Oral squamous cell carcinoma (OSCC) is a significant public health challenge associated with high mortality rates primarily due to its invasive and metastatic behavior. This study aimed to evaluate the expression patterns of five critical biomarkers: β-catenin, E-cadherin, podoplanin (PDPN), CXCR4, and p53 in OSCC tissues and to investigate their correlations with clinicopathologic features and patient outcomes. We conducted an immunohistochemical analysis utilizing tissue microarrays (TMAs) from 95 patients diagnosed with primary OSCC. The expression levels of the five biomarkers were quantified using H-scores. Statistical analyses, including Kruskal-Wallis tests, Dunn’s post-hoc tests, and correlation analyses, were performed to explore the associations between biomarker expression, clinicopathologic parameters, and overall patient survival. The study found that loss of E-cadherin and β-catenin expression was significantly associated with increased tumor depth and lymphatic invasion, corroborating their role in the process of epithelial-mesenchymal transition (EMT). High levels of PDPN were noted in both early and late-stage OSCC, indicating its potential involvement in initiating invasive behaviors. Notably, CXCR4 expression exhibited positive correlations with E-cadherin and β-catenin, suggesting a hybrid invasion phenotype incorporating both EMT and collective invasion strategies. Although Cox regression analysis did not reveal significant associations between biomarker expression and overall survival (OS) or disease-specific survival (DSS), factors such as alcohol consumption, tumor size, lymph node involvement, and advanced clinical stage emerged as significant negative predictors of both OS and DSS. The expression profiles of β-catenin, E-cadherin, PDPN, CXCR4, and p53 in OSCC tissues provide valuable insights into a hybrid model of invasion that integrates mechanisms of EMT with an important rule in the tumor invasion. This nuanced understanding of OSCC progression highlights the potential of PDPN and CXCR4 as novel therapeutic targets, emphasizing the need for further investigation into their roles in OSCC biology and the development of targeted treatments that could improve patient outcomes and survival rates.

Este artigo apresenta um relato de experiência sobre a implementação de uma avaliação global multimodal no curso de medicina. Focado na integração de conhecimento teórico e habilidades práticas, este estudo inovador envolveu estudantes do primeiro ao oitavo semestre, avaliados por colegas dos semestres finais. A avaliação abrangeu três modalidades: provas escritas para conhecimento teórico, estações práticas para habilidades médicas, e o Exame Clínico Objetivo Estruturado (OSCE) para atitudes. Descrever a metodologia e implementação da avaliação global multimodal no curso de graduação em medicina. Utilizou-se uma abordagem qualitativa, coletando dados por meio de observações, feedback de estudantes e professores, e análise documental. A análise enfocou as implicações práticas, desafios operacionais e reações dos envolvidos. Os resultados revelaram que a avaliação global multimodal efetivamente integrou conhecimento teórico e habilidades práticas. Os estudantes demonstraram uma compreensão aprofundada e aplicação das competências médicas, traduzindo-se em maior engajamento e entendimento holístico da medicina. Os professores notaram um avanço significativo no processo de aprendizagem e preparo dos alunos para enfrentar desafios clínicos. A avaliação global multimodal emergiu como uma inovação relevante na educação médica, desafiando o modelo tradicional de ensino e avaliação. Este estudo contribui para o debate sobre práticas eficazes de avaliação na educação médica, evidenciando a importância desta abordagem no desenvolvimento de competências médicas adaptadas às exigências contemporâneas do campo.

O desenvolvimento de competências e habilidades necessárias para o processo de pesquisa científica na graduação em medicina deve ser parte integrante do currículo de uma escola médica preocupada com a formação de profissionais relevantes para a sociedade. Integrar pesquisa científica com a formação em saúde é um desafio que exige mudança na cultura institucional. É necessário haver espaços específicos na matriz curricular para o desenvolvimento de atividades de produção e divulgação científica, para que a comunidade acadêmica seja motivada a participar desse processo. Descrever a reestruturação das disciplinas de Habilidade de Pesquisa Científica em um curso de medicina de uma instituição de ensino superior privada; relatar a experiência de desenvolvimento de competências e habilidades pelos estudantes na vivência dessa reestruturação na matriz curricular. Estudo descritivo, qualitativo, do tipo relato de experiência do planejamento e do desenvolvimento das disciplinas de Habilidades de Pesquisa Científica, ao longo de quatro semestres, em um curso de medicina de uma instituição de ensino superior do interior paulista. Trata-se da descrição da reestruturação das disciplinas de Habilidades de Pesquisa Científica em um curso de medicina, visando aprimorar a formação dos alunos. A iniciativa surgiu em 2018, após a análise dos Trabalhos de Conclusão de Curso (TCC) desenvolvidos pelos graduandos em medicinas, o que levou à extinção do TCC da matriz curricular, com redirecionando de esforços e recursos para iniciações científicas. Em 2019, foi lançado o Programa de Iniciação Científica, incentivando bolsas de iniciação científica. A reestruturação efetiva da disciplina, iniciada em 2022, promoveu nítidos avanços quantitativos e qualitativos, desenvolvendo competências e habilidades diversas, relacionadas às competências de leitura e escrita de artigos, desenvolvimento de pesquisas com impacto na comunidade e divulgação científica. As alterações resultaram em significativo aumento da participação de alunos e professores em atividades de pesquisa na FACERES e aumento na produção científica, evidenciando um novo paradigma na formação científica em medicina na instituição. A pesquisa científica, essencial para se concretizar a Medicina Baseada em Evidências, exige compreensão metodológica. As Diretrizes Curriculares Nacionais (DCN) de 2014 propõem integração entre ensino, pesquisa e extensão, mas a aplicabilidade é ainda um desafio. Estimular a pesquisa requer mudança de atitude, tempo e percepção. Fóruns de pesquisa e eventos científicos promovem inclusão e integração, ampliando a produção científica. Ao final desse processo de reorganização das atividades de produção científica, pode-se observar a concretização do que as DCN do curso de graduação em Medicina definem como competências da prática médica. Em uma paráfrase livre dessa resolução do Ministério da Educação, pode-se afirmar que os futuros médicos mobilizaram conhecimentos, habilidades e atitudes das mais diversas ordens, ao participarem de um processo longitudinal que propicia condições para compreenderem, na prática, o que é, como se faz e como se divulga ciência em saúde. A introdução precoce, de forma planejada e focada em resultados do processo de pesquisa acadêmica resultou em aumento significativo de produções científicas. Atualmente, mais de 35% dos alunos da instituição participam de pesquisa e iniciação científica, com perspectivas de ampliação para 50% desse total. Em adição, foi possível observar que a reestruturação da disciplina pode ao longo do tempo diminuir as dificuldades dos estudantes em relação a pesquisa científica, e originar a percepção da pesquisa como uma ferramenta útil para no seu futuro profissional, enquanto também desenvolve atitudes científicas favoráveis.

INTRODUÇÃO: As normas e leis da sociedade, até recentemente, permitiam ou não puniam a violência de gênero, como nos casos de assassinatos de mulheres em que se alegava a defesa da honra. Assim, nos últimos anos, várias medidas foram tomadas com o intuito de prevenir e combater o problema. OBJETIVO: Descrever as novas abordagens médicas as mulheres vítimas de violência doméstica na atenção primária. MÉTODO: A coleta dos dados se deu por meio de um questionário confeccionado por estudantes de medicina, após a consulta pela telemedicina, quando foram identificadas as mulheres em situação de vulnerabilidade. A seguir, foi feita a montagem do plano terapêutico objetivando sua melhora e futura análise dos dados e foi anexado ao prontuário das pacientes. RESULTADOS: Durante atendimento através da telemedicina houve dez pacientes que foram orientadas sobre o que poderiam fazer durante seu dia a dia para melhorar a qualidade de vida no período da pandemia. Entretanto, apenas seis pacientes retornaram à ligação após as orientações e, dentre estas, quatro tiveram resultados de violência confirmados. CONCLUSÃO: Com o advento da pandemia do COVID 19, as mulheres ficaram mais expostas a violência doméstica e ao desenvolvimento de transtornos psicológicos associados com esse trauma. A telemedicina pode ser uma ferramenta de apoio importante nestas situações.

Introdução: O planejamento dos cuidados para manejo adequado de sintomas, baseado na autonomia, desejos e valores do paciente em cuidados paliativos, tem como recurso de auxílio importante as Diretivas Antecipadas de Vontade (DAVs). A aplicação das DAVs pode ser uma ferramenta de auxílio na concordância entre desejos de cuidados em fim-de-vida expressos pelos pacientes, tomada de decisões compartilhadas entre paciente, família, médicos e demais profissionais da equipe de saúde, e consequentemente influenciar para uma melhor qualidade de morte dos pacientes. Objetivo: Avaliar os efeitos das DAVs na qualidade de morte de pacientes em cuidados paliativos. Métodos: Estudo de revisão integrativa utilizando as bases de dados Pubmed/Medline, LILACS e Biblioteca Virtual em Saúde (BVS). A pesquisa foi conduzida considerando os termos “Advance directives” and "palliative care" and “death”. Resultados: Após análise de elegibilidade foram incluídos 16 estudos. A metodologia observacional do tipo coorte retrospectiva foi predominante (n=9). Notou-se que, dos artigos incluídos, 12 deles responderam diretamente à pergunta de pesquisa, e destes 11 artigos confirmaram efeitos positivos na qualidade de morte e na diminuição de intensidade de procedimentos hospitalares em fim-de-vida. Conclusão: A realização das DAVs o mais precoce possível com qualidade nas informações prestadas e comunicação adequada, possibilita uma tomada de decisão compartilhada em relação aos desejos, cuidados e opções terapêuticas para o fim-de-vida. O planejamento de cuidados quando discutido podem promover uma diminuição dos cuidados agressivos recebidos em final de vida, e uma melhor qualidade de morte.

Introdução: A incontinência urinária (IU) emerge como uma questão de relevância crítica, afetando significativamente a qualidade de vida dos idosos que vivem em Instituições de Longa Permanência para Idosos (ILPIs). Objetivo: Compartilhar abordagens para lidar com a incontinência urinária, enfocando educação, apoio familiar e empatia. Relato da Experiência: Uma roda de conversa de alunos com pacientes foi realizada para avaliar a prevalência da IU e iniciar o diálogo sobre a condição. Foi evidenciada a baixa escolaridade entre as idosas incontinentes. Reflexão sobre a Experiência: A experiência ressaltou a importância da empatia e do respeito pela dignidade dos idosos, indo além da precisão diagnóstica. Conclusões ou Recomendações: A abordagem multidimensional da IU, incorporando aspectos médicos, emocionais, educacionais e de apoio social, é fundamental para melhorar a qualidade de vida dos idosos.

Introduction: Although the literature recognizes the benefits of Palliative Care (PC) integrated with standard cancer treatment, access to PC is limited by barriers and stigmas and ends up directly influencing the care and support of cancer patients and their family caregivers. Objective: To analyze the implications of stigmas and barriers related to palliative care in the care of cancer patients. Methods: Systematic review study using Medline, SciELO, and LILACS databases to search for studies published from 2017 to 2022. The search was conducted considering the terms “stigmas”, “barriers”, “palliative care” and “cancer”. The quality of articles was assessed using the Study Quality Assessment Tool from the Department of Health and Human Services. Results: A total of 63 studies were identified; 8 studies were eligible and included. North America and Europe were the countries with the highest number of studies included (n=3, n=2, respectively). The stigmas and barriers related to PC identified were administrative, economic, institutional (n=3), cultural (n=2), knowledge (n=6), communication (n=3), geographic (n=1) and social ( n=1). Inaccessibility to PC or late referral as a result of PC-related stigma and/or barriers was identified in all studies. Patients with the maintenance of the expectation of healing, receiving futile care at the end of life (n=1), impact on the desires for end-of-life care, autonomy and dignity (n=1), unmanaged psychological and spiritual suffering (n=1), purchase of drugs for analgesia with own resources (n=1); non-shared decision-making (n=1) and worsening of the mental health of professionals in pediatric oncology (n=1). Conclusion: The barriers and stigmas related to PC can influence the care received by patients, especially in end-of-life care, due to lack of access to PC or late access. Heterogeneity regarding study design and results, and low methodological quality are challenges when reaching conclusions.

Introduction: Religion, spirituality, and sport are increasingly popular disciplines in the sport. As a historical memorial to the Greek Olympic Games, human movement activities were part of religious cults and rites in ancient societies. The modern athlete normally follows his or her religious tradition privately. Thus, the practice of sports activities linked to spirituality/religiosity (S/R) has acquired increasing importance, becoming an important cultural paradigm. Objective: To carry out a systematic review on the main considerations of spirituality and religiosity in sport, showing the state of the art. Methods: The present study followed a concise systematic review model, following the rules of the systematic review – PRISMA. The search strategy was carried out in PubMed, Cochrane Library, and Scopus databases, in addition to Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 156 articles were found, of which 76 articles were fully evaluated and 10 were included and evaluated in the present study to compose the systematic review. Based on the literary findings, spirituality/religiosity plays a vital role in improving sports performance and contributes to the well-being of athletes. In addition, spirituality/religiosity practices represent a driving force in the sport, helping athletes to deal with the uncertainties that can make them stressed/anxious, making them more motivated, confident, and responsible to play to the best of their ability. capacity as they perceive their athletic talent as a gift from God, thus reducing the pressure placed on them to cope with the competitive environment, better coping with sports injuries, and building trust between coaches and athletes.

Objective: The objectives of this review are to ascertain the diseases that result in palliative care in neonates in NICU and whether such care can ease the suffering of the child or the family. Methods: This is a narrative and descriptive literature review carried out in MEDLINE, PUBMED, VHL, and LILACS BVS databases during November 2020 to May 2021. Descriptors used are “Intensive Care Units,” “Ethics,” “Palliative Care,” and “Newborn,” which are related to Boolean descriptor “AND.” Articles published in English and within the last five years were included in this article. Results: The respiratory diseases and distress, prematurity, congenital abnormalities, and patients at risk of neurological injury represents some of the reasons to refer the patient to the ICU. Beyond that, the three most life-timing complex chronic conditions are neurological, neuromuscular, and cardiovascular diseases. The research emphasizes that the relief in the neonatal ICU is an important factor, in this way, palliative care should be focused mostly on the patient. Conclusion: To date, palliative care is appropriate from the moment when a serious diagnosis is made, otherwise it requires the creation of a protocol that guides patients to healthcare professionals. Regardless, to improve the life quality of the neonates during development, their care must be maintained at all moments of the therapeutic intervention.

Introduction: In leprosy, for the study of disabilities, functional limitation (physical deformities), activity limitation, and social participation are considered, such disabilities can be measured respectively by the simplified neurological assessment of eyes, hands, and feet (EHF) and by the scales SALSA and Social Participation. This process can be facilitated with the support of artificial intelligence (AI), specifically by Bayesian networks (BN). Objective: To present and discuss the relative results of two modules of SADHANS, SalsaS, which presents the conditions of the evolution of functional limitation, and the SpartS, which presents the evolution of the restriction to social participation in patients after discharge from leprosy. Methods: This work described a cross-sectional study to model (STROBE rules) a support system for the identification of the development of disabilities in leprosy (SADHANS), especially concerning activity limitation (SalsaS) and social participation (SpartS).Its performance was approved by the Research Ethics Committee of the Pontifical Catholic University of Paraná – PUCPR, opinion 0004697/11. Results and Conclusion: The SalsaS and SpartS modules were developed to help identify the probabilities that a patient discharged from leprosy has developed disabilities related to activity limitation and social participation. The system is essential to help health services to care for patients during treatment and after the therapeutic cure of leprosy, as it directly assists in the prevention of disabilities, presenting what should be monitored. The main contribution of the modules is in offering the probabilities that involve the development of new and the evolution of disabilities, according to the characteristics of the patient. It is a system modeled from Bayesian networks, which indicates the elements that must be monitored to avoid and/or control the evolution of disabilities. According to the research results, it appears that the disability prevention policies developed by the health system must overcome the discussion and practices aimed at physical deformities, offering answers to problems also related to social participation and limitation of activities. Finally, it is considered that the modules are ready to be applied in the health system for the care of patients after leprosy discharge.

The impact of spirituality and religiosity on health is an increasingly discussed topic in literature, although the World Health Organization has already included the spiritual dimension as being important since 1998. However, there is some confusion between the definition of spirituality and religiosity [1,2]. Spirituality is defined as the human being's search about his or her purpose in life, which can be found in religion, in relationships with other people, in nature, in art, in his or her own thoughts, and in relationships with some divine figure or transcendence. In other words, spirituality is the belief that provides the individual a purpose in life [3]. It contains all the possible needs that an individual requires, which provides perspectives that will guide a person's priorities, and may or may not have an associated religious belief. Therefore, spirituality is present in the daily lives of many individuals because it is an important source of emotional support, helping people to deal with their difficulties and, consequently, influencing their mental and physical health [4]. Thus, when a person faces some types of illness, spiritual beliefs will be a support for that person to deal with suffering and difficulties. Therefore, doctors, even though they may not believe in the patient's beliefs, should respect and support the patient in order to help in treatment and contribute to the patient's coping with the disease. For these reasons, the health of the human being is not only determined as physical and mental, but also spiritual [5]. Religiosity, in turn, involves the systematization of a cult and doctrine shared by a group. Although it can be a positive tool for coping with problems, religiosity can also bring some negative aspects face to this illness. It is because there are some risks that religion can bring during this period, such as, for example, patients associating the disease with some guilt and this can bring suffering; there may be some religious guidelines that may interfere in the patient's therapeutic process, or the physician may also approach the patient about his own religious beliefs, and, consequently, affect their relationship (both of them) [6]. Even knowing the importance of the theme, there are several barriers that make it difficult for physicians to approach spirituality with the patient. One of them is that they don't know the right time and the right way to talk about it with the patients, because they have a certain difficulty in dealing with the subject due to the lack of knowledge. In addition, there are doctors who are afraid that the subject won't please the patient, and others think that it's not their job to talk about it or that it wouldn't have a positive impact on the individual's treatment. As soon as physicians begin to study the subject and increase their knowledge about it, these difficulties are overcome and, consequently, they begin to approach spirituality more naturally, bringing benefits to the doctor-patient relationship [7]. International research on the relationship between religiosity/spirituality and health has been increasing in recent years, and some universities around the world are adding this content to the doctor's curriculum. However, most physicians do not study this subject during graduation and more in-depth studies on how to apply this subject in the discipline [8]. Regarding the spirituality/religiosity of a healthcare professional, especially the oncologist, who works in sectors where there is a lot of pain and suffering, this has a positive impact and will help him to deal with these difficult moments and maintain his mental health. Therefore, it is important that the health professional knows how to look at the patient as a unique being and be able to integrate all the necessary dimensions of assistance, D O I: 1 0 .5 4 4 4 8 / m d n t2 1 6 2 1

Introduction: It is known that very few issues related to death and religiosity/spirituality are addressed during medical graduation. Understanding the process of death and dying is still a problem for medical students before the terminal condition of a patient. Probably the medical students of the fifth graders overestimate their abilities, probably because they have not yet had contact with terminally ill patients or because they have not graduated, they do not take responsibility for the death of a patient they are following. In Brazil, many students believe that the topic of spirituality influences health, but they do not feel prepared to address this issue with patients. Objective: It was to analyze whether there is a relationship between religiosity and thanatophobia in medical students. It also analyzed whether there was a correlation between fear of death and specific religions, sex and age, and the index of religiosity with sex and age. Methods: Followed a prospective observational cross-sectional model, following the STROBE clinical research rules. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 2,031,705, and obtaining the patient's consent. Results: A total of 542 students (61.2% of the total) answered the questionnaire. Most were female (65.7%) and with a mean age of 22.31 (ranging from 17 to 39 years). The majority of students have a religion (90.1%) and 90.4% considered it important to address the issue of death and religiousness during graduation. In this study, it was observed that most students, in addition to having some kind of religion, consider it important to address the themes highlighted during the course. This was similar to the findings in other studies. There was no statistically significant relationship between having a religion and being less afraid of death. However, students with higher levels of intrinsic religiosity showed greater discomfort when dealing with terminal patients. Furthermore, no studies comparing these two subjects were found. It was also found in this research that students with high levels of religiosity consider it more important to address the issues in question, with the majority being female students. Conclusion: It is necessary to include the topic in the medical academy, and it is essential to prepare a more humanistic and dedicated professional for patients, whether active or palliative treatment.

O distanciamento social em virtude da pandemia do novo Coronavírus no Brasil é de fundamental importância no combate a disseminação do vírus. Como a sua transmissão acontece essencialmente por contato próximo com pessoas infectadas através de gotículas de saliva, espirro, tosse e objetos contaminados, o ato de afastar os indivíduos do convívio social e evitar possíveis aglomerações emprega-se como medida de proteção para diminuir a disseminação da doença. Sendo assim, o objetivo desse estudo foi avaliar a aderência e a percepção dos alunos de medicina sobre o distanciamento social vivenciado, através de um questionário semiestruturado online, após aprovação do Comitê de Ética. Responderam 204 alunos de medicina da Instituição. A maioria dos estudantes (70%) disse ter conhecimento sobre as medidas de distanciamento social, porém 79,4% descumpre as normas de segurança mesmo acreditando na importância das medidas. Outro dado relevante é que 52% dos participantes possuíam familiares positivos para COVID, o que não interferiu na concepção em relação a importância do distanciamento social em 69,6% dos participantes. Conclui-se que, mesmo futuros profissionais da saúde, conhecedores da gravidade do atual cenário, e instruídos quanto as normas perante a pandemia, não foram capazes de cumpri-las. Do mesmo modo, mesmo com a vida de um familiar em risco foram incapazes de mudar sua percepção sobre o combate à doença, o que acaba refletindo no cenário atual de descumprimento do distanciamento social generalizado.

The new coronavirus (SARS-CoV-2), whose disease is COVID-19, in March 2020, spread around the world. To minimize the deleterious effects of emotional vulnerability, many strategies are in use worldwide, such as support groups, online courses, use of social networks, web meetings, yoga practice, meditation, and other contemplative religious and spiritual activities. Religious and spiritual beliefs have been used to deal with tough situations and, through scientific literature is still not so clear about the role of spirituality and religiosity (S/R) in physical and mental health during the pandemic. Therefore, this article proposes a discussion about the physiopathological mechanisms of COVID-19 and how S/R could be useful in this context. In this sense, religious faith can be a powerful resource for good health and well-being with a positive impact verified in mental health outcomes it is plausible to suggest that S/R should be an important tool in minimizing the population suffering at this moment. Spiritual care has long been recognized as one of the domains of quality palliative care, but every health care professional is ultimately responsible for ensuring spiritual care to deal with spiritual distress and improve quality of life in the scenarios inherent to COVID-19.

Special education follows the social and political movements of history and consists of a medical and clinical model [1]. Previously, regular school education was not considered essential for people with special needs [1]. Today, education for people with special needs is becoming increasingly inclusive and is considered an official public policy in the country [1-2]. This began through the Public Law of the United States of America (USA) no. 94,142 and is considered a modality of school education understood by the "process of inclusion of people with special needs or learning disorders in the common school system in all schools seven degrees" [2]. Furthermore, this inclusion has an important role in society and for this it is necessary to develop a teaching strategy in order to promote the learning of students with some type of disability [2-3]. The process in question has been addressed by the Brazilian government since the beginning of the 90s [1]. In addition, the educator and the family act as sociocultural mediators of the student, strengthening their knowledge [4]. Report the experience of a fourth-year medical student during volunteer work in a non-profit institution for people with physical-intellectual disabilities.

Renal injury induced by rheumatoid arthritis is not clear and may be related to the angiotensin II. We aim to investigate the adjuvant-induced arthritis (AIA) injury in rat kidney, focusing the angiotensin II/AT1 pathway. Male Wistar rats were allocated in to three groups: Control, AIA and AIA plus losartan. The AIA was induced by injection of 100 µL of an emulsion of dissected Mycobacterium tuberculosis (50 mg/mL) on the paw. Treatment with losartan was initiated on the first day of immunization (daily subcutaneous injection, 1 mg/kg). After 60 days post immunization, we evaluated kidney function by plasma creatinine, urea and uric acid levels and creatinine depuration; kidney injury by apoptosis analysis and inflammation markers such as macrophages, transforming growth factor beta (TGF-β) and inducible nitric oxide synthase (iNOS) expression; oxidative stress by plasma thiobarbituric acid reactive substances (TBARS); renal expression of angiotensin receptors subtype 1 (AT1 ) and 2 (AT2 ) and plasma concentration of angiotensin II. AIA rats showed elevated plasma levels of creatinine, urea, uric acid, TBARS and Ang II and reduced creatinine depuration, and enhanced kidney macrophage number, TGF-β, caspase-3, iNOS and AT1 /AT2 receptors expression. The losartan reduced plasma creatinine and its clearance, reduced macrophages and the expression of TGF-β and iNOS in renal tissues, and reduced plasma TBARS. We conclude that AIA causes kidney injury by a physiopathological mechanism that involves AT1  stimulation in renal tissue, elevating the presence of macrophages, the expression of TGF-β and iNOS, as well the local oxidative stress, which contribute to renal function deterioration.

ABSTRACT Introduction: During physical activity, the body diverts blood to essential areas such as skeletal muscle, reducing the supply to non-essential areas such as the kidney. Whey protein is one of the most widely used supplements in gyms. Objectives: To evaluate renal function and renal structure in rats submitted to physical exercise with and without the use of protein supplementation. Methods: The protein used was Whey Hydro PRO 2 - Probiotica®. It was administered orally (by gavage), diluted in mineral water (1.8 g/kg of body weight, shortly after swimming training). The rats were divided into four groups: rats with exercise (Exc), rats without exercise (ñExc), rats with exercise and with protein supplementation (Prot/Exc) and rats without exercise and with protein supplementation (Prot/ñExc). The training consisted of swimming for 30 minutes, using load equivalent to 2% of body weight, five times a week for a total of 10 weeks. The protein was administered by gavage, once daily, immediately after the training. Results: A reduced glomerular filtration rate was observed in the animals of the Exc group compared to those of the Prot/Exc group. Plasma creatinine values were similar between the groups submitted to exercise and those not submitted to exercise. Plasma sodium and the sodium excretion fraction were lower in the Prot/Exc group compared to the Exc group. Urinary excretion was similar between groups. Histological analysis: Significant hydropic degeneration was observed in the animals that received protein supplementation and submitted to exercise. Conclusion: These results show that exercise associated with protein supplementation (2g/day/kg) leads to changes in the tubular mechanisms of sodium adjustments and structural changes in the renal parenchyma. Level of evidence II; Therapeutic studies - Investigation the results of treatment.