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(1) Background: Psoriasis is a common chronic inflammatory skin disease with different manifestations, affecting the quality of life at social, emotional, and professional dimensions and requiring long-term treatment. This study aimed to investigate the effect of psychosocial and clinical factors on adherence to topical treatment in psoriasis. (2) Methods: Self-reported measures and weighing the medicines were used to assess adherence. Psychopathological symptoms were measured using the Brief Symptoms Inventory (BSI). Social and clinical factors were assessed by a sociodemographic and clinical questionnaire. Adherence to treatment with topical medication was assessed using a sample of 102 psoriasis patients. (3) Results: The explanatory models of adherence to topical treatment in psoriasis translated into positive associations between adherence and the education level (higher education) (p = 0.03; φ = 0.23), the single-family household (p = 0.01; φ = 0.44), active employment status (p = 0.05; φ = -0.19), familiar history of psoriasis (p = 0.04; φ = -0.21), and the presence of obsessive-compulsive symptoms (p = 0.01; d = 0.29). (4) Conclusions: In patients who present the characteristics identified that influence non-adherence, instructions should be reinforced to increase adherence. The experimental mortality (39.6%) reduced the sample size, representing a limitation of the study.
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OBJECTIVE: Depressive symptoms following birth are common and can have adverse effects for mothers, children, and families. Changes in hypothalamic-pituitary-adrenal (HPA) axis regulation during pregnancy may be implicated in the development of postpartum depressive symptoms, particularly changes in placental corticotropinreleasing hormone (pCRH). However, few studies have tested how dynamic pCRH changes over pregnancy relate to postpartum depressive symptoms. This preregistered investigation tests associations of both pCRH levels and changes from early to late pregnancy with postpartum depressive symptoms. METHODS: The sample consists of 173 women studied in early, mid, and late pregnancy who later reported on depressive symptoms with the Edinburgh Postpartum Depression Scale during interviews at 1, 6 and 12 months postpartum. Blood samples were collected at each prenatal timepoint and assayed for pCRH using radioimmunoassay. Latent growth curve analysis was employed to identify distinct trajectories of pCRH during pregnancy. RESULTS: We identified three prenatal pCRH trajectories labeled as typical, flat, and accelerated. Each trajectory showed exponential increases in pCRH levels over the course of gestation but differed in overall levels and rates of change. pCRH levels were not associated with postpartum depressive symptoms. However, women with accelerated pCRH trajectories reported marginally higher depressive symptoms one month postpartum. Primary analysis models adjusted for marital status, income, prepregnancy BMI, parity, prenatal depressive symptoms, and gestational age. CONCLUSIONS: These findings add to our understanding of dynamic changes to maternal HPA axis regulation during pregnancy and contribute to growing evidence on how pCRH changes relate to the development of postpartum depressive symptoms.
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Hormônio Liberador da Corticotropina , Depressão Pós-Parto , Criança , Gravidez , Feminino , Humanos , Placenta , Depressão , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Período Pós-Parto , Hormônio AdrenocorticotrópicoRESUMO
Quercus suber is considered a sustainable tree mainly due to its outer layer (cork) capacity to regenerate after each harvesting cycle. Cork bark is explored for several application; however, its industrial transformation generates a significant amount of waste. Recently, cork by-products have been studied as a supplier of bioactive ingredients. This work aimed to explore whether near infrared spectroscopy (NIRS), a non-destructive analysis, can be employed as a screening device for selecting cork by-products with higher potential for bioactives extraction. A total of 29 samples of cork extracts were analysed regarding their qualitative composition. Partial least squares (PLS) models were developed for quantification purposes, and R2P and RER values of 0.65 and above 4, respectively, were obtained. Discrimination models, performed through PLS-DA, yielded around 80% correct predictions, revealing that four out of five of samples were correctly discriminated, thus revealing that NIR can be successfully applied for screening purposes.
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BACKGROUND: Corticobasal syndrome (CBS) is associated with diverse underlying pathologies, including the four-repeat (4R)-tauopathies. The Movement Disorders Society (MDS) criteria for progressive supranuclear palsy (PSP) proposed the novel category "probable 4R-tauopathy" to address the phenotypic overlap between PSP and corticobasal degeneration (CBD). OBJECTIVES: To investigate the clinical ability of the MDS-PSP criteria for probable 4R-tauopathy in predicting a negative amyloid-PET in CBS. Additionally, this study aims to explore CBS patients classified as 4R-tauopathy concerning their clinical features and neuroimaging degeneration patterns. METHODS: Thirty-two patients with probable CBS were prospectively evaluated and split into those who fulfilled or did not fulfill the 4R-tauopathy criteria (CBS-4RT+ vs. CBS-4RT-). All patients underwent positron emission tomographies (PET) with [18 F]fluorodeoxyglucose and [11 C]Pittsburgh Compound-B (PIB) on a hybrid PET-MRI scanner to perform multimodal quantitative comparisons with a control group. RESULTS: Eleven patients were clinically classified as CBS-4RT+, and only one had a positive PIB-PET. The CBS-4RT+ classification had 92% specificity, 52% sensitivity, and 69% accuracy in predicting a negative PIB-PET. The CBS-4RT+ group presented with dysarthria and perseveration more often than the CBS-4RT- group. Moreover, the CBS-4RT+ group showed a prominent frontal hypometabolism extending to the supplementary motor area and striatum, and brain atrophy at the anterior cingulate and bilateral striata. CONCLUSIONS: The 4R-tauopathy criteria were highly specific in predicting a negative amyloid-PET in CBS. Patients classified as 4R-tauopathy presented distinct clinical aspects, as well as brain metabolism and atrophy patterns previously associated with tauopathies.
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Degeneração Corticobasal , Tauopatias , Humanos , Fluordesoxiglucose F18/metabolismo , Tauopatias/metabolismo , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Atrofia/metabolismoRESUMO
Introdução: Pacientes com câncer apresentaram risco de desenvolver quadros respiratórios graves quando acometidos por covid-19, com necessidade de suporte intensivo e de ventilação mecânica invasiva (VMI). Objetivo: Avaliar os fatores associados ao óbito em pacientes oncológicos que tiveram covid-19 e evoluíram com insuficiência respiratória e necessidade de VMI. Método: Estudo de coorte retrospectivo de pacientes com câncer em uma unidade de terapia intensiva (UTI) oncológica, com covid-19 e em VMI de abril de 2020 a dezembro de 2021. Foram incluídos de forma sequencial todos os pacientes com câncer admitidos na UTI em VMI ou que evoluíram com VMI por agravamento da covid-19, sendo excluídos aqueles em controle da doença oncológica há mais de cinco anos. Para a análise estatística, foram utilizadas medidas de tendência central e dispersão, assim como frequências absolutas e relativas. A regressão logística múltipla foi aplicada para a avaliação dos fatores associados à mortalidade, considerando estatisticamente significantes valores de p < 0,05. Resultados: Foram incluídos no estudo 85 pacientes. O óbito foi maior entre os pacientes com tumores sólidos (OR = 3,64; IC 95%: 1,06-12,52; p = 0,04), entre os que necessitaram de suporte renal durante a internação na UTI (OR = 6,88; IC 95%: 1,82-25,98; p = 0,004), os que não puderam ser extubados (OR = 8,00; IC 95%: 2,16-29,67; p = 0,002) e os que apresentaram o valor de pressão de distensão alveolar maior do que 15cmH2O por pelo menos um dia (OR = 5,9; IC 95%: 1,76-19,80; p = 0,004). Conclusão: Características clínicas e de VMI estavam associadas à morte de pacientes oncológicos com covid-19 e em VMI.
Los pacientes con cáncer corrían riesgo de desarrollar afecciones respiratorias graves al ser afectados por la COVID-19, requiriendo soporte intensivo y ventilación mecánica invasiva (VMI). Objetivo: Evaluar los factores asociados a la muerte en pacientes con cáncer que tuvieron COVID-19 y que desarrollaron insuficiencia respiratoria y necesidad de VMI. Método: Estudio de cohorte retrospectivo en pacientes oncológicos internados en una unidad de cuidados intensivos (UCI) de oncología, con COVID-19 y en VMI de abril de 2020 a diciembre de 2021. Se incluyeron secuencialmente todos los pacientes con cáncer ingresados en UCI con VMI o que necesitaron VMI por empeoramiento de la COVID-19, excluyendo a aquellos que llevaban más de cinco años bajo control de la enfermedad oncológica. Para el análisis estadístico se utilizaron medidas de tendencia central y dispersión, así como frecuencias absolutas y relativas. Se aplicó regresión logística múltiple para evaluar los factores asociados a la mortalidad, considerando valores de p<0,05 estadísticamente significativos. Resultados: Se incluyeron en el estudio 85 pacientes. La muerte fue mayor entre los pacientes con tumores sólidos (OR= 3,64; IC 95%, 1,06-12,52; p=0,04), entre los que requirieron soporte renal durante la estancia en UCI (OR = 6,88; IC 95%, 1,82-25,98; p= 0,004), entre los que no pudieron ser extubados (OR= 8,00; IC 95%, 2,16-29,67; p= 0,002) y entre los que presentaron un valor de presión de distensión alveolar mayor a 15cmH2O durante al menos un día (OR = 5,9; IC 95%, 1,76-19,80; p=0,004). Conclusión: Las características clínicas y de VMI se asociaron con la muerte en pacientes oncológicos con COVID-19 y en VMI.
Cancer patients were at risk of developing severe respiratory conditions when affected by COVID-19, requiring intensive support and invasive mechanical ventilation (IMV). Objective: Evaluate the factors associated with death of cancer patients by COVID-19 who developed respiratory failure and need of IMV. Method: Retrospective cohort study of cancer patients in an oncology intensive care unit (ICU), with COVID-19 and on IMV was carried out from April 2020 to December 2021. All patients with cancer admitted to the ICU on IMV or who developed IMV due to worsening of COVID-19 were sequentially included, excluding those who had been in follow-up of the oncological disease for more than five years. For statistical analysis, measures of central tendency and dispersion were used, as well as absolute and relative frequencies. Multiple logistic regression was applied to evaluate factors associated with mortality, considering statistically significant values of p < 0.05. Results: 85 patients were included in the study. Death was higher for patients with solid tumors (OR= 3.64; 95% CI, 1.06-12.52; p = 0.04), in addition to those who required renal support while in ICU (OR = 6.88; 95% CI, 1.82-25.98; p = 0.004), those who could not be extubated (OR= 8.00; 95% CI, 2.16-29.67; p = 0.002) and who presented an alveolar distension pressure value greater than 15cmH2O for at least one day (OR= 5.9; 95% CI, 1.76-19.80; p = 0.004). Conclusion:Clinical and IMV characteristics were associated with death in cancer patients with COVID-19 and IMV
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Neoplasias , Síndrome do Desconforto Respiratório do Recém-Nascido , Ventiladores Mecânicos , Epidemiologia , Cuidados Críticos , COVID-19RESUMO
INTRODUCTION: Pyruvate Dehydrogenase Complex (PDC) is a pivotal gatekeeper between cytosolic glycolysis and mitochondrial oxidative phosphorylation, playing important role in aerobic energy metabolism. Most PDC deficiency, cases being caused by mutations in PDHA1 encoding the α subunit of the rate-limiting E1 enzyme, which is characterized by abnormal phenotypes caused by energy deprivation at peripheral/central nervous systems and muscular tissues. This study aims to evaluate the potential therapeutic effect of arginine and thiamine in ameliorating mitochondrial function in patient-derived cultured cells. MATERIALS AND METHODS: PDC-deficient cell lines, carrying three different PDHA1 variants, were cultured in the absence and presence of arginine and/or thiamine at therapeutical levels, 4 mM and 100 µM, respectively. Mitochondrial bioenergetics profile was evaluated using the Seahorse extracellular flux analyzer. RESULTS: In physiological conditions, control cells presented standard values for all parameters evaluating the mitochondrial function, no differences being observed after supplementation of culture medium with therapeutic levels of arginine and/or thiamine. However, PDC-PDHA1 deficient cell lines consumed less oxygen than the control cells, but arginine and thiamine supplementation increased the basal respiration for values similar or higher than the control cell line. Moreover, arginine and thiamine treatment highlighted an inefficient oxidative phosphorylation carried out by PDC-deficient cell lines. Finally, this treatment showed an increased oxygen consumption by enzymes other than those in the respiratory chain, thus proving the dependence of these mutant cell lines on cytosolic sources for ATP production, namely glycolysis. CONCLUSIONS: This study showed that arginine and thiamine, at therapeutical levels, increase the basal oxygen consumption rate of PDC-deficient cell lines, as well as their ATP-linked respiration. This parameter measures the capacity of the cell to meet its energetic demands and, therefore, its increase reveals a higher electron flow through the respiratory chain, which is coupled to elevated oxidative phosphorylation, thus indicating an overall increased robustness in mitochondrial- related bioenergetics.
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INTRODUCTION: Glutaric acidemia type 1 (GA1) is a rare autosomal recessive disorder characterized by a deficiency of glutaryl-CoA dehydrogenase, resulting in the accumulation of glutaric acid (GA), 3-hydroxyglutaric acid, and glutarylcarnitine, especially in the brain. GA1-affected children are clinically characterized by macrocephaly. Neurological abnormalities usually appear between 6 and 18 months of age, often triggered by a catabolic event. On the other hand, several biochemically affected individuals may remain asymptomatic or experience an insidious onset of mild neurological abnormalities. METHODS: Retrospective study of GA1 patients followed at a Portuguese Hereditary Metabolic Disease Center, to characterize the phenotypic and genotypic variations associated with GA1. Therefore, we analyzed the clinical, neuroradiological, biochemical, and genetic information from 14 patients. RESULTS: 14 patients (four months-27 years old) were identified in the last 26 years, 9 were male, 1 was from a consanguineous family. 11 were diagnosed by newborn screening (NBS), and 3 identified following clinical symptoms (later diagnosed, LD). There were 3 phenotypic presentations: 6 asymptomatic, 3 with a motor disability after encephalopathic crisis (EC), and 5 with insidious onset. Acute EC occurred in 1/3 of the LD patients and in 2/11 NBS-identified patients. About urinary GA concentrations: 5 were low excretors (LE), 9 were high excretors (HE). All LE showed symptoms, and 2 had EC. Concerning HE, 3 showed symptoms and 1 had EC. GCDH analysis showed: 6 compound heterozygotes and 8 homozygotes. most frequent variant was c.1204C>T (p.R402W). All of them received appropriate therapy from the time of diagnosis, with a mean age of 23.3 months in LD patients and 13.3 days in NBS-identified patients. CONCLUSION: The outcomes were different between the two groups: all the LD patients presented motor dysfunction however in the NBS-identified patients only 5 developed this symptom. Patients identified by NBS had better outcomes showing that NBS enables an early diagnosis, and treatment, and consequently improves the clinical outcomes for these patients. No correlation was observed with clinical phenotype between LE and HE, as both groups can suffer the most severe neurological manifestations. These conclusions are in agreement with previous cohorts described in the literature.
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Introduction: Adolescence is a critical period of development during which young people are vulnerable to engaging in risky be haviors, including drug use. Early use of psychoactive substances can interfere with normal development and have both short-term and long-term social and health problems. Objectives: This case report aims to review important aspects of the substance abuse disorder treatment in teenage patients, based on the detailed description of a clinical case. Methods: Description of a clinical case of an 18-year-old patient who began using psychoactive substances at the age of 13. The information used in the review was gathered from relevant publications found through a selective search in PubMed on substance use disorders in children and adolescents. Results: This case report describes the substance use disorder of an 18-year-old female patient, who began using psychoactive substances at the age of 13. The patient had a history off loss of her mother, depressive symptoms and self-injurious behavior, which likely contributed to her increased risk for substance use. The patients substance use began with tobacco and gradually progressed to cannabinoids, ecstasy, opioids, and cocaine. Due to her continued substance use, she was referred for consultation at a specialized treatment team. The patient received a combination of psychotherapeutic interventions for substance use and individual therapy. The plan included also coordination with social work and psychology, and the involvement of the individuals family in the process.Despite these efforts, the patient was ultimately hospitalized for severe self-harm behaviors and entered a therapeutic community.Discussion and Conclusion: This case highlights the complexity of substance use disorders in adolescents and the importance of addressing multiple individual and environmental factors in order...(AU)
Introducción: La adolescencia es un período crítico del desarrollo durante el cual los jóvenes son vulnerables a adoptar conductas de riesgo, incluyendo el consumo de drogas. El uso temprano de sustancias psicoactivas puede interferir con el desarrollo normal y tener problemas sociales y de salud, tanto a corto como a largo plazo.Metas: Este reporte de caso tiene como objetivo revisar aspectos fundamentales del tratamiento del trastorno por abuso de sustancias en pacientes adolescentes, a partir de la descripción detallada de un caso clínico.Métodos: Descripción de un caso clínico de una paciente de 18 años que empezó a consumir sustancias psicoactivas a partir de los 13 años. La información utilizada en esta revisión se obtuvo de publicaciones relevantes encontradas mediante una búsqueda selectiva, en la plataforma PubMed, sobre trastornos por consumo de sustancias en niños y adolescentes.Resultados: Este reporte de caso describe el trastorno por consumo de sustancias de una paciente de sexo femenino de 18 años, que empezó a consumir sustancias psicoactivas a partir de los 13 años. La paciente tenía antecedentes de pérdida de su madre, síntomas depresivos y comportamiento autoagresivo, que probablemente contribuyó a su mayor riesgo de consumo de sustancias. El consumo de sustancias de la paciente empezó con el tabaco y progresó gradualmente a cannabinoides, éxtasis, opioides y cocaína.Debido al consumo continuado de sustancias, fue derivada a consulta, a un equipo de tratamiento especializado. La paciente recibió una combinación de intervenciones psicoterapéuticas para el uso de sustancias y terapia individual. El plan incluía también la coordinación con trabajo social y psicología, y la participación de la familia en el proceso. A pesar de estos esfuerzos, la paciente finalmente fue hospitalizada por conductas autolesivas severas y ingresó a una comunidad terapéutica.(AU)
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Humanos , Masculino , Feminino , Adolescente , Transtornos Relacionados ao Uso de Substâncias/psicologia , Consumo de Álcool por Menores , Comportamento de Procura de Droga , Processos Psicoterapêuticos , Comportamento do Adolescente , Depressão , Saúde do Adolescente , Saúde Mental , Psicologia do Adolescente , Psiquiatria , Medicina Psicossomática , Pacientes Internados , Exame FísicoRESUMO
BACKGROUND: Xeroderma pigmentosum group E (XP-E) is one of the least common forms of XP, a rare syndrome where patients are prone to develop skin cancer in exposed sunlight areas. XP-E patients are generally not diagnosed until they are adults due to the mild phenotype. CASE PRESENTATION: two XP-E siblings, female, 23 years, and male, 25 years, from a Brazilian consanguineous family carrying the novel missense pathogenic variant in DDB2 gene, NM_000107.3:c.1027G > C, associated with skin cancer early-onset and severe phenotype, as nodular melanoma in the cornea and in the ear. CONCLUSION: The assessment of genomic variant pathogenicity was a challenge since this family belongs to an underrepresented population in genomic databases. Given the scarcity of literature documenting XP-E cases and the challenges encountered in achieving an early diagnosis, this report emphasizes the imperative of sun protection measures in XP-E patients. Additionally, it highlights the detrimental impact of the COVID-19 pandemic on cancer diagnosis, leading to the manifestation of a severe phenotype in affected individuals.
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COVID-19 , Melanoma , Neoplasias Cutâneas , Xeroderma Pigmentoso , Masculino , Feminino , Humanos , Xeroderma Pigmentoso/genética , Xeroderma Pigmentoso/epidemiologia , Xeroderma Pigmentoso/patologia , Brasil , Pandemias , Irmãos , COVID-19/epidemiologia , Melanoma/genética , Neoplasias Cutâneas/genética , Reparo do DNA , Proteínas de Ligação a DNA/genéticaRESUMO
Floods have caused socio-economic and environmental damage globally and, thus, require research. Several factors influence flooding events, such as extreme rainfall, physical characteristics, and local anthropogenic factors; therefore, such factors are essential for mapping flood risk areas and enabling measures that mitigate the damage they cause. This study aimed to map and analyze regions susceptible to flood risk in three different study areas belonging to the same Atlantic Forest biome, in which flood disasters are recurrent. Due to the presence of numerous factors, a multicriteria analysis using the Analytical Hierarchical Process was conducted. First, a geospatial database was composed of layers of elevation, slope, drainage distance, soil drainage, soil hydrological group, precipitation, relief, and land use and cover. Flood risk maps for the study area were then generated, and patterns in the study areas were verified, with the greatest influence being exerted by intense precipitation on consecutive days, elevation at the edges of the channel with low altimetric variation and a flat combination, densely built areas close to the banks of the main river, and an expressive water mass in the main watercourse. The results demonstrate that these characteristics together can indicate the occurrence of flooding events.
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Desastres , Inundações , Cidades , Brasil , EcossistemaRESUMO
Wheat (Triticum aestivum L.) is a major source of nutrients for populations across the globe, but the amino acid composition of wheat grain does not provide optimal nutrition. The nutritional value of wheat grain is limited by low concentrations of lysine (the most limiting essential amino acid) and high concentrations of free asparagine (precursor to the processing contaminant acrylamide). There are currently few available solutions for asparagine reduction and lysine biofortification through breeding. In this study, we investigated the genetic architecture controlling grain free amino acid composition and its relationship to other traits in a Robigus × Claire doubled haploid population. Multivariate analysis of amino acids and other traits showed that the two groups are largely independent of one another, with the largest effect on amino acids being from the environment. Linkage analysis of the population allowed identification of quantitative trait loci (QTL) controlling free amino acids and other traits, and this was compared against genomic prediction methods. Following identification of a QTL controlling free lysine content, wheat pangenome resources facilitated analysis of candidate genes in this region of the genome. These findings can be used to select appropriate strategies for lysine biofortification and free asparagine reduction in wheat breeding programs.
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Aminoácidos , Triticum , Aminoácidos/genética , Mapeamento Cromossômico , Triticum/genética , Triticum/química , Asparagina/análise , Asparagina/genética , Lisina/genética , Melhoramento Vegetal , Grão Comestível/genética , Reino UnidoRESUMO
Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren's syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS.
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Síndrome Antifosfolipídica , Produtos Biológicos , Lúpus Eritematoso Sistêmico , Síndrome de Sjogren , Humanos , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/tratamento farmacológico , Rituximab/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Terapia BiológicaRESUMO
OBJECTIVE: Vasculitis are a very heterogenous group of systemic autoimmune diseases, affecting large vessels (LVV), small vessels or presenting as a multisystemic variable vessel vasculitis. We aimed to define evidence and practice-based recommendations for the use of biologics in large and small vessels vasculitis, and Behçet's disease (BD). METHODS: Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice on autoimmune diseases management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2022. Preliminary recommendations were drafted by working groups for each disease and voted in two rounds, in June and September 2021. Recommendations with at least 75% agreement were approved. RESULTS: A total of 32 final recommendations (10 for LVV treatment, 7 for small vessels vasculitis and 15 for BD) were approved by the experts and several biologic drugs were considered with different supporting evidence. Among LVV treatment options, tocilizumab presents the higher level of supporting evidence. Rituximab is recommended for treatment of severe/refractory cryoglobulinemic vasculitis. Infliximab and adalimumab are most recommended in treatment of severe/refractory BD manifestations. Other biologic drugs can be considered is specific presentations. CONCLUSION: These evidence and practice-based recommendations are a contribute to treatment decision and may, ultimately, improve the outcome of patients living with these conditions.
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Síndrome de Behçet , Produtos Biológicos , Vasculite , Humanos , Síndrome de Behçet/tratamento farmacológico , Vasculite/tratamento farmacológico , Rituximab/uso terapêutico , Terapia Biológica , Produtos Biológicos/uso terapêuticoRESUMO
The growing threat of climatic crisis and fossil fuel extinction has caused a boom in sustainability trends. Consumer demand for so-called eco-friendly products has been steadily increasing, built upon the foundation of environmental protection and safeguarding for future generations. A natural product that has been used for centuries is cork, resulting from the outer bark of Quercus suber L. Currently, its major application is the production of cork stoppers for the wine industry, a process that, although considered sustainable, generates by-products in the form of cork powder, cork granulates, or waste such as black condensate, among others. These residues possess constituents of interest for the cosmetic and pharmaceutical industries, as they exhibit relevant bioactivities, such as anti-inflammatory, antimicrobial, and antioxidant. This interesting potential brings forth the need to develop methods for their extraction, isolation, identification, and quantification. The aim of this work is to describe the potential of cork by-products for the cosmetic and pharmaceutical industry and to assemble the available extraction, isolation, and analytical methods applied to cork by-products, as well the biological assays. To our knowledge, this compilation has never been done, and it opens new avenues for the development of new applications for cork by-products.
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Quercus , Quercus/química , Preparações FarmacêuticasRESUMO
Skin repair encompasses epidermal barrier repair and wound healing which involves multiple cellular and molecular stages. Therefore, many skin repair strategies have been proposed. In order to characterize the usage frequency of skin repair ingredients in cosmetics, medicines, and medical devices, commercialized in Portuguese pharmacies and parapharmacies, a comprehensive analysis of the products' composition was performed. A total of 120 cosmetic products, collected from national pharmacies online platforms, 21 topical medicines, and 46 medical devices, collected from INFARMED database, were included in the study, revealing the top 10 most used skin repair ingredients in these categories. A critical review regarding the effectiveness of the top ingredients was performed and an in-depth analysis focused on the top three skin repair ingredients pursued. Results demonstrated that top three most used cosmetic ingredients were metal salts and oxides (78.3%), vitamin E and its derivatives (54.2%), and Centella asiatica (L.) Urb. extract and actives (35.8%). Regarding medicines, metal salts and oxides were also the most used (47.4%) followed by vitamin B5 and derivatives (23.8%), and vitamin A and derivatives (26.3%). Silicones and derivatives were the most common skin repair ingredients in medical devices (33%), followed by petrolatum and derivatives (22%) and alginate (15%). This work provides an overview of the most used skin repair ingredients, highlighting their different mechanisms of action, aiming to provide an up-to-date tool to support health professionals' decisions.
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Topical treatments are essential approaches to skin diseases but are associated with poor adherence. Topical vehicles have the primary purpose of ensuring drug effectiveness (by modulating drug stability and delivery, as well as skin properties) but have a marked impact on treatment outcomes as they influence patient satisfaction and, consequently, adherence to topical treatments. There is also a wide variety of vehicles available for topical formulations, which can complicate the decisions of clinicians regarding the most appropriate treatments for specific skin disorders. One of the possible strategies to improve topical-treatment adherence is the implementation of patient-centric drug-product design. In this process, the patient's needs (e.g., those related to motor impairment), the needs associated with the disease (according to the skin lesions' characteristics), and the patient's preferences are taken into consideration and translated into a target product profile (TPP). Herein, an overview of topical vehicles and their properties is presented, along with a discussion of the patient-centric design of topical dermatological medicines and the proposal of TPPs for some of the most common skin diseases.
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Resveratrol (RSV), a naturally occurring metabolite, is widely used in skincare products, but its hydrophobicity impairs its own incorporation into cosmetic formulations. RSV-GS is a synthetic hydrophilic sulfated glycosylated derivative inspired by marine natural products that present a lower cytotoxicity than RSV while exhibiting similar levels of bioactivity. Herein, we predict the skin sensitization potential of this new compound using an in vitro approach based on the OECD 442E guideline. Furthermore, the anti-allergic potential of RSV-GS was also disclosed. The monocyte THP-1 cell line was stimulated with RSV and RSV-GS in the presence or absence of the extreme skin allergen 1-fluoro-2,4-dinitrobenzene (DNFB). The results demonstrated that RSV-GS alone (500 µM) evoked a relative fluorescence index (RFI) lower than the thresholds established by the OECD guideline for CD54 (200%) and CD86 (150%), indicating the absence of a skin sensitization potential. Interestingly, in the presence of the skin allergen DNFB, RSV-GS exhibited the ability to rescue the DNFB-induced maturation of THP-1 cells, with RFI values lower than those for RSV, suggesting the potential of RSV-GS to mitigate skin sensitization evoked by allergens and, consequently, allergic contact dermatitis. These results open new avenues for the use of RSV-GS as a safe and anti-allergic active cosmetic ingredient.
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Antialérgicos , Resveratrol/farmacologia , Sulfatos , Dinitrofluorbenzeno , AlérgenosRESUMO
Pruritus, the most common symptom in dermatology, is an innate response capable of protecting skin against irritants. Nonetheless, when it lasts more than six weeks it is assumed to be a chronic pathology having a negative impact on people's lives. Chronic pruritus (CP) can occur in common and rare skin diseases, having a high prevalence in global population. The existing therapies are unable to counteract CP or are associated with adverse effects, so the development of effective treatments is a pressing issue. The pathophysiological mechanisms underlying CP are not yet completely dissected but, based on current knowledge, involve a wide range of receptors, namely neurokinin 1 receptor (NK1R), Janus kinase (JAK), and transient receptor potential (TRP) ion channels, especially transient receptor potential vanilloid 1 (TRPV1) and transient receptor potential ankyrin 1 (TRPA1). This review will address the relevance of these molecular targets for the treatment of CP and molecules capable of modulating these receptors that have already been studied clinically or have the potential to possibly alleviate this pathology. According to scientific and clinical literature, there is an increase in the expression of these molecular targets in the lesioned skin of patients experiencing CP when compared with non-lesioned skin, highlighting their importance for the development of potential efficacious drugs through the design of antagonists/inhibitors.
Assuntos
Canais de Cátion TRPV , Canais de Potencial de Receptor Transitório , Humanos , Canais de Cátion TRPV/metabolismo , Prurido/tratamento farmacológico , Prurido/metabolismo , Pele/metabolismo , Desenho de FármacosRESUMO
The nutritional safety of wheat-based food products is compromised by the presence of the processing contaminant acrylamide. Reduction of the key acrylamide precursor, free (soluble, non-protein) asparagine, in wheat grain can be achieved through crop management strategies, but such strategies have not been fully developed. We ran two field trials with 12 soft (biscuit) wheat varieties and different nitrogen, sulfur, potassium, and phosphorus fertilizer combinations. Our results indicated that a nitrogen-to-sulfur ratio of 10:1 kg/ha was sufficient to prevent large increases in free asparagine, whereas withholding potassium or phosphorus alone did not cause increases in free asparagine when sulfur was applied. Multispectral measurements of plants in the field were able to predict the free asparagine content of grain with an accuracy of 71%, while a combination of multispectral, fluorescence, and morphological measurements of seeds could distinguish high free asparagine grain from low free asparagine grain with an accuracy of 86%. The acrylamide content of biscuits correlated strongly with free asparagine content and with color measurements, indicating that agronomic strategies to decrease free asparagine would be effective and that quality control checks based on product color could eliminate high acrylamide biscuit products.
RESUMO
Ultraviolet (UV) radiation promotes the generation of reactive oxygen species (ROS) and nitrogen species (RNS), resulting in skin damage. Cosmetic industries have adopted a strategy to incorporate antioxidants in sunscreen formulations to prevent or minimize UV-induced oxidative damage, boost photoprotection effectiveness, and mitigate skin photoaging. Many antioxidants are naturally derived, mainly from terrestrial plants; however, marine organisms have been increasingly explored as a source of new potent antioxidant molecules. This work aims to characterize the frequency of the use of antioxidants in commercial sunscreens. Photoprotective formulations currently marketed in parapharmacies and pharmacies were analyzed with respect to the composition described on the label. As a result, pure compounds with antioxidant activity were found. The majority of sunscreen formulations contained antioxidants, with vitamin E and its derivatives the most frequent. A more thorough analysis of these antioxidants is also provided, unveiling the top antioxidant ingredients found in sunscreens. A critical appraisal of the scientific evidence regarding their effectiveness is also performed. In conclusion, this work provides an up-to-date overview of the use of antioxidants in commercial sunscreens for a better understanding of the advantages associated with their use in photoprotective formulations.