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

Estudo da etiologia do câncer genital masculino: prevalência do papilomavírus humano (HPV), vírus Epstein-barr (EBV) e poliomavírus de células Merkel (MCPYV)

Introdução: A infecção genital pelo papilomavírus humano (HPV) causa uma doença sexualmente transmissível (DST) que pode ser associada a lesões precursoras da carcinogênese do trato genital. Embora diversos estudos tenham definido o HPV como agente etiológico do câncer cervical, a etiologia do câncer de pênis permanece por ser elucidada, sendo grande a carência de estudos. Entretanto, outros fatores podem estar associados ao início ou progressão do processo de malignização tecidual, como o vírus Epstein-Barr (EBV) e, particularmente, o poliomavírus de células Merkel (MCPyV), cuja prevalência na forma de infecções latentes pode se dar tanto em epitélio saudável quanto em lesões, e que, sob determinadas condições, pode apresentar perfil oncogênico neste tecido. Este estudo visa contribuir para o conhecimento epidemiológico a respeito da prevalência destes vírus em lesões neoplásicas penianas. Objetivos: Investigar a presença do HPV, do EBV e do MCPyV em lesões malignas do trato genital masculino, genotipar o HPV e o EBV quando presentes, quantificar e sequenciar o MCPV quando presente, e correlacionar os tipos de HPV e grau da lesão com a presença e carga viral do MCPyV e do EBV. Metodologia: Um total de 112 amostras de câncer peniano foram coletadas para um estudo transversal, a fim de avaliar prevalência da infecção por HPV, EBV e MCPyV. A metodologia empregada consistiu em: 1 – Detectar a presença do DNA do HPV pela técnica de PCR usando os primers genéricos MY09/11; 2 – Genotipar os HPV através da PCR com primers específicos para o gene E6 dos HPV 6, 11, 16, 18, 31, 33, 35, 45 e 58 e, se necessário, pelo ensaio de Microarranjo de DNA; 3 – Detectar e quantificar o DNA do MCPyV pela técnica de Nested PCR e PCR em tempo real, respectivamente; 4 - Detectar e genotipar o EBV pela PCR. 5 – Correlacionar o grau de invasibilidade das lesões, a dispersão linfonódica de células malignas e o grau histopatológico das lesões, com a presença dos vírus estudados. Resultados: Verificamos a presença do HPV em 64 (57,1%) amostras, nas quais o tipo mais prevalente foi o HPV16 (32,8%). Todas as amostras se encontravam infectadas por pelo menos um tipo de HPV de alto risco oncogênico, exceto seis amostras, infectadas somente pelo HPV6. O MCPyV foi detectado em 4 (3,5%) amostras. O EBV foi detectado em 53 (47,3%) amostras, dentre as quais o EBV1 foi o mais prevalente. Foi encontrado um caso de infecção múltipla por HPV, MCPyV e EBV em um carcinoma de células escamosas de pênis. Este foi o primeiro relato da presença do MCPyV neste tipo de lesão peniana. Conclusão: As prevalências das infecções por HPV e EBV indicam um papel preponderante destes vírus na malignização do tecido peniano. O papel da infecção viral se mostrou significativo dentro da multifatorialidade da etiologia do câncer de pênis. Houve correlação estatística entre o grau de invasibilidade da lesão, e a presença de HPVs de alto risco, EBV1, e coinfecção HPV/EBV. Não houve correlação estatística entre a dispersão linfonófica e o grau histopatológico das lesões com a presença dos vírus estudados A prevalência do MCPyV não foi significante, mas sua presença indica o potencial oportunista deste vírus, e sugere a importância de estudos adicionais e vigilância epidemiológica.Introduction: The genital infection by the human papillomavirus (HPV) can result in a sexually transmitted disease (STD) associated with precursor lesions for carcinogenesis in the genital tract. In recent years, evidence was accumulated defining human papillomavirus (HPV) as the etiologic agent of cervical cancer, however, the etiology of penile cancer is still open and in lack of studies. Although HPV is an important factor for malignization, other oncogenic factors may be associated with the initiation or progression of the tissue malignancy process, such as the Epstein-Barr virus (EBV) and, particularly, the Merkel cell polyomavirus (MCPyV), which detection is achieved in both healthy and lesioned epithelium, and, under appropriate conditions, might present an oncogenic behavior within the epithelial tissue. This study aims to contribute to the epidemiologic knowledge regarding the prevalence of these viruses in malignant lesions of the male genital tract. Objectives: To investigate the presence of MCPyV, EBV and HPV in penile malignant lesions; to genotype HPV when present; to quantify the MCPyV when present; and to correlate HPV types and lesion degree with the presence and viral load of MCPyV and EBV. Methods: A total of 112 penile cancer samples were collected in a cross-sectional study. The detection methodology consisted of: 1 - Detecting the presence of HPV DNA by the PCR technique with generic primers; 2 - Genotyping the HPV through PCR with specific primers and by using Microarray assay; 3 - Detecting and quantifying the MCPyV DNA by the Nested PCR and real-time PCR, respectively; 4 - Detecting, quantifying and genotyping EBV by PCR. 5 – Correlate the histopathology, tumour invasiveness, and the dispersion of malignant cells by the lymphonodes, with the presence of the studied viruses Results: The HPV prevalence was 57.1% (64) while MCPyV was detected in 3.5% (4) of the samples. EBV was detected in 47.3% (53), and EBV1 was the most prevalent genotype. All patients positive for MCPyV were also positive for HPV, and we described an unprecedented case of multi-infection by all three viruses in a penile squamous cells carcinoma. This was the first report in the literature in this kind of penile lesion. Conclusion: The prevalence of HPV and EBV infections indicates an important role of these viruses in the penile tissue malignancy. The role of the viral infection was significant within the multifactorial etiology of penile cancer. There was statistical significance between the lesion invasiveness and the presence of the EBV1, high-risk HPV and HPV/EBV infection. We have found no statistical correlation between the lymphonodic dispersion, nor the histopathology grade, with the presence of the studied viruses. The prevalence of MCPyV was found not significant, but its presence indicates the opportunistic infectious potential of this virus, and suggests the importance of further studies and epidemiological surveillance.141f

Prevalência da infecção por papilomavírus humano no trato genital de homens assintomáticos: aspectos virológicos e epidemiológicos

A infecção do trato genital pelo papilomavírus humano (HPV) é uma das viroses sexualmente transmissíveis mais prevalentes no mundo. Entretanto, ainda existem lacunas de conhecimento a respeito da etiologia do câncer de pênis, e a história natural do HPV no homem ainda não está totalmente elucidada. Este estudo teve como objetivo determinar a prevalência da infecção por HPV em amostras de esfregaços de pênis, oriundos de uma população masculina clinicamente assintomática. Para tanto, foram analisadas 261 amostras, coletadas entre 2010 e 2013 em diferentes instituições na cidade do Rio de Janeiro, incluindo hospitais, uma clínica de dermatologia e uma empresa metalúrgica. Também contabilizamos variáveis epidemiológicas de 182 destes indivíduos, através da aplicação de um questionário para auxílio na investigação de possíveis fatores de risco. A identificação viral foi feita através das técnicas de reação em cadeia da polimerase genérica e tipo-específica, e RFLP (Restriction Fragment Length Polimorfism), quando necessário. Foi encontrada uma prevalência geral para infecção por HPV de 16,47% (43 indivíduos). O tipo de HPV mais prevalente foi o HPV 6 (34,88%), seguido pelos HPV 16 (23,25%), HPV 11 (16,27%), HPV 45 (9,30%) e HPV 58 (2,32%); assim, encontramos infecção por HPV de baixo risco oncogênico em 53,66%, e de alto risco oncogênico em 46,34% dos indivíduos infectados. A idade dos indivíduos analisados variou entre 18 e 65 anos, com média de idade de 26,30 anos. Dentre as variáveis epidemiológicas estudadas, houve significância estatística apenas para o grupo de indivíduos circuncisos (p<0,05). Dois dos três indivíduos que afirmaram ter histórico de outras DST (Doenças Sexualmente Transmissíveis) se encontravam infectados. Assim, pudemos inferir que a prevalência da infecção na população masculina assintomática estudada é considerável, embora bem menor do que a descrita em alguns estudos publicados recentemente. Acreditamos que os resultados possam contribuir para uma visão mais clara a respeito da circulação do HPV na população masculina geral, bem como a identificação de fatores de risco associados à epidemiologia da infecção em nosso estado.The genital tract infection by human papillomavirus (HPV) is one of the most prevalent sexually transmitted diseases in the world. However, there are still gaps in the knowledge regarding the etiology of penile cancer, and the natural history of HPV infection in men is not yet fully elucidated. This study aimed to determine the prevalence of HPV infection in penile swab samples, derived from a clinically asymptomatic male population. For this purpose, 261 samples were collected between 2010 and 2013 in different institutions in the city of Rio de Janeiro, including hospitals, dermatology clinics and a metallurgical company. Also, we analyzed epidemiological variables of 182 of these individuals through the application of a questionnaire to aid in the investigation of possible risk factors. The viral identification was made through the generic and type-specific polymerase chain reaction and restriction fragment length polymorphism (when needed) techniques. An overall prevalence of HPV infection in 16.47 % (43 individuals) was found. The most prevalent HPV type was HPV 6 (34.88%), followed by HPV 16 (23.25%), HPV 11 (16.27%), HPV 45 (9.30%) and HPV 58 (2.32%); so, we have found infection by the low-risk oncogenic types in 53.66% of the infected individuals, and by high-risk oncogenic types in 46.34 % of these individuals. The age of the subjects studied ranged between 18 and 65 years with a mean age of 26.30 years. Among the epidemiological variables, statistical significant results were found for the group of men who have sex with men, for the group who have kept anal intercourse during sexual relationship, for the group that always uses condom and for the group of circumcised individuals (p<0.05). Two of the three individuals who reported having a history of STDs (Sexually Transmitted Diseases) were infected. Thus, we can infer that the prevalence of HPV infection among asymptomatic male population is considerably high, although lower than that reported in some recently published studies. We believe that the results may contribute to a clearer view about the circulation of HPV in the general male population, as well as to the identification of risk factors associated with the epidemiology of HPV infection in our state

Epidemiological situation of avian mycoplamosis in the State of Rio de Janeiro, Brazil

ABSTRACT. Teixeira V.C.M., Baptista D.Q., Carlos F.C., Menezes W.R., José D.S., Barreto M.L., Abreu D.L.C., Pereira V.L.A. & Nascimento E.R. [Epidemiological situation of avian mycoplamosis in the State of Rio de Janeiro, Brazil.] Situação epidemiológica da micoplasmose aviária no Estado do Rio de Janeiro. Revista Brasileira de Medicina Veterinária, 37(4):379-385, 2015. Departamento de Saúde Coletiva Veterinária e Saúde Pública, Faculdade de Medicina Veterinária, Universidade Federal Fluminense, Rua Vital Brasil, 64, Santa Rosa, Niterói, RJ 24320-340, Brasil. E-mail: [email protected] This study was conducted to characterize the Mycoplasmosis epidemiological situation in Rio de Janeiro State. The state was divided into three regions considered  significant in poultry production in the state and 252 samples of tracheal specimens were taken, using swabs dipped in 1.5ml of Frey medium and 2.5 ml of blood from 884 birds, in 47 flocks, from 11broiler chickens farms, 6 laying hens farms and 1 broiler breeders farm, of which were evaluated 334 broilers, 205 laying hens and 345 broilers breeders. The serums were subjected to Rapid Serum Agglutination  (RSA) and ELISA for detection of antibodies against Mycoplasma gallisepticum (MG) and M. synoviae (MS) and the swabs used in the polymerase chain reaction (PCR) for those agents detection. Were obtained by SAR for MG and MS in the 884 birds studied, frequencies of 14.25% (126/884) and 13.68% (121/884), respectively. By ELISA, were btained 16.17% (143/884) for MG and 15.61% (138/884) for MS. According to the type of production, it was found in broilers chickens by SAR, 11.37% (38/334) for MG and 9.5% (32/334) for MS and in the ELISA, 9.28% (31/334) for MG and 9.88% (33/334) for MS. In laying chickens, the frequency of positive birds by SAR for MG and MS were in an amount of 42.92% (88/205) and 43.41% (89/205), respectively, and by ELISA, 54.63% (112/205) for MG and 49.75% (102/205) for MS. The broiler breeders shown to be negative for MG by SAR and by ELISA, but for MS, 0.86% (2/345) were positive only by ELISA. When comparing the frequencies for MG and MS in the flocks studied, by SAR, was obtained a total of positivity of 55.31% (26/47) for MG and 63.82% (30/47) for MS, and by ELISA, 51.06% (24/47) and 68.08% (32/47), respectively. For each type of production, was obtained for the broilers chickens a positivity to the SAR of 40% (10/25) for MG e 56% (14/25) for MS; and to the ELISA, 28% (7/25) e 60% (15/25) for MG and MS, respectively. In laying chickens was obtained values of 80% (16/20) for the MG and MS by SAR, whereas by ELISA, was obtained 85% (17/20) for MG and 75% (15/20) for MS. In breeders, by ELISA both two flocks studied were positive only for MS. By PCR, the total of positivity for MG and MS were in an amount of 1.19% (3/252) and 9.92% (25/252), respectively. For each type of production, were obtained 0.78% (1/127) of positive for MS in broilers chickens. In laying hens chickens, the results were 2.6% (3/115) positive for MG and 20.86% (24/115) for MS. About the broiler breeders, there was no positivity by PCR. The frequency of positives for MG and MS, by PCR, in the total of the flocks studied were, respectively, 2.12% (1/47) and 21.27% (10/47). By type of production, were not found positive flocks for MG, however, for MS was obtained 4% (1/25) in the broilers. In laying chickens, it was verified  that 5% (1/20) of the flocks were positive for MG and 45% (9/20) for MS. All flocks of broiler breeders were negative for MG and MS. Higher prevalence for MS were detected in the layeing hens farms than in the broilers farms and breeders farm, such as by serology as by PCR. The prevalence of MG was higher in broilers chickens than in broilers breeders. There was high positivity in laying hens, whose data was not considered because included vaccinated chickens. There were differences in the results obtained for the broilers flocks and laying hens flocks and in the positivity among the flocks, which can be attributed to differences in farm building and structures, in the ambience and manger inherent to each type of production. In this research for MG and MS in poultry production, was obtained higher frequency of positive by ELISA than by SAR, with a low agreement between the tests

An evaluation of p16INK4a expression in cervical intraepithelial neoplasia specimens, including women with HIV-1

Although several studies have evaluated the role of p16INK4a as a diagnostic marker of cervical intraepithelial neoplasia (CIN) and its association with disease progression, studies regarding the role of p16INK4a in human immunodeficiency virus (HIV)-infected patients remain scarce. The present study was designed to determine the potential utility of p16INK4a as a diagnostic marker for CIN and invasive cervical cancer in HIV-positive and negative cervical specimens. An immunohistochemical analysis of p16INK4a was performed in 326 cervical tissue microarray specimens. Performance indicators were calculated and compared using receiving operating characteristics curve (ROC)/area under the curve. In HIV-1-negative women, the percentage of cells that was positive for p16INK4a expression was significantly correlated with the severity of CIN (p < 0.0001). A ROC curve with a cut-off value of 55.28% resulted in a sensitivity of 89%, a specificity of 81%, a positive predictive value of 91% and a negative predictive value of 78%. HIV-seropositive women exhibited decreased expression of p16INK4a in CIN2-3 specimens compared with HIV-negative specimens (p = 0.031). The ROC data underscore the potential utility of p16INK4a under defined conditions as a diagnostic marker for CIN 2-3 staging and invasive cervical cancer. HIV-1 infection, however, is associated with relatively reduced p16INK4a expression in CIN 2-3