Queratite por Acantamoeba - Revisão de 6 Casos Clínicos. Centro Hospitalar Lisboa Central

Objectivo: Determinar os factores de risco, características clínicas e desfecho da queratite por acantamoeba. Métodos: Os autores revêem os casos de queratite por acantamoeba em 6 doentes (3 do sexo masculino e 3 do sexo feminino) com idades compreendidas entre os 18 e os 41 anos, vigiados no Departamento de Córnea do nosso Hospital. As suas características e curso clínicos foram estudados retrospectivamente. Resultados: Todos os doentes eram portadores de lentes de contacto. Quatro dos 6 casos tiveram início do quadro entre final de Maio e Julho. A suspeita inicial de queratite bacteriana, fúngica ou viral precedeu o diagnóstico final de queratite por acantamoeba em todos os doentes. O diagnóstico foi feito através de observação clínica, PCR (polymerase chain reaction) ou microscopia confocal. Em todos os casos a terapêutica dirigida foi iniciada com propamidina, com adição de clorohexidina em um doente. Em 3 doentes verificou-se necessidade de realização de queratoplastia penetrante: um caso por incapacidade de controlo da infecção e por sequelas noutros dois. Conclusão: É necessário um grande nível de suspeita de infecção por acantamoeba em indivíduos utilizadores de lente de contacto e falência inicial à terapêutica antimicrobiana ou antiviral. A microscopia confocal é um auxiliar importante no diagnóstico da queratite por este microrganismo.

Glioblastoma in elderly patients: health-related quality of life (hrqol) in a randomized trial comparing 6-weeks of tadiotherapy (rt) vs hypofractionated rt over 2 weeks vs temozolomide chemotherapy (tmz)

BACKGROUND: Despite advances in treatment, survival of patients with GBM over 60 years is still often less than 1 year. In the perspective of a short expected survival, the quality of the remaining life and the effects of therapy on health-related quality of life (HRQoL) should be given special emphasis when recommending treatment for the individual patients. Several studies have focused on survival of the elderly, but few data are available on HRQoL for different treatments. In a randomized trial, we compared survival and HRQoL for 3 treatment options, 6 weeks of RT, vs hypofractionated RT, or chemotherapy with TMZ. MATERIALS AND METHODS: Newly diagnosed GBM patients, age ≥60 years with PS 0-2, were randomized to either standard RT (60 Gy in 2-Gy fractions over 6 weeks), hypofractionated RT (34 Gy in 3.4-Gy fractions over 2 weeks), or 6 cycles of chemotherapy with TMZ (200 mg/m2 day 1-5 every 28 days). QoL was determined by the EORTC QLQ 30 questionnaire and the Brain Cancer Module at inclusion, before start of therapy, at 6 weeks, 3 months, and 6 months after start of treatment. Patients were followed until death. The primary study endpoint was overall survival (OS) and secondary objectives were HRQoL, neurologic symptom control, and safety. RESULTS: A total of 342 patients were included and 292 patients were randomized between the 3 treatment options and 50 patients between hypofractionated RT and TMZ. Median age was 70 years (range 60-92) with 58% being male. Performance status was 0-1 for 75% of patients and 73% had undergone surgical resection. CONCLUSION: The results from the HRQoL analysis of this trial will be presented together with survival data at the upcoming EANO meeting.

Synthetic model of a new deoxybenzoin derivative from Deguelia hatschbachii A.M.G. Azevedo

In this paper we describe the synthesis of 2´,4´-dimethoxy-8-(propyl-2-one)-deoxybenzoin, a new compound employed as a model for the comparison with the respective spectral data for 6',4-dihydroxy-3'-(3,3- dimethylallyl)-2",2"-dimethylchromene(5",6":5',4')-2'-methoxy-8-(propyl-2-one) deoxybenzoin, recently isolated from Deguelia hatschbachii A.M.G. Azevedo. Both compounds have a "propyl-2-one" group attached to C-8 of the deoxybenzoin skeleton, for which there is no precedent in the literature. The Friedel-Crafts reaction of 1,3-dimethoxybenzene with phenylacetyl chloride furnished 2´,4´-dimethoxydeoxybenzoin, that after reaction with allyl bromide gave 2´,4´-dimethoxy-8-(allyl)-deoxybenzoin . Wacker oxidation gave the desired model compound in 15% overall yield. The corresponding spectral data reinforced the structure previously determined for the natural product.

Simulação das perdas de água por evaporação e arraste, no aspersor NY-7 (4,6 mm x 4,0 mm), em sistemas de aspersão convencional

As perdas de água por evaporação e arraste em sistemas de irrigação por aspersão podem assumir valores consideráveis, reduzindo a eficiência do sistema. Os objetivos do presente trabalho foram avaliar a capacidade preditiva de cinco modelos empíricos para estimar perdas de água por evaporação e arraste em aspersores modelo NY-7 (bocais de 4,6 mm x 4,0 mm), trabalhando sob diferentes condições operacionais e ambientais, e ajustar modelos específicos para o aspersor NY-7. Comparando os resultados medidos em ensaios de campo, com os resultados simulados, foi possível concluir que os cinco modelos empíricos considerados apresentaram pouca ou nenhuma adequação, tanto para os ensaios com um único aspersor (quadrado do erro-médio de 5,27; 20,70; 5,07; 6,95 e 7,06% para os modelos empíricos 1; 2; 3; 4 e 5, respectivamente) quanto para os ensaios com linhas laterais contendo aspersores (quadrado do erro-médio de 7,41; 24,43; 6,72; 3,16 e 2,9% para os modelos empíricos 1; 2; 3; 4 e 5, respectivamente). Comparados aos cinco modelos empíricos considerados, os novos modelos ajustados apresentaram menores erros, indicando que a aplicação de modelos empíricos deve ser limitada às condições de operação (diâmetro de bocal, pressão de operação, etc.) similares àquelas em que os modelos foram desenvolvidos.

High doses of riboflavin and the elimination of dietary red meat promote the recovery of some motor functions in Parkinson's disease patients

Abnormal riboflavin status in the absence of a dietary deficiency was detected in 31 consecutive outpatients with Parkinson's disease (PD), while the classical determinants of homocysteine levels (B6, folic acid, and B12) were usually within normal limits. In contrast, only 3 of 10 consecutive outpatients with dementia without previous stroke had abnormal riboflavin status. The data for 12 patients who did not complete 6 months of therapy or did not comply with the proposed treatment paradigm were excluded from analysis. Nineteen PD patients (8 males and 11 females, mean age ± SD = 66.2 ± 8.6 years; 3, 3, 2, 5, and 6 patients in Hoehn and Yahr stages I to V) received riboflavin orally (30 mg every 8 h) plus their usual symptomatic medications and all red meat was eliminated from their diet. After 1 month the riboflavin status of the patients was normalized from 106.4 ± 34.9 to 179.2 ± 23 ng/ml (N = 9). Motor capacity was measured by a modification of the scoring system of Hoehn and Yahr, which reports motor capacity as percent. All 19 patients who completed 6 months of treatment showed improved motor capacity during the first three months and most reached a plateau while 5/19 continued to improve in the 3- to 6-month interval. Their average motor capacity increased from 44 to 71% after 6 months, increasing significantly every month compared with their own pretreatment status (P < 0.001, Wilcoxon signed rank test). Discontinuation of riboflavin for several days did not impair motor capacity and yellowish urine was the only side effect observed. The data show that the proposed treatment improves the clinical condition of PD patients. Riboflavin-sensitive mechanisms involved in PD may include glutathione depletion, cumulative mitochondrial DNA mutations, disturbed mitochondrial protein complexes, and abnormal iron metabolism. More studies are required to identify the mechanisms involved.

Effect of high hydrostatic pressure on the barrier properties of polyamide-6 films

Little is known about the barrier properties of polymer films during high pressure processing of prepackaged foods. In order to learn more about this, we examined the influence of high hydrostatic pressure on the permeation of raspberry ketone (dissolved in ethanol/water) through polyamide-6 films at temperatures between 20 and 60ºC. Permeation was lowered by increasing pressure at all temperatures. At 23°C, the increasing pressure sequence 0.1, 50, 100, 150, and 200 MPa correlated with the decreasing permeation coefficients P/(10(9) cm² s-1) of 6.2, 3.8, 3.0, 2.2, and 1.6. Analysis of the permeation kinetics indicated that this effect was due to a reduced diffusion coefficient. Pressure and temperature acted antagonistically to each other. The decrease in permeation at 200 MPa was compensated for by a temperature increase of 20ºC. After release of pressure, the former permeation coefficients were recovered, which suggests that this `pressure effect' is reversible. Taken together, our data revealed no detrimental effects of high hydrostatic pressure on the barrier properties of polymer films.

Caspase dependence of the death of neonatal retinal ganglion cells induced by axon damage and induction of autophagy as a survival mechanism

We examined the degeneration of post-mitotic ganglion cells in ex-vivo neonatal retinal explants following axon damage. Ultrastructural features of both apoptosis and autophagy were detected. Degenerating cells reacted with antibodies specific for activated caspase-3 or -9, consistent with the presence of caspase activity. Furthermore, peptidic inhibitors of caspase-9, -6 or -3 prevented cell death (100 µM Ac-LEDH-CHO, 50 µM Ac-VEID-CHO and 10 µM Z-DEVD-fmk, respectively). Interestingly, inhibition of autophagy by 7-10 mM 3-methyl-adenine increased the rate of cell death. Immunohistochemistry data, caspase activation and caspase inhibition data suggest that axotomy of neonatal retinal ganglion cells triggers the intrinsic apoptotic pathway, which, in turn, is counteracted by a pro-survival autophagic response, demonstrated by electron microscopy profiles and pharmacological autophagy inhibitor.

Potentiel acoustique évoqué chez le poulain de la naissance jusqu'à l'âge de 6 mois

Le potentiel acoustique évoqué (PAE) est influencé par l’âge dans de nombreuses espèces. Chez l’homme, l’augmentation de la fréquence de stimulation améliore la détection des anomalies du tronc cérébral. Son utilisation chez le poulain demeure anecdotique. Les buts de cette étude étaient: 1) de déterminer les valeurs de référence du PAE pour 3 différents protocoles de stimulation (11.33 Hz/70 dBNHL; 11.33 Hz/90 dBNHL; 90 Hz/70 dBNHL); 2) d’évaluer les effets de l’âge et de la fréquence de répétition de la stimulation acoustique sur les tracés du PAE chez le poulain de moins de 6 mois; 3) de comparer les données obtenues chez les poulains normaux à celles recueillies chez des poulains présentant des troubles neurologiques. Trente-neuf poulains normaux et 16 poulains avec des déficits neurologiques ont été inclus dans l’étude. Aucun effet de l’âge n’a été mis en évidence (p> 0,005). Aucune différence significative n’a été mise en évidence lorsque les latences absolues et relatives des poulains neurologiques ont été comparées à celles des poulains normaux (p>0,005). L’augmentation de la fréquence de stimulation acoustique n’a pas amélioré la détection d’anomalies sur les tracés de PAE chez les poulains neurologiques. Bien que toutes leurs valeurs de latences absolues et relatives soient demeurées à l’intérieur des valeurs de référence, 78,6% des poulains avec un déficit neurologique présentaient une asymétrie entre les tracés des deux oreilles. Cela démontre une différence de conduction de l’influx nerveux entre le côté droit et le côté gauche du tronc cérébral chez ces sujets. En conclusion, nous présentons ici les valeurs de référence du PAE chez le poulain de moins de 6 mois pour 3 protocoles de stimulation différents. D’autres études seraient nécessaire afin de déterminer si l’utilisation d’une fréquence de stimulation acoustique plus élevée est utile dans la détection d’anomalies du PAE chez les poulains souffrant de troubles neurologiques. La majorité des poulains avec des déficits neurologiques ont présenté des anomalies du PAE ce qui valide son utilisation pour le diagnostic de troubles neurologiques chez le poulain de moins de 6 mois.

A simplified, high-yield synthesis, and crystal structure of [tris{bis(2,4,6-triisopropylphenyl)tin}]

The species [{Sn(C2H2iPr3-2,4,6)2}3] has been obtained in a simple, essentially quantitative, synthesis from SnCl2 and ArLi in diethyl ether at low temperature. The crystal structure analysis confirms the trimeric nature of the molecular units but reveals some unusual features. The crystal contains the unusual feature of an asymmetric unit that consists of three units of [{SnAr2}3] in P21/c; the molecular unit is a scalene triangle, showing high consistency between the three molecules, in contrast to analogous trimeric species of silicon or germanium. The SnSn bonds are lengthened (average value 2.942 Å) owing to steric crowding.

Actinobacillus actinomycetemcomitans lipopolysaccharide induces interleukin-6 expression through multiple mitogen-activated protein kinase pathways in periodontal ligament fibroblasts

Actinobacillus actinomycetemcomitans plays a major role in the pathogenesis of aggressive periodontitis. Lipopolysaccharide (LPS) derived from A. actinomycetemcomitans is a key factor in inflammatory cytokine generation within periodontal tissues. In this study, we identify major mitogen-activated protein kinase (MAPK) signaling pathways induced by A. actinomycetemcomitans LPS, Escherichia coli LPS and interleukin-1 beta (IL-1 beta) in a murine periodontal ligament (mPDL) fibroblast cell line. Immunoblot analysis was used to assess the phosphorylated forms of p38, extracellular-regulated kinase (ERK) and c-jun N-terminal kinase (JNK) MAPK following stimulation with A. actinomycetemcomitans LPS, E. coli LPS and IL-1 beta. IL-6 mRNA induction was detected via reverse transcription-polymerase chain reaction, while protein levels were quantified via enzyme-linked immunosorbent assays (ELISA). We utilized biochemical inhibitors of p38, ERK and JNK MAPK to identify the MAPK signaling pathways needed for IL-6 expression. Additional use of stable mPDL cell lines containing dominant negative mutant constructs of MAPK kinase-3 and -6 (MKK-3/6) and p38 null mutant mouse embryonic fibroblast (MEF) cells were used to substantiate the biochemical inhibitor data. Blocking p38 MAPK with SB203580 reduced the induction of IL-6 mRNA by A. actinomycetemcomitans LPS, E. coli LPS and IL-1 beta by > 70%, > 95% and similar to 60%, respectively. IL-6 ELISA indicated that blocking p38 MAPK reduced the IL-6 protein levels induced by A. actinomycetemcomitans LPS, E. coli LPS and IL-1 beta by similar to 60%, similar to 50% and similar to 70%, respectively. All MAPK inhibitors significantly reduced the IL-6 protein levels induced by A. actinomycetemcomitans LPS, E. coli LPS and IL-1 beta whereas only p38 inhibitors consistently reduced the A. actinomycetemcomitans LPS, E. coli LPS and IL-1 beta induction of IL-6 mRNA steady-state levels. The contribution of p38 MAPK LPS-induced IL-6 expression was confirmed using MKK-3/6 dominant negative stable mPDL cell lines. Wild-type and p38 alpha(-/-) MEF cells provided additional evidence to support the role of p38 alpha MAPK in A. actinomycetemcomitans LPS-stimulated IL-6. Our results indicate that induction of IL-6 by E. coli LPS, IL-1 beta and A. actinomycetemcomitans LPS requires signaling through MKK-3-p38 alpha ERK, JNK and p38 MAPK in mPDL cells.

Atividade antiproliferativa e antineoplásica de flavonóides da espécie Brosimum acutifolium em modelo de glioblastoma in vitro

Dentre os tumores que acometem o sistema nervoso, o glioblastoma multiforme (GBM), destaca-se por seu alto grau de agressividade e baixo prognóstico, apresentando em média uma sobrevida de 15 meses a partir do diagnóstico. O presente estudo objetivou investigar a atividade antiproliferativa e antineoplásica de quatro flavonoides isolados da espécie Brosimum acutifolium (Huber), duas flavanas: 4’-hidroxi-7,8-(2”,2”-dimetilpirano) flavana (BAS-1) e 7,4’-dihidroxi-8,(3,3-dimetilalil)-flavana, (BAS-4); e duas chalconas: 4,2’-dihidroxi-3’,4’-(2”,2”-dimetilpirano)-chalcona (BAS-6) e 4,2’,4’-trihidroxi-3’-(3,3-dimetilalil)-chalcona (BAS-7), em glioblastoma C6 de rato in vitro. Nossos resultados mostraram boa atividade citotóxica para as flavanas (BAS-1, -4) e para a chalcona BAS-7, com IC50 menor que 100 μM em teste de viabilidade pelo MTT, já a chalcona BAS-6, não demonstrou atividade citotóxica nas concentrações testadas. Estes flavonoides mostram ser menos citotóxico para célula não neoplásica (glia), com grau de segurança maior para a BAS-4 e BAS-7, uma vez que apresentaram menor efeito citotóxico à célula não neoplásica e menores índices hemolíticos. A análise de migração celular mostrou que o tratamento com BAS-1, BAS-4 e BAS-7 em baixas concentrações foi efetivo em promover inibição da migração celular. Estes três flavonoides também foram muito promissores em inibir a formação e o crescimento de colônia, além de promover parada no ciclo celular, com substancial aumento na população SubG0 para o tratamento com BAS-1 e BAS-4 com 100 μM. As flavanas BAS-1 e BAS-4 também mostraram maior capacidade de promover a perda na integridade do potencial de membrana mitocondrial (ΔΨm) e aumento para marcação com anexina V, indicativo de que estas drogas promovem morte por apoptose. No entanto a análise por microscopia eletrônica demonstrou marcantemente no tratamento com a BAS-4 a presença de vacúolos autofágicos, sugestivo que o processo de morte neste tratamento ocorre tanto por apoptose quanto autofagia. Com base nestes resultados pode-se concluir que dos flavonoides testados a BAS-1, BAS-4 e BAS-7 possuem potencial como agente antineoplásico na terapia do GBM, sendo a BAS-4 a mais promissora de todas.

Efeito protetor da flavana extraída da espécie Brosimum acutifolium contra danos causados por hipóxia em células retinianas: um estudo in vitro

O acidente vascular cerebral isquêmico (AVCi) causa danos celulares por provocar intensa excitotoxicidade e estresse oxidativo após privação de oxigênio e glicose para uma região do encéfalo. Neste trabalho, investigamos o potencial neuroprotetor da planta amazônica Brosimum acutifolium que é rica em flavanas como a 4',7-diidroxi-8-(3,3-dimetilalil)flavana (brosimina b, aqui abreviada como Bb) que apresenta elevado potencial antioxidante. Utilizamos cultura de células retinianas de embrião de galinha submetidas a hipóxia experimental, por privação de oxigênio e glicose, para avaliarmos o potencial antioxidante da Bb através da análise do sequestro do radical 2,2-difenil-1-picril-hidrazil (DPPH). Além disso, avaliamos a viabilidade celular (VC) e o perfil oxidativo e antioxidativo após 3, 6 e 24 horas de hipóxia, pela produção de oxigênio reativo (O₂^-) e atividade antioxidante endógena pela enzima catalase, respectivamente. Nossos resultados demonstram que nosso modelo experimental de hipóxia in vitro provoca redução tempo-dependente da VC, acompanhada por intenso estrese oxidativo, devido à excessiva produção de oxigênio reativo (O₂^-). O tratamento com Bb (10μM) protegeu significativamente a viabilidade celular durante 3 e 6 h de hipóxia experimental em células retiniana cultivadas in vitro, além de favorecer o aumento da atividade da enzima catalase em todos os tempos testados. Desta forma, concluímos que a Bb possui ação antioxidante e neuroprotetor por contribuir na defesa contra o estresse oxidativo induzido em condições de hipóxia, tornando-se como uma droga com potencial uso em tratamentos em casos de AVCi in vivo.

Avalição comparativa das intercorrências dialíticas de pacientes com lesão ranal aguda submetidos a sessões de hemodiálise prolongada de 6 e 10 horas

Pós-graduação em Fisiopatologia em Clínica Médica - FMB