Immunoblot analysis of the seroreactivity to recombinant Borrelia burgdorferi sensu lato antigens, including VlsE, in the long-term course of treated patients with Erythema migrans

Objective: We evaluated whether immunoblotting is capable of substantiating the posttreatment clinical assessment of patients with erythema migrans ( EM), the hallmark of early Lyme borreliosis. Methods: In 50 patients, seroreactivity to different antigens of Borrelia burgdorferi sensu lato was analyzed by a recombinant immunoblot test (IB) in consecutive serum samples from a minimum follow-up period of 1 year. Antigens in the IgG test were decorin- binding protein A, internal fragment of p41 (p41i), outer surface protein C (OspC), p39, variable major protein-like sequence expressed (VlsE), p58 and p100; those in the IgM test were p41i, OspC and p39. Immune responses were correlated with clinical and treatment-related parameters. Results: Positive IB results were found in 50% before, in 57% directly after therapy and in 44% by the end of the follow-up for the IgG class, and in 36, 43 and 12% for the IgM class. In acute and convalescence phase sera, VlsE was most immunogenic on IgG testing 60 and 70%), and p41i (46 and 57%) and OspC (40 and 57%) for the IgM class. By the end of the follow-up, only the anti-p41i lgM response was significantly decreased to 24%. Conclusions: No correlation was found between IB results and treatment-related parameters. Thus, immunoblotting does not add to the clinical assessment of EM patients after treatment. Copyright (c) 2008 S. Karger AG, Basel

Long-term efficacy of botulinum toxin A for treatment of blepharospasm,hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

PURPOSE: To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. METHODS: All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. RESULTS: BEB, HFS, and EN patients received a mean BoNT-A dose with a significant inter-group difference (P<0.0005, respectively). The mean (+/-SD) effect duration was statistically different (P=0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean (+/-SD) values of BEI-U and BEI-% were statistically different (P=0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P=0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. CONCLUSIONS: This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vsolder BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation

Cobertura populacional do Sistema de Vigilância Alimentar e Nutricional no Estado de São Paulo, Brasil

O objetivo deste artigo é estimar a cobertura populacional do Sistema de Vigilância Alimentar e Nutricional (SISVAN) nos diferentes estágios de vida e avaliar seu funcionamento no estado de São Paulo. O estudo incluiu 65 municípios divididos em 14 regiões do estado. A cobertura do SISVAN foi estimada a partir de dados de monitoramento do estado nutricional disponíveis nos relatórios públicos, e do número de usuários que frequentam os serviços públicos de saúde. O total de usuários foi obtido pela diferença entre o total de habitantes e o número de beneficiários de planos de saúde privados. A maioria das regiões apresentou uma cobertura reduzida (<10%). Cerca de 57% revelaram cobertura entre 5 e 10%. Constatou-se uma preponderância de registros do estado nutricional de crianças para todas as regiões do Estado. Chama a atenção a reduzida cobertura entre os idosos, que é inexistente ou próxima de zero na maioria das regiões. Apesar dos esforços empreendidos pelo governo visando à ampliação e à qualificação do SISVAN, o monitoramento nutricional no estado de São Paulo ainda é insuficiente. Esta condição compromete sua utilização na elaboração de políticas efetivas na área de alimentação e nutrição.This article sets out to estimate the population coverage of the Food and Nutrition Surveillance System (SISVAN) at different phases of life and to evaluate its operation in the state of Sao Paulo. The study included 65 cities divided in 14 state regions. The coverage of SISVAN was estimated using data from nutritional status monitoring available in public reports and on government websites, as well as the number of users attended by the public health services. Total users of public health services were obtained by the difference between the total number of inhabitants of 65 cities and the number of beneficiaries of private health plans. Most regions presented reduced population coverage (< 10%). Approximately 57% revealed population coverage of between 5 and 10%. There was a preponderance of records of the nutritional status of children for all regions of the state. A startling statistic was the low coverage for the elderly population, which was zero or near zero in most regions. Despite the efforts by the government to expand and enhance SISVAN, nutritional monitoring in Sao Paulo is still insufficient. This condition hinders the use of SISVAN to produce effective changes in food and nutrition policies.Pontifícia Universidade Católica de Campinas Faculdade de NutriçãoUniversidade Federal de São CarlosUniversidade Estadual Paulista Julio de Mesquita Filho Instituto de BiociênciasUniversidade Estadual Paulista Julio de Mesquita Filho Instituto de Biociência

Análise dos atributos dos cuidados primários em saúde utilizando os prontuários eletrônicos na cidade do Rio de Janeiro

Resumo A epidemiologia desempenha um papel estratégico neste estágio do ciclo de política, contribuindo para o estabelecimento de metas, alocação de recursos e uso de sistemas de informação. Em 2009, a Secretaria Municipal de Saúde do Rio de Janeiro iniciou uma reforma do modelo de atenção, utilizando como principal influência o conceito de Atenção Primária em Saúde. Este estudo avalia a tendência de indicadores selecionados do &#8220;pay-for-performance&#8221; que mensuram o processo de cuidado em saúde na APS da cidade. Estudo de painéis repetidos, a partir dos registros administrativos e clínicos dos prontuários eletrônicos no período de 2012 a 2016. Foram escolhidos sete indicadores que analisaram o desempenho longitudinal dentro da meta estabelecida, entre aqueles que representam acesso, longitudinalidade, coordenação do cuidado &#8211; atributos da APS, assim como outras características dos serviços como desempenho assistencial e eficiência econômica. Este estudo demonstrou que a descentralização da gestão para níveis mais próximos do usuário é potencialmente exitoso para o registro de dados clínicos, caso seja realizado um adequado monitoramento dos indicadores, auditorias clínicas frequentes e realizado periodicamente um &#8220;feedback&#8221; aos profissionais de saúde com os dados e indicadores acompanhados

Oesophageal adenocarcinoma is associated with a deregulation in the MYC/MAX/MAD network

Oesophageal adenocarcinoma, which arises from an acquired columnar lesion, Barrett's metaplasia, is rising in incidence more rapidly than any other cancer in the Western world. Elevated expression of c-MYC has been demonstrated in oesophageal adenocarcinoma; however, the expression of other members of the MYC/MAX/MAD network has not been addressed. The aims of this work were to characterise the expression of c-MYC, MAX and the MAD family in adenocarcinoma development and assess the effects of overexpression on cellular behaviour. mRNA expression in samples of Barrett's metaplasia and oesophageal adenocarcinoma were examined by qRT–PCR. Semi-quantitative immunohistochemistry and western blotting were used to examine cellular localisation and protein levels. Cellular proliferation and mRNA expression were determined in SEG1 cells overexpressing c-MYCER or MAD1 using a bromodeoxyuridine assay and qRT–PCR, respectively. Consistent with previous work expression of c-MYC was deregulated in oesophageal adenocarcinoma. Paradoxically, increased expression of putative c-MYC antagonists MAD1 and MXI1 was observed in tumour specimens. Overexpression of c-MYC and MAD proteins in SEG1 cells resulted in differential expression of MYC/MAX/MAD network members and reciprocal changes in proliferation. In conclusion, the expression patterns of c-MYC, MAX and the MAD family were shown to be deregulated in the oesophageal cancer model

Localized-Statistical Quantification of Human Serum Proteome Associated with Type 2 Diabetes

BACKGROUND: Recent advances in proteomics have shed light to discover serum proteins or peptides as biomarkers for tracking the progression of diabetes as well as understanding molecular mechanisms of the disease. RESULTS: In this work, human serum of non-diabetic and diabetic cohorts was analyzed by proteomic approach. To analyze total 1377 high-confident serum-proteins, we developed a computing strategy called localized statistics of protein abundance distribution (LSPAD) to calculate a significant bias of a particular protein-abundance between these two cohorts. As a result, 68 proteins were found significantly over-represented in the diabetic serum (p<0.01). In addition, a pathway-associated analysis was developed to obtain the overall pathway bias associated with type 2 diabetes, from which the significant over-representation of complement system associated with type 2 diabetes was uncovered. Moreover, an up-stream activator of complement pathway, ficolin-3, was observed over-represented in the serum of type 2 diabetic patients, which was further validated with statistic significance (p = 0.012) with more clinical samples. CONCLUSIONS: The developed LSPAD approach is well fit for analyzing proteomic data derived from biological complex systems such as plasma proteome. With LSPAD, we disclosed the comprehensive distribution of the proteins associated with diabetes in different abundance levels and the involvement of ficolin-related complement activation in diabetes