Coinfection with Different Trypanosoma cruzi Strains Interferes with the Host Immune Response to Infection

A century after the discovery of Trypanosoma cruzi in a child living in Lassance, Minas Gerais, Brazil in 1909, many uncertainties remain with respect to factors determining the pathogenesis of Chagas disease (CD). Herein, we simultaneously investigate the contribution of both host and parasite factors during acute phase of infection in BALB/c mice infected with the JG and/or CL Brener T. cruzi strains. JG single infected mice presented reduced parasitemia and heart parasitism, no mortality, levels of pro-inflammatory mediators (TNF-α, CCL2, IL-6 and IFN-γ) similar to those found among naïve animals and no clinical manifestations of disease. On the other hand, CL Brener single infected mice presented higher parasitemia and heart parasitism, as well as an increased systemic release of pro-inflammatory mediators and higher mortality probably due to a toxic shock-like systemic inflammatory response. Interestingly, coinfection with JG and CL Brener strains resulted in intermediate parasitemia, heart parasitism and mortality. This was accompanied by an increase in the systemic release of IL-10 with a parallel increase in the number of MAC-3+ and CD4+ T spleen cells expressing IL-10. Therefore, the endogenous production of IL-10 elicited by coinfection seems to be crucial to counterregulate the potentially lethal effects triggered by systemic release of pro-inflammatory mediators induced by CL Brener single infection. In conclusion, our results suggest that the composition of the infecting parasite population plays a role in the host response to T. cruzi in determining the severity of the disease in experimentally infected BALB/c mice. The combination of JG and CL Brener was able to trigger both protective inflammatory immunity and regulatory immune mechanisms that attenuate damage caused by inflammation and disease severity in BALB/c mice

New endoscopic secondary tracheoesophageal voice prosthesis placement technique

OBJECTIVE. the aim of this study was to present a new technique of secondary vocal prosthesis placement on an outpatient basis without general anesthesia by means of digestive endoscopy.METHODS: It is a prospective study, 35 laryngectomized patients were sedated with midazolam and underwent digestive endoscopy and tracheoesophageal punch with vocal prosthesis insertion.RESULTS: A success rate of 94.2% was achieved with this surgical technique. the mean procedure time was estimated at 12 minutes, and no serious complications due to the prosthesis insertion were observed.CONCLUSION: the advantages of this new technique over the classic technique are lack of use of general anesthesia, performance of procedure on an outpatient basis, lower complication risks (including hemorrhage, mediastinitis, vertebral fracture, esophageal perforation; and minor oropharyngeal, and esophageal mucosal trauma), and direct visualization of the prosthesis in the esophageal lumen.Universidade Federal de São Paulo, Escola Paulista Med, Dept Head & Neck Surg, São Paulo, BrazilPontifice Univ Campinas, Hosp & Maternidade Celso Pierro, Dept Head & Neck Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Head & Neck Surg, São Paulo, BrazilWeb of Scienc

Reabilitação vocal de laringectomizados com prótese traqueoesofágica Vocal reabilitation of patients with laringectomy using tracheoesofogeal proteses

Material: No período de 23 de fevereiro de 1999 a junho de 2000 foram estudados 23 pacientes submetidos à laringectomia total que receberam a prótese traqueoesofágica do tipo Blom-Singer Indeweling Low Presure, sendo 22 pacientes do sexo masculino, com faixa etária variando de 40 a 80 anos. O tempo de acompanhamento variou de 150 a 462 dias. Um paciente era do estádio clínico I, com comprometimento da comissura posterior; um, do estádio II, com lesão na subglote; 13, do estádio III; e sete do IV. Forma de estudo: Prospectivo clínico não randomizado. Método: A prótese foi locada concomitante à laringectomia em sete pacientes; secundariamente, com anestesia geral, em cinco; e, por endoscopia digestiva alta, sob sedação e anestesia local, em quatorze. Foram estudadas as complicações decorrentes da colocação e uso da prótese vocal, avaliação da qualidade da voz e da inteligibilidade de fala, utilizando parâmetro perceptivo-auditivo, antes e depois da fonoterapia e do tempo necessário para reabilitação vocal. Resultados: Houve três complicações pós-operatórias relacionadas com procedimento cirúrgico terapêutico, que impossibilitaram a reabilitação vocal; dos vinte possíveis de serem reabilitados com a prótese, dezoito se reabilitaram com índice de 90% de sucesso. O tempo médio para reabilitação variou de um a 65 dias. Conclusão: Concluímos que as complicações decorrentes da colocação e uso da prótese não inviabilizaram o sucesso do método; o tempo médio para aquisição da voz foi de sete dias; a qualidade vocal e a inteligibilidade de fala apresentaram melhora após a realização da fonoterapia, sem diferença estatística significativa; e a colocação secundária da prótese vocal, utilizando nova técnica, por endoscopia digestiva alta, mostrou-se mais eficaz em relação às técnicas convencionais.<br>We studied the complications resulting from the placement and use of the vocal prosthesis, assessment of voice quality and speech intelligibility using perceptive-auditory parameters before and after speech therapy and the period needed for vocal rehabilitation. From February 1999 to June 2000, a study was conducted on 23 patients who underwent total laryngectomy and were given a tracheoesophageal prosthesis like the Blom-Singer Indwelling Low Pressure. Study design: Prospective clinical not randomized. Material and method: The study consisted of 22 males and their ages ranged from 40 years to 80 years. The follow up period varied between 150 days to 462 days. One patient with the posterior commissure affected was at stadium I; stadium II had one patient with a lesion in the subglottic region; stadium III had 13 patients; stadium IV had four patients. The prosthesis was placed in seven patients concomitantly with the laryngectomy, while the placement was secondary in the remaining group. Aim: We studied the complications resulting from the placement and use of the vocal prosthesis, assessment of voice quality and speech intelligibility using perceptive-auditory parameters before and after speech therapy and the period needed for vocal rehabilitation impossible. The success rating was 90% with 18 patients rehabilitated with the help of the prosthesis. The rehabilitation period varied between one day to 65 days. Conclusions: the complications resulted from placement and use of this prosthesis did not hamper its success; the average time taken for voice acquisition was seven days, vocal quality and intelligibility of speech showed improvement after the phonoterapy without significant statistics difference and the secondary placement through new surgical technique by digestive endoscopy is better than the conventional technique

Prevalência dos sintomas otológicos na desordem temperomandibular: estudo de 126 casos Prevalence of otologic symptoms in temperomandibular disorders: 126 case studies

Introdução: A presença de sintomas otológicos associados à desordem temporomandibular (DTM) é discutida há seis décadas; entretanto, sua etiologia ainda permanece obscura. Forma de estudo: Prospectivo clínico randomizado. Objetivo: Neste estudo foram avaliadas a prevalência de sintomas otológicos na DTM, sua correlação com a dor muscular e a ausência de dentes posteriores. Material e Método: Foram avaliados 126 pacientes portadores de DTM, através de questionário subjetivo dos sintomas, palpação dos músculos de mastigação, temporal, masséter, pterigóideo lateral, pterigóideo medial, digástrico, tendão do músculo temporal e dos músculos esternocleidomastóideo e trapézio. Foram feitas radiografias panorâmica e transcraniana e modelos de gesso das arcadas superior e inferior dos pacientes. Os dados obtidos foram analisados através do Teste Exato de Fisher, com percentil de significância menor que 0,05. Resultados: Houve presença de sintomas otológicos em 80% dos pacientes, sendo que 50% apresentavam dor referida em ouvido; 52%, plenitude auricular; 50%, tinitus; 34%, tontura; 9%, sensação de vertigem; e 10% relataram hipoacusia. O músculo pterigóideo lateral foi o músculo mais sensível em 94% dos pacientes, seguido do músculo temporal em 69%, masséter em 62%, digástrico em 60%, pterigóideo medial em 50%, tendão do músculo temporal e esternocleidomastóideo em 49% e trapézio em 42% dos pacientes. Houve significância para dor muscular, e a presença de sintomas otológicos, nos músculos masséter e esternocleidomastóideo. Os sintomas tinitus, plenitude auricular e dor referida em ouvido apresentaram alta correlação de significância entre si. Não houve significância para a ausência de dentição e sintomas otológicos. Conclusão: 1) Dor referida em ouvido, tínitus, plenitude auricular e tontura foram prevalentes; 2) os sintomas otológicos presentes na DTM podem estar relacionados com a dor muscular em masséter e esternocleidomastóideo; 3) não houve correlação entre os sintomas otológicos e a ausência de dentes posteriores.<br>Introduction: A presence of otologic symptoms associated to the temporomandibular disorders (TMD) is discussed since six decades ago, however its etiology still stays obscure. Study design: Prospective clinical randomized. Aim: In that study it was appraised the prevalence of otologic symptoms in TMD, the correlation with the muscular pain and the absence of posterior teeth. Material and Methods: 126 patients, presented TMD, were appraised through questionnaire about their symptoms, palpation of the masticatory muscles, temporal, masseter, lateral pterygoid medial, pterigoyd, digastric, temporal muscle tendon, esternocleidomastoid and trapezius and panoramic and transcranian X-rays and plaster´s models of the superior and inferior arcades. The data obtained were analyzed through Exact Test of Fisher, with p value < 0,05. Results: The otologic symptoms were presented in 80% of the patients (50% presented hear pain 52% aural fullness, 50% tinitus, 34% dizziness, 9% sensation of vertigo and 10% told hypoacusis). The palpation revelated lateral pterigoyd as the most sensitive 94%, followed by the temporal muscle ( 69%), masseter (62%), digastric (60%), medial pterigoyd (50%), temporal muscle tendon and sternocleidomastoid (49%) and trapezius (42%). The muscular pain and otologic symptoms were statistically significant in the masseter and esternocleidomastoid muscles. Tinitus, aural fullness and otologic pain presented high significant correlation to each other. There was not significance between the absence of teeth and otologic symptoms. Conclusion: 1) otalgia, tinitus, aural fullness and dizziness were prevalentes 2) the otologic symptoms present in TMD can be relation with the muscular pain in masseter and esternocleidomastoid 3) there was not correlation between the otologic symptoms and the absence of posterior teeth