RESUMO
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a useful intervention for patients with impaired swallowing and a functional gastrointestinal system. Neurological diseases that cause neuromotor dysphagia, brain tumors, and cerebrovascular disease are the most frequent indications; complications are rare, and morbidity and mortality rates are low. OBJECTIVE: To describe the usefulness of PEG in patients with neurological diseases, and its impact on care, survival, and costs and benefits. MATERIAL AND METHODS: We performed a retrospective observational study, reviewing clinical files of patients hospitalised at the National Institute of Neurology and Neurosurgery (years 2015-2017) who underwent PEG placement. RESULTS: The sample included 51 patients: 62.7% were women and the mean (SD) age was 54.4 (18.6) years (range, 18-86). Diagnosis was tumor in 37.3% of cases and cerebrovascular disease in 33.3%. Sixteen patients (33.3%) died and 11 presented minor complications. The PEG tube remained in place for a mean of 9.14 months; in 52.9% of patients it was removed due to lack of improvement and/or tolerated oral intake, with removal occurring after a mean of 5.1 (4.4) months. Among patients' family members, 78.4% reported a great benefit, 43.1% reported difficulty caring for the PEG, and 45.1% reported complicated care in general. The monthly cost of maintaining the PEG was 175.78 on average (range, 38.38-293.45). DISCUSSION AND CONCLUSIONS: This preliminary study reveals that PEG was well indicated in patients with neurological diseases, with survival rates similar to those reported in other studies with long follow-up periods. In patients with cerebrovascular disease, the PEG tube remained in place a mean of 9.14 months, during recovery of swallowing function; however, the cost is high for our population.
Assuntos
Neoplasias Encefálicas , Transtornos Cerebrovasculares , Transtornos de Deglutição , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Nutrição Enteral/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Restrictive strabismus resulting from the presence of an accessory extraocular muscle has rarely been reported in the literature. Most articles written on this topic are isolated case reports. The purpose of this paper is to describe a series of 7 similar patients presenting with atypical restrictive strabismus associated with enophthalmos in the affected eye, which was found to be caused by an accessory extraocular muscle attached to the posterior globe near the optic nerve. The medical records of 7 patients who shared these clinical characteristics were retrospectively analyzed. Orbital imaging was obtained in the 7 cases, which were compared. Three of the patients were females and four were males. The left eye was affected in all 4 males and the right eye was affected in the 3 females. The 7 patients presented with the following clinical characteristics: enophthalmos, restriction to eye movements in most fields of gaze, and presence of an anomalous orbital structure that was interpreted on magnetic resonance imaging (MRI) to be an accessory extraocular muscle inserting onto the posterior surface of the globe in the affected eye. The fellow eye was normal in all cases. Five of the 7 patients underwent surgical correction with partial improvement in only one patient. The presence of an accessory extraocular muscle should be included in the differential diagnosis of patients with atypical restrictive strabismus. Orbital computed tomography or MRI are essential for correct diagnosis in these cases.
Assuntos
Anormalidades do Olho/complicações , Músculos Oculomotores/anormalidades , Estrabismo/etiologia , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Enoftalmia/diagnóstico , Enoftalmia/etiologia , Anormalidades do Olho/diagnóstico por imagem , Movimentos Oculares/fisiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculos Oculomotores/diagnóstico por imagem , Estudos Retrospectivos , Estrabismo/diagnóstico , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Modern management of Oesophageal and oesophagogastric junction (OGJ) cancers requires a multidisciplinary approach, which was implemented at our health centre in 2005. This study aimed to assess the impact of this change on clinical outcomes. METHODS: A retrospective cohort study was conducted, covering all patients treated for oesophageal and OGJ cancer at the cancer centre established by the Bellvitge University Hospital and Catalonian Institute of Oncology, over two time periods, i.e. 2000-2004 and 2005-2008. Descriptive and multivariate analyses were performed using survival at 1 and 3 years as dependent variables. RESULTS: Between 1 January 2000 and 31 December 2008, 586 patients were included. Number of patients with unknown stage at diagnosis was significantly reduced. Preoperative strategies at the oesophageal location clearly increased in the recent period. A multidisciplinary approach resulted in a significant reduction in surgical mortality (11.8 vs. 2 %) in the period 2005-2008. Analysis restricted to patients undergoing surgery with curative intent indicated a significant increase in 1- and 3-year survival in the latter period (68.4 vs. 89.8 and 38.2 vs. 57.1 %, respectively). Multivariate analysis showed that variables associated with improved survival were: age; tumour stage; radical intent of treatment (surgery and radical combined chemoradiotherapy); and therapeutic strategy. CONCLUSION: Better selection of patients for therapy together with improved staging resulted in a significant improvement in 1- and 3-year survival in cases undergoing surgery with curative intent. These changes would support the adoption of a multidisciplinary approach to clinical decision-making in cases of oesophageal and OGJ cancer.
Assuntos
Neoplasias Esofágicas/mortalidade , Junção Esofagogástrica/patologia , Neoplasias Gástricas/mortalidade , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Antecedentes: Las roturas bilaterales de tendones cuadricipitales son enfermedades de muy baja frecuencia. Las reparaciones quirúrgicas suelen ser los tratamientos más adecuados y exigen tiempos de recuperación de varios meses. Métodos: Presentamos el caso de un paciente con rotura bilateral de tendones cuadricipitales tras un traumatismo de baja energía, que fue tratado mediante sutura transpatelar quirúrgica reforzada con plasma rico en factores de crecimiento (PRGF-Endoret). Resultados: Los resultados a corto plazo evidenciaron una recuperación funcional y mediante imagen en poco más de dos meses. Conclusiones: La utilización de PRGF asociado a la cirugía habitual puede ayudar a la realización de una rehabilitación precoz.
Background: Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. Methods: We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). Results: Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.
Assuntos
Idoso , Humanos , Masculino , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Plasma , Traumatismos dos Tendões/terapia , Músculo Quadríceps , RupturaRESUMO
BACKGROUND: Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. METHODS: We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). RESULTS: Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.
Assuntos
Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Plasma , Traumatismos dos Tendões/terapia , Idoso , Humanos , Masculino , Músculo Quadríceps , RupturaRESUMO
Los profesionales de Enfermería reconocen que la investigación en esta disciplina, inicia con los registros detallados de las observaciones de Florencia Nightingale, quien aplicó sus conocimientos de historia y filosofía al estudio del entorno, lo que le permitió definir el cuidado como eje de su actuación e ideología de vida; plasmó la lógica del pensamiento y actuar de Enfermería, y sentó las bases filosóficas, epistemológicas y éticas a partir del análisis del contexto histórico sociocultural en el cual desarrolló su principal obra; todo a partir de una bitácora con sus notas, que ha servido de referencia para el desarrollo de las actuales teorías de Enfermería. Para el caso de nuestro país, en los últimos años las Instituciones donde se desarrollan los profesionales de Enfermería en un esfuerzo conjunto han tratado de insertar e impulsar unidades destinadas a la investigación de Enferme- ría, siempre con el objetivo de la reflexión sobre el cuidado desde diferentes ángulos, miradas o aproximaciones para de esta manera obtener resultados propositivos, intervenir oportunamente y ser competitivos en los diferentes niveles de atención de manera interdisciplinar en el campo de la práctica clínica, la gestión y la enseñanza.
Assuntos
Humanos , Masculino , FemininoRESUMO
BACKGROUND: The prognosis of late onset Perthes cases is usually poor and the proposed treatments vary based on the surgeon's preferences and experience, as well as on the available resources. Most of them are salvage procedures with a short follow-up and non-standardized application criteria. METHODS: Hip arthroscopy and arthrodiastasis with external fixator are indicated for certain situations in Perthes disease. Based on the results obtained with each of these techniques separately, both of them were used to treat a case of Perthes disease involving a poor prognosis. RESULTS: Results two years after surgery are good. CONCLUSIONS: The use of both techniques together may produce a good result in these patients.
Assuntos
Artroscopia , Fixadores Externos , Doença de Legg-Calve-Perthes/cirurgia , Adolescente , Fatores Etários , Humanos , Masculino , Procedimentos Ortopédicos/métodosRESUMO
Se ha relacionado la satisfacción laboral con el desempeño y en los servicios de salud además, con la calidad del cuidado que se brinda. Objetivos. Establecer el grado de satisfacción laboral e identificar los factores asociados a ésta en personal de enfermería de cuatro Instituciones públicas de salud del tercer nivel de atención. Metodología: Estudio transversal, observacional y descriptivo. La muestra comprendió 594 profesionales de enfermería. Se aplicó una encuesta integrada por dos apartados, uno de datos socio-demográficos y otro para medir los factores intrínsecos y extrínsecos relacionados con la satisfacción laboral de acuerdo al instrumento de Font Roja ampliado (9 factores con 26 ítems en total). Resultados: Se obtuvo una confiabilidad del instrumento de 0.8 de alfa de Cronbach, 35% de los encuestados es personal especializado, la calificación de Satisfacción Laboral tuvo un promedio global de 101±10. Los factores identificados con insatisfacción fueron la promoción y competencia profesional, los mejor calificados la relación interpersonal con los jefes y con los compañeros. Los factores extrínsecos no mostraron diferencias estadísticamente significativas. Discusión: Los resultados concuerdan con la literatura, la promoción profesional y la competencia laboral son los que más se observan afectados. La institución "C" es la que tiene mayor nivel de satisfacción, también se resalta que el profesional que labora en áreas críticas se encuentra más satisfecho. Conclusiones: El personal de enfermería en estas instituciones tiene una calificación de nivel medio a alto de SL, la identificación de factores de insatisfacción así como de satisfacción son importantes para fundamentar mejoras e incidir en la calidad de los cuidados.
Job satisfaction has been linked to performance and, in the health services, to the quality of the care being given. Objectives.To establish the job satisfaction grade and to identify the factors associated to it in nursing staff of four tertiary care public health institutions. Methodology. Cross-sectional, observational, and descriptive study. The sample comprised 594 nursing professionals. A survey was applied, it consisted of two sections, one of socio-demographic data and the other to measure the intrinsic and extrinsic factor relate to job satisfaction in accordance to the extended Font Roja questionnaire (9 factors with 26 total items). Results. Instrument reliability with a cron bach's alpha value of 0.8 was obtained. 35% of the respondents are specialized personnel; the job satisfaction score had a. global mean of 101±10. Factor associated with dissatisfaction were job promotion and professional competence, factors with highest marks were interpersonal relationship with boss and workmates. Extrinsic factors did not show statistically significant differences. Discussion. Results are consistent with the literature; professional promotion and job competence are the most affected factors. Institution "C" has the highest ranks in job satisfaction, the fact that a professional working in critical areas is more satisfied is highlighted too. Conclusions. Nursing staff in the surveyed institutions have a medium to high level of job satisfaction, the identification of dissatisfaction and satisfaction factors is important to establish improvements in the health care quality.
Assuntos
Humanos , Masculino , FemininoRESUMO
La Plastinación es la técnica más moderna para la conservación de piezas anatómicas y especímenes. Esta técnica consta de cuatro etapas: fijación, deshidratación, impregnación forzada y curado. Este trabajo pretende mejorar la eficiencia en la producción de órganos plastinados mediante la técnica de Plastinación estándar denominada S 10. Se utilizaron riñones de equinos mestizos criollos provenientes del Frigorífico Aimar S/A, ubicado en la zona rural de Río Cuarto. Luego de realizar la fijación del órgano con formalina se procedió a deshidratarlo. La deshidratación se llevó a cabo en tres sub-etapas donde en cada una de ellas se trabajó a la misma temperatura y se utilizó como solvente una solución de acetona en diferentes concentraciones. Las mediciones se realizaron con acetómetro registrándose el tiempo insumido para lograr la deshidratación. Los datos se analizaron estadísticamente por medio de: análisis de la varianza multivariada y análisis de correlación simple utilizando el paquete estadístico InfoStat. Los resultados muestran que los tiempos de deshidratación se ven influenciados por la edad del animal pero no por la posición ni por el peso del órgano.
Plastination is the most modern technique for the preservation of anatomical pieces and specimens. This technique consists of four stages: fixation, dehydration, forced impregnation, and cured. This research aims at improving the efficiency of production plastinated organs through the standard technique known as S10. Kidneys of criole mestizo equines from Frigorifico Aimar S.A placed in the rural area of Rio IV were used. After binding the organ with formalin, it was dehydrated. The dehydration was carried out in three sub-stages working at the same temperature, and a solvent composed of solution of acetone of different concentrations was used. The measurements were analysed with acetometer, keeping register of the time consumption to reach dehydration. The resulting data was statistically analysed using Infostat program. Results showed that the time consumed to reach dehydration was influenced by the horses age but not by the kidney's weight, there were no significant differences between right and left kidneys neither.
Assuntos
Animais , Masculino , Cavalos/anatomia & histologia , Soluções para Preservação de Órgãos , Rim/anatomia & histologia , Rim/inervação , Rim/ultraestrutura , Anatomia Veterinária/educaçãoRESUMO
A 55-year-old man with an implantable cardioverter-defibrillator (ICD) placed after diagnosis of Brugada syndrome 4 years earlier was admitted to hospital with dyspnea and a large left pleural effusion. After several episodes of cardiorespiratory arrest and application of advanced cardiac life support measures, an emergency sternotomy was performed. Cardiac and pleural perforation by the ICD lead was observed and the device was removed. Since the ICD was introduced in 1980, it has been effective in the treatment of malignant ventricular arrhythmias and in reducing the incidence of sudden death. Increased use, however, has meant a rise in the number of complications, some of which are potentially fatal. The rare complication we describe should therefore be considered whenever a patient with an ICD develops sudden respiratory failure or massive hemoptysis that cannot be explained by other causes.
Assuntos
Desfibriladores Implantáveis/efeitos adversos , Traumatismos Cardíacos/etiologia , Pleura/lesões , Suporte Vital Cardíaco Avançado , Síndrome de Brugada/terapia , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Respiração ArtificialRESUMO
OBJECTIVE: To provide an outpatient facility to improve the management of chemotherapy toxicity in cancer patients. PATIENTS AND METHODS: We set up an oncology acute toxicity unit (OATU) to improve toxicity management. A telephone helpline was the initial contact which filters out inappropriate non-toxicity-related events. Patients were provided an information booklet describing the possible side effects of the chemotherapy and the helpline telephone number. A specialist nurse received the calls and consulted the doctor if necessary. Depending on requirements, the patient's problem was resolved by telephone, or a consultation visit at the OATU was arranged. RESULTS: Between February 1999 and August 2001, 1126 patients made 2007 contacts with the OATU. The most common tumours were breast (26%), colorectal (20%) and lung (20%). The telephone helpline was used in 87% of contacts and 37% were considered inappropriate. Of the 1263 appropriate contacts, the most frequent chemotherapy schedules that had been administered were 5FU-leucovorin (11.2%) and CMF (10.4%). The most frequent side effects were fever (35.5%), diarrhoea (18.5%), mucositis (16.2%) and emesis (13%). The problem was resolved by telephone in 48% of cases and 52% required attendance in the OATU, of which 40% required hospital admission, i.e., 21.1% of the initial appropriate helpline contacts. The most frequent reason was Grade 3-4 neutropenic fever (56.5%). CONCLUSIONS: The OATU enables prompt and efficient access of patients to medical oncology facilities in the event of toxicity due to chemotherapy. Unnecessary emergency room use is avoided while oncology outpatient and hospitalisation facilities are optimised.
Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Serviço Hospitalar de Oncologia/organização & administração , Ambulatório Hospitalar/organização & administração , Toxicologia/organização & administração , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Linhas Diretas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Telefone , Vômito/induzido quimicamenteRESUMO
The trachea of a 39-year-old man ruptured following intubation for fiberoptic bronchoscopy; the complication became evident during surgery as extensive subcutaneous emphysema developed. The emphysema resolved with conservative treatment. Tracheobronchial lesions are generally caused by direct trauma to the chest. Tracheal rupture due to intubation maneuvers is one of the complications anesthetists fear most. Although infrequent, such lesions are potentially fatal. Signs and symptoms can vary widely, from self-limiting asymptomatic subcutaneous emphysema immediately following surgery to severe complications such as tension pneumothorax, acute respiratory failure, pneumomediastinum, or even pneumopericardium. The absence of complications in patients treated conservatively has increased interest in using this approach to management when conditions are favorable, always with fiberoptic assessment to evaluate whether the lesion has resolved completely and without sequelae.
Assuntos
Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Doenças Mandibulares/cirurgia , Complicações Pós-Operatórias/cirurgia , Pseudoartrose/cirurgia , Traqueia/lesões , Adulto , Remoção de Dispositivo , Diagnóstico Diferencial , Fixação Interna de Fraturas , Humanos , Doença Iatrogênica , Fixadores Internos/efeitos adversos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Masculino , Fraturas Mandibulares/cirurgia , Pneumotórax/diagnóstico , Respiração Artificial , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ruptura/terapia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagemRESUMO
Presentamos el caso de una niña de 14 meses con colomboma coroideo bilateral y proptosis paraaxial progresiva del ojo izquierdo, en la que se halló un quiste meníngeo en la órbita izquierda con tejido cerebeloso ectópico. La lesión se resolvió hallar otros dos casos similares en la literatura, describiendo tejido cerebeloso ectópico en la órbita
Assuntos
Criança , Humanos , Feminino , Cerebelo , Coristoma , Órbita/fisiopatologia , Órbita/patologia , Transplante de Tecido Encefálico , Cistos , Pseudotumor OrbitárioRESUMO
Presentamos el caso de una niña de 14 meses con colomboma coroideo bilateral y proptosis paraaxial progresiva del ojo izquierdo, en la que se halló un quiste meníngeo en la órbita izquierda con tejido cerebeloso ectópico. La lesión se resolvió hallar otros dos casos similares en la literatura, describiendo tejido cerebeloso ectópico en la órbita
Assuntos
Criança , Humanos , Feminino , Cerebelo , Órbita/fisiopatologia , Órbita/patologia , Coristoma/classificação , Coristoma/diagnóstico , Coristoma/patologia , Coristoma/virologia , Cistos , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/enfermagem , Pseudotumor Orbitário/patologia , Transplante de Tecido EncefálicoRESUMO
The transition of Candida albicans from commensalism to pathogenicity is associated with the immune status of the host; resistance to fungus involves macrophages (Mphi) and polymorphonuclear neutrophils (PMN), which act as effector cells. T-cell function is also involved. Previously, we found that in Wistar rats exposed to chronic varied stress (CVS) immediately after C. albicans infection (Ca-S group) some functions of phagocytic cells, such as killer activity and NO production, were strongly modified compared with unstressed, infected animals (Ca group). We examined the phenotypic and functional changes of these effector cells recruited at the site of C. albicans infection. The recruitment of peritoneal cells (PC) was markedly reduced in Ca-S animals and the arrival of Mphi and PMN was selectively diminished after CVS exposure. The integrin CD11b/CD18, implicated in migration and C. albicans phagocytosis, was downregulated in Mphi of Ca-S animals. The activation markers CD54 and MHC-II were upregulated in Mphi after fungal contact. The expression of CD54 was only changed in Ca-S rats. Finally, TNF-alpha production was reduced in PC of Ca-S animals, suggesting an impairment of functional activity. Taken together, the phenotypic and functional changes detected in effector cells may account for the decreased resistance to candidiasis seen in conjunction with CVS. The changes seen also expand our knowledge of the role of Mphi in the control of C. albicans dissemination.
Assuntos
Candidíase/imunologia , Fagócitos/imunologia , Estresse Fisiológico/imunologia , Animais , Antígenos CD18/análise , Doença Crônica , Feminino , Receptores de Hialuronatos/análise , Ativação de Macrófagos , Macrófagos Peritoneais/imunologia , Neutrófilos/imunologia , Fenótipo , Ratos , Fator de Necrose Tumoral alfa/biossínteseRESUMO
OBJECTIVE: Candidiasis is a prototypic opportunistic fungal disease that may follow severe modulations of the immune system of the host. The purpose of this study was to evaluate which innate immune mechanisms involved in the protection against fungal invasion are impaired under stress conditions. METHODS: Wistar rats were infected intraperitoneally with Candida albicans and immediately exposed to chronic varied stress (CVS) over 10 days (CVS; Ca-S); the fungal burden (CFU), histopathological lesion and ACTH levels were evaluated. Additionally, functional assessment of peritoneal cells (PC) included the phagocytic and anticandidacidal activities and the production of H(2)O(2) and NO. RESULTS: In the only infected animals (Ca), C. albicans colonization stimulated an efficient inflammatory response, while in Ca-S rats poor tissue reactions were associated with increased CFU in livers and kidneys (p < 0.05, Ca vs. Ca-S). Whereas the phagocytic process was not modified, the candidacidal activity of PC was significantly decreased after the application of CVS (p < 0.001, Ca vs. Ca-S). The H(2)O(2) production by macrophages and neutrophils was downregulated by the infection, and while at early intervals these cells possessed a residual oxidative capacity, by day 10, the production of this metabolite was blocked. Spontaneous NO production by macrophages was significantly increased in both Ca and Ca-S animals (p < 0.001), but in stressed rats, this reactive nitrogen intermediate was noticeably downregulated (p < 0.05, Ca vs. Ca-S). The hyperactivity of hypothalamus-pituitary-adrenal axis after exposure to stress was confirmed by an increase in baseline plasma ACTH levels. CONCLUSION: These results show that during infection with C. albicans, the exposure to CVS contributes to the spread of the fungus and downregulates critical functions of phagocytic cells involved in the control of this opportunistic pathogen.
Assuntos
Candidíase/imunologia , Macrófagos Peritoneais/fisiologia , Neuroimunomodulação/fisiologia , Peritonite/imunologia , Fagocitose , Estresse Fisiológico/imunologia , Hormônio Adrenocorticotrópico/sangue , Animais , Candidíase/complicações , Candidíase/fisiopatologia , Aglomeração , Progressão da Doença , Feminino , Privação de Alimentos , Abrigo para Animais , Peróxido de Hidrogênio/metabolismo , Rim/microbiologia , Fígado/microbiologia , Ativação de Macrófagos , Neutrófilos/fisiologia , Óxido Nítrico/biossíntese , Odorantes , Infecções Oportunistas/complicações , Infecções Oportunistas/imunologia , Infecções Oportunistas/fisiopatologia , Cavidade Peritoneal/microbiologia , Peritonite/complicações , Sistema Hipófise-Suprarrenal/fisiopatologia , Ratos , Ratos Wistar , Restrição Física , Estresse Fisiológico/fisiopatologia , Natação , Privação de ÁguaRESUMO
The purpose of this article is to discuss basic aspects of the interplay between the neuroendocrine and the immune systems. Two pathways link the brain and the immune system: the autonomic nervous system and the neuroendocrine outflow via the pituitary. Most of the influence of the brain on immune events is exerted through the hypothalamic-pituitary-adrenal (HPA) axis. Moreover, certain neurotransmitters, neuropeptides, and neurohormones affect immune function both in vivo and in vitro. Receptors for these molecules are present on immune cells. This cell-to-cell communication is bi-directional, since impulses from the immune system can affect many functions of the central nervous system. Cytokines released during the activation of the immune system, in turn, can alter the function of the HPA axis. In this context, we also describe our main findings working with a model of Candida albicans infection in rats exposed to chronic varied stress.
Assuntos
Sistema Hipotálamo-Hipofisário/fisiologia , Sistema Imunitário/fisiologia , Sistema Hipófise-Suprarrenal/fisiologia , Animais , Autoimunidade , Candidíase/imunologia , Comunicação Celular , Ratos , Estresse Fisiológico/imunologiaRESUMO
The purpose of this article is to discuss basic aspects of the interplay between the neuroendocrine and the immune systems. Two pathways link the brain and the immune system: the autonomic nervous system and the neuroendocrine outflow via the pituitary. Most of the influence of the brain on immune events is exerted through the hypothalamic-pituitary-adrenal (HPA) axis. Moreover, certain neurotransmitters, neuropeptides, and neurohormones affect immune function both in vivo and in vitro. Receptors for these molecules are present on immune cells. This cell-to-cell communication is bi-directional, since impulses from the immune system can affect many functions of the central nervous system. Cytokines released during the activation of the immune system, in turn, can alter the function of the HPA axis. In this context, we also describe our main findings working with a model of Candida albicans infection in rats exposed to chronic varied stress.
RESUMO
Stress disturbs homeostasis by altering the equilibrium of various hormones which have a significant impact on immune responses. Few studies have examined the influence of stressors on autoimmune disease in animal models. In our work, we studied the effects of long-term exposure (14 days) to chronic varied stress (CVS) in a model of experimental autoimmune encephalomyelitis (EAE) in Wistar rats. We studied whether the exposure to CVS before or after the immune challenge would correlate with differences in the clinical course of the disease. We also examined whether the CVS would modulate the magnitude of the cellular or the humoral immune response. We observed opposite effects on the clinical signs in animals stressed before or after the immune challenge. The clinical signs of the disease were attenuated in animals stressed before but not after the immune challenge. Relationships were found in the modulation of the clinical severity related to the time of exposure to the CVS, the histological alterations and the proliferative results. Stressed animals with milder clinical signs presented an exacerbated humoral response against myelin antigens while stressed animals with more severe clinical symptoms exhibited a significantly diminished one. Besides, we detected the presence of specific IgG1 associated with the exposure to CVS before the induction of EAE. Our results show that, depending on the timing of the exposure of Wistar rats to the CVS, the neuroendocrine disbalance favors a more pronounced humoral or cellular profile of the response.