Effect of Casearia sylvestris on the obliteration of dentinal tubules and the control of dental sensitivity / Efecto de Casearia sylvestris sobre la obliteración de los túbulos dentinarios y el control de la sensibilidad dental

The present study evaluated the efficacy of the mineralizing action of Casearia sylvestris ethanolic extract on bovine dentin blocks in its pure form and in dental paste, through scanning electron microscopy. The dentin blocks were immersed in artificial saliva and incubat ed at 37°C for 7 days. Subsequently, six groups were treated with different test substances and analysed qualitatively and quantitatively at 30 and 60 days. The tests used were Kruskal - Wallis and Dunn's. Shapiro - Wilk and ANOVA. The qualitative analysis at 30 days showed a difference between the groups treated with ethanolic extract and toothpaste. Quantitatively, at 30 days, treatment with ethanolic extract of Casearia showed a greater number of open dentinal tubules. At 60 days, the difference persisted on ly for the blocks treated with toothpaste. The results obtained indicated that there is a positive relationship between the use of Casearia sylvestris and obliteration of dentinal tubules

El presente estudio evaluó la eficacia de la acción mineralizante del extracto etanólico de Casearia sylvestris sobre bloques de dentina bovina en su forma pura y en pasta dental, mediante microscopía electrónica de barrido. Los bloques de dentina se sumergieron en saliva artificial y se incubaron a 37°C durante 7 días. Posteriormente, se trataron seis grupos con diferentes sustancias de ensayo y se analizaron cualitativa y cuantitativamente a los 30 y 60 días. Las p ruebas utilizadas fueron Kruskal - Wallis y Dunn's. Shapiro - Wilk y ANOVA. El análisis cualitativo a los 30 días mostró una diferencia entre los grupos tratados con extracto etanólico y pasta dentífrica. Cuantitativamente, a los 30 días, el tratamiento con ex tracto etanólico de Casearia mostró un mayor número de túbulos dentinarios abiertos. A los 60 días, la diferencia persistió sólo para los bloques tratados con pasta dentífrica. Los resultados obtenidos indicaron que existe una relación positiva entre el us o de Casearia sylvestris y la obliteración de los túbulos dentinarios

Lab-made disposable screen-printed electrochemical sensors and immunosensors modified with Pd nanoparticles for Parkinson's disease diagnostics.

A new conductive ink based on the addition of carbon black to a poly(vinyl alcohol) matrix is developed and investigated for electrochemical sensing and biosensing applications. The produced devices were characterized using morphological and electrochemical techniques and modified with Pd nanoparticles to enhance electrical conductivity and reaction kinetics. With the aid of chemometrics, the parameters for metal deposition were investigated and the sensor was applied to the determination of Parkinson's disease biomarkers, specifically epinephrine and α-synuclein. A linear behavior was obtained in the range 0.75 to 100 µmol L-1 of the neurotransmitter, and the device displayed a limit of detection (LOD) of 0.051 µmol L-1. The three-electrode system was then tested using samples of synthetic cerebrospinal fluid. Afterward, the device was modified with specific antibodies to quantify α-synuclein using electrochemical impedance spectroscopy. In phosphate buffer, a linear range was obtained for α-synuclein concentrations from 1.5 to 15 µg mL-1, with a calculated LOD of 0.13 µg mL-1. The proposed immunosensor was also applied to blood serum samples, and, in this case, the linear range was observed from 6.0 to 100.5 µg mL-1 of α-synuclein, with a LOD = 1.3 µg mL-1. Both linear curves attend the range for the real diagnosis, demonstrating its potential application to complex matrices.

Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in São Paulo, Brazil.

INTRODUCTION: This study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil. METHODS: A multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged ≥18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves. RESULTS: We assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1±5.0 vs. 5.6±3.9 days after the onset of symptoms, p<0.001), were younger (61.4±13.7 vs. 63.8±13.6 years, p = 0.023), had a lower frequency of diabetes (37.1% vs. 47.1%, p = 0.009) and obesity (29.5% vs. 40.0%, p = 0.007), had a greater need for vasopressors (93.3% vs. 84.6%, p<0.001) and mechanical ventilation (95.7% vs. 87.8%, p<0.001), and had higher lethality (84.8% vs. 72.7%, p<0.001) than first-wave patients. KRT quality markers were independently associated with a reduction in the OR for death in both pandemic waves. CONCLUSIONS: In the Sao Paulo megalopolis, the lethality of critically ill patients with COVID-19-associated AKI treated with KRT was higher in the second wave of the pandemic, despite these patients being younger and having fewer comorbidities. Potential factors related to this poor outcome were difficulties in health care access, lack of intra-hospital resources, delay vaccination and virus variants.

DISTRIBUTION AND ANTIMICROBIAL RESISTANCE OF STAPHYLOCOCCI ISOLATED FROM FREE-LIVING SOUTH AMERICAN COATI (NASUA NASUA) IN AN URBAN PARK IN MINAS GERAIS, BRAZIL.

The scientific information regarding staphylococci in procyonids is scarce. Hence, the aim of this study was to evaluate the frequency, distribution, and pattern of antimicrobial resistance of staphylococcal species isolated from free-roaming coatis (Nasua nasua) in an urban park in Belo Horizonte, Minas Gerais, Brazil. Rectal swabs from 55 free-living coatis were plated onto mannitol salt agar for isolating staphylococci, and species were identified using matrix-assisted laser desorption/ionization-time of flight mass spectrometry, polymerase chain reaction (PCR) of nuc, and sequencing of 16S rRNA and rpoB when needed. Antimicrobial susceptibility was investigated using the disk diffusion method, and the presence of the mecA gene was investigated by PCR. A total of 72.7% of the animals tested positive for staphylococci. Nine different species were identified, and Staphylococcus intermedius (60.4%) and S. delphini (20.9%) were the most frequently isolated species. Most of the isolates were susceptible to most of the antimicrobials evaluated, with a resistance pattern seen for penicillin (13.9%). One isolate was multidrug-resistant (MDR). The present study suggests that coatis are natural hosts of S. intermedius and S. delphini and, despite living in a heavily anthropized environment, the Staphylococcus spp. isolates showed a low incidence of drug resistance.

Impacto do volume de contraste utilizado após procedimentos coronários percutâneos em pacientes predispostos a desenvolver nefropatia induzida pelo contraste / Impact of contrast volume used after percutaneous coronary procedures in patients predisposed to developing contrast-induced nephropathy

INTRODUÇÃO: A nefropatia induzida por contraste (NIC) é uma complicação dos procedimentos angiográficos que requerem a administração de meios de contraste. Grandes volumes estão associados à NIC. Não está claro se o tipo de contraste interfere nessa diferença. OBJETIVO: Avaliar se o volume de contraste utilizado nos procedimentos percutâneos tem interação com o tipo de contraste (baixa ou isosmolar) no desenvolvimento de NIC. MÉTODOS: A NIC é definida como uma elevação de creatinina sérica de mais de 25% ou ≥0,5 mg/dl da basal após 48 h. Subanálise de estudo randomizado, centro único, incluindo 2268 pacientes consecutivos submetidos a procedimentos coronários diagnósticos e terapêuticos entre 2016 a 2018. Todos os procedimentos foram realizados com contraste de baixa osmolaridade ou iso-osmolar. A amostra foi dividida em 2 grupos em relação ao volume de 150ml de contraste. Análise estatística: para avaliar o efeito do contrate e do volume no NIC, utilizou-se um modelo de regressão logística com efeito de interação. Este modelo foi avaliado também ajustado para síndrome coronária aguda, disfunção ventricular, creatinina basal, sexo e idade. Os dados foram analisados com uso do software R versão 4.1.2. RESULTADOS: População predominantemente masculina, HAS (85%), DM (52%), DRC (31%). Modelo de regressão logística com efeito de interação entre contraste e volume (p>0,999). Modelos aditivos para NIC apresentado sem diferença entre os grupos (p= 0.974 e p= 0.202) ajustado para sexo, idade, creatinina basal, IC, SCA. CONCLUSÃO: Nesse estudo, mesmos nos casos em que maior quantidade de contraste foi utilizada, o tipo de contraste (iso-osmolar ou de baixa osmolaridade) não foi associado à ocorrência de NIC.

Cirurgia de revascularização miocárdica em mulheres jovens: características clínicas, resultados e seguimento tardio / Myocardial revascularization surgery in young women: clinical characteristics, results and late follow-up

INTRODUÇÃO: A maioria dos estudos epidemiológicos sobre doença cardiovascular baseia-se em modelos masculinos, e seus resultados têm sido extrapolados para a população feminina. Contudo, observa-se que as mulheres possuem peculiaridades relacionadas à doença arterial coronária e cirurgia de revascularização miocárdica (CRM). OBJETIVO: Análise das características clínicas, resultados e sobrevida em mulheres que realizaram a CRM isolada antes dos 45 anos de idade. MÉTODOS: Análise transversal de 91 pacientes do sexo feminino que foram consecutivamente submetidas à CRM isolada no período de 1999 a 2011 com base no banco de dados de hospital terciário especializado em cardiologia na última década. Análise Estatística: Medidas quantitativas foram descritas por média, mediana e desvio padrão. Curva de sobrevida através de Kaplan-Meier. RESULTADOS: No período analisado 91 pacientes do sexo feminino foram submetidas a cirurgia, sendo a idade média de 41,9 anos (DP 3,4 anos) e mediana de 43 anos; portadoras de hipertensão arterial (82,4%), diabetes melitus (31,9%), tabagismo (41,8%), história familiar positiva (30,8%), infarto prévio (57,1%). A maioria era triarterial (35,2%), lesão de tronco presente em 20,9%, lesão uniarterial (14,3%) e biarterial (29,7%). Na fase hospitalar, ocorreram 4 óbitos. Principais complicações relacionadas foram infarto perioperatório (6,6%), síndrome de baixo débito (7,7%), arritmia (5,5%). A curva de sobrevida em 10 anos neste grupo foi de 88%. O tempo médio de acompanhamento das pacientes pós-cirurgia foi de 5,5 anos. O tempo máximo de seguimento foi de 23 anos. CONCLUSÃO: População exclusivamente feminina com DAC grave apresentou evolução tardia satisfatória após CRM. Entender as características clínicas e os possíveis fatores relacionados à morbimortalidade após cirurgia são essenciais para tecer estratégias em busca de melhores resultados.

Impacto do volume de contraste utilizado após procedimentos coronários percutâneos / Impact of contrast volume used after percutaneous coronary procedures

INTRODUÇÃO: A nefropatia induzida por contraste (NIC) é uma complicação dos procedimentos angiográficos que requerem a administração de meios de contraste. Grandes volumes estão associados à NIC. Não está claro se o tipo de contraste interfere nessa diferença. OBJETIVO: Avaliar se o volume de contraste utilizado nos procedimentos percutâneos tem interação com o tipo de contraste (baixa ou isosmolar) no desenvolvimento de NIC. MÉTODOS: A NIC é definida como uma elevação de creatinina sérica de mais de 25% ou ≥0,5 mg/dl da basal após 48 h. Subanálise de estudo randomizado, centro único, incluindo 2268 pacientes consecutivos submetidos a procedimentos coronários diagnósticos e terapêuticos entre 2016 a 2018. Todos os procedimentos foram realizados com contraste de baixa osmolaridade ou iso-osmolar. A amostra foi dividida em 2 grupos em relação ao volume de 150ml de contraste. Análise estatística: para avaliar o efeito do contrate e do volume no NIC, utilizou-se um modelo de regressão logística com efeito de interação. Este modelo foi avaliado também ajustado para síndrome coronária aguda, disfunção ventricular, creatinina basal, sexo e idade. Os dados foram analisados com uso do software R versão 4.1.2. RESULTADOS: População predominantemente masculina, HAS (85%), DM (52%), DRC (31%). Modelo de regressão logística com efeito de interação entre contraste e volume (p>0,999). Modelos aditivos para NIC apresentado.

Ioxaglate Versus IoDixanol for the Prevention of Contrast-Induced Nephropathy: The IDPC Trial.

BACKGROUND: Despite the potential benefits of percutaneous procedures for the assessment and treatment of coronary artery disease, these interventions require the use of iodine contrast, which might lead to contrast-induced nephropathy (CIN) and increased risk of dialysis and major adverse cardiac events (MACE). AIMS: We sought to compare two different iodine contrasts (low vs. iso-osmolar) for the prevention of CIN among high-risk patients. METHODS: This is a single-center, randomized (1:1) trial comparing consecutive patients at high risk for CIN referred to percutaneous coronary diagnostic and/or therapeutic procedures with low (ioxaglate) vs. iso-osmolarity (iodixanol) iodine contrast. High risk was defined by the presence of at least one of the following conditions: age >70 years, diabetes mellitus, non-dialytic chronic kidney disease, chronic heart failure, cardiogenic shock, and acute coronary syndrome (ACS). The primary endpoint was the occurrence of CIN, defined as a >25% relative increase and/or >0.5 mg/dL absolute increase in creatinine (Cr) levels compared with baseline between the 2nd and 5th day after contrast media administration. RESULTS: A total of 2,268 patients were enrolled. Mean age was 67 years. Diabetes mellitus (53%), non-dialytic chronic kidney disease (31%), and ACS (39%) were highly prevalent. The mean volume of contrast media was 89 ml ± 48.6. CIN occurred in 15% of all patients, with no significant difference regarding the type of contrast used (iso = 15.2% vs. low = 15.1%, P>.99). Differences were not observed in specific subgroups such as diabetics, elderly, and ACS patients. At 30-day follow-up, 13 patients in the iso-osmolarity group and 11 in low-osmolarity group required dialysis (P =.8). There were 37 (3.3%) deaths in the iso-osmolarity cohort vs. 29 (2.6%) in the low-osmolarity group (P =.4). CONCLUSION: Among patients at high risk for CIN, the incidence of this complication was 15%, and independent of the use of low- or iso-osmolar contrast.

Ioxaglate versus IoDixanol for the prevention of contrast-induced nephropathy: the IDPC trial

BACKGROUND. Despite the potential benefits of percutaneous procedures for the assessment and treatment of coronary artery disease, these interventions require the use of iodine contrast, which might lead to contrast-induced nephropathy (CIN) and increased risk of dialysis and major adverse cardiac events (MACE). Aims. We sought to compare two different iodine contrasts (low vs. iso-osmolar) for the prevention of CIN among high-risk patients. METHODS. This is a single-center, randomized (1:1) trial comparing consecutive patients at high risk for CIN referred to percutaneous coronary diagnostic and/or therapeutic procedures with low (ioxaglate) vs iso-osmolarity (iodixanol) iodine contrast. High risk was defined by the presence of at least one of the following conditions: age >70 years, diabetes mellitus, non-dialytic chronic kidney disease, chronic heart failure, cardiogenic shock, and acute coronary syndrome (ACS). The primary endpoint was the occurrence of CIN, defined as a >25% relative increase and/or >0.5 mg/dL absolute increase in creatinine (Cr) levels compared with baseline between the 2nd and 5th day after contrast media administration. RESULTS. A total of 2268 patients were enrolled. Mean age was 67 years. Diabetes mellitus (53%), non-dialytic chronic kidney disease (31%), and ACS (39%) were highly prevalent. The mean volume of contrast media was 89 ml ± 48.6. CIN occurred in 15% of all patients, with no significant difference regarding the type of contrast used (iso = 15.2% vs low = 15.1%, P>.99). Differences were not observed in specific subgroups such as diabetics, elderly, and ACS patients. At 30-day follow-up, 13 patients in the iso-osmolarity group and 11 in low-osmolarity group required dialysis (P=.8). There were 37 (3.3%) deaths in the iso-osmolarity cohort vs 29 (2.6%) in the low-osmolarity group (P=.4). CONCLUSION. Among patients at high risk for CIN, the incidence of this complication was 15%, and independent of the use of low- or iso-osmolar contrast.

Impacto do volume de contraste utilizado após procedimentos coronários percutâneos em pacientes predispostos a desenvolver nefropatia induzida pelo contraste / Impact of contrast volume used after percutaneous coronary procedures in patients predisposed to developing contrast-induced nephropathy

INTRODUÇÃO: A nefropatia induzida por contraste (NIC) é uma complicação dos procedimentos angiográficos que requerem a administração de meios de contraste. Grandes volumes estão associados à NIC. Não está claro se o tipo de contraste interfere nessa diferença. OBJETIVO: Avaliar se o volume de contraste utilizado nos procedimentos percutâneos tem interação com o tipo de contraste (baixa ou isosmolar) no desenvolvimento de NIC. MÉTODOS: A NIC é definida como uma elevação de creatinina sérica de mais de 25% ou ≥0,5 mg/dl da basal após 48 h. Subanálise de estudo randomizado, centro único, incluindo 2268 pacientes consecutivos submetidos a procedimentos coronários diagnósticos e terapêuticos entre 2016 a 2018. Todos os procedimentos foram realizados com contraste de baixa osmolaridade ou iso-osmolar. A amostra foi dividida em 2 grupos em relação ao volume de 150ml de contraste. Análise estatística: para avaliar o efeito do contrate e do volume no NIC, utilizou-se um modelo de regressão logística com efeito de interação. Este modelo foi avaliado também ajustado para síndrome coronária aguda, disfunção ventricular, creatinina basal, sexo e idade. Os dados foram analisados com uso do software R versão 4.1.2. RESULTADOS: População predominantemente masculina, HAS (85%), DM (52%), DRC (31%). Modelo de regressão logística com efeito de interação entre contraste e volume (p>0,999). Modelos aditivos para NIC apresentado na tabela 1 abaixo. CONCLUSÃO: Nesse estudo, mesmos nos casos em que maior quantidade de contraste foi utilizada, o tipo de contraste (iso-osmolar ou de baixa osmolaridade) não foi associado à ocorrência de NIC.

Insights on the taxonomy of Haemoproteus parasites infecting cracid birds.

The Haemosporida order is a well-supported clade of heteroxenous parasites transmitted by dipteran insects and frequently found parasitizing wild birds. These parasites have already been reported in all zoogeographic regions of the world, except for Antarctica. One of the potential hosts of haemosporidians is the Cracidae family, which includes approximately 50 species, 22 of which are present in Brazil, classified within nine genera. Data on haemosporidian infecting individuals of the Cracidae family is scarce, with only three Haemoproteus species being recorded in this group of birds. We found Haemoproteus spp. infection in all Penelope obscura bronzina analyzed. Among the parasites found, we observed two lineages of Haemoproteus (PENOBS02 and PENOBS03), which were characterized by morphological, molecular and phylogenetic approaches. The morphological data on cracid haemosporidian parasites, together with our phylogenetic results, allows discussions on the taxonomy of the Haemoproteus parasites that infect birds of the Cracidae family.

Ácido acetilsalicílico versus inibidores dos receptores P2Y12 para prevenção secundária em pacientes tratados por meio de intervenção coronária percutânea / Aspirin versus P2Y12 inhibitors for secondary prevention after percutaneous coronary intervention

Na atualidade, as intervenções coronárias percutâneas com implante de um stent farmacológico constituem o principal método de revascularização miocárdica em centros hospitalares terciários, independentemente da forma clínica de apresentação da doença arterial coronária. É de conhecimento geral que, para sua efetivação, há necessidade do uso de um esquema antiplaquetário duplo, constituído pela associação do ácido acetilsalicílico e um inibidor dos receptores plaquetários P2Y12, que é o cerne da prevenção das tromboses após implantes das endopróteses, sendo também indicado para prevenir a ocorrência de eventos aterotrombóticos na evolução clínica tardia, qualquer que seja o modelo de stent utilizado. Após período variável de tempo, independentemente de fatores como forma clínica de apresentação da coronariopatia e do tipo de stent implantado, esse esquema é interrompido, e, na atualidade, as principais diretrizes preconizam a suspensão do inibidor dos receptores P2Y12 e a manutenção do ácido acetilsalicílico em longo prazo como uma das principais medidas farmacológicas de prevenção secundária da aterosclerose. No entanto, recentemente, em razão de sua maior potência antiplaquetária e provável menor potencial de causar hemorragias significantes, em especial no tubo digestivo, os inibidores P2Y12 têm sido considerados alternativa válida e atraente como antiplaquetário de utilização em longo prazo, alternativa ainda não referendada pelas diretrizes. Esta revisão discute os pormenores relacionados a essa importante decisão que deve ser tomada pelo cardiologista no momento da interrupção dos diferentes esquemas antitrombóticos inicialmente utilizados após uma intervenção coronária percutânea. Em princípio, a escassez de estudos clínicos conclusivos e normativos, em especial na população tratada por meio de uma intervenção percutânea, faz com que o ácido acetilsalicílico ainda se mantenha como o único antiagregante plaquetário com indicação classe I com a finalidade de prevenção secundária da aterosclerose.

Currently, percutaneous coronary intervention with a drug-eluting stent implantation is the main method of myocardial revascularization in tertiary care hospitals, regardless of the clinical presentation of coronary artery disease. It is well known that to be effective, it requires the use of a dual antiplatelet therapy, which is a combination of acetylsalicylic acid and a P2Y12 platelet receptor inhibitor, which plays a key role in preventing thromboses after endoprosthesis implantation and is also indicated to prevent atherothrombotic events in the late clinical course, regardless of the stent model used. After a variable period of time, depending on some factors, such as the clinical presentation of coronary artery disease and the type of stent implanted, this therapy is discontinued, and the main current guidelines recommend interrupting the P2Y12 receptor inhibitor and maintaining acetylsalicylic acid in the long term, as one of the main pharmacological measures for secondary prevention of atherosclerosis. However, recently, due to their greater antiplatelet potency and probable lower potential for significant bleeding, especially in the digestive tract, P2Y12 inhibitors have been considered a valid and attractive option as an antiplatelet agent for long-term use; but this alternative has not been endorsed by guidelines yet. This review discusses the details related to this important decision that must be made by cardiologists when discontinuing the different antithrombotic therapies initially used after percutaneous coronary intervention. In principle, the scarcity of conclusive and normative clinical studies, especially in the population treated by percutaneous intervention, means that acetylsalicylic acid is the only antiplatelet agent with class I indication for secondary prevention of atherosclerosis.

De-escalação de inibidores dos receptores P2Y12 após intervenção coronária percutânea / P2Y12 inhibitor de-escalation after percutaneous coronary interventions

Em pacientes que apresentam síndromes coronárias agudas e são tratados com intervenção coronária percutânea, a prescrição do esquema antiplaquetário duplo, composto de ácido acetilsalicílico e um inibidor dos receptores P2Y12, é mandatória, contribuindo para a redução de eventos cardíacos maiores. No entanto, ao mesmo tempo em que previne eventos isquêmicos, essa associação pode precipitar complicações hemorrágicas maiores, o que é mais comumente observado quando são prescritos os medicamentos mais potentes, como o prasugrel ou o ticagrelor. Essas constatações levaram à procura de alternativas terapêuticas capazes de manter a proteção contra eventos isquêmicos e, ao mesmo tempo, prevenir a ocorrência de hemorragias. Uma das estratégias que está em estudo é a de-escalação dos inibidores P2Y12, que consiste no uso dos medicamentos mais potentes numa fase precoce após o procedimento, com substituição deles pelo clopidogrel, após um período de, em geral, 30 dias de evolução; outra possibilidade seria a simples redução da dose do fármaco de maior potência, algo que, até o momento, só pode ser cogitado com o prasugrel. A de-escalação pode ser feita de forma guiada, utilizando testes de mensuração objetiva da agregação plaquetária ou exames para avaliar o perfil genético dos pacientes, ou não guiada, na qual o cardiologista simplesmente faz a substituição ou redução da dose ao fim do período estipulado, sem o auxílio de exames complementares. A literatura contempla ensaios clínicos com essas duas opções de estratégia, os quais são discutidos nesta revisão. Até o momento, nenhuma diretriz médica recomenda de forma explícita o uso regular dessa alternativa terapêutica.

In patients who have acute coronary syndromes and are treated with percutaneous coronary intervention, the prescription of a dual antiplatelet regimen, consisting of acetylsalicylic acid and a P2Y12 receptor inhibitor, is mandatory, contributing to the reduction of major cardiac events. However, while preventing ischemic events, this association may precipitate major bleeding complications, which is more commonly seen when more potent drugs, such as prasugrel or ticagrelor, are prescribed. These findings led to the search for therapeutic alternatives that could maintain the protection against ischemic events and, at the same time, prevent the occurrence of hemorrhages. One of the strategies being studied is de-escalation of P2Y12 inhibitors, which consists of the use of more potent drugs in an early phase after the procedure, replacing them with clopidogrel, after a period of, in general, 30 days of clinical course. Another possibility would be to simply reduce the dose of the most potent drug, which so far can only be considered with prasugrel. De-escalation can be done in a guided way, using objective measuring tests of platelet aggregation or exams to assess the genetic profile of patients, or unguided, in which the cardiologist simply replaces or reduces the dose at the end of the stipulated period, with no ancillary tests. The literature includes clinical trials with these two strategy options, which are discussed in this review. So far, no medical guideline explicitly recommends the regular use of this therapeutic alternative.

A Sexologia e Seus Especialistas na Mídia Durante a Pandemia da Covid-19 / Sexology and Its Media Experts During the Covid-19 Pandemic / Sexología y Sus Expertos en Medios Durante la Pandemia del Covid-19

No escopo de uma pesquisa de abrangência nacional sobre práticas sexuais e gestão de risco, nos chamou atenção, na procura por materiais de mídia relacionando sexo e sexualidades com a pandemia de Covid-19, a presença majoritária de um grupo de "especialistas" ligados ao campo heterogêneo da Sexologia, tais como psicólogas, psiquiatras, urologistas, sexólogas, educadoras sexuais, associadas/os aos infectologistas. Por meio da pesquisa de palavras-chave, via buscador do Google, inventariamos um número de 44 matérias oriundas de sites de grupos jornalísticos grandes e alternativos, bem como de clínicas, associações profissionais e blogs particulares, publicadas entre março de 2020 a julho de 2021. Dessas, concentramos nossa análise em 30 matérias correspondentes àquelas veiculadas pelos grupos jornalísticos grandes e alternativos. A leitura realizada foi inspirada pela problemática da produção de objetos via práticas enunciativas e materiais, mediante as quais associações entre elementos diversos, perguntas e respostas explicitadas vão estabilizando não só os sentidos, mas os próprios objetos em disputa, no caso aqui observado, as práticas sexuais. Ao final de nosso estudo, percebeu-se que o sexo e a sexualidade produzidos pelos "especialistas" através dos canais de mídia tendem à generalização dos corpos e a descontextualização das práticas.

In the scope of a nationwide survey on sexual practices and risk management, what caught our attention, in the search for media materials relating sex and sexualities to the Covid-19 pandemic, the majority presence of a group of "specialists" linked to the heterogeneous field of Sexology, such as psychologists, psychiatrists, urologists, sexologists, sex educators, associated with infectologists. Through keyword research, via google search, we inventoried a number of 44 articles from large and alternative journalistic groups websites, as well as clinics, professional associations and private blogs, published between March 2020 and July 2021. From these, we focused our analysis on 30 articles corresponding to those published by large and alternative journalistic groups. The reading performed was inspired by the problematic of the production of objects via enunciative and material practices, through which associations between different elements, questions and explicit answers, stabilize not only the senses, but the objects in dispute, in the case observed here, sexual practices. At the end of our study, it was noticed that the sex and sexuality produced by the "specialists" through the media channels tends to the generalization of bodies and the decontextualization of practices.

En el ámbito de una encuesta a nivel nacional sobre prácticas sexuales y gestión de riesgos, lo que llamó nuestra atención, en la búsqueda de materiales mediáticos que relacionan el sexo con la pandemia de la Covid-19, destaca la presencia mayoritaria de un grupo de especialistas vinculados al heterogéneo campo de la Sexología, como psicólogos, psiquiatras, urólogos, sexólogos, y otra. A través de una investigación de palabras clave, a través de una búsqueda en Google, inventariamos una serie de 44 artículos de sitios web de grupos periodísticos grandes y alternativos, así como clínicas, asociaciones profesionales y blogs privados, publicados entre marzo de 2020 y julio de 2021. Enfocamos nuestro análisis en 30 artículos publicados por grandes y alternativos grupos periodísticos. La lectura realizada se inspiró en el problema de la producción de objetos a través de prácticas enunciativas y materiales, a través de las cuales asociaciones entre diferentes elementos, preguntas y respuestas explícitas, estabilizan no sólo los sentidos, sino los objetos en disputa, en el caso, prácticas sexuales. Al final de nuestro estudio, se percibió que el sexo y la sexualidad producidos por los especialistas tienden a la generalización de los cuerpos ya la descontextualización de las prácticas.

Bromoditerpenes from the Red Seaweed Sphaerococcus coronopifolius as Potential Cytotoxic Agents and Proteasome Inhibitors and Related Mechanisms of Action.

Seaweeds are a great source of compounds with cytotoxic properties with the potential to be used as anticancer agents. This study evaluated the cytotoxic and proteasome inhibitory activities of 12R-hydroxy-bromosphaerol, 12S-hydroxy-bromosphaerol, and bromosphaerol isolated from Sphaerococcus coronopifolius. The cytotoxicity was evaluated on malignant cell lines (A549, CACO-2, HCT-15, MCF-7, NCI-H226, PC-3, SH-SY5Y, and SK-MEL-28) using the MTT and LDH assays. The ability of compounds to stimulate the production of hydrogen peroxide (H2O2) and to induce mitochondrial dysfunction, the externalization of phosphatidylserine, Caspase-9 activity, and changes in nuclear morphology was also studied on MCF-7 cells. The ability to induce DNA damage was also studied on L929 fibroblasts. The proteasome inhibitory activity was estimated through molecular docking studies. The compounds exhibited IC50 values between 15.35 and 53.34 µM. 12R-hydroxy-bromosphaerol and 12S-hydroxy-bromosphaerol increased the H2O2 levels on MCF-7 cells, and bromosphaerol induced DNA damage on fibroblasts. All compounds promoted a depolarization of mitochondrial membrane potential, Caspase-9 activity, and nuclear condensation and fragmentation. The compounds have been shown to interact with the chymotrypsin-like catalytic site through molecular docking studies; however, only 12S-hydroxy-bromosphaerol evidenced interaction with ALA20 and SER169, key residues of the proteasome catalytic mechanism. Further studies should be outlined to deeply characterize and understand the potential of those bromoditerpenes for anticancer therapeutics.

Profile of hospitalization in the health unic system in the municipality of São Paulo for acute myocardial infarction in the year 2021

INTRODUCTION: Despite significant scientific advances and public prevention policies, acute myocardial infarction corresponds to a high rate of hospitalizations and morbidity and mortality. OBJECTIVE: To analyze and describe the profile of patients who are hospitalized in the city of São Paulo for Acute Myocardial Infarction in the year 2021. METHODOLOGY: It consists of a descriptive, retrospective, longitudinal epidemiological study, based on the analysis of a secondary source of data, with the aim of the studies being hospital admissions in the Unified Health System of the city of São Paulo, in the year 2021, for causes related to diseases. hypertensive As inclusion criteria, all hospital admissions were selected through the Hospital Information System (SIH), through DATASUS. The period studied was the year 2021. The morbidities were separated and selected according to the main hospitalization diagnosis and classified according to the International Disease Code 10 (ICD10), the following being selected: I10 -Essential hypertension, I11 - Hypertensive heart disease , I12 - Hypertensive kidney disease, I13 - Hypertensive heart and kidney disease, I15 - Secondary hypertension. Gender, race/color and age group were also taken into account. RESULTS: During the study period, 2219 hospitalizations were performed for hypertensive diseases, of which 49.2% were male and 50.8% female. Among the target audience of the study, when considering race/color, 35.8% of patients consider themselves white, 8% black, 29.5% brown and 0.2% yellow. 26.5% of the registered admissions had no description of race/color. Regarding the age groups studied, there is a gradual increase in the number of hospitalizations as the observed age group also increases, with the group of patients over 80 years of age having the highest number of hospitalizations, corresponding to 14% of all the hospitalizations. CONCLUSION: Hospitalizations in the city of São Paulo due to hypertensive syndromes were slightly higher in males, most of whom were white and aged over 80 years.

Hospitalization in the public health system in the municipality of São Paulo resulting from hypertensive diseases in the year of 2021

INTRODUCTION: In Brazil, arterial hypertension has a high prevalence and low control rate, being a risk factor for cardiovascular diseases, which implies large public health expenses related to hospitalizations resulting from complications. OBJECTIVE: To quantitatively analyze the hospitalizations resulting from hypertensive syndromes in the city of São Paulo in the year 2021. METHODOLOGY: It consists of a descriptive, retrospective, longitudinal epidemiological study, based on the analysis of a econdary source of data, with the aim of the studies being hospital admissions in the Unified Health System of the city of São Paulo, in the year 2021, for causes related to diseases. Hypertensive as inclusion criteria, all hospital admissions were selected through the Hospital Information System (SIH), through DATASUS. The period studied was the year 2021. The morbidities were separated and selected according to the main hospitalization diagnosis and classified according to the International Disease Code 10 (ICD10), the following being selected: I10 - Essential hypertension, I11 - Hypertensive heart disease, I12 - Hypertensive kidney disease, I13 - Hypertensive heart and kidney disease, I15 - Secondary hypertension. Gender, race/color and age group were also taken into account. RESULTS: During the study period, 2219 hospitalizations were performed for hypertensive diseases, of which 49.2% were male and 50.8% female. Among the target audience of the study, when considering race/color, 35.8% of patients consider themselves white, 8% black, 29.5% brown and 0.2% yellow. 26.5% of the registered admissions had no description of race/color. Regarding the age groups studied, there is a gradual increase in the number of hospitalizations as the observed age group also increases, with the group of patients over 80 years of age having the highest number of hospitalizations, corresponding to 14% of all the hospitalizations. CONCLUSIONS: Hospitalizations in the city of São Paulo due to hypertensive syndromes were slightly higher in males, most of whom were white and aged over 80 years.

Perfil contemporâneo dos pacientes portadores de minoca atendidos em hospital terciário / Contemporary profile of patients with minoca treated in a tertiary hospital

INTRODUÇÃO: O termo MINOCA (infarto do miocárdio sem obstrução coronária significativa), recentemente incorporado a 4ª Definição Universal de Infarto do iocárdio, tem despertado crescente interesse, pois é um diagnóstico sindrômico que inclui diversas causas, cardíacas e não cardíacas. Como a literatura nacional é escassa sobre as características desta população, optamos por expor nossa experiência inicial. OBJETIVO: Traçar o perfil clínico-epidemiológico-angiográfico dos pacientes portadores de MINOCA atendidos em nosso Serviço. MÉTODOS: Estudo observacional, retrospectivo, utilizando um banco de dados de laboratório de hemodinâmica de um hospital terciário. Foram incluídos 2002 pacientes, submetidos ao cateterismo cardíaco diagnóstico entre 2018 e 2021, correspondendo a 20,8% dos 9.631 dos casos de Síndromes Coronárias Agudas (SCA) identificados nesse período, incluídos de forma sequencial. Exclusões: antecedentes de revascularização prévia. Os resultados clínicos expostos foram restritos à fase hospitalar. RESULTADOS: A maioria era do sexo masculino (51%) e idade média de 59 anos. Do total de pacientes, 77% eram hipertensos, 51% dislipidêmicos, 26% portadores de diabetes, 20% com doença renal crônica, 16% tabagistas e 2,3% apresentavam antecedente de insuficiência cardíaca. Infarto prévio foi observado em 20% dos pacientes. Na base dados, todos os pacientes foram admitidos com diagnóstico de SCA sem supradesnivelamento do segmento ST, sendo que 67% foram classificados como baixo risco e apenas 6% como alto risco, de acordo com o escore de risco TIMI. Sobre a terapia medicamentosa, 90% dos pacientes foram medicados com ácido acetilsalicílico; 86% com estatinas; 71%, utilizaram betabloqueador; 78% clopidogrel; 85% inibidores da ECA/ bloqueadores dos receptores da angiotensina 2. Eventos cardíacos maiores na fase hospitalar ocorreram em 5% dos casos, sendo: mortalidade em 5% e infarto em 1.8%; não observamos casos de isquemia cerebral. CONCLUSÃO: Os casos de MINOCA à estratificação invasiva após SCA constituíram um número expressivo da população total (acima de 20%). Diferente da literatura, discreta maioria era do sexo masculino. Embora não se possa afirmar de forma categórica, nossa impressão é que estes casos apresentam menos fatores de risco clássicos para coronariopatia do que os que se apresentam com aterosclerose significativa. A mortalidade intra-hospitalar foi discretamente superior à citada na literatura.

A Case of Recurrent Idiopathic Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is a rare chronic neutrophilic dermatosis that can be associated with underlying conditions, such as inflammatory bowel disease and neoplasms, or can be idiopathic. Classically, it presents as painful skin lesions. We present a case of a 54-year-old woman who got a synovial cyst removed from her left hand, which later aggravated into a non-healing wound, and subsequently a painful necrotic ulcer. The histological pattern combined with the clinical features suggested PG. General wound care was performed, associated with topical tacrolimus and oral corticotherapy with a good response. Three similar episodes with lesions scattered over the body followed and required a combination of other pharmacological alternatives. An extensive etiological study was carried out to screen secondary causes without any relevant findings. Therefore, an idiopathic relapsing PG was assumed. PG is poorly understood, underdiagnosed and hard to treat. It has a clear impact on the quality of life of the patient, so high suspicion and timely treatment are essential to minimize complications.

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil.

INTRODUCTION: Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. METHODS: This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. RESULTS: The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. CONCLUSION: AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).