Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach.

BACKGROUND: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease. OBJECTIVE: To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients. METHODS: Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario. CONCLUSION: We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.

ANTECEDENTES: A esclerose múltipla (EM) e a doença do espectro neuromielite optica (NMOSD) são as doenças autoimunes mais comuns do sistema nervoso central (SNC). Ambas apresentam curso crônico com recaídas (surtos) e exigem tratamento com drogas modificadoras de doenças (DMDs) para a prevenção de atividade inflamatória. As DMDs levam à imunomodulação ou imunossupressão através de diversos mecanismos (por exemplo deslocando e/ou suprimindo subpopulações linfocitárias ou alterando perfil de produção de citocinas). Desta forma, os pacientes com EM ou NMOSD são mais propensos a complicações infecciosas, as quais podem levar ao agravamento de suas doenças de base. OBJETIVO: Apresentar estratégias viáveis para mitigar o risco de infecção de pacientes com EM ou NMOSD sob tratamento. MéTODOS: Revisão bibliográfica focada em manejo de risco de infecção com ênfase em vacinação, medidas específicas de tratamento e particularidades de doenças infecciosas endêmicas do Brasil. CONCLUSãO: Propomos um calendário de vacinação, rotina de triagem infecciosa e medidas profiláticas baseadas em evidências científicas atuais. A conscientização das doenças tropicais emergentes é necessária devido a evidências de eventos desmielinizantes e possíveis casos parainfecciosos de EM e NMOSD.

Susceptibilidad antimicrobiana de bacterias aisladas en sepsis del acceso vascular. Instituto de Nefrología, 2019 / Antimicrobial susceptibility of bacteria isolated from vascular access sepsis. Institute of Nephrology, 2019

Introducción: El acceso vascular en hemodiálisis es esencial para el enfermo renal por su repercusión en la calidad de vida. La fístula arteriovenosa, los catéteres para hemodiálisis o las prótesis vasculares, aunque han evolucionado gradualmente hacia el perfeccionamiento, son proclives a las infecciones debidas fundamentalmente a bacterias de la microbiota de la piel y mucosas. Objetivo: Caracterizar la susceptibilidad antimicrobiana de las bacterias aisladas de pacientes con sepsis del acceso vascular en el servicio de hemodiálisis del Instituto de Nefrología. Material y Métodos: Estudio de corte transversal, en el período comprendido entre enero a diciembre de 2019. El universo estuvo constituido por 112 aislamientos obtenidos a partir de muestras de hemocultivos, secreciones y puntas de catéter de los pacientes con bacteriemias, sepsis o secreción en el sitio de inserción del catéter o acceso vascular. Resultados: El 72,3 por ciento de las muestras estudiadas fueron hemocultivos. Se obtuvo 38,3 % de aislamientos de Staphylococcus aureus, sensibles en su totalidad a la vancomicina. El 68,1 % de las cepas de Escherichia coli fueron productoras de betalactamasas de espectro extendido (BLEE) con sensibilidad superior a 60 % a aminoglucósidos y carbapenémicos; similar patrón de sensibilidad mostraron las cepas de Pseudomonas, no obstante, el 100% fue resistente a las cefalosporinas. Conclusiones: No se reportó resistencia a la vancomicina en el estudio. Los aislamientos de los gérmenes gramnegativos mostraron elevada resistencia a las cefalosporinas y una buena sensibilidad a aminoglucósidos y carbapenémicos(AU)

Introduction: The vascular access in hemodialysis is essential for the renal patient both for its associated morbidity and mortality as well as for its impact on quality of life. Although arteriovenous fistula, hemodialysis catheters or vascular prostheses have gradually evolved toward improvement, they are prone to infections primarily due to bacteria on the skin and mucosal microbiota. Objective: To characterize the antimicrobial susceptibility of bacteria isolated from patients with vascular access sepsis in the hemodialysis service of the Institute of Nephrology. Material and Methods: A cross-sectional study was conducted in the period January-December 2019. The universe consisted of all 112 isolates obtained from blood culture samples, secretions and catheter tips from patients with bacteremia, sepsis or discharge at the site of catheter insertion or vascular access. Results: The results show that 72.3% of the samples studied were blood cultures. Also, 38.3 percent of Staphylococcus aureus isolates, which were totally sensitive to vancomycin, were obtained. On the other hand, 68.1% of Escherichia coli strains were extended spectrum beta-lactamases (ESBL) producers with sensitivity to aminoglycosides and carbapenems greater than 60%. Pseudomonas strains exhibited a similar pattern of sensitivity, however, 100% were resistant to cephalosporins. Conclusions: No resistance to vancomycin was reported in this study. Gram-negative isolates showed high resistance to cephalosporins and good sensitivity to aminoglycosides and carbapenems(AU)

Asociación del grupo sanguíneo ABO con susceptibilidad a COVID-19 / Association of ABO blood group with COVID-19 susceptibility

La pandemia de COVID-19, causada por el virus SARS-CoV-2, ha infectado ya a más de 25 millones de personas, ocasionando más de 850,000 muertos y causando serios problemas en hospitales y sistemas de salud en todo el mundo. Una de las mayores dificultades que presenta la infección por SARS-CoV-2 es su gran variación en presentación clínica, que puede ir desde casos asintomáticos hasta síndromes de distrés respiratorio agudo, fallo múltiple de órganos y muerte. De aquí la importancia del estudio de factores demográficos, clínicos y genéticos que permitan la identificación de personas con mayor riesgo de adquirir la infección y sufrir manifestaciones graves de la enfermedad. Un número creciente de reportes en la literatura han sugerido que el grupo sanguíneo ABO está relacionado con el riesgo a COVID-19, coincidiendo en que personas con sangre del grupo A muestran el mayor riesgo, mientras que personas con sangre del grupo O el menor. Los objetivos de esta revisión son presentar un resumen de la evidencia existente en la literatura científica reciente y discutir estas observaciones en el contexto del conocimiento sobre la asociación de los grupos sanguíneos a varias infecciones y otras enfermedades, así como de los mecanismos potenciales involucrados. Finalmente, las implicaciones de la relación entre el grupo sanguíneo y susceptibilidad a COVID-19 son también discutidas con relación a la población guatemalteca.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has already infected more than 25 million people, resulting in more than 850,000 deaths and causing serious problems in hospitals and health systems worldwide. One of the biggest problems posed by the SARS-CoV-2 infection is its great variation in clinical presentation, which can range from asymptomatic cases to syndromes of acute respiratory distress, multiple organ failure, and death. Hence the importance of studying demographic, clinical and genetic factors that allow the identification of people at increased risk of suffering serious manifestations. A growing number of reports in the literature have suggested that the ABO blood group is related to the risk of COVID-19, demonstrating that people with type A blood have the highest risk, while people with type O blood the lowest. The objective of this review is to present a summary of the existing evidence in the recent scientific literature and to discuss these observations in the context of the knowledge of the association of blood groups to various infections and other diseases, as well as the potential mechanisms involved. Finally, the implications of the relationship between the blood groups and COVID-19 susceptibility are also discussed in relationship to the Guatemalan population.

Precocious obesity predisposes the development of more severe cisplatin-induced acute kidney injury in young adult mice.

Obesity and its consequences can damage the kidney over time. However, less is known about the impact of developing overweight/obesity during childhood on the kidney in adulthood and the renal impact of a superimposed acute kidney injury (AKI). This study evaluated the effect of obesity induced by a high-fat diet initiated soon after weaning on the adult life of mice and their response to superimposed nephrotoxic effects of cisplatin. C57BL/6 post-weaning mice (3 weeks old) were divided into a control group (CT, n = 12) and a high-fat diet group (HF, n = 12). After 9 weeks, animals were further divided into the following groups: CT, CT treated with a single dose of cisplatin (CTCis, 20 mg/kg, i.p.), HF and HF treated with cisplatin (HFCis). The HF group exhibited higher body weight gain compatible with a moderate obesity. Obese mice presented increased visceral adiposity, hyperkalemia, sodium retention, glomerular hyperfiltration and proteinuria, without any significant changes in blood pressure and glycemia. AKI induced by cisplatin was exacerbated in obese animals with a 92% reduction in the GFR versus a 31% decrease in the CTCis group; this sharp decline resulted in severely elevated serum creatinine and urea levels. Acute tubular necrosis induced by cisplatin was worsened in obese mice. The HFCis group exhibited robust systemic and intrarenal inflammation that was significantly higher than that in the CTCis group; the HFCis group also showed a higher degree of renal oxidative stress. In conclusion, the moderate degree of obesity induced shortly after weaning resulted in mild early renal alterations, however, obese young animals were prone to develop a much more severe AKI induced by cisplatin.

Influência do tratamento com benzonidazol na resposta imunológica de camundongos infectados com cepas do trypanosoma cruzi de diferentes biodemas / Influence of treatment with benznidazole in the immune response of mice infected with Trypanosoma cruzi strains of different biodemes

A infecção pelo Trypanosoma cruzi determina uma resposta imunológica inata do hospedeiro vertebrado, decorrente da multiplicação parasitaria em macrófagos e a produção de Interferon gama (IFNy) pelas células T ativadas, além de estimulação policlonal de células do baço, com imunossupressão. Por outro lado tem sido demonstrado que o tratamento com quimioterápico Benzonidazol em camundongos infectados, além de determinar uma destruição dos parasitos, tem também uma ação sobre o sistema imunológico em camundongos infectados com cepas do T. cruzi com diferentes graus de suscetibilidade ao Benzonidazol, como a cepa Y (suscetível ao quimioterápico) e a cepa Colombiana (resistente). No presente estudo procura-se investigar a influência do tratamento com o Benzonidazol sobre a resposta imunológica em camundongos infectados com cepa suscetível (Cepa Y) ou resistente (Colombiana). Foram utilizados 320 camundongos, subdivididos em grupos experimentais: Infectados tratados cepa Y (YT) e não tratados (Y-NT); Colombiana tratados (COL-T) e não tratados (COL-NT), Tratados não infectados (TNI) e Controles sem tratamento (CI). O inóculo foi de 1,0 x 104 por via intraperitoneal. O tratamento foi iniciado no pico parasitêmico de cada cepa, sendo no 7º dia após a infecção nos animais infectados pela cepa Y e, nos tratados e não infectados, no 18º dia de infecção na cepa Colombiana. A quimioterapia foi realizada em 60 doses (100mg/kg/dia de Benzonidazol-Benz). Os camundongos sacrificados na fase aguda e na fase crônica em todos os grupos tiveram as secções de coração e músculo esquelético coletadas, fixadas e processadas para o estudo histopatológico em secções coradas pela Hematoxilina & Eosina e Picro-Sirius. Investigou-se a resposta humoral pela sorologia (Imunofluorescência indireta) e pela reação de Elisa. A resposta celular pela proliferação celular do baço, e pela avaliação quantitativa das subpopulações celulares no baço de CD4+, CD8+...

Infection with T. cruzi determines an immunological response in the vertebrate host, wit h parasites multiplication in macrophages, with production of TNFα by these cells an IFNγ, by stimulated T. cells: a polyclonal multiplication of spleen cells is present, with immunossuppression. Treatment of infected mice with BENZ showed that this chemotherapy determines parasitic destruction and also stimulates the immunological system in mice infected either with the Y or the Colombian strain which differs in the susceptibility to chemotherapy with BENZ. In the present study we intend to investigate the influence of treatment with BENZ on the immunological response in mice infected either with the Y strain (susceptible) or the Colombian strain (resistant). This study was performed by comparing the results obtained with the groups of mice not infected and treated, and infected controls, not treated. Material and methods : Number of animals: 320, sub-divided in the experimental groups:Ystrain infected and treated with BENZ(YT) or not-treated (YNT); Colombian treated (COL-T) and not-treated (COL-NT); treated not infected (TNI); Control not treated (COL-NT). Inoculum : 1x104 trypomastigotes, (blood forms) injected intraperitoneally. Treatment was initiated in the peak of parasitemia for each strain:7th day for the Y strain and in the 18th day in the infection with the Colombian strain. Chemotherapy was performed in 60 doses (100mg x kg x day) of BENZ. Mice were killed in the acute and chronic phases post infection; sections of the heart and skeletal muscles were collected, fixed and processed for histopathology, in sections stained with Hematoxylin and Eosin, and with Picro-Sirius staining, for collagen. The humoral response was evaluated by serological reactium of indirect immununofluorescence and ELISA reaction. Celular responses were evaluated by celular proliferation in the spleen of CD4+, CD8+...

Early life events predispose the onset of childhood functional gastrointestinal disorders.

BACKGROUND: Functional gastrointestinal disorders (FGIDs) are common digestive conditions characterized by chronic or recurrent symptoms in the absence of a clearly recognized gastrointestinal etiology. The biopsychosocial model, the most accepted concept explaining chronic pain conditions, proposes that the interplay of multiple factors such as genetic susceptibility, early life experiences, sociocultural issues, and coping mechanisms affect children at different stages of their lives leading to the development of different pain phenotypes and pain behaviors. Early life events including gastrointestinal inflammation, trauma, and stress may result in maladaptive responses that could lead to the development of chronic pain conditions such as FGIDs. AIMS: In this review, we discuss novel findings from studies regarding the long-term effect of early life events and their relationship with childhood chronic abdominal pain and FGIDs. METHODS: A bibliographic search of the PubMed database was conducted for articles published over the last 20 years using the keywords: "Functional gastrointestinal disorders", "chronic abdominal pain", "chronic pain", "gastrointestinal inflammation", and "early life events". Forty-three articles were chosen for review. RESULTS: Based on the current evidence, events that take place early in life predispose children to the development of chronic abdominal pain and FGIDs. Conditions that have been studied include cow's milk protein hypersensitivity, pyloric stenosis, gastrointestinal infections, and Henoch-Schonlein purpura, among others. CONCLUSIONS: Early events may play an important role in the complex pathogenesis of functional gastrointestinal conditions. Timely intervention may have a critical impact on the prevention of this group of chronic incapacitating conditions.

Tubal occlusion causing infertility due to an excessive inflammatory response in patients with predisposition for keloid formation.

Infertility is a condition that affects approximately 15-25% of couples with the desire to procreate. The integrity of the feminine reproductive tract is essential for this purpose, but the occlusion of the Fallopian tubes occurs in 12-33% of infertile women. The infection by Chlamydia trachomatis is one of the principle causes of tubal injury, which could finally lead to tubal occlusion. The tract infection has also been related to the use of intrauterine device, basically due to the fact that the insertion of the device could carry bacteria to the endometrial cavity. Keloid scars result from alterations in the normal process of wound healing, and it affects principally the population in reproductive age, maybe due to specific hormonal influence. These fibroproliferative alterations may produce significant deformations and alter organ function. The genetic factors have been studied in order to have a better understanding of the pathophysiology of keloid scarring. With these assessments, many other factors have been known to have a relationship with this abnormal healing process. This keloid scarring involves an excess in extracellular matrix production and inhibition of apoptosis, for which a several growth factors and interleukins are needed. One of the most important growth factors is IGF-1, which increases the expression of type I and III procollagen (found in the uterus); the IGF-1 receptor is overexpressed in the fibroblasts of keloids. Based on those previous observations a hypothesis that the chronic and repeated infection, and the use of IUD, generate an exaggerated inflammatory response in patients with a predisposition for keloid formation (which frequently form in childbearing age), in comparison to the patients that do not form this type of scarring, has been proposed. This makes a major frequency of adherences and finally tubal occlusion and infertility. The tendency of excessive scarring could not be exclusive of skin and generate abnormal scarring responses in feminine reproductive tract, leading to a major frequency of infertility. Thus, it could be suggested the use of other contraceptive methods and a more aggressive treatment against infections of the reproductive tract, taking in consideration the pathophysiology of keloid scar formation and its relationship with tubal occlusion.