Electric hand warmer versus observation to avoid discomfort during scalp cooling for chemotherapy-induced alopecia prevention: a randomized study.

Chemotherapy-induced alopecia (CIA) is a challenge in the management of cancer patients. Scalp cooling (SC) leads to reduction in CIA, however it is associated with significant adverse events, leading to 3-13% discontinuation rates. This pilot study evaluated the role of Electric Hand Warmers (EHW) on thermal (TC), sensorial (SCo) and general comfort (GC) in patients with breast cancer (BC) undergoing chemotherapy and SC to reduce CIA. Patients were randomly assigned to EHW use or observation. TC, SCo and GC were evaluated after each chemotherapy infusion. Favorable outcomes in both TC and SCo defined a positive result on GC. We analysed the impact of age, alopecia, chemotherapy regimen and EHW use in the different comfort scales using a Logistic Regression (LR) model. Forty women with early breast cancer were randomly assigned to EHW (n = 20) or observation (n = 20) during neo(adjuvant) chemotherapy. Median age was 53 years. In the EHW arm, favorable thermal response was reported by 79% versus 50% in the control arm (odds ratio [OR] 3.79, p < 0.001). SCo was satisfactory in 82% in the EHW arm versus 74% in the control arm (OR 1.62, p = 0.1). Overall, 73% in the EHW arm had favorable GC versus 44% in the control arm (OR 3.4, p < 0.001). Age, alopecia, and chemotherapy regimen did not impact on comfort measures. Conclusion: Our study suggests that the use of an EHW has a consistent favorable impact on TC and GC of BC patients under SC technology to prevent CIA.

Cost Evaluation Analysis of Genetic Testing and Tailored Adjuvant Imatinib in Patients With Resected High-Risk GI Stromal Tumors: The Brazilian Perspective.

PURPOSE: Mutations of the KIT gene are the molecular hallmark of most GI stromal tumors (GISTs). Imatinib has revolutionized GIST treatment. Adjuvant imatinib for 3 years is the standard of care for high-risk resected GIST. However, the GIST molecular biologic profile has found different responses to this approach. Despite this, genetic testing at diagnosis is not a routine and empirical adjuvant imatinib remains the rule. Barriers to genetic profiling include concerns about the cost and utility of testing. This analysis aims to determine whether targeted genetic testing reduces costs as an ancillary tool for a limited-resource scenario instead of adjuvant empirical imatinib in patients with resected high-risk GIST. METHODS: The cost evaluation analysis of molecular testing for GIST was based on the Cost of Preventing an Event (COPE), considering the Number Needed to Treat and the costs of each test compared with the cost of 3-year empirical adjuvant imatinib and real treatment costs (median number of cycles) from the public and private Brazilian Healthcare System's perspective. The analysis compared the costs of the molecular tests (broad next-generation sequencing [NGS], GS Infinity DNA/RNA assay, and targeted NGS: GS Focus GIST and the Fleury GIST Tumor DNA sequencing panel), costs of drug acquisition, considering discounts (imatinib mesylate and Glivec), and the costs of supportive care. RESULTS: In both scenarios, public and private, regardless of the use of imatinib or Glivec, tailoring adjuvant treatment reduced costs, irrespective of the number of cycles. The only exception was the combination of the broad NGS test and imatinib in the Public Healthcare System. CONCLUSION: The molecularly tailored adjuvant imatinib reduced costs considering the COPE of available NGS tests for both the public and private Brazilian health care systems.

BRAF, TERT and HLA-G Status in the Papillary Thyroid Carcinoma: A Clinicopathological Association Study.

As BRAF, TERT, HLA-G, and microRNAs have been individually associated with papillary thyroid carcinoma (PTC), we aimed to evaluate the individual and collaborative role of these markers in PTC in the same patient cohort. HLA-G and BRAF tumor expression was evaluated by immunohistochemistry. Using molecular methods, BRAFV600E and TERT promoter mutations were evaluated in thyroid fine needle aspirates. MicroRNA tumor profiling was investigated using massively parallel sequencing. We observed strong HLA-G (67.96%) while BRAF (62.43%) staining was observed in PTC specimens. BRAF overexpression was associated with poor response to therapy. The BRAFV600E (52.9%) and TERTC228T (13%) mutations were associated with extrathyroidal extension, advanced-age, and advanced-stage cancer. The TERT rs2853669 CC+TC genotypes (38%) were overrepresented in metastatic tumors. Nine modulated microRNAs targeting the BRAF, TERT, and/or HLA-G genes were observed in PTC and involved with cancer-related signaling pathways. The markers were individually associated with PTC features, emphasizing the synergistic effect of BRAFV600E and TERTC228T; however, their collaborative role on PTC outcome was not fully demonstrated. The differentially expressed miRNAs targeting the BRAF and/or HLA-G genes may explain their increased expression in the tumor milieu.

Chagas cardiomyopathy is associated with a high susceptibility to T. cruzi infection in monocyte-derived macrophages and a predominance of CD4+CD45RO+ T-cells with immunoregulatory patterns.

The pathogenesis of Chronic Chagas Cardiomyopathy (CCC) is still not fully understood, and the persistence of the parasite in tissues seems to be essential for the onset and progression of heart disease, tissue destruction, and chronic inflammation. It is clear that the polarity found between the asymptomatic (IND) and cardiac clinical forms refers mainly to the mechanisms involved in the regulation of the host's immune response. Thus, to elucidate aspects of the susceptibility of host phagocytes to T. cruzi infection, the present study explored novel aspects of innate immune response, integrating data on susceptibility to infection and intracellular replication, using monocyte-derived macrophages from CCC patients, together with memory CD4+ T-cells (CD45RO+). The isolation of PBMC was conducted by means of in vitro infection assay with T. cruzi trypomastigotes and flow cytometry analysis of the intracytoplasmic cytokine production by CD4+T-cells. Our findings indicated that monocytes derived from individuals with CCC are more susceptible to the infection and replication of intracellular amastigotes. Moreover, the stimulation of CD4+ T-cells from CCC patients, together with T. cruzi trypomastigotes, induces a predominance of a regulatory response over a type 1 response, demonstrated by an increase in IL-10 production and a reduction in the IFN-γ and IFN-γ/IL-10. Suppression of the function of monocyte-derived macrophages, from CCC patients, to control trypomastigote infection and intracellular replication sheds light on a potential susceptibility of these cells isolated from peripheral blood, which may reflect the ineffectiveness of parasite control by phagocytes in cardiac tissues, which can subsequently result in serious heart disease.

Barriers in precision medicine implementation among Advanced Nonsquamous Cell Lung Cancer-patients: A Real-World Evidence Scenario.

Background: Precision oncology has a prominent role in nonsquamous non-small cell lung cancer (nsNSCLC) treatment progress; however, its access in a real-world scenario might be limited. Objective: To investigate the time spent in nsNSCLC molecular profile evaluation and its influence on clinical decisions. Methods: nsNSCLC patients who underwent molecular testing in a private referral Brazilian center between November 2015 and February 2020 were identified. The interval from nsNSCLC diagnosis to the characterization of the molecular profile was determined. Other outcomes, focusing on the biomarker tissue journey, were also assessed. Results: In this cohort (n = 78), the median time between the advanced nsNSCLC diagnosis and biomarker characterization was 40.5 days (range, 29.5-68.5). The median interval between the diagnosis and the test request was longer than the interval between the request and the results (respectively 29.0 versus 12.0 days; p < 0.001). At the treatment initiation, 51% (36/71) of the patients who received any systemic therapy did not have their driver mutations panel results available. But on these, 42% (15/36) had a targetable alteration identified later on. Among patients harboring a targetable alteration, only 46% (n = 13/28) received a tyrosine kinase inhibitor (TKI) as first-line therapy. The median time to the TKI initiation was even longer than the median time to all treatment initiation (92.0 versus 40.0 days). Conclusions: Our data show a long median time from advanced nsNSCLC diagnosis and the availability of the biomarker testing in medical practice, which impacted the choice of a non-personalized therapy as the first-line.

Impact of the COVID-19 Pandemic on Cancer Staging: An Analysis of Patients With Breast Cancer From a Community Practice in Brazil.

PURPOSE: A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. METHODS: We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. RESULTS: We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor-positive/human epidermal growth factor receptor 2-negative and human epidermal growth factor receptor 2-positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. CONCLUSION: We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.

Fluorouracil Bolus Use in Infusional Regimens Among Oncologists-A Survey by Brazilian Group of Gastrointestinal Tumors.

PURPOSE: The utility of administering fluorouracil (5-FU) in bolus in regimens of infusional 5-FU has been questioned. We aimed to quantify the use of 5-FU bolus in infusional regimens for gastrointestinal malignancies among Brazilian oncologists. METHODS: This was a cross-sectional electronic survey composed of eight multiple-choice questions sent to Brazilian oncologists during 14 days in February 2021. The survey instrument collected demographic data of participants and assessed practices in terms of 5-FU bolus use. We evaluated the association of demographic variables and 5-FU prescribing patterns with Fisher's exact test (odds ratio [OR]). RESULTS: The survey was completed by 332 medical oncologists. Overall, 37% were experienced oncologists and 32% were gastrointestinal specialists. In the first-line metastatic and in the adjuvant settings, 40% and 67% of oncologists always prescribe 5-FU bolus in infusional regimens, respectively. Experienced oncologists more frequently omit 5-FU bolus when compared with early-career oncologists, both in the metastatic (41% v 26%; OR, 1.98; P = .005) and adjuvant settings (28% v 14%; OR, 2.32; P = .003). In addition, more GI specialists remove 5-FU bolus when compared with generalists, but only in the metastatic setting (44% v 25%; OR, 2.33; P = .001). GI specialists are more likely to consider that treatment efficacy is not affected by 5-FU bolus withdrawal than are generalists (89% v 75%; OR, 2.65; P = .003). Most respondents (67%) keep leucovorin at the same doses when omitting 5-FU bolus, and only 16% always recommend dihydropyrimidine dehydrogenase testing. CONCLUSION: Our survey indicates that experience in oncology practice and percentage of time dedicated to treat GI cancers influence the prescription of 5-FU bolus in Brazil, with more frequent omission of it among experienced gastrointestinal specialists, particularly in the metastatic setting.

Increased PD-1 Level in Severe Cervical Injury Is Associated With the Rare Programmed Cell Death 1 (PDCD1) rs36084323 A Allele in a Dominant Model.

The high-risk oncogenic human papillomavirus (HPV) has developed mechanisms for evasion of the immune system, favoring the persistence of the infection. The chronic inflammation further contributes to the progression of tissue injury to cervical cancer. The programmed cell death protein (PD-1) after contacting with its ligands (PD-L1 and PD-L2) exerts an inhibitory effect on the cellular immune response, maintaining the balance between activation, tolerance, and immune cell-dependent lesion. We evaluated 295 patients exhibiting or not HPV infection, stratified according to the location (injured and adjacent non-injured areas) and severity of the lesion (benign, pre-malignant lesions). Additionally, we investigated the role of the promoter region PDCD1 -606G>A polymorphism (rs36084323) on the studied variables. PD-1 and PDCD1 expression were evaluated by immunohistochemistry and qPCR, respectively, and the PDCD1 polymorphism was evaluated by nucleotide sequencing. Irrespective of the severity of the lesion, PD-1 levels were increased compared to adjacent uninjured areas. Additionally, in cervical intraepithelial neoplasia (CIN) I, the presence of HPV was associated with increased (P = 0.0649), whereas in CIN III was associated with decreased (P = 0.0148) PD-1 levels, compared to the uninjured area in absence of HPV infection. The PDCD1 -606A allele was rare in our population (8.7%) and was not associated with the risk for development of HPV infection, cytological and histological features, and aneuploidy. In contrast, irrespective of the severity of the lesion, patients exhibiting the mutant PDCD1 -606A allele at single or double doses exhibited increased protein and gene expression when compared to the PDCD1 -606GG wild type genotype. Besides, the presence of HPV was associated with the decrease in PDCD1 expression and PD-1 levels in carriers of the -606 A allele presenting severe lesions, suggesting that other mediators induced during the HPV infection progression may play an additional role. This study showed that increased PD-1 levels are influenced by the -606G>A nucleotide variation, particularly in low-grade lesions, in which the A allele favors increased PDCD1 expression, contributing to HPV immune system evasion, and in the high-grade lesion, by decreasing tissue PD-1 levels.

Haematological and immunophenotypic evaluation of peripheral blood cells of cattle naturally infected with bovine papillomavirus.

Papillomaviruses are among the most widespread animal viruses, with many hosts harbouring multiple virus types. The present study aimed to evaluate the haematological and immunophenotypic profile of cattle infected with bovine papillomavirus (BPV). Blood samples were collected from 10 animals with clinical cutaneous BPV and without clinical papillomatosis (control). Haematological analysis demonstrated a significant reduction in haemoglobin and haematocrit for BPV-infected animals. The results also showed an increase of natural killer cells and a decrease of γδ+ T-cells and the CD4+/CD8+ ratio for the BPV group when compared to the control group. The infection was also found to stimulate a pro-inflammatory profile with the participation of CD8+T cells producing elevated IFN-γ and IL-17. These findings, although preliminary, provide a better understanding of the immune response of cattle infected with BPV.

MicroRNA expression profiles discriminate childhood T- from B-acute lymphoblastic leukemia.

MicroRNAs (miRNAs) play a critical role on biological and cellular processes; the search for functional markers may be of importance for differential diagnosis, prognosis, and development of new therapeutic regimens. In this context, we evaluated the bone marrow miRNA profile of Brazilian children exhibiting T- or B-cell acute lymphoblastic leukemia (T-ALL or B-ALL), using massive parallel sequencing, using the HiSeq 2500 platform (Illumina). The differential expression analysis was conducted considering a leave-one-out approach and FDR ≤ 0.05. Machine learning algorithms were applied to search for the disease subset biomarkers. Target prediction, functional enrichment, and classification of biological categories were also performed. Sixteen miRNAs were differentially expressed between T- and B-ALL, of which 10 (miR-708-5p, miR-497-5p, miR-151a-5p, miR-151b, miR-371b-5p, miR-455-5p, miR-195-5p, miR-1266-5p, miR-574-5p, and miR-425-5p) were downregulated and six (miR-450b-5p, miR-450a-5p, miR-542-5p, miR-424-5p, miR-629-5p, and miR-29c-5p) were upregulated in childhood T-ALL. These miRNAs may be used for distinguishing childhood lymphoblastic leukemia subtypes, since it provided the clear separation of patients in these two distinct groups. Six relevant biological pathways were identified according to their role in leukemia, namely, viral carcinogenesis, cell cycle, and B-cell receptor signaling pathways for induced miRNAs and TGF-beta signaling, apoptosis, and NF-kappa B signaling for the repressed miRNAs, of which several miRNA gene targets participate in cell differentiation and hematopoiesis processes. Machine learning analysis pointed out miR-29c-5p expression as the best discriminator between childhood T- and B-ALL, which is involved in calcium signaling, critical for B-cell lymphocyte fate. Further studies are needed to assure the role of the 16 miRNAs and miR-29c-5p on acute lymphoblastic leukemia subtypes and on disease prognosis.

Caracterização de biomarcadores imunológicos em pacientes portadores de leishmaniose cutânea da comunidade indígena Xakriabá, Minas Gerais, Brasil

A leishmaniose cutânea (LC) é uma doença inflamatória crônica causada por espécies dermotrópicas pertencentes aos subgêneros Viannia e Leishmania, sendo a L. (V.) braziliensis o principal agente etiológico no Brasil. O estabelecimento e evolução das lesões causadas pela infecção por L. (V.) braziliensis são altamente dependentes da imunidade celular, contudo um estudo que avalia o impacto da interação parasito-monócitos no perfil de resposta imune associado ao estabelecimento/manutenção da infecção em humanos ainda não foi realizado. Nesse contexto, o objetivo do trabalho foi caracterizar biomarcadores imunológicos, no sangue periférico e no infiltrado inflamatório de lesões cutâneas, em indígenas da comunidade Xakriabá portadores de LC (grupo LC) e com teste de Montenegro positivo sem lesão (grupo TM+sL), com intuito de melhor compreender os mecanismos imunológicos envolvidos na progressão dessa patologia, bem como dos eventos associados à resistência à infecção. A análise dos resultados mostrou que pacientes do grupo LC apresentaram menor capacidade em internalizar formas promastigotas vivas de L. (V.) braziliensis em relação ao grupo TM+sL. Além disso, observou-se que pacientes do grupo LC apresentaram perfil ativado, principalmente pelo maior percentual/Índice de Estimulação (IE) da molécula de ativação CD23, com produção de altos níveis de TNF-, provenientes de monócitos que não fagocitaram e fagocitaram formas promastigotas de L. (V.) braziliensis.

Contudo, os níveis de TNF- correlacionaram de forma negativa com a produção de NO, sugerindo que essa citocina estaria muito mais associada ao desenvolvimento das lesões do que controle da doença. Por outro lado, pacientes do grupo TM+sL apresentaram maior equilíbrio entre a produção de citocinas inflamatórias (IL-12, IFN-, IL-17) e moduladoras (IL-10, IL-4) e sintetizaram maiores níveis de NO, indicando que esse perfil de resposta imune balanceada e efetora poderia combater a infecção sem provocar dano tecidual. A análise do perfil fenotípico-funcional de monócitos e linfócitos T CD4+ e CD8+ circulantes e de citocinas e quimiocinas no infiltrado inflamatório das lesões mostrou que o tempo de evolução da lesão teve grande influência no perfil de resposta imune dos pacientes do grupo LC. Nesse contexto, observou-se que monócitos e linfócitos T CD4+ e CD8+ circulantes de pacientes do grupo lesão recente apresentaram menor IE das moléculas de ativação CD23 e co-estimulação CD80, acompanhado pela menor produção das citocinas inflamatórias (TNF-, IL-17) e moduladoras (IL-10, TGF- e IL-4) em relação ao grupo lesão tardia. Por outro lado, observou-se que esses pacientes apresentaram maior capacidade fagocítica juntamente com maior IE de monócitos expressando os receptores CD16, TLR-2 e TLR-4 e produção de NO.

A análise da resposta imune localizada mostrou que pacientes do grupo lesão recente apresentaram maiores níveis de transcritos de IL12B, IFNG, TNF, IL10, TGFB1, IL4, CCL2, CCL3, CCL5 e CXCL10, bem como maior carga parasitária em relação ao grupo lesão tardia. Os resultados obtidos no presente estudo forneceram informações importantes sobre a infecção causada pela L. (V.) braziliensis, permitindo a identificação e proposição de potenciais biomarcadores associados à resistência à LC (IL-12, IL-17 e NO) e ao desenvolvimento e manutenção da lesão (TNF-α). Além disso, esse foi o primeiro estudo que avaliou aspectos imunológicos da LC em uma população indígena brasileira.

Caracterização de biomarcadores imunológicos em pacientes portadores de leishmaniose cutânea da comunidade indígena Xakriabá, Minas Gerais, Brasil / Characterization of immunological biomarkers in patients with cutaneous leishmaniasis of the indigenous community Xakriabá, Minas Gerais, Brazil

A leishmaniose cutânea (LC) é uma doença inflamatória crônica causada por espécies dermotrópicas pertencentes aos subgêneros Viannia e Leishmania, sendo a L. (V.) braziliensis o principal agente etiológico no Brasil. O estabelecimento e evolução das lesões causadas pela infecção por L. (V.) braziliensis são altamente dependentes da imunidade celular, contudo um estudo que avalia o impacto da interação parasito-monócitos no perfil de resposta imune associado ao estabelecimento/manutenção da infecção em humanos ainda não foi realizado. Nesse contexto, o objetivo do trabalho foi caracterizar biomarcadores imunológicos, no sangue periférico e no infiltrado inflamatório de lesões cutâneas, em indígenas da comunidade Xakriabá portadores de LC (grupo LC) e com teste de Montenegro positivo sem lesão (grupo TM+sL), com intuito de melhor compreender os mecanismos imunológicos envolvidos na progressão dessa patologia, bem como dos eventos associados à resistência à infecção. A análise dos resultados mostrou que pacientes do grupo LC apresentaram menor capacidade em internalizar formas promastigotas vivas de L. (V.) braziliensis em relação ao grupo TM+sL. Além disso, observou-se que pacientes do grupo LC apresentaram perfil ativado, principalmente pelo maior percentual/Índice de Estimulação (IE) da molécula de ativação CD23, com produção de altos níveis de TNF-, provenientes de monócitos que não fagocitaram e fagocitaram formas promastigotas de L. (V.) braziliensis...

Acompanhamento clínico, epidemiológico e imunológico de pacientes portadores da fase aguda da esquistossomose mansoni, submetidos à terapêutica específica com Praziquantel

Nesse estudo foi realizada avaliação epidemiológica e acompanhamento clínico-laboratorial e imunológico de pacientes portadores da forma clínica aguda da esquistossomose mansoni. Nosso objetivo foi investigar as principais alterações clínicas, ultrassonográficas e imunofenotípicas provocadas pela infecção pelo Schistosoma mansoni e o impacto que a quimioterapia específica com praziquantel teria nesse contexto. Os pacientes avaliados nesse estudo (grupo AGD-AT) adquiriram a forma clínica aguda da infecção pelo S. mansoni na zona rural de Igarapé, município da região metropolitana de Belo Horizonte, MG. Amostras de fezes e sangue periférico dos pacientes foram coletadas para realização do exame parasitológico e hemograma, respectivamente. Os pacientes foram submetidos à anamnese detalhada a fim de avaliar as principais manifestações clínicas observadas durante a fase aguda da infecção. Posteriormente, os pacientes foram submetidos ao exame de ultrassom para avaliar comprometimento hepático e/ou esplênico. O perfil imunofenotípico dos leucócitos do sangue periférico dos pacientes também foi realizado por citometria de fluxo Os resultados mostraram que dos 38 pacientes previamente avaliados (idade: 01-65 anos; sexo: 16 homens, 22 mulheres), 34 (89,5%) apresentaram exame parasitológico de fezes positivo para ovos do S. mansoni. No entanto devido aos critérios de exclusão adotados para esse estudo, dezesseis pacientes foram acompanhados. Os resultados da anamnese demonstraram que os sintomas/sinais clínicos mais frequentes foram dor de cabeça (62,5%), febre e cólica abdominal (ambos com 56,3% de frequência), diarreia, tosse, emagrecimento e astenia (todos com 43,8% de frequência).

Com relação ao perfil hematológico, observou-se redução significativa do número de hemácias (mm3), da concentração de hemoglobina (g/dL), do percentual do hematócrito, aumento do número de plaquetas (mm3) e aumento da global de leucócitos (mm3) dos pacientes do grupo AGD-AT, refletido nas populações de eosinófilos, neutrófilos e linfócitos, quando comparados aos indivíduos saudáveis (grupo CT). As alterações ultrassonográficas mais comumente observadas foram linfonodomegalia periportal (88%), hepatomegalia (88%) e espessamento ecogênico incipiente da parede da veia porta-Fibrose grau I (75%). Na avaliação do perfil imunofenotípico, os dados mostraram aumento do número absoluto de linfócitos T CD3+ dos pacientes do grupo AGD-AT, refletido nas subpopulações CD4+ e CD8+, quando comparados aos indivíduos do grupo CT. Além disso, leucócitos circulantes dos pacientes do grupo AGD-AT apresentaram ativação celular determinada pela expressão de moléculas co-estimuladoras CD28, CD80 e CD86 e moléculas de ativação como, CD25, HLA-DR e CD69. Foi observado também aumento das moléculas de adesão celular CD18, CD44 e CD54 do grupo AGD-AT quando comparado ao grupo CT Com relação aos receptores de quimiocinas foi observado aumento da expressão de CCR5 e CXCR3 do grupo AGD-AT quando comparado ao grupo CT.

Contudo, embora, a maioria dos aspectos clínico-laboratoriais e imunofenotípicos avaliados dos pacientes do grupo AGD-AT retornaram à normalidade após quimioterapia específica com praziquantel, as principais alterações ultrassonográficas e algumas alterações imunológicas ainda permanecem (hepatomegalia, esplenomegalia, fibrose periportal incipiente, bem como aumento do número absoluto de CD28, CD80, CD86, CD18, CCR2, CXCR3 em eosinófilos, diminuição de CD62L em neutrófilos, aumento de linfócitos T CD8+ e de CD18 em linfócitos T CD4+). A permanência dessas alterações, mesmo um ano após o tratamento, sugere um impacto a longo prazo da terapêutica específica pós-fase aguda da infecção esquistossomótica sobre o estado geral dos pacientes

Acompanhamento clínico, epidemiológico e imunológico de pacientes portadores da fase aguda da esquistossomose mansoni, submetidos à terapêutica específica com Praziquantel / Monitoring clinical, epidemiological and immunological characteristics in patients with the acute phase of schistosomiasis, undergoing specific treatment with Praziquantel

Nesse estudo foi realizada avaliação epidemiológica e acompanhamento clínico-laboratorial e imunológico de pacientes portadores da forma clínica aguda da esquistossomose mansoni. Nosso objetivo foi investigar as principais alterações clínicas, ultrassonográficas e imunofenotípicas provocadas pela infecção pelo Schistosoma mansoni e o impacto que a quimioterapia específica com praziquantel teria nesse contexto. Os pacientes avaliados nesse estudo (grupo AGD-AT) adquiriram a forma clínica aguda da infecção pelo S. mansoni na zona rural de Igarapé, município da região metropolitana de Belo Horizonte, MG. Amostras de fezes e sangue periférico dos pacientes foram coletadas para realização do exame parasitológico e hemograma, respectivamente. Os pacientes foram submetidos à anamnese detalhada a fim de avaliar as principais manifestações clínicas observadas durante a fase aguda da infecção. Posteriormente, os pacientes foram submetidos ao exame de ultrassom para avaliar comprometimento hepático e/ou esplênico. O perfil imunofenotípico dos leucócitos do sangue periférico dos pacientes também foi realizado por citometria de fluxo Os resultados mostraram que dos 38 pacientes previamente avaliados (idade: 01-65 anos; sexo: 16 homens, 22 mulheres), 34 (89,5%) apresentaram exame parasitológico de fezes positivo para ovos do S. mansoni. No entanto devido aos critérios de exclusão adotados para esse estudo, dezesseis pacientes foram acompanhados. Os resultados da anamnese demonstraram que os sintomas/sinais clínicos mais frequentes foram dor de cabeça (62,5%), febre e cólica abdominal (ambos com 56,3% de frequência), diarreia, tosse, emagrecimento e astenia (todos com 43,8% de frequência).

Com relação ao perfil hematológico, observou-se redução significativa do número de hemácias (mm3), da concentração de hemoglobina (g/dL), do percentual do hematócrito, aumento do número de plaquetas (mm3) e aumento da global de leucócitos (mm3) dos pacientes do grupo AGD-AT, refletido nas populações de eosinófilos, neutrófilos e linfócitos, quando comparados aos indivíduos saudáveis (grupo CT). As alterações ultrassonográficas mais comumente observadas foram linfonodomegalia periportal (88%), hepatomegalia (88%) e espessamento ecogênico incipiente da parede da veia porta-Fibrose grau I (75%). Na avaliação do perfil imunofenotípico, os dados mostraram aumento do número absoluto de linfócitos T CD3+ dos pacientes do grupo AGD-AT, refletido nas subpopulações CD4+ e CD8+, quando comparados aos indivíduos do grupo CT. Além disso, leucócitos circulantes dos pacientes do grupo AGD-AT apresentaram ativação celular determinada pela expressão de moléculas co-estimuladoras CD28, CD80 e CD86 e moléculas de ativação como, CD25, HLA-DR e CD69. Foi observado também aumento das moléculas de adesão celular CD18, CD44 e CD54 do grupo AGD-AT quando comparado ao grupo CT Com relação aos receptores de quimiocinas foi observado aumento da expressão de CCR5 e CXCR3 do grupo AGD-AT quando comparado ao grupo CT.

Contudo, embora, a maioria dos aspectos clínico-laboratoriais e imunofenotípicos avaliados dos pacientes do grupo AGD-AT retornaram à normalidade após quimioterapia específica com praziquantel, as principais alterações ultrassonográficas e algumas alterações imunológicas ainda permanecem (hepatomegalia, esplenomegalia, fibrose periportal incipiente, bem como aumento do número absoluto de CD28, CD80, CD86, CD18, CCR2, CXCR3 em eosinófilos, diminuição de CD62L em neutrófilos, aumento de linfócitos T CD8+ e de CD18 em linfócitos T CD4+). A permanência dessas alterações, mesmo um ano após o tratamento, sugere um impacto a longo prazo da terapêutica específica pós-fase aguda da infecção esquistossomótica sobre o estado geral dos pacientes