Volunteers living in an area where schistosomiasis mansoni is endemic were subjected to ultrasound examination and classified into groups according to the levels of fibrosis diagnosed, namely, absence of indications of fibrosis (group 0), incipient fibrosis (group 1), and moderate/severe fibrosis (group 2). Peripheral blood mononuclear cells (PBMC) collected from the volunteers were stimulated with soluble antigens from adult schistosomes or from schistosome eggs, and the production of the cytokines gamma interferon, tumor necrosis factor alpha, transforming growth factor ␤ (TGF-␤), interleukin-4 (IL-4), IL-10, and IL-13 was determined. Potential associations of the level of fibrosis with age, sex, intensity of infection, and cytokine production were investigated between the three groups. Univariate analysis identified associations of age (>50), gender (male), and absence of eggs/g of feces with moderate/severe fibrosis and an association of intensity of infection (>100 eggs) with incipient fibrosis. When cytokine production in PBMC cultures stimulated by soluble egg antigens was categorized as low or high, significant differences in the distribution of IL-13 levels were established between groups 0 and 2. No significant differences were detected between the groups in the cytokines produced by PBMC cultures stimulated with soluble antigens from adult schistosomes. When all variables were tested in multivariate analyses, only IL-13 was strongly associated with fibrosis (odds ratio ‫؍‬ 5.8; 95% confidence interval [CI] ‫؍‬ 1

Background Leishmania (Viannia) braziliensis has been associated with a broad range of clinical manifestations ranging from a simple cutaneous ulcer to destructive mucosal lesions. Factors leading to this diversity of clinical presentations are not clear, but parasite factors have lately been recognized as important in determining disease progression. Given the fact that the activity of ecto-nucleotidases correlates with parasitism and the development of infection, we evaluated the activity of these enzymes in promastigotes from 23 L. braziliensis isolates as a possible parasite-related factor that could influence the clinical outcome of the disease.Methodology/Principal FindingsOur results show that the isolates differ in their ability to hydrolyze adenine nucleotides. Furthermore, we observed a positive correlation between the time for peak of lesion development in C57BL/6J mice and enzymatic activity and clinical manifestation of the isolate. In addition, we found that L. (V.) braziliensis isolates obtained from mucosal lesions hydrolyze higher amounts of adenine nucleotides than isolates obtained from skin lesions. One isolate with high (PPS6m) and another with low (SSF) ecto-nucleotidase activity were chosen for further studies. Mice inoculated with PPS6m show delayed lesion development and present larger parasite loads than animals inoculated with the SSF isolate. In addition, PPS6m modulates the host immune response by inhibiting dendritic cell activation and NO production by activated J774 macrophages. Finally, we observed that the amastigote forms from PPS6m and SSF isolates present low enzymatic activity that does not interfere with NO production and parasite survival in macrophages.Conclusions/SignificanceOur data suggest that ecto-nucleotidases present on the promastigote forms of the parasite may interfere with the establishment of the immune response with consequent impaired ability to control parasite dissemination and this may be an important factor in determining the clinical outcome of leishmaniasis.

Estagiários do Internato Rural da Faculdade de Medicina da

RESUMOA Medicina de Família e Comunidade (MFC) presta cuidados primários, personalizados e continuados a indivíduos, famílias e coletividades; contribuindo expressivamente para redução de morbidades e mortalidade. Objetivo: associar a produção científica brasileira sobre MFC e a maior expectativa de vida. Realizou-se um levantamento de dados a partir da base Scopus com o descritor "Family Practice". Paralelamente, obtiveram-se indicadores do site do Instituto Brasileiro de Geografia e Estatística. Foram aplicados teste de Mann-Whitney e regressão linear simples, com significância fixada em p<0,05. Totalizaram-se 2.649 manuscritos, com destaque para as Regiões Sudeste (n=1.743; 65,7%) e Sul (n=860; 32,4%). Estados com maiores probabilidades de um recém-nascido completar 1 ano de vida tiveram mais publicações em comparação aos demais (p=0,0001). Unidades da federação com maiores expectativas de vida também exibiram maiores concentrações de trabalhos (p=0,0005). Além disso, territórios com maiores probabilidades de um indivíduo de 60 anos chegar a faixa etária de 80 também evidenciaram um maior quantitativo de manuscritos sobre MFC (p=0,0034). Houve relação entre a progressão temporal e o aumento do número de publicações brasileiras sobre MFC (p=0,0001). Percebe-se, portanto, a relevância das pesquisas acerca da temática. Logo, é imperativa a continuidade de investimento em estudos sobre MFC no Brasil.

No abstract

Background Schistosomiasis is a chronic disease that affects over 200 million people worldwide. A pivotal role of IL-10 is down-regulating Th1 and Th2 responses to schistosome antigens, which can favor the parasite establishment. The SmATPDases degrade ATP and ADP in AMP and adenosine, a molecule with anti-inflammatory properties. We evaluated the expression of SmATPDases 1 and 2 enzymes in S. mansoni eggs obtained from infected individuals as a possible parasite-related factor that could influence the host immune response and the clinical outcome of the disease. Methods Fecal samples were collected from 40 infected individuals to detect coding regions of the enzymes by the qPCR. The production of cytokines was measured in supernatants of PBMC cultures. The analysis was performed by the global median determination for each cytokine and set up high producers (HP) of cytokines. Results Six individuals expressed SmATPDase 1 in their fecal samples, 6 expressed SmATPDase 2, and 6 expressed both enzymes. The group who expressed only SmATPDase 1 showed a high frequency of IFN-γ, TNF, IL-4 HP, and a low frequency of IL-6 HP. The group who expressed only SmATPDase 2 showed a high frequency of IFN-γ, IL-6, and IL-4 HP and a low frequency of IL-10 HP. The group who expressed both enzymes showed a high frequency of IL-10 HP and low frequencies of IFN-γ, IL-6, IL-2, IL-4, and IL-13 HP. In the group that had SmATPDase 2 expression was observed higher indices the ratio between IFN-γ/IL-10 than individuals that showed expression both enzymes. The positive correlation between infection intensity and IL-10 levels remained only in the positive SmATPDase group. Overall, the analysis revealed that 62.5% of the cytokines presented reduced frequency in the group of individuals expressing both enzymes, the IL-10 is the only cytokine induced by the expression of both enzymes and the expression profile of SmATPDases is relevant data for grouping individuals. Conclusions The expression of both enzymes in the parasite's eggs seems to be a new undescribed factor that negatively modulates the host immune response by inducing high IL-10 production, which, in turn, can contribute to the survival of the parasite.

Evolução da vacinologia na última década: uma análise cientométrica a partir de base de dados selecionada Evolution of vaccinology in the last decade: a scientometric analysis from a selected database

RESUMOO câncer de esôfago é o oitavo tipo de neoplasia maligna mais incidente em âmbito mundial, constituindo a terceira causa de morte por câncer no sistema digestivo. Dentre os fatores de risco, o tipo adenocarcinoma está atrelado à doença do refluxo gastroesofágico e ao esôfago de Barrett. O carcinoma epidermóide, por sua vez, está associado ao menor nível socioeconômico e à história pregressa de tabagismo e etilismo. O objetivo do presente trabalho consiste em caracterizar as internações hospitalares por câncer de esôfago no município de Governador Valadares (Minas Gerais), entre os anos de 2011 e 2020. Trata-se de um estudo ecológico com dados secundários de domínio público disponíveis no Portal de Vigilância da Secretaria de Estado de Saúde de Minas Gerais. Para caracterização, as informações consideradas foram: ano de internação, sexo, faixa etária, óbitos, caráter de atendimento, dias de permanência e gastos. Totalizaram-se 1.892 internações hospitalares por câncer de esôfago em todo o período estudado, com destaque para o caráter de urgência (n=1.081; 95,1%). Quanto ao regime, a maioria das fichas continha essa informação ignorada (n=1.037; 52,3%); enquanto 38,4% (n=761) das internações ocorreram sabidamente no sistema privado e 94 (4,7%) no sistema público. Frisam-se ainda sexo masculino (n=1.452; 76,7%) e faixas etárias 60 a 69 anos (n=595; 31,4%) e 50 a 59 anos (n=608; 26,8%). Ademais, 288 casos evoluíram para óbito (letalidade hospitalar de 15,2%). O perfil de falecimentos foi semelhante ao de internações, com cerne para homens (n=223; 77,4%) e idade 60 a 69 anos (n=82; 28,5%). A letalidade hospitalar foi levemente mais expressiva no sexo masculino (15,4%) comparando-se ao feminino (14,8%), porém em se tratando da idade, foi proeminente entre indivíduos de 80 anos ou mais (19,1%). Do ponto de vista temporal, o menor número de hospitalizações por câncer de esôfago foi registrado em 2011 (n=155; 8,2%), atingindo o maior valor em 2016 (n=266; 14,0%) e concluindo a série histórica em 2020 com 180 (9,5%) internações. Acerca do tempo de permanência dos pacientes nos hospitais, acumularam-se 8.062 dias. Consoante aos gastos totais contabilizou-se R$