Avaliação de células natural killers (NK) em sangue de circulação periférica e fluido de lavado broncoalveolar de pacientes portadores de sepse pulmonar : estudo de casos-controle

Orientadora : Profª. Drª. Anita NishiyamaTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Fisiologia. Defesa: Curitiba, 29/08/2017Inclui referênciasResumo: A sepse é uma disfunção orgânica aguda complexa potencialmente fatal consequente de uma síndrome de resposta inflamatória sistêmica desencadeada por um quadro infeccioso. Os mecanismos subjacentes à fisiopatologia da sepse que envolve processos dinâmicos pró e anti-inflamatórios ainda permanecem mal compreendidos. As células do Natural Killers (NK) desempenham papel crucial na fisiopatologia da sepse, com íntima relação aos processos de inflamação exagerada decorrentes de sua resposta rápida e da produção de citocinas pró-inflamatórias, como o interferon gama (IFN-?). Vários estudos já mostraram que as células NK tem seus níveis reduzidos no plasma de sangue periférico de pacientes portadores de sepse. No entanto, nossa atual compreensão dos mecanismos por trás do seu tráfego celular, assim como, no seu papel no desenvolvimento da doença está restrita aos estudos em modelos animais de sepse. Neste estudo, buscamos comparar os níveis do subconjunto de células NK humanas (CD56bright e CD56dim) no plasma de sangue periférico e fluido de lavado broncoalveolar (LBA) de pacientes portadores de sepse pulmonar. Realizou-se um estudo caso-controle constituído por 10 pacientes saudáveis (controle) e 23 pacientes portadores de sepse pulmonar internados em Unidades de Terapia Intensiva do Hospital Universitário Cajuru da Pontifícia Universidade Católica do Paraná no período de 2013 a 2015. Embora pudéssemos confirmar observações anteriormente descritas de linfopenia do plasma de sangue periférico, não foram detectadas diferenças significativas nos níveis de células NK no LBA desses pacientes. Em geral, esses achados reforçam a evidência de que a redução dos níveis de células NK no plasma de sangue periférico pode estar associada à mecanismos de morte celular e apoptose consequentes da sepse. Palavras-chave: Células Natural Killers; sepse pulmonar; linfopenia; interleucinas; citocinas pró-inflamatórias; CD4; CD8; lavado broncoalveolar.Abstract: Sepsis is a complex systemic inflammatory syndrome, the most common cause of which is attributed to systemic underlying bacterial infection. The complete mechanisms of the dynamic pro- and anti-inflammatory processes underlying the pathophysiology of sepsis remain poorly understood. Natural killer (NK) cells play a crucial role in the pathophysiology of sepsis, leading to exaggerated inflammation due their rapid response and production of proinflammatory cytokines such as interferon gamma (IFN- ?). Several studies have already shown that NK cells undergo lymphopenia in the peripheral blood of patients with sepsis. However, our understanding of the mechanisms behind its cellular trafficking and its role in disease development is restricted to studies in animal models. In this study, we aimed to compare the human NK cell subset (CD56bright or dim) levels in the peripheral blood and bronchoalveolar lavage (BAL) fluid of sepsis patients. We conducted a case-control study with a sample size consisting of 10 control patients and 23 sepsis patients enrolled at the Hospital Cajuru (Curitiba/PR, Brazil) from 2013 to 2015. Although we were able to confirm previous observations of peripheral blood lymphopenia, no significant differences were detected in NK cell levels in the BAL fluid of these patients. Overall, these findings strengthened the evidence that peripheral blood lymphopenia is likely to be associated with cell death as a consequence of sepsis. Keywords: natural killer cells; lung sepsis; lymphopenia; bronchoalveolar lavage

Risk factors for surgical site infection in patients of myocardial revascularization surgery in Montes Claros, Brazil, between 2008 to 2012

Objective: To identify the risk factors for the development of surgical site infection in patients undergoing myocardial revascularization at a philanthropic and educational hospital in Brazil. Methods: Retrospective cohort study at a philanthropic hospital of Minas Gerais, Brazil, with patients submitted to myocardial revascularization in the period from 2008 to 2012. Data were collected from medical records and records of hospital infection notification. The patients were divided into two groups according to the presence or absence of surgical site infection. For data analysis, one used logistic regression model, with a significance level of 5%. Results: Among the 120 patients studied, 22.5% (27) presented surgical site infection. The presence of hypertension (OR=7.5; CI 95% 2.4-23.6); use of chest tube for a period greater than three days (OR=7.5; CI 95% 2.4-23.6); staying at the hospital after surgery for more than 18 days (OR=9.8; CI 95% 3.1-30.8) remain associated with the surgical site infection. Conclusion: One proposes greater effort in an attempt to reduce the length of stay in hospital after surgery for myocardial revascularization, encouraging the removal, in the shortest possible time, of invasive devices such as the chest tube, aimed at better outcome of patients undergoing that type of surgery

Using timescales to interpret dissolved oxygen distributions in the bottom waters of Chesapeake Bay

A simplified conceptual model based on timescales of gravitational circulation, vertical exchange, and total oxygen consumption rate of the biochemical processes is presented to provide insight into the relationships between estuarine dynamics and bottom water dissolved oxygen (DO). Two dimensionless parameters are introduced to diagnose the relationship between the vertical exchange process and the biochemical DO consumption and the influence of gravitational circulation on replenishment of bottom DO. The relative magnitudes of these timescales provide a linkage between the physical and biochemical processes. The hypoxic and anoxic conditions in deep waters of Chesapeake Bay are successfully interpreted with these three proposed timescales. Because the Bay is a long estuary, the replenishment of the bottom DO due to gravitational circulation diminishes as the bottom water travels farther upstream. The bottom DO is mainly modulated by the vertical exchange process in the middle and upper portions of the Bay. In addition to other physical processes that affect vertical exchange, wind and freshwater are the major predictors of the vertical exchange time. The model is applicable to Chesapeake Bay and other estuaries with persistent gravitational circulation if the dimensionless parameters can be appropriately estimated

Analysis of the racial profile of women with COVID-19: a cross-sectional study about evolution to death of black women in the southeast region of Brazil

Introduction: The first coronavirus disease (COVID-19) case in Brazil was registered in December 2019. Since then, an important social situation has been highlighted. Black women correspond to the highest death rate, by group, in the Southeast even not occupying the highest percentage of diagnosis. This scenario was also experienced in other places around the world. Therefore, some questions must be highlighted, such as social and economic vulnerability of black population in brazilian territory, less access to health service and testing for Covid-19. Objective: This study analyzed the clinical picture and evolution - cure or death-of black women with COVID-19 in the Southeast region. In addition, consolidating knowledge about the factors that precede death in black women and comparing them with other race groups. Methods:  Cross-sectional study with data from the Ministry of Health's Severe Acute Respiratory Syndrome (SARS) from March to November 23, 2020, with a total number of women classified as level 5, with SARS caused by the virus SARS-Cov-2, equal to 33,991, being 21,551 white and 12,063 black. Results and Conclusion: Therefore, black women present themselves as a vulnerable group in relation to COVID-19. This group was less present in the ICU, but both groups, white and black women, had dyspnea as an aggravating factor. Considering those facts, it's possible that black women had less access, this would explain a greater number of deaths among this group compared to white women, which could signify a failure in the health care of this population. When analyzing deaths by age group, it is evident that white women followed the literature pattern - severe forms occur in patients over 65 years of age with comorbidities, while there was a rejuvenation of deaths among black women. It is a limitation of our study not to include comorbidities in the analysis. This situation becomes relevant for directing public policies that aim to reverse the factors associated with this situation. More studies are needed to elucidate the socioeconomic issues that support this outcome, seeking to reduce the number of deaths from COVID-19 in black women

The comprehensive nature of primary health care: evaluation from the user standpoint

This study sought to evaluate the comprehensive nature of Primary Health Care (PHC),from the standpoint of the users of the Family Health Strategy (FHS) and users ofothers services of PHC. It involved a cross-sectional, analytical and quantitativestudy conducted in Montes Claros in the Brazilian state of Minas Gerais. For datacollection, the adult version of a validated Primary Care Assessment Toolquestionnaire was applied to 373 adult service users, of which 124 (33.6%) reportedattendance by the FHS and 249 (66.4%) reported attendance by other services. Scorewere assigned for the eight dimensions of the instrument, though only three were usedfor this study, namely first contact, accessibility, and longitudinality. The resultshowed that in relation to the comprehensive nature of PHC, there was a betterevaluation by the population that uses the FHS compared to those who use otherservices. The first contact, accessibility and longitudinality attributes obtainedhigher scores in the FHS care provided in comparison with other services, withstatistical significance for all attributes. The conclusion drawn is that it is offundamental importance to assess the attributes of PHC in order to improve thequality of services provided.Este estudo objetivou avaliar o processo de integralidade da Atenção Primária à Saúde(APS), sob o ponto de vista dos usuários da Estratégia Saúde da Família (ESF) e dodemais serviços da APS. Estudo transversal, analítico e quantitativo, realizado emMontes Claros, Minas Gerais, Brasil, que utilizou questionário validado Primary CareAssessment Tool, versão adulto, aplicado a 373 usuários adultos, sendo que 124(33,6%) referiram atendimento pela ESF e 249 (66,4%) referiram atendimento por outroserviços. Atribuíram-se escores para as oito dimensões do instrumento, entretanto, opresente estudo trabalhou com apenas três: primeiro contato; acessibilidade; e,longitudinalidade. Em relação à integralidade da APS, houve melhor avaliação pelapopulação que utiliza a ESF, comparando com a de quem utiliza outros serviços. Oatributos primeiro contato, acessibilidade e longitudinalidade obtiveram escores maielevados na modalidade de ESF em comparação com outros serviços, com significânciaestatística para todos os domínios. Conclui-se que é de fundamental importânciaavaliar os atributos da APS, com vistas à melhoria da qualidade dos serviçoprestados.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Enfermagem Programa de Pós-Graduação em CiênciasFaculdade de Saúde e Desenvolvimento Humano Santo Agostinho Departamento de EnfermagemUniversidade Estadual de Montes Claros Departamento de EnfermagemUNIFESP, EPE Programa de Pós-Graduação em CiênciasSciEL

Suplementos alimentares para desempenho físico e composição corporal: condutas baseadas em evidências / Dietary supplements for physical performance and body composition: evidence-based approaches

Objetivo: indicar as principais evidências sobre os suplementos alimentares, utilizados como recursos na melhoria do desempenho físico e da composição corporal. Método: revisão de ensaios clínicos randomizados, a partir das bases de dados Pubmed e SciELO. Foram considerados artigos que apresentavam resultados sobre Nutrição e composição corporal, assim como sobre a influência da Nutrição no desempenho físico. A qualidade dos artigos foi avaliada, antes dos resultados serem incluídos na revisão. Além das evidências científicas indicadas, recomendações atualizadas dos principais Guidelines de Nutrição, no contexto da atividade física, foram consideradas. Resultados: as evidências indicaram recomendações diárias para suplementos preparados com as proteínas do soro do leite, aminoácidos de cadeia ramificada, creatina, cafeína, bicarbonato de sódio, beta-alanina, nitrato e vitaminas e minerais. Indicaram as principais relações com modulação da composição corporal e melhora da performance, tanto em atividades aeróbicas quanto em anaeróbicas. Os suplementos antioxidantes com objetivo de recuperação muscular, após atividade física, não indicaram uma relação clara, sendo considerados inconclusivos, ainda. Conclusão: suplementos alimentares podem auxiliar no desempenho físico e nas mudanças da composição corporal, mas avaliar o estado nutricional é importante, para que esses recursos ergogênicos possam contribuir de forma significativa. Há, ainda, a necessidade de novas orientações científicas, que apoiem a prática baseada na ciência

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio