First molecular-based detection study of Leishmania infantum in the Tapirapé indigenous population in the Brazilian Amazon.

Species of the genus Leishmania parasitize mammals and have life cycles that alternate between vertebrate and invertebrate hosts. Most species develop in a hematophagous arthropod and infect a specific vertebrate host that may belong to diverse orders and families. Visceral leishmaniasis is a chronic zoonosis with a wide geographic distribution, affecting 350 million people globally, mostly in areas with a high risk of infection. In Brazil, this disease not only has a high incidence but is also expanding to new areas, both in urban centers and rural areas, including territories with tribal communities, due to increasing human intervention. The objective of this study was to perform cathepsin L-like gene-based molecular diagnosis of Leishmania infantum in the indigenous Tapirapé ethnic group in the state of Mato Grosso. From the 372 individuals assessed, only 0.8% (3/372) tested positive for L. infantum, all from the same village (Urubu Branco). Despite the small number of infected individuals, this study demonstrates the first human cases of Leishmania infantum infection in this population, suggesting the need for regular monitoring of visceral leishmaniasis in the area and leading to a broad discussion on the planning and implementation of public health measures for the indigenous population, while respecting their distinctive territories and culture.

First molecular-based detection study of Leishmania infantum in the Tapirapé indigenous population in the Brazilian Amazon

Species of the genus Leishmania parasitize mammals and have life cycles that alternate between vertebrate and invertebrate hosts. Most species develop in a hematophagous arthropod and infect a specific vertebrate host that may belong to diverse orders and families. Visceral leishmaniasis is a chronic zoonosis with a wide geographic distribution, affecting 350 million people globally, mostly in areas with a high risk of infection. In Brazil, this disease not only has a high incidence but is also expanding to new areas, both in urban centers and rural areas, including territories with tribal communities, due to increasing human intervention. The objective of this study was to perform cathepsin L-like gene-based molecular diagnosis of Leishmania infantum in the indigenous Tapirapé ethnic group in the state of Mato Grosso. From the 372 individuals assessed, only 0.8% (3/372) tested positive for L. infantum, all from the same village (Urubu Branco). Despite the small number of infected individuals, this study demonstrates the first human cases of Leishmania infantum infection in this population, suggesting the need for regular monitoring of visceral leishmaniasis in the area and leading to a broad discussion on the planning and implementation of public health measures for the indigenous population, while respecting their distinctive territories and culture.

Molecular characterisation and evolutionary relationships of a potyvirus infecting Crotalaria in Brazil. Brief report.

The 3' terminal genomic region of a potyvirus causing mosaic disease in several Crotalaria species has been cloned and sequenced. Comparisons of the nucleotide and deduced amino acid (aa) sequences of the cloned cDNA with those from other potyviruses show that the Crotalaria-infecting virus (designated Crotalaria mosaic virus; CrMV) is closely related to Cowpea aphid-borne mosaic virus (CABMV). Maximum identity (95.4%) at the coat protein (CP) aa level was observed between CrMV and a Brazilian strain of CABMV. Phylogenetic analyses derived from the sequence alignments of the CP and 3' untranslated region confirmed the identification of CrMV as a strain of CABMV and the name CABMV-Cr is suggested.

Octreotide in acute bleeding esophageal varices: a prospective randomized study.

BACKGROUND/AIMS: To assess the value of octreotide in the control of acute bleeding esophageal varices, in a prospective randomized study. METHODOLOGY: One hundred and ninety-seven patients admitted for variceal bleeding confirmed at endoscopy were recruited and divided into two groups: group I (n = 111) with endoscopic stigmata of recent bleeding; and group II (n = 86) with active bleeding at emergency endoscopy. Patients in group I were randomized to receive a continuous infusion of octreotide (n = 58) or emergency sclerotherapy (n = 53). Patients in group II were assigned to sclerotherapy (n = 42) or to sclerotherapy plus octreotide (n = 44). At the end of the period of study (48 hours), patients were submitted to sclerotherapy or band ligation until variceal obliteration was achieved. RESULTS: In group I, octreotide was found to be as effective as sclerotherapy regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. Transfusion needs were not significantly different for the two treatment modalities. In group II, the association of octreotide with sclerotherapy was significantly better than sclerotherapy alone either in controlling acute active bleeding (P < 0.001) or in achieving hemostasis at 48 hours (P < 0.01). Transfusion needs were significantly fewer in patients treated with this therapeutic association as compared to sclerotherapy alone. CONCLUSIONS: These results suggest that octreotide infusion is effective in the treatment of variceal bleeding. In patients with recent bleeding, octreotide infusion is as effective as emergency sclerotherapy. In active variceal bleeding, it is a valuable adjuvant treatment in association with emergency sclerotherapy.

Treatment of benign hepatic cysts by instillation of tetracycline hydrochloride.

BACKGROUND/AIMS: Despite the high frequency of benign hepatic cysts, they rarely cause symptoms. Large cysts, however, may produce clinical manifestations. In these cases, ultrasonography-guided therapy has been proposed. We report the results of this therapy in patients with symptomatic benign hepatic cysts. METHODOLOGY: Seven patients with non-parasitic, non-neoplastic benign hepatic cysts were submitted to fine-needle ultrasonography-guided aspiration, followed by injection of diluted tetracycline hydrochloride (1 g). In all cases, cytology, tumour markers and microbiology analysis of aspirates were performed. One patient required two sessions. The grade of patient satisfaction and ultrasonography changes were assessed 1, 3 and 6 months after the procedure. RESULTS: Cyst size decreased in all patient, with total collapse in three. No major complications occurred. Cytology, alpha fetoprotein, CA19.9, CEA and microbiology of the cyst fluid confirmed the initial ultrasonographic diagnosis of simple biliary cysts. Clinical complaints improved in 2 cases, and 5 patients became asymptomatic. Ultrasonography evaluation 3 months after the procedure was more reliable in predicting successful treatment. CONCLUSION: Intracystic instillation of tetracycline hydrochloride is an effective and safe technique and may become the first choice therapy for benign hepatic cysts.

Effect of electroacupuncture on physical performance of young men and responses to exercise

Chinese Medicine uses acupuncture points K-3 (Taixi), Li-3 (taichong), S-36 (Zusanli), Ren-4 (Guanyuan)and Ren-6 (Qihai) to enhance the individual's general energy, improving capacity to physical efforts, and the body threshold to fadigue. We studied the influence of these specific points on physical performance capacity (PPC) and physiological responses to excercise (PRE). Material - We assigned 27 healthy men at random to three groups: acupuncture (A), acupuncture sham (S) and control group (no acupuncture (N). Methods - Performance was determined through of a spiroergometric test was carried out at the beginning and at the end of five sucessive daily sessions, consisting of 20 minutes of electroacupuncture (EA) of the selected points. They performed a continuous incremental (25 watts/min) test until exhaunstion in bicycle ergometer (Cibex the Bike). Respiratory and metabolic variables were calculated every 20s during excercise by a computerized spiroergometric system (Vista CX). The heart was obtained by telemetry (Polar), The rate of perceived exertion (RPE) was measured by the Borg's revised scale. Results - The results before and after treatment were compared in these conditions: rest (R); moderate exercise (M); at the anaerobic threshold (AT); intense exercise (I); maximal exercise (MX) and recovery (RC). The subjects from group A didn't increase the maximal performance capacity neither the PPC at AT. Respiratory, cardiovascular responses and movement economy in M, AT, I and MX didn't improve in these group. We detected a positive effect of EA only in RPE during M. There was no differences between tests in groups S an N. Conclusion - These results suggest that the EA in studied conditions isn't effective to increase PPC or improve PRE.

Recurrence of a renal myogenic tumor presented as a duodenal ulcerated lesion.

BACKGROUND/AIM: The authors report on an extremely rare case of a recurrent myogenic tumor of renal origin presented exclusively with gastrointestinal signs and symptoms resulting from duodenal invasion. PATIENTS AND MATERIALS: A 49-year-old woman was admitted for epigastric pain and recent history of melenae. She had been submitted to right nefrectomy due to a smooth muscle tumor five years ago. RESULTS: Pathology described it as a bizarre leiomyoma. Diagnostic procedures showed lobulated and ulcerated lesions in the duodenum, a nodule within the anterior abdominal wall, a large neoplasm fulfilling the right renal loca and invading the duodenum, and another nodule at the left kidney. Histological features of all tumors were similar to those seen in the primary renal tumor. The abdominal wall nodule was the only resectable lesion. Although biopsies taken initially from the duodenal lesions failed to reveal smooth muscle tissue, they were repeated one year later and disclosed duodenal invasion from a leiomyosarcoma. CONCLUSION: This extremely rare case illustrates the striking disagreement between pathological diagnosis and clinical course of smooth muscle tumors that sometimes occur.

Endoscopic ultrasonography in the treatment of oesophageal varices by endoscopic sclerotherapy and band ligation: do we need it?

OBJECTIVE: To assess the role of endoscopic ultrasonography (EUS) in monitoring the treatment of oesophageal varices by endoscopic sclerotherapy and band ligation. METHODS: We studied 35 patients with portal hypertension undergoing elective treatment for oesophageal varices by injection sclerotherapy with absolute ethanol (group 1, n = 19) or by endoscopic variceal ligation (EVL; group 2, n = 16). All patients were examined by EUS before treatment to assess the status of their oesophago-gastric varices and the presence of collateral and perforating veins. Evaluation with EUS was repeated to confirm variceal eradication whenever endoscopy suggested successful obliteration, or to determine the reason for failure when treatment did not appear to be successful. Depending on the endosonographic findings, treatment was continued until EUS showed complete variceal eradication. RESULTS: After treatment, EUS showed insufficient variceal thrombosis in six (17%) patients who appeared to have variceal eradication at endoscopy. EUS was also superior to endoscopy for diagnosing gastric varices and showed patent vessels in 26 (74%) out of 35 patients. Gastric varices observed on EUS were detected at endoscopy in only 60% of cases. Endoscopic sclerotherapy and EVL had induced characteristic changes on EUS evaluation, and oesophageal fibrosis was observed more frequently in endoscopic sclerotherapy than in EVL-treated patients. CONCLUSION: EUS provides valuable information on the status of oesophago-gastric varices and can be used to assess the efficiency of endoscopic sclerotherapy and EVL.