Respuesta inmunológica a varias proteínas del H. pylori en pacientes guatemaltecos / Inmune response to various H. pylori proteins in Guatemalan patients

Se determinó la respuesta inmunológica a proteínas recombinantes de Helicobacter pylori en pacientes dis-pépticos (adultos y niños), pacientes con cáncer gástrico y sus familiares asintomáticos adultos viviendo con ellos. Se utilizó la prueba recomLine® Helicobacter IgG e IgA, y con base en el reconocimiento de los factores de virulencia VacA y CagA se determinó si la cepa de H. pylori era de tipo I o II. El análisis de los datos fue descriptivo y analítico y se estimaron los intervalos de confianza de 95%, con un nivel de error de 0.05 y Odds ratio. El 58.7% (121/206) de los pacientes presentó la bacteria en tinción histológica de biopsia, positividad que disminuyó con la edad y daño histológico. La frecuencia de la respuesta a los anticuerpos IgG fue mayor que IgA, en ambos casos ésta fue menor en los niños. Las proteínas del H. pylori más reconocidas tanto por IgA como IgG fueron VacA y CagA, y la respuesta a las otras proteínas investigadas fue mayor al aumentar el daño histológi-co. La cepa tipo I fue la que predominó en la población en estudio con 66% (136/206). Se deben continuar con los estudios de prevalencia de la cepa tipo I del H. pylori y del reconocimiento de sus antígenos en la población guatemalteca a fin de determinar su utilidad en el diagnóstico y pronóstico de la infección.

The immune response to recombinant Helicobacter pylori proteins was determined in dyspeptic patients (adults and children), patients with gastric cancer and their asymptomatic adults' relatives living with them. The recomLine® Helicobacter IgG and IgA test was used and based on the recognition of the virulence factors VacA and CagA, it was determined whether the H. pylori strain was type I or II. The data analysis was descriptive and analytic, and 95% confidence intervals were estimated, with an error level of 0.05, and Odds ratio. The patients that presented the bacterium in histological biopsy were 58.7% (121/206), positivity that decreased with age and histological damage. The frecuency of response to IgG antibodies was higher than IgA, in both cases it was lower in children. VacA and CagA were the H. pylori proteins most recognized by both IgA and IgG and it was observed that the number of recognized proteins was greater with increasing histological damage. The type I strain was the one that predominated in the study population 66% (136/206). Prevalence studies of the type I strain of H. pylori ant the recognition of its antigens in the Guatemalan population should continue in order to determine its usefulness in the diagnosis and prognosis of infection.

Lupus eritematoso sistémico en actividad y cociente albúmina/globulina invertido, ¿hallazgo propio de la enfermedad? / Systemic Erythematosus Lupus and Albumin-Globulin Index, a specific finding in lupus flares?

Introducción: El lupus eritematoso sistémico es el modelo clásico de enfermedad autoinmune. En el desarrollo de la enfermedad intervienen varios tipos de inmunoglobulinas, con predominio de la IgG, IgM e IgA. Objetivo: Describir la utilidad del cociente albúmina/globulina como un indicador de actividad en el lupus eritematoso sistémico. Desarrollo: Se estima que el 50 por ciento de los pacientes con lupus eritematoso sistémico muestran una hipoalbuminemia con una hipergammaglobulinemia. La hipoalbuminemia en mayor medida está relacionada con la presencia de nefritis lúpica. La mitad de los pacientes con nefritis lúpica presentan proteinuria en el orden del síndrome nefrótico. Esta proteinuria iguala o invierte parcialmente el valor del cociente albúmina/globulina. El cociente albúmina/globulina invertido por sí solo es insuficiente para afirmar la presencia de actividad en el lupus eritematoso sistémico. Se deben excluir otras entidades clínicas causantes de hipergammaglobulinemia policlonal. Los criterios de actividad del lupus eritematoso sistémico incrementan la sensibilidad del cociente albúmina/globulina invertido. Conclusiones: La interpretación del cociente albúmina/globulina debe ir aparejada a la estimación de actividad por los criterios clínicos de mayor uso (SLICC, SLEDAI, BILAG). No en todos los pacientes con lupus eritematoso sistémico puede interpretarse como criterio de actividad, por lo que es necesario excluir otras entidades clínicas(AU)

Introduction: Systemic lupus erythematosus is the model of autoimmune disease. Several types of immunoglobulins are involved in the development of the disease, mainly IgG, IgM and IgA. Objective: To describe the potential use of the albumin/globulin ratio as an indicator of activity in systemic lupus erythematosus. Development: fifty percent of patients with systemic lupus erythematosus exhibit hypoalbuminemia with hypergammaglobulinemia. Hypoalbuminemia is mainly related to the presence of lupus nephritis. The half of patients with lupus nephritis develops proteinuria with values of nephrotic syndrome. The proteinuria equals or partially reverses the albumin/globulin ratio. The inverted albumin/globulin ratio is insufficient to establish the presence of lupus activity. Other clinical entities producing polyclonal hypergammaglobulinaemia should be excluded. The systemic lupus erythematosus activity criteria increase the sensitivity of the inverted albumin/globulin ratio. Conclusions: The interpretation of the albumin/globulin ratio requires the activity estimation by different clinical criteria (SLICC, SLEDAI, BILAG). The inverted albumin/globulin ratio cannot be interpreted as a stand-alone indicator of disease activity in every systemic lupus erythematosus patients(AU)

Búsqueda, diagnóstico y tratamiento de la enfermedad celíaca: guía clínica 2015 / Screening, diagnosis and treatment of celiac disease: clinical guide 2015

Generar recomendaciones basadas en la mejor evidencia disponible acerca de la entrega de respecto a la pesquisa, diagnóstico y tratamiento de adolescentes con depresión. Adolescentes sospecha o diagnóstico de depresión, que reciben atención en el nivel primario, secundario y terciario de salud en el sector público y privado de salud. Todos los profesionales de salud con responsabilidades en la atención de adolescentes con depresión. Las recomendaciones de esta Guía fueron elaboradas de acuerdo con el sistema "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE). Luego de priorizadas las preguntas a responder, se realizó la búsqueda y la síntesis de evidencia, para finalmente generar las recomendaciones a través del juicio del Panel de Expertos.

Effect of visfatin on the structure and immune levels in the small intestine of LPS-induced rats / Efecto de la visfatina sobre la estructura y los niveles de inmunidad en el intestino delgado de ratas inducidas por lipopolisacáridos

This study investigated the effects of visfatin on the structure and the immunity levels in the small intestine of LPS-induced rats. Forty Wistar male and female SPF rats were randomly and equally divided into four groups: the saline (control), vistfatin, lipopolysaccharide (LPS), and visfatin+LPS co-stimulated. The functions of visfatin in the intestinal mucosal immunity were investigated by examining the variation of tissue structure, inflammation and immunity-related proteins in the intestine of immunologically stressed rats using HE staining, ELISA, immunohistochemistry and Western Blot. The results showed that, when compared with the control group, the visfatin-treated group showed a decrease in the intestinal villus height and width, and a significant increase in the levels of IL-6 and TNF-ð as well as Immunoglobulin A (IgA) positive cells. Additionally, when compared with the LPS-treated group, the visfatin+LPS co-stimulated group showed a decrease in the villus height and width as well as the levels of IL-6 and TNF-ð, and an increase in IgA levels, implying a shrinking response to LPS injection. All the results suggest that, under normal physiological conditions, visfatin disturbs the body's homeostasis and causes intestinal villus atrophy by increasing IgA expression. While under immune response conditions, LPS acts as an exogenous antigen to promote visfatin against LPS-induced inflammation by decreasing the expression of IgA. Under immune stress conditions, visfatin as an exogenous stimulus promotes the immune response by regulating the protein levels of IL-6, TNF-ð and IgA.

Este estudio investigó los efectos de la visfatina sobre la estructura y los niveles de inmunidad en el intestino delgado de ratas inducidas por lipopolisacáridos (LPS). Cuarenta ratas Wistar se dividieron aleatoriamente e igualmente en cuatro grupos: solución salina (control), vistafin, LPS y visfatina + LPS co-estimuladas. Las funciones de la visfatina en la inmunidad de la mucosa intestinal se investigaron mediante el examen de variación de la estructura del tejido, la inflamación y las proteínas relacionadas con la inmunidad en el intestino de ratas estresadas inmunológicamente; usando tinción HE, ELISA, inmunohistoquímica y Western Blot. Los resultados mostraron que, en comparación con el grupo control, el grupo tratado con visfatina presentó una disminución en la altura y ancho de las vellosidades intestinales, y un aumento significativo en los niveles de IL-6 y TNF-ð, así como inmunoglobulina A (IgA células positivas). Además, al comparar este grupo con el grupo tratado con LPS- el grupo visfatina + LPS co-estimulado mostró una disminución en la altura y ancho de las vellosidades, así como en los niveles de IL-6 y TNF-ð, y un aumento en los niveles de IgA, lo que implica reducción de una respuesta a la inyección LPS. Todos los resultados sugieren que, en condiciones fisiológicas normales, la visfatina perturba la homeostasis del cuerpo y provoca la atrofia de las vellosidades intestinales mediante el aumento de la expresión de IgA. Mientras que bajo condiciones de la respuesta inmune, LPS actúa como un antígeno exógeno para promover visfatina contra la inflamación inducida por LPS por la disminución de la expresión de IgA. En condiciones de estrés inmunológico, la visfatina como estímulo exógeno promueve la respuesta inmune mediante la regulación de los niveles de proteína de IL-6, TNF-ð e IgA.

Doenças sexualmente transmissíveis curáveis: diagnóstico laboratorial / Curable sexually transmitted diseases: laboratory diagnosis

As doenças sexualmente transmissíveis (DSTs) compreendem um dos grandes problemas de saúde pública. Estima-se que ocorram anualmente cerca de 92 milhões de casos de DSTs em todo o mundo, sendo mais prevalentes Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae e Treponema pallidum, além das infecções pelo vírus herpes simplex e pelo HIV.

The sexually transmitted diseases (STDs) are one of the biggest problems of public health. It is estimated that occurr anually about 92 million of STDs events all over the world. The most prevalent are Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae and Treponema pallidum besides the herpes simplex virus infections and HIV.

IgG/IgA pemphigus reactive with desmoglein 1 with additional undetermined reactivity with epidermal basement membrane zone.

IgG/IgA pemphigus is an extremely rare subset of pemphigus, showing anti-keratinocyte cell surface antibodies of both IgG and IgA classes. Herein, we describe a unique case of IgG/IgA pemphigus with clinical features of edematous erythema and peripheral vesiculopustules. Histopathology showed the presence of subcorneal pustules and acantholytic blisters in the mid-epidermis with neutrophilic infiltration and eosinophilic spongiosis. Direct immunofluorescence of perilesional skin showed both IgG and IgA deposits to keratinocyte cell surfaces and unusual granular deposits of IgG, IgM, and C3 along basement membrane zone. On enzyme linked immunosorbent assay , the auto-antibodies were found to be reactive to desmoglein 1 antigen. Various clinical, histopathological, and immunological findings in our case overlapped with the features of IgA pemphigus, pemphigus herpetiformis, and pemphigus foliaceus. These findings indicate that IgG/IgA pemphigus may be a transitional form between IgA pemphigus and pemphigus herpetiformis, and thus provides insight into the pathogenicity of this rare disorder.

Candida spp. adherence to oral epithelial cells and levels of IgA in children with orthodontic appliances

Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis. Orthodontic and other oral appliances seem to favor candidal presence. The aim of this work was to compare the presence of Candida species in saliva, their adherence to oral epithelial cells, and the levels of anti-C. albicans IgA in children with or without orthodontic appliances. This study included 30 children 5 to 12 years old (9.1 ± 1.7 years old) who were users of removable orthodontic devices for at least 6 months and 30 control children of similar ages (7.7 ± 1.5 years old). The presence of yeast species in the saliva was evaluated by microbiological methods. Candida species were identified using phenotypic methods. Anti-C. albicans IgA levels in saliva were analyzed by ELISA. The yeasts adhering to oral epithelial cells were assessed by exfoliative cytology. No statistically significant differences were observed for saliva yeast counts and anti-C. albicans IgA levels between the studied groups. Children with orthodontic devices exhibited more yeast cells adhering to oral epithelial cells and a higher percentage of non-albicans species relative to the control group. In conclusion, orthodontic appliances may favor the adherence of Candida to epithelial cells but do not influence the presence of these yeasts in saliva, and the levels of anti-C. albicans IgA do not correlate with yeast adherence or presence of Candida in the oral cavity.

Mucosal Immune Responses of Mice Experimentally Infected with Pygidiopsis summa (Trematoda: Heterophyidae)

Mucosal immune responses against Pygidiopsis summa (Trematoda: Heterophyidae) infection were studied in ICR mice. Experimental groups consisted of group 1 (uninfected controls), group 2 (infection with 200 metacercariae), and group 3 (immunosuppression with Depo-Medrol and infection with 200 metacercariae). Worms were recovered in the small intestine at days 1, 3, 5, and 7 post-infection (PI). Intestinal intraepithelial lymphocytes (IEL), mast cells, and goblet cells were counted in intestinal tissue sections stained with Giemsa, astra-blue, and periodic acid-Schiff, respectively. Mucosal IgA levels were measured by ELISA. Expulsion of P. summa from the mouse intestine began to occur from days 3-5 PI which sustained until day 7 PI. The worm expulsion was positively correlated with proliferation of IEL, mast cells, goblet cells, and increase of IgA, although in the case of mast cells significant increase was seen only at day 7 PI. Immunosuppression suppressed all these immune effectors and inhibited worm reduction in the intestine until day 7 PI. The results suggested that various immune effectors which include IEL, goblet cells, mast cells, and IgA play roles in regulating the intestinal mucosal immunity of ICR mice against P. summa infection.

Effects of probiotic bacteria on Candida presence and IgA anti-Candida in the oral cavity of elderly

Imbalance in the resident microbiota may promote the growth of opportunistic microorganisms, such as yeasts of Candida genus and the development of diseases, especially in aged people. This study evaluated whether the consumption of the probiotic Yakult LB® (Lactobacillus casei and Bifidobacterium breve) was able to influence on the specific immunological response against Candida and on the presence of these yeasts in the oral cavity of 42 healthy aged individuals. Saliva samples were collected before and after the probiotic use for 30 days, 3 times a week. The samples were plated in Dextrose Saboraud Agar with chloramphenicol, the colony-forming units (CFU/mL) were counted and the Candida species were identified. Anti-Candida IgA analysis was conducted using the ELISA technique. ANOVA and Student's t-test were used for normally distributed data and the Wilcoxon test was used for data with non-normal distribution (α=0.05). The results showed a statistically significant reduction (p<0.05) in Candida prevalence (from 92.9% to 85.7%), in CFU/mL counts of Candida and in the number of non-albicans species after consumption of the probiotic. Immunological analysis demonstrated a significant increase (p<0.05) in anti-Candida IgA levels. In conclusion, probiotic bacteria reduced Candida numbers in the oral cavity of the elderly and increased specific secretory immune response against these yeasts, suggesting its possible use in controlling oral candidosis.

Desequilíbrios na microbiota residente podem promover o crescimento de microrganismos oportunistas, como as leveduras do gênero Candida, e o desenvolvimento de doenças, especialmente na população idosa. Este estudo investigou se o consumo do probiótico Yakult LB® (Lactobacillus casei e Bifidobacterium breve) era capaz de influenciar na resposta imune secretória anti-Candida e na presença destes microrganismos na cavidade bucal de 42 idosas saudáveis. Amostras de saliva foram coletadas antes e depois do consumo do probiótico por 30 dias, 3 vezes por semana. As amostras foram semeadas em Agar Saboraud Dextrose com cloranfenicol, as unidades formadoras de colônias (UFC/mL) foram contadas e as espécies de Candida foram identificadas. A análise de IgA anti-Candida foi realizada pela técnica ELISA. Os resultados demonstraram redução na prevalência de Candida (de 92,9% para 85,7%), na contagem de UFC/mL (p≤0,05) e no número de espécies não-albicans, depois do consumo do probiótico. As análises imunológicas mostraram um aumento significativo dos níveis de IgA anti-Candida (p≤0,05). Concluindo, as bactérias probióticas reduziram significantemente a quantidade de Candida na cavidade bucal dos idosos e aumentaram a resposta imune secretória específica para esta levedura, sugerindo a possibilidade de sua utilização no controle da candidose bucal.

Los niveles de anticuerpos anti factor plaquetario 4-heparina y el índice 4T para trombocitopenia inducida por heparina / Levels of antiplatelet factor 4-heparin antibodies and 4T score for heparin induced thrombocitopenia

La trombocitopenia inducida por heparina (HIT) es un efecto adverso del tratamiento con heparina, mediada por anticuerpos anti complejo factor plaquetario 4 (PF4)-heparina (HPIA). La HIT es frecuentemente moderada pero pueden desarrollarse complicaciones trombóticas. El diagnóstico precoz es importante. La detección de HPIA por ELISA tiene alta sensibilidad pero baja especificidad (títulos bajos sin significación clínica). El índice de las 4T (índice 4T) puede detectar pacientes con alto riesgo de HIT. El propósito del estudio fue correlacionar los niveles de HPIA y el índice 4T de un grupo de pacientes derivados a nuestro centro. Evaluamos 84 pacientes, 34 de ellos desarrollaron trombosis. Cada médico completó un cuestionario clínico que fue remitido con la muestra a nuestro centro. Los cuestionarios fueron analizados por un investigador externo y el índice 4T se calculó previamente al ensayo. Los HPIA se determinaron por un ELISA (Asserachrom HPIA) que detecta los 3 isotipos, IgG, IgM e IgA, único reactivo disponible en Argentina. Los resultados se expresaron como porcentaje de absorbancia (%ABS). La correlación del índice 4T con los HPIA fue 0.472 (rho spearman, p < 0.001). Los pacientes con índice 4T ≥ 6 presentaban %ABS mayores que los ≤ 5 (67 vs. 39, p < 0.001). Aquéllos con trombosis presentaron títulos mayores que los que no la desarrollaron (%ABS 59 vs. 39, p = 0.017). En conclusión: Los títulos altos de HPIA medidos por ELISA, que detecta los 3 isotipos, correlacionaron claramente con el índice 4T ≥ 6 y fueron más frecuentes en los pacientes con trombosis, coincidiendo con lo ya descripto para ensayos de ELISA específicos para isotipo IgG.

Heparin induced thrombocytopenia (HIT) is an immune-mediated disorder due to antibodies anti platelet factor 4-heparin (HPIA). Thrombocytopenia is often moderate but certain patients can develop morbid thrombotic complications. HPIA detection by ELISA has high sensitivity but low specificity, and low titers (without clinical significance) are frequent. A pretest clinical score (4T´s) was developed in order to recognize patients that are at high risk of HIT. The aim of this study was to correlate HPIA levels and the 4T´s score of consecutive patients derived to our center. We evaluated 84 patients (35 of them developed thrombosis); the clinical questionnaire was sent along with the sample and was analyzed by an investigator who did not know the patients´ characteristics, and 4T´s scores were calculated before performing the laboratory tests. HPIA were measured by ELISA (Asserachrom HPIA) that detects IgG, IgM and IgA isotypes, (the only reagent available in our country). 4T´s score correlated with HPIA levels (rho spearman 0.472, p < 0.001). Patients with 4T´s ≥ 6 had higher absorbance percentages than those with ≤ 5 (67 vs. 39%, p < 0.001), and patients with thrombosis also presented higher titers (59 vs. 39%, p = 0.017) than those who did not develop this complication. In conclusion, high titers of HPIA measured by EIA which detects the 3 isotypes, clearly correlate with 4T´s score ≥ 6 and are more frequent in patients who develop thrombosis, just as reported when an IgG specific ELISA is used.

Effects of Aroma Self-Foot Reflexology Massage on Stress and Immune Responses and Fatigue in Middle-Aged Women in Rural Areas

PURPOSE: This study was done to examine the effects of aroma self-foot reflexology massage on stress and immune responses and fatigue in middle-aged women in rural areas. METHODS: The study was a nonequivalent control group pre-post test design. The participants were 52 middle-aged women from rural areas of which 26 were assigned to the experimental group and 26 to the control group. Data were collected from July to September, 2011 and analyzed using SPSS Win 17.0 version program. The intervention was conducted 3 times a week for six weeks. RESULTS: There were significant differences in reported perceived stress, systolic blood pressure, diastolic blood pressure and fatigue between the two groups. However, the issue of salivary cortisol and immune response were not significant. CONCLUSION: Aroma self-foot reflexology massage can be utilized as an effective intervention for perceived stress, systolic blood pressure, diastolic blood pressure and fatigue in middle-aged woman in rural areas.

Auto-anticorpos anti-β2-glicoproteína I e síndrome metabólica / Anti-beta2-glycoprotein I autoantibodies and metabolic syndrome / Anticuerpos anti-β2-glicoproteína I y síndrome metabólico

FUNDAMENTO: A síndrome metabólica (SM) é uma entidade pró-aterogênica. Autoanticorpos tais como β2-glicoproteína I (β2-gpI) podem influenciar o aparecimento de ateromas. Estudos anteriores confirmaram uma associação entre anticorpos IgA anti-β2-gpI e isquemia cerebral, infarto do miocárdio, doença arterial periférica e doença da carótida. OBJETIVO: O objetivo desse estudo de caso-controle foi avaliar uma possível associação entre anticorpos anti-β2-gpI e anticardiolipina (aCL) com SM não-complicada. MÉTODOS: Pacientes com SM sem histórico de eventos vasculares e indivíduos-controle, consistindo em pacientes da Enfermaria de Ortopedia admitidos devido a doenças musculoesqueléticas foram incluídos no estudo. Idade, sexo, etnia, histórico de hipertensão, tabagismo, hipercolesterolemia e diabetes mellitus foram avaliados como fatores de risco em ambos os grupos. Anticorpos IgG, IgM, e IgA anti-β2-gpI e aCL foram detectados através de imunoensaios enzimáticos. RESULTADOS: Um total de 68 pacientes com SM e 82 controles foram estudados. Os pacientes com SM tinham média de idade superior à dos controles (P = 0,001), enquanto homens (P = 0,003; OR 0,31; IC95 por cento: 0,15-0,16) e etnia caucasiana (P = 0,004; OR 0,25; IC95 por cento:0,10-0,60) eram predominantes nos controles. Histórico de hipertensão, hipercolesterolemia e diabetes mellitus foi mais prevalente nos pacientes com SM do que nos controles (P < 0.05). A frequência de anticorpos aCL (todos os isotipos) e do IgG e IgM anti-β2 gpI não diferiu de forma significante nos pacientes com SM e controles. Anticorpos IgA anti-β2-gpI foram significantemente mais frequentes nos pacientes com SM (42,2 por cento) do que nos controles (10,9 por cento) (P < 0,001). O OR ajustado para anticorpos IgA anti-β2-gpI foi 3,60 (IC95 por cento: 1,55-8,37; P = 0,003). CONCLUSÃO: O presente estudo mostra que níveis elevados de autoanticorpos IgA para β2-gpI podem estar independentemente associados com SM.

BACKGROUND: The metabolic syndrome (MetS) is a proatherogenic entity. Autoantibodies to phospholipid cofactors such as beta2-glycoprotein I (beta2-gpI) can influence atheroma appearance. Previous studies confirmed an association of IgA anti-beta2-gpI antibodies with cerebral ischemia, myocardial infarction, peripheral artery disease and carotid disease. OBJECTIVE: This case-control study evaluates a possible association of anti-beta2-gpI and anticardiolipin (aCL) antibodies with non-complicated MetS. METHODS: Cases comprised patients with MetS without history of vascular events; controls included individuals from the Orthopedic Infirmary admitted due to musculoskeletal disorders. Age, sex, race, history of hypertension, smoking, hypercholesterolemia and diabetes mellitus were evaluated as risk factors in both groups. IgG, IgM, and IgA anti-beta2-gpI and aCL antibodies were detected by enzymatic immunoassay. RESULTS: Sixty-eight patients with MetS and 82 controls were studied. Patients with MetS showed mean age higher than controls (P = 0.001), while males (P = 0.003; OR 0.31; 95 percentCI 0.15-0.16) and Caucasian ethnicity (P = 0.004; OR 0.25; 95 percentCI 0.10-0.60) predominated in controls. History of hypertension, hypercholesterolemia and diabetes mellitus were more prevalent in cases than in controls (P < 0.05). The frequency of aCL antibodies (all isotypes) and of IgG and IgM anti-beta2 gpI did not significantly differ in cases and controls. IgA anti-beta2-gpI antibodies were significantly more frequent in MetS patients (42.2 percent) than controls (10.9 percent) (P < 0.001). The adjusted OR for IgA anti-beta2-gpI antibodies was 3.60 (95 percentCI 1.55-8.37; P = 0.003). CONCLUSION: The current study shows that elevated levels of IgA autoantibodies to β2-gpI might be independently associated to MetS.

FUNDAMENTO: El síndrome metabólico (SM) es una entidad pro-aterogénica. Autoanticuerpos tales como β2-glicoproteína I (β2-GPI) pueden influir en la aparición de ateromas. Estudios previos han confirmado una asociación entre anticuerpos IgA anti-β2-GPI y la isquemia cerebral, infarto de miocardio, enfermedad arterial periférica y enfermedad carotidea. OBJETIVO: El objetivo de este estudio de caso-control fue evaluar una posible asociación entre los anticuerpos anti-β2-GPI y anticardiolipina (aCL) con SM complicada. MÉTODOS: Se incluyeron en el estudio a los pacientes con SM sin antecedentes de eventos vasculares y los sujetos control, que consiste en pacientes de la Internación de Ortopedia ingresados debido a enfermedades musculoesqueléticas. Edad, sexo, origen étnico caucásico, antecedentes de hipertensión, tabaquismo, hipercolesterolemia y diabetes mellitus fueron evaluados como factores de riesgo en ambos grupos. Anticuerpos IgG, IgM, e IgA anti-β2-GPI y aCL se detectaron a través de inmunoensayos enzimáticos. RESULTADOS: Un total de 68 pacientes con SM y 82 controles se estudiaron. Los pacientes con SM tenían un promedio de edad superior de los controles (p = 0,001), mientras que los hombres (p = 0,003; OR 0,31; IC95 por ciento: 0,15-0,16) y origen étnico caucásica (p = 0,004; OR 0,25; IC95 por ciento:0,10-0,60) eran predominantes en los controles. Historia de hipertensión, hipercolesterolemia y diabetes mellitus fue más prevalente en los pacientes con SM que en los controles (p < 0,05). La frecuencia de anticuerpos aCL (todos los isotipos) y del IgG e IgM anti-β2 gpI no se distinguió de forma significante en los pacientes con SM y controles. Anticuerpos IgA anti-β2-gpI fueron significantemente más frecuentes en los pacientes con SM (42,2 por ciento) que en los controles (10,9 por ciento) (p < 0,001). El OR ajustado para anticuerpos IgA anti-β2-gpI fue 3,60 (IC95 por ciento: 1,55 a 8,37, p = 0,003). CONCLUSIÓN: El presente estudio muestra que los niveles elevados de autoanticuerpos IgA para β2-gpI pueden estar independientemente asociados con la SM.

Immunoglobulin A, G and M levels in saliva in children between 3-12 years of age, healthy and with gingivitis

El objetivo de este estudio cuantificar los niveles de inmunoglobulinas A, G y M en saliva de niños entre 3 – 12 añossanos y con gingivitis. Métodos: la muestra fue de 177 niños distribuidos en dos grupos: 24 sanos y 153 con diagnóstico de gingivitis según el índice de Loe a quienes se les tomaron muestras de saliva y por medio de la prueba de ELISA se obtuvieronlas concentraciones de las inmunoglobulinas expresadas enµg/ml. Resultados: Se encontró que en la saliva de los niños sanos los niveles de IgG son significativamente mayores que en los niños con gingivitis. El grupo gingivitis estuvo conformado por un 95.8 por ciento de niños con diagnóstico de gingivitis incipiente que presentó un promedio bajo de índice de placabacteriana. Al hacer análisis de correlación entre las variables estudiadas, se encontró una correlación directa entre la edad y el índice gingival, una correlación inversa entre la edad y el índice de placa bacteriana, correlación directa entre los niveles de IgA y la edad y correlación directa entre el índice gingival y la IgM. Conclusiones: Se encontró que en la medida en que el individuo crece aumenta el índice gingival, aunque se presenta menor cantidad de placa bacteriana. También seconcluyó que la edad es mejor predictor de los niveles de IgA que el índice gingival y el índice de placa bacteriana y que el índice gingival es mejor predictor de los niveles de IgM que la edad y el índice de placa bacteriana.

Avaliação da influência do dispositivo de coleta de saliva na análise de imunoglobulina A secretora e alfa-amilase / Influence of the saliva collection device on the analysis of secretory immunoglobulin-A and alpha-amylase

Introdução: A saliva humana tem sido amplamente utilizada para quantificar biomarcadores com finalidade científica e de diagnóstico, pois sua coleta é simples, não-invasiva e livre de estresse. O Salivette é o dispositivo de coleta de saliva mais empregado, devido à sua praticidade e aceitação pelo paciente, entretanto é desconhecida a influência de sua versão de poliéster nas análises das concentrações salivares de algumas substâncias. Objetivo: O objetivo deste trabalho foi avaliar a influência do Salivette poliéster na determinação das concentrações salivares de sIgA e alfa-amilase. Métodos: Foram coletadas amostras de saliva de 15 adultos jovens com bom estado de saúde, livres de infecções e mucosa bucal íntegra. Cada amostra de saliva foi dividida em duas porções: uma foi colocada sobre o poliéster do Salivette e a outra foi mantida no frasco original (controle), todas foram centrifugadas e armazenadas a -80ºC até a análise laboratorial. Resultados: As amostras salivares passadas pelo Salivette mostraram uma redução estatisticamente significante da concentração de sIgA, com uma redução de 17,3%±15,2, porém esta diferença não foi significante para as concentrações de alfa-amilase (p<0,05). Conclusão: A utilização do Salivette poliéster para coleta de saliva não influencia a concentração de alfa-amilase, porém altera de forma significante os níveis de sIgA.

Introduction: Human saliva has been widely used to quantify biomarkers for research and diagnostic purposes, once its collection is simple, non-invasive and stress-free. Although Salivette is the most used saliva collection device, due to its practicality and patient acceptance, the influence of its polyester version on the analysis of the salivary concentrations of some substances is unknown. Objective: This study aimed to assess the influence of polyester Salivette on the salivary concentrations of secretory immunoglobulin-A (s-IgA) and alpha-amylase. Methods: Salivary samples from 15 young adults, in good general health, free from infections and with a healthy oral mucosa, were collected. Each salivary sample was divided in two portions: one was placed on the Salivette polyester and the other was kept in the original flask (control). The samples were centrifuged and stored at -80ºC, until laboratory analysis was performed. Results: The salivary samples which had contact with Salivette showed a statistically significant reduction of s-IgA (17.3%±15.2). The difference was not significant for alpha-amylase (p<0.05). Conclusion: The polyester Salivette collection device does not influence alpha-amylase concentrations, but significantly reduces s-IgA levels.

Doença celíaca em familiares de primeiro grau de portadores / Celiac disease in first-degree relatives of patients

OBJETIVO: Determinar a prevalência da doença celíaca e descrever as alterações histológicas, manifestações clínicas e condições associadas de um grupo de familiares de primeiro grau de celíacos na cidade de Recife (PE), Nordeste do Brasil. MÉTODO: O estudo foi realizado em ambulatórios de gastropediatria da cidade de Recife. Foram incluídos no estudo 174 familiares de primeiro grau submetidos à pesquisa do anticorpo antitransglutaminase IgA. Os familiares com sorologia positiva foram convidados a realizar biópsia do intestino delgado (classificadas segundo Marsh) e avaliação do peso, estatura, manifestações clínicas e condições associadas à doença celíaca. Foram utilizados os testes do qui-quadrado e de Fisher para avaliar as diferenças, considerando-se significativo o valor de p < 0,05. RESULTADOS: O anticorpo antitransglutaminase IgA foi positivo em 20,1 por cento (34/174) dos familiares (IC95 por cento 14,6-26,5). Não se observou diferença na positividade da sorologia quanto ao grau de parentesco, nem quanto ao sexo. Vinte e dois pacientes submeteram-se a biópsia. Treze apresentaram alterações histológicas grau III de Marsh; sete, grau I; e dois, grau zero, conferindo uma prevalência presumível de 11,5 por cento. Todos os pacientes, exceto um, eram sintomáticos; o único paciente sem sintomas tinha baixa estatura. CONCLUSÃO: A prevalência de doença celíaca nesse grupo de familiares foi elevada. Todos os novos casos identificados tinham sintomas ou condições associadas. Nesse grupo, houve uma frequência elevada de indivíduos com sorologia positiva, sintomatologia sugestiva de doença celíaca e sem evidência de atrofia vilositária na mucosa intestinal.

OBJECTIVE: To determine the prevalence of celiac disease and to describe the histological alterations, clinical manifestations, and conditions associated with a group of first-degree relatives of celiac disease patients in the municipality of Recife, Northeast Brazil. METHOD: The study was conducted in outpatient clinics of pediatric gastroenterology located in Recife. We included in the study 174 first-degree relatives who were screened for the anti-transglutaminase IgA antibody. Those relatives who had positive serological tests were invited to undergo a small intestine biopsy (classified according to Marsh). They were also evaluated regarding weight, height, clinical symptoms and conditions associated with celiac disease. The chi-square test and Fisher's exact test were used to assess the differences with a significance level of p < 0.05. RESULTS: The anti-transglutaminase IgA antibody was positive for 20.1 percent (34/174) of the relatives (95 percentCI 14.6-26.5). There was no difference in terms of positive serological tests regarding either degree of kinship or sex. Twenty-two patients underwent biopsy. Thirteen had histological alterations classified as Marsh stage 3; seven had stage 1; and two had stage zero, with a probable prevalence of 11.5 percent. All patients, except for one, had symptoms; the only patient with no symptoms was short. CONCLUSION: Celiac disease prevalence in this group of relatives was high. All new cases identified were symptomatic or had associated conditions. In this group, there was a high frequency of individuals with positive serological tests, symptoms suggestive of celiac disease, and no evidence of villous atrophy in the intestinal mucosa.

Imunoglobulina intravenosa para tratamento de epidermólise bolhosa adquirida grave refratária a terapia imunossupressora convencional / Intravenous immunoglobulin for treatment of severe acquired bullous epidermolysis refractory to conventional immunosuppressive therapy

A epidermólise bolhosa adquirida é doença bolhosa subepidérmica crônica e rara. Geralmente, inicia-se na fase adulta, sendo a etiologia desconhecida, embora vinculada à presença de anticorpos contra o colágeno tipo VII. Há formação de bolhas, espontaneamente ou após trauma, podendo causar complicações graves. O tratamento é desapontador e difícil. Além da terapia convencional com corticoides sistêmicos, recentemente, novas modalidades terapêuticas promissoras estão sendo utilizadas, dentre elas, a imunoglobulina intravenosa. Destaca-se, neste relato, o difícil manejo clínico desta doença, e a melhora importante com a imunoglobulina intravenosa.

Acquired bullous epidermolysis is a chronic and rare bullous subepidermal disease. It usually begins in adulthood and its etiology is unknown although it is associated with antibodies against type VII collagen. There are spontaneous and trauma induced formation of blisters that may cause serious complications. Treatment is disappointing and difficult. Apart from conventional therapy with systemic corticosteroid, new therapeutic modalities such as intravenous immunoglobulin are currently being used. This report highlights the extremely difficult clinical management of this rare disease and the important improvement provided by intravenous immunoglobulin.

Salivary IgA and IgE levels in healthy subjects: relation to age and gender

It has been reported that the immune system undergoes age and gender changes. The aim of this study was to investigate the age- and gender-dependent changes of salivary IgA and IgE levels among healthy subjects. A total of 203 healthy individuals (aged 1-70 years) were enrolled in the study. Two milliliters of saliva were collected from all participants, and salivary IgA and IgE levels were measured by the ELISA technique. Mean salivary IgA levels were significantly higher in subjects aged 11-20 years as compared to subjects aged 1-10 years (P < 0.01). Mean salivary IgA levels increased with age up to the age of 60 years, and then slightly decreased in subjects aged 61-70 years. The frequency of subjects with detectable levels of salivary IgE and mean salivary IgE levels gradually increased with age, with maximum levels being observed in the 31-40 years age group and not changing significantly thereafter. The mean levels of salivary IgA and IgE in adults were significantly higher than those observed in children (P < 0.00001 and P < 0.05, respectively). No significant differences were observed between men and women regarding both salivary immunoglobulins. These results showed age-dependent changes of the salivary IgA and IgE levels. Gender had no effect on the salivary levels of IgA and IgE.

Imunoglobulina A salivar (IgA-s) e exercício: relevância do controle em atletas e implicações metodológicas / Salivary immunoglobulin A (s-lgA) and exercise: relevance of its control in athletes and methodological implications

O objetivo do presente estudo é realizar uma análise e discussão dos principais achados envolvendo o comportamento da imunoglobulina A salivar (IgA-s) em relação ao estímulo do exercício e evidenciar a importância de seu controle em atletas. O exercício físico é um importante modulador das características do sistema imune, sobretudo do comportamento da IgA-s, componente fundamental na proteção de infecções do trato respiratório superior (ITRS). No entanto, a relação direta entre baixas concentrações de IgA-s e ITRS precisa de mais evidências para ser confirmada. As concentrações de IgA-s durante e logo após um exercício intenso diminuem, deixando o indivíduo mais suscetível à infecção, porém, atletas envolvidos em atividades extenuantes não são clinicamente imunodeficientes, comparados com indivíduos sedentários. Essas modificações são transitórias, com retorno aos valores normais após aproximadamente 48 horas de repouso. A razão dessas alterações não é clara, mas se apresenta multifatorial: elevação de hormônios estressores; fatores nutricionais; ação de espécies reativas de oxigênio; e estresse psicológico. Apesar do efeito transitório das alterações provocadas nos elementos do sistema imune frente ao exercício, observa-se diferença na variabilidade da IgA-s em populações com diferentes níveis de condicionamento. Diferenças metodológicas - como o protocolo de exercício, o método de coleta, armazenamento e manipulação da saliva, a forma de expressão da IgA-s, o nível de hidratação, o controle da dieta, a sazonalidade do período de competição, a aclimatação entre outros fatores - devem ser levadas em consideração para comparação entre os estudos. Além disso, ajudam a explicar, em parte, os resultados adversos envolvendo exercício moderado e os intermitentes, em que se encontram aumento, redução e até ausência de alteração nos níveis de IgA-s. Investigações de elementos inovadores, como os toll-like receptors, e o avanço tecnológico podem ...

The present study aimed to discuss the main findings involving salivary immunoglobulin A (s-IgA) and exercise and evidence the importance of the control in athletes. Exercise is a great modulator of immune system characteristics such as the s-IgA that exerts important defense against upper respiratory tract infections (URTI). However, more evidence is needed to confirm a direct association between low levels of s-IgA and URTI. The level of s-IgA decreases after a high-intense exercise, increasing thus, the individual's susceptibility to infection, but athletes engaged in exhausting exercise are not clinically immune-deficient compared with sedentary subjects. The changes in s-IgA are transitory returning to normal status in approximately 48-h rest. The reason of these alterations remains unclear, but many causes have been investigated: hormones stressors rise; nutrition influences; action of reactive oxygen species, psychological stress. Despite the transitory effects of the exercise on the immune system, the variability in s-IgA differs in populations with different fitness levels. Differences in exercise protocols, saliva collection, manipulation or storage methods, the method used to assess s-IgA, subject's hydration status, dietary control, competition's seasonality, acclimatization, among other factors should be considered to compare different studies. In addition, these factors could partially explain the adverse results of studies involving moderate and intermittent exercise that have found increase, decrease and no changes in s-IgA levels. Investigations of recent immunologic issues such as the toll like-receptors and the advances in technology may contribute to increase the evidence on this issue.

Frecuencia de anticuerpos IgA e IgM anti Chlamydia trachomatis: en mujeres embarazadas procedentes de una consulta prenatal Cumaná, Estado Sucre, Venezuela, marzo-junio de 2006 / Frequency of IgA and IgM anti Chlamydia trachomatis antibodies: in pregnant women coming from a prenatal consult in Cumana, State of Sucre, Venezuela, march-june of 2006

Con el propósito de establecer la frecuencia de anticuerpos IgA e IgM anti-C-trachomatis en mujeres embarazadas se realizó un estudio en 84 mujeres con esa condición, en edades comprendidas entre 14 y 43 años, que acudieron a la consulta prenatal, del Servicio Autónomo Hospital Universitario “Antonio Patricio de Alcalá”, en Cumaná, estado Sucre, Venezuela, durante el período marzo-junio de 2006. Para ello se obtuvieron 84 muestras de suero para la determinación de anticuerpos IgA e IgM anti C-trachomatis a través del método de inmunoabsorción ligado a enzimas ELISA (Diagnostic Automation INC). Del total de muestras analizadas 16 (19,05 por ciento) y 55 (65,48 por ciento) resultaron positivas para la determinación de anticuerpos IgA e IgM anti C-trachomatis respectivamente. No se encontró asociación entre la presencia de estos anticuerpos con la edad de las pacientes, aunque el mayor número de pacientes positivas se ubicó en el intervalo de edades comprendidas entre 14 a 23 años. Asimismo al asociarse las manifestaciones clínicas genitales con la presencia de anticuerpos IgA e IgM anti C- trachomatis no se encontraron valores estadísticamente significativos. Por lo anteriormente expuesto se concluye que la infección genital por Chlamydia trachomatis en mujeres embarazadas es extremadamente frecuente, de manera especial en las edades comprendidas entre 24 a 33 años, y ocurre habitualmente en forma asintomática con las graves repercusiones que esto acarrea a la paciente, al feto y a su pareja.

In order to establish the frequency of IgA and IgM anti-C. Trachomatis antibodies in expectant women, a study was made of 84 women between the ages of 14 and 43, who attended prenatal consults in the Autonomous Service at the University Hospital “Antonio Patricio of Alcalá,” Cumaná, State of Sucre, during the March-June period, 2006. 84 serum samples were obtained to determine IgA and IgM anti-C. trachomatis antibodies using the immunoabsorption method connected to ELISA enzymes (Diagnostic Automation INC). Of the total samples studied, 16 (19.05 percent) and 55 (65.48 percent) resulted positive for the IgA and IgM anti-C. trachomatis antibodies, respectively. No association was found between the presence of these antibodies and the age of the patients, although the greater number of positive patients was in the 14 to 23 year age interval. Likewise, no statistically significant values were found between the association of clinical genital manifestations and the presence of IgA and IgM anti C- trachomatis antibodies; therefore, it was shown that Chlamydia trachomatis is presented asymptomatically in most cases. Conclusions were that genital infection by Chlamydia trachomatis in pregnant women is extremely frequent, especially for ages between 24 and 33 years, and it occurs habitually in an asymptomatic form with the serious repercussions that this produces on the patient, the fetus and the partner.

The Effects of Aromatherapy on Stress and Stress Responses in Adolescents

PURPOSE: This study was done to examine the effects of aromatherapy on stress and stress responses in adolescents. METHODS: A two-group cross-over design was used for this study. The experimental treatment was aroma essential oil inhalation and the placebo treatment was carrier oil inhalation using a necklace. The sample included 36 female high school students. Fisher's exact test, t-test, and paired t-test using SPSS/WIN program were used to analyze the data. RESULTS: Stress levels were significantly lower when the students received the aroma treatment compared to when they received the placebo treatment. The stress responses except salivary IgA levels were significantly lower when the students received the aroma treatment. CONCLUSION: Aroma inhalation could be a very effective stress management method for high school students. Therefore, it is recommended that this program be used in clinical practice as an effective nursing intervention for high school students