Doctors' awareness concerning primary immunodeficiencies in Brazil.

BACKGROUND: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.

Níveis séricos de proteína catiônica eosinofílica e contagem de eosinófilos em crianças enteroparasitadas,residentes em área de baixo nível sócio-econômico na cidade de Natal, RN, Brasil / Serum eosinophil cationic protein levels end eosinophil counting in children enteroparasited

A Proteína Catiônica Eosinofílica (ECP) foi purificada de células humanas, pela primeira vez, em 1971 e, após cinco anos, foi identificada como sendo uma proteína granular eosinofílica que possui uma potente toxicidade para uma variedade de helmintos, bactérias e outros microrganismos. O objetivo deste trabalho foi diagnosticar as infecções por enteroparasitas correlacionando com níveis séricos de proteína catiônica eosinofílica e eosinofilia. Foram estudadas 150 crianças de ambos os sexos, com idade variando entre 3 e 6 anos, residentes no mesmo bairro e frequentadoras de creche. A Infecção Parasitária foi investigada por Exames de fezes pelosMétodos de Hoffmann, Pons & Janer e o de Baermann-Morais. Os níveis séricos de proteína catiônica eosinofílica foram determinadospor Fluoroenzimaimunoensaio, utilizando o Kit Unicap (Pharmacia & Upjonh) e a contagem de eosinófilos realizada em esfregaço sanguíneo corado pelo Leishman. Das crianças estudadas 140 (93,3%) apresentaram infecção por enteroparasitas e 10 (6,7%) apresentaram ausência de ovos e larvasde helmintos e cistos de protozoários. Cento e quarenta e oito amostras de soro foram analisadas para determinar os níveis de proteína catiônica eosinofílica e os resultados obtidos mostraram que foi 45,45μg/L a mediana das concentrações observadas e que com relação aos níveis de ECP em crianças parasitadas e não parasitadas por helmintos observou-se que as crianças parasitadas apresentaramconcentrações (MD=52,20μg/L) significantemente mais elevadas do que as não parasitadas (MD=29,70μg/L) e que houve uma correlação positiva entre níveis séricos de ECP e eosinófilos ( p< 0,0001 e r= 0,57).

The eosinophil cationic protein was purified from human cells, for the fist time in 1971, after five years, it was identified as being a eosinophil granular protein that is potencially toxic for helminthics, bacteria and other microorganisms. The purpose of this study was to diagnose the enteroparasitics infections co-related to the serum levels of eosinophil cationic protein and eosinophilia. One hundred and fifty children form both sexes, ages varying from 3 to 6 years old who live in the same neighbourhood and go to the same nursery were observed. The parasitic infection was investigated by faecal examinations using the Hoffmann, Pons & Janer and Baermann-morais methods. The serum cationic protein levels were determined by fluorimmunassay using the unicap kit (Pharmacia & Upjohn) and the counting of eosinophis was made by Leishman- stained smears. From the studied children 140 (93,3%) were infected by enteroparasitics and 10 (6,7%) showed no signs of eggs, helminthics, larva,and protozoarios cysts. One hundred and light samples of serum were analysed to determine the levels of eosinophil cationis protein and the obtaind results have showed that 45,45 ìg/L was the overage of the studied concentrations and that the relationship between the levels of eosinophil cationic protein (ECP) in parasited and non-parasited children was that the parasited children showed significantly hight concentrations (MD=52,20ìg/L) than the non-parasited children (MD=29,70 ìg/L). The results also have showed that there was a positive correlation between the serum levels of ECP and eosinophis ( p<0,0001 and r = 0,57).

IgA secretora total e específica no colostro e leite de mães da cidade do Natal-Rio Grande do Norte, Brasil / Total and specific IgA in colostrum and milk of mothers of Natal-Rio Grande do Norte, Brasil

PURPOSE: To determine the concentration of total secretory IgA and evaluate the repertoire of IgA antibodies to enteropathogenic Escherichia coli and Shigella flexneri antigens in colostrums and milk from mothers in Natal, RN. METHODS: The sample was constituted by 22 healthy clinically women whose babies were born at public hospital in Natal, RN. To determine total secretory IgA a radial immunedifusion tecnique (Mancini et al, 1965), was employed and to detect specific antibodies, immuneenzimatic assays, ELISA was used. RESULTS: The median values of total secretory IgA concentration presented individual variations with high levels in colostrums samples, decreasing during lactation, it was observed a p < 0.001 among the samples from the first day of lactation, to the thirtieth for total IgA concentration. All the donators present in colostrum and milk specific antibodies to Escherichia coli enteropathogenic (EPEC) and Shigella flexneri with titles higer in colostrum. There was parallel and directional pattern between total IgA and IgA anti-EPEC and Shegella flexneri, during period. CONCLUSION: The concentrations of total SIgA and specific antibodies to enteropathogenic Escherichia coli and Shigella flexneri in colostrums and milk in our study do not differ from others accomplished among populations with the same social and econimic features, stressing the importance of human milk as a protector agent against pathogens.

Avaliação nutricional em crianças com infecçoes por enteroparasitas / Nutritional evaluation of children with enteroparasitosis

PURPOSE: To evaluate the nutritious state in children of low social-economic class in order to look over a possible corelationship among this status and the infections caused by enteroparasites. METHODS: 103 children were submitted to a nutritions evolution and to accomplish a exam of serial samples. The method employed searched protozoan cystos, helmints eggs and larvae and it counted helmint eggs when presented through 4 different methods of diagnosis. RESULTS: The results obtained show that the poor environmental and social-economic conditions helped create a high infectious frequency caused by enteroparasites, mainly by Trichuris trichiura and Ascaris lumbricoides, among the helminthes, and Endolimax nana and Giardia lamblia, among the protozoans. light malnutrition without protein deficit was found in 93.55% and moderate malnutrition in 6.45% of the children malnutrition (30.7%). CONCLUSION: Then, it is possible to suggest that children besides bearing many parasitosis were not weth their nutritional state deeply compromised.

Immunotherapy of metastases with lymphocytes treated with exogenous RNA in mice bearing B16 melanoma.

Subline B16-F10, a variant cell line of B16 melanoma, is highly metastatic to the lung when injected intravenously into C57BL/6 mice. This experimental metastasis model was used to test the anti-tumor effect of exogenous RNA extracted from the lymphoid organs of immunized animals with B16-F10 cells. This RNA preparation is referred to as B16-RNA. Adoptive immunotherapy with lymphocytes treated with B16-RNA was effective in reducing significantly the number of pulmonary metastatic nodules. Lymphocytes incubated with medium alone or with RNA from non-immunized animals (N-RNA) were used as controls. The ability of B16-RNA in modulating antimetastatic activity of normal lymphocytes is abolished by hydrolysis with KOH. This finding indicates that the integrity of the polynucleotide chain is essential for the activity of B16-RNA. The anti-tumor effect of lymphocytes treated with B16-RNA was enhanced by incubation with a low dose of interleukin-2 (IL-2). A possible role of the double-stranded RNA dependent protein kinase in this phenomenon is discussed.