Delay of neuropathic pain sensitization after application of dexamethasone-loaded implant in sciatic nerve-injured rats

Neuroimmune interactions underlying the development of pain sensitization in models of neuropathic pain have been widely studied. In this study, we evaluated the development of allodynia and its reduction associated with peripheral antineuroinflammatory effects induced by a dexamethasone-loaded biodegradable implant. Chronic constriction injury (CCI) of the sciatic nerve was performed in Wistar rats. The electronic von Frey test was applied to assess mechanical allodynia. The dexamethasone-loaded implant was placed perineurally at the moment of CCI or 12 days after surgery. Dorsal root ganglia (DRG; L4-L5) were harvested and nuclear extracts were assayed by Western blot for detection of nuclear factor (NF)-κB p65/RelA translocation. Dexamethasone delivered from the implant delayed the development of allodynia for approximately three weeks in CCI rats when the implantation was performed at day 0, but allodynia was not reversed when the implantation was performed at day 12. NF-κB was activated in CCI rat DRG compared with naïve or sham animals (day 15), and dexamethasone implant inhibited p65/RelA translocation in CCI rats compared with control. This study demonstrated that the dexamethasone-loaded implant suppresses allodynia development and peripheral neuroinflammation. This device can reduce the potential side effects associated with oral anti-inflammatory drugs.

Pneumonia Adquirida na Comunidade / Community-Acquired Pneumonia

A pneumonia é uma infecção do parênquima pulmonar que, embora cause morbidade e mortalidade significativas, é comumente mal diagnosticada e tratada inadequadamente. A etiologia da pneumonia adquirida na comunidade (PAC) apresenta variações na incidência dos diversos patógenos envolvidos, dependendo da procedência do paciente. Neste estudo, foram abordados os diferentes esquemas terapêuticos nos pacientes ambulatoriais e hospitalares. A escolha do local de tratamento do paciente baseia-se em dois métodos classificatórios: o Índice de Gravidade de Pneumonia (PSI - Pneumonia Severity Index) e a escala de gravidade da PAC da British Thoracic Society (BTS), mas devem ser considerados outros fatores, como o nível sócio-econômico-cultural do paciente e o julgamento do médico responsável. Considerando-se as variáveis formas de tratamento e a importante escolha do local mais apropriado para a condução do caso, o médico deve estar bem informado para tomar as decisões mais adequadas para cada paciente, em concordância com o sistema de saúde em que está inserido. Por meio desta revisão, buscou-se condensar as últimas atualizações da literatura a fim de auxiliar nesta tomada de decisões.

Pneumonia is an infection of the lung parenchyma that is often misdiagnosed and treated inappropriately, though it causes significant morbidity and mortality. The etiology of community-acquired pneumonia (CAP) shows variations amongst the incidence of the numerous pathogens involved, depending on the patient’s origin. This study examines the different therapeutic regimens: outpatient and hospital patient. The choice of where to treat the patient is based on two classification methods: Pneumonia Severity Index (PSI) and the severity scale of PAC by the British Thoracic Society (BTS). Nonetheless other factors should be considered, for instance the social-economic-cultural aspects and the physician’s experience. Considering the variable forms of treatment and the importance of choosing the most appropriated local to deal with the case, the physician should be well informed to make the most appropriate decisions for each patient, according to the health system in which it is inserted. This review sought to condense the literature latest updates in order to assist this decision.

Pneumonia Adquirida na Comunidade ­ Relato de Caso / Community - Acquired Pneumonia

A Pneumonia Adquirida na Comunidade (PAC) é uma doença de alta incidência e grande importância como causa de morbimortalidade no mundo. Possui grande impacto no sistema de saúde, tanto nos aspectos econômicos quanto nos sociais. Este trabalho se configura em um relato de caso clínico de um paciente de 33 anos que foi assistido no Pronto Atendimento do Hospital das Clínicas da UFMG (HC-UFMG) com quadro clínico, sinais radiológicos e evolução típicos da entidade nosológica apresentada – PAC. Optou-se por tratamento em regime hospitalar. A decisão do local de tratamento, a utilização de métodos de imagem para PAC, a valorização do quadro clínico e, finalmente, a abordagem global do estado de saúde do paciente são os pontos discutidos neste trabalho.

Community-acquired pneumonia (CAP) is a disease with high prevalence and importance due its association with great morbidity and mortality worldwide. Consequently, there is an intrinsic impact on health systems on both economical and social issues. This is a case report of a 33 year-old woman, that came into the Emergency Room of the Hospital das Clínicas da UFMG (HC-UFMG), with clinical and radiological signs and typical evolution of the nosological entity presented - CAP. The option was for treatment in hospital. The decision regarding the regimen of treatment, the use of radiological methods for CAP, the relevance of the clinical signs and symptoms presented by the patient and the approach of these items are discussed in this paper.