A importância da reabilitação pulmonar em pacientes com COVID-19 / The importance of pulmonary rehabilitation in patients with COVID-19

Introdução: Uma doença altamente infecciosa do trato respiratório, a doença de coronavírus 2019 (COVID-19) pode causar disfunção respiratória, física e psicológica em pacientes. Portanto, a reabilitação pulmonar é crucial para pacientes admitidos e que recebem alta da COVID-19. As sequelas de longo prazo são desconhecidas, mas as evidências de surtos anteriores de CoV demonstram comprometimento da função pulmonar e física, redução da qualidade de vida e sofrimento emocional. Métodos: Trata-se de uma revisão sistemática da literatura realizada através de busca digital em artigos publicados em revistas impressas e eletrônicas, ensaios clínicos, estudos randomizados, revisões sistemáticas, no período compreendido entre os anos de 2003 e 2020. Resultados: Muitos sobreviventes da COVID-19 que necessitam de cuidados críticos podem desenvolver comprometimentos psicológicos, físicos e cognitivos. Conclusão: Existe uma clara necessidade de orientação sobre a reabilitação dos sobreviventes da COVID-19. (AU)

Introduction: A highly infectious disease of the respiratory tract, coronavirus disease 2019 (COVID-19) can cause respiratory, physical, and psychological dysfunction in patients. Therefore, pulmonary rehabilitation is crucial for patients admitted and discharged from COVID-19. The long-term sequelae of COVID-19 are unknown, but evidence of previous CoV outbreaks demonstrates impaired lung and physical function, reduced quality of life and emotional distress. Methods: This is a systematic review of the literature carried out through digital bibliographic search of scientific articles published in printed and electronic journals, clinical trials, randomized studies, systematic reviews, in the period between the years 2003 and 2020. Results: Many survivors of COVID-19 that require critical care can develop psychological, physical, and cognitive impairments. Conclusion: There is a clear need for guidance on the rehabilitation of COVID-19 survivors. (AU)

Chronic treatment with zoledronic acid alters the expression levels of inflammatory, bone, and apoptotic markers and Toll-like receptors 2 and 4 in rat dental pulp.

OBJECTIVE: The aim of this study was to evaluate the immunostaining of inflammatory, apoptotic, and bone markers, as well as Toll-like-receptors (TLRs) 2 and 4 in the dental pulp in rats treated with zoledronic acid (ZA). STUDY DESIGN: We administered 4 intravascular infusions of saline (control group) or 0.20 mg.kg-1 ZA in Wistar rats (n = 6/group). After 70 days, the 3 rights molars (n = 18/group) were microscopically evaluated (presence of ectasic/dilated blood vessels and inflammatory cells). Immunohistochemistry was performed for tartrate resistant acid phosphatase 5 (TRAP; cell counting), cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), TLR2, TLR4, receptor activator of nuclear kappa B ligand (RANKL), osteoprotegerin (OPG), and caspase-3 (scored 0-3 in odontoblast and nonodontoblast dental pulp cells). Mann-Whitney and Fisher's exact tests and Spearman's correlation were used (GraphPad Prism 5.0). RESULTS: There was no alteration in ectasic/dilated blood vessels (P = .101) or inflammatory cells (P = .500), but the number of TRAP-positive cells was reduced in the ZA-group (P = .027). In ZA-group odontoblasts, immunostaining for COX-2 (P = .044), TLR4 (P = .003), OPG (P = .035) and caspase-3 (P = .039) increased, and that for RANKL (P = 0.045) decreased. In nonodontoblast dental pulp cells, RANKL immunostaining decreased (P = .009). In the ZA group, the RANKL/OPG ratio decreased in odontoblast (P = .022) and nonodontoblast dental pulp cells (P = .007). IL-6 did not differ between the groups. CONCLUSIONS: ZA increases the expression levels of inflammatory, apoptotic markers, and TLR4 and alters bone makers in the dental pulp of rats.

Chronic treatment with zoledronic acid increases inflammatory markers in periodontium of rats.

BACKGROUND: Bisphosphonates (BF) rise proinflammatory markers and irreversibly bind to bone. Chronically, BF can lead to an inflammatory status and can increase the local oxidative stress in periodontium. Therefore, the objective of this study was to evaluate whether the chronic infusion of Zoledronic Acid (ZA) increases inflammatory markers in periodontium of rats. METHODS AND RESULTS: Chronically, infusion therapy was performed with ZA (0.04, 0.2 or 1 mg/kg or saline) by four doses in over a 70-day period to analyze periodontium of the first right inferior molar using histologic, histochemical (toluidine blue), and immunohistochemical (CD68, tumor necrosis factor-α (TNF-α), interleukin-1beta (IL-1ß), inducible nitric oxide synthase (iNOS) and nuclear factor kappa B (NF-kB)) tests. The experiment was replicated (ZA 0.2 mg/kg versus saline) for myeloperoxidase (MPO) assay and dose TNF-α, IL-1ß, malondialdehyde (MDA) and glutathione (GSH) in gingiva of the same tooth. Despite there is no alteration in mast cells (P = .608) and CD68 mononuclear-positive cells (P = .351), in the periodontium of the ZA-treated group, was observed an increase in the presence of inflammatory cells (P = .001) and cytoplasmic immunostaining for TNF-α (P = .003), IL-1b (P = .004), iNOS (P = .008), and NF-kB (P =  .025). Levels of MPO (P < .001), TNF-α (P = .002), IL-1ß (P < .001), and GSH (P = .005) were augmented in gingiva of ZA-treated group but MDA (P = .993) levels and NF-kB nuclear staining (P = .923) were not altered. CONCLUSIONS: Chronic treatment with ZA increase proinflammatory cytokines and the number of inflammatory cells in periodontium of rats and GSH are expressed probably in a compensatory manner.

Azithromycin: a new concept in adjuvant treatment of periodontitis.

In most patients periodontitis is successfully treated by scaling and root planing, but some studies have shown that certain sites continue to show periodontal tissue destruction despite conventional periodontal therapy. To solve this problem, antibiotics may be administered as an adjuvant treatment. This includes azithromycin (AZM), which is effective against Gram-negative aerobic and anaerobic bacteria and has a long half-life in periodontal tissues. The purpose of the present study was to determine the efficacy of azithromycin as an adjuvant treatment for periodontitis through a review of the literature in Medline, Lilacs and Scielo, combining the keywords "azithromycin", "periodontal treatment" and "periodontitis" in both Portuguese and English languages. To be included, articles had to be clinical trials, randomized, controlled, double-blind or blind, and published between 2001 and 2011. 70 articles were found, of which 12 were selected based on title and abstract. Most studies used AZM as an adjuvant treatment for chronic periodontitis, usually in a single daily dose of 500 mg over three days, and indicated that AZM significantly reduced probing depth and increased periodontal attachment when compared to controls. Furthermore, a reduction in red and orange complex and an increase in bacteria associated with healthy periodontal conditions were observed in subjects treated with AZM. It may be concluded that the use of AZM as an adjuvant treatment for periodontitis improves clinical and microbiological parameters when compared to conventional treatment alone.