América Latina ao extremo: relato a partir da cidade do México

O conflito sensibiliza o cenário internacional, fazendo com que os atores tomem medidas para se proteger perante situações perigosas para o interesse nacional. A América Latina, em especial o Brasil e o México, vem falhado, no entanto, de proteger o seu maior tesouro: sua população. Em um mundo de incertezas, duas coisas são factuais: a balança de poder é fluída, e as marcas do passado histórico, social e econômico dos Estados brasileiro e mexicano, somado a uma má gestão do poder público se mostram, até hoje, ineficientes para sanar as necessidades de sua própria população.El conflicto sensibiliza la escena internacional, haciendo que los actores tomen medidas para protegerse en situaciones que son peligrosas para el interés nacional. Sin embargo, América Latina, especialmente Brasil y México, no ha logrado proteger su mayor tesoro: su población. En un mundo de incertidumbres, dos cosas son objetivas: el equilibrio de poder es fluido, y las marcas del pasado histórico, social y económico de los Estados brasileño y mexicano, además de la mala gestión del poder público, siguen siendo ineficientes al atender las necesidades de su propia población.The conflict sensitizes the international scenario, causing the actors to take measures to protect themselves in situations that are dangerous to the national interest. Latin America, especially Brazil and Mexico, has failed, however, to protect its greatest treasure: its own population. In a world of uncertainties, two things are factual: the balance of power is fluid, and the marks of the historical, social and economic past of the Brazilian and Mexican states, in addition to the poor management of public power, are still inefficient to address the needs of its own population.La scène internationale est sensibilisée contre le virus, en faisant que les acteurs se protègent face à des situations dangereuses par rapport l’intérêt nationale. L’Amérique Latine, notamment le Brésil et le Mexique, n’a pas réussi à préserver son trésor le plus précieux : sa population. Dans un monde d’incertitudes, deux choses sont cependant factuelles : la fluidité de la balance du pouvoir et l’héritage socio-économique des États brésilien et mexicain, ajoutées à une mauvaise gestion de la part du pouvoir publique, se révèlent insuffisants par rapport les besoins de la population en temps de crise pandémique

ChAracterization of ItaliaN severe uncontrolled Asthmatic patieNts Key features when receiving Benralizumab in a real-life setting: the observational rEtrospective ANANKE study

Background: Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in patients with severe eosinophilic asthma (SEA). We conducted a real-world study examining the baseline characteristics of a large SEA population treated with benralizumab in clinical practice and assessed therapy effectiveness. Methods: ANANKE is an Italian multi-center, retrospective cohort study including consecutive SEA patients who had started benralizumab therapy ≥ 3 months before enrolment (between December 2019 and July 2020), in a real-world setting. Data collection covered (1) key patient features at baseline, including blood eosinophil count (BEC), number and severity of exacerbations and oral corticosteroid (OCS) use; (2) clinical outcomes during benralizumab therapy. We also conducted two post-hoc analyses in patients grouped by body mass index and allergic status. Analyses were descriptive only. Results: Of 218 patients with SEA enrolled in 21 Centers, 205 were evaluable (mean age, 55.8 ± 13.3 years, 61.5% females). At treatment start, the median BEC was 580 cells/mm3 (interquartile range [IQR]: 400-850); all patients were on high-dose inhaled controller therapy and 25.9% were on chronic OCS (median dose: 10 mg/die prednisone-equivalent [IQR: 5-25]); 92.9% experienced ≥ 1 exacerbation within the past 12 months (annualized exacerbation rate [AER] 4.03) and 40.3% reported ≥ 1 severe exacerbation (AER 1.10). During treatment (median duration: 9.8 months [IQR 6.1-13.9]; ≥ 12 months for 34.2% of patients), complete eosinophil depletion was observed; exacerbation-free patients increased to 81% and only 24.3% reported ≥ 1 severe event. AER decreased markedly to 0.27 for exacerbations of any severity (- 93.3%) and to 0.06 for severe exacerbations (- 94.5%). OCS therapy was interrupted in 43.2% of cases and the dose reduced by 56% (median: 4.4 mg/die prednisone-equivalent [IQR: 0.0-10.0]). Lung function and asthma control also improved. The effectiveness of benralizumab was independent of allergic status and body mass index. Conclusions: We described the set of characteristics of a large cohort of patients with uncontrolled SEA receiving benralizumab in clinical practice, with a dramatic reduction in exacerbations and significant sparing of OCS. These findings support benralizumab as a key phenotype-specific therapeutic strategy that could help physicians in decision-making when prescribing biologics in patients with SEA. Trial registration ClinicalTrials.gov Identifier: NCT04272463

Benralizumab in Patients With Severe Eosinophilic Asthma With and Without Chronic Rhinosinusitis With Nasal Polyps: An ANANKE Study post-hoc Analysis

Background: Severe eosinophilic asthma (SEA) in the presence of chronic rhinosinusitis with nasal polyps (CRSwNP) indicates the presence of a more extensive eosinophilic inflammation. Post-hoc analyses from a pivotal clinical trial have demonstrated the enhanced efficacy of benralizumab on asthma outcomes in patients with CRSwNP as a comorbidity. Methods: This is a post-hoc analysis from the Italian multi-center observational retrospective ANANKE study. Patients were divided into two groups based on self-reported CRSwNP. Baseline clinical and laboratory features in the 12 months prior to benralizumab prescription were collected. Data of change over time of blood eosinophils, annualized exacerbations rates (AER), asthma control, lung function, oral corticosteroids (OCS) use, and benralizumab discontinuation were collected during the observation period. Results: At baseline, the 110 patients with CRSwNP were less frequently female (50.9% vs 74.2%) and obese (9.1% vs. 22.6%) with higher eosinophils (605 vs. 500 cells/mm3) and OCS use when compared to patients without CRSwNP. Similar reductions of AER were seen (-95.8% vs. -91.5% for any exacerbation and -99.1% vs. -92.2% for severe exacerbations in patients with and without CRSwNP, respectively). During benralizumab treatment, comorbid SEA+CRSwNP was associated with a lower risk of any exacerbation (p = 0.0017) and severe exacerbations (p = 0.025). After a mean ± SD exposure of 10.3 ± 5.0 months, half of the SEA+CRSwNP patients eliminated OCS use. No discontinuation for safety reasons was recorded. Conclusions: This study helped to confirm the baseline clinical features that distinguish patients with and without CRSwNP being prescribed benralizumab. Numerically enhanced OCS reduction and lower exacerbation risk were observed in patients with SEA and comorbid CRSwNP treated with benralizumab

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Flora da Bahia: Amaranthaceae - Amaranthoideae e Gomphrenoideae

This account of the Amaranthaceae: Amaranthoideae and Gomphrenoideae is a further contribution to the ongoing Flora of Bahia project. A total of 16 genera and 67 species are recognized for the state of Bahia, Brazil. The genera represented with number of species are: Achyranthes (1 sp.), Alternanthera (13 spp.), Amaranthus (3 spp.), Blutaparon (2 spp.), Celosia (3 spp.), Chamissoa (2 spp.), Cyathula (2 spp.), Froelichia (2 spp.), Gomphrena (23 spp.), Hebanthe (1 sp.), Herbstia (1 sp.), Iresine (1 sp.), Lecosia (1 sp.), Pfaffia (9 spp.), Quaternella (1 sp.) e Xerosiphon (2 spp.). Keys for genera and species are provided, together with descriptions, ilustrations and general notes on the species.É apresentado o levantamento florístico de Amaranthaceae: Amaranthoideae e Gomphrenoideae da Bahia, Brasil, como contribui à flora do Estado. Foram reconhecidos 16 gêneros e 67 espécies: Achyranthes (1 sp.), Alternanthera (13 spp.), Amaranthus (3 spp.), Blutaparon (2 spp.), Celosia (3 spp.), Chamissoa (2 spp.), Cyathula (2 spp.), Froelichia (2 spp.), Gomphrena (23 spp.), Hebanthe (1 sp.), Herbstia (1 sp.), Iresine (1 sp.), Lecosia (1 sp.), Pfaffia (9 spp.), Quaternella (1 sp.) e Xerosiphon (2 spp.). São apresentadas chaves de identificação para os gêneros e espécies, além de descrições, ilustrações e comentários gerais das espécies

Um estudo sobre a lembrança de marcas patrocinadoras das Copas do Mundo do Brasil de 2014 e da Rússia de 2018

Objetivo do estudo: Analisar o nível de lembrança (recall) dos respondentes das marcas patrocinadoras oficiais e das não oficiais durante a realização das copas do mundo de 2014 e 2018. Metodologia: Pesquisa exploratória, realizada de forma quantitativa, não probabilística, com respostas colhidas por conveniência através de instrumento de coleta de dados por formulário eletrônico e físico, com e sem apoio de entrevistadores. Este trabalho baseia-se em um modelo de pesquisa desenvolvido por Meng-Lewis, Y. (2014), para avaliação do comportamento dos consumidores chineses em recall de patrocinadores dos jogos olímpicos de Pequim. Originalidade/Relevância: a presente pesquisa consiste em analisar a lembrança pelos espectadores brasileiros das marcas patrocinadoras, ou não, nas duas edições (2014/2018) da Copa do Mundo de Futebol, realizando uma série histórica de dois grandes eventos consecutivos. Principais resultados:  a análise estatística revelou que as empresas patrocinadoras oficiais obtiveram os melhores resultados em termos de recall para ambas as edições e as empresas que não foram patrocinadoras oficiais e ainda assim obtiveram bons resultados, indicando a utilização da estratégia de marketing de embosca. Contribuições teóricas e metodológicas: O modelo estudado poderá auxiliar a compreensão do processo de lembrança das marcas patrocinadoras de grandes eventos, que podem ser reproduzidos em diferentes esportes. Os dados obtidos contribuem para melhor decisão na implementação de estratégias de comunicação e investimento em marketing esportivo

Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registry

Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registr