Prevalência de doença celíaca entre usuários idosos do laboratório de patologia clínica do Hospital Universitário de Brasília

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Curso de Pós-Graduação em Ciências Médicas, 2012.Introdução: Inicialmente enfocada por Arateus da Capadócia no século II dC e posteriormente novamente descrita por Samuel Gee em 1888 a doença celíaca é uma afecção crônica de origem auto-imune que concomitantemente afeta o sistema gastrointestinal e vários outros órgãos e sistemas e que é induzida pela ingestão de glúten em indivíduos geneticamente predispostos. As anormalidades clássicas da DC são predominantemente caracterizadas por atrofia das vilosidades intestinais, hipertrofias das criptas e infiltração linfocitária da mucosa jejunal secundárias a resposta auto-imune mediada por linfócitos T à enzima transglutaminase 2. Objetivos: Determinar a prevalência de DC entre idosos (≥60 anos) e comparar com grupo de crianças com prevalência de DC determinada pertencentes a mesma área e com similar nível socioeconômico. Métodos: Amostras de sangue de 946 idosos foram testados quanto à presença de anticorpos IgA anti-transglutaminase (IgA-tTG2) e naqueles que tinham níveis anormais destes anticorpos, foi realizado o teste IgA anti-endomísio (IgA-EMA) e tipagem de alelos HLA predisponentes. Resultados: Um dentre 946 indivíduos era celíaco diagnosticado por biópsia e dentre os nove pacientes com níveis anormais de IgA-tTG2, nenhum tinha positividade para o teste IgA-EMA e seis tinham alelos HLA-DQ2 ou HLA-DQ8 ou ambos. Conclusões: No presente estudo, a prevalência de DC no grupo estudado foi 5,4 vezes maior do que a encontrada em crianças e adolescentes na mesma região geográfica. Sem excluir as outras possíveis causas, a razão mais provável para esta diferença entre os grupos é um aumento da mortalidade entre pacientes celíacos associado com condições ambientais adversas. ______________________________________________________________________________ ABSTRACTIntroduction: Initially described by Arateus of Cappadocia in the second century AD and later re-described by Samuel Gee in 1888, celiac disease (CD) is a chronic autoimmune disease that simultaneously affects the gastro-intestinal system and various other organs and systems and is induced by the ingestion of gluten in genetically predisposed individuals. The classical DC clinical picture is predominantly characterized by intestinal villous atrophy, crypt hyperplasia, and lymphocytic infiltration of the jejunal mucosa secondary to autoimmune response to the enzyme transglutaminase 2 mediated by T lymphocytes. Objective: The aim of this study was to determine the prevalence of celiac disease (CD) in a group of Brazilian individuals over 60 years of age and compare it with the previously known prevalence in the pediatric population of the same area. To date, the limited number of studies addressing this issue report contradictory results. Methods: Blood samples from 946 outpatients aged 60 years or older were tested for immunoglobulin A anti-transglutaminase antibodies by ELISA. All positive sera were further tested for anti-endomysium antibodies. HLA genotyping was performed for all individuals who exhibited discrepant serologic results. Results: Among the 946 subjects only one previously diagnosed case of biopsy-proven CD was detected. Among the remaining subjects, nine tested positive for immunoglobulin A anti-transglutaminase antibodies; however, none of them tested positive for immunoglobulin A human anti-endomysium antibodies. HLA genotyping of those nine subjects revealed six individuals positive for DQ2, DQ8 or both alleles. Conclusions: In the present study, the prevalence of CD in the studied group was 5.4 times lower than the one found in children and adolescents. Without excluding other possible causes, the most likely reason for this difference is increased CD patient mortality associated with adverse environmental conditions

Avaliação de estratégias de relaxamento do distanciamento social para o Brasil e estado do Rio de Janeiro

In this technical note we discuss some measures to release social distancing and their impacts in the epidemiological sense in order to assess the effects on the projections of the COVID-19 epidemic in Brazil and, in particular, in the state of Rio de Janeiro. The analysis of possible relaxation scenarios for social distancing is a topic of great relevance to aid the estimation of the most appropriate moment for the return to normality in daily life. In this context, we discuss the importance - and possible consequences - of relaxing social distancing at an appropriate time. The results suggest that the adoption of gradual release policies of social distancing is feasible when epidemiological control is assured. On the other hand, in the absence of verification of epidemiological control, both gradual and abrupt relaxation strategies generate a substantial increase in the number of confirmed cases and deaths, in addition to evidence of a considerable increase in the time required to eradicate the disease. Therefore, in the scenario where it is not possible to guarantee epidemiological control, social distancing release policies analyzed in this research are not recommended.En esta nota técnica discutimos algunas medidas para relajar el distanciamiento social y sus impactos en el sentido epidemiológico para evaluar los efectos en las proyecciones de la epidemia de COVID-19 en Brasil y, en particular, en el estado de Rio de Janeiro. El análisis de posibles escenarios de relajación para el distanciamiento social es un tema de gran relevancia para ayudar a estimar el momento más apropiado para el retorno a la normalidad en la vida diaria. En este contexto, discutimos la importancia, y las posibles consecuencias, de relajar el distanciamiento social en el momento adecuado. Los resultados indican que la adopción de medidas de relajación gradual de el distanciamiento social, en una situación de control epidemiológico, es factible. Por otro lado, en ausencia de verificación del control epidemiológico, las medidas de relajación gradual y abrupta generan un aumento sustancial en el número de casos confirmados y muertes, además de evidencia de un aumento considerable en el tiempo requerido para erradicar la enfermedad. Por lo tanto, en el escenario donde no es posible asegurar el control epidemiológico, no se recomiendan las medidas de relajación de el distanciamiento social estudiadas en esta investigación.Nesta nota técnica discutimos algumas medidas de relaxamento do distanciamento social e seus impactos no sentido epidemiológico com o objetivo de avaliar os efeitos nas projeções da epidemia da COVID-19 no Brasil e, em particular, no estado do Rio de Janeiro. A análise de possíveis cenários de relaxamento do distanciamento social é tema de grande relevância para auxiliar a estimar o momento mais apropriado para o retorno à normalidade do cotidiano. Neste contexto, discutimos a importância -- e as possíveis consequências -- de realizar o relaxamento do distanciamento social em um momento adequado. Os resultados indicam que a adoção de medidas de relaxamento gradual do distanciamento social, quando em situação de controle epidemiológico, são viáveis. Por outro lado, na ausência de verificação de controle epidemiológico, tanto medidas de relaxamento gradual quanto abruptas geram substancial aumento no número de casos confirmados e óbitos, além de evidências de considerável aumento no tempo necessário para a erradicação da doença. Portanto, no cenário em que não é possível aferir o controle epidemiológico, as medidas de relaxamento do distanciamento social estudadas nesta pesquisa não são recomendadas

Transtorno autístico e doença celíaca : sem evidências de associação

Objective: To evaluate the possible association between celiac disease (CD) and/or gluten sensitivity (GS) and autism spectrum disorder (ASD). Methods: Occurrences of CD were determined in a group of children and adolescents affected by ASD and, conversely, occurrences of ASD were assessed in a group of biopsy-proven celiac patients. To detect the possible existence of GS, the levels of antigliadin antibodies in ASD patients were assessed and compared with the levels in a group of non-celiac children. Results: The prevalence of CD or GS in ASD patients was not greater than in groups originating from the same geographical area. Similarly the prevalence of ASD was not greater than in a group of biopsy-proven CD patients. Conclusion: No statistically demonstrable association was found between CD or GS and ASD. Consequently, routine screening for CD or GS in all patients with ASD is, at this moment, neither justifed nor cost-effective. ___________________________________________________________________________________ RESUMOObjetivo: Avaliar a possível associação entre doença celíaca (DC) e/ou sensibilidade ao glúten (SG) e transtorno do espectro autista (TEA). Métodos: Ocorrências de DC foram determinadas em um grupo de crianças e adolescentes afetados pelo TEA e a ocorrência d TEA foi avaliada em um grupo de pacientes com DC comprovada por biópsia. Para detectar a possível existência de SG, foram determinados níveis de anticorpos antigliadina em pacientes com TEA e comparados ao grupo de crianças sem a doença celíaca. Resultados: A prevalência de DC ou SG não foi maior no grupo de pacientes com TEA quando comparada a grupos de indivíduos originários da mesma região geográfca. De modo similar, a prevalência do TEA não foi maior ao ser comparada ao grupo de pacientes com DC. Conclusão: Não houve associação estatisticamente demonstrável entre DC ou SG e TEA. Consequentemente, não são justifcáveis, no momento, exames de rotina para detecção de DC ou SG em pacientes com TEA

Healing incisional surgical wounds using Rose Hip oil in rats

Purpose: To evaluate incisional surgical wound healing in rats by using Rose Hip (Rosa rubiginosa L.) oil. Methods: Twenty-one days after the oophorectomy procedure, twenty-seven female, adult, Wistar rats were distributed into three groups: Control group (wound treatment with distilled water); Collagenase group (treatment with collagenase ointment); and Rose Hip group (wound treatment with Rose Hip oil). Each group was distributed according to the date of euthanasia: 7, 14 and 21 days. The wound was evaluated considering the macroscopic and microscopic parameters. Results: The results indicated differences in the healing of incisional wounds between treatments when compared to control group. Accelerated wound healing was observed in the group treated with Rose Hip oil in comparison to the control and collagenase, especially after the 14th day. Morphometric data confirmed the structural findings. Conclusion: There was significant effect in topical application of Rose Hip oil on incisional surgical wound healing

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Análise do risco genético associado à presença de alelos HLA-DQ em pacientes com Doença Celíaca

Introdução: O desenvolvimento da Doença Celíaca (DC) está fortemente relacionado à presença de HLA-DQ2.5, HLA-DQ2.2 e HLA-DQ8. Há poucos dados sobre a distribuição desses alelos em pacientes celíacos e na população geral no Brasil e não há informação sobre seu uso clínico. A ausência deles torna pouco provável o desenvolvimento da DC. Assim, para levantar dados consistentes sobre a frequência de alelos HLA-DQ predisponentes à DC e sugerir risco genético de desenvolver a DC, realizamos este estudo caso-controle. Metodologia: 237 pacientes celíacos e 237 controles (ambos os grupos com 164 mulheres) foram testados quanto à presença de anticorpos anti-transglutaminase (htTG-IgA) e antiendomísio (EMA-IgA) e genotipados quanto à presença dos alelos HLA-DQ predisponentes à DC utilizando qPCR e kit comercial. As frequências de HLA-DQ2.5, -DQ2.2 e -DQ8 entre pacientes celíacos e controles foi comparada (teste de Fischer e teste do qui-quadrado). Os resultados foram considerados significantes quando p<0.05. O risco foi apresentado como 1:N para cada uma das categorias HLA-DQ descritas neste estudo. Resultados: Os resultados de qPCR foram 100 % concordantes com aqueles gerados por kit comercial. HLA-DQ2.5 e/ou HLA-DQ8 foi detectado em 224 pacientes (94,5 %) e em 84 controles (35,4 %). Oito celíacos (3,4 %) e 38 controles (16 %) possuíam exclusivamente HLA-DQ2.2. HLA-DQ2.5, sem HLADQ8, foi encontrado em 178 celíacos (75,1 %) e 38 controles (16 %). HLA-DQ8, sem outros alelos HLA-DQ predisponentes à DC, estava presente em dez celíacos (4,2 %) e em 36 controles (15,2 %). Indivíduos que possuem apenas DQA1*05 ou DQA1*03 ou não possuem alelos predisponentes à DC somam, juntos, 5 celíacos (2,1 %) e 115 controles (48,4 %). Os riscos genéticos variaram entre 1:7 a 1:3014 sendo que HLA-DQ2.5/DQ2.5, HLA-DQ2.5/DQ2.2 e HLA-DQ2.5/DQ8 predispõem mais ao desenvolvimento da DC. Embora HLA-DQ2.2 tenha baixo risco de desencadear a DC (1:251, homozigose e 1:550, heterozigose com HLA-DQ ≠ HLA-DQ2.5 e HLA-DQ8), quando associado a HLA-DQ2.5 mostra o segundo maior risco de desenvolvê-la (1:10; p < 0.0001). Conclusões: O estudo permitiu gerar dados significantes sobre a frequência de HLA-DQ2.5, -DQ2.2, e -DQ8 em grupo populacional representativo de pacientes celíacos e controles do Distrito Federal, Brasil, e estabelecer um gradiente de risco baseado em alelos HLA-DQ aplicável à população brasileira. __________________________________________________________________________________________________ ABSTRACTIntroduction: Celiac Disease (CD) development is strongly related to HLA-DQ2.5, HLA-DQ2.2 and HLA-DQ8 genotypes. In Brazilian population, few studies have described the frequency of these genotypes. All of them have just used few cases and no clinical use was attributed to this information. DC is unlikely in people without predisposing genotypes. In order to establish the frequency of HLA-DQ predisposing alleles to CD and a risk gradient related to HLA-DQ, this case-control study was developed. Methodology: 237 celiac and 237 controls were tested to IgA-htTG and IgA-EMA (both groups with 164 females and 73 males). All of them were genotyped for CD predisposing genotypes/alleles HLA-DQ by qPCR and commercial kit. HLADQ2.5, -DQ2.2 and -DQ8 frequencies were compared between celiac and controls (Fisher exact test and qui-squared test). The results were significant when p<0.05. The risk were assigned using 1:N representation, according to each HLA-DQ category described. Results: qPCR results were 100 % concordant with the commercial kit results. HLA-DQ2.5 and/or HLADQ8 were detected in 224 patients (94.5 %) and in 84 controls (35 %). HLA-DQ2.2, without another CD HLA-DQ, were detected in eight celiac (3.4 %) and 38 controls (16 %). HLA-DQ2.5, without HLA-DQ8 were detected in 178 celiac (75.1 %) and 38 controls (16 %). Isolated HLADQ8 were present in ten celiac (4.2 %) and 36 controls (15.2 %). Five celiac (2.1 %) and 115 controls (48.4 %) had α5 (DQA1*05), α8 (DQA1*03) or no CD HLA-DQ. Genetic risk ranged from 1:7 to 1:3014 with HLA-DQ2.5/DQ2.5, HLA-DQ2.2/DQ2.2 and HLA-DQ2.5/DQ8 being the major CD risk factors. Even though HLA-DQ2.2 showed a low CD risk of 1:251 (homozygosis) and 1:550 (heterozygosis with HLA-DQ different from HLA-DQ2.5 and HLA-DQ8), when associated with HLA-DQ2.5 it showed a second highest CD risk of 1:10 (p < 0.0001). Conclusions: This study enables us to show the frequency of genotypes HLA-DQ2.5, -DQ2.2, - DQ8 in a representative population group of celiac patients and controls in the city of Brasilia (Brazil) and surroundings (DF) and to establish a risk gradient based on HLA-DQ profile applicable to the Brazilian population