Efeitos do uso tópico do óleo de andiroba puro e ozonizado em feridas induzidas em cavalos

Este trabalho realizou uma avaliação clínica e histopatológica da aplicação tópica do óleo de andiroba (Carapa guianensis Aublet), puro e ozonizado, no processo de cicatrização de feridas em cinco equinos saudáveis. Oito feridas de 6,25 cm2 foram induzidas cirurgicamente, quatro de cada lado da região lombar, craniais em relação à região sacral. Em três animais, o lado esquerdo foi destinado à avaliação macroscópica e mensuração de área, enquanto o lado direito foi destinado à análise histopatológica. Nos outros dois animais, as avaliações foram invertidas. O tratamento tópico foi iniciado 12 horas após a indução cirúrgica e foi mantido diariamente até a completa cicatrização das feridas. Foram usados, sequencialmente e bilateralmente, no sentido craniocaudal: solução salina (GC), solução salina ozonizada (GO), óleo de andiroba puro (GAP) e óleo de andiroba ozonizado (GAO). Aleatoriamente, a sequência de tratamentos foi modificada. As análises macroscópicas e microscópicas foram realizadas 3, 7, 14 e 21 dias após a cirurgia, e o tempo total para cicatrização registrado. A contração da ferida foi de 67,75% para GC, 65,26% para GO, 67,91% para GAP, e 69,84% para GAO. A avaliação histopatológica demonstrou que as feridas tratadas com GAO e GAP apresentaram uma avançada epitelização, proliferação fibroblástica e deposição de colágeno, moderada proliferação vascular e presença de infiltrados de células polimorfonucleares (PMN) e discreta proliferação de células mononucleares (MN). Foi possível concluir que todos os tratamentos usados foram benéficos perante o grupo de controle, mostrando que as versões pura e ozonizada do óleo de andiroba representam alternativas terapêuticas ao tratamento de feridas em equinos.The aim of this study was to evaluate clinical and histopathological aspects of topical application of pure and ozonized andiroba oil (Carapa guianensis Aublet.) on the healing process of wounds of healthy horses. Eight 6.25-cm2 wounds were surgically produced on each horse, cranial to the sacrum, being four wounds on each side of the lumbar region. In three animals, left side was used for macroscopic observations and area measurement and right side was used for histopathological analysis. For the other two animals, evaluations were inverted. Beginning of the topical treatment occurred 12 hours after surgical induction of the injuries and was maintained daily until complete healing of the wounds, using sequentially and bilaterally in the craniocaudal direction saline solution (GC), ozonized saline solution (GO), pure andiroba oil (GAP) and ozonized andiroba oil (GAO). Randomly, sequence of the treatments was modified. Macroscopic and histopathological analyses were performed at 3, 7, 14, and 21 days after surgery. Completed healing time for all wounds were recorded. A wound contraction of 67.75% for GC, 65.26% for GO, 67.91% for GAP, and 69.84% for GAO were recorded. Histopathologic evaluation revealed that wounds from the GAO and GAP had an advanced epithelialization, fibroblast proliferation and collagen deposition, moderate vascular proliferation, and presence of PMN infiltrate and discrete viewing of MN. It was possible to conclude that all treatments had benefits when comparing to control group and both pure and ozonized andiroba oil can be good options for wound treatment in horses

CUIDADOS COM A PESSOA COM DISTROFIA MUSCULAR DE DUCHENNE: REVISANDO AS RECOMENDAÇÕES

A Distrofia Muscular de Duchenne (DMD) é doença genética ligada ao X e afeta 1 a cada 3.600-6.000 nascidos vivos. Trata-se de doença progressiva e incapacitante, causada por mutações no gene da distrofina, levando à necrose das fibras musculares. A história natural da doença é de perda da marcha por volta de 13 anos de idade e, sem tratamento, morte antes dos 20 anos por complicações cardiorrespiratórias. Atualmente não há tratamento curativo disponível. As principais recomendações de manejo e cuidado na DMD,visando melhora da qualidade de vida foram publicadas entre 2009 e 2010.O objetivo deste trabalho é estudar o estado da arte destas recomendações. Realizada revisão de literatura com busca sistemática nas bases Pubmed e a BIREME, entre os anos de 2009 e 2016, com chaves de busca (consensus OR guideline OR recommendation) AND (Duchenne OR muscular dystrophy OR neuromuscular disease) e (Protocolo + Duchenne), (Recomendação + Duchenne) e (Consenso + Duchenne). Dos 1.032 artigos encontrados, 32 preencheram todos os critérios de elegibilidade para a revisão, contendo recomendações sobre diagnóstico5, corticoterapia1, manejos ortopédico2, cardíaco5, respiratório14 e cirúrgico1, além de recomendações gerais3 e sobrequalidade de vida1 . Após a cuidadosa leitura e coleta de informações, concluímos que apesar dos vários trabalhos posteriores ao consenso, as recomendações ali contidas permanecem atuais, mas hápotenciais créscimos que deveriam ser considerados em uma nova reunião de consenso.

Prejuízos à saúde e econômicos inerentes ao uso indiscriminado de antimicrobianos na atenção primária – revisão integrativa

Objective: To analyze and describe the scientific evidence on the occurrence of inappropriate use of antimicrobials in primary health care and the main associated harm. Data sources: National Library of Medicine and Virtual Health Library (BVS/MEDLINE), using 2 search strategies with categorization of studies, evaluation, interpretation of results and synthesis of knowledge. Data synthesis: Eight articles were included in this review, in which 100% cited harm from the indiscriminate use of antimicrobials in the primary health sector, such as therapeutic failure and increased bacterial resistance. There was also an economic impact with an increase in health costs mentioned in 25% of the studies. The most frequent etiological agent was gram-negative bacteria (62,5%), especially Escherichia coli and gram-positive bacteria (50%) with emphasis on Streptococcus pneumoniae. Regarding resistance to antimicrobials, emphasis was observed on the class of penicillins (62,5%). Conclusion: There was an association between the occurrence of inappropriate use of antimicrobials in primary health care and the associated losses, such as therapeutic limitation, worse prognosis and increased costs.Objetivo: Analisar e descrever as evidências científicas sobre a ocorrência do uso inadequado de antimicrobianos na atenção primária de saúde e os principais prejuízos associados. Fontes de dados: National Library of Medicine e Biblioteca Virtual em Saúde (BVS/MEDLINE), com emprego de 2 estratégias de busca com categorização dos estudos, avaliação, interpretação dos resultados e síntese do conhecimento. Síntese de dados: Foram incluídos nessa revisão 8 artigos, dos quais, 100% citaram prejuízos do uso indiscriminado de antimicrobianos no setor primário da saúde, como falha terapêutica e aumento da resistência bacteriana. Houve ainda impacto econômico com aumento nos custos da saúde, mencionado em 25% dos estudos. Os agentes etiológicos mais frequentes foram as bactérias gram-negativas (62,5%), especialmente Escherichia coli e as gram-positivas (50%), com destaque para Streptococcus pneumoniae. Em relação à resistência aos antimicrobianos observou-se ênfase para classe das penicilinas (62,5%). Conclusões: Evidenciou-se a associação entre a ocorrência do uso inadequado de antimicrobianos na atenção primária de saúde e os prejuízos associados, como a limitação terapêutica, pior prognóstico e aumento dos gastos

Avaliação da idade gestacional do recém-nascido (RN), pelo método de Capurro, por enfermeiros e médicos que atuam na Unidade de Neonatologia do Hospital de Clínicas de Porto Alegre, UIN-HCPA

O estudo compara a avaliação da idade gestacional do RN, pelo método de Capurro, por médicos e enfermeiros da UIN-HCPA. Não houve diferença significativa entre as médias dos dias avaliados por estes profissionais. Recomenda-se o procedimento, uma vez que favorece a identificação precoce do RN com risco provável

Effects of topical application of pure and ozonized andiroba oil on experimentally induced wounds in horses

The aim of this study was to evaluate clinical and histopathological aspects of topical application of pure and ozonized andiroba oil (Carapa guianensis Aublet.) on the healing process of wounds of healthy horses. Eight 6.25-cm2 wounds were surgically produced on each horse, cranial to the sacrum, being four wounds on each side of the lumbar region. In three animals, left side was used for macroscopic observations and area measurement and right side was used for histopathological analysis. For the other two animals, evaluations were inverted. Beginning of the topical treatment occurred 12 hours after surgical induction of the injuries and was maintained daily until complete healing of the wounds, using sequentially and bilaterally in the craniocaudal direction saline solution (GC), ozonized saline solution (GO), pure andiroba oil (GAP) and ozonized andiroba oil (GAO). Randomly, sequence of the treatments was modified. Macroscopic and histopathological analyses were performed at 3, 7, 14, and 21 days after surgery. Completed healing time for all wounds were recorded. A wound contraction of 67.75% for GC, 65.26% for GO, 67.91% for GAP, and 69.84% for GAO were recorded. Histopathologic evaluation revealed that wounds from the GAO and GAP had an advanced epithelialization, fibroblast proliferation and collagen deposition, moderate vascular proliferation, and presence of PMN infiltrate and discrete viewing of MN. It was possible to conclude that all treatments had benefits when comparing to control group and both pure and ozonized andiroba oil can be good options for wound treatment in horses

Intoxicação por chá de Brugmansia suaveolens (trombeta de anjo) em paciente jovem previamente hígido: relato de caso

 Introdução: A Brugmansia suaveolens, conhecida como “trombeta de anjo,” é uma planta com alcaloides anticolinérgicos que provocam inibição da atividade de receptores muscarínicos no sistema nervoso central e periférico. Sua toxicidade resulta em agitação, alucinações, hipertermia, taquicardia, rabdomiolise, insuficiência renal e morte. Objetivo: Descrever um caso de intoxicação aguda por chá de trombeta, cursando com hepatite fulminante. Materiais e Métodos: Trata-se de um relato de caso, com dados clínicos e laboratoriais coletados a partir dos registros em prontuário. Termo de Consentimento Livre e Esclarecido foi obtido com familiar e o projeto foi aprovado pelo Comitê de Ética em Pesquisa. Relato de Caso: Masculino de 19 anos, saudável, internado por quadro de febre de 41°C e crises convulsivas tônico-clônicas generalizadas, evoluindo para intubação orotraqueal. Apresentava midríase fixa e rigidez de nuca. Família relata que o paciente tinha feito uso de chá de “trombeta de anjo”. À admissão, realizou tomografia computadorizada de crânio, que não evidenciou desvio de linha média, líquor sem alterações, gasometria arterial com acidose metabólica grave, insuficiência renal aguda com necessidade dialítica e insuficiência hepática aguda fulminante. Conclusões: A intoxicação pelo “chá de trombeta” é uma emergência neurológica que deve ser rapidamente reconhecida por ser potencialmente fatal. Tendo meningite como diagnóstico diferencial, é importante obter história clínica completa para investigar possível contato prévio com a planta. Para nosso conhecimento, esse é o primeiro caso a relatar quadro de hepatite fulminante pela “trombeta de anjo,” além dos sintomas neurológicos já descritos em literatura, o que corrobora ainda mais para a importância do tema em questão.INTRODUCTION: Brugmansia suaveolens, popularly known as “angel’s trumpet,” is a plant with anticholinergic alkaloids that inhibit the activity of muscarinic receptors in the central and peripheral nervous system. Its toxicity results in agitation, hallucinations, hyperthermia, tachycardia, rhabdomyolysis, renal failure, and death. OBJECTIVE: Report a case of acute intoxication due to ingestion of “angel’s trumpet” tea, with associated fulminant hepatitis. METHODS: We present a case report with clinical and laboratory data collected from medical records. The study was approved by the Research Ethics Committee, and Written Informed Consent was obtained from a legally responsive relative. CASE REPORT: A healthy 19-year-old male was hospitalized with a fever of 41°C and generalized tonic-clonic seizures, progressing to orotracheal intubation. He exhibited fixed mydriasis and neck stiffness. We were informed by the family that the patient had made use of the tea from the “angel’s trumpet” plant. At admission, he performed a computerized cranial tomography, which showed no midline shift, cerebrospinal fluid without alterations, arterial blood gas analysis with severe metabolic acidosis, acute renal failure requiring dialysis, and fulminant acute liver failure. CONCLUSIONS: “Trumpet tea” intoxication is a neurological emergency that must be quickly recognized for its potential fatal effects. With meningitis as a differential diagnosis, it is important to collect a complete history taking to investigate possible previous contact with the plant. To our knowledge, this is the first case report of fulminant hepatitis caused by “angel’s trumpet,” in addition to the neurological symptoms already described in the literature, which further corroborates the importance of the topic in question

1α,25(OH)2-3-Epi-Vitamin D3, a Natural Physiological Metabolite of Vitamin D3: Its Synthesis, Biological Activity and Crystal Structure with Its Receptor

Background: The 1 alpha,25-dihydroxy-3-epi-vitamin-D(3) (1 alpha,25(OH)(2)-3-epi-D(3)), a natural metabolite of the seco-steroid vitamin D(3), exerts its biological activity through binding to its cognate vitamin D nuclear receptor (VDR), a ligand dependent transcription regulator. In vivo action of 1 alpha,25(OH)(2)-3-epi-D(3) is tissue-specific and exhibits lowest calcemic effect compared to that induced by 1 alpha,25(OH)(2)D(3). To further unveil the structural mechanism and structure-activity relationships of 1 alpha,25(OH)(2)-3-epi-D3 and its receptor complex, we characterized some of its in vitro biological properties and solved its crystal structure complexed with human VDR ligand-binding domain (LBD). Methodology/Principal Findings: In the present study, we report the more effective synthesis with fewer steps that provides higher yield of the 3-epimer of the 1 alpha,25(OH)(2)D(3). We solved the crystal structure of its complex with the human VDR-LBD and found that this natural metabolite displays specific adaptation of the ligand-binding pocket, as the 3-epimer maintains the number of hydrogen bonds by an alternative water-mediated interaction to compensate the abolished interaction with Ser278. In addition, the biological activity of the 1 alpha,25(OH)(2)-3-epi-D(3) in primary human keratinocytes and biochemical properties are comparable to 1 alpha,25(OH)(2)D(3). Conclusions/Significance: The physiological role of this pathway as the specific biological action of the 3-epimer remains unclear. However, its high metabolic stability together with its significant biologic activity makes this natural metabolite an interesting ligand for clinical applications. Our new findings contribute to a better understanding at molecular level how natural metabolites of 1 alpha,25(OH)(2)D(3) lead to significant activity in biological systems and we conclude that the C3-epimerization pathway produces an active metabolite with similar biochemical and biological properties to those of the 1 alpha,25(OH)(2)D(3)

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R$^{2}$ = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R$^{2}$ = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega‐phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran's eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white‐sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R2 = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R2 = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long‐standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions