Prevalence of uterine curettages at Instituto da Mulher Dona Lindu in 2014 - Manaus - AM, Brazil / Prevalência de Curetagens uterinas no Instituto da Mulher Dona Lindu no ano de 2014 – Manaus – AM, Brasil

Uterine curettage is a medical-gynecological procedure whose function is to remove remnants of an abortion, whether spontaneous or induced. In Manaus, as well as data from other public maternities in all of Brazil, most of the abortions occur in young patients and are presumably induced. For this reason, our objective was to present a descriptive analysis of the data on the curettage procedure as well as to highlith the most prevalent age group at the Instituto da mulher Dona Lindu, Manaus-Am in 2014. Despite the continuing need for more research, in order to suggest more effective measures about sexual health education, the findings of the present study that at least half of abortions are induced and occurred in girls aged 14 to 18 years corroborate with most of the research on the subject

Virulence Attenuation of Candida albicans Genetic Variants Isolated from a Patient with a Recurrent Bloodstream Infection

The incidence of Candida albicans infections and the relapse episodes after antifungal treatment have increased in recent decades. Recurrences are mainly due to the persistence of the original infecting strain that may present genetic and genomic rearrangements during interaction with the host, reflecting strain adaptation. In this study, four isolates recovered from a patient during recurrent candidemia episodes were genotyped by microsatellite length polymorphism (MLP) and by multilocus sequence typing (MLST) and found to be genetic variants of the same strain. Using experimental mouse infections, a progressive reduction in the virulence of the four isolates was observed, with the first two isolates more virulent than the third and fourth. Additionally, in the mouse model, the first isolate resisted host control more efficiently, resulting in higher kidney fungal burdens and necrosis as compared to the third isolate. The resolution of inflammation was delayed in mice challenged with the first isolate and the message for IFN-γ and TNF-α in the spleen was lower within the first few hours post-infection. Original and recurrent isolates also displayed different phenotypes regarding activity of secreted enzymes and response to stress agents. Overall, the comparative analysis indicated that the virulence decrease of these isolates was related to a lower ability to resist to the host anticandida effector mechanisms. We showed for the first time that C. albicans genetic variants of the same strain, sequentially isolated from an immunocompromised patient, underwent adaptations in the human host that resulted in virulence attenuation when tested in mice

Microsatellite genotypes and diploid sequence types (DSTs) obtained by MLP and MLST analysis of the clinical isolates used in this study.

<p>The corresponding date and local of isolation, as well as clade assignment based on MSLT, are also shown.</p><p>- data unknown; DST – diploid sequence type; S* - singleton.</p

<i>In vitro</i> susceptibility assay.

<p>Growth of 124A and 140A yeast cells at 37°C for 48 h on YPD and YPD containing 20mM acetic acid, 0.3M CaCl₂, 1M NaCl, 10mM MnSO₄, and 12mM caffeine. Drop tests were performed by spotting 10 µl of 10⁵, to 10² cells/ml dilutions.</p

Kidney histology.

<p>Representative micrographs of H&E/PAS-stained paraffin sections of kidneys recovered from mice infected with 10⁶ yeast cells at days 1 (A and B), 3 (C and D) and 7 (E and F) days post-infection with isolates 124A and 140A.The bar −100 µM.</p

Real time PCR cytokine quantification.

<p>RNA was extracted from spleen homogenates in HBSS of mice infected with 10⁶ yeast cells of 124A (□) or 140A (▪) by using the Trizol method and mRNA levels of IFN-γ (A), TNF-α (B) and IL-4 (C) quantified and expressed as copies per HPRT gene. Statistical significance was calculated by using Student's <i>t</i> test and significant differences are labeled with a single asterisk (<i>P</i><0.05) or triple asterisks (<i>P</i><0,0001).</p

<i>C. albicans</i> strain clustering.

<p>Similarities between MLST data were analyzed in terms of p distance with MEGA version 4.0 and nodal support values, after 1000 bootstrap replications, were calculated and are depicted on the UPGMA dendrogram.</p

Kidney fungal burden.

<p>Groups of four mice infected i.v. with 10⁶<i>C. albicans</i> cells were killed at 1, 3 and 7 days after challenge. Organs were homogenized in HBSS and the suspension diluted and cultured on Sabouraud dextrose agar. Results are presented as log of colony-forming units (CFUs). Statistically significant differences between results at each hour of infection as evaluated by Student's <i>t</i> test are labeled with single asterisk (<i>P</i><0.05).</p

Survival of BALB/c mice following i.v. infection with <i>C. albicans</i> strain variants.

<p>Mice were infected i.v with (A) 2×10⁶ cells of isolates 124A, 140, 140A or 144 or (B) 1×10⁶ cells of SC5314, 124A or 140A and the condition of the mice were assessed daily for 30 days.</p

Intraperitoneal inflammatory response to <i>C. albicans</i> strain variants.

<p>Kinetics of neutrophils (A) and macrophages (B) in the peritoneal cavity following i.p. infection of BALB/c mice with 10⁷ cells from strains 124A (solid line) and 140A (dashed lines). Cells were recovered by peritoneal lavage, and counting of leukocytes was performed by flow citometry. Statistically significant differences between results at 3, 8, 24 and 48 hours of infection, as evaluated by Student's <i>t</i> test, are labeled with double asterisks (<i>P</i><0.001).</p