Economic burden for the Unified Health System attributable to excessive sodium consumption in Brazil

OBJECTIVES

This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019.

STUDY DESIGN

Ecological study.

METHOD

This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019.

RESULTS

Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium.

CONCLUSION

Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality.

Systemic toxicity of snake venom metalloproteinases: Multi-omics analyses of kidney and blood plasma disturbances in a mouse model

Snakebite envenomation is classified as a Neglected Tropical Disease. Bothrops jararaca venom induces kidney injury and coagulopathy. HF3, a hemorrhagic metalloproteinase of B. jararaca venom, participates in the envenomation pathogenesis. We evaluated the effects of HF3 in mouse kidney and blood plasma after injection in the thigh muscle, mimicking a snakebite. Transcriptomic analysis showed differential expression of 31 and 137 genes related to kidney pathology after 2 h and 6 h, respectively. However, only subtle changes were observed in kidney proteome, with differential abundance of 15 proteins after 6 h, including kidney injury markers. N-terminomic analysis of kidney proteins showed 420 proteinase-generated peptides compatible with meprin specificity, indicating activation of host proteinases. Plasma analysis revealed differential abundance of 90 and 219 proteins, respectively, after 2 h and 6 h, including coagulation-cascade and complement-system components, and creatine-kinase, whereas a semi-specific search of N-terminal peptides indicated activation of endogenous proteinases. HF3 promoted host reactions, altering the gene expression and the proteolytic profile of kidney tissue, and inducing plasma proteome imbalance driven by changes in abundance and proteolysis. The overall response of the mouse underscores the systemic action of a hemorrhagic toxin that transcends local tissue damage and is related to known venom-induced systemic effects.

Mortality attributable to diets low in fruits, vegetables, and whole grains in Brazil in 2019: evidencing regional health inequalities

OBJECTIVE

The objective of this study was to describe non-communicable disease (NCD) mortality attributable to diets low in whole grains, fruits, and vegetables in Brazil in 2019.

STUDY DESIGN

Ecological study.

METHODS

Data from the Global Burden of Disease 2019 for adults aged ≥25 years of both sexes in Brazil and its 27 states were used to estimate the intake of fruits, vegetables, and whole grains; the NCD mortality attributable to these dietary risk factors; and the correlation between socio-demographic index (SDI), the age-standardised mortality rate (ASMR) per 100,000 population, and intake.

RESULTS

The Brazilian population had suboptimal consumption of fruits, vegetables, and whole grains, and 62,439 NCD deaths were attributable to these three dietary risk factors in 2019. The highest ASMRs were found for diets low in whole grains (14.4, 95% uncertainty interval [95% UI]: 7.8-18.4), followed by diets low in vegetables (7.6, 95% UI: 4.8-10.3) and fruits (5.0, 95% UI: 3.2-7.0). A similar ranking was observed for all Brazilian states. The SDI was negatively correlated with ASMRs and was positively correlated with the investigated dietary risks. The population from the Northeast and North states presented the lowest SDI and the highest NCD ASMRs attributable to diets low in fruits, vegetables, and whole grains and consumed less of all three health foods.

CONCLUSION

Diets low in fruits, vegetables, and mainly whole grains substantially contributed to NCD mortality in Brazil, especially in states with low SDI. Our findings support the need to target food interventions to reduce regional health inequalities within the country.

Systemic Effects of Hemorrhagic Snake Venom Metalloproteinases: Untargeted Peptidomics to Explore the Pathodegradome of Plasma Proteins

Hemorrhage induced by snake venom metalloproteinases (SVMPs) is a complex phenomenon that involves capillary disruption and blood extravasation. HF3 (hemorrhagic factor 3) is an extremely hemorrhagic SVMP of Bothrops jararaca venom. Studies using proteomic approaches revealed targets of HF3 among intracellular and extracellular proteins. However, the role of the cleavage of plasma proteins in the context of the hemorrhage remains not fully understood. The main goal of this study was to analyze the degradome of HF3 in human plasma. For this purpose, approaches for the depletion of the most abundant proteins, and for the enrichment of low abundant proteins of human plasma, were used to minimize the dynamic range of protein concentration, in order to assess the proteolytic activity of HF3 on a wide spectrum of proteins, and to detect the degradation products using mass spectrometry-based untargeted peptidomics. The results revealed the hydrolysis products generated by HF3 and allowed the identification of cleavage sites. A total of 61 plasma proteins were identified as cleaved by HF3. Some of these proteins corroborate previous studies, and others are new HF3 targets, including proteins of the coagulation cascade, of the complement system, proteins acting on the modulation of inflammation, and plasma proteinase inhibitors. Overall, the data indicate that HF3 escapes inhibition and sculpts the plasma proteome by degrading key proteins and generating peptides that may act synergistically in the hemorrhagic process.

Does access to healthy food vary according to socioeconomic status and to food store type? an ecologic study

BACKGROUND

The food environment can influence opportunities and barriers to food access. This study aimed to investigate whether access to healthy foods varies according to store types and the socioeconomic status of the users of the public health promotion program in Brazil, known as the Health Academy Program.

METHODS

A total of 18 Health Academy Program centers were selected via simple conglomerate sampling. Health Academy Program users living up to 1 km from the food stores were evaluated (n = 2831). Their socioeconomic status was investigated via face-to-face interviews. The food stores were audited through direct observation. Variables included the community nutrition environment (type and location) and consumer nutrition environment (healthy food store index, involving variables such as availability, variety, and advertising of healthy and unhealthy products). Multiple linear regression analysis was performed to examine the association between access to healthy foods, socioeconomic status, and food store type.

RESULTS

A total of 336 stores were investigated. The majority were specialty fruit and vegetable markets/stores or open-air food markets. Access to healthy food was only associated with the food store type. An increase of 1% in the availability of specialized fruits and vegetable markets or open-air food markets and supermarket raised healthy food store index values by 0.12 and 0.07, respectively.

CONCLUSIONS

Public food supply policies aimed at improving the diet quality of the population and reducing inequality in access should prioritize the implementation of stores of better quality, such as specialty fruit and vegetable markets and open-air food markets.

Early response of C2C12 myotubes to a sub-cytotoxic dose of hemorrhagic metalloproteinase HF3 from Bothrops jararaca venom

Manifestations of local tissue damage, such as hemorrhage and myonecrosis, are among the most dramatic effects of envenomation by viperid snakes. Snake venom metalloproteinases (SVMPs) of the P-III class are main players of the hemorrhagic effect due to their activities in promoting blood vessel disruption. Hemorrhagic Factor 3 (HF3), a P-III class SVMP from Bothrops jararaca, shows a minimum hemorrhagic dose of 240 fmol on rabbit skin. The aim of this study was to assess the effects of a sub-cytotoxic dose of HF3 (50 nM) on the proteomic profile of C2C12 differentiated cells (myotubes) in culture, and on the peptidomic profile of the culture supernatant. Quantitative proteomic analysis using stable-isotope dimethyl labeling showed differential abundance of various proteins including enzymes involved in oxidative stress and inflammation responses. Identification of peptides in the supernatant of HF3-treated myotubes revealed proteolysis and pointed out potential new substrates of HF3, including glyceraldehyde-3-phosphate dehydrogenase, and some damage-associated molecular patterns (DAMPs). These experiments demonstrate the subtle effects of HF3 on muscle cells and illustrate for the first time the early proteolytic events triggered by HF3 on myotubes. Moreover, they may contribute to future studies aimed at explaining the inflammation process, hemorrhage and myonecrosis caused by SVMPs. SIGNIFICANCE: One of the main features of viperid snake envenomation is myotoxicity at the bite site, which, in turn is often associated with edema, blistering and hemorrhage, composing a complex pattern of local tissue damage. In this scenario, besides muscle cells, other types of cells, components of the extracellular matrix and blood vessels may also be affected, resulting in an outcome of deficient muscle regeneration. The main venom components participating in this pathology are metalloproteinases and phospholipases A2. Muscle necrosis induced by metalloproteinases is considered as an indirect effect related to ischemia, due to hemorrhage resulted from damage to the microvasculature. The pathogenesis of local effects induced by Bothrops venoms or isolated toxins has been studied by traditional methodologies. More recently, proteomic and peptidomic approaches have been used to study venom-induced pathogenesis. Here, in order to investigate the role of metalloproteinase activity in local tissue damage, we asked whether the hemorrhagic metalloproteinase HF3, at sub-cytotoxic levels, could alter the proteome of C2C12 myotubes in culture, thereby providing an insight into the mechanisms for the development of myonecrosis. Our results from mass spectrometric analyses showed subtle, early changes in the cells, including differential abundance of some proteins and proteolysis in the culture supernatant. The data illustrate the potential ability of metalloproteinases to trigger early systemic responses progressing from local cells and up to tissues.

Leptospira interrogans Secreted Proteases Degrade Extracellular Matrix and Plasma Proteins From the Host

Leptospires are highly motile spirochetes equipped with strategies for efficient invasion and dissemination within the host. Our group previously demonstrated that pathogenic leptospires secrete proteases capable of cleaving and inactivating key molecules of the complement system, allowing these bacteria to circumvent host's innate immune defense mechanisms. Given the successful dissemination of leptospires during infection, we wondered if such proteases would target a broader range of host molecules. In the present study, the proteolytic activity of secreted leptospiral proteases against a panel of extracellular matrix (ECM) and plasma proteins was assessed. The culture supernatant of the virulent L. interrogans serovar Kennewicki strain Fromm (LPF) degraded human fibrinogen, plasma fibronectin, gelatin, and the proteoglycans decorin, biglycan, and lumican. Interestingly, human plasminogen was not cleaved by proteases present in the supernatants. Proteolytic activity was inhibited by 1,10-phenanthroline, suggesting the participation of metalloproteases. Moreover, production of proteases might be an important virulence determinant since culture-attenuated or saprophytic Leptospira did not display proteolytic activity against ECM or plasma components. Exoproteomic analysis allowed the identification of three metalloproteases that could be involved in the degradation of host components. The ability to cleave conjunctive tissue molecules and coagulation cascade proteins may certainly contribute to invasion and tissue destruction observed upon infection with Leptospira.

Replication Protein A-1 Has a Preference for the Telomeric G-rich Sequence in Trypanosoma cruzi

Replication protein A (RPA), the major eukaryotic single-stranded binding protein, is a heterotrimeric complex formed by RPA-1, RPA-2, and RPA-3. RPA is a fundamental player in replication, repair, recombination, and checkpoint signaling. In addition, increasing evidences have been adding functions to RPA in telomere maintenance, such as interaction with telomerase to facilitate its activity and also involvement in telomere capping in some conditions. Trypanosoma cruzi, the etiological agent of Chagas disease is a protozoa parasite that appears early in the evolution of eukaryotes. Recently, we have showed that T. cruziRPA presents canonical functions being involved with DNA replication and DNA damage response. Here, we found by FISH/IF assays that T. cruziRPA localizes at telomeres even outside replication (S) phase. In vitro analysis showed that one telomeric repeat is sufficient to bind RPA-1. Telomeric DNA induces different secondary structural modifications on RPA-1 in comparison with other types of DNA. In addition, RPA-1 presents a higher affinity for telomeric sequence compared to randomic sequence, suggesting that RPA may play specific roles in T. cruzi telomeric region.

Hemorrhagic activity of HF3, a snake venom metalloproteinase: insights from the proteomic analysis of mouse skin and blood plasma

Hemorrhage induced by snake venom metalloproteinases (SVMPs) is a complex phenomenon resulting in capillary disruption and blood extravasation. The mechanism of action of SVMPs has been investigated using various methodologies however the precise molecular events associated with microvessel disruption remains not fully understood. To gain insight into the hemorrhagic process, we analyzed the global effects of HF3, an extremely hemorrhagic SVMP from Bothrops jararaca, in the mouse skin and plasma. We report that in the HF3-treated skin there was evidence of degradation of extracellular matrix (collagens and proteoglycans), cytosolic, cytoskeleton, and plasma proteins. Furthermore, the data suggest that direct and indirect effects promoted by HF3 contributed to tissue injury as the activation of collagenases was detected in the HF3-treated skin. In the plasma analysis after depletion of the 20 most abundant proteins, fibronectin appeared as degraded by HF3. In contrast, some plasma proteinase inhibitors showed higher abundance compared to control skin and plasma. This is the first study to assess the complex in vivo effects of HF3 using high-throughput proteomic approaches, and the results underscore a scenario characterized by the interplay between the hydrolysis of intracellular, extracellular, and plasma proteins and the increase of plasma inhibitors in the hemorrhagic process.

Sex-based individual variation of snake venom proteome among eighteen Bothrops jararaca siblings

Variation of venom proteome is relevant to basic research, to management of envenoming, and to studies on the evolution of poisonous snakes. In this study, we explored the venom proteomes of eighteen Bothrops jararaca specimens of a single litter born and raised in laboratory. Using electrophoretic techniques and various protocols for measuring the proteolytic activities of these venoms we have detected individual variability and highlighted sex-specific proteomic similarities and differences among sibling snakes. SDS-polyacrylamide gel electrophoresis under non-reducing conditions showed protein bands of approximately 100 kDa specific of male venoms. 2D-electrophoresis showed regions with varying spot complexity between pooled female and male venoms as well as spots that were gender specific. Gelatin zymography showed that female venoms contained proteinases of approximately 25 kDa absent from male venoms. Female venoms were more active than male venoms in degrading fibrinogen whereas on fibrin no significant differences were detected. Among various chromogenic peptide substrates tested, male venoms showed higher amidolytic activity than female venoms on D-Val-Leu-Lys-pNA and D-Phe-Pip-Arg-pNA. Taken together, these results show sex-based differences in the venom proteome of sibling snakes of a single litter raised under controlled conditions which seem to be genetically inherited and imposed by evolutionary forces.

In vitro inhibitory activity of tumor necrosis factor alpha and interleukin-2 of human immunoglobulin preparations

Human immunoglobulin preparations have been used in a number of clinical settings with good results, although in many of them the mechanism of action is not yet known. One possible mechanism is the modulation of cytokine activity. This study investigated the presence of inhibitory activity in intravenous immunoglobulin (IVIg) and F(ab')2 fragment preparations to two cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2). Cytotoxic activity of human recombinant TNF-alpha or TNF-alpha secreted by peripheral blood mononuclear cells (PBMC) on L929 cells and the proliferative activity of the IL-2 on CTLL-2 cells were examined. Human serum albumin (HSA) was used as control. F(ab')2 inhibited, in a dose-dependent fashion, the TNF-alpha activity secreted by PBMC serial dilutions or, at the higher concentrations (25 and 10 mg/ml), recombinant TNF-alpha activity. In contrast, IVIg was able to inhibit only at 25 and 10 mg/ml the TNF-alpha activity secreted by any PBMC dilution tested, and did not inhibit the recombinant TNF-alpha activity. With IL-2, however, even HSA was able to inhibit its proliferative activity, possibly through a carrier effect. The IVIg inhibition of IL-2 activity was not different from that of HSA, but F(ab')2, at 12.5 mg/ml, was capable of inhibiting significantly more the IL-2 activity than HSA. Our results suggest an anticytokine effect of the immunoglobulin preparations that this activity may be mainly mediated by variable regions of the immunoglobulins, and that the more pronounced effect of F(ab')2 may be due to its greater molar concentration compared to intact IgG molecules.

[Alzheimer's disease. Relationship between time of disease and its staging]

Forty-nine patients with clinical diagnosis of Alzheimer's disease were submitted to neuropsychological evaluation for staging the disease. The time of the initial symptoms was correlated to the stage of the disease. The evolution was protracted in 28.5% of the patients with only insidious memory deterioration. For another group of patients (12.2%) the evolution was serious since the beginning of the disease, with apraxo-agnosic signs. For the 34 patients with apraxo-agnosic impairment, in 50% this manifestation began in the first two years of the disease. Data suggest the occurrence of two subgroups. In the first the evolution of the disease is rapid, and in the second it is protracted. Also, they suggest that the evolution in the first two years is critical for characterizing the severity of progression in the clinical manifestations of Alzheimer's disease.