RESUMO
BACKGROUND: The National Examination of Knowledge in Medicine establishes the knowledge profile (PdC) a physician must possess to practice public medicine in Chile. However, no study has evaluated the perception of dermatology training regarding the acquisition of the minimum competencies required. This study described and compared the impressions of the dermatology training received by the University of Chile (UCh) graduates with graduates from other national and international faculties of medicine. MATERIALS AND METHODS: This was a cross-sectional study, based on a single survey model, applied via E-mail to registered physicians in an online database, with emphasis on UCh medicine graduates, from the generations 2012 to 2016. The data were collected anonymously, tabulated, and analyzed in MINITAB. RESULTS: From 908 UCh graduates, 141 surveys were answered (15.5%). Nine of 10 physicians considered "important" to obtain knowledge in dermatology. About 68.8% found the information they received was adequate. When comparing UCh graduates with other Chilean universities, UCh graduates had a slightly better impression of their training. When comparing Chilean versus foreign graduates, the latter presented a better perception of their preparation in cutaneous pathology. CONCLUSION: UCh graduates were satisfied with their dermatological training at the undergraduate level and felt better prepared than colleagues from other Chilean universities when facing cutaneous pathologies.
RESUMO
Clinical manifestations of leptospirosis are diverse and very similar to other febrile diseases, hence early and accurate detection of subclinical infections is a key element in disease control. We evaluated immunomagnetic separation (IMS) capture technology coupled with a standard quantitative PCR (qPCR) system for the detection of pathogenic Leptospira in urine samples from 803 cows from dairy herds with a history of clinical cases of leptospirosis. The urine samples were first processed in a purification step, then subdivided into 2 subsamples, one that continued to DNA extraction and direct qPCR, and one that was pretreated by IMS before continuing to DNA extraction and qPCR. Overall, 133 of 803 (16.6%) samples were IMS-qPCR positive, whereas only 92 of 803 (11.5%) were positive when using direct qPCR. Statistically significant differences were observed between the mean estimated Leptospira load between the IMS-qPCR and the direct qPCR positive urine samples. The IMS-qPCR technology revealed a larger number of positive results and higher bacterial loads than direct qPCR. This difference is most likely the result of the high antigen-binding capacity and capture efficiency of the IMS system. The use of polyclonal antibodies produced by the inoculation of 3 synthetic peptides, which make up the extracellular regions of the LipL32 protein, provided a high detection capacity to the IMS-qPCR technique, resulting in performance superior to direct qPCR.
Assuntos
Criação de Animais Domésticos , Doenças dos Bovinos/diagnóstico , Leptospira/isolamento & purificação , Leptospirose/veterinária , Animais , Bovinos , Doenças dos Bovinos/urina , Chile , Indústria de Laticínios , Feminino , Separação Imunomagnética/veterinária , Leptospira/genética , Leptospira/imunologia , Leptospirose/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Sensibilidade e Especificidade , Urinálise/veterináriaRESUMO
La Telemedicina constituye una herramienta que permite proporcionar atención médica especializada usando la tecnología de las telecomunicaciones.Entre mayo del 2015 y julio del 2017 se realizaron 1020 atenciones a través de esta modalidad, entre el Hospital Puerto Montt (HPM) y distintos centros de Atención primaria del SS Reloncaví.Se utilizaron dos modalidades de atención: asincrónica y sincrónica con presencia virtual del paciente.Se realizaron 1020 atenciones con una resolución inmediata en el 61,7% de los casos. Esta modalidad de atención implicó un ahorro de 139.412 Km, y por concepto de pasajes de $ 10.675.200 requeridos para el desplazamiento de los pacientes desde su lugar de origen al HPM.En lugares geográficamente distantes, la Telereumatología se convierte en una herramienta fundamental que permite expandir la cobertura de atenciones de salud por especialista, reducir las listas de espera, disminuir los tiempos de traslado y el costo que estos implican.
Telemedicine constitutes a tool that allows to provide specialized medical attention using telecommunications technology.Between May 2015 and July 2017, 1,020 care were carried out through this modality, between the Puerto Montt Hospital (HPM) and different primary care centers of the SS Reloncavi.Two care modalities were used: asynchronous and synchronous with the virtual presence of the patient.1020 visits were performed with immediate resolution in 61.7% of the cases.This care modality implied a saving of 139,412 km, and for the concept of passages of $ 10,675,200 required for the movement of patients from their place of origin to the HPM.In geographically remote places, Telerheumatology becomes a fundamental tool that allows expanding the coverage of health care by specialist, reducing waiting lists, reducing travel times and the cost that these imply.
Assuntos
Humanos , Doenças Reumáticas/diagnóstico , Telemedicina/economia , Telemedicina/métodos , Reumatologia , Chile , Satisfação do PacienteRESUMO
Golgi phosphoprotein 3 (GOLPH3) is a conserved protein of the Golgi apparatus that in humans has been implicated in tumorigenesis. However, the precise function of GOLPH3 in malignant transformation is still unknown. Nevertheless, clinicopathological data shows that in more than a dozen kinds of cancer, including gliomas, GOLPH3 could be found overexpressed, which correlates with poor prognosis. Experimental data shows that overexpression of GOLPH3 leads to transformation of primary cells and to tumor growth enhancement. Conversely, the knocking down of GOLPH3 in GOLPH3-overexpressing tumor cells reduces tumorigenic features, such as cell proliferation and cell migration and invasion. The cumulative evidence indicate that GOLPH3 is an oncoprotein that promotes tumorigenicity by a mechanism that impact at different levels in different types of cells, including the sorting of Golgi glycosyltransferases, signaling pathways, and the actin cytoskeleton. How GOLPH3 connects mechanistically these processes has not been determined yet. Further studies are important to have a more complete understanding of the role of GOLPH3 as oncoprotein. Given the genetic diversity in cancer, a still outstanding aspect is how in this inherent heterogeneity GOLPH3 could possibly exert its oncogenic function. We have aimed to evaluate the contribution of GOLPH3 overexpression in the malignant phenotype of different types of tumor cells. Here, we analyzed the effect on cell migration that resulted from stable, RNAi-mediated knocking down of GOLPH3 in T98G cells of glioblastoma multiforme, a human glioma cell line with unique features. We found that the reduction of GOLPH3 levels produced dramatic changes in cell morphology, involving rearrangements of the actin cytoskeleton and reduction in the number and dynamics of focal adhesions. These effects correlated with decreased cell migration and invasion due to affected persistence and directionality of cell motility. Moreover, the knocking down of GOLPH3 also caused a reduction in autoactivation of focal adhesion kinase (FAK), a cytoplasmic tyrosine kinase that regulates focal adhesions. Our data support a model in which GOLPH3 in T98G cells promotes cell migration by stimulating the activity of FAK.
Assuntos
Proteína-Tirosina Quinases de Adesão Focal/metabolismo , Adesões Focais/fisiologia , Proteínas de Membrana/metabolismo , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Linhagem Celular Tumoral , Movimento Celular , Proliferação de Células , Glioblastoma/metabolismo , Glioblastoma/patologia , Humanos , Proteínas de Membrana/antagonistas & inibidores , Proteínas de Membrana/genética , Fosforilação , Interferência de RNA , RNA Interferente Pequeno/metabolismoRESUMO
Neutrophils play an important role in the exacerbation and maintenance of severe equine asthma; persistent neutrophil activity and delayed apoptosis can be harmful to surrounding tissues. Tamoxifen (TX) is a nonsteroidal estrogen receptor modulator with immunomodulatory effects and induces early apoptosis of blood and bronchoalveolar lavage neutrophils from horses with acute lung inflammation. This study investigated if the in vitro effects of tamoxifen are produced by its action on nuclear (α and ß) and membrane (GPR30) estrogen receptors in healthy equine neutrophils. Results showed that TX inhibits neutrophil respiratory burst induced by opsonized zymosan in a dose-dependent manner. Nuclear (17-ß-Estradiol) and GPR30 cell membrane (G1) estrogen receptor agonists and their antagonists (ICI 182,780 and G15, respectively) do not block or reproduce the effect of TX. Therefore, TX does not inhibit respiratory burst through estrogen receptors. TX (8.5 µM) also increased phosphatidylserine translocation, a marker of early apoptosis, which did not occur with any of the estrogen receptor agonists or antagonists. Thus, tamoxifen generates dose-dependent inhibition of respiratory burst and increased early apoptosis in healthy equine neutrophils, independently of nuclear or membrane estrogen receptors. Further studies are necessary to explore the signaling pathways of tamoxifen-induced ROS inhibition and phosphatidylserine translocation.
Assuntos
Apoptose/efeitos dos fármacos , Antagonistas de Estrogênios/farmacologia , Neutrófilos/efeitos dos fármacos , Receptores de Estrogênio/metabolismo , Explosão Respiratória/efeitos dos fármacos , Tamoxifeno/farmacologia , Animais , Relação Dose-Resposta a Droga , Fulvestranto/farmacologia , Cavalos , Neutrófilos/metabolismo , Fosfatidilserinas/metabolismo , Receptores de Estrogênio/antagonistas & inibidores , Receptores de Estrogênio/efeitos dos fármacosRESUMO
BACKGROUND: It is accepted that T regulatory cells (Treg) control different types of immune responses. In connection with this role, we have recently described an important increase in CD4+, CD25high, Foxp3+ lymphocytes in the airway system of horses coursing with an exacerbation of severe equine asthma (EA). To explore the potential role of this population in the resolution of EA inflammation, we used a murine experimental model in which airway neutrophilic inflammation, which is similar to that observed in EA, is induced in mice by continual exposure to Aspergillus fumigatus contaminated hay. This model has the advantage that in mice we may induce a reduction of the Treg population using low doses of cyclophosphamide (Cy). RESULTS: The results indicated that the percentage of Treg cells increased with allergen exposure, as in horses; and animals partially depleted of Treg cells by treatment with Cy showed increased airway inflammation, demonstrated by an increased percentage of neutrophils and specific immunoglobulins in bronchoalveolar lavage fluid (BALF). Furthermore, a histopathologic study of animals that were pretreated with Cy before antigenic challenge showed higher cellular infiltration in the lung and deeper remodeling changes in the bronchi, including epithelial and goblet cell hyperplasia as well as airway smooth muscle hypertrophy. CONCLUSION: In this murine model of EA, the reduced number and function of Treg induced by low doses of Cy, which directly correlates with increased airway inflammation and lung infiltration, indicates that Treg may play a major role in the regulation and resolution of EA.
Assuntos
Asma/veterinária , Doenças dos Cavalos/imunologia , Linfócitos T Reguladores/fisiologia , Doença Aguda , Alérgenos/imunologia , Ração Animal/microbiologia , Animais , Aspergillus fumigatus/imunologia , Asma/imunologia , Líquido da Lavagem Broncoalveolar/citologia , Modelos Animais de Doenças , Feminino , Cavalos , Camundongos , Linfócitos T Reguladores/imunologiaRESUMO
BACKGROUND AND OBJECTIVE: Neutrophilic asthma is an important disease subgroup, including patients with severe phenotypes and erratic responses to standard treatments. Tamoxifen (TX), a selective estrogen receptor modulator (SERM) used as treatment of human breast cancer, has been shown to induce early apoptosis of equine blood and bronchoalveolar lavage fluid (BALF) neutrophils in vitro. Equine recurrent airway obstruction (RAO) is a naturally occurring neutrophilic condition, closely related with human asthma. Our purpose was to investigate the therapeutic potential of tamoxifen in horses with neutrophilic lung inflammation. METHODS: Twelve horses underwent acute lung inflammation through exposure to allergens known to cause RAO, after which they received treatment with either tamoxifen or dexamethasone. Outcome measures included evaluation of clinical signs, BALF cytology, and early apoptosis of blood and BALF neutrophils. RESULTS: Tamoxifen treatment decreased BALF neutrophil counts (65.3 ± 19.38% before treatment; 7.6 ± 4.5% 2 days post-treatment,; and 13.6 ± 9.3% 5 days post-treatment). A similar decrease was observed with dexamethasone treatment (48.6 ± 5.88% before treatment; 11.5 ± 8.1% 2 days post-treatment; 14.6 ± 10.3% 5 days post-treatment). Clinical and endoscopic scores improved in both treatment groups. Tamoxifen treatment significantly increased early apoptosis of peripheral blood neutrophils at 5 days post-treatment (27.04 ± 15.2%), and in BALF neutrophils at 2 and 5 days post-treatment (42.11 ± 11.67% and 48.98 ± 2.6%, respectively). CONCLUSION: Tamoxifen treatment in horses with induced acute pulmonary inflammation promoted early apoptosis of blood and BALF neutrophils, reduction in BALF neutrophils and improvement in the animals' clinical status.
Assuntos
Asma , Neutrófilos/imunologia , Pneumonia , Tamoxifeno/farmacologia , Obstrução das Vias Respiratórias/tratamento farmacológico , Obstrução das Vias Respiratórias/imunologia , Obstrução das Vias Respiratórias/patologia , Alérgenos/imunologia , Animais , Anti-Inflamatórios/farmacologia , Apoptose/efeitos dos fármacos , Apoptose/imunologia , Asma/tratamento farmacológico , Asma/imunologia , Asma/patologia , Líquido da Lavagem Broncoalveolar/imunologia , Dexametasona/farmacologia , Modelos Animais de Doenças , Cavalos , Humanos , Pneumonia/tratamento farmacológico , Pneumonia/imunologia , Pneumonia/patologia , Moduladores Seletivos de Receptor Estrogênico/farmacologiaRESUMO
Recurrent airway obstruction (RAO) is an equine immune-mediated disease with a high incidence worldwide. The aim of this work was to contribute to the understanding of RAO pathogenesis by studying T cells bearing regulatory markers in peripheral blood (PB) and in bronchoalveolar lavage fluid (BALF) recovered from the same group of susceptible horses before and after exposure to moldy hay, which has been shown to induce RAO signology in our horse herd. With this purpose, mononuclear cells were obtained from the BALF and PB from horses before and after antigenic challenge and were stained with fluorochrome-conjugated antibodies against CD4, CD25 and Foxp3 and subsequently analyzed by flow cytometry. The results indicated that the percentage of CD4+, Foxp3+ cells clearly increased in PB and BALF obtained from horses with RAO. In addition, the percentage of CD4+, CD25(high) cells was greatly augmented in BALF of RAO positive horses compared with a baseline. No changes were observed in the PB compartment. The percentage of CD4+, CD25(high), Foxp3+ cells in BALF increased in horses with active disease compared to horses in remission; this cell population also does not show changes in the PB compartment when RAO positive and RAO negative horses were compared. On the other hand, when the percentage of CD4, Foxp3 positive cells were compared with the percentage of CD4+, CD25(high) cells, the numbers were very similar. This observation was true for PB and BALF cells from non exposed horses as well as horses exposed to antigen. In all the experimental situations studied, the population expressing all of the markers CD4+, CD25(high), Foxp3+ represent only a minor percentage of CD4+, CD25(high) or CD4+, Foxp3 subpopulations; therefore, an significant number of CD4+, CD25(high), Foxp3- and CD4+, CD25(null), Foxp3+ cells must exist. Finally, we conclude that horses with RAO show an airway accumulation of T cells bearing regulatory markers that probably are modulating the course of this disease, and that these T cells may be involved in the resolution of immune-mediated bronchial inflammation.
Assuntos
Obstrução das Vias Respiratórias/veterinária , Doenças dos Cavalos/imunologia , Linfócitos T Reguladores/imunologia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/imunologia , Alérgenos/administração & dosagem , Animais , Antígenos de Fungos/administração & dosagem , Aspergillus fumigatus/imunologia , Aspergillus fumigatus/patogenicidade , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Antígenos CD4/metabolismo , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/classificação , Linfócitos T CD4-Positivos/imunologia , Chile , Echinochloa/imunologia , Echinochloa/microbiologia , Fatores de Transcrição Forkhead/metabolismo , Doenças dos Cavalos/etiologia , Cavalos , Subunidade alfa de Receptor de Interleucina-2/metabolismo , RecidivaRESUMO
Recurrent airway obstruction (RAO, also known as equine heaves) is an inflammatory condition similar to human asthma caused by exposure of susceptible horses to poorly ventilated stable environments. The disease is characterized by neutrophilic airway inflammation, mucus hypersecretion and reversible bronchoconstriction. This inflammatory process is mediated by several factors, including antibodies, cytokines, resident cells of the airway and inflammatory cellular components that arrive in the respiratory tract. An increasing body of evidence has lent support to the concept that a dysregulation of T cell apoptosis may play a central role in the development of airway inflammation and the associated asthma. Therefore, the aim of this study was to investigate early and late apoptosis of CD4 and CD8 T cell subpopulations obtained from the airways of acute RAO-positive animals after exposure to hay/straw. The percentages of CD4 and CD8 T cells and their associated frequencies of apoptosis were quantified using flow cytometry. Hay/straw exposure induced clinical airway obstruction, airway neutrophilia and increased airway mucus production in RAO-positive horses. In addition, allergen exposure increased the percentage of CD4 T cells in RAO-positive horses as well as the frequency of early and late apoptosis in both CD4 and CD8 lymphocyte subpopulations. These results suggest that the higher frequency of lymphocyte apoptosis may play a role in disease progression of horses afflicted with RAO and may partially explain the characteristic remission of this pathological condition once the allergen source is removed. However, further studies are needed to clarify the role of T cell apoptosis in RAO-affected horses.