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Intercity Swallow appreciation
Intercity Swallow livery, as carried by HST, class 47s, 73s, 86s, 87s, the 89, 90s and 91s in the early 1990's. A very smart colour scheme which suited all of these classes and is leagues above most modern rail company liveries!
#trains#diesel locomotive#intercity 125#br class 47#electric locomotive#br class 73#br class 86#br class 87#br class 89#br class 90#intercity 225#British Rail Intercity sector#intercity#90's nostalgia
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भारतीय संविधान🔥|| Genral knowledge Lucent Book || सामान्य ज्ञान @shivanidangistudylover by Shivani Dangi study lover! Genral knowledge Lucent Book🔥 || भारतीय संविधान || सामान्य ज्ञान @shivanidangistudylover #gk Your quarry: 1. Gk 2. General knowledge 3. Importance Gk questions and answers 4.quize test 5. br gk study 6. Importance Gk quiz test 7. Compititive quize 8. Compititive general knowledge 9. Gk in hindi 10. hindi gk 11. India Gk 12. Gk Questions answers 13. gk questions in hindi 14. general knowledge questions with answers. 15. Gk quiz 16. general knowledge questions 17. quize questions 18. 2023 gk questions and ans 19. Lucent gk in hindi 20. Lucent gk in hindi video 21. Lucent politiy in hindi 22. Lucent politiy 23. Political gk questions 24. Politics gk in hindi 25. Politics gk questions 26. Politics gk in hindi 27. lucent 1000 questions 28. Lucent 1000 prashan 29. Lucent gk ka nichod 30. Lucent gk in imp questions 31. Lucent gk important questions in hindi 32. Lucent for ssc CGL 33. lucent for ssc 34. lucent for railway 35. geography gk 36. lucent MCQ 37. lucent MCQ in hindi 38. Lucent book 39. gk 40. G k 41. g k questions and answers 42. gk ke question 43. general knowledge questions and answers #sarkarinaukarigk 44. Gk ka sawaal 45. Knowledge 46. Questions answers 47. gk knowledge 48. IPS questions and answers 49. जनरल नॉलेज 50. जनरल नॉलेज सामान्य ज्ञान 51. gktoday 52. gk tricks 53. gk study adda 54. Gk video 55. Gk live 56. gk by Kumar gourav sir 57. gk by Khan sir 58. gk today current affairs 59. question 60. सामान्य ज्ञान 61. general knowledge ke question 61. Gk knowledge 62. Gk dijiye 63. gk live 64. general class 66. general knowledge ki video in hindi 67. General knowledge 2023 68. general knowledge for kids #brgkstudy 69. जीके 70. जीके के सवाल 71. बीआर जीके स्टडी 72. Gk 2023 73. Gk 2022 74. Gk 2021 75. Gk 2020 76. gk police 77. gk IAS 78. gk IAS 79. janral nolej in hindi 80. Br gk study 2020 81. Br gk study 2021 82. Br gk study 2022 83. Br gk study 2023 84. tense 85. Current affairs 86. gK 87. G K 88. GK BR #gk 89. #G_k #g_k #g.k 90. gk ke video 91. Good sawaal 92. सवाल आपके जवाब हमारे 93. Gk ka sawaal 94. Samanya gyan 95. GK number 1 96. new gk questions 97. new gk question 98. Gk gk 99. GK GK GK #gkquiz #gkquestion #gktoday #gkstudyadda #gktoday #generalknowledge #general_knowledge #gkinhindi #politics #police #political #samvidhan #samvidhangk 100. जीके के क्वेशन Copyright disclaimer under section 107 of the copyright act 1976, allowance, is made for "fair use" for purposes such as criticism, comments, news reporting, teaching, scholarship, education and research. This video has not any negative impact. This video is only for teaching purpose. If you find any such content in this video that belongs to you and you feel that it should be removed from this video So please contact me on this Gmail ID: [email protected] before contacting YouTube. Then I will remove the that content immediately. I have worked so hard to build this channel. I am sure that you will understand my word. via YouTube https://youtu.be/oEKu8op_YzQ
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975025 Derby by James Windows Via Flickr: Inspection Saloon No. 975025 'Caroline' and Class 47 No. 47853 are seen about to return to the technical centre after their day out in the East Midlands working the 08:22 Derby RTC to Derby RTC via the freight-only route to Coalville, then on to Bedford and Luton prior to returning via Melton Mowbray and Loughborough on 28th May 2014. No. 975025 'Caroline' was originally built in 1958 at Eastleigh works as a trailer restaurant buffet car (TRB) S60755, for a BR Class 203 diesel-electric multiple-unit No. 1036, These 'Hastings Units' had a narrow body profile for working through tunnels on the Hastings line, and is the reason for the narrow width of Caroline. In 1969 it was converted into the Southern Region General Manager's Saloon and was fitted with Southern region style multiple working controls allowing usage with BR Class 33 and 73 and diesel locomotives, the saloon has push-pull driving controls to allow it to remotely control an accompanying locomotive. Further modifications in 2000 allowed it to work with other locos including Class 37 and 47 locos.
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@fandoms-love
#laurellanceedit#arrowedit#dcmultiverse#dctvladies#laurel lance#dcladies#laurel lance icons#my icons#icons#got bored and figured it was worth a shot
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Undertale Character Heights (Transport, Travel and Vacations)
Undertale Character Heights (Transport, Travel and Vacations)
Can Asgore Fit in a Car? Minicompact car: No.
Asgore's car options would be limited by necessity. He would need something with broad seats for his broad body and something to accommodate his horns, whether very high head space, always-open skylights very close to above the driver’s seat, a convertible, or some combination of the three.
The Toyota HiAce, a Japanese commercial van, has a height of 87.4 inches (~7.2 feet). If Asgore’s sitting height is 53% of his standing height in the shortest calculations, his sitting height is ~4 feet, 5 inches. Even if the passenger-holding height is smaller than the total vehicle height, he might be able to sit comfortably, even if getting inside is difficult. However, his wide body would still make things cramped, like obese people fitting in small airplane seats.
In smaller van-type cars, he might need to hunch or tilt over awkwardly just to fit. In some cases, it might be so difficult to get into the car through the door that he'd have to drop in through the sunroof to avoid catching his horns on the doorway....or he’d resign himself to be a passenger. (many larger cars have bench seating in the second row) What’s worse, because he needs a big, driver-level sunroof that’s always open or a convertible with the roof down, he simply won’t be able to drive anywhere where it’s raining or snowing...unless he wants to be cold, sopping wet, and possibly smell like wet dog.
If, however, it’s a variant from the store (or modified) to have a bigger-than-average, openable sunroof, that would give Asgore horn space. However, since he’s not sitting straight in the middle, he would have to hunch and tilt his head to the left the entire time he was driving, to ensure one of his horns fit under the ceiling, or poke one horn out the window and the other up the sunroof (depending on horn width), or constantly drive with his head facing to the side (very unsafe). Alternatively, he could sit on the passenger’s side, facing the driver the entire time, his body angled to fit his horns in the sunroof.
Toriel Estimations
Toriel, being shorter with much smaller horns and a seemingly slimmer body, would find driving much easier. Assuming the shortest estimation (Papyrus and Human Male) and assuming her sitting height is 51% of her standing height, her sitting height would be ~3 feet, 8 inches (technically 3 feet, 7.86 inches). For comparison, 38 inches headroom (~3.16 inches) is the ideal minimum for tall people (humans), according to the car blog Autoblog. If she hunched a little, she would comfortably fit in a Ford Transit (~3.83 inches room), a common model of van/minivan, and fit quite comfortably in a Ford Transit Connect Wagon (3 feet, 10.8 inches headroom).
There are probably several kinds of camper vans that could fit either, to various levels of comfort, but it’s unlikely they would buy a camping van for normal activities. Conversion vans, which are vans converted for suitability in camping or for use as school buses, shuttle buses, or wheelchair vans, would probably also suit Toriel and Asgore better than standard cars or minivans.
Can Asgore Fit on a Bus?
Asgore may not be able to use a public bus comfortably. Information on the interior height of public buses is scarce, so the information will be extrapolated from U.S. schoolbuses and Australian public buses.
According to Skoolie.net, the typical interior height of a schoolbus is 6 feet. Assuming the sitting height of an adult human is 51% of the standing height, if Asgore were proportionate to a human, the sitting height (with horns) of Basketball Asgore (86 inches) would be ~3 feet, 8 inches.
However, when measuring the horns, Asgore’s legs are 29.7% of his body height. (Even not counting horns, it’s 47%, meaning he’s rather short-legged by human standards.) Therefore, he wouldn’t lose as much height by sitting as a human normally would. For comparison, a 73-inch (6 foot, 1 inch)-tall man is considered “tall” in Europe and in the United States; one can guess such a man’s sitting height is around 37.23 inches (~3 feet, 1 inch).
One ResearchGate article puts the height of an Australian public bus as ~8.2 feet. Asgore would have to duck, but it would be reasonably comfortable until he could find a seat. If, however, an American public bus has an interior of 6 feet tall, like a schoolbus, Asgore would have to duck quite significantly, and he’d be very uncomfortable if he can’t find a seat at all.
Trouble at the Airport
TSA Scanners
It’s hard to find the size of a TSA body scanner for an airport. National Public Radio provides the closest estimate of a normal TSA body scanner size, claiming one new design for a body scanner is the size of a “tall refrigerator”. The website SFGate puts “tall refrigerator” at 70 inches (5 feet, 10 inches). So, using this back-of-the-envelope calculation, not even the shortest Asgore could fit in that scanner. In fact, even if he were just basketball-player size, the wide span of his horns and his broad body would make it quite awkward to get in there.
Airplanes
The cabin height of a Boeing 737, according to the research website ResearchGate, 2.19 m, or ~7. feet, 2 inches. Even under the shortest estimate, Asgore would have to duck significantly to get in.
Based on the basketball estimation, Asgore's legs are ~2.13 feet tall. Asgore's total height, according to the basketball estimation, is 86 inches. 25.6 inches is 29.7% of Asgore's total height...which means his legs are rather short relative to his total height. Without the horns, the proportion of his legs to his height is 47%, which is apparently within a normal human range but still more short-legged than average.
Assuming the height of the seats is 60% of the total cabin height for a Boeing 737, the Boeing 737 designers apparently assume a human is less than ~4 feet, 3 inches when seated. However, even if he lacked legs entirely, Asgore would be 5 feet and 10 inches, which is too big. (And in any case, since he’s both tall and wide, it would be difficult for people to move around him.)
It’s a good thing he wouldn’t even fit in a standard airplane, because he absolutely wouldn’t fit in an airplane bathroom. Older, standard airplane bathrooms were 34 inches (2 feet, 10 inches) wide; now many airlines have 24-inch (2 feet) wide bathrooms.
That’s not even considering his shoulder width. If one can calculate width with the same multipliers as height, then, suffice to say, even if the shortest calculations were off by a whole foot he couldn’t fit through the doorway, much less the bathroom.
Asgore Can’t Ride Things at the Six Flags Theme Park
In one Growth Spurt comic by Potoobrigham, Asgore takes a teenage Asriel and Frisk out to Six Flags, an American amusement park. But could a teenage Asriel (more than 7 feet tall here) and Asgore actually take the ride?1
Too Short
On the Six Flags of America theme park, the BATWING Coaster has a height requirement of 54” inches, or 4.5 feet. Sans, on the Papyrus and Human Male calculations and Basketball calculations, would not be able to go on this ride. The Magic Flyer junior-sized roller coaster has a height limit of 54 inches (4.5 feet). Sans could ride that in the Papyrus and Human Male and Basketball calculations, but not in the band of plausibility calculations.
Too Tall
Amusement park rides aren’t always able to accommodate people who are especially tall or wide. Asgore is both, and his minimum height (with horns) is 8 feet, 5 inches. If any roller coaster rides involve going into tunnels around that height at high speed, it would probably snap his horns off, possibly at the risk of injuring his head.
It’s unclear what Asgore’s weight is; it is possible monsters’ bodies, due to being made of magic, don’t have the same density as human bodies. Suffice to say, if he’s as wide as an obese human, rides with seatbelts connecting to a harness would be very difficult, if not impossible, to ride for him. (those with lap bars instead might fit him.) Depending on the roller coaster specifications, he might not be able to fit even on seats meant for extra-tall or extra-wide people.
In fact, under some calculations monsters Papyrus’s height and over wouldn’t be able to fit on amusement park rides. The (apparently defunct) Green Lantern: First Flight roller coaster ride has a maximum passenger height of six feet, 5 inches, so, from the Door calculation and onwards, Papyrus would not be able to fit on similarly-built rides.
Part 1 → Part 2 → Part 3 → Part 4 (upcoming)
If you enjoyed the article, consider staring intensely at the author's Patreon or Ko-Fi. Donating money would also be appreciated.
Strictly speaking, the heights in the comic should be calculated differently from in-game heights. For one thing, Toriel’s height is listed as seven feet, which is two inches less than the shortest estimate for her in this post series. ↩︎
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[TRANS] Stray Kids, Sold Out All Seats of All 4 Dates of Their First Europe Tour..19000 Fans’ Enthusiasm
Stray Kids successfully finished their first Europe showcase tour and showed off their image as ‘new K-pop generation’s representative group.’
On the 28th of last month, Stray Kids started off their tour at the London '02Acadamy Brixton', ‘Les Docks De Paris-Pullman’ in Paris on the 30th, Berlin’s ‘Verti Music Hall’ on 8/2, and Moscow’s ‘Adrenaline Stadium’ on the 4th, for a total of 4 solo concerts and reaching around 19000 fans.
This first Europe showcase tour sold out all 4 concerts in each of the 4 cities, proving Stray Kids’ rising global popularity.
During their Europe tour, Stray Kids performed a variety of stages with their self-composed, lyricized, and self-produced songs including ‘Hellevator’, ‘District 9’, ‘My Pace’, ‘I am YOU’, ‘MIROH’, etc.
Stray Kids, who have show their own musical world and their 9-person-9-color charm to fans around the world, opened their first overseas fansign in Paris, and had a meaningful time with fans. In said fansign, fans from all over the world gathered and allowed Stray Kids to feel their global popularity.
Following their U.S tour, which had 1 additional date for a total of 5 concerts, and now their Europe tour, Stray Kids have sold out all dates, showing their enormous ticketing power.
Their first overseas showcase tour ‘UNVEIL TOUR ‘I am…’’, which started in Thailand in January of this year, is an extension of the Stray Kids’ showcase series ‘UNVEIL [Op.01 : I am NOT]’, ‘UNVEIL [Op.02 : I am WHO]’, and ‘UNVEIL [Op.03 : I am YOU]’, that opened with each new album release.
Including Jakarta, Melbourne, Sydney, Manila, ‘Home of Pop’ U.S.A Newark, Los Angeles, Houston, London, Paris, Berlin, Moscow, Stray Kids are receiving praise for meeting with global fans in various regions. Source: OSEN Translation: Candace @ FY!SKZ ; take out with full credit
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A META: LER 1 LIVRO POR DIA, EXCETO SE FOR UM CALHAMAÇO, DAÍ É UMA 1 SEMANA HEHEHE
1. HARRY POTTER 1 2. HARRY POTTER 2 3. HARRY POTTER 3 4. HARRY POTTER 4 5. HARRY POTTER 5 6. HARRY POTTER 6 7. HARRY POTTER 7 8. WOMAN AT POINT ZERO 9. THE INFERNO 10. GIRL, INTERRUPTED 11. THE PLAYS OS OSCAR WILDE 12. THE CASE BOOK OF SIR SHERLOOK SHOLMES 13. NINETEEN EIGTHY-FOUR 14. ANIMAL FARM 15. THE TREE MUSKETEERS 16. THE CACHER IN THE RYER 17. FOR WHOM THE BELL TOLLS 18. THE WITCHES 19. A CASA SOTURNA 20. ANNA KARIENNINA 21. A MONTANHA MÁGICA 22. DRÁCULA 23. JAMES JOYCE 24. EM BUSCA DO TEMPO PERDIDO 25. COMTOS COMPLETOS DO OSCAR WILDE 26. CONTOS COMPLETOS DO CAIO FERNANDO 27. NIX 28. DAVID COPPERFIELD 29. O DIA EM QUE SHERLOCK HOLMES MORREU 30. OS IRMÃOS KARAMÁZOV 31. GUERRA E PAZ 32. MULHERES QUE CORREM COM OS LOBOS 33. O ILUMINADO 34. IT A COISA 35. OUTSIDER 36. A ESPERA DE UM MILAGRE 37. SALÉM 38. A CAIXA DE GWENDI 39. O INSTITUTO 40. MS MERCEDES 41. STEPEHN KING 42. CORAÇÃO DAS TREVAS 43. PEDRO PÁRAMO 44. A MULHER NO ESCURO 45. ATORMENTADA 46. POR TRÁS DE SEUS OLHOS 47. PACIÊNTE SILENCIOSA 48. PEQUENAS REALIDADES 49. LARANNJA MECÂNICA 50. O FIM DA INFÂNCIA 51. BLADE RUNNER 52. REUNORAANCER 53. O FIM DA ETERNIDADE 54. O HOMEM INVISÍVEL 55. O CONTO DA AIA 56. OS TESTAMENTOS 57. MATADOURO CINCO 58. A REVOLUÇÃO DOS BICHOS BR 59. PONTO ÔMEGA 60. SUA VOZ DENTRO DE MIM 61. JANE EYRE 62. ENSAIO SOBRE A CEGUEIRA 63. SOL É PARA TODOS 64. O RETRATO DE DORYAN GRAY 65. A TRAGÉDIA DE OTELO, O MOURO DE VENEZA 66. MADAME BOVARY 67. SONHO DE UMA NOITE DE VERÃO 68. MACBETH 69. ROMEU DE JULIETA 70. O NOME DA ROSA 71. A ALAMEDA DE NORTHANGER 72. O PAI GORIOT 73. O LIVRO DE MORIARTY 74. O SIGNO DOS QUATRO 75. O DIÁRIO DE MIRIAM 76. O APANHADOR NO CAMPO DE CENTEIO BR 77. ADVERSÁRIO SECRETO 78. O DOS VENTOS UIVANTES 79. O CÃO DOS BASKERVILLE 80. O AMOR NOS TEMPOS DO CÓLERA 81. CEM ANOS DE SOLIDÃO 82. CRÔNICA DE UMA MORTE ANUNCIADA 83. DO AMOR E OUTROS DEMÔNIOS 84. O REI DE HAVANA 85. DOZE CONTOS ( ESPANHOL) 86. O VELHO E O MAR 87. A PEQUENA SEREIA 88. ALICE 89. MONDION 1 90. MONDION 2 91. MONDION 3 92. GOOD OMENS 93. s. BERNARDO 94. CAPITÃES DA AREIA 95. CLARA DOS ANJOS 96. MEMÓRIAS PÓSTUMAS DE Brás Cubas 97. TERRA SONABULA 98. AS INTERMITÊNCIAS DA MORTE 99. A HORA DA ESTRELA 100. AINDA SOU EU 101. DEPOIS DE VOCÊ 102. ESTAMOS BEM 103. O SEGREDO DO MEU MARIDO 104. OBJETOS AFIADOS 105. ONDE ESTIVERES A NOITE 106. LEVE-ME COM VOCÊ 107. A CINCO PASSOS DE VOCÊ 108. SHARP OBJECTS 109. PEQUENAS REALIDADES 110. O SEGREDO DO MEU MARIDO 111. ESTAMOS BEM 112. ELANOR E PARK 113. ATORMENTADA 114. A MULHER NO ESCURO 115. POR TRÁS DE SEUS OLHOS 116. SIGNO DOS 4 117. AINDA SOU EU 118. CORAÇÃO DAS TREVAS 119. TERRA SONÂMBULA 120. HAMBLET 121. NÓS 122. REDOMA DE VIDRO 123. CLARA DOS ANJOS 124. MEMÓRIAS PÓSTUMAS DE BRÁS CUBAS 125. A HORA DA ESTRELA 126. ILHAS DE DISTÂNCIA 127. INSTRUMENTOS MORTAIS 1 128. INSTRUMENTOS MORTAIS 2 129. INSTRUMENTOS MORTAIS 3 130. INSTRUMENTOS MORTAIS 4 131. INSTRUMENTOS MORTAIS 5 132. INSTRUMENTOS MORTAIS 6 133. AMERICANAH 134. O CAMINHO DE CASA 135. HIBISCO ROXO 136. FICA COMIGO 137. ALEGRIAS DA MATERNIDADE 138. NO FUNDO DO POÇO 139. CIDADÂ DE SEGUNDA CLASSE 140. ÚSULA 141. MRS. DALLOWAY 142. AO FAROL 143. ÚLTIMO DEUS 144. ALICE 145. A MENINA SUBMERSA 146. VIDAS SECAS 147. INTERMITÊNCIAS DA MORTE 148. UM ESTUDO EM VERMELHO 149. APANHADOR NO CAMPO DE CENTEIO 150. O SILÊNCIO DOS INOCÊNTES 151. PEDRO PARAMO 152. ORLANDO 153. A PEQUENA SEREIA
--------------------------------------------------------- 1. O FILHO DE MIL HOMENS 2. A MAQUINA DE FAZER ESPANHÓIS 3. HOMENS IMPRUDENTEMENTE POÉTICOS 4. A DESUMANIZAÇÃO 5. O REMORSO DE BALTAZAR SEPAPIÃO 6. O NOSSO REINO
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<img src="https://i.pinimg.com/originals/73/5b/f3/735bf3dd99e4a49386c9e5df1801264f.jpg"height="auto"width="550"title="E350 Sport Sedan in Iridium Si..."alt="E350 Sport Seda"/></br></br>E350 Sport Sedan in Iridium Silver with full-LED headlamps Aggressively sculpted lower bodywork underscores the new grille-mounted Star in an E-Class Sedan.</br>
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O que asma dermatite atópica e rinossinusite crônica têm em comum?
Inflamação é um processo natural do corpo e algo mais comum do que gostaríamos. Trata-se de uma resposta fisiológica que pode ser desencadeada em situações de trauma (como cortes, quedas ou a implacável topada no dedo do pé), por algumas doenças ou ainda pela ação de vírus e bactérias. Inchaço, dor, vermelhidão e até febre são alguns dos sintomas desse fenômeno, ativado pelo organismo para convocar os glóbulos brancos e outras células de defesa a entrar em ação e começar o processo de cura.
Nos últimos anos, uma série de estudos vem apontando que uma categoria específica de inflamação pode ser o ponto em comum entre enfermidades como asma, dermatite atópica e rinossinusite crônica com pólipo nasal. Trata-se da inflamação tipo 2.²⁻⁴ Assim como os demais tipos, ela é um sistema de defesa do organismo – nesse caso, acionado pela exposição a alérgenos como poluição, fumaça de cigarro e até elementos aparentemente inofensivos, como plantas e pelos de animais domésticos.²⁻⁴ Tal qual outras inflamações, a tipo 2 por si só não é uma doença.
O problema é que, em algumas pessoas, essa resposta do organismo acontece de maneira exagerada, aí sim, provocando enfermidades. Essa reação acentuada libera as chamadas citocinas tipo 2, que causam alterações nas barreiras mucosas do nariz, pulmão e pele e um aumento na produção de anticorpos – especialmente aqueles que provocam a alergia.²⁻⁴
“As doenças alérgicas e a inflamação do tipo 2 estão aumentando exatamente porque nós estamos modificando o nosso estilo de vida. Fatores como poluição, tabagismo e estresse podem também disparar a resposta do tipo 2 a partir das mucosas ou da pele”, afirma Norma Rubini, professora titular de alergia e imunologia da Universidade Federal do Estado do Rio de Janeiro (Unirio) e coordenadora da comissão de políticas de saúde da Associação Brasileira de Alergia e Imunologia (Asbai).
Doenças relacionadas à inflamação tipo 2
É comum que os portadores dessa inflamação apresentem duas ou mais enfermidades relacionadas a ela.²⁻⁴ A asma, por exemplo, é uma doença crônica associada, na maioria dos casos, à inflamação das vias aéreas, do nariz aos bronquíolos. “Em cerca da metade dos pacientes, observa-se a inflamação tipo 2, caracterizada essencialmente pela ocorrência de alergia respiratória e/ou pelas contagens elevadas de eosinófilos no sangue. Esses glóbulos brancos são biomarcadores da inflamação tipo 2, ou seja, indicam a sua presença”, explica o pneumologista Álvaro Cruz.
<span class=”hidden”>–</span>ABC/Abril Branded Content
Segundo o otorrinolaringologista Fabrizio Romano, a rinossinusite crônica pode ter diversas características e é dividida entre primária e secundária. A secundária tem uma causa específica; já a primária não. “Entre as primárias, dividimos em quando é decorrente de uma inflamação tipo 2 e quando não é. Normalmente, as tipo 2 são mais difíceis de tratar e precisa-se usar medicações, principalmente os corticosteroides, que são a primeira linha de tratamento”, diz Romano.
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No caso da dermatite atópica, ela se manifesta como um eczema. “Podem aparecer manchas claras ou avermelhadas, ter muita coceira e, com o passar do tempo, a pele vai ficando seca. Nessa doença, há duas heranças genéticas: disfunção da barreira cutânea e a desregulação imunológica da inflamação tipo 2. E descobrimos recentemente que a própria inflamação tipo 2 agrava os problemas de barreira da pele. Por isso é muito importante fazer o diagnóstico e tratar essa inflamação”, diz Norma. “Nos casos mais leves de dermatite atópica, algumas medidas simples, como a hidratação da pele, evitar banhos muito quentes e o uso de roupas de algodão, são suficientes. Mas, quando chega a um estágio moderado, é importante fazer o tratamento medicinal”, alerta a médica.
Meios de controle
A identificação da inflamação tipo 2 pode ser feita por características clínicas ou por exames comumente realizados, como o hemograma. “Normalmente, o diagnóstico era feito considerando aspectos clínicos, se o paciente possuía polipose, asma… Agora, já existem marcadores biológicos que dão mais certeza a respeito desse tipo de inflamação, garantindo melhores resultados nos tratamentos escolhidos”, afirma o otorrinolaringologista.
“O diagnóstico permite fazer tanto a prevenção, investigando os fatores que provocam a doença, quanto o tratamento com medicamentos mais modernos”, explica Norma. Normalmente essas patologias são tratadas com anti-histamínicos, broncodilatadores e corticoides – remédios com uma série de efeitos colaterais, como obesidade, hipertensão, osteoporose e diabetes –, mas agora uma nova classe de medicamentos, os chamados imunobiológicos, promete uma revolução do ponto de vista do tratamento.
“Em vez de bombardear toda a resposta inflamatória do indivíduo com corticoides, os imunobiológicos permitem atuar de forma mais precisa diretamente na inflamação tipo 2”, afirma Norma. Em linhas gerais, eles são prescritos para as formas graves da doença, depois de sucessivas tentativas com os remédios disponíveis e dos diagnósticos clínico e laboratorial. Segundo a médica, estudos comprovam impacto significativo nos sintomas, com diminuição das crises, hospitalizações e, no caso dos pólipos nasais, também das cirurgias.
Na prática, isso significa o controle perene e com mais segurança das doenças – o que, para quem sofre com seus sintomas debilitantes e os tratamentos agressivos que tentam debelar as crises, é uma mudança e tanto. “Estamos falando de melhora na qualidade de vida do paciente”, conclui a médica.
MAT-BR-2001274 – Setembro /2020. Material destinado ao público geral.
Referências:
Cruvinel WM, Mesquita Jr. D, Araújo JAP, Catelan TTT, Souza AWS, Silva NP, Andrade LEC. Sistema Imunitário – Parte I. Fundamentos da imunidade inata com ênfase nos mecanismos moleculares e celulares da resposta inflamatória. 2010. Rev Bras Reumatol.
Gandhi NA, Bennett BL, Graham NM. Targeting key proximal drivers of type 2 inflammation in disease. Nature Reviews Drug Discovery, vol. 15, no. 1, pp. 35-50, 16 October 2016.
Carr s, Chan E, Watson W. Eosinophilic esophagitis. Allergy, Asthma & Clinical Immunology, vol. 14, no. Suppl 1, p. 58, 2018.
Steinke JW, Wilson JM. Aspirinexacerbated respiratory disease: pathophysiological insights and clinical advances. Journal of Asthma and Allergy, vol. 9, pp. 37-43, 2016.
Heffler E et al. J Allergy Clin Immunol Pract, 2018 [E-Pub].
Shaw DE et al. Eur Respir J, 2015; 46:1308-1321.
Maio S et al. Allergy, 2018; 73:683-695.
Simpson E et al. J Am Acad Dermatol, 2016; 74:491-498.
Silverberg JI et al. Ann Allergy Asthma Immunol, 2018; 121:604-612.
Won H, Kim Y, Kang M. Age-related prevalence of chronic rhinosinusitis and nasal polyps and their relationships with asthma onset. Ann Allergy Asthma Immunol, vol. 120, no. 4, pp. 389-394, 2018.
Staniorski CJ et al. Int Forum Allergy Rhinol, 2018; 8:495-503.
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MedicinaMedicinaIvermectina: o que sabemos sobre seu uso contra o coronavírus
MedicinaMedicinaA transmissão do coronavírus por pessoas assintomáticas e pré-sintomáticas
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MedicinaMedicinaQuais são os sintomas do coronavírus?
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O Conteúdo O que asma, dermatite atópica e rinossinusite crônica têm em comum? Apareceu Primeiro no Site Saúde é Vital
O conteúdo O que asma dermatite atópica e rinossinusite crônica têm em comum? Aparece primeiro em Suplemento e Dieta
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O que asma dermatite atópica e rinossinusite crônica têm em comum?
Inflamação é um processo natural do corpo e algo mais comum do que gostaríamos. Trata-se de uma resposta fisiológica que pode ser desencadeada em situações de trauma (como cortes, quedas ou a implacável topada no dedo do pé), por algumas doenças ou ainda pela ação de vírus e bactérias. Inchaço, dor, vermelhidão e até febre são alguns dos sintomas desse fenômeno, ativado pelo organismo para convocar os glóbulos brancos e outras células de defesa a entrar em ação e começar o processo de cura.
Nos últimos anos, uma série de estudos vem apontando que uma categoria específica de inflamação pode ser o ponto em comum entre enfermidades como asma, dermatite atópica e rinossinusite crônica com pólipo nasal. Trata-se da inflamação tipo 2.²⁻⁴ Assim como os demais tipos, ela é um sistema de defesa do organismo – nesse caso, acionado pela exposição a alérgenos como poluição, fumaça de cigarro e até elementos aparentemente inofensivos, como plantas e pelos de animais domésticos.²⁻⁴ Tal qual outras inflamações, a tipo 2 por si só não é uma doença.
O problema é que, em algumas pessoas, essa resposta do organismo acontece de maneira exagerada, aí sim, provocando enfermidades. Essa reação acentuada libera as chamadas citocinas tipo 2, que causam alterações nas barreiras mucosas do nariz, pulmão e pele e um aumento na produção de anticorpos – especialmente aqueles que provocam a alergia.²⁻⁴
“As doenças alérgicas e a inflamação do tipo 2 estão aumentando exatamente porque nós estamos modificando o nosso estilo de vida. Fatores como poluição, tabagismo e estresse podem também disparar a resposta do tipo 2 a partir das mucosas ou da pele”, afirma Norma Rubini, professora titular de alergia e imunologia da Universidade Federal do Estado do Rio de Janeiro (Unirio) e coordenadora da comissão de políticas de saúde da Associação Brasileira de Alergia e Imunologia (Asbai).
Doenças relacionadas à inflamação tipo 2
É comum que os portadores dessa inflamação apresentem duas ou mais enfermidades relacionadas a ela.²⁻⁴ A asma, por exemplo, é uma doença crônica associada, na maioria dos casos, à inflamação das vias aéreas, do nariz aos bronquíolos. “Em cerca da metade dos pacientes, observa-se a inflamação tipo 2, caracterizada essencialmente pela ocorrência de alergia respiratória e/ou pelas contagens elevadas de eosinófilos no sangue. Esses glóbulos brancos são biomarcadores da inflamação tipo 2, ou seja, indicam a sua presença”, explica o pneumologista Álvaro Cruz.
<span class="hidden">–</span>ABC/Abril Branded Content
Segundo o otorrinolaringologista Fabrizio Romano, a rinossinusite crônica pode ter diversas características e é dividida entre primária e secundária. A secundária tem uma causa específica; já a primária não. “Entre as primárias, dividimos em quando é decorrente de uma inflamação tipo 2 e quando não é. Normalmente, as tipo 2 são mais difíceis de tratar e precisa-se usar medicações, principalmente os corticosteroides, que são a primeira linha de tratamento”, diz Romano.
Continua após a publicidade
No caso da dermatite atópica, ela se manifesta como um eczema. “Podem aparecer manchas claras ou avermelhadas, ter muita coceira e, com o passar do tempo, a pele vai ficando seca. Nessa doença, há duas heranças genéticas: disfunção da barreira cutânea e a desregulação imunológica da inflamação tipo 2. E descobrimos recentemente que a própria inflamação tipo 2 agrava os problemas de barreira da pele. Por isso é muito importante fazer o diagnóstico e tratar essa inflamação”, diz Norma. “Nos casos mais leves de dermatite atópica, algumas medidas simples, como a hidratação da pele, evitar banhos muito quentes e o uso de roupas de algodão, são suficientes. Mas, quando chega a um estágio moderado, é importante fazer o tratamento medicinal”, alerta a médica.
Meios de controle
A identificação da inflamação tipo 2 pode ser feita por características clínicas ou por exames comumente realizados, como o hemograma. “Normalmente, o diagnóstico era feito considerando aspectos clínicos, se o paciente possuía polipose, asma… Agora, já existem marcadores biológicos que dão mais certeza a respeito desse tipo de inflamação, garantindo melhores resultados nos tratamentos escolhidos”, afirma o otorrinolaringologista.
“O diagnóstico permite fazer tanto a prevenção, investigando os fatores que provocam a doença, quanto o tratamento com medicamentos mais modernos”, explica Norma. Normalmente essas patologias são tratadas com anti-histamínicos, broncodilatadores e corticoides – remédios com uma série de efeitos colaterais, como obesidade, hipertensão, osteoporose e diabetes –, mas agora uma nova classe de medicamentos, os chamados imunobiológicos, promete uma revolução do ponto de vista do tratamento.
“Em vez de bombardear toda a resposta inflamatória do indivíduo com corticoides, os imunobiológicos permitem atuar de forma mais precisa diretamente na inflamação tipo 2”, afirma Norma. Em linhas gerais, eles são prescritos para as formas graves da doença, depois de sucessivas tentativas com os remédios disponíveis e dos diagnósticos clínico e laboratorial. Segundo a médica, estudos comprovam impacto significativo nos sintomas, com diminuição das crises, hospitalizações e, no caso dos pólipos nasais, também das cirurgias.
Na prática, isso significa o controle perene e com mais segurança das doenças – o que, para quem sofre com seus sintomas debilitantes e os tratamentos agressivos que tentam debelar as crises, é uma mudança e tanto. “Estamos falando de melhora na qualidade de vida do paciente”, conclui a médica.
MAT-BR-2001274 – Setembro /2020. Material destinado ao público geral.
Referências:
Cruvinel WM, Mesquita Jr. D, Araújo JAP, Catelan TTT, Souza AWS, Silva NP, Andrade LEC. Sistema Imunitário – Parte I. Fundamentos da imunidade inata com ênfase nos mecanismos moleculares e celulares da resposta inflamatória. 2010. Rev Bras Reumatol.
Gandhi NA, Bennett BL, Graham NM. Targeting key proximal drivers of type 2 inflammation in disease. Nature Reviews Drug Discovery, vol. 15, no. 1, pp. 35-50, 16 October 2016.
Carr s, Chan E, Watson W. Eosinophilic esophagitis. Allergy, Asthma & Clinical Immunology, vol. 14, no. Suppl 1, p. 58, 2018.
Steinke JW, Wilson JM. Aspirinexacerbated respiratory disease: pathophysiological insights and clinical advances. Journal of Asthma and Allergy, vol. 9, pp. 37-43, 2016.
Heffler E et al. J Allergy Clin Immunol Pract, 2018 [E-Pub].
Shaw DE et al. Eur Respir J, 2015; 46:1308-1321.
Maio S et al. Allergy, 2018; 73:683-695.
Simpson E et al. J Am Acad Dermatol, 2016; 74:491-498.
Silverberg JI et al. Ann Allergy Asthma Immunol, 2018; 121:604-612.
Won H, Kim Y, Kang M. Age-related prevalence of chronic rhinosinusitis and nasal polyps and their relationships with asthma onset. Ann Allergy Asthma Immunol, vol. 120, no. 4, pp. 389-394, 2018.
Staniorski CJ et al. Int Forum Allergy Rhinol, 2018; 8:495-503.
Mais Lidas
MedicinaMedicinaIvermectina: o que sabemos sobre seu uso contra o coronavírus
MedicinaMedicinaA transmissão do coronavírus por pessoas assintomáticas e pré-sintomáticas
MedicinaMedicinaHipertensão: causas, sintomas, diagnóstico e como baixar a pressão
MedicinaMedicinaQuais são os sintomas do coronavírus?
Continua após a publicidade
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La Vuelta a España -2017: Climbing to the blue
La Vuelta a España -2017: Climbing to the blue
Hola! Today’s image is taken from Stage 5 and shows something that strikes me every time I see the Mediterranean coastline – the sky and sea are such amazing blues – so intense. The race took a route through these gorgeous colours finishing on a very sharp climb which pushed even the best to their limits. Another fab day!
Climbing to the blue
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