IMUNOPATOLOGIA INFLAMATÓRIA DA COVID-19 E SUA CORRELAÇÃO COM A GRAVIDADE DA DOENÇA

SARS-CoV-2, which caused the coronavirus pandemic in 2019 (COVID-19), is a beta-coronavirus, and its infection in host cells can activate innate and adaptive immune responses through the activation of several pro-inflammatory cytokines. Thus, in this study we established the relationship between the severity and immunopathology of COVID-19 through the main inflammatory cytokines. Results show that tumor necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ) and interleukins (IL), such as IL-6, are stimulated by the activation of T cell subsets, which results in immune-mediated cellular destruction. Several cytokines reduce the immune response and predispose to a pro-inflammatory and auto-reactive state, including IL-1β, IL-1RA, IL-7, IL-8, IL-9, IL-10, and associated inflammatory markers (LDH, GM-CSF and VEGF). These higher cytokine levels end up favoring tissue damage in multiple systems, including lungs, heart, gastrointestinal, brain, kidneys and other organs. Increasingly, a greater impact of the markers IL-6, ferritin, pro-calcitonin, lactic dehydrogenase, D-dimer and hypoalbuminemia was observed in patients with severe infection of the disease. In general, the data analyzed confirmed that COVID-19 severity is not caused simply by the viral infection, but rather by immune response and aberrant inflammation. In this way, this study allows a contribution to clinical practice, and it shows that it is essential to carry out in-depth studies about the immunopathology of COVID-19, in order to determine the severity markers involved in the pathogenesis of the viral infection.O SARS-CoV-2, causador da doença coronavírus 2019 (COVID-19), é um beta-coronavírus, e sua infecção nas células do hospedeiro pode ativar respostas imunes inata e adaptativa, por meio da secreção de várias citocinas pró-inflamatórias. Assim, estabelecemos neste estudo a correlação da gravidade e imunopatologia da COVID-19 com as principais citocinas inflamatórias. Resultados mostram que o fator de necrose tumoral alfa (TNF-α), interferon-gama (IFN-γ) e interleucinas (IL), como a IL-6, são estimulados pela ativação de subconjuntos de células T, o que resulta em destruição celular imunomediada. Sendo que, diversas citocinas deprimem a resposta imune sadia, e predispõem a um estado pró-inflamatório e auto-reativo, dentre elas, IL-1β, IL-1RA, IL-7, IL-8, IL-9, IL-10, e os marcadores inflamatórios associados (LDH, GM-CSF e VEGF). Isso acaba por favorecer danos teciduais em múltiplos sistemas, como no pulmonar, cardíaco, gastrointestinal, cerebral, renal, dentre outros. Acrescenta-se que foi observado um impacto maior dos marcadores IL-6, ferritina, pró-calcitonina, desidrogenase láctica, D-dímero e hipoalbuminemia em pacientes com infecção grave da doença. De forma geral, pela análise de dados, verificou-se que a gravidade da doença COVID-19 parece ser modulada não apenas pela infecção viral, mas também por respostas imunes e inflamatórias aberrantes no hospedeiro. Dessa forma, este estudo permite contribuir para o auxílio da prática clínica, sendo imprescindível a realização de estudos aprofundados acerca da imunopatologia da COVID-19, a fim de que se determine os marcadores de gravidade envolvidos na patogênese da infecção viral

Ensino médico e as controvérsias da realidade no rastreamento inicial do câncer de mama na mulher

O ensino médico de ginecologia deve orientar os seus discentes para a importância da mamografia no rastreamento do câncer de mama da mulher, porque este método diagnóstico tem sido considerado o exame mais sensível para a detecção precoce deste tipo de câncer. O programa Viva Mulher do Ministério da Saúde, é um programa multidisciplinar de aconselhamento genético, estabelecendo um cenário ideal para orientação das famílias de alto risco e com protocolo de pesquisa coordenados pelo corpo docente, e poderá ser dimensionado para o ensino médico. Uma vez que a lei estabelece a realização da mamografia a partir dos 40 anos nas mulheres, como método de rasteamento inicial do câncer de mama, sem, no entanto, especificar o tempo em anos da repetição do exame, o profissional fica exposto a questões éticas e aos processos judiciais inerentes aos atendimentos desses pacientes do Sistema Único de Saúde (SUS), realizados nos ambulatórios. É necessário dentro da academia, o levantamento e discussão desta questão, para que o futuro médico tenha sua base de atendimento e experiência consolidados ainda no curso de Graduação em Medicina e apto para o mercado de trabalho neste setor

[paracoccidioidomycosis In Cerebral Hemisphere And Brainstem: Case Report].

We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100 mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines).64686-

Paracoccidioidomycosis in cerebral hemisphere and brainstem: case report

We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines).Relata-se sobre um homem de 36 anos com passagem quatro anos antes pela selva amazônica. Admitido após seis meses do aparecimento progressivo de tetraparesia, ataxia de marcha, disfagia, disartria, dispnéia e soluço. A ressonância magnética revelou lesão parietoccipital à direita e no bulbo, sendo esta última maior. Investigações para tuberculose e síndrome da imunodeficiência adquirida tiveram resultados negativos. Foi submetido a microcirurgia da lesão do bulbo. O estudo anatomopatológico revelou paracoccidioidomicose. Recebeu tratamento com anfotericina B até 2100 mg, e sulfametoxazol-trimetoprim por três meses, e fisioterapia. Voltou às atividades após seis meses do término do tratamento. Comenta-se sobre a participação do sistema imunológico e das citocinas (interleucinas).68668

Influence of vegetation physiognomy, elevation and fire frequency on medium and large mammals in two protected areas of the Espinhaco Range

The objectives of this study were to determine the richness of medium and large mammal species in two protected areas of the Espinhaço Mountain Range, state of Minas Gerais, Brazil; and to investigate the factors affecting the occurrence of those species. To accomplish that we placed 49 camera traps activated by heat and motion at Rio Preto State Park (RPSP) and 48 at Sempre Vivas National Park (SVNP). We also collected data on three environmental variables: vegetation physiognomy, elevation and wildfire frequency, to evaluate the influence of these factors on species richness and use intensity (inferred from camera trap detection rate) by large mammals. We recorded 23 large mammal species in the two parks combined. The lowest species richness was found at the rupestrian habitat of RPSP, and in the open grasslands of SVNP. The forest and savannah physiognomies were used more intensively by large mammals. Species richness was higher and use was greater at lower elevations of RPSP. In SVNP, fire frequency did not affect species richness or use intensity. The savannah habitat had very similar richness compared to the forests of the two protected areas. The high species richness and use intensity observed in these forest habitats highlights the importance of riparian environments in the Cerrado biome. The highest species richness and use intensity observed at low elevation follows patterns found in the literature, probably due to variation in the vegetation, which results in greater resource availability. Although rupestrian habitats at high elevations of the Espinhaço Range are known to have a high degree of endemism for some taxa, large mammal richness and use were not high in this habitat. These results indicate that the protection of native vegetation at lower elevations is crucial for the long-term conservation of large mammals in the Espinhaço Range