IL-6 levels are associated with clinical status in patients with Myasthenia Gravis

Background: Myasthenia gravis (MG) is an autoimmune disease marked by fluctuating course of muscle weakness. Objectives: The current study was designed to evaluate plasma levels of cytokines (IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL17A) in patients with MG and controls and to investigate whether cytokines levels are associated with clinical parameters. This study was conducted at the Neuromuscular Diseases Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil. Methods: Peripheral blood was drawn, and plasma levels of cytokines were measured by cytometric bead array (CBA) in 80 treated patients with MG and 50 controls. The MG Composite (MGC) was used to evaluate muscle weakness and severity of typical motor symptoms of MG. Results: Patients with MG undergoing treatment exhibit lower levels of all evaluated cytokines compared to controls. There was a negative correlation between IL-6 levels and the MG Composite score, indicating that higher levels of IL-6 were associated with better control of the disease. Conclusion: This exploratory study suggests that IL-6 is associated with MG clinical status, as assessed by the MG

Patient-Reported Value of a Standardized Welcome Letter for Huntington Disease Clinic

Communication is an essential component of patient satisfaction, which can be especially challenging in patients with neurobehavioral symptoms. As an effective form of communication, Patient Welcome Letter (PWL) should be designed in a way to cover a wide range of literacy. We designed a PWL for our Huntington Disease (HD) clinic using readability and suitability measures. Of the 80 patients that received the PWL, 47 filled out the survey. A majority of patients (\u3e90%) found the PWL clear, understandable, and well-organized. The PWL was deemed valuable overall by 91.4% of participants

CONHECIMENTO DE ESTUDANTES DE ENFERMAGEM SOBRE PARADA CARDIORRESPIRATÓRIA: ESTUDO TRANSVERSAL

Objetivo: avaliar o conhecimento de estudantes de enfermagem sobre o atendimento ao paciente em parada cardiorrespiratória. Método: estudo transversal com abordagem quantitativa, realizado com 136 acadêmicos do curso de enfermagem de uma instituição de ensino superior. Os dados foram coletados por meio de instrumento semiestruturado. A análise efetivou-se por meio da estatística descritiva e inferencial. Resultados: os discentes que se autoavaliaram positivamente, mostraram um bom nível de conhecimento sobre a temática (r=0,29; p=0,001), assim como aqueles que haviam cursado a disciplina de primeiros socorros em períodos anteriores (p=0,012). As questões nas quais obtiveram erro foram aquelas a respeito das vias de administração da droga e suporte ventilatório em pacientes não intubados. Conclusão: os discentes de enfermagem demonstraram um nível adequado de compreensão dos protocolos sobre o atendimento ao paciente em parada cardiorrespiratória e possuíam arcabouço teórico obtido na disciplina de primeiros socorros, bem como em cursos de aperfeiçoamento. Descritores: Enfermagem. Estudantes de Enfermagem. Conhecimento. Parada Cardíaca.

Two protocols of aerobic exercise modulate the counter-regulatory axis of the renin-angiotensin system.

Aims: The renin-angiotensin system (RAS) is a dual system with two opposite arms: i) the classical one formed by the angiotensin converting enzyme (ACE), angiotensin (Ang) II and angiotensin type 1 (AT1) receptors; ii) the counter-regulatory arm consisting of ACE2, Ang-(1?7) and Mas receptor. Physical exercise can modulate this system, however, only animal studies have compared the effects of different intensity protocols on the RAS. No data with humans were provided. Therefore, we investigated the acute effect of two protocols of isowork aerobic exercise [High-Intensity Interval Exercise (HIIE) and Moderate-Intensity Continuous Exercise (MICE)] in plasma and urinary levels of RAS components in physically active men. Main methods: The HIIE protocol included a 5-minute warm-up cycling at 60?70% of heart rate peak (HRp) intensity followed by 10 sets of 30 s above 90% with 1 min of recovery and 3 min of cool down. The MICE protocol was performed at a constant power corresponding to 60?70% of HRp and finalized at the same total work of HIIE. Blood and urine samples were collected before and after the protocols. Plasma and urinary levels of ACE, ACE2, Ang-(1?7) and Ang II were analyzed by enzyme-linked immunoassay. Key findings: While the HIIE protocol significantly increased urinary levels of ACE and plasma levels of ACE2, the MICE protocol elevated urinary concentrations of ACE2 and of Ang-(1?7). A greater increase of urine concentrations of Ang-(1?7) occurred in the MICE if compared with the HIIE protocol. Significance: Aerobic physical exercise acutely increases the activity of the counter-regulatory RAS axis, mostly the MICE protocol

Profile of occurrence in the service to elderly people by the mobile pre-hospital care service / Perfil de ocorrência no atendimento aos idosos pelo serviço de atendimento pré-hospitalar móvel

Objetivo: analisar o perfil das ocorrências clínicas e traumatológicas em idosos atendidos pelo Serviço de Atendimento Móvel de Urgências. Métodos: estudo descritivo, transversal, documental retrospectivo, realizado em 359 registros do Serviço de Atendimento Móvel de Urgência em um município da Paraíba, entre julho de 2017 e julho de 2018. Utilizou-se um instrumento com questões sociodemográfica, natureza da ocorrência e intervenções realizadas. Analisou-se os dados com estatística descritiva e inferencial. Resultados: a maioria das ocorrências acometeram homens de 80 anos ou mais. Os agravos clínicos predominaram em ambos os sexos (79,9%), seguido pelas ocorrências traumáticas (19,4%). Destas, 84,2% foram quedas, 14,3% acidentes e 1,5% afogamento. A Unidade de Suporte Avançado de Vida foi utilizada em 77,2% das ocorrências. As intervenções prevalentes foram a instalação do acesso venoso periférico e a oxigenoterapia. Conclusão: enfatiza-se a necessidade do reconhecimento dos grupos vulneráveis para compreender os aspectos relacionados as ocorrências e implementar medidas preventivas.

Institucionalização da pessoa idosa: determinantes e caracterização sociodemográfica

Introdução. A pessoa idosa necessita de demandas de cuidado específicas, o que impulsiona as famílias a buscarem internações para estes em Instituições de Longa Permanência. Objetivo: investigar, à luz da literatura, os determinantes da institucionalização e as características sociodemograficas dos idosos institucionalizados. Métodos. Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados LILACS, MEDILINE e BDENF, com os Descritores em Ciênias da Saúde e seus respectivos correspondentes do Medical Subject Headings: idoso (aged), institucionalização (institutionalization), envelhecimento (aging). A amostra final foi constituída por 30 estudos. A análise dos dados foi feita por meio da análise categorial temática proposta por Bardin. Resultados. Os determinantes da institucionalização da pessoa idosa identificados foram: falta de cuidador formal; falta de disponibilidade dos familiares; abandono; decisão do idoso; problemas de saúde; morar na rua e restrições financeiras. Quanto às caracteristicas sociodemográficas ocorreu predominância do sexo feminino; idade entre 65 e 75 anos; solteiros e viúvos; baixa escolaridade e baixa renda. Considerações finais. Estudos, como este, cooperam para o planejamento de cuidados de enfermagem mais eficaz fortalecendo as ações voltadas à prevençao deste desfecho.Introducción. Los ancianos necesitan demandas de atención específicas, lo que lleva a las familias a buscar hospitalización en instituciones de atención a largo plazo. Objetivo. Investigar, a la luz de la literatura, los determinantes de la institucionalización y las características sociodemográficas de los ancianos institucionalizados. Métodos. Esta es una revisión de literatura integradora, realizada en las bases de datos LILACS, MEDILINE, y BDENF, con los Descriptores de Ciencias de la Salud y sus respectivos corresponsales de Encabezamientos de Temas Médicos: ancianos (ancianos), institucionalización (institucionalización), envejecimiento. La muestra final consistió en 30 estudios. El análisis de datos se realizó utilizando el análisis categórico temático propuesto por Bardin. Resultados. Los determinantes de la institucionalización de los ancianos identificados fueron: falta de cuidador formal; falta de disponibilidad de miembros de la familia; abandono decisión de los ancianos; problemas de salud; vivir en la calle y restricciones financieras. En cuanto a las características sociodemográficas, hubo un predominio de las mujeres; edad entre 65 y 75 años; soltero y viudo; baja educación y bajos ingresos. Consideraciones finales. Estudios como este, cooperan para una planificación más eficaz de la atención de enfermería, fortaleciendo las acciones destinadas a prevenir este resultado.Introduction. The elderly need specific care demands, which drives families to seek hospitalization for them in long-term care institutions. Objective. To investigate, in the light of the literature, the determinants of institutionalization and the sociodemographic characteristics of institutionalized elderly. Methods. This is an integrative literature review, performed in the databases LILACS, MEDILINE, and BDENF, with the Health Science Descriptors and their respective Medical Subject Headings correspondents: elderly (aged), institutionalization (institutionalization), aging. The final sample consisted of 30 studies. Data analysis was performed using the thematic categorical analysis proposed by Bardin. Results. The determinants of institutionalization of the elderly identified were: lack of formal caregiver; lack of availability of family members; abandonment; decision of the elderly; health problems; live on the street and financial restrictions. As for sociodemographic characteristics, there was a predominance of females; age between 65 and 75 years; single and widowed; low education and low income. Final considerations. Studies, such as this one, cooperate for more effective nursing care planning, strengthening actions aimed at preventing this outcome

Revisiting the role of eotaxin-1/CCL11 in psychiatric disorders

Eotaxin-1/CCL11 is a chemokine originally implicated in the selective recruitment of eosinophils into inflammatory sites during allergic reactions, being thoroughly investigated in asthma, allergic rhinitis, and other eosinophil-related conditions. Eotaxin-1/CCL11 is also involved with a skewed immune response toward a type-2 (Th2) profile. In addition to its role in immune response, recent studies have shown that eotaxin-1/CCL11 is associated with aging, neurogenesis and neurodegeneration, being able to influence neural progenitor cells, and microglia. Increased circulating levels of eotaxin-1/CCL11 have been described in major psychiatric disorders (schizophrenia, bipolar disorder, major depression), sometimes correlating with the severity of psychopathological and cognitive parameters. As similar findings have been reported in neurodegenerative conditions such as Alzheimer’s disease, it has been hypothesized that mechanisms involving eotaxin-1/CCL11 signaling may underlie the “accelerated aging” profile commonly linked to psychiatric disorders. Future studies must determine whether eotaxin-1/CCL11 can be regarded as a prognostic biomarker and/or as therapeutic target for resistant/progressive cases

Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management

Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of “mild behavioral impairment”, the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects

Promises and pitfalls of immune-based strategies for Huntington's disease

Huntington's disease (HD) is an autosomal-dominant neurodegenerative disease characterized by the selective loss of neurons in the striatum and cortex, leading to progressive motor dysfunction, cognitive decline and behavioral symptoms. HD is caused by a trinucleotide (CAG) repeat expansion in the gene encoding for huntingtin. Several studies have suggested that inflammation is an important feature of HD and it is already observed in the early stages of the disease. Recently, new molecules presenting anti-inflammatory and/or immunomodulatory have been investigated for HD. The objective of this review is to discuss the data obtained so far on the immune-based therapeutic strategies for HD