[Mechanical ventilator test protocol for care of patients with COVID-19 in porcine model]. / Protocolo de prueba de ventilador mecánico para atención de pacientes con COVID-19 en modelo porcino.

As a result of the SARS-CoV-2 pandemic, health systems globally have seen a dramatic increase in the occupancy of intensive care units, with mechanical ventilators being a resource in high demand in the care of these patients. This article proposes a protocol for testing low-cost mechanical ventilators in pig models, as part of the development of locally manufactured biomedical equipment that can support the health crisis caused by the pandemic. The protocol addresses aspects that include the pre-test phase, anesthetic and airway management, laboratory monitoring, recovery and monitoring of the animal. This document presents to the academic community a validation protocol of a mechanical ventilator prototype in a pig specimen that can be a reference for its application and revalidation by other groups interested in the development of local and low-cost technologies.

A raíz de la pandemia generada por el SARS-CoV-2, los sistemas de salud de los distintos países han experimentado un dramático aumento en la ocupación de las unidades de cuidado intensivo y, por ende, una alta demanda de ventiladores mecánicos. En este artículo se propone un protocolo de pruebas de ventiladores mecánicos de bajo costo en modelos porcinos, como parte del desarrollo de equipos biomédicos que pueden apoyar la crisis sanitaria suscitada por la pandemia. El protocolo aborda aspectos que incluyen la fase previa a la prueba, el manejo anestésico, de vía aérea, seguimiento de laboratorio, recuperación y seguimiento del animal. Como resultado, se presenta a la comunidad académica un protocolo de validación de prototipo de ventilador mecánico en espécimen porcino como un referente para su aplicación y revalidación por parte de grupos interesados en el desarrollo de tecnologías locales de bajo costo.

Protocolo de prueba de ventilador mecánico para atención de pacientes con COVID-19 en modelo porcino / Mechanical ventilator test protocol for care of patients with COVID-19 in porcine model

RESUMEN A raíz de la pandemia generada por el SARS-CoV-2, los sistemas de salud de los distintos países han experimentado un dramático aumento en la ocupación de las unidades de cuidado intensivo y, por ende, una alta demanda de ventiladores mecánicos. En este artículo se propone un protocolo de pruebas de ventiladores mecánicos de bajo costo en modelos porcinos, como parte del desarrollo de equipos biomédicos que pueden apoyar la crisis sanitaria suscitada por la pandemia. El protocolo aborda aspectos que incluyen la fase previa a la prueba, el manejo anestésico, de vía aérea, seguimiento de laboratorio, recuperación y seguimiento del animal. Como resultado, se presenta a la comunidad académica un protocolo de validación de prototipo de ventilador mecánico en espécimen porcino como un referente para su aplicación y revalidación por parte de grupos interesados en el desarrollo de tecnologías locales de bajo costo.

ABSTRACT As a result of the SARS-CoV-2 pandemic, health systems globally have seen a dramatic increase in the occupancy of intensive care units, with mechanical ventilators being a resource in high demand in the care of these patients. This article proposes a protocol for testing low-cost mechanical ventilators in pig models, as part of the development of locally manufactured biomedical equipment that can support the health crisis caused by the pandemic. The protocol addresses aspects that include the pre-test phase, anesthetic and airway management, laboratory monitoring, recovery and monitoring of the animal. This document presents to the academic community a validation protocol of a mechanical ventilator prototype in a pig specimen that can be a reference for its application and revalidation by other groups interested in the development of local and low-cost technologies.

Protocolo de prueba de ventilador mecánico para atención de pacientes con COVID-19 en modelo porcino / Mechanical ventilator test protocol for care of patients with COVID-19 in porcine model

RESUMEN A raíz de la pandemia generada por el SARS-CoV-2, los sistemas de salud de los distintos países han experimentado un dramático aumento en la ocupación de las unidades de cuidado intensivo y, por ende, una alta demanda de ventiladores mecánicos. En este artículo se propone un protocolo de pruebas de ventiladores mecánicos de bajo costo en modelos porcinos, como parte del desarrollo de equipos biomédicos que pueden apoyar la crisis sanitaria suscitada por la pandemia. El protocolo aborda aspectos que incluyen la fase previa a la prueba, el manejo anestésico, de vía aérea, seguimiento de laboratorio, recuperación y seguimiento del animal. Como resultado, se presenta a la comunidad académica un protocolo de validación de prototipo de ventilador mecánico en espécimen porcino como un referente para su aplicación y revalidación por parte de grupos interesados en el desarrollo de tecnologías locales de bajo costo.

ABSTRACT As a result of the SARS-CoV-2 pandemic, health systems globally have seen a dramatic increase in the occupancy of intensive care units, with mechanical ventilators being a resource in high demand in the care of these patients. This article proposes a protocol for testing low-cost mechanical ventilators in pig models, as part of the development of locally manufactured biomedical equipment that can support the health crisis caused by the pandemic. The protocol addresses aspects that include the pre-test phase, anesthetic and airway management, laboratory monitoring, recovery and monitoring of the animal. This document presents to the academic community a validation protocol of a mechanical ventilator prototype in a pig specimen that can be a reference for its application and revalidation by other groups interested in the development of local and low-cost technologies.

Post-fire recovery of a dense ombrophylous forest in Amazon.

The fires that occur in the Amazon are as damaging as the deforestation is. There is a need for further long-term studies on dynamics of tree communities in forests affected by fires. In the present study we evaluated the dynamics of tree species, before and after an accidental fire that occurred in 1997 in an experimental area of terra firme forest in the Floresta Nacional do Tapajós, in western Pará State, Brazil. Approximately 3500 trees with diameter measured at 1.30 m above ground (DBH) ≥ 5 cm were botanically identified and measured in 12 permanent plots of 0.25 ha (50 m x 50 m), in 1983, 1987, 1989, 1995, 2008 and 2012. Analyses of survival, mortality and recruitment of trees were performed. The results showed that although the fire has increased the mortality and recruitment rates after 15 years, the highest mortality occurred on trees with smaller diameters (DBH < 30 cm), so the fire did not affect the survival of large trees in the long term, explaining why the reduction in density of living trees has not greatly influenced the decrease in basal area in the burned forest.

Composition and Structure of Thripidae Populations in Crops of Three Geographical Regions in Colombia.

The composition and structure of thrips populations were determined in agroecosystems of 10 crops in the Andean, Caribbean, and Orinoquia regions of Colombia. From 18,183 identified specimens, 81 species belonging to 20 genera and three families were found. The Andean region was the most diverse with 60 species (n = 11,360, Chao 1 = 70.5, H' = 1.986), followed by the Caribbean region with 42 (n = 5,960, Chao 1 = 57.6, H' = 2.256) and the Orinoquia with 24 (n = 863, Chao 1 = 31; H' = 2.301). The crop with the richest fauna was avocado (Persea americana) Mill. with 40 species (n = 4,047, Chao 1 = 55.17, H' = 1.302), followed by coffee (Coffea arabica) L. with 26 (n = 1,395, Chao 1 = 33; H' = 1.026), cassava (Manihot esculenta) Crantz. with 25 (n = 1,050, Chao 1 = 29.67, H' = 1.635), citrus (Citrus spp.) with 22 (n= 836, Chao 1 = 25.75, H' = 1.748), corn (Zea mays) L. with 22 (n = 1,647, Chao 1 = 24.5, H' = 1.365), mango (Mangifera indica) L. with 17 (n = 1,144, Chao 1 = 18.5, H' = 1.303), blackberry (Rubus glaucus) Bentham. with 11 (n = 545, Chao 1 = 16, H' = 0.886), banana (Musa spp.) with 9 species (n = 1,798, Chao 1 = 9, H' = 0.208), cotton (Gossypium hirsutum) L. with 8 (n = 5,621, Chao 1 = 11, H' = 0.913), and rubber tree (Hevea brasiliensis) Müll.Arg. with 4 species (n = 90, Chao 1 = 4, H' = 0.594). Differences were found in the distribution of the species in the altitudinal gradients and in the biogeographical regions. Frankliniella gardeniae Moulton, was the most abundant species, with the highest presence in crops, the greatest geographic and altitudinal distribution.

Antral Follicles Count and Anti-Müllerian Hormone Levels after Gonadotoxic Chemotherapy in Patients with Breast Cancer: Cohort Study.

Aim To assess ovarian reserve (OVR) by means of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) measurement in eumenorrheic women with breast cancer, exposed to gonadotoxic chemotherapy. Method Fifty-two women (35.3 ± 3.8 years old) with breast cancer and undergoing cyclophosphamide-containing chemotherapy were enrolled. The assessment was performed before chemotherapy (T1) and after 2 (T2) and 6 months (T3). Results Six months after chemotherapy, the prevalence of regular cycles was 60%. Anti-Müllerian hormone decreased down to undetectable levels at T2 and T3 (T1: 2.53 [1.00-5.31]; T2 < 0.08; T3: < 0.08 [< 0.08-1.07] ng/mL), (p < 0.0001). Antral follicle count was 11 [8.0-13.5] follicles at T1 and lower at T2 (5.50 [3.75-8.0] and T3 (5.0 [2.5-7.0]) (p < 0.0001). In patients who remained with regular cycles during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged. Conclusion Anti-Müllerian hormone and AFC are useful as markers of OVR decline in women exposed to chemotherapy. Follicle-stimulating hormone is only adequate in women who become amenorrheic.

Antral Follicles Count and Anti-Müllerian Hormone Levels after Gonadotoxic Chemotherapy in Patients with Breast Cancer: Cohort Study / Contagem de folículos antrais e níveis de hormônio anti-Mülleriano após quimioterapia gonadotóxica em pacientes com câncer de mama: estudo de coorte

Abstract Aim To assess ovarian reserve (OVR) by means of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) measurement in eumenorrheic women with breast cancer, exposed to gonadotoxic chemotherapy. Method Fifty-two women (35.3 ± 3.8 years old) with breast cancer and undergoing cyclophosphamide-containing chemotherapy were enrolled. The assessment was performed before chemotherapy (T1) and after 2 (T2) and 6 months (T3). Results Six months after chemotherapy, the prevalence of regular cycles was 60%. Anti-Müllerian hormone decreased down to undetectable levels at T2 and T3 (T1: 2.53 [1.00–5.31]; T2 < 0.08; T3: < 0.08 [< 0.08–1.07] ng/mL), (p< 0.0001). Antral follicle count was 11 [8.0–13.5] follicles at T1 and lower at T2 (5.50 [3.75–8.0] and T3 (5.0 [2.5–7.0]) (p< 0.0001). In patients who remained with regular cycles during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged. Conclusion Anti-Müllerian hormone and AFC are useful as markers of OVR decline in women exposed to chemotherapy. Follicle-stimulating hormone is only adequate in women who become amenorrheic.

Resumo Objetivo Avaliar a reserva ovariana (OVR) através da contagem de folículos antrais (AFC), dosagem sérica de hormônio folículo estimulante (FSH) e hormônio anti-Mülleriano (AMH) em mulheres com câncer de mama submetidas a quimioterapia gonadotóxica. Método Foram incluídas na pesquisa 52 mulheres (35,3 ± 3,8 anos) com câncer de mama, em tratamento com quimioterapia com ciclofosfamida. As dosagens e medidas foram realizadas antes do início da quimioterapia (T1) e após 2 (T2) e 6 meses (T3). Resultados Seis meses após quimioterapia, a prevalência de ciclos regulares foi de 60%. O AMH sérico diminuiu a níveis indetectáveis em T2 e T3 (T1: 2,53 [1,00–5,31] ]; T2 < 0,08; T3: < 0,08 [< 0,08–1,07] ng/mL) (p< 0,0001). A contagem de folículos antrais foi de 11 [8,0–13,5] folículos em T1, e ainda menor em T2 (5,50 [3,75–8,0] e T3 (5,0 [2,5–7,0]), (p< 0,0001). Em pacientes que mantiveram ciclos regulares durante a quimioterapia ou retomaram a menstruação normalmente, os níveis de FSH e estradiol permaneceram inalterados. Conclusão O AMH e a AFC são marcadores úteis do declínio da OVR em mulheres expostas à quimioterapia. O FSH só é adequado em mulheres que se tornam amenorreicas.

Alternativa de un programa de ejercicios simultáneos para la rehabilitación de pacientes hemipléjicos / Alternative of a program of simultaneous exercises for the rehabilitation of hemiplegic patient

Introducción: las enfermedades cerebrovasculares constituyen afecciones en las que los vasos sanguíneos cerebrales se encuentran lesionados. Dicho proceso puede ser intrínseco del vaso o consecuencia de émbolos que provienen del corazón o de la circulación extracraneal. Objetivo: evaluar la eficacia de la aplicación de un programa de ejercicios de forma alterna y coordinada en la rehabilitación de pacientes con hemiplejía causada por enfermedad cerebrovascular isquémica. Método: se realizó un estudio experimental tipo ensayo clínico terapéutico controlada fase II, a ciegas por terceros, en la sala de rehabilitación del policlínico René Vallejo Ortíz de Bayamo en el periodo comprendido entre marzo del 2014-marzo del 2015 para evaluar la eficacia de un programa de ejercicios para la rehabilitación de pacientes hemipléjicos. El universo de trabajo estuvo constituido por 23 pacientes con hemiplejia que acudieron a dicha sala de rehabilitación en el periodo de estudio y la muestra por 16 que cumplieron con los criterios de inclusión. Resultados: al analizar la respuesta terapéutica se pudo apreciar que existió una diferencia de proporciones de p=0,1573, estando estos resultados influenciados por el tamaño de la muestra y aunque desde el punto de vista estadísticos no tienen una diferencia significativa, desde el punto de vista social se alcanza el objetivo trazado. Conclusiones: se pudo concluir que con la aplicación de dicho método mejora la fuerza muscular y la marcha en un periodo corto de tiempo, por lo que resulta eficaz para lograr su rehabilitación(AU)

Introduction: cerebrovascular diseases are conditions in which the cerebral blood vessels are injured. Such a process may be intrinsic to the vessel or the consequence of emboli originating from the heart or extracranial circulation. Objective: to evaluate the effectiveness of the application of an alternating and coordinated exercise program in the rehabilitation of patients with hemiplegia caused by ischemic cerebrovascular disease. Method: an experimental study was conducted in the rehabilitation room of the René Vallejo Ortiz polyclinic from Bayamo in the period from March 2014 to March 2015 to evaluate efficacy of an exercise program for the rehabilitation of hemiplegic patients. The work universe consisted of 23 patients with hemiplegia who came to the rehabilitation room during the study period and the sample by 16 who met the inclusion criteria. Results: when analyzing the therapeutic response, it was observed that there was a difference of proportions of P = 0.1573, these results being influenced by the size of the sample and although from the statistical point of view they do not have a significant difference, from the point Social objective is achieved the goal outlined. Conclusions: it was possible to conclude that with the application of this method improves muscle strength and gait in a short period of time, making it effective to achieve rehabilitation(EU)

Age, anti-müllerian hormone, antral follicles count to predict amenorrhea or oligomenorrhea after chemotherapy with cyclophosphamide.

BACKGROUND: A cohort study was performed to identify ovarian reserve markers (ORM) that predicts amenorrhea or oligomenorrhea 6 months after cyclophosphamide CTX in women with breast cancer. METHODS: 52 eumenorrheic patients with breast cancer were enrolled. FSH, anti-Müllerian hormone (AMH), antral follicles count (AFC) were measured before and 6 months after CTX. A logistic regression for independent samples and determination of the ROC curve were performed. RESULTS: The age of 32 years presented 96 % of sensitivity and 39 % of specificity to predict amenorrhea or oligomenorrhea with ROC area under the curve (AUC) of 0.77. ovarian reserve marker (ORM) with power to predict amenorrhea or oligomenorrhea in women after CTX were AMH <3.32 ng/mL (sensitivity of 85 %, specificity of 75 % and AUC 0.87), AFC <13 follicles (sensitivity 81 %, specificity 62 %, AUC 0.81). AMH cutoff to predict amenorrhea was 1.87 ng/mL (sensitivity 82 %, specificity 83 %, AUC 0.84) and AFC cutoff was 9 follicles (sensitivity 71 %, specificity 78 %, AUC 0.73). CONCLUSIONS: ≥32-years-old women, AMH <3.32 ng/mL and AFC <13 follicles determined significantly higher risk of amenorrhea or oligomenorrhea after CTX with cyclophosphamide. The ORM age (≥32 years) analyzed together with AMH or AFC increases sensitivity and specificity in predicting amenorrhea or oligomenorrhea.

Dimensionamento amostral para avaliação de altura e diâmetro de mudas de Cabralea canjerana / Sample size for evaluating the height and diameter of seedlings Cabralea canjerana

Em viveiros florestais, é importante determinar o número de plantas a serem avaliadas para que as inferências sobre crescimento das mudas sejam confiáveis. O objetivo deste trabalho foi estimar o tamanho de amostra (número de plantas) necessário para avaliar a altura de planta, o diâmetro do coleto e a relação altura de planta/diâmetro do coleto de mudas de canjerana (Cabralea canjerana (Vell.) Mart.) e verificar a variabilidade do tamanho de amostra entre tubetes, substratos e idades de avaliação. Foi conduzido um experimento, em viveiro, no qual foram avaliados nove tratamentos, formados pela combinação de três tamanhos de tubetes (100, 180 e 280cm³) e três tipos de substratos (100% de turfa, 80% de turfa + 20% de casca de arroz carbonizada e 60% de turfa + 40% de casca de arroz carbonizada), no delineamento experimental em blocos ao acaso, com quatro repetições. Em dez idades de avaliação, foram mensurados os caracteres altura de planta e diâmetro do coleto, e calculada a relação altura de planta/diâmetro do coleto, em dez plantas, tomadas aleatoriamente, na área central de cada unidade experimental. Foram realizadas análises de variância, testes de comparação de médias, verificação de normalidade e calculado o tamanho de amostra. O tamanho de amostra para avaliar a altura de planta, o diâmetro do coleto e a relação altura de planta/diâmetro do coleto de mudas de canjerana é dependente da idade de avaliação. Para os tubetes, substratos e idades de avaliação estudados, 18 plantas por unidade experimental (bandeja) são suficientes para a estimação da média desses caracteres, para um erro de estimação igual a 10% da média estimada, com grau de confiança de 95%.

In nurseries, it is important to determine the number of plants to be evaluated so that inferences about seedling growth are reliable. The aim of this research was to estimate the sample size (number of plants) necessary to evaluate plant height, collar diameter and relation plant height/collar diameter of canjerana seedlings (Cabralea canjerana (Vell.) Mart.) and to verify its variability among tubes, substrates and ages evaluation. An experiment was conducted in the nursery, in which nine treatments, organized in randomizes blocks design with four replication, were formed by the combination of three sizes of tubes (100, 180 and 280cm³) and three substrates (100% peat, 80% peat + 20% rice hulls and 60% peat + 40% rice hulls). It was evaluated the following characters, in ten ages: plant height, collar diameter and relation plant height/collar diameter, in ten plants sampled at random in each experimental unit. Analyses of variance, means comparison tests and verification of normality were carried and the sample size was calculated. The sample size to evaluate the plant height, collar diameter and relation plant height/collar diameter of canjerana seedlings is dependent on age evaluation. For the tubes, substrates and ages evaluation studied, 18 plants per experimental unit (pot) are enough to predict the these characters average, with an estimation error equal to 10% of estimated average, with a degree confidence of 95%.

Isolation and molecular identification of Leishmania chagasi from a bat (Carollia perspicillata) in northeastern Venezuela.

This report describes the isolation of a Leishmania chagasi strain from a bat (Carollia perspicillata), and its identification using biological methods and molecular characterization. The parasites were isolated in an artificial culture medium from a blood sample extracted from a bat heart. The isolate was then inoculated into the footpads of Balb/c mice, which subsequently developed a typical nodular leishmanial lesion; the parasites were confirmed as Leishmania by smear and histopathology. Molecular characterization of the parasites was performed by polymerase chain reaction with species-specific primers, kDNA restriction pattern following Hae III endonuclease digestion and dot blot hybridization using a kDNA probe. This report demonstrates that bats can be hosts for L. chagasi species and suggests the need for studies to determine whether they may be involved in foci of visceral leishmaniasis.

Isolation and molecular identification of Leishmania chagasi from a bat (Carollia perspicillata) in northeastern Venezuela

This report describes the isolation of a Leishmania chagasi strain from a bat (Carollia perspicillata), and its identification using biological methods and molecular characterization. The parasites were isolated in an artificial culture medium from a blood sample extracted from a bat heart. The isolate was then inoculated into the footpads of Balb/c mice, which subsequently developed a typical nodular leishmanial lesion; the parasites were confirmed as Leishmania by smear and histopathology. Molecular characterization of the parasites was performed by polymerase chain reaction with species-specific primers, kDNA restriction pattern following Hae III endonuclease digestion and dot blot hybridization using a kDNA probe. This report demonstrates that bats can be hosts for L. chagasi species and suggests the need for studies to determine whether they may be involved in foci of visceral leishmaniasis.

Immediate ureterovaginal fistula secondary to oocyte retrieval--a case report.

OBJECTIVE: To report a case of ureterovaginal fistula secondary to transvaginal oocyte retrieval (TVOR). DESIGN: Case report. SETTING: IVF Center IN a private hospital. PATIENT(S): A 31-year-old woman presented immediately after TVOR with right lower abdominal pain with irradiation to the suprapubic area and vaginal discharge. INTERVENTION(S): Vaginal examination, creatinine dosage in plasma and vaginal discharge, excretory urography. A double-J catheter was inserted under general anesthesia. MAIN OUTCOME MEASURE(S): Clinical follow-up. RESULT(S): Vaginal leakage ceased a few hours after catheter insertion. Transfer of two embryos was performed 3 days after TVOR, but no pregnancy occurred. The double-J catheter was removed 21 days after its placement. Imaging studies done 6 weeks later demonstrated a normal urinary tract morphology. CONCLUSION(S): Given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureterovaginal fistula.

Hormônio anti-mulleriano: um marcador mais fidedigno da reserva ovariana? / Anti-mullerian hormone: a better marker of ovarian reserve?

O Hormônio anti-mulleriano (HAM) é uma glicoproteína dimérica, membro da super família TGF (transforming growth factor), descoberto em 1947 por Alfred Jost. Além da produção de HAM pelas células de Sertoli testiculares, as células da granulosa dos folículos ovarianos sintetizam HAM em discretas quantidades a partir de 32 semanas de vida intra-uterina, com níveis séricos variáveis ao longo da vida reprodutiva. O HAM parece ter ação regulatória no desenvolvimento folicular com ação inibitória sobre o crescimento de folículos primordiais e crescimento folicular induzido pelo FSH. Por estas razões, acredita-se que o HAM tenha relação direta com o pool folicular apontando como novo marcador de reserva ovariana. Foi realizada revisão na literatura dos principais estudos sobre o HAM e suas implicações na regulação do desenvolvimento folicular, marcador de reserva ovariana, preditor de desfecho em ciclos de fertilização in vitro e de ocorrência da menopausa, associação com amenorréia secundária e neoplasias. O HAM parece ser um marcador mais fiel e fidedigno para avaliação da reserva ovariana, sendo melhor do que o FSH e Inibina B e correlacionando-se com a contagem de folículos antrais, apesar de ainda dispormos de poucos estudos para abordarmos sua dosagem como rotina.

Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report.

Severe mucocutaneous (MCL) and diffuse (DCL) forms of American cutaneous leishmaniasis (ACL) are infrequent in Venezuela. Chemotherapy produces only transitory remission in DCL, and occasional treatment failures are observed in MCL. We have evaluated therapy with an experimental vaccine in patients with severe leishmaniasis. Four patients with MCL and 3 with early DCL were treated with monthly intradermal injections of a vaccine containing promastigotes of Leishmania (Viannia) braziliensis killed by pasteurization and viable Bacillus Calmette- Guerin. Clinical and immunological responses were evaluated. Integrity of protein constituents in extracts of pasteurized promastigotes was evaluated by gel electrophoresis. Complete remission of lesions occurred after 5-9 injections in patients with MCL or 7-10 injections in patients with early DCL. DCL patients developed positive skin reactions, average size 18.7 mm. All have been free of active lesions for at least 10 months. Adverse effects of the vaccine were limited to local reactivity to BCG at the injection sites and fever in 2 patients. Extracts of pasteurized and fresh promastigotes did not reveal differences in the integrity of protein components detectable by gel electrophoresis. Immunotherapy with this modified vaccine offers an effective, safe option for the treatment of patients who do not respond to immunotherapy with vaccine containing autoclaved parasites or to chemotherapy.

Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report

Severe mucocutaneous (MCL) and diffuse (DCL) forms of American cutaneous leishmaniasis (ACL) are infrequent in Venezuela. Chemotherapy produces only transitory remission in DCL, and occasional treatment failures are observed in MCL. We have evaluated therapy with an experimental vaccine in patients with severe leishmaniasis. Four patients with MCL and 3 with early DCL were treated with monthly intradermal injections of a vaccine containing promastigotes of Leishmania (Viannia) braziliensis killed by pasteurization and viable Bacillus Calmette- Guerin. Clinical and immunological responses were evaluated. Integrity of protein constituents in extracts of pasteurized promastigotes was evaluated by gel electrophoresis. Complete remission of lesions occurred after 5-9 injections in patients with MCL or 7-10 injections in patients with early DCL. DCL patients developed positive skin reactions, average size 18.7 mm. All have been free of active lesions for at least 10 months. Adverse effects of the vaccine were limited to local reactivity to BCG at the injection sites and fever in 2 patients. Extracts of pasteurized and fresh promastigotes did not reveal differences in the integrity of protein components detectable by gel electrophoresis. Immunotherapy with this modified vaccine offers an effective, safe option for the treatment of patients who do not respond to immunotherapy with vaccine containing autoclaved parasites or to chemotherapy.