Márcio José Martins Alves

Increased IgG1, IFN-γ, TNF-α and IL-6 responses to Mycobacterium tuberculosis antigens in patients with Tuberculosis are lower after chemotherapy

Detection of specific antibodies may represent an additional tool in diagnosis of tuberculosis (TB). Herein, levels of serum IgG antibodies against early secreted antigenic target (ESAT-6), culture filtrate antigen-10 (CFP-10) and 16 kDa Mycobacterium tuberculosis antigens were measured in 33 active pulmonary TB patients (0M-TB), in 47 patients after 1-3 months of treatment (3M-TB) and in 22 patients who had completed 6 months of chemotherapy (6M-TB). The control group consisted of 38 BCG-vaccinated healthy controls (HC). In addition, IFN-gamma, tumor necrosis factor (TNF)-alpha, IL-6, IL-2, IL-4 and IL-10 production in PBMC cultures from 20 patients were measured following stimulation with the M. tuberculosis-specific fusion protein ESAT-6/CFP-10. Elevated levels of IgG against ESAT-6, CFP-10 and 16 kDa antigens were detected in 0M-TB and 3M-TB patients in comparison to the HC and 6M-TB groups. Receiver operating characteristic analysis indicated sensitivity of 85, 94 and 61% and specificity of 89, 87 and 89% for serum IgG against ESAT-6, CFP-10 and 16 kDa, respectively. A predominant IgG1 response to ESAT-6 and CFP-10 was observed in 0M-TB patients, together with ESAT-6/CFP-10-specific IFN-gamma, TNF-alpha and IL-6 that were produced at lower levels in the 6M-TB group. These data indicate that a T(h)1 phenotype against early phase Mtb antigens appears to be dominant in the peripheral blood of patients with active pulmonary TB that is reduced after chemotherapy. Taken together, ESAT-6/CFP-10 cytokine tests together with detecting IgG antibodies specific to ESAT-6 and CFP-10 may be the useful TB disease biomarkers in monitoring treatment success.

Prevalência de perda auditiva induzida por ruído em empresa metalúrgica

OBJETIVO: Analisar a prevalencia dos casos sugestivos de perda auditiva induzida por ruido em trabalhadores metalurgicos, potencialmente expostos ao ruido ocupacional (83 a 102 dB). METODOS: Estudo transversal conduzido em empresa metalurgica prestadora de servicos localizada no municipio do Rio de Janeiro, Brasil. Com o Programa de Conservacao Auditiva da empresa, foram analisados dados clinicos e ocupacionais de 182 trabalhadores, em atividade no periodo de novembro de 2001 a marco de 2002. Utilizou-se da classificacao acustica das unidades operacionais das empresas contratantes para a caracterizacao do status de exposicao ao ruido no ambiente de trabalho, em funcao da dificuldade de quantificacao em nivel individual. Foram testadas associacoes entre esses casos e variaveis tais como idade, tempo de atividade na empresa, tempo de exposicao ao ruido ocupacional e uso regular de equipamento de protecao individual, por meio de razao de prevalencia e analise de regressao logistica. RESULTADOS: A prevalencia de casos sugestivos de perda auditiva induzida por ruido foi de 15,9% e, na analise multivariada, foram identificadas associacoes significativas (p<0,05) entre esses casos e as variaveis idade e uso regular de equipamento de protecao individual. CONCLUSOES: Os resultados encontrados contribuiram para melhor compreensao do comportamento de algumas das principais caracteristicas relacionadas a perda auditiva induzida por ruido, em uma situacao particular de organizacao do trabalho, relativamente comum nas industrias brasileiras.

4-aminoquinoline analogues and its platinum (II) complexes as antimalarial agents.

The high incidence of malaria and drug-resistant strains of Plasmodium have turned this disease into a problem of major health importance. One of the approaches used to control it is to search for new antimalarial agents, such as quinoline derivates. This class of compounds composes a broad group of antimalarial agents, which are largely employed, and inhibits the formation of β-haematin (malaria pigment), which is lethal to the parasite. More specifically, 4-aminoquinoline derivates represent potential sources of antimalarials, as the example of chloroquine, the most used antimalarial worldwide. In order to assess antimalarial activity, 12 4-aminoquinoline derived drugs were obtained and some of these derivatives were used to obtain platinum complexes platinum (II). These compounds were tested in vivo in a murine model and revealed remarkable inhibition of parasite multiplication values, whose majority ranged from 50 to 80%. In addition they were not cytotoxic. Thus, they may be object of further research for new antimalarial agents.

Associação entre a contagem de linfócitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical diagnosticada pela histopatologia em mulheres infectadas pelo HIV

OBJETIVO: avaliar a associacao entre a contagem de linfocitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical em pacientes HIV positivas. METODOS: estudo transversal no qual foram incluidas 87 pacientes infectadas pelo HIV, confirmado por testes sorologicos previos. Todas eram portadoras do HPV cervical, diagnosticado por meio da reacao em cadeia da polimerase. Foram realizados anamnese, exame fisico e colposcopia de todas em pacientes. A biopsia do colo uterino foi realizada quando indicada pelo exame colposcopico. Os resultados histopatologicos foram classificados com neoplasia intra-epitelial de baixo grau (NIC I) ou de alto grau (NIC II e II). A associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao foi verificada por meio da comparacao de medias utilizando a analise da variância (ANOVA). RESULTADOS: entre as 60 pacientes biopsiadas foram encontrados 24 casos (40,0%) com NIC I, oito (13,3%) NIC II, tres (5%) NIC III, 14 (23,3%) pacientes somente com cervicite cronica e 11 (18,3%) apresentando efeito citopatico produzido pelo HPV, mas sem perda da polaridade celular. Isso equivale a 35 mulheres com lesao intra-epitelial de baixo grau (NIC I + HPV) (58,3%) e 11 (18,3%) com lesao intra-epitelial de alto grau (NIC II + NIC III). A associacao entre a media da contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial cervical nao foi significativa (p=0,901). CONCLUSOES: nao houve associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial do colo uterino, diagnosticada pelo exame histopatologico.

Fatores associados ao abandono de tratamento em saúde mental em uma unidade de nível secundário do Sistema Municipal de Saúde

A ocorrencia de abandono de tratamento psiquiatrico de nivel secundario e uma relevante questao clinica e economica. Taxas de abandono em psiquiatria sao mais altas que em outras especialidades medicas. Estudos publicados nos ultimos 15 anos tem identificado diversos fatores estatisticamente associados ao nao-comparecimento as consultas e/ou ao abandono de tratamento em saude mental. OBJETIVO: Avaliar variaveis demograficas, psicopatologicas, de diagnostico e tratamento enquanto possiveis preditores de abandono de tratamento em servico especializado de saude mental. METODO: Estudo observacional, avaliando 896 pacientes encaminhados, no periodo de abril de 2004 a marco de 2006, por Unidades Basicas de Saude da area de abrangencia do servico especializado. RESULTADOS: Pacientes solteiros, com idade abaixo da media do grupo (39,2 anos) e desempregados abandonaram significantemente mais o tratamento. Duas variaveis relativas ao exame psicopatologico se associaram significantemente com abandono de tratamento (memoria quanto ao passado recente e relacao do humor com fatos reais, atuais). Pacientes adultos que receberam diagnostico psiquiatrico de oligofrenia abandonaram significantemente menos e pacientes com diagnostico relativo aos transtornos da infância e adolescencia (F80-F98 da CID-10) tambem abandonaram significantemente mais o tratamento. O registro de comorbidade psiquiatrica e tratamento exclusivamente farmacologico se associaram a nao abandono do tratamento. CONCLUSAO: Os resultados confirmam achados de diferentes autores da evidencia de caracteristicas associadas a abandono ao tratamento. Tais achados sugerem que determinados subgrupos de pacientes necessitem de abordagens customizadas, a fim de influenciar positivamente sua adesao final ao tratamento indicado.

Comparação da assistência em saúde mental em unidades básicas de saúde com ou sem equipe do Programa de Saúde da Família

INTRODUCAO: O objetivo deste estudo foi comparar o perfil de assistencia em saude mental realizado por unidade basica de saude (UBS) com equipe de Programa de Saude da Familia (PSF) e sem equipe de PSF. METODO: Estudo observacional, avaliando pacientes encaminhados por UBS da area de abrangencia de um servico especializado de saude mental no periodo de abril de 2003 a marco de 2006. RESULTADOS: A UBS com equipe de PSF apresentou melhor padrao global de registros de dados, maior responsabilidade exclusiva do medico em suas referencias ao nivel especializado (p = 0,000), menor capacidade de retencao dos usuarios na UBS (p = 0,099), maiores taxas de abandono de tratamento em nivel secundario (p = 0,060) e menor percentual de contrarreferencia pela equipe especializada (p = 0,028). A taxa de concordância diagnostica global foi semelhante entre os dois modelos de UBS, com razoavel nivel de concordância (indice kappa de 44,5 e 43,0%, respectivamente, para UBS com e sem equipe PSF). CONCLUSAO: A UBS com equipe de PSF nao apresentou resultados compativeis com o que seria de se esperar, em funcao de sua hipotetica melhor qualidade de estrutura.

The impact of multidrug therapy on the epidemiological pattern of leprosy in Juiz de Fora, Brazil

We investigated the impact of multidrug therapy (MDT) on the epidemiological pattern of leprosy in Juiz de Fora, Brazil, from 1978 to 1995. Evaluation of 1,283 medical charts was performed according to the treatment regimen used in two different periods. Following the introduction of MDT in 1987, prevalence of leprosy decreased from 22 patients/10,000 inhabitants to 5.2 patients/10,000 inhabitants in 1995. Incidence rate of leprosy was lower in period II (1987-1995) than in period I (1978-1986). Decreasing prevalence and incidence appear to be related to drug efficacy rather than decreased case identification, since both self-referred and professionally referred treatment increased markedly from period I to period II. For both periods, multibacillary leprosy was the most frequent clinical form of the disease (+/-68%), and the main infection risk factor identified was household contact. Leprosy is predominantly manifested in adults, but an increase in the number of very old and very young patients was observed in period II. The MDT program has been effective both in combating leprosy and in promoting awareness of the disease.

Prevention of lower-limb lesions and reduction of morbidity in diabetic patients.

Objective To assess the impact of a diabetic foot outpatient clinic on reducing the morbidity of this disease, with emphasis on lower-limb lesions. Methods This was a prospective observational study with a target population of 30 cases out of a total of 77 patients in the diabetic foot outpatient clinic. The inclusion criterion was that data relating to laboratory tests, clinical examinations, neuropathic and vascular tests and the elbow-arm index needed to be available from all the patients, with repetition after 18 months of follow-up, so as to analyze their evolution. The statistical analysis was done using the McNemar chi-square test for dependent samples. Results The patients’ mean age was 61 years. All of them had type 2 diabetes mellitus (DM), which had started 14.5 years previously, on average, and 20% had neuropathies. After 18 months, there was no change in the frequency of lesions in diabetes target organs (p = 1.000) or in the neuropathy rate (p = 1.000). However, there were significant improvements in neuropathic symptoms, from 70% to 36.7% (p = 0.035), and in peripheral arterial disease, from 73.3% to 46.7% (p = 0.021). There was also a decrease in ulcers from 13.3% to 10% (p = 1.000). Conclusions Creation of specialized outpatient clinics for prevention of diabetic foot is a viable investment, which has low cost compared with the high costs generated through the complications from this disease. This approach noticeably improves the patients’ quality of life, with reduction of morbidity.

Diagnostic accuracy of rKLO8 versus rK26 ELISAs for screening of canine visceral leishmaniasis

Canine visceral leishmaniasis (CVL) represents an important public health issue. Despite numerous diagnostic tests available, CVL diagnosis still needs to be improved to achieve a more accurate detection rate. Recently, rKLO8, a new antigenic protein of Sudanese Leishmania donovani, was studied for the first time in diagnosis of human visceral leishmaniasis (HVL) and showed good performance. The present study aimed to evaluate serum reactivity to rKL08 and the reference antigen rK26, and to compare both diagnostic proteins with the combined DPP® CVL rapid test and ELISA (EIE-Bio-Manguinhos) confirmatory test, which are both recommended for the diagnosis of CVL in Brazil. Serum samples of dogs were grouped into: (I) DPP®/EIE negative (n=100) and (II) DPP®/EIE positive sera (n=100). Enhanced levels of IgG, mainly IgG2, to both rKLO8 and rK26 were found in group II. Sensitivity was 68% and 77% and specificity was 92% and 91%, for rKLO8 and rK26 antigens, respectively. Moreover, the combination of rKLO8 and rK26 antigens (rKLO8+rK26) exhibited higher sensitivity (85%) and specificity (93%). Thus, our results show that apart from the improved diagnostic power of rKLO8 in HVL, this new antigen is also suitable for the diagnosis of CVL. Further, the combination of rKLO8 and rK26 antigens increases the diagnostic accuracy of CVL.

Langerhans cell density in cervical intraepithelial neoplasia associated with human papillomavirus infection in HIV-infected and HIV-noninfected Brazilian women.

Objective Local immunity plays an important role in the cervical defense mechanisms that prevent the development of cervical intraepithelial neoplasia. The objective of this study was to determine the involvement of local immunity by evaluating Langerhans cell (LC) density in cervical biopsies of human immunodeficiency virus (HIV)-positive and HIV-negative women. Materials and Methods A cross-sectional study was developed by including HIV-positive and HIV-negative women. All patients presented human papillomavirus DNA from the uterine cervix, which was detected by polymerase chain reaction or hybrid capture II. Cervical biopsies were assessed for LC density and cervical intraepithelial neoplasia. Langerhans cells were identified by immunohistochemistry using anti-CD1a and anti-S100 antibodies. Associations among cervical LC density, the type of cervical lesion, CD4+ lymphocyte count, and HIV viral load were analyzed using logistic regression (SPSS, version 12.0). Results Seventy-seven women (40 seropositive and 37 seronegative) were enrolled. The mean ± SD LC density identified with the anti-CD1a antibody was 0.80 ± 0.7 cells versus 2.6 ± 1.6 cells (P < 0.0001), whereas the mean ± SD LC density identified by the anti-S100 antibody was 1.3 ± 1.0 cells versus 3.6 ± 1.7 cells (P < 0.0001) among the HIV-positive and HIV-negative women, respectively. There were no associations between LC density and HIV viral load, CD4+ lymphocyte count, or human papillomavirus genotype (P > 0.05). In a logistic regression model, HIV infection was the only factor independently associated with a decrease in LC density. Conclusions Human immunodeficiency virus infection was found to be an independent factor that explains the decrease in local immunity in the uterine cervix, which could allow the development of cervical lesions. This effect was not associated with CD4+ lymphocyte count or HIV viral load.