New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients.

OBJECTIVES: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. METHODS: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. RESULTS: A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8-9.0); heart rate 120 bpm, OR 2.9 (1.2-7.4); respiratory rate 22 bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). CONCLUSIONS: The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.

Prevention of infections associated with peripheral catheters: construction and validation of clinical scenario.

OBJECTIVES: to describe the process of construction and content validation of a clinical setting for teaching and learning the recommended practices for preventing bloodstream infection, associated with peripheral venous catheters, for nursing professionals. METHODS: methodological study of the construction of the scenario based on the National League Nursing Jeffries Simulation Theory, International Nursing Association for Clinical Simulation and Learning, and the Brazilian Health Regulatory Agency. Twelve experts performed content validation. We used to assess the degree of agreement between them, the Content Validity Index, and a descriptive analysis of the suggestions presented. RESULTS: all the requirements of the simulated clinical scenario reached an agreement between judges of more than 80% in terms of clarity and relevance. CONCLUSIONS: the steps adopted in the construction and validation of the clinical scenario proved to be adequate and relevant, and the scenario is suitable for training professionals.

Inflammatory and Infectious Processes Serve as Links between Atrial Fibrillation and Alzheimer's Disease.

Atrial fibrillation (AF) is one of the most prevalent forms of arrhythmia that carries an increased risk of stroke which, in turn, is strongly associated with cognitive decline. The majority of dementia cases are caused by Alzheimer's disease (AD) with obscure pathogenesis. While the exact mechanisms are unknown, the role of inflammatory processes and infectious agents have recently been implicated in both AD and AF, suggesting a common link between these maladies. Here, we present the main shared pathways underlying arrhythmia and memory loss. The overlapping predictive biomarkers and emerging joint pharmacological approaches are also discussed.

Local and systemic effects of aging on acute pancreatitis.

BACKGROUND: /Objectives: Evaluation of the local and systemic effects of aging on the severity of acute pancreatitis (AP) in an experimental rat model in elderly animals. METHODS: AP was induced in Wistar rats by intraductal 2.5% taurocholate injection and divided into two groups: Young (3 month old) and Aged (18 month old). Two and 24 h after AP induction blood samples were collected for determinations of amylase, AST, ALT, urea, creatinine, glucose, and of plasma I-FABP. TNF-α and IL-6 levels were determined in serum and ascitic fluid. Liver mitochondrial function and malondialdehyde (MDA) contents, pancreas histological analysis, and pulmonar myeloperoxidade (MPO) activity were performed. Bacterial translocation was evaluated by bacterial cultures of pancreas. RESULTS: A significant increase in serum amylase, AST, ALT, urea, creatinine, glucose, I-FABP, and IL-6 levels, and a reduction in serum and ascitic fluid TNF-α levels were observed in the aged group compared to the young group. Liver mitochondrial dysfunction, MDA contents, and pulmonary MPO activity were increased in the Aged AP group compared to the Young AP group. Positive bacterial cultures obtained from pancreas tissue in aged group were significantly increased compared to the young group. Acinar necrosis was also increased in aged AP group when compared to young AP group. CONCLUSION: Aging worsens the course of acute pancreatitis evidenced by increased local and systemic lesions and increased bacterial translocation.

Backward Bifurcation as a Desirable Phenomenon: Increased Fecundity Through Infection.

Backward or subcritical bifurcation is usually considered an undesirable phenomenon in epidemiology since control measures require a reduction in R0 not below one but below a much smaller value. However, there are contexts for which a backward or subcritical bifurcation is not a bad thing; it can even be desirable. Such is the case for any characteristic that can be passed to the next generation (genetically fixed or not) and that increases the effective reproductive rate of the host or the total number of individuals. In the present work, we study an epidemiological model consisting of two classes, susceptible and "infected" individuals; the model considers a characteristic that is passed from "infected" to "susceptible" by direct "contact," for instance increased fecundity. We analyze conditions for the appearance of a backward or subcritical bifurcation. We discuss the advantage for the population under infection, since the total number of individuals increases at equilibrium. If one takes that as a proxy for increased fitness, it would increase the species' ecological success. One key element in the model is the fact that "susceptible" individuals have "susceptible" descendants, but "infected" individuals can have "infected" descendants as well as "susceptible" ones. A somehow rare addition for epidemiological models, the fact that "infected" individuals reproduce more rapidly than the susceptible ones, leads to unexpected consequences. Facilitating the "inoculation" increases the total population size, i.e., the backward or subcritical bifurcation appears, with desirable consequences for the population. We show that an increase in the number of susceptible newborns is the main reason for the appearance of a backward or subcritical bifurcation, which induces a bigger population size. We analyze the effect of different combinations of susceptible/infected birth rates. This kind of phenomenon has been observed for bacterial infections in several insects-bacteria and nematodes-bacteria interactions; in particular, it has been intensely studied in interactions of wasps and flies with the genus Wolbachia. It has also been shown in amphibians.

Neonatal Pain and Infection Relate to Smaller Cerebellum in Very Preterm Children at School Age.

OBJECTIVE: To examine whether specific neonatal factors differentially influence cerebellar subregional volumes and to investigate relationships between subregional volumes and outcomes in very preterm children at 7 years of age. STUDY DESIGN: Fifty-six children born very preterm (24-32 weeks gestational age) followed longitudinally from birth underwent 3-dimensional T(1)-weighted neuroimaging at median age 7.6 years. Children with severe brain injury were excluded. Cerebellar subregions were automatically segmented using the multiple automatically generated templates algorithm. The relation between cerebellum subregional volumes (adjusted for total brain volume and sex) and neonatal clinical factors were examined using constrained principal component analysis. Cognitive and visual-motor integration functions in relation to cerebellar volumes were also investigated. RESULTS: Higher neonatal procedural pain and infection, as well as other clinical factors, were differentially associated with reduced cerebellar volumes in specific subregions. After adjusting for clinical risk factors, neonatal procedural pain was distinctively associated with smaller volumes bilaterally in the posterior VIIIA and VIIIB lobules. Specific smaller cerebellar subregional volumes were related to poorer cognition and motor/visual integration. CONCLUSIONS: In very preterm children, exposure to painful procedures, as well as additional neonatal risk factors such as infection, were associated with reduced cerebellar volumes in specific subregions and poorer outcomes at school age.

Correlation between nutritional, hematological and infectious characteristics and classification of the type of epidermolysis bullosa of patients assisted at the Dermatology Clinic of the Hospital Universitário de Brasília.

Epidermolysis bullosa comprises a group of phenotypically different genodermatosis, hereditary or acquired, characterized by skin fragility and subsequent formation of blisters in response to mechanical trauma, and which may also affect mucous membranes. This study aimed to analyze the relation between the nutritional, hematologic, infectious characteristics and the type of epidermolysis bullosa, through a descriptive case study based on data from medical records of 10 patients with epidermolysis bullosa assisted regularly at the Dermatology Clinic of the Hospital Universitário de Brasília. The old classification of the type of epidermolysis bullosa, weight and height, blood count, white blood cell count, platelet count and description of the type and frequency of secondary infections during the service were considered. We verified a predominance of iron deficiency anemia, chronic leukocytosis, thrombocytosis, chronic malnutrition, low height for age and thinness, and people with epidermolysis bullosa simplex exhibited appropriate relation between height/age and BMI/age. The non-specific skin infection was the most prevalent in both sexes. The severity of the type of epidermolysis bullosa and frequency of secondary infections did not form a directly proportional relation. The absence of direct proportion in all cases between the type of epidermolysis bullosa and the analysis parameters suggest a possible significant interference from other aspects such as the extent of the affected skin area, extracutaneous type of engagement and specific genetic mutation. The inclusion of these factors in the new classification proposed by Fine et al can contribute significantly to a better correlation of clinical parameters and appropriate preventive and therapeutic approaches.

Infection and other clinical correlates of abnormal heart rate characteristics in preterm infants.

OBJECTIVE: To identify clinical conditions associated with a large increase (spike) in the heart rate characteristics index in very low birth weight (VLBW) infants. STUDY DESIGN: Retrospective medical record review within a day of all large heart rate characteristics index spikes (increase of ≥3 from the previous 5-day average) in VLBW infants at a single center enrolled from 2007 to 2010 in a multicenter trial of heart rate characteristics monitoring. In the trial, infants were randomized to having their heart rate characteristics index displayed to clinicians or not displayed. RESULTS: Of 274 eligible infants, 224 large heart rate characteristics spikes occurred in 105 infants. Thirty-three spikes were associated with surgery or procedures requiring anesthetic or anticholinergic medications, and infection-related conditions were the most common clinical association with the other spikes. Of the first spikes in 47 infants randomized to conventional monitoring (heart rate characteristics index not displayed to clinicians), 53% were associated with suspected or proven infection. Respiratory deterioration without suspected infection occurred with 34%, and no association was identified in 13%. Infants randomized to having their heart rate characteristics index displayed were more likely to have antibiotics initiated around the time of a large heart rate characteristics index spike. CONCLUSIONS: Sepsis, other infectious or systemic inflammatory conditions, respiratory deterioration, and surgical procedures are the most common clinical associations with a large increase in the heart rate characteristics index in VLBW infants. This information may improve use of heart rate characteristics monitors in patients in the neonatal intensive care unit.

Autophagy in inflammation, infection, neurodegeneration and cancer.

In its classical form, autophagy is an essential, homeostatic process by which cytoplasmic components are degraded in a double-membrane-bound autophagosome in response to starvation. Paradoxically, although autophagy is primarily a protective process for the cell, it can also play a role in cell death. The roles of autophagy bridge both the innate and adaptive immune systems and autophagic dysfunction is associated with inflammation, infection, neurodegeneration and cancer. In this review, we discuss the contribution of autophagy to inflammatory, infectious and neurodegenerative diseases, as well as cancer.

Considerações sobre a perfusão regional antibiótica em membros de equinos / Considerations about the regional antibiotic perfusion in equine limbs / Consideraciones acerca de la perfusión regional de antibióticos en las extremidades de equinos

As infecções que acometem o sistema locomotor de equinos são tratadas comumente com o uso de antimicrobianos e antinflamátorios sistêmicos. No entanto, atualmente ocorre a expansão da indicação e uso da perfusão regional de antimicrobianos (IVAR ou antibiose) nas infecções distais dos membros de equinos.Essa técnica pode ser usada acompanhando a terapia conservadora ou como única forma de terapia antimicrobiana. O objetivo desta revisão é fornecer subsídios para o clínico de equino acerca da perfusão regional antibiótica em membros de equinos, suas indicações, os principais fármacos utilizados, métodos de aplicação e possíveis complicações.

Infections that affect the musculo skeletal system in horses are treated with systemic antimicrobialsand anti-inflammatory drugs. However, the expansion of the indication and the use of antibiotic regional perfusion(IVAR or antibiosis) in distal equine infections members currently occur. This technique can be used following the conservative or the only way to antimicrobial therapy. The aim of this review is to provide grants for clinical equine about antibiotic regional perfusion in limbs of horses, their indications, main drugs used, application methods and possible complications.

Infecciones que afectan el sistema músculo-esquelético en caballos son tratados con antibióticos sistémicos y los medicamentos anti-inflamatorios. Sin embargo, Ia expansión de Ia indicación y el uso de Iaperfusión regional de antibióticos (IVAR o antibiosis) en distales miembros infecciones de equinos se produce actualmente. Esta técnica se puede utilizar seguiendo de Ia conservadora o Ia única forma de terapia antimicrobiana.EI objetivo de esta revisión es proporcionar subvenciones para veterinario de equinos acerca de Ia perfusión regional de antibióticos en Ias extremidades de los caballos, sus indicaciones, los principales fármacos utilizados,métodos de aplicación y Ias posibles complicaciones.

Considerações sobre a perfusão regional antibiótica em membros de equinos / Considerations about the regional antibiotic perfusion in equine limbs / Consideraciones acerca de la perfusión regional de antibióticos en las extremidades de equinos

As infecções que acometem o sistema locomotor de equinos são tratadas comumente com o uso de antimicrobianos e antinflamátorios sistêmicos. No entanto, atualmente ocorre a expansão da indicação e uso da perfusão regional de antimicrobianos (IVAR ou antibiose) nas infecções distais dos membros de equinos.Essa técnica pode ser usada acompanhando a terapia conservadora ou como única forma de terapia antimicrobiana. O objetivo desta revisão é fornecer subsídios para o clínico de equino acerca da perfusão regional antibiótica em membros de equinos, suas indicações, os principais fármacos utilizados, métodos de aplicação e possíveis complicações.(AU)

Infections that affect the musculo skeletal system in horses are treated with systemic antimicrobialsand anti-inflammatory drugs. However, the expansion of the indication and the use of antibiotic regional perfusion(IVAR or antibiosis) in distal equine infections members currently occur. This technique can be used following the conservative or the only way to antimicrobial therapy. The aim of this review is to provide grants for clinical equine about antibiotic regional perfusion in limbs of horses, their indications, main drugs used, application methods and possible complications.(AU)

Infecciones que afectan el sistema músculo-esquelético en caballos son tratados con antibióticos sistémicos y los medicamentos anti-inflamatorios. Sin embargo, Ia expansión de Ia indicación y el uso de Iaperfusión regional de antibióticos (IVAR o antibiosis) en distales miembros infecciones de equinos se produce actualmente. Esta técnica se puede utilizar seguiendo de Ia conservadora o Ia única forma de terapia antimicrobiana.EI objetivo de esta revisión es proporcionar subvenciones para veterinario de equinos acerca de Ia perfusión regional de antibióticos en Ias extremidades de los caballos, sus indicaciones, los principales fármacos utilizados,métodos de aplicación y Ias posibles complicaciones.(AU)

[Cytokines and the nervous system: the relationship between seizures and epilepsy]. / Citocinas y sistema nervioso: relacion con crisis convulsivas y epilepsia.

INTRODUCTION. The immune system and the peripheral and central nervous system are in constant communication by means of messengers and signalling molecules released, such as cytokines, neuropeptides, neurohormones and neurotransmitters, among others. Seizures are defined as the transitory appearance of signs and symptoms that trigger an abnormally excessive neuronal activity in the brain. Following seizures the generation of a neuroinflammatory process has been observed to occur, with the consequent release of proinflammatory cytokines and inflammation-mediating molecules, which make the patient more prone to epilepsy. AIM. To offer evidence suggesting and supporting the role of cytokines in the appearance of seizures and in epilepsy, since these molecules have proven to have dual properties. DEVELOPMENT. The central nervous system, by means of the blood-brain barrier, restricts the flow of activated cells and inflammation mediators released from the peripheral system towards the brain parenchyma. Moreover, there is also another series of mechanisms that contributes to the 'selective and modified' immunity of the central nervous system. The purpose of all this series of events is to limit the responses of the immune system at central level, although it has been shown that in the central nervous system they are permanently under the control and regulation of the immune system. CONCLUSIONS. Cytokines in epilepsy play a dual role with pro- and anti-convulsive properties. Seizures do not induce the expression of cytokines only inside the brain, but also peripherally.

TITLE: Citocinas y sistema nervioso: relacion con crisis convulsivas y epilepsia.Introduccion. El sistema inmune y el sistema nervioso periferico y central se encuentran en constante comunicacion a traves de mensajeros y moleculas de señalizacion liberadas, como las citocinas, los neuropeptidos, las neurohormonas y los neurotransmisores, entre otros. Las convulsiones se definen como la aparicion transitoria de signos y sintomas que inducen una actividad neuronal excesiva anormal en el cerebro; despues de una crisis convulsiva, se ha observado la generacion de un proceso neuroinflamatorio, con la consecuente liberacion de citocinas proinflamatorias y de moleculas mediadoras de inflamacion, que predisponen a la epilepsia. Objetivo. Mostrar la evidencia que sugiere y apoya el papel de las citocinas en la aparicion de crisis convulsivas y en la epilepsia, ya que estas moleculas han demostrado propiedades duales. Desarrollo. El sistema nervioso central, a traves de la barrera hematoencefalica, restringe el flujo de celulas activadas y de mediadores de inflamacion liberados desde el sistema periferico hacia el parenquima cerebral; ademas, existe otra serie de mecanismos que contribuyen a la inmunidad 'selectiva y modificada' del sistema nervioso central. Toda esta serie de eventos tiene la finalidad de limitar respuestas del sistema inmune a nivel central, aunque se ha demostrado que en el sistema nervioso central se encuentran de manera permanente bajo el control y la regulacion del sistema inmune. Conclusiones. Las citocinas en la epilepsia muestran un papel dual con propiedades pro y anticonvulsionantes. Las convulsiones no solamente inducen la expresion de citocinas dentro del cerebro, sino tambien perifericamente.

Relationship between Helicobacter pylori detection and an increased risk of infection in childhood

The risk of developing gastric cancer is believed to be related to differences among Helicobacter pylori strains and the inflammatory responses mediated by host genetic factors. H. pylori infection is acquired at an early age and in the absence of appropriate antibiotic therapy, it generally persists for life. Tp53 gene regulates the transcription of several cytokines and chemokines involved in innate immunity and its action may be influenced by the presence of different H. pylori strains. The present study aimed to detect H. pylori in pediatric patients, to access Tp53 polymorphism at codon 72 and to correlate such findings with age and histopathological results. Three hundred and forty-two patients were analyzed. DNA from their gastric biopsies was extracted and the detection of H. pylori was performed through polymerase chain reaction assays, urease test and histopathologic examination. Allelic discrimination of SNP rs1042522 (Tp53) was performed by real-time polymerase chain reaction. Our results suggest a possible relationship between the presence of H. pylori and chronic gastritis in children and young patients, and showed a significant association between ageing and positivity for H. pylori. It was verified that patients aged < 10 years were 1.3 times more likely to have infection by H. pylori when compared with those aged > 10 years. Finally, no association was found between Tp53 polymorphisms and the presence of H. pylori.(AU)

Aceptabilidad del tratamiento empírico de la infección urinaria aguda en el niño / Acceptability of the ®empirical¼ treatment of acute urinary infection in children

Las guías propuestas por grupos internacionales enfatizan en la importancia del diagnóstico de la infección del tracto urinario en la atención primaria de salud, para poder iniciar un tratamiento precoz con antibióticos en los casos de mayor riesgo. El médico de atención primaria en ocasiones realiza su trabajo lejos de los laboratorios de microbiología y no puede realizar el urocultivo con la rapidez necesaria para un tratamiento adecuado. Este médico necesita disponer de pruebas diagnósticas rápidas que le ayuden a tomar la decisión médica más adecuada, aunque ninguna combinación de ellas puede sustituir al urocultivo. En esta propuesta se analizan las situaciones en las que el médico debe esperar el resultado del estudio bacteriológico y en las que puede iniciar un tratamiento empírico después de tomar la muestra para el urocultivo, si este puede realizarse. En los casos excepcionales de imposibilidad de realizar el estudio bacteriológico, el médico tiene que actuar utilizando los llamados métodos de diagnóstico rápido(AU)

The guidances proposed for international groups emphasize the significance of diagnosis of the urinary tract infection in primary health care to start an early antibiotics treatment in cases of a major risk. The primary care physician sometimes works far from the microbiology laboratories and can not to carry out a fast uroculture for an appropriate treatment. This physician needs to have available fast diagnostic tests helping him to make a more suitable medical decision, although any combination of them may to replace the uroculture. In present proposal are analyzed those situations where the physician must to await for bacteriological study results to start the empirical treatment after the sample take for uroculture if it may to be carry out. In exceptional cases of impossibility to conduct the bacteriological study, the physician must to act using the so called fast diagnosis methods(AU)

Risk factors for feline leukemia virus (FeLV) infection in cats in São Paulo, Brazil / Fatores de risco da leucemia viral felina em São Paulo, Brazil

The aim of this study was to identify risk factors for feline leukemia virus (FeLV) infection in cats (n = 812) from the city of São Paulo. Information on age, gender, outdoor access, reproductive status, origin and number of potential contacts were obtained for each animal. Direct immunofluorescence test was used to identify the infected cats. Fifty cats (6.2 %) were positive for FeLV infection. The risk factors identified were “outdoor access” (OR = 47.2; p < 0.001), “having been rescued from the street” (OR = 3.221; p = 0.008) or being three to six year old (OR = 3.046; p = 0.009); the most important risk factor was free outdoor access. A predictive model for FeLV infection was built based on the results of the multivariate analysis. Cats with free outdoor access are more predisposed to infection, with 18% more chances of becoming infected. If the animal is one to three year old, the probability increases, reaching 34%. If the cat is exposed to these three risk factors, the probability of infection is even higher (63%). When analyzed together or as isolated risk factors, the age and being rescued from the street represent less impact on the spreading of the FeLV, as the probability of infection for cats exposed to each of these risk factors is 1 and 4%, respectively. Thus, free roaming and outdoor access are the most important risk factors associated to FeLV infection among cats in São Paulo city and must be taken in consideration in the prevention of this retrovirus infection.

O objetivo deste estudo foi o de identificar os fatores de risco para a leucemia viral felina (FeLV) em uma amostragem de 812 gatos da cidade de São Paulo, Brasil. Informações sobre idade, sexo, acesso à rua, estado reprodutivo, origem e número de contactantes foram obtidos para cada animal. Teste de imunofluorescência direto para a pesquisa de antígeno viral em esfregaço de sangue periférico foi utilizado para a identificação dos felinos infectados. Foram encontrados 51 gatos (6,2%) positivos para a infecção. Os fatores de risco identificados foram “acesso a rua” (OR = 47,2; p < 0,001), “ter sido resgatado da rua” (OR = 3,221; p = 0,008) e “ter idade entre 3 e 6 anos” (OR = 3,046; p = 0,009), sendo o “livre acesso à rua” o fator de risco mais importante. Foi elaborado um modelo preditivo para a infecção pelo FeLV, baseandose nos resultados da análise multivariada. Gatos com acesso livre à rua apresentam 18% mais chances de se infectarem e se estiverem na faixa etária entre 3 e 6 anos de idade o risco aumenta para 34%. Se o gato estiver exposto aos três fatores de risco, a probabilidade de infecção é ainda mais alta, de 63%. Quando analisados em conjunto ou como fatores de risco isolados, a idade e o fato de “ter sido resgatado da rua” possuem menor impacto na disseminação de FeLV, já que a probabilidade de infecção para os gatos expostos a cada um desses fatores é de 1% e de 4%, respectivamente. Assim, o acesso livre a rua e ter sido resgatado da rua foram os fatores de risco mais importantes associados com a infecção pelo FeLV na cidade de São Paulo e devem ser levados em consideração na profilaxia da leucemia viral felina.

Risk factors for feline leukemia virus (FeLV) infection in cats in São Paulo, Brazil / Fatores de risco da leucemia viral felina em São Paulo, Brazil

The aim of this study was to identify risk factors for feline leukemia virus (FeLV) infection in cats (n = 812) from the city of São Paulo. Information on age, gender, outdoor access, reproductive status, origin and number of potential contacts were obtained for each animal. Direct immunofluorescence test was used to identify the infected cats. Fifty cats (6.2 %) were positive for FeLV infection. The risk factors identified were “outdoor access” (OR = 47.2; p < 0.001), “having been rescued from the street” (OR = 3.221; p = 0.008) or being three to six year old (OR = 3.046; p = 0.009); the most important risk factor was free outdoor access. A predictive model for FeLV infection was built based on the results of the multivariate analysis. Cats with free outdoor access are more predisposed to infection, with 18% more chances of becoming infected. If the animal is one to three year old, the probability increases, reaching 34%. If the cat is exposed to these three risk factors, the probability of infection is even higher (63%). When analyzed together or as isolated risk factors, the age and being rescued from the street represent less impact on the spreading of the FeLV, as the probability of infection for cats exposed to each of these risk factors is 1 and 4%, respectively. Thus, free roaming and outdoor access are the most important risk factors associated to FeLV infection among cats in São Paulo city and must be taken in consideration in the prevention of this retrovirus infection.(AU)

O objetivo deste estudo foi o de identificar os fatores de risco para a leucemia viral felina (FeLV) em uma amostragem de 812 gatos da cidade de São Paulo, Brasil. Informações sobre idade, sexo, acesso à rua, estado reprodutivo, origem e número de contactantes foram obtidos para cada animal. Teste de imunofluorescência direto para a pesquisa de antígeno viral em esfregaço de sangue periférico foi utilizado para a identificação dos felinos infectados. Foram encontrados 51 gatos (6,2%) positivos para a infecção. Os fatores de risco identificados foram “acesso a rua” (OR = 47,2; p < 0,001), “ter sido resgatado da rua” (OR = 3,221; p = 0,008) e “ter idade entre 3 e 6 anos” (OR = 3,046; p = 0,009), sendo o “livre acesso à rua” o fator de risco mais importante. Foi elaborado um modelo preditivo para a infecção pelo FeLV, baseandose nos resultados da análise multivariada. Gatos com acesso livre à rua apresentam 18% mais chances de se infectarem e se estiverem na faixa etária entre 3 e 6 anos de idade o risco aumenta para 34%. Se o gato estiver exposto aos três fatores de risco, a probabilidade de infecção é ainda mais alta, de 63%. Quando analisados em conjunto ou como fatores de risco isolados, a idade e o fato de “ter sido resgatado da rua” possuem menor impacto na disseminação de FeLV, já que a probabilidade de infecção para os gatos expostos a cada um desses fatores é de 1% e de 4%, respectivamente. Assim, o acesso livre a rua e ter sido resgatado da rua foram os fatores de risco mais importantes associados com a infecção pelo FeLV na cidade de São Paulo e devem ser levados em consideração na profilaxia da leucemia viral felina.(AU)

Nutritional imbalances and infections affect the thymus: consequences on T-cell-mediated immune responses.

The thymus gland, where T lymphocyte development occurs, is targeted in malnutrition secondary to protein energy deficiency. There is a severe thymic atrophy, resulting from massive thymocyte apoptosis (particularly affecting the immature CD4+CD8+ cell subset) and decrease in cell proliferation. The thymic microenvironment (the non-lymphoid compartment that drives intrathymic T-cell development) is also affected in malnutrition: morphological changes in thymic epithelial cells were found, together with a decrease of thymic hormone production, as well as an increase of intrathymic contents of extracellular proteins. Profound changes in the thymus can also be seen in deficiencies of vitamins and trace elements. Taking Zn deficiency as an example, there is a substantial thymic atrophy. Importantly, marginal Zn deficiency in AIDS subjects, children with diarrhoea and elderly persons, significantly impairs the host's immunity, resulting in an increased risk of opportunistic infections and mortality; effects that are reversed by Zn supplementation. Thymic changes also occur in acute infectious diseases, including a severe thymic atrophy, mainly due to the depletion of CD4+CD8+ thymocytes, decrease in thymocyte proliferation, in parallel to densification of the epithelial network and increase in the extracellular matrix contents, with consequent disturbances in thymocyte migration and export. In conclusion, the thymus is targeted in several conditions of malnutrition as well as in acute infections. These changes are related to the impaired peripheral immune response seen in malnourished and infected individuals. Thus, strategies inducing thymus replenishment should be considered as adjuvant therapeutics to improve immunity in malnutrition and/or acute infectious diseases.

Neutrophil paralysis in sepsis.

Sepsis develops when the initial host response is unable to contain the primary infection, resulting in widespread inflammation and multiple organ dysfunction. The impairment of neutrophil migration into the infection site, also termed neutrophil paralysis, is a critical hallmark of sepsis, which is directly related to the severity of the disease. Although the precise mechanism of this phenomenon is not fully understood, there has been much advancement in the understanding of this field. In this review, we highlight the recent insights into the molecular mechanisms of neutrophil paralysis during sepsis.