RESUMO
In this investigation, machine-enhanced techniques were applied to bring about scientific insights to identify a minimum set of phenotypic/functional memory-related biomarkers for post-vaccination follow-up upon yellow fever (YF) vaccination. For this purpose, memory status of circulating T-cells (Naïve/early-effector/Central-Memory/Effector-Memory) and B-cells (Naïve/non-Classical-Memory/Classical-Memory) along with the cytokine profile (IFN/TNF/IL-5/IL-10) were monitored before-NV(day0) and at distinct time-points after 17DD-YF primary vaccination-PV(day30-45); PV(year1-9) and PV(year10-11). A set of biomarkers (eEfCD4; EMCD4; CMCD19; EMCD8; IFNCD4; IL-5CD8; TNFCD4; IFNCD8; TNFCD8; IL-5CD19; IL-5CD4) were observed in PV(day30-45), but not in NV(day0), with most of them still observed in PV(year1-9). Deficiencies of phenotypic/functional biomarkers were observed in NV(day0), while total lack of memory-related attributes was observed in PV(year10-11), regardless of the age at primary vaccination. Venn-diagram analysis pre-selected 10 attributes (eEfCD4, EMCD4, CMCD19, EMCD8, IFNCD4, IL-5CD8, TNFCD4, IFNCD8, TNFCD8 and IL-5CD4), of which the overall mean presented moderate accuracy to discriminate PV(day30-45)&PV(year1-9) from NV(day0)&PV(year10-11). Multi-parameter approaches and decision-tree algorithms defined the EMCD8 and IL-5CD4 attributes as the top-two predictors with moderated performance. Together with the PRNT titers, the top-two biomarkers led to a resultant memory status observed in 80% and 51% of volunteers in PV(day30-45) and PV(year1-9), contrasting with 0% and 29% found in NV(day0) and PV(year10-11), respectively. The deficiency of memory-related attributes observed at PV(year10-11) underscores the conspicuous time-dependent decrease of resultant memory following17DD-YF primary vaccination that could be useful to monitor potential correlates of protection in areas under risk of YF transmission.
Assuntos
Anticorpos Antivirais/sangue , Biomarcadores/sangue , Vacinação , Vacina contra Febre Amarela/imunologia , Febre Amarela/prevenção & controle , Vírus da Febre Amarela/imunologia , Adolescente , Adulto , Idoso , Linfócitos B/imunologia , Linfócitos T CD8-Positivos/imunologia , Citocinas/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Febre Amarela/imunologia , Febre Amarela/virologia , Adulto JovemRESUMO
Colecistite aguda é uma complicaçäo em 96% dos casos, cabendo os 4% restantes a várias causas infreqüentes como tumor, gânglio, brida, aderência, arterite, fatores metabólicos, infecçäo, Ascaris lumbricoides e outras. Colecistite aguda é uma doença mecânica originada pela oclusäo do canal cístico ou do colo da vesícula biliar por cálculo, na maioria das vezes. Näo é uma doença infecciosa. Quando a infecçäo surge, é em caráter secundário e infreqüentemente isto acontece antes de 48 horas de evoluçäo da crise, mas quatro dias ou mais após. Por isso, nem tem indicaçäo o uso de antibiótico nas fases iniciais da afecçäo, a näo ser em debilitados e diabéticos