Síndromes mielodisplásicos y sistema inmunitario / Myelodysplastic Syndrome and Immune System

Introducción: Los síndromes mielodisplásicos constituyen un grupo heterogéneo de desórdenes hematológicos clonales adquiridos, que afectan la célula madre. Se caracterizan morfológicamente por: hematopoyesis ineficaz, citopenias periféricas progresivas, displasia en uno o más linajes celulares y tendencia evolutiva a leucemia aguda. Los avances recientes en la comprensión de los mecanismos genéticos y moleculares de los síndromes mielodisplásicos, han revelado la asociación entre alteraciones inmunológicas y las mutaciones recurrentes. Las células de la respuesta inmune innata y adaptativa, así como diversos mediadores solubles liberados por ellas, pueden establecer una respuesta antitumoral protectora o, por el contrario, inducir eventos de inflamación crónica que favorezcan la promoción y progresión de esta enfermedad. Objetivos: Resumir los conocimientos actuales de la relación sistema inmune-síndromes mielodisplásicos, enfatizando en las células inmunes del microambiente de la médula ósea y su importancia en la clínica de la enfermedad. Métodos: Se realizó investigación bibliográfica-documental acerca del tema. Se consultaron las bases de datos Scielo y Pubmed. Conclusiones: La comprensión de la función dual que ejerce el sistema inmune en los síndromes mielodisplásicos, constituye un desafío y son necesarios estudios clínicos rigurosos para poder establecer el valor de la manipulación del sistema inmune como una forma posible de tratamiento de esta enfermedad(AU)

Introduction: Myelodysplastic syndromes (MDS) constitute a heterogeneous group of acquired clonal hematological disorders that affect the stem cell. These are characterized morphologically and clinically by: ineffective hematopoiesis, progressive peripheral cytopenia, dysplasia in one or more cell lineages, in most of cases and evolutionary tendency to acute leukemia. Recent advances in understanding the genetic and molecular mechanisms of MDS have revealed the association between immunological alterations and recurrent mutations. Cells of the innate and adaptive immune response, as well as various soluble mediators released by them, can establish a protective antitumor response or, on the contrary, induce events of chronic inflammation that favor the promotion and progression of this disease. Objective: To summarize the current knowledge of the immune system-MDS relationship, emphasizing the immune cells of the bone marrow microenvironment and their importance in the clinic of the disease. Methods: A bibliographic-documentary research was carried out on the subject. The Scielo and Pubmed databases were consulted. Conclusions: Understanding the dual role of the immune system in MDS constitutes a challenge and rigorous clinical studies are necessary to establish the value of manipulating the immune system as a possible form of treatment of this disease(AU)

Revisión bibliográfica sobre la COVID 19 en pacientes con cáncer de pulmón / Bibliographic review on COVID 19 in patients with lung cancer

RESUMEN La COVID 19 es una enfermedad pandémica producida por el virus SARS-CoV-2, tiene dentro de los grupos vulnerables al cáncer de pulmón por presentar una inmunodepresión adquirida por los tratamientos oncoespecíficos administrados y esto conlleva a una mayor exposición a complicaciones si se contrae esta terrible infección que azota al mundo en la actualidad. El objetivo fue exponer los riesgos y complicaciones que tienen los pacientes con cáncer de pulmón que reciben tratamientos oncoespecíficos si se infectan con el SARS-COV-2. Se realizó una revisión sistemática de los principales artículos publicados en inglés y en español por autores cubanos y extranjeros en revistas de alto impacto a nivel mundial, información reportada por la Organización Mundial de la Salud, la red de Infomed y el Ministerio de Salud Pública de Cuba. Se concluyó que los pacientes con cáncer de pulmón no presentan un riesgo superior a la población general para contraer la COVID 19, sí existe cierta evidencia de que estos pacientes puedan sufrir una infección más grave si la adquieren (AU).

SUMMARY COVID-19 is a pandemic disease produced by SARS-CoV-2 virus; the group of patients with lung cancer is vulnerable to this disease because of presenting an acquired immune depression due to administered oncospecific treatments, leading to higher exposition to complications if the patient gets this terrible disease striking worldwide nowadays. The objective of this review was exposing the risk and complications affronted by patients suffering lung cancer with oncospecific treatment if they get infected by SARS-CoV-2. The authors carried out a systematic review of the main articles published in Spanish and English by Cuban and foreign authors in high impact journals around the world, information reported by the World Health Organization, INFOMED and the Ministry of Public Health of Cuba. It was concluded that patients with lung cancer are not at a higher risk of catching COVID-19 than general population; it does exist certain evidence of that these patients could suffer a more serious infection if they get the disease (AU).

Soledad social en ancianos hospitalizados en el servicio de Geriatría. Hospital "Comandante Faustino Pérez" / Social loneliness in elder people hospitalized in the Geriatrics service. Clinical Surgical Hospital "Comandante Faustino Pérez"

RESUMEN Introducción: la soledad social se define como la experiencia subjetiva de insatisfacción frente a la sociedad en la que se vive; en términos de estilos de vida, de valores y de uso de nuevas tecnologías, entre otros aspectos. Objetivo: caracterizar la soledad social en los adultos mayores hospitalizados. Materiales y método: se realizó un estudio observacional, descriptivo, transversal en pacientes que ingresaron en el servicio de Geriatría del Hospital Clínico Quirúrgico "Comandante Faustino Pérez", provincia Matanzas, desde octubre 2015 - 2016. El universo estuvo constituido por 212 pacientes que vivían en compañía y no padecían de demencia, confusión mental ni enfermedades graves. Para la recogida de la información se aplicó al universo de estudio la Escala ESTE II de soledad social, validada a nivel nacional e internacional para identificar el nivel de soledad social. Se utilizaron métodos de estadística descriptiva. Los resultados se presentaron en tablas. Resultados: alto nivel de soledad social en los ancianos estudiados, en el grupo atareo de 60-70 años, sin pareja, de bajo nivel de escolaridad y con enfermedades crónicas. Insuficiente percepción de apoyo y participación social, así como un limitado uso de las nuevas tecnologías. Conclusiones: predominó alto nivel de sentimiento de soledad en los ancianos, asociado a insuficiente percepción de apoyo y participación social, más un bajo acceso a las nuevas tecnologías (AU).

ABSTRACT Introduction: social loneliness is defined as the subjective experience of dissatisfaction toward society in which one lives, in terms of lifestyles, values ​​and use of new technologies among others. Objective: to characterize social loneliness in hospitalized elder adults. Material and Method: a cross-sectional, observational, descriptive, study was conducted in patients admitted to the Geriatrics Service of the Clinical Surgical Hospital "Comandante Faustino Pérez", province of Matanzas, in the period October 2015 - 2016. The universe was formed by 212 patients who lived accompanied and did not suffer from dementia, mental confusion nor serious illnesses. For collecting the information of the studied universe, the authors used the ESTE II Scale of social loneliness validated at national and international level to identify the level of social loneliness. Descriptive statistical methods were used and the results were shown in tables. Results: high level of social loneliness in studied elder people of the 60-70 years-old group, without a partner, with a low level of scholarship and with chronic diseases. They had an insufficient perception of support and social participation, as well as made a limited use of the new technologies. Conclusions: a high level of the loneliness feeling predominated in elder people, associated to an insufficient perception of support and social participation, plus a low access to the new technologies (AU).

Use of probiotics in atopic dermatitis

SUMMARY Atopic dermatitis is a common skin disease. Its increased incidence has changed the focus of research on atopic dermatitis toward epidemiology, prevention, and treatment. Evidence suggests that intestinal microbiota plays an important role in the pathogenesis of atopic dermatitis inducing immunosuppression, but its exact mechanism is still unclear. Probiotics have been widely reported to act on the immune system. They are living microorganisms with immunomodulatory effects that stimulate Th1 cytokines and suppress the Th2 response, which are being researched for the treatment of several diseases. Probiotics most commonly used are part of the intestinal microflora like lactobacilli, bifidobacteria, and enterococci. We describe here a case of evident response to the use of probiotics in a girl with severe atopic dermatitis, with a significant change in severity scores of atopic dermatitis (BSA/SCORAD/FDLQI). Modulation of the intestinal microbiota with probiotics may offer a way to prevent or treat allergic diseases, including atopic dermatitis.

RESUMO A dermatite atópica é uma doença de pele comum. O aumento da incidência mudou o foco da pesquisa em dermatite atópica para epidemiología, prevenção e tratamento. Evidências sugerem que a microbiota intestinal desempenha um papel importante na patogênese da dermatite atópica, induzindo imunossupressão, mas o mecanismo exato ainda não está claro. Os probióticos foram amplamente divulgados para atuar no sistema imunológico. Eles são microrganismos vivos com efeitos imunomoduladores que estimulam as citocinas Th1 e suprimem a resposta Th2 que vem sendo pesquisada para o tratamento de diversas doenças. Probióticos mais comumente usados são parte da microflora intestinal como lactobacilos, bifidobactérias e enterococos. Descrevemos um caso de resposta evidente ao uso de probióticos em uma menina com dermatite atópica grave, com grande alteração nos escores de gravidade da dermatite atópica (BSA/Scorad/FDLQI). A modulação da microbiota intestinal com probióticos pode oferecer uma maneira de prevenir ou tratar doenças alérgicas, incluindo a dermatite atópica.

Factores psicosocio-inmunogenéticos en pacientes diabéticos con complicaciones vasculares / Psychological, social and immunogenetic factors observed in diabetic patients with vascular complications

El desarrollo de la medicina, la ciencia y los medios científicos técnicos, permiten explicar de manera didáctica e integral con un enfoque dialéctico-materialista los fenómenos complejos y sus interrelaciones entre sistemas, en diferentes entidades clínicas como la diabetes mellitus, objeto del presente trabajo. Describir la interacción entre factores psicosocio-inmuno-genéticos en pacientes diabéticos con complicaciones vasculares, fue el objetivo de nuestro trabajo. Se trabajó con las bases de datos PubMed, MedLine, SciELO, Ebsco y artículos científicos publicados en revistas cubanas entre 2011-2015. Se revisaron trabajos en español, inglés y francés. Se analizó la interrelación dialéctica e indisoluble de la función integradora del sistema inmune con los sistemas nervioso y endocrino, la que descansa en las relaciones entre los fenómenos psíquicos y orgánicos, y esto solo puede comprenderse completamente cuando se tiene en cuenta la interacción del hombre con el medio social en que se desenvuelve, así como la relación de este con la naturaleza, que es en definitiva el centro de su actividad creadora y transformadora y sobre todo el análisis de las implicaciones prácticas que conlleva para el campo de la clínica y la ciencia. Podemos concluir que el conocimiento de las interacciones entre factores psicosocio-inmuno-genéticos en pacientes diabéticos tipo 2 con complicaciones vasculares, es imprescindible para comprender la dinámica de los fenómenos bioquímicos, así como entre los tres sistemas integradores: neurológico, endocrino e inmune que tienen lugar en estos pacientes, lo que posibilita el tratamiento más adecuado y eficaz y la prevención de la enfermedad hereditaria en familias portadoras(AU)

The development of medicine, science and technical scientific devices allow explaining didactically and comprehensively, with a dialectical-materialist approach, complex phenomena and their interrelationships in different clinical conditions such as diabetes mellitus The objectives of this paper were to describe the interaction among psychological, social, and immunogenetic factors in diabetic patients with vascular complications and to address how these factors are associated with immunosupression state of type 2 diabetic patients. For this purpose, worked with PubMed, MedLine, SciELO, EBSCO databases and scientific articles published in 2011-2015 journals were consulted. A number of papers in Spanish, English and French languages were reviewed. The dialectic and permanent interrelation of the integrative function of the immune system with the nervous and endocrine systems, which is based on the relationship between psychic and phenomena, was analyzed. All this can only be fully understood when one takes into account man's interaction with the social environment as well as his relationship with nature, which is ultimately the core of their creative and transforming activity and particularly, the analysis of the practical implications for the clinical and scientific fields. The knowledge of the interactions among systems is imperative to understand homeostasis and dynamics of biochemical phenomena that occur in humans, both in the relationship between the biological and the psychic areas, and in the biological and the socio environmental areas, thus allowing scientific advances in this field for the development of more effective therapeutic and prevention methods(AU)

Immune System Dysfunction in the Elderly

ABSTRACT Human aging is characterized by both physical and physiological frailty that profoundly affects the immune system. In this context aging is associated with declines in adaptive and innate immunity established as immunosenescence. Immunosenescence is a new concept that reflects the age-associated restructuring changes of innate and adaptive immune functions. Thus elderly individuals usually present chronic low-level inflammation, higher infection rates and chronic diseases. A study of alterations in the immune system during aging could provide a potentially useful biomarker for the evaluation of immune senescence treatment. The immune system is the result of the interplay between innate and adaptive immunity, yet the impact of aging on this function is unclear. In this article the function of the immune system during aging is explored.

El sistema inmune en los linfedemas y linfangitis de los miembros inferiores / The immune system in lymphedema and lymphangitis of the lower limbs

El sistema inmune es el mecanismo de resistencia del organismo ante las infecciones. El sistema linfático juega un importante papel en el control fisiológico del fluido tisular y en la iniciación de la respuesta inmune. Nos proponemos describir la función de los componentes celulares del sistema inmune en las linfopatías de miembros inferiores no asociadas a cánceres tales como el linfedema y la linfangitis.Se revisaron las bases de datos PubMed, MedLine, SciELO, Clinical Key, Liliacs, Ebsco y artículos científicos publicados en revistas cubanas entre 2000-2015. Los estudios recientes muestran que el crecimiento de nuevos vasos linfáticos es una característica distintiva de las reacciones inflamatorias agudas y crónicas que caracterizan a las linfopatías, mediado por un incremento en el drenaje del fluido fuera del vaso y de células inflamatorias, así como de la modulación de las respuestas inmunes. Es apremiante continuar investigando, específicamente en lo concerniente al comportamiento de la inmunidad humoral y celular en los pacientes que padecen de linfedema o linfangitis, pues no se encontraron trabajos que aborden de manera específica la posible relación entre ambos. Se sugiere que las subpoblaciones de células T son un componente crítico en la respuesta celular inflamatoria crónica y subaguda en las linfopatías. La comprensión de la función reguladora del fluido linfático en la respuesta inflamatoria puede dar un importante paso en el desarrollo de tratamientos que puedan bloquear el inicio o la progresión de las consecuencias anómalas de las lesiones linfáticas(AU)

The immune system is the body´s mechanism of resistance to infections. The lymph system plays an important role in the physiological control of the tissue fluid and in the onset of the immune response. We intended to describe the function of the cell components of the immune system in the cancer-unrelated lymphopathies of the lower limbs such as lymphedema and lymphangitis. To this end, Pubmed, Medline, Scielo, Clinical Key, Liliacs, Ebsco and scientific articles published in Cuban medical journals from 2000 to 2015 were reviewed. The recent studies show that the growth of new lymphatic vessels is a distinctive characteristic of the acute and chronic inflammatory reactions of lymphopathies, mediated by increase of the fluid drainage outside the vessel and of inflammatory cells as well as the immune response modulations. It is urgent to continue studying this topic, mainly the behavior of the humoral and cell immunity in patients suffering from lymphedema or lymphangitis, since no research papers dealing with the possible relation between both aspects were found. It is suggested that the T-cell subpopulations are a key component of the chronic and sub-acute inflammatory response in lymphopaties. Hence, understanding of the regulating function of the lymph fluid in the inflammatory response may represent an important step in the development of therapies that might block the onset or progression of the anomalous consequences of lymphatic injures(AU)

Pathophysiology of bacterial infection of the central nervous system and its putative role in the pathogenesis of behavioral changes

Invasion of the central nervous system (CNS) by microorganisms is a severe and frequently fatal event during the course of many infectious diseases. It may lead to deafness, blindness, cerebral palsy, hydrocephalus, cognitive impairment or permanent neurological dysfunction in survivors. Pathogens can cross the blood-brain barrier by transcellular migration, paracellular migration and in infected macrophages. Pathogens may breach the blood-brain barrier and be recognized by antigen-presenting cells through the binding of Toll-like receptors. This induces the activation of nuclear factor kappa B or mitogen-activated protein kinase pathways and subsequently induces leukocyte infiltration and proliferation and the expression of numerous proteins involved in inflammation and the immune response. Many brain cells can produce cytokines, chemokines and other pro-inflammatory molecules in response to bacteria stimuli; as a consequence, polymorphonuclear cells are attracted and activated, and release large amounts of superoxide anion and nitric oxide, leading to peroxynitrite formation and oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage and blood-brain barrier breakdown, contributing to cellular injury during neuronal infection. Current evidence suggests that bacterial CNS infections can play a role in the etiopathogenesis of behavioral disorders by increasing pro-inflammatory cytokines and bacterial virulence factors. The aim of this review is to summarize the current knowledge of the relevant pathophysiologic steps in CNS infections.

Fisiopatología y manejo de la fiebre: (2ª parte) / Pathophysiology and management of fever: (Part 2)

A pesar de que la fiebre fue entendida durante mucho tiempo y por muchas Civilizaciones como un recurso dei organismo para controlar algunas enfermedades, esta idea comenzó a perderse en el siglo XIX, cuando los estudios dei médico francés Claude Bernard (1813-1878) hicieron que la medicina alópata la considerara como un evento perjudicial. No obstante, la perspectiva homeopática considera que la fiebre es una expresión de los esfuerzos dei organismo por restablecer su salud, de modo que debe de manejarse con criteria y buscar su regulación, y no solamente suprimiria por el hecho de que exista. Así, la propu esta hahnemanniana consiste en suministrar medicamentos que estimulen ai cuerpo humano para recuperar su armonía de manera ordenada. En este mismo tenor, recientes investigaciones in vitro en el campo de la inmunología aportan conclusiones parecidas a las dei enfoque homeopático, ya que sus resultados sugieren que el aumento en la temperatura corporal es un recurso complejo que no sólo inhibiría el desarrollo de ciertos agentes patógenos, sino que mejoraría el funcionamiento de algunos mecanismos dei sistema in munológico. De esta forma, existen pruebas que permiten entrever que, en realídad, la erradicación de la fiebre que propone el enfoque alopático reduciría la efectividad de mecanismos generados durante siglas de evolución de los seres vivos. Presentamos a nuestros lectores la segunda y última parte de este trabajo.

Although fever has been understood for a long time and by many civilizations as a organism resource to control diseases, this idea began to get lost in the nineteenth century, when French physician Claude Bernard (1813-1878) studies made allopathic medicine considered it as a damaging event However, in a homeopathic perspective fever is an expression of the organism efforts to restore its health so it must be handled with discretion and seek their regulation, and not only suppress it by fact that exist, the hahnemannian proposal is to pro vide medicines that stimulate the human body to regain its harmony in an orderly way. In the same way, in vitro recent research in the field of immunology provide similar conclusions to those in the homeopathic approach, as the results suggest that the increase in body temperature is a complex resource that not only inhibit the development of certain pathogens , but would improve the functioning of some immune mechanisms. Thus, there is evidence to support the conclusion that, in fact, indiscriminate suppression of fever could sometimes reduce the effectiveness of proposed mechanisms generated during centuries of evolution of living beings. We present to our readers the second and final part of this paper.

Plantas y hongos comestibles en la modulación del sistema inmune / Eatable plants and mushroom in the immune system modulation

Introducción: Se presenta una revisión que considera resultados de investigaciones que han centrado su atención en la búsqueda de compuestos obtenidos de plantas medicinales y hongos comestibles, capaces de estimular la respuesta inmunitaria. Objetivos: Recopilar y actualizar la información científica publicada acerca de las plantas medicinales y hongos comestibles activos sobre el sistema inmune. Métodos: Se realizó una búsqueda bibliográfica de artículos científicos relacionados con la temática, en las bases de datos disponibles (PubMed, EBSCO, SciELO, LILACS, CUMED, MEDNAT) así como varios libros y sitios web. Resultados: En los estudios realizados se refiere como las principales plantas con actividad inmunomoduladora: Allium sativum (Liliaceae), Aloe vera (Aloaceae), Uncaria tomentosa (Rubiaceae), Morinda citrifolia (Rubiaceae), Echinacea purpurea (Asteraceae) y Mangifera indica (Anacardiaceae). Diversos hongos comestibles activos sobre el sistema inmune han sido examinados: Ganoderma lucidum (Ganodermataceae), Grifola frondosa (Polyporaceae), Lentinus edodes (Agaricaceae), Pleurotus spp. (Pleurotaceae) y Schizophylum commune (Schizophyllaceae), entre otros. Asimismo se destacan las posibilidades que estas fuentes naturales podrían ofrecer en la manipulación de la respuesta inmune, al aumentar la calidad de vida de pacientes con inmunodeficiencias y cáncer. Conclusiones: El estudio de productos naturales derivados de plantas y hongos comestibles-medicinales ofrece amplias perspectivas para el desarrollo de nuevos agentes inmunomoduladores, eficaces y seguros. Se debe continuar trabajando en la identificación de los principios activos y en la dilucidación del mecanismo mediante el que actúan

Introduction: Present review asses the results of researches basing its attention in the search of compounds obtained from medicinal plants and mushrooms, able to stimulate the immune response. Objectives: To collect and to update the scientific information published on the medicinal plants and active mushrooms on immune system. Methods: A bibliographic search of scientific papers related to this subject matter in the available databases (PubMed, EBSCO, SciELO, LILACS, CUMED, MEDNAT) as well as some books and websites. Results: In studies conducted it is mentioned how the main plants with immunomodulation activity: Allium sativum (Liliaceae), Aloe vera (Aloaceae), Uncaria tomentosa (Rubiaceae), Morinda citrifolia (Ribiaceae), Echinacea purpurea (Asteraceae) and Mangifera indica (Anacardiacear). Different active mushrooms on the immune system have been examined: Ganoderma lucidum (Ganodermataceae), Frifola frondosa (Polyporaceae), Lentinus edodes (Agaricaceae), Pleurotus spp. (Pleurotaceae) and Schizophylum commune (Schizophyllaceae) among others. Likewise, authors emphasized the possibilities that these natural sources could offer in management of immune response increasing the quality of life of patients presenting with immunodeficiencies and cancer. Conclusions: The study of natural products derived of medicinal plants and mushrooms offers many perspectives for the development of new effective and safe immunomodulation agents. It is necessary to continue working in the identification of the active principles and in the elucidation of the mechanism by means of they act

Dendritic cells in immunosenescence: [review]

The term immunosenescence usually refers to the aging of the immune system. Aging isassociated with the progressive decline in immune function, resulting in an increasing susceptibility of the bodyto infection, taking into account the specific changes in T- cells, macrophages, neutrophils and dendritic cells.Dendritic cells (DCs) are play a key role in the induction of both innate and adaptive immunity. There areimmature and mature forms located in the non-lymphatic organs and lymph nodes, respectively. DCs initiateand regulate the highly pathogen-specific adaptive immune responses, and are central to the development ofimmunologic memory and tolerance. In this text, we will briefly review DCs and changes associated withhuman aging, such as cytokine secretion, antigen capture, migration and priming of T cells. This functionaldecline would lead to major morbidity associated with infections such as influenza and pneumonia, whichaffect mucosal surfaces; in addition the increased incidence of cancer in the elderly is associated with thepotential role of DCs.

El sistema inmunológico también envejece / The immune system ages too

El sistema inmunológico envejece con el paso del tiempo al igual que otras funciones del organismo. Contrariamente a lo que se creía, la respuesta inmune es una de las funciones corporales que más profundamente se ve afectada por el envejecimiento (Ruiz Fernández NA, Solano L, 2001). Esto nos obliga a tomar ciertos recaudos antes de proceder a efectuar alguna técnica invasiva en personas mayores, aún aparentemente sanas, ya que en algunos casos los riesgos son grandes. La mortalidad debida a infecciones es cinco veces mayor en los ancianos. En este artículo se describen cuáles son los cambios encontrados y cómo tratar de evitar sus consecuencias.

Imunodeficiência primária: quando investigar, como diagnosticar / Primary immunodeficiency: when to investigate, how to diagnose

O sistema imunológico normal possui duas ações de trabalho para manter a função normal do hospedeiro: a resposta imunológica inespecífica e a específica. Qualquer desequilíbrio em alguma parte da resposta imunológica pode resultar em uma inabilidade de controlar a infecção com doença subjacente. As imunodeficiências incluem uma variedade de doenças que deixam os pacientes mais susceptíveis a infecções e são classificadas em primárias e secundárias. Imunodeficiência primária deve ser suspeitada em todo o paciente com infecções recorrentes inexplicadas, infecções oportunistas, infecções que não respondem à terapia e que apresentam déficit pôndero-estatural. As imunodeficiências primárias incluem as doenças da imunidade humoral, os defeitos da célula T, os defeitos combinados da célula B e T, as doenças dos fagócitos e as deficiências do complemento..

The normal immune system has two arms work to maintain normal host function: nonspecific responses (innate immune responses) and immune specific response. Disruption of any part of the immune response can result in an inability to control infection and subsequent illness. Immunodeficiencies include a variety of disorders that render patients more susceptible to infections and are classified in primary and secondary. Primary immunodeficiency is suspected on the patient with unexplained recurrent infections, infections with opportunistic pathogens, infection with no response to therapy and failure to thrive. Common primary immunodeficiencies include disorders of humoral immunity, T-cell defects and combined B and T-cell defects, phagocytic disorders and complement deficiencies...

Aspectos inmunológicos en la depresión / Immunological aspects in the depression

Existe evidencia que el sistema inmune puede modular tanto los neurotransmisores a nivel central como la respuesta endocrina, interrelación que explicaría los síntomas de la depresión. Se analizaron una serie de investigaciones que relacionaban la depresión y función inmune predominando hallazgos heterogéneos. Se ha descrito un patrón de citoquinas similar al del cáncer, como posible perfil depresivo carcinógeno de las citoquinas. Por otro lado, existe una hiperfunción del eje hipotálamo, hipófisis suprarrenal con alteración de la retroalimentación negativa. A pesar de estos avances, existe controversia acerca de la relación causal entre el estado pro inflamatorio y las alteraciones conductuales de la depresión, necesitándose esclarecer si los cambios inmunológicos son directamente responsables de la alteración de los neurotransmisores a nivel central. Se reportó cómo diversos antidepresivos modifican la hiperactividad del eje y modifican la inmunidad humoral y celular, abriendo la posibilidad de modular la respuesta inmune a través de estos fármacos.

There is evidence that immune system modulates neurotransmitters at central level as well as the endocrine response, interrelation that would explain the depression symptoms. A series of investigations that related the depression and immune function was analyzed, predominating heterogeneous findings. A pattern of cytokines has been described as similar as the one of cancer, suggesting a depressive carcinogenic cytokines profile. On the other hand, a hyperfuntion of the hypothalamus, hypofisis adrenal axis, with alteration of the negative feedback exists in these patients. Despite of these advances, controversy about the causal relationship between the pro inflammatory state and the behavior alterations of depression exists, being needed to clarify if the immunological changes are directly responsible for the neurotransmitters alteration at central level. It was reported how diverse antidepressants modify the hyperactivity of axis and modify the humoral and cellular immunity, opening the possibility of modulating the immune response through these drugs.

Mediators and mechanisms of pancreatic beta-cell death in type 1 diabetes

Type 1 diabetes mellitus (T1D) is characterized by severe insulin deficiency resulting from chronic and progressive destruction of pancreatic beta-cells by the immune system. The triggering of autoimmunity against the beta-cells is probably caused by environmental agent(s) acting in the context of a predisposing genetic background. Once activated, the immune cells invade the islets and mediate their deleterious effects on beta-cells via mechanisms such as Fas/FasL, perforin/granzyme, reactive oxygen and nitrogen species and pro-inflammatory cytokines. Binding of cytokines to their receptors on the beta-cells activates MAP-kinases and the transcription factors STAT-1 and NFkappa-B, provoking functional impairment, endoplasmic reticulum stress and ultimately apoptosis. This review discusses the potential mediators and mechanisms leading to beta-cell destruction in T1D.

O diabetes melito tipo 1 (DM1) tem como característica uma grave deficiência de insulina que resulta da destruição da célula-beta, crônica e progressiva, pelo sistema imune. O desencadeamento da autoimunidade contra a célula-beta é causado, provavelmente, por agentes ambientais que atuam quando existe predisposição genética. Uma vez ativadas, células imunes invadem as ilhotas, e os efeitos deletérios sobre as células-beta são mediados por mecanismos relacionados a Fas/FasL, perforina/granzima, espécies reativas de oxigênio e nitrogênio, e a citocinas pró-inflamatórias. A ligação de citocinas a seus receptores na célula-beta ativa MAP-quinase e fatores de transcrição STAT-1 e NFkapaB, provocando prejuízo funcional, estresse de retículo endoplasmático e, por fim, apoptose. Esta revisão discute os mecanismos e os mediadores potenciais que levam à destruição da célula-beta no DM1.

Estado de vitamina A y su relación con antecedentes infecciosos en escolares venezolanos / Vitamin A status and the relationship with morbidity in venezuelan school children

La vitamina A (VA) cumple una función importante sobre el sistema inmunológico demostrándose una relación sinérgica entre estado corporal de VA, y procesos infecciosos. El objetivo fue evaluar la relación entre niveles séricos de retinol y la Citología de Impresión Conjuntival (CIC) con el estado nutricional antropométrico y antecedentes infecciosos en escolares de bajos recursos económicos de una zona urbana de Valencia. Se evaluaron 445 niños (4-13 años de edad), de ambos géneros. Se determinó: retinol sérico (HPLC-r), proteína C reactiva (nefelometría), CIC (ICEPO), los indicadores antropométricos peso-talla (PT) y talla-edad (TE) según referencia nacional y el registro de enfermedades infecciosas (diarrea, enfermedades respiratorias, sarampión y parasitosis) dos meses previos al estudio. El 92,3 por ciento estaban en situación de pobreza, 7 por ciento presentó déficit nutricional (PT ≤ p10), 10,8 por ciento exceso (PT > p90) y 1,5 por ciento talla baja (TE = p3); 18 por ciento de los niños presentó al menos un episodio de diarrea, 39,8 por ciento infección respiratoria superior, 28,1 por ciento inferior y 32,8 por ciento parasitosis. El 10,3 por ciento mostró niveles altos de PCR (> 10 mg/L), el valor promedio de retinol fue 35,7 ± 9,2 μg/dL con una prevalencia de valores bajos (< 20 μg/dL) de 0,7 por ciento, niveles marginales (20-30 μg/dL) de 27,4 por ciento y 9,5 por ciento déficit de VA según CIC. Se encontró correlación significativa entre retinol sérico y CIC y asociación significativa entre retinol sérico y las enfermedades respiratorias superiores únicamente. No se encontró asociación entre los indicadores antropométricos con el estado de vitamina A ni con la morbilidad. No fue posible demostrar la relación entre el estado de vitamina A y los antecedentes infecciosos como diarrea, enfermedades del tracto respiratorio inferior y sarampión, sin embargo, la alta prevalencia de morbilidad y de niveles marginales de VA, hacen que el grupo estudiado...

Vitamin A (VA) is an essential micronutrient for the immune system and several researchs have shown a synergic relationship between vitamin A status and morbidity. The aim was to show the relationship between serum retinol level, Conjunctival Impression Cytology (CIC), anthropometric status, and morbidity in low income school children. 445 children (both genders) between 4 and 13 years old were assessed. Serum retinol levels (HPLC-r), C-reactive protein (nefelometry) and CIC (ICEPO), anthropometric indicators (Weight-height (WH), height-age (HA)according to national references values), morbidity (diarrhea, respiratory tract infections, measles, and parasitosis) two months prior to the evaluation, were determined. The poverty was 92.3%, wasting (WH ≤ p10) 7%, overweight (WH > p90) 10.8%, and stunting (HA = p3) 1.5%. 18% had one or more diarrhea episodes, 39.8% upper respiratory tract infections, 28.1% lower respiratory tract infections, and 32.8% intestinal parasitosis; 10.3% showed ahigh level of C-reactive protein (CRP > 10 mg/L). The average retinol level was 35.7 ± 9.2 μg/dL, with 0.7% low level(< 20 μg/dL), 27.4% of the children at risk of vitamin A deficiency (20-30 μg/dL), and 9.5% deficient according CIC. There was a significant correlation between serum retinol and CIC, and a significant association between serum retinol and upper respiratory tract infections, but not between morbidity and CIC. There was not a significant association between anthropometric indicators and vitamin A status and morbidity. In this study it was not possible to demonstrate the relationship between vitamin A status and diarrhea, measles, lower respiratory tract infections and parasitosis but the high prevalence of marginal serum retinol levels and morbidity in this group makes it susceptible to nutritional surveillance.

Neuroimunomodulação: sobre o diálogo entre os sistemas nervoso e imune / Neuroimmunomodulation: the cross-talk between nervous and immune systems

OBJETIVO: Trabalhos de pesquisa provenientes do campo da neuroimunomodulação vêm tornando explícitas as intrincadas relações existentes entre o sistema nervoso central e o sistema imune. Uma revisão bibliográfica foi realizada com o objetivo de descrever as bases de estudo da neuroimunomodulação. MODELOS EXPERIMENTAIS: Sabe-se, hoje, que estados emocionais como ansiedade e depressão são capazes de modificar a atividade do sistema imune como também o fazem o estresse e fármacos com ação no sistema nervoso central. COMPORTAMENTO DOENTIO: Os comportamentos apresentados por um organismo doente devem ser encarados como decorrência de estratégias homeostáticas de cada indivíduo. POSSÍVEIS MECANISMOS DE SINALIZAÇÃO DO SISTEMA IMUNE PARA O SISTEMA NERVOSO CENTRAL: Grande destaque tem sido atribuído para a participação do eixo hipotálamo-pituitária-adrenal, do sistema nervoso autônomo simpático e das citocinas nas sinalizações entre o sistema nervoso central e o sistema imune. CONCLUSÃO: O presente artigo pretende mostrar a relevância dos fenômenos de neuroimunomodulação; ele faz uma análise crítica das influências do sistema nervoso central sobre o sistema imune e vice-versa.

OBJECTIVE: Several papers arriving from the neuroimmunomodulation field are showing the relevant relationships between the nervous and the immune systems. A review of studies was carried out to describe the bases of the studies on neuroimmunomodulation. EXPERIMENTAL MODELS: It is clear nowadays that emotional states such as anxiety and depression change immune system activity, an affect also observed after both stress and use of nervous system acting drugs. SICK BEHAVIOR: The behavior displayed by sick organisms might be thought as being a consequence of homeostatic strategies. POSSIBLE MECHANISM OF THE ACTION BY MEANS OF IMMUNE SYSTEM TO NERVOUS SYSTEM: A very big emphasis is being given to Hipothalamus-pituitary-adrenal axis, simpathetic nervous system and cytokines participation on nervous system and immune system relationships. CONCLUSION: The present revision intend to show some essential studies in the neuroimmunomodulation field; it makes a critical analysis of the mutual relationships between nervous system and immune system.

Interações imunocerebrais e implicações nos transtornos psiquiátricos / Brain-immune interactions and implications in psychiatric disorders

OBJETIVO: Nesta revisão será focado o papel das citocinas no sistema nervoso central e suas implicações para o quadro depressivo. Posteriormente, serão discutidos os principais achados sobre medidas de citocinas em pacientes com depressão maior. MÉTODO: Foi realizada uma pesquisa no Pubmed selecionando estudos entre 1999-2007, utilizando as seguintes palavras-chave: "depression, cytokine"; "depressive disorder, cytokine". Focou-se nos estudos de medidas de citocinas pró-inflamatórias em pacientes com síndrome depressiva que utilizaram critérios DSM. RESULTADOS: Várias linhas de evidência sugerem que as citocinas possam exercer um papel na depressão. Entre elas, destacam-se: citocinas induzindo a "comportamento doentio"; doenças clínicas relacionadas com citocinas também apresentam associação com quadros depressivos; uso de imunoterapia levando ao desenvolvimento de depressão. Além disso, níveis elevados de citocinas pró-inflamatórias em pacientes com depressão foram relatados, apesar de resultados contraditórios. CONCLUSÃO: O papel das citocinas na fisiopatologia em alguns casos de depressão é descrito; porém, uma relação causal não foi ainda estabelecida. Novos estudos são necessários para determinar padrões específicos de citocinas em pacientes com depressão, levando em consideração outros fatores associados à ativação imunológica. Além disso, medidas simultâneas de múltiplos marcadores biológicos podem gerar informações importantes para a compreensão dos mecanismos fisiopatológico da depressão e em doenças relacionadas à produção de citocinas.

OBJECTIVE: This review will focus on the role of cytokines in the central nervous system and its implications to depressive disorder. We will then discuss the main findings of cytokine measurements in patients with major depressive disorder. METHOD: We searched Pubmed for studies published from 1999-2007, using the keywords depression and cytokine; and depressive disorder and cytokine. We have focused on pro-inflammatory cytokine measurements in patients with depression syndrome using DSM-criteria. RESULTS: Several lines of evidence suggest that cytokines have effects on depression, such as the induction of sickness behavior; clinical conditions related to cytokines that also overlap depressive symptoms; and immunotherapy that can lead to depressive symptoms attenuated by antidepressant treatment. Finally, patients with depression exhibit increased levels of pro-inflammatory cytokines, although conflicting results have been described. CONCLUSION: Cytokines may play a role in the pathophysiology of some cases of depression, although a causal link has not been established yet. Further longitudinal studies are needed to determine patterns of cytokine in patients with major depressive disorder, taking into account confounding factors closely associated with the activation of pro-inflammatory cytokines. In addition, simultaneous measurements of multiple biomarkers could provide critical insights into mechanisms underlying major depressive disorder and a variety of common cytokine-related diseases.