Ramon de Almeida Kruschewsky

Impaired T Helper 2 Response to Aeroallergen in Helminth-Infected Patients with Asthma

Helminthic infections have been shown to inhibit allergy skin-prick tests and to modify the course of asthma. We evaluated Dermatophagoides pteronyssinus-specific immune responses in patients with asthma by measuring levels of T helper 2 (Th2) cytokines in peripheral blood mononuclear cell (PBMC) cultures. PBMCs from Schistosoma mansoni-infected patients with asthma living in an area of polyhelminthic endemicity produced lower levels of interleukin (IL)-5 and IL-4 in response to D. pteronyssinus antigen (Ag) 1 than did PBMCs from helminth-free patients with asthma. In contrast, D. pteronyssinus Ag 1-specific production of IL-10 was higher in helminth-infected patients than in helminth-free patients. The addition of recombinant human IL-10 to D. pteronyssinus Ag 1-stimulated cultures of PBMCs from helminth-free patients led to down-modulation of production of IL-5. After helminth-infected patients with asthma received antihelminthic treatment, there was down-modulation of D. pteronyssinus Ag 1-specific production of IL-10 in vitro. S. mansoni-infected patients with asthma produce lower levels of Th2 cytokines than do helminth-free patients with asthma, and this modulation is likely done by IL-10.

Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: a randomized crossover clinical trial

BACKGROUNDnLow back pain is highly prevalent in patients with HTLV-1. The effects of physical activity on this condition are not known, but postural misalignment and motor deficits are frequently present.nnnOBJECTIVESnTo assess the effect of Pilates exercises on chronic low back pain in these patients, and its impact on quality of life.nnnMETHODSnA randomized crossover clinical trial was conducted, involving 22 patients from a reference center in Salvador, Bahia, Brazil. The VAS was used to evaluate the effect of Pilates on pain intensity and the SF-36 to assess its impact on quality of life.nnnRESULTSnOur results provide evidence of positive effects on pain intensity and almost all domains of quality of life when patients followed the Pilates exercise program described.nnnCONCLUSIONnThe Pilates method may be a useful tool in alleviating the symptoms of low back pain, and had a significant impact on quality of life in this sample of patients.

Impact of depression on quality of life in people living with human T cell lymphotropic virus type 1 (HTLV-1) in Salvador, Brazil.

PurposeA previous study found the prevalence of depression in HTLV-1-infected patients to be approximately 30%, but few studies have attempted to correlate depression with quality of life (QOL) in these patients. The present study investigates the association between depression and QOL in people living with HTLV-1.MethodsA clinical-epidemiological questionnaire, the Mini International Neuropsychiatric Interview and the WHOQOL-Bref were applied to 88 HTLV-1-infected patients (32 with TSP/HAM) at the HTLV Center of the Bahiana School of Medicine and Public Health, Salvador, Brazil.ResultsThe prevalence of depression among people living with HTLV-1 was 34.1%. Depression was significantly associated with a poor QOL in the physical, psychological, social relationship and environment domains, when controlling for other variables, such as gender, age, time of knowledge of serological diagnosis and presence of tropical spastic paraparesis/HTLV-1associated myelopathy (TSP/HAM). Moreover, patients with TSP/HAM experienced a reduction in their QOL in the physical, psychological and environment domains.ConclusionOur results showed that depression negatively affects the quality of life of people living with HTLV-1, regardless of the presence of TSP/HAM. Since it is possible to improve a patient’s QOL by treating depression, psychological evaluations are strongly recommended as a measure to integrate the treatment protocols of HTLV-1 intervention programs.

Quality of life (QOL) and depression in HTLV-1 carriers

Material and methods A cross-sectional study was carried out from March to November, 2009 in Salvador, Brazil. The instruments used were a questionnaire for the collection of clinical and epidemiological data, the Mini International Neuropsychiatric Interview, Brazilian Version 5.0.0 (M.I.N.I.) to estimate the rate of depression and the short version of the WHO quality of life scale (WHOQOL-BREF).

HTLV-1 proviral load of HAM/TSP patients according to new diagnostic criteria of HAM/TSP

A high HTLV-1 proviral load is described in HTLV-1-associated diseases, especially HAM/TSP. However, the cutoff value to define high levels of HTLV-1-proviral load is not well established.

Dr. James Matthew Lipton, 1938-2016

Dr. Jim Lipton died on the 10th of July this year. It was a great loss not only to his family and friends but also to the scientific world. The facts and dates of his life are well expressed in the obituary written by his daughter reprinted above, with permission. Many years ago, when Jim and his buddy, S.M. ‘Don’ McCann were both Professors of Physiology in Dallas, they suggested we start a new NIM journal. I was opposed to the idea, because there were already too many journals proliferating at a dizzying pace. The success of the ISNIM journal proved that they were right and I was wrong. One could not imagine two more disparate personalities, but they always managed to work together harmoniously. Both were geniuses, Jim soft-spoken and modest ... and Don, with an amazing photographic memory, boisterous (Don was first my professor at the University of Pennsylvania, and later, my student and honorary lecturer and awardee of the Novera Spector lectureship). A book needs to be written about Don, but most observers agree that he should have shared at least one Nobel Prize. Both remained my good friends all their lives. At one point I went to an international congress organized by Jim, only to find that he had dedicated this meeting to me! I hope that his friends and especially his wife, Luby, will I have been asked to write an obituary-memoriam for the cofounder of Neuroimmunomodulation (NIM) , who died on the 10th of July this year. Below is an obituary written by Jim’s daughter and reprinted with her permission, followed by some informal remembrances from Luby, his widow, and me.

Immunological Profile in Individuals with Schistosomal Myeloradiculopathy

Background: Schistosomal myeloradiculopathy (SMR) is the most serious ectopic presentation of Schistosoma mansoni infection. The pathogenesis occurs mainly via the host inflammatory response to the eggs of the parasite that are stuck in the central nervous system, and the diagnosis is generally made by the exclusion of other neurological diseases. Objective: We aimed to evaluate the immune status of SMR patients and to identify a marker for SMR diagnosis. Methods: We enrolled 15 patients with a presumptive diagnosis of SMR, and the control groups included 17 patients with myelopathy associated with human T cell lymphotropic virus type 1 (HTLV-1) and 11 with other neurological disorders. The determination of soluble egg antigen-specific IgE and the levels of cytokines from Th1, Th2, Th17 and T-regulatory cell profiles and the chemokines MIP-1a and RANTES were measured in the cerebrospinal fluid (CSF) and serum using an ELISA technique. Results: We observed that SMR leads to an increase in IgE levels in the CSF compared to serum, and the levels of IL-13 and MIP-1α were significantly higher in the CSF and serum of the SMR patients than in the patients with HTLV-1-associated myelopathy. The levels of MIP-1α and RANTES were higher in the CSF than in the serum of the SMR group. The ratio between levels of IL-13, MIP-1α and RANTES over IL-10 was positive in the CSF of the SMR patients. Conclusions: These results indicate that S. mansoni-specific IgE in the CSF is a promising marker for the diagnosis of SMR and that the cytokines and chemokines associated with the Th2 profile may be important factors in the immunopathogenesis of SMR.

Incidence of tropical spastic parapesis/ HTLV-1 associated myelopathy/ (TSP/HAM) in patients followed in a Reference center in Salvador, Brasil

It is estimated that currently 5 to 10 million people are infected with HTLV-1 worldwide. In Brazil, Salvador is the city with the highest prevalence of HTLV-1 (2% in women and 1.2% in men). Tropical spastic paraparesis/ HTLV associated myelopathy (TSP/HAM) is an insidious and disabling chronic neurological disease. The incidence of TSP/HAM varies in different geographical regions with low rate in Japan and Caribbean islands and higher in Minas Gerais, Brazil. The incidence of TSP/HAM among patients attending the CHTLV in Salvador/BA, from 22 to 2013 was estimated. The outcome of interest was the evolution from asymptomatic status for TSP/HAM diagnosis, which was based on the Belem criteria. The follow-up for individuals that remained asymptomatic was the time between the year of the last medical consultation and the year of the HTLV-1 serological diagnosis and for those that developed TSP/HAM the time between the year of diagnosis of TSP/HAM and the year of HTLV-1 serological diagnosis. The exclusion criteria were a diagnosis of TSP/HAM at the first medical consultation, records with incomplete data and TSP/HAM possible diagnosis. From a sample of 243 patients, 91 were included. Two patients developed TSP/HAM definite and four had TSP/HAM probable diagnosis. The incidence density of TSP/HAM definite was 6.9 and 13 per 1,0 HTLV-1 infected individuals per year, respectively. The cumulative incidence to TSP/HAM definite was 2.29% while to TSP/HAM probable was 4.39%. The incidence rate found herein was higher than that observed in previous studies in Japan and Caribbean, however, similar to that reported in Brazil. More accurate cohort studies should be conducted to measure the actual risk of developing this disease.

Assessment of functional capacity and flexibility of patients infected with HTLV-1

HTLV-1 infects 5 to 10 million people worldwide. Tropical spastic paraparesis / HTLV associated myelopathy (TSP/HAM) is a neurological disease, that impairs functional capacity, daily life activities and quality of life of infected individual. Objective: To evaluate the functional capacity and flexibility of patients infected with HTLV-1. Methods: Sample was comprised of 65 HTLV-1-infected individuals (41 asymptomatic, 24 TSP/HAM definite) followed at the referral center for HTLV of Bahiana School of Medicine and Public Health in Salvador, Brazil. Twenty-six uninfected individuals were enrolled as controls. Inclusion criteria were age from 18 to 65 years, HTLV-1 serology (ELISA and Western Blot) positive (HTLV-group) and negative (uninfected individuals) and for HTLV-1 infected individuals clinical status defined according to the Belem criteria for the HAM/TSP diagnosis. Patients with stroke or trauma history, those coinfected with HIV, HBV, HCV or syphilis were excluded. The functional capacity of all individuals was assessed using the Group of Latin American development for Maturity (GDLAM) protocol: i) 10 Meter Walking Test, ii) time to get up from a chair, iii) time to get up from the prone position and iv) time to get up from a chair and walk around the house. Test performances were expressed in seconds, and used to calculate the GDLAM index. The flexibility was assessed using the sit and reach test, measured in centimeters. Results: The GDLAM index was significantly lower in the uninfected controls (20.80±3.75 seconds) compared to both asymptomatic (26.45±5.99 seconds) and TSP/HAM patients (51.37±14.99 seconds) (p=0, 1). Moreover, the flexibility of uninfected controls (29.16 ± 7.52cm) was significantly higher compared to asymptomatic HTLV-1-infected individuals (23.36 ± 7.97cm) and HAM/TSP patients (14.45 ± 7.52cm) (p=0, 1). Conclusions: HTLV-1-infeted individuals have an impairment of their functional capacity and flexibility when compared to uninfected individuals, especially patients with TSP/HAM. Interestingly, HTLV-1 asymptomatic individuals also had a decrease of both functional capacity and flexibility, prior to clinically detectable signs of myelopathy.