Bacterial vaginosis: prevalence, risk profile and association with sexually transmitted infections

Background and Objectives: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in the world. The study aimed to estimate the prevalence and to identify risk factors associated with bacterial vaginosis. Methods: A cross-sectional study was conducted in Ouro Preto, Brazil, between February and December 2017. Three hundred and forty-one women aged 18 years or older, users of the Brazilian Unified Health System, participated in this study. Women who used oral or topical antibiotics in the four weeks prior to the sample collection and women who had undergone a total hysterectomy were excluded from the study. After signing the Informed Consent Form and filling out a questionnaire containing sociodemographic, behavioral and sexual data, the participants were directed to the collection room, where the nurse collected the samples for the preventive examination of the cervix and also two vaginal swabs. Vaginal swabs and cervical samples were analyzed for cytological abnormalities and BV using Gram staining and cytology. Pathogens causing sexually transmitted infections (STIs) were identified by Polymerase Chain Reaction (PCR). For the analysis of the data, statistical package STATA version 10.0 was used. This study was approved by the Research Ethics Committee of the Federal University of Ouro Preto (UFOP). Results: During the study, 341 women were evaluated. The prevalence of BV using Gram staining (32.5% [CI95% 27.7=37.7%]) and cytology (27.7% [CI95% 23.0=32.8%]) was similar, however, the sensitivity of cytology was lower (77.8%). Risk factors associated with BV were smoking (IRR 1.5[CI95%: 1.1 = 2.1]), use of an intrauterine device (IRR 2.8 [CI95%: 1.2 = 6.5]), and past medical history of BV (IRR 1.5 [CI95%: 1.1 = 2.1]). Correlation between the presence of BV and Trichomonas vaginalis (TV) infection (r=0.24) was observed. Conclusion: The prevalence of BV was affected by life habits and was prevalent in women with TV. Thus, behavioral and social prevention approaches to women with diverse risk profiles may help mitigate TV/BV prevalence and recurrence of BV

Methods for in vitro evaluating antimicrobial activity of medicinal plants : the need for standardization.

A crescente incid?ncia de pat?genos resistentes aos medicamentos atuais incentiva a busca de novos agentes antimicrobianos. Neste contexto, as plantas medicinais se destacam, sendo uma importante fonte de novos f?rmacos. Existem diversos m?todos para avaliar a atividade antibacteriana e antif?ngica de extratos, fra??es, ?leos essenciais e subst?ncias isoladas de vegetais. Os mais conhecidos incluem m?todos de difus?o, dilui??o e bioautografia. A proposta desse trabalho ? apresentar os m?todos mais utilizados atualmente, juntamente com suas vantagens, desvantagens e fatores interferentes. Entre os artigos indexados na biblioteca SciELO, abrangendo os ?ltimos dez anos, somente 4,4% das pesquisas com plantas medicinais est?o relacionadas com atividade antimicrobiana. O m?todo mais utilizado foi a microdilui??o (57,9%), o mais recomendado devido ? alta sensibilidade, ? quantidade m?nima de reagentes e amostra e ? possibilidade de um maior n?mero de r?plicas. Nos trabalhos que utilizaram esse m?todo, foram verificadas diverg?ncias de fatores que podem interferir nos resultados. A fim de facilitar a obten??o de resultados compar?veis e reprodut?veis, destaca-se a necessidade da padroniza??o dos m?todos utilizadas pelos pesquisadores. Recomenda-se utilizar como refer?ncia as normas estabelecidas pelo CLSI para meio de cultura e concentra??o de in?culo nos testes. Al?m disso, tamb?m recomenda-se a inclus?o de um controle negativo da forma de solubiliza??o das amostras, com quantifica??o do crescimento microbiano, para evitar a interfer?ncia nos resultados.The increasing incidence of resistant pathogens to current drugs encourages the search for new antimicrobial agents. In this context, medicinal plants are an important source of new drugs. There are several methods for evaluating the antibacterial and antifungal activity of extracts, fractions, essential oils and isolated substances from the plant. The most known include diffusion, dilution and bioautography methods. The purpose of this paper is to present the most used methods currently, along with their advantages, disadvantages and interfering factors. Among the works available in the SciELO database, covering the last ten years, only 4,4% of research on medicinal plants are related to the antimicrobial activity. The most used method is microdilution (57,9%), the best recommended due to high sensitivity, the minimum quantity of reagents and sample and the possibility of a more significant number of replicates. In articles that used this method, differences were observed in factors that may affect the results. Thereby, there is the need for standardization of methods used by researchers to facilitate obtaining comparable and reproducible results. To achieve comparable and reproducible results, there is the need to standardize the methods used by the researchers. It is recommended to use as reference the standards established by CLSI for culture medium and inoculum concentration in the tests. It also recommended the inclusion of negative control of the solubilization of the samples with quantification of microbial growth to avoid interference with the results

Polymeric micelles containing resveratrol: development, characterization, cytotoxicity on tumor cells and antimicrobial activity

Antimicrobial and antitumor activities of resveratrol, a compound found mainly in grapes, have already been demonstrated. However, its low bioavailability is a limiting factor for therapeutic application. Polymeric micelles can be an approach to solve this problem since they can encapsulate hydrophobic substances. We developed and characterized micellar formulations containing resveratrol and evaluated their cytotoxic and antimicrobial effects. The formulations were prepared by the cold dispersion method with different concentrations of F127 (5 or 10% w/w) and resveratrol (500 or 5000 µM). The formulations were characterized according to size, polydispersity index, pH, encapsulation rate and in vitro release. Cytotoxic effect was evaluated on a bladder cancer cell line and antimicrobial effect was evaluated on E. coli, S. aureus and C. albicans. One of the formulations (10% w/w of F127 and 5000 µM of resveratrol) was a monodispersed solution with high encapsulation rate, thus it was chosen for the cytotoxicity and antimicrobial assays. MS10+RES-3 was able to preserve the antimicrobial and cytotoxic activity of resveratrol. This is the first study that evaluated antimicrobial potential and cytotoxicity of micelles containing resveratrol on bladder cancer cells and the results showed that micellar nanostructures could ensure the maintenance of the biological activity of resveratrol

As manifestações clínicas do portador de paralisia facial

Introdução: A paralisia facial e um sintoma de um transtorno de base resultante em imobilidade e incapacidade de executar a mímica facial e a expressão emotiva. São várias as etiologias deste acometimento, sendo a classificação em paralisia facial periférica, representada classicamente pela paralisia de Bell e a central, pelo acidente vascular encefálico, adotada para auxiliar na investigação e seguimento clínico adequado. Objetivo: Descrever sobre a paralisia facial, com foco em características clínicas que propiciem ao diagnóstico precoce, medidas terapêuticas e restauração imediata. Metodologia: Revisão narrativa que selecionou artigos disponibilizados na íntegra publicados no recorte temporal de 2008 até 2022. Resultados: Dos 10 artigos incluídos neste estudo, todos realizaram uma ampla análise sobre a temática, a qual propiciou a disseminação de informações atualizadas sobre conceito, diagnóstico diferencial entre duas condições clínicas opostas resultantes em paralisia facial, manifestações, avaliação clínica e manejo adequado. Conclusão: Estudos ainda urgem em ser feitos no intuito de orientar melhor os profissionais e a comunidade a respeito da paralisia facial e a importância que possui o acompanhamento e seguimento precoce. Destarte,

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Métodos para avaliação in vitro da atividade antimicrobiana de plantas medicinais: a necessidade da padronização

A crescente incidência de patógenos resistentes aos medicamentos atuais incentiva a busca de novos agentes antimicrobianos. Neste contexto, as plantas medicinais se destacam, sendo uma importante fonte de novos fármacos. Existem diversos métodos para avaliar a atividade antibacteriana e antifúngica de extratos, frações, óleos essenciais e substâncias isoladas de vegetais. Os mais conhecidos incluem métodos de difusão, diluição e bioautografia. A proposta desse trabalho é apresentar os métodos mais utilizados atualmente, juntamente com suas vantagens, desvantagens e fatores interferentes. Entre os artigos indexados na biblioteca SciELO, abrangendo os últimos dez anos, somente 4,4% das pesquisas com plantas medicinais estão relacionadas com atividade antimicrobiana. O método mais utilizado foi a microdiluição (57,9%), o mais recomendado devido à alta sensibilidade, à quantidade mínima de reagentes e amostra e à possibilidade de um maior número de réplicas. Nos trabalhos que utilizaram esse método, foram verificadas divergências de fatores que podem interferir nos resultados. A fim de facilitar a obtenção de resultados comparáveis e reprodutíveis, se faz necessária a padronização dos métodos utilizados pelos pesquisadores. Recomenda-se utilizar como A crescente incidência de patógenos resistentes aos medicamentos atuais incentiva a busca de novos agentes antimicrobianos. Neste contexto, as plantas medicinais se destacam, sendo uma importante fonte de novos fármacos. Existem diversos métodos para avaliar a atividade antibacteriana e antifúngica de extratos, frações, óleos essenciais e substâncias isoladas de vegetais. Os mais conhecidos incluem métodos de difusão, diluição e bioautografia. A proposta desse trabalho é apresentar os métodos mais utilizados atualmente, juntamente com suas vantagens, desvantagens e fatores interferentes. Entre os artigos indexados na biblioteca SciELO, abrangendo os últimos dez anos, somente 4,4% das pesquisas com plantas medicinais estão relacionadas com atividade antimicrobiana. O método mais utilizado foi a microdiluição (57,9%), o mais recomendado devido à alta sensibilidade, à quantidade mínima de reagentes e amostra e à possibilidade de um maior número de réplicas. Nos trabalhos que utilizaram esse método, foram verificadas divergências de fatores que podem interferir nos resultados. A fim de facilitar a obtenção de resultados comparáveis e reprodutíveis, se faz necessária a padronização dos métodos utilizados pelos pesquisadores. Recomenda-se utilizar comoreferência as normas estabelecidas pelo CLSI para meio de cultura e concentração de inóculo nos testes. Além disso, também se recomenda a inclusão de um controle negativo da forma de solubilização das amostras, com quantificação do crescimento microbiano, para evitar a interferência nos resultados