Impactos negativos da administração de hidroxicloroquina e anticoagulante em pacientes com infecção por SARS-COV-2: um ensaio clínico randomizado

Objetivo: Avaliar antimalárico com ou sem tratamento anticoagulante, em pacientes com infecção recente por SARS-COV-2. Métodos: Estudo clínico realizado no Hospital das Clínicas Samuel Libânio da Universidade do Vale do Sapucaí, Pouso Alegre-MG. Aprovado pelo Comitê de Ética (4.034.077) e registrado nos Ensaios Clínicos (NCT04788355). Pacientes suspeitos de COVID-19 foram incluídos na sala de emergência. Os grupos foram: C (controle) com 6 pacientes, A (anticoagulante apixabana) com 9 pacientes, H (hidroxicloroquina) com 5 pacientes e HA (hidroxicloroquina e anticoagulante apixabana) com 8 pacientes. Resultados: não houve diferenças significativas entre os grupos. O grupo HA, no qual houve intervenção com dois medicamentos, apresentou maior número de dias com sintomas (p = 0,037) e piores resultados, quando comparado ao controle: os sintomas mais relevantes foram: tosse (p = 0,001), e anosmia/ageusia (p = 0,011) cefaléia (p = 0,001). Conclusão: O presente estudo teve início quando havia dúvidas sobre o uso de medicamentos como hidroxicloroquina (HCQ) e apixabana (APX). O “n” reduzido foi definido por meio de questões burocráticas e polêmicas independentes das ações dos autores. Nenhum benefício clínico foi associado com HCQ e APX. Houve um aumento no número de dias sintomáticos quando HCQ e APX foram administrados. Apesar das limitações, não houve indicação terapêutica dos medicamentos avaliados.Purpose: To evaluate antimalarial with or without anticoagulant treatment, in patients with recent SARS-COV-2 infection. Methods: Clinical study carried out at Samuel Libânio Clinic Hospital, University of Vale do Sapucaí, Pouso Alegre-MG. Approved by the Ethics Committee (4.034.077) and registered in the Clinical Trials (NCT04788355). Suspected patients for COVID-19 were included in the emergency room. The groups were: C (control) with 6 patients, A (anticoagulant apixaban) with 9 patients, H (hydroxychloroquine) with 5 patients and HA (hydroxychloroquine and anticoagulant apixaban) with 8 patients. Results: there were no significant differences between groups. The HA group, in which there was an intervention with two drugs, presented a greater number of days with symptoms (p = 0.037) and worse results, when compared to the control: most relevant symptoms, were: cough (p = 0.001), and anosmia / ageusia (p = 0.011) headache (p = 0.001). Conclusion: The present study began when there were doubts about the use of drugs such as Hydroxychloroquine (HCQ) and apixaban (APX). The reduced “n” was defined through bureaucratic and polemic issues independent of the authors’ actions. No clinical benefit was associated with HCQ and APX. There was an increase in the number of symptomatic days when HCQ and APX were administered. Despite the limitations, there was no therapeutic indication of the evaluated drugs

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Qualidade bacteriológica de águas de irrigação de hortas nos municípios Araraquara, Boa Esperança do Sul e Ibitinga, SP

O consumo de alimentos frescos como frutas e hortaliças representa riscos à saúde humana, uma vez que tais alimentos podem estar contaminados, constituindo veículos de transmissão de várias doenças. A água utilizada na irrigação de hortas representa umas das possíveis fontes desse tipo de contaminação, comprometendo a qualidade do produto e, principalmente, a saúde humana. Assim, o controle da qualidade bacteriológica de águas utilizadas para tal finalidade torna-se de vital importância para a saúde pública. O objetivo deste trabalho foi avaliar a qualidade bacteriológica de amostras de águas utilizadas na irrigação de 40 hortas dos municípios de Araraquara, Boa Esperança do Sul e Ibitinga, SP. Foram colhidas em cada horta duas amostras de águas destinadas à irrigação. Tais amostras foram colhidas no mesmo ponto e em diferentes meses, caracterizando dois grupos de coleta com 40 amostras cada, totalizando 80 amostras. Foi determinado o número mais provável (NMP/100 mL) de coliformes totais, coliformes termotolerantes e enterococos, através da técnica dos tubos múltiplos (APHA, 2005). Foi utilizado o padrão de qualidade estabelecido pela Resolução n°357 do Conselho Nacional do Meio Ambiente- CONAMA, que determina um limite de 200 coliformes termotolerantes em 100 mL de amostra de água utilizada para irrigação de hortaliças consumidas cruas (CONAMA, 2005). Após a análise das amostras referentes à primeira coleta, os proprietários das hortas, cujas águas utilizadas na irrigação não atenderam ao padrão de qualidade estabelecido pela Resolução CONAMA n°357 foram orientados quanto à necessidade de medidas de desinfecção das mesmas ou suas fontes. A segunda coleta das amostras ocorreu somente após terem sido tomadas as providências para a melhoria da qualidade da água, nos casos em que isso foi necessário. Após a primeira análise observou-se...The consumption of fresh foods such as fruits and vegetables represents risks to human health, since these foods may be contaminated, behaving as sources of various diseases. The water used for irrigation of vegetables gardens represents one of the possible sources of contamination, which may compromise the quality of the product and, mainly, the human health. Thus, the bacteriological quality control of water used for such purposes becomes vitally important for public health. The objective of this paper was to evaluate the bacteriological quality of water used for irrigation of 40 vegetables gardens in the municipalities of Araraquara, Boa Esperança do Sul and Ibitinga, SP. Were collected in each vegetables garden two samples of water for irrigation. The samples were collected in different months at the same point, featuring two groups collection with 40 samples each, totaling 80 samples. It was determined the most probable number (MPN/100 mL) of total coliforms, termotolerants coliforms and enterococcus using the multiple tube technique (APHA, 2005). It was used the quality standard established by Resolution n°357 of Environmental National Council - CONAMA, which determines a limit of 200 termotolerants coliforms in 100 mL of sample of water used for irrigation of vegetables consumed raw (CONAMA, 2005). After the analysis of the samples from the first collects, the owners of the vegetables gardens, whose waters used in irrigation not satisfy the quality standard established by CONAMA Resolution n°357, were instructed about the necessary disinfection measures of the water or its sources. The second collects of the samples occurred only after been taken steps to improve water quality, when it was necessary. After the first analysis it was observed the presence of termotolerants coliforms, in quantities above the permitted by law, in nine samples (22,5%). The owners of these vegetable... (Complete abstract click electronic access below

Bacteriological quality of irrigation water from vegetable gardens in the municipalities of Araraquara, Boa Esperança do Sul and Ibitinga, SP

This work aimed to assess the bacteriological quality of water used in the irrigation of vegetable gardens in the municipalities of Araraquara, Boa Esperança do Sul and Ibitinga, São Paulo, Brazil. A total of 80 samples of water used in the irrigation of 40 vegetable gardens were analyzed, two samples coming from each vegetable garden. They were collected at the same site in different months, which resulted in two sample collection groups. The most probable number (MPN/100mL) of total coliforms, thermotolerant coliforms and enterococci was identifi ed by means of the multiple tube technique. The analysis of the fi rst group samples showed quantities of thermotolerant coliforms above the amount allowed by current law for irrigation water (CONAMA Resolution n. 357) in nine cases. The owners of those vegetable gardens were then instructed in water disinfection procedures. After the analysis of the second group samples, it was noticed that only one sample did not meet the quality standards, and it was collected at a site where no disinfection procedure had been carried out. According to the results, 77.5% of the vegetable gardens were using water whose samples meet the quality standards. After the owners were instructed with regard to disinfection procedures, that number changed to 97.5%, which confi rms the importance of controlling and supervising irrigation water qualityO objetivo deste trabalho foi avaliar a qualidade bacteriológica de águas utilizadas na irrigação de hortas nos municípios de Araraquara, Boa Esperança do Sul e Ibitinga, SP. Foram analisadas 80 amostras de águas utilizadas na irrigação de 40 hortas, sendo duas amostras de cada horta, coletadas no mesmo ponto e em diferentes meses, caracterizando dois grupos de coleta. Foi determinado o número mais provável (NMP/ 100mL) de coliformes totais, coliformes termotolerantes e enterococos, através da técnica dos tubos múltiplos. Após a análise das amostras referentes à primeira coleta, observou-se a presença de coliformes termotolerantes em quantidades acima da permitida pela legislação vigente para águas destinadas à irrigação (Resolução CONAMA n.357) em nove casos. Os proprietários dessas hortas foram orientados sobre medidas de desinfecção das águas e, após a análise das amostras referentes à segunda coleta, observou-se que apenas uma continuou fora do padrão de qualidade, sendo esta obtida em um ponto de coleta no qual não foi realizado nenhum procedimento de desinfecção. De acordo com os resultados, 77,5% das hortas utilizam águas cujas amostras atendem ao padrão de qualidade e após a intervenção junto aos proprietários este valor sobe para 97,5%, o que confi rma a importância da fi scalização e controle da qualidade da água empregada na irrigação

Castleman's disease as an uncommon cause of a neck mass.

Abstract: Castleman's disease is an uncommon benign disease that causes progressive lymph node enlargement. We report 12 cases of Castleman's disease in the head and neck region in a retrospective review of the medical records of all patients with the pathological diagnosis of Castleman's disease during the period of 1993 through 2002. In the 12 patients, the neck was the most commonly involved site with 9 (75%) cases. Level III was the most common subsite (five cases). The most common sign in our study was an asymptomatic neck mass. No patient had any past histories that required medical attention. Preoperative work up such as fine-needle aspiration and radiographic study was not helpful for diagnostic confirmation. The histopathologic evaluation was the only way to make a definitive diagnosis. The histopathologic subtype of our study was hyaline-vascular type. Excision was curative for all cases. There was no evidence of recurrence with a minimum follow-up duration of 24 months

Activity of compounds isolated from Baccharis dracunculifolia D.C. (Asteraceae) against Paracoccidioides brasiliensis

Submitted by Nuzia Santos ([email protected]) on 2015-08-07T13:00:11Z No. of bitstreams: 1 Activity of compounds isolated from Baccharis dracunculifolia D.C. (Asteraceae) against Paracoccidioides brasiliensis.pdf: 4339932 bytes, checksum: 08a64f488f301f8bd6b181053db4af17 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-08-07T13:00:19Z (GMT) No. of bitstreams: 1 Activity of compounds isolated from Baccharis dracunculifolia D.C. (Asteraceae) against Paracoccidioides brasiliensis.pdf: 4339932 bytes, checksum: 08a64f488f301f8bd6b181053db4af17 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-08-07T13:07:23Z (GMT) No. of bitstreams: 1 Activity of compounds isolated from Baccharis dracunculifolia D.C. (Asteraceae) against Paracoccidioides brasiliensis.pdf: 4339932 bytes, checksum: 08a64f488f301f8bd6b181053db4af17 (MD5)Made available in DSpace on 2015-08-07T13:07:23Z (GMT). No. of bitstreams: 1 Activity of compounds isolated from Baccharis dracunculifolia D.C. (Asteraceae) against Paracoccidioides brasiliensis.pdf: 4339932 bytes, checksum: 08a64f488f301f8bd6b181053db4af17 (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Química de Produtos Naturais. Belo Horizonte, MG, Brasil/Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Microbiologia. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Química de Produtos Naturais. Belo Horizonte, MG, Brasil/Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Microbiologia. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Química de Produtos Naturais. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Microbiologia. Belo Horizonte, MG, BrazilUniversidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Microbiologia. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Química de Produtos Naturais. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Química de Produtos Naturais. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Química de Produtos Naturais. Belo Horizonte, MG, BrasilParacoccidioidomycosis is a prevalent systemic mycosis in Latin America which requires prolonged treatment with highly toxic antifungals.Baccharis dracunculifolia is a medicinal plant in Brazil that is a candidate in the search for new drugs. Fractions of the hexanic extracts were obtained using chromatographic procedures and assessed using an antifungal assay with Paracoccidioides brasiliensis (Pb18), tumor cell lines and amastigote forms of Leishmania, L. amazonensis. Four compounds were isolated, i.e., ursolic acid (1), methyl linolenate (2), caryophyllene oxide (3), and trans-nerolidol (4). Compounds 2, 3 and 4 displayed antifungal activity against four isolates of Paracocci dioides with MIC values ranging from 3.9–250 μg/ml. Only caryophyllene oxide showed differences in the MIC values against Pb18 when the medium was supplemented with ergosterol, which suggested that the compound interacts with ergosterol. Ursolic acid was active in the cytotoxic assays and showed leishmanicidal activity. Scanning electron microscopy demonstrated that compounds 2, 3 and 4 decreased the cell size and produced an irregular cell wall surface on P. brasiliensiscells. The present results showed the biological activities of the isolated compounds and revealed that these compounds may affect the cell surface and growth of P. brasiliensis isolate

The antimicrobial activity of lapachol and its thiosemicarbazone and semicarbazone derivatives

Lapachol was chemically modified to obtain its thiosemicarbazone and semicarbazone derivatives. These compounds were tested for antimicrobial activity against several bacteria and fungi by the broth microdilution method. The thiosemicarbazone and semicarbazone derivatives of lapachol exhibited antimicrobial activity against the bacteria Enterococcus faecalis and Staphylococcus aureus with minimal inhibitory concentrations (MICs) of 0.05 and 0.10 &#181;mol/mL, respectively. The thiosemicarbazone and semicarbazone derivatives were also active against the pathogenic yeast Cryptococcus gattii (MICs of 0.10 and 0.20 &#181;mol/mL, respectively). In addition, the lapachol thiosemicarbazone derivative was active against 11 clinical isolates of Paracoccidioides brasiliensis, with MICs ranging from 0.01-0.10 &#181;mol/mL. The lapachol-derived thiosemicarbazone was not cytotoxic to normal cells at the concentrations that were active against fungi and bacteria. We synthesised, for the first time, thiosemicarbazone and semicarbazone derivatives of lapachol. The MICs for the lapachol-derived thiosemicarbazone against S. aureus, E. faecalis, C. gattii and several isolates of P. brasiliensis indicated that this compound has the potential to be developed into novel drugs to treat infections caused these microbes

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013