Impact on facial skin aging signs of a 1-year standardized photoprotection over a classical skin care routine in skin phototypes II-VI individuals: A prospective randomized trial.

BACKGROUND: Data reflecting the impact of photoprotection on cutaneous aging are scarce and mostly limited to fair skin. OBJECTIVE: To assess the effectiveness of a photoprotective product in counteracting the photoaging process in different skin phototypes over 1 year compared against a classical routine. MATERIALS AND METHODS: Two hundred and ninety Brazilian women aged 30-65 years, with skin phototype II-VI were equally randomized in two groups. Group 1 kept on their routine whereas Group 2 applied, twice daily, a photoprotective product (SPF 60, PPD = 24.1) replacing the one they routinely used. Volunteers reported the duration of their daily sun-exposure. Standardized photographs taken at D0 and D365 were analysed by 15 dermatologists to assess eight wrinkles and pigmentation signs. RESULTS: A global increase in severity was reported which was significant for Group 1. This increase was lower in Group 2 where only half the signs showed significant worsening. In Group 2 versus Group 1, the increase in forehead wrinkles, marionette lines, wrinkles created by ptosis and size of dark spot was significantly (p < 0.05) decreased by 30%-50%. CONCLUSION: Daily application of a high photoprotective product significantly decreases the progression of skin aging signs after 1 year in skin phototypes II-VI.

Effect of three pretreatment techniques on the chemical composition and on the methane yields of Opuntia ficus-indica (prickly pear) biomass.

Opuntia ficus-indica (OFI) is an emerging biomass that has the potential to be used as substrate in anaerobic digestion. The goal of this work was to investigate the effect of three pretreatment techniques (thermal, alkaline, acidic) on the chemical composition and the methane yield of OFI biomass. A composite experimental design with three factors and two to three levels was implemented, and regression modelling was employed using a total of 10 biochemical methane potential (BMP) tests. The measured methane yields ranged from 289 to 604 NmL/gVSadded; according to the results, only the acidic pretreatment (HCl) was found to significantly increase methane generation. However, as the experimental values were quite high with regards to the theoretical methane yield of the substrate, this effect still needs to be confirmed via further research. The alkaline pretreatment (NaOH) did not noticeably affect methane yields (an average reduction of 8% was recorded), despite the fact that it did significantly reduce the lignin content. Thermal pretreatment had no effect on the methane yields or the chemical composition. Scanning electron microscopy images revealed changes in the chemical structure after the addition of NaOH and HCl. Modelling of the cumulated methane production by the Gompertz modified equation was successful and aided in understanding kinetic advantages linked to some of the pretreatments. For example, the alkaline treatment (at the 20% dosage) at room temperature resulted to a µmax (maximum specific methane production rate [NmLCH4/(gVSadded·d)]) equal to 36.3 against 18.6 for the control.

Antibacterial plant compounds, extracts and essential oils: An updated review on their effects and putative mechanisms of action.

BACKGROUND: Antibiotic-resistant bacteria pose a global health threat. Traditional antibiotics can lose their effectiveness, and the development of novel effective antimicrobials has become a priority in recent years. In this area, plants represent an invaluable source of antimicrobial compounds with vast therapeutic potential. PURPOSE: To review the full possible spectrum of plant antimicrobial agents (plant compounds, extracts and essential oils) discovered from 2016 to 2021 and their potential to decrease bacterial resistance. Their activities against bacteria, with special emphasis on multidrug resistant bacteria, mechanisms of action, possible combinations with traditional antibiotics, roles in current medicine and future perspectives are discussed. METHODS: Studies focusing on the antimicrobial activity of compounds of plant origin and their mechanism of action against bacteria were identified and summarized, including contributions from January 2016 until January 2021. Articles were extracted from the Medline database using PubMed search engine with relevant keywords and operators. RESULTS: The search yielded 11,689 articles from 149 countries, of which 101 articles were included in this review. Reports from 41 phytochemicals belonging to 20 families were included. Reports from plant extracts and essential oils from 39 plant species belonging to 17 families were also included. Polyphenols and terpenes were the most active phytochemicals studied, either alone or as a part of plant extracts or essential oils. Plasma membrane disruption was the most common mechanism of antimicrobial action. Number and position of phenolic hydroxyl groups, double bonds, delocalized electrons and conjugation with sugars in the case of flavonoids seemed to be crucial for antimicrobial capacity. Combinations of phytochemicals with beta-lactam antibiotics were the most studied, and the inhibition of efflux pumps was the most common synergistic mechanism. CONCLUSION: In recent years, terpenes, flavones, flavonols and some alkaloids and phenylpropanoids, either isolated or as a part of extracts, have shown promising antimicrobial activity, being membrane disruption their most common mechanism. However, their utilization as appropriate antimicrobials need to be boosted by means of new omics technologies and network pharmacology to find the most effective combinations among them or in combination with antibiotics.

Multidisciplinary Management of the Adverse Effects of Apremilast. / Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar.

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients.

High-performance liquid chromatography with diode array detection coupled to electrospray time-of-flight and ion-trap tandem mass spectrometry to identify phenolic compounds from a Cistus ladanifer aqueous extract.

INTRODUCTION: Cistus ladanifer is an aromatic shrub that is widespread in the Mediterranean region. The labdanum exudate is used in the fragrance industry and has been characterised. However, there is not enough information about the phenolic content of the raw plant, the aerial part of it being a very rich source of bioactive compounds. OBJECTIVE: Characterisation of the bioactive compounds of the raw plant and its aerial parts. METHODOLOGY: High-performance liquid chromatography with diode array and electrospray ionisation mass spectrometric detection was used to carry out the comprehensive characterisation of a Cistus ladanifer shrub aqueous extract. Two different MS techniques were coupled to HPLC: time-of-flight mass spectrometry and tandem mass spectrometry. RESULTS: Many well-known compounds present in Cistus ladanifer were characterised, such as flavonoids, phenolic acids, ellagitanins, hexahydroxydiphenoyl and derivatives, and other compounds. CONCLUSION: The method described simultaneously separated a wide range of phenolic compounds and the proposed characterisation of the major compounds of this extract was carried out. It is important to highlight that, to our knowledge, this is the first time that a Cistus ladanifer aqueous extract from the raw plant has been characterised.

Bronchoscopic balloon dilatation in the management of bronchial stenosis following lung transplantation.

BACKGROUND: Bronchial stenosis (BS) is currently found in 7-15% of lung transplantation (LT) recipients. Current treatment strategies have included Nd:Yag laser, cryotherapy, bougie dilatation and stent placement. Bronchoscopic balloon dilatation has been used as alternative treatment in a few cases with controversial results. This is a study to prospectively assess the efficacy of bronchoscopic balloon dilatation as a first step in the management of post-LT BS. METHODS: From January 1995 to December 2002, bronchoscopic balloon dilatation was evaluated as first therapeutic option in all consecutive LT patients with BS. Symptoms, pulmonary function tests, airway diameter and use of other therapeutic techniques were evaluated. RESULTS: A total of 10 out of 284 anastomed airways (3.5%) in 9 out of 152 LT patients were included in the study and follow-up lasted from 6 to 81 months. Dilatation of all but one BS met with initial success: increase of both luminal dimensions and forced vital capacity (P=0.01), and relief of symptoms. Bronchoscopic balloon dilatation long-term follow-up showed effective results in 5 out of 10 (50%) bronchial stenoses, after an average of 4 bronchoscopic balloon dilatation procedures (range 1-8). No severe complications were observed. Stent placement was required in the other 5 bronchial stenoses. CONCLUSIONS: Bronchoscopic balloon dilatation is a safe method that should be considered as first therapeutic treatment of post-LT BS. Its use avoids the need for stent placement in up to 50% of cases.

Detection of Exudates and Microaneurysms in the Retina by Segmentation in Fundus Images / Detección de Exudados y Microaneurismas en la Retina por Segmentación en Imágenes de Fondo

ABSTRACT This article proposes two methodologies for the detection of lesions in the retina, which may indicate the presence of diabetic retinopathy (DR). Through the use of digital image processing techniques, it is possible to isolate the pixels that correspond to a lesion of RD, to achieve segmenting microaneurysms, the edges of the objects contained in the image are highlighted in order to detect the contours of the objects to select by size those that meet an area of 15 to 25 pixels in the case of 512x512 images and identify the objects as possible microaneurysms, while for the detection of exudates the green channel is selected to contrast the luminous objects in the retinography and from the conversion to gray scale, a histogram is graphed to identify the ideal threshold for the segmentation of the pixels that belong to the exudates at the end of the optical disk previously identified by a specialist. A confusion matrix supervised by an ophthalmologist was created to quantify the results obtained by the two methodologies, obtaining a specificity of 0.94 and a sensitivity of 0.97, values that are outstanding to proceed with the classification stage.

RESUMEN Este artículo propone dos metodologías para la detección de lesiones en la retina, que pueden significar la presencia de retinopatía diabética (RD). Mediante el uso de técnicas de procesamiento de imágenes digitales se logra aislar los pixeles que corresponden a una lesión propia de RD, para lograr segmentar microaneurismas se resaltan los bordes de los objetos contenido en la imagen con la finalidad de detectar los contornos de los objetos para seleccionar por tamaño los que cumplan con un área de 15 a 25 pixeles en el caso de imágenes de 512x512 y se identifiquen los objetos como posibles microaneurismas, mientras que para la detección de exudados se selecciona el canal verde para contrastar los objetos luminosos en la retinografía y a partir de la conversión a escala de grises se grafica un histograma para identificar el umbral idóneo para la segmentación de los pixeles que pertenecen a los exudados al final eliminar el disco óptico previamente identificado por un especialista. Se creó una matriz de confusión supervisada por un oftalmólogo para cuantificar los resultados obtenidos por las dos metodologías obteniendo una especificidad del 0.94 y una sensibilidad del 0.97, unos valores que son sobresalientes para proceder con la etapa de clasificación.

[The use of fibrinogen-thrombin via endoscope in the treatment of massive hemoptysis]. / Utilización de fibrinógeno-trombina por vía endoscópica en el tratamiento de la hemoptisis masiva.

We assessed the efficacy of fibrinogen-thrombin instillation through the fiberoptic bronchoscope to treat massive hemoptysis in patients to whom embolization of bronchial arteries was not available, was contraindicated or had failed. The fibrinogen-thrombin solution used was Tissucol, which in addition to 2% fibrinogen and 4 U/ml of thrombin, also contained factor XIII an aprotinin. The fibrinogen-thrombin solution was instilled with the aid of the Duplojec system and a 70 cm x 2 mm 4-way catheter. In 53 of the 628 fiberoptic bronchoscopies performed during the study, the indication was hemoptysis > or = 150 ml/12 h. Of these, bronchoscopic instillation of fibrinogen-thrombin was indicated in 5 cases because bronchial artery embolization was impossible. The point of bleeding was located by bronchoscopy in all cases and fibrinogen-thrombin instillation controlled hemoptysis immediately and throughout the follow-up period, which ranged 4 to 10 months. Morning expectoration of blood (< 10 ml) was observed in only 1 patient in the 3 days after treatment. The mean time taken for bronchoscopic exploration was 3 minutes (range, 2-7). In all cases fiberoptic bronchoscopy was performed without complications that might have required the procedure to be suspended. We conclude that the local use of fibrinogen-thrombin or fibrin glue instilled through the fiberoptic bronchoscope to the point of bleeding is a simple, fast and cheap way to control massive hemoptysis on a short and long-term basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Protective effects of citrus and rosemary extracts on UV-induced damage in skin cell model and human volunteers.

Ultraviolet radiation absorbed by the epidermis is the major cause of various cutaneous disorders, including photoaging and skin cancers. Although topical sunscreens may offer proper skin protection, dietary plant compounds may significantly contribute to lifelong protection of skin health, especially when unconsciously sun UV exposed. A combination of rosemary and citrus bioflavonoids extracts was used to inhibit UV harmful effects on human HaCaT keratinocytes and in human volunteers after oral intake. Survival of HaCaT cells after UVB radiation was higher in treatments using the combination of extracts than in those performed with individual extracts, indicating potential synergic effects. The combination of extracts also decreased UVB-induced intracellular radical oxygen species (ROS) and prevented DNA damage in HaCaT cells by comet assay and decreased chromosomal aberrations in X-irradiated human lymphocytes. The oral daily consumption of 250 mg of the combination by human volunteers revealed a significant minimal erythema dose (MED) increase after eight weeks (34%, p<0.05). Stronger protection was achieved after 12 weeks (56%, p<0.01). The combination of citrus flavonoids and rosemary polyphenols and diterpenes may be considered as an ingredient for oral photoprotection. Their mechanism of action may deserve further attention.

A metabolite-profiling approach to assess the uptake and metabolism of phenolic compounds from olive leaves in SKBR3 cells by HPLC-ESI-QTOF-MS.

Olive leaves, an easily available natural low-cost material, constitute a source of extracts with significant antitumor activity that inhibits cell proliferation in several breast-cancer-cell models. In this work, a metabolite-profiling approach has been used to assess the uptake and metabolism of phenolic compounds from an olive-leaf extract in the breast-cancer-cell line SKBR3 to evaluate the compound or compounds responsible for the cytotoxic activity. For this, the extract was firstly characterized quantitatively by high-performance liquid chromatography coupled to electrospray ionization-quadrupole time-of-flight mass spectrometry (HPLC-ESI-QTOF-MS). Then, SKBR3 cells were incubated with 200 µg/mL of the olive-leaf extract at different times (15 min, 1, 2, 24, and 48 h). A metabolite-profiling approach based on HPLC-ESI-QTOF-MS was used to determine the intracellular phenolic compounds, enabling the identification of 16 intact phenolic compounds from the extract and four metabolites derived from these compounds in the cell cytoplasm. The major compounds found within the cells were oleuropein, luteolin-7-O-glucoside and its metabolites luteolin aglycone and methyl-luteolin glucoside, as well as apigenin, and verbascoside. Neither hydroxytyrosol nor any of its metabolites were found within the cells at any incubation time. It is proposed that the major compounds responsible for the cytotoxic activity of the olive-leaf extract in SKBR3 cells are oleuropein and the flavones luteolin and apigenin, since these compounds showed high uptake and their antitumor activity has been previously reported.

Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar / Multidisciplinary Management of the Adverse Effects of Apremilast

En el presente artículo, en base a una revisión de la literatura y su experiencia personal, un equipo multidisciplinar de 14 profesionales sanitarios (incluyendo dermatólogos, reumatólogos, neurólogos, gastroenterólogos, farmacéuticos y enfermeras) ha elaborado una serie de recomendaciones generales y específicas (basadas en la fisiopatología) para el manejo de los efectos adversos secundarios a apremilast que con mayor frecuencia conducen a la suspensión del tratamiento (diarrea, náuseas y cefalea). Se aportan algoritmos sencillos de manejo que incluyen aspectos clínicos de evaluación y sugerencias de tratamiento farmacológico. Los efectos adversos de apremilast pueden ser abordados desde un punto de vista multidisciplinar y la optimización en su manejo pretende proporcionar un beneficio clínico a los pacientes que los sufren

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients

[Oral drugs that should not be crushed]. / Fármacos orales que no deben ser triturados1

In patients hospitalized in intensive care units (ICUs) nasogastric tubes are used for enteral feeding and solid pharmaceutical preparations are commonly administered. These drugs must be crushed before administration, which may alter their pharmacokinetic properties and consequently their therapeutic effects and adverse reactions, etc. The aim of this study was to review the orally-administered drugs used in our unit that should not be crushed, to propose alternative measures and to make recommendations for their correct administration. Their descriptive study was performed in the ICU of a University Hospital with 12 general-purpose beds. We reviewed all the oral medication currently administered in our unit and its form of administration through the nasogastric tube. Oral pharmaceutical preparations that should not be crushed were identified through a review of articles in MEDLINE published between 1991 and 2000 and through consultations with various pharmacy departments. Alternatives to these drugs were sought. Of the 115 drugs used in our unit, 50 could not be crushed. The pharmaceutical preparation of this group of drugs should not be modified because crushing would alter their characteristics, pharmacokinetic properties, etc. We present alternatives and make recommendations for their correct administration. In conclusion, a practical guide for the administration of drugs through nasogastric tubes is required. In our unit, such a guide would increase the efficacy and safety of the pharmacological treatment administered in this way. Collaboration with the pharmacy department is also advisable.

[Mycotic anuerysm secondary to bacterial endocarditis. Review apropos of a case]. / Anuerisma micótico secundario a endocarditis bacteriana. Revisión a propósito de un caso.

A case is presented of Subacute Bacterial Endocarditis on a biological Duramater Prosthesis. In the evolution curse, the patient presented an intraparenchimal cerebral haemorrhage, where--upon the angiographic studies demonstrated the existence of a mycotic aneurysm in the left median cerebral arterial territory. With specific antibiotic therapy and replacement of the prosthesis, the clinical evolution of the case, was positive, and later angiographies evidenced the disappearance of the aneurysm. The incidence of intracranial mycotic aneurysm complicating bacterial endocarditis is relatively high (up to 4% in post-mortem series). There have been very few cases communicated up to now with angiographic demonstration. Mortality is similar in patients under surgical or medical treatment. The aetipothogenic aspects are discussed, as well as the recommended therapeutic measures.

Polymorphism of glutathione S-transferase M3: interaction with glutathione S-transferase M1 and lung cancer susceptibility.

GSTM3 is one of five mu-class genes (M1-M5) belonging to a cluster located in chromosome 1. GSTM3 has been found to be polymorphic in humans with a number of individuals presenting a 3 bp deletion within intron 6 (GSTM3*B). In this study we have addressed the possible role of the GSTM3 polymorphism on lung cancer susceptibility. GSTM3 was genotyped in a group of lung cancer patients (n=176) and in a control group of healthy smokers (n=175). The frequency distribution of GSTM3*A/GSTM3*A, GSTM3*A/GSTM3*B and GSTM3*B/GSTM3*B showed no significant differences between patients and controls. Allelism at GSTM3 was also analysed in combination with the GSTM1 polymorphism. The chi(2) analysis confirmed that GSTM3*B allele is in linkage desequilibrium with GSTM1*A. The over-representation of GSTM1 null detected in previous studies, appeared to be restricted to those individuals with both GSTM1 null and GSTM3*A/GSTM3*A (48.3% in patients versus 36.0% in controls). The application of a second order logistic regression model revealed a significant adjusted odds ratio for the interaction term between GSTM1 null and GSTM3*A/GSTM3*A (OR: 2.14 95% CI 1.08-4.25) suggesting that this combined genotype may increase lung cancer risk. The analysis of transcription factor binding sites near the deleted sequence suggests that the heat-shock transcription factor 1 (HSTF1) could be involved in an enhanced expression of GSTM3*B, thus providing a possible mechanistic basis for a protective role of this allele.