year-old female patient, with healthy backgrounds, smoker, under stress, who consulted because of painful aphthous lesions on the left lateral border and tongue dorsum. Conclusions: The patient with aphthous stomatitis, treated with chamomile tincture at 20 %, showed pain moderation after 3 days, satisfactory general evolution and healing of the lesions 5 days after the first application.

Evaluation of retinal and choroidal microvascular changes in patients who received hydroxychloroquine by optical coherence tomography angiography / Avaliação de alterações microvasculares da retina e coroide em pacientes sob hidroxicloroquina através da angiografia por tomografia de coerência óptica

ABSTRACT Purpose: The aim of the study is to evaluate the retinal and choroidal microvascular changes via optical coherence tomography angiography in patients who received hydroxy­chloroquine. Methods: In total, 28 eyes of 28 patients (24 females, and 4 males) receiving treatment with hydroxy­chloroquine were assessed in this cross-sectional cohort study (hydroxychloroquine group). The high-and low-risk groups consisted of patients receiving hydroxychloroquine for ≥5 years (14 eyes of 28 patients) and <5 years (14 eyes of 28 patients), respectively. A total of 28 age- and gender-matched volunteers were enrolled as the control group. The macular flow area (superficial, deep, and choriocapillaris), superficial and deep vessel density, foveal avascular zone area, central foveal thickness, and subfoveal choroidal thickness parameters were measured by optical coherence tomography angiography. Results: The mean age of the 28 patients who received hydroxychloroquine and the 28 age-matched controls was 45.5 ± 11.1 years (range: 29-70 years) and 44.5 ± 13.9 years (range: 28-70 years), respectively. In patients who received hydroxychloroquine, the values for the superficial, deep, and choriocapillaris macular flow areas were 13.578 ± 0.30, 13.196 ± 0.31, and 17.617 ± 0.42, respectively. In controls, these values were 16.407 ± 0.95, 13.857 ± 0.31, and 18.975 ± 0.76, respectively (p<0.05 for all). The superficial, deep, and cho­riocapillaris flow areas were significantly smaller in patients who received hydroxychloroquine than those in controls (p<0.05 for all). Superficial and deep vessel densities were significantly reduced in patients who received hydroxychlo­roquine in all regions (i.e., foveal, parafoveal, temporal, superior, nasal, and inferior) (p<0.05 for all). Moreover, significant difference was observed between the groups in the foveal avascular zone area (superficial and deep), central foveal thickness, and subfoveal choroidal thickness (p<0.05 for all). Conclusions: Retinochoroidal microvascular flow and vessel density of the macular area were significantly decreased in patients who received hydroxychloroquine. Hy­droxychloroquine may damage the retinochoroidal mi­cro­vascular architecture. Optical coherence tomography angiography may contribute to the early detection of hy­dro­xychloroquine-induced retinal toxicity.

RESUMO Objetivo: O objetivo do estudo foi de avaliar as alterações microvasculares da retina e da coroide em pacientes sob hidroxicloroquina, através da angiografia por tomografia de coerência óptica. Métodos: Este é um estudo transversal de coorte que avaliou um total de 28 olhos de 28 pacientes (24 mulheres e 4 homens) submetidos a tratamento com hidroxicloroquina (grupo da hidroxicloroquina). Catorze olhos de 28 pacientes em uso de hidroxicloroquina por mais de 5 anos foram definidos como sendo o grupo de alto risco, ao passo que o grupo de baixo risco consistiu em 14 olhos de 28 pacientes em uso de hidroxicloroquina por menos de 5 anos. Foram ainda incluídos 28 voluntários como grupo de controle, pareados por idade e sexo. Através de angiografia por tomografia de coerência óptica, foram medidos os seguintes parâmetros: área do fluxo macular (superficial, profundo e coriocapilar), densi­dade vascular superficial e profunda, área da zona avascular foveal e espessura da coroide subfoveal. Resultados: Foram recrutados para o estudo um total de 28 pacientes sob tratamento com hidroxicloroquina, com idade média de 45,5 ± 11,1 (29-70) anos, e 28 membros do grupo de controle, pareados por idade e sexo, com idade média de 44,5 ± 13,9 (28-70) anos. As áreas superficial, profunda e coriocapilar do fluxo macular foram respectivamente de 13,578 ± 0,30, 13,196 ± 0,31 e 17,617 ± 0,42 nos pacientes em tratamento com hidroxicloroquina e, respectivamente de 16,407 ± 0,95, 13,857 ± 0,31 e 18,975 ± 0,76 no grupo de controle (p<0,05 para todos os valores). As três medições de área do fluxo macular foram significativamente menores nos pacientes em uso de hidroxicloroquina em comparação com os indivíduos do grupo de controle (p<0,05 para todos os valores). As densidades vasculares superficial e profunda mostraram-se significativamente reduzidas em todas as regiões (foveal, parafoveal, temporal, superior, nasal e inferior) nos pacientes em uso de hidroxicloroquina (p<0,05 para todos os valores). Finalmente, também foi observada uma diferença significativa entre os grupos em relação à área da zona avascular foveal (superficial e profunda), à espessura foveal central e à espessura da coroide subfoveal (p<0,05 para todos os valores). Conclusão: O fluxo microvascular retinocoroidal e a densidade vascular da área macular mostraram-se significativamente diminuídos nos pacientes sob hidroxicloroquina. Este fármaco pode danificar a arquitetura microvascular retinocoroidal e a angiografia por tomografia de coerência óptica pode contribuir para a detecção precoce da toxicidade retiniana induzida pela hidroxicloroquina.

Relationship between irradiation time of riboflavin-ultraviolet A scleral collagen cross-linking and retinal injury / 中华实验眼科杂志

Objective:To investigate the effects of riboflavin-ultraviolet A scleral collagen cross-linking on the retina under different irradiation time, and to determine the safe irradiation time.Methods:Sixty healthy New Zealand white rabbits were randomly divided into control group (0 minute group), 10 minutes group, 20 minutes group, 30 minutes group and 40 minutes irradiation group according to the irradiation time, with 12 rabbits in each group.The left eye was irradiated with riboflavin-ultraviolet A scleral collagen (370 nm, 10 mW/cm 2). The histopathological change of retina was observed by light microscope and transmission electron microscope and compared among different groups.The concentration of MDA and the activities of SOD, CAT and GSH-Px in retinal tissue were detected by corresponding kits.The expression levels of SOD and CAT proteins in retinal tissue were detected by Western blot method.The study protocol was approved by the Binzhou Medical University Laboratory Animal Ethical Committee (No.2017-80). The use and care of animals complied with the statement of ARVO and the Regulation on the Management of Laboratory Animal Quality of China. Results:Under the light microscope, the structure of the retinas in the control group was orderly arranged.Under the transmission electron microscope, the lamellar structure in the inner segment and the mitochondrial structure in the outer segment of the photoreceptor cells were intact, and the mitochondrial ridge was continuous in the control group.There was no obvious difference in retinal morphology between the 10 minutes irradiation group and the control group under both the light microscope and the transmission electron microscope, and the retinal damage became more severe with the prolongation of irradiation time.The concentration of MDA in the retina of each group was elevated gradually with the increase of irradiation time, and the difference was statistically significant ( F=65.25, P<0.05). The concentration of MDA was (11.31±1.84), (14.94±1.04)and (18.25±1.42)nmol/mgprot in the 20 minutes, 30 minutes and 40 minutes irradiation groups respectively, which were significantly higher than (1.13±0.02)nmol/mgprot in the control group (all at P<0.05). The MDA concentration in 20 minutes, 30 minutes and 40 minutes irradiation groups was increased successively, showing statistically significant differences (all at P<0.05). With the prolongation of irradiation time, the activities of SOD, CAT and GSH-Px as well as the expression levels of SOD and CAT proteins were significantly decreased gradually ( F=44.09, 34.18, 35.60, 115.75, 78.86; all at P<0.05). The differences between the control group and 20 minutes, 30 minutes, 40 minutes irradiation groups, and the differences among 20 minutes, 30 minutes, 40 minutes irradiation groups were statistically significant (all at P<0.05). Conclusions:Riboflavin-ultraviolet A 10 mW/cm 2 scleral collagen cross-linking irradiation for 10 minutes is safe.Excessive irradiation time can cause damage to the retina of rabits.

Estudo da Reatividade Microvascular em Pacientes Hipertensos com Adiposidade Corporal Elevada / Microvascular Reactivity in Hypertensive Patients with High Body Adiposity

Resumo Fundamento: Diversos índices antropométricos têm sido propostos para determinar a associação entre excesso de peso e fatores de risco cardiovascular. Objetivo: Avaliar a relação entre adiposidade corporal e reatividade microvascular em pacientes hipertensos sob terapia anti-hipertensiva. Métodos: Pacientes hipertensos tratados de 40 a 70 anos foram submetidos à avaliação de índices antropométricos: conicidade (IC), adiposidade corporal (IAC), adiposidade visceral (IAV) e relação cintura-estatura (RCE). Os participantes foram divididos pelos tercis de percentual de gordura (%G) obtido pela bioimpedância elétrica (BIA) e submetidos a teste de reatividade microvascular (laser speckle contrast image), medida da velocidade da onda de pulso (VOP). O valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: A variação da área sob a curva (ASC) da perfusão cutânea foi inferior no tercil superior (97 ± 57% vs. 67 ± 36%; p = 0,027). O %G apresentou correlação significativa com RCE (r = 0,77; p < 0,001), IAV (r = 0,41; p = 0,018), IC (r = 0,60; p < 0,001) e IAC (r = 0,65; p < 0,001) nos homens e somente com RCE (r = 0,55; p < 0,001) e IAC (r = 0,60; p < 0,001) nas mulheres. Na regressão linear, a ASC mostrou associação independente com o %G (β =-3,15; p = 0,04) nas mulheres e com a glicemia (β = -1,15; p = 0,02) nos homens. Não houve diferença nas medidas de VOP. Conclusão: Os índices antropométricos de obesidade foram mais associados ao %G nos homens. A maior adiposidade corporal foi relacionada com menor reatividade microvascular, o que foi mais evidente nas mulheres. Não houve diferença na rigidez arterial, o que pode ter sido influenciado pelo tratamento anti-hipertensivo.

Abstract Background: Several anthropometric indexes have been proposed to determine the association between overweight and cardiovascular risk factors. Objective: To evaluate the relationship between body adiposity and microvascular reactivity in hypertensive patients under antihypertensive therapy. Methods: Treated hypertensive patients aged 40 to 70 were submitted to evaluation of anthropometric indexes: conicity (CI), body adiposity (BAI), visceral adiposity (VAI) and waist-to-height ratio (WHtR). Participants were divided by the terciles of fat percentage (%F) obtained by bioelectrical impedance. The patients underwent microvascular reactivity test (Laser Speckle Contrast Image) and pulse wave velocity (PWV) measurement. The p value <0.05 was considered statistically significant. Results: The variation of the area under the curve (AUC) of the skin perfusion was lower in the upper tercile (97±57% vs. 67±36%; p=0.027). %F showed significant correlation with WHtR (r=0.77; p<0.001), VAI (r=0.41; p=0.018), CI (r=0.60; p<0.001), BAI (r=0.65; p<0.001) in men and only with WHtR (r=0.55; p<0.001) and BAI (r=0.60; p<0.001) in women. In linear regression, AUC was independently associated with %F (β=−3.15; p=0.04) in women and with blood glucose (β=−1.15; p=0.02) in men. There was no difference in PWV measurements. Conclusion: Anthropometric indices were more associated with %F in men. Higher body adiposity was associated with lower microvascular reactivity, which was more evident in women. There was no difference in arterial stiffness, which may have been influenced by antihypertensive treatment.

Suspensão oral de rutina interfere na hiperplasia hepática em ratos / Oral rutin suspension intervene in hepatic hyperplasia in rats

ABSTRACT BACKGROUND: Rutin is a flavonol glycoside that can be found in a wide variety of vegetables and has activity, anti-cancer, anti-inflammatory and anti-diabetic properties. OBJECTIVE: This study investigated the effect of rutin oral administration on Wistar rats submitted to hepatic hyperplasia after partial hepatectomy (PH). METHODS: To achieve this, we considered the analysis of hepatic hyperplastic and plasma biochemical activity of Wistar rats, subjected to treatment with rutin 40 mg/kg/day for 10 days in group 1 (G1) or saline in group 2 (G2), followed by partial hepatectomy. RESULTS: The results indicated an increase in the number of mitoses after 24 hours and 48 hours (P=0.0022 and P=0.0152, respectively) of PH in the group that received rutin, as well as an increase in AST serum levels after 24 hours (P=0.0159) and 48 hours (P=0.0158) and alkaline phosphatase after 24 hours (P=0.015) in the same group, in relation to the respective controls. The group that received rutin showed a more evident variation than the control group when comparing the 24 hour and 48 hour results regarding AST, number of mitoses and number of apoptosis (P<0.005). CONCLUSION: It was concluded that rutin intervened in hepatic hyperplasia after 24 hours and 48 hours of PH, favoring hepatic hyperplasia.

RESUMO CONTEXTO: A rutina é um flavonoide que pode ser encontrado em grande variedade de vegetais e apresenta atividades anticâncer, anti-inflamatória e antidiabética. OBJETIVO: O objetivo deste estudo foi investigar o efeito da administração oral de rutina sobre a hiperplasia hepática em ratos Wistar submetidos à hepatectomia parcial. MÉTODOS: Foi realizada a análise da hiperplasia hepática e da bioquímica plasmática dos ratos Wistar tratados com rutina 40 mg/kg por 10 dias no grupo 1 (G1) ou salina no grupo 2 (G2), seguido da hepatectomia parcial. RESULTADOS: Os resultados indicaram aumento do número de mitoses após 24 e 48 horas (P=0,0022 e P=0,0152, respectivamente) da hepatectomia parcial no grupo que recebeu rutina, além de um aumento nos níveis séricos de AST após 24 horas (P=0,0159) e 48 horas (P=0,0158) e de fosfatase alcalina após 24 horas (P=0,015) no mesmo grupo, em relação aos respectivos controles. O grupo que recebeu rutina mostrou variação mais evidente do que o grupo controle quando se comparou os resultados de 24 horas e 48 horas em relação a AST, número de mitoses e número de apoptoses (P<0,005). CONCLUSÃO: Foi possível concluir que a rutina interferiu na hiperplasia hepática após 24 e 48 horas após a hepatectomia parcial, favorecendo a hiperplasia hepática.

Resultados de la cicatrización con bevacizumab en la degeneración macular relacionada con la edad húmeda / Results of the cicatrization with bevacizumab in the age-related humid macular degeneration

RESUMEN Fundamento: la degeneración macular relacionada con la edad está entre las causas más comunes de pérdida visual severa e irreversible en pacientes mayores de 60 años en el mundo industrializado. Es considerado el aumento de la esperanza de vida en la población de los adultos mayores, la necesidad de un diagnóstico temprano y oportuno, es obvio para esta enfermedad que constituye un problema de salud a resolver. Objetivo: describir los resultados de la cicatrización con el uso del bevacizumab en la degeneración macular relacionada con la edad húmeda. Métodos: se realizó un estudio descriptivo, longitudinal en pacientes con el diagnóstico de degeneración macular relacionada con la edad húmeda. La población la conformaron 25 pacientes que acudieron a la consulta de retina en el periodo de octubre 2018 a abril 2019 y que cumplieron con los criterios de selección. Se les aplicó una encuesta y se estudiaron variables como: edad, sexo, antecedentes patológicos personales, número de inyecciones intravitreas colocadas a cada paciente, complicaciones post inyección y cicatrización de la lesión macular. BMMEM Resultados: según el comportamiento de los grupos de edades y el sexo, se encontró que la edad entre 60 y 69 fue de diez pacientes y el sexo femenino 15 pacientes fueron los más frecuentes. La hipertensión ocular fue la complicación que predominó. El antecedente patológico personal más frecuente fue la hipertensión arterial con cuatro pacientes. La mayor cantidad de ojos cicatrizaron con la administración de una y dos dosis del medicamento. Conclusiones: predominó el grupo de edad de 60 a 69 años y el sexo femenino. La hipertensión ocular fue la complicación más frecuente. Se constató la hipertensión arterial como el antecedente patológico personal más habitual. La cicatrización de los ojos ocurrió con la administración entre una y dos dosis.

ABSTRACT Background: the age-related macular degeneration is among the most common causes of harsh and irreversible visual loss in patient elders of 60 years in the industrialized world. Considering the increase of life expectancy and the rise in population of the senior citizens, the need of an early and opportune diagnosis, it is obvious for this disease that constitutes a health problem we have to solve. Objective: to describe the results of the cicatrization with the use of the bevacizumab in the age-related humid macular degeneration. Methods: a descriptive, longitudinal study in patients with the diagnosis of age-related humid macular degeneration was carried out. 25 patients that attended the retinal consultation in the period October, 2018 to April, 2019 and who fulfilled the criteria constituted the population of selection. They were applied an opinion poll and they studied variables were: Age, sex, pathological personal background, number of intravitreous injections placed to each patient, complications after injection and cicatrization of the macular injury. B Results: according to the age groups and the sex, it was shown that the age between 60 and 69, ten patients and the feminine sex 15 patients were the most frequent. The ocular hypertension was the complication that predominated with four patients. The greatest amount of eyes healed with the administration of one and two doses of the medication. Conclusions: the age group from 60 to 69 years and the feminine sex predominated. The ocular hypertension was the most frequent complication. It was verified high blood pressure as the most frequent pathological antecedent. The cicatrization of the eyes happened with the administration between one and two doses.

Topical mitomycin in endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in older children / Mitomicina tópica em sondagem endoscópica assistida para tratar obstrução congênita do ducto nasolacrimal em crianças mais velhas

ABSTRACT Purpose: Mitomycin C has been used in ophthalmic surgery to mitigate postoperative scarring. However, the outcomes of endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction with adjunctive mitomycin C in children remain unknown. Our study was aimed to evaluate the efficacy and safety of adjunctive application of mitomycin C after endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in children. Methods: This is a retrospective chart review performed in a tertiary eye care hospital involving children with congenital nasolacrimal duct obstruction, who underwent endoscopic-assisted probing from October 2013 to August 2015. We compared children who underwent endoscopic-assisted probing with mitomycin C (mitomycin C group) versus others who underwent endoscopic-assisted probing without mitomycin C (endoscopic-assisted probing group). The mitomycin C group received 0.2 mg/ml within 4 min to the nasolacrimal duct ostium using a cotton tip applicator immediately after probing. Probing was considered successful when patient complaints of tearing were reduced or the results of the dye disappearance test were normal. Demographic data, clinical features, and intraoperative and postoperative variables were correlated to the success rate. Results: The study sample comprised 68 lacrimal vies. The majority of children had bilateral obstruction and no previous history of probing. The mean age of the patients was approximately 4 years. Most obstructions were considered complex. The success rates were high in both groups (p>0.05). There were no adverse events related to the use of mitomycin C (p>0.05). Conclusions: Although mitomycin C has no adverse effects when applied to the opening of the nasolacrimal duct, its use after lacrimal probing for the treatment of congenital nasolacrimal duct obstruction does not improve the chance of success.

RESUMO Objetivo: A mitomicina C tem sido usada em cirurgia oftálmica para reduzir cicatrizes pós-operatórias. Entretanto, os resultados da sondagem endoscópica assistida para o tratamento da obstrução congênita do ducto nasolacrimal com mitomicina C adjuvante em crianças permanecem desconhecidos. Nosso estudo teve como objetivo avaliar a eficácia e a segurança da aplicação da mitomicina C após a sondagem endoscópica assistida para o tratamento da obstrução congênita do ducto nasolacrimal em crianças. Métodos: Trata-se de uma revisão retrospectiva de prontuários, realizads em um hospital terciário de oftalmologia, envolvendo crianças com obstrução congênita do ducto nasolacrimal, submetidas à sondagem endoscópica de Outubro de 2013 a Agosto de 2015. Comparamos crianças submetidas à sondagem endoscópica com mitomicina C (grupo mitomicina C) versus outros que foram submetidos à sondagem endoscópica sem mitomicina C (grupo de sondagem endoscópica). O grupo mitomicina C recebeu 0,2 mg/ml em 4 min para o óstio do ducto nasolacrimal usando um aplicador de ponta de algodão imediatamente após a sondagem. A sondagem foi considerada bem-sucedida quando as queixas de lacrimejamento dos pacientes foram reduzidas ou os resultados do teste de desaparecimento do corante foram normais. Dados demográficos, sinais clínicos, variáveis intra e pós-operatórias foram correlacionados com a taxa de sucesso. Resultados: A amostra do estudo foi composta por 68 vias lacrimais. A maioria das crianças apresentava obstrução bilateral e sem histórico prévio de sondagem. A média de idade dos pacientes era de aproximadamente 4 anos. A maioria das obstruções foi considerada complexa. As taxas de sucesso foram altas nos dois grupos (p>0.05). Não houve efeitos adversos relacionados ao uso da mitomicina C (p>0.05). Conclusões: Apesar a mitomicina C não tenha efeitos adversos quando aplicada à abertura do ducto nasolacrimal, seu uso após sondagem lacrimal no tratamento da obstrução congênita do ducto nasolacrimal não melhora a chance de sucesso.

Caracterización de pacientes con carcinoma basocelular tratados con HeberFERON / Caracterization of patiens with basal cell carcinoma treated with HeberFERON

RESUMEN Fundamento: el carcinoma basocelular es el cáncer cutáneo más frecuente. El tratamiento de elección es quirúrgico, existen otras terapéuticas. El HeberFERON es una formulación farmacéutica que contiene una mezcla de interferones alfa2b y Y en proporciones sinérgicas de actividad anti-tumoral. Objetivo: caracterizar los pacientes con carcinoma basocelular tratados con HeberFERON. Métodos: se realizó un estudio observacional descriptivo transversal. El universo lo constituyeron 22 pacientes con diagnóstico clínico e histológico de carcinoma basocelular, que asistieron a consulta de Dermatología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, durante el periodo de estudio se administró 3,5 millones UI de HeberFERON, perilesional, tres veces por semana en días alternos, durante tres semanas, seguidos cada 15 días durante 13 semanas, con evaluación final a la semana 16. Las variables estudiadas fueron: sexo, foto tipo cutáneo, localización, tamaño de las lesiones, subtipo clínico, ocupación laboral, respuesta clínica, efecto cosmético y reacciones adversas. La información obtenida fue procesada mediante el paquete estadístico SPSS v21.Los métodos empleados fueron estadística descriptiva con distribución de frecuencias absolutas y relativas. Los resultados se expusieron en tablas y gráficos. Resultados: predominó el sexo masculino, foto tipo cutáneo III en más de la mitad de los enfermos. Las lesiones en cara predominaron en más de las cuatro quintas partes de ellos, casi las dos terceras medían menos de dos centímetros. Prevaleció el subtipo clínico nodular en la mitad de estos, igual que los trabajadores expuestos al sol. Todos tuvieron respuesta clínica favorable, con respuesta completa en los dos tercios, y parcial en un tercio, igual que el efecto cosmético aceptable. La mayoría presentó escalofríos como reacción adversa, seguida de fiebre. Conclusiones: el HeberFERON resultó un medicamento eficaz y seguro para tratar el carcinoma basocelular; ofrece una alternativa en enfermos que no pueden ser sometidos a cirugía.

ABSTRACT Background: basal cell carcinoma is the most frequent skin cancer. The treatment of choice is surgical, but there are other therapies. HeberFERON is a pharmaceutical formulation containing a mixture of interpheron alpha2b and IFN-Y in synergistic proportions of anti-tumor activity. Objective: to characterize patients with basal cell carcinoma treated with HeberFeron. Methods: a transversal, observational, descriptive study was carried out in which 22 patients were clinically and histologically diagnosed with basal cell carcinoma, who attended a Dermatology consultation at the University Hospital Manuel Ascunce Domenech, Camagüey, Cuba. 3.5 million IU of HeberFeron, was administered, near the lesion, three times a week on alternate days for three weeks, followed biweekly for 13 weeks, with final evaluation at week 16. The variables studied were: sex, skin photo-type, tumor site, size of lesions, clinical subtype, occupation, clinical response, cosmetic effect and adverse reactions. The information obtained was processed using the statistical package SPSS v21. The methods used were descriptive statistics with distribution of absolute and relative frequencies. The results were presented in tables and graphs. Results: male sex, cutaneous photo-type III, predominated in more than half of the patients. Face lesions predominated in more than four fifths of them, and almost two thirds measured less than two centimeters. The nodular clinical subtype prevailed in half of these, just like workers exposed to the sun. All had a favorable clinical response, with a complete response in two thirds, and partial in a third, as well as an acceptable cosmetic effect. Most presented chills as an adverse reaction, followed by fever. Conclusions: the HeberFERON was an effective and safe medicine to treat basal cell carcinoma, and offer an alternative in patients who cannot be operated on.

Deprescribing: Barriers, Benefits, and Harms

Polypharmacy, which is the practice of prescribing five or more medicines to the same patient is associated withmany problems like adverse drug reactions and poor adherence to therapy and can be harmful. Recently, the termdeprescribing is used to describe the systematic process of identifying and discontinuing medicines in situationsin which potential or existing harms outweigh potential or existing benefits for the seek of individual patient caregoals and preferences. Many studies assessed the attitude of patients or perceptions of health care practitionerstowards deprescribing, others evaluated barriers or factors affecting deprescribing. Since the practice ofdeprescribing is growing, this study aimed to review the harms, benefits, and barriers of deprescribing. Somestudies reported that patients may be interested in withdrawing one or more of their medicines if advised by theirtreating doctors and at the same time costs and experiencing medication adverse effects may result in awillingness to decrease the number of medications taken. Harms that may occur due to deprescribing can beminimized or even prevented by using a structured and patient-specific deprescribing process with properplanning and careful monitoring during and after medication withdrawal.

Academic performance and use of psychoactive drugs among healthcare students at a university in southern Brazil: cross-sectional study

ABSTRACT BACKGROUND: People have been using psychoactive substances for a long time. Over the last few years, this practice has spread among university students, who use these substances to improve their academic performance, relieve stress and increase concentration and memory. OBJECTIVES: To estimate the use of psychoactive drugs among healthcare students at a higher education institution in the city of Passo Fundo (RS), Brazil, and to ascertain the associated demographic and lifestyle factors. DESIGN AND SETTING: Cross-sectional study in a higher education institution. METHODS: We included 287 undergraduate medicine and dentistry students in this study. They answered a self-administered questionnaire regarding sociodemographic, lifestyle and health variables. The statistical analysis used univariate and bivariate analyses with Pearson's chi-square test (P-value < 0.05). ­Multivariate analyses were used to estimate odds ratios (OR) and their respective 95% confidence intervals. The SPSS software, version 20.0, was used. RESULTS: The prevalence of use of psychoactive substances among the students was 24.7%. Among these students, high frequencies of psychoactive drugs had been prescribed by physicians (95.8%) and for the purpose of relaxation or stress relief (73.2%). Women, medical students (compared with dental students) and participants with lower academic performance were more likely to use psychoactive drugs. After the multivariate adjustment, the "course" and "academic performance" remained associated with use of psychoactive drugs. CONCLUSION: There was high prevalence of psychoactive drug use among the students at the higher education institution investigated. Some variables (female sex, medical students and low academic performance) were associated with the outcome.

Prevalence of and factors associated with the use of methylphenidate for cognitive enhancement among university students / Prevalência e fatores associados ao uso de metilfenidato para neuroaprimoramento farmacológico entre estudantes universitários

ABSTRACT Objective To estimate the prevalence of and factors associated with the use of methylphenidate for cognitive enhancement among undergraduate students. Methods Simple random sample of students of the Universidade Federal de Minas Gerais (n=438), invited to answer an online questionnaire about the use of methylphenidate. Data collection occurred from September 2014 to January 2015. The sample was described by means of proportions, means and standard deviations. A multivariate analysis was performed using the Classification and Regression Tree algorithm to classify the cases of use of methylphenidate for cognitive enhancement in groups, based on the exposure variables. Results Out of 378 students included, 5.8% (n=22) reported using methylphenidate for cognitive enhancement; in that, 41% (9/22) in the 4 weeks prior to the survey. The housing situation was the variable most often associated with the use of methylphenidate for cognitive enhancement. Eleven students reported using methylphenidate for cognitive enhancement and other purposes 4 weeks prior to the survey, 27% of whom had no medical prescription to purchase it. Conclusion The use of methylphenidate for cognitive enhancement is frequent among Brazilian undergraduate students and should be considered a serious public health problem, especially due to risks of harm and adverse effects associated with its use.

RESUMO Objetivo Estimar a prevalência e os fatores associados ao uso de metilfenidato para neuroaprimoramento entre estudantes universitários. Métodos Amostra aleatória simples de discentes da Universidade Federal de Minas Gerais (n=438), convidados a responder um questionário online sobre o consumo de metilfenidato. A coleta ocorreu de setembro de 2014 a janeiro de 2015. A amostra foi descrita em termos de proporções, médias e desvio padrão. A análise multivariada foi realizada utilizando o algoritmo Classification and Regression Tree para classificação dos casos de uso do metilfenidato para neuroaprimoramento em grupos, com base nas variáveis de exposição. Resultados Dos 378 alunos incluídos, 5,8% (n=22) declararam ter feito uso de metilfenidato para neuroaprimoramento, sendo 41% (9/22) nas 4 semanas anteriores à pesquisa. A situação da moradia foi a variável mais associada ao uso de metilfenidato para neuroaprimoramento. Relataram o uso do metilfenidato para neuroaprimoramento e outros fins nas 4 semanas anteriores à pesquisa 11 estudantes, sendo que 27% não apresentaram prescrição médica para adquiri-lo. Conclusão O uso de metilfenidato para neuroaprimoramento ocorre no meio acadêmico brasileiro e deve ser considerado sério problema de saúde pública, principalmente diante dos riscos de danos e efeitos adversos associados ao seu uso.