Green Synthesis of Er-Doped ZnO Nanoparticles: An Investigation on the Methylene Blue, Eosin, and Ibuprofen Removal by Photodegradation.

We present a study on the green synthesis of undoped and Er-doped ZnO compounds using Mangifera indica gum (MI). A set of tests were conducted to assess the structure of the material. The tests included X-ray diffraction, Raman, and Fourier-transform infrared spectroscopy. Optical properties were studied using diffuse reflectance and photoluminescence. Morphological and textural investigations were done using SEM images and N2 adsorption/desorption. Furthermore, photocatalytic tests were performed with methylene blue (MB), yellow eosin (EY), and the pharmaceutical drug ibuprofen (IBU) under UV irradiation. The study demonstrated that replacing the stabilizing agent with Mangifera indica gum is an effective method for obtaining ZnO nanoparticles. Additionally, the energy gap of the nanoparticles exhibits a slight reduction in value. Photoluminescence studies showed the presence of zinc vacancies and other defects in both samples. In the photocatalytic test, the sample containing Er3+ exhibited a degradation of 99.7% for methylene blue, 81.2% for yellow eosin, and 52.3% for ibuprofen over 120 min. In the presence of methyl alcohol, the degradation of MB and EY dyes is 16.7% and 55.7%, respectively. This suggests that hydroxyl radicals are responsible for the direct degradation of both dyes. In addition, after the second reuse, the degradation rate for MB was 94.08%, and for EY, it was 82.35%. For the third reuse, the degradation rate for MB was 97.15%, and for EY, it was 17%. These results indicate the significant potential of the new semiconductor in environmental remediation applications from an ecological synthesis.

Facile Synthesis of Ni-Doped ZnO Nanoparticles Using Cashew Gum: Investigation of the Structural, Optical, and Photocatalytic Properties.

This work adopted a green synthesis route using cashew tree gum as a mediating agent to obtain Ni-doped ZnO nanoparticles through the sol-gel method. Structural analysis confirmed the formation of the hexagonal wurtzite phase and distortions in the crystal lattice due to the inclusion of Ni cations, which increased the average crystallite size from 61.9 nm to 81.6 nm. These distortions resulted in the growth of point defects in the structure, which influenced the samples' optical properties, causing slight reductions in the band gaps and significant increases in the Urbach energy. The fitting of the photoluminescence spectra confirmed an increase in the concentration of zinc vacancy defects (VZn) and monovacancies (Vo) as Zn cations were replaced by Ni cations in the ZnO structure. The percentage of VZn defects for the pure compound was 11%, increasing to 40% and 47% for the samples doped with 1% and 3% of Ni cations, respectively. In contrast, the highest percentage of VO defects is recorded for the material with the lowest Ni ions concentration, comprising about 60%. The influence of dopant concentration was also reflected in the photocatalytic performance. Among the samples tested, the Zn0.99Ni0.01O compound presented the best result in MB degradation, reaching an efficiency of 98.4%. Thus, the recovered material underwent reuse tests, revealing an efficiency of 98.2% in dye degradation, confirming the stability of the photocatalyst. Furthermore, the use of different inhibitors indicated that •OH radicals are the main ones involved in removing the pollutant. This work is valuable because it presents an ecological synthesis using cashew gum, a natural polysaccharide that has been little explored in the literature.

Piplartine-Inspired 3,4,5-Trimethoxycinnamates: Trypanocidal, Mechanism of Action, and In Silico Evaluation.

Chagas disease (CD) is one of the main neglected tropical diseases that promote relevant socioeconomic impacts in several countries. The therapeutic options for the treatment of CD are limited, and parasite resistance has been reported. Piplartine is a phenylpropanoid imide that has diverse biological activities, including trypanocidal action. Thus, the objective of the present work was to prepare a collection of thirteen esters analogous to piplartine (1-13) and evaluate their trypanocidal activity against Trypanosoma cruzi. Of the tested analogues, compound 11 ((E)-furan-2-ylmethyl 3-(3,4,5-trimethoxyphenyl)acrylate) showed good activity with IC50 values = 28.21 ± 5.34 µM and 47.02 ± 8.70 µM, against the epimastigote and trypomastigote forms, respectively. In addition, it showed a high rate of selectivity to the parasite. The trypanocidal mechanism of action occurs through the induction of oxidative stress and mitochondrial damage. In addition, scanning electron microscopy showed the formation of pores and leakage of cytoplasmic content. Molecular docking indicated that 11 probably produces a trypanocidal effect through a multi-target mechanism, including affinity with proteins CRK1, MPK13, GSK3B, AKR, UCE-1, and UCE-2, which are important for the survival of the parasite. Therefore, the results suggest chemical characteristics that can serve for the development of new trypanocidal prototypes for researching drugs against Chagas disease.

Biomedical informatics: characterization of the offer of massive open online courses. / Informática biomédica: caracterización de la oferta de cursos abiertos masivos en línea.

Introduction: Informatics applied to health sciences has brought cutting-edge solutions to healthcare problems. However, the number of health professionals trained in "Health Informatics" is low. Virtual education, such as massive online open courses, provide the opportunity for training in this field. Objective: To estimate the global offer of massive online open biomedical informatics courses and characterize their content. Methods: A search for massive online open courses was conducted throughout December 2021 on 25 platforms offering these courses. The search strategy included the terms "health informatics" and "biomedical informatics". The application areas of biomedical informatics, platform, institution, duration, time required per week, language, and subtitles available for each course were evaluated. Data were analyzed descriptively, reporting absolute and relative frequencies. Results; Our search strategy identified 1333 massive online open courses. Of these, only 79 were related to health informatics. Most of these courses (n = 44; 55.7%) were offered through Coursera. More than half (n = 55; 69.6%) were conducted by U.S. institutions in english (n = 76; 96.2%). Most courses focused on areas of translational bioinformatics (n = 27; 34.2%), followed by public health informatics (n = 23; 29.1%), and clinical research informatics (n = 13, 16.5%). Conclusions: We found a significant supply of massive online open courses on health informatics. These courses favor the training of more professionals worldwide, mostly addressing competencies to apply informatics in clinical practice, public health, and health research.

Introducción: La informática biomédica ha traído consigo soluciones innovadoras a problemas sanitarios. Sin embargo, el número de profesionales sanitarios capacitados en informática biomédica es bajo. La educación virtual, como los cursos masivos abiertos en línea, brindan la oportunidad de formación en este campo. Objetivo: Estimar la oferta global de cursos masivos abiertos en línea sobre informática biomédica y conocer las características de su contenido. Métodos: Se realizó una búsqueda de cursos masivos abiertos en línea durante diciembre de 2021 en 25 plataformas que ofertan estos cursos. La estrategia de búsqueda incluyó los descriptores "" y "". Se evaluaron las áreas de aplicación de informática biomédica, la plataforma, la institución, la duración, el tiempo requerido por semana, el idioma y los subtítulos disponibles para cada curso. Se analizaron los datos descriptivamente, reportándose frecuencias absolutas y relativas. Resultados: Nuestra estrategia de búsqueda identificó 1333 cursos masivos abiertos en línea. De ellos, solo 79 estaban relacionados con informática de la salud. La mayoría de estos cursos (n = 44; 55,7%) se ofrecieron a través de Coursera. Más de la mitad (n = 55; 69,6%) fueron realizados por instituciones de Estados Unidos y en el idioma inglés (n = 76; 96,2%). La mayor parte de los cursos se centraron en áreas de bioinformática traslacional (n = 27; 34,2%), seguido de informática de la salud pública (n = 23; 29,1%), e informática de la investigación clínica (n = 13; 16,5%). Conclusiones: Se encontró una importante oferta de cursos masivos abiertos en línea sobre informática biomédica. Estos cursos favorecen la formación de más profesionales en todas las regiones del mundo, abordando en su mayoría competencias para aplicar la informática en la práctica clínica, la salud pública y la investigación en salud.

Informática biomédica: caracterización de la oferta de cursos abiertos masivos en línea / Biomedical informatics: characterization of the offer of massive open online courses

INTRODUCCIÓN: La informática biomédica ha traído consigo soluciones innovadoras a problemas sanitarios. Sin embargo, el número de profesionales sanitarios capacitados en informática biomédica es bajo. La educación virtual, como los cursos masivos abiertos en línea, brindan la oportunidad de formación en este campo. OBJETIVO: Estimar la oferta global de cursos masivos abiertos en línea sobre informática biomédica y conocer las características de su contenido. MÉTODOS: Se realizó una búsqueda de cursos masivos abiertos en línea durante diciembre de 2021 en 25 plataformas que ofertan estos cursos. La estrategia de búsqueda incluyó los descriptores "" y "". Se evaluaron las áreas de aplicación de informática biomédica, la plataforma, la institución, la duración, el tiempo requerido por semana, el idioma y los subtítulos disponibles para cada curso. Se analizaron los datos descriptivamente, reportándose frecuencias absolutas y relativas. RESULTADOS: Nuestra estrategia de búsqueda identificó 1333 cursos masivos abiertos en línea. De ellos, solo 79 estaban relacionados con informática de la salud. La mayoría de estos cursos (n = 44; 55,7%) se ofrecieron a través de Coursera. Más de la mitad (n = 55; 69,6%) fueron realizados por instituciones de Estados Unidos y en el idioma inglés (n = 76; 96,2%). La mayor parte de los cursos se centraron en áreas de bioinformática traslacional (n = 27; 34,2%), seguido de informática de la salud pública (n = 23; 29,1%), e informática de la investigación clínica (n = 13; 16,5%). CONCLUSIONES: Se encontró una importante oferta de cursos masivos abiertos en línea sobre informática biomédica. Estos cursos favorecen la formación de más profesionales en todas las regiones del mundo, abordando en su mayoría competencias para aplicar la informática en la práctica clínica, la salud pública y la investigación en salud.

INTRODUCTION: Informatics applied to health sciences has brought cutting-edge solutions to healthcare problems. However, the number of health professionals trained in "Health Informatics" is low. Virtual education, such as massive online open courses, provide the opportunity for training in this field. OBJECTIVE: To estimate the global offer of massive online open biomedical informatics courses and characterize their content. METHODS: A search for massive online open courses was conducted throughout December 2021 on 25 platforms offering these courses. The search strategy included the terms "health informatics" and "biomedical informatics". The application areas of biomedical informatics, platform, institution, duration, time required per week, language, and subtitles available for each course were evaluated. Data were analyzed descriptively, reporting absolute and relative frequencies. RESULTS: Our search strategy identified 1333 massive online open courses. Of these, only 79 were related to health informatics. Most of these courses (n = 44; 55.7%) were offered through Coursera. More than half (n = 55; 69.6%) were conducted by U.S. institutions in english (n = 76; 96.2%). Most courses focused on areas of translational bioinformatics (n = 27; 34.2%), followed by public health informatics (n = 23; 29.1%), and clinical research informatics (n = 13, 16.5%). CONCLUSIONS: We found a significant supply of massive online open courses on health informatics. These courses favor the training of more professionals worldwide, mostly addressing competencies to apply informatics in clinical practice, public health, and health research.

Evidence for a neuromuscular circuit involving hypothalamic interleukin-6 in the control of skeletal muscle metabolism.

Hypothalamic interleukin-6 (IL6) exerts a broad metabolic control. Here, we demonstrated that IL6 activates the ERK1/2 pathway in the ventromedial hypothalamus (VMH), stimulating AMPK/ACC signaling and fatty acid oxidation in mouse skeletal muscle. Bioinformatics analysis revealed that the hypothalamic IL6/ERK1/2 axis is closely associated with fatty acid oxidation- and mitochondrial-related genes in the skeletal muscle of isogenic BXD mouse strains and humans. We showed that the hypothalamic IL6/ERK1/2 pathway requires the α2-adrenergic pathway to modify fatty acid skeletal muscle metabolism. To address the physiological relevance of these findings, we demonstrated that this neuromuscular circuit is required to underpin AMPK/ACC signaling activation and fatty acid oxidation after exercise. Last, the selective down-regulation of IL6 receptor in VMH abolished the effects of exercise to sustain AMPK and ACC phosphorylation and fatty acid oxidation in the muscle after exercise. Together, these data demonstrated that the IL6/ERK axis in VMH controls fatty acid metabolism in the skeletal muscle.

Cefalea mortal: aneurisma en espejo a propósito de un caso

Introducción: Los aneurismas intracerebrales son hallazgos incidentales en estudios de imágenes realizado por otros diagnósticos. Reporte de Caso: Paciente femenino de 35 años, que presentó sincope después de cefalea de gran intensidad sin ceder a tratamiento convencional de AINES; con antecedente de cefalea de larga data y tratamiento esporádico. Al examen: neurológico: despierta, asimetría facial, disartria, fuerza muscular disminuida en ambos miembros inferiores, no signos meníngeos; el informe tomográfico cerebral sin contraste indicó: lesiones cerebrales expansivas de etiología a determinar a nivel de ambos lados de diencéfalo: descartar glioma vs aneurismas; Angiotac cerebral con contraste, refleja aneurismas de carótida interna intracraneal bilateral y cerebral media (en espejo). Posteriormente la paciente fue evaluada por neurocirujano de turno, quien indica referir a centro de mayor complejidad, por no contar con instrumental necesario para intervención quirúrgica; paciente fallece camino a centro de referencia. Conclusiones: Al ser una patología poco frecuente, no es considerada como una primera opción de sospecha diagnostica tras un evento de cefalea.

Background: Intracerebral aneurysms are incidental findings in imaging studies performed for other diagnoses. Case Report: 35- year-old female patient, who presented syncope after severe headache without yielding to conventional treatment with NSAIDs; with a history of long-standing headache and sporadic treatment. On examination: neurological: awake, facial asymmetry, dysarthria, decreased muscle strength in both lower limbs, no meningeal signs; the brain tomographic report without contrast indicated: expansive brain lesions of etiology to be determined at both sides of the diencephalon: rule out glioma vs aneurysms; cerebral Angiotac with contrast, reflects bilateral intracranial internal carotid and middle cerebral (mirror) aneurysms. Subsequently the patient was evaluated by the neurosurgeon on duty, who indicated to refer to a center of higher complexity, for not having the necessary instruments for surgery; patient died on the way to the referral center. Conclusions: Being a rare pathology, it is not considered as a first option for diagnostic suspicion after a headache event.

Antiparasitary and antiproliferative activities in vitro of a 1,2,4-oxadiazole derivative on Trypanosoma cruzi.

Chagas disease (CD) is a neglected disease, prevalent and endemic in Latin America, but also present in Europe and North America. The main treatment used for this disease is benznidazole, but its efficacy is variable in the chronic phase and presents high toxicity. So, there is a need for the development of new therapeutic agents. The five-membered heterocyclic 1,2,4-oxadiazole ring has received attention for its unique properties and a broad spectrum of biological activities and is therefore a potential candidate for the development of new drugs. Thus, the aim of this study was to evaluate the activity of the N-cyclohexyl-3-(3-methylphenyl)-1,2,4-oxadiazol-5-amine (2) on the evolutionary forms of Trypanosoma cruzi strain Y, as well as its mechanisms of action and in silico theoretical approach. The results by computational method showed an interaction of the 1,2,4-oxadiazole (2) with TcGAPDH, cruzain, and trypanothione reductase, showing good charge distribution and affinity in those three targets. Furthermore, cytotoxicity in LLC-MK2 cells was performed by the MTT method. In the assays with different parasite forms, the tested compound showed similar time-dependent concentration effect. The evaluation of the antiamastigote effect between the two concentrations tested showed a reduction in the number of infected cells and also in the number of amastigotes per infected cell. By flow cytometry, the compound (2) displayed alterations suggestive of necrotic events. Finally, in scanning electron microscopy structural alterations were present, characteristic of necrosisin the epimastigote forms. Overall, the 1,2,4-oxadiazole derivative (2) here evaluated opens perspectives to the development of new antichagasic agents.

Occurrence of methicillin-resistant Staphylococcus aureus (MRSA) in 'coalho' cheese produced in Brazil.

The experiments reported in this research communication analysed the presence of methicillin-resistant Staphylococcus aureus (MRSA) in 112 samples of 'coalho' cheese, from 56 dairy producing farms in 28 cities in all mesoregions of the State of Ceará, Brazil. To assess antimicrobial resistance we also examined the presence of genes encoding enterotoxins and toxic shock syndrome toxin, as well as the presence of the blaZ gene for ß-lactamases, and resistance to oxacillin. The research found 69 isolates of S. aureus, of which 13.04% had the mecA gene encoding the penicillin-binding protein, which confers resistance to methicillin, in cheese samples from 6 different cities. This included the state capital, Fortaleza, which had the largest prevalence (23.19%) of mecA positive isolates. It was also found that 55.07% of the isolates of S. aureus had the blaZ gene, and 7.25% demonstrated resistance to oxacillin in the plate disc diffusion tests. We did not show the presence of isolates carrying toxigenic genes. The findings suggest that strict supervision of production processes in the dairy industry is necessary in all production scale processes, thus preventing contamination and possible problems for consumers.

Antiproliferative activity on Trypanosoma cruzi (Y strain) of the triterpene 3ß,6ß,16ß-trihidroxilup-20 (29)-ene isolated from Combretum leprosum.

Chagas disease infects approximately seven million people worldwide. Benznidazole is effective only in the acute phase of the disease, with an average cure rate of 80% between acute and recent cases. Therefore, there is an urgent need to find new bioactive substances that can be effective against parasites without causing so many complications to the host. In this study, the triterpene 3ß-6ß-16ß-trihydroxilup-20 (29)-ene (CLF-1) was isolated from Combretum leprosum, and its molecular structure was determined by NMR and infrared spectroscopy. The CLF-1 was also evaluated in vitro and in silico as potential trypanocidal agent against epimastigote and trypomastigote forms of Trypanosoma cruzi (Y strain). The CLF-1 demonstrated good results highlighted by lower IC50 (76.0 ± 8.72 µM, 75.1 ± 11.0 µM, and 70.3 ± 45.4 µM) for epimastigotes at 24, 48 and 72 h, and LC50 (71.6 ± 11.6 µM) for trypomastigotes forms. The molecular docking study shows that the CLF-1 was able to interact with important TcGAPDH residues, suggesting that this natural compound may preferentially exert its effect by compromising the glycolytic pathway in T. cruzi. The ADMET study together with the MTT results indicated that the CLF-1 is well-absorbed in the intestine and has low toxicity. Thus, this work adds new evidence that CLF-1 can potentially be used as a candidate for the development of new options for the treatment of Chagas disease.Communicated by Ramaswamy H. Sarma.

Design guidelines and usability for cognitive stimulation through technology in Mexican older adults.

To develop software to stimulate cognitive functions of attention, memory, reasoning, planning, language, and perception in Mexican older adults, and to evaluate the usability of software based on system utility, information quality, and interface quality.For the development of the cognitive stimulation software, an inductive-deductive methodology was used in three stages: Analysis (system requirements), design and coding (cognitive stimulation software), evaluation (usability results).The usability of the software was assessed in 89 older adults between the ages of 60 and 84 years, through a usability questionnaire with evidence of reliability and validity.Eight exercises about attention, seven on memory, three on reasoning, one about planning and language, and two on perception were developed. We evaluated the usability of the developed software using the Computer System Usability Questionnaire, obtaining medium-high usability in 76.2% of the participants regarding the system utility, in 77.7% concerning the information quality and, in 84.2% in the interface quality.The software was developed considering aspects of usability and based on changes and losses associated with aging, as well as on the stimulation of cognitive functions related to instrumental activities of daily living, including exercises based on traditional pencil-paper exercises.

Insights into the Antimicrobial Activity of Hydrated Cobaltmolybdate Doped with Copper.

Molybdates are biocidal materials that can be useful in coating surfaces that are susceptible to contamination and the spread of microorganisms. The aim of this work was to investigate the effects of copper doping of hydrated cobalt molybdate, synthesized by the co-precipitation method, on its antibacterial activity and to elucidate the structural and morphological changes caused by the dopant in the material. The synthesized materials were characterized by PXRD, Fourier Transformed Infrared (FTIR), thermogravimetric analysis/differential scanning calorimetry (TG/DSC), and SEM-Energy Dispersive Spectroscopy (SEM-EDS). The antibacterial response of the materials was verified using the Minimum Inhibitory Concentration (MIC) employing the broth microdilution method. The size of the CoMoO4·1.03H2O microparticles gradually increased as the percentage of copper increased, decreasing the energy that is needed to promote the transition from the hydrated to the beta phase and changing the color of material. CoMoO4·1.03H2O obtained better bactericidal performance against the tested strains of Staphylococcus aureus (gram-positive) than Escherichia coli (gram-negative). However, an interesting point was that the use of copper as a doping agent for hydrated cobalt molybdate caused an increase of MIC value in the presence of E. coli and S. aureus strains. The study demonstrates the need for caution in the use of copper as a doping material in biocidal matrices, such as cobalt molybdate.

Quantum computational investigations and molecular docking studies on amentoflavone.

Chagas disease is a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi, with approximately 6-7 million people infected worldwide, becoming a public health problem in tropical countries, thus generating an increasing demand for the development of more effective drugs, due to the low efficiency of the existing drugs. Aiming at the development of a new antichagasic pharmacological tool, the density functional theory was used to calculate the reactivity descriptors of amentoflavone, a biflavonoid with proven anti-trypanosomal activity in vitro, as well as to perform a study of interactions with the enzyme cruzain, an enzyme key in the evolutionary process of T-cruzi. Structural properties (in solvents with different values of dielectric constant), the infrared spectrum, the frontier orbitals, Fukui analysis, thermodynamic properties were the parameters calculated from DFT method with the monomeric structure of the apigenin used for comparison. Furthermore, molecular docking studies were performed to assess the potential use of this biflavonoid as a pharmacological antichagasic tool. The frontier orbitals (HOMO-LUMO) study to find the band gap of compound has been extended to calculate electron affinity, ionization energy, electronegativity electrophilicity index, chemical potential, global chemical hardness and global chemical softness to study the chemical behaviour of compound. The optimized structure was subjected to molecular Docking to characterize the interaction between amentoflavone and cruzain enzyme, a classic pharmacological target for substances with anti-gas activity, where significant interactions were observed with amino acid residues from each one's catalytic sites enzyme. These results suggest that amentoflavone has the potential to interfere with the enzymatic activity of cruzain, thus being an indicative of being a promising antichagasic agent.

A novel green approach based on ZnO nanoparticles and polysaccharides for photocatalytic performance.

Novel green photocatalysts based on ZnO in the presence of arabic gum (AGZ) or karaya gum (KGZ) were synthesized by a sol-gel method for photocatalytic performance. The materials were characterized by XRD, FTIR spectroscopy, SEM, nitrogen adsorption/desorption, and PL and diffuse reflectance spectroscopy. Photocatalytic test was performed using methylene blue (MB) dye as the target pollutant under visible light. The reuse of photocatalysts and Artemia saline bioassays were investigated. The ZnO nanoparticles showed a hexagonal structure and the values of the band gaps were 2.95 (AGZ) and 2.98 eV (KGZ). The PL results demonstrated emission bands at 440, 473 or 478 and 549 nm. The textural properties indicated the presence of typically mesoporous materials. The MB discoloration efficiency was 81.5% and 91.0% for AGZ and KGZ, respectively. The photocatalytic activity of AGZ and KGZ was maintained after the third run. The ˙OH radicals are the main species involved in the MB discoloration. The MB discoloration from the photocatalysts showed no toxicity; therefore, they are considered to be promising materials for the degradation of the dye in the photocatalytic process.

Trypanocidal Mechanism of Action and in silico Studies of p-Coumaric Acid Derivatives.

Trypanosoma species are responsible for chronic and systemic infections in millions of people around the world, compromising life quality, and family and government budgets. This group of diseases is classified as neglected and causes thousands of deaths each year. In the present study, the trypanocidal effect of a set of 12 ester derivatives of the p-coumaric acid was tested. Of the test derivatives, pentyl p-coumarate (7) (5.16 ± 1.28 µM; 61.63 ± 28.59 µM) presented the best respective trypanocidal activities against both epimastigote and trypomastigote forms. Flow cytometry analysis revealed an increase in the percentage of 7-AAD labeled cells, an increase in reactive oxygen species, and a loss of mitochondrial membrane potential; indicating cell death by necrosis. This mechanism was confirmed by scanning electron microscopy, noting the loss of cellular integrity. Molecular docking data indicated that of the chemical compounds tested, compound 7 potentially acts through two mechanisms of action, whether by links with aldo-keto reductases (AKR) or by comprising cruzain (CZ) which is one of the key Trypanosoma cruzi development enzymes. The results indicate that for both enzymes, van der Waals interactions between ligand and receptors favor binding and hydrophobic interactions with the phenolic and aliphatic parts of the ligand. The study demonstrates that p-coumarate derivatives are promising molecules for developing new prototypes with antiprotozoal activity.

Evaluación de estrategias para reducir los tiempos de reperfusión en el infarto agudo de miocardio con elevación del segmento ST. Experiencia en salud móvil (mHealth) / Evaluation of Strategies to Reduce Reperfusion Times in ST-Segment Elevation Acute Myocardial Infarction. Mobile Health Experience (mHealth)

RESUMEN Introducción: La transmisión de la foto del electrocardiograma vía teléfono móvil, reduciría los tiempos de reperfusión en el infarto agudo de miocardio con elevación del segmento ST. Objetivo: Evaluar la eficacia de la tecnología celular como estrategia para acortar los tiempos de reperfusión. Material y métodos: Estudio cuasi experimental, multicéntrico, que incluyó pacientes del Gran San Miguel de Tucumán, desde agosto de 2017 a abril de 2018. La estrategia consistió en la transmisión de fotos del electrocardiograma vía WhatsApp, para la activación temprana del protocolo de infarto. Se midió tiempos de demora e impacto en la calidad de atención. Resultados: Se analizaron 105 pacientes. Se observó reducción significativa del tiempo diagnóstico, 30 (10-90) vs. 10 (5-15) minutos en el grupo salud móvil < p = 0,0001; y en el tiempo puerta balón, 166 (135-210) vs. 132 (80-150) minutos p = 0,019. Conclusiones: La estrategia salud móvil mejoró los tiempos al diagnóstico y puerta balón, aunque, siguen siendo subóptimos.

ABSTRACT Background: Mobile phone transmission of electrocardiogram photos would reduce time to reperfusion in ST-segment elevation acute myocardial infarction. Objective: The aim of this study was to evaluate the efficacy of mobile phone technology as a strategy to shorten times to reperfusion. Methods: A quasi-experimental, multicenter study, including patients from the Greater San Miguel de Tucumán, was carried out from August 2017 to April 2018. The strategy consisted in the transmission of electrocardiogram photos by WhatsApp, for the early activation of the infarction protocol. Delay times and impact on the quality of care were assessed. Results: A total of 105 patients were analyzed. A significant reduction of the time to diagnosis was observed in the mobile health group [30 min (10-90) vs. 10 min (5-15); <p=0.0001] and in the door-to-balloon time [166 min (135-210) vs. 132 min (80-150); p=0.019]. Conclusions: The mobile health strategy improved the diagnosis and the door-to-balloon times, though they are still suboptimal.

Involvement of Nitric Oxide on Bothropoides insularis Venom Biological Effects on Murine Macrophages In Vitro.

Viperidae venom has several local and systemic effects, such as pain, edema, inflammation, kidney failure and coagulopathy. Additionally, bothropic venom and its isolated components directly interfere on cellular metabolism, causing alterations such as cell death and proliferation. Inflammatory cells are particularly involved in pathological envenomation mechanisms due to their capacity of releasing many mediators, such as nitric oxide (NO). NO has many effects on cell viability and it is associated to the development of inflammation and tissue damage caused by Bothrops and Bothropoides venom. Bothropoides insularis is a snake found only in Queimada Grande Island, which has markedly toxic venom. Thus, the aim of this work was to evaluate the biological effects of Bothropoides insularis venom (BiV) on RAW 264.7 cells and assess NO involvement. The venom was submitted to colorimetric assays to identify the presence of some enzymatic components. We observed that BiV induced H2O2 production and showed proteolytic and phospholipasic activities. RAW 264.7 murine macrophages were incubated with different concentrations of BiV and then cell viability was assessed by MTT reduction assay after 2, 6, 12 and 24 hours of incubation. A time- and concentration-dependent effect was observed, with a tendency to cell proliferation at lower BiV concentrations and cell death at higher concentrations. The cytotoxic effect was confirmed after lactate dehydrogenase (LDH) measurement in the supernatant from the experimental groups. Flow cytometry analyses revealed that necrosis is the main cell death pathway caused by BiV. Also, BiV induced NO release. The inhibition of both proliferative and cytotoxic effects with L-NAME were demonstrated, indicating that NO is important for these effects. Finally, BiV induced an increase in iNOS expression. Altogether, these results demonstrate that B. insularis venom have proliferative and cytotoxic effects on macrophages, with necrosis participation. We also suggest that BiV acts by inducing iNOS expression and causing NO release.

Bothropoides insularis venom cytotoxicity in renal tubular epithelia cells.

Bothropoides insularis (jararaca-ilhoa) is a native endemic snake limited to the specific region of Queimada Island, on São Paulo coast. Several local and systemic effects have been described due to envenomation caused by it, such as edema, tissue necrosis, hemorrhage and acute renal failure. Our previous studies have shown that Bothropoides insularis venom (BinsV) demonstrated important functional and morphologic alterations in rat isolated kidney, especially decrease in tubular electrolyte transport, osmotic clearance and tubular necrosis. In order to elucidate the direct nephrotoxicity mechanism, the aim of the present study was to investigate BinsV cytotoxicity effect on renal epithelial cells. The treatment with BinsV over MDCK culture decreased cell viability in all concentrations tested with IC50 of 9 µg/mL. BinsV was able to induce membrane rupture and cell death with phosphatidilserine externalization. Furthermore, BinsV induced ROS overproduction and mitochondrial membrane potential collapse, as well as Bax translocation and caspases 3 and 7 expression. Therefore, these events might be responsible by BinsV-induced cell death caused by mitochondrial dysfunction and ROS overproduction in the direct cytotoxicity process.