Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients.

BACKGROUND: Health literacy is the ability to deal with information related to one's health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. METHODS: We included adult patients with CKD stages 1-5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively. RESULTS: Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25-2.33) for two comorbidities to 2.71 (2.00-3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16-2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. CONCLUSIONS: Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients.

A comparison between endoscopic and microscopic approaches for stapes surgery: a systematic review.

OBJECTIVES: To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery. METHODS: Systematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results. RESULTS: Fourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques. CONCLUSION: Studies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.

Intestinal cell migration damage induced by enteropathogenic Escherichia coli strains.

Epithelial cell migration is an essential response to enteric pathogens such as enteropathogenic Escherichia coli (EPEC). This study aimed to investigate the effects of EPEC infection on intestinal epithelial cell migration in vitro, as well as the involvement of type III secretion system (T3SS) and Rho GTPases. Crypt intestinal epithelial cells (IEC-6) were infected with EPEC strains (E2348/69, ΔescF, and the LDI001 strain isolated from a malnourished Brazilian child) and commensal E. coli HS. Wound migration and cell death assays were performed at different time-points. Transcription and expression of Rho GTPases were evaluated using real-time PCR and western blotting. Overall, EPEC E2348/69 reduced migration and increased apoptosis and necrosis levels compared to EPEC LDI001 and E. coli HS strains. Moreover, EPEC LDI001 impaired cell migration at a higher level than E. coli HS and increased necrosis after 24 hours compared to the control group. The different profiles of virulence genes between the two wild-type EPEC strains, characterized by the absence of espL and nleE genes in the LDI001, might explain the phenotypic results, playing significant roles on cell migration impairment and cell death-related events. Moreover, the type III secretion system is determinant for the inhibition of intestinal epithelial cell migration by EPEC 2348/69, as its deletion prevented the effect. Active Rac1 concentrations were increased in E2348/69 and LDI001-infected cells, while the T3SS-deficient strain did not demonstrate this activation. This study contributes with valuable insight to characterize the mechanisms involved in the impairment of intestinal cell migration induced by EPEC.

Bactérias zoonóticas isoladas de Passeriformes silvestres recuperados do tráfico de animais no estado do Ceará/Brasil / Zoonotic bacteria isolated from wild Passeriformes recovered from animal trafficking in the State of Ceará/Brazil

A ordem dos Passeriformes é uma das mais pressionadas pelas ações antrópicas, especialmente as relativas ao tráfico de animais, que, devido às más condições de manejo e higiênico-sanitárias, favorecem a infecção dos espécimes por patógenos virulentos e zoonóticos, como cepas de Escherichia coli e Salmonella spp., cujo isolamento em suabes cloacais, bem como a análise dos genes de virulência das cepas de E. coli foram objetivos do estudo. Para isso, 120 Passeriformes silvestres nativos, recebidos pelo Cetas/CE, foram avaliados individualmente. As cepas isoladas foram submetidas a teste de disco difusão para determinação da sensibilidade aos antimicrobianos. Em etapa posterior, foi realizada PCR para a detecção de oito genes de virulência dos principais patotipos diarreiogênicos de E. coli. Quanto aos resultados, nenhuma cepa de Salmonella spp. foi isolada, no entanto a ocorrência de E. coli foi de 40,8%. Foi observada elevada resistência, principalmente aos antimicrobianos tetraciclina, ampicilina e sulfazotrim, ocorrendo multirresistência em 42,8% das cepas. Pela análise molecular, foram diagnosticados quatro entre os nove genes pesquisados, com a identificação de EPEC típicas, EPEC atípicas, ETEC, EHEC e EAEC. Os resultados apontam para a importância de Passeriformes como possíveis disseminadores de zoonoses.(AU)

The order Passeriformes is one of the most pressured by anthropic actions, especially those related to animal trafficking. Due to poor sanitary and hygienic conditions, the infection of the specimens is favored by virulent and zoonotic pathogens such as strains of Escherichia coli and Salmonella spp., whose isolation in cloacal swabs as well as the analysis of the virulence genes of E. coli strains were the objectives of the study. For this, 120 native wild Passeriformes, received by CETAS/CE were individually evaluated. The isolated strains were submitted to diffusion disc test to determine sensitivity to antimicrobials. In a later stage, PCR was performed for the detection of eight virulence genes from the main E. coli diarrhoeagenic pathogens. Regarding the results, no strain of Salmonella spp. was isolated; however, the occurrence of E. coli was 40.8%. High resistance was observed, mainly to the antimicrobials Tetracycline, Ampicillin and Sulfazotrim, with multi-resistance in 42.8% of the strains. By molecular analysis, four of the nine genes were diagnosed, identifying typical EPEC, atypical EPEC, ETEC, EHEC and EAEC. The results point to the importance of Passeriformes as possible disseminators of zoonoses.(AU)

Intestinal cell migration damage induced by enteropathogenic Escherichia coli strains

Epithelial cell migration is an essential response to enteric pathogens such as enteropathogenic Escherichia coli (EPEC). This study aimed to investigate the effects of EPEC infection on intestinal epithelial cell migration in vitro, as well as the involvement of type III secretion system (T3SS) and Rho GTPases. Crypt intestinal epithelial cells (IEC-6) were infected with EPEC strains (E2348/69, ΔescF, and the LDI001 strain isolated from a malnourished Brazilian child) and commensal E. coli HS. Wound migration and cell death assays were performed at different time-points. Transcription and expression of Rho GTPases were evaluated using real-time PCR and western blotting. Overall, EPEC E2348/69 reduced migration and increased apoptosis and necrosis levels compared to EPEC LDI001 and E. coli HS strains. Moreover, EPEC LDI001 impaired cell migration at a higher level than E. coli HS and increased necrosis after 24 hours compared to the control group. The different profiles of virulence genes between the two wild-type EPEC strains, characterized by the absence of espL and nleE genes in the LDI001, might explain the phenotypic results, playing significant roles on cell migration impairment and cell death-related events. Moreover, the type III secretion system is determinant for the inhibition of intestinal epithelial cell migration by EPEC 2348/69, as its deletion prevented the effect. Active Rac1 concentrations were increased in E2348/69 and LDI001-infected cells, while the T3SS-deficient strain did not demonstrate this activation. This study contributes with valuable insight to characterize the mechanisms involved in the impairment of intestinal cell migration induced by EPEC.

Quality and stability of oral extemporaneous formulations developed from commercial tablets containing spironolactone / Desenvolvimento e estudo de estabilidade de formulações extemporâneas de uso oral a partir de comprimidos comerciais contendo espironolactona

The purpose of this study was to develop extemporaneous liquid pharmaceutical formulations from commercial tablets containing spironolactone and to assess their stability for use in children or adults with difficulty in swallowing. The content and stability of spironolactone in the tablets, as well as in water, 1.5% carboxymethylcellulose (CMC) or simple syrup dispersions were determined by high performance liquid chromatography (HPLC) analysis on a C18 silica column (250 mm ? 4.6 mm ? 5 ?m), with a mobile phase of methanol:water (75:25 v/v), flowing at 1 mL/min, and UV detection at 240 nm. The extemporaneous formulations were tested over a 35-day period at 8, 27, and 40 ºC. Drug content in the aqueous dispersion was far lower than expected, with significant fluctuations at all temperatures, owing to rapid sedimentation. The content proved adequate in aqueous 1.5% CMC dispersion at 27 ºC, with undesirable variations at the other temperatures. The syrup-based dispersion remained stable at all three temperatures, with suitable drug content and no significant variability. No degradation products were observed in any of the formulations. The syrup-based dispersion is easy to prepare, self-preserving, stable, palatable, offering satisfactory drug content per dose, and can therefore be recommended as an extemporaneous formulation for enhancing treatment adherence and effectiveness...

O objetivo desse trabalho foi desenvolver e avaliar a estabilidade de formas farmacêuticas líquidas extemporâneas, a partir de amostras comerciais (comprimidos), contendo espironolactona, para que possam ser empregadas em pacientes pediátricos ou adultos com dificuldade de deglutição. A metodologia empregada para a análise do teor e da estabilidade do fármaco espironolactona nos comprimidos e nas dispersões utilizando água, carboximetilcelulose (CMC) 1,5% e xarope simples foi a Cromatografia Líquida de Alta Eficiência (CLAE), utilizando coluna de sílica C18 (250 mm x 4,6 mm x 5 μm), fluxo de 1 mL/min, comprimento de onda 240 nm e fase móvel metanol:água (75:25 v/v). As formulações extemporâneas foram analisadas durante 35 dias nas temperaturas de 8, 27 e 40 ºC. A dispersão aquosa apresentou teor muito abaixo do esperado, com variações significativas em todas as temperaturas, devido à rápida sedimentação. A dispersão aquosa de CMC 1,5% apresentou teor adequado na temperatura de 27 ºC com variações indesejadas nas demais temperaturas. A dispersão de xarope simples apresentou-se estável nas três temperaturas, com teor adequado e sem variações significativas. Não foi observado produto de degradação em nenhuma das formulações propostas. Por ser de fácil preparação, autoconservante, estável e de sabor agradável, a dispersão de xarope simples é a formulação extemporânea recomendada, pois garante teor satisfatório por dose e, portanto, favorece aumento à adesão e à eficácia do tratamento...

Effect of fibrin glue derived from snake venom on the viability of autogenous split-thickness skin graft

The aim of this study was to analyze the effect of snake venom derived from fibrin glue on the viability of split-thickness skin graft. Nine crossbreed dogs were used. Full-thickness skin segments measuring 4X4 cm were bilaterally excised from the proximal radial area on each dog. A split-thickness skin graft was harvested from left lateral thoracic area using a freehand graft knife, and was secured to the left recipient bed using several simple interrupted sutures of 3-o nylon (sutured graft). A split-thickness skin graft was harvested from the right lateral thoracic area using a graft knife. Fibrin glue derived from snake venom was applied to the recipient bed, and 8 equidistant simple interrupted sutures of 3-0 nylon were used to secure the skin graft (glued graft). Viable and nonviable areas were traced on a transparent sheet and measured using a Nikon Photomicroscope connected to a KS-300 image analysis system. The skin graft and recipient bed were collected from three dogs at day 7,15, and 30 postoperative. The glued grafs had statistically higher graft viability than sutured grafts. Histological examination showed that the tissue repair process in the glued grafts was more accentuated than sutured grafts. It was possible to conclude that fibrin glue derived from snake venom increased survival of autogenous split-thickness skin graft.

Fixação de enxerto cutâneo em malha de espessura total com sutura ou cola de fibrina / Fixation of full-thickness mesh skin using suture or fibrin glue

Avaliou-se a influência da cola de fibrina, derivada do veneno de serpente, na fixação e integração de enxerto de pele. Foram utilizados nove cães, sem raça definida, com peso médio de 15kg. Foi induzida ferida de 4I4cm de área, na face crânio-proximal dos antebraços direito e esquerdo. Um enxerto de espessura total foi colhido da região torácica e expandido por meio de expansor de pele. No membro direito o enxerto foi estabilizado no leito receptor por meio de pontos isolados simples; no esquerdo foi fixado pela aplicação de cola de fibrina e oito pontos de sutura. O sítio doador foi fechado empregando-se retalho cutâneo bipediculado. As bandagens do leito receptor foram oclusivas e não aderentes e aplicou-se pomada de neomicina com bacitracina. A troca de bandagens ocorreu diariamente até o sétimo dia de pós-operatório e, posteriormente, a cada três dias. A área de sobrevivência do enxerto foi obtida pela subtração das áreas não viáveis e total medidas com fotomicroscópio Nikon conectado a um sistema de análise de imagem KS-300 aos três, sete, 15 e 30 dias de pós-operatório. Para a avaliação microscópica, a área do enxerto foi colhida em três animais aos sete, 15 e 30 dias de pós-operatório. Não houve diferença entre momentos de avaliação e técnicas de fixação quanto à área de enxerto viável. Os enxertos fixados com cola apresentaram estágio de reparação mais avançado em todos os momentos. Concluiu-se que a cola de fibrina derivada do veneno de serpente tem moderado poder adesivo e, pela análise microscópica, favorece a integração do enxerto cutâneo em malha de espessura total.