Severe dengue is a global health threat, affecting 4 billion people, with nearly 1 million hospitalizations during epidemics and around 25,000 annual deaths. Severe dengue presentations are characterized by vascular leakage, hemorrhagic manifestations, and shock, which can lead to multiorgan failure. Recent studies highlight the crucial role of extracellular vesicles (EVs) in the pathogenesis of dengue, influencing immune response and disease progression. EVs, nanometric structures secreted by cells, mediate viral dissemination, immune modulation, and endothelial dysfunction by transporting biomolecules such as microRNAs (miRNAs) and viral proteins. Infected cell-derived EVs carry viral components, including NS protein and miRNAs like miR-21 and miR-126-5p, which compromise endothelial integrity and activate immune pathways such as Toll-like receptor, NF-κB, and JAK-STAT signaling. This, together with the immune response, leads to the release of pro-inflammatory cytokines, including TNF-α, IL-1β, IL-6, and IFN-γ. EVs also facilitate viral immune evasion by suppressing antiviral responses. Recent analyses of miRNAs within EVs suggest their potential as biomarkers for disease progression. Differentially expressed miRNAs in circulating EVs correlate with severe outcomes, providing tools for risk stratification and therapeutic monitoring. Advanced techniques, such as nanoparticle tracking analysis and flow cytometry, allow precise EV characterization, supporting their integration into clinical applications.

The aim of this study was to conduct a systematic review in order to evaluate the main effects of intradialytic physical exercise on different parameters of functional capacity in dialytic patients. The clinical question that guided the objective of this study was developed using the PICO method (Population, Intervention, Comparation and Outcome)." Where i) population: patients on hemodialysis; ii) intervention: physical exercise; iii) comparison: active vs sedentary patients; and iv) outcome: functional capacity. The combinations of the following keywords were used: CKD, physical exercise, exercise, physical training and hemodialysis. The selection of studies was performed using the PubMed database and only studies dating from 2011 to 2021 were selected. The search results led to 53 studies. The following steps were carefully analyzed, such as the title, abstract and the full paper description to evaluate whether they met the following inclusion criteria: i) target audience of the studies should be patients on hemodialysis; ii) outcomes that analyze different parameters of functional capacity; iii) Intervention using physical exercise; and iii) intradialytic exercise. The final results indicate that intradialytic physical exercise can cause significant changes in the evaluated outcomes of functional capacity, such as increased strength, improvement of cardiorespiratory function, and improvement of locomotor activity. It was concluded that intradialytic training protocols should be encouraged in clinical practices because they are responsible for causing beneficial changes in the functional capacity of hemodialytic patients.

Current evidence show that exercise has beneficial effects on skeletal muscle function in individuals with chronic kidney disease (CKD). The STAT3 signaling pathway and the apelin axis (apelin receptor, APLNR- and ligands, -apelin and/or -elabela), participate in the processes of kidney inflammation and fibrosis and both may be involved in muscle wasting during CKD. Herein we report that STAT3 pathway and APLNR are in fact involved in the muscle impairment concomitant to CKD in experimental model and in adult individuals with CKD. Male BALB/c mice were first submitted to an 8-week ladder climbing resistance training (RT) protocol and further were submitted to doxorubicin-induced experimental CKD with or without use of the STAT3 inhibitor (Stattic). The GSE157712 dataset was used to assess the muscle transcriptome profile of CKD patients. Bioinformatics' analysis of gene set enrichment analysis (GSEA) and gene ontology (GO) were performed and the APLNR was found to be a central component of muscle response over kidney stress. Mice from the RT protocol showed a protective effect of blocking STAT3 against kidney and muscle injury markers, while both CKD individuals and CKD mice reported alterations in the APLNR muscle expression. In conclusion, the muscle tissue function is affected during CKD, which can be attenuated by a protective and synergistic effect of exercise and STAT3 inhibition. Thus, APLNR appears as a key gene associated with muscle dysfunction in CKD patients and its muscle expression can be regulated by resistance exercise.

Severe dengue is a global health threat, affecting 4 billion people, with nearly 1 million hospitalizations during epidemics and around 25,000 annual deaths. Severe dengue presentations are characterized by vascular leakage, hemorrhagic manifestations, and shock, which can lead to multiorgan failure. Recent studies highlight the crucial role of extracellular vesicles (EVs) in the pathogenesis of dengue, influencing immune response and disease progression. EVs, nanometric structures secreted by cells, mediate viral dissemination, immune modulation, and endothelial dysfunction by transporting biomolecules such as microRNAs (miRNAs) and viral proteins. Infected cell-derived EVs carry viral components, including NS protein and miRNAs like miR-21 and miR-126-5p, which compromise endothelial integrity and activate immune pathways such as Toll-like receptor, NF-κB, and JAK-STAT signaling. This, together with the immune response, leads to the release of pro-inflammatory cytokines, including TNF-α, IL-1β, IL-6, and IFN-γ. EVs also facilitate viral immune evasion by suppressing antiviral responses.Recent analyses of miRNAs within EVs suggest their potential as biomarkers for disease progression. Differentially expressed miRNAs in circulating EVs correlate with severe outcomes, providing tools for risk stratification and therapeutic monitoring. Advanced techniques, such as nanoparticle tracking analysis and flow cytometry, allow precise EV characterization, supporting their integration into clinical applications.