In Duchenne muscular dystrophy (DMD), the search for new biomarkers to follow the evolution of the disease is of fundamental importance in the light of the evolving gene and pharmacological therapies. In addition to the lack of dystrophin, secondary events including changes in calcium levels, inflammation and fibrosis greatly contribute to DMD progression and the molecules involved in these events may represent potential biomarkers. In this study, we performed a comparative evaluation of the progression of dystrophy within muscles that are differently affected by dystrophy (diaphragm; DIA and quadriceps; QDR) or spared (intrinsic laryngeal muscles) using the mdx mice model of DMD. We assessed muscle levels of calsequestrin (calcium-related protein), tumour necrosis factor (TNF-α; pro-inflammatory cytokine), tumour growth factor (TGF-β; pro-fibrotic factor) and MyoD (muscle proliferation) vs. histopathology at early (1 and 4 months of age) and late (9 months of age) stages of dystrophy. Fibrosis was the primary feature in the DIA of mdx mice (9 months: 32% fibrosis), which was greater than in the QDR (9 months: 0.6% fibrosis). Muscle regeneration was the primary feature in the QDR (9 months: 90% of centrally nucleated fibres areas vs. 33% in the DIA). The QDR expressed higher levels of calsequestrin than the DIA. Laryngeal muscles showed normal levels of TNF-α, TGF-β and MyoD. A positive correlation between histopathology and cytokine levels was observed only in the diaphragm, suggesting that TNF-α and TGF-β serve as markers of dystrophy primarily for the diaphragm.

Objetivo:  Avaliar a funcionalidade do membro superior dos pacientes submetidos ao esvaziamento cervical. Método:  Trata-se de um estudo prospectivo, de antes e depois que consistia de duas avaliações, a primeira foi realizada 24 horas antes da cirurgia e a segunda avaliação foi realizada no intervalo de 20 a 60 dias. Os instrumentos de avaliação utilizados foram: Goniometria, Dinamometria manual, Disabilities of the Arm, Shoulder and Hand (DASH) e Escala Visual Analógica (EVA).  Resultados: O estudo verificou que 68% dos pacientes relataram dor, com o escore de média da EVA de 3,18 ±2,74 na avaliação pós-cirúrgico. A média da pontuação do DASH antes e após a cirurgia foi de 0,1075 e 15,28 respectivamente, demostrando uma redução na funcionalidade no membro superior. relação a amplitude de movimento do membro superior houve diferença comparando antes e após a cirurgia, na flexão, extensão e abdução. Conclusão: Concluindo que os pacientes que foram submetidos ao esvaziamento cervical mesmo com a utilização de técnicas cirúrgicas mais conservadoras, apresentam alterações na amplitude de movimento interferindo diretamente na perda da funcionalidade do membro acometido.

No abstract

Evidências reforçam que a abreviação do jejum perioperatório reduz complicações e desconfortos evitáveis. No entanto, a realidade do jejum prolongado persiste e compromete a segurança alimentar e nutricional do paciente cirúrgico em hospitais brasileiros. O presente estudo teve como objetivo investigar as características de jejum alimentar e hídrico de pacientes oncológicos no período perioperatório. Participaram sessenta pacientes admitidos para cirurgias eletivas no tratamento de canceres do trato gastrointestinal. À beira do leito, um questionário foi aplicado e complementado por registros do bloco cirúrgico e prontuários. Durante o jejum, cerca de 1 hora antes e 4 horas após a cirurgia, os pacientes relataram a última e a primeira refeição e ingestão de água, intercorrências alimentares, fome e sede. Foi conduzida análise estatística descritiva e inferencial. Houve grande variação de duração com mediana de 17 horas (mín. 5 -máx. 330) do jejum pré-operatório alimentar e 14,1 horas (mín. 2,25 -máx. 417) do jejum hídrico. No pós-operatório a mediana do jejum alimentar e hídrico foi de 19,2 horas (mín. 2,42 -máx. 200) e 21 horas (mín. 2,5 -máx. 201) respectivamente. O jejum alimentar e hídrico foi demasiadamente prolongado e alheio à características determinantes de risco nutricional como a faixa etária, a oferta dietética pré e pós-jejum, as intercorrências alimentares e o desconforto por fome e sede.Palavras-chave: Assistência perioperatória. Segurança do paciente. Segurança alimentar e nutricional. Oncologia cirúrgica.

Background Some antiretrovirals (ARVs) cause muscle toxicity and their use has been attributed to beginning of respiratory and peripheral muscle weakness in people living with HIV/AIDS (PLWHA) on treatment. Dolutegravir (DTG) has been adopted by Brazil as a first-line regimen with Tenofovir/Lamivudine (TDF/3TC) since 2017, with low toxicity profile. Due to the short use of this regimen, we have not found data in the literature regarding its effects in the respiratory and peripheral muscles in PLWHA. The aim of this study was to compare respiratory and peripheral muscle strength before and after start of this new combined ART (TDF/3TC/DTG).Methods Descriptive, longitudinal and prospective study, observational and analytical with 41 PLWHA evaluated before the initiation of antiretroviral therapy (ART) (T0) which of these, 28 were reevaluated after more than 50 days of treatment (T1).The assessments of maximum functional capacity (six-minute walk test distance), maximal inspiratory (MIP) and expiratory (MEP) pressures and handgrip strength (HGS) were performed using standardized methods. In addition, laboratory data (CD4, CD4/CD8 ratio and viral load-VL) were collected. Shapiro-Wilk test was applied for normality while Fisher's exact test and t-test or Wilcoxon test were used for comparisons of categorical and continuous variables, respectively. Pearson or Spearman correlations were used according to data normality and p-value < 0.05 were considered significant for all analyzes.Results The frequency of peripheral muscle weakness in patients evaluated at T0 was 97.6%, while 31.7% had inspiratory and / or expiratory muscle weakness. HGS was positively correlated with CD4 (p = 0.027) and negatively correlated with VL (p = 0.046). Both MIP (p = 0.0176) and HGS (p = 0.0018) showed improvement in T1.Conclusion ART combined with TDF / 3TC / DTG increased MIP and HGS after more than 50 days of treatment. Cohort studies are needed to better understand the action of these medications on PLWHA musculature under treatment.