Macrophage immunophenotypes in Jorge Lobo's disease and lepromatous leprosy- A comparative study.

Jorge Lobo's disease (JLD) and lepromatous leprosy (LL) share several clinical, histological and immunological features, especially a deficiency in the cellular immune response. Macrophages participate in innate and adaptive inflammatory immune responses, as well as in tissue regeneration and repair. Macrophage function deficiency results in maintenance of diseases. M1 macrophages produce pro-inflammatory mediators and M2 produce anti-inflammatory cytokines. To better understand JLD and LL pathogenesis, we studied the immunophenotype profile of macrophage subtypes in 52 JLD skin lesions, in comparison with 16 LL samples, using a panmacrophage (CD68) antibody and selective immunohistochemical markers for M1 (iNOS) and M2 (CD163, CD204) responses, HAM56 (resident/fixed macrophage) and MAC 387 (recently infiltrating macrophage) antibodies. We found no differences between the groups regarding the density of the CD163, CD204, MAC387+ immunostained cells, including iNOS, considered a M1 marker. But HAM56+ cell density was higher in LL samples. By comparing the M2 and M1 immunomarkers in each disease separately, some other differences were found. Our results reinforce a higher M2 response in JLD and LL patients, depicting predominant production of anti-inflammatory cytokines, but also some distinction in degree of macrophage activation. Significant amounts of iNOS + macrophages take part in the immune milieu of both LL and JLD samples, displaying impaired microbicidal activity, like alternatively activated M2 cells.

Association of Bartonella spp bacteremia with Chagas cardiomyopathy, endocarditis and arrythmias in patients from South America

Infection with Bartonella spp may cause cardiac arrhythmias, myocarditis and endocarditis in humans. The aim of the present study was to evaluate a possible association between Bartonella spp bacteremia and endocarditis, arrhythmia and Chagas cardiomyopathy in patients from Brazil and Argentina. We screened for the presence of bacterial 16S rRNA in human blood by PCR using oligonucleotides to amplify a 185-bp bacterial DNA fragment. Blood samples were taken from four groups of subjects in Brazil and Argentina: i) control patients without clinical disease, ii) patients with negative blood-culture endocarditis, iii) patients with arrhythmias, and iv) patients with chronic Chagas cardiomyopathy. PCR products were analyzed on 1.5% agarose gel to visualize the 185-bp fragment and then sequenced to confirm the identity of DNA. Sixty of 148 patients (40.5%) with cardiac disease and 1 of 56 subjects (1.8%) from the control group presented positive PCR amplification for Bartonella spp, suggesting a positive association of the bacteria with these diseases. Separate analysis of the four groups showed that the risk of a Brazilian patient with endocarditis being infected with Bartonella was 22 times higher than in the controls. In arrhythmic patients, the prevalence of infection was 45 times higher when compared to the same controls and 40 times higher for patients with Chagas cardiomyopathy. To the best of our knowledge this is the first report of the association between Bartonella spp bacteremia and Chagas disease. The present data may be useful for epidemiological and prevention studies in Brazil and Argentina.

Evaluación de conocimientos médicos: diagnóstico de afecciones dermatológicas prevalentes / Evaluation of medical skills: diagnosis of prevalent dermatological lesions

Objetivo. La enseñanza de la dermatología es a menudo poco apreciada, a pesar de las frecuentes afecciones dermatológicas en la práctica clínica. El objetivo de este estudio es valorar los conocimientos de médicos no dermatólogos de estudiantes del curso de medicina de la Facultad de Ciencias Médicas de la Universidad Estatal de Campinas, Brasil, en el tratamiento de pacientes con afecciones dermatológicas. Entre los estudiantes había 24que integraban un nuevo modelo curricular, después de la reforma educativa, lo que permitió un mayor número de actividades relacionadas con la especialidad. Sujetos y métodos. Este estudio se desarrolló a través de un examen escrito con diez casos clínicos y sus imágenes. El sujeto evaluado debía marcar una de las cinco alternativas para cada pregunta. Este instrumento se administró a 83médicos y 55 estudiantes de medicina, de forma anónima. Entre el grupo de médicos, ocho eran especialistas en Dermatología y sirvieron como referencia para el estudio. Resultados. Los estudiantes del nuevo plan de estudios obtuvieron un promedio de 6,34 en relación con la puntuación de los dermatólogos, considerada de 10, la más alta posible. La puntuación promedio de los otros estudiantes fue de 3,82, y la de los médicos no especialistas de las unidades básicas, de 3,32. Conclusiones. El estudio permitió demostrar que los cambios en la enseñanza de la Dermatología fueron importantes para la adquisición de conocimientos de la especialidad por los alumnos que siguieron el nuevo currículo de la facultad y para asumir que los médicos no especialistas del Programa de Salud Familiar que prestan servicios en atención primaria de las regiones estudiadas no recibían formación suficiente para el ejercicio de la especialidad en la calidad de médicos conformación general (AU)

Aim. Instruction in dermatology is often under-valued, inspite of the frequency of dermatological complaints in clinical practice. The aim of this study is to evaluate the skill of doctors who are not dermatologists as well as the students of the Medical School at the Campinas State University, Brazil, in the treatment of patients with dermatological lesions. Among the students, there are 24 participating in a new model of curriculum, which came as a result of a revision of teaching methods, which allows a greater number of activities relating to this specialty. Subjects and methods. This study was designed by using a writing test which contains ten clinical cases and the images relating to these cases. The person being evaluated was required to choose one of five alternatives for each question. This instrument was applied anonymously to 83 doctors and 55 medical students. In this group of doctors, eight were specialists in dermatology and served as a point of reference for the study. Results. Students of the new curriculum had an average of 6.34 considering the note of dermatologists as ten, the maximum score possible. The average of the other students was 3.82 and the average of the non-specialist doctors attending in primary care units was 3.32. Conclusions. The research demonstrated that the change in teaching of dermatology was a relevant factor for the acquisition of knowledge in this area in the new curriculum at the university. It also supported what had been previously supposed, that non-specialists in the Family Health Program who attend patients at health primary care in the regions evaluated did not receive adequate training for the performance of this specialty as expected to general practitioners (AU)