Rubens Pontello

Analysis of the CC chemokine receptor 5 delta32 polymorphism in a Brazilian population with cutaneous leishmaniasis.

Abstract:  Patients with mucocutaneous leishmaniasis (MCL) show a vigorous T‐cell immune response against Leishmania braziliensis. Because the Th response is associated with inflammation, the non‐functional CC chemokine receptor 5 (CCR5) may rely in a less severe inflammatory state. The aim of this study was to investigate the CCR5 gene in a Brazilian population with leishmaniasis compared with healthy control subjects and to determine the progression from cutaneous to MCL in the Δ32 allele carriers. Among 100 patients with Montenegro skin test and indirect immunofluorescence assay (IIF) values positive for leishmaniasis, there were 32% women and 68% men. The patients were 89% CCR5/CCR5, 10% CCR5/Δ32, and 1% Δ32/Δ32, while healthy subjects showed a 91% incidence of CCR5/CCR5, 8% of CCR5/Δ32, and 1% of Δ32/Δ32. The CCR5/CCR5 patients (89%) showed a large spectrum of clinical manifestations, where 22.47% had active mucous lesions and 77.53% had cutaneous lesions. In this work, the Δ32 allele carriers (10%) showed only cutaneous manifestations when compared with wild‐type individuals. Finally, with regard to the Δ32 allele carriers, a less severe spectrum of clinical manifestations was observed in comparison with wild‐type individuals. Although a lack of mucocutaneous lesions was evident among Δ32 allele carriers, the number of individuals studied was small. Therefore, further investigations are needed to elucidate the role of CCR5 in the clinical aspects of leishmaniasis.

Intradermal vaccination of adults with three low doses (2 µg) of recombinant hepatitis B vaccine. I. Seroconversion rate and adverse effects

A total of 250 dentists (53.6% men and 46.4% women), with a mean age of 35.1 ± 9.8 years, were submitted toserological tests for the diagnosis of hepatitis B (HB) – HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe – using aradioimmunoassay. One or more of these markers were detected in 78 individuals (31.2%) who were excluded fromthe group to be vaccinated. Of the 172 HB-susceptible individuals, 135 (78.5%) responded to the call and wereintradermally injected with three 2 µg doses of the Belgian HB recombinant vaccine, applied at an interval of onemonth between the 1st and 2nd dose and of five months between the 2nd and 3rd dose. A new determination of HBmarkers carried out 50 days after the 3rd dose showed that 110 (81.5%) individuals had become anti-HBs positive(65.5% good responders and 34.5% poor responders). Mean serum anti-HBs titer of these 110 dentists was 42.4 US/N, similar in both sexes. The adverse effects analyzed in 106 dentists were: (a) local: pain (12.3%), burningsensation (14.1%), pruritus (25.5%), erythema (28.3%), local heat (18.9%), and a hypochromic spot (32.1%); (b)systemic (4.7%): discomfort in two patients, and fever, anorexia, and asthenia in one patient each. Intradermaladministration of a fourth 2 µg vaccine dose to 39 dentists (poor or non-responders) increased the total number ofanti-HBs-positive individuals from 110 (81.5%) to 114 (84.4%), with the number of good responders increasingfrom 72 (65.5%) to 85 (74.6%). We conclude that the Belgian recombinant vaccine applied in the scheme used hereinduces a high rate of seroconversion and causes only mild and transitory adverse effects.

Intradermal vaccination of adults with three low doses (2 µg) of recombinant hepatitis B vaccine. II. Persistence of immunity and induction of immunologic memory

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> or = 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 micrograms booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB--with intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine at 0, 1, and 6 months--carried out eight years before in 51 dentists.

Dermatite esfoliativa: estudo clínico-etiológico de 58 casos

FUNDAMENTO: Dermatite esfoliativa e sindrome cutânea caracterizada por eritema e descamacao generalizados, que pode ser consequente ou estar associada a varias doencas dermatologicas previas, doencas sistemicas ou reacoes medicamentosas. OBJETIVOS: Relatar a frequencia das diferentes causas e caracteristicas clinicas associadas a dermatite esfoliativa nos pacientes atendidos no Setor de Dermatologia do Hospital Universitario Regional do Norte do Parana, da Universidade Estadual de Londrina. METODOS: Foram revisados os registros de pacientes com diagnostico de dermatite esfoliativa diagnosticados no Hospital Universitario Regional do Norte do Parana no periodo de 10 anos. RESULTADOS: Foi encontrado o total de 58 pacientes com diagnostico de dermatite esfoliativa, com idade media de 56,89 anos. Em 33 pacientes, foi definida uma dermatose como causa (psoriase, 11 casos; dermatite de contato, nove casos; eritrodermia ictiosiforme congenita, tres casos; dermatite seborreica, cinco casos; dermatite atopica, tres casos; pitiriase rubra pilar, dois casos). Reacoes a drogas foram observadas em 11 pacientes. Em 14 casos (24%) nao foi possivel determinar a causa basica. CONCLUSOES: Numa amostra de pacientes atendidos num servico de referencia em dermatologia, a dermatite esfoliativa foi ocorrencia pouco comum, e a maior parte dos casos estava relacionada a doencas dermatologicas.

Cross-sectional study of the microbiological safety profile of reusing hyaluronic acid fillers

Facial filling with hyaluronic acid (HA) is a dermatological procedure that has been emerging today. There are not many references regarding safety of reusing the remaining product for later touch‐up in the same patient.