Bacterial recognition and induced cellular activation are fundamental for the host control of infection, yet the limit between protective and harmful response is still inexact. Forty-one patients were enrolled in this study: 14 with sepsis, 12 with severe sepsis, and 15 with septic shock. Seventeen healthy volunteers (HV) were included as control. The expression of TLR2, TLR4, CD14, CD11b, and CD11c was analyzed on monocytes surface in whole blood. sCD14 was measured in serum, and TNF-α, IL-6, and IL-10 cytokine levels were measured in PBMC supernatants after LPS, IL-1β, and TNF-α stimuli by ELISA. An increase in sCD14 and a decreased mCD14 were found in patients as compared with HV (P < 0.001). However, no differences in the expression of TLR2, TLR4, and CD11c were found among the groups. A trend toward differential expression of CD11b was observed, with higher values found in patients with sepsis as compared with HV. A negative regulation of the inflammatory cytokine production was observed in patients with severe sepsis and shock septic in relation to sepsis and HV, regardless of the stimulus. No significant difference in IL-10 production was found among the groups. In this study, we show that the inflammatory response is associated with the continuum of clinical manifestations of sepsis, with a strong inflammatory response in the early phase (sepsis) and a refractory picture in the late phases (severe sepsis and septic shock). Correlation between cell surface receptors and cytokine production after IL-1β and TNF-α stimuli and the observation of a single and same standard response with the different stimulus suggest a pattern of immunology response that is not dependent only on the expression of the evaluated receptors and that is likely to have a regulation in the intracellular signaling pathways.

Several studies have reported high prevalence of risk factors for cardiovascular disease in adolescents. To perform: i) systematically review the literature on the prevalence of high blood pressure (HBP) in adolescents; ii) analyze the possible methodological factors associated with HBP; and iii) compare the prevalence between developed and developing countries. We revised 10 electronic databases up to August 11, 2013. Only original articles using international diagnosis of HBP were considered. The pooled prevalence's of HBP were estimated by random effects. Meta-regression analysis was used to identify the sources of heterogeneity across studies. Fifty-five studies met the inclusion criteria and total of 122,053 adolescents included. The pooled-prevalence of HBP was 11.2%, 13% for boys, and 9.6% for girls (P < 0.01). Method of measurement of BP and year in which the survey was conducted were associated with heterogeneity in the estimates of HBP among boys. The data indicate that HBP is higher among boys than girls, and that the method of measurement plays an important role in the overall heterogeneity of HBP value distributions, particularly in boys.

This study evaluated the adherence to antiretroviral therapy (ART) in 322 Brazilian outpatient services located in seven states providing care to 87,000 patients (72%) under ART. A previous study classified the 322 health services into four levels of quality of care. Sixty of them were randomly chosen on the basis of these levels. A cross-section of 1972 patients under ART visiting these services was interviewed using a structured questionnaire. Patients who reported taking more than 95% of the prescribed antiretroviral pills in the past 3 days were considered adherent. The chi-square test was first used to compare the prevalence of non-adherence among two or more categories of variables. A chi-square test for linear trend was used for ordinal variables. Three multivariate models were applied using health services predictors, treatment predictors, and personal characteristics predictors. The predictors were fitted into logistic regression models using backward elimination procedures. The adherence prevalence was 75% (95% confidence interval 73.08-76.95). The level of quality of care was not associated with non-adherence. The models showed the following predictors of non-adherence: related to health services: services with 100 patients or less and missed appointments; related to treatment: more complex regimens and a high number of pills; related to personal characteristics: under 2 years of formal education. The adherence prevalence was similar to the rates currently obtained in developed countries. However, services with few patients need to be carefully monitored to maintain high rates. Care planning that prioritizes patients at risk also needs to be improved.