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ABSTRACT Objective: MicroRNAs are small non-coding RNAs that are abundantly expressed in various biofluids, making them promising candidates for cancer biomarkers. This review aims to present current evidence on the use of miRNA as biomarkers for the non-invasive diagnosis of bladder cancer. Methods: A systematic literature review, using the Medline database, was performed in July 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All articles were required to satisfy the risk-of-bias assessment using the Joanna Briggs Institute Critical Assessment Tools. Data were collected based on miRNA expression, sample type, expression profiles, and accuracy. Results: The initial search retrieved 437 studies, 21 of which were included in the final analysis. Most studies on miRNA expression in human fluids used urine samples for analysis. Conclusion: There is a trend to cluster the expressed miRNAs to build diagnostic panels or use them in association with other diagnostic methods to achieve reasonable accuracy. Prospero database registration: (https://www.crd.york.ac.uk/prospero/) under ID CRD42022351686.

This study explores a nanoemulsion formulated with açaí seed oil, known for its rich fatty acid composition and diverse biological activities. This study aimed to characterise a nanoemulsion formulated with açaí seed oil and explore its cytotoxic effects on HeLa and SiHa cervical cancer cell lines, alongside assessing its antioxidant and toxicity properties both in vitro and in vivo. Extracted from fruits sourced in Brazil, the oil underwent thorough chemical characterization using gas chromatography–mass spectrometry. The resulting nanoemulsion was prepared and evaluated for stability, particle size, and antioxidant properties. The nanoemulsion exhibited translucency, fluidity, and stability post centrifugation and temperature tests, with a droplet size of 238.37, PDI -9.59, pH 7, and turbidity 0.267. In vitro assessments on cervical cancer cell lines revealed antitumour effects, including inhibition of cell proliferation, migration, and colony formation. Toxicity tests conducted in cell cultures and female Swiss mice demonstrated no adverse effects of both açaí seed oil and nanoemulsion. Overall, açaí seed oil, particularly when formulated into a nanoemulsion, presents potential for cancer treatment due to its bioactive properties and safety profile.

Abstract Introduction: Chronic kidney disease (CKD) and metabolic syndrome (MS) are recognized as public health problems which are related to overweight and cardiometabolic factors. The aim of this study was to develop a model to predict MS in people with CKD. Methods: This was a prospective cross-sectional study of patients from a reference center in São Luís, MA, Brazil. The sample included adult volunteers classified according to the presence of mild or severe CKD. For MS tracking, the k-nearest neighbors (KNN) classifier algorithm was used with the following inputs: gender, smoking, neck circumference, and waist-to-hip ratio. Results were considered significant at p < 0.05. Results: A total of 196 adult patients were evaluated with a mean age of 44.73 years, 71.9% female, 69.4% overweight, and 12.24% with CKD. Of the latter, 45.8% had MS, the majority had up to 3 altered metabolic components, and the group with CKD showed statistical significance in: waist circumference, systolic blood pressure, diastolic blood pressure, and fasting blood glucose. The KNN algorithm proved to be a good predictor for MS screening with 79% accuracy and sensitivity and 80% specificity (area under the ROC curve – AUC = 0.79). Conclusion: The KNN algorithm can be used as a low-cost screening method to evaluate the presence of MS in people with CKD.

Abstract Background The prevalence of Human Papillomavirus (HPV) infection in the general population is widely known, however, there are still few studies related to this infection in minority groups, Thus, the objective is to analyze the frequency of human papillomavirus and associated factors in quilombola and gypsy women. Methods Cross-sectional research with 145 quilombola and gypsy women from Caxias, Maranhão. Two Pap smear collections were performed and a questionnaire with 46 questions was applied between January, 2020 and March, 2021. Descriptive analysis and Odds Ratio with 95% confidence interval were performed. The research was approved by the ethics committee. Results There were 09 cases of atypia. The frequency of human papillomavirus was 41.37%, with a higher risk in quilombolas 55 (91.70%). Multiple infections were prevalent (53%) with high-risk genotypes 21 (35%). Types 16 and 18 together accounted for 42.85% of cases. Conclusions The frequency of human papillomavirus infection was higher than those recorded in the Northeast and Brazil, and therefore type 16 predominated. Due to limitations, the virus lineages and sublineages were not evaluated. Quilombola women had a higher rate of infection than gypsies.

ABSTRACT Purpose: To evaluate the effects of deep resection of endometriosis in the posterior pelvic region on urodynamic parameters. Methods: A prospective observational study conducted with female patients diagnosed with deep pelvic endometriosis before and after endometriosis resection surgery. Clinical history, image exams, the Female Lower Urinary Tract Symptoms questionnaire, urodynamic examination, cystometry, and voiding study were evaluated. Results: Patients aged 30–39 years old, operative duration of 132.5 minutes, and 2.7 days of hospital stay. Uroflowmetry and cystometry showed tendency for an increase after the surgery in the flow duration, time to maximum flow, and first voiding desire and decreased residual volume and maximum cystometric capacity. Opening, maximum urinary flow, and maximum flow pressure decreased at T1, and the closing parameters increased, although statistically non significant. The variables decreased at T1 in the urodynamic, except for detrusor overactivity. Although we observed a reasonable number of low bladder compliance and abnormal bladder sensation, the results were maintained at T1. General scores for filling and incontinence showed a significant decrease after surgery. Conclusions: A significant response in the patient’s perception of urinary function was demonstrated after surgery. It is observed that the surgical procedure did not affect the uroflowmetric and cystometric characteristics of the evaluated patients.

Cervical cancer is caused by a persistent and high-grade infection. It is caused by the Human Papillomavirus (HPV), which, when entering cervical cells, alters their physiology and generates serious lesions. HPV 18 is among those most involved in carcinogenesis in this region, but there are still no drug treatments that cause cure or total remission of lesions caused by HPV. It is known that L-asparaginase is an amidohydrolase, which plays a significant role in the pharmaceutical industry, particularly in the treatment of specific cancers. Due to its antitumor properties, some studies have demonstrated its cytotoxic effect against cervical cancer cells. However, the commercial version of this enzyme has side effects, such as hypersensitivity, allergic reactions, and silent inactivation due to the formation of antibodies. To mitigate these adverse effects, several alternatives have been explored, including the use of L-asparaginase from other microbiological sources, which is the case with the use of the fungus Aspergillus niger, a high producer of L-asparaginase. The study investigated the influence of the type of fermentation, precipitant, purification, characterization, and in vitro cytotoxicity of L-asparaginase. The results revealed that semisolid fermentation produced higher enzymatic activity and protein concentration of A. niger. The characterized enzyme showed excellent stability at pH 9.0, temperature of 50 °C, resistance to surfactants and metallic ions, and an increase in enzymatic activity with the organic solvent ethanol. Furthermore, it exhibited low cytotoxicity in GM and RAW cells and significant cytotoxicity in HeLa cells. These findings indicate that L-asparaginase derived from A. niger may be a promising alternative for pharmaceutical production. Its attributes, including stability, activity, and low toxicity in healthy cells, suggest that this modified enzyme could overcome challenges associated with antitumor therapy.

Açaí, Euterpe oleracea Mart. is rich in several phytochemical substances with antioxidant, anti-inflammatory and antitumor activities. The açaí seed is a waste product, being little used in the economy, being relevant to study the antitumor properties of this by-product. This study aims to analyze the effects of hydroalcoholic açaí seed extract in Ehrlich mice model in preventive and treatment schemes. The animals were treated with different concentrations of the extract (100, 300 and 1000 mg/kg) by gavage in preventive (30 days before tumor induction) and intervention (15 days after tumor induction) regimens. In in vivo experiments, the use of the extract at a dose of 1000 mg/kg in preventive regimens reduced tumor volume, decreased tumor weight, maintained the weight of treated animals and induced an immunomodulatory response, with an increase in TNF-α. The treatment also increased the area of tumor necrosis when compared to the control. Our results suggest the antitumor potential of açaí seed extract in in vivo models of breast cancer, contributing to obtain an active drug from a known natural product. In addition, the use of açaí seed residue will contribute to the local economy and sustainability.

Background: Human Papillomavirus (HPV) is the main etiological factor for the development of cervical cancer. HPV 18 is the second most frequent type, accounting for up to 65% of all cases. HPV intratypic variation may influence the potential for progression to invasive cancer. The aim of this study was to evaluate the prevalence of human papillomavirus 18 intratypic variants in cervical cancer samples from women in the state of Maranhão, Brazil. Methods: The study included 118 women over 18 years of age with a diagnosis of cervical cancer. Tumor fragments were collected and subjected to DNA extraction and Polymerase Chain Reaction (PCR) for HPV detection using the PGMY09/11 and GP+5/6 primers. Positive samples were submitted to automated sequencing for viral genotyping. To determine the HPV 18 lineages, positive samples were submitted to PCR, using specific primers to amplify the LCR and E6 regions of HPV 18 virus. Results: HPV was present in 88 women (73.3%). Of those, 48 (54%) were HPV 16, the most prevalent, followed by 12 (13.6%) HPV 18. Histologically, squamous cell carcinoma was predominant (79.1%). Among the HPV 18 variants identified, 10 (80%) belonged to lineage A, and sublineages A1, A2, A3, and A4. Two (29%) HPV 18 B variant was also detected, with the sublineages B1 and B2. In this study, the C variant was not found. There was no statistically significant association between the HPV 18 lineages found and sociodemographic and lifestyle variables (p > 0.05). Conclusions: A higher frequency of HPV 16 and 18 were found in women with cervical cancer in the state of Maranhão, Brazil, with a high prevalence of the lineage A among women with HPV 18.

Background: HPV is strongly related to cervical cancer. HPV lineages can contribute to a response to cervical cancer therapy. The aim of this research was to estimate the frequency of human papillomavirus (HPV)-16 lineages in specimens of cervical cancer, relate the pathological factors in these variants, and assess their response to treatment with radical chemoradiotherapy. Methods: Samples of cervical cancer were collected from women who were referred to a reference cancer hospital to test the presence of human papillomavirus-type DNA. The standard protocol of this service consisted of cisplatin-based chemotherapy of 40 mg/m2, plus conventional pelvic irradiation in doses of 45–50.4 Gy and high dose-rate brachytherapy of 28–30 Gy to Point A. The response to chemotherapy was evaluated after three months in patients with the HPV-16 lineage. Results: HPV DNA was detected in 104 (88.1%) of the 118 patients. HPV-16 was present in 63 patients (53%). Lineages of HPV-16 were identified in 57 patients and comprised 33 instances of (57.8%) lineage A, 2 instances of lineage B (3.5%), 2 instances of lineage C (3.5%), and 20 instances of (35.0%) lineage D. The median age of the patients was 48.4 years (range 25–85 years). Squamous cell carcinoma was detected 48 times (84.2%). Adenocarcinoma was more likely to occur in lineage D, as three of the four cases occurred in this lineage. A total of 11 patients with the HPV-16 variant were treated with chemoradiotherapy. After three months, it was observed that nine of the eleven patients (81.8%) achieved a complete response, five with the lineage A type, two with the lineage C type, and two with the lineage D type. The two cases of partial response and disease progression, one of each, occurred in lineage A. Conclusions: In addition to the small number of patients and HPV variants, we noticed a better response in patients with the HPV-16 lineage A. Increasing the sample size could be helpful to better assess the impact of HPV variants on cervical cancer treatment.

Abstract Background Cervical cancer is the fourth most common type of cancer affecting women globally. In Brazil, it is the third most frequent type of cancer in women and HPV is present in approximately 90% of cases. Evidence suggests that variants of HPV 16 can interfere biologically and etiologically during the development of cervical cancer. Methods Cervix tumor fragments were collected, their DNA was extracted, and nested PCR was used to detect HPV. Positive samples were sequenced to determine the viral genotype. To characterize the HPV 16 strains, positive samples PCR was used to amplify the LCR and E6 regions of the HPV 16 virus. Results Data from 120 patients with cervical cancer were analyzed. Most women were between 41 and 54 years of age, had schooling until primary school, a family income between 1 and 2 times the minimum wage and were married/in a consensual union. There was no statistically significant association between HPV or socio-demographic variables and risk factors for cervical cancer (P

Objectives: Talaromyces purpurogenus is a fungus species widely found in the marine environment. When in a hostile environment, it produces a series of secondary metabolites with important biotechnological potential, such as meroterpenoids. In our previous report, we demonstrated that the culture broth ethyl acetate extract from T. purpurogenus reduced the cellular infiltration of lymphoid organs and circulating levels of TNF-α. To elucidate this anti-inflammatory effect, this work aimed to study T. purpurogenus isolated from a marine-polluted environment regarding the chemical composition of its culture broth and mycelial ethyl acetate extract (CBEAE and MEAE respectively), as well as its action on pro-inflammatory markers in LPS-stimulated RAW 264.7 cells and carrageenan-induced mice paw edema. Methods: Chemical characterization was performed by HPLC-DAD-UV. Cytotoxicity in vitro and endotoxin quantification in extracts were preformed prior the experiments. In vitro inhibitory effect of T. purpurogenus extracts were evaluated by cytokines and nitrite quantification in cell supernatant of RAW 264.7 cells. The effect of T. purpurogenus in murine acute inflammation model of carrageenan-induced paw edema was verified by thickness kinetic and histology evaluation. Results: The CBEAE demonstrated a richer chemical composition than MEAE, presenting nine meroterpenoid compounds, while MEAE displayed only two meroterpenoid and one phenolic compound. Cytotoxicity in RAW 264.7 macrophages was not observed at any concentration treatment for both extracts. Endotoxin quantification also demonstrated absence of endotoxins in both extracts. At 500 μg/mL, the CBEAE and MEAE extracts inhibited nitrite (p = 0.0450 and p = 0.0497), TNF-α (p = 0.0076 and p = 0.0001) and IL-1β (p = 0.0042 and p = 0.0031), but only CBEAE inhibited IL-6 levels in LPS-stimulated cells (p = 0.0234). CBEAE, but not MEAE, also inhibited nitrite (p = 0.0353) and IL-1β (p = 0.0386) in non-stimulated cells. In addition, CBEAE at 250 and 500 mg/kg inhibited edema thickness and mast cells (p = 0.0303 and p = 0.0130) in λ-carrageenan-induced mice paw edema. Conclusions: Talaromyces purpurogenus isolated from marine-polluted environment inhibited pro-inflammatory markers in LPS-stimulated RAW 264.7 cells and in murine model of paw edema. The promising anti-inflammatory activity in vitro and in vivo, especially the culture broth ethyl acetate extract, demonstrates its potential for further studies to elucidate its mechanism of action.

Açaí, Euterpe oleracea Mart., is a native plant from the Amazonian and is rich in several phytochemicals with anti-tumor activities. The aim was to analyze the effects of açaí seed oil on colorectal adenocarcinoma (ADC) cells. In vitro analyses were performed on CACO-2, HCT-116, and HT-29 cell lines. The strains were treated with açaí seed oil for 24, 48, and 72 h, and cell viability, death, and morphology were analyzed. Molecular docking was performed to evaluate the interaction between the major compounds in açaí seed oil and Annexin A2. The viability assay showed the cytotoxic effect of the oil in colorectal adenocarcinoma cells. Acai seed oil induced increased apoptosis in CACO-2 and HCT-116 cells and interfered with the cell cycle. Western blotting showed an increased expression of LC3-B, suggestive of autophagy, and Annexin A2, an apoptosis regulatory protein. Molecular docking confirmed the interaction of major fatty acids with Annexin A2, suggesting a role of açaí seed oil in modulating Annexin A2 expression in these cancer cell lines. Our results suggest the anti-tumor potential of açaí seed oil in colorectal adenocarcinoma cells and contribute to the development of an active drug from a known natural product.

BackgroundZika virus (ZIKV) is a flavivirus associated with microcephaly and other fetal anormalities. However, evidence of asymptomatic ZIKV infection in pregnant women is still scarce. This study investigated the prevalence of Zika infection in asymptomatic pregnant women attending two public maternities in Maranhão state, Northeast Brazil.MethodsA total of 196 women were recruited at the time of delivery by convenience sampling from two maternity clinics in São Luís, Maranhão, Brazil, between April 2017 and June 2018. Venous blood, umbilical cord blood and placental fragments from maternal and fetal sides were collected from each subject. ZIKV infection was determined by reverse transcription polymerase chain reaction (RT-qPCR) for ZIKV and by serology (IgM and IgG). Nonspecific laboratory profiles (TORCH screen) were obtained from medical records.ResultsThe participants were mostly from São Luís and were of 19-35 years of age. They had 10-15 years of schooling and they were of mixed race, married, and Catholic. ZIKV was identified in three umbilical cord samples and in nine placental fragments. Mothers with positive ZIKV RT-qPCR were in the age group older than 19 years. Of the 196 women tested by ZIKV rapid test, 6 and 117 women were positive for anti-ZIKV IgM and anti-ZIKV IgG antibodies, respectively. Placental Immunohistochemistry study detected ZIKV in all samples positive by RT-PCR. The newborns did not show any morphological and/or psychomotor abnormalities at birth.ConclusionsAsymptomatic ZIKV infection is frequent, but it was not associated to morphological and/or psychomotor abnormalities in the newborns up to 6 months post-birth. Although pathological abnormalities were not observed at birth, we cannot rule out the long term impact of apparent asymptomatic congenital ZIKV infection.

ABSTRACT Objective: To investigate how mothers of children with congenital syndrome (microcephaly) associated with Zika virus perceive their quality of life. Methods: This is a qualitative study carried out in two stages: at the Maternal and Child University Hospital and at Casa de Apoio Ninar through semi-structured interviews with mothers of children with congenital syndrome associated with Zika virus. Ten women comprised the sample. Results: In line with the critical discourse analysis, four categories emerged based on Fairclough’s 2008 assumptions: Quality of Life and Health - quality of life perception associated with the broad meaning of the term health; Quality of Life and Health Care Systems - characterized by care instability and fragmentation; Quality of Life and Free Time - lack of free time for activities of daily living and leisure; Quality of Life and Future Perspectives - lack of future perspective, considering that most participants had to stop working and studying to take care of their children. Conclusions: Mothers of children with congenital syndrome associated with Zika virus are devoted to their children’s care. Their lack of prospects was considered a consequence of the lack of time for activities of daily living and leisure.

This study aimed at the investigation of physicochemical characteristics of oils and the morphometric characteristics of fruits and seeds (almonds) of babassu (Orbignya phalerata Martius), by ecological region of the state of Maranhão. For this, samples of babassu were obtained from the following regions: Litoral, Cocais, Baixada, Cerrado and Pre-Amazonia of the state of Maranhão, and analyzed the following physicochemical parameters: acidity index, saponification index, refraction index and humidity using Analytical Standards of the Adolfo Lutz Institute. Fruits were collected from the same regions to analyze the morphometric characteristics by measuring the fruits and almonds of the studied species. The results indicate that the acidity indexes are within the maximum limit established by the ANVISA National Standard and the saponification indexes indicate the presence of medium to high molecular weight lipids. The refractometric results are in line with current standards and the moisture content was less than 1%. The lots of Orbignya phalerata Martius babassu presented a significant variability in size and weight for fruits and almonds by region.

Abstract Background Human papillomavirus (HPV) is a member of the Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women. Methods This cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups. Results HPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection. Conclusions It is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão.

This study evaluated the effect of green propolis extract on the adhesion and biofilm formation of Candida species in dentistry materials. Phytochemical analysis of green propolis extract was performed by high-performance liquid chromatography. Adhesion was quantified by counting the number of yeast cells adherent to dental material fragments in a Neubauer chamber. Biofilm formation was determined by counting colony-forming units recovered from dental material fragments. The intensity of biofilm adhesion was classified as negative, weak, moderate, strong, or very strong. Fifteen compounds, mainly flavonoids, were identified in green propolis extract. All strains adhered to and formed biofilms on the surfaces of the orthodontic materials studied. On steel and resin, yeast cell adhesion intensities were weak at all incubation times, except for those of Candida parapsilosis and C. tropicalis, which were moderate at 12 h. At 24 and 48 h, C. albicans formed biofilms on steel with moderate adhesion affinities; at 24 and 48 h, C. parapsilosis formed biofilms with very strong affinities. C. tropicalis formed biofilms with strong and very strong affinities at 24 and 48 h, respectively. On resin, all species displayed strong affinity for biofilm formation at 24 and 48 h, except for C. tropicalis, which displayed very strong affinity at only 48 h. Green propolis extract displayed antifungal activity and inhibited both adhesion and biofilm formation at 2.5 μg/mL. This study reinforces the idea that green propolis has antifungal activity and interferes with the virulence of Candida species.

Background. Flavonoids from a variety of fruits, including açaí, have beneficial antioxidant activity in several diseases, including cancer. Breast cancer is the second most prevalent cancer among Brazilian women. Studies have shown the action of flavonoids on neoplastic cells, as well as on diabetes and neurodegenerative and cardiovascular diseases. Objective. To analyze the relationship between the consumption of açaí and the presence of chronic diseases in women residing in the rural area of São Luís, Maranhão. Methods. A convenience sample of 150 women residing in the Maracanã neighborhood in São Luís, Maranhão, was used; the collected data included sociodemographic characteristics, habits, sexual and reproductive history, consumption of açaí, and history of cancer and other chronic diseases. The sample was divided into women who consumed açaí at least once a week (cases) and women who did not consume açaí (controls). Statistical analysis was performed to assess the relationships between those variables and the consumption of açaí. Results. A total of 141 women (94%) consumed açaí. Among these, 79.3% were aged between 20 and 50 years, 78.67% were farmers or housewives, 64.67% were Pardo (mixed race), 76.67% were nonsmokers, 70% were not receiving hormonal therapy, 40.67% had already undergone mammography, 28% had already undergone breast ultrasound, and 27.33% had a family history of cancer, with breast cancer being the second most prevalent cancer. There was a higher prevalence of hypertension among women who did not consume açaí than that among those who did; however, previous cancer, family history of cancer, heart disease, and diabetes were more prevalent among the consumers of açaí. There were no statistically significant relationships. Conclusion. Flavonoids are known to have a beneficial effect on some types of neoplastic cells and other diseases; therefore, larger studies are necessary to better evaluate the beneficial effects of consuming foods containing flavonoids on these diseases.

Introduction. In recent decades, there has been an intensification of environmental problems, which are becoming increasingly critical and frequent due to population growth. Microorganisms, including soilborne fungi, play an essential role in maintaining and balancing the environment. One of the most impacted ecosystems in São Luís, Maranhão, Brazil, is the Jansen Lagoon State Park, an important tourist spot, which has suffered anthropogenic actions such as the dumping of household waste (sewage) in its body of water. As a consequence, these pollutants can accumulate in the adjacent soil, since the body of water is near this substrate. The objectives were to isolate and identify filamentous fungi from the soil of the Jansen Lagoon State Park. Methods. Monthly soil samples were collected and later processed using the modified suspension technique according to Clark (1965). Results. The isolated genera were Aspergillus, Penicillium, Trichoderma, Absidia, and Fusarium. Aspergillus is the fungal genus of greater dominance in the soil of the Jansen Lagoon State Park. Aspergillus niger was the dominant species (37%), followed by A. tamarii (21.6%). Conclusion. The main isolated fungi from the Jansen Lagoon State Park were Aspergillus niger and Aspergillus tamrii. These fungi can be used as biological markers of pollution and as biodegraders and/or bioremediators to improve the area studied.

Euterpe oleracea Mart. (açai) is a native palm from the Amazon region. There are various chemical constituents of açai with bioactive properties. This study aimed to evaluate the chemical composition and cytotoxic effects of açai seed extract on breast cancer cell line (MCF-7). Global Natural Products Social Molecular Networking (GNPS) was applied to identify chemical compounds present in açai seed extract. LC-MS/MS and molecular networking were employed to detect the phenolic compounds of açai. The antioxidant activity of açai seed extract was measured by DPPH assay. MCF-7 breast cancer cell line viability was evaluated by MTT assay. Cell death was evaluated by flow cytometry and time-lapse microscopy. Autophagy was evaluated by orange acridin immunofluorescence assay. Reactive oxygen species (ROS) production was evaluated by DAF assay. From the molecular networking, fifteen compounds were identified, mainly phenolic compounds. The açai seed extract showed cytotoxic effects against MCF-7, induced morphologic changes in the cell line by autophagy and increased the ROS production pathway. The present study suggests that açai seed extract has a high cytotoxic capacity and may induce autophagy by increasing ROS production in breast cancer. Apart from its antioxidant activity, flavonoids with high radical scavenging activity present in açai also generated NO (nitric oxide), contributing to its cytotoxic effect and autophagy induction.

Açaí berry is a fruit from the tree commonly known as açaízeiro (Euterpe oleracea Mart.) originated from the Amazonian region and widely consumed in Brazil. There are several reports of the anti-inflammatory activity of its pulp and few data about the seed’s potential in inflammation control. This work aimed to evaluate the effect of catechin-rich açaí extract on lipopolysaccharide (LPS)-stimulated RAW 264.7 cells and carrageenan-induced paw edema. The treatment with E. oleracea ethyl acetate extract (EO-ACET) was used in an in vitro model performed with macrophages stimulated by LPS, in which pro-inflammatory markers were evaluated, and in an in vivo model of acute inflammation, in which edema inhibition was evaluated. EO-ACET showed an absence of endotoxins, and did not display cytotoxic effects in RAW 264.7 cells. LPS-stimulated cells treated with EO-ACET displayed low levels of nitrite and interleukins (IL’s), IL-1β, IL-6 and IL-12, when compared to untreated cells. EO-ACET treatment was able to inhibit carrageenan-induced paw edema at 500 and 1000 mg/kg, in which no acute inflammatory reaction or low mast cell counts were observed by histology at the site of inoculation of λ-carrageenan. These findings provide more evidence to support further studies with E. oleracea seeds for the treatment of inflammation.

ABSTRACT Introduction: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. Objectives: Identify risk factors related to osteoporosis in women attending Propis/Proex/UFMA, tracing a socio-demographic characterization and considering community lifestyles. Material and methods: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís (MA) with 107 women treated at the Programa de Práticas de Integralidade em Saúde (Propis - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info® software, version 3.4.1. Results: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p < 0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p < 0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. Conclusion: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

Background: This study addresses the antitumoral properties of Penicillium purpurogenum isolated from a polluted lagoon in Northeastern Brazil. Methods: Ethyl Acetate Extracellular Extract (EAE) was used. The metabolites were studied using direct infusion mass spectrometry. The solid Ehrlich tumor model was used for antitumor activity. Female Swiss mice were divided into groups (n = 10/group) as follows: The negative control (CTL−), treated with a phosphate buffered solution; the positive control (CTL+), treated with cyclophosphamide (25 mg/kg); extract treatments at doses of 4, 20, and 100 mg/kg; animals without tumors or treatments (Sham); and animals without tumors treated with an intermediate dose (EAE20). All treatments were performed intraperitoneally, daily, for 15 days. Subsequently, the animals were euthanized, and the tumor, lymphoid organs, and serum were used for immunological, histological, and biochemical parameter evaluations. Results: The extract was rich in meroterpenoids. All doses significantly reduced tumor size, and the 20 and 100 mg/kg doses reduced tumor-associated inflammation and tumor necrosis. The extract also reduced the cellular infiltration of lymphoid organs and circulating TNF-α levels. The extract did not induce weight loss or renal and hepatic toxic changes. Conclusions: These results indicate that P. purpurogenum exhibits immunomodulatory and antitumor properties in vivo. Thus, fungal fermentation is a valid biotechnological approach to the production of antitumor agents.

AimTo investigate circulating hormonal, metabolic and inflammatory biomarker profiles in obese and non-obese middle-aged women.MethodsA total of 110 women, aged 40-60 years, were included in this cross-sectional study. Patients were allocated, according to the occurrence of menopause and body mass index (BMI), into four groups: PM0 (premenopausal non-obese), PM1 (premenopausal obese), M0 (postmenopausal non-obese), and M1 (postmenopausal obese). Serum levels of gonadotropins, sex hormones, lipid markers, leptin, hs-CRP and interleukin-6 were obtained using either colorimetric or immunoenzymatic assays. Univariate and correlation analyses were performed among all clinical and laboratorial parameters. Principal component analysis was used to characterize subsets of biomarkers, which had their discriminatory capacity tested using discriminant function analysis.ResultsLevels of gonadotropins and female sex hormones were similar between PM0 and PM1 and between M0 and M1 (p > 0.05), all of them varied between PM0 and M0 (p < 0.05), but only estradiol was significantly altered in the comparison between PM1 and M1 (p = 0.027). Regarding metabolic markers, leptin was lower in PM0 than in M0 (p = 0.010) and higher in M1 than in M0 (p = 0.046). In premenopausal women, BMI correlated only to leptin, while it correlated to several other markers in postmenopausal women. A combination of FSH and leptin serum levels significantly discriminated the four groups (Wilks's lambda < 0.001, in canonical functions 1 and 2).ConclusionA combined analysis of hormonal biomarkers may potentially distinguish obese from non-obese women with distinct menopause status. Further research is thus required to clarify the clinical significance of such findings.

Background. Cardiovascular diseases are leading causes of death worldwide. Recent studies suggest that infection by some viruses, including the human papillomavirus (HPV), may increase the risk of developing atheromatous lesions on coronary arteries. However, there is a lack of data regarding the possible association between HPV infection and coronary artery disease (CAD) in women. Objective. To investigate whether HPV infection is associated with the occurrence of CAD among climacteric women. Methods. The presence of CAD and cervical HPV DNA was investigated in 52 climacteric women. Social and demographic variables and metabolic profiles were also investigated. Results. Among 27 women with CAD, 16 were positive for HPV, whereas 11 were negative. The presence of cervical HPV was strongly associated with CAD, after adjusting for demographic variables, health and sexual behaviors, comorbidities, and known cardiovascular risk factors. HPV-positive women showed a greater likelihood of having CAD (odds ratio [OR] = 3.74; 95% confidence interval [CI]: 1.16 to 11.96) as compared with HPV-negative women, particularly those infected with high-risk HPV types (OR = 4.90; 95% CI: 1.26 to 19.08). Conclusion. These results support the hypothesis that HPV infection might be associated with CAD among climacteric women, though further studies are needed to investigate the mechanisms involved.

ABSTRACT Introduction: Candida parapsilosis is one of the main species that is able to adhere to forming biofilms on inert materials. Adhesion is the first step towards the colonization and invasion of host cells during the infectious process. Among the infections, vulvovaginal candidiasis is increasingly common. The objective was to evaluate the profile of adherence and biofilm formation of eight isolates of C. parapsilosis on the metal used in intrauterine devices (IUDs). Methods: Eight strains of C. parapsilosis presenting strong adhesion and biofilm formation properties were isolated from vaginal secretions in a previous study. To assay the adhesion and biofilm formation, copper fragments were made and cultivated in tubes containing 3 mL of phosphate-buffered saline and incubated for 6 and 24 h at 37 °C to evaluate biofilm formation. After incubation, the intensity of adherence and of biofilm formation on copper fragments were determined by performing a colony count. Results: All isolates were able to form biofilms and the isolate Cp62 showed many cells joined in a planktonic mode forming biofilms. The use of an IUD is one of the main factors that favors vulvovaginal candidiasis, and the presence of copper in this device increases the chance of recurrent vulvovaginal candidiasis (CVVR) due to the ease with which species of the genus Candida can adhere to inert surfaces. Conclusion: This research showed that the clinical isolates studied adhered to IUD copper fragments and formed biofilms, further increasing their virulence.

Background: Gaucher disease is an inborn, autosomal recessive error of the metabolism which belongs to the group of lysosomal storage disorders. Objective: This work reports on the treatment of Gaucher disease in several members of the same family from the countryside of Maranhão. Methods: This was an observational, retrospective and prospective, descriptive case study about the efficacy of enzyme replacement therapy. Results: The results showed that women were more affected (80% of patients) by the disease, age at diagnosis ranged from 24 to 33 years, the predominant ethnicity was mulatto (80%) and all cases were classified as type 1. The diagnosis of these patients was performed by measuring the levels of glucocerebrosidase and chitotriosidase enzymes and confirmed by genotyping. All patients suffering from Gaucher disease had low glucocerebrosidase levels. Before replacement therapy, hepatosplenomegaly was the most common clinical manifestation (100%) and osteopenia was seen in 80% of the cases. Regarding hematological manifestations, anemia and leukopenia were found in 40% of patients at diagnosis; however the hemoglobin and leukocyte levels were normalized after four years of therapy. Thrombocytopenia, observed in 20% of cases, was normalized after the second year of treatment. Conclusion: In these cases, despite gaps in the treatment as the family resides in the rural region of the state, the patients with Gaucher disease showed satisfactory therapeutic response over time.

Introduction: There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. Methods: The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. Results: In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. Conclusions: The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation.

Introduction: This study aimed to identify airborne fungi in São Luis, Maranhão, Brazil, to determine the prevalent genera and to correlate these genera with the area and season. Methods: In total, 1,510 colony-forming units (CFUs) of airborne fungi were isolated from the north, south, east and west sides and from the center of the city from January to December 2007. The samples were collected on Petri dishes that were exposed to the fungi by the gravitational method. Results: Twenty genera of fungi were isolated; the most common were Aspergillus (33.5%), Penicillium (18.8%), Cladosporium (14.2%), Curvularia (10.6%) and Fusarium (7.6%). The CFUs of the fungi were statistically significant (p < 0.0001). Fungal biological diversity was present all year, without any large seasonal variations but with slight increases in May, August and September. Conclusions: The fungal genera identified in this study were correlated with natural systems and could be useful when evaluating the impact of environmental changes on the region.

INTRODUCTION: One of the important current problems in HIV/AIDS infection is the establishment of epidemiological and laboratorial prognostic parameters during patient follow-up. This study aimed at analyzing the evolution of laboratory tests: CD4 lymphocyte count, viral load, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the epidemiological variables sex and age as prognostic factors for survival in progression to death among AIDS patients. METHODS: A retrospective study was conducted using analysis of medical records, and prospective 24-month follow-up of patients with HIV/ AIDS attended at the President Vargas Hospital Outpatient Clinic, a reference center in HIV/ AIDS attendance in the State of Maranhão, Brazil. The study analyzed patients aged 10 to 60 years old, who manifested AIDS and who were not using antiretroviral therapy or had used it for less than 5 years. The Chi-square test was used for statistical analysis. RESULTS: The sample included 100 patients - 57 were current outpatients, and 43 had died. The variables viral load (p=0.726), ALT (p=0.314), sex (p=0.687), and age (p=0.742) were analyzed, and no evidence of association between them and worst prognosis was observed. CONCLUSIONS: A significant relation was verified between low Hb levels (p=0.000) and CD4 (p=0.000) and shorter survival.INTRODUÇÃO: Uma das importantes dificuldades atuais na infecção HIV/AIDS é estabelecer parâmetros epidemiológicos e laboratoriais prognósticos no seguimento dos pacientes. Esse trabalho objetivou analisar a evolução dos exames laboratoriais: contagem de linfócitos CD4, carga viral, dosagem de hemoglobina (Hb), de aspartato aminotransferase (AST), de alanino aminotransferase (ALT) e as variáveis epidemiológicas: sexo e idade, como fatores prognósticos de sobrevida na evolução para o óbito em pacientes com AIDS. MÉTODOS: Foi realizado um estudo retrospectivo a partir da análise de prontuários e um prospectivo por seguimento de pacientes portadores de HIV/AIDS, no Serviço Ambulatorial da referência assistencial em HIV/AIDS, no Estado do Maranhão, durante 24 meses. Os pacientes analisados tinham faixa etária compreendida entre 10 e 60 anos, apresentavam quadro clínico manifesto e não faziam uso de antirretroviral ou ainda o faziam há menos de 5 anos. Para análise estatística, foi adotado o teste qui-quadrado. RESULTADOS: A amostra compreendeu 100 pacientes, dos quais 57 se encontravam em tratamento ambulatorial e 43 já tinham ido a óbito. Variáveis como carga viral (p= 0,726), ALT (p=0,314), sexo (p=0,687) e faixa etária (p=0,742) foram analisadas e nenhuma evidência de associação entre elas com o pior prognóstico foi verificada. CONCLUSÕES: Constatou-se uma significante relação entre baixos níveis de Hb (p=0,000) e de CD4 (p=0,000) com menor sobrevida.

Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.

Objective: to evaluate the prevalence of cardiovascular risk factors associated with dyslipidemia in Quilombola communities in Maranhão, Brazil. Methods: a cross-sectional study was performed from February 2010 to November 2011. A total of 202 individuals belonging to the Quilombola communities in Codó, Maranhão were assessed. Risk factors associated with dyslipidemia and metabolic syndrome (MS) were evaluated. Results: the results showed a high prevalence of dyslipidemia (72.28%) and hypertension (43.07%). Isolated hypertriglyceridemia (38.61%) with normal levels of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol was present in most individuals. Furthermore, the prevalence of MS and the estimated cardiovascular risks were low in this population. Conclusion: dyslipidemia, at the expense of triglycerides, and hypertension was highly prevalent. However, the frequency of other risk factors for cardiovascular events was low. A low prevalence of MS and cardiovascular risk according to the Framingham score for cardiovascular diseases was also identified.

Realizou-se estudo prospectivo com 1.520 indivíduos menores de 15 anos no Município de São José de Ribamar, Maranhão, Brasil, de junho de 1994 a janeiro de 1995, com o objetivo de avaliar a prevalência e as características (fatores sócio-econômicos, ambientais e hábitos de vida) associadas à infecção por Leishmania chagasi. Realizou-se Intradermorreação de Montenegro (IDRM) e sorologia por Enzyme Linked Immunosorbant Assay (ELISA-rK39 e CRUDE). Na análise estatística foi utilizado o teste chi2 com correção de Yates, sendo considerado significante um valor de p < 0,05. A prevalência de infecção foi de 61,7% pela IDRM, 19,4% pelo ELISA-rK39 e 19,7% pelo ELISA-CRUDE. Foi observada associação entre leishmaniose na família (p = 0,001), tipo de abastecimento de água (p = 0,000) e aplicação de inseticida (p = 0,000) com a infecção por L. chagasi pela IDRM. Nenhuma associação com infecção por L. chagasi foi observada utilizando-se a sorologia ELISA-rK39 ou CRUDE. Medidas de controle mais efetivas são necessárias para reduzir a prevalência da doença e detectar casos assintomáticos dentre o elevado porcentual de infectados nessa localidade.A prospective study was undertaken in 1,520 children less than 15 years of age in São José de Ribamar, Maranhão, Brazil, from June 1994 to January 1995, to evaluate the prevalence and characteristics (socioeconomic, environmental, and behavioral) associated with infection by Leishmania chagasi. Montenegro skin test (MST) and enzyme-linked immunosorbent assay (ELISA-rK39 and CRUDE) test were used to detect infection. The statistical analysis used the chi2 test with Yates correction and a p value less than 0.05 was considered statistically significant. Prevalence of infection was 61.7% as measured by MST, 19.4% according to ELISA (rK39), and 19.7% by ELISA (CRUDE). Association was detected between leishmaniasis in the family, water supply, application of insecticide, and infection by L. chagasi using MST. No association with infection by L. chagasi was detected using ELISA rK39 or CRUDE. More effective control measures are needed to reduce prevalence and to detect asymptomatic cases in this high percentage of infected children.

INTRODUCTION: Visceral leishmaniasis is a serious public health problem that requires global control strategies, especially with respect to factors that may intervene in reducing the incidence of endemicity. In this work, rainfall density and temperature were correlated with the incidence of human cases in an area endemic for leishmaniasis in São Luis do Maranhão, Northeastern Brazil. METHODS: Notification of human cases by the National Health Foundation/Regional Coordination of Maranhão (FUNASA/COREMA) from 2002 to 2010 was used. Ecological data (mean temperature and rainfall density) were provided by the Meteorological Office of State. RESULTS: A significant association was verified between the number of VL cases and rainfall rate but not in the analysis concerning mean temperatures. CONCLUSIONS: These data suggest that the control actions in visceral leishmaniasis should be performed during rainy season in the State of Maranhão, which is in the first half of the year.