In-Vitro Assessment of the Acaricidal Properties of Artemisia annua and Zataria multiflora Essential Oils to Control Cattle Ticks

Background: The aim of this study was to investigate the ‘acaricidal effect' of Zataria multiflora and Ar­temisia annua essential oils on Rhipicephalus (Boophilus) annulatus.Methods: This study was carried out in 2009 in the Laboratory of Parasitology of the Faculty of Veteri­nary Medicine of Shahrekord University, west central Iran. Six dilutions (5, 10, 20, 40, 60 and 80 µL/cm3) of both essential oils were used against engorged female R. (Boophilus) annula­tus ticks using an in vitro immersion method. The mortality rates for each treatment were re­corded 6, 15 and 24 hours post inoculation (hpi). Mortality rate was analyzed using Repeated Meas­ures Analysis of Variance, and compari­son of means was carried out using General Linear Models Procedure.Results: The mortality rate caused by different dilutions of Z. multiflora essential oil ranged from 26.6% (using 10 µL/cm3) to 100% (using 40 µL/cm3) and for A. annua essential oil it was 33.2 to 100% (using 20 and 80 µL/cm3, respectively) by the end of the experiment (36 hpi). No mortality was recorded for the non-treated control group or for dilutions less than 5 and 10 µL/cm3 using Zataria and Artemisia essential oils, respectively. For Z. multiflora mortality peaked at 15 hpi for all concentrations other than 20 µL/cm3 and took 24 h to achieve its maximum effect while for A. an­nua the two highest concentrations needed 24 hpi to reach their full effect. In addition, essen­tial oils applied at more than 20 and 60 µL/cm3 caused 100% egg-laying failure in engorged fe­male ticks by Zataria and Artemisia, respectively while no failure was observed for the non-treated control group. The mortality rate in both botanical acaricides was dose-dependent.Conclusion: Both these medicinal plants have high potential acaricidal effects on the engorged stage of R. (Boophilus) annulatus in vitro

Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study

Objective. SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares.Methods. This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score ≥4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation.Results. A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors.Conclusion. Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention

Exercise echocardiography for the assessment of pulmonary hypertension in systemic sclerosis: a systematic review

BACKGROUND: Pulmonary arterial hypertension (PAH) complicates the course of systemic sclerosis (SSc) and is associated with poor prognosis. The elevation of systolic pulmonary arterial pressure (sPAP) during exercise in patients with SSc with normal resting haemodynamics may anticipate the development of PAH. Exercise echocardiography (ExEcho) has been proposed as a useful technique to identify exercise-induced increases in sPAP, but it is unclear how to clinically interpret these findings. In this systematic review, we summarize the available evidence on the role of exercise echocardiography to estimate exercise-induced elevations in pulmonary and left heart filling pressures in patients with systemic sclerosis. METHODS: We conducted a systematic review of the literature using MEDLINE, Cochrane Library and Web of Knowledge, using the vocabulary terms: ('systemic sclerosis' OR 'scleroderma') AND ('exercise echocardiography') AND ('pulmonary hypertension'). Studies including patients with SSc without a prior diagnosis of PAH, and subjected to exercise echocardiography were included. All searches were limited to English and were augmented by review of bibliographic references from the included studies. The quality of evidence was assessed by the Effective Public Health Practice Project system. RESULTS: We identified 15 studies enrolling 1242 patients, who were mostly middle-aged and female. Several exercise methods were used (cycloergometer, treadmill and Master's two step), with different protocols and positions (supine, semi-supine, upright); definition of a positive test also varied widely. Resting estimated sPAP levels varied from 18 to 35 mm Hg, all in the normal range. The weighted means for estimated sPAP were 22.2 ± 2.9 mmHg at rest and 43.0 ± 4.3 mmHg on exercise; more than half of the studies reported mean exercise sPAP ≥40 mmHg. The assessment of left ventricular diastolic function on peak exercise was reported in a minority of studies; however, when assessed, surrogate variables of left ventricular (LV) diastolic dysfunction were associated with higher sPAP on exercise. CONCLUSIONS: We found very high heterogeneity in the methods, the protocols and the estimated sPAP response to exercise. LV diastolic dysfunction was common and was associated with greater elevation of sPAP on exercise.info:eu-repo/semantics/publishedVersio

Um Caso Clínico de Diabetes - Discutido no "Workshop": Diabetes e Osteoporose

Introdução: A diabetes mellitus tipo 2 constitui actualmente um grave problema de saúde pública, pela sua elevada incidência e prevalência. A evolução do conhecimento científico conduziu à introdução recente de novos fármacos, assim como à revisão das recomendações internacionais para o tratamento da hiperglicémia e dos objectivos terapêuticos a atingir. No dia 13 de Dezembro de 2008, realizou-se no Palace Hotel do Buçaco um Workshop Multidisciplinar subordinado ao tema “Diabetes e Osteoporose”, dirigido a internos de Endocrinologia, Medicina Interna e Reumatologia. Foram discutidos de forma interactiva dois casos clínicos, um na área da Diabetologia e outro de Reumatologia. Apresentamos os pontos fundamentais da discussão do caso clínico de Diabetes. Caso Clínico: Doente do sexo feminino, 52 anos, obesa, observada em Consulta de Diabetes por apresentar A1c de 8%, apesar da dieta e da medicação (metformina).Apresentava uma tensão arterial (TA) de 150/95 mmHg, colesterol total (CL–T) 250 mg/dL, triglicerídeos (TG) 220 mg/dL, HDL 35 mg/dL e LDL 160 mg/dL. Questão: Quais as medidas terapêuticas a adoptar? Passados 6 meses, apresentava HbA1c 7,8%, CL-T 200 mg/dL,TG 190 mg/dL, HDL 40 mg/dL, LDL 130 mg/dL e microalbuminúria 30 mg/24h. Questão: Quais as modificações terapêuticas a instituir? Um ano depois, regressa à consulta, medicada com prednisolona por patologia reumatismal, com glicémias de 300 mg/dL em jejum e A1c 10,2%. Questão: Qual a estratégia terapêutica a adoptar? Dois anos mais tarde, a doente apresenta A1c 12%, CL-T 280 mg/dL, HDL 30 mg/dL, LDL 180 mg/dL e TG 200 mg/dL,TA 160/95 mmHg. Antecedentes de Acidente Vascular Cerebral, encontrando-se novamente medicada com antidiabéticos orais. Questão: Perante este quadro, o que prescrever? Conclusões: A diabetes mellitus implica uma abordagem multifactorial, dirigida à hiperglicemia e aos restantes factores de risco associados: dislipidemia, hipertensão arterial, hipercoagulabilidade, insulinorresistência e obesidade. De acordo com a Sociedade Europeia para o Estudo da Diabetes e com Sociedade Portuguesa de Diabetologia, o objectivo é alcançar uma A1c inferior a 6,5%, no sentido de prevenir e evitar a progressão das complicações. Os novos antidiabéticos orais conduziram a um aumento das opções terapêuticas disponíveis e implicaram uma revisão das recomendações internacionais.info:eu-repo/semantics/publishedVersio

In vitro direct rhizogenesis from Gerbera jamesonii Bolus leaf

The present report describes an original protocol for in vitro direct induction of roots from leaf explants of gerbera for the first time. Since gerbera has immense potential as a premium cut-flower, the major attempts were made on in vitro mass propagation chiefly through in vitro multiple shoot proliferation or callus regeneration. Nevertheless, rhizogenesis could be impending an unattempted method with its yet-to-be known advantages. In our study, the optimum conditions for direct root induction from leaf explants were assessed employing tissue culture technique. Leaves were inoculated to MS medium containing no or variable auxin sources and concentrations namely, 2,4-dichlorophenoxyacetic acid, indole-3-acetic acid (IAA), indole-3-butyric acid or α-naphthaleneacetic acid for root induction. It was evident that the maximum root induction (with a frequency of 92.6 %) occurred on MS media fortified with 1.5 mg l−1 IAA, wherein root induction was observed as early as 11 days of culture and an average of ~19 roots with ~13 mm length was obtained from 4 cm2 leaf segment after 45 days of culture. Stereo microscopic observation revealed the induction of roots and gradual developmental stages of rhizogenesis. The efficiency of direct root induction without any interim growth stages (such as, callus or shoots) in our study offers a reproducible system that could provide a model protocol for more comprehensive developmental studies on root growth

The Portuguese Society of Rheumatology position paper on the use of biosimilars

Biotechnological drugs have become a fundamental resource for the treatment of rheumatic patients. Patent expiry of some of these drugs created the opportunity for biopharmaceutical manufacturers to develop biosimilar drugs intended to be as efficacious as the originator product but with a lower cost to healthcare systems. Due to the complex manufacturing process and highly intricate structure of biologicals, a biosimilar can never be an exact copy of its reference product. Consequently, regulatory authorities issued strict preclinical and clinical guidelines to ensure safety and efficacy equivalence and, in September 2013, the biosimilar of infliximab was the first biosimilar monoclonal antibody to be authorized for use in the European Union. The current document is a position statement of the "Sociedade Portuguesa de Reumatologia" (Portuguese Society of Rheumatology) on the use of biosimilar drugs in rheumatic diseases. Two systematic literature reviews were performed, one concerning clinical trials and the other one concerning international position papers on biosimilars. The results were presented and discussed in a national meeting and a final position document was discussed, written and approved by Portuguese rheumatologists. Briefly, this position statement is contrary to automatic substitution of the originator by the biosimilar, defends either a different INN or the prescription by brand name, supports that switching between biosimilars and the originator molecule should be done after at least 6 months of treatment and based on the attending physician decision and after adequate patient information, recommends the registration of all biosimilar treated patients in Reuma.pt for efficacy, safety and immunogenicity surveillance, following the strategy already ongoing for originators, and opposes to extrapolation of indications approved to the originator to completely different diseases and/or age groups without adequate pre-clinical, safety or efficacy data.info:eu-repo/semantics/publishedVersio