Immunological imbalance in microcephalic children with congenital Zika virus syndrome.

Microcephalic children due congenital Zika virus syndrome (CZS) present neurological symptoms already well described. However, several other alterations can also be observed. Here, we aimed to evaluate the immune system of microcephaly CZS children. We showed that these patients have enlarged thymus, spleen and cervical lymph nodes, analysed by ultrasound and compared to the reference values for healthy children. In the periphery, they have an increase in eosinophil count and morphological alterations as hypersegmented neutrophils and atypical lymphocytes, even in the absence of urinary tract infections, parasitological infections or other current symptomatic infections. Microcephalic children due CZS also have high levels of IFN-γ, IL-2, IL-4, IL-5 and type I IFNs, compared to healthy controls. In addition, this population showed a deficient cellular immune memory as demonstrated by the low reactivity to the tuberculin skin test even though they had been vaccinated with BCG less than 2 years before the challenge with the PPD. Together, our data demonstrate for the first time that CZS can cause alterations in primary and secondary lymphoid organs and also alters the morphology and functionality of the immune system cells, which broadens the spectrum of CZS symptoms. This knowledge may assist the development of specific therapeutic and more efficient vaccination schemes for this population of patients.

Parasite Infections, Allergy and Asthma: A Role for Tropomyosin in Promoting Type 2 Immune Responses.

INTRODUCTION: The relationship of parasite infections and promotion or protection from allergy and asthma is controversial. Currently, over 1.5 billion people are infected with parasites worldwide, and Ascaris lumbricoides is the most frequent soil-transmitted helminth. OBJECTIVES: To evaluate the biological activity of recombinant A. lumbricoides tropomyosin and investigate IgE cross-reactive responses to tropomyosins by means of microarray methodology for the detection of sensitization to allergen components. METHODS: Forty patients 12-75 years of age (25 males) with asthma and/or rhinitis and 10 nonallergic control subjects participated in this study. All patients presented positive skin tests to cockroach extracts and underwent skin prick testing (SPT) with recombinant (r) tropomyosins rPer a 7 from Periplaneta americana and rAsc l 3 from A. lumbricoides, at 10 µg/mL. IgE to cockroach and parasite tropomyosins were measured by chimeric ELISA and ImmunoCAP-ISAC, and total IgE was quantitated by ImmunoCAP. Agreement of results was assessed by κ statistics. RESULTS: Recombinant A. lumbricoides showed biological activity, inducing positive skin tests in 50% patients with asthma and/or rhinitis. IgE to cockroach and parasite tropomyosins were detected in 55-62% of patients. There was good-to-excellent agreement of results of SPT and IgE measurements by ELISA and ImmunoCAP-ISAC, with κ indices of 0.66-0.95. No skin test reactivity or IgE antibodies to tropomyosins were found in nonallergic individuals. CONCLUSIONS: Our results suggest that IgE responses to tropomyosin from A. lumbricoides may enhance reactivity to homologous allergens upon exposure by inhalation or ingestion, promoting allergic reactions and asthma, or increasing the severity of these clinical conditions.

Blue November Campaign as an annual male self-care strategy for healthy aging.

Men ignore self-care, displaying low frequency in health services. Aging increases the prevalence of LUTS and BPE, impacting the quality of life. The objective is to understand how the advancement of age can be determinant for men's health in Natal, Brazil. Then, 503 men aged between 43 and 83 attended the Blue November Campaign of 2015. All subjects were submitted to anamnesis, clinical and laboratorial evaluation including measuring their blood pressure, waist circumference, glucose, total cholesterol, HDL-C, LDL-C, triglycerides and BMI was calculated. In addition, IPSS, PSA, IIEF-5 and DRE data were collected. The mean IPSS presented an increase with age, 43-59 years (6.28 ± 6.02) and 70-80 years or more (8.65 ± 5.80). PSA dosages increase with aging (adult group 1.63 ± 2.70), being more accentuated in the older group (4.66 ± 5.70), while the mean IIFE-5 showed a decrease with aging in 43-59 years (21.79 ± 4.67) and an important decrease at 70-80 years or more (16.24 ± 6.71). The number of DRE > 30 g showed significant growth in the older group. All presented statistical significance (p < .05) and were associated with aging. The Blue November Campaign creates an annual self-care opportunity for aging men as their health is gradually affected.

Analysis of HFE genes C282Y, H63D, and S65D in patients with hyperferritinemia from northeastern Brazil.

BACKGROUND: Hereditary hemochromatosis (HH) is a genetic disease caused by the high absorption and deposition of iron in several organs. This accumulation results in several clinical complications such as cirrhosis, arthritis, cardiopathies, diabetes, sexual disorders, and skin darkening. The H63D and C282Y mutations are well defined in the HH etiology. The objective of this article is identification of the H63D and C282Y mutations in the HFE protein gene and the frequency assessment of these mutations in patients with persistent increase of serum ferritin in patients from Natal City from state of Rio Grande do Norte, located in northeastern Brazil. RESULTS: Of the 299 patients studied for C282Y and H63D, 48.49% showed absence of mutation and 51.51% showed some sort of mutation: heterozygous C282Y mutation in 4.35% patients, homozygous C282Y mutation in 2.67% patients, heterozygous H63D mutation in 31.44% patients, homozygous H63D mutation in 8.03% patients, and heterozygous for the mutation in both genes (C282Y/H63D) in 5.02% patients. The S65C mutation was studied in 112 patients and heterozygous mutation (S65D/WT) in 2.67% of patients and double mutation (H63D/S65C) in 1.78% of patients were observed. CONCLUSION: Due to the high prevalence of hemochromatosis, its genetic diagnosis has become a challenge, especially in the high-risk group.

Ataxia-telangiectasia in Latin America: clinical features, immunodeficiency, and mortality in a multicenter study.

Ataxia-telangiectasia (AT) is a rare genetic disorder leading to neurological defects, telangiectasias, and immunodeficiency. We aimed to study the clinical and immunological features of Latin American patients with AT and analyze factors associated with mortality. Referral centers from 9 Latin American countries participated in this retrospective cohort study, and 218 patients were included. Median (IQR) ages at symptom onset and diagnosis were 1.0 (1.0-2.0)  and 5.0 (3.0-8.0) years, respectively. Most patients presented recurrent airway infections, which was significantly associated with IgA deficiency. IgA deficiency was observed in 60.8% of patients and IgG deficiency in 28.6%. T- and B-lymphopenias were also present in most cases. Mean survival was 24.2 years, and Kaplan-Meier 20-year-survival rate was 52.6%, with higher mortality associated with female gender and low IgG levels. These findings suggest that immunologic status should be investigated in all patients with AT.

Influence of age and fitness level on immune responses of T and NK cells in healthy physically active subjects after strenuous aerobic exercise: a cross-sectional study.

Aim: The aim of this study is to analyze whether immune responses after strenuous exercise are influenced by chronological age and fitness level in physically active healthy men. Methods: Cross-sectional study with a sample of 32 physically active men. Participants were divided into two groups based on chronological age (younger: age 21.8 ± 1.8 vs. older: age 34.6 ± 8.3) and subsequently regrouped and divided based on fitness level (More conditioned: excellent and superior VO2max vs. Less conditioned: VO2max: weak, regular and good). Fitness was classified according to VO2max levels obtained by a treadmill test using a gas analyzer. Before and immediately after the ergospirometry test, blood samples were collected for evaluation of immunological markers: leukocytes, neutrophils, lymphocytes and subpopulations. Results: Chronological age had a moderate effect on CD3+CD4+ lymphocyte count (effect size: 0.204) and CD4/CD8 ratio (effect size: 0.278), favoring older subjects. The level of physical fitness had no significant effect on the analyzed immunological markers. Conclusions: Immune responses observed immediately after strenuous exercise may be more dependent on chronological age than on fitness level in healthy, physically active men.

Low CCL2 and CXCL8 Production and High Prevalence of Allergies in Children with Microcephaly Due to Congenital Zika Syndrome.

Congenital Zika Syndrome (CZS) is associated with an increased risk of microcephaly in affected children. This study investigated the peripheral dysregulation of immune mediators in children with microcephaly due to CZS. Gene expression quantified by qPCR in whole blood samples showed an increase in IFNγ and IL-13 transcripts in children affected with microcephaly compared to the control group. The microcephaly group exhibited significantly decreased CCL2 and CXCL8 levels in serum, quantified by CBA assay. An allergic profile questionnaire revealed a high prevalence of allergies in the microcephaly group. In accordance, elevated serum IgE level measured by the Proquantum Immunoassay was observed in children affected with microcephaly compared to the control group. Altogether, these findings show a persistent systemic inflammation in children with microcephaly due to CZS and suggest a possible impairment in leukocyte migration caused by low production of CCL2 and CXCL8, in addition to high levels of IgE associated with high prevalence of allergies. The dysregulation of inflammatory genes and chemokines underscores the importance of understanding the immunological characteristics of CZS. Further investigation into the long-term consequences of systemic inflammation in these children is crucial for developing appropriate therapeutic strategies and tailored vaccination protocols.

Flow cytometry immunophenotyping evaluation in acute lymphoblastic leukemia: correlation to factors affecting clinic outcome.

The authors conducted a flow cytometry immunophenotyping study in patients with acute lymphoblastic leukemia (ALL) from Natal, Rio Grande do Norte, Brazil. The patients (n = 126) were newly diagnosed using a panel of monoclonal antibodies: CD1a, CD2, CD3, CD4, CD7, CD8, CD10, CD13, CD33, CD14, CD19, CD22, CD79a, CD117, CD34, anti-IgM, anti-TdT, anti-HLA-Dr, and anti-human kappa and lambda light chains. Additional data, such as patients' age and gender, clinical and laboratory findings such as presence of tumor masses, lymphadenopathy, hepatomegaly, splenomegaly, leukemic infiltration in the central nervous system (CNS) were also investigated. Results showed that 56.7% of the cases were B-lineage ALL and 55% were T-cell ALL. Also, we found that males were more affected by the disease, regardless of immunological classification. The correlation between age and immunological subtypes showed that the B-lineage ALL occurred more frequently in patients aged under 15 while the T-cell ALL subtype was more frequent in adults. Immunophenotypic profiles and morphological subtypes showed a direct correlation between L3 subtype and B-lineage ALL, while L1 and L2 subtypes correlated more often with B-cell lineage and T-cell ALL, respectively. Correlation analysis between immunophenotypic and clinical profiles showed that T-cell ALL was more associated with a higher incidence of lymphadenopathy, hepatomegaly, splenomegaly and CNS leukemic infiltration, also showing a greater blast cell count in peripheral blood than the other subgroups. The presented data suggest that immunophenotyping is an important method in the diagnosis, monitoring and prognostic assessment in determining the pathological mechanisms of evolution of ALL.

Effects of purified Saccharomyces cerevisiae (1→3)-ß-glucan on venous ulcer healing.

Water-insoluble glucan was isolated from the baker's yeast Saccharomyces cerevisiae. The yeast cells were treated with alkali and the residue then with acid. Chemical and NMR (1D and 2D) analyses showed that a linear (1→3)-ß-glucan was purified that was not contaminated with other carbohydrates, proteins or phenolic compounds. The effects of the glucan on wound healing were assessed in human venous ulcers by histopathological analysis after 30 days of topical treatment. (1→3)-ß-glucan enhanced ulcer healing and increased epithelial hyperplasia, as well as increased inflammatory cells, angiogenesis and fibroblast proliferation. In one patient who had an ulcer that would not heal for over 15 years, glucan treatment caused a 67.8% decrease in the area of the ulcer. This is the first study to investigate the effects of (1→3)-ß-glucan on venous ulcer healing in humans; our findings suggest that this glucan is a potential natural biological response modifier in wound healing.

Breathing pattern and muscle activity using different inspiratory resistance devices in children with mouth breathing syndrome.

Aim: The aim of this study was to evaluate the acute effects of different inspiratory resistance devices and intensity of loads via nasal airway on the breathing pattern and activity of respiratory muscles in children with mouth breathing syndrome (MBS). Methods: Children with MBS were randomised into two groups based on inspiratory load intensity (20% and 40% of the maximal inspiratory pressure). These subjects were assessed during quiet breathing, breathing against inspiratory load via nasal airway and recovery. The measurements were repeated using two different devices (pressure threshold and flow resistance). Chest wall volumes and respiratory muscle activity were evaluated by optoelectronic plethysmography and surface electromyography, respectively. Results: During the application of inspiratory load, there was a significant reduction in respiratory rate (p<0.04) and an increase in inspiratory time (p<0.02), total time of respiratory cycle (p<0.02), minute ventilation (p<0.03), tidal volume (p<0.01) and scalene and sternocleidomastoid muscles activity (root mean square values, p<0.01) when compared to quiet spontaneous breathing and recovery, regardless of load level or device applied. The application of inspiratory load using the flow resistance device showed an increase in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02). Conclusion: For both devices, the addition of inspiratory loads using a nasal interface had a positive effect on the breathing pattern. However, the flow resistance device was more effective in generating volume and, therefore, has advantages compared to pressure threshold.

Good clinical practice recommendations in allergen immunotherapy: Position paper of the Brazilian Association of Allergy and Immunology - ASBAI.

Background: Allergen Immunotherapy (AIT) represents one of the pillars in the treatment of allergic diseases. AIT is the only therapeutic strategy with curative potential, promoting the reduction of drug use and long-term symptom control even after the end of the treatment. The European Academy of Allergy, Asthma and Immunology (EAACI) guidelines, position papers of World Allergy Organization (WAO), and the US Practice Parameters are the leading official documents that set scientific standard for the use of AIT in the world. The use of AIT in Brazil has specific regional conditions due to the pattern of allergen sensitization, as well as genetic, socioeconomic, and cultural characteristics, climate conditions, and the availability of allergenic extracts. The most prevalent house dust mites are Dermatophagoides pteronyssinus, Dermatophagoides farinae and their allergens have the highest clinical relevance. Blomia tropicalis is also very frequent. This position paper has been prepared by the Brazilian Association of Allergy and Clinical Immunology (ASBAI) Taskforce on AIT for respiratory allergy and Hymenoptera venom allergy. Objective: According to the current scientific literature adapted to the Brazilian reality, this position paper aims to establish the main recommendations for the good clinical practice parameters for AIT in Brazil. Methods: A systematic review using the Pub Med and Cochrane databases was performed, and the websites of major allergy and immunology organizations were consulted. The research was limited to English language literature and was conducted between March 30, 2002, and March 30, 2022. The terms used for the research were: Allergen Immunotherapy, sublingual immunotherapy (SLIT), subcutaneous immunotherapy (SCIT), venom-specific immunotherapy (VIT), and allergen extract. Results: The several recommendations that establish the clinical practices for AIT recommended by the main Allergy, Asthma and Immunology world organizations were analyzed and adapted to the Brazilian situation. Conclusion: This position paper establishes the main recommendations for the effective clinical practice of AIT in Brazil, using current knowledge of evidence-based medicine and precision medicine.

Effects of Inspiratory Load on Chest Wall Kinematics, Breathing Pattern, and Respiratory Muscle Activity of Mouth-Breathing Children.

BACKGROUND: We sought to evaluate the acute effects of different inspiratory loads using nasal and oral interfaces on the volumes of the chest wall and its compartments, breathing pattern, and respiratory muscle activation in children with mouth-breathing syndrome. METHODS: Children with mouth-breathing syndrome were randomized into 2 groups, one with an inspiratory load intensity 20% of maximum inspiratory pressure (n = 14), and the other with an inspiratory load intensity 40% of maximum inspiratory pressure (n = 15). The chest wall volumes and electromyography of sternocleidomastoid, rectus abdominis, scalene, and internal intercostal muscles were used to analyze respiration against the 2 load intensities and using 2 interfaces (ie, nasal and oral). RESULTS: A total of 72 children with mouth-breathing syndrome were recruited, and 29 were evaluated in this study. The use of inspiratory load promoted improvement in the components of the breathing pattern: breathing frequency (P = .039), inspiratory time (P = .03), and total respiratory time (P = .043); and increases in tidal volume (P < .001), end-inspiratory volume (P < .001), and electrical activity of scalene muscles and sternocleidomastoid muscles (P < .001) when compared to quiet breathing. The load imposed via a nasal interface versus an oral interface provided an increase in tidal volume (P = .030), end-inspiratory volume (P = .02), and electrical activity of scalene muscles (P < .001) and sternocleidomastoid muscles (P = .02). CONCLUSIONS: The use of acute inspiratory loads improved the breathing pattern and increased lung volume and electrical activity of inspiratory muscles. This work brings new perspective to the investigation of using nasal interfaces during the application of inspiratory loads. The nasal interface was more effective compared to the oral interface commonly used in clinical practice.

Prosopis juliflora as a new cosmetic ingredient: Development and clinical evaluation of a bioactive moisturizing and anti-aging innovative solid core.

Prosopis juliflora is an invasive plant distributed throughout the world and presents metabolites of interest for cosmetology. The aim of this work was to develop a new polysaccharide-based ingredient from P. juliflora and analyze its application in a solid core formulation that upon contact with water instantly forms a gel to improve moisturizing and anti-aging skin properties. Purified extracts by gel chromatography were characterized by NMR and LC-DAD-MS-MS. The in vitro and in vivo safety, antioxidant activity, formulation development and clinical evaluation were performed. The extract was characterized as containing an α-glucan and phenolics. It was non-cytotoxic, non-phototoxic and no skin reactions were observed in vivo. Antioxidant activity were present through different mechanisms. Clinical evaluation reinforced the potential of P. juliflora in skin hydration and microrelief improvement. This innovative form proved to be a prototype of a new product and the first study of an α-glucan as a cosmetic ingredient.

P-glycoprotein and multidrug resistance-associated protein-1 expression in acute myeloid leukemia: Biological and prognosis implications.

BACKGROUND: Despite the advances in the cure rate for acute myeloid leukemia (AML), a considerable number of patients die from the disease due to the occurrence of multidrug resistance (MDR). Overexpression of the transporter proteins, such as P-glycoprotein (Pgp) and multidrug resistance-associated protein (MRP), confers resistance to the treatment of these leukemias. METHODS: To analyze the expression of the Pgp and MRP1 in patients with AML and determine their correlation between expression and demographic, clinical, and laboratorial variables, bone marrow and peripheral blood samples from 346 patients with a diagnosis of AML were assessed for the expression of Pgp and MRP1 by flow cytometry. RESULTS: The expression of Pgp and MRP1 was found in 111 (32.1%) and 133 (38.4%) patients, respectively, with greater prevalence in older patients and lower in children, while also observing a high incidence in patients with refractory, recurrence, and secondary disease in comparison with the cases of de novo AML. Regarding the laboratory findings, we observed an association between the expression of Pgp and MRP1 and CD34, CD7, and also M7, M5a, and M2-AML of French-American-British classification. CONCLUSIONS: The results showed that the detection of MDR phenotype by flow cytometry can be a molecular marker for prognosis of patients with AML.

Cross-reactive IgE antibody responses to tropomyosins from Ascaris lumbricoides and cockroach.

BACKGROUND: Evidence indicates that infection with Ascaris lumbricoides may promote development of allergy and asthma. OBJECTIVE: To study the role of tropomyosin, a pan-allergen in invertebrates, in IgE responses to A lumbricoides. METHODS: Recombinant A lumbricoides and Periplaneta americana tropomyosins were expressed in Pichia pastoris. Levels of IgE to tropomyosins from A lumbricoides and P americana were determined by chimeric ELISA in sera from 119 children living in a parasite-endemic area and 112 patients with cockroach allergy from the allergy clinics. Presence of tropomyosin in A lumbricoides larvae at L3 stage was evaluated by immunofluorescence using mAb 1A6, directed against mite tropomyosin. Molecular modeling of P americana and A lumbricoides tropomyosins was performed by using the MODELLER program. RESULTS: A lumbricoides tropomyosin showed 69% to 98% sequence identity to tropomyosins from other invertebrates. The predicted structure of A lumbricoides tropomyosin was similar to that of P americana tropomyosin and showed the characteristic coiled-coil structure. Strong correlation was found for IgE antibodies to tropomyosins from A lumbricoides and P americana in sera from children living in a parasite-endemic area and from patients with cockroach allergy. Larvae of A lumbricoides reacted strongly with mAb 1A6. CONCLUSION: Tropomyosin induces IgE responses in A lumbricoides-infected children and in patients allergic to cockroach.

Prevalence of the metabolic syndrome according to different criteria in the male population during the Blue November Campaign in Natal, RN, Northeastern Brazil.

BACKGROUND: Metabolic syndrome (MetS) is an aggregation of risk factors associated with increased incidence of cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality. Information on MetS prevalence is scarce in the northeast region, Brazil. This study aims to estimate the prevalence of MetS according to different diagnostic criteria in a community sample of men during the November Blue Campaign living in the metropolitan area of Natal, Rio Grande do Norte, Brazil. METHODS: This is a cross-sectional study on 500 men aged 40 years or older invited by the Blue November Campaign of 2015, an awareness program aimed at the prevention of male diseases. The evaluation included blood pressure, anthropometric measurements (weight, height, and waist circumference), fasting blood glucose, and blood lipid profile. The diagnosis of MetS was made according to the criteria of International Diabetes Federation (IDF)/American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI), IDF, and National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATPIII). RESULTS: The prevalence was high by considering the following three criteria: IDF/AHA/NHLBI (66.8%), IDF (60.0%), and NCEP-ATPIII (46.4%). Concordance between diagnostic criteria measured by the kappa statistic (k) was excellent between IDF/AHA/NHLBI and IDF (k=0.85, P<0.0001) and moderate between IDF/AHA/NHLBI and NCEP-ATPIII (k=0.59) and IDF and NCEP-ATPIII (k=0.54). CONCLUSION: Prevalence of MetS in the male population was high using the three diagnostic criteria. IDF/AHA/NHLBI and IDF criteria have a high level of agreement, but NCEP-ATPIII criteria identify a lower number of MetS cases.

Conhecimentos e práticas sobre telemedicina entre alergistas e imunologistas brasileiros / Telemedicine knowledge and practices among Brazilian allergists and immunologists

Introdução: O objetivo deste estudo foi avaliar as características das práticas de telemedicina (TM) entre médicos alergistas/ imunologistas (A/I) brasileiros e avaliar seu conhecimento sobre as recomendações regulatórias. Métodos: Uma pesquisa eletrônica autorreferida foi enviada por e-mail uma vez por semana entre agosto e outubro/2021 a 2.600 médicos A/I brasileiros. Resultados: 205 (7,9%) participantes preencheram os formulários. 143 (70,2%) médicos usaram TM em sua prática clínica, e 184 (89,9%) nunca o usaram antes da pandemia de COVID-19. Dentre os médicos, 192 (93,8%) utilizaram a TM para consultas de acompanhamento, 186 (91%) para verificação de exames complementares e 136 (66,7%) nas primeiras consultas. Cento e quarenta e três médicos A/I (70,2%) sentiram-se seguros em seu diagnóstico por meio da TM, e 7 (3,5%) responderam que não conseguiram encontrar um diagnóstico correto usando a TM. Os principais benefícios da TM relatados foram: maior acessibilidade, principalmente em áreas mais distantes 159 (77,6%), redução dos custos de deslocamento 158 (77,1%) e segurança quanto à transmissão do COVID-19 145 (71,2%). Por outro lado, algumas desvantagens da TM foram listadas pelos participantes: ausência de exame físico 183 (89,7%), relação médico-paciente fragilizada 59 (28,8%) e problemas de Internet 45 (22%). Em relação ao campo jurídico/ético, 105 (51,4%) dos especialistas aplicaram o termo de consentimento e 34 (16,7%) registraram a teleconsulta, ambas as etapas exigidas em uma consulta de TM, conforme recomendações regulatórias locais. Além disso, plataformas online inadequadas para TM, como aplicativos de mídia social e programas de reuniões online não específicos, foram relatadas como sendo usadas por 131 (64,1%) dos participantes. Oitenta (40%) não leram as declarações e recomendações oficiais que regulamentam a prática da TM no Brasil. Conclusões: Observouse um uso crescente de TM no Brasil, influenciado principalmente pela pandemia de COVID-19. Apesar de ser ferramenta útil na pandemia, com vantagens e desvantagens, há necessidade de conhecer as recomendações regulatórias.

Introduction: The aim of this study was to evaluate the characteristics of telemedicine (TM) practices among Brazilian allergists/immunologists (A/I) and to assess their knowledge of regulatory recommendations. Methods: A self-report electronic survey was sent by email once a week between August and October 2021 to 2,600 Brazilian A/I physicians. Results: A total of 205 (7.9%) participants completed the survey. TM was used in clinical practice by 143 (70.2%) physicians, and 184 (89.9%) had never used it before the COVID-19 pandemic. Among participants, 192 (93.8%) used TM for follow-up consultations, 186 (91%) for checking complementary exams, and 136 (66.7%) for first consultations. The number of A/I physicians (70.2%) that felt confident in their diagnosis using TM was 143, and 7 (3.5%) reported that they could not reach the correct diagnosis using TM. Participants reported that the main benefits of TM were greater accessibility, especially in more distant areas (159, 77.6%), reduced travel costs (158, 77.1%), and safety regarding the transmission of COVID-19 (145, 71.2%). Conversely, the lack of physical examination (183, 89.7%), poor doctor-patient relationship (59, 28.8%), and internet connection problems (45, 22%) were mentioned as disadvantages. Regarding legal/ethical aspects, 105 (51.4%) physicians reported applying a consent form and 34 (16.7%) reported making a record of the teleconsultation, both of which are required for TM consultations, according to local regulatory recommendations. The use of inappropriate online platforms for TM, such as social media applications and nonspecific online meeting programs, was reported by 131 (64.1%) participants. Eighty (40%) participants did not read the official statements and recommendations that regulate the practice of TM in Brazil. Conclusions: An increasing use of TM was observed in Brazil, mainly influenced by the COVID-19 pandemic. Despite being a useful tool in the pandemic, with advantages and disadvantages, physicians should have knowledge of regulatory recommendations.

Glucan and glutamine reduce bacterial translocation in rats subjected to intestinal ischemia-reperfusion.

Intestinal ischemia/reperfusion (I/R) may induce bacterial translocation (BT). Glutamine (GLN)-enriched nutrition decreases BT. However, little is known about the effect of glucan (GL) in BT. This study investigated the combined effect of GL/GLN on BT, intestinal damage, and portal blood cytokines in animals under I/R. Four groups of 10 rats each were subjected to 60 min of intestinal ischemia and 120 min of reperfusion. The control group (group 1) received only rat food/water, group 2 received glutamine via gavage, group 3 received subcutaneuos soluble (1, 3)-d-glucan, and group 4 received GL + GLN. A sham group (group 5) served as a normal control. Bacterial cultures of ileum, mesenteric lymph nodes (MLN), liver and lung biopsies, histological changes of ileum, and serum cytokines variables were examined after I/R. Data were analyzed by analysis of variance (ANOVA) and the Newman-Keuls test. Results showed that GLN, GL, and GL/GLN significantly reduced BT to MLN, liver, and lung. BT was more attenuated after GL treatment than GLN (P < .05). Rats treated with both GL and GLN exhibited lower bacterial colony counts than the ones treated only with GLN or GL. Severe mucosal damage on histological findings was shown in group 1, but these findings were significantly ameliorated (P < .05) in groups 3 and 4. Tumor necrosis factor (TNF)-a and interleukin (IL)-6 levels in portal serum were significantly reduced and IL-10 was increased by GL and GLN treatment. In conclusion, the use of GL was more effective than GLN in reducing BT, intestinal damage, and cytokine levels after I/R. Additionally, the combination of GL and GLN improved results.

[Nutritional evaluation of children with enteroparasitosis]. / Avaliação nutricional em crianças com infecções por enteroparasitas.

PURPOSE: To evaluate the nutritious state in children of low social-economic class in order to look over a possible corelationship among this status and the infections caused by enteroparasites. METHODS: 103 children were submitted to a nutritions evolution and to accomplish a exam of serial samples. The method employed searched protozoan cystos, helmints eggs and larvae and it counted helmint eggs when presented through 4 different methods of diagnosis. RESULTS: The results obtained show that the poor environmental and social-economic conditions helped create a high infectious frequency caused by enteroparasites, mainly by Trichuris trichiura and Ascaris lumbricoides, among the helminthes, and Endolimax nana and Giardia lamblia, among the protozoans. light malnutrition without protein deficit was found in 93.55% and moderate malnutrition in 6.45% of the children malnutrition (30.7%). CONCLUSION: Then, it is possible to suggest that children besides bearing many parasitosis were not weth their nutritional state deeply compromised.

[Total and specific IgA in colostrum and milk of mothers of Natal-Rio Grande do Norte, Brasil]. / IgA secretora total e específica no colostro e leite de mães da cidade do Natal-Rio Grande do Norte, Brasil.

PURPOSE: To determine the concentration of total secretory IgA and evaluate the repertoire of IgA antibodies to enteropathogenic Escherichia coli and Shigella flexneri antigens in colostrums and milk from mothers in Natal, RN. METHODS: The sample was constituted by 22 healthy clinically women whose babies were born at public hospital in Natal, RN. To determine total secretory IgA a radial immunedifusion tecnique (Mancini et al, 1965), was employed and to detect specific antibodies, immuneenzimatic assays, ELISA was used. RESULTS: The median values of total secretory IgA concentration presented individual variations with high levels in colostrums samples, decreasing during lactation, it was observed a p < 0.001 among the samples from the first day of lactation, to the thirtieth for total IgA concentration. All the donators present in colostrum and milk specific antibodies to Escherichia coli enteropathogenic (EPEC) and Shigella flexneri with titles higer in colostrum. There was parallel and directional pattern between total IgA and IgA anti-EPEC and Shegella flexneri, during period. CONCLUSION: The concentrations of total SIgA and specific antibodies to enteropathogenic Escherichia coli and Shigella flexneri in colostrums and milk in our study do not differ from others accomplished among populations with the same social and econimic features, stressing the importance of human milk as a protector agent against pathogens.