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BACKGROUND: Methylene blue (MB)-mediated photodynamic inactivation (PDI) has shown good results in killing Candida spp. Although MB solutions are commonly used, new formulations have been designed to improve PDI. However, chemical substances in the formulation may interfere with the PDI outcome. In this sense, different methodologies should be used to evaluate PDI in vitro. Herein, we report different methodologies to evaluate the effects of PDI with an oral formulation (OF) containing 0.005% MB on Candida albicans biofilm. METHODS: Biofilms were treated using the MB-OF, with 5 min pre-irradiation time and exposure to a 640 nm LED device (4.7 J/cm2). PDI was evaluated by the XTT reduction test, counting the colony forming units (CFU), a filamentation assay, crystal violet (CV) staining, and scanning electronic microscopy (SEM). RESULTS: PDI was able to reduce around 1.5 log10 CFU/mL, even though no significant differences were noted in metabolic activity in comparison to the control immediately after PDI. A significant decrease in yeast to hyphae transition was observed after PDI, while the biofilm exhibited flattened cells and a reduced number of yeasts in SEM. The CV assay showed increased biomass. CONCLUSION: MB-OF-mediated PDI was effective in C. albicans biofilms, as it significantly reduced the CFU/mL and the virulence of surviving cells. The CV data were inconclusive, since the OF components interacted with the CV, making the data useless. Taken together, our data suggest that the association of different methods allows complementary responses to assess how PDI mediated by a formulation impacts biofilms.
Assuntos
Candida albicans , Fotoquimioterapia , Biofilmes , Candida , Azul de Metileno/farmacologia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologiaRESUMO
Inadequate nutrient intake can lead to worse outcomes in patients with heart failure (HF). This prospective cohort study aimed to assess the prevalence of inadequate micronutrient intake and their association with prognosis in 121 adult and elderly outpatients with HF. Habitual micronutrient intake was evaluated using 24-h dietary recalls (minimum 2 and maximum 6). Participants were grouped into moderate (n = 67) and high (n = 54) micronutrient deficiency groups, according to the individual assessment of each micronutrient intake. Patients' sociodemographic, clinical, and anthropometric data and clinical outcomes (hospitalization and mortality) within 24 months were collected. Overall and event-free survival rates were calculated using Kaplan-Meier estimates, and curves were compared using the log-rank test. The death risk rate (hazard ratio (HR)) was calculated using Cox's univariate model. The rate of inadequate intake was 100% for vitamins B1 and D and above 80% for vitamins B2, B9, and E, calcium, magnesium, and copper. No differences in overall survival and event-free survival were observed between groups of HF outpatients with moderate and high micronutrient deficiencies (HR = 0.94 (CI = 0.36-2.48), p = 0.91, and HR = 1.63 (CI = 0.68-3.92), p = 0.26, respectively), as well as when the inadequacy of each micronutrient intake was evaluated alone (all p > 0.05). In conclusion, a high prevalence of inadequate micronutrient intake was observed in outpatients with HF. Inadequate micronutrient intake was not associated with hospitalization and mortality in this group of patients.
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Insuficiência Cardíaca , Pacientes Ambulatoriais , Adulto , Idoso , Ingestão de Alimentos , Insuficiência Cardíaca/complicações , Humanos , Micronutrientes , Prognóstico , Estudos ProspectivosRESUMO
Background: Few studies have explored the impact of ischemic and non-ischemic etiologies of heart failure and other factors associated with heart failure on zinc and copper status. This study examined zinc and copper status in 80 outpatients with ischemic (n = 36) and non-ischemic (n = 44) heart failure and associations with biodemographic, clinical, biochemical, and nutritional parameters.Materials: Biomarkers of plasma zinc and copper, copper-zinc ratio, 24-h urinary zinc excretion, ceruloplasmin, and dietary intake of zinc and copper were assessed. Plasma zinc and copper and urinary zinc were measured by inductively coupled plasma mass spectrometry (ICP-MS).Results: Patients with ischemic heart failure showed lower dietary zinc intake and higher dietary copper intake (both p = 0.02). Zinc and copper in plasma, copper-zinc ratio, ceruloplasmin, and 24-h urinary zinc excretion showed no statistical differences between the groups (all p ≥ 0.05). An inverse association was found between age (ß =-0.001; p = 0.005) and the use of diuretics (ß = -0.047; p = 0.013) and plasma zinc. Copper levels in plasma (ß = 0.001; p < 0.001), and albumin (ß = 0.090; p<0.001) were directly associated with plasma zinc. A positive association was found between ceruloplasmin (ß = 0.011; p < 0.001), gamma-glutamyl transferase (ß = 0.001; p < 0.001), albumin (ß = 0.077; p = 0.001), and high-sensitivity c-reactive protein (ß = 0.001; p = 0.024) and plasma copper.Conclusion: Zinc and copper biomarkers in clinically stable patients with heart failure did not seem to be responsive to the differences in zinc and copper intake observed in this study, regardless of heart failure etiology. The predictors of plasma zinc and copper levels related to oxidative stress and inflammation should be monitored in heart failure clinical practice.
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Insuficiência Cardíaca , Zinco , Biomarcadores , Proteína C-Reativa/metabolismo , Ceruloplasmina/metabolismo , Cobre , Humanos , Pacientes AmbulatoriaisRESUMO
INTRODUCTION: Aims: hypovitaminosis D has frequently been identified in patients with heart failure (HF). However, few studies have been conducted in regions with high solar incidence. Therefore, this study aimed to evaluate vitamin D status and predictors of 25-hydroxyvitamin D (25(OH)D) levels in patients with HF living in a sunny region (5 °- 6 °S). Methods: this cross-sectional study enrolled 70 patients with HF. Biodemographic, clinical, biochemical, dietary, and sun exposure data were collected, and 25(OH)D levels were measured. Results: the mean 25(OH)D level was 40.1 (12.4) ng/mL, and 24.3 % (95 % CI: 14.2-33.8) of patients with HF had hypovitaminosis D (25(OH)D < 30 ng/mL). Female patients (p = 0.001), those with ischemic etiology (p = 0.03) and those with high parathyroid hormone levels (> 67 pg/mL) (p = 0.034) were more likely to present hypovitaminosis D. Higher 25(OH)D levels were observed in men than in women (ß = 7.78, p = 0.005) and in patients with HF in New York Heart Association (NHYA) functional class I when compared to those in class III/IV (ß = 8.23, p = 0.032). Conclusions: the majority of patients with HF had sufficient 25(OH)D levels. Sex and functional classification were identified as independent predictors of 25(OH)D levels. These results highlight the need for increased monitoring of vitamin D status among female patients with heart failure and those with more severe symptoms.
INTRODUCCIÓN: Objetivos: la hipovitaminosis D se ha identificado con frecuencia en pacientes con insuficiencia cardíaca (IC). Sin embargo, pocos estudios se han realizado en regiones con una alta exposición solar. Por lo tanto, este estudio tuvo como objetivo evaluar el estado de la vitamina D y los predictores de los niveles de 25-hidroxivitamina D (25(OH)D) en pacientes con IC que viven en una región soleada (5 °-6 °S). Métodos: este estudio transversal incluyó a 70 pacientes con IC. Se recopilaron datos biodemográficos, clínicos, bioquímicos, dietéticos y de exposición solar, y se midieron los niveles de 25(OH)D. Resultados: el nivel medio de 25(OH)D fue de 40,1 (12,4) ng/mL y el 24,3 % (IC 95 %: 14,2-33,8) de los pacientes con IC tenían hipovitaminosis D (25(OH)D < 30 ng/mL. Las pacientes mujeres (p = 0,001), aquellos con IC de etiología isquémica (p = 0,03) y aquellos otros pacientes con niveles altos de hormona paratiroidea (> 67 pg/mL) (p = 0,034) tenían más probabilidades de presentar hipovitaminosis D. Se observaron niveles más altos de 25(OH)D en los hombres que en las mujeres (ß = 7,78, p = 0,005), y en los pacientes con IC de clase funcional I de la New York Heart Association (NHYA) que en los de clase III/IV (ß = 8,23, p = 0,032). Conclusiones: la mayoría de los pacientes con IC tenían niveles suficientes de 25(OH)D. El sexo y la clasificación funcional se identificaron como predictores independientes de los niveles de 25(OH)D. Estos resultados destacan la necesidad de un mayor control del estado de la vitamina D entre las mujeres con insuficiencia cardíaca y los pacientes con síntomas más graves.
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Insuficiência Cardíaca/sangue , Luz Solar , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fatores Sexuais , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: to estimate the prevalence and factors associated with suicide risk among nurses and physicians. METHOD: a cross-sectional study carried out at a university hospital with 216 health professionals, who answered a socio-demographic-labor questionnaire, the Mini International Neuropsychiatric Interview (MINI) for assessing suicide risk, and the Depression, Anxiety and Stress Scale (DASS 21). The Poisson Regression Model was used for multiple analysis. RESULTS: it was identified that variables such as not having a partner, history of attempted suicide, stress and depression symptoms were statistically associated with suicide risk. The prevalence of lifelong suicide attempts among nurses was 9.41%, and among physicians, 2.29%. CONCLUSION: the findings of this investigation enable the understanding of suicidal behavior among hospital nurses and physicians, in addition to enabling the development of prevention strategies in order to reduce suicide risk prevalence in this population group.
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Enfermeiras e Enfermeiros/psicologia , Médicos/estatística & dados numéricos , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Tentativa de Suicídio/psicologiaRESUMO
ABSTRACT Objective: to estimate the prevalence and factors associated with suicide risk among nurses and physicians. Method: a cross-sectional study carried out at a university hospital with 216 health professionals, who answered a socio-demographic-labor questionnaire, the Mini International Neuropsychiatric Interview (MINI) for assessing suicide risk, and the Depression, Anxiety and Stress Scale (DASS 21). The Poisson Regression Model was used for multiple analysis. Results: it was identified that variables such as not having a partner, history of attempted suicide, stress and depression symptoms were statistically associated with suicide risk. The prevalence of lifelong suicide attempts among nurses was 9.41%, and among physicians, 2.29%. Conclusion: the findings of this investigation enable the understanding of suicidal behavior among hospital nurses and physicians, in addition to enabling the development of prevention strategies in order to reduce suicide risk prevalence in this population group.
RESUMEN Objetivo: estimar la prevalencia y los factores asociados al riesgo de suicidio entre enfermeros y médicos. Método: estudio transversal, desarrollado en un hospital universitario con 216 profesionales de la salud, quienes respondieron un cuestionario sociodemográfico-laboral; el Mini International Neuropsychiatric Interview (MINI), para evaluar el riesgo de suicidio; Escala de Depresión, Ansiedad y Estrés (DASS 21). El modelo de regresión de Poisson se utilizó para el análisis múltiple. Resultados: se identificó que variables como no tener pareja, antecedentes de intento de suicidio, síntomas de estrés y depresión se asociaron estadísticamente con el riesgo de suicidio. La prevalencia de intentos de suicidio de por vida entre enfermeras y médicos fue del 9,41% y del 2,29%. Conclusión: los hallazgos de esta investigación permiten comprender la conducta suicida entre enfermeros y médicos del área hospitalaria, además de posibilitar el desarrollo de estrategias de prevención con el fin de reducir la prevalencia de riesgo suicida en este grupo poblacional.
RESUMO Objetivo: estimar a prevalência e os fatores associados ao risco de suicídio entre enfermeiros e médicos. Método: estudo transversal, desenvolvido em um hospital universitário com 216 profissionais da saúde, que responderam a um questionário sociodemográfico-laboral; ao Mini International Neuropsychiatric Interview (MINI), para avaliação do risco de suicídio; Escala de Depressão, Ansiedade e Estresse (DASS 21). Utilizou-se para análise múltipla, o Modelo de Regressão de Poisson. Resultados: identificou-se que variáveis, como não ter companheiro, histórico de tentativa de suicídio, sintomas de estresse e depressão se associaram estatisticamente ao risco de suicídio. A prevalência das tentativas de suicídios ao longo da vida entre enfermeiros foi de 9,41% e médicos de 2,29%. Conclusão: Os achados desta investigação possibilitam a compreensão do comportamento suicida entre os enfermeiros e médicos da área hospitalar, além de viabilizar a elaboração de estratégias de prevenção com intuito de diminuir a prevalência do risco de suicídio nesse grupo populacional.
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O estudo da dor e suas particularidades é de grande importância para o tratamento de diversas patologias e para a melhora na qualidade de vida dos pacientes. A maioria das disfunções orgânicas tem a dor como um ponto importante da sua manifestação. Dessa maneira, é justificável a elaboração de conteúdo para auxiliar os profissionais da saúde no entendimento e tratamento das principais causas de dores agudas e crônicas. Este livro foi elaborado com o objetivo de servir como um guia prático para o manejo da dor por profissionais e acadêmicos de Medicina. Engloba temas como conceitos e aspectos biopsicossociais da dor, além de questões mais complexas como a fisiologia da dor e o tratamento medicamentoso com o arsenal terapêutico existente. Finalmente, também trata dos diversos tipos de dor mais prevalentes e o conhecimento básico que envolve seu manejo.
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Humanos , Masculino , Feminino , Gravidez , Pré-Escolar , Adulto , Idoso , Adulto Jovem , Dor/história , Dor/psicologia , Dor Pós-Operatória , Exame Físico , Qualidade de Vida , Medição da Dor/psicologia , Terapias Complementares , Idoso , Nociceptores , Fibromialgia , Criança , Dor Pélvica , Dor do Parto , Tratamento Farmacológico , Percepção da Dor/fisiologia , Dor Aguda , Dor Musculoesquelética , Dor Crônica , Dor do Câncer , Cefaleia , Analgesia , AnamneseRESUMO
Methylene Blue (MB) has been widely used in antimicrobial Photodynamic Therapy (aPDT), however, the mechanisms of action (Type I or Type II) are defined by its state of aggregation. In this sense, the identification of the relationships between aggregation, the mechanisms of action and the effectiveness against microorganisms, as well as the establishment of the means and the formulations that may favor the most effective mechanisms, are essential. Thus, the objective of this study was to assess the in vitro aPDT efficacies against Candida albicans, by using MB in vehicles which may influence the aggregation and present an oral formulation (OF) containing MB, to be used in clinical aPDT procedures. The efficacy of MB at 20 mg L-1 was tested in a range of vehicles (water, physiological solution - NaCl 0.9%, phosphate saline buffer - PBS, sodium dodecyl sulfate 0.25% - SDS and urea 1 mol L-1) in a C. albicans planktonic culture, when using 4.68 J cm-2 of 640 ± 12 nm LED for the irradiations, as well as 5 minutes of pre-irradiation time, together with measuring the UFC mL-1. Based upon these analyses, an OF containing MB in the most effective vehicle was tested in the biofilms, as a proposal for clinical applications. When comparing some of the vehicles, sodium dodecyl sulfate was the only one that enhanced an MB aPDT efficacy in a planktonic C. albicans culture. This OF was tested in the biofilms and 50 mg L-1 MB was necessary, in order to achieve some reduction in the cell viabilities after the various treatments. The light dosimetries still need further adaptations, in order for this formulation to be used in clinical applications. The present research has indicated that the development of this formulation for the control of MB aggregations may result in more effective clinical protocols.
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Candida albicans/efeitos dos fármacos , Candidíase/tratamento farmacológico , Dimerização , Azul de Metileno/administração & dosagem , Veículos Farmacêuticos/química , Fármacos Fotossensibilizantes/administração & dosagem , Antifúngicos/administração & dosagem , Antifúngicos/química , Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Candida albicans/fisiologia , Candidíase/microbiologia , Humanos , Azul de Metileno/química , Azul de Metileno/farmacologia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/química , Fármacos Fotossensibilizantes/farmacologia , Dodecilsulfato de Sódio/químicaRESUMO
Candida albicans and Candida tropicalis are commensal microorganisms occurring in the oral cavity of approximately 50%-70% of healthy individuals. However, these microbes can become pathogenic through changes in the environment or weakened host immune system. Thus, the aim of this investigation was to evaluate the interaction between species of the genus Candida in the biofilm formation, filamentation, gene expression and virulence in Galleria mellonella. Coincubation of C. albicans with C. tropicalis cells after 48 h resulted in significant reduction of biofilm formation by decreasing viable cell counts, metabolic activity and hyphal growth. The C. albicans genes (BCR1, CPH1, EFG1, UME6, HWP1, ALS3, SAP5 and PLB2) were quantified by quantitative real-time polymerase chain reaction and most of genes were downregulated. Regarding in vivo assay, the groups that the larvae received C. albicans and C. tropicalis had a significant survival increase compared to the control group of C. albicans (P = 0.0001) in agreement with the in vitro results. In conclusion, C. tropicalis colonization was associated with a decrease in the growth of C. albicans, suggesting an antagonistic relation between these two species. Therefore, C. tropicalis by reducing C. albicans virulence profile may limit the ability of this pathogenic fungus to cause infection.
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Candida albicans/patogenicidade , Candida tropicalis/fisiologia , Candidíase/microbiologia , Candidíase/patologia , Interações Microbianas , Animais , Biofilmes/crescimento & desenvolvimento , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Regulação Fúngica da Expressão Gênica , Hifas/crescimento & desenvolvimento , Lepidópteros , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sobrevida , Virulência , Fatores de Virulência/biossínteseRESUMO
The objective of this study was to evaluate the effects of photodynamic inactivation (PDI) on Candida albicans biofilms, evaluating its effects on gene expression of ALS3, HWP1, BCR1, TEC1, CPH1, and EFG1 by yeast. Three samples of C. albicans were used in this study: a clinical sample from a patient with HIV (39S), a clinical sample from a patient with denture stomatitis lesion (Ca30), and a standard strain ATCC 18804. The quantification of gene expression was related to the production of those genes in the samples referred above using quantitative polymerase chain reaction (qPCR) assay in real time. The photosensitizer methylene blue at 300 uM and erythrosine at 400 uM, sensitized with low-power laser (visible red, 660 nm) and green LED (532 nm), respectively, were used for PDI. Four groups of each sample and PDI protocol were evaluated: (a) P+L+: sensitization with the photosensitizer and irradiation with light, (b) P+L-: only treatment with the photosensitizer, (c) P-L+: only irradiation with light, and (d) P-L-: without sensitization with the dye and absence of light. The results were analyzed by t test, with a significance level of 5%. The photodynamic inactivation was able to reduce the expression of all genes for both treatments, laser and LED. The fold-decrease for the genes ALS3, HWP1, BCR1, TEC1, CPH1, and EFG1 were 0.73, 0.39, 0.77, 0.71, 0.67, and 0.60 for laser, respectively, and 0.66, 0.61, .050, 0.43, 0.54, and 0.66 for LED, respectively. It could be concluded that PDI showed a reduction in the expression of C. albicans genes, suggesting its virulence decrease.