Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Prevalência de enteroparasitoses em manipuladores de alimentos, Florianópolis, SC Enteroparasitosis prevalence in food handlers, Florianópolis, SC

Analisamos 238 amostras fecais oriundas de duas populações de indivíduos na cidade de Florianópolis, Santa Catarina, Brasil: os que trabalhavam em uma empresa de alimentos e trabalhadores de feiras livres e sacolões. Observou-se que esses manipuladores de alimentos apresentaram elevados índices de parasitose.<br>We analyzed 238 feces samples in two populations of individuals in the city of Florianópolis, Santa Catarina State, Brazil: we selected workers in a fast food company and workers in street markets and vegetable and fruit markets. The intestinal parasites were high in these food handlers

Qualidade parasitológica e condições higiênico-sanitárias de hortaliças comercializadas na cidade de Florianópolis, Santa Catarina, Brasil Parasitological quality and hygienic-sanitary conditions of vegetables sold in the city of Florianópolis, Santa Catarina, Brazil

Embora as hortaliças sejam amplamente comercializadas e consumidas no Brasil, o consumo de verduras cruas constitui importante meio de transmissão de parasitas intestinais. Neste estudo, avaliou-se a presença de formas transmissíveis de três tipos de hortaliças (rúcula, agrião e alface-crespa) comercializadas em cinco principais pontos de venda aos consumidores (dois supermercados, dois "sacolões" e em uma feira livre), na cidade de Florianópolis, Santa Catarina, Brasil, no período de junho 2003 a maio 2004. As hortaliças in natura foram lavadas com água e esta foi submetida ao método de sedimentação, durante um período de 24 horas. Concomitante à pesquisa laboratorial, foram avaliadas as condições de cultivo e manipulação de diferentes produtores agrícolas, os quais forneciam as hortaliças que eram posteriormente comercializadas em Florianópolis. A análise parasitológica mostrou alta freqüência de parasitas intestinais na maioria das amostras analisadas (40% a 76%). Entre os fatores envolvidos na contaminação das verduras, destacaram-se a origem das águas de irrigação, o acondicionamento, o transporte e a manipulação destas durante a coleta. Conclui-se que as hortaliças comercializadas nesta região têm relevante papel na transmissão de enfermidades intestinais, havendo necessidade de medidas específicas que evitem a contaminação desses vegetais.<br>Although vegetables are widely sold and consumed in Brazil, the ingestion of raw vegetables is an important way of transmission of intestinal parasites. In this study, the presence of transmissible forms of intestinal parasites in three vegetable species commercially available in five very busy locations (two supermarkets, two "kilo markets" and a street market) located in the city of Florianópolis, Santa Catarina, Brazil, within the period between June 2003 and May 2004 was evaluated. The in natura vegetables were washed with water and the washing water was submitted to the spontaneous sedimentation method for a period of 24 hours. Concomitantly to the laboratory research, the conditions of cultivation and manipulation of the producers of the vegetables sold in Florianópolis were evaluated. The parasitologic analysis confirmed the presence of intestinal parasites in most of the vegetables analyzed (40% to 76%). Among the factors involved in the contamination of vegetables, the origin of the water used for irrigation, storage and transportation of vegetables and the degree of manipulation during the sampling process can be included. From the results, it can be concluded that vegetables sold in the investigated region play an important role in the transmission of intestinal diseases, and, therefore, specific measures should to be taken in order to avoid the contamination of these vegetables

Acorn consumption improves the immune response of the dung beetle Thorectes lusitanicus

Thorectes lusitanicus, a typically coprophagous species is also actively attracted to oak acorns, consuming, burying them, and conferring ecophysiological and reproductive advantages to both the beetle and the tree. In this study, we explored the possible relation between diet shift and the health status of T. lusitanicus using a generalist entomopathogenic fungus (Metarhizium anisopliae) as a natural pathogen. To measure the health condition and immune response of beetles, we analysed the protein content in the haemolymph, prophenoloxidase (proPO) content, phenoloxidase (PO) activity and mortality of beetles with diets based on either acorns or cow dung. Protein content, proPO levels and PO levels in the haemolymph of T. lusitanicus were found to be dependent on the type of diet. Furthermore, the beetles fed with acorns developed a more effective proPO-PO system than the beetles fed with cow dung. Furthermore, a significant decrease in mortality was observed when infected individuals were submitted to an acorn-based diet. In addition to enhancing an understanding of the relevance of dietary change to the evolutionary biology of dung beetles, these results provide a more general understanding of the ecophysiological implications of differential dietary selection in the context of fitness.Financial support was provided by the Projects CGL2008/03878/BOS and CGL2011-25544 of the Secretaría de Estado de Investigación-Ministerio de Educación, Ciencia e Innovación (http://www.mecd.gob.es/portada-mecd/) and OAPN 762/2012, Ministerio de Agricultura, Alimentación y Medio Ambiente (http://www.magrama.gob.es/es/)

Elevada porcentagem de blastocistose em escolares de São Paulo, SP Blastocystosis: a high proportion of cases found in schoolchildren of São Paulo, State of São Paulo, Brazil

Em exame parasitológico de fezes de 227 alunos de escola pública de São Paulo (SP), encontramos 87 (38,3%) positivas para Blastocystis hominis. A blastocistose ainda suscita controvérsias e indefinições, merecedoras de esclarecimentos sobretudo para evitar contratempos no âmbito da saúde pública e das atenções médico-assistenciais.<br>As a part of medical assistance activities, parasitological examination of fecal samples from 227 school children from a public institution of São Paulo (SP) revealed a rather high proportion of results positive for Blastocystis hominis. Other protozoan and worm species were markedly scarcer, a peculiar situation according to our judgement. It is acknowledged that blastocystosis is still largely an indefinite and controversial subject, which deserves adequate analysis to avoid drawbacks in the sphere of action of public health and general medical assistance