Manifestaciones clínicas y anticuerpos asociados y específicos de miositis en 15 pacientes chilenos con dermatomiositis: serie clínica en un centro universitario / Clinical manifestations and antibody profile in 15 patients with dermatomyositis

Background: Certain associated and specific myositis antibodies are related to certain clinical phenotypes of dermatomyositis (DM), disease severity and the presence of cancer. Aim: To describe the clinical profile of Chilean patients with DM and their associated and specific myositis antibodies. Material and Methods: Review of medical records of 15 patients with DM aged 31 to 72 years. Their clinical characteristics, laboratory tests and complementary tests were reviewed. In serum samples from each patient the presence of 16 specific antibodies was analyzed by immunoblot technique (Myositis Profile Euroline Blot test kit). Results: Fourteen (93.3%) patients had skin manifestations, five (33.3%) had pulmonary involvement, two (13.3%) had an associated cancer and nine (60%) had specific antibodies associated with myositis. Conclusions: These patients with DM had a clinical profile similar to what has been described elsewhere. The profile of myositis specific antibodies was different from reports in other populations.

Innate immunity and effector and regulatory mechanisms involved in allergic contact dermatitis

Abstract: Skin's innate immunity is the initial activator of immune response mechanisms, influencing the development of adaptive immunity. Some contact allergens are detected by Toll-like receptors (TLRs) and inflammasome NLR3. Keratinocytes participate in innate immunity and, in addition to functioning as an anatomical barrier, secrete cytokines, such as TNF, IL-1β, and IL-18, contributing to the development of Allergic Contact Dermatitis. Dendritic cells recognize and process antigenic peptides into T cells. Neutrophils cause pro-inflammatory reactions, mast cells induce migration/maturation of skin DCs, the natural killer cells have natural cytotoxic capacity, the γδ T cells favor contact with hapten during the sensitization phase, and the innate lymphoid cells act in the early stages by secreting cytokines, as well as act in inflammation and tissue homeostasis. The antigen-specific inflammation is mediated by T cells, and each subtype of T cells (Th1/Tc1, Th2/Tc2, and Th17/Tc17) activates resident skin cells, thus contributing to inflammation. Skin's regulatory T cells have a strong ability to inhibit the proliferation of hapten-specific T cells, acting at the end of the Allergic Contact Dermatitis response and in the control of systemic immune responses. In this review, we report how cutaneous innate immunity is the first line of defense and focus its role in the activation of the adaptive immune response, with effector response induction and its regulation.

Suppression of wheal and flare in histamine test by the main H1 antihistamines commercialized in Brazil

Abstract: Background: Several dermatoses are mediated by histamine, such as urticaria, angioedema, and papular urticaria. There are no Brazilian studies comparing the potency of antihistamines. Objectives: To evaluate the tolerability and efficacy of the main commercial brand and generic H1 antihistamines, regarding the suppression of the wheal and flare to the histamine test. Methods: A quasi-experimental, open study with 10 healthy adults submitted to the histamine test on the ventral aspect of the forearms. After 20 minutes, wheal and flares were measured. The tests were performed after two hours of intake of dexchlorpheniramine, hydroxyzine, levocetirizine, fexofenadine, cetirizine, loratadine, ebastine, desloratadine, epinastine and rupatadine, as well as generics of loratadine, cetirizine and fexofenadine. Results: All antihistamines presented a reduction in the wheal compared to the control (p <0.02), as well as in the flare, except for rupatadine (p = 0.70). In the internal comparison, cetirizine, fexofenadine, epinastine, levocetirizine, dexchlorpheniramine and hydroxyzine were the most potent, with no difference between them (p > 0.1). As for halo, cetirizine, epinastine, hydroxyzine and fexofenadine were the most potent, with no difference between them (p > 0.1). The most common adverse effect was drowsiness, which was more prevalent among first-generation drugs (p < 0.01). Generic loratadine, fexofenadine and cetirizine halos were higher than their controls (p <0.03).. Study limitations: A single-center study evaluating only aspects related to histamine. Conclusions: Brazilian commercial antihistamines presented different profiles of inhibition of wheal and flares in the histamine test, as well as adverse effects. Generic loratadine, fexofenadine and cetirizine presented larger flares than brand drugs.

Attenuation of Peripheral Regulatory T-Cell Suppression of Skin-Homing CD8+T Cells in Atopic Dermatitis

PURPOSE: Cutaneous lymphocyte-associated antigen (CLA)-expressing CD8+T cells have been known to play an important role in the pathogenesis of atopic dermatitis (AD). However, the mechanisms underlying the loss of self-tolerance remain unclear. Regulatory T cells (Tregs) play a key role in the development of homeostasis in the immune system. We, therefore, hypothesized that a reduced ability of Tregs to inhibit autologous CD8+CLA+T cells might be underlying mechanism in AD. MATERIALS AND METHODS: CD8+CLA+T cells and Tregs were obtained from the peripheral blood of AD patients and control volunteers. The frequencies of CD8+CLA+T cells were evaluated. The proliferative responses of CD8+CLA+T cells were assessed by flow cytometry, and the levels of transforming growth factor-beta1 (TGF-beta1) and interleukin-10 (IL-10) in culture supernatants were detected by enzyme-linked immunosorbent assay. RESULTS: Our results revealed higher frequency and increased expression of perforin and granzyme-B in peripheral CD8+CLA+T cells in AD, and lower inhibitory ability of Tregs on proliferation of CD8+CLA+T cells in AD. Meanwhile, the levels of TGF-beta1 produced by Tregs were significantly lower in AD, and anti-TGF-beta1 abolished such suppression. CONCLUSION: The attenuated inhibitory ability of Tregs on hyper-activated autologous CD8+CLA+T cells, mediated by TGF-beta1, plays an important role in the pathogenesis of AD.

Chronic Toxoplasmosis Modulates the Induction of Contact Hypersensitivity by TNCB in Mouse Model

Mouse models of chronic toxoplasmosis and atopic dermatitis (AD) were combined to clarify the effect of opportunistic Toxoplasma gondii infection on the development of AD. AD was induced as a chronic contact hypersensitivity (CHS) with repeated challenge of 2,4,6-trinitro-1-chlorobenzene (TNCB) on the dorsal skin of mice. TNCB induced skin thickness increases in both normal and toxoplasmic mice. The changing patterns were different from the sigmoidal which saturated at 20 days in normal mice to the convex saturated at 12 days in toxoplasmic mice with the crossing at 18 days. Compared to normal mice, toxoplasmic mice presented CHS more severely in earlier times and then moderately in later times. These data suggest that host immune modification by T. gondii infection enhances CHS in early times of atopic stimulation but soothes the reaction of CHS in later times in mouse model.

Infección necrosante de tejidos blandos y neoplasia gastrointestinal / Necrotizing soft tissue infection and gastrointestinal malignancy

Las infecciones necrosantes de tejidos blandos presentan altas tasas de mortalidad. Estas se han relacionado con diferentes causas, incluidas las enfermedades neoplásicas. En la literatura se ha descrito infección necrosante especialmente en pacientes con neoplasias del tracto gastrointestinal bajo. La presentación de este caso clínico tiene como objetivo recordar a los médicos de urgencias la pertinencia de considerar este diagnóstico en pacientes con neoplasias de colon y recto en estadio avanzado y presentar una breve revisión de la literatura.

Necrotizing soft tissue infections have high mortality rates. These infections have been linked to various causes, including those related to neoplastic diseases. The literature has described necrotizing particularly in patients with malignancies of the colon and rectum. The presentation of this case is intended to remind emergency physicians to consider this diagnosis in patients with advanced-stage gastrointestinal tract tumors and to present a brief review of the literature.

Review: dermatitis herpetiformis / Revisao: dermatite herpetiforme

Dermatitis herpetiformis (DH) or Duhring-Brocq disease is a chronic bullous disease characterized by intense itching and burning sensation in the erythematous papules and urticarial plaques, grouped vesicles with centrifuge growth, and tense blisters. There is an association with the genotypes HLA DR3, HLA DQw2, found in 80-90% of cases. It is an IgA-mediated cutaneous disease, with immunoglobulin A deposits appearing in a granular pattern at the top of the dermal papilla in the sublamina densa area of the basement membrane, which is present both in affected skin and healthy skin. The same protein IgA1 with J chain is found in the small intestinal mucosa in patients with adult celiac disease, suggesting a strong association with DH. Specific antibodies such as antiendomysium, antireticulina, antigliadin and, recently identified, the epidermal and tissue transglutaminase subtypes, as well as increased zonulin production, are common to both conditions, along with gluten-sensitive enteropathy and DH. Autoimmune diseases present higher levels of prevalence, such as thyroid (5-11%), pernicious anemia (1-3%), type 1 diabetes (1-2%) and collagen tissue disease. The chosen treatment is dapsone and a gluten-free diet.

Dermatite herpetiforme é uma doença bolhosa crônica caracterizada por intenso prurido e sensação de queimação em pápulas eritematosas e placas urticariformes, vesículas agrupadas com crescimento centrífugo e bolhas tensas. Apresenta associação com genótipos de HLA DR3, HLA DQW2 encontrados em 80 a 90% dos casos. É uma doença cutânea mediada por IgA com depósito de imunoglobulina A em padrão granular no topo da papila dérmica na área da sublâmina densa na zona da membrana basal, presente tanto na pele lesada com em área de pele sã. A mesma cadeia J da proteína IgA1 é encontrada na mucosa do intestino delgado em pacientes com doença celíaca do adulto, sugerindo forte associação com a dermatite herpetiforme. Anticorpos específicos com anti-endomísio, anti-reculina, anti-gliadina, e recentemente identificado, o subtipo transglutaminase epidérmica e tecidual, assim como a produção aumentada da zonulina, são descritas em ambas as afecções enteropatia sensível ao glúten e a deramtite herpetiforme. Exibe depósitos de IgA em padrão granular na papila dérmica. Doenças auto-imunes exibem maior prevalência como tireoidopatia em 5 a 11%, anemia perniciosa em 1 a 3%, diabetes tipo 1 em 1 a 2% e doença do colágeno. O tratamento de escolha é a dapsona e dieta isenta de glútem.

Aspectos inmunológicos de la fototerapia / Immunological aspects of phototherapy

La exposición a la radiación ultravioleta se ha asociado con efectos indeseables como envejecimiento y carcinogénesis pero así mismo se le reconoce por sus efectos benéficos y en actualidad es una importante modalidad terapéutica en diferentes entidades dermatológicas como psoriasis, linfoma, atopia y otras. En las últimas décadas se ha logrado conocer los mecanismos moleculares e inmunológicos de la fototerapia y la fotoquimioterapia, también la penetración a las capas de la piel de las diferentes longitudes de onda, permitiendo utilizar de una manera adecuada y eficaz estas opciones de tratamiento como una alternativa y en muchos casos la primera elección para manejo de muchas dermatosis. En este escrito revisamos las diferentes modalidades de utilización de la luz ultravioleta, sus mecanismos de acción e indicaciones terapéuticas, pasando por un corto recuento histórico.

The ultraviolet radiation has been associated with undesirable effects like aging and carcinogenesis but also with beneficial and therapeutic effects in a variety of skin diseases like psoriasis, lymphoma atopic dermatitis and others. In the last decades it know the molecular and immunological mechanisms of phototherapy and the photochemotherapy the penetration to the layers of the skin of the different wavelengths allowing to use these options of treatment as an alternative and in many cases the first election for handling of many dermatosis. In this writing were viewed the different modalities from use of the ultraviolet light, its mechanisms of action and therapeutic indications, happening through a short historical count.

Efeitos da radiação solar crônica prolongada sobre o sistema imunológico de pescadores profissionais em Recife (PE), Brasil / Effects of long-term chronic exposure to sun radiation in immunological system of commercial fishermen in Recife, Brazil

FUNDAMENTOS: Existe um consenso de que a exposição à radiação ultravioleta determina alterações n o sistema imunológico da pele, o que permite que se avente a hipótese de que a exposição prolongada e crônica ao Sol pode representar uma das maiores agressões ambientais à saúde humana. Entre as várias ocupações que requerem, necessariamente, exposição prolongada e crônica ao Sol está a de pescador. No entanto, a experiência clínica dermatológica, amealhada ao longo de vários anos de exercício da Medicina, não parece confirmar essa hipótese. OBJETIVO: Avaliar efeitos clínicos, histológicos e imunológicos da exposição crônica e prolongada à radiação ultravioleta em pescadores. MÉTODOS: Em estudo prospectivo, transversal, observacional, foram caracterizadas lesões dermatológicas, marcadores imunológicos e alterações histológicas de pescadores e subpopulações de linfócitos comparadas a grupo-controle. Empregaram-se testes de Mann-Whitney, exato de Fisher, Wilcoxon em nível de 0,05. RESULTADOS: Houve diferenças entre os grupos exposto e protegido em elastose (p = 0,03), ectasia de vasos dérmicos (p = 0,012) e número de células nas camadas epidérmicas entre os cones (p = 0,029). Foram mais comuns em pescadores CD45RO, CD68+ e mastócitos na pele (p = 0,040, p < 0,001 e p = 0,001); CD3CD8CD45RO no sangue (p = 0,016). CONCLUSÃO: As alterações sugerem que exposição crônica e prolongada ao sol promove tolerância à radiação ultravioleta, protetora da imunossupressão.

BACKGROUND: Among the various occupations which necessarily require long-term and chronic sun exposure is that of a fisherman. However, clinical experience in dermatology earned over several years of medical practice does not seem to confirm this hypothesis. OBJECTIVE: To evaluate clinical, histological and immunological effects of long-term and chronic exposure to ultraviolet radiation in fishermen. METHODS: A prospective, cross-sectional and observational study characterized skin lesions, immunological markers and histological alterations in fishermen, as well as lymphocyte subpopulations compared to a control group. Mann-Whitney, Fisher's and Wilcoxon statistical tests were used at a significance level of 0.05. RESULTS: There were significant differences between the exposed group and the group protected due to elastosis (p = 0.03), ectasia of dermal vessels (p = 0.012) and number of cells in the epidermal layers between cones (p = 0.029). Most common among fishermen were CD45RO, CD68 + and mastocytes in the skin (p = 0.040, p <0.001, p = 0.001) and CD3CD8CD45RO in the blood (p = 0.016). CONCLUSION: The alterations suggest that long-term and chronic sun exposure promotes tolerance to ultraviolet radiation, which protects against immunosuppression.

Mecanismos que controlan la migración del linfocito T a la piel / Mechanisms that control T lymphocyte migration into the skin

La piel es un órgano complejo que cumple funciones de barrera física e inmunológica. La presencia de numerosos tipos celulares explica su participación en la inmunidad innata y adaptativa y su capacidad de iniciar una cascada de eventos con repercusión sistémica, a la vez que la hace órgano blanco de procesos patológicos sistémicos. Uno de los principales componentes del sistema inmunitario cutáneo son las células de Langerhans, especializadas en la captura y presentación de antígenos; ante estímulos como la captura de antígenos extraños o propios alterados, migran al ganglio linfático para presentar los antígenos a los linfocitos T. Una vez activados, los linfocitos T pueden migrar a la piel gracias a la expresión de CLA (Cutaneous Lymphocyte-associated Antigen), cuyo ligando, la E-Selectina, se expresa en los endotelios dérmicos. Este proceso de migración y alojamiento en la piel está controlado por quimiocinas, citocinas y moléculas de adhesión que se presentan en el texto.

Histomorphometric analysis of cutaneous remodeling in the early stage of the scleroderma model

INTRODUCTION/OBJECTIVES: Systemic sclerosis, or scleroderma, is a rheumatic disease characterized by autoimmunity, vasculopathy, and fibrosis of the skin and several internal organs. In the present study, our aim was to assess the skin alterations in animals with scleroderma during the first stages of disease induction. METHODS: To induce scleroderma, female New Zealand rabbits (n = 12) were subcutaneously immunized with 1 mg/ml of collagen V (Col V) in complete Freund's adjuvant, twice with a thirty-day interval. Fifteen days later, the animals received an intramuscular booster with type V collagen in incomplete Freund's adjuvant, twice with a fifteen-day interval. The control group was inoculated with 1 ml of 10 mM acetic acid solution diluted with an equal amount of Freund's adjuvant. Serial dorsal skin biopsies were performed at 7, 15, and 30 days and stained with H&E, Masson's trichrome and Picrosírius for morphological and morphometric analyses. RESULTS: Immunized rabbits presented a significant increase in collagen in skin collected seven days after the first immunization (p=0.05). CONCLUSION: The results from this experimental model may be very important to a better understanding of the pathogenic mechanisms involved in the beginning of human SSc. Therapeutic protocols to avoid early remodeling of the skin may lead to promising treatments for SSc in the future.

Susceptibilidad de distintas cepas de ratones a la infección por Leishmania amazonensis / Susceptibility of different mouse strains to Leishmania amazonensis infection

Antecedentes. En el modelo murino más estudiado, producido por L, major, se observa correlación entre cepas resistentes (C57BL6) y susceptibles (BALB/c), con respuestas inmunes Th1 o Th2, respectivamente. Esta dicotomía no se observa en modelos desarrollados con otras especies de Leishmania (L). Por ello es importante avanzar en el estudio de modelos experimentales con especies predominantes de nuestra zona. El objetivo fue reproducir la enfermedad en diferentes cepas murinas luego de la infección por L. amazonensis. Métodos. Para conocer el efecto de la variable cepa de ratones sobre la susceptibilidad a la infección por L. amazonensis, se aplicó un inóculo constante del parásito a las cepas en estudio. Se evaluó la respuesta de las cepas C57BL/6, BALB/c y Swiss, por medición de lesiones, estimación de carga parasitaria e histopatología. Por ELISA se determinaron anticuerpos y citoquinas en suero. Test estadístico: análisis de la varianza (ANOVA). Resultados. BALB/c demostró máxima susceptibilidad a la infección; Swiss presentó un fenotipo intermedio, y C57BL/6 fue la menos susceptible. Se obtuvieron modelos murinos que reprodujeron distintas formas clínicas comparables a la enfermedad humana. Conclusiones. Los resultados servirán para extrapolar a la patología humana las conclusiones de posteriores ensayos terapéuticos y profilácticos sobre animales experimentales.

Background.Most studies have been based onL. majormouse mo-dels, where Th1 and Th2 immune responses are associated with resistant(C57BL/6) and susceptible (BALB/c) strains, respectively. This dichotomyis not generally observed in models developed with otherLeishmania (L.)species. Therefore, the study of mouse models involving species respon-sible for human infections in our region represents an important challen-ge. The aim was to induce the disease in diff erent mouse strains after theinfection withL. amazonensis.Methods.To study the eff ect of “mice strain” variable over “susceptibilityforL. amazonensisinfection”, a constant parasite inoculum was appliedto the studied mice strains. Response to infection was characterized inC57BL/6, BALB/c, and Swiss strains by lesion measurement, parasitic loadestimate and histological analysis. Serum presence of antibodies andcytokines was determinated by ELISA. Statistical analysis: ANOVA test.Results.BALB/c showed the maximum level of susceptibility towardsthe infection. Swiss demonstrated an intermediate phenotype andC57BL/6 was the most resistant strain. We could obtain murine modelsrefl ecting diff erent clinical forms present in human disease.Conclusions.These results will be useful to extrapolate to human pa-thology future conclusions about therapeutic and prophylaxis analysison experimental models (Dermatol Argent 2009;15(5):334-339)

Caracterização fenotípica e funcional de células T reguladoras em um modelo experimental de Leishmaniose Tegumentar Americana / Phenotypic charactrization and functional regulatory T cells in an experimental model of leishmaniasis american tegumentar

A Leishmaniose Tegumentar (LT) constitui um grave problema de saúde pública no Brasil. As células T reguladoras (CD4+CD25+) (Tregs) executam um papel geral na regulação imune, prevenindo uma resposta imune patológica induzida. As Tregs naturais são definidas a partir da expressão constitutiva de CD25, CTLA-4, GITR, CD103 e FoxP3, entre outros marcadores. As células Tregs, ao se acumularem no sítio de infecção por Leishmania, suprimem a proliferação de células T CD4+CD25-, levando à persistência do parasita por mecanismos dependentes de IL-10. Nosso objetivo foi caracterizar a população de células Treg em camundongos BALB/c infectados e re-infectados com L. Braziliensis e avaliar se estas células estão relacionadas com a persistência do parasota. Células T CD4+CD25+, obtidas de camundongos infectados, expressam diferentes marcadores de superfície de Tregs (CD103, GITR, FoxP3) e foram capazes de suprimir a proliferação das células T CD4+CD25-. Observamos também a produção IFN-y e IL-10 por parte de células T CD4+CD25+. Observamos que os parasitas persistem no lifondo e no baço cuja infecção, contudo na orelha, o número de parasitas diminui com a cicatrização da lesão. Observamos também que não há reativação da lesão após o desafio. Nossos resultados mostram que as células Tregs estão presentes na infecção experimental por L. Braziliensis e sugerem que estas células estão associadas com a ausência de reativação da doença após um desafio.

Are cutaneous hypersensitivity tests to inhalant allergens a severity marker for vernal keratoconjunctivitis?

PURPOSE: The purpose of this study was to analyze the cutaneous sensitivity to a variety of allergens in patients with vernal keratoconjunctivitis (VKC) and to demonstrate the relation between skin response and clinical aspects of the disease. METHODS: Twenty patients with vernal keratoconjunctivitis were randomly chosen from the External Disease and Cornea Sector. They were clinically evaluated, and a score ranging from 0 to 20 was applied based on signs and symptoms on ophthalmic examination. All subjects underwent a skin prick test against standardized allergens, such as house dust mites D. pteronyssinus, D. farinae, and Blomia tropicalis, as well as allergens from cat, dog, fungi and feather. RESULTS: Seventy-five per cent of patients were positive for at least one of the allergens tested. House dust mites were responsible for the majority of the cases (75 percent). There was a poor correlation between the clinical score and sensitivity to allergens (r= - 0.119 for fungi; r= - 0.174 for dog; r= - 0.243 for house dust mites; r= - 0.090 for feather). A significant correlation was found only for cat allergen extract (r = - 0.510; p=0.024). CONCLUSIONS: Our study demonstrated poor correlation between cutaneous hypersensitivity tests and clinical findings in patients with vernal keratoconjuntivitis. We concluded that skin response to inhalant allergens is not a useful test to identify clinical severity and chronicity of inflammatory process in this disease.

OBJETIVO: Avaliar o papel da sensibilização cutânea a diferentes aeroalérgenos em pacientes com ceratoconjuntivite vernal e a correlação entre esta e os aspectos clínicos da doença. MÉTODOS: Vinte pacientes do setor de doenças externas e córnea foram aleatoriamente convidados para participar deste estudo. Os pacientes foram avaliados e a eles foi atribuído um escore clínico variando de 0 a 20 de acordo com sinais e sintomas presentes no exame oftalmológico. Todos os pacientes foram submetidos a testes cutâneos de hipersensibilidade imediata contra aeroalérgenos padronizados como os ácaros domiciliares D. pteronyssinus, D. farinae e Blomia tropicalis, assim como também a alérgenos de epitélio de gato, epitélio de cão, mistura de fungos e mistura de penas. RESULTADOS: Setenta e cinco por cento dos pacientes tiveram teste de hipersensibilidade imediata positivo contra pelo menos um dos antígenos testados. Os ácaros domiciliares foram responsáveis pela maioria destes casos (75 por cento). Houve uma pobre correlação entre o escore clínico e a hipersensibilidade cutânea aos alérgenos (r= -0,119 para fungos; r= -0,174 para epitélio de cão; r= -0,243 para ácaros domiciliares; r= -0,090 para mistura de penas). Houve correlação significativa apenas contra epitélio de gatos (r= -0,510; p=0,024). CONCLUSÃO: O estudo demonstrou uma pobre correlação entre os testes cutâneos de hipersensibilidade imediata e os achados clínicos nos pacientes com ceratoconjuntivite vernal. Os testes cutâneos de hipersensibilidade imediata contra aeroalérgenos não foi parâmetro eficaz na identificação dos casos de maior gravidade e cronicidade de ceratoconjuntivite vernal.

Detection of pemphigus autoantibodies in healthy relatives of Turkish patients with pemphigus.

BACKGROUND: Pemphigus autoantibodies have been reported in healthy relatives of pemphigus patients suggesting a genetic predisposition in the pathogenesis of the disease. AIMS: To test for the presence of pemphigus autoantibodies in healthy relatives of Turkish patients of pemphigus. METHODS: The study group comprised 45 pemphigus patients, 75 unaffected family members and 47 healthy individuals in the control group. Direct and indirect immunofluorescence techniques were performed to determine the presence of pemphigus autoantibodies. RESULTS: By indirect immunofluorescence staining, circulating pemphigus autoantibodies were found in 26.7% of the relatives and in only two of the controls (P value = 0.0001). A direct immunofluorescence technique revealed positive results in three (4%) of the relatives and none of the controls. CONCLUSION: The presence of pemphigus autoantibodies in clinically healthy relatives indicates that genetic predisposition is necessary but not sufficient for the development of clinical disease.

Fine needle aspiration cytology in reactional and non-reactional leprosy.

BACKGROUND: Histopathological evaluation of skin lesions is not feasible in many leprosy endemic areas. Fine needle aspiration cytology (FNAC) is a simpler tool compared to histopathology for the evaluation of the cytomorphology of skin lesions. AIMS: To study the cytomorphology of leprosy lesions in fine needle aspirates and correlate it with the histopathology. METHODS: Seventy leprosy patients diagnosed and classified according to Ridley Jopling scale were included. Fine needle aspirates were taken from the lesion followed by a skin biopsy from the same site for histopathological examination after H/E staining. RESULTS: Borderline leprosy patients with Type I reaction showed significantly large numbers of giant cells, collagen and elastin in their smears as compared to those without reaction. The smears were more heavily cellular with fragmented collagen and elastin along with significant increase in neutrophils in patients with Type II reaction while foamy macrophages with fatty background were common in non-reactional lepromatous leprosy patients. A complete correlation between histopathological and cytomorphological findings was observed in 77.3% of cases. CONCLUSION: FNAC may be used as an alternative tool to assess leprosy lesions in areas where histopathological services are not readily available.

Efeitos da radiação solar crônica e prolongada sobre o sistema imunológico de pescadores do Recife / The ultraviolet radiation effects on the human immunological system are highly complex, disturbing some components of immune response

Para avaliar os efeitos clínicos, histopatológicos e imunológicos da radiação solar em pescadores do sexo masculino com mais de dez anos de atividade ininterrupta, foi realizado estudo prospectivo, transversal, observacional e analítico, incluindo 19 pescadores, da comunidade do Pina, Pernambuco, Brasil. O efeito barreira à penetração da radiação solar, representado por elastose, aumento do número de células nas camadas entre os cones, aumento de melanócitos e da vasculatura dérmica, representada pela ectasia, sugere a existência de um efeito de tolerância ao dano da radiação solar, o qual provavelmente inibe a instalação da imunodepressão e é reforçado pelo aumento do CD3CD8CD45RO+ e da expressão da linhagem CD28+, capaz de proteger as células CD4+ da apoptose induzida pelo CD95

To evaluate the clinical, histopathological and immunological effects of solar radiation in male fishermen with more than 10 years of uninterrupted activity, a prospective, transversal, observational and analytical study was performed including 19 fishermen at a community in Pina, in the state of Pernambuco, Brazil. The barrier effect to the penetration of the solar radiation established by elastosis, increase of cellular number of cell layers between cones, increase of melanocytes and of dermal vasculature, represented by the ectasy, suggests the existence of a tolerance effect to sun radiation damage, which probably inhibits the installation of immunodepression and is endorsed by the increasing of CD3CD8CD45RO+ and in trend of CD28+ expression, capable to protect Cd4+ cells apoptosis induced from CD95

Incidence of anaphylaxis in the emergency department: a 1-year study in a university hospital.

The aim of this study was to estimate the incidence of anaphylaxis in an emergency department, identify rate and risk factors of recurrent anaphylaxis, and describe its clinical features and management. A retrospective study of patients who attended the emergency department at Thammasat University Hospital was conducted during 2003-2004 with anaphylactically related ICD-9 and ICD-10 terms. There were 64 patients who experienced 65 anaphylactic episodes during the 1-year period. The anaphylaxis occurrence rate was 223 per 100,000 patients per year. The most common manifestations were cutaneous symptoms and signs, followed by respiratory expression. Food allergy was the most common cause of anaphylaxis. Eighty-five percent of admitted cases had monophasic anaphylaxis. Patients with and without biphasic reactions did not differ significantly in terms of epinephrine and steroid usage. In conclusion, anaphylaxis is not rare. Epinephrine and steroid usage did not prevent biphasic reactions.