Potentially Synbiotic Yellow Mombin Beverages: Stability during Refrigerated Storage, Physicochemical Characteristics, and Sensory Properties.

This study aimed to develop potentially synbiotic yellow mombin (Spondias mombin L.) beverages added with fructooligosaccharides and Lactiplantibacillus plantarum NRRL B-4496. Six formulations of yellow mombin beverages were prepared to measure the influence of fermentation and pH, which was adjustment to 4.5 for stability and quality parameters. Formulations were evaluated for probiotic survival, pH, titratable acidity, total phenolic compounds (TPC), and antioxidant activity for 28 days at 4 °C. Additionally, the proximate composition, color, sensory aspects, and survival to simulated gastrointestinal conditions were studied. At 21 days of storage, the viability of L. plantarum was 9 CFU/mL for the fermented symbiotic (SYNf) and non-fermented symbiotic with adjusted pH (SYNa) formulations. In addition, the fermented synbiotic with an adjusted pH beverage (SYNfA) showed a count of 8.2 log CFU/mL at 28 days. The formulations showed a high TPC (234-431 mg GAE/L), antioxidant activity (48-75 µM trolox), and a potential use as low-calorie beverages. The SYNf formulation showed an acceptability index higher than 70% and a high purchase intent. The SYNf and SYNa formulations maintained suitable probiotic counts after exposure to the simulated gastrointestinal digestion. Therefore, it was possible to develop a new potentially synbiotic yellow mombin beverage with a high sensory acceptance, supplying the market with a new functional food alternative.

CAREGIVERS OF PATIENTS WITH CANCER AT THE END OF LIFE: PSYCHOLOGICAL SUFFERING AND REDUCED WELFARE / CUIDADORES DE PACIENTES COM CÂNCER NO FINAL DA VIDA: SOFRIMENTO PSÍQUICO E REDUÇÃO DE BEM-ESTAR

Introduction: Caregivers of end-of-life patients are exposed to great emotional overload and suffering. This study aims to investigate signs of psychological distress (depression, anxiety and anguish) and the presence of well-being in caregivers of patients at the end of life hospitalized in an oncology palliative care ward. Methods: This is a cross-sectional descriptive study, which included a non-probabilistic sample of 90 main caregivers of individuals hospitalized in the palliative care sector of a cancer reference hospital. The subjects were assessed for the presence of well-being using the Well-Being Assessment Questionnaire (GCQ); the presence of anguish (distress) through the Distress Thermometer; and anxiety and depression by the Anxiety and Depression Scale. Statistical correlations were made between the variables. Results: Female caregivers who lived with the patient had lower levels of well-being. Anxious symptoms were present in 76%, with higher scores in caregivers with less education, who lived with the patient and who cared for other people. Depressive symptoms were present in 55%, with a higher rate in caregivers who lived with the patient. Women and caregivers who performed rotation had a higher distress score. Well-being was inversely proportional to depression, distress and anxiety. Conclusion: This analysis showed higher rates of depression, anxiety and anguish among caregivers, as well as lower well-being. The improvement in well-being can alleviate anxiety, depressive and anguish symptoms. Strategies to improve communication and welcoming in the hospital environment can promote well-being and reduce the symptoms of psychic illness in caregivers of patients at the end of life.

Introdução: Cuidadores de pacientes em fim de vida estão expostos a grande sobrecarga emocional e sofrimento. Esse estudo objetiva investigar sinais de sofrimento psíquico (depressão, ansiedade e angústia) e presença de bem-estar em cuidadores de pacientes no fim da vida hospitalizados em enfermaria de cuidados paliativos oncológicos. Métodos: Trata-se de estudo descritivo transversal, o qual contou com uma amostra não probabilística de 90 cuidadores principais de indivíduos hospitalizados no setor de cuidados paliativos de um hospital referência em câncer. Os sujeitos foram avaliados quanto à presença de bem-estar por meio do Questionário de Avaliação do Bem-Estar (GCQ); a presença de angústia (distress) através do Termômetro de Distress; e ansiedade e depressão pela Escala de Depressão e Ansiedade. Foram feitas correlações estatísticas entre as variáveis. Resultados: Cuidadores do gênero feminino e que residiam com o paciente apresentaram menores índices de bem-estar. Sintomas ansiosos estiveram presentes em 76%, com maiores escores em cuidadores com menor escolaridade, que residiam com o paciente e que cuidavam de outras pessoas. Sintomas depressivos apresentaram-se em 55%, com maior índice em cuidadores que residiam com o paciente. Mulheres e cuidadores que realizavam rodízio apresentaram maior escore de angústia. Bem-estar foi inversamente proporcional a depressão, angústia e ansiedade. Conclusão: A partir desta análise demonstrou-se maiores índices de depressão, ansiedade e angústia entre cuidadores, assim como menor bem-estar. A melhora no bem-estar pode aliviar sintomas ansiosos, depressivos e angústia. Estratégias para a melhoria da comunicação e acolhimento no ambiente hospitalar podem promover bem-estar e redução dos sintomas de adoecimento psíquico de cuidadores de pacientes no final da vida.

Phenotypic Characterization of CD4+ T Lymphocytes in Periportal Fibrosis Secondary to Schistosomiasis.

Schistosomiasis is a parasitic disease that affects about 166 million people around the world. It is estimated that 5%-10% of individuals with schistosomiasis develop severe forms of the disease, which are characterized by pulmonary hypertension, ascites, periportal fibrosis, and other significant complications. The chronic phase of the disease is associated with a Th2 type immune response, but evidence also suggests there are roles for Th1 and Th17 in the development of severe disease. The aim of this study was to evaluate the CD4+ T lymphocyte profile of patients with different degrees of periportal fibrosis secondary to schistosomiasis. These individuals had been treated for schistosomiasis, but since they live in a S. mansoni endemic area, they are at risk of reinfection. They were evaluated in relation to the degree of periportal fibrosis and classified into three groups: without fibrosis or with incipient fibrosis (WF/IFNE), n=12, possible periportal fibrosis/periportal fibrosis, n=13, and advanced periportal fibrosis/advanced periportal fibrosis with portal hypertension, n=4. We observed in the group without fibrosis a balance between the low expression of Th2 cytokines and high expression of T reg cells. As has already been described in the literature, we found an increase of the Th2 cytokines IL-4, IL-5, and IL-13 in the group with periportal fibrosis. In addition, this group showed higher expression of IL-17 and IL-10 but lower IL-10/IL-13 ratio than patients in the WF/IFNE group. Cells from individuals who present any level of fibrosis expressed more TGF-ß compared to the WF/IFNE group and a positive correlation with left lobe enlargement and portal vein wall thickness. There was a negative correlation between IL-17 and the thickness of the portal vein wall, but more studies are necessary in order to explore the possible protective role of this cytokine. Despite the fibrosis group having presented a higher expression of pro-fibrotic molecules compared to WF/IFNE patients, it seems there is a regulation through IL-10 and T reg cells that is able to maintain the low morbidity of this group.

Dissemination of the ST-103 clonal complex serogroup C meningococci in Salvador, Brazil.

Invasive meningococcal disease (IMD) is a major public health problem worldwide. An epidemic of serogroup C (NmC) IMD occurred in 2010 in the city of Salvador. In this study, we describe the antigenic and genetic characterization of meningococcal isolates collected from meningitis cases in Salvador from 2001 to 2012. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed for the analysis of IMD isolates. A total of 733 cases were identified, and the serogroup was determined for 391 (53.0%) of these. Most cases were caused by NmC (53%) or B (47%). The most prevalent strains were B:4,7:P1.19,15 (32.9%; 129/391) and C:23:P1.14-6 (28.6%; 112/391). Based on PFGE/MLST analysis, 71.3% (77/108 PFGE-tested isolates) clustered as two clones of sequence type ST-3779 and ST-3780, both belonging to the ST-103 clonal complex. ST-3779 has been detected in Salvador since 1996 and together with ST-3780 became predominant after 2005. There was a predominance of C:23:P1.14-6, ST-3779/3780 in Salvador during the period of 2007-2012, establishing a major clonal lineage, which remained in the community for a long time; this has serious implications for public health, particularly in terms of prevention and control strategies of IMD.

Susceptibility of dendritic cells from individuals with schistosomiasis to infection by Leishmania braziliensis.

Coinfection with leishmaniasis and schistosomiasis has been associated with increased time to healing of cutaneous lesions of leishmaniasis. The objective of this study was to evaluate the effect of Leishmania braziliensis infection on co-cultures of monocyte-derived dendritic cells (MoDCs) with autologous lymphocytes from patients with schistosomiasis and patients with cutaneous leishmaniasis. MoDCs were differentiated from peripheral blood monocytes, isolated by magnetic beads, infected with L. braziliensis, and co-cultured with autologous lymphocytes. Expression of HLA-DR, CD1a, CD83, CD80, CD86, CD40, and the IL-10 receptor (IL-10R) on MoDCs as well as CD28, CD40L, CD25, and CTLA-4 on lymphocytes were evaluated by flow cytometry. The production of the cytokines IL-10, TNF, IL-12p40, and IFN-γ were evaluated by sandwich ELISA of the culture supernatant. The infectivity evaluation was performed by light microscopy after concentration of cells by cytospin and Giemsa staining. It was observed that the frequency of MoDCs expressing CD83, CD80, and CD86 as well as the MFI of HLA-DR were smaller in the group of patients with schistosomiasis compared to the group of patients with leishmaniasis. On the other hand, the frequency of IL-10R on MoDCs was higher in patients with schistosomiasis than in patients with leishmaniasis. CD4+ and CD8+ T lymphocytes from patients with schistosomiasis presented a lower frequency of CD28 and a higher frequency of CTLA-4 compared to lymphocytes from patients with leishmaniasis. Levels of IL-10 were higher in the supernatants of co-cultures from individuals with schistosomiasis compared to those with leishmaniasis. However, levels of TNF, IL-12p40, and IFN-γ were lower in the group of individuals with schistosomiasis. Regarding the frequency of MoDCs infected by L. braziliensis after 72h in culture, it was observed that higher frequencies of cells from patients with schistosomiasis were infected compared to cells from patients with leishmaniasis. It was concluded that MoDCs from patients with schistosomiasis are more likely to be infected by L. braziliensis, possibly due to a lower degree of activation and a regulatory profile.

Conservation aspects of sea turtles in Maranhao island, Sao Luis, Brazil / Aspectos da conservação de tartarugas marinhas na ilha do Maranhão, Municipality of São Luis, Brasil

Visando obter informações sobre as espécies de tartarugas marinhas que ocorrem na Ilha, iniciaramse levantamentos de encalhes e pesca acidental desses animais em parceria com comunidades pesqueiras da ilha, de junho de 2006 a outubro de 2007. São cinco as espécies de tartarugas marinhas que habitam a zona costeira brasileira e todas elas foram encontradas em São Luís tais como: tartaruga cabeçuda (Caretta caretta), tartaruga de pente (Eretmochelys imbricata), tartaruga de couro (Dermochelys coriacea), tartaruga oliva (Lepidochelys olivacea), e tartaruga verde ou aruanã (Chelonia mydas). Foram observados filhotes recém eclodidos de E. imbricata (demonstrando atividade reprodutiva na região). Todos os espécimes adultos e juvenis localizados vivos ou mortos estavam com alguma marca ou indícios característicos de interação com a pesca como marcas de emalhes de redes de pesca, espinhel ou golpes de faca na cabeça ou na região do casco. Esses animais estão em situação de risco de extinção devido ao consumo por comunidades pesqueiras, muitas vezes ocasionadas pela pesca acidental e pela ausência de informação dos pescadores sobre a adequada devolução ao mar. Portanto os esforços de conservação destes animais devem se concentrar não somente na atividade reprodutiva, mas na conscientização sobre pesca e consumo ilegal junto às comunidades pesqueiras da zona costeira. Neste aspecto a importância deste trabalho foi delinear os principais impactos sobre as espécies para melhorar sua proteção nas praias e a relação com as atividades de pesca na Ilha. Os resultados desta pesquisa podem levar à intensificação de esforços de conservação dessas espécies da zona costeira de toda a Ilha do Maranhão, incluindo também São José de Ribamar, Paço do Lumiar e Raposa, inserindo-as no programa nacional de conservação de espécies em risco de extinção.

In order to obtain information about the species of sea turtles that occur on the island of Maranhão, São Luis, surveys were started through observations of catching and stranding of these animals in partnership with fishing communities, from June 2006 to October 2007. There are five species of sea turtles that inhabit the coastal area of Brazil and all of them were observed in Maranhão Island, São Luís, such as: loggerhead turtle (Caretta caretta), hawksbill turtles (Eretmochelys imbricata), leatherback turtle (Dermochelys coriacea), olive turtle (Lepidochelys olivacea) and green turtle (Chelonia mydas). It was observed puppies newly hatched of E. imbricata (indicating reproductive activity). All adult and juvenile specimens found dead or alive were observed with some injury due fishing artifacts such as fishing gill, fishing nets, long lines or knife blows on the head or on the hull. These animals are at risk of extinction due to the consumption by fishing communities, caused by catch and the lack of information of the fishermen how to manage the returning of the animals to the sea. For this reason, conservation efforts for these animals should focus not only on reproductive activity, but in raising awareness of illegal fishing and consumption by the fishing communities along the coastal zone. In this aspect, the importance of this work was to delineate the main impacts on these animals to improve the protection at the beaches and the fishing activities on the Island. The results of this research may lead to the intensification of efforts to conserve these species in the coastal zone of all the island of Maranhão, including also the municipalities of São José de Ribamar, Paço do Lumiar and Raposa to insert them at the national conservation program of endangered species.

The role of inflammatory and anti-inflammatory cytokines in the pathogenesis of human tegumentary leishmaniasis.

In tegumentary leishmaniasis caused by Leishmania braziliensis, there is evidence that increased production of IFN-γ, TNF-α and absence of IL-10 is associated with strong inflammatory reaction and with tissue destruction and development of the lesions observed in cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML). We evaluate the role of regulatory cytokines and cytokine antagonists in the downregulation of immune response in L. braziliensis infection. Peripheral blood mononuclear cells from CL and ML were stimulated with soluble Leishmania antigen in the presence or absence of regulatory cytokines (IL-10, IL-27 and TGF-ß) or antagonists of cytokines (α-TNF-α and α-IFN-γ). Cytokines production (IL-10, IL-17, TNF-α and IFN-γ) was measured by ELISA. IL-10 and TGF-ß downmodulate TNF-α and IL-17 production, whereas IL-27 had no effect in the production of TNF-α, IFN-γ and IL-17 in these patients. Neutralization of TNF-α decreased IFN-γ level and the neutralization of IFN-γ decreased TNF-α level and increased IL-10 production. This study demonstrate that IL-10 and TGF-ß are cytokines that appear to be more involved in modulation of immune response in CL and ML patients. IL-10 might have a protective role, since the neutralization of IFN-γ decreases the production of TNF-α in an IL-10-dependent manner.

Ceratoplastia endotelial lamelar profunda em distrofia de Fuchs: relato de caso / Deep lamellar endothelial keratoplasty in Fuchs' dystrophy: case report

Descrever o caso de paciente portador de distrofia de Fuchs submetido a ceratoplastia endotelial lamelar profunda. O procedimento cirúrgico foi realizado no olho direito em um caso de distrofia de Fuchs com falência endotelial. Realizou-se incisão límbica superior, o estroma corneano foi delaminado e um disco lamelar de 8,5 mm com 0,150 mm de espessura, contendo estroma, membrana de Descemet e endotélio, foi transplantado sem sutura corneana. Foram avaliados: acuidade visual sem e com correção, biomicroscopia, topografia, paquimetria ultra-sônica e densidade endotelial. A paciente apresentava na avaliação pré-operatória acuidade visual com correção de 20/100 (+4,00 DE -3,25 DC x 60º), astigmatismo de 6,6 dioptrias (37,5 a 12º x 44,1 a 102º), espessura paquimétrica de 0,625 mm e contagem endotelial de 720 cel/mm². Após três meses da cirurgia, apresentava-se com acuidade visual com correção de 20/30 (-1,25 DE -0,50 DC x 45º), astigmatismo regular de 1,0 dioptria (37,2 a 75º x 38,2 a 165º), espessura paquimétrica de 0,503 mm e contagem endotelial de 2447 cel/mm². Observaram-se como complicações: corte inadvertido da íris, má coaptação de bordas, dobras do disco doador e nébula na interface. Os resultados preliminares sugerem que a ceratoplastia endotelial lamelar posterior é uma alternativa para o tratamento cirúrgico da distrofia de Fuchs com falência endotelial. Seguimento mais prolongado e maior número de casos são necessários para melhor entendimento e caracterização desta técnica e de suas repercussões.