Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB.

The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.

7.1',8.3'- and 7.3',8.5'-Connected Bicyclo[3.2.1]octanoids and Oxabicyclo[3.2.2]nonane-Type Neolignans from Ocotea aciphylla: Structures and Absolute Configurations.

The phytochemical investigation of the leaves and trunk bark of a specimen of Ocotea aciphylla collected in the southern portion of the Amazon forest led to the isolation of an oxabicyclo[3.2.2]nonane-type neolignan and 15 bicyclo[3.2.1]octanoid neolignans, 14 of which are unreported compounds (2-15), including one with an unusual oxidation pattern of the side chain at C-1' and two rare 7.1',8.3'-connected bicyclo[3.2.1]octanoid derivatives. Their structures and relative configurations were determined by extensive spectrometric analysis based on 1D- and 2D-NMR spectroscopy and HRESIMS data, while their absolute configurations were unambiguously assigned using electronic and vibrational circular dichroism data assisted by density functional theory calculations. Additionally, known sesquiterpenes, phenylpropanoids, and phytosterols were also isolated.

Anti-TNF therapy for ulcerative colitis in Brazil: a comparative real-world national retrospective multicentric study from the Brazilian study group of IBD (GEDIIB).

BACKGROUND: Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment. METHODS: A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ2 or Fisher's exact test when appropriated, and Kaplan Meier analysis. RESULTS: Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p < 0.0001) and 52 (65.24% vs. 51.35%, p < 0.0001) when compared to ADA. According to Kaplan-Meier survival curve loss of response was less frequent in the Infliximab compared to Adalimumab group (p = 0.001). Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the groups (p = 0.114). Colectomy was performed in 23 patients (5.99%). Age, non-prior exposure to biological therapy, use of IFX and endoscopic remission at week 26 were associated with clinical remission after 52 weeks. Variables associated with endoscopic remission were non-prior exposure to biological therapy, and clinical and endoscopic remission at week 26. CONCLUSIONS: IFX was associated with higher rates of clinical remission after 1 year in comparison to ADA. Non-prior exposure to biological therapy and early response to anti-TNF treatment were associated with higher rates of clinical and endoscopic remission.

Siolmatra brasiliensis stem extract ameliorates antioxidant defenses and mitigates glycoxidative stress in mice with high-fat diet-induced obesity.

BACKGROUND: Obesity is accompanied by insulin resistance and glucose intolerance, which favor the onset of complications related to oxidative stress. The aim of this study was to investigate the effects and underlying mechanisms of hydroethanolic extract from Siolmatra brasiliensis stems on insulin resistance, glucose intolerance, advanced glycation end product (AGE) formation, and oxidative stress in mice with induced obesity. METHODS: C57BL-6 J mice were fed a high-fat diet for 14 weeks and treated with 125 or 250 mg/kg S. brasiliensis extract during the last 7 weeks. The study assessed glucose tolerance and insulin sensitivity, lipid profile, plasma levels of thiobarbituric acid reactive substances (TBARS, biomarkers of oxidative damage), fluorescent AGEs (biomarkers of advanced glycation), and paraoxonase 1 (PON1) activity (antioxidant enzyme). The activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) in the liver and kidneys were also investigated. RESULTS: Siolmatra brasiliensis extract had antiobesogenic effects; improved insulin sensitivity and glucose tolerance; decreased the total plasma cholesterol levels; decreased the levels of glycoxidative stress biomarkers, including AGEs (plasma, liver, kidneys) and TBARS (liver, kidneys); and also improved endogenous antioxidant defenses by increasing the activities of PON1 (plasma), SOD (kidneys), CAT (liver, kidneys), and GSH-Px (kidneys). CONCLUSION: This study expands on our knowledge about the pharmacological properties of S. brasiliensis and substantiates the potential of this plant species to be used as a complementary therapeutic agent to alleviate the metabolic dysfunctions resulting from dyslipidemia and glycoxidative stress.

Safety assessment for temporary hospitals during the COVID-19 pandemic: A simulation approach.

Amid the devastating effects caused by the pandemic of the new Coronavirus (COVID-19), health leaders around the world are adding efforts to search efficient and effective responses in the fight against the disease. Conventional health centers, such as hospitals and emergency departments have been registering an increase in demand and atypical patterns due to the high transmissibility of the virus. In this context, the adoption of Temporary Hospitals (THs) is effective in trying to relieve conventional hospitals and direct efforts in the treatment of suspected and positive patients for COVID-19. However, some requirements should be considered regarding the processes performed by THs to maintain the health and safety of patients and staff. Based on the literature, we evaluated aspects related to patient safety in THs, especially linked to biosafety of medical facilities, and patient transport and visit. We highlight the analysis of flows and layouts, hospital cleaning and patient care. We described two case studies to demonstrate the proposed approach. As result, simulation tests improved safety metrics, such as waiting time for procedures, movement intensity in each area, length of stay and TH capacity. We conclude that the approach allows us to provide better THs that prevent cross-contamination, provide suitable care, and meet the demand.

Benefits of Sebastiania hispida (Euphorbiaceae) extract and photobiomodulation therapy as potentially adjunctive strategies to be explored against snake envenoming.

The purpose of this study was to assess the topic use of Sebastiania hispida extract and low-level gallium-arsenide laser irradiation (GaAs, 904 nm) to reduce the local myonecrosis and edema of Bothrops moojeni snake venom-injected gastrocnemius. Wistar rats receiving intramuscular venom injection (VBm) were compared with saline control (S) and envenomed rats receiving local exposure to plant extract (VExt) or laser irradiation (VL). The phytochemistry and thin-layer chromatography of S. hispida extract indicated the presence of phenolic compounds like gallic acid and flavonoids including quercetin. Gastrocnemius of VExt and VL groups had a significant reduction of edema and creatine kinase (CK) activities and a greater Myogenin (MyoG) expression compared to VBm group, with the plant extract efficacy better than laser exposure. Reduction of edema and serum CK activities reflects a lessening of muscle damage, whereas the increase of MyoG indicates myoblast differentiation and acceleration of muscle repair. The S. hispida richness in phenolic compounds and flavonoids, such as the light modulatory ability to triggering a multitude of cell signalings likely underlie the positive outcomes. Our findings suggest both treatments as potential auxiliary tools to be explored in clinical trials in combination with anti-venom therapy after Bothropic snakebites.

Encapsulation of the black pepper (Piper nigrum L.) essential oil by lactoferrin-sodium alginate complex coacervates: Structural characterization and simulated gastrointestinal conditions.

Black pepper essential oil (EO) was encapsulated by complex coacervation with lactoferrin and sodium alginate using transglutaminase as a cross-linking agent. The encapsulation efficiency varied from 31.66 to 84.48%. Chemical and morphological characteristics suggest that the EO was encapsulated in a lactoferrin/sodium alginate shell. The chemical composition of the encapsulated EO was identified by gas chromatography (GC) and nuclear magnetic resonance (NMR). The GC and NMR analyses indicated good core protection with the materials used. The stability of the black pepper EO capsules under in vitro digestion was evaluated. Theses capsules demonstrated the low release of the EO during gastric digestion and higher release in intestinal digestion. These results suggest that these capsules can be used to transport active ingredients and that they are resistant to oral and gastric conditions that were tested in vitro.

Physicochemical, thermal and rheological properties of synthesized carboxymethyl tara gum (Caesalpinia spinosa).

Carboxymethyl tara gum (CMTG) was synthesized from the reaction between tara gum (TG) and monochloroacetic acid (MCA) in the presence of sodium hydroxide. The modification reaction was optimized in terms of the MCA/NaOH ratio, reaction time and temperature evaluated for degree of substitution (DS). The etherification was confirmed by FTIR and 13C NMR spectroscopy, and it was characterized by different analyses. After carboxymethylation, CMTG showed new bonds at 1592, 1413 and 1320 cm-1 by FTIR and a new peak at δ = 178 ppm by 13C NMR in response to the insertion of the carbonyl group. The microscopy showed higher degradation on the surface of the CMTG particles, and XRD indicated low crystallinity of the CMTG. Static light scattering demonstrated a reduction in the molar mass of tara gum after carboxymethylation. Thermal analysis (TGA and DSC) revealed a lower thermal stability of carboxymethylated gum compared to that of unmodified gum. Despite the insertion of negative charges demonstrated by the potential-zeta, CMTG and TG presented pseudoplastic behavior according to the rheological analyses, and CMTG presented lower viscosity at the concentrations that were studied.

Dammarane-type triterpenoids from the stem of Ziziphus glaziovii Warm. (Rhamnaceae).

Seven undescribed dammarane-type triterpenoids, together with ten known compounds, were isolated from the stems of Ziziphus glaziovii Warm (= Sarcomphalus glaziovii (Warm.) Hauenschild). The structures were fully assigned by means of uni- and bidimensional NMR and HR-ESI-MS experiments. Extract, fractions and also isolated compounds were evaluated for their antibacterial (against Bacillus subtilis and Aliivibrio fischeri), cytotoxic (against PC-3 and HT-29 human cancer cell lines), anthelmintic (against Caenorhabditis elegans) and antifungal (against Septoria triciti, Botrytis cinerea and Phytopthoria infestans) activities. The methanolic crude extract exhibited substantial antibacterial and cytotoxic activity. The known triterpenes epigouanic acid and alphitolic acid were the most active compounds against B. subtilis, with IC50 of 12 and 22 µM, respectively. The isolated compounds presented up to a concentration of 10 µM none or only weak effects in the cytotoxicity assays. No anthelminthic and antifungal activities were observed.

New compounds of Siolmatra brasiliensis and inhibition of in vitro protein glycation damage.

Twenty compounds were isolated from the hydroethanolic extract of the stems of Siolmatra brasiliensis, five flavonoids, two lignans, one glucosyl phytosterol, seven nor-cucurbitacins, one new phenolic derivative named siolmatrin (1) and four new dammarane-type saponins named siolmatrosides II-V (2-5), the structures of the compounds were assigned by means of 1D and 2D NMR experiments and HRESIMS of the natural compounds and some acetyl derivatives. The effects of the crude hydroethanolic extract (SbExt) and the ethyl acetate fraction (SbEtAc) of Siolmatra brasiliensis stems on the formation of advanced glycation end-products (AGEs) were also investigated. In the in vitro model system of protein glycation using bovine serum albumin (BSA) and glucose, addition of SbExt or SbEtAc inhibited the formation of fluorescent AGEs, in parallel to minor levels of fructosamine (SbEtAc) and markers of tyrosine and tryptophan oxidation (SbExt and SbEtAc). Protein crosslinking, which represents changes of late stages of protein glycation, was reduced in the presence of SbExt and SbEtAc. Siolmatra brasiliensis stems seem to be a promising source of compounds having ability to prevent glycoxidation changes, arising as an interesting option to be studied as a complementary therapy for complications of diabetes.

Atorvastatin Protects Kidney from Remote Reperfusion Injury.

BACKGROUND: There is a need to find an effective treatment against reperfusion injury. The aim of the present study was to evaluate the capacity of the ischemic postconditioning and statin to prevent renal reperfusion injury. DESIGN AND SETTING: An experimental study developed at Universidade Anhanguera-Uniderp. METHODS: A total of 41 Wistar rats were distributed into 5 groups: ischemia and reperfusion (I/R), ischemic postconditioning (IPC), postconditioning + statin (IPC + S), statin (S), and sham. In the sham group, the infrarenal abdominal aorta was dissected and isolated; all others were submitted to aortic clamping for 70 min (ischemia) and posterior removal of the clamp (reperfusion, 70 min). In the IPC and IPC + S groups, postconditioning was performed in ischemia and reperfusion phases by 4 cycles of reperfusion and ischemia lasting 30 sec each. In the IPC + S and S groups, preceding the surgical procedure, atorvastatin was administered 3.4 mg/day for 7 days by gavage. After the procedure, the left kidney was removed for histological study. RESULTS: The mean renal lesion was 4 in the I/R group, 2.44 in the IPC group, 1.22 in the IPC + S group, 1.11 in the S group, and 1 in the sham group. The I/R group had a higher degree of tissue injury when compared to the others (P < 0.001) and the IPC + S and S groups improved protection against IPC alone (P < 0.05). CONCLUSIONS: Ischemic postconditioning and atorvastatin can minimize renal remote reperfusion injury.

Ischemic Postconditioning Assessment in the Liver of Rats Undergoing Mesenteric Ischemia and Reperfusion.

Introduction: Ischemic postconditioning is a method that shows evidence of efficacy in minimizing reperfusion injury; however, its effectiveness in preventing injuries in distant organs is still unknown, especially in those who have undergone mesenteric ischemia and reperfusion. Objective: To evaluate the effect of ischemic postconditioning in preventing reperfusion injury in the liver of rats submitted to mesenteric ischemia and reperfusion, comparing two different methods of ischemic postconditioning. Methods: 30 Wistar male rats were used, distributed into three groups: Group A: Ten rats submitted to intestinal ischemia for 30 minutes followed by reperfusion for 60 minutes; Group B: Ten rats subjected to ischemia and reperfusion; after ischemia, two cycles of reperfusion (two minutes each) interleaved with two cycles of ischemia (two minutes each); and Group C: Ten rats subjected to ischemia and reperfusion; after ischemia, four cycles of reperfusion (30 seconds each) interspersed with four cycles of ischemia (30 seconds each). After the experiment, the left lobe of the liver was resected for subsequent histological analysis, using the following classification: grade 1 - centrilobular congestion; grade 2 - centrilobular congestion with some degeneration of hepatocytes in one or two central veins; and grade 3 - multifocal centrilobular congestion and degeneration of portal hepatocytes. Results: The mean degree of liver damage found was 1.8 in group A, 1.7 in group B and 1.3 in group C. There was no statistically significant difference between the groups. Conclusion: Ischemic postconditioning was unable to minimize reperfusion injury in rats undergoing mesenteric ischemia and reperfusion.

Genetic differentiation in red-bellied piranha populations (Pygocentrus nattereri, Kner, 1858) from the Solimões-Amazonas River.

Red-bellied piranhas (Pygocentrus nattereri) are widely caught with different intensities throughout the region of Solimões-Amazonas River by local fishermen. Thus, the management of this resource is performed in the absence of any information on its genetic stock. P. nattereri is a voracious predator and widely distributed in the Neotropical region, and it is found in other regions of American continent. However, information about genetic variability and structure of wild populations of red-bellied piranha is unavailable. Here, we describe the levels of genetic diversity and genetic structure of red-bellied piranha populations collected at different locations of Solimões-Amazonas River system. We collected 234 red-bellied piranhas and analyzed throughout eight microsatellite markers. We identified high genetic diversity within populations, although the populations of lakes ANA, ARA, and MAR have shown some decrease in their genetic variability, indicating overfishing at these communities. Was identified the existence of two biological populations when the analysis was taken altogether at the lakes of Solimões-Amazonas River system, with significant genetic differentiation between them. The red-bellied piranha populations presented limited gene flow between two groups of populations, which were explained by geographical distance between these lakes. However, high level of gene flow was observed between the lakes within of the biological populations. We have identified high divergence between the Catalão subpopulation and all other subpopulations. We suggest the creation of sustainable reserve for lakes near the city of Manaus to better manage and protect this species, whose populations suffer from both extractive and sport fishing.

A new dammarane saponin and other triterpenoids from Siolmatra brasiliensis and evaluation of the antidiabetic activity of its extract.

Context Siolmatra brasiliensis (Cogn.) Baill (Cucurbitaceae) is a climbing plant widely used for the treatment of diabetes mellitus symptoms. Objective This work evaluates the antidiabetic activity of an extract of S. brasiliensis in streptozotocin-diabetic rats and promotes the phytochemical investigation to isolate the major compounds of the same extract. Materials and methods Male Wistar rats were divided into normal (N) and diabetic rats (DC) treated with water; diabetic rats treated with 3U insulin (DI) or with 250 (DSb250) or 500 mg/kg (DSb500) of hydroalcoholic extract of the stalks of S. brasiliensis, via oral gavage, for 21 days. Physiological and biochemical parameters classically altered in diabetes were monitored. The triterpenoids were isolated from the ethyl acetate fraction under silica gel column chromatography and Sephadex-LH20 methods and their structures were determined by NMR, HR-ESI-MS and DC analysis. Results When compared with DC, DSb250 rats showed a reduction in the hyperglycemia (DC: 26.46 ± 0.69 versus DSb250: 19.67 ± 1.06 mmol/L) and glycosuria (DC: 43.02 ± 3.19 versus DSb250: 28.46 ± 2.14 mmol/24 h) and increase in hepatic glycogen (DC: 14.44 ± 1.26 versus DSb250: 22.08 ± 4.26 mg/g). Three known cucurbitacins were isolated from a hydroalcoholic extract of S. brasiliensis, i.e., cayaponosides A1, B4, D, and a new dammarane saponin 3-O-ß-d-gentiobiosyl-26-O-ß-d-glucopyranosyl-20-hydroxydammar-24-ene. The structures of these compounds were elucidated by spectral data analysis of the natural products and their acetyl derivatives. Discussion and conclusion The known cucurbitacins and/or the new identified saponin may be related with the antidiabetic activity of S. brasiliensis.

Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results.

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence.

The influence of physical activity in the progression of experimental lung cancer in mice.

Lung cancer is one of the most incident neoplasms in the world, representing the main cause of mortality for cancer. Many epidemiologic studies have suggested that physical activity may reduce the risk of lung cancer, other works evaluate the effectiveness of the use of the physical activity in the suppression, remission and reduction of the recurrence of tumors. The aim of this study was to evaluate the effects of aerobic and anaerobic physical activity in the development and the progression of lung cancer. Lung tumors were induced with a dose of 3mg of urethane/kg, in 67 male Balb - C type mice, divided in three groups: group 1_24 mice treated with urethane and without physical activity; group 2_25 mice with urethane and subjected to aerobic swimming free exercise; group 3_18 mice with urethane, subjected to anaerobic swimming exercise with gradual loading 5-20% of body weight. All the animals were sacrificed after 20 weeks, and lung lesions were analyzed. The median number of lesions (nodules and hyperplasia) was 3.0 for group 1, 2.0 for group 2 and 1.5-3 (p=0.052). When comparing only the presence or absence of lesion, there was a decrease in the number of lesions in group 3 as compared with group 1 (p=0.03) but not in relation to group 2. There were no metastases or other changes in other organs. The anaerobic physical activity, but not aerobic, diminishes the incidence of experimental lung tumors.