Racial disparity and prognosis in patients with mouth and oropharynx cancer in Brazil.

BACKGROUND: Oral and oropharyngeal cancer (OPC) is an important cause of morbidity and mortality worldwide. Populations in situations of social vulnerability tend to have higher incidences of cancer, a higher proportion of late diagnosis, greater difficulties in accessing health services, and, consequently, worse prognosis. The aim of this study was to evaluate the relationship between race/skin color and OPC prognosis in Brazil. MATERIAL AND METHODS: This is a cross-sectional epidemiological study using OPC data from the National Cancer Institute between the years 2000 and 2019. The selected variables were: gender, race/skin color, age, education, smoking and alcohol consumption, stage of the disease and disease status at the end of the 1st treatment. RESULTS: 154,214 cases were recorded. Black men, in the 6th decade of life, were the most affected population. Blacks had a lower level of education when compared to non-blacks (p<0.001). Blacks were more exposed to smoking and alcohol consumption (p<0.001). At the time of diagnosis, the black population was at the most advanced stage when compared to non-blacks (p<0.001). At the end of the 1st treatment, more black patients had disease in progression, as well as more black patients died (p<0.001). CONCLUSIONS: Blacks had a worse prognosis for OPC in Brazil. Despite the limitations, these results are important to elucidate the scenario of health disparities in relation to the race/skin color of the Brazilian population.

High prevalence of oral potentially malignant disorders and risk factors in a semi-urban brazilian city: a population-based cross-sectional study.

BACKGROUND: Oral Potentially Malignant Disorders (OPMDs) are defined as lesions with a greater likelihood of progressing to cancer. Population-based studies that evaluate the prevalence of OPMDs are scarce in Brazil. The aim of the present study was to determine the prevalence of OPMDs and associated risk factors in a semi-urban Brazilian population. MATERIAL AND METHODS: This is a cross-sectional study, whose universe included individuals aged 40 years or older residing in a medium-sized city of northeastern Brazil. Data collection was divided into two steps: interview and oral examination. The outcome variable was the presence of OPMDs. The predictor variables were sociodemographic characteristics and risk habits. The bivariate analysis was performed through chi-square test. The crude prevalence ratios (PR) and its respective 95% confidence intervals (CI) were calculated. Poisson regression analysis with robust variance was used to calculate adjusted PRs and 95% CI. RESULTS: Three hundred fourteen individuals were included in the study. When asked about risk habits, 58.9% reported being current smokers or ex-smokers and 62.2% reported being current drinkers or ex-drinkers. The prevalence of OPMDs was 7.6% and was significantly higher among individuals with black skin color (p < 0.001), alcohol users (p = 0.017), and individuals with both tobacco and alcohol habits (p = 0.012). CONCLUSIONS: Therefore, the population in the present study had a high frequency of risk habits associated with PMDs of the oral cavity.

The influence of lactation on BMD measurements and TBS: a 12-month follow-up study.

Although lactation is associated with transient bone loss and body weight changes, the unchanged TBS could highlight a limited effectiveness in detecting dynamic bone properties in the first year postpartum. PURPOSE: To evaluate trabecular bone score (TBS) and bone mineral density (BMD) in postpartum women. METHODS: This was a 12-month prospective cohort study with 40 lactating postpartum women and 44 non-pregnant women. The inclusion criteria were as follows: aged between 18 and 35 years old, an uncomplicated term (≥37 weeks) pregnancy with a single fetus, and no intention of becoming pregnant within 12 months. BMD measurements, including spine, hip, forearm and whole body, were performed by DXA at four different time points after delivery: (1) 1st month, (2) 3rd-4th month, (3) 6th-9th month, and (4) ≥ 12th month postpartum. RESULTS: BMD measurements showed a statistically significant decrease at spine (1.134 vs. 1.088 g/cm2, p < 0.01), femoral neck (0.988 vs. 0.946 g/cm2, p < 0.01), total femur (0.971 vs. 0.933 g/cm2, p < 0.01), and whole body (1.132 vs. 1.119 g/cm2, p = 0.03) at the 2nd assessment (peak of lactation). There was early spinal recovery after the 3rd assessment with complete recovery in all skeletal sites. Although it has had significant weight loss (67.3 vs. 63.2 kg, p < 0.01) and body mass index reduction (25.2 vs. 23.4, p < 0.01), there was significant increment of spine BMD (1.134 vs. 1.165 g/cm2, p < 0.01) after 12-month follow-up. The TBS did not change over time. CONCLUSIONS: Although lactation is associated with transient bone loss and body weight changes, the unchanged TBS could highlight a limited effectiveness in detecting dynamic bone properties in the first year postpartum.

Random regression models for the evaluation of the growth of goats of the Anglonubian breed / Modelos de regressão aleatória para avaliação do crescimento de caprinos da raça Anglonubiana

A total of 6593 weight records collected from 796 male and female Anglo-Nubian goats aged up to 130 days, offspring from 29 sires and 225 dams, were used to compare models and estimate genetic parameters throughout the growth curve by applying random regression models. Direct and maternal additive genetic effects and direct and maternal permanent environmental effects were included as random in the models. The contemporary groups were included as fixed effects and goat age at kidding was included as a covariable (linear and quadratic). The choice of the best model was based on the AIC, BIC and AICc criteria. Variance estimates of the four random effects increased as the animals aged. Direct heritability (h2) rose from 0.13 to 0.40 with age, whereas maternal heritability showed a low value. Genetic correlations of weight between closer ages were high. The most suitable random regression model to compare the fitting of random effects was that which employed the Legendre polynomials of quadratic order with homogeneous variance (3333-1).(AU)

Utilizaram-se 6593 pesos de 796 caprinos da raça Anglonubiana, coletados em machos e fêmeas com idade até 130 dias, descendentes de 29 reprodutores e 225 matrizes, com o objetivo de se compararem modelos e de se estimarem parâmetros genéticos ao longo da curva de crescimento com aplicação de modelos de regressão aleatória. Nos modelos, incluíram-se os efeitos genéticos aditivos diretos e maternos e os de ambiente permanente diretos e maternos como aleatórios; os grupos de contemporâneos foram incluídos como efeitos fixos, e a idade da cabra ao parto como covariável (linear e quadrática). A escolha do melhor modelo foi realizada pela avaliação dos critérios AIC, BIC e AICc. As estimativas de variâncias dos quatro efeitos aleatórios cresceram de acordo com o aumento da idade. A herdabilidade direta (h2) aumentou de 0,13 a 0,40 com a idade, e a materna apresentou baixo valor. As correlações genéticas do peso entre idades mais próximas foram altas. O modelo de regressão aleatório mais adequado ao se comparar o ajuste dos efeitos aleatórios foi o que empregou polinômios de Legendre de ordem quadrática com variância homogênea (3333-1).(AU)

How does women's bone health recover after lactation? A systematic review and meta-analysis.

This is a systematic review aiming to evaluate the recovery of bone mass after lactation-related loss. Bone loss is transitory with recovery depending on the return of menstruation and weaning, and several compensatory homeostatic mechanisms are involved to minimize any significant damage to the maternal skeleton. Lactation has been associated with significant temporary bone loss, especially during the exclusive breastfeeding period. In the bone recovery phase, there is wide methodological heterogeneity among clinical trials, including follow-up timing, methods and sites of bone measurements, and body composition changes. The purpose of this study is to perform a systematic review and meta-analysis aiming to evaluate the recovery rate of bone mass after lactation-related loss, including the PubMed, Web of Science, and Scopus databases, with no publication date restrictions. The following MeSH terms were used: "bone diseases," "bone resorption," "bone density," "osteoporosis," "calcium," "postpartum period," "weaning," "breast feeding," and "lactation." The inclusion criteria were as follows: prospective human studies in women of reproductive age and bone measurements with two assessments in the postpartum period at least: the first one within the first weeks of lactation and another one 12 months after delivery, 3 months following the return of menses or 3 months postweaning. This research was recorded on the Prospero database (CRD42018096586Bone). A total of 9455 studies were found and 32 papers met the inclusion criteria. The follow-up period ranged from one to 3.6 years postpartum. Lactation was associated with transient bone loss, with a strong tendency to recover in all the sites studied, depending on the return of menstruation and weaning. Small deficits in the microarchitecture of the peripheral skeleton may be present, especially in women with prolonged breastfeeding, but with no deficit regarding the hip geometry was found. Women with a successive gestation after prolonged lactation and women who had breastfed when adolescents had no significant bone loss. Bone loss related to lactation is transitory, and several compensatory homeostatic mechanisms are involved to minimize any significant damage to the maternal skeleton.

Organ and Tissue Donations for Transplants in the Macroregional North of Paraná, Brazil.

BACKGROUND: Few studies have analyzed the results of the organ and tissue donation process for transplants. OBJECTIVES: To analyze donations of organs and tissues for transplants in the Macroregional North of Paraná. MATERIAL AND METHODS: Cross-sectional and retrospective study, using data from 7383 death certificates of eligible donors notified in 2015 by 16 hospitals accredited to the Organ Procurement Organization. The data were analyzed using the prevalence ratio (PR) and the Wald test. RESULTS: Among the 934 eligible donors, the prevalence of effective donations was 23.4% (219) Among the 582 organs and tissues donated, corneas were predominant. Organs became available for donation from younger individuals (PR = 0.992), due to brain death (PR = 2.482), notified by the type III Intra-Hospital Organ and Tissue Donation Commissions for Transplants (PR = 2.016), which took place in intensive care units (PR = 1.471). The relatives interviewed were the partners and/or children (PR = 0.469), and the interviews were held by the nurse (PR = 1.324). CONCLUSION: Effective donations were able to take place through proper organizational structure and trained human resources, highlighting the role of the nurse in the optimization of the organ and tissue donation process for transplants.

Brain Death: Knowledge of Future Brazilian Physicians.

BACKGROUND: Thousands of people die on the waiting list for transplants. The shortage of organs and tissues for transplantation is considered a serious global problem. Brain death (BD) is the main source of organs for transplantations. OBJECTIVE: Given that BD is assessed by medical staff and that this diagnosis is ethically relevant, the goal of this work was to analyze the knowledge of 5th- and 6th-year medical students of Southern Brazil regarding the process of determining BD. METHOD: This observational, cross-sectional study was conducted between September 2013 and March 2014. RESULTS: A total of 635 students participated in the study, with 337 (53.1%) from public and 298 (46.9%) from private schools. Approximately 333 (52.4%) attended the 6th year of the medical program. The mean age of the students was 25.4 ± 3.56 years, with a prevalence of females of 54.6% (347) and a prevalence of Catholic religion of 61.7% (392); 84.2% of the students reported not feeling confident performing the BD protocol. A low percentage (15.7%) correctly answered 75% or more of the questions about BD, a criterion used to determine sufficient knowledge of BD. Approximately 45% (282) of respondents were not able to identify the patients who were candidates for the BD protocol. Analyzing the medical students' knowledge at the end of the program can provide information about the quality of undergraduate education on the topic of determining BD. CONCLUSION: It was concluded that 5th- and 6th-year medical students of Paraná State have little knowledge about the BD protocol.

Carbon disulfide mediated self-assembly of Laccase and iron oxide nanoparticles on gold surfaces for biosensing applications.

A simple one-step methodology was explored to prepare enzyme-modified nanostructured electrodes for the development of biosensing interfaces. Magnetite type nanoparticles conjugated with Laccase were immobilized on gold surfaces. This approach relies on the reaction between carbon disulfide and amine groups of biomolecules to form dithiocarbamate (DTC) moieties, as well as on the strong affinity between sulfur species and metals. Special emphasis was given to demonstrate DTC formation in aqueous solution and further attachment to iron oxide nanoparticles and to gold electrodes. UV-visible spectroscopy confirmed the functionalization of nanoparticles by DTC using a model secondary amine (N-hexylmethylamine). The direct attachment of modified iron oxide nanoparticles (with ca. 20 or 40nm mean sizes) to gold electrodes was investigated using the hormone epinephrine, with well-known electrochemical properties. A high amount of immobilized epinephrine and a facilitated redox conversion was observed for modified electrodes containing iron oxide nanoparticles. The success of this simple and robust method was confirmed by X-ray photoelectronic spectroscopy. Finally, the catalytic activity of modified gold with iron oxide nanoparticles and Laccase was evaluated toward 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid diammonium salt (ABTS). Chronoamperometric studies revealed a significant catalytic activity of immobilized Laccase in the presence of the nanoparticles, in particular for the largest ones (40nm), with a sensitivity for ABTS oxidation of 100mAM-1cm-2.

Organ and tissue donation for transplantation from fatal trauma victims.

INTRODUCTION: The aim of this study was to analyze multiple aspects of organ donation after mortality owing to trauma-related causes. METHODS: We completed a cross-sectional, retrospective, descriptive study that used data were extracted from monthly death reports and clinical records of fatal external injury victims 2-70 years of age who were assisted at 1 of 4 hospitals in the municipality of Maringá and the surrounding metropolitan area in Paraná state, Brazil, in 2012. RESULTS: A total of 871 individuals within the age range for donation died, 15.4% owing to external causes of injury. Of these 134 cases, 80.6% were male and 52.23% were 18-40 years old. A total of 57% of deaths were owing to traffic accidents, 58% of which involved motorcycles. Aggression was a factor in 25% of deaths, with 55% owing to firearm wounds. Approximately 52% of families consented to organ donation when asked. A total of 58% of families who refused consent did not indicate a specific reason. At 62%, the majority of refusals involved brain-dead patients. Approximately 58% of the families did not receive a request for consent. Out of these 78 cases, 83% showed contraindications, 44% had sepsis, 40% hemodilution, and 10% logistical/infrastructural problems. CONCLUSIONS: The highest proportion of non donor cases was owing to the lack of a formal request for consent from the family. Thus, continued training for health care professionals on the donation-transplantation process and early identification of potential donors and appropriate organ maintenance is necessary.

Consanguinity and founder effect for Gaucher disease mutation G377S in a population from Tabuleiro do Norte, Northeastern Brazil.

Gaucher's disease (GD) is caused by a ß-glucocerebrosidase deficiency, leading to the accumulation of glucocerebroside in the reticuloendothelial system. The prevalence of GD in Tabuleiro do Norte (TN) (1:4000) is the highest in Brazil. The purpose of this study was to present evidence of consanguinity and founder effect for the G377S mutation (c.1246G>A) among GD patients in TN based on enzyme, molecular and genealogical studies. Between March 2009 and December 2010, 131 subjects at risk for GD (GC in dried blood ≤2.19 nmol/h/ml) and 5 confirmed GD patients from the same community were submitted for molecular analysis to characterize the genetic profile of the population. Based on the enzymatic and molecular analysis, the subjects were classified into three categories: affected (n = 5), carrier (n = 20) and non-carrier (n = 111). All carriers were (G377S/wt). Affected subjects were homozygous (G377S/G377S). The identification of a single mutation in carriers and homozygotes from different generations, the history of the community and the genealogy study suggest that the high prevalence of GD in this population may be due to a combination of consanguinity and founder effect for the G377S mutation.

Causes of organ donation failure in Brazil.

INTRODUCTION: There has been a great improvement in transplantation medicine in Brazil in the last 2 decades. However, there remain several barriers regarding notification of brain and cardiac death as well as completion of the donation process. METHODS: This retrospective study was performed between January 2008 and December 2010. We reviewed all deaths in a University Hospital, observing the causes of non-notification to the State Transplantation Authority and non-donations. RESULTS: There were 41 notifications of brain death resulting in donation in only 19.5% of those cases. Cardiac death was diagnosed in 21 patients, resulting in 52.4% donations. The main cause for non-donation were family refusal (37.2%), infectious diseases (30.2%), and clinical contraindications (32.6%). Most of the missed possible donors occurred during the night (54.8%) and in the emergency room (80.9%). CONCLUSION: There is an urgent need for better education of the Brazilian population about organ donation and brain death definitions. Other identified problems include lack of uniformity in brain death determinations among hospitals, rigid contraindications to donation in the State of Parana, physician unawareness or disbelief about brain death diagnostic criteria, and lack of structure of our Hospital.

Effect of autologous bone marrow-derived cells associated with guided bone regeneration or not in the treatment of peri-implant defects.

This study investigated the effect of bone marrow-derived cells associated with guided bone regeneration in the treatment of dehiscence bone defects around dental implants. Iliac-derived bone marrow cells were harvested from dogs and phenotypically characterized with regard to their osteogenic properties. After teeth extraction, three implant sites were drilled, dehiscences created and implants placed. Dehiscences were randomly assigned to: bone marrow-derived cells, bone marrow-derived cells+guided bone regeneration, and control (no treatment). After 3 months, implants with adjacent tissues were processed histologically, bone-to-implant contact, bone fill within the threads, new bone area in a zone lateral to the implant, new bone height, and new bone weight at the bottom of the defect were determined. Phenotypic characterization demonstrated that bone marrow-derived cells presented osteogenic potential. Statistically higher bone fill within the threads was observed in both bone marrow-derived cells+guided bone regeneration bone marrow-derived cell groups compared with the control group (P<0.05), with no difference between the groups treated with cells (P>0.05). For the other parameters (new bone area, bone-to-implant contact, new bone height and new bone weight), only the bone marrow-derived cells+guided bone regeneration group presented higher values compared with the non-treated control (P<0.05). Bone marrow-derived cells provided promising results for peri-implantar bone regeneration, although the combined approach seems to be relevant, especially to bone formation out of the implant threads.

Reversible flow of cholesteryl ester between high-density lipoproteins and triacylglycerol-rich particles is modulated by the fatty acid composition and concentration of triacylglycerols.

We determined the influence of fasting (FAST) and feeding (FED) on cholesteryl ester (CE) flow between high-density lipoproteins (HDL) and plasma apoB-lipoprotein and triacylglycerol (TG)-rich emulsions (EM) prepared with TG-fatty acids (FAs). TG-FAs of varying chain lengths and degrees of unsaturation were tested in the presence of a plasma fraction at d > 1.21 g/mL as the source of CE transfer protein. The transfer of CE from HDL to FED was greater than to FAST TG-rich acceptor lipoproteins, 18% and 14%, respectively. However, percent CE transfer from HDL to apoB-containing lipoproteins was similar for FED and FAST HDL. The CE transfer from HDL to EM depended on the EM TG-FA chain length. Furthermore, the chain length of the monounsaturated TG-containing EM showed a significant positive correlation of the CE transfer from HDL to EM (r = 0.81, P < 0.0001) and a negative correlation from EM to HDL (r = -041, P = 0.0088). Regarding the degree of EM TG-FAs unsaturation, among EMs containing C18, the CE transfer was lower from HDL to C18:2 compared to C18:1 and C18:3, 17.7%, 20.7%, and 20%, respectively. However, the CE transfer from EMs to HDL was higher to C18:2 than to C18:1 and C18:3, 83.7%, 51.2%, and 46.3%, respectively. Thus, the EM FA composition was found to be the rate-limiting factor regulating the transfer of CE from HDL. Consequently, the net transfer of CE between HDL and TG-rich particles depends on the specific arrangement of the TG acyl chains in the lipoprotein particle core.

Reversible flow of cholesteryl ester between high-density lipoproteins and triacylglycerol-rich particles is modulated by the fatty acid composition and concentration of triacylglycerols

We determined the influence of fasting (FAST) and feeding (FED) on cholesteryl ester (CE) flow between high-density lipoproteins (HDL) and plasma apoB-lipoprotein and triacylglycerol (TG)-rich emulsions (EM) prepared with TG-fatty acids (FAs). TG-FAs of varying chain lengths and degrees of unsaturation were tested in the presence of a plasma fraction at d > 1.21 g/mL as the source of CE transfer protein. The transfer of CE from HDL to FED was greater than to FAST TG-rich acceptor lipoproteins, 18 percent and 14 percent, respectively. However, percent CE transfer from HDL to apoB-containing lipoproteins was similar for FED and FAST HDL. The CE transfer from HDL to EM depended on the EM TG-FA chain length. Furthermore, the chain length of the monounsaturated TG-containing EM showed a significant positive correlation of the CE transfer from HDL to EM (r = 0.81, P < 0.0001) and a negative correlation from EM to HDL (r = -041, P = 0.0088). Regarding the degree of EM TG-FAs unsaturation, among EMs containing C18, the CE transfer was lower from HDL to C18:2 compared to C18:1 and C18:3, 17.7 percent, 20.7 percent, and 20 percent, respectively. However, the CE transfer from EMs to HDL was higher to C18:2 than to C18:1 and C18:3, 83.7 percent, 51.2 percent, and 46.3 percent, respectively. Thus, the EM FA composition was found to be the rate-limiting factor regulating the transfer of CE from HDL. Consequently, the net transfer of CE between HDL and TG-rich particles depends on the specific arrangement of the TG acyl chains in the lipoprotein particle core.

Atheromatosis extent in coronary artery disease is not correlated with apolipoprotein-E polymorphism and its plasma levels, but associated with cognitive decline.

BACKGROUND: Apolipoprotein-E (apoE) ε4 allele is a known risk factor for Alzheimer's disease (AD). Polymorphism of apoE is also one of the most important genetic markers for coronary artery disease (CAD). The allelic variation in the apoE gene has a significant effect on inter-individual variation of lipids and lipoprotein plasma levels as well. This study investigated whether apoE polymorphism affects the plasma levels of apoE and the possible association to CAD extent and cognitive functions. METHODS: Plasma apoE levels and apoE genotypes were evaluated of subjects with normal coronary arteries, and individuals with angiographycally confirmed mild/moderate or severe atheromatosis. The cognitive performance of the volunteers was also measured by mini-mental state examination (MMSE). RESULTS: Out of the 6 expected genotypes, only 5 were detected in participants: E3/3 (56.0%), E3/4 (23.6%), E4/4 (8.2%), E2/4 (3.3%), E2/3 (8.9%). The ε3 allele (72%) was the most frequent, followed by ε4 (22%) and ε2 (6%). No difference was found in plasma levels of either apoE or in apoE genotype frequencies among the groups, however MMSE scores of CAD patients irrespective of their atheromatosis extent were significantly lower than that seen in the normal population. CONCLUSIONS: Although neither apoE plasma levels, nor apoE polymorphism in patients presenting with mild/moderate or severe atheromatosis showed to be associated with CAD severity, the presence of atheromatosis in the heart vessels positively correlated with cognitive dysfunction.

Investigation of whole blood of SJL/J mice using neutron activation analysis

Eleven whole blood samples were analyzed in the IEA-R1 nuclear reactor at IPEN (São Paulo, Brazil). These data contribute for applications in veterinary medicine related to biochemistry analyses using whole blood. Moreover, the correlation with human blood estimation allows to checking the similarities for studying muscular dystrophy using this model animal.

Autoantibody response to chromatographic fractions from oxidized LDL in unstable angina patients and healthy controls.

Levels of autoantibodies to oxidized low-density lipoprotein (oxLDL) have been correlated to atherosclerosis; however, contradictory results have been shown. To better understand the role of autoantibodies to oxLDL in atherogenesis, and their potential to predict risk of developing coronary artery disease we investigated the antibody response of unstable angina (UA) patients and healthy controls against chromatographic separated fractions of oxLDL. Five major peaks were detected after chromatographic separation of oxLDL and 10 fractions were collected. Surprisingly, when the response to high molecular weight fractions was analysed, we observed a significant increase in the levels of autoantibodies in controls compared to UA. In contrast, when the autoantibody response to intermediate and low molecular weight fractions was analysed, we observed that the UA group showed consistently higher levels compared with controls. Our data demonstrates that within oxLDL there are major fractions that can be recognized by autoantibodies from either UA patients or healthy individuals, and that the use of total oxLDL as an antigen pool may mask the presence of some antigenic molecules and their corresponding antibodies. Further studies are needed, but the analysis of antibody profiles may indeed open up a novel approach for evaluation and prevention against atherosclerosis.

Effect of insulin-like growth factor-I on Leishmania amazonensis promastigote arginase activation and reciprocal inhibition of NOS2 pathway in macrophage in vitro.

We showed previously that insulin-like growth factor (IGF)-I induces an exacerbation of the lesion development in experimental cutaneous leishmaniasis favouring parasite growth within host macrophages. Here we studied the effect of IGF-I in vitro in BALB/c mouse peritoneal macrophages infected with stationary phase Leishmania amazonensis promastigotes. IGF-I was used to pre-incubate either macrophage or parasite before infection of the macrophages or adding it at the start of the Leishmania-macrophage culture and maintaining it throughout the experimental period. Independent of stimulation protocol, IGF-I induced significantly increased parasite growth within macrophages. Arginase activation considered as a key factor in Leishmania growth was studied, and its expression and activity were increased in Leishmania-infected macrophages but significantly more in infected cells upon IGF-I stimulus, an effect specifically inhibited by NOHA. Arginase known to be present on Leishmania was also studied, and its expression and activity were seen in the absence of any stimulus but significantly increased after 5 min of incubation with IGF-I. In addition, Leishmania was pre-incubated with NOHA for 5 min, washed, then macrophages infected observing a significantly reduced parasite burden in both IGF-I-stimulated and non-stimulated macrophages. Reciprocal decrease in the nitric oxide (NO) level and inhibition of nitric oxide synthase (NOS2) expression were also observed in IGF-I-stimulated infected macrophages. Our data strongly suggest that IGF-I induces preferential expression and activation of Leishmania promastigote arginase, contributes to the alternative activation of macrophages in the context of innate immunity and interferes with NOS pathway in infected macrophages probably as a reciprocal effect.