Evaluation of a combination of Citrus aurantium var. Dulcis essential oil and albendazole for the treatment of sheep gastrointestinal nematodes.

Citrus fruits are consumed all over the world and their by-products are used for animal feed and essential oils production. This study aimed to evaluate the in vitro and in vivo activity of Citrus aurantium var. Dulcis essential oil (CaEO) combined with ABZ against benzimidazole resistant Haemonchus contortus. In vitro egg hatching assays (EHA) were performed using CaEO and ABZ to estimate the effective concentration to achieve 50% egg death (EC50) values and calculate the test essential oil and drug combinations using a simplex-centroid mixture design. These concentrations were used for a second round of EHAs. Sixteen sheep were randomly allocated into two groups and treated with ABZ and the combination of CaEO and ABZ, and faecal egg count reduction tests were performed. In the first round of EHA, CaEO and ABZ showed EC50 values of 0.57 and 0.0048 mg mL-1, respectively. The H. contortus strain used in the study was shown to be highly benzimidazole resistant, with only 1.5% of parasites having susceptible ß-tubulin SNP genotypes. The ABZ reduced the shedding of nematode eggs by 78%, however, its combination with CaEO reduced faecal egg counts by only 9%. The present study is important to highlight the interferences of natural products in anthelmintic metabolism and consequently in drug efficacy.

Ciência da palhaçaria: estudos teóricos e práticas em saúde mental / Science of clowning: theoretical and practical studies in mental health/

O livro Ciência da Palhaçaria: estudos teóricos e práticas em saúde mental aborda no campo da saúde possibilidades de pensar cientificamente a arteterapia, principalmente da palhaçaria. O nariz vermelho do palhaço simboliza o potencial aplicado da arte na saúde mental. Deste modo, apresentamos vários trabalho sob a luz da ciência, para que mais pessoas pudessem conhecer essa experiência e receber este cuidado em saúde como fundamentação para novas práticas.

Vitamin D Toxicity from an Unusual and Unexpected Source: A Report of 2 Cases.

INTRODUCTION: Hypervitaminosis D is a relatively uncommon etiology of hypercalcemia. Toxicity is usually caused by very high doses, mostly secondary to erroneous prescription or administration of vitamin D, and less commonly, contaminated foods or manufacturing errors of vitamin D-containing supplements. CASE PRESENTATION: A 16-year-old male, previously healthy, presented with 2-week history of nonspecific symptoms (fatigue, gastrointestinal complaints). Investigations showed acute kidney injury and hypercalcemia (total calcium 3.81 mmol/L). Further diagnostic workup revealed markedly elevated 25-hydroxyvitamin D levels (1,910 nmol/L). He denied taking any vitamin D supplements; however, he reported consumption of creatine and protein supplements. Mass spectrometry analysis of the creatine supplement estimated a vitamin D content of 425,000 IU per serving (100 times the upper tolerable daily dose). A few months later, another previously healthy adolescent presented with severe hypercalcemia and acute kidney injury secondary to hypervitaminosis D. He was also using a creatine supplement, from the same manufacturer brand and lot. Both patients were treated with intravenous hydration, calcitonin, and pamidronate. They maintained normocalcemia after their initial presentation but required low-calcium diets and laboratory testing for months after this exposure. DISCUSSION/CONCLUSION: We present 2 cases of hypervitaminosis D caused by a manufacturing error of a natural health product which did not claim to contain vitamin D. The use of dietary supplements is highly prevalent; this should be incorporated while taking medical history, and considered a potential source of toxicity when an alternative source cannot be found, regardless of the product label.

Anthelmintic evaluation and essential oils composition of Hyptis dilatata Benth. and Mesosphaerum suaveolens Kuntze from the Brazilian Amazon.

Hyptis dilatata and Mesosphaerum suaveolens belong to Lamiaceae, are aromatic and medicinal subshrubs with antiparasitic potential and occurrence in the Amazon Region. The essential oils of both species were extracted, analyzed, and identified by GC and GC-MS and then evaluated their anthelmintic activities against the nematode Caenorhabditis elegans. Primary constituents of the samples of H. dilatata oils were limonene (72.6%), myrcene (11.5%), and p-cymene (10.3%) to PAMA19 sample, and camphor (25.5%), α-pinene (25.4%), 1,8-cineole (18.8%), ß-pinene (12.0%), and limonene (5.9%) to PAMA108 sample, while in the oil of M. suaveolens, PAMA131 sample, predominated bicyclogermacrene (23.5%, 1,8-cineole (23.0%), germacrene D (17.2%), and (E)-caryophyllene (10.4%). The sample oil of H. dilatata (PAMA108) exhibited the lower anthelmintic inhibitory concentration, with an IC50 value of 2.09 mg/mL for C. elegans Bristol N2 strain, while the oils of H. dilatata (PAMA19) and M. suaveolens (PAMA131) showed an IC50 up of 4 mg/mL for C. elegans IVR15 and Bristol N2 strains. These results suggest that the H. dilatata and M. suaveolens oils constituents' combination can be helpful as a nematicidal agent due to their synergistic action.

Distinguishing cotton seed genotypes by means of vibrational spectroscopic methods (NIR and Raman) and chemometrics.

The use of vibrational spectroscopy, such as near infrared (NIR) and Raman, combined with multivariate analysis methods to analyze agricultural products are promising for investigating genetically modified organisms (GMO). In Brazil, cotton is grown under humid tropical conditions and is highly affected by pests and diseases, requiring the use of large amounts of phytosanitary chemicals. To avoid the use of those pesticides, genetic improvement can be carried out to produce species tolerant to herbicides, resistant to fungi and insects, or even to provide greater productivity and better quality. Even with these advantages, it is necessary to manage and limit the contact of transgenic species with native ones, avoiding possible contamination or even extinction of conventional species. The identification of the presence of GMOs is based on complex DNA-based analysis, which is usually laborious, expensive, time-consuming, destructive, and generally unavailable. In the present study, a new methodology to identify GMOs using partial least squares discriminant analysis (PLS-DA) on NIR and Raman data is proposed to distinguish conventional and transgenic cotton seed genotypes, providing classification errors for prediction set of 2.23% for NIR and 0.0% for Raman.

Chemometric strategies for near infrared hyperspectral imaging analysis: classification of cotton seed genotypes.

Hyperspectral images have been increasingly employed in the agricultural sector for seed classification for different purposes. In the present paper we propose a new methodology based on HSI in the near infrared range (HSI-NIR) to distinguish conventional from transgenic cotton seeds. Three different chemometric approaches, one pixel-based and two object-based, using partial least squares discriminant analysis (PLS-DA) were built and their performances were compared considering the pros and cons of each approach. Specificity and sensitivity values ranged from 0.78-0.92 and 0.62-0.93, respectively, for the different approaches.

Aspectos éticos no cuidado de enfermagem ao idoso em cuidados paliativos: revisão integrativa / Ethical aspects of nursing care for the elderly in palliative care

Objetivo: Identificar e descrever as evidências disponíveis na literatura sobre os aspectos éticos do cuidado do enfermeiro ao idoso em cuidados paliativos. Metodologia: Revisão integrativa na literatura com busca na Biblioteca Virtual em Saúde, no período abril a maio de 2019, com combinação dos descritores: "cuidados paliativos", "enfermagem", "idoso" e "ética". Resultado: Amostra de 04 artigos agrupados nas categorias temáticas: "princípios éticos e o dilema do enfermeiro na prestação dos cuidados paliativos" e "o papel do enfermeiro no alívio do sofrimento do idoso em cuidados paliativos". Identificou-se que o princípio ético mais discorrido foi a da autonomia e a importância do conhecimento para a manutenção da ética das relações foi salientada. Conclusão: Entender o indivíduo na sua singularidade e preservar a sua dignidade, é papel do enfermeiro. Considerando a importância do tema, o volume de publicações sobre o assunto foi insuficiente para responder as inquietações do estudo. (AU)

Objective: To identify and describe the available evidence in the literature on the ethical aspects of nursing care for the elderly in palliative care. Methods: Integrative review in the literature with search in the Virtual Health Library, from April to May 2019, combining the descriptors: "palliative care", "nursing", "elderly" and "ethics". Results: Sample of 04 articles grouped in the categories: "ethical principles and the dilemma of nurse in the palliative care delivery " and "the role of the nurse in the relief of the suffering of the elderly in palliative care". It was identified that the most ethical principle was autonomy and the importance of knowledge for the maintenance of the ethics of relations was evidenced. Conclusion: To understand the individual in his singularity and to preserve his dignity, is the role of the nurse. Considering the importance of the topic, the volume of publications on the subject was insufficient to respond to the concerns of the study. (AU)

Objetivo: Identificar y describir las evidencias disponibles en la literatura sobre los aspectos éticos del cuidado del enfermero al anciano en cuidados paliativos. Métodos: Revisión integrativa en la literatura con búsqueda en la Biblioteca Virtual en Salud, en el período abril a mayo de 2019, con combinación de los descriptores: "cuidados paliativos", "enfermería", "anciano" y "ética". Resultados: Muestra de 04 artículos agrupados en las categorías: "principios éticos y el dilema de la enfermera em prestación de los cuidados paliativos" y "el papel del enfermero en el alivio del sufrimiento del anciano en cuidados paliativos". Se identificó que el principio ético más discutido fue la de la autonomía y se evidenció la importancia del conocimiento para el mantenimiento de la ética de las relaciones. Conclusión: Entender al individuo en su singularidad y preservar su dignidad, es papel del enfermero. Considerando la importancia del tema, el volumen de publicaciones sobre el tema fue insuficiente para responder a las inquietudes del estudio. (AU)

Resposta para: A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto / Reply to: Adequacy of enteral nutrition support in intensive care units does not affect the short- and long-term prognosis of mechanically ventilated patients: a pilot study

Ao Editor Nosso estudo "A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto"(1) foi dimensionado (tamanho amostral) como uma pesquisa para avaliar efeitos em curto prazo e, nesse sentido, não se trata de um estudo piloto. Contudo, não tínhamos informação disponível na literatura e muito menos no cenário brasileiro sobre qual seria o tamanho amostral para um estudo em longo prazo. Assim, ele foi considerado um estudo piloto, o que nos permitiu estimar a magnitude das perdas e dos óbitos e calcular a amostra.(2) A ausência de dados em relação ao que realmente é ofertado é a limitação. Os pacientes foram separados em dois diferentes grupos (≥ 70% versus < 70%) de adequação calórica considerando apenas os registros do que foi prescrito, que constitui informação passível de recuperação em prontuários. No hospital em que foi realizado o estudo, infelizmente, não há registro do que realmente foi ofertado ou, melhor ainda, do que foi entregue. Essa é uma limitação comum nesse tipo de estudo. A progressão da dieta enteral é registrada em prontuário, mas, por vezes, a oferta é menor (por exemplo: pausa para uma tomografia). A falta de avaliação da capacidade funcional do paciente no momento de sua internação na unidade de terapia intensiva (UTI) é uma grande limitação. Ainda assim, é razoável especular que os pacientes que se recuperam ao longo do tempo o façam pela adequação nutricional ou pela tolerância à progressão da dieta - esta última indicando que eles seriam menos graves já na UTI. A inferência é especulativa. O tamanho amostral não permite conclusões definitivas, e o artigo deixa isso claro desde o título. O título ("um estudo piloto") é uma clara mensagem de que a informação será eventualmente usada no planejamento de um estudo maior. Nós agradecemos as considerações e tomamos todas como pertinentes. Esperamos ter esclarecido o principal.

Combination treatments with hydroxychloroquine and azithromycin are compatible with the therapeutic induction of anticancer immune responses.

Amid controversial reports that COVID-19 can be treated with a combination of the antimalarial drug hydroxychloroquine (HCQ) and the antibiotic azithromycin (AZI), a clinical trial (ONCOCOVID, NCT04341207) was launched at Gustave Roussy Cancer Campus to investigate the utility of this combination therapy in cancer patients. In this preclinical study, we investigated whether the combination of HCQ+AZI would be compatible with the therapeutic induction of anticancer immune responses. For this, we used doses of HCQ and AZI that affect whole-body physiology (as indicated by a partial blockade in cardiac and hepatic autophagic flux for HCQ and a reduction in body weight for AZI), showing that their combined administration did not interfere with tumor growth control induced by the immunogenic cell death inducer oxaliplatin. Moreover, the HCQ+AZI combination did not affect the capacity of a curative regimen (cisplatin + crizotinib + PD-1 blockade) to eradicate established orthotopic lung cancers in mice. In conclusion, it appears that HCQ+AZI does not interfere with the therapeutic induction of therapeutic anticancer immune responses.

Photobiomodulation in oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis followed by a cost-effectiveness analysis.

BACKGROUND: Oral mucositis (OM) is an oral toxicity caused by cancer treatment, found often in patients with head and neck cancer. Low-intensity laser therapy for OM has anti-inflammatory, analgesic, and tissue reparative properties. OBJECTIVE: The objective of this work is to perform a systematic review and meta-analysis of the randomized clinical trials of OM laser therapy in patients undergoing treatment for head and neck cancers, followed by a cost-effectiveness analysis of the therapy. METHOD: The search terms, mucositis and phototherapy, laser therapy and mucositis, photobiomodulation and mucositis, and low-level laser therapy and mucositis, were used to search the databases of PubMed, Web of Science, and MEDLINE. Randomized clinical trials were divided into two groups: one treated with laser therapy and the other given a placebo. Only 13 studies were included in the systematic review, and 6 studies in the meta-analysis. RESULTS: The results of the systematic review and meta-analysis show that the laser therapy presented good results in clinical improvement and pain reduction, decreasing the patients' likelihood of developing OM, with degrees of debilitating lesions, to 64% (RR = 0.36 [95% CI = 0.29-0.44]). The cost-effectiveness analysis revealed an incremental cost of R$ 3687.53 for the laser group, with an incremental effectiveness of 132.2. The incremental cost-effectiveness ratio (ICER) was 27.89, for the severe OM cases that were avoided. CONCLUSION: It was concluded, therefore, that photobiomodulation for OM in patients receiving head and neck cancer treatment was clinically effective and cost-effective.

Brazilian cardio-oncology: the 10-year experience of the Instituto do Cancer do Estado de Sao Paulo.

BACKGROUND: In recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes. METHODS: A retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity). RESULTS: From a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48-66], 66 [58-74] and 69 [62-76], p < 0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p < 0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p < 0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p < 0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p = 0.650]). CONCLUSION: The number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.

Reply to: Adequacy of enteral nutrition support in intensive care units does not affect the short- and long-term prognosis of mechanically ventilated patients: a pilot study. / Resposta para: A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto.

Nosso estudo "A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto"(1) foi dimensionado (tamanho amostral) como uma pesquisa para avaliar efeitos em curto prazo e, nesse sentido, não se trata de um estudo piloto. Contudo, não tínhamos informação disponível na literatura e muito menos no cenário brasileiro sobre qual seria o tamanho amostral para um estudo em longo prazo. Assim, ele foi considerado um estudo piloto, o que nos permitiu estimar a magnitude das perdas e dos óbitos e calcular a amostra.(2) A ausência de dados em relação ao que realmente é ofertado é a limitação. Os pacientes foram separados em dois diferentes grupos (≥ 70% versus < 70%) de adequação calórica considerando apenas os registros do que foi prescrito, que constitui informação passível de recuperação em prontuários. No hospital em que foi realizado o estudo, infelizmente, não há registro do que realmente foi ofertado ou, melhor ainda, do que foi entregue. Essa é uma limitação comum nesse tipo de estudo. A progressão da dieta enteral é registrada em prontuário, mas, por vezes, a oferta é menor (por exemplo: pausa para uma tomografia). A falta de avaliação da capacidade funcional do paciente no momento de sua internação na unidade de terapia intensiva (UTI) é uma grande limitação. Ainda assim, é razoável especular que os pacientes que se recuperam ao longo do tempo o façam pela adequação nutricional ou pela tolerância à progressão da dieta - esta última indicando que eles seriam menos graves já na UTI. A inferência é especulativa. O tamanho amostral não permite conclusões definitivas, e o artigo deixa isso claro desde o título. O título ("um estudo piloto") é uma clara mensagem de que a informação será eventualmente usada no planejamento de um estudo maior. Nós agradecemos as considerações e tomamos todas como pertinentes. Esperamos ter esclarecido o principal.

Art as a Therapeutic Tool in Depressive Disorders: a Systematic Review of the Literature.

Different alternative forms of therapy have been studied in relation to their applicability and effectiveness. The use of art therapy in the treatment of depressive disorder is an example frequently employed in several countries. The aim of this research was to identify and discuss which artistic techniques have been applied most frequently in the treatment of depressive disorders and what their main effects are. The research was conducted in the MEDLINE/PubMed, American Psychological Association (APA) and Web of Science databases. The articles were selected through the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA protocol). 14 articles were selected, among which the main techniques of art therapy used were: manual work (drawing, painting, and modeling), music, poetry, photography, theater and contemplation of art pieces. It was found that most of the researches are European and as a field of knowledge they depart mainly from medicine. Of the 14 researches of this review, only two failed in the use of art therapy techniques as a therapeutic tool. It can be understood that art therapy is a safe and reliable tool for treatment not only of depression but also of other mental disorders.

Parkia platycephala lectin enhances the antibiotic activity against multi-resistant bacterial strains and inhibits the development of Haemonchus contortus.

Lectins have been studied in the past few years as an alternative to inhibit the development of pathogenic bacteria and gastrointestinal nematodes of small ruminants. The development of new antibacterial and anthelmintic compounds is necessary owing to the increase in drug resistance among important pathogens. Therefore, this study aimed to evaluate the capacity of a glucose/mannose-binding lectin from Parkia platycephala seeds (PPL) to inhibit the development of Haemonchus contortus and to modulate antibiotic activity against multi-resistant bacterial strains, thereby confirming its efficacy when used in combination with gentamicin. PPL at the concentration of 1.2 mg/mL did not show inhibitory activity on H. contortus in the egg hatch test or the exsheathment assay. However, it did show significant inhibition of H. contortus larval development with an IC50 of 0.31 mg/mL. The minimum inhibitory concentration (MIC) obtained for PPL against all tested bacterial strains was not clinically relevant (MIC ≥ 1024 µg/mL). However, when PPL was combined with gentamicin, a significant increase in antibiotic activity was observed against S. aureus and E.coli multi-resistant strains. The inhibition of hemagglutinating activity by gentamicin (MIC = 50 mM) revealed that it may be interacting with the carbohydrate-binding site of PPL. It is this interaction between the antibiotic and lectin carbohydrate-binding site that may be responsible for the enhanced activity of gentamicin against multi-resistant strains. It can be concluded that PPL showed selective anthelmintic effect, inhibiting the development of H. contortus larvae and that it increased the effect of the antibiotic gentamicin against multi-resistant bacterial strains, thus constituting a potential therapeutic resource against resistant bacterial strains and H. contortus.

Photobiomodulation therapy reduces acute pain and inflammation in mice.

Photobiomodulation (PBM) is a therapy suggested for the treatment of pain and inflammation. Different mechanisms have been proposed to explain the analgesic and inflammatory effects of photobiomodulation, but there are still gaps on the mechanisms underlying. The objective was to investigate the analgesic and anti-inflammatory effect of red LED, as well as to investigate the possible mechanism of action in acute nociception models. Radiation was applied with red LED (660 nm, 215 mW, 84.64 mW/cm2, 2.531 J/cm2 (30s); 5.07 J/cm2 (60s) 7.61 J/cm2 (90s) and 10.15 J/cm2 (120 s)). The red LED applied 60 s before the experiments, promoted reduction of the nociceptive neurogenic (1st phase) and inflammatory pain (2nd phase) induced by intraplantar (i.pl.) injection of formalin. This effect duration in the second phase was 180 min after pretreatment of the LED. Red LED also reduced nociception induced by intraperitoneal injection of acetic acid. Furthermore, red LED prevented nociception induced by i.pl. injection of cinnamaldehyde, capsaicin, menthol and acidified saline. It was demonstrate the involvement of glutamatergic system with the reduction the nociception induced by glutamate. The red LED was able to prevent nociception induced by intracellular signaling cascades activators, phorbol 12-myristate 13-acetate (PMA), bradykinin, forskolin and prostaglandin. In addition, red LED, respectively, from 30 to 90s demonstrated an antiedematogenic effect on ear edema and reduction the migration of inflammatory cells induced by single application of croton oil. Thus, the new findings in this study support some underlying mechanism by which red LED phototherapy reduces acute pain. However, need further clarification regarding analgesic and anti-inflammatory effect of the photobiomodulation in preclinical studies.

Adequacy of enteral nutritional support in intensive care units does not affect the short- and long-term prognosis of mechanically ventilated patients: a pilot study. / A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto.

OBJECTIVE: To correlate short-term (duration of mechanical ventilation and length of intensive care unit stay) and long-term (functional capacity) clinical outcomes of patients who reached nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization in the intensive care unit. METHODS: This was a prospective observational pilot study conducted in an 18-bed intensive care unit. A total of 100 mechanically ventilated patients receiving exclusive enteral nutritional support and receiving intensive care for more than 72 hours were included. Patients who never received enteral nutrition, those with spinal cord trauma, pregnant women, organ donors and cases of family refusal were excluded. The variables studied were nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization, length of intensive care unit stay, duration of mechanical ventilation and the ability to perform activities of daily living after 12 months, assessed via telephone contact using the Lawton Activities of Daily Living Scale. RESULTS: The mean duration of mechanical ventilation was 18 ± 9 days, and the mean intensive care unit length of stay was 19 ± 8 days. Only 45% of the patients received more than 70% of the target nutrition in 72 hours. There was no association between nutritional adequacy and short-term (duration of mechanical ventilation, length of stay in the intensive care unit and mortality) or long-term (functional capacity and mortality) clinical outcomes. CONCLUSION: Critically ill patients receiving caloric intake ≥ 70% in the first 72 hours of hospitalization did not present better outcomes in the short term or after 1 year.

OBJETIVO: Correlacionar os desfechos clínicos, em curto (tempo em ventilação mecânica e tempo de unidade de terapia intensiva) e longo prazos (capacidade funcional), dos pacientes que atingiram adequação nutricional ≥ 70% do previsto nas primeiras 72 horas de internação na unidade de terapia intensiva. MÉTODOS: Estudo piloto prospectivo observacional, realizado em unidade de terapia intensiva de 18 leitos. Foram incluídos cem pacientes mecanicamente ventilados, recebendo suporte nutricional enteral exclusivo e submetidos à terapia intensiva por mais de 72 horas. Foram excluídos pacientes que nunca receberam nutrição enteral, gestantes, com trauma raquimedular, doadores de órgãos e casos de recusa familiar. As variáveis estudadas foram adequação nutricional ≥ 70% do previsto nas primeiras 72 horas de internação, tempo de unidade de terapia intensiva, tempo em ventilação mecânica e, após 12 meses, via contato telefônico, a capacidade de realizar Atividades da Vida Diária por meio do instrumento Lawton-Atividades de Vida Diária. RESULTADOS: O tempo médio em ventilação mecânica foi de 18 ± 9 dias, e de internação na unidade de terapia intensiva de 19 ± 8 dias. Somente 45% dos pacientes receberem mais de 70% do alvo nutricional em 72 horas. Não houve associação entre a adequação nutricional e os desfechos em curto prazo (tempo de permanência em ventilação mecânica, tempo de internação na unidade de terapia intensiva e mortalidade), nem com os desfechos clínicos em longo prazo (capacidade funcional e mortalidade). CONCLUSÃO: Pacientes criticamente enfermos que recebem aporte calórico ≥ 70%, nas primeiras 72 horas de internação não apresentaram melhores desfechos em curto prazo ou após 1 ano.

A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto / Adequacy of enteral nutritional support in intensive care units does not affect the short- and long-term prognosis of mechanically ventilated patients: a pilot study

RESUMO Objetivo: Correlacionar os desfechos clínicos, em curto (tempo em ventilação mecânica e tempo de unidade de terapia intensiva) e longo prazos (capacidade funcional), dos pacientes que atingiram adequação nutricional ≥ 70% do previsto nas primeiras 72 horas de internação na unidade de terapia intensiva. Métodos: Estudo piloto prospectivo observacional, realizado em unidade de terapia intensiva de 18 leitos. Foram incluídos cem pacientes mecanicamente ventilados, recebendo suporte nutricional enteral exclusivo e submetidos à terapia intensiva por mais de 72 horas. Foram excluídos pacientes que nunca receberam nutrição enteral, gestantes, com trauma raquimedular, doadores de órgãos e casos de recusa familiar. As variáveis estudadas foram adequação nutricional ≥ 70% do previsto nas primeiras 72 horas de internação, tempo de unidade de terapia intensiva, tempo em ventilação mecânica e, após 12 meses, via contato telefônico, a capacidade de realizar Atividades da Vida Diária por meio do instrumento Lawton-Atividades de Vida Diária. Resultados: O tempo médio em ventilação mecânica foi de 18 ± 9 dias, e de internação na unidade de terapia intensiva de 19 ± 8 dias. Somente 45% dos pacientes receberem mais de 70% do alvo nutricional em 72 horas. Não houve associação entre a adequação nutricional e os desfechos em curto prazo (tempo de permanência em ventilação mecânica, tempo de internação na unidade de terapia intensiva e mortalidade), nem com os desfechos clínicos em longo prazo (capacidade funcional e mortalidade). Conclusão: Pacientes criticamente enfermos que recebem aporte calórico ≥ 70%, nas primeiras 72 horas de internação não apresentaram melhores desfechos em curto prazo ou após 1 ano.

ABSTRACT Objective: To correlate short-term (duration of mechanical ventilation and length of intensive care unit stay) and long-term (functional capacity) clinical outcomes of patients who reached nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization in the intensive care unit. Methods: This was a prospective observational pilot study conducted in an 18-bed intensive care unit. A total of 100 mechanically ventilated patients receiving exclusive enteral nutritional support and receiving intensive care for more than 72 hours were included. Patients who never received enteral nutrition, those with spinal cord trauma, pregnant women, organ donors and cases of family refusal were excluded. The variables studied were nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization, length of intensive care unit stay, duration of mechanical ventilation and the ability to perform activities of daily living after 12 months, assessed via telephone contact using the Lawton Activities of Daily Living Scale. Results: The mean duration of mechanical ventilation was 18 ± 9 days, and the mean intensive care unit length of stay was 19 ± 8 days. Only 45% of the patients received more than 70% of the target nutrition in 72 hours. There was no association between nutritional adequacy and short-term (duration of mechanical ventilation, length of stay in the intensive care unit and mortality) or long-term (functional capacity and mortality) clinical outcomes. Conclusion: Critically ill patients receiving caloric intake ≥ 70% in the first 72 hours of hospitalization did not present better outcomes in the short term or after 1 year.

Antiparasitic activities of hydroethanolic extracts of Ipomoea imperati (Vahl) Griseb. (Convolvulaceae).

Ipomoea imperati is widely used in tropical areas to treat several pathological conditions. The effect of this plant against parasitic species has not been investigated even being used for this purpose in the Brazilian northeastern. This study aimed to evaluate the anthelmintic and acaricide potential of a hydroethanolic extract of I. imperati leaves and stolons. I. imperati leaves and stolons were crushed and subjected to maceration in ethanol 70% (v/v), after which the solvent was removed using a rotary evaporator. The chromatographic profile of the extract was obtained by UV Spectrum high-performance liquid chromatography and compounds were identified by liquid chromatography/electrospray ionization tandem mass spectrometry. Identification of the compounds present in the extract was achieved by comparing their retention times and UV spectra with data in the literature. Anthelmintic activity was evaluated by larval exsheathment inhibition assays using Haemonchus contortus larvae and five concentrations of each extract ranging from 0.07 to 1.2 mg/mL. Acaricide activity was evaluated via larval immersion of Rhipicephalus microplus in eight concentrations of each extract ranging from 5.0 to 25.0 mg/mL. Live and dead larvae were counted after 24 hours. The median inhibitory concentration (IC50) for H. contortus larvae and the median lethal concentration (LC50) for R. microplus larvae were calculated. Twelve compounds were observed in the hydroethanolic extract of leaves, with a predominance of the aglycone form of flavonoids and tannins. This extract was effective against H. contortus larvae, presenting an average inhibitory concentration of 0.22 mg/mL, but showed no activity toward R. microplus larvae. The stolon hydroethanolic extract presented 11 compounds, with phenolic acids and glycosylated flavonoids prevailing. This extract showed low activity on R. microplus and no effect on inhibiting H. contortus larval exsheathment at the concentrations tested. This study is the first to assess the anthelmintic and acaricidal activities of I. imperati. Data reported confirm promising potential of I. imperati leaves hydroethanolic extract against H. contortus. This effect could be due to its secondary compounds presents in this extract, such as procyanidin, kaempferol, isoquercitrin and rutin.

A cysteine protease from the latex of Ficus benjamina has in vitro anthelmintic activity against Haemonchus contortus / Atividade anti-helmíntica in vitro de uma protease cisteínica do látex de Ficus benjamina contra Haemonchus contortus

Abstract Haemonchus contortus is a gastrointestinal nematode that is responsible for high mortality rates in ruminant herds. The resistance of nematodes to synthetic anthelmintics is widespread and requires a continuous search for new bioactive molecules, such as proteins. The objective of this study was to evaluate the anthelmintic potential of a protease purified from the latex of Ficus benjamina against H. contortus . Fresh latex was collected from plants via small incisions in the green stems, the rubber was removed by centrifugation, and the latex protein extract (LPE) was obtained. After LPE fractionation with ammonium sulfate and chromatography of the fraction containing the highest proteolytic activity on CM-cellulose, a cysteine protease (FbP) was purified. FbP has a molecular mass of approximately 23.97 kDa, and its proteolytic activity was stable between pH 6.0 and pH 10 and over a broad temperature range, with optimum activity at 60 °C. FbP inhibited both the development and exsheathment of H. contortus larvae, with 50% effective concentrations of 0.26 and 0.79 mg/mL, respectively. We conclude that this cysteine protease from F. benjamina latex with anthelmintic activity against H. contortus could be a promising alternative for the development of products for use in parasite control programmes.

Resumo Haemonchus contortus é um nematoide gastrintestinal, responsável por altas taxas de mortalidade em rebanhos de pequenos ruminantes. A resistência dos nematoides aos anti-helmínticos sintéticos está generalizada e requer uma busca contínua por novos compostos bioativos, como as proteínas. O objetivo deste trabalho foi avaliar o potencial anti-helmíntico da protease purificada do látex de Ficus benjamina contra H. contortus . O látex fresco foi coletado das plantas por pequenas incisões nas hastes verdes e o extrato proteico de látex (EPL) foi obtido. Após o fracionamento do EPL com sulfato de amônio e cromatografia da fração contendo a maior atividade proteolítica da CM-Celulose, uma protease cisteínica (FbP) foi purificada. A FbP tem massa molecular de cerca de 23,97 kDa, a atividade proteolítica foi estável entre pH 6,0 e pH 10 e ao longo de uma ampla faixa de temperatura, com atividade ótima a 60 °C. A FbP inibiu tanto o desenvolvimento quanto o desembainhamento das larvas de H. contortus, com 50% de inibição nas concentrações de 0,26 e 0,79 mg/mL, respectivamente. Concluímos que esta protease cisteínica do látex de F. benjamina, com ação anti-helmíntica contra H. contortus, pode ser uma alternativa promissora para o desenvolvimento de produtos a serem utilizados em programas de controle de parasitos.