Resumo Fundamento Apesar da necessidade de opções terapêuticas específicas para a doença do coronavírus 2019 (covid-19), ainda não há evidências da eficácia de tratamentos específicos no contexto ambulatorial. Há poucos estudos randomizados que avaliam a hidroxicloroquina (HCQ) em pacientes não hospitalizados. Esses estudos não indicaram benefício com o uso da HCQ; no entanto, avaliaram desfechos primários diferentes e apresentaram vieses importantes na avaliação dos desfechos. Objetivo Investigar se a HCQ possui o potencial de prevenir hospitalizações por covid-19 quando comparada ao placebo correspondente. Métodos O estudo COVID-19 Outpatient Prevention Evaluation (COPE) é um ensaio clínico randomizado, pragmático, duplo-cego, multicêntrico e controlado por placebo que avalia o uso da HCQ (800 mg no dia 1 e 400 mg do dia 2 ao dia 7) ou placebo correspondente na prevenção de hospitalizações por covid-19 em casos precoces confirmados ou suspeitos de pacientes não hospitalizados. Os critérios de inclusão são adultos (≥ 18 anos) que procuraram atendimento médico com sintomas leves de covid-19, com randomização ≤ 7 dias após o início dos sintomas, sem indicação de hospitalização na triagem do estudo e com pelo menos um fator de risco para complicações (> 65 anos, hipertensão, diabetes melito, asma, doença pulmonar obstrutiva crônica ou outras doenças pulmonares crônicas, tabagismo, imunossupressão ou obesidade). Todos os testes de hipótese serão bilaterais. Um valor de p < 0,05 será considerado estatisticamente significativo em todas as análises. Clinicaltrials.gov: NCT04466540. Resultados Os desfechos clínicos serão avaliados centralmente por um comitê de eventos clínicos independente cegado para a alocação dos grupos de tratamento. O desfecho primário de eficácia será avaliado de acordo com o princípio da intenção de tratar. Conclusão Este estudo apresenta o potencial de responder de forma confiável a questão científica do uso da HCQ em pacientes ambulatoriais com covid-19. Do nosso conhecimento, este é o maior estudo avaliando o uso de HCQ em indivíduos com covid-19 não hospitalizados.

Abstract Background Despite the need for targeting specific therapeutic options for coronavirus disease 2019 (COVID-19), there has been no evidence of effectiveness of any specific treatment for the outpatient clinical setting. There are few randomized studies evaluating hydroxychloroquine (HCQ) in non-hospitalized patients. These studies indicate no benefit from the use of HCQ, but they assessed different primary outcomes and presented important biases for outcome evaluation. Objective To evaluate if HCQ may prevent hospitalization due to COVID-19 compared to a matching placebo. Methods The COVID-19 Outpatient Prevention Evaluation (COPE) study is a pragmatic, randomized, double-blind, placebo-controlled clinical trial evaluating the use of HCQ (800 mg on day 1 and 400 mg from day 2 to day 7) or matching placebo for the prevention of hospitalization due to COVID-19 in early non-hospitalized confirmed or suspected cases. Inclusion criteria are adults (≥ 18 years) seeking medical care with mild symptoms of COVID-19, with randomization ≤ 7 days after symptom onset, without indication of hospitalization at study screening, and with at least one risk factor for complication (> 65 years; hypertension; diabetes mellitus; asthma; chronic obstructive pulmonary disease or other chronic lung diseases; smoking; immunosuppression; or obesity). All hypothesis tests will be two-sided. A p-value < 0.05 will be considered statistically significant in all analyses. Clinicaltrials.gov: NCT04466540. Results Clinical outcomes will be centrally adjudicated by an independent clinical event committee blinded to the assigned treatment groups. The primary efficacy endpoint will be assessed following the intention-to-treat principle. Conclusion This study has the potential to reliably answer the scientific question of HCQ use in outpatients with COVID-19. To our knowledge, this is the largest trial evaluating HCQ in non-hospitalized individuals with COVID-19.

Abstract Zoonotic spillover is a phenomenon characterized by the transfer of pathogens between different animal species. Most human emerging infectious diseases originate from non-human animals, and human-related environmental disturbances are the driving forces of the emergence of new human pathogens. Synthesizing the sequence of basic events involved in the emergence of new human pathogens is important for guiding the understanding, identification, and description of key aspects of human activities that can be changed to prevent new outbreaks, epidemics, and pandemics. This review synthesizes the connections between environmental disturbances and increased risk of spillover events based on the One Health perspective. Anthropogenic disturbances in the environment (e.g., deforestation, habitat fragmentation, biodiversity loss, wildlife exploitation) lead to changes in ecological niches, reduction of the dilution effect, increased contact between humans and other animals, changes in the incidence and load of pathogens in animal populations, and alterations in the abiotic factors of landscapes. These phenomena can increase the risk of spillover events and, potentially, facilitate new infectious disease outbreaks. Using Brazil as a study model, this review brings a discussion concerning anthropogenic activities in the Amazon region and their potential impacts on spillover risk and spread of emerging diseases in this region.

Resumo Introdução: A estimulação não-invasiva tem sido amplamente utilizada nos últimos 30 anos no estudo e no tratamento de um grande número de doenças neurológicas, incluindo distúrbios do movimento. Objetivos: Nesta revisão crítica, discutimos o embasamento científico do uso da estimulação não-invasiva em distúrbios do movimento e as evidências científicas dos principais ensaios clínicos realizados. Métodos: Um grupo de especialistas realizou uma revisão crítica abrangente da literatura a fim de analisar as principais aplicações da estimulação magnética transcraniana (EMT) e da estimulação transcraniana por corrente contínua (ETCC) em distúrbios do movimento. As classes de evidência e de recomendação foram descritas para cada doença. Resultados: Apesar da grande variabilidade da metodologia e baixo efeito clínico, a EMT é provavelmente eficaz para o tratamento dos sintomas motores e da depressão na doença de Parkinson. A eficácia em outros distúrbios do movimento ainda é incerta. A EMT é possivelmente eficaz para o tratamento da distonia focal da mão, do tremor essencial e da ataxia cerebelar. No entanto, é provavelmente ineficaz na redução dos tiques na síndrome de Tourette. Finalmente, a ETCC é provavelmente eficaz na melhora da marcha na doença de Parkinson. Conclusões: As evidências até o momento sugerem que a estimulação não-invasiva pode ser benéfica para o alívio de alguns sintomas em determinados distúrbios do movimento como a doença de Parkinson, o tremor essencial, a distonia e a ataxia. Os protocolos de aplicação e paradigmas de estimulação ainda precisam ser investigados em ensaios clínicos maiores, assim como os seus efeitos a longo prazo.

Abstract Background: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. Objective: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson’s disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

A novel anti-inflammatory hybrid 3-ibuprofenyl-copalic acid (3-IbuCA) was synthesized from 3-hydroxy-copalic acid isolated from Amazonian copaiba oil (Copaifera multijuga Hayne), and the anti-inflammatory ibuprofen. After full characterization, several assays to verify its anti-inflammatory effects were performed in vitro, in vivo and in silico (molecular docking). Induced fit docking was performed to observe the interactions with the enzymes cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). In vitro tests of cytotoxicity and tumor necrosis factor (TNF)-α inhibition, and in vivo tests of pleurisy, protein expression and gastrocytotoxicity were performed. Molecular docking studies with COX-1 and 2 showed binding free energies (ΔG) of -2.2 and -7.8 kcal mol-1, respectively, while for mofezolac and indomethacin, the binding free energies ΔG presented values of -8.5 and -10.1 kcal mol-1, which makes 3-IbuCA selective for COX-2 inhibition. This hybrid showed no toxicity against human macrophage at concentrations up to 2 µM, and inhibited TNF-α production in lipopolysaccharide (LPS)-stimulated macrophages. In the pleurisy assays, 3-IbuCA reduced the total leukocytes and mononuclear cells, which was followed by reduction of p-IKBα (phosphorylated nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha) protein expression. Compared with ibuprofen alone, the hybrid caused less gastric damage. Thus, the docking, together with in vitro and in vivo studies suggest that this novel hybrid has potential as a new anti-inflammatory agent.

Abstract Amazonian biodiversity is increasingly threatened due to the weakening of policies for combating deforestation, especially in Brazil. Loss of animal and plant species, many not yet known to science, is just one among many negative consequences of Amazon deforestation. Deforestation affects indigenous communities, riverside as well as urban populations, and even planetary health. Amazonia has a prominent role in regulating the Earth’s climate, with forest loss contributing to rising regional and global temperatures and intensification of extreme weather events. These climatic conditions are important drivers of emerging infectious diseases, and activities associated with deforestation contribute to the spread of disease vectors. This review presents the main impacts of Amazon deforestation on infectious-disease dynamics and public health from a One Health perspective. Because Brazil holds the largest area of Amazon rainforest, emphasis is given to the Brazilian scenario. Finally, potential solutions to mitigate deforestation and emerging infectious diseases are presented from the perspectives of researchers in different fields.

Chagas' disease is a parasitic disease with unsatisfactory treatment, mainly in chronic stage. This study aimed to evaluate the trypanocidal activity and action mechanisms of α/β-amyrin and its semi-synthetic derivatives, together with four isolated natural triterpenes, tested against trypomastigote and amastigote forms. The structure-activity relationship was suggested and cytotoxicity was measured. In general, greater polar compounds may have improved the selectivity to the protozoan. Action mechanisms were only performed for the amastigotes of Trypanosoma cruzi by evaluating the ultrastructural alterations, membrane permeability, mitochondrial membrane potential and cell volume, since the majority of compounds displayed promising antiamastigote activities. Triterpenes promoted changes on mitochondrial membrane potential and ultrastructural features that suggest autophagy processes. Both combinations between α/β-amyrin and 3-O-acetyl-11-oxo-α/β-amyrin and 3-O-acetyl-α/β-amyrin with benznidazole displayed synergistic effects against amastigotes and antagonistic effects on LLCMK2 cells. The antiamastigote activities, chemical derivatization, drug combinations and action mechanisms revealed to be crucial approaches toward this chronic disease.

The IV Debate Forum of the SENPE values from a multidisciplinary and multi-professional perspective the questions on clinical research in nutrition in Spain, focusing on enteral nutrition due to the lack of legislation on this issue. The concluding remarks point out the SENPE commitment with promoting quality, education and facilitation of research, greater help to emergent groups, looking for financial support, and timely information on the several summons from public systems and reference centers.

El IV Foro de Debate SENPE valora desde un punto de vista multidisciplinar y multiprofesional la problemática de la investigación clínica en nutrición en España centrándose, debido a la falta de legislación, en la nutrición enteral. Se concluye en el compromiso de la SENPE en la potenciación de la calidad, en la formación y facilitación de la investigación, en una mayor ayuda a los grupos investigadores emergentes, en la búsqueda de financiación y en una puntual información sobre las diferentes convocatorias de los sistemas públicos y sobre los centros de referencia.

Case report: We report the case of a child short in stature with brachydactyly and brachymorphy who was referred to our office complaining of poor vision. This was a case of Weill-Marchesani’s syndrome described in a family, in which four of the eight children were affected by spherophakia, brachymorphy and brachydactyly. Discussion: There are few familial cases of Weill-Marchesani’s syndrome reported in the literature. Both autosomal dominant and recessive inheritances have been described. The opththalmologist plays a crucial role in its diagnosis and management, since the ocular involvement is the most severe one.

Caso clínico: Presentamos el caso clínico de un niño con talla baja, braquidactilia y braquimorfia remitido a la consulta por baja visión. Se trata de un caso de síndrome de Weill-Marchesani en una familia en la que cuatro de los ocho hijos presentan esferofaquia, braquimorfia y braquidactilia. Discusión: Existen pocos casos familiares del síndrome de Weill-Marchesani reflejados en la literatura. Se han descrito patrones de herencia tanto autosómico dominante como recesivo. El papel del oftalmólogo en su diagnóstico y manejo es esencial, ya que la afectación oftalmológica es la más grave.

Seis amostras comerciais de queijo petit suisse foram coletadas em supermercados da cidade de Campinas e analisadas quanto à composição química, capacidade de retenção de água, propriedades reológicas e aceitação sensorial. Os produtos comerciais diferiram especialmente em relação ao tipo de hidrocolóide adicionado e na relação proteína/gordura. O produto B apresentou uma capacidade de retenção de água maior que o dobro da apresentada pelas demais amostras. Este produto apresentou uma relação proteína/gordura intermediária e continha os hidrocolóides concentrado protéico de soro (CPS) e pectina. A amostra E apresentou os maiores valores de viscosidade aparente (etaa), viscosidade complexa (eta*), módulo de armazenamento (G’), módulo de dissipação (G’’) e também apresentou a maior relação proteína/gordura, sugerindo haver boa correlação entre a razão proteína/gordura e os parâmetros reológicos. A relação proteína/gordura influenciou significativamente os valores G’, G’’ e eta*, confirmando a influência da composição do produto na estrutura e na elasticidade do queijo petit suisse. Todas as amostras mostraram comportamento viscoelástico, sendo que G’ (o caráter elástico) foi maior que G’’ (o caráter viscoso), em todas as freqüências estudadas. Todas as amostras apresentaram características de "gel fraco" com a relação G’/G’’ entre 3 e 4. Houve diferença significativa (p<0,05) entre as amostras quanto aos atributos sensoriais aparência global e sabor. Em geral, os produtos apresentaram aceitação variando entre gostei ligeiramente e gostei muito. A única rejeição foi atribuída ao produto A, provavelmente devido à elevada sinerese apresentada. Em geral, as amostras E e F receberam a melhor aceitação sensorial e a amostra B, a aceitação mais baixa. A alta aceitação de alguns dos produtos analisados indica um bom potencial de consumo por adultos, que pode ser explorado pelos fabricantes de queijo petit suisse nacional.

The chemical composition, water holding capacity, rheological properties and sensory acceptability of six commercial brands of Brazilian petit suisse cheeses collected from local markets, where analyzed after 20 days of storage at temperatures between 8 and 12°C. The commercial products differed mainly with respect to the type of hydrocolloid added and protein/fat ratio. Product B showed more than two times the water holding capacity as compared to the other samples presenting an intermediate protein/fat ratio and whey protein concentrate and pectin added. The highest apparent viscosity, complex viscosity, G’ and G’’ where presented by product E which also showed the highest protein/fat ratio, suggesting that there was a good correlation between these rheological parameters and protein/fat ratio. The protein/fat ratio significantly influenced (p<0,05) G’, G’’ and the complex viscosity, showing the impact of product composition on the petit suisse cheese structure and elasticity. All the samples showed viscoelastic behavior but G’ was higher than G’’ for all studied frequencies, The G’/G’’ ratio was between 3 and 4, characteristic of "weak gel" for this type of cheese. Sensory scores for taste, global appearance, texture and global terms where significantly different among the samples. Products E and F received the highest acceptability scores and the product B, the lowest. Product A received the highest acceptability scores for taste and texture, but also presented the lowest acceptance in global appearance, due to its high syneresis. In general, the samples were well accepted by adult consumers indicating a good potential in this segment to be explored by national processors of petit suisse cheese.

Diversos parâmetros fornecidos pela análise de solo têm sido usados no Estado de São Paulo para discriminar as respostas à adubação de culturas. Neste trabalho foi avaliada a eficiência desses parâmetros como critério de interpretação, através de estudos de correlação entre resultados de análise de solo e respostas de milho à adubação com nitrogênio, fósforo e potássio em 25 ensaios. Nenhum critério se revelou eficaz para nitrogênio. O teor de fósforo solúvel em H2SO, 0,05N foi eficiente, não tendo havido melhora apreciável das correlações pela consideração dos teores de matéria orgânica, argila ou pH. O teor de potássio trocável revelou-se eficaz, não tendo sido observada melhoria da correlação pela consideração de cálcio e magnésio ou saturação de potássio. No trabalho são apresentadas curvas médias de resposta, bem como as eficiências fertilizantes de nitrogênio, fósforo e potássio, em conjunto para o primeiro elemento e separadas em grupos de acordo com a análise de terra para os dois outros nutrientes.

In this paper some of the criteria that have been used in the State of São Paulo in soil test interpretation were studied, correlating soil test parameters with corn response to applied nitrogen, phosphorus or potassium in 25 field experiments. Exchangeable potassium and phosphorus soluble in 0.05N H2SO, correlated well with responses of the crop to the applied nutrients. Nitrogen responses could not be correlated to soil test values. Response curves and fertilizer efficiencies are presented for nitrogen, phosphorus and potassium. For the two last nutrients, the average curves are given for very low, low, medium and high soil test values.