Most studies that have evaluated the stomachs of patients with Chagas disease were performed before the discovery of Helicobacter pylori and used no control groups. This study compared the gastric ...features of chagasic and non-chagasic patients and assessed whether gastritis could be associated with Chagas disease.
Gastric biopsy samples were taken from patients who underwent endoscopy for histological analysis according to the Updated Sydney System. H. pylori infection was assessed by histology, 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR), serology and the 13C-urea breath test. Patients were considered H. pylori-negative when all of these diagnostic tests were negative. Clinical and socio-demographic data were obtained by reviewing medical records and using a questionnaire.
The prevalence of H. pylori infection (70.3% versus 71.7%) and chronic gastritis (92.2% versus 85%) was similar in the chagasic and non-chagasic groups, respectively; such as peptic ulcer, atrophy and intestinal metaplasia. Gastritis was associated with H. pylori infection independent of Chagas disease in a log-binomial regression model. However, the chagasic H. pylori-negative patients showed a significantly higher grade of mononuclear (in the corpus) and polymorphonuclear (PMN) (in the antrum) cell infiltration. Additionally, the patients with the digestive form of Chagas disease showed a significantly lower prevalence of corpus atrophy than those with other clinical forms.
The prevalence of H. pylori infection and of gastric histological and endoscopic features was similar among the chagasic and non-chagasic patients. Additionally, this is the first controlled study to demonstrate that H. pylori is the major cause of gastritis in patients with Chagas disease.
Hysteroscopy has become the first choice approach for patients with suspicion for intrauterine lesions. The one-stop approach in which diagnosis and hysteroscopic treatment is performed in one ...session has been described as being highly appreciated by the patient, has a low risk profile, and is a cost-efficient approach. This study addresses the value of hysteroscopy on diagnostic accuracy and its effectiveness to the one-stop therapeutic approach. This is a prospective study of patients admitted in the ambulatory surgery unit of the Sto. André–Leiria Hospital (Portugal) from February 2005 to February 2008 for a one-stop diagnostic and therapeutic approach. Patient selection was done on transvaginal ultrasound findings or on clinical pathology. Depending on the transvaginal ultrasound report and the clinical data, the instrumentation and analgesia for the one-stop approach was defined. The average age was 54 years (range24–87 years). The majority of patients (96.2%) presented with a transvaginal ultrasonographic lesion. The hysteroscopic evaluation characterized the hysteroscopic findings in two groups: the “uterine cavity lesions” (endometrial and cervical polyps, myomas, malignant smooth muscle tumor, placenta or first trimester debris, bone, adhesions or septum, lost IUD, or no lesion) and “the endometrial characterization” (which include functional atrophic or thin endometrium, dysfunctional, endometritis, cystic atrophy, hyperplasia, polypoid, and carcinoma). We concluded that the ambulatory performance of direct visualization of uterine cavity by hysteroscopy guarantees a high diagnostic accuracy, allowing the simultaneous accomplishment of biopsies and surgical treatment of the visualized lesions.
Aim: To determine the prevalence and risk factors associated with Helicobacter pylori infection among children up to 6 years. Methods: Cross-sectional study carried out in a poor urban community in ...Fortaleza Northeast Brazil. A standardized questionnaire was applied. Helicobacter pylori status was evaluated by 13C-urea breath test (13C-UBT) in children up to 48 months and by ELISA in the mothers. Sera were assayed by the Cobas Core anti-H. pylori IgG EIA. Results: The overall prevalence of H. pylori infection was 40% (88/217), 41% (46/112) boys and 40% (42/105) girls were infected. The prevalence rate of infection by H. pylori increased significantly with age, from 29% (27/93) in the youngest group (3 months to 2 years) to 59% (35/59) in the oldest group (6 years), (p < 0.001). There was no significant difference in the prevalence of infection between gender, height and weight adjusted for age, history of breastfeeding, mother's education, number of people per room, number of people per bed, smoking habit of the mother and children's history of antibiotic intake. A significant difference was found in the prevalence of H. pylori infection and H. pylori status of mother (p = 0.02; odds ratio (OR) 2.98; 95% confidence interval (CI): 1.19–7.46) that remained significant after adjustment for covariates in multivariate analysis (p = 0.012; OR 4.65; 95%CI: 1.39–15.58). Conclusions: This study shows that children living in low socioeconomic status and poor hygienic conditions are infected very early in childhood. It identifies age and H. pylori positive mother as independent risk factors for infection.
The definition of immune Thrombocytopenia (ITP) as a peripheral blood platelet count less than 100 × 10⁹/L instead of the historical criteria of 150 × 10⁹/L renders subjects with platelets between ...100 and 150 × 10⁹/L without a diagnosis. Here, we demonstrated that these subjects have enhanced levels of proinflammatory cytokines linked to Th1 and Th17 cell response, and are more frequently carriers of polymorphisms in genes that code cytokines involved in the commitment of Th1 and Th17 immune response, when compared with controls, similarly to that observed in patients with ITP.
We evaluated, employing a logistic regression model, the association between Helicobacter pylori infection and cirrhosis in a cohort of 106 patients (57 males; mean age, 52.9 years; range, 20-78 ...years) with chronic hepatitis C virus (HCV) from Rosario, Argentina. HCV was confirmed by ELISA and PCR. H. pylori status was determined by ELISA. Of the 106 patients evaluated, 47 (44.3%) had cirrhosis. A total of 70.2% (33/47) of cirrhotic patients and 47.5% (28/59) of noncirrhotic patients were H. pylori-positive. In univariate analyses, cirrhosis was associated with age (P = 0.016) and H. pylori-positive status (P = 0.019) but not with gender (P = 0.28) or length of infection (P = 0.35). In multivariate analysis, H. pylori infection (P = 0.037; OR = 2.42; 95% CI = 1.06-5.53) and age (P = 0.033; OR = 1.04; 95% CI = 1.00-1.07) of patients remained significant and independently associated with cirrhosis. In conclusion, our results demonstrate an association between H. pylori infection and cirrhosis in patients with hepatitis C virus.
•Energy metabolism is disrupted in blood of septic patients.•Central glucose and glutamate abnormalities were observed in a rat model of sepsis.•Sepsis-activated PBMC mediators are able to direct ...trigger astrocyte reactivity.•PI3K inhibition recapitulates astrocyte energy crisis induced by PBMC mediators.
Sepsis is characterized by a severe and disseminated inflammation. In the central nervous system, sepsis promotes synaptic dysfunction and permanent cognitive impairment. Besides sepsis-induced neuronal dysfunction, glial cell response has been gaining considerable attention with microglial activation as a key player. By contrast, astrocytes’ role during acute sepsis is still underexplored. Astrocytes are specialized immunocompetent cells involved in brain surveillance. In this context, the potential communication between the peripheral immune system and astrocytes during acute sepsis still remains unclear. We hypothesized that peripheral blood mononuclear cell (PBMC) mediators are able to affect the brain during an episode of acute sepsis. With this in mind, we first performed a data-driven transcriptome analysis of blood from septic patients to identify common features among independent clinical studies. Our findings evidenced pronounced impairment in energy-related signaling pathways in the blood of septic patients. Since astrocytes are key for brain energy homeostasis, we decided to investigate the communication between PBMC mediators and astrocytes in a rat model of acute sepsis, induced by cecal ligation and perforation (CLP). In the CLP animals, we identified widespread in vivo brain glucose hypometabolism. Ex vivo analyses demonstrated astrocyte reactivity along with reduced glutamate uptake capacity during sepsis. Also, by exposing cultured astrocytes to mediators released by PBMCs from CLP animals, we reproduced the energetic failure observed in vivo. Finally, by pharmacologically inhibiting phosphoinositide 3-kinase (PI3K), a central metabolic pathway downregulated in the blood of septic patients and reduced in the CLP rat brain, we mimicked the PBMC mediators effect on glutamate uptake but not on glucose metabolism. These results suggest that PBMC mediators are capable of directly mediating astrocyte reactivity and contribute to the brain energetic failure observed in acute sepsis. Moreover, the evidence of PI3K participation in this process indicates a potential target for therapeutic modulation.
Helicobacter pylori infection is mainly acquired in childhood, and polymorphisms in the host genes coding for Toll-like receptors (TLRs) may influence the innate and adaptive immune response to the ...infection, affecting the susceptibility to
H. pylori or the disease outcomes. Our aim was to investigate whether
TLR4,
TLR2, and
TLR5 polymorphisms were associated with
H. pylori susceptibility and risk for duodenal ulcer in children. Gastric biopsy specimens were obtained at endoscopy for evaluation of
H. pylori status,
TLR4,
TLR2 and
TLR5 polymorphisms from 486 children (254
H. pylori-negative and 232
H. pylori-positive: 72 with and 160 without duodenal ulcer).
cagA status of
H. pylori infection was investigated by PCR. The levels of gastric cytokines were detected by ELISA.
H. pylori-positivity or duodenal ulcer were not associated with
TLR2,
TLR4 or
TLR5 polymorphisms. Otherwise, the presence of
TLR4 polymorphic allele was associated with infection by
cagA-positive strains and with increased gastric levels of interleukin-8 and interleukin-10.
TLR4 polymorphism might ultimately contribute to more severe consequences of the infection in adulthood since it was associated with susceptibility to
cagA-positive
H. pylori infection early in life.
•Effects of prenatal caffeine intake were investigated on synaptic proteins in the embryonic periods E18 and E20.•Body weight was decreased by higher caffeine in embryos E20.•Brain-derived ...neurotrophic factor (BDNF) was differently altered in the cortex at E18 and E20.•Sonic hedgehog (Shh) was increased by moderate and high doses of caffeine in the hippocampus and cortex.•Caffeine at lower dose increased NeuN-stained nuclei in the cortex at E20 and moderate dose in the hippocampus at E18.
Caffeine is the psychostimulant most consumed worldwide. However, little is known about its effects during fetal brain development. In this study, adult female Wistar rats received caffeine in drinking water (0.1, 0.3 and 1.0g/L) during the active cycle in weekdays, two weeks before mating and throughout pregnancy. Cerebral cortex and hippocampus from embryonic stages 18 or 20 (E18 or E20, respectively) were collected for immunodetection of the following synaptic proteins: brain-derived neurotrophic factor (BDNF), TrkB receptor, Sonic Hedgehog (Shh), Growth Associated Protein 43 (GAP-43) and Synaptosomal-associated Protein 25 (SNAP-25). Besides, the estimation of NeuN-stained nuclei (mature neurons) and non-neuronal nuclei was verified in both brain regions and embryonic periods. Caffeine (1.0g/L) decreased the body weight of embryos at E20. Cortical BDNF at E18 was decreased by caffeine (1.0g/L), while it increased at E20, with no major effects on TrkB receptors. In the hippocampus, caffeine decreased TrkB receptor only at E18, with no effects on BDNF. Moderate and high doses of caffeine promoted an increase in Shh in both brain regions at E18, and in the hippocampus at E20. Caffeine (0.3g/L) decreased GAP-43 only in the hippocampus at E18. The NeuN-stained nuclei increased in the cortex at E20 by lower dose and in the hippocampus at E18 by moderate dose. Our data revealed that caffeine transitorily affect synaptic proteins during fetal brain development. The increased number of NeuN-stained nuclei by prenatal caffeine suggests a possible acceleration of the telencephalon maturation. Although some modifications in the synaptic proteins were transient, our data suggest that caffeine even in lower doses may alter the fetal brain development.
Resumo: Introdução: A mentoria na Faculdade de Medicina da Universidade Federal de Minas Gerais se iniciou em 2001, em resposta a dificuldades emocionais dos estudantes, mas foi precedida por um ...projeto experimental, fundamentado no modelo de ajuda, em 1983. Relato de experiência e discussão: Desde o seu início, muitos foram os desafios enfrentados, desde sua valorização e o entendimento de sua finalidade até a dificuldade de participação e manutenção dos mentores, bem como a ocorrência de uma mudança curricular nesse período. Para responder a esses desafios, algumas soluções foram propostas, como a educação continuada e a supervisão para os mentores, a criação da comentoria e da monitoria com o mentor júnior, e a busca de mentores voluntários. Novos desafios surgem a cada dia, mas a mentoria completou 20 anos de funcionamento no formato de disciplina obrigatória. Convive atualmente com dificuldades que a fragilizam e ameaçam, principalmente o fato de, embora institucional, ser dependente do esforço pessoal de um grupo de profissionais que nela acreditam. Conclusão: A difusão do conceito de mentoring e de sua importância na formação médica, a valorização de professores que se interessam pela atividade de mentoria, com reconhecimento de seu trabalho pela instituição, e a formação continuada de mentores foram e continuam sendo medidas necessárias para o fortalecimento da mentoria.
Abstract: Introduction: Mentoring at the Federal University of Minas Gerais Medical School started in 2001 in response to emotional difficulties reported by students, but was preceded by an experimental project based on the aid model in 1983. Experience report and discussion: Many challenges have been faced from the outset, from appreciating and understanding the purpose of the program, to ensuring the participation of and maintaining mentors, in addition to a curricular change that occurred in this period. In response to these challenges, some solutions have been proposed, such as continuing education and supervision for mentors, the creation of co-mentoring and undergraduate course monitoring, with the junior mentor and the search for volunteer mentors. New challenges arise every day, but the mentoring program is now twenty years’ old as a compulsory subject of the medicine course. Mentoring currently has difficulties that weaken and threaten it, especially its dependence on the personal effort of a group of professionals who believe in it. Conclusion: The diffusion of the concept of mentoring and its importance in medical training; the appreciation of teachers who are interested in the mentoring activity, with recognition of their work by the institution, and the continued training of mentors have been and continue to be necessary measures to strengthen mentoring.
Objective. Helicobacter pylori infection causes hyperproliferation which is believed to predispose to the development of gastric carcinoma. The aim of this study was to analyze epithelial cell ...proliferation topographically in H. pylori gastritis in relationship to cagA status. Material and methods. The proliferative index (PI: Ki-67-labeled nuclei/total number of foveolar nuclei) was determined in gastric mucosa biopsies taken at the antrum (lesser and greater curvatures), incisura, and corpus (greater curvature) from 78 patients with H. pylori gastritis and 20 H. pylori-negative patients. H. pylori and cagA status were determined by polymerase chain reaction (PCR) and serology. Results. PIs were significantly higher in H. pylori- and cagA-positive patients, in comparison with H. pylori- and cagA-negative patients, at all sites (p≤0.002 and p≤0.009) and in the antrum in comparison to the corpus, in both H. pylori-negative (p=0.04) and positive patients (p<10−3). At the antral lesser curvature, PIs were higher than in all the other sites, both in H. pylori- (p≤0.002) and cagA-positive groups (p≤0.02). The PI correlated directly and significantly with inflammation in infected patients (r=0.45, p<10−3) and in cagA-positive patients (r=0.41, p=0.005). The PI was significantly higher in the antrum of infected patients with atrophy (p=0.03) and intestinal metaplasia (p=0.05) than in those without atrophy and intestinal metaplasia, respectively. Conclusions. We demonstrated that H. pylori infection and cagA-positive strains promote epithelial proliferation that was correlated with host inflammatory reaction and mostly at the antral lesser curvature, which is recognized as the area where most carcinomas arise.
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