Benefícios da utilização de bifidobactérias e lactobacilos no tratamento da colite ulcerativa: uma revisão / Benefits of the use of bifidobacteria and lactobacilos in the treatment of ulcerative colitis: a review

Introdução: a colite ulcerativa é uma doença crônica que ocasiona inflamação das mucosas do cólon, ceco e reto. Algumas evidências sugerem que o desenvolvimento e as recidivas da colite estão relacionadas à susceptibilidade genética, ao desequilíbrio da microbiota intestinal e à resposta anormal do sistema imunológico a antígenos entéricos. Diante disso, a modulação da microbiota pode ser útil para o tratamento da doença. Objetivo: compilar os principais resultados de ensaios clínicos randomizados sobre a utilização de bifidobactérias e lactobacilos no tratamento da colite ulcerativa. Metodologia: trata-se de uma revisão sistemática que utilizou as bases de dados Pubmed e Google Acadêmico para pesquisar artigos originais de ensaios clínicos randomizados em humanos, publicados entre 2003 e 2017, em inglês. Resultados: foram incluídos: dois ensaios multicêntricos, randomizados, duplo-cego; dois ensaios randomizados, duplo-cego; dois ensaios randomizados; e um ensaio randomizado aberto. O tratamento com L. delbruekii e L. fermentum melhorou a inflamação. O leite fermentado com B. breve, B. bifidum e L. acidophilus e a suplementação L. rhamnosus estirpe GG melhoraram os sintomas clínicos, chegando a superar o tratamento padrão. A cepa B. longum induziu a remissão. E o leite fermentado com B. breve e L. acidophilus manteve a remissão da doença. Conclusão: embora, a maior parte dos resultados tenha sido positiva, algumas limitações reduzem a aplicabilidade desses achados em outras populações, como o desenho experimental, o tamanho da amostra e a diversidade de cepas probióticas. Por isso, novos ensaios clínicos randomizados, controlados e com populações maiores devem ser realizados

Introduction: ulcerative colitis is a chronic disease, which causes inflammation of the mucous membranes of the colon, cecum and rectum. Some evidence suggests that colitis development and recurrence are related to genetic susceptibility, intestinal microbiota imbalance and abnormal response of the immune system to enteric antigens. In view of this, modulation of the microbiota may be useful for the treatment of the disease. Objective: to compile the main results of randomized clinical trials on the use of bifidobacteria and lactobacilli in the treatment of ulcerative colitis. Methodology: this is a systematic review using the Pubmed and Google Scholar databases for original articles from randomized clinical trials in humans published between 2003 and 2017 in English. Results: two double-blind, multicenter, randomized trials were included; two randomized, double-blind trials; two randomized trials; and an open randomized trial. Treatment with L. delbruekii and L. fermentum improved inflammation. The milk fermented with B. breve, B. bifidum and L. acidophilus and L. rhamnosus strain GG supplementation improved the clinical symptoms, even surpassing the standard treatment. B. longum strain induced remission. And the milk fermented with B. breve and L. acidophilus maintained remission of the disease. Conclusion: although most of the results were positive, some limitations reduce the applicability of these findings in other populations, such as experimental design, sample size and diversity of probiotic strains. Therefore, new, randomized, controlled trials with larger populations should be performed.

Avaliação, Ensinagem e Metodologias Ativas: uma Experiência Vivenciada no Componente Curricular Mecanismos de Agressão e de Defesa, no curso de Medicina da Universidade do Estado da Bahia, Brasil / Evaluation, Teaching and Active Methodologies: an Experience as Part of the Curricular Component Mechanisms of Aggression and Defense of the Medicine course of Universidade do Estado da Bahia, Brazil

RESUMO A contemporaneidade e a docência nas áreas de saúde e formação profissional, tem se transformado e evoluído nos últimos tempos, com a introdução das metodologias ativas no processo ensino-aprendizagem, nas instituições de ensino superior no Brasil. Essas metodologias ativas de aprendizagem, como a ABP, Aprendizagem Baseada em Problemas, são utilizadas com a finalidade de que estudantes da área da saúde adquiram o conhecimento de forma significativa, em relação ao ensino tradicional. A educação médica no Brasil tem sido assunto de muitas discussões sobre a formação profissional em saúde e vem passando por significativas mudanças nos últimos anos. O presente artigo tem por objetivo relatar uma experiência docente no ensino de graduação em Medicina, nos componentes curriculares Mecanismo de Agressão e Defesa I e II (MADs), na Universidade do Estado da Bahia - Campus I. MADs é um componente curricular atualmente presente em diferentes cursos da área de saúde do Brasil. Este componente é composto pelas disciplinas microbiologia, parasitologia, imunologia e patologia, lecionado de forma integrada. Foram aplicadas metodologias ativas de ensino, do tipo aprendizagem baseada em problemas (ABP), que abrangeram sessões tutoriais, atividades em laboratórios, apresentações científicas e o uso de filmes. Além disto, foram utilizados recursos lúdicos e a ferramenta MOODLE no campus virtual. Esta proposta teve início no ano de 2012 e vem sendo aplicada a partir desta data até os dias atuais. A experiência vivenciada nas MADs, com a utilização de variadas formas de metodologias de ensinagem, tem permitido "romper" com o tradicional, isto é, tem levado o discente a desenvolver habilidades, competências e construção dos saberes. Estas novas alternativas de ensino nos permitiu uma interação mais ampla entre a relação discente-docente e nos fez refletir e avançar no processo avaliativo, que tem sido realizado de forma ampla e processual. Além disso, um impacto positivo para sua formação pode ser observado. No que se refere ao processo de ensino, aprendizagem e avaliações, novas propostas pedagógicas devem ser inseridas priorizando o caráter formativo e de desenvolvimento dos discentes, para que haja a construção de competências necessárias ao perfil estabelecido pelas DCNs, Diretrizes Curriculares Nacionais, do curso de Graduação em Medicina e demais cursos de saúde.

ABSTRACT Changes are occurring in health teaching and professional training, due to the introduction of active methodologies to the teaching-learning process in Brazilian higher education institutions. These active learning methodologies, such as PBL (Problem-Based Learning), are used to help medical students acquire knowledge in a more relevant way, compared to traditional teaching. Medical education in Brazil has been the subject of much discussion, and has undergone significant changes in recent years. The objective of the present work is to report the teaching experience in the curricular components Mechanisms of Aggression and Defense I (MAD I) and Mechanisms of Aggression and Defense II (MAD II) of Universidade do Estado da Bahia [State University of Bahia] - Campus I in undergraduate teaching in Medicine. These subjects are composed of the disciplines microbiology, parasitology, immunology (MAD I and II) and pathology (MAD II), taught in an integrated way. Active teaching methodologies were applied, such as problem-based learning, laboratory activities, scientific presentations and the use of film. In addition, the MOODLE tool was used in the virtual campus. This proposal began in 2012 and has been applied since then. The experience of the MADs, with the use of different forms of teaching methodologies, has led to a transformation of traditional teaching, leading students to develop their skills and competencies and build knowledge. These new teaching alternatives allow for a broader interaction between the students and the teacher and led us to reflect and advance in the evaluation process, which has been carried out in a broad and procedural way. Moreover, a positive impact on the students' training was observed. As for the processes of teaching, learning and evaluation, new pedagogical proposals should be introduced, prioritizing the formative and developmental character of students so that the necessary competences can be built into the profile established by the National Curricular Guidelines (DCNs) of the Undergraduate Medicine course and other courses in the area of health.

Humoral and cellular immune responses in mice against secreted and somatic antigens from a Corynebacterium pseudotuberculosis attenuated strain: Immune response against a C. pseudotuberculosis strain.

BACKGROUND: Corynebacterium pseudotuberculosis is the etiologic agent of caseous lymphadenitis (CL), a chronic disease that affects goats and sheep. CL is characterized by the formation of granulomas in lymph nodes and other organs, such as the lungs and liver. Current knowledge of CL pathogenesis indicates that the induction of humoral and cellular immune responses are fundamental to disease control. The aim of this study was to evaluate the humoral and cellular immune responses in BALB/c mice inoculated with a C. pseudotuberculosis strain isolated in the state of Bahia, Brazil. RESULTS: The lymphocyte proliferation and in vitro production of IFN-γ, IL-4, IL-10, IL-12 and nitric oxide by spleen cells stimulated with secreted and somatic antigens from the studied strain were evaluated. IgG subclasses were also analyzed. Results showed a significant increase of Th1-profile cytokines after 60 days post-inoculation, as well as an important humoral response, represented by high levels of IgG2a and IgG1 against C. pseudotuberculosis. CONCLUSION: The T1 strain of C. pseudotuberculosis was shown to induce humoral and cellular immune responses in BALB/c mice, but, even at a dosage of 1x10(7) CFU, no signs of the disease were observed.

MAPK involvement in cytokine production in response to Corynebacterium pseudotuberculosis infection.

BACKGROUND: Caseous lymphadenitis (CL) is a contagious infectious disease of small ruminants caused by Corynebacterium pseudotuberculosis. Is characterized by the formation of abscesses in the lymph nodes and intestines of infected animals, induced by inflammatory cytokines. The production of cytokines, such as IL-10, TNF-α, IL-4 and IFN-γ, is regulated by mitogen-activated protein kinase (MAPK) pathway activation. The present study investigated the involvement of MAPK pathways (MAPK p38, ERK 1 and ERK 2) with respect to the production of cytokines induced by antigens secreted by C. pseudotuberculosis over a 60-day course of infection. CBA mice (n = 25) were divided into three groups and infected with 102 colony forming units (CFU) of attenuated strain T1, 102 CFU of virulent strain VD57 or sterile saline solution and euthanized after 30 or 60 days. Murine splenocytes were treated with specific inhibitors (MAPK p38 inhibitor, ERK 1/2 inhibitor or ERK 2 inhibitor) and cultured with secreted antigens obtained from pathogenic bacteria (SeT1 or SeVD57). RESULTS: The MAPK pathways evaluated were observed to be involved in the production of IL-10, under stimulation by secreted antigens, while the MAPK p38 and ERK 1 pathways were shown to be primarily involved in TNF-α production. By contrast, no involvement of the MAPK p38 and ERK 1 and 2 pathways was observed in IFN-γ production, while the ERK 2 pathway demonstrated involvement in IL-4 production only in the mouse splenocytes infected with VD57 under stimulation by SeT1. CONCLUSION: The authors hypothesize that MAPK p38 and ERK 1 pathways with respect to TNF-α production, as well as the MAPK p38 and ERK 1 and 2 pathways in relation to IL-10 production under infection by C. pseudotuberculosis are important regulators of cellular response. Additionally, the lack of the MAPK p38 and ERK 1/2 pathways in IFN-γ production in infected CBA murine cells stimulated with the two secreted/excreted antigens, in IL-4 production showing involvement only via the ERK 2 pathway under stimulation by SeT1 antigen during 60-day infection period with the virulent strain, suggests that these pathways regulated the production of pro-inflammatory and regulatory cytokines in the splenic cells of CBA mice.