Antibiotic consumption in Portugal: 2010 and 2011

The use of antibiotics has contributed to a marked decrease in morbidity caused by communicable and infec- tious diseases over the past few years. The aim of our study is to evaluate the use of antibiotics in clinic in 2010 and 2011, considering two different methodologies: the defined daily dose per 1000 inhabitants per day (DHD) and the number of packages per 1000 inhabitants per day (PHD)

Consensus must be found on intravenous fluid therapy management in trauma patients

Introduction: Trauma is an important cause of death among young people and 30-40% of this mortality rate is due to hypovolemic shock, intensified by trauma's lethal triad: Hypothermia, Acidosis, and Coagulopathy. Nurses are responsible for managing fluid therapy administration in trauma victims. The purpose of this study is to analyse the reasons why intravenous fluid therapy is recommended for trauma patients' hemodynamic stabilization. Methods: This narrative literature review included published and unpublished studies in English, Spanish or Portuguese between 1994 and January 2019. The search results were analyzed by two independent reviewers. Inclusion criteria encompasses quantitative studies involving trauma victims aged over 18 who underwent fluid therapy in a prehospital assessment context. Results&Discussion: 11 quantitative studies were included. 9 involved the use of fluid therapy for hypotension treatment and 2 of the studies analyzed involved the use of warmed fluid therapy for hypothermia treatment. The analysis performed reveals that the administration of aggressive fluid therapy seems to be responsible for the worsening of the lethal triad. In the presence of traumatic brain injury, permissive hypotension is not allowed due to the negative impact on cerebral perfusion pressure. Used as warming measure, warmed fluid therapy does not seem to have a significant impact on body temperature. Conclusions: There is no consensus regarding the administration of fluid therapy to trauma patients. This conclusion clearly supports the need to develop more randomized controlled trials in order to understand the effectiveness of such measure when it comes to control hypovolemia and hypothermia.info:eu-repo/semantics/publishedVersio

Development of TNBS-induced colitis: animal model to test new pharmacological approaches

IBD is a gastro-intestinal disorder marked with chronic inflammation of intestinal epithelium, dam- aging mucosal tissue and manifests into several intestinal and extra-intestinal symptoms. Currently used medical therapy is able to induce and maintain the patient in remission, however no modifies or reverses the underlying pathogenic mechanism. The research of other medical approaches is crucial to the treatment of IBD and, for this, it ́s important to use animal models to mimic the characteristics of disease in real life. The aim of the study is to develop an animal model of TNBS-induced colitis to test new pharmacological approaches. TNBS was instilled intracolonic single dose as described by Morris et al. It was administered 2,5% TNBS in 50% ethanol through a catheter carefully inserted into the colon. Mice were kept in a Tredelenburg position to avoid reflux. On day 4 and 7, the animals were sacrificed by cervical dislocation. The induction was confirmed based on clinical symptoms/signs, ALP determination and histopathological analysis. At day 4, TNBS group presented a decreased body weight and an alteration of intestinal motility characterized by diarrhea, severe edema of the anus and moderate morbidity, while in the two control groups weren’t identified any alteration on the clinical symptoms/signs with an increase of the body weight. TNBS group presented the highest concentrations of ALP comparing with control groups. The histopathology analysis revealed severe necrosis of the mucosa with widespread necrosis of the intestinal glands. Severe hemorrhagic and purulent exsudates were observed in the submucosa, muscular and serosa. TNBS group presented clinical symptoms/ signs and histopathological features compatible with a correct induction of UC. The peak of manifestations became maximal at day 4 after induction. This study allows concluding that it’s possible to develop a TNBS- induced colitis 4 days after instillation. DII é um distúrbio gastro-intestinal caracterizado por inflamação crónica do epitélio intestinal com dano associado da mucosa, manifestando-se a partir de sintomas intestinais e extra-intestinais. A terapia médica utilizada é capaz de induzir e manter o doente em remissão, mas não modifica ou inverte o mecanismo patogénico subjacente. A procura de outras abordagens terapêuticas é crucial para o tratamento de DII e, para tal, é importante o uso de modelos animais para mimetizar as características da doença. O objetivo do estudo é desenvolver um modelo animal de colite induzida por TNBS de modo a testar novas abordagens farmacológicas. O TNBS foi instilado por via intracolónica em dose única como descrito por Morris et al. Foi administrado 2,5% de TNBS em 50% de etanol através de um cateter inserido no cólon. Os animais foram mantidos em posição Tredelenburg para evitar o refluxo. Nos dias 4 e 7, os animais foram sacrificados por deslocamento cervical. A indução de colite foi caracterizada com base nos sintomas/sinais clínicos, determinação de ALP e análise histopatológica. No dia 4, o grupo TNBS apresentou uma diminuição do peso corporal e uma alteração da motilidade intestinal caracterizada por diarreia, edema severo do ânus e morbilidade moderada, enquanto nos dois grupos controlo não foram identificados quaisquer alterações nos sintomas/ sinais clínicos com um aumento do peso corporal. O grupo TNBS apresentou as maiores concentrações de ALP, comparando com os grupos controlo. A análise histopatológica demonstrou necrose grave da mucosa com necrose generalizada das glândulas intestinais. Foi observado exsudato hemorrágico e purulento ao nível da submucosa, muscular e serosa. O grupo TNBS apresentou sintomas / sinais clínicos e características histopatológicas compatíveis com uma correta indução de colite. O pico das manifestações tornou-se máximo ao 4º dia após a indução. Este estudo permite concluir que é possível desenvolver colite induzida por TNBS 4 dias após a instilação.

Monitoring Antibiotic Comsumption in the Surgery and Orthopaedics

A monitorização do consumo de antimicrobianos é um instrumento de interesse indiscutível e tem merecido uma atenção particular nos últimos anos, devido às crescentes preocupações com a emergência de estirpes microbianas multi-resistentes. Os objectivos do presente estudo consistiram, por um lado, na monitorização do consumo e na avaliação do impacto económico da prescrição hospitalar de antimicrobianos, em serviços de cirurgia e ortopedia. Por outro lado, pretendeu-se estudar e a relação indicação-prescrição terapêutica e profilática. Tendo presentes estes objectivos realizou-se um estudo-piloto longitudinal, com recolha de dados durante o mês de Maio de 2004, em seis Hospitais SA, incidindo numa amostra total de 1.122 doentes internados. Verificámos uma taxa de incidência de prescrição de 76,9%, com dispensa de 1.154 antimicrobianos, dos quais 71,2% se destinaram, em média, à profilaxia da infecção pós-cirúrgica, atestando a adesão geral à prática da profilaxia da infecção no local cirúrgico. O custo médio da antibioterapia foi mais elevado nos casos de “suspeita de infecção” (€9,09) ou “infecção declarada” (€8,74) e mais baixo quando utilizados para “profilaxia” (€5,67), facto relacionado com a menor duração média dos episódios de profilaxia. Os regimes de profilaxia utilizados apresentaram variações consideráveis entre os diferentes hospitais no que respeita ao tipo de antibiótico utilizado e uma duração média de 2,61 dias, com cerca de metade dos episódios de profilaxia prolongando-se por mais de 24 horas, sugerindo uma implementação insuficiente das actuais recomendações quanto ao tipo de fármaco a utilizar para esta prática, o que aponta para o necessidade duma avaliação da existência nas unidades hospitalares, de recomendações claras para a profilaxia da infecção do local cirúrgico, bem como da adesão dos clínicos a estas

Bioactivity studies and chemical profile of the antidiabetic plant Genista tenera

Aim of the study: Genista tenera is a plant endemic to the island of Madeira and is used in folk medicine to control diabetes. In the present work we evaluate the antihyperglycaemic activity of its n-butanol extract and determine its chromatographic profile. In addition, this extract, the ethyl acetate and diethyl ether plant extracts were studied in order to assess the plant antioxidant and acetylcholinesterase inhibitory activities, as well as its cyto- and genotoxicities. Materials and methods: HPLC-DAD-ESI-MS was used to analyze the flavonoid profile of the n-butanol extract. The antihyperglycaemic activity of this extract was performed over streptozotocin induced diabetic Wistar rats (200mg/kg, bw/day), for 15 days. Antioxidant activity (DPPH assay) and acetylcholinesterase inhibitory effect (Ellman method) were also performed. Acute cytotoxicity and genotoxicity were assessed by proliferative index quantification and the short-term chromosomal aberration technique, after exposure of lymphocytes to the extracts. Results and conclusions: The n-butanol extract, where 21 monoglycosyl and 12 diglycosyl flavonoids were detected, significantly lowered blood glucose levels, bringing them to normal values after 15 days of treatment. The best radical scavenging activity was observed for the ethyl acetate extract (48.7% at 139.1μg/mL), which was also the most effective one at the minimal concentration tested. The highest acetylcholinesterase inhibitory activity (77.0% at 70. 0μg/mL) was also obtained with the ethyl acetate extract. In vitro toxicity studies showed no evidence for acute cytotoxicity or genotoxicity. This is the first report on antidiabetic activity of genus Genista.MCES, FCT, British Council; BBSRC and Merck, Sharp & Dohm

Effects of some natural 5-hydroxy-isoflavones on cultured human endothelial cells in presence and absence of hydrogen peroxide

Due to their biological activity, it has been suggested that consumption of isoflavone-rich diets may prevent prostate and breast cancers, osteoporosis and cardiovascular diseases. Preventive effects of isoflavones on cancer and cardiovascular diseases have been associated with their oestrogenic and antioxidant properties. However, concerns still exist about the potential dangers of consuming high levels of these compounds, since it is known that some of them have cytostatic or cytotoxic properties, depending on the concentration. To evaluate the potential cytotoxic risk and antioxidant benefit of natural 5-hydroxy-isoflavones (5-OH-isoflavones) for human vascular endothelium, the effect of some natural 5-OH-isoflavones was evaluated on cultured human endothelial cells, in the presence and absence of H2O2 (3 mM for 4 h). None of the isoflavones tested were able to prevent oxidative damage to endothelial cells at maximal extracellular concentrations of 1 mm. The low antioxidant capacity of these compounds was also shown by the DPPH (1,1-diphenyl-2-picrylhydrazyl radical) method. On the other hand, genistein and biochanin A, having a free 7-OH group, were toxic to the human endothelial cells in a dose-dependent manner, at concentrations = 300 mu m and = 100 mu m, respectively. These results indicate that the non-specific cytotoxic effect of 5-OH-isoflavones is associated with the free 7-OH group. In conclusion, we were not able to show that 5-OH-isoflavones are beneficial to human endothelial cells when the cells were exposed to oxidative stress caused by 3 mm of H2O2, but it can be concluded that consumption of 5-OH-isoflavones is of no direct cytotoxic risk to the human vascular endothelium since toxic concentrations are believed to be unreachable in-vivo