IFNG +874T/A polymorphism is not associated with American tegumentary leishmaniasis susceptibility but can influence Leishmania induced IFN-γ production

<p>Abstract</p> <p>Background</p> <p>Interferon-gamma is a key cytokine in the protective responses against intracellular pathogens. A single nucleotide polymorphism (SNP) located in the first intron of the human IFN-γ gene can putatively influence the secretion of cytokine with an impact on infection outcome as demonstrated for tuberculosis and other complex diseases. Our aim was to investigate the putative association of IFNG+874T/A SNP with American tegumentary leishmaniasis (ATL) and also the influence of this SNP in the secretion of IFN-γ <it>in vitro</it>.</p> <p>Methods</p> <p>Brazilian ATL patients (78 cutaneous, CL, and 58 mucosal leishmaniasis, ML) and 609 healthy volunteers were evaluated. The genotype of +874 region in the IFN-γ gene was carried out by Amplification Refractory Mutational System (ARMS-PCR). <it>Leishmania</it>-induced IFN-γ production on peripheral blood mononuclear cell (PBMC) culture supernatants was assessed by ELISA.</p> <p>Results</p> <p>There are no differences between +874T/A SNP frequency in cases and controls or in ML versus CL patients. Cutaneous leishmaniasis cases exhibiting AA genotype produced lower levels of IFN-γ than TA/TT genotypes. In mucosal cases, high and low IFN-γ producers were clearly demonstrated but no differences in the cytokine production was observed among the IFNG +874T or A carriers.</p> <p>Conclusion</p> <p>Our results suggest that +874T/A polymorphism was not associated with either susceptibility or severity to leishmaniasis. Despite this, IFNG +874T/A SNP could be involved in the pathogenesis of leishmaniasis by influencing the amount of cytokine released by CL patients, although it could not prevent disease development. On the other hand, it is possible that in ML cases, other potential polymorphic regulatory genes such as TNF-α and IL-10 are also involved thus interfering with IFN-γ secretion.</p

Prevalence of HPV infection among Greek women attending a gynecological outpatient clinic

Background: Human papillomavirus (HPV) infection is a causative factor for cervical cancer. Early detection of high risk HPV types might help to identify women at high risk of cervical cancer. The aim of the present study was to examine the HPV prevalence and distribution in cervical smears in a sample of Greek women attending a gynecological outpatient clinic and to explore the determinants of the infection.Methods: A total of 225 women were studied. All women underwent a regular gynecological control. 35 HPV types were studied; 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84, 85 and 89. Also, basic demographic information, sociodemographic characteristics and sexual behavior were recorded.Results: HPV was detected in 22.7% of the study population. The percentage of the newly diagnosed women with HPV infection was 17.3%. HPV-16 was the most common type detected (5.3%) followed by HPV-53 (4.9%). 66.2% of the study participants had a Pap test during the last year without any abnormalities. HPV infection was related positively with alcohol consumption (OR: 2.19, 95% CI: 1.04-4.63, P = 0.04) and number of sexual partners (OR: 2.16, 95% CI: 1.44-3.25, P < 0.001), and negatively with age (OR: 0.93, 95% CI: 0.87-0.99, P = 0.03), and monthly income (OR: 0.63, 95% CI: 0.44-0.89, P = 0.01).Conclusion: The prevalence of HPV in women attending an outpatient clinic is high. Number of sexual partners and alcohol consumption were the most significant risk factors for HPV infection, followed by young age and lower income

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Knowledge about aids and drugs among undergraduate students in a higher education institution in the state of Paraná El conocimiento sobre sida y drogas entre alumnos de graduación de una institución de enseñanza superior en el estado de Paraná Conhecimento sobre aids e drogas entre alunos de graduação de uma instituição de ensino superior do estado do Paraná

The main objective of this study was to measure the knowledge of undergraduate nursing students about Acquired Immunodeficiency Syndrome (AIDS) and drugs. The study was carried out in 2007 with a random sample of 289 undergraduate students at a State University in the Northwest of Paraná, Brazil. The students self-applied a questionnaire validated by experts. Questions were divided into three levels of complexity: low, average and high. The level of correct answers was higher in the questions of low complexity, diminishing as the questions' complexity increased. Thirteen percent of questions concerning risk factors and vulnerability to HIV infection among injection drug users (IDU) and biological material for diagnosis of AIDS was correctly answered by 90% of students. Students possessed knowledge concerning AIDS and drugs, however such knowledge was considered insufficient, showing lack of information and gaps in education with a dissociation of interdisciplinary and inter-curricular content.<br>Este trabajo tuvo como principal objetivo investigar el conocimiento de universitarios sobre el síndrome de inmunodeficiencia adquirida (SIDA) y drogas. La investigación se realizó en el año 2007 a partir de una muestra aleatoria de 289 alumnos de los cursos de graduación de una facultad estatal de la región noroeste de Paraná, en Brasil. Los alumnos respondieron un cuestionario auto aplicable, validado por especialistas del área. Las preguntas fueron divididas en tres niveles de complejidad: baja, media y alta. El índice de aciertos de los alumnos fue mayor en las preguntas de baja complejidad, disminuyendo con el aumento del grado de complejidad. El índice de 90% de aciertos ocurrió en 13% de las preguntas, que se referían a los factores de riesgo y vulnerabilidad para la infección por el virus de la inmunodeficiencia humana (HIV) en usuarios de drogas inyectables (UDI) y el material biológico para el diagnóstico de SIDA. Los alumnos poseían conocimientos sobre SIDA y drogas, sin embargo, este es insuficiente, demostrando falta de información y vacíos en la enseñanza, con disociación de contenidos interdisciplinares e intercurriculares.<br>Este trabalho teve como principal objetivo investigar o conhecimento de universitários sobre a síndrome de imunodeficiência adquirida (AIDS) e drogas. Realizou-se a pesquisa no ano 2007 a partir de amostra aleatória de 289 alunos dos cursos de graduação de uma faculdade estadual da região noroeste do Paraná. Os alunos responderam um questionário autoaplicável, validado por especialistas na área. As questões foram divididas em três níveis: baixa, média e alta complexidade. O índice de acertos dos alunos foi maior nas questões de baixa complexidade, diminuindo com o aumento do grau de complexidade. O índice de 90% de acertos ocorreu em 13% das questões, que se referiam aos fatores de risco e vulnerabilidade para a infecção pelo vírus da imunodeficiência humana (HIV) em usuários de drogas injetáveis (UDI) e o material biológico para o diagnóstico de AIDS. Os alunos possuíam conhecimento sobre AIDS e drogas, porém, insuficiente, demonstrando falta de informação e lacunas no ensino, com dissociação de conteúdos interdisciplinares e intercurriculares

Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city

Few healthcare centers in Brazil perform thrombolytic therapy for acute ischemic stroke (AIS) patients. OBJECTIVE: The aim of this study was to describe an interinstitutional protocol for the rapid identification and thrombolytic treatment of AIS patients at a public health hospital in a large Brazilian city. METHOD: Emergency medical services (EMS) personnel evaluated 433 patients with possible stroke during a six-month period. After a standard checklist, patients with suspected AIS and symptoms onset of less than two hours were evaluated at our University Hospital (UH). RESULTS: Sixty-five (15%) patients met the checklist criteria and had a symptom onset of less than two hours, but only 50 (11%) patients were evaluated at the UH. Among them, 35 (70%) patients had ischemic stroke, 10 (20%) had hemorrhagic stroke, and 5 (10%) had other diagnoses. Of the 35 ischemic stroke patients, 15 (43%) underwent IV thrombolysis. CONCLUSION: The present study demonstrated that trained EMS workers could help to improve the rate of thrombolytic treatment in large Brazilian cities. Permanent training programs for EMS and hospital staff, with quality control and correct identification of AIS patients, should be implemented to increase appropriate thrombolytic therapy rates in Brazil

Innovations in diagnosis and post-therapeutic monitoring of Chagas disease : simultaneous flow cytometric detection of IgG1 antibodies anti-live amastigote, anti-live trypomastigote, and anti-fixed epimastigote forms of Trypanosoma cruzi.

This study developed a remarkable methodological innovation (FC-ATE) which enables simultaneous detection of antibodies specific to the three evolutive forms of Trypanosoma cruzi: live amastigote (AMA), live trypomastigote (TRYPO), and fixed epimastigote (EPI) using a differential fluorescence staining as low (AMA), intermediate (TRYPO), and high (EPI). An outstanding performance (100%) was observed in the discrimination of the chagasic (CH) and non-chagasic (NCH) patients. In the applicability of FC-ATE in the diagnosis of Chagas disease, 100% of the CH samples presented positivity in the percentage of positive fluorescent parasites (PPFP) for all the three forms of T. cruzi. Moreover, 94% of the samples of NCH presented negative values of PPFP with AMA and TRYPO, and 88% with EPI. Samples from the NCH group with falsepositive results were those belonging to the leishmaniasis patients. Considering the applicability of this technique in post-therapeuticmonitoring of Chagas disease, 100% of non-treated (NT) and treated non-cured (TNC) samples were positive with the three T. cruzi evolutive forms, while a percentage of 100% fromsamples of the treated cured (TC) patientswere negativewith AMA, 93% with TRYPO and 96% with EPI. The comparison between FC-ATE and two other flow cytometric tests using the same samples of patients NT, TNC and TC showed that the three techniques presented different reactivities, although categorical correlation between the methodologies was observed. Taken together, the results obtained with the novel FC-ATE method have shown an outstanding performance in the diagnosis and post-therapeutic monitoring of Chagas disease