Alignment of amino acid positions among peptides predicted from 45 alleles found for the <i>gp63</i> gene fragment studied.

<p>The 45 translated alleles were detected among 41 different isolates of <i>L</i>. <i>(V</i>.<i>) braziliensis</i> from ATL patients of Corte de Pedra. Alleles 1 to 28 derived from 35 parasite isolates obtained from ATL patients between 1992 and 2001. Alleles 29 to 45 derived from 6 parasite isolates obtained from ATL patients between 2008 and 2011. Alignment was generated by MEGA 5.0 software. Numbers boxed in top three rows correspond to amino acid positions in the <i>gp63</i> gene used a reference (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0163284#sec002" target="_blank">methods</a>). Top sequence in bold corresponds to the amino acids found for each displayed position in the reference <i>gp63</i> sequence. Rows numbered 1 to 45 at left correspond to the 45 alleles of <i>gp63</i> detected in Corte de Pedra. Dots indicate same amino acids as in reference sequence, while letters indicate the substituting amino acids in the study fragments. Regular letters indicate hydrophilic, italicized letters indicate intermediary, and bold letters indicate hydrophobic amino acids. Shaded positions correspond to the segments PAVGVINIPA, SRYD, HEVAH and KAREQYGC referred to in text.</p

Counts of nucleotide/amino acid polymorphisms in nucleic acid/predicted amino acid sequences from 405 base-pairs study fragments of <i>L</i>. <i>(V</i>.<i>) braziliensis gp63</i>.

<p>Columns show data for all forty-five <i>gp63</i> alleles (total) identified and alleles stratified according to clustering analysis depicted in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0163284#pone.0163284.g002" target="_blank">Fig 2</a> (clades A to D).</p

Alignment of polymorphic nucleotide positions of 45 polymorphic alleles found for the <i>gp63</i> gene fragment studied.

<p>Alleles 1 to 28 were detected among 35 different isolates of <i>L</i>. <i>(V</i>.<i>) braziliensis</i> from ATL patients diagnosed between 1992 and 2001 in Corte de Pedra, Brazil. Alleles 29 to 45 were detected among isolates of the parasite drawn from six different patients of the same area between 2008 and 2011. Alignment was generated by MEGA 5.0 software. Numbers boxed in top three rows correspond to nucleotide position in the <i>gp63</i> gene used as reference (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0163284#sec002" target="_blank">methods</a>). Top sequence in bold corresponds to the nucleotides found in each displayed position in the reference <i>gp63</i> sequence. Rows numbered 1 to 45 at left correspond to the 45 alleles of <i>gp63</i> detected in Corte de Pedra. Dots indicate same nucleotide as reference sequence, while letters indicate the substituting nucleotides in the study fragments. (*) Positions with silent polymorphisms in study <i>gp63</i> fragments. (#) Positions with polymorphisms that may be silent or lead to predicted amino acid substitution (highlighted in gray), depending on the study <i>gp63</i> allele. All other positions resulted in predicted amino acid substitution in study <i>gp63</i> alleles.</p

Medical Training at UFSB: III. Competency and Problem Based Learning

<p></p><p>ABSTRACT Curricular reforms in medical education has been much debated in the specialized Brazilian literature. Some reforms have sought to introduce active learning strategies, but with few effective changes. In previous articles, we have introduced the general model of a medical course based on cycles, proposed by the Federal University of Southern Bahia. In this article, we submit to debate the set of pedagogical strategies structuring this project. First, we discuss the concept of “competence” articulated to the demands of a broad professional citizen formation, incorporating effective technologies to humanized care and to labor processes in health. Then, we present learning tools and methodologies that conform a matrix of active pedagogical strategies adopted by the course, based on four central devices: Significant Learning Commitments; Active Learning Teams; Integrated Shared Learning System; Competency and Problem-Based Learning. Such devices (and related strategies) promote the application of strategies and instruments of active and solidary learning in all stages of training, with intensive use of digital technologies and social media. We discuss the fundamentals and perspectives of this pedagogical organization format, which refers to the consistency with the curricular model, emphasizing the strategy of learning oriented by concrete problems as the central axis of training guided by health care practices. As a standardized and dynamic tool for patient follow-up, the patient's record oriented by problems and evidence (POPE) is used, in a computerized version, more adequate and efficient than the traditional template, adapted for use in the different contexts of UFSB clinical practice. This proposal is part of the effort to build a new pedagogical culture based on a sociocritical (inter-cultural, inter-personal, interprofessional and interdisciplinary) perspective of medical education, capable of articulating, in an integrated way, the education system in health to those of science, technology and innovation, aiming to promote integrality, humanization and resolution in health care practices. 300 words</p><p></p

Spearman correlation between frequency of closest recent leishmaniasis cases and distance to a new leishmaniasis diagnosis in Corte de Pedra.

<p>Recent cases defined as those cases occurring within the previous six months to a newly diagnosed case are depicted. (A) ATL cases (r = -0.94, p = 0.0083). (B) CL cases (r = -0.94, p = 0.0083). (C) DL cases (r = -0.99, p = 0.0014). (D) ML cases (r = 0.26, p = 0.3292). For each newly diagnosed (i.e. novel) case of leishmaniasis, the closest recent case of the same clinical type was determined. Then, the number of newly diagnosed cases that presented a closest recent case within a discrete 2.5 km distance interval was plotted against the distance interval units. The following distance intervals (in meters) were employed: 0–2500, 2501–5000, 5001–7500, 7501–10000 and 10001–12500.</p

Spearman coefficient (r) and significance (p) values of the correlations between distances to novel cases and number of novel cases with closest recent cases of ATL, CL, DL or ML at the distance interval units^$.

<p>Spearman coefficient (r) and significance (p) values of the correlations between distances to novel cases and number of novel cases with closest recent cases of ATL, CL, DL or ML at the distance interval units<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006015#t002fn001" target="_blank">^$</a>.</p

Annual incidences of different ATL forms in Corte de Pedra during study years of 1999 to 2003 and 2008 to 2011.

<p>Annual incidences of different ATL forms in Corte de Pedra during study years of 1999 to 2003 and 2008 to 2011.</p

Dynamic distribution of ATL in Corte de Pedra.

<p>(A) Cumulative distribution of DL during three time periods: (red) 1992–1996, (white) 1999–2003, (black) 2008–2011. (B) Cumulative distribution of ML during two time periods: (white) 1999–2003, (black) 2008–2011. (C) Cumulative distribution of CL during two time periods: (white) 1999–2003, (black) 2008–2011.</p

Atypical Manifestations of Cutaneous Leishmaniasis in a Region Endemic for <i>Leishmania braziliensis</i>: Clinical, Immunological and Parasitological Aspects

<div><p>Background</p><p>Atypical cutaneous leishmaniasis (ACL) has become progressively more frequent in Corte de Pedra, Northeast Brazil. Herein we characterize clinical presentation, antimony response, cytokine production and parasite strains prevailing in ACL.</p><p>Methodology/Principal Findings</p><p>Between 2005 and 2012, 51 ACL (cases) and 51 temporally matched cutaneous leishmaniasis (CL) subjects (controls) were enrolled and followed over time in Corte de Pedra. Clinical and therapeutic data were recorded for all subjects. Cytokine secretion by patients’ peripheral blood mononuclear cells (PBMC) stimulated with soluble parasite antigen in vitro, and genotypes in a 600 base-pair locus in chromosome 28 (CHR28/425451) of the infecting <i>L</i>. <i>(V</i>.<i>) braziliensis</i> were compared between the two groups. ACL presented significantly more lesions in head and neck, and higher rate of antimony failure than CL. Cytosine–Adenine substitutions at CHR28/425451 positions 254 and 321 were highly associated with ACL (p<0.0001). In vitro stimulated ACL PBMCs produced lower levels of IFN-γ (p = 0.0002) and TNF (p <0.0001), and higher levels of IL-10 (p = 0.0006) and IL-17 (p = 0.0008) than CL PBMCs.</p><p>Conclusions/Significance</p><p>ACL found in Northeast Brazil is caused by distinct genotypes of <i>L</i>. <i>(V</i>.<i>) braziliensis</i> and presents a cytokine profile that departs from that in classical CL patients. We think that differences in antigenic contents among parasites may be in part responsible for the variation in cytokine responses and possibly immunopathology between CL and ACL.</p></div

Atypical (ACL) and localized cutaneous leishmaniasis (CL) cases distribute similarly in Corte de Pedra, Brazil.

<p>ACL (N = 51) and temporally matched CL (N = 51) cases diagnosed between 2005 and 2012 in Corte de Pedra were mapped, and the resulting sets of geographic events were statistically compared. Black dots and red triangles correspond to ACL and CL patients, respectively. Total number of dots and triangles plotted is smaller than the actual number of corresponding cases due to overlap of some patients' geographic coordinates. The two manifestations of leishmaniasis present similar distributions in Corte de Pedra, with Cuzick and Edward´s comparison yielding non-significant (p = 0.26). For details refer to Methods section.</p