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1.
Int. j. morphol ; 38(3): 585-591, June 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1098291

RESUMO

Acetaminophen (also called paracetamol, or APAP) induced nephrotoxicity is reported after accidental or intentional ingestion of an overdose of the drug. Renal tubular ultrastructural alterations induced by APAP overdose associated with the induction of biomarkers of kidney injury have not been investigated before. Also, we investigated whether the combined polyphenolic anti-inflammatory and antioxidants agents, resveratrol (RES) and quercetin (QUR) can protect against APAP-induced acute kidney injury. The model group of rats received a single dose of APAP (2 g/kg), whereas the protective group of rats was pre-treated for 7 days with combined doses of RES (30 mg/kg) and QUR (50 mg/kg) before being given a single dose of APAP. All rats were then sacrificed one day post APAP ingestion. Harvested kidney tissues were prepared for transmission electron microscopy (TEM) staining and blood samples were assayed for urea, creatinine, and biomarkers of inflammation and oxidative stress. TEM images and blood chemistry analysis showed that APAP overdose induced kidney damage as demonstrated by substantial alterations to the proximal convoluted tubule ultrastructure, and a significant (p<0.05) increase in urea, creatinine, tumor necrosis factor-alpha (TNF-a), and malondialdehyde (MDA) blood levels, which were protected by RES+QUR. These findings indicate that APAP induces alterations to the renal tubular ultrastructure, which is inhibited by resveratrol plus quercetin, which also decreases blood levels of kidney injury biomarkers.


El objetivo de este trabajo fue estudiar la nefrotoxicidad inducida por acetaminofeno (también llamado paracetamol o APAP) después de la ingestión accidental o intencional de una sobredosis de la droga. Las alteraciones ultraestructurales tubulares renales inducidas por sobredosis de APAP asociadas con la inducción de biomarcadores de daño renal no se han investigado. Además, estudiamos si los agentes combinados antiinflamatorios y antioxidantes polifenólicos, el resveratrol (RES) y la quercetina (QUR) pueden proteger contra la lesión renal aguda inducida por APAP. El grupo modelo de ratas recibió una dosis única de APAP (2 g / kg), mientras que el grupo protector de ratas se trató previamente durante 7 días con dosis combinadas de RES (30 mg / kg) y QUR (50 mg / kg) antes de recibir una dosis única de APAP. Todas las ratas se sacrificaron un día después de la ingestión de APAP. Los tejidos renales fueron preparados para el análisis a través de la microscopía electrónica de transmisión (MET). En las muestras de sangre se determinaron la urea, creatinina y los biomarcadores de inflamación y estrés oxidativo. Las imágenes MET y el análisis químico de la sangre mostraron que la sobredosis de APAP inducía daño renal, como lo demuestran las alteraciones sustanciales en la ultraestructura del túbulo contorneado proximal, y además, de un aumento significativo (p <0,05) de la urea, creatinina, factor de necrosis tumoral alfa y niveles sanguíneos de malondialdehído, protegidos por RES + QUR. Estos hallazgos indican que APAP induce alteraciones en la ultraestructura tubular renal, inhibida por el resveratrol más quercetina, que también disminuye los niveles sanguíneos de biomarcadores de daño renal.


Assuntos
Animais , Ratos , Quercetina/administração & dosagem , Resveratrol/administração & dosagem , Túbulos Renais/efeitos dos fármacos , Acetaminofen/toxicidade , Quercetina/farmacologia , Ureia/sangue , Ratos Sprague-Dawley , Creatinina/sangue , Microscopia Eletrônica de Transmissão , Modelos Animais de Doenças , Overdose de Drogas , Resveratrol/farmacologia , Túbulos Renais/patologia , Anti-Inflamatórios/administração & dosagem , Antioxidantes/administração & dosagem
3.
Braz. j. biol ; 80(1): 57-65, Feb. 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1089300

RESUMO

Abstract Selaginella convoluta (Arn.) Spring is a species popularly known as "jericó", and used in folk medicine as analgesic and anti-inflammatory. This study aimed to investigate in mice the antinociceptive and anti-inflammatory activities of the hexane (Sc-Hex) and chloroform (Sc-CHCl3) fractions (100, 200 and 400 mg/kg) obtained by partition of crude ethanol extract from S. convoluta. The preliminary phytochemical analysis of the fractions was performed. Antinociceptive activity was evaluated by writhing, formalin and hot-plate tests. Anti-inflammatory activity was evaluated using carrageenan-induced pleurisy. The rota-rod test was used to evaluate motor coordination. Preliminary phytochemical screening showed that the Sc-Hex and the Sc-CHCl3 were positive for the presence of flavonoids, anthracene derivatives, quinones, triterpenes and steroids. Inhibition of writhing was observed for fractions tested. The Sc-Hex at all doses tested was effective in reducing the nociceptive behavior produced by formalin only in the second phase. However, the Sc-CHCl3 decreased the paw licking time in the first and second phases. In the hot plate no significant effect was observed for any fraction. In the rota-rod test, treated mice did not demonstrate any significant motor performance changes. In the carrageenan-induced pleurisy, Sc-CHCl3 (200 mg/kg) reduced cell migration to the pleural cavity. These results reveal the antinociceptive properties of S. convoluta , which support, in part, its traditional use, since the fractions did not presented significant activity in the inflammatory response profile. We further verify that this antinociceptive effect could be by activation of nociceptive peripheral pathway.


Resumo Selaginella convoluta é uma espécie popularmente conhecida como "jericó", e usada na medicina popular como analgésica e anti-inflamatória. Este estudo teve como objetivo investigar em camundongos as atividades antinociceptiva e anti-inflamatória das frações hexânica (Sc-Hex) e clorofórmica (Sc-CHCl3) (100, 200 e 400 mg/kg) obtidas por partição do extrato etanólico bruto de S. convoluta . A análise fitoquímica preliminar das frações foi realizada. A atividade antinociceptiva foi avaliada pelos testes de contorções abdominais, formalina e placa quente. A atividade anti-inflamatória foi avaliada usando pleurisia induzida por carragenina. O teste do rota-rod foi utilizado para avaliar a coordenação motora. A triagem fitoquímica preliminar mostrou que Sc-Hex e Sc-CHCl3 apresentaram reação positiva para a presença de flavonoides, derivados antracênicos, quinonas, triterpenos e esteroides. A inibição das contorções foi observada para as frações testadas. Sc-Hex em todas as doses testadas foi efetivo na redução do comportamento nociceptivo produzido pela formalina somente na segunda fase. No entanto, Sc-CHCl3 diminuiu o tempo de lambida da pata na primeira e segunda fases. Na placa quente, nenhum efeito significativo foi observado para qualquer fração. No teste do rota-rod os camundongos tratados não demonstraram mudanças significativas na coordenação motora. Na pleurisia induzida por carragenina, Sc-CHCl3 (200 mg/kg) reduziu a migração celular para a cavidade pleural. Estes resultados revelam a propriedade antinociceptiva de S. convoluta, justificando, em parte, seu uso tradicional, uma vez que os extratos não apresentaram atividade significativa no perfil de resposta inflamatória. Verificamos ainda que esse efeito antinociceptivo mostrou-se ligado à ativação da via periférica nociceptiva.


Assuntos
Animais , Ratos , Selaginellaceae , Dor , Extratos Vegetais , Carragenina , Analgésicos , Anti-Inflamatórios
4.
Int. j. morphol ; 37(4): 1422-1428, Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1040148

RESUMO

Paracetamol (also called acetaminophen, or APAP) overdose causes acute damage to the liver and kidneys in both humans and experimental animal models via the induction of the oxidative stress pathway. We sought to determine whether the combined antioxidants and anti-inflammatory compounds, resveratrol (RES) and quercetin (QUR) can protect against kidney injury induced by a toxic dose of APAP in a rat model of APAP-induced acute kidney injury. Rats were either received a single dose of APAP (2 g/kg) before being sacrificed after 24 hours or were pre-treated for 7 days with combined doses of RES (30 mg/kg) and QUR (50 mg/kg) before being given a single dose of APAP and then sacrificed 24 hours post APAP ingestion. Harvested kidney tissues were prepared for light microscopy staining, and tissue samples were assayed for (i) biomarkers of oxidative stress and antioxidant, malondialdehyde (MDA) and superoxide dismutase (SOD); and (ii) biomarkers of inflammation, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Hematoxylin and eosin (H&E) stained images showed that APAP overdose induced acute kidney injury as demonstrated by widening of glomeruli space (Bowman space), tubular dilatation, numerous cellular debris in the renal tubules with tubular epithelial degeneration, and vacuolization, which were effectively protected by RES+QUR except a partial protection of the glomeruli space was observed. In addition, APAP significantly (p<0.05) modulated tissue levels of MDA, SOD, TNF-α, and IL-6, which were protected by RES+QUR. Furthermore, a significant (p<0.0001) positive correlation was observed between glomeruli space and TNF-α, (r=0.8899), IL-6 (r=0.8986), and MDA (r=0.8552), whereas glomeruli space scoring versus SOD showed negative correlation (r= - 0.7870). We conclude that resveratrol plus quercetin substantially protects against APAP-induced acute kidney injury in rats, possibly via the augmentation of antioxidants and inhibition of oxidative stress and inflammation.


La sobredosis de paracetamol (también llamado acetaminofen o APAP) causa un daño agudo en el hígado y los riñones, tanto en humanos como en modelos animales experimentales, a través de la inducción de la vía del estrés oxidativo. Intentamos determinar si los antioxidantes y los compuestos antiinflamatorios combinados, el resveratrol (RES) y la quercetina (QUR) pueden proteger contra la lesión renal inducida por una dosis tóxica de APAP en un modelo de rata de lesión renal aguda inducida por APAP. Las ratas recibieron una dosis única de APAP (2 g / kg) antes de ser sacrificadas después de 24 horas o se trataron previamente durante 7 días con dosis combinadas de RES (30 mg / kg) y QUR (50 mg / kg), antes de ser tratadas, se administró una dosis única de APAP y luego fueron sacrificadas 24 horas después de la ingestión. Los tejidos renales recolectados se tiñeron con H-E y fueron observados a través de microscopía óptica. Las muestras de tejido se analizaron para (i) biomarcadores de estrés oxidativo y antioxidante, malondialdehído (MDA) y superóxido dismutasa (SOD); y (ii) biomarcadores de inflamación, factor de necrosis tumoral alfa (TNF-α) e interleucina-6 (IL-6). Las imágenes teñidas con H & E mostraron que la sobredosis de APAP indujo daño renal agudo como lo demuestra la ampliación del espacio glomerular, la dilatación tubular, numerosos desechos celulares en los túbulos renales con degeneración epitelial tubular y la vacuolización, que se protegieron eficazmente con RES + QUR Se observó una protección parcial del espacio glomerular. Además, APAP modificó significativamente (p <0.05) los niveles tisulares de MDA, SOD, TNF-α e IL-6, que estaban protegidos por RES + QUR. Además, se observó una correlación positiva significativa (p <0,0001) entre el espacio glomerular y el TNF-α, (r = 0,8899), IL-6 (r = 0,8986) y MDA (r = 0,8552), mientras que la puntuación del espacio glomerular versus SOD mostró correlación negativa (r = - 0,7870). Concluimos que el resveratrol más quercetina protege sustancialmente contra la lesión renal aguda inducida por APAP en ratas, posiblemente a través del aumento de antioxidantes y la inhibición del estrés oxidativo y la inflamación.


Assuntos
Animais , Ratos , Quercetina/uso terapêutico , Lesão Renal Aguda/tratamento farmacológico , /uso terapêutico , Acetaminofen/toxicidade , Quercetina/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Modelos Animais de Doenças , Quimioterapia Combinada , Lesão Renal Aguda/induzido quimicamente , /farmacologia , Acetaminofen/antagonistas & inibidores , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico
6.
Acta cir. bras ; 34(11): e201901104, Nov. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1054677

RESUMO

Abstract Purpose: Myocardial ischemia/reperfusion (Ml/R) injury is a leading cause of damage in cardiac tissues, with high rates of mortality and disability. Biochanin A (BCA) is a main constituent of Trifolium pratense L. This study was intended to explore the effect of BCA on Ml/R injury and explore the potential mechanism. Methods: In vivo MI/R injury was established by transient coronary ligation in Sprague-Dawley rats. Triphenyltetrazolium chloride staining (TTC) was used to measure myocardial infarct size. ELISA assay was employed to evaluate the levels of myocardial enzyme and inflammatory cytokines. Western blot assay was conducted to detect related protein levels in myocardial tissues. Results: BCA significantly ameliorated myocardial infarction area, reduced the release of myocardial enzyme levels including aspartate transaminase (AST), creatine kinase (CK-MB) and lactic dehydrogenase (LDH). It also decreased the production of inflammatory cytokines (IL-1β, IL-18, IL-6 and TNF-α) in serum of Ml/R rats. Further mechanism studies demonstrated that BCA inhibited inflammatory reaction through blocking TLR4/NF-kB/NLRP3 signaling pathway. Conclusion: The present study is the first evidence demonstrating that BCA attenuated Ml/R injury through suppressing TLR4/NF-kB/NLRP3 signaling pathway-mediated anti-inflammation pathway.


Assuntos
Animais , Masculino , Cardiotônicos/farmacologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , NF-kappa B/efeitos dos fármacos , Genisteína/farmacologia , Receptor 4 Toll-Like/efeitos dos fármacos , Proteína 3 que Contém Domínio de Pirina da Família NLR/efeitos dos fármacos , Aspartato Aminotransferases/sangue , Valores de Referência , Traumatismo por Reperfusão Miocárdica/metabolismo , Transdução de Sinais/efeitos dos fármacos , Western Blotting , Reprodutibilidade dos Testes , Citocinas/sangue , NF-kappa B/metabolismo , Ratos Sprague-Dawley , Creatina Quinase/sangue , Lactato Desidrogenases/sangue , Receptor 4 Toll-Like/metabolismo , Anti-Inflamatórios/farmacologia
7.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(5): 419-427, Sept.-Oct. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039115

RESUMO

Objective: To evaluate whether an animal model of mania induced by lisdexamfetamine dimesylate (LDX) has an inflammatory profile and whether immune activation by lipopolysaccharides (LPS) has a cumulative effect on subsequent stimuli in this model. We also evaluated the action of lithium (Li) on inflammatory and neurotrophic factors. Methods: Adult male Wistar rats were subjected to an animal model of mania. After the open-field test, they were given LPS to induce systemic immune activation. Subsequently, the animals' blood was collected, and their serum levels of brain-derived neurotrophic factor and inflammatory markers (tumor necrosis factor [TNF]-α, interleukin [IL]-6, IL-1β, IL-10, and inducible nitric oxide synthase [iNOS]) were measured. Results: LDX induced hyperactivity in the animals, but no inflammatory marker levels increased except brain-derived neurotrophic factor (BDNF). Li had no effect on serum BDNF levels but prevented iNOS levels from increasing in animals subjected to immune activation. Conclusion: Although Li prevented an LPS-induced increase in serum iNOS levels, its potential anti-inflammatory effects in this animal model of mania were conflicting.


Assuntos
Animais , Masculino , Transtorno Bipolar/imunologia , Modelos Animais de Doenças , Dimesilato de Lisdexanfetamina , Lítio/farmacologia , Anti-Inflamatórios/farmacologia , Fatores de Crescimento Neural/efeitos dos fármacos , Fatores de Tempo , Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/induzido quimicamente , Ensaio de Imunoadsorção Enzimática , Lipopolissacarídeos/farmacologia , Reprodutibilidade dos Testes , Citocinas/sangue , Resultado do Tratamento , Ratos Wistar , Fator Neurotrófico Derivado do Encéfalo/sangue , Óxido Nítrico Sintase Tipo II/sangue , Locomoção/efeitos dos fármacos
8.
Biosci. j. (Online) ; 35(5): 1599-1613, sept./oct. 2019. graf, tab
Artigo em Inglês | LILACS | ID: biblio-1049060

RESUMO

Annona nutans (Annonaceae) is a plant species found in Bolivia, Paraguay, Argentina, and the Brazilian Cerrado, specifically in the states of Mato Grosso and Mato Grosso do Sul (Brazil). Its common names are Araticû-Mi and Araticû-Ñu. The research contributions regarding the chemical composition and biological activities of extracts from A. nutans are rare, with only four articles being found in the literature. Therefore, the present study evaluated the anti-inflammatory and antinociceptive activities of the hydromethanolic fraction (FHMeOH) using carrageenan-induced paw edema and hot-plate tests. In addition, the antioxidant activity was evaluated by DPPH radical scavenging, total phenolic, flavonoid and tannin content assays and quantification of the major metabolites by LC-MS were performed. Oral treatment with the FHMeOH (at a dose of 300 mg.kg-1) significantly reduced paw edema 2 h and 4 h after the inflammatory stimulus. The intraperitoneal (i.p.) treatment with the FHMeOH (50 and 100 mg.kg-1) proved to be most effective, and the inhibition of acute inflammation was still visible 6 h after carrageenan injection. At doses of 50 and 100 mg.kg-1 (i.p.), FHMeOH exhibits central antinociceptive effects by increasing the latency of the reaction in the hot-plate model. The FHMeOH showed antioxidant potential, and the metabolites quercetin-3-O-galactoside, quercetin-3-O-glucoside, isorhamnetin-3-O-galactoside, quercetin-3-O-ß-D-apiofuranosyl-(1→2)-galactopyranoside, and chlorogenic acid were identified and quantified by LC-MS. Our results indicate, for the first time, that FHMeOH has anti-inflammatory, antinociceptive and antioxidant potential, and it is a promising source of studies for new herbal medicines


Annona nutans (Annonaceae) é uma espécie de planta encontrada na Bolívia, Paraguai, Argentina e no Cerrado brasileiro, especificamente nos estados de Mato Grosso e Mato Grosso do Sul (Brasil). Seus nomes mais comuns são aratico e Araticû-Mi e Araticû-Ñu. As contribuições da pesquisa em relação à composição química e atividades biológicas dos extratos de A. nutans são raras, com apenas quatro artigos encontrados na literatura. Portanto, o presente estudo avaliou as atividades anti-inflamatória e antinociceptiva da fração hidrometanólica (FHMeOH) utilizando edema de pata induzido por carragenina e testes de placaquente. Além disso, a atividade antioxidante foi avaliada por meio de sequestro de radical DPPH, e foram realizados ensaios de quantificação de fenóis, flavonoides e taninos totais e quantificação dos principais metabólitos por CL-EM. O tratamento oral com a FHMeOH (na dose de 300 mg.kg-1) reduziu significativamente o edema da pata 2 e 4 h após o estímulo inflamatório. Por outro lado, o tratamento intraperitoneal (i.p.) com FHMeOH (50 e 100 mg.kg-1) provou ser mais eficaz e a inibição da inflamação aguda foi ainda visível 6 horas após a injeção de carragenina. Nas doses de 50 e 100 mg.kg-1 (i.p.), FHMeOH exibiu efeitos antinociceptivos centrais aumentando a latência da reação no modelo de placa quente. FHMeOH apresentou potencial antioxidante e os metabólitos quercetina-3-O-galactosídeo, quercetina-3-O-glicosídeo, isoramnetina-3-O-galactosídeo, quercetina- 3-O-ß-D-apiofuranosil-(1 → 2)-galactopiranosídeo e ácido clorogênico foram identificados e quantificados por CL-EM. Nossos resultados indicam, pela primeira vez, que o FHMeOH possui efeitos anti-inflamatórios, antinociceptivos e antioxidantes, sendo uma fonte promissora de estudos para novos medicamentos fitoterápicos.


Assuntos
Flavonoides , Annonaceae , Medicamentos Fitoterápicos , Analgésicos , Anti-Inflamatórios , Antioxidantes
9.
Rev. bras. farmacogn ; 29(4): 529-558, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1042286

RESUMO

Abstract The species Kalanchoe laciniata (L.) DC. and Bryophyllum pinnatum (Lam) Pers. are native from Brazil and Madagascar, respectively. Both belonging to the Crassulaceae family and being widely used by population as a natural anti-inflammatory agent. These species have similar leaf morphology and for this reason, they are known by the same popular name as " saião " or " coirama ". Several studies have been published involving different parts and preparations of these species. Therefore, this review aims to provide an update overview about the traditional uses, chemical constitution, pharmacology and toxicology of K. laciniata and B. pinnatum species. An extensive literature review was conducted in different scientific databases. Various chemical constituents have been identified in extracts from different parts of K. laciniata and B. pinnatum , being flavonoids the major compounds. They have been traditionally used to treat inflammation, microbial infection, pain, respiratory diseases, gastritis, ulcers, diabetes and cancer tumors. Non-clinical in vitro assays evaluated mainly the antimicrobial and antioxidant activities, while in vivo assays evaluated the leishmanicide, anti-inflammatory and immunomodulatory activities. Regarding toxicity, few studies have been conducted for the two species. The information reported in this work might contribute to the recognition of the importance of K. laciniata and B. pinnatum species, as well as to direct further studies. (AU)


Assuntos
Plantas Medicinais , Etnofarmacologia , Crassulaceae , Kalanchoe , Medicamentos Fitoterápicos , Anti-Inflamatórios
10.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 268-271, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1023051

RESUMO

Os estudos com estatinas envolvendo desfechos clínicos mostraram que, mesmo atingindo as metas lipídicas, os pacientes que persistem com níveis aumentados de proteína C-reativa, têm maior risco de eventos cardiovasculares. A doença aterosclerótica das coronárias também apresentou maior regressão nos estudos com estatinas, quando ocorreu além de redução efetiva de LDL-colesterol, redução da proteína-C reativa. Nos últimos anos, dois importantes estudos com terapias anti-inflamatórias mostraram resultados divergentes. O estudo CANTOS, com o anticorpo monoclonal canaquinumabe, mostrou redução do eventocombinado de morte cardiovascular, infarto ou acidente vascular cerebral não fatais, e a magnitude do benefício foi associada ao grau de diminuição de marcadores inflamatórios, como proteína C-reativa ou interleucina 6. No estudo CIRT, os pacientes que receberam o anti-inflamatório metotrexato não tiveram redução de desfechos cardiovasculares, mas tampouco tiveram redução dos mencionados marcadores inflamatórios. Esses resultados, em conjunto, sugerem que o bloqueio específico de uma via inflamatória, como a citocina, pode ser mais relevante do que efeito anti-inflamatório per se e revela um caminho para diminuição do risco inflamatório residual


Studies with statins involving clinical endpoints have shown that, in spite of achieving lipid goals, patients with high levels of C-reactive protein are at higher risk for cardiovascular events. Atherosclerotic coronary artery disease has also presented greater regression in studies with statins when, in addition to an effective reduction in LDL cholesterol, a reduction in C-reactive protein was achieved. In recent years, two important studies involving anti-inflammatory therapies reported divergent results. The CANTOS study, with the human monoclonal antibody canakinumab, showed a decrease in combined cardiovascular death, non-fatal myocardial infarction or non-fatal stroke events and the magnitude of that benefit was associated with the degree of reduction in the inflammatory markers, such as C-reactive protein and interleukin-6. In the CIRT study, patients who received the anti-inflammatory methotrexate did not have a decrease in cardiovascular outcomes, but neither was there a reduction in the inflammatory markers mentioned. Taken together, these results suggest that the specific blockade of an inflammatory pathway, such as that of cytokine,may be more relevant than the antiinflammatory effect per se and reveal a promising way to reduce the residual inflammatory risk


Assuntos
Humanos , Masculino , Feminino , Doença da Artéria Coronariana , Prática Clínica Baseada em Evidências , Inflamação , Sistema Renina-Angiotensina , Doenças Cardiovasculares , Metotrexato , Fatores de Risco , Interleucina-6 , Interleucina-1 , Inibidores de Hidroximetilglutaril-CoA Redutases , Anti-Inflamatórios
11.
J. pediatr. (Rio J.) ; 95(3): 275-281, May-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1012612

RESUMO

Abstract Objective: The objective of this review is to provide an overview of the practical diagnostic and therapeutic approaches to eosinophilic esophagitis and to increase the visibility of the disease among pediatricians. Sources: A search of the MEDLINE, Embase, and CINAHL databases and recent consensus statements and guidelines were performed. Summary of the findings: The definition of eosinophilic esophagitis is based on symptoms and histology. It is important to rule out other diseases associated with esophageal eosinophil-predominant inflammation. It is not yet clear whether the increased prevalence is due to a real increase in incidence or a result of increased awareness of the disease. Various options for management have been used in pediatric patients, including proton pump inhibitors, dietary restriction therapies, swallowed topical steroids, and endoscopic dilations. More recently, proton pump inhibitor-responsive esophageal eosinophilia and eosinophilic esophagitis have been contemplated on the same spectrum, and proton pump inhibitors should be considered the initial step in the treatment of these patients. Conclusions: Eosinophilic esophagitis is a relatively new disease with a remarkable progression of its incidence and prevalence in the past two to three decades, and diagnostic criteria that are constantly evolving. It is important to better understand the pathogenesis of the disease, the predisposing factors, the natural history, and the categorization of varying phenotypes to develop diagnostic and therapeutic strategies that meet the clinical needs of patients.


Resumo Objetivo: Fornecer uma visão geral do diagnóstico e do tratamento da esofagite eosinofílica na prática clínica e aumentar a visibilidade da doença entre os pediatras. Fontes dos dados: Foi feita uma busca na literatura relevante nos bancos de dados Medline, Embase, CINAHL e consensos e diretrizes recentes foram revisados. Síntese dos dados: A definição de esofagite eosinofílica é baseada nos sintomas e na histologia. É importante excluir outras doenças associadas com inflamação esofágica predominantemente eosinofílica. Ainda não está claro se o aumento na prevalência é devido a um real aumento da incidência ou se é o resultado da maior suspeição diagnóstica. Várias opções para tratamento, inclusive inibidores de bomba de prótons, restrições dietéticas, esteroides tópicos deglutidos e dilatações endoscópicas têm sido usadas em pacientes pediátricos. Mais recentemente a eosinofilia esofágica responsiva a inibidores de bomba de prótons e a esofagite eosinofílica têm sido contempladas no mesmo espectro e os inibidores de bomba de prótons devem ser considerados como opção inicial no tratamento desses pacientes. Conclusões: A esofagite eosinofílica é uma doença relativamente nova com uma notável progressão da incidência e prevalência nas últimas 2-3 décadas e critérios diagnósticos estão em evolução constante. É importante entender melhor a patogênese dessa doença, os fatores predisponentes, a história natural e a categorização dos diferentes fenótipos para desenvolver estratégias diagnósticas e terapêuticas que vão ao encontro das necessidades clínicas dos pacientes.


Assuntos
Humanos , Criança , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Esofagoscopia , Dilatação , Inibidores da Bomba de Prótons/uso terapêutico , Anti-Inflamatórios/uso terapêutico
12.
J. bras. nefrol ; 41(2): 293-295, Apr.-June 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1012528

RESUMO

ABSTRACT Pauci-immune glomerulonephritis (GN) is more common in elderly people compared to children and the etiology is not completely understood yet. Antineutrophil cytoplasmic antibody (ANCA) positivity occurs in 80% of the patients. We report a case of a 7-year-old girl who presented with malaise and mildly elevated creatinine diagnosed as ANCA-associated pauci-immune crescentic glomerulonephritis with crescents in 20 of 25 glomeruli (80%). Of these 20 crescents, 12 were cellular, 4 fibrocellular, and 4 globally sclerotic. She did not have purpura, arthritis, or systemic symptoms and she responded well to initial immunosuppressive treatment despite relatively severe histopathology. The patient was given three pulses of intravenous methylprednisolone (30 mg/kg on alternate days) initially and continued with cyclophosphamide (CYC; 2 mg/kg per day) orally for 3 months with prednisone (1 mg/kg per day). In one month, remission was achieved with normal serum creatinine and prednisone was gradually tapered. The case of this child with a relatively rare pediatric disease emphasizes the importance of early and aggressive immunosuppressive treatment in patients with renal-limited ANCA-associated pauci-immune crescentic GN even if with a mild clinical presentation. As in our patient, clinical and laboratory findings might not always exactly reflect the severity of renal histopathology and thus kidney biopsy is mandatory in such children to guide the clinical management and predict prognosis.


RESUMO A glomerulonefrite (GN) pauci-imune é mais comum em idosos em comparação com crianças, e a etiologia ainda não é completamente compreendida. A positividade do anticorpo citoplasmático antineutrófilo (ANCA) ocorre em 80% dos pacientes. Relatamos o caso de uma menina de 7 anos de idade que apresentou mal-estar e creatinina discretamente elevada, diagnosticada como glomerulonefrite rapidamente progressiva pauci-imune associada a ANCA com crescentes em 20 dos 25 glomérulos (80%). Destes 20 crescentes, 12 eram celulares, 4 fibrocelulares e 4 globalmente escleróticos. Ela não apresentava púrpura, artrite ou sintomas sistêmicos e respondeu bem ao tratamento imunossupressor inicial, apesar da histopatologia relativamente grave. A paciente recebeu três pulsos de metilprednisolona intravenosa (30 mg/kg em dias alternados) inicialmente e continuou com ciclofosfamida (2 mg/kg por dia) por via oral durante 3 meses com prednisona (1 mg/kg por dia). Em um mês, a remissão foi alcançada com creatinina sérica normal e a prednisona foi gradualmente reduzida. O caso desta criança com uma doença pediátrica relativamente rara enfatiza a importância do tratamento imunossupressor precoce e agressivo em pacientes com GN rapidamente progressiva renal associada à ANCA, mesmo com uma apresentação clínica leve. Como em nossa paciente, os achados clínicos e laboratoriais podem nem sempre refletir exatamente a gravidade da histopatologia renal e, assim, a biópsia renal é obrigatória nessas crianças para orientar a conduta clínica e auxiliar no prognóstico.


Assuntos
Humanos , Criança , Anticorpos Anticitoplasma de Neutrófilos/sangue , Glomerulonefrite/diagnóstico , Glomerulonefrite/sangue , Rim/patologia , Biópsia , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Seguimentos , Resultado do Tratamento , Creatinina/sangue , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Glomerulonefrite/tratamento farmacológico , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico
14.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 274-282, May-June 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1002225

RESUMO

Cardiovascular diseases (CVD) are the main cause of death globally and most CVD can be prevented by addressing their risk factors, such as an unhealthy diet. Many authors have studied the benefits of nut consumption on CVD. Nuts contain high amounts of vegetable protein, unsaturated fatty acids, dietary fibers, vitamins, minerals and many other bioactive compounds, like phytosterols and phenolic compounds, which are able to reduce cholesterol levels and promote antioxidant and anti-inflammatory effects, thereby reducing cardiovascular risks. This review aims to describe studies involving the consumption of nuts, including Brazil nuts and CVD risk factors with positive results in the improvement of lipid profile, glucose metabolism, vascular function, and inflammatory and oxidative stress biomarkers


Assuntos
Humanos , Masculino , Feminino , Brasil , Doenças Cardiovasculares/mortalidade , Nozes , Sementes , Biomarcadores , Colesterol , Fatores de Risco , Dieta Rica em Proteínas , Hipertensão , HDL-Colesterol/análise , LDL-Colesterol/análise , Anti-Inflamatórios , Antioxidantes
16.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 274-282, may.-june. 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1006132

RESUMO

Cardiovascular diseases (CVD) are the main cause of death globally and most CVD can be prevented by addressing their risk factors, such as an unhealthy diet. Many authors have studied the benefits of nut consumption on CVD. Nuts contain high amounts of vegetable protein, unsaturated fatty acids, dietary fibers, vitamins, minerals and many other bioactive compounds, like phytosterols and phenolic compounds, which are able to reduce cholesterol levels and promote antioxidant and anti-inflammatory effects, thereby reducing cardiovascular risks. This review aims to describe studies involving the consumption of nuts, including Brazil nuts and CVD risk factors with positive results in the improvement of lipid profile, glucose metabolism, vascular function, and inflammatory and oxidative stress biomarkers


Assuntos
Humanos , Masculino , Feminino , Brasil , Doenças Cardiovasculares/mortalidade , Nozes , Sementes , Biomarcadores , Colesterol , Fatores de Risco , Dieta Rica em Proteínas , Hipertensão , HDL-Colesterol/análise , LDL-Colesterol/análise , Anti-Inflamatórios , Antioxidantes
17.
An. bras. dermatol ; 94(2,supl.1): 48-55, Mar.-Apr. 2019.
Artigo em Inglês | LILACS | ID: biblio-1011089

RESUMO

Abstract: Dermatitis herpetiformis and linear IgA bullous dermatosis are autoimmune diseases that present with pruritic urticarial papules and plaques, with formation of vesicles and blisters of subepidermal location, mediated by IgA antibodies. Mucosal lesions are present only in linear IgA bullous dermatosis. The elaboration of this consensus consisted of a brief presentation of the different aspects of these dermatoses and, above all, of an updated literature review on the various therapeutic options that were discussed and compared with the authors' experience, aiming at the treatment orientation of these diseases in Brazil. Dermatitis herpetiformis is a cutaneous manifestation of celiac disease, and can be controlled with a gluten-free diet and dapsone. On the other hand, linear IgA bullous dermatosis arises spontaneously or is triggered by drugs, and can be controlled with dapsone, but often requires the association of systemic corticosteroids and eventually immunosuppressants.


Assuntos
Humanos , Consenso , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Prognóstico , Sociedades Médicas , Brasil , Dermatite Herpetiforme/terapia , Corticosteroides/uso terapêutico , Dapsona/uso terapêutico , Dermatologia , Dieta Livre de Glúten/métodos , Anti-Inflamatórios
18.
An. bras. dermatol ; 94(2,supl.1): 33-47, Mar.-Apr. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1011091

RESUMO

Abstract: Bullous pemphigoid, mucous membrane pemphigoid and epidermolysis bullosa acquisita are subepidermal autoimmune blistering diseases whose antigenic target is located at the basement membrane zone. Mucous membrane pemphigoid and epidermolysis bullosa acquisita can evolve with cicatricial mucosal involvement, leading to respiratory, ocular and/or digestive sequelae with important morbidity. For each of these dermatoses, a literature review covering all therapeutic options was performed. A flowchart, based on the experience and joint discussion among the authors of this consensus, was constructed to provide treatment orientation for these diseases in Brazil. In summary, in the localized, low-risk or non-severe forms, drugs that have immunomodulatory action such as dapsone, doxycycline among others may be a therapeutic option. Topical treatment with corticosteroids or immunomodulators may also be used. Systemic corticosteroid therapy continues to be the treatment of choice for severe forms, especially those involving ocular, laryngeal-pharyngeal and/or esophageal mucosal involvement, as may occur in mucous membrane pemphigoid and epidermolysis bullosa acquisita. Several immunosuppressants are used as adjuvant alternatives. In severe and recalcitrant cases, intravenous immunoglobulin is an alternative that, while expensive, may be used. Immunobiological drugs such as rituximab are promising drugs in this area. Omalizumab has been used in bullous pemphigoid.


Assuntos
Humanos , Epidermólise Bolhosa Adquirida/tratamento farmacológico , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Penfigoide Bolhoso/tratamento farmacológico , Consenso , Prognóstico , Sociedades Médicas , Brasil , Epidermólise Bolhosa Adquirida/diagnóstico , Penfigoide Mucomembranoso Benigno/diagnóstico , Penfigoide Bolhoso/diagnóstico , Corticosteroides/uso terapêutico , Dermatologia , Imunossupressores/uso terapêutico , Anti-Inflamatórios/uso terapêutico
19.
An. bras. dermatol ; 94(2,supl.1): 67-75, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011092

RESUMO

Abstract: BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.


Assuntos
Humanos , Consenso , Dermatite Atópica/tratamento farmacológico , Sociedades Médicas , Terapia Ultravioleta , Índice de Gravidade de Doença , Brasil , Administração Tópica , Corticosteroides/uso terapêutico , Dermatologia , Inibidores de Calcineurina/uso terapêutico , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/uso terapêutico
20.
Rev. medica electron ; 41(2): 546-554, mar.-abr. 2019. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004287

RESUMO

RESUMEN Se reportó el caso clínico de una fémina de 50 años de edad. Acudió a los Servicios de Oftalmología, del Hospital Provincial Comandante Faustino Pérez Hernández, de Matanzas. Refirió síntomas irritativos y disminución visual por el ojo izquierdo. El examen oftalmológico mostró en dicho ojo la presencia de lesiones esferoideas de color ámbar, conjuntivo corneales en periferia (horas 3-4 y 9). Se extendían en banda a la córnea central, algunas con aspecto nodular. En el ojo derecho presentaba lesiones similares pero localizadas mayoritariamente en la periferia corneal y conjuntiva horas 3 y 9. Con estos elementos se estableció diagnóstico clínico de degeneración esferoidea, enfermedad degenerativa corneal poco frecuente y generalmente asintomática siempre que no progrese y afecte la visión. Se aplicó como tratamiento una queratectomia superficial, manual, con colocación de una lente de contacto terapéutica en el ojo izquierdo, sin complicaciones. Hubo regresión de los síntomas irritativos y mejoría de la agudeza visual constatada en las consultas de seguimiento. Se recomendó la necesidad de protección solar al constituir las radiaciones ultravioletas un factor de riesgo de importancia en el desarrollo de esta enfermedad.


ABSTRACT The authors reported the case of a woman, aged 50 years, who assisted the Ophthalmology service of the Provincial Hospital "Comandante Faustino Pérez Hernández", of Matanzas. She referred irritant symptoms and left eye visual decrease. The ophthalmologic examination showed the presence of amber-color spheroidal lesions, corneal conjunctives in periphery (3-4 and 9 hours) in that eye. They extended in bands to the central cornea, some of them with nodular aspect. There were similar lesions in the right eye, but they were located mainly corneal and peripheral conjunctive hours 3 and 9. With these elements it was established the clinical diagnosis of spheroidal degeneration, a few frequent corneal degenerative disease that is almost always asymptomatic if it does not progress and affects sight. As a treatment the patient underwent a manual, superficial keratectomy with location of therapeutic contact lens without complications. There it was a regression of the irritant symptoms and an improvement of the visual acuity stated in the follow-up consultations. The patients was recommended sun protection because ultraviolet rays are important risk factors in the development of this disease.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças da Córnea , Fator de Proteção Solar , Ceratectomia/métodos , Ceratite/cirurgia , Ceratite/diagnóstico , Ceratite/terapia , Soluções Oftálmicas , Esteroides , Lentes de Contato , Doenças da Córnea/cirurgia , Doenças da Córnea/terapia , Anti-Inflamatórios
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