Vaginal candidiasis, fungal infection caused by species of Candida spp. that affects women of all ages, cultures, habits, social and economic conditions. Its frequency and epidemiology is already ...reported, but resistance and therapeutic failures have been recorded. Methodology: In the Laboratory of Clinical and Toxicological Analyzes of the Faculty of Pharmacy of UFRGS (LACT), cervicovaginal collections of women were performed for Candida research and determination of species, after which susceptibility tests were performed to fluconazole, itraconazole, ketoconazole and nystatin. With the results obtained complement with the Pharmaceutical Care Project. Results: C. albicans was identified in 37% and in non-albicans species, C. glabrata in 27%. C. albicans was more sensitive to antifungals than C. glabrata, which presented a minimum inhibitory concentration (MIC) higher than C. albicans. Conclusion: Antifungal resistance has increased due to the use in prophylaxis and treatments without the correct diagnosis, requiring a more careful look at these patients. Thus, it is necessary to follow up the diagnosis and treatment by the health professional, the pharmacist, who has knowledge of the drug therapy used and this is obtained by the Pharmaceutical Care acting in the Project.
Vaginal candidiasis, fungal infection caused by species of Candida spp. that affects women of all ages, cultures, habits, social and economic conditions. The present study had as its main objective ...to determine the identification of Candida spp. isolated in a vaginal sample, collected together with the collection for the cytopathological exam, in women treated in a university extension project, aiming at allowing a suitable therapeutics afterwards. The extension project began in January 2014 to June 2019 at the UFRGS. The patients who sought the Laboratory of Clinical and Toxicological Analysis (LACT) of the Faculty of Pharmacy of UFRGS first answered a questionnaire to obtain epidemiological data. Cytopathological diagnosis, Papanicolao smear, and presence of Candida spp. yeast, culture and identification and Trichomonas vaginalis, light microscopy. During the study period, 227 patients, 25.11%, aged 15 to 82 years, presented positive culture for Candida spp. Six species were identified, C. albicans (40.35%), C. glabrata (28.07%) and C. parapsilosis, 15.79%. C. krusei, C. guilliermondii and C. tropicalis totaled (15.79%). Regarding the inflammatory process, present in 49.12%, in C. krusei (75%) and C. guilliermondii (100%), and absence in C. tropicalis. The correct diagnosis and treatment of patients with vaginal candidiasis, even if not considered sexually transmitted, enables to prevent contamination through direct contact, sexual or otherwise, with other individuals and the improvement of self-esteem and quality of life. The prevalence of Candida albicans is still the main cause of vaginal candidiasis, but not neglecting the increase in the number of cases associated with non-albicans species, as well as other infectious agents such as Trichomonas vaginalis, and bacteria.
Superficial skin ringworm is a fungal disease that affects external tissues such as nails, skin and hair of humans and animals. The infection can be transmitted directly, through contact with another ...infected individual or animal, or indirectly, through contaminated materials, these mycoses being potentially contagious. The main objective of the present study was to identify the etiologic agents of potentially contagious cutaneous superficial mycoses present in southern Brazil, correlating with the gender and the most affected sites of the patients.The study period corresponded from January 2011 to June 2019. Prior to the collection, an interview was conducted with patients to obtain epidemiological information. The collected material was scraped from lesions on the skin and nails and hair epilated. The patients were received at the Clinical Analysis Laboratory (LACT) of the UFRGS School of Pharmacy and at the Rio Grande do Sul State Laboratory (LACEN-RS). Subsequently, with the report of the mycological examination, patients treated at LACT were referred to the Dermatology Service of the State of Rio Grande do Sul for medical care and therapy. During the study period, 6010 nail and skin scrapes were obtained and hair, of which 4560 (76%) were negative and 1450 (24%) positive on mycological examination. The most isolated species were T. rubrum (54%), Candida spp. (19%), T. mentagrophytes (14%) and Malassezia spp. (5%). The Female (70%) were the most affected, and nails (72%) were the most affected followed by skin (27%) and hair (1%). With the data obtained on isolated fungal species, we still have much to work with the community developing educational and preventive measures in conjunction with public policies, to try to reduce the risk of contamination by reaching mainly individuals in a higher state of social vulnerability.
Cutaneous superficial mycoses appear as lesions on the skin, hair and nails. The highest prevalence is of fungal infections caused by the fungi of the genus Microsporum, Epidermophyton, Trichophyton, ...Candida and Malassezia. These mycoses are common in tropical regions and are commonly neglected due to lack of patient knowledge, difficult diagnosis and lack of access to health facilities, which makes them a public health problem. In research, mycological examination of patients using Basic Health Units (BHU) was carried out in order to diagnose mycoses. Through this action, it was possible to diagnose and refer to the appropriate treatment 5359 patients, seeking to improve their quality of life. From the results of the mycological exams of these patients during the period from 2011 to 2016, it was possible to trace the epidemiological profile of the State of Rio Grande do Sul and the most prevalent species, contributing to the accomplishment of measures in public health.
Cutaneous superficial mycoses appear as lesions on the skin, hair and nails. The highest prevalence is of fungal infections caused by the fungi of the genus Microsporum, Epidermophyton, Trichophyton, ...Candida and Malassezia. These mycoses are common in tropical regions and are commonly neglected due to lack of patient knowledge, difficult diagnosis and lack of access to health facilities, which makes them a public health problem. In research, mycological examination of patients using Basic Health Units (BHU) was carried out in order to diagnose mycoses. Through this action, it was possible to diagnose and refer to the appropriate treatment 5359 patients, seeking to improve their quality of life. From the results of the mycological exams of these patients during the period from 2011 to 2016, it was possible to trace the epidemiological profile of the State of Rio Grande do Sul and the most prevalent species, contributing to the accomplishment of measures in public health.
Cellular cycle proteins like the p16INK4a and the Ki67 proliferation nuclear antigen have been used as oncogenicity cellular markers. The E6 and E7 oncoproteins interact with tumor suppressor genes ...p53 and pRb, culminating with the p16INK4a overexpression.
The objective of this study was to evaluate the presence of HPV-DNA in 174 cervical biopsies and correlate the different histological grades with the p16INK4a and Ki67 immunohistochemical expression (IHC).
A cross-sectional study that enrolled a total of 174 women who underwent uterine cervical biopsies between February 2003 and December 2006, in southern Brazil, was performed. Cervical smear samples were analyzed for the presence of HPV-DNA through polymerase chain reaction (PCR), and biopsy samples were examined for p16INK4A and Ki67 expression through IHC techniques.
The presence of HPV-DNA was observed in 89% of the tested patients, among which 52% were positive for high-risk (HR) viral types 16, 18 and 31. Regarding p16INK4a, an expression of 69% was observed, being expressed in 100% of the high-grade squamous lesions (HSIL) and HR-HPV-DNA positives. Ki67 expression was associated with the lesion grade, being more expressive in the most severe lesions (p<0.001). p16INK4A and Ki67 markers coexpression was present in 86% of the samples (p<0.001), being 100% among those positive to HR-HPV-DNA with HSIL (p<0.001).
The results suggest an association between the presence of HR-HPV infection and the p16INK4a and Ki67 expression and which is even stronger among women with HSIL.
Cellular cycle proteins like the p16(INK4a) and the Ki67 proliferation nuclear antigen have been used as oncogenicity cellular markers. The E6 and E7 oncoproteins interact with tumor suppressor genes ...p53 and pRb, culminating with the p16(INK4a) overexpression. The objective of this study was to evaluate the presence of HPV-DNA in 174 cervical biopsies and correlate the different histological grades with the p16(INK4a) and Ki67 immunohistochemical expression (IHC). A cross-sectional study that enrolled a total of 174 women who underwent uterine cervical biopsies between February 2003 and December 2006, in southern Brazil, was performed. Cervical smear samples were analyzed for the presence of HPV-DNA through polymerase chain reaction (PCR), and biopsy samples were examined for p16(INK4A) and Ki67 expression through IHC techniques. The presence of HPV-DNA was observed in 89% of the tested patients, among which 52% were positive for high-risk (HR) viral types 16, 18 and 31. Regarding p16(INK4a), an expression of 69% was observed, being expressed in 100% of the high-grade squamous lesions (HSIL) and HR-HPV-DNA positives. Ki67 expression was associated with the lesion grade, being more expressive in the most severe lesions (p<0.001). p16(INK4A) and Ki67 markers coexpression was present in 86% of the samples (p<0.001), being 100% among those positive to HR-HPV-DNA with HSIL (p<0.001). The results suggest an association between the presence of HR-HPV infection and the p16(INK4a) and Ki67 expression and which is even stronger among women with HSIL.
We aimed to assess efficacy and safety, with a special focus on cardiovascular safety, of the novel dual GIP and GLP-1 receptor agonist tirzepatide versus insulin glargine in adults with type 2 ...diabetes and high cardiovascular risk inadequately controlled on oral glucose-lowering medications.
This open-label, parallel-group, phase 3 study was done in 187 sites in 14 countries on five continents. Eligible participants, aged 18 years or older, had type 2 diabetes treated with any combination of metformin, sulfonylurea, or sodium-glucose co-transporter-2 inhibitor, a baseline glycated haemoglobin (HbA1c) of 7·5–10·5% (58–91 mmol/mol), body-mass index of 25 kg/m2 or greater, and established cardiovascular disease or a high risk of cardiovascular events. Participants were randomly assigned (1:1:1:3) via an interactive web-response system to subcutaneous injection of either once-per-week tirzepatide (5 mg, 10 mg, or 15 mg) or glargine (100 U/mL), titrated to reach fasting blood glucose of less than 100 mg/dL. The primary endpoint was non-inferiority (0·3% non-inferiority boundary) of tirzepatide 10 mg or 15 mg, or both, versus glargine in HbA1c change from baseline to 52 weeks. All participants were treated for at least 52 weeks, with treatment continued for a maximum of 104 weeks or until study completion to collect and adjudicate major adverse cardiovascular events (MACE). Safety measures were assessed over the full study period. This study was registered with ClinicalTrials.gov, NCT03730662.
Patients were recruited between Nov 20, 2018, and Dec 30, 2019. 3045 participants were screened, with 2002 participants randomly assigned to tirzepatide or glargine. 1995 received at least one dose of tirzepatide 5 mg (n=329, 17%), 10 mg (n=328, 16%), or 15 mg (n=338, 17%), or glargine (n=1000, 50%), and were included in the modified intention-to-treat population. At 52 weeks, mean HbA1c changes with tirzepatide were −2·43% (SD 0·05) with 10 mg and −2·58% (0·05) with 15 mg, versus −1·44% (0·03) with glargine. The estimated treatment difference versus glargine was −0·99% (multiplicity adjusted 97·5% CI −1·13 to −0·86) for tirzepatide 10 mg and −1·14% (−1·28 to −1·00) for 15 mg, and the non-inferiority margin of 0·3% was met for both doses. Nausea (12–23%), diarrhoea (13–22%), decreased appetite (9–11%), and vomiting (5–9%) were more frequent with tirzepatide than glargine (nausea 2%, diarrhoea 4%, decreased appetite <1%, and vomiting 2%, respectively); most cases were mild to moderate and occurred during the dose-escalation phase. The percentage of participants with hypoglycaemia (glucose <54 mg/dL or severe) was lower with tirzepatide (6–9%) versus glargine (19%), particularly in participants not on sulfonylureas (tirzepatide 1–3% vs glargine 16%). Adjudicated MACE-4 events (cardiovascular death, myocardial infarction, stroke, hospitalisation for unstable angina) occurred in 109 participants and were not increased on tirzepatide compared with glargine (hazard ratio 0·74, 95% CI 0·51–1·08). 60 deaths (n=25 3% tirzepatide; n=35 4% glargine) occurred during the study.
In people with type 2 diabetes and elevated cardiovascular risk, tirzepatide, compared with glargine, demonstrated greater and clinically meaningful HbA1c reduction with a lower incidence of hypoglycaemia at week 52. Tirzepatide treatment was not associated with excess cardiovascular risk.
Eli Lilly and Company.
As coastal communities around the globe contend with the impacts of climate change including coastal hazards such as sea level rise and more frequent coastal storms, educating stakeholders and the ...general public has become essential in order to adapt to and mitigate these risks. Communicating SLR and other coastal risks is not a simple task. First, SLR is a phenomenon that is abstract as it is physically distant from many people; second, the rise of the sea is a slow and temporally distant process which makes this issue psychologically distant from our everyday life. Virtual reality (VR) simulations may offer a way to overcome some of these challenges, enabling users to learn key principles related to climate change and coastal risks in an immersive, interactive, and safe learning environment. This article first presents the literature on environmental issues communication and engagement; second, it introduces VR technology evolution and expands the discussion on VR application for environmental literacy. We then provide an account of how three coastal communities have used VR experiences developed by multidisciplinary teams—including residents—to support communication and community outreach focused on SLR and discuss their implications.
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