Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT): A case series from a center in Brazil.

Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.

Ulectomy in a patient with nephrotic syndrome under investigation for Galloway-Mowat syndrome: a case report.

The aim of this study is to report a case in which a patient with nephrotic syndrome underwent surgery to remove fibrous gum tissue (ulectomy). An 8-year-old patient, diagnosed with early onset nephrotic syndrome due to a mutation in the NUP107 gene, had received a kidney transplant and was therefore taking various medications, including immunosuppressants. On oral examination, the patient was found to have a fibrous gingiva that was preventing the eruption of the upper permanent central incisors. A ulectomy was performed and the gingival tissue was sent for histopathological analysis, which showed normal aspects. The upper right central incisor was seen in the oral cavity 15 days after surgery. A second procedure was carried out to facilitate the eruption of the upper left incisor, which was visualized in the oral cavity 30 days later. In addition, oral manifestations such as maxillary atresia, ogival palate and mouth breathing were observed. Therefore, the role of the dental surgeon in the lives of transplanted children is considered important, as they often take various medications that can affect their oral health. Thus, early diagnosis and effective treatment will be essential to prevent future malocclusions and thus improve the quality of life of these patients.

Cytotoxic/antiproliferative and nutraceutical activity of aqueous and ethanolic extracts of green and mature Averrhoa carambola.

Averrhoa carambola L. presents in its composition diversity of nutrients and vitamins. The present study aimed to extract water and fat-soluble compounds from this fruit at different stages of maturation (green and mature), perform the physical-chemical characterization as well as evaluate its cytotoxicity against hepatoma cells of Rattus norvegicus (HTC). The physicochemical results showed that the pH and molar acidity is influenced by the fruit maturation state. The fruit presented high percentage of moisture, while the percentage of total minerals (ash) increased according to its maturation stage. The results of the phytochemical screening showed that star fruits present phenolic compounds. The antioxidant activity showed greater potential for the ethanolic extracts of the green and mature star fruit. For HTC cells treated with ethanolic extract of green and mature star fruit the data show absence of cytotoxic effect. The tests with the aqueous extract showed cytotoxic/antiproliferative effect of green and mature star fruit extract, in 24, 48 and 72 hours. The presence of nutraceutical compounds and the cytotoxic/antiproliferative activity were more expressive in the aqueous extract, being an option of easily accessible solvent economic and not harmful to organisms.

Intravenous Ceftriaxone on an Outpatient Basis in the Treatment of Ocular Syphilis.

PURPOSE: The goal of this study is to describe the clinical and laboratory outcomes of patients with syphilitic uveitis treated with 2 g intravenous Ceftriaxone daily on an outpatient treatment basis for 14 days, in the setting of the COVID pandemic and lack of hospitalization availability. METHODS: This study included a review of the clinical records from patients from January 2020 to December 2021 and who were then followed for 6 months at the Research Laboratory of Infectious Diseases in Ophthalmology of the National Institute of Infectious Diseases Evandro Chagas (INI) FIOCRUZ, Rio de Janeiro, Brazil. CONCLUSION: This study showed that almost all of the 15 patients were well treated for ocular syphilis with Ceftriaxone without any signs of therapeutic failure with documented clinical improvement and satisfactory decreasing VDRL titers.

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts / Adhesión a la ventilación mecánica protectora en el síndrome de dificultad respiratoria aguda asociado a COVID-19 o asociado a otras etiologias: comparación entre dos cohortes prospectivas

Objective To compare adherence to protective mechanical ventilation (MV) parametersin patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. Design Multiple prospective cohort study. Setting: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). Patients: ARDS patients under MV. Interventions: None. Main variables of interest: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. Results Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. Conclusions Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients (AU)

Objetivo Comparar la adhesión a la ventilación mecánica (VM) protectora en pacientes con síndrome de dificultad respiratoria aguda (SDRA) causada por COVID-19 con pacientes con SDRA de otras etiologías. Diseño Estudio de cohorte prospectivo. Âmbito: Se evaluaron dos cohortes de pacientes con SDRA: 1.pacientes con COVID-19 ingresados en dos unidades de cuidados intensivos (UCI) brasileñas en 2020 y 2021 (C-ARDS, n=282); 2.pacientes con SDRA de otras etiologías ingresados en 37 UCI brasileñas en 2016 (NC-ARDS, n=120). Pacientes: Pacientes con SDRA bajo VM invasiva. Intervenciones: No. Variables de interés principals: Adhesión a la VM protectora (volumen tidal ≤8mL/kg; presión de meseta ≤30cmH2O; y presión de distensión [PD] ≤15cmH2O), adhesión a cada componente individual de la VM protectora, y la asociación entre la VM protectora y la mortalidad. Resultados La adhesión a la VM protectora fue mayor en la cohorte C-ARDS que en la NC-ARDS (65,8% vs. 50,0%, p=0,005), principalmente debido a mayor adhesión a la PD≤15cmH2O (75,0% vs. 62,4%, p=0,02). La regresión logística multivariable mostró que la cohorte C-ARDS se asoció de forma independiente con la adhesión a la VM protectora. Entre los componentes de la VM protectora, sólo la limitación de la PD se asoció de forma independiente con menor mortalidad en la UCI. Conclusión La mayor adhesión a la VM protectora en los pacientes con C-ARDS fue secundaria a la mayor adhesión a limitación da PD. Además, una menor PD se asoció de forma independiente a menor mortalidad en la UCI, lo que sugiere que limitar la exposición a altas PD puede mejorar la supervivencia en estos pacientes (AU)

Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study / Impactos de un protocolo de ajuste de la fracción de oxígeno inspirado en pacientes con COVID-19 sometidos a ventilación mecánica: un estudio de cohorte prospectivo

Objective We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. Design Prospective cohort study. Settin Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. Patients Consecutive patients with COVID-19 mechanically ventilated. Interventions One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. Main variables of interest Prevalence of hyperoxemia (PaO2>100mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2>0.6 in patients with hyperoxemia) were compared between the two ICUs. Results Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p<0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p<0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p<0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. Conclusions Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic (AU)

Objetivo Evaluar si un protocolo para el ajuste de la FiO2 reduce la hiperoxemia y el uso excesivo de oxígeno en pacientes con COVID-19 en ventilación mecánica. Diseño Estudio de cohorte prospectivo. Ámbito Unidades de cuidados intensivos (UCI) dedicadas a pacientes con COVID-19 en Brasil. Pacientes Pacientes con COVID-19. Intervenciones Una UCI siguió un protocolo de ajuste de FiO2 basado en SpO2 (UCI de oxigenoterapia conservadora, N=82) y la otra no siguió el protocolo (UCI control, N=145). Principales variables de interés Prevalencia de hiperoxemia (PaO2>100mmHg) en el día 1, hiperoxemia sostenida (presente en los días 1 y 2) y exceso de uso de oxígeno (FiO2>0,6 en pacientes con hiperoxemia) entre las 2 UCI. Resultados La UCI de oxigenoterapia conservadora presentó menor prevalencia de hiperoxemia en el día 1 (40,2 vs. 75,9%; p<0,001) y de hiperoxemia sostenida (12,2 vs. 49,6%; p<0,001). El uso excesivo de oxígeno fue menos frecuente en la UCI de oxigenoterapia conservadora el día 1 (18,3 vs. 52,4%; p<0,001). El ingreso en la UCI control se asoció de forma independiente con la hiperoxemia y el uso excesivo de oxígeno. Los análisis multivariables no encontraron una relación independiente entre hiperoxemia o uso excesivo de FiO2 y resultados clínicos adversos. Conclusiones Seguir el protocolo de FiO2 se asoció con menor hiperoxemia y menor consumo de oxígeno en exceso. Aunque esos resultados no se asociaron con mejores resultados clínicos, la adopción del protocolo FiO2 puede ser útil en un escenario de recursos de oxígeno agotados, como se vio durante la pandemia de COVID-19 (AU)

Mental stress induces endothelial dysfunction by AT1R-mediated redox imbalance in overweight/obese men.

The main goal of this study was to determine whether oxidative imbalance mediated by AT1 receptor (AT1R) is responsible for deleterious endothelial responses to mental stress (MS) in overweight/obese class I men. Fifteen overweight/obese men (27±7 years old; 29.8±2.6 kg/m2) participated in three randomized experimental sessions with oral administration of the AT1R blocker olmesartan (40 mg; AT1R blockade) or ascorbic acid (AA; 3g) infusion or placebo [both intravenously (0.9% NaCl) and orally]. After two hours, endothelial function was determined by flow-mediated dilation (FMD) before (baseline), 30 min (30MS), and 60 min (60MS) after a five-minute acute MS session (Stroop Color Word Test). Blood was collected before (baseline), during MS, and 60 min after MS for redox homeostasis profiling: lipid peroxidation (TBARS; thiobarbituric acid reactive species), protein carbonylation, and catalase activity by colorimetry and superoxide dismutase (SOD) activity by an ELISA kit. At the placebo session, FMD significantly decreased 30MS (P=0.05). When compared to baseline, TBARS (P<0.02), protein carbonylation (P<0.01), catalase (P<0.01), and SOD (P<0.01) increased during the placebo session. During AT1R blockade, FMD increased 30 min after MS (P=0.01 vs baseline; P<0.01 vs placebo), while AA infusion increased FMD only 60 min after MS. No differences were observed during MS with the AT1R blockade and AA regarding TBARS, protein carbonylation, catalase, and SOD. AT1R-mediated redox imbalances played an important role in endothelial dysfunction to mental stress.

Laser acupuncture in the treatment of neuropathies in dentistry: a systematic review.

Laser acupuncture can be used to treat neurosensory alterations and motor disorders caused by dental treatments. This study aimed to review the existing literature on the effects of laser acupuncture on neuropathies in the context of dentistry and to search for treatment modalities in which this technique is used. This systematic review was conducted in accordance with the Cochrane Collaboration guidelines and the PICOS strategy. Randomized clinical trials that evaluated laser acupuncture as a primary intervention for facial neuropathy were included. We searched the database for relevant studies and manually searched the gray literature until April 2022, and finally included four studies. The study was considered eligible if it included patients with paresthesia, facial paralysis, or neuralgia, neuropathies within dentistry, and referred to the application of laser acupuncture as a treatment method. The risk of bias was assessed using the RoB 2 tool. It was observed that the recommended wavelengths ranged from 790 nm to 810 nm, with a frequency of at least two applications per week, and to a greater or lesser degree, all evaluated studies obtained an improvement in sensory or motor recovery of the facial nerves. The use of laser acupuncture presented itself as a viable alternative in dentistry for the treatment of paresthesia and facial paralysis due to its therapeutic potential in neuropathic treatment (CRD42022344339).

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts.

OBJECTIVE: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. DESIGN: Multiple prospective cohort study. SETTING: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). PATIENTS: ARDS patients under MV. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. RESULTS: Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. CONCLUSIONS: Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.

Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study.

OBJECTIVE: We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. DESIGN: Prospective cohort study. SETTING: Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. PATIENTS: Consecutive patients with COVID-19 mechanically ventilated. INTERVENTIONS: One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. MAIN VARIABLES OF INTEREST: Prevalence of hyperoxemia (PaO2>100mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2>0.6 in patients with hyperoxemia) were compared between the two ICUs. RESULTS: Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p<0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p<0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p<0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. CONCLUSIONS: Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.

Portuguese version of Parent-reported Drug Hypersensitivity Quality of Life Questionnaire (P-DrHy-Q): assessment of reliability and validity.

Summary: Background. Drug hypersensitivity in children impacts the quality of life of the patients and their caregivers. The parent-reported drug hypersensitivity quality of life questionnaire (P-DrHy-Q), the first disease-specific quality-of-life questionnaire for caregivers who have children with drug hypersensitivity, was recently developed. The aim of this study was to assess the validity and reliability of the portuguese version of the P-DrHy-Q. Methods. A translation of the Parent-reported Drug Hypersensitivity Quality of Life Questionnaire (P-DrHy-Q) to the Portuguese population was performed, assessing its applicability in 74 caregivers from two allergy departments. The analyses included internal consistency (Cronbach's alpha) and test-retest reliability: 14 caregivers completed the P-DrHy-Q without any intervention one week after answering the first questionnaire. Results. The 12-item scale assessed the mental health and social activity. The internal consistency of the scale was good (Cronbach's alpha = 0.884) and the test-retest associations were excelent (intra-class correlation coefficient = 0.985; p < 0.001). The mean value of the questionnaire was 37.01 (SD 18.57) with Mental Health being more affected than Social Activity. Employed caregivers had a significant higher score (p < 0.001). No other factor was statistically significant. Conclusions. The Portuguese version of the P-DrHy-Q is valid for evaluating quality of life impairment in Portuguese caregivers of children with drug hypersensitivity. Its application might be relevant for future research and provide clinicians and researchers with a tool to define which psychosocial support is required to provide more comprehensive care in drug hypersensitivity.

Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study.

Objective: We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. Design: Prospective cohort study. Setting: Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. Patients: Consecutive patients with COVID-19 mechanically ventilated. Interventions: One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. Main variables of interest: Prevalence of hyperoxemia (PaO2 >100 mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2 > 0.6 in patients with hyperoxemia) were compared between the two ICUs. Results: Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p < 0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p < 0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p < 0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. Conclusions: Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.

Objetivo: Evaluar si un protocolo para el ajuste de la FiO2 reduce la hiperoxemia y el uso excesivo de oxígeno en pacientes con COVID-19 en ventilación mecánica. Diseño: Estudio de cohorte prospectivo. Ámbito: Unidades de cuidados intensivos (UCI) dedicadas a pacientes con COVID-19 en Brasil. Pacientes: Pacientes con COVID-19. Intervenciones: Una UCI siguió un protocolo de ajuste de FiO2 basado en SpO2 (UCI de oxigenoterapia conservadora, N = 82) y la otra no siguió el protocolo (UCI control, N = 145). Principales variables de interés: Prevalencia de hiperoxemia (PaO2 > 100 mmHg) en el día 1, hiperoxemia sostenida (presente en los días 1 y 2) y exceso de uso de oxígeno (FiO2 > 0,6 en pacientes con hiperoxemia) entre las 2 UCI. Resultados: La UCI de oxigenoterapia conservadora presentó menor prevalencia de hiperoxemia en el día 1 (40,2 vs. 75,9%; p < 0,001) y de hiperoxemia sostenida (12,2 vs. 49,6%; p < 0,001). El uso excesivo de oxígeno fue menos frecuente en la UCI de oxigenoterapia conservadora el día 1 (18,3 vs. 52,4%; p < 0,001). El ingreso en la UCI control se asoció de forma independiente con la hiperoxemia y el uso excesivo de oxígeno. Los análisis multivariables no encontraron una relación independiente entre hiperoxemia o uso excesivo de FiO2 y resultados clínicos adversos. Conclusiones: Seguir el protocolo de FiO2 se asoció con menor hiperoxemia y menor consumo de oxígeno en exceso. Aunque esos resultados no se asociaron con mejores resultados clínicos, la adopción del protocolo FiO2 puede ser útil en un escenario de recursos de oxígeno agotados, como se vio durante la pandemia de COVID-19.

Mental stress induces endothelial dysfunction by AT1R-mediated redox imbalance in overweight/obese men

The main goal of this study was to determine whether oxidative imbalance mediated by AT1 receptor (AT1R) is responsible for deleterious endothelial responses to mental stress (MS) in overweight/obese class I men. Fifteen overweight/obese men (27±7 years old; 29.8±2.6 kg/m2) participated in three randomized experimental sessions with oral administration of the AT1R blocker olmesartan (40 mg; AT1R blockade) or ascorbic acid (AA; 3g) infusion or placebo [both intravenously (0.9% NaCl) and orally]. After two hours, endothelial function was determined by flow-mediated dilation (FMD) before (baseline), 30 min (30MS), and 60 min (60MS) after a five-minute acute MS session (Stroop Color Word Test). Blood was collected before (baseline), during MS, and 60 min after MS for redox homeostasis profiling: lipid peroxidation (TBARS; thiobarbituric acid reactive species), protein carbonylation, and catalase activity by colorimetry and superoxide dismutase (SOD) activity by an ELISA kit. At the placebo session, FMD significantly decreased 30MS (P=0.05). When compared to baseline, TBARS (P<0.02), protein carbonylation (P<0.01), catalase (P<0.01), and SOD (P<0.01) increased during the placebo session. During AT1R blockade, FMD increased 30 min after MS (P=0.01 vs baseline; P<0.01 vs placebo), while AA infusion increased FMD only 60 min after MS. No differences were observed during MS with the AT1R blockade and AA regarding TBARS, protein carbonylation, catalase, and SOD. AT1R-mediated redox imbalances played an important role in endothelial dysfunction to mental stress.

Fatores associados ao insucesso da cateterização intravenosa periférica em crianças com câncer / Factores asociados al fracaso del cateterismo intravenoso periférico en niños con cáncer / Factors associated with peripheral intravenous catheterization failure in children with cancer

Resumo Objetivo Estimar a prevalência de insucesso na inserção de cateteres intravenosos periféricos em crianças com câncer e sua associação com características demográficas, clínicas, da cateterização e terapia intravenosa utilizada previamente. Métodos Estudo de corte transversal e exploratório realizado na unidade de clínica oncológica pediátrica de um hospital público. Foram utilizados dados provenientes da observação de 130 cateterizações intravenosas periféricas e prontuários das crianças. Analisadas as características demográficas, clínicas, da cateterização intravenosa periférica e terapia intravenosa utilizada e sua relação com o insucesso da cateterização. Utilizou-se regressão de Poisson com variância robusta para determinar os fatores associados ao desfecho estudado, considerando p<0,05. Resultados A prevalência do insucesso foi de 38,5% e esteve estatisticamente associada ao tempo de hospitalização (RP=1,6; IC95% 1,05-2,56), uso de terapia intravenosa prévia prolongada (RP=2,1; IC95% 1,32-3,20), antecedente de extravasamento (RP=1,99; IC95% 1,15-3,28) e agitação da criança (RP=1,41; IC95% 1,02-1,94). Conclusão Observou-se elevada prevalência de insucesso da cateterização intravenosa periférica em crianças com câncer, associada ao tempo de hospitalização maior ou igual a oito dias, uso de TIV prévia prolongada, antecedente de extravasamento e agitação da criança durante a inserção do cateter.

Resumen Objetivo Estimar la prevalencia de fracaso en la inserción de catéteres intravenosos periféricos en niños con cáncer y su relación con características demográficas, clínicas, del cateterismo y de terapia intravenosa previamente utilizada. Métodos Estudio de corte transversal y exploratorio realizado en la unidad de clínica oncológica pediátrica de un hospital público. Se utilizaron datos provenientes de la observación de 130 cateterismos intravenosos periféricos y las historias clínicas de los niños. Se analizaron las características demográficas, clínicas, del cateterismo intravenoso periférico y terapia intravenosa utilizada y su relación con el fracaso del cateterismo. Se utilizó regresión de Poisson con varianza robusta para determinar los factores asociados al evento estudiado, considerando p<0,05. Resultados La prevalencia del fracaso fue del 38,5 % y estuvo estadísticamente relacionada con el tiempo de internación (RP=1,6; IC95% 1,05-2,56), el uso de terapia intravenosa previa prolongada (RP=2,1; IC95% 1,32-3,20), antecedentes de extravasación (RP=1,99; IC95% 1,15-3,28) y la agitación del niño (RP=1,41; IC95% 1,02-1,94). Conclusión Se observó una elevada prevalencia de fracaso del cateterismo intravenoso periférico en niños con cáncer, relacionada con el tiempo de internación mayor o igual a ocho días, el uso de TIV previa prolongada, antecedentes de extravasación y agitación del niño durante la inserción del catéter.

Abstract Objective To estimate the prevalence of peripheral intravenous catheter insertion failure in children with cancer and its association with demographic, clinical, catheterization and previously used intravenous therapy characteristics. Methods This is a cross-sectional and exploratory study conducted at the pediatric oncology clinic of a public hospital. Data from the observation of 130 peripheral intravenous catheterizations and medical records of children were used. We analyzed the demographic and clinical characteristics of peripheral intravenous catheterization and intravenous therapy used and its relationship with catheterization failure. Poisson regression with robust variance was used to determine the factors associated with the outcome studied, considering p<0.05. Results The prevalence of failure was 38.5% and was statistically associated with length of stay (PR=1.6; 95%CI 1.05-2.56), previous prolonged intravenous therapy use (PR=2.1; 95%CI % 1.32-3.20), history of extravasation (PR=1.99; 95%CI 1.15-3.28) and child agitation (PR=1.41; 95%CI 1.02-1.94). Conclusion There was a high prevalence of peripheral intravenous catheterization failure in children with cancer, associated with length of hospitalization greater than or equal to eight days, previous prolonged IVT use, history of extravasation and child agitation during catheter insertion.

Thermo-resistant enzyme-producing microorganisms isolated from composting / Microrganismos produtores de enzimas termo-resistentes isolados de compostagem

Organo-mineral fertilizers supplemented with biological additives are an alternative to chemical fertilizers. In this study, thermoresistant microorganisms from composting mass were isolated by two-step procedures. First, samples taken at different time points and temperatures (33 days at 52 ºC, 60 days at 63 ºC, and over 365 days at 26 ºC) were pre-incubated at 80 oC for 30 minutes. Second, the microbial selection by in vitro culture-based methods and heat shock at 60 oC and 100 oC for 2h and 4h. Forty-one isolates were able to grow at 60 °C for 4h; twenty-seven at 100 °C for 2h, and two at 100 °C for 4h. The molecular identification by partial sequencing of the 16S ribosomal gene using universal primers revealed that thirty-five isolates were from eight Bacillus species, one Brevibacillus borstelensis, three Streptomyces thermogriseus, and two fungi (Thermomyces lanuginosus and T. dupontii). Data from amylase, phytase, and cellulase activity assays and the enzymatic index (EI) showed that 38 of 41 thermo-resistant isolates produce at least one enzyme. For amylase activity, the highest EI value was observed in Bacillus licheniformis (isolate 21C2, EI= 4.11), followed by Brevibacillus borstelensis (isolate 6C2, EI= 3.66), Bacillus cereus (isolate 18C2, EI= 3.52), and Bacillus paralicheniformis (isolate 20C2, EI= 3.34). For phytase, the highest EI values were observed for Bacillus cereus (isolate 18C2, EI= 2.30) and Bacillus licheniformis (isolate 3C1, EI= 2.15). Concerning cellulose production, B. altitudinis (isolate 6C1) was the most efficient (EI= 6.40), followed by three Bacillus subtilis (isolates 9C1, 16C2, and 19C2) with EI values of 5.66, 5.84, and 5.88, respectively, and one B. pumilus (isolate 27C2, EI= 5.78). The selected microorganisms are potentially useful as a biological additive in organo-mineral fertilizers and other biotechnological processes.

Os fertilizantes organo-minerais suplementados com aditivos biológicos são uma alternativa aos adubos químicos. Neste estudo, microrganismos termoresistentes foram isolados de compostagem por procedimentos de duas etapas. Inicialmente, as amostras tomadas em diferentes períodos e temperaturas (33 dias a 52 ºC, 60 dias a 63 ºC e mais de 365 dias a 26 ºC) foram pré-incubadas a 80 oC por 30 minutos. Posteriormente, a seleção microbiana foi conduzida por métodos baseados em cultura in vitro e choque térmico a 60 oC e 100 oC por 2h e 4h. Quarenta e um isolados foram capazes de crescer a 60 °C por 4h; vinte e sete a 100 °C por 2h e dois a 100 °C por 4h. A identificação molecular por sequenciamento parcial do gene ribossomal 16S usando primers universais revelou que trinta e cinco isolados eram de oito espécies de Bacillus, um Brevibacillus borstelensis, três Streptomyces thermogriseus e dois fungos (Thermomyces lanuginosus e T. dupontii). Os dados dos ensaios de atividade de amilase, fitase e celulase e o índice enzimático (IE) mostraram que 38 dos 41 isolados termorresistentes produziram pelo menos uma enzima. Para a atividade da amilase, o maior valor de IE foi observado em Bacillus licheniformis (isolado 21C2, IE = 4,11), seguido por Brevibacillus borstelensis (isolado 6C2, IE = 3,66), Bacillus cereus (isolado 18C2, IE = 3,52) e Bacillus paralicheniformis (isolado 20C2, IE = 3,34). Para a fitase, os maiores valores de IE foram observados para B. cereus (isolado 18C2, IE = 2,30) e B. licheniformis (isolado 3C1, IE = 2,15). Em relação à produção de celulose, B. altitudinis (isolado 6C1) foi o mais eficiente (IE = 6,40), seguido por três Bacillus subtilis (isolados 9C1, 16C2 e 19C2) com valores de IE de 5,66, 5,84 e 5,88, respectivamente, e um B. pumilus (isolado 27C2, IE = 5,78). Pode-se inferir que os microrganismos selecionados são potencialmente úteis como aditivos biológicos em fertilizantes organo-minerais e outros processos biotecnológicos.

Thermo-resistant enzyme-producing microorganisms isolated from composting

Abstract Organo-mineral fertilizers supplemented with biological additives are an alternative to chemical fertilizers. In this study, thermoresistant microorganisms from composting mass were isolated by two-step procedures. First, samples taken at different time points and temperatures (33 days at 52 ºC, 60 days at 63 ºC, and over 365 days at 26 ºC) were pre-incubated at 80 oC for 30 minutes. Second, the microbial selection by in vitro culture-based methods and heat shock at 60 oC and 100 oC for 2h and 4h. Forty-one isolates were able to grow at 60 °C for 4h; twenty-seven at 100 °C for 2h, and two at 100 °C for 4h. The molecular identification by partial sequencing of the 16S ribosomal gene using universal primers revealed that thirty-five isolates were from eight Bacillus species, one Brevibacillus borstelensis, three Streptomyces thermogriseus, and two fungi (Thermomyces lanuginosus and T. dupontii). Data from amylase, phytase, and cellulase activity assays and the enzymatic index (EI) showed that 38 of 41 thermo-resistant isolates produce at least one enzyme. For amylase activity, the highest EI value was observed in Bacillus licheniformis (isolate 21C2, EI= 4.11), followed by Brevibacillus borstelensis (isolate 6C2, EI= 3.66), Bacillus cereus (isolate 18C2, EI= 3.52), and Bacillus paralicheniformis (isolate 20C2, EI= 3.34). For phytase, the highest EI values were observed for Bacillus cereus (isolate 18C2, EI= 2.30) and Bacillus licheniformis (isolate 3C1, EI= 2.15). Concerning cellulose production, B. altitudinis (isolate 6C1) was the most efficient (EI= 6.40), followed by three Bacillus subtilis (isolates 9C1, 16C2, and 19C2) with EI values of 5.66, 5.84, and 5.88, respectively, and one B. pumilus (isolate 27C2, EI= 5.78). The selected microorganisms are potentially useful as a biological additive in organo-mineral fertilizers and other biotechnological processes.

Resumo Os fertilizantes organo-minerais suplementados com aditivos biológicos são uma alternativa aos adubos químicos. Neste estudo, microrganismos termoresistentes foram isolados de compostagem por procedimentos de duas etapas. Inicialmente, as amostras tomadas em diferentes períodos e temperaturas (33 dias a 52 ºC, 60 dias a 63 ºC e mais de 365 dias a 26 ºC) foram pré-incubadas a 80 oC por 30 minutos. Posteriormente, a seleção microbiana foi conduzida por métodos baseados em cultura in vitro e choque térmico a 60 oC e 100 oC por 2h e 4h. Quarenta e um isolados foram capazes de crescer a 60 °C por 4h; vinte e sete a 100 °C por 2h e dois a 100 °C por 4h. A identificação molecular por sequenciamento parcial do gene ribossomal 16S usando primers universais revelou que trinta e cinco isolados eram de oito espécies de Bacillus, um Brevibacillus borstelensis, três Streptomyces thermogriseus e dois fungos (Thermomyces lanuginosus e T. dupontii). Os dados dos ensaios de atividade de amilase, fitase e celulase e o índice enzimático (IE) mostraram que 38 dos 41 isolados termorresistentes produziram pelo menos uma enzima. Para a atividade da amilase, o maior valor de IE foi observado em Bacillus licheniformis (isolado 21C2, IE = 4,11), seguido por Brevibacillus borstelensis (isolado 6C2, IE = 3,66), Bacillus cereus (isolado 18C2, IE = 3,52) e Bacillus paralicheniformis (isolado 20C2, IE = 3,34). Para a fitase, os maiores valores de IE foram observados para B. cereus (isolado 18C2, IE = 2,30) e B. licheniformis (isolado 3C1, IE = 2,15). Em relação à produção de celulose, B. altitudinis (isolado 6C1) foi o mais eficiente (IE = 6,40), seguido por três Bacillus subtilis (isolados 9C1, 16C2 e 19C2) com valores de IE de 5,66, 5,84 e 5,88, respectivamente, e um B. pumilus (isolado 27C2, IE = 5,78). Pode-se inferir que os microrganismos selecionados são potencialmente úteis como aditivos biológicos em fertilizantes organo-minerais e outros processos biotecnológicos.

Fusion of Tumor-Derived Exosomes with Long-Circulating and pH-Sensitive Liposomes Loaded with Doxorubicin for the Treatment of Breast Cancer.

Doxorubicin (DOX) is a chemotherapeutic agent that has been used in the treatment of breast cancer. However, serious toxic effects have limited its use, mainly cardiotoxicity. To minimize the adverse effects, liposomal preparations containing DOX have been developed. These preparations can reach the target in the tumor region as well as bypass the resistance-related problems. An alternative to increased therapeutic efficacy may be the fusion of liposomes with exosomes released from tumor cells to facilitate membrane and fusion interactions, achieving greater cell uptake. Thus, the purpose of this study was the fusion of exosomes derived from breast tumor cells with long-circulating and pH-sensitive liposomes loading DOX (ExoSpHL-DOX) for the treatment of breast cancer. The mean diameter of ExoSpHL-DOX was 100.8 ± 7.8 nm, the polydispersity index was 0.122 ± 0.004, and the encapsulated DOX content was equal to 83.5 ± 2.5%. The fusion of exosomes with long-circulating and pH-sensitive liposomes was confirmed by Fourier transform infrared spectroscopy, Raman spectroscopy, and nano-flow cytometry. The physicochemical characteristics of ExoSpHL-DOX were maintained for 60 days, at 4 °C. The study of the release of DOX from ExoSpHL-DOX in dilution media with different pH values showed the pH sensitivity characteristic of the nanosystem, since 96.6 ± 0.2% of DOX was released from ExoSpHL-DOX at pH 5.0, while at pH 7.4, the release was 70.1 ± 1.7% in the medium. The cytotoxic study against the breast cancer cell line demonstrated that ExoSpHL-DOX treatment significantly reduced the cancer cell viability.

Bacillary layer detachment in serpiginous-like choroiditis of presumed intraocular tuberculosis: Report of two cases.

Purpose: To describe the presence of bacillary layer detachment (BALAD) in serpiginous-like choroiditis (SLC) in presumed intraocular tuberculosis. Observations: Clinical and multimodal imaging including fundus photography, fundus autofluorescence, and spectral domain and enhanced-deep imaging optical coherence tomography (OCT) of two cases of SLC in presumed intraocular tuberculosis. Two patients (26 and 38-year-old woman) presented with unilateral, decreased vision of acute onset. They were diagnosed with SLC in presumed intraocular tuberculosis, and OCT revealed splitting of the ellipsoid zone, resembling BALAD. All two patients showed complete resolution after treatment with antitubercular therapy (ATT). Conclusions and Importance: BALAD appears in the acute stage of SLC in presumed intraocular tuberculosis and resolves rapidly at the beginning of ATT.