Cytokine profile of patients with chronic immune thrombocytopenia affects platelet count recovery after Helicobacter pylori eradication.

Helicobacter pylori eradication induces platelet recovery in a subgroup of patients with chronic immune thrombocytopenia (cITP), but the mechanisms involved are still not understood. We aimed to evaluate the effect of H. pylori eradication on platelet response and to identify the associated serum cytokine profile in 95 patients with cITP. Serum cytokine concentrations were determined by enzyme-linked immunosorbent assay prior to and 6 months after H. pylori eradication. Remission of cITP was observed in 17 (28·8%) of 59 patients in whom the bacterium was eradicated. Six months after treatment, a significant reduction in the concentrations of T-helper (Th) 1 and Th17 cells and an increase in T regulatory (Treg) and Th2-cell commitment cytokines were observed in patients who recovered, but not in those whose platelet count did not recover. Patients who had a platelet response to eradication of the bacteria had higher pre-treatment serum levels of γ-interferon (IFNG, IFN-γ), transforming growth factor-ß (TGFB1, TGF-ß) and interleukin 17 (IL17A, IL-17) than patients who did not respond, but only higher pre-treatment TGFB1 levels was independently associated with platelet response. In conclusion, amelioration of cITP after eradication of H. pylori was linked to a more efficient suppression of Th1 and Th17 response and a more pronounced Treg cell response.

The levels of IL-17A and of the cytokines involved in Th17 cell commitment are increased in patients with chronic immune thrombocytopenia.

Th17 cells have been associated with immune-mediated diseases in humans but it has still not been determined whether they play a role in immune thrombocytopenia. We evaluated representative cytokines of the Th17, Th1, Th2 and Treg cell commitment in the serum of patients with chronic immune thrombocytopenia, as well as the cell source of IL-17A. Higher levels of IL-17A and Th17-related cytokines, and an increased percentage of IL-17A producing CD4+ and neutrophils were observed in patients. The levels of cytokines involved in Th1 cell commitment IFN-γ, IL-2, IL12-p70 and the percentages of Th1 cells were also increased, but IL-4 was not detected. Although the concentrations of IL-10 were higher, the levels of TGF-ß were similar in both groups. In conclusion, our results point to a putative role for Th-17 cells/IL-17A cytokine in the pathogenesis of chronic immune thrombocytopenia.

IL1RN VNTR and IL2-330 polymorphic genes are independently associated with chronic immune thrombocytopenia.

Chronic Immune Thrombocytopenia (cITP) is an acquired immune-mediated disease associated with a T-helper cell type 1 (Th1) immune polarization, whose genetic risk factors, however, are largely unknown. We investigated polymorphisms in promoter regions of genes that code molecules involved in proinflammatory immune response [IL1B-31T/C, IL1RN variable number tandem repeats (VNTR), IL2-330T/G, and TNF-307G/A] as well as in genes that code Toll like receptors (TLR) (TLR2 Arg753Gln, TLR4 Asp299Gly and TLR5 Arg(392stop)) in 122 patients with cITP and 541 blood donors. The frequencies of the IL1RN polymorphic allele 2 (P = 0·001) and of the IL2-330 polymorphic allele G (P =0·004) were significantly higher in cITP patients than in blood donors. In logistic analysis adjusting for age and gender, the polymorphisms remained independently associated with cITP. Enhanced serum concentrations of interleukin (IL)-1α and IL-1ß were observed in cITP (P < 10(-3) ) and blood donor (P = 0·04) carriers of the IL1RN*2. Also, the serum levels of IL-2 and γ-interferon (IFN-γ) were increased in cITP patients (P < 10(-3) and P = 0·04 respectively) and blood donors (P < 10(-3) and P = 0·03 respectively) harbouring the IL2-330G allele. Here we demonstrated that IL2-330G and IL1RN*2 are independently associated with cITP and are functional in vivo, which strongly suggests that they contribute to the pathogenesis of cITP.

The serum levels of the cytokines involved in the Th17 and Th1 cell commitment are increased in individuals with borderline thrombocytopenia.

The definition of immune Thrombocytopenia (ITP) as a peripheral blood platelet count less than 100 × 109/L instead of the historical criteria of 150 × 109/L renders subjects with platelets between 100 and 150 × 109/L without a diagnosis. Here, we demonstrated that these subjects have enhanced levels of proinflammatory cytokines linked to Th1 and Th17 cell response, and are more frequently carriers of polymorphisms in genes that code cytokines involved in the commitment of Th1 and Th17 immune response, when compared with controls, similarly to that observed in patients with ITP.

Long-term effect of Helicobacter pylori eradication on plasma homocysteine in elderly patients with cobalamin deficiency.

BACKGROUND: Helicobacter pylori gastritis may lead to impairment of the production of pepsinogen and acid, which are essential to cobalamin absorption. In turn, cobalamin deficiency leads to hyperhomocysteinaemia, a risk factor for cardio and cerebrovascular diseases. AIM: To evaluate the effect of H pylori eradication on plasma homocysteine levels in elderly patients. PATIENTS: Sixty-two H pylori-positive elderly patients with cobalamin deficiency were prospectively studied. METHODS: Homocysteine and cobalamin concentrations were determined before, 6 and 12 months after H pylori eradication. RESULTS: Corpus atrophy was observed in a few patients; otherwise, in most of them, the degree of corpus gastritis was moderate to severe. The initial homocysteine mean (SD) levels decreased from 41.0 (27.1) to 21.6 (10.1) micromol/l at the 6 month follow-up (p<0.001) and to 13.1 (3.8) micromol/l 12 months after H pylori eradication (p<0.001). Conversely, initial cobalamin mean levels increased from 145.5 (48.7) pmol/l to 209.8 (87.1) pmol/l and to 271.2 (140.8) pmol/l, 6 and 12 months after treatment, respectively (p<0.001 for both). Although the erythrocyte mean corpuscular volume was within reference intervals, it decreased significantly 6 (p = 0.002) and 12 (p<0.001) months after treatment. CONCLUSIONS: The results of the current study demonstrated that the eradication of H pylori in elderly patients with cobalamin deficiency is followed by increasing of cobalamin and decreasing of homocysteine blood levels.

Principais síndrome geriátricas / Main geriatric syndromes

Revisão acerca das grandes síndromes geriátricas: incapacidade cognitiva, instabilidade postural, imobilidade e incapacidade comunicativa, com enfoque nos aspectos etiológicos, diagnóstico e condutas terapêuticas. A saúde do idoso está estritamente relacionada com a sua funcionalidade global, definida como a capacidade de gerir a própria vida ou cuidar de si mesmo. Essa capacidade de funcionar sozinho é avaliada por meio da análise das atividades de vida diária, que são tarefas do cotidiano realizadas pelo paciente. A saúde do idoso é determinada pelo funcionamento harmonioso de quatro domínios funcionais: cognição, humor, mobilidade e comunicação. A perda dessas funções resulta nas grandes síndromes geriátricas abordadas.

Review about major geriatric syndromes: cognitive impairment, postural instability, immobility and communicative disability, focusing on the etiology, diagnosis and therapeutic aspects. The health of the elderly is closely related to their overall functionality, defined as their ability to manage their own life or take care of themselves. This ability of functioning alone is evaluated by the analysis of the daily activities, which are the daily tasks carried out by the patient. The elderly health is determined by the harmonic functioning of four functional domains: cognition, mood, mobility and communication. The loss of these functions results in the major geriatric syndromes addressed.

Características da gastrite crônica associada a Helicobacter pylori: aspectos topográficos, doenças associadas e correlação com o status cagA / Helicobacter pylori associated gastritis: topographical pattern, associated diseases and correlation with cagA status

OBJETIVOS: Analisar o padrão topográfico da gastrite por H. pylori em relação ao status cagA e associação com úlcera duodenal (UD) e carcinoma gástrico precoce (CaGp). MATERIAL E MÉTODO: Estudamos prospectivamente 160 biopsias endoscópicas e 40 peças de gastrectomia por CaGp. Amostras do antro e do corpo na pequena e grande curvaturas, da incisura e do tumor, foram processadas rotineiramente para histologia com histoquímica para caracterização da metaplasia intestinal (MI). O Helicobacter pylori foi avaliado por histologia, imuno-histoquímica, cultura e reação em cadeia de polimerase (PCR) e o status cagA por PCR. A gastrite crônica (GC) foi classificada segundo o sistema Sydney. Realizou-se estudo topográfico em 130 pacientes, analisando os parâmetros de gastrite comparativamente entre as áreas e em relação ao status cagA. RESULTADOS: Cento e vinte e um pacientes apresentaram GC, 24 UD e 14 eram normais. Detectaram-se amostras cagA-positivas em 59 pacientes com GC, 17 com UD e 24 com CaGp. Todos os parâmetros de GC foram significativamente mais intensos nos pacientes infectados por amostras cagA-positivas, que se associavam ainda à presença de atrofia e MI. A MI foi significativamente mais intensa na porção média da pequena curvatura antral do que nas demais regiões. Nos pacientes com GC e CaGp, infectados por amostras cagA-positivas, inflamação e atividade acometiam igualmente o antro e corpo distal, enquanto a atrofia e a MI predominavam no antro, particularmente na pequena curvatura do antro médio. Nos pacientes cagA-negativos a GC era predominantemente antral, e na UD a GC apresentava predominância antral, independentemente do status cagA. CONCLUSÕES: Nossos dados sugerem que o padrão de gastrite por H. pylori se relaciona com fatores de virulência da bactéria. As lesões pré-neoplásicas são significativamente mais intensas na pequena curvatura do antro médio, onde surge a maioria dos carcinomas gástricos (CaG).

Infecção pelo HIV no idoso / HIV infection in elderly patients

Justificativa e objetivos: a infecção pelo vírus do HIV vem aumentando sua incidência em pacientes maiores de 50 anos. Diante disso, faz-se necessário entender as peculiaridades da epidemia nesta faixa etária, a abordagem do diagnóstico e as interações farmacológicas mais frequentes nesta população, em função das doenças degenerativas.Relato do caso: trata-se de relato de caso de paciente de 65 anos com diagnóstico de pancitopenia à esclarecer, posteriormente diagnosticada como infecção pelo vírus da imunodeficiência humana (HIV).Conclusão: a faixa etária do paciente não deve ser considerada como fator de exclusão para suspeita de diagnósticos, tais como a infecção pelo HIV.

O jogo dramático na educação - em busca de uma sociabilidade cidadã / Dramatic play in education - in search of citizen sociability

Esta pesquisa de iniciação científica origina-se na caminhada da aluna autora do Curso de Comunicação e Artes do Corpo, com experiência de trabalho em teatro-participativo, voltado para crianças, e que aqui realiza sua aproximação com a Educação, numa perspectiva emancipadora. A temática central é a relação entre o jogo dramático na Educação e a construção de uma sociabilidade cidadã, entendida como possibilitadora da comunicabilidade, da expressão espontâneo-criativa, tendo em vista a participação social pautada em relações de co-operação. Propôs-se à construção de uma proposta socioeducativa, tendo por base o jogo dramático, desenvolvida com uma professora de Educação Artística de uma Escola Pública, para uma 5ª série do Ensino Fundamental. Buscou-se compreender e explicitar o(s) sentidos(s) desta experiência vivida com os sujeitos - atores sociais, envolvidos no aprender a se relacionar consigo mesmo, com o outro e com o grupo-classe, ponto de partida para a busca de uma nova convivência nas relações sociais. Desafio a que fomos expostos, frente a necessidade do trabalho pessoal e coletivo que o jogo dramático, fundado no teatro espontâneo, possibilita. O marco teórico convergiu para uma visão do ser humano , que se constrói nas relações, e está voltada para a importância de possibilitar experiências educativas que buscam a transformação pessoal e social integrando o corpo, a afetividade e a cognição. Para essa direção apontam J.L. Moreno, Paulo Freire e autores que estudam Arte/Teatro-Educação, como Anamae Barbosa, Augusto Boal e Viola Spolin.Trata-se de uma pesquisa qualitativa, buscando a compreensão e explicitação da experiência humana e pesquisa-ação, por partir de um projeto de intervenção em que sujeitos e pesquisadora se envolvem numa co-criação. Os procedimentos utilizados envolveram a construção de protocolos do trabalho realizado em conjunto com a professora oficial, sobre os quais se reflete, e, em caráter complementar, a proposição de um questionário aberto, no início e ao final do trabalho, que incluiu um procedimento ociométrico.Consideramos que os objetivos da pesquisa foram atingidos. A sala de aula foi trabalhada como espaço da cultura, laboratório da vida social possibilitando uma nova cidadania, em que o poder e o saber são repartidos numa experiência democrática, ateavés do jogo dramático(AU)

This scientifically-oriented research has originated in the authors' journey as trainees on a Communication and Bodily Arts Course, and their experiences with participative theatre involving children. Looking at Education from an emancipating perspective, the central theme of this paper is the relationship between Dramatic Play applied in Education and the development of citizen sociability, understood as something that enables communication and spontaneous-creative expression, and which focuses on social participation guided by co-operative relationships. We offer a socio-educational proposal, based on Dramatic Play and developed together with an Art teacher in the 5th grade of a public school. The aim is to try and understand and define the significance this experience had for those who participated in it - social actors, engaged in learning how to relate to themselves, to others and to their wider peer-group - an experience that served as a starting point in the search of a new experience of social relationships. This was the challenge we faced in terms of both personal and collective work enabled by dramatic play (with its foundations in spontaneous theatre). Our theoretical approach points towards a view of the human being as someone who develops through relationships, and it stresses the importance of educational experiences that aim for personal and social transformation through the integration of the body, the feelings and the cognition. This is the direction that J.L. Moreno and Paulo Freire also followed, jointly with other authors coming from an Art/Theatre/Education background, such as Anamae Barbosa, Augusto Boal and Viola Spolin. On the one hand, this is a qualitative research, aiming to understand and define the human experience; on the other, it is an action-based research, a project of intervention where subjects and researchers engage together in co-creation. The applied procedures involved work protocols carried out and analyzed together with the official teacher, as well as an open questionnaire involving a sociometric process, wich was applied at the begenning and the end of the work. The classroom has been transformed into a cultural space, a laboratory of social life, enabling a new citizenship to develop, where power and knowledge are shared in a democratic experience, through dramatic play(AU)

Dez anos de parceria: a história do curso "Formação em psicodrama", do convênio SOPSP/PUC-SP

O tema desenvolvido pelas autoras é o histórico do curso "Formação em Psicodrama", do Convênio SOPSP/ PUC-SP,e seu estágio atual. Para tanto, apresentam a estrutura geral das entidades que compõem a parceria, a estrutura do curso e os resultados de uma pesquisa de avaliação do projeto educacional do curso, realizada com os professores(AU)

Within this paper the authors present the history of the Psychodrama Training Course run by the SOPSP/ PUC-SP covenant, and the present state of this training. In order to do so they present the general structure of the two entities that form this partnership, the structure of the course and the results of the outcome measures of the course's educational project that has been carried out together with the trainers on the course(AU)