Background
Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management ...of these transmural defects remains therapeutically challenging.
Objectives
The aim of this study is to perform a systematic review and meta‐analysis to investigate the efficacy and safety of self‐expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects.
Methods
Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events.
Results
Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10–0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03–0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38–20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13–0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay.
Conclusion
Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
A combustão em meios porosos tem sido uma alternativa promissora para produção de energia térmica tornando o processo mais eficiente e menos poluente. A combustão de GLP (Gás Liquefeito de Petróleo) ...em um queimador poroso melhorado cataliticamente com perovskitas (LaFe0,6Co0,4O3 e LaCoO3) impregnadas em esferas de alumina (Al2O3) foi avaliada. A fase catalítica foi sintetizada pelo método Citrato. A combustão do GLP foi estudada e os parâmetros do processo analisados (velocidade de chama, eficiência total, razão de equivalência, emissões), os parâmetros foram avaliados em meio inerte e catalítico. Ao revestir o meio poroso Al2O3 com catalisadores de perovskitas foi observado a redução das emissões de CO (58%) e NO (87%) na diminuição da razão de equivalência (ɸ) 0,7. O queimador teve uma eficiência total máxima de 94,31% no leito catalítico. Temperaturas são alcançadas com maiores eficiências e menores emissões de poluentes no processo de combustão com o uso de perovskitas.
Despite being a curable disease, tuberculosis (TB) remains a public health problem worldwide mainly due to lengthy treatment, as well as its toxic effects, TB/HIV co-infection and the emergence of ...resistant
strains. These barriers reinforcing the need for development of new antimicrobial agents, that ideally should reduce the time of treatment and be active against susceptible and resistant strains. Quinones are compounds found in natural sources and among them, the naphthoquinones show antifungal, antiparasitic, and antimycobacterial activity. Thus, we evaluated the potential antimycobacterial activity of six 1,4-naphthoquinones derivatives. We determined the minimum inhibitory concentration (MIC) of the compounds against three
strains: a pan-susceptible H37Rv (ATCC 27294); one mono-resistant to isoniazid (ATCC 35822); and one mono-resistant to rifampicin (ATCC 35838); the cytotoxicity in the J774A.1 (ATCC TIB-67) macrophage lineage; performed
analysis about absorption, distribution, metabolism, and excretion (ADME) and docking sites. All evaluated naphthoquinones were active against the three strains with MIC between 206.6 and 12.5 μM, and the compounds with lower MIC values have also showed low cytotoxicity. Moreover, two naphthoquinones derivatives 5 and 6 probably do not exhibit cross resistance with isoniazid and rifampicin, respectively, and regarding ADME analysis, no compound violated the Lipinski's rule-of-five. Considering the set of findings in this study, we conclude that these naphthoquinones could be promising scaffolds to develop new therapeutic strategies to TB.
To perform a systematic review of the viscosupplementation effectiveness with hyaluronic acid (HA) in the articular Temporomandibular Dysfunctions (TMDs) clinical management.
Electronic searches were ...performed in the following databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library, EMBASE, LILACS, BBO, SIGLE (System for Information on Grey Literature in Europe), ClinicalTrials.gov, and the Brazilian Clinical Trials Registry (ReBec). Only randomized clinical trials that evaluated the intra-articular administration of HA or its derivatives in osteoarthritis and/or anterior displacement of the temporomandibular joint (TMJ) disc were included. The primary outcomes evaluated were patients' self-report of pain and/or discomfort in the TMJ. Each study was assessed for the risk of bias, using the Cochrane collaboration's risk of bias tool.
A total of 640 studies were obtained in the electronic search. After the application of the eligibility criteria, manual search, and duplicate removal, 21 articles were included. Five articles classified their volunteers with internal derangements of the TMJ, in 4 articles the treatment was directed to participants with disc displacement with reduction and the other articles evaluated HA therapy in osteoarthritis. The protocols presented heterogeneity, varying in the form of application, associated or not with arthrocentesis, number of applications, molecular weight, dose and concentration. Nine studies presented high risk of bias.
Due to the heterogeneity and methodological inconsistencies of the studies evaluated, it was not possible to establish the efficacy of HA in articular TMDs.
•A systematic review is a key tool to establish the efficacy of clinical therapies.•The synthesis of all articles evaluated revealed great heterogeneity in the clinical protocols applied.•Furthermore, high risk of bias was found in several studies, limiting the level of evidence obtained.•The results of the current systematic review suggest that isolated injections of HA are effective in relieving TMD pain.•At the same time, arthrocentesis plus HA does not appear to be superior to arthrocentesis alone.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The obligate intracellular protozoan Trypanosoma cruzi is the causative agent of Chagas disease, a neglected illness affecting millions of people in Latin America that recently entered non-endemic ...countries through immigration, as a consequence of globalization. The chemotherapy for this disease is based mainly on benznidazole and nifurtimox, which are very efficient nitroderivatives against the acute stage but present limited efficacy during the chronic phase. Our group has been studying the trypanocidal effects of naturally occurring quinones and their derivatives, and naphthoimidazoles derived from β-lapachone N1, N2 and N3 were the most active. To assess the molecular mechanisms of action of these compounds, we applied proteomic techniques to analyze treated bloodstream trypomastigotes, which are the clinically relevant stage of the parasite.
The approach consisted of quantification by 2D-DIGE followed by MALDI-TOF/TOF protein identification. A total of 61 differentially abundant protein spots were detected when comparing the control with each N1, N2 or N3 treatment, for 34 identified spots. Among the differentially abundant proteins were activated protein kinase C receptor, tubulin isoforms, asparagine synthetase, arginine kinase, elongation factor 2, enolase, guanine deaminase, heat shock proteins, hypothetical proteins, paraflagellar rod components, RAB GDP dissociation inhibitor, succinyl-CoA ligase, ATP synthase subunit B and methionine sulfoxide reductase.
Our results point to different modes of action for N1, N2 and N3, which indicate a great variety of metabolic pathways involved and allow for novel perspectives on the development of trypanocidal agents.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Brain iron accumulation neurodegeneration (NBIA) comprises a group of rare diseases characterized by deposits of this metal in brain structures. It presents a great variability of ...progression, which can be fast enough to lead the patient to death in the first years of life, or slow enough to be confused with non-progressive diseases.
Case presentation
Female, 19-year-old patient, cesarean delivery at 38 weeks of gestation. History of multiple sclerosis in a second-degree paternal aunt. Normal neuropsychomotor growth and development up to 11 months, when changes in gait began. After that, it got worse, with decreased muscle strength and falls, but it progressed so slowly that she was diagnosed with cerebral palsy, a non-progressive condition. At the age of 16, she underwent molecular analysis by exome sequencing, being diagnosed with the NBIA Phospholipase A2 (PLAN) variant. Currently doing physical therapy, hydrotherapy, occupational therapy and sertraline.
Conclusions
The report draws attention to the variability of the disease and the possibility of confusion with other diagnoses, which may delay proper management.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The aim was to evaluate the chemical composition, carbohydrates, protein fractionation and in vitro gas production of silages composed of spineless cactus and tropical forages and their effect on ...sheep performance. Treatments consisted of silages: corn silage (CS), spineless cactus silage (SCS), spineless cactus + gliricidia (SCG), spineless cactus + buffel grass silage (SCBG) and spineless cactus + pornunça (SCP). Silos were opened 60 days after ensiling, and analyses were carried out. The digestibility test lasted for 36 days, with eight animals per treatment. A completely randomized design was adopted. Considering carbohydrate fractionation, CS, SCS and SCBG silages had higher total carbohydrate content (
= 0.001). The SCS silage presented a higher A + B1 fraction (
= 0.001). The SCBG and SCG silages showed a higher B2 fraction (
< 0.0001) compared to the CS and SCS silages. The SCBG and SCP silages presented a higher C fraction (
= 0.001). For protein fractionation, the SCP and SCG silages showed higher crude protein contents (
= 0.001). The CS and SCS silages showed a higher A fraction (
= 0.001). The SCBG silage presented a higher B1 + B2 fraction (
= 0.001). The SCG silage showed a higher B3 fraction (
= 0.006) compared to SCBG silage. The SCS and SCP silages showed a higher C fraction (
= 0.001). Exclusive SCS silage showed higher in vitro dry matter digestibility (
= 0.001), dry matter degradability (
= 0.001) and total gas production (
= 0.001). The use of the SCBG, SCP and SCG silages to feed sheep increased the dry matter intake (
< 0.001). Sheep fed the SCG silage showed greater dry matter and crude protein digestibility compared to the sheep fed the CS, SCS and SCP silages (
= 0.002). There was a higher water intake (
< 0.001) with the use of the SCS and SCG silages to feed the sheep. The SCP and SCG silages provided a greater intake (
< 0.001) and excretion (
< 0.001) of nitrogen by the animals. Although there were no differences between the treatments for daily gains, lambs that received the spineless cactus-based silage associated with tropical forages showed higher gains (160-190 g/day) than lambs that received CS silage (130 g/day). Thus, the use of spineless cactus associated with buffelgrass, pornunça and gliricidia to prepare mixed silages (60:40) to feed sheep has potential use to feed sheep, with positive effects on nutrient degradation and increases in dry matter intake. Under experimental conditions, we recommend the exclusive use of spineless cactus silage associated with buffel grass, pornunça and gliricidia in feeding sheep in semi-arid regions, as it provides nutrients, water and greater daily gains compared to corn silage.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe ...Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19).
This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil's federal law recommendations.
The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment's health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated.
In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To determine the main changes that took place in the daily lives of students in the health area during the beginning of the Covid-19 pandemic in Brazil.
This is a cross-sectional study, carried out ...from May to June 2020, with 1786 students over 18 years old, regularly enrolled in health courses at higher education institutions in five regions of Brazil. Sampling was by convenience, typified as snowball. In order to collect data, an instrument to describe the sociodemographic profile and the daily lives of students during the pandemic period was used, which was applied via a digital platform on the web.
The main changes that took place in the daily lives of academic students in the health area in the face of the Covid-19 pandemic in Brazil are related to lower productivity; difficulty concentrating; increased hours of sleep, use of electro-electronic equipment and weight; poorer quality of food; higher consumption of food, legal and illegal substances and medications (mainly analgesics, anxiolytics and antidepressants); less interest in personal appearance; and greater contact with relatives. Regarding emotional changes, it should be underlined the complaints of anxiety, stress, anguish, confusion, helplessness and depression.
During the beginning of the Covid-19 pandemic in Brazil, the students in the health area experienced several changes in their daily lives, which deserve special attention from higher education institutions and health systems, envisioning interventions to minimize health risks to this population.
Cactus pear is used in large proportions in diets for small ruminants in semiarid regions. However, its exclusive use is not recommended due to the low fiber and crude protein content and the high ...water and mineral content, leading to metabolic disorders, low dry matter intake, and weight loss. The use of mixed cactus silage associated with protein and fibrous sources seeks to overcome the deficits in dry matter, fiber and crude protein, aiming to improve the nutritional quality of the diets that will be offered to ruminants. Thus, the use of gliricidia hay in cactus pear silages could represent an important alternative to improve the nutritional and fermentative characteristics of the ensiled material. Therefore, our aim was to evaluate the fermentation dynamics, nutritional characteristics, and aerobic stability of mixed silages of cactus pear combined with different levels of gliricidia hay. This was a completely randomized experimental design with five treatments and five repetitions. The treatments consisted of different levels of inclusion of gliricidia hay (0, 10, 20, 30, and 40% on a dry matter basis) in the composition of mixed cactus pear silages. The inclusion of gliricidia hay in the composition of mixed silages of cactus pear resulted in a quadratic effect for dry matter recovery, pH, NH
-N, buffering capacity, aerobic stability, ether extract, P, K, Na, and Zn (
< 0.05). There was a reduction in density, effluent losses, maximum pH, mineral matter, non-fiber carbohydrates, Ca, Mg, Fe, and Mn (
< 0.05), and an increase in the time to reach maximum pH as well as an upward trend in pH, dry matter, organic matter, crude protein, neutral detergent fiber, acid detergent fiber, and B (
< 0.05). Under experimental conditions, the inclusion of gliricidia hay between 20 and 30% in cactus pear-based silage provided an improvement to the chemical composition and fermentation parameters of the silages.
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