Caracterización del estado funcional del sistema inmunitario en individuos de diferente entorno geográfico análisis del impacto de la infección crónica asintomática por virus

De este estudio de análisis de los niveles séricos de las citoquinqas (IL-2, Diferencias en la ubicación geográfica y en los factores medioambientales y socioculturales se asocian a distintos patrones de concentraciones séricas de citoquinas circulantes. En los individuos NI-VHB se observó: a) predominio de un patrón inflamatorio de citoquinas circulantes (elevación de IL-6, IL-10, IL-12 y TNF-¿ en los indígenas, b) predominio de un patrón Th1 (elevación de IFN-y) en los urbanos venezolanos, y c) reducción de las proteínas reguladoras en los españoles. , IL-12, IL-18, Diferencias en la ubicación geográfica y en los factores medioambientales y socioculturales se asocian a distintos patrones de concentraciones séricas de citoquinas circulantes. En los individuos NI-VHB se observó: a) predominio de un patrón inflamatorio de citoquinas circulantes (elevación de IL-6, IL-10, IL-12 y TNF-¿ en los indígenas, b) predominio de un patrón Th1 (elevación de IFN-y) en los urbanos venezolanos, y c) reducción de las proteínas reguladoras en los españoles. , IFN-Y) en individuos infectados pro el virus de la hepatitis B del medio rural y urbano venezolano y de sujetos españoles libres de esta infección se concluye que: 1.Diferencias en la ubicación geográfica y en los factores medioambientales y socioculturales se asocian a distintos patrones de concentraciones séricas de citoquinas circulantes. En los individuos NI-VHB se observó: a) predominio de un patrón inflamatorio de citoquinas circulantes (elevación de IL-6, IL-10, IL-12 y TNF-¿ en los indígenas, b) predominio de un patrón Th1 (elevación de IFN-y) en los urbanos venezolanos, y c) reducción de las proteínas reguladoras en los españoles. 2.El impacto de la infección crónica por el virus B de la hepatitis se asocia a un patrón diferente de las concentraciones séricas de citoquinas en pacientes indígenas o urbanos venezolanos 3.En el medio urbano, la infección por el virus B de la hepatitis se asocia a mayores cifras séricas de citoquinas inflamatorias (IL-6, IL-10 y TNF-¿) y a una marcada reducción el patrón Th1 (disminución de IFN-y). Por el contrario en los pacientes rurales no se observa un cambio significativo en las cifras de las citoquinas circulantes Por lo tanto, existen factores exógenos que condicionan el estado funcional del sistema inmune de los sujetos sanos y de los que presentan evidencia de una infección crónica, lo que determina que los márgenes de normalidad en las variables analíticas inmunológicas deben adaptarse a las poblaciones objetos de estudio

Editorial: Reflexiones de fin de a\uf1o

Si bien es cierto que el a\uf1o que est\ue1 por terminar ha sido un periodo dif\uedcil, lo cual ha influido en un sentimiento de apat\ueda que sin querer parece se est\ue1 transmitiendo en forma general en la poblacion. La falta de estimulo, las preocupaciones del d\ueda a d\ueda que cada vez se nos hace m\ue1s dif\uedcil resolver por diversos motivos (econ\uf3micos, tiempo etc), la situaci\uf3n pol\uedtica del pa\ueds, la inseguridad a la que nos vemos expuesto en cada momento, son algunos de los factores que inciden en nuestra actitud ante la vida y ante nuestro deber a cumplir, sea cual fuese este. Sin embargo, debemos asumir y aceptar que estamos ante cambios de paradigmas y venideros comienzos que implican en primer lugar aceptar el reto y estar abiertos y preparados para ello, lo contrario significar\ueda perderte en la desesperanza y en la depresi\uf3n, propia de la falta de valent\ueda necesaria para seguir adelante en lo \ufanico que tenemos en estos momentos seguro, la vida. Te invito a renovar tu entusiasmo y confianza en ti mismo y en la vida, agradece a Dios por todo aquello que te ha dado y por lo que no te ha dado, agrad\ue9celo igualmente, solo \uc9l sabe lo que te conviene y necesitas. Es \ue9poca propicia para reconciliarnos con nosotros mismos y con las personas que nos rodean, aceptemos a cada quien como es y resaltemos todas las cosas positivas que tienen y minimicemos aquello que nosotros creemos son sus defectos, posiblemente los nuestros son mayores y sin embargo nos queremos intensamente. Que en el venidero a\uf1o 2010 nuestra mirada se enfoque en las nuevas oportunidades que Dios nos da cada d\ueda. Gracias por haber compartido los momentos dif\uedciles y satisfactorios que transitamos este a\uf1o, esperamos seguir contando contigo, cuenta t\ufa con nosotros. Te deseamos una hermosa navidad en uni\uf3n de toda tu familia y un prospero a\uf1o 2010

Concentrations of Cytokines, Soluble Interleukin-2 Receptor, and Soluble CD30 in Sera of Patients with Hepatitis B Virus Infection during Acute and Convalescent Phases

The immunoregulatory roles of interleukin-2 (IL-2), IL-4, IL-10, gamma interferon (IFN-γ), tumor necrosis factor alpha (TNF-α), the soluble form of the IL-2 receptor (sIL-2R), and the soluble form of CD30 (sCD30) were evaluated in patients with hepatitis B virus (HBV) infection. Two groups of subjects were studied: 15 healthy individuals without hepatitis antecedents and 15 patients with HBV infection. Blood samples were taken during the acute and convalescent phases. The analysis of the samples was done by the enzyme-linked immunosorbent assay technique. IFN-γ and TNF-α levels decreased in the convalescent phase. IL-10, IL-2, and sIL-2R levels increased in the acute and convalescent phases, while sCD30 levels increased during the acute phase. The IL-4 concentrations decreased in both phases. During the acute phase, IFN-γ and TNF-α induced increases in IL-2, sIL-2R, IL-10, and sCD30 levels in serum, which allowed the development of immunity characterized by the nonreactivity of the HBV surface antigen, the onset of antibodies to the HBV surface antigen (anti-HBs), and normal alanine aminotransferase levels during the convalescent phase. Increased IL-2 levels during the acute phase would stimulate the activities of NK cells and CD8(+) lymphocytes, which are responsible for viral clearing. The raised sIL-2R levels reveal activation of T lymphocytes and control of the IL-2-dependent immune response. The sCD30 increment during the acute phase reflects the greater activation of the Th2 cellular phenotype. Its decrease in the convalescent phase points out the decrease in the level of HBV replication. The increase in IL-10 levels could result in a decrease in IL-4 levels and modulate IFN-γ and TNF-α levels during both phases of disease, allowing the maintenance of anti-HBs concentrations

Low prevalence of hepatitis C virus infection in Amerindians from Western Venezuela

Previous studies have not found hepatitis C virus (HCV) infection in Amerindians from Western Venezuela. A survey of 254 Bari and Yukpa natives aged 10-60 years (mean ± SD age = 35 ± 5.4 years) from four communities, two Bari and two Yukpa, in this area were studied to assess the prevalence of antibodies to HCV (anti-HCV) and HCV RNA among these indigenous populations. Serum samples were examined initially for anti-HCV by a four generation enzyme-linked immunosorbent assay (ELISA). Reactive samples were then tested using a third generation recombinant immunoblot assay (RIBA-3). Viral RNA was investigated in all immunoblot-reactive samples by a nested polymerase chain reaction (PCR) method. Six (2.3%) of 254 natives were positive by ELISA, one (2.2%) of these reactive samples were positive by RIBA, and four (1.5%) were indeterminate. Only two (0.8%) were positive by PCR, corresponding to 1 (2.1%) of 47 inhabitants of a Yukpa community and to 1 (2.2%) of 45 subjects of a Bari community. Iatrogenic is thought to play a role in acquisition of the infection. The findings indicate a HCV focus of low endemicity and are compatible with a low degree of exposures of the natives to the virus. Studies are necessary to assess the risk factors for infection in these Amerindians

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used