The Risks of Self - Medication: Case Report of Familial Misuse of AM3 (Immunoferon®)

Over the last decades extended medical knowledge has been an important health care benefit in terms of disease prevention and management. However, probably with no exception, most pharmaceutical products are not devoid of adverse consequences. Immunomodulators are commonly considered a “benign” drug whose advantages bypass consequences. The immunomodulator AM3 (Immunoferon®) is a clinically used, orally administered compound whose active principle is stabilised in an inorganic matrix of calcium. We report the misuse of AM3 in three members of a family; father and two children. The drug was prescribed to the father who subsequently administered it to the children without seeking medical advice. Two months later, all subjects developed abdominal and/or flank colicky pain. Hypercalciuria was diagnosed in the children with different degrees of severity. It is likely that the calcium content of the inorganic matrix played an important role in the onset of symptoms. No adverse side effects related to the inorganic matrix of calcium of immunoferon® have been documented so far. This family case report calls attention to the risks of self -medication in a susceptible family. Paediatric patients are vulnerable as they rely on adults for the supply of medications. Concerning the use of drugs in family, especially nonprescription drugs, the quality of health care provided to the children depends on the health literacy of their parents

Tuberculosis among the homeless: should we change the strategy?

BACKGROUND: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. OBJECTIVES: To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless. DESIGN: This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression. RESULTS: TB incidence among the homeless was 122/100 000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection. CONCLUSION: TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.CONTEXTE : La tuberculose (TB) est un souci majeur dans les populations à haut risque comme les personnes sans domicile fixe. OBJECTIFS : Evaluer le taux d’incidence de la TB et les resultats du traitement parmi des patients sans domicile fixe au Portugal et identifier les facteurs de préediction d’ échec du traitement de la TB parmi ces patients. SCHÉMA : Etude rétrospective de cohorte incluant tous les patients TB notifies au Portugal entre 2008 et 2014. Les caractéristiques des patients sans domicile fixe ont été ́évaluées et les facteurs de prédiction d’ échec du traitement de la TB ont été déterminés par ŕegression logistique. RESULTATS : Le taux d’incidence de la TB parmi les personnes sans domicile fixe a été de 122/100 000, et il a été positivement corrélé avec l’incidence de la TB parmi le reste de la population. Les patients tuberculeux sans domicile fixe avaient une prévalence plus élevée de consommation d’alcool et/ou de drogues, de co- infection au virus de l’immunodéficience humaine (VIH), de forme caverneuse et de frottis positif. Le taux d’ ́echec du traitement a ́et ́e de 28,6% ; l’ ́echec a ́ et ́esignificativement associé à un âge plus avancé, à la consommation de drogues injectables et à la co-infection par le VIH. CONCLUSION : L’incidence dela TB parmi les personnes sans domicile fixe a été cinq fois plus élevée que celle du reste de la population et plus haute dans les régions ou l’incidence dans le reste de la population est egalement plus élevée. Leur taux d’ échec du traitement à été plus faible. Les facteurs de prédiction d’ échec du traitement ont été l´âge, la consommation de drogues injectables et la co-infection `a VIH. Des programmes de TB intégrés ciblant les patients sans domicile fixe et les autres, avec des mesures spécifiques adaptées à leurs caractéristiques particulières, pourrait contribuer à l’ élimination de la TB au Portugal.MARCO DE REFERENCIA: La tuberculosis (TB) constituye una gran preocupación en las poblaciones muy vulnerables como las personas sin hogar. OBJETIVOS: Evaluar la tasa de incidencia de TB y los desenlaces terapéuticos en las personas sin domicilio en Portugal y definir los factores pronósticos de fracaso terapéutico en este grupo de la población. MÉTODO: Fue este un estudio retrospectivo de cohortes de todos los pacientes con diagnóstico de TB notificados del 2008 al 2014 en Portugal. Mediante un análisis de regresión logística se analizaron las características de los pacientes tuberculosos sin hogar y los factores pronósticos de fracaso terapéutico. RESULTADOS: La tasa de incidencia de TB en la población sin hogar fue 122 por 100 000 personas y exhibió una correlación positiva con la incidencia de TB en las personas con domicilio. Los pacientes con diagnóstico de TB y sin hogar presentaron una prevalencia más alta de consumo de alcohol y/o de drogas, de coinfección por el virus de la inmunodeficiencia humana (VIH), de lesiones cavernosas y de resultados positivos de la baciloscopia. La tasa de fracaso terapéutico en esta población fue 28,6% y se asoción de manera significativa con una mayor edad, el consumo de drogas intravenosas y la coinfección por el VIH. CONCLUSIÓN: La incidencia de TB en las personas sin hogar fue cinco veces mayor que en las personas con domicilio y fue más alta en las regiones con una mayor incidencia de TB en las personas con domicilio. La tasa de éxito terapéutico en las personas sin hogar fue más baja. Los factores pronósticos de fracaso terapéutico fueron la edad, el consumo de drogas intravenosas y la coinfecció non por el VIH. La ejecución de programas integrados de atención de la TB dirigidos a las personas sin hogar y con domicilio, que comporten medidas específicas que aborden sus características particulares, podrıa contribuir a la eliminación de la TB en PortugalStudy Group for Infectious Diseases of Instituto de Saúde Púublica da Universidade do Porto who collaborated on this project: B Miranda, C Carvalho, C Matos, C Carvalho, G Rodrigues, J Goncalves, L Maio and T Rito. This work was supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants under the Public Health Initiatives Programme (PT 06, grant number 138DT1). RG was also partially supported by Centro de Matemática da Universidade do Porto (UID/MAT/00144/2013), which is funded by Fundação do Ministério de Ciência e Tecnologia(Portugal) with national (MEC) and European structural funds (Fonds europeen de d ́eveloppement economique et regional) under the PT2020 Partnership Agreementinfo:eu-repo/semantics/publishedVersio

Framing REDD+ in the Brazilian national media: how discourses evolved amid global negotiation uncertainties

Reducing emissions from deforestation and degradation (REDD+) in tropical countries is an important and contested element of the post-Kyoto climate regime. For policy options which generate controversy between diverse actor groups, such as REDD+, mass media plays an important role in defining and supporting policy possibilities. Analysis of the way in which national media frames issues of climate change and deforestation can offer insights into the nature of the contested domains of the REDD+ policy process. Here, we examine the Brazilian national media discourses surrounding REDD+ because it contributes to setting the tone of policy debates at the federal level. Specifically, we ask the following: (i) How was REDD+ portrayed in the Brazilian national print media and whose opinions and perceptions were represented? and (ii) How have media frames on REDD+ in the national print media changed over time? Our results contribute with new knowledge for understanding the observed progress of REDD+ in Brazil. We identify two main themes that dominate the focus in the national media coverage of REDD+, specifically “politics and policymaking” (representing half the coverage) and “economics and market” (with over a third). Results show that discussions around carbon markets were amongst the most contested and that optimism in relation to REDD+ effectiveness declined over time. The analysis suggests that positions adopted on the national REDD+ strategy were shaped by state and federal collision of interests. We demonstrate an evolution of national concerns from an initial focus on efficiency (e.g. finance and carbon markets) to a recentred focus on equity issues (e.g. implementation of safeguards). We conclude with some thoughts on the implications of these features for REDD+ interventions and implementation in Brazil

Understanding the formation of deep eutectic solvents: betaine as a universal hydrogen bond acceptor

© 2020 Wiley-VCH GmbH The mechanism of formation of betaine-based deep eutectic solvents (DES) is presented for the first time. Due to its polarity unbalance, it was found that betaine displays strong negative deviations from ideality when mixed with a variety of different organic substances. These results pave the way for a comprehensive design of novel deep eutectic solvents. A connection to biologically relevant systems was made using betaine (osmolyte) and urea (protein denaturant), showing that these two compounds formed a DES, the molecular interactions of which were greatly enhanced in the presence of water.This work was developed within the scope of the projects CICECO-Aveiro Institute of Materials, UIDB/50011/2020 & UIDP/50011/2020, financed by national funds through the Portuguese Foundation for Science and Technology/MCTES, and CIMO-Mountain Research Center, UIDB/00690/2020, financed by national funds through the FCT/MEC and when appropriate cofinanced by FEDER under the PT2020 Partnership Agreement.info:eu-repo/semantics/publishedVersio

Tuberculosis inequalities and socio-economic deprivation in Portugal

OBJECTIVE: To analyse the geographical distribution of tuberculosis (TB) in Portugal and estimate the association between TB and socio-economic deprivation. METHODS: An ecological study at the municipality level using TB notifications for 2010–2014 was conducted. Spatial Bayesian models were used to calculate smoothed standardised notification rates, identify high- and low-risk areas and estimate the association between TB notification and the European Deprivation Index (EDI) for Portugal and its component variables. RESULTS: Standardised notification rates ranged from 4.41 to 76.44 notifications per 100 000 population. Forty-one high-risk and 156 low-risk municipalities were identified. There was no statistically significant association between TB notification rate and the EDI, but some of its variables, such as the proportion of manual workers and the percentage unemployed, were significantly and directly associated with TB notification, whereas the variable ‘proportion of residents with low education level' showed an inverse relationship. CONCLUSION: Wide inequalities in TB notification rates were observed, and some areas continued to exhibit high TB notification rates. We found significant associations between TB and some socio-economic factors of the EDI.This work was supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants, under the Public Health Initiatives Programme (PT 06, grant number 138DT1)

Exposure of neonatal rats to maternal cafeteria feeding during suckling alters hepatic gene expression and DNA methylation in the insulin signalling pathway

Nutrition in early life is a determinant of lifelong physiological and metabolic function. Diseases that are associated with ageing may, therefore, have their antecedents in maternal nutrition during pregnancy and lactation. Rat mothers were fed either a standard laboratory chow diet (C) or a cafeteria diet (O) based upon a varied panel of highly palatable human foods, during lactation. Their offspring were then weaned onto chow or cafeteria diet giving four groups of animals (CC, CO, OC, OO n=9-10). Livers were harvested 10 weeks post-weaning for assessment of gene and protein expression, and DNA methylation. Cafeteria feeding post-weaning impaired glucose tolerance and was associated with sex-specific altered mRNA expression of peroxisome proliferator activated receptor gamma (PPARg) and components of the insulin-signalling pathway (Irs2, Akt1 and IrB). Exposure to the cafeteria diet during the suckling period modified the later response to the dietary challenge. Post-weaning cafeteria feeding only down-regulated IrB when associated with cafeteria feeding during suckling (group OO, interaction of diet in weaning and lactation P=0.041). Responses to cafeteria diet during both phases of the experiment varied between males and females. Global DNA methylation was altered in the liver following cafeteria feeding in the post-weaning period, in males but not females. Methylation of the IrB promoter was increased in group OC, but not OO (P=0.036). The findings of this study add to a growing evidence base that suggests tissue function across the lifespan a product of cumulative modifications to the epigenome and transcriptome, which may be both tissue and sex-specific

Photodynamic and Antibiotic Therapy Impair the Pathogenesis of Enterococcus faecium in a Whole Animal Insect Model

Enterococcus faecium has emerged as one of the most important pathogens in healthcare-associated infections worldwide due to its intrinsic and acquired resistance to many antibiotics, including vancomycin. Antimicrobial photodynamic therapy (aPDT) is an alternative therapeutic platform that is currently under investigation for the control and treatment of infections. PDT is based on the use of photoactive dye molecules, widely known as photosensitizer (PS). PS, upon irradiation with visible light, produces reactive oxygen species that can destroy lipids and proteins causing cell death. We employed Galleria mellonella (the greater wax moth) caterpillar fatally infected with E. faecium to develop an invertebrate host model system that can be used to study the antimicrobial PDT (alone or combined with antibiotics). In the establishment of infection by E. faecium in G. mellonella, we found that the G. mellonella death rate was dependent on the number of bacterial cells injected into the insect hemocoel and all E. faecium strains tested were capable of infecting and killing G. mellonella. Antibiotic treatment with ampicillin, gentamicin or the combination of ampicillin and gentamicin prolonged caterpillar survival infected by E. faecium (P = 0.0003, P = 0.0001 and P = 0.0001, respectively). In the study of antimicrobial PDT, we verified that methylene blue (MB) injected into the insect followed by whole body illumination prolonged the caterpillar survival (P = 0.0192). Interestingly, combination therapy of larvae infected with vancomycin-resistant E. faecium, with antimicrobial PDT followed by vancomycin, significantly prolonged the survival of the caterpillars when compared to either antimicrobial PDT (P = 0.0095) or vancomycin treatment alone (P = 0.0025), suggesting that the aPDT made the vancomycin resistant E. faecium strain more susceptible to vancomycin action. In summary, G. mellonella provides an invertebrate model host to study the antimicrobial PDT and to explore combinatorial aPDT-based treatments

Nephrolithiasis in a Portuguese Pediatric Population

Introduction and Aims: Nephrolithiasis incidence in children has increased considerably. It is associated with substantial morbidity, recurrence and increased adulthood cardiovascular risk and chronic kidney disease. A thorough investigation is essential, as rare forms of urolithiasis have increased risk of renal failure. We aim to determine the epidemiology and outcomes of a pediatric population with nephrolithiasis presented in a nephrology unit of a tertiary centre. Methods: Retrospective study of the records of all children (<18 years) with nephrolithiasis diagnosis between 2008‑17. Clinical features, etiology, recurrence, treatment, and outcomes were evaluated and compared throughout the study period through two equal periods (2008‑12 versus 2013‑17). Results: We identified 80 cases: isolated nephrolithiasis (86%) and associated with nephrocalcinosis (14%). Mean follow‑up was 36 months (14–120). Median age at presentation was 8.6 years [3 months – 17 years]: 21% < 2 years‑old and 46% ≥ 10 years. The annual ratio of referrals for nephrolithiasis increased on average 1.2% per year [0.3‑11.8%]. Multiple etiological factors were present in 34%. A metabolic abnormality was identified in 54%: hypocitraturia (34%), hypercalcuria (24%), hyperoxaluria (15%), hyperuricosuria (15%) and cystinuria (1%), without age predominance (p=0.2). Urinary tract infection (24%) was the next most significant etiology and was more frequent below 2 years of age (p=0.001) and associated with struvite calculi (p=0.033). Median age at diagnosis was significantly lower in the study’s first half (5 vs 10 years; p=0.019) and an infectious etiology was more frequent (p=0.043). In a logistic‑regression analysis, a family history of nephrolithiasis was associated with a metabolic cause (p<0.01). Sixty‑three percent became stone free and 24% had recurrence. Discussion: Nephrolithiasis new referrals gradually increased throughout the study period. The most common etiology was metabolic, which is usually responsible for nephrolithiasis appearance and its recurrence, emphasizing the need for a complete evaluation.info:eu-repo/semantics/publishedVersio