José Renan da Cunha Melo

II Consenso Brasileiro em Doença de Chagas, 2015

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

2 nd Brazilian Consensus on Chagas Disease, 2015

Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research .

Hyperbaric oxygen therapy aggravates liver reperfusion injury in rats

PURPOSE To evaluate the effects of hyperbaric oxygen (HO) therapy in the protection against liver ischemia/reperfusion injury. METHODS Thirty-two male Wistar rats were divided into four groups of eight animals each: group A - laparotomy and liver manipulation, group B - liver ischemia and reperfusion, group C - HO pretreatment for 60 min followed by liver ischemia and reperfusion, and group D - pretreatment with ambient air at 2.5 absolute atmospheres for 60 min followed by liver ischemia and reperfusion. Plasma was assayed for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). Intra-arterial blood pressure was monitored continuously. Myeloperoxidase activity in the liver and lung was assessed 30 min after reperfusion. RESULTS Plasma AST, ALT and LDH increased after reperfusion in all animals. Plasma ALT values and myeloperoxidase activity in the liver parenchyma were higher in HO-pretreated animals than in groups A, B and D. HO had a negative hemodynamic effect during liver reperfusion. CONCLUSION Liver preconditioning with hyperbaric oxygen therapy aggravated liver ischemia/reperfusion injury in rats as demonstrated by plasma ALT and liver myeloperoxidase activity.

Mast cells are crucial in the resistance against Toxoplasma gondii oral infection

During oral infection, mucosal immunity assumes a predominant role. Here, we addressed the role of mast cells (MCs), which are mainly located in mucosa during oral infection with Toxoplasma gondii, using MC‐deficient (W/Wv) mice. We show that in the absence of MCs the resistance of W/Wv mice to oral infection was considerably reduced. W/Wv mice uniformly succumbed within 15 days of infection after administration of cysts of the ME49 strain of T. gondii. The rapid lethality of T. gondii in W/Wv mice correlated with a delayed Th1‐cell response, since IFN‐γ and IL‐12 levels peaked in the later phase of the infection. In vitro, BM‐derived MCs were able to recognize parasite lysate in a MyD88‐dependent way, reaffirming the role of this TLR adapter in immune responses to T. gondii. The importance of MCs in vivo was confirmed when W/Wv mice reconstituted with BM‐derived MCs from control mice retrieved an early strong Th1‐cell response and specially a significant IL‐12 production. In conclusion, MCs play an important role for the development of a protective immune response during oral infection with T. gondii.

Matriz de competências essenciais para a formação e avaliação de desempenho de estudantes de medicina

OBJETIVO: O artigo propoe uma matriz de competencias essenciais para valorizacao e intencionalidade dos percursos academicos e como referencia de processos avaliativos dos estudantes. METODOLOGIA: O estudo apresenta delineamento quanti-qualitativo. Apos revisao integrativa da literatura e pesquisa documental, foi elaborada e consolidada a versao inicial. O teste piloto com 12 professores, membros do Colegiado de Graduacao do curso medico da UFMG, contribuiu para ajustes do documento. A validacao da matriz foi orientada pela metodologia Delphi, com avaliacao docente individual, por via eletronica e utilizacao da ferramenta Googledocs. RESULTADOS: Houve consenso entre os 112 professores avaliadores para aprovacao da matriz, composta por seis grandes dominios - profissionalismo; relacionamentos interpessoais e comunicacao; atencao integral a saude da pessoa; organizacao de sistemas de saude e atencao em saude publica; gestao do conhecimento; conhecimento medico -, 28 subdominios e 204 descritores dos conhecimentos, habilidades e atitudes essenciais na formacao do medico, durante sua graduacao. CONCLUSOES: Considera-se que a matriz contribuira na qualificacao da formacao medica e na certificacao das competencias para o atendimento adequado as demandas de saude, dentro de padroes de excelencia tecnica e responsabilidade social.

Alterações quantitativas das células neuroendócrinas no Megacólon chagásico

Silver stainings (Masson-Fontana and Sevier- Munger methods) were applied to sections from surgical specimens of chagasic megasigmoid. The distribution and the number of both enterochromaffin (EC) cells and EC plus argyrophyl (ARG) cells were studied. Both of them, EC and ARG cells presented a predominantly basal localization in mucosal glands of megasigmoids (n = 16) and Controls (n= 8) The counting of EC cells and EC plus ARG cells has shown that only the group EC plus ARG cells was significantly increased. Morphometric studies revealed a significant increase in the thickness of the muscle and mucosa layers of the megasigmoid when compared to the Controls.

The skin migratory stage of the schistosomulum of Schistosoma mansoni has a surface showing greater permeability and activity in membrane internalisation than other forms of skin or mechanical schistosomula

Skin schistosomula can be prepared by collecting them after isolated mouse skin have been penetrated by cercariae in vitro. The schistosomula can also migrate out of isolated mouse skin penetrated by cercariae in vitro and from mouse skin penetrated by cercariae in vivo. Schistosomula can also be produced from cercariae applied through a syringe or in a vortex. When certain surface properties of the different forms of schistosomula were compared, those migrating from mouse skin penetrated by cercariae in vivo or in vitro had greatly increased permeability to membrane impermeant molecules such as Lucifer yellow and high molecular weight dextrans. These migrating forms also possessed surfaces which showed greatly enhanced uptake into internal membrane vesicles of the dye FM 143, a marker for endocytosis. This greatly enhanced activity and permeability of the surfaces of tissue migrating schistosomula is likely to be of great importance in the adaptation to the new host.

Análise ecocardiográfica da função diastólica do ventrículo esquerdo após infarto do miocárdio em ratos

OBJECTIVE: To evaluate the diastolic left ventricular function by echocardiography one and three weeks after acute myocardial infarction (AMI). METHOD: Nineteen Wistar rats (mean 209 g) were utilized. After anesthesia with ketamine (50mg/kg) and xylazine (10mg/kg), the left coronary artery was ligated after left thoracotomy to cause myocardial infarction. The animals were divided in two groups: group A (control, n=7) and group B (n=9). Echocardiographic evaluation was undertaken in the control group and one week (B1, n=9) and three weeks (B3, n=8) post-AMI in group B animals. The cardiac function was evaluated using a 21275 A HP Sonos 1500 Echocardiography equipped with 7.5/5.5 MHz transducer. Diastolic function was evaluated by transmitral flow, by analysis of the A wave, E wave and atrial left volume (LAV). Histological specimens were evaluated on third week. RESULTS: There were no differences on E wave analyses (A=62cm/s, B1=65cm/s, B3=69cm/s) or A wave analyses (A=43cm/s, B1=40cm/s, B3=41cm/s) between the groups. There was an increase in LAV; A vs B1 and A vs B3 (A=0.05mL vs B1=0.15mL, p=0.04 e A vs B3=0.14mL, p=0.01). Histological examination confirmed AMI in all animals. CONCLUSIONS: The LAV may be useful to assess the diastolic function in rats with AMI. LAV could reflect increases in left ventricular end-diastolic pressure secondary to systolic or diastolic dysfunction.

Portal cholangiopathy: case report

The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

Regional Blood Flow after Intravenous Administration of Scorpion Venom in Rats

The accidents by scorpion stings in Brazil, particularly in Belo Horizonte, capital of Minas Gerais state are caused by Tityus serrulatus species and accounts for fatal stings, especially in children and elderly people. The death in severe evenomation is caused by a circulatory shock, associated with respiratory and cardiovascular arrhythmias, cardiogenic shock, pulmonary edema, respiratory depression, acid-base disorders and serious coagulation disturbance. Our group has been involved in the study of several aspects of the mechanism of action of scorpion toxins injected in animals. However some aspects of the envenomation, such as, the regional blood flow distribution to several organs need further studies. The aim of the present work was to determine the flow to different organs after intravenous injection of the gamma fraction of toxins isolated from the T. serrulatus scorpion venom adding more information that would contribute to a better understanding of the pathophysiology of scorpion sting envenomation. The fluorescent microspheres deposition technique was used to evaluate the regional blood flow and regional vascular resistance of several organs in anesthetized rats after Tityus serrulatus scorpion venom (Tx) injection. Fluorescent microspheres of different colors were injected into the left ventricle through the carotid artery. Reference blood samples were collected from the left femoral artery at baseline (before) and 5, 15 and 30 min after toxin injection. Tissue samples from the adrenal gland, spleen, brain, heart, liver, ileum, mesentery, muscle, skin, lung and kidney were harvested and prepared for fluorescent measurements using a spectrophotometer. Hemodynamic parameters were monitored continuously. Blood flow variation was detected in the tissue samples and were different among the organs. The most common finding was a decrease in flow, varying with time and the severity of the intoxication. However, intrinsic mechanisms of auto-regulation of blood flow and vascular resistance possibly protect the heart and the brain from hypoperfusion after Tx injection.