Onset and duration of symptoms of loss of smell/taste in patients with COVID-19: A systematic review.

OBJECTIVE: The aim of the study was to conduct a systematic review of the literature to investigate the time of onset and duration of symptoms of loss of smell and taste in patients diagnosed with COVID-19. METHODS: Two independent authors performed a systematic review of the Medline/PubMed, SCOPUS, COCHRANE, Lilacs and Web of Science electronic databases. The time of onset and duration of symptoms were considered primary outcomes. The sex and age of individuals, the geographical location of the study, the prevalence of symptoms, other associated symptoms, associated comorbidities, and the impact on quality of life and eating habits were considered secondary outcomes. RESULTS: Our search generated 17 articles. Many of the studies reported that the onset of anosmia and ageusia occurred 4 to 5 days after the manifestation of other symptoms of the infection and that these symptoms started to disappear after one week, with more significant improvements in the first two weeks. CONCLUSION: The present study concludes that the onset of symptoms of loss of smell and taste, associated with COVID-19, occurs 4 to 5 days after other symptoms, and that these symptoms last from 7 to 14 days. Findings, however, varied and there is therefore a need for further studies to clarify the occurrence of these symptoms. This would help to provide early diagnosis and reduce contagion by the virus.

Propriedades psicométricas do WHODAS para uso em pessoas com chikungunya no Brasil / Propiedades psicométricas de WHODAS para uso en personas con chikungunya en Brasil / Psychometric properties of WHODAS for use in patients with chikungunya in Brazil

RESUMO O objetivo deste estudo é validar um instrumento de aferição da funcionalidade segundo a proposta conceitual da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para uso em pessoas pós-chikungunya. Este é um estudo de validação com indivíduos >17 anos, de ambos os sexos, em atendimento para manejo clínico da chikungunya. A coleta de dados foi realizada por meio de entrevistas coletando informações sobre funcionalidade (WHODAS), qualidade de vida (WHOQOL-bref) e sociodemográficas. A análise estatística usou o coeficiente alfa de Cronbach (consistência interna) e coeficiente de correlação de Spearman (validade convergente), médias e desvios-padrão para a determinação do perfil de qualidade de vida, com nível de significância de 5%. A amostra foi composta por 68 indivíduos. Os valores médios das pontuações dos instrumentos foram: 45,4 (±16,38) para o WHODAS e 12,1 (±2,10) para o WHOQOL-bref. O alfa de Cronbach do valor total foi de α=0,93; todos os domínios do WHODAS apresentaram valores acima de 0,75. O valor total do WHODAS 2.0 apresentou forte correlação com o domínio físico (r=−0,74) e moderada correlação com os domínios psicológico (r=−0,68) e social (r=−0,42) do WHOQOL-bref. Os resultados indicam que o WHODAS 2.0 é um instrumento válido para a mensuração da autopercepção de alteração da funcionalidade em pacientes acometidos pela chikungunya, capaz de fornecer dados que podem ajudar a construir um perfil de impacto da doença no perfil de funcionalidade dessa população.

RESUMEN El objetivo de este estudio es validar un instrumento de evaluación del funcionamiento de acuerdo con la propuesta conceptual de la Clasificación Internacional del Funcionamiento de la Discapacidad y de la Salud (CIF), para su uso en personas postchikungunya. Se trata de un estudio de validación con individuos >17 años, de ambos sexos, en atención para el manejo clínico de chikungunya. La recolección de datos se realizó mediante entrevistas, que reunieron informaciones sobre el funcionamiento (WHODAS), la calidad de vida (WHOQOL-bref) y los datos sociodemográficos. El análisis estadístico utilizó el coeficiente alfa de Cronbach (consistencia interna) y el coeficiente de correlación de Spearman (validación convergente), medias y desviaciones estándar para determinar el perfil de la calidad de vida, con un nivel de significación del 5%. La muestra consistió en 68 individuos. Los valores medios de las puntuaciones fueron: 45,4 (±16,38) para WHODAS; y 12,1 (±2,10) para WHOQOL-bref. El alfa de Cronbach del valor total fue α=0,93; Todos los dominios WHODAS presentaron valores superiores a 0,75. El valor total de WHODAS 2.0 tuvo una fuerte correlación con el dominio físico (r=−0,74) y una correlación moderada con los dominios psicológico (r=−0,68) y social (r=−0,42) del WHOQOL-bref. Los resultados indican que WHODAS 2.0 es un instrumento válido para medir la alteración del funcionamiento autopercibido en pacientes afectados por chikungunya, siendo capaz de proporcionar datos que pueden ayudar a construir un perfil de impacto de la enfermedad en el perfil de esta población.

ABSTRACT The aim of this study is to validate an assessment tool for functioning and health according to the conceptual proposal of the International Classification of Functioning, Disability and Health (ICF), for its use in post-chikungunya patients. This is a validation study with individuals >17 years old of both sexes. Data collection was performed through interviews, gathering information on functioning (WHODAS), quality of life (WHOQOL-bref) and socio-demographic data. Statistical analysis used the Cronbach alpha coefficient (internal consistency) and Spearman correlation coefficient (convergent validation), means and standard deviations, with significance level of 5%. The sample consisted of 68 individuals. The mean values of scores were: 45.4 (±16.38) for WHODAS and 12.1 (±2.10) for WHOQOL-bref. The Cronbach's alpha of the total value was α=0.93; all WHODAS domains presented values ≥0.75. The total value of WHODAS 2.0 had strong correlation with the physical domain (r=−0.74) and moderate correlation with the psychological (r=−0.68) and social (r=−0.42) domains of the WHOQOL-bref. The results indicate that WHODAS 2.0 is a valid instrument for the measurement of self-perceived functioning alteration in patients affected by chikungunya.

Considerações sobre a discussão da revisão do esquema da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) / Thoughts on the discussion about the revision of the International Classification of Functioning, Disability and Health (ICF) scheme

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) apresenta uma abordagem inovadora ao funcionamento: o modelo biopsicossocial. Desde então, a estrutura da CIF e seu esquema explicativo têm sido utilizados em muitos contextos, incluindo saúde, previdência social e educação. Recentemente, surgiram algumas críticas e surgiram propostas a respeito de suas revisões. Objetivos: Este artigo discute propostas anteriores de revisões do esquema da CIF e apresenta sugestões de uma nova. Métodos: Descrevemos algumas das sugestões de esquemas de funcionamento alternativo da CIF e apresentamos algumas de suas características. Resultados: Também propomos nosso próprio esquema, destacando suas vantagens sobre os antecessores. Em nossa proposta, os componentes atuais do esquema são mantidos e dispostos equidistantemente ao longo de uma estrutura tridimensional de "casco de bola" conectada por setas de duas pontas. Nosso esquema é inovador, pois não apresenta nenhum componente como central, permitindo que o esquema seja mais adaptável à realidade de cada perfil funcional. Também é dinâmico, girando em 3 eixos, possibilitando o posicionamento central do componente mais importante. As esferas para cada componente podem ser ampliadas, demonstrando a magnitude de cada componente. Conclusão: Esperamos contribuir para a discussão atual sobre o esquema da CIF e sua revisão.

The International Classification of Functioning, Disability and Health (ICF) presents an innovative approach to functioning: the biopsychosocial model. Since then, the ICF framework and its explanatory scheme has been used in many settings, including health, social security, and education. Recently, some criticism has arisen and proposals have ensued regarding its revisions. Objective: This paper discusses previous proposals for revisions to the ICF scheme and present suggestions of a new one. Methods: We outline some of the suggestions of ICF alternative functioning schemes, and present some of their features. Results: We also propose our own scheme, highlighting its advantages over predecessors. In our proposal, current scheme components are kept and arranged equidistantly along a three dimension 'ball shell' structure connected by double-headed arrows. Our scheme is innovative in that it does not present any component as central, allowing the scheme to be more adaptable to the reality of each functioning profile. It is also dynamic, by rotating on 3 axes, making possible the central positioning of the most important component. The spheres for each component can be enlarged, demonstrating ​​the magnitude of each component. Conclusion: We hope to contribute to the current discussion on ICF scheme and its revision.

Perfil sociodemográfico e clínico de pacientes em pós-operatório de confecção de estomas intestinais de eliminação / Perfil sociodemográfico y clínico de pacientes en posoperatorio de producción de estomas intestinales / Sociodemographic and clinical profile of patients in postoperative recovery from intestinal stoma creation

RESUMO Objetivo: Analisar o perfil sododemográfico e clínico dos pacientes no pós-operatório de confecção de estoma intestinal. Material e método: Estudo de abordagem quantitativa, descritiva, realizado no período de agosto a outubro de 2015, em um serviço filantrópico de referência em oncologia, localizado em Teresina, capital da província do Piauí, Brasil. Um questionário sociodemográfico, clínico e um exame físico com ênfase na avaliação do abdome e do estoma foram aplicados em 56 pacientes. Resultados: Perfil sociodemográfico: idade média de 57,75 anos, predominantemente mulheres (67,9%), do interior do Piauí (62,5%), residentes em áreas urbanas (69,6%), raça mulata (53,6%), religião católica (78,6%), com ensino fundamental incompleto (37,5%) e renda até um salário mínimo (67,9%). Perfil clínico: 42,9% tinham câncer de reto como diagnóstico médico, 85,7% tinham colostomia, em 76,8% a cirurgia era eletiva e não demarcada (57,1%), com equipamento coletor de 1 peça (51,8%), boa fixação da equipe de coleta (87,5%) e estoma com boa função (89,3%). Conclusão: A assistência ao estomizado deve estar embasada no conhecimento científico do processo de enfermagem e identificar as principais necessidades de cada paciente, de acordo com seus perfis sociodemográficos e clínicos.

ABSTRACT Objective: To evaluate the sociodemographic and clinical profile of patients in the postoperative period following intestinal stoma surgery. Material and method: Quantitative study, with a descriptive approach carried out between August and October 2015, in a philanthropic service of reference in an oncology unit, located in Teresina, capital of the province of Piauí, Brazil. A sociodemographic and clinical questionnaire plus a physical examination with emphasis on the evaluation of the abdomen and stoma were applied to 56 patients. Results: Sociodemographic profile: average age of 57.75 years, mostly women (67.9%), from the interior of Piauí (62.5%), who live in urban areas (69.6%), of mulatto ethnicity (53.6%), Catholic religion (78.6%), with incomplete primary education (37.5%) and an income up to minimum wage (67.9%). Clinical profile: 42.9% had rectal cancer as a medical diagnosis, 85.7% had colostomy; the surgery was elective in 76.8% and not demarcated (57.1%), with a one-piece collector bag system (51.8%), good fixation of the collector bag (87.5%) and stoma with good function (89.3%). Conclusion: The care of patients with stomas should be based on scientific knowledge of the nursing process, and the main needs of each patient should be identified based on their sociodemographic and clinical profiles.

RESUMEN Objetivo: Evaluar el perfil sociodemográfico y clínico de los pacientes en posoperatorio mediato de estoma intestinal. Material y método: Estudio de abordaje cuantitativo, descriptivo realizado entre agosto a octubre de 2015, en un servicio filantrópico de referencia en oncología, ubicado en Teresina, capital de la provincia de Piauí, Brasil. A 56 pacientes se les aplicó un cuestionario sociodemográfico y clínico más un examen físico con énfasis en la evaluación del abdomen y el estoma. Resultados: Perfíl sociodemográfico: edad media de 57,75 años, en su mayoría mujeres (67,9%), del interior del Piauí (62,5%), que viven en zonas urbanas (69,6%), de raza mulata (53,6%), religión católica (78,6%), con escolaridad primaria incompleta (37,5%) y un ingreso de hasta un salario mínimo (67,9%). Perfil clínico: el 42,9% tenía cáncer del recto como un diagnóstico médico, el 85,7% tenía colostomía, en el 76,8% la cirugía fue electiva y no demarcada (57,1%), con equipos colectores de 1 pieza (51,8%), buena fijación del equipo recolector (87,5%) y estoma con buena función (89,3%). Conclusión: La atención al paciente estomizado debe basarse en el conocimiento científico del proceso de enfermería e identificar las principales necesidades de cada paciente en función de sus perfiles sociodemográficos y clínicos.

Redescobrindo um panorama de possibilidades: práticas de ressocialização oferecidas pelo centro de atenção psicossocial / Rediscovering a view of possibilities: re-socialization practices offered by the psychosocial care center

Objetivo: analisar as práticas de ressocialização e reabilitação desenvolvidas no Centro de Atenção Psicossocial (CAPS). Método: estudo descritivo, de abordagem qualitativa, desenvolvido no com 17participantes, envolvendo profissionais e usuários, a partir de dois roteiros de entrevista semiestruturados, analisados a partir da técnica de Análise de Conteúdo. Resultados: o desenvolvimento das práticas terapêuticas acontece efetivamente e há um cuidado dos profissionais mesmo frente às dificuldades, para realiza-las com maestria. Foi possível identificar que os usuários que participavam com frequência das atividades, apresentaram mudanças positivas em seu comportamento, sobretudo, no que diz respeito à ressocialização. Conclusão: as práticas terapêuticas repercutiram de modo positivo, pois se constatou melhora na condição dos usuários em se tratando da autoestima, da qualidade de vida e na redução do número de crises.

Thyroid hormones reorganize the cytoskeleton of glial cells through Gfap phosphorylation and Rhoa-dependent mechanisms.

Thyroid hormones (3,5,3'-triiodo-L: -thyronine, T3; 3,5,3',5'-L: -tetraiodothyronine, T4; TH) play crucial roles in the growth and differentiation of the central nervous system. In this study, we investigated the actions of TH on proliferation, viability, cell morphology, in vitro phosphorylation of glial fibrillary acidic protein (GFAP) and actin reorganization in C6 glioma cells. We first observe that long-term exposure to TH stimulates cell proliferation without induce cell death. We also demonstrate that after 3, 6, 12, 18, and 24 h treatment with TH, C6 cells and cortical astrocytes show a process-bearing shape. Furthermore, immunocytochemistry with anti-actin and anti-GFAP antibodies reveals that TH induces reorganization of actin and GFAP cytoskeleton. We also observe an increased in vitro 32P incorporation into GFAP recovered into the high-salt Triton insoluble cytoskeletal fraction after 3 and 24 h exposure to 5 x 10(-8) and 10(-6) M T3, and only after 24 h exposure to 10(-9) M T4. These results show a T3 action on the phosphorylating system associated to GFAP and suggest a T3-independent effect of T4 on this cytoskeletal protein. In addition, C6 cells and astrocytes treated with lysophosphatidic acid, an upstream activator of the RhoA GTPase pathway, totally prevented the morphological alterations induced by TH, indicating that this effect could be mediated by the RhoA signaling pathway. Considering that IF network can be regulated by phosphorylation leading to reorganization of IF filamentous structure and that alterations of the microfilament organization may have important implications in glial functions, the effects of TH on glial cell cytoskeleton could be implicated in essential neural events such as brain development.

Resveratrol increases glutamate uptake and glutamine synthetase activity in C6 glioma cells.

Resveratrol, a phytoalexin found mainly in grapes, is a promising natural product with anti-cancer and cardio-protective activities. Here, we investigated, in C6 glioma cells, the effect of resveratrol on some specific parameters of astrocyte activity (glutamate uptake, glutamine synthetase and secretion of S100B, a neurotrophic cytokine) commonly associated with the protective role of these cells. Cell proliferation was significantly decreased by 8% and 26%, following 24h of treatment with 100 and 250 microM resveratrol. Extracellular S100B increased after 48 h of resveratrol exposure. Short-term resveratrol exposure (from 1 to 100 microM) induced a linear increase in glutamate uptake (up to 50% at 100 microM resveratrol) and in glutamine synthetase activity. Changes in these glial activities can contribute to the protective role of astrocytes in brain injury conditions, reinforcing the putative use of this compound in the therapeutic arsenal against neurodegenerative diseases and ischemic disorders.

Morphological alterations and induction of oxidative stress in glial cells caused by the branched-chain alpha-keto acids accumulating in maple syrup urine disease.

Maple syrup urine disease (MSUD) is an inherited neurometabolic disorder biochemically characterized by the accumulation of the branched-chain alpha-keto acids (BCKA) alpha-ketoisocaproic (KIC), alpha-keto-beta-methylvaleric (KMV) and alpha-ketoisovaleric (KIV) and their respective branched-chain alpha-amino acids in body fluids and tissues. Affected MSUD patients have predominantly neurological features, including cerebral edema and atrophy whose pathophysiology is not well established. In the present study we investigated the effects of KIC, KMV and KIV on cell morphology, cytoskeleton reorganization, actin immunocontent and on various parameters of oxidative stress, namely total antioxidant reactivity (TAR), glutathione (GSH) and nitric oxide concentrations, and on the activities of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) in C6 glioma cells. We initially observed that C6 cultivated cells exposed for 3 h to the BCKA (1 and 10 mM) changed their usual rounded morphology to a fusiform or process-bearing cell appearance, while 24 h exposure to these organic acids elicited massive cell death. Rhodamine-labelled phalloidin analysis revealed that these organic acids induced reorganization of the actin cytoskeleton with no modifications on total actin content. It was also observed that 3h cell exposure to low doses of all BCKA (1 mM) resulted in a marked reduction of the non-enzymatic antioxidant defenses, as determined by TAR and GSH measurements. In addition, KIC provoked a reduced activity of SOD and GPx, whereas KMV caused a diminution of SOD activity. In contrast, CAT activity was not modified by the metabolites. Furthermore, nitric oxide production was significantly increased by all BCKA. Finally, we observed that the morphological features caused by BCKA on C6 cells were prevented by the use of the antioxidants GSH (1.0 mM), alpha-tocopherol (trolox; 10 microM) and Nomega-nitro-L-arginine methyl ester (L-NAME; 500 microM). These results strongly indicate that oxidative stress might be involved in the cell morphological alterations and death, as well as in the cytoskeletal reorganization elicited by the BCKA. It is presumed that these findings are possibly implicated in the neuropathological features observed in patients affected by MSUD.

Creatine and antioxidant treatment prevent the inhibition of creatine kinase activity and the morphological alterations of C6 glioma cells induced by the branched-chain alpha-keto acids accumulating in maple syrup urine disease.

Accumulation of the branched-chain alpha-keto acids (BCKA), alpha-ketoisocaproic acid (KIC), alpha-keto-beta-methylvaleric acid (KMV), and alpha-ketoisovaleric acid (KIV) and their respective branched-chain alpha-amino acids (BCAA) in tissues and biological fluids is the biochemical hallmark of patients affected by the neurometabolic disorder known as maple syrup urine disease (MSUD). Considering that brain energy metabolism is possibly altered in MSUD, the objective of this study was to determine creatine kinase (CK) activity, a key enzyme of energy homeostasis, in C6 glioma cells exposed to BCKA. The cells were incubated with 1, 5, or 10 mM BCKA for 3 h and the CK activity measured afterwards. The results indicated that the BCKA significantly inhibited CK activity at all tested concentrations. Furthermore, the inhibition caused by the BCKA on CK activity was totally prevented by preincubation with the energetic substrate creatine and by coincubation with the N-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, indicating that deficit of energy and nitric oxide (NO) are involved in these effects. In contrast, other antioxidants such as glutathione (GSH) and trolox (soluble Vitamin E) were not able to prevent CK inhibition. In addition, we observed that the C6 cells changed their usual rounded morphology when exposed for 3 h to 10 mM BCKA and that creatine and L-NAME prevented these morphological alterations. Considering the importance of CK for brain metabolism homeostasis, it is conceivable that inhibition of this enzyme by increased levels of BCKA may contribute to the neurodegeneration of MSUD patients.

Branched-chain alpha-keto acids accumulating in maple syrup urine disease induce reorganization of phosphorylated GFAP in C6-glioma cells.

In this study we investigate the effects of the branched-chain keto acids (BCKA) alpha-ketoisocaproic (KIC), alpha-ketoisovaleric (KIV), and alpha-keto-beta-methylvaleric (KMV) acids, metabolites accumulating in maple syrup urine disease (MSUD), on the in vitro phosphorylation of glial fibrillary acidic protein (GFAP) and cytoskeletal reorganization in C6-glioma cells. We observed that after 3 h treatment with KIC, KIV, or KMV cells showed retracted cytoplasm with bipolar processes containing packed GFAP filaments as revealed by immunocytochemistry. Western Blot analysis by anti-GFAP monoclonal antibody demonstrated that BCKA were not able to alter GFAP immunocontent in total cell homogenate, but the immunocontent as well as the in vitro (32)P incorporation into GFAP recovered into the high salt Triton-insoluble cytoskeletal fraction were significantly increased. Western Blot using monoclonal antiphosphoserine antibody showed that BCKA induced increased immunocontent of phosphoserine-containing amino acids in several proteins in total cell homogenate. In addition, the immunocontent of phosphoserine-containing amino acids was also greatly increased in GFAP recovered in the high-salt Triton insoluble cytoskeletal fraction, corresponding to the polymerized intermedite filament (IF) proteins present in the cell. In conclusion, our results indicate that KIC, KIV, or KMV increased the serine/threonine in vitro phosphorylation of GFAP leading to increased Triton-insoluble GFAP immunocontent and cytoskeletal reorganization. Considering IF networks can be regulated by phosphorylation of polypeptide subunits leading to reorganization of the IF filamentous structure, we could suppose that GFAP hyperphosphorylation and disorganization of cellular structure could be involved in the brain damage characteristic of MSUD patients.