Toxocariasis: a silent threat with a progressive public health impact

Background: Toxocariasis is a neglected parasitic zoonosis that afflicts millions of the pediatric and adolescent populations worldwide, especially in impoverished communities. This disease is caused by infection with the larvae of Toxocara canis and T. cati, the most ubiquitous intestinal nematode parasite in dogs and cats, respectively. In this article, recent advances in the epidemiology, clinical presentation, diagnosis and pharmacotherapies that have been used in the treatment of toxocariasis are reviewed. Main text: Over the past two decades, we have come far in our understanding of the biology and epidemiology of toxocariasis. However, lack of laboratory infrastructure in some countries, lack of uniform case definitions and limited surveillance infrastructure are some of the challenges that hindered the estimation of global disease burden. Toxocariasis encompasses four clinical forms: visceral, ocular, covert and neural. Incorrect or misdiagnosis of any of these disabling conditions can result in severe health consequences and considerable medical care spending. Fortunately, multiple diagnostic modalities are available, which if effectively used together with the administration of appropriate pharmacologic therapies, can minimize any unnecessary patient morbidity. Conclusions: Although progress has been made in the management of toxocariasis patients, there remains much work to be done. Implementation of new technologies and better understanding of the pathogenesis of toxocariasis can identify new diagnostic biomarkers, which may help in increasing diagnostic accuracy. Also, further clinical research breakthroughs are needed to develop better ways to effectively control and prevent this serious disease

Clinical and Virological Factors Influencing the Performance of a NS1 Antigen-Capture Assay and Potential Use as a Marker of Dengue Disease Severity

Dengue is the most prevalent arthropod-borne disease in tropical regions. The clinical manifestation may vary from asymptomatic to potentially fatal dengue shock syndrome. Early laboratory confirmation of dengue diagnosis is essential since many symptoms are not specific. Dengue non-structural protein 1 (NS1) may be used in simple antigen-capture ELISA for early detection of dengue virus infection. Our result demonstrated that the Platelia NS1 antigen detection kit had a quite low overall sensitivity. However, sensitivity rises significantly when used in combination with MAC-ELISA. When taking into account the various forms of dengue infection, the NS1 antigen detection was found relatively high in patients sampled during the first 3 days of fever onset, in patients with primary infection, DENV-1 infection, with high level of viremia and in mild form of dengue fever. In asymptomatically infected individuals, RT-PCR assay has proved to be more sensitive than NS1 antigen detection. Moreover, the NS1 antigen level correlated significantly with high viremia and low level of NS1 antigen was associated with more severe disease

Relação entre a queixa auditiva e os achados audiológicos de um grupo de idosos ativos

OBJETIVO: investigar a presença de queixa auditiva em um grupo de idosos ativos e verificara possível relação entre a autopercepção da condição de escuta e os achados audiológicos.MÉTODOS: foram avaliados 55 idosos socialmente ativos, de ambos os sexos e faixa etária igual ou superior a 60 anos. As variáveis analisadas foram as respostas à três perguntas: "O(a) senhor(a) acha que escuta bem?", "O(a) senhor(a) escuta rádio ou televisão em volume muito alto?" e "O(a) senhor(a) tem dificuldade para escutar quando muitas pessoas conversam ao mesmo tempo?" que foram comparadas às médias tritonais dos limiares das frequências de 500, 1000 e 2000 Hz (MTT1) e de 3.000, 4.000 e 6.000 Hz (MTT2), Limiar de Reconhecimento de Fala (LRF) e Índice Percentual de Reconhecimento de Fala (IPRF).RESULTADOS: os idosos que referiram não escutar bem, apresentaram piores desempenhos nas médias de todas as variáveis analisadas. Os idosos que mencionaram aumentar o volume do rádio ou televisão não apresentaram diferença estatisticamente significante na análise da MTT2 em comparação aos que não o fazem, porém, houve esta diferença quando analisadas as variáveis MTT1, LRF e IPRF. Os sujeitos que referiram dificuldade de escutar quando muitas pessoas conversam ao mesmo tempo, não apresentaram diferença estatisticamente significante, mas as médias das variáveis evidenciaram piores desempenhos destes sujeitos, quando comparados àqueles sem a queixa.CONCLUSÃO: houve presença de queixa auditiva em todas as questões e foi verificada relação entre a autopercepção da condição de escuta e os resultados da avaliação audiológica

Health services users with diabetes mellitus: from knowledge to the use of healthcare rights

This descriptive study with qualitative approach analyzes the knowledge of individuals with diabetes mellitus (DM) concerning their health rights. Open interviews were conducted with 12 individuals with DM in a university center in the interior of Sao Paulo, Brazil. Content analysis enabled the identification of two categories: the users’ (lack of) knowledge concerning their rights and the unaware exercise of their rights. The results revealed that despite the legal advancements achieved in public policies, most users with DM are unaware of their rights, although they use the benefits that accrue from law in an unconscious way. Providing complete and sufficient information is essential so that individuals are able to make the best decision in relation to their treatment, preserving their autonomy.Se trata de un estudio descriptivo de abordaje cualitativo, con el objetivo de analizar el conocimiento de los usuarios de los servicios de salud con diabetes mellitus (DM) acerca de sus derechos. Participaron 12 personas con DM atendidas en un centro universitario del interior paulista en 2008, por medio de entrevista abierta. El análisis de contenido temático de los datos posibilitó identificar dos categorías: el (des)conocimiento de los usuarios de los servicios de salud con diabetes sobre sus derechos y el ejercicio no consciente de sus derechos por las personas con DM. Fue posible constatar que, a pesar de los avances legalmente alcanzados por las políticas públicas, la mayoría de los usuarios de los servicios de salud con DM desconoce sus derechos, a pesar de que utilizan los beneficios provenientes de la legislación, de manera no consciente. Se resalta como punto fundamental proveer informaciones completas y suficientes para que la persona pueda tomar la mejor decisión en relación a su tratamiento, preservando su autonomía en los servicios de salud.Estudo descritivo de abordagem qualitativa, e teve como objetivo analisar o conhecimento dos usuários dos serviços de saúde com diabetes mellitus (DM), acerca dos seus direitos. Participaram 12 pessoas com DM, atendidas em um centro universitário do interior paulista, em 2008, por meio de entrevista aberta. A análise de conteúdo temática dos dados possibilitou identificar duas categorias: o (des)conhecimento dos usuários dos serviços de saúde com diabetes sobre seus direitos e o exercício não consciente dos seus direitos pelas pessoas com DM. Foi possível constatar que, apesar dos avanços legalmente alcançados pelas políticas públicas, a maioria dos usuários dos serviços de saúde com DM desconhece seus direitos, embora utilize, de maneira não consciente, os benefícios advindos da legislação. Ressalta-se como ponto fundamental prover informações completas, suficientes para que a pessoa possa tomar a melhor decisão em relação ao seu tratamento, preservando sua autonomia, nos serviços de saúde

Eosinophils in glioblastoma biology

Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. The development of this malignant glial lesion involves a multi-faceted process that results in a loss of genetic or epigenetic gene control, un-regulated cell growth, and immune tolerance. Of interest, atopic diseases are characterized by a lack of immune tolerance and are inversely associated with glioma risk. One cell type that is an established effector cell in the pathobiology of atopic disease is the eosinophil. In response to various stimuli, the eosinophil is able to produce cytotoxic granules, neuromediators, and pro-inflammatory cytokines as well as pro-fibrotic and angiogenic factors involved in pathogen clearance and tissue remodeling and repair. These various biological properties reveal that the eosinophil is a key immunoregulatory cell capable of influencing the activity of both innate and adaptive immune responses. Of central importance to this report is the observation that eosinophil migration to the brain occurs in response to traumatic brain injury and following certain immunotherapeutic treatments for GBM. Although eosinophils have been identified in various central nervous system pathologies, and are known to operate in wound/repair and tumorstatic models, the potential roles of eosinophils in GBM development and the tumor immunological response are only beginning to be recognized and are therefore the subject of the present review

Heat-Killed Trypanosoma cruzi Induces Acute Cardiac Damage and Polyantigenic Autoimmunity

Chagas heart disease, caused by the protozoan parasite Trypanosoma cruzi, is a potentially fatal cardiomyopathy often associated with cardiac autoimmunity. T. cruzi infection induces the development of autoimmunity to a number of antigens via molecular mimicry and other mechanisms, but the genesis and pathogenic potential of this autoimmune response has not been fully elucidated. To determine whether exposure to T. cruzi antigens alone in the absence of active infection is sufficient to induce autoimmunity, we immunized A/J mice with heat-killed T. cruzi (HKTC) emulsified in complete Freund's adjuvant, and compared the resulting immune response to that induced by infection with live T. cruzi. We found that HKTC immunization is capable of inducing acute cardiac damage, as evidenced by elevated serum cardiac troponin I, and that this damage is associated with the generation of polyantigenic humoral and cell-mediated autoimmunity with similar antigen specificity to that induced by infection with T. cruzi. However, while significant and preferential production of Th1 and Th17-associated cytokines, accompanied by myocarditis, develops in T. cruzi-infected mice, HKTC-immunized mice produce lower levels of these cytokines, do not develop Th1-skewed immunity, and lack tissue inflammation. These results demonstrate that exposure to parasite antigen alone is sufficient to induce autoimmunity and cardiac damage, yet additional immune factors, including a dominant Th1/Th17 immune response, are likely required to induce cardiac inflammation