Possible Uses for Silymarin in Human Health: Systematic Review

Silymarin, from the fruit of Silybum marianum, is known for its hepatoprotective action. The aim of this study was to review the mechanisms of action of the silymarin phytocomplex to expand the possibilities for its application in human health. The search for published articles was carried out on the CAPES Journals Portal platform, which covers worldwide scientific databases. Publications from 2010 to 2022 were included. Of the 311 articles retrieved, 21 were included. The articles discuss the diversity of silymarin’s applications and the possibility of optimizing its bioavailability using drug delivery systems. Silymarin shows promise in numerous diseases, such as liver, kidney, cardiovascular, respiratory and others. Its antiviral action has been demonstrated in studies and silymarin has the potential to be used as a complementary therapy in the treatment of many diseases, with the expectation that, in the future, it will be used in therapeutic protocols for exclusive use.

Profile of Female Patients at a Sexology Ambulatory in the Brazilian Public Health System

Introduction: Sexual problems are fairly common, and sexuality is an important parameter of health and quality of life. However, only a few centers in Brazil have ambulatories specialized in sexual dysfunction. This study was conducted in a service that is a state reference for these pathologies. Methods: This study was conducted at the human sexuality ambulatory of a large public hospital in southern Brazil. It was a cross-sectional descriptive study with women attending at the first medical visit to the ambulatory of human sexuality in a period of four years. Female Sexual Function Index (FSFI) questionnaires with both qualitative and quantitative questions were applied in all first medical visits to the ambulatory. Results: The 153 women attending had a mean age of 40.9 (±12.9) years. The most frequent complaint was “lack of desire” (56.8%), followed by pain in intercourse (25.4%) and lack of pleasure or inability to achieve orgasm (12.4%). The prevalence of sexual dysfunction (FSFI cut-off score < 26.5) was 74.5%. The patient’s age, the age of the partner, and the length of the relationship with the partner had a significant correlation with a lower FSFI score. There was an inverse correlation between the length of the relationship and the FSFI score. The self-attributed score for satisfaction with sexual life had a significant correlation with the FSFI total score (r = 0.708, p 0.01). Conclusion: We conclude that women who seek care in sexuality are in the perimenopausal period and that factors such as the number of children, age of menopause and length of the relationship have a negative influence on sexuality. The score for the self-assessment of sexuality could serve as an initial screening for sexual dysfunction, since it is quick and easy to apply in routine medical visits. However, more studies are required to compare the FSFI and this score.

Therapeutic Approach in Female Sexual Dysfunctions in an Outpatient Clinic of Sexology in the Public Health System: A Longitudinal and Prospective Study

INTRODUCTION: Sexuality is one of the parameters of quality of life, and it is essential to include care for sexual dysfunctions in primary health care. OBJECTIVE: To evaluate the therapeutic approach in female sexual dysfunction in a public health outpatient clinic. DESIGN: A prospective cohort of women with sexual dysfunctions in an outpatient clinic of sexology in the Public Health System. The Female Sexual Function Index (FSFI) and scored 0 - 10 their sexual satisfaction were applied at the beginning and end of the follow-up. RESULTS: Eighty-nine women were included with a median age of 45 years, 69 (77.5%) had less than 11 years of schooling and 95.5% lived with a partner. The main reasons for referral for follow-up at the outpatient clinic of sexuality were dysfunction of hypoactive sexual desire disorder in 67.4% and pain related to sexual function in 46%. The average number of consultations was five and the main therapeutic interventions were guidance and clarification on sexuality (86.5%), use of topical estrogen (56.2%), and relaxation techniques (37.1%). All FSFI-19 domains had better post-intervention rates (p ≤ 0.005). Considering the domains of the FSFI-19, the medians of desire, arousal, lubrication, orgasm, pleasure and pain were higher in the post-intervention period in relation to the pre-intervention period (p ≤ 0.0001 for all analysis). In addition, the score given by the participant on their sexual satisfaction was higher at the post-intervention time compared to the pre-intervention period (p ≤ 0.0001). CONCLUSION: In public health, even with the care being performed by different professionals in each consultation, we conclude that through simple interventions, it is possible to improve the sexualities of the women attended. Still, offering care in sexuality is fundamental as part of primary health care and the training of medical professionals.

Anti-inflammatory natural products modulate interleukins and their related signaling markers in inflammatory bowel disease:A systematic review

This review aims to identify in vivo studies investigating the potential of plant substances and their natural molecules in managing inflammatory bowel disease(IBD).Specifically,the objective is to examine the impact of these substances on interleukins and other key inflammatory signaling markers.Relevant articles published up to December 2022 were identified through a search of the PubMed,Scopus,Web of Science,and Embase databases.The search used keywords including“inflammatory bowel disease”,“medicinal plants”,“natural molecules”,“anti-inflammatory”,and“ulcerative colitis”,and identified 1,878 potentially relevant articles,of which 89 were included in this review after completion of the selection process.This study provides preclinical data on natural products(NPs)that can potentially treat IBD,including ulcerative colitis.The main actions of these NPs relate to their effects on nuclear factor kappa B(NF-κβ),the Janus kinase(JAK)/signal transducer and activator of transcription(STAT)signaling pathway,the regulation of T helper 17/regulatory T cells balance,and oxidative stress.The ability of these NPs to inhibit intestinal inflammation appears to be dependent on lowering levels of the pro-inflammatory cytokines tumor necrosis factor-alpha(TNF-α),interleukin(IL)-1β,and IL-17,via the Jun N-terminal kinase(JNK)1,NF-κβ-p65,and STAT3 pathways.In addition,NPs were shown to reduce oxidative stress and the severity of ulcerative colitis,as well as increase the activity of antioxidant enzymes.These actions suggest that NPs represent a promising treatment for IBD,and potentially have greater efficacy and safety than current treatments.

Review of anticancer mechanisms of isoquercitin

This review was based on a literature search of PubM ed and Scielo databases using the keywords "quercetin,rutin,isoquercitrin,isoquercitin(IQ),quercetin-3-glucoside,bioavailability,flavonols and favonoids,and cancer" and combinations of all the words.We collected relevant scientific publications from 1990 to 2015 about the absorption,bioavailability,chemoprevention activity,and treatment effects as well as the underlying anticancer mechanisms of isoquercitin.Flavonoids are a group of polyphenolic compounds widely distributed throughout the plant kingdom.The subclass of flavonols receives special attention owing to their health benefits.The main components of this class are quercetin,rutin,and IQ,which is a flavonoid and although mostly found as a glycoside,is an aglycone(lacks a glycoside side chain).This compound presents similar therapeutic profiles to quercetin but with superior bioavailability,resulting in increased efficacy compared to the aglycone form.IQ has therapeutic applications owing to its wide range of pharmacological effects including antioxidant,antiproliferative,anti-inflammatory,anti-hypertensive,and anti-diabetic.The protective effects of IQ in cancer may be due to actions on lipid peroxidation.In addition,the antitumor effect of IQ and its underlying mechanism are related to interactions with Wnt signaling pathway,mixed-lineage protein kinase 3,mitogen-activated protein kinase,apoptotic pathways,as well proinflammatory protein signaling.This review contributed to clarifying the mechanisms of absorption,metabolism,and actions of IQ and isoquercitrin in cancer.

Duodenal adenoma surveillance in patients with familial adenomatous polyposis

Familial adenomatous polyposis(FAP) is a hereditary disorder caused by Adenomatous Polyposis Gene mutations that lead to the development of colorectal polyps with great malignant risk throughout life. Moreover, numerous extracolonic manifestations incorporate different clinical features to produce varied individual phenotypes. Among them, the occurrence of duodenal adenomatous polyps is considered an almost inevitable event, and their incidence rates increase as a patient's age advances. Although the majority of patients exhibit different grades of duodenal adenomatosis as they age, only a small proportion(1%-5%) of patients will ultimately develop duodenal carcinoma. Within this context, the aim of the present study was to review the data regarding the epidemiology, classification, genetic features, endoscopic features, carcinogenesis, surveillance and management of duodenal polyps in patients with FAP.

Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

Co-expression of HBZ,TAX and FOXp3 and HTLV-1-associated myelopathy/tropical spastic paraparesis development in HTLV-1-infected individuals:A systematic review

Human T-cell lymphotropic virus type 1(HTLV-1)is associated with the development of HTLV-1-associated myelopathy/tropical spastic paraparesis(HAM/TSP).It has been reported that the HTLV-1 proteins(specifically TAX and HBZ)can modulate FOXp3,resulting in an immune imbalance that can favor the progression of HAM/TSP.This review aims to summarize the literature in order to clarify the relationship between the expression of HTLV-1 m RNAs and/or viral proteins(TAX and HBZ)with the expression of mRNA and/or protein FOXp3 and their correlation with HAM/TSP development.This systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.The search strategy was performed on the Medical Literature Analysis and Retrieval System Online and Latin American and Caribbean Literature in Health Sciences Platform using subject descriptors.After screening,six articles were included in this review.The studies suggested that TAX and HBZ have a directly proportional correlation with FOXp3 in individuals with HAM/TSP,which also presented an increased expression of FOXp3 compared to asymptomatic controls and/or healthy donors.This systematic review indicates that TAX and HBZ can interact with FOXp3 and that interaction may influence HAM/TSP development.

Obesity in people with diabetes in COVID-19 times: Important considerations and precautions to be taken

At the end of 2019,a new disease with pandemic potential appeared in China.It was a novel coronavirus called coronavirus disease 2019(COVID-19).Later,in the first quarter of 2020,the World Health Organization declared the outbreak of this disease a pandemic.Elderly people,people with comorbidities,and health care professionals are more vulnerable to COVID-19.Obesity has been growing exponentially worldwide,affecting several age groups.It is a morbidity that is associated with genetic,epigenetic,environment factors and/or interaction between them.Obesity is associated with the development of several diseases including diabetes mellitus,mainly type 2.Diabetes affects a significant portion of the global population.Obesity and diabetes are among the main risk factors for the development of severe symptoms of COVID-19,and individuals with these conditions constitute a risk group.Based on a literature review on obesity in people with diabetes in the framework of the COVID-19 pandemic,this study presents updated important considerations and care to be taken with this population.

Bernard-Soulier Syndrome in Pregnancy: A Case Report

Background: Bernard-Soulier Syndrome (BSS) is a rare autosomal recessively inherited bleeding disorder of platelet function. Pregnancy in BSS is associated with a high risk of serious bleeding for both mother and neonate, and current data show no consensual approach. Aim: To report the case of a pregnant woman with BSS, in order to provide more information about management of these cases. Case Presentation: This case report describes a successful pregnancy outcome in a woman with BSS who was closely monitored throughout pregnancy and postpartum period, and had a judiciously planned birth. Conclusion: Management of BSS during pregnancy is still unclear. However, it is important to strictly control platelet counts and plan the birth in advance.

Acute Generalized Exanthematous Pustulosis during Puerperal Period Induced by Azithromycin: Case Report

Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics.

Practice Patterns and Adequacy of Maintenance Hemodialysis in Rio Grande, RS, Brazil

Introduction: Hemodialysis is the most common end-stage renal disease treatment worldwide. Several factors may influence treatment outcomes. Adequacy (dose) of hemodialysis remains controversial;however, investigations on the effectiveness rate (Kt/V ≥ 1.2), which could reflect morbimortality, are preferred. Objective: This study aimed to describe the level of adequacy of hemodialysis among patients undergoing treatment in the city of Rio Grande (RS), Brazil. Method: In this prospective cohort study, 156 patients undergoing hemodialysis treatment between July 2016 and June 2017 in the two hemodialysis centers in the city of Rio Grande (RS), Brazil, were included. Frequency distribution as per Kt/V stratification was analyzed. Chi-square test was used to compare proportions. Results: Adequate hemodialysis (Kt/V ≥ 1.2) was observed in 105 patients (67%), 88% were from the municipality (mean age, 59 years), and 43% had visited the hospital before knowing about their kidney disease. Most of them were referred to a nephrologist (70%). Of the 156 patients, 114 patients (73%) remained in dialysis treatment, 10 (6%) underwent transplantation, 9 (6%) were transferred, and 23 (15%) died at the end of 12 months. Conclusion: Primary care should be expanded for early diagnosis of chronic kidney disease, improved venous access preparation, and increased number of patients with hemodialysis adequacy. Hemodialysis adequacy in patients undergoing treatment in the city of Rio Grande (RS), Brazil, needs to be improved.

Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case.

Clinical and Evolutionary Characteristics of Pregnant and Postpartum Women with COVID-19 Admitted to a Hospital in the Central Region of Brazil

Objective: To describe the demographic and evolutionary characteristics of pregnant and postpartum women with coronavirus disease 2019 (COVID-19) admitted to a medium-sized hospital in Brazil. Method: This is a descriptive and retrospective study, collected from medical records, from March 2020 to October 2021 in a hospital located in Cuiabá (MT). Results: Pregnant and puerperal women with COVID-19 who needed hospitalization were mixed-race, from the metropolitan area, and carriers of moderate and severe forms of the disease. The primary risk condition found was overweight/obesity, and pre-gestational diabetes, hypertension, asthma, and autoimmune disease were the most prevalent comorbidities in the group. Elevated lactate dehydrogenase (LDH), c-reactive protein (CRP), and D-dimer were relevant laboratory findings in this group of patients. The most frequent maternal outcomes were respiratory failure, invasive ventilatory support, thromboembolic phenomena, sepsis, and preterm labor. Maternal death occurred in 6.4% of pregnant women. Most maternal deaths were of women who lived in the interior of the state, and the minority arrived on adequate ventilatory support. Prematurity and the need for neonatal intensive care unit (NICU) were significant complications for neonates. Stillbirth/neonatal mortality occurred in 11.0%. Conclusion: The clinical conditions at hospitalization were associated with worse living conditions and lack of access to health care, resulting in increased chances of severity and worsening outcomes in this group of women and neonates.

Prevalence of Frailty Syndrome in the Elderly and Associated Factors in Brazil

This paper aims to identify the prevalence of frailty syndrome and its association with demographic, economic, health, psychological and functional variables in Brazilian population. The study was cross-sectional and composed of 385 elderly aged from 65 years, an average age of 73.92 years. A multivariate Poisson regression was used to check for conditions associated with frailty and to determine the prevalence (α = 0.05). The prevalence of frailty was 8.7% and pre-frailty of 50.4%. The frail and pre-frail older adults showed larger and increasing prevalence ratios for marital status, difficulty performing instrumental activities of daily living, old age, involuntary loss of feces, depression and negative affections. These results can guide the establishment of preventive measures and the development of intervention strategies aimed at minimizing the adverse effects of frailty in elderly people.

First Experience Using Brazilian Ingamed^&regCervical Pessary in Twin Pregnancy: A Case Series

Background: The rate of prematurity in twin pregnancies is higher than 50%. Due to its multifactorial nature, different strategies are necessary to reduce the incidence of premature birth or to increase the gestational age at birth of pregnancies at risk. In this context, cervical pessary may be indicated in twin pregnancies with short cervix. Methods: In this case series, we describe six twin pregnancies that were considered as high-risk for preterm labor due to short cervix (CL at second trimester and multiple risk factors for prematurity. Several strategies were associated for the goal of delaying gestational age at birth. The main strategies were: removal of labor activities, treatment of infections, vaginal micronized progesterone 400 mg/day and vaginal pessary insertion (Ingamed&reg?Brazil). Results: The gestational age of insertion of the pessary ranged from 16 to 24 weeks. The gestational age of birth ranged from 26 to 34 weeks. Three of the pregnancies were delivered due to spontaneous onset of labor, and three were delivered due to medical reasons. The mean length of pregnancy since pessary insertion to birth was 9 weeks (range 2 to 17 weeks). All infants without severe fetal malformation were discharged from the hospital without major sequelae. Conclusion: The use of cervical pessaries associated to micronized progesterone at a dose of 400 mg/day may be an option in the management of twins at risk for preterm birth. More controlled studies are needed to evaluate the simultaneous use of cervical pessary and progesterone on twin pregnancies.

Massive Splenomegaly in Pregnancy: Case Report

A 33-year-old primigravida presented to an appointment at a high-risk prenatal outpatient service due to a history of splenomegaly. Her spleen occupied of the abdominal cavity and shifted the uterus to the right side of the abdomen. During investigation, an intrauterine growth restriction (IURG) and a series of other clinical complications were discovered. We admitted her to inpatient care at 28 + 1 weeks’ gestation for a better investigation of her extensive splenomegaly and for pregnancy monitoring, with a further successful delivery.

Female Sexual Function after Surgical Treatment of Urinary Incontinence

Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery.

Health Education for Chronic Obstructive Pulmonary Disease (COPD): Observational Study

Health Education has shown itself as essential for the understanding of individuals about psychological and physical changes caused by diseases. The chronic obstructive pulmonary disease (COPD) is a severe public health problem, and it depends on health education measures for its control. A group of patients with COPD, in pneumatological medical treatment, were investigated to find information about the disease. An observational, descriptive and analytical study with analysis and application of a semistructured questionnaire to evaluate the individuals’ knowledge about the COPD. Collected data were registered and analyzed using Google Docs. The software used for the calculation of statistical measures was Microsoft Excel®. For the research participants’ characterization analysis, the use of grouped data for the frequency distribution of Sturges Rule was necessary. This study provided knowledge about which information a group of bearers of COPD receives at a college hospital providing treatment. The interviewed have an average age of 70 years old and most are women with education level between elementary and high school and diagnose time of 6.8 years. Most of the sample reported knowledge and consciousness about the disease, informed by the doctors, followed by physiotherapists. Although the role of the Ministry of Health in health education, subjects were better informed about the disease by their doctors instead of public campaigns.

Opportunistic Infections in Late Kidney Transplantation with Death Outcome: Case Report

Cytomegalovirus (CMV) and Pneumocystis jirovecii fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus® and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or Pneumocystis jirovecii. Treatment with Ganciclovir® and Bactrim® was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and Pneumocystis jirovecii. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and Pneumocystis jirovecii. Adjusting the doses of immunosuppressants to individual needs can be an important measure for maintaining the proper immune system and consequently avoiding late opportunistic infections and death outcomes.