Validation of the Ottawa Ankle Rules: Strategies for Increasing Specificity

Introduction: The majority of patients with ankle injuries undergo radiological examinations of the foot, ankle or both. The objective of this study was in the first place to validate the Ottawa Ankle Rules (OARs) for the population of our centre. Secondly, an attempt was made to identify parameters that contribute to improve the specificity of the method, with a view to reduce the need for patients to be exposed to radiation as well as optimizing the expenses of the Emergency Ward (EW). Materials and methods: This was a prospective study conducted during a 9-month period. The study population included 148 patients, in 54 (36%) of the patients a fracture was present on the exams performed. Patients were submitted to a sequential protocol in the EW with a form completion, evaluation of OARs, application of the Visual Analog Pain Scale (VAS) and radiographic exams. Results: We found a sensitivity of OARs in ankle injuries of 100%, specificity of 26% and in midfoot injuries of 100% and 62% respectively. All patients with fractures had a VAS of 5 or more points in any of the tested sites. With the VAS criterium, we found a significant increase of global specificity (38% vs 15%), as well as when applied only to the ankle (26% to 47%) or to midfoot trauma (62% to 67%). In both, there would have been a 100% reduction of CT scans. Patients with a fracture or with fractures who required surgical treatment had a mean VAS significantly higher than patients with no fracture or fractures submitted to conservative treatment respectively. Although there was a lower percentage of fractures in the group of injuries in Work Accidents (31% vs 37% Sports Activity and 38% Leisure Activity), there was a statistically significant increase in the sum of average VAS in Accidents at Work vs Leisure Activities and vs Sports Activities. Conclusion: We seek to confirm the usefulness of OARs for our population and we investigated strategies to further reduce the need for unnecessary radiographs. The introduction of parameters for grading pain and adapting to the context of the accident seem promisinginfo:eu-repo/semantics/publishedVersio

Is gut microbiota the key?

Funding: This study was supported by ERDF through the operation POCI-01-0145-ERDF-007746 funded by Programa Operacional Competitividade e Internacionalização—COMPETE2020 and by National Funds through FCT—Fundação para a Ciência e a Tecnologia within CINTESIS, R&D Unit (reference UID/IC/4255/2013) and CHRC (UIDB/04923/2020 and UIDP/04923/2020). This study was also supported by Emilio Peres grant from the Portuguese Society of Diabetology.The Mediterranean diet (MD) has been recommended for type 2 diabetes (T2D) treatment. The impact of diet in shaping the gut microbiota is well known, particularly for MD. However, the link between MD and diabetes outcome improvement is not completely clear. This study aims to evaluate the role of microbiota modulation by a nonpharmacological intervention in patients with T2D. In this 12-week single-arm pilot study, nine participants received individual nutritional counseling sessions promoting MD. Gut microbiota, biochemical parameters, body composition, and blood pressure were assessed at baseline, 4 weeks, and 12 weeks after the intervention. Adherence to MD [assessed by Mediterranean Diet Adherence Screener (MEDAS) score] increased after the intervention. Bacterial richness increased after 4 weeks of intervention and was negatively correlated with fasting glucose levels and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Prevotella to Bacteroides ratio also increased after 4 weeks. In contrast, glycated haemoglobin (HbA1c) and HOMA-IR were only decreased at the end of study. Alkaline phosphatase activity was assessed in fecal samples and was negatively correlated with HbA1c and positively correlated with bacterial diversity. The results of this study reinforce that MD adherence results in a better glycemic control in subjects with T2D. Changes in gut bacterial richness caused by MD adherence may be relevant in mediating the metabolic impact of this dietary intervention.publishersversionpublishe

A Randomized, Double-Blind, Controlled Trial

Funding This work was supported by ERDF through the operation POCI-01−0145-ERDF-007746 funded by the Programa Operacional Competitividade e Internacionalização − COMPETE2020 and by FCT - Fundação para a Ciência e a Tecnologia, IP national support through CINTESIS, R&D Unit (UIDB/4255/2020), CHRC (UIDP/04923/2020 and UIDB/04923/2020) and through the project reference PTDC/BAA-AGR/7419/2020.Gut microbiota modulation might constitute a mechanism mediating the effects of beer on health. In this randomized, double-blinded, two-arm parallel trial, 22 healthy men were recruited to drink 330 mL of nonalcoholic beer (0.0% v/v) or alcoholic beer (5.2% v/v) daily during a 4-week follow-up period. Blood and faecal samples were collected before and after the intervention period. Gut microbiota was analyzed by 16S rRNA gene sequencing. Drinking nonalcoholic or alcoholic beer daily for 4 weeks did not increase body weight and body fat mass and did not changed significantly serum cardiometabolic biomarkers. Nonalcoholic and alcoholic beer increased gut microbiota diversity which has been associated with positive health outcomes and tended to increase faecal alkaline phosphatase activity, a marker of intestinal barrier function. These results suggest the effects of beer on gut microbiota modulation are independent of alcohol and may be mediated by beer polyphenols.publishersversionpublishe

Kinins Released by Erythrocytic Stages of Plasmodium falciparum Enhance Adhesion of Infected Erythrocytes to Endothelial Cells and Increase Blood Brain Barrier Permeability via Activation of Bradykinin Receptors

Background:Plasmodium falciparum, the etiologic agent of malaria, is a major cause of infant death in Africa. Although research on the contact system has been revitalized by recent discoveries in the field of thrombosis, limited efforts were done to investigate the role of its proinflammatory arm, the kallikrein kinin system (KKS), in the pathogenesis of neglected parasitic diseases, such as malaria. Owing to the lack of animal models, the dynamics of central nervous system (CNS) pathology caused by the sequestration of erythrocytic stages of P. falciparum is not fully understood. Given the precedent that kinins destabilize the blood brain barrier (BBB) in ischemic stroke, here we sought to determine whether Plasmodium falciparum infected erythrocytes (Pf-iRBC) conditioned medium enhances parasite sequestration and impairs BBB integrity via activation of the kallikrein kinin system (KKS).Methods: Monolayers of human brain endothelial cell line (BMECs) are preincubated with the conditioned medium from Pf-iRBCs or RBCs (controls) in the presence or absence of HOE-140 or DALBK, antagonists of bradykinin receptor B2 (B2R) and bradykinin receptor B1 (B1R), respectively. Following washing, the treated monolayers are incubated with erythrocytes, infected or not with P. falciparum mature forms, to examine whether the above treatment (i) has impact on the adhesion of Pf-iRBC to BMEC monolayer, (ii) increases the macromolecular permeability of the tracer BSA-FITC, and (iii) modifies the staining pattern of junctional proteins (ZO-1 and β-catenin).Results: We found that kinins generated in the parasite conditioned medium, acting via bradykinin B2 and/or B1 receptors (i) enhanced Pf-iRBC adhesion to the endothelium monolayer and (ii) impaired the endothelial junctions formed by ZO-1 and β-catenin, consequently disrupting the integrity of the BBB.Conclusions: Our studies raise the possibility that therapeutic targeting of kinin forming enzymes and/or endothelial bradykinin receptors might reduce extent of Pf-iRBC sequestration and help to preserve BBB integrity in cerebral malaria (CM)

LEVANTAMENTO DE LAGARTAS (LEPIDOPTERA) NO PARQUE RECREATIVO SUCUPIRA E COMPARAÇÃO DE INTERAÇÕES COM PLANTAS HOSPEDEIRAS NO CERRADO DO BRASIL CENTRAL

Brazilian Cerrado is considered an important area for environment conservation, due to its high species’ richness and endemism. Nevertheless, this biome has been intensely destroyed because of its potential for agriculture – of plants and animals. For this reason, it is important to have tools to evaluate quickly the effects of such threats on biological diversity. A type of approach that has been investigated lately is using ecological interactions, since species exclusion or a change on its abundance caused by human disturbance may cause co-extinctions. Therefore, getting to know different aspects on interactions between species may be the fi rst step to understand the stability of an ecosystem after such threats. So, in the present work the utilization of fi ve plant species by caterpillars (Lepidoptera) was surveyed in a urban park at Planaltina, Federal District. Since there is quite an extensive information on the ecology of these animals at the region, this work aimed to compare the amount of interactions between caterpillars and plants at the urban park with data in the literature, considering the situation at wellpreserved areas. Besides, considering the level of integrity on interactions, it was also aimed to suggest how human visitation at the park threatens caterpillars. To this purpose, caterpillars were surveyed at fi ve host plants, Byrsonima coccolobifolia, Kielmeyera sp., Himathantus obovatus, Pouteria ramifl ora e Roupala montana, in June, when caterpillars are more abundant in the fi eld. Using the community structure that was found, it was estimated species richness at each host plant. It was found 32 caterpillar species. In four out of fi ve studied plants, the number of estimated species is not much lower than the ones at preserved areas. Only in R. montana it was not found a species richness as high as expected, by considering literature data. This work reinforces the application of rapid surveys for conservation actions and suggests that other groups of organism should be considered in the future to confi rm the preservation pattern of study area.O bioma Cerrado é considerado importante por abrigar alta riqueza de espécies e endemismos. No entanto, este vem sofrendo uma intensa destruição, devido ao seu potencial agrícola e pecuário. Por esse motivo, é importante que se tenham ferramentas para avaliar, de forma rápida, os efeitos dessas pressões na integridade da diversidade biológica. Uma das abordagens que vem sendo investigada é a de considerar interações ecológicas, porque a exclusão e/ou alteração da abundância de espécies, causada pela perturbação, podem promover co-extinção destas. Assim, conhecer diferentes características de interações entre espécies pode ser o primeiro passo para acessar a estabilidade do ecossistema frente a tais perturbações. Nesse sentido, no presente trabalho foi levantada a utilização de cinco espécies de plantas hospedeiras por lagartas (Lepidoptera), em um Parque urbano de Planaltina, no Distrito Federal. Uma vez que existe uma grande quantidade de informação ecológica sobre esses animais no Distrito Federal, o objetivo principal deste trabalho foi o de comparar a quantidade de interações lagartas x plantas encontradas no Parque urbano com a descrita na literatura científi ca para áreas mais preservadas. Além disso, através dessa comparação, considerando a integridade das interações, objetivou-se propor o grau de distúrbio causado pela visitação humana no Parque. Para isso, durante o mês de junho, quando há maior abundância de lagartas no campo, foi feito um levantamento das mesmas nas plantas Byrsonima coccolobifolia, Kielmeyera sp., Himathantus obovatus, Pouteria ramifl ora e Roupala montana. A partir da estrutura da comunidade de Lepidoptera encontrada, foi estimada a riqueza total de espécies de lagartas em cada planta hospedeira. Durante o levantamento, foram encontradas 32 espécies de lagartas no total. Em quatro espécies de plantas, os resultados obtidos pelas estimativas de riqueza de espécies indicaram que o número de interações encontradas no Parque urbano não é tão menor do que o encontrado nas áreas preservadas. Somente em R. montana foi encontrada uma riqueza de espécies abaixo à esperada, de acordo com as comunidades descritas na literatura. Sob esse aspecto, sugere-se que o Parque parece estar em bom estado de conservação. O presente trabalho reforça a aplicação de levantamentos rápidos em práticas de conservação e sugere a inclusão de novos grupos de organismos no futuro, para confi rmar o padrão sobre o grau de preservação da área de estudo

SARS-CoV-2 uses CD4 to infect T helper lymphocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.</p

SARS-CoV-2 uses CD4 to infect T helper lymphocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.</p