Introdução: Na forma grave de COVID-19 pode ocorrer infiltração maciça de neutrófilos no tecido pulmonar, com consequente liberação das NETs pelos neutrófilos, acarretando extenso danos às células epiteliais do pulmão. Objetivo: Compreender a relação entre as NETs e o estado hiperinflamatório induzido pelo SARS-CoV-2. Método: Revisão de literatura que incluiu estudos em língua inglesa e portuguesa, publicados no último ano, envolvendo a relação entre as NETs e a COVID-19, e indexados nas bases de dados PubMed e SciELO. A estratégia de busca foi: “NETs and COVID-19”. Foram incluídos artigos que continham dados no título ou no resumo sobre essa associação e cujo acesso ao texto completo foi possível. Resultados: A literatura foi unânime em afirmar que há uma influência do processo de formação de NETs sobre a hiperinflamação observada na COVID-19. Em geral, o processo começa com a ativação de neutrófilos por receptores de reconhecimento de padrões. Porém, o próprio SARS-CoV-2 estimula diretamente os neutrófilos a liberar as NETs, que são redes extracelulares de filamentos de cromatina, cobertas de peptídeos e enzimas, como catepsina G, elastase e mieloperoxidase. Essa liberação destrói não somente o vírus, mas também o tecido ao redor, uma vez que a resposta é inespecífica. Este processo pode exacerbar o estado inflamatório e a desregulação da resposta imune, estimulando a produção de citocinas pró-inflamatórias e acarretando a síndrome respiratória aguda grave, principal causa de morte dos pacientes com COVID. Laboratorialmente, a presença de neutrofilia associada à linfopenia sugere um pior prognóstico. Tal perpetuação depende de fatores do próprio hospedeiro, como sexo masculino, idade avançada e presença de comorbidades, como obesidade, diabetes melitos, imunossupressão, entre outras. Conclusão: O mecanismo de defesa neutrofílico por meio da liberação de NETs pode ser uma “faca de dois gumes”, em que, por um lado, pode combater eficazmente a infecção, resultando na captura e morte dos vírus; mas, por outro, pode perpetuar o estado inflamatório com dano pulmonar e piora do prognóstico. Assim, a inibição de NETs representa um potencial alvo terapêutico para COVID-19.

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BACKGROUND Anxiety disorders are prevalent and can be disabling when not diagnosed. In chronic diseases, this symptom is often underestimate. Ankylosing spondylitis (AS) is a chronic disease that affects young adults, with implications for both the physical and mental health of those affected. A prolonged coexistence with pain and deformity that the illness causes often implies alterations and emotional disorders in these patients. MATERIALS AND METHODS Quantitative cross-sectional study based on the data collected through an application of the Generalized Anxiety Disorders (GAD-7) questionnaire. It's an instrument used to assess these anxiety disorders, validated in Brazil in 2006. It presents seven items with scores from 0 to 3 in each one, and the total score ranging from 0 to 21. Values higher than or equal to ten are correlated with a generalized anxiety disorder. The Ethical Committee approved the study of research, and the participants filled the free and clarified consent term. RESULTS The study involved a total of 104 patients with Ankylosing spondylitis, and 74% were male, with an age range below 45 years seen in 60% of the sample. The level of schooling above seven years presented in almost 70% and disease time above six years in this same proportion. Smoking and alcohol consumption observed in 10% and 21%, respectively. Forty-three percent of the sample was professionally active, almost 30% were unemployed, and 27% were retired. A score greater than or equal to 10 in the total sum of GAD-7 was found in 38% of the patients, thus, filling criteria for generalized anxiety disorder. Twothirds of the patients diagnosed with an anxiety disorder had schooling above seven years of study. The average GAD-7 score of the positive cases was 12. CONCLUSION An anxiety disorder diagnosed in more than one-third of patients with AS. The level of education showed a positive correlation with this diagnosis. The use of an appropriate instrument, such as GAD-7, to assess anxiety may be a device for the determination of this comorbidity, which is very frequent and compromises the well being of those who live with it.

BACKGROUND Polyarteritis nodosa (PAN) is a rare vasculitis, reaching 6 per 100,000 individuals, affecting mainly men in the fifth decade of life. Despite the systemic involvement, presenting nonspecific symptoms such as fever, asthenia, and arthralgia, most of the symptoms are of cutaneous origins, such as livedo reticularis, Raynaud's phenomenon, ulcers and ischemic alterations of the fingertips and calcaneus. If not diagnosed, it can be fatal due to renal, cardiovascular, and neurological repercussions. The use of glucocorticoids and cyclophosphamide in the remission of this disease changed the prognosis and survival of patients. Unfortunately, some cases do not respond to or tolerate this medication, and failure to treat it can be fatal in most cases. With a higher definition of the role of B lymphocytes in the pathogenesis of these diseases, the use of rituximab, an anti-CD20 monoclonal antibody, appears as a therapeutic option. The aim is to report the case of a young woman with PAN, treated with anti-CD20 monoclonal antibody. CASE REPORT A 42-year-old woman, in 2015, initiated symptoms of paresthesia in the lower limbs and afternoon fever. Slow and progressive evolution, with the appearance of livedo reticularis, Raynaud's phenomenon, areas of necrosis in the 4th left pododactyl and ulcer in the 5th right chirodactyl, being admitted for investigation. Due to the chronic and intense ischemic pain, the patient used exacerbated potent analgesics and morphine. FAN, rheumatoid factor, P and C-ANCA tests, and research for thrombophilia were negative. Serology for hepatitis B and C was also negative. An electroneuromyography of the upper and lower limbs showed multiple confluent mononeuritis. A skin biopsy suggestive of vasculitis. She was treated with corticosteroids, with low adherence to the treatment because she presented depressive condition, besides Cyclophosphamide pulses. However, the patient presented severe infectious complications, making continuity impossible. Then, it was decided to use the rituximab, the patient performed two biweekly doses of 1g of medication and showed marked improvement in ischemic lesions. Six-monthly maintenance infusions were scheduled. CONCLUSION Because polyarteritis nodosa is a rare and debilitating disease, it requires immediate diagnostic and therapeutic efficacy. Rituximab has proven to be a promising option for patients with PAN, with some intolerance or refractoriness to standard therapies.

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