Patterns and Risk Factors for Rehospitalizations Within the First 90 Days Following Discharge After Heart Transplantation.

BACKGROUND: Heart transplantation (HT) recipients are at risk for urgent rehospitalizations following discharge. However, data on prevalence, risk factors and clinical outcomes associated with post-HT rehospitalization are limited. METHODS: This study aims to describe patterns of urgent rehospitalizations in HT recipients at a cardiology reference center in Brazil. Rehospitalizations and deaths occurring within the first 90 days following hospital discharge were identified. Regression models were used to identify variables associated with urgent rehospitalizations. RESULTS: A total of 239 patients were included. Of those, 118 (49.4%) presented with a rehospitalization within 90 days following hospital discharge and 5 (2.01%) died. Most patients who were rehospitalized had one new hospital admission (86.0%). The main cause of urgent rehospitalization was infection (55.0%). In the multivariate analysis, elevated C-reactive protein at discharge and the occurrence of intracranial bleeding at index hospitalization were associated with an increased risk of readmission. Longer duration of index hospitalization and use of lower doses of azathioprine were associated with a lower risk of rehospitalization. CONCLUSION: Around half of HT recipients were rehospitalized within the first 90 days after hospital discharge. Understanding factors associated with post-HT rehospitalization may help the implementation of strategies to avoid patient morbidity and hospital costs.

Acute myeloid leukemia with neutrophilic differentiation in a 12-year-old African lion (Panthera leo).

OBJECTIVE: To describe the clinical presentation, progression, and diagnosis of acute myeloid leukemia (AML) with neutrophilic differentiation in an African lion (Panthera leo). ANIMAL: A 12-year-old male African lion kept at a zoological institution in Colombia. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The lion presented for anorexia, pale mucous membranes, and a hind limb lameness of acute onset. Feline leukemia virus testing was negative, and repeated blood samples revealed severe anemia, intermittent thrombocytopenia, lymphopenia, and neutrophilia. Coinfection with Anaplasma and Mycoplasma spp and chronic kidney disease were diagnosed based on clinicopathological findings. TREATMENT AND OUTCOME: The lion received symptomatic treatment, doxycycline, and methylprednisolone or prednisolone. Euthanasia was elected due to clinical deterioration and unresponsive anemia, despite the resolution of Anaplasma and Mycoplasma spp infections. AML with neutrophilic differentiation was diagnosed based on bone marrow cytology, histopathology, and immunohistochemistry. CLINICAL RELEVANCE: AML is a rare, aggressive hematopoietic disorder in domestic cats, although it has not yet been reported in nondomestic cats. This is the first description of the clinicopathological, histological, and immunohistochemical features of AML with neutrophilic differentiation in an FeLV-negative African lion that lacked circulating blasts.

Tratamiento de la fibrilación auricular en el servicio de urgencias: una revisión práctica de la literatura / Atrial fibrillation treatment in the emergency room: a practical narrative review

Resumen La fibrilación auricular es la arritmia cardíaca más frecuente del mundo y, de igual manera, es la arritmia predominante en los servicios de urgencias. Cada vez hay más prevalencia de esta enfermedad y, en consecuencia, mayores probabilidades de que los médicos en los servicios de urgencias se enfrenten a ella. Las estrategias de tratamiento estándar de la fibrilación auricular suelen ser "conservadoras" y tradicionalmente han sido el control de la frecuencia, la anticoagulación y la hospitalización. La principal motivación de este tipo de estrategia es prevenir el accidente cerebrovascular. Cuando pasa el tiempo y se produce remodelado atrial, la fibrilación auricular es cada vez más refractaria a la conversión al ritmo sinusal y cuanto más tiempo persiste y el daño cardíaco estructural aumenta, más se incrementa la duración de la fibrilación auricular. Así, en el servicio de urgencias, el manejo adecuado de un primer episodio o de una complicación, puede minimizar costos y reducir exposiciones innecesarias a terapias inadecuadas. Esta revisión aborda el manejo de la fibrilación auricular en el servicio de urgencias con base en la evidencia que se tiene disponible en el momento.

Abstract Atrial fibrillation is the most common arrhythmia, in emergency rooms and around the globe. Its frequency is constantly increasing and the likelihood of a physician encountering it at any time is high. Usual treatment approaches are "conservative", traditionally including heart rate control, anticoagulation and hospitalization. The main goal with this approach is stroke prevention. As time goes by, atrial remodeling takes place and the chance to restore sinus rhythm decreases. A longer time in atrial fibrillation leads to more structural heart disease. Thus, adequate management in the emergency room for an initial or complicated episode reduces the risk of inadequate therapies and healthcare costs. This review will focus on atrial fibrillation in the emergency room according to current evidence.

Helicobacter pylori virulence genotypes in Bogotá River and wastewater treatment plants in Colombia.

BACKGROUND: Helicobacter pylori is a bacterium that infects 70%-80% of the population in Colombia, causing chronic gastritis in all those infected and gastric cancer in 1%-2% of those infected. In Colombia, some studies have identified the presence of vacA and cagA genes in environmental samples such as treated, surface, and wastewater, but they have not been evaluated in the Bogotá River. For this, the aim of this study was to identify the virulence genotypes of H. pylori present in samples from the Bogotá River and domestic wastewater treatment plants (WWTPs). MATERIALS AND METHODS: A total of 75 water samples (51 from the Bogotá River and 24 from wastewater treatment plants) were collected. The presence of H. pylori DNA and its virulence genotypes was determined by polymerase chain reaction (PCR). RESULTS: The presence of H. pylori DNA was demonstrated in 44% (33/75) of the samples, obtaining 63.6% (21/33) from the Bogotá River and 36.4% (12/33) from the WWTPs. The most prevalent H. pylori genotype was cagA (-) and vacAm1/s1/i1 being the most virulent of the vacA gene. CONCLUSIONS: This is the first study in Colombia that determines the cagA and vacA genotypes in surface water and WWTPs, indicating the circulation of virulent genotypes in the population. The presence of this pathogen in the waters can be represent a risk to the health of the surrounding population since these waters are reused by the communities for different purposes.

Aminas Biógenas encontradas en carnes, pescado y productos cárnicos: formación y efectos en la salud / Update on biogenic amines present in meat, fish, and fermented meat products: formation, health effects, detection methods, and reduction strategies

Introducción: las aminas biógenas (AB) son compuestos nitrogenados que pueden formarse en carnes, pescados y productos cárnicos fermentados, por acción de microorganismos como bacterias ácido-lácticas, Enterobacteriaceae, Enterococci, Staphylococcus spp., Pseudomonas y otros, principalmente mediante descarboxilación enzimática. Altas concentraciones indican deterioro de la calidad del alimento y se relacionan con efectos nocivos para la salud. Lo anterior, ha generado la necesidad de desarrollar métodos de detección rápida, económica y sencilla, que demuestre la importancia de establecer las cantidades máximas de cada AB permitidas y a su vez genere la necesidad de desarrollar estrategias que permitan la inhibición y/o reducción de su formación. Objetivo: Mostrar información actualizada sobre el contenido de AB en carnes, pescados y productos cárnicos fermentados, los microorganismos principales que intervienen en su formación, el efecto del consumo para la salud, los métodos de detección y las estrategias actuales para prevenir su formación. Metodología: se realizó una búsqueda bibliográfica en ScienceDirect, Scielo, PubMed, SpringerLink y Clinicalkey. Se seleccionaron artículos en español e inglés publicados entre los años 2018-2023. Resultados: el consumo excesivo de AB tiene efectos nocivos para la salud que incluyen intoxicaciones, crisis hipertensivas, citotoxicidad in vitro y formación de compuestos cancerígenos; sin embargo, las regulaciones que determinan las cantidades máximas permitidas de AB en alimentos son limitadas. Debido a esto, surge la necesidad de desarrollar métodos rápidos, sensibles, asequibles y económicos para su detección, como biosensores enzimáticos y nanoenzimas; además, cobran relevancia los métodos para reducir su formación con resultados prometedores tras el uso de algunos compuestos bioactivos y cultivos iniciadores.

Introduction: Biogenic amines (BA) are nitrogenous compounds that can form in meat, fish, and fermented meat products due to the enzymatic decarboxylation caused by microorganisms like lactic acid bacteria, Enterobacteriaceae, Enterococci, Staphylococcus spp, Pseudomonas, among others. High concentrations of BA indicate food deterioration and are associated with adverse health effects. Therefore, there is a need to develop rapid, affordable, and simple detection methods to establish the maximum allowable amounts of each BA. Additionally, strategies for inhibiting and reducing its formation are necessary. Objective: The objective is to present updated information about the content of BA in meat, fish, and fermented meat products, identify the main microorganisms involved in their formation, explore the effects of consumption on health, review current detection methods, and evaluate the current strategies for preventing their formation. Methodology: A bibliographic search on various databases including ScienceDirect, Scielo, PubMed, SpringerLink, and Clinicalkey was conducted. Articles published in Spanish and English between 2018-2023 were selected for analysis. Results: Excessive consumption of BA has harmful health effects including poisoning, hypertensive crises, in vitro cytotoxicity, and carcinogenic compounds formation. However, regulations on the maximum allowable concentrations of BA in food are limited. Therefore, it is necessary to develop fast, sensitive, affordable, and economical detection methods, such as enzymatic biosIntroduction: Biogenic amines (BA) are nitrogenous compounds that can form in meat, fish, and fermented meat products due to the enzymatic decarboxylation caused by microorganisms like lactic acid bacteria, Enterobacteriaceae, Enterococci, Staphylococcus spp, Pseudomonas, among others. High concentrations of BA indicate food deterioration and are associated with adverse health effects. Therefore, there is a need to develop rapid, affordable, and simple detection methods to establish the maximum allowable amounts of each BA. Additionally, strategies for inhibiting and reducing its formation are necessary. Objective: The objective is to present updated information about the content of BA in meat, fish, and fermented meat products, identify the main microorganisms involved in their formation, explore the effects of consumption on health, review current detection methods, and evaluate the current strategies for preventing their formation. Methodology: A bibliographic search on various databases including ScienceDirect, Scielo, PubMed, SpringerLink, and Clinicalkey was conducted. Articles published in Spanish and English between 2018-2023 were selected for analysis. Results: Excessive consumption of BA has harmful health effects including poisoning, hypertensive crises, in vitro cytotoxicity, and carcinogenic compounds formation. However, regulations on the maximum allowable concentrations of BA in food are limited. Therefore, it is necessary to develop fast, sensitive, affordable, and economical detection methods, such as enzymatic biosensors and nanoenzymes. Furthermore, strategies to reduce BA formation are promising, with the use of certain bioactive compounds and starter cultures showing positive resultsensors and nanoenzymes. Furthermore, strategies to reduce BA formation are promising, with the use of certain bioactive compounds and starter cultures showing positive results.

O enfermeiro no processo de captação de coração e pulmão em um centro transplantador / La enfermera en el proceso de captura de corazón y pulmón en un centro de trasplantes / The nurse's performance in the heart and lung capture process in transplantation center

Objetivo:Descrever as atividades implementadas pelo enfermeiro no processo de captação de coração e pulmão em um centro transplantador brasileiro e sua implicação no aumento do número de transplantes realizados. Métodos: Estudo descritivo e observacional, com foco no organograma instituído sobre as atividades do enfermeiro para avaliação e o aceite do doador. Resultados:Com a formação da unidade, exclusivamente dedicada ao processo captação/transplante, houve entre os meses de agosto de 2013 e dezembro de 2021, um aumento de 138,18% na realização de transplantes cardíacos adultos, 76,54% nos transplantes pediátricos e/ou cardiopatias congênitas e 63,22% nos procedimentos de pulmão,quando comparado ao mesmo período dos anos anteriores.Conclusão: O estudo descreve pela primeira vez a importância da atuação do enfermeiro na implementação de um programa de transplantes de sucesso e como suas ações contribuíram para o aumento do número de procedimentos realizados e podem servir de modelo para outros centros.(AU)

Objective: To describe the activities performed by nurses in the heart and lung harvesting process in a Brazilian transplant center and their implication in the increase in the number of transplants performed. Methods: Descriptive and observational study, focusing on the organizational chart established on the activities of nurses for the evaluation and acceptance of the donor. Results: With the formation of the unit, exclusively dedicated to the capture/transplantation process, between August 2013 and December 2021, there was an increase of 138.18% in adult heart transplants, 76.54% in pediatric transplants and/ or congenital heart disease and 63.22% in lung procedures, when compared to the same period in previous years. Conclusion: The study describes for the first time the importance of nurses' performance in the implementation of a successful transplant program and how their actions contributed to the increase in the number of procedures performed and can serve as a model for other centers.(AU)

Objetivo: Describir las actividades realizadas por enfermeros en el proceso de extracción de corazón y pulmón en un centro de trasplante brasileño y su implicación en el aumento de trasplantes realizados. Métodos: Estudio descriptivo y observacional, con foco en el organigrama establecido sobre las actividades de los enfermeros para la evaluación y aceptación del donante. Resultados: Con la formación de la unidad, dedicada exclusivamente al proceso de captación/trasplante, entre agosto de 2013 y diciembre de 2021, hubo un aumento del 138,18% en trasplantes cardíacos adultos, 76,54% en trasplantes pediátricos y/o cardiopatías congénitas y 63,22% % en procedimientos pulmonares, en comparación con años anteriores. Conclusión: El estudio describe por primera vez la importancia de la actuación de los enfermeros en la implementación de un programa de trasplante exitoso y cómo sus acciones contribuyeron para el aumento del número de procedimientos realizados y pueden servir de modelo para otros centros.(AU)

Cecropia pachystachya Trécul: a promising ingredient for skin-whitening cosmetics

Abstract Because it promotes the lightening of pigment spots, tyrosinase inhibition is one of the mechanisms of depigmenting cosmetic products. Considering the adverse effects produced by synthetic depigmenting actives, the search for new therapeutic options is desirable, and plant extracts are possible candidates for hyperpigmentation treatment. Glycolic extracts of Cecropia pachystachya Trécul are, therefore, the focus of this study. Its chemical characterization, antioxidant activity, tyrosinase inhibition, and cell viability were evaluated. Glycolic extracts were obtained by macerating the leaves of C. pachystachya in grain alcohol and glycerin or propylene glycol. Both had a similar chemical constitution, the glycerin being more efficient in concentrating phenolic compounds and flavonoids. Analyses by UHPLC-MS detected quinic acid, chlorogenic acid isomers, proanthocyanidin dimers type B and C, catechin/epicatechin, orientin/isoorientin, isoorientin 2"-O-xyloside, vitexin/isovitexin, and rutin. 5-O-caffeoylquinic acid was then quantified was then quantified, with predominance in the extract produced with propylene glycol. These extracts showed a high antioxidant capacity by the method of DPPH, ß-carotene, and nitric oxide. As for depigmenting activity, both extracts were able to inhibit tyrosinase. Cell viability assay also revealed that the extracts could safely be used in concentrations of ≤ 125 µg/mL. Thus, this study demonstrated for the first time that the glycolic extracts of C. pachystachya have promising chemical and biological characteristics for the development of a multifunctional cosmetic with antioxidant and tyrosinase-inhibition activities

Effect of probiotic, prebiotic, and synbiotic on the gut microbiota of autistic children using an in vitro gut microbiome model.

Imbalances in gut microbiota composition occur in individuals with autism spectrum disorder (ASD). The administration of probiotics, prebiotics, and synbiotics is emerging as a potential and promising strategy for regulating the gut microbiota and improving ASD-related symptoms. We first investigated the survival of the probiotics Limosilactobacillus (L.) reuteri and Bifidobacterium (B.) longum alone, mixed and combined with a galacto-oligosaccharide (GOS) under simulated gastrointestinal conditions. Next, we evaluated the impact of probiotics (L. reuteri + B. longum), prebiotic (GOS), and synbiotic (L. reuteri + B. longum + GOS) on gut microbiota composition and metabolism of children with ASD using an in vitro fermentation model (SHIME®). The combination of L. reuteri, B. longum, and GOS showed elevated gastrointestinal resistance. The probiotic, prebiotic, and synbiotic treatments resulted in a positive modulation of the gut microbiota and metabolic activity of children with ASD. More specifically, the probiotic treatment increased the relative abundance of Lactobacillus, while the prebiotic treatment increased the relative abundance of Bifidobacterium and decreased the relative abundance of Lachnoclostridium. Changes in microbial metabolism were associated with increased short-chain fatty acid concentrations and reduced ammonium levels, particularly in the prebiotic and synbiotic treatments.

Adjusting RT-qPCR conditions to avoid unspecific amplification in SARS-CoV-2 diagnosis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 and quickly spread around the world, forcing global health authorities to develop protocols for its diagnosis. Here we report dimer formation in the N2 primers-probe set (CDC 2019-nCoV Real-Time RT-PCR) used in the diagnostic routine, and propose alternatives to reduce dimerization events. Late unspecific amplifications were visualized in 56.4% of negative samples and 57.1% of no-template control, but not in positive samples or positive control. In silico analysis and gel electrophoresis confirmed the dimer formation. The RT-qPCR parameters were optimized and the late unspecific amplifications decreased to 11.5% in negative samples and no-template control. The adjustment of PCR parameters was essential to reduce the risk of false-positives results and to avoid inclusive results requiring repeat testing, which increases the costs and generates delays in results or even unnecessary requests for new samples.

Preclinical studies indicate that INFLATIV, an herbal medicine cream containing Pereskia aculeata, presents potential to be marketed as a topical anti-inflammatory agent and as adjuvant in psoriasis therapy.

OBJECTIVES: A previous study reported that the hexane fraction (HF) obtained from Pereskia aculeata leaves showed promising topical anti-inflammatory activity. Intending its future use in clinical practice, a herbal medicine cream named INFLATIV was developed. Its anti-inflammatory and antipsoriatic potential were investigated. INFLATIV was subjected to preliminary accelerated stability tests and to a degradation profile assessment. METHODS: INFLATIV was prepared at 6% and 12%. The anti-inflammatory activity was assessed by croton oil single and multiple application challenge in mice. Mouse tail test was used for antipsoriatic potential investigation. Cutaneous atrophy test was performed. Preliminary accelerated stability tests were performed together with a degradation profile by GC-MS analysis. KEY FINDINGS: The anti-inflammatory activity shown by INFLATIV was comparable to dexamethasone. However, the skin atrophy caused by that drug was not observed. INFLATIV modified skin parakeratotic differentiation into orthokeratosis, which revealed its antipsoriatic potential. The ingredients used were suitable to carry the bioactives as they were well permeated by the skin. The preliminary accelerated stability tests indicated that INFLATIV 6% is more stable than 12%. CONCLUSIONS: The results demonstrated the relevant therapeutic and marketing potentials of INFLATIV, which is likely to be further evaluated in clinical trials for drug registration process with regulatory agencies.

Estudio observacional de la microbiota intestinal aeróbica / Observational study of the aerobic gut microbiota

El ecosistema microbiano asociado al intestino es el más diverso y complejo, en el ser humano cambia durante las diferentes etapas de la vida. La pérdida del equilibrio de este ecosistema intestinal se conoce como disbiosis. Establecer la posible relación entre la disbiosis aeróbica con diversas enfermedades de interés clínico encontradas. Se estudiaron 377 casos de disbiosis con diferentes patologías como trastorno del espectro autista (TEA), enfermedad inflamatoria intestinal, alergias, intolerancia alimentaria, entre otras; y un grupo control de 497 personas aparentemente sanas. Para el análisis de la información se utilizaron las pruebas de T de Student y regresión logística multinominal, ajustadas a un intervalo de confianza del 95%. Hubo variabilidad en el crecimiento de la microbiota benéfica del grupo de casos de disbiosis respecto al grupo control (p<0,001). La microbiota transitoria causante de disbiosis estuvo conformada principalmente por cocos grampositivos: Streptococcus grupo viridans, Enterococcus faecium y Enterococcus gallinarum; bacilos gramnegativos: Klebsiella pneumoniae, complejo Enterobacter cloacae y Klebsiella oxytoca y especies de Candida albicans, Candida tropicalis y complejo Candida parapsilosis. La población más susceptible con disbiosis fueron niños con edades comprendidas entre 2 y 6 años. Los TEA y la intolerancia alimentaria estuvieron asociados significativamente con la disbiosis (p<0,05)

The microbial ecosystem associated with the intestine is the most diverse and complex in the human being, since it changes during the different stages of life. Losing balance of this intestinal ecosystem is known as dysbiosis. To establish the possible relationship between aerobic dysbiosis and diseases of clinical interest found. Three hundred and seventy-seven (377) cases of dysbiosis with different pathologies such as autism spectrum disorder (ASD), inflammatory bowel disease, allergies, food intolerance, among others; and a control group of 497 apparently healthy people, were studied. For the analysis of the information, multinomial logistic regression and Student's t tests were used, adjusted to a 95% confidence interval. The growth of beneficial microbiota showed variability in the dysbiosis case group compared to the control group (p <0.001). The transient microbiota causing dysbiosis was mainly made up of gram-positive cocci: Streptococcus viridans group, Enterococcus faecium and Enterococcus gallinarum; gram-negative bacilli: Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella oxytoca and Candida albicans, Candida tropicalis and Candida parapsilosis complex species. The most susceptible population with dysbiosis was children aged between 2 and 6 years. The ASD and food intolerance were significantly associated with dysbiosis (p <0.05)

Modulation of the intestinal microbiota and the metabolites produced by the administration of ice cream and a dietary supplement containing the same probiotics.

The aim of the present work was to compare the capacity to modulate the intestinal microbiota and the production of metabolites after 14 d administration of a commercial dietary supplement and a manufactured ice cream, both containing the same quantity of inulin and the same viable counts of Lactobacillus acidophilus LA-5 and Bifidobacterium animalis BB-12, using the Simulator of the Human Intestinal Microbial Ecosystem (SHIME®) model. Samples of the colonic contents were evaluated microbiologically by real-time quantitative PCR (qRT-PCR) and next-generation sequencing and chemically by the production of SCFA (acetate, propionate and butyrate) and ammonium ions ($\text{NH}_4^ + $). Statistical analyses were carried out for all the variables using the two-way ANOVA followed by the Tukey multiple comparisons test (P < 0·05) for metabolite production, qRT-PCR and the bioinformatics analysis for microbiota diversity. Dietary supplement and ice cream were able to deliver the probiotic L. acidophilus and B. animalis to the simulated colon and modulate the microbiota, increasing beneficial micro-organisms such as Bifidobacterium spp., Bacteroides spp. and Faecalibacterium spp. for dietary supplement administration, and Lactobacillus spp. for ice cream supplementation. However, the ice cream matrix was probably more favourable for the maintenance of the metabolic activity of the probiotics in the SHIME® model, due to the larger amounts of acetate, propionate, butyrate and ammonium ions obtained after 14 d of supplementation. In conclusion, both ways of probiotic supplementation could be efficient, each with its own particularities.

Hemophagocytic Lymphohistiocytosis in Autopsied Adults: Clinical, Laboratory and Immunohistochemical Evaluation for CD68 and CD57. Case Report and Literature Review / Linfohistiocitose Hemofagocítica em Adultos Autopsiados: Avaliação Clínica, Laboratorial e Imunohistoquímica para CD68 e CD57. Relato de Caso e Revisão de Literatura

Hemophagocytic lymphohistiocytosis (HLH) is a rare, usually fatal and underdiagnosed autoimmune-activated disease. The present study aimed to perform a macroscopic, histopathological and immunohistochemical evaluation for CD68 and CD57 in organs of autopsied adults with HLH. A total of 604 autopsy reports were analyzed, and all the patients that filled the diagnostic criteria for HLH (n = 2) were selected. These patients were 18 and 37 years old. Were evaluated both clinical and autopsy reports and performed histopathological and immunohistochemical analysis of the liver and spleen. Both patients filled the diagnostic criteria for HLH, as well as presented common signs and symptoms of this disease, such as chills, abdominal pain, diaphoresis, and jaundice. Hemophagocytosis was observed in the spleen, bone marrow, and lymph nodes of the two patients at autopsy. Immunostaining in the liver and spleen of both patients was mainly severe for CD68, and predominantly mild for CD57, indicating a decrease in NKC numbers and an increase in the number of macrophages, respectively. This was the first study to evaluate CD57 and CD68 in autopsies of adults with HLH. Thus, more studies are required, not only to better elucidate the pathogenetic mechanisms involved in the secondary HLH, but also to disseminate the results in the clinical environment, contributing to the early diagnosis and treatment with consequent reduction of mortality rate. (AU)

A Linfohistiocitose Hemofagocítica (HLH) é uma doença autoimune rara, geralmente fatal e subdiagnosticada. Este estudo tem como objetivo realizar avaliação macroscópica, histopatológica e imunohistoquímica para CD68 e CD57 em órgãos de pacientes adultos com HLH submetidos a autópsia. Um total de 604 laudos de autópsias foram analisados e todos os pacientes que preencheram os critérios diagnósticos para HLH (n = 2) foram selecionados. Esses pacientes tinham 18 e 37 anos de idade. Foram analisados tanto os prontuários quanto os laudos de autópsia, bem como foram realizadas análises histopatológicas e imunohistoquímicas do fígado e baço dos pacientes. Ambos preencheram os critérios diagnósticos para HLH e apresentarem sinais e sintomas comuns da doença, como calafrios, dor abdominal, sudorese e icterícia. A hemofagocitose foi observada no baço, medula óssea e linfonodos dos dois pacientes na autópsia. A imunohistoquímica do fígado e do baço de ambos os pacientes demonstrou imunomarcação acentuada para CD68 e predominantemente discreta para CD57, que indicam diminuição do número de NKC e aumento do número de macrófagos, respectivamente. Este foi o primeiro estudo a avaliar o CD57 e CD68 em autópsias de adultos com HLH. Assim, mais estudos são necessários, não apenas para melhor elucidar os mecanismos patogenéticos envolvidos na HLH secundária, mas também para disseminar os resultados no ambiente clínico, contribuindo para o diagnóstico e tratamento precoces com consequente redução da taxa de mortalidade. (AU)

Avaliação de uma coorte de transplante cardíaco por escore relacionado ao doador / Assessment of a heart transplantation cohort using a donor-related scoring system

Existem poucos sistemas de avaliação de mortalidade após transplante cardíaco (TC) que se baseiem em fatores relacionados com o doador e que sejam capazes de predizer o prognóstico. Identificar características dos doadores que têm impacto na sobrevida depois do TC pode contribuir para melhorar os resultados e a alocação de órgãos. Aplicamos um sistema de avaliação americano para predizer a mortalidade pós-TC em uma coorte brasileira. Objetivo: Avaliar um escore americano como preditor de mortalidade depois de TC em uma coorte brasileira. Métodos: Análise de uma base de dados de um centro de TC brasileiro de 2013 a 2015. Foram avaliadas quatro características dos doadores: tempo de isquemia, idade do doador, discordância racial doador/receptor e a função renal do doador. A sobrevida foi estimada pelo teste de log-rank em faixas de pontuação pré-determinadas. Resultados: Foram 110 doadores, 89% homens e 62% brancos. A principal causa de morte foi trauma (66,6%). Os doadores tinham em média 29,8 anos, 18,6 de relação Nitrogênio da ureia sanguínea / Creatinina, 175 minutos de tempo de isquemia e 42% de discordância racial com o receptor. Não houve diferença de sobrevida entre as faixas de pontuação. Conclusão: Apesar de preditor de mortalidade após transplante cardíaco em uma população americana, esse escore não foi útil para uma coorte de transplante brasileira. As diferenças, inclusive a alta taxa de miscigenação pode ser uma explicação para esses achados

here are few systems to assess mortality after heart transplantation (CT) that are based on donor-related factors and can predict prognosis. Identifying donor characteristics that impact post-CT survival can contribute to improved outcomes and organ allocation. We applied a US evaluation system to predict mortality after CT in a Brazilian cohort. Objective: To evaluate an American score as a predictor of mortality following CT in a Brazilian cohort. Method: Database analysis of a Brazilian CT center from 2013 to 2015. Four donor characteristics were evaluated: ischemia time, donor age, donor-recipient race mismatch, and donor renal function. Survival was estimated by the log-rank test in predetermined score ranges. Results: There were 110 donors, 89% male and 62% white. The main cause of death was trauma (66.6%). Donors had a mean age of 29.8 years, a mean blood urea nitrogen / creatinine ratio of 18.6, a mean ischemia time of 175 minutes, and race mismatch with the recipient of 42%. There was no difference in survival between the score ranges. Conclusion: Although it was a predictor of mortality after cardiac transplantation in an American population, this score was not useful for a Brazilian transplant cohort. Differences, including the high rate of miscegenation, may explain these findings

Gut microbiome approaches to treat obesity in humans.

The rising worldwide prevalence of obesity has become a major concern having many implications for the public health and the economy. It is well known that many factors such as lifestyle, increased intake of foods high in fat and sugar and a host's genetic profile can lead to obesity. Besides these factors, recent studies have pointed to the gut microbiota composition as being responsible for the development of obesity. Since then, many efforts have been made to understand the link between the gut microbiota composition and obesity, as well as the role of food ingredients, such as pro- and prebiotics, in the modulation of the gut microbiota. Studies involving the gut microbiota composition of obese individuals are however still controversial, making it difficult to treat obesity. In this sense, this mini-review deals with obesity and the relationship with gut microbiota, summarising the principal findings on gut microbiome approaches for treating obesity in humans.

Avaliação histológica do músculo grande dorsal submetido à expansão tecidual pós-infiltração com toxina botulínica: estudo experimental em ratas / Histological evaluation of latissimus dorsi muscle subjected to tissue expansion after infiltration with botulinum toxin: an experimental study in rats

Os autores descrevem as alterações histológicas no músculo grande dorsal submetido à expansão após relaxamento com toxina botulínica e as possíveis correlações dos achados com os benefícios práticos como, por exemplo, aumento da complacência muscular e melhor acomodação da prótese. Foi empregado o modelo experimental, com dez ratas com peso médio de 300 g, mesma faixa etária, da cepa Wistar (Rattus norvegicus) e o músculo grande dorsal. Biópsias musculares foram feitas antes e após as expansões, no músculo normal, no grupo controle (apenas com expansores) e no grupo com expansores e toxina botulínica. Expansores de 3 centímetros cúbicos eram posicionados abaixo do músculo e expandidos com 0,3 mililitros de soro fisiológico semanalmente, por 10 semanas. Os cortes histológicos foram corados segundo as técnicas de Hematoxilina-eosina, para avaliação geral, e tricrômio de Masson para avaliação do tecido conjuntivo. As fibras musculares submetidas à expansão sob a ação da toxina botulínica apresentaram focos de fibrose e proliferação de vasos sanguíneos menos intensos que no grupo sem toxina botulínica e a diminuição do número de fibras musculares e a atrofia eram menores que no grupo que não utilizou a toxina. Os achados nos permitem presumir que a expansão muscular associada ao relaxamento com toxina botulínica preserva as características da musculatura esquelética, oferecendo melhor acomodação e proteção da prótese e facilitando a dinâmica da expansão, além de diminuir a dor.

The authors describe histological changes in the latissimus dorsi muscle submitted to expansion after relaxation with botulinum toxin. The possible practical benefits include increased muscle compliance and better accommodation of a prosthesis. The experimental model involved 10 Wistar rats (Rattus norvegicus) of the same age, with average weight of 300 g. Muscle biopsies before and after expansion were performed in normal muscle, in a control group (with expanders alone), and in a group with expanders and botulinum toxin. Expanders measuring 3 cm3 were positioned below the muscle and expanded with 0.3 ml of saline weekly, for 10 weeks. Histological sections were stained using hematoxylin-eosin for general evaluation and Masson's trichrome for evaluation of connective tissue. The muscle fibers submitted to expansion under the action of botulinum toxin showed less fibrosis and less intense proliferation of blood vessels than in the group without botulinum toxin, and the atrophy and reduction in the number of muscle fibers were less prominent than in the group that did not receive botulinum toxin. The findings suggest that muscle expansion associated with botulinum toxin relaxation preserves skeletal muscle characteristics by providing better accommodation and protection for a prosthesis and facilitating expansion dynamics; this method may also reduce pain.

Cigarette Smoking and its Association with In-Hospital Mortality in Hemorrhagic Stroke Patients / Tabaquismo y su asociación con mortalidad intrahospitalaria en pacientes con ictus hemorrágico

Abstract Backgroud: Smoking is a well-known reversible risk factor associated with acute ischemic stroke (AIS), however, some data showed that in-hospital mortality rates among smoker's patients with hemorrhagic stroke is lower when compared with non-smokers patients. The objective of this analysis was to assess in-hospital patient mortality rate between smokers and non-smokers patients with confirmed diagnosis of hemorrhagic stroke. Methods and Results: We analyzed all the data from patients diagnosed with hemorrhagic stroke that were registered in the Florida Stroke database from 2008-2012. Among the 21,013 patients diagnosed with hemorrhagic stroke, 10.9% of patients were smokers. A Multivariable model was used to estimate the adjusted odds ratio of in-hospital mortality rate in smokers versus non-smokers. Smoking was associated with lower in-hospital mortality in hemorrhagic patients. (UOR= 0.71 vs. AOR= 0.75). Other risk factors like hypertension, BMI>40 and hyperlipidemia, remained significantly associated after modeling, and some others like gender, race, health insurance coverage, and diabetes became insignificant. The difference between unadjusted and adjusted odds ratios for smoking (0.71 versus 0.75) indicates no presence of substantial confounding by age and other control variables. Conclusions: Among patients hospitalized for hemorrhagic stroke, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted analyses probably represents other unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.

Resumen Antecedentes: El fumar es un factor de riesgo tradicional claramente identificado con un mayor riesgo de desarrollar accidente cerebrovascular (ACV). A pesar de existir un riesgo más elevado de desarrollar ACV, algunos reportes han demostrado que pacientes ya hospitalizados con diagnóstico de ACV hemorrágico tienen una mortalidad intrahospitalaria menor a sus pares no fumadores, situación conocida como la paradoja del tabaquismo. El objetivo de este estudio es analizar la mortalidad Intrahospitalaria de Pacientes con Accidente Cerebrovascular Hemorrágico entre aquellos pacientes fumadores versus los no fumadores. Métodos y resultados: Este estudio epidemiológico observacional analítico de casos y controles incluyó a todos los pacientes con diagnóstico de accidente cerebrovascular hemorrágico incluidos en el "Registro de Accidentes Cerebrovasculares de Florida" entre el año 2008 y 2012. Entre los 21.013 pacientes diagnosticados con accidente cerebrovascular hemorrágico, el 10,9% de los pacientes fueron fumadores. Se utilizaron modelos multivariables para estimar la tasa de probabilidad ajustada de mortalidad intrahospitalaria en fumadores versus no fumadores. El tabaquismo se asoció con una menor mortalidad hospitalaria en pacientes hemorrágicos. (UOR = 0,71 frente a AOR = 0,75). Como se observa en las tablas, muchos de los factores de confusión, la hipertensión, IMC> 40, y la hiperlipidemia, tuvieron asociación significativa después del modelamiento estadístico mientras que otros factores como el sexo, la raza, el tipo de seguro de salud y la presencia de diabetes no tuvieron una asociación estadísticamente significativa. La diferencia entre las tasas de probabilidad no ajustadas y ajustadas para el tabaquismo (0,71 frente a 0,75 respectivamente) indica que no hay presencia de factores de confusión sustanciales por edad y otras variables de control. Conclusiones: Entre los pacientes hospitalizados por accidente cerebrovascular hemorrágico, el tabaquismo es un factor de riesgo para el desarrollo del mismo, especialmente en pacientes jóvenes, incluso entre aquellos con pocos factores de riesgo vascular, sin embargo, la asociación persistente con menor mortalidad intrahospitalaria después de los análisis ajustados probablemente represente otra confusión no medida, aunque no se puede excluir un efecto biológico del tabaquismo. Se necesitan más estudios clínicos basados en la población para explorar las variables que contribuyen a los resultados en estos pacientes.

Effects of dimethylsulfoxide and pentoxifylline in the vitality of cutaneous flaps in rats.

OBJECTIVES: to verify the influence of dimethylsulfoxide and pentoxifylline on the vitality of cutaneous flaps in rats and the tissue repair process. METHODS: were studied 30 Wistar rats, submitting them to a 2cm wide by 8cm long dorsal cutaneous flap, of caudal base. We distributed the animals in three groups: Control Group (n=10) with application gauze moistened with 0.9% Saline in the flap bed for 30 seconds; Dimethylsulfoxide group (n=10), with administration of 1ml of 5% dimethylsulfoxide divided into five injections of 0.2ml in the transition of the flap segments; Pentoxifylline group (n=10), with administration of pentoxifylline 20mg/kg, diluted to 1ml and divided into five injections of 0.2ml in the transition of the flap segments. Drugs were administered intraoperatively, in a single dose and subcutaneously. We observed the skin flaps for changes in color and texture. On the 10th postoperative day, we checked the dimensions of viable and necrotic tissues, followed by excision of the specimen for histological analysis. RESULTS: the measurements of length of the viable and necrotic tissues between groups showed no differences. Histological analysis showed that the Dimethylsulfoxide group presented neovascularization, inflammatory infiltrate with leukocytes and more structured conjunctival stroma. The Pentoxifylline group showed neovascularization and inflammatory infiltrate, with moderate to intense granulation. The control group evolved with a higher rate of necrosis in the distal segment. CONCLUSION: dimethylsulfoxide and pentoxifylline influenced the vitality of the flap and the tissue repair process. However, they did not prevent necrosis macroscopically.

Effects of dimethylsulfoxide and pentoxifylline in the vitality of cutaneous flaps in rats / Efeitos do dimetilsulfóxido e da pentoxifilina na vitalidade de retalhos cutâneos em ratos

ABSTRACT Objectives: to verify the influence of dimethylsulfoxide and pentoxifylline on the vitality of cutaneous flaps in rats and the tissue repair process. Methods: were studied 30 Wistar rats, submitting them to a 2cm wide by 8cm long dorsal cutaneous flap, of caudal base. We distributed the animals in three groups: Control Group (n=10) with application gauze moistened with 0.9% Saline in the flap bed for 30 seconds; Dimethylsulfoxide group (n=10), with administration of 1ml of 5% dimethylsulfoxide divided into five injections of 0.2ml in the transition of the flap segments; Pentoxifylline group (n=10), with administration of pentoxifylline 20mg/kg, diluted to 1ml and divided into five injections of 0.2ml in the transition of the flap segments. Drugs were administered intraoperatively, in a single dose and subcutaneously. We observed the skin flaps for changes in color and texture. On the 10th postoperative day, we checked the dimensions of viable and necrotic tissues, followed by excision of the specimen for histological analysis. Results: the measurements of length of the viable and necrotic tissues between groups showed no differences. Histological analysis showed that the Dimethylsulfoxide group presented neovascularization, inflammatory infiltrate with leukocytes and more structured conjunctival stroma. The Pentoxifylline group showed neovascularization and inflammatory infiltrate, with moderate to intense granulation. The control group evolved with a higher rate of necrosis in the distal segment. Conclusion: dimethylsulfoxide and pentoxifylline influenced the vitality of the flap and the tissue repair process. However, they did not prevent necrosis macroscopically.

RESUMO Objetivos: verificar a influência do dimetilsulfóxido e da pentoxifilina na vitalidade e no processo de reparo tecidual de retalhos cutâneos em ratos. Método: foram estudados 30 ratos Wistar, nos quais foi confeccionado retalho cutâneo dorsal de 2cm de largura por 8cm de comprimento, de base caudal, e distribuídos em três grupos: Grupo Controle (n=10) com aplicação de gaze umedecida com solução salina a 0,9%, no leito do retalho, por 30 segundos; Grupo dimetilsulfóxido (n=10) com injeção de 1ml de dimetilsulfóxido a 5% divididos em cinco injeções de 0,2ml na transição dos segmentos do retalho; Grupo pentoxifilina (n=10) com injeção de 1ml pentoxifilina 20mg/kg, divididos em cinco injeções de 0,2ml na transição dos segmentos do retalho. Os fármacos foram administrados no transoperatório, em dose única e por via subcutânea. Os retalhos cutâneos foram observados quanto às alterações de cor e textura. No décimo dia de pós-operatório aferiu-se a dimensão do tecido viável e de necrose, seguido da exérese da peça para análise histológica. Resultados: a medida da dimensão de tecido viável e de necrose dos grupos não apresentou diferenças. A análise histológica mostrou que o grupo dimetilsulfóxido apresentou neovascularização, infiltrado inflamatório com leucócitos e estroma conjuntivo mais estruturado. O grupo pentoxifilina, mostrou neovascularização e infiltrado inflamatório com granulação moderada e intensa. O grupo controle evoluiu com maior índice de necrose no segmento distal. Conclusão: dimetilsulfóxido e pentoxifilina influenciaram na vitalidade do retalho e no processo de reparo tecidual. Entretanto, não evitaram a necrose macroscopicamente.

[Retracted Article] Gastric and jejunal histopathological changes in patients undergoing bariatric surgery / [Artigo Retratado] Alterações histopatológicas gástricas e jejunais em pacientes submetidos à cirurgia bariátrica

ABSTRACT BACKGROUND Morbid obesity is a multifactorial disease that is increasingly treated by surgery. OBJECTIVE To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. METHODS This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. RESULTS In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in Helicobacter pylori infection (P=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. CONCLUSION There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.

RESUMO CONTEXTO A obesidade mórbida é doença multifatorial cujo tratamento cirúrgico é cada vez mais indicado. OBJETIVO Avaliar alterações histopatológicas gástricas em obesos e comparar com os submetidos à bypass gastrojejunal e a mucosa jejunal após a operação. MÉTODOS Estudo observacional realizado em hospital público terciário avaliando biópsias endoscópicas de 36 pacientes no pré-operatório e 35 no pós-operatório. RESULTADOS: No pré-operatório 80,6% apresentaram gastrite crônica, 38,9% em atividade (77,1% e 20,1%, respectivamente, no pós-operatório). O grupo pós-operatório apresentou diminuição significativa na infecção por Helicobacter pylory (P=0,0001). Maior comprimento do coto gástrico e tempo de operação superior a dois anos associaram-se a infecção por Helicobacter pylori. A mucosa jejunal foi normal em 91,4% e apresentava leve inflamação crônica inespecífica em 8,6%. CONCLUSÃO Houve diminuição da infecção por Helicobacter pylori após a operação. Maior comprimento do coto gástrico e do tempo de operação associaram-se à infecção por Helicobacter pylori. A mucosa jejunal foi considerada normal na maioria absoluta dos pacientes do grupo pós-operatório.