Functional variations in MBL2 gene are associated with cutaneous leishmaniasis in the Amazonas state of Brazil.

Functional variations in the mannose-binding lectin (MBL2) gene causing low levels of serum MBL are associated with susceptibility to numerous infectious diseases. We investigated whether there is genetic association of MBL2 variant alleles with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis. We used PCR-restriction fragment length polymorphism to genotype six MBL2 variants, three in the promoter region and three in the exon 1. An association was noted between the single nucleotide polymorphism -221X/Y of the MBL2 gene and CL (P=2.9 × 10(-6); odds ratio (OR)=1.9 (1.4-2.5) consistent with the hypothesis that the -221X allele confers high risk to development of CL among L. guyanensis-infected individuals. Furthermore, L. guyanensis-infected individuals bearing the codon 57 allele C had a higher risk of developing CL (P=5 × 10(-5); OR=1.9 (1.4-2.6)). The low MBL expressor haplotype LXPB was also associated to CL (P=6 × 10(-4)). This study raises the possibility that functional polymorphisms in MBL2 gene play a role in clinical outcome of Leishmania infection.

Feelings of powerlessness in individuals with either venous or diabetic foot ulcers.

AIM: To assess feelings of powerlessness in patients with either venous or diabetic foot ulcers. METHODS: This was an exploratory, descriptive, cross-sectional study conducted from May 2010 to August 2012. Two hundred adult patients with either venous leg ulcers (N=100) or diabetic foot ulcers (N=100) were consecutively recruited from an outpatient wound care clinic of a university hospital in the city of São Paulo (Brazil). Eligibility criteria included patients with type 1 and 2 diabetes and foot ulcers, and those with venous leg ulcers and ankle-arm index between 0.8 and 1.0. Patients unable to respond to a questionnaire due to physical or cognitive deficit were excluded. Two instruments were used for data collection: a questionnaire assessing sociodemographic and clinical characteristics, and the Powerlessness Assessment Tool (PAT) for adult patients. RESULTS: Most patients were women, aged 60-70 years, and smokers. Fifty-seven patients (57%) with diabetes had had foot ulcers for 3-6 years and 55 (55%) patients had had venous ulcers for 7-10 years. Wound odor and exudate were present in most ulcers. The total PAT score was significantly higher (P=0.002) for patients with foot ulcers (mean, 57.10) than for patients with venous ulcers (mean, 55.12). The highest mean scores for patients with venous and diabetic foot ulcers were 58.09 and 58.10, respectively, on the "self-perception of decision-making capacity" domain. CONCLUSION: Patients with venous and diabetic foot ulcers had very strong feelings of powerlessness, but these feelings were significantly stronger in those with foot ulcerations.

Feelings of powerlessness in patients with venous leg ulcers.

OBJECTIVE: To assess feelings of powerlessness in patients with venous leg ulcers. METHOD: An exploratory, descriptive, analytic, cross-sectional study was conducted at the Plastic Surgery Outpatient Clinic of the São Paulo Hospital (HSP) and at the Outpatient Wound-Care Clinic of the Sorocaba Hospital Complex (CHS), Brazil, from May 2010 to April 2012. Sixty patients with venous leg ulcers (VLUs), of both sexes, aged greater than or equal to 18 years, from the two outpatient wound-care clinics were selected to participate in the study. All participants responded to the Powerlessness Assessment Tool (PAT) for adult patients. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test and Kruskal-Wallis test at a significance level of 5% (p<0.05). RESULTS: Forty-four (73%) patients were women and 38 (63%) were aged 61-70 years. Eight (13%) patients were alcoholics and 46 (77%) were smokers. Thirty-two (53%) patients had a VLU for more than 10 years; the ulcer area ranged from 11-20 cm2 in 19 (32%) patients and was >30 cm2 in 18 (30%) patients. Mean total PAT score was 47.83 ± 7.99 and ranged from 51-60 for 31 (52%) patients and from 41-50 for 19 (32%) patients. CONCLUSION: Most patients with venous leg ulcers reported high PAT scores, revealing the presence of strong feelings of powerlessness. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.