RESUMEN
Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715).
Asunto(s)
Enfermedad de Chagas , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Ritmo Circadiano , Humanos , HipertensiónRESUMEN
Resumo Fundamento O acometimento do sistema nervoso autônomo é um dos mecanismos propostos para explicar a progressão da lesão miocárdica na doença de Chagas. Evidências indicam alterações do sistema nervoso simpático e parassimpático desde a fase aguda, e estudos são necessários para se entender os aspectos fisiopatológicos e o valor prognóstico dessas alterações. Objetivo Analisar o comportamento da pressão arterial pela monitorização ambulatorial da pressão arterial (MAPA) em pacientes normotensos com doença de Chagas aguda (DCA) sem envolvimento cardíaco aparente, e a influência da infecção no descenso fisiológico do sono. Métodos Foi realizado a MAPA em 54 pacientes com DCA e utilizado um grupo controle de 54 indivíduos normotensos, pareados para idade e sexo. O nível de significância adotado foi para um erro tipo I (alfa) de 5%. Resultados Em um total de 54 pacientes com DCA ocorreu ausência de descenso sistólico do sono em 74,0%*, ausência de descenso diastólico do sono em 53,7%*, e ausência de descenso sistólico e diastólico do sono (51,8%)*, (*p<0,05). Em 12,9% ocorreu ascensão sistólica da pressão no sono e em 18,5% ascensão diastólica (p<0,05). Conclusão Em pacientes com Doença de Chagas aguda, houve ausência significativa do descenso fisiológico da pressão arterial durante o sono, tanto da pressão arterial sistólica quanto a diastólica, e alguns pacientes apresentaram ascensão noturna desses parâmetros. Esses achados sugerem alterações autonômicas na doença de Chagas desde a fase aguda. (Arq Bras Cardiol. 2020; 114(4):711-715)
Abstract Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715)
Asunto(s)
Humanos , Enfermedad de Chagas , Presión Sanguínea , Determinación de la Presión Sanguínea , Ritmo Circadiano , Monitoreo Ambulatorio de la Presión Arterial , HipertensiónRESUMEN
Peripheral inflammatory stimuli increase proinflammatory cytokines in the bloodstream and central nervous system and activate microglial cells. Here we tested the hypothesis that contrasting environments mimicking sedentary and active lives would be associated with differential microglial morphological responses, inflammatory cytokines concentration, and virus load in the peripheral blood. For this, mice were maintained either in standard (standard environment) or enriched cages (enriched environment) and then subjected to a single (DENV1) serotype infection. Blood samples from infected animals showed higher viral loads and higher tumor necrosis factor-α (TNFα) mRNA concentrations than control subjects. Using an unbiased stereological sampling approach, we selected 544 microglia from lateral septum for microscopic 3D reconstruction. Morphological complexity contributed most to cluster formation. Infected groups exhibited significant increase in the microglia morphological complexity and number, despite the absence of dengue virus antigens in the brain. Two microglial phenotypes (type I with lower and type II with higher morphological complexity) were found in both infected and control groups. However, microglia from infected mice maintained in enriched environment showed only one morphological phenotype. Two-way ANOVA revealed that environmental changes and infection influenced type-I and II microglial morphologies and number. Environmental enrichment and infection interactions may contribute to microglial morphological change to a point that type-I and II morphological phenotypes could no longer be distinguished in infected mice from enriched environment. Significant linear correlation was found between morphological complexity and TNFα peripheral blood. Our findings demonstrated that sedentary-like and active murine models exhibited differential microglial responses and peripheral inflammation to systemic non-neurotropic infections with DENV1 virus.