RESUMO
Despite their biological importance, the role of stem cells in human aging remains to be elucidated. In this work, we applied a machine learning methodology to GTEx transcriptome data and assigned stemness scores to 17,382 healthy samples from 30 human tissues aged between 20 and 79 years. We found that ~60% of the studied tissues exhibit a significant negative correlation between the subject's age and stemness score. The only significant exception was the uterus, where we observed an increased stemness with age. Moreover, we observed that stemness is positively correlated with cell proliferation and negatively correlated with cellular senescence. Finally, we also observed a trend that hematopoietic stem cells derived from older individuals might have higher stemness scores. In conclusion, we assigned stemness scores to human samples and show evidence of a pan-tissue loss of stemness during human aging, which adds weight to the idea that stem cell deterioration may contribute to human aging.
Assuntos
Envelhecimento , Senescência Celular , Humanos , Envelhecimento/fisiologia , Idoso , Pessoa de Meia-Idade , Adulto , Feminino , Senescência Celular/fisiologia , Células-Tronco/metabolismo , Masculino , Proliferação de Células , Adulto Jovem , Transcriptoma , Aprendizado de Máquina , Células-Tronco Hematopoéticas/metabolismoRESUMO
Snake venom metalloproteases (SVMPs) are hydrolytic enzymes dependent on metal binding, primarily zinc (Zn2+), at their catalytic site. They are classified into three classes (P-I to P-III). BjussuMP-II, a P-I SVMP isolated from Bothrops jararacussu snake venom, has a molecular mass of 24 kDa. It exhibits inhibitory activity on platelet aggregation and hydrolyzes fibrinogen. TNF-α upregulates the expression of adhesion molecules on endothelial cell surfaces, promoting leukocyte adhesion and migration during inflammation. Literature indicates that SVMPs may cleave the TNF-α precursor, possibly due to significant homology between metalloproteases from mammalian extracellular matrix and SVMPs. This study aimed to investigate BjussuMP-II's effects on human umbilical vein endothelial cells (HUVEC), focusing on viability, detachment, adhesion, release, and cleavage of TNF-α, IL-1ß, IL-6, IL-8, and IL-10. HUVEC were incubated with BjussuMP-II (1.5-50 µg/mL) for 3-24 h. Viability was determined using LDH release, MTT metabolization, and 7AAD for membrane integrity. Adhesion and detachment were assessed by incubating cells with BjussuMP-II and staining with Giemsa. Cytokines were quantified in HUVEC supernatants using EIA. TNF-α cleavage was evaluated using supernatants from PMA-stimulated cells or recombinant TNF-α. Results demonstrated BjussuMP-II's proteolytic activity on casein. It was not toxic to HUVEC at any concentration or duration studied but interfered with adhesion and promoted detachment. PMA induced TNF-α release by HUVEC, but this effect was not observed with BjussuMP-II, which cleaved TNF-α. Additionally, BjussuMP-II cleaved IL-1ß, IL-6, and IL-10. These findings suggest that the zinc metalloprotease BjussuMP-II could be a valuable biotechnological tool for treating inflammatory disorders involving cytokine deregulation.
Assuntos
Adesão Celular , Citocinas , Células Endoteliais da Veia Umbilical Humana , Metaloproteases , Humanos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Citocinas/metabolismo , Metaloproteases/metabolismo , Adesão Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Bothrops/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Animais , Venenos de Crotalídeos/metabolismo , Venenos de Crotalídeos/toxicidade , Proteólise/efeitos dos fármacosRESUMO
Surgical site infections (SSI) constitute 31% of all hospital-acquired conditions, with ankle and foot surgical procedures showing an incidence of SSI ranging from 0.5% to 6.5%. This study aimed to assess the incidence of both superficial and deep surgical site infections in foot and ankle surgery, along with associated factors. Conducted as a retrospective cohort study, it included 2180 patients undergoing foot and ankle surgery in a private hospital between 2014 and 2020, encompassing elective and trauma cases. Outcome variables comprised SSI, while predictor variables encompassed sex, age, diabetes mellitus, systemic arterial hypertension, smoking, American Society of Anesthesiologists (ASA) score, and body mass index. Logistic regression models were employed to identify associations between study variables. The incidence of surgical site infections stood at 4% (83/2180), comprising a rate of 2.8% (57/2180) for superficial infections and 1.2% (26/2180) for deep infections. Smoking (OR 2.9, 95%CI 1.4-5.3) and ASA score >2 (OR 3.4, 95%CI 1.2-8.4) emerged as independent factors associated with surgical site infections. The group with deep infections exhibited higher proportions of smokers (p = 0.002), systemic arterial hypertension (p = 0.018), trauma surgery (p = 0.049), and an ASA score >2 (p = 0.011). Overall infection incidence in this cohort reached 4%, with trauma cases, smoking, hypertension, and an ASA score >2 independently linked to deep infections. Surgeons should be cognizant of these risk factors when managing prophylactic antibiotic regimens for patients.
Assuntos
Pé , Infecção da Ferida Cirúrgica , Humanos , Infecção da Ferida Cirúrgica/epidemiologia , Masculino , Feminino , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Pé/cirurgia , Adulto , Idoso , Tornozelo/cirurgia , Estudos de Coortes , Procedimentos Ortopédicos/efeitos adversosRESUMO
BACKGROUND: Disparities in health outcomes among racial groups warrant investigation, even among elite athletes. Therefore, understanding the impact of race upon post-medal survival in Brazilian Olympians becomes essential. OBJECTIVE: To compare post-medal survival between white and non-white Brazilian Olympic medalists from 1920 to 1992. METHODS: This study used publicly available data for a retrospective cohort study on all Brazilian Olympic medalists from 1920 to 1992 (males only). Athletes were classified into white and non-white groups using structured ethnicity determination. Kaplan-Meier analyses computed the restricted mean survival time (RMST) for each ethnic group. A Cox proportional hazards analysis assessed ethnicity-based survival differences, adjusting for medal-winning age and birth year (p<0.05). RESULTS: Among 123 athletes (73.9% white), the mean age of medal achievement was 25.03±4.8 years. During the study, 18.7% of white and 37.5% of non-white athletes died (p=0.031). White athletes had a mean age at death of 75.10±18.01 years, while non-white athletes had an age of 67.13±14.90 years (p=0.109). The RMST for white athletes was 51.59 (95% CI 49.79-53.39) years, while for non-white athletes, it was 45.026 (95% CI 41.31-48.74) years, resulting in a ΔRMST of 6.56 (95% CI 2.43-10.70; p=0.0018). Multivariate analysis showed that non-white athletes had a higher mortality risk than did white athletes (HR 5.58; 95% CI, 2.18-14.31). CONCLUSION: Following their first medal, white Brazilian Olympians typically enjoy a six-year longer lifespan than their non-white counterparts, illustrating a marked mortality gap and health disparities among healthy individuals in Brazil.
FUNDAMENTO: As disparidades nos resultados de saúde entre grupos raciais merecem investigação, mesmo em atletas de elite. Portanto, compreender o impacto da raça na sobrevida pós-medalha em atletas olímpicos brasileiros torna-se essencial. OBJETIVO: Comparar a sobrevida pós-medalha entre medalhistas olímpicos brasileiros brancos e não brancos de 1920 a 1992. MÉTODOS: Utilizamos dados disponíveis publicamente para um estudo de coorte retrospectivo de todos os medalhistas olímpicos brasileiros de 1920 a 1992 (somente homens). Os atletas foram classificados nos grupos brancos e não brancos usando determinação estruturada de etnia. As análises de Kaplan-Meier calcularam o tempo médio de sobrevida restrito (TMSR) para cada grupo étnico. Uma análise de riscos proporcionais de Cox avaliou as diferenças de sobrevida baseadas na etnia, ajustando para a idade da conquista da medalha e ano de nascimento (p<0,05). RESULTADOS: Entre 123 atletas (73,9% brancos), a idade média da conquista de medalhas foi de 25,03 ± 4,8 anos. Durante o estudo, 18,7% dos atletas brancos e 37,5% dos atletas não brancos morreram (p=0,031). Os atletas brancos tiveram média de idade ao óbito de 75,10 ± 18,01 anos, enquanto os atletas não brancos tiveram idade média de 67,13 ± 14,90 anos (p=0,109). O TMSR para atletas brancos foi de 51,59 (IC 95%, 49,79 - 53,39) anos, e para atletas não brancos foi de 45,026 (IC 95%, 41,31 - 48,74) anos, resultando em um ΔTMSR de 6,56 (IC 95%, 2,43 - 10,70; p=0,0018). A análise multivariada mostrou que atletas não brancos apresentavam maior risco de mortalidade do que atletas brancos (RC 5,58; IC 95%, 2,18 - 14,31). CONCLUSÃO: Após a primeira medalha, os atletas olímpicos brasileiros brancos normalmente desfrutam de uma expectativa de vida seis anos mais longa do que seus colegas não brancos, ilustrando uma acentuada diferença de mortalidade e disparidades de saúde entre indivíduos saudáveis no Brasil.
Assuntos
Esportes , Masculino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Brasil , Estudos Retrospectivos , AtletasRESUMO
Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.
Assuntos
Dor Crônica , Procedimentos Ortopédicos , Tenodese , Humanos , Tendões/cirurgia , Perna (Membro) , ArtralgiaRESUMO
Resumo Fundamento: As disparidades nos resultados de saúde entre grupos raciais merecem investigação, mesmo em atletas de elite. Portanto, compreender o impacto da raça na sobrevida pós-medalha em atletas olímpicos brasileiros torna-se essencial. Objetivo: Comparar a sobrevida pós-medalha entre medalhistas olímpicos brasileiros brancos e não brancos de 1920 a 1992. Métodos: Utilizamos dados disponíveis publicamente para um estudo de coorte retrospectivo de todos os medalhistas olímpicos brasileiros de 1920 a 1992 (somente homens). Os atletas foram classificados nos grupos brancos e não brancos usando determinação estruturada de etnia. As análises de Kaplan-Meier calcularam o tempo médio de sobrevida restrito (TMSR) para cada grupo étnico. Uma análise de riscos proporcionais de Cox avaliou as diferenças de sobrevida baseadas na etnia, ajustando para a idade da conquista da medalha e ano de nascimento (p<0,05). Resultados: Entre 123 atletas (73,9% brancos), a idade média da conquista de medalhas foi de 25,03 ± 4,8 anos. Durante o estudo, 18,7% dos atletas brancos e 37,5% dos atletas não brancos morreram (p=0,031). Os atletas brancos tiveram média de idade ao óbito de 75,10 ± 18,01 anos, enquanto os atletas não brancos tiveram idade média de 67,13 ± 14,90 anos (p=0,109). O TMSR para atletas brancos foi de 51,59 (IC 95%, 49,79 - 53,39) anos, e para atletas não brancos foi de 45,026 (IC 95%, 41,31 - 48,74) anos, resultando em um ΔTMSR de 6,56 (IC 95%, 2,43 - 10,70; p=0,0018). A análise multivariada mostrou que atletas não brancos apresentavam maior risco de mortalidade do que atletas brancos (RC 5,58; IC 95%, 2,18 - 14,31). Conclusão: Após a primeira medalha, os atletas olímpicos brasileiros brancos normalmente desfrutam de uma expectativa de vida seis anos mais longa do que seus colegas não brancos, ilustrando uma acentuada diferença de mortalidade e disparidades de saúde entre indivíduos saudáveis no Brasil.
Abstract Background: Disparities in health outcomes among racial groups warrant investigation, even among elite athletes. Therefore, understanding the impact of race upon post-medal survival in Brazilian Olympians becomes essential. Objective: To compare post-medal survival between white and non-white Brazilian Olympic medalists from 1920 to 1992. Methods: This study used publicly available data for a retrospective cohort study on all Brazilian Olympic medalists from 1920 to 1992 (males only). Athletes were classified into white and non-white groups using structured ethnicity determination. Kaplan-Meier analyses computed the restricted mean survival time (RMST) for each ethnic group. A Cox proportional hazards analysis assessed ethnicity-based survival differences, adjusting for medal-winning age and birth year (p<0.05) Results: Among 123 athletes (73.9% white), the mean age of medal achievement was 25.03±4.8 years. During the study, 18.7% of white and 37.5% of non-white athletes died (p=0.031). White athletes had a mean age at death of 75.10±18.01 years, while non-white athletes had an age of 67.13±14.90 years (p=0.109). The RMST for white athletes was 51.59 (95% CI 49.79-53.39) years, while for non-white athletes, it was 45.026 (95% CI 41.31-48.74) years, resulting in a ΔRMST of 6.56 (95% CI 2.43-10.70; p=0.0018). Multivariate analysis showed that non-white athletes had a higher mortality risk than did white athletes (HR 5.58; 95% CI, 2.18-14.31). Conclusion: Following their first medal, white Brazilian Olympians typically enjoy a six-year longer lifespan than their non-white counterparts, illustrating a marked mortality gap and health disparities among healthy individuals in Brazil.
RESUMO
L-Amino acid oxidase (LAAO) is an enzyme found in snake venom that has multifaceted effects, including the generation of hydrogen peroxide (H2O2) during oxidative reactions, leading to various biological and pharmacological outcomes such as apoptosis, cytotoxicity, modulation of platelet aggregation, hemorrhage, and neutrophil activation. Human neutrophils respond to LAAO by enhancing chemotaxis, and phagocytosis, and releasing reactive oxygen species (ROS) and pro-inflammatory mediators. Exosomes cellular nanovesicles play vital roles in intercellular communication, including immune responses. This study investigates the impact of Calloselasma rhodostoma snake venom-derived LAAO (Cr-LAAO) on human neutrophil exosome release, including activation patterns, exosome formation, and content. Neutrophils isolated from healthy donors were stimulated with Cr-LAAO (100 µg/mL) for 3 h, followed by exosome isolation and analysis. Results show that Cr-LAAO induces the release of exosomes with distinct protein content compared to the negative control. Proteomic analysis reveals proteins related to the regulation of immune responses and blood coagulation. This study uncovers Cr-LAAO's ability to activate human neutrophils, leading to exosome release and facilitating intercellular communication, offering insights into potential therapeutic approaches for inflammatory and immunological disorders.
Assuntos
Exossomos , L-Aminoácido Oxidase , Humanos , L-Aminoácido Oxidase/farmacologia , L-Aminoácido Oxidase/metabolismo , Neutrófilos , Exossomos/metabolismo , Peróxido de Hidrogênio/farmacologia , Proteômica , Venenos de SerpentesRESUMO
INTRODUCTION: Understanding changes in cell identity in cancer and ageing is of great importance. In this work, we analyzed how gene expression changes in human tissues are associated with tissue specificity during cancer and ageing using transcriptome data from TCGA and GTEx. RESULTS: We found significant downregulation of tissue-specific genes during ageing in 40% of the tissues analyzed, which suggests loss of tissue identity with age. For most cancer types, we have noted a consistent pattern of downregulation in genes that are specific to the tissue from which the tumor originated. Moreover, we observed in cancer an activation of genes not usually expressed in the tissue of origin as well as an upregulation of genes specific to other tissues. These patterns in cancer were associated with patient survival. The age of the patient, however, did not influence these patterns. CONCLUSION: We identified loss of cellular identity in 40% of the tissues analysed during human ageing, and a clear pattern in cancer, where during tumorigenesis cells express genes specific to other organs while suppressing the expression of genes from their original tissue. The loss of cellular identity observed in cancer is associated with prognosis and is not influenced by age, suggesting that it is a crucial stage in carcinogenesis.
Assuntos
Neoplasias , Transcriptoma , Humanos , Envelhecimento/genética , Neoplasias/genética , Perfilação da Expressão Gênica , Carcinogênese/genéticaRESUMO
Long-term sequelae of coronavirus disease (COVID)-19 are frequent and of major concern. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection affects the host gut microbiota, which is linked to disease severity in patients with COVID-19. Here, we report that the gut microbiota of post-COVID subjects had a remarkable predominance of Enterobacteriaceae strains with an antibiotic-resistant phenotype compared to healthy controls. Additionally, short-chain fatty acid (SCFA) levels were reduced in feces. Fecal transplantation from post-COVID subjects to germ-free mice led to lung inflammation and worse outcomes during pulmonary infection by multidrug-resistant Klebsiella pneumoniae. transplanted mice also exhibited poor cognitive performance. Overall, we show prolonged impacts of SARS-CoV-2 infection on the gut microbiota that persist after subjects have cleared the virus. Together, these data demonstrate that the gut microbiota can directly contribute to post-COVID sequelae, suggesting that it may be a potential therapeutic target.
Assuntos
COVID-19 , Microbioma Gastrointestinal , Animais , Camundongos , SARS-CoV-2 , Antibacterianos , Progressão da DoençaRESUMO
The occurrence of neurological manifestations and complications in pregnant women compared to non-pregnant women with COVID-19 is unclear. This cross-sectional study included women aged over 18 years hospitalized with SARS-CoV-2 infection confirmed by RT-PCR from March to June 2020 in Recife, Brazil. We evaluated 360 women, including 82 pregnant patients who were significantly younger (27.5 vs. 53.6 years; p < 0.01) and less frequently obese (2.4% vs. 15.1%; p < 0.01) than the non-pregnant group. All pregnancies were confirmed using ultrasound imaging. Abdominal pain was the only more frequent COVID-19 manifestation during pregnancy (23.2% vs. 6.8%; p < 0.01), but was not associated with the outcomes. Almost half the pregnant women presented neurological manifestations, including anosmia (31.7%), headache (25.6%), ageusia (17.1%), and fatigue (12.2%). However, neurological manifestations occurred similarly in pregnant and non-pregnant women. Four (4.9%) pregnant women and 64 non-pregnant women (23%) presented delirium, but the frequency with age-adjustment was similar in the non-pregnant group. Pregnant women with COVID and preeclampsia (19.5%) or eclampsia (3.7%) were older (31.8 vs. 26.5 years; p < 0.01), and epileptic seizures occurred more often in association with eclampsia (18.8% vs. 1.5%; p < 0.01) regardless of previous epilepsy. There were three maternal deaths (3.7%), one dead fetus, and one miscarriage. The overall prognosis was good. There was no difference in prolonged hospital stay, the need for ICU and mechanical ventilation, or death when comparing pregnant and non-pregnant women.
Assuntos
COVID-19 , Eclampsia , Complicações Infecciosas na Gravidez , Gravidez , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , COVID-19/complicações , Estudos Transversais , SARS-CoV-2RESUMO
BACKGROUND: The Creutzfeldt-Jakob disease (CJD) is a spongiform encephalopathy that manifests as a rapidly progressive dementia syndrome. Currently, CJD has no cure, and many patients die within the first year, but some drugs are being studied as options for managing this condition. OBJECTIVE: To evaluate the effectiveness of pharmacological treatments offered to patients with CJD as a means to increase survival and reduce cognitive deterioration. METHODS: A systematic review of the literature was performed using 4 independent reviewers and 1 extra reviewer to resolve possible divergences in the search and analysis of papers indexed in MedLINE (PubMed), SciELO and Lilacs databases. The Medical Subject Heading (MeSH) terms used were: prion diseases, Creutzfeldt-Jakob disease, pharmacologic therapy, therapeutics, quinacrine, doxycycline, flupirtine, and pentosan polysulfate, with the Boolean operators AND and OR. This search included controlled clinical trials, uncontrolled clinical trials, and case series published from the year 2000 onwards, in the English language. RESULTS: A total of 85 papers were found using the descriptors used. At the end of the selection analyses, 9 articles remained, which were analyzed fully and individually. CONCLUSIONS: None of the drugs evaluated proved significantly effective in increasing survival in patients with CJD. Flupirtine appears to have a beneficial effect in reducing cognitive deterioration in patients with CJD. However, additional studies are needed to establish better evidence and therapeutic options for the management of patients with CJD.
ANTECEDENTES: A doença de Creutzfeldt-Jakob (DCJ) é uma encefalopatia espongiforme que se manifesta como síndrome demencial rapidamente progressiva. Atualmente, a DCJ não possui cura e muitos pacientes morrem no primeiro ano de doença, mas alguns medicamentos vêm sendo estudados como opções no manejo desta condição. OBJETIVO: Avaliar a eficácia dos tratamentos farmacológicos oferecidos aos pacientes com DCJ no aumento de sobrevida e na redução da deterioração cognitiva. MéTODOS: Foi realizada uma revisão sistemática da literatura utilizando 4 revisores independentes e 1 extra para resolver divergências eventuais na busca e na análise de trabalhos indexados nas bases de dados MedLINE (via PubMed), SciELO e Lilacs. Os termos Medical Subjects Heading (MeSH) utilizados foram: prion diseases, creutzfeldt jakob disease, pharmacologic therapy, therapeutics, quinacrine, doxycycline, flupirtine e pentosan polysulfate, com os operadores booleanos AND e OR. Essa pesquisa incluiu ensaios clínicos controlados, não controlados e séries de casos, publicados a partir do ano 2000 no idioma inglês. RESULTADOS: Ao todo, foram encontrados 85 trabalhos através dos descritores utilizados. Ao final das análises de seleção, restaram 9 artigos, que foram analisados na íntegra individualmente. CONCLUSõES: Nenhuma das drogas avaliadas se mostrou significativamente eficaz no aumento da sobrevida dos pacientes com DCJ. A flupirtina parece ter um efeito benéfico na redução da deterioração cognitiva dos pacientes com DCJ. Entretanto, estudos adicionais são necessários para o estabelecimento de melhores evidências e opções terapêuticas para o manejo dos pacientes com DCJ.
Assuntos
Síndrome de Creutzfeldt-Jakob , Doenças Priônicas , Aminopiridinas , Síndrome de Creutzfeldt-Jakob/tratamento farmacológico , Síndrome de Creutzfeldt-Jakob/psicologia , Doxiciclina/uso terapêutico , Humanos , Poliéster Sulfúrico de Pentosana/uso terapêutico , Quinacrina/uso terapêuticoRESUMO
Abstract Background The Creutzfeldt-Jakob disease (CJD) is a spongiform encephalopathy that manifests as a rapidly progressive dementia syndrome. Currently, CJD has no cure, and many patients die within the first year, but some drugs are being studied as options for managing this condition. Objective To evaluate the effectiveness of pharmacological treatments offered to patients with CJD as a means to increase survival and reduce cognitive deterioration. Methods A systematic review of the literature was performed using 4 independent reviewers and 1 extra reviewer to resolve possible divergences in the search and analysis of papers indexed in MedLINE (PubMed), SciELO and Lilacs databases. The Medical Subject Heading (MeSH) terms used were: prion diseases, Creutzfeldt-Jakob disease, pharmacologic therapy, therapeutics, quinacrine, doxycycline, flupirtine, and pentosan polysulfate, with the Boolean operators AND and OR. This search included controlled clinical trials, uncontrolled clinical trials, and case series published from the year 2000 onwards, in the English language. Results A total of 85 papers were found using the descriptors used. At the end of the selection analyses, 9 articles remained, which were analyzed fully and individually. Conclusions None of the drugs evaluated proved significantly effective in increasing survival in patients with CJD. Flupirtine appears to have a beneficial effect in reducing cognitive deterioration in patients with CJD. However, additional studies are needed to establish better evidence and therapeutic options for the management of patients with CJD.
Resumo Antecedentes A doença de Creutzfeldt-Jakob (DCJ) é uma encefalopatia espongiforme que se manifesta como síndrome demencial rapidamente progressiva. Atualmente, a DCJ não possui cura e muitos pacientes morrem no primeiro ano de doença, mas alguns medicamentos vêm sendo estudados como opções no manejo desta condição. Objetivo Avaliar a eficácia dos tratamentos farmacológicos oferecidos aos pacientes com DCJ no aumento de sobrevida e na redução da deterioração cognitiva. Métodos Foi realizada uma revisão sistemática da literatura utilizando 4 revisores independentes e 1 extra para resolver divergências eventuais na busca e na análise de trabalhos indexados nas bases de dados MedLINE (via PubMed), SciELO e Lilacs. Os termos Medical Subjects Heading (MeSH) utilizados foram: prion diseases, creutzfeldt jakob disease, pharmacologic therapy, therapeutics, quinacrine, doxycycline, flupirtine e pentosan polysulfate, com os operadores booleanos AND e OR. Essa pesquisa incluiu ensaios clínicos controlados, não controlados e séries de casos, publicados a partir do ano 2000 no idioma inglês. Resultados Ao todo, foram encontrados 85 trabalhos através dos descritores utilizados. Ao final das análises de seleção, restaram 9 artigos, que foram analisados na íntegra individualmente. Conclusões Nenhuma das drogas avaliadas se mostrou significativamente eficaz no aumento da sobrevida dos pacientes com DCJ. A flupirtina parece ter um efeito benéfico na redução da deterioração cognitiva dos pacientes com DCJ. Entretanto, estudos adicionais são necessários para o estabelecimento de melhores evidências e opções terapêuticas para o manejo dos pacientes com DCJ.
RESUMO
While neurologic complications are frequently reported among patients with COVID-19 in the general population, they are unknown in pregnant women. This paper summarizes the case reports of pregnant women with confirmed SARS-CoV-2 infection plus a specified neurologic diagnosis. Until November 2021, 18 case reports were found. Both the central and peripheral nervous systems were equally affected: delirium (n = 1), posterior reversible encephalopathy syndrome (n = 4), cerebrovascular disease (n = 2), acute cerebral demyelinating disease (n = 1), acute necrotizing encephalopathy (n = 1), Guillain-Barré syndrome (n = 5), including one patient who also had vestibular neuritis, Bell's palsy (n = 3), and rhabdomyolysis (n = 1). The median maternal age was 32.5 (25-35) years, the median gestational age was 34 (30-36.5) weeks, and 38.9% presented previous medical conditions. Respiratory symptoms were reported in 76.5%, and 76.5% received immunotherapies to treat the COVID-19 or the neurologic complications. Half the women required admission to ICU and, more often, were those with central nervous system involvement (77.8% vs. 22.2%; Chi-square test, p = .018). For 64.7% of women, the most common method of delivery was surgical, although just one case was due to the neurologic complication. There were reports of one spontaneous abortion, two fetal deaths, and no maternal deaths. Only one case presented a poor neurologic outcome. It is possible that our findings are underestimated, considering that there are thousands of reports regarding neurologic complications in the general population with COVID-19.
Assuntos
Aborto Espontâneo , COVID-19 , Síndrome da Leucoencefalopatia Posterior , Complicações na Gravidez , Aborto Espontâneo/epidemiologia , Adulto , COVID-19/complicações , Feminino , Humanos , Lactente , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/terapia , Resultado da Gravidez , SARS-CoV-2RESUMO
BACKGROUND: Neurological manifestations are frequent during COVID-19 but have been poorly studied as prognostic markers of COVID-19. OBJECTIVES: The aim of this study was to assess whether neurological manifestations are associated with a poor prognosis of COVID-19, and which patient and COVID-19 characteristics were associated with encephalopathy. METHODS: This was a retrospective cohort study and included patients admitted with COVID-19 in four hospitals from Recife, Brazil. Data were collected by reviewing medical records. RESULTS: 613 were included; 54.6% were male, the median age was 54 (41-68) years, 26.4% required mechanical ventilation, and 24.1% died. The neurological symptoms presented were: myalgia (25.6%), headache (22%), fatigue (22%), drowsiness (16%), anosmia (14%), disorientation (8.8%), ageusia (7.3%), seizures (2.8%), and dizziness (1.5%). Twelve patients (2%) had strokes (ischemic strokes: 9) and 149 (24.3%), encephalopathy. Older age, a prolonged hospitalization, diabetes mellitus, a previous history of stroke and having epileptic seizures during hospitalization were significantly associated with the occurrence of encephalopathy. Older age, smoking and requiring mechanical ventilation were associated with prolonged hospitalization. Older patients, those requiring mechanical ventilation and those with encephalopathy presented a significantly higher risk, while those who had anosmia presented a significantly lower risk of dying. CONCLUSIONS: Neurological symptoms are frequent among patients with COVID-19. Encephalopathy was the most frequent neurological complication and was associated with a higher mortality. Those with anosmia had a lower mortality.
Assuntos
COVID-19 , Acidente Vascular Cerebral , Anosmia , COVID-19/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Convulsões/epidemiologia , Convulsões/etiologia , Acidente Vascular Cerebral/etiologiaRESUMO
BACKGROUND: Neurological symptoms are frequent among patients with COVID-19. Little is known regarding the repercussions of neurological symptoms for patients and how these symptoms are related to one another. OBJECTIVES: To determine whether there is an association between the neurological symptoms in patients with COVID-19, and to characterize the headache. METHOD: This was a cross-sectional study. All hospital inpatients and health workers at the Hospital Universitario Oswaldo Cruz with a PCR-confirmed COVID-19 infection between March and June 2020 were considered for the study and were interviewed by telephone at least 2-months after the acute phase of the disease. These patients were identified by the hospital epidemiological surveillance department. A semi-structured questionnaire was used containing sociodemographic and clinical data and the ID-Migraine. RESULTS: A total of 288 patients was interviewed; 53.1% were male; with a median age of 49.9 (41.5-60.5) years; 91.7% presented some neurological symptom; 22.2% reported some neurological symptom as the symptom that troubled them most during COVID-19. Neurological symptoms were: ageusia (69.8%), headache (69.1%), anosmia (67%), myalgia (44.4%), drowsiness (37.2%), agitation (20.8%); mental confusion (14.9%), syncope (4.9%) and epileptic seizures (2.8%). Females, those who presented with fever, sore throat, anosmia/ageusia and myalgia also presented significantly more with headache (logistic regression). The most frequent headache phenotype was a non-migraine phenotype, was of severe intensity and differed from previous headaches. This persisted for more than 30 days in 18% and for more than 90 days in 10% of patients. Thirteen percent of those with anosmia and 11% with ageusia continued with these complaints after more than 90 days of the acute phase of the disease. Aged over 50 years, agitation and epileptic seizures were significantly associated with mental confusion (logistic regression). CONCLUSION: Headache is frequent in COVID-19, is associated with other symptoms such as fever, sore throat, anosmia, ageusia, and myalgia, and may persist beyond the acute phase of the disease.
Assuntos
Ageusia , COVID-19 , Idoso , Anosmia , Estudos Transversais , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
The objective was to evaluate the effect of different irrigation systems and harvest frequencies on the cultivation of cactus pear. The study was conducted in the semi-arid region, in the municipality of Russas, CE, Brazil. The experiment was a split plot randomized block design, with four replications. Plots were represented by irrigation systems (surface drip, microsprinkler, Micro Spray Jet, and conventional sprinkler) and subplots by harvest frequencies (6, 9, 12, and 18 months). Cactus pear biomass production characteristics were evaluated. Most of the productive characteristics evaluated were influenced by harvest frequency and irrigation system. The harvest frequency of 12 months combined with conventional sprinkler system resulted in a total dry biomass production of 16,400 kg ha−1. The conventional sprinkler system showed the highest number of second-order cladodes (4.9 cladodes plant−1). The conventional sprinkler and Micro Spray Jet systems showed the highest values for various structural characteristics. For water use efficiency (WUE), the highest value was found at the frequency of six months (8.46 kg ha−1 mm−1). Regarding the effects of irrigation system on WUE, the highest values were observed with the conventional sprinkler system (8.20 kg ha−1 mm−1). The harvest frequency of 12 months combined with the conventional sprinkler system presents better results in the evaluated productive characteristics, mainly the cactus pear production by area.(AU)