Resumo O impacto da infecção por Chlamydia trachomatis (CT) na fertilidade feminina ainda não está completamente estabelecido, uma vez que o nível de evidência associando esses fatores ainda é insignificante. Assim, o objetivo desta revisão é contribuir para uma melhor elucidação deste assunto. A base de dados eletrônica escolhida foi a Medline/PubMed, com a última pesquisa em 11 de maio de 2021. Utilizou-se como filtro a data de publicação, sendo selecionados os 5 anos anteriores. Foram usados os seguintes descritores: Chlamydia trachomatis E infertility; Chlamydia trachomatis E tubal alteration E infertility; Chlamydia E low pregnancy rates. Dos 322 estudos selecionados, 293 que não atenderam aos nossos critérios de elegibilidade foram excluídos. Posteriormente, retiramos sete estudos por não terem como foco principal a possível correlação entre infecção por CT e infertilidade feminina e três por tratarem de infecções sexualmente transmissíveis (ISTs) em geral. Além disso, dois estudos concebidos como revisões também foram excluídos. Portanto, incluímos 17 estudos em nossa análise qualitativa. Os autores realizaram pesquisas individualmente e analisaram criteriosamente os estudos selecionados. Como obtivemos as informações necessárias para nosso estudo por meio da leitura dos textos, nenhum contato foi feito com os autores. Esta revisão sistemática corrobora a hipótese de que a infecção por CT potencializa a infertilidade feminina, pois 76,47% dos estudos incluídos encontraram correlação positiva entre eles. Concluímos que existe uma associação importante entre infecção por CT e infertilidade feminina. Portanto, tornar os procedimentos de triagem por CT parte da rotina de investigação de infertilidade é relevante e justificável.

Abstract The impact of Chlamydia trachomatis (CT) infection on female’s fertility is not completely established yet, since the level of evidence associating these factors is still weak. Hence, the goal of the present review is to contribute to a better elucidation of this matter. The electronic database chosen was the Medline/PubMed, with the last survey on May 11, 2021. Publication date was used as a filter, with the previous 5 years having been selected. The following describers were used: chlamydia trachomatis AND infertility; chlamydia trachomatis AND tubal alteration AND infertility; chlamydia AND low pregnancy rates. From the 322 studies screened, 293 that failed to meet our eligibility criteria were excluded. Subsequently, we removed seven studies for not having the possible correlation between CT infections and female infertility as its main focus, and three for being about sexually transmitted infections (STIs) in general. Moreover, two studies designed as reviews were also excluded. Ergo, we included 17 studies in our qualitative analysis. The authors conducted research individually and analyzed carefully the studies selected. As we retrieved the information needed for our study through reading the texts, no contact was made with the authors of the studies selected. This systematic review corroborates the hypothesis that CT infection potentiates female infertility, as 76.47% of the included studies found a positive correlation between them. We conclude that there is an important association between CT infection and female infertility. Ergo, making CT screening part of the infertility investigation routine is relevant and has a reasonable justification.

Abstract Introduction and objective Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians. Methods A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU. Results 360 physicians participated in the study, with median time of 10 (5-18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p< 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p< 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p< 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p< 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care. Conclusion Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU.

Abstract Introduction and objective Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians. Methods A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU. Results 360 physicians participated in the study, with median time of 10 (5-18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p< 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p< 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p< 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p< 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care. Conclusion Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU.

Abstract Purpose To evaluate the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. Methods In an experimental study, 30 rats were enrolled and divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to create ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n=15) received ADSC treatment at the end of surgery while the other group, the control (n=15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by Paint-Autocad- 2015 software to define the area of flap necrosis in each rat. Student T test was performed to compare the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. Results Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI 95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. Conclusion The application of adipose-derived stem cells reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection.

Objective: demonstrate adipokines progression, along 12 months, in obese children and adolescents who attend the Obesity Outpatient Clinic for Children and Adolescents of the HCPA. Methods: children and adolescents in medical treatment for obesity were followed for 12 months, assessing anthropometry, blood pressure, waist circumference, lipid profile, fasting blood sugar and insulin, inter leukine- 6, tumor necrosis factor alpha, and adiponectin in two points in time: at inclusion and after 12 months follow-up in the Obesity Outpatient Clinic for Children and Adolescents. Results: 27 children and adolescents were assessed with median age of 10.3 years. The mean BMI z-scores lowered during this period (p < 0.01), HDL-c increased in the period (p = 0.025). The medians of adipokines did not vary during the period: IL-6 (p = 0.470), TNF-α (p = 0.753) and adiponectin (p = 0.943). There was no correlation of IL-6 and TNF-α with central and global obesity along the 12-months follow-up. Adiponectin increased in 45% of the sample, the increase being more pronounced in females. Conclusion: children and adolescents in medical treatment for obesity, after one-year follow-up, did not improve their adiponectin profile.

Objetivo: demostrar la evolución de las adipocinas a lo largo de 12 meses en niños obesos usuarios del Ambulatorio de Obesidad Infantojuvenil. Métodología: se hizo el seguimiento de niños y adolescentes en tratamiento clínico para obesidad a lo largo de 12 meses. Se los evaluó en lo tocante a antropometría, presión arterial, circunferencia de cintura, perfil lipídico, glicemia e insulina en ayuno, interleucina 6, factor de necrosis tumoral alfa y adiponectina en dos instancias: inclusión y después de 12 meses de seguimiento en el Ambulatorio de Obesidad Infantojuvenil. Resultados: se evaluaron 27 niños y adolescentes con una media de edad de 10,3 años. Los valores promedio de la puntuación-z del IMC bajaron en el periodo (p < 0,01), el HDL-c aumentó sus niveles en este periodo (p = 0,025). Las medianas de las adipocinas no variaron a lo largo del periodo: IL-6 (p = 0,470), TNF-α (p = 0,753) y adiponectina (p = 0,943). No hubo correlación entre la IL-6 y el TNF-α con obesidad central y global a lo largo de los 12 meses de seguimiento. El 45% de la muestra aumentó sus valores de adiponectina, siendo mayor este aumento en el sexo femenino. Conclusión: los niños y adolescentes en tratamiento clínico para obesidad tras un año de seguimiento no mejoraron su perfil de adipocinas.

Objetivo: Avaliar a associação do polimorfismo rs1893217 no gene PTPN2 com DM1 e/ou suas características clínicas e laboratoriais em uma população de brancos do Sul do Brasil. Sujeitos e métodos: Quatrocentos e oitenta e seis pacientes com DM1 e 484 indivíduos não diabéticos foram incluídos no estudo. A genotipagem do PTPN2 rs1893217 foi realizada por PCR em tempo real. Resultados: As frequências genotípicas não diferiram entre os pacientes com DM1 e indivíduos não diabéticos (p = 0,265). O alelo C foi observado em 14,5% da amostra com DM1 e 12,2% no grupo de não diabéticos (p = 0,152). Além disso, as frequências dessa variante não diferiram estatisticamente entre os pacientes com DM1 e indivíduos não diabéticos considerando-se os modelos de herança recessivo, dominante ou aditivo. As características clínicas e laboratoriais dos pacientes com DM1 também não diferiram significativamente entre os três genótipos do polimorfismo rs1893217. Conclusão: O polimorfismo rs1893217 do gene PTPN2 não está associado com DM1 em brancos do Sul do Brasil.

Objective: To evaluate the association of the PTPN2 rs1893217 polymorphism with T1DM and/or its clinical and laboratory characteristics in a Caucasian population from Southern Brazil. Subjects and methods: Four hundred and eighty six patients with T1DM and 484 non-diabetic subjects were included in the study. Genotyping of the PTPN2 rs1893217 was performed by real-time PCR. Results: Genotype frequencies did not differ between T1DM patients and non-diabetic subjects (P = 0.265). The C allele was observed in 14.5% of the T1DM sample and 12.2% of the non-diabetic group (P = 0.152). Moreover, the frequencies of this variant did not differ statistically between T1DM patients and non-diabetic subjects when assuming recessive, dominant, or additive inheritance models. The clinical and laboratory characteristics of T1DM patients did not differ significantly among the three genotypes of the rs1893217 polymorphism, either. Conclusion: The PTPN2 rs1893217 polymorphism is not significantly associated with T1DM in Caucasian subjects from Southern Brazil.

O diabetes melito tipo 1 (T1DM) é uma doença autoimune crônica e progressiva caracterizada por descompensações metabólicas frequentemente acompanhadas por desidratação e cetoacidose. Os agentes virais parecem ter um papel importante no desencadeamento da destruição autoimune que leva ao desenvolvimento do T1DM. Entre as cepas virais estudadas até agora, a família dos enterovírus foi consistentemente associada ao surgimento da doença em humanos. Um dos mediadores do dano viral é o RNA fita dupla (RNAfd) gerado durante a replicação e transcrição de RNA e DNA viral. O gene IFIH1 codifica um receptor citoplasmático pertencente à família dos pattern-recognition receptors (PRRs) que reconhece o RNAfd, tendo um papel importante na resposta imune inata desencadeada por infecção viral. A ligação do RNAfd a essa PRR desencadeia a liberação de citocinas pró-inflamatórias como interferons (IFNs), os quais exibem uma potente ação antiviral e têm como objetivo proteger as células não infectadas e induzir apoptose naquelas já contaminadas. O gene IFIH1 parece ter uma participação importante no desenvolvimento de algumas doenças autoimunes. Por isso, esse gene é um candidato ao desenvolvimento do T1DM. Dentro desse contexto, o objetivo da presente revisão foi abordar o papel do IFIH1 no desenvolvimento do T1DM.

Type 1 diabetes mellitus (T1DM) is a chronic, progressive, autoimmune disease characterized by metabolic decompensation frequently leading to dehydration and ketoacidosis. Viral pathogens seem to play a major role in triggering the autoimmune destruction that leads to the development of T1DM. Among several viral strains investigated so far, enteroviruses have been consistently associated with T1DM in humans. One of the mediators of viral damage is the double-stranded RNA (dsRNA) generated during replication and transcription of viral RNA and DNA. The IFIH1 gene encodes a cytoplasmic receptor of the pattern-recognition receptors (PRRs) family that recognizes dsRNA, playing a role in the innate immune response triggered by viral infection. Binding of dsRNA to this PRR triggers the release of proinflammatory cytokines, such as interferons (IFNs), which exhibit potent antiviral activity, protecting uninfected cells and inducing apoptosis of infected cells. The IFIH1 gene appears to play a major role in the development of some autoimmune diseases, and it is, therefore, a candidate gene for T1DM. Within this context, the objective of the present review was to address the role of IFIH1 in the development of T1DM.

CONTEXTO: A citocina TGFß1 (Fator Transformador de Crescimento, TGFß1) desempenha um papel fundamental na fibrogênese, mas sua importância como biomarcador da doença hepática ainda tem sido debatida. OBJETIVO: Quantificar o TGFß1 sérico e estudar a sua associação com o conteúdo de colágeno no tecido hepático em ratos expostos ao Tetracloreto de Carbono (CCl4). MÉTODOS: Ratos foram submetidos ao modelo de fibrose por CCl4 e sacrificados após 6, 10, 12 e 16 semanas de tratamento. Os níveis séricos de TGFß1 foram quantificados por ELISA e a densidade de colágeno foi definida por morfometria. RESULTADOS: Os níveis séricos de TGFß1 aumentaram entre 6 e 10 semanas, enquanto a densidade de colágeno aumentou entre 12 e 16 semanas. Foi detectada uma correlação negativa entre a deposição hepática de colágeno e a concentração sérica de TGFß1 (r = -0,48; P<0,05). CONCLUSÃO: O nível sérico de TGFß1 foi inversamente proporcional à intensidade do colágeno no fígado de ratos com cirrose por CCl4, o que indica que seu uso como biomarcador em estágios avançados da doença pode ter utilidade limitada.

CONTEXT: Transforming Growth Factor ß1 (TGFß1) plays a fundamental role in fibrogenesis, although its importance as a biomarker of liver disease is still matter of debate. OBJECTIVE: Quantify serum TGFß1 and its association to liver collagen content in rats exposed to Carbon Tetrachloride (CCl4). METHODS: Rats were submitted to a fibrosis model using CCl4 and sacrificed after 6, 10, 12 and 16 weeks of treatment. Serum levels of TGFß1 were measured by ELISA and collagen content was defined by morphometric analysis. RESULTS: Serum levels of TGFß1 increased between 6 and 10 weeks, whereas collagen density increased between 12 and 16 weeks. A negative correlation was observed between liver collagen deposition and serum levels of TGFß1 (r = -0. 48; P<0. 05). CONCLUSION: Serum levels of TGFß1 were inversely proportional to collagen intensity in cirrhotic livers of rats exposed to CCl4, thus suggesting a limited use as biomarker in advanced liver disease.