[Communication with a culturally and linguistically diverse population from Primary Care]. / La comunicación con población cultural y lingüísticamente diversa desde la Atención Primaria.

The care of a culturally and linguistically diverse population is a challenge in primary health care due to language barriers and cultural differences. For this reason, good communication and cultural competence of health personnel is key within medical consultation. Thus, during consultations with this group of people, it is the doctor's duty to identify the patient's culture, their perception of the concept of health, in what way and to what extent they want to be informed, and the role they want to assign to the members of their family before the treatment process begins. For this reason, there are interventions that seek to optimize the care provided to these patients and mitigate the cultural barrier, including the use of multimodal digital tools, the use of translators or interpreters, and training of health personnel in communication and intercultural skills.

Progesterone in vitro increases growth, motility and progesterone receptor expression in third stage larvae of Toxocara canis.

The in vitro effect of progesterone in T. canis larvae on their enlargement and motility were evaluated, together to the possible presence of progesterone receptors (PRs). T. canis larvae were cultured in RPMI-1640 with different concentrations of progesterone (0, 20, 40, 80, 400 and 800 ng/mL). Enlargement and increases in motility were dependent on the concentration only from 0 to 80 ng/mL (p < 0.05). The mean percentage of PR + cells in newly obtained larvae as measured by flow cytometry was 8.16 ± 0.4. The number of PR + cells increased depending on concentration from 0 to 80 ng/mL (p < 0.001). Cells obtained from larvae stimulated at any of the studied hormone concentrations showed greater mean fluorescence intensity when compared to non-stimulated cells. Additionally, the expression and location of PR + cells were determined in the larvae. The sequence of an amplicon (420-bp) obtained by PCR from T. canis larvae showed 100% homology with a gene fragment that codes for the PR of the dog. PR + cells were immunolocated using confocal microscopy in the intestinal region of the larvae that had been recently obtained. The results of this study show that T. canis larvae can recognize and respond to the presence of progesterone through a molecule possibly able to bind it. Since we previously observed a similar response to prolactin, we suggest that both hormones could participate sequentially in the reactivation of T. canis larvae in pregnant bitches.

Proteomic profile associated with cell death induced by androgens in Taenia crassiceps cysticerci: proposed interactome.

Androgens have been shown to exert a cysticidal effect upon Taenia crassiceps, an experimental model of cysticercosis. To further inquire into this matter, the Taenia crassiceps model was used to evaluate the expression of several proteins after testosterone (T4) and dihydrotestosterone (DHT) in vitro treatment. Under 2-D proteomic maps, parasite extracts were resolved into approximately 130 proteins distributed in a molecular weight range of 10-250 kDa and isoelectrical point range of 3-10. The resultant proteomic pattern was analysed, and significant changes were observed in response to T4 and DHT. Based on our experience with electrophoretic patterns and proteomic maps of cytoskeletal proteins, alteration in the expression of isoforms of actin, tubulin and paramyosin and of other proteins was assessed. Considering that androgens may exert their biological activity in taeniids through the non-specific progesterone receptor membrane component (PGRMC), we harnessed bioinformatics to propose the identity of androgen-regulated proteins and establish their hypothetical physiological role in the parasites. These analyses yield a possible explanation of how androgens exert their cysticidal effects through changes in the expression of proteins involved in cytoskeletal rearrangement, dynamic vesicular traffic and transduction of intracellular signals.

Predominance of Nyssomyia neivai (Pinto) on the Islands of the Paraná River, Southern Brazil.

Leishmaniasis is a vector-borne disease caused by the protozoan Leishmania and it is one of the six most important infectious diseases in the world. The aim of this study was to conduct a research on the fauna and most frequented ecotopes by sandflies on islands of the Paraná River. The sandflies were collected with Falcão light traps in 10 islands in the municipalities of São Pedro do Paraná, Porto Rico, and Querência do Norte, in Paraná State, Brazil, from November 2012 to November 2014. In total, 76,145 specimens of Nyssomyia neivai, the only species found, were collected, of which 63,015 were female and 13,130, male. The largest number of sandflies was collected mainly in domiciles and peridomiciles. The islands of the Paraná River showed predominance of Ny. neivai, which is largely involved in the transmission of Leishmania and a risk of human leishmaniasis to the island inhabitants and tourists.

Progesterone inhibits the in vitro L3/L4 molting process in Haemonchus contortus.

We evaluated the direct effects of progesterone on the morphology, maturation and behavior of Haemonchus contortus larvae in vitro. The presence and location of possible progesterone receptors in these larvae were also determined. The addition of 8ng/mL of progesterone to larval cultures over 10days reduced larval enlargement, while the addition of 160ng/mL of the hormone increased the enlargement. Up to 62% and 65% of the H. contortus larvae molted from third-stage larvae (L3) to fourth-stage larvae (L4) when cultured in RPMI-1640 media without hormone for 5 and 10days, respectively. The addition of different progesterone concentrations (1, 8, 16, 80 and 160ng/mL) to the larval cultures significantly inhibited the molting process within the same periods. The addition of 8ng/mL or higher progesterone concentrations to the cultures significantly increased larval motility (p<0.05) compared with unstimulated larvae. Flow cytometry showed the expression of progesterone receptors (P4-R) in 15% of the cells from newly isolated H. contortus larvae. When the larvae were cultured for 5days in the presence of the hormone, the percentage of P4-R+ cells remained the same. In contrast, unstimulated larvae showed a significant reduction in the number of P4-R+ cells. Using confocal microscopy, a greater concentration of P4-Rs was immunolocated in the anterior portion of the alimentary tract of the larvae, suggesting that the cells in this region are targeted by the hormone. The results of the present study show that H. contortus larvae have possible P4-Rs and respond to this hormone by inhibiting their molting process, thereby suggesting the participation of progesterone in the larval arrest phenomenon.

Evaluation of a genetic assay for canine transmissible venereal tumour diagnosis in Brazil.

The canine transmissible venereal tumour (CTVT) is a transmissible cancer that is spread between dogs by the allogeneic transfer of living cancer cells. The infectious agents in CTVT are the living cancer cells themselves, which are transmitted between dogs during coitus. CTVT first arose several thousand years ago and the disease has a global distribution and is frequently observed in dogs from Brazil. We evaluated the utility of a LINE-MYC quantitative polymerase chain reaction for diagnosis of CTVT cases in Brazil. Our analysis indicated that the LINE-MYC rearrangement was detectable in all CTVT samples but not in their corresponding hosts. This genetic assay proves to be a useful tool for providing a definitive molecular diagnosis of CTVT, which presents with varying degrees of aggressiveness and invasiveness in different host dogs and can therefore be a diagnostic challenge in some specific cases.

The in vitro effect of prolactin on the growth, motility and expression of prolactin receptors in larvae of Toxocara canis.

The in vitro effect of prolactin (PRL) on the growth and motility of Toxocara canis larvae was assessed. Additionally, the expression and location of prolactin receptors (PRL-Rs) were determined in the larvae. Larvae of T. canis were incubated with different concentrations of PRL for different periods of time. The stimulated larvae accelerated their enlargement and increased their motility. The mean percentage of PRL-R+ cells in non-stimulated larvae, measured by flow cytometry was 7.3±0.3%. Compared with non-stimulated larvae, the mean fluorescence intensity (p<0.05) increased in larvae incubated with 40ng/mL of PRL for 10 days. A 465-bp length fragment was amplified from larvae gDNA by PCR. The sequence of this fragment showed 99% similarity with the gene fragment that codes for the PRL-R of the domestic dog. A high concentration of PRL-Rs was immune-located in the posterior region of the larval intestine; therefore, the intestinal cells in this region were most likely the targets for this hormone. Based on these results, PRL-Rs were identified in T. canis larvae, and the in vitro stimulation with PRL increased the number of these receptors, accelerated the growth and modified the activity of larvae. All of the above suggest that T. canis larvae are evolutionarily adapted to recognize the PRL of their definitive host and furthermore might explain the reactivation of tissue-arrested larvae during the gestation of bitches, which does not occur in gestating females of other species.

Serological, biochemical and enzymatic alterations in rodents after experimental envenomation with Hadruroides lunatus scorpion venom.

Toxic effects of Peruvian Hadruroides lunatus scorpion venom on different biochemical and enzymatic parameters in blood serum of Wistar rats and Swiss mice were determined after experimental envenomation. An increase in enzymatic activities of Aspartate Aminotransferase (AST), Lactate Dehydrogenase (LDH) and levels of serum protein and albumin were observed while a decrease in creatinine level in serum was perceived after 30 min of envenomation. No alterations in urea levels and in kidney histology were detected in the envenomed rats. The global leukocytes count was diminished, with decrease in lymphocytes, eosinophils and neutrophils levels in the bloodstream, while no alterations were found in hematological parameters of red series in rats injected with H. lunatus venom. IL-2, IL-4, IL-6, INF-γ, TNF, IL-17A and IL-10 levels were evaluated 0.5, 3 and 6 h after experimental envenomation of mice with H. lunatus venom. From all the analyzed cytokines, only IL-6 showed an increase in serum levels. Taken together, these results point out that envenomation by H. lunatus can impair hematological and immunological parameters and therefore might be monitored in accidents involving this species.

Identification and characterization of B-cell epitopes of 3FTx and PLA(2) toxins from Micrurus corallinus snake venom.

The main goal of this work was to develop a strategy to identify B-cell epitopes on four different three finger toxins (3FTX) and one phospholipase A2 (PLA2) from Micrurus corallinus snake venom. 3FTx and PLA2 are highly abundant components in Elapidic venoms and are the major responsibles for the toxicity observed in envenomation by coral snakes. Overlapping peptides from the sequence of each toxin were prepared by SPOT method and three different anti-elapidic sera were used to map the epitopes. After immunogenicity analysis of the spot-reactive peptides by EPITOPIA, a computational method, nine sequences from the five toxins were chemically synthesized and antigenically and immunogenically characterized. All the peptides were used together as immunogens in rabbits, delivered with Freund's adjuvant for a first cycle of immunization and Montanide in the second. A good antibody response against individual synthetic peptides and M. corallinus venom was achieved. Anti-peptide IgGs were also cross-reactive against Micrurus frontalis and Micrurus lemniscatus crude venoms. In addition, anti-peptide IgGs inhibits the lethal and phospholipasic activities of M. corallinus crude venom. Our results provide a rational basis to the identification of neutralizing epitopes on coral snake toxins and show that their corresponding synthetic peptides could improve the generation of immuno-therapeutics. The use of synthetic peptide for immunization is a reasonable approach, since it enables poly-specificity, low risk of toxic effects and large scale production.

Short communication: Viable Mycobacterium avium subspecies paratuberculosis in retail artisanal Coalho cheese from Northeastern Brazil.

Mycobacterium avium ssp. paratuberculosis (MAP) is the etiologic agent of paratuberculosis and it potentially plays a role in Crohn's disease. In humans, the main route of transmission of MAP might be the intake of contaminated milk and dairy products. Considering that MAP has already been detected in many types of cheese in different counties, and that Coalho cheese is an important dairy product in northeastern Brazil, the aim of this study was to report the first detection of MAP in retail Coalho cheese in Brazil by PCR and culture. Of 30 retail Coalho cheese samples, 3 (10%) amplified fragments of a similar size to that expected (626 bp) were obtained and viable MAP was recovered by culture from 1 (3.3%) sample. The DNA from the positive culture sample was sequenced and showed 99% identity with the insertion sequence IS900 deposited in GenBank. It was possible to identify the presence of MAP-specific DNA in the analyzed samples for the first time in Brazil, and to recover viable cells from retail Coalho cheese.

Melanosis bucal asociada a tabaquismo inhalado en un grupo de venezolanos: estudio clínico transversal / Oral melanosis related to smoking in a group of venezuelans: cross sectional clinical study

El objetivo del presente trabajo fue determinar la prevalencia de melanosis asociada a tabaquismo en un grupo de individuos venezolanos. Metodología: Fueron evaluados clínicamente 50 individuos fumadores (grupo fumadores) (GF) y 50 individuos no fumadores (grupo control) (GC) (n=100) que acudían a consulta odontológica de rutina. Después de firmado el correspondiente consentimiento informado, los datos epidemiológicos fueron recolectados así como la presencia de melanosis en la mucosa bucal. La prevalencia y el riesgo de melanosis por tabaquismo fueron determinados mediante SPSS versión 17.0 Resultados: El GF estuvo constituido por 18 mujeres (36%) y 32 hombres (64%) con una media de edad de 32.98±13.56 años. El GC fue conformado por 30 mujeres (60%) y 20 hombres (40%) con una media de edad de 34.4±13.88 años. 20 individuos del GF mostraron melanosis en la mucosa bucal (40%), principalmente localizadas en la encía y sólo 1 individuo (2%) del GC presentó pigmentaciones generalizadas. La presencia de melanosis fue estadísticamente mayor en el GF (p=0.0001), así como el riesgo a tener la entidad cuando se fuma (OR=32.67; 95%IC 26.36 a 38.97). Conclusiones: La melanosis o pigmentaciones bucales, principalmente de la encía, fueron una lesión frecuente observada en los individuos fumadores estudiados. Una persona con tabaquismo tiene un riesgo 30 veces mayor que una persona no fumadora de desarrollar melanosis de la mucosa bucal especialmente en la encía de la zona anterior

The aim of this study was to determine the prevalence of melanosis associated with smoking in a group of Venezuelans. Methodology: 50 smokers (smoking group) (GF) and 50 nonsmokers (control group) (GC) (n=100) were clinically evaluated during a routine dental appointment. After signing the corresponding informed consent, epidemiological data and the presence of melanosis in the oral mucosa were collected. The data were statistically analyzed by SPSS version 11.0. The prevalence and risk of melanosis by smoking were determined. Results: The GF was formed by 18 women (36%) and 32 men (64%) with a mean age of 32.98 ± 13.56 years. The GC was formed by 30 women (60%) and 20 men (40%) with a mean age of 34.4 ± 13.88 years. GF 20 individuals showed melanosis of the oral mucosa (40%), mainly located in the gums and only 1 patient had pigmentation GC (2%) of generalized type. The presence of melanosis was statistically higher in the GF (p = 0.0001), and the risk of getting that condition when smoked (OR = 32.67, 95% CI 26.36 to 38.97). Conclusions: The oral melanosis or pigmentation, especially the gum, was a common injury in smokers studied. A person who smokes has a risk 30 times greater than a nonsmoker to develop melanosis of the oral mucosa especially in the anterior gingiva

Beyond the reproductive effect of sex steroids: their role during immunity to helminth parasite infections.

During the helminth infections, the immune system tends to be modulated by host's sex hormones. Actually, many studies show the reciprocal relationship between sex steroids, the immune system and the elimination or establishment of helminth parasites. Is well known that innate immune response determines the type of adaptive immune response, so the effects in the innate immune response by hormones may affect subsequent adaptive immunity. The sex steroids as estrogens, progesterone and testosterone regulate growth, differentiation, survival and function of many cell types that could be involved in process like homeostasis and immunity, but also have a direct effect on the helminthes, that may probably be mediated by specific receptors on these parasites. Sex steroids, parasites and immunity are closely connected, and their interconnection is involved in the maintenance of elimination or establishment of helminthes in an immunocompetent host. For that reason, understanding the action's mechanisms of sex steroids on immune cells and its direct effect on helminth parasites is important for further progress in the development of novel therapies for chronic helminth diseases associated to immune dysregulation. In this review, we will describe the effects of sex steroids on the immune response during helminth infections as well as the direct effect in these parasites, and the possible implications of these effects on the incidence of several helminth infections.

Perceived migraine triggers: do dietary factors play a role?

The present cross-sectional study was designed to assess the frequency of 36 possible triggering factors precipitating a migraine crisis (hormonal, environmental, and dietary) in adult outpatients suffering from migraine attacks. A group of 123 migraine sufferers, aged 43.2 ± 13.9 (mean ± SD) years, including 114 (92.7%) women, 68.3% having migraine without aura, 68.3% reporting pain severe enough to require drug prophylaxis, and 29.3% presenting with hypertension, were evaluated. The most common triggers were stress and fasting, and environmental and hormonal factors were frequently found to precipitate a crisis. More than 90% of the patients reported susceptibility to 5 or more factors, and only 2.4% did not complain about any dietary factor. The large number of triggers detected in the present study emphasises the importance of awareness and avoidance of these factors in the management of patients with migraine.

The effect of Mycoplasma and mycoplasma removal agent on the hydrolase activity in fibroblasts of patients with lysosomal diseases.

This study was designed to evaluate the effect of mycoplasma contamination on acid hydrolase activity and the action of the mycoplasma removal agent (MRA), in cultures of human fibroblasts from individuals with lysosomal diseases. For this purpose, we measured the activity of the b-galactosidase, arylsulphatase B (ASB), hexosaminidase A and a-glucosidase enzymes. The activity of the above mentioned enzymes in fibroblasts contaminated by mycoplasma was measured before and after the addition of the MRA. The results were then compared to the enzymatic activity in contamination-free cultures. Only the ASB enzyme showed significant alteration in activity both in the presence of mycoplasma and MRA. The remaining enzymes did not suffer significant interference by the presence of the two agents. Of the four enzymes tested, three did not suffer significant alterations by the presence of the mycoplasma nor from the MRA. However, the activity measured in the ASB enzyme increased significantly in the presence of mycoplasma and MRA and could lead to a doubtful diagnosis. Therefore, we suggest that contamination should be prevented by using aseptic techniques as well as the MRA in those fibroblast cultures that cannot be discarded.

Preliminary in vitro studies on the Marsypianthes chamaedrys (boia-caá) extracts at fibrinoclotting induced by snake venoms.

The extract of Marsypianthes chamaedrys, a plant used against snakebites, in the present study was shown to inhibit fibrinoclotting induced by several Brazilian snake venoms or thrombin. These data indicate that this extract affected thrombin-like enzymes. In this first report we determine some features of the components present in the extract regarding the antifibrinoclotting action. Our results show that active components responsible for those effects are thermo-resistant and are concentrated in the methanolic fraction.

Survey of drug resistance of Mycobacterium tuberculosis in 3 Mexican states, 1997.

BACKGROUND: Drug resistance threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Mexico. OBJECTIVE: To obtain population-based data on Mycobacterium tuberculosis drug resistance in Mexico. METHODS: To obtain drug resistance data, we conducted a population-based study of TB cases in the states of Baja California, Sinaloa, and Oaxaca, Mexico. We performed cultures and drug susceptibility testing on M tuberculosis isolates from patients with newly diagnosed, smear-positive TB from April 1 to October 31, 1997. RESULTS: Mycobacterium tuberculosis was isolated from 460 (75%) of the 614 patients. Levels of resistance in new and retreatment TB cases to 1 or more of the 3 current first-line drugs used in Mexico (isoniazid, rifampin, and pyrazinamide) were 12.9% and 50.5%, respectively; the corresponding levels of multi-drug-resistant TB were 2.4% and 22.4%. Retreatment cases were significantly more likely than new cases to have isolates resistant to 1 or more of the 3 first-line drugs (relative risk [RR], 3.9; 95% confidence interval [CI], 2.8-5.5), to have isoniazid resistance (RR, 3.6; 95% CI, 2.5-5.2), and to have multi-drug-resistant TB (RR, 9.4; 95% CI, 4.3-20.2). CONCLUSIONS: This population-based study of M tuberculosis demonstrates moderately high levels of drug resistance. Important issues to consider in the national strategy to prevent M tuberculosis resistance in Mexico include consideration of the most appropriate initial therapy in patients with TB, the treatment of patients with multiple drug resistance, and surveillance or periodic surveys of resistance among new TB patients to monitor drug resistance trends.

HIV infection and AIDS in Latin America. Epidemiologic features and clinical manifestations.

This article updates the epidemiologic situation of HIV and AIDS infection and summarizes the most common clinical manifestations in Latin American countries. As of December 1992, a total of 59,723 AIDS cases had been reported to the Pan American Health Organization from Mexico, Central America, South America, and the Latin Caribbean. The number of deaths totaled 24,500, or 41% of the reported cases. HIV transmission patterns and clinical manifestations vary by region. The most common opportunistic illnesses in Latin America and their symptoms, including gastrointestinal, pulmonary, and dermatologic complications are discussed.

PIP: More than 1.3 million of the estimated 12.9 million people who were infected with HIV by 1992 live in Latin American countries. Although HIV and AIDS cases have been reported from all PAHO member countries, relatively limited country-specific information exists about specific patterns of HIV-related conditions. Drawing upon data from Puerto Rico and the US, this review updates available epidemiologic information, common clinical manifestations, and therapeutic options for HIV-related conditions in Latin American countries. Sections consider AIDS surveillance, demographic characteristics and risks for HIV transmission, HIV prevalence surveys, clinical manifestations of HIV, and therapeutic options and future challenges, and stress that Latin American societies must join forces to combat HIV and AIDS.

An overview of the problem of toxoplasmosis and pneumocystosis in AIDS in the USA: implication for future therapeutic trials.

By the end of 1989, 18,518 cases of Pneumocystis carinii infection and 5,614 cases of Toxoplasma gondii infection were reported to the Centers for Disease Control as the AIDS indicator disease. Pneumocystosis did not vary according to gender, race or risk factors; whereas toxoplasmosis was more common in black males with no known risk factors. Immigrants to the USA from Africa, Latin America and Haiti are three to four times more likely to develop toxoplasmic encephalitis than American-born patients with AIDS. The implications of this epidemiologic data for the predictive value of serology and clinical trials are discussed.

The epidemiology of HIV transmission among paid plasma donors, Mexico City, Mexico.

Screening of blood product donations for antibody to HIV began in Mexico in May 1986. From June to October 1986, the HIV cumulative seroprevalence increased from 6.3 to 9.2% in a commercial plasma collection center. Of the 281 people who donated the antibody-positive units, 62 (22.1%) had documented seroconversion during these 5 months. An epidemiologic study of 54 seropositive and 58 seronegative donors was carried out. The HIV serologic status did not change in any of these donors after repeat testing. Only 13.0% of the seropositives and 15.5% of the seronegatives had any of the known risk factors for AIDS. There was a direct relationship between frequency of plasma donation and the risk of being seropositive. A survey of employees disclosed the frequent re-use of disposable blood collection equipment. We conclude that HIV transmission had probably occurred in this plasma collection center.

PIP: This report provides the results of a study of plasma donor clients from records abstracted between June-October 1986. The purpose was to identify risk factors for HIV infection among donors at the National Center for Blood Transfusions. Screening for HIV among donors began in May 1986. 54 Seropositive donors were identified and located from 281 and 58 seronegative donors were randomly selected. 16 employees of the plasma collection center were locatable and also included in the study. The results were that seroprevalence increased between June-October from 6.3% to 9.2%. The total donations were 3201 of which 294 were seropositive. Of 281 seropositive clients, 62 (22%) had seroconversion (a prior seronegative donation). Seroconversions increased from 1.6% in July to 50% in October. On retesting of the 112 study participants, no change in status was found. The groups were similar and both groups had relatively low risk factors for (13% for HIV seropositive and 15.5% for HIV seronegative donors). The rate of seropositivity increased with the frequency of plasma donations from 19.6% for those donating 1-3 times/month to 88.9% for those donating 10 times/month. Of the 16 employees, 1 died who was HIV seropositive; 5 were directly involved in plasma collection and reported reuse of saline solution and intravenous tubing. The results lead the authors to suggest that HIV was transmitted in the collection process. Support for this suggestion comes from the number of seroconversions; the risk factors among the seropositive donors had no known risk factors. Although not statistically significant, male seropositive donors had greater contract with prostitutes in Mexico City, but prostitutes had shown in the past 2 years a seropositivity rate of 1%. More demonstrative evidence comes from the increased rate of seropositivity with frequency of donation, and the employee reports of reutilization of blood collection materials. Other studies have postulated plasma donor site risk. Regardless of the expense of intravenous equipment, it is suggested that the risk of HIV transmission precludes reuse of materials. At present, all blood is collected from volunteer donors with disposable equipment. Other countries need to assess the safety of blood donor centers, particularly with paid donors.