Topical treatment of actinic keratosis with imiquimod 5% cream / Tratamento tópico de ceratose actínica com imiquimod creme 5%

The viability and the efficiency of imiquimod 5% cream in a cat which suffered from nasal actinic keratosis were evaluated. The procedures were carried out at home by the owners themselves. Six packets of the cream were used, one per week, in three consecutive daily applications, with a four-day interval (without treatment). The cytological results were negative for neoplastic cells 30 days after the end of the treatment. A clinical revision was conducted 18 months later and the animal showed no signs of recurrence. The cream proved to be safe and efficient. There are no reports regarding efficiency in animals concerning the treatment with imiquimod 5% cream and also regarding other effects related to this treatment. A case report presenting a positive response can reveal with terapeutical possibilities that it would be easily available and applicable for all professionals. In the future it would be a new alternative to avoid progressions of this kind of neoplasia which is often observed in the small animal clinic.

Avaliaram-se a viabilidade e a eficácia da utilização do imiquimod creme 5% em um gato portador de ceratose actínica nasal. As aplicações foram realizadas no domicílio, pelos proprietários, sendo utilizados seis sachês do creme, um por semana, em protocolo de três aplicações diárias consecutivas e quatro dias de descanso (sem tratamento). Após 30 dias do término do tratamento, obteve-se citologia negativa para células neoplásicas. Em revisão clínica 18 meses após o tratamento, o paciente apresentava-se sem sinais de recidiva. O protocolo mostrou-se seguro e eficaz. Em animais não há relatos sobre a eficácia da terapia com imiquimod, bem como sobre efeitos adversos decorrentes deste tratamento. A apresentação de um caso em que se observou resposta positiva pode descortinar uma nova possibilidade terapêutica, acessível a todo clínico, que poderá evitar a progressão destas neoplasias que são frequentemente observadas na clínica de pequenos animais.

Implementation of a cardiology care program in remote areas in Brazil: influence of governability.

INTRODUCTION: A telecardiology remote cardiology medical care system was implemented in 82 municipalities of Minas Gerais State, Brazil to support basic network services in the early diagnosis and management of cardiovascular diseases. OBJECTIVE: To investigate the factors associated with the implementation of this program in the municipalities. METHOD: This 2006 ecological study involved 393 candidate municipalities to implement the system. The municipalities were divided into two groups: non-random intervention (n = 82) and comparative (n = 311). The social, structure, healthcare needs, and governability indexes of the two groups of municipalities were compared by descriptive and multiple regression analysis using the generalized estimation equation model. RESULTS: After fitting for other characteristics, participation of the municipalities in the intervention was associated with a higher social responsibility index (OR: 2.44, CI: 1.50-3.96) and lower healthcare needs (OR: 2.29, CI: 1.24-4.22). CONCLUSION: Greater efforts by municipality management was the key to attracting and implementing the remote cardiology intervention, even when fitted for lower healthcare needs, which suggests greater municipal political and social engagement. This translated to improved access to cardiovascular health care for Brazilian rural and remote populations in the intervention municipalities.

Prevalence of primary drug resistance-associated mutations among HIV type 1 vertically Infected children in Belo Horizonte, Brazil.

In the past few years there has been increasing concern about the transmission of drug-resistant HIV. This study aimed to describe the frequency of primary mutations associated with HIV-1 drug resistance and the prevalence of genetic HIV subtypes in a population of vertically infected children before the initiation of HAART. At the time of genotypic testing, the median age was 6.0 years (IQR 25-75%: 3.8-9.2) and the median age at admission was 3.84 years (IQR 25-75%: 1.23-6.11). Antepartum maternal ARV exposure for PMTCT occurred for three (7.3%) mothers. According to the WHO criteria, primary ARV resistance mutations were detected in four out of 41 (9.8%) children. Subtype B was the most prevalent (63.4%). The relatively high prevalence of primary HIV-1 DRMs in this cohort of perinatally infected children in Brazil supports the local recommendation to perform resistance testing in all newly diagnosed children, regardless of age at diagnosis and antenatal ARV exposure.

Genetic polymorphisms in vitamin D receptor, vitamin D-binding protein, Toll-like receptor 2, nitric oxide synthase 2, and interferon-γ genes and its association with susceptibility to tuberculosis: [review]

Mycobacterium tuberculosis kills more people than any other single pathogen, with an estimated one-third of the world's population being infected. Among those infected, only 10 percent will develop the disease. There are several demonstrations that susceptibility to tuberculosis is linked to host genetic factors in twins, family and associated-based case control studies. In the past years, there has been dramatic improvement in our understanding of the role of innate and adaptive immunity in the human host defense to tuberculosis. To date, attention has been paid to the role of genetic host and parasitic factors in tuberculosis pathogenesis mainly regarding innate and adaptive immune responses and their complex interactions. Many studies have focused on the candidate genes for tuberculosis susceptibility ranging from those expressed in several cells from the innate or adaptive immune system such as Toll-like receptors, cytokines (TNF-α, TGF-β, IFN-γ, IL-1b, IL-1RA, IL-12, IL-10), nitric oxide synthase and vitamin D, both nuclear receptors and their carrier, the vitamin D-binding protein (VDBP). The identification of possible genes that can promote resistance or susceptibility to tuberculosis could be the first step to understanding disease pathogenesis and can help to identify new tools for treatment and vaccine development. Thus, in this mini-review, we summarize the current state of investigation on some of the genetic determinants, such as the candidate polymorphisms of vitamin D, VDBP, Toll-like receptor, nitric oxide synthase 2 and interferon-γ genes, to generate resistance or susceptibility to M. tuberculosis infection.

Genetic polymorphisms in vitamin D receptor, vitamin D-binding protein, Toll-like receptor 2, nitric oxide synthase 2, and interferon-gamma genes and its association with susceptibility to tuberculosis.

Mycobacterium tuberculosis kills more people than any other single pathogen, with an estimated one-third of the world's population being infected. Among those infected, only 10% will develop the disease. There are several demonstrations that susceptibility to tuberculosis is linked to host genetic factors in twins, family and associated-based case control studies. In the past years, there has been dramatic improvement in our understanding of the role of innate and adaptive immunity in the human host defense to tuberculosis. To date, attention has been paid to the role of genetic host and parasitic factors in tuberculosis pathogenesis mainly regarding innate and adaptive immune responses and their complex interactions. Many studies have focused on the candidate genes for tuberculosis susceptibility ranging from those expressed in several cells from the innate or adaptive immune system such as Toll-like receptors, cytokines (TNF-alpha, TGF-beta, IFN-gamma, IL-1b, IL-1RA, IL-12, IL-10), nitric oxide synthase and vitamin D, both nuclear receptors and their carrier, the vitamin D-binding protein (VDBP). The identification of possible genes that can promote resistance or susceptibility to tuberculosis could be the first step to understanding disease pathogenesis and can help to identify new tools for treatment and vaccine development. Thus, in this mini-review, we summarize the current state of investigation on some of the genetic determinants, such as the candidate polymorphisms of vitamin D, VDBP, Toll-like receptor, nitric oxide synthase 2 and interferon-gamma genes, to generate resistance or susceptibility to M. tuberculosis infection.

A putative gene located at the MHC class I region around the D6S105 marker contributes to the setting of CD8+ T-lymphocyte numbers in humans.

Significant associations between human leucocyte antigen (HLA)-A and -B alleles and CD8+ T-lymphocyte numbers have been reported in the literature in both healthy populations and in HFE-haemochromatosis patients. In order to address whether HLA alleles themselves or alleles at linked genes are responsible for these associations, several genetic markers at the MHC class I region were typed on a population of 147 apparently healthy unrelated subjects phenotypically characterized for their CD8+ and CD4+ T-lymphocyte numbers. By using a machine learning approach, a set of rules was generated that predict the number of CD8+ T-lymphocyte numbers on the basis of the information of the D6S105 microsatellite alleles only. We demonstrate that the previously reported associations with HLA-A and -B alleles are due to the presence of common long (up to 4 megabases long) haplotypes that increased in frequency recently due to positive selection and that encompass a region where a putative gene contributing to the setting of CD8+ T lymphocytes is located, in the neighbourhood of microsatellite locus D6S105, in the 6p21.3 region.

Does net energy cost of swimming affect time to exhaustion at the individual's maximal oxygen consumption velocity?

AIM: The purpose of the present study was to examine the relationship between time limit at the minimum velocity that elicits the individual's maximal oxygen consumption (TLim-v VO2max) and three swimming economy related parameters: the net energy cost corresponding to v VO2max (Cv VO2max), the slope of the regression line obtained from the energy expenditure (E) and corresponding velocities during an incremental test (C(slope)) and the ratio between the mean E value and the velocity mean value of the incremental test (C(inc)). Complementarily, we analysed the influence of Cv VO2max, C(slope) and C(inc) on TLim-v VO2max by swimming level. METHODS: Thirty swimmers divided into 10 low-level (LLS) (4 male and 6 female) and 20 highly trained swimmers (HTS) (10 of each gender) performed an incremental test for v VO2max assessment and an all-out TLim-v VO2max test. RESULTS: TLim-v VO2max, v VO2max, Cv fVO2max, C(slope) and C(inc) averaged, respectively, 313.8+/-63 s, 1.16+/-0.1 m x s(-1), 13.2+/-1.9 J x kg(-1) x m(-1), 28+/-3.2 J x kg(-1) x m(-1) and 10.9+/-1.8 J x kg(-1) x m(-1) in the LLS and 237.3+/-54.6 s, 1.4+/-0.1 m x s(-1), 15.6+/-2.2 J x kg(-1) x m(-1), 36.8+/-4.5 J x kg(-1) x m(-1) and 13+/-2.3 J x kg(-1) x m(-1) in the HTS. TLim-v VO2max was inversely related to C(slope) (r = -0.77, P < 0.001), and to v VO2max (r = -0.35, P = 0.05), although no relationships with the Cv VO2max and the C(inc) were observed. CONCLUSIONS: The findings of this study confirmed exercise economy as an important factor for swimming performance. The data demonstrated that the swimmers with higher and v VO2max performed shorter time in TLim-v VO2max efforts.

Time limit and VO2 slow component at intensities corresponding to VO2max in swimmers.

The purpose of this study was to measure, in swimming pool conditions and with high level swimmers, the time to exhaustion at the minimum velocity that elicits maximal oxygen consumption (TLim at vVO(2)max), and the corresponding VO(2) slow component (O(2)SC). The vVO(2)max was determined through an intermittent incremental test (n = 15). Forty-eight hours later, TLim was assessed using an all-out swim at vVO(2)max until exhaustion. VO(2) was measured through direct oximetry and the swimming velocity was controlled using a visual light-pacer. Blood lactate concentrations and heart rate values were also measured. Mean VO(2)max for the incremental test was 5.09 +/- 0.53 l/min and the corresponding vVO(2)max was 1.46 +/- 0.06 m/s. Mean TLim value was 260.20 +/- 60.73 s and it was inversely correlated with the velocity of anaerobic threshold (r = -0.54, p < 0.05). This fact, associated with the inverse relationship between TLim and vVO(2)max (r = -0.47, but only for p < 0.10), suggested that swimmers' lower level aerobic metabolic rate might be associated with a larger capacity to sustain that exercise intensity. O(2)SC reached 274.11 +/- 152.83 l/min and was correlated with TLim (r = 0.54), increased ventilation in TLim test (r = 0.52) and energy cost of the respiratory muscles (r = 0.51), for p < 0.05. These data suggest that O(2)SC was also observed in the swimming pool, in high level swimmers performing at vVO(2)max, and that higher TLim seems to correspond to higher expected O(2)SC amplitude. These findings seem to bring new data with application in middle distance swimming.

HFE, the MHC and hemochromatosis: paradigm for an extended function for MHC class I.

HFE was discovered as the hereditary hemochromatosis (HH) gene. It is located on chromosome 6 (6p21.3), 4Mb telomeric to the HLA-A locus, and its product has a structure similar to MHC class I molecules. HFE encodes two frequent mutations: C282Y and H63D. One of these (C282Y) is present in a large proportion of Caucasian HH patients. HFE has a tissue distribution compatible with a role in iron absorption (intestine), recycling (macrophages) and transport to the fetus (placenta).

Clinical and genetic heterogeneity in hereditary haemochromatosis: association between lymphocyte counts and expression of iron overload.

To identify a new marker of expression of disease, independent of HFE genotype in patients with hereditary haemochromatosis (HHC), the total peripheral blood lymphocyte counts were analysed according to iron status in two groups of subjects with HFE mutations. The groups consisted of 38 homozygotes for C282Y, and 107 heterozygotes for the C282Y or compound heterozygotes for C282Y and H63D. For control purposes, total lymphocyte counts and iron status were also examined in 20 index patients with African dietary iron overload, a condition not associated with HFE mutations, and in 144 members of their families and communities. Mean lymphocyte numbers were lower in C282Y homozygous HHC index subjects with cirrhosis and higher iron stores than in those without cirrhosis and with lower iron burdens [(1.65 +/- 0.43) x 10(6)/mL vs. (2.27 +/- 0.49) x 10(6)/mL; p = 0.008]. Similarly, mean lymphocyte counts were significantly lower in C282Y heterozygotes and C282Y/H63D compound heterozygotes with iron overload and increased serum ferritin concentrations compared to those with normal serum ferritin concentrations (p < 0.05). Statistically significant negative correlations were found, in males, between lymphocyte counts and the total body iron stores, either in C282Y homozygous HHC patients (p = 0.031 in a multiple regression model dependent on age) and in C282Y heterozygotes or C282Y/H63D compound heterozygotes with iron overload (p = 0.029 in a simple linear model). In contrast, lymphocyte counts increased with increasing serum ferritin concentrations among the index subjects with African iron overload (r = 0.324, not statistically significant) and among the members of their families and communities (r = 0.170, p = 0.042). These results suggest that a lower peripheral blood lymphocyte count is associated with a greater degree of iron loading in HFE haemochromatosis but not in African iron overload, and they support the notion that the lymphocyte count may serve as a marker of a non-HFE gene that influences the clinical expression of HFE haemochromatosis.

Comparative study of the two more frequent HFE mutations (C282Y and H63D): significant different allelic frequencies between the North and South of Portugal.

An earlier study of reference values of iron parameters in Portugal showed significant differences between populations from northern and southern villages. This study addresses the question of the geographical distribution in Portugal of the two main mutations (C282Y and H63D) of the hereditary hemochromatosis gene, HFE. For that purpose, a stratified sample of 640 anonymous dried blood spot samples was randomly selected from the major regions of Portugal: North, Center, Lisbon and the Tagus Valley, Alentejo and Algarve. Differences in the geographical distribution of these two mutations were observed thus confirming the presumed differences between the age of the two mutations which is compatible with the postulated Celtic/Nordic origin of the C282Y mutation. The finding of a significantly higher allelic frequency of the C282Y mutation in the North (0.058) than in the South (0.009) could also point to an effect of differential selective forces acting in the different geographical areas of the country. Data on archaeological, ethnographic and linguistic records and on the North/South distribution of Portuguese cattle breeds of European or African origin have also been reported. In addition to their interest for population genetics, the results represent a reminder of the need to take into account regional differences in the design of strategies for population screening of hereditary hemochromatosis.

Competência social de psicóticos: validaçäo social de habilidades específicas / Social skills of psychiatric patients: socialvalidation of specific skills

Esta pesquisa identifica as dificuldades de interaçäo social de pacientes psiquiátricos, em termos de medidas moleculares da competência social, referentes aos componentes verbais, näo-verbais, paralingüísticos, de expressividade e da habilidade de soluçäo de problemas dos sujeitos em quatro situaçöes cotidianas. Foi utilizada a estratégia de validaçäo social, na qual 35 pacientes psiquiátricos foram comparados a um grupo de referência de sua própria comunidade. Dois juízes previamente treinados observaram e cotaram a presença e ausência de comportamento específicos para cada um dos componentes descritos acima, utilizando uma grade de observaçäo sistemática do comportamento (EEHS). Os resultados mostram que as dificuldades dos pacientes säo mais acentuadas com relaçäo ao componente verbal e desoluçäo de problemas, mas envolvem também os componentes paralingüísticos, näo verbal e de expressividade. As dificuldades observadas, dentro de cada um dos componentes acima, se referem a alguns comportamentos particulares e näo a outros, identificando a especificifdade do déficit apresentado por esta clientela e portanto a necessidade de intervençöes clínicas específicas. Em alguns aspectos da competência social, o grupo de referência apresenta dificuldades semelhantes ao do grupo clínico. Os resultados säo discutidos em termos da importância da estratégia de validaçäo social para a escolha de objetivos socialmente pertinenetes em sua comunidade

Competencia social de psicoticos: validacao social de habilidades especificas

Esta pesquisa identifica as dificuldades de interacao social de pacientes psiquiatricos, em termos de medidadas moleculares da competencia social, referentes aos componentes verbais, nao-verbais, paralinguisticos, de expressividade e da habilidade de solucao de problemas dos sujeitos em quatro situacoes cotidianas. Foi utilizada a estrategia de validacao social, na qual 35 pacientes psiquiatricos foram comparados a um grupo de referencia de sua propria comunidade. Dois juizes previamente treinados observaram e cotaram a presenca e ausencia de comportamentos especificos para cada um dos componentes descritos acima, utilizando uma grade de observacao sistematica do comportamento (EEHS). Os resultados mostram que as dificuldades dos pacientes sao mais acentuados com relacao ao componente verbal e de solucao de problemas, mas envolvem tambem os componentes paralinguisticos, nao verbal e de expressividade. As dificuldades observadas, dentro de cada um dos componentes acima, se referem a alguns comportamentos particulares e nao a outros, identificando a especificidade do deficit apresentado por esta clientela e portanto a necessidade de intervencoes clinicas especificas. Em alguns aspectos da competencia social, o grupo de referencia apresenta dificuldades semelhantes ao do grupo clinico. Os resultados sao discutidos em termos da importancia da estrategia de validacao social para a escolha de objetivos socialmente pertinentes em sua comunidade.