Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic Ischemia Grade in STEMI / Associação entre a Relação Neutrófilos/Linfócitos e o Grau de Isquemia Eletrocardiográfica no IAMEST

Background: Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI. Objective: To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification. Methods: Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I). Results: Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001). Conclusion: We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores. .

Fundamento: A relação neutrófilos/linfócitos (N/L) tem sido descrita como boa preditora de eventos cardiovasculares adversos futuros em pacientes com infarto agudo do miocárdio com elevação do segmento ST (IAMEST). Mudanças na porção terminal do complexo QRS também têm sido associadas a eventos adversos após IAMEST. Objetivo: Investigar a associação entre o grau de isquemia no ECG e a relação N/L em pacientes com IAMEST para determinar fatores de risco convencionais adicionais na estratificação precoce de risco. Métodos: Pacientes com IAMEST foram investigados. O grau de isquemia foi analisado a partir do ECG obtido à admissão. A contagem de leucócitos e seus subtipos foi realizada a partir de hemograma automatizado. De acordo com o grau de isquemia presente no ECG de admissão, os pacientes foram classificados em dois grupos, isquemia grau 2 (IG2) e isquemia grau 3 (IG3). Resultados: Pacientes com IG3 apresentaram valores médios significativamente menores de fração de ejeção do ventrículo esquerdo do que os pacientes com IG2 (44,58 ± 7,23 versus 48,44 ± 7,61; p = 0,001). Como esperado, a taxa de mortalidade intra-hospitalar aumentou proporcionalmente com o aumento no grau de isquemia (p = 0,036). Houve diferenças significativas nas porcentagens de linfócitos (p = 0,010) e de neutrófilos (p = 0,004) e, portanto, a relação N/L diferiu significativamente entre pacientes com IG2 e IG3 (p < 0,001). À análise de regressão logística multivariada, apenas a relação N/L emergiu como variável independente com efeito significativo sobre o grau de isquemia no ECG (odds ratio = 1,254; intervalo de confiança de 95% 1,120-1,403; p < 0,001). Conclusão: Nós encontramos uma associação entre IG3 e relação N/L aumentada em pacientes com IAMEST. Acreditamos que esta associação possa oferecer um valor prognóstico adicional para estratificação de risco em pacientes com IAMEST quando usado em combinação com escores de risco padronizados. .

Morfometría ultraestructural de la glándula adrenal de ratones infectados experimentalmente con dos aislados venezolanos de trypanosoma evansi / Ultrastructural morphometry of the adrenal gland of mice experimentally infected with two Venezuelan isolates of trypanosoma evansi

Este trabajo describe cualitativamente y analiza cuantitativamente las variaciones ultraestructurales de la glándula adrenal de ratones durante el desarrollo de infecciones murinas experimentales por dos aislados venezolanos de Trypanosoma evansi, uno proveniente de asno y otro de caballo. Las modificaciones submicroscópicas observadas incluyeron alteraciones en el retículo endoplasmático liso, mitocondrias, gotas lipídicas, aparato de Golgi y núcleo. También se apreciaron alteraciones en el número de vesículas de epinefrina, norepinefrina, gránulos de lipofucsina y presencia singular de figuras mielínicas. Estos cambios ultraestructurales estarían asociados a problemas metabólicos que inducirían la muerte de los animales infectados. El estudio cuantitativo demostró diferencias significativas en las características y las magnitudes del daño causado por ambos aislados, siendo el tripanosoma proveniente de caballo más patogénico. El análisis multivariante de los cambios submicroscópicos discriminó la acción patogénica en la glándula adrenal de tripanosomas de la misma especie que provienen de hábitats diferentes (Equus asinus y E. caballus) y de zonas geográficas distintas (estado Apure y estado Guárico).

This work describes qualitatively and analyzes quantitatively the ultrastructural variations of the mice adrenal gland during the development of murine experimental infections by two Venezuelan isolates of Trypanosoma evansi, one de rived from a donkey and another from a horse. The submicroscopic modifications included modifications in the smooth endoplasmic reticulum, mitochondria, lipid droplets, Golgi apparatus, and nucleus. Alterations in the number of epinephrine, norepinephrine vesicles, and lipofuscin granules and singular myelin-like figures were also observed. Such ultrastructural changes would be associated to metabolic problems including the infected animal’s death. The quantitative study demonstrated significant differences in the characteristics and magnitude of the damage caused by both isolates, being more pathogenic the horse derived trypanosome. The multivariate analysis of the submicroscopic changes discriminated the pathogenic action of trypanosomes of the same species coming from different habitats (Equus asinus and E. caballus) and different geographic zones (Apure state and Guarico state) in the adrenal gland.

Experimental transmission of the parasitic flagellates Trypanosoma cruzi and Trypanosoma rangeli between triatomine bugs or mice and captive neotropical bats

Trypanosoma cruzi and Trypanosoma rangeli-like trypanosomes have been found in a variety of neotropical bat species. In this study, bats (Artibeus lituratus, Carollia perspicillata, Desmodus rotundus, Glossophaga soricina, Molossus molossus, Phyllostomus hastatus) were maintained under controlled conditions, and experiments were conducted to determine how they might become infected naturally with trypanosomes. All bats were first screened for existing infections by hemoculture and the examination of blood smears, and only apparently uninfected animals were then used in the experiments. Proof was obtained that the triatomine bug Rhodnius prolixus would readily feed upon some of the bats, and two species became infected after being bitten by bugs infected with T. rangeli. Some bats also became infected by ingesting R. prolixus carrying T. cruzi, or following subcutaneous or intragastic inoculation with fecal suspensions of R. prolixus containing T. cruzi. P. hastatus became infected after ingesting mice carrying T. cruzi. All of the bats studied inhabit roosts that may be occupied by triatomine bugs and, with the exception of D. rotundus, all also feed to at least some extent upon insects. These findings provide further evidence of how bats may play significant roles in the epidemiology of T. cruzi and T. rangeli in the New World tropics.

Towards an understanding of the interactions of Trypanosoma cruzi and Trypanosoma rangeli within the reduviid insect host Rhodnius prolixus

Esta revisão destaca aspectos dos estágios do desenvolvimento de Trypanosoma cruzi e Trypanosoma rangeli em seu hospedeiro invertebrado, Rhodnius prolixus Atenção especial é dada às interações desses parasitas com moléculas presentes no tubo digestivo e na hemolinfa e efeitos da organização das células epiteliais sobre o desenvolvimento do parasita. A susceptibilidade do inseto vetor ao T. cruzi, o qual desenvolve no tubo digestivo, dependem do estado nutricional do hospedeiro, da cepa do parasita e de interações moleculares com compostos tripanolíticos, lectinas e bactérias residentes no tubo digestivo. O T. rangeli invade a hemocele e pode ser reconhecido e ativar o sistema de defesa do inseto vetor, ou seja, o sistema profenoloxidase, fagocitose, microagregação hemocitária,atividade de superóxido e óxido nítrico e a via de biossíntese dos eicosanóides. Estes fatos fornecem uma compreensão melhor das interações parasita-inseto vetor, e também oferecem novas idéias sobre os processos básicos envolvidos na transmissão parasitária.

Trypanosoma rangeli interactions within the vector Rhodnius prolixus: a mini review

This article is an integrative mini review of the research on the interactions between Trypanosoma rangeli and the insect vector, Rhodnius prolixus. Special attention is given to the interactions of these parasites with the gut environment, gut walls, with hemolymph invasion, hemocytes, hemocyte microaggregations, prophenoloxidase-activating system, superoxide, and nitric acid generation and eicosanoid pathways. We described factors affecting vectorial capacity and suggested that T. rangeli may modulate the hemocoelic invasion and the survival of the parasites by overcoming the cellular and humoral defense reactions of the insect vector at different physiological events. The mechanisms of these interactions and their significance for parasite transmission are discussed.

The distribution of agglutinins and lytic activity against Trypanosoma rangeli and erythrocytes in Rhodnius prolixus and Triatoma infestans tissue extracts and haemolymph

Haemolymph, heads, salivary glands, crops, midguts, hindguts, and Malpighian tubules from Rhodnius prolixus and Triatoma infestans were extracted in phosphate or Tris buffer saline with calcium, and tested for agglutination and lytic activities by microtitration against both vertebrateerythrocytes and cultured epimatigote forms of Trypanosoma rangeli. Haemagglutination activity against rabbit erythrocytes was found in the crop, midgut and hindgut extracts of T. infestans but only in the haemolymph of R. prolixus. Higher titres of parasite agglutinins were found in R. prolixus haemolymph than T. infestans, whilst the converse occurred for the tissue extracts. In addition, the extracts of T. infestans salivary glands, but not those of R. prolixus, showed a trypanolytic activity that was heat-inactivated and was not abolished by pre-incubation with any of the sugars or glycoproteins tested. T. infestans, which is refractory to infection by T. rangeli, thus appears to contain a much wider distribution of agglutinating and trypanolytic factors in its tissues than the more susceptible species, R. prolixus

Trypanosoma rangeli (Tejera, 1920) isolated from a sylvatic rodent (Echimys dasythrix) in Santa Catarina island, Santa Catarina state: first report of this trypanosome in southern Brazil

A trypanosome strain isolated from a sylvatic rodent (Echimys dasythrix) from Santa Catarina Island (Santa Catarina State, Brazil) was characterized by the following methods: experimental transmission and development in invertebrate hosts, morphometry, cross protection, complement sensitivity, lectin agglutination and isoenzyme profiles. Comparasions were made with standard Trypanosoma cruzi and T. rangeli strains. All methods except isoenzyne analysis led to the identification of the isolate as T. rangeli. The isoenzyme differences found could be explained on the basis of polymorphism. Therefore this is the first report of T. rangeli in southern Brazil, increasing the geographical distribution of this parasite

Comportamiento de la infección y diferenciación morfologica entre trypanosoma cruzi y T. rangeli en el intestino del vector Rhodnius prolixus / Course of the infection and morphological differentiation between trypanosoma cruzi and T. rangeli in the intestine of the vector Rhodnius prolixus

A distribuiçäo de amastigotas, epimastigotas, esferomastigotas e tripomastigotas foi estudada no intestino de Rhodnius prolixus infectado com Trypanosoma cruzi (amostra Molino) e T. rangeli (amostra San Agustín). Medidas foram feitas de 500 cinetoplastos de organismos morfologicamente diferentes para verificar se é possível identificar as espécies usando esse caracter. A maioria dos tripomastigotas de cada espécie foi diferenciada pelo comprimento do corpo e o tamanho do cinetoplasto. Porém, em algumas infeccöes por T. rangeli, foi observado que menos de 1% dos epimastigotas curtos eram morfologicamente idênticos às mesmas formas de T. cruzi. Nesses casos o T. rangeli pode ser confundidos com T. cruzi, e que poderia ter graves implicaçöes