Repeated human leukocyte antigens eplets, importance of typing the partner.

INTRODUCTION: Antibody-mediated rejection (AMR) is the most common cause of immune-mediated allograft failure after kidney transplant and impacts allograft survival. Previous sensitization is a major risk factor for development of donor specific antibodies (DSA). AMR can have a wide range of clinical features such as impaired kidney function, proteinuria/hypertension or can be subclinical. HLA molecules have specific regions of antigens binding antibodies called epitopes and eplets are considered essential components responsible for immune recognition. We present a patient with subclinical AMR 1 week post transplantation. CASE REPORT: A 48-year-old, caucasian woman with end-stage kidney disease (ESKD) secondary to autosomal dominant polycystic kidney disease (ADPKD) on peritoneal dialysis was registered in deceased donor waitlist. She was a hypersensitized patient from 3 prior pregnancies with a calculated panel reactive antibody of 93,48%. She was transplanted through kidney paired exchange donation with no evidence of DSA pre transplantation. Surgery and post-op were unremarkable with excellent and immediate graft function. Per protocol DSA levels on the 5th day was DR1 of 3300 MFI, with an increase in MFI by day 13 with 7820 MFI and a new B41 1979MFI. Allograft kidney biopsy findings were diagnostic of AMR and she was treated with immunoglobulin and plasmapheresis. As early onset AMR post transplantation was observed an anamnestic response was hypothesized from a previous exposure to allo-HLA. We decided to type her husband, her son's father, which was presented with DSA. Mismatch eplet analysis revealed a shared 41 T and 67LQ eplets between the donor and husband, responsible for the reactivity and new HLA class I B41 and HLA class II DR1 DSA, respectively. DISCUSSION: Shared eplets between the patient husband and donor was responsible for the alloimmune response and early development of DSAs. This case highlights the importance of early monitoring DSA levels in highly sensitized patients after transplant in order to promptly address and lower inflammatory damage. Mismatch eplet analysis can provide a thorough and precise evaluation of immune compatibility providing a useful technique to immune risk stratification, donor selection and post-transplant immunosuppressive therapy and monitoring.

Disturbed flow increases endothelial inflammation and permeability via a Frizzled-4-ß-catenin-dependent pathway.

Multidirectional or disturbed flow promotes endothelial dysfunction and is associated with early atherogenesis. Here we investigated the role of Wnt signalling in flow-mediated endothelial dysfunction. The expression of Frizzled-4 was higher in cultured human aortic endothelial cells (ECs) exposed to disturbed flow compared to that seen for undisturbed flow, obtained using an orbital shaker. Increased expression was also detected in regions of the porcine aortic arch exposed to disturbed flow. The increased Frizzled-4 expression in cultured ECs was abrogated following knockdown of R-spondin-3. Disturbed flow also increased the nuclear localisation and activation of ß-catenin, an effect that was dependent on Frizzled-4 and R-spondin-3. Inhibition of ß-catenin using the small-molecule inhibitor iCRT5 or knockdown of Frizzled-4 or R-spondin-3 resulted in reduced expression of pro-inflammatory genes in ECs exposed to disturbed flow, as did inhibition of WNT5A signalling. Inhibition of the canonical Wnt pathway had no effect. Inhibition of ß-catenin also reduced endothelial paracellular permeability; this was associated with altered junctional and focal adhesion organisation and cytoskeletal remodelling. These data suggest the presence of an atypical Frizzled-4-ß-catenin pathway that promotes endothelial dysfunction in response to disturbed flow.

A intimidade do casal como fator de proteção para cuidados em saúde: uma revisão sistemática / Couple intimacy as a protective factor for health care: a systematic review / Intimidad de la pareja como factor protector para el cuidado de la salud: una revisión sistemática

A intimidade na relação conjugal é um aspecto pertencente ao ciclo da vida humana que compreende a união e troca de afetos entre duas pessoas, sendo que a presença da mesma na díade permite que haja confiança, partilha, revelação de vulnerabilidades e reciprocidade. O objetivo deste artigo foi identificar na literatura se a intimidade em casais é compreendida enquanto um fator de proteção para cuidados em saúde de pacientes portadores de doenças crônicas. Desta forma, foi realizado a pesquisa dos artigos através do recurso de base de dados relacionadas com a temática e incluídos estudos com amostras compostas de casais em que um dos parceiros possuía diagnóstico de doença crônica. A partir dos resultados encontrados foi possível verificar que a presença da intimidade na díade, apesar dos prejuízos ocasionados pela doença e os respectivos tratamentos, acaba por se tornar um espaço onde o paciente obtêm a vivência de conforto, amparo e segurança.

Intimacy in marital relationships is an aspect belonging to the human life cycle that comprises union and exchange of affection between two people, and its presence in this dyad allows for trust, sharing, revelation of vulnerabilities and reciprocity. The objective of this article was to identify in the literature whether intimacy in couples is understood as a protective factor for health care in patients with chronic diseases. Thus, articles related to the theme were searched in databases, and the studies with samples composed of couples in which one of the partners had a diagnosis of chronic disease were included. From the results, the investigation verified that the presence of intimacy in the dyad, despite the damage caused by the disease and the respective treatments, turns into a space where the patient obtains the experience of comfort, support and security.

La intimidad en la relación conyugal es un aspecto perteneciente al ciclo vital humano que comprende la unión y el intercambio de afectos entre dos personas, su presencia en la díada permite que haya la confianza, el compartir, la revelación de vulnerabilidades y la reciprocidad. El objetivo de este artículo fue identificar en la literatura si la intimidad en las parejas es comprendida como un factor de protección para el cuidado de la salud de los pacientes con enfermedades crónicas. De esta manera, fue realizada la búsqueda de artículos a través del recurso de bases de datos relacionadas con el tema y se incluyeron estudios con muestras compuestas por parejas en las que uno de los miembros de la pareja tenía un diagnóstico de enfermedad crónica. A partir de los resultados fue posible verificar que la presencia de la intimidad en la díada, a pesar de los perjuicios causados por la enfermedad y los respectivos tratamientos, se convierte en un espacio donde el paciente obtiene confort, apoyo y seguridad.

Noemy Silveira, Isaías Alves, and educational psychology: dialogs between Brazil, France, and the USA. / Noemy Silveira, Isaías Alves e a psicologia educacional: diálogos entre Brasil, França e EUA.

This article relates the intelligence testing experiments conducted by Isaías Alves and Noemy Silveira to the broader context of how psychological concepts moved within the Brazilian educational field. Their work acts as a resource to understand how this movement occurred, indicating the different events that helped shape the understanding of this tool. The goal is to show how, even despite their similar initial interests and shared experience at Columbia University, Alves and Silveira did not use the same strategies during their work to apply these tests in schools while they both headed psychology services for the boards of education in São Paulo and Rio de Janeiro.

O artigo relaciona as experiências com testes de inteligência realizadas por Isaías Alves e Noemy Silveira com o contexto de circulação das concepções de psicologia no campo educacional brasileiro. Os trabalhos que desenvolveram funcionam como recurso para entender como se deu essa circulação, apontando as diferentes instâncias que contribuíram para configurar o modo como compreenderam essa ferramenta. O artigo pretende sinalizar como, mesmo partindo de interesses semelhantes e tendo em comum a experiência na Columbia University, Alves e Silveira não usaram as mesmas estratégias durante o trabalho de aplicação que desenvolveram nas escolas, enquanto estiveram à frente de serviços de psicologia ligados a diretorias de instrução de São Paulo e do Distrito Federal.

Noemy Silveira, Isaías Alves e a psicologia educacional: diálogos entre Brasil, França e EUA / Noemy Silveira, Isaías Alves, and educational psychology: dialogs between Brazil, France, and the USA

Resumo O artigo relaciona as experiências com testes de inteligência realizadas por Isaías Alves e Noemy Silveira com o contexto de circulação das concepções de psicologia no campo educacional brasileiro. Os trabalhos que desenvolveram funcionam como recurso para entender como se deu essa circulação, apontando as diferentes instâncias que contribuíram para configurar o modo como compreenderam essa ferramenta. O artigo pretende sinalizar como, mesmo partindo de interesses semelhantes e tendo em comum a experiência na Columbia University, Alves e Silveira não usaram as mesmas estratégias durante o trabalho de aplicação que desenvolveram nas escolas, enquanto estiveram à frente de serviços de psicologia ligados a diretorias de instrução de São Paulo e do Distrito Federal.

Abstract This article relates the intelligence testing experiments conducted by Isaías Alves and Noemy Silveira to the broader context of how psychological concepts moved within the Brazilian educational field. Their work acts as a resource to understand how this movement occurred, indicating the different events that helped shape the understanding of this tool. The goal is to show how, even despite their similar initial interests and shared experience at Columbia University, Alves and Silveira did not use the same strategies during their work to apply these tests in schools while they both headed psychology services for the boards of education in São Paulo and Rio de Janeiro.

Factors facilitating implementation of school-based sexuality education in Portugal.

OBJECTIVES: The aims of the study were to examine in Portuguese schools the facilitating factors at micro- and exosystem levels generally associated with more effective implementation of sexuality education (SE). METHODS: A representative sample of principals/lead teachers from 296 Portuguese schools completed a questionnaire about SE at school that included items related to factors at micro- and exosystem levels. Bivariate and multivariate logistic regression analyses were performed to examine factors associated with the development of an SE project. RESULTS: The majority of schools (96%) implemented some form of SE. Specifically, 79% of schools had developed an SE project. The odds that a school had designed an SE project increased significantly when the school did not implement extracurricular activities only (odds ratio [OR] 7.9), when it had an SE team (OR 7.2) and when it had established partnerships (OR 4.5). Bivariate and multivariate logistic regression models for each factor and each level revealed that other variables were associated with the development of a project, such as the perceived support offered by the regional education department. CONCLUSIONS: The results highlight the importance of variables at micro- and exosystem levels as facilitating factors, and reinforce the ecological approach as being well suited for SE/health education in schools. The findings have implications for policy-makers as well as for practice.

Sexuality education in a representative sample of Portuguese schools: examining the impact of legislation.

OBJECTIVES: To share Portugal's experience with school-based sexuality education, and to describe its implementation at a local level, following an ecological model and using a mixed methodology approach. The study also examines the impact of the latest policies put into effect, identifying potential weaknesses and strengths affecting the effectiveness of sexuality education enforcement. METHODS: A representative sample of 296 schools in Portugal was analysed. Teachers representing the school completed a questionnaire and were asked to share any kind of official document from their sexuality education project (such as curriculum content). A subsample of these documents was analysed by two coders. Quantitative analysis was carried out using descriptive statistics. RESULTS: The majority of Portuguese schools delivered sexuality education, in line with Portuguese technical guidelines and international recommendations. There were common procedures in planning, implementation and evaluation of sexuality education. Some strengths and weaknesses were identified. Results highlighted the impact of the various systems on the planning, enforcement and evaluation of sexuality education in school. CONCLUSIONS: The latest policies introduced valuable changes in school-based sexuality education. A way of assessing effectiveness of sexuality education is still needed.

Morphometric changes in C57BL/6 mice retina infected by Toxoplasma gondii ME 49 strain.

This study evaluated the morphometric implications in C57BL/6 mouse retina infected by Toxoplasma gondii, ME 49 strain. Twenty C57BL/6 female mice were divided into group 1 (n=8, intraperitoneally infected with 30 cysts of T. gondii ME 49 strain) and group 2 (n=12 non-infected controls). The eyes were enucleated on the 60th day after infection, fixed and processed for light microscopy. Changes in retinal thickness and in the perimeter/area ratio (P/A) of the retinal layers were analyzed by digital morphometry. We considered that P/A was the measurement of retinal architecture distortion induced by toxoplasmosis. This study considered the ganglion cells and nerve fiber layers as a monolayer, thus six layers of retina were evaluated: photoreceptors (PRL), outer nuclear (ONL), outer plexiform (OPL), inner nuclear (INL), inner plexiform (IPL) and ganglion cells/nerve fiber monolayer (GNL). Histological analysis of infected mouse retina showed inflammatory infiltrate, necrosis, glial reaction and distortion of the retina architecture. It also presented increased thickness (167.8±24.9µm versus 121.1±15.4µm, in controls) and increased retinal thickness within the retinitis foci (187.7±16.6µm versus 147.9±12.2µm out of the retinitis foci). A statistically significant difference in P/A was observed between infected and uninfected mouse retinas. The same was observed in PRL, OPL, INL and GNL. Retinal morphometry may be used to demonstrate differences between infected and uninfected mouse retinas.

Combined use of late phase dimercapto-succinic acid renal scintigraphy and ultrasound as first line screening after urinary tract infection in children.

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of dimercapto-succinic acid renal scintigraphy and renal ultrasound in identifying high grade vesicoureteral reflux in children after a first episode of urinary tract infection. MATERIALS AND METHODS: A total of 533 children following a first urinary tract infection were included in the analysis. Patients were assessed by 3 diagnostic imaging studies, renal ultrasound, dimercapto-succinic acid scan and voiding cystourethrography. The main event of interest was the presence of high grade (III to V) vesicoureteral reflux. The combined and separate diagnostic accuracy of screening methods was assessed by calculation of diagnostic OR, sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio. RESULTS: A total of 246 patients had reflux, of whom 144 (27%) had high grade (III to V) disease. Sensitivity, negative predictive value and diagnostic OR of ultrasound for high grade reflux were 83.3%, 90.8% and 7.9, respectively. Dimercapto-succinic acid scan had the same sensitivity as ultrasound but a higher negative predictive value (91.7%) and diagnostic OR (10.9). If both tests were analyzed in parallel by using the OR rule, ie a negative diagnosis was established only when both test results were normal, sensitivity increased to 97%, negative predictive value to 97% and diagnostic OR to 25.3. Only 9 children (6.3%) with dilating reflux had an absence of alterations in both tests. CONCLUSIONS: Our findings support the idea that ultrasound and dimercapto-succinic acid scan used in combination are reliable predictors of dilating vesicoureteral reflux.

Necrólise epidérmica tóxica precipitada por excipiente medicamentoso: relato de caso / Toxic epidermic necrolysis triggered by drug excipient: case report

Este trabalho salienta a possibilidade de a alteração do excipiente de medicamentos tomados por longos períodos desencadear a Necrólise Epidérmica Tóxica. É feita a descrição clínica de paciente de 30 anos com farmacodermia associada ao uso de antirretrovirais.

This work emphasizes the possibility that changing the excipient of some drugs taken over long periods can trigger Toxic Epidermic Necrolysis. This article shows the clinical aspects of a patient who took AZT/r since March/2007. Thus, the suspicion that this drug would trigger Stevens-Johnson syndrome isn’t significative. On the other hand, the fact that the antiretroviral vehicle has been changed leads to a strong suspicion that it could be involved in triggering this syndrome. It is reported the clinical description of a 30-year patient eruption associated with the use of retroviral.

Virulence factors of avian pathogenic Escherichia coli isolated from broilers from the south of Brazil.

Sixty-three Escherichia coli strains isolated from broilers with respiratory problems were examined for virulence factors, hemolysin synthesis ability, motility, hemagglutination capacity, operon pap presence, colicin production, and serum resistance. The capacity to hemagglutinate guinea pig erythrocytes was found in 53 (84.1%) of the samples, but only 30 (47.6%) agglutinated chicken erythrocytes. D-mannose-sensitive hemagglutination against guinea pig erythrocytes was found in 19 (30.2%) samples and against chicken erythrocytes, in 15 (23.8%) samples, whereas the D-mannose-resistant hemagglutination with guinea pig erythrocytes was found in 34 (54%) samples, and 13 of these (20.6%) showed this characteristic against chicken erythrocytes. Operon pap, P fimbria codifier, was detected in 26 samples in a total of 34 D-mannose-resistant samples. Colicin production was observed in 55 (87.3%) of the strains, and 41.8% presented V colicin production. Of the samples analyzed, 56 (88.9%) presented serum resistance, six (9.5%) were intermediate, and only one (1.6%) was sensitive to the action of the complement. The diversity of virulence profiles detected in the samples in this study explains in part the multifactorial characteristics of avian colibacillosis.

Conseqüências materno-fetais da malária falciparum em multípara semi-imune. Relato de caso / The consequenses of the malaria falciparum halfimmune multipara - case report

A região amazônica é responsável pela maioria dos casos de malária registrados no Brasil. Nessa região, pouco tem sido estudado sobre efeitos da doença durante a gestação. Visando contribuir para o conhecimento da malária em área endêmica da Amazônia, os autores propõem descrever as conseqüências da malária falciparum em multípara semi-imune, procedente da reserva indígena localizada na divisa Pará - Maranhão. Os dados epidemiológicos, parasitológicos, laboratoriais e clínicos - evolutivos foram obtidos, parcialmente, da paciente hospitalizada no Hospital Universitário João de Barros barreto (HUJBB) e complementados com as informações do agente da FUNAI, acompanhante. Foram observadas as seguintes alterações: - no organismo materno: anemia, alterações neurológicas (forma cerebral da malária) e a interrupção da gravidez; na placenta lesões vasculares e pigmento malárico no espaço interviloso; sobre o concepto: morte intra útero e expulsão (aborto no 1§ trimestre). conclui-se que em área endêmica de malária na Amazônia Oriental, as gestantes, ainda que semi-imunes, podem desenvolver formas graves da doença com sérios danos para o concepto