Apoptose em otorrinolaringologia e cabeça e pescoço

This paper intend to review recent advances in our understanding of programmed cell death, or apoptosis, and discuss implications of these basic science advances in the development of causes and potential treatments of a variety of diseases of the head and neck. Conclusions: apoptosis is now understood to be important in the normal development and survival of all multicellular organism. Deregulation of this normally tighly controlled process underlies a variety of disease states, including neoplasia, autoimmune disease, and disorders of the central nervous system. A better understanding of this process and regulation may help otolaryngologists better understand diseases relevant to this specialty and will lead to improved therapeutic interventions.

The role of myofibroblasts and interstitial fibrosis in the progression of membranous nephropathy

Renal interstitial fibrosis has been observed in a large number of nephropathies and contributes to the progressive deterioration of renal function. Myofibroblasts have been implicated in the reparative process of tissue injury, including renal scarring secondary to glomerular diseases. We performed a retrospective study on 28 patients with biopsy-proven primary membranous nephropathy, to determine whether interstitial myofibroblasts and tubulointerstitial lesions correlated with renal function at follow-up. Tubulointerstitial pathology was evaluated by morphometric and semiquantitative methods. Interstitial myofibroblasts were counted; 24-hour urinary protein and serum creatinine at the time of diagnosis and at the end of follow-up were available for all the patients. There were 20 males and 8 females, age 2-67 years (mean 42.3±153), most of them with nephrotic syndrome (78.6%). The final renal function had deteriorated in 16 patients (57.1%) and in 5 patients (17.8%) reached end-stage. The renal outcome was correlated with histological changes. We found a positive correlation between the severity of tubulointerstitial damage and the deterioration of the final serum creatinine (r 2=0.185; p=0.016). Myofibroblasts did not predict impaired renal function at the final follow-up. The current data do not support previous suggestions that myofibroblasts are a useful a predictor of end-stage renal disease.

The number of podocyte and slit diaphragm is decreased in experimental diabetic nephropathy

Purpose: To determine the number of podocyte, slit diaphragms, slit diaphragm extensions and GBM thickness in diabetic nephropathy. Methods: Sixty Rattus Wistarof both sexes weighing 200-300g were divided in two experimental groups: normal group 10 animals, and alloxan diabetic rats - 50 animals. Alloxan was administered in a single IV dose of 42mg/kg body weight. Body weight, water and food intake, diuresis, and blood and urine glucose were determined in both groups before alloxan injection and two weeks, six and twelve months after alloxan injection. Proteinuria was measured at 12 months in both groups. After 12 months animals were sacrificed, and the right kidney processed for electron microscopy. Results: Clear clinical and laboratory signs of severe diabetes were seen, in all alloxan-diabetic rats at all follow-up times. Glomerular basement membrane (GBM) thickening, podocyte number, and slit diaphragm number and extension were determined. GBM of all diabetic rats was significantly thicker (median=0.29μm; semi-interquartile range=0.065μm) than in the normal rats (0.23μm; 0.035μm). Diabetic rat podocyte number (8; 1), slit diaphragm number (4; 1), and slit diaphragm extension (0.021μm; 0.00435μm) were significantly lower than in normal rats (11; 1) and (7; 1.5), and (0.031μm; 0.0058μm). Diabetic rat proteinuria (0.060mg/24h; 0.037mg/24h) was higher than in normal rats (0.00185mg/24h; 0.00055mg/24h). Conclusion: Experimental diabetes is associated with significant (p<0.05) changes in podocyte foot process, slit number, slit diaphragm extension, and GBM thickness.

Importância de Yersinia enterocolitica em microbiologia médica

Y. enterocolitica is a human invasive enteropathogen which causes a number of intestinal and extraintestinal clinical symptoms of various degrees of severity, ranging from mild gastroenteritis to mesenteric lymphadenitis, which mimics appendicitis and in rare cases can evolve to septicemia. Infection by Y. enterocolitica can also lead to post-infection immunological sequelae including arthritis, erythema nodosum and glomerulonephritis. Pathogenic Y. enterocolitica strains have traditionally been linked to specific biotypes and serogroups and associated to a variety of phenotypic characteristics related to virulence. Molecular genetics studies have pointed to the importance of the pYV virulence plasmid, which encodes various virulence genes, as well that of specific chromosomal virulence genes, in determining the pathogenesis of this bacterium. Intestinal infections by Y. enterocolitica are mostly self-limiting and usually do not need an antibiotic treatment. The occurrence of this microorganism is not as frequently described in Brazil as it is in other countries, such as Japan, USA and many European countries. This review focuses on the general characteristics, pathogenesis, clinical symptoms, virulence characteristics, treatment and antibiotic susceptibility of Yersinia enterocolitica strains isolated in Brazil and around the world.

Acute antibody-mediated rejection of renal transplant associated with cellular crescents: First case report

Acute antibody-mediated rejection is characterized by histological abnormalities such as glomerulitis, capillaritis, or thrombosis associated with presence of C4d and specific anti-donor antibodies. Reports on the association of glomerular injuries with cellular crescents in antibody-mediated rejection are not found in the literature. We report a unique case of antibody-mediated rejection associated with cellular crescents and suggest that such histological abnormality should be considered in the differential diagnosis of acute antibody-mediated rejection. © 2011 Elsevier Inc.

Hipertensão arterial sistêmica e sua correlação com as lesões renais de cães naturalmente acometidos por leishmaniose visceral

Pós-graduação em Ciência Animal - FMVA

Leishmaniose visceral canina: aspectos clínico-laboratoriais, histopatologia renal e testes específicos para diagnóstico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Histopatologia da série eritróide da medula óssea e do tecido renal de cães com insuficiência renal crônica

Pós-graduação em Medicina Veterinária - FMVZ

Alterações morfológicas e funcionais dos rins de cães com insuficiência renal crônica

Pós-graduação em Medicina Veterinária - FCAV

Estudo epidemiológico descritivo dos pacientes atendidos na unidade de hemodiálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Pesquisa e genotipagem do vírus da hepatite C em portadores de doenças renais crônicas submetidos à hemodiálise

Pacientes com doença renal crônica tem alto risco de adquirir o vírus da hepatite C (VHC). A prevalência de hepatite C em unidades de hemodiálise é elevada. O estudo teve por objetivo avaliar a presença do VHC e seus diferentes genótipos em portadores de doença renal crônica que realizaram hemodiálise em Belém e região metropolitana, no Estado do Pará, Brasil, determinando a prevalência do vírus, genótipos e as características epidemiológicas dos portadores da doença renal crônica. Foi realizado um estudo transversal, em sete unidades de hemodiálise das cidades de Belém e região metropolitana, no período de outubro de 2011 a abril de 2012. Foi aplicado um questionário com dados sociais, epidemiológicos e sobre a presença de fatores de risco para hepatites virais. Material biológico foi coletado dos pacientes para os exames ELISA e PCR VHC. Os pacientes com presença de RNA viral foram avaliados quanto aos genótipos. A prevalência dos anticorpos para VHC entre os indivíduos estudados foi de 8,4%, enquanto 5,4% apresentaram RNA viral, com 0,1% entre os não reagentes. O genótipo 1 foi o mais prevalente, com 86,1%, seguido do tipo 2, com 11,6%. O tipo 3 teve somente 2,3%. A análise epidemiológica mostrou predomínio do sexo masculino, faixa etária de 49 anos, casados ou em união estável, com baixo nível de escolaridade e renda familiar de até 2 salários mínimos. A principal causa da doença renal crônica foi o diabetes mellitus (34,4%), seguida de glomerulonefrites (18,6%) e hipertensão arterial (17,1%). O tempo de hemodiálise foi significativamente importante fator de risco para aquisição do VHC (p=0,012), com a maioria dos portadores do VHC que adquiriram a doença durante hemodiálise estava acima de 5 anos de tratamento (p= 0,0001). Outro fator de risco associado ao VHC foi transplante de órgão prévio. Conclui-se que, em Belém e região metropolitana, a prevalência de VHC em hemodiálise foi elevada e o genótipo mais frequente é o mesmo da população geral no norte do Brasil.

Streptococcal acute pharyngitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Morphological, immunohistochemical and molecular study of renal lesions in canine visceral leishmaniasis (CVL)

Canine visceral leishmaniasis (CVL) is an anthropozoonosis characterized by a clinically chronic progressive disease. Non lymphoid organs are also affected, especially the kidneys. Dogs with leishmaniasis usually die with renal failure despite treatment. Haematoxylin-eosin (HE) staining in kidney tissue sections has low sensitivity for parasite identification. Immunohistochemistry (IHC) and polymerase chain reaction (PCR) are efficient methods for Leishmania sp. antigen and DNA detection in cases of low parasite burden. The present study aims to identify renal lesions of CVL and correlate them with microscopic findings determined by histochemistry, IHC and PCR. Both IHC and PCR provided similar positivity for amastigote identification, 3/20 animals (15%), thus increasing detection of the parasite in renal tissues when compared with histopathologic examination. The lesion most commonly observed with visceral leishmaniasis-positive canine kidney tissue was membranoproliferative glomerulonephritis, followed by interstitial nephritis without correlation to the number of amastigotes.

Urinary MCP-1 and RBP: Independent predictors of renal outcome in macroalbuminuric diabetic nephropathy

Background: Albuminuria has been considered a sine qua non condition for the diagnosis of diabetic nephropathy (DN) and has been widely used as a surrogate outcome of chronic kidney disease (CKD). However, recent data suggest that albuminuria may fail as a biomarker in a subset of patients, and the search for novel markers is intense. Methods: We analyzed the role of urinary RBP and of serum and urinary cytokines (TGF-beta, MCP-1 and VEGF) as predictors of the risk of dialysis. doubling of serum creatinine or death (primary outcome. PO) in 56 type 2 diabetic patients with macroalbuminuric DN. Results: Mean follow-up time was 30.7 +/- 10 months. Urinary RBP and MCP-1 were significantly higher in patients presenting the PO, whereas no difference was shown for TGF-beta or VEGF. In the Cox regression, urinary RBP. MCP-1 and VEGF were positively associated and serum VEGF was inversely related to the risk of the PO. However, after adjustments for creatinine clearance, proteinuria, and blood pressure only urinary RBP (OR 11.6; 95% CI 2.7-49.2, p = 0.001 for log RBP) and urinary MCP-1 (OR 11.0; 95% CI 1.6-76.4, p = 0.02 for log MCP-1) remained as significant independent predictors of the PO. Conclusion: Urinary RBP and MCP-1 are independently related to the risk of CKD progression in patients with macroalbuminuric DN. Whether these biomarkers have a role in the setting of normoalbuminuria and microalbuminuria in DN should be further investigated. (C) 2012 Elsevier Inc. All rights reserved.

The IgA1 immune complex-mediated activation of the MAPK/ERK kinase pathway in mesangial cells is associated with glomerular damage in IgA nephropathy

IgA nephropathy (IgAN), the most common primary glomerulonephritis worldwide, has significant morbidity and mortality as 20-40% of patients progress to end-stage renal disease within 20 years of onset. In order to gain insight into the molecular mechanisms involved in the progression of IgAN, we systematically evaluated renal biopsies from such patients. This showed that the MAPK/ERK signaling pathway was activated in the mesangium of patients presenting with over 1 g/day proteinuria and elevated blood pressure, but absent in biopsy specimens of patients with IgAN and modest proteinuria (<1 g/day). ERK activation was not associated with elevated galactose-deficient IgA1 or IgG specific for galactose-deficient IgA1 in the serum. In human mesangial cells in vitro, ERK activation through mesangial IgA1 receptor (CD71) controlled pro-inflammatory cytokine secretion and was induced by large-molecular-mass IgA1-containing circulating immune complexes purified from patient sera. Moreover, IgA1-dependent ERK activation required renin-angiotensin system as its blockade was efficient in reducing proteinuria in those patients exhibiting substantial mesangial activation of ERK. Thus, ERK activation alters mesangial cell-podocyte crosstalk, leading to renal dysfunction in IgAN. Assessment of MAPK/ERK activation in diagnostic renal biopsies may predict the therapeutic efficacy of renin-angiotensin system blockers in IgAN. Kidney International (2012) 82, 1284-1296; doi:10.1038/ki.2012.192; published online 5 September 2012