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BackgroundComplicated skin and skin structure infections (cSSSIs) frequently result in hospitalization with significant morbidity and mortality.MethodsIn this phase 3b/4 parallel, randomized, open-label, comparative study, 531 subjects with cSSSI received tigecycline (100 mg initial dose, then 50 mg intravenously every 12 hrs) or ampicillin-sulbactam 1.5-3 g IV every 6 hrs or amoxicillin-clavulanate 1.2 g IV every 6-8 hrs. Vancomycin could be added at the discretion of the investigator to the comparator arm if methicillin-resistant Staphylococcus aureus (MRSA) was confirmed or suspected within 72 hrs of enrollment. The primary endpoint was clinical response in the clinically evaluable (CE) population at the test-of-cure (TOC) visit. Microbiologic response and safety were also assessed. The modified intent-to-treat (mITT) population comprised 531 subjects (tigecycline, n = 268; comparator, n = 263) and 405 were clinically evaluable (tigecycline, n = 209; comparator, n = 196).ResultsIn the CE population, 162/209 (77.5%) tigecycline-treated subjects and 152/196 (77.6%) comparator-treated subjects were clinically cured (difference 0.0; 95% confidence interval [CI]: -8.7, 8.6). The eradication rates at the subject level for the microbiologically evaluable (ME) population were 79.2% in the tigecycline treatment group and 76.8% in the comparator treatment group (difference 2.4; 95% CI: -9.6, 14.4) at the TOC assessment. Nausea, vomiting, and diarrhea rates were higher in the tigecycline group.ConclusionsTigecycline was generally safe and effective in the treatment of cSSSIs.Trial registrationClinicalTrials.gov NCT00368537

A multi-national working group on antibiotic stewardship, from the International Society of Chemotherapy, put together ten recommendations to physicians prescribing antibiotics to outpatients. These recommendations are: (1) use antibiotics only when needed; teach the patient how to manage symptoms of non-bacterial infections; (2) select the adequate ATB; precise targeting is better than shotgun therapy; (3) consider pharmacokinetics and pharmacodynamics when selecting an ATB; use the shortest ATB course that has proven clinical efficacy; (4) encourage patients’ compliance; (5) use antibiotic combinations only in specific situations; (6) avoid low quality and sub-standard drugs; prevent prescription changes at the drugstore; (7) discourage self-prescription; (8) follow only evidence-based guidelines; beware those sponsored by drug companies; (9) rely (rationally) upon the clinical microbiology lab; and (10) prescribe ATB empirically – but intelligently; know local susceptibility trends, and also surveillance limitations.

Introdução: Na atualidade, as doenças crônicas não transmissíveis são consideradas grande problema de saúde pública. No Brasil, a principal causa de morte é por doença arterial coronariana. Entre os fatores de risco, o colesterol vem sendo apontado tanto em evidências observacionais quanto em experimentais pré-clínicas e clínicas como o principal fator de risco modificável. O objetivo desse estudo de revisão foi avaliar a ação da espécie Allium sativum sobre o perfil lipídico sanguíneo de adultos com dislipidemia. Desenvolvimento: Foi realizada uma revisão da literatura nos seguintes bancos de dados: SciELO e PubMed. O idioma de pesquisa foi o inglês através dos seguintes descritores: "Allium sativum", "hypercholesterolaemia", "dyslipidemia", "cardiovascular diseases" e "chronic diseases". O estudo priorizou artigos entre os anos de 1993 e 2014, não excluindo artigos considerados clássicos. O número amostral das pesquisas avaliadas com Allium sativum variou entre 15 e 192, tendo sido empregadas, nas intervenções, doses desde a forma crua até extrato padronizado, que variaram entre 5 e 7200 mg de alho total. Apesar das limitações metodológicas observadas, como oscilações entre as doses, formas de apresentação e amostra reduzida, 58%, aproximadamente, indicaram benefícios da utilização do alho sobre o controle do perfil lipídico, principalmente no que diz respeito à alteração de colesterol total e lipoproteína de baixa densidade, sugerindo que a substância alicina, presente em relação à quantidade do alho cru, pó ou extrato total, seria a principal moduladora dos efeitos observados sobre o perfil lipídico. Observou-se que a redução de colesterol total variou entre 4,2 e 12,1%, e a variação na redução de lipoproteína de baixa densidade entre 6,6 e 17,6%. Conclusão: Allium sativum parece ser uma alternativa eficaz e segura sobre a redução da hipercolesterolemia. Entretanto, pesquisas que demonstrem evidências clínicas são necessárias para excluir as possíveis variáveis de confundimento.

Data de entrada do artigo: 02/08/2013 Data de aceite do artigo: 03/02/2014 Introdução: Atualmente, a obesidade é vista como um problema de saúde pública, apresentando-se como uma epidemia mundial. Alguns nutrientes específicos estão sendo estudados em relação ao seu papel adjuvante no tratamento dessa doença, como, por exemplo, o cálcio. Objetivo: Realizar revisão de literatura científica sobre a relação entre o consumo de cálcio e a alteração da composição corporal e redução do peso. Materiais e Métodos: Foram utilizados livros de nutrição clínica e as bases de dados SciELO, PubMed e LILACS para a procura de artigos, nos idiomas português e inglês, publicados a partir de 2010. Resultados: Estudos têm evidenciado relação inversa entre o consumo de cálcio, medidas antropométricas, gordura corporal e índice de massa corporal em adultos. O mecanismo de ação responsável por esses efeitos ainda não está bem esclarecido, mas suspeita-se que tenha relação com os hormônios estrogênio, cortisol e paratormônio, além de vitamina D e redução da absorção de gordura no intestino. Em contrapartida, há estudos que não mostram relação significativa. Conclusão: Evidências recentes têm demonstrando o papel adjuvante do cálciona redução e manutenção da gordura e peso corporal, sendo os resultados mais significativos na população feminina e quando a fonte de cálcio é proveniente dos alimentos, e não do uso de suplementação.Palavras-chave: cálcio; obesidade; composição corporal; perda de peso. RESUMOIntroduction: Obesity is currently seen as a public health issue, now a worldwide epidemic. Some specifics nutrients, as calcium, have been studied in relation to their role in the adjuvant treatment of this disease.Objective: To review the scientific literature on the relationship between calcium intake, changes in body composition and weight reduction. Materials and Methods: Clinical nutrition books were used and the databases SciELO, PubMed and LILACS were searched for articles in Portuguese and English, published since 2010.Results: Studies have shown an inverse relationship between calcium intake, anthropometric measurements, body fat and body mass index in adults. The mechanism of action responsible for these effects is not well understood yet, but it is suspected that it is related to the hormones estrogen, cortisol, and paratjormone, as well as vitamin D and reduced intestinal fat absorption. In contrast, there are studies that show no significant relationship among these factors. Conclusion: Recent evidences have demonstrated the adjuvant role of calcium in reducing and maintaining the fat and body weight, and the most significant results are seen in females and when the source of calcium is food, not the use of supplements.

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Introduction: astaxanthin is a carotenoid compound found in marine organisms that, according to several studies, has significantly increased antioxidant properties, with possible benefits for the prevention and treatment of chronic diseases and metabolic syndrome. Objective: to indicate the possible biological effects of astaxanthin, as well as its forms of prescription and possible benefits for the prevention and treatment of chronic diseases and metabolic syndrome. Method: integrative review of clinical experimental studies, mainly, but of some pre-clinical studies, also published since 2000. The searches were carried out in the following databases: Pubmed, SciELO and Semantic Scholar. Results: the results indicated doses between 0.5 and 21.6mg/day, for a period from 2 weeks to 12 months, involving volunteers aged between 8 and 85 years, both genders. Supplements with astaxanthin indicated the ability to reduce oxidative stress, as well as biochemical parameters in the blood, such as low-density lipoprotein, total cholesterol, fasting glucose, triglycerides, glycated hemoglobin and others. The bioactive substance is also associated with a reduction in blood pressure, increased blood operations of high-density lipoprotein and adiponectin, reinforcing the hypothesis that astaxanthin is promising, as an aid in the prevention and treatment of chronic diseases and metabolic syndrome. Conclusion: astaxanthin appears to be a complementary and innovative element for the prevention and treatment of chronic diseases and metabolic syndrome. However, no supplement will have a “miraculous” effect and will replace with constant changes in lifestyle, including healthy eating. The antioxidant effects of astaxanthin were confirmed and associated with the most varied metabolic and clinical outcomes. However, due to the reduced amount of evidence and heterogeneity of variables, further research is needed.

Objective: to elucidate publications and indicate reflections that describe and discuss the "state of the art", involving trans people and important agendas of the transsexualization process in health. Method: narrative review, with literature published in books and scientific evidence, as well as information on bills, resolutions and decrees, with reflections on the main historical perspectives, epistemological and contemporary aspects involving transgender people. Development: gender identity contemplates the essentialist, constructivist and post-structuralist perspective. In the post-structuralist perspective, gender would be a mechanism through which the notions of masculine and feminine are built, to be a woman is to become a woman insofar as the body is forced to correspond to a historical model of woman, materializing itself even within certain conditions, limits and possibilities delimited by culture. Over the decades, some rights have been achieved with the emergence of new forms of recognition of different gender identities. In the United States, in the National Transgender Discrimination Survey, one of the “Gender Not Listed Here” questions is already being considered. In Germany, the option "diverse" as a gender category, in certificates and other documents, is already part of the routine, including highlighting that binary designations would be discriminatory and violate guarantees of individual freedom. In Austria, for example, there is the option to register as a non-binary person since 2018, through the European Convention on Human Rights. In Japan, the gender considered X refers to a non-binary identity, known as an alternative to man and to woman. In Australia, the option of gender, in the passport, has already made possible some alternatives since 2003. In Brazil, some advances in ensuring respect for the gender identity of trans people can be highlighted. In 2018, a decision of the Federal Supreme Court authorized the change of the civil registry name and biological sex, without the need for surgery or a psychiatric report, dispensing with the opening of legal proceedings, and the procedure can be carried out directly at the notary's office. Science-based health is also a relevant issue and over the past 10 years, health research involving gender identity has increased significantly. This is inevitably reflected in care protocols, materials provided by the SUS, consensus and clinical guidelines. There are important data on the cardiometabolic vulnerability of the trans population, dermatoses, bone susceptibility, among other demands, due to hormone. In addition, health professionals, in most cases, are not trained with this type of content and the situation follows a vicious cycle. Final considerations: it is interesting to note how access to healthcare technologies, such as transgenitalization surgery or hormone, influence transgender identities, research about the construction of political identities, movements, highlighting the influence of social indicators of class and generation in the conflicts related to the identities of the transsexual woman and the non-binary trans. The text brings fundamental reflections and allows health professionals to acquire and update their knowledge on this topic in a short period of time.