TRATAMENTO DA ÚLCERA GÁSTRICA RELACIONADA AO HELICOBACTER PYLORI: ABORDAGENS CIRÚRGICAS E CONSERVADORAS - UMA REVISÃO BIBLIOGRÁFICA

Introduction: Helicobacter pylori-related gastric ulcer is a significant clinical condition marked by challenges such as antibiotic resistance and complications. Surgical and conservative therapeutic approaches play a crucial role in the management of this condition. Objective: This literature review seeks to address surgical and conservative approaches to the treatment of Helicobacter pylori-related gastric ulcers. Methods: A literature review was carried out using scientific databases such as PubMed, Web of Science, Scopus and Google Scholar, from 2004 to 2024. Original studies and reviews investigating therapeutic approaches, pathophysiology and quality of life related to gastric ulcer and H. pylori were included. Results and Discussion: The results and discussion emphasize the effectiveness of conservative therapeutic approaches, such as triple regimens, and the benefits of surgical ones, such as laparoscopic gastrectomy. Challenges such as antibiotic resistance, complications and adherence to treatment are also addressed, highlighting the importance of a multidisciplinary approach. Conclusion: An integrated, evidence-based approach is key to optimizing the management of H. pylori-related gastric ulcers. Areas for future research are highlighted, such as personalized therapies and strategies to overcome challenges such as antibiotic resistance and complications, with the aim of improving clinical outcomes and patients' quality of life.Introducción: La úlcera gástrica relacionada con Helicobacter pylori es una afección clínica importante marcada por retos como la resistencia a los antibióticos y las complicaciones. Los enfoques terapéuticos quirúrgicos y conservadores desempeñan un papel crucial en el tratamiento de esta afección. Objetivo: Esta revisión bibliográfica pretende abordar los enfoques quirúrgicos y conservadores en el tratamiento de la úlcera gástrica relacionada con Helicobacter pylori. Métodos: Se realizó una revisión bibliográfica utilizando bases de datos científicas como PubMed, Web of Science, Scopus y Google Scholar, desde 2004 hasta 2024. Se incluyeron estudios originales y revisiones que investigaran enfoques terapéuticos, fisiopatología y calidad de vida relacionados con la úlcera gástrica y H. pylori. Resultados y discusión: Los resultados y la discusión enfatizan la eficacia de los enfoques terapéuticos conservadores, como los regímenes triples, y los beneficios de los quirúrgicos, como la gastrectomía laparoscópica. También se abordan retos como la resistencia a los antibióticos, las complicaciones y la adherencia al tratamiento, haciendo hincapié en la importancia de un enfoque multidisciplinar. Conclusión: Un enfoque integrado y basado en la evidencia es clave para optimizar el tratamiento de las úlceras gástricas relacionadas con H. pylori. Se destacan las áreas de investigación futura, como las terapias personalizadas y las estrategias para superar retos como la resistencia a los antibióticos y las complicaciones, con el objetivo de mejorar los resultados clínicos y la calidad de vida de los pacientes.A úlcera gástrica relacionada ao Helicobacter pylori é uma condição clínica significativa, marcada por desafios como resistência antibiótica e complicações. Abordagens terapêuticas cirúrgicas e conservadoras desempenham um papel crucial no manejo dessa condição.Objetivo: Esta revisão bibliográfica busca abordar abordagens cirúrgicas e conservadoras no tratamento da úlcera gástrica relacionada ao Helicobacter pylori. Métodos: Foi realizada uma revisão bibliográfica utilizando bases de dados científicas, como PubMed, Web of Science, Scopus e Google Scholar, no período de 2004 a 2024. Foram incluídos estudos originais e revisões que investigaram abordagens terapêuticas, fisiopatologia e qualidade de vida relacionada à úlcera gástrica e H. pylori. Resultados e Discussão: Os resultados e discussão enfatizam a eficácia das abordagens terapêuticas conservadoras, como regimes triplos, e os benefícios das cirúrgicas, como gastrectomia laparoscópica. Também são abordados desafios como resistência antibiótica, complicações e adesão ao tratamento, ressaltando a importância de uma abordagem multidisciplinar. Conclusão: Uma abordagem integrada e baseada em evidências é fundamental para otimizar o manejo da úlcera gástrica relacionada ao H. pylori. São destacadas áreas de pesquisa futuras, como terapias personalizadas e estratégias para superar desafios como resistência antibiótica e complicações, visando melhorar os resultados clínicos e a qualidade de vida dos pacientes.Introdução: A úlcera gástrica relacionada ao Helicobacter pylori é uma condição clínica significativa, marcada por desafios como resistência antibiótica e complicações. Abordagens terapêuticas cirúrgicas e conservadoras desempenham um papel crucial no manejo dessa condição.Objetivo: Esta revisão bibliográfica busca abordar abordagens cirúrgicas e conservadoras no tratamento da úlcera gástrica relacionada ao Helicobacter pylori. Métodos: Foi realizada uma revisão bibliográfica utilizando bases de dados científicas, como PubMed, Web of Science, Scopus e Google Scholar, no período de 2004 a 2024. Foram incluídos estudos originais e revisões que investigaram abordagens terapêuticas, fisiopatologia e qualidade de vida relacionada à úlcera gástrica e H. pylori. Resultados e Discussão: Os resultados e discussão enfatizam a eficácia das abordagens terapêuticas conservadoras, como regimes triplos, e os benefícios das cirúrgicas, como gastrectomia laparoscópica. Também são abordados desafios como resistência antibiótica, complicações e adesão ao tratamento, ressaltando a importância de uma abordagem multidisciplinar. Conclusão: Uma abordagem integrada e baseada em evidências é fundamental para otimizar o manejo da úlcera gástrica relacionada ao H. pylori. São destacadas áreas de pesquisa futuras, como terapias personalizadas e estratégias para superar desafios como resistência antibiótica e complicações, visando melhorar os resultados clínicos e a qualidade de vida dos pacientes

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

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

Utilização de métodos auxiliares na identificação endoparasitária em ovelhas no Amazonas

A verminose é causada por várias espécies de helmintos que parasitam o trato gastrintestinal dos ovinos, causando baixa produtividade e altos índices de morbidade e mortalidade. Objetivou-se avaliar o método que se observa a coloração da conjuntiva ocular, conhecida como método Famacha, como estratégia auxiliar na identificação da carga parasitária nos animais. Foi realizado em conjunto o método de contagem de ovos de parasitas por grama de fezes (OPG).  Foi utilizado 18 ovelhas de padrão racial Santa Inês. O acompanhamento parasitário pelas duas metodologias ocorreu no período de novembro de 2011 a abril de 2012. As avaliações pelos métodos Famacha e OPG foram realizadas mensalmente e individualmente nas ovelhas para o controle. A escala do método Famacha observado variou de 1 à 3 que correspondeu de 0 à 6.500 OPG. Ao término do experimento, ocorreu redução de 64,8% na utilização de medicação antiparasitária nas ovelhas. O método Famacha foi eficiente na identificação dos animais que necessitavam de tratamento antiparasitário para Haemonchus contortus e reduziu a frequência de dosificações de anti-helmíntico.

Time-Course of Redox Status, Redox-Related, and Mitochondrial-Dynamics-Related Gene Expression after an Acute Bout of Different Physical Exercise Protocols

We investigated the magnitude of exercise-induced changes in muscular bioenergetics, redox balance, mitochondrial function, and gene expression within 24 h after the exercise bouts performed with different intensities, durations, and execution modes (continuous or with intervals). Sixty-five male Swiss mice were divided into four groups: one control (n = 5) and three experimental groups (20 animals/group), submitted to a forced swimming bout with an additional load (% of animal weight): low-intensity continuous (LIC), high-intensity continuous (HIC), and high-intensity interval (HII). Five animals from each group were euthanized at 0 h, 6 h, 12 h, and 24 h postexercise. Gastrocnemius muscle was removed to analyze the expression of genes involved in mitochondrial biogenesis (Ppargc1a), fusion (Mfn2), fission (Dnm1L), and mitophagy (Park2), as well as inflammation (Nos2) and antioxidant defense (Nfe2l2, GPx1). Lipid peroxidation (TBARS), total peroxidase, glutathione peroxidase (GPx), and citrate synthase (CS) activity were also measured. Lactacidemia was measured from a blood sample obtained immediately postexercise. Lactacidemia was higher the higher the exercise intensity (LIC < HIC < HII), while the inverse was observed for TBARS levels. The CS activity was higher in the HII group than the other groups. The antioxidant activity was higher 24 h postexercise in all groups compared to the control and greater in the HII group than the LIC and HIC groups. The gene expression profile exhibited a particular profile for each exercise protocol, but with some similarities between the LIC and HII groups. Taken together, these results suggest that the intervals applied to high-intensity exercise seem to minimize the signs of oxidative damage and drive the mitochondrial dynamics to maintain the mitochondrial network, similar to low-intensity continuous exercise

Heterologous Expression, Purification, and Immunomodulatory Effects of Recombinant Lipoprotein GUDIV-103 Isolated from Ureaplasma diversum

Ureaplasma diversum is a bacterial pathogen that infects cattle and can cause severe inflammation of the genital and reproductive systems. Lipid-associated membrane proteins (LAMPs), including GUDIV-103, are the main virulence factors in this bacterium. In this study, we heterologously expressed recombinant GUDIV-103 (rGUDIV-103) in Escherichia coli, purified it, and evaluated its immunological reactivity and immunomodulatory effects in bovine peripheral blood mononuclear cells (PBMCs). Samples from rabbits inoculated with purified rGUDIV-103 were analysed using indirect enzyme-linked immunosorbent assay and dot blotting to confirm polyclonal antibody production and assess kinetics, respectively. The expression of this lipoprotein in field isolates was confirmed via Western blotting with anti-rGUDIV-103 serum and hydrophobic or hydrophilic proteins from 42 U. diversum strains. Moreover, the antibodies produced against the U. diversum ATCC 49783 strain recognised rGUDIV-103. The mitogenic potential of rGUDIV-103 was evaluated using a lymphoproliferation assay in 5(6)-carboxyfluorescein diacetate succinimidyl ester&ndash;labelled bovine PBMCs, where it induced lymphocyte proliferation. Quantitative polymerase chain reaction analysis revealed that the expression of interleukin-1&beta;, toll-like receptor (TLR)-&alpha;, TLR2, TLR4, inducible nitric oxide synthase, and caspase-3&ndash;encoding genes increased more in rGUDIV-103&ndash;treated PBMCs than in untreated cells (p &lt; 0.05). Treating PBMCs with rGUDIV-103 increased nitric oxide and hydrogen peroxide levels. The antigenic and immunogenic properties of rGUDIV-103 suggested its suitability for immunobiological application

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt