Caracterização dos pacientes internados em uti- covid com evolução a óbito / Characterization of patients admitted to uti-covid and evolution to death / Caracterización de pacientes ingresados en uti-covid y evolución a muerte

A infecção humana pelo SARS-CoV-2 desencadeia alterações respiratórias altamente patogênicas e contagiosas e já culminou em mais de 15 milhões de mortes no mundo. Mesmo com o desenvolvimento de vacinas específicas, o COVID-19 persiste até o momento, devido fatores como o surgimento de variantes virais e o declínio da imunidade. O objetivo foi determinar as caraterísticas clínicas, laboratoriais e de imagem dos pacientes que foram a óbito por COVID-19 hospitalizados em um hospital do Meio Oeste de Santa Catarina, entre 2020 e 2022. Trata-se de um estudo observacional descritivo, com coleta de dados secundários e abordagem quantitativa, no período de 2022 a 20223. Foram incluídos prontuários de pacientes da população alvo registrados nos sistemas de informação do hospital. Com isso, foram incluídos na pesquisa 62 pacientes com média de idade de 79 anos, do sexo feminino (55%), branco (80%), com baixa escolaridade (61%), com comorbidades (84%) sendo a principal comorbidade hipertensão, seguido por dislipidemia e cardiopatia. A causa da morte mais frequente foi insuficiência respiratória aguda (27,9%), após uma média de 5 dias de internação, sendo que antes disso, a média de dias desde o surgimento dos sintomas até a internação foram de 6 dias. A ocorrência de vidro fosco na avaliação tomográfica inicial foi de 67%. Laboratorialmente, os exames; d-dímero, creatinina, ureia e leucócitos apresentaram elevação com a progressão da doença, enquanto os valores médios das hemácias, hemoglobina, linfócitos e de albumina tiveram valores reduzidos. Concluindo, é importante conhecer o perfil do paciente e estudar os preditores que apresentam possíveis mecanismos de progressão da doença, para o desenvolvimento de estratégias de prevenção e de tratamento do COVID-19 com foco nos grupos com maior risco de evolução desfavorável, nesse estudo representado pelo sexo feminino, com idade elevada, com doenças crônicas e que usam medicamentos para estas comorbidades e que apresentaram acometimento tomográfico e laboratorial precoce.

Human infection by SARS-CoV-2 triggers highly pathogenic and contagious respiratory changes and has already led to over 15 million deaths worldwide. Even with the development of specific vaccines, COVID-19 persists to date, due to factors such as the emergence of viral variants and declining immunity. The aim was to determine the clinical, laboratory and imaging characteristics of patients who died from COVID-19 hospitalized in a hospital in the Midwest of Santa Catarina between 2020 and 2022. This is a descriptive observational study, with secondary data collection and quantitative approach, in the period from 2022 to 20223. Patient charts of the target population recorded in the hospital's information systems were included. With this, 62 patients were included in the research with a mean age of 79 years, female (55%), white (80%), with low education (61%), with comorbidities (84%) being the main comorbidity hypertension, followed by dyslipidemia and heart disease. The most frequent cause of death was acute respiratory failure (27.9%), after a mean of 5 days of hospitalization, and before that, the mean number of days from onset of symptoms to hospitalization was 6 days. The occurrence of ground glass on initial CT evaluation was 67%. Laboratory tests; d-dimer, creatinine, urea and leukocytes showed elevation with disease progression, while mean values of RBCs, hemoglobin, lymphocytes and albumin had reduced values. In conclusion, it is important to know the patient's profile and study the predictors that present possible mechanisms of disease progression, for the development of prevention and treatment strategies for COVID-19 focusing on groups at higher risk of unfavorable evolution, in this study represented by female, aged, with chronic diseases and who use medications for these comorbidities and who presented early tomographic and laboratory involvement.

La infección humana por SARS-CoV-2 desencadena alteraciones respiratorias altamente patógenas y contagiosas y ya ha provocado más de 15 millones de muertes en todo el mundo. Incluso con el desarrollo de vacunas específicas, el COVID- 19 persiste hasta la fecha, debido a factores como la aparición de variantes virales y la disminución de la inmunidad. El objetivo fue determinar las características clínicas, de laboratorio y de imagen de los pacientes fallecidos por COVID-19 hospitalizados en un hospital del Centro-Oeste de Santa Catarina entre 2020 y 2022. Se trata de un estudio observacional descriptivo, con recolección de datos secundarios y abordaje cuantitativo, en el período de 2022 a 20223. Fueron incluidas las historias clínicas de los pacientes de la población objetivo registradas en los sistemas de información del hospital. Con esto, 62 pacientes fueron incluidos en la investigación con edad media de 79 años, sexo femenino (55%), raza blanca (80%), con baja escolaridad (61%), con comorbilidades (84%) siendo la principal comorbilidad la hipertensión, seguida de dislipidemia y cardiopatía. La causa más frecuente de muerte fue la insuficiencia respiratoria aguda (27,9%), tras una media de 5 días de hospitalización, y antes de eso, la media de días desde el inicio de los síntomas hasta la hospitalización fue de 6 días. La aparición de vidrio deslustrado en la evaluación inicial por TC fue del 67%. Las pruebas de laboratorio; d-dímero, creatinina, urea y leucocitos mostraron elevación con la progresión de la enfermedad, mientras que los valores medios de GR, hemoglobina, linfocitos y albúmina presentaron valores reducidos. En conclusión, es importante conocer el perfil del paciente y estudiar los predictores que presentan posibles mecanismos de progresión de la enfermedad, para el desarrollo de estrategias de prevención y tratamiento de la COVID- 19 con enfoque en los grupos de mayor riesgo de evolución desfavorable, en este estudio representados por el sexo femenino, de edad avanzada, con enfermedades crónicas y que utilizan medicamentos para estas comorbilidades y que presentaron compromiso tomográfico y laboratorial precoz.

Spine-Adjusting Instrument (Impulse®) Attenuates Nociception and Modulates Oxidative Stress Markers in the Spinal Cord and Sciatic Nerve of a Rat Model of Neuropathic Pain.

OBJECTIVE: Oxidative stress plays an important role in neuropathic pain (NP). Spinal manipulative therapy (SMT) can exert beneficial effects on pain outcomes in humans and in animal models. SMT can also modulate oxidative stress markers in both humans and animals. We aimed to determine the effect of Impulse®-assisted SMT (ISMT) on nociception and oxidative stress biomarkers in the spinal cords and sciatic nerves of rats with NP. METHODS: NP was induced by chronic constriction injury (CCI) of the sciatic nerve. Animals were randomly assigned to naive, sham (rats with sciatic nerve exposure but without ligatures), or CCI, with and without ISMT. ISMT was applied onto the skin area corresponding to the spinous process of L4-L5, three times per week for 2 weeks. Mechanical threshold, latency to paw withdrawal in response to thermal stimulus, and oxidative stress biomarkers in the spinal cord and sciatic nerve were the main outcomes evaluated. RESULTS: ISMT significantly increased mechanical threshold and withdrawal latency after CCI. In the spinal cord, ISMT prevented the increase of pro-oxidative superoxide anion generation and hydrogen peroxide levels. Lipid hydroperoxide levels both in the spinal cord and in the sciatic nerve were attenuated by ISMT. Total antioxidant capacity increased in the spinal cords and sciatic nerves of CCI rats with and without ISMT. CCI and ISMT did not significantly change the total thiol content of the spinal cord. CONCLUSIONS: Our findings suggest that reduced oxidative stress in the spinal cord and/or nerve may be an important mechanism underlying a therapeutic effect of SMT to manage NP nonpharmacologically.

Aqueous leaf extract from Luehea divaricata Mart. Modulates oxidative stress markers in the spinal cord of rats with neuropathic pain.

ETHNOPHARMACOLOGICAL RELEVANCE: Reactive oxygen species (ROS) play an important role in neuropathic pain (i.e., pain caused by lesion or disease of the somatosensory system). We showed previously that the aqueous extract prepared from Luehea divaricata leaves, a plant explored by native ethnic groups of Brazil to treat different pathologic conditions, exhibits good antioxidant activity and induces analgesia in rats with neuropathic pain (J Ethnopharmacol, 2020; 256:112761. doi: 10.1016/j.jep.2020.112761). The effect was comparable to that of gabapentin, a drug recommended as first-line treatment for neuropathic pain. However, increasing evidence has indicated the need to accurately determine the oxidative stress level of an individual before prescribing supplemental antioxidants. AIM OF THE STUDY: This study assessed the effects of the oral administration of aqueous extract from leaves of L. divaricata on the sciatic functional index (SFI) and spinal-cord pro-oxidant and antioxidant markers of rats with neuropathic pain. MATERIALS AND METHODS: Placement of four loose chromic thread ligatures around the sciatic nerve produced chronic constriction injury (CCI) of the sciatic nerve, a commonly employed animal model to study neuropathic pain. Aqueous extract from leaves of L. divaricata (100, 300, 500 and 1000 mg/kg), gabapentin (50 mg/kg) and aqueous extract (500 mg/kg) + gabapentin (30 mg/kg) were administrated per gavage daily for 10 or 35 days post-CCI. Antinociception was assessed using the von Frey test while SFI showed functional recovery post-nerve lesion throughout the experimental period. At days 10 and 35 post-surgery, the lumbosacral spinal cord and a segment of the injured sciatic nerve were dissected out and used to determine lipid hydroperoxide levels and total antioxidant capacity (TAC). The spinal cord was also used to determine superoxide anion generation (SAG), hydrogen peroxide (H2O2) levels and total thiol content. RESULTS: As expected, the extract, gabapentin and extract + gabapentin induced antinociception in CCI rats. While no significant functional recovery was found at 10 days post-CCI, a significant recovery was found in SFI of extract-treated CCI rats at 21 and 35 days post-CCI. A significant functional recovery was found already at day 10 post-CCI in gabapentin and gabapentin + extract-treated CCI rats. The extract treatment prevented increases in lipid hydroperoxides levels and TAC in injured sciatic nerve, which were found in this tissue of vehicle-treated rats at 10 days post-CCI. Extract also prevented an increase in SAG, H2O2 and lipid hydroperoxides levels in the spinal cord, which were elevated in this tissue of vehicle-treated rats at 10 and 35 days post-CCI. Extract also prevented a decrease in total thiol content and an increase in TAC in the spinal cord of CCI rats in these same time periods. CONCLUSIONS: Aqueous extract from L. divaricata leaves was demonstrated, for the first time, to improve SFI and modulate oxidative stress markers in injured sciatic nerve and spinal cord of CCI rats. Thus, the antinociceptive effect of the extract involves modulation of oxidative stress markers in injured sciatic nerve and spinal cord.

Conflitos morais na prática fisioterapêutica: percepção de fisioterapeutas e alunos / Moral conflicts in physiotherapy practice: perception of physiotherapists and students

Os conflitos morais são inerentes à prática da fisioterapia, tanto mais que manifestações da evolução científica estão cada vez mais presentes na práxis profissional do fisioterapeuta, o que exige um contato próximo entre o profissional e o paciente. O objetivo deste estudo foi analisar a percepção de fisioterapeutas e alunos de um curso de fisioterapia sobre os conflitos morais na prática clínica. Foi realizado um estudo transversal por meio de questionário aplicado aos alunos das etapas inicial (Grupo 1) e final (Grupo 2) de um curso de fisioterapia e também a fisioterapeutas (Grupo 3) que atuam em cidades do Meio-Oeste de Santa Catarina, Brasil. A amostra foi composta por 110 alunos, sendo 59 do Grupo 1 e 51 do Grupo 2, com média de idade de 22,7 anos e predominantemente do sexo feminino. Além disso, havia 36 fisioterapeutas incluídos no Grupo 3, a maioria do sexo feminino, com idades variando de 31 a 40 anos e com 11 a 20 anos de formação. Quase todos os alunos e profissionais relataram que a abordagem da ética profissional e da bioética na formação profissional são particularmente importantes. Os alunos de estágios mais avançados, que realizaram o curso de bioética, apresentaram maior conhecimento geral quando comparados aos demais grupos, indicando a importância do ensino dessa temática na graduação. A maioria dos profissionais (75%) relatou pouco conhecimento sobre os temas abordados no Código de Ética e Deontologia da Fisioterapia; 72% afirmaram ter lido parcialmente o documento, mas apenas 47% recebem atualizações anuais sobre o código de ética. Os conflitos mais citados pelos profissionais foram sigilo e confidencialidade (61,1%), relacionamento intra e interprofissional (33,3%), honorários (30,5%), autonomia profissional (25%), veracidade das informações (19,4%), relacionamento terapeuta / paciente (16,7%) e autonomia, decência e intimidade do paciente (5,5%). Os conflitos morais fazem parte da prática da fisioterapia, mesmo que não tenham sido suficientemente reconhecidos pelos participantes em alguns casos. Com base neste estudo, algumas medidas são necessárias quanto ao ensino, à atualização profissional e à inclusão de temas no código profissional da fisioterapia, visto que algumas questões constituem um desafio para a formação ética. Infelizmente, eles não são abordados no código de ética profissional do fisioterapeuta e os profissionais que concluíram o treinamento antes não tiveram um aprendizado adequado sobre os temas discutidos.

Moral conflicts are inherent to the practice of physiotherapy, more so as manifestations of the scientific evolution are increasingly more present in the professional praxis of the physiotherapist, which demands a close contact between the professional and the patient. The objective of this study was to analyze the perception of physiotherapists and students in a physiotherapy program towards moral conflicts in clinical practice. A cross-sectional study was performed by means of a questionnaire applied to students in initial (Group 1) and final (Group 2) stages of a physiotherapy course as well as to physiotherapists (Group 3) working in cities in the Midwest of Santa Catarina, Brazil. The sample consisted of 110 students, 59 in Group 1 and 51 in Group 2, with a mean age of 22.7 years old and were predominantly females. Moreover, there were 36 physiotherapists included in Group 3, most of whom were female, with ages ranging from 31 to 40 years old and with 11 to 20 years of training. Almost all students and professionals reported that approaching professional ethics and bioethics in professional training is particularly important. The students in the more advanced stages, who had taken the bioethics course, showed greater general knowledge when compared to the other groups, indicating the importance of teaching this theme at the undergraduate level. Most professionals (75%) self-reported little knowledge on the topics discussed in the Ethics and Deontology Code of Physiotherapy; 72% affirmed having partially read the document, but only 47% get annual updates on the ethics code. The conflicts most frequently mentioned by the professionals were secrecy and confidentiality (61.1%), intra- and interprofessional relationship (33.3%), fees (30.5%), professional autonomy (25%), truthfulness of information (19.4%), therapist/patient relationship (16.7%), and patient autonomy, decency, and intimacy (5.5%). Moral conflicts are part of the practice of physiotherapy, even if it was not sufficiently acknowledged by the participants in some cases. Based on this study, some measures are needed regarding teaching, professional recycling, and the inclusion of themes in the professional code of physiotherapy, considering that some issues constitute a challenge for ethical training. Unfortunately, but they are not addressed in the physiotherapist's professional code of ethics and professionals who finished training before did not have adequate learning on the topics discussed.

Aqueous extract from Luehea divaricata Mart. Leaves reduces nociception in rats with neuropathic pain.

ETHNOPHARMACOLOGICAL RELEVANCE: Luehea divaricata, popularly known in Brazil as "açoita-cavalo", has been widely explored by different ethnic groups native to Brazil to treat different pathologic conditions, including inflammatory pain. However, no report could be found on the effect that extract of L. divaricata has on neuropathic pain. This is an important topic because convergent and divergent mechanisms underlie inflammatory vs. neuropathic pain indicate that there may not always be a clear mechanistic delineation between these two conditions. AIM OF THE STUDY: The study aimed to determine antioxidant activity and macronutrient composition of aqueous extract from leaves of L. divaricata, and the effect of oral administration on nociception in rats with chronic constriction injury (CCI) of sciatic nerve-induced neuropathic pain, one of the most commonly employed animal models of neuropathic pain. MATERIALS AND METHODS: The antioxidant activity of the extract was evaluated by total phenolic content and DPPH, ABTS●+ and ORAC methods. Vitexin was determined by HPLC to show that the composition of the extract of the present study is similar to that used in previous studies with this genus. Total sugar and sucrose concentrations were assessed by the anthrone method, while glucose and triacilglycerides were determined using commercially available kits. Fructose concentration was calculated from values for total sugars, glucose and sucrose. Total protein was determined by Bradford assay. The effect on DNA strand breaking was investigated by inhibition of strand breaking of supercoiled DNA by hydroxyl radical. The antinociceptive effects of aqueous extract (100, 300, 500, and 1000 mg/kg, i.g.) were evaluated on thermal and mechanical thresholds for neuropathic pain induced by chronic constriction injury (CCI) of the sciatic nerve in rats. We also compared the antinociceptive effect of the extract (500 mg/kg, i.g.) with that induced by gabapentin (50 mg/kg, i.g.), a first-line clinical treatment for neuropathic pain. The effect of co-administration of extract (500 mg/kg, i.g.) and low-dose gabapentin (30 mg/kg, i.g.) was also assessed. In addition, the effect of the extract on body weight, and blood and hepatic parameters were investigated to reveal possible side effects of treatment. RESULTS: The extract showed high content of total phenol; good reducing capacity for DPPH, ABTS●+ and ORAC assays; presence of vitexin; and a high capacity to inhibit strand breaking of supercoiled DNA. The predominant sugar was sucrose, followed by glucose and fructose. Total protein was greater than triacylglycerides, with the latter being present in a trace amount in the extract. The extract increased the thermal and mechanical thresholds, which was reduced by CCI. The antinociceptive effect was comparable to gabapentin and was also found after co-administration of extract and low-dose gabapentin. No significant change was found in body weight and blood and hepatic indicators after extract treatment. CONCLUSIONS: Aqueous extract from L. divaricata leaves was as effective as gabapentin at attenuating CCI-induced neuropathic pain, indicating for first time the therapeutic potential of this species for this type of pain.

IL-10 Cytokine as Potential Biomarkers in Women with Fibromyalgia Who Underwent to a Short Balneotherapy Treatment

Abstract Fibromyalgia (FM) is a nonarticular rheumatic syndrome that leads to diffuse myalgia, sleep disturbances and morning stiffness. Balneotherapy has been shown an effective strategy to improve the health conditions of patients; however, the treatment follow-up is based on patient report due to the lack of biomarkers. Thus, this study evaluated the application of cytokines and phosphoglycerate mutase I (PGAM-I) to monitoring FM patient underwent to balneotherapy treatment. Eleven healthy and eleven women with FM were submitted to daily sessions of balneotherapy during 10 days. Clinical and quality of life parameters were assessed through a FIQ questionnaire. Blood levels of TNF-(, interleukins (IL-1, IL-2 and IL-10) and PGAM-I expression in patients' saliva were also evaluated. Patients with FM showed significant improvements in their clinical status after treatment. Also, FM patients has IL-10 levels lower than healthy women and the balneotherapy increased the expression of this cytokine in both groups, concomitantly to pain relief. Although inflammatory cytokines (IL-1, IL-2 and TNF-() were more expressed in FM patients than healthy patients their levels did not reduce after treatment. A slight increase of PGAM-I expression was observed. In conclusion, IL-10 levels could be a useful biomarker to balneotherapy follow-up of FM patients. However, these findings must be analyzed in a larger number of patients in order to validate IL-10 as an effective biomarker.

Influencia da laserterapia no processo cicatricial de queimaduras de terceiro grau / Influence of low intensity light therapy in wound healing of third-degree burns

O objetivo do presente trabalho consistiu na avaliaçao da resposta ao tratamento fisioterapeutico, atraves de laser, em ratos com queimaduras de terceiro grau. A amostra foi composta por 10 ratos Wistar, sendo lesado o dorso dos animais em ambos os lados, sendo realizada a aplicaçao do laser somente em um lado e no outro nao (considerado controle). O acompanhamento da evoluçao do processo cicatricial foi realizado atravez da analise histologica aos 07 dias, 14 dias, e 21 dias apos o tratamento, que consistiu em 5 sessoes de laserterapia por semana, com duraçao de 10 min cada sessao, com 4J/cm² por varredura. O presente trabalho demonstrou que nas lesoes tratadas por laserterapia verificou-se a presença de fibras colagenas e elasticas verdadeiras e que os vasos sanguineos de neoformaçao estavam amadurecidos, enquanto que, nas lesoes nao submetidas a laserterapia observou-se tecido conjuntivo frouxo, infiltrados moderadamente acentuados de macrofagos e linfocito, vasos sanguineos de neoformaçao com maior calibre e fibras colagenas discretas ou ausentes. Os dados permitem concluir que o laser em queimaduras de ratos contribuiu para acelerar e melhorar a qualidade do tecido neoformado.