THE HEALTH SCHOOL PROGRAMME: A HEALTH PROMOTION STRATEGY IN PRIMARY CARE IN BRAZIL

Introduction: the Health School Programme (HSP) should be understood as a permanent development process. In this context, the actions of a policy aimed at children and adolescentsare paramount in the HSP. Objective: to identify and describe the actions developed by the Family Health Group in the HSP, from the National Programme for ImprovingAccess and Quality of Primary Care (PIPCAQ). Methods: this cross-sectional research used secondary data collected fromthe 17,202 groups who joined PIPCAQ in 2012. Results: all regions showed significant results concerning the execution of school activities. the Northern region was the one that performed most school actions (80.5%), followed by the Northeast, Midwest, South and Southeast, respectively. However, some items, such as professional training in education and health work need to be streng the ned. Conclusion: HSP in Brazil has mobilised significant actions, even though it has not happened in homogeneously in all Brazilian regions

A novel case of human visceral leishmaniasis from the urban area of the city of Rio de Janeiro: autochthonous or imported from Spain ?

Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle, 10ª Enfermaria. Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de Janeiro. Centro de Ciências Biológicas e da Saúde. Hospital Universitário Gaffrée e Guinle. Serviço de Anatomia Patológica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses. Rio de Janeiro, RJ, Brasil

CD3+CD4negCD8neg (double negative) T lymphocytes and NKT cells as the main cytotoxic-related-CD107a+ cells in lesions of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis

Abstract Background Cutaneous leishmaniasis (CL) is caused by Leishmania (Viannia) braziliensis, which infects dermal macrophages and dendritic cells, causing an intense immune-mediated-tissue inflammation and a skin ulcer with elevated borders that can heal spontaneously or after antimonial therapy. The resolution of lesions depends on an adaptive immune response, and cytotoxic cells seem to have a fundamental role in this process. The aim of this study is to better understand the role of cytotoxicity mediated mechanisms that occur during the immune response in the CL lesion milieu, considering distinct cytotoxic-related CD107a+ cells, such as CD8+, CD4+, CD4neg CD8neg (double-negative, DN) and CD4+CD8+ (double-positive, DP) T lymphocytes, as well as NK and NKT cells. Methods Lesion derived cells were assessed for T cell subpopulations and NK cells, as well as CD107a expression by flow cytometry. In addition, cytometric bead array (CBA) was used to quantify cytokines and granzyme B concentrations in supernatants from macerated lesions. Results Flow cytometry analyses revealed that NKT cells are the major CD107a-expressing cell population committed to cytotoxicity in CL lesion, although we also observed high frequencies of CD4+ and DN T cells expressing CD107a. Analysing the pool of CD107a+-cell populations, we found a higher distribution of DN T cells (44%), followed by approximately 25% of NKT cells. Interestingly, NK and CD8+ T cells represented only 3 and 4% of the total-CD107a+-cell pool, respectively. Conclusions The cytotoxicity activity that occurs in the lesion milieu of CL patients seems to be dominated by DN T and NKT cells. These findings suggest the need for a reevaluation of the role of classical-cytotoxic NK and CD8+ T cells in the pathogenesis of CL, implicating an important role for other T cell subpopulations

Contribution of Leishmania braziliensis antigen-specific CD4+ T, CD8+ T, NK and CD3+CD56+NKT cells in the immunopathogenesis of cutaneous leishmaniasis patients: Cytotoxic, activation and exhaustion profiles.

The pathogenesis of cutaneous leishmaniasis (CL) caused by Leishmania (Viannia) braziliensis is dictated mainly by the immune-mediated-tissue inflammation developed. The understanding of the immunological mechanisms that generate tissue damage or resolution of lesions is the key to the development of effective vaccine protocols and proper therapeutic schemes. It is clear that the specific immune response mediated by T cells is responsible for the beneficial outcome of the disease, however, the roles of CD4+ T, CD8+ T, NK and NKT cell subpopulations in immunopathogenesis of CL need to be elucidated. Peripheral blood cells from patients before, during and after the antimonial therapy, as well as healthy individuals (HI) were cultured with (LbAgS) or without (NS) L. braziliensis antigens (LbAg). Afterwards, the frequencies of LbAg-specific-cytotoxic CD8+ T, CD4+ T, NK and CD3+CD56+ NKT cells, as well as their activation and exhaustion profiles, were defined by flow cytometry. We observed higher frequencies of CD8+ T, NK and CD3+CD56+ NKT cells and lower frequencies of CD4+ T lymphocytes in LbAgS cell cultures from patients before treatment. The specific response to LbAg resulted in an expansion of cytotoxic-activated CD4+ T, CD8+ T, and NK cells, before and during treatment, indicating specificity in the response by these cells against L. braziliensis. Furthermore, comparing the differences of frequencies of cytotoxic-activated CD4+T, CD8+T, and NK cells, among before and during treatment patients and HI groups, we conclude that these cell populations are in charge of immune response elicited by antimonial therapy. Interestingly, we also observed that NK cells were induced by LbAg to an exhaustion profile during all clinical stages of the disease. The increased antigen-specific activation and cytotoxic activity are in line with the strong inflammatory response described in this disease, a likely cause of tissue damage. These findings reinforce the involvement of these distinct cytotoxic-activated cell populations in the immunopathogenesis of CL, showing a character of specificity in this immune response

Is There Any Difference between the In Situ and Systemic IL-10 and IFN-γ Production when Clinical Forms of Cutaneous Sporotrichosis Are Compared?

Submitted by Sandra Infurna ([email protected]) on 2016-12-15T11:14:37Z No. of bitstreams: 1 fernanda_morgado_etal_IOC_2016.pdf: 4768094 bytes, checksum: 5ab755cd6bdf28be44e74b4620b05950 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2016-12-15T11:30:54Z (GMT) No. of bitstreams: 1 fernanda_morgado_etal_IOC_2016.pdf: 4768094 bytes, checksum: 5ab755cd6bdf28be44e74b4620b05950 (MD5)Made available in DSpace on 2016-12-15T11:30:54Z (GMT). No. of bitstreams: 1 fernanda_morgado_etal_IOC_2016.pdf: 4768094 bytes, checksum: 5ab755cd6bdf28be44e74b4620b05950 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ. Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Leishmaniose. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil / New University of Lisbon (UNL). Hygiene and Tropical Medicine Institute (IHMT). Lisboa, Portugal.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ. Brasil.Fungus of the Sporothrix schenckii complex can produce skin lesions in humans, commonly lymphocutaneous (LC) and fixed (F) forms of sporotrichosis. Some authors have suggested that clinical forms are influenced by differences in virulence and genetic profile of isolates. But little is known about the role of immune response in determining the clinical outcome of sporotrichosis. To verify the profile of systemic and in situ IFN-γ and IL-10 expression in sporotrichosis patients, and consequently to detect any difference between the two compartments and/or clinical presentation, we quantified the number of IFN-γ and IL-10 producer peripheral blood mononuclear cells stimulated with S. schenckii antigen (Ss-Ag) by Elispot, and quantified cytokines expression by in situ immunohistochemistry in the same patient. Three groups were formed: 1- LC (n = 9); 2- F (n = 10); 3- healthy individuals (n = 14). All sporotrichosis patients produced high amounts of systemic IFN- γ when compared to uninfected individuals. No differences were observed between LC and F groups. Regarding in situ IL-10 expression, a difference between LC and F groups was observed: LC lesions presented higher amounts of IL-10 than F lesions differently from systemic IL-10 which showed similarities. Our data suggests that LC lesions present higher IL-10 expression which could be related to regulatory mechanisms for compensating the tissue injury, however favoring fungal persistence in the lesions. Surprisingly, there were no differences in systemic and in situ IFN- γ expression between CL and F patients, although it was significantly higher expressed in these patients than in healthy individuals

Apoptosis and frequency of total and effector CD8+ T lymphocytes from cutaneous leishmaniasis patients during antimonial therapy

Submitted by sandra infurna ([email protected]) on 2016-03-01T14:57:53Z No. of bitstreams: 1 raquel_ferraz_etal_IOC_2015.pdf: 2179704 bytes, checksum: b04464e6d07d3b6431bfb4cf63a70251 (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2016-03-01T15:29:07Z (GMT) No. of bitstreams: 1 raquel_ferraz_etal_IOC_2015.pdf: 2179704 bytes, checksum: b04464e6d07d3b6431bfb4cf63a70251 (MD5)Made available in DSpace on 2016-03-01T15:29:07Z (GMT). No. of bitstreams: 1 raquel_ferraz_etal_IOC_2015.pdf: 2179704 bytes, checksum: b04464e6d07d3b6431bfb4cf63a70251 (MD5) Previous issue date: 2015Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Plataforma de Citometria de Fluxo – Purificação celular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Interdisciplinar de Pesquisas Médicas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilãncia para Leishmaniose. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilãncia para Leishmaniose. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilãncia para Leishmaniose. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Vigilãncia para Leishmaniose. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Escola de Medicina. Departamento de Otorrinolaringologia e Oftalmologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Interdisciplinar de Pesquisas Médicas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Plataforma de Citometria de Fluxo – Purificação celular. Rio de Janeiro, RJ, Brasil /Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Plataforma de Citometria de Fluxo – Purificação celular. Rio de Janeiro, RJ, Brasil.Background: Leishmaniasis is an important parasitic disease affecting millions worldwide. Human cutaneous leishmaniasis (CL) is endemic in Rio de Janeiro, Brazil, where is caused by Leishmania braziliensis. The adaptive immune response is accountable for the healing of CL and despite of key role of CD8+ T cells in this immune response little is known about the CD8+ T lymphocytes frequencies, apoptosis and antigen-responsive CD8+ T lymphocytes of CL patients during antimonial therapy. Methods: Using flow cytometry, we examined total and effector CD8+ T cells from CL patients before (PBT), during (PDT) and after (PAT) treatment for apoptosis and frequencies upon isolation and after in vitro L. braziliensis antigens (LbAg)-stimulation culture. Besides, a correlation study between immunological findings and lesion size was done. Results: PDT showed lower frequencies of total CD8+ T lymphocytes and higher levels of apoptosis of these cells, which were also observed following LbAg-stimulation culture. Regarding effector CD8+ T cells, high frequencies were observed in PDT, while lower frequencies were observed in PAT. Interestingly, PDT showed higher frequencies of apoptotic-effector CD8+ T lymphocytes. Similar results were seen after in vitro antigenic-stimulation assays. Correlation analysis showed that the greater the size of lesion, the smaller the frequency of effector CD8+ T lymphocytes in PDT and PAT, as well as a positive correlation between apoptotic-effector CD8+ T cells frequency and lesion size of PDT. Conclusions: Changes in effector CD8+ T–lymphocyte frequencies, during and after treatment, seem to represent a critical stage to generate an efficient immune response and suggest that these cells would be evolved in the triggering or in the resolution of lesion, under the influence of therapy. This hypothesis opens new perspectives to clarify controversial statements about the protective or deleterious role of CD8+ T cells in the cure or aggravation of CL and the new approach of evaluating patients during treatment proved to be of utmost importance for understanding the immune response in the healing process of human CL

<i>In situ</i> IFN-γ and IL-10 expression in lymphocutaneous and fixed lesions of sporothrichosis.

<p>The <i>in situ</i> IFN-γ and IL-10 expression was detected by immunohistochemistry. The arrows point positive areas (red/AEC– 3-amino-9-ethylcarbazole). The intensity of staining was scored in ten microscopic fields (200x magnification) as rare (at least 1 positive area / field), discrete (2–3 positive areas / field), moderate (4–5 positive areas / field) and intense (>5 positive areas / field). Scale bar = 10μm.</p