Antiretroviral Treatment in HIV-1-Positive Mothers: Neurological Implications in Virus-Free Children

Since the worldwide introduction of antiretroviral therapy (ART) in human immunodeficiency virus type 1, HIV-1-positive mothers, together with HIV-1 testing prior to pregnancy, caesarian birth and breastfeeding cessation with replacement feeding, a reduction of HIV-1 mother-to-child transmission (MTCT) has been observed in the last few years. As such, an increasing number of children are being exposed in utero to ART. Several questions have arisen concerning the neurological effects of ART exposure in utero, considering the potential effect of antiretroviral drugs on the central nervous system, a structure which is in continuous development in the fetus and characterized by great plasticity. This review aims at discussing the possible neurological impairment of children exposed to ART in utero, focusing attention on the drugs commonly used for HIV-1 MTCT prevention, clinical reports of ART neurotoxicity in children born to HIV-1-positive mothers, and neurologic effects of protease inhibitors (PIs), especially ritonavir-"boosted" lopinavir (LPV/r) in cell and animal central nervous system models evaluating the potential neurotoxic effect of ART. Finally, we present the findings of a meta-analysis to assess the effects on the neurodevelopment of children exposed to ART in utero

The use of different stingless bee species to pollinate cherry tomatoes under protected cultivation

Under standard greenhouse conditions, the tomato fruits of spontaneous self-pollination are expected to be of lower quality than those of bee pollination, as well as that simultaneously use different bee species which can complement pollination services. To test these hypotheses, we evaluated the complementarity of pollination services from the use of three native stingless bee species that have distinct foraging behaviors, Melipona bicolor Lepeletier 1836, Nannotrigona testaceicornis (Lepeletier 1836) and Partamona helleri (Friese 1900) during flowering of cherry tomatoes in greenhouses. Fruit quality parameters resulted from pollination experiments were measured and the acclimatization of the analyzed bee species was evaluated. Visits of M. bicolor and N. testaceicornis to the tomato flowers contributed significantly to the increase in the average weight, seed number, and thickness of the pericarp (only for N. testaceicornis) of the fruits, compared to the spontaneous self-pollination treatment. Partamona helleri, however, did not show any pollen collection behavior in the experimental conditions. Although N. testaceicornis do not perform the buzzing behavior, fruits from its pollination were equivalent to those fruits from pollination by M. bicolor. The simultaneous use of bee species with different flower-visiting behaviors can optimize tomato pollination in greenhouses, contributing significantly to the quality of the fruits and the increase of productivity and consequently the commercial value

CONTRIBUIÇÃO DO FARMACÊUTICO PARA A PROMOÇÃO DE SAÚDE NA FARMÁCIA COMUNITÁRIA

O farmacêutico com a sua profissão vem sofrendo modificações constantes. Essas mudanças ocorre principalmente na ara da farmácia comunitária como por exemplo farmacêuticos do XX só tinha como obrigação trabalhos burocráticos farmacêuticos do XXI tem como obrigação a clínica com o paciente a gerencia da farmácia comercial e trabalhos burocráticos. Nos últimos 30 anos, a farmácia privativa e as drogarias decifraram receitas e entregaram aos usuários do serviço os produtos correspondentes, quase sempre sem qualquer tipo de orientação sobre o uso dos mesmos. A manipulação de fórmulas também não fugiu a esta regra por isso a importância do farmacêutico dentro das farmácias comerciais e de manipulação, pois o mesmo pode tirar dúvidas de como usar os medicamentos esse serviço nos últimos 30 anos tem sido negligenciado pelos os donos de farmácia. No Brasil, a partir de meados dos anos 1990, a presença marcante das ações dos conselhos de farmácia e vigilância sanitária em estabelecimentos comerciais farmacêuticos está mudando o panorama nacional. A exigência da presença do farmacêutico no setor privado está trazendo-o para o desempenho de suas funções em farmácias e drogarias. o medicamento como parte do complexo médico-industrial influi na percepção da saúde e da doença, tanto nos profissionais de saúde quanto na sociedade. O medicamento não se apresenta sozinha como sustância química, mas está acompanhado por um cortejo de publicidade, informação, brindes, estudos etc., que vai configurando uma forma de pensar

Blockade of CXCR1/2 chemokine receptors protects against brain damage in ischemic stroke in mice

OBJECTIVE: Ischemic stroke may result from transient or permanent reductions of regional cerebral blood flow. Polymorphonuclear neutrophils have been described as the earliest inflammatory cells to arrive in ischemic tissue. CXCR1/2 receptors are involved in the recruitment of these cells. However, the contribution of these chemokine receptors during transient brain ischemia in mice remains poorly understood. In this work, we investigated the effects of reparixin, an allosteric antagonist of CXCR1/2 receptors, in a model of middle cerebral artery occlusion and reperfusion in mice. METHODS: C57BL/6J male mice treated with reparixin or vehicle were subjected to a middle cerebral artery occlusion procedure 1 h after the treatment. Ninety minutes after ischemia induction, the monofilament that prevented blood flow was removed. Twenty-four hours after the reperfusion procedure, behavioral changes, including motor signs, were analyzed with the SmithKline/Harwell/lmperial College/Royal Hospital/Phenotype Assessment (SHIRPA) battery. The animals were sacrificed, and brain tissue was removed for histological and biochemical analyses. Histological sections were stained with hematoxylin and eosin, neutrophil infiltration was estimated by myeloperoxidase activity and the inflammatory cytokine IL-iβ was measured by ELISA. RESULTS: Pre-treatment with reparixin reduced the motor deficits observed in this model of ischemia and reperfusion. Myeloperoxidase activity and IL-iβ were reduced in the reparixin-treated group. Histological analysis revealed that ischemic injury was also attenuated by reparixin pre-treatment. CONCLUSIONS: Our results suggest that the blockade of the CXCR1/2 receptors by reparixin promotes neuroprotective effects by reducing the levels of polymorphonuclear infiltration in the brain and the tissue damage associated with middle cerebral artery occlusion and reperfusion

Increased risk of dizziness in human immunodeficiency virus-infected patients taking zidovudine and efavirenz combination: a Brazilian cohort study.

Abstract Objectives Neuropsychiatric adverse effects (NPAE) related to efavirenz, mainly dizziness, is detrimental to human immunodeficiency virus (HIV) treatment. Our study aims at evaluating if zidovudine use potentiates the risk of dizziness related to efavirenz when used together and whether there are significant differences in over time distribution of this NPAE and others relatively frequents regarding efavirenz regimen without zidovudine. Methods Human immunodeficiency virus-infected patients under efavirenz-containing different therapy were enrolled. A retrospective analysis of official medical records was accomplished to collect clinical data regarding NPAE occurrence and severity. Univariate statistic and statistical model based on survival analyses were performed. Key findings One hundred sixty-two patients were included, of these seventy-seven (47.5%) had NPAE reported, such as dizziness (more frequent), depression and insomnia. Univariate statistical analysis demonstrated that the combined use of efavirenz with zidovudine increased the NPAE risk (OR: 2.5; P-value: 0.008), mainly dizziness risk (OR: 3.5; P-value: 0.009) and survival analysis showed that such combination is associated with dizziness occurrence faster (HR: 2.9; P-value: 0.02). Conclusions The results may contribute to clarify the dizziness occurrence dynamics in therapy with efavirenz and zidovudine by identifying susceptibilities and assisting in the choice of combined antiretroviral therapy

Remdesivir and corticosteroids in the treatment of hospitalized COVID-19 patients

okCoronavirus disease 2019 (COVID-19) is a pandemic infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2. Remdesivir (RDV) and corticosteroids are used mainly in COVID-19 patients with acute respiratory failure. The main objective of the study was to assess the effectiveness of remdesivir with and without corticosteroids in the treatment of COVID-19 patients. We conducted a prospective observational study, including adult patients consecutively hospitalized with confirmed COVID-19 and acute respiratory failure. Patients were divided according to treatment strategy: RDV alone versus RDV with corticosteroids. The primary outcome was the time to recovery in both treatment groups. We included 374 COVID-19 adult patients, 184 were treated with RDV, and 190 were treated with RDV and corticosteroid. Patients in the RDV group had a shorter time to recovery in comparison with patients in the RDV plus corticosteroids group at 28 days after admission [11 vs. 16 days (95% confidence Interval 9.7-12.8; 14.9-17.1; p = .016)]. Patients treated with RDV alone had a shorter length of hospital stay. The use of corticosteroids as adjunctive therapy of RDV was not associated with improvement in mortality of COVID-19 patients.publishersversionpublishe

ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER

ABSTRACT Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy. The objective of this Brazilian College of Digestive Surgery Position Paper is to present new advances in AC treatment in high-risk surgical patients to help surgeons, endoscopists, and physicians select the best treatment for their patients. The effectiveness, safety, advantages, disadvantages, and outcomes of each procedure are discussed. The main conclusions are: a) AC patients with elevated surgical risk must be preferably treated in tertiary hospitals where surgical, radiological, and endoscopic expertise and resources are available; b) The optimal treatment modality for high-surgical-risk patients should be individualized based on clinical conditions and available expertise; c) Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available; d) Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist; e) Cholecystostomy catheter should be removed after resolution of AC. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively; f) If the cholecystostomy catheter is maintained for a long period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent AC; g) The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. h) Long waiting periods between cholecystostomy and cholecystectomy may be associated with new episodes of acute cholecystitis, multiple hospital readmissions, and increased costs. Finally, when selecting the best treatment option other aspects should also be considered, such as costs, procedures available at the medical center, and the patient’s desire. The patient and his family should be fully informed about all treatment options, so they can help making the final decision

Habilidades Sociais e Gestão Social: possibilidades nas áreas de pesquisa, ensino e extensão

Este artigo propõe situar a temática das Habilidades Sociais (HSs) entre os interesses de ensino, pesquisa e extensão do campo da Gestão Social (GS). Mediante a discussão conceitual sobre o fenômeno das HSs e de suas repercussões sobre o bem-estar e sobre o processo de desenvolvimento local, busca-se estabelecer a pertinência e relevância do tema para estudantes, gestores e pesquisadores da área. Apresenta-se e comenta-se os principais desafios teóricos e metodológicos e propõe-se uma agenda de pesquisa, ensino e extensão e possibilidades de atuação prática