TCD4+ Lymphocyte are Related to Muscle Strength Parameters in HIV-1 Positive Adolescents: A Preliminary Study

Introduction: Catabolism of muscle and loss of function are complications that can occur during the course of HIV infection, and are commonly seen in a majority of adolescents with vertically transmitted Human Immunodeficiency Virus-type 1 (HIV-1). The levels of CD4+ and CD8+ lymphocytes, reference markers for the treatment of vertically transmitted HIV-1, also decline as the disease progresses. Alterations on these reference markers may be associated with neuromuscular force parameters in sedentary adolescents that have potential as prognostic indicators for treatment administration. Objective: To investigate the relationship between maximal isometric muscular contraction force and levels of CD4+ and CD8+ lymphocytes in sedentary, vertically transmitted HIV-1 positive adolescents. Methods: The sample consisted of twenty individuals, adolescents (N= 9 males, 11 females, age 15-17 years), vertically transmitted HIV-1 patients from Institute of Infectious Diseases Emilio Ribas in São Paulo, Brazil, who were undergoing HAART therapy randomly selected to participate in the study. The number of CD4+ and CD8+ cells was determined by flow cytometry using BD FacsCalibur Multitest Equipment, and Multiset-BD software. Viral load was determined using b-DNA methodology, on Siemens System Versátil 440 equipment. All analyses followed standard procedures approved by the Brazilian Ministry of Health. Muscular strength measurements were completed in the morning after blood collection and weight and height measurements. Prior to starting, patients were familiarized with all testing procedures and strength exercises that were used for testing. After the warm up, maximum voluntary isometric muscular strength of the elbow flexors and knee extensors were assessed using an electric dynamometer (EMG210C, EMGLAB System of Brazil). Each patient made three attempts with a rest interval of two minutes between trials. The highest isometric force and torque value were recorded and used for analyses. Results: Upper body force (r=0.70, p=0.001) and maximal torque (r=0.69, p=0.001) were significant correlated with CD4+ count. Similar observations between CD4+ count and lower body muscular force (r=0.62, p=0.005) and maximum torque (r=0.61, p=0.007) were also observed. CD8+ was not associated with any strength measures. Conclusion: CD4+ lymphocytes showed a strong correlation with force parameters in sedentary HIV-1 positive adolescents. Given that those individuals with higher TCD4+ counts showed a tendency towards manifesting higher muscle strength, this may be used as a predictor to indicate the level of physical capacity of patients and consequently help optimize treatment. Further research is needed to explore the potential prognostic value of muscle strength parameters in HIV-1 positive adolescents

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Esclerose múltipla: estudo clínico e patológico de um caso

Apresentamos um caso com diagnóstico definido de esclerose múltipla confirmado pelos achados necroscópicos. Os aspectos anatomopatológicos nessa doença são bem conhecidos e têm sido referidos por vários autores. O objetivo desta apresentação é a divulgação do primeiro caso de esclerose múltipla autopsiado na Santa Casa de São Paulo, onde já foram realizadas cerca de 30500 autópsias. Os achados macro e microscópicos observados no sistema nervoso central, com placas de desmielinização em fases diferentes de aíividade, são características da doença. A detecção de imunoglobulinas nessas placas, pelo método de imuno-histoquímica, adicionou aos achados morfológicos a hipótese patogênica de uma doença imunologicamente mediada

Schwannoma maligno de órbita

RESUMO Relatamos um caso de tumor maligno de nervo periférico (schwannoma) na órbita e revisamos a literatura existente sobre essa rara lesão

Crotalphine Attenuates Pain and Neuroinflammation Induced by Experimental Autoimmune Encephalomyelitis in Mice

Multiple sclerosis (MS) is a demyelinating disease of inflammatory and autoimmune origin, which induces sensory and progressive motor impairments, including pain. Cells of the immune system actively participate in the pathogenesis and progression of MS by inducing neuroinflammation, tissue damage, and demyelination. Crotalphine (CRO), a structural analogue to a peptide firstly identified in Crotalus durissus terrificus snake venom, induces analgesia by endogenous opioid release and type 2 cannabinoid receptor (CB2) activation. Since CB2 activation downregulates neuroinflammation and ameliorates symptoms in mice models of MS, it was presently investigated whether CRO has a beneficial effect in the experimental autoimmune encephalomyelitis (EAE). CRO was administered on the 5th day after immunization, in a single dose, or five doses starting at the peak of disease. CRO partially reverted EAE-induced mechanical hyperalgesia and decreased the severity of the clinical signs. In addition, CRO decreases the inflammatory infiltrate and glial cells activation followed by TNF-α and IL-17 downregulation in the spinal cord. Peripherally, CRO recovers the EAE-induced impairment in myelin thickness in the sciatic nerve. Therefore, CRO interferes with central and peripheral neuroinflammation, opening perspectives to MS control

Crotalphine Attenuates Pain and Neuroinflammation Induced by Experimental Autoimmune Encephalomyelitis in Mice

Multiple sclerosis (MS) is a demyelinating disease of inflammatory and autoimmune origin, which induces sensory and progressive motor impairments, including pain. Cells of the immune system actively participate in the pathogenesis and progression of MS by inducing neuroinflammation, tissue damage, and demyelination. Crotalphine (CRO), a structural analogue to a peptide firstly identified in Crotalus durissus terrificus snake venom, induces analgesia by endogenous opioid release and type 2 cannabinoid receptor (CB2) activation. Since CB2 activation downregulates neuroinflammation and ameliorates symptoms in mice models of MS, it was presently investigated whether CRO has a beneficial effect in the experimental autoimmune encephalomyelitis (EAE). CRO was administered on the 5th day after immunization, in a single dose, or five doses starting at the peak of disease. CRO partially reverted EAE-induced mechanical hyperalgesia and decreased the severity of the clinical signs. In addition, CRO decreases the inflammatory infiltrate and glial cells activation followed by TNF-α and IL-17 downregulation in the spinal cord. Peripherally, CRO recovers the EAE-induced impairment in myelin thickness in the sciatic nerve. Therefore, CRO interferes with central and peripheral neuroinflammation, opening perspectives to MS control

Interobserver Variability in Applying American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 Guidelines for Estimation of Left Ventricular Filling Pressure

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