Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.

BACKGROUND/METHODS: In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. RESULTS: The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. CONCLUSION: An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.

Airway epithelium mediates the anti-inflammatory effects of exercise on asthma.

Airway epithelium plays an important role in the asthma physiopathology. Aerobic exercise decreases Th2 response in murine models of allergic asthma, but its effects on the structure and activation of airway epithelium in asthma are unknown. BALB/c mice were divided into control, aerobic exercise, ovalbumin-sensitized and ovalbumin-sensitized plus aerobic exercise groups. Ovalbumin sensitization occurred on days 0, 14, 28, 42, and aerosol challenge from day 21 to day 50. Aerobic exercise started on day 22 and ended on day 50. Total cells and eosinophils were reduced in ovalbumin-sensitized group submitted to aerobic exercise. Aerobic exercise also reduced the oxidative and nitrosative stress and the epithelial expression of Th2 cytokines, chemokines, adhesion molecules, growth factors and NF-kB and P2X7 receptor. Additionally, aerobic exercise increased the epithelial expression of IL-10 in non-sensitized and sensitized animals. These findings contribute to the understanding of the beneficial effects of aerobic exercise for chronic allergic airway inflammation, suggesting an immune-regulatory role of exercise on airway epithelium.

Nutritional factors in milk from brazilian mothers delivering small for gestational age neonatal

A composiçäo do leite de mäes brasileiras de lactentes de baixo peso e sua adequaçäo como fonte de nutrientes para este grupo ainda näo foi totalmente elucidada. Um total de 209 amostras de leite de 66 nutrizes foram analisadas. As mäes foram divididas em três grupos: G1, mäes de recém-nascidos (RN) a termo, com baixo peso (TSGA, n=16); G2, mäes de RN pré-termo, com peso adequado (PTAGA, n=20); G3, mäes de RN a termo e peso adequado (TAGA, n=30). Os seguintes fatores foram analisados: osmolaridade, proteínas totais e fraçöes, crematócrito, sódio, potássio, cálcio e magnésio. As amostras foram coletadas 48 h, no 7§, 15§, 30§ e 60§ dias após o parto. Os grupos näo diferiram em termos de osmolaridade, proteínas totais e fraçöes, crematócrito, cálcio, magnésio ou potássio durante o estudo. Os níveis de sódio foram maiores em todas as amostras de mäes de TSGA e em mäes de PTAGA no 7§, 15§ e 30§ dias em relaçäo a mäes de TAGA. Foram consideradas as necessidades dos lactentes de baixo peso e TAGA, e estes níveis de sódio podem ser necessários para o crescimento dos RN de baixo peso