Epidemiologia da anafilaxia no Brasil: Registro Brasileiro de Anafilaxia (RBA) da Associação Brasileira de Alergia e Imunologia (ASBAI) / Epidemiology of anaphylaxis in Brazil: The Brazilian Registry of Anaphylaxis (RBA) of the Brazilian Association of Allergy and Immunology (ASBAI)

INTRODUÇÃO: A anafilaxia é uma reação alérgica multissistêmica grave, de início agudo e potencialmente fatal. Poucos são os dados sobre sua epidemiologia no Brasil. O Registro Brasileiro de Anafilaxia da Associação Brasileira de Alergia e Imunologia (RBAASBAI) teve como objetivo ampliar o conhecimento sobre anafilaxia em indivíduos brasileiros. MÉTODOS: Estudo observacional transversal com questionário online sobre dados demográficos, desencadeantes suspeitos, manifestações clínicas, atendimento durante a reação, investigação diagnóstica e aconselhamento após a reação de pacientes que experimentaram uma reação anafilática. RESULTADOS: Entre junho/2021 e abril/2023, foram incluídos 237 pacientes (131 femininos): 99 crianças/adolescentes; 127 adultos e 11 idosos. Houve predomínio de meninos entre crianças/adolescentes (55,5%), e de mulheres entre os adultos (64,5%), e mediana de idade de 22 anos (< 1 a 77 anos). As manifestações cutâneas (92,8%) foram as mais frequentes, seguidas pelas respiratórias (70,1%), gastrointestinais (52,3%), neurológicas (36,3%) e cardiovasculares (35,3%). Os principais desencadeantes foram: alimentos (43,0%), medicamentos (26,2%), himenópteros (21,6%) e látex (2,5%); os alimentos entre crianças (leite, ovo, amendoim/castanhas), e os fármacos (anti-inflamatórios e antibióticos) entre os adultos. Quanto ao tratamento, 61,1% recebeu adrenalina (52,7% por profissional e 8,4% via autoinjetor de adrenalina -AIA). Uma adolescente (12 anos) faleceu após picada de abelha. A maioria recebeu plano escrito de emergência (78,1%) e foi ensinada a usar o AIA (70%). CONCLUSÃO: Os alimentos foram os desencadeantes mais comuns entre crianças/adolescentes, e os fármacos entre adultos brasileiros. A adrenalina continua sendo subutilizada, reforçando a necessidade de maior disseminação do tratamento adequado da anafilaxia.

INTRODUCTION: Anaphylaxis is a life-threatening, acute, severe multisystem allergic reaction.There is little data on its epidemiology in Brazil. The Brazilian Anaphylaxis Registry of the Brazilian Association of Allergy and Immunology (RBA-ASBAI) was devised to expand knowledge about anaphylaxis in Brazilian individuals. METHODS: Cross-sectional observational study using an online questionnaire to collect data on demographics, suspected triggers, clinical manifestations, treatment during the reaction, diagnostic workup, and post-reaction counseling in patients who have experienced an anaphylactic reaction. RESULTS: Between June 2021 and April 2023, 237 patients were included (131 female): 99 children/adolescents (<18yo), 127 adults (18-64yo), and 11 older adults (65-77yo). There was a male predominance in the pediatric group (55.5%), while females were predominant among adults (64.5%). The median age was 22 years (range, <1 to 77). The most frequent clinical manifestations were cutaneous (92.8%), followed by respiratory (70.1%), gastrointestinal (52.3%), neurological (36.3%), and cardiovascular (35.3%). The most common triggers were foods (43.0%), drugs (26.2%), venoms (21.6%), and latex (2.5%). Foods (milk, egg, peanuts/tree nuts) predominated among children, versus drugs (mostly nonsteroidal anti-inflammatory drugs and antibiotics) among adults. Regarding treatment, 61.1% received epinephrine (52.7% by a healthcare professional and 8.4% via epinephrine auto-injector [EAI]). One teenager (12yo) died due to a bee sting. Most patients received a written emergency plan (78.1%) and were taught how to use the EAI (70%). CONCLUSION: Foods were the most common triggers of anaphylaxis among Brazilian children and adolescents, while drugs predominated among adults. Epinephrine continues to be underused, highlighting the need for greater awareness of proper treatment of anaphylaxis.

Lithium activates brain phospholipase A2 and improves memory in rats: implications for Alzheimer's disease.

Phospholipase A2 (Pla2) is required for memory retrieval, and its inhibition in the hippocampus has been reported to impair memory acquisition in rats. Moreover, cognitive decline and memory deficits showed to be reduced in animal models after lithium treatment, prompting us to evaluate possible links between Pla2, lithium and memory. Here, we evaluated the possible modulation of Pla2 activity by a long-term treatment of rats with low doses of lithium and its impact in memory. Wistar rats were trained for the inhibitory avoidance task, treated with lithium for 100 days and tested for perdurability of long-term memory. Hippocampal samples were used for quantifying the expression of 19 brain-expressed Pla2 genes and for evaluating the enzymatic activity of Pla2 using group-specific radio-enzymatic assays. Our data pointed to a significant perdurability of long-term memory, which correlated with increased transcriptional and enzymatic activities of certain members of the Pla2 family (iPla2 and sPla2) after the chronic lithium treatment. Our data suggest new possible targets of lithium, add more information on its pharmacological activity and reinforce the possible use of low doses of lithium for the treatment of neurodegenerative conditions such as the Alzheimer's disease.

D1/D5 dopamine receptors modulate spatial memory formation.

We investigated the effect of the intra-CA1 administration of the D1/D5 receptor antagonist SCH23390 and the D1/D5 receptor agonist SKF38393 on spatial memory in the water maze. When given immediately, but not 3h after training, SCH23390 hindered long-term spatial memory formation without affecting non-spatial memory or the normal functionality of the hippocampus. On the contrary, post-training infusion of SKF38393 enhanced retention and facilitated the spontaneous recovery of the original spatial preference after reversal learning. Our findings demonstrate that hippocampal D1/D5 receptors play an essential role in spatial memory processing.

The molecular cascades of long-term potentiation underlie memory consolidation of one-trial avoidance in the CA1 region of the dorsal hippocampus, but not in the basolateral amygdala or the neocortex.

Data accumulated through the past 15 years showed that memory consolidation of one-trial avoidance learning relies on a sequence of molecular events in the CA1 region of the hippocampus that is practically identical to that of long-term potentiation (LTP) in that area. Recent findings have indeed described CA1 LTP concomitant to the consolidation of this and other tasks. However, abundant evidence suggests that, in addition, other molecular events, involving some of the same steps but with different timing and in different sequence in the basolateral amygdala, entorhinal, parietal and cingulate cortex are as important as those of the hippocampus for memory consolidation. Here we review the hippocampal mechanisms involved and the possible interconnections between all these processes. Overall, the findings indicate that memory consolidation of even a task as deceivingly simple as one-trial avoidance relies on hippocampal LTP but also requires the concomitant participation of other brain systems and molecular events. Further, they point to the mechanisms that account for the enhanced consolidation usually seen for emotion-laden memories.

The evidence for hippocampal long-term potentiation as a basis of memory for simple tasks.

Long-term potentiation (LTP) is the enhancement of postsynaptic responses for hours, days or weeks following the brief repetitive afferent stimulation of presynaptic afferents. It has been proposed many times over the last 30 years to be the basis of long-term memory. Several recent findings finally supported this hypothesis: a) memory formation of one-trial avoidance learning depends on a series of molecular steps in the CA1 region of the hippocampus almost identical to those of LTP in the same region; b)hippocampal LTP in this region accompanies memory formation of that task and of another similar task. However, CA1 LTP and the accompanying memory processes can be dissociated, and in addition plastic events in several other brain regions(amygdala, entorhinal cortex, parietal cortex) are also necessary for memory formation of the one-trial task, and perhaps of many others.

The evidence for hippocampal long-term potentiation as a basis of memory for simple tasks

Long-term potentiation (LTP) is the enhancement of postsynaptic responses for hours, days or weeks following the brief repetitive afferent stimulation of presynaptic afferents. It has been proposed many times over the last 30 years to be the basis of long-term memory. Several recent findings finally supported this hypothesis: a) memory formation of one-trial avoidance learning depends on a series of molecular steps in the CA1 region of the hippocampus almost identical to those of LTP in the same region; b)hippocampal LTP in this region accompanies memory formation of that task and of another similar task. However, CA1 LTP and the accompanying memory processes can be dissociated, and in addition plastic events in several other brain regions(amygdala, entorhinal cortex, parietal cortex) are also necessary for memory formation of the one-trial task, and perhaps of many others.

A potenciação de longa duração (LTP) é o aumento de respostas pós-sinápticas durante horas, dias ou semanas após a breve estimulação repetitiva de aferentes pre-sinápticos. Foi proposto durante 30 anos ser a base da memória de longa duração. Vários achados recentes finalmente apoiaram esta hipótese: a) a formação da memória de esquiva inibitória adquirida numa sessão depende de uma cadeia de processos moleculares na região CA1 do hipocampo quase idêntica à da LTP nessa mesma região; b) LTP hipocampal nessa região acompanha a formação da memóría dessa tarefa e de outra semelhante. No entanto, a LTP de CA1 e os processos de memória podem ser dissociados e, fora disso, processos plásticos em outras regiões cerebrais (amígdala, córtex entorrinal, córtex parietal) também são necessários para a formação da memória da tarefa de uma sessão e talvez de muitas outras.

Inhibition of mRNA synthesis in the hippocampus impairs consolidation and reconsolidation of spatial memory.

Using two different mRNA synthesis inhibitors, we show that blockade of hippocampal gene expression during restricted posttraining or postretrieval time windows hinders retention of long-term spatial memory for the Morris water maze task, without affecting short-term memory, nonspatial learning, or the functionality of the hippocampus. Our results indicate that spatial memory consolidation induces the activation of the hippocampal transcriptional machinery and suggest the existence of a gene expression-dependent reconsolidation process that operates in the dorsal hippocampus at the moment of retrieval to stabilize the reactivated mnemonic trace.

Guarana (Paullinia cupana var. sorbilis), an anciently consumed stimulant from the Amazon rain forest: the seeded-fruit transcriptome.

Guarana (Paullinia cupana var. sorbilis) is a plant native to the central Amazon basin. Roasted seed extracts have been used as medicinal beverages since pre-Colombian times, due to their reputation as stimulants, aphrodisiacs, tonics, as well as protectors of the gastrointestinal tract. Guarana plants are commercially cultivated exclusively in Brazil to supply the national carbonated soft-drink industry and natural product stores around the world. In this report, we describe and discuss the annotation of 15,387 ESTs from guarana seeded-fruits, highlighting sequences from the flavonoid and purine alkaloid pathways, and those related to biotic stress avoidance. This is the largest set of sequences registered for the Sapindaceae family.

Molecular epidemiology of dengue type 3 virus in Brazil and Paraguay, 2002-2004.

We studied the molecular epidemiology of dengue virus type 3 (DENV-3) in Brazil and Paraguay by analyzing the 5' and 3' untranslated regions (5' and 3'UTRs) and the E protein gene of viruses isolated between 2002 and 2004. Both 5' and 3'UTRs were highly conserved. However, the 3'UTR of two isolates from Brazil contained eight nucleotide deletions compared with the remaining 26 viruses. Phylogenetic analyses suggested that DENV-3 was introduced into Brazil from the Caribbean Islands at least twice and into Paraguay from Brazil at least three times.

Histamine enhances inhibitory avoidance memory consolidation through a H2 receptor-dependent mechanism.

Several evidences suggest that brain histamine is involved in memory consolidation but the actual contribution of the hippocampal histaminergic system to this process remains controversial. Here, we show that when infused into the CA1 region of the dorsal hippocampus immediately after training in an inhibitory avoidance task, but not later, histamine induced a dose-dependent promnesic effect without altering locomotor activity, exploratory behavior, anxiety state or retrieval of the avoidance response. The facilitatory effect of intra-CA1 histamine was mimicked by the histamine N-methyltransferase inhibitor SKF-91844 as well as by the H2 receptor agonist dimaprit and it was blocked completely by the H2 receptor antagonist ranitidine. Conversely, the promnesic action of histamine was unaffected by the H1 receptor antagonist pyrilamine, the H3 receptor antagonist, thioperamide, and the NMDAr polyamine-binding site antagonist ifenprodil. By themselves, ranitidine, pyrilamine, thioperamide, and ifenprodil did not affect IA memory consolidation. Our data indicate that, when given into CA1, histamine enhances memory consolidation through a mechanism that involves activation of H2 receptors; however, endogenous CA1 histamine does not seem to participate in the consolidation of IA memory at least at the post-training times analyzed.

Estudo de casos sobre abandono do tratamento da tuberculose: avaliaçäo do atendimento, percepçäo e conhecimentos sobre a doença na perspectiva dos clientes (Fortaleza, Ceará, Brasil) / Non-adherence to tuberculosis treatment: a study on perceptions and knowledge of the disease and evaluation of health services from the patient perspective (Fortaleza, Ceará, Brazil)

Pesquisa foi desenvolvida em 1995 e 1996 no Centro de Saúde Oliveira Pombo, Fortaleza, Ceará. Os objetivos foram os seguintes: geral - identificaçäo de fatores que determinam o abandono do tratamento da tuberculose; específicos - análise da dinâmica do atendimento e da freqüência de casos e de abandono do tratamento; identificaçäo das características sócio-econômicas e culturais dos clientes (atores sociais); causas impeditivas ao tratamento; conhecimentos e percepçäo da doença pelos clientes. Duas abordagens metodológicas fora utilizadas: de natureza epidemiológica descritiva e sociológica interpretativa, utilizando questionário semi-estruturado com os seguintes conteúdos: sexo; idade; estado civil; escolaridade; ocupaçäo; rendimento; descriçäo da residência; formas de deslocamento; níveis de conhecimentos e percepçäo sobre a doença e o tratamento; identificaçäo de sentimentos reativos à doença; avaliaçäo sobre o atendimento; comportamento e estilos de vida prejudiciais; decisöes de mudanças para melhoria da saúde. Os resultados obtidos apontaram fatores múltiplos de natureza complexa, que influem direta ou indiretamente para o abandono do tratamento.

Study of the anti-hyperglycemic effect of plants used as antidiabetics.

The purpose of this research was to study the anti-hyperglycemic effect of 28 medicinal plants used in the treatment of diabetes mellitus. Each plant was processed in the traditional way and intragastrically administered to temporarily hyperglycemic rabbits. The results showed that eight out of the 28 studied plants significantly decrease the hyperglycemic peak and/or the area under the glucose tolerance curve. These plants were: Guazuma ulmifolia, Tournefortia hirsutissima, Lepechinia caulescens, Rhizophora mangle, Musa sapientum, Trigonella foenum graceum, Turnera diffusa, and Euphorbia prostrata. The results suggest the validity of their clinical use in diabetes mellitus control, after their toxicological investigation.

Nutritional evaluation of a high-temperature dried soft wheat pasta supplemented with cowpea (Vigna unguiculata (L) Walp).

The objective of this study was to determine the nutritional quality of the pasta described above. The work was unique in the following aspects: 1) the drying process was a nonconventional method, consisting of a high-temperature short-time (HTST) process; 2) the nutritional quality of the wheat pasta was improved by the cowpea supplementation. Cowpea was especially chosen due to it being a staple food in the diet of the people in Northeast Brazil. Benefits attributed to the HTST drying process include a reduction in bacterial counts, shorter processing time and less energy consumption. In addition, there are reports in the literature of improved pasta firmness, color intensity, and cooking characteristics, when non Triticum durum materials plus drying are used. The pasta produced in this work was made using 100% soft wheat flour (SP), and soft wheat flour (SF) mixed supplemented with 10, 20 and 30% dehulled cowpea meal (CM); referred to as 10, 20 and 30% SP, respectively. The methods utilized in this project included: AACC methods for proximate analyses and trypsin inhibitor activity determination, atomic absorption spectrophotometry for mineral determination, a dye binding procedure for measuring available lysine, HPLC for amino acid quantification., FAO/WHO amino acid scoring patterns for chemical scores and AOAC for protein digestibility. The protein content of the past as supplemented with CM ranged from 11.3 to 14.2%, while the 100% SF pasta (SP) contained 10.9%. CM supplementation resulted in 52 to 113% more total lysine, and 26 to 82% more available lysine in the CM pasta compared to the SP. Chemical scores for SP were 45 and 59% for preschool and school-age children, respectively. Adding 30% CM to SP improved the above chemical scores to 89 and 100+, respectively. However, the addition of CM compromised the in vitro protein digestibility of SP from 4 to 6%. The addition fo 30% CM provided the SP with greater calcium (Ca), iron (Fe), zinc (Zn) and copper (Cu): 44, 49, 91 and 402% respectively. Cooking the CM pasta resulted in a 50 to 90% retention of mineral content, with the greatest loss being for Cu. In the cooked 30% CM pasta, the contents of Fe, Zn and Ca were, respectively, 50, 67 and 243% greater than their content in the cooked SP. Of the cooked pasta, the only one displaying trypsin inhibitor activity was the 30% CM pasta, which had 0.8 TIU.

Clinical acceptability of ACE inhibitor therapy in mild to moderate hypertension, a comparison between perindopril and enalapril.

The aim of this 3-month double-blind study was to assess the antihypertensive effect and acceptability of perindopril in comparison with enalapril in patients with mild to moderate essential hypertension. After a 4-week placebo run-in period, 161 patients with supine diastolic blood pressure (DBP) between 95 and 115 mmHg were randomized to receive perindopril 4 mg or enalapril 10 mg once daily. If supine DBP was higher than 90 mmHg, treatment was adjusted monthly, first by doubling the dose and then by addition of hydrochlorothiazide 12.5 mg. After 3 months of active treatment the decrease in supine and standing blood pressures was statistically significant within both groups but was not statistically different between groups. The percentage of patients (65%) who achieved supine DBP of < or = 90 mmHg in the perindopril group was not significantly different from the enalapril group (73%). Monotherapy resulted in control of supine DBP in 56% of the perindopril group and 58% of the enalapril group; the addition of hydrochlorothiazide resulted in control of supine DBP in 6% and 15% respectively. The number of withdrawals for adverse events was statistically significant between groups (0 in the perindopril group and 7 in the enalapril group, p = 0.01). During active treatment the most frequently reported complaints were headaches and cough; there was not statistically difference between groups. Changes in laboratory parameters were minor and not significantly different between the two groups except for serum glucose, potassium, and triglyceride levels. In conclusion, there was no significance between perindopril and enalapril in terms of efficacy. Clinical acceptability seems to be better in the perindopril group.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of dehulling, cooking and storage conditions on protein quality and digestibility of soybeans.

Soybeans were dehulled, stored under two environmental conditions [25 degrees C/75% R.H. (Env. 1) and 38 degrees C/90% R.H. (Env.2)], optimally cooked and assayed for trypsin inhibitor and protein quality with laboratory rats. Dehulling did not significantly affect protein quality (PER and NPR) and protein digestibility of raw and cooked soybeans. Raw soybeans diets were significantly poorer in protein quality and digestibility when compared with cooked counterparts. PER values of dehulled-cooked soybean diets decreased significantly (P<0.05) as seeds were stored for up to 3 months under either environment. There were no significant differences in PER values due to storage during the period from 3 to 6 months. PER values for whole-cooked soybean diets exhibited a significant decline only when stored for 6 months under Env. 2.

Effects of dehulling, cooking and storage conditions on protein quality and digestibility of soybeans / Efecto del descascarado, cocción y almacenamiento sobre la calidad de la proteína y digestibilidad de la soya

Soybeans were debulled, stored under two environmental conditions [25ºC/75 por ciento RH (Env. 1) and 38ºC/90 por ciento RH (Env. 2)], optimally cooked and assayed for trypsin inhibitor and protein quality with laborary rats. Dehulling not significantly effects protein quality (PER and NPR) and protein digestibility of raw and cooked soybeans. Raw soybeans diets were significantly poorer in protein quality and digestibility when compared with cooked counterparts. PER values of dehulled-cooked soybean diets decreased significantly (p<0.05) as seeds were stored for up to 3 months under either environment. These were no significant differences in PER values due to etorage suring the period from 3 a 6 months. PER values for whole-cooked soybean diets exhibited a significant decline only when stored for 6 months under Env. 2

Mineral composition of some traditional Mexican teas.

Teas of plant origin traditionally consumed by the Mountain Pima of Chihuahua, Mexico, were analyzed for mineral nutritional content. Fe, Cu, Zn, Ca, and Mg composition was determined for native teas made from shoots of Tagetes lucida, T. filifolia, Elytraria imbricata, and Holodiscus dumosus, and from root xylem of Ceanothus depressus and Phaseolus ritensis. Native uses of these teas are also described.

Gaining control in a changing environment.

The rapid evolution of home care has frequently produced chaotic and unmanageable situations for home care personnel. This article will assist clinical supervisors with daily operations as they teach their staff how to effectively gain control and stabilize the chaos--how to manage, rather than be managed by, home care.