Loredana Nilkenes Gomes da Costa

Role of innate immunity-triggered pathways in the pathogenesis of Sickle Cell Disease: a meta-analysis of gene expression studies.

Despite the detailed characterization of the inflammatory and endothelial changes observed in Sickle Cell Disease (SCD), the hierarchical relationship between elements involved in the pathogenesis of this complex disease is yet to be described. Meta-analyses of gene expression studies from public repositories represent a novel strategy, capable to identify key mediators in complex diseases. We performed several meta-analyses of gene expression studies involving SCD, including studies with patient samples, as well as in-vitro models of the disease. Meta-analyses were performed with the Inmex bioinformatics tool, based on the RankProd package, using raw gene expression data. Functional gene set analysis was performed using more than 60 gene-set libraries. Our results demonstrate that the well-characterized association between innate immunity, hemostasis, angiogenesis and heme metabolism with SCD is also consistently observed at the transcriptomic level, across independent studies. The enrichment of genes and pathways associated with innate immunity and damage repair-associated pathways supports the model of erythroid danger-associated molecular patterns (DAMPs) as key mediators of the pathogenesis of SCD. Our study also generated a novel database of candidate genes, pathways and transcription factors not previously associated with the pathogenesis of SCD that warrant further investigation in models and patients of SCD.

Evaluation of PCR in the diagnosis of canine leishmaniasis in two different epidemiological regions: Campinas (SP) and Teresina (PI), Brazil.

SUMMARY Using the polymerase chain reaction (PCR) test for diagnosis of canine leishmaniasis has greater sensitivity and specificity than culture and visualization of the parasite. This study compares PCR for the diagnosis of the genus and species of Leishmania with serological techniques used for the control of canine visceral leishmaniasis (CVL) in Brazil, considering two regions. We analysed peripheral blood samples collected from 195 dogs in the Campinas (SP) and Teresina (PI) regions. ELISA was performed as a serological method and PCR was performed using specific primers for the genus Leishmania spp. and the species Leishmania chagasi. In Campinas, a greater sensitivity of PCR (88.24%) (P = 0.0455) compared to Teresina (14.71%) (P < 0.0001) was observed, and an agreement was observed for Cohens kappa index (0.9096). Both PCR and ELISA showed discordance for sensitivity (Campinas 100%, Teresina 21.74%), specificity (Campinas 30.77%, Teresina 100%), positive predictive value (Campinas 68.97%, Teresina 100%), negative predictive value (Campinas 100%, Teresina 37.94%) and Cohens kappa index (0.1238). This study confirms the importance of PCR in analysis of the canine reservoir, and as an effective method for the detection of active and recent infection.

Evaluation of the immature platelet fraction contribute to the differential diagnosis of hereditary, immune and other acquired thrombocytopenias

The differential diagnosis of immune (ITP) and hereditary macrothrombocytopenia (HM) is key to patient management. The immature platelet fraction (IPF) represents the subset of circulating platelets with higher RNA content, and has been shown to distinguish hypo- from hyperproliferative thrombocytopenias. Here we evaluated the diagnostic accuracy of IPF in the differential diagnosis between HM and other thrombocytopenias in a population of patients with post-chemotherapy thrombocytopenia (n = 56), bone marrow failure (n = 22), ITP (n = 105) and HM (n = 27). TPO levels were also measured in HM and ITP matched for platelet counts. Platelet counts were similar in all patient groups. Higher IPF values were observed in both ITP (12.3%; 2.4–65.6%) and HM (29.8%; 4.6–65.9%) compared to hypoproliferative thrombocytopenias. IPF values were also higher in HM compared to ITP, yielding a diagnostic accuracy of 0.80 (95%CI 0.70–0.90; P < 0.0001) to distinguish these two conditions. Intra- and inter-assays reproducibility of IPF in HM patients revealed that this is a stable parameter. In conclusion, IPF is increased in HM compared to both ITP and other thrombocytopenias and contributes to the differentiation between ITP and HM. Further studies are warranted to understand the biological rationale of these findings and to its incorporation in diagnostic algorithms of HM.

Intestinal microsporidiosis in a reference center

In the last two decades, the scientific community has recognized the Microsporidia importance and associated it with serious infections in immunocompromised patients.1 Since its discovery in 1857, there was controversies in its phylogenetic classification, being recently classified as fungi.1,2 There have been described 150 genera and over 1300 species. Eight genera are described in human hosts: Enterocytozoon, Encephalitozzon, Pleistophora, Trachipleistophora, Vittaforma, Brachiola, Nosema, and Microsporidium. Fourteen species are associated with human diseases, including Enterocytozoon bieneusi and Encephalitozoon intestinalis. Microsporidia causes systemic and non-systemic diseases, with wide spectrum of clinical manifestation, principally chronic diarrhea.3 As little is known about microsporidia and its importance as infectious agent in immunocompromised patients, we conducted a retrospective study in 347 stool samples analyzed for the presence of microsporidiosis to describe the associated underlying diseases. The data were registered in the Parasitology Laboratory of UNICAMP (2011–2012). All patients for whom there was a medical request to exam the stools for the presence of microsporidia were included. Patients’ underlying disease was recorded. Out of the 347 [210 (60.52%) males] fecal samples analyzed, 140 (40.34%) were positive for microsporidia. The majority of the positive samples came from male patients [94 (67.14%)].

Intestinal Microsporidiosis In A Reference Center.

In the last two decades, the scientific community has recognized the Microsporidia importance and associated it with serious infections in immunocompromised patients.1 Since its discovery in 1857, there was controversies in its phylogenetic classification, being recently classified as fungi.1,2 There have been described 150 genera and over 1300 species. Eight genera are described in human hosts: Enterocytozoon, Encephalitozzon, Pleistophora, Trachipleistophora, Vittaforma, Brachiola, Nosema, and Microsporidium. Fourteen species are associated with human diseases, including Enterocytozoon bieneusi and Encephalitozoon intestinalis. Microsporidia causes systemic and non-systemic diseases, with wide spectrum of clinical manifestation, principally chronic diarrhea.3 As little is known about microsporidia and its importance as infectious agent in immunocompromised patients, we conducted a retrospective study in 347 stool samples analyzed for the presence of microsporidiosis to describe the associated underlying diseases. The data were registered in the Parasitology Laboratory of UNICAMP (2011–2012). All patients for whom there was a medical request to exam the stools for the presence of microsporidia were included. Patients’ underlying disease was recorded. Out of the 347 [210 (60.52%) males] fecal samples analyzed, 140 (40.34%) were positive for microsporidia. The majority of the positive samples came from male patients [94 (67.14%)].

Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages.

Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.