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Regardless of the containment of the SARS-CoV-2 pandemic, it remains paramount to comprehensively understand its underlying mechanisms to mitigate potential future health and economic impacts, comparable to those experienced throughout the course of the pandemic. The angiotensin-converting enzyme 2 (ACE2) provides anchorage for SARS-CoV-2 binding, thus implicating that ACE and ACE2 might contribute to the variability in infection severity. This study aimed to elucidate predisposing factors influencing the disease course among people infected by SARS-CoV-2, focusing on angiotensin-converting enzyme (ACE) and ACE2 polymorphisms. Notably, despite similar demographics and comorbidities, COVID-19 patients exhibit substantial differences in prognosis. Genetic polymorphisms in ACE and ACE2 have been implicated in disease progression, prompting our investigation into their role in COVID-19 evolution. Using next-generation sequencing (NGS), we analyzed ACE and ACE2 genes in a sample group comprising six subjects infected by SARS-CoV-2. Our findings revealed a correlation between specific polymorphisms and COVID-19 outcomes. Specifically, ACE and ACE2 intronic deletions were observed in all deceased patients, suggesting a potential association with mortality. These results highlight the significance of genetic factors in shaping the clinical course of COVID-19, emphasizing the importance of further research into the impact of genetic variations on COVID-19 severity.
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OBJECTIVE: Evaluate the influence of the BsmI polymorphism of the vitamin D receptor gene on vitamin D levels, and inflammatory and oxidative stress markers in patients with Cystic Fibrosis supplemented with cholecalciferol megadose. METHODS: We performed a single-arm, non-randomized pre- and post-study of 17 patients aged 5 to 20 years with cystic fibrosis diagnosed with vitamin D insufficiency/deficiency 25-hydroxy vitamin< 30 ng/mL. Individuals were genotyped for the BsmI polymorphism of the vitamin D receptor gene and all received cholecalciferol supplementation of 4,000 IU daily for children aged 5 to 10 years and 10,000 IU for children over 10 years of age for 8 weeks. Interviews were conducted with personal data, sun exposure, anthropometric and blood samples of 25-hydroxy vitamin parathormone, serum calcium, ultrasensitive C-reactive protein, alpha 1 acid glycoprotein, total antioxidant capacity, malondialdehyde and kidney and liver function. Inter- and intra-group assessment was assessed by paired t-test Anova test or its non-parametric counterparts. RESULTS: The individuals were mostly male and reported no adverse effects from the use of supplementation, 64 % had 25-hydroxy vitamin levels >30 ng/mL. Patients with BB and Bb genotypes showed increased serum levels of 25-hydroxy vitamin. The group with BB genotype showed a reduction in alpha 1 acid glycoprotein. And individuals with the bb genotype had high levels of malondialdehyde compared to the pre-intervention time. CONCLUSION: It is concluded that variations of the BsmI polymorphism of the vitamin D receptor gene have different responses in vitamin D levels and markers of inflammation and oxidative stress.
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Fibrosis Quística , Deficiencia de Vitamina D , Niño , Femenino , Humanos , Masculino , Colecalciferol , Fibrosis Quística/genética , Suplementos Dietéticos , Malondialdehído , Orosomucoide/metabolismo , Estrés Oxidativo , Receptores de Calcitriol/genética , Receptores de Calcitriol/metabolismo , Vitamina D , Deficiencia de Vitamina D/genética , Vitaminas , Preescolar , Adolescente , Adulto JovenRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Maytenus ilicifolia Mart. ex Reissek, a medicinal plant used for treating gastritis, ulcers, and gastric disorders, possesses therapeutic properties attributed to diverse leaf compounds-terpenoids, alkaloids, flavonoids, phenols, and tannins, reflecting the ethnopharmacological knowledge of traditional users. AIMS OF THE STUDY: We aimed to assess the antioxidant and antiglycant capacities of Maytenus ilicifolia's ethanolic extract and organic fractions, identify bioactive compounds through HPLC-MS/MS analysis, and conduct phytochemical assessments. We also assessed their potential to inhibit digestive and cholinesterase enzymes, mitigate oxidation of human LDL and rat hepatic tissue, and examine their antimicrobial and cytotoxic properties. MATERIALS AND METHODS: Organic fractions (hexane - HF-Mi, dichloromethane - DMF-Mi, ethyl acetate - EAF-Mi, n-butanol - BF-Mi, and hydromethanolic - HMF-Mi) were obtained via liquid-liquid partitioning. Antioxidant (DPPH, FRAP, ORAC) and antiglycant (BSA/FRU, BSA/MGO, ARG/MGO/LDL/MGO models) capacities were tested. Phytochemical analysis employed HPLC-MS/MS. We also studied the inhibitory effects on α-amylase, acetylcholinesterase, butyrylcholinesterase, human LDL and rat hepatic tissue oxidation, antimicrobial activity, and cytotoxicity against RAW 264.7 macrophages. RESULTS: HPLC-ESI-MS/MS identified antioxidant compounds such as catechin, quercetin, and kaempferol derivatives. Ethanolic extract (EE-Mi) and organic fractions demonstrated robust antioxidant and antiglycant activity. EAF-Mi and BF-Mi inhibited α-amylase (2.42 µg/mL and 7.95 µg/mL) compared to acarbose (0.144 µg/mL). Most organic fractions exhibited â¼50% inhibition of acetylcholinesterase and butyrylcholinesterase, rivaling galantamine and rivastigmine. EAF-Mi, BF-Mi, and EE-Mi excelled in inhibiting lipid peroxidation. All fractions, except HMF-Mi, effectively countered LDL oxidation, evidenced by the area under the curve. These fractions protected LDL against lipid peroxidation. CONCLUSION: This study unveils Maytenus ilicifolia's ethanolic extract and organic fractions properties. Through rigorous analysis, we identify bioactive compounds and highlight their antioxidant, antiglycant, enzyme inhibition, and protective properties against oxidative damage. These findings underline its significance in modern pharmacology and its potential applications in healthcare.
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Antiinfecciosos , Celastraceae , Maytenus , Humanos , Animales , Ratas , Peroxidación de Lípido , Acetilcolinesterasa , Butirilcolinesterasa , Antioxidantes/farmacología , Reacción de Maillard , Óxido de Magnesio , Espectrometría de Masas en Tándem , Fitoquímicos , alfa-Amilasas , Extractos Vegetales/farmacologíaRESUMEN
OBJECTIVES: The aim of this study was to` investigate the effects of intermittent fasting (IF) and the possible association with aerobic exercise on performance, oxidative, biochemical, and somatic parameters of Wistar rats. METHODS: Forty rats were randomized into the following groups: sedentary (SC) and trained (TC) controls, sedentary intermittent fasting (SIF), and trained intermittent fasting (TIF). The rats were subjected to IF for 15 h every day and aerobic exercise lasting 30 min, five times a week, at a speed of 15 m/min for 4 wk. Performance tests were performed at the beginning and end of the protocol. Glucose and insulin tolerance, somatic parameters, lipidogram, leptin, insulin, malondialdehyde, antioxidant capacity, C-reactive protein, alpha acid glycoprotein, creatine kinase, lactate dehydrogenase, and muscle histology were analyzed. RESULTS: The trained groups had similar performance and significantly improved performance at the end of the experiment. TIF showed lower body weight (-16 g), lean mass (22.49%), homeostatic model assessment for insulin resistance (29%), and lactate dehydrogenase (48%), and higher malondialdehyde (53%) and antioxidant capacity (75%) than the TC group. The SIF and TIF groups showed a fiber area reduction and positivity marking for tumor necrosis factor-α in the muscles. CONCLUSION: Although IF associated with aerobic exercise improved antioxidant capacity caused damage to muscle fibers and lean mass loss, it did not change the performance of the rats.
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ETHNOPHARMACOLOGICAL RELEVANCE: The Waltheria viscosissima A. St.- Hil (Malvaceae) is also known as 'Malva branca', has been reported as ethnopharmacologically useful plant containing antinociceptive and anti-inflammatory properties, but scientific evidence is absent. AIM OF THE STUDY: Elucidate the antinociceptive, anti-inflammatory and antioxidant activity of the crude ethanol extract (EEBWa.v) and alkaloid fraction (FAWa.v) of aerial parts of the W. viscosissima in healthy mice with induced inflammation. MATERIALS AND METHODS: EEBWa.v and FAWa.v (50, 100 and 200 mg/kg) and morphine (10 mg/kg) were used in vivo tests of chemical nociception induced by acetic acid (0.6%; 10 mg/kg) and formalin (2.5%) in Swiss male mice. Acute inflammation was induced by carrageenan (1%) in vivo tests and there were several groups tested. The control (inflammation induced without treatment) and the groups treated with EEBWa.v (100 mg/kg), FAWa.v (100 mg/kg) and dexamethasone (2 mg/kg). After this procedure, the animals were euthanized and the peritoneal fluid was collected to evaluate cell migration and redox balance (malondialdehyde - MDA and Total Antioxidant Capacity - TAC). RESULTS: The morphine, EEBWa.v (50 and 100 mg/kg) and FAWa.v (100 mg/kg) significantly reduced the number of abdominal writhes compared to the control group. FAWa.v (100 mg/kg) was superior to FAWa.v (200 mg/kg). In the formalin-induced nociception model (neurogenic phase) EEBWa.v (50 and 200 mg/kg) significantly reduced the number of paw licks. In the inflammatory phase with peripheral action, FAWa.v (100 mg/kg) was superior to EEBWa.v (200 mg/kg). EEBWa.v and FAWa.v (100 mg/kg) proved to be significant for the next experiments. Both samples showed reduction in cell migration, as well as those treated with dexamethasone, in animals with inflammation induced by carrageenan, compared to the untreated group. The redox balance (TAC and MDA) revealed that only EEBWa.v (100 mg/kg) had higher antioxidant potential than the untreated group and the dexamethasone group, p < 0.005 and p < 0.001, respectively. FAWa.v (100 mg/kg) did not show antioxidant activity superior to EEBWa.v. It was also detected that EEBWa.v and FAWa.v (100 mg/kg) failed to inhibit lipid peroxidation. CONCLUSIONS: The W. viscosissima stimulates pain control, which can be mediated by both central and peripheral action. These bioactive compounds showed promising and potential to replace standard medicines. This bioactive effect is statistically similar to morphine and dexamethasone, standard medicines on the market, but with the advantage of antioxidant activity.
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Alcaloides , Malvaceae , Alcaloides/uso terapéutico , Analgésicos/efectos adversos , Animales , Antiinflamatorios/efectos adversos , Antioxidantes/efectos adversos , Carragenina , Dexametasona/uso terapéutico , Edema/tratamiento farmacológico , Etanol/química , Formaldehído , Inflamación/inducido químicamente , Inflamación/tratamiento farmacológico , Masculino , Ratones , Morfina/farmacología , Morfina/uso terapéutico , Dolor/inducido químicamente , Dolor/tratamiento farmacológico , Extractos Vegetales/efectos adversosRESUMEN
Cervical cancer is one of the most frequently diagnosed gynecological malignancies among women worldwide. The main cause of cervical cancer is the human papilloma virus (HPV). Mahmood et al. investigated in detail the role of the fibroblast growth factor (FGF)-FGF receptor (FGFR) signaling axis in the development of the invasive form of the disease. The presented work clearly indicates the FGFR signaling as an additional but important factor for the development of a highly malignant tumor. Comment on https://doi.org/10.1111/febs.16331.
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Receptores de Factores de Crecimiento de Fibroblastos , Neoplasias del Cuello Uterino , Femenino , Factores de Crecimiento de Fibroblastos/genética , Factores de Crecimiento de Fibroblastos/metabolismo , Humanos , Receptor Tipo 1 de Factor de Crecimiento de Fibroblastos/genética , Receptor Tipo 1 de Factor de Crecimiento de Fibroblastos/metabolismo , Receptores de Factores de Crecimiento de Fibroblastos/genética , Transducción de Señal , Neoplasias del Cuello Uterino/genéticaRESUMEN
Rab5 and Rab7a are the main determinants of early and late endosomes and are important regulators of endosomal progression. The transport from early endosomes to late endosome seems to be regulated through an endosomal maturation switch, where Rab5 is gradually exchanged by Rab7a on the same endosome. Here, we provide new insight into the mechanism of endosomal maturation, for which we have discovered a stepwise Rab5 detachment, sequentially regulated by Rab7a. The initial detachment of Rab5 is Rab7a independent and demonstrates a diffusion-like first-phase exchange between the cytosol and the endosomal membrane, and a second phase, in which Rab5 converges into specific domains that detach as a Rab5 indigenous endosome. Consequently, we show that early endosomal maturation regulated through the Rab5-to-Rab7a switch induces the formation of new fully functional Rab5-positive early endosomes. Progression through stepwise early endosomal maturation regulates the direction of transport and, concomitantly, the homeostasis of early endosomes.
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Endosomas , Proteínas de Unión al GTP rab5 , Endosomas/metabolismo , Vesículas Transportadoras/metabolismo , Proteínas de Unión al GTP rab5/genética , Proteínas de Unión al GTP rab5/metabolismoRESUMEN
The objective of this study was to verify the influence of the Pro12Ala polymorphism of the PPARγ2 gene in response of a training program on the body composition. Sixty-nine previously inactive men and women (32.8 ± 8.2 years) were genotyped and underwent a 12-week aerobic (running/walking) training program (3-5 sessions, 40 - 60 min per session, and intensity between the aerobic and anaerobic threshold) (experimental group n = 53) or were part of the control group (n = 16). They were tested for aerobic capacity (ergospirometry), body composition (DXA), abdomen, waist and hip circumferences and nutritional assessment before and 48 h after the experimental protocol. Two-way repeated measures ANOVA test was used to verify possible differences in variables between the experimental vs. control groups or Pro/Pro vs. Pro/Ala groups, and the Chi-squared test was used to verify the distribution of responders and non-responders according to genotype (p < 0.05). Frequencies of 75.5% Pro/Pro (n = 40) and 24.5% Pro/Ala (n = 13) were found, without any occurrence of the recessive homozygote. Body fat reduction was initially confirmed compared to a control group which did not exercise (n = 16; 29.1 ± 8.8 years), so that the exercise group obtained a reduction of -1.3 kg vs. -0.3 kg in the control group (p = 0.03). When they were divided by genotype, there were significant changes in fat mass (-1.3 ± 2.1 kg; p = 0.00), lean mass (0.6 ± 1.5 kg; p = 0.02), fat percentage (-1.3 ± 1.6; p = 0.00), waist circumference (-2.2 ± 2.9 cm; p = 0.00), abdomen circumference (-3.3 ± 3.6 cm; p = 0.00) and hip circumference (-2.7 ± 2.7 cm; p = 0.00) for Pro/Pro genotypes; and fat mass (-1.1 ± 1.7 kg; p = 0.04), fat percentage (-0.9 ± 1.5; p = 0.04), abdomen circumference (-3.9 ± 3.5 cm; p = 0.00) and hip circumference (-1.8 ± 1.8 cm; p = 0.00) for Pro/Ala genotypes, without any group interaction differences. The Chi squared test revealed no differences in the distribution of responders or non-responders according to genotype. It is concluded that an aerobic training program promotes weight loss, but the Pro12Ala polymorphism in the PPARγ2 gene does not influence the variability of aerobic-induced exercise weight loss.
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INTRODUCTION: MTHFR methylation status is associated with microvascular complications in diabetes, but the factors influencing this profile remain unknown. OBJECTIVE: The aim of this study was to evaluate the influence of physical activity level and nutritional status on the methylation profile of the MTHFR gene in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 111 patients, 43 men and 68 women diagnosed with DM (7.0 ± 2.3 years), answered the International Physical Activity Questionnaire (IPAQ) and underwent blood collection for biochemical analysis, DNA extraction, and MTHFR gene methylation profile determination. RESULT: The comparison of the methylation pattern showed that the partially methylated profile predominates in the insufficiently active group (85%), which does not occur in the sufficiently active group (54%) (p = 0.012). No differences were found in the nutritional status comparison. Logistic regression including overweight, waist circumference, gender, age, time of DM, hypertension, dyslipidemia, smoking, alcoholism, and family DM revealed that the association of the level of physical activity with methylation profile proved to be independent of these confounding variables. Considering the partially methylated profile as a result, being physically inactive favors the partially methylated MTHFR pattern in patients with DM. CONCLUSION: We concluded that insufficient physical activity is associated with partially methylated pattern of MTHFR promoter.
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Justificativa e Objetivos: A Leishmaniose Cutânea Americana (LCA) é uma doença de cadeia de transmissão complexa sujeita a diversos determinantes, em uma mesma região. Este estudo teve como objetivo analisar o comportamento e determinar o perfil epidemiológico da LCA em uma região da Amazônia Sul-ocidental utilizando técnicas de análises multivariadas. Métodos: Utilizou-se as informações do Sistema de Informação de Agravos de Notificação (Sinan), 2001 a 2010,para o estado do Acre e técnicas de análises de agrupamento hierárquico e de componentes principais. Resultados: Foram analisados um total de 10.984 casos de LCA e discriminados três grupos. O primeiro grupo se destacou por apresentar maior porcentagem de indivíduos do sexo feminino, com predominância da forma clínica mucosa, idade até 20 anos, que residiam e trabalhavam em áreas rurais e florestais; o segundo grupo foi discriminado por agrupar indivíduos do sexo masculino, com forma clínica cutânea, idade superior a 40 anos de idade, que residiam e trabalhavam em áreas urbanas; o terceiro grupo foi constituído por indivíduos do sexo masculino, forma clínica cutânea, idades entre 20 e 40 anos, que residiam e trabalhavam em áreas rurais. Conclusão: Há evidências que para cada tipo de transmissão de LCA florestal, urbano e rural, exista um perfil epidemiológico correspondente e as técnicas de análises multivariadas foram eficientes em destacar o comportamento da LCArelacionando-os ao perfil dos indivíduos acometidos.(AU)
Background and Objectives: The American Cutaneous Leishmaniasis (ACL) is a disease of complex chain of transmission subject to various determinants, in the same region. Theaim was to analyze the ACL behavior and identify the epidemiological profile in a Brazilian Southwestern Amazonia region, using multivariate analysis techniques. Methods: The hierarchic cluster and principal components analysis were performed using the Brazilian System for Disease Notification (Sinan), from 2001 until 2010, recorded in the state of Acre. Results: 10,984 cases were analysed and discriminated three groups of ACL. In the first group, the epidemiological profile presented a higher percentage, in relation to the other two groups, of women with predominance of ACL mucosa form, aging less than 20 years, living and working in rural and forest environment; In the second group, the epidemiological profile consisted of male patients, with ACL in the cutaneous form, age of 40 years or older, living and working in urban areas. In the third group, there was predominance of male patients, ACL cutaneous form, ages between 20 and 40 years, living and working in rural areas. Conclusion: There are evidences that for each type of transmission, namely forest, urban and rural, there is a corresponding epidemiological profile and techniques of multivariate analyzes were effective to evidence the ACL behaviour relating them to the profile of the affected individuals.(AU)
Justificación y objetivos: LeishmaniasisCutanea Americana (LCA)es una enfermedad de ciclo de contaminación compleja afectada por diversos factores, en una misma zona. Este estudio tuvo como objetivo el análisis del comportamiento y el perfil de salud en la zona de Amazonia Sul-occidental empleando técnicas de análisis multivariantes. Métodos: se ha empleado las informciones del Sistema de Informação de Agravos de Notificação (SINAN), 2001 a 2010, para la Provincia de Acre y técnicas de análisis por conglomerados y análisis de componente principal. Resultados: han sido analisados un total de 10.984 casos de LCA y diferenciados en tres grupos. El primer grupo se ha destacado por presentar un mas grande percentual de personas del sexo femenino, con predominancia de forma clinica mucosa, edad hacia los 20 años, que vivian y trabajavan en diversas zonas, rurales y florestales; el según grupo fue diferenciado por incorporar personas del sexo masculino, con forma clínica cutanea, edad arriba de 40 años, que vivian y trabajaban en zonas urbanas; el tercer grupo se ha constituído por personas del sexo masculino, forma clínica cutanea, edades entre los 20 y 40 años, que vivian y trabajaban en zonas rurales. Conclusión: hay evidencias que para cada tipo de contaminación de LCAflorestales, urbanas y rurales, existía un perfil epidemiológico compatible y las técnicas de análisis multivariantes han sido eficientes en distinguir la actuación de la LCA relacionándose al perfil de las personas infectadas.(AU)
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Humanos , Perfil de Salud , Leishmaniasis CutáneaRESUMEN
The Endoplasmic Reticulum (ER) is a membranous organelle with diverse structural and functional domains. Peripheral ER includes interconnected tubules, and dense tubular arrays called "ER matrices" together with bona fide flat cisternae. Transitions between these states are regulated by membrane-associated proteins and cytosolic factors. Recently, the small GTPases Rab10 and Rab18 were reported to control ER shape by regulating ER dynamics and fusion. Here, we present evidence that another Rab protein, Rab7a, modulates the ER morphology by controlling the ER homeostasis and ER stress. Indeed, inhibition of Rab7a expression by siRNA or expression of the dominant negative mutant Rab7aT22â¯N, leads to enlargement of sheet-like ER structures and spreading towards the cell periphery. Notably, such alterations are ascribable neither to a direct modulation of the ER shaping proteins Reticulon-4b and CLIMP63, nor to interactions with Protrudin, a Rab7a-binding protein known to affect the ER organization. Conversely, depletion of Rab7a leads to basal ER stress, in turn causing ER membrane expansion. Both ER enlargement and basal ER stress are reverted in rescue experiments by Rab7a re-expression, as well as by the ER chemical chaperone tauroursodeoxycholic acid (TUDCA). Collectively, these findings reveal a new role of Rab7a in ER homeostasis, and indicate that genetic and pharmacological ER stress manipulation may restore ER morphology in Rab7a silenced cells.
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Estrés del Retículo Endoplásmico/genética , Retículo Endoplásmico/genética , Homeostasis/genética , Proteínas de Unión al GTP rab/genética , Regulación de la Expresión Génica , Células HeLa , Humanos , Proteínas de la Membrana/genética , Proteínas Nogo/genética , Unión Proteica , ARN Interferente Pequeño/genética , Ácido Tauroquenodesoxicólico/farmacología , Proteínas de Transporte Vesicular/genética , Proteínas de Unión a GTP rab7RESUMEN
Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct. RESUMO A drenagem percutânea das vias biliares é um procedimento estabelecido para obstruções malignas, nos quais, muitas vezes, não se consegue um diagnóstico histológico. Descrevemos a técnica de biópsia da lesão obstrutiva através do acesso de drenagem biliar, utilizando um fórcipe de biópsia endoscópica 7F, amplamente disponível e alguns reutilizáveis. Esta técnica aplica-se a lesões dos ductos hepáticos, do hepático comum e de toda extensão do colédoco.
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Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/complicaciones , Biopsia/métodos , Colestasis/etiología , Colestasis/patología , HumanosRESUMEN
ABSTRACT Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct.
RESUMO A drenagem percutânea das vias biliares é um procedimento estabelecido para obstruções malignas, nos quais, muitas vezes, não se consegue um diagnóstico histológico. Descrevemos a técnica de biópsia da lesão obstrutiva através do acesso de drenagem biliar, utilizando um fórcipe de biópsia endoscópica 7F, amplamente disponível e alguns reutilizáveis. Esta técnica aplica-se a lesões dos ductos hepáticos, do hepático comum e de toda extensão do colédoco.
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Humanos , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/complicaciones , Biopsia/métodos , Colestasis/etiología , Colestasis/patologíaRESUMEN
A acalasia caracteriza-se pelo aumento da pressão basal do esfíncter esofagiano inferior, com relaxamento incompleto à deglutição e aperistalse do esôfago. É o distúrbio de motilidade esofágica mais comum. Com a evolução do processo, o esôfago se dilata, originando o megaesôfago, uma alteração anatômica secundária a um distúrbio funcional. O início da sintomatologia é gradual, todos os pacientes apresentam disfagia para sólidos e a maioria apresenta graus variados de disfagia para líquidos. O diagnóstico é feito por anamnese e exame físico e confirmado por exames complementares. O tratamento, seja clínico, endoscópico ou cirúrgico, é paliativo e visa o alívio sintomático e a profilaxia das complicações. J.E.S., paciente de 48 anos, sexo masculino, relata início de disfagia para sólidos há 18 anos, com evolução gradual e progressiva da disfagia também para líquidos, quadro este associado à regurgitação e pirose, refere ainda perda ponderal significativa. Diagnosticado com acalasia há 15 anos, submetido a três abordagens endoscópicas com dilatação pneumática, evoluindo com melhora parcial do quadro, seguida de recidiva dos sintomas. Submetido à esofagocardiomiotomia com fundoplicatura videolaparoscópica à Heller-Pinotti, apresentou boa evolução pós-operatória, com regressão quase total dos sintomas, ganho ponderal e melhora expressiva na qualidade de vida. Esta opção cirúrgica em pacientes com megaesôfago avançado tem demonstrado bons resultados, com boa resolutividade em uma avaliação precoce e com menor morbimortalidade pós-operatória, postergando ou mesmo excluindo a necessidade de realização da esofagectomia, associada a maiores riscos. Consiste no procedimento cirúrgico de escolha para acalasia e apresenta resultados satisfatórios, com baixa morbimortalidade. (AU)
Achalasia is characterized by increased basal pressure of the lower esophageal sphincter, with incomplete relaxation to swallowing and nonperistalsis in the esophagus. It is the most common esophageal motility disorder. With the evolution of the process, the esophagus dilates, originating megaesophagus, an anatomical alteration secondary to a functional disorder. The onset of symptoms is gradual, with all patients presenting with dysphagia for solids and most presenting varying degrees of dysphagia for liquids. The diagnosis is made through anamnesis and physical examination and is confirmed by complementary exams. The treatment, whether clinical, endoscopic, or surgical, is palliative and has the purpose of symptomatic relief and prophylaxis of complications. J.E.S., a 48-year-old male patient, reported onset of dysphagia for solids for 18 years, with gradual and progressive evolution of dysphagia also for liquids, a condition associated with regurgitation and pyrosis. Diagnosed with achalasia for 15 years, three endoscopic approaches with pneumatic dilatation were performed, evolving with partial clinical improvement, followed by relapse of the symptoms. After undergoing laparoscopic surgery, Heller-Pinotti´s esophagocardiomyotomy with fundoplication, presented good postoperative evolution, with almost total regression of the symptoms, weight gain and significant improvement in quality of life. This surgical option in patients with advanced megaesophagus has shown good results, with good resolution in an early evaluation and with lower postoperative morbidity and mortality, postponing or even excluding the need for esophagectomy, associated with greater risks. It consists of the surgical procedure of choice for achalasia and presents satisfactory longterm results and low morbidity and mortality. (AU)
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Humanos , Masculino , Persona de Mediana Edad , Acalasia del Esófago , Acalasia del Esófago/cirugía , Laparoscopía , Cirugía General , Trastornos de Deglución , Fundoplicación , Miotomía de HellerRESUMEN
OBJECTIVE: to evaluate the efficacy of the amniotic membrane used with polypropylene mesh against the formation of adhesions and its influence on healing. METHODS: twenty five female Wistar rats were anesthetized for creating a parietal defect in the anterior abdominal wall. Its correction was made with polypropylene mesh alone and associated with amniotic membrane. In the control group (n=11), the screen was inserted alone. In group A (n=7) we interposed the amniotic membrane between the screen and the abdominal wall. In group B, the amniotic membrane was placed on the mesh, covering it. After seven days, the animals were euthanized for macroscopic and microscopic evaluation of healing. RESULTS: adhesions were observed in all animals except one in the control group. Severe inflammation was observed in all animals in groups A and B and in three of the control group, with significant difference between them (A and B with p=0.01). Pronounced angiogenic activity was noted in one animal in the control group, six in group A and four in group B, with a significant difference between the control group and group A (p=0.002) and group B (p=0.05). The scar collagen was predominantly mature, except in five animals of the control group, with significant difference between the control group and group A (p=0.05) and group B (p=0.05). CONCLUSION: The amniotic membrane did not alter the formation of adhesions in the first postoperative week. There were also pronounced inflammation, high angiogenic activity and predominance of mature collagen fibers, regardless of the anatomical plane that it was inserted in.
Asunto(s)
Pared Abdominal/cirugía , Técnicas de Cierre de Herida Abdominal , Amnios , Cavidad Peritoneal/cirugía , Polipropilenos , Mallas Quirúrgicas , Adherencias Tisulares/prevención & control , Animales , Femenino , Ratas , Ratas Wistar , Cicatrización de HeridasRESUMEN
OBJECTIVE: To evaluate the efficacy of the amniotic membrane used with polypropylene mesh against the formation of adhesions and its influence on healing. METHODS: twenty five female Wistar rats were anesthetized for creating a parietal defect in the anterior abdominal wall. Its correction was made with polypropylene mesh alone and associated with amniotic membrane. In the control group (n=11), the screen was inserted alone. In group A (n=7) we interposed the amniotic membrane between the screen and the abdominal wall. In group B, the amniotic membrane was placed on the mesh, covering it. After seven days, the animals were euthanized for macroscopic and microscopic evaluation of healing. RESULTS: adhesions were observed in all animals except one in the control group. Severe inflammation was observed in all animals in groups A and B and in three of the control group, with significant difference between them (A and B with p=0.01). Pronounced angiogenic activity was noted in one animal in the control group, six in group A and four in group B, with a significant difference between the control group and group A (p=0.002) and group B (p=0.05). The scar collagen was predominantly mature, except in five animals of the control group, with significant difference between the control group and group A (p=0.05) and group B (p=0.05). CONCLUSION: The amniotic membrane did not alter the formation of adhesions in the first postoperative week. There were also pronounced inflammation, high angiogenic activity and predominance of mature collagen fibers, regardless of the anatomical plane that it was inserted in.
OBJETIVO: Avaliar a eficácia da membrana amniótica usada com tela de polipropileno contra a formação de aderências e sua influência na cicatrização. MÉTODOS: vinte e cinco ratas Wistar foram anestesiadas para criação de um defeito parietal na parede abdominal anterior. Sua correção foi feita com tela de polipropileno isolada e associada à membrana amniótica. No grupo Controle (n=11), a tela foi inserida isoladamente intra abdominal. No grupo A (n=7), interpôs-se a membrana amniótica entre a tela e a parede abdominal. No grupo B, a membrana amniótica foi colocada sobre a tela, recobrindo-a. Após sete dias, os animais foram eutanasiados para avaliação macroscópica e microscópica da cicatrização. RESULTADOS: aderências foram observadas em todos os animais, exceto em um do grupo Controle. Inflamação acentuada foi observada em todos os animais dos grupos A e B e em três do grupo Controle, com diferença significativa entre eles (A e B com p=0,01). Acentuada atividade angiogênica foi notada em um animal do grupo Controle, seis do grupo A e quatro do grupo B, com diferença significativa entre o grupo Controle e os grupos A (p=0,002) e B (p=0,05). O colágeno cicatricial foi predominantemente maduro, exceto em cinco animais do grupo Controle, com diferença significativa entre o grupo Controle e os grupos A (p=0,05) e B (p=0,05). CONCLUSÃO: a presença da membrana amniótica não alterou a formação de aderências na primeira semana de pós-operatório. Associou-se à inflamação acentuada, elevada atividade angiogênica e predomínio de fibras colágenas maduras, independente do plano anatômico em que foi inserida.
Asunto(s)
Humanos , Pared Abdominal , Amnios , Colágeno , Ratas , Adherencias TisularesRESUMEN
Esta revisão objetivou a descrição da paramentação cirúrgica e suas reais necessidades. Procedimentos cirúrgicos e anestésicos tornam necessárias precauções para reduzir os riscos biológicos que ocorrem em pacientes e na equipe multiprofissional em contato com líquidos, tecidos orgânicos e agentes infecciosos em centro cirúrgico. Seu intuito é proteger pacientes e a equipe multiprofissional contra microrganismos presentes e liberados em centro cirúrgico. A paramentação cirúrgica é a troca das vestimentas rotineiras por outras adequadas, em áreas restritas ou semirrestritas do centro cirúrgico, proporcionando barreiras contra ainvasão de microrganismos. Utilizou-se a seleção de artigos publicados na MEDLINE, LILACS, PUBMED, COCHRANE LIBRARY e livros. Não existem normas de leis para o uso da paramentação cirúrgica, ficando sob a vigilância sanitária vigente em cada município e ainda às normas internas de funcionamento de cada centro cirúrgico. Constitui-se em medida eficaz na redução dos processos infecciosos pós-operatórios, mesmo com resultados contraditórios em vários estudos sobre o reconhecimento das reais fontes e formas de transmissão dos microrganismos em um centro cirúrgico.
This review focused on the description of surgical attire and its actual requisite use. Surgical and anesthetic procedures requite that precautions are taken to reduce biological risk to patients and to the multiprofessional team in contact with fluids, organic tissues and infectious agents in the surgical center. Its purpose is protecting patients and the multiprofessional team against microorganisms existing and released in the surgical center. Use of surgical attire includes the exchange of everyday clothing for more adequate pieces in restricted or semi-restricted areas in the operatingroom, thus providing barriers against the invasion of microorganisms. A selection of articles published in MEDLINE, LILACS, PUBMED, COCHRANE LIBRARY and books were used. There are no regulations in place for the use of surgical attire, and its use is controlled by each municipaltiy's health surveillance team as well as by internal rules of operation in every surgical center. It constitutes an effective measure to decrease postoperative infectious processes, even though several studies contradict with regards to the actual sources and modes of transmission of microorganisms in the operating room.