Effects of LED lights and cytokinin on the phytotreatment of simulated swine wastewater by Azolla spp.: Pollutant removal and biomass valorization.

Phytoremediation is an eco-friendly and affordable option for tackling wastewater pollutants. The study focused on how light-emitting diodes (LED) light exposure, measured by intensity and duration (photoperiod), along with cytokinin, impacts Azolla microphylla's simulated swine wastewater treatment performance and biomass production. Under optimal treatment conditions, high removals of COD (89.2 % to 90.8 %), N-NH4+ (72.6 % to 91.2 %), N-NO3- (84.4 % to 88.6 %), Cu (75.4 % to 86.4 %), sulfamethoxazole (77.0 % to 79.0 %), P-PO43- (54.1 % to 59.9 %) and DOC (67.4 % to 71.3 %) while Zn presented a more moderate reduction (2.0 % to 9.7 %). Biomass productivity reached up to 34.8 t ha-1 yr-1. Protein production accounted for 23 % to 27 % of dry weight, while lipids ranged from 20 % to 34 % of dry biomass. Carbohydrate content varied from 8 % to 28 % of fresh weight. Higher light intensities, with both high or low values of photoperiods, and low concentrations of cytokinin were identified as optimal conditions for removal of almost all pollutants. However, pollutant removal was impacted differently by LED light and cytokinin concentration. In treatment conditions with the shortest photoperiods (8 h), the lowest residual Cu and Zn concentrations, whereas with longer photoperiods (24 h), the lowest residual concentrations of N-NH4+ and P-PO43- concentrations were recorded. On the other hand, SMX was the only parameter in which cytokinin had a clear influence on its removal, with the lowest residual concentration observed under 8-hour photoperiods combined with the lowest tested cytokinin concentrations (0.3 mg L-1). For residual COD and N-NO3-, no discernible pattern was evident for any of the analyzed factors. Therefore, the study demonstrates the potential for treating simulated swine wastewater using Azolla microphylla, aligned with its ability to produce biomass rich in high-value compounds.

Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance.

Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

Primary cutaneous nocardiosis of the ankle caused by N. brasiliensis: a case report.

Nocardia is a genus of aerobic, Gram-positive bacteria known for their filamentous and branching morphology. N. brasiliensis is the most common species causing cutaneous nocardiosis. We present a 67-year-old woman who developed abscesseson the back of her right ankle after walking barefoot on soil. Cultures from the cutaneous lesions grew N. brasiliensis. Antibiotic therapy with trimethoprim-sulfamethoxazole given for a month provided near-complete resolution of her lesions.

Integrated AI-driven optimization of Fenton process for the treatment of antibiotic sulfamethoxazole: Insights into mechanistic approach.

Antibiotics, as a class of environmental pollutants, pose a significant challenge due to their persistent nature and resistance to easy degradation. This study delves into modeling and optimizing conventional Fenton degradation of antibiotic sulfamethoxazole (SMX) and total organic carbon (TOC) under varying levels of H2O2, Fe2+ concentration, pH, and temperature using statistical and artificial intelligence techniques including Multiple Regression Analysis (MRA), Support Vector Regression (SVR) and Artificial Neural Network (ANN). In statistical metrics, the ANN model demonstrated superior predictive accuracy compared to its counterparts, with lowest RMSE values of 0.986 and 1.173 for SMX and TOC removal, respectively. Sensitivity showcased H2O2/Fe2+ ratio, time and pH as pivotal for SMX degradation, while in simultaneous SMX and TOC reduction, fine tuning the time, pH, and temperature was essential. Leveraging a Hybrid Genetic Algorithm-Desirability Optimization approach, the trained ANN model revealed an optimal desirability of 0.941 out of 1000 solutions which yielded a 91.18% SMX degradation and 87.90% TOC removal under following specific conditions: treatment time of 48.5 min, Fe2+: 7.05 mg L-1, H2O2: 128.82 mg L-1, pH: 5.1, initial SMX: 97.6 mg L-1, and a temperature: 29.8 °C. LC/MS analysis reveals multiple intermediates with higher m/z (242, 270 and 288) and lower m/z (98, 108, 156 and 173) values identified, however no aliphatic hydrocarbon was isolated, because of the low mineralization performance of Fenton process. Furthermore, some inorganic fragments like NH4+ and NO3- were also determined in solution. This comprehensive research enriches AI modeling for intricate Fenton-based contaminant degradation, advancing sustainable antibiotic removal strategies.

Preliminary insights on the development of a continuous-flow solar system for the photocatalytic degradation of contaminants of emerging concern in water.

The ubiquity and impact of pharmaceuticals and pesticides, as well as their residues in environmental compartments, particularly in water, have raised human and environmental health concerns. This emphasizes the need of developing sustainable methods for their removal. Solar-driven photocatalytic degradation has emerged as a promising approach for the chemical decontamination of water, sparking intensive scientific research in this field. Advancements in photocatalytic materials have driven the need for solar reactors that efficiently integrate photocatalysts for real-world water treatment. This study reports preliminary results from the development and evaluation of a solar system for TiO2-based photocatalytic degradation of intermittently flowing water contaminated with doxycycline (DXC), sulfamethoxazole (SMX), dexamethasone (DXM), and carbendazim (CBZ). The system consisted of a Fresnel-type UV solar concentrator that focused on the opening and focal point of a parabolic trough concentrator, within which tubular quartz glass reactors were fixed. Concentric springs coated with TiO2, arranged one inside the other, were fixed inside the quartz reactors. The reactors are connected to a raw water tank at the inlet and a check valve at the outlet. Rotating wheels at the collector base enable solar tracking in two axes. The substances (SMX, DXC, and CBZ) were dissolved in dechlorinated tap water at a concentration of 1.0 mg/L, except DXM (0.8 mg/L). The water underwent sequential batch (~ 3 L each, without recirculation) processing with retention times of 15, 30, 60, 90, and 120 min. After 15 min, the degradation rates were as follows: DXC 87%, SMX 35.5%, DXM 32%, and CBZ 31.8%. The system processed 101 L of water daily, simultaneously removing 870, 355, 256, and 318 µg/L of DXC, SMX, DXM, and CBZ, respectively, showcasing its potential for real-world chemical water decontamination application. Further enhancements that enable continuous-flow operation and integrate highly effective adsorbents and photocatalytic materials can significantly enhance system performance.

Application of artificial intelligence for the optimization of advanced oxidation processes to improve the water quality polluted with pharmaceutical compounds.

Sulfamethoxazole and metronidazole are emerging pollutants commonly found in surface water and wastewater. These compounds have a significant environmental impact, being necessary in the design of technologies for their removal. Recently, the advanced oxidation process has been proven successful in the elimination of this kind of compounds. In this sense, the present work discusses the application of UV/H2O2 and ozonation for the degradation of both molecules in single and binary systems. Experimental kinetic data from O3 and UV/H2O2 process were adequately described by a first and second kinetic model, respectively. From the ANOVA analysis, it was determined that the most statistically significant variables were the initial concentration of the drugs (0.03 mmol L-1) and the pH = 8 for UV/H2O2 system, and only the pH (optimal value of 6) was significant for degradation with O3. Results showed that both molecules were eliminated with high degradation efficiencies (88-94% for UV/H2O2 and 79-98% for O3) in short reaction times (around 30-90 min). The modeling was performed using a quadratic regression model through response surface methodology representing adequately 90 % of the experimental data. On the other hand, an artificial neural network was used to evaluate a non-linear multi-variable system, a 98% of fit between the model and experimental data was obtained. The identification of degradation byproducts was performed by high-performance liquid chromatography coupled to a time mass detector. After each process, at least four to five stable byproducts were found in the treated water, reducing the mineralization percentage to 20% for both molecules.

Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia: a case report of severe adverse events with a common drug

ABSTRACT Trimethoprim-sulfamethoxazole (TMP-SMX) is the primary therapeutic option for Pneumocystis jirovecii pneumonia (PCP). Gastrointestinal symptoms and cutaneous rash are common side effects, with hyperkalemia being uncommon in patients without kidney dysfunction, and myelotoxicity being even rarer. We present the case of a male patient with hypertension and a recent diagnosis of non-Hodgkin lymphoma, undergoing rituximab treatment for two months. He was admitted to the intensive care unit due to dyspnea, tachypnea, and pleuritic pain, requiring mechanical ventilation. Chest computed tomography showed bilateral and multilobed ground-glass opacities, compromising more than 80% of the lung parenchyma. Pulmonary tuberculosis and COVID-19 were ruled out. An angiotomography and Doppler ultrasound revealed an extensive pulmonary thrombus and deep venous thrombosis. Empiric treatment with TMP-SMX for PCP was initiated, but within four days, the patient experienced metabolic acidosis and severe hyperkalemia, necessitating hemodialysis. He also presented with progressive pancytopenia and critical levels of leukopenia and thrombocytopenia. The hypothesis of TMP-SMX-induced myelotoxicity was suspected. Considering the unavailability of an alternative treatment, it was opted to continue TMP-SMX and initiate a granulocyte-colony-stimulating factor. However, the patient maintained medullary deterioration, becoming refractory to the transfusion of blood derivates. On the 17th day of treatment, a clinical decision was made to suspend TMP-SMX, leading to improvements within 48 hours in marrow and kidney functions, metabolic acidosis, and hyperkalemia. Despite all efforts, the patient died after 35 days of hospitalization due to hospital-acquired infections. This case highlights the importance of clinicians recognizing potential myelotoxicity with TMP-SMX and promptly discontinuing the drug if necessary.

Thymidine-dependent Staphylococcus aureus and lung function in patients with cystic fibrosis: a 10-year retrospective case-control study

ABSTRACT Objective: Thymidine-dependent small-colony variants (TD-SCVs) of Staphylococcus aureus are being isolated with increasing frequency from patients with cystic fibrosis (CF). The aim of this study was to evaluate the relationship between TD-SCV isolation and pulmonary function in patients with CF, as well as to determine whether the emergence of TD-SCVs was associated with trimethoprim-sulfamethoxazole (TMP-SMX) use and with coinfection with other microorganisms. Methods: This was a retrospective case-control study including patients with CF who visited the Clinical Hospital Complex of the Federal University of Paraná, in Curitiba, Brazil, between 2013 and 2022. Demographic, clinical, and spirometric data, as well as information on TD-SCVs and other isolated microorganisms, were collected from the medical records of patients with CF and TD-SCVs (TD-SCV group; n = 32) and compared with those of a matched group of patients with CF without TD-SCVs (control group; n = 64). Results: Isolation of TD-SCVs was positively associated with TMP-SMX use (p = 0.009), hospitalization (p < 0.001), and impaired pulmonary function (p = 0.04). Conclusions: The use of TMP-SMX seems to contribute to the emergence of TD-SCVs, the isolation of which was directly associated with worse pulmonary function in our sample.

Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

Abstract Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

Ascorbate and Antibiotics, at Concentrations Attainable in Urine, Can Inhibit the Growth of Resistant Strains of Escherichia coli Cultured in Synthetic Human Urine.

There are conflicting reports on the antibacterial activity of ascorbate; all at concentrations much higher than the typical in human plasma, but that can be reached in urine. The effect of 10 mM ascorbate (in itself not inhibitory) along with antibiotics, was tested both in Mueller-Hinton broth (MHb) and in synthetic human urine (SHU), against resistant isolates of Escherichia coli from lower urinary infections. The activity of nitrofurantoin and sulfamethoxazole was higher in SHU than in MHb; minimal inhibitory concentrations (MICs) in SHU with ascorbate were below typical urinary concentrations. For other antibiotics, MICs were the same in MHb vs. SHU, with no effect of ascorbate in MHb; but in SHU with ascorbate, MICs of ciprofloxacin and gentamicin also went below reported urinary concentrations, with a lesser effect with norfloxacin and trimethoprim, and none with ampicillin. The effect of ascorbate was independent of oxygen and not related to the susceptibility of each strain to oxidative stress. Ascorbate oxidizes during incubation in SHU, and bacterial growth partially prevented oxidation. These results suggest that 10 mM ascorbate can enhance the inhibitory activity of antibiotics upon resistant strains in urine. Clinical experimentation with ascorbate-antibiotic combinations against urinary infections caused by resistant bacteria is warranted.

Antibiofilm and antimicrobial activity of curcumin-chitosan nanocomplexes and trimethoprim-sulfamethoxazole on Achromobacter, Burkholderia, and Stenotrophomonas isolates.

BACKGROUND: Non-fermenting Gram-negative Achromobacter xylosoxidans, Burkholderia cepacia complex, and Stenotrophomonas maltophilia species cause healthcare-associated infections, often showing resistance to first-line drugs such as trimethoprim-sulfamethoxazole (TMP-SXT). The aim of this study was to determine the effect of curcumin-chitosan nanocomplexes on biofilm-producing clinical isolates of non-fermenting Gram-negative bacilli. METHODS: A. xylosoxidans, B. cepacia complex, and S. maltophilia clinical isolates were identified by MALDI-TOF mass spectrometry. Antimicrobial susceptibility was determined by broth microdilution. Curcumin (Cur), chitosan (Chi), and sodium tripolyphosphate (TPP) were encapsulated by ionotropic gelation in magnetic nanoparticles (MNP) and were assessed by scanning electron microscopy (SEM) and Fourier-transform infrared (FTIR). Biofilm inhibition and eradication by Cur-Chi-TPP-MNP with TMP-SXT was assessed. RESULTS: Cur-Chi-TPP-MNP in combination with TMP-SXT showed biofilm inhibition activity in A. xylosoxidans (37.5 µg/mL), B. cepacia (18.75 µg/mL), and S. maltophilia (4.69-18.75 µg/mL) and low biofilm eradication activity in all three strains (150 - 300 µg/mL). CONCLUSIONS: Cur-Chi-TPP-MNP in combination with TMP-SXT was able to inhibit biofilm and in lower effect to eradicate established biofilms of clinical isolates of A. xylosoxidans, B. cepacia complex, and S. maltophilia species. Our results highlight the need to assess these potential treatment options to be used clinically in biofilm-associated infections.

Acute Toxicity of Daphnia magna Neonates Exposed to Single and Composite Mixtures of Four Emerging Contaminants.

The effects of emerging contaminants on environmental health are of high concern, especially those potentially induced by mixtures. We assessed single and composite mixtures of triclosan (T), 17ß-estradiol (E2), sulfamethoxazole (SMX), and nicotine (N) at various concentrations, on neonates of Daphnia magna. When used in single exposure, T and N induced high toxicity (100% immobility, each one), compared to SMX and E2 (2.5% and 10% immobility, respectively). When T, E2, SMX and N were in mixture, T had the highest contribution to the overall toxicity in mixture exposures. The N toxicity lowered when in a fourfold exposure (85% immobility in fourfold exposure). Due to the high toxicity of T and N, both alone and in the mixtures, our results can serve as a warning about the use of these substances and their release in the aquatic ecosystem.

Theoretical analysis of the effects of counterions on the supramolecular arrangement of sulfamethoxazole.

Active pharmaceutical ingredients are formulated as the salt form, aiming to modulate their physicochemical properties. In this regard, the optimization and choice of the salt former have a strong influence on toxicity, therapeutic efficiency, and bioavailability. Sulfamethoxazole (SMZ) salts with Na+, Cl-, and Br- counterions influence in the supramolecular arrangement as well as in their thermodynamic and kinetic parameters. Herein, we analyzed the interactions of the Na+, Cl-, and Br- counterions on the supramolecular arrangement of the sulfamethoxazole salts by Hirshfeld surfaces, fingerprint plots, and theoretical methods-quantum theory of atoms in molecules and natural bond orbitals. Moreover, we evaluated their electronic structure by density functional theory using calculation of the frontier molecular orbitals. Molecular electrostatic potential maps were also obtained to predict the interactions of the counterions along crystalline arrangements. We observed that the structures of [SMZ]+ and [SMZ]- ions differ slightly from the SMZ. The chemical reactivity indices show that the SMZ is kinetically more stable than its respective ions, while its anion is more polarizable, and its cation has a higher global electrophilicity index. The molecular electrostatic potential maps show high charge density in the sulfonyl group (nucleophilic region) and the heterocyclic amino group (electrophilic region). Although the molecular skeleton is identical among the three SMZ species and the presence of different counterions in the formation of the crystalline structure of the salts results in supramolecular arrangements with different patterns of intermolecular interactions, despite being very similar in terms of intensities.

Hipercalemia asociada a la administración de trimetoprima y sulfametoxazol

Introducción la trimetoprima y el sulfametoxazol es una combinación de agentes antimicrobianos, con su uso se han descrito algunas reacciones adversas, entre las que están las alteraciones electrolíticas como la hipercalemia. Objetivo la revisión de este caso se propone como una estrategia que permite proveer herramientas al personal de salud para la detección de un evento adverso como la hipercalcemia asociada a la administración de trimeoprim sulfametoxazol, antimicrobianos ampliamente usados en servicios de urgencias, hospitalización, unidades de cuidados especiales/intensivos e incluso de manera ambulatoria. Presentación de caso se presenta el reporte de un paciente sin los factores de riesgo descritos en la literatura para el desarrollo de hipercalemia, permitiendo a través de su discusión sensibilizar al personal de salud sobre este efecto, siendo además el primer caso reportado en nuestro medio en un paciente menor de 50 años. Discusión y conclusión Desde 1983 se registran los primeros casos de hipercalcemia asociados a la administración de estos antimicrobianos, describiéndose diferentes factores de riesgo como la edad, la coexistencia de insuficiencia renal, el uso de diuréticos ahorradores de potasio, antihipertensivos inhibidores de la enzima convertidora de angiotensina y receptores de angiotensina 2, si bien es importante vigilar estrechamente a estos grupos de riesgo, este evento puede presentarse también en ausencia de los mismos, como en el caso de este paciente.

Introduction Trimethoprim and sulfamethoxazole is a combination of antimicrobial agents, with its use some adverse reactions have been described, including electrolyte disturbances such as hyperkalemia. Purpose The review of this case is proposed as a strategy that allows providing iper to health personnel for the detection iper adverse iperc such as ipercalcemia associated with the administration of trimeoprim sulfamethoxazole, antimicrobials widely used in emergency services, hospitalization, special/intensive care units and even on an outpatient basis. Case presentation A patient case report is presented without the additional risk factors described in the literature for the development of hyperkalemia, allowing through its discussion to sensitize health personnel about this effect, also being the first case reported in our environment in a patient under 50 years old. Discussion and conclusion Since 1983, the first cases of hypercalcaemia associated with the administration of these antimicrobials have been recorded, describing different risk factors such as age, the coexistence of renal failure, the use of potassium-sparing diuretics, antihypertensive inhibitors of the angiotensin-converting enzyme and receptors. Of angiotensin 2, although it is important to closely monitor these risk groups, this event can also occur in their absence, as in the case of this patient.

Dermatosis Pustulosa Subcórnea / Subcorneal pustular dermatosis

RESUMEN La dermatosis pustulosa subcórnea o enfermedad de Sneddon Wilkinson, es una enfermedad poco frecuente, caracterizada por lesiones pustulosas, recurrentes que suelen coalescer. Esta afección también se relaciona con enfermedades neoplásicas o inmunológicas. El propósito de este estudio es describir un caso clínico de ladermatosis referida en una paciente de 54 años de edad inicialmente tratada con dapsona, aunque,si bien, durante dos meses hubo mejoría, posteriormente se observa desarrollo de nuevas lesiones y alteración de las transaminasas. Por este motivo se procede a cambiar de tratamiento, por trimetoprima /sulfametoxazol.

Abstract Subcorneal pustular dermatosis or Sneddon Wilkinson's disease is a rare disease characterized by recurrent pustular lesions that often coalesce. This condition is also associated with neoplastic or immunologic diseases. The purpose of this study is to describe a clinical case of the referred dermatosis in a 54-year-old female patient initially treated with dapsone, although there was improvement for two months, subsequently new lesions developed and transaminase alteration was observed, for this reason the treatment was changed to trimethoprim/sulfamethoxazole.

Hipersensibilidad al trimetoprim + sulfametoxazol en un paciente con osteomielitis en esquema de desensibilización

Introducción: La osteomielitis es una inflamación del tejido óseo, la cual puede ser causada por un agente infeccioso de tipo Gram positivo como Gram negativo, generalmente ocasionado por Staphylococcus aureus; esta infección usualmente es tratada con trimetoprim + sulfametoxazol, desafortunadamente durante el tratamiento pueden aparecer reacciones adversas a medicamentos de tipo alérgicas, lo que implicaría un cambio de antibiótico o someter al paciente a esquema de desensibilización. Objetivo: Reportar el caso de un paciente que fue sometido a dicho esquema, empleando la vía intravenosa. Resultados: Paciente masculino de 14 años de edad ingresó a la institución con osteomielits de tibia derecha en su posoperatorio de osteosintesis realizado dos meses antes. Se decidió iniciar tratamiento con TMP-SMX 300 mg intravenoso (IV) cada 12 horas. Se informó al paciente y ya que era menor de edad, a su familiar a cargo sobre la importancia del procedimiento, posibles riesgos y beneficios mediante consentimiento informado por escrito. El paciente presentó una erupción cutánea acompañada de prurito en el pecho y espalda, lo cual fue tratado y solucionado, por consiguiente se dispuso a someter al paciente al esquema para su desensibilización el cual fue realizado empleando el medicamento en solución inyectable (trimetoprim + sulfametoxazol 400 mg + 80 mg/5 mL) para dar continuidad a su tratamiento, además el paciente fue monitorizado y no se le administró tratamiento con antihistamínicos o corticoides para así evitar una respuesta errónea o resultados falsos/positivos durante el procedimiento. Conclusión: El paciente fue desensibilizado con éxito para continuar con su tratamiento farmacológico. Este caso reportado puede contribuir a modificar los esquemas de desensibilización actuales, el esquema de desensibilización es una herramienta muy útil para continuar el tratamiento farmacológico en pacientes con hipersensibilidad al TMP/SMX, sin necesidad de optar por otras alternativas terapéuticas que podrían ser menos eficaces para el control de la infección.

SUMMARY Introduction: Osteomyelitis is an inflammation of the bone tissue, which can be caused by a Gram-positive or Gram-negative infectious agent, generally caused by Staphylococcus aureus. This infection is usually treated with trimethoprim + sulfamethoxazole. Unfortunately, adverse drug reactions of the allergic type may appear during treatment, which would imply a change of antibiotic or subject the patient to a desensitization scheme. Objective: To report the case of a patient who underwent this scheme, using the intravenous route. Results: A 14-year-old male patient was admitted to the institution with osteomyelitis of the right tibia in his postoperative period of osteosynthesis performed two months earlier. It was decided to start treatment with TMP-SMX 300 mg intravenously (IV) every 12 hours. The patient and, since he was a minor, his dependent relative were informed about the importance of the procedure, possible risks and benefits through written informed consent. The patient presented a skin rash accompanied by itching on the chest and back. which was treated and resolved, therefore, the patient was submitted to the scheme for his desensitization, which was carried out using the medicine in injectable solution (trimethoprim + sulfamethoxazole 400 mg + 80 mg/5 mL) to continue his treatment, In addition, the patient was monitored and treatment with antihistamines or corticosteroids was not administered in order to avoid an erroneous response or false/positive results during the procedure. Conclusion: The patient was successfully desensitized to continue with his pharmacological treatment. This reported case can contribute to modify the current desensitization schemes; the desensitization scheme is a very useful tool to continue pharmacological treatment in patients with hypersensitivity to TMP/SMX, without the need to opt for other therapeutic alternatives that could be less effective for infection control.

Introdução: A osteomielite é uma inflamação do tecido ósseo, que pode ser causada por um agente infeccioso Gram-positivo ou Gram-negativo, geralmente causado por Staphylococcus aureus; essa infecção geralmente é tratada com trimetoprima + sulfametoxazol, mas infelizmente, durante o tratamento, podem surgir reações adversas medicamentosas do tipo alérgico, o que implicaria na troca de antibiótico ou submeter o paciente a um esquema de dessensibilização. Objetivo: Relatar o caso de um paciente submetido a esse esquema, pela via intravenosa. Resultados: Um paciente do sexo masculino de 14 anos foi admitido na instituição com osteomielite da tíbia direita em pós-operatório de osteossíntese realizada há dois meses. Optou-se por iniciar o tratamento com TMP-SMX 300 mg por via intravenosa (IV) a cada 12 horas. O paciente e, por ser menor de idade, seu familiar dependente foram informados sobre a importância do procedimento, possíveis riscos e benefícios por meio do termo de consentimento livre e esclarecido. O paciente apresentou erupção cutânea acompanhada de coceira no tórax e nas costas, que foi tratado e resolvido, portanto, o paciente foi submetido ao esquema para sua dessensibilização, que foi realizada utilizando o medicamento em solução injetável (trimetoprim + sulfa-metoxazol 400 mg + 80 mg/5 mL) para continuar seu tratamento. o paciente foi monitorado e não foi administrado tratamento com anti-histamínicos ou corticos-teróides para evitar resposta errônea ou resultados falsos/positivos durante o procedimento. Conclusão: O paciente foi dessensibilizado com sucesso para continuar com seu tratamento farmacológico. Este caso relatado pode contribuir para modificar os esquemas de dessensibilização atuais, o esquema de dessensibilização é uma ferramenta muito útil para continuar o tratamento farmacológico em pacientes com hipersensibilidade ao TMP/SMX, sem a necessidade de optar por outras alternativas terapêuticas que poderiam ser menos eficazes para o controle de infecção.

Simultaneous determination of sulfamethoxazole, trimethoprim and bromhexine in veterinary formulation using high performance liquid chromatography (HPLC)

Objetivo: desarrollar y validar un método simple, sensible y rápido para la determinación simultánea de sulfametoxazol (SMT), trimetoprima (TMP) y bromhexina (BMX) en formulación veterinaria por cromatografía líquida de alta resolución de acuerdo con las directrices de validación y control. Guía para la calidad analítica de medicamentos en productos alimenticios y medicamentos veterinarios, RDC 166/2017 y guías internacionales Conferencia Internacional sobre Armonización y Asociación Internacional de Químicos Analíticos Oficiales. Materiales y métodos: la separación se realizó en una columna analítica ThermoScientific® C18 AcclaimTM120 (4,6 x 250 mm, 5 µm), con caudal de 0,7 mL min-1 y detección a 245 nm, 265 nm y 271 nm, para BMX, SMT y TMP, respectivamente. Todas las mediciones se realizaron en metanol:agua (84:16 v/v; pH 3,0). Las curvas analíticas fueron lineales (r > 0,9997) en el rango de concentración de 15.0 a 30.0 µg-mL-1 para SMT, 3.0 a 9.0 µg-mL-1 para TMP y 0,5 a 2,0 µg-mL-1 para BMX. Resultados: el método demostró ser preciso con coeficientes de variación por debajo del límite máximo de 2,0%, robusto, sin influencia significativa de las variaciones utilizadas en el análisis, exacto (recuperación >99%) y selectivo, en la evaluación de la interferencia de adyuvantes Conclusión: por lo tanto, el método desarrollado demostró ser adecuado para los análisis de control de calidad de rutina para la determinación simultánea de SMT, TMP y BMX en formulaciones farmacéuticas.

SUMMARY Aim: To develop and to validate a simple, sensitive and fast method for the simultaneous determination of sulfamethoxazole (SMT), trimethoprim (TMP) and bromhexine (BMX) in veterinary formulation by high performance liquid chromatography according to the guidelines of the Validation and Control Guide for analytical quality of medicines in food products and veterinary medicines, RDC 166/2017 and international guides International Conference on Harmonization and International Association of Official Analytical Chemists. Materials and methods: The separation was performed on a ThermoScientific® C18 AcclaimTM120 analytical column (4.6 X 250 mm, 5 µm), with a flow rate of 0.7 mL min-1 and detection at 245 nm, 265 nm and 271 nm, for BMX, SMT and TMP, respectively. All measurements were performed in methanol: water (84:16 v/v; pH 3.0). The analytical curves were linear (r > 0.9997) in the concentration range of 15.0 to 30.0 µg-mL-1 for SMT, 3.0 to 9.0 µg-mL-1 for TMP and 0.5 to 2.0 µg-mL-1 for BMX. Results: The method proved to be accurate, with coefficients of variation below the maximum limit of 2.0%, robust, without significant influence of the variations used in the analysis, exact (recovery >99%) and selective, in the assessment of interference from adjuvants. Conclusion: Therefore, the developed method proved to be suitable for routine quality control analyzes for the simultaneous determination of SMT, TMP and BMX in pharmaceutical formulations.

Objetivo: desenvolver e validar um método simples, sensível e rápido para a determinação simultânea de sulfametoxazol (SMT), trimetoprima (TMP) e bromexina (BMX) em formulação veterinária por cromatografia líquida de alta eficiência de acordo com as diretrizes do Validation and Control Guia de qualidade analítica de medicamentos em produtos alimentícios e medicamentos veterinários, RDC 166/2017 e guias internacionais Conferência Internacional de Harmonização e Associação Internacional de Químicos Analíticos Oficiais. Materiais e métodos: a separação foi realizada em coluna analítica ThermoScientific® C18 AcclaimTM120 (4,6 X 250 mm, 5 µm), com vazão de 0,7 mL min-1 e detecção em 245 nm, 265 nm e 271 nm, para BMX , SMT e TMP, respectivamente. Todas as medições foram realizadas em metanol:água (84:16 v/v; pH 3,0). As curvas analíticas foram lineares (r > 0,9997) na faixa de concentração de 15,0 a 30,0 µg-mL-1 para SMT, 3,0 a 9,0 µg-mL-1 para TMP e 0,5 a 2,0 µg-mL-1 para BMX. Resultados: o método mostrou-se preciso, com coeficientes de variação abaixo do limite máximo de 2,0%, robusto, sem influência significativa das variações utilizadas na análise, exato (recuperação >99%) e seletivo, na avaliação da interferência de adjuvantes. Conclusão: portanto, o método desenvolvido mostrou-se adequado para análises de controle de qualidade de rotina para a determinação simultânea de SMT, TMP e BMX em formulações farmacêuticas.

Modeling the sulfamethoxazole degradation by active chlorine in a flow electrochemical reactor.

The aim of this study is to propose a continuous physicochemical model accounting for the active chlorine production used to degrade recalcitrant sulfamethoxazole (SMX) in an electrochemical flow reactor. The computational model describes the fluid mechanics and mass transfer occurring in the re/actor, along with the electrode kinetics of hydrogen evolution reaction arising on a stainless steel cathode, and the chloride oxidation on a DSA. Specifically, the anodic contributions assume the heterogeneous nature of the adsorbed chlorine species formed on this surface, which are a model requirement to correctly define the experimental reactor performance and degradation efficiency of the contaminant. The experimental validation conducted at different applied current densities, volumetric flows, and chloride concentrations is adequately explained by the model, thus evidencing some of the phenomena controlling the electrocatalytic chlorine production for environmental applications. The best conditions to eliminate the SMX are proposed based on the theoretical analysis of the current efficiency calculated with the model, and experimentally confirmed. The use of the Ti/RuO2-ZrO2-Sb2O3 anode at the bench scale improves the SMX removal by using electro-generated chlorine species adsorbed on its surface, which remarkably increases the oxidation potential of the system along with chlorine desorbed from the electrode. This is a technological innovation concerning other mediated oxidation methods entirely using oxidants in solution.

Retinocoroiditis toxoplásmica y la evolución del resultado visual en pacientes inmunocompetentes / Toxoplasmic retinochoroiditis and the evolution of visual results in immunocompetent patients

Objetivo: Determinar la evolución del resultado visual en pacientes con toxoplasmosis ocular activa. Métodos: Se realizó un estudio observacional prospectivo longitudinal en 101 pacientes inmunocompetentes con toxoplasmosis ocular activa, atendidos en la consulta de Uveítis del Hospital General Docente "Abel Santamaría", desde enero de 2012 a diciembre de 2018. Se evaluaron las variables localización de la lesión, tamaño, número, episodio, grado de inflamación, complicaciones, recurrencia postratamiento y mejor agudeza visual corregida. Se analizaron los resultados utilizando frecuencias absolutas y relativas, la asociación estadística chi cuadrado, las pruebas U Mann-Whitney o Kruskall Wallis, Friedman y de rangos con signos de Wilcoxon. Resultados: Según la localización de la lesión, los resultados visuales inferiores se presentaron en los pacientes con lesiones en zona I y los mejores se obtuvieron cuando hubo afectación en zona III. Se mostró una mejor evolución del resultado visual en los que tuvieron lesiones menores o iguales a un diámetro papilar. Existió diferencia estadística entre los diferentes grados de gravedad de la inflamación, con tendencia al incremento de la mejor agudeza visual corregida en el tiempo, después del tratamiento. Conclusiones: Durante la evolución de los pacientes inmunocompetentes con toxoplasmosis ocular activa se logra mejoría de la visión(AU)

Objective: Determine the evolution of visual results in patients with active ocular toxoplasmosis. Methods: An observational longitudinal prospective study was conducted of 101 immunocompetent patients with active ocular toxoplasmosis attending the Uveitis Service at Abel Santamaría General University Hospital from January 2012 to December 2018. The variables evaluated were injury location, size, number, episode, degree of inflammation, complications, post-treatment recurrence and best corrected visual acuity. Results were analyzed with absolute and relative frequencies, chi-square statistical association, the Mann-Whitney U or Kruskall Wallis tests, the Friedman test and the Wilcoxon signed-rank test. Results: According to injury location, the lowest visual results were obtained in patients with zone I lesions, whereas the best results corresponded to zone III lesions. A better visual result evolution was achieved in patients with lesions smaller than or equal to a papillary diameter. A statistical difference was found between the various degrees of inflammation severity, with a tendency to an increase in best corrected visual acuity with the passing of time after treatment. Conclusions: Visual improvement is achieved during the evolution of immunocompetent patients with active ocular toxoplasmosis(AU)