Position statement of the Brazilian Academy of Rhinology on the use of antihistamines, antileukotrienes, and oral corticosteroids in the treatment of inflammatory sinonasal diseases

Introduction: Inflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available. Objective: The present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions. Methods: The methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors' needs. Results: Relevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs. Conclusion: There is support in the literature for the use of these drugshowever, final considerations about the role of each of them have been made. (C) 2017 Published by Elsevier Editora Ltda. on behalf of Associacao Brasileira de Otorrino-laringologia e Cirurgia Cervico-Facial.Univ Sao Paulo, Disciplina Otorrinolaringol, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Dept Otorrinolaringol, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Otorrinolaringol, Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Ciencias Saude, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Otorrinolaringol, Sao Paulo, SP, BrazilUniv Fed Minas Gerais, Fac Med, Belo Horizonte, MG, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Ribeirao Preto, SP, BrazilUniv Fed Bahia, Fac Med, Disciplina Otorrinolaringol, Salvador, BA, BrazilHosp Inst Paranaense Otorrinolaringol, Centro Rinite & Alergia, Curitiba, PR, BrazilUniv Estado Rio De Janeiro, Rio De Janeiro, RJ, BrazilUniv Brasilia, Fac Med, Brasilia, DF, BrazilUniv Fed Sao Paulo, Dept Otorrinolaringol & Cabeca & Pescoco, Sao Paulo, SP, BrazilUniv Luterana Brasil, Fac Med, Otorrinolaringol, Canoas, RS, BrazilMt Sinai Hosp, Dept Othorhinolaryngol, Toronto, ON, CanadaUniv Sao Paulo, Fac Med, Ciencias, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Oftalmol Otorrinolaringol & Cirurgia Cabeca, Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Ciencias Saude, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Otorrinolaringol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Otorrinolaringol & Cabeca & Pescoco, Sao Paulo, SP, BrazilWeb of Scienc

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Avaliação da associação do quimioterápico benzonidazol a outros fármacos com ação anti-t cruzi no tratamento da doença de chagas experimental

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-07-21T18:21:23Z No. of bitstreams: 1 Marcio Cerqueira de Almeida, Avaliação da associação... 2013.pdf: 1510563 bytes, checksum: 0e9c49e3f55ccee94564fa6d382253e8 (MD5)Made available in DSpace on 2014-07-21T18:21:23Z (GMT). No. of bitstreams: 1 Marcio Cerqueira de Almeida, Avaliação da associação... 2013.pdf: 1510563 bytes, checksum: 0e9c49e3f55ccee94564fa6d382253e8 (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilA doença de Chagas (DC) é causada pelo protozoário hemoflagelado Trypanosoma cruzi. Estima-se que ainda existam 10 milhões de pessoas infectadas na América Latina. Para a quimioterapia específica da DC o benzonidazol (BZ) é o medicamento de escolha. A eficácia terapêutica dos compostos atualmente em uso clínico tem sido questionada, tendo em conta os diferentes índices de cura já registrados na literatura. A associação do BZ, com medicamentos que apresentem um efeito anti-T. cruzi poderá potencializar a ação antiparasitária do mesmo e possivelmente permitirá o uso de doses menores e consequentemente diminuição dos efeitos tóxicos. O objetivo da presente investigação é avaliar o efeito do tratamento com o BZ associado aos medicamentos nifurtimox (NF) e cetoconazol (CETO), em duplas combinações, sobre o curso da infecção aguda pela cepa Y do T. cruzi, em camundongos suíços. Foram feitos três experimentos: A e B, nos quais os camundongos foram inoculados com 5 X 104 formas de tripomastigotas sanguícolas do T. cruzi e o C formado por animais não infectados. O tratamento foi feito por entubação (via oral) a partir do 6º dia pós-infecção e teve duração de 60 dias. Experimento A (A1 – controles infectados e não tratados; A2 – infectados e tratados com 100 mg/kg/dia BZ; A3 – infectados e tratados com dose inicial de 200mg/kg/dia e seguidos de 50 mg/kg/dia NF; A4 – infectados e tratados com BZ + NF); Experimento B (B1 – controles infectados e não tratados; B2 – infectados e tratados com 100 mg/kg/dia BZ; B3 – infectados e tratados com 120 mg/kg/dia CETO; B4 – infectados e tratados com BZ + CETO); Experimento C (C1 – tratados com 100 mg/kg/dia BZ; C2 – tratados com dose inicial de 200 mg/kg/dia seguido de 50 mg/kg/dia NF; C3 – tratados com 120 mg/kg/dia CETO; C4 – tratados com BZ + NF; C5 – tratados com BZ + CETO). Os níveis parasitêmicos e a mortalidade foram avaliados a partir do 6º dia pós-infecção, e trinta dias após o fim do tratamento foram realizados os testes de cura parasitológicos (parasitemia, xenodiagnóstico e hemocultura) e o teste sorológico de imunofluorescência indireta (IFI). O critério de cura foi baseado na combinação dos resultados dos testes de cura parasitológicos com a IFI. Os resultados do Experimento A indicaram uma taxa de mortalidade de 100% para o grupo controle, 5,26% para os grupos BZ e BZ + NF e 0% para o NF; o índice de cura foi de 80% para o grupo BZ, 5,26% para o NF e 100% para o BZ + NF; Os resultados do Experimento B mostraram uma taxa de mortalidade de 100% para o grupo controle, 0% para os grupos BZ e CETO, e 5,26% para o BZ + CETO; o índice de cura foi de 80% para o grupo BZ, 81,8% para o CETO e 100% para o BZ + CETO. O estudo histopatológico demonstrou que o tratamento com BZ isoladamente ou em combinação com o NF ou com o CETO determinou significativa diminuição da intensidade das lesões no miocárdio e músculo esquelético quando comparado aos controles não tratados. O grupo GC, não demonstrou alterações inflamatórias em miocárdio. Em conclusão, o tratamento combinado do BZ com outras drogas (NF e CETO) não determinou aumento significante dos índices de cura e diminuição das lesões histopatológicas do miocárdio quando comparado com o tratamento isolado com o BZ. Provavelmente, o uso neste trabalho, de doses previamente estabelecidas, influenciou no efeito das referidas associações. Novos experimentos são necessários, com o uso de doses decrescentes do BZ, para melhor avaliar o efeito das referidas combinações sobre a toxicidade da droga.Chagas’disease (CD) is caused by the hemoflagelate protozoa Trypanosoma cruzi. It is estimated that 10 million infected people are still living in Latin America. For the specific chemotherapy of CD, the Benznidazole (BZ) is the drug of choice. However, the therapeutic efficacy of the compounds now in clinical use is not confirmed, taking into account that different cure rates have been registered. It is possible that the association of BZ with other drugs with an anti-T. cruzi action could improve its anti-parasitic effect, with the use of lower dose and consequent decrease of the toxic effects. The objective of the present investigation is to evaluate the effect of the treatment with BZ in association with the drugs Nifurtimox (NF) and Ketoconazole (CETO) in double combinations, on the evolution of the acute phase of the infection of Swiss mice, with the Y strain of T. cruzi. Three experimental groups were performed: Group A (GA) and Group B (GB) in which the mice were inoculated with 5x104 trypomastigote blood forms; Group GC of uninfected mice, submitted to the same treatment schedules. Treatment was performed by gavage (oral route) from the 6th day after infection, during 60 days; Group GA: I - infected, non treated controls; II - infected and treated with 100 mg/kg/day of BZ; III - infected and treated with NF ( initially 200 mg/kg/day, followed by 50 mg/kg/day); IV – infected and treated with BZ + NF; Group GB: I - infected, non treated controls; II - infected and treated with 100 mg/kg/day of BZ; III - infected and treated with 120 mg/kg/day CETO; IV – infected and treated with BZ + CETO; Group C: I - treated with 100 mg/kg/day of BZ; II - treated with NF ( initially 200 mg/kg/day, followed by 50 mg/kg/day); III - treated with 120 mg/kg/day CETO; IV - treated with BZ + NF; V - treated with BZ + CETO. Parasitemia and mortality were evaluated from the 6th day of infection. Thirty days after the end of treatment, parasitologic cure tests of the mice of the several groups were performed (parasitemia after Cyclophosphamide injection: 250mg/kg b.w, xenodiagnosis and hemoculture). Cure criteria was based on the combination of the results of parasitological tests and the serological titles (cut off 1:20). Results: GA – 100% of mortality for untreated control, 5,26% for sub-groups BZ and BZ +NF and 0% for NF group. Cure rate was of 80% for the subgroup BZ, 5.26%, for the NF group and 100% for the group BZ+NF Results – GB – 100% of mortality for untreated controls; 0% for the subgroups BZ and CETO and 5.26% for the group BZ + CETO. Cure rates: 80% for the subgroup BZ, 81.8% for the subgroup CETO and 100% for the group BZ + CETO. Histopatological study showed that treatment with BZ only or in combination with NF or CETO determined significant decrease in the intensity of the inflammatory lesions of the myocardium and skeletal muscles, as compared with untreated controls. However isolated treatment with NF or CETO did not determined regression of the inflammatory lesions. The group GC did not show inflammatory lesions in the myocardium or skeletal muscle. Conclusion – the combined treatment with BENZ and other drugs (NF and CETO) did not determine a significant increase of the cure indices when compared to the isolated treatment with BZ. These combinations have not determined a significant decrease of histopathological lesions of the myocardium, as compared to the treatment with BZ. Probably the use of previously established doses interferes with the analysis of the effect of the cited combinations. New experiments are necessary with the use of lower doses of BZ to a better evaluation of the efficacy and toxicity of the drug

Agglutination of histoplasma capsulatum by IgG monoclonal antibodies against Hsp60 impacts macrophage effector functions

11 p. : il., tab.Histoplasma capsulatum can efficiently survive within macrophages, facilitating H. capsulatum translocation from the lung into the lymphatics and bloodstream. We have recently generated monoclonal antibodies (MAbs) to an H. capsulatum surface-expressed heat shock protein of 60 kDa (Hsp60) that modify disease in a murine histoplasmosis model. Interestingly, the MAbs induced different degrees of yeast cell agglutination in vitro. In the present study, we characterized the agglutination effects of the antibodies to Hsp60 on H. capsulatum yeast cells by light microscopy, flow cytometry, dynamic light scattering, measuring zeta potential, and using optical tweezers. We found that immunoglobulin Gs (IgGs) to Hsp60 cause H. capsulatum aggregation dependent on the (i) concentration of MAbs, (ii) MAb binding constant, and (iii) IgG subclass. Furthermore, infection of macrophages using agglutinates of various sizes after incubation with different Hsp60-binding MAbs induced association to macrophages through distinct cellular receptors and differentially affected macrophage antifungal functions. Hence, the capacity of IgG MAbs to agglutinate H. capsulatum significantly impacted pathogenic mechanisms of H. capsulatum during macrophage infection, and the effect was dependent on the antibody subclass and antigen epitope

Evaluation of clinical tests and magnetic resonance imaging for knee meniscal injuries: correlation with video arthroscopy

ABSTRACT Objective: To determine the specificity, sensitivity, accuracy, likelihood, and correlation of the findings of meniscal tests and magnetic resonance imaging (MRI) to knee video arthroscopy., Methods: A cross-sectional study, conducted between June and December 2015, which evaluated 84 patients with meniscal tears (MT) selected for video arthroscopy. Two orthopedic trainees and a resident performed a physical examination with specific tests. The results and reports from MRI were compared with arthroscopy findings. The data were analyzed in the statistical program , R. Results: The Steinmann I, test was the most specific, with specificity of 86% and 91% for medial meniscus tears (MMT) and lateral meniscus tears (LMT), respectively. With regard to accuracy, the pain test on palpation of the joint interline (PPJI) showed values of 67% and 73% for detection of MMT and LMT, respectively. The PPJI test showed higher sensitivity, with a 77% chance of detecting MMT. Analysis of the set of three tests (McMurray, PPJI, and Steinmann , I, ) compared to arthroscopy showed 85% sensitivity for MMT and 70% sensitivity for LMT. MRI showed a greater specificity for the diagnosis of MMT and LMT; the values were 82% and 91%, respectively. Conclusion: The combination of the three tests shows better results compared to the isolated tests and thus can be associated to the MRI to make an effective diagnosis. However, further studies assisting in the development of a protocol to standardize diagnostic evaluation are required