O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos / What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

ABSTRACT Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

Efeito do treinamento físico sobre o perfil metabólico e ósseo de ratos recém-desmamados / Effect of physical training on metabolic and bone profile in weanling rats

INTRODUÇÃO: A prática de exercícios de intensidade moderada pode reduzir o risco de infecções e melhorar os aspectos metabólicos do indivíduo. OBJETIVO: Investigar os efeitos do treinamento físico aeróbio sobre os aspectos metabólicos, ósseo e sistema imunológico. MÉTODOS: Vinte ratos machos, recém-desmamados, foram distribuídos em dois grupos experimentais: grupo sedentário (GS) e grupo treinado (GT). O GT foi submetido a um protocolo de natação, durante seis semanas consecutivas. Ao final do período experimental, foi realizada a contagem total e diferencial de leucócitos e hematócrito. Após o sacrifício, foram analisados: glicose, proteínas totais, triglicérides, colesterol; amostras do fígado e músculo para a determinação dos teores de glicogênio; e tíbia para determinação do comprimento e área óssea. Os dados foram analisados pela análise de variância ANOVA one-way e o nível de significância estabelecido foi p<0,05. RESULTADOS: O hematócrito (%) analisado apresentou diferença significativa, com maior valor para o GT (54,63 ± 1,41) que para o GS (49,5 ± 1,65). A contagem total de leucócitos não apresentou diferença significativa, assim como também não houve diferença na contagem diferencial. O colesterol total apresentou relevante diminuição no GT (GT = 68,27 ± 13,71 mg/dL; GS = 94,44 ± 28,09); os níveis de proteínas totais também apresentaram importante redução (GT = 7,3 ± 0,40 g/dL; GS = 7,74 ± 0,36 g/dL); os níveis de glicose e triglicérides não apresentaram diferenças significativas. Já o comprimento ósseo apresentou diferença significativa, com o comprimento do tibial do GT (40 ± 0,14* mm) sendo menor que o GC (42,10 ± 0,12 mm). A área tibial demonstrou menor valor para o GT (1,53 ± 0,12 cm²) que para o GS (1,67 ± 0,18 cm²), entretanto, a diferença não foi estatisticamente significante. CONCLUSÃO: O treinamento físico aeróbio é capaz de produzir algumas modificações fisiológicas peculiares em ratos jovens.

INTRODUCTION: The practice of moderate-intensity exercise can reduce the risk of infections and improve metabolic aspects of the person. OBJECTIVE: To investigate the effects of aerobic physical training on endocrine and metabolic aspects, bone and immune system. METHODS: Twenty Wistar rats were divided in two groups: sedentary (GS) and trained group (TG). Training program consisted in swimming, 6 weeks, supporting a workload corresponding to 5% of body weight. At the end of the experiment, were performed counting total and differential leukocyte count and hematocrit. After training period, were analyzed glucose, total protein, triglycerides, cholesterol, liver and muscle samples for the determination of the levels of glycogen, and determination of the tibia length and bone area. All dependent variables were analyzed by one-way analysis of variance (ANOVA) and a significance level of P < 0.05 was used for all comparisons. RESULTS: Hematocrit (%) analyzed showed a significant difference, with higher values ​​for TG (54.63 ± 1.41) than for the GS (49.5 ± 1.65). The total leukocyte count was not significantly different, as there was no difference in the differential count. Total cholesterol showed significant decrease in GT (GT = 68.27 ± 13.71 mg/dL; GS = 94.44 ± 28.09), the total protein levels also showed significant reduction (GT = 7.3 ± 0,40 g/dL; GS = 7.74 ± 0.36 g/dL) glucose levels and triglyceride showed no significant differences.The bone length showed a significant difference (GT = 40±0.14 mm; CG = 42.10 ± 0.12mm). The tibial area showed the lowest value for the GT (1.53 ± 0.12cm²) than for the GS (1.67 ± 0.18cm²) however the difference was not statistically significant. CONCLUSION: It can be concluded that aerobic exercise training is able to produce some unique physiological changes in young rats. There is also the need to prescribe exercises that meet the particular maturational stage of development.

Efeito da caminhada sobre a qualidade de vida e auto-eficácia de mulheres com síndrome da fibromialgia / Effect of practical of walk on the quality life and self- efficacy of women with fibromyalgia syndrome

Verificar o efeito da prática de 10 sessões de caminhada sobre a qualidade de vida e auto-eficácia de mulheres com Síndrome da Fibromialgia (FM). Método: Participaram do estudo oito mulheres com diagnóstico clínico de FM, selecionadas de forma não-probabilística intencional. As avaliações foram realizadas antes e após 10 sessões da prática de caminhada. Os instrumentos utilizados foram o Questionário Sócio-demográfico e Clínico, o Questionário de Impacto da Fibromialgia e a Escalade Auto-eficácia para Dor Crônica. Após a verificação da normalidade através do teste Shapiro-Wilk, osdados foram tratados com estatística descritiva (freqüência, média e desvio padrão) e inferencial (teste t de Student e teste de Pearson). Resultados: A média de idade das participantes foi de 49 anos (+12,8), o impacto da síndrome da fibromialgia na qualidade de vida no pré-teste foi de 53,64 pontos e no pós-teste de 51,99 pontos (p=0,73) e a Auto-eficácia no pré-teste foi de 147,57 pontos e no pós-teste foi de 172,27 pontos (p=0,15). Em relação aos três domínios deste questionário, apenas o domínio da Auto-eficácia para lidar com outros sintomas apresentou diferença significativa entre o pré e pós-teste (p=0,02). Houve correlação negativa pós-teste (r=-0,72; p=0,042) entre o impacto da fibromialgia e a auto-eficácia. Conclusão: Apesar do curto período de intervenção realizado, a prática de caminhada melhorou o domínio da auto-eficácia para lidar com outros sintomas em mulheres com FM. Em relação à qualidade de vida, não ocorreram melhoras.

Objective: Verify the effect of practical of 10 walk sessions on the quality life and self efficacy of women with Fibromyalgia Syndrome (FM). Method: eight women with clinical diagnosis of FM had participated of the study. The evaluations were before and after 10 sessions of the practical of walking. The used instruments were the “Questionário Sócio-Demográfico e Clínico”, “The Fibromyalgia Impact Questionnaire”, and the “Chronic Pain Self-efficacy Scale”. After the verification of normality through the Shapiro-Wilk test, the data were dealt with descriptive statistics (frequency, average and deviation standard), test t and Pearson. Results: The average of age of the participants was of 49 years (±12,8), the impact of the fibromyalgia syndrome in the quality of life in the daily pay-test was of 53,64 points and in the after-test of 51,99 points (p=0,73) and the self-efficacy in the daily pay-test was of 147,57 points and in the after test was of 172,27 points (p=0,15). In respect to the three domains of this questionnaire, only the domain of the self-efficacy to deal with other symptoms presented significant difference between the daily pay and after-test (p=0,02). After test had negative correlation (r=-0,72; p=0,042) on the impact of the fibromyalgia and self-efficacy. Conclusion: Although the small number of accomplished sessions (10 sessions), the practical of walking improved the domain of the self-efficacy to deal with other symptoms in women with FM. In the analysis of the quality of life, had not occurred improvements.

Intestinal fibrovascular nodules caused by Schistosoma mansoni infection in Calomys callosus Rengger, 1830 (Rodentia: Cricetidae): a model of concomitant fibrosis and angiogenesis

Human schistosomiasis develops extensive and dense fibrosis in portal space, together with congested new blood vessels. This study demonstrates that Calomys callosus infected with Schistosoma mansoni also develops fibrovascular lesions, which are found in intestinal subserosa. Animals were percutaneously infected with 70 cercariae and necropsied at 42, 45, 55, 80, 90 and 160 days after infection. Intestinal sections were stained for brightfield, polarization microscopy, confocal laser scanning, transmission and scanning electron microscopies. Immunohistological analysis was also performed and some nodules were aseptically collected for cell culture. Numerous intestinal nodules, appearing from 55 up to 160 days after infection, were localized at the interface between external muscular layer and intestinal serosa, consisting of fibrovascular tissue forming a shell about central granuloma(s). Intranodular new vessels were derived from the vasculature of the external vascular layer and were positive for laminin, chondroitin-sulfate, smooth muscle alpha-actin and FVIII-RA. Fibroblastic cells and extracellular matrix components (collagens I, III and VI, fibronectin and tenascin) comprised the stroma. Intermixed with the fibroblasts and vessels there were variable number of eosinophils, macrophages and haemorrhagic foci. In conclusion, the nodules constitute an excellent and accessible model to study fibrogenesis and angiogenesis, dependent on S. mansoni eggs. The fibrogenic activity is fibroblastic and not myofibroblastic-dependent. The angiogenesis is so prominent that causes haemorrhagic ascites

Anopheles albitarsis embryogenesis: morphological identification of major events

Anopheles albitarsis embryogenesis was analyzed through confocal microscopy of clarified eggs. Using Drosophila melanogaster as reference system, the major morphogenetic events (blastoderm, gastrulation, germ band extension, germ band retraction, dorsal closure) were identified. The kinetics of early events is proportionally similar in both systems, but late movements (from germ band retraction on) progress slower in An. albitarsis. Major differences in An. albitarsis related to D. melanogaster were: (1) pole cells do not protrude from the blastoderm; (2) the mosquito embryo undergoes a 180º rotation movement, along its longitudinal axis; (3) the head remains individualized throughout embryogenesis; (4) extraembryonary membranes surround the whole embryo. A novel kind of malaria control is under development and is based on the use of genetically modified mosquitoes. Phenotypic analysis of the embryonic development of mutants will be imposed as part of the evaluation of effectiveness and risk of employment of this strategy in the field. In order to accomplish this, knowledge of the wild type embryo is a prerequisite. Morphological studies will also serve as basis for subsequent development biology approaches