Over-the-counter Pediculus humanus capitis treatment: The nit comb is not appropriate for all hair types!

Biological diversity of hair affects what stress the hair can withstand. This proves to create a gap in care when evaluating over-the-counter (OTC) products available to treat Pediculus humanus capitis (head lice) in the United States. The nit comb would not be conducive for use in an individual with African hair, yet all OTC product instructions list the requirement of the nit comb. Lice treatment products provide instructions that are applicable for only specific hair types and do not address treatment recommendations for African hair. The OTC product instructions are outdated and exclusionary. A clear discrepancy and gap in care exist for many Americans seeking self-care treatment of pediculosis capitis. Pharmacists should remain aware of this discrepancy and counsel on alternative practices such as applying the active formulations in the hair but refrain from using the nit comb following the application of the topical medication.

Genomic monitoring unveil the early detection of the SARS-CoV-2 B.1.351 (beta) variant (20H/501Y.V2) in Brazil.

Sao Paulo State, currently experiences a second COVID-19 wave overwhelming the healthcare system. Due to the paucity of SARS-CoV-2 complete genome sequencing, we established a Network for Pandemic Alert of Emerging SARS-CoV-2 Variants to rapidly understand and monitor the spread of SARS-CoV-2 variants into the state. Through analysis of 210 SARS-CoV-2 complete genomes obtained from the largest regional health departments we identified cocirculation of multiple SARS-CoV-2 lineages such as B.1.1 (0.5%), B.1.1.28 (23.2%), B.1.1.7 (alpha variant, 6.2%), B.1.566 (1.4%), B.1.544 (0.5%), C.37 (0.5%) P.1 (gamma variant, 66.2%), and P.2 (zeta variant, 1.0%). Our analysis allowed also the detection, for the first time in Brazil, the South African B.1.351 (beta) variant of concern, B.1.351 (501Y.V2) (0.5%), characterized by the following mutations: ORF1ab: T265I, R724K, S1612L, K1655N, K3353R, SGF 3675_F3677del, P4715L, E5585D; spike: D80A, D215G, L242_L244del, A262D, K417N, E484K, N501Y, D614G, A701V, C1247F; ORF3a: Q57H, S171L, E: P71L; ORF7b: Y10F, N: T205I; ORF14: L52F. The most recent common ancestor of the identified strain was inferred to be mid-October to late December 2020. Our analysis demonstrated the P.1 lineage predominance and allowed the early detection of the South African strain for the first time in Brazil. We highlight the importance of SARS-CoV-2 active monitoring to ensure the rapid detection of potential variants for pandemic control and vaccination strategies. Highlights Identification of B.1.351 (beta) variant of concern in the Sao Paulo State. Dissemination of SARS-CoV-2 variants of concern and interest in the Sao Paulo State. Mutational Profile of the circulating variants of concern and interest.

Novel partial duplication of EYA1 causes branchiootic syndrome in a large Brazilian family.

OBJECTIVE: To identify novel genetic causes of syndromic hearing loss in Brazil. DESIGN: To map a candidate chromosomal region through linkage studies in an extensive Brazilian family and identify novel pathogenic variants using sequencing and array-CGH. STUDY SAMPLE: Brazilian pedigree with individuals affected by BO syndrome characterized by deafness and malformations of outer, middle and inner ear, auricular and cervical fistulae, but no renal abnormalities. RESULTS: Whole genome microarray-SNP scanning on samples of 11 affected individuals detected a multipoint Lod score of 2.6 in the EYA1 gene region (chromosome 8). Sequencing of EYA1 in affected patients did not reveal pathogenic mutations. However, oligonucleotide-array-CGH detected a duplication of 71.8Kb involving exons 4 to 10 of EYA1 (heterozygous state). Real-time-PCR confirmed the duplication in fourteen of fifteen affected individuals and absence in 13 unaffected individuals. The exception involved a consanguineous parentage and was assumed to involve a different genetic mechanism. CONCLUSIONS: Our findings implicate this EYA1 partial duplication segregating with BO phenotype in a Brazilian pedigree and is the first description of a large duplication leading to the BOR/BO syndrome.

Alternative flours from pulp melons (Cucumis melo L.): Seasonality influence on physical, chemical, technological parameters, and utilization in bakery product.

Fresh vegetables have high water content and low acidity, so drying can extend shelf life, allowing the obtaining of alternative flours for the development of new products. The study aimed to investigate the influence of the melon harvest and off-season on the chemical composition of melon (Cantaloupe, Charentais e Honey Dew) flours and the potential application in products. The flours were evaluated for granulometry, morphology, centesimal composition, lipid and mineral content, total phenolic compound (TPC), antioxidant activity, and technological properties. Cakes containing melon flour were produced to replace wheat flour (0, 25, and 50 %) and evaluated for proximate composition, microbiology, and sensory parameters. Flours were classified as fine-grained (MESH >16), except Charentais off-season (medium - MESH 8-16, and fine-grained - MESH >16), and all presented a rough surface and minimal cell wall ruptures. The harvest homogeneously influenced the humidity, as all the off-season flours showed higher levels [17-22 %] (p < 0.05) due to weather conditions. For TPC, Cantaloupe melon flours from the harvest (CFH) [208 mg/100 g] and off-season [877 mg/100 g] stood out (p < 0.05), and the latter showed greater antioxidant potential [328 µmol TE/g]. Palmitic, linoleic, and linolenic acid stood out in all flours, and potassium for minerals (63-78 %) in the harvest and off-season. The harvest and off-season specifically influenced the flour of each variety in swelling power, water solubility, oil absorption, and emulsifying capacity. For cakes with CFH, no thermotolerant coliforms and Escherichia coli were detected, and the mesophilic count was <1.0 CFU/g. The ash, protein, lipid, and fiber contents increased proportionally to melon flour addition (p < 0.05). Sensory acceptance was high for cakes containing 25 and 50 % of CFH [82.78 % and 82.53 %], and most consumers would likely buy the products (4.04 and 3.99) (p < 0.05). The study contributed to knowledge about the seasonality effect and demonstrated the potential use of melon flour in developing new products.

Insertional translocation of 15q25-q26 into 11p13 and duplication at 8p23.1 characterized by high resolution arrays in a boy with congenital malformations and aniridia.

We report on a boy presenting submucous cleft palate, hydronephrosis, ventriculoseptal defect, aniridia, and developmental delay. Additional material on 11p13 was cytogenetically visible and array analyses identified a duplicated segment on 15q25-26 chromosome region; further, array analyses revealed a small deletion (49 kb) at 11p13 region involving the ELP4 gene and a duplication at 8p23.1. Results were confirmed with both molecular and molecular cytogenetics techniques. Possibilities for etiological basis of clinical phenotype are discussed.

Allan-Herndon-Dudley syndrome in a female patient and related mechanisms.

Allan-Herndon-Dudley syndrome (AHDS) is characterized by neuropsychomotor developmental delay/intellectual disability, neurological impairment with a movement disorder, and an abnormal thyroid hormone profile. This disease is an X-linked disorder that mainly affects men. We described a female patient with a de novo variant in the SLC16A2 gene, a milder AHDS phenotype, and a skewed X chromosome inactivation profile. We discuss the mechanisms associated with the expression of the phenotypic characteristics in female patients, including SLC16A2 gene variants and cytogenomic alterations, as well as preferential inactivation of the normal X chromosome.

Detection of germline variants in Brazilian breast cancer patients using multigene panel testing.

Genetic diversity of germline variants in breast cancer (BC) predisposition genes is unexplored in miscegenated populations, such those living in Latin America. We evaluated 1663 Brazilian BC patients, who underwent hereditary multigene panel testing (20-38 cancer susceptibility genes), to determine the spectrum and prevalence of pathogenic/likely pathogenic (P/LP) variants and variants of uncertain significance (VUS). Associations between P/LP variants and BC risk were estimated in a case-control analysis of BC patients and 18,919 Brazilian reference controls (RC). In total, 335 (20.1%) participants carried germline P/LP variants: 167 (10.0%) in BRCA1/2, 122 (7.3%) in BC actionable non-BRCA genes and 47 (2.8%) in candidate genes or other cancer predisposition genes. Overall, 354 distinctive P/LP variants were identified in 23 genes. The most commonly mutated genes were: BRCA1 (27.4%), BRCA2 (20.3%), TP53 (10.5%), monoallelic MUTYH (9.9%), ATM (8.8%), CHEK2 (6.2%) and PALB2 (5.1%). The Brazilian variant TP53 R337H (c.1010G>A, p.Arg337His), detected in 1.6% of BC patients and 0.1% of RC, was strongly associated with risk of BC, OR = 17.4 (95% CI: 9.4-32.1; p < 0.0001); monoallelic MUTYH variants c.1187G>A and c.536A>G, detected in 1.2% (0.9% RC) and 0.8% (0.4% RC) of the patients, respectively, were not associated with the odds of BC, the former with OR = 1.4 (95% CI: 0.8-2.4; p = 0.29) and the latter with OR = 1.9 (95% CI: 0.9-3.9; p = 0.09). The overall VUS rate was 46.1% for the entire patient population. Concluding, the use of multigene panel testing almost doubled the identification of germline P/LP variants in clinically actionable predisposition genes in BC patients. In Brazil, special attention should be given to TP53 P/LP variants.

Maternally inherited partial monosomy 9p (pter → p24.1) and partial trisomy 20p (pter → p12.1) characterized by microarray comparative genomic hybridization.

We report on a 17-year-old patient with midline defects, ocular hypertelorism, neuropsychomotor development delay, neonatal macrosomy, and dental anomalies. DNA copy number investigations using a Whole Genome TilePath array consisting, of 30K BAC/PAC clones showed a 6.36 Mb deletion in the 9p24.1-p24.3 region and a 14.83 Mb duplication in the 20p12.1-p13 region, which derived from a maternal balanced t(9;20)(p24.1;p12.1) as shown by FISH studies. Monosomy 9p is a well-delineated chromosomal syndrome with characteristic clinical features, while chromosome 20p duplication is a rare genetic condition. Only a handful of cases of monosomy 9/trisomy 20 have been previously described. In this report, we compare the phenotype of our patient with those already reported in the literature, and discuss the role of DMRT, DOCK8, FOXD4, VLDLR, RSPO4, AVP, RASSF2, PROKR2, BMP2, MKKS, and JAG1, all genes mapping to the deleted and duplicated regions.

Magnetic field-magnetic nanoparticle culture system used to grow in vitro murine embryonic stem cells.

The in vitro growth of embryonic stem cells (ESCs) is usually obtained in the presence of murine embryonic fibroblasts (MEF), but new methods for in vitro expansion of ESCs should be developed due to their potential clinical use. This study aims to establish a culture system to expand and maintain ESCs in the absence of MEF by using murine embryonic stem cells (mECS) as a model of embryonic stem cell. Magnetic nanoparticles (MNPs) were used for growing mESCs in the presence of an external magnetic field, creating the magnetic field-magnetic nanoparticle (MF-MNP) culture system. The growth characteristics were evaluated showing a doubling time slightly higher for mESCs cultivated in the presence of the system than in the presence of the MEF. The undifferentiated state was characterized by RT-PCR, immunofluorescence, alkaline phosphatase activity and electron microscopy. Murine embryonic stem cells cultivated in presence of the MF-MNP culture system exhibited Oct-4 and Nanog expression and high alkaline phosphatase activity. Ultrastructural morphology showed that the MF-MNP culture system did not interfere with processes that cause structural changes in the cytoplasm or nucleus. The MF-MNP culture system provides a tool for in vitro expansion of mESCs and could contribute to studies that aim the therapeutic use of embryonic stem cells.

Molecular characterization of adenovirus detected from fecal samples obtained from children in the Central West region of Brazil.

The adenoviruses are frequently associated with sporadic gastroenteritis outbreaks in different parts of the world. This study aimed at the molecular characterization of human adenoviruses (HAdV) species and serotypes, in fecal samples from children, by multiplex-PCR and by PCR-RFLP, respectively, followed by genomic sequencing. Of 39 adenovirus-positive samples, 30 (76.9%) were classified as species F, six (15.4%) as species C, and two (5.1%) as species A, and one (2.6%) had a mixed F/C pattern. The serotyping showed that 14 (41.2%) were HAdV-41, 15 (44.1%) were HAdV-40, five (14.7%) were HAdV-5, and five samples could not be serotyped. This is the first study to molecularly characterize HAdV in the Central West region of Brazil, and the results highlight the circulation of the HAdV-5 among children with acute gastroenteritis in this region.

Biallelic loss of function variants in ATP1A2 cause hydrops fetalis, microcephaly, arthrogryposis and extensive cortical malformations.

The Na+/K+- ATPase acts as an ion pump maintaining the essential plasma membrane potential in all mammalian cell types, and is essential for many cellular functions. There are four α isoforms (α1, α2, α3 and α4) with distinct expression patterns, kinetic properties and substrate affinity. The α2-isoform is encoded by ATP1A2 and evidence supports its utmost importance in Cl- homeostasis in neurons, and in the function of respiratory neurons at birth. Monallelic pathogenic variants in ATP1A2 are associated with familial hemiplegic migraine type 2 (FHM2) and on rare occasions with alternating hemiplegia of childhood 1 (AHC1). To date, no instances of biallelic loss of function variants have been reported in humans. However, Atp1a2 homozygous loss of function knockout mice (α2-/- mice) show severe motor deficits, with lack of spontaneous movements, and are perinatally lethal due to absent respiratory activity. In this report we describe three newborns from two unrelated families, who died neonatally, presenting in utero with an unusual form of fetal hydrops, seizures and polyhydramnios. At birth they had multiple joint contractures (e.g. arthrogryposis), microcephaly, malformations of cortical development, dysmorphic features and severe respiratory insufficiency. Biallelic loss of function variants in ATP1A2, predicted to be pathogenic were found on whole exome sequencing. We propose that this is a distinctive new syndrome caused by complete absence of Na+/K+- ATPase α2-isoform expression.

Heterozygous loss of function of NR4A2 is associated with intellectual deficiency, rolandic epilepsy, and language impairment.

Recognition of a de novo mutation in NR4A2 associated with a neurodevelopmental phenotype reinforces its role in 2q23q24 microdeletion syndrome. Using the proband WES data and the probability of loss-of-function intolerance index (pLi) set at 1.0 (highest intolerance constraint), we could target NR4A2 as the candidate gene in this patient.

In vitro biological activities of anionic gamma-Fe2O3 nanoparticles on human melanoma cells.

Three magnetic fluid (MF) samples containing gamma-Fe2O3 (maghemite) nanoparticles surface-coated with either meso-2,3-dimercaptosuccinic acid (DMSA), citric acid or lauric acid were prepared, characterized, and assessed for their cytotoxic potential on the human SK-MEL-37 melanoma cell line. Ultra-structural analysis was also performed using transmission electron microscopy (TEM). In vitro cytotoxicity was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The inhibitory concentration (IC50) derived from the sigmoidal dose response curve was 254 microg-iron/mL (95% confidence interval 239-270 microg-iron/mL) for lauric acid-coated nanoparticles. DMSA-coated nanoparticles did not exhibit a clear trend toward toxicity (IC50 value is more than 2260 +/- 50 microg-iron/mL) and the IC50 value was about 433 +/- 14 microg-iron/mL for citric-acid coated nanoparticles. The cytotoxic response correlated with both the hydrodynamic diameter and the zeta potential suggests that the chain length of the carboxylic acid of the coating species may influence metabolic cellular process. Also the assayed nanoparticles can be considered non-cytotoxic to human melanoma cells since IC50 values are higher than plasma concentration usually observed in clinical use of contrast agents. Using TEM we verified that all assayed nanoparticles were internalized by cells through endocytic vesicles. Additionally, cells treated with lauric acid-coated nanoparticles at high concentration (588 or 840 microg-iron/mL) displayed morphological features of apoptosis (surface blebbing, intense vacuolization and chromatin condensation) or a typical DNA ladder pattern when analyzed by TEM or agarose gel electrophoresis, respectively. Apoptotic events may be operative, suggesting a promising therapeutic application for the lauric acid-coated nanoparticle in the treatment of cancer cells.

Predictors of 25-hydroxyvitamin D status among individuals with metabolic syndrome: a cross-sectional study.

BACKGROUND: The risk of metabolic syndrome can be influenced by inadequate vitamin D levels, and exposure to sunlight is the main external source of vitamin D. The present study assessed the influence of environmental, biological, and nutritional factors in relation to seasonal 25-hydroxyvitamin D (25OHD) concentration in individuals with metabolic syndrome. METHODS: This cross-sectional study enrolled 180 individuals with metabolic syndrome aged between 18 and 80 years. The 25OHD concentration was considered the dependent variable; independent variables included age, sex, skin color, use of sunscreen, skin type, sun exposure score, ultraviolet radiation index, geographic location, season, body mass index, waist:hip ratio, waist circumference, parathyroid hormone level, total serum calcium level, and calcium and vitamin D intake. RESULTS: The average vitamin D in individuals evaluated in summer 32 ± 10 ng/mL was greater than in the winter 26 ± 8 ng/mL (p < 0.017). HDL-cholesterol was the only component of the MetS that differed significantly between the seasons (p < 0.001), showing higher concentrations in autumn 45 ± 8 mg/dL than in summer 35 ± 8 mg/dL. In the multiple regression model, gender, WHR, sun exposure score, and winter vs. summer explained 10% of the variation in 25OHD concentration (p = 0.004). CONCLUSIONS: Sex, waist:hip ratio, sun exposure, and summer season were predictors of 25OHD status among individuals with metabolic syndrome. HDL-cholesterol was the only component of metabolic syndrome that differed significantly between the seasons.

Psychosocial stress and central adiposity: A Brazilian study with a representative sample of the public health system users.

OBJECTIVE: To assess the association between indicators of psychosocial stress and central adiposity in adult users of the Unified Health System (SUS) from Southeast of Brazil. METHODS: This cross-sectional study was conducted with 384 adults (20 to 59 years old) from the city of Alegre, Southeastern Brazil. The simple random sample represented the population using the public health system of the municipality. The prevalence of obesity was based on the Body Mass Index, and central adiposity (dependent variable) was measured by waist circumference in centimeters. The independent variables were the following indicators of psychosocial stress: food and nutrition insecurity (yes/no), serum cortisol (µg/dL), symptoms suggestive of depression using the Beck Depression Inventory-II ≥ 17 (yes/no), and altered blood pressure ≥ 130/85 mmHg (yes/no). Univariate linear regression was performed between central adiposity and each stress indicator, and later the models were adjusted for socioeconomic, health, and lifestyle variables. All analyses were made separately by rural and urban location. RESULTS: The prevalence of weight excess, by the classification of the Body Mass Index ≥ 25.0 kg/m2, was 68.3% and, by waist circumference, 71.5% of individuals presented an increased risk for metabolic complications related to central adiposity. Mean waist circumference scores for the rural and urban population were 89.3 ± 12.7 cm and 92.9 ± 14.7 cm, respectively (p = 0.012). Indicators of stress that were associated with central adiposity were: cortisol in the rural population (ß = -0.60; 95% CI = -1.09;-0.11) and altered blood pressure in the urban population (ß = 6.66; 95% CI = 2.14;11.18). This occurred both in the raw analysis and in the models adjusted for confounding factors. CONCLUSION: Central adiposity was inversely associated with cortisol in the rural population and directly associated with higher arterial blood pressure in the urban population, suggesting a local influence on how individuals react to stress.

Competencies for the provision of comprehensive medication management services in an experiential learning project.

OBJECTIVE: To understand students' and tutors' perceptions of the development of clinical competencies for the delivery of comprehensive medication management services in an experiential learning project linked to a Brazilian school of pharmacy. METHODS: An autoethnographic qualitative study was carried out based on participant observation, focus groups and individual interviews with students and tutors involved in an experiential learning project. RESULTS: The study revealed the development of competencies related to the philosophy of practice, the pharmacotherapy workup of drug therapy and interprofessional relationships. CONCLUSIONS: The experiential learning project contributed to the professional development of pharmacy students in pharmaceutical care practice, pointing to its potential benefits for incorporation into professional pharmacy curricula.

Dietary intake and zinc status in amyotrophic lateral sclerosis patients.

BACKGROUND: There is considerable evidence that abnormal zinc homeostasis is related to amyotrophic lateral sclerosis (ALS) pathogenesis, and malnutrition is an independent prognostic factor for worsened survival of ALS patients. OBJECTIVE: To evaluate the dietary intake and zinc status in patients with ALS, treated in a specialized outpatient facility in Natal, Brazil. METHODS: Twenty patients with ALS (case group) and 37 healthy subjects (control group) were included. Clinical and anthropometric assessments were carried out and dietary intake was obtained from two 24-hour recalls. Plasma and urinary zinc concentrations were determined by atomic absorption spectrophotometry. RESULTS: Most of the participants were eutrophic. Mean energy, protein, carbohydrate and fat intake was significantly lower for the case group. There was greater prevalence of inadequate zinc intake in the case group (35%) compared to controls (27%). Mean plasma zinc was significantly lower in the case group than in controls (77.13 ± 22.21 vs 87.84 ± 17.44 µgZn/dl). Urinary zinc did not differ significantly between cases and controls. In the case group, plasma and urinary zinc concentrations were below reference values in 50.0% and 52.6% of patients, respectively. CONCLUSION: A large portion of patients with ALS exhibited poor dietary intake and changes in body zinc status. The zinc deficiency found in half of the ALS patients may contribute to a worsened prognosis and should be the target of nutritional intervention that aims to correct this deficiency.

Zinc Status Biomarkers and Cardiometabolic Risk Factors in Metabolic Syndrome: A Case Control Study.

Metabolic syndrome (MS) involves pathophysiological alterations that might compromise zinc status. The aim of this study was to evaluate zinc status biomarkers and their associations with cardiometabolic factors in patients with MS. Our case control study included 88 patients with MS and 37 controls. We performed clinical and anthropometric assessments and obtained lipid, glycemic, and inflammatory profiles. We also evaluated zinc intake, plasma zinc, erythrocyte zinc, and 24-h urinary zinc excretion. The average zinc intake was significantly lower in the MS group (p < 0.001). Regression models indicated no significant differences in plasma zinc concentration (all p > 0.05) between the two groups. We found significantly higher erythrocyte zinc concentration in the MS group (p < 0.001) independent from co-variable adjustments. Twenty-four hour urinary zinc excretion was significantly higher in the MS group (p = 0.008), and adjustments for age and sex explained 21% of the difference (R² = 0.21, p < 0.001). There were significant associations between zincuria and fasting blood glucose concentration (r = 0.479), waist circumference (r = 0.253), triglyceride concentration (r = 0.360), glycated hemoglobin concentration (r = 0.250), homeostatic model assessment-insulin resistance (r = 0.223), and high-sensitivity C-reactive protein concentration (r = 0.427) (all p < 0.05) in the MS group. Patients with MS had alterations in zinc metabolism mainly characterized by an increase in erythrocyte zinc and higher zincuria.

Effects of veratrine on skeletal muscle mitochondria: ultrastructural, cytochemical, and morphometrical studies.

The alkaloid veratrine is a lipid-soluble neurotoxin, which target voltage-gated Na+ channels for their primary action. Recently, we showed that this alkaloid may cause myonecrosis and evidences suggest mitochondria as one of its cell targets. Herein, we investigate the effects caused by variable concentration of veratrine (250 and 550 microg/mL) on mitochondrial oxygen consumption, respiratory chain enzymes activities, and ultrastructure, combining electron microscopy with cytochemical and biochemical approaches. The results showed different sort of ultrastructural changes, both in isolated and intramuscular mitochondria. Veratrine decreased mitochondrial nicotinamide adenine dinucleotide dehydrogenase (NADH-d), succinic dehydrogenase (SDH), and cytochrome oxidase (COX) activities, significantly and dose-dependently inhibited the state 3 respiration rate, respiratory control ratio (RCR), and ADP/O on isolated rat skeletal muscle mitochondria, whereas state 4 was unaffected. A tendency of increase in mitochondria diameter was seen with 250 microg/mL veratrine. We conclude that the alkaloid would probably act on mitochondrial membrane phospholipid configuration, which would explain the changes observed.