Perspectivas epidemiológicas, clínicas e terapêuticas do transtorno bipolar em comorbidade com o uso de drogas: revisão de sistemática: Epidemiological, clinical and therapeutic perspectives of bipolar disorder in comorbidity with drug use: a systematic review

Conhecida como transtorno maníaco-depressivo, atualmente possui um novo nome: Transtorno Afetivo Bipolar, visto que com o passar do tempo foi se percebendo que esse transtorno não se tratava de uma alteração psicótica, e mais de um prejuízo afetivo. O transtorno bipolar possui alguns tipos, não se caracterizando em apenas uma forma, sua manifestação varia conforme o indivíduo e suas tendências, disforia e/ou euforia porém independente da forma expressa o paciente bipolar pode ter sua vida social comprometida, se não tratada, visto a irregularidade no estado de humor; bem como pode fazer uso de substâncias psicoativas, o que prejudica a sua condição clínica. Objetivo central da pesquisa é de apresentar a correlação do transtorno bipolar com o uso de drogas, mediante uma revisão de literatura integrativa realizada entre os meses de março de 2022 a julho de 2022, através da busca de artigos científicos nos bancos de dados online PubMed, Scielo e Google Acadêmico, utilizando como critério de refinamento de pesquisa artigos de todas as línguas publicados entre os anos 2000 e 2022

Uso de drogas e o aumento das infecções sexualmente transmissíveis: uma revisão sistemática: Drug use and the increase in sexually transmitted infections: a systematic review

Populações de usuários de drogas têm sido associadas a epidemias de infecções ou Infecções Sexualmente Transmissíveis, especialmente a infecção pelo HIV (que está associada a drogas injetáveis, uso de equipamentos contaminados para drogas injetáveis e sexo inseguro). A droga mais associada às DSTs é a cocaína fumável de base livre (crack), devido ao aumento dos comportamentos sexuais de risco. Diante disso, o presente estudo teve como objetivo compreender o impacto do uso de drogas no aumento das infecções sexualmente transmissíveis. Para isso, adotou-se como metodologia a revisão sistemática de literatura, realizando buscas nas bases de dados Scielo, Pubmed e BVS/Medline a partir do uso de descritores DeCS/MeSH e aplicação de critérios de inclusão e exclusão. A partir da análise e interpretação dos dados, concluiu-se que que pessoas que fazem uso abusivo de drogas lícitas ou ilícitas, sejam elas mulheres, homens, adolescentes, jovens, adultos, idosos, em situação de rua ou não, tendem a desenvolver comportamentos vulneráveis que pode resultar em IST. Somado a isso, enquanto comportamento de risco, tem-se a preferência por não usar preservativo, seja em relações sexuais com pessoas monogâmicas como com dois ou mais parceiros. Nesses casos, tanto o uso exacerbado de drogas como a falta de informação sobre comportamento sexual demonstram-se insuficientes

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Experimental orthotopic breast cancer as a model for investigation of mechanisms in malignancy and metastasis to the lymph nodes

To understand the fundamental mechanisms behind malignancy of breast tumors and also contribute to the discovery of improved methods for prevention, diagnosis and treatment, animal cancer models remain essential. We aimed to establish an optimal orthotopic cancer model for breast cancer in the immunocompetent Swiss mouse, describing the detailed microanatomy of the mammary glands, the sentinel lymph node and lymphatic mapping, evaluating histopathological changes and characterizing the tumor by computed microtomography and interleukins expression. The inoculation of fresh Ehrlich tumor cells led to a detectable tumor as early as 24 hours later; after 7 days, mammary, muscular, dermal vascular and lymphatic invasion were observed and also micrometastases in mammary adipose tissue, sentinel lymph node and contralateral lymph node. From the inoculation site the tumor invaded the host mammary gland structures, the dermis and endomysium of skeletal muscle tissue. Type 1 T helper cytokine levels (IL-1β and IL-17) were significantly higher than anti-inflammatory Type 2 T helper (IL-4) after inoculation of fresh tumor cells. Differently, frozen tumor cells induced tumor development only 14 days after the inoculation while presenting expression of distinct interleukins. The set of findings indicates that orthotopic transplantation provides the microenvironment critical for cell interactions involved in the development of cancer and subsequent metastasis. In this regard, the anatomical and physiological knowledge of the mammary glands and ductal networks favor studies, diagnoses and therapies related to breast cancer and metastasis. Moreover, this study provides anatomical support for the understanding of the lymphatic spread process of cancer cells.</p

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-11-17T12:41:59Z No. of bitstreams: 1 Nogueira ML (PREPRINT) Adverse birth outcomes associated with Zika virus exposure during pregnancy in São....pdf: 2093267 bytes, checksum: 6543c2d2fad9c94caa4b20a635a1eab9 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-11-17T12:43:36Z (GMT) No. of bitstreams: 1 Nogueira ML (PREPRINT) Adverse birth outcomes associated with Zika virus exposure during pregnancy in São....pdf: 2093267 bytes, checksum: 6543c2d2fad9c94caa4b20a635a1eab9 (MD5)Made available in DSpace on 2017-11-17T12:43:36Z (GMT). No. of bitstreams: 1 Nogueira ML (PREPRINT) Adverse birth outcomes associated with Zika virus exposure during pregnancy in São....pdf: 2093267 bytes, checksum: 6543c2d2fad9c94caa4b20a635a1eab9 (MD5) Previous issue date: 2017The São Paulo Research Foundation (FAPESP) via Grant 262 No. 2013/21719-3 and 2016/15021-1for M.L.N, Grant No. 2015/12295-0 for A.C.B.T., and Grant 263 No. 2016/05115-9 for L.C.M. P.F.C.V. was supported by the Zika Virus Fast Track program pro264 vided by the Association for the Improvement of Higher Education Personnel (CAPES) and the 265 Brazilian National Council for Scientific and Technological Development (CNPq) via Grant Nos. 266 303999/2016-0, 440405/2016-5, and 457664/2013-4. MLM is a CNPq Research Fellow.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.Evandro Chagas Institute. Ananindeua, PA, Brazil.Evandro Chagas Institute. Ananindeua, PA, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Federal University of Bahia. Salvador, BA, Brazil / Yale School of Public Health. New Haven, Connecticut, USA.Fundacao Oswaldo Cruz. Rio de Janeiro, RJ, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.University of Texas Medical Branch. Galveston, Texas, USA.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.Yale School of Public Health. New Haven, Connecticut, USA.Objective: We aimed to report the first 54 cases of pregnant women infected by Zika vírus (ZIKV) and their virological and clinical outcomes, as well as the newborns’ outcomes in 2016, after the emergence of ZIKV in dengue endemic areas of São Paulo, Brazil. Methods: This is a descriptive study performed from February to October 2016 on 54 qPCR ZIKV50 positive pregnant women identified by the Public Health Authority of São Jose do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiological data collected before and after birth. Adverse outcomes in newborns were analyzed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by RT-PCR. Results: 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis con55 firmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited ad56 verse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though the broad clinical spectrum of outcomes, as lenticulostriate vasculopathy, subependymal cysts, auditive and ophtalmological dis59 orders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes. Conclusions: Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or non-existent in this study. The clinical presentation in our newborns was mild compared to other reports, suggesting that there is significant heterogeneity of Congenital Zika Infection

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (&lt;45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale &amp; Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting &amp; Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (&lt;60, 60-69, and &gt;_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 &amp; PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages &lt;60, 60-69, and &gt;_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791