Cirugía bariátrica y evolución de COVID-19 / Bariatric surgery and evolution of COVID-19

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

Morphological Effects of Cigarette Smoking on Respiratory System and Related Functions Based on AQPs Expression

SUMMARY: A great deal of attention of air pollution on respiratory health is increasing, particularly in relation to haze days. It is that exposure to cigarette smoke augments the toxicity of common air contaminants, thereby increasing the complexity of respiratory diseases. Although there are various mechanisms involved to respiratory diseases caused or worsen by cigarette smoking, in which the role of AQPs in the lung with regard to fluid homeostasis still remains elusive. In this paper, we copied the rat models based on smoke generator, and investigated the morphological changes of mucosa and related functions depending on the balance of lining liquid of alveoli via AQPs expression. Compared with normal group, weak labelling of AQP1 and AQP5 protein abundance were clearly detected in the corresponding part of smoke exposure groups compared with normal group. Hence, it is suggested that the contribution of AQPs in the lung is diminished, thereby causing perturbed balancing between resorptive and secretory fluid homeostasis under cigarette smoking.

Cada vez se presta más atención a la contaminación del aire en la salud respiratoria, particularmente, en relación con los días de neblina. En consecuencia la exposición al humo del cigarrillo aumenta la toxicidad de los contaminantes comunes del aire, lo que además aumenta la complejidad de las enfermedades respiratorias. Aunque existen varios mecanismos involucrados en las enfermedades respiratorias causadas o empeoradas por el tabaquismo, en las que el papel de las AQP en el pulmón respecto a la homeostasis de líquidos sigue siendo difícil de alcanzar. En este artículo, copiamos los modelos de rata basados en el generador de humo e investigamos los cambios morfológicos de la mucosa y las funciones relacionadas según el equilibrio del líquido de revestimiento de los alvéolos a través de la expresión de AQP. En comparación con el grupo normal, se detectó claramente un etiquetado débil de la abundancia de proteínas AQP1 y AQP5 en la parte correspondiente de los grupos de exposición al humo en comparación con el grupo control. Por lo tanto, se sugiere que la contribución de las AQP en el pulmón está disminuida, provocando así un equilibrio perturbado entre la homeostasis del líquido secretor y de reabsorción bajo el hábito de fumar cigarrillos.

Fisiología respiratoria: mecanismos de defensa del sistema respiratorio / Defense mechanisms of the respiratory system

El sistema respiratorio cumple múltiples funciones no respiratorias, entre ellas es fundamental su rol en la defensa del organismo frente a una gran variedad de agentes externos potencialmente nocivos. Para ello, cuenta con mecanismos de protección de la vía aérea, dado por sus estructuras anatómicas, reflejos y el transporte mucociliar, además de un complejo y amplio desarrollo del sistema inmune pulmonar. El objetivo de este articulo es revisar los conceptos y componentes más importantes de función defensiva del sistema respiratorio.

The respiratory system fulfills multiple non-respiratory functions, including its role in defending the body against a wide variety of potentially harmful external agents. For this, it has airway protection mechanisms, given by its anatomical structures, reflexes and mucociliary transport, as well as a complex and extensive development of the pulmonary immune system. The objective of this article is to review the most important concepts and components of the defensive function of the respiratory system.

Perfil epidemiológico dos casos de neoplasias pulmonares durante a pandemia da COVID-19 no Brasil / Epidemiological profile of lung cancer cases during the COVID-19 pandemic in Brazil

Objetivo: analisar o perfil epidemiológico dos casos de neoplasia do sistema respiratório que foram diagnosticados e tratados nos anos de 2017 a 2019 e comparar com os casos ocorridos durante a pandemia da COVID-19 no Brasil. Método: estudo transversal com dados de neoplasia maligna da traqueia, dos brônquios e dos pulmões fornecidos pelo Departamento de Informática do Sistema Único de Saúde. Os casos foram coletados e analisados conforme a modalidade terapêutica e o sexo, por meio da incidência anual para cada região brasileira, comparando-se o período da pandemia e os anos de 2017, 2018 e 2019. Resultados: durante a pandemia, nos casos de neoplasias do sistema respiratório, que acometeram o sexo masculino, foram observadas reduções da realização de procedimentos terapêuticos em todas as regiões brasileiras, notando-se, principalmente, diminuições de 68,22%, 19,58% e 57,24% dos casos tratados com cirurgias, quimioterapia e radioterapia na Região Nordeste. Nos casos de neoplasias que acometeram o sexo feminino, foram detectados aumentos de cirurgias e reduções de radioterapia em todas as regiões federativas, notando-se, principalmente, um aumento de 64,03% e uma redução de 59,73%, respectivamente, dos casos tratados com cirurgia no Centro-Oeste e com radioterapia no Sudeste. Conclusão: o remanejamento dos tratamentos está correlacionado aos aumentos e às reduções dos casos tratados de neoplasias do sistema respiratório. Nesse contexto, os serviços de saúde devem adotar medidas para reduzir a exposição e a contaminação dos indivíduos com a COVID-19, de modo que os tratamentos oncológicos não sejam afetados, e evitar desfechos graves.

Objective: to analyze the epidemiological profile of cases of neoplasms of the respiratory system, which were diagnosed and treated in the years 2017 to 2019, and to compare with the cases that occurred during the COVID-19 pandemic in Brazil. Method: a cross-sectional study with data on the malignant neoplasm of the trachea, bronchi, and lungs provided by the Department of Informatics of the Unified Health System. The cases were collected and analyzed according to the therapeutic modality and sex through the annual incidence for each Brazilian region, comparing the period of the pandemic and the years 2017, 2018, and 2019. Results: during the pandemic, cases of respiratory system neoplasms that affected males and reductions in the performance of therapeutic procedures were observed in all Brazilian regions, noting mainly, decreases of 68.22%, 19.58%, and 57.24% of cases treated with surgeries, chemotherapy, and radiotherapy in the Northeast region. In the cases of neoplasms that affected females, increases in surgeries and reductions in radiotherapy were detected in all federative regions, noting, mainly, an increase of 64.03% and a reduction of 59.73%, respectively, of the cases treated with surgery in the Midwest and with radiotherapy in the Southeast. Conclusion: the relocation of treatments is correlated with increases and decreases in cases of treated respiratory system neoplasms. In this context, health services must adopt measures to reduce the exposure and contamination of individuals with COVID-19 so that cancer treatments are not affected and avoid serious outcomes.

Ensino do exame respiratório: o que é história e o que é necessidade? / Teaching the respiratory physical examination: what is history and what is needed?

A semiologia é uma das técnicas mais utilizadas na prática médica há séculos. Ensinada por meio de roteiros sistematizados, estudantes de inúmeras escolas da área de saúde por todo o mundo aprendem as manobras semiológicas como fundamento na avaliação dos pacientes. No entanto, apesar de extremamente difundida, discute-se pouco sobre sua acurácia como manobra diagnóstica. Tendo este ponto em vista, este artigo aborda a precisão das diversas manobras semiológicas do exame físico do aparelho respiratório e a descrição comparativa do seu ensino em diferentes escolas médicas no mundo. Como resultados, tem-se valores de acurácia discordantes, o que pode ser justificado pela qualidade dos estudos ou pelas variáveis analisadas que diferem entre os estudos e propostas de padronização. Em conclusão, a semiologia é a base da avaliação médica, independentemente dos avanços e disponibilidade dos exames de imagens, e cada manobra deve ser ensinada com seu devido valor científico. Conhecer a aplicabilidade e individualizar a prática das etapas do exame respiratório pode ser um caminho possível de adequação aos tempos atuais, sem impor perdas de informações relevantes para o desenvolvimento do raciocínio clínico (AU)

Medical semiology has been one of the most common techniques used in medical practice for centuries. Health science students around the globe learn these techniques through a systematized model as a fundamental skill for patient evaluation. However, though being widespread, little is known about semiology's true accuracy as a diagnostic maneuver. Knowing that, through a literature review, this paper evaluated the precision of the preconized procedures that are used as part of the exam of the respiratory system and the comparative description of its teaching in different medical schools around the world. As a result, disagreement between several papers was found, which can be justified by the poor quality of the studies and the different variables that were studied in each one. However, one thing is still clear: respiratory physical examination continues to be essential in medical practice, independently of the recent advances and availability of imaging exams. Teaching each step should consider available scientific evidence. The knowledge of the applicability and practical individualization of the respiratory examination can be a possible way for the current times without missing relevant information for developing clinical reasoning (AU)

Evidence-based anti-viral and immunomodulatory potential of Black cumin (Nigella sativa L) in COVID-19 / Potencial antivírico e inmunomodulador en COVID-19 del comino negro (Nigella sativa L) basado en la evidencia

Currently, the whole world is facing a life-threatening novel coronavirus 2019 (COVID-19) pandemic. Natural products are well-known for their potential role against viral disease, and some anti-viral agents have been developed to combat these diseases. Herein, the authors investigated the possible effects of this Holy plant Nigella sativa L. (NS), against coronavirus, using evidence-based and mechanistic approaches to conclude the immune-boosting and alleviation of respiratory systemeffects of NS. The pharmacological studies established a prominent role in treating various respiratory, immune systems, cardiovascular, skin, and gastrointestinal disorders. Literature supported the significant anti-viral role and showed an inhibitory role for NS against MHV-A59 CoV (mouse-hepatitis virus­A59) infected Hela, i.e., HeLaCEACAM1a (HeLa-epithelial carcinoembryonic antigen-related cell adhesion molecule 1a) cell. NS is a safe herbal product or dietary supplement and could be an effective and affordable community adjuvant treatment for coronavirus in the current scenario.

Actualmente, el mundo entero se enfrenta a una pandemia del nuevo coronavirus 2019 (COVID-19) que amenaza la vida. Los productos naturales son bien conocidos por su papel potencial contra las enfermedades virales, y se han desarrollado algunos agentes antivirales para combatir estas enfermedades. En este documento, los autores investigaron los posibles efectos de esta planta sagrada Nigella sativa L. (NS), contra el coronavirus, utilizando enfoques mecanicistas y basados en la evidencia para concluir el refuerzo inmunológico y el alivio de los efectos del SN en el sistema respiratorio. Los estudios farmacológicos establecieron un papel destacado en el tratamiento de diversos trastornos respiratorios, del sistema inmunológico, cardiovasculares, cutáneos y gastrointestinales. La literatura apoyó el importante papel antivírico y mostró un papel inhibidor de NS contra células Hela infectadas con MHV-A59 CoV (virus de la hepatitis de ratón-A59), es decir, HeLaCEACAM1a (molécula de adhesión celular 1a relacionada con el antígeno carcinoembrionario epitelial de HeLa). NS es un producto a base de hierbas o un suplemento dietético seguro y podría ser un tratamiento adyuvante comunitario eficaz y asequible para el coronavirus en el escenario actual.

Poluição do ar e saúde respiratória / Air pollution and respiratory health

O aumento da prevalência de doenças respiratórias crônicas coincide com o da exposição aos poluentes atmosféricos pelo crescente processo de industrialização, aumento do tráfego veicular e migração da população para áreas urbanas. A poluição do ar é uma mistura complexa de poluentes e outros compostos químicos tóxicos e não tóxicos, e o efeito na saúde pode derivar dessa mistura e da interação com parâmetros meteorológicos. Apesar disso, busca-se estabelecer o papel de um poluente específico em separado e consideram-se os parâmetros meteorológicos como fatores de confusão. Há evidências de que a exposição aos poluentes contribui para maior morbidade e mortalidade por doenças respiratórias, especialmente nas crianças, mesmo em concentrações dentro dos padrões estabelecidos pela legislação. Identificar os efeitos dos poluentes no sistema respiratório, isoladamente e em associação, é um desafio, e os estudos têm limitações devido à variabilidade de resposta individual, a presença de doenças pré-existentes, aos fatores socioeconômicos, às exposições a poluentes intradomiciliares, ocupacionais e ao tabaco. A maioria das evidências sobre o efeito dos poluentes no sistema respiratório de crianças deriva de estudos que incluem desfechos de função pulmonar. Entretanto, esses estudos têm diferenças quanto ao desenho, ao método de avaliação de exposição aos poluentes, às medidas de função pulmonar, às covariáveis consideradas como capazes de alterar a resposta aos poluentes e aos tipos de modelos utilizados na análise dos dados. Considerar todas essas diferenças é fundamental na interpretação e comparação dos resultados dessas pesquisas com os dados já existentes na literatura.

The increase in the prevalence of chronic respiratory diseases coincides with that of exposure to air pollutants due to the growing industrialization process, increased vehicular traffic and population migration to urban areas. Air pollution is a complex mixture of pollutants and other toxic and non-toxic chemical compounds and its effect on health can derive from this mixture and the interaction with meteorological parameters. Despite this, it seeks to establish the role of a specific pollutant separately and considers the meteorological parameters as confounding factors. There is evidence that exposure to pollutants contributes to greater morbidity and mortality from respiratory diseases, especially in children, even at concentrations within the standards established by legislation. Identifying the effects of pollutants on the respiratory system, alone and in association, is a challenge and studies have limitations due to the variability of individual response, the presence of pre-existing diseases, socioeconomic factors, exposure to indoor, occupational and environmental pollutants as well tobacco. Most of the evidence on the effect of pollutants on the respiratory system of children comes from studies that include lung function outcomes. However, these studies differ in terms of design, method of assessing exposure to pollutants, measures of lung function, covariates considered capable of altering the response to pollutants, and types of models used in data analysis. Considering all these differences is fundamental in interpreting and comparing the results of these researches with data already existing in the literature.

Asma tem cura? / Is asthma curable?

A asma é o produto de processos coordenados, interligados e complexos que têm origem nos genes/epigenética, microbioma e ambiente/estilo de vida. Os medicamentos atualmente disponíveis não são capazes de interferir com a inserção da asma no organismo. A abordagem terapêutica atual envolve fármacos que visam controlar os sintomas e antagonizar parte dos efeitos de algumas das citocinas envolvidas. Dessa forma, o tratamento atual visa o controle da asma e não a sua cura. Mecanismos epigenéticos traduzem os estímulos microbiômicos e ambientais em comportamento celular alterado. Por essa razão, a identificação de marcadores epigenéticos certamente apontará novos alvos terapêuticos e, idealmente, estratégias para reverter o comportamento celular alterado no trato respiratório. Aí, sim, poderíamos dizer que a asma tem cura.

Asthma is the product of coordinated, interconnected and complex processes that originate in genes/epigenetics, microbiome, and environment/lifestyle. Currently available drugs are not able to interfere with the insertion of asthma into the body. The current therapeutic approach involves drugs that aim to control symptoms and antagonize part of the effects of some of the cytokines involved. Thus, the current treatment is aimed at controlling asthma and not curing it. Epigenetic mechanisms translate the microbiological and environmental stimuli into altered cellular behavior. For this reason, the identification of epigenetic markers will certainly point out to new therapeutic targets and, ideally, strategies to reverse the altered cellular behavior in the respiratory tract. Then, yes, we could say that asthma is curable.

Morbimortalidade por doenças do aparelho respiratório no brasil: um estudo ecológico / Morbimortality from respiratory system diseases in Brazil: an ecological study / Morbimortalidad por enfermedades del sistema respiratorio en Brasil: un estudio ecológico

Introdução:As doenças do aparelho respiratório se configuram como o segundo principal motivo de internações hospitalares no Brasil entre 2013 e 2017. Objetivo:Analisar a morbimortalidade de doenças do aparelho respiratório da população brasileira, segundo faixa etária,no período compreendido entre os anos de 2015 a 2019. Metodologia:Trata-se de um estudo do tipo ecológico, retrospectivo, realizado sobre o território brasileiro. Os dados foram coletados a partir do Departamento de Informática do Sistema Único de Saúde, nas seções de Morbidade Hospitalar, de Mortalidade e População Residente. Foram analisados os dados entre 2015 a 2019 e de todas as faixas etárias. Resultados:Ao investigar a mortalidade por doenças do sistema respiratório entre os anos de 2015 e 2019, as cinco causas mais frequentes foram: influenza e pneumonia; doenças crônicas das vias aéreas inferiores; outras doenças do aparelho respiratório; outras doenças respiratórias que afetam principalmente interstício; doenças pulmonares devidas a agentes externos, nessa ordem. Enquanto as cinco causas de morbidades mais frequentes foram: pneumonia; outras doenças do aparelho respiratório; bronquite, enfisema e outras doenças pulmonares obstrutivas crônicas; asma; bronquite aguda e bronquiolite aguda. Conclusões:Verificou-se que a pneumonia, influenza, doenças respiratórias do trato inferior e outras doenças crônicas respiratórias foram as mais prevalentes entre a população respectivamente. Dentre o público mais acometido, foi possível constatar que o público infantil e a população idosa foram os mais atingidos tanto na mortalidade quanto na morbidade (AU).

Introduction:Introduction: Respiratory diseases are the second main reason for hospital admissions in Brazil between 2013 and 2017. Objective:To analyze the morbidity and mortality of respiratory diseases of the Brazilian population, according to age group, in the period from 2015 to 2019. Methodology:This is an ecological, retrospective study conducted on the Brazilian territory. Data were collected from the Informatics Department of the Unified Health System, in the Sections of Hospital Morbidity, Mortality and Resident Population. Data were analyzed between 2015 and 2019 and all age groups. Results:When investigating mortality from respiratory system diseases between 2015 and 2019, the five most frequent causes were: influenza and pneumonia; chronic diseases of the lower airways; other diseases of the respiratory system; other respiratory diseases that mainly affect interstitium; diseases due to external agents, in that order. Conclusions:It was found that pneumonia, influenza, respiratory diseases of the lower tract and other chronic respiratory diseases were the most prevalent among the population, respectively. Among the most affected public, it was possible to observe that the child's public and the elderly population were the most affected in both mortality and morbidity (AU).

Introducción: Las enfermedades respiratorias son la segunda razón principal de los ingresos hospitalarios en Brasil entre 2013 y 2017. Objetivo: Analizar la morbilidad y mortalidad de las enfermedades respiratorias de la población brasileña, según el grupo de edad, en el período comprendido entre 2015 y 2019.Metodología: Se trata de un estudio ecológico y retrospectivo realizado en territorio brasileño. Los datos fueron recogidos del Departamento de Informática del Sistema Unificado de Salud, en las Secciones de Morbilidad Hospitalaria, Mortalidad y Población Residente. Los datos se analizaron entre 2015 y 2019 y todos los grupos de edad. Resultados: Al investigar la mortalidad por enfermedades del sistema respiratorio entre 2015 y 2019, las cinco causas más frecuentes fueron: gripe y neumonía; enfermedades crónicas de las vías respiratorias inferiores; otras enfermedades del sistema respiratorio; otras enfermedades respiratorias que afectan principalmente al intersticio; enfermedades debidas a agentes externos, en ese orden.Mientras que las cinco causas más frecuentes de morbilidad fueron: neumonía; otras enfermedades del sistema respiratorio; bronquitis, enfisema y otras enfermedades pulmonares obstructivas crónicas; asma; bronquiolitis aguda y bronquiolitis aguda. While the five most frequent causes of morbidities were: pneumonia; other diseases of the respiratory system; bronchitis, emphysema and other chronic obstructive pulmonary diseases; asthma; acute bronchitis and acute bronchiolitis. Conclusiones: Se encontróque la neumonía, la influenza, las enfermedades respiratorias de las vías inferiores y otras enfermedades respiratorias crónicas eran las más prevalentes entre la población, respectivamente. Entre el público más afectado, se pudo observar que el público del niño y la población de edad avanzada eran los más afectados tanto en la mortalidad como en la morbilidad (AU).

Efeito agudo do método reequilíbrio toracoabdominal em lactentes com diagnóstico de bronquiolite / Acute effect of thoracic-abdominal rebalance method in infants diagnosed with bronchiolitis

Nos lactentes, o sistema imunológico ainda é imaturo, o que torna as crianças mais suscetíveis ao vírus sincicial respiratório, o principal causador da bronquiolite. O Reequilíbrio Toraco-abdominal (RTA) é um método de terapia manual que atua sobre o sistema respiratório por meio de uma leitura global em situações de doenças. Objetivos: Avaliar os efeitos do método RTA, comparado à fisioterapia tradicional (FT) em lactentes com bronquiolite. Metodologia: Pesquisa experimental e prospectiva, na qual 24 lactentes foram divididos em dois grupos, FT (n = 12) e RTA (n = 12). Parâmetros fisiológicos (frequência respiratória, frequência cardíaca, saturação de pulso de oxigênio e ausculta pulmonar), desconforto respiratório e desequilíbrio da biomecânica respiratória foram avaliados antes e após os manuseios. Resultados: A idade média foi de 13 (± 11,07) semanas no grupo FT e no grupo RTA 13,3 (± 8,41) semanas. Após os manuseios, obteve diferença estatística no grupo do RTA comparado ao da FT nos seguintes parâmetros: observamos uma diminuição significativa da frequência cardíaca (p = 0,02) e da frequência respiratória (p = 0,0002), no quesito esforço respiratório em tórax superior (p = 0,004) e tórax inferior (p = 0,017) e no escore de Wood-Downes em moderada com (p = 0,0001). Conclusão: O RTA mostrou-se mais eficaz que as técnicas da FT em relação aos benefícios ao lactente. (AU)

Pseudomonas aeruginosa associated pulmonary infections and in vitro amplification virulent rhamnolipid (rhlR) gene / Infecções pulmonares associadas a Pseudomonas aeruginosa e gene ramnolipídeo virulento (rhlR) da amplificação in vitro

Background: Pseudomonas aeruginosa is a common opportunistic pathogenic bacterium with the ability to develop a strong communication pathway by quorum sensing system and different virulent factors. Among the various important secretions of P. aeruginosa rhamnolipid is important biological detergent, believed to be involved in the development of the biofilm and intercellular communication. It readily dissolves the lung surfactants that are then easily catalyzed by the phospholipases and in this way is involved in the acute pulmonary infection. Objective: research work was designed to investigate virulence and gene associated with virulence in P. aeruginosa responsible for pulmonary infections. Methods: In current study polymerase chain reaction (PCR) was used for the detection of the rhlR (rhamnolipid encoding) gene of isolated strains. A number of assays were performed that ensured its virulent behavior. Disc diffusion method was used to check its antibiotic resistance. Isolated strains were resistant to a number of antibiotics applied. Result: It was found that males are more prone to respiratory infections as compared to females. Male members with age of 44-58 and 59-73 are at a higher risk, while females with age of 44-58 are also at a risk of pulmonary infections. Antibiotic resistance was observed by measuringzone of inhibition in strains GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 and GCU-SG-M6. GCU-SG-M2 was resistant to fluconazole (FLU), clarithromycin (CLR), cefixime (CFM) and Penicillin (P10). No zone of inhibition was observed. But it showed unusual diffused zone around the Ak and MEM antibiotic discs. rhl R gene and 16s rRNA gene were characterized and analyzed. Conclusion: Findings from current study would help[...].

Antecedentes: Pseudomonas aeruginosa é uma bactéria patogênica oportunista comum, com a capacidade de desenvolver uma forte via de comunicação pelo sistema de detecção de quorum e diferentes fatores virulentos. Entre as várias secreções importantes de P. aeruginosa rhamnolipid, há um importante detergente biológico, que se acredita estar envolvido no desenvolvimento do biofilme e na comunicação intercelular. Dissolve rapidamente os surfactantes pulmonares que são facilmente catalisados pelas fosfolipases e, dessa maneira, estão envolvidos na infecção pulmonar aguda. Objetivo: O trabalho de pesquisa foi desenhado para investigar a virulência e o gene associado à virulência em P. aeruginosa responsável por infecções pulmonares. Métodos: No presente estudo, a reação em cadeia da polimerase (PCR) foi utilizada para a detecção do gene rhlR (codificação ramnolipídeo) de cepas isoladas. Foram realizados vários ensaios que garantiram seu comportamento virulento. O método de difusão em disco foi utilizado para verificar sua resistência a antibióticos. As estirpes isoladas foram resistentes a vários antibióticos aplicados. Resultado: Verificou-se que os homens são mais propensos a infecções respiratórias em comparação às mulheres. Membros do sexo masculino com idade entre 44 e 58 e 59 e 73 anos correm maior risco, enquanto mulheres com idade entre 44 e 58 anos também correm risco de infecções pulmonares. A resistência aos antibióticos foi observada medindo a zona de inibição nas cepas GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 e GCU-SG-M6. O GCU-SG-M2 foi resistente ao fluconazol (FLU), claritromicina (CLR), cefixima (CFM) e penicilina (P10). Nenhuma zona de inibição foi observada. Mas se notou uma zona difusa incomum ao redor dos discos antibióticos Ak e MEM. Os genes rhl R e 16s rRNA foram caracterizados e analisados. Conclusão: As conclusões do presente estudo ajudariam a aumentar a conscientização sobre a resistência a antibióticos de, [...].

Inhibition of TAK1 aggravates airway inflammation by increasing RIPK1 activity and promoting macrophage death in a mouse model of toluene diisocyanate-induced asthma / 南方医科大学学报

OBJECTIVE@#To explore the effect of transforming growth factor-β (TGF-β)-activated kinase 1 (TAK1) on toluene diisocyanate (TDI)-induced allergic airway inflammation in mice.@*METHODS@#Thirty-two mice were randomly divided into AOO group, AOO+5Z-7-Oxozeaenol group, TDI group, and TDI+5Z-7-Oxozeaenol group. Another 32 mice were randomly divided into AOO group, TDI group, TDI +5Z-7-Oxozeaenol group, and TDI +5Z-7-Oxozeaenol + Necrostatin-1 group. TAK1 inhibitor (5Z-7-Oxozeaenol, 5 mg/kg) and/or RIPK1 inhibitor (Necrostatin-1, 5 mg/kg) were used before each challenge. Airway responsiveness, airway inflammation and airway remodeling were assessed after the treatments. We also examined the effect of TDI-human serum albumin (TDI-HSA) conjugate combined with TAK1 inhibitor on the viability of mouse mononuclear macrophages (RAW264.7) using CCK8 assay. The expressions of TAK1, mitogen-activated protein kinase (MAPK) and receptor interacting serine/threonine protease 1 (RIPK1) signal pathway in the treated cells were detected with Western blotting. The effects of RIPK1 inhibitor on the viability of RAW264.7 cells and airway inflammation of the mouse models of TDI-induced asthma were evaluated.@*RESULTS@#TAK1 inhibitor aggravated TDI-induced airway inflammation, airway hyper responsiveness and airway remodeling in the mouse models (P < 0.05). Treatment with TAK1 inhibitor significantly decreased the viability of RAW264.7 cells, which was further decreased by co-treatment with TDI-HSA (P < 0.05). TAK1 inhibitor significantly decreased the level of TAK1 phosphorylation and activation of MAPK signal pathway induced by TDI-HSA (P < 0.05). Co-treatment with TAK1 inhibitor and TDI-HSA obviously increased the level of RIPK1 phosphorylation and caused persistent activation of caspase 8 (P < 0.05). RIPK1 inhibitor significantly inhibited the reduction of cell viability caused by TAK1 inhibitor and TDI-HSA (P < 0.05) and alleviated the aggravation of airway inflammation induced by TAK1 inhibitors in TDI-induced mouse models (P < 0.05).@*CONCLUSION@#Inhibition of TAK1 aggravates TDI-induced airway inflammation and hyperresponsiveness and may increase the death of macrophages by enhancing the activity of RIPK1 and causing persistent activation of caspase 8.

Analysis of volatile organic compounds in exhaled breath after radiotherapy / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Radiotherapy uses high-energy X-rays or other particles to destroy cancer cells and medical practitioners have used this approach extensively for cancer treatment (Hachadorian et al., 2020). However, it is accompanied by risks because it seriously harms normal cells while killing cancer cells. The side effects can lower cancer patients' quality of life and are very unpredictable due to individual differences (Bentzen, 2006). Therefore, it is essential to assess a patient's body damage after radiotherapy to formulate an individualized recovery treatment plan. Exhaled volatile organic compounds (VOCs) can be changed by radiotherapy and thus used for medical diagnosis (Vaks et al., 2012). During treatment, high-energy X-rays can induce apoptosis; meanwhile, cell membranes are damaged due to lipid peroxidation, converting unsaturated fatty acids into volatile metabolites (Losada-Barreiro and Bravo-Díaz, 2017). At the same time, radiotherapy oxidizes water, resulting in reactive oxygen species (ROS) that can increase the epithelial permeability of pulmonary alveoli, enabling the respiratory system to exhale volatile metabolites (Davidovich et al., 2013; Popa et al., 2020). These exhaled VOCs can be used to monitor body damage caused by radiotherapy.

Involvement and therapeutic implications of airway epithelial barrier dysfunction in type 2 inflammation of asthma / 中华医学杂志(英文版)

Type 2 inflammation is a complex immune response and primary mechanism for several common allergic diseases including allergic rhinitis, allergic asthma, atopic dermatitis, and chronic rhinosinusitis with nasal polyps. It is the predominant type of immune response against helminths to prevent their tissue infiltration and induce their expulsion. Recent studies suggest that epithelial barrier dysfunction contributes to the development of type 2 inflammation in asthma, which may partly explain the increasing prevalence of asthma in China and around the globe. The epithelial barrier hypothesis has recently been proposed and has received great interest from the scientific community. The development of leaky epithelial barriers leads to microbial dysbiosis and the translocation of bacteria to inter- and sub-epithelial areas and the development of epithelial tissue inflammation. Accordingly, preventing the impairment and promoting the restoration of a deteriorated airway epithelial barrier represents a promising strategy for the treatment of asthma. This review introduces the interaction between type 2 inflammation and the airway epithelial barrier in asthma, the structure and molecular composition of the airway epithelial barrier, and the assessment of epithelial barrier integrity. The role of airway epithelial barrier disruption in the pathogenesis of asthma will be discussed. In addition, the possible mechanisms underlying the airway epithelial barrier dysfunction induced by allergens and environmental pollutants, and current treatments to restore the airway epithelial barrier are reviewed.

Efecto inmediato de dos ejercicios con tracto vocal semiocluido en el contacto glótico de usuarios ocupacionales de la voz / Immediate effect of two semi-occluded vocal tract exercises in glottal contact of occupational voice users

Introducción. Los docentes son usuarios ocupacionales de la voz con alto riesgo de desarrollar patologías vocales a causa de su labor. Para enfrentar esta proble-mática, suelen usarse ejercicios con tracto vocal semiocluido (TVSO), estrategia de educación/rehabilitación empleada para generar un cambio en el patrón de vibración de los pliegues vocales, minimizando el riesgo de lesión vocal al reducir el estrés de colisión al que se someten los tejidos. Diversos reportes han indicado que este tratamiento tiene efectos en el cociente de cierre (CQ), medida indirecta del estrés de colisión.Objetivo. Examinar el efecto fisiológico de dos ejercicios con TVSO en la actividad laríngea de profesores con esfuerzo vocal constante pero sin patología vocal. Metodología. Se registraron muestras de 43 profesores antes, durante y después de la realización de dos ejercicios con TVSO (vibración lingual y fonación en tubos). Las muestras de electroglotografía se analizaron para obtener el CQ. Resultados y conclusión. Se observó una diferencia significativa al comparar los valores del CQ antes y durante la realización de ambos ejercicios. No se encontraron cambios en este parámetro después de ejecutar la actividad. Estos hallazgos concuer-dan con reportes previos en los cuales el CQ tiende a aumentar durante la fonación en tubos; contrariamente, la realización de la vibración lingual tiende a decrecer el valor del CQ. Es posible que este comportamiento se deba a los mecanismos biome-cánicos particulares de cada ejercicio

Introduction. Teachers are occupational voice users with high risk of developing vocal pathologies due to their work. To face this situation, it is common the use of semi-occluded vocal tract (SOVT) exercises, a strategy of voice education/rehabil-itation implemented to induce a change in the vibration pattern of the vocal folds, mitigating, therefore, the risk of vocal lesion by reducing the collision stress applied to tissues. A variety of reports have indicated that this treatment has effects in the closed quotient (CQ), an indirect measure of collision stress. Aim. The purpose of this study was to examine the physiological effect of two dif-ferent SOVT exercises in larynx activity of teachers with constant vocal effort but without vocal pathology. Methods. 43 samples of teachers were recorded before, during and after executing two SOVT exercises (tongue trill and tube phonation). Electroglottographic samples were analyzed in order to obtain CQ. Results and conclusion. Both exercises had a significant difference of CQ scores when before and during conditions were compared. Any difference was found on this parameter after executing the activity. These findings agree with previous reports where CQ tends to increase during phonation through resonance tubes; on the con-trary, execution of tongue trill tends to decrease CQ values. This behavior might be because of the particular biomechanical mechanisms of each exercise

Resistencia antimicrobiana y daño al medio ambiente, en el contexto COVID-19: Una revisión sistemática / Antimicrobial resistance and damage to the environment, in the context of COVID-19: A systematic review

Las pautas de abordaje de los pacientes con COVID-19, al inicio de la pandemia, se realizó por ensayo, ya que se desconocía la fisiopatología de esta nueva enfermedad, entre las acciones médicas se describió el uso de antiboticoterapias de manera indiscriminada, también se instó a realizar desinfección profundas, muchas veces, con sustancias químicas con impacto negativo en la salud ambiental, tanto a nivel de la microbiota encargada del equilibrio ecológico, como en la contaminación ambiental, principalmente del agua. Aunado a esto, debido a la emergencia sanitaria, se requirió usar en mayor cantidad equipos de protección personal de un solo uso y, como consecuencias el aumento de desechos sólidos peligrosos, cuya composición son de degradación tardía. Por tanto, la respuesta sanitaria ante la pandemia, probablemente fue escenario para acentuar la resistencia antimicrobiana y el riesgo de daño ambiental. En este, artículo se realizó una revisión sistemática de la literatura científicas en torno a estos tópicos, las evidencias demostraron el aumento de mecanismos de resistencias de bacterias, principalmente, patógenas del tracto respiratorio. De igual manera, el impacto negativo por uso irracional de desinfectantes químicos, traducido en bacterias resistentes especialmente a compuestos de amonio cuaternario. La bioacumulación y biomagnificación de estas sustancias ha provocado toxicidad, mutaciones, propagación de genes de resistencia. Por lo tanto, se sugiere que se priorice las estrategias que mitiguen el rastro que ha venido extendiéndose al paso de la pandemia por el SAR- CoV-2(AU)

The guidelines for the approach of patients with COVID-19, at the beginning of the pandemic, were carried out by trial, since the pathophysiology of this new disease was unknown, among the medical actions the use of antibiotic therapies indiscriminately was described, also the urged to carry out deep disinfection, many times, with chemical substances with a negative impact on environmental health, both at the level of the microbiota responsible for the ecological balance, and in environmental pollution, mainly of water. In addition to this, due to the health emergency, it was required to use more single-use personal protective equipment and, as a consequence, the increase in hazardous solid waste, whose composition is delayed degradation. Therefore, the health response to the pandemic was probably the setting to accentuate antimicrobial resistance and the risk of environmental damage. In this article, a systematic review of the scientific literature on these topics was carried out, the evidence demostrated the increase in resistance mechanisms of bacteria, mainly pathogens of the respiratory tract. Anyways, the negative impact due to the irrational use of chemical disinfectants, translated into resistant bacteria, especially to quaternary ammonium compounds. The bioaccumulation and biomagnification of these substances has caused toxicity, mutations, propagation of resistance genes. Therefore, it is suggested that strategies be prioritized that mitigate the trail that has been spreading as the pandemic passed by SAR-CoV-2(AU)

Análise fisiopatológica das manifestações clínicas respiratórias em pessoas infectadas pelo vírus SARS-CoV-2 / Pathophysiological analysis of respiratory clinical manifestations in people infected with SARS-CoV-2 virus

Na atualidade, a população mundial vive um dos momentos mais críticos e assustadores relacionados à área da saúde, onde a mutação viral da família do "coronavírus" trouxe o SARS-CoV-2, um agente patogênico que deriva da linhagem do SARS-CoV e MERS-CoV, e que ataca e debilita o funcionamento fisiológico, principalmente, do sistema respiratório. Vários países vivenciam a pandemia denominada "novo coronavírus", vale resaltar que a escolha do nome vem das várias formas já vivenciadas desse vírus, iniciando em 1937, com os primeiros isolamentos por manifestação dessa família viral. Assim, após a descoberta dessa nova mutação dos ancestrais virais, no final do ano de 2019, acontece seu primeiro surto na China. O objetivo desse artigo é analisar a fisiopatologia do "novo coronavírus" em busca das respostas orgânicas a esse ataque. Foi utilizada a metodologia em caráter de revisão integrativa descritiva e qualitativa de artigos indexados na plataforma PubMed, SciELO e por informações disponíveis no portal Manual MSD, Ministério da Saúde do Brasil e Organização Mundial de Saúde. Os resultados encontrados indicam que as alterações fisiopatológicas manifestadas na infecção por SARS-CoV-2, possuem as características estreitamente semelhantes às encontradas na síndrome respiratória aguda grave (SARS-CoV) e na síndrome respiratória do oriente médio (MERS-CoV), que são desencadeadas por outros patógenos da família coronavírus. Conclui-se que estamos lidando com um tipo específico de pneumonia e que possui um acometimento progressivo e fatal, levando a destruição de estruturas pulmonares indispensáveis para a difusão de gases (hematose).

Currently, the world population lives one of the most critical and frightening moments related to the health area, where the viral mutation of the "coronavirus" family brought SARSCoV-2, a pathogenic agent that derives from the SARS-CoV and MERS-Cov, attacking and weakening the physiological functioning, mainly, of the respiratory system. Currently, several countries are experiencing a pandemic called "novel coronavirus", emphasizing that the choice of name comes from the various forms already experienced of this virus, starting in 1937, with the first isolations due to the manifestation of this viral family. Thus, the discovery of this new mutation of viral ancestors, at the end of 2019, happens its first outbreak in China and has spread throughout the world in a fast and incessant contamination, surprising health professionals who seek more and more knowledge and property to understand and treat the victims of this pandemic. The purpose of this article is to analyze the pathophysiology of the "novel coronavirus" in search of organic responses to this attack. The methodology was used as an integrative descriptive and qualitative review of articles indexed on the PubMed, SciELO platform and information available on the portal of the Ministry of Health of Brazil and the World Health Organization (WHO). The results found indicate that the pathophysiological changes manifested in the SARSCoV-2 infection have the characteristics closely similar to those found in the severe acute respiratory syndrome (SARS-CoV) and in the middle east respiratory syndrome (MERSCoV) that are triggered by other pathogens of the coronavirus family. It is concluded that we are dealing with a specific type of pneumonia and that it has a progressive, rapid and fatal involvement, leading to the destruction of pulmonary structures indispensable for the diffusion of gases (hematosis). It still has action on the production of secretion causing respiratory distress destining its victims to death

COVID-19 y metabolismo: una mirada más allá del sistema respiratorio y de la enfermedad trombótica / COVID-19 and metabolism: a look beyond the respiratory system and thrombotic disease

Resumen La COVID-19 es una enfermedad infecciosa causada por el coronavirus del síndrome respiratorio agudo severo 2 (SARS-CoV-2) que tiene importantes manifestaciones sobre el sistema cardiovascular y respiratorio. Esta enfermedad, descrita en los primeros días de diciembre de 2019 en la ciudad de Wuhan, capital de la provincia de Hubei, en China, tuvo una rápida expansión mundial y fue declarada por la Organización Mundial de la Salud como pandemia el 11 de marzo de 2020. Tiene diferentes presentaciones clínicas, como neumonía, hipoxemia, falla renal, falla multisistémica, compromiso endotelial que lleva a lesiones trombóticas venosas y arteriales, y problemas cardiacos como insuficiencia cardiaca, miocarditis, arritmias e infarto de miocardio de los tipos 1 y 2. La mayoría de las personas presentan una enfermedad leve o no complicada (80%), y otras (20%) pueden desarrollar un cuadro grave con neumonía, síndrome de dificultad respiratoria, choque cardiogénico, trombosis y tormenta de citocinas (el 15% se manejan con oxigenoterapia y el 5% ameritan tratamiento en la unidad de cuidados intensivos). La mortalidad está relacionada con la edad y con la comorbilidad (hipertensión arterial, diabetes mellitus, enfermedades respiratorias, enfermedades cardiacas en general, enfermedades renales y obesidad). El objetivo de esta revisión narrativa es describir las alteraciones metabólicas y la relación de la diabetes mellitus, la obesidad, el síndrome metabólico y la dislipidemia con la morbilidad y la mortalidad vinculadas a la COVID-19.

Abstract COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that has important manifestations on the cardiovascular system and respiratory. This disease described in the first days of December 2019 in the city of Wuhan, capital of the province of Hubei, China, with a rapid global expansion and declared by the World Health Organization as a pandemic on March 11, 2020, has different clinical presentations such as pneumonia, hypoxemia, kidney failure, multisystem failure, endothelial involvement leading to venous and arterial thrombotic lesions, and heart problems such as heart failure, myocarditis, arrhythmias, and type 1 and 2 myocardial infarction. Most people have a mild or uncomplicated disease (80%), and others (20%) may develop a severe case with pneumonia, respiratory distress syndrome, cardiogenic shock, thrombosis, and cytokine storm (15% are managed with oxygen therapy and 5% merit treatment in the intensive care unit). Mortality is related to age and comorbidity (high blood pressure, diabetes mellitus, respiratory diseases, heart diseases in general, kidney diseases, and obesity). The objective of this narrative review is to describe the metabolic alterations and the relationship between diabetes mellitus, obesity, metabolic syndrome, and dyslipidemia with the morbidity and mortality associated with COVID-19 infection.