BACKGROUND Metformin (MET) is a hypoglycemic drug used for the treatment of diabetes, despite interference in host immunity against microorganisms. Cutaneous infection caused by pathogens such as Leishmania braziliensis (Lb), the agent responsible for cutaneous leishmaniasis (CL) in Brazil, represents an interesting model in which to evaluate the effects associated with MET. OBJECTIVE To evaluate the modulatory effect of MET in Lb infection. MATERIAL AND METHODS Experimental study of Lb infection and MET treatment in BALB/c mice and Raw 264.7 macrophages. FINDINGS MET treatment interfered with lesion kinetics, increased parasite load and reduced macrophage proliferation. Low concentrations of MET in Lb culture allow for the maintenance of stationary parasite growth phase. Lb-infected cells treated with MET exhibited increased parasite load. While both MET and Lb infection alone promoted the production of intracellular reactive oxygen species (ROS), reduced levels of ROS were seen in MET-treated Lb-infected macrophages. MAIN CONCLUSION Experimental treatment with MET interfered with the kinetics of cutaneous ulceration, increased Lb parasite load, altered ROS production and modulated cellular proliferation. Our experimental results indicate that MET interfere with the evolution of CL.

BACKGROUND Leprosy is a chronic infectious disease caused by the obligate intracellular bacillus Mycobacterium leprae. Because leprosy diagnosis is complex and requires professional expertise, new tools and methodologies are needed to detect cases in early stages and prevent transmission. The M. leprae genome contains mce1A, which encodes a putative mammalian cell entry protein (Mce1A). We hypothesised that the presence of Mce1A on the cell surface could be detected by the host's immune system. OBJECTIVE The aim of this study was to evaluate antibody responses against the Mce1A protein in leprosy patients, household contacts of patients, and the general population to present an addition tool for leprosy diagnosis. METHODS A cross-sectional study involving 89 volunteers [55 leprosy cases, 12 household contacts (HHC) and 22 endemic controls (EC)] was conducted at Couto Maia Hospital, in Salvador, Bahia (BA), Brazil. RESULTS The median anti-Mce1A IgA was significantly higher in multibacillary (MB) and paucibacillary (PB) cases than in EC (p < 0.0001). A similar trend was observed in IgM levels, which were significantly higher in both MB (p < 0.0001) and PB (p = 0.0006) groups compared to in EC individuals. The greatest differences were observed for IgG class-specific antibodies against Mce1A. The median levels of MB and PB were significantly higher compared to both controls HHC and EC (MB or PB vs EC, MB vs HHC p < 0.0001; PB vs HHC, p = 0.0013). Among leprosy cases, IgG enzyme-linked immunosorbent assay sensitivity and specificity were 92.7% and 97.1%, respectively. IgG positivity was confirmed in 92.1% and 94.1% of MB and PB patients, respectively. CONCLUSION This novel diagnostic approach presents an easy, non-invasive, and inexpensive method for leprosy screening, which may be applicable in endemic areas.

Cutaneous leishmaniasis (CL) is the most frequent clinical form of tegumentary leishmaniasis and is characterised by a single or a few ulcerated skin lesions that may disseminate into multiple ulcers and papules, which characterise disseminated leishmaniasis (DL). In this study, cells were quantified using immunohistochemistry and haematoxylin and eosin staining (CD4+, CD68+, CD20+, plasma cells and neutrophils) and histopathology was used to determine the level of inflammation in biopsies from patients with early CL, late CL and DL (ulcers and papules). The histopathology showed differences in the epidermis between the papules and ulcers from DL. An analysis of the cells present in the tissues showed similarities between the ulcers from localised CL (LCL) and DL. The papules had fewer CD4+ T cells than the DL ulcers. Although both CD4+ cells and macrophages contribute to inflammation in early CL, macrophages are the primary cell type associated with inflammation intensity in late ulcers. The higher frequency of CD20+ cells and plasma cells in lesions demonstrates the importance of B cells in the pathogenesis of leishmaniasis. The number of neutrophils was the same in all of the analysed groups. A comparison between the ulcers from LCL and DL and the early ulcers and papules shows that few differences between these two clinical forms can be distinguished by observing only the tissue.

The formula proposed by Rich in 1951 explained the formation in a tuberculous lesion in a period that was unknown cellular functions, cytokines and other immunological aspects involved in granuloma formation by tuberculosis; its components are assembled conceptually to explain the pathogenic mechanisms involved in the granulomatous lesion in tuberculosis. In this manuscript, we report an update of Rich's formula based on the new and old concepts about pathogenic mechanisms involved in the granulomatous lesion in tuberculosis. Current knowledge allows us to conclude that the balance between the characteristics of the bacillus and host protective response is necessary to indicate the outcome of pathogenesis, infection or active disease and the necrosis degree of the tuberculosis lesion.

Este estudo objetivou discutir o processo psicoterapêutico de um menino de 12 anos de idade com Síndrome de Asperger, um transtorno global do desenvolvimento, atendido em um ambulatório de psicoterapia de um hospital público. Osetting terapêutico e a caixa lúdica tiveram que ser modificados e flexibilizados para atender às peculiaridades da criança. São discutidos o vínculo terapêutico e a importância de se manejarem as diferenças entre eu/não-eu para a terapia. Percebeu-se que o atendimento, adaptado às condições do ambulatório público, contribuiu para a capacidade de comunicação e de interação da criança, fato que aponta para a importância do debate sobre a psicoterapia psicodinâmica com esta população e formas de realizá-la.

This study's objective was to discuss the psychotherapy process of a 12-year old boy affected by Asperger Syndrome, a pervasive developmental disorder, cared for in a public outpatient service. The therapeutic setting and the box of toys had to be modified and made more flexible to address the child's peculiarities. The bond established between the therapist and patient and the importance of dealing with the differences between Self/Not-self are discussed. The treatment, adapted to the conditions of a public outpatient service, contributed to the child's communication and interaction skills, which shows the importance of discussing psychodynamic psychotherapy with this population and how to implement it.

La finalidad de ese trabajo fue discutir el proceso psicoterápico de un niño con 12 años de edad con Síndrome de Asperger, un trastorno global de desarrollo, atendido en un ambulatorio psicoterapéutico de un hospital público. El escenario terapéutico y la caja de juegos tuvieron de ser modificados para las necesidades y peculiaridades del niño. Fueron discutidos el vínculo con la terapeuta y la importancia de trabajar las diferencias entre el yo y el no-yo. La atención, adaptada a las condiciones de un ambulatorio público, contribuyó a la capacidad de comunicación y interacción del niño, hecho que indica la importancia del debate sobre la psicoterapia psicodinámica con esa población y formas de ponerla en práctica.

Disseminated leishmaniasis (DL) differs from other clinical forms of the disease due to the presence of many non-ulcerated lesions (papules and nodules) in non-contiguous areas of the body. We describe the histopathology of DL non-ulcerated lesions and the presence of CD4-, CD20-, CD68-, CD31- and von Willebrand factor (vW)-positive cells in the inflamed area. We analysed eighteen biopsies from non-ulcerated lesions and quantified the inflamed areas and the expression of CD4, CD20, CD68, CD31 and vW using Image-Pro software (Media Cybernetics). Diffuse lymphoplasmacytic perivascular infiltrates were found in dermal skin. Inflammation was observed in 3-73% of the total biopsy area and showed a significant linear correlation with the number of vW+ vessels. The most common cells were CD68+ macrophages, CD20+ B-cells and CD4+ T-cells. A significant linear correlation between CD4+ and CD20+ cells and the size of the inflamed area was also found. Our findings show chronic inflammation in all DL non-ulcerated lesions predominantly formed by macrophages, plasmacytes and T and B-cells. As the inflamed area expanded, the number of granulomas and extent of the vascular framework increased. Thus, we demonstrate that vessels may have an important role in the clinical evolution of DL lesions.

Tuberculosis is the most prevalent infectious disease in the world. Granuloma formation and caseous necrosis are hallmarks of M. tuberculosis infection and they represent the protective and inflammatory reactions in the infected tissues. The molecular mechanisms that mediate granuloma necrosis are still not well understood. Objectives: To immunolocalize and correlate the amounts of CD68+ macrophages and CD8+ lymphocytes to caseous necrosis extension in granulomas of tuberculous pleurisy. Methods: The study is a retrospective analysis of 30 pleural biopsies with histopathological diagnosis of chronic granulomatous pleurisy with caseous necrosis. These biopsies were classified according to necrosis intensity as minimal (N1), moderate (N2) and intense (N3). The number of granulomas was also observed and categorized as G1 (1 to 4 granulomas per section), G2 (5 to 8 granulomas per section), and G3 (more than 8 granulomas per section). Results: The means of CD68+ cells counts per mm² in N1, N2 and N3 categories of necrosis were 1,287 ± 254, 1086 ±181 and 930 ± 115 respectively. The means for CD8+ cells were 483.7 ± 396, 366.3 ± 43 and 558 ± 53 cells per mm² in N1, N2 and N3 respectively. Conclusions: There were no significant statistical correlations between necrosis extension and cell counts. In analyzed biopsies, the number of CD68+ cells was significantly higher than the number of CD8+ cells.

La tuberculosis es una de las enfermedades más prevalentes en el mundo. La formación del granuloma junto con la necrosis caseosa son características propias de la infección por M. tuberculosis y representan reacciones inflamatorias y protectoras en los tejidos infectados. No se conocen bien los mecanismos moleculares que median la necrosis en el granuloma. Los objetivos fueron inmunolocalizar y correlacionar la cantidad de macrófagos CD68+ y linfocitos CD8+ con la extensión de la necrosis caseosa, en los granulomas de tuberculosis pleural. Análisis retrospectivo que incluyeron 30 biópsias con diagnóstico histopatológico de tuberculosis pleural granulomatosa crónica con necrosis caseosa. Estas biópsias fueron clasificadas según la intensidad de necrosis como mínima (N1), moderada (N2) e intensa (N3). También se determinó el número de granulomas, que fueron clasificados como G1 (1 a4 granulomas por sección), G2 (5 a 8 granulomas por sección), y G3 (más de 8 granulomas por sección). La cuantificación de células CD68+ por mm² en las categorías N1, N2 y N3 de necrosis fue de 1,287 ± 254; 1086 ±181 y 930 ± 115, respectivamente. La cuantificación de las células CD68+ fue de 483,7 ± 396; 366,3 ± 43 y 558 ± 53 células por mm² para N1, N2 y N3, respectivamente. No hubo correlación estadísticamente significativa entre la extensión de la necrosis y la cuantificación celular. El número de células CD68+ fue significativamente mayor que el número de células CD8+ en las biópsias analizadas.

OBJETIVO: Determinar a prevalência de aspergilose broncopulmonar alérgica (ABPA) em pacientes com fibrose cística acompanhados em um centro de referência da Bahia. MÉTODOS: Estudo transversal, com coleta prospectiva de dados, realizado no Centro de Referência de Fibrose Cística da Bahia do Hospital Especializado Octavio Mangabeira. Foram incluídos no estudo 74 pacientes que tinham diagnóstico de fibrose cística, com idade acima de 6 anos e tratados entre 9 de dezembro de 2003 e 7 de março de 2005. Foram analisadas as seguintes variáveis: gênero, idade, capacidade vital forçada, volume expiratório forçado no primeiro segundo, resposta a prova farmacodinâmica, achados em radiografia torácica e de seios de face, presença de sibilância, culturas para Aspergillus spp., imunoglobulina E (IgE) total, IgE específica para Aspergillus fumigatus e teste cutâneo de leitura imediata para aspergilina. RESULTADOS: Dos 74 pacientes, 2 foram diagnosticados com ABPA. Níveis de IgE total > 1.000 UI/mL foram observados em 17 pacientes (23%), teste cutâneo de leitura imediata para A. fumigatus positivos em 19 (25,7%) e sibilância em 60 (81,1%). CONCLUSÕES: A taxa de prevalência de ABPA foi de 2,7%. As altas taxas de IgE total, de teste cutâneo imediato para A. fumigatus positivos e de sibilância sugerem que estes pacientes devam ser acompanhados cuidadosamente por haver a possibilidade do desenvolvimento de ABPA.

OBJECTIVE: To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis treated at a referral center in the state of Bahia, Brazil. METHODS: A cross-sectional study, with prospective data collection, carried out at the Cystic Fibrosis Referral Center of Bahia of the Octavio Mangabeira Specialized Hospital. We evaluated 74 patients diagnosed with cystic fibrosis, older than six years of age, treated between December 9, 2003 and March 7, 2005. We analyzed the following variables: gender, age, forced vital capacity, forced expiratory volume in one second, pharmacodynamic response, chest X-ray findings, facial sinus X-ray findings, wheezing, cultures for Aspergillus spp., total immunoglobulin E (IgE), specific IgE for Aspergillus fumigatus and immediate skin test reactivity to A.fumigatus antigen. RESULTS: Of the 74 patients, 2 were diagnosed with ABPA. We found total IgE levels > 1,000 IU/mL in 17 (23%), positive immediate skin reactivity to A. fumigatus antigen in 19 (25.7%) and wheezing in 60 (81.1%). CONCLUSIONS: The prevalence of ABPA was 2.7%. The high levels of total IgE, high incidence of wheezing and high rate of immediate skin test reactivity to A. fumigatus antigen suggest that these patients should be carefully monitored due to their propensity to develop ABPA.

Objetiva-se descrever e discutir a formação do vínculo terapêutico entre uma criança com diagnóstico de autismo infantil e sua psicoterapeuta. Trata-se de um estudo de caso que utiliza o método clínico-qualitativo, apoiando-se em autores e textos de orientação psicodinâmica. Discute-se e analisa-se o material clínico proveniente da história de vida de uma criança de oito anos de idade, e da psicoterapia lúdica realizada semanalmente, por 16 meses, em um ambulatório público. São comentados alguns aspectos que foram fundamentais para a formação do vínculo, a saber: a configuração do setting terapêutico, o processo de discriminação eu/não-eu, o processo de construção da identidade da criança, a função de holding materno assumida pela psicóloga. O acolhimento da terapeuta foi fundamental para a psicoterapia e para o desenvolvimento psicológico do paciente, permitindo que a criança estabelecesse e desenvolvesse algum tipo de vínculo afetivo.

The purpose of this study is to describe and discuss the therapeutic relationship between a child diagnosed with infantile autism and the psychotherapist. This is a case study that used the clinical-qualitative method and supported from psychodynamically-oriented authors and texts. The clinical material obtained from the eight year-old child's life history and the weekly play therapy conducted over a period of 16 months was discussed and analyzed. An analysis was performed about the therapeutic setting, the "I/not I" discrimination process, the identity construction process, the patient-therapist relationship, and the function of maternal holding. The fact that a child with autism could establish and develop a relationship with the psychotherapist was fundamental to psychotherapy and psychological development.

Resumo: Este trabalho tem como objetivo compreender o processo de mudanças no discurso de um grupo de professoras de ciências do ensino fundamental que participaram de um curso de formação continuada. Ao analisar nossos dados foi possível identificar quatro etapas: a primeira, caracterizou-se por uma situação marcada por uma queixa generalizada; a segunda, pela necessidade de capacitação pelas professoras e a superação das deficiências de conteúdo decorrentes da precária formação no magistério; a terceira, por uma ênfase nos aspectos metodológicos das atividades de ensino e; a quarta, por um engajamento e uma postura mais reflexiva. Para interpretar nossos resultados utilizamos um esquema heurístico de orientação psicanalítica, denominado captura por discursos. Entre as principais conclusões podemos destacar que para que haja mudança do discurso da queixa para a reflexão o professor deve deslocar-se da castração imaginária para a castração simbólica, abandonando sua posição de impotência e resgatando sua autoridade perdida.

Abstract: This work has as objective to analyze the speeches of a group of teachers of basic education. When analyzing our data were possible to identify four stages: the first one, was characterized for a situation marked for a generalized complaint; second, for the necessity of qualification for the teachers and the overcoming of the decurrent deficiencies of content of the precarious formation in the teaching; third, for an emphasis in the methodological aspects of the activities of education e; fourth, for an enrollment and a new reflexive position. To interpret our results we use a heuristical project of psychoanalytical orientation, called capture for speeches. Among the main conclusions we can detach that so that has change of the speech of the complaint for the reflection the professor must dislocate itself from the imaginary castration for the symbolic castration, abandoning its position of impotence and rescuing its lost authority.

Trata-se do estudo de caso de uma criança com AIDS, atendida semanalmente em psicoterapia lúdica de orientação psicodinâmica durante um ano. São descritas e discutidas fantasias, angústias e defesas relacionadas às dificuldades emocionais de vivenciar sua doença e a perda de seus pais falecidos por complicações decorrentes da AIDS. Essa criança se expressou principalmente por meio de desenhos, utilizando inicialmente a negação como mecanismo de defesa. No decorrer do processo de ludoterapia, pôde usar outras defesas e formas de expressão. São observados sentimentos de abandono e de culpa relacionados com sua doença e com a morte dos pais, e fantasias inconscientes de haver provocado o falecimento dos genitores.

This is a case report of a child with AIDS who has taken part into psychotherapeutic sessions for an year. Considering the emotional difficulties experienced by the patient regarding the disease as well as the loss of his parents, caused by AIDS, an analysis based on psychodynamic psychology was conducted in relation to the unconscious fantasies, anxieties and defenses. At first, the child had used denial as a defense and expressed himself mainly through drawings. Along the play psychotherapy, the child was able to use less primitive defenses and express himself in other ways, such as games and drawings. The child's suffering seemed to be a result of abandonment and guilt feelings in relation to the disease and to his parents` death, as well as to unconscious fantasies of having provoked their death.

Inspirados numa leitura epistemológica feyerabendiana, este trabalho sugere uma abordagem metodológica pluralista para o ensino das ciências. Defendemos que esse estratagema didático seja potencialmente mais eficaz para a aprendizagem, na medida em que procura dar conta do espectro de questões que se apresentam na sala de aula.

Inspired by an epistemological reading of Feyerabend, this paper proposes a pluralist methodological approach to science teaching. We propose that this didactic strategy is potentially more effective in the learning process because it tries to account for the spectrum of questions that are presented in the classroom.

Este trabalho procura contribuir com as críticas que vêm sendo realizadas na educação científicaque tomam por base orientações instrucionais fundamentadas em pressupostos pedagógicos construtivistas. Além de mostrar os argumentos atuais que se opõem a essas orientações e pressupostos,procuramos ampliá-los e apresentar novos.

This work tries to contribute with criticism that is being conducted in science education on the basisof on instructional orientations grounded on constructivist pedagogical presuppositions. Besides current arguments that oppose these orientations and presuppositions, we intend to extend them and present new ones.

This paper reports the overall effects of three lectins, extracted from Canavalia brasiliensis, Dioclea violacea, and D. grandiflora, on BALB/c mice popliteal draining lymph nodes. These lectins have presented high stimulatory capacity on lymph node T cells. Additionally, they were able to induce apoptosis and inflammation (frequently associated with high endothelial venule necrosis). The data presented here suggest that the Diocleinae lectins studied can stimulate in vivo T cell activation and apoptosis, as well as present important side effects.

Este trabalho faz uma analogia entre os programas de pesquisa de Lakatos e a dinâmica das idéias dos estudantes em situações de sala de aula. Esta analogia revelou-se uma maneira produtiva de análise do desenvolvimento das concepções dos estudantes durante um processo de discussão. Com as condições de inteligibilidade, plausibilidade e frutibilidade de Posner et alii (1982), pudemos enriquecer a análise baseada previamente nos programas. Mostramos com um exemplo videogravado durante uma aula que a nossa abordagem pode ser efetivamente usada como um instrumento analítico para ajudar o professor a entender e melhorar os processos de ensino e de aprendizagem.

It is shown in this work an analogy between Lakatos' research programmes and the dynamics of students ideas in classroom situations. This analogy revealed itself a productive manner to analyse the development of students' concepcions during a discussion process. With the conditions of intelligibility, plausibility and fruitfulness of Posner et alii. (1982) the analysis previously based in programmes could be enriched. We show with an example video-recorded during a class that our approach can be used as an effective analytical instrument to help teachers understanding and improving the processes of teaching and learning.