ABSTRACT
O estudo pretendeu avaliar a fisiopatologia correlacionada, as diferenças de sexo e as comorbidades associadas à síndrome da apneia e hipopneia obstrutiva do sono. Trata-se de uma revisão de literatura realizada a partir dos dados obtidos pesquisas com as palavras-chaves "Síndrome de Apneia e Hipopneia do Sono", "Fisiopatologia", "Fatores de Risco", "Comorbidades e Sexo" nas plataformas digitais SciELO, PubMed, DESC Bireme e Google Acadêmico no período de 2008 a 2018. O sono é dividido em sono Rapid Eye Movement e sono Non-Rapid Eye Movement. A síndrome da apneia e hipopneia do sono é observada pelo ronco e caracterizada pela obstrução total (apneia) ou parcial (hipopneia) das vias aéreas superiores, que leva ao colapso e à dessaturação da oxi-hemoglobina e, consequentemente, causa hipóxia. Os índices de apneia e hipopneia são diagnosticados pela polissonografia e classificam o distúrbio em leve, moderado ou grave. A síndrome da apneia e hipopneia do sono apresenta-se frequentemente associada à obesidade e a doenças cardiovasculares, sendo principalmente observada em homens. A síndrome é considerada um problema de saúde pública mundial e envolve uma equipe multidisciplinar para o tratamento farmacológico ou não farmacológico. Dentre as principais comorbidades verificadas estão obesidade, hipertensão, arritmias e diabetes Mellitus tipo 2.
To evaluate correlated pathophysiologies, sex differences, and comorbidities associated with Obstructive Sleep Apnea-Hypopnea Syndrome. This is a literature review based on data obtained in SciELO, PubMed, DESC Bireme, and Google Scholar in the period between 2008 and 2018, using the following keywords: "Sleep Apnea and Hypopnea Syndrome", "Pathophysiology", "Risk Factors", "Comorbidities and Sex". Sleep is divided into Rapid Eye Movement sleep and Non- Rapid Eye Movement sleep. Obstructive Sleep Apnea-Hypopnea Syndrome is characterized by the total (apnea) or partial (hypopnea) obstruction of the upper airways, which results in snoring and leads to the collapse and desaturation of oxyhemoglobin, causing hypoxia. Apnea and hypopnea indexes are diagnosed by polysomnography and classified as mild, moderate, and severe. ApneaHypopnea Syndrome is often associated with obesity and cardiovascular diseases, and it is mainly observed in men. Apnea-Hypopnea Syndrome is a global public health problem, involving a multidisciplinary team for pharmacological or non-pharmacological treatment. Among the main comorbidities observed are: obesity, hypertension, arrhythmias, and type 2 diabetes Mellitus
Subject(s)
Sleep Stages , Cardiovascular Diseases , Comorbidity , Sleep Apnea, Obstructive , Diabetes Mellitus , ObesityABSTRACT
Objetivo Determinar estrutural básica e modelagem molecular por via comparativa da giroxina, uma serinoprotease trombina símile isolada do veneno da Crotalus durissus terrificus. Métodos As análises de similaridade de estrutura primária e secundária foram geradas através de sistemas logarítmicos e probabilísticos de modo a encontrar um molde proteico da mesma família da giroxina com capacidade de servir de molde para gerar estruturas tridimensionais comparativas da proteína selecionada. Resultados A giroxina é uma proteína com 241 aminoácidos, de caráter ácido, instável e de melhor ação em meio aquoso. Possui um peso molecular de 26.1kDa e 6 prováveis pontes de dissulfeto. Conclusões A giroxina é uma proteína trombina símile com ação na dissolução de coágulos e seu estudo estrutura-atividade pode trazer novos fármacos para embolias pulmonares, infartos cardíacos e trombose de membros baixos. Novos estudos observam a interação da giroxina com receptores PAR-1 de astrócitos o que pode indicar uma nova classe de medicamentos para tratamento de síndromes neurodegenerativas, tais como a síndrome de Parkinson.
Objective To determination basic structure and molecular modeling by comparative means of gyroxin, a serinoproteases trombinelike isolated from the Crotalus durissus terrifius venom. Methods Analysis of similarity of primary and secondary structures generated through logaritmic and probabilistic systems to find a protein model of the same family with capacity to be used as template to create tridimensional comparative structures of the selected protein. Results The gyroxin is a 241 aminoacids protein, of acid qualities, instable and have better activity in water solutions. It has 26.1kDa of molecular weight and 6 probable dissulfide bonds. Conclusions Gyroxin is a trombine-like protein acting to dissolve blood clots and her structure-activity study may bring new drugs to treat pulmonary embolism, cardiac arrest and lower members tromboses. New studies appoint the interaction between gyroxin and PAR-1 astrocytes receptors who may indicate a new class of neurodegeneratives syndromes drugs, such as Parkinson's syndrome.
ABSTRACT
Apesar de estarmos completando praticamente um século desde a realização da primeira pleurodese, a metodologia não está consensualmente definida. A tendência atual de executarmos procedimentos minimamente invasivos estimulou novas pesquisas com o objetivo de reduzir a agressão, incluindo o uso de novas substâncias, a colocação de drenos mais finos e a redução ou abolição da necessidade de internação hospitalar. Dentre as drogas esclerosantes, o talco tem a preferência mundial. Entretanto, o possível desenvolvimento da síndrome da angústia respiratória, por vezes fatal, fez renascer o interesse por outras drogas. Os quimioterápicos não têm evidente efeito esclerosante e originam importantes efeitos colaterais. Os agentes irritantes hidróxido de sódio e nitrato de prata produzem pleurodese efetiva. Ambos podem ser utilizados em seres humanos
Subject(s)
Humans , Animals , Pleural Effusion/drug therapy , Pleurodesis/methods , Sclerosing Solutions/administration & dosage , Sodium Hydroxide/administration & dosage , Mechlorethamine/administration & dosage , Silver Nitrate/administration & dosage , Talc/administration & dosageABSTRACT
The ideal agent for producing pleurodesis has not been identified. Talc, the most commonly used, poses several problems. Another possibility is silver nitrate, which was widely used in the past. PURPOSE: To determine the influence of the intrapleural instillation of lidocaine in producing a pleurodesis with silver nitrate, to define the effect of lidocaine in the maturation of the collagen fibers, and to confirm that the pleurodesis after silver nitrate is stronger than after talc. METHODS: We studied three groups of 8 rabbits. Two groups received 0.5 percent silver nitrate; in one we had previously injected 0.5 ml of 2 percent lidocaine. The third group received 400 mg/kg talc (2 ml). The animals were sacrificed 28 days after the injection, and the pleural spaces were assessed grossly for evidence of pleurodesis and microscopically for evidence of inflammation and fibrosis. The total amount of pleural collagen and the distribution of thick and thin collagen fibers were quantified. Collagen was identified using picrosirius red stain. RESULTS: In the two groups that received silver nitrate (without lidocaine: 3.5 + 03 and with lidocaine: 3.2 + 0.3), the macroscopic pleurodesis (scale 0 3/4 4) was significantly (p = 0.001) better than that resulting from talc (1.6 + 0.2). The mean degree of pleural fibrosis induced by silver nitrate (3.5 + 0.2) was significantly (p = 0.004) higher than that induced by talc (1.9 + 0.1). The previous instillation of lidocaine resulted in a tendency for decreased amounts of fibrosis (3.1 + 0.4). The mean amount (10(3)mm2) of pleural collagen was significantly (p = 0.009) greater in the rabbits that received silver nitrate (116.9 + 22.7) than in those that received talc (10.7 + 3.4). The injection of lidocaine slightly reduced the collagen (80.1 + 30.3). The distribution of collagen fibers did not differ among the groups. CONCLUSION: This rabbit model clearly confirms that intrapleural silver nitrate is more effective than talc for producing pleurodesis. The previous intrapleural instillation of lidocaine results in a decreasing trend in the amount of collagen, but does not change the effectiveness of the pleural fusion or modify the process of collagen maturation.