Asian Oceanian Association of Neurology: Past, present, future

@#Four and a half decades ago, Dr. Charles M. Posner, a World Federation of Neurology representative toured the Asian and Oceanian countries and challenged its neurologists to form an association that would promote and foster the advancement and exchange of neuro-scientific information within the region. In response, Dr. Shigeo Okinaka invited the region’s neurologists to a planning meeting in Tokyo, Japan which subsequently resulted to the birth of the Asian and Oceanian Association of Neurology (AOAN) on June 26, 1961. The main objectives of the association according to the AOAN Statutes, as stated in Article 2, are to promote and foster on an international scale the advancement, the exchange and diffusion of information and ideas relating to the nervous system and encourage scientific researches in neurological problems. Article 3 likewise states the hosting of the Asian and Oceanian Congress of Neurology (AOCN) once every four years.

Reconstrucción con colgajo de músculo temporal en defecto del tercio medio de la región facial. Nuestra experiencia en un hospital de mediana complejidad / TEMPORALIS MUSCLE FLAP RECONSTRUCTION IN FACIAL REGION DEFECTS. OUR EXPERIENCE IN MEDIUM COMPLEXITY HOSPITAL

Introducción: El colgajo pediculado realizado con músculo temporal es una opción terapéutica válida para la reconstrucción de defectos de la región facial posterior a una resección quirúrgica, es una alternativa aceptable a los colgajos libres cuando estos no pueden ser utilizados ya sea por el performance status o patología de base de los pacientes a tratar o por no contar con cirujano microvascular. Objetivo: Describir nuestra experiencia en el uso de este colgajo para la reconstrucción de 7 pacientes con defectos de órbita, paladar y mucosa yugal tras la cirugía ablativa de diversas patologías. Materiales y métodos: Revisión retrospectiva de los pacientes del Servicio de Cirugía General del Hospital José Ramon Vidal, Corrientes-Argentina operados en el periodo comprendido desde enero del 2019 hasta enero del 2021.En este lapso, 7 pacientes fueron sometidos a cirugía reconstructiva inmediata con colgajo de músculo temporal en defectos del tercio medio de la región facial. Resultados: Un total de siete pacientes, (4 masculino- 3 femenino), sometidos a cirugía ablativa por presentar patología maligna (6) y patología benigna (1), con una edad media de 60 años. Dos colgajos se utilizaron para defectos de región orbitaria y partes blandas, seis para defectos en la cavidadoral­ en un paciente se emplearon los 2 músculos temporales-. El colgajo fue exitoso en todos los casos, se presentaron complicaciones menores como: dolor postoperatorio, hematoma, trismus, depresión de la zona dadora. Se obtuvo márgenes libres en el total de los procedimientos. Discusión: La cirugía reconstructiva con colgajo pediculado de musculo temporal es una excelente alternativa de colgajo regional con buenos resultados, posee alta tasa de éxito justificada por su buena vascularización. Además, la proximidad del músculo temporal con la región maxilofacial y su inserción contribuyen a obtener un arco de rotación hasta 180° sin comprometersu vitalidad. Es útil para la reconstrucción en un acto quirúrgico, acortando el tiempo intraoperatorio y sin cambios posicionales. Conclusiones: El colgajo de músculo temporal resulta una opción válida a los colgajos libres osteo-mio-cutáneos para defectos mixtos (óseos y de partes blandas) del tercio medio facial luego de la cirugía ablativa, cuando estos últimos no pueden ser implementados teniendo en cuenta varios aspectos como performance estatus de los pacientes, patología de base y necesidad de contar con un cirujano microvascular

Introduction: temporalis muscle vascularized flaps is a valid therapeutic option for reconstruction of defects in facial region after surgical resections. It is an acceptable alternative to free transfer flaps when these cannot be used because of the patient's performance state and base pathologies. Or because of the lack of a microvascular surgeon. Objectives: To describe on experience applying this kind of flaps for the reconstruction or 7 patients, with defects in palate orbit and yugal mucose after resective surgeries for various pathologies. Materials and methods: retrospective revision of patients in the general department, of Jose R Vidal Hospital (Corrientes - Argentina) into underwent surgery during the period between January 2019 ad January 2021. A total of 7 patients underwent immediate reconstructive surgery using a temporalis muscle flap. Results: 7 patients (4 males y 3 female) underwent resective surgery for different malignant (6) and benign (1) with a median age of 60. Two flaps were used for defects of the orbitary region and soft tissue, six for defects of the oral cavity (in one patient both temporalis muscle were used. Te procedure was successful in all cases, and minor complication were present, (post operatory pain, hematoma, trismus, excavation of the donor region) all procedures resulted un surgical margins of lesion of malignancy. Discussion: reconstructive surgery using a vascularized flap of temporalis muscle is an excellent alternative for regional flaps with good results and a high success justified because of its a good irrigation. Besides the proximity between temporalis muscle and the maxillofacial region, possibilities a flap rotation of up to 180 grades without compromising its vitality it is also useful for reconstruction in a single surgery shortening intra-operatory time while avoiding repositioning of the patients during the procedure. Conclusions: Temporalis muscle flaps are valid option to free osteo- mayo- cutaneal flaps for mixed defects (involving bone and soft tissue) of the medium third of facial region after resective surgeries when the latter cannot be carried and because of various aspects little performance status base pathologies and lack of microvascular margin.

Telerehabilitation in a developing country toward the tail end of the COVID-19 pandemic: Is it here to stay?

@#After two years of the Coronavirus Disease 2019 (COVID-19) pandemic, cases have generally begun to decline in the different regions of the world, and consequently a lot of people are gradually returning to face-to-face interactions, including health-related activities. Based on scarce local literatures published recently, telerehabilitation was envisioned to be a viable solution to bridge the perennial gaps in the delivery of rehabilitation services across the Philippine archipelago, such as the lack of manpower and resources, aggravated by the pandemic.

Statistical association of rs2243250 polymorphism of IL4 gene and hemorrhagic stroke in Brazilian population / Associação estatística entre o polimorfismo rs2243250 no gene da IL-4 e o AVC hemorrágico na população brasileira

ABSTRACT Interleukin-4 (IL-4) has great significance in inflammatory processes in cases of stroke, since it is able to polarize microglia to the antiinflammatory phenotype called M2. This study analyzed if the variation between TT genotype and the other genotypes (CT and CC), in -589 (rs2243250) polymorphism of IL4 gene, has association with the prognosis of hemorrhagic stroke (HS) and with clinical aspects which are risk factors for cerebrovascular diseases. The result of this study shows that there is no statistical association of the IL4 polymorphism with either prognosis or clinical aspects in HS patients.

RESUMEN La interleucina-4 (IL-4) tiene gran importancia en los procesos inflamatorios en casos de accidente cerebrovascular (ACV), puesto que hace que las microglías sean polarizadas hacia el fenotipo antiinflamatorio M2. Este estudio analizó si la variación entre el genotipo TT y los demás genotipos (CT y CC), en el polimorfismo -589 (rs2243250) del gen IL4, posee asociación con el pronóstico de ACV hemorrágico y con aspectos clínicos que son factores de riesgo para enfermedades cerebrovasculares. El resultado de este estudio enseña que no hay asociación estadística del polimorfismo del IL4 ni con el pronóstico ni con los aspectos clínicos de pacientes con ACV hemorrágico.

RESUMO A interleucina-4 (IL-4) tem grande importância nos processos inflamatórios em casos de acidente vascular cerebral (AVC), uma vez que ela é capaz de polarizar micróglias para o fenótipo anti-inflamatório chamado M2. Este estudo analisou se a variação entre o genótipo TT e os demais genótipos (CT e CC), no polimorfismo -589 (rs2243250) do gene IL4, possui associação com o prognóstico de AVC hemorrágico e com aspectos clínicos que são fatores de risco para doenças cerebrovasculares. O resultado deste estudo mostra que não há associação estatística do polimorfismo do IL4 nem com prognóstico nem com os aspectos clínicos dos pacientes com AVC hemorrágico.

Migration of Oxidized Cellulose to the Ventricle as a Complication of Endoscopic Third Ventriculostomy: A Case Report

Endoscopic third ventriculostomy (ETV) is an increasingly common neurosurgical procedure. Hemostatic agentes (porcine gelatin and oxidized cellulose) are normally placed to plug the cortical hole after ETV to avoid cerebral spinal fluid leakage, subdural hygroma, and hemorrhage. Here we report the case of a 6-year-old boy with hydrocephalus who underwent ETV and which oxidized cellulose was placed to plug the cortical hole.Magnetic resonance imaging of the head performed 3 months after the procedure showed the presence of oxidized cellulose in the ventricle. After an unsuccessful attempt to remove the cellulose, it was decided that the patient should be kept under observation. Twoyears later, the child is in good health and without any complaints. Hemostatic agents (especially oxidized cellulose) used on the cortical hole after ETV can migrate to the ventricle and compromise the procedure. Follow-up should be performedfor such patients, and the main focus should be on not causing further injury.

Serra Pelada: the first Amazonian Meteorite fall is a Eucrite (basalt) from Asteroid 4-Vesta

ABSTRACT Serra Pelada is the newest Brazilian eucrite and the first recovered fall from Amazonia (State of Pará, Brazil, June 29th 2017). In this paper, we report on its petrography, chemistry, mineralogy and its magnetic properties. Study of four thin sections reveals that the meteorite is brecciated, containing basaltic and gabbroic clasts, as well of recrystallized impact melt, embedded into a fine-medium grained matrix. Chemical analyses suggest that Serra Pelada is a monomict basaltic eucritic breccia, and that the meteorite is a normal member of the HED suite. Our results provide additional geological and compositional information on the lithological diversity of its parent body. The mineralogy of Serra Pelada consists basically of low-Ca pyroxene and high-Ca plagioclase with accessory minerals such as quartz, sulphide (troilite), chromite - ulvöspinel and ilmenite. These data are consistent with the meteorite being an eucrite, a basaltic achondrite and a member of the howardite-eucrite-diogenite (HED) clan of meteorites which most likely are from the crust asteroid 4 Vesta.

Dysfunctional eating behaviors, anxiety, and depression in Italian boys and girls: the role of mass media

Objective: Extensive research has implicated identification with characters in mass media in the emergence of disordered eating behavior in adolescents. We explored the possible influence of the models offered by television (TV) on adolescents' body image, body uneasiness, eating-disordered behavior, depression, and anxiety. Methods: Three hundred and one adolescents (aged 14-19) from southern Italy participated. They completed a questionnaire on media exposure and body dissatisfaction, the Eating Disorder Inventory-2, the Body Uneasiness Test, the Beck Depression Inventory, and the State-Trait Anxiety Inventory - Form Y. Results: The main factors contributing to females' eating-disordered behaviors were their own desires to be similar to TV characters, the amount of reality and entertainment TV they watched, and the discrepancy between their perceptions of their bodies and those of TV characters. Friends' desire to be similar to TV characters contributed most to depression, anxiety, body uneasiness, and eating disorders for both males and females. Conclusion: Our data confirm that extensive watching of reality and entertainment TV correlates with eating-disordered behavior among females. Moreover, the well-known negative effects of the media on adolescents' eating-disordered behaviors may also be indirectly transmitted by friends who share identification with TV characters.

Presence of Cells in Fresh-Frozen Allogeneic Bone Grafts from Different Tissue Banks

Bone replacement materials have been widely used to reconstruct atrophic jawbones. Based on previous reports demonstrating the presence of viable cells in bone blocks even after processing by musculoskeletal tissue banks for orthopedic use, the aim of this study was to evaluate the presence of cells in bone blocks from three Brazilian tissue banks for maxillary reconstructions. All samples were processed by the respective tissue banks, according to the guidelines of the Brazilian National Sanitary Surveillance Agency. Three samples were removed from each block for subsequent histological processing and stained using hematoxylin & eosin. Further evaluation included section staining by the Feulgen method and ultrastructural analysis using scanning electron microscopy (SEM). Light microscopy images from all bone samples showed presence of osteocyte-like cells in all groups and intense Feulgen staining, demonstrating presence of DNA in bone even after tissue processing. The ultrastructural analysis showed red blood cells in lacunae within the bone tissue. In conclusion, despite bone tissue processing by the musculoskeletal tissue banks, cells may be found within the bone used for allogeneic grafts.

Resumo Substitutos ósseos têm sido amplamente utilizados para reconstrução de ossos maxilares atróficos. Uma vez que relatos anteriores demonstram a existência de células viáveis em blocos ósseos após processamento pelos bancos de tecidos músculo-esqueléticos para uso ortopédico, o objetivo deste trabalho foi avaliar a presença de células provenientes de três bancos de tecidos músculo-esqueléticos do Brasil. Todas as amostras foram processadas pelos respectivos bancos seguindo as normas da Agência Nacional de Vigilância Sanitária brasileira. Foi realizada a retirada de 3 amostras de cada bloco, que foram destinadas para processamento histológico e subsequente coloração por hematoxilina e eosina e Feugen e análise ultra-estrutural através de microscopia eletrônica de varredura (MEV). As imagens de microscopia de luz de todos os fragmentos de enxertos ósseos mostraram presença de células do tipo osteócito em todos os grupos avaliados, bem como intensa coloração por Feulgen, demonstrando a presença de DNA nos ossos mesmo após o processamento realizado. As análises ultraestruturais evidenciaram a presença de hemácias nas lacunas do tecido ósseo. Conclui-se que mesmo após os processamentos realizados pelos bancos de tecidos músculo-esqueléticos é possível encontrar células nos ossos utilizados para enxertia alógena.

Eficácia dos tratamentos estabelecidos pelo Manual da IETS, em oócitos, expostos à Leptospira interrogans / Effectiveness of treatments established by the Manual of IETS, in oocytes, exposed to Leptospira interrogans

Avaliou-se a eficácia dos tratamentos, definidos pela International Embryo Transfer Society (IETS), de oócitos bovinos, maturados in vitro e expostos experimentalmente à Leptospira interrogans sorovar Grippotyphosa. Os oócitos foram obtidos por meio de punção folicular, selecionados e distribuídos em quatro grupos, expostos ao patógeno e submetidos aos diferentes tipos de tratamentos. Foram expostos à cepa na concentração de 4,7.10(5)/µL, virulenta e não adaptada ao meio de manutenção EMJH, e, de 6,3.10(5)/µL, avirulenta e adaptada ao meio, por 24 horas. Os grupos tratados com tripsina ou antibióticos apresentaram eficácia de 21,7 por cento, e o grupo lavado sequencialmente 33,4 por cento. Os tratamentos não foram eficazes para os contaminados com a cepa avirulenta. Concluiu-se que as normas de controle de qualidade estabelecidas pela IETS poderiam ser revisadas e, possivelmente, redefinidas, uma vez que a eficácia dos tratamentos, provavelmente, não depende somente da espécie do patógeno, pois há interferência da virulência e de ação dos tratamentos sobre o tipo de patógeno.

The research purpose was to evaluate the effectiveness of treatments established by the IETS, in bovine oocytes maturated in vitro, exposed experimentally to Leptospira interrogans serovar Grippotyphosa. The oocytes were obtained through follicular puncture, selected and randomly allotted in four groups, exposed to the pathogen and subjected to different types of treatments. They were exposed to the strain in the concentration of 4.7x10(5)/µL virulent and not adapted to the EMJH, and to 6,3x10(5)/µL, virulent and adapted to the medium, for 24 hours. The treatments presented for the groups with trypsin or antibiotics, 21.7 percent efficiency, and the group washed sequentially presented 33.4 percent efficiency. The treatments were not effective for those infected with avirulent strain. In the statistical analysis, by χ², was found significance in the results obtained. The standards of quality control established by IETS could be reviewed and possibly redefined, since the effectiveness of treatment probably depends not only on the species of the pathogen, but is also affected by its virulence and treatment effectiveness.

An eight-year experience of implementing a pro-active approach to early detection of breast cancer in a community

OBJECTIVES: The objectives of this study were to determine the demographic as well as clinical profile of patients participating in the breast cancer community outreach program and determine if the Breast Cancer Community Outreach Program can successfully find breast cancer cases in the community.METHODS: In 2001, a breast cancer community outreach program was organized by the Vicente Sotto Memorial Center - Breast Center. The program components included breast cancer lay forum, breast self-examination (BSE) classes and breast clinic. Twenty seven breast cancer community outreach program were conducted in a span of 8 years.RESULTS: There were 1719 participants with a mean age of 32.5 years. The most common reason for consultation was breast check-up (79.6%), majority had normal breast examination findings (75.9%) and breast cancer was also identified in only 19 out of 1719 (1.1%). Most of these were early breast cancer.CONCLUSION: The Breast Cancer Community Outreach Program was not only vital in providing an-site breast cancer cases among women consulting at the community breast clinic.

Herpes genital / Genital herpes

O herpes genital é uma doença infectocontagiosa sujeita a recidivas, tendo como agente etiológico duas cepas diferentes do vírus herpes simples (HSV), o tipo 1 (HSV-1) e o tipo 2 (HSV-2). A grande maioria dos casos de herpes genital é causada pelo HSV-2, embora a prevalência do HSV-1 esteja em ascensão, principalmente na população jovem e devido à prática de sexo oral. A manifestação clínica pode ser primária ou recorrente, esta última acontecendo por reativação viral. O diagnóstico é feito pelas características clínicas associadas às confirmações laboratoriais da infecção. Diversos estudos clínicos e epidemiológicos demonstram a sinergia entre herpes genital e aids. Na gravidez, a grande preocupação acerca da infecção pelo HSV refere-se à morbidadee à mortalidade associadas à infecção neonatal. Atualmente não existe nenhum tratamento eficaz na cura do herpes genital, mas alguns medicamentos antivirais são capazes de diminuir o tempo da doença e prevenir as erupções. A maioria dos esforços para combater a infecção herpética genital concentrase no desenvolvimento de vacinas.

Genital herpes is an infectious disease subject to recurrent crises, with the etiologic agent of two different strains of herpes simplex virus (HSV), the type 1 (HSV-1) and type 2 (HSV-2). The vast majority of genital herpes cases is caused by HSV-2, although the prevalence of HSV-1 is on the rise, especially in young population and due to oral sex. The clinical manifestations may be primary or recurrent, the latter going on viral reactivation. The diagnosis is made by the clinical characteristics associated with laboratory confirmation of infection. Several epidemiological and clinical studies demonstrate the synergybetween genital herpes and aids. In pregnancy, the major concern about HSV infection refers to the morbidity and mortality associated with neonatal infection. Currently, there is no treatment capable of curing genital herpes, but some antiviral drugs are able to decrease the duration of the disease and prevent flares. Most efforts to combat genital herpes infection are focused on vaccine development.

Ticks infesting amphibians and reptiles in Pernambuco, Northeastern Brazil / Carrapatos infestando anfíbios e répteis em Pernambuco, Nordeste do Brasil

Ticks infesting amphibians and reptiles in the State of Pernambuco are reviewed, based on the current literature and new collections recently carried out by the authors. To date, three tick species have been found on amphibians and reptiles in Pernambuco. Amblyomma fuscum appears to be exclusively associated with Boa constrictor, its type host. Amblyomma rotundatum has a relatively low host-specificity, being found on toads, snakes, and iguana. Amblyomma dissimile has been found on a lizard and also small mammals (i.e., rodents and marsupials). New tick-host associations and locality records are given.

Os carrapatos encontrados infestando anfíbios e répteis no Estado de Pernambuco são revisados com base na literatura atual e em novas coletas realizadas recentemente pelos autores. Até o momento, três espécies de carrapatos foram encontradas sobre anfíbios e répteis em Pernambuco. Amblyomma fuscum parece estar exclusivamente associado à Boa constrictor, seu hospedeiro-tipo. Amblyomma rotundatum tem uma especificidade parasitária relativamente baixa, sendo encontrado em sapos, serpentes e iguana. Amblyomma dissimile já foi encontrado sobre um lagarto e também sobre pequenos mamíferos (isto é, roedores e marsupiais). Novas associações carrapato-hospedeiro e novos registros de localidades são apresentados.

The N-terminal 1-16 peptide derived in vivo from protein seminal vesicle protein IV modulates alpha-thrombin activity: potential clinical implications

We have previously shown that seminal vesicle protein IV (SV-IV) and its 1-70 N-terminal fragment have anti-inflammatory activity and modulate anti-thrombin III (AT) activity. Moreover, mass spectrometry analysis of purified SV-IV has shown that the protein was found to be highly heterogeneous and 14% of the total SV-IV molecules are truncated forms, of particular interest the 1-16, 1-17, and 1-18 peptides. In this work we report experimental data which demonstrate that the 1-16 peptide (P1-16) possesses a marked effect on the AT activity by preventing the formation of the thrombin-AT complex. We found that the formation of thrombin-AT complex is markedly decreased in the presence of P1-16 used at equimolar concentration with thrombin as evaluated with SDS-PAGE. We also monitored the conformational changes of thrombin in the presence of different P1-16 concentrations, and calculated the K(d) of thrombin/P1-16 system by circular dichroism technique. The probable interaction sites of P1-16 with thrombin have been also evaluated by molecular graphics and computational analyses. These results have potential implications in the treatment of sterility and thrombotic diseases.

FASMA: a service to format and analyze sequences in multiple alignments / 基因组蛋白质组与生物信息学报·英文版

Multiple sequence alignments are successfully applied in many studies for under- standing the structural and functional relations among single nucleic acids and protein sequences as well as whole families. Because of the rapid growth of sequence databases, multiple sequence alignments can often be very large and difficult to visualize and analyze. We offer a new service aimed to visualize and analyze the multiple alignments obtained with different external algorithms, with new features useful for the comparison of the aligned sequences as well as for the creation of a final image of the alignment. The service is named FASMA and is available at http://bioinformatica.isa.cnr.it/FASMA/.

Aspectos epidemiológicos e terapêuticos das infecções oculares em serviços de referência / Epidemiology and therapy of ocular infections in eye's hospitals

Introdução: As infecções oculares são um desafio constante na prática oftalmológica diária. Material e Métodos: Foram analisados 155 casos de infecções oculares supostamente bacterianas, atendidos nos serviços do Instituto/Fundação Hilton Rocha, de janeiro de 1996 a dezembro de 1999. Resultados: O quadro clínico predominante foi a conjuntivite (29,6 por cento), seguido pela blefarite (27,09 por cento) e úlcera de córnea (21,29 por cento). Nos casos de cultura positiva, os microorganismos mais comumente isolados foram o estafilococos epidermidis (48,12 por cento) e o estafilococos aureus (38,34 por cento). Dentre os agentes patológicos detectados, o estafilococos aureus foi o que apresentou maior resistência aos antibióticos utilizados na prática oftalmológica (41,18 por cento a ofloxacina). Conclusão: A análise laboratorial rigorosa e a escolha criteriosa dos medicamentos, muitas vezes com associação de drogas, são passos fundamentasis para o sucesso nestes casos.

Vibrio cholerae resistant to 2,4-diamino-6,7-diisopropylpteridine (O/129) isolated from patients with enteritis in Ceará, Brazil.

This paper reports the characterization of clinical Vibrio cholerae resistant to vibriostatic agent O/129, using classical and plasmid analysis. In a study conducted during December 1991-September 1993, two of 7,058 V. cholerae strains, obtained from patients suspected to have cholera in the State of Ceará, northeast Brazil, were resistant to 150 micrograms of the vibriostatic agent O/129 (2,4-diamino-6,7-diisopropylpteridine). One strain was identified as V. cholerae O1 El Tor Inaba and the other one as serogroup O22. Only one O1 strain harboured a plasmid of 147 kb transferable to Escherichia coli K12, and five strains of V. cholerae O1 and non-O1 were sensitive to O/129 and plasmid-negative at a frequency between 8 x 10(-2) and 3.6 x 10(-5). Additionally, O/129-resistant strains of V. cholerae O1 and O22 were resistant to trimethoprim/sulphamethoxazole.

Gangrena de Fournier: experiência de uma equipe cirúrgica em um Hospital Geral / Fournier's gangrene: surgical team experiences at General Hospital

A gangrena de Fournier foi primeiramente descrita em 1883, como fasciíte necrotizante do períneo ou genitália em pacientes de ambos os sexos. Neste estudo realizamos uma análise retrospectiva dos principais aspectos de 19 casos de gangrena de Fournier registrados no Hospital Nossa Senhora da Conceição, em Porto Alegre, entre janeiro de 1996 e maio 1997. Nove pacientes (47,4 por cento) eram do sexo feminino e 10 (52,6 por cento) do sexo masculino. Os fatores de risco mais freqüentes foram diabetes mellitus (31,5 por cento), abscesso perianal (31,5 por cento), alcoolismo (15,8 por cento) e imunossupressão (10,5 por cento). Obteve-se uma média de dois debridamentos por paciente. Foi realizada colostomia em dois pacientes (10,5 por cento) e cistostomia em três (15,8 por cento) A mortalidade compreendeu 31,5 por cento. A gangrena de Fournier consiste em uma patologia de etiologia variada, com sucesso terapêutico agressivo associado à antibioticoterapia de largo espectro e ao suporte clínico adequado

O Clostridium difficile como agente indutor de diarréia inflamatória / Clostridium difficile as an inflammatory diarrhea inducer agent

O Clostridium difficile tem sido apontado como um importante agente causador de doenças diarreicas associadas ao uso de antimicrobianos. Contudo, em razäo da sua complexidade a fisiopatologia dessas doenças ainda se encontra apenas parcialmente esclarecida, muito embora, uma série de trabalhos cienfíficos demonstrem a importância das toxinas A e B na patogênese da diarréia inflamatória induzida por esse microrganismo. Os mecanismos inflamatórios envolvidos nas atividades biológicas dessas toxinas säo bastante complexos. Existem alguns estudos relatando que a toxina B é desprovida de efeitos enterotóxicos, in vivo. No entanto, essa toxina provoca, de forma dose-dependente, alteraçöes eletrofisiológicas e morfológicas na mucosa colônica humana, in vitro. Ademais, a toxina B estimula a síntese de potentes mediadores inflamatórios, por monócitos e macrófagos. Os efeitos provocados pela toxina A sobre a mucosa intestinal säo bastante evidentes e caracterizam-se por uma intensa secreçäo de fluidos e por um grande acúmulo de células inflamatórias, do tipo macrófagos, mastócitos, linfócitos e neutrófilos, com a conseqüente liberaçäo de seus mediadores, tais como prostaglandinas, leucotrienos, fator de agregaçäo plaquetária, óxido nítrico e citocinas