RESUMEN
BACKGROUND: People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3). METHODS: A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. FINDINGS: We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100-200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. INTERPRETATION: A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. FUNDING: None.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Mpox , Adulto , Masculino , Humanos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Recuento de Linfocito CD4 , Carga ViralRESUMEN
BACKGROUND: The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. MATERIALS AND METHODS: We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. RESULTS: We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67-0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. CONCLUSION: The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.
Asunto(s)
COVID-19 , Oxigenación por Membrana Extracorpórea , Humanos , Masculino , Estudios Retrospectivos , Calibración , Curva ROC , COVID-19/terapiaRESUMEN
ABSTRACT: Balikian, P, Gomes de Araujo, G, Prado, ES, Ryan Geraldes, AA, Marinho de Lima, AH, and Mendes, EV. Anaerobic threshold in stand-up paddle: comparison between direct and alternative methods. J Strength Cond Res 36(7): 1896-1900, 2022-The purpose of this study was to test the validity of alternative protocols, mean velocity during 30 minutes of continuous effort (V30min) and critical velocity (CV), to estimate the anaerobic threshold in stand-up paddle (SUP). Eight athletes performed: 3 maximal efforts at 400-, 500-, and 800-m distances to determine CV values, using the distance-time relationship; 3 efforts at 85, 90, and 100% of maximal 500-m effort to determine the velocity related to 3.5 mmol·L-1 of lactate, assumed as the onset of blood lactate accumulation (OBLA) and; a 30-minute continuous effort to determine the V30min. All evaluations were separated by 48 hours, with the athletes using their own boards and paddles in the water. No differences were observed between the OBLA (2.35 ± 0.13 m·s-1) and alternative methods (CV: 2.42 ± 0.20 m·s-1; p = 0.10 and V30min: 2.32 ± 0.13 m·s-1; p = 0.63). Although strong correlations were observed between the OBLA and alternative methods (CV: r = 0.84 and V30min: r = 0.94), the limits of agreement were higher in CV (±0.23 m·s-1) than V30min (±0.08 m·s-1). These results demonstrate that both the CV and V30min are valid to estimate the OBLA. In view of the specificity of SUP and the high levels of agreement, the use of the V30min is recommended to prescribe training intensities.
Asunto(s)
Umbral Anaerobio , Prueba de Esfuerzo , Atletas , Prueba de Esfuerzo/métodos , Humanos , Ácido LácticoRESUMEN
Keto analogues and amino acids (KAAA) supplementation can reduce blood ammonia concentrations in athletes undergoing high-intensity exercise under both ketogenic and thermoneutral conditions. This study evaluated the acute effects of KAAA supplementation on ammonia metabolism during extenuating endurance exercise in rats fed a ketogenic diet. In all, eighty male Fischer rats at 90 d of age were divided into eight groups, and some were trained using a swimming endurance protocol. A ketogenic diet supplemented with keto analogues was administered for 10 d. Administration of the ketogenic diet ended 3 d before the exhaustion test (extenuating endurance exercise). A ketogenic diet plus KAAA supplementation and extenuating endurance exercise (trained ketogenic diet supplemented with KAAA (TKKa)) increased blood ammonia concentrations by approximately 50 % compared with the control diet (trained control diet supplemented with KAAA (TCKa)) and similar training (effect size=1·33; statistical power=0·50). The KAAA supplementation reduced blood urea concentrations by 4 and 18 % in the control and ketogenic diet groups, respectively, compared with the groups fed the same diets without supplementation. The trained groups had 60 % lower blood urate concentrations after TCKa treatment than after TKKa treatment. Our results suggest that KAAA supplementation can reduce blood ammonia concentrations after extenuating endurance exercise in rats fed a balanced diet but not in rats fed a ketogenic diet.
Asunto(s)
Aminoácidos/uso terapéutico , Amoníaco/sangre , Dieta , Suplementos Dietéticos , Hiperamonemia/prevención & control , Cetoácidos/uso terapéutico , Resistencia Física/fisiología , Aminoácidos/farmacología , Animales , Dieta Cetogénica , Hiperamonemia/sangre , Hiperamonemia/etiología , Cetoácidos/farmacología , Masculino , Condicionamiento Físico Animal/fisiología , Ratas Endogámicas F344RESUMEN
This study aimed to verify whether salivary total protein (STP) would reflect anaerobic threshold in elderly athletes subjected to an incremental exercise test. METHODS: Seven elderly elite athletes (EEA) and six physically active elderly men (PAE) completed a treadmill protocol in which blood and saliva samples were collected. RESULTS: Blood lactate (BL) and STP increased significantly in EEA during the test (0.8 ± 0.2 to 5.1 ± 2.0 mmol/L and 42.5 ± 7.5 to 222.5 ± 63.8 mg/dL, respectively) and remained elevated at five minutes after exercise (5.0 ± 1.9 mmol/L and 147.2 ± 50.0 mg/dL, respectively). Furthermore, correlations between STP and heart rate (r = 0.87, p < 0.001), and between BL and STP (r = 0.96, p < 0.001), were observed in the elderly athletes. CONCLUSIONS: STP represents a potential non-invasive biomarker for determining anaerobic threshold during an incremental exercise test, and this parameter may be used as an indicator of physical exercise intensity in elderly athletes.
RESUMEN
BACKGROUND: Sedative overdoses pose a risk of delirium among patients in the ICU, with potential mitigation through the use of a processed EEG monitor (the bispectral index [BIS]) to guide depth of sedation. RESEARCH QUESTION: Can BIS-guided deep sedation (Richmond Agitation Sedation Scale RASS score, -4 or -5) reduce sedative dosage and increase delirium-free and coma-free (DFCF) days? STUDY DESIGN AND METHODS: A randomized controlled trial was conducted in a tertiary mixed ICU, enrolling patients requiring deep sedation for > 8 h. Patients were assigned randomly to either the clinical assessment (CA) or BIS groups (BIS range, 40-60). Both groups used a BIS sensor, whereas the CA group's screen remained covered. After deep sedation, BIS sensors were removed, and delirium was assessed twice daily by researchers masked to the randomization. The primary outcome was the number of DFCF days within 14 days after deep sedation. Additionally, we compared doses of sedative drugs and BIS values during deep sedation. RESULTS: Ninety-nine patients were included in the study. We found no significant difference in DFCF days (P = .1) between CA and BIS arms, but propofol doses were significantly lower in the BIS group (CA group, 1.77 mg/kg/h [95% CI, 1.60-1.93] vs BIS group, 1.44 mg/kg/h [95% CI, 1.04-1.83]; P = .03). During deep sedation, the CA group spent 46% of the total hours (95% CI, 35%-57%) with BIS values of < 40, whereas the BIS group spent 32% (95% CI, 25%-40%; P = .03). Subgroup analysis focusing on patients sedated for > 24 h revealed an increase in DFCF days in the BIS group (CA group: median, 1 day [interquartile range (IQR), 0-9 days] vs BIS group: median, 8 days [IQR, 0-13 days]; P = .04). INTERPRETATION: BIS-guided deep sedation did not improve DFCF days, but did reduce sedative drug use. In patients requiring sedation for > 24 h, it showed an improvement in DFCF days. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03840577; URL: www. CLINICALTRIALS: gov.
RESUMEN
MoS2 nanosheets belong to an emerging family of nanomaterials named bidimensional transition metal dichalcogenides (2D TMDCs). The use of such promising materials, featuring outstanding chemical and physical properties, is expected to increase in several fields of science and technology, with an enhanced risk of environmental dispersion and associated wildlife and human exposures. In this framework, the assessment of MoS2 nanosheets toxicity is instrumental to safe industrial developments. Currently, the impact of the nanomaterial on the nervous tissue is unexplored. In this work, we use as in vivo experimental model the early-stage zebrafish, to investigate whether mechano-chemically exfoliated MoS2 nanosheets reach and affect, when added in the behavioral ambient, the nervous system. By high throughput screening of zebrafish larvae locomotor behavioral changes upon exposure to MoS2 nanosheets and whole organism live imaging of spinal neuronal and glial cell calcium activity, we report that sub-acute and prolonged ambient exposures to MoS2 nanosheets elicit locomotor abnormalities, dependent on dose and observation time. While 25 µg mL-1 concentration treatments exerted transient effects, 50 µg mL-1 ones induced long-lasting changes, correlated to neuroinflammation-driven alterations in the spinal cord, such as astrogliosis, glial intracellular calcium dysregulation, neuronal hyperactivity and motor axons retraction. By combining integrated technological approaches to zebrafish, we described that MoS2 2D nanomaterials can reach, upon water (i.e. ambient) exposure, the nervous system of larvae, resulting in a direct neurological damage.
Asunto(s)
Disulfuros , Locomoción , Molibdeno , Médula Espinal , Pez Cebra , Animales , Locomoción/efectos de los fármacos , Disulfuros/química , Disulfuros/toxicidad , Molibdeno/toxicidad , Molibdeno/química , Médula Espinal/efectos de los fármacos , Enfermedades Neuroinflamatorias/inducido químicamente , Nanoestructuras/toxicidad , Nanoestructuras/química , Larva/efectos de los fármacos , Neuronas/efectos de los fármacosRESUMEN
The field of nanotechnology has developed rapidly in recent decades due to its broad applications in many industrial and biomedical fields. Notably, 2D materials such as graphene-related materials (GRMs) have been extensively explored and, as such, their safety needs to be assessed. However, GRMs tend to deposit quickly, present low stability in aqueous solutions, and adsorb to plastic materials. Consequently, traditional approaches based on static assays facilitate their deposition and adsorption and fail to recreate human physiological conditions. Organ-on-a-chip (OOC) technology could, however, solve these drawbacks and lead to the development of microphysiological systems (MPSs) that mimic the microenvironment present in human tissues. In light of the above, in the present study a microfluidic system under flow conditions has been optimised to minimise graphene oxide (GO) and few-layer graphene (FLG) adsorption and deposition. For that purpose, a kidney-on-a-chip was developed and optimised to evaluate the effects of exposure to GO and FLG flakes at a sublethal dose under fluid flow conditions. In summary, MPSs are an innovative and precise tool for evaluating the effects of exposure to GRMs and other type of nanomaterials.
Asunto(s)
Grafito , Grafito/química , Humanos , Dispositivos Laboratorio en un Chip , Adsorción , Nanoestructuras/química , Animales , Sistemas MicrofisiológicosRESUMEN
Caffeine is a well-described ergogenic aid used to enhance athletic performance. Using animal models can greatly increase our understanding of caffeine's mechanisms in performance. Here, we adapted an animal weight-lifting exercise model to demonstrate caffeine's ergogenic effect in rats. Male Wistar rats (315 ± 35 g) were randomly divided into two groups: one group received 5 mg·kg-1 of caffeine (0.5 mL; CEx; n = 5) and the other 0.9% NaCl (0.5 mL; PEx; n = 4) through an orogastric probe (gavage) one hour before exercise. Weight-lifting exercise sessions were performed over three subsequent days, and the number of complete squats performed was counted. Analyses of the area under the curve in all three experiments showed that the CEx group responded more to stimuli, performing more squats (1.7-, 2.0-, and 1.6-fold; p < 0.05) than the control group did. These three days' data were analyzed to better understand the cumulative effect of this exercise, and a hyperbolic curve was fitted to these data. Data fitting from the caffeine-supplemented group, CEx, also showed larger Smax and Kd (2.3-fold and 1.6-fold, respectively) than the PEx group did. Our study demonstrated an acute ergogenic effect of caffeine in an animal weight-lifting exercise model for the first time, suggesting potential avenues for future research.
Asunto(s)
Cafeína , Ratas Wistar , Levantamiento de Peso , Animales , Cafeína/farmacología , Cafeína/administración & dosificación , Masculino , Proyectos Piloto , Ratas , Levantamiento de Peso/fisiología , Condicionamiento Físico Animal/fisiología , Sustancias para Mejorar el Rendimiento/farmacología , Sustancias para Mejorar el Rendimiento/administración & dosificaciónRESUMEN
OBJECTIVE: To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock. DESIGN: Retrospective cohort study. SETTING: Two intensive care units in Argentina. PATIENTS: Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis. RESULTS: 80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC=0.52, p=0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60-0.83; p=0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57-0.80; p=0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%. CONCLUSIONS: urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.
RESUMEN
PURPOSE: Alactic base excess (ABE) is a novel biomarker defined as the sum of lactate and standard base excess and estimates the renal capability of handling acid-base disturbances in sepsis. The objective of this study is to see if ABE is an independent predictor of mortality in septic patients with and without renal dysfunction. MATERIALS AND METHODS: We retrospectively studied 1178 patients with sepsis and septic shock. Patients were divided according to ABE values: 1) negative ABE (<-3 mmol/L); 2) neutral ABE (≥ - 3 and < 4 mmol/L); and 3) positive ABE (≥4 mmol/L). The effect of ABE on mortality was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment. Additionally, we performed a stratified analysis in patients with GFR > 60 mL/min/1.73 m2. RESULTS: Negative ABE patients had higher mortality than patients with neutral ABE (adjusted HR 1.43; 95%CI 1.02-2.01). Also, in patients with GFR > 60 mL/min/1.73 m2 (n = 493), we observed higher mortality in patients with negative ABE (adjusted HR 2.43; 95%CI 1.07-5.53). CONCLUSIONS: Negative ABE is an independent predictor of in-hospital mortality in septic patients with and without renal dysfunction.
Asunto(s)
Enfermedades Renales , Sepsis , Choque Séptico , Humanos , Estudios Retrospectivos , Puntaje de Propensión , PronósticoRESUMEN
OBJECTIVES: Monkeypox (Mpox) recent outbreak has changed in terms of predominant transmission route and typical presentation. Describing current epidemiological and clinical characteristics is crucial to identifying cases and halting transmission. METHODS: An observational study was conducted at a Peruvian tertiary-level hospital and included all individuals with Mpox virus infection between July 01 and September 03, 2022. RESULTS: Among 205 confirmed cases, 99% (202/205) were men, 94% (192/205) were men who have sex with men or bisexual, and 66% (136/205) were living with HIV. Regarding sexual behavior, 87% (179/205) had a sexual encounter 21 days before consultation, although only 8% (17/205) identified sexual contact with a Mpox confirmed case; 65% (133/205) had sexual intercourse with casual partners, 55% (112/205) reported a last sexual partner unknown, and 21.5% (44/205) continued having sexual intercourse with symptoms. Systemic symptoms were fever (162/205, 79%), malaise (123/205, 60%), headache (119/205, 58%), fatigue (105/205, 52%), and lymphadenopathy (111/205, 54%). The distribution of skin lesions was generalized (166/205, 81%), located in the anogenital area (160/205, 78%), polymorphic (174/205, 85%), and it was the first symptom identified in 46% (94/205) of cases. Overall, 10% (21/205) required hospitalization, of whom 85.7% (18/205) have HIV infection. Complications included bacterial superinfection (n = 18), proctitis (n = 6), balanitis (n = 4), and necrosis of skin lesions (n = 3). CONCLUSION: In 2022, Mpox mainly affects men who have sex with men and People living with HIV/AIDS. It presents with skin lesions localized to the anogenital area and can lead to severe complications requiring hospitalization.
Asunto(s)
Infecciones por VIH , Mpox , Minorías Sexuales y de Género , Masculino , Humanos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Perú/epidemiología , Mpox/epidemiología , Monkeypox virus , HospitalesRESUMEN
Tyrosine metabolism has an intense role in the synthesis of neurotransmitters. Our study used an untargeted, sportomics-based analysis of urine samples to investigate changes in metabolism during a soccer match in 30 male junior professional soccer players. Samples were collected before and after the match and analyzed using liquid chromatography and mass spectrometry. Results showed significant changes in tyrosine metabolism. Exercise caused a downregulation of the homogentisate metabolites 4-maleylacetoacetate and succinylacetone to 20% (p = 4.69E-5) and 16% (p = 4.25E-14), respectively. 4-Hydroxyphenylpyruvate, a homogentisate precursor, was found to be upregulated by 26% (p = 7.20E-3). The concentration of hawkinsin and its metabolite 4-hydroxycyclohexyl acetate increased ~six-fold (p = 1.49E-6 and p = 9.81E-6, respectively). Different DOPA metabolism pathways were also affected by exercise. DOPA and dopaquinone increased four-to six-fold (p = 5.62E-14 and p = 4.98E-13, respectively). 3-Methoxytyrosine, indole-5,6-quinone, and melanin were downregulated from 1 to 25%, as were dopamine and tyramine (decreasing to up to 5% or 80%; p= 5.62E-14 and p = 2.47E-2, respectively). Blood TCO2 decreased as well as urinary glutathione and glutamate (40% and 10% respectively) associated with a two-fold increase in pyroglutamate. Our study found unexpected similarities between exercise-induced changes in metabolism and the inherited disorder Hawkinsinuria, suggesting a possible transient condition called exercise-induced hawkinsinuria (EIh). Additionally, our research suggests changes in DOPA pathways may be involved. Our findings suggest that soccer exercise could be used as a model to search for potential countermeasures in Hawkinsinuria and other tyrosine metabolism disorders.
RESUMEN
INTRODUCTION: Both smoking and depression have been associated with increased inflammatory markers. As there are few studies on inflammatory markers that distinguish between depressed and nondepressed smokers, it is unclear if there is a cumulative impact of these mediators of inflammation. The aim of this study was to investigate inflammatory markers in tobacco smokers and compare depressed and nondepressed smokers. METHODS: Smokers (n = 155) were recruited from the Cigarette Smoking Cessation Service, Londrina. Mental health status was assessed using the Diagnostic Interview for Research, in accordance with the International Classification of the Disorders-10th (ICD-10). Demographic information was collected by self-report questionnaire, and the Fagerström Test for Nicotine Dependence was administered. Blood specimens were simultaneously collected and measured for C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). RESULTS: Depressed smokers had significantly higher levels of hs-CRP (p = .05), IL-6 (p = .039), and TNF-α (p = .021) compared with nondepressed smokers. Depressed smokers were also significantly more likely than nondepressed smokers to have been hospitalized in the previous month (p < .032), to suffer from cardiovascular disease (p < .001) and lung disease (p < .003), and to have more work-related disability (p = .001). CONCLUSIONS: These findings demonstrate that depressed smokers had higher hs-CRP, IL-6, and TNF-α levels than nondepressed smokers and had worse physical health outcomes and greater work-related disability. This may have important implications in identifying shared risk pathways for depressive and somatic disorders.
Asunto(s)
Biomarcadores/sangre , Depresión/sangre , Inflamación/sangre , Fumar/sangre , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Queensland , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We have been using sportomics to understand hypermetabolic stress. Cross Combat (CCombat) has recently been initiated as a high-intensity functional training method inspired by CrossFit. We used a CCombat session to induce metabolic stress and evaluated its effects on hydration and kidney function. Blood samples were collected from 16 elite-level professional male athletes engaged in training sessions over a 96-h protocol. Blood myoglobin increased by ~ 3.5-fold (119 ± 21 to 369 ± 62 nmol/L; p = .001) in response to the protocol, returning to the pre-exercise level within 48 h. Furthermore, D-dimer levels increased from 6.5 ± 0.6 to 79.4 ± 21.3 µmol/L (p < .001) in response to exercise decreasing during recovery with high variability among the studied athletes. Albuminemia and creatininemia increased ~ 10% and cystatin C increased ~ 240% (1.7 ± 0.1 to 5.7 ± 0.5 mg/L; p < .001; effect size = 2.4) in response to the protocol. We measured albuminuria (HuA) to assess kidney permeability to albumin caused by exercise. HuA increased ~ 16-fold (0.16 ± 0.03 to 2.47 ± 0.41 µmol/L; p < .001; effect size = 1.4) in response to exercise, dropping and reaching basal levels during 48 h. Here, we suggest that microalbuminuria can be used as an early, sensitive, easy, and inexpensive biomarker to evaluate hydration status changes during intensive exercise, decreasing chronic impairment in renal function.
Asunto(s)
Albuminuria , Atletas , Biomarcadores , Ejercicio Físico/fisiología , Humanos , MasculinoRESUMEN
BACKGROUND: Prolonged exercise in the heat can promote dehydration, which could impair ammonia metabolism, cognitive-motor performance, and muscle damage. However, exercise heat acclimation induces physiological adaptations that improve performance, metabolism, and cellular protection. This study aimed to evaluate different dehydration levels and their impact on blood ammonia, cognitive-motor performance, and muscle damage after a race in the heat in acclimated runners. METHODS: Sixteen male amateur endurance runners performed a half marathon race. After the race, the runners were divided into two groups according to their percentage body mass change (Δ% BM): Δ% BM less than 3% (G1%; N.=8) and Δ% BM greater than or equal to 3% (G3%; N.=8). Hydration status, biochemical parameters, and cognitive-motor performance were assessed before and after the race. RESULTS: Blood ammonia concentrations were increased in both G1% (before: 46±26 µmol/L; after: 118±22 µmol/L) and G3% (before: 41±15 µmol/L; after: 108±15 µmol/L) groups. There was an early increase in all markers of muscle damage (creatine kinase [CK], lactate dehydrogenase [LDH], aspartate aminotransferase [AST], and alanine aminotransferase [ALT]) in both groups, but only LDH was greater in the G3% group than in the G1% group. Cognitive-motor performance did not differ between groups. CONCLUSIONS: Dehydration up to ~4% BM loss does not affect blood ammonia concentrations and cognitive-motor performance in acclimated runners. The results also suggest that exercising in the heat induces the early appearance of several markers of muscle damage in acclimated runners regardless of hydration status.
Asunto(s)
Carrera , Masculino , Humanos , Carrera/fisiología , Amoníaco , Deshidratación , Músculo Esquelético , L-Lactato Deshidrogenasa , Biomarcadores , Aclimatación , Cognición , Resistencia Física/fisiologíaRESUMEN
Hyperammonaemia is related to both central and peripheral fatigue during exercise. Hyperammonaemia in response to exercise can be reduced through supplementation with either amino acids or combined keto analogues and amino acids (KAAA). In the present study, we determined the effect of short-term KAAA supplementation on ammonia production in subjects eating a low-carbohydrate diet who exercise. A total of thirteen male cyclists eating a ketogenic diet for 3 d were divided into two groups receiving either KAAA (KEx) or lactose (control group; LEx) supplements. Athletes cycled indoors for 2 h, and blood samples were obtained at rest, during exercise and over the course of 1 h during the recovery period. Exercise-induced ammonaemia increased to a maximum of 35 % in the control group, but no significant increase was observed in the supplemented group. Both groups had a significant increase (approximately 35 %) in uraemia in response to exercise. The resting urate levels of the two groups were equivalent and remained statistically unchanged in the KEx group after 90 min of exercise; an earlier increase was observed in the LEx group. Glucose levels did not change, either during the trial time or between the groups. An increase in lactate levels was observed during the first 30 min of exercise in both groups, but there was no difference between the groups. The present results suggest that the acute use of KAAA diminishes exercise-induced hyperammonaemia.
Asunto(s)
Aminoácidos/metabolismo , Dieta Baja en Carbohidratos , Dieta Cetogénica , Suplementos Dietéticos , Ejercicio Físico/fisiología , Hiperamonemia/sangre , Cetoácidos/metabolismo , Adulto , Análisis de Varianza , Área Bajo la Curva , Atletas , Glucemia/análisis , Estudios de Casos y Controles , Humanos , Hiperamonemia/metabolismo , Hiperamonemia/prevención & control , Ácido Láctico/sangre , Masculino , Urea/sangreRESUMEN
OBJECTIVES: Both exercise and a ketogenic (low-carbohydrate) diet favor glycogen depletion and increase ammonemia, which can impair physical performance. Caffeine supplementation has been routinely used to improve exercise performance. Herein, the effect of xanthine was evaluated on ammonemia in cyclists who were placed on a ketogenic diet and engaged in prolonged exercise. METHODS: Fourteen male cyclists followed a ketogenic diet for 2 d before and during the experimental trial. The cyclists were assigned to either the caffeine- (CEx; n = 7) or placebo-supplemented (LEx; n = 7) group. Blood samples were obtained during cycling and the recovery periods. RESULTS: The CEx group showed a significant decrease (up to 25%) in blood ammonia at 60, 90, and 120 min after beginning exercise compared with the LEx group. A higher concentration of apparent blood urea was observed in the LEx group than in the CEx group at 60 to 90 min of exercise (~10%). In addition, a significant increase in blood glucose levels was evident at 30 min of exercise (~28%), and an increase in blood lactate levels was visible during the first 30 to 60 min of exercise (~80%) in the CEx group. CONCLUSIONS: Our results suggest that the consumption of caffeine might attenuate the increase in ammonemia that occurs during exercise.
Asunto(s)
Cafeína , Dieta Cetogénica , Atletas , Ciclismo , Glucemia , Ejercicio Físico , Humanos , Masculino , Consumo de Oxígeno , Resistencia FísicaRESUMEN
OBJECTIVE: To analyze whether changes in medical care due to the application of COVID-19 protocols affected clinical outcomes in patients without COVID-19 during the pandemic. METHODS: This was a retrospective, observational cohort study carried out in a thirty-eight-bed surgical and medical intensive care unit of a high complexity private hospital. Patients with respiratory failure admitted to the intensive care unit during March and April 2020 and the same months in 2019 were selected. We compared interventions and outcomes of patients without COVID-19 during the pandemic with patients admitted in 2019. The main variables analyzed were intensive care unit respiratory management, number of chest tomography scans and bronchoalveolar lavages, intensive care unit complications, and status at hospital discharge. RESULTS: In 2020, a significant reduction in the use of a high-flow nasal cannula was observed: 14 (42%) in 2019 compared to 1 (3%) in 2020. Additionally, in 2020, a significant increase was observed in the number of patients under mechanical ventilation admitted to the intensive care unit from the emergency department, 23 (69%) compared to 11 (31%) in 2019. Nevertheless, the number of patients with mechanical ventilation after 5 days of admission was similar in both years: 24 (69%) in 2019 and 26 (79%) in 2020. CONCLUSION: Intensive care unit protocols based on international recommendations for the COVID-19 pandemic have produced a change in non-COVID-19 patient management. We observed a reduction in the use of a high-flow nasal cannula and an increased number of tracheal intubations in the emergency department. However, no changes in the percentage of intubated patients in the intensive care unit, the number of mechanical ventilation days or the length of stay in intensive care unit.
OBJETIVO: Analisar se as modificações na atenção médica em razão da aplicação dos protocolos para COVID-19 afetaram os desfechos clínicos de pacientes sem a doença durante a pandemia. MÉTODOS: Este foi um estudo observacional de coorte retrospectiva conduzido em uma unidade de terapia intensiva clínica e cirúrgica com 38 leitos, localizada em hospital privado de alta complexidade na cidade de Buenos Aires, Argentina, e envolveu os pacientes com insuficiência respiratória admitidos à unidade de terapia intensiva no período compreendido entre março e abril de 2020 em comparação com o mesmo período no ano de 2019. Compararam-se as intervenções e os desfechos dos pacientes sem COVID-19 tratados durante a pandemia em 2020 e os pacientes admitidos em 2019. As principais variáveis avaliadas foram os cuidados respiratórios na unidade de terapia intensiva, o número de exames de tomografia computadorizada do tórax e lavados broncoalveolares, complicações na unidade de terapia intensiva e condições quando da alta hospitalar. RESULTADOS: Observou-se, em 2020, uma redução significante do uso de cânula nasal de alto fluxo: 14 (42%), em 2019, em comparação com 1 (3%), em 2020. Além disso, em 2020, observou-se aumento significante no número de pacientes sob ventilação mecânica admitidos à unidade de terapia intensiva a partir do pronto-socorro, de 23 (69%) em comparação com 11 (31%) em 2019. Contudo, o número de pacientes com ventilação mecânica 5 dias após a admissão foi semelhante em ambos os anos: 24 (69%), em 2019, e 26 (79%) em 2020. CONCLUSÃO: Os protocolos para unidades de terapia intensiva com base em recomendações internacionais para a pandemia de COVID-19 modificaram o manejo de pacientes sem COVID-19. Observamos redução do uso da cânula nasal de alto fluxo e aumento no número de intubações traqueais no pronto-socorro. Entretanto, não se identificaram alterações na percentagem de pacientes intubados na unidade de terapia intensiva, número de dias sob ventilação mecânica ou número de dias na unidade de terapia intensiva.