RESUMEN
American cutaneous leishmaniasis (ACL) has different clinical manifestations and these manifestations are dependent on the immunological status of the host. As CD4(+) and CD8(+) T cells and their mediators play a fundamental role in the host response to Leishmania and there is also a search for antigenic molecules to be used as future vaccines and tools for prognostic tests, this study characterized ACL patients' immune response after stimulation with soluble and insoluble fractions of L. (V.) braziliensis. We demonstrated a prevailing production of the Th2 cytokines, IL-4 and IL-10 and a specific production of IFN-γ and TNF-α in patients before treatment. There was also a predominance of CD4(+) T cells and a small percentage CD8(+) T cells. The insoluble antigenic fraction primarily stimulated CD4(+) T cells, while the soluble antigenic fraction showed a mixed profile, with CD4(+) T cells being the main responsible for Th2 cytokines and CD8(+) T cells for Th1 cytokines. Therefore, our results showed that a down-modulation of the Th1 type of response occurs in the initial phase of L. braziliensis disease, being the antigenic fractions capable of stimulating a specific immune response.
Asunto(s)
Antígenos de Protozoos/inmunología , Citocinas/metabolismo , Leishmania braziliensis/inmunología , Leishmania braziliensis/patogenicidad , Leishmaniasis Cutánea/inmunología , Células Th2/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos de Protozoos/química , Linfocitos T CD4-Positivos/inmunología , Femenino , Citometría de Flujo , Humanos , Interleucina-10/metabolismo , Interleucina-4/metabolismo , Leishmaniasis Cutánea/parasitología , Leishmaniasis Cutánea/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: The aim of this study was to evaluate the cardiovascular effects of maxillary infiltration using 2% lidocaine with 1:100,000 adrenaline, 4% articaine with 1:200,000 adrenaline, and 4% articaine with 1:100,000 adrenaline in different stages during restorative dental procedures. METHODS: Twenty healthy patients randomly received 1.8 mL of the three local anaesthetics. Systolic blood pressure, average blood pressure, diastolic blood pressure, and heart rate were evaluated by the oscillometric and photoplethysmograph methods in seven stages during the appointment. RESULTS: Statistical analysis by ANOVA and Tukey tests of cardiovascular parameters did not show significant differences between the anaesthetic associations. There were significant differences for the parameters among different clinical stages. CONCLUSIONS: The variation of cardiovascular parameters was similar for lidocaine and articaine with both adrenaline concentrations and showed no advantage of one drug over the other. Cardiovascular parameters were influenced by the stages of the dental procedures, which showed the effect of anxiety during restorative dental treatment.
Asunto(s)
Anestésicos Locales/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Restauración Dental Permanente/métodos , Frecuencia Cardíaca/efectos de los fármacos , Adolescente , Adulto , Presión Sanguínea/fisiología , Carticaína/administración & dosificación , Ansiedad al Tratamiento Odontológico/fisiopatología , Preparación de la Cavidad Dental/instrumentación , Preparación de la Cavidad Dental/métodos , Prueba de la Pulpa Dental , Estimulación Eléctrica , Epinefrina/administración & dosificación , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Inyecciones , Lidocaína/administración & dosificación , Masculino , Monitoreo Fisiológico , Oscilometría , Fotopletismografía/efectos de los fármacos , Factores de Tiempo , Vasoconstrictores/administración & dosificación , Adulto JovenRESUMEN
More precise and rapid diagnostic methods for American cutaneous leishmaniasis (ACL) are necessary because of the growing number of cases observed in Brazil, including the northeastern region of the State of São Paulo. We applied PCR to 54 skin or mucosal biopsies from patients with a clinical and/or laboratory diagnosis of ACL using primers 13A and 13B, with positive results being obtained for 82% of the samples. When the PCR results were compared to those of histopathological leishmania detection, PCR showed superior results with 81.5% sensitivity and 95% CI of 68.0-95.1%. The Montenegro skin test (MST) was positive in 88.7% of patients. Since MST cannot be used as a diagnostic tool in endemic areas, the present results strongly suggest the use of PCR for the etiological confirmation of ACL, with emphasis on the mucosal form.
Asunto(s)
ADN de Cinetoplasto/análisis , Leishmania/aislamiento & purificación , Leishmaniasis Cutánea/diagnóstico , Reacción en Cadena de la Polimerasa , Animales , Estudios de Casos y Controles , Humanos , Leishmania/genética , Leishmaniasis Cutánea/patología , Sensibilidad y EspecificidadRESUMEN
More precise and rapid diagnostic methods for American cutaneous leishmaniasis (ACL) are necessary because of the growing number of cases observed in Brazil, including the northeastern region of the State of Säo Paulo. We applied PCR to 54 skin or mucosal biopsies from patients with a clinical and/or laboratory diagnosis of ACL using primers 13A and 13B, with positive results being obtained for 82 percent of the samples. When the PCR results were compared to those of histopathological leishmania detection, PCR showed superior results with 81.5 percent sensitivity and 95 percent CI of 68.0-95.1 percent. The Montenegro skin test (MST) was positive in 88.7 percent of patients. Since MST cannot be used as a diagnostic tool in endemic areas, the present results strongly suggest the use of PCR for the etiological confirmation of ACL, with emphasis on the mucosal form
