Immune Reconstitution Inflammatory Syndrome: Opening Pandora's Box

One of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid progression phenotype, who started ART with TCD4+ of 53 cells/mm(3) (3,3%) and HIV RNA = 890000 copies/mL (6 log). Four weeks later he was admitted to the intensive care unit with severe sepsis. The diagnostic pathway identified progressive multifocal leukoencephalopathy, digestive Kaposi sarcoma, and P. aeruginosa bacteraemia. Five weeks after starting ART, TCD4+ cell count was 259 cells/mm(3) (15%) and HIV RNA = 3500 copies/mL (4 log). He developed respiratory failure and progressed to septic shock and death. Those complications might justify the outcome but its autopsy opened Pandora's box: cerebral and cardiac toxoplasmosis was identified, as well as hemophagocytic syndrome, systemic candidiasis, and Mycobacterium avium complex infection. IRIS remains a concern and eventually a barrier to ART. Male gender, young age, low TCD4 cell count, and high viral load are risk factors. The high prevalence of subclinical opportunistic diseases highlights the need for new strategies to reduce IRIS incidence.info:eu-repo/semantics/publishedVersio

Idiopathic Pulmonary Fibrosis in the Era of Antifibrotic Therapy: Searching for New Opportunities Grounded in Evidence

Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease that up to now has been associated with a poor prognosis. However, the results of the INPULSIS and ASCEND trials and the approval of nintedanib and pirfenidone have marked the beginning of a new era for IPF patients. Questions remain, however. Should these drugs be used earlier? What effect will they have on more severe disease? Will their effects last beyond the trial period? This manuscript is the outcome of a multidisciplinary meeting between pulmonology, radiology, and pathology clinicians on the use of antifibrotic agents in IPF. In our opinion, the existing data show that pirfenidone and nintedanib slow functional decline in early stages of disease. These drugs also appear to result in therapeutic benefits when administered to patients with advanced disease at diagnosis and maintain effective over time. The data also suggest that continuing antifibrotic therapy after disease progression may confer benefits, but more evidence is needed. Early diagnosis and treatment are crucial for reducing functional decline, slowing disease progression, and improving quality of life.info:eu-repo/semantics/publishedVersio

Caracterização de Potencial Xilanase de Paenibacillus sp. WS30.

Xilanases são enzimas que catalisam a hidrólise da ligação glicosídica ??(1,4) da cadeia linear da xilana, um dos principais polissacarídeos estruturais das células vegetais e o segundo mais abundante na natureza. Bactérias e fungos são eficientes produtores de enzimas xilanolíticas, sendo assim nesse trabalho genes de potenciais xilanases da coleção de microrganismos da Embrapa Agroenergia foram clonados em cepas de Escherichia coli Tuner DE3 por meio do plasmídeo pET21a. Oriundo de Paenibacillus sp. o gene P_X6 foi expresso em E. coli e destacou?se pela atividade da enzima produzida sobre xilana. A proteína P_X6 apresenta 39,65 kDa de massa molecular, tendo o gene que a codifica 1.023 pares de bases. A atividade enzimática de P_X6 foi avaliada nos substratos sintéticos pNPG, pNPGal, pNPC, pNP?G e pNPX e nos naturais xilana, celobiose, maltose, lactose, salicina e xilobiose. Posto isso, após 72 horas de expressão, concentração da amostra e purificação por cromatografia de afinidade, verificou?se a presença de atividade enzimática em pNPX, pNPC e em xilana. A P_X6 se mostrou promissora por apresentar alta atividade em xilana de faia

Application of Dielectric Barrier Discharge (DBD) atmospheric pressure plasma for pretreatment of medical textiles

Conventional pretreatment by wet chemistry and/or low-pressure plasma have several drawbacks [1]. Atmospheric plasma is an alternative and cost-competitive method to low-pressure plasma and wet chemical pretreatments, allowing continuous and uniform processing of fibers, substrates and films surfaces, improving its functionalization performance [2]. This technology has been studied in the field of the R&D project - PLASMAMED. The main objective of this project is to produce a new generation of coatings containing nanoparticles (NPs) and enzybiotics, with controllable antibacterial activity, on medical textiles, with special emphasis in antimicrobial dressing for pressure injury and hernia meshes. To achieve this goal, a dielectric barrier discharge (DBD) atmospheric pressure plasma was used as a pretreatment sustainable alternative. In this sense, medical-grade 100% polyester (PES) fabrics were pretreated by atmospheric plasma technology, where various processing conditions were tested. Different treatment speeds and discharges powers were tested, as well as the application of various gases (such as helium, oxygen and nitrogen) and a corona treatment (air), with a carrier gas (argon). The characterization of these pretreated textiles was carried out by contact angle (CA), through the sessile drop technique, with 3 µL water droplets on the surface of the textile. In general, contact angles exhibit a significant decrease (between 40º and 60º for all studied gases), when compared with the standard values for substrate without treatment (around 120º). Therefore, plasma pretreatment significantly improved the hydrophilicity of these fabrics (Figure 1), which reveals to be an advantage for the further functionalization step

Identification of a cytokine network sustaining neutrophil and Th17 activation in untreated early rheumatoid arthritis

© 2010 Cascão et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by sustained synovitis. Recently, several studies have proposed neutrophils and Th17 cells as key players in the onset and perpetuation of this disease. The main goal of this work was to determine whether cytokines driving neutrophil and Th17 activation are dysregulated in very early rheumatoid arthritis patients with less than 6 weeks of disease duration and before treatment (VERA). Methods: Cytokines related to neutrophil and Th17 activation were quantified in the serum of VERA and established RA patients and compared with other very early arthritis (VEA) and healthy controls. Synovial fluid (SF) from RA and osteoarthritis (OA) patients was also analyzed. Results: VERA patients had increased serum levels of cytokines promoting Th17 polarization (IL-1b and IL-6), as well as IL-8 and Th17-derived cytokines (IL-17A and IL-22) known to induce neutrophil-mediated inflammation. In established RA this pattern is more evident within the SF. Early treatment with methotrexate or corticosteroids led to clinical improvement but without an impact on the cytokine pattern. Conclusions: VERA patients already display increased levels of cytokines related with Th17 polarization and neutrophil recruitment and activation, a dysregulation also found in SF of established RA. 0 Thus, our data suggest that a cytokine-milieu favoring Th17 and neutrophil activity is an early event in RA pathogenesis.This work was supported by a grant from Sociedade Portuguesa de Reumatologia/Schering-Plough 2005. RAM and RC were funded by Fundação para a Ciência e a Tecnologia (FCT) SFRH/BD/30247/2006 and SFRH/BD/40513/2007, respectively. MMS-C was funded by Marie Curie Intra-European Fellowship PERG-2008-239422 and a EULAR Young Investigator Award

Mulheres idosas: desvelando suas vivências e necessidades de cuidado

Estudo qualitativo com abordagem da fenomenologia social que objetivou a compreensão da vivência da mulher idosa, suas necessidades de cuidado e expectativas nesse período da vida. Participaram nove mulheres, cujos depoimentos foram obtidos de fevereiro a maio de 2011, por meio de entrevista semiestruturada. A mulher idosa refere limitações de ordem física, mental e social, e valoriza a preservação de sua autonomia nas atividades diárias e no cuidado consigo mesma. Refere a família como suporte fundamental e tem expectativas e necessidades de se manter saudável, da busca pelo lazer e de ter melhor acesso aos serviços de saúde para receber informações e atendimento qualificado. Nessa fase, a ausência de perspectivas relaciona-se à perda de pessoas significativas e da saúde. Este estudo revelou facetas da vivência da mulher idosa, suscitando novas investigações e a adequação do ensino, prática e gestão às reais necessidades dessa mulher