Effects of the probiotic Bacillus cereus GM on experimental schistosomiasis mansoni.

Probiotics contribute to the integrity of the intestinal mucosa and preventing dysbiosis caused by opportunistic pathogens, such as intestinal helminths. Bacillus cereus GM obtained from Biovicerin® was cultured to obtain spores for in vivo evaluation on experimental schistosomiasis. The assay was performed for 90 days, where all animals were infected with 50 cercariae of Schistosoma mansoni on the 15th day. Three experimental groups were formed, as follows: G1-saline solution from the 1st until the 90th day; G2-B. cereus GM (105 spores in 300 µL of sterile saline) from the 1st until the 90th day; and G3-B. cereus GM 35th day (onset of oviposition) until the 90th day. G2 showed a significant reduction of 43.4% of total worms, 48.8% of female worms and 42.5% of eggs in the liver tissue. In G3, the reduction was 25.2%, 29.1%, and 44% of the total number of worms, female worms, and eggs in the liver tissue, respectively. G2 and G3 showed a 25% (p < 0.001) and 22% (p < 0.001) reduction in AST levels, respectively, but ALT levels did not change. ALP levels were reduced by 23% (p < 0.001) in the G2 group, but not in the G3. The average volume of granulomas reduced (p < 0.0001) 65.2% and 46.3% in the liver tissue and 83.0% and 53.2% in the intestine, respectively, in groups G2 and G3. Th1 profile cytokine (IFN-γ, TNF-α, and IL-6) and IL-17 were significantly increased (p < 0.001) stimulated with B. cereus GM in groups G2 and G3. IL-4 showed significant values when the stimulus was mediated by ConA. By modulating the immune response, B. cereus GM reduced the burden of worms, improved some markers of liver function, and reduced the granulomatous inflammatory reaction in mice infected with S. mansoni, especially when administered before infection.

Biofortification of Kidney Bean (Phaseolus vulgaris L.) Crops Applying Zinc Sulfate and Ferric Sulfate: Pilot Crop in Colombia.

Agriculture is one of the economic activities with the most potential in Colombia, given its climatic and geographical conditions. Bean cultivation is classified as climbing, which grows in a branched way, and bushy, whose growth occurs up to 70 cm. The objective of this research was to study zinc and iron sulfates in different concentrations as fertilizers capable of increasing the nutritional value of kidney beans (Phaseolus vulgaris L.), whose strategy is known as biofortification, and thus determine the most effective sulfate. The methodology details the sulfate formulations, their preparation, the application of additives, sampling and quantification methods of total iron, total zinc, °Brix, carotenoids, chlorophylls a, b, and antioxidant capacity using the DPPH (2,2-diphenyl-1-picrylhydrazyl) method in leaves and pods. As for the results, it was found that biofortification with iron sulfate and zinc sulfate is a strategy that favors the country's economy and human health, because it allows the increase of minerals, antioxidant capacity and total soluble solids.

Influence of design implant and apical depth in post-extraction sockets: an in vitro simulated study.

BACKGROUND: Implant design and apical stability are principal parameters involved in achieving successful primary stability. Using polyurethane models to simulate post-extraction sockets, we investigated the effects of using differing blade designs on the primary stability of tapered implants and the impact of apical depth. METHOD: Six polyurethane blocks were used to simulate post-extraction pockets. One of the implants presented self-tapping blades (Group A), while the other (Group B) did not. Seventy-two implants were placed at 3 different depths (5 mm, 7 mm, and 9 mm), and a torque wrench was used to measure the stability of the implants. RESULTS: When evaluating the implants (placed at 5 mm, 7 mm, and 9 mm apical to the socket), we observed that the torque of the Group B implants was higher than that of Group A implants (P < 0.01). At the 9-mm depth, there was no difference between the groups (Drive GM 34.92 Ncm and Helix GM 32.33 Ncm) (P > 0.001), and considering the same implant groups, those placed at 7-mm and 9-mm depths presented higher torques (p < 0.01) than those placed at 5-mm (p > 0.01). CONCLUSION: Considering both groups, we concluded that an insertion depth of greater than 7 mm is needed for initial stability, and in situations involving reduced supportive bone tissue or low bone density, a non-self-tapping thread design improves implant stability.

Extract from Ascaris suum and N-acetyl-L-cysteine induces an immunosuppressant effect in model of autoimmune hepatitis.

BACKGROUND: Extract of adult Ascaris suum (ASC) worms attenuated the liver damage in experimental autoimmune hepatitis (EAH) with induction of Th2 immune response, but fibrosis occurred. N-acetyl-L-cysteine (NAC) has protective effects against liver fibrosis. OBJECTIVES: Evaluate the association ASC + NAC on the T- and B-cell activation, inflammation and fibrogenic markers in the liver in EAH. METHODS: Experimental autoimmune hepatitis was induced intravenously with concanavalin A in BALB/c mice. EAH + ASC+NAC group received NAC and ASC; EAH + ASC group received ASC; EAH group received PBS. Doubly labelled CD4+ T (CD28, CTLA-4, CD40L or IL-10) and CD45R+ B lymphocytes (IL-10) and CD4+ CD25+ FoxP3+ cells were evaluated, along with gene expression of Col1a1, α-SMA, Fizz1, Arg1 and PPAR-γ and histomorphometry. RESULTS: Experimental autoimmune hepatitis group showed high frequency of CD28+ and CD40L+  T lymphocytes, but not the EAH + ASC group. In relation to EAH group, the Fizz1 expression was lower in both groups treated, but Arg1 expression was lower in only EAH + ASC+NAC group. In the EAH + ASC+NAC group, there were higher frequencies of CD4+ IL-10+ and CD4+ CD25+ FoxP3+ cells, but not CD45R+ IL-10+ , along with mitigated inflammation and collagen production. CONCLUSIONS: Ascaris suum favoured immunosuppression in EAH limiting the T cells activation. However, association ASC and NAC was necessary for attenuating the inflammatory process and collagen production.

Enteral Docosahexaenoic Acid Reduces Analgesic Administration in Neonates Undergoing Cardiovascular Surgery.

BACKGROUND: Neonates undergoing surgery require analgesic medication to ameliorate acute pain. These medications produce negative side effects. Docosahexaenoic acid (DHA) has an antinociceptive effect in animals, but this has not been evaluated in human neonates. We evaluated the DHA effect on cumulative dose and duration of analgesics administered to neonates undergoing cardiovascular surgery. METHODS: A secondary analysis was performed with data from a clinical trial, in which enteral DHA was administered perioperatively compared with sunflower oil (SO). Present study assessed the antinociceptive effect of DHA by measuring the cumulative dose and duration of analgesics administered during postoperative stay in a neonatal intensive care unit. Multivariate linear regression models were performed. RESULTS: Seventeen neonates received DHA and 18 received SO in the control group. Compared with the control group, the DHA group received lower cumulative dose (14.6 ± 2.2 vs. 25.2 ± 4.8 µg/kg, p = 0.029) and shorter duration of buprenorphine (2 days (1-8) vs. 4.5 days (1-12); p = 0.053). After adjusting for confounders, the DHA group received significantly lesser buprenorphine (ß = -27 µg/kg, p = 0.028; R2 model = 0.90) for shorter duration (ß = -9 days, p = 0.003; R2 model = 0.94). No differences in fentanyl or ketorolac were detected. CONCLUSIONS: Buprenorphine administration was reduced in neonates who received DHA, suggesting that DHA likely has analgesic effects.

Beneficial Effects of Enteral Docosahexaenoic Acid on the Markers of Inflammation and Clinical Outcomes of Neonates Undergoing Cardiovascular Surgery: An Intervention Study.

BACKGROUND: Neonates undergoing surgery are at risk for uncontrolled inflammatory response and adverse clinical outcomes. Docosahexaenoic acid (DHA) ameliorates inflammation, improving clinical outcomes. However, its effect has not been evaluated in neonates undergoing surgery. We evaluated the effect of DHA on markers of inflammation and clinical outcomes in neonates undergoing surgery. METHODS: A double-blind clinical trial evaluated the effect of enteral DHA (DHA group) versus sunflower oil (SO group) perioperatively administered in neonates scheduled for cardiovascular surgery. Inflammation was evaluated by percentage of cells+ for cytokines and CD69 in mononuclear cells at baseline, 24 h and 7 days post surgery. Clinical outcomes measured were sepsis, organ dysfunctions (ODs), length of stay in intensive care and bleeding. Repeated measures analysis of variance and logistic regression were applied. RESULTS: Sixteen neonates received DHA and 18 received SO. Cells+ from neonates in the DHA group showed an early increase in receptor antagonist of interleukin (IL)-1+ (IL-1ra+) and IL-10+ and a late decrease in IL-6+. IL-1ß+ and IL-10+ changes were different between groups. After adjusting for confounders, less cells from DHA group were IL-1ß+, IL-6+, IL-1ra+ and IL-10+. DHA group presented less sepsis, ODs and shorter stay, but no difference in CD69+CD4+ cells or bleeding between groups. CONCLUSIONS: Administration of enteral DHA ameliorates markers of inflammation and improves clinical outcomes in surgical neonates.

Study protocol for the Maule Cohort (MAUCO) of chronic diseases, Chile 2014-2024.

BACKGROUND: Maule Cohort (MAUCO), a Chilean cohort study, seeks to analyze the natural history of chronic diseases in the agricultural county of Molina (40,000 inhabitants) in the Maule Region, Chile. Molina´s population is of particular interest because in the last few decades it changed from being undernourished to suffering excess caloric intake, and it currently has the highest national rates of cardiovascular diseases, stomach cancer and gallbladder cancer. Between 2009 and 2011 Molina´s poverty rate dropped from 24.1 % to 13.5 % (national average 20.4 %); in this period the county went from insufficient to almost complete basic sanitation. Despite these advances, chemical pollutants in the food and air are increasing. Thus, in Molina risk factors typical of both under-developed and developed countries coexist, generating a unique profile associated with inflammation, oxidative stress and chronic diseases. METHODS/DESIGN: MAUCO is the core project of the recently established Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile. In this study, we are enrolling and following 10,000 adults aged 38 to 74 years over 10 years. All eligible Molina residents will be enrolled. Participants were identified through a household census. Consenting individuals answer an epidemiological survey exploring risk factors (psycho-social, pesticides, diet, alcohol, and physical activity), medical history and physical and cognitive conditions; provide fasting blood, urine, and saliva samples; receive an electrocardiogram, abdominal ultrasound and bio-impedance test; and take a hand-grip strength test. These subjects will be re-interviewed after 2, 5 and 7 years. Active surveillance of health events is in place throughout the regional healthcare system. The MAUCO Bio-Bank will store 30 to 50 aliquots per subject using an NIH/NCI biorepository system for secure and anonymous linkage of samples with data. DISCUSSION: MAUCO´s results will help design public health interventions tailored to agricultural populations in Latin America.

Beyond the mouth: Uncovering non-secretory multiple myeloma through oral symptoms.

Non-secretory multiple myeloma (NSMM) is a rare cancer of plasma cells characterized by the absence of detectable monoclonal M protein in the blood or urine. A 57-year-old woman presented with mandibular pain but without intraoral swelling. Imaging studies revealed multiple osteolytic lesions in her mandible and pronounced root resorption of the left mandibular second molar. Biopsy results showed atypical plasmacytoid cells positive for anti-kappa, CD138, MUM1, and CD79a antibodies, but negative for anti-lambda and CD20. These results were indicative of a malignant plasma cell neoplasm. No abnormalities were revealed by free light chain assay or by serum or urine protein electrophoresis, leading to a diagnosis of NSMM. The patient began chemotherapy in conjunction with bisphosphonate therapy and achieved remission following treatment. This case underscores the critical role of dentists in the early detection and prevention of NSMM complications, as the disease can initially present in the oral cavity.

Ultrastructural characteristics of fibrin clots from canine and feline platelet concentrates activated with calcium gluconate or calcium gluconate plus batroxobin.

BACKGROUND: The aim of this study was to use transmission electron microscopy to describe the ultrastructural characteristics of clots obtained from canine and feline platelet concentrates (PC) that had been activated with calcium gluconate (CG) or CG plus batroxobin (CGB). Platelets from fibrin clots were classified according their morphological changes. The area of the intercellular space (µm2), the area of the fibrin fibers (µm2), and the width of the fibrin fibers (µm) were determined for the dog clots. The platelet area (µm2), the area of fibrin fibers (µm2), the ratio of the minor and major axes of platelets, the ratio of the major and minor axes of platelets, and the number of α-granules found within platelets were measured for the cat clots. RESULTS: Cat platelets displayed full activation. Dog platelets displayed lysis with loss of normal architecture. In both species, a statistically significant difference was found (P < 0.01) between the fibrin fiber measurements in the PC clots activated with CG and CGB. CONCLUSIONS: The findings suggest that activation with CG caused platelet alpha granules to release their contents. In cats, fibrin production was greater when the PC was activated with CG. In dogs, activation with CG produced thick fibrin fibers.

Clinical, Economic, and Humanistic Impact of Short-Bowel Syndrome/Chronic Intestinal Failure in Portugal (PARENTERAL Study).

Introduction: This study aimed to assess the clinical, economic, and humanistic impact of short-bowel syndrome/chronic intestinal failure (SBS/CIF) in Portugal. Methods: This is a retrospective multicenter cohort chart review study, with a cross-sectional component for quality-of-life (QoL) evaluation. Inclusion criteria comprised patients with SBS/CIF, aged ≥1 year, with stable parenteral nutrition (PN). Data collection included patient chart review over a 12-month period and patient/caregiver self-report and SF-36/PedsQL™ questionnaires. Main endpoints comprised clinical and PN characterization, healthcare resource use (HRU), direct costs, and patient QoL. Results: Thirty-one patients were included (11 adults and 20 children). Patients' mean age (standard deviation [SD]) was 57.9 (14.3) years in adults and 7.5 (5.0) years in children, with a mean time since diagnosis of 10.2 (5.9) and 6.6 (4.2) years, respectively. PN was administered for a mean of 5.2 and 6.6 days/week in adults and children, respectively; home PN occurred in 81.8% of adults and 90.0% of children for a mean of 9.6 and 10.8 months/year, respectively. The mean annual number of hospitalizations was 1.9 and 2.0 which lasted for a mean of 34.0 and 29.4 days in adults and children, respectively. Twenty-one and forty hospitalization episodes were reported in adults and children, respectively, of which 71.4% and 85.0% were due to catheter-related complications. Mean annual direct costs per patient amounted to 47,857.53 EUR in adults and 74,734.50 EUR in children, with PN and hospitalizations as the main cost-drivers. QoL assessment showed a clinically significant impaired physical component in adults and a notable deterioration in the school functioning domain in children. Conclusion: In Portugal, SBS/CIF patient management is characterized by a substantial therapeutic burden and HRU, translating into high direct costs and a substantial impairment of the adults' physical function and children's school functioning.

Introdução: Este estudo teve como objetivo avaliar o impacto clínico, económico e social da síndrome do intestino curto/falência intestinal crónica (SIC/FIC) em Portugal. Métodos: Estudo de coorte retrospectivo e multicêntrico de revisão dos processos clínicos incluindo uma componente transversal para avaliação da qualidade de vida (QV). Os critérios de elegibilidade incluíram doentes com SIC/FIC, idade ≥1 ano, em nutrição parenteral (NP) e clinicamente estáveis. A recolha de dados incluiu a revisão dos processos clínicos ao longo de um período de 12 meses e a aplicação de questionários auto-administrados a doentes e cuidadores e de questionários de QV (SF-36/PedsQL™). Os indicadores principais foram a caracterização clínica e da NP, a utilização de recursos de saúde, custos diretos e QV dos doentes. Resultados: Foram incluídos 31 doentes (11 adultos e 20 crianças). A idade média (desvio padrão: DP) foi de 57.9 (14.3) anos nos adultos e de 7.5 (5.0) nas crianças com um tempo médio desde o diagnóstico de 10.2 (5.9) e 6.6 (4.2) anos, respetivamente. A NP foi administrada durante uma média de 5.2 e 6.6 dias por semana, em adultos e crianças respetivamente, em 81.8% e 90.0% dos adultos/crianças foi feita em casa durante uma média de 9.6 ou 10.8 meses por ano, respetivamente. O número médio anual de hospitalizações foi de 1.9 (1.6) e 2.0 (1.5) com uma duração média de 34.0 (47.4) e 29.4 (32.3) dias, em adultos e crianças, respetivamente. Foram reportados 21 e 40 episódios de hospitalização em adultos/crianças, dos quais 71.4% e 85.0% foram devido a complicações relacionadas ao uso de cateter. Os custos diretos anuais médios por doente ascenderam a 47,857.53 EUR nos adultos e a 74,734.50 EUR nas crianças, sendo que os maiores responsáveis foram a NP e as hospitalizações. A avaliação da QV mostrou um comprometimento clinicamente significativo da componente física nos adultos e uma deterioração relevante da dimensão escolar nas crianças. Conclusões: A gestão dos doentes com SIC/FIC em Portugal é caracterizada por uma sobrecarga substancial a nível terapêutico e de utilização de recursos de saúde, o que se traduz em elevados custos diretos e comprometimento substancial da componente física nos adultos e do desempenho escolar nas crianças.

Effectiveness of four manual breast pumps for mothers after preterm delivery in a developing country.

BACKGROUND: Hospital-grade electric pumps may be useful to initiate and sustain adequate milk production for mothers who are unable to breast-feed their babies hospitalized at special care nurseries (SCN), but their cost is generally not affordable for SCN and for most mothers in developing countries. Therefore, manual breast pumps (MBPs) can be an alternative, but the best option is unknown considering clinical parameters and mothers' preference from among currently available MBPs. OBJECTIVE: To compare the effectiveness of four MBPs in terms of milk volume, nutritional composition, and breast emptying in order to assist in making a choice for health care personnel and mothers in SCN settings. Duration of expression and maternal preference were also evaluated as secondary outcomes. METHODS: Mothers of preterm infants used 4 MBPs in a random order, 2 with a squeeze-handle mechanism (Isis and Harmony) and 2 with a cylindrical mechanism (Little Heart and Evenflo), both at the hospital and in home settings using each pump over one 24-hour period. RESULTS: Milk volume, nutritional composition, breast emptying, and duration of expression were not different among MBPs. Scale of maternal preference rated higher those with the squeeze-handle mechanism than the cylindrical mechanism (p < 0.05). CONCLUSIONS: There was no difference found in the effectiveness across the four pumps tested. The mothers' rating for comfort and ease of use showed a marked difference between pumps. These factors, plus cost, need to be considered when evaluating manual pumps for use in SCN settings in developing countries.

Comparison of the effect of calcium gluconate and batroxobin on the release of transforming growth factor beta 1 in canine platelet concentrates.

BACKGROUND: The clinical use of autologous platelet concentrates (also known as platelet-rich plasma) on the field of regenerative therapy, in the last decade has been the subject of several studies especially in equine medicine and surgery. The objectives of this study was: 1) to describe and compare the cellular population in whole blood, lower fraction (A) and upper fraction (B) of platelet concentrates, 2) to measure and compare the transforming growth factor beta 1 (TGF-ß1) concentration in plasma and both platelet concentrates after be activated with calcium gluconate or batroxobin plus calcium gluconate and, 3) to determine correlations between cell counts in platelet concentrates and concentrations of TGF-ß1. Blood samples were taken from 16 dogs for complete blood count, plasma collection and platelet concentrates preparation. The platelet concentrates (PC) were arbitrarily divided into two fractions, specifically, PC-A (lower fraction) and PC-B (upper fraction). The Platelet concentrates were analyzed by hemogram. After activated with calcium gluconate or batroxobin plus calcium gluconate, TGF-ß1 concentration was determined in supernatants of platelet concentrates and plasma. RESULTS: There were differences statistically significant (P < 0.05) for the platelet count and leukocyte count and TGF-ß1 concentration between whole blood, plasma and both platelet concentrates. A significant correlation was found between the number of platelets in both platelet concentrates and TGF-ß1 concentration. Platelet collection efficiency was 46.34% and 28.16% for PC-A and PC-B, respectively. TGF-ß1 concentration efficiency for PC activated with calcium gluconate was 47.75% and 31.77%, for PC-A and PC-B, respectively. PC activated with batroxobin plus CG showed 46.87% and 32.24% for PC-A and PC-B, respectively. CONCLUSIONS: The methodology used in this study allows the concentration of a number of platelets and TGF-ß1 that might be acceptable for a biological effect for clinical or experimental use as a regenerative therapy in dogs.

Evaluation of the effect of calcium gluconate and bovine thrombin on the temporal release of transforming growth factor beta 1 and platelet-derived growth factor isoform BB from feline platelet concentrates.

BACKGROUND: There are not reported regarding the protocols for obtaining platelet concentrates (PC) in cats for medical purposes. The objectives of this study were: 1) to describe a manual method for producing two kinds of PC in cats (PC-A and PC-B), 2) to describe the cellular population of the PC, 3) to measure and compare the effect of calcium gluconate (CG) and bovine thrombin (BT) on the temporal release of transforming growth factor beta 1 (TGF-ß1) and platelet-derived growth factor type BB (PDGF-BB) at 3 and 12 hours post-activation and 4) to establish correlations between the cellular population of both PCs and the concentration of growth factors (GF). Blood samples were taken from 16 cats for complete blood count, plasma collection and PC preparation. The PC were arbitrarily divided into two fractions, specifically, PC-A (lower fraction) and PC-B (upper fraction). RESULTS: The platelet counts were significantly different (P<0.05) between the PC and whole blood but not between the PC fractions. The TGF-ß1 concentration efficiencies for PC-A and PC-B activated with CG were 42.86% and 46.54%, and activated with BT were 42.88% and 54.64%, respectively. The PDGF-BB concentration efficiencies for PC-A and PC-B activated with CG were 61.36% and 60.61%, and activated with BT were 65.64% and 72.12%, respectively. The temporal release of GFs showed no statistically significant difference (P>0.05) between the activating substances at the time or for any PC fraction. CONCLUSIONS: Whatever the activation means, these preparations of cat PC provide significant concentrations of platelets and GFs for possible clinical or experimental use.

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro.

DILI is a major cause of attrition in drug development with over 1000 FDA-approved drugs known to potentially cause DILI in humans. Unfortunately, DILI is often not detected until drugs have reached clinical stages, risking patients' safety and leading to substantial losses for the pharma industry. Taking into account that standard 2D models have limitations in detecting DILI it is essential to develop in vitro models that are more predictive to improve data translatability. To understand causality and mechanistic aspects of DILI in detail, a human liver MPS consisting of human primary liver parenchymal and non-parenchymal cells (NPCs) and cultured in 3D microtissues on an engineered scaffold under perfusion has been developed. Cryopreserved primary human hepatocytes (PHHs) and Kupffer cells (HKCs) were cocultured as microtissues in the MPS platform for up to two weeks, and each compound of interest was repeatably dosed onto liver microtissues at seven test concentrations for up to four days. Functional liver-specific endpoints were analyzed (including clinical biomarkers such as alanine aminotransferase, ALT) to evaluate liver function. Acute and chronic exposure to compounds of various DILI severities can be assessed by comparing responses to single and multi-dosed microtissues. The methodology has been validated with a broad set of severe and mildly hepatotoxic compounds. Here we show the data for pioglitazone and troglitazone, well-known hepatotoxic compounds withdrawn from the market for causing liver failures. Overall, it has been shown that the liver MPS model can be a useful tool to assess DILI and its association with changes in hepatic function. The model can additionally be used to assess how novel compounds behave in distinct patient subsets and how toxicity profiles may be affected by liver disease states (e.g., viral hepatitis, fatty liver disease).

Perception of neonatology staff regarding the availability of equipment and supplies for the care of patients in need of nCPAP.

BACKGROUND: Respiratory distress syndrome (RDS) is Mexico's second leading cause of neonatal mortality. The 75% reduction in mortality due to RDS has been attributed to the use of nasal continuous positive airway pressure (nCPAP). A survey was conducted to determine the perception of the medical staff regarding the availability of nCPAP equipment and supplies in Mexican hospitals with neonatal intensive care units (NICUs). METHODS: We sent a survey via e-mail to several neonatologists in each state of the country, requesting only one response per hospital. We performed statistical analysis with SPSS software. RESULTS: We received 195 surveys from private (HPri) and public (HPub) hospitals with NICUs nationwide: 100% of HPri and 39% of HPub. More than 75% of the nursing and medical staff had received formal training in nCPAP in 11% of HPri and 5% of HPub. The perceived availability of CPAP equipment was 83.7% vs. 52.1%; nasal cannula supply, 75.5% vs. 36.3%; air/oxygen blender availability, 51.0% vs. 32.9%, in HPri and HPub, respectively. The observed differences were statistically significant. Significant differences were also found among healthcare institutions. CONCLUSIONS: The availability of CPAP equipment and consumables between HPub and HPri is unbalanced and is lower in public institutions. Bubble CPAP is not included essential equipment in the national catalog of instruments and equipment for public hospitals, and its request is complicated. The training of CPAP staff and the availability of bubble CPAP and supplies in public hospitals should be improved.

INTRODUCCIÓN: El síndrome de dificultad respiratoria (SDR) es la segunda causa de mortalidad neonatal en México. La reducción del 75% de la mortalidad por SDR se le ha atribuido al uso de la presión positiva nasal continua de las vías respiratorias (nCPAP). Se realizó una encuesta con el objetivo de conocer la percepción del personal médico acerca de la disponibilidad del equipo e insumos para nCPAP en hospitales de México que cuenten con unidades de cuidados intensivos neonatales (UCIN). MÉTODOS: La encuesta se envió por correo electrónico a varios neonatólogos de cada estado del país y se solicitó una sola respuesta por cada hospital. El análisis estadístico se realizó con el software SPSS. RESULTADOS: Se recibieron 195 encuestas respondidas tanto de hospitales privados (HPri) como públicos (HPub) que cuentan con UCIN a escala nacional: el 100% de HPri y el 39% de HPub. Más del 75% del personal de enfermería y médico recibió una capacitación formal en nCPAP en el 11% de HPri y el 5% de HPub. La percepción de disponibilidad de equipos de presión positiva continua de las vías respiratorias (CPAP) fue del 83.7% vs. el 52.1%; el abasto de cánulas nasales, del 75.5% vs. el 36.3%; la disponibilidad del mezclador aire/oxígeno, del 51.0 % vs. el 32.9%, en HPri y HPub, respectivamente. Las diferencias fueron estadísticamente significativas. También se encontraron diferencias significativas entre las instituciones de salud. CONCLUSIONES: La disponibilidad de equipo y material de consumo para CPAP entre HPub y HPri es desequilibrada, y es menor en las instituciones públicas. El CPAP burbuja no se encuentra incluido en el cuadro básico de equipo médico y se dificulta su solicitud. Debe mejorarse la capacitación del personal en CPAP y la disponibilidad de CPAP burbuja e insumos en los hospitales públicos.

Online naphazoline quality control by micellar-enhanced spectrofluorimetry.

The aim of this study was to develop a method for online spectrofluorimetric quality control of naphazoline (NPZ) in pharmaceuticals and raw drugs. A combination of a flow-injection analysis (FIA) system with micellar-enhanced fluorescence detection is presented as a powerful alternative for the rapid and sensitive analysis of naphazoline. Since NPZ shows low native fluorescence, the use of an anionic surfactant, such as sodium dodecyl sulphate (SDS), provides a considerable enhancement of fluorescence intensity and the nature of the technique allows a possible and easy adaptation to a FIA system. Using λ(exc) = 280 nm and λ(em) = 326 nm, a good linear relationship (LOL) was obtained in the range 0.003-10 µg mL(-1) with a detection limit (LOD) of 3 × 10(-4) µg mL(-1) (s/n = 3). Parameters related to the nature of the analytical signal and to the FIA manifold were optimized. Satisfactory recoveries were obtained in the analysis of commercial pharmaceutical formulations. The proposed method is simple, accurate and allows for high-speed sampling and considerably shorter analysis times. In addition, it requires inexpensive equipment and reagents and has easy operational conditions and no side effects, thus avoiding environmental pollution through toxic waste.

Evolution of the provision of speech therapists in the Brazilian public healthcare system: study on correlations with social indictors in the last decade. / Evolução da oferta de Fonoaudiólogos no SUS: um estudo sobre a correlação com os indicadores sociais no Brasil na última década.

PURPOSE: Investigate the correlation between the provision of speech therapists in the Brazilian public healthcare system and social indicators between 2007 and 2016. METHODS: An ecological study was conducted. The units of analysis were the 27 federative units of Brazil. Indicators of the provision of speech therapists in public healthcare and the relative evolution of this provision in the period as well as the Human Development Index and Gini Index related to the year 2010 were analyzed. Correlations were investigated using Spearman's test (α = 5%). RESULTS: In 2007, the provision of speech therapists in the public healthcare system was 3.55/105 residents, with the lowest indicator in the state of Amazonas and the highest in the state of Mato Grosso do Sul. In 2016, this indicator nearly doubled in the country; the lowest indicator was again in the state of Amazonas and the highest was in the state of Piauí. An important relative evolution occurred in the provision of speech therapists in Brazil in the period analyzed, with significant variation among the federative units. A negative correlation was found between the relative evolution in the last decade and the Human Development Index and a positive correlation was found with the Gini Index. CONCLUSION: The increase in the provision of speech therapists in the Brazilian public healthcare system was greater in federative units with lower human development and a greater concentration of income. Despite this, the results from 2016 showed the maintenance of the status quo, with a greater provision in federative units with greater human development.

OBJETIVO: Investigar a correlação entre a oferta de Fonoaudiólogos no Sistema Único de Saúde (SUS) e os indicadores sociais no Brasil, entre 2007 e 2016. MÉTODO: Estudo ecológico, cujas unidades de análise foram as 27 Unidades Federativas (UFs) do país. Foram calculados os indicadores da oferta de Fonoaudiólogos no SUS e a evolução relativa desta oferta no período, bem como o Índice de Desenvolvimento Humano (IDH) e o Índice de Gini, ambos referentes ao ano de 2010. A correlação foi investigada utilizando o teste de Spearman, com α=5%. RESULTADOS: Em 2007, a oferta de Fonoaudiólogos no SUS foi de 3,55/105 habitantes, com o menor indicador no Amazonas e o maior no Mato Grosso do Sul. Em 2016, este indicador quase dobrou no país, com permanência do menor valor no Amazonas e o maior no Piauí. Ocorreu uma importante evolução relativa da oferta de Fonoaudiólogos no Brasil, neste período, com significativas variações entre as UFs. Houve correlação negativa entre a evolução relativa na última década e o IDH, e positiva com o Índice de Gini. CONCLUSÃO: A evolução da oferta de Fonoaudiólogos no SUS foi maior nas unidades federativas com menor desenvolvimento humano e maior concentração de renda. Não obstante, os resultados referentes a 2016 mostraram a manutenção do status quo, com a maior oferta naquelas unidades federativas com maior desenvolvimento humano.

ERRATUM: "Evolution of speech therapists supply in SUS: a study about the correlation with social indicatiors in Brazil in the last decade". / ERRATA: "Evolução da oferta de Fonoaudiólogos no SUS: um estudo sobre a correlação com os indicadores sociais no Brasil na última década".

[This corrects the article doi: 10.1590/2317-1782/20202019243] [This corrects the article doi: 10.1590/2317-1782/20202019243].

Congenital Glucagon-like Peptide-1 Deficiency in the Pathogenesis of Protracted Diarrhea in Mitchell-Riley Syndrome.

CONTEXT: Mitchell-Riley syndrome due to RFX6 gene mutations is characterized by neonatal diabetes and protracted diarrhea. The RFX6 gene encodes a transcription factor involved in enteroendocrine cell differentiation required for beta-cell maturation. In contrast to the pathway by which RFX6 mutations leads to diabetes, the mechanisms underlying protracted diarrhea are unknown. OBJECTIVE: To assess whether glucagon-like peptide-1 (GLP-1) was involved in the pathogenesis of Mitchell-Riley syndrome protracted diarrhea. METHODS: Two case report descriptions. in a tertiary pediatric hospital. "Off-label" treatment with liraglutide. We describe 2 children diagnosed with Mitchell-Riley syndrome, presenting neonatal diabetes and protracted diarrhea. Both patients had nearly undetectable GLP-1 plasma levels and absence of GLP-1 immunostaining in distal intestine and rectum. The main outcome was to evaluate whether GLP-1 analogue therapy could improve Mitchell-Riley syndrome protracted diarrhea. RESULTS: "Off-label" liraglutide treatment, licensed for type 2 diabetes treatment in children, was started as rescue therapy for protracted intractable diarrhea resulting in rapid improvement during the course of 12 months. CONCLUSION: Congenital GLP-1 deficiency was identified in patients with Mitchell-Riley syndrome. The favorable response to liraglutide further supports GLP-1 involvement in the pathogenesis of protracted diarrhea and its potential therapeutic use.