Perfil epidemiológico de doentes renais crônicos em tratamento hemodialítico: uma revisão de literatura

Doença Renal Crônica é caracterizada como uma síndrome de redução da função renal e de depuração sanguínea com repercussões metabólicas. A hemodiálise é um processo de filtração sanguínea extracorpórea que proporciona concentrações plasmáticas semelhantes à de indivíduos saudáveis. Com o intuito de traçar o perfil epidemiológico dos usuários de hemodiálise, foi realizado estudo bibliográfico por meio de indexadores nacionais e internacionais através de pesquisa nas bases de dados Biblioteca Virtual da Saúde e Scientific Electronic Library Online (SciELO), no período de 2006 a 2014. Foram utilizados os descritores: Perfil epidemiológico, Hemodiálise, Insuficiência Renal, Terapêutica. Foram selecionados 20 artigos e, após a análise dos dados, foi traçado um perfil que indica uma maior prevalência de Doença Renal Crônica em homens, na faixa etária entre 50 e 55 anos. As comorbidades associadas, foram o Diabetes Mellitus e a Hipertensão Arterial Sistêmica. E a mortalidade variou entre 10,4% a 42 % da população. O estado nutricional foi considerado bom em uma ínfima parcela de pacientes, sendo que a maioria possuía níveis reduzidos de creatinina, colesterol e hemoglobina. O conhecimento do perfil dos pacientes em hemodiálise é de suma importância para delimitar o grupo de risco que poderá apresentar Doença Renal Crônica e, por meio de ações de prevenção e conscientização da população na atenção básica, reduzir a incidência desta doença na população e melhorar a qualidade de vida brasileira

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

The Effects of Acute Exercise and Exercise Training on Plasma Homocysteine: A Meta-Analysis.

BACKGROUND:Although studies have demonstrated that physical exercise alters homocysteine levels in the blood, meta-analyses of the effects of acute exercise and exercise training on homocysteine blood concentration have not been performed, especially regarding the duration and intensity of exercise, which could affect homocysteine levels differently. OBJECTIVE:The aim of this meta-analysis was to ascertain the effects of acute exercise and exercise training on homocysteine levels in the blood. METHOD:A review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the online databases PubMed, SPORTDiscus, and SciELO to identify relevant studies published through June 2015. Review Manager was used to calculate the effect size of acute exercise and exercise training using the change in Hcy plasmaserum concentration from baseline to post-acute exercise and trained vs. sedentary control groups, respectively. Weighted mean differences were calculated using random effect models. RESULTS:Given the abundance of studies, acute exercise trials were divided into two subgroups according to exercise volume and intensity, whereas the effects of exercise training were analyzed together. Overall, 22 studies with a total of 520 participants indicated increased plasma homocysteine concentration after acute exercise (1.18 μmol/L, 95% CI: 0.71 to 1.65, p < .01). Results of a subgroup analysis indicated that either long-term exercise of low-to-moderate intensity (1.39 μmol/L, 95% CI: 0.9 to 1.89, p < .01) or short-term exercise of high intensity (0.83 μmol/L, 95% CI: 0.19 to 1.40, p < .01) elevated homocysteine levels in the blood. Increased homocysteine induced by exercise was significantly associated with volume of exercise, but not intensity. By contrast, resistance training reduced plasma homocysteine concentration (-1.53 μmol/L, 95% CI: -2.77 to -0.28, p = .02), though aerobic training did not. The cumulative results of the seven studies with a total of 230 participants in exercise training analysis did not demonstrate a significant impact on homocysteine levels in the blood (-0.56 μmol/L, 95% CI: -1.61 to 0.50, p = .23). CONCLUSIONS:Current evidence demonstrates that acute exercise increases homocysteine levels in the blood independent of exercise duration and intensity. Resistance, but not aerobic training decreases plasma homocysteine levels

O trabalho do cirurgião-dentista e o estresse: considerações teóricas - doi:10.5020/18061230.2005.p50

The activity of Dentistry is facing serious problems nowadays, which is projected in an unprecedented crisis. Dentists are suffering from decrease in income, reduction of the number of patients in the private clinic due to the decrease in the patients’ acquisitive power and the increase in the costs of materials and equipments imposed by new technologies. This work aims at making a reflection about the determinant factors of the stress affecting dentists who work full time. The results of the study showed that dentists with more than twenty years’ professional practice complain about diseases related to psychological stress such as postural disturbances, cervical column pains, persistent head-aches, arterial hypertension, depression, fibro-muscular pain, sexual activity upsets, heart attacks, breathing insufficiencies, precocious aging and cancer. Thus, it is concluded that the activities developed by those professionals bring serious psychological consequences demonstrated by the psychosomatic diseases they present. There is need to promote Health Education activities in order to improve the dentists’ self-esteem by means of discussions and reflections on those problemsA atividade odontológica vem sofrendo graves problemas nos dias atuais, os quais se projetam em uma crise sem precedentes. Registram-se a diminuição da receita, a redução do número de pacientes na clínica privada, em razão da queda do poder aquisitivo das pessoas e o aumento dos custos com insumos e equipamentos impostos pelas novas tecnologias. Este trabalho tem como objetivo realizar uma reflexão sobre os fatores determinantes do estresse apresentados pelo cirurgião-dentista num contexto de jornada dupla de trabalho. Os resultados do estudo demonstraram que os cirurgiões-dentistas com mais de vinte anos de atividade profissional queixam-se de doenças sabidamente relacionadas ao estresse psicológico tais como: distúrbios posturais, dores na coluna cervical, enxaquecas constantes, hipertensão arterial, depressão, fibromialgias, distúrbios da atividade sexual, infartos, insuficiências respiratórias, envelhecimento precoce e câncer. Assim, conclui-se que as atividades desenvolvidas por esses profissionais trazem sérias conseqüências psicológicas demonstradas pelas doenças psicossomáticas apresentadas pelos mesmos. Há necessidade de promoverem-se atividades de Educação em Saúde para ajudar na melhoria da auto-estima através de discussões e reflexões sobre esses problema

Meta-analysis performed on the effects of exercise training on blood Hcy concentration demonstrated as trained vs sedentary control groups.

<p>Calculation based on random effects model. Results are expressed as weighted mean difference (WMD) of Hcy (μmol/l) and 95% confidence intervals (95% CI).</p

Bubble plot showing the dose–response relationship between the mean volume (A) and Intensity (B) of exercise intervention and effect size changes for Hcy plasma levels (%) for the eighteen included studies.

<p>For one single continuous variable, the fitted regression line together with circles representing the estimates from each study, sized according to precision of each estimate in the fitted random-effects meta-regression. Studies included: Murawaska-Cialowicz [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref042" target="_blank">42</a>], Deminice et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref053" target="_blank">53</a>], Iglesias-Gutiérrez et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref033" target="_blank">33</a>], Hammouda et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref034" target="_blank">34</a>], McAnulty et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref044" target="_blank">44</a>], Bizheh [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref048" target="_blank">48</a>], Benedini et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref051" target="_blank">51</a>], Venta et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref035" target="_blank">35</a>], Subaşı et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref047" target="_blank">47</a>], Gelecek et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref045" target="_blank">45</a>], Real et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref052" target="_blank">52</a>], O’dochartaigh et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref039" target="_blank">39</a>], König et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref049" target="_blank">49</a>], Herrmann et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref050" target="_blank">50</a>], De Crée et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref040" target="_blank">40</a>], De Crée et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref041" target="_blank">41</a>], Wright et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151653#pone.0151653.ref046" target="_blank">46</a>].</p

PRISMA flow diagram of the study selection process.

<p>After careful discussion between the 2 reviewers, two outcomes were identified and included in the meta-analysis.</p

Characteristics of studies included in the exercise training analysis (outcome 2).

<p>Characteristics of studies included in the exercise training analysis (outcome 2).</p