RESUMO

Background: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data. Methods: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I2 statistic. The study was registered in the PROSPERO database (CRD42022354237). Findings: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (ß = -0.05, P < 0.001) form, and directly associated with CCM (ß = 0.06, P < 0.001) and digestive (ß = 0.02, P < 0.001) forms. Heterogeneity was overall high. Interpretation: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form. Funding: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.

RESUMO

BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.

RESUMO

La tuberculosis (TB) es una enfermedad infecciosa, reemergente, ligada a condiciones de pobreza, curable, de presentación clínica variable y con formas graves de enfermedad prevenibles con la vacuna del BCG. Objetivo: Determinar las características de la enfermedad tuberculosa y su asociación con la presencia de la cicatriz de la vacuna (BCG) en los niños que asistieron a la unidad de Tisiología del Ambulatorio docente del HUC. Métodos: Se realizó un estudio de tipo descriptivo, observacional, de corte transversal mediante revisión de las históricas clínicas de todos los niños con el diagnóstico de enfermedad tuberculosa en cualquiera de sus formas clínicas que acudieron al Ambulatorio Docente del HUC durante los años 2014 al 2018, verificando la presencia de la cicatriz de la BCG y su correlación con las formas de la enfermedad. Resultados: Se incluyeron 68 pacientes que cumplieron con los criterios de inclusión y exclusión. El 57 % fue del sexo femenino, el grupo preescolar fue el más frecuente (41 %). La forma clínica predominante fue la pulmonar (63 %), seguida por ganglionar (10 %), meníngea y pleural (5,8 %), la TB miliar (2,9 %). 52 pacientes (76 %) presentaron cicatriz de BCG, siendo en este grupo la forma de presentación clínica más frecuente TB pulmonar (69 %). De los pacientes con ausencia de la cicatriz, el 43,6 % presentó formas graves y extrapulmonares. Conclusiones: La ausencia de cicatriz de BCG, se relacionó con mayoría de formas graves de TB, destacándose la importancia de realizar la vacunación con BCG para la prevención de la enfermedad o de sus formas graves.

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Tuberculosis (TB) is an infectious disease, reemerging, linked to conditions of poverty, curable, with variable clinical presentation and with serious forms of disease, preventable through the BCG vaccine. Objective: To determine the characteristics of tuberculosis disease and its association with the presence of the BCG scar in children who attended the consultation of the Tisiology unit of the Teaching Outpatient HUC, in the period January 2014 to December 2018. Methods: A descriptive, observational, cross-sectional study was carried out by reviewing the clinical histories of all children with a diagnosis of tuberculosis disease in any of its clinical forms who attended the HUC Teaching Outpatient Clinic during the period of study, verifying the presence of the BCG scar and its correlation with the different forms of the disease. Results: 68 patients who met the inclusion and exclusion criteria were included. 57 % were female, the most frequent age group was preschool (41 %). The predominant clinical form was pulmonary (63 %), followed by lymph node (10 %), meningeal and pleural (5.8 %), miliary TB (2.9 %). 52 patients (76 %) presented BCG scar, being the most frequent clinical presentation of pulmonary TB (69 %) in this group. Of the patients with absence of the scar, 43.6 % presented severe and extrapulmonary forms. Conclusions: The absence of BCG scar was related to the majority of severe forms of TB, highlighting the importance of BCG vaccination for the prevention of the disease or its serious forms.

RESUMO

BACKGROUND: The purpose of this research was to compare the clinical and epidemiological characteristics of patients with chronic Chagas disease with and without positive blood cultures for Trypanosoma cruzi. METHODS: This was a retrospective longitudinal study that included 139 patients with chronic Chagas disease who underwent blood culture for T. cruzi. Blood cultures were performed using Novy-MacNeal-Nicolle medium enriched with Schneider's medium. Multivariate Cox proportional hazards regression analysis adjusting for age and sex was performed to identify if positive blood culture for T. cruzi was associated with all-cause mortality. RESULTS: The blood culture positivity rate was 30.9%. Most patients were born in the Northeast and Southeast regions of Brazil. Patients with positive blood cultures were older (52±13 vs 45±13 y; p=0.0009) and more frequently women (72.1% vs. 53.1%; p=0.03) than patients with negative blood cultures. The frequency of patients with cardiac or cardiodigestive forms was higher among patients with positive vs negative blood cultures (74.4% vs 54.1%; p=0.02). A total of 28 patients died during a mean follow-up time of 6.6±4.1 y. A positive blood culture was associated with all-cause mortality (hazard ratio 2.26 [95% confidence interval 1.02 to 5.01], p=0.045). CONCLUSIONS: We found a higher proportion of patients with Chagas heart disease among patients with T. cruzi-positive blood cultures. A positive blood culture was associated with an increased risk of all-cause mortality. Therefore T. cruzi persistence may influence Chagas disease pathogenesis and prognosis.

Assuntos

Doença de Chagas , Trypanosoma cruzi , Hemocultura , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Estudos Retrospectivos

RESUMO

Introducción: El pie diabético es una causa importante de morbilidad y constituye una complicación crónica de la diabetes mellitus que repercute en la calidad de vida. Los pacientes con pie diabético tienen una tasa alta de amputación, procedimiento quirúrgico que afecta emocional y económicamente a pacientes, familiares, médicos de asistencia y a la sociedad. Objetivos: Identificar los factores pronósticos de amputación mayor en pacientes con pie diabético sometidos a cirugía. Métodos: Se realizó un estudio descriptivo analítico de corte transversal en 73 pacientes con diagnóstico de pie diabético: 29 con amputación mayor y 44 con amputación menor. Las variables estudiadas fueron: edad, sexo, tipo de diabetes y su tiempo de evolución, pulsos arteriales, tipo de pie diabético, presencia de úlcera isquémica infectada, absceso, osteomielitis, úlcera neuropática, gangrena digital, necrosis tisular progresiva e infección. Se calcularon las frecuencias absolutas y relativas, y se asociaron las variables. Resultados: Hubo predominio del sexo masculino (56,2 por ciento) y de la diabetes mellitus de tipo 2 (93,2 por ciento). La necrosis tisular progresiva se observó en 30 pacientes y la úlcera isquémica representó el 30,1 por ciento. Conclusiones: La úlcera isquémica con infección, la gangrena digital y la necrosis tisular progresiva resultaron los factores pronósticos de amputación mayor identificados en los pacientes con pie diabético sometidos a cirugía(AU)

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Introduction: Diabetic foot ulcer is a major cause of morbidity and it is a chronic complication of diabetes mellitus that impacts quality of life. Patients with diabetic feet have a high amputation rate, a surgical procedure that emotionally and economically affects patients, family members, physicians and society. Objective: To identify the prognostic factors for major amputation in patients with diabetic foot ulcer undergoing surgery. Methods: A descriptive cross-sectional analytical study was conducted in 73 patients diagnosed with diabetic foot ulcer: 29 with major amputation and 44 with minor amputation. The variables studied were: age, sex, type of diabetes and its evolution time, arterial pulses, type of diabetic foot, presence of infected ischemic ulcer, abscess, osteomyelitis, neuropathic ulcer, digital gangrene, progressive soft-tissue necrosis and infection. Absolute and relative frequencies were calculated, and variables were associated. Results: There was predominance of the male sex (56.2 percent) and of diabetes mellitus type 2 (93.2 percent). Progressive soft-tissue necrosis was observed in 30 patients and the ischemic ulcer represented the 30.1 percent. Conclusions: Ischemic ulcer with infection, digital gangrene and progressive soft-tissue necrosis resulted in the major amputation´s prognostic factors identified in diabetic foot patients undergoing surgery(AU)

Assuntos

Humanos , Procedimentos Cirúrgicos Operatórios , Pé Diabético/complicações , Diabetes Mellitus , Amputação Cirúrgica , Epidemiologia Descritiva , Estudos Transversais

RESUMO

Paracoccidioidomycosis (PCM) is an important endemic, systemic disease in Latin America caused by Paracoccidioides spp. This mycosis has been associated with high morbidity and sequels, and its clinical manifestations depend on the virulence of the infecting strain, the degree and type of immune response, infected tissues, and intrinsic characteristics of the host. The T helper(Th)1 and Th17/Th22 cells are related to resistance and control of infection, and a Th2/Th9 response is associated with disease susceptibility. In this study, we focused on interleukin(IL)-12p35 (IL12A), IL-18 (IL18), and IFN-γ receptor 1 (IFNGR1) genetic polymorphisms because their respective roles have been described in human PCM. Real-time PCR was employed to analyze IL12A-504 G/T (rs2243115), IL18-607 C/A (rs1946518), and IFNGR1-611 A/G (rs1327474) single nucleotide polymorphisms (SNP). One hundred forty-nine patients with the acute form (AF), multifocal chronic (MC), or unifocal chronic (UC) forms of PCM and 110 non-PCM individuals as a control group were included. In the unconditional logistic regression analysis adjusted by ethnicity and sex, we observed a high risk of the IL18-607 A-allele for both AF [p = 0.015; OR = 3.10 (95% CI: 1.24-7.77)] and MC groups [p = 0.023; OR = 2.61 (95% CI: 1.14-5.96)] when compared with UC. The IL18-607 A-allele associated risk for the AF and MC groups as well as the protective role of the C-allele in UC are possibly linked to higher levels of IL-18 at different periods of the course of the disease. Therefore, a novel role of IL18-607 C/A SNP is shown in the present study, highlighting its importance in the outcome of PCM.

Assuntos

Interleucina-18 , Paracoccidioidomicose , Regiões Promotoras Genéticas , Índice de Gravidade de Doença , Feminino , Humanos , Interleucina-18/genética , Interleucina-18/imunologia , Masculino , Pessoa de Meia-Idade , Paracoccidioides/imunologia , Paracoccidioidomicose/genética , Paracoccidioidomicose/imunologia , Linfócitos T Auxiliares-Indutores/imunologia

RESUMO

RESUMEN Introducción: La esclerosis lateral amiotrófica (ELA) es la más frecuente del grupo heterogéneo de las enfermedades de la motoneurona. Objetivo: Caracterizar la sobrevida de los pacientes con diagnóstico de esclerosis lateral amiotrófica partiendo de factores relacionados con su comportamiento clínico en el Instituto Nacional de Neurología y Neurocirugía "Dr. José Rafael Estrada González" de a Habana, Cuba. Material y Métodos: Se realizó una investigación descriptiva y retrospectiva de una serie de 147 casos de pacientes diagnosticados con ELA, por la confirmación clínica, neurofisiológica e imágenes, atendidos en la consulta multidisciplinaria en el periodo de octubre de 2005 a octubre de 2015, de los cuales ya han fallecido 110. Resultados: La mayor frecuencia de la enfermedad por grupos de edades estuvo entre 51 y 60 años. En los primeros 40 meses murió la mayor parte de los pacientes (80). La forma clínica espinal predominó en varones quienes, además, tuvieron mayor sobrevida, la bulbar prevaleció en mujeres. El mayor número de pacientes no tenía factores de riesgo. Entre las comorbilidades destacan la diabetes, hipertensión arterial, enfermedad cerebrovascular isquémica, neoplasias, hepatitis C, traumatismo craneal, asma bronquial y la cardiopatía isquémica, y hubo casos de la enfermedad en una misma familia. Conclusiones: La mayor sobrevida desde el diagnóstico de la enfermedad estuvo en el grupo de 51 a 60 años alcanzando algunos hasta 10 años. El promedio general de sobrevida estuvo entre 2 y 5 años. En los pacientes con comorbilidades, antecedentes familiares y forma bulbar, la sobrevida fue menor. La supervivencia al evaluar la efectividad del tratamiento con Riluzol no fue significativa.

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ABSTRACT Introduction: Amyotrophic lateral sclerosis (ALS) is the most frequent disease in the heterogeneous group of disorders with motor neuron diseases. Objective: To characterize the survival of patients diagnosed with amyotrophic lateral sclerosis considering factors related to their clinical behavior at "Dr. Jose Rafael Estrada Gonzalez" National Institute of Neurology and Neurosurgery, Havana, Cuba. Material and Methods: A descriptive and retrospective research was conducted. The study included a case series of 147 patients diagnosed with ALS by clinical and neurophysiological confirmation and images. The patients were treated in the multidisciplinary consultation in the period from October 2005 to October 2015. A total of 110 of them already died. Results: The disease most often occurs between the ages of 51 and 60. In the first 40 months, most of the patients in the series died, for a total of 80 people. The spinal clinical form predominated in males who had higher survival; the bulbar form prevailed in women. Most of the patients had no risk factors. Diabetes, arterial hypertension, ischemic cerebrovascular disease, neoplasms, hepatitis C, head trauma, bronchial asthma and ischemic heart disease stand out as comorbidities. There were cases of the disease within a single family. Conclusions: The greatest survival from the diagnosis of the disease was observed in the group between 51 and 60 years of diagnosis of the disease, some of them reaching up to 10 years. The general average of survival was between 2 and 5 years. It was lower in patients with comorbidities, family history and bulbar form. After evaluating the effectiveness of the treatment with Riluzole, the survival was not significant.

RESUMO

Lipophosphoglycan (LPG) is the major Leishmania surface glycoconjugate having importance during the host-parasite interface. Leishmania (Viannia) braziliensis displays a spectrum of clinical forms including: typical cutaneous leishmaniasis (TL), mucocutaneous (ML), and atypical lesions (AL). Those variations in the immunopathology may be a result of intraspecies polymorphisms in the parasite's virulence factors. In this context, we evaluated the role of LPG of strains originated from patients with different clinical manifestations and the sandfly vector. Six isolates of L. braziliensis were used: M2903, RR051 and RR418 (TL), RR410 (AL), M15991 (ML), and M8401 (vector). LPGs were extracted and purified by hydrophobic interaction. Peritoneal macrophages from C57BL/6 and respective knock-outs (TLR2-/- and TLR-4-/-) were primed with IFN-γ and exposed to different LPGs for nitric oxide (NO) and cytokine production (IL-1ß, IL-6, IL-12, and TNF-α). LPGs differentially activated the production of NO and cytokines via TLR4. In order to ascertain if such functional variations were related to intraspecies polymorphisms in the LPG, the purified glycoconjugates were subjected to western blot with specific LPG antibodies (CA7AE and LT22). Based on antibody reactivity preliminary variations in the repeat units were detected. To confirm these findings, LPGs were depolymerized for purification of repeat units. After thin layer chromatography, intraspecies polymorphisms were confirmed especially in the type and/size of sugars branching-off the repeat units motif. In conclusion, different isolates of L. braziliensis from different clinical forms and hosts possess polymorphisms in their LPGs that functionally affected macrophage responses.

Assuntos

Glicoesfingolipídeos/química , Glicoesfingolipídeos/imunologia , Leishmania braziliensis/genética , Leishmania braziliensis/metabolismo , Leishmaniose Cutânea/imunologia , Ativação de Macrófagos , Receptor 4 Toll-Like/metabolismo , Animais , Citocinas/metabolismo , Técnicas de Inativação de Genes , Glicoesfingolipídeos/isolamento & purificação , Interações Hospedeiro-Patógeno , Humanos , Imunidade Inata , Macrófagos/imunologia , Macrófagos Peritoneais/parasitologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Óxido Nítrico , Psychodidae/parasitologia , Receptor 4 Toll-Like/genética , Fatores de Virulência

RESUMO

Abstract INTRODUCTION: Chagas disease (CD) prevention and control rely on studies of its distribution, characteristics of individuals affected and mode of transmission. CD data in Brazil are scarce; a retrospective analysis of the clinical characteristics of 80 patients treated at the Clinical Hospital of UNICAMP, Campinas, Brazil, was performed. METHODS: Patient data records were analyzed. RESULTS: Thirty percent of the patients probably got infected through vector-borne transmission, 65% came from endemic areas, a predominance of cardiac and cardiodigestive forms was found among males, and the cardiac form prevailed (51%). CONCLUSIONS: The results update the view on the epidemiology of CD in Campinas, Brazil.

Assuntos

Humanos , Masculino , Feminino , Registros Hospitalares/estatística & dados numéricos , Doença de Chagas/diagnóstico , Doença de Chagas/tratamento farmacológico , Doença de Chagas/epidemiologia , Brasil/epidemiologia , Prevalência , Estudos Retrospectivos , Pessoa de Meia-Idade

RESUMO

Abstract Introduction Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks. Objectives The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo. Methods The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level. Results The average serum level of 25-OH D3 among respondents was 20.78 ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis. Conclusions There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.

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Resumo Introdução Vertigem posicional paroxística benigna é a causa mais comum de tonturas na população em geral. É uma condição no qual níveis reduzidos de vitamina D podem ter um potencial impacto para o desenvolvimento de crises recorrentes. Objetivos O objetivo desse estudo foi medir os níveis séricos de 25-hidroxivitamina D3 (25-OH D3) em pacientes com vertigem posicional paroxística benigna e determinar se há diferença nos níveis séricos de vitamina D3 entre pacientes com e sem recorrência, bem como entre as diferentes formas clínicas de vertigem posicional paroxística benigna. Método O estudo incluiu 40 pacientes submetidos a exame médico regular, diagnosticados com vertigem posicional paroxística benigna de canal posterior baseado no resultado positivo do teste de Dix-Hallpike. Todos os pacientes foram submetidos à manobra de Epley após o diagnóstico. Os pacientes foram classificados de acordo com as diretrizes atuais para os níveis de vitamina D3 sérica em três grupos: deficiência, insuficiência e nível adequado. Resultados O nível sérico médio de 25-OH D3 entre os indivíduos avaliados foi de 20,78 ng/mL, indicando falta ou insuficiência desta vitamina. De acordo com os níveis de 25-OH D3, a maioria dos pacientes apresentou deficiência (47,5%). Sete indivíduos (17,5%) entrevistados tinham nível sanguíneo adequado de 25-OH D3 e 14 (35%) apresentavam insuficiência. Não foi encontrada diferença significativa no nível sérico de 25-OH D3 entre pacientes com e sem recidiva de vertigem posicional paroxística benigna. Houve uma diferença significativa nos níveis séricos de 25-OH D3 de acordo com a forma clínica da doença. Baixos níveis de 25-OH D3 foram mais encontrados em pacientes com canalitíase em comparação com aqueles com cupulolitíase. Conclusões Não houve diferenças significativas no nível sérico de vitamina D3 em pacientes com e sem recorrência. O estudo mostrou um baixo nível de vitamina D3 sérica na maioria dos pacientes, indicando a necessidade de terapia suplementar.

Assuntos

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Calcifediol/sangue , Colecalciferol/sangue , Vertigem Posicional Paroxística Benigna/sangue , Recidiva , Valores de Referência , Deficiência de Vitamina D/sangue , Cálcio/sangue , Estatísticas não Paramétricas , Vertigem Posicional Paroxística Benigna/patologia

RESUMO

INTRODUCTION: Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks. OBJECTIVES: The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo. METHODS: The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level. RESULTS: The average serum level of 25-OH D3 among respondents was 20.78ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis. CONCLUSIONS: There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.

Assuntos

Vertigem Posicional Paroxística Benigna/sangue , Calcifediol/sangue , Colecalciferol/sangue , Idoso , Vertigem Posicional Paroxística Benigna/patologia , Cálcio/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Valores de Referência , Estatísticas não Paramétricas , Deficiência de Vitamina D/sangue

RESUMO

OBJECTIVES: We aimed to determine whether the presentation of Chikungunya virus (CHIKV) infection differs between older and younger adults with regard to clinical form during the acute phase defined by the World Health Organization: acute clinical, atypical, and severe acute. DESIGN: Cross-sectional, retrospective. SETTING: University Hospital of Martinique. PARTICIPANTS: Individuals aged 65 and older (n = 267, mean age 80.4 ± 87.9) who attended the emergency department with a positive biological diagnosis of CHIKV (reverse transcriptase polymerase chain reaction) between January and December 2014 and a randomly selected sample of individuals younger than 65 (n = 109, mean age 46.2 ± 12.7). RESULTS: Typical presentation was present in 8.2% of older adults and 59.6% of younger individuals (P < .001), atypical presentation in 29.6% of older adults and 5.6% of younger individuals (P < .001), and severe presentation in 19.5% of older adults and 17.4% of younger individuals (P = .65). One hundred fourteen (42.7%) of the older group and 19 (17.4%) of the younger group could not be classified in any category (absence of fever, absence of joint pain, or both) (P < .001). CONCLUSION: Only 8.2% of the older adults presenting in the acute phase of CHIKV have typical forms, suggesting that the most-frequent clinical presentation of CHIKV in older adults differs from that in younger individuals.

Assuntos

Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/isolamento & purificação , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artralgia/virologia , Estudos Transversais , Feminino , Febre de Causa Desconhecida/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco

RESUMO

The clonal evolution of Trypanosoma cruzi sustains scientifically the hypothesis of association between parasite's genetic, biological behavior and possibly the clinical aspects of Chagas disease in patients from whom they were isolated. This study intended to characterize a range of biological properties of TcI, TcII and TcVI T. cruzi samples in order to verify the existence of these associations. Several biological features were evaluated, including in vitro epimastigote-growth, "Vero"cells infectivity and growth, along with in vivo studies of parasitemia, polymorphism of trypomastigotes, cardiac inflammation, fibrosis and response to treatment by nifurtimox during the acute and chronic murine infection. The global results showed that the in vitro essays (acellular and cellular cultures) TcII parasites showed higher values for all parameters (growth and infectivity) than TcVI, followed by TcI. In vivo TcII parasites were more virulent and originated from patients with severe disease. Two TcII isolates from patients with severe pathology were virulent in mice, while the isolate from a patient with the indeterminate form of the disease caused mild infection. The only TcVI sample, which displayed low values in all parameters evaluated, was also originated of an indeterminate case of Chagas disease. Response to nifurtimox was not associated to parasite genetic and biology, as well as to clinical aspects of human disease. Although few number of T. cruzi samples have been analyzed, a discreet correlation between parasite genetics, biological behavior in vitro and in vivo (murine model) and the clinical form of human disease from whom the samples were isolated was verified.

Assuntos

Doença de Chagas/parasitologia , Nifurtimox/farmacologia , Tripanossomicidas/farmacologia , Trypanosoma cruzi/efeitos dos fármacos , Trypanosoma cruzi/patogenicidade , Animais , Células Cultivadas , Modelos Animais de Doenças , Humanos , Camundongos , Trypanosoma cruzi/isolamento & purificação , Virulência

RESUMO

The aim of the present study was to evaluate inflammatory, oxidative, and nitrosative stress (IO&NS) blood markers as possible predictors of multiple sclerosis (MS) and its clinical forms. This study included 258 MS patients (175 with relapsing-remitting MS (RRMS) and 83 with progressive MS clinical forms) and 249 healthy individuals. Peripheral blood samples were obtained to determine serum levels of albumin, ferritin, C-reactive protein (CRP), total protein, lipid hydroperoxide by tert-butyl hydroperoxide-initiated chemiluminescence (CL-LOOH), carbonyl protein content, advanced oxidation protein products (AOPP), nitric oxide metabolites (NOx), and total radical-trapping antioxidant parameter (TRAP). MS patients showed higher ferritin (p < 0.001) and CL-LOOH (p < 0.001) and lower albumin (p = 0.001), TRAP (p < 0.001), AOPP (p = 0.013), and NOx values (p < 0.001) than controls. Difference was not observed in CRP, total protein, and carbonyl proteins between patients and controls. In the logistic regression age-adjusted, ferritin and CL-LOOH showed positive association with MS and were predictors of MS development (OR: 1.006, 95 % CI: 1.003-1.009, p < 0.001 and OR: 1.029, 95 % CI: 1.007-1.052, p = 0.009, respectively). Albumin, TRAP, AOPP, and NOx were negatively associated with MS (p = 0.019, p = 0.003, p = 0.001, and p = 0.003, respectively). Moreover, other logistic regression age-adjusted showed that MS patients with progressive clinical forms had lower albumin and higher AOPP than those with RRMS (p = 0.037). In conclusion, ferritin, albumin, and biomarkers of IO&NS, such as CL-LOOH, AOPP, TRAP, and NOx were predictors of MS diagnosis, whereas albumin and AOPP were predictors that differentiated RRMS from the progressive clinical forms of MS.

Assuntos

Albuminas/metabolismo , Esclerose Múltipla Crônica Progressiva/diagnóstico , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Inflamação/sangue , Inflamação/patologia , Modelos Logísticos , Masculino , Esclerose Múltipla Crônica Progressiva/sangue , Esclerose Múltipla Recidivante-Remitente/sangue , Nitrosação , Oxirredução , Estresse Oxidativo

RESUMO

La lepra es una enfermedad infecto-contagiosa crónica, no hereditaria, curable y controlable, causada por el Mycobacterium leprae, que afecta principalmente la piel, mucosas y nervios periféricos. En Argentina es un problema regional y nacional, por la migración que abarca a las provincias de Formosa, Chaco, Corrientes, Entre Ríos, Misiones, Santa Fe y Buenos Aires. Objetivo General: determinar el comportamiento clínico-epidemiológico de la lepra en la Provincia de Santa Fe, desde el 1º de Enero del año 2012 al 31 de Agosto del año 2016. Métodos y Materiales: la información se obtuvo de la revisión de las fichas epidemiológicas, de pacientes con diagnóstico de lepra en el período abarcado. Las variables utilizadas fueron: edad y sexo del paciente, residencia, foco epidemiológico, condiciones ambientales y económicas, clínica, tipo de lepra, grado de discapacidad general y tratamiento. Resultados: se diagnosticaron 86 casos de lepra; 59,3% correspondieron al sexo masculino y 40, 7% al sexo femenino. El promedio de edad fue de 56 años. El 86% de los casos fueron multibacilares y la lepra lepromatosa, fue la forma clínica más frecuente. El 26,7% presentó discapacidad al momento del diagnóstico, 16,3% grado 1 y 10,5% grado 2. Conclusión: la detección de nuevos casos en la Provincia de Santa Fe, fue en promedio de 18 casos anuales, excluido el año 2016, en vigencia. Rosario fue el departamento con más casos registrados. El 60% de los casos se comunicó entre los 35 y 66 años; el sexo masculino fue el más afectado. Los casos multibacilares prevalecieron sobre los paucibacilares; la forma clínica más frecuente fue la lepra lepromatosa. Se estableció discapacidad en uno de cada cuatro pacientes.

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Leprosy is a chronic disease which, despite having a variable clinic, is diagnosable and treatable when receiving a multidrug therapy (MDT) as the one proposed by the World Health Organization (WHO). In Argentina, it is characterized by moderate endemicity and focus on certain geographic areas (provinces of northeastern, northwest and center of Argentina). General Objective: determine the clinical and epidemiological behavior of leprosy in the province of Santa Fe. Methods and Materials: the cases reported since 1º January 2012 to 31 August 2016, were retrospectively collected from the review of the epidemiological records of the Ministry of Health, Environment and Social Action of the Province of Santa Fe. The variables were: age and sex of the patient, residence, epidemiological focus, environmental and economic conditions, kind of leprosy, degree of disability and finally the treatment. Results: 86 cases of leprosy were diagnosed: 59,3% were male and 40,7% sex, were female. The average age was 56 years. 86% of cases were multibacillary and lepromatous leprosy was the most frequent clinical form. The 26,7% had disability at the moment of diagnosis, 16,3% 10,5% grade 1 and grade 2. Conclusion: in the Province of Santa Fe, the detection of new leprosy cases have been stable in the last years, with a minimun of 17 and a maximum of 29 cases per year. Rosario was the city with more registered cases, followed by: La capital, General Obligado y Nueve de Julio. The most affected patients were male, and 60% of cases reported between 35 and 66 years. Multibacillary cases prevailed over paucibacillary; the most frequent clinical form was lepromatous leprosy. One in four patients had disability at the moment of diagnosis.

RESUMO

Biomarkers or biosignature profiles have become accessible over time in population-based studies for Chagas disease. Thus, the identification of consistent and reliable indicators of the diagnosis and prognosis of patients with heart failure might facilitate the prioritization of therapeutic management to those with the highest chance of contracting this disease. The purpose of this paper is to review the recent state and the upcoming trends in biomarkers for human Chagas disease. As an emerging concept, we propose a classification of biomarkers based on plasmatic-, phenotype-, antigenic-, genetic-, and management-related candidates. The available data revisited here reveal the lessons learned thus far and the existing challenges that still lie ahead to enable biomarkers to be employed consistently in risk evaluation for this disease. There is a strong need for biomarker validation, particularly for biomarkers that are specific to the clinical forms of Chagas disease. The current failure to achieve the eradication of the transmission of this disease has produced determination to solve this validation issue. Finally, it would be strategic to develop a wide variety of biomarkers and to test them in both preclinical and clinical trials.

RESUMO

BACKGROUND: Current scientific information reported that due to successive treatments of schistosomiasis cases in endemic areas of Brazil in the last 30 years, there has been a decrease in severe clinical form (hepatosplenic) and mortality from upper gastrointestinal bleeding due to this disease. Against this information, literature data show that the state of Pernambuco presents significant percentage of deaths and hospitalizations due to schistosomiasis, and occurrence of severe clinical forms as schistosomiasis myeloradiculopathy and persistence of localities with high parasite loads. This scenario justified this research which seeking to update the morbidity and mortality of schistosomiasis in Pernambuco. OBJECTIVE: To conduct a temporal analysis on the evolution of deaths, hospital admissions and severe forms of Manson's schistosomiasis over the last 16 years in Pernambuco, Brazil. METHODS: It was performed a gathering secondary data on schistosomiasis, from healthcare information systems and from the records of Hospital das Clínicas, Federal University of Pernambuco (HC-UFPE), covering the period from 1999 to 2014. RESULTS: From 1999 to 2013 were registred 2578 deaths due to schistosomiasis and between 2008 and 2014 were recorded 473 hospitalizations for this disease. Among 1999-2014 were identified 1943 cases of schistosomiasis treated at the Hospital das Clínicas of Pernambuco. Among these cases, 72.6% (n. 1411) of the individuals presented the hepatosplenic clinical form (HE), 60.8% (n. 858) were at the age group 30-59 years (adults) and 58% were female. Among the HE cases, 4.6% (n. 58) had ascites, 43.2% (n. 556) had upper gastrointestinal bleeding and 39.1% (n. 489) had collateral circulation. The pattern of fibrosis in the liver E/EC (advanced fibrosis) and F/FC (very advanced fibrosis) occurred in 65.5% (n. 793) of cases. Between 1999-2014 the evolution curve of severe clinical forms of schistosomiasis remained stable, showing a tendency to decline from 2012. CONCLUSION: When compared to other states of Brazil, Pernambuco shows high numbers of deaths and hospital admissions due to schistosomiasis. The actions of the Schistosomiasis Control Program (PCE) have been developed in a disintegrated, disjointed and discontinuous way, which may explain the magnitude of deaths, hospitalizations and severe forms of the disease in Pernambuco, showing a lack of control and the maintenance of severe frame morbidity of schistosomiasis in this state.

Assuntos

Hospitalização/estatística & dados numéricos , Esquistossomose mansoni/mortalidade , Adolescente , Adulto , Animais , Ascite/epidemiologia , Ascite/parasitologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Cirrose Hepática/mortalidade , Cirrose Hepática/parasitologia , Masculino , Pessoa de Meia-Idade , Morbidade , Mortalidade/tendências , Esquistossomose mansoni/complicações , Fatores de Tempo , Adulto Jovem

RESUMO

OBJECTIVE: Trypanosoma cruzi is subdivided into six discrete typing units (DTUs), TcI-TcVI. The precise identification of each can contribute to tracking wild DTUs that invade the domiciliary environment. METHODS: Twenty T. cruzi stocks isolated from 16 chagasic patients, two Panstrongylus lutzi, one Galea spixii, and one Euphractus sexcinctus, from different localities in the State of Rio Grande do Norte, Brazil, were characterized by genotyping the 3' region of the 24Sα rRNA gene, the mitochondrial cytochrome oxidase subunit 2 gene, and the spliced leader intergenic region. RESULTS: TcIII was identified in 18.7% (3/16) of patients from different municipalities, as well as in P. lutzi, G. spixii, and E. sexcinctus, indicating the connection between the sylvatic and domestic cycles in this Brazilian semi-arid region. TcI and TcII were also detected, in 37.5% (6/16) and 43.8% (7/16) of patients, respectively. These DTUs were associated with cardiac, digestive, and indeterminate clinical forms, while TcIII was identified only in patients with the indeterminate form. CONCLUSIONS: The occurrence of these DTUs reveals important phylogenetic diversity in T. cruzi isolates from humans. TcIII is reported for the first time in northeastern Brazil. These findings appear to indicate an overlap between the sylvatic and domestic transmission cycles of the parasite in this region.

Assuntos

Doença de Chagas/parasitologia , Trypanosoma cruzi/classificação , Adulto , Idoso , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Clima , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Trypanosoma cruzi/genética , Trypanosoma cruzi/isolamento & purificação

RESUMO

Visceral leishmaniasis has a great impact on public health, and dogs are considered the main domestic reservoir of Leishmania infantum, the causal parasite. In this study, 159 animals naturally infected by L. infantum from an endemic area of Brazil were evaluated through an analysis of cellular responses, using flow cytometry, and of the hematological parameters. The results confirmed that disease progression is associated with anemia and reductions in eosinophils, monocytes and lymphocytes. The investigation of the immune response, based on the immunophenotypic profile of peripheral blood, showed declines in the absolute numbers of T lymphocytes CD5(+) and their subsets (CD4(+) and CD8(+)) and a drop of B lymphocytes in asymptomatic seropositive (AD-II) and symptomatic seropositive (SD) dogs. Neutrophils, when stimulated with soluble antigen of L. infantum, showed higher synthesis of interferon (IFN)-γ(+) in AD-II and SD groups, with decreased production of interleukin (IL)-4(+) in asymptomatic seronegative dogs positive for L. infantum infection based on polymerase chain reaction testing (AD-I group). In the AD-II and SD groups, subpopulations of stimulated lymphocytes (CD4(+) and CD8(+)) also exhibited greater synthesis of IFN-γ(+) and IL-4(+) in culture. These results suggest that the animals of the AD-II and SD groups exhibited a mixed immune response (Type 1 and 2) and the AD-I group presenting an immune profile very similar to normal control animals.

Assuntos

Anticorpos Antiprotozoários/sangue , Doenças do Cão/parasitologia , Leishmania infantum/imunologia , Leishmaniose Visceral/veterinária , Animais , Biomarcadores/metabolismo , Brasil/epidemiologia , Resistência à Doença , Suscetibilidade a Doenças , Cães , Eosinófilos/imunologia , Feminino , Citometria de Fluxo/veterinária , Leishmaniose Visceral/parasitologia , Masculino , Monócitos/imunologia , Linfócitos T/imunologia

RESUMO

This case report alerts to the existence of atypical forms of cutaneous leishmaniasis (CL). A woman with nodular cutaneous lesions over a neck with papules and pustules located deep in the hypodermis that formed plaques with subcutaneous induration and satellite papules was confirmed to have CL. After confirmation, the patient was treated with remission of the lesions, scarring and thickening of the skin.