RESUMO
BACKGROUND: A new formula for estimating small, dense, low-density lipoprotein cholesterol (sdLDL-C) based on the results of the standard lipid panel is proposed. OBJECTIVES: To assess the association between estimated sdLDL-C (EsdLDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk. METHODS: A total of 12,192 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) database between 2010 and 2020 were included in this cross-sectional study. EsdLDL-C was calculated as EsdLDL-C= LDL-C - [1.43 × LDL-C - (0.14 × (ln (TG) × LDL-C)) - 8.99]. Logistic regression analyses were utilized to assess the association between EsdLDL-C and ASCVD risk. Subgroup analyses were performed based on age, body mass index (BMI), hypertension, and diabetes. An odds ratio (OR) with a 95% confidence interval (CI) was used for evaluation. P<0.05 was considered statistically significant. RESULTS: Among 12,192 participants, 1,239 (10.16%) had ASCVD. The mean sdLDL-C of participants was estimated to be 42.43±14.75 mg/dL using the formula. Elevated EsdLDL-C levels (OR=1.33; 95%CI, 1.06-1.66) were associated with an increased risk of ASCVD. Subgroup analyses found that there may be an interaction between EsdLDL-C (Pinteraction= 0.001) or non-HDL-C (Pinteraction= 0.015) and hypertension on ASCVD risk. CONCLUSIONS: Elevated estimated sdLDL-C levels were associated with the risk of ASCVD, and estimated sdLDL-C might be an alternative to sdLDL-C measurement for ASCVD risk assessment.
FUNDAMENTO: Uma nova fórmula para estimar o colesterol de lipoproteínas pequenas, densas e de baixa densidade (sdLDL-C) com base nos resultados do painel lipídico padrão é proposto. OBJETIVOS: Para avaliar a associação entreestimado sdLDL-C (EsdLDL-C) e o risco de doença cardiovascular arterosclerótica (DCVA). MÉTODOS: Um total de 12.192 participantes do banco de dados do Korea National Health and Nutrition Examination Survey (KNHANES) entre 2010 e 2020 foram incluídos neste estudo transversal. EsdLDL-C foi calculada como EsdLDL-C = LDL-C- [1,43 × LDL-C - (0,14 × (ln (TG) × LDL-C)) - 8,99]. Análises de regressão logística foram utilizadas para avaliar a associação entre EsdLDL-C e risco de DCVA. As análises de subgrupos foram realizadas com base na idade, índice de massa corporal (IMC), hipertensão, e diabetes. Uma razão de possibilidades (OR) com um intervalo de confiança de 95% (IC) foi utilizado para avaliação. P<0,05 foi considerado estatisticamente significativo. RESULTADOS: Entre 12.192 participantes, 1.239 (10,16%) tinham DCVA. A média de sdLDL-C dos participantes foi estimada em 42,43±14,75 mg/dL usando a fórmula. Níveis elevados de EsdLDL-C (OR=1,33; IC 95%, 1,06-1,66) foram associados a um aumento do risco de DCVA. As análises de subgrupos descobriram que pode haver uma interação entre EsdLDL-C (Pinteração=0,001) ou não-HDL-C (Pinteração=0,015) e hipertensão no risco de DCVA. CONCLUSÕES: Níveis elevados estimados de sdLDL-C foram associados ao risco de DCVA, e o sdLDL-C estimado pode ser uma alternativa à medição do sdLDL-C para avaliação do risco de DCVA.
Assuntos
Aterosclerose , LDL-Colesterol , Inquéritos Nutricionais , Humanos , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , LDL-Colesterol/sangue , Aterosclerose/sangue , Fatores de Risco , República da Coreia/epidemiologia , Medição de Risco , Adulto , Idoso , Índice de Massa Corporal , Modelos Logísticos , Doenças Cardiovasculares/sangue , Biomarcadores/sangue , Hipertensão/sangue , Fatores de Risco de Doenças CardíacasRESUMO
The unprecedented worldwide pandemic caused by COVID-19 has motivated several research groups to develop machine-learning based approaches that aim to automate the diagnosis or screening of COVID-19, in large-scale. The gold standard for COVID-19 detection, quantitative-Real-Time-Polymerase-Chain-Reaction (qRT-PCR), is expensive and time-consuming. Alternatively, haematology-based detections were fast and near-accurate, although those were less explored. The external-validity of the haematology-based COVID-19-predictions on diverse populations are yet to be fully investigated. Here we report external-validity of machine learning-based prediction scores from haematological parameters recorded in different hospitals of Brazil, Italy, and Western Europe (raw sample size, 195554). The XGBoost classifier performed consistently better (out of seven ML classifiers) on all the datasets. The working models include a set of either four or fourteen haematological parameters. The internal performances of the XGBoost models (AUC scores range from 84% to 97%) were superior to ML models reported in the literature for some of these datasets (AUC scores range from 84% to 87%). The meta-validation on the external performances revealed the reliability of the performance (AUC score 86%) along with good accuracy of the probabilistic prediction (Brier score 14%), particularly when the model was trained and tested on fourteen haematological parameters from the same country (Brazil). The external performance was reduced when the model was trained on datasets from Italy and tested on Brazil (AUC score 69%) and Western Europe (AUC score 65%); presumably affected by factors, like, ethnicity, phenotype, immunity, reference ranges, across the populations. The state-of-the-art in the present study is the development of a COVID-19 prediction tool that is reliable and parsimonious, using a fewer number of hematological features, in comparison to the earlier study with meta-validation, based on sufficient sample size (n = 195554). Thus, current models can be applied at other demographic locations, preferably, with prior training of the model on the same population. Availability: https://covipred.bits-hyderabad.ac.in/home; https://github.com/debashreebanerjee/CoviPred.
Assuntos
COVID-19 , Aprendizado de Máquina , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/sangue , COVID-19/diagnóstico , Itália/epidemiologia , Brasil/epidemiologia , Europa (Continente)/epidemiologia , SARS-CoV-2/isolamento & purificação , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: Given the importance of reducing lowvalue care practices and acknowledging that vitamin D testing in the general population is rising despite the absence of evidence to support such conduct, we decided to investigate its overuse. MATERIALS AND METHODS: Design: cross-sectional study. DATA SOURCE: electronic medical records. POPULATION: patients aged between 18 and 64 on the Hospital Italiano de Buenos Aires Health Maintenance Organization membership list, to whom at least one test of vitamin D had been performed between July 1st and December 31st 2022. A sample of electronic medical records was manually analyzed. In the presence/suspicion of a clinical condition that counts with recommendation for Vitamin D testing, its indication was considered appropriate; however, in its absence, it was considered inappropriate. RESULTS: A total of 10 095 vitamin D tests were performed on 9623 patients (mean age 47, 78.1% female). These patients were 10% of the 97 584 HMO members aged between 18 and 64 in 2022. A hundred and sixty of the 242 patients whose electronic medical records were analyzed (66%, CI 95% 60 - 72), did not have a clinical condition that justified vitamin D testing. The most frequent clinical conditions found for testing were osteopenia in 37/242 patients (15%); osteoporosis, 13/242 (5%) and chronic kidney disease 11/242 (5%). DISCUSSION: Two-thirds of the vitamin D tests performed did not have a clinical condition that justified the practice. These findings represent an opportunity to design strategies to institutionally reduce this low-value care practice.
Introducción: Dada la importancia de reducir las prácticas de bajo valor y teniendo en cuenta que los dosajes séricos de vitamina D en la población general están aumentando, a pesar de la ausencia de evidencia que respalde dicha conducta, decidimos investigar su sobreúso. Materiales y métodos: Diseño: corte transversal. Fuente de datos: historia clínica electrónica. Población: pacientes de entre 18 y 64 años afiliados al plan de medicina prepaga del Hospital Italiano de Buenos Aires a quienes se les realizóal menos un dosaje de vitamina D en el segundo semestre de 2022. Se analizó manualmente una muestra de historias clínicas. Ante la presencia/sospecha de una condición clínica que contase con recomendación de dosaje de vitamina D, la indicación para realizarlo se consideróadecuada, mientras que ante su ausencia se consideróinapropiada. Resultados: Un total de 10 095 determinaciones de vitamina D fueron realizadas a 9623 pacientes (78% mujeres, edad media 47 años), quienes representan el 10% de la población (97 584). En 160 (66%, CI 95% 60-72) de los 242 pacientes cuyas historias clínicas fueron revisadas, no había documentada condición clínica que avalara la prueba. En 37/242 (15%) se constatóosteopenia como motivo de la determinación; en 13/242 (5%), osteoporosis y en 11/242 (5%), enfermedad renal crónica. Discusión: Dos tercios de las determinaciones de vitamina D pueden ser interpretadas como inapropiadamente indicadas. Estos datos representan una oportunidad para diseñar estrategias que reduzcan esta práctica de bajo valor a nivel institucional.
Assuntos
Registros Eletrônicos de Saúde , Vitamina D , Humanos , Estudos Transversais , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Vitamina D/sangue , Vitamina D/análise , Adolescente , Adulto Jovem , Registros Eletrônicos de Saúde/estatística & dados numéricos , Argentina , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologiaRESUMO
Low oxygen (O2) affinity hemoglobin (Hb) variants are a group of structural hemoglobinopathies, caused in most cases by point mutations in beta or alpha globin genes. The clinical presentation is widely variable, from asymptomatic patients to those presenting cyanosis and/or low O 2 saturation without signs of chronic hypoxia. Accurate identification of these patients is essential to avoid invasive cardiorespiratory procedures that could be unnecessary. We present the case of a girl in an acute viral illness context, with repeated low peripheral O2 saturation (SpO2) readings without clinical picture of hypoxemia. The differential diagnosis included a low O 2 affinity Hb, suspected by an increased partial pressure of O2 at 50% (p50) and confirmed by molecular biology. We highlight the usefulness of arterial blood gas analysis and the p50 determination in the initial phase of evaluation of an unexplained "hypoxemia".
Las variantes de hemoglobinas (Hb) con baja afinidad por el oxígeno (O2) son un grupo de hemoglobinopatías estructurales, causadas en la mayoría de los casos por variantes puntuales en los genes de beta o alfa globina. La presentación clínica es muy variable, desde pacientes asintomáticos, a aquellos que se manifiestan con cianosis y/o baja saturación de O2, sin signos de hipoxia crónica. Su correcta identificación resulta fundamental para evitar procedimientos cardiorrespiratorios invasivos y en algunos casos innecesarios. Presentamos el caso de una niña que, en el marco del estudio de un cuadro viral agudo, presentóreiteradas lecturas de saturación periférica de O 2 (SpO2) bajas, sin una evidente justificación clínica de hipoxemia. El diagnóstico diferencial incluyóuna Hb de baja afinidad por el O2, que fue evidenciada con el estudio de la presión parcial de O2 al 50% (p50) aumentada y confirmada por biología molecular. Se destaca en estos casos la utilidad de la gasometría arterial y la determinación de la p50 en la fase inicial de la evaluación de la "hipoxemia".
Assuntos
Hemoglobinopatias , Hipóxia , Humanos , Feminino , Hemoglobinopatias/diagnóstico , Hemoglobinopatias/genética , Hemoglobinopatias/sangue , Hipóxia/diagnóstico , Hipóxia/sangue , Diagnóstico Diferencial , Gasometria , Saturação de Oxigênio , CriançaRESUMO
Freshwater ecosystem pollution has motivated an extensive list of studies due to deleterious impacts becoming a threat to aquatic organisms that inhabit these environments. This is the first approach to water pollution impact derived from human activities on native ichthyofauna in the Garagoa river basin in Boyacá (Colombian Andes). Therefore, the aim of the present study was to evaluate the occurrence of mercury and arsenic in catfishes and armored catfishes from the Garagoa River basin and the presence of hepatic alterations and genotoxicity in peripheral blood. Biomarkers of effect were analyzed in fishes caught in eight tributaries from Garagoa river basin. The increased presence of lesions in the hepatic architecture and nuclear abnormalities in peripheral blood erythrocytes in Dolichancistrus fuesslii, Chaetostoma joropo, Astroblepus latidens and Trichomycterus cf. knerii individuals could be associated with exposure of pollutants. The tissue alterations observed compromise the fish health, due to the biotransformation processes of xenobiotics such as mercury and arsenic and probably other contaminants. We need to increase surveillance in the Garagoa River to ensure ecological health, recognize hematological and tissue effects in native fishes, and develop effective monitoring strategies to mitigate sources of pollution.
Assuntos
Arsênio , Peixes-Gato , Monitoramento Ambiental , Mercúrio , Rios , Poluentes Químicos da Água , Animais , Rios/química , Colômbia , Poluentes Químicos da Água/análise , Mercúrio/sangue , Mercúrio/análise , Mercúrio/toxicidade , Arsênio/análise , Dano ao DNA , Fígado/química , Fígado/patologia , Fígado/efeitos dos fármacosRESUMO
OBJECTIVE: This study evaluated the effect of Stemregen® nutritional supplement on inflammation and resorption in apical periodontitis using a rat model. METHODOLOGY: Rats were divided in three groups: negative control (n=7), positive control (n=10), and Stemregen® (Stem) (n=10). Apical periodontitis was induced in the positive control and Stem groups, and all rats were sacrificed on the 30th day. Serum phosphorus (P), calcium (Ca), and alkaline phosphatase (ALP) were analyzed. Histopathological assessments measured osteoblastic and osteoclastic activity, inflammation, fibrosis, and abscess density. Immunohistochemical analyses evaluated RANKL, TRAP, and OPG levels. RESULTS: Results showed significantly lower osteoblastic activity in the negative control compared to Stem and positive control groups (p=0.005). Osteoclastic activity was higher in the positive control (p=0.032). Inflammation and abscess formation were reduced in the Stem group compared to the positive control (p<0.001). OPG levels were lower in the negative control compared to the other groups (p=0.005). CONCLUSION: Stemregen® effectively reduced inflammation and bone destruction, suggesting potential benefits for apical periodontitis management, though further research is needed.
Assuntos
Fosfatase Alcalina , Modelos Animais de Doenças , Osteoprotegerina , Periodontite Periapical , Ratos Wistar , Animais , Periodontite Periapical/terapia , Osteoprotegerina/análise , Masculino , Fosfatase Alcalina/sangue , Fosfatase Alcalina/análise , Cálcio/análise , Cálcio/sangue , Fósforo/sangue , Fósforo/análise , Fatores de Tempo , Reprodutibilidade dos Testes , Resultado do Tratamento , Ligante RANK/análise , Imuno-Histoquímica , Osteoclastos/efeitos dos fármacos , Osteoblastos/efeitos dos fármacos , Distribuição Aleatória , Fosfatase Ácida Resistente a Tartarato/análise , Fosfatase Ácida Resistente a Tartarato/sangue , RatosRESUMO
BACKGROUND: Although emergency Percutaneous Coronary Intervention (PCI) has been shown to reduce mortality in patients with Acute Myocardial Infarction (AMI), the risk of in-hospital death remains high. In this study, the authors aimed to identify risk factors associated with in-hospital mortality in AMI patients who underwent PCI, develop a nomogram prediction model, and evaluate its effectiveness. METHODS: The authors retrospectively analyzed data from 1260 patients who underwent emergency PCI at Dongyang People's Hospital between June 1, 2013, and December 31, 2021. Patients were divided into two groups based on in-hospital mortality: the death group (n = 61) and the survival group (n = 1199). Clinical data between the two groups were compared. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select non-zero coefficients of predictive factors. Multivariable logistic regression analysis was then performed to identify independent risk factors for in-hospital mortality in AMI patients after emergency PCI. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed, and its predictive performance was evaluated using the c-index. Internal validation was performed using the bootstrap method with 1000 resamples. The Hosmer-Lemeshow test was used to assess the goodness of fit, and a calibration curve was plotted to evaluate the model's calibration. RESULTS: LASSO regression identified d-dimer, B-type natriuretic peptide, white blood cell count, heart rate, aspartate aminotransferase, systolic blood pressure, and the presence of postoperative respiratory failure as important predictive factors for in-hospital mortality in AMI patients after PCI. Multivariable logistic regression analysis showed that d-dimer, B-type natriuretic peptide, white blood cell count, systolic blood pressure, and the presence of postoperative respiratory failure were independent factors for in-hospital mortality. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed using these independent predictive factors. The Hosmer-Lemeshow test yielded a Chi-Square value of 9.43 (p = 0.331), indicating a good fit for the model, and the calibration curve closely approximated the ideal model. The c-index for internal validation was 0.700 (0.560â0.834), further confirming the predictive performance of the model. Clinical decision analysis demonstrated that the nomogram model had good clinical utility, with an area under the ROC curve of 0.944 (95 % CI 0.903â0.963), indicating excellent discriminative ability. CONCLUSION: This study identified B-type natriuretic peptide, white blood cell count, systolic blood pressure, d-dimer, and the presence of respiratory failure as independent factors for in-hospital mortality in AMI patients undergoing emergency PCI. The nomogram model based on these factors showed high predictive accuracy and feasibility.
Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio , Nomogramas , Intervenção Coronária Percutânea , Humanos , Intervenção Coronária Percutânea/mortalidade , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Medição de Risco/métodos , Fatores de Risco , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/sangue , Modelos LogísticosRESUMO
INTRODUCTION: Inflammation is hypothesized to be a pivotal factor influencing muscle function, with C-Reactive Protein (CRP) serving as a common biomarker of inflammation. However, the literature pertaining to the relationship between CRP and muscle mass remains scant, particularly among representative adult populations in the United States. The present study aimed to delve into the association between serum CRP levels and muscle mass among American adults, leveraging data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006. METHODS: A cohort of 13,518 participants, representative of the US adult population, underwent dual-energy X-Ray Absorptiometry (DXA) to assess Appendicular Skeletal Muscle Mass (ASM) and had their CRP levels measured. Muscle mass was defined using ASM adjusted by Body Mass Index (ASM/BMI) criteria. Employing weighted logistic regression models, restricted cubic spline analysis, and subgroup analyses, the authors examined the association between serum CRP and low muscle mass. RESULTS: After meticulously adjusting for various covariates, the present findings revealed a positive association between serum CRP levels and the risk of low muscle mass in American adults (OR = 1.07, 95 % CI 1.01â1.14, p = 0.016). Notably, an inverse J-shaped relationship was observed, with serum CRP inflection points of 0.273 mg/dL for the overall population, 0.172 mg/dL for males, and 0.296 mg/dL for females. Subgroup analysis further demonstrated that factors such as gender, race, educational level, smoking status, congestive heart failure, stroke, renal weakness/failure, coronary heart disease, diabetes, hypertension, vigorous physical activity, moderate physical activity, and muscle strengthening activities did not significantly impact this positive correlation (all p for interaction values > 0.05). CONCLUSIONS: This nationally representative cross-sectional study provides robust evidence of an inverse J-shaped association between serum CRP levels and the risk of low muscle mass in adults in the United States, with a critical inflection point of 0.273 mg/dL. These findings may inform future research and clinical strategies aimed at mitigating the negative effects of inflammation on muscle mass and function in the adult population.
Assuntos
Absorciometria de Fóton , Biomarcadores , Proteína C-Reativa , Músculo Esquelético , Inquéritos Nutricionais , Humanos , Proteína C-Reativa/análise , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estados Unidos , Músculo Esquelético/anatomia & histologia , Biomarcadores/sangue , Índice de Massa Corporal , Estudos Transversais , Sarcopenia/sangue , Idoso , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: The impact of a healthy diet on the secondary prevention of ischemic stroke (IS) remains uncertain. Levels of low-density lipoprotein cholesterol (LDL-C) are inversely associated with the risk of IS recurrence. A Mediterranean diet (MeDi), consisting of a preference for fish/poultry, monosaturated fats from olive oil, fruit, vegetables, whole grains, legumes/nuts and limited red meats, animal fats and sweetened beverages, reduces metabolic syndrome, LDL-C levels and stroke risk. Avocados also reduce metabolic syndrome and LDL-C levels but are not part of the traditional MeDi diet. The effects of an avocado-based Mediterranean diet on LDL-C were investigated and compared to those of a low-fat diet in patients with previous IS. METHODS: The Avocado-Based Mediterranean Diet on Serum Lipids for Secondary Prevention after Ischemic Stroke (ADD-SPISE) was a prospective, randomized, open-label, blinded outcome assessment, phase 2, clinical trial. The participants were adults with an IS in the previous month who were randomly assigned at a 1:1 ratio to a MeDi or a low-fat diet for three months. Outcome assessors of laboratory results and data analysts were masked. The primary outcome was the mean difference in LDL-C between groups at 90 days, adjusted by statin use. Safety, feasibility and acceptability (assessed through a 14-item questionnaire administered to all patients who completed the follow-up) were also evaluated. RESULTS: From August 2018 to October 2022, 200 participants were enrolled (97 randomized to the low-fat diet and 103 to the MeDi), with 189 (94.5%) completing the study. There were no significant differences in LDL-C levels between the MeDi group and the low-fat group at 90 days: 66.5 mg/dL (95% confidence interval [CI] 59.6, 73.4) in the MeDi group and 69.9 mg/dL (62.6, 77.2) in the low-fat group at the end of follow-up. The adjusted difference was - 3.4 mg/dL (-13.4, -6.62); P = 0.50. The intervention group showed significant improvements in Mediterranean diet adherence (P < 0.01). Moreover, no significant differences in adverse events were observed between the groups. CONCLUSION: Compared with a low-fat diet, the avocado-based MeDi did not significantly lower LDL-C in IS patients after three months. The intervention was safe, feasible, and well accepted. Larger trials should establish whether longer dietary interventions could yield clinically significant benefits in these patients. The study is registered under ADD-SPISE at www. CLINICALTRIALS: gov . Identifier: NCT03524742.
Assuntos
LDL-Colesterol , Dieta Mediterrânea , AVC Isquêmico , Persea , Prevenção Secundária , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Prevenção Secundária/métodos , AVC Isquêmico/prevenção & controle , AVC Isquêmico/sangue , AVC Isquêmico/dietoterapia , LDL-Colesterol/sangue , Projetos Piloto , Dieta com Restrição de Gorduras , Lipídeos/sangue , Estudos ProspectivosRESUMO
Hepatitis B virus surface antigen (HBsAg), IgM and IgG antibodies to hepatitis B virus core antigen (anti-HBcIgM and anti-HBcIgG) comprise serological markers of hepatitis B virus (HBV) infection of great importance in the epidemiological surveillance of hepatitis B, since they have been routinely considered for classifying the acute and chronic clinical forms of HBV infection. This classification is established according to the expression and dynamics of these markers in the infected person's bloodstream, which serves as the basis for the differential diagnosis between the two clinical entities. However, in certain circumstances, both acute and chronic infection, the detection of these markers may not occur in the bloodstream, favoring the occurrence of atypical serological profiles of infection, and compromising the correct infection clinical classification. In addition, the complex and varied nature of hepatitis B serological profiles may compromise the health professional's ability to analyze the case and, thus, correctly classify the infection's clinical form. Since the expression of these markers in the bloodstream occurs dynamically, with consequent changes in the patient's serological profile as he progresses towards recovery or chronicity, the diagnosis of acute or chronic infection may also be compromised, if it is established based on the collection of a single sample and without knowing the patient's clinical history and their epidemiological antecedents. This manuscript addresses the sensitivity and specificity of HBsAg, anti-HBcIgM, and anti-HBcIgG serological markers detection in the clinical classification of HBV infection and in the epidemiological surveillance of hepatitis B. This review is covering the clinical and epidemiological interpretations of the markers in and of themselves, not in reference to any specific assays.
Assuntos
Antígenos do Núcleo do Vírus da Hepatite B , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B , Hepatite B , Imunoglobulina G , Imunoglobulina M , Humanos , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Hepatite B/epidemiologia , Hepatite B/imunologia , Hepatite B/diagnóstico , Hepatite B/sangue , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Anticorpos Anti-Hepatite B/sangue , Anticorpos Anti-Hepatite B/imunologia , Biomarcadores/sangue , Monitoramento EpidemiológicoRESUMO
PURPOSE: A vegan diet is associated with health benefits but may also lead to inadequate intake of essential nutrients. Due to the lower selenium content in plant-based compared to animal-based foods, many vegans do not reach the recommended selenium intake in Europe. The only plant-based food with high selenium content is the Brazil nut, even though there is also a high variability. Therefore, we investigated the effectiveness of Brazil nut butter compared to a dietary supplement as selenium source to improve the selenium status of vegans and omnivores. METHODS: 44 vegans and 42 omnivores were randomly assigned to one of three intervention groups, either receiving placebo or consuming additional 55 µg of selenium daily as Brazil nut butter or supplement for two weeks. Serum selenium concentrations, glutathione peroxidase 3 (GPX3), and selenoprotein P (SELENOP) were measured at baseline and after intervention. Additionally, dietary selenium intake was estimated using a five-day dietary protocol. RESULTS: The estimated selenium intake was significantly lower in vegans compared to omnivores and correlated with all three selenium biomarkers. Independent of the dietary pattern (vegan or omnivore), Brazil nut butter as well as supplement significantly increased serum selenium and SELENOP concentrations, while there were no changes in the placebo groups. Both interventions were equally effective in increasing selenium levels, but the upregulation of SELENOP was more pronounced in vegans than in omnivores. CONCLUSION: Brazil nuts are a plant-based source of selenium suitable for vegans and omnivores to improve their selenium status when consumed once in a while. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: Clinical trials registration number: NCT05814874, April 18 2023.
Assuntos
Bertholletia , Suplementos Nutricionais , Selênio , Humanos , Selênio/sangue , Selênio/administração & dosagem , Bertholletia/química , Masculino , Feminino , Adulto , Veganos , Pessoa de Meia-Idade , Dieta Vegana/estatística & dados numéricos , Adulto Jovem , Nozes , Biomarcadores/sangue , Dieta/métodos , Dieta/estatística & dados numéricosRESUMO
PURPOSE: To establish a profile of the inflammatory response in the preoperative and postoperative period of pulmonary resection of patients without postoperative complications, in order to trace the inflammatory profile of lung resection surgery. METHODS: Six collections of arterial and venous blood were performed for data analysis, one sample in the preoperative, immediate postoperative, 4, 8, 24, and 48 hours after surgery. Twenty-seven patients with a median age of 63 years old, ranging from 29 to 80 years old, were included. RESULTS: The leukocyte count showed a significant increase in the times: immediate postoperative and 4 hours after surgery, in relation to the preoperative period. Concomitantly, there was an increase in lactate, heart rate, interleukin (IL)-6 and IL-8 after 4 hours of surgery. The platelet count showed a significant decrease in 48 h, associated with an increase in IL-1ß and tumor necrosis factor-α. A significant increase in IL-10 was observed in the immediate postoperative. CONCLUSION: The study may contribute to the search for more specific and adequate alternatives for controlling the inflammatory response. In this way, the intervention would be specific to that cytokine that causes the greatest harm to the patient, as well as to the moment of the intervention.
Assuntos
Inflamação , Pneumonectomia , Período Pré-Operatório , Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Masculino , Adulto , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Período Pós-Operatório , Idoso de 80 Anos ou mais , Inflamação/sangue , Fatores de Tempo , Contagem de Leucócitos , Citocinas/sangue , Contagem de PlaquetasRESUMO
Malaria is a parasitic disease of great relevance in global public health. The development of new sensitive and specific diagnostic high-throughput methods remains a challenge in the eradication of this disease. In this study, we developed a flow cytometry test using latex microbeads and polyclonal antibodies obtained from rabbits and mice for the detection of the P. vivax lactate dehydrogenase (PvLDH) antigen. We processed 50 samples from Brazilian patients diagnosed with malaria caused by P. vivax and 40 samples from healthy individuals. The assay presented sensitivity of 64%, specificity of 97%, a positive predictive value of 97%, and a negative predictive value of 57% when analyzed using the fluorescent labeling method. Using the mean fluorescence intensity (MFI) analysis method, the sensitivity was 53%, specificity was 89%, the positive predictive value was 95%, and the negative predictive value was 33%. In both methods of analysis, we observed significant statistical differences between the analyzed groups (P-value <0.0001). A high correlation (0.60) between the two methods and a low correlation between PvLDH concentration and parasite density was found. The test was able to detect the PvLDH protein with high specificity, but its sensitivity should be improved. More promising results were observed when the samples were analyzed according to the percentage of fluorescent labeling. Improvement of this assay would enable its application as a serological test for the detection of asymptomatic patients and for the validation of rapid diagnostic tests.
Assuntos
Citometria de Fluxo , L-Lactato Desidrogenase , Malária Vivax , Microesferas , Plasmodium vivax , Sensibilidade e Especificidade , Citometria de Fluxo/métodos , Humanos , Plasmodium vivax/enzimologia , L-Lactato Desidrogenase/análise , Animais , Coelhos , Malária Vivax/diagnóstico , Camundongos , Látex , Estudos de Casos e Controles , Anticorpos Antiprotozoários/sangue , Anticorpos Antiprotozoários/análise , Valor Preditivo dos TestesRESUMO
This systematic review of inception prospective cohort studies aimed to investigate whether autoantibodies are potential prognostic factors for short- and long-term clinical outcomes of COVID-19. Searches were conducted in MEDLINE, EMBASE, AMED, GLOBAL HEALTH, and COCHRANE databases from 2019 to 2022. When possible, meta-analysis was conducted, otherwise findings from individual studies were reported using odds ratios (OR) with 95% confidence intervals (CI). Quality of evidence was summarized using the GRADE criteria. We identified 2292 references, 18 inception prospective cohort studies (3178 patients) were included in the systematic review, and 12 studies reached criteria for meta-analysis. Studies achieved, in general, low to moderate risk of bias. Moderate quality of evidence showed that anti-interferon (IFN) was associated with increased risk of severity (OR=7.75; CI=1.79-33.61) and mechanical ventilation (OR=4.19; CI=2.06-8.53), but not with COVID-19 mortality (OR=1.68; CI=0.63-4.44). Antiphospholipids were not associated with COVID-19 mortality (OR=1.42; CI=0.85-2.37; P=0.18; I2=3.21) nor with thrombosis risk (OR=1.41; CI: 0.71-2.8; P=0.33). Antinuclear antibody level was not associated with risk of mortality or severity (risk for mortality: OR=3.8; CI=0.78-18.6; P=0.1; I2: 32.3; severity: OR=1.74; CI=0.96-3.16; P=0.07). Evidence currently available is insufficient for a quantitative analysis of autoantibodies association with long COVID-19. Anti-IFN measurement should be considered in COVID-19 follow-up. In a population-based rational, optimized vaccination strategies should be considered for individuals with anti-IFN antibodies since it could represent a risk for a worse prognosis. High-quality prospective studies for short- and long-term disease effects and autoantibody evaluation are still needed.
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Autoanticorpos , COVID-19 , SARS-CoV-2 , Humanos , COVID-19/imunologia , COVID-19/mortalidade , Autoanticorpos/sangue , Prognóstico , SARS-CoV-2/imunologia , Estudos ProspectivosRESUMO
INTRODUCTION: The escalating resistance of microorganisms to antimicrobials poses a significant public health threat. Strategies that use biomarkers to guide antimicrobial therapy-most notably Procalcitonin (PCT) and C-reactive protein (CRP)-show promise in safely reducing patient antibiotic exposure. While CRP is less studied, it offers advantages such as lower cost and broader availability compared with PCT. METHODS AND ANALYSIS: This randomised clinical trial aims to evaluate a novel algorithm for non-critically ill adult patients. The algorithm incorporates key clinical variables and CRP behaviour. It will be applied through a mobile application as a digital clinical decision support system. The primary goal will be to assess the algorithm's effectiveness in reducing treatment duration compared with standard care based on current guidelines, while ensuring patient safety by monitoring the occurrence of adverse events. ETHICS AND DISSEMINATION: Only patients who agree to participate in the study after reading the informed consent form will be included. This project was submitted for consideration to the Research Ethics Committee of the Federal University of Minas Gerais (COEP-UFMG) and received approval (Approval Number: 5.905.290). Collection of clinical and laboratory data from 200 patients is expected, extracted from electronic medical records and laboratory systems, along with serum samples stored for potential future analyses. Data will be preserved using the Research Electronic Data Capture platform, and serum samples will be stored in a regulated biorepository at UFMG. Access will be controlled via credentials, with privacy protections and anonymisation prior to sharing, which will occur during scientific publications. TRIAL REGISTRATION NUMBER: This trial was registered on ClinicalTrials.gov (NCT05841875) and was last updated on 5 December 2024 at 12:49.
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Algoritmos , Antibacterianos , Proteína C-Reativa , Sistemas de Apoio a Decisões Clínicas , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Proteína C-Reativa/análise , Biomarcadores/sangue , Aplicativos MóveisRESUMO
BACKGROUND: Urban arboviruses pose a significant global burden, particularly in tropical regions like Brazil. São Sebastião, a lower-middle-class urban area just 26 km from the Brazilian capital, is an endemic area for dengue. However, asymptomatic cases may obscure the actual extent of the disease. In this study, we measured the seroprevalence of dengue, Zika virus, and chikungunya, and compared these findings with surveillance data. METHODS: A cross-sectional study was conducted involving 1,535 households. ELISA serological tests were performed to detect IgM and IgG antibodies against dengue, Zika virus, and chikungunya. History of previous exposure to arboviruses, data on age, gender, and education level were collected through a questionnaire. Participants who tested positive for IgM and/or IgG were classified as soropositive. Statistical analyses included tests for normality, associations, mean comparisons, and correlations. Positive serological results were compared with cases captured by local epidemiological surveillance. RESULTS: The study included 1,405 individuals, divided into two groups related to pre-pandemic and pandemic COVID-19 phases. Among participants, 0.7% to 28.8% self-reported history of dengue, Zika, or chikungunya. However, the estimated overall seroprevalence was 64.3% (95% CI: 61.8-66.7) for dengue virus, 51.4% (95% CI: 48.8-53.9) for Zika virus, and 5.4% (95% CI: 4.4-6.7) for chikungunya virus. Multiple arboviruses were noted at 4.0% (95% CI: 3.1-5.1). Advancing age and lower education were associated with higher exposure to arboviruses (p < 0.05). The estimated number of urban arboviral infections was 84 times higher than reported cases. CONCLUSIONS: The large gap between seroprevalence estimates and cases captured by epidemiological surveillance suggests a silent circulation of arboviruses, highlighting the need for comprehensive serological surveys in endemic regions. Addressing these discrepancies is crucial for effective resource allocation and implementation of public health interventions.
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Anticorpos Antivirais , Febre de Chikungunya , Dengue , Infecção por Zika virus , Zika virus , Humanos , Estudos Soroepidemiológicos , Brasil/epidemiologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/sangue , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/sangue , Febre de Chikungunya/virologia , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Adolescente , Dengue/epidemiologia , Dengue/sangue , Adulto Jovem , Criança , Zika virus/imunologia , Anticorpos Antivirais/sangue , Pré-Escolar , Vírus Chikungunya/imunologia , Vírus da Dengue/imunologia , Idoso , Imunoglobulina M/sangue , Lactente , Imunoglobulina G/sangue , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Research into the mechanisms of growth control during birth and postnatal life has shown that adipose tissue regulates many physiological functions in the body by secreting adipokines. The aims of this study were to investigate the serum levels of visfatin and vaspin in healthy and unhealthy pregnant women and its relationship with their newborns' anthropometric measurements. MATERIALS AND METHODS: A total of 82 pregnant women were included in this study with their respective newborn, healthy pregnant women (n = 30), with obesity (n = 26) and with gestational diabetes (GD) (n = 26). We assessed differences between groups with ANOVA or Kruskal Wallis and correlation between adipokines and anthropometric measurements of the newborn with Spearman correlation. RESULTS: Visfatin serum concentrations were higher in umbilical cord serum of newborns from mothers with obesity (p = 0.006). Maternal visfatin correlated negatively with their newborn's anthropometric measurements (p < 0.05). Umbilical cord visfatin correlated positively with maternal weight and body mass index (p < 0.05). Umbilical cord vaspin correlated positively with fat mass (p = 0.036) and weight gain of infants (p = 0.046). CONCLUSIONS: These adipokines may be significant in the development of elevated adiposity in newborns. Offspring form mothers with obesity or GD are at higher risk.
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Nicotinamida Fosforribosiltransferase , Serpinas , Humanos , Nicotinamida Fosforribosiltransferase/sangue , Feminino , Gravidez , Serpinas/sangue , Recém-Nascido , Adulto , Antropometria , Diabetes Gestacional/sangue , Obesidade/sangue , Complicações na Gravidez/sangue , CitocinasRESUMO
Childhood obesity increases the risk of developing metabolic diseases in adulthood, since environmental stimuli during critical windows of development can impact on adult metabolic health. Studies demonstrating the effect of prepubertal diet on adult metabolic disease risk are still limited. We hypothesized that a prepubertal control diet (CD) protects the adult metabolic phenotype from diet-induced obesity (DIO), while a high-fat diet (HFD) would predispose to adult metabolic alterations. Sprague-Dawley male rats were fed either a CD or a HFD during the prepubertal period (day 30-40 of age) and subsequently a chronic HFD or CD, respectively, until adulthood (day 220 of age). As controls, rats aged 30 days were exclusively fed a CD or a HFD until adulthood. Body weight and composition, metabolic rate, biochemical and hormonal plasma measurements, hepatic gene expression and methylation and hydroxymethylation levels were analyzed at ages 30, 40 and 220 days. The prepubertal CD prevented fat mass accumulation, lean mass loss and metabolic inflexibility, showed lower insulin, leptin and cholesterol concentrations in adulthood despite the chronic HFD. Notably, the prepubertal CD led to higher hepatic Lxrα expression, lower hepatic global DNA methylation and higher hydroxymethylation in adulthood despite a chronic HFD. Conversely, a prepubertal HFD decreased adult metabolic flexibility, increased serum cholesterol, and decreased Lxrα expression and global DNA hydroxymethylation, while also increasing DNA methylation levels despite a chronic CD. In summary, a prepubertal CD protected the adult metabolic phenotype from high cholesterol concentrations associated with increased hepatic Lxrα expression and lower hepatic global DNA methylation in adulthood, despite exposure to a chronic HFD. Conversely, a prepubertal HFD altered the adult metabolic phenotype.
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Colesterol , Metilação de DNA , Dieta Hiperlipídica , Receptores X do Fígado , Fígado , Ratos Sprague-Dawley , Animais , Masculino , Metilação de DNA/efeitos dos fármacos , Receptores X do Fígado/metabolismo , Receptores X do Fígado/genética , Fígado/metabolismo , Ratos , Colesterol/sangue , Colesterol/metabolismo , Dieta Hiperlipídica/efeitos adversos , Receptores Nucleares Órfãos/metabolismo , Receptores Nucleares Órfãos/genética , Obesidade/metabolismo , Obesidade/etiologia , Peso Corporal/efeitos dos fármacosRESUMO
Chikungunya virus (CHIKV) is primarily associated with non-human-primates (NHPs) in Africa, which also infect humans. Since its introduction to Brazil in 2014, CHIKV has predominantly thrived in urban cycles, involving Aedes aegypti mosquitoes. Limited knowledge exists regarding CHIKV occurrence and implications in rural and sylvatic cycles where neotropical NHPs are potential hosts, from which we highlight Leontopithecus chrysomelas (Kuhl, 1820), the golden-headed lion tamarin (GHLT), an endangered species endemic to the Atlantic Forest (AF) in Southern Bahia State, Brazil. The present study investigated wild GHLT groups across two municipalities, Ilhéus and Una, Bahia. Surveys were conducted in three groups within cocoa agroforests (cabrucas) in Ilhéus, and four groups in anthropized forest and agroforestry fragments in Una, between 2021 and 2022. Thirty-two GHLT specimens were captured and chemically immobilized, examined and submitted to blood sample collection; nine specimens were later recaptured in 2022, totaling 41 samples. CHIKV viremia was not detected in any specimens (as assayed by RT-qPCR). Plaque reduction neutralization test (PRNT90) detected CHIKV antibodies in two (6.3%) GHLTs, with 10-20 antibody titers. Seroprevalence in 2021 was 5.6% and in 2022 was 8.7% with an incidence of 4.5%, whereas, a male adult tested seropositive in both years, suggesting either natural re-exposure and antibody maintenance over time. All samples tested seronegative for Mayaro Virus. Eight mosquito species from the Culicidae family were collected, identified and assayed for CHIKV genomes, showing negative results. This study provides the first evidence of natural CHIKV exposure among free-living GHLTs in Brazil, emphasizing their susceptibility and potential role as reservoirs. These findings underscore the possible consequences of anthropic disturbances in the Brazilian AF, without a seroprevalence difference between non-protected forest formations, agroforest fragments and various mosaic farming landscapes in South Bahia, and highlight the importance of conservation efforts for this endemic and endangered primate species.
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Anticorpos Antivirais , Febre de Chikungunya , Vírus Chikungunya , Leontopithecus , Animais , Leontopithecus/virologia , Brasil/epidemiologia , Vírus Chikungunya/isolamento & purificação , Vírus Chikungunya/imunologia , Masculino , Feminino , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/virologia , Anticorpos Antivirais/sangue , Estudos Soroepidemiológicos , Doenças dos Macacos/virologia , Doenças dos Macacos/epidemiologia , HumanosRESUMO
BACKGROUND: MicroRNAs (miRNAs) are crucial post-transcriptional regulators involved in inflammatory diseases, such as asthma. Poor lung function and airflow issues in childhood are linked to the development of chronic obstructive pulmonary disease (COPD) in adulthood. METHODS: We analyzed small RNA-Seq data from 365 peripheral whole blood samples from the Genetics of Asthma in Costa Rica Study (GACRS) for association with airflow levels measured by FEV1/FVC. Differentially expressed (DE) miRNAs were identified using DESeq2 in R, adjusting for covariates and applying a 10% false discovery rate (FDR). The analysis included 361 samples and 649 miRNAs. The two DE miRNAs were further tested for association with airflow obstruction in a study of adult former smokers with and without COPD. RESULTS: We found 1 upregulated and 1 downregulated miRNA in participants with airflow below the threshold compared to those above it. In the adult study, the same miRNAs were upregulated and downregulated in individuals with FEV1/FVC < 0.7 versus those with FEV1/FVC > 0.7, showing suggestive statistical evidence. The target genes of these miRNAs were enriched for PI3K-Akt, Hippo, WNT, MAPK, and focal adhesion pathways. CONCLUSIONS: Two differentially expressed miRNAs were associated with airflow levels in children with asthma and airflow obstruction in adults with COPD. This suggests that shared genetic regulatory systems may influence childhood airflow and contribute to adulthood airflow obstruction.