RESUMEN
Demyelination is among the most conspicuous neurological sequelae of SARS-CoV-2 infection (COVID-19) in both the central (CNS) and peripheral (PNS) nervous systems. Several hypotheses have been proposed to explain the mechanisms underlying demyelination in COVID-19. However, none have considered the SARS-CoV-2's effects on the renin-angiotensin-aldosterone system (RAAS). Therefore, our objective in this review is to evaluate how RAAS imbalance, caused by direct and indirect effects of SARS-CoV-2 infection, could contribute to myelin loss in the PNS and CNS. In the PNS, we propose that demyelination transpires from two significant changes induced by SARS-CoV-2 infection, which include upregulation of ADAM-17 and induction of lymphopenia. Whereas, in the CNS, demyelination could result from RAAS imbalance triggering two alterations: (1) a decrease in angiotensin type II receptor (AT2R) activity, responsible for restraining defense cells' action on myelin; (2) upregulation of ADAM-17 activity, leading to impaired maturation of oligodendrocytes and myelin formation. Thus, we hypothesize that increased ADAM-17 activity and decreased AT2R activity play roles in SARS-CoV-2 infection-mediated demyelination in the CNS.
RESUMEN
Cefaleia é um sintoma de alta prevalência, com importante impacto nas atividades da vida diária. Estudante de medicina é uma população vulnerável à cefaleia, tanto devido a uma carga de trabalho exaustiva, como hábitos favoráveis como a privação do sono, alimentação irregular, sedentarismo e estresse. O objetivo foi avaliar a prevalência da cefaleia e seu impacto nos estudantes de medicina de uma universidade pública de Alagoas. Foram selecionados, de forma aleatória, 97 estudantes de medicina regularmente matriculados do 1º ao 6º ano. Foi aplicado um questionário padronizado e validado contendo questões objetivas e subjetivas sobre condições sociodemográfcas e aspectos clínico-epidemiológicos. A prevalência de cefaleia foi de 95,9%. A maioria do gênero feminino (55,3%). Todos que alegaram cefaleia, a relataram em algum momento, como causa de absenteísmo e comprometimento de rendimento nos estudos. A maioria dos casos positivos afrmaram nunca ter realizado tratamento com neurologista (95,9%). 76,5% alegaram automedicação com analgésicos comuns, apresentando relevância estatística (p:0,0). Foi encontrado um percentual de prevalência maior no sexo feminino, corroborando com a literatura. Houve uma atribuição da cefaleia a períodos de maior estresse durante o semestre letivo, logo é sabido que são vários os fatores descritos como desencadeantes ou atenuantes no aparecimento. Tendo em vista o relato de absenteísmo e comprometimento de rendimento, bem como a não procura de especialista e automedicação, é necessário que haja uma orientação a estes estudantes a fm de incentivá-los à busca pelo tratamento adequado, a fm de terem uma melhor qualidade de vida.
Headache is a symptom of high prevalence, with important impact on the activities of daily living. Medical student is a vulnerable population to headache due to an exhausting workload, as well as favorable habits like sleep deprivation, irregular eating, physical inactivity and stress. The objective was to evaluate the prevalence of headache and its impact on medical students at a public university in Alagoas. 97 medical students from the 1st to the 6th grade were randomly selected. A standardized and validated questionnaire containing objective and subjective questions about sociodemographic conditions and clinical-epidemiological aspects was applied. The prevalence of headache was 95.9%. The majority was female gender (55.3%). All the positives cases reported the headache as a cause of absenteeism and impaired performance in the studies, it at some point. Most of the positive cases reported never having treated with a neurologist (95.9%). 76.5% claimed self-medication with common analgesics, presenting statistical relevance (p: 0.0). A higher prevalence rate was found in females, corroborating with the literature. There was an attribution of headache to periods of greater stress during the school semester, so it is well known that several factors are described as triggering or attenuating. In view of the report of absenteeism and academic performance impairment, added to a non-search of medical care and and self-medication, it is necessary to provide guidance in order to encourage these students to seek appropriate treatment and then achieve a better quality of life.