Applications of Antioxidant Secondary Metabolites of Sargassum spp.

Sargassum is one of the largest and most diverse genus of brown seaweeds, comprising of around 400 taxonomically accepted species. Many species of this genus have long been a part of human culture with applications as food, feed, and remedies in folk medicine. Apart from their high nutritional value, these seaweeds are also a well-known reservoir of natural antioxidant compounds of great interest, including polyphenols, carotenoids, meroterpenoids, phytosterols, and several others. Such compounds provide a valuable contribution to innovation that can translate, for instance, into the development of new ingredients for preventing product deterioration, particularly in food products, cosmetics or biostimulants to boost crops production and tolerance to abiotic stress. This manuscript revises the chemical composition of Sargassum seaweeds, highlighting their antioxidant secondary metabolites, their mechanism of action, and multiple applications in fields, including agriculture, food, and health.

Effect of Vapor-Phase Oregano Essential Oil on Resistant Candida Species Biofilms: Mechanisms of Action.

Vulvovaginal candidiasis (VVC) is one of the most prevalent vaginal infectious diseases. The increasing incidence of drug-resistant Candida strains and the limited therapeutic options make the discovery of effective alternative therapies fundamental. Essential oils (EOs) have been suggested as a promising alternative, and interestingly, vapor-phase essential oils (VP-EOs) present more advantages than their direct application. Thus, this study aims to evaluate the effect of oregano VP-EO (VP-OEO) on biofilms of antifungal-resistant vaginal isolates of Candida species (Candida albicans and Candida glabrata) and determine its mode of action. CFU, membrane integrity, and metabolic activity were evaluated. Furthermore, a reconstituted vaginal epithelium was used to mimic vaginal conditions and evaluate the effect of VP-OEO on Candida species infection, analyzed by DNA quantification, microscopy, and lactate dehydrogenase activity. The results revealed high VP-OEO antifungal activity. There was a significant reduction (>4 log CFU) in Candida species biofilms. Furthermore, the results show that the mechanisms of action of VP-OEO are related to membrane integrity and metabolic activity. The epithelium model confirms the effectiveness of VP-OEO. This study suggests that VP-EO can be considered a first approach for the development of an alternative form of VVC treatment. IMPORTANCE This work presents a new approach to the application of essential oils, exposure to the vapor phase, which can be considered a first approach for the development of a complementary or alternative form of vulvovaginal candidiasis (VVC) treatment. VVC is a significant infection caused by Candida species and remains a common disease that affects millions of women every year. The great difficulty in treating VVC and the extremely limited effective therapeutic options make the development of alternative treatments crucial. In this scope, this study aims to contribute to the development of effective, inexpensive, and nontoxic strategies for the prevention and treatment of this infectious disease, based on natural products. Moreover, this new approach has several advantages for women, such as lower costs, easy access, an easier mode of application, avoidance of skin contact, and, therefore, fewer negative impacts on women's health.

Overview of Phlorotannins' Constituents in Fucales.

Fucales are an order within the Phaeophyceae that include most of the common littoral seaweeds in temperate and subtropical coastal regions. Many species of this order have long been a part of human culture with applications as food, feedand remedies in folk medicine. Apart from their high nutritional value, these seaweeds are also a well-known reservoir of multiple bioactive compounds with great industrial interest. Among them, phlorotannins, a unique and diverse class of brown algae-exclusive phenolics, have gathered much attention during the last few years due to their numerous potential health benefits. However, due to their complex structural features, combined with the scarcity of standards, it poses a great challenge to the identification and characterization of these compounds, at least with the technology currently available. Nevertheless, much effort has been taken towards the elucidation of the structural features of phlorotannins, which have resulted in relevant insights into the chemistry of these compounds. In this context, this review addresses the major contributions and technological advances in the field of phlorotannins extraction and characterization, with a particular focus on Fucales.

Vapor-Phase of Essential Oils as a Promising Solution to Prevent Candida Vaginal Biofilms Caused by Antifungal Resistant Strains.

BACKGROUND: Vulvovaginal candidiasis (VVC) is a disease with high incidence, a huge impact on the quality of life and health of women, and which represents a great challenge to treat. The growing need to apply antifungal intensive therapies have contributed to an emergence of drug-resistant Candida strains. Thus, effective therapeutic options, to meet the antifungal-resistance challenge and to control high resilient biofilms, are urgently needed. This study aimed to investigate the antifungal activity of essentials oils (EOs) on drug-resistant Candida vaginal isolates. METHOD: Therefore, the antimicrobial effect of tea tree, niaouli, white thyme, and cajeput EOs on the planktonic growth of Candida isolates was initially evaluated by an agar disc diffusion method. Then, the vapor-phase effect of tea tree EO (VP-TTEO) on biofilm formation and on pre-formed biofilms was evaluated by crystal violet staining, XTT reduction assay, colony forming units' enumeration, and scanning electron microscopy. RESULTS: The results revealed high antifungal activity of EOs against drug-resistant Candida isolates. Additionally, the VP-TTEO showed a significant inhibitory effect on the biofilm formation of all tested isolates and was able to provoke an expressive reduction in mature Candida albicans biofilms. CONCLUSIONS: Overall, this study suggests that the VP-EO may be a promising solution that is able to prevent biofilm-related VVC caused by antifungal-resistant strains.

Avaliação da espiritualidade e do bem-estar espiritual em estudantes da graduação de enfermagem / Evaluación de espiritualidad y bienestar espiritual en estudiantes de graduación de enfermería / Evaluation of spirituality and spiritual well-being in nursing graduation students

Objetivo: avaliar a espiritualidade e o bem-estar espiritual em estudantes de graduação em enfermagem. Método: estudo quantitativo e observacional com estudantes de enfermagem do primeiro e último ano no primeiro semestre de 2020, de quatro universidades em uma cidade no norte do Estado do Paraná. Foram aplicados e analisados Escala de avaliação da espiritualidade,e Escala de Bem-Estar Espiritual, e apresentados por meio de análise descritiva dos dados. Resultados: 87,8% (n=58) dos participantes têm pensamentos espirituais e 83,4% (n=55) com influência da religiosidade, com alto score de espiritualidade com 22,2 pontos, 54,5% (n=36) apresentaram alto score de bem-estar espiritual classificados como positivo, enquanto 45,5% (n=30) apresentaram score negativo. Conclusão: a maioria dos estudantes se esforçam em viver de acordo com sua crença religiosa, bem como sua vida está baseada na espiritualidade que possui. Na escala de bem-estar espiritual, observou-se pouca diferença entre os índices positivo e negativo no grupo. (AU)

Objetivo: evaluar la espiritualidad y el bienestar espiritual en estudiantes de graduación en enfermería. Método: estudio observacional con estudiantes de primero y último año del primer semestre de 2020, de cuatro universidades de una ciudad del estado de Paraná. Se aplicaron la Escala de Evaluación de la Espiritualidad y de Bienestar Espiritual, y se presentaron a través del análisis descriptivo de los datos. Resultados: el 87,8% (n=58) de los participantes tienen pensamientos espirituales y el 83,4% (n=55) están influenciados por la religiosidad, con un puntaje alto de espiritualidad con 22,2 puntos, el 54,5% (n=36) tienen un alto bienestar espiritual, siendo el puntaje clasificado como positivo, mientras que el 45,5% (n=30) tuvo un puntaje negativo. Conclusión: los estudiantes se esfuerzan por vivir de acordó con su creencia religiosa, así como su vida se basa en la espiritualidad que poseen. El bienestar espiritual hubo poca diferencia de índices positivo/negativo en el grupo.(AU)

Objective: to evaluate spirituality and well-being spiritual in undergraduate nursing students. Method: quantitative and observational study with first and last year nursing students in the first semester of 2020, from four universities in a city in the north of the state of Paraná. The Spirituality Assessment Scale and the Spiritual Well-Being Scale were applied and treated through descriptive data analysis. Results: 87.8% (n=58) of the participants have spiritual thoughts and 83.4% (n=55) are influenced by religiosity, with a high spirituality score with 22.2 points, 54.5% (n=36) had a high spiritual well-being score classified as positive, while 45.5% (n=30) had a negative score. Conclusion: most students strive to live according to their religious belief, as well as their life is based on the spirituality they have. On the spiritual well-being scale, there was little difference between the positive and negative indices in the group.(AU)

Differential NMR and chromatography for the detection and analysis of adulteration of vetiver essential oils.

Adulteration of essential oils is a common and serious problem. Adequate and fast methods are required to establish the authenticity and purity. GC-MS, 1H and 13C NMR were compared in combination with similarity calculations as well as differential spectroscopy and chromatography for the authentication and determination of purity of vetiver essential oils. In the investigation of eight commercial oils 1H and 13C NMR adequately detected all six adulterants encountered in four of the commercial samples, while GC-MS was not able to detect adulteration with vegetable oils. A great advantage of the combined use of similarity calculation and NMR is that the authenticity can be verified without the need of concomitant measurement of a standard sample. The calculation can be carried out with a registered reference spectrum, in the case of 1H NMR acquired using the same magnetic field, but in the case of 13C NMR the spectrum can be obtained with another magnetic field. 1H NMR has the advantage of high speed, and the results can be obtained within minutes. 13C NMR was found to be superior in its ability to provide unequivocal identification of eventual adulterants, with differential spectroscopy revealing all signals of the adulterants.

Hypoglycaemic and Antioxidant Properties of Acrocomia aculeata (Jacq.) Lodd Ex Mart. Extract Are Associated with Better Vascular Function of Type 2 Diabetic Rats.

Oxidative stress is involved in the metabolic dysregulation of type 2 diabetes (DM2). Acrocomia aculeata (Aa) fruit pulp has been described for the treatment of several diseases, and recently we have proved that its leaves have phenolic compounds with a marked antioxidant effect. We aimed to assess whether they can improve metabolic, redox and vascular functions in DM2. Control Wistar (W-Ctrl) and non-obese type 2 diabetic Goto-Kakizaki (GK-Ctrl) rats were treated for 30 days with 200 mg.kg-1 aqueous extract of Aa (EA-Aa) (Wistar, W-EA-Aa/GK, GK-EA-Aa). EA-Aa was able to reduce fasting glycaemia and triglycerides of GK-EA-Aa by improving proteins related to glucose and lipid metabolism, such as GLUT-4, PPARγ, AMPK, and IR, when compared to GK-Ctrl. It also improved viability of 3T3-L1 pre-adipocytes exposed by H2O2. EA-Aa also increased the levels of catalase in the aorta and kidney, reduced oxidative stress and increased relaxation of the aorta in GK-treated rats in relation to GK-Ctrl, in addition to the protective effect against oxidative stress in HMVec-D cells. We proved the direct antioxidant potential of the chemical compounds of EA-Aa, the increase in antioxidant defences in a tissue-specific manner and hypoglycaemic properties, improving vascular function in type 2 diabetes. EA-Aa and its constituents may have a therapeutic potential for the treatment of DM2 complications.

Curcumin derivatives for Type 2 Diabetes management and prevention of complications.

Type 2 diabetes Mellitus (T2DM) is characterized by chronically increased blood glucose levels, which is associated with impairment of the inflammatory and oxidative state and dyslipidaemia. Although it is considered a world heath concern and one of the most studied diseases, we are still pursuing an effective therapy for both the pathophysiological mechanisms and the complications. Curcumin, a natural compound found in the rhizome of Curcuma longa, is well known for its numerous biological activities, as demonstrated by several studies supporting that curcumin possesses hypoglycaemic, hypolipidemic, anti-inflammatory and antioxidant properties, among others. These effects have been explored to the attenuation of hyperglycaemia and progression of DM complications, being appointed as a potential therapeutic approach. Besides its strong intrinsic activity, the polyphenol has low bioavailability, compromising its therapeutic efficacy. In order to overcome this limitation, several chemical strategies have been applied to curcumin, such as drug delivery systems, chemical manipulation and the use of adjuvant therapies. Given the promising results obtained with curcumin derivative, in this review we discuss not only the therapeutic targets of curcumin, but also its most recently developed analogues and their efficacy in the management of T2DM pathophysiology and complications.

Acute kidney injury due to excessive and prolonged intramuscular injection of veterinary supplements containing vitamins A, D and E: A series of 16 cases / Daño renal agudo debido a inyección intramuscular excesiva y prolongada de suplementos veterinarios con vitaminas A, D y E: serie de 16 casos

Background: Despite well-documented risks, injectable supplements containing high doses of vitamins are commonly used. Objectives: To describe acute kidney injury (AKI) as a complication of vitamin intoxication. Methods: Our series consisted of 16 patients with kidney complications resulting from the use of veterinary intramuscular injection supplements of vitamin A, D and E. The patients were admitted to two referral hospitals in Fortaleza (Brazil) between January 2010 and January 2015. Results: Patients’ mean age was 28.3±8.9 years (19-53 years), and 11 (68.7%) were male. Main signs and symptoms upon admission were nausea (68.7%), vomiting (62.5%), weight loss (43.7%), epigastric pain (31.2%) and headache (31.2%). At hospital admission the mean laboratory values were: hemoglobin 10±2.0g/dL (6.1-14.2), leukocytes 10,542 ± 4871/mm3 (4100-5,100), creatinine 3.9 ± 5.2mg/dL (0.7-22) and urea 91 ± 88mg/dL (22-306), respectively. Serum calcium was 12 ± 2.2 mg/dL (8.8-15.5), 24-h urine calcium was 575 ± 329 mg (10.7-1058), serum PTH was 55 ± 141pg/mL (2-406), and serum vitamin D concentration was 135 ± 75ng/mL (22-265). Using KDIGO criteria, AKI was diagnosed in 13 patients (81.2%), classified as stage 1 (n = 3), stage 2 (n = 3) or stage 3 (n = 7). No deaths occurred in the study period. Conclusions: Excessive use of veterinary vitamin supplements containing high doses of vitamin A, D and E was associated with AKI. Hypercalcaemia, which was a common finding, appears to be a contributing factor to the development of this type of AKI (AU)

Antecedentes: Suplementos inyectables que contienen altas dosis de vitaminas son utilizados con frecuencia, a pesar de los riesgos bien documentados. Objetivo: Describir la ocurrencia de daño renal agudo (IRA) como complicación de intoxicación por suplementos vitamínicos. Métodos: Esta es una serie de 16 pacientes con complicaciones renales resultantes de la utilización de inyección intramuscular de suplementos veterinarios con vitaminas A, D y E. Los pacientes fueron ingresados en 2 hospitales de referencia en Fortaleza (Brasil), entre enero de 2010 y enero de 2015. Resultados: La edad media de los pacientes fue de 28,3 ± 8,9 años (19-53 años) y 11 (68,7%) eran varones. Signos y síntomas principales al ingreso fueron náuseas (68,7%), vómitos (62,5%), pérdida de peso (43,7%), dolor epigástrico (31,2%) y cefalea (31,2%). Al ingreso en el hospital los valores medios de laboratorio fueron: hemoglobina 10 ± 2,0g/dL (6,1+14,2), leucocitos 10.542 ± 4.871/mm3 (4.100-15.100), creatinina 3,9 ± 5,2mg/dL (0,7-22) y urea 91 ± 88mg/dL (22-306), respectivamente. El nivel de calcio sérico fue de 12 ± 2,2 mg/dL (8,8-15,5), el de calcio en orina de 24 h fue de 575 ± 329 mg (10,7-1.058), el de PTH sérico fue de 55 ± 141 pg/mL (2-406) y el nivel de vitamina D sérica fue de 135 ± 75 ng/mL (22-265). Utilizando criterios KDIGO, se diagnosticó IRA en 13 pacientes (81,2%); fueron clasificadas como clase 1 (n = 3), clase 2 (n = 3) y clase 3 (n = 7). No hubo muertes en el período de estudio. Conclusiones: El uso excesivo de suplementos vitamínicos veterinarios que contienen altas dosis de vitamina A, D y E se asoció con IRA. La hipercalcemia, un hallazgo común, parece ser un factor que contribuye al desarrollo de este tipo de IRA (AU)

Acute kidney injury due to excessive and prolonged intramuscular injection of veterinary supplements containing vitamins A, D and E: A series of 16 cases.

BACKGROUND: Despite well-documented risks, injectable supplements containing high doses of vitamins are commonly used. OBJECTIVES: To describe acute kidney injury (AKI) as a complication of vitamin intoxication. METHODS: Our series consisted of 16 patients with kidney complications resulting from the use of veterinary intramuscular injection supplements of vitamin A, D and E. The patients were admitted to two referral hospitals in Fortaleza (Brazil) between January 2010 and January 2015. RESULTS: Patients' mean age was 28.3±8.9 years (19-53 years), and 11 (68.7%) were male. Main signs and symptoms upon admission were nausea (68.7%), vomiting (62.5%), weight loss (43.7%), epigastric pain (31.2%) and headache (31.2%). At hospital admission the mean laboratory values were: hemoglobin 10±2.0g/dL (6.1-14.2), leukocytes 10,542±4871/mm3 (4100-15,100), creatinine 3.9±5.2mg/dL (0.7-22) and urea 91±88mg/dL (22-306), respectively. Serum calcium was 12±2.2mg/dL (8.8-15.5), 24-h urine calcium was 575±329mg (10.7-1058), serum PTH was 55±141pg/mL (2-406), and serum vitamin D concentration was 135±75ng/mL (22-265). Using KDIGO criteria, AKI was diagnosed in 13 patients (81.2%), classified as stage 1 (n=3), stage 2 (n=3) or stage 3 (n=7). No deaths occurred in the study period. CONCLUSIONS: Excessive use of veterinary vitamin supplements containing high doses of vitamin A, D and E was associated with AKI. Hypercalcaemia, which was a common finding, appears to be a contributing factor to the development of this type of AKI.

Novel strategies to fight Candida species infection.

In recent years, there has been a significant increase in the incidence of human fungal infections. The increase in cases of infection caused by Candida species, and the consequent excessive use of antimicrobials, has favored the emergence of resistance to conventional antifungal agents over the past decades. Consequently, Candida infections morbidity and mortality are also increasing. Therefore, new approaches are needed to improve the outcome of patients suffering from Candida infections, because it seems unlikely that the established standard treatments will drastically lower the morbidity of mucocutaneous Candida infections and the high mortality associated with invasive candidiasis. This review aims to present the last advances in the traditional antifungal therapy, and present an overview of novel strategies that are being explored for the treatment of Candida infections, with a special focus on combined antifungal agents, antifungal therapies with alternative compounds (plant extracts and essential oils), adjuvant immunotherapy, photodynamic therapy and laser therapy.

Impact of long-stay beds on the performance of a tertiary hospital in emergencies.

OBJECTIVE: To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS: For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS: Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index - 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) - the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS: Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

Evaluation of the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice.

PURPOSE: To evaluate the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice. METHODS: The anti-inflammatory effect of alcoholic extracts of green tea (AE) was evaluated in a cell migration assay with four groups of six Swiss mice receiving 0.07 g/Kg or 0.14 g/Kg EA (treatment groups), saline (negative control) or 10mg/Kg indomethacin (positive control) by gavage. One hour later 300 µg carrageen an was administered intraperitoneally or subcutaneously. The analgesic effect was evaluated using four groups of six animals receiving 0.07 g/Kg or 0.14 g/Kg EA, saline or 10mg/Kg indomethacin subcutaneously, followed 30 minutes later by 1% acetic acid. RESULTS: When administered subcutaneously at either dose (0.07 g/Kg and 0.14 g/Kg), AE inhibited carrageenan-induced cell migration (p<0.05). However, when administered by gavage, only the latter (0.14 g/Kg) was efficient (p<0.05). AE at both doses (0.07 g/Kg and 0.14 g/Kg) inhibited abdominal contortions (p<0.05), but the effect was not dose-dependent. CONCLUSION: Green tea was shown to have analgesic and anti-inflammatory properties and may constitute a natural treatment option in chronic inflammatory disorders.

Evaluation of the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice

PURPOSE: To evaluate the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice. METHODS: The anti-inflammatory effect of alcoholic extracts of green tea (AE) was evaluated in a cell migration assay with four groups of six Swiss mice receiving 0.07g/Kg or 0.14g/Kg EA (treatment groups), saline (negative control) or 10mg/Kg indomethacin (positive control) by gavage. One hour later 300 µg carrageen an was administered intraperitoneally or subcutaneously. The analgesic effect was evaluated using four groups of six animals receiving 0.07g/Kg or 0.14g/Kg EA, saline or 10mg/Kg indomethacin subcutaneously, followed 30 minutes later by 1% acetic acid. RESULTS: When administered subcutaneously at either dose (0.07g/Kg and 0.14g/Kg), AE inhibited carrageenan-induced cell migration (p<0.05). However, when administered by gavage, only the latter (0.14 g/Kg) was efficient (p<0.05). AE at both doses (0.07g/Kg and 0.14g/Kg) inhibited abdominal contortions (p<0.05), but the effect was not dose-dependent. CONCLUSION: Green tea was shown to have analgesic and anti-inflammatory properties and may constitute a natural treatment option in chronic inflammatory disorders. .

Decoction, infusion and hydroalcoholic extract of cultivated thyme: antioxidant and antibacterial activities, and phenolic characterisation.

Bioactivity of thyme has been described, but mostly related to its essential oils, while studies with aqueous extracts are scarce. Herein, the antioxidant and antibacterial properties of decoction, infusion and hydroalcoholic extract, as also their phenolic compounds, were evaluated and compared. Decoction showed the highest concentration of phenolic compounds (either phenolic acids or flavonoids), followed by infusion and hydroalcoholic extract. In general, the samples were effective against gram-positive (Staphylococcus aureus and Staphylococcus epidermidis) and gram-negative (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Enterococcus aerogenes, Proteus vulgaris and Enterobacter sakazakii) bacteria, with decoction presenting the most pronounced effect. This sample also displayed the highest radical scavenging activity and reducing power. Data obtained support the idea that compounds with strong antioxidant and antibacterial activities are also water-soluble. Furthermore, the use of thyme infusion and decoction, by both internal and external use, at recommended doses, is safe and no adverse reactions have been described.

Evaluation of bioactive properties and phenolic compounds in different extracts prepared from Salvia officinalis L.

The therapeutic benefits of medicinal plants are well known. Nevertheless, essential oils have been the main focus of antioxidant and antimicrobial studies, remaining scarce the reports with hydrophilic extracts. Thus, the antioxidant and antifungal activities of aqueous (prepared by infusion and decoction) and methanol/water (80:20, v/v) extracts of sage (Salvia officinalis L.) were evaluated and characterised in terms of phenolic compounds. Decoction and methanol/water extract gave the most pronounced antioxidant and antifungal properties, being positively related with their phenolic composition. The highest concentration of phenolic compounds was observed in the decoction, followed by methanol/water extract and infusion. Fungicidal and/or fungi static effects proved to be dependent on the extracts concentration. Overall, the incorporation of sage decoction in the daily diet or its use as a complement for antifungal therapies, could provide considerable benefits, also being an alternative to sage essential oils that can display some toxic effects.

Impact of long-stay beds on the performance of a tertiary hospital in emergencies / Impacto de leitos de longa permanência no desempenho de hospital terciário em emergências

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index - 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) - the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

RESUMO OBJETIVO Avaliar o impacto da implantação de leitos de longa permanência para pacientes de baixa complexidade e alta dependência em hospitais de pequeno porte sobre o desempenho de hospital terciário de referência em emergência. MÉTODOS Para este estudo longitudinal, foram identificados hospitais em três municípios no departamento regional de saúde coberto pela instância terciária e que forneciam 10 leitos de longa permanência cada. Os pacientes foram transferidos para os hospitais desses municípios com base em protocolo específico. Obteve-se o desfecho dos pacientes transferidos por acompanhamento diário. Fatores de confusão foram ajustados por regressão logística e semiparamétrica de Cox. RESULTADOS Entre 1 de setembro de 2013 e 30 de setembro de 2014, foram transferidos 97 pacientes, sendo 72,1% homens, com idade média de 60,5 anos (DP = 1,9), para os quais foram realizadas 108 transferências. Desses pacientes, 41,7% evoluíram ao óbito, 33,3% receberam alta, 15,7% retornaram à instância terciária, e apenas 9,3% permaneceram internados até o final do período analisado. Foi calculado o índice de comorbidade de Charlson - 0 (n = 28 [25,9%]), 1 (n = 31 [56,5%]) e ≥ 2 (n = 19 [17,5%]) - a única variável que aumentou a chance de óbito ou retorno ao hospital terciário (Razão de Chances = 2,4; IC95% 1,3;4,4). O tempo de permanência nos leitos de longa permanência foi de 4.253 pacientes-dia, que representariam 607 vagas no hospital terciário, considerando-se a média de internação de sete dias. O hospital terciário aumentou o número de vagas em 50,0% para terapia intensiva, 66,0% para neurologia e 9,3% para as vagas totais. A permanência dos pacientes nos leitos de longa permanência limitou-se em grande parte aos primeiros 30 (50,0%) e 60 (75,0%) dias. CONCLUSÕES A implantação de leitos de longa permanência teve impacto no aumento de vagas novas oferecidas pela instância terciária tanto gerais como para áreas de estrangulamento do sistema, como a Neurologia e Terapia Intensiva. O índice de comorbidade de Charlson está associado à chance de o paciente evoluir ao óbito ou retornar para a instância terciária, mesmo quando ajustado por possíveis fatores de confusão.

Decoction, infusion and hydroalcoholic extract of Origanum vulgare L.: different performances regarding bioactivity and phenolic compounds.

Bioactivity of oregano methanolic extracts and essential oils is well known. Nonetheless, reports using aqueous extracts are scarce, mainly decoction or infusion preparations used for therapeutic applications. Herein, the antioxidant and antibacterial activities, and phenolic compounds of the infusion, decoction and hydroalcoholic extract of oregano were evaluated and compared. The antioxidant activity is related with phenolic compounds, mostly flavonoids, since decoction presented the highest concentration of flavonoids and total phenolic compounds, followed by infusion and hydroalcoholic extract. The samples were effective against gram-negative and gram-positive bacteria. It is important to address that the hydroalcoholic extract showed the highest efficacy against Escherichia coli. This study demonstrates that the decoction could be used for antioxidant purposes, while the hydroalcoholic extract could be incorporated in formulations for antimicrobial features. Moreover, the use of infusion/decoction can avoid the toxic effects showed by oregano essential oil, widely reported for its antioxidant and antimicrobial properties.

Antifungal activity of phenolic compounds identified in flowers from North Eastern Portugal against Candida species.

AIM: To evaluate the antifungal effect of gallic acid, catechin, luteolin and quercetin, phenolic compounds identified from flowers of North Eastern Portugal, against Candida planktonic and biofilm cells. MATERIALS & METHODS: The MICs were determined in Candida planktonic cells and the effect of phenolic compounds on Candida biofilms was assessed through quantification of colony-forming units. RESULTS: MIC values demonstrated that gallic acid presented the highest effect against all Candida species. Catechin showed a similar effect against Candida albicans American Type Culture Collection (ATCC) 90028 cells. In addition, gallic acid and quercetin had demonstrated only a minimal effect against Candida species biofilms. CONCLUSION: Gallic acid affected the growth of the different planktonic Candida species in all concentrations used; still, catechin showed a similar effect against C. albicans ATCC 90028 and Candida glabrata ATCC 2001 cells. In addition, only gallic acid and quercetin demonstrated a slight effect against all Candida species biofilms.