Immunodominant Antigens of Leishmania chagasi Associated with Protection against Human Visceral Leishmaniasis

One of the most striking features of infection by Leishmania chagasi is that infection leads to a spectrum of clinical outcomes ranging from asymptomatic infection to active disease. The existence of asymptomatic infected people has served as an incentive to believe that an effective vaccine is possible, but unfortunately no successful immunological characterization of such cases was obtained. Patients recovered from visceral leishmaniasis show a similar immunological profile to asymptomatic infected individuals and both exhibit a strong cell-mediated immune response against Leishmania antigens and are resistant to disease. Since the past decade several approaches were undertaken to try to shed light on the immunological profile associated with such “resistance” to infections, notwithstanding antigenic recognition profile associated to resistance to infection was not successfully explored. In the present manuscript we describe a specific IgG recognizing pattern associated with resistant individuals (asymptomatic infected people and recovery patients to visceral leishmaniasis). These data highlight the possibility of using specific proteins in serological tests for the identification of asymptomatic infected individuals

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Correlações entre protocolos de determinação do limiar anaeróbio e o desempenho aeróbio em nadadores adolescentes Correlations between anaerobic threshold determination protocols and aerobic performance in adolescent swimmers

O objetivo do presente estudo foi correlacionar as velocidades de limiar anaeróbio (LAn) obtidas a partir de concentrações fixas de lactato (VLAn 4 e VLAn 3,5mM), velocidade de lactato mínimo (VLac min) e velocidade crítica (VC) determinada a partir de diferentes distâncias e número de coordenadas: VC1 (50/100/200m), VC2 (100/200/400m), VC3 (50/100/200/400m) e VC4 (200/400m) com o desempenho nos 400m(s) em nadadores adolescentes. Fizeram parte da amostra 15 nadadores (10 meninos e cinco meninas = 14,7 &plusmn; 0,7 anos; 61,9 &plusmn; 8,5kg; 171,1 &plusmn; 8,8cm) de nível nacional, com experiência entre cinco e sete anos na natação competitiva. Para análise das correlações entre os índices e o desempenho nos 400m(s) foi utilizado o coeficiente de correlação de Pearson. O nível de significância adotado foi de p < 0,01. As correlações entre a VLAn 4mM, VLAn 3,5mM, VLac min e o desempenho nos 400m(s) foram de r = -0,63, r = -0,90 e r = -0,91, respectivamente (p < 0,01). As correlações entre a VC1 (50/100/200m), VC2 (100/200/400m), VC3 (50/100/200/400m), VC4 (200/400m) e o desempenho nos 400m(s) foram: r = -0,62, r = -0,97, r = -0,98 e r = -0,94, respectivamente (p < 0,01). Sugere-se que o LAn determinado a partir da concentração fixa de lactato de 3,5mM, bem como a VLac min e a VC obtidas por meio de distâncias maiores parecem ser os mais adequados índices preditores do desempenho aeróbio nos nadadores adolescentes estudados. Além disso, o número de coordenadas parece não influenciar a relação entre a VC e desempenho aeróbio.<br>The purpose of this study was to correlate the anaerobic threshold speeds (ATS) obtained from fixed lactate blood concentration (ATS 4 e ATS 3.5 mM), lactate minimum speed (Lac minS) and the critical speed (CS) determined from different distances and number of coordinates: CS1 (50/100/200 m), CS2 (100/200/400 m), CS3 (50/100/200/400 m) and CS4 (200/400 m) with the performance in 400 meters (s) in adolescent swimmers. The sample was constituted by 15 swimmers (10 boys and five girls = 14.7 &plusmn; 0.7 years; 61.9 &plusmn; 8.5 kg; 171.1 &plusmn; 8.8 cm) of national level, with five to seven years of experience in competitive swimming. The correlation between the indexes and the performance in 400 m (s) was made using Pearson correlation coefficients. Significance was set at p < 0.01. The correlations between ATS 4 mM, ATS 3.5 mM, Lac minS and the performance in 400 m (s) were: r = -0.63, r = -0.90 e r = 0.91, respectively (p < 0.01). The correlations between CS1 (50/100/200 m), CS2 (100/200/400 m), CS3 (50/100/200/400 m), CS4 (200/400 m) and the performance in 400 m (s) were: r = -0.62, r = -0.97, r = -0.98 e r = -0.94, respectively (p < 0.01). We suggest that ATS obtained from fixed lactate blood concentration of 3.5 mM, as well as Lac minS and the CS obtained through larger distances seem to be the most fitted indexes of prediction of the aerobic performance in the studied adolescent swimmers. Additionally, the number of coordinates seems no influencing the relation between CS and aerobic performance

Actinic cheilitis and squamous cell carcinoma of the lip: clinical, histopathological and immunogenetic aspects Queilite actínica e carcinoma espinocelular do lábio: aspectos clínicos, histopatológicos e imunogenéticos

Actinic cheilitis is the main precancerous lesion of the lip. Squamous cell carcinoma of the lip is reported together with oral carcinomas in the Brazilian official statistics. Overall, they account for 40% of the head and neck carcinomas. In general, physicians and dentists know little about what causes oral tumor development and progression. Tumor suppressor genes and cell proliferation regulatory proteins play a role in the progression of actinic cheilitis to squamous cell carcinoma and in its biological behavior. Knowledge on prognostic and diagnostic markers has a positive impact on the follow-up of these patients.<br>Queilite actínica é a principal lesão pré-neoplásica do lábio. O carcinoma espinocelular do lábio é incluído nas estatísticas brasileiras junto com os cânceres de boca e, em conjunto, somam 40% dos cânceres de cabeça e pescoço. Há certo desconhecimento médico e odontológico em geral quanto aos fatores relacionados à carcinogênese e à progressão de tumores de boca. Genes de supressão tumoral e proteínas regulatórias de proliferação celular exercem papel na evolução da queilite actínica para carcinoma espinocelular e no comportamento biológico deste. O conhecimento de marcadores de diagnóstico e prognóstico e sua investigação têm utilidade no acompanhamento de tais pacientes