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Humanos , Feminino , Criança , Staphylococcus aureus/isolamento & purificação , Doenças do Sistema Nervoso Central/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/tratamento farmacológico , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Ecocardiografia , AntibioticoprofilaxiaRESUMO
BACKGROUND: Convenience stores in Guatemala provide essential consumer goods in communities, but many dispense antibiotics illegally. Federal legislation, passed in August of 2019, requires prescriptions for antibiotic purchase at pharmacies but it is unclear if this legislation is enforced or if it has any impact on unlawful sales of antibiotics. METHODS: To determine if antibiotic availability changed in convenience stores, we carried out a repeated measures study collecting antibiotic availability data before and after implementation of the dispensing regulation. RESULTS: There was no statistical difference in the proportion of convenience stores that sold antibiotics before and after antibiotic regulations [66.6% (295/443) and 66.7% (323/484), respectively, P>0.96], nor in the number of stores selling amoxicillin [55.5% (246/443) and 52.3% (253/484), respectively, P>0.96], but fewer stores (20%) sold tetracycline capsules after regulation was passed (P<0.05). For stores visited both before and after passage of legislation (n=157), 15% stopped selling antibiotics while 25% started selling antibiotics. Antibiotics from convenience stores were reportedly sold for use in people and animals. CONCLUSIONS: Antibiotics remain widely available in convenience stores consistent with no significant change in the informal sector after implementation of prescription requirements for pharmacies. Importantly, effects from regulatory change could have been masked by potential changes in antibiotic use during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic.
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Antibacterianos , Farmácias , Humanos , Antibacterianos/uso terapêutico , Comércio , Prescrições de Medicamentos , Amoxicilina , TetraciclinaRESUMO
PURPOSE: A variable number of tandem repeats (VNTR) in the insulin gene (INS) control region may be involved in type 2 diabetes (T2D). The TH01 microsatellite is near INS and may regulate it. We investigated whether the TH01 microsatellite and INS VNTR, assessed via the surrogate marker single nucleotide polymorphism rs689, are associated with T2D and serum insulin levels in a Mexican population. METHODS: We analyzed a main case-control study (n = 1986) that used univariate and multivariate logistic regression models to calculate the risk conferred by TH01 and rs689 loci for T2D development; rs689 results were replicated in other case-control (n = 1188) and cross-sectional (n = 1914) studies. RESULTS: TH01 alleles 6, 8, 9, and 9.3 and allele A of rs689 were independently associated with T2D, with differences between sex and age at diagnosis. TH01 alleles with ≥ 8 repeats conferred an increased risk for T2D in males compared with ≤ 7 repeats (odds ratio, ≥ 1.46; 95% confidence interval, 1.1-1.95). In females, larger alleles conferred a 1.5-fold higher risk for T2D when diagnosed ≥ 46 years but conferred protection when diagnosed ≤ 45 years. Similarly, rs689 allele A was associated with T2D in these groups. In males, larger TH01 alleles and the rs689 A allele were associated with a significant decrease in median fasting plasma insulin concentration with age in T2D cases; the reverse occurred in controls. CONCLUSION: Larger TH01 alleles and rs689 A allele may potentiate insulin synthesis in males without T2D, a process disabled in those with T2D.
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Diabetes Mellitus Tipo 2 , Tirosina 3-Mono-Oxigenase , Feminino , Masculino , Humanos , Secreção de Insulina , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Repetições Minissatélites , Estudos de Casos e Controles , Estudos Transversais , Jejum , Insulina , Repetições de Microssatélites/genéticaRESUMO
INTRODUCTION: Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira, which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved. METHODS AND ANALYSIS: This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400 adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation. ETHICS AND DISSEMINATION: This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities. TRIAL REGISTRATION NUMBER: Brazilian Clinical Trials Registry (RBR-8cjjpgm).
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Leptospira , Leptospirose , Animais , Ratos , Brasil/epidemiologia , Leptospirose/epidemiologia , Leptospirose/prevenção & controle , Pobreza , SoloRESUMO
BACKGROUND: Low-income urban communities in the tropics often lack sanitary infrastructure and are overcrowded, favoring Aedes aegypti proliferation and arboviral transmission. However, as Ae. aegypti density is not spatially homogeneous, understanding the role of specific environmental characteristics in determining vector distribution is critical for planning control interventions. The objectives of this study were to identify the main habitat types for Ae. Aegypti, assess their spatial densities to identify major hotspots of arbovirus transmission over time and investigate underlying factors in a low-income urban community in Salvador, Brazil. We also tested the field-collected mosquitoes for arboviruses. METHODS: A series of four entomological and socio-environmental surveys was conducted in a random sample of 149 households and their surroundings between September 2019 and April 2021. The surveys included searching for potential breeding sites (water-containing habitats) and for Ae. aegypti immatures in them, capturing adult mosquitoes and installing ovitraps. The spatial distribution of Ae. aegypti density indices were plotted using kernel density-ratio maps, and the spatial autocorrelation was assessed for each index. Visual differences on the spatial distribution of the Ae. aegypti hotspots were compared over time. The association of entomological findings with socio-ecological characteristics was examined. Pools of female Ae. aegypti were tested for dengue, Zika and chikungunya virus infection. RESULTS: Overall, 316 potential breeding sites were found within the study households and 186 in the surrounding public spaces. Of these, 18 (5.7%) and 7 (3.7%) harbored a total of 595 and 283 Ae. aegypti immatures, respectively. The most productive breeding sites were water storage containers within the households and puddles and waste materials in public areas. Potential breeding sites without cover, surrounded by vegetation and containing organic matter were significantly associated with the presence of immatures, as were households that had water storage containers. None of the entomological indices, whether based on immatures, eggs or adults, detected a consistent pattern of vector clustering in the same areas over time. All the mosquito pools were negative for the tested arboviruses. CONCLUSIONS: This low-income community displayed high diversity of Ae. aegypti habitats and a high degree of heterogeneity of vector abundance in both space and time, a scenario that likely reflects other low-income communities. Improving basic sanitation in low-income urban communities through the regular water supply, proper management of solid wastes and drainage may reduce water storage and the formation of puddles, minimizing opportunities for Ae. aegypti proliferation in such settings.
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Aedes , Febre de Chikungunya , Vírus Chikungunya , Dengue , Infecção por Zika virus , Zika virus , Animais , Feminino , Brasil/epidemiologia , Mosquitos Vetores , Infecção por Zika virus/epidemiologia , ÁguaRESUMO
INTRODUCTION: the tibial slope has been identified as one of the factors associated with graft failure after anterior cruciate ligament (ACL) reconstruction; however, its relationship with functional results has been little studied. The main purpose of this study is to determine the effect of the tibial slope on functional recovery in patients undergoing reconstruction of the anterior cruciate ligament. MATERIAL AND METHODS: we included patients with a diagnosis of anterior cruciate ligament injury undergoing primary reconstruction, from May 2018 to May 2019, who had a complete radiographic and clinical record; also, the scores from questionnaires of the International Knee Documentation Committee (IKDC) and Lysholm scores were collected pre surgical procedures and throughout the one-year follow-up. The measurement of the tibial slope was performed in lateral knee X-rays from the electronic clinical record. A descriptive analysis of first intention was done, and to achieve the objectives, we compared 25 patients who had normal tibial slope that were selected randomly with 25 patients who had increased tibial slope. RESULTS: a total of 98 patients were included, 73 had a normal tibial slope (equal to or less than 12 degrees) and 25 with an increased tibial slope (greater than 12 degrees), the average age in both groups was 28.43 years for the group with normal tibial slope and 28.26 for patients with increased tibial slope. Regarding the functional assessment, the IKDC and Lysholm scores at the end of the follow-up were better for patients with normal tibial slope. Graft failure was only identified in the group with increased tibial slope. On the other hand, the comparative analysis with the control group randomly selected who had normal tibial slope, showed a better functional result assessed by IKDC score at the end of the follow-up for the group with normal tibial slope. CONCLUSION: patients undergoing ACL reconstruction and increased Tibial Slope have an inferior functional result at one year of follow-up assessed by IKDC, when compared with patients with normal tibial slope.
INTRODUCCIÓN: el slope tibial (inclinación) se ha identificado como uno de los factores asociados a la falla del injerto tras una reconstrucción de ligamento cruzado anterior (LCA); sin embargo, su relación con los resultados funcionales ha sido poco estudiada. El objetivo de este estudio es determinar el efecto del slope tibial en la recuperación funcional, en pacientes sometidos a reconstrucción de LCA. MATERIAL Y MÉTODOS: se incluyeron los pacientes con lesión de LCA sometidos a reconstrucción primaria, de Mayo de 2018 a Mayo de 2019, midiendo el slope tibial y recabando los puntajes de IKDC y Lysholm. Se elaboró un análisis descriptivo de primera intención y para alcanzar los objetivos se realizó una comparativa de 25 pacientes con slope tibial normal seleccionados aleatoriamente contra 25 pacientes con slope tibial aumentado. RESULTADOS: se incluyeron 98 pacientes, 73 contaban con un slope tibial normal y 25 con un slope tibial aumentado. Los puntajes de IKDC y Lysholm al final del seguimiento fueron mejores en los pacientes con slope tibial normal. La falla del injerto sólo se identificó en el grupo con slope tibial aumentado. Por otro lado, al análisis comparativo con el grupo control demostró un mejor resultado funcional al final del seguimiento valorado por IKDC en el grupo con slope tibial normal. CONCLUSIÓN: los pacientes sometidos a reconstrucción de LCA y slope tibial aumentado tienen un resultado funcional inferior al año de seguimiento evaluado por IKDC en comparación con pacientes con slope tibial dentro de parámetros normales.
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Reconstrução do Ligamento Cruzado Anterior , Adulto , HumanosRESUMO
The present study investigated the spermatological characteristics of raw semen of Lebranche mullet (Mugil liza), namely pH, and sperm density, and motility; and subsequently evaluated the effects of different times of exposure to cryoprotectants, and the application of an ultra-rapid freezing protocol, on sperm motility and plasma membrane integrity. Semen samples were analyzed undiluted (control) and diluted 1:50 v/v in CF-HBSS + 10% Dimethyl sulfoxide + 30% Ethylene glycol + 94.58 gL-1 Trehalose dehydrate (n = 15). Two treatments - diluted semen samples in cryoprotective medium without ultra-rapid freezing (T1), and diluted semen in cryoprotective medium with ultra-rapid freezing (T2) - were evaluated at 0, 2, 4, 6 and 8 min. The frozen samples were thawed at 37ºC for 60 s. The spermatological characteristics recorded for the semen were: pH: 7.57 ± 0.21; sperm density: 30.4 ± 2.9 × 109 sperm mL-1; motility: 82 ± 4.9%. Sperm motility presented differences after 2 min exposure to cryoprotectants (70.0 ± 2.7%) and ultra-rapid freezing (66.5 ± 5.8%) compared to the control group (98.5 ± 1.9% and 98.5 ± 2.1%, respectively; p < 0.05). On the other hand, the plasma membrane integrity of the spermatozoa after 2 min exposure to cryoprotectants (64.0 ± 8.6%) and ultra-rapid freezing (62.5 ± 5.2%) presented no differences compared to the control group (69.5 ± 3.9% and 70.0 ± 3.5%, respectively p > 0.05); however, differences were observed in the parameters evaluated after longer exposure and cryopreservation times. This is the first report evaluating the effects of different times of exposure to cryoprotectants and direct ultra-rapid freezing in liquid nitrogen on Mugil liza sperm. Our results demonstrated the protocol of sperm ultra-freezing is safe within a time´s window of 2 min of exposure to cryoprotectants, after which a toxicity effect on sperm can be observed.
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Preservação do Sêmen , Smegmamorpha , Animais , Criopreservação/métodos , Criopreservação/veterinária , Crioprotetores/toxicidade , Congelamento , Masculino , Preservação do Sêmen/métodos , Preservação do Sêmen/veterinária , Motilidade dos Espermatozoides , EspermatozoidesRESUMO
Summary: Background. Papular urticaria is a chronic allergic reaction induced by insect bites. In México the most common causative arthropods reported are bed bugs, fleas and mosquitoes. Approximately 70% of people who are bitten by Cimex lectularius experience hypersensitive reactions, papular urticaria, extensive erythema, urticaria, and even anaphylaxis has been reported, pruritus is the major complaint, impairing quality of life and sleep. Immunotherapy has been used in mosquito bite papular urticaria resulting in improvement of skin lesions and possibly protecting against reactions to subsequent exposures to mosquitoes. Methods. Children, 4-10 years of age, with recurrent papular urticaria due to bedbugs not responsive to multiple treatments were included. An initial allergy assessment included clinical history, skin prick test (SPT), and specific IgE sensitisation was performed to confirmed bedbug sensitization. Twenty children were randomized to receive subcutaneous specific immunotherapy (SSI) with whole body bed bug extract or conventional treatment. The treatment was carried out over twelve months and the response was assessed using the Dermatology Quality of Life Index (DLQ), the immunotherapy satisfaction questionnaire (ESPIA questionnaire) and the 12-Item Pruritus Severity Scale (12-IPSS). The results from both the treated and control groups were compared. Results. The twenty patients were randomized, 12 to receive immunotherapy and 8 to receive conventional treatment for 12 months. Quality of life improved with a reduction in the DLQI score of 19.83 in the immunotherapy group versus 9 in the conventional treatment group (p = 0.03). Itch improved with a reduction in the 12-IPSS of 16.5 in the immunotherapy group versus 9.63 in the conventional treatment group (p = 0.02). After twelve months of treatment, all 12 patients who received immunotherapy, reported a decrease of persistent cutaneous lesions but the 8 on conventional treatment did not. A mean score of 95.75 (SD 3.3) was recorded for satisfaction with immunotherapy. Conclusions. Patients with papular urticaria by Cimex lectularius receiving allergen immunotherapy for 1 year showed a significant improvement compared with baseline and patients receiving conventional treatment regarding skin lesions, quality of life impairment, intensity of pruritus and satisfaction with immunotherapy.
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Percevejos-de-Cama , Urticária , Criança , Animais , Humanos , Projetos Piloto , Qualidade de Vida , Urticária/terapia , Urticária/etiologia , Prurido/terapia , ImunoterapiaRESUMO
The encapsulation of magnetic nickel nanowires (NiNWs) with gelatin is proposed as an alternative for optical label detection. Magnetic nanowires can be detected at very low concentrations using light-scattering methods. This detection capacity could be helpful in applications such as transducers for molecular and biomolecular sensors; however, potential applications require the attachment of specific binding molecules to the nanowire structure. In the present study, a method is presented which is helpful in coating magnetic nanowires with gelatin, a material with the potential to handle specific decoration and functionalization of the nanowires; in the first case, silver nanoparticles (AgNPs) are efficiently used to decorate the nanowires. Furthermore, it is shown that the synthesized gelatin-coated particles have excellent detectability to the level of 140 pg/mL; this level of detection outperforms more complex techniques such as ICP-OES (~3 ng/mL for Ni) and magnetoresistance sensing (~10 ng/mL for magnetic nanoparticles).
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INTRODUCTION: Total knee arthroplasty (TKA) is one of the most successful orthopedic treatments, however, it has been associated with severe postsurgical pain in 30-60% of patients. We propose that infiltration of the articular capsule of the knee during surgery will decrease postsurgical pain. MATERIAL AND METHODS: Experimental, randomized, double-blind study in patients undergoing unilateral TKA between April 2018 and January 2019. Patients were divided into two groups, the first infiltration with placebo and the second with anesthetic solution and adjuvants (fentanyl, epinephrine and ketorolac). Pain was measured with the visual analog scale (VAS) at 4, 6, 8, 12, 18, 24, 36 and 48 hours postsurgical, as well as the consumption of opioid analgesics and antiemetics. RESULTS: 20 patients in each group, with a follow-up of 4 weeks. There were no significant differences in demographic characteristics between the two groups. Better control of postsurgical pain was observed in the group that received infiltration with anesthetic and adjuvant, as well as a decrease in the consumption of opioid analgesics and antiemetics. There was no difference in bleeding or in the incidence of infections between the two groups. CONCLUSION: Peri-capsular infiltration is a safe and effective method, as part of multimodal analgesia in total knee arthroplasty, as it decreases postsurgical pain, opioid and antiemetic use and does not increase postsurgical bleeding.
INTRODUCCIÓN: La artroplastía total de rodilla (ATR) es uno de los tratamientos ortopédicos más exitosos; sin embargo, se ha asociado a dolor postquirúrgico intenso en 30-60% de los pacientes. Nosotros planteamos que la infiltración de la cápsula articular de la rodilla durante la cirugía disminuirá el dolor postquirúrgico. MATERIAL Y MÉTODOS: Estudio experimental, aleatorio, doble ciego, en pacientes sometidos a ATR unilateral entre Abril de 2018 a Enero de 2019. Los pacientes fueron divididos en dos grupos, el primero infiltración con placebo y el segundo con solución anestésica y adyuvantes (fentanilo, epinefrina y ketorolaco). Se cuantificó mediante escala visual análoga (EVA) del dolor a las cuatro, seis, ocho, 12, 18, 24, 36 y 48 horas postquirúrgicas, así como del consumo de analgésicos opioides y antieméticos. RESULTADOS: Veinte pacientes en cada grupo, con un seguimiento de cuatro semanas. No hubo diferencias significativas en las características demográficas entre ambos grupos. Se observó un mejor control del dolor postquirúrgico en el grupo que recibió infiltración con anestésico y adyuvante, además de una disminución en el consumo de analgésicos opioides y antieméticos. No hubo diferencia en sangrado ni en la incidencia de infecciones entre ambos grupos. CONCLUSIÓN: La infiltración pericapsular es un método seguro y eficaz, como parte de la analgesia multimodal en la artroplastía total de rodilla, ya que disminuye el dolor postquirúrgico, el consumo de opioides y antieméticos y no incrementa el sangrado postquirúrgico.