Leishmaniose mucosa ("espundia") respondendo a baixa dose de N-metil-glucamina (Glucantime ®) no Rio de Janeiro, Brasil

Response to treatment with antimonial drugs varies considerably depending on the parasite strain involved, immune status of the patient and clinical form of the disease. Therapeutic regimens with this first line drug have been frequently modified both, in dose and duration of therapy. A regimen of 20 mg/kg/day of pentavalent antimony (Sb5+) during four weeks without an upper limit on the daily dose is currently recommended for mucosal disease ("espundia"). Side-effects with this dose are more marked in elderly patients, more commonly affected by this form of leishmaniasis. According to our experience, leishmaniasis in Rio de Janeiro responds well to antimony and, in cutaneous disease, high cure rates are obtained with 5 mg/kg/day of Sb5+ during 30 to 45-days. In this study a high rate of cure (91.4%) employing this dose was achieved in 36 patients with mild disease in this same geographic region. Side-effects were reduced and no antimony refractoriness was noted with subsequent use of larger dose in patients that failed to respond to initial schedule.A resposta de pacientes com leishmaniose ao tratamento antimonial pode variar em função de fatores como a cepa do parasito envolvido, estado imunológico do paciente e a forma clínica da doença. Os esquemas terapêuticos com antimônio pentavalente (Sb5+) têm sido frequentemente modificados quanto à dose e duração da terapia. Os efeitos colaterais observados com o uso de 20 mg/kg/dia de Sb5+ durante quatro semanas (dose recomendada para o tratamento da forma mucosa) são mais acentuados em pacientes idosos, os mais afetados pela forma mucosa (espundia) da doença. Nossa experiência demonstra que a forma cutânea ocorrendo no Rio de Janeiro responde muito bem ao tratamento com a dose de 5 mg/kg/dia de Sb5+ durante 30 ou 45 dias. Neste estudo foi obtida elevada eficácia (91,4%) com o mesmo regime terapêutico em 36 pacientes com espundia (que evoluem, contudo, com lesão crônica menos destrutiva do que o observado em outras áreas endêmicas) procedentes desta região. Os efeitos colaterais foram reduzidos, não havendo também qualquer resistência ao emprego de doses maiores nos casos que não responderam ao tratamento inicial

Proposta de uma bateria de testes para avaliação de habilidades de locomoção em usuários de cadeiras de rodas

Our objective was to propose a battery of tests for the evaluation of skills in wheelchair users. The proposed circuit involves seven different skill types, which must be performed with the best possible fit of the users' manual wheelchairs. The evaluator will receive a score at the beginning of each skill (2.0) and in the course of his or her course will be added or removed from his score if he gets a performance failure or even a good performance (0.2 points per error). The maximum allowed score is 15.4 points. After battery creation, three wheelchair users (quadriplegia, poliomyelitis and cerebral palsy) were tested to verify the applicability of the proposal. It was observed that the final scores reached after the circuit followed the limitation level of the subjects (tetraplegia = 13.6, poliomyelitis = 14.2, and cerebral palsy = 6.49 points). It is concluded that the proposal tested was well accepted by the evaluated ones reflecting the experiences of their daily life.Nosso objetivo foi propor uma bateria de testes para avaliação de habilidades em usuários de cadeira de rodas. O circuito proposto envolve sete tipos de habilidades diferentes, que devem ser realizadas com o melhor ajuste possível das cadeiras de rodas manuais dos usuários. O avaliado receberá uma pontuação no início de cada habilidade (2,0) e no decorrer do seu trajeto será acrescentado ou retirado de sua pontuação caso o mesmo obtenha uma falha da execução ou até mesmo um bom desempenho (0,2 ponto por erro). A pontuação máxima permitida é de 15,4 pontos. Após a criação da bateria, foram testados três usuários de cadeiras de rodas (tetraplegia, poliomielite e paralisia cerebral), para verificação da aplicabilidade da proposta. Observou-se que os escores finais atingidos após o circuito seguiu o nível de limitação dos sujeitos (tetraplegia=13,6; poliomielite=14,2; e paralisia cerebral=6,49 pontos). Conclui-se que a proposta testada foi bem aceita pelos avaliados refletindo as experiências do seu cotidiano

Production of Sunflower Oil in Response to Nitrogen Fertilization under Semiarid Conditions under Irrigation

Sunflower is one of the most important oilseeds in the world, whose achenes are valued in several industrial chains, mainly for the extraction and processing of its oil. Although there is some information in the literature, the nitrogen (N) requirements for sunflower in semiarid conditions under irrigation are not yet clear. The experimental design used randomized blocks, with treatments in subdivided plots with four replications during two agricultural seasons. The N doses (e.g., 0, 30, 60, 90 and 120 kg ha-1) were assigned to the plots, and to the four sunflower cultivars used (e.g., Aguará 06, Altis 99, Multissol and BRS 122), which were planted in the subplots. The N doses for the maximum achene yields for the Multissol and BRS 122 cultivars were 81.8 and 86.6 kg ha-1, respectively, while N doses of 120 kg ha-1 produced the maximum achene yields for the Altis 99 and Aguará 06 cultivars in the 2016 crop season. In 2017, the Multissol and BRS 122 cultivars were given N doses of 100.7 and 92.8 kg ha-1, respectively, and the Altis 99 and Aguará 06 cultivars were each given an N dose of 120 kg ha-1 of N. The fertirrigated doses of maximum economic efficiency of N were 60 and 70 kg ha-1 for the Multissol and BRS 122 cultivars, respectively. For the oil yields, the maximum N doses of 78.0 and 86.7 kg ha-1 for the BRS 122 and Aguará 06 cultivars and for the Multissol and Altis 99 cultivars at an N dose of 120 kg ha-1 were used for the 2016 harvest. In 2017, the BRS 122 and Multissol cultivars received N doses of 88.6 and 99.1 kg ha-1, respectively, and the Altis 99 and Aguará 06 cultivars received N doses of 120 kg ha-1. The use of fertigation allowed greater efficiency for the N doses in the sunflower cultivars in the semiarid region

Development and validation of PCR-based assays for diagnosis of American cutaneous leishmaniasis and identificatio nof the parasite species

In this study, PCR assays targeting different Leishmania heat-shock protein 70 gene (hsp70) regions, producing fragments ranging in size from 230-390 bp were developed and evaluated to determine their potential as a tool for the specific molecular diagnosis of cutaneous leishmaniasis (CL). A total of 70 Leishmania strains were analysed, including seven reference strains (RS) and 63 previously typed strains. Analysis of the RS indicated a specific region of 234 bp in the hsp70 gene as a valid target that was highly sensitive for detection of Leishmania species DNA with capacity of distinguishing all analyzed species, after polymerase chain reaction-restriction fragment length polymorfism (PCR-RFLP). This PCR assay was compared with other PCR targets used for the molecular diagnosis of leishmaniasis: hsp70 (1400-bp region), internal transcribed spacer (ITS)1 and glucose-6-phosphate dehydrogenase (G6pd). A good agreement among the methods was observed concerning the Leishmania species identification. Moreover, to evaluate the potential for molecular diagnosis, we compared the PCR targets hsp70-234 bp, ITS1, G6pd and mkDNA using a panel of 99 DNA samples from tissue fragments collected from patients with confirmed CL. Both PCR-hsp70-234 bp and PCR-ITS1 detected Leishmania DNA in more than 70% of the samples. However, using hsp70-234 bp PCR-RFLP, identification of all of the Leishmania species associated with CL in Brazil can be achieved employing a simpler and cheaper electrophoresis protocol

Análise da eficácia do uso terapêutico da trimetazidina nas principais síndromes coronarianas agudas

A injúria de reperfusão, ou isquemia, é um mecanismo fisiopatológico que ocorre nas etiopatogenias do miocárdio, como na angina instável. Assim, são utilizados fármacos adjuvantes citoprotetores, como a trimetazidina (TMZ), que visam à diminuição do tempo de hospitalização e melhora na função cardíaca com ação profilática contra essa lesão. No entanto, apesar dos seus potenciais benefícios no tratamento da síndrome coronariana aguda, ainda não está clara a sua eficácia em relação a outras terapias disponíveis. Nesse sentido, o objetivo do estudo é analisar a eficácia do uso terapêutico da trimetazidina nas principais síndromes coronarianas agudas. Foi realizada uma revisão sistemática usando as bases de dados PubMed, Cochrane Library e Embase. Um total de 3 estudos foi incluído na análise. Os resultados mostraram que a terapia com trimetazidina reduziu significativamente a incidência de eventos cardíacos adversos maiores (ECAM) (OR = 0,33, IC 95% 0,15-0,75, p = 0,007), menor dano miocárdico (p < 0,05) e fração de ejeção ventricular esquerda mais elevada e menos eventos adversos em comparação com o grupo placebo (p < 0,05). Não foram observadas diferenças significativas entre os grupos de trimetazidina e controle em termos de mortalidade por todas as causas, mortalidade cardiovascular ou incidência de eventos adversos. Os resultados deste estudo sugerem que a terapia adjuvante com trimetazidina pode melhorar os resultados clínicos e a função cardíaca em pacientes com IAM sem aumentar o risco de eventos adversos. No entanto, são necessários mais ensaios clínicos randomizados em larga escala para confirmar esses resultados e determinar a duração e dose ideais da terapia com trimetazidina nessa população de pacientes

Successful therapeutic response of resistant cases of mucocutaneous leishmaniasis to a very low dose of antimony

Two mucocutaneous leishmaniasis cases resistant to therapy are reported here. After the failure of initial therapies (antimony, amphotericin B and/or pentamidine) patients received a low-dose schedule: one ampoule of meglumine antimoniate (405mg of pentavalent antimony [Sb v]) by intramuscular injection, three times a week until complete healing of the lesions. One patient was cured with a total of 30 ampoules in 10 weeks and the other received 36 ampoules in 12 weeks. Both remain clinically cured after one year of follow-up

An alternative antimonial schedule to be used in cutaneous leishmaniasis when high doses of antimony are undesirable

Despite more than half a century of use in leishmaniasis, antimony therapy still presents serious problems concerning dosage and toxicity. Low and high doses have been shown to be equally effective. In this paper, the feasibility of injecting one ampoule of meglumine antimoniate intramuscularly every other day until clinical cure is demonstrated, while studying a series of 40 cutaneous leishmaniasis cases. Total dose used varied from 1,822.5 to 12,150mg of pentavalent antimony and total time of treatment varied from 3 to 10 weeks, with 86% efficacy. Thirty-six out of the 40 patients are still on follow-up with a mean time of 10.7 ± 7 months and a median of 9 months. No relapse or mucosal lesions have been noted so far. The schedule showed good tolerance and easy application and its efficacy was comparable to the officially recommended WHO schedule. Therefore, such a schedule represents a valuable alternative for the cases with high toxicicity to antimony or daily injections are an obstacle to the treatment