Antonio Condino Neto

Targeting Neutrophils to Prevent Malaria-Associated Acute Lung Injury/Acute Respiratory Distress Syndrome in Mice

Malaria remains one of the greatest burdens to global health, causing nearly 500,000 deaths in 2014. When manifesting in the lungs, severe malaria causes acute lung injury/acute respiratory distress syndrome (ALI/ARDS). We have previously shown that a proportion of DBA/2 mice infected with Plasmodium berghei ANKA (PbA) develop ALI/ARDS and that these mice recapitulate various aspects of the human syndrome, such as pulmonary edema, hemorrhaging, pleural effusion and hypoxemia. Herein, we investigated the role of neutrophils in the pathogenesis of malaria-associated ALI/ARDS. Mice developing ALI/ARDS showed greater neutrophil accumulation in the lungs compared with mice that did not develop pulmonary complications. In addition, mice with ALI/ARDS produced more neutrophil-attracting chemokines, myeloperoxidase and reactive oxygen species. We also observed that the parasites Plasmodium falciparum and PbA induced the formation of neutrophil extracellular traps (NETs) ex vivo, which were associated with inflammation and tissue injury. The depletion of neutrophils, treatment with AMD3100 (a CXCR4 antagonist), Pulmozyme (human recombinant DNase) or Sivelestat (inhibitor of neutrophil elastase) decreased the development of malaria-associated ALI/ARDS and significantly increased mouse survival. This study implicates neutrophils and NETs in the genesis of experimentally induced malaria-associated ALI/ARDS and proposes a new therapeutic approach to improve the prognosis of severe malaria.

Gene polymorphisms as susceptibility factors in Brazilian asthmatic children and adolescents

Background Asthma is a complex disease due to the contribution of both genetic and environmental factors. Several genes and polymorphisms have been associated to asthma susceptibility and development, leading to distinct clinical patterns. The aim of this study was to analyze sixteen genetic polymorphisms in eleven genes previously associated to asthma in a Brazilian family-based population study.

Single-guidewire double-tip cannulation for difficult biliary access: the DTC technique

The double-guidewire technique (DGT) for difficult biliary cannulation was first described by Dumonceau et al. in 1998 [1]. Over recent years, DGT has become an important advanced technique after unsuccessful standard retrograde cannulation (guidewire-assisted or contrast-assisted), especially when unintentional pancreatic duct cannulation occurs [2]. The success rate of DGT for biliary cannulation in randomized controlled trials ranges from 66.6% to 92.5% [3]. We describe a similar alternative to DGT using a single guidewire with two hydrophilic tips. A 75-year-old man was admitted to the hospital with non-severe pancreatitis. Physical examination was unremarkable except for mild jaundice. Abdominal ultrasound showed gallstones inside the common bile duct, and laboratory studies revealed total bilirubin of 4.8mg/dL (direct bilirubin 3.5mg/dL). After resolution of the pancreatitis, the patient was referred for endoscopic retrograde cholangiopancreatography with stone extraction. During the procedure, we encountered difficult biliary access, with three pancreatic duct cannulations (▶Fig. 1). In our unit, we routinely employ sphincterotome-assisted guidewire cannulation. In this case, we used a Hydra Jagwire (Boston Scientific, Marlborough, Massachusetts, USA), which offers two hydrophilic tips. After the third pancreatic duct cannulation, the first tip was kept inside the main pancreatic duct. We removed the sphincterotome, reinserted the second tip through its guidewire channel (▶Fig. 2), and successfully performed biliary cannulation similarly to DGT (▶Fig. 3, ▶Video1). Finally, we performed the sphincterotomy and balloon sweeping. At follow-up, the patient presented neither abdominal pain nor hyperamylasemia and was referred to a gastrointestinal surgeon for laparoscopic cholecystectomy. DGT for difficult biliary access is effective and widespread but carries high related costs owing to the need for an extra guidewire. The single-guidewire doubletip cannulation (DTC) technique is as ef▶ Fig. 1 First guidewire tip inside the main pancreatic duct.

Stent migration requiring surgical removal: a serious adverse event after bariatric megastent placement

Leaks are serious complications after sleeve gastrectomy, with an incidence rate up to 7% [1]. Currently, stent placement and other endoscopic techniques are recommended for the treatment of post-bariatric leaks (PBLs) [2]. Bariatric stents are a feasible, effective and lifesaving method [3]. They achieve leak closure rates between 72.8% and 87.8% but are associated with significant migration rates (16.9%–28.2%) [1, 4]. The large bariatric-specific stent (LBSS) has been developed as an important device to fit bariatric anatomy and avoid migration because of its long length with the distal edge being placed in the duodenum [5]. We report the case of 34-year-old woman who underwent sleeve gastrectomy. On the 5th post-operative day (POD), she developed abdominal pain and purulent output from the drain. Computed tomography (CT) scanning showed a leak at the angle of His without any collections. We opted to place an LBSS (24 cm× 28mm; Hanarostent, MITECH) to bypass the whole stomach (▶Fig. 1). The LBSS was removed 4 weeks later (33th POD), but the leak persisted. We then placed two single-pigtail stents (▶Fig. 2) and kept them in place for 10 days, but this was also unsuccessful. On the 43 rd POD, we removed the pigtail stents, performed a septotomy, and placed a second LBSS (▶Fig. 3). After 3 weeks (64th POD), the patient again presented with abdominal pain. On this occasion, esophagogastroduoE-Videos

Os primeiros passos dos Arquivos de Asma, Alergia e Imunologia

325 Arq Asma Alerg Imunol. 2017;1(4):325-6. Os primeiros passos dos Arquivos de Asma, Alergia e Imunologia (AAAI) foram dados, e criaram um forte alicerce para o desenvolvimento e crescimento de nossa revista. Em 2017, o início de nossa jornada, a AAAI publicou 64 artigos divididos em 4 números, com versão impressa e digital, além de um suplemento em versão digital com os resumos dos estudos apresentados no XLIV Congresso Nacional da Associação Brasileira de Alergia e Imunologia (ASBAI). Foram 9 editoriais, 7 artigos especiais, 11 artigos de revisão, 20 artigos originais, 10 comunicações clínicas ou experimentais breves, 5 cartas ao editor e 2 imagens em alergia e imunologia. Os associados da ASBAI foram os autores de mais de 90% dos estudos publicados, os quais abrangeram os diversos temas de nossa especialidade, como doenças atópicas, urticária/angioedema/ anafilaxia, imunodeficiências, reações adversas a medicamentos, alergia alimentar, imunoterapia, imunomodulação e vacinas. A versão impressa foi distribuída para cerca de 1.700 associados, além de instituições de saúde e ensino, e a versão digital foi acessada cerca de 350.000 vezes, seja na forma de HTML ou PDF. Tudo isso só foi possível em decorrência da estrutura criada, composta por um Corpo Editorial e um Grupo de Revisores de notoriedade acadêmica, ambos com componentes nacionais e estrangeiros, além do apoio incondicional da Diretoria da ASBAI.

Doença granulomatosa crônica: diagnóstico no primeiro episódio infeccioso

Objective: To report a case of chronic granulomatous dis- ease diagnosed during the first infectious episode in order to collaborate with the Brazilian Group for Immunodeficiency, in sensitizing the general pediatrician that the early diagno- sis of primary immunodeficiency results in better quality of life and longer life expectancy for the patients. Case Description: Male patient, 39 days, admitted to the pediatric emergency ward with fever for the last five days and irritability. On the following day, a cervical abscess was noted and a community Staphylococcus aureus was isolated. During hospital stay, other abscesses were observed in the skin and in the deep ganglia chains, with a slow response to antibiotics. Investigation of immunodeficiency was re - quested and chronic granulomatous disease was confirmed by quantification of superoxide anions and nitrobluetetrazo - lium tests. The patient was transferred to a specialized clinic for bone marrow transplantation, performed six months after diagnosis. Four months afterwards, the normalization of oxidative burst was noted, indecating the success of the transplantation.