Análise do polimorfismo HLA/DR-DQ em Angolanos portadores de Diabetes Mellitus tipo I

A diabetes mellitus do tipo 1 (DM1) é o distúrbio endócrino-metabólico mais frequente em crianças. É uma doença autoimune resultado da destruição selectiva das células beta pancreáticas. A velocidade de destruição das células beta pode ser rápida em algumas pessoas e lenta em outras; esta última é típica de adulto é conhecido como diabetes autoimune latente em adulto (LADA). A sua etiologia envolve factores ambientais e genéticos, dos genes envolvidos a maior contribuição vem da região do genoma onde estão localizados os genes do Complexo Principal de Histocompatibilidade (MHC). A combinação de diferentes alelos do sistema de antigénio leucocitário humano tipo II (HLAII) esta associada a susceptibilidade da doença e as principais molécula envolvidas são a DQ e DR. O estágio pré-clínico da doença se caracteriza pela presença de auto-anticorpos, sendo o anti-GAD o mais sensível nesta patologia. OBJECTIVO: Analizar a frequência dos polimorfismos HLA-DR/DQ em angolanos portadores de diabetes tipo 1, residentes em Luanda. O tipo de estudo adotado foi casocontrolo num universo de voluntários provenientes da consulta externa de hospitais e clínicas locais no período de outubro de 2012 a outubro 2013. A amostra biológica utilizada foi sangue total, tendo sido processada no laboratório LABGENE, da Faculdade de Medicina (FM) da Universidade Agostinho Neto (UNA). Os auto-anticorpos, anti-GAD, foram doseados pelo método de ELISA. O ADN genómico foi extraído à partir de sangue total periférico e tipagem genética foi realizada mediante PCR-SSP.O alelo DQB1*02 (DQ2/DQ2) (p=0,033, OR= 4, IC (1,2-13,3) foi associado a susceptibilidade da DM1; os alelos DQB1*06 (DQ6/DQ6) (p=0,000, OR=0,30, IC (0,17-0,54); *11 (p=0,011, OR=0,14, IC=0,032-0,62); *13 (p=0,006, OR=0,13, IC=0,049-0,588) e *15 (p=0,001, OR=0,044, IC=0,005-0,39) foram associados a proteção. Foi encontrado 29,2% de positividade para o anti-GAD, não houve associação significativa (p=0,69) entre a resposta positiva do anti-GAD e a idade. Não foi encontrada associação significativa (p=0,39) entre o tempo de diagnóstico e resposta humoral. Observou-se associação significativa entre os alelos de risco DQB1*02 (p=0.000) e resposta positiva para anti-GAD; da mesma maneira houve uma associação significativa para os alelos DQB1*06 (p=0,002), DRB1*11 (p=0,048); *13 (p=0,004) e *15 (p=0,021) e a resposta negativa do anti-GAD.Os dados demostram o forte envolvimentos do gene HLA-II (DQ) com a suceptibilidade a DM1 e sugere que a autoimunidade se desenvolve na presença de susceptibilidade genética, quer dizer, em associação com alelos HLA-II específicos.

Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country. In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia. The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection. Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.

Studies on human anti-rabies immunization in Brazil: I - Evaluation of the 3 + 1 pre-exposure vaccination schedule under field conditions

The currently used pre-exposure anti-rabies immunization schedule in Brazil is the one called 3+1, employing suckling mouse brain vaccine (3 doses on alternate days and the last one on day 30). Although satisfactory results were obtained in well controlled experimental groups using this immunization schedule, in our routine practice, VNA levels lower than 0.5 IU/ml are frequently found. We studied the pre-exposure 3+1 schedule under field conditions in different cities on the State of São Paulo, Brazil, under variable and sometimes adverse circumstances, such as the use of different batches of vaccine with different titers, delivered, stored and administered under local conditions. Fifty out of 256 serum samples (19.5%) showed VNA titers lower than 0.5 IU/ml, but they were not distributed homogeneously among the localities studied. While in some cities the results were completely satisfactory, in others almost 40% did not attain the minimum VNA titer required. The results presented here, considered separately, question our currently used procedures for human pre-exposure anti-rabies immunization. The reasons determining this situation are discussed.

As Reformas Militares do Século XX Português – Da I República ao fim do Estado Novo

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em História Contemporânea

Os reais hospitais militares em Portugal administrados e fundados pelos Irmãos Hospitaleiros de S. João de Deus 1640-1834

RESUMO: Desde 1640 até data extrema de 1834, os Irmãos Hospitaleiros de S. João de Deus foram os responsáveis, directa e indirectamente, pela administração e corpo de enfermagem dos Reais Hospitais Militares em Portugal, actividades que analisamos ao longo dos séculos, desenvolvendo pressupostos temáticos relativamente a sua actuação no tempo e no espaço. É durante o séc. XVII até ao séc. XIX, que vemos os cuidados da corte para com a assistência aos soldados enfermos e doentes, ao publicar inúmera legislação relativamente à complexidade assistencial na área militar, a qual foi por nós compilada para melhor contextualização da importância dos Hospitais Militares em Portugal. Os Regimentos, os Alvarás, os Regulamentos e as Ordens do Dia, constituem um objecto fundamental de pesquisa e análise para caracterizar o quotidiano nesses mesmos locais. Os Hospitais Militares desde a sua fundação, dos primórdios das Guerras da Aclamação em 1640, até ao advento do liberalismo em 1834, eram centros de conhecimento técnico e científico com um corpo assistencial especializado, onde um conjunto pluridisciplinar de profissionais zelava qualitativamente pelos assistidos, e onde os Irmãos Hospitaleiros de S. João de Deus desempenhavam funções de administradores, enfermeiros e capelães. Nesse sentido elaboramos uma listagem cronológica para inter relacionar os Irmãos Hospitaleiros e os Hospitais Militares, pois é impossível separar a Ordem de S. João de Deus da componente assistencial aos enfermos e doentes militares em Portugal. A importância urbana e arquitectónica, que os Reais Hospitais Militares tiveram no contexto orgânico e defensivo nas Praças de Guerra, é realçado pela forma como estes se encontravam implantados e construídos, demarcando-se esteticamente da globalidade edificada, pois constituíam parte integrante dos equipamentos militares, como era teorizado pelos técnicos militares. Assim analisamos a localização dos imóveis, para além do próprio edifício hospitalar, com o meio, ou seja com a urbanidade das Praças de guerra. A sobriedade arquitectónica dos Hospitais Militares, integrada nos grandes ciclos das correntes culturais europeia e nacional, associada à riqueza decorativa e iconoclasta desenvolvida nesses locais, dá-nos uma dimensão da importância científica que esses núcleos assistenciais tiveram, contribuindo para a difusão do culto e circulação da imaginária de S. João de Deus em Portugal e dos Santos venerados nos Hospitais Militares. Desta forma compreendemos o alicerçar devocional que o reino tinha por este Santo, como o fundador do conceito assistencial do hospital moderno. Estando intrinsecamente ligado a este facto vemos o proliferar do culto e da imaginária de S. João de Deus em Portugal, centrando-se a iconografia artística do Santo em torno das localidades onde se enraizaram os Hospitais Militares. Hoje, nos imóveis hospitalares, não é difícil analisar uma lenta evolução da funcionalidade dos seus espaços, gravitando o desenvolvimento estrutural assistencial em torno das enfermarias e salas de cirurgia, mantendo-se perene este arquétipo arquitectónico desde o séc. XVII até meados do séc. XIX, as quais foram levantadas, comparadas e analisadas. Foi com a exclaustração das Ordens Religiosas, pelo Decreto de 29 de Maio de 1834, que acabou a extraordinária e valorosa acção administrativa, tutelar e corpo de enfermagem dos Irmãos Hospitaleiros de S. João de Deus, na área específica da assistência militar em Portugal, extinguindo-se, nalguns casos, os Hospitais Militares, pois o reino não estava preparado para substituir esses profissionais de saúde. O nosso estudo desenvolve-se por cerca de 295 anos, espaço temporal em que os Hospitais Militares foram administrados e fundados pelos Irmãos de S. João de Deus em Portugal.---------ABSTRACT: Since 1640 until 1834 the Hospitaller Brothers of S. John of God were the responsibles, direct and indirectly, for the administration and nursing body of the Royal Military Hospitals in Portugal, activities that we analyse throughout the centuries, developing thematic presuppositions regarding its performance in time and in space. It is during the 17th century until the 19th century, that we see the court’s care with the assistance of the wounded and sick by the publishing of much legislation regarding the assistance complexity in the military area, which was compiled by us in order to achieve a better comprehension of the importance of the Military Hospitals in Portugal. The Regiments, Charters, Regulations and Orders of Day constitute a fundamental object of research and analysis to characterise the quotidian of these locations. The Military Hospitals, since its foundation, in the beginning of the Wars of Acclamation in 1640, until the advent of liberalism in 1834, were centres of technical and scientific knowledge with a specialized assistance body, were a multidisciplinary set of professionals took qualitatively care of the attended, and where the Hospitaller Brothers of S. John of God performed the tasks of administrators, nurses and chaplains. In this perspective, we created a chronological listing in order to relate the Hospitaller Brothers with the Military Hospitals, since it is impossible to separate the Hospitaller Order of S. John of God from the component of assistance to the military sick and wounded in Portugal. The urban and architectural importance that the Royal Military Hospitals had in the organic and defensive context of the War Fortifications is emphasized by the way these were implanted and built and by its architectural demarcation of the edified whole, since they constituted an integrant part of the military equipments, as it was theorized for the military architecture. Therefore we analyse the location of the real estate, analysing not only the hospital building itself, but also its relation with the environment, i. e. with the urbanism of the war fortifications. The architectural sobriety of Military Hospitals, integrated in the big cycles of cultural streams in Europe and Portugal, associated to the decorative and iconoclastic wealth developed in these locations, give us a dimension of the scientific importance that these hospitals had, contributing to the diffusion of the cult and circulation of sculptures and paintings of S. John of God in Portugal and of the Saints revered in the Hospitals. In this way, we understand the consolidation of the devotion that the kingdom had for this Saint, the founder of the assistance concept of the modern hospital. The proliferation of the cult and iconography of S. John of God is intrinsically connected to this fact, the artistic iconography concentrating itself around the localities were the Military Hospitals were built. Today, in the assistance buildings, it is not difficult to analyse a slow evolution of the functionality of its spaces, gravitating the structural assistance development around the infirmaries and surgery rooms, this architectural archetype being perennial from the 17th century until the middle of the 19th century. These infirmaries were pointed out, compared and analysed. It was the expulsion of the Religious Orders, by the Decree of May 29th 1834, that ended with the extraordinary and valorous administrative and tutelary action and nursing body of the Hospitaller Brothers of S. John of God, in the specific area of military assistance in Portugal, extinguishing, in some cases, the Military Hospitals, since the kingdom wasn’t prepared to substitute these health professionals. Our study is developed in a timeframe of 295 years, period in which the Military Hospitals were administrated and founded by the Brothers of S. John of God in Portugal.

Prevalence of HTLV-I and HTLV-II infections among HIV-1-infected asymptomatic individuals in São Paulo, Brazil

Human immunodeficiency virus (HIV-1)-infected subjects with acquired immunodeficiency syndrome (AIDS) are often infected with multiple pathogens. In particular, HTLV-I and HTLV-II infections have been found more frequently in AIDS patients than in asymptomatic individuals in Europe and Japan. We carried out a serosurvey among asymptomatic HIV-1-infected subjects in São Paulo, Brazil and compared our results with those of other investigators. In this study, we found HTLV infection in 1.5% of 266 asymptomatic and 14% of 28 AIDS patients. Epidemiological data obtained from patients pointed out the use of intravenous drugs as the principal risk factor for acquiring retroviruses. In conclusion, our results are in accordance with other studies done in Brazil and elsewhere where the principal risk group for HIV/HTLV-I/II coinfection was IDU

DETECTION OF HTLV-I ANTIBODIES AND DNA IN BLOOD SAMPLE OF A PATIENT WITH MYELOPATHY IN NIGERIA

We describe a case of human T-lymphotropic virus type I associated myelopathy in a 50-year old woman in Nigeria. The patient presented with progressive loss of tone to the two lower limbs and later inability to walk. The HTLV-I antibody presence in the plasma collected from the patient was repeatedly detected by enzyme immunoassays (Abbott HTLV-I EIA and Coulter SELECT-HTLV I/II) and confirmed by Western blot technique. In addition, HTLV-I DNA was amplified from the genomic DNA isolated from the peripheral blood mononuclear cells of the patient by the polymerase chain reaction technique. This finding is significant being the first report of association of HTLV-I with myelopathy in Nigeria.

VERTICAL TRANSMISSION OF HTLV-I/II: A review

The vertical transmission of the human T-cell lymphotropic virus type I (HTLV-I) occurs predominantly through breast-feeding. Since some bottle-fed children born to carrier mothers still remain seropositive with a frequency that varies from 3.3% to 12.8%, an alternative pathway of vertical transmission must be considered. The prevalence rate of vertical transmission observed in Japan varied from 15% to 25% in different surveys. In Brazil there is no evaluation of this form of transmission until now. However, it is known that in Salvador, Bahia, 0.7% to 0.88% of pregnant women of low socio-economic class are HTLV-I carriers. Furthermore the occurrence of many cases of adult T-cell leukemia/lymphoma and of four cases of infective dermatitis in Salvador, diseases directly linked to the vertical transmission of HTLV-I, indicates the importance of this route of infection among us. Through prenatal screening for HTLV-I and the refraining from breast-feeding a reduction of ~ 80% of vertical transmission has been observed in Japan. We suggest that in Brazil serologic screening for HTLV-I infection must be done for selected groups in the prenatal care: pregnant women from endemic areas, Japanese immigrants or Japanese descendents, intravenous drug users (IDU) or women whose partners are IDU, human immunodeficiency virus carriers, pregnant women with promiscuous sexual behavior and pregnant women that have received blood transfusions in areas where blood donors screening is not performed. There are in the literature few reports demonstrating the vertical transmission of HTLV-II.

Luz e arquitectura do espaço no filme. Imagem, memória e emoção na década da mente

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Doutor em Ciências da Comunicação, Especialidade de Cinema

Políticas da memória da I Guerra Mundial em Portugal 1918-1933. Entre a experiência e o mito

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Doutor em História