Correlation between pre- and post-dialysis blood pressure levels in hemodialysis patients with intradialytic hypertension.

PURPOSE: To determine the association between arterial systolic blood pressure values at the beginning and at the end of a hemodialysis (HD) session in intradialytic hypertension patients. METHODS: This study evaluated the arterial systolic blood pressure patterns in 154 chronic kidney failure patients; among these patients, 18 were identified as having intradialytic hypertension. In the patients with intradialytic hypertension, four consecutive HD sessions were analyzed in which the systolic, diastolic, mean, and pulse blood pressures were automatically determined every 30 min. RESULTS: A linear relationship was revealed between the systolic blood pressure levels measured after 30 min and those obtained after 240 min of HD (r = 0.3894, p = 0.001). This association became stronger after 90 min (r = 0.5471; p < 0.001), indicating that for intradialytic hypertension patients, systolic blood pressure values at the beginning of HD were correlated with systolic blood pressure values at the end of the session. CONCLUSIONS: For intradialytic hypertension patients, values obtained at the end of HD are correlated with the initial values. This information could facilitate planning and earlier treatment.

Influence of the Notch system in the therapeutic response of American tegumentary leishmaniasis.

BACKGROUND: The evolution and therapeutic outcome of American tegumentary leishmaniasis (ATL) depend upon many factors, including the balance between Th1 and Th2 cytokines to control parasite multiplication and lesion extension. Other cytokines known for their role in inflammatory processes such as interleukin IL-17 or IL-18 as well as factors controlling keratinocyte differentiation and the inflammatory process in the skin, like the Notch system, could also be involved in the disease outcome. Notch receptors are a group of transmembrane proteins that regulate cell fate decisions during development and adulthood in many tissues, including keratinocyte differentiation and T-cell lineage commitment, depending on their activation by specific groups of ligands (Delta-like or Jagged). OBJECTIVES: To compare the in situ expression of Notch system proteins (receptors, ligands and transcriptional factors) and cytokines possibly involved in the disease outcome (IL-17, IL-18, IL-23 and transforming growth factor-ß) in ATL cutaneous and mucosal lesions, according to the response to therapy with N-methyl glucamine. METHODS: Cutaneous and mucosal biopsies obtained from patients prior to therapy with N-methyl glucamine were analysed by immunohistochemistry and real-time polymerase chain reaction. RESULTS: Notch receptors and Delta-like ligands were found increased in patients with ATL, particularly those with poor response to therapy or with mucosal lesions. CONCLUSIONS: The increase of Notch receptors and Delta-like ligands in patients with a poor response to treatment suggests that these patients would require a more aggressive therapeutic approach or at least a more thorough and rigorous follow-up.

Infecção experimental de embriões de frango de corte com Salmonella enterica sorovar Enteritidis fagotipo 4 / Experimental infection of broiler embryos with Salmonella enterica sorovar Enteritidis phagotype 4

Avaliou-se a infecção experimental por Salmonella Enteritidis fagotipo 4 (SEpt4) em embriões de frango de corte para averiguar a habilidade de penetração através da casca e o efeito da inoculação no albúmen, considerando-se a mortalidade, a eclodibilidade e a colonização intestinal dos pintos eclodidos. Foram realizados dois experimentos, distribuídos em quatro tratamentos (T) cada, com 200 e 194 ovos incubáveis das linhagens Ross e ISA Label, respectivamente. Utilizaram-se ovos não sanitizados e inoculados na casca com Salmonella Enteritidis (T1) ou com placebo (T2); ou inoculados no albúmen com Salmonella Enteritidis (T3) ou com placebo (T4). Imediatamente após a inoculação, os ovos foram incubados, e a mortalidade embrionária avaliada após 96, 432 e 528 horas. Salmonella Enteritidis inoculada na casca manteve-se viável na casca e nas membranas durante todo o período de incubação e migrou para o interior dos ovos, entretanto não afetou os parâmetros de incubação. O patógeno inoculado no albúmen determinou mortalidade embrionária tardia nas linhagens Ross, 17,0 por cento, e ISA Label, 13,0 por cento, e originou pintos com maior freqüência de colonização intestinal por Salmonella Enteritidis, 76,7 por cento e 26,7 por cento para Ross e ISA Label, respectivamente.

The experimental infection of Salmonella Enteritidis phagotype 4 (SEpt4) was evaluated in broilers embryos to verify the ability of penetration through eggshell and the effect of albumen inoculation considering embryo mortality, hatchability, and intestinal colonization of hatched chicks. Two trials were conducted using in four treatments each, totaling 200 and 194 fertile eggs of Ross and ISA Label lineages, respectively. Non-sanitized eggs were inoculated on the shell with Salmonella Enteritidis (Treatment 1) or placebo (Treatment 2); and eggs were inoculated in albumen with Salmonella Enteritidis (Treatment 3) or placebo (Treatment 4). Immediately after inoculation, the eggs were incubated and embryo mortality was evaluated after 96, 432, and 528 hours. The results showed that Salmonella Enteritidis inoculated on egg shell remained active there and in shell membranes during all incubation period and migrated to the interior of the eggs; however, it did not affect the incubation parameters. It was observed that Salmonella Enteritidis inoculated in albumen caused late embryo mortality in Ross (17.0 percent) and ISA Label (13.0 percent) lineages, and originated chicks with high frequency of intestinal colonization by Salmonella Enteritidis, being 76.7 percent and 26.7 percent for Ross and ISA Label, respectively.

Leishmanial antigens in the diagnosis of active lesions and ancient scars of American tegumentary leishmaniasis patients.

Cutaneous biopsies (n = 94) obtained from 88 patients with American tegumentary leishmaniasis were studied by conventional and immunohistochemical techniques. Specimens were distributed as active lesions of cutaneous leishmaniasis (n = 53) (Group I), cicatricial lesions of cutaneous leishmaniasis (n = 35) (Group II) and suggestive scars of healed mucosal leishmaniasis patients (n = 6) (Group III). In addition, active cutaneous lesions of other etiology (n = 24) (Group C1) and cutaneous scars not related to leishmaniasis (n = 10) (Group C2) were also included in the protocol. Amastigotes in Group I biopsies were detected by routine histopathological exam (30.2%), imprint (28.2%), culture (43.4%), immunofluorescence (41.4%) and immunoperoxidase (58.5%) techniques; and by the five methods together (79.3%). In Group II, 5.7% of cultures were positive. Leishmanial antigen was also seen in the cytoplasm of macrophages and giant cells (cellular pattern), vessel walls (vascular pattern) and dermal nerves (neural pattern). Positive reaction was detected in 49 (92.5%), 20 (57%) and 4 (67%) biopsies of Groups I, II and III, respectively. Antigen persistency in cicatricial tissue may be related to immunoprotection or, on the contrary, to the development of late lesions. We suggest that the cellular, vascular and neural patterns could be applied in the immunodiagnosis of active and cicatricial lesions in which leishmaniasis is suspected.

American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics.

BACKGROUND: Rio de Janeiro State in Brazil is an endemic area of American tegumentary leishmaniasis (ATL) induced by Leishmania (Viannia) braziliensis. Objective Our purpose was to describe the main clinical and epidemiologic characteristics of the disease in Rio de Janeiro State. METHODS: Patients from endemic areas of Rio de Janeiro State attending the Evandro Chagas Hospital were included in the study. A general physical, dermatologic, and otorhinolaryngologic examination was performed in all patients, as well as a Leishmanin skin test. Skin biopsy specimens were obtained and utilized for touch preparations (stained with Leishman dye), culture in special media (Nicolle, Nevy and McNeal; NNN), and histopathologic examination after hematoxylin and eosin stain. Positive cultures were identified with regard to species by the isoenzyme technique. Therapy with pentavalent antimonial compounds was employed in all cases. Eco-epidemiologic characteristics were studied through regular field visits to endemic foci. RESULTS: Cutaneous disease was present in 87.2% of patients, and mucosal disease in only 12.7%. A single ulcerative cutaneous lesion was the most common clinical presentation. Demonstration of the parasite was always difficult and culture in special media gave the best results for diagnosis. The species involved in transmission was Leishmania (Viannia) braziliensis. Vectors included phlebotomine sand flies (Diptera: Psychodidae) of the genus Lutzomyia, and the most common species was Lutzomyia intermedia, captured mainly on the external walls of houses. CONCLUSIONS: ATL in Rio de Janeiro is mostly a cutaneous disease. In general, the cases showed great sensitivity to antimony. A pattern of peridomestic transmission seems to be the rule.

South American cutaneous leishmaniasis of the eyelids: report of five cases in Rio de Janeiro State, Brazil.

PURPOSE: To describe American cutaneous leishmaniasis of the eyelids and highlight the main clinical and diagnostic features of lesions, which are rare in this location. DESIGN: Retrospective, noncomparative case series METHODS: Leishmanin skin test, touch preparations, histopathologic analysis, and culture in appropriate media were used for clinical confirmation and parasitologic diagnosis. Positive cultures were identified by the iso-enzymes technique. All patients were treated with pentavalent antimony applied intramuscularly. RESULTS: Leishmanin skin test was positive in all five patients. Touch preparations, histopathologic analysis, and culture were performed in four patients. Touch preparations were positive (presence of Leishman's bodies) in two patients; histopathologic analysis showed a granulomatous infiltrate in four patients and parasite was present in two patients; culture was positive in three patients, and in two the parasite was identified as Leishmania (Viannia) braziliensis. Therapy was effective for all patients. CONCLUSIONS: Cutaneous leishmaniasis of the eyelids is uncommon in the Americas. The disease may present diagnostic difficulties when appearing in nonendemic areas. The clues for diagnosis are the clinical aspect of lesions, the epidemiologic data, and a positive Leishmanin skin test. Demonstration of parasite is not always possible. Pentavalent antimonial compounds are the therapy of choice. Formerly, transmission of leishmaniasis occurred only when humans penetrated forested areas and became an incidental host. Now, eyelid lesions are part of the changing pattern in the transmission of the disease. With the increase in ecotourism, these lesions may begin to be seen in air travelers returning to other parts of the world.