A hanseníase é geralmente agravada pelo aparecimento de reações, que são quadros inflamatórios de difícil tratamento e a principal causa de seqüelas. Nossa hipótese é de que deficiência e/ou perda da função das células T reguladoras (Tregs) podem estar envolvidas no desenvolvimento das reações. Além da avaliação da frequência das Tregs circulantes em pacientes com reação tipo 1 (R1) e reação tipo 2 (R2), também foi avaliada a frequência in situ de FoxP3, IL-17, IL-6 e TGFbeta. Pacientes com R2 apresentaram expressiva diminuição na frequência das Tregs circulantes e in situ em comparação com pacientes com R1 e com os controles. Paralelamente a diminuição das Tregs nas R2 foi observado aumento da expressão de IL-17 in situ e diminuição da expressão de TGFbeta. Biópsias obtidas de pacientes com R1 e R2 antes do episódio reacional mostraram números de células FoxP3+ e IL-17+ similares entre os dois grupos. Entretanto, nas biópsias obtidas durante a reação foi observado diminuição de Tregs e aumento de células IL-17+ em pacientes com R2, enquanto que pacientes com R1 apresentaram o oposto: aumento de Tregs e diminuição de células IL-17+. Além disso, foi observada diminuição da expansão das Tregs frente ao estímulo in vitro com Mycobacterium leprae e uma tendência a baixa expressão de FoxP3 e da molécula imunossupressora CTLA-4 em Tregs de pacientes com R2. Nossos resultados sugerem que nas R2, a diminuição na frequência de Tregs possa estar favorecendo o desenvolvimento de uma resposta Th17, a qual é característica deste tipo de reação. Adicionalmente, com a finalidade de obter um número suficiente de Tregs para realização de ensaios funcionais com estas células, uma vez que se trata de uma subpopulação com baixa freqüência no sangue periférico ( < 10%), foram estabelecidos e avaliados três protocolos distintos para expansão in vitro de Tregs: protocolo Rapamicina, protocolo TGFbeta e protocolo Vitamina D3. Todos os protocolos foram capazes de induzir expansão de Tregs viáveis nos grupos estudados (paucibacilares e multibacilares sem reação, R1 e R2). Em todos os grupos estudados as Tregs expandidas apresentaram capacidade de suprimir a proliferação de linfócitos TCD4+ e TCD8+. Apesar dos três protocolos testados apresentarem capacidade de expandir Tregs in vitro, selecionamos para ensaios futuros os protocolos Rapamicina e TGFbeta por apresentarem melhor custo-benefício. A expansão in vitro será utilizada para estudos funcionais das Tregs buscando melhor entendimento do envolvimento desta subpopulação na patogenia das reações hansênicas / Leprosy is frequently complicated by the appearance of reactions that are difficult to treat and are the main cause of sequelae. We speculated that disturbances in regulatory T-cells (Tregs) could play a role in leprosy reactions. We determined the frequency of circulating Tregs in patients with type 1 reaction (T1R) and type 2 reaction (T2R). The in situ frequency of FoxP3 and interleukin (IL)-17, IL-6, and transforming growth factor beta (TGF)-beta expressing cells was also determined. T2R patients showed markedly lower number of circulating and in situ Tregs than T1R patients and controls. This decrease was paralleled by increased in situ IL-17 expression but decreased TGF-beta expression. Biopsies from T1R and T2R patients before the reaction episodes showed similar number of forkhead box protein P3 + (FoxP3+) and IL-17+ cells. However, in biopsies taken during the reaction, T2R patients showed a decrease in Tregs and increase in IL-17+ cells, whereas T1R patients showed the opposite: Tregs increased but IL17+ cells decreased. We also found decreased expansion of Tregs upon in vitro stimulation with Mycobacterium leprae and a trend for lower expression of FoxP3 and the immunosuppressive molecule CTLA-4 in T2R Tregs. Our results provide some evidence to the hypothesis that, in T2R, downmodulation of Tregs may favor the development of T-helper-17 responses that characterize this reaction. In addition, aiming to provide sufficient number of Tregs to perform functional assays with these cells, as they correspond to a subtle subpopulation among the peripheral blood mononuclear cells ( < 10%), we established and analyzed three different protocols for in vitro Tregs: a Rapamycin protocol, a TGFbeta protocol and a Vitamina D3 protocol. All three protocols were able to induce the expansion of viable in the four types of patients of the study (paucibacillary and multibacillary patients without reaction, and R1 and R2 patients). In these four groups the tregs were able to suppress the proliferative response of TCD4+ e TCD8+ lymphocytes. Although the three protocols resulted in expansion of Tregs, we selected two of them, Rapamycin and TGFbeta for further assays since they showed better cost-benefit. The in vitro expansion will be used to perform functional assays of the Tregs aiming at a better understanding of the involvement of this subpopulation in the pathogenesis of the leprosy reaction episodes

Neglected tropical diseases (NTD) in low- and middle-income countries are still not on target per the World Health Organization's (WHO) elimination goal of 2020. Mass drug administration (MDA) is one of the effective strategies supported by the WHO for the control and subsequent elimination of NTD. This quantitative study explored how supply chain logistic capacity may be hampering MDA coverage in countries in which the diseases are endemic. The study examined secondary data from WHO data bank for MDA coverage, to quantify the relationship between supply chain logistics capacity, as measured by the World Bank's logistics performance index (LPIs), and the control of NTD using MDA. The ecological theory of health behavior was the theoretical framework for this study. The research questions explored whether a low- and/or middle-income country's supply chain infrastructure, logistics services, customs and border procedures, and supply chain reliability, predict the coverage of MDA in controlling NTD. A multiple regression model determined the linear relations between each predictor: supply chain infrastructure (H1), logistics services (H2), custom and border procedures (H3), and supply chain reliability (H4) and the control of neglected diseases as determine by MDA. Results indicated that supply chain capacity, custom and border processes, and supply chain reliability are statistically significant in predictors of MDA coverage in the control of NTD in developing countries. This study may enhance social change by improving supply chain capacity for more effective distribution of PCT drugs, thus helping with the elimination of NTDs and improved health outcomes in low- and middle-income countries.

Medieval glasses have for long been a neglected object group in archeological research in Sweden. With that in mind I choose to write about those in my essay. The aim of this paper is to bring the medieval glasses into the archaeological research. I intend to show where you can find medieval glass in Sweden and what kind of glasses have been made. I will also discuss why the archeological research is so limited when it comes to the medieval drinking glasses. The archeological sites for my analysis are Sigtuna, Stockholm, Lödöse and Skanör. My theoretical approach is Material agency and I have looked at what role the drinking glasses could have had during the medieval period. I think my essay will show that you can find medieval glasses in trade or exchange contexts and that the medieval glasses absence in the archeological research has more to do with that previous research is poor rather than that glasses do not exist in the medieval period. / Gamla Uppsala - framväxten av ett mytiskt centrum

This qualitative study is a narrative investigation that analyzes the educational experiences of the segregated Turkish people of Sumter County, South Carolina during the integration movement. Four participants share their stories of how attending an elementary school for Turkish students affected their integration into White high schools. Oral history is the specific research methodology that is used. The theoretical framework that guides this study is critical-narrative theory. Through critical research, the researcher analyzes how “the social institution of school is structured such that the interests of some members and classes of society are preserved and perpetuated at the expense of others” (Merriam, 2001, p. 5). Narrative theory also informs this study. Connelly and Clandinin (1990) explain that the heart of narrative analysis is “the ways humans experience the world” (p. 2). The research questions that guide this study are the following: (1) How do the Turkish people of Sumter County, South Carolina, who attended public school during the early part of the 20th century, describe their educational experiences?, and (2) What are the perceptions of the Turkish people regarding the integration movement, educational power struggles and oppression? Through in-depth interviews, participants discuss (a) thoughts on being Turkish, (b) feelings of isolation, (c) experiences at the Dalzell School, (d) experiences at the high schools (Edmunds and Hillcrest), (e) attitudes toward other ethnic groups, and (f) perceptions of the integration movement. The overwhelming evidence from interviews supports Freire’s (2006) two stages of the pedagogy of the oppressed. Freire states, In the first, the oppressed unveil the world of oppression and through the praxis commit themselves to its transformation. In the second stage, in which the reality of oppression has already been transformed, this pedagogy ceases to belong to the oppressed and becomes a pedagogy of all people in the process of permanent liberation (p. 54). The educational implications of this study offer insight into how today’s educators are called to “renew our minds so that the way we live, teach, and work can reflect our joy in cultural diversity, our passion for justice, and our love of freedom” (bell hooks, 1994, p.34).

Comprendre les rétroactions entre les maladies infectieuses, la structure des écosystèmes et le développement économique est nécessaire pour alléger le fardeau des maladies tropicales négligées. Ce groupe d'infections parasitaires, virales, et bactériennes est étroitement associé à des conditions géographiques, environnementales, sanitaires et économiques particulières aux régions tropicales. A travers l'étude de l'ulcère de Buruli, une maladie émergente et négligée associé à une morbidité et handicap très importants dans des régions tropicales, ce travail de thèse s'intéresse aux interactions complexes entre ces différents composants des systèmes épidémiologiques. Combinant un travail de terrain important pour la collecte des données environnementales avec une approche de recherche multidisciplinaire, cette thèse vise à améliorer notre compréhension des différents aspects de l'écologie et de l'épidémiologie de cette maladie infectieuse. Notamment, la dynamique de son agent pathogène, M. ulcerans, est caractérisée pour un large éventail d'écosystèmes et communautés aquatiques au Cameroun, permettant d'identifier les facteurs environnementaux permettant sa propagation. En outre, nous évaluons la transmission de l'agent pathogène de l'environnement à l'homme et l'impact de la maladie sur le développement économique des populations endémiques. Ainsi, ce travail montre comment les dynamiques écologiques, épidémiologiques, environnementales et économiques interagissent de concert, mettant en évidence de façon criante le besoin d'une telle approche interdisciplinaire dans l'étude des maladies tropicales négligées. / Understanding the feedbacks between infectious diseases, ecosystem structure and economic development is necessary to alleviate the burden of Neglected Tropical Diseases. This group of parasitic, viral, and bacterial infections is closely associated with particular geographical and environmental conditions mainly present in the tropics, thriving under conditions of poverty, inefficient sanitation and malnutrition. This PhD thesis works through the case study of Buruli ulcer, an emerging and neglected infectious disease associated with a great morbidity and disability burden in tropical regions. Relying on an extensive environmental field survey and a multidisciplinary research approach, this PhD attempts to gain a better understanding of different aspects of the ecology and epidemiology of Buruli ulcer. Notably, the dynamics of its pathogen, M. ulcerans are characterized for a wide range of freshwater ecosystems and aquatic communities in Cameroon, and the environmental drivers of M. ulcerans presence are investigated. Furthermore, we assess the transmission of the pathogen from the environment to humans and the impact of the disease on the economic development of endemic populations. Thus, this work shows how the interplay between ecological, epidemiological and economic dynamics interact together and calls for an urgent need to apply such inter-disciplinary approach to decrease the burden of neglected tropical diseases.

This investigation presents two literary case studies that demonstrate the heterogeneity of Wilhelmine popular fiction, both in terms of thematic orientation and aesthetic quality. The chosen authors are women from bourgeois backgrounds who were prolific and well-known during their life-time, but who have since been relegated. They target the ‘new middle class’ of that era as their readership and, respectively, represent two important but contested genres of late nineteenth-century popular fiction: Heimatkunst and the Sozialroman. Heimatkunst has been dismissed as a homogeneous propagator of right-wing ideology. Yet the texts of Charlotte Niese evidence ‘resistant practice’ within and against prevailing discourse parameters. Her autobiographical writing demonstrates a type of nationalism orientated in dignity and independence, rather than competition and militarism, while also showing how political indoctrination and imposition poisoned the vernacular social status quo which otherwise managed to integrate antagonistic values and attitudes. Her fictional narratives highlight how writing dubbed Heimatkunst was subject to hybridisation, at times to amount to an approximation of a modernist aesthetic. The Sozialroman has been dismissed as a trivial ‘variety of social recipes’. Luise Westkirch’s narratives, however, incorporate thorough-going social reform. Her shorter narratives include astute, psychologically-based social critique which facilitates insights into contemporaneous preoccupations and slow perceptual changes. Incorporating tenets derived from the German romantic legacy, her narratives challenge dominant discourse parameters directly. In the process, the internationally ubiquitous interpretation of competition and power as basic instinctual drives is deconstructed as an erroneous and self-destructive assumption. Westkirch’s complex narratives establish sub-textual agendas through ‘thematic compounding’ that directs the reader’s attention overtly at one set of issues while covertly commenting on another. In this way, she constructs gender inequality as an indictment of normative socio-political systems. This study therefore argues that popular fiction located in a time of cultural crisis has the potential to make explicit the parameters of the prevailing dominant discourse, against which specific values are articulated. Since a conscious formulation of these parameters is essential to the loosening of any conceptual hegemony, which depends on implicitness, fiction thus situated can yield new perspectives, not only in terms of historical insight, but in terms of conceptual alternatives that also have contemporary relevance.

Submitted by Claudio Rodrigues (cmrodrigues@fiocruz.br) on 2016-06-28T19:14:00Z No. of bitstreams: 1 CLAUDIO RODRIGUES_DISSERTAÇAO CORRIGIDA .pdf: 2265812 bytes, checksum: 68f7d8387b81a68dfe4e2de14e1cb850 (MD5) / Approved for entry into archive by Vanessa Suane (vanessa.suane@icict.fiocruz.br) on 2016-06-30T13:57:52Z (GMT) No. of bitstreams: 1 CLAUDIO RODRIGUES_DISSERTAÇAO CORRIGIDA .pdf: 2265812 bytes, checksum: 68f7d8387b81a68dfe4e2de14e1cb850 (MD5) / Made available in DSpace on 2016-06-30T13:57:52Z (GMT). No. of bitstreams: 1 CLAUDIO RODRIGUES_DISSERTAÇAO CORRIGIDA .pdf: 2265812 bytes, checksum: 68f7d8387b81a68dfe4e2de14e1cb850 (MD5) Previous issue date: 2016 / Made available in DSpace on 2016-07-13T19:26:55Z (GMT). No. of bitstreams: 3 CLAUDIO RODRIGUES_DISSERTAÇAO CORRIGIDA .pdf.txt: 244228 bytes, checksum: d272b68943e8fa361482f6a470d564f7 (MD5) license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5) CLAUDIO RODRIGUES_DISSERTAÇAO CORRIGIDA .pdf: 2265812 bytes, checksum: 68f7d8387b81a68dfe4e2de14e1cb850 (MD5) Previous issue date: 2016 / Fiocruz. Centro de Desenvolvimento Tecnológico em Saúde / A leptospirose é a zoonose de maior incidência mundial, apesar de não haver uma confiável estimativa de sua carga global. Calcula-se que anualmente ocorram mais de um milhão de casos no mundo, o que possivelmente leve a 58.900 óbitos em todo planeta. No Brasil, o Ministério da Saúde vem empregando esforços para qualificar o diagnóstico e o tratamento da doença, mas que não necessariamente repercute na elevação do número de notificações de suspeitos. Sendo assim, foi proposta a Matriz do Círculo Vicioso da Negligência da Leptospirose no Brasil avaliando diversos aspectos inerentes a falta de um diagnóstico mais precoce e preciso para evitar a subnotificação de casos e a falta de uma real incidência e de carga global da doença, o que impactaria diretamente no planejamento da gestão em saúde, corroborada por pesquisa de opinião com especialistas defendendo a visão da negligência para com a informação em saúde no Brasil. A coleta de dados foi realizada por um questionário eletrônico, do tipo opinião, e disponibilizada através de e-mail a profissionais e pesquisadores selecionados previamente através de parâmetros curriculares na Plataforma Lattes. Como uma síntese do resultado podemos afirmar que, no geral, tanto os pesquisadores quanto os profissionais em saúde humana e animal foram coesos quanto à adesão às premissas enunciadas. Das 22 questões apenas três foram fortemente refutadas, o que confere certo grau de adesão às premissas apresentadas, agregando valor simbólico à matriz proposta. / Leptospirosis is the worldwide most incident zoonosis in the world, although there is no estimate global load that can be trustable. The annual appraisal cases suggested more than a million cases in a globally analysis, what may lead to a death rate near 58.900 people. Therefore, to leptospirosis ongoing circle matrix was proposed in Brazil to evaluate inherent features of the disease, as the lack of a real incidence rate, by means of underreporting and the absence of a precise global charge disease information. These two factors has an impact that could inevitably lead to a lack of awareness to implement forthright health planning emplacement in the future, by Brazilian government, coupled to the fact that the country public health specialist standpoints agreed with the lack of this reliability about Brazilian health data. The process of data gathering was performed by statement opinion electronic quiz, sent by email to previously selected researchers trough curriculum background criteria at Plataforma Lattes. As a synthesis of the results, we could assure allege that as well as researchers and professionals, even at human or animal health agreed with the prior placed assumptions. Only three of 22 questions at the quiz were contested, which besides conferring some adhesion to the previously presented assumptions, also adds emblematic value to the proposed matrix.

Introdução: A DCh (doença de Chagas) é uma doença negligenciada, com evolução para formas graves em 30% dos casos. No passado, era restrita à América Latina, entretanto, nas últimas décadas, o fenômeno migratório modificou o perfil epidemiológico, globalizando a doença. Inegáveis avanços aconteceram no Brasil, nas últimas décadas, mesmo assim, restam aproximadamente 3 milhões de pacientes. Desigualdades regionais são encontradas, com indicadores desfavoráveis na região Nordeste, relacionados não só ao predomínio de casos em crianças, identificados por avaliação sorológica, mas também pelo número de mortes relacionado à doença. Na fase crônica, amplo espectro de apresentações pode ser encontrado, variando desde a forma indeterminada, com favorável evolução, até pacientes com grave envolvimento cardíaco e alta mortalidade. Diante da apresentação heterogênea, a predição do risco de evolução e morte na DCH continua sendo um grande desafio. Maior ainda é a identificação de fatores determinantes, sobretudo do tipo de acometimento cardíaco. Assim, é possível que marcadores genéticos possam contribuir efetivamente, nesse cenário. O valor dos polimorfismos nos genes do fator de necrose tumoral (TNF) e da enzima conversora da angiotensina (ECA) na doença de Chagas é controverso. Objetivo: avaliar se os polimorfismos da I/D da ECA e do TNF-308 são marcadores de risco para a ocorrência de Insuficiência cardíaca na cardiopatia chagásica crônica (CCC), em população do Nordeste brasileiro. Material e métodos: realizado estudo tipo caso-controle. Foram analisados 201 pacientes portadores de T. cruzi + classificados em estágios, de acordo com a Diretriz Latino Americana para Cardiopatia Chagásica - Sociedade Brasileira de Cardiologia. Foram incluídos 99 pacientes em estágio C com presença de disfunção ventricular, definida por fração de ejeção do ventrículo esquerdo menor que 50% e sintomas prévios ou atuais de IC e 102 em estágio A, pacientes assintomáticos, com eletrocardiograma e ecocardiograma normais. Foram excluídos portadores de manifestação digestiva. Analisaram-se os polimorfismos da I/D da ECA e do TNF-308. Resultados: o perfil geral da população estudada apresenta pacientes naturais de estados do Nordeste brasileiro, com 81,1% do estado de Pernambuco, com baixos indicadores de escolaridade (frequência à escola de até 4 anos: 52,7% e renda familiar de até 1 salário mínimo: 64,7%). Há predominância feminina (64%), com igualdade entre grupos (p=0,3). Idade média de 55 anos, sendo mais jovens no estágio A (idade média: 51 anos) (p=0,001). A hipertensão arterial sistêmica esteve presente em 40% da população, com discreto predomínio entre pacientes do estágio C (p=0,05), e a Diabetes esteve presente em 8%, sem diferença entre os grupos (p=0,5). A fração de ejeção do ventrículo esquerdo média do estágio C foi 38±9% e de 67±5% no estágio A. Na avaliação de associação entre os genótipos dos polimorfismos TNF-308 e I/D do gene da ECA e as distintas formas clínicas na DCh foi encontrada associação entre o genótipo II no polimorfismo da ECA e a permanência no estágio A. O padrão não permaneceu quando a avaliação do OR foi ajustada para sexo, idade e uso de benznidazol e também no estudo por alelos, evidenciando ausência de associação entre todos os polimorfismos estudados. Conclusão: os polimorfismos TNF-308 e I/D do gene da ECA pesquisados não se constituíram em marcadores de risco para o desenvolvimento de CCC grave / Intoduction: Chagas disease (CD) is a neglected disease, with progression to severe forms in 30% of cases. In the past, it was restricted to Latin America. However, in recent decades, the phenomenon of migration has led to its epidemiological profile having changed and the disease is now a global one. Despite undeniable advances having taken place in Brazil in recent decades, there remain close to 3 million cases. Regional inequalities are found including unfavorable indicators in the Northeast which are not only about the predominance of cases in children, identified by serological evaluation, but also the number of deaths related to CD. In the chronic phase, a broad spectrum of presentations can be found, ranging from the indeterminate form, with favorable evolution, to patients with severe cardiac involvement and high mortality. Given the heterogeneous presentation, predictions on the risk of progression and death due to CD remain very challenging. Greater still is the identification of their determining factors, particularly as to the type of cardiac involvement. Thus, it is possible that genetic markers may contribute effectively, given this situation. The value of polymorphisms in the genes of the tumor necrosis factor (TNF), and of the angiotensin converting enzyme (ACE) in Chagas\' disease is controversial. Objective: To assess whether the I/D polymorphisms of ACE and TNF-308 are risk factors for the occurrence of heart failure (HF) in chronic Chagas cardiomyopathy (CCC), in the population of Northeast Brazil. Materials and methods: A case-control study was conducted. 201 patients with T. cruzi + classified in stages, in accordance with the Latin American guideline for Chagas cardiopathy - Brazilian Society of Cardiology, were analyzed. These included 99 patients in stage C (presence of ventricular dysfunction (defined as the ejection fraction of the left ventricle being less than 50%) and previous or current symptoms of HF and 102 patients in stage A (asymptomatic patients) whose electrocardiograms and echocardiograms were normal. Those with digestive manifestation were excluded. The I/D polymorphisms of ACE and TNF-308 were analyzed. Results: The general profile of the population studied presents patients from states in the Northeast of Brazil of whom 81.6% are from the State of Pernambuco, and whose education indicators are low (4 years of elementary schooling: 52.7%) and whose family income is up to 1 minimum wage: 64.7%. Females predominate (64%), with equality between groups (p=0.3). Average age is 55 years and younger in Stage A (mean age: 51 years) (p=0.001). Systemic arterial hypertension was present in 40% of the population, with a slight predominance among patients in Stage C (p=0.05), and 8% had Diabetes, with no difference between groups (p=0.5). The mean ejection fraction of the left ventricular of Stage C patients was 38±9% and 67±5% in stage A patients. On evaluating the association between the genotypes of the I/D polymorphisms of TNF-308 and the ACE gene and the distinct clinical forms in CD, an association was found between genotype A in the polymorphism of ACE and permanence in Stage A. The pattern did not remain when the evaluation of OR was adjusted for sex, age and use of benznidazole, nor did it in the study by alleles, thus showing evidence of the absence of association between all of the polymorphisms studied. Conclusion: The TNF-308 polymorphisms and the I/D of the ACE gene surveyed were not found to be risk factors for the development of serious CCC

A neurocisticercose (NC) é uma doença infecciosa de origem parasitária, caracterizada pelo acometimento do sistema nervoso central (SNC) pela forma larvária da Taenia solium. É considerada uma das doenças infecciosas mais freqüentes nesta localização em humanos. Representa um dos grandes problemas de saúde pública para a maioria dos países em desenvolvimento, sendo que dados recentes mencionam 50 mil mortes por ano e não menos que 20 milhões de pessoas infectadas pelo cisticerco no mundo. Os objetivos deste estudo foram: avaliar a utilidade do uso da seqüência FLAIR de ressonância magnética (RM) no diagnóstico desta doença; comparar os principais achados da seqüência FLAIR com os das demais seqüências de RM; determinar a localização preferencial das lesões de NC, bem como os estágios da forma larval mais encontrados nesta série. Avaliaram-se prospectivamente, exames de RM de 115 pacientes com NC, com idades entre quatro e 64 anos, apresentando lesões intracranianas. Realizaram-se seqüências pesadas em T1, T2, FLAIR e T1 após a injeção do meio de contraste paramagnético. As seqüências pós-contraste foram realizadas imediatamente após a injeção e após alguns minutos. Todos os exames de RM foram avaliados por dois examinadores. Para poder avaliar a utilidade do uso da seqüência FLAIR em casos da doença, valorizou-se a detecção do escólex, que é considerada como patognomônica de NC. Cada um dos examinadores detectou, para cada uma das seqüências em cada exame de RM, a localização das lesões (parenquimatosa, meníngea, ventricular ou associação de uma ou mais das anteriores), o número total de lesões e em quantas foi visualizado o escólex e o número de lesões calcificadas. Determinaram-se ainda a topografia das lesões, ou seja, supratentorial, infratentorial ou associação de ambas, e o estágio em que as lesões se encontravam dentro do espectro da doença: vesicular, vesicular coloidal, nodular ou nodular calcificado. Não foi observada diferença estatística significativa entre os resultados obtidos pelos dois examinadores, demonstrando concordância interna. Dos 115 exames de RM oitenta (69,6%), apresentavam lesões parenquimatosas; onze (9,6%) meníngeas; seis (5,2%) ventriculares; dezoito (15,6%), associação. A seqüência FLAIR foi a que permitiu a detecção do maior número de lesões com escólex; já a seqüência T1 pós-contraste tardio foi a que propiciou a detecção do maior número de lesões. Em 32 casos para o examinador A e em 28 para o B, o escólex foi visualizado em apenas uma das seqüências, sendo em 27 e 24 destes casos respectivamente, na seqüência FLAIR. Constatou-se, predominância de lesões em situação supratentorial. Em relação aos estágios da forma larval, observou-se que, em 98,3 a 99,1% dos casos, existia o estágio vesicular; entre 47,0 e 50,4% estágio vesicular coloidal; estágio nodular foi caracterizado entre 65,2 e 69,6% dos casos e em 31,3 a 33% observou-se o estágio nodular calcificado. Em conclusão: a seqüência FLAIR foi a que proporcionou a caracterização do maior número de escólex, cuja detecção é considerada critério absoluto e permite o diagnóstico definitivo da doença. A seqüência FLAIR demonstrou um número total de lesões maior que as seqüências T1 pré-contraste e T2; porém, a seqüência T1 pós-contraste tardio foi a que permitiu a visualização do maior número total de lesões. A forma parenquimatosa foi a mais encontrada nesta série: 69,6% dos pacientes. Predominaram lesões em situação supratentorial (68,7% a 71,3%). Com relação ao estágio evolutivo da forma larval, houve uma predominância do estágio vesicular (98,3 a 99,1%), associação de pelo menos dois estágios em 65,2 e 69,6%, e a presença dos quatro estágios do cisticerco em 31,3 a 33,0% dos casos / Neurocysticercosis (NC) is an infectious disease of parasitic origin characterized by the involvement of the central nervous system (SNC) by the larval form of the Taenia solium, being considered as one of the more frequent infectious diseases in this location in humans. It represents an important public health problems, for most of the development countries. Recent data mention 50,000 deaths a year and not less than 20 million people infected by the cisticerci, in the world. The objectives of this study went evaluate to usefulness of the use of the sequence FLAIR of magnetic resonance (MR), in the diagnosis of this disease, to compare the main findings of the sequence FLAIR to the other sequences of MR and to define the preferential location of the NC lesions, as well as the apprenticeships in the larval way more found in this series. We studied prospectly MR exams of 115 patients with NC, with ages varying between 4 and 64 years, presenting intracranial lesions. The MR protocol inclued T1, T2, FLAIR and T1 weighted after the injection of the paramagnetic contrast. The post-contrast sequences were done immediately after the injection and after some minutes. All the RM exams were evaluated by two examiners. So that it was possible to evaluate the usefulness of the use of the sequence FLAIR in the detection of the scolex that is considered pathognomonic of this disease. Each one of the examiners detected for each one of the sequences in each exam of MR, which the location of the lesions (parenchymal, subarachnoid, ventricular or association of one or more of the previous ones), the total number of lesions, in how many it was visualized the scolex and the number of calcified lesions. It was still determined which the topography of the lesions (supratentorial, infratentorial or association of both), and which the apprenticeship of the lesions in the spectrum of the disease: vesicular, colloidal vesicular, nodular or calcified nodular. Significant statistical difference was not observed among the results obtained by the two examiners, demonstrating internal agreement. Of the 115 exams of RM 80 (69.6%), presented parenchymal lesions, 11 (9.6%) subarachnoid, 6 (5.2%) ventricular and 18 (15.6%) association. FLAIR allowed the detection of the largest number of lesions with scolex, the late post-enhanced detected the largest number of lesions. In 32 cases for the examiner A and in 28 for B, the scolex was visualized in just one of the sequences, being respectively in 27 and 24 of these cases, in the FLAIR sequence. It preferential location of lesions was in the supratentorial compartment. In relation to the apprenticeships in the larval way it was observed that in 98.3 to 99.1% of the cases the vesicular apprenticeship existed, among 47.0 to 50.4% presence of the colloidal vesicular apprenticeship, the nodular was characterized among 65.2 to 69.6% of the cases and in 31.3 to 33% it was observed to the presence of the calcified nodular lesions. In conclusion: the sequence FLAIR detected the larger number of scólex, whose that is considered a criteria for the definitive diagnosis of the disease. The FLAIR sequence demonstrated a larger total number of lesions that the sequences pré-contrast T1 and T2, but the late post-enhanced T1 was the sequence that allowed the visualization of the largest total number of lesions. The parenchymal was found in this series 69.6% of the patients. Lesions prevailed in supratentorial situation (68.7% to 71.3%). With relationship to the evolutionary apprenticeship in the larval way there was a prevalence of the vesicular apprenticeship (98.3 to 99.1%), association of at least two stages in 65.2 to 69.6% and the presence of the four stages of the disease among 31.3 to 33.0% of the cases

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-03-10T13:11:37Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Rafael de Freitas e Silva.pdf: 13510018 bytes, checksum: 080b7ee10e7a8be555cb7a7ca29c10fb (MD5) / Made available in DSpace on 2017-03-10T13:11:37Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Rafael de Freitas e Silva.pdf: 13510018 bytes, checksum: 080b7ee10e7a8be555cb7a7ca29c10fb (MD5) Previous issue date: 2016-09-06 / As leishmanioses são doenças causadas por protozoários do gênero Leishmania e estão presentes em 98 países e territórios e possuem incidência anual de 2 milhões de casos. A Leishmania (Viannia) braziliensis (L.V. braziliensis) é uma das principais espécies causadoras da leishmaniose cutânea (LC) no Brasil. Apesar disso, ainda não há uma vacina segura e eficaz para ser utilizada em seres humanos. Nesse sentido, o objetivo deste trabalho foi identificar no proteoma predito de L.V. braziliensis, potenciais epítopos de linfócitos T e avaliá-los por meio de ensaios imunológicos. No primeiro capítulo, o proteoma predito de L. braziliensis foi comparado ao de outras espécies e analisado quanto a presença de epítopos. Nessa etapa foram encontrados epítopos derivados de mais de 8 mil proteínas conservadas entre diferentes espécies de Leishmania. Os epítopos foram clusterizados e então utilizados para etapa de docagem molecular com estruturas de MHC I e MHC II depositadas no Protein Data Bank. A docagem molecular resultou em epítopos peptídicos de 15 aminoácidos com alta afinidade de ligação às moléculas de MHC I e MHC II. Os 10 melhores resultados foram então sintetizados e avaliados, in vitro, quanto à capacidade de estimular a proliferação de células mononucleares do sangue periférico (PBMC) de indivíduos com LC após o tratamento (PT). Os resultados indicaram que 50% das moléculas testadas apresentaram capacidade de estimular, significativamente (p<0,05), a proliferação celular quando comparado às células de indivíduos saudáveis que não vivem em região endêmica para LC. No segundo capítulo, os peptídeos foram avaliados quanto à capacidade de estimular a proliferação de PBMC de indivíduos com LC em sua fase ativa (AD) e indivíduos moradores de área endêmica para LC resistentes à infecção (RT). Em paralelo, quantificou-se a expressão do fator de transcrição T-bet em PBMC de indivíduos PT, e citocinas dos perfis Th1, Th2 e Th17 foram mensuradas no sobrenadante de cultura das células de indivíduos PT e AD. Os resultados demonstraram altos níveis de proliferação nas células do grupo RT para todos os peptídeos testados. Além disso, níveis significativos de Tbet foram observados em linfócitos T CD4+ e CD8+ após estímulo com seis peptídeos. Níveis significativos de IFN-γ, TNF e IL-6 foram observados no sobrenadante das células do grupo PT com quatro dos peptídeos testados. Altos níveis dessas citocinas também foram encontrados no sobrenadante do grupo AD. No terceiro capítulo, avaliou-se o efeito dos peptídeos sobre células dendríticas de medula (BMDC) murinas, produção de citocinas de sobrenadante, e células dendríticas esplênicas murinas após estímulo com os peptídeos. Verificou-se altos níveis de MHC II e CD40 em uma subpopulação de BMDC estimuladas com as moléculas e altos níves de TNF e IL-6 após 48h de estímulo. Para as células esplênicas, foram observados altos níveis de subpopulações celulares expressando CD11b+, IL-12p70+, CD205+ e CD11b+ após estímulo com o peptídeo que teve o melhor resultado in silico. Por fim, os resultados indicam o grande potencial imunogênico que os epítopos identificados apresentam, o que dá suporte ao desenvolvimento futuro de abordagens vacinais. / The leishmaniasis are diseases caused by protozoans from the genus Leishmania which are present in 98 countries and territories, with an annual incidence of 2 million cases. Among the other species, Leishmania (Viannia) braziliensis is the main specie implicated with cutaneous leishmaniasis (CL) in Brazil. Besides that, there is no safe and effective vaccine against leishmaniasis to be applied in humans. In this context, the aim of this work was to identify in the predicted proteome of L. braziliensis potential CD4+ and CD8+ T cell epitopes and evaluate them by immunological assays. In the first chapter, the predicted proteome of L. braziliensis was compared with other species and analyzed for the presence of epitopes. In this step, epitopes from more than 8,000 conserved proteins were found among other species of Leishmania. The epitopes were clustered and then used for the molecular docking with MHC I and MHC II structures deposited in the Protein Data Bank. This approach resulted in 15 aminoacids peptide epitopes with high binding affinity for MHC I and MHC II. The 10 best results were synthesized and evaluated in vitro for their capacity to stimulate the proliferation of peripheral blood mononuclear cells (PBMC) of individuals with CL post treatment (PT). The results have shown that 50% of the tested molecules had the capacity to stimulate, significantly (p<0.05), cell proliferation when compared with cells of healthy individuals living in non-endemic regions. For the second chapter, the peptides were evaluated for their capacity to stimulate the proliferation of PBMC from CL individuals with active disease (AD) and of individuals resistant to infection (RT) living in endemic region. In parallel, the T-bet transcription factor expression was quantified in PBMC of PT individuals, and cytokines from the Th1, Th2 and Th17 profiles were measured in culture supernatant of PT and AD groups. High levels of cell proliferation in the RT group were demonstrated for all peptides tested. Moreover, significant levels of T-bet in CD4+ and CD8+ T cells were verified after stimulation with six peptides. For IFN-γ, TNF and IL-6, significant levels were detected in the supernatant of cultures from the PT group with four peptides tested. High levels of these same cytokines were also present in the supernatant of AD group. In the third chapter, the peptide effects over murine bone marrow dendritic cells (BMDC), the production of cytokines in the supernatant and murine spleen dendritic cell subsets were evaluated after peptide stimuli. High levels of MHC II and CD40 were verified for stimulated BMDC and high levels of TNF and IL-6 after 48h of stimuli. For spleen cells, high levels of cells expressing CD11b+, IL-12p70+, CD205+ e CD11b+ were observed after stimulation with the peptide which showed the best in silico result. In conclusion, the results indicate the great immunogenic potential of the identified peptides and support the further development of vaccine approaches using those molecules.