Pharmacokinetic and toxicological prediction of the chemical constituents of the essential oil of the leaves of Croton heliotropiifolius Kunth.

The development of new drugs through studies of candidate molecules is a complex undertaking; however, computational or in silico approaches aimed at optimizing molecules with greater development potential are being utilized for predictions of pharmacokinetic properties such as absorption, distribution, metabolism and excretion (ADME) as well as toxicological parameters. The objective of this study was to examine in silico and in vivo pharmacokinetic and toxicological properties of the chemical constituents present in the essential oil of Croton heliotropiifolius Kunth leaves. The following Pubchem platform as well as Software SwissADME and PreADMET software were employed for in silico studies while micronucleus (MN) testing for in vivo determination of mutagenicity, using Swiss adult male Mus musculus mice. In silico findings demonstrated that all chemical constituents presented (1) high oral absorption (2) medium cellular permeability and (3) high blood brain permeability. As for toxicity, these chemical constituents exhibited low to medium risk of occurrence of cytotoxicity. Regarding in vivo evaluation, peripheral blood samples obtained from animals tested with the oil showed no significant differences in number of MN compared to negative controls. Data indicate that further investigations are necessary to corroborate the findings of this study. Our data suggest that essential oil extracted from Croton heliotropiifolius Kunth leaves may serve as a candidate for new drug development.

Challenges associated with spray drying of lactic acid bacteria: Understanding cell viability loss.

Lactic acid bacteria (LAB) cultures used in food fermentation are often dried to reduce transportation costs and facilitate handling during use. Dried LAB ferments are generally lyophilized to ensure high cell viability. Spray drying has come to the forefront as a promising technique due to its versatility and lower associated energy costs. Adverse conditions during spray drying, such as mechanical stress, dehydration, heating, and oxygen exposure, can lead to low LAB cell viability. This reduced viability has limited spray drying's industrial applications thus far. This review aims to demonstrate the operations and thermodynamic principles that govern spray drying, then correlate them to the damage suffered by LAB cells during the spray-drying process. The particularities of spray drying that might cause LAB cell death are detailed in this review, and the conclusion may enhance future studies on ways to improve cell viability.

The influence of adaptive stresses on the survival of spray-dried Lactococcus lactis cells.

The research described in this technical research communication examines the hypothesis that sublethal stress conditions can improve the survival of Lactococcus lactis subsp. lactis during drying and subsequent storage. After drying, the L. lactis that had adapted to acid or osmotic stresses did not differ statistically in terms of cell viability loss compared to the control samples tested (~0.38 log cycles). However, the cells that had adapted to oxidative conditions demonstrated a cell viability loss of only 0.01 log cycles. After 45 d of storage at temperatures of 4 and 25 °C, the final L. lactis sample populations were shown to be higher (112.5%) when they had been submitted to sublethal conditions of oxidative stress. When the cell samples were exposed to acid stress conditions, they exhibited a viability loss (0.82 log cycles) that was statistically different from the control sample (0.58 log cycles) after 45 d. Osmotic stress conditions did not demonstrate any influence over cell survival rates. Thus, submitting cells to oxidative stress conditions prior to storage has been shown to be a potential strategy for producing dehydrated cultures of L. lactis strains that are less sensitive to oxygen exposure.

Terpinen-4-ol as an Antibacterial and Antibiofilm Agent against Staphylococcus aureus.

Staphylococcus aureus is able to rapidly develop mechanisms of resistance to various drugs and to form strong biofilms, which makes it necessary to develop new antibacterial drugs. The essential oil of Melaleuca alternifolia is used as an antibacterial, a property believed to be mainly due to the presence of terpinen-4-ol. Based on this, the objective of this study was to evaluate the antibacterial and antibiofilm potential of terpinen-4-ol against S. aureus. The Minimal Inhibitory and Minimal Bactericidal Concentrations (MIC and MBC) of terpinen-4-ol were determined, and the effect of its combination with antibacterial drugs as well as its activity against S. aureus biofilms were evaluated. In addition, an in silico analysis of its pharmacokinetic parameters and a molecular docking analysis were performed. Terpinen-4-ol presented a MIC of 0.25% (v/v) and an MBC of 0.5% (v/v) (bactericidal action); its association with antibacterials was also effective. Terpinen-4-ol has good antibiofilm activity, and the in silico results indicated adequate absorption and distribution of the molecule in vivo. Molecular docking indicated that penicillin-binding protein 2a is a possible target of terpinen-4-ol in S. aureus. This work highlights the good potential of terpinen-4-ol as an antibacterial product and provides support for future pharmacological studies of this molecule, aiming at its therapeutic application.

5-Hydroxymethylfurfural formation and color change in lactose-hydrolyzed Dulce de leche.

The work described in this Research Communication concerns the production of Dulce de leche (DL), that is a traditional product from South America obtained by concentration. Maillard reaction (MR) products are mainly responsible for the formation of color and flavor in this product. Lactose-hydrolyzed products have been developed to supply consumer demand, but this hydrolysis may affect the flavor, color, taste, texture and even some nutritional aspects of the product. We studied the influence of different levels of lactose-hydrolysis, sucrose addition and initial pH on the development of MR, appraised by the determination of 5-hydroxymethylfurfural (HMF). A process simulator with multi-monitoring system was used to produce 15 DL. Box-Behnken 33 experimental design was applied for the three factors: pH, lactose-hydrolysis level and sucrose concentration. Lipids, protein, ashes, carbohydrates, water activity, dissolved solids, colorimetric analysis and HMF (free and total) are among the physicochemical attributes and MR indicators analyzed in this work. The products showed significant differences in composition but all the values were in agreement with the literature. Moreover, higher levels of lactose hydrolysis and higher pH presented a direct relation with the development of MR, observed by an increase in coloration (lower luminosity) and more formation of HMF, both free and total. The present study expands the knowledge about DL spread made of lactose-hydrolyzed milk, allowing the food industries to produce a lactose free DL with nutritional and sensory characteristics closer to the traditional product.

Healing at the interface between recipient sites and autologous block bone grafts affixed by either position or lag screw methods: a histomorphometric study in rabbits.

OBJECTIVE: To compare the sequential healing at the interface gap occurring between autologous bone grafts and recipient sites using two types of fixation techniques. MATERIAL AND METHODS: Twenty-four adult male New Zealand white rabbits were used. Two bone grafts were collected from the calvaria and secured to the lateral aspect of the angle of mandible in each animal. Cortical perforations at the recipient sites were performed. However, no modifications were applied to the graft for its adaptation to the recipient site. Two types of fixation techniques by position or lag screws were applied. This was done by preparing osteotomy holes smaller or larger than the screw diameter, respectively. The animals were sacrificed after 3, 7, 20, and 40 days. RESULTS: After 3 days, the distance between the graft and the recipient site was similar between the two different fixations. Due to the anatomical shapes of the recipient sites and grafts, the distance between the two parts was lower in the central region (<0.1 mm) compared to the external regions of the graft (0.5-0.6 mm). The first evidence of small amounts of new (woven) bone was seen after 7 days, forming from the parent bone. The percentage increased after 20 and 40 days. After 40 days, the grafts were well incorporated within the recipient sites in both groups without any statistically significant difference. CONCLUSIONS: The present study did not show superiority of one method over another. A fixation to a recipient site with perforations may be sufficient for incorporating an autologous bone graft even if its adaptation is not perfect and irrespectively of the fixation method. Distances of approximately half millimeter were bridged with newly formed bone.

Oil encapsulation in core-shell alginate capsules by inverse gelation II: comparison between dripping techniques using W/O or O/W emulsions.

In the first part of this article, it was described an innovative method of oil encapsulation from dripping-inverse gelation using water-in-oil (W/O) emulsions. It was noticed that the method of oil encapsulation was quite different depending on the emulsion type (W/O or oil-in-water (O/W)) used and that the emulsion structure (W/O or O/W) had a high impact on the dripping technique and the capsules characteristics. The objective of this article was to elucidate the differences between the dripping techniques using both emulsions and compare the capsule properties (mechanical resistance and release of actives). The oil encapsulation using O/W emulsions was easier to perform and did not require the use of emulsion destabilisers. However, capsules produced from W/O emulsions were more resistant to compression and showed the slower release of actives over time. The findings detailed here widened the knowledge of the inverse gelation and gave opportunities to develop new techniques of oil encapsulation.

Oil encapsulation techniques using alginate as encapsulating agent: applications and drawbacks.

Oils are used in agriculture, nutrition, food and cosmetics; however, these substances are oxidisable and may readily lose their properties. To reduce their degradation or to mask certain undesirable aspects, one strategy consists in encapsulating the oil in inert structures (capsules). The capsules are classified according to the morphology, the number of cores and size, can be produced by several techniques: jet-cutting, vibrating jet, spray-drying, dispersion and milli-microfluidic. Among the polymers used as a membrane in the capsules, alginates are used in oil encapsulation because of their high gelling capacity, biocompatibility and low toxicity. In the presence of calcium ions, the alginate macromolecules crosslink to form a three-dimensional network called hydrogel. The oil encapsulation using alginate as encapsulating material can be carried out using technologies based on the external, internal or inverse gelation mechanisms. These capsules can found applications in areas as cosmetics, textile, foods and veterinary, for example.

Oil encapsulation in core-shell alginate capsules by inverse gelation. I: dripping methodology.

The production of capsules by inverse gelation consists of adding dropwise oil containing calcium dispersion into an alginate bath. A dripping technique to produce capsules from oil-in-water (O/W) emulsions was proposed by Abang. However, little is known about the oil encapsulation using water-in-oil (W/O) emulsions. This work aims to develop a new method of W/O emulsions encapsulation by inverse gelation. The success of the W/O emulsion encapsulation is due to three factors: 1) use of an emulsion with moderate stability (50 min); 2) production of an emulsion with at least 90 g/L of CaCl2 and 3) addition of ethanol (20% v/v) into the alginate bath. Both wet and dry capsules were obtained with a spherical shape with diameters of 7 and 3.6 mm, respectively. All volume of oil was encapsulated and the oil loading in the wet and dry capsules was of 23 and 68% v/v, respectively.

Oil core microcapsules by inverse gelation technique.

A promising technique for oil encapsulation in Ca-alginate capsules by inverse gelation was proposed by Abang et al. This method consists of emulsifying calcium chloride solution in oil and then adding it dropwise in an alginate solution to produce Ca-alginate capsules. Spherical capsules with diameters around 3 mm were produced by this technique, however the production of smaller capsules was not demonstrated. The objective of this study is to propose a new method of oil encapsulation in a Ca-alginate membrane by inverse gelation. The optimisation of the method leads to microcapsules with diameters around 500 µm. In a search of microcapsules with improved diffusion characteristics, the size reduction is an essential factor to broaden the applications in food, cosmetics and pharmaceuticals areas. This work contributes to a better understanding of the inverse gelation technique and allows the production of microcapsules with a well-defined shell-core structure.

Evaluation of DFT methods for predicting geometries and NMR spectra of Bi(III) dithiocarbamate complexes with antitumor properties.

CONTEXT: Bismuth complexes with dithiocarbamate ligands have attracted attention because of their biological applications, such as antimicrobial, antileishmanial, and anticancer properties. These complexes have high cytotoxic activity against cancer cells, being more active than the standard drugs cisplatin, doxorubicin, and tamoxifen. In the present study, we investigated the ability of some DFT methods to reproduce the geometries and NMR spectra of the Bi(III) dithiocarbamate complexes, selected based on their proven antitumor activity. Our investigation revealed that the M06-L/def2-TZVP/ECP/CPCM method presented good accuracy in predicting geometries, while the TPSSh/def2-SVP/ECP/CPCM method proved effective in analyzing the 13C NMR spectra of these molecules. In general, all examined methods exhibited comparable performance in predicting 1H NMR signals. METHODS: Calculations were performed with the Gaussian 09 program using the def2-SVP and def2-TZVP basis sets, employing relativistic effective core potential (ECP) for Bi and using the CPCM solvent model. The exchange-correlation functionals BP86, PBE, OLYP, M06-L, B3LYP, B3LYP-D3, M06-2X, TPSSh, CAM-B3LYP, and ωB97XD were used in the study. Geometry optimizations were started from crystallographic structures available at the Cambridge Structural Database. The theoretical results were compared with experimental data using the mean root-mean-square deviation (RMSD), mean absolute deviations (MAD), and linear correlation coefficient (R2).

Design, Optimization, and Modeling Study of Ultrasound-Assisted Extraction of Bioactive Compounds from Purple-Fleshed Sweet Potatoes.

This study focuses on optimizing the ultrasound-assisted extraction (UAE) of bioactive compounds from purple-fleshed sweet potatoes (PFSP) for potential use as natural colorants. Factors such as time, temperature, and solid-to-liquid ratio were varied using a Box-Behnken Design. The optimal conditions were determined as 75 min, 70 °C, and a 1:15 m/v solid-to-liquid ratio, resulting in 18.372 mg/100 g total anthocyanin (TA) and 151.160 mg GAE/100 g total phenolic content (TPC). The validation yielded 18.822 mg/100 g for total anthocyanin and 162.174 mg GAE/100 g for total phenolic content, showing a 7% difference from predictions. UAE significantly increased TA extraction by 81% and TPC by 93% compared with the conventional method, with a notable reduction in process time from 24 h to 75 min. Additionally, three kinetic models were tested to compare extraction mechanisms, confirming the efficiency of UAE for PFSP bioactive compound recovery. This study proposes the UAE technique as a highly effective means of extracting bioactive compounds from PFSP, offering promising applications across multiple industries.

Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients.

BACKGROUND: Pupil reactivity and the Glasgow Coma Scale (GCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. OBJECTIVE: We evaluated the accuracy of the GCS-Pupil score (GCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining GCS and pupil response with additional clinical and radiological prognostic factors. METHODS: Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of GCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the GCS-P score by multivariate binary logistic regression. RESULTS: Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the GCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The GCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. CONCLUSION: Our results support the external validation of the GCS-P to predict hospital mortality following a severe TBI. The predictive value of the GCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

ANTECEDENTES: A reatividade pupilar e o escore da Escala de Coma de Glasgow (ECG) representam as informações clínicas mais relevantes para predizer a sobrevivência de pacientes com traumatismo cranioencefálico (TCE). OBJETIVO: Avaliar a acurácia da ECG com resposta pupilar (ECG-P) como índice prognóstico para predizer mortalidade hospitalar em pacientes brasileiros acometidos por TCE grave e compará-lo com um modelo combinando ECG e resposta pupilar com fatores prognósticos radiológicos. MéTODOS: Foram analisados dados de 1.066 pacientes com TCE grave de 5 estudos prospectivos. Foi determinada a associação entre mortalidade hospitalar e a combinação de ECG, reatividade pupilar, idade, níveis glicêmicos, tomografia computadorizada (TC) de crânio ou o escore ECG-P por regressão logística binária multivariada. RESULTADOS: Oitenta e cinco por cento (n = 908) dos pacientes eram homens. A média de idade foi de 35 anos e a mortalidade hospitalar geral foi de 32,8%. A AUROC (em português, Curva Característica de Operação do Receptor) foi de 0,73 (0,70­0,77) para o modelo utilizando o escore ECG-P e de 0,80 (0,77­0,83) para o modelo incluindo variáveis clínicas e radiológicas. O escore ECG-P mostrou acurácia semelhante na previsão da mortalidade relatada para pacientes com TCE grave derivados dos estudos International Mission for Prognosis and Clinical Trials in TBI (IMPACT, na sigla em inglês) e Corticosteroid Randomization After Significant Head Injury (CRASH, na sigla em inglês). CONCLUSãO: Nossos resultados apoiam a validação externa da ECG-P para prever a mortalidade hospitalar após um TCE grave. O valor preditivo da ECG-P para mortalidade a longo prazo, resultados funcionais e neuropsiquiátricos em pacientes brasileiros com TCE leve, moderado e grave precisam ser investigados.

Combination of Milk and Plant Proteins to Develop Novel Food Systems: What Are the Limits?

In the context of a diet transition from animal protein to plant protein, both for sustainable and healthy scopes, innovative plant-based foods are being developing. A combination with milk proteins has been proposed as a strategy to overcome the scarce functional and sensorial properties of plant proteins. Based on this mixture were designed several colloidal systems such as suspensions, gels, emulsions, and foams which can be found in many food products. This review aims to give profound scientific insights on the challenges and opportunities of developing such binary systems which could soon open a new market category in the food industry. The recent trends in the formulation of each colloidal system, as well as their limits and advantages are here considered. Lastly, new approaches to improve the coexistence of both milk and plant proteins and how they affect the sensorial profile of food products are discussed.

Strategies for the Development of Bioprotective Cultures in Food Preservation.

Consumers worldwide are increasingly demanding food with fewer ingredients, preferably without chemical additives. The trend called "Clean Label" has stimulated the development and commercialization of new types of bioprotective bacterial cultures. These bacteria are not considered new, and several cultures have been available on the market. Additionally, new bioprotective bacteria are being identified to service the clean label trend, extend the shelf life, and, mainly, improve the food safety of food. In this context, the lactic acid bacteria (LAB) have been extensively prospected as a bioprotective culture, as they have a long history in food production and their antimicrobial activity against spoilage and pathogenic microorganisms is well established. However, to make LAB cultures available in the market is not that easy, the strains should be characterized phenotypically and genotypically, and studies of safety and technological application are necessary to validate their bioprotection performance. Thus, this review presents information on the bioprotection mechanisms developed by LAB in foods and describes the main strategies used to identify and characterize bioprotective LAB with potential application in the food industry.

Diversity of Filamentous Fungi Associated with Dairy Processing Environments and Spoiled Products in Brazil.

Few studies have investigated the diversity of spoilage fungi from the dairy production chain in Brazil, despite their importance as spoilage microorganisms. In the present study, 109 filamentous fungi were isolated from various spoiled dairy products and dairy production environments. The isolates were identified through sequencing of the internal transcribed spacer (ITS) region. In spoiled products, Penicillium and Cladosporium were the most frequent genera of filamentous fungi and were also present in the dairy environment, indicating that they may represent a primary source of contamination. For dairy production environments, the most frequent genera were Cladosporium, Penicillium, Aspergillus, and Nigrospora. Four species (Hypoxylon griseobrunneum, Rhinocladiella similis, Coniochaeta rosae, and Paecilomyces maximus) were identified for the first time in dairy products or in dairy production environment. Phytopathogenic genera were also detected, such as Montagnula, Clonostachys, and Riopa. One species isolated from the dairy production environment is classified as the pathogenic fungi, R. similis. Regarding the phylogeny, 14 different families were observed and most of the fungi belong to the Ascomycota phylum. The understanding of fungal biodiversity in dairy products and environment can support the development of conservation strategies to control food spoilage. This includes the suitable use of preservatives in dairy products, as well as the application of specific cleaning and sanitizing protocols designed for a specific group of target microorganisms.

Weissella: An Emerging Bacterium with Promising Health Benefits.

Weissella strains have been the subject of much research over the last 5 years because of the genus' technological and probiotic potential. Certain strains have attracted the attention of the pharmaceutical, medical, and food industries because of their ability to produce antimicrobial exopolysaccharides (EPSs). Moreover, Weissella strains are able to keep foodborne pathogens in check because of the bacteriocins, hydrogen peroxide, and organic acids they can produce; all listed have recognized pathogen inhibitory activities. The Weissella genus has also shown potential for treating atopic dermatitis and certain cancers. W. cibaria, W. confusa, and W. paramesenteroides are particularly of note because of their probiotic potential (fermentation of prebiotic fibers) and their ability to survive in the gastrointestinal tract. It is important to note that most of the Weissella strains with these health-promoting properties have been shown to be save safe, due to the absence or the low occurrence of virulence or antibiotic-resistant genes. A large number of scientific studies continue to report on and to support the use of Weissella strains in the food and pharmaceutical industries. This review provides an overview of these studies and draws conclusions for future uses of this rich and previously unexplored genus.

Health beliefs towards kefir correlate with emotion and attitude: A study using an emoji scale in Brazil.

Emojis can be used to explore food-evoked emotions in order to provide information that can support the product development and marketing decisions. This study aimed to evaluate consumers' acceptance, purchase intent and emotional responses to milk beverages, with and without kefir added, before and after these consumers were informed about the products' composition (0%, 15%, 30% and 50% m/v) and health claims toward kefir (blind and informed tests, respectively). Emotional responses were assessed by emoji use within a RATA questionnaire in order quantify the perceived significance of the emojis chosen. In the informed test, the consumers' perception of the sensory attributes of the milk beverages, such as their perception of an acid taste in added kefir beverages was shown to have changed. Overall, participants attributed significantly higher acceptance and purchase intent scores to added kefir beverages after they had been informed on its health benefits. In addition, expressions of positive emotion increased when participants were exposed to stimuli related to health benefits of kefir (15%, 30% and 50% m/v), while negative expressions of emotion decreased. The provided information of kefir modified valence and arousal in subjects, and it can be said that to 30% of kefir can be added to yogurt without compromising its sensory acceptability. Thus, health benefits alone cannot improve product acceptance, since participants found a 50% addition of kefir to be unpleasant when tasted during a blind test. Mixed beverages may present a probiotic beverage alternative for consumers who dislike kefir milk, but want to include it in their diets. The implications of liking and purchase intent and how they are linked to emotions are discussed in this paper as well.

Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of incapacity and mortality worldwide, with most of the burden occurring in low-income and middle-income countries. A number of clinical, demographic, and neurosurgical variables of patients with TBI were associated with their outcome. METHODS: We investigated the mortality of Brazilian patients with severe TBI at the time of discharge, using a multiple logistic regression analysis. Clinical, demographic, radiologic, and neurosurgical variables, and mortality at time of discharge of all consecutive patients (n = 748) with severe TBI (admission Glasgow scale < or = 8) treated in our intensive care unit were analyzed. The variables were collected in a prospective manner between January 1994 and December 2003. RESULTS: Eighty-four percent (n = 631) of the patients were men. The mean age was 34.8 (+/-16.3) years and the mortality was 33.3%. After the multiple logistic regression, the adjusted odds ratio (OR) for death was higher in older (> 60 years) than younger (up to 30 years) patients (OR = 2.51, 95% confidence interval [CI] 1.31-4.79, p = 0.006). The mortality was also associated with sub-arachnoid hemorrhage (OR = 1.86, 95% CI = 1.23-2.81, p = 0.003) on computed tomography (CT) scan; admission Glasgow Scale of 3 or 4 in comparison to 7 or 8 (OR = 3.97, 95% CI = 2.49- 6.31, p < 0.001); bilateral midryasis (OR = 11.52, 95% CI = 5.56-23.87, p < 0.0001), or anisocoria (OR = 2.65, 95% CI = 1.69-4.17, p < 0.0001) in comparison to isocoric pupils. There was a trend for higher mortality in patients with type III injury on the Marshall classification of CT (OR = 3.63, 95% CI = 0.84-15.76, p = 0.08) than in patients with normal CT. Patients without thoracic trauma disclose higher mortality than patients with associated thoracic trauma do (OR = 2.02, 95% CI = 1.19-3.41, p = 0.009). The final model presented disclosed 76.9% of overall correct prediction with the survival and death predicted at 87.6% and 55.6%, respectively. CONCLUSION: Age, CT findings, Glasgow coma scale, pupil examination, and the presence of thoracic trauma at admission were independently associated with mortality at the time of discharge in Brazilian patients with severe TBI.

Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients / Escala de coma de Glasgow com resposta pupilar (ECC-P) e mortalidade hospitalar em traumatismo cranioencefálico grave: análise de 1.066 pacientes brasileiros

Abstract Background Pupil reactivity and the Glasgow Coma Scale (CCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. Objective We evaluated the accuracy of the CCS-Pupil score (CCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining CCS and pupil response with additional clinical and radiological prognostic factors. Methods Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of CCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the CCS-P score by multivariate binary logistic regression. Results Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the CCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The CCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. Conclusion Our results support the external validation of the CCS-P to predict hospital mortality following a severe TBI. The predictive value of the CCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

Resumo Antecedentes A reatividade pupilar e o escore da Escala de Coma de Glasgow (ECC) representam as informações clínicas mais relevantes para predizer a sobrevivência de pacientes com traumatismo cranioencefálico (TCE). Objetivo Avaliar a acurácia da ECC com resposta pupilar (ECC-P) como índice prognóstico para predizer mortalidade hospitalar em pacientes brasileiros acometidos por TCE grave e compará-lo com um modelo combinando ECC e resposta pupilar com fatores prognósticos radiológicos. Métodos Foram analisados dados de 1.066 pacientes com TCE grave de 5 estudos prospectivos. Foi determinada a associação entre mortalidade hospitalar e a combinação de ECC, reatividade pupilar, idade, níveis glicêmicos, tomografia computadorizada (TC) de crânio ou o escore ECC-P por regressão logística binária multivariada. Resultados Oitenta e cinco por cento (n = 908) dos pacientes eram homens. A média de idade foi de 35 anos e a mortalidade hospitalar geral foi de 32,8%. A AUROC (em português, Curva Característica de Operação do Receptor) foi de 0,73 (0,70-0,77) para o modelo utilizando o escore ECC-P e de 0,80 (0,77-0,83) para o modelo incluindo variáveis clínicas e radiológicas. O escore ECC-P mostrou acurácia semelhante na previsão da mortalidade relatada para pacientes com TCE grave derivados dos estudos International Mission for Prognosis and Clinical Trials in TBI (IMPACT, na sigla em inglês) e Corticosteroid Randomization After Significant Head Injury (CRASH, na sigla em inglês). Conclusão Nossos resultados apoiam a validação externa da ECC-P para prever a mortalidade hospitalar após um TCE grave. O valor preditivo da ECC-P para mortalidade a longo prazo, resultados funcionais e neuropsiquiátricos em pacientes brasileiros com TCE leve, moderado e grave precisam ser investigados.