Evaluation of the Glomerular Filtration Barrier by Electron Microscopy

The plasma filtration and formation of the urine is a very complex process necessary for the elimination of metabolites, toxins, and excessive water and electrolytes from the body. The initial process of urine formations is done by the glomerular filtration barrier inside the glomeruli. This specialized barrier consists of three layers, fenestrated endothelium, basement membrane, and podocytes, which ensure that water and small molecules pass through while cells and large molecules are retained. The glomerular filtration barrier is found with abnormal morphology in several diseases and is associated with renal malfunction; thus, it is interesting to study these structures in different experimental and clinical conditions. The normal glomerular barrier and its alterations in some conditions (hypertension, diabetes, and fetal programming) are discussed in this chapter. Furthermore, some methods for studying the glomerular filtration barrier by electron microscopy, both by qualitative and quantitative methods, are present

DIAGNOSIS OF DIOCTOPHYMA RENALE USING ULTRASONOGRAPHY AND MICROSCOPY - A CASE REPORT

Dioctophyma renale is classified as a cosmopolitan zoonotic helminth, belonging to Nematoda class and Dioctophymoidea superfamily. Dogs are considered definitive hosts, suffering with large kidney damage, and the disease diagnosis can be done through ultrasound, x-ray and light microscopy. The aim in this paper was to report the sonographic and microscopic aspects of a canine affected by Dioctophyma renale. Dark colored urine evolving to hematuria and abdominal pain was the main symptoms observed in the animal. Performing urinalysis it was verified D. renale eggs. Ultrasonography could observe total destruction of the right renal parenchyma, hyperechoic structures of cylindrical and rounded shape bounded by the renal capsule, suggesting the presence of the parasite, while the left kidney had normal size. The animal was submitted to nephrectomy, confirming the worm presence, measuring 31.8 cm long. It can be stated that ultrasound and light microscopy are highly effective to establish a definitive diagnosis of Dioctophyma renale

Fibrossarcoma em sítio de osteossíntese de fêmur com pino e placa em um felino

A 6-year old spayed female Siamese cat was presented with a history of left limb acute lameness. Radiographic imaging revealed a complete comminuted diaphyseal femur fracture, which was corrected through intramedullary pin placement along with plate osteosynthesis. After two months the animal returned to the hospital presenting severe diffuse enlargement of the left hindlimb, characterized as a non-delimited, solid, and firm plaque-like mass surrounding the pin and bone, which extended from the femorotibiopatelar joint to the pelvis, and infiltrated the adjacent musculature. Incisional biopsy exam indicated a highly malignant sarcoma. The entire limb was surgically removed and sent to histopathological evaluation. Microscopically, the mass was composed of spindle shaped cells, displaying high pleomorphism and cellular atypia. Abundant collagen production was evidenced through Masson’s trichrome stain and strong cytoplasmic staining for vimentin. These results were consistent with fibrosarcoma. The cat went through one session of chemotherapy; however, tumor recurrence occurred 20 days later, and the animal was submitted to euthanasia. This is the first description of fibrosarcoma arising in the vicinity of an intramedullary pin and plate in a cat.Uma gata, castrada, 6 anos de idade, da raça Siamês, apresentou histórico clínico de claudicação aguda do membro pélvico esquerdo. O exame radiográfico revelou uma fratura completa cominutiva diafisária do fêmur, a qual foi corrigida através de osteossíntese pela implantação de um pino intramedular, além de placa metálica. Depois de dois meses, o felino retornou ao hospital apresentando aumento severo e difuso do membro pélvico, caracterizada por uma massa não delimitada, sólida, como uma placa, circundando o pino e o osso, a qual se estendia da articulação femorotibiopatelar até a pelve, e infiltrava a musculatura adjacente. A biópsia incisional indicou sarcoma de alta malignidade. O membro inteiro foi cirurgicamente removido e enviado para análise histopatológica. Microscopicamente, a massa era composta por células fusiformes, demonstrando alto pleomorfismo e atipia celular. Abundante produção de colágeno foi evidenciada através da técnica histoquímica de tricrômico de Masson e forte imunomarcação citoplasmática para vimentina. Esses resultados foram consistentes com fibrossarcoma. O felino foi submetido a uma sessão de quimioterapia, porém houve recorrência tumoral 20 dias após a sessão, e o paciente foi submetido a eutanásia. Essa é a primeira descrição de fibrossarcoma que surgiu em local próximo a implantação de pino intramedular e placa em um felino

Equação de predição para o miniexame do estado mental: influência da educação, idade e sexo

O mini-exame do estado mental (MEEM) é um teste de rastreio mundialmente utilizado para identificar alterações no âmbito da cognição. Estudos têm demonstrado a influência da educação, idade e gênero na pontuação do MEEM. No entanto, no Brasil, os estudos consideram apenas um fator para a pontuação no teste. O objetivo do estudo foi estabelecer uma equação preditiva para o MEEM. Um estudo transversal exploratório foi desenvolvido e examinadores treinados avaliaram participantes da comunidade. Os voluntários foram avaliados pelo MEEM e pela Escala de Depressão Geriátrica (EDG). A pontuação do MEEM foi a variável dependente. A idade, nível educacional, gênero e pontuação na EDG foram as variáveis independentes. A análise de regressão multivariada foi utilizada para determinar o modelo de melhor valor preditivo para os escores do MEEM. Foram avaliados 250 indivíduos entre 20 e 99 anos, sem comprometimento cognitivo. O nível educacional, a idade e o sexo explicaram 38% da variância total da pontuação do MEEM (p<0,0001) e resultaram na equação: MEEM=23,350+0,265(anos de escolaridade)-0,042(idade)+1,323(gênero), em que mulher=1 e homem=2. A pontuação do MEEM pode ser melhor explicada e predita quando o nível educacional, idade e gênero são considerados. Os resultados contribuem para o conhecimento sobre as variáveis que influenciam o escore do MEEM, bem como fornece uma maneira de considerá-las na pontuação do teste, proporcionando uma melhor triagem desses pacientes.El mini-examen del estado mental (MEEM) es una prueba de rastreo mundialmente utilizada para identificar alteraciones en el ámbito de la cognición. Los estudios han demostrado la influencia de la educación, la edad y el sexo en la puntuación del MEEM. Sin embargo, en Brasil, los estudios consideran sólo un factor para la puntuación en la prueba. El objetivo del estudio fue establecer una ecuación predictiva para el MEEM. Un estudio transversal exploratorio fue desarrollado y examinadores entrenados evaluaron a participantes de la comunidad. Los participantes fueron evaluados por el MEEM y la Escala de Depresión Geriátrica (EDG). La puntuación del MEEM fue la variable dependiente. La edad, nivel educativo, sexo y puntuación en la EDG fueron las variables independientes. El análisis de regresión multivariada fue utilizado para determinar el modelo de mejor valor predictivo para los escores del MEEM. Se evaluaron 250 individuos entre 20 y 99 años, sin comprometimiento cognitivo. El nivel educativo, la edad y el sexo explicaron el 38% de la varianza total de la puntuación del MEEM (p <0,0001) y resultaron en la ecuación: MEEM=23,350+0,265(años de escolaridad)-0,042 (edad)+1,323 (sexo), en que mujer = 1 y hombre = 2. La puntuación del MEEM puede ser mejor explicada y predecible cuando se considera el nivel educativo, la edad y el sexo. Los resultados contribuyen para el conocimiento sobre las variables que influencian el score del MEEM, así como proporciona una manera de considerar las variables en la puntuación de la prueba, proporcionando una mejor forma de triar a estos pacientes.The mini-mental state examination (MMSE) is a screening test used worldwide for identifying changes in the scope of cognition. Studies have shown the influence of education, age and sex in the MMSE score. However, in Brazil, the studies consider only one factor to score it. The aim of this study was to establish a prediction equation for the MMSE. An exploratory cross-sectional study was developed and trained researchers examined participants at the community. The volunteers were evaluated by the MMSE and also by the Geriatric Depression Scale (GDS). The MMSE score was the dependent variable. Age, educational level, sex, and GDS score were the independent variables. Multivariate regression analysis was used to determine the model of best prediction value for MMSE scores. A total of 250 participants aged 20-99 years, without cognitive impairment, were assessed. The educational level, age, and sex explained 38% of the total variance of the MMSE score (p<0.0001) and resulted in the following equation: MMSE=23.350+0.265(years of schooling)- 0.042(age)+1.323(sex), in which female=1 and male=2. The MMSE scores can be better explained and predicted when educational level, age, and sex are considered. These results enhance the knowledge regarding the variables that influence the MMSE score, as well as provide a way to consider all of them in the test score, providing a better screening of these patients

Benefits of the flipped classroom in health education - a systematic review / Benefícios da sala de aula virada ao contrário na educação sanitária - uma revisão sistemática interrelationship

Introduction: The flipped classroom method is characterized by its contents presentation to the learners before classes and online, reserving the face-to-face meetings to deepen and apply these contents. Objective: To search through literature for the most recent flipped classroom method benefits in the health area. Method: The guidelines for the preparation of systematic reviews were followed, collecting relevant studies, searching for published data sources, selecting the terms for the research, evaluating the eligibility of studies, and extracting relevant data. Results and Discussion: 20 articles published between 2016 and 2020 were selected from the PUBMED, SCIELO, ERIC and MEDLINE databases, according to the eligibility criteria. The main benefits of flipped classroom for students were language development, greater interaction between learners, greater engagement in activities and involvement in projects, flexibility in learning styles, better use of time and better performance in assessments. The professors agreed with such benefits but pointed out that a longer time for the preparation of activities would be a limitation. Conclusion: Flipped classroom method has shown itself to be a promising strategy with many health benefits. More research is needed on its implementation in the current context of the Coronavirus Pandemic in 2020. 

Hipercapnia permissiva em neonatologia na prevenção da displasia broncopulmonar: revisão sistemática.

Objective: To analyze the effects of permissive hypercapnia in reducing lung injury and the development of BPD in newborns in the Neonatal Intensive Care Unit. Methodology: This is a systematic review, using Pubmed, Electronic Library Online (Scielo) and Lilacs databases. Being articles and literature described in English, Portuguese and Spanish. Result: This study identified that most authors obtained benefits related to the use of permissive hypercapnia in the short term, in the duration of the use of mechanical ventilation and oxygen supplementation, however, the potential benefits of exposing children to hypercapnia do not seem to be improve pulmonary outcome and in some studies outcomes are accompanied by neurological sequelae. Conclusion: The evidence of efficacy for the prevention of BPD is inconclusive in relation to conventional ventilation, the current concept that maintaining PaCO2 levels between 45-55 mmHg in high-risk NBs is safe and inconsistent, requiring further randomized studies and clinical trials that demonstrate benefits without presenting greater risks.Objetivo: Analisar os efeitos da hipercapnia permissiva na redução de lesão pulmonar e desenvolvimento da DBP no Recém-Nascido em Unidade de Terapia Intensiva Neonatal. Metodologia: Trata-se de uma revisão sistemática, utilizando as bases de dados Pubmed, Electronic Library Online (Scielo) e Lilacs. Sendo artigos e literaturas descritos em Inglês, Português e Espanhol. Resultados: Este estudo identificou, que em sua maioria os autores obtiveram benefícios relacionados ao uso da hipercapnia permissiva à curto prazo, no tempo de duração ao uso da ventilação mecânica e suplementação de Oxigênio, contudo, os benefícios potenciais de expor crianças a hipercapnia não parecem melhorar o desfecho pulmonar e em alguns estudos os desfechos são acompanhados por sequelas neurológicas. Conclusão: As evidências da eficácia para a prevenção da DBP são inconclusivas em relação à ventilação convencional, o conceito atual de que mantendo os níveis de PaCO2 entre 45-55 mmHg em RNs de alto risco são seguros e inconsistente, necessitando de mais estudos randomizados e ensaios clínicos que demonstrem benefícios sem apresentar maiores riscos

Hipertensão secundária - principais considerações na abordagem clínica: Secondary hypertension - main considerations in the clinical approach

A hipertensão arterial sistêmica (HAS) corresponde à doença crônica mais prevalente no mundo - com cerca de 800 milhões de adultos portadores da doença. Além disso, representa também o fator de risco modificável mais importante para morbidade e mortalidade por todas as causas em todo o mundo, pois pode levar ao desenvolvimento de doenças cardiovasculares, as quais são as principais causas de óbito, mundialmente. Dessa maneira, a hipertensão arterial sistêmica secundária (HASS) representa a forma menos prevalente da doença, contudo, apresenta maiores chances de complicações cardiovasculares devido a sua maior gravidade. Outrossim, a HASS possui múltiplas etiologias e inúmeras causas já foram identificadas, como o hiperaldosteronismo primário e a hipertensão renovascular, as quais são as causas mais prevalentes da doença. Ademais, a doença deve ser considerada, principalmente, em indivíduos com sinais e sintomas característicos, tais como: hipertensão em adultos jovens, pacientes hipertensos que possuam neoplasias, aumento agudo de pressão arterial - em relação à medidas anteriores - e hipertensão arterial sistêmica primária que não responda à terapia medicamentosa. Para o diagnóstico, exames complementares distintos podem ser requisitados, a depender da etiologia suspeita como causa da HASS; bem como o tratamento, o qual irá ser específico para cada causa da doença

SARS-CoV-2 uses CD4 to infect T helper lymphocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.</p

SARS-CoV-2 uses CD4 to infect T helper lymphocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.</p