Fisiopatología de la enfermedad COVID-19 / Pathophysiology of COVID-19 / Fisiopatologia da doença COVID-19

La enfermedad por coronavirus es una infección respiratoria causada por el virus SARS-CoV 2, el cual genera una cascada de eventos sistémicos, afectando diferentes órganos y tejidos. El entendimiento de la fisiopatología del COVID-19 es indispensable no solo al momento de brindar tratamiento a los pacientes, sino que también para comprender las causas de las complicaciones que presentan un número importante de pacientes recuperados. El objetivo de este trabajo es presentar una revisión actualizada de los efectos de la infección en diferentes órganos y sistemas principales que sea de utilidad como material de referencia para profesionales y estudiantes de la salud. Para ello se realizó una búsqueda bibliográfica en los portales PubMED, Scielo, Google Scholar, Cochrane y Springer Link, así como en las bases de repositorios científicos pre-publicación bioRxiv ("bioarchives") y medRxiv ("med-archives") y sobre un total de cerca de 200 mil artículos, se seleccionaron 100 artículos para esta revisión en base a su relevancia o sugerencias de parte de profesionales especializados.

Coronavirus disease is a respiratory infection caused by the SARS-CoV-2 virus, which causes a cascade of systemic events, affecting various organs and tissues. Understanding the pathophysiology of COVID-19 is essential to treat patients and understand the causes of the complications in a significant number of recovered patients. This article presents a review of the effects of infection on various organs and systems that will be useful as reference material for healthcare professionals and medical students. To this end, a literature search was conducted in PubMED, Scielo, Google Scholar, Cochrane, and Springer Link portals, as well as in the pre-publication scientific repositories bioRxiv ("bioarchives") and medRxiv ("med-archives") databases. From about 200,000 papers, 100 articles were selected for this review based on their relevance or suggestions from experts in the field.

A doença coronavírus é uma infecção respiratória causada pelo vírus SARS-CoV-2, que gera uma cascata de eventos sistêmicos, afetando diferentes órgãos e tecidos. Compreender a fisiopatologia da COVID-19 é essencial não apenas no tratamento de pacientes, mas também para compreender as causas das complicações que um número significativo de pacientes recuperados apresenta. O objetivo deste trabalho é apresentar uma revisão atualizada dos efeitos da infecção em diferentes órgãos e principais sistemas que seja útil como material de referência para profissionais de saúde e estudantes. Para isso, foi realizada uma pesquisa bibliográfica nos portais PubMED, Scielo, Google Scholar, Cochrane e Springer Link, bem como nos repositórios científicos de pré-publicação bioRxiv ("bioarquivos") e medRxiv ("arquivos med"). Num total de cerca de 200 mil artigos, 100 artigos foram selecionados para esta revisão por sua relevância ou sugestões de profissionais especializados.

Osteoporosis: parte II: en enfermedades hepáticas y del tubo digestivo / Osteoporosis: part II: in liver and digestive tract diseases

The present review addresses liver and gastrointestinal diseases that are more frequently associated to osteopenia and osteoporosis. For each disease, we describe the prevalence and physiopathology of these bone metabolism conditions. The purpose is to create awareness of this scenario and prompt early analysis if these patients, and in other cases, to provide prophylaxis and treatment of these disorders.

En esta revisión se abordan las enfermedades hepáticas y del tubo digestivo que con mayor frecuencia se asocian a osteopenia y osteoporosis. En cada patología describimos la prevalencia y fisiopatología de estas afecciones del metabolismo óseo. El objetivo es dar a conocer esta realidad e inducir a que estos pacientes sean estudiados precozmente, en otros casos aplicar la profilaxis y tratar estos desórdenes.

Intestinal microbiota: its role in digestive diseases.

It is now well known that intestinal microbiota exerts not only several physiological functions, but has also been implied in the mechanisms of many conditions, both intestinal and extraintestinal. These advances, to the best of our knowledge, have been made possible by the development of new ways of studying gut flora. Metagenomics, the study of genetic material taken directly from environmental samples, avoiding individual culture, has become an excellent tool to study the human microbiota. Therefore, it has demonstrated an association between an altered intestinal microbiota and inflammatory bowel disease or irritable bowel syndrome, perhaps the most extensively studied conditions associated with this particular subject. However, microbiota has a potential role in the development of other diseases; their manifestations are not confined to the intestine only. In this article, an extensive updated review is conducted on the role intestinal microbiota has in health and in different diseases. Focus is made on the following conditions: inflammatory bowel disease, irritable bowel syndrome, celiac disease, hepatic encephalopathy, and obesity.

Pathophysiology of cystic fibrosis and drugs used in associated digestive tract diseases.

Cystic fibrosis (CF) causes chronic infections in the respiratory tract and alters the digestive tract. This paper reviews the most important aspects of drug treatment and changes in the digestive tract of patients with CF. This is a review of the literature, emphasizing the discoveries made within the last 15 years by analyzing scientific papers published in journals indexed in the Scientific Electronic Library Online, Sciences Information, United States National Library of Medicine and Medical Literature Analysis and Retrieval System Online databases, both in English and Portuguese, using the key words: cystic fibrosis, medication, therapeutic, absorption, digestion. Randomized, observational, experimental, and epidemiological clinical studies were selected, among others, with statistical significance of 5%. This review evaluates the changes found in the digestive tract of CF patients including pancreatic insufficiency, constipation and liver diseases. Changes in nutritional status are also described. Clinical treatment, nutritional supplementation and drug management were classified in this review as essential to the quality of life of CF patients, and became available through public policies for monitoring and treating CF. The information gathered on CF and a multi professional approach to the disease is essential in the treatment of these patients.

Rol del estómago en la regulación del apetito: la ghrelina en condiciones fisiológicas y en patología digestiva / Role of the stomach in the regulation of the appetite: ghrelin in physiologic conditions and digestive disorders

El cerebro regula la homeostasis energética en respuesta a señales del tracto gastrointestinal y adiposo. La vía de ingesta y el gasto energético se ajustan constantemente, manteniéndose así el peso de manera estable. La ghrelina es una hormona peptídica que estimula el apetito actuando a nivel del núcleo arquato, región conocida por controlar la ingesta de alimento. Se secreta desde el estómago y circula en el plasma bajo condiciones de ayuno. Su regulación depende de varios mecanismos como son, hormonas, control autonómico, nutrientes sanguíneos y el ejercicio. Además la ghrelina juega un rol importante para mantener la secreción de la hormona de crecimiento. Se analizan cambios observados en varias patologías gastroduodenales.

The brain regulates energy homeostasis in response to signals from both adipose and the gastrointestinal tract. The drive to eat and energy expenditure are adjusted so that over time, body weight remains stable. Ghrelin is a peptide hormone that stimulates appetite by acting on the arquate nucleus, a region known to control food intake. It is secreted from the stomach and circulates in the bloodstream under fasting conditions. Its regulation depends on a variety of mechanisms such as, hormones, autonomic control, bloodstream nutrients and exercise. Ghrelin also play an important role in growth hormone release. Ghrelin changes observed in several gastro duodenal disorders are analyzed.

Central nervous system plus autonomic nervous system disorders responsible for gastrointestinal and pancreatobiliary diseases.

Clinical digestive disorders depend on the non-adequate coupling of functioning of the gastrointestinal tract with that of its affluent systems, namely, the pancreatic exocrine and the hepato-biliary secretions. The secretion of gastrointestinal hormones is monitored by the peripheral autonomic nervous system. However, the latter is regulated by the central nervous system (CNS) circuitry localized at the medullary pontine segment of the CNS. In turn, both parasympathetic and adrenergic medullary circuitries are regulated by the pontine A5 noradrenergic (NA) and the dorsal raphe serotonergic nuclei, respectively. DR-5HT is positively correlated with the C1-Ad medullary nuclei (responsible for adrenal gland secretion), whereas the MR-5HT nucleus is positively correlated with the A5-NA pontomedullary nucleus. The latter is responsible for neural sympathetic activity (sympathetic nerves). Both types of sympathetic activities maintain an alternation with the peripheral parasympathetic branch, which is positively correlated with the enterochromaffin cells that secrete serotonin. Serotonin displays hormonal antagonism to the circulating catecholamines.

Os medicamentos e o sistema digestório / Drugs and the Digestive System

A introdução de novos medicamentos para o tratamento de doenças do trato digestório foi marcante para a terapia de patologias que antes necessitavam de intervenção cirúrgica. Os antagonistas de receptores H2 de histamina; os inibidores da bomba de próton; os compostos de bismuto; o sucralfato; os análogos de prostaglandinas associados aos antibióticos claritromicina e amoxicilina somaram-se aos antiácidos para o tratamento da úlcera péptica, do refluxo gastro-esofágico e de lesões da mucosa gástrica produzidas pelo uso crônico de antiinflamatórios não esteroidais. Contudo, recentes descobertas estão trazendo novas perspectivas para a farmacologia do sistema digestório, inclusive a utilização do óxido nítrico e de outras citocinas, da vacina contra a bactéria Helicobacter pylori e dos agentes bioterapêuticos

El empacho en textos novohispanos (1552-1819). Manifestaciones clínicas / \"Empacho\" in the texts of new Spain (1552-1819). clinical manifestations

El empacho es una enfermedad popular que se presenta en toda América Latina desde el sur y suroeste de los Estados Unidos hasta la Patagonia. En México tenemos testimonios de su presencia desde la llegada de los europeos hasta la actualidad. Para este trabajo hemos revisado 17 textos coloniales que informan de las manifetaciones clínicas del empacho. En ellos aparece como una enfermedad gastrointestinal caracterizada por distensión y dolor abdominales, hipertermia, náusea, vómito, eructos, acedías, evacuaciones diarreicas y datos inespecíficos como astenia, adinamia e hiporexia. Los médicos españoles Agustín Farfán y Juan de Cárdenas son los autores que más aportan y profundizan en las consideraciones clínicas de la enfermedad