Enfermedad pulmonar por Mycobacterium intracellulare, un reto diagnóstico. Reporte de caso / Lung disease due to Mycobacterium intracellulare. A diagnostic challenge, Case report

La incidencia de infección por micobacterias no tuberculosas (MNT) y el número de casos han ido en aumento, especialmente en mujeres y personas mayores, teniendo en los Estados Unidos entre el 2008 y 2015 una incidencia de 4.16 a 6.69 por 100000 entre las mujeres y de 12.70 a 18.37 por 100000, entre los mayores de 65 años. "Los pacientes con compromiso estructural del parénquima pulmonar, antecedente de inmunosupresión o inmunodeficiencia tienen mayor riesgo de desarrollar infección por MNT". Sin embargo, se han presentado informes de pacientes inmunocompetentes en asociación con opacidades nodulares y bronquiectasias. Se trata de una mujer de 79 años con antecedente de tuberculosis pulmonar documentada en dos oportunidades: último proceso infeccioso en el año 2021. Recibió manejo por seis meses de esquema vigente con tetraconjugado. Actualmente acude a consulta con cuadro clínico de más de seis meses de evolución dados por pérdida de peso de más del 10 % en un año, disnea a moderados esfuerzos y tos con expectoración purulenta. Al examen físico se encontró índice de masa corporal (IMC) bajo, tórax hipoexpansible con estertores tipo crépitos en ambos hemitórax. En la tomografía de tórax se evidenciaron bronquiectasias generalizadas, algunas áreas de árbol en gemación y lesiones cavitadas. Se consideró la realización de fibrobroncoscopia con lavado broncoalveolar documentándose baciloscopias negativas, con cultivo positivo para micobacteria no tuberculosa. Se solicitó tipificación de micobacterias con coloración de Kinyoun, y pruebas bioquímicas a partir de cepas de cultivo del lavado broncoalveolar, con reporte positivo para Mycobacterium intracellulare. Se inició por lo tanto manejo con azitromicina 500 mg, rifampicina 600 mg y etambutol 975 mg diarios. Los profesionales sanitarios deben ser conscientes de la posible infección por MNT sobre todo existiendo afectación estructural pulmonar previa, basando el tratamiento en la sospecha clínica y/o las circunstancias epidemiológicas.

The incidence of non-tuberculous mycobacterial (NTM) infection and the number of cases have been increasing, especially in women and the elderly, having EE. Between 2008 and 2015 an incidence of 4.16 to 6.69 per 100,000 among women and from 12.70 to 18.37 per 100,000 among those over 65. "Patients with structural involvement of the pulmonary parenchyma, history of immunosuppression or immunodeficiency have a higher risk of developing NTM infection". However, immunocompetent patients have been reported in association with nodular opacities and bronchiectasis. This is a 79-year-old woman with a history of pulmonary tuberculosis documented on 2 occasions: the last infectious process in 2021. It received management for 6 months of the current tetraconjugate schema. He is currently in consultation with a clinical picture of more than 6 months of evolution given by weight loss of more than 10% in a year, dyspnea to moderate efforts and cough with purulent expectoration. Physical examination revealed low body mass index (BMI) and, a hypoexpandable thorax with a crescent-like sternum in both hemithorax. Chest tomography revealed widespread bronchiectasis, some groaning tree areas and cavitated lesions. Bronchoscopy fibro bronchoscopy with bronchoalveolar lavage has been reported negative bacilloscopies, positive culture for non-tuberculosis mycobacteria. Mycobacteria typing, Kinyoun coloration, and biochemical tests were requested from bronchoalveolar lavage culture strains with positive reports for Mycobacterium intracellulare. Management was therefore initiated with azithromycin 500 mg, rifampin 600 mg and ethambutol 975mg daily. Healthcare professionals should be aware of possible NTM infection especially existing prior lung structural involvement based on clinical suspicion and/or epidemiological circumstances.

Severe cryptogenic bronchiolitis: Case report.

Bronchiolitis obliterans (BO) is a progressive fibrotic process that predominantly affects the small airways and is identified as constrictive bronchiolitis by pathologists. It is commonly associated with allogeneic hematopoietic stem cell transplant (HSCT), lung transplant, exposure to inhaled toxins, post-infectious processes, autoimmune diseases, and sometimes, no known cause. In the latter case, it is referred to as cryptogenic bronchiolitis obliterans. A 52-year-old Hispanic man with a medical history of hypertension, diabetes mellitus, and coronary artery disease was referred to the pulmonary department due to experiencing dyspnea on exertion, intermittent dry cough, and progressive limitation of activities of daily living. Spirometry revealed severe obstructive changes, and chest high-resolution computed tomography showed ground-glass opacities with nodular infiltrates in the upper lobes, leading to a presumptive diagnosis of hypersensitivity pneumonitis. The patient underwent a lung surgical biopsy of the right upper and lower lobes, which revealed extensive constrictive bronchiolitis. Due to the patient's worsening general condition, bilateral lung transplantation succeeded without any further complications. Following the transplantation, the patient showed good recovery and functional improvement. Bronchiolitis obliterans, or constrictive bronchiolitis, has a variable natural history. It is associated with a higher risk of mortality in allogenic HSCT. When BO is secondary to inhalation of toxic gases, it is usually nonprogressive and limited to toxin exposure. Autoimmune diseases or cryptogenic bronchiolitis are rare and have a heterogeneous clinical course. To make a proper diagnosis, clinical history, radiologic and histologic findings must be considered.

Congenital transmission of Mexican strains of Trypanosoma cruzi TcIa: interaction between parasite and human placental explants.

Congenital transmission of Chagas disease plays an important role in endemic countries because it is not a diagnosis that is encountered frequently in prenatal care. Due to limited information regarding congenital transmission of Trypanosoma cruzi in Mexico, the present study aimed to investigate protozoan infectivity and modulation of immune responses in human placental explants infected with T. cruzi Ia Mexican strains. The Inc-5 strain showed increased infectivity and modulated IL-1ß, IL-10 and TLR-4, decreasing their expression after 24 h of infection. Both strains (Inc-5 and Ninoa) stimulated the production of TNF-α and decreased IL-6 levels 96 h after infection. An important detachment of the syncytiotrophoblast caused by infection with T. cruzi was observed after 24 h of infection. In this study, ex vivo infection of human placental villi was performed to better understand interactions involving parasitic T. cruzi and human placental tissue. It was concluded that the strains of TcIa present parasitism in placental tissue, modulation of the innate immune system of the placenta, and cause intense detachment of the syncytiotrophoblast, a fact that may be more associated with abortion and premature birth events than the congenital transmission itself, justifying the low rate of this transmission mechanism by this genotype.

Characteristics of patients undergoing robotic-assisted prostatectomy. Observational study / Características de pacientes sometidos a prostatectomía robótica. Estudio observacional

Abstract Introduction Prostatectomy is the standard treatment for patients with clinically localized prostate cancer. Currently, robot-assisted radical prostatectomy (RARP) is widely used for its advantages, as it provides better visualization, precision, and reduced tissue manipulation. However, RARP requires a multidisciplinary approach in which anesthesia and analgesia management are especially important. Objective This study aims to describe our experience delivering anesthesia for the first cases of patients undergoing RARP in a teaching hospital in Bogotá, Colombia. Methodology An observational study was conducted. We included all patients undergoing RARP from September 2015 to December 2019 at Fundación Santa Fe de Bogotá. All patients with incomplete data were excluded. Patient demographics were recorded, and significant perioperative events were reviewed. Results A total of 301 patients were included. At our institution, the mean age for patients undergoing RARP was 61.4 ± 6.7 years. The mean operative time was 205 ± 43 min and mean blood loss was 300 [200400] mL. Only 6 (2%) patients required transfusion. Age and BMI were not associated with clinical outcomes. Conclusions An adequate perioperative approach in RARP is important to minimize complications, which in this study and in this institution were infrequent.

Resumen Introducción La prostatectomía es el tratamiento estándar para pacientes con cáncer de próstata localizado. Actualmente, la prostatectomía radical asistida por robot es ampliamente utilizada por sus ventajas en visualización, precisión y manipulación de los tejidos. Sin embargo, este abordaje requiere un manejo multidisciplinario, pues el enfoque analgésico y anestésico es fundamental para optimizar los desenlaces. Objetivo Describir los primeros casos de prostatectomía radical asistida por robot realizadas en un hospital universitario de cuarto nivel en Bogotá, Colombia. Metodología Estudio observacional en el cual se incluyeron todos los pacientes sometidos a prostatectomía radical asistida por robot (PRAR) en el hospital Fundación Santa Fe de Bogotá entre septiembre de 2015 y diciembre de 2019. Se excluyeron los pacientes con historia clínica incompleta. Se registraron los datos demográficos y se revisaron los eventos perioperatorios importantes. Resultados Se analizaron 301 pacientes. La edad media de pacientes sometidos a PRAR fue 61,4 ± 6,7 años. El tiempo quirúrgico promedio fue 205 ± 43 minutos y la pérdida sanguínea media fue 300 [200-400] mL. Solo 6 pacientes (2 %) requirieron transfusión. La edad y el IMC no mostraron una asociación relevante con los desenlaces clínicos. Conclusiones El adecuado abordaje perioperatorio en PRAR es importante para minimizar las complicaciones, las cuales en este estudio y en esta institución fueron infrecuentes.

Trypanosoma rangeli 28Sß Ribosomal Gene Allows Intra and Interspecific Molecular Differentiation.

Trypanosoma rangeli is an avirulent flagellate protozoan that could mislead correct diagnosis of Trypanosoma cruzi infection, the causative agent of Chagas' disease, given their high similarity. Besides, T. rangeli presents two genetic groups, whose differentiation is achieved mainly by molecular approaches. In this context, ribosomal DNA (rDNA) is a useful target for intra and interspecific molecular differentiation. Analyzing the rDNA of T. rangeli and comparison with other trypanosomatid species, two highly divergent regions (Trß1 and Trß2) within the 28Sß gene were found. Those regions were amplified and sequenced in KP1(+) and KP1(-) strains of T. rangeli, revealing group-specific polymorphisms useful for intraspecific distinction through restriction fragment length polymorphism technique. Also, amplification of Trß1 allowed differentiation between T. rangeli and T. cruzi. Trß2 predicted restriction length profile, allowed differentiation between T. rangeli, T. cruzi, Trypanosoma brucei, and Leishmania braziliensis, increasing the use of Trß1 and Trß2 beyond a molecular approach for T. rangeli genotyping, but also as a useful target for trypanosomatid classification.

Evaluation of the multispecies coalescent method to explore intra-Trypanosoma cruzi I relationships and genetic diversity.

Chagas Disease is a zoonosis caused by the parasite Trypanosoma cruzi. Several high-resolution markers have subdivided T. cruzi taxon into at least seven lineages or Discrete Typing Units (DTUs) (TcI-TcVI and TcBat). Trypanosoma cruzi I is the most diverse and geographically widespread DTU. Recently a TcI genotype related to domestic cycles was proposed and named as TcIDOM. Herein, we combined traditional markers and housekeeping genes and applied a Multispecies Coalescent method to explore intra-TcI relationships, lineage boundaries and genetic diversity in a random set of isolates and DNA sequences retrieved from Genbank from different countries in the Americas. We found further evidence supporting TcIDOM as an independent and emerging genotype of TcI at least in Colombia and Venezuela. We also found evidence of high phylogenetic incongruence between parasite's gene trees (including introgression) and embedded species trees, and a lack of genetic structure among geography and hosts, illustrating the complex dynamics and epidemiology of TcI across the Americas. These findings provide novel insights into T. cruzi systematics and epidemiology and support the need to assess parasite diversity and lineage boundaries through hypothesis testing using different approaches to those traditionally employed, including the Bayesian Multispecies coalescent method.

Human leishmaniasis in Brazil: A general review.

Leishmaniasis is a disease with ample clinical spectrum and epidemiological diversity and is considered a major public health problem. This article presents an overview of the transmission cycles, host-parasite interactions, clinical, histological and immunological aspects, diagnosis and treatment of various forms of the human disease.

Human leishmaniasis in Brazil: A general review / Leishmaniose humana no Brasil: uma revisão geral

Summary Leishmaniasis is a disease with ample clinical spectrum and epidemiological diversity and is considered a major public health problem. This article presents an overview of the transmission cycles, host-parasite interactions, clinical, histological and immunological aspects, diagnosis and treatment of various forms of the human disease.

Resumo A leishmaniose representa um complexo de doenças com amplo espectro clínico e diversidade epidemiológica, sendo considerada um grande problema de saúde pública. O presente artigo apresenta uma revisão geral sobre os ciclos de transmissão, as interações parasito-hospedeiro, os aspectos clínicos, histopatológicos e imunológicos, o diagnóstico e o tratamento das diversas formas da doença humana.

Identification of bat trypanosomes from Minas Gerais state, Brazil, based on 18S rDNA and Cathepsin-L-like targets.

Several bat species can be infected by trypanosomes, but there is not much information about which of these parasites infect bats from Triângulo Mineiro and Alto Paranaíba, Minas Gerais state, Brazil, a formerly endemic region for Trypanosoma cruzi, the causative agent of Chagas disease. The aim of this study was to describe, characterize, and identify the presence of trypanosomes in bats. The captured bats (448) belong to four families and to 19 different species. Of those, 37 bats were found to be positive for trypanosomes by microhematocrit, (infection rate 8.3%) and 27 were positive after hemoculture analysis. Initially, the isolates were identified by PCR (18S rDNA, 24Sα rDNA, spliced leader, COII RFLP-PCR) using primers originally designed for T. cruzi. PCRs (18S rDNA, 24Sα rDNA) showed compatible bands for TcI, whereas COII RFLP-PCR showed a similar pattern associated to TcII. However, there was no DNA amplification using spliced leader as a target, revealing a discrepancy between the results. Phylogenetic analysis of Cathepsin L-like and 18S rDNA sequences proved that 15 of the isolates corresponded to Trypanosoma cruzi marinkellei and one to Trypanosoma dionisii. These results revealed that the diversity of trypanosome species in a region considered endemic for Chagas disease is greater than previous descriptions. All this can confirm the necessity of using DNA sequencing approaches in order to determinate trypanosomes species isolated from bats.

Use of Tc-rCRP as a target for lytic antibody titration after experimental Trypanosoma cruzi infection.

Experimental Chagas disease has been used as a model to identify several host/parasite interaction factors involved in immune responses to Trypanosoma cruzi infection. One of the factors inherent to this parasite is the complement regulatory protein (Tc-CRP), a major epitope that induces production of lytic antibodies during T. cruzi infections. Previous studies have evaluated the function of Tc-CRP as an antigenic marker via ELISAs, which demonstrated high sensitivity and specificity when compared to other methods. Therefore, this study aimed to assess and compare the levels of lytic antibodies induced by this protein following experimental infection using different T. cruzi strains. Our results demonstrated that infections induced by strains isolated from vectors resulted in subpatent parasitaemia and low reactivity, as assessed by Tc-rCRP ELISAs. On the other hand, mice inoculated with T. cruzi strains isolated from patients developed patent parasitaemia, and presented elevated lytic antibodies titres, as measured by Tc-rCRP ELISA. In addition, comparison between different mouse lineages demonstrated that Balb/c mice were more reactive than C57BL/6 mice in almost all types of infections, except those infected by the AQ-4 strain. Parasites from the Hel strain generated the greatest lytic antibody response in all evaluated models. Therefore, application of sensitive techniques for monitoring immune responses would enable us to establish growth curves for lytic antibodies during the course of the infection, and allow us to discriminate between T. cruzi strains that originate from different hosts.

DNA content analysis allows discrimination between Trypanosoma cruzi and Trypanosoma rangeli.

Trypanosoma cruzi, a human protozoan parasite, is the causative agent of Chagas disease. Currently the species is divided into six taxonomic groups. The genome of the CL Brener clone has been estimated to be 106.4-110.7 Mb, and DNA content analyses revealed that it is a diploid hybrid clone. Trypanosoma rangeli is a hemoflagellate that has the same reservoirs and vectors as T. cruzi; however, it is non-pathogenic to vertebrate hosts. The haploid genome of T. rangeli was previously estimated to be 24 Mb. The parasitic strains of T. rangeli are divided into KP1(+) and KP1(-). Thus, the objective of this study was to investigate the DNA content in different strains of T. cruzi and T. rangeli by flow cytometry. All T. cruzi and T. rangeli strains yielded cell cycle profiles with clearly identifiable G1-0 (2n) and G2-M (4n) peaks. T. cruzi and T. rangeli genome sizes were estimated using the clone CL Brener and the Leishmania major CC1 as reference cell lines because their genome sequences have been previously determined. The DNA content of T. cruzi strains ranged from 87,41 to 108,16 Mb, and the DNA content of T. rangeli strains ranged from 63,25 Mb to 68,66 Mb. No differences in DNA content were observed between KP1(+) and KP1(-) T. rangeli strains. Cultures containing mixtures of the epimastigote forms of T. cruzi and T. rangeli strains resulted in cell cycle profiles with distinct G1 peaks for strains of each species. These results demonstrate that DNA content analysis by flow cytometry is a reliable technique for discrimination between T. cruzi and T. rangeli isolated from different hosts.

Amiodarone and itraconazole improve the activity of pentavalent antimonial in the treatment of experimental cutaneous leishmaniasis.

Leishmaniasis affect millions of people, causing morbidity and mortality, especially in developing tropical and subtropical countries. Unfortunately, the possibilities of treatment for these infections are still quite limited and most of the available drugs present serious side effects. The objective of this paper was to evaluate the therapeutic role of amiodarone and itraconazole in the treatment of cutaneous leishmaniasis caused by Leishmania (Leishmania) amazonensis. In order to perform this evaluation, hamsters were infected with 1 × 106 metaciclic promastigotes of the parasite in the hind footpad and, after the onset of the lesions, were treated with glucantime, amiodarone, itraconazole, glucantime and amiodarone, glucantime and itraconazole or amiodarone and itraconazole. The treatments' efficacy was evaluated per analysis of the size of the cutaneous lesions and by parasitic investigation of the infected foot (by histopathological examination and PCR) and possible side effects were analyzed taking into account the weight of the animals and some biochemical and metabolic parameters (glucose, urea, creatinine, AST, ALT and ALP). The results have shown that, in hamsters, amiodarone and itraconazole, either used isolated or in combination, are unable to stop the development of cutaneous lesions caused by L. (L.) amazonensis, but improve the activity of glucantime in the treatment of these lesions and seem to present no evident side effects. More studies are necessary in order to investigate the clinical potential of these combinations, so there can be the possibility of broadening the therapeutic options available, especially in resistant cases.

Célula de Büngner / Büngner cell

Las lesiones del nervio periférico constituyen una condición clínica frecuente; por ello, entender su fisiopatología y los avances en el campo de la regeneración nerviosa es fundamental para brindar el mejor tratamiento a los pacientes. En los últimos años se ha venido dando cada vez mayor importancia a los eventos regenerativos después de la lesión, donde interviene en gran medida una expresión fenotípica única en este proceso, derivada de células ya presentes, fenómeno clave para la recuperación de la función del nervio lesionado. Este artículo revisó la literatura disponible con el objetivo de entender mejor este evento regenerativo y se encontraron procesos celulares y moleculares que suceden en los axones.

Peripheral nerve injuries are a common clinical condición for which the understanding of the pathophysiology and advances in the fteld of nerve regeneration are important to provide the best treatment for patients. In recent years, it has been giving increasing importance to the regenerative events after injury, where it operares largely unique phenotypic expression in this process, derived from cells already present, kev event for the recoven- of nerve function injured. A review of the literature is done with the aim of a better understanding of this regenerative event, fínding a series of cellular and molecular processes that go on axonal level.

Effect of the saliva from different triatomine species on the biology and immunity of TLR-4 ligand and Trypanosoma cruzi-stimulated dendritic cells.

BACKGROUND: Triatomines are blood-sucking vectors of Trypanosoma cruzi, the causative agent of Chagas disease. During feeding, triatomines surpass the skin host response through biomolecules present in their saliva. Dendritic cells (DCs) play a crucial role in the induction of the protection to aggressive agents, including blood-sucking arthropods. Here, we evaluated if salivary components of triatomines from different genera evade the host immunity by modulating the biology and the function of LPS- or T. cruzi-stimulated DCs. METHODS: Saliva of Panstrongylus lignarius, Meccus pallidipennis, Triatoma lecticularia and Rhodnius prolixus were obtained by dissection of salivary glands and the DCs were obtained from the differentiation of mouse bone marrow precursors. RESULTS: The differentiation of DCs was inhibited by saliva of all species tested. Saliva differentially inhibited the expression of MHC-II, CD40, CD80 and CD86 in LPS-matured DCs. Except for the saliva of R. prolixus, which induced IL-6 cytokine production, TNF-α, IL-12 and IL-6 were inhibited by the saliva of the other three tested species and IL-10 was increased in all of them. Saliva per se, also induced the production of IL-12, IL-6 and IL-10. Only the saliva of R. prolixus induced DCs apoptosis. The presence of PGE2 was not detected in the saliva of the four triatomines studied. Finally, T. cruzi invasion on DCs is enhanced by the presence of the triatomine saliva. CONCLUSIONS: These results demonstrate that saliva from different triatomine species exhibit immunomodulatory effects on LPS and T. cruzi-stimulated DCs. These effects could be related to hematophagy and transmission of T. cruzi during feeding.

Correlation between the virulence of T. cruzi strains, complement regulatory protein expression levels, and the ability to elicit lytic antibody production.

Trypanosoma cruzi trypomastigotes are able to resist lysis via the complement system, which involves many surface proteins including the complement regulatory protein (CRP). To examine the diversity in CRP recognition among strains of T. cruzi, the expression levels of the translated protein on trypomastigote surfaces were analyzed by flow cytometry, and associations between protein expression and the biological behavior of these strains, especially the ability to induce lytic antibodies in animal models, were assessed. The highly virulent T. cruzi strains Ninoa, INC-5, and Colombiana and the less virulent strains CL-Brener, LGB-231, and JG were used in the experiments. An expression profile analysis showed that the Colombiana and INC-5 strains have higher translated protein levels and induced higher production of antibodies in mice than the other strains. Our results indicated that there are differences in the surface expression of CRP between parasite strains, with a tendency for the most virulent strains to have higher expression levels. Combined, these results contribute to a better understanding of CRP functions and the complexity of host-parasite interactions, considering the large number of virulence factors involved in the process.

Semisolid liver infusion tryptose supplemented with human urine allows growth and isolation of Trypanosoma cruzi and Trypanosoma rangeli clonal lineages.

INTRODUCTION: This work shows that 3% (v/v) human urine (HU) in semisolid Liver Infusion Tryptose (SSL) medium favors the growth of Trypanosoma cruzi and T. rangeli. METHODS: Parasites were plated as individual or mixed strains on SSL medium and on SSL medium with 3% human urine (SSL-HU). Isolate DNA was analyzed using polymerase chain reaction (PCR) and pulsed-field gel electrophoresis (PFGE). RESULTS: SSL-HU medium improved clone isolation. PCR revealed that T. cruzi strains predominate on mixed-strain plates. PFGE confirmed that isolated parasites share the same molecular karyotype as parental cell lines. CONCLUSIONS: SSL-HU medium constitutes a novel tool for obtaining T. cruzi and T. rangeli clonal lineages.

Reconstrucción microquirúrgica de lengua / Microsurgical tongue reconstruction

Malignant tumors of tongue are a common pathology with high morbidity and mortality. Treatment requires surgical oncology and systemic management, with the respective reconstruction in order to achieve an adequate quality of life, due to the primary function of the tongue during feeding, communication, social and labor interaction. That is why the choice of donor tissue for reconstruction depends heavily on its characteris-tics and the type of defect, essential to obtain favorable results in the patients. A review of the classification of resulting defects after tongue's tumors resection is performed, and management algorithm and microvascular free flaps more frequently used in this type of reconstruction.

Los tumores malignos de lengua son una patología frecuente con alto grado de morbilidad y mortalidad. Su tratamiento requiere manejo quirúrgico y sistémico oncológico, con la respectiva reconstrucción, para lograr así una adecuada calidad de vida, debido a la función primordial de la lengua durante la alimentación, la comunicación, la interacción social y laboral. Es por esto que la elección de los tejidos donantes para ello depende en gran medida de sus características y del tipo de defecto, aspecto fundamental para obtener resultados favorables en los pacientes. Se realiza una revisión de la clasificación de los defectos resultantes después de la resección de tumores de lengua, un algoritmo de manejo y los colgajos libres microvasculares más utilizados en este tipo de reconstrucción.

The Driving of Immune Response by Th1 Adjuvants in Immunization of Mice with Trypanosoma cruzi marinkellei Elicits a Controversial Infection Control.

In previous studies, we have demonstrated that inoculation with a Trypanosoma cruzi marinkellei (avirulent RM1 strain) was able to reduce parasitemia in mice challenged with T. cruzi, although it was not able to prevent histopathological lesions. Th1 response stimulation by immunization is necessary for T. cruzi infection control, but the resistance is also dependent on immunoregulatory mechanisms, which can be induced by adjuvants. Thus, we evaluated whether inoculation of T. cruzi marinkellei associated with administration of different adjuvants would be capable of inducing different patterns of immune response to maximize the immune response against T. cruzi (virulent Romildo strain) infection. Two hundred eighty nonisogenic mice were divided into 14 groups according to the immunization scheme and the subsequent challenge with virulent Romildo T. cruzi strain. Nonimmunized groups and animals inoculated without adjuvants were also included. Immune protection was not observed with Th2 adjuvants (incomplete Freund's adjuvant [IFA] and Alum) due to high parasitemia. Th1/Th2-polarizing adjuvants also did not induce immune protection because inulin was unable to maintain survival, and immune-stimulating complexes induced intense inflammatory processes. Animals sensitized with RM1 strain without adjuvants were able to reduce parasitemia, increase survival, and protect against severe histological lesions, followed by adequate cytokine stimulation. Finally, our results demonstrate that the early and balanced IFN-γ production becomes critical to promote protection and that Th1 adjuvant elicited a controversial infection control due to increased histopathological damage. Therefore, the host's immunomodulation remains one of the most important challenges in the research for effective protection against T. cruzi infection. Similarly, the identification of protective antigens in the RM1 strain of T. cruzi marinkellei may contribute to further studies on vaccine development against human Chagas disease.

Experiencia personal en mano metacarpiana / Personal experience in metacarpal hand

Antecedentes y Objetivos. La mano forma parte no solo de la apariencia física del individuo, sino también de las funciones evolutivas más importantes del ser humano. La amputación de múltiples dedos genera una importante limitación y afecta a la calidad de vida de estos pacientes. Pacientes y Método. Exponemos la técnica quirúrgica realizada por nuestro equipo en casos de transferencias del segundo artejo, así como la transferencia combinada del segundo y tercer dedos para el tratamiento de la denominada mano metacarpiana. Resultados. Detallamos los resultados obtenidos en una serie de 5 pacientes. Conclusiones. La reconstrucción de la mano metacarpiana mediante transferencia de dedos de los pies se convierte en la mejor alternativa para devolver la funcionalidad a la mano y mejorar la calidad de vida (AU)

Background and Objectives. The hand is part of not only the physical appearance of the individual but also of the most important evolutionary functions of human beings. The amputation of multiple fingers generates a major constraint affecting the quality of life of these patients. Patients and Methods. In this article we present the surgical technique performed by our team in cases of transfer from the second toe and of combined transfer from the second and third toes for the treatment of the metacarpal hand. Results. We detail the results obtained in a group of 5 patients. Conclusions: Reconstruction of metacarpal hand by transferring toes becomes the best alternative to restore hand functionality and improve quality of life (AU)

RESPUESTA DE PARÁMETROS HEMATOLÓGICOS A UNA SESIÓN DE ENTRENAMIENTO INTERVÁLICO DE ALTA INTENSIDAD TIPO CROSSFIT® / RESPOSTA HEMATOLÓGICA A UMA SESSÃO DE TREINAMENTO INTERVALADO DE ALTA INTENSIDADE TIPO CROSSFIT / HEMATOLOGIC RESPONSE TO A CROSSFIT®-BASED HIGH-INTENSITY INTERVAL TRAINING (HIT) SESSION

Objetivo: evaluar la respuesta hematológica a una sesión de entrenamiento interválico de alta intensidad (EIAI) tipo CrossFit®. Método: estudio pre-experimental en el que participaron nueve hombres (25.4 ± 4.3 años), a quienes se les realizó un análisis de muestras sanguíneas antes y después de una sesión de EIAI, con una duración, en su fase principal, de 15 minutos. Las variables hematológicas fueron analizadas por un cuadro hemático de IV generación. Resultados: se presentó una diferencia significativa (p<0.05) en los hematíes (%Δ: -1.35; ES: 0,222), concentración de hemoglobina (%Δ: -1,18; ES: 0,263), el porcentaje de hematocrito (%Δ: -1,72; ES: 0,448), el volumen corpuscular medio (%Δ: -0,47; ES: 0,108), el recuento de linfocitos (%Δ: -24,89; ES: 0,855) y los eosinófilos (%Δ: -24,32; ES: 0,290), al comparar las muestras antes y después de la sesión. Conclusión: se hace necesario profundizar en el estudio de variables hematológicas en el EIAI, de manera que permita optimizar parámetros de rendimiento, disminuir la prevalencia de lesiones y mejorar las estrategias nutricionales y de suplementación.

Aim: To evaluate the hematologic response to a CrossFit®-based high-intensity interval training (HIIT) session. Method: Pre-experimental study involving nine men (25.4 ± 4.3 years). In this study, blood samples were taken before and after a HIIT training session of 15 minutes in the main phase. Hematological variables were analyzed through a blood count of fourth generation. Results: The obtained results showed a significant difference (p<0.05) in red blood cells (%Δ: -1.35; ES: 0,222), hemoglobin concentration (%Δ: -1,18; ES: 0,263), hematocrit percentage (%Δ: -1,72; ES: 0,448), Mean Corpuscular Volume (%Δ: -0,47; ES: 0,108), and lymphocyte (%Δ: -24,89; ES: 0,855), and eosinophils count (%Δ: -24,32; ES: 0,290) when comparing samples before and after the session. There were no significant changes in other parameters. Conclusion: It is necessary to go deeper in the study of hematological variables in the HIIT, in order to optimize performance parameters, decrease the prevalence of injuries, and improve nutrition and supplementation strategies.

Objetivo: avaliar a resposta hematológica de uma sessão de treinamento intervalado de alta intensidade (TIAI) tipo CrossFit®. Método: estudo pre-experimental no qual se retirou mostras sanguíneas de 9 homens (25.4 ± 4.3 anos), antes e depois de uma sessão de CrossFIT®, com duração na fase principal de 15 minutos. As variáveis hematológicas foram analisadas por um quadro hemático de IV geração. Resultados: análise mostrou diferenças significativas (p<0.05) nos hematies (%Δ: -1.35; ES: 0,222), concentração de hemoglobina (%Δ: -1,18; ES: 0,263), percentagem de hematócrito (%Δ: -1,72; ES: 0,448), volume corpuscular médio (%Δ: -0,47; ES: 0,108), quantidade de linfócitos (%Δ: -1,72; ES: 0,448) e eosinófilos (%Δ: -24,32; ES: 0,290). Nos outros parâmetros do quadro hemático não houve diferenças significativas. Conclusão: de acordo com esses resultados, nota-se a necessidade de aprofundar os estudos hematológicos, para se aperfeiçoar parâmetros de rendimento, diminuição de riscos de lesões e melhorar a intervenção nutricional e de suplementação nesse tipo de treinamento.