Impacto de una intervención educativa en el conocimiento y manejo de residuos peligrosos biológico-infecciosos / Impact of an educational intervention on the knowledge and management of infectious biological hazardous waste

Introducción: el personal de enfermería tiene una participación fundamental en el manejo de los residuos peligrosos biológico-infecciosos (RPBI) durante la atención en salud, situación que hace indispensable el conocimiento respecto a la peligrosidad y riesgo en el manejo de estos residuos. Objetivo: evaluar el impacto de una intervención educativa acerca del conocimiento y manejo de RPBI, en el personal de enfermería de un hospital general regional. Metodología: estudio cuasi experimental, pretest/postest, prospectivo y longitudinal. Se realizó una intervención educativa, y antes y después de esta se aplicó un cuestionario para evaluar conocimientos relacionados con RPBI y una lista de cotejo del Modelo Institucional para la Prevención de Infecciones Nosocomiales (MIPRIN) para evaluar el manejo de RPBI. Resultados: la intervención educativa demostró un efecto positivo en los conocimientos del personal de enfermería en relación con el manejo de RPBI. En la evaluación pretest se obtuvo un porcentaje de conocimientos de 65.2% y en la postest fue de 78.3% (p < 0.001). Respecto al cumplimiento en el manejo de RPBI, hubo un incremento; sin embargo, no se puede atribuir a la intervención, puesto que se evaluó por servicio y no de manera directa con los participantes. Conclusión: la intervención educativa mostró cambios significativos en los conocimientos y el manejo de RPBI del personal de enfermería.

Introduction: Nursing staff represent an important percentage in the management of biological hazardous waste (BHW) during health care, a situation that makes this knowledge essential regarding the danger and risk in handling these wastes. Objective: To evaluate the impact of an educational intervention about the knowledge and management of BHW in the nursing staff of a regional general hospital. Methods: quasi-experimental, pre-test/post-test, prospective and longitudinal study. An educational intervention was carried out; before and after this intervention, a questionnaire was administered to evaluate knowledge related to BHW and a checklist of the Institutional Model for the Prevention of Nosocomial Infections (MIPRIN, according to its initials in Spanish) to evaluate the management of BHW. Results: The educational intervention showed a positive effect in the nursing staff's knowledge in relation to BHW. In the pre-test evaluation a knowledge percentage of 65.2% was obtained and in the post-test evaluation it was 78.3% (p < 0.001). Regarding compliance in the management of BHW there was an increase; however, it cannot be attributed to the intervention, since it was evaluated by service and not directly with the participants.

Retratamento com surfactante em prematuros de muito baixo peso: preditores de risco e sua influência nos resultados neonatais / Retreatment with surfactant in very low birth weight preterm infants: risk predictors and their influence on neonatal outcomes

ABSTRACT Objective: To assess clinical predictors and outcomes associated to the need for surfactant retreatment in preterm infants. Methods: Retrospective cohort study, including very low birth weight preterm infants from January 2006 to December 2015 who underwent surfactant replacement therapy. Beractant was used (100 mg/kg), repeated every six hours if FiO2 ≥0.40. The subjects were classified into two groups: single surfactant dose; and more than one dose (retreatment). We evaluated maternal and neonatal predictors for the need of retreatment and neonatal outcomes associated to retreatment. Results: A total of 605 patients (44.5%) received surfactant; 410 (67.8%) one dose, and 195 (32.2%) more than one dose: 163 (83.5%) two doses and 32 (16.4%) three doses. We could not find clinical predictors for surfactant retreatment. Retreatment was associated to a greater chance of BPD in infants >1000 g (RR 1.78; 95%CI 1.30‒2.45) and ≤1000 g (RR 1.33; 95%CI 1.04‒1.70), in infants with gestational age<28 weeks (RR 1.56; 95%CI 1.12‒2.18) and ≥28 weeks (RR 1.50; 95%CI 1.17‒1.92), in neonates with early sepsis (RR 1.48; 95%CI 1.20‒1.81), and in infants not exposed to antenatal corticosteroids (RR 1.62; 95%CI 1.20‒2.17) Conclusions: We could not find predictor factors associated to surfactant retreatment. The need for two or more doses of surfactant was significantly related to bronchopulmonary dysplasia.

RESUMO Objetivo: Avaliar preditores clínicos e resultados associados à necessidade de retratamento com surfactante. Métodos: Coorte retrospectiva com prematuros de muito baixo peso, no período de janeiro de 2006 a dezembro de 2015, em uso de terapia de reposição de surfactante. O surfactante utilizado foi beractante (100 mg/kg), repetido a cada seis horas se FiO2≥0.40. Foram analisados dois grupos: dose única de surfactante e mais de uma dose (retratamento). Foram avaliados preditores maternos e neonatais para retratamento e resultados neonatais. Resultados: 605 pacientes (44,5%) receberam surfactante; 410 (67,8%) uma dose e 195 (32,2%) mais de uma dose: 163 (83,5%) duas doses e 32 (16.4%) três doses. Não foram encontrados fatores associados ao retratamento com surfactante. A displasia broncopulmonar (DBP) foi associada ao retratamento (p<0.01). A presença de retratamento aumentou a chance de ocorrência de DBP em neonatos >1000 g (RR 1,78; IC95% 1,30‒2,45) e ≤1000 g (RR 1,33; IC95% 1,04‒1,70), em recém-nascidos com idade gestacional <28 semanas (RR 1,56; IC95% 1,12‒218) e ≥28 semanas (RR 1,50; IC95% 1,17‒1,92), naqueles com sepse precoce (RR 1,48; IC95% 1,20‒1,81), e nos que não foram expostos ao corticoide antenatal (RR 1,62; IC95% 1,20‒2,17). Conclusões: Não encontramos fatores preditores associados à necessidade de retratamento. A necessidade de duas ou mais doses de surfactante está associada à displasia broncopulmonar.

Protein PEGylation for the design of biobetters: from reaction to purification processes

The covalent attachment of polyethylene glycol (PEG) to therapeutical proteins is an important route to develop biobetters for biomedical, biotech and pharmaceutical industries. PEG conjugation can shield antigenic epitopes of the protein, reduce degradation by proteolytic enzymes, enhance long-term stability and maintain or even improve pharmacokinetic and pharmacodynamics characteristics of the protein drug. Nonetheless, correct information in terms of the PEGylation process from reaction to downstream processing is of paramount importance for the industrial application and processing scale-up. In this review we present and discuss the main steps in protein PEGylation, namely: PEGylation reaction, separation of the products and final characterization of structure and activity of the resulting species. These steps are not trivial tasks, reason why bioprocessing operations based on PEGylated proteins relies on the use of analytical tools according to the specific pharmaceutical conjugate that is being developed. Therefore, the appropriate selection of the technical and analytical methods may ensure success in implementing a feasible industrial process

Biologia molecular de leveduras e sua aplicação biotecnológica para estudo de mecanismos celulares do câncer e seu tratamento / Molecular biology of yeast and its biotechnological application to study the cellular mechanisms of cancer and its treatment

A levedura Saccharomyces cerevisiae é o eucarioto mais bem caracterizado quanto às vias metabólicas, celulares e funções de genes. Calcula-se que dos 6.000 genes codificadores de proteínas, pelo menos 3.000 tenham homologia com genes humanos. Além disso, mesmo quando não há homologia direta, os mecanismos moleculares são conservados e em ensaios de complementação de função é possível caracterizar funções análogas em humanos. Leveduras apresentam além de mecanismos conservados, diversas semelhanças metabólicas com células tumorais; talvez a mais marcante delas seja a repressão catabólica por glicose. Esse fenômeno causa uma superativação da via glicolítica e inibição da cadeia respiratória, o que lembra muito o efeito Warburg apresentado pelas células tumorais. Esse comportamento metabólico tem relação estreita com a homeostase redox celular. Estes fatores mostram o quanto à caracterização dessas células fúngicas pode ser aplicada ao entendimento e tratamento do câncer. Mesmo assim, 20 anos após o término do sequenciamento do genoma de S. cerevisiae, mais de 1.000 genes continuam anotados como não caracterizados. Além disso, as leveduras têm papel fundamental na produção biotecnológica de insumos farmacêuticos. Nesse texto sistematizado relato as contribuições dos meus estudos, juntamente com os resultados do meu grupo de pesquisa, usando a biologia molecular das leveduras, para responder questões aplicadas à compreensão de funções celulares (com destaque à resposta antioxidante), mecanismos moleculares de resposta aos antitumorais e produção de biofármacos. Além de modelo celular, as leveduras representam excelentes plataformas para expressão heteróloga de proteínas de interesse Biotecnológico-Farmacêutico

The yeast Saccharomyces cerevisiae is the most well characterized eukaryote for metabolic, cellular and gene functions. It is estimated that of the 6,000 protein-encoding genes, at least 3,000 have homology to human genes. Moreover, even when there is no direct homology, the molecular mechanisms are conserved and through function complementation assays it is possible to characterize analogous functions in humans. Yeasts present, in addition to conserved mechanisms, diverse metabolic similarities with tumor cells; perhaps the most remarkable of them is the catabolic repression by glucose. This phenomenon causes an over activation of the glycolytic pathway and inhibition of the respiratory chain, which strongly resembles the Warburg effect presented by tumor cells. This metabolic behavior is closely related to cellular redox homeostasis. These factors show how much the characterization of these fungal cells can be applied to the understanding and treatment of cancer. Even so, 20 years after the end of the sequencing of the S. cerevisiae genome, more than 1,000 genes remain annotated as uncharacterized. In addition, yeasts play a key role in the biotechnological production of pharmaceutical inputs. In this systematized text I show the contributions of my studies, together with the results of my research group, using molecular biology of yeast to answer questions applied to understanding cellular functions (with emphasis on the antioxidant response), molecular response mechanisms to antitumor drugs and biopharmaceutical production. In addition to cellular model, yeasts represent excellent platforms for the heterologous expression of proteins of Biotechnological-Pharmaceutical interes

Less invasive beractant administration in preterm infants: a pilot study

OBJECTIVES: The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born at <32 weeks of gestation and to compare short- and long-term outcomes between this approach and standard treatment, consisting of intubation, administration of surfactant and early extubation to nasal continuous positive airway pressure. METHOD: This was a single-center, prospective, open-label, non-randomized, controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the standard approach. Beractant (4 ml/kg) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30% FiO2. Clinicaltrials.gov: NCT02611284. RESULTS: In the group with less invasive surfactant administration, beractant was successfully administered in all patients. Thirteen patients (43.3%) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life, compared with 22 (73%) in the control group (p<0.036). The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups (46% vs. 40%, respectively). There were no differences in other outcomes. CONCLUSION: The administration of beractant (4 ml/kg) using a less invasive surfactant administration technique with a specifically designed cannula for administration is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation, surfactant administration and early extubation.

Barcode e bioprospecção de metabólitos das algas marinhas Laurencia aldingensis, L. dendroidea e Laurenciella sp. (Ceramiales, Rhodophyta) / Barcode and bioprospecting of metabolites from the marine algae Laurencia aldingensis, L. dendroidea e Laurenciella sp. (Ceramiales, Rhodophyta)

A natureza e diversidade das estruturas químicas com atividade farmacológica que se tem encontrado nos organismos marinhos justificam a busca por novos compostos que são de interesse nas mais diversas áreas de aplicação. As espécies de macroalgas vermelhas, em especial Laurencia spp., merecem destaque pela enorme variedade de terpenos e acetogeninas que produzem, sendo consideradas de grande potencial na produção de novos fármacos. O estudo de seus constituintes pode fornecer importantes subsídios para a quimiotaxonomia, ecologia química, caracterização das espécies e avaliação do potencial biotecnológico. Baseado nisso, Laurencia aldingensis, L. dendroidea e Laurenciella sp. foram selecionadas para o presente estudo para isolamento, caracterização e teste de atividades biológicas dos seus compostos. A técnica do DNA barcoding foi utilizada como ferramenta de diagnóstico para garantir a similaridade entre as amostras de cada espécie, que foram coletadas em época e locais diferentes. Do extrato orgânico de Laurencia aldingensis, nove substâncias foram isoladas, sendo quatro esfingosinas (1-4), três terpenos (5-7) e duas novas substâncias halogenadas (8 e 9). Do extrato orgânico de Laurencia dendroidea formam isolados dois terpenos halogenados conhecidos (10, 11) e, do extrato de Laurenciella sp. três novas substâncias halogenadas alifáticas insaturadas (12-14), assim como um ácido graxo (15) e um esterol (16) conhecidos. Dentre elas, a 8 apresentou atividade citotóxica, mas não se mostrou seletivo, e as substâncias 4 e 11 apresentaram atividade esquistossomicida, bastante promissora. No entanto, nenhum deles apresentou atividade antioxidante. Diante desta investigação, podemos dizer que as informações geradas com os estudos de Laurencia aldingensis, L. dendroidea e Laurenciella sp. expandiram significantemente o conhecimento no que tange a diversidade química no gênero e o potencial biológico-farmacêutico dos mesmos

The nature and diversity of chemical structures with pharmacological activity that have been found in marine organisms justifies the search for new compounds that may have applications in various areas of interest. Species of red seaweeds, especially Laurencia spp., are special because of the unprecedented variety of terpenes and acetogenins they produce that are considered potentially useful for the production of new drugs. Study of their constituents can also provide important insights relating to their chemotaxonomy, chemical ecology, characterization of species and biotechnological potential. On this basis Laurencia aldingensis, L. dendroidea and Laurenciella sp., were selected for study and isolation, characterization, and biological activity assessment of isolatable quantities of their compounds. The technique of DNA barcoding was used as a diagnostic tool to ensure similarity between samples of each species collected at different times and places. From the organic extract of Laurencia aldingensis nine compounds were isolated; four sphingosines (1-4), three terpenes (5-7) and other two new halogenated compound (8, 9). From the organic extract of Laurencia dendroidea two known halogenated terpenes (10, 11) were isolated while from a similar extract of Laurenciella sp., three new halogenated aliphatic compounds (12-14) were isolated together with known fatty acid (15) and sterol (16). Among all isolates, 8 demonstrated unspecific cytotoxic activity and compounds 4 and 11 showed promising schistosomicidal activity. In applied antioxidant assays none of the isolates we noted to have activity. From the overall investigation it is also clear that the information gleaned from the studies of Laurencia aldingensis, L. dendroidea and Laurenciella sp., significantly expanded our knowledge base concerning chemical diversity in the genus Laurencia and their biological-pharmaceutical potential

Current concepts in the management of rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate, a synthetic disease-modifying antirheumatic drug (DMARD), and biologic DMARD has revolutionized treatment of RA. Clinical remission is now realistic targets, achieved by a large proportion of RA patients, and rapid and appropriate induction of remission by intensive treatment with biological DMARD and methotrexate is prerequisite to halt joint damage and functional disabilities. However, biological DMARD is limited to intravenous or subcutaneous uses and orally available small but strong molecules have been developed. Oral administration of tofacitinib targeting the Janus kinase (JAK) is significantly effective than placebo in active patients with methotrexatenaive, inadequately responsive to methotrexate or tumor necrosis factor (TNF)-inhibitors. The efficacy was rapid and as strong as adalimumab, a TNF-inhibitor. Meanwhile, association of tofacitinib on carcinogenicity and malignancy is under debate and further investigation on post-marketing survey would be warranted. On the other hand, discontinuation of a biological DMARD without disease flare is our next goal and desirable from the standpoint of risk reduction and cost effectiveness, especially for patients with clinical remission. Recent reports indicate that more than half of early RA patients could discontinue TNF-targeted biological DMARD without clinical flare and functional impairment after obtaining clinical remission. Contrarily, for established RA, fewer patients sustained remission after the discontinuation of biological DMARD and "deep remission" at the discontinuation was a key factor to keep the treatment holiday of biological DMARD.

Prospecção de bioativos farmacológicos em algas marinhas Rhodophyta e Heterokontophyta e avaliação de citotoxicidade / Prospection of pharmaceutical bioactive compounds in marine algae Rhodophyta and Heterokontophyta and cytotoxicity evaluation

Muitas drogas terapêuticas produzidas pela indústria farmacêutica são estruturas químicas isoladas de organismos encontrados na natureza ou moléculas baseadas nelas. Podem ser incluídas nesse grupo drogas isoladas de organismos marinhos, como corais, esponjas e algas marinhas, conhecidos como produtores de grandes quantidades de metabólitos secundários. Com base neste fato o presente estudo teve como objetivo realizar a prospecção de moléculas bioativas com propósito farmacológico, em extratos de algas marinhas vermelhas (Rhodophyta) e pardas (Heterokontophyta) coletadas no litoral brasileiro. A prospecção foi realizada por meio de avaliação de seus potenciais antioxidante, antibacteriano, antifúngico, anticancerígeno, e antiparasitário contra organismos causadores de leishmaniose e esquistossomose. Para as avaliações foram empregadas os extratos supercríticos de 5 espécies diferentes, sendo 2 pardas: Dictyota dichotoma e D. menstrualis e três vermelhas: Chondria littoralis, Spyridia hypnoides e Plocamium brasiliense. Os extratos foram avaliados quanto aos seus potenciais bioativos e os resultados mais promissores foram selecionados para as etapas seguintes do fracionamento. Em uma avaliação geral os extratos apresentaram bons resultados e representam uma potencial fonte de bioativos. Os extratos das espécies de D. dichotoma e D. menstrualis foram então submetidos a um procedimento de fracionamento bioguiado pela atividade esquistossomicida. Incorporou-se ainda um terceiro extrato de D. mertensii aos estudos e todas as etapas do fracionamento foram monitoradas por LC-MS. Comparando-se as massas detectadas em todas as frações que apresentaram atividade, para os 3 extratos, foi verificado que a substância de m/z 271,24 estava presente em todas elas, portanto os procedimentos de isolamento foram direcionados a esta molécula para a qual foi possível isolar 7 mg. Diferentemente do que era esperado a molécula quando avaliada isoladamente não apresentou atividade esquistossomicida, levando a hipótese de que a atividade seja decorrente de uma molécula diferente para cada espécie ou ainda que a mesma seja decorrente de uma interação com outras substâncias por um mecanismo de ação aditivo ou sinérgico. O trabalho avaliado de forma geral apresentou resultados promissores e representa um grande embasamento para servir como base para posteriores trabalho de fracionamento

Several therapeutic drugs manufactured by the pharmaceutical industry are chemical structures isolated from organisms that are found in nature or molecules based on that. May be included at this group drugs isolated from marine organisms, like corals, sponges and seaweeds, known as great secondary metabolites producers. Based on this facts the objective of the present study is to perform a prospection study to achieve bioactive molecules with pharmaceutical purposes, on extracts made from red (Rhodophyta) and brown (Heterokontophyta) seaweed collected in the Brazilian shore. The prospection studies was performed by means of evaluation of the antioxidant, antibacterial, antifungal, anticancer and antiparasitic (against Leishmania and Schistosoma) potential. In the evaluation were tested the supercritical extracts of 5 different species, including 2 brown species: Dictyota dichotoma and D. menstrualis and 3 red species: Chondria littoralis, Spyridia hypnoides and Plocamium brasiliense. The extracts were evaluated by their potential bioactive compounds and the most promising results were selected for the following fractionation steps. Overall the extracts have shown good results and may be represent a potential source of bioactive molecules. The extracts of both D. dichotoma and D. menstrualis were submitted to a bioguided fractionation process by their antischistosomal activities. It was still included a third extract from D. mertensii to the studies and every step was monitored by LC-MS techniques. Comparing the detected mass for each active fraction, it was observed the presence of a substance with m/z 271,24 in all of the extracts, so the isolating procedures were directed to obtain that specific molecule, which was obtained in a biomass of 7 mg. Differently than expected the molecule when evaluated isolated do not show the antischistosomal activity, leading to the hypothesis that the activity was related to different molecules for each species or even the observed effect is resulted by an interaction mechanism with another substances by an additive or synergist mechanism. The overall evaluation of the whole work show some promising results and it represent a great support for future fractionation works

IGF2, LEPR, POMC, PPARG, and PPARGC1 gene variants are associated with obesity-related risk phenotypes in Brazilian children and adolescents

Association studies of genetic variants and obesity and/or obesity-related risk factors have yielded contradictory results. The aim of the present study was to determine the possible association of five single-nucleotide polymorphisms (SNPs) located in the IGF2, LEPR, POMC, PPARG, and PPARGC1 genes with obesity or obesity-related risk phenotypes. This case-control study assessed overweight (n=192) and normal-weight (n=211) children and adolescents. The SNPs were analyzed using minisequencing assays, and variables and genotype distributions between the groups were compared using one-way analysis of variance and Pearson's chi-square or Fisher's exact tests. Logistic regression analysis adjusted for age and gender was used to calculate the odds ratios (ORs) for selected phenotype risks in each group. No difference in SNP distribution was observed between groups. In children, POMC rs28932472(C) was associated with lower diastolic blood pressure (P=0.001), higher low-density lipoprotein (LDL) cholesterol (P=0.014), and higher risk in overweight children of altered total cholesterol (OR=7.35, P=0.006). In adolescents, IGF2 rs680(A) was associated with higher glucose (P=0.012) and higher risk in overweight adolescents for altered insulin (OR=10.08, P=0.005) and homeostasis model of insulin resistance (HOMA-IR) (OR=6.34, P=0.010). PPARG rs1801282(G) conferred a higher risk of altered insulin (OR=12.31, P=0.003), and HOMA-IR (OR=7.47, P=0.005) in overweight adolescents. PARGC1 rs8192678(A) was associated with higher triacylglycerols (P=0.005), and LEPR rs1137101(A) was marginally associated with higher LDL cholesterol (P=0.017). LEPR rs1137101(A) conferred higher risk for altered insulin, and HOMA-IR in overweight adolescents. The associations observed in this population suggested increased risk for cardiovascular diseases and/or type 2 diabetes later in life for individuals carrying these alleles.

Efficacy of Surfactant-TA, Calfactant and Poractant Alfa for Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

PURPOSE: To compare the efficacy of the new drug calfactant with the commonly used drugs surfactant-TA and poractant alfa. MATERIALS AND METHODS: A total of 332 preterm infants at 24-31 weeks' gestation with respiratory distress syndrome (RDS) were enrolled and allocated to three groups according to the surfactant instilled; Group 1 (n=146, surfactant-TA), Group 2 (n=96, calfactant), and Group 3 (n=90, poractant alfa). The diagnosis of RDS and the decision to replace the pulmonary surfactant were left to the attending physician and based on patient severity determined by chest radiography and blood gas analysis. Data were collected and reviewed retrospectively using patient medical records. RESULTS: Demographic factors including gestational age, birth weight, Apgar score, clinical risk index for babies II score, and maternal status before delivery were not different between the study groups. Instances of surfactant redosing and pulmonary air leaks, as well as duration of mechanical ventilation, were also not different. Rates of patent ductus arteriosus, intraventricular hemorrhage (> or =grade III), periventricular leukomalacia, high stage retinopathy of prematurity, necrotizing enterocolitis (> or =stage II), and mortality were also similar, as was duration of hospital stay. Cases of pulmonary hemorrhage and moderate to severe bronchopulmonary dysplasia were increased in Group 3. CONCLUSION: Calfactant is equally as effective as surfactant-TA and poractant alfa. This was the first study comparing the efficacy of surfactant-TA, calfactant, and poractant alfa in a large number of preterm infants in Korea. Further randomized prospective studies on these surfactants are needed.

Efficacy of Surfactant-TA, Calfactant and Poractant Alfa for Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

PURPOSE: To compare the efficacy of the new drug calfactant with the commonly used drugs surfactant-TA and poractant alfa. MATERIALS AND METHODS: A total of 332 preterm infants at 24-31 weeks' gestation with respiratory distress syndrome (RDS) were enrolled and allocated to three groups according to the surfactant instilled; Group 1 (n=146, surfactant-TA), Group 2 (n=96, calfactant), and Group 3 (n=90, poractant alfa). The diagnosis of RDS and the decision to replace the pulmonary surfactant were left to the attending physician and based on patient severity determined by chest radiography and blood gas analysis. Data were collected and reviewed retrospectively using patient medical records. RESULTS: Demographic factors including gestational age, birth weight, Apgar score, clinical risk index for babies II score, and maternal status before delivery were not different between the study groups. Instances of surfactant redosing and pulmonary air leaks, as well as duration of mechanical ventilation, were also not different. Rates of patent ductus arteriosus, intraventricular hemorrhage (> or =grade III), periventricular leukomalacia, high stage retinopathy of prematurity, necrotizing enterocolitis (> or =stage II), and mortality were also similar, as was duration of hospital stay. Cases of pulmonary hemorrhage and moderate to severe bronchopulmonary dysplasia were increased in Group 3. CONCLUSION: Calfactant is equally as effective as surfactant-TA and poractant alfa. This was the first study comparing the efficacy of surfactant-TA, calfactant, and poractant alfa in a large number of preterm infants in Korea. Further randomized prospective studies on these surfactants are needed.

Medicamentos biológicos (infliximabe, etanercepte, adalimumabe, rituximabe, abatacepte, tocilizumabe, golimumabe e certolizumabe pegol) para o tratamento da artrite reumatóide / Biological drugs (infliximab, etanercept, adalimumab, rituximab, abatacept, tocilizumab, golimumab and certolizumab pegol) for the treatment of rheumatoid arthritis

A DOENÇA: A artrite reumatóide (AR) é uma doença autoimune inflamatória e crônica, caracterizada por poliartrite periférica e simétrica, que leva à deformidade e destruição das articulações devido à erosão da cartilagem e do osso1. Acomete articulações de pequenas dimensões, como as das mãos e pés, mas qualquer articulação sinovial do corpo pode ser acometida. Com a progressão da doença, os pacientes desenvolvem incapacidade para realização de suas atividades, tanto cotidianas como profissionais, com impacto socioeconômico significativo para o indivíduo e para a sociedade. Aproximadamente 50% dos indivíduos com AR ficam impossibilitados de trabalhar em 10 anos a partir do início da doença. A TECNOLOGIA: Vários foram os demandantes que solicitaram a incorporação dos medicamentos biológicos no SUS, dentre eles, algumas empresas fabricantes e a Associação Nacional de Grupos de Pacientes Reumáticos ­ Anapar. Nem todos os medicamentos biológicos foram demandados, no entanto, a CONITEC decidiu fazer uma avaliação conjunta de todos os atualmente registrados no Brasil. Desta maneira, garante-se a eficiência de avaliação da incorporação de tecnologias e da revisão do Protocolo Clínico e Diretrizes Terapêuticas da Artrite Reumatóide. EVIDÊNCIAS CIENTÍFICAS: Os medicamentos biológicos atualmente disponíveis no SUS para o tratamento da AR são infliximabe, adalimumabe e etanercepte1. A CONITEC decidiu avaliar todos os oitos medicamentos biológicos, registrados no Brasil para tratamento dessa doença, para verificar se um traz algum benefício sobre outro com relação à eficácia e segurança. No entanto, não há ensaios clínicos publicados que comparem diretamente todos os oito biológicos. Com isso, a Secretaria-Executiva da CONITEC realizou uma busca na literatura com o objetivo de encontrar revisões sistemáticas de estudos de comparação indireta entre esses medicamentos. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na reunião do plenário do dia 05/07/2012, por unanimidade, ratificaram a deliberação de recomendar a incorporação dos medicamentos para AR: golimumabe, certolizumabe pegol, rituximabe, abatacepte e tocilizumabe, bem como a manutenção dos medicamentos infliximabe, adalimumabe e etanercepte no SUS, com as seguintes condições: atualizar o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) do Ministério da Saúde em conformidade com a deliberação da CONITEC; não haver associação de agentes biológicos devido ao seu conhecido potencial de imunodepressão e eventos adversos; reduzir o preço dos medicamentos biológicos, tendo em vista que a incorporação de todas as alternativas biológicas disponíveis no mercado para o tratamento da AR se dará exclusivamente se houver redução ao menor custo de tratamento. DECISÃO: PORTARIA SCTIE-MS N.º 24, de 10 de setembro de 2012 - Torna pública a decisão de incorporar os medicamentos golimumabe, certolizumabe pegol, rituximabe, abatacepte e tocilizumabe, bem como a manutenção dos medicamentos infliximabe, adalimumabe e etanercepte para o tratamento da Artrite Reumatóide (AR) no Sistema Único de Saúde (SUS).

Novas opções terapêuticas na síndrome de aspiração de mecônio / New therapeutic options in meconium aspiration syndrome

OBJETIVOS: revisar a literatura sobre a síndrome de aspiração de mecônio (SAM), enfocando aspectos clínicos, fisiopatológicos e abordagem terapêutica, com destaque ao uso do surfactante e lavado broncoalveolar. MÉTODOS: revisão baseada em artigos publicados na MEDLINE, SCIELO e resumos de congressos internacionais de 1988 a 2004, incluindo ensaios randomizados ou quasi-randomizados, estudos caso-controle e metanálises. RESULTADOS: devido à comprovação da inibição do surfactante na SAM, houve modificações em sua abordagem terapêutica. O manejo atual consiste na aspiração das vias aéreas na sala de parto, seguida de suporte ventilatório necessário para manter a oxigenação arterial adequada, e tratamento das complicações. Tendo em vista a obstrução mecânica do mecônio e seu efeito inibitório sobre o surfactante, a reposição e lavado broncoalveolar com surfactante estão sendo estudados atualmente. CONCLUSÕES: estudos em animais e em recém-nascidos apresentam resultados controversos quanto aos benefícios do uso de surfactante e lavado broncoalveolar na SAM. Torna-se importante a realização de mais estudos para avaliar novas estratégias ventilatórias e se existem vantagens no uso do surfactante e lavado broncoalveolar com surfactante na SAM.

OBJECTIVES: to review the literature on meconium aspiration syndrome (MAS) focusing on clinical aspects, pathophysiology, and treatment with emphasis on surfactant and bronchoalveolar lavage. METHODS: review including articles from MEDLINE, SCIELO and abstracts published in the national and international literature, from 1988 to 2004 using the keywords meconium aspiration syndrome, surfactant and bronchoalveolar lavage. Randomized and quasi-randomized trials, case control studies, meta-analyses and recently published reviews were selected. Other articles were included for their valuable contribution to the subject. RESULTS: the discovery of new pathophysiological mechanisms ensued new therapeutic options availability. MAS management is initiated with airway aspiration in the delivery room, followed by the ventilatory management required to maintain optimal arterial oxygenation, as well as complications treatment. Considering evidences showing that meconium mechanical airway obstruction and its inhibitory effect on the surfactant system, the use of surfactant replacement and bronchoalveolar lavage with surfactant suspension are under study. CONCLUSIONS: experimental studies and studies focused on newborn using different surfactant suspensions have demonstrated controversial results. Therefore, it is very important to identify new ventilatory strategies and evaluate whether there are advantages in using surfactant and bronchoalveolar lavage with surfactant suspension in MAS.

Sensibilidade "in vitro" de Vibrio cholerae 01, de origem humana e ambiental, a produtos naturais e a antibióticos tradicionais / Sensitivity in vitro of Vibrio cholerae 01 from human and environmental, natural products and traditional antibiotics

Foi avaliada a sensibilidade "in vitro" de 43 cepas de Vibrio cholerae 01 (22 de origem humana e 21 ambientais) com relação a seis antibióticos usados na quimioprofilaxia da diarréia colérica (TET, ERI, CLO, AMP, SUT, NOR ), a cinco produtos naturais com atividade antimicrobiana (extratos de B. virgiloides, C. altissiana e P. sellowinus e óleos essenciais de C. citratus e C. limonum), e a duas imidas semi-sintéticas análogas de filantimidas. Todas as cepas foram sensíveis a TET, AMP, CLO. SUT e NOR. Apenas uma, de origem humana, foi resistente a ERI. Dos fitoterápicos, tiveram atividade antimicrobiana os óleos essenciais "in natura" e as duas imidas semi-sintéticas. O óleo de C. citratus inibiu o crescimento de todas as cepas com halos ≥16mm e o de C. limonum inibiu apenas 41% com halos médios de 10mm. A atividade antimicrobiana destes óleos é atribuída a seus constituintes químicos (pineno, E-citral, 7-citral, α-terpinemo, mirceno e citronela). As imidas apresentam forte atividade antimicrobiana em concentrações ≥12,3 µg/mL. Os extratos de B. virgiloides (leguminoseae), C. altissiana e P. sellowinus (Euphorbiaceae), apesar de apresentarem constituintes químicos como alcalóides, taninos, e óleos com propriedade antimicrobiana, não apresentaram atividade, provavelmente por terem maior efeito contra bactérias Gram positivas. Os resultados sugerem o possível emprego de produtos naturais como alternativos no tratamento da cólera.

Manejo del carcinoma superficial de vejiga; BCG intravesical: la nueva alternativa / BCG in the management or superficial blader neoplasms: the new alternative

La BCG intravesical representa una nueva forma de terapia intravesical para el tratamiento del cáncer superficial de vejiga reportado en un rango que va de 10 (por ciento) a 20 (por ciento). La rata de recurrencia es comparable al 40 (por ciento) de la thiotepa y 60 (por ciento) de fulguración sólo. Presenta un 59 (por ciento) a 83 (por ciento) de incidencia de regresión del tumor residual, lo cual es comparable con el 30 a 50 (por ciento) de la thiotepa y una incidencia de un 60 a 80 (por ciento) de regresión del carcinoma in situ, el cual es comparable con el 55 (por ciento) de la thiotepa y el 8 (por ciento) de la fulguración. Hay muchos protocolos en la aplicación de la terapia, uno de los más aceptados es Pasteur BCG 120 MG. en 50 cc de Salina administrado semanalmente por seis semanas, empezando 1 ó 2 semanas después de la resección, una dósis de BCG equivale en costo a 30 MG de thiotepa el agente quimioterapéutico más barato. La terapia es seguida de cistoscopía, biopsias y citología, cada 3 meses por 2 años. El estado de la prueba cutánea con PPD, la radiografía de torax y la química sanguínea, deben ser monitorizados antes y después de la terapia. La conversión de la prueba cutánea es positiva en el transcurso de la terapia y la aparición de granulomas en la vejiga se considera un efecto terapéutico beneficioso. Los efectos secundarios de la BCG son síntomas irritativos leves que no tienen trascendencia. Todavía no hay nada conclusivo en la relación sobre la cepa óptima y la ruta de administración. No se conoce a largo plazo el efecto antitumoral y efecto secundario de la BCG en la vejiga. Para finalizar, la terapia con BCG es sin duda alguna la mejor opción para el paciente con cáncer superficial de vejiga, pero todavía hay mucho que aprender para mejorar la eficacia óptima de este tratamiento