965 resultados para Plaque Variants


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OBJECTIVE: To determine the prevalence of fibroblast growth factor receptor 1 (FGFR1) mutations and their predicted functional consequences in patients with idiopathic hypogonadotropic hypogonadism (IHH). DESIGN: Cross-sectional study. SETTING: Multicentric. PATIENT(S): Fifty unrelated patients with IHH (21 with Kallmann syndrome and 29 with normosmic IHH). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patients were screened for mutations in FGFR1. The functional consequences of mutations were predicted by in silico structural and conservation analysis. RESULT(S): Heterozygous FGFR1 mutations were identified in six (12%) kindreds. These consisted of frameshift mutations (p.Pro33-Alafs*17 and p.Tyr654*) and missense mutations in the signal peptide (p.Trp4Cys), in the D1 extracellular domain (p.Ser96Cys) and in the cytoplasmic tyrosine kinase domain (p.Met719Val). A missense mutation was identified in the alternatively spliced exon 8A (p.Ala353Thr) that exclusively affects the D3 extracellular domain of FGFR1 isoform IIIb. Structure-based and sequence-based prediction methods and the absence of these variants in 200 normal controls were all consistent with a critical role for the mutations in the activity of the receptor. Oligogenic inheritance (FGFR1/CHD7/PROKR2) was found in one patient. CONCLUSION(S): Two FGFR1 isoforms, IIIb and IIIc, result from alternative splicing of exons 8A and 8B, respectively. Loss-of-function of isoform IIIc is a cause of IHH, whereas isoform IIIb is thought to be redundant. Ours is the first report of normosmic IHH associated with a mutation in the alternatively spliced exon 8A and suggests that this disorder can be caused by defects in either of the two alternatively spliced FGFR1 isoforms.

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OBJECTIVE: To assess the spectrum and prevalence of mutations in the GJB2 gene in Portuguese nonsyndromic sensorineural hearing loss (NSSHL) patients. DESIGN: Sequencing of the coding region, basal promoter, exon 1, and donor splice site of the GJB2 gene; screening for the presence of the two common GJB6 deletions. STUDY SAMPLE: A cohort of 264 Portuguese NSSHL patients. RESULTS: At least one out of 21 different GJB2 variants was identified in 80 (30.2%) of the 264 patients analysed. Two mutant alleles were found in 53 (20%) of these probands, of which 83% (44/53) harboured at least one c.35delG allele. Twenty-seven (10.2%) of the probands harboured only one mutant allele. Subsequent analysis revealed that the GJB6 deletion del(GJB6-D13S1854) was present in at least 7.4% (2/27) of the patients carrying only one mutant GJB2 allele. Overall, one in five (55/264) of the patients were diagnosed as having DFNB1-related NSSHL, of which the vast majority (53/55) harboured only GJB2 mutations. CONCLUSIONS: This study provides clear demonstration that mutations in the GJB2 gene are an important cause of NSSHL in Portugal, thus representing a valuable indicator as regards therapeutical and rehabilitation options, as well as genetic counseling of these patients and their families.

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Urofacial syndrome (UFS) is an autosomal recessive congenital disease featuring grimacing and incomplete bladder emptying. Mutations of HPSE2, encoding heparanase 2, a heparanase 1 inhibitor, occur in UFS, but knowledge about the HPSE2 mutation spectrum is limited. Here, seven UFS kindreds with HPSE2 mutations are presented, including one with deleted asparagine 254, suggesting a role for this amino acid, which is conserved in vertebrate orthologs. HPSE2 mutations were absent in 23 non-neurogenic neurogenic bladder probands and, of 439 families with nonsyndromic vesicoureteric reflux, only one carried a putative pathogenic HPSE2 variant. Homozygous Hpse2 mutant mouse bladders contained urine more often than did wild-type organs, phenocopying human UFS. Pelvic ganglia neural cell bodies contained heparanase 1, heparanase 2, and leucine-rich repeats and immunoglobulin-like domains-2 (LRIG2), which is mutated in certain UFS families. In conclusion, heparanase 2 is an autonomic neural protein implicated in bladder emptying, but HPSE2 variants are uncommon in urinary diseases resembling UFS.

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Dissertação apresentada para obtenção do Grau de Doutor em Biologia, na especialidade de Genética Molecular, pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

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The clinical records of 182 patients with cutaneous leishmaniasis probably due to Leishmania braziliensis braziliensis are analysed. 68% had a single lesion which was usually an ulceron the lower anterior tibial third. Many had short histories of one to two months and all age groups were represented 13% had closed lesions of a verrucose or plaque like nature. Evolution of these skin lesions after treatment was related to the regularity of antimony therapy. Although healing usually occurred in three months, the time to scarring after commencing treatment was variable and related to the size ofthe lesion (p < 0.01). Usually if sufficient antimony treatment was given the lesion closed. Seven of the ten patients with initially negative leishmanin skin tests converted to positive after treatment. A significant decline of indirect fluorescent antibody titres occurred in patients followed, during and after therapy.

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Immunological tolerance, that is, the failure to mount an immune response to an otherwise immunogenic molecule, is one of the fundamental questions in immunology. The fact that lymphocytes express antigen receptors that are generated randomly and have the potential to recognize any conceivable antigen, adds another puzzle to the physiology of immunological tolerance. The other side of the coin, the general absence of immune responses to self antigens, is ensured by a tight regulation and several selection steps during T and B cell differentiation. One of these processes is the differentiation of regulatory T cells (Treg). While developing in the thymus, T cell clones bearing receptors with high affinity/avidity to antigens present at the time of differentiation may be eliminated by apoptosis or, alternatively, express Foxp3 and become Treg. Treg are key players in the regulation of immunological tolerance since humans and mice with complete loss of function variants of this gene develop fatal autoimmune conditions early in life.(...)

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Dissertação apresentada para obtenção do Grau de Mestre em Engenharia Electrotécnica e de Computadores, pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

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This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients’ benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients’ benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favors more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems.

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In August/1999, a group of 14 adults from the staff of a private hospital in Contagem -- Minas Gerais State, Brazil, received unintentionally a 25 times concentrated dose of the 17-DD yellow fever vaccine (Bio-Manguinhos), due to a mistake at the reconstitution step. All patients were clinically and laboratorially evaluated at days 5, 13 and 35 post vaccination. Frequency of side effects and clinical observations of this group of individuals were not different from the observed in recipients immunized with normal doses of the vaccine. At the second and third evaluation none of the subjects reported symptoms. None of the patients presented abnormalities at the physical examination at none of the time points and in all cases the blood examination was normal, except for a reduced number of platelets that was detected in one subject at the first and second evaluation and reverted to normal at third evaluation. At the first evaluation point, 8 subjects were serum negative and 6 serum positive for yellow fever at the plaque reduction neutralization test. In 5 subjects the observed titre was 10 times higher as the baseline of 2.36 Log10 mUI/ml. The samples collected at second and third evaluation (13th and 35th days) demonstrated that all subjects responded to the vaccination with the exception of one that did not present a positive result in any of the samples collected. This evaluation confirms the safety of the 17-DD yellow fever vaccine.

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Dissertation presented to obtain the Ph.D degree in Systems Biology

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RESUMO: Apesar de toda a evolução farmacológica e de meios complementares de diagnóstico possível nos últimos anos, o enfarte agudo do miocárdio e a morte súbita continuam a ser a primeira manifestação da aterosclerose coronária para muitos doentes, que estavam previamente assintomáticos. Os exames complementares de diagnóstico tradicionalmente usados para avaliar a presença de doença coronária, baseiam‐se na documentação de isquémia do miocárdio e por este motivo a sua positividade depende da presença de lesões coronárias obstrutivas. As lesões coronárias não obstrutivas estão também frequentemente implicadas no desenvolvimento de eventos coronários. Apesar de o risco absoluto de instabilização por placa ser superior para as lesões mais volumosas e obstrutivas, estas são menos prevalentes do que as placas não obstrutivas e assim, por questões probabilísticas, os eventos coronários resultam com frequência da rotura ou erosão destas últimas. Estudos recentes de imagiologia intracoronária avançada forneceram evidência de que apesar de ser possível identificar algumas características de vulnerabilidade em placas associadas ao desenvolvimento subsequente de eventos coronários, a sua sensibilidade e especificidade é muito baixa para aplicação clínica. Mais do que o risco associado a uma placa em particular, para o doente poderá ser mais importante o risco global da sua árvore coronária reflexo da soma das probabilidade de todas as suas lesões, sendo que quanto maior for a carga aterosclerótica maior será o seu risco. A angio TC cardíaca é a mais recente técnica de imagem não invasiva para o estudo da doença coronária e surgiu nos últimos anos fruto de importantes avanços na tecnologia de TC multidetectores. Estes avanços, permitiram uma progressiva melhoria da resolução espacial e temporal, contribuindo para a melhoria da qualidade dos exames, bem como uma significativa redução da dose de radiação. A par desta evolução tecnológica, foi aumentando a experiência e gerada mais evidência científica, tornando a angio TC cardíaca cada vez mais robusta na avaliação da doença coronária e aumentando a sua aplicabilidade clínica. Mais recentemente apareceram vários trabalhos que validaram o seu valor prognóstico, assinalando a sua chegada à idade adulta. Para além de permitir excluir a presença de doença coronária e de identificar a presença de estenoses significativas, a angio TC cardíaca permite identificar a presença de lesões coronárias não obstrutivas, característica impar desta técnica como modalidade de imagem não invasiva. Ao permitir identificar a totalidade das lesões ateroscleróticas (obstrutivas e não obstrutivas), a 18 angio TC cardíaca poderá fornecer uma quantificação da carga aterosclerótica coronária total, podendo essa identificação ser útil na estratificação dos indivíduos em risco de eventos coronários. Neste trabalho foi possível identificar preditores demográficos e clínicos de uma elevada carga aterosclerótica coronária documentada pela angioTC cardíaca, embora o seu poder discriminativo tenha sido relativamente modesto, mesmo quando agrupados em scores clínicos. Entre os vários scores, o desempenho foi um pouco melhor para o score de risco cardiovascular Heartscore. Estas limitações espelham a dificuldade de prever apenas com base em variáveis clínicas, mesmo quando agrupadas em scores, a presença e extensão da doença coronária. Um dos factores de risco clássicos, a obesidade, parece ter uma relação paradoxal com a carga aterosclerótica, o que pode justificar algumas limitações da estimativa com base em scores clínicos. A diabetes mellitus, por outro lado, foi um dos preditores clínicos mais importantes, funcionando como modelo de doença coronária mais avançada, útil para avaliar o desempenho dos diferentes índices de carga aterosclerótica. Dada a elevada prevalência de placas ateroscleróticas identificáveis por angio TC na árvore coronária, torna-‐se importante desenvolver ferramentas que permitam quantificar a carga aterosclerótica e assim identificar os indivíduos que poderão eventualmente beneficiar de medidas de prevenção mais intensivas. Com este objectivo, foi desenvolvido um índice de carga aterosclerótica que reúne a informação global acerca da localização, do grau de estenose e do tipo de placa, obtida pela angio TC cardíaca, o CT--‐LeSc. Este score poderá vir a ser uma ferramenta útil para quantificação da carga aterosclerótica coronária, sendo de esperar que possa traduzir a informação prognóstica da angio TC cardíaca. Por fim, o conceito de árvore coronária vulnerável poderá ser mais importante do que o da placa vulnerável e a sua identificação pela angio TC cardíaca poderá ser importante numa estratégia de prevenção mais avançada. Esta poderá permitir personalizar as medidas de prevenção primária, doseando melhor a sua intensidade em função da carga aterosclerótica, podendo esta vir a constituir uma das mais importantes indicações da angio TC cardíaca no futuro.---------------- ABSTRACT Despite the significant advances made possible in recent years in the field of pharmacology and diagnostic tests, acute yocardial infarction and sudden cardiac death remain the first manifestation of coronary atherosclerosis in a significant proportion of patients, as many were previously asymptomatic. Traditionally, the diagnostic exams employed for the evaluation of possible coronary artery disease are based on the documentation of myocardial ischemia and, in this way, they are linked to the presence of obstructive coronary stenosis. Nonobstructive coronary lesions are also frequently involved in the development of coronary events. Although the absolute risk of becoming unstable per plaque is higher for more obstructive and higher burden plaques, these are much less frequent than nonobstructive lesions and therefore, in terms of probability for the patient, coronary events are often the result of rupture or erosion of the latter ones. Recent advanced intracoronary imaging studies provided evidence that although it is possible to identify some features of vulnerability in plaques associated with subsequente development of coronary events, the sensitivity and sensibility are very limited for clinical application. More important than the individual risk associated with a certain plaque, for the patient it might be more important the global risk of the total coronary tree, as reflected by the sum of the diferent probabilities of all the lesions, since the higher the coronary Atherosclerotic burden, the higher the risk for the patient. Cardiac CT or Coronary CT angiography is still a young modality. It is the most recente noninvasive imaging modality in the study of coronary artery disease and its development was possible due to important advances in multidetector CT technology. These allowed significant improvements in temporal and spatial resolution, leading to better image quality and also some impressive reductions in radiation dose. At the same time, the increasing experience with this technique lead to a growing body of scientific evidence, making cardiac CT a robust imaging tool for the evaluation of coronary artery disease and increased its clinical indications. More recently, several publications documented its prognostic value, marking the transition of cardiac CT to adulthood. Besides being able to exclude the presence of coronary artery disease and of obstructive lesions, Cardiac CT allows also the identification of nonobstructive lesions, making this a unique tool in the field of noninvasive imaging modalities. By evaluating both obstructive and nonobstructive lesions, cardiac CT can provide for the quantification of total coronary atherosclerotic burden, and this can be useful to stratify the risk of future coronary events. In the present work, it was possible to identify significant demographic and clinical predictors of a high coronary atherosclerotic burden as assessed by cardiac CT, but with modest odds ratios, even when the individual variables were gathered in clinical scores. Among these diferent clinical scores, the performance was better for the Heartscore, a cardiovascular risk score. This modest performance underline the limitations on predicting the presence and severity of coronary disease based only on clinical variables, even when optimized together in risk scores, One of the classical risk factors, obesity, had in fact a paradoxical relation with coronary atherosclerotic burden and might explain some of the limitations of the clinical models. On the opposite, diabetes mellitus was one of the strongest clinical predictors, and was considered to be a model of more advanced coronary disease, useful to evaluate the performance of diferent plaque burden scores. In face of the high prevalence of plaques that can be identified in the coronary tree of patients undergoing cardiac CT, it is of utmost importance to develop tools to quantify the total coronary atherosclerotic burden providing the identification of patients that could eventually benefit from more intensive preventive measures. This was the rational for the development of a coronary atherosclerotic burden score, reflecting the comprehensive information on localization, degree of stenosis and plaque composition provided by cardiac CT – the CT-LeSc. This score may become a useful tool to quantify total coronary atherosclerotic burden and is expected to convey the strong prognostic information of cardiac CT. Lastly, the concept of vulnerable coronary tree might become more important than the concept of the vulnerable plaque and his assessment by cardiac CT Might become important in a more advance primary prevention strategy. This Could lead to a more custom-made primary prevention, tailoring the intensity of preventive measures to the atherosclerotic burden and this might become one of the most important indications of cardiac CT In the near future.

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As estratégias de malevolência implicam que um indivíduo pague um custo para infligir um custo superior a um oponente. Como um dos comportamentos fundamentais da sociobiologia, a malevolência tem recebido menos atenção que os seus pares o egoísmo e a cooperação. Contudo, foi estabelecido que a malevolência é uma estratégia viável em populações pequenas quando usada contra indivíduos negativamente geneticamente relacionados pois este comportamento pode i) ser eliminado naturalmente, ou ii) manter-se em equilíbrio com estratégias cooperativas devido à disponibilidade da parte de indivíduos malevolentes de pagar um custo para punir. Esta tese propõe compreender se a propensão para a malevolência nos humanos é inerente ou se esta se desenvolve com a idade. Para esse efeito, considerei duas experiências de teoria de jogos em crianças em ambiente escolar com idades entre os 6 e os 22 anos. A primeira, um jogo 2x2 foi testada com duas variantes: 1) um prémio foi atribuído a ambos os jogadores, proporcionalmente aos pontos acumulados; 2), um prémio foi atribuído ao jogador com mais pontos. O jogo foi desenhado com o intuito de causar o seguinte dilema a cada jogador: i) maximizar o seu ganho e arriscar ter menos pontos que o adversário; ou ii) decidir não maximizar o seu ganho, garantindo que este não era inferior ao do seu adversário. A segunda experiência consistia num jogo do ditador com duas opções: uma escolha egoísta/altruísta (A), onde o ditador recebia mais ganho, mas o seu recipiente recebia mais que ele e uma escolha malevolente (B) que oferecia menos ganhos ao ditador que a A mas mais ganhos que o recipiente. O dilema era que se as crianças se comportassem de maneira egoísta, obtinham mais ganho para si, ao mesmo tempo que aumentavam o ganho do seu colega. Se fossem malevolentes, então prefeririam ter mais ganho que o seu colega ao mesmo tempo que tinham menos para eles próprios. As experiências foram efetuadas em escolas de duas áreas distintas de Portugal (continente e Açores) para perceber se as preferências malevolentes aumentavam ou diminuíam com a idade. Os resultados na primeira experiência sugerem que (1) os alunos compreenderam a primeira variante como um jogo de coordenação e comportaram-se como maximizadores, copiando as jogadas anteriores dos seus adversários; (2) que os alunos repetentes se comportaram preferencialmente como malevolentes, mais frequentemente que como maximizadores, com especial ênfase para os alunos de 14 anos; (3) maioria dos alunos comportou-se reciprocamente desde os 12 até aos 16 anos de idade, após os quais começaram a desenvolver uma maior tolerância às escolhas dos seus parceiros. Os resultados da segunda experiência sugerem que (1) as estratégias egoístas eram prevalentes até aos 6 anos de idade, (2) as tendências altruístas emergiram até aos 8 anos de idade e (3) as estratégias de malevolência começaram a emergir a partir dos 8 anos de idade. Estes resultados complementam a literatura relativamente escassa sobre malevolência e sugerem que este comportamento está intimamente ligado a preferências de consideração sobre os outros, o paroquialismo e os estágios de desenvolvimento das crianças.************************************************************Spite is defined as an act that causes loss of payoff to an opponent at a cost to the actor. As one of the four fundamental behaviours in sociobiology, it has received far less attention than its counterparts selfishness and cooperation. It has however been established as a viable strategy in small populations when used against negatively related individuals. Because of this, spite can either i) disappear or ii) remain at equilibrium with cooperative strategies due to the willingness of spiteful individuals to pay a cost in order to punish. This thesis sets out to understand whether propensity for spiteful behaviour is inherent or if it develops with age. For that effect, two game-theoretical experiments were performed with schoolboys and schoolgirls aged 6 to 22. The first, a 2 x 2 game, was tested in two variants: 1) a prize was awarded to both players, proportional to accumulated points; 2), a prize was given to the player with most points. Each player faced the following dilemma: i) to maximise pay-off risking a lower pay-off than the opponent; or ii) not to maximise pay-off in order to cut down the opponent below their own. The second game was a dictator experiment with two choices, (A) a selfish/altruistic choice affording more payoff to the donor than B, but more to the recipient than to the donor, and (B) a spiteful choice that afforded less payoff to the donor than A, but even lower payoff to the recipient. The dilemma here was that if subjects behaved selfishly, they obtained more payoff for themselves, while at the same time increasing their opponent payoff. If they were spiteful, they would rather have more payoff than their colleague, at the cost of less for themselves. Experiments were run in schools in two different areas in Portugal (mainland and Azores) to understand whether spiteful preferences varied with age. Results in the first experiment suggested that (1) students understood the first variant as a coordination game and engaged in maximising behaviour by copying their opponent’s plays; (2) repeating students preferentially engaged in spiteful behaviour more often than maximising behaviour, with special emphasis on 14 year-olds; (3) most students engaged in reciprocal behaviour from ages 12 to 16, as they began developing higher tolerance for their opponent choices. Results for the second experiment suggested that (1) selfish strategies were prevalent until the age of 6, (2) altruistic tendencies emerged since then, and (3) spiteful strategies began being chosen more often by 8 year-olds. These results add to the relatively scarce body of literature on spite and suggest that this type of behaviour is closely tied with other-regarding preferences, parochialism and the children’s stages of development.

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INTRODUCTION: Rabies is an acute disease of the central nervous system and is responsible for the deaths of thousands of humans, wild animals and livestock, particularly cattle, as well as causing major economic losses. This study describes the genetic characterization of rabies virus variants that circulate in Desmodus rotundus populations and are transmitted to herbivores. METHODS: Fifty rabies virus isolates from bovines and equines in the States of São Paulo and Minas Gerais, Brazil, were genetically characterized and compared with sequences retrieved from GenBank. RESULTS: Two clusters (I and II) with mean nucleotide identities of 99.1 and 97.6% were found. The first of these contained nearly all the samples analyzed. Lineages from other Brazilian states grouped in cluster II. CONCLUSIONS: Analysis of the amino acid sequences of the N proteins revealed the existence of genetic markers that may indicate possible variations between geographic regions, although the biologically active regions are conserved within the species over space and time.

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INTRODUCTION: Rabies is an important zoonosis that causes thousands of deaths worldwide each year. Although the terrestrial cycle, mainly transmitted by dogs, is controlled in Brazil, the aerial cycle remains a serious public health issue, besides the economic problem. In the aerial cycle, the haematophagous bat Desmodus rotundus is the main source of infection, where several different species of non-haematophagous bats can be infected and can transmit the virus. METHODS: The aim of this work was to study the epidemiological pattern of rabies using antigenic characterization with monoclonal antibodies and genetic characterization by reverse-transcriptase polymerase chain reaction followed by sequencing and phylogenetic analysis of non-haematophagous bats' and herbivorous animals' central nervous system samples from the western region of the State of São Paulo, Brazil. RESULTS: From 27 samples, 3 antigenic variants were identified: AgV-3, AgV-4, and AgV-6; and from 29 samples, 5 different clusters were identified, all belonging to the rabies virus species. CONCLUSIONS: Although only non-haematophagous bats were evaluated in the studied region, the majority of samples were from antigenic and genetic variants related to haematophagous bats Desmodus rotundus. Samples from the same antigenic variant were segregated in more than one genetic cluster. This study demonstrated the diversity of rabies virus genetic lineages presented and circulating in non-haematophagous bats in the studied region.

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INTRODUCTION: The precise identification of the genetic variants of the dengue virus is important to understand its dispersion and virulence patterns and to identify the strains responsible for epidemic outbreaks. This study investigated the genetic variants of the capsid-premembrane junction region fragment in the dengue virus serotypes 1 and 2 (DENV1-2). METHODS: Samples from 11 municipalities in the State of Paraná, Brazil, were provided by the Central Laboratory of Paraná. They were isolated from the cell culture line C6/36 (Aedes albopictus) and were positive for indirect immunofluorescence. Ribonucleic acid (RNA) extracted from these samples was submitted to the reverse transcription polymerase chain reaction (RT-PCR) and nested PCR. RESULTS: RT-PCR revealed that 4 of the samples were co-infected with both serotypes. The isolated DENV-1 sequences were 95-100% similar to the sequences of other serotype 1 strains deposited in GenBank. Similarly, the isolated DENV-2 sequences were 98-100% similar to other serotype 2 sequences in GenBank. According to our neighbor-joining tree, all strains obtained in this study belonged to genotype V of DENV-1. The DENV-2 strains, by contrast, belonged to the American/Asian genotypes. CONCLUSIONS: The monitoring of circulating strains is an important tool to detect the migration of virus subtypes involved in dengue epidemics.