COMPLICAÇÕES CARDIOVASCULARES DA DOENÇA DE KAWASAKI: REVISÃO INTEGRATIVA

Kawasaki Disease corresponds to a primary vasculitis that mainly affects preschool children, with a slight predominance of males and Asian ethnicity. It is the main vasculitis in developed countries and the 2nd in underdeveloped countries. The diagnosis is essentially clinical, characterized by the presence of fever lasting 5 days or more, associated with conjunctivitis, cervical lymphadenopathy, mucositis, changes in the extremities and rash. Treatment is essentially carried out with immunoglobulin and AAS. Diagnosis and treatment must be carried out effectively and in an ideal time in order to reduce the chance of progression to the main complication of the pathology: coronary artery aneurysm.A Doença de Kawasaki corresponde a uma vasculite primária que afeta, principalmente, crianças em idade pré-escolar, com leve predominância do sexo masculino e etnia asiática. É a principal vasculite em países desenvolvidos e a 2ª em países subdesenvolvidos. O diagnóstico é essencialmente clínico, caracterizado pela presença de febre com duração igual ou superior a 5 dias, associada a conjuntivite, linfadenopatia cervical, mucosite, alterações em extremidades e exantema. O tratamento é realizado essencialmente com imunoglobulina e AAS. O diagnóstico e o tratamento devem ser realizados de forma eficaz e em tempo ideal com o intuito de diminui a chance de evolução para principal complicação da patologia: aneurisma de artéria coronariana

Dexmedetomidina versus outros sedativos na prevenção de Delirium nos adultos em ventilação mecânica

Delirium é uma síndrome neurocognitiva aguda relativamente comum e grave que se caracteriza por desatenção, consciência alterada, disfunção cognitiva e curso flutuante, e pode levar à mortalidade, declínio funcional, institucionalização e demência, com maior incidência nos pacientes mais velhos. Pacientes hospitalizados na Unidade de Terapia Intensiva (UTI) e em uso de ventilação mecânica (VM), quando sedados em excesso, possuem maior duração de permanência na UTI, aumento da duração da VM, maior incidência de delirium e mortalidade. Estudos apontam que a dexmedetomidina reduz a incidência de delirium em pacientes adultos hospitalizados na UTI e em uso de ventilação mecânica quando comparada com outros sedativos. Desse modo, o objetivo do estudo é comparar a dexmedetomidina e outros sedativos na prevenção de delirium nos adultos em ventilação mecânica. Trata-se de uma revisão bibliográfica integrativa, do tipo quantitativa, que utilizou as plataformas do PubMed, SciELO e Cochrane Library como bases de dados para seleção dos artigos, todos na língua inglesa. Foram utilizadas literaturas publicadas com recorte temporal de 2017 a 2022. De acordo com as literaturas analisadas, conclui-se que, quando comparado com outros sedativos gabaminérgicos, como os benzodiazepínicos e o propofol, a dexmedetomidina diminui significativamente a incidência de delirium nos pacientes adultos em ventilação mecânica na UTI, com melhora da capacidade de despertar do paciente, preservação do desempenho cognitivo e redução do risco de depressão respiratória. Desse modo, pesquisas futuras sobre as propriedades farmacológicas da dexmedetomidina podem ajudar a determinar se esta droga possui propriedades neuroprotetoras intrínsecas, sendo assim, tal descoberta facilitaria o desenvolvimento de análogos com menos efeitos colaterais cardiorrespiratórios, tendo em vista seu efeito hemodinâmico, com bradicardia e possível hipotensão associadas

Análise da pevalência da osteoporose e dos principais fatores associados á perda óssea em portadores de cirrose

Cirrhotic patients are often compromised by nutritional deficiencies and loss of bone density through mechanisms as low ingestion of nutrients and lack of physical activity. The aim of this study was evaluate the prevalence of bone alterations and investigate if nutritional and hepatic tests would be related to the bone loss (osteoporosis or osteopenia) in cirrhotic outpatients from the Botucatu medical school (FMB-UNESP). Nutritional, hepatic and bone assessments were performed through anthropometric measurement, handgrip strength, dualenergy X-Ray absorptiometry (DXA) exam and laboratory tests. The study sample was composed by 129 subjects (77 men and 52 women), who were divided according to the Child-Pugh classification as follows: Child-Pugh A (69%), Child- Pugh B (24.8%) and Child-Pugh C (6.2%). The mean of the Model for End-Stage Liver Disease (MELD) score was 10.6 ± 3.99. The rates of osteoporosis and osteopenia were 31.01% and 32.56%, respectively. The results were assessed by backward linear regression model, showing that low handgrip strength, high parathyroid hormone (PTH) and low body mass index (BMI) were predictors of low t-score values in the lumbar spine. Additionally, only age was a predictor of low t-score values in the femoral neck. The model did not select the liver disease severity as a significant predictor of bone disease. As the liver cirrhosis is more aggressive in the lumbar spine, we suggest that handgrip strength, BMI and PTH should be tested in all cirrhotic patients to select the ones with higher risk of bone disease, in order to perform specific bone exams more often when these tests are altered, even in compensated cirrhosisPacientes com cirrose hepática são comumente acometidos por deficiências nutricionais e perda de massa óssea, por mecanismos como baixa ingestão de nutrientes e falta de atividade física. O objetivo deste estudo foi aferir a prevalência de doença óssea na cirrose e avaliar se alterações nutricionais e hepáticas estariam correlacionadas à perda de massa óssea (osteopenia ou osteoporose) em pacientes ambulatoriais atendidos na Faculdade de Medicina de Botucatu (FMB) - UNESP. Avaliações nutricionais e da massa óssea foram feitas por meio de antropometria, medidas de força muscular (pelo handgrip), absorciometria de raios X de dupla energia (dual-energy X-ray absorptiometry - DXA) e exames bioquímicos. A amostra foi de 129 indivíduos (77 homens e 52 mulheres), classificados em Child A (69%), Child B (24,8%) e Child C (6,2%). A média do escore Model for End-Stage Liver Disease (MELD) foi de 10,60 ± 3,99. A prevalência de osteoporose foi de 31,01% e a de osteopenia foi de 32,56%. Os resultados foram avaliados pelo modelo de regressão linear de Backward, mostrando que baixos valores de força muscular pelo handgrip, níveis elevados de paratormônio (PTH) e baixo índice de massa corporal (IMC) foram preditores de baixo t-escore da coluna, enquanto a idade e o IMC foram fatores preditores de baixo t-escore de quadril. A gravidade da doença hepática não influenciou a presença da doença óssea. Como a cirrose acomete mais os ossos da coluna, sugerimos que exames de PTH, handgrip e o IMC sejam utilizados rotineiramente na avaliação de portadores de cirrose, e se esses exames estiverem alterados a densidade óssea seja medida com mais frequência, mesmo na cirrose compensad

Hancornia speciosa extract presents antimicrobial action against Pseudomonas aeruginosa and Staphylococcus aureus Extract shows antimicrobial activity / O extracto de Hancornia speciosa apresenta acção antimicrobiana contra Pseudomonas aeruginosa e Staphylococcus aureus O extracto mostra actividade antimicrobiana

Aims: To evaluate the preliminary phytochemical profile of the leaf and fruit ethanolic extracts of Hancornia speciosa Gomes, as well as its antimicrobial and anti-biofilm activities.Methods and Results:  Samples of the leaves and fruits of H. speciosa Gomes, collected in the city of Estância, Sergipe state, Brazil, were used to obtain the extract. Each material was macerated in 96% alcohol and submitted to the ultrasonic bath. The extracts showed effectiveness against gram positive and Gram-negative planktonic bacteria, where the leaves presented better results, with a minimum inhibitory concentration (MIC) of 0.625 mg.ml-1 against hospital Staphylococcus aureus, and 1.25 mg.ml-1 against the standard strain of this species. Regarding the percentage of inhibition of biofilms, leaf extract remained more efficient, although the effects were quite varied, strongly dependent on the individual features of each lineage. Conclusions:  The provided data demonstrate that crude extracts were able to inhibit some multi-resistant microorganisms.Significance and Impact of Study: This study evaluated another potential pharmacological property of the extract of Hancornia speciosa Gomes, in a context of dissemination bacterial multiresistance, which demands the discovery of new alternative methods for the treatment of infections

Handgrip strength as a predictor of bone mineral density in cirrhotic outpatients

Osteoporosis is well recognized as a cirrhosis complication; however, most studies assessing this condition included only patients on liver transplantation lists with an elevated rate of bone diseases. While general population studies show that handgrip strength is clearly associated with bone mineral density, until now this tool has not been applied to cirrhotic patients in relation to their bone condition. This study aimed to evaluate whether handgrip strength, bone and liver tests may be useful as predictors of bone disease in cirrhotic outpatients. 129 subjects were included (77 men and 52 women). Dual energy X-ray absorptiometry was applied to evaluate lumbar-spine and femoral-neck T scores. Osteoporosis/osteopenia rates were 26.3%/35.6% in the lumbar spine and 6.9%/41.8% in the femoral neck, respectively. Model selections were based on backward procedures to find the best predictors of low T scores. For lumbar spine, only low handgrip strength and high parathyroid hormone levels were clearly related to low T scores. For femoral neck, only age was associated with low T scores. Handgrip strength may serve as an effective predictor of low lumbar spine T score among cirrhotic outpatients. As cirrhosis affects the lumbar spine more than the femoral neck, these results suggest that handgrip strength should be tested in all cirrhotic patients as a first indicator of bone health. This article is protected by copyright. All rights reserved

Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial

Branched-chain amino acids increase the brain perfusion of patients with hepatic encephalopathy (HE), but the amino acid and the mechanisms involved are still unknown. This study compared brain perfusion and clinical improvement during leucine or isoleucine supplementation. After randomization, 27 subjects with cirrhosis and HE received leucine or isoleucine supplements for one year. Brain single Photon Emission Computed Tomography (SPECT) and dynamic brain scintigraphy (DBS) were performed pretreatment and at 1, 8 and 12 months of supplementation. Brain perfusion was increased only in the isoleucine group at 8 months of treatment by both SPECT and DBS (p < 0.001 and p = 0.05, respectively) and by SPECT at the 12th month (p < 0.05). This was associated with hepatic encephalopathy improvement at 8 and 12 months (p = 0.008 and 0.004, respectively), which was not observed in the leucine group (p = 0.313 and 0.055, respectively). Isoleucine supplementation achieved a better impact on brain perfusion restoration in HE. Keywords: Hepatic encephalopathy, Liver cirrhosis, Branched-chain amino acids, Cerebral blood flo

Antibiotic-Induced Pathobiont Dissemination Accelerates Mortality in Severe Experimental Pancreatitis

Although antibiotic-induced dysbiosis has been demonstrated to exacerbate intestinal inflammation, it has been suggested that antibiotic prophylaxis may be beneficial in certain clinical conditions such as acute pancreatitis (AP). However, whether broad-spectrum antibiotics, such as meropenem, influence the dissemination of multidrug-resistant (MDR) bacteria during severe AP has not been addressed. In the currently study, a mouse model of obstructive severe AP was employed to investigate the effects of pretreatment with meropenem on bacteria spreading and disease outcome. As expected, animals subjected to biliopancreatic duct obstruction developed severe AP. Surprisingly, pretreatment with meropenem accelerated the mortality of AP mice (survival median of 2 days) when compared to saline-pretreated AP mice (survival median of 7 days). Early mortality was associated with the translocation of MDR strains, mainly Enterococcus gallinarum into the blood stream. Induction of AP in mice with guts that were enriched with E. gallinarum recapitulated the increased mortality rate observed in the meropenem-pretreated AP mice. Furthermore, naïve mice challenged with a mouse or a clinical strain of E. gallinarum succumbed to infection through a mechanism involving toll-like receptor-2. These results confirm that broad-spectrum antibiotics may lead to indirect detrimental effects during inflammatory disease and reveal an intestinal pathobiont that is associated with the meropenem pretreatment during obstructive AP in mice

Serum soluble mediator profiles and networks during acute infection with distinct DENV serotypes

Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPq. Funding was also obtained from Fundacao de Amparo a Pesquisa do Estado do Amazonas (FAPEAM/PPP-CNPq, EDITAL N. 016/2014), Ministerio da Saude do Brasil (Chamada Publica no 01/2012, Convenio # 776823/2012) and INCT para Febres Hemorragicas Virais (INCT-FHV - 573739/2008-0).Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilU.S. Food and Drug Administration. Center for Biologics Evaluation and Research. Office of Blood Research and Review. Silver Spring, MD, United States.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilUniversidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Microbiologia. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil / Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Vírus Respiratórios e Sarampo. Rio de Janeiro, RJ, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Instituto de Pesquisa Clínica Carlos Borborema. Manaus, AM, Brazil / Universidade Federal do Amazonas. Escola de Enfermagem de Manaus. Manaus, AM, BrazilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Instituto de Pesquisa Clínica Carlos Borborema. Manaus, AM, Brazil / Universidade Federal do Amazonas. Escola de Enfermagem de Manaus. Manaus, AM, BrazilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Instituto de Pesquisa Clínica Carlos Borborema. Manaus, AM, BrazilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Instituto de Pesquisa Clínica Carlos Borborema. Manaus, AM, BrazilUniversidade Federal do Amazonas. Escola de Enfermagem de Manaus. Manaus, AM, BrazilFundação de Medicina Tropical Dr. Heitor Vieira Dourado. Instituto de Pesquisa Clínica Carlos Borborema. Manaus, AM, Brazil / Universidade Federal do Amazonas. Escola de Enfermagem de Manaus. Manaus, AM, Brazil / Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas. Diretoria de Ensino e Pesquisa. Manaus, AM, BrazilUniversidade Federal de Uberlândia. Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia. Laboratório de Bioinformática e Análises Moleculares. Patos de Minas, MG, BrazilUniversidade Federal de Uberlândia. Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia. Laboratório de Bioinformática e Análises Moleculares. Patos de Minas, MG, BrazilMinistério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, BrazilMinistério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.A panoramic analysis of chemokines, pro-inflammatory/regulatory cytokines, and growth factors was performed in serum samples from patients with acute DENV infection (n=317) by a high-throughput microbeads array. Most soluble mediators analyzed were increased in DENV patients regardless of the DENV serotype. The substantial increase (>= 10-fold) of CXCL10, IL-6, and IFN-gamma, and decreased levels of PDGF (= 3-9-fold) were selectively observed in DENV2 as compared to DENV1 and DENV4. Heatmap and biomarker signatures further illustrated the massive release of soluble mediators observed in DENV patients, confirming the marked increase of several soluble mediators in DENV2. Integrative correlation matrices and networks showed that DENV infection exhibited higher connectivity among soluble mediators. Of note, DENV2 displayed a more complex network, with higher connectivity involving a higher number of soluble mediators. The timeline kinetics (Day 0-1, D2, D3, D4-6) analysis additionally demonstrated differences among DENV serotypes. While DENV1 triggers a progressive increase of soluble mediators towards D3 and with a decline at D4-6, DENV2 and DENV4 develop with a progressive increase towards D4-6 with an early plateau observed in DENV4. Overall, our results provided a comprehensive overview of the immune response elicited by DENV infection, revealing that infection with distinct DENV serotypes causes distinct profiles, rhythms, and dynamic network connectivity of soluble mediators. Altogether, these findings may provide novel insights to understand the pathogenesis of acute infection with distinct DENV serotypes