Cognitive changes in patient living with HIV-AIDS and apolipoprotein-E polymorphism: is there an association?

Patients with HIV-AIDS treated with antiretroviral drugs still have high prevalence of cognitive disorders and many factors are likely to contribute for ongoing neurologic decline such as chronic low-level infection, coinfections with hepatitis B and C and genetic influences, both the virus and the host. Some evidences suggest that the genetic APOE polymorphism may be an associated risk factor. This study aimed to evaluate the association between APOE polymorphisms and cognitive disorders in patients with HIV-AIDS. This was a cross-sectional study comprising 133 patients aged 19-59 years old, with HIV-AIDS and were assisted at the infectious disease outpatient clinics at Hospital Universitário Oswaldo Cruz, in Recife, Brazil. For cognitive evaluation, Mini-Mental State Examination test (MMSE) and Montreal Cognitive Assessment test (MoCA) were used. The determination of APOE gene polymorphism was performed by using the PCR-RFLP technique. Sociodemographic and clinical characteristics were not significantly associated to APOE ε4 polymorphism, except for the high results of CD4 rate (p < 0.015). There was an absence associated between APOE ε4 polymorphism and neurocognitive tests. This study found no association between cognitive alterations and APOE polymorphism in patients with HIV-AIDS in the Northeast of Brazil. The imbalance of APOE allelic frequency distribution, according to Hardy-Weinberg law, there could be an adjustment phase of its equilibrium suffered by the HIV virus, however, the mechanism is still unknown.

Effect of Menstrual Cycle on Acute Intermittent Porphyria.

A 16-year-old female who was attended as an outpatient reported localized, acute abdominal pain with vomiting, symmetrical motor weakness, and burning sensation in both arms and legs. Her medical history showed irrational behavior, repeated admissions at the emergency units of many other reference hospitals, where she had been investigated for celiac disease and treated with analgesics for pain events. Her clinical condition remained unchanged despite the use of many oral analgesics. In those admissions, she showed dysautonomia, vomiting, and abdominal pain. Diagnosis investigation disclosed a notable serum hyponatremia (133.7 mEq/L). She was referred for endoscopy and the histopathological lesion of the antrum in the stomach did not show neoplastic lesions. Colonoscopy, pelvic magnetic resonance imaging (MRI), total abdominal computed tomography, and video laparoscopy were without significant abnormalities. Suspicion of acute intermittent porphyria was confirmed by quantitative urine porphobilinogen-level tests and genetic analysis. Patient was successfully treated with intravenous infusion of glucose and hemin therapy.

Distinct Roles of Th17 and Th1 Cells in Inflammatory Responses Associated with the Presentation of Paucibacillary Leprosy and Leprosy Reactions.

It is well established that helper T cell responses influence resistance or susceptibility to Mycobacterium leprae infection, but the role of more recently described helper T cell subsets in determining severity is less clear. To investigate the involvement of Th17 cells in the pathogenesis of leprosy, we determined the immune profile with variant presentations of leprosy. Firstly, IL-17A, IFN-γ and IL-10 were evaluated in conjunction with CD4+ T cell staining by confocal microscopy of lesion biopsies from tuberculoid (TT) and lepromatous leprosy (LL) patients. Secondly, inflammatory cytokines were measured by multiplex assay of serum samples from Multibacillary (MB, n = 28) and Paucibacillary (PB, n = 23) patients and household contacts (HHC, n = 23). Patients with leprosy were also evaluated for leprosy reaction occurrence: LR+ (n = 8) and LR- (n = 20). Finally, peripheral blood mononuclear cells were analysed by flow cytometry used to determine the phenotype of cytokine-producing cells. Lesions from TT patients were found to have more CD4+ IL-17A+ cells than those from LL patients. Higher concentrations of IL-17A and IL-1ß were observed in serum from PB than MB patients. The highest serum IFN-γ concentrations were, however, detected in sera from MB patients that developed leprosy reactions (MB LR+ ). Together, these results indicate that Th1 cells were associated with both the PB presentation and also with leprosy reactions. In contrast, Th17 cells were associated with an effective inflammatory response that is present in the PB forms but were not predictive of leprosy reactions in MB patients.

A rare paracoccidioidomycosis diagnosis in a kidney transplant receptor: case report.

INTRODUCTION: Paracoccidioidomycosis (PCM) is a systemic mycosis of chronic presentation more frequent in adults, which may lead to disseminated severe and lethal forms involving the lungs, skin, lymph nodes, spleen, liver, and lymphoid organs of the digestive tract. Common in Latin America, it is rare in transplanted patients, with few cases described in the literature. PURPOSE: To report a case of a patient who underwent kidney transplant 3 years ago with a pseudotumoral cervical PCM diagnosis. METHODS: A male patient, 45 years old, who underwent kidney transplantation 3 years ago presenting with diarrhea, severe weight loss, and anemia; no breathing complaints. Parasitological stool tests, fecal culture, urine culture, and abdomen USG were performed in order to assess the diarrhea, and were inconclusive. He was treated with antibiotics and antiparasitic drugs with no improvement and continued with weight loss of 15 kg within 3 months. Immunosuppression was changed, with the mycophenolic acid reduced until it was replaced by everolimus. The diarrhea returned to intensify, and there was an increase in the creatinine (from 1.5 to 3.4). He was empirically treated with sulfamethoxazole/trimethoprim, with total remission of the diarrhea. The patient underwent a kidney biopsy, anti-HIV examinations, PCR BK virus, and PCR for Mycobacterium tuberculosis-with no diagnostic conclusion. During his fifth hospitalization (6 months after the beginning of the diagnostic research), presenting a quite compromised general state, loss of 20 kg, anemia, kidney failure, and fever, he developed skin lesions on the legs and a voluminous and hard tumor in the right cervical region. Chest computed tomography was performed, and the tumoral lesions were removed from those regions. He was started on tuberculostatics and underwent a biopsy of the cervical tumoral lesion. RESULT: Biopsy of the cervical tumor showed a fungal infection by paracoccidioidomycosis. The BAAR test of the biopsy was negative. The patient died a few weeks after the diagnosis. CONCLUSION: The association between the organ transplant and PCM is rare and, in unusual clinical presentations, the diagnosis difficulty may compromise a successful treatment.

Drought sensitivity of Amazonian carbon balance revealed by atmospheric measurements.

Feedbacks between land carbon pools and climate provide one of the largest sources of uncertainty in our predictions of global climate. Estimates of the sensitivity of the terrestrial carbon budget to climate anomalies in the tropics and the identification of the mechanisms responsible for feedback effects remain uncertain. The Amazon basin stores a vast amount of carbon, and has experienced increasingly higher temperatures and more frequent floods and droughts over the past two decades. Here we report seasonal and annual carbon balances across the Amazon basin, based on carbon dioxide and carbon monoxide measurements for the anomalously dry and wet years 2010 and 2011, respectively. We find that the Amazon basin lost 0.48 ± 0.18 petagrams of carbon per year (Pg C yr(-1)) during the dry year but was carbon neutral (0.06 ± 0.1 Pg C yr(-1)) during the wet year. Taking into account carbon losses from fire by using carbon monoxide measurements, we derived the basin net biome exchange (that is, the carbon flux between the non-burned forest and the atmosphere) revealing that during the dry year, vegetation was carbon neutral. During the wet year, vegetation was a net carbon sink of 0.25 ± 0.14 Pg C yr(-1), which is roughly consistent with the mean long-term intact-forest biomass sink of 0.39 ± 0.10 Pg C yr(-1) previously estimated from forest censuses. Observations from Amazonian forest plots suggest the suppression of photosynthesis during drought as the primary cause for the 2010 sink neutralization. Overall, our results suggest that moisture has an important role in determining the Amazonian carbon balance. If the recent trend of increasing precipitation extremes persists, the Amazon may become an increasing carbon source as a result of both emissions from fires and the suppression of net biome exchange by drought.

Inhibition of autonomic storm by epidural anesthesia does not influence cardiac inflammatory response after brain death in rats.

BACKGROUND: After brain death (BD) donors usually experience cardiac dysfunction, which is responsible for a considerable number of unused organs. Causes of this cardiac dysfunction are not fully understood. Some authors argue that autonomic storm with severe hemodynamic instability leads to inflammatory activation and myocardial dysfunction. OBJECTIVES: To investigate the hypothesis that thoracic epidural anesthesia blocks autonomic storm and improves graft condition by reducing the inflammatory response. METHODS: Twenty-eight male Wistar rats (250-350 g) allocated to four groups received saline or bupivacaine via an epidural catheter at various times in relation to brain-death induction. Brain death was induced by a sudden increase in intracranial pressure by rapid inflation of a ballon catheter in the extradural space. Blood gases, electrolytes, and lactate analyses were performed at time zero, and 3 and 6 hours. Blood leukocytes were counted at 0 and 6 hours. After 6 hours of BD, we performed euthanasia to measure vascular adhesion molecule (VCAM)-1, intracellular adhesion molecule (ICAM)-1, interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, Bcl-2 and caspase-3 on cardiac tissue. RESULTS: Thoracic epidural anesthesia was effective to block the autonomic storm with a significant difference in mean arterial pressure between the untreated (saline) and the bupivacaine group before BD (P < .05). However, no significant difference was observed for the expressions of VCAM-1, ICAM-1, TNF-α, IL-1ß, Bcl-2, and caspase-3 (P > .05). CONCLUSION: Autonomic storm did not seem to be responsible for the inflammatory changes associated with BD; thoracic epidural anesthesia did not modify the expression of inflammatory mediators although it effectively blocked the autonomic storm.

Effects of individual housing on behavior and resistance to Ehrlich tumor growth in mice.

This study analyzed in Balb/C mice the effects of individual housing on behavior, serum corticosterone and resistance to Ehrlich tumor growth. Mice (60 days old) were individually (IH) or grouped housed (G) (10-12 animals/cage) for 14-21 days. The 1st day of the housing condition was considered experimental day 1 (ED1). Results showed that on ED21, IH mice, when compared to G mice, presented no differences on corticosterone serum levels when kept undisturbed; however, an increased level of this hormone was observed in IH mice after an immobilization stress challenge. An increased time spent in the plus-maze closed arms and a decreased time in the open arms were also observed in IH mice. When compared to G animals, after inoculation with 10(5) Ehrlich tumor cells on ED1, IH mice presented an increase in volume of ascitic fluid and number of tumor cells. The survival time of IH mice was also shorter than that measured in G animals. Furthermore, IH mice injected with a different number of tumor cells on ED1 always presented increased Ehrlich tumor cells than G group. Interestingly, these effects were not observed when the tumor cells injection was done on ED4. These results suggest that individual-housing conditions induce an altered immune-endocrine response and, at the same time, decrease animals' resistance to Ehrlich tumor growth. It is proposed that the neural link between the behavioral and immunological changes observed after the stress of individual housing might involve the activation of the HPA axis.

Spray-dried propolis extract, II: prenylated components of green propolis.

The effect of spray drying conditions on the chemical composition of Brazilian green propolis extract was investigated using a factorial design and high performance liquid chromatography. The raw and dried extract contents of caffeic acid, p-coumaric acid, drupanin, isosakuranetin, artepillin C, baccharin and 2,2-dimethyl-6-carboxyethenyl-2H-1-benzopyran were quantified using veratraldehyde (3,4-dimethoxybenzaldehyde) as internal standard. The baccharin content in spray-dried propolis was affected by the drying temperature with a 5% significance level, while the coumaric acid and drupanin contents were dependent on drying temperature at a 15% significance level. The other chemical markers, caffeic acid, isosakuranetin, artepillin C and 2,2-dimethyl-6-carboxyethenyl-2H-1-benzopyran, showed to be independent of drying conditions. However, all the chemical markers showed some loss on drying, which varied from 30 to 50%. The results showed that prenylated compounds are sensitive to drying, but their losses may be considerably reduced under low temperatures, around 40 degrees C. The antioxidant activity of the spray dried propolis was determined by the diphenylpicrylhydrazyl (DPPH) method and showed a quadratic dependency on the temperature; extract feed rate and the interaction between them. However, spray dried propolis extracts presented antioxidant activities similar to the original propolis tincturae.

Estudo da bula de medicamentos: uma análise da situação / An enquiry into pharmaceutical package inserts: analysis of the current situation

Estudo desenvolvido na cidade de Araraquara-SP-Brasil, onde foram entrevistadas 1829 pessoas, moradores de 42 bairros, selecionadas aleatoriamente. Foram feitas perguntas acerca da utilização de medicamentos tais como, os itens mais lidos na bula, dificuldades encontradas na leitura da bula, etc. A entrevista foi realizada em duas etapas, a primeira quando em vigor a Portaria 110/97, a segunda, após a vigência da RDC 140/03, sendo que dos 1829 entrevistados, 1597 relataram estar fazendo uso de algum medicamento. Em ambas as etapas do trabalho, os resultados referentes às bulas foram semelhantes quanto ao tamanho reduzido da letra, a linguagem muito científica e a excessiva quantidade de informações utilizadas constituíram os fatores que dificultam sua leitura. Este trabalho, mostra que é necessário disponibilizar informações mais simples que permitam ao paciente vislumbrar a importância do conhecimento destas informações, estando apto a detectar problemas advindos do uso e sua imediata solução. Adiciona-se a isto a contribuição que traz para avaliação, se as bulas elaboradas conforme a RDC140/03 passarão a servir como fonte de informação e orientação do paciente, promovendo o uso racional do medicamento ou, se as bulas passarão apenas a apresentar uma nova formatação, mas com manutenção de fatores que prejudicam o seu entendimento e utilização.

Preparation and characterization of diacetylene polymerized liposomes for detection of autoantibodies.

Affinity diacetylene liposomes were prepared with 10,12-tricosadiynoic acid and cardiolipin as the affinity ligand for anticardiolipin antibodies at a molar ratio of 80:20. Polymerization was carried out under UV irradiation, and the color transitions were monitored by visible absorption spectroscopy. Peaks at 635 nm (blue form), 540 nm (purple form), and 480 nm (red form) were observed as a function of time. These polymerized liposomes were used in a noncompetitive immunoassay for detection of anticardiolipin antibodies. Color changes were observed when reference serum containing specific immunoglobulin G, IgG, was added to polymerized liposome dispersions. The colorimetric signal due to IgG adsorption on the liposome surface was quantified as a colorimetric response defined as the change in percentage of blue color related to the initial percentage of blue color in the solutions. The colorimetric response was 10 times higher for specific IgG compared with nonspecific ones. These results suggest the unique potentialities of affinity diacetylene polymerized liposomes in the development of biosensors for diagnosis of autoimmune diseases.

Interstitial irradiation for CNS lesions.

In this study, we investigated the efficacy of brachytherapy in the treatment of 138 patients with intracranial neoplasms of the CNS. Of the total number of patients, 50 presented with glioblastoma multiforme, 45 presented with low-grade glioma, 19 presented with anaplastic astrocytoma, 23 presented with metastases and 1 presented with meningioma. During the execution of this study, seeds of 125I (10-20 mCi) were inserted into the lesions to aim the irradiation at a low dose of 60 Gy in the margin of benign lesions or 1 cm beyond the radiological border of malignant lesions, which were visualized on CT scan. The results of this procedure were evaluated in terms of the survival rates, which were assessed by Kaplan-Meier curves. Significant relationships were not observed between the volume and location of the lesions, the whole-brain radiotherapy and chemotherapy, and the survival time of the patients. A low Karnofsky Index score and older age were associated with a short survival time. In light of the above, it was concluded that interstitial irradiation is a safe and effective method of treatment for brain tumors.

Heck arylation of endocyclic enecarbamates with diazonium salts. Improvements and a concise enantioselective synthesis of (-)-codonopsinine.

Total enantioselective synthesis of the natural (-)-codonopsinine was accomplished in seven steps with an overall yield of approximately 16% starting from the five-membered endocyclic enecarbamate 4. The total synthesis features a highly efficient and stereoselective Heck arylation of endocyclic enecarbamate 4 with p-methoxybenzenediazonium tetrafluoroborate and a stereoselective epoxidation/epoxide opening sequence as key steps.

Proteinase activities in total extracts and in medium conditioned by Acanthamoeba polyphaga trophozoites.

Acanthamoeba species can cause granulomatous encephalitis and keratitis in man. The mechanisms that underlie tissue damage and invasion by the amoebae are poorly understood, but involvement of as yet uncharacterized proteinases has been suggested. Here, we employed gelatin-containing gels and azocasein assays to examine proteinase activities in cell lysates and in medium conditioned by Acanthamoeba polyphaga trophozoites. Azocasein hydrolysis by cell lysates was optimally detected at pH 4.0-5.0 and was predominantly associated with the activity of cysteine proteinases. Compatible with enzyme activation during secretion, culture supernatants additionally contained a prominent azocasein hydrolyzing activity attributable to serine proteinases; these enzymes were better detected at pH 6.0 and above, and resolved at 47, 60, 75, 100, and >110 kDa in overlay gelatin gels. Although a similar banding profile was observed in gels of trophozoite lysates, intracellular serine proteinases were shown to be activated during electrophoresis and to split the substrate during migration in sodium dodecyl sulfate gels. Blockage of serine proteinases with phenylmethylsulfonylfluoride prior to electrophoresis permitted the detection of 43-, 59-, 70-, and 100-130-kDa acidic cysteine proteinases in cell lysates, and of 3 (43, 70, and 130 kDa) apparently equivalent enzymes in culture supernatants. Under the conditions employed, no band associated with a metalloproteinase activity could be depicted in substrate gels, although the discrete inhibition of supernatants' azocaseinolytic activity by 1,10-phenanthroline suggested secretion of some metalloproteinase.

[Laterality of musical functions in partial epilepsy]. / Lateralização das funções musicais na epilepsia parcial.

Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the electroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.

[Hemispheric functional specialization in motor aphasia. Neurophysiologic findings with computerized electroencephalographic brain mapping during musical and oral sound stimulation. Study of 2 cases]. / Especialização funcional hemisférica na afasia motora. Achados neurofisiológicos ao mapeamento eletrencefalográfico computadorizado sob estimulação sonora musical e verbal. Estudo de dois casos.

This study concerns about brain electrical activity during auditory stimulation in 2 aphasic patients, one with classical (left hemisphere lesion) and another with cross aphasia (right hemisphere lesion). Both cases were submitted to dichotic listening test (consonant-vowel-consonant task) and music audition (gregorian chant), during brain mapping examination. We found, in both cases, a great proportion in delta frequency and power in non-lesional hemisphere during dichotic and musical stimulation. Besides, increasing in frequency of alpha activity was observed only in the non-lesional hemisphere restricted to temporal lobe region. Such findings suggest an interesting field of research about measurements of neurophysiological correlates of auditory stimulation and brain electrical activity in aphasia.

Area esquistossomotica do Distrito Federal: estudo sobre destino de dejetos e conhecimento da transmissao da molestia. / Schistosomal area of the Federal District: study of the refuse disposal and knowledge on the transmission of the disease

Antecedendo um programa de implantacao de melhorias sanitarias na area esquistossomotica do Distrito Federal, foi realizado um inquerito populacional visando levantar dados sobre necessidades de fossas higienicas, razoes da sua ausencia, motivacoes de uso, contacto com potenciais criadouros de caramujo e conhecimentos sobre a transmissao da doenca. Alem da baixa proporcao de fossas existentes na area e dos contactos frequentes com colecoes de agua, verificou-se um desconhecimento acentuado sobre o modo de transmissao da doenca, mesmo em domicilios onde ja ocorreram casos de esquistossomose. Chama-se atencao para a baixa efetividade dos metodos educacionais usados tradicionalmente e recomenda-se a participacao comunitaria efetiva como uma das alternativas para o problema