Plantas medicinais do Sistema Único de Saúde com potencial antifúngico

As plantas medicinais produzem uma série de metabólitos secundários que podem ser usados para fins terapêuticos e antimicrobianos. No Brasil, o SUS disponibiliza uma série de medicamentos fitoterápicos como alternativa ao tratamento de diversas enfermidades. Considerando a importância da utilização dessas plantas na produção de medicamentos que ampliem as opções terapêuticas e melhorem a atenção à saúde de usuários do sistema, elaborou-se este estudo de revisão com o objetivo de estimar quantitativamente a atividade antifúngica das plantas utilizadas como fitoterápicos contidas na RENAME. A seleção de artigos deu-se por meio de três etapas distintas: leitura e escolha de títulos relacionados à ação antifúngica, leitura dos resumos e leitura na íntegra dos artigos selecionados. Esta revisão selecionou 22 estudos de interesse, sendo 12 elaborados no Brasil e 10 em outros países. Os artigos escolhidos testaram a ação inibitória das plantas contra espécies de fungos de importância agrícola e sanitária, entre filamentosos e leveduriformes, sendo Candida albicans a espécie mais testada. Trinta e nove espécies foram inibidas por alguma concentração do extrato utilizado, havendo aumento ou diminuição da atividade antifúngica conforme substância extratora utilizada. A planta mais analisada foi a espécie Schinus terebinthifolius Raddi., estudada em sete artigos. Os resultados encontrados demonstram a importância da análise de plantas medicinais e da incorporação de medicamentos à base de plantas como fonte alternativa de tratamento, salientando a necessidade de estudos que demonstrem sua citotoxicidade e mecanismos de ação terapêutica no organismo humano.Medicinal plants synthesize various secondary metabolites that can be used for therapeutic and antimicrobial purposes. In Brazil, the Unified Health System (SUS) offers several herbal medicines as an alternative in the treatment of various diseases. Considering the importance of these plants in the production of chemicals that expand therapeutic options and improve the health of SUS users, this review was carried out to quantitatively determine the antifungal activity of plants used as phytotherapeutics at RENAME. The selection of papers was performed at three distinct stages: examining and choosing titles related to antifungal action, reading the abstracts, and reading the whole selected articles. This review selected 22 studies of interest; 12 of them were conducted in Brazil and 10 were carried out in other countries. The papers chosen tested the growth inhibitory effect of plants against fungal species of agricultural and health importance, ranging from filamentous to yeast-like fungi, and Candida albicans was the most tested species. The growth of 39 fungal species were inhibited by some concentration of the extract used, with either an increase or decrease in antifungal activity depending on the extract used. The most frequently analyzed plant was the species Schinus terebinthifolius Raddi., studied in seven papers. The results found demonstrate the importance of analyzing medicinal plants and incorporating plant-based medicines in healthcare as an alternative source of treatment, highlighting the need for studies that evaluate the mechanisms action of their cytotoxicity and therapeutic effects in the human body

Energetische Sanierung von Bestandsgebäuden oder Neubau : ökologische Bewertung hinsichtlich Materialbedarf, Primärenergieverbrauch und damit verbundenen Treibhausgas-Emissionen ; Endbericht

Die Bauindustrie und die Immobilienwirtschaft gehören zu den ressourcenintensivsten Sektoren der heutigen Zeit. Jährlich werden Millionen Tonnen mineralischer Rohstoffe, Metalle, Holz, Kunststoff, Glas und anderen Materialien für die Erstellung und Sanierung von Wohngebäuden genutzt. Auch die Herstellung von Zement ist als ein Hauptbestandteil von Beton mit enormen Treibhausgas-Emissionen verbunden. Der Neubau, die Sanierung und der Abriss von Gebäuden sorgt zudem für große Mengen Bau- und Abbruchabfälle. Für die Immobilienwirtschaft stellt sich daher die Frage, wie sie ihren Gebäudebestand ökologisch optimieren kann. Doch was wiegt ökologisch stärker: der Mehrbedarf an Rohstoffen und die anfallenden Abfallmengen bei Abriss und Neubau oder die ressourcenintensivere Nutzungsphase von sanierten Bestandsgebäuden, wenn deren energetische Qualität niedriger ist als bei Neubauten? Vor diesem Hintergrund hat das Wohnungsunternehmen LEG das Wuppertal Institut beauftragt, anhand von drei exemplarischen LEG-Gebäuden die energetische Gebäudesanierungen im Vergleich zur Alternative eines Abrisses und Neubaus ökologisch zu bewerten. Im Fokus der Untersuchung standen dabei der Primärenergieverbrauch, die damit verbundenen Treibhausgas-Emissionen der Nutzungsphase sowie die gespeicherte Graue Energie der Gebäude und den hiermit verbundenen Treibhausgas-Emissionen. Nun liegen die Studienergebnisse vor: Wird der gesamte Lebenszyklus berücksichtigt, verursacht die energetische Sanierung nur die Hälfte der CO2-Fußabdrücke eines Neubaus. Um das Ziel zu erreichen, müsse der Weg zur Elektrifizierung von Heizsystemen noch beschleunigt und damit die Abhängigkeit von fossilen Energieträgern verringert werden. Zwar gleicht der Neubau das Ungleichgewicht zwischen Angebot und Nachfrage aus und hat damit einen sozialen Wert, eine Alternative zur Sanierung in Beständen ist er aus ökologischer Sicht allerdings nicht

Genomic basis of a social polymorphism in a halictid bee

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Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries.

OBJECTIVE: To determine if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality. DESIGN: Population based cohort study. SETTING: European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries. PARTICIPANTS: 521 324 adults; at recruitment, country specific and validated dietary questionnaires were used to assess their usual dietary intakes. A FSAm-NPS score was calculated for each food item per 100 g content of energy, sugars, saturated fatty acids, sodium, fibre, and protein, and of fruit, vegetables, legumes, and nuts. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed. The higher the score the lower the overall nutritional quality of the diet. MAIN OUTCOME MEASURE: Associations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models. RESULTS: After exclusions, 501 594 adults (median follow-up 17.2 years, 8 162 730 person years) were included in the analyses. Those with a higher FSAm-NPS dietary index score (highest versus lowest fifth) showed an increased risk of all cause mortality (n=53 112 events from non-external causes; hazard ratio 1.07, 95% confidence interval 1.03 to 1.10, P<0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, P<0.001 for trend) and diseases of the circulatory (1.04, 0.98 to 1.11, P=0.06 for trend), respiratory (1.39, 1.22 to 1.59, P<0.001), and digestive (1.22, 1.02 to 1.45, P=0.03 for trend) systems. The age standardised absolute rates for all cause mortality per 10 000 persons over 10 years were 760 (men=1237; women=563) for those in the highest fifth of the FSAm-NPS dietary index score and 661 (men=1008; women=518) for those in the lowest fifth. CONCLUSIONS: In this large multinational European cohort, consuming foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher mortality for all causes and for cancer and diseases of the circulatory, respiratory, and digestive systems, supporting the relevance of FSAm-NPS to characterise healthier food choices in the context of public health policies (eg, the Nutri-Score) for European populations. This is important considering ongoing discussions about the potential implementation of a unique nutrition labelling system at the European Union level

Development and validation of combined symptom-medication scores for allergic rhinitis*

Background Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air(R) app to generate and validate hypothesis- and data-driven CSMSs. Methods We used MASK-air(R) data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air(R) data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air(R), and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). Results We assessed 317,176 days of MASK-air(R) use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820). Conclusion The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials.Peer reviewe

Behavioural patterns in allergic rhinitis medication in Europe : A study using MASK-air(R) real-world data

Background Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. Methods We analysed 2015-2020 MASK-air(R) European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. Results We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H-1-antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. Conclusions Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.Peer reviewe

Development and validation of combined symptom‐medication scores for allergic rhinitis*

Background: Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air® app to generate and validate hypothesis- and data-driven CSMSs. Methods: We used MASK-air® data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air® , and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). Results: We assessed 317,176 days of MASK-air® use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820). Conclusion: The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials

Allergen immunotherapy in MASK-air users in real-life : Results of a Bayesian mixed-effects model

Background Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies. Objective To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air(R) app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. Methods We assessed the MASK-air(R) data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season. Results We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2). Conclusion In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.Peer reviewe

Consistent trajectories of rhinitis control and treatment in 16,177 weeks : The MASK-air (R) longitudinal study

Introduction: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air (R), these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air (R) longitudinally, clustering weeks according to reported rhinitis symptoms.Methods: We analyzed MASK-air (R) data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results.Results: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age +/- SD = 39.1 +/- 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control.Conclusions: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.[GRAPHICS].Peer reviewe