Ecological aspects of the sandfly fauna (Diptera, Psychodidae) in an American cutaneous leishmaniasis endemic area under the influence of hydroelectric plants in Paranapanema river, State of Paraná, Brazil

INTRODUCTION: An epidemiological study was undertaken to identify determinant factors in the occurrence of American cutaneous leishmaniasis in areas under the influence of hydroelectric plants in Paranapanema river, State of Paraná, Brazil. The ecological aspects of the phlebotomine fauna were investigated. METHODS: Sandflies were sampled with automatic light traps from February 2004 to June 2006 at 25 sites in the urban and rural areas of Itambaracá, and in Porto Almeida and São Joaquim do Pontal. RESULTS: A total of 3,187 sandflies of 15 species were captured. Nyssomyia neivai predominated (34.4%), followed by Pintomyia pessoai (32.6%), Migonemyia migonei (11.6%), Nyssomyia whitmani (8.8%), and Pintomyia fischeri (2.7%), all implicated in the transmission of Leishmania. Males predominated for Ny. neivai, and females for the other vector species, with significant statistical differences (p < 0.001). Nyssomyia neivai, Pi. pessoai, Ny. whitmani, Brumptomyia brumpti, Mg. migonei, and Pi. fischeri presented the highest values for the Standardized Species Abundance Index (SSAI). The highest frequencies and diversities were found in the preserved forest in Porto Almeida, followed by forests with degradation in São Joaquim do Pontal and Vila Rural. CONCLUSIONS: Sandflies were captured in all localities, with the five vectors predominating. Ny. neivai had its highest frequencies in nearby peridomestic environments and Pi. pessoai in areas of preserved forests. The highest SSAI values of Ny. neivai and Pi. pessoai reflect their wider dispersion and higher frequencies compared with other species, which seems to indicate that these two species may be transmitting leishmaniasis in the area.

Association of postalimentary lipemia with atherosclerotic manifestations

We identified different lipemic and metabolic responses after the ingestion of a standardized meal by healthy adults and related them to atherosclerotic markers. Samples from 60 normolipidemic adults were collected before and after a liquid meal (40 g fat/m² body surface) at 0, 2, 4, 6, and 8 h for measurements of lipids, free fatty acids (FFA), insulin, cholesteryl ester transfer protein (CETP), autoantibodies to epitopes of oxidized LDL (oxLDL Ab), lipolytic activities, and apolipoprotein E polymorphism. Mean carotid intima-media thickness (cIMT) was determined by Doppler ultrasound. The volunteers were classified into early (N = 39) and late (N = 31) triacylglycerol (TAG) responders to the test meal. Late responders showed lower HDL cholesterol concentration at fasting and in the TAG peak, lower insulin and higher FFA concentrations compared to early responders. Multivariate regression analyses showed that mean cIMT was associated with gender (male) and age in early responders and by cholesterol levels at the 6th hour in late responders. oxLDL Ab were explained by lipoprotein lipase and negatively by hepatic lipase and oxLDL Ab (fasting period) by CETP (negative) and FFA (positive). This study is the first to identify a postalimentary insulin resistance state, combined with a reduced CETP response exclusively among late responders, and the identification of the regulators of postalimentary atherogenicity. Further research is required to determine the metabolic mechanisms described in the different postalimentary phenotypes observed in this study, as well as in different pathological states, as currently investigated in our laboratory.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

Active cutaneous warming systems to prevent intraoperative hypothermia: a systematic review

This study analyzed the evidence available in the literature concerning the effectiveness of different active cutaneous warming systems to prevent intraoperative hypothermia. This is a systematic review with primary studies found in the following databases: CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline. The sample comprised 23 randomized controlled trials. There is evidence in the literature indicating that the circulating water garment system is the most effective in maintaining patient body temperature. These results can support nurses in the decision-making process concerning the implementation of effective measures to maintain normothermia, though the decision of health services concerning which system to choose should also take into account its cost-benefit status given the cost related to the acquisition of such systems.

Oral manifestations in HIV+ children in Mozambique

O objetivo deste estudo foi identificar a prevalência das manifestações bucais em pacientes HIV+/SIDA do Hospital Pediátrico DIA de Maputo. Foram incluídos 90 pacientes na pesquisa. Cárie dentária (índice ceod/CPOD), mucosa e fluxo salivar foram avaliados. Informações sobre alimentação e hábitos de higiene bucal foram obtidas por meio de um questionário. Para a análise estatística foram utilizados os testes t-student e qui-quadrado. A lesão oral mais frequente foi a candidíase (5,5%) e no exame extra-oral foi observada uma prevalência de alargamento da parótida de 23%. A média do ceod foi 2,6 (± 3,6) dentes, consideravelmente alta em relação ao CPOD que foi de 0,6 (±1,6) dentes, sendo esta diferença estatisticamente significante (p<0,05). A ocorrência de lesões na mucosa bucal foi maior em crianças que não faziam uso da terapia antiretroviral (TRA). O uso da TRA esteve associado com a redução da prevalência de lesões bucais em pacientes HIV+, contudo cáries rampantes foram maiores neste grupo. Pacientes HIV+ mostraram maior risco de cáries na dentadura decídua.

Epidemiological aspects of American cutaneous leishmaniasis and phlebotomine sandfly population, in the municipality of Monte Negro, State of Rondônia, Brazil

INTRODUCTION: This work was carried out on the purpose of identifying the species of phlebotomine sandflies in the municipality of Monte Negro, state of Rondonia, Brazil, that may have been transmitting the American cutaneous leishmaniasis (ACL), and concisely describe epidemiological aspects of disease. METHODS: The epidemiologic and socioeconomical indicators were obtained from government institutions and the local Municipal Secretary of Health. Phlebotomine sandflies were captured using CDC light traps between July 2006 to July 2008. The total of 1,240 of female sandflies were examined by PCR method directed to k-DNA. RESULTS: There has been a significant decrease in the incidence of ACL of about 50% over the last ten years in the municipality. A total of 1,935 specimens of 53 sandfly species were captured, three of the genus Brumptomyia genus and 50 of the genus Lutzomyia. The predominant species was Lutzomyia acanthopharynx, Lutzomyia whitmani, Lutzomyia geniculata and Lutzomyia davisi. None were positive for Leishmania sp. CONCLUSIONS: Four sandflies species were found in the State of Rondonia for the first time: Brumptomyia brumpti, Lutzomyia tarapacaensis, Lutzomyia melloi and Lutzomyia lenti. The presence of Lutzomyia longipalpis, was also captured. Socioeconomical improvement of Brazilian economy and the increase of environmental surveillance in the last 15 years collaborated in the decrease of people exposed to vectors, reducing the incidence of ACL.

Sindrome di Buschke-Ollendorff: clinica e genetica

Buschke Ollendorff syndrome (BOS) is a rare autosomal dominant genodermatosis, with high penetrance and variable expressivity, characterized by the association of connective tissue naevi and osteopoikilosis. Both cutaneous and osseous manifestations are usually asymptomatic. The disease is caused by a loss-of-function mutation in the gene LEMD3, that is located on chromosome 12q13. Differential diagnosis mainly includes pseudoxantoma elasticum, morphea, lipoid proteinosis, papular elastorrhexis, juvenile elastoma, papular mucinosis. The 2 cases of BOS here reported are an example of segmental type 2 autosomal dominant genodermatosis, that is due to the loss of heterozygosity occurring at an early developmental stage in a heterozygous patient, causing a segmental homozygosity. Such patients usually have pronounced segmental lesions in the first years of life and later develop disseminated symmetrical lesions.

The KIT gene in familial mastocytosis

Familial cutaneous mastocytosis is an exceptional condition of unknown etiology. In this study we report the largest series of patients with familial cutaneous mastocytosis without other manifestations (18 affected subjects from seven unrelated families), and we investigate the role of germ-line KIT mutations in the pathogenesis of the disease. The mean age at onset was 5.4 years (range from birth to 22 years), and the clinical behavior was variable over a mean follow up period of 15.1 years (range 2-36): improvement in seven, stability in eight and worsening in the remaining three patients. The pattern of inheritance was compatible with an autosomal dominant trait with incomplete penetrance; a female preponderance (14 females vs 4 males, ratio 3.5:1) was noted; among the six women who have been pregnant at least once, three experienced important clinical changes during pregnancy. No germ-line mutation was found in the exons 10, 11, and 17 of the KIT proto-oncogene, which are the most commonly mutated exons in sporadic mastocytosis. However, in the majority of affected subjects we found the Met541Leu polymorphic variant of the KIT gene, which seems to confer a growth advantage to mast cells in vitro. This observation further suggests that the Met541Leu may be a predisposing factor of cutaneous mastocytosis, although it seems to be neither necessary nor sufficient for the development of the disease.

Studying MHC I-dependent CD8 + T cell responses in the model of murine cutaneous leishmaniasis

Der Ausheilung von Infektionen mit Leishmania major liegt die Sekretion von IFN- von sowohl CD4+ als auch CD8+ T Zellen zugrunde.rnAktuell konnte in der Literatur nur ein Epitop aus dem parasitären LACK Protein für eine effektive CD4+ T Zell-vermittelte Immunantwort beschrieben werden. Das Ziel der vorliegenden Arbeit bestand daher darin, mögliche MHC I abhängige CD8+ T Zell Antworten zu untersuchen. rnFür diesen Ansatz wurde als erstes der Effekt einer Vakzinierung mit LACK Protein fusioniert an die Protein-Transduktionsdomäne des HIV-1 (TAT) analysiert. Die Effektivität von TAT-LACK gegenüber CD8+ T Zellen wurde mittels in vivo Protein-Vakzinierung von resistenten C57BL/6 Mäusen in Depletions-Experimenten gezeigt.rnDie Prozessierung von Proteinen vor der Präsentation immunogener Peptide gegenüber T Zellen ist unbedingt erforderlich. Daher wurde in dieser Arbeit die Rolle des IFN--induzierbaren Immunoproteasoms bei der Prozessierung von parasitären Proteinen und Präsentation von Peptiden gebunden an MHC I Moleküle durch in vivo und in vitro Experimente untersucht. Es konnte in dieser Arbeit eine Immunoproteasom-unabhängige Prozessierung aufgezeigt werden.rnWeiterhin wurde Parasitenlysat (SLA) von sowohl Promastigoten als auch Amastigoten fraktioniert. In weiterführenden Experimenten können diese Fraktionen auf immunodominante Proteine/Peptide hin untersucht werden. rnLetztlich wurden Epitop-Vorhersagen für CD8+ T Zellen mittels computergestützer Software von beiden parasitären Lebensformen durchgeführt. 300 dieser Epitope wurden synthetisiert und werden in weiterführenden Experimenten zur Charakterisierung immunogener Eigenschaften weiter verwendet. rnIn ihrer Gesamtheit trägt die vorliegende Arbeit wesentlich zum Verständnis über die komplexen Mechanismen der Prozessierung und letztendlich zur Identifikation von möglichen CD8+ T Zell Epitopen bei. Ein detailiertes Verständnis der Prozessierung von CD8+ T Zell Epitopen von Leishmania major über den MHC Klasse I Weg ist von höchster Bedeutung. Die Charakterisierung sowie die Identifikation dieser Peptide wird einen maßgeblichen Einfluss auf die weiteren Entwicklungen von Vakzinen gegen diesen bedeutenden human-pathogenen Parasiten mit sich bringen. rn

Indolent CD8+ lymphoid proliferation of the ear: A phenotypic variant of the small-medium pleomorphic cutaneous T-cell lymphoma?

Recently, Petrella et al. described four patients with an unusual CD8+ lymphoid proliferation arising on the ear. These cases do not correspond clearly to any recognized category of cutaneous T-cell lymphoma (CTCL) described in the World Health Organization (WHO)/European Organization for Research and Treatment of Cancer (EORTC) 2005 classification.

High numbers of DC-SIGN+ dendritic cells in lesional skin of cutaneous T-cell lymphoma

The role of dendritic cells (DCs) in disease progression of primary cutaneous T-cell lymphoma (CTCL) is not well understood. With their unique ability to induce primary immune responses as well as immunotolerance, DCs play a critical role in mediation of anti-tumor immune responses. Tumor-infiltrating DCs have been determined to represent important prognostic factors in a variety of human tumors.

Specific nail alterations in cutaneous T-cell lymphoma: successful treatment with topical mechlorethamine

Cutaneous T-cell lymphoma can be associated with clinically significant nail alterations, the presentation of which can be protean and misleading. To date, only a few reports have demonstrated direct specific tumor infiltration of the nail bed, while little is known about the efficacy of topical treatments.

Behçet's disease: Successful treatment with infliximab in 7 patients with severe vascular manifestations - a retrospective analysis

To evaluate the therapeutic effect of infliximab in patients with inflammatory vascular lesions due to Behçet's disease (BD).

Radio-guided surgery: advantages of a new portable γ-camera (Sentinella(®) ) for intraoperative real time imaging and detection of sentinel lymph nodes in cutaneous malignancies

The histological status of the sentinel lymph node (SLN) is one of the most relevant prognostic factors for the overall survival of patients with cutaneous malignancies, independent of tumour depth of the primary tumour.