The Evolution of HIV-1 Diversity in Rural Cameroon and its Implications in Vaccine Design and Trials

West-Central Africa is an epicenter of the HIV pandemic; endemic to Cameroon are HIV-1 viruses belonging to all (sub)subtypes and numerous Circulating Recombinant Forms (CRFs). The rural villages of Cameroon harbor many strains of HIV-1, though these areas are not as well monitored as the urban centers. In the present study, 82 specimens obtained in 2000 and 2001 from subjects living in the rural villages of the South and West Regions of Cameroon were subtyped in gag, pol, and env and compared to 90 specimens obtained in 2006-2008 in the same regions, in order to analyze HIV-1 evolution in these rural areas. It was found that in the South Region, the proportion of unique recombinant forms (URFs) remained constant (~40%), while the amount of URFs containing fragments of a CRF increased by 25%. (Sub)subtypes A1, F2, H, and K, and CRF09_cpx, identified in 2000 and 2001, were replaced by CRFs 01_AE, 13_cpx, 14_BG, and 18_cpx in 2006-2008. In the West Region, (sub)subtypes A2, C, G, and H, and CRFs 01_AE and 09_cpx, identified in 2000-2001, were replaced by sub-subtype A1 and CRFs 25_cpx and 37_cpx in 2006-2008. The proportion of URFs in the West Region dropped significantly over the time period by 43%. In both Regions, the proportion of CRF02_AG increased at all loci. These findings demonstrate that the evolution of HIV-1 is distinct for each endemic region, and suggests that the proportion of URFs containing CRF fragments is increasing as the genetic identity of the virus continues to shift dramatically. This highlights the concern that subtype-specific vaccines may not be relevant in Cameroon, and that the distribution of viral diversity in these regions of Cameroon must be carefully monitored.     

Influence of HLA-DRB-1 alleles on the production of antibody against CSP, MSP-1, AMA-1, and DBP in Brazilian individuals naturally infected with Plasmodium vivax

We evaluated the influence of allelic frequency of the human leukocyte antigen (HLA) -DRB1 on the acquisition of antibody response against malaria sporozoite and merozoite peptides in patients with Plasmodium vivax malaria acquired in endemic areas of Brazil. IgG antibodies were detected by enzyme-linked immunosorbent assay against four peptides of circumsporozoite protein (CSP) (amino, carboxyl, and VK210 and VK247 repeats) and peptides of merozoite surface protein 1 (MSP-1), apical membrane antigen 1 (AMA-1), and Duffy-binding protein (DBP). We found an association between HLA-DR3 and HLA-DR5 alleles and lack of antibody response to CSP amino terminal, as well as an association between HLA-DR3 and the highest antibody response to MSP1 (Pv200L). In conclusion, we suggest a potential regulatory role of the HLA-DRB1 alleles in the production of antibodies to a conserved region of P. vivax CSP and MSP1 in Brazilian population exposed to malaria.     

Polyarticular lipoma arborescens—a clinical and aesthetical case

Lipoma arborescens is a benign tumor, but it may be a reactive process to other disorders, and its clinical, analytical, radiological and ultrasound presentation may be redundant to any synovial tumor. Despite the characteristic feature on magnetic resonance imaging (MRI), the correct differential diagnosis in atypical presentation, and the need for timely removal of the lesion to prevent joint damage, forces, ultimately, to invasive procedures. The clinical case reported here, fourth described in English language publications on the polyarticular form, also presented other specificities related to one of the swellings, in the knee. Because of its atypical location in the popliteal fossa, recurrent episodes of joint effusion, personal history of knee trauma, pulmonary tuberculosis, and family history of rheumatoid arthritis required particular attention. This process was hampered by the refusal of knee (and ankle) surgery by the patient. He accepted surgical removal of the swellings of the wrists, for aesthetical reasons, with pathologic confirmation of the diagnosis, and clinical success in that location. MRI of the knee showed the typical image of lipoma arborescens, but also other changes that compromise the prognosis.     

Genetic Variability in Platelet Integrin α2β1 Density: Possible Contributor to Plasmodium vivax–induced Severe Thrombocytopenia

Understanding the pathogenesis of Plasmodium vivax malaria is challenging. We hypothesized that susceptibility to P. vivax-induced thrombocytopenia could be associated with polymorphisms on relevant platelet membrane integrins: integrin α2 (C807T), and integrin β3 (T1565C). Although β3 polymorphism was not related with P. vivax malaria, α2 807T carriers, which show high levels of integrin α2β1, had a higher probability for severe thrombocytopenia than wild-type carriers. This evidence of the association of integrin polymorphism and P. vivax morbidity was further demonstrated by a moderate but significant correlation between clinical disease and surface levels of the integrin α2β1.Plasmodium vivax infection is no longer considered a benign disease because it might cause severe or fatal episodes.^1,2 Although the mechanisms underlying P. vivax-induced pathogenesis remain poorly studied, thrombocytopenia is frequently observed in P. vivax infection.³ Recent studies suggest an association between deep thrombocytopenia and severity of the illness.⁴ However, the mechanisms leading to thrombocytopenia, as well as its contribution to malaria pathogenesis, are not well understood.Besides their central role in homeostasis, platelets contain a wide range of inflammatory, immune-modulating, and angiogenic factors. Consequently, it is not surprising that the role of platelets in the development of an array of disorders continues to emerge.⁵ Although P. vivax-induced thrombocytopenia has not been investigated in detail,³ several lines of evidence suggest that platelets participate actively in the pathogenesis of malaria.⁶ In P. vivax malaria, platelets release microparticles into the circulation, and these platelet-derived microparticles seem to be associated with acute inflammatory symptoms of disease.⁷ In addition, we have shown that levels of plasma cell-free circulating nucleic acids were closely correlated with platelet counts, increasing in a linear fashion with the spectrum of P. vivax malaria.⁸ On the basis of these observations, we hypothesized that platelet receptor polymorphisms that result in a gain of function in platelet adhesion and/or aggregation in vivo might place carriers at increased risk for P. vivax-induced thrombocytopenia.We studied the association between P. vivax and polymorphisms of platelet integrins (cell-surface heterodimeric proteins that mediate cell-matrix and cell-cell interactions⁹). The focus of this study was two gain-of-function platelet receptor single-nucleotide polymorphisms: the C807T polymorphism of integrin α2 (also known as platelet glycoprotein Ia, GPIa) and the T1565C of integrin β3 (platelet glycoprotein IIIa, GPIIIa). Both polymorphisms have been implicated in different clinical events, including those related to the coronary syndromes, probable because of their gain-of-function mechanisms.^10,11 Integrin α2, a platelet receptor for collagen, forms a functional receptor with the integrin β₁ subunit, which is essential for platelet function.⁹ The C807T single nucleotide polymorphism (single-nucleotide polymorphism no. rs1126643; National Center for Biotechnology Information, Bethesda, MD) is considered a genetic marker of the integrin α2β1 density.^12,13 Integrin β3, a common β subunit for β3-integrins, such as αIIbβ3, has a key role in platelet function by binding fibrinogen and von Willebrand factor (vWF),¹⁴ and the T1565C polymorphism (rs5918) seems to increase platelet aggregation.¹⁵ To the best of our knowledge, there has been no study that assessed the association between integrin polymorphisms and P. vivax malaria.A total of 150 P. vivax patients 2–78 years of age were enrolled in the study after written informed consent, as specified by the Brazilian National Council of Health (Protocol CEPSH/CPqRR/03/2008). Antimalarial and supportive therapies were given according to standard protocols. The study included patients with symptomatic but uncomplicated P. vivax malaria, and all volunteers were negative for P. falciparum and/or P. malariae by microscopy and polymerase chain reaction. Demographic, clinico-epidemiologic, and hematologic data of P. vivax-infected volunteers are shown in

Rabies in southeast Brazil: a change in the epidemiological pattern

This epidemiological study was conducted using antigenic and genetic characterisation of rabies virus isolates obtained from different animal species in the southeast of Brazil from 1993 to 2007. An alteration in the epidemiological profile was observed. One hundred two samples were tested using a panel of eight monoclonal antibodies, and 94 were genetically characterised by sequencing the nucleoprotein gene. From 1993 to 1997, antigenic variant 2 (AgV-2), related to a rabies virus maintained in dog populations, was responsible for rabies cases in dogs, cats, cattle and horses. Antigenic variant 3 (AgV-3), associated with Desmodus rotundus, was detected in a few cattle samples from rural areas. From 1998 to 2007, rabies virus was detected in bats and urban pets, and four distinct variants were identified. A nucleotide similarity analysis resulted in two primary groups comprising the dog and bat antigenic variants and showing the distinct endemic cycles maintained in the different animal species in this region.     

Pharmacists and travel advice for tropics in Lisbon (Portugal)

BACKGROUND: In Portugal, little is known about the quality of advice given to international travelers by pharmacists. The aim of this study was to determine pharmacists' training, experience, and interest in travel medicine and to assess the technical quality of the information given. METHODS: We sent a postal questionnaire to all pharmacies in the Lisbon area. The technical director or another graduate pharmacist was asked to complete the questionnaire. RESULTS: A total of 251 pharmacists participated in the study. Most of them (93.2%) did not have any training in travel medicine, and most of them expressed a wish to be informed and/or updated on this subject. The number of advised travelers was low. The use of repellent, protective clothes, and mosquito bed nets was the most frequent advice on protection against mosquito bites. From a subgroup of 170 pharmacists, 43.5% indicated mefloquine and 44.1% indicated chloroquine as malaria chemoprophylaxis to African countries. A significant association existed between the variables "to indicate mefloquine" and "seeks to be informed/updated on travel medicine." Those who indicated chloroquine tended to like travel medicine less. Concerning diarrhea prevention and treatment, the consumption of bottled and/or treated water and the administration of antibiotics during the episode were the most reported advice. Concerning vaccination against yellow fever, only 8 of 91 pharmacists correctly indicated all Portuguese-speaking countries with and without the risk of this disease. CONCLUSIONS: Studied pharmacists need training in travel medicine. Travel advice was incomplete and/or incorrect and must be improved.     

History and perspectives of nurses' organization in union movements

This article presents a reflection about the history of nurses' organization in union movements just like the Central Unica dos Trabalhadores--CUT (Workers Central Union) and its perspectives for the future. The objective is to clarify the presenting ways for the union movements at present time. Primary sources for reflections was CUT's documentation. The approach considers a retrospective of CUT movement in Brazil, discussing its constituting principles. The workers union reformation was also approached, inquiring if the ways to follow in current conjuncture are respecting these principles and assuming the defense of workers' rights. This union movement defended the independence of political party, focusing nursing union as well as the National Federation of Nurses, pointing out perspectives and suggesting discussing issues and linkages to the general fight of Brazilian workers.