Autoimmune gastrointestinal complications in patients with Systemic Lupus Erythematosus: case series and literature review

The association of systemic lupus erythematosus (SLE) with gastrointestinal autoimmune diseases is rare, but has been described in the literature, mostly as case reports. However, some of these diseases may be very severe, thus a correct and early diagnosis with appropriate management are fundamental. We have analysed our data from the SLE patient cohort at University College Hospital London, established in 1978, identifying those patients with an associated autoimmune gastrointestinal disease. We have also undertaken a review of the literature describing the major autoimmune gastrointestinal pathologies which may be coincident with SLE, focusing on the incidence, clinical and laboratory (particularly antibody) findings, common aetiopathogenesis and complications

Relationship among Apis mellifera L. stings, swarming and climate conditions in the city of Rio Claro, SP, Brazil

The presence of bees (Apis mellifera L.) in urban areas has increased in recent years due to environmental disturbances caused by humans. Bee migration to cities may provoke serious accidents, since some people present allergic reactions to their venoms. In Rio Claro city, São Paulo state, Brazil, the number of calls to the fire brigade for removal of bee swarms, and the number admissions in local hospitals due to bee stings were investigated during 2002 and 2003, and a correlation between these data and the average temperature, rainfall and relative humidity was found. The study period was divided into three phases according to the number of times that the fire brigade was called to remove swarms (263 times): January to July 2002 - 51 calls (19.39%); August 2002 to July 2003 - 140 calls (53.23%); and August to December 2003 - 72 calls (27.38%). A significant correlation among the number of calls, the local temperature and rainfall was detected. The number of accidents was not associated with environmental variables. Based on the current results, public activities for prevention of bee attacks may be developed to avoid unwanted contact between humans and these insects, and/or provide the appropriate management of the colonies

Regulation of immunity during visceral Leishmania infection

Unicellular eukaryotes of the genus Leishmania are collectively responsible for a heterogeneous group of diseases known as leishmaniasis. The visceral form of leishmaniasis, caused by L. donovani or L. infantum, is a devastating condition, claiming 20,000 to 40,000 lives annually, with particular incidence in some of the poorest regions of the world. Immunity to Leishmania depends on the development of protective type I immune responses capable of activating infected phagocytes to kill intracellular amastigotes. However, despite the induction of protective responses, disease progresses due to a multitude of factors that impede an optimal response. These include the action of suppressive cytokines, exhaustion of specific T cells, loss of lymphoid tissue architecture and a defective humoral response. We will review how these responses are orchestrated during the course of infection, including both early and chronic stages, focusing on the spleen and the liver, which are the main target organs of visceral Leishmania in the host. A comprehensive understanding of the immune events that occur during visceral Leishmania infection is crucial for the implementation of immunotherapeutic approaches that complement the current anti-Leishmania chemotherapy and the development of effective vaccines to prevent disease.The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement No.602773 (Project KINDRED). VR is supported by a post-doctoral fellowship granted by the KINDReD consortium. RS thanks the Foundation for Science and Technology (FCT) for an Investigator Grant (IF/00021/2014). This work was supported by grants to JE from ANR (LEISH-APO, France), Partenariat Hubert Curien (PHC) (program Volubilis, MA/11/262). JE acknowledges the support of the Canada Research Chair Program

Balance of IL-10 and Interferon-γ plasma levels in human visceral leishmaniasis: Implications in the pathogenesis

BACKGROUND: Leishmaniasis remains a serious public health problem in several parts of the developing world. Effective prophylactic measurements are hampered by imprecise comprehension of different aspects of the disease, including its immunoregulation. A better comprehension of immunoregulation in human VL may be useful both for designing and evaluating immunoprophylaxis. METHODS: To explore immunoregulatory mechanisms, 20 visceral leishmaniasis (VL) patients were evaluated during active disease and at different periods up to one year after treatment determining their plasma cytokine levels, clinical parameters (palpable spleen and liver) and antibody levels. RESULTS: Elevated plasma levels of IFN-γ and of IL-12 p40 were observed during active disease, significantly decreasing after treatment whereas in vitro Leishmania antigen-stimulated IFN-γ production by PBMC exhibited an inverse pattern being low during disease and increasing steadily thereafter. Absence of IFN-γ activity is a hallmark of VL. The main candidate for blunting IFN-γ activity is IL-10, a cytokine highly elevated in plasma with sharp decrease after treatment. Activity of IL-10 is inferred by high levels of anti-Leishmania specific IgG1 and IgG3. TGF-β had elevated total, but not of active, levels lessening the likelihood of being the IFN-γ counterpart. Spleen or liver size presented a steady decrease but return to normal values at only 120 days after treatment. Anti-Leishmania IgG (total and subclasses) levels and DTH or Leishmania-stimulated lymphocyte proliferation conversion to positive also present a slow decrease after treatment. IL-6 plasma levels were elevated in only a few patients. CONCLUSION: Taken together our results suggest that IFN-γ and IL-10 are the molecules most likely involved in determining fate of disease. After treatment, there is a long delay before the immune profile returns to normal what precludes using plasma cytokine levels as criteria of cure as simpler clinical evaluations, as a palpable spleen or liver, can be used

Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave lithotripsy – the controversy continues

BACKGROUND: To determine factors influencing the clearance of fragments after extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC) stones. METHODS: In the period between July 1998 and Oct 2001, 100 patients with isolated lower polar calyceal calculi ≤ 20 mm, in patients aged ≥ 14 years, were included in the study. Intravenous urograms (IVU) were reviewed to define the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end points i.e. stone free status; number of shock waves used and number of sessions were correlated with variables like LPC anatomy, body mass index and stone size. RESULTS: At three months follow up the clearance for stone size ≤ 10 mm, 11–15 mm and 16–20 mm were 95, 96 and 90% respectively. Patients with acute LPC (<90°) and obtuse angle (>90°) had stone clearance of 94 and 100% respectively. For the infundibular width of < 4 mm, the stone clearance was 93% were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30 kg/m(2), the stone clearance was 92 and 95% respectively. CONCLUSIONS: There is a trend towards more ESWL sessions and shock wave requirement in patients with acute pelvi-calyceal angle and narrow infundibulum but it is not statistically significant. Size (≤ 20 mm) and BMI has no relation with stone clearance. With modern lithotripter, stones up to 20 mm could primarily be treated by ESWL, irrespective of an un-favorable lower polar calyceal anatomy and body habitus

Dimensão pessoal do processo de trabalho para enfermeiras de Unidades de Terapia Intensiva

OBJETIVO: Compreender os aspectos da dimensão pessoal do processo de trabalho para enfermeiras que atuam em Unidades de Terapia Intensiva (UTI) de um hospital universitário do interior do Estado de São Paulo. MÉTODOS: Estudo de abordagem qualitativa utilizando o método fenomenológico. Foram entrevistadas 12 enfermeiras que trabalhavam nas UTI de adulto, pediátrica e coronariana dessa instituição hospitalar e para análise dos relatos, utilizou-se o referencial da estrutura do fenômeno situado. RESULTADOS: A análise dos relatos permitiu identificar a categoria: dimensão pessoal do trabalho na UTI, com os temas - trabalho gratificante, trabalho desgastante e (des) valorização do trabalho. CONCLUSÃO: Os resultados do estudo revelam que as enfermeiras das UTI selecionadas identificam-se com o trabalho, porém vivenciam situações desmotivadoras decorrentes da elevada carga de trabalho, que dificulta o desenvolvimento do processo de trabalho e compromete a qualidade do cuidado.OBJETIVO: Comprender los aspectos de la dimensión personal del proceso de trabajo para enfermeras que actúan en Unidades de Cuidados Intensivos (UCI) de un hospital universitario del interior del Estado de Sao Paulo. MÉTODOS: Se trata de un estudio con abordaje cualitativo en el que se usó el método fenomenológico. Se entrevistaron a 12 enfermeras que trabajaban en las UCI de adulto, pediátrica y coronaria de esa institución hospitalaria y para el análisis de los relatos, se consideró el referencial de la estructura del fenómeno situado. RESULTADOS: El análisis de los relatos permitió identificar la categoría: dimensión personal del trabajo en la UCI, con los temas - trabajo gratificante, trabajo desgastante y (des) valorización del trabajo. CONCLUSIÓN: Los resultados del estudio revelan que las enfermeras de las UCI seleccionadas se identifican con el trabajo, no obstante vivencian situaciones desmotivadoras como consecuencia de la elevada carga de trabajo, que dificulta el desarrollo del proceso de trabajo y compromete la calidad del cuidado.OBJECTIVE: To understand the personal dimension of the work process for nurses working in intensive care units (ICU) of a university hospital in the state of São Paulo. METHODS: A qualitative study using the phenomenological method. We interviewed 12 nurses working in adult, pediatric and coronary ICUs in this hospital; to analyze results, we used the phenomenonogical method. RESULTS: The analysis of the results identified the category, personal dimension of ICU work, which included the themes, "rewarding work", "exhausting work", and, "lack of appreciation of the work". CONCLUSION: The results of this study revealed that the ICU nurses interviewed identified with their work, but that they experience discouraging situations resulting from high workload, which hinders the development of the work process and compromises the quality of care