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Parasitic infections acquired by the population cause substantial morbidity worldwide, with individuals from developing countries being most affected. Some parasites remain in the host for long periods, settling in different organs, manipulating the flow of nutrients and metabolites, and influencing the immune response, favoring their adaptation. The host attempts to counteract the metabolic and immunological alterations and the possible damage caused by infection. These metabolic and immunological changes experienced by the host can influence the progression of other existing morbidities or those that will be acquired in the future. Cancer and metabolic diseases are also frequent causes of morbidity in the world population. The large numbers of individuals affected by cancer and metabolic diseases and the high prevalence of morbidity caused by parasitic diseases favor the development of comorbidity involving these pathologies. This review provides an overview of major advances in research on cancer and metabolic diseases associated with parasitic infections. Information about hosts and parasites such as alterations of the immune response, metabolism and adaptation mechanisms of the parasites, and parasitic molecules with therapeutic potential is provided, as well as the beneficial results or complications related to the comorbidities discussed herein. We emphasize the need to conduct additional studies addressing comorbidities associated with parasitic infections to improve the understanding of the impact of this association on the progression of morbidities, as well as the possibility of the therapeutic use of and therapeutic approaches involving parasites.

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Parasitic agents have been known to cause human disease since ancient times and are endemic in tropical and subtropical regions. Complications of parasitic diseases, including kidney involvement, are associated with worse outcomes. Chagas disease, filariasis, leishmaniasis, malaria and schistosomiasis are important parasitic diseases that can damage the kidney. These diseases affect millions of people worldwide, primarily in Africa, Asia and Latin America, and kidney involvement is associated with increased mortality. The most common kidney complications of parasitic diseases are acute kidney injury, glomerulonephritis and tubular dysfunction. The mechanisms that underlie parasitic disease-associated kidney injury include direct parasite damage; immunological phenomena, including immune complex deposition and inflammation; and systemic manifestations such as haemolysis, haemorrhage and rhabdomyolysis. In addition, use of nephrotoxic drugs to treat parasitic infections is associated with acute kidney injury. Early diagnosis of kidney involvement and adequate management is crucial to prevent progression of kidney disease and optimize patient recovery.

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The Muscovy duck is a commercially important bird on the island of Marajó usually raised in a peculiar system that includes supplying fish viscera to the birds under semi-extensive farming conditions. This enables a risk of contamination and losses in the production of these birds, resulting from injuries caused by helminth infections, especially nematodes. The objective of this study was to evaluate the histopathological changes caused by nematodes of the genera: Eucoleus, Anisakis and Contracaecum. Thirty-three ducks with lesions in the esophagus and ventricle were analyzed. Histopathological exams showed a mild inflammatory infiltrate in the submucosa of the esophagus caused by the fixation of E. contortus and third stage larvae of Anisakis sp., and we recorded third stage larvae of Contracaecum sp. parasitizing the ventricle, this being the first record of this parasite in ducks in Brazil.(AU)

O pato doméstico é uma ave amplamente comercializada na Ilha de Marajó, com um peculiar manejo que inclui a oferta de vísceras de peixes aos animais em criações semiextensivas, propiciando, assim, risco de contaminação e perdas na produção dessas aves decorrentes de lesões oriundas de infecções por helmintos, especialmente os nematódeos. Nesse sentido, objetivou-se avaliar as alterações histopatológicas causadas por nematódeos dos gêneros: Eucoleus, Anisakis e Contracaecum. Foram analisados 33 patos, e três exemplares apresentaram lesões no esôfago e no ventrículo. Exames histopatológicos demonstraram discreto infiltrado inflamatório na submucosa do esôfago ocasionado pela fixação de E. contortus e larvas de terceiro estágio de Anisakis sp., bem como foram registradas larvas de terceiro estágio de Contracaecum sp. parasitando o ventrículo, sendo esse o primeiro registro desse parasito em patos no Brasil.(AU)

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The aim of this study was to describe the reproductive disorders related to experimental infection by artificial insemination with semen contaminated with Toxoplasma gondii of four goats in the chronic phase of the infection. In the end of the study, the does were submitted to necropsy, and PCR and histopathological evaluations were performed. Among infected does that exhibited embryonic loss, two were in anestrus and two exhibited repeated estrus. One of the latter animals exhibited clinical signs of estrus at seven-day intervals, whereas the other had a 21-day estrous cycle. However, both does were naturally mated on subsequent natural estrous and were not able to get pregnant until the end of the experiment (90 d). Two of the goats exhibited abnormalities in the ultrasound examinations, one of which was an ovarian cyst, while the other was a hydrosalpinx, both of which were confirmed in the post-mortem examination. The main microscopic injuries in this group were neutrophilic infiltration of the lungs, interstitial glomerulonephritis and neutrophilic infiltration of the liver. T. gondii DNA was found in the organs (heart and brain) of three does. In conclusion, does infected with Toxoplasma gondii in semen at the time of artificial insemination display reproductive disorders in the chronic phase of infection that might be associated with toxoplasmosis.

Objetivou-se descrever os distúrbios reprodutivos associados à infecção experimental por Toxoplasma gondii através da inseminação artificial com sêmen contaminado em quatro cabras no estágio crônico da infecção. As características do trato reprodutor foram avaliadas através de ultrassonografia transretal, visando o diagnóstico gestacional ou de desordens reprodutivas, após a infecção experimental. Ao final do experimento, os animais foram necropsiados e avaliações histopatológicas e PCR foram realizados. Dentre os animais infectados que exibiram mortalidade embrionária, duas apresentaram anestro e duas apresentaram repetição de estro, sendo que destas uma apresentou intervalos entre estros reduzido (sete dias) e outra em intervalo regular (21 dias). Todavia, ambas foram submetidas a monta natural durante os estros naturais subsequentese não foi confirmada gestação até o final do experimento (90 dias). Duas cabras exibiram alterações nos exames de ultrassonografia, sendo identificadas um cisto ovariano, e uma hidrossalpinge, ambas confirmadas no exame post-mortem. As principais lesões microscópicas nesse grupo foram infiltração neutrofílica dos pulmões, glomerulonefrite intersticial e infiltração neutrofílica do fígado. O DNA de T. gondii foi encontrado nos órgãos (coração e cérebro) de três cabras. Em conclusão, cabras infectadas comsêmen contendoT. gondii no momento da inseminação artificial apresentam distúrbios reprodutivos na fase crônica da infecção que podem estar associados à toxoplasmose.

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Resumen Objetivo: Actualizar la información sobre la prevalencia de parasitosis en niños en Costa Rica y la relación de esta con factores socioeconómicos. Metodología: se realizó un estudio para determinar la prevalencia de parásitos y comensales intestinales en niños de 1-7 años, de 13 centros que cuentan con dos modalidades de programas de alimentación. A los padres se les administró un cuestionario estructurado (n=2514; 96,8% de los padres invitados a participar accedieron). Se recolectaron muestras de heces de los niños (n=1368, 54,0%), que fueron analizadas por frotis directo y montaje de Kato. Se corrieron pruebas de chi cuadrado, se calcularon las razones de probabilidades (OR) y se realizó un modelo de regresión logística binaria para examinar las asociaciones entre las características socioeconómicas de las familias de los niños y su probabilidad de desarrollar parasitosis. Resultados: la prevalencia de protozoarios comensales, protozoarios patógenos, helmintos o una combinación de los anteriores (CPH) fue del 24,1% (IC 95%: 21,9-26,4). La prevalencia de parásitos patógenos y la de helmintiasis fue del 8,5% (IC 95%: 7,5-10,5) y 0,7% (IC 95%: 0,1-1,5), respectivamente. El protozoario patógeno más frecuente fue Giardia intestinalis (8,0%), el comensal fue Endolimax nana (7,7%) y el helminto fue Ascaris lumbricoides (0,4%). No se observaron diferencias significativas en la prevalencia de CPH o parasitosis según sexo o programa de alimentación. Las prevalencias más altas de CPH y parasitosis se observaron en La Uruca (46,9% y 17,2%, respectivamente) y las más bajas en Paso Ancho (7,7% y 0%, respectivamente). Tener una edad >5 años, vivir en una casa con paredes construidas con material de desecho o zinc, habitar en una vivienda no adecuada (i.e., vivienda indígena, cuarto en cuartería, tugurio, casa móvil, pensión o convento) y tener una familia con más de 4 miembros, fueron identificados como posibles factores de riesgo para CPH. Conclusiones: la prevalencia de comensales, patógenos, helmintos encontrada en este estudio fue menor a la observada en la última Encuesta Nacional de Nutrición de Costa Rica (32,6%), realizada en 2008-2009. Sin embargo, el estudio muestra que existen condiciones permisivas para la trasmisión de enteroparásitos, y que resulta necesario darle seguimiento a las medidas preventivas y de tratamiento de las parasitosis.

Abstract Objective: to determine the prevalence of parasitosis in children in Costa Rica and its association with socioeconomic factors. Methods: We conducted a cross-sectional study to assess the prevalence of intestinal parasites and commensals in children aged 1-7 years old, from 13 centers with two types of food distribution programs. We administered a structured questionnaire, which included some questions from the 2014 Costa Rican National Home Survey, to most of the parents who consented for their children to participate in the study (n=2435 out of 2514). We collected stool samples from children (n=1368; 54,0%) and then analyzed them using a direct smear and Kato assembly. Odds ratios (OR) and chi-square tests were calculated and a binary logistic regression model was fitted to assess the associations between socioeconomic characteristics of the children's families and the probability of having an intestinal parasitic infection. Results: The prevalence of commensal protozoans, pathogenic protozoans, helminthes, or a combination of them (referred to henceforth as CPH) was 24.1% (95% CI: 21.9-26.4), whereas prevalences of pathogenic parasites and helmithiasis were 8.5% (95% CI: 7.5-10.5) and 0.7% (95% CI: 0.1-1.5), respectively. The most prevalent pathogenic parasite was Giardia intestinalis (8.0%), the most frequent commensal protozoan was Endolimax nana (7.7%), and the most prevalent helminth was Ascaris lumbricoides (0.4%). There were no significant differences in the prevalence of CPH or parasitosis by sex or nutritional program. The highest prevalences of CPH and parasitosis were observed in La Uruca (46.9% and 17.2%, respectively) and the lowest in Paso Ancho (7.7% and 0%, respectively). Being 5 years old or above, living in a house with walls made up of waste material or zinc, having a non-suitable house (i.e., indigenous housing, living in a small room inside a quartery house, slums, mobile housing, pension, or convent), and having more than 4 family members were identified as risk factors for having a CPH. Conclusions: The CPH prevalence found in this study was lower than the one observed in the Costa Rican National Nutritional Survey 2008-2009 (32.6%). However, this study shows that there are several permissive conditions that allow the transmission of intestinal parasites and that it is necessary to improve the preventive and treatment measures of intestinal parasites.

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Introducción: las infecciones por parasitismo intestinal, se consideran un problema de salud por sus altas tasas de prevalencia. La población infantil resulta la más afectada. A esta realidad no escapa la comunidad "Pepita de Oro", de Ecuador. Objetivo: evaluar conocimientos y hábitos higiénicos sobre parasitosis intestinal en niños de 1 a 9 años en dicha comunidad. Materiales y métodos: se realizó un estudio observacional, transversal, correlacional, en el período comprendido de agosto 2015 a septiembre 2016, en la comunidad urbana marginal "Pepita de Oro", de la ciudad del Tena, en la amazonia del Ecuador. Se aplicó encuestas a 50 padres de familia y se les realizó coproparasitario a sus 50 niños, previo consentimiento. Se trabajó con las siguientes variables: sexo, edad, tipo de parasitosis, abasto de agua, tratamiento de la misma, condiciones higiénicas, conocimientos sobre parasitismo intestinal y normas higiénicas. Resultados: se detectó que en los hábitos como el lavado de las manos antes de comer fue alto, para el 94 %; el lavado de las manos después de ir al baño, fue de 88 %. Según coproparasitario el porcentaje mayor se encontró poliparasitado, con el 77 % y 23 % monoparasitado. El grupo atareo más afectado con monoparasitismo fue de 5 a 9 años, con el 18 %; mientras que por el poliparasitismo fue de 1 a 4 años con el 67 %. El 60 % fue evaluado con parasitosis y con desconocimiento de las diferentes normas higiénicas. Conclusiones: los conocimientos y práctica de los hábitos higiénicos fueron insatisfactorios y existe la prevalencia de parasitosis (AU).

Introduction: the infections caused by intestinal parasitism are considered a health problem because of their high prevalence rates. Child population is the most affected one. The community "Pepita de Oro" does not scape this reality. Objective: to evaluate hygienic habits and knowledge on intestinal parasitism in 1-9 years-old in that community. Materials and methods: An observational, correlational and cross-sectional study was carried out in the urban marginal community "Pepita de Oro" from the city Tena, in the Ecuadorian Amazonia, in the period from August 2015 to September 2016. 50 family fathers applied a survey and coproparasitical tests were made to their 50 children, after obtaining the previous consent. The following variables were worked out: sex, age, kind of parasitism, water supply, water treatment, hygienic conditions, knowledge on intestinal parasitism and hygienic norms. Results: it was found that the habit of washing hands before eating was high, 94 %; washing hands after going to the toilet was 88 %. According to the results of the coproparasitical tests, the highest percent of children was found poliparasitized, with 77 % and 23 % were monoparasitized. The age group that was most affected by mono-parasitism was the 5-9 years-old group, with 18 %, while the 1-4 years-old group was the most affected with poliparasitism. 60 % was evaluated with parasitism and lack of knowledge on the different hygienic norms. Conclusions: hygienic habits knowledge and practice were poor and there is a prevalence of parasitism (AU).

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Introducción: las infecciones por parasitismo intestinal, se consideran un problema de salud por sus altas tasas de prevalencia. La población infantil resulta la más afectada. A esta realidad no escapa la comunidad "Pepita de Oro", de Ecuador. Objetivo: evaluar conocimientos y hábitos higiénicos sobre parasitosis intestinal en niños de 1 a 9 años en dicha comunidad. Materiales y métodos: se realizó un estudio observacional, transversal, correlacional, en el período comprendido de agosto 2015 a septiembre 2016, en la comunidad urbana marginal "Pepita de Oro", de la ciudad del Tena, en la amazonia del Ecuador. Se aplicó encuestas a 50 padres de familia y se les realizó coproparasitario a sus 50 niños, previo consentimiento. Se trabajó con las siguientes variables: sexo, edad, tipo de parasitosis, abasto de agua, tratamiento de la misma, condiciones higiénicas, conocimientos sobre parasitismo intestinal y normas higiénicas. Resultados: se detectó que en los hábitos como el lavado de las manos antes de comer fue alto, para el 94 %; el lavado de las manos después de ir al baño, fue de 88 %. Según coproparasitario el porcentaje mayor se encontró poliparasitado, con el 77 % y 23 % monoparasitado. El grupo atareo más afectado con monoparasitismo fue de 5 a 9 años, con el 18 %; mientras que por el poliparasitismo fue de 1 a 4 años con el 67 %. El 60 % fue evaluado con parasitosis y con desconocimiento de las diferentes normas higiénicas. Conclusiones: los conocimientos y práctica de los hábitos higiénicos fueron insatisfactorios y existe la prevalencia de parasitosis (AU).

Introduction: the infections caused by intestinal parasitism are considered a health problem because of their high prevalence rates. Child population is the most affected one. The community "Pepita de Oro" does not scape this reality. Objective: to evaluate hygienic habits and knowledge on intestinal parasitism in 1-9 years-old in that community. Materials and methods: An observational, correlational and cross-sectional study was carried out in the urban marginal community "Pepita de Oro" from the city Tena, in the Ecuadorian Amazonia, in the period from August 2015 to September 2016. 50 family fathers applied a survey and coproparasitical tests were made to their 50 children, after obtaining the previous consent. The following variables were worked out: sex, age, kind of parasitism, water supply, water treatment, hygienic conditions, knowledge on intestinal parasitism and hygienic norms. Results: it was found that the habit of washing hands before eating was high, 94 %; washing hands after going to the toilet was 88 %. According to the results of the coproparasitical tests, the highest percent of children was found poliparasitized, with 77 % and 23 % were monoparasitized. The age group that was most affected by mono-parasitism was the 5-9 years-old group, with 18 %, while the 1-4 years-old group was the most affected with poliparasitism. 60 % was evaluated with parasitism and lack of knowledge on the different hygienic norms. Conclusions: hygienic habits knowledge and practice were poor and there is a prevalence of parasitism (AU).

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Malaria-enteroparasitic co-infections are known for their endemicity. Although they are prevalent, little is known about their epidemiology and effect on the immune response. This study evaluated the effect of enteroparasite co-infections with malaria caused by Plasmodium vivax in a border area between Brazil and French Guiana. The cross sectional study took place in Oiapoque, a municipality of Amapá, on the Amazon border. Malaria was diagnosed using thick blood smears, haemoglobin dosage by an automated method and coproparasitology by the Hoffman and Faust methods. The anti-PvMSP-119 IgG antibodies in the plasma were evaluated using ELISA and Th1 (IFN-γ, TNF-α and IL-2), and Th2 (IL-4, IL-5 and IL-10) cytokine counts were performed by flow cytometry. The participants were grouped into those that were monoinfected with vivax malaria (M), vivax malaria-enteroparasite co-infected (CI), monoinfected with enteroparasite (E) and endemic controls (EC), who were negative for both diseases. 441 individuals were included and grouped according to their infection status: [M 6.9% (30/441)], [Cl 26.5% (117/441)], [E 32.4% (143/441)] and [EC 34.2% (151/441)]. Males prevailed among the (M) 77% (23/30) and (CI) 60% (70/117) groups. There was a difference in haemoglobin levels among the different groups under study for [EC-E], [EC-Cl], [E-M] and [Cl-M], with (p < 0.01). Anaemia was expressed as a percentage between individuals [CI-EC (p < 0.05)]. In terms of parasitaemia, there were differences for the groups [CI-M (p < 0.05)]. Anti-PvMSP-119 antibodies were detected in 51.2% (226/441) of the population. The level of cytokines evaluation revealed a large variation in TNF-α and IL-10 concentrations in the co-infected group. In this study we did not observe any influence of coinfection on the acquisition of IgG antibodies against PvMSP119, as well as on the profile of the cytokines that characterize the Th1 and Th2 patterns. However, co-infection increased TNF-α and IL-10 levels.

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The scope of this article is to analyze the influence of hospitalizations by infectious diseases (diarrhea and pneumonia) and parasitism in nutritional evolution, over the period of a year, among children enrolled in municipal public day care centers. Mothers of children in a cohort were asked about previous hospitalization due to diarrhea and pneumonia, as well as in relation to the elimination of worms, during the period of one year of attendance at day care centers. Anthropometrics were measured at each visit. An adjusted model to examine the relationship between infections experienced and growth outcomes (weight and height) was applied. In a subset analysis of 269 children followed up at every visit over the course of 12 months, hospitalization due to pneumonia and parasite infection were associated with decelerated growth in weight and height. Parasitic infection and pneumonia were associated with growth impairment in terms of weight and height.

O objetivo deste artigo é analisar a influência das hospitalizações por doenças infecciosas (diarreia e pneumonia) e do parasitismo na evolução nutricional, ao longo de um ano, entre crianças assistidas em creches públicas municipais. Mães de crianças de uma coorte responderam sobre a hospitalização por diarreia e pneumonia, assim como em relação ao parasitismo, durante o período de um ano de frequência à creche. Medidas antropométricas foram tomadas em cada visita. Usou-se modelo ajustado para examinar a relação entre a experiência de processos infecciosos e os desfechos do crescimento (peso e estatura). Numa amostra de 269 crianças monitoradas no período de 12 meses, a hospitalização por pneumonia e a infecção parasitária estiveram associadas com o crescimento desacelerado do peso e da estatura. Infecções parasitárias e pneumonia associaram-se ao comprometimento do crescimento em termos de peso e estatura.

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Parasitic infections are among the oldest and most common infections in humans. Host defense alterations caused by autoimmune diseases or immunosuppressive drugs can cause modifications of the symptoms: indolent parasites can be reactivated, asymptomatic patients may experience new symptoms, or mild or moderate symptoms can become serious and, rarely, may lead to death. In recent years, new drugs have been used in the treatment of rheumatoid arthritis (RA), causing a greater level of immunosuppression and, therefore, more concerns regarding the risk of serious parasitic diseases. Of note, experimental studies have demonstrated that the immunomodulation induced by infection with helminths can minimize the occurrence and severity of rheumatoid arthritis. Products derived from helminths (such as glycoprotein ES-62) can exert favorable effects in RA patients via their anti-inflammatory actions. Greater knowledge of these substances may serve as a basis for the development of new treatments for RA. The full impact of parasitic diseases on patients with rheumatoid arthritis remains controversial, and further studies are warrented.

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Introducción: El hierro es un componente esencial de la hemoglobina, junto con el ácido fólico y la vitamina B12, cuya función es esencial en la oxigenación del organismo. La anemia es una de las principales manifestaciones de los problemas nutricionales en el país y la asociación a parasitismo, incrementa la deficiencia de hierro. Entre los grupos que pueden tener grandes demandas en hierro se tienen a los bebés prematuros, los que no lactaron y los adolescentes. Objetivo: Exponer las revisiones bibliográficas sobre la anemia ferropénica en niños menores de 5 años. Resultados: La deficiencia de hierro es la causa más frecuente de anemia en el niño, observándose en mayor medida en edad preescolar, especialmente entre los 6 y 24 meses de edad. El estado nutricional de hierro de una persona depende del balance determinado por la interacción entre contenido en la dieta, biodisponibilidad, pérdidas y requerimientos por crecimiento. El tratamiento debe apuntar a corregir la anemia, almacenar hierro en depósitos y corregir la causa primaria. Conclusiones: La estrategia ideal para prevenir la deficiencia de hierro consiste en practicar la lactancia materna exclusiva por 6 meses, con la administración de sales de hierro a partir del tercero o cuarto mes de vida. A partir de los 6 meses de edad, la alimentación complementaria debe basarse en cereales suplementados con hierro (fumarato ferroso) y en la carne o su jugo como alimentos primarios

Introduction: Iron is an essential component of hemoglobin, along with folic acid and vitamin B12, whose function is essential in the oxygenation of the body. Anemia is one of the main manifestations of nutritional problems in the country and the association with parasitism increases iron deficiency. Among the groups that may have great demands on iron are premature babies, those who did not breastfeed and adolescents. Objective: To present the bibliographic reviews on iron deficiency anemia in children under 5 years of age. Results: Iron deficiency is the most frequent cause of anemia in the child, being observed to a greater extent in pre-school age, especially between 6 and 24 months of age. The nutritional status of a person's iron depends on the balance determined by the interaction between content in the diet, bioavailability, losses and requirements for growth. Treatment should aim to correct anemia, store iron in deposits and correct the primary cause. Conclusions: The ideal strategy to prevent iron deficiency is to practice exclusive breastfeeding for 6 months, with the administration of iron salts from the third or fourth month of life. From 6 months of age, supplementary feeding should be based on cereals supplemented with iron (ferrous fumarate) and in meat or its juice as primary foods

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Objetivo: Enfatizar la importancia de sospechar esta etiología en la patogenia de la apendicitis aguda, especialmente en pacientes procedentes de países endémicos. Casos clínicos: Presentamos dos casos, con cursos clínicos divergentes.

Aim: We would like to emphasize the importance of having a high grade of suspect about the parasitic etiology of appendicitis acute, especially in patients from endemic countries. Case report: We present two cases with divergent clinical evolution.

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Introdução: A esquistossomose, parasitose tropical, pode provocar hipertensão pulmonar grave (HAPE), que leva a remodelamento e disfunção do ventrículo direito (VD), que pode ser detectada pela diminuição da excursão sistólica do anel tricúspide (TAPSE) e da variação de áreas do VD. No VD normal, rico em fibras longitudinais, predomina o strain longitudinal, sendo menor o strain transversal. Objetivo: Avaliar, com ecocardiografia convencional e com strain bidimensional do VD, pacientes portadores de HAPE, comparando os resultados com dados clínicos, hemodinâmicos e com parâmetros ecocardiográficos obtidos em controles sadios. Material: Trinta e dois pacientes com HAPE, média etária de 45 ± 12 anos. Vinte e três controles sadios, média etária de 48 ± 18 anos.Métodos: Foram avaliados os parâmetros de função do VD (variação de áreas e TAPSE) e o gradiente de refluxo tricúspide. Foi determinado o strain longitudinal e transversal do VD em pacientes com HAPE e em controles sadios. Resultados: Entre os pacientes com HAPE e os controles sadios, a variação das áreas foi, respectivamente, 28% e 46% (p = 0,0001), o TAPSE, 1,9 cm e 2,2 cm (p = 0,02); gradiente de regurgitação tricúspide, 76 mmHg e 28 mmHg (p = 0,0001); deformação longitudinal da parede lateral do VD -22% e -37% (p = 0,0001); e deformação transversal 39% e 21% (p = 0,001). Conclusão: Pacientes com HAPE modificaram o padrão de deformação do VD, com aumento do strain transversal, provavelmente por adaptação do VD à sobrecarga pressórica. O ecocardiograma convencional também foi útil paraavaliar a função do VD na HAPE.

Introduction: Schistosomiasis is a tropical parasitic disease may cause severe pulmonary hypertension (SIPH), which leads to right ventricular (RV) remodeling and dysfunction, which can be detected by decreased tricuspid annular plane systolic excursion (TAPSE) and variation of RV areas. In normal RV, rich in longitudinal fibers, longitudinal strain prevails, and transverse strain is smaller. Objective: To assess, using conventional echocardiography and two-dimensional RV strain, patients with SIPH, comparing the results with clinical and hemodynamic data and echocardiographic parameters obtained from healthy controls. Material: Thirty-two patients with SIPH, mean age 45 ± 12 years old. Twenty-three healthy controls, mean age 48 ± 18 years old. Methods: RV function parameters (range of areas and TAPSE) and the tricuspid regurgitation gradient were evaluated. Longitudinal and transverse RV strain RV were determined in patients with SIPH and in healthy controls. Results: Among SIPH patients and healthy controls, the variation of areas was 28% and 46%, respectively (p = 0.0001), TAPSE was 1.9 cm and 2.2 cm (p = 0.02); tricuspid regurgitation gradient was 76 mmHg and 28 mmHg (p = 0.0001); RV sidewall longitudinal strain -22% and -37%(p = 0.0001); and transverse strain of 39% and 21% (p = 0.001). Conclusion: Patients with SIPH changed the RV strain pattern with increased transverse strain, probably due to RV adaptation to pressure overload. Conventional echocardiography was also useful to assess RV function in SIPH.

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This study analyzes hospitalizations due to ambulatory care-sensitive conditions with a focus on infectious and parasitic diseases (IPDs) and validates the Hospital Information System, Brazilian Unified National Health System (SIH/SUS) for recording hospitalizations due to ambulatory care-sensitive conditions in a hospital in the Federal District, Brazil, in 2012. The study estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SIH for recording hospitalizations due to ambulatory care-sensitive conditions, with the patient's medical file as the gold standard. There were 1,604 hospitalizations for hospitalizations due to ambulatory care-sensitive conditions (19.6%, 95%CI: 18.7-20.5), and the leading IPDs were renal and urinary tract infection, infection of the skin and subcutaneous tissue, and infectious gastroenteritis. IPDs were the leading cause of hospitalization in the 20 to 29-year age bracket and caused 28 deaths. Sensitivity was 70.1% (95%CI: 60.5-79.7), specificity 88.4% (95%CI: 85.6-91.2), PPV = 51.7% (95%CI: 42.7-60.7), and NPV = 94.3% (95%CI: 92.2-96.4). The findings for admissions due to ACSCs in this hospital were similar to those of other studies, featuring admissions for IPDs. The SIH/SUS database was more specific than sensitive.

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Pathogenic mechanisms underlying multiple sclerosis development have yet to be clearly identified, but considerable evidence indicates that autoimmunity plays an important role in the etiology of the disease. It is generally accepted that autoimmune diseases like MS arise from complex interactions between genetic susceptibility and environmental factors. Although environmental factors unequivocally influencing MS development have yet to be established, accumulating evidence singles out several candidates, including sunlight-UV exposure or vitamin D deficiency, viral infections, hygiene, and cigarette smoking. Vitamin D deficiency has been associated with different autoimmune diseases. Several investigations indicate 125 (OH)2 vitamin D plays a critical role in shaping T-cell response and inducing T cells with immunosuppressive properties. Likewise, helminth infections represent another potential environmental factor exerting immunomodulatory properties. Both epidemiological and experimental data provide evidence to support autoimmune down-regulation secondary to parasite infections in patients with MS, through regulatory T- and B-cell action, with effects extending beyond simple response to an infectious agent. Finally, different epidemiological studies have demonstrated that Epstein-Barr virus infection confers added risk of developing MS. Proposed mechanisms responsible for this association include activation and expansion of self-reactive T and B cells, lower threshold for self-tolerance breakdown, and enhanced autoreactive B-cell survival, all to be discussed in this review. Understanding environmental factors influencing propensity to MS will lead to new and more effective approaches to prevent and treat the disease.

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O objetivo do presente estudo foi avaliar a influência do parasitismo intestinal crônico sobre parâmetros hematológicos e de líquido peritoneal por meio da comparação dessas características em equinos naturalmente parasitados e após administração de anti-helmíntico. Utilizaram-se 21 cavalos de tração urbana, entre dois e 19 anos, sem raça definida e com resultado de exame parasitológico superior a 300 ovos por grama de fezes. Foi realizada avaliação física e coleta de fezes, de líquido peritoneal e de sangue em dois momentos do experimento (D0 e D15), sendo efetuado tratamento antiparasitário no D0. No fluido peritoneal foram avaliadas características físicas, bioquímicas, bem como contagem de células nucleadas (CTCN) e diferenciação celular. No sangue foram determinados valores eritrocitários, leucocitários, proteínas plasmáticas totais, glicose e fibrinogênio plasmáticos, além de fosfatase alcalina (FA) sérica. A análise dos parâmetros avaliados não demonstrou diferença significativa entre animais parasitados e após administração de anti-helmíntico, exceto para valores de CTCN, contagem de neutrófilos segmentados e grau de turbidez do líquido peritoneal. As médias se mantiveram dentro dos intervalos de referência, com exceção da CTCN do líquido peritoneal no D0. No líquido peritoneal, houve predomínio de neutrófilos segmentados, seguidos por macrófagos, linfócitos e eosinófilos em ambos os momentos de avaliação. Observaram-se tendência do quadro eritrocitário em manter-se próximo aos limites inferiores e leve leucocitose no D0. A infecção parasitária nos animais estudados foi predominantemente moderada, o que oferece poucos riscos clínicos. Nessas condições, pode-se afirmar que a CTCN, a contagem absoluta de neutrófilos segmentados e o grau de turbidez do líquido peritoneal são influenciados e podem ser considerados ferramentas diagnósticas e prognósticas úteis nas parasitoses intestinais crônicas.(AU)

The aim of this study was to evaluate the influence of chronic intestinal parasitism on hematological parameters and peritoneal fluid. It was done by comparing these features in horses used for traction naturally parasitized and after the administration of anthelmintic. Twenty-one horses, between two and nineteen years of age, of mixed breed and with results of parasitological examination of more than 300 eggs per gram of feces were studied. Physical assessment and samples of feces were conducted, as well as blood and peritoneal fluid in the two phases of the experiment (D0 and D15). Antiparasitic treatment in D0 has also been done. The peritoneal fluid was evaluated for physical and biochemical features, and also total count of nucleated cells (TCNC) and cell differentiation. The blood was determined for erythrocyte, leukocyte, plasma total protein, glucose and plasma fibrinogen, and alkaline phosphatase (ALP) levels. The analysis of these parameters showed no significant difference between parasitized animals and after administration of anthelmintic except for TCNC values, segmented neutrophil count and degree of turbidity in peritoneal fluid. The averages remained within the reference ranges, except the TCNC in the peritoneal fluid in D0. In the peritoneal fluid there was a predominance of segmented neutrophils, followed by macrophages, lymphocytes and eosinophils in both time points. A trend was observed in erythrocyte frame to keep close to the lower limits and mild leukocytosis in D0. Parasitic infection of the animals studied was predominantly moderate, which offered minimal clinical risks. After that, it can be affirmed that the TCNC, absolute segmented neutrophil count and targeted degree of turbidity in peritoneal fluid are influenced and can be considered useful diagnostic and prognostic tools in chronic intestinal parasitism.(AU)

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A retired man in his 60s was referred to the on call orthopaedic team by his general practitioner following several attempts to extricate a human botfly larva from his forearm. While on holiday in Belize with his daughter 8 weeks previously they both were bitten by some insects. She developed an infestation which was treated locally. Once back in the UK, he subsequently reported of localised itching and discomfort. A botfly larva was successfully removed in the emergency department following local anaesthetic infiltration.

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