IPTSP - Instituto de Patologia Tropical e Saúde Pública

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    Avaliação da resposta imune celular a antígenos recombinantes do Mycobacterium leprae e potencial aplicação para o diagnóstico da hanseníase paucibacilar
    (Universidade Federal de Goiás, 2011-06-30) Sampaio, Lucas Henrique Ferreira; Stefani, Mariane Martins de Araújo; http://lattes.cnpq.br/5581414958714905; Stefani, Mariane Martins de Araújo; Grossi, Maria Aparecida Faria; Moraes, Mílton Osório; Kipinis, Ana Paula Junqueira; Araújo Filho, João Alves de
    Title: The evaluation of cellular immune responses to Mycobacterium leprae recombinant antigens and potential application for the diagnosis of paucibacillary leprosy. Introduction: Leprosy is a chronic and debilitating infectious disease that is characterized by a spectrum of dermato-neurological manifestations associated with different patterns of immune responses. At one end of the spectrum paucibacillary patients (PB) which include tuberculoid (TT) and borderline tuberculoid (BT) patients mount a strong cellular immune response. On the extreme multibacillary (MB) patients including borderline-borderline (BB), borderline-lepromatous (BL) and lepromatous (LL) forms, respond to infection with vigorous antibody production. The diagnosis of leprosy is based on clinical manifestations hampering the early diagnosis before the onset of sequelae. The development laboratory tests applicable for early leprosy diagnosis is considered essential to reduce possible sources of transmission and the number of patients with physical disabilities. Methods: This work investigated the immune reactivity of a panel of 41 M. leprae (ML) recombinant proteins. The immune reactivity to ML proteins was evaluated by the production of IFNy, measured by ELISA, in the supernatants of 24 hours cultures of heparinized whole blood (whole blood assays/WBA) stimulated with ML antigen (10ug/ml). Study groups were leprosy patients both PB (TT / BT) and MB (BL / LL), newly diagnosed, untreated, classified according to Ridley and Jopling criteria. Household contacts of MB patients (HHC), HIV-1 negative patients with pulmonary tuberculosis (TB) and healthy individuals from the same endemic area (EC) were also investigated. In silico predictions were used to investigate the level of identity of the ML proteins with counterparts in other mycobacteria and to assesse the presence of potential T cell epitopes. For a selected group of immunogenic and specific ML antigens, the profile of 14 cytokines/chemokines induced in WBA was also investigated by Multiplex plataform. Results and Conclusions: The WBA results identified 11 out of 41 M. leprae recombinant proteins (ML0405, ML2055, ML2331, ML0840, ML1623, ML1556, MLI632, ML1685, ML0276, ML2044, 46f) that were classified as immunogenic and capable of inducing specific cellular immune response. These ML antigens were considered to have potential application for the development of laboratory tests for the diagnosis of PB leprosy. The same pattern of immunoreactivity identified among PB leprosy patients was observed among HHC, while MB leprosy, TB patients and healthy individuals did not respond to these antigens. In silico predictions of immunogenicity and specificity were not confirmed by ex vivo WBA results. The multiplex cytokine study with a selected group of ML antigens showed that besides IFNy, patients with PB leprosy produce other cytokines characteristic of Th1 cells (IL-2 and IL-12). Nevertheless these results that IFNy remained the best immunological marker of cellular immune response of PB patients to recombinant M. leprae proteins. MB leprosy patients secrete mainly Th2 type cytokines such as IL-4 and IL-5 in response to recombinant ML proteins. None of the 14 cytokines/chemokines analyzed in the multiplex was able to distinguish the cellular immune responses of PB patients from the majority of HHC. Although the majority of HHC response identically to PB, we observed that some individuals at greater risk of leprosy infection can mount a Th2 response, similar to MB patients.
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    Práticas integrativas e complementares na atenção primária à saúde: percepções dos profissionais sobre a oferta dos serviços na Região Metropolitana de Goiânia
    (Universidade Federal de Goiás, 2019-04-29) Silva, Pedro Henrique Brito da; Oliveira, Ellen Synthia Fernandes de; http://lattes.cnpq.br/3128365764211694; Oliveira, Ellen Synthia Fernandes de; Teixeira, Ricardo Antônio Gonçalves; Barros, Nelson Filici de
    Researches involving Complementary and Alternative Medicine (CAM) have been increasingly encouraged in order to understand how these unconventional care practices are provided in Primary Health Care (PHC). They acquire even more relevance from the perception of professionals who use them. They are important so that professionals can know the reality of these services in order to support planning and management strategies. CAM are in accordance with what is recommended at work in the field of Collective Health and in the Unified Health System, since they aim at the integrality, conection and protagonism of users regarding their care, being health promotion the structuring axis in a dialogical, creative and innovative perspective. The objective of this study was to understand the perception of health professionals who provide CAM on their use in PHC services in the Metropolitan Region of Goiânia. This is a descriptive, exploratory study with a qualitative approach. Twenty professionals who used to provide CAM took part of our study in 14 PHC services in three cities in the Metropolitan Region of Goiânia between January and August, 2018. Data were collected through semi-structured interviews, which were transcribed and analyzed through Content Analysis with the aid of NVivo© software to identify thematic categories. Most of them were nurses, aged between 31 and 40 years, and auriculotherapy was the most common complementary and alternative practice provided. The results were grouped into three categories: a) Training and qualification of professionals in CAM; b) Working with CAM; c) Conceptions of health and care. We could demonstrate that provision of ICP depended on the prior competence of the professionals or on their training in service. CAM were being organized and inserted into PHC by professionals from the Family Health Strategy (FHS), the Family Health Support Center (NASF) and the Health Academy, in a complementary way to the biomedical model. Such professionals have suffered from the disregard and ignorance of their work as well as from the lack of discussion about CAM in team meetings and lack of notes in the patients' medical records, which lends public invisibility and social humiliation to those professionals, who work within the limits imposed by the current biomedical model. On the other hand, CAM showed some change in health practices since they have contributed with a holistic perspective, individual empowerment, and a possibility of social de-medicalization, which have been enhancing the work between the Family Health teams and the Family Health Support Centers. However, there is still a concept of health and care that is rooted in disease prevention and in stimulating users’ behavioral changes. In this perspective, CAM are present in PHC, but we confirm that they have found barriers for their legitimacy, even in the presence of a national policy that establishes them.