Abstract Abstract: Sepsis is a life-threatening organ dysfunction induced by a disrupted host response to infecting pathogens. Inflammation and oxidative stress are intrinsically related to sepsis progression and organ failure. Vitamin B6 is an important cellular cofactor for metabolic processes and has anti-inflammatory and antioxidant properties. We aimed at evaluating the effect of vit B6 on inflammation and oxidative stress markers in the liver and lung of rats subjected to a relevant animal model of polymicrobial sepsis. Adult male Wistar rats were submitted to cecal ligation and perforation model and immediately after sepsis induction, vit B6 was administered as a single dose (600 mg/kg, subcutaneous). Twenty-four hours later, the lung and liver were harvest for neutrophil infiltration, oxidative markers to lipids and protein and antioxidant activity of endogenous enzyme. Vitamin B6 diminished neutrophil infiltration in both organs, oxidative markers in the liver and restored catalase activity levels in the lung of septic animals. Vitamin B6 exerts anti-inflammatory and antioxidant effects in peripheral organs after polymicrobial sepsis.

RESUMO Objetivo: Análise comparativa da qualidade de vida e funcionalidade dos pacientes submetidos a artrodese de coluna lombar devido a doença degenerativa da coluna lombar. Os autores buscaram correlacionar a influência dos sintomas de ansiedade e depressão antes e após a cirurgia. Métodos: Estudo de coorte prospectivo, que acompanhou 32 pacientes submetidos à artrodese por doença degenerativa da coluna lombar e aplicou os questionários escala visual analógica da dor (EVA), Oswestry Disability Index (ODI), Medical Outcomes Survey Short Form - 36 items (SF-36) e Hospital Anxiety and Depression Scale (HADS). Esses questionários foram aplicados no período pré-operatório e quatro meses após o procedimento. Resultados: Observou-se melhoria nas médias das pontuações das escalas EVA (p < 0,001) e ODI (p < 0,001). No pré-operatório, as variáveis que apresentaram diferença entre pacientes com e sem sintomas ansiosos foram os domínios de SF36 de estado geral de saúde (p = 0,031), aspectos sociais (p = 0,008) e saúde mental (p = 0,035). No pós-operatório, os pacientes sem sintomas de ansiedade demonstraram melhores resultados nos domínios vitalidade (p = 0,004), aspectos sociais (p = 0,001), saúde mental (p < 0,001) e dor (p = 0,011). No pré-operatório, a variável que apresentou diferença entre pacientes com e sem depressão foi o domínio do SF36 de aspectos emocionais (p = 0,022). No pós-operatório os pacientes sem depressão apresentaram melhores resultados nos domínios dor (p = 0,009), estado geral de saúde (p = 0,001), vitalidade (p < 0,001), aspectos sociais (p < 0,001), aspectos emocionais (p = 0,004) e saúde mental (p = 0,001). Conclusão: A artrodese de coluna lombar mostrou-se efetiva na melhoria da dor, lombalgia, capacidade funcional, limitação por aspectos físicos e vitalidade, bem como em aspectos sociais e emocionais. Pacientes sem sintomas ansiosos e depressivos apresentaram melhores resultados nas escalas avaliadas quando comparados com aqueles com sintomas de ansiedade e depressão.

ABSTRACT Objective: Comparative analysis of the quality of life and functionality of patients undergoing lumbar spine arthrodesis due to degenerative lumbar spine disease. The authors sought to correlate the influence of anxious and depressive symptoms before and after surgery. Methods: A prospective cohort study was performed, with 32 patients submitted to arthrodesis due to degenerative lumbar spine disease and the visual analogue pain scale pain questionnaire, the Oswestry Disability Index questionnaire, the Medical Outcomes Survey Short Form questionnaire - 36 items (SF-36), and the Hospital Anxiety and Depression Scale, applied in the preoperative period and four months after the procedure. Results: There was improvement in the mean scores of the visual analogue pain scale (p < 0.001) and the Oswestry Disability Index (p < 0.001). In the preoperative period, the variables that presented a difference between patients with and without anxiety symptoms were the SF-36 domains of general health (p = 0.031), social aspects (p = 0.008), and mental health (p = 0.035). In the postoperative period, patients without anxiety symptoms showed better results in the vitality (p = 0.004), social aspects (p = 0.001), mental health (p < 0.001), and pain (p = 0.011) domains. In the preoperative period, the variable that presented a difference between patients with and without depression was the SF-36 domain of emotional aspects (p = 0.022). In the post-operative period, patients without depression presented better vitality (p < 0.001), social aspects (p < 0.001), emotional aspects (p = 0.004), and mental health results (p = 0.001). Conclusion: Lumbar spine arthrodesis was effective in improving pain, low back pain, functional capacity, limitation due to physical aspects, vitality, and social and emotional aspects. Patients without anxiety and depression symptoms had better results on the scales compared to those with such symptoms.

O objetivo deste estudo foi determinar parâmetros de metabolismo de NO no plasma e placenta de pacientes com pré-eclâmpsia (PE). Foi realizado um estudo de caso-controle no Hospital São José, Brasil. Trinta e três PE e 33 gestantes normotensas foram incluídas no estudo. O diagnóstico de PE foi estabelecido em conformidade com as definições do Colégio Americano de Obstetras e Ginecologistas. Amostras de sangue venoso periférico e placenta foram obtidos no período de pós-parto. Os níveis plasmáticos de NO e atividade SOD foram significativamente menores e os níveis de endotelina-1 e da atividade da arginase foram significativamente maiores em mulheres PE quando comparados aos controles. Nenhum dos parâmetros analisados foram diferentes na placenta entre os grupos. Nossos resultados sugerem que os parâmetros associados ao metabolismo do NO estão alterados apenas no nível sistêmico, mas não na placenta de pacientes PE.

The aim of this study was to determine parameters of NO metabolism in plasma and placenta of preeclamptic (PE) patients. It was conducted a case-control study at São José Hospital, Brazil. Thirty-three PE and 33 normotensive pregnant were included in the study. The diagnosis of PE was established in accordance with the definitions of American College of Obstetricians and Gynecologists. Peripheral venous blood and placenta samples were obtained at postpartum period. Plasma NO levels and SOD activity were significantly lower and endothelin-1 levels and arginase activity were significantly higher in PE women when compared to controls. None of the analyzed parameters were different in the placenta between groups. Our findings suggest that parameters associated with NO metabolism are altered only at the systemic level, but not in placenta of PE patients.

Objective: To evaluate the influence of environmental enrichment (EE) on memory, cytokines, and brain-derived neurotrophic factor (BDNF) in the brain of adult rats subjected to experimental pneumococcal meningitis during infancy. Methods: On postnatal day 11, the animals received either artificial cerebrospinal fluid (CSF) or Streptococcus pneumoniae suspension intracisternally at 1 × 106 CFU/mL and remained with their mothers until age 21 days. Animals were divided into the following groups: control, control + EE, meningitis, and meningitis + EE. EE began at 21 days and continued until 60 days of age (adulthood). EE consisted of a large cage with three floors, ramps, running wheels, and objects of different shapes and textures. At 60 days, animals were randomized and subjected to habituation to the open-field task and the step-down inhibitory avoidance task. After the tasks, the hippocampus and CSF were isolated for analysis. Results: The meningitis group showed no difference in performance between training and test sessions of the open-field task, suggesting habituation memory impairment; in the meningitis + EE group, performance was significantly different, showing preservation of habituation memory. In the step-down inhibitory avoidance task, there were no differences in behavior between training and test sessions in the meningitis group, showing aversive memory impairment; conversely, differences were observed in the meningitis + EE group, demonstrating aversive memory preservation. In the two meningitis groups, IL-4, IL-10, and BDNF levels were increased in the hippocampus, and BDNF levels in the CSF. Conclusions: The data presented suggest that EE, a non-invasive therapy, enables recovery from memory deficits caused by neonatal meningitis.

Objective: To evaluate the relationship between brain damage biomarkers and mortality in the intensive care unit (ICU). Methods: The sample comprised 70 patients admitted to an ICU. Blood samples were collected from all patients on ICU admission, and levels of S100β and neuron-specific enolase (NSE) were determined by ELISA. Results: Acute Physiologic and Chronic Health Evaluation (APACHE II) score was associated with mortality, but NSE and S100β were not associated with this outcome. In contrast, S100β levels were significantly higher in delirious and non-delirious patients who required mechanical ventilation during ICU stay. Conclusion: Levels of brain biomarkers at the time of ICU admission did not predict mortality in critically ill patients.

OBJECTIVE: Oxidative stress plays an important role in skeletal muscle damage in sepsis. Aerobic exercise can decrease oxidative stress and enhance antioxidant defenses. Therefore, it was hypothesized that aerobic exercise training before a sepsis stimulus could attenuate skeletal muscle damage by modulating oxidative stress. Thus, the aim of this study was to evaluate the effects of aerobic physical preconditioning on the different mechanisms that are involved in sepsis-induced myopathy. METHODS: Male Wistar rats were randomly assigned to either the untrained or trained group. The exercise training protocol consisted of an eight-week treadmill program. After the training protocol, the animals from both groups were randomly assigned to either a sham group or a cecal ligation and perforation surgery group. Thus, the groups were as follows: sham, cecal ligation and perforation, sham trained, and cecal ligation and perforation trained. Five days after surgery, the animals were euthanized and their soleus and plantaris muscles were harvested. Fiber cross-sectional area, creatine kinase, thiobarbituric acid reactive species, carbonyl, catalase and superoxide dismutase activities were measured. RESULTS: The fiber cross-sectional area was smaller, and the creatine kinase, thiobarbituric acid reactive species and carbonyl levels were higher in both muscles in the cecal ligation and perforation group than in the sham and cecal ligation and perforation trained groups. The muscle superoxide dismutase activity was higher in the cecal ligation and perforation trained group than in the sham and cecal ligation and perforation groups. The muscle catalase activity was lower in the cecal ligation and perforation group than in the sham group. CONCLUSION: In summary, aerobic physical preconditioning prevents atrophy, lipid peroxidation and protein oxidation and improves superoxide dismutase activity in the skeletal muscles of septic rats.

OBJETIVOS: Sepse neonatal corresponde a uma síndrome complexa, causada por resposta inflamatória sistêmica descontrolada, associada a um foco infeccioso que pode determinar disfunção ou falência de um ou mais órgãos ou mesmo a morte. Apresenta incidência elevada em neonatos prematuros, sendo importante correlacionarmos fatores prognósticos para otimizar nosso diagnóstico precoce e resposta a terapêutica nestes pacientes. Este estudo teve por objetivo determinar a relação entre marcadores inflamatórios e parâmetros oxidativos com fatores prognósticos em sepse neonatal precoce. MÉTODOS: Foi realizado um estudo observacional, prospectivo e foram coletados os dados de 120 pacientes, da maternidade de hospital universitário. Foram incluídos na pesquisa neonatos prematuros (< 37 semanas de gestação) com pelo menos um outro fator de risco para sepse neonatal. Foram determinados os níveis de interleucina (IL)-6, IL-10, substâncias reativas ao ácido tiobarbitúrico e de proteínas carboniladas em sangue do cordão umbilical e sua relação com gravidade de sepse. RESULTADOS: Os níveis das substâncias reativas ao ácido tiobarbitúrico e IL-6, mas não IL-10 e proteínas carboniladas, apresentaram correlação significativa com o escore de gravidade SNAPPE-II (r=0,385, p=0,017 e r=0,435 / p=0,02, respectivamente). Não houve relação dos marcadores com a mortalidade dos pacientes. CONCLUSÃO: Substâncias reativas ao ácido tiobarbitúrico e IL-6 têm uma correlação de média a moderada com o escore de gravidade SNAPPE-II, mas não com mortalidade.

OBJECTIVES: Neonatal sepsis is a complex syndrome involving an uncontrolled systemic inflammatory response associated with an infection. It may result in the dysfunction or failure of one or more organs or even death. Given its high incidence in premature neonates, the identification of prognostic factors to optimize the early diagnosis and therapeutic interventions are highly desirable. This objective study determine the relationship between inflammatory markers and oxidative parameters as prognostic factors in early neonatal sepsis. METHODS: We conducted a prospective observational study by collecting data from 120 patients in the maternity unit of a university hospital. Preterm (<37 weeks of pregnancy) infants with at least one additional risk factor for neonatal sepsis were included. The levels of interleukin (IL)-6, IL-10, thiobarbituric acid reactive species (TBARS) and protein carbonyls and their association with sepsis severity were determined in the cord blood. RESULTS: Levels of IL-6 and TBARS, but not IL-10 and protein carbonyls, demonstrated a mild to moderate correlation with the SNAPPE-II severity score (r=0.435, p=0.02 and r = 0.385, p = 0.017, respectively). No correlations were found between these markers and mortality. CONCLUSION: TBARS and IL-6 have a mild to moderate correlation with SNAPPE-II, but none of the studied markers were able to predict mortality in our sample.

INTRODUÇÃO: Transfusão de concentrado de hemácias é freqüentemente prescrita nas unidades de terapia intensiva. Durante muito tempo a transfusão de hemácias era vista como tendo benefícios clínicos óbvios. Entretanto nos últimos anos a prática de transfusão sanguínea tem sido examinada de uma forma mais cautelosa, levando a investigações a respeito dos benefícios transfusionais, incluindo aqui o fato de os efeitos imunomoduladores relacionados à transfusão podem aumentar o risco de morbimortalidade dos pacientes. OBJETIVOS: Avaliar o efeito da transfusão de concentrado de hemácias e sua relação com a produção de citocinas inflamatórias e dano oxidativo em pacientes criticamente enfermos admitidos em uma unidade de terapia intensiva. MÉTODOS: Foram analisados durante 6 meses, no ano de 2008, pacientes internados na unidade de terapia intenvia que realizaram transfusão de concentrado de hemácias. Foram analisados os níveis séricos pré e pós transfusionais de interleucina-6 (IL-6), proteínas carboniladas e substâncias reativas ao ácido tiobarbitúrico (TBARS). RESULTADOS: Houve diminuição dos níveis séricos de IL-6 pós-transfusionais e um aumento significativo tanto para TBARS quanto para proteínas carboniladas. No entanto não houve significância estatística entre os níveis séricos de IL-6, TBARS antes e após transfusão de concentrado de hemácias e a taxa de mortalidade. Contudo ocorreu significância da relação dos níveis pós transfusionais de proteínas carboniladas e mortalidade. CONCLUSÃO: Transfusão de concentrado de hemácias é associada a aumento dos marcadores de dano oxidativo e diminuição de IL-6 em pacientes criticamente enfermos.

INTRODUCTION: Red blood cell transfusions are common in intensive care units. For many years, transfusions of red blood were thought to have obvious clinical benefits. However, in recent years, the risks and benefits of blood transfusions have been examined more carefully, including the risk of increased morbidity and mortality due to transfusion-related immunomodulation effects. OBJECTIVES: To evaluate red blood cell transfusion effects and the relationship of this procedure to the production of inflammatory cytokines and oxidative damage in critically ill patients admitted to an intensive care unit. METHODS: For 6 months in 2008, we evaluated patients admitted to an intensive care unit who underwent packed red blood cell transfusions. Pre- and post-transfusion levels of interleukin-6, carbonylated proteins and thiobarbituric acid reactive substances were assessed. RESULTS: Serum post-transfusion interleukin-6 levels were reduced, and thiobarbituric acid reactive substances and carbonylated proteins were significantly increased. No statistically significant relationship was found between the levels of pre- and post-transfusion interleukin-6 and thiobarbituric acid reactive substances and the mortality rate. However, there was a significant relationship between levels of post-transfusion carbonylated proteins and mortality. CONCLUSION: Red blood cell transfusion is associated with increased oxidative damage markers and reduced interleukin-6 levels in critically ill patients.