Some immunological aspects in the reaccional states of Hansen disease

The crucial clinical problem in leprosy is represented by episodes of intense inflammation that produce nerve damage. When Mycobacterium leprae has been eliminated by means of antibiotics, the death of the bacteria is not a complete solution to the damage caused in nerves. Two of the more frequent immunopathological phenomena in Hansen's disease are Type I, reactions, known as Reversal Reactions (RR), and Type II reactions, of which the most frequent and well known are those called Erythema Nodosum Leprosum (ENL). Type II reactions have been defined as an immunologic complication in multibacillary patients. Both types of reactions are accompanied mainly by the increase of pro-inflammatory cytokines TNF-alpha, IL-1, IL-2, IL-4, IL-6, IL-8, INF-gamma, IL-10, IL-12, among others. In a retrospective analysis of a population of 150 patients of the Central Service of Dermatology, Institute of Biomedicine, where these patients were subjected to Multidrug Therapy (MDT) and MDT + inmunotherapy (IMT), both groups presented type II reactions, but the group that additionally received inmunotherapy also presented type I reactions. In the group of patients that presented ENL, it appeared to be associated with the large amount of bacilli in their lesions.     

Acetylcholine in the accumbens is decreased by diazepam and increased by benzodiazepine withdrawal: a possible mechanism for dependency

Diazepam is a benzodiazepine used in the treatment of anxiety, insomnia and seizures, but with the potential for abuse. Like the other benzodiazepine anxiolytics, diazepam does not increase dopamine in the nucleus accumbens. This raises the question as to which other neurotransmitter systems are involved in diazepam dependence. The goal was to monitor dopamine and acetylcholine simultaneously following acute and chronic diazepam treatment and after flumazenil-induced withdrawal. Rats were prepared with microdialysis probes in the nucleus accumbens and given diazepam (2, 5 and 7.5 mg/kg) acutely and again after chronic treatment. Accumbens dopamine and acetylcholine decreased, with signs of tolerance to the dopamine effect. When these animals were put into the withdrawal state with flumazenil, there was a significant rise in acetylcholine (145%, P<0.001) with a smaller significant rise in dopamine (124%, P<0.01). It is suggested that the increase in acetylcholine release, relative to dopamine, is a neural component of the withdrawal state that is aversive.     

Stereotactic radiofrequency amygdalohippocampectomy: Does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome?

Purpose: Stereotactic radiofrequency amygdalohippocampectomy (SAHE) has been modified recently in our center for the therapy of mesial temporal epilepsy (MTLE). It has promising clinical results comparable with microsurgical amygdalohippocampectomy despite smaller volume reduction of the hippocampus. We hypothesized that the extent of perirhinal and entorhinal cortex (PRC, EC) reduction could explain the clinical outcome. Therefore, we performed, retrospectively, volumetric analysis of PRC and EC and compared it with the seizure control. Methods: Twenty‐six consecutive patients with MTLE treated by SAHE were included. PRC and EC volumes were measured from magnetic resonance imaging (MRI) records obtained before and 1 year after SAHE. The clinical outcome was assessed each year after SAHE using Engel’s classification. Key Findings: Twenty‐six patients were analyzed. The volume of PRC decreased by 46 ± 17% (p < 10⁻¹²); EC volume decreased by 56 ± 20% (p < 10⁻¹⁰). Two years after the procedure, 73% of patients were classified as Engel’s I, 19% as Engel’s II; in 2 (8%) the treatment failed (were reoperated). Eighteen patients finished 3 years follow‐up; 72% of them were classified as Engel’s I, 17% as Engel’s II, and in 2 (11%) above‐mentioned patients the treatment failed. Thirteen patients finished 4 years of follow‐up, 11 of them as Engel’s I. There was no significant correlation of the clinical outcome to PRC and EC volume reductions. Significance: The clinical effect of SAHE is not clearly explained by the volume reductions of PRC and EC (nor of the hippocampus and the amygdala). It promotes opinion that the extent of resection/destruction is not important for seizure outcomes.     

Interdisciplinary European Guidelines for Surgery for Severe (Morbid) Obesity

Foreword In 2005, for the first time, an expert panel named “The Bariatric Scientific Collaborative Group” (BSCG), was appointed through a joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: International Federation for the Surgery of Obesity – European Chapter (IFSO-EC), European Association for the Study of Obesity (EASO), European Childhood Obesity Group (ECOG) and the International Obesity Task Force (IOTF) which was represented during the completion process by its representatives. The BSCG was composed of officers representing the respective Scientific Societies (including four acting Presidents, two past Presidents, one Honorary President, and three Executive Directors). The panel was also balanced by the presence of many other opinion leaders in the field of obesity. The BSCG composition allowed coverage of the key disciplines in comprehensive obesity management, as well as being reflective of European geographic and ethnic diversity. This joint BSCG Expert Panel has convened several meetings which were entirely focused on guideline creation during the past 2 years. There was a specific effort to develop and concur on clinical guidelines which reflect current knowledge, expertise and evidence- based data on treatment of morbid obesity.     

Viral evolution in macaques coinfected with CCR5- and CXCR4-tropic SHIVs in the presence or absence of vaccine-elicited anti-CCR5 SHIV neutralizing antibodies

Macaques were immunized with SF162 Env-based gp140 immunogens and challenged simultaneously with the CCR5-tropic homologous SHIV(SF162P4) and the CXCR4-tropic heterologous SHIV(SF33A) viruses. Both mock-immunized and immunized animals became dually infected. Prior immunization preferentially reduced the viral replication of the homologous virus during primary infection but the relative replication of the two coinfecting viruses during chronic infection was unaffected by prior immunization, despite the fact that five of six immunized animals maintained a significantly lower overall viral replication that the control animals. Neutralizing antibodies participated in controlling the replication of SHIV(SF162P4), but not that of SHIV(SF33A). Dual infection resulted in the emergence and predominance within the circulating CCR5 virus pool, of a variant with a distinct neutralization phenotype. The signature of this variant was the presence of three amino acid changes in gp120, two of which were located in the receptor and coreceptor binding sites. Also, a significant fraction of the viruses circulating in the blood, as early as two weeks post-infection, was recombinants and prior immunization did not prevent their emergence. These findings provide new insights into the dynamic interaction of CCR5- and CXCR4-tropic HIV isolates that are potentially relevant in better understanding HIV-mediated pathogenesis.     

Postpartum depressive symptoms and the combined load of paid and unpaid work: a longitudinal analysis

Purpose  

To investigate the effects of total workload and other work-related factors on postpartum depression in the first 6 months after childbirth, utilizing a hybrid model of health and workforce participation.