Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World

Comorbidity from tegumentary leishmaniasis and AIDS is poorly characterized. To describe a series of patients coinfected with Leishmania and human immunodeficiency virus (HIV). Clinical records from patients were analysed by demographic data, clinical manifestations, diagnoses, treatments and outcomes. Fifteen cases of AIDS/tegumentary leishmaniasis were found. The diagnosis of leishmaniasis was confirmed by the detection of Leishmania amastigotes or antigens from the cutaneous or mucosal lesions. The mean CD4+ T-cell count was 84 cells mm(-3) (range 8-258) and all patients were classified as having AIDS according to the Centers for Disease Control and Prevention. A wide range of manifestations was found, varying from a single ulcer to multiple and polymorphic lesions. Mucosal lesions were present in 80% and cutaneous lesions in 73% of patients (53% with mucocutaneous form), disseminated lesions in 60% and genital lesions in 27% of patients. All patients received anti-Leishmania therapy and 53% showed relapses. Sixty-seven per cent received highly active antiretroviral therapy but showed no difference in outcomes and relapses compared with those not using medication. Forty per cent died during the study period. In these patients, the anti-Leishmania antibody and Montenegro skin test were useful in the diagnosis of leishmaniasis, probably because leishmaniasis preceded immunosuppression due to HIV infection. Clinical manifestations of tegumentary leishmaniasis in HIV-infected patients are diverse. Our data emphasize possible unusual manifestations of this disease in HIV-infected patients, particularly in severely immunosuppressed cases (< 200 CD4+ cells mm(-3)).

Distinct resistance mutation and polymorphism acquisition in HIV-1 protease of subtypes B and F1 from children and adult patients under virological failure

The goal of this work was to compare the differences between human immunodeficiency Virus type 1 (HIV-1) of B and F1 Subtypes in the acquisition of major and rninot- protease inhibitor (P1)-associated resistance mutations and of other polymorphisms at the protease (PR) gene, through a cross sectional Study. PR sequences from subtypes B and F1 isolates matched according to P1 exposure time from Brazilian patients were included in this study. Sequences were separated in four groups: 24 and 90 from children and 141 and 99 from adults infected with isolates of subtypes F1 and B, respectively. For comparison, 211 subype B and 79 subtype F1 PR sequences from drug-naive individuals Were included. Demographic and clinical data were similar among B- and F1-infected patients. In untreated patients, Mutations L1OV, K20R, and M361 were more frequent in subtype F1, while L63P, A7IT, and V771 were more prevalent in Subtype B. In treated patients, K20M, D30N, G73S, 184V, and L90M, were More prevalent in subtype B, and K20T and N88S Were more prevalent in Subtype F1. A higher proportion of subtype F1 than Of subtype B Strains Containing other polymorphisms was observed. V82L mutation was Present With increased frequency in isolates from children compared to isolates from adults infected with both subtypes. We could observe a faster resistance emergence in children than in adults, during treatment with protease inhibitors. This data provided evidence that, although rates of overall drug resistance do not differ between subtypes B and F1, the former accumulates resistance at higher proportion in specific amino acid positions of protease when compared to the latter. (c) 2008 Elsevier B.V. All rights reserved.

Mucosal and systemic anti-GAG immunity induced by neonatal immunization with HIV LAMP/gag DNA vaccine in mice

Vaccines capable of inducing mucosal immunity in early postnatal life until adulthood, protecting early sexual initiation, should be considered as strategies to vaccination against HIV. The HIV-1 GAG protein as a chimera with the lysosome-associated membrane protein (LAMP/gag), encoded by a DNA vaccine, is targeted to the endosomal/lysosomal compartment that contains class II MHC molecules and has been shown to be immunogenic in adult mice. Assuming that one such strategy could help to overcome the immunological immaturity in the early postnatal period, we have evaluated the systemic and mucosal immunogenicity of LAMP/gag immunization in neonatal mice. Intranasal immunization with LAMP/gag vaccine induced higher levels of sIgA and IgG anti-GAG antibodies in intestinal washes than did the gag vaccine. The combination of ID injections and the IN protocol with the chimeric vaccine promoted the increase of Ab levels in sera. Both vaccines induced splenic IFN-gamma- secreting cells against GAG peptide pools, as well as in vivo cytotoxic T lymphocyte (CTL) function, and increased the percentage of CD8+ T cells to the immunodominant class I peptide in gut and spleen. However, only the chimeric vaccine was able to enhance Th1/Th2 cytokine secretion in response to class II GAG peptide and to enhance IL-4-secreting cells against GAG peptides and p24 protein stimuli. Long-lasting humoral and cellular responses were detected until adult age, following neonatal immunization with the chimeric vaccine. The LAMP/gag vaccination was able to induce potent GAG-specific T and B cell immune responses in early life which are essential to elicit sustained and long-lasting mucosal and systemic humoral response. (C) 2010 Elsevier GmbH. All rights reserved.

A subunit vaccine based on biodegradable microspheres carrying rHsp65 protein and KLK protects BALB/c mice against tuberculosis infection

Of the hundreds of new tuberculosis ( TB) vaccine candidates some have therapeutic value in addition to their prophylactic properties. This is the case for the DNA vaccine encoding heat-shock protein 65 (DNAhsp65) from Mycobacterium leprae. However, there are concerns about the use of DNA vaccines in certain populations such as newborns and pregnant women. Thus, the optimization of vaccination strategies that circumvent this limitation is a priority. This study evaluated the efficacy of a single dose subunit vaccine based on recombinant Hsp65 protein against infection with M. tuberculosis H37Rv. The Hsp65 protein in this study was either associated or not with immunostimulants, and was encapsulated in biodegradable PLGA microspheres. Our results demonstrate that the protein was entrapped in microspheres of adequate diameter to be engulfed by phagocytes. Mice vaccinated with a single dose of Hsp65-microspheres or Hsp65 + CpG-microspheres developed both humoral and cellular-specific immune responses. However, they did not protect mice against challenge with M. tuberculosis. By contrast, Hsp65+KLK-microspheres induced specific immune responses that reduced bacilli loads and minimized lung parenchyma damage. These data suggest that a subunit vaccine based on recombinant protein Hsp65 is feasible.

Sistema de Controle log??stico de Medicamentos Antirretrovirais (SICLOM)

O Sistema de Controle Log??stico de Medicamentos Antirretrovirais (Siclom) ?? uma ferramenta criada com o objetivo de gerenciamento log??stico dos medicamentos antirretrovirais (ARV) e de aprimoramento da qualifica????o da dispensa????o. Esse sistema permite que o departamento de DST, Aids e Hepatites Virais, secretarias estaduais e municipais de Sa??de mantenham-se atualizados em rela????o ao fornecimento, dispensa????o de medicamentos aos pacientes em tratamento conforme as recomenda????es existentes no Consenso Terap??utico Brasileiro, al??m do controle dos estoques de cada medicamento nas v??rias regi??es do pa??s. As informa????es de consumo e estoques s??o fundamentais para que o adequado suprimento aos estados ocorra evitando, assim, a ruptura dos estoques locais e preju??zo no atendimento aos pacientes. Atualmente utilizam o sistema 670 unidades dispensadoras de medicamentos, distribu??das em todo o Brasil; 27 coordena????es estaduais de DST/Aids; 61 almoxarifados; e 936 maternidades

Texto para discuss??o 19: forma????o e capacita????o na constru????o de um novo Estado

Esse ensaio procura tra??ar os contornos desse novo Estado, os perfis dos agentes necess??rios ao seu funcionamento e as formas poss??veis para sua capacita????o. Ao final, faz-se uma avalia????o dos processos de mudan??a que come??am a ocorrer nas organiza????es p??blicas brasileiras, em que se evidencia o grande potencial que nelas existe para seu pr??prio desenvolvimento

Sistema de educa????o a dist??ncia: cursos de treinamento para profissionais de laborat??rio (Telelab)

O Sistema de Educa????o a Dist??ncia ??? Telelab tem o prop??sito de planejar, produzir, implantar e avaliar treinamentos, em uma abordagem que favorecesse o repensar da pr??tica dos profissionais da ??rea de sa??de envolvidos com diagn??stico laboratorial das Doen??as Sexualmente Transmiss??veis (DST), da infec????o pelo HIV e das doen??as oportunistas associadas ?? aids

Reflex??es sobre a emerg??ncia da participa????o social na agenda das pol??ticas p??blicas: desafios ?? forma de organiza????o burocr??tica do Estado

No Brasil, a Constitui????o de 1988 institucionalizou a participa????o social em conselhos a serem compostos por representantes de diferentes setores da sociedade, do Estado e, em alguns casos, dos trabalhadores. A partir dos anos 2000, a realiza????o de confer??ncias passou a ser disseminada como mais uma forma de participa????o, que auxilia no mapeamento das demandas e na constru????o de consensos entre os movimentos sociais nos momentos que antecedem a formula????o de pol??ticas pelo poder executivo. Seja qual for a forma de participa????o social institucionalizada, regras e procedimentos regulamentados pelo Estado regem as intera????es com a Sociedade. Esse ensaio se dedica a problematizar a efetividade dos espa??os e mecanismos do ponto de vista do processamento de pol??ticas p??blicas dentro do aparato burocr??tico a partir de conceitos derivados das teorias de complexidade, participa????o e burocracia com a inten????o de contribuir para o debate sobre o aperfei??oamento desse campo

Gest??o ativa transparente

O presente ensaio apresenta um cen??rio da evolu????o do acesso ?? informa????o no Brasil tendo como objetivo identificar, nesse processo, os pontos de inflex??o no relacionamento de Estado com a sociedade.

Dilemas contempor??neos das pol??ticas p??blicas

O presente ensaio trata de temas identificados como dilemas de pol??ticas p??blicas: a transversalidade e o compartilhamento da gest??o das pol??ticas de prote????o do meio ambiente. O objeto espec??fico de an??lise deste texto situa-se na incorpora????o da vari??vel ambiental nas pol??ticas setoriais para o avan??o do desenvolvimento sustent??vel.

Pol??ticas sociais: focaliza????o versus universaliza????o

Neste ensaio, pretende-se analisar brevemente o importante dilema atual das pol??ticas p??blicas referente ?? redu????o das desigualdades e ?? promo????o do desenvolvimento: a dicotomia ???focaliza????o??? versus ???universaliza????o???.

SUS: avan??os e obst??culos no processo de descentraliza????o e coordena????o intergovernamental

Este ensaio pretende realizar uma breve an??lise do Sistema ??nico de Sa??de (SUS) e explicar como a pol??tica setorial de sa??de, no Brasil, enfrenta o desafio de coordena????o nas rela????es intergovernamentais, produzindo o redesenho das compet??ncias e atribui????es entre as esferas de governo nessa ??rea.

A pol??tica social que queremos: um embate entre universalismo e focaliza????o

A id??ia de que crescimento econ??mico por si s?? ?? necess??rio, mas n??o suficiente para o desenvolvimento ?? quest??o j?? bastante discutida e acertada no Brasil. Desenvolvimento implica crescimento econ??mico, como tamb??m mudan??as de estrutura n??o apenas no ??mbito econ??mico e produtivo, mas tamb??m no social. ?? nesse contexto que se torna clara a import??ncia da pol??tica social na redu????o das desigualdades e na promo????o do desenvolvimento social do pa??s. Fortemente presente na agenda do atual governo, a quest??o que se coloca para os gestores de pol??ticas p??blicas hoje ??: Qual pol??tica social desejamos? Trata-se de pergunta abrangente que envolve escolhas institucionais, a partir das quais as estruturas de incentivos s??o criadas e condicionam todo o processo de formula????o, implementa????o e avalia????o de pol??ticas.

Interesse, ??tica e pol??tica no servi??o p??blico

J?? faz algumas d??cadas que a Ci??ncia Pol??tica vem transpondo para seu campo de investiga????o o paradigma do homo oeconomicus ??? a psicologia egoc??ntrica utilizada pela teoria econ??mica convencional para dar conta das intera????es sociais no mercado. ???Seu campo de investiga????o???, isto ??, o comportamento de atores coletivos, como os partidos, os sindicatos e os gabinetes governamentais, ou de atores individuais, como as lideran??as partid??rias, os parlamentares, os eleitores, etc. Para o assunto que nos interessa aqui, houve grande impacto, no debate posterior, o uso que se fez do paradigma econ??mico para entender certos problemas da administra????o p??blica e da a????o coletiva.

Cidadania e civiliza????o tecnol??gica: a mudan??a de quadros conceptuais em forma????o e educa????o

O modelo conceptual e pr??tico com que, durante s??culos, a nossa civiliza????o se regeu era insepar??vel da distin????o entre ???ci??ncia??? e ???t??cnica???. O momento em que nos encontramos, momento em que, por um lado, ???ci??ncia??? e ???t??cnica??? vieram a constituir uma unidade indissol??vel e em que, por outro lado (que ??, talvez, apenas um outro aspecto do mesmo acontecimento), tal unidade fez com que a civiliza????o deixasse de ser ???nossa??? e se tornasse global, obriga necessariamente a repensar os t??poi da ???ci??ncia??? e da ???t??cnica??? e da nossa rela????o com elas. Ci??ncia e t??cnica, com os seus pap??is diferentes, tinham tamb??m ???tempos??? diferentes. Ali??s, e porque se trata de repensar os t??poi da ci??ncia e da t??cnica, ?? preciso ter em conta que o t??pos n??o ??, em grego cl??ssico, um conceito meramente espacial, mas sim um conceito ???eco-l??gico???. O t??pos de uma coisa ?? o seu ???lugar??? de implanta????o na exist??ncia, isto ??, num espa??o/tempo do todo do mundo. O t??pos ?? um conceito ???eco-l??gico???, porque assinala que o logos de uma coisa, a sua raz??o de ser, coloca-a num ???lugar??? espa??o/temporal que lhe ?? pr??prio, a sua ???casa-no-mundo??? (oikos).