Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

Estudo fitoquímico e avaliação in vitro da atividade anti-Trypanosoma cruzi cepa Y de Pilocarpus spicatus St. Hil. (Rutaceae) / Phytochemical study and in vitro evaluation of the anti-Trypanosoma cruzi Y strain activity of Pilocarpus spicatus A. St. Hil.

A investigação química da espécie Pilocarpus spicatus, popularmente conhecida como jaborandi e usada na medicina tradicional para doenças como estomatite, febre, bronquite e psoríase, teve por objetivo o isolamento e/ou identificação de substâncias ativas e a avaliação da atividade antiparasitária dos extratos frente às formas epimastigotas de Trypanosoma cruzi. O estudo resultou na identificação de nove substâncias, tais como: tridecanona, 2-heptadecanona, espatulenol, aromadendreno, β-cariofileno, ácido 3α-hidroxitirucala-7,24-dien-21-óico, (+)-isoangenomalina, episesamina e sesamina. As estr uturas dos compostos foram elucidadas por análises espectroscópicas e comparação com dados da literatura. Os extratos hexânico e metanólico de folhas e raízes foram testados in vitro contra o Trypanosoma cruzi cepa Y e apresentaram atividade tripanomicida.

The chemical investigation of the species Pilocarpus spicatus - popularly known as jaborandi and used in traditional medicine for diseases, such as stomatitis, fever, bronchitis and psoriasis - aimed to isolate and / or identify the active substances and evaluate the antiparasitic activity of the extracts against the Trypanosoma cruzi epimastigote forms. The study resulted in the identification of nine substances, such as tridecanone, 2-heptadecanone, spathulenol, aromadendrene, β-caryophyllene, 3α-hydroxytirucalla-7,24-dien-21-oic acid, (+)-isoangenomaline, episesamin and sesamin. The structures were elucidated by spectroscopic analysis and comparison with literature data. The hexane and methanol extracts from leaves and roots were tested in vitro against Trypanosoma cruzi Y strain and showed trypanocidal activity.

Estudo farmacobotânico das folhas de Garcinia brasiliensis Mart. (Clusiaceae) / Pharmacobotanical studies of Garcinia brasiliensis Mart. (Clusiaceae) leaves

A espécie Garcinia brasiliensis Mart. (Clusiaceae), nativa da região Amazônica e cultivada em todo o território brasileiro, vem sendo bastante estudada devido seu potencial farmacológico, porém são escassos estudos que tratam da caracterização farmacobotânica desta espécie. Considerando as propriedades terapêuticas para tornar-se um medicamento fitoterápico, o presente trabalho teve como objetivos estudar a anatomia e histoquímica da folha e do pecíolo e elaborar dados macroscópicos e microscópicos que forneçam características marcantes para sua identificação além de dar subsídios para a análise farmacognóstica no controle de qualidade da droga vegetal. O material vegetal foi fixado e submetido às técnicas usuais de microscopia de luz e a testes histoquímicos. As folhas de G. brasiliensis são opostas, simples, descolores, forma elíptica com nervação peninérvia. As células epidérmicas, em vista frontal, apresentam contorno sinuoso e estômatos paracíticos somente na face abaxial. O mesofilo é dorsiventral, a nervura central apresenta contorno biconvexo e feixe vascular em forma de semi-arco fechado envolto por bainha esclerenquimática. Inclusões inorgânicas de cristais na forma de drusas e orgânicas representadas por compostos fenólicos e grãos de amidos estão dispersos ao longo de toda lâmina foliar e pecíolo. Observa-se com frequência a presença de canais secretores preenchidos por um conteúdo lipídico dispersos pelo parênquima fundamental e próximos aos feixes vasculares. Estes dados fornecem subsídios para o controle de qualidade da matéria-prima utilizada para a produção de fitoterápicos.

The Garcinia brasiliensis Mart. (Clusiaceae) species, native of the Amazon region and cultivated throughout the Brazilian territory, has been widely studied due to its pharmacological potential, but there are few studies dealing with the pharmacobotanic characterization of this species. Considering the therapeutic properties in order to become an herbal medicine, the present paper had the purpose of studying the anatomical and histochemical characterization of the leaf and petiole, as well as producing macroscopic and microscopic data that provide important characteristics for its identification, in addition to providing subsidies for the pharmacognostical analysis in order to offer elements for the quality assurance of the drug. The botanical material was prepared through the usual optical and histochemical microtechniques. The leaves of G. brasiliensis are simple, opposed, colorless, and they show an elliptical shape. As seen from the front, the epidermal cells have a sinuous contour, and paracytic stomata occur on the low surface. The leaves are hipostomatic and dorsiventral with heterogeneous mesophile. The mesophile is dorsiventral, the central midrib shows a biconvex contour and vascular system in a semi-closed arch shape surrounded by a sclerenchymatic sheath. Inorganic inclusions of crystals in the shape of druses, and organic inclusions represented by phenolic compounds and starch grains are found throughout the leaf blade and petiole. It is common to find secretory canals filled with a lipid content dispersed throughout the parenchyma and near the vascular bundles. These data support the quality assurance of the elements used to produce herbal medicines.

Induction of cell migration and activation in mice by the freshwater sponge Drulia uruguayensis Bonetto & Ezcurra de Drago, 1968 (Porifera: Metaniidae)

Freshwater sponges are abundant in the Amazon region and they have been known to cause dermatitis (acute inflammation) since the beginning of the 20th century. To determine whether additional constituents, besides their body spicules, cause dermatological reactions in humans, an experimental study was developed and carried out using mice and Drulia uruguayensis prepared in three different forms: intact sponges (IS), macerated sponges (MS) or isolated spicules - megascleres (ISM). The cells most commonly involved in inflammatory reactions (mast cells, eosinophils and neutrophils), as well as intraepithelial lymphocytes and degranulated mast cells, were counted so that they could be used as parameters to determine which of the sponge preparations induced the greatest reaction. The effects of the sponge on the skin were then determined by histological analysis. The results obtained showed that IS caused the greatest inflammatory reaction (p = 0.000005), activating mainly mast cells (p = 0.0018). The histopathological analysis revealed a slight loss of continuity of the epidermis when ISM or IS were applied. These findings allow us to conclude that a structurally intact sponge can cause a greater inflammatory reaction in the first contact because of its ability to perforate the skin and allow inflammatory agents to enter. Other proteins present in dried sponge bodies could induce allergic but not toxic responses (in contact with the entire sponge, a large number of pharmacologically inert proteins may be introduced, with a potential allergen).

Hiperlipoproteinemia tipo IIa: caso clínico com três manifestaçöes dermatológicas / Hyperlipoproteinemia type IIa: case report presenting three dermatological manifestations

Os autores relatam um caso de hiperlipoproteinemia tipo IIa, em paciente feminina, branca, 31 anos, com exuberante associaçao de xantelasma, xantoma tendinoso, xantoma tuberoso e hipertensao arterial. O diagnóstico foi estabelecido através dos exames: clínico, lipidograma e histopatológico. Foi feita também uma revisao da literatura.

Itraconazol no tratamento da esporotricose: relato de 3 casos / Itraconsazole in the treatment of sporothricosis: report of three case

O itraconazol é um composto triazólico primariamente fungistático que age alterando a permeabilidade da célula fúngica. Tem mostrado maior atividade contra o Sporothrix schnckii quando comparado a outros antifúngicos. Os autores descrevem três casos de esporotricose na forma cutâneo-linfática tratados com itraconazol na dose de 100 mg por dia, via oral, durante três meses aproximadamente, com completa cicatrizaçäo das lesöes

Censo Epidemiológico de lesôes e afeccôes cutâneas em escolares de Ribeirâo Prêto, S. P., Brasil / Epidemiologieal census of cutaneous lesions in schoolchildren of R. Preto, S.P., Brazil

Um total de 5150 escolares de 6 a 16 anos foram examinados em uma cidade subtropical. Excluídas cicatrizes e lesôes traumáticas a prevalência de dermatoses foi de 72%. As mais comun (>2%) foram nevos pigmentados (72%),cicatrizes e lesôes residuais (36%), efélides (19,6%), pediculose (19,6%), dermatite seborréica (19,5%), dermatoviroses (18,6%), acne (15,7%), lesôes traumáticas (9,5%), pitiríase capitis (5%), piodermites (4,3%), dermatite eozematosa (2,6%), estrófulo + picada de inseto (3,1%), ceratose palmar el ou plantar (2,1%) e disidrose (2%). Muitos doentes apresentaron dois ou mais tipos de lesoes ou affeccôes cutâneas. A prevalencia de vibix, estomatite angular, dermatoses actínicas, ictiose, pele xerótica, intertrigo, milia, livedo reticular, hipertricosee escabiose foi menor porén relativamente elevada (de 1,61 a 0,66%). A prevalencia foi discretamente maior em escolares de sexo masculino que no feminino e as diferencas estatisticamente significantes (p<0,001). A diferenca de prevalência entre os grupos etarios nâo foi significante para masculinos e femininos. As meninas aprentaron taxa mais elevada de pediculose, enquanto em meninos prevaleceram pitiríase alba (dartro volante), pitiríase versicolor e piodermites. As condicôes sócioeconômicas parecen ter tido influencia nas taxas de prevalênia de pediculose, pitiríase alba e "tinea pedis", mas nâo nas de dermatoviroses, pitiríase versicolor e piodermite. Os resultados e comentários sâo válidos para uma àrea subtropical semelhante à de Ribeirâo Prêto, com as mesmas características ecológicas, socio-econômicas e de populacâo. Quando se planeja um programa de saúde pública em escolas é importante realizar antes um censo epidemiológico ou estudo piloto, a fim de obter as relevantes informacôes bàsicas.