Synchronous and metachronous thoracic aortic aneurysms in patients with abdominal aortic aneurysms : a systematic review and meta‐analysis

© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are madeBackground: The prevalence of thoracic aortic aneurysms (TAA) in patients with known abdominal aortic aneurysms (AAA) is not well known and understudied. Our aim was to conduct a systematic review and meta‐analysis of the overall prevalence of synchronous and metachronous TAA (SM‐TAA) in patients with a known AAA and to understand the characteristics of this sub‐population. Methods and Results: We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) from inception to November 2019 for all population‐based studies reporting on the prevalence of SM‐TAAs in a cohort of patients with AAA. Article screening and data extraction were performed by 2 authors and data were pooled using a random‐effects model of proportions using Freeman‐Tukey double arcsine transformation. The main outcome was the prevalence of SM‐TAAs in patients with AAAs. Secondary outcomes were the prevalence of synchronous TAAs, metachronous TAAs, prevalence of TAAs in patients with AAA according to the anatomic location (ascending, arch, and descending) and the differences in prevalence of these aneurysms according to sex and risk factors. Six studies were included. The pooled‐prevalence of SM‐TAA in AAA patients was 19.2% (95% CI, 12.3–27.3). Results revealed that 15.2% (95% CI, 7.1–25.6) of men and 30.7% (95% CI, 25.2–36.5) of women with AAA had an SM‐TAA. Women with AAA had a 2‐fold increased risk of having an SM‐TAA than men (relative risk [RRs], 2.16; 95% CI, 1.32–3.55). Diabetes mellitus was associated with a 43% decreased risk of having SM‐TAA (RRs, 0.57; 95% CI, 0.41–0.80). Conclusions: Since a fifth of AAA patients will have an SM‐TAA, routine screening of SM‐TAA and their clinical impact should be more thoroughly studied in patients with known AAA.info:eu-repo/semantics/publishedVersio

Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: a systematic review and meta-analysis of observational studies

© 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/Objectives: Acute Aortic dissection (AAD) may present as out-of-hospital cardiac arrest (OHCA). However, the incidence of this presentation is not well known. Our aim was to perform a systematic review and meta-analysis of all observational studies reporting on the incidence of AAD in patients with OHCA. Methods: We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to March-2021, for observational studies reporting on the incidence of AAD in patients with OHCA. Data was pooled using a random-effects model of proportions. The primary outcome was the incidence of AAD in OHCA patients. Secondary outcomes were the incidence of type A aortic dissections (TAAD) and type B aortic dissections (TBAD) in OHCA patients, overall mortality following AAD-OHCA and risk of death in AAD-OHCA patients compared to risk of death of non-AAD-OHCA patients. Results: Fourteen studies were included. The pooled calculated incidence of OHCA due to AAD was 4.39% (95 %CI: 2.55; 6.8). Incidence of OHCA due to TAAD was 7.18% (95 %CI: 5.61; 8.93) and incidence of OHCA due to TBAD was 0.47% (95 %CI: 0.18; 0.85). Overall mortality following OHCA due to AAD was 100% (95 %CI: 97.62; 100). The risk of death in AAD-OHCA patients compared with non-AAD-OHCA patients was 1.10 (95 %CI: 0.94; 1.30). Conclusion: AAD as a cause of OHCA is more frequent than previously thought. Prognosis is dire, as it is invariably lethal. These findings should lead to a higher awareness of AAD when approaching a patient with OHCA and to future studies on this matter.info:eu-repo/semantics/publishedVersio

Low-dose naltrexone: a novel adjunctive treatment in symptomatic alopecias?

Naltrexone is a competitive antagonist of μ, κ and γ opioid receptors, used for treatment of alcoholism and opioid addiction. Low-dose naltrexone (LDN) is defined as daily doses ranging from 1mg to 5mg. This is purported to have a paradoxical effect that leads to an increase in endogenous opioids, including beta-endorphins, which have anti-inflammatory properties. Theses mechanisms may also justify their possible role in the treatment of inflammatory conditions. The aim of this article is to discuss the use of LDN as an adjuvant therapeutic option in symptomatic alopecias presenting with trichodynia. Trichodynia is defined as scalp discomfort of variable intensity presenting as diffuse or localized dysesthesia and may be described by patients as pain, pruritus, or burning. These are common symptoms in patients with hair loss that negatively impacts quality of life. Scalp discomfort may be refractory to conventional therapies and does not yet have a specific therapeutic guideline. For these cases, LDN would be a possible alternative to be added to the therapeutic arsenal owing to its anti-inflammatory properties, analgesic potential, low cost, and few adverse effects described. Further studies are needed to standardize dosing, better understand its mechanism of action, and evaluate its potential therapeutic indications

Development of a phage cocktail to prevent Proteus mirabilis biofilm formation in urinary catheters

Proteus mirabilis is an enterobacterium that causes catheter-associated urinary tract infections (CAUTIs) due to its ability to form crystalline biofilms on the surfaces. These CAUTIs are very difficult to treat, since the biofilm structures are extremely tolerant to high concentrations of antibiotics. Bacteririophages (phages) have been used widely to control and prevent a diversity of bacterial species, however a limited number of phages for P. mirabilis have been isolated and studied. Here we report the isolation of two novel virulent phages, the myovirus vB_PmiM_5460 and the podovirus vB_PmiP_5461 able to target respectively 57% and 100% of all Proteus strains tested in this study. Both phages have been characterized thoroughly and sequencing data revealed no traces of genes associated with lysogeny. To further evaluate the phages ability to prevent catheter colonization by Proteus, phages adherence to silicon surfaces was assessed. Both phages were able to adhere, but the extent of adhesion was found to be phage dependent. Further tests in phagecoated catheters using a dynamic biofilm model simulating CAUTIs, have shown a 90% significant reduction of P. mirabilis biofilm formation up to 168 h of catheterization. These results highlight the potential usefulness of the two isolated phages for the prevention of surface colonization by this bacterium

DESEMPENHO ECONÔMICO E FINANCEIRO DAS EMPRESAS BRASILEIRAS DE CAPITAL ABERTO: UM ESTUDO DAS CRISES DE 2008 E 2012

Nos últimos anos, o mundo se viu frente      aduas grandes crises financeiras. Uma delas foi a crise de 2008, conhecida como crise subprime, iniciada nos Estados Unidos e que teve grande repercussão na economia mundial. A segunda foi em 2012, que se originou na Zona do Euro. Diante disso, o objetivo deste trabalho é analisar o comportamento do valor de mercado das empresas brasileiras de capital aberto, em relação à situação econômico-financeira dessas empresas nos anos de 2008 e 2012. Além disso, pretende-se verificar se a avaliação do mercado precificou as situações macroeconômicas, consideradas mais adequadas. Para a análise, utilizou-se a abordagem quantitativa, adotando como métodos a Análise de Variância (ANOVA) e a Análise Discriminante. Para isso, definiram-se dois grupos, sendo o primeiro composto pelas empresas que possuíam um percentual de variação do valor de mercado em relação ao patrimônio líquido abaixo da média e o segundo, formado pelas empresas que tinham variações acima da média. Para discriminar os grupos, utilizaram-se variáveis de liquidez, de endividamento e de lucratividade. Os resultados demonstraram que, em 2008, as empresas com variação no valor de mercado acima da média, possuíam menor liquidez, maior endividamento e maior lucratividade. De forma contrária, em 2012, as empresas acima da média apresentaram maior liquidez, menor endividamento e menor rentabilidade. Além disso, foi possível inferir que em 2008 o valor de mercado estava mais associado à alavancagem e que, em 2012, esse valor estava mais associado à liquidez das empresas, demonstrando que o mercado já precificava que as medidas anticíclicas já não eram adequadas à crise de 2012, como consideravam em 2008

Estudo clínico-epidemiológico da linfadenite caseosa em caprinos no estado de Pernambuco

Caseous lymphadenitis (CL), a contagious infectious disease caused by Corynebacterium pseudotuberculosis, stands out with great economic relevance for goat breeding in the country because it is one of the main causes of carcass condemnation and intense depreciation of the leather of small ruminants. The objective was to carry out a descriptive study of the clinical and epidemiological aspects of CL in goats in the state of Pernambuco and also to evaluate the detection of C. pseudotuberculosis in milk, blood, and stool samples by real-time PCR. Six hundred and forty-three goats were evaluated, of which 76 (11.8%) presented clinical signs suggestive of CL. And 88.9% (24/27) of the breeding was considered focus. Among symptomatic animals, 25 were selected and submitted to the collection of abscess content for bacteriological isolation. Milk, blood, and stool samples were analyzed for PLD gene detection by real-time polymerase chain reaction (PCR). Out of the 25 samples of abscess content, 72% (18/25) were positive. The PLD gene was detected in the frequencies of 8% (2/25) and 4% (1/25) in milk and blood samples, respectively. Caseous lymphadenitis is possibly widespread in the dairy herds of goats in the state of Pernambuco, especially in adult animals, with a higher occurrence of submandibular lymph node abscesses. The preliminary detection of C. pseudotuberculosis by mammary and hematogenous pathways may contribute to future approaches on the mechanisms of organic dissemination performed by the pathogen. However, it has little relevance to diagnosing the disease.A linfadenite caseosa (LC), doença infectocontagiosa ocasionada pelo Corynebacterium pseudotuberculosis, se destaca com grande relevância econômica para a caprinocultura no país por ser umas das principais causas de condenação de carcaças e intensa depreciação do couro de pequenos ruminantes. Objetivou-se realizar um estudo descritivo dos aspectos clínico-epidemiológicos da LC em caprinos no estado de Pernambuco e, adicionalmente, avaliar a detecção do C. pseudotuberculosis em amostras de leite, sangue e fezes por PCR em tempo real. Foram avaliados 643 caprinos, dos quais 76 (11,8%) apresentaram sinais clínicos sugestivos de LC. E 88,9% (24/27) das propriedades foram consideradas foco. Dentre os animais sintomáticos, 25 foram selecionados e submetidos à colheita de conteúdo de abscesso para isolamento bacteriológico. Amostras de leite, sangue e fezes foram analisadas para detecção do gene PLD pela reação em cadeia da polimerase (PCR) em tempo real. Das 25 amostras de conteúdo de abscesso, 72% (18/25) resultaram positivas. O gene PLD foi detectado nas frequências de 8% (2/25) e 4% (1/25) em amostras de leite e sangue, respectivamente. A linfadenite caseosa possivelmente encontra-se disseminada nos rebanhos leiteiros de caprinos do estado de Pernambuco, sobretudo em animais adultos, com maior ocorrência de abscessos em linfonodos submandibulares. A detecção preliminar do C. pseudotuberculosis pelas vias mamária e hematógena pode contribuir para abordagens futuras sobre os mecanismos de disseminação orgânica realizados pelo patógeno, apesar de ser pouco relevante para diagnóstico da doença

Encapsulated bacteriophages in alginate-nanohydroxyapatite hydrogel as a novel delivery system to prevent orthopedic implant-associated infections

Supplementary data to this article can be found online at: https://doi.org/10.1016/j.nano.2019.102145.An innovative delivery system based on bacteriophages-loaded alginate-nanohydroxyapatite hydrogel was developed as a multifunctional approach for local tissue regeneration and infection prevention and control. Bacteriophages were efficiently encapsulated, without jeopardizing phage viability and functionality, nor affecting hydrogel morphology and chemical composition. Bacteriophage delivery occurred by swelling-disintegration-degradation process of the alginate structure and was influenced by environmental pH. Good tissue response was observed following the implantation of bacteriophages-loaded hydrogels, sustaining their biosafety profile. Bacteriophages-loaded hydrogels did not affect osteoblastic cells' proliferation and morphology. A strong osteogenic and mineralization response was promoted through the implantation of hydrogels system with nanohydroxyapatite. Lastly, bacteriophages-loaded hydrogel showed excellent antimicrobial activity inhibiting the attachment and colonization of multidrug-resistant E. faecalis surrounding and within femoral tissues. This new local delivery approach could be a promising approach to prevent and control bacterial contamination during implantation and bone integration.Funding: This work was supported by FEDER – Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 – Operational Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, by Portuguese funds through FCT/MCTES in the framework of the project “institute for Research and Innovation in Health Sciences (POCI-01-0145-FEDER-007274), by Project Biotherapies (NORTE-01-0145-FEDER-000012) and by Joana Barrosʼ PhD grant (SFRH/BD/102148/2014). This work was also supported by Portuguese funds through FCT/MCTES (UID/QUI/50006/2019).info:eu-repo/semantics/publishedVersio

Proximal, local, and distal muscle morphology in women with patellofemoral pain

Objective: The objective of this study was to compare proximal, local, and distal muscle morphology in women with and without patellofemoral pain (PFP). Materials and Methods: Proximal, local, and distal muscle thicknesses (MTs) were obtained with B-mode sonography in healthy (control group [CG], n = 20) and PFP (PFP group, n = 20) women. In addition, muscle mass was measured by the sum of the synergistic MTs. Data were analyzed by independent t-test, Mann-Whitney U test, and effect size. Results: PFP women had smaller gluteus medius (P = .02, d = 0.7), vastus medialis (P < .01, d = 1.0), and flexor digitorum brevis (P < .01, d = 1.0) MT and greater gastrocnemius medialis (P = .04, d = 0.6) MT than CG. Quadriceps muscle mass (P = .01, d = 0.8) and foot muscle mass (P = .008, d = 0.9) were smaller, while plantar flexor muscle mass was greater in the PFP group than in CG (P = .01, d = 0.8). Conclusion: PFP women have proximal, local, and distal MT alterations in comparison with CG, which may explain possible changes in muscle strength and functionality

Remoção cirúrgica tardia de implante dentário deslocado para o interior do seio maxilar: relato de caso clínico / Delay surgical removal of dental implants displaced into the inside of the maxillary sinus: clinical case report

A instalação de implantes dentários na região posterior da maxila é um procedimento relativamente simples, porém, necessita de uma avaliação e planejamento adequado, pois a região apresenta peculiaridades específicas, como baixa quantidade e qualidade óssea, sendo possível a presença de intercorrências no local. A falha em se obter a estabilidade primária pode ocasionar o deslocamento do implante para o interior do seio maxilar, podendo resultar em patologias sinusais, sendo necessário a remoção cirúrgica do implante deslocado. O objetivo desse trabalho é relatar um caso de remoção cirúrgica de um implante dentário no interior do seio maxilar pela técnica de Caldwell Luc. Paciente do gênero feminino, 41 anos de idade, compareceu a clínica integrada do Centro Universitário Sul-Americano (UNIFASAM) para a remoção de um implante dentário no interior do seio maxilar direito com um ano após a instalação na região do dente 15. Na anamnese, verificou-se que na cirurgia de reabertura do implante, após três meses de sua instalação, foi observado que o implante não se apresentava osseintegrado, sendo acidentalmente, deslocado para o interior da cavidade antral, confirmado por meio de radiografia periapical da região. Foi solicitado uma Tomografia Computadorizada de Feixe Cônico (TCCF), no qual pode-se confirmar a presença do implante na parede inferior do seio maxilar, com espessamento da membrana sinusal. O plano de tratamento foi a abordagem cirúrgica por meio do acesso de Caldwell Luc sob anestesia local e, posterior, remoção do corpo estranho. O deslocamento do implante dentário para o interior do seio maxilar é um acidente incomum na prática clínica, sendo fundamental a individualização de cada caso, com a finalidade de promover o melhor plano de tratamento para o paciente a fim de evitar ou minimizar as intercorrências

Rural area of the Brazilian Pantanal wetlands associated with the occurrence of anti-Leishmania spp. antibodies in dogs

Neste trabalho foi realizada uma avaliação sobre a presença de anticorpos anti-Leishmania infantum chagasi em cães domésticos das áreas urbanas e rurais da região do Pantanal brasileiro usando técnicas sorológicas. Um total de 429 cães foram amostrados em três áreas do bioma do Pantanal, incluindo os municípios de Poconé, Santo Antônio de Leverger e Barão de Melgaço, em Mato Grosso, e o município de Corumbá, em Mato Grosso do Sul. A reação de imunofluorescência indireta (RIFI) foi utilizada para detectar anticorpos (ponto de corte de 40) de Leishmania infantum chagasi como antígeno. Devido à possibilidade de reação cruzada entre as espécies do gênero Leishmania, as amostras positivas na RIFI para L. infantum chagasi foram também avaliadas na RIFI utilizando L. amazonensis e L. braziliensis como antígenos. As amostras positivas na RIFI para L. infantum chagasi foram avaliadas utilizando o ensaio de imunoadsorção ligado à enzima (ELISA). Os resultados mostraram a presença de anticorpos contra L. infantum chagasi em 23 (5,36%; IC 95%: 3,50% -8,05%) cães e pelo menos um cão soro-reativo foi encontrado em todos os municípios avaliados neste estudo. Os títulos de anticorpos variaram de 40 a 5.120 e todas as amostras positivas na RIFI foram positivas no ELISA. Entre os 23 cães positivos, nove também reagiram para L. amazonensis e L. braziliensis. A ocorrência de anticorpos anti-L. infantum chagasi em cães foi maior nas áreas rurais (7,06%) do que nas áreas urbanas (2,50%) (P &lt; 0,05). Com base neste estudo, concluímos que cães de áreas rurais do Pantanal tiveram contato com espécies de Leishmania, o que é uma informação relevante, dada a sua importância para a saúde pública.An evaluation was made of the presence of anti-Leishmania infantum chagasi antibodies in domestic dogs from the urban and rural areas of Brazil’s Pantanal wetland region using serological techniques. A total of 429 dogs were sampled in three areas of the Pantanal biome, including the municipalities of Poconé, Santo Antônio de Leverger, and Barão de Melgaço, in the state of Mato Grosso, and in the municipality of Corumbá, in the state of Mato Grosso do Sul. The immunofluorescence assay (IFA) was used to detect antibodies (cut-off point 40) using Leishmania infantum chagasi antigen. Because of the possibility of cross-reactivity between species of the genus Leishmania, samples that were positive in the IFA against L. infantum chagasi were also tested by IFA in the same conditions, using L. amazonensis and L. braziliensis antigens. IFA-positive samples to L. infantum chagasi were also evaluated using Enzyme-Linked Immunosorbent Assay (ELISA). The results showed the presence of antibodies against L. infantum chagasi in 23 (5.36%; 95% CI: 3.50%-8.05%) dogs and at least one seroreactive dog was found in each of the municipalities evaluated in this study. Antibody titers ranged from 40 to 5,120, and all IFA positive samples were positive in the ELISA. Among the 23 positive dogs, nine were also were seroreactive for L. amazonensis and L. braziliensis antigens. The occurrence of anti- L. infantum chagasi antibodies in dogs was higher in rural areas (7.06%) than in urban areas (2.50%) (P &lt; 0.05). Based on this study, we concluded that dogs from rural areas of the Pantanal wetlands were in contact with Leishmania species, which is relevant information given their importance to public health