Care Technologies to Improve Treatment Adherence in Patients Undergoing Organ Transplant: A Scoping Review.

BACKGROUND: The objective of this study was to map care technologies being developed to improve treatment adherence in patients undergoing organ transplant. METHODS: A scoping review was developed according to the Joanna Briggs Institute manual. The research question was developed according to the population, concept, and context strategy. Searches were conducted independently in 6 databases between June and August 2021. The data were evaluated and organized together. The review protocol was published. RESULTS: Fifteen articles were part of the study, mostly published in the United States (33.3%) and in 2016 (33.3%). The main research method identified was clinical studies (80%). Most of the care technologies identified are in relation to medication adherence in the post-transplant setting. Another intervention identified was health education action with the support of mobile apps, electronic monitoring systems, and a card game. CONCLUSIONS: The results present technologies directed at the importance of post-transplant drug adherence; however, it is important to adapt the technologies to the reality experienced by the patient, as well as to train patients so that they can introduce these technologies in their daily lives. Furthermore, it is important that technologies are developed that include other aspects of adherence to post-transplant treatment.

Brewer's yeast and sugarcane yeast as protein sources for dogs.

Brewer's yeast (BY), autolysed sugarcane yeast (ASCY) and integral sugar cane yeast (ISCY) were studied in two experiments as ingredients for dog diets. In the first experiment, 28 dogs were randomly assigned to four diets; one reference diet and three test diets containing 15% of BY, ASCY or ISCY and 85% of the reference diet (as-fed basis). The digestibilities of the yeasts were calculated by the substitution method. In the second experiment, 35 dogs were randomized to five diets with similar chemical composition but different levels of sugarcane yeast inclusion (0%, 7.5% ASCY, 15% ASCY, 7.5% ISCY and 15% ISCY). In both experiments, the coefficient of total tract apparent digestibility (CTTAD) of nutrients was determined through total collection of faeces. During experiment, two additional analyses of food palatability, nitrogen balance and urea postprandial responses were performed. The data were submitted to analysis of variance, and the means were compared by orthogonal or polynomial contrasts or Tukey's test (p < 0.05). In experiment 1, CTTAD of protein was lower for both sugarcane yeasts than for BY (p = 0.012), as was metabolizable energy content (p = 0.025). In experiment 2, a linear reduction in energy digestibility with ASCY inclusion (p = 0.05) was verified. Furthermore, faecal score and DM content were reduced with ISCY inclusion (p < 0.003). No effect of yeast inclusion on nitrogen balance or postprandial urea response was found. Also, the inclusion of 7.5% of ASCY or ISCY increased diet palatability (p < 0.01). Yeasts present adequate digestibility by dogs, but its effect on faecal formation needs to be considered. No clear advantage for the use of ASCY over ISCY was found. In conclusion, we find that sugarcane yeast is suitable for inclusion in dog food and can enhance the overall palatability of the diet.

Hypoadiponectinaemia in nonalcoholic fatty liver disease obese women is associated with infrequent intake of dietary sucrose and fatty foods.

BACKGROUND: The present study aimed to investigate the relationship between adiponectinaemia and food intake among obese women with nonalcoholic fatty liver disease (NAFLD). METHODS: In total, 60 obese women were examined by abdominal ultrasound for liver steatosis and subcutaneous and visceral adiposity. A standard interview (including questions about alcohol intake, medical history and physical activity), a physical examination (including height, weight, body mass index, waist and hip circumferences, waist-to-hip ratio, and body composition) and biochemical and clinical parameters (including serum glucose and insulin, homeostatic model assessment insulin resistance, lipid profile, aminotransferases, C-reactive protein, adiponectin, leptin, resistin, tumour necrosis factor-α, interleukin-6 levels and blood pressure) were performed. Food intake was evaluated by a qualitative food frequency questionnaire. RESULTS: Twenty-four NAFLD patients and thirty-six controls were analysed. The Mann-Whitney test showed lower adiponectin levels in the liver disease group compared to controls (P < 0.05). The Pearson correlation coefficient indicated that adiponectinaemia was negatively correlated with lipid profile and serum tumour necrosis factor-α (P = 0.05) and was positively associated with adiposity measures and serum leptin (P < 0.05). By simple linear regression, all of these variables predicted serum adiponectin levels. Chi-squared and Fisher's exact tests indicated that, in both groups, food intake showed no differences, although sucrose and fatty foods were associated with lower adiponectin levels in the liver disease group (P < 0.05 and P < 0.05, respectively), as well as in the control group (P = 0.05 and P < 0.05, respectively). CONCLUSIONS: Hypoadiponectinaemia in NAFLD was associated with dietary sucrose and fatty food intake, emphasising the important role of diet in the occurrence of this disease.

Estatística espacial de varredura na detecção de áreas de risco para a cisticercose bovina no estado da Bahia / Spatial scan statistic in the detection of risk areas for bovine cysticercosis in the state of Bahia

No intuito de classificar a distribuição geográfica da procedência dos animais infectados e mensurar as áreas quanto ao risco de se contrair a cisticercose bovina, foi utilizada a análise espacial de varredura para identificação de aglomerados de risco a partir dos casos positivos para o Cysticercus bovis registrados no período de 2006 a 2007, provenientes de seis matadouros frigoríficos do Serviço de Inspeção Federal, distribuídos para fins administrativos em Territórios de Identidade do estado da Bahia. O número de bovinos abatidos foi de 825.951, dentre os quais (0,7%) 5.395 foram diagnosticados positivos para a doença, mediante a inspeção post mortem dos animais. A análise espacial de varredura, por meio do teste da razão de verossimilhança, demonstrou que a distribuição da cisticercose bovina se concentra, com menor probabilidade de ter ocorrido ao acaso, em área geográfica definida, com risco estimado em 13,6, englobando 101 municípios do estado pertencentes aos territórios de Itapetinga, Litoral Sul, Médio Rio de Contas, Vitória da Conquista e Extremo Sul.

In order to identify the spatial geographical distribution of the infected animals and measure the areas under risk of contracting bovine cysticercosis, spatial scan analysis was used to identify clusters of positive bovine for Cysticercus bovis recorded in the period from 2006 to 2007, from six slaughterhouses under the Federal Inspection Service. The number of slaughtered cattle was 825,951, of which (0.7%) 5,395 were diagnosed as positive for the disease, through post-mortem inspection. The spatial scan analysis through the likelihood ratio showed the spatial distribution of bovine cysticercosis concentrated in defined a geographic area less likely to have occurred by chance, with an estimated risk of 13.6. This specific area encompasses 101 municipalities that belong to Itapetinga, Litoral Sul, Médio Rio de Contas, Vitória da Conquista and Extremo Sul Territories of Identification in Bahia State.

Estatística espacial de varredura na detecção de áreas de risco para a cisticercose bovina no estado da Bahia / Spatial scan statistic in the detection of risk areas for bovine cysticercosis in the state of Bahia

No intuito de classificar a distribuição geográfica da procedência dos animais infectados e mensurar as áreas quanto ao risco de se contrair a cisticercose bovina, foi utilizada a análise espacial de varredura para identificação de aglomerados de risco a partir dos casos positivos para o Cysticercus bovis registrados no período de 2006 a 2007, provenientes de seis matadouros frigoríficos do Serviço de Inspeção Federal, distribuídos para fins administrativos em Territórios de Identidade do estado da Bahia. O número de bovinos abatidos foi de 825.951, dentre os quais (0,7%) 5.395 foram diagnosticados positivos para a doença, mediante a inspeção post mortem dos animais. A análise espacial de varredura, por meio do teste da razão de verossimilhança, demonstrou que a distribuição da cisticercose bovina se concentra, com menor probabilidade de ter ocorrido ao acaso, em área geográfica definida, com risco estimado em 13,6, englobando 101 municípios do estado pertencentes aos territórios de Itapetinga, Litoral Sul, Médio Rio de Contas, Vitória da Conquista e Extremo Sul.(AU)

In order to identify the spatial geographical distribution of the infected animals and measure the areas under risk of contracting bovine cysticercosis, spatial scan analysis was used to identify clusters of positive bovine for Cysticercus bovis recorded in the period from 2006 to 2007, from six slaughterhouses under the Federal Inspection Service. The number of slaughtered cattle was 825,951, of which (0.7%) 5,395 were diagnosed as positive for the disease, through post-mortem inspection. The spatial scan analysis through the likelihood ratio showed the spatial distribution of bovine cysticercosis concentrated in defined a geographic area less likely to have occurred by chance, with an estimated risk of 13.6. This specific area encompasses 101 municipalities that belong to Itapetinga, Litoral Sul, Médio Rio de Contas, Vitória da Conquista and Extremo Sul Territories of Identification in Bahia State.(AU)

Molecular characterization of a neutralizing murine monoclonal antibody against Tityus serrulatus scorpion venom.

Monoclonal antibodies (mAbs) against Tityus serrulatus venom were obtained by the fusion of SP2/0 murine myeloma cells and spleen cells from BALB/c mice immunized with a toxic fraction (TstFG50) of the Tityus venom (this G50 chromatography fraction represents most of the toxicity of the crude venom) conjugated to bovine serum albumin (BSA) with glutaraldehyde. From the initial screening of over 200 hybridoma fusion wells, a panel of 9 anti-TstFG50 secreting hybridomas was established. The capacity of mAbs to neutralize the TstFG50 toxic fraction toxic was determined by in vitro neutralization assays and by inhibition of the binding of 125I-TsVII to its site on rat brain synaptosomes. Only mAbTs1 neutralized 50% of the toxic effects produced by scorpion venom and showed 35% inhibition of the binding of 125I-TsVII at 10(-7) M. To map the epitope recognized by the protective mAbTs1, we prepared a comprehensive series of overlapping 15-mer synthetic peptides covering the amino acid sequences of the four Tityus proteins. MAbTs1 reacted with peptide 26 of TsIV (KKSKDKKADSGYSYW), peptide 30 of TsVII (KKGSSGYSAWPASYS) and peptide 31 of TsNTxP (KKGSSGYSAWPASYS). MAbTs1 was not reactive with any peptide from TsII. The N-terminal lysine residue from the epitope was found to be critical for mAbTs1 binding. The epitope was positioned on the available three-dimensional structure of TsVII together with the recently identified residues from the pharmacophore of beta-scorpion toxins. The neutralizing properties of mAbTs1 might be explained by spatial vicinity of epitope residues with pharmacophore residues.

Virulence for BALB/c mice and antigenic diversity of eight Toxoplasma gondii strains isolated from animals and humans in Brazil.

With the purpose of establishing alternative parameters to determine the virulence of Toxoplasma gondii strains, the antigenic diversity of eight strains of the parasite isolated in Brazil was evaluated. BALB/c mice were inoculated i.p. with 10(0), 10(1), 10(2) and 10(3) tachyzoites from each strain. The mortality and time to death of the animals showed that T. gondii strains may be divided in three groups: three strains resulted in 100% of mortality, 5-10 days post inoculation (DPI); three strains resulted in 100% of mortality, 7-19 DPI and brain cysts were observed in the mice which were inoculated; two strains resulted in 0% of mortality, 30 DPI. The analysis of the antigenic profile of different T. gondii strains through Western blotting, using rabbit antiserum to T. gondii, revealed that most antigens are similar to all strains. The mAb 4C3H4 recognized antigens only in the RH, N, AS28 and ME49 strains.

Vertical toxoplasmosis in a murine model. Protection after immunization with antigens of Toxoplasma gondii incorporated into liposomes.

Distinct Toxoplasma gondii antigens were entrapped within liposomes and evaluated for their ability to protect Balb/c mice against congenital transmission: soluble tachyzoite antigen (L/STAg), soluble tissue cyst antigen (L/SCAg), soluble tachyzoite plus tissue cyst (L/STCAg) or purified 32kDa antigen of tachyzoite (L/pTAg). Soluble tachyzoite antigen alone in PBS (STAg) or emulsified in Freund's Complete Adjuvant (FCA/STAg) was also evaluated. Dams were inoculated subcutaneously with these antigens 6, 4 and 2 weeks prior to a challenge with four tissue cysts of the P strain of T. gondii orally between 10 and 14 days of pregnancy. Significant diminution differences were observed between the frequency of infected pups born of the dams immunized with the antigens incorporated into liposomes and that of pups born of the dams immunized with antigen emulsified in FCA or non immunized group (p<0.05). There was a significant decrease in the number of pups born dead in the groups L/STAg, L/SCAg and L/pTAg when compared with pups from all other groups (p <0.05). All dams immunized with or without adjuvant showed an antibody response and a proliferation of T-cells. However, no correlation was found between immune response and protection against the challenge.

Production and characterization of a panel of monoclonal antibodies for the identification of antigens of Babesia bovis.

A panel of monoclonal antibodies was produced and characterized by an indirect fluorescent antibody test (IFAT), an enzyme-linked immunosorbent assay (ELISA) and Western blotting with the aim of identifying antigens of Babesia bovis. After fusion, the resultant hybrids were selected by the IFAT, cloned, maintained in culture in vitro, and cryopreserved in liquid nitrogen. Ten clones producing monoclonal antibodies were found to react against the entire merozoites, three reacted on the surface of the merozoites, and one clone reacted against the polar region of the merozoites. All monoclonal antibodies reacted in ELISA, with the optical density varying from 0.368 to 0.502 (cut off = 0.022). The bands recognized by the monoclonal antibodies in Western blotting had molecular weights ranging from 162 to 19 kDa. Four clones recognized a single band of 73 kDa, and another four did not react in Western blotting.

Neutralization of the hemorrhagic activity of Bothrops and Lachesis snake venoms by a monoclonal antibody against mutalysin-II.

One mAb reactive with mutalysin-II, a hemorrhagic metalloproteinase isolated from Lachesis muta muta venom, was produced in mice immunized with L. m. muta venom. Indirect ELISA was employed to compare the antigenic cross-reactivity among the venoms from Bothrops snakes. The mAb anti-mutalysin-II efficiently neutralized the hemorrhagic effect of both mutalysin-II and L. m. muta crude venom. Furthermore, the mAb were cross-reactive with B. alternatus, B. atrox, B. itapetiningae, B. jararaca and B. neuwiedii and showed variable potencies in neutralizing the hemorrhagic activity of several bothropic venoms.

Protection against toxoplasmosis in mice immunized with different antigens of Toxoplasma gondii incorporated into liposomes.

Different toxoplasma antigens were entrapped within liposomes and evaluated, in this form, for their ability to protect Swiss mice against toxoplasma infection: soluble tachyzoite antigen (L/TAg), tissue cyst (L/CAg), tachyzoite plus tissue cyst (L/TCAg) or purified antigen of tachyzoite (L/pTAg). The protein used in L/pTAg was purified from tachyzoites using a stage-specific monoclonal antibody which reacted at a molecular weight of 32 kD in SDS PAGE and silver stain using reduced condition. To compare the immuno-adjuvant action of liposomes and of Freund's Complete Adjuvant (FCA), another group of mice was immunized with soluble tachyzoite antigen (STAg) emulsified in FCA (FCA/TAg). Control groups were inoculated with (STAg) alone, phosphate-buffered saline (PBS), FCA with PBS (FCA/PBS) and empty liposomes (L/PBS). Mice were inoculated subcutaneously with these antigens six, four and two weeks before a challenge with 80 tissue cysts of the P strain of Toxoplasma gondii orally. All mice immunized with or without adjuvant showed a humoral response, as measured by Elisa. However, no correlation was found between antibody titer and protection against the challenge. All mice immunized with L/pTAg or L/TCAg survived (100), whereas 80% and 90% of mice from groups which received respectively PBS or FCA/PBS and L/PBS died. All mice immunized with antigens entrapped within liposomes (L/TAg, L/CAg, L/TCAg and L/pTAg) showed low numbers of intracerebral cysts.

Comparative kinetics of bloodmeal intake by Triatoma infestans and Rhodnius prolixus, the two principal vectors of Chagas disease.

Chagas disease vector insects Triatoma infestans and Rhodnius prolixus (fifteen stage III nymphs per 4 litre cage) were allowed to feed on anaesthetized mice for 1 h (control group), or on active non-anaesthetized mice (NAM) for 2, 4 or 8 h exposure. The bloodmeal size (weight increase) for both species was proportional to the duration of contact with NAM, due to ingestion of multiple small bloodmeals, up to 142% of control weight for T. infestans with 8 h exposure to NAM. The mean weight increase of T. infestans nymphs after 4 h contact with NAM was similar to that of the control group, whereas for R. prolixus, 8 h contact with NAM gave only 64% of the control value. For both species of insect, within 4 h of feeding, > 20% of the bloodmeal weight was lost by defaecation and diuresis. The proportions of unfed nymphs and mortality during 2 h contact with NAM were significantly higher for R. prolixus, demonstrating better exploitation of the host blood source by T. infestans, apparently because during blood-feeding the latter insect species caused less irritation to the host.

Purification and stability studies of immunoglobulins from Lachesis muta muta antivenom.

Immunoglobulins were isolated from hyperimmune horse plasma against Lachesis muta muta venom by ammonium sulfate precipitation and immunoaffinity technique (Sepharose-venom L. m. muta column). When necessary, limited proteolysis with pepsin was used to generate a bivalent antigen-binding fragment (F(ab')2). Solutions with immunoglobulins or F(ab')2 fragments were fractionated by molecular filtration chromatography (Superose 12) and the expected mol. wt species were observed. The L. m. muta venom shows caseinolytic and haemorrhagic activities. Incubation of the venom with these purified antibodies resulted in a decrease of both activities. High temperatures promote aggregation and the formation of protein precipitates. Sorbitol (1.0 M) was used as an osmolyte (a natural substance or an organic compound capable of stabilizing proteins) and decreased the formation of protein precipitates in solutions of antibodies, as judged by a spectrophotometric assay (280 nm), by nephelometry or when tested by enzyme-linked immunosorbent assay. Circular dichroism was used to study the spectra of antibodies in the presence of phosphate-buffered saline or sorbitol. Up to an osmolyte concentration of 1.0 M, there was no significant perturbation of the F(ab')2 fragments spectra in the amide region. However, whole immunoglobulins in the presence of 1.0 M sorbitol presented a small spectral perturbation, suggesting that the beta-structure was reinforced. The effect of osmolyte on the affinity of antibodies was observed by enzyme-linked immunosorbent assay. There was no significant difference in the results when the antibodies were previously incubated with venom in phosphate-buffered saline or in the presence of 1.0 M sorbitol. In conclusion, an osmolyte (sorbitol) was shown to be capable of stabilizing antibodies at high temperatures, with no significant perturbation in the secondary structure or affinity to L. m. muta venom. These results point to the possibility of using sorbitol, or other osmolytes, as stabilizers of immunoglobulin preparations.

Anticoagulant activity of Triatoma infestans and Panstrongylus megistus saliva (Hemiptera/Triatominae).

Salivary gland extract of Triatoma infestans prolonged thrombin time, prothrombin time, and activated partial thromboplastin time, while salivary gland extract of Panstrongylus megistus delayed thrombin time and activated partial thromboplastin time. However, saliva of P. megistus prolonged activated partial thromboplastin time and saliva of T. infestans delayed activated partial thromboplastin time and prothrombin time. T. infestans saliva interferes particularly with activity of factor VIII (intrinsic pathway) and factor V (common pathway), but also affects other factors. Saliva of the triatomine species studied presented distinct SDS-PAGE profiles. These results demonstrate that there are differences in anticoagulant activity and protein composition of triatomine saliva.

Estudo dos níveis de exposiçäo e efeitos à saúde por mercúrio metálico em uma populaçäo urbana de Paconé, Mato Grosso, Brasil / Study of exposure to and health effects of atmospheric metallic mercury pollution in an urban population of Poconé, Mato Grosso, Brazil

Foram avaliados os níveis de exposiçäo e dos efeitos causados por emissöes na atmosfera de mercúrio metálico proveniente de casas compradoras de ouro na populaçäo do município de Paconé, estado de Mato Grosso. O projeto foi desenvolvido através da comparaçäo da morbidade referida, dos exames clínicos e da análise dos teores de mercúrio na urina de três grupos populacionais. As análises dos teores de mercúrio na urina mostraram diferenças altamente significativas entre os grupos centro e periferia em comparaçäo ao grupo-controle. Entrevistas com as pessoas que apresentavam teores elevados evidenciaram que a exposiçäo no centro da cidade poderia ser proveniente das casas compradoras de ouro e, no caso da periferia, poderia ter ocorrido exposiçäo através da queima de amálgamas no interior das residências. Os dados de morbidade referida apresentaram proporçöes maiores de queixas entre os moradores do centro em comparaçäo aos outros grupos e também maior número de alteraçöes no exame clínico. Conclui-se que há maiores exposiçäo e efeitos à saúde devido ao mercúrio metálico entre pessoas pertencentes aos primeiros dois grupos.

Entamoeba histolytica: fecal antigen capture immunoassay for the diagnosis of enteric amebiasis by a monoclonal antibody.

Amebiasis continues to be of epidemiological importance in underdeveloped countries. Clinical diagnosis and epidemiological setting in a region are based on the fecal microscopic identification of cysts or trophozoites. This procedure requires well trained personnel, is laborious, of low sensitivity and frequently yields false-positives results. The present study was designed to develop an immunoenzymatic fecal 96 kDa antigen capture test (COPROELISA-Eh) more sensitive and specific than microscopic diagnosis of amebiasis. Triplicates of 177 stool samples processed by the formol-ether concentration method, were defined as positive or negative by three experienced microscopic observers. Another aliquot was submitted to the antigen capture test by a monoclonal antibody against a specific membrane antigen of pathogenic strains of Entamoeba histolytica. Optical densities were interpreted as positive when they exceeded the mean value of negative samples plus two standard deviations. COPROELISA-Eh showed a 94.4% sensitivity, 98.3% specificity, 96.2% positive predictive value and 97.6% negative predictive value for the detection of E. histolytica in feces. COPROELISA-Eh is more sensitive and specific than microscopic examination, does not require specially trained personnel and allows the simultaneous processing of a large number of samples.

Triatoma infestans is more efficient than Panstrongylus megistus in obtaining blood meals on non Anaesthetized mice

We compared the influence of the bug density in the capacity of Triatoma infestans and Panstrongylus megistus in obtaining blood meal in non anaesthetized mice. The regression anlysis for increase in body weight (mg) versus density (no. of bugs/mouse) showed that in experiments with anaesthetized mice (AM), no correlation was observed. In experiments with non anaesthetized mice (NAM) the weight increase was inversely proportional to density. The regression slope for blood meal size on density was less steep for T. infestans than for P. megistus (-1.9 and -3.0, respectively). The average weight increase of P. megistus nymphus in experiments with AM was higher than for T. infestans nymphs; however, in experiments with NAM such results were inverted. Mortality of P. megistus was significantly higher than of T. infestans with NAM. However, in experiments with AM very low mortality was observed. Considering the mortality and the slope of regression line on NAM, T. infestans is more efficient than P. megistus in obtaining blood meal in similar densities, possibly because it caused less irritation of the mice. The better exploitation of blood source of T. infestans when compared with P. megistus in similar densities, favours the maintenance of a better nutritional status in higher densities. This could explain epidemiological findings in which T. infestans not only succeeds in establishing larger colonies but also dislodges P. megistus in human dwellings when it is introduced in areas where the latter species prevails.