Allergic bronchopulmonary aspergillosis: diagnostic and treatment challenges

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder, occurring mostly in asthmatic and cystic fibrosis patients, caused by an abnormal T-helper 2 lymphocyte response of the host to Aspergillus fumigatus antigens. ABPA diagnosis is defined by clinical, laboratory and radiological criteria including active asthma, immediate skin reactivity to A. fumigatus antigens, total serum IgE levels>1000 IU/mL, fleeting pulmonary parenchymal opacities and central bronchiectases that represent an irreversible complication of ABPA. Despite advances in our understanding of the role of the allergic response in the pathophysiology of ABPA, pathogenesis of the disease is still not completely clear. In addition, the absence of consensus regarding its prevalence, diagnostic criteria and staging limits the possibility of diagnosing the disease at early stages. This may delay the administration of a therapy that can potentially prevent permanent lung damage. Long-term management is still poorly studied. Present primary therapies, based on clinical experience, are not yet standardized. These consist in oral corticosteroids, which control acute symptoms by mitigating the allergic inflammatory response, azoles and, more recently, anti-IgE antibodies. The latter two are used as a steroid-sparing agent to prolong the remission stage of the disease. Anti-IgE antibodies also have immunomodulatory properties. At present, the only way to bypass these limits and allow for an early diagnosis, is to assume ABPA in all patients with difficult-to-control asthma or cystic fibrosis. They should then be screened for sensitization to A. fumigatus antigens and, if positive, monitored more closely. Future controlled studies are needed to standardize present therapy, standardize cut-off values of various investigations, define the role of different novel immunomodulatory therapies, define the role of novel assays (such as recombinant A. fumigatus antigens and CCL17) and confirm new diagnostic and staging criteria

Avaliação farmacológica de Capsicum baccatum var. pendulum L. em um protocolo experimental patronizado de síndrome metabólica in vivo

O gênero Capsicum compreende mais de 200 espécies de pimentas e pimentões e diversas atividades farmacológicas são descritas na literatura. Estudos prévios do nosso grupo de pesquisa têm explorado diferentes atividades biológicas de Capsicum baccatum var. Pendulum (Solanaceae), como antioxidante, antiinflamatória, hipoglicemiante e antidislipidêmica. A prevalência da síndrome metabólica, caracterizada por fatores como obesidade, resistência à insulina, dislipidemia e hipertensão, tem atingido proporções epidêmicas e acomete cerca de 20% da população mundial. Muitas vezes, apenas a mudança no estilo de vida não é eficaz para impedir a progressão da doença, sendo necessário aderir ao tratamento farmacológico. No entanto, não existem fármacos específicos para o tratamento da síndrome, levando à utilização de polifarmácia, que gera dificuldades de adesão ao tratamento e risco de interações medicamentosas. O principal objetivo desse estudo foi avaliar o efeito do extrato butanólico (BUT) e da fração ativa (AF) dos frutos de C. baccatum em um modelo de síndrome metabólica induzido por dieta em camundongos C57BL/6. Inicialmente apresentamos uma revisão de estudos publicados, que utilizam diferentes tipos de dietas hipercalóricas para induzir a síndrome metabólica em roedores. Ao compararmos esses estudos, observamos a forte tendência à utilização de camundongos da linhagem C57BL/6 machos e jovens, respondendo de forma satisfatória à indução da síndrome metabólica. Após, apresentamos o efeito do BUT e AF, nas doses de 200 e 50 mg/kg, respectivamente, sobre os parâmetros glicídicos e lipídicos em modelo de síndrome metabólica em camundongos C57BL/6 submetidos a uma dieta hiperpalatável (HPD) durante 120 dias. Nesse estudo foi visto que o tratamento com C. baccatum via oral, preveniu o ganho de peso, o desenvolvimento de um perfil de intolerância à glicose, o acúmulo de gordura na região abdominal e a elevação nos níveis de insulina e leptina plasmáticas quando comparados ao grupo HPD. Além disso, também preveniu o acúmulo de colesterol e triglicerídeos no fígado e preservou a morfologia do tecido hepático. Assim, C. baccatum se mostrou promissor, prevenindo alterações dos diversos componentes importantes da síndrome metabólica.The genus Capsicum comprises more than 200 species of peppers and a range of pharmacological activities are described in the literature. Previous studies of our research group have explored several activities for Capsicum baccatum var. pendulum (Solanaceae) species, as antioxidant, anti-inflammatory, hypoglycemic and antidyslipidemic, since the studies with this species are scarce. The prevalence of metabolic syndrome, characterized by the association of factors such as obesity, insulin resistance, dyslipidemia and hypertension, is reaching epidemic proportions worldwide, affecting approximately 20% of world's population. Often, only lifestyle change is not effective in preventing the progression of the disease, being necessary adherence to pharmacological treatment. However, there are no specific drugs for the treatment of the syndrome, leading to the use of polypharmacy, which generates an increase in public spending, difficulties of adherence to treatment, and enhanced risk to drug interactions. The main objective of this study was to evaluate the effect of butanolic extract (BUT) and the active fraction (AF) of C. baccatum on a model of diet-induced metabolic syndrome in C57BL/6 mice. We first present a review of published studies, which use different types of hypercaloric diets to induce metabolic syndrome in rodents. When comparing these studies, we observed a strong trend towards the use of male and young C57BL/6 mice, responding satisfactorily to the metabolic syndrome induction through hypercaloric diets. After, we present the effect of BUT and AF, on glucose and lipid parameters in a model of metabolic syndrome in C57BL/6 mice submitted to a hyperpalatable diet (HPD) for 120 days. In this study, it was seen that oral C. baccatum treatment prevented weight gain, development of a glucose intolerance profile, accumulation of fat in the abdominal area and the increase in plasma insulin and leptin levels when compared to group HPD. Also, it prevented the accumulation of cholesterol and triglycerides in the liver, and preserved the liver tissue morphology. Thus, these results showed the effects of C. baccatum, especially AF, preventing changes in several important components of the metabolic syndrome

Capsicum baccatum red pepper prevents cardiometabolic risk in rats fed with an ultra-processed diet

Metabolic syndrome is a serious health condition reaching epidemic proportions worldwide and is closely linked to an increased risk of cardiovascular problems. The lack of appropriate treatment paves the way for developing new therapeutic agents as a high priority in the current research. In this study, we evaluated the protective effects of Capsicum baccatum red pepper on metabolic syndrome scenarios induced by an ultra-processed diet in rats. After four months, the ultra-processed diet increased central obesity, triglycerides, total cholesterol, LDL-cholesterol plasma levels, and impaired glucose tolerance. The oral administration of C. baccatum concomitantly with the ultra-processed diet avoided the accumulation of adipose tissue in the visceral region, reduced the total cholesterol and LDL fraction, and improved glucose homeostasis, factors commonly associated with metabolic syndrome. The data presented herein reveal an important preventive action of C. baccatum in developing metabolic disorders among animals fed a hypercaloric diet, significantly reducing their cardiometabolic risk. Allied with the absence of toxic effects after chronic use, our study suggests C. baccatum red pepper as a secure and enriched source of bioactive compounds promising to protect against pathological processes associated with metabolic syndrome

Effect of Root Canal Preparation on Propagation of Dentinal Microcracks

Introduction: This study evaluated the propagation of dentinal microcracks and the root canal volume increase after being prepared with two endodontic instruments: ProTaper Next (PTN) and WaveOne Gold (WOG) by micro-computed tomography analysis. Methods and Materials: We selected 48 maxillary molars randomly distributed in two groups: PTN and WOG. The samples were scanned before and after instrumentation, and then the image analysis was performed to detect the propagation of pre-existing dentinal micro-cracks and calculate the pre- and post-instrumentation volume. The statistical analysis was performed using Student’s t-test, Fisher's exact test, and ANCOVA (P<0.05). Results: Dentinal microcracks were observed in 95.8% of the samples, both PTN and WOG instruments propagated microcracks after instrumentation, but there was no significant difference between the instruments (P=0.538). In relation to the root canal volume there was no statistic difference between PTN and WOG systems for the mesiobuccal (P=0.426) and distobuccal root canals (P=0.523). Conclusion: We can conclude that both ProTaper Next and WOG systems propagate dentinal microcracks after root canal preparation in this in vitro study, without statistical significance. The root canal volume prepared also showed no statistically significant difference between the two groups. This in vitro study requires further studies for more concrete conclusions

Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a Joint Position Paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

© The Author 2020. This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal - Cardiovascular Pharmacotherapy following peer review. The version of record [Gorog et al., Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a Joint Position Paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Journal - Cardiovascular Pharmacotherapy, pvaa009] is available online at: https://doi.org/10.1093/ehjcvp/pvaa009.Peer reviewedFinal Accepted Versio

Long-Term Oral Administration of Capsicum baccatum

Our group showed that crude ethanol (CE) and butanol (BUT) extracts of Capsicum baccatum presented anti-inflammatory and antioxidant properties. Furthermore, the flavonoid and total phenolic contents were positively correlated with both of these properties observed for C. baccatum extracts. The present study demonstrated that 60 days of oral administration of CE and BUT (200 mg/kg) in mice did not cause significant differences in the following parameters evaluated: hematological profile, body weight and relative weight of visceral organs, systemic lipid profile, glucose homeostasis (GTT), kidney and hepatic biochemical markers, and spontaneous locomotion and anxiety-like behavior. Altogether, these results indicate for the first time that the long-term oral administration of C. baccatum extracts does not affect specific aspects of CF1 mice physiology, suggesting their safety, building up the venue to test their efficacy in animal models underlying persistent activation of oxidative and inflammatory pathways

Alimentação saudável: prevenindo a síndrome metabólica

A síndrome metabólica é um grupo de disfunções orgânicas que implica alterações nos níveis de glicemia, triglicérides, HDL-C e pressão arterial, levando ao desenvolvimento de doenças cardiovasculares, diabetes tipo 2 e obesidade. A alimentação saudável e as atividades físicas regulares ajudam a prevenir a síndrome metabólica. Este artigo tem como objetivo descrever uma ação educativa sobre a prevenção da síndrome metabólica por meio de recursos educacionais que estimulem o processo de conscientização dos indivíduos sobre a relevância de adotar um estilo de vida saudável. Com a participação de nutricionistas, esta ação educativa se concentrou em 57 funcionários não docentes de nível básico da universidade pública do município de São Paulo, entre dezembro de 2013 e março de 2014. Os tópicos abordados nos folhetos informativos foram "café da manhã", "como escolher o que comer", “o poder das frutas e legumes" e "proteger o seu coração". A avaliação, por meio de um questionário, mostrou que os folhetos contribuíram para a apreensão de informações, principalmente sobre a seleção de alimentos em refeições e a importância de tomar café da manhã.

Associação entre colesterol hepático e ácido oleico no fígado de ratos tratados com gordura vegetal parcialmente hidrogenada

Objective The aim of the present study was to investigate the lipid profiles of the hepatic and adipose tissues of Wistar rats treated for 21 days with a diet high in saturated fat (high saturated fat, n=6) or high in hydrogenated fat, that is, having 50% partially hydrogenated vegetable oil in its composition (high hydrogenated fat, n=6), and compare them to those of a control group (control group, n=6). Methods Adipose tissue and total hepatic fat were higher in the saturated fat group than in the hydrogenated fat group. Hepatic lipid peroxidation was greatest in the saturated fat group, with consequent lower hepatic vitamin E and A levels. In contrast, serum vitamin A was highest in the saturated fat group. Analysis of hepatic lipid fractions found more cholesterol and less high density lipoprotein-cholesterol in the hydrogenated fat group. The hydrogenated fat group had the highest levels of triacylglycerols, followed by the saturated fat group. Results Significant amounts of trans fatty acids were detected in the hepatic and adipose tissues of the hydrogenated fat group. Among the identified fatty acids, 18:1n9 had a higher positive association with hepatic cholesterol and triacylglycerols, and a higher negative association with high density lipoprotein-cholesterol. Partially hydrogenated vegetable oil promotes greater accumulation of cholesterol and triacylglycerols in the liver than saturated fats. Conclusion Trans fatty acids were incorporated into hepatocytes and adipocytes in a highly efficient manner.OBJETIVO: Esta pesquisa investigou a composição lipídica dos tecidos hepático e adiposo de ratos Wistar tratados durante 21 dias com uma dieta rica em gordura saturada (grupo gordura saturada, n=6) ou rica em gordura hidrogenada, ou seja, 50% da gordura consistindo de gordura vegetal parcialmente hidrogenada (grupo gordura hidrogenada, n=6) e compará-los a um grupo-controle (grupo-controle, n=6). \ud MÉTODOS: As quantidades de tecido adiposo e gordura hepática total foram maiores no grupo gordura saturada do que no grupo gordura hidrogenada. A peroxidação lipídica hepática foi maior no grupo gordura saturada, com consequente diminuição dos níveis hepáticos de vitaminas E e A. Por outro lado, o nível sérico de vitamina A foi maior no grupo gordura saturada do que nos outros grupos. A análise das frações lipídicas hepáticas revelou mais colesterol e menos colesterol da lipoproteína de alta densidade no grupo gordura hidrogenada. O grupo gordura hidrogenada apresentou os maiores níveis de triglicérides, seguido do grupo gordura saturada. Quantidades significativas de ácidos graxos trans foram detectados nos tecidos hepático e adiposo do grupo gordura hidrogenada. \ud RESULTADOS: Dentre os ácidos graxos identificados, o 18:1n9 apresentou uma associação positiva maior com o colesterol hepático e triglicérides, e uma associação negativa maior com o colesterol da lipoproteína de alta densidade. A gordura vegetal parcialmente hidrogenada promove um maior acúmulo de colesterol e triglicérides no fígado do que a gordura saturada. \ud CONCLUSÃO: Os ácidos graxos trans foram incorporados aos hepatócitos e adipócitos de forma altamente eficiente.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazi

Genetic bases of C7 deficiency: systematic review and report of a novel deletion determining functional hemizygosity

Primary complement system (C) deficiencies are rare but notably associated with an increased risk of infections, autoimmunity, or immune disorders. Patients with terminal pathway C-deficiency have a 1,000- to 10,000-fold-higher risk of Neisseria meningitidis infections and should be therefore promptly identified to minimize the likelihood of further infections and to favor vaccination. In this paper, we performed a systematic review about clinical and genetic patterns of C7 deficiency starting from the case of a ten-year old boy infected by Neisseria meningitidis B and with clinical presentation suggestive of reduced C activity. Functional assay via Wieslab ELISA Kit confirmed a reduction in total C activity of the classical (0.6% activity), lectin (0.2% activity) and alternative (0.1% activity) pathways. Western blot analysis revealed the absence of C7 in patient serum. Sanger sequencing of genomic DNA extracted from peripheral blood of the patient allowed the identification of two pathogenetic variants in the C7 gene: the already well-characterized missense mutation G379R and a novel heterozygous deletion of three nucleotides located at the 3’UTR (c.*99_*101delTCT). This mutation resulted in an instability of the mRNA; thus, only the allele containing the missense mutation was expressed, making the proband a functional hemizygote for the expression of the mutated C7 allele