Clinical standards for the diagnosis and management of asthma in low- and middle-income countries.

BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.

Mielorradiculopatia esquistossomótica: relato de caso em paciente pediátrico / Schistosomal Myeloradiculopathy: case report in a pediatric patient

A esquistossomose é uma endemia parasitária típica das Américas, Ásia e África. A Mielorradiculopatia Esquistossomótica surge como uma evolução severa da infecção por esquistossomose e, apesar de muito comum, sua prevalência em áreas endêmicas vem sendo subestimada. Objetivo: relatar caso de Mielorradiculopatia Esquistossomótica ocorrido em paciente pediátrico. Metodologia: estudo descritivo do tipo Relato de Caso retrospectivo, submetido e aprovado pelo Comitê de Ética em Pesquisa do Centro Universitário CESMAC, CAAE: 28835220.0.0000.0039, N.º do Parecer: 3.898.292. Relato de caso: paciente do sexo masculino, previamente hígido, 11 anos, iniciou quadro com história álgica aguda em membros inferiores que piorava no período da noite acompanhada de relato de febre. Quadro clínico evoluiu com lombalgia, disúria, oligúria, posterior anúria e formação de globo vesical. Evoluiu, também, com paresia de membros inferiores. A investigação realizou-se com Exame Parasitológico de Fezes positivo para esquistossomose, além de Ressonância Magnética de coluna lombo-sacra que corroboraram com a hipótese diagnóstica. Instituiu-se tratamento com Albendazol, Praziquantel e pulsoterapia com Metilprednisolona durante internação. Paciente teve alta hospitalar com melhora de quadro neurológico, em uso de prednisona 40 mg/dia. Conclusão: a MRE constitui a forma mais grave dentre as manifestações ectópicas da esquistossomose. A dificuldade do reconhecimento do quadro clínico e a limitação no acesso aos métodos complementares diagnósticos contribuem para o subdiagnóstico da enfermidade, acarretando sequelas graves para os portadores da doença e ocultando sua importância epidemiológica principalmente em pacientes pediátricos e jovens. (AU)

Schistosomiasis is a parasitic endemic typical of the Americas, Asia and Africa. Schistosomal Myeloradiculopathy is a severe evolution of schistosomiasis infection and, although very common, the prevalence in endemic areas has been underestimated. Objective: to report Schistosomal Myeloradiculopathy case in a pediatric patient. Methodology: descriptive study of the type Case Report retrospective, submitted and approved by the Research Ethics Committee of the CESMAC University Center, CAAE: 28835220.0.0000.0039, Opinion N.º: 3.898.292. Case report: a previously healthy 11-year-old boy, started with a history of acute pain in lower limbs that worsened during the night accompanied of fever. Evolved with low back pain, dysuria, oliguria, subsequent anuria, vesical globe formation and lower limbs paresis. The investigation resulted in positive stool examination for schistosomiasis and magnetic resonance imaging of lumbosacral spine that corroborated the diagnostic hypothesis. The treatment included Albendazol, Praziquantel and pulsetherapy with Methylprednisolone during hospitalization. The patient was discharged from the hospital with improved neurological status, using prednisone 40 mg/day. Conclusion: Schistosomal Myeloradiculopathy is the most severe form of the ectopic manifestations of schistosomiasis. The difficulty in recognizing the clinical condition and the limitation of access to complementary diagnostic methods contributes to the underdiagnosis of the disease, causing severe sequels for patients with disease and hiding its epidemiological importance, especially in pediatric and young patients. (AU)

Cloxacillin nanostructured formulation for the treatment of bovine keratoconjunctivitis.

Infectious bovine keratoconjunctivitis (IBK) is a widespread, contagious ocular disease that affects cattle, especially dairy breeds. The disease is caused by Gram-negative bacteria mainly Moraxella bovis, and its treatment consists of parenteral or topic antibiotic therapy. The topic treatment approach is used more commonly in lactating cows, to avoid milk disposal. However, treatment failures are common, because the antibiotic is removed during lacrimation. This study aimed to evaluate the susceptibility of commercial cloxacillin and evaluate the efficacy of nanostructured cloxacillin in clinical cases of IBK by Moraxella. The minimum inhibitory concentration (MIC) of nanoparticle cloxacillin nanocoated, the nanoparticle without the antibiotic and the commercial cloxacillin were determined in vitro with field samples of Moraxella ovis (5) and Moraxella bovis (5). The efficiency of nanoparticles was tested in three cows naturally infected that were treated with 1.0 mL (with 0.32 mg of nanostructured cloxacillin) for the ocular route. Moraxella bovis was isolated and identified by biochemical and molecular methods before the treatment. The animals were treated every 12 h for six days. The cure was considered by the absence of clinical symptoms and bacteria after treatment. The mucoadhesive nanoparticle-based formulation promoted clinical cure with a low number of doses of antibiotics, probably due to the maintenance of the MIC in the ocular mucosa for longer due to the mucoadhesive characteristics of the nanoparticle. The results indicate that the use of nanocoated cloxacillin is possible to control infectious bovine keratoconjunctivitis.

SHORT-COMMUNICATION Evaluation of perfused bovine udder for gene expression studies in dairy cows.

Intramammary infections are one of the main causes of productivity loss in dairy cows. To better understand the immune system response and to avoid the use of live animals, we validated the use of isolated bovine udder as an ex situ model. Six mammary glands were collected from cows ready for culling. Three udders were perfused with Tyrode's solution and three were not-perfused. During six hours, we collected perfusate samples for biochemical analysis. We also collected alveolar and teat canal tissue to evaluate gene expression. The biochemical parameters indicated that the perfused udders remained viable for the entire period of the experiment. A real-time polymerase chain reaction showed an increase in 18S rRNA gene expression in the alveolar tissue at 3 and 4 h after perfusion. There was also an increase in the Ubiquitin gene in the teat canal from not-perfused udders at 1, 3, and 4 h after slaughter. In general, gene expression was stable during the experiment. Our results indicated that the isolated perfused bovine udder model is appropriate for genetic studies, opening a new perspective in animal experimentation methods.

Helminth fauna of Astyanax fasciatus Cuvier, 1819, in two distinct sites of the Taquari River, São Paulo State, Brazil.

This study assessed the helminth fauna of Astyanax fasciatus in two distinct sites of the Taquari River, São Paulo State, with 30 individuals sampled in a lotic site and 30 in a lentic site, recording the monogeneans: Cacatuocotyle paranaensis, Characithecium costaricensis, Diaphorocleidus kabatai, Jainus sp., Notozothecium sp. and Gyrodactylus sp., the digenean Antorchis lintoni and no-identified metacercariae; the nematode Procamallanus (Spirocamallanus) inopinatus and no-identified larvae. The mean abundances of total monogeneans (U = 1053; p = 0.042) and C. costaricensis (U = 1107; p = 0.005) were higher in the lotic site. This difference may be due to the higher density of the host population in the lotic site, and the water transparence in lentic environments that prevents A. fasciatus to form shoals, precluding the exchange of parasites with direct cycle within a host population. This study is the first report of the helminth fauna of A. fasciatus in the Taquari River, with ten taxa recorded, and reports A. fasciatus as a new host for Notozothecium sp. and C. paranaensis.

Helminth fauna of Astyanax fasciatus Cuvier, 1819, in two distinct sites of the Taquari River, São Paulo State, Brazil / Fauna de helmintos de Astyanax fasciatus Cuvier, 1819, em dois locais distintos do rio Taquari, estado de São Paulo, Brasil

This study assessed the helminth fauna of Astyanax fasciatus in two distinct sites of the Taquari River, São Paulo State, with 30 individuals sampled in a lotic site and 30 in a lentic site, recording the monogeneans: Cacatuocotyle paranaensis, Characithecium costaricensis, Diaphorocleidus kabatai, Jainus sp., Notozothecium sp. and Gyrodactylus sp., the digenean Antorchis lintoni and no-identified metacercariae; the nematode Procamallanus (Spirocamallanus) inopinatus and no-identified larvae. The mean abundances of total monogeneans (U = 1053; p = 0.042) and C. costaricensis (U = 1107; p = 0.005) were higher in the lotic site. This difference may be due to the higher density of the host population in the lotic site, and the water transparence in lentic environments that prevents A. fasciatus to form shoals, precluding the exchange of parasites with direct cycle within a host population. This study is the first report of the helminth fauna of A. fasciatus in the Taquari River, with ten taxa recorded, and reports A. fasciatus as a new host for Notozothecium sp. and C. paranaensis.

Este estudo avaliou a helmintofauna de Astyanax fasciatus em dois trechos distintos no rio Taquari, São Paulo, com 30 indivíduos coletados no trecho lótico e 30 no trecho lêntico, registrando os monogenóides: Cacatuocotyle paranaensis, Characithecium costaricensis, Diaphorocleidus kabatai, Jainus sp., Notozothecium sp. e Gyrodactylus sp., o digenético Antorchis lintoni e metacercárias não identificadas, o nematoide Procamallanus (Spirocamallanus) inopinatus e larvas não identificadas. A abundância média de monogenóides total (U = 1053; p = 0,042) e C. costaricensis (U = 1107; p = 0,005) foi maior no trecho lótico. Esta diferença pode ser devido à densidade mais alta da população de hospedeiros no trecho lótico e à transparência da água em trechos lênticos que previne a formação de cardumes de A. fasciatus e a troca de parasitas com ciclo direto dentro da população de hospedeiros. Este estudo é o primeiro registro da helmintofauna de A. fasciatus no rio Taquari, com dez taxa encontrados, e registra A. fasciatus como novo hospedeiro para os monogenóides Notozothecium sp. e C. paranaensis.

Using ichthyotoxic plants as bioinsecticide: A literature review / Uso de plantas ictiotóxicas como bioinseticida: revisão de literatura

ABSTRACTSome ichthyotoxic plants are study object aiming to discover promising substances in the field of Biotechnology, in search of plant extracts which can be used or even transformed into natural insecticides. This paper presents a bibliographical survey in order to check the traditional use of ichthyotoxic plants as bioinsecticide. Among the plants identified as ichthyotoxic, the most cited in traditional use are those from the genera Derris, Serjania, Lonchocarpus, Magonia, and Tephrosia. The survey suggests that ichthyotoxic plant extracts can contain classes of chemical compounds such as isoflavonoids and tannins with a bioinsecticidal effect and, thus, they can be used in Biotechnology, contributing to reduce the use of synthetic insecticides that present a high toxicity level.

RESUMOUso de plantas ictiotóxicas como bioinseticida: revisão de literatura. Algumas plantas ictiotóxicas são objeto de estudos com a finalidade de descobrir substâncias promissoras no campo da Biotecnologia, na busca de extratos vegetais que possam ser usados ou mesmo transformados em inseticidas naturais. Esse artigo apresenta uma pesquisa bibliográfica sobre o uso tradicional de plantas ictiotóxicas como bioinseticida. Entre as plantas identificadas como ictiotóxicas, as mais citadas no uso tradicional são as dos gêneros Derris, Serjania, Lonchocarpus, Magonia e Tephrosia. A pesquisa sugere que extratos de plantas ictiotóxicas podem conter classes de compostos químicos, como isoflavonoides e taninos, com efeito bioinseticida e, assim, podem ser usados na Biotecnologia, contribuindo na redução do uso de inseticidas sintéticos que possuem alto nível de toxicidade.

First record of an epibiont protozoan Epistylis sp. (Ciliophora, Peritrichia) attached to Ergasilus chelangulatus (Ergasilidae) in Brazil.

In the present paper, we described the first record of an epibiont protozoan Epistylis sp. Ehrenberg, 1830 (Ciliophora, Peritrichia) attached to Ergasilus chelangulatus Thatcher and Brasil-Sato, 2008, parasite of Pimelodus maculatus Lacépède, 1803 in Brazil, with electron microscope observations. Fish were collected in Veados River, state of São Paulo and the crustacean Ergasilus chelangulatus being registered for the first time in this river, expanding its geographical distribution in Brazil.

First record of an epibiont protozoan Epistylis sp. (Ciliophora, Peritrichia) attached to Ergasilus chelangulatus (Ergasilidae) in Brazil / Primeiro registro do protozoário epibionte Epistylis sp. (Ciliophora, Peritrichia) aderido à Ergasilus chelangulatus (Ergasilidae) no Brasil

In the present paper, we described the first record of an epibiont protozoan Epistylis sp. Ehrenberg, 1830 (Ciliophora, Peritrichia) attached to Ergasilus chelangulatus Thatcher and Brasil-Sato, 2008, parasite of Pimelodus maculatus Lacépède, 1803 in Brazil, with electron microscope observations. Fish were collected in Veados River, state of São Paulo and the crustacean Ergasilus chelangulatus being registered for the first time in this river, expanding its geographical distribution in Brazil.

No presente trabalho nós descrevemos o primeiro registro de um protozoário epibionte Epistylis sp. Ehrenberg, 1830 (Ciliophora, Peritrichia) aderido à Ergasilus chelangulatus Thatcher e Brasil-Sato, 2008, parasito de Pimelodus maculatus Lacépède, 1803 no Brasil, com observações de microscopia eletrônica. Os peixes foram coletados no Rio dos Veados, estado de São Paulo e o crustáceo Ergasilus chelangulatus está sendo registrado pela primeira vez neste rio, ampliando sua distribuição geográfica no Brasil.

Food preferences of middle aged and elderly subjects in a Brazilian city.

OBJECTIVES: The objectives of this study were to assess data on the consumption frequency of some food items and the places they are purchased, especially by adults and elderly subjects, and finally to determine their food preference using cluster and correspondence analyses as a diagnosis and prevention factor. DESIGN: Cross-sectional study. SETTING: Town of Serranópolis do Iguaçú, State of Paraná, Brazil, city with 4,854 inhabitants of which 22% are over 50 years old. PARTICIPANTS: Two hundred and ninety five randomly selected subjects (96 men and 199 women), between 51 and 91 years old. MEASUREMENTS: A socio-demographic and food frequency questionnaire was applied via home visits including questions on socioeconomic, anthopometric and health characteristics concerning the consumption frequency of 45 food items and the places they were purchased, using a five point category scale to obtain consumption data as well. The body mass index (BMI) was calculated using the Quetelet Index and compared with the World Health Organization Report Consultation on obesity. The cluster and correspondence statistical analysis were used to determine their food preference. RESULTS: From the correspondence mapping (which explained 89.1 % of the variance), it was possible to determine aspects regarding the non-consumption of instant soups, frozen vegetables, cookies, crystallized fruits, canned fruit, distilled drinks and beer. CONCLUSIONS: The dimensional representation structure demonstrated that the population of Serranópolis, who were 62 % overweight, preferred high fat content products, suggesting a reevaluation of their eating habits in the expectation of preventing non transmissible chronic diseases. The value given to farm production in Serranópolis do Iguaçú was also observed.

Cytotoxicity and expression of genes involved in the cellular stress response and apoptosis in mammalian fibroblast exposed to cotton cellulose nanofibers.

Cellulose nanofibers (CNF) have mechanical properties that make them very attractive for applications in the construction of polymeric matrices, drug delivery and tissue engineering. However, little is known about their impact on mammalian cells. The objective of this study was to evaluate the cytotoxicity of CNF and their effect on gene expression of fibroblasts cultured in vitro. The morphology of CNF was analyzed by transmission electron microscopy and the surface charge by Zeta potential. Cell viability was analyzed by flow cytometry assay and gene expression of biomarkers focused on cell stress response such as Heat shock protein 70.1 (HSP70.1) and Peroxiredoxin 1 (PRDX1) and apoptosis as B-cell leukemia (BCL-2) and BCL-2 associated X protein (BAX) by RT-PCR assay. Low concentrations of CNF (0.02-100 µg ml(-1)) did not cause cell death; however, at concentrations above 200 µg ml(-1), the nanofibers significantly decreased cell viability (86.41 ± 5.37%). The exposure to high concentrations of CNF (2000 and 5000 µg ml(-1)) resulted in increased HSP70.1, PRDX1 and BAX gene expression. The current study concludes that, under the conditions tested, high concentrations (2000 and 5000 µg ml(-1)) of CNF cause decreased cell viability and affect the expression of stress- and apoptosis-associated molecular markers.

The occurrence of Austrodiplostomum compactum (Lutz, 1928) (Digenea: Diplostomidae) metacercariae in the eyes of loricariid fish (Siluriformes: Osteichthyes: Loricariidae) from Brazil.

The aim of this study was to report the occurrence of Austrodiplostomum compactum metacercariae in the eyes of 98 specimens of loricariid fish (Hypostomus ancistroides, H. hermanni, H. iheringii, H. margaritifer, H. regani, H. strigaticeps, Hypostomus sp. and Megalancistrus parananus) from the Chavantes reservoir (23°07'36″S and 49°37'35″W) located in the rio Paranapanema, upper Paraná river basin, municipality of Ipaussu, São Paulo State, Brazil. Fish were collected from October 2007 to February 2009 using nylon monofilament gill nets and transported to the field laboratory where they were euthanized and the eyes were taken and examined under a stereomicroscope. Hypostomus ancistroides and M. parananus were not infected by this diplostomid. Hypostomus hermanni and H. margaritifer were represented by only one specimen but both had a high intensity of A. compactum metacercarie (27 and 35, respectively). Hypostomus strigaticeps (n = 45) and H. iheringii (n = 28) were the most representative specimens and the prevalence, mean intensity of infection and mean abundance were 24.4%, 10.3 and 2.7, and 64.2%, 13.1 and 8.4, respectively. No correlation was observed between the intensity of infection and the standard length (r = - 0.223; P = 0.827) and weight (r = 0.03; P = 0.779) of studied fish. Similarly, linear regression among these variables showed a poor correlation and indicated that the infection by A. compactum metacercariae occurs similarly in small and large fish specimens. A seasonal pattern of infection was not observed. Hypostomus hermanni, H. iheringii, H. margaritifer and H. strigaticeps were new hosts recorded for A. compactum metacercariae. A review of morphometric data of A. compactum metacercariae is presented.

Bronchoalveolar lavage findings in pulmonary paracoccidioidomycosis.

Bronchoalveolar fluid cytology from six progressive pulmonary paracoccidioidomycotic patients showed an alveolitis of neutrophilic pattern which was independent of the of the duration of the chronic fungal disease. The percentage of neutrophils in paracoccidioidomycotic alveolitis was higher than in other neutrophilic alveolitis conditions.