Estudo da correlação das características clínico-patológicas do câncer colorretal com a expressão imunohistoquímica de proteínas da progressão tumoral

Except the non-melanoma skin tumors, colorectal cancer is the second most common in the Southeastern Region of Brazil, the third most common in the Southern and Central Regions. It is also the forth most common in the Northern Region and it is the fifth one in the Northeastern. To assess pathological and clinical variables of colorectal Cancer is crucial to know the possible conclusions for the survival of patients and point out the characteristics in the progress of tumor, such as the profile of tumor invasion and its angiogenesis. This work focuses on analyzing clinically and pathologically some settings in colorectal cancer patients (CRC) in the city of Natal and its countryside through those variables as parameters of prognosis and determine the level of protein expression, for instance: E-cadherin (E-cad), beta- -catenin (β-cat), galectin-3 (gal-3), matrix metalloproteinases (MMP) 2 and 9 and vascular-endothelial growth factor alpha (α VEGF) in the tumor tissues. A retrospective study was done in colorectal cancer cases in the regions of Rio Grande do Norte state from 1995 to 2005, specifically in Natal city/RN/Brazil. The pathological and clinical variables, such as: age, gender, ethnicity, lifestyle, family history, the location of the primary tumor, level of differentiation, TDM staging, modified Dukes’, treatment and survival were analyzed. The pathological and clinical data were collected from medical records through a specific form and were filed on Excel. A total of 534 patients were selected from the Pathology Department file in this institution, however, 176 patients were excluded. 358 patients were included for Epidemiological analysis and its clinical and pathological correlations were selected. 180 patients were also selected for histological and immunohistochemical studies. The tumor progression of these selected proteins mentioned before were analyzed. The Paraffin blocks of these samples were treated by Microarray Tissue technique and its blades subjected to immunohistochemistry to test the intensity of these proteins in tumor tissues. The results of this analysis were correlated with clinicopathologic variables of patients. Statistical analysis using the chi-frame Pearson test and analysis of midlife by Kaplan-Meier curve was also utilized. P values < 0.05 were considered statistically significant. The average age of our sample was 58.8 years and 51.7 % were female. Alcohol consumption has increased by 1.71 time the risk of death by CCR (p = 0.034) and tobacco consumption increased 2.7 times the chance of developing tumors of high TNM stage (p = 0.001). Cancer patients had a family history of 3,833 times the chance of developing the CCR (p = 0.002). The expression of MMP-2 showed a significant association with tumors of high TNM stage (p <0.046) and mortality (p = 0.041). The α VEGF expression had statistically significant correlation with high TNM stage (p <0.009), degree of cell indifferentiation (p <0.025) and mortality (p <0.035). Expressions of E-cadherin and beta-catetina demonstrated tumor linked to high TNM stage (p = 0.0001) and Dukes› modified (p = 0.05), lesions in the rectum (p = 0.03 and p = 0.007, respectively), smoking (p = 0.05) and indifferentiation (p = 0.001). The expression of Gal-3 showed statistical significance with high TNM stage of patients (p = 0.01), smokers (p = 0.01), alcohol drinking (p = 0.03), indifferentiation (p = 0.0001) and mortality (p = 0.0001). Based on the results, therefore, we could realize that lifestyle and family history had correlation in the CCR prognosis, as well as MMP-2 expression, MMP-9, VEGF alpha, E-cadherin, Beta-catenin and Galectin-3 were important prognostic markers in tumor progression in colorectal cancer.

Avaliação da imagem corporal de mulheres submetidas à cirurgia oncológica mamária

Breast cancer is the second type of cancer that affects more women of reproductive age in Brazil. Surgical treatments include: conserving surgery or mastectomy. Aimed to evaluate body image of women undergoing breast cancer surgery, based on the scale Body Image After Breast Cancer Questionnaire. It is a descriptive, exploratory, transversal, with a quantitative approach. Data were collected in Norte-riograndense League Against Cancer, between the months from March to May 2015, after consideration of the Research Ethics Committee of that institution CAEE 35155714.1.0000.5293. The study population consisted of women undergoing breast onco-surgery. To calculate the sample considered the finite population, totaling 120 subjects, collected four guys the most. Data were analyzed by the software Statistical Package for Social Sciences version 20.0. The domain scores of the scale were evaluated using descriptive and inferential statistics. The surgical group mastectomy without reconstruction showed greater impairment of body image in the field "vulnerability", "Care for the body" and "transparency" in relation to other surgical types, and suggests susceptibility to cancer, body appearance and worry that disturb other. The Kruskal-Wallis test showed greater dissatisfaction with body image in the fields "body Stigma" and "transparency" to the radical neoplastic surgery over other surgical types. Dissatisfaction with body image and physical appearance was detected in this study in all six image fields present in scale, with emphasis on the "body Stigma" and "Transparency". This means that the body image disorder is formulated based on the perception of others about themselves and not by perception "self", which justifies the concern with appearance, with body and hide the consequences stemmed cancer. It is expected that the data obtained from the evaluation of body image presented in this study contribute to enable the assistance to oncocirurgiada woman breast integral, essential for the practice of Nursing.

Avaliação da imagem corporal de mulheres submetidas à cirurgia oncológica mamária

Breast cancer is the second type of cancer that affects more women of reproductive age in Brazil. Surgical treatments include: conserving surgery or mastectomy. Aimed to evaluate body image of women undergoing breast cancer surgery, based on the scale Body Image After Breast Cancer Questionnaire. It is a descriptive, exploratory, transversal, with a quantitative approach. Data were collected in Norte-riograndense League Against Cancer, between the months from March to May 2015, after consideration of the Research Ethics Committee of that institution CAEE 35155714.1.0000.5293. The study population consisted of women undergoing breast onco-surgery. To calculate the sample considered the finite population, totaling 120 subjects, collected four guys the most. Data were analyzed by the software Statistical Package for Social Sciences version 20.0. The domain scores of the scale were evaluated using descriptive and inferential statistics. The surgical group mastectomy without reconstruction showed greater impairment of body image in the field "vulnerability", "Care for the body" and "transparency" in relation to other surgical types, and suggests susceptibility to cancer, body appearance and worry that disturb other. The Kruskal-Wallis test showed greater dissatisfaction with body image in the fields "body Stigma" and "transparency" to the radical neoplastic surgery over other surgical types. Dissatisfaction with body image and physical appearance was detected in this study in all six image fields present in scale, with emphasis on the "body Stigma" and "Transparency". This means that the body image disorder is formulated based on the perception of others about themselves and not by perception "self", which justifies the concern with appearance, with body and hide the consequences stemmed cancer. It is expected that the data obtained from the evaluation of body image presented in this study contribute to enable the assistance to oncocirurgiada woman breast integral, essential for the practice of Nursing.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Eficiência mastigatória e qualidade das próteses totais confeccionadas pelas técnicas tradicionais e simplificada: um ensaio clínico

Traditional methods for dentures fabrication require a wide clinical and laboratory procedures; however, there is no scientific evidence that these methods can produce better results when compared with simplified methods. Aim: To evaluate the effectiveness of a simplified methods for denture fabrication, comparing it to the traditional one through masticatory efficiency and prosthesis quality. Method: A randomized controlled trial was conducted with 50 patients, 25 rehabilitated with prosthesis produced by traditional technique and 25 rehabilitated by a simplified technique. The masticatory efficiency was evaluated by colorimetric method, using chewing capsules. The quality of prosthesis was obtained using a reliable and reproducible instrument. Statistical analysis of the masticatory efficiency and quality of the prosthesis was obtained by the Mann-Whitney test. Results: 39 patients completed the study, 18 on traditional group and 21 on simplified group. There was no difference between groups for the masticatory efficiency (p = 0.835) and the quality of the prosthesis (p = 0672). The evaluation of the overall quality of the prosthesis according to oral conditions, demonstrated significant difference on the height of the mandibular ridges (p = 0.010) and mandibular muscle attachments (p = 0.039). Conclusion: Complete dentures fabricated by simplified method were considered effective from the point of view of masticatory efficiency and quality of prosthetics, with results similar to those made by the traditional method.

Eficiência mastigatória e qualidade das próteses totais confeccionadas pelas técnicas tradicionais e simplificada: um ensaio clínico

Traditional methods for dentures fabrication require a wide clinical and laboratory procedures; however, there is no scientific evidence that these methods can produce better results when compared with simplified methods. Aim: To evaluate the effectiveness of a simplified methods for denture fabrication, comparing it to the traditional one through masticatory efficiency and prosthesis quality. Method: A randomized controlled trial was conducted with 50 patients, 25 rehabilitated with prosthesis produced by traditional technique and 25 rehabilitated by a simplified technique. The masticatory efficiency was evaluated by colorimetric method, using chewing capsules. The quality of prosthesis was obtained using a reliable and reproducible instrument. Statistical analysis of the masticatory efficiency and quality of the prosthesis was obtained by the Mann-Whitney test. Results: 39 patients completed the study, 18 on traditional group and 21 on simplified group. There was no difference between groups for the masticatory efficiency (p = 0.835) and the quality of the prosthesis (p = 0672). The evaluation of the overall quality of the prosthesis according to oral conditions, demonstrated significant difference on the height of the mandibular ridges (p = 0.010) and mandibular muscle attachments (p = 0.039). Conclusion: Complete dentures fabricated by simplified method were considered effective from the point of view of masticatory efficiency and quality of prosthetics, with results similar to those made by the traditional method.

Reorientação da formação em saúde: a contribuição do programa PET-Saúde

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Associação da depressão e distúrbio do sono em pacientes com e sem disfunção temporomandibular

Objective: To evaluate the inter-relationship between TMD (temporomandibular disorder), depression and sleep disorder. Methods: This is a case-control study with questionnaires in 111 patients, allocated from the Dentistry Department of UFRN, Natal, Brazil, from September 2014 to June 2015, for evaluation of depressive symptoms through the BDI (Beck Depression Inventory); sleep disorder, the PSQI (Pittsburgh Sleep Quality Index) and DTM through the RDC / TMD (diagnostic criteria to search for DTM). All indexes were applied by a single examiner previously trained and calibrated. The collected data were analyzed with chi-square tests of Pearson (χ2) and the unconditional logistic regression. Results: women had a risk of 2.85 times more likely to develop TMD (p = 0.046). The OR (odds ratio) shows that sleep disturbance increases by 2.19 the chances of having TMD (p = 0.062) and depressive symptoms increase the risk by 3.16 times in developing dysfunction (p = 0.053). Conclusion: The data of this research allows us to conclude that patients with TMD, in this population, were more likely to develop changes in sleep and depressive symptoms.

Resposta clínica periodontal e controle glicêmico em pacientes com e sem diabetes tipo II portadores de periodontite crônica ao tratamento periodontal “full mouth desinfection”

There is a bidirectional association between periodontal disease (PD) and diabetes mellitus, in which diabetes favors the development of PD and PD, if left untreated, can worsen the metabolic control of diabetes. Thus, periodontal disease should be treated to restore periodontal health and reduce the complications of diabetes. Therefore, the objective is assess the effect of full mouth periodontal therapy decontamination (Full Mouth Desinfection - FMD) in diabetic type II patients with chronic periodontitis during 12 months. Thirty-one patients in group one (G1) and 12 in group two (G2) were followed at baseline, 03, 06 09 and 12 months. There following clinical parameters were accessed: probing on bleeding (BOP), visible plaque index (PI), probing depth (PD), clinical attachment level (CAL) and gingival recession (GR). For diabetic patients, there were also made laboratory tests to evaluate blood parameters: fasting glucose and glycated hemoglobin. The results had been analyzed in two ways: all sites in the mouth and another with diseased sites. The Mann-Whitney, Friedman and Wilcoxon tests were used with 5% significance. Intergroup analysis of all sites it is clear that there was no significant difference over time concerning PD, BOP, PI, CAL and RG. However, when evaluating the diseased sites, we observed significant difference for CAL and PD, with higher values in G1. The intragroup analysis for all sites showed a statistically significant reduction at PD, PI and BOP in both groups. Intragroup analysis of periodontal affected sites showed a statistically significant reduction in PD, BOP and CAL in both groups. There was also a statistically significant increase in RG values. There was no significant change concerning glycated hemoglobin and fasting glucose in the G1. Therefore, it can be concluded that there were improvements in periodontal parameters over the 12 months of research, but without changes in glycemic levels of diabetic patients. Thus, periodontal therapy proved effective in maintaining oral health.

Avaliação clínica e da qualidade de vida utilizando dois protocolos para recuperação miofuncional em pacientes que se submeteram à cirurgia ortognática: resultados preliminares

The objective of this randomized, blind and prospective clinical trial was to compare the pain, the edema, the mandibular movements, the masticatory efficiency and life quality, in the first 60 days after surgery using 2 different clinical protocols for myofunctional recovery, in patients who underwent orthognathic surgery. A sample of 19 patients was used and divided into 2 groups. The control group (CG) consisted of 10 patients who had postoperative rehabilitation guided by a standard protocol, conducted by the Service of Surgery and Traumatology Oral and Maxillofacial. In other hand, the experimental group (EC) totaled 9 patients who received the speech therapy rehabilitation protocol specialized, by professionals in the area. The variables pain, edema and mandibular movements were analyzed during 48h, 96h, 7 days, 14 days, 30 and 60 days post-surgery. The masticatory efficiency and the quality of life were classified with 60 days after surgery . The data were submitted an analysis of variance, Student's t-test and Fisher's independence, at the level of 5% probability. It was identified that patients of GE have benefited in the first 14 days(p<0,001), as they have had reported less pain than those in the CG. Significant statistics differences between groups for pain parameters (after 14 days) (p=0,065), edema(p=0,063), mandibular movements(p=0,068), masticatory efficiency(p=0,630) and the impact on quality of life (p=0,813) were not observed on this study. The speech therapy protocol for myofunctional recovery (EG), although it has not obtained statistical results superiors than the CG in the general context, presents itself as a viable alternative to conventional therapy assumed by many maxillofacial surgeons, allowing the surgeon to optimize time with patients in the period postoperatively.

Modelos matemáticos para estimativa do consumo máximo de oxigênio pela ventilometria de esforço em indivíduos saudáveis

The relation between metabolic demand and maximal oxygen consumption during exercise have been investigated in different areas of knowledge. In the health field, the determination of maximal oxygen consumption (VO2max) is considered a method to classify the level of physical fitness or the risk of cardiocirculatory diseases. The accuracy to obtain data provides a better evaluation of functional responses and allows a reduction in the error margin at the moment of risk classification, as well as, at the moment of determination of aerobic exercise work load. In Brasil, the use of respirometry associated to ergometric test became an opition in the cardiorespiratory evaluation. This equipment allows predictions concerning the oxyredutase process, making it possible to identify physiological responses to physical effort as the respiratory threshold. This thesis focused in the development of mathematical models developed by multiple regression validated by the stepwise method, aiming to predict the VO2max based on respiratory responses to physical effort. The sample was composed of a ramdom sample of 181 healthy individuals, men and women, that were randomized to two groups: regression group and cross validation group (GV). The voluntiars were submitted to a incremental treadmill test; objetiving to determinate of the second respiratory threshold (LVII) and the Peak VO2max. Using the método forward addition method 11 models of VO2max prediction in trendmill were developded. No significative differences were found between the VO2max meansured and the predicted by models when they were compared using ANOVA One-Way and the Post Hoc test of Turkey. We concluded that the developed mathematical models allow a prediction of the VO2max of healthy young individuals based on the LVII

Avaliação da efetividade de estratégias não farmacológicas para o alívio da dor de parturientes na fase ativa do período de dilatação no trabalho de parto

This study was aim to evaluate the effectiveness of strategies non pharmacological for the relief of the intensity of the parturient pain in the phase activates of the dilation period in the labor. Is a clinic rehearse of the type therapeutic intervention before and after" with a quantitative approach, accomplished in the Humanized Unit of Childbirth of the Maternity Januário Cicco School of the Federal University of Rio Grande do Norte, in Natal/RN, whit 130 parturient, being 30 in the pre-test of the strategies and 100 in the application of the strategies non pharmacological combined (breathing exercises, muscular relaxation and lombossacral massage) and isolated (shower bath in a normal temperature). We used the visual analogical scale to evaluate the intensity of the pain of the study parturient before and after" to the application of the strategies in the phases of acceleration, maximum inclination and desaceleration in the phase activates of dilation period in the labor. The principal results showed that the majority of the study parturient was between 20 to 30 years old (60%); with incomplete fundamental teaching (85%); family income until 2 minimum wages (74%); 78% had a companion and these, 44% were the own husband. The oxytocin was administered in the parturient during the phase activates of the labor in 81% of the cases and only 15% these women didn´t reciev anything medication. We verified significant relief (ρ=0.000) of intensity of the pain of the study parturient after application of the strategies non pharmacological combined and isolated. We concluded that the strategies non pharmacological combined and isolated were effective in the relief of the pain of the study parturient in the phase activates de labor

Estudos analíticos dos grafoelementos do eletroencefalograma em sono: fusos do sono, ondas agudas do vértex e o gradiente de freqüência e amplitude, como indicadores de comprometimento neurológico na criança

Innumerable studies have focused been reported on the sleep spindles (SS), Sharp Vertex Waves (SVW) and REM, NREM Sleep as indicators interpreting EEG patterns in children. However, Frequency and Amplitud Gradient (FAG) is rarely cited sleep parameter in children,that occurs during NREM Sleep. It was first described by Slater and Torres, in 1979, but has not been routinely evaluated in EEG reports. The aim of this study was to assess the absence of SS, SVW and FAG, as an indication of neurological compromise in children. The sample consisted of 1014 EEGs of children referred to the Clinical Neurophysiology Laboratory, Hospital Universitário de Brasília (HUB), from January 1997 to March 2003, with ages ranging from 3 months to 12 years old, obtained in spontaneous sleep or induced by choral hydrate. The study was transversal and analytical, in which, visual analysis of EEG traces was perfumed individually and independently by two electroencephalographers without prior knowledge of the EEG study or neurological findings. After EEG selection, the investigators analyzed the medical reports in order to define and correlate neurological pattern was classified according to the presence or absence of neurological compromise, as Normal Neurological Pattern (NNP), and Altered Neurological Pattern (ANP) respectively. From the visual analysis of the EEG(s), it was possible to characterize 6 parameters: 1- FAG present (64,1%); 2- FAG absent (35,9%); 3 - normal SS (87,9%); 4 - altered SS s (12,1%); 5 - normal SVW s (95,7%); 6 - altered SVW s (4,3%). The prevalence of well-formed FAG is found in the 3 months to 5 years age group in the children with NNF. FAG was totally absent from the age of 10 years. When comparing the three sleep graphielements, it was observed that SVW and SS were predominant in children with NNF. However, FAG absent was more prevalent in the ANF than in altered SS an SVW. The statistical analysis showed that there is a strong association of FAG absent, with isolated alteration, in ANF patients, in that the prevalence ratio was 6,60. The association becomes stronger when FAG absent + altered SS(s) is considered (RP= 6,68). Chi-square test, corrected by Yates technique, showed a highly significant relation for FAG ρ= 0,00000001, for error X of 5%, or else the 95% confidence interval (ρ<0,05). Thus, the FAG absent were more expressive in ANF patient than altered SS(s) and SVW(s). The association becomes stronger in order to establish a prognostic relation, when the FAG is combined with the SS. The results os this study allow us to affirm that the FAG, when absent at ages ranging from 3 months to 5 years , is an indication of neurological compromise. FAG is an age-dependent EEG parameter and incorporated systematically, in the interpretation criteria of the EEG of children s sleep, not only in the maturational point of view, but also neurological disturbances with encephalic compromise

Antígenos da forma amastigota de Leishmania chagasi identificados por dupla varredura da biblioteca de cDNA

Control of human visceral leishmaniasis in endemic regions is hampered in part by the lack of knowledge with respect of the role reservoirs and vector. In addition, there is not yet an understanding of how non-symptomatic subclinical infection might influence the maintenance of infection in a particular locality. Of worrisome is the limited accessibility to medical care in places with emerging drug resistance. There is still no available protective vaccine either for humans or other reservoirs. Leishmania species are protozoa that express multiple antigens which are recognized by the vertebrate immune system. Since there is not one immunodominant epitope recognized by most hosts, strategies must be developed to optimize selection of antigens for prevention and immunodiagnosis. For this reason, we generated a cDNA library from the intracellular amastigote form of Leishmania chagasi, the causative agent of South American visceral leishmaniasis. We employed a two-step expression screen of the library to systematically identify T and T-dependent B cell antigens. The first step was aimed at identifying the largest possible number of clones producing an epitope-containing polypeptide with a pool of sera from Brazilians with documented visceral leishmaniasis. After removal of clones encoding heat shock proteins, positive clones underwent a second step screen for their ability to cause proliferation and IFN-γ responses of T cells from immune mice. Six unique clones were selected from the second screen for further analysis. The clones encoded part of the coding sequence of glutamine synthetase, transitional endoplasmic reticulum ATPase, elongation factor 1γ, kinesin K-39, repetitive protein A2, and a hypothetical conserved protein. Humans naturally infected with L. chagasi mounted both cellular and antibody responses to these protein Preparations containing multiple antigens may be optimal for immunodiagnosis and protective vaccines against Leishmania