RESUMO
BACKGROUND: Type 2 diabetes has economic implications involving family income and out-of-pocket spending. OBJECTIVE: Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income. MATERIAL AND METHODS: Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages. RESULTS: The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income. CONCLUSION: The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income.
ANTECEDENTES: La diabetes tipo 2 tiene implicaciones económicas en el ingreso familiar y el gasto de bolsillo. OBJETIVO: Determinar el gasto de bolsillo familiar en la atención de la diabetes mellitus tipo 2 y el porcentaje que representa en el ingreso familiar. MATERIAL Y MÉTODOS: Estudio de gasto de bolsillo de las familias con pacientes con diabetes tipo 2 atendidos en el primer nivel de atención. El gasto de bolsillo familiar incluyó gasto en traslado, alimentos-bebidas y medicamentos externos. El ingreso familiar correspondió al total de ingresos económicos aportados por los miembros de la familia. El porcentaje del gasto de bolsillo con relación al ingreso familiar se identificó con la relación entre estas dos variables. El análisis estadístico incluyó promedios y porcentajes. RESULTADOS: El gasto de bolsillo familiar anual en transporte fue de $2621.24, en alimentos y bebidas fue de $1075.67 y en medicamentos externos fue de $722.08. El gasto familiar de bolsillo total anual fue de $4418.89 y correspondió a 4.73 % del ingreso familiar. CONCLUSIÓN: El gasto de bolsillo en las familias con un paciente con diabetes mellitus tipo 2 fue de $4418.89 y representó 4.73 % del ingreso familiar.
Assuntos
Diabetes Mellitus Tipo 2 , Gastos em Saúde , Renda , Humanos , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/terapia , Gastos em Saúde/estatística & dados numéricos , Masculino , Feminino , Atenção Primária à Saúde/economia , Pessoa de Meia-Idade , Família , Efeitos Psicossociais da DoençaRESUMO
The aim of the present work was to evaluate the distribution of the different clones of the parasite prevailing after treatment with benznidazole (BZ) and clomipramine (CLO), in mice infected with Trypanosoma cruzi, Casibla isolate which consists of a mixture of two discrete typing units (DTUs). Albino Swiss mice were infected and treated with high and low concentrations of BZ (100 or 6.25 mg/kg), CLO (5 or 1.25 mg/kg), or the combination of both low doses (BZ6.25 + CLO1.25), during the acute phase of experimental infection. Treatment efficacy was evaluated by comparing parasitaemia, survival and tissular parasite presence. For DTUs genotyping, blood, skeletal and cardiac muscle samples were analysed by multiplex quantitative polymerase chain reaction. The combined treatment had similar outcomes to BZ6.25; BZ100 was the most effective treatment, but it failed to reach parasite clearance and produced greater histological alterations. Non-treated mice and the ones treated with monotherapies showed both DTUs while BZ6.25 + CLO1.25 treated mice showed only TcVI parasites in all the tissues studied. These findings suggest that the treatment may modify the distribution of infecting DTUs in host tissues. Coinfection with T. cruzi clones belonging to different DTUs reveals a complex scenario for the treatment of Chagas disease and search for new therapies.
Assuntos
Doença de Chagas , Coinfecção , Trypanosoma cruzi , Animais , Doença de Chagas/tratamento farmacológico , Doença de Chagas/parasitologia , Combinação de Medicamentos , Genótipo , Camundongos , Distribuição TecidualRESUMO
Type 2 diabetes mellitus (DM2) is a disease that reports high morbidity and mortality rates worldwide. Between its complications, one of the most important is the development of plantar ulcers. The role of the polymorphonuclear cells (PMNs) is affected by metabolic diseases like DM2. Fifteen years ago, reports about a new mechanism of innate immune response where PMNs generate some kind of webs with their chromatin were published. This mechanism was called NETosis. Also, some researchers have demonstrated that NETosis is responsible for the delay of the ulcer healing both in patients with DM2 and in animal models of DM2. Purified PMNs from healthy and DM2 human volunteers were incubated with diethylcarbamazine (DEC) and then induced to NETosis using phorbol 12-myristate 13-acetate (PMA). In a randomized blind study model, the NETosis was documented by confocal microscopy. On microphotographs, the area of each extracellular neutrophil trap (NET) formed at different times after stimuli with PMA was bounded, and the intensity of fluorescence (IF) from the chromatin dyed with 4',6-diamidino-2-phenylindole dihydrochloride (DAPI) was quantified. PMNs from healthy volunteers showed the development of NETs at expected times according to the literature. The same phenomenon was seen in cultures of PMNs from metabolically controlled DM2 volunteers. The use of DEC one hour before of the challenge with PMA delayed the NETosis in both groups. The semiquantitative morphometric analysis of the IF from DAPI, as a measure of PMN's capacity to forming NETs, is consistent with these results. The ANOVA test demonstrated that NETosis was lower and appeared later than expected time, both in PMNs from healthy (p ≤ 0.000001) and from DM2 (p ≤ 0.000477) volunteers. In conclusion, the DEC delays and decreases the NETosis by PMNs from healthy as well as DM2 people.
Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Dietilcarbamazina/farmacologia , Armadilhas Extracelulares/efeitos dos fármacos , Imunidade Inata/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Adulto , Armadilhas Extracelulares/metabolismo , Humanos , Neutrófilos/metabolismo , Acetato de Tetradecanoilforbol/farmacologiaRESUMO
BACKGROUND: A question of epidemiological relevance in Chagas disease studies is to understand Trypanosoma cruzi transmission cycles and trace the origins of (re)emerging cases in areas under vector or disease surveillance. Conventional parasitological methods lack sensitivity whereas molecular approaches can fill in this gap, provided that an adequate sample can be collected and processed and a nucleic acid amplification method can be developed and standardized. We developed a duplex qPCR assay for accurate detection and quantification of T. cruzi satellite DNA (satDNA) sequence in samples from domestic and sylvatic mammalian reservoirs. The method incorporates amplification of the gene encoding for the interphotoreceptor retinoid-binding protein (IRBP), highly conserved among mammalian species, as endogenous internal amplification control (eIAC), allowing distinction of false negative PCR findings due to inadequate sample conditions, DNA degradation and/or PCR interfering substances. RESULTS: The novel TaqMan probe and corresponding primers employed in this study improved the analytical sensitivity of the assay to 0.01 par.eq/ml, greater than that attained by previous assays for Tc I and Tc IV strains. The assay was tested in 152 specimens, 35 from 15 different wild reservoir species and 117 from 7 domestic reservoir species, captured in endemic regions of Argentina, Colombia and Mexico and thus potentially infected with different parasite discrete typing units. The eIACs amplified in all samples from domestic reservoirs from Argentina and Mexico, such as Canis familiaris, Felis catus, Sus scrofa, Ovis aries, Equus caballus, Bos taurus and Capra hircus with quantification cycles (Cq's) between 23 and 25. Additionally, the eIACs amplified from samples obtained from wild mammals, such as small rodents Akodon toba, Galea leucoblephara, Rattus rattus, the opossums Didelphis virginiana, D. marsupialis and Marmosa murina, the bats Tadarida brasiliensis, Promops nasutus and Desmodus rotundus, as well as in Conepatus chinga, Lagostomus maximus, Leopardus geoffroyi, Lepus europaeus, Mazama gouazoubira and Lycalopex gymnocercus, rendering Cq's between 24 and 33. CONCLUSIONS: This duplex qPCR assay provides an accurate laboratory tool for screening and quantification of T. cruzi infection in a vast repertoire of domestic and wild mammalian reservoir species, contributing to improve molecular epidemiology studies of T. cruzi transmission cycles.
Assuntos
Doença de Chagas/veterinária , Reservatórios de Doenças/parasitologia , Mamíferos/parasitologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Animais , Animais Domésticos/parasitologia , Animais Selvagens/parasitologia , Doença de Chagas/diagnóstico , Primers do DNA/genética , Sondas de DNA/genética , DNA de Protozoário/isolamento & purificação , DNA Satélite/isolamento & purificação , Proteínas do Olho/genética , Proteínas de Ligação ao Retinol/genética , Sensibilidade e Especificidade , Trypanosoma cruziRESUMO
Resumen: La amiloidosis cardíaca es una entidad poco frecuente y progresiva que resulta en una cardiomiopatía restrictiva produciendo síntomas de falla cardíaca, síncope, arritmias o puede ser un hallazgo de ecocardiografía como pseudohipertrofia del ventrículo izquierdo (VI). La imagen molecular a través de la medicina nuclear permite diferenciar entre los dos tipos más comunes de amiloidosis sin necesidad de biopsia endomiocárdica. Presentamos el caso de un paciente de 75 años, con disnea progresiva, en el que la resonancia magnética (RM) informa sospecha de amiloidosis cardíaca, la que se confirma mediante centellografía.
Summary: Cardiac amyloidosis is a rare and progressive entity that results in a restrictive cardiomyopathy producing symptoms of heart failure, syncope, arrhythmias or it can be a finding of echocardiography as pseudo-hypertrophy of the left ventricle. Molecular imaging with nuclear medicine allows differentiating between the two most common types of amyloidosis without the need for endomyocardial biopsy. We present the case of a 75-year-old male with progressive dyspnea, in whom magnetic resonance imaging shows suspicion of cardiac amyloidosis, which is confirmed by scintigraphy.
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Trypanosoma cruzi has been subdivided into seven Discrete Typing Units (DTUs), TcI-TcVI and Tcbat. Two major evolutionary models have been proposed to explain the origin of hybrid lineages, but while it is widely accepted that TcV and TcVI are the result of genetic exchange between TcII and TcIII strains, the origin of TcIII and TcIV is still a matter of debate. T. cruzi satellite DNA (SatDNA), comprised of 195 bp units organized in tandem repeats, from both TcV and TcVI stocks were found to have SatDNA copies type TcI and TcII; whereas contradictory results were observed for TcIII stocks and no TcIV sequence has been analyzed yet. Herein, we have gone deeper into this matter analyzing 335 distinct SatDNA sequences from 19 T. cruzi stocks representative of DTUs TcI-TcVI for phylogenetic inference. Bayesian phylogenetic tree showed that all sequences were grouped in three major clusters, which corresponded to sequences from DTUs TcI/III, TcII and TcIV; whereas TcV and TcVI stocks had two sets of sequences distributed into TcI/III and TcII clusters. As expected, the lowest genetic distances were found between TcI and TcIII, and between TcV and TcVI sequences; whereas the highest ones were observed between TcII and TcI/III, and among TcIV sequences and those from the remaining DTUs. In addition, signature patterns associated to specific T. cruzi lineages were identified and new primers that improved SatDNA-based qPCR sensitivity were designed. Our findings support the theory that TcIII is not the result of a hybridization event between TcI and TcII, and that TcIV had an independent origin from the other DTUs, contributing to clarifying the evolutionary history of T. cruzi lineages. Moreover, this work opens the possibility of typing samples from Chagas disease patients with low parasitic loads and improving molecular diagnostic methods of T. cruzi infection based on SatDNA sequence amplification.
Assuntos
DNA de Protozoário/genética , DNA Satélite/genética , Evolução Molecular , Trypanosoma cruzi/classificação , Trypanosoma cruzi/genética , Sequência de Bases , Doença de Chagas/parasitologia , Variação Genética , Genótipo , Técnicas de Diagnóstico Molecular , Tipagem Molecular , Filogenia , Análise de Sequência de DNARESUMO
Real-Time PCR (qPCR) testing is recommended as both a diagnostic and outcome measurement of etiological treatment in clinical practice and clinical trials of Chagas disease (CD), but no external quality assurance (EQA) program provides performance assessment of the assays in use. We implemented an EQA system to evaluate the performance of molecular biology laboratories involved in qPCR based follow-up in clinical trials of CD. An EQA program was devised for three clinical trials of CD: the E1224 (NCT01489228), a pro-drug of ravuconazole; the Sampling Study (NCT01678599), that used benznidazole, both conducted in Bolivia; and the CHAGASAZOL (NCT01162967), that tested posaconazole, conducted in Spain. Four proficiency testing panels containing negative controls and seronegative blood samples spiked with 1, 10 and 100 parasite equivalents (par. eq.)/mL of four Trypanosoma cruzi stocks, were sent from the Core Lab in Argentina to the participating laboratories located in Bolivia and Spain. Panels were analyzed simultaneously, blinded to sample allocation, at 4-month intervals. In addition, 302 random blood samples from both trials carried out in Bolivia were sent to Core Lab for retesting analysis. The analysis of proficiency testing panels gave 100% of accordance (within laboratory agreement) and concordance (between laboratory agreement) for all T. cruzi stocks at 100 par. eq./mL; whereas their values ranged from 71 to 100% and from 62 to 100% at 1 and 10 par. eq./mL, respectively, depending on the T. cruzi stock. The results obtained after twelve months of preparation confirmed the stability of blood samples in guanidine-EDTA buffer. No significant differences were found between qPCR results from Bolivian laboratory and Core Lab for retested clinical samples. This EQA program for qPCR analysis of CD patient samples may significantly contribute to ensuring the quality of laboratory data generated in clinical trials and molecular diagnostics laboratories of CD.
Assuntos
Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Triazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Doença de Chagas/sangue , Humanos , Monitorização Fisiológica/métodosRESUMO
This study aimed to evaluate well-documented diagnostic antigens, named B13, 1F8 and JL7 recombinant proteins, as potential markers of seroconversion in treated chagasic patients. Prospective study, involving 203 patients treated with benznidazole, was conducted from endemic areas of northern Argentina. Follow-up was possible in 107 out of them and blood samples were taken for serology and PCR assays before and 2, 3, 6, 12, 24 and 36 months after treatment initiation. Reactivity against Trypanosoma cruzi lysate and recombinant antigens was measured by ELISA. The rate of decrease of antibody titers showed nonlinear kinetics with an abrupt drop within the first three months after initiation of treatment for all studied antigens, followed by a plateau displaying a low decay until the end of follow-up. At this point, anti-B13, anti-1F8 and anti-JL7 titers were relatively close to the cut-off line, while anti-T. cruzi antibodies still remained positive. At baseline, 60.8% (45/74) of analysed patients tested positive for parasite DNA by PCR and during the follow-up period in 34 out of 45 positive samples (75.5%) could not be detected T. cruzi DNA. Our results suggest that these antigens might be useful as early markers for monitoring antiparasitic treatment in chronic Chagas disease.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Anticorpos Antiprotozoários/sangue , Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Antígenos de Protozoários/imunologia , Argentina , Doença de Chagas/sangue , Doença Crônica , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Seguimentos , Estudos Prospectivos , Fatores de TempoRESUMO
This study aimed to evaluate well-documented diagnostic antigens, named B13, 1F8 and JL7 recombinant proteins, as potential markers of seroconversion in treated chagasic patients. Prospective study, involving 203 patients treated with benznidazole, was conducted from endemic areas of northern Argentina. Follow-up was possible in 107 out of them and blood samples were taken for serology and PCR assays before and 2, 3, 6, 12, 24 and 36 months after treatment initiation. Reactivity against Trypanosoma cruzi lysate and recombinant antigens was measured by ELISA. The rate of decrease of antibody titers showed nonlinear kinetics with an abrupt drop within the first three months after initiation of treatment for all studied antigens, followed by a plateau displaying a low decay until the end of follow-up. At this point, anti-B13, anti-1F8 and anti-JL7 titers were relatively close to the cut-off line, while anti-T. cruzi antibodies still remained positive. At baseline, 60.8% (45/74) of analysed patients tested positive for parasite DNA by PCR and during the follow-up period in 34 out of 45 positive samples (75.5%) could not be detected T. cruzi DNA. Our results suggest that these antigens might be useful as early markers for monitoring antiparasitic treatment in chronic Chagas disease.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Adulto , Antígenos de Protozoários/imunologia , Argentina , Doença de Chagas/sangue , Doença Crônica , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
OBJETIVO: Determinar los factores asociados a hemorragia intraventricular en neonatos prematuros en el Hospital Regional Docente de Trujillo en los periodos Diciembre 2011 a Diciembre 2013. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio analítico, retrospectivo de casos y controles. La población estuvo constituida por 108 pacientes: 54 neonatos prematuros con Hemorragia intraventricular y 54 neonatos prematuros sin Hemorragia intraventricular. RESULTADOS: El peso al nacer resultó ser significativo (x2: 6.438; valor p: 0.011) obteniendo mayor frecuencia de peso menor o igual a 1500 g. El sexo del recién nacido resultó ser una variable significativa (x2: 6.366; valor p: 0.012) siendo en su mayoría el sexo masculino. La edad gestacional resultó ser una variable significativa (x2: 10.394; valor p: 0.001) siendo más frecuente la edad menor o igual a 32 semanas. La vía de nacimiento no fue un factor significativo (x2: 0.150, valor p: 0.699), sin embargo la cesárea fue más frecuente (OR: 0.861). La valoración de Apgar al minuto y a los 5 minutos no fue una variable significativa. El uso de soluciones hiperosmolares no resultó ser significativa (x2: 0.228, valor p: 0.633, OR: 0.795). el uso de ventilación mecánica no fue una variable significativa (x2: 1.662, valor p: 0.197, OR: 1.75). El uso de reanimación cardiopulmonar no fue una variable significativa (x2: 0.055, valor p: 0.814, OR: 0.895). El uso de surfactante pulmonar no fue una variable significativa (x2: 0.892, valor p: 0.322, OR: 1.643). CONCLUSIÓN: Los factores asociados a hemorragia intraventricular son el peso al nacer menor o igual a 1500 g, edad gestacional menor a 32 semanas y el sexo masculino, sin embargo la vía de nacimiento, la valoración de Apgar, el uso de soluciones hiperosmolares, el uso ventilación mecánica, el requerimiento de reanimación cardiopulmonar y uso de surfactante pulmonar no fueron factores de riesgo. El grado de Hemorragia intraventricular en neonatos prematuros fue el Grado I según la clasificación de Papile.
OBJECTIVE: To determine the factors associated with intraventricular hemorrhage in preterm newborns in "Hospital Regional Docente de Trujillo" in the period December 2011 to December 2013. MATERIAL AND METHODS: Analytical, retrospective case-control study was conducted. The population consisted of 108 patients: 54 preterm infants with intraventricular hemorrhage and 54 preterm infants without intraventricular hemorrhage. RESULTS: Birth weight was found to be significant (x2: 6.438, p-value: 0.011) reaching the rank of most frequent weight less or equal to 1500. The sex of child proved to be a significant variable (x2: 6.366, p-value: 0.012) being mostly males. Gestational age was found to be a significant variable (x2: 10.394, p-value: 0.001) being the most common age less or equal to 32 Weeks. Birth type was not a significant factor (x2: 0.150, p-value: 0.699), but caesarean section was more frequent (OR: 0.861). The Apgar score at one minute and five minutes was not a significant variable. The use of hyperosmolar solutions was not found to be significant (x2: 0.228, p-value: 0.633, OR: 0.795). The use of mechanical ventilation was not a significant variable (x2: 1.662, p-value: 0.197, OR: 1.75). The use of cardiopulmonary resuscitation was not a significant variable (x2: 0.055, p-value: 0.814, OR: 0.895). The use of pulmonary surfactant was not a significant variable (x2: 0.892, p-value: 0.322, OR: 1.643). CONCLUSION: Factors associated with intraventricular hemorrhage are birth weight less than or equal to 1500 g, gestational age less than or equal to 32 weeks and male gender of the newborn, but the type of birth, Apgar score, the use of hyperosmolar solutions, using mechanical ventilation, requirement of CPR and use of pulmonary surfactant was not a risk factor. The degree of intraventricular hemorrhage in preterm infants was the Grade I according to the classification of Papile.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Recém-Nascido , Hemorragia Cerebral , Idade GestacionalRESUMO
The asymmetric unit of the title compound, C17H14N2S, consists of two crystallographically independent mol-ecules with similar conformations. The dihedral angles between the phenyl rings are 89.32â (5) and 82.80â (5)° in the two mol-ecules. In the crystal, mol-ecules are linked by C-Hâ¯π inter-actions, forming a three-dimensional network.
RESUMO
El hemoneumotórax espontáneo es una condición inusual, caracterizada por la acumulación de aire y sangre en la cavidad pleural, no precedida por trauma. La radiografía de tórax es la herramienta principal en el diagnóstico de esta entidad. Se presenta el caso de un hombre de 22 años con hemoneumotórax espontáneo. El paciente se recuperó sin complicaciones luego de la cirugía.
Spontaneous hemopneumothorax is an unusual condition, characterized by the accumulation of air and blood in the pleural cavity, not preceded by trauma. Chest radiography is the main tool in the diagnosis of this entity. We present, a case of a 22-year-old male with spontaneous hemopneumothorax. The patient recovered after surgery with no complications.
Assuntos
Humanos , Hemopneumotórax , Pneumotórax , Hemotórax , Hidropneumotórax , HidrotóraxRESUMO
In the crystal of the title compound, C19H14N4O4, the asymmetric unit consists of two discrete mol-ecules. The C=N bonds in both mol-ecules show an E conformation. The dihedral angles between the C atoms of the 2,4-dinitrobenzene rings and the C=N-N planes are 13.52â (9) and 13.82â (9)° for the two mol-ecules. In the crystal, C-Hâ¯O hydrogen bonds, mainly between the phenyl ring and the nitro group along the b axis.
RESUMO
BACKGROUND: The analytical validation of sensitive, accurate and standardized Real-Time PCR methods for Trypanosoma cruzi quantification is crucial to provide a reliable laboratory tool for diagnosis of recent infections as well as for monitoring treatment efficacy. METHODS/PRINCIPAL FINDINGS: We have standardized and validated a multiplex Real-Time quantitative PCR assay (qPCR) based on TaqMan technology, aiming to quantify T. cruzi satellite DNA as well as an internal amplification control (IAC) in a single-tube reaction. IAC amplification allows rule out false negative PCR results due to inhibitory substances or loss of DNA during sample processing. The assay has a limit of detection (LOD) of 0.70 parasite equivalents/mL and a limit of quantification (LOQ) of 1.53 parasite equivalents/mL starting from non-boiled Guanidine EDTA blood spiked with T. cruzi CL-Brener stock. The method was evaluated with blood samples collected from Chagas disease patients experiencing different clinical stages and epidemiological scenarios: 1- Sixteen Venezuelan patients from an outbreak of oral transmission, 2- Sixty three Bolivian patients suffering chronic Chagas disease, 3- Thirty four Argentinean cases with chronic Chagas disease, 4- Twenty seven newborns to seropositive mothers, 5- A seronegative receptor who got infected after transplantation with a cadaveric kidney explanted from an infected subject. CONCLUSIONS/SIGNIFICANCE: The performing parameters of this assay encourage its application to early assessment of T. cruzi infection in cases in which serological methods are not informative, such as recent infections by oral contamination or congenital transmission or after transplantation with organs from seropositive donors, as well as for monitoring Chagas disease patients under etiological treatment.
Assuntos
Doença de Chagas/parasitologia , DNA Satélite/genética , Reação em Cadeia da Polimerase Multiplex/métodos , Carga Parasitária/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Trypanosoma cruzi/genética , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Masculino , Reação em Cadeia da Polimerase Multiplex/normas , Carga Parasitária/normas , Gravidez , Reação em Cadeia da Polimerase em Tempo Real/normas , Sensibilidade e EspecificidadeRESUMO
La enfermedad pélvica inflamatoria es un padecimiento del tracto genital femenino y motivo frecuente de consulta en ginecología. El diagnóstico se consigue con la combinación de los procedimientos clínicos, de laboratorio y quirúrgicos. Para su tratamiento, la elección apropiada de los antibióticos es esencial, ya que es una entidad polimicrobiana que generalmente incluye diferentes tipos de gérmenes aerobios, anaerobios, Gram positivos o Gram negativos. El caso que se presenta a continuación tiene una de las bacteria aisladas menos frecuentes en la enfermedad inflamatoria pélvica, el Haemophilus influenzae.
The inflammatory pelvic disease is a disorder of the female genital tract and is a common cause for consultation in Gynecology. The diagnosis is achieved with the combination of clinical, laboratory and surgical procedures. For its treatment, the appropriate choice of antibiotics is essential, because it is a polymicrobial entity that usually involving different type of germs aerobic, anaerobic, Gram positive or Gram negative. The case presented below, has a less frequent isolated bacteria, in the pelvic inflammatory disease the Haemophilus influenza.
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We report a case of a 39 year-old Asian man in whom profound lower limb paralysis, along with severe hypokalemia and electrocardiographic changes, were the presenting features of Graves' disease (GD)-related thyrotoxicosis. Rapid recognition and management of the disorder were the key factors to avoid fatal hypokalemia-induced cardiac arrhythmias and promptly restore patient's capacity to ambulate.
Assuntos
Doença de Graves/complicações , Paralisia Periódica Hipopotassêmica/etiologia , Tireotoxicose/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Antitireóideos/uso terapêutico , Eletrocardiografia , Emergências , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , Hong Kong/etnologia , Humanos , Paralisia Periódica Hipopotassêmica/sangue , Paralisia Periódica Hipopotassêmica/tratamento farmacológico , Paralisia Periódica Hipopotassêmica/etnologia , Transporte de Íons , Masculino , Metimazol/uso terapêutico , Exame Neurológico , Potássio/metabolismo , Cloreto de Potássio/uso terapêutico , Propranolol/uso terapêutico , ATPase Trocadora de Sódio-Potássio/metabolismo , Estresse Psicológico/complicações , Tireotoxicose/tratamento farmacológicoRESUMO
Interferon-gamma (IFN-gamma) is a critical cytokine involved in control of different infections. Actinomycetoma is a chronic infectious disease mainly caused by the bacterium Nocardia brasiliensis, which destroys subcutaneous tissue, including bone. Currently, the mechanism of pathogenesis in N. brasiliensis infection is not known. Here, we demonstrate that N. brasiliensis induced an IFN-gamma response in serum after 24 h of infection, while, in infected tissue, positive cells to IFN-gamma appeared in 2 early peaks: the first was present only 3 h after infection, then transiently decreased; and the second peak appeared 12 h after infection and was independent of interleukin-10. Resident macrophages produced an immediate IFN-gamma response 1 h after in vitro infection, and spleen-positive cells began later. The phase of growth of N. brasiliensis affected cytokine production, and exposure of macrophages to Nocardia opsonized with either polyclonal anti-Nocardia antibodies or anti-P61 monoclonal antibody led to a suppression of cytokine production. Our report provides evidence that N. brasiliensis as an intracellular bacterium modulates macrophage cytokine production, which helps survival of the pathogen. Modulation of these cytokines may contribute to pathogenesis once this bacterium is inside the macrophage.
Assuntos
Interferon gama/biossíntese , Interleucina-10/biossíntese , Interleucina-12/biossíntese , Nocardia/fisiologia , Animais , Anticorpos/imunologia , Células Cultivadas , Ensaio de Imunoadsorção Enzimática , Imuno-Histoquímica , Interferon gama/sangue , Interleucina-10/sangue , Interleucina-12/sangue , Camundongos , Camundongos Endogâmicos BALB C , Nocardiose/sangue , Baço/metabolismoRESUMO
Rheumatoid arthritis is an autoimmune disease that affects human beings worldwide. Infections have been associated to autoimmune diseases because their ability to induce a dominant cytokine response. Joint inflammation has been related to Th1 response because they induce high expression of proinflammatory cytokines TNF-alpha, IL-1, IFN-gamma. MRL/lpr mice spontaneously develop an autoimmune disease affecting joints, kidneys, etc. We compared incidence and severity of arthritis, antibody response, cytokine production, in mice infected with bacteria or helminthes in the Murphy Roths Large (MRL)lpr mice. Infections with helminthes Heligmosomoides polygyrus, Nippostrongylus brasiliensis or bacteria Nocardia brasiliensis and Staphylococcus aureus were studied. IL-4, IFN-gamma and IgG1, IgG2a antibody productions were determined. IFN-gamma was increased in all groups, the highest production was observed after bacterial infection; IL-4 production was higher after helminthes infection. IgG1 sera levels were increased in the helminthes infected group. IgG2a sera concentration was stimulated by bacterial infection. The histopathology showed that 100% of bacterial infected mice developed arthritis and severe tissue damage such as cartilage erosion and bone destruction. Animals infected with parasites showed a decreased incidence and severity of arthritis. Severity of tissue damage in joints is correlated with increased numbers of lymphocytes and macrophages immunoreactive to proinflammatory cytokines.
Assuntos
Artrite Experimental/fisiopatologia , Artrite Reumatoide/fisiopatologia , Nippostrongylus/imunologia , Infecções Estafilocócicas , Staphylococcus aureus/imunologia , Infecções por Strongylida , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Anti-Helmínticos/sangue , Artrite Experimental/imunologia , Artrite Reumatoide/imunologia , Citocinas/metabolismo , Modelos Animais de Doenças , Feminino , Humanos , Camundongos , Camundongos Endogâmicos MRL lpr , Nippostrongylus/patogenicidade , Índice de Gravidade de Doença , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/fisiopatologia , Staphylococcus aureus/metabolismo , Staphylococcus aureus/patogenicidade , Infecções por Strongylida/imunologia , Infecções por Strongylida/fisiopatologia , Células Th1/imunologiaRESUMO
OBJECTIVE: Analysing equity in access to health care in Antioquia, Colombia. METHODS: Poorer and richer groups' access to health-care was evaluated, as was that of people with insurance and those without it. A Logit model was estimated for analysing the main determinants of access to curative and preventative health-care services; explanatory variables were socioeconomic status, education level, self-reported health status, age, gender, urban/rural location and social security affiliation. RESULTS: There was no difference in health-care service access amongst people affiliated to contribution-based and subsidised regimes. However, financial constraints represented important obstacles for subsidised regime members and those having no affiliation. Contribution-based regime members had greater resources for continuing to receive attention. There was positive bias in using preventative services thereby favouring people having higher socioeconomic status. CONCLUSIONS: Educational level, age and being affiliated to social security were the main factors explaining health-care service access. Gender, self-reported health status and geographical location were additional factors explaining preventative health-service access.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Colômbia , HumanosRESUMO
Objetivo Analizar la equidad en el acceso a servicios de salud en Antioquia así como sus principales determinantes. Metodología para el análisis descriptivo se discriminan variables de acceso a servicios de salud por nivel socioeconómico y tipo de afiliación. Para identificar los determinantes del acceso a servicio de salud se construye un modelo Logit cuyas variables explicativas son el estatus socioeconómico, edad, educación, género, ubicación urbano/rural, estado de salud autorreportado y tipo de afiliación a la seguridad social. Resultados Ante la necesidad de buscar atención no se observan diferencias entre afiliados al régimen contributivo y subsidiado, pero sí entre éstos y los no afiliados. Las barreras financieras se constituyen en el principal obstáculo para no acceder a servicios de salud para los afiliados al régimen subsidiado y los no afiliados. Se evidencian inequidades entre afiliados y no afiliados, en tanto los del régimen contributivo tienen mayores facilidades para continuar con la atención. Existe un sesgo positivo en el acceso a servicios de salud preventivos que favorece los de mejor situación económica. Conclusiones La educación, edad y tipo de afiliación a la seguridad social son los principales factores que inciden sobre el acceso a servicios curativos y preventivos. El género, estado de salud autorreportado y ubicación geográfica son factores adicionales para explicar el acceso a servicios preventivos, pero que no inciden en el acceso a servicios curativos.
Objective Analysing equity in access to health care in Antioquia, Colombia. Methods Poorer and richer groups' access to health-care was evaluated, as was that of people with insurance and those without it. A Logit model was estimated for analysing the main determinants of access to curative and preventative health-care services; explanatory variables were socioeconomic status, education level, self-reported health status, age, gender, urban/rural location and social security affiliation. Results There was no difference in health-care service access amongst people affiliated to contribution-based and subsidised regimes. However, financial constraints represented important obstacles for subsidised regime members and those having no affiliation. Contribution-based regime members had greater resources for continuing to receive attention. There was positive bias in using preventative services thereby favouring people having higher socioeconomic status. Conclusions Educational level, age and being affiliated to social security were the main factors explaining health-care service access. Gender, self-reported health status and geographical location were additional factors explaining preventative health-service access.