Analysis of the effects of hyperbaric oxygen therapy associated with surgical treatment in brain injuries secondary to experimental hydrocephalus

A hidrocefalia é caracterizada pelo acúmulo de líquor dentro dos ventrículos cerebrais e do espaço subaracnoideo. O volume ventricular pode aumentar progressivamente e gerar graves lesões ao sistema nervoso, tendo a hipóxia/isquemia cerebral como um dos mais importantes fatores envolvidos. A oxigenoterapia hiperbárica (OHB) tem como principal efeito a melhora do aporte de oxigênio aos tecidos, o que pode diminuir a progressão das lesões secundárias ao aumento ventricular. O objetivo deste trabalho foi avaliar se a OHB associada à cirurgia de derivação liquórica promove efeitos neuroprotetores para as estruturas lesadas de forma secundária à hidrocefalia e compreender sua atuação. Foram utilizados ratos machos da linhagem Wistar Hannover com sete dias de vida submetidos à hidrocefalia por injeção intracisternal de caulim 15%. Contendo dez animais em cada, seis grupos foram formados: controle, controle associado à terapia hiperbárica, hidrocefálico sem tratamento, hidrocefálico tratado com oxigenoterapia hiperbárica (3 ATA/2h/dia), hidrocefálico tratado com derivação liquórica e hidrocefálico tratado com oxigenoterapia hiperbárica (3 ATA/2h/dia) associada à derivação liquórica. Para avaliação da resposta ao tratamento foram realizados testes de comportamento (campo aberto, labirinto aquático de Morris modificado e reconhecimento de objetos), avaliação por ultrassonografia transcraniana, estudos histológicos (hematoxilinaeosina e luxol fast blue), imunoistoquímicos (GFAP, Ki-67, Caspase-3, COX-2, NeuN e SOD1) e bioquímicos para quantificação das proteínas GFAP e MBP através do método ELISA. Os resultados mostram que a associação dos tratamentos exerce efeitos neuroprotetores como a melhora neurocomportamental, preservação das estruturas periventriculares e redução de danos decorrentes da isquemia e do processo inflamatório. Concluímos que a oxigenoterapia hiperbárica possui potencial para ser utilizada como tratamento associado à cirurgia de derivação liquórica na hidrocefalia experimental.Hydrocephalus is characterized by the accumulation of CSF inside the cerebral ventricles and the subarachnoid space. Ventricular volume can progressively increase and generate serious damage to the nervous system, with cerebral hypoxia/ischemia as one of the most important factors involved. Hyperbaric oxygen therapy (HBOT) has as its main effect the improvement of oxygen supply to tissues, which can reduce the progression of injuries secondary to ventricular enlargement. This study aimed to evaluate whether HBOT associated with CSF shunt surgery promotes neuroprotective effects for injured structures secondary to hydrocephalus and to understand its role. Seven-day-old male Wistar Hannover rats submitted to hydrocephalus by intracisternal injection of 15% kaolin were used. Containing ten animals in each, six groups were formed: control, control associated with hyperbaric therapy, hydrocephalic without treatment, hydrocephalic treated with hyperbaric oxygen therapy (3 ATA/2h/day), hydrocephalic treated with CSF derivation, and hydrocephalic treated with hyperbaric oxygen therapy (3 ATA/2h/day) associated with CSF derivation. To assess the response to treatment, behavioral tests were performed (open field, modified Morris water maze and object recognition), evaluation by transcranial ultrasonography, histological studies (hematoxylin-eosin and Luxol fast blue), immunohistochemical (GFAP, Ki-67, Caspase-3, COX-2, NeuN, and SOD1) and biochemicals for quantification of GFAP and MBP proteins through the ELISA method. The results show that the combination of treatments exerts neuroprotective effects such as neurobehavioral improvement, preservation of periventricular structures, and reduction of damage resulting from ischemia and the inflammatory process. We conclude that hyperbaric oxygen therapy has the potential to be used as a treatment associated with CSF shunt surgery in experimental hydrocephalus

Epidemiology of hydrocephalus in Brazil

Objective: Describe the epidemiological profile and social-economic burden that hydrocephalus patients represent to the national public health system, using data available at the online database of the Brazilian Health Ministry (DataSUS). Methods: This is a populational study based on descriptive statistics of all clinical and surgical appointments included in the DataSUS database. Data included herein were collected between 2015 and 2021 and subdivided into three main groups, related to hydrocephalus incidence and mortality, hospitalizations, and financial costs. Results: In the study period, 3993 new cases of congenital hydrocephalus were diagnosed, with 6051 deaths overall. The mortality rate in the country was 1.5/100000 live births and the prevalence was 0.374/100000 inhabitants. The number of hospitalizations resulting from treatment procedures and complications of hydrocephalus was 137,880 and there was a reduction of up to 27.2% during the SARS-CoV-2 pandemics concerning previous years. Total costs for hydrocephalus management in the country amounted to 140,610,585.51 dollars. Conclusions: Hydrocephalus has a significant impact on public health budgets and pediatric mortality rates; however, it is probably underestimated, due to the paucity of demographic data and epidemiological studies in Latin America and, specifically, in Brazil. The dataSUS also has several limitations in accessing certain data related to hydrocephalus, making it difficult to have a more assertive understanding of the disease in Brazil. The results of this study provide important guidance for future research projects in clinical and experimental hydrocephalus and also the creation of public policies for better governance and care of hydrocephalus patients

. Estratégia de monitoramento da fadiga orgânica em um grupo de idosos cardiopatas inseridos no programa de reabilitação cardíaca

Este estudo teve como objetivo identificar a ocorrência de fadiga, a qualidade do sono, e o padrão morfológico do estresse oxidativo em 11 pacientes cardiopatas submetidos à intervenção fisioterapêutica para reabilitação físico-funcional. Trata-se de um estudo observacional, longitudinal e amostra de conveniência. Os resultados mostraram que programas de reabilitação cardíaca são fundamentais para mudanças no estilo de vida e redução de novos eventos cardiovasculares. Conclui-se que idosos portadores de doença coronariana, submetidos ao programa de reabilitação cardíaca baseado na intervenção cinesioterapêutica, apresentam-se sem fadiga orgânica, com uma boa qualidade de sono, sob um estresse oxidativo com variação entre os níveis normal, leve ou moderado.  </p