RESUMO
Traumatic Brain Injury (TBI) is still the worldwide leading cause of mortality and morbidity in young adults. Improved safety measures and advances in critical care have increased chances of surviving a TBI, however, numerous secondary mechanisms contribute to the injury in the weeks and months that follow TBI. The past 4 decades of research have addressed many of the metabolic impairments sufficient to mitigate mortality, however, an enduring secondary mechanism, i.e. neuroinflammation, has been intractable to current therapy. Neuroinflammation is particularly difficult to target with pharmacological agents due to lack of specificity, the blood brain barrier, and an incomplete understanding of the protective and pathologic influences of inflammation in TBI. Recent insights into TBI pathophysiology have established microglial activation as a hallmark of all types of TBI. The inflammatory response to injury is necessary and beneficial while the death of activated microglial is not. This review presents new insights on the therapeutic and maladaptive features of the immune response after TBI with an emphasis on microglial polarization, followed by a discussion of potential targets for pharmacologic and non-pharmacologic treatments. In aggregate, this review presents a rationale for guiding TBI inflammation towards neural repair and regeneration rather than secondary injury and degeneration, which we posit could improve outcomes and reduce lifelong disease burden in TBI survivors.
Assuntos
Lesões Encefálicas Traumáticas/complicações , Microglia/metabolismo , Doenças Neuroinflamatórias/tratamento farmacológico , Animais , Barreira Hematoencefálica/metabolismo , Modelos Animais de Doenças , Humanos , Inflamação/tratamento farmacológico , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Transdução de Sinais/efeitos dos fármacosRESUMO
Objetivo: Analisar o perfil de mortalidade infantil indiÌgena. MeÌtodo: Estudo epidemioloÌgico, transversal realizado com 254 oÌbitos em crianças indiÌgenas menores de um ano, notificadas ao Sistema de InformaçaÌo da AtençaÌo aÌ SauÌde IndiÌgena, no estado do ParaÌ, no periÌodo de 2013 a 2018. Resultados: Identificou-se proporçaÌo maior de oÌbitos em crianças do sexo masculino (53,9%; n=137), nas etnias KaiapoÌ (38,2%; n=97), Munduruku (27,6%; n=70) e Xicrim (13,8%; n=35). Os oÌbitos ocorreram nos hospitais (53,9%; n=137), e nos domiciÌlios (24%; n=61), e as principais causas foram: as afecçoÌes perinatais (27,2%; n=69); as doenças do aparelho respiratoÌrio (18,9%; n=48), doenças infecciosas e parasitaÌrias (15,7%; n=40). ConclusaÌo: A mortalidade infantil indiÌgena eÌ mais elevada em algumas etnias, o que favorece açoÌes de enfrentamento naquelas mais acometidas. EÌ necessaÌrio a valorizaçaÌo da cultura indiÌgena e o reconhecimento dos problemas socioeconoÌmicos a serem contemplados num plano de açaÌo para reduçaÌo desse indicador.
Objective: To analyze the profile of indigenous infant mortality. Method: Cross-sectional epidemiological study conducted with 254 deaths in indigenous children under one year of age, notified to the Indigenous Health Care Information System, in the state of ParaÌ, from 2013 to 2018. Results: A higher proportion of deaths in male children (53.9%; n=137), KaiapoÌ (38.2%; n=97), Munduruku (27.6%; n=70) and Xicrim (13.8%; n=35) were identified. The deaths occurred in hospitals (53.9%; n=137), and in homes (24%; n=61), and the main causes were: perinatal diseases (27.2%; n=69); respiratory system diseases (18.9%; n=48), infectious and parasitic diseases (15.7%; n=40). Conclusion: The indigenous infant mortality is higher in some ethnicities, which favors actions of confrontation in those more affected. It is necessary to value the indigenous culture and recognize the socioeconomic problems to be contemplated in an action plan to reduce this indicator.