Benznidazole therapy for Chagas disease in asymptomatic Trypanosoma cruzi -seropositive former blood donors: evaluation of the efficacy of different treatment regimens.

INTRODUCTION:: Chagas disease currently affects 5.7 million people in Latin America and is emerging in non-endemic countries. There is no consensus concerning the efficacy of trypanocidal therapy for patients with the chronic form of the disease. We evaluated cardiac function and sociodemographic, clinical, and serologic characteristics of a group of asymptomatic Trypanosoma cruzi-seropositive former blood donors, and compared the effects of benznidazole treatment applied for different lengths of time. METHODS:: Blood donors who screened positive for T. cruzi between 1998 and 2002 were recruited 10 years later for follow-up (n = 244); 46 individuals had received treatment. Three subjects had terminated treatment prematurely. The remaining 43 individuals were divided into two groups: individuals who had received benznidazole therapy for 50-60 days (n = 28; BT ≤60 group) or more than 60 days (n = 15; BT >60). Serologic assays, biochemical tests, electrocardiographic, echocardiographic, and clinical examinations were performed on all participants. Parasite loads were determined by qualitative and quantitative polymerase chain reaction. RESULTS:: Parasitemia was significantly reduced in the BT ≤60 and BT >60 groups compared with the untreated group. There were no differences in epidemiologic profiles or clinical, biochemical, electrocardiographic, or echocardiographic data between any of the groups. CONCLUSIONS:: Despite elimination or significant reduction in parasitemia in patients with chronic Chagas disease who received benznidazole, there was no clinical difference between those who were treated for >60 days and those treated for a shorter duration. Furthermore, the adverse effects of benznidazole appear to be less severe than previous reports would suggest.

Benznidazole therapy for Chagas disease in asymptomatic Trypanosoma cruzi -seropositive former blood donors: evaluation of the efficacy of different treatment regimens

Abstract: INTRODUCTION: Chagas disease currently affects 5.7 million people in Latin America and is emerging in non-endemic countries. There is no consensus concerning the efficacy of trypanocidal therapy for patients with the chronic form of the disease. We evaluated cardiac function and sociodemographic, clinical, and serologic characteristics of a group of asymptomatic Trypanosoma cruzi-seropositive former blood donors, and compared the effects of benznidazole treatment applied for different lengths of time. METHODS: Blood donors who screened positive for T. cruzi between 1998 and 2002 were recruited 10 years later for follow-up (n = 244); 46 individuals had received treatment. Three subjects had terminated treatment prematurely. The remaining 43 individuals were divided into two groups: individuals who had received benznidazole therapy for 50-60 days (n = 28; BT ≤60 group) or more than 60 days (n = 15; BT >60). Serologic assays, biochemical tests, electrocardiographic, echocardiographic, and clinical examinations were performed on all participants. Parasite loads were determined by qualitative and quantitative polymerase chain reaction. RESULTS: Parasitemia was significantly reduced in the BT ≤60 and BT >60 groups compared with the untreated group. There were no differences in epidemiologic profiles or clinical, biochemical, electrocardiographic, or echocardiographic data between any of the groups. CONCLUSIONS: Despite elimination or significant reduction in parasitemia in patients with chronic Chagas disease who received benznidazole, there was no clinical difference between those who were treated for >60 days and those treated for a shorter duration. Furthermore, the adverse effects of benznidazole appear to be less severe than previous reports would suggest.

Fatores associados a doenças crônicas em idosos atendidos pela Estratégia de Saúde da Família / Factors associated with chronic diseases among the elderly receiving treatment under the Family Health Strategy

Resumo Descreve-se no estudo o perfil da população idosa e urbana assistida pela Estratégia de Saúde da Família em Teófilo Otoni, MG, e investiga-se fatores associados à prevalência de doenças. Em amostragem aleatória simples, 385 idosos foram entrevistados com base na Ficha A e Ficha do Idoso do Sistema de Informação de Atenção Básica. Dentre os idosos, 83,1% reportaram ter pelo menos uma doença, 69,9% eram hipertensos e 17,7% diabéticos. Análises de regressão de Poisson detectaram que os principais fatores associados à hipertensão e outras doenças foram cor de pele não branca, baixa escolaridade, consumo de medicamentos, uso de prótese dentária e necessidade do serviço público de saúde; já a diabetes foi associada ao sexo feminino e dependência de terceiros. Conclui-se que os idosos da comunidade estudada que apresentam características indicadoras de baixo nível socioeconômico e cultural são mais susceptíveis ao desenvolvimento de doenças, particularmente hipertensão. Embora o índice de diabetes tenha sido mais baixo, essa doença requer controle. Sugere-se investimentos na estruturação da rede de serviços de saúde ofertados para a população de idosos e preparação de profissionais da saúde para que possam atuar efetivamente na melhoria da qualidade de vida do idoso brasileiro.

Abstract The profile of a sample population of elderly receiving treatment under the Family Health Strategy in the municipality of Teófilo Otoni, State of Minas Gerais, Brazil, is described, and the factors associated with diseases prevalence examined. Using simple random sampling, 385 elderly were interviewed using Form A and Elderly Form from the Primary Health Care Information System. The majority of the sample (83.1%) self-reported at least one disease, 69.9% had hypertension, and 17.7% had diabetes. Poisson regression analysis showed that the main factors associated with hypertension and other diseases were being non-white, having a low level of education, medication use, dental prosthesis use, and lack of a private health plan. The prevalence of diabetes was greater among women and individuals who depended on other people to live. It can be concluded that this sample population of elderly has a generally low socioeconomic status and are more susceptible to developing diseases, particularly hypertension. Diabetes should be controlled although had relatively low prevalence. It is suggested investments in structuring the health system network to provide adequate care for the elderly and in training health professionals to play an effective role in improving the quality of life of the elderly in Brazil.

Factors associated with chronic diseases among the elderly receiving treatment under the Family Health Strategy.

The profile of a sample population of elderly receiving treatment under the Family Health Strategy in the municipality of Teófilo Otoni, State of Minas Gerais, Brazil, is described, and the factors associated with diseases prevalence examined. Using simple random sampling, 385 elderly were interviewed using Form A and Elderly Form from the Primary Health Care Information System. The majority of the sample (83.1%) self-reported at least one disease, 69.9% had hypertension, and 17.7% had diabetes. Poisson regression analysis showed that the main factors associated with hypertension and other diseases were being non-white, having a low level of education, medication use, dental prosthesis use, and lack of a private health plan. The prevalence of diabetes was greater among women and individuals who depended on other people to live. It can be concluded that this sample population of elderly has a generally low socioeconomic status and are more susceptible to developing diseases, particularly hypertension. Diabetes should be controlled although had relatively low prevalence. It is suggested investments in structuring the health system network to provide adequate care for the elderly and in training health professionals to play an effective role in improving the quality of life of the elderly in Brazil.

Identification of dietary patterns of adolescents attending public schools / Identificação de padrões alimentares de adolescentes de escolas públicas

OBJECTIVE: to identify the dietary patterns of adolescents attending public municipal schools in Northern Minas Gerais, Brazil, and to test the association between these patterns and socioeconomic variables and nutritional status of the adolescents. METHODS: this was an analytical, cross-sectional study with randomized sample of 474 adolescents of both genders, between 11 and 17 years of age, attending municipal public schools in the urban area of Montes Claros, MG, Brazil. The parents provided demographic and economic data. The nutritional status (body mass index - BMI) of the adolescents was determined at school, and their dietary habits were assessed though the administration of the Food Frequency Questionnaire for Adolescents (FFQA). Based on 26 categories extracted from FFQA, dietary patterns were determined using principal component analysis (PCA) and associated to anthropometric and socioeconomic factors using multiple regression analysis. RESULTS: the three dietary patterns identified, "junk food," "healthy," and "traditional", explained 23.26%, 6.90%, and 5.24% of data variability, respectively. Adolescents with per capita family income exceeding half a minimum wage were more likely to consume the "junk food" pattern (OR = 1.66; 95% CI = 1.07-2.56), and overweight adolescents had lower chances of eating the "healthy" food pattern (OR = 0.56, 95% CI = 0.35-0.91). CONCLUSIONS: deviations from the "healthy" patterns were not associated to low income, but rather to bad eating habits in the studied population. Overweight adolescents did not adhere to the "healthy" dietary pattern, emphasizing the need for nutritional education among them. .

OBJETIVOS: identificar os padrões de consumo alimentar de adolescentes de escolas públicas do norte de Minas Gerais e testar a associação desses padrões com variáveis socioeconômicas e estado nutricional. MÉTODOS: estudo analítico e transversal com amostra aleatória de 474 adolescentes de ambos os sexos, 11 a 17 anos de idade, matriculados do 6º ao 9º ano de escolas públicas municipais da zona urbana de Montes Claros, MG. Os pais forneceram informações demográficas e econômicas. Nas escolas, avaliou-se o estado nutricional dos adolescentes (índice de massa corporal - IMC) e investigou-se seus hábitos alimentares aplicando-se um Questionário de Frequência Alimentar para Adolescentes (QFAA). Com base em 26 categorias de alimentos extraídas do QFAA, aplicou-se uma análise fatorial de componentes principais (ACP) para identificar os padrões alimentares, que foram associados a fatores antropométricos e socioeconômicos por análise de regressão múltipla. RESULTADOS: os três padrões alimentares identificados, ''junk food'', ''saudável'' e ''tradicional'', explicaram 23,26%, 6,90% e 5,24% da variabilidade dos dados, respectivamente. Adolescentes com renda familiar per capita superior a 1/2 salário mínimo apresentaram maior chance de aderir ao padrão ''junk food'' (OR = 1,66; IC 95% = 1,07-2,56), enquanto aqueles com excesso de peso possuíram menor chance de aderir ao padrão ''saudável'' (OR = 0,56; IC95% = 0,35-0,91). CONCLUSÕES: desvios do padrão alimentar ''saudável'' não estão relacionados à baixa renda, mas sim aos maus hábitos alimentares da população estudada. Adolescentes com sobrepeso não aderiram ao padrão ''saudável'', reforçando a necessidade da implementação ...

Distal and lateral toenail onychomycosis caused by Trichophyton rubrum: treatment with photodynamic therapy based on methylene blue dye.

The study showed the effectiveness of photodynamic therapy based on methylene blue to treat severe distal and lateral subungual toenail onychomycosis. 22 patients were divided into two groups: group A consisting of 11 patients with severe toenail onychomycosis and group B consisting of 11 patients with mild-to-moderate toenail onychomycosis. All patients had onychomycosis caused by Trichophyton rubrum. The patients were treated with sessions of 2% methylene blue aqueous solution irradiated with light emission diode device with 630 nm and 36 J/cm2 biweekly for six months. The clinical response was significantly better in patients with mild-to-moderate (100%) onychomycosis compared with patients with severe onychomycosis (63.6%).

Identification of dietary patterns of adolescents attending public schools.

OBJECTIVE: to identify the dietary patterns of adolescents attending public municipal schools in Northern Minas Gerais, Brazil, and to test the association between these patterns and socioeconomic variables and nutritional status of the adolescents. METHODS: this was an analytical, cross-sectional study with randomized sample of 474 adolescents of both genders, between 11 and 17 years of age, attending municipal public schools in the urban area of Montes Claros, MG, Brazil. The parents provided demographic and economic data. The nutritional status (body mass index - BMI) of the adolescents was determined at school, and their dietary habits were assessed though the administration of the Food Frequency Questionnaire for Adolescents (FFQA). Based on 26 categories extracted from FFQA, dietary patterns were determined using principal component analysis (PCA) and associated to anthropometric and socioeconomic factors using multiple regression analysis. RESULTS: the three dietary patterns identified, "junk food," "healthy," and "traditional", explained 23.26%, 6.90%, and 5.24% of data variability, respectively. Adolescents with per capita family income exceeding half a minimum wage were more likely to consume the "junk food" pattern (OR=1.66; 95% CI=1.07-2.56), and overweight adolescents had lower chances of eating the "healthy" food pattern (OR=0.56, 95% CI=0.35-0.91). CONCLUSIONS: deviations from the "healthy" patterns were not associated to low income, but rather to bad eating habits in the studied population. Overweight adolescents did not adhere to the "healthy" dietary pattern, emphasizing the need for nutritional education among them.

[Excess weight and food consumption of adolescents in public schools in northern Minas Gerais state, Brazil]. / Excesso de peso e consumo alimentar em adolescentes de escolas públicas no norte de Minas Gerais, Brasil.

This study sought to identify the prevalence of excess weight and food consumption patterns among adolescents attending public schools in northern Minas Gerais state. A cross-sectional study was conducted with a random and representative sample of adolescents. Demographic and economic data were collected. Food consumption was evaluated by applying a semi-quantitative food questionnaire. Body weight and height were measured to assess the nutritional status based on the Body Mass Index (BMI) by Age. The sexes were compared by Student's t test (comparison of samples) and chi-square test (goodness of fit) at a level of significance of p <0.05. 535 adolescents were evaluated and prevalence of excess weight was detected in 18.5% of the group. BMI (p = 0,001) was statistically different between the sexes and higher for girls. The average energy consumption of the group was 3096.30 kcal/day. Fiber consumption was insufficient in 35% of the adolescents, vitamin A and calcium in 80% and unsaturated fats in 100%. Carbohydrate and cholesterol were consumed in excess by 20.6% and 48%, respectively. The prevalence of excess weight and inadequate food consumption is of great concern for the population studied and requires appropriate nutritional intervention.

Excesso de peso e consumo alimentar em adolescentes de escolas publicas no norte de Minas Gerais, Brasil / Excess weight and food consumption of adolescents in public schools in northern Minas Gerais state, Brazil

Este estudo objetivou identificar a prevalência excesso de peso e o consumo alimentar entre adolescentes de rede pública de ensino ao norte de Minas Gerais. Desenvolveu-se estudo transversal com amostra aleatória e representativa de adolescentes. Foram coletadas informações demográficas e econômicas. O consumo alimentar foi avaliado pela aplicação de questionário semiquantitativo. Aferiu-se peso e altura para avaliação do estado nutricional com base no Índice de Massa Corporal (IMC) por Idade. A comparação entre os gêneros foi conduzida por meio do teste t de Student (médias) ou qui-quadrado (proporções), assumindo-se um nível de significância de p < 0,05. Foram avaliados 535 adolescentes e registrada uma prevalência de excesso de peso para 18,5%. Houve diferença significativa entre os gêneros para o IMC (p = 0,001), maior entre as meninas. O consumo médio de energia foi de 3.096,30kcal/dia. Observou-se consumo insuficiente de fibras em 35% dos adolescentes, de cálcio e vitamina A em 80% e gorduras insaturadas em 100%. Carboidratos e colesterol eram consumidos em excesso por 20,6% e 48%, respectivamente. A prevalência do excesso de peso e o consumo alimentar inadequado mostrou-se preocupante para a população estudada e demandam adequada intervenção nutricional. .

This study sought to identify the prevalence of excess weight and food consumption patterns among adolescents attending public schools in northern Minas Gerais state. A cross-sectional study was conducted with a random and representative sample of adolescents. Demographic and economic data were collected. Food consumption was evaluated by applying a semi-quantitative food questionnaire. Body weight and height were measured to assess the nutritional status based on the Body Mass Index (BMI) by Age. The sexes were compared by Student's t test (comparison of samples) and chi-square test (goodness of fit) at a level of significance of p <0.05. 535 adolescents were evaluated and prevalence of excess weight was detected in 18.5% of the group. BMI (p = 0,001) was statistically different between the sexes and higher for girls. The average energy consumption of the group was 3096.30 kcal/day. Fiber consumption was insufficient in 35% of the adolescents, vitamin A and calcium in 80% and unsaturated fats in 100%. Carbohydrate and cholesterol were consumed in excess by 20.6% and 48%, respectively. The prevalence of excess weight and inadequate food consumption is of great concern for the population studied and requires appropriate nutritional intervention. .

Histopathological and immunohistochemical aspects of American cutaneous leishmaniasis before and after different treatments.

BACKGROUND: The histopathology and immune responses of the healing process of leishmaniasis are still poorly studied. OBJECTIVES: This study aimed to examine the histopathological and immunological aspects of lesions of patients with cutaneous leishmaniasis before and after different therapeutic methods. METHODS: We studied 23 individuals grouped according to the treatments: Glucantime, Glucantime + Leishvacin and Glucantime + Leishvacin associated with Bacillus Calmette-Guerin. For analysis of the histopathological changes present in the dermis and epidermis, histological sections were stained with hematoxylin and eosin. The samples were immunostained before and after treatment to analyze the expression of interferon (IFN)-γ, interleukin (IL) 12, IL-10 and IL-4. RESULTS: Before treatment the presence of intense infiltrates of mononuclear cells was noticed and after treatment, even with a diagnosis of clinical cure, the subjects still showed a moderate inflammatory process. In the immunohistochemical analyses, we noticed a difference between the cytokines, with increased expression of cytokines IFN-γ and IL-12 compared to IL 10 and IL-4, both before and after treatment and, comparatively, the difference in this expression was more intense before treatment. However, the cytokine expression analyzed by treatment group showed no statistically significant difference. CONCLUSION: We conclude that a clinical cure does not always coincide with the histopathological one, and that before treatment there is a predominance of Th1 cytokines. In terms of treatment type, there was no difference in the progression of healing for all the three types of treatment, indicating their clinical equivalence.

Histopathological and immunohistochemical aspects of American cutaneous leishmaniasis before and after different treatments* / Aspectos histopatológicos e imuno-histoquímicos da leishmaniose tegumentar americana antes e depois de diferentes tratamentos

The histopathology and immune responses of the healing process of leishmaniasis are still poorly studied. This study aimed to examine the histopathological and immunological aspects of lesions of patients with cutaneous leishmaniasis before and after different therapeutic methods. We studied 23 individuals grouped according to the treatments: Glucantime, Glucantime + Leishvacin and Glucantime + Leishvacin associated with Bacillus Calmette-Guerin. For analysis of the histopathological changes present in the dermis and epidermis, histological sections were stained with hematoxylin and eosin. The samples were immunostained before and after treatment to analyze the expression of interferon (IFN)-γ, interleukin (IL) 12, IL-10 and IL-4. Before treatment the presence of intense infiltrates of mononuclear cells was noticed and after treatment, even with a diagnosis of clinical cure, the subjects still showed a moderate inflammatory process. In the immunohistochemical analyses, we noticed a difference between the cytokines, with increased expression of cytokines IFN-γ and IL-12 compared to IL 10 and IL-4, both before and after treatment and, comparatively, the difference in this expression was more intense before treatment. However, the cytokine expression analyzed by treatment group showed no statistically significant difference. We conclude that a clinical cure does not always coincide with the histopathological ...

A histopatologia e as respostas imunológicas do processo de cura da leishmaniose são ainda pouco estudadas. Este estudo teve como objetivo avaliar os aspectos histopatológicos e imunológicos das lesões de pacientes com leishmaniose tegumentar, antes e após diferentes métodos terapêuticos. Foram estudados 23 indivíduos agrupados de acordo com os tratamentos: Glucantime, Glucantime + Leishvacin e Glucantime + Leishvacin associado com Bacilo Calmette-Guerin. Para a análise das alterações histopatológicas presentes na derme e epiderme, cortes histológicos foram corados com hematoxilina e eosina. Para avaliar a expressão de interferon (IFN)-γ, interleucina (IL) 12, IL-10 e IL-4 foi utilizada a técnica de imuno-histoquímica antes e após o tratamento. Antes do tratamento houve um intenso infiltrado de células mononucleares, após o tratamento, mesmo com um diagnóstico de cura clínica, apresentou-se ainda um moderado processo inflamatório. Na análise imuno-histoquímica, notamos uma diferença entre as citocinas, com expressão aumentada de citocinas IFN-γ e IL-12 em comparação com IL-10 e IL-4 tanto antes quanto depois do tratamento, e comparativamente, a diferença nesta expressão mostrou-se mais intensa antes do tratamento. No entanto, a expressão das citocinas analisadas por grupo de tratamento não mostraram diferenças ...

Endonyx toenail onychomycosis caused by Trichophyton rubrum: treatment with photodynamic therapy based on methylene blue dye.

This study shows the effectiveness of photodynamic therapy based on methylene blue dye for the treatment of endonyx toenail onychomycosis. Four patients with endonyx onychomycosis caused by Trichophyton rubrum were treated with 2% methylene blue aqueous solution irradiated with light emission diode at 630 nm and an energy density of 36 J/cm2 for 6 months at 2-week intervals. The preliminary study showed the effectiveness of this therapy in the treatment of endonyx onychomycosis, and also indicated that the disease can be caused by T. rubrum.

Immunohistochemical profile of HIF-1α, VEGF-A, VEGFR2 and MMP9 proteins in tegumentary leishmaniasis.

BACKGROUND: Leishmaniasis is one of the most important infectious diseases worldwide. Our study can provide more knowledge about angiogenic and hypoxic events in leishmaniasis. We attempted to verify whether the HIF-1 α protein expression may be associated to VEGF-A, VEGFR2 and MMP9 in leishmanial lesions. OBJECTIVES: Besides understanding the pathway, we performed the correlation of VEGF-A, VEGFR2 and MMP9 proteins. METHODS: In this study, we gathered 54 paraffin blocks taken from skin lesions in patients from northern Minas Gerais, Brazil, with confirmed diagnosis of tegumentary leishmaniasis. Immunohistochemistry was used to evaluate the expression of the proteins. The expression of HIF-1α was categorized into two groups according to the median: HIF-1 α lower and HIF-1 α higher. RESULTS: We observed increase of VEGFR2 and MMP9 protein expressions in HIF-1 α higher group of epithelial cells. Spearman analyses in epithelial cells showed correlation between VEGF-A and MMP9, VEGFR2 and MMP9 protein expression. CONCLUSIONS: HIF-1 α higher group showed increase of VEGFR2 and MMP9 proteins. In epithelial cells, VEGF-A was correlated to MMP9 protein. Furthermore, considering leukocyte cells, VEGFR2 was negatively correlated to MMP9 protein levels. This pathway possibly prepares the cells for a higher activity in a hypoxic or an angiogenic microenvironment. Other in vitro and in vivo studies may clarify the activation mechanism and the response from the proteins HIF-1 α, VEGFR2 and MMP-9 in tegumentary leishmaniasis.

Immunohistochemical profile of HIF-1α, VEGF-A, VEGFR2 and MMP9 proteins in tegumentary leishmaniasis / Estudo da expressão imunohistoquímica das proteínas HIF-1α, VEGF-A, VEGFR2 e MMP9 em leishmaniose tegumentar americana

BACKGROUND: Leishmaniasis is one of the most important infectious diseases worldwide. Our study can provide more knowledge about angiogenic and hypoxic events in leishmaniasis. We attempted to verify whether the HIF-1 α protein expression may be associated to VEGF-A, VEGFR2 and MMP9 in leishmanial lesions. OBJECTIVES: Besides understanding the pathway, we performed the correlation of VEGF-A, VEGFR2 and MMP9 proteins. METHODS: In this study, we gathered 54 paraffin blocks taken from skin lesions in patients from northern Minas Gerais, Brazil, with confirmed diagnosis of tegumentary leishmaniasis. Immunohistochemistry was used to evaluate the expression of the proteins. The expression of HIF-1α was categorized into two groups according to the median: HIF-1 α lower and HIF-1 α higher. RESULTS: We observed increase of VEGFR2 and MMP9 protein expressions in HIF-1 α higher group of epithelial cells. Spearman analyses in epithelial cells showed correlation between VEGF-A and MMP9, VEGFR2 and MMP9 protein expression. CONCLUSIONS: HIF-1 α higher group showed increase of VEGFR2 and MMP9 proteins. In epithelial cells, VEGF-A was correlated to MMP9 protein. Furthermore, considering leukocyte cells, VEGFR2 was negatively correlated to MMP9 protein levels. This pathway possibly prepares the cells for a higher activity in a hypoxic or an angiogenic microenvironment. Other in vitro and in vivo studies may clarify the activation mechanism and the response from the proteins HIF-1 α, VEGFR2 and MMP-9 in tegumentary leishmaniasis.

FUNDAMENTOS: A leishmaniose é uma das mais importantes doenças infecciosas em todo o mundo. Em leishmaniose, tem sido sugerido que muitas características da lesão está associado a eventos de hipóxia, podendo este ter um papel fundamental na evolução da doença. OBJETIVO: O presente estudo pode fornecer dados acerca do fenômeno hipóxia e da angiogênese em leishmaniose tegumentar americana. Buscou-se verificar se a expressão da proteína HIF-1 α associa-se à expressão das proteínas VEGF-A, VEGFR2 e MMP9 em lesões de Leishmania sp. MÉTODOS: Neste estudo retrospectivo, foram utilizados 54 blocos de parafina de lesões de leishmaniose tegumentar americana de pacientes do norte de Minas Gerais, Brasil, com diagnóstico confirmado de leishmaniose tegumentar americana. A técnica de imunohistoquimica foi utilizada para avaliação da expressão das proteínas. A expressão da HIF-1α foi categorizada em dois grupos de acordo com a mediana: HIF-1 α abaixo e HIF-1 α acima da mediana. RESULTADOS: Observamos aumento das expressões das proteínas VEGFR2 e MMP9 no grupo HIF-1 α acima da mediana. A análise de Spearman demonstrou correlação entre as proteínas VEGF-A e MMP9, VEGFR2 e MMP9. CONCLUSÃO: Os dados aqui apresentados indicam uma alta expressão da proteína HIF-1 α em LTA. O grupo HIF-1α acima da mediana apresentou maior expressão das proteínas VEGFR2 e MMP9. Foi demonstrada correlação entre as proteínas VEGF-A e MMP9, VEGFR2 e MMP9. Outros estudos in vitro e in vivo devem ser realizados a fim de esclarecer o mecanismo de ativação e resposta das proteínas HIF-1 α, VEGFR2 e MMP-9 em leishmaniose tegumentar americana.

Infiltrating CD57+ inflammatory cells in head and neck squamous cell carcinoma: clinicopathological analysis and prognostic significance.

This study investigated the immunodetection of CD57+ inflammatory cells in patients with head and neck squamous cell carcinoma (HNSCC) and its association with clinicopathological parameters and overall survival. Data collected from the morphological analysis and immunohistochemical reaction testing of archived HNSCC specimens (n=70) were statistically analyzed by bivariate and multivariate statistical testing at a significance level of P<0.05. The results indicate that CD57+ inflammatory cells predominate within the peritumoral stroma of HNSCC lesions and the existence of two significant relationships: between high CD57+ cell density and the development of a tumor of a large size [odds ratio (OR)=5.610, 95% confidence interval (CI)=1.516-20.763) and between high CD57+ cell density and the development of locoregional metastatic disease (OR=3.401, 95% CI=1.162-9.951). A significant difference in the rate of survival was detected only in HNSCC patients that presented large size tumors (OR=4.747, 95% CI=1.281-17.594). Together, these results suggest that although high CD57+ inflammatory cell density is associated with HNSCC lesions of greater clinical severity, the variable of cell density is not an independent predictor of HNSCC patient survival. Our findings also suggest that the relatively aggressive infiltration of CD57+ inflammatory cells in the peritumoral stroma of head and neck carcinomas may contribute to an ineffective locoregional antitumoral response.

Aspectos clínico-epidemiológicos da leishmaniose tegumentar americana em Montes Claros, Minas Gerais / Clinical and epidemiologic aspects of American tegumentary leishmaniasis in the Municipality of Montes Claros, State of Minas Gerais, Brazil

A leishmaniose tegumentar americana é doença polimorfa da pele e/ou mucosas, que provoca lesões ulceradas, nodulares, únicas ou múltiplas, causada por protozoários do gênero A doença apresenta ampla distribuição no país, com registro de casos em todas as regiões brasileiras. Para conhecer o perfil dos pacientes com leishmaniose cutânea foram descritas as características epidemiológicas e clínicas desses pacientes no município de Montes Claros-MG. Trata-se de estudo retrospectivo de informações clínicas nas fichas do Sistema Nacional de Agravos de Notificação de pacientes com leishmaniose cutânea, no período de 2002 a 2010. As notificações foram de 446 pacientes, sendo 283 homens e 163 mulheres. A idade dos pacientes variou entre um e 90 anos. A forma clínica predominante (93,95%) foi a cutânea, tendo sido registrados 93,95% de novos casos da doença. No diagnóstico, a reação intradérmica de Montenegro apresentou casos positivos em 281 pacientes (64,35%), em 308 testes realizados. Em 92% dos casos, foi administrado, para tratamento, antimonial pentavalente, sendo que 423 pacientes (94,84%) obtiveram cura clínica. A partir das características clínicas e epidemiológicas identificadas no estudo pode-se sugerir que os casos de leishmaniose cutânea estão em crescimento no município e que há necessidade de se criar um programa de conscientização da população sobre a expansão da doença nos últimos anos.

American tegumentary leishmaniasis is a polymorphous skin and/or mucosa disease caused by Leishmania protozoans that results in single or multiple ulcerated and nodular lesions. The disease is widely spread in Brazil with records in all the Brazilian macro-regions. This paper reports on a retrospective study that investigated the clinical and epidemiologic characteristics of patients with cutaneous leishmaniasis aiming to describe their profile in Montes Claros, a municipality in the State of Minas Gerais. Patients? clinical information were obtained in a national notification databank (Sistema Nacional de Agravos de Notificação) for the period from 2002 through 2010. Data comprises 446 patients: 283 men and 163 women at age ranging from 1 to 90 years. The major clinical form was cutaneous leishmaniasis (93.95 %). The Montenegro skin test used for diagnosis revealed 281 positive cases, i.e. 64.34 % of the 308 tests carried out. The most common treatment (92 % of cases) was pentavalent antimonial, and 423 patients (94.84 %) had clinical cure. The clinical and epidemiologic characteristics herein identified suggest that cases of cutaneous leishmaniasis are increasing in the municipality and that policies.

Immunotherapy, immunochemotherapy and chemotherapy for American cutaneous leishmaniasis treatment.

The first choice of treatment for American cutaneous leishmaniasis is the pentavalent antimonial drug. Although it has been shown that this treatment is mostly effective and indicated, some disadvantages should be taken into account such as side effects, long term treatment inconveniences and counter-indication for patients suffering from cardiopathy, nephropathy; yet, aging, pregnancy and other conditions. With the advent of the vaccine anti-American cutaneous leishmaniasis as a prophylactic measure, studies on therapy using the vaccine associated or not with other drugs have been performed by many investigators and it is currently among the alternative treatments and prevention measures for American cutaneous leishmaniasis. In conclusion, the association between antimony and vaccine (immunochemotherapy) showed the same cure rate when compared with the standard treatment (100%) and it was also able to reduce the salt volume in 17.9% and treatment length from 87 to 62 days, decreasing side effects.

Immunotherapy, immunochemotherapy and chemotherapy for American cutaneous leishmaniasis treatment

O tratamento de primeira escolha para leishmaniose tegumentar americana é o antimonial pentavalente. Embora este tratamento seja na maioria das vezes efetivo e indicado, devem ser consideradas as desvantagens tais como efeitos colaterais, longa duracão do tratamento e contra-indicacão para cardiopatas, nefropatas, idosos, grávidas e outras condicões. Com o advento da vacina antileishmaniose tegumentar americana para fins profiláticos e terapêuticos, associando-a ou não a outros fármacos, muitas pesquisas têm sido desenvolvidas, sendo a vacina a principal entre os atuais recursos no tratamento e prevencão da leishmaniose tegumentar americana. Em conclusão, a associacão do antimônio com a vacina (imunoquimioterapia) apresentou o mesmo índice de cura em relacão ao tratamento padrão (100%), e ainda reduziu o volume do sal em 17,9% e o tempo de cura significativamente, de 87 para 62 dias; conseqüentemente, reduzindo os efeitos colaterais.

Análise de marcadores fenotípicos das populações celulares no exsudato inflamatório da lesão e no sangue periférico de pacientes portadores de Leishmaniose Tegumentar Americana (LTA) antes e após diferentes tratamentos

As leishmanioses são doenças causadas por várias espécies de protozoários digenéticos dogênero Leishmania, que acometem o Homem e diferentes espécies animais silvestres edomésticos. A transmissão da doença para o Homem ocorre pela picada das fêmeas dosinsetos vetores - gênero Lutzomyia - que, ao picar o hospedeiro vertebrado parasitado, suga asamastigotas. No tubo digestivo do inseto multiplicam-se e transformam-se em promastigotas:forma infectante para o Homem. No Brasil, as leishmanioses polarizam-se em dois grandesgrupos: a Leishmaniose Tegumentar Americana (LTA) e a Leishmaniose Visceral Americana(LVA) ou Calazar Americano. Nos últimos 20 anos, a incidência de LTA no Brasil temaumentado, em praticamente todos os Estados. Surtos epidêmicos têm ocorrido nas regiõesSudeste, Centro-Oeste, Nordeste, sendo um problema de saúde pública. Entre 1981 e l991, emMinas Gerais foram notificados, pela Secretaria de Estado de Saúde e pela Fundação Nacionalde Saúde, 8.303 casos de LTA. Muitos destes casos ocorreram na população rural do Norte,Nordeste e Sudeste do Estado. O Município de Caratinga, localizado no Vale do Rio Doce, éárea endêmica para a LTA.Atualmente, o tratamento de primeira escolha constitui-se dos antimoniais pentavalentes e noBrasil, o Glucantime® (antimoniato de N-metilglucamina) é o fármaco disponível. Por aindanão ser considerado satisfatório, inúmeros estudos vêm sendo realizados em busca do melhorfármaco e do melhor esquema terapêutico, pois mesmo para o Glucantime® vários são osesquemas propostos. A imunoterapia é uma alternativa promissora para o tratamento dasleishmanioses e vem sendo utilizada, juntamente com o Glucantime®, no tratamento da LTAno Município de Caratinga, no Ambulatório Paulo Araújo de Magalhães.[...]

Short report: quantification of leishmaniavirus RNA in clinical samples and its possible role in pathogenesis.

Leishmaniavirus (LRV) is a double-stranded RNA virus that infects the protozoa Leishmania and has been identified in numerous strains of Leishmania braziliensis and L. braziliensis guyanensis. In general, the species of Leishmania dictates disease manifestation except in the case of L. braziliensis, which is capable of causing either cutaneous or mucocutaneous leishmaniasis. We wanted to determine 1) the quantity of LRV RNA present in a clinical sample and 2) if infection with LRV was associated with a specific disease manifestation. A real-time reverse transcriptase-polymerase chain reaction assay was used to assay clinical samples for the presence of LRV. Of 47 samples tested, 12 positive samples were obtained from patients with cutaneous lesions, lesions in the process of scarring, and cutaneous scars. This is the first study to examine the prevalence of LRV RNA within a small cohort from Brazil.