RESUMO
Se presentan 3 casos clínicos de féminas con síndrome de Asherman, procedentes del Policlínico Docente "Ramón López Peña", tratadas con medicina natural y tradicional. Se aplicaron técnicas bioenergéticas (acupuntura y microsistema de oreja, hidroterapia, dietas hipotóxicas, reflexoterapia podal) y de respiración. Todas las pacientes mejoraron su cuadro clínico, pues se le restableció el flujo menstrual y la gestación, lo cual demostró la eficacia del tratamiento empleado.
Three case reports of females with Asherman syndrome, belonging to "Ramón López Peña" Teaching Polyclinic, treated with natural and traditional medicine are presented. Bioenergetic techniques (acupuncture and ear microsystem, hydrotherapy, hipotoxic diets, foot reflex therapy) and breathing techniques were applied. All the patients improved their clinical pattern, because the menstrual flow and pregnancy were reestablished, which demonstrated the effectiveness of the treatment.
Assuntos
Ginatresia , Medicina Tradicional , Amenorreia , HidroterapiaRESUMO
Visual symptoms are common among the nonmotor symptoms in Parkinson's disease. The aims of this study were to assess the diagnostic accuracy and relationship of retinal morphologic and functional changes with motor and non-motor symptoms disturbances in Parkinson's disease. Thirty patients with Parkinson's disease, with a median Hoehn-Yahr stage of 2 (1-4), were compared to 30 age- and gender-matched controls. Retinal thinning and function were measured using optical coherence tomography (OCT), visual evoked potentials (VEP), and pattern electroretinography. Motor impairment and motor laterality were measured using the Short Parkinson's Evaluation Scale/Scales for Outcomes in Parkinson's disease, and non-motor symptoms severity using the nonmotor symptoms questionnaire. Only pattern electroretinography, P50 and N95 amplitudes, were lower in patients with Parkinson's disease, compared to controls (p = 0.01, respectively). Age, disease duration, levodopa dose, motor, and non-motor impairment were not significantly associated with retinal thinning and functional changes. The patients vs. controls area under the curve of OCT, VEP, and pattern electroretinography receiver-operating-characteristic curves were<0.50. In conclusion, morphologic and functional retina changes are not significantly correlated with motor and non-motor symptoms impairment severity, and do not discriminate between Parkinson's disease and controls.
Assuntos
Atividade Motora/fisiologia , Doença de Parkinson/patologia , Retina/patologia , Retina/fisiopatologia , Transtornos da Visão/etiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Eletrorretinografia , Potenciais Evocados Visuais/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Curva ROC , Tomografia de Coerência ÓpticaRESUMO
The prophylactic capacity of the RUTI® vaccine, based on fragmented cells of Mycobacterium tuberculosis, has been evaluated in respect to aerosol challenge with virulent bacilli. Subcutaneous vaccination significantly reduced viable bacterial counts in both lungs and spleens of C57Bl mice, when challenged 4 weeks after vaccination. RUTI® protected the spleen less than BCG. Following a 9 month vaccination-challenge interval, protection was observed for the lungs, but not for the spleen. Survival of infected guinea pigs was prolonged by vaccination given 5 weeks before challenge. Inoculations of RUTI® shortly after infection significantly reduced the viable bacterial counts in the lungs, when compared with infected control mice. Thus, vaccination by RUTI® has potential for both the prophylaxis and immunotherapy of tuberculosis.
Assuntos
Vacinas Bacterianas/imunologia , Mycobacterium tuberculosis/citologia , Mycobacterium tuberculosis/imunologia , Tuberculose/prevenção & controle , Vacinação/métodos , Animais , Feminino , Cobaias , Camundongos , Fatores de TempoRESUMO
We have evaluated the influence of age and immunization routes for induction of HIV-1- and M. tuberculosis-specific immune responses after neonatal (7 days old) and adult (7 weeks old) BALB/c mice immunization with BCG.HIVA(222) prime and MVA.HIVA boost. The specific HIV-1 cellular immune responses were analyzed in spleen cells. The body weight of the newborn mice was weekly recorded. The frequencies of HIV-specific CD8(+) T cells producing IFN-γ were higher in adult mice vaccinated intradermally and lower in adult and newborn mice vaccinated subcutaneously. In all cases the IFN-γ production was significantly higher when mice were primed with BCG.HIVA(222) compared with BCGwt. When the HIV-specific CTL activity was assessed, the frequencies of specific killing were higher in newborn mice than in adults. The prime-boost vaccination regimen which includes BCG.HIVA(222) and MVA.HIVA was safe when inoculated to newborn mice. The administration of BCG.HIVA(222) to newborn mice is safe and immunogenic and increased the HIV-specific responses induced by MVA.HIVA vaccine. It might be a good model for infant HIV and Tuberculosis bivalent vaccine.
Assuntos
Vacinas contra a AIDS/imunologia , Imunidade Adaptativa/imunologia , Vacina BCG/imunologia , Infecções por HIV/prevenção & controle , HIV-1/imunologia , Vacinação , Vacinas contra a AIDS/genética , Fatores Etários , Animais , Animais Recém-Nascidos , Vacina BCG/genética , Linfócitos T CD8-Positivos/imunologia , Vias de Administração de Medicamentos , Epitopos/imunologia , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Tuberculina/imunologia , Vacinas de DNARESUMO
A transthoracic infection involving a low dose of Mycobacterium tuberculosis has been used to establish a new model of infection in minipigs. The 20-week monitoring period showed a marked Th1 response and poor humoral response for the whole infection. A detailed histopathological analysis was performed after slicing the formalin-fixed whole lungs of each animal. All lesions were recorded and classified according to their microscopic aspect, their relationship with the intralobular connective network and their degree of maturity in order to obtain a dissemination ratio (DR) between recent and old lesions. CFU counts and evolution of the DR with time showed that the proposed model correlated with a contained infection, decreasing from week 9 onwards. These findings suggest that the infection induces an initial Th1 response, which is followed by local fibrosis and encapsulation of the granulomas, thereby decreasing the onset of new lesions. Two therapeutic strategies were applied in order to understand how they could influence the model. Thus, chemotherapy with isoniazid alone helped to decrease the total number of lesions, despite the increase in DR after week 9, with similar kinetics to those of the control group, whereas addition of a therapeutic M. tuberculosis fragment-based vaccine after chemotherapy increased the Th1 and humoral responses, as well as the number of lesions, but decreased the DR. By providing a local pulmonary structure similar to that in humans, the mini-pig model highlights new aspects that could be key to a better understanding tuberculosis infection control in humans.
Assuntos
Fibrose/patologia , Granuloma/patologia , Tuberculose/terapia , Animais , Vacinas Bacterianas/farmacologia , Modelos Animais de Doenças , Imunidade Humoral/efeitos dos fármacos , Isoniazida/farmacologia , Mycobacterium tuberculosis , Suínos , Porco Miniatura , Células Th1/imunologia , Tuberculose/patologiaRESUMO
The membrane-associated histidine-rich protein-1 (MAHRP-1) is a Maurer's cleft-resident molecule that has been recently described as an important protein for the trafficking of PfEMP-1 to infected erythrocyte membrane, a major virulence factor. We have studied the specific interactions between 20-mer-long synthetic peptides spanning the complete MAHRP-1 sequence and erythrocytes. A high-activity binding peptide (HABP) with saturable binding to a 46-kDa erythrocyte membrane protein was identified and its binding was affected by chymotrypsin treatment. Random coil and alpha-helical features were found in the HABP's structure. Our results suggest that MAHRP-1 specifically interacts with erythrocyte membrane through a 20-mer-long amino acid region, raising questions about this region's potential as a therapeutic target against malaria.
Assuntos
Proteínas de Transporte/metabolismo , Membrana Eritrocítica/metabolismo , Membrana Eritrocítica/parasitologia , Plasmodium falciparum/fisiologia , Proteínas de Protozoários/metabolismo , Sequência de Aminoácidos , Animais , Proteínas de Transporte/química , Proteínas de Transporte/genética , Proteínas de Membrana , Dados de Sequência Molecular , Peptídeos/química , Peptídeos/genética , Peptídeos/metabolismo , Plasmodium falciparum/metabolismo , Proteínas de Protozoários/química , Proteínas de Protozoários/genéticaRESUMO
The chronic phase of Mycobacterium tuberculosis infection in mouse experimental models is characterized by the accumulation of foamy macrophages (FM)--which shape the outer ring of the granuloma - in the alveolar spaces, as detected in paraffin-embedded tissues stained with hematoxylin-eosin. In this study, the use of semi- and ultra-thin sections offers more detailed information about the origin of FM both in mouse and guinea-pig experimental models. Lipid bodies (LB) are present in macrophages from the beginning of infection and accumulate in the chronic phase. LB progress from an early (ELB) to a late (LLB) stage, defined according to their progressive capacity to generate cholesterol crystals, resembling atherosclerotic lesions. FM arise from massive accumulation of LLB. Electronic microscopy reveals intracellular lipophilic inclusions (ILIs) in those M. tuberculosis bacilli inside FM. It is our hypothesis that the accumulation of lipids in M. tuberculosis concomitant to the establishment of the non-replicating state prepares the bacilli for future reactivation and for facing future stressful environments.
Assuntos
Células Espumosas/ultraestrutura , Granuloma/patologia , Tuberculose Pulmonar/patologia , Animais , Colesterol/metabolismo , Doença Crônica , Modelos Animais de Doenças , Progressão da Doença , Feminino , Células Espumosas/metabolismo , Granuloma/metabolismo , Cobaias , Pulmão/metabolismo , Pulmão/patologia , Macrófagos Alveolares/metabolismo , Macrófagos Alveolares/ultraestrutura , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Microscopia Eletrônica , Necrose/metabolismo , Necrose/patologia , Fagossomos/ultraestrutura , Tuberculose Pulmonar/metabolismoRESUMO
Gamma interferon responses of spleen cells in mice were examined during postchemotherapy relapse of intraperitoneally induced latent tuberculous infection. The mycobacterial extract RUTI, which prevented the relapse, significantly enhanced the immune responses to secreted and structural recombinant mycobacterial antigens, suggesting that RUTI-mediated protection was mediated by activated T cells.
Assuntos
Imunoterapia/métodos , Interferon gama/biossíntese , Leucócitos Mononucleares/imunologia , Baço/imunologia , Tuberculose/terapia , Animais , Camundongos , RecidivaRESUMO
RUTI is a therapeutic vaccine that is generated from detoxified and liposomed Mycobacterium tuberculosis cell fragments that has demonstrated its efficacy in the control of bacillus reactivation after short-term chemotherapy. The aim of this study was to characterize the cellular immune response generated after the therapeutic administration of RUTI and to corroborate the lack of toxicity of the vaccine. Mouse and guinea pig experimental models were infected with a low-dose M. tuberculosis aerosol. RUTI-treated animals showed the lowest bacillary load in both experimental models. RUTI also decreased the percentage of pulmonary granulomatous infiltration in the mouse and guinea pig models. This was not the case after Mycobacterium bovis BCG treatment. Cellular immunity was studied through the characterization of the intracellular gamma interferon (IFN-gamma)-producing cells after the splenocytes' stimulation with M. tuberculosis-specific structural and growth-related antigens. Our data show that the difference between the therapeutic administration of BCG and RUTI resides mainly in the stronger activation of IFN-gamma(+) CD4(+) cells and CD8(+) cells against tuberculin purified protein derivative, ESAT-6, and Ag85B that RUTI generates. Both vaccines also triggered a specific immune response against the M. tuberculosis structural antigens Ag16kDa and Ag38kDa and a marked mRNA expression of IFN-gamma, tumor necrosis factor, interleukin-12, inducible nitric oxide synthase, and RANTES in the lung. The results show that RUTI's therapeutic effect is linked not only to the induction of a Th1 response but also to the stimulation of a quicker and stronger specific immunity against structural and growth-related antigens that reduces both the bacillary load and the pulmonary pathology.
Assuntos
Antígenos de Bactérias/imunologia , Antituberculosos , Mycobacterium tuberculosis/imunologia , Linfócitos T/imunologia , Vacinas contra a Tuberculose , Tuberculose Pulmonar , Animais , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Vacina BCG/administração & dosagem , Vacina BCG/imunologia , Feminino , Cobaias , Humanos , Interferon gama/metabolismo , Isoniazida/administração & dosagem , Isoniazida/uso terapêutico , Lipossomos/administração & dosagem , Lipossomos/uso terapêutico , Camundongos , Camundongos Endogâmicos C57BL , Rifampina/administração & dosagem , Rifampina/análogos & derivados , Rifampina/uso terapêutico , Organismos Livres de Patógenos Específicos , Fatores de Tempo , Resultado do Tratamento , Vacinas contra a Tuberculose/administração & dosagem , Vacinas contra a Tuberculose/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/terapiaRESUMO
We investigated the protective role of immune-sera against reactivation of Mycobacterium tuberculosis infection in SCID mice and found that passive immunization with sera obtained from mice treated with detoxified M. tuberculosis extracts (delivered in liposomes in a composition known as RUTI) exerted significant protection. Our SCID mouse model consisted of aerosol infection by M. tuberculosis, followed by 3 to 8weeks of chemotherapy with isoniazid+rifampicin (INH+RIF) (25 and 10mg/kg, respectively). After infection and antibiotic administration, two groups of mice were treated for up to 10weeks with intraperitoneal passive immunization using hyperimmune serum (HS) obtained from mice infected with M. tuberculosis, treated with chemotherapy (INH+RIF) for 8weeks and inoculated with RUTI (HS group) or with normal serum (CT group). Significant differences were found between HS and CT groups in the number of bacilli in the lungs (3.68+/-2.02 vs. 5.72+/-1.41log(10) c.f.u.), extent of pulmonary granulomatomous infiltration (10.33+/-0.67 vs. 31.2+/-1.77%), and percentage of animals without pulmonary abscesses (16.7% vs. 45.5%). These data strongly suggest a protective role of specific antibodies against lung dissemination of M. tuberculosis infection.
Assuntos
Soros Imunes/administração & dosagem , Imunização Passiva , Mycobacterium tuberculosis/imunologia , Tuberculose/prevenção & controle , Animais , Anticorpos Antibacterianos/administração & dosagem , Anticorpos Antibacterianos/imunologia , Antituberculosos/uso terapêutico , Modelos Animais de Doenças , Feminino , Humanos , Soros Imunes/imunologia , Isoniazida/uso terapêutico , Pulmão/microbiologia , Camundongos , Camundongos Endogâmicos DBA , Camundongos SCID , Rifampina/uso terapêutico , Prevenção Secundária , Organismos Livres de Patógenos Específicos , Tuberculose/tratamento farmacológico , Tuberculose/imunologia , Tuberculose/microbiologiaRESUMO
Intragranulomatous necrosis is a primary feature in the natural history of human tuberculosis (TB). Unfortunately, this phenomenon is not usually seen in the experimental TB murine model. Artificial induction of this necrosis in pulmonary granulomas (INPG) may be achieved through aerosol inoculation of lipopolysaccharide (LPS) 3 weeks after Mycobacterium tuberculosis infection. At week 9 post-infection, the centre of primary granulomas became larger, showing eosinophilic necrosis. Interestingly, INPG induction was related to mice strains C57BL/6 and 129/Sv, but not to BALB/c and DBA/2. Furthermore, the same pattern was obtained with the induction of infection using a clinical M. tuberculosis strain (UTE 0335R) that naturally induces INPG. In all the mice strains tested, the study of pulmonary mRNA expression revealed a tendency to increase or to maintain the expression of RANTES, interferon-gamma, tumour necrosis factor and iNOS, in both LPS- and UTE 0335R-induced INPG, thus suggesting that this response must be necessary but not sufficient for inducing INPG. Our work supports that INPG induction is a local phenomenon unrelated to the resistant (C57BL/6 and BALB/c) or susceptible (129/Sv and DBA/2) background of mice strains against M. tuberculosis infection.
Assuntos
Aerossóis , Granuloma do Sistema Respiratório/patologia , Pneumopatias/patologia , Tuberculose/patologia , Animais , Quimiocina CCL5/análise , Modelos Animais de Doenças , Eosinofilia/patologia , Feminino , Granuloma do Sistema Respiratório/microbiologia , Haplótipos , Interferon gama/análise , Lipopolissacarídeos/administração & dosagem , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias/microbiologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Necrose , Óxido Nítrico Sintase Tipo II/análise , RNA Mensageiro/análise , Tuberculose/microbiologia , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia , Fator de Necrose Tumoral alfa/análiseRESUMO
Low dose aerosol infection of C57BL/6 mice with a clinical strain of Mycobacterium tuberculosis (UTE 0335 R) induced intragranulomatous necrosis in pulmonary granulomas (INPG) at week 9 postinfection. Infection of different knockout (KO) mouse strains with UTE 0335 R induced INPG in all strains and established two histopathological patterns. The first pattern was seen in SCID mice and in mice with deleted alpha/beta T receptor, TNF R1, IL-12, IFN-gamma, or iNOS genes, and showed a massive INPG with a high granulomatous infiltration of the lung, a large and homogeneous eosinophilic necrosis full of acid-fast bacilli, with marked karyorrhexis, coarse basophilic necrosis, and surrounded by patches delimited by partially conserved alveolar septum full of PMNs. The second pattern was seen in mice with deleted IL-1 R1, IL-6, IL-10, CD4, CD8 or gamma/delta T cell receptor genes, and showed more discrete lesions with predominant homogeneous eosinophilic necrosis with few bacilli and surrounded by a well-defined lymphocyte-based ring. Local expression of IFN-gamma, iNOS, TNF and RANTES showed no significant differences between these mouse strains generating a discrete INPG. Mouse strains showing a massive INPG showed higher, lower or equal expression values compared to the control strain. In conclusion, the severity of the INPG pattern correlated with pulmonary CFU counts, irrespective of the genetic absence or the infection-induced levels of cytokine mediators.
Assuntos
Citocinas/metabolismo , Pulmão/microbiologia , Pulmão/patologia , Subpopulações de Linfócitos T/metabolismo , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia , Animais , Citocinas/genética , Feminino , Regulação da Expressão Gênica , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Necrose/metabolismo , Necrose/microbiologia , Necrose/patologia , RNA Mensageiro/metabolismo , Subpopulações de Linfócitos T/imunologia , Tuberculose Pulmonar/metabolismoRESUMO
Objetivo: actualizar las cifras y la causalidad de muerte materna en los hospitales del Perú. Diseño: Se elaboró un manual de autoevaluación y se seleccionó 31 hospitales, 7 en Lima y Callao y 24 en las diferentes regiones. Se envió anticipadamente a los hospitales el manual de autoevaluación y se les solicitó preparar informe. El equipo técnico visitó cada hospital en forma programada y llevó a cabo reunión con los directivos. Se recogió información de indicadores correspondientes a los tres años previos a la encuesta. La información recogida se procesó en computadora utilizando el programa Fox ProV2,6. Resultados: diecisiete hospitales correspondieron a la costa, 10 a la sierra y 4 a la selva; 25 al Ministerio de Salud, 3 al Instituto Peruano de Seguridad Social, 2 hospitales integrados entre dos instituciones anteriores y 1 privado. El total de partos atendidos el año anterior a la encuesta fue 100 963; de los cuales 66,6 por ciento correspondió a partos con 1 ó mas controles prenatales; sólo 43,6 por ciento de las parturientas había tenido 4 ó más; hubo 20,5 por ciento de cesáreas y 2,2 por ciento de partos instrumentados; 15,4 por ciento de abortos, 6,7 por ciento de niños de peso bajo al nacer y 4,3 por ciento de recién nacidos deprimidos. Entre un total de 155 797 partos con nacido vivo reunidos en los tres años anteriores a la encuesta hubo 349 casos de muerte materna, lo que da una tasa de 224,04 por cien mil nacidos vivos. A Lima le correspondió una tasa de 120,14 y al resto del país 255,66. En los hospitales de la Costa, la tasa encontrada fue 147,11, en la Sierra 145,36 y en la selva 728,00. Los hospitales integrados presentaron una tasa mayor que los otros; asimismo, la tasa fue mayor en los hospitales, más pequeños y en los más grandes. Las causas directas responsables del 84.5 por ciento de las muertes y las indirectas del 15.5 por ciento. Entre las causas directas, la hemorragia fue la más frecuente, siendo seguida por la hipertensión inducida por el embarazo. Conclusión: La tasa de mortalidad materna continúa siendo alta en los hospitales del Perú y es la hemorragia su causa más importante.
Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez/mortalidade , Planos e Programas de Saúde , Mortalidade Materna , PeruRESUMO
Reportamos un caso de concepción y gestación a termino en una paciente con esclerosis sistémica y tuberculosis renal, mientras estaba recibiendo tratamiento anti-tuberculoso. Durante el embarazo desarrolló oligoamnios y retardo de crecimiento intrauterino, pero la esclerosis sistémica permaneció estable y no desarrolló complicaciones. Después del parto la paciente fue dada de alta y se perdió de seguimiento luego de un año
Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez , Escleroderma Sistêmico/complicações , Retardo do Crescimento Fetal/etiologia , Oligo-Hidrâmnio/etiologia , Tuberculose Renal/complicaçõesRESUMO
Durante los años 1991 y 1992, en el "Hospital María Auxiliadora" se escogió 1500 parturientas, de las cuales 587 fueron nuliparas y 913 multiparas. A todas se les aplicó los siguientes criterios: cronologia del embarazo entre 37 y 41 semanas, ausencia de patología, parto de inicio y evolución espontanea, no medicación durante el parto, pelvis normal, presentación cefálica y recien nacido de 2500 a 4000 gramos con score de Apgar mayor de 6 al nacer. Despues de aplicar estos criterios, reunimos finalmente 317 nuliparas (209 con membranas integras y 108 con membranas rotas) y 306 multiparas (231 con membranas integras y 75 con membranas rotas). Todas las pacientes estuvieron en decubito durante el trabajo de parto y fueron controladas en el centro obstetrico utilizando el partograma diseñado por el CLAP y cuidando de hacer los registros gráficos a partir de los 4 a 5 cms de dilatación cervical en adelante. Los datos de dilatación del cuello uterino en relación al tiempo fueron procesados en computadoras y se calculo el percentil 10, o sea el tiempo máximo aceptable que demora la dilatación cervical de centimetro a centimetro hasta el periodo expulsivo, y con ellos se construyo las curvas de alerta para cada uno de los cuatros subgrupos. La pendiente seguida en el proceso de dilatación del cuello uterino es la misma en nuestras parturientas que las reportadas por el CLAP, pero los tiempos estan recostados un poco hacia la derecha, particularmente en el subgrupo de nuliparas con membranas integras