Aspectos genéticos e imunopatogênicos da doença celíaca: visão atual

RACIONAL: A doença celíaca ou enteropatia por sensibilidade ao glúten, é uma forte condição hereditária. Embora a associação genética da doença celíaca com os haplótipos HLA-DQ2 e DQ8 seja conhecida há muito tempo, outros genes HLA e não-HLA também são importantes no desenvolvimento da afecção. A doença celíaca resulta de um efeito combinado de produtos de diferentes genes funcionantes normalmente. A lesão intestinal é imunologicamente mediada e múltiplos mecanismos efetores são responsáveis pela sua expressão. A interação entre fatores genéticos, imunológicos e ambientais explicam o amplo espectro de alterações clínicas, histológicas e sorológicas observadas nos diferentes estágios de desenvolvimento da doença, ressaltando a natureza poligênica da mesma. CONCLUSÃO: Os avanços recentes na compreensão da imunopatogenia, genética e diagnóstico da doença celíaca têm permitido que rígidos conceitos e critérios pré-estabelecidos sejam revistos e adequados às novas evidências, visando melhor diagnóstico e orientação para pacientes celíacos e familiares

Cefepime versus extended spectrum β-lactamase-producing Enterobacteriaceae

The objective of this study was to evaluate the susceptibility to cefepime of a large group of ESBL- producing enterobacteria recently isolated in a Brazilian teaching hospital . The study included 280 strains of ESBL-producing enterobacteria, isolated between 2005 and 2008. The presence of the genes blaCTX-M, blaTEM and blaSHV was determined by PCR and confirmed by nucleotide sequencing. Susceptibility testing for cefepime was performed by disc-diffusion, agar dilution method and E-test®. Among the isolates, 34 (12.1%) presented a cefepime inhibition zone > 21 and MIC < 8 mg/L by agar dilution and E-strip methods. The use of cefepime for the treatment of infections caused by ESBL-producing bacteria has been controversial. Some studies of PD/PK show the probability of achieving the required PD parameters for cefepime, when the MICs were < 8 mg/L, whereas others have reported therapeutic failure with the same MIC. Additional data is essential to come to terms about the report and treatment with cefepime in ESBL-producing organisms especially when these microorganisms are isolated from sterile sites and from critically ill patients

Haplotype frequencies (% ± standard deviation) in Brazilian leprosy patients and controls, and association with MASP-2 and MAp19 concentration and the disease (adjusted effect ± standard deviation).

<p>N: number of alleles; n.a.: not applicable; n.s.: not significant; #: corrected for MAp19 levels; &: not significant with the Fisher’s exact test. In the phylogenetic <i>MASP2</i> nomenclature, small capitalized “h,” “i,” or “l” refer to “high”, “intermediate” or “low” MASP-2 levels in serum, respectively <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0069054#pone.0069054-Boldt1" target="_blank">[12]</a>. Within brackets: rs2273344 (intron 4) and rs9430347 (intron 5) variant <i>in cis</i> combinations. In bold: significant differences.</p

MASP-2 and MAp19 levels in groups of exon 5 flanking <i>MASP2</i> genotypes in the Danish population.

<p>Data is shown with medians and interquartile ranges. One outlier (1198 ng/mL in the <i>AG/AG</i> group) was excluded for better visualization of MAp19 levels. Mann-Whitney P values were calculated between <i>AG/AG</i> and <i>AG/GA</i>, <i>AG/GA</i> and <i>GA/GA</i> groups. n.s.: not significant,* P_Bf = 0.03.</p