Physical exercise as a modulator of the purinergic system in the control of sarcopenia in individuals with chronic kidney disease on hemodialysis.

The word sarcopenia derives from the Greek terms "sarx" for meat and "penia" for loss, thus being used to define reductions in muscle mass, muscle strength, and lower physical performance that compromise, mainly, the elderly population. Its high negative impact on patients' quality of life encourages the production and publication of new studies that seek to find methods to prevent and reverse cases of loss of muscle mass and strength. Furthermore, the high prevalence of sarcopenia in patients with chronic kidney disease (CKD) is closely related to its pathophysiology, which consists of a state of increased protein catabolism and decreased muscle tissue synthesis. Also considering the inflammatory nature of CKD and sarcopenia, the purinergic system has been an important target of studies, which seek to relate it to the two previous conditions. This system achieves anti-inflammatory action by inhibiting, through adenosine, pro-inflammatory factors such as interleukin-12 (IL-12), tumor necrosis factor alpha (TNF-α), and nitric oxide (NO), as well as by releasing anti-inflammatory substances such as interleukin-10 (IL-10). Simultaneously, the purinergic system presents pro-inflammatory activity, signaled by adenosine triphosphate (ATP), which occurs through the activation of T cells and the release of pro-inflammatory factors such as those mentioned above. Therefore, the ability of this system to act on inflammatory processes can promote positive and negative changes in the clinical aspect of patients with CKD and/or sarcopenia. Furthermore, it appears that there is a correlation between the practice of repeated physical exercise with the clinical improvement and in the quality of life of these patients, presenting a decrease in the levels of C-reactive protein (CRP), NTPDase, and the pro-inflammatory cytokine IL-6, such as increases in IL-10 resulting from modulation of the purinergic system. In this way, the present article seeks to evaluate the effect of physical exercise as a modulator of the purinergic system in the control of sarcopenia in patients with CKD on hemodialysis, in order to trace a relationship that can bring benefits both for biological markers and for quality of life of these patients.

Biochemical analysis of oxidative stress and purinergic system in pregnant women with gestational diabetes mellitus / Análise bioquímica do estresse oxidativo e do sistema purinérgico em gestantes com diabetes mellitus gestacional

Background: Pregnancy is characterized as a physiological period with greater sensitivity to insulin resistance and changes in oxidative stress. Purinergic signaling is directly related to diabetes, as this condition modifies the concentration of extracellular ATP and the level of degradation of ATP to adenosine. Objective: Analyze oxidative stress and the purinergic system in pregnant women with Gestational Diabetes Mellitus (GDM) and compare them with low-risk pregnant women (LR). Materials and Methods: The research was of a quantitative approach of an experimental nature. The study was carried out at the Clínica da Mulher, which serves high-risk pregnant women, and at the Family Health Centers, which serves low-risk pregnant women, both located in Chapecó, Santa Catarina, Brazil. Results: From the analysis, it was observed that oxidative stress was increased in pregnant women in LR compared to pregnant women with GDM by increasing the concentration of TBARS and reducing the concentration of Carbonyl Protein in pregnant women with LR. Regarding the purinergic system, there was a significant decrease in the hydrolysis of the nucleotides ATP, ADP, and AMP in pregnant women with GDM, and a significant increase in the hydrolysis of ADA, also in pregnant women with GDM. Conclusion: Therefore, pregnant women with GDM have less oxidative stress compared to pregnant women in LR concerning TBARS and Carbonyl Protein markers, thus allowing a greater antioxidant defense mechanism. Furthermore, concerning the purinergic system, there is an increase in the activity of ADA, which is directly related to the immunosuppression process, a necessary condition for the protection of the fetus during the gestational period (AU).

Introdução: A gravidez é caracterizada como um período fisiológico em que há uma maior sensibilidade a resistência à insulina e alterações no estresse oxidativo. A sinalização purinérgica está diretamente relacionada ao diabetes, pois esta condição modifica a concentração de ATP extracelular e o nível de degradação de ATP em adenosina. Objetivo:Analisar o estresse oxidativo e o sistema purinérgico em gestantes com Diabetes Mellitus Gestacional (DMG) e compará-los com gestantes de baixo risco (BR). Materiais e Métodos: A pesquisa foi de abordagem quantitativa, de caráter experimental. O estudo foi realizado na Clínica da Mulher, que atende gestantes de alto risco, e nas Unidades de Saúde da Família, que atendem gestantes de baixo risco, ambas localizadas no município de Chapecó, Santa Catarina, Brasil. Resultados: A partir das análises, observou-se que o estresse oxidativo apresentou-se aumentado em gestantes de BR quando comparado a gestantes com DMG. No que tange ao sistema purinérgico, houve uma diminuição significativa na hidrólise dos nucleotídeos ATP, ADP e AMP em gestantes com DMG, bem como um aumento significativo na hidrólise de ADA, também em gestantes com DMG. Conclusão: Portanto, gestantes com DMG possuem menor estresse oxidativo quando comparado a gestantes de BR, permitindo assim, um maior mecanismo de defesa antioxidante. Para mais, no que se refere ao sistema purinérgico, verifica-se o aumento da concentração de ADA está diretamente relacionada ao processo de imunossupressão, condição necessária à proteção do feto durante o período gestacional (AU).

Therapeutic Properties of Flavonoids in Treatment of Cancer through Autophagic Modulation: A Systematic Review.

Cancers have high morbidity and mortality rates worldwide. Current anticancer therapies have demonstrated specific signaling pathways as a target in the involvement of carcinogenesis. Autophagy is a quality control system for proteins and plays a fundamental role in cancer carcinogenesis, exerting an anticarcinogenic role in normal cells and can inhibit the transformation of malignant cells. Therefore, drugs aimed at autophagy can function as antitumor agents. Flavonoids are a class of polyphenolic secondary metabolites commonly found in plants and, consequently, consumed in diets. In this review, the systematic search strategy was used, which included the search for descriptors "flavonoids" AND "mTOR pathway" AND "cancer" AND "autophagy", in the electronic databases of PubMed, Cochrane Library, Web of Science and Scopus, from January 2011 to January 2021. The current literature demonstrates that flavonoids have anticarcinogenic properties, including inhibition of cell proliferation, induction of apoptosis, autophagy, necrosis, cell cycle arrest, senescence, impaired cell migration, invasion, tumor angiogenesis and reduced resistance to multiple drugs in tumor cells. We demonstrate the available evidence on the roles of flavonoids and autophagy in cancer progression and inhibition. (Registration No. CRD42021243071 at PROSPERO).

Pet-saúde como ferramenta de identificação dos níveis de estresse nos profissionais da atenção primária em saúde / Pet-health as a tool for identifying stress levels in primary healthcare professionals

Evidenciado na atualidade que as condições de trabalho podem contribuir para alterações da saúde física e mental dos indivíduos, estudos apontam a relação destes transtornos com a insatisfação, falta de reconhecimento profissional, desgaste provocado pelo contato direto com o paciente, as recompensas insuficientes, a falta de autonomia, as relações interpessoais disfuncionais, os conflitos de valores, a falta de recursos humanos e materiais, a longa jornada de trabalho, a baixa remuneração, o estreitamento do mercado de trabalho, a alta exposição a riscos ocupacionais e a indefinição do papel profissional. A pesquisa emergiu das vivências iniciais do projeto PET-Saúde Interprofissionalidade. Objetivo: Analisar níveis de estresse entre os profissionais de um Centro de Saúde da Família (CSF), através da aplicação do teste de Lipp - Inventário de Sintomas de Stress Lipp (ISSL). Metodologia: Realizou-se a pesquisa quantitativa, descritiva, transversal. Participaram da pesquisa 30 profissionais que atuavam no serviço. Resultados:Dos profissionais avaliados, 6,7% apresentaram-se na fase de alerta, 56,6% em fase de resistência e 16,7% em fase de exaustão. Os sintomas mais identificados foram os físicos, uma vez que, os sintomas psicológicos encontrados são intrínsecos e identificados mediante informações dadas pelos profissionais. Conclusão: Desta forma, torna-se necessário a realização de estratégias para prevenção e controle de transtornos que acometem e/ou tendem a acometer estes profissionais, melhorando, assim, sua qualidade de vida, bem como a assistência aos usuários (AU).

Evidenced today that working conditions can contribute to changes in the physical and mental health of individuals, studies point to the relationship of these disorders with dissatisfaction, lack of professional recognition, exhaustion caused by direct contact with the patient, insufficient rewards, lack of autonomy, dysfunctional interpersonal relationships, conflict of values, lack of human and material resources, long working hours, low pay, narrowing of the labor market, high exposure to occupational risks and the lack of definition of the professional role. The research emerged from the initial experiences of the PET-Saúde Interprofissionalidade project. Objective: Analyze stress levels among professionals at a Family Health Center (FHC), through the application of the Lipp test - Lipp Stress Symptoms Inventory (ISSL). Methodology: A quantitative, descriptive, transversal research was carried out. Thirty professionals who worked in the service participated in the research. Results: Of the professionals evaluated, 6.7% were in the alert phase, 56.6% in the resistance phase and 16.7% in the exhaustion phase. The most identified symptoms were physical, since the psychological symptoms found are intrinsic and identified through information given by professionals. Conclusion: In this way, it is necessary to carry out strategies for the prevention and control of disorders that affect and/or tend to affect these professionals, thus improving their quality of life, as well as assistance to users (AU).

Influence of exercise and vitamin D on the immune system against Covid-19: an integrative review of current literature.

Respiratory infections of viral origin have become the leading cause of infectious diseases in the world. In 2020, the World Health Organization (WHO) declared a pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Coronavirus Disease 2019 (Covid-19). The pandemic caused by the new coronavirus has challenged the entire global health system, since Covid-19 has a high rate of morbidity and mortality. The immune response to the virus depends on factors such as age, genetics, nutritional status, physical status, as well as environmental factors. Despite scientific advances, so far, there is still no specific therapy for the disease. Thus, this study aims to analyze the contribution of physical exercise and maintenance and/or supplementation of vitamin D to the strengthening of the immune system against viral infections, among them, Covid-19. Regular practice of moderate-intensity physical activity is responsible for promoting a reduction in the concentrations of pro-inflammatory cytokines (IL-6, TNF-α and IL-1ß), as well as triggering the increase in the production of anti-inflammatory cytokines (IL-4 and IL-10). In addition, hypovitaminosis D predisposes to the development of chronic diseases and infections. Therefore, in patients affected by Covid-19, the maintenance of vitamin D levels contributes significantly to the 0prevention of the cytokine storm. Thus, the association between maintaining vitamin D levels and performing moderate-intensity physical exercise is responsible for strengthening the immune system and, therefore, triggering a defense mechanism against infections by intracellular microorganisms, in which SARS -CoV-2.

Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature.

Acute viral respiratory infections are the main infectious disease in the world. In 2020, a new disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), became a global pandemic. The immune response to the virus depends on factors such as genetics, age and physical state, and its main input receptor is the angiotensin-converting enzyme 2. The practice of physical exercises acts as a modulator of the immune system. During and after physical exercise, pro- and anti-inflammatory cytokines are released, lymphocyte circulation increases, as well as cell recruitment. Such practice has an effect on the lower incidence, intensity of symptoms and mortality in viral infections observed in people who practice physical activity regularly, and its correct execution must be considered to avoid damage. The initial response is given mainly by type I interferons (IFN-I), which drive the action macrophages and lymphocytes, followed by lymphocyte action. A suppression of the IFN-I response has been noted in COVID-19. Severe conditions have been associated with storms of pro-inflammatory cytokines and lymphopenia, as well as circulatory changes and virus dispersion to other organs. The practice of physical activities strengthens the immune system, suggesting a benefit in the response to viral communicable diseases. Thus, regular practice of adequate intensity is suggested as an auxiliary tool in strengthening and preparing the immune system for COVID-19. Further studies are needed to associate physical exercise with SARS-CoV-2 infection.

Avaliação da Sonolência Diurna de pacientes que iniciaram tratamento hemodialítico pelo Sistema Único de Saúde no oeste catarinense / Evaluation of Dayless Dreams of patients who started hemodialytic treatment by the Health Unic System in west catarinense

A Doença Renal Crônica caracteriza ­ se pela redução significativa das funções renais. Dessa forma, esta doença classifica ­ se em estágios, de modo que, quando o paciente atinge o estágio cinco, faz - se necessário iniciar a terapia renal substitutiva, a saber: a hemodiálise. Ao iniciar a hemodiálise, alterações significativas são perceptíveis na vida do paciente, haja vista que o tratamento possui elevada complexidade, interferindo, assim, na qualidade de vida do doente. Essas alterações podem ser percebidas por meio da modificação do padrão do sono. O objetivo do estudo foi avaliar a porcentagem de pacientes com sonolência diurna excessiva em tratamento hemodialítico no Sistema Único de Saúde, no oeste de Santa Catarina. A população alvo compreendeu pacientes em terapia renal substitutiva na modalidade hemodiálise de ambos os sexos, maiores de 18 anos, em tratamento por um período superior a um mês e inferior a doze meses. A análise foi quantitativa, sendo realizado o cálculo por porcentagem. Os 22 pacientes participantes do estudo que iniciaram o tratamento hemodialítico há um curto período de tempo (um mês à doze meses), apresentaram os seguintes resultados por meio da aplicação da escala de Epworth: 05 pontos: 8 pacientes; 710 pontos: 4 pacientes; 1115 pontos: 8 pacientes; 1621 pontos: 2 pacientes. Por conseguinte, 45,5 % dos pacientes apresentaram sonolência excessiva diurna, conforme escores da escala. Os pacientes em hemodiálise apresentam mudanças deletérias em suas atividades diárias em decorrência do tratamento, desse modo, é indispensável identificar essas alterações para, posteriormente, reduzi-las, principalmente no que tange ao padrão do sono.

Chronic Kidney Disease is characterized by a significant reduction in renal function. Thus, this disease is classified in stages, so that when the patient reaches stage 5, it is necessary to initiate renal replacement therapy, namely: hemodialysis. When initiating hemodialysis, significant changes are noticeable in the patient's life, since the treatment has high complexity, thus interfering in the quality of life of the patient. These changes can be perceived by modifying the sleep pattern. The objective of the study was to evaluate the percentage of patients with excessive daytime sleepiness on hemodialysis treatment in the Unified Health System, in the west of Santa Catarina. The target population comprised patients undergoing hemodialysis renal replacement therapy of both sexes, over 18 years of age, undergoing treatment for a period of one month and less than twelve months. The analysis was quantitative, and the calculation was performed by percentage. The 22 study participants who underwent hemodialysis treatment for a short time (one month to twelve months) presented the following results using the Epworth scale: 05 points: 8 patients; 710 points: 4 patients; 1115 points: 8 patients; 1621 points: 2 pa patients. Therefore, 45.5% of the patients presented excessive daytime sleepiness, according to scale scores. Patients on hemodialysis show deleterious changes in their daily activities as a result of the treatment, so it is essential to identify these changes and subsequently reduce them, especially regarding the sleep pattern.