ABSTRACT
BACKGROUND: Trypanosoma cruzi shows an exuberant genetic diversity. Currently, seven phylogenetic lineages, called discrete typing units (DTUs), are recognised: TcI-TcVI and Tcbat. Despite advances in studies on T. cruzi and its populations, there is no consensus regarding its heterogeneity. OBJECTIVES: This study aimed to perform molecular characterisation of T. cruzi strains, isolated in the state of São Paulo, to identify the DTUs involved and evaluate their genetic diversity. METHODS: T. cruzi strains were isolated from biological samples of chronic chagasic patients, marsupials and triatomines through culture techniques and subjected to molecular characterisation using the fluorescent fragment length barcoding (FFLB) technique. Subsequently, the results were correlated with complementary information to enable better discrimination between the identified DTUs. FINDINGS: It was possible to identify TcI in two humans and two triatomines; TcII/VI in 19 humans, two marsupials and one triatomine; and TcIII in one human host, an individual that also presented a result for TcI, which indicated the possibility of a mixed infection. Regarding the strains characterised by the TcII/VI profile, the correlation with complementary information allowed to suggest that, in general, these parasite populations indeed correspond to the TcII genotype. MAIN CONCLUSIONS: The TcII/VI profile, associated with domestic cycles and patients with chronic Chagas disease, was the most prevalent among the identified DTUs. Furthermore, the correlation of the study results with complementary information made it possible to suggest that TcII is the predominant lineage of this work.
Subject(s)
Chagas Disease , Marsupialia , Trypanosoma cruzi , Humans , Animals , Trypanosoma cruzi/genetics , Phylogeny , Brazil , Chagas Disease/parasitology , Genotype , Genetic Variation/geneticsABSTRACT
BACKGROUND Trypanosoma cruzi shows an exuberant genetic diversity. Currently, seven phylogenetic lineages, called discrete typing units (DTUs), are recognised: TcI-TcVI and Tcbat. Despite advances in studies on T. cruzi and its populations, there is no consensus regarding its heterogeneity. OBJECTIVES This study aimed to perform molecular characterisation of T. cruzi strains, isolated in the state of São Paulo, to identify the DTUs involved and evaluate their genetic diversity. METHODS T. cruzi strains were isolated from biological samples of chronic chagasic patients, marsupials and triatomines through culture techniques and subjected to molecular characterisation using the fluorescent fragment length barcoding (FFLB) technique. Subsequently, the results were correlated with complementary information to enable better discrimination between the identified DTUs. FINDINGS It was possible to identify TcI in two humans and two triatomines; TcII/VI in 19 humans, two marsupials and one triatomine; and TcIII in one human host, an individual that also presented a result for TcI, which indicated the possibility of a mixed infection. Regarding the strains characterised by the TcII/VI profile, the correlation with complementary information allowed to suggest that, in general, these parasite populations indeed correspond to the TcII genotype. MAIN CONCLUSIONS The TcII/VI profile, associated with domestic cycles and patients with chronic Chagas disease, was the most prevalent among the identified DTUs. Furthermore, the correlation of the study results with complementary information made it possible to suggest that TcII is the predominant lineage of this work.
ABSTRACT
PURPOSE: Obstructive sleep apnea (OSA) is a common sleep disorder which prevalence is 22% in men and 17% in women. It is well described that females presented different clinical and polysomnographic characteristics compared with men. Those studies were performed in plain areas. We described the analysis by gender and clinical profiles of a sample of patients with diagnostic of OSA and living at high altitude. PATIENTS AND METHODS: It is an observational study that describes differences between clinical and polysomnographic characteristics by gender in patients with OSA. Additionally, an unsupervised cluster algorithm was used to find groups of patients with similar clinical and polysomnographic characteristics. RESULTS: We included 709 patients, 51.6% were females and 48.3% were males with mean age of 64 and 62 years old, respectively, in which 90.97% presented OSA. Men presented a higher apnea and hypopnea index than women (p=0.002), besides presented more sleep polysomnographic alterations. Meanwhile, women evidenced better sleep quality based on parameters. Additionally, in the sample of patients, we found four separated clinical profiles characterized mainly by differences in the severity of polysomnographic parameters. CONCLUSION: The patients were more obese, older, and had lower SpO2 values than most of those previously reported. Men had greater severity in most of the parameters measured by polysomnography. Polysomnographic variables were different both in the OSA patient profiles and in the gender comparison. However, the REM sleep apnea hypopnea index did not differ between sexes, indicating the importance of this variable in the evaluation of OSA severity in women. In contrast to previous reports, clinical and demographic characteristics showed few differences in both analyses. This result suggests that the behavior of OSA at high altitudes may have particularities with respect to low altitudes.
ABSTRACT
Introducción: el síndrome de Guillain Barré es considerada una de las principales causas de parálisis neuromuscular aguda. Actualmente existen dos alternativas igual de efectivas clínicamente en el tratamiento de esta enfermedad: la inmunoglobulina intravenosa y la plasmaféresis. Objetivo: estimar cuál de los dos tratamientos es menos costoso en la atención hospitalaria de pacientes con diagnóstico de síndrome de Guillain Barré en estadios moderados a severos en la Fundación Cardioinfantil en Bogotá, Colombia. Materiales y métodos: se incluyeron todos los pacientes que egresaron entre enero y diciembre de 2014 con síndrome de Guillain Barré según el sistema de información clínica de la Fundación Cardioinfantil. La información de los costos por cada paciente fue provista por el Departamento de Cuentas Médicas de la Fundación Cardioinfantil y se estableció el costo total de la atención desde el ingreso hasta el egreso del paciente. La comparación del costo total de la atención de los pacientes tratados con inmunoglobulina intravenosa (IGIV) vs., los pacientes tratados con plasmaféresis, se realizó por medio de la prueba de Mann-Whitney. Resultados: la atención de los pacientes con IGIV tuvo un costo total de 9.976 USD, mientras el costo de los pacientes tratados con plasmaféresis fue de 23.354 USD. El costo de atención en este último grupo de pacientes se ve afectado por el mayor número de complicaciones derivadas del mismo tratamiento. Conclusión: entre los dos tratamientos considerados en el síndrome de Guillain Barré en estadios avanzados, la IGIV ofrece una buena alternativa para minimizar costos en la atención hospitalaria del paciente con diagnóstico de síndrome de Gullian Barré en la Fundación Cardioinfantil de Bogotá.
Introduction: Guillain Barre Syndrome is considered one of the most important causes of acute neuromuscular paralysis. Currently there are two clinically effective therapies for the treatment of disease: IVIG and plasmapheresis. Objective: To estimate which therapy is less expensive for the in-hospital care of patients diagnosed with moderate to severe Guillain Barre in the Fundación Cardioinfantil of Bogotá, Colombia. Materials and Methods: All patients that were discharged between January and December 2014 with GuillainBarre syndrome diagnosis were included. The cost information for each patient was provided by department of medical bills and the total cost of care was established from admission to patient discharge. The comparison of the total costs of care of patients treated with IVIG vs. patients treated with plasmapheresis was performed by means of the Mann-Whitney analysis. Results: The cost of care of patients with intravenous immunoglobulin was 9,976 USD while the total cost of patients with plasmapheresis was 23,354 USD. The higher cost of care in this last group of patients was driven by the increased number of complications arising from the same treatment. Conclusion:Between the two treatments considered in the advanced states of Guillain Barre Syndrome, IVIG offers an adequate strategy to minimize the cost of hospital patient care in patients with a diagnosis of Guillain-Barre syndrome in the Fundación Cardioinfantil of Bogotá.
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INTRODUCTION: Trypanosoma rangeli is a species of trypanosome second to T. cruzi, that is infective to humans in Latin America. Variability in the biological, biochemical and molecular characteristics between different isolates isolates of this parasite have been recorded. OBJECTIVE: Morphological and molecular characteristics were recorded from strains of T. rangeli that were isolated from different species of Rhodnius and maintained in different vertebrate species. MATERIALS AND METHODS: Nineteen strains of T. rangeli were isolated from R. prolixus, R. pallescens and R. colombiensis in Colombia, R. ecuadoriensis in Peru and R. pallescens in Panama. Polymorphism of blood trypomastigotes in ICR mice was evaluated and pleomorphism of P53 strain of T. rangeli KP1(-) inoculated in mouse, marsupial and canine was studied. RAPD analysis (randomly amplified polymorphic DNA analysis) of 12 strains isolated from four species of Rhodnius was performed. RESULT: Based on the total length of blood trypomastigotes, three discrete groups were observed. The P53 strain showed significant differences in the size of blood trypomastigotes in mouse, marsupial and canine. RAPD analysis showed that the strains segregated into two branches corresponding to strains of T. rangeli KP1(+) and T. rangeli KP1(-). All strains of T. rangeli KP1(-) clustered according to the species of Rhodnius from which they were isolated. CONCLUSION: These data reveal, for the first time, a close association amongst T. rangeli strains and Rhodnius species, confirming that each species of Rhodnius transmits to vertebrate hosts a parasite population with clear phenotypic and genotypic differences. This is further evidence that supports the concept of clonal evolution of these parasites.
