Objective: Hereby we present the epidemiological and clinical profile of HIV-infected population before and during the highly active antiretroviral therapy (HAART) era from a tertiary care hospital in the Southeastern region of Brazil. Methods: A retrospective, cross-sectional and descriptive study was carried out, this involved the analysis of the medical records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the municipality of Catanduva, State of São Paulo, Brazil. Results: In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were associated with AIDS in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic infection (OI) was lower in the HAART period. Among all OI it is worth mentioning pulmonary pneumocystosis, which despite being common in two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OIs according to the HIV-1 viral load and serial count of T CD4 + lymphocytes, a significant association was observed. The association between the number of deaths by OIs and death in the 1st year of diagnosis in the HAART treatment was significant. Conclusions: The clinical and epidemiological profile of a specialized HIV-1/AIDS center in Catanduva, Southeastern Brazilian region, is consistent with the epidemiology of AIDS in the country.
Interleukin 2 (IL-2) is a monomeric glycoprotein that is primarily produced by activated CD4+ T cells, CD8+ T cells and dendritic cells. It is characterized as a proinflammatory cytokine that is secreted by Th1 cells. IL-2 plays a central role in the activation of regulatory T cells to produce the cytokines tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ). IL-2 may also enhance the cytolytic activity of natural killer cells, thereby ensuring their significance in the control of the immune response, and effectively participate in the pathogenesis of several pathological conditions, such as cancer and metabolic, infectious, autoimmune and inflammatory diseases. We emphasize the importance of studies of IL-2 and discuss perspectives resulting from our increasing understanding of genetic diversity and its role in the immune response.
The development of an effective immune response can help decrease mortality from malaria and its clinical symptoms. However, this mechanism is complex and has significant inter-individual variation, most likely owing to the genetic contribution of the human host. Therefore, this study aimed to investigate the influence of polymorphisms in genes involved in the costimulation of B-lymphocytes in the naturally acquired humoral immune response against proteins of the asexual stage of Plasmodium vivax. A total of 319 individuals living in an area of malaria transmission in the Brazilian Amazon were genotyped for four SNPs in the genes CD40, CD40L, BLYS and CD86. In addition, IgG antibodies against P. vivax apical membrane antigen 1 (PvAMA–1), Duffy binding protein (PvDBP) and merozoite surface protein 1 (PvMSP–119) were detected by ELISA. The SNP BLYS –871C>T was associated with the frequency of IgG responders to PvAMA–1 and PvMSP–119. The SNP CD40 –1C>T was associated with the IgG response against PvDBP, whereas IgG antibody titers against PvMSP–119 were influenced by the polymorphism CD86 +1057G>A. These data may help to elucidate the immunological aspects of vivax malaria and consequently assist in the design of malaria vaccines.
Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi-prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.
Background Humoral immune responses against proteins of asexual blood-stage malaria parasites have been associated with clinical immunity. However, variations in the antibody-driven responses may be associated with a genetic component of the human host. The objective of the present study was to evaluate the influence of co-stimulatory molecule gene polymorphisms of the immune system on the magnitude of the humoral immune response against a Plasmodium vivax vaccine candidate antigen.MethodsPolymorphisms in the CD28, CTLA4, ICOS, CD40, CD86 and BLYS genes of 178 subjects infected with P. vivax in an endemic area of the Brazilian Amazon were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The levels of IgM, total IgG and IgG subclasses specific for ICB2-5, i.e., the N-terminal portion of P. vivax merozoite surface protein 1 (PvMSP-1), were determined by enzyme-linked immuno assay. The associations between the polymorphisms and the antibody response were assessed by means of logistic regression models.ResultsAfter correcting for multiple testing, the IgG1 levels were significantly higher in individuals recessive for the single nucleotide polymorphism rs3116496 in CD28 (p = 0.00004). Furthermore, the interaction between CD28 rs35593994 and BLYS rs9514828 had an influence on the IgM levels (p = 0.0009).ConclusionsThe results of the present study support the hypothesis that polymorphisms in the genes of co-stimulatory components of the immune system can contribute to a natural antibody-driven response against P. vivax antigens.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1350-2) contains supplementary material, which is available to authorized users.
The results of this study show that, although the investigated CD40, CD40L and BLYS alleles differ functionally, this variation does not alter the functionality of the molecules in a way that would interfere in susceptibility to the disease. The variants of these genes may influence the clinical course rather than simply increase or decrease susceptibility.
OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR) with
that of cultures in the detection of the Mycobacterium
tuberculosis complex in pulmonary and extrapulmonary specimens.
METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively,
of 67 hospitalized patients suspected of having tuberculosis. An automated
microbial system was used for the identification of Mycobacterium spp.
cultures, and M. tuberculosis IS6110 was
used as the target sequence in the NPCR. The kappa statistic was used in
order to assess the level of agreement among the results. RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary
and extrapulmonary tuberculosis, and the NPCR was positive in all of the
cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR
were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the
results of NPCR with those of cultures (the gold standard), we found that
NPCR had a sensitivity and specificity of 100% and 83%, respectively, in
pulmonary specimens, compared with 83% and 96%, respectively, in
extrapulmonary specimens, with good concordance between the tests (kappa,
0.50 and 0.6867, respectively). CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of
M. tuberculosis complex, clinical, epidemiological, and
other laboratory data should also be considered in the diagnosis and
treatment of pulmonary and extrapulmonary tuberculosis.
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