RESUMO
PURPOSE: Rooted in a trans-territorial framework, the present study was designed to provide new evidence regarding the patterns of communication among Hurricane Maria survivors who migrated to the U.S. in the aftermath of the storm. METHODS: A total of 319 Hurricane Maria survivor adults ages 18 and older were recruited into the Adelante Boricua study between August 2020 and October 2021. Most participants had relocated to the U.S. between 2017 and 2018. We used latent profile analysis and multinomial regression to examine the relationship of technology-based communication with depressive symptoms, well-being, cultural connection, and migration stress. RESULTS: We identified a five-class solution, consisting of (1) moderate communication (32%), (2) disengaged (24%), (3) no social media (18%), (4) daily with family in Puerto Rico (6%), and (5) daily trans-territorial (13%) typologies. Participants in the disengaged class were more likely to report elevated depressive symptoms and limited English proficiency, lower prosocial behaviors, lower levels of religiosity, lower attendance at religious services in the U.S., and less engagement in social activities, compared to participants in the Moderate Communication class. CONCLUSION: Roughly one in four individuals in our sample reported very limited technology-based communication with friends/family in their sending and new-receiving communities. As technology and smartphones continue to become integrated into 21st-century life, it is vital that researchers explore how the tremendous potential for connectedness relates to trans-territorial crisis migrants' well-being and adaptation.
Assuntos
Tempestades Ciclônicas , Migrantes , Adulto , Estados Unidos , Humanos , Porto RicoRESUMO
Salmonella enterica can survive in surface waters (SuWa), and the role of nonhost environments in its transmission has acquired increasing relevance. In this study, we conducted comparative genomic analyses of 172 S. enterica isolates collected from SuWa across 3 months in six states of central Mexico during 2019. S. enterica transmission dynamics were assessed using 87 experimental and 112 public isolates from Mexico collected during 2002 through 2019. We also studied genetic relatedness between SuWa isolates and human clinical strains collected in North America during 2005 through 2020. Among experimental isolates, we identified 41 S. enterica serovars and 56 multilocus sequence types (STs). Predominant serovars were Senftenberg (n = 13), Meleagridis, Agona, and Newport (n = 12 each), Give (n = 10), Anatum (n = 8), Adelaide (n = 7), and Infantis, Mbandaka, Ohio, and Typhimurium (n = 6 each). We observed a high genetic diversity in the sample under study, as well as clonal dissemination of strains across distant regions. Some of these strains are epidemiologically important (ST14, ST45, ST118, ST132, ST198, and ST213) and were genotypically close to those involved in clinical cases in North America. Transmission network analysis suggests that SuWa are a relevant source of S. enterica (0.7 source/hub ratio) and contribute to its dissemination as isolates from varied sources and clinical cases have SuWa isolates as common ancestors. Overall, the study shows that SuWa act as reservoirs of various S. enterica serovars of public health significance. Further research is needed to better understand the mechanisms involved in SuWa contamination by S. enterica, as well as to develop interventions to contain its dissemination in food production settings. IMPORTANCE Surface waters are heavily used in food production worldwide. Several human pathogens can survive in these waters for long periods and disseminate to food production environments, contaminating our food supply. One of these pathogens is Salmonella enterica, a leading cause of foodborne infections, hospitalizations, and deaths in many countries. This research demonstrates the role of surface waters as a vehicle for the transmission of Salmonella along food production chains. It also shows that some strains circulating in surface waters are very similar to those implicated in human infections and harbor genes that confer resistance to multiple antibiotics, posing a risk to public health. This study contributes to expand our current knowledge on the ecology and epidemiology of Salmonella in surface waters.
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Salmonella enterica , Agricultura , Aquicultura , Genômica , Humanos , México/epidemiologia , Salmonella enterica/genéticaRESUMO
Blastocystis is the most prevalent protist of the human intestine, colonizing approximately 20% of the North American population and up to 100% in some nonindustrialized settings. Blastocystis is associated with gastrointestinal and systemic disease but can also be an asymptomatic colonizer in large populations. While recent findings in humans have shown bacterial microbiota changes associated with this protist, it is unknown whether these occur due to the presence of Blastocystis or as a result of inflammation. To explore this, we evaluated the fecal bacterial and eukaryotic microbiota in 156 asymptomatic adult subjects from a rural population in Xoxocotla, Mexico. Colonization with Blastocystis was strongly associated with an increase in bacterial alpha diversity and broad changes in beta diversity and with more discrete changes to the microbial eukaryome. More than 230 operational taxonomic units (OTUs), including those of dominant species Prevotella copri and Ruminococcus bromii, were differentially abundant in Blastocystis-colonized individuals. Large functional changes accompanied these observations, with differential abundances of 202 (out of 266) predicted metabolic pathways (PICRUSt), as well as lower fecal concentrations of acetate, butyrate, and propionate in colonized individuals. Fecal calprotectin was markedly decreased in association with Blastocystis colonization, suggesting that this ecological shift induces subclinical immune consequences to the asymptomatic host. This work is the first to show a direct association between the presence of Blastocystis and shifts in the gut bacterial and eukaryotic microbiome in the absence of gastrointestinal disease or inflammation. These results prompt further investigation of the role Blastocystis and other eukaryotes play within the human microbiome. IMPORTANCE Given the results of our study and other reports of the effects of the most common human gut protist on the diversity and composition of the bacterial microbiome, Blastocystis and, possibly, other gut protists should be studied as ecosystem engineers that drive community diversity and composition.
RESUMO
The study of the composition of the intestinal flora is important to the health of the host, playing a key role in maintaining intestinal homeostasis and the evolution of the immune system. For these studies, various universal primers of the 16S rDNA gene are used in microbial taxonomy. Here, we report an evaluation of 5 universal primers to explore the presence of microbial DNA in colon biopsies preserved in RNAlater solution. The DNA extracted was used for the amplification of PCR products containing the variable (V) regions of the microbial 16S rDNA gene. The PCR products were studied by restriction fragment length polymorphism (RFLP) analysis and DNA sequence, whose percent of homology with microbial sequences reported in GenBank was verified using bioinformatics tools. The presence of microbes in the colon of rats was quantified by the quantitative PCR (qPCR) technique. We obtained microbial DNA from rat, useful for PCR analysis with the universal primers for the bacteria 16S rDNA. The sequences of PCR products obtained from a colon biopsy of the animal showed homology with the classes bacilli (Lactobacillus spp) and proteobacteria, normally represented in the colon of rats. The proposed methodology allowed the attainment of DNA of bacteria with the quality and integrity for use in qPCR, sequencing, and PCR-RFLP analysis. The selected universal primers provided knowledge of the abundance of microorganisms and the formation of a preliminary test of bacterial diversity in rat colon biopsies.
Assuntos
Colo/microbiologia , Microbioma Gastrointestinal , Tipagem Molecular/métodos , RNA Ribossômico 16S/genética , Animais , Bactérias/genética , Primers do DNA/genética , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Genes Bacterianos , Masculino , Reação em Cadeia da Polimerase/métodos , Polimorfismo de Fragmento de Restrição , Ratos , Análise de Sequência de DNARESUMO
OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) high-risk types; the prevalence of pre-cancer and cervical cancer and its correlation with HPV high-risk serotypes and sexual and reproductive health risk factors; and the HPV vaccine acceptability by the persons interviewed in St Kitts and Nevis. SUBJECTS AND METHODS: A cross-sectional study of 500 eligible women 30 years and older was conducted from February to November 2014. Each participant was interviewed from a validated questionnaire followed by a gynaecological examination that included specimens collected for a Papanicolaou test and an HPV DNA highrisk screening test. Typing for specific high-risk HPV types was done on the cervical specimens that tested positive on the HPV DNA high-risk screening test. RESULTS: The prevalence of HPV high-risk genotype was 25.2%. Overall, HPV high-risk genotypes 52, 35, 51, 31and 45 were the most prevalent in descending order. Women with abnormal smears were twice as likely to have high-risk HPV types (RR = 1.94; [1.31, 2.88]) and younger women were nearly twice more likely to have a high-risk HPV infection (RR = 1.94; [1.33, 2.85]). Nearly all of the participants indicated that they wanted to be vaccinated against HPV and if they had daughters, they would also want their daughters vaccinated. CONCLUSION: High-risk HPV is prevalent in St Kitts and Nevis and women are very interested in receiving HPV vaccine for themselves and their daughters. This finding is very positive for the introduction of the HPV vaccine.
Assuntos
Feminino , Papillomaviridae , Neoplasias do Colo do Útero , Fatores de Risco , Vacinação , São Cristóvão e NévisRESUMO
Metacaspases (MCAs) are caspase family cysteine peptidases that have been implicated in cell death processes in plants, fungi and protozoa. MCAs have also been suggested to be involved in cell cycle control, differentiation and clearance of aggregates; they are virulence factors. Dissecting the function of MCAs has been complicated by the presence in many organisms of multiple MCA genes or limitations on genetic manipulation. We describe here the creation of a MCA gene-deletion mutant (Δmca) in the protozoan parasite Leishmania mexicana, which has allowed us to dissect the role of the parasite's single MCA gene in cell growth and cell death. Δmca parasites are viable as promastigotes, and differentiate normally to the amastigote form both in in vitro macrophages infection and in mice. Δmca promastigotes respond to cell death inducers such as the drug miltefosine and H(2)O(2) similarly to wild-type (WT) promastigotes, suggesting that MCAs do not have a caspase-like role in execution of L. mexicana cell death. Δmca amastigotes replicated significantly faster than WT amastigotes in macrophages and in mice, but not as axenic culture in vitro. We propose that the Leishmania MCA acts as a negative regulator of amastigote proliferation, thereby acting to balance cell growth and cell death.
Assuntos
Caspases/metabolismo , Leishmania mexicana/enzimologia , Animais , Antiprotozoários/farmacologia , Caspases/genética , Feminino , Leishmania mexicana/efeitos dos fármacos , Leishmania mexicana/crescimento & desenvolvimento , Macrófagos/metabolismo , Macrófagos/parasitologia , Camundongos , Camundongos Endogâmicos BALB C , Fosforilcolina/análogos & derivados , Fosforilcolina/farmacologiaRESUMO
OBJECTIVE: The study was done to assess knowledge, attitudes and practices of women within the child bearing age with regard to smoking and exposure to environmental tobacco smoke (ETS) on children's health. SUBJECTS AND METHODS: A cross-sectional study with quantitative and qualitative components was designed to collect data from women in the child-bearing age. The sample comprised of persons from the two largest combined family planning and antenatal clinics in Kingston, Jamaica. RESULTS: The women surveyed had a fair level of knowledge about ETS health risks, negative attitudes to smoking in general, and most supported a ban on smoking in public places. Significant knowledge differences existed between young and older women and between smokers and non-smokers. CONCLUSION: Women with the highest level of knowledge were the non-smokers: of the low knowledge score group (current smokers), 50% were in the 15-24-year age range. There is a need for more public education on smoking and the consequences of environmental tobacco smoke exposure on children's health.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Escolaridade , Emprego , Feminino , Humanos , Jamaica , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto JovemRESUMO
OBJECTIVE: The study was done to assess knowledge, attitudes and practices of women within the child bearing age with regard to smoking and exposure to environmental tobacco smoke (ETS) on children's health. SUBJECTS AND METHODS: A cross-sectional study with quantitative and qualitative components was designed to collect data from women in the child-bearing age. The sample comprised of persons from the two largest combined family planning and antenatal clinics in Kingston, Jamaica. RESULTS: The women surveyed had a fair level of knowledge about ETS health risks, negative attitudes to smoking in general, and most supported a ban on smoking in public places. Significant knowledge differences existed between young and older women and between smokers and non-smokers. CONCLUSION: Women with the highest level of knowledge were the non-smokers: of the low knowledge score group (current smokers), 50% were in the 15-24-year age range. There is a need for more public education on smoking and the consequences ofenvironmental tobacco smoke exposure on children s health.
OBJETIVO: El estudio fue realizado para evaluar los conocimientos, actitudes y prácticas de las mujeres en edad de procrear, en relación con el hábito de fumar y la exposición al humo de tabaco ambiental (HTA) sobre la salud de los niños. SUJETOS Y MÉTODOS: Se diseñó un estudio transversal con componentes cuantitativos y cualitativos con el propósito de recopilar datos de las mujeres en edad fértil. La muestra abarcó personas de las dos clínicas más grandes en Kingston, que combinan la atención prenatal con la planificación familiar. RESULTADOS: Las mujeres encuestadas tenían un nivel razonable de conocimientos acerca de los riesgos del HTA para la salud, actitudes negativas hacia el hábito de fumar en general, y la mayoría apoyaban la prohibición de fumar en lugares públicos. Se hallaron diferencias significativas en el conocimiento existente entre las mujeres jóvenes y mayores, así como entre las fumadoras y no fumadoras. CONCLUSIÓN: Las mujeres con el más alto nivel de conocimientos fueron las no fumadoras. Del grupo de bajo puntaje de conocimiento (actuales fumadoras), el 50% estaban en el rango de edad de 15-24 años. Existe una necesidad de mayor educación pública acerca del hábito de fumar y las consecuencias de la exposición al humo de tabaco ambiental sobre la salud de los niños.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Adulto Jovem , Conhecimentos, Atitudes e Prática em Saúde , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Escolaridade , Emprego , Jamaica , Fumar/prevenção & controle , Poluição por Fumaça de Tabaco/prevenção & controleRESUMO
Researchers have found that immigrants in the United States gradually relinquish cultural practices and adopt health behaviors similar to native born individuals as they acculturate. Few studies have looked at acculturation and Complementary and Alternative Medicine (CAM) use, particularly ethnic forms of CAM. This study uses data from the 2001 California Health Interview Survey-Complementary and Alternative Medicine (CHIS-CAM) supplement to estimate the prevalence of CAM provider use among Mexican- and Asian- Americans and examine the relationship of acculturation on use. Multinomial logistic regression models were used to predict the probability of provider use based on socio-demographic variables, health status and acculturation. Mexican- and Asian- Americans who have spent more time in the US were more likely to use chiropractors or massage therapists compared to no CAM provider. Both groups were less likely to use ethnic-specific CAM providers with more time in the US compared to chiropractors or massage therapists.
Assuntos
Aculturação , Asiático/estatística & dados numéricos , Terapias Complementares/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Intervalos de Confiança , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Masculino , Manipulação Quiroprática/estatística & dados numéricos , Massagem/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Satisfação do Paciente , Prevalência , Estados Unidos , Adulto JovemRESUMO
From September through November 2000 we conducted an experimental field study of tool use in a group of 15 wild white-faced capuchins (Cebus capucinus) in Costa Rica. The problem presented to the capuchins involved the use of wooden dowels as probes to obtain a food reward (two bananas) located inside a clear Plexiglas box. Specifically, the task required the capuchins to manually insert a dowel into any of six holes drilled into the box in order to push the bananas off a shelf. The banana could then be retrieved through a large opening at the bottom of the box. The capuchins visited the tool-use platform 702 times over the course of 55 consecutive days and under several experimental conditions. During the first 21 days of the study, they explored the box but made no attempt to touch or pick up the dowels. Even after we placed the dowels in the holes, the capuchins only occasionally manipulated them. Overall, the results indicate that the capuchins did not use a tool to solve this novel foraging problem.
Assuntos
Cebus/psicologia , Comportamento Alimentar , Resolução de Problemas , Desempenho Psicomotor , Animais , Costa RicaRESUMO
Synaptosomes from the optic lobes of squid (Loligo forbesi) were prepared by homogenization and allowed to settle onto glass coverslips. Synaptosomes were loaded with Ca(2+) sensitive dyes (Fura-2 AM, Calcium Green-1 AM and Calcium Green-5N AM), visualized by light microscopy and Ca(2+) sensitive fluorescence signals recorded and analyzed. With Fura-2, resting Ca(2+) was found to be 80 nM (n = 10, SEM 5.7). Addition of K(+) (30 mM), caffeine (3 mM) and thapsigargin (10 microM) evoked transient increases in cytoplasmic Ca(2+). Addition of BAPTA-AM (20 microM) decreased intrasynaptosomal free Ca(2+). Similar results were obtained with Calcium Green-1 AM but not with Calcium Green-5N AM. We conclude that synaptosomes from the squid optic lobe posses intact membranes and mechanisms to regulate intrasynaptosomal free [Ca(2+)], as well as caffeine sensitive Ca(2+) stores. The results of this study are discussed with respect to the role of Ca(2+) in presynaptic protein synthesis.
Assuntos
Cálcio/metabolismo , Corantes Fluorescentes/metabolismo , Lobo Óptico de Animais não Mamíferos/metabolismo , Sinaptossomos/metabolismo , Animais , Cafeína/farmacologia , Estimulantes do Sistema Nervoso Central/farmacologia , Quelantes/farmacologia , Decapodiformes , Ácido Egtázico/análogos & derivados , Ácido Egtázico/farmacologia , Inibidores Enzimáticos/farmacologia , Potenciais da Membrana/efeitos dos fármacos , Potenciais da Membrana/fisiologia , Lobo Óptico de Animais não Mamíferos/efeitos dos fármacos , Compostos Orgânicos , Cloreto de Potássio/farmacologia , Sinaptossomos/efeitos dos fármacos , Tapsigargina/farmacologiaRESUMO
Samples of human and rat skin in short-term organ culture exposed to ALA or a range of hydrophobic derivatives were examined for their effect on the accumulation of protoporphyrin IX (PpIX) measured using fluorescence spectroscopy. With the exception of carbobenzoyloxy-D-phenylalanyl-5-ALA-ethyl ester the data presented indicate that, in normal tissues, ALA derivatives generate protoporphyrin IX more slowly than ALA, suggesting that they are less rapidly taken up and/or converted to free ALA. However, the resultant depot effect may lead to the enhanced accumulation of porphyrin over long exposure periods, particularly in the case of ALA-methyl ester or ALA-hexyl ester, depending on the applied concentration and the exposed tissue. Addition of the iron chelator, CP94, greatly increased PpIX accumulation in human skin exposed to ALA, ALA-methyl ester and ALA-hexyl ester. The effect in rat skin was less marked.
Assuntos
Ácido Aminolevulínico/farmacologia , Protoporfirinas/biossíntese , Pele/efeitos dos fármacos , Ácido Aminolevulínico/análogos & derivados , Animais , Feminino , Humanos , Microscopia de Fluorescência , Técnicas de Cultura de Órgãos , Ratos , Ratos Wistar , Pele/metabolismoRESUMO
Chronic mucocutaneous candidiasis is a heterogenous group of disorders, associated with a variety of autoimmune disorders and a broad spectrum of immune aberrations. We describe 2 patients with chronic mucocutaneous candidiasis who had cerebrovascular disease with severe neurologic sequelae. Results of angiography of cerebral vessels and brain biopsy in one were consistent with the diagnosis of cerebral vasculitis.
Assuntos
Candida albicans/isolamento & purificação , Candidíase Mucocutânea Crônica/complicações , Candidíase Mucocutânea Crônica/microbiologia , Córtex Cerebral/microbiologia , Hematoma/microbiologia , Vasculite/etiologia , Adulto , Antígenos de Bactérias/imunologia , Antígenos CD/imunologia , Angiografia Cerebral/métodos , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Hematoma/diagnóstico por imagem , Hematoma/patologia , Humanos , Imunoglobulinas/sangue , Imunoglobulinas/imunologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
A 10-year prospective cohort study followed the evolution of antibodies in children less than 4 years of age with hypogammaglobulinemia. Three patterns were identified: in group 1, immunoglobulins and antibody production normalized;iin group 2, patients continued to have low IgG levels; and in group 3, IgG levels normalized but antibody levels were transient. Statistical analysis showed that invasive infection or low tetanus antibodies at presentation were associated with the development of significant humoral immunodeficiency.
Assuntos
Agamaglobulinemia , Deficiência de IgG , Agamaglobulinemia/imunologia , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Deficiência de IgG/imunologia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Masculino , Estudos ProspectivosRESUMO
Asherman's syndrome is an uncommon finding at hysterosalpingography for infertility. Modern day management entails hysteroscopic confirmation and adhesiolysis. We present one such case of a young woman who had secondary infertility after dilatation and curettage, and who was diagnosed and treated with a successful outcome.
Assuntos
Humanos , Feminino , Adulto , Gravidez , Ginatresia , Histeroscopia , Aderências Teciduais , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Resultado da GravidezRESUMO
Asherman's syndrome is an uncommon finding at hysterosalpingography for infertility. Modern day management entails hysteroscopic confirmation and adhesiolysis. We present one such case of a young woman who had secondary infertility after dilatation and curettage, and who was diagnosed and treated with a successful outcome.(AU)
Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Gravidez , Ginatresia , Histeroscopia , Aderências Teciduais , Resultado da Gravidez/etiologia , Infertilidade Feminina/terapiaRESUMO
OBJECTIVE: We tested the hypothesis that vitamin C supplementation of premature neonates is associated with hemolysis. STUDY DESIGN: A double-blind, randomized, controlled trial of vitamin C supplementation (50 mg/day) was undertaken in premature neonates (birth weight, 1000 to 1500 gm). Infants were randomly assigned to receive vitamin C (Ce-Vi-Sol) (n = 32) or placebo (n = 24) for 14 days. Twenty-three subjects per group were required to detect a difference of 1 SD in corrected carboxyhemoglobin values (alpha = 0.05, beta = 0.10). RESULTS: Day 14 vitamin C levels were lower in control subjects than in supplemented neonates (62 +/- 24 vs 125 +/- 62 micromol/L, p = 0.005). There was no difference in corrected blood carboxyhemoglogin concentrations (0.72 +/- 0.44 vs 0.72 +/- 0.23%; p = 0.95), other parameters of hemolysis, weight gain, blood sampled, presumed septic episodes, necrotizing enterocolitis, feeding intolerance, or transfusion. On day 14, bilirubin values were higher in control subjects than in the supplemented group (77 +/- 37 vs 55 +/- 33 micromol/L; p = 0.04). When a distant outlier in the nonsupplemented group was excluded (163 micromol/L), statistical significance was lost (73 +/- 32 vs 55 +/- 33 micromol/L; p = 0.09). CONCLUSION: Oral supplementation of premature infants with vitamin C is not associated with evidence of increased erythrocyte destruction, hyperbilirubinemia, or other morbidity.
Assuntos
Ácido Ascórbico/efeitos adversos , Hemólise/efeitos dos fármacos , Recém-Nascido Prematuro/fisiologia , Anemia Hemolítica/induzido quimicamente , Ácido Ascórbico/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Hiperbilirrubinemia/induzido quimicamente , Recém-Nascido , Doenças do Prematuro/induzido quimicamente , MasculinoRESUMO
Asherman's syndrome is an uncommon finding at hysterosalpingography for infertility. Modern day management entails hysteroscopic confirmation and adhesiolysis. We present one such case of a young woman who had secondary infertility after dilatation and curettage, and who was diagnosed and treated with a successful outcome.
Assuntos
Ginatresia , Histeroscopia , Adulto , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Gravidez , Resultado da Gravidez , Aderências TeciduaisRESUMO
HYPOTHESIS: The major clinical manifestations of sickle cell disease (SCD) are hemolytic anemia, predisposition to infection, and recurrent vaso-occlusive episodes resulting in pain, organ dysfunction, or both. There has been no satisfactory treatment for children with recurrent severe painful episodes caused by SCD. Hydroxyurea is an antimetabolite drug shown in adults with SCD to increase fetal hemoglobin levels and reduce the symptoms of SCD. We hypothesized that hydroxyurea therapy in children with severe (defined as > or = 3 vaso-occlusive events per year) SCD could improve hematologic parameters and reduce vaso-occlusive events. OBJECTIVE: To assess the safety and efficacy of hydroxyurea for the treatment of severe SCD in children. STUDY DESIGN: After obtaining informed consent, we initiated hydroxyurea therapy at a dosage of 10 to 20 mg/kg per day in 15 patients with severe SCD (hemoglobin SS, hemoglobin SS-alpha thalassemia, or hemoglobin S-beta0-thalassemia). Doses were escalated as tolerated. Patients were monitored with bimonthly physical examinations and monthly laboratory measures. To assess the impact of hydroxyurea on clinical symptoms, we recorded the number of inpatient days for each patient during the period of treatment and compared it with the number of inpatient days for the 12- to 24-month period before institution of hydroxyurea therapy, using the subject as his or her own control subject. RESULTS: Thirteen patients received hydroxyurea for a median of 24 months (range, 6 to 39 months). The mean dose of hydroxyurea was 21.4 +/- 5.2 mg/kg. Treatment with hydroxyurea induced statistically significant increases in the total hemoglobin concentration, mean corpuscular volume, and percentage of hemoglobin F, and a decrease in the serum concentration of bilirubin. Toxic effects included three episodes of a reversible myelotoxic reaction, two of which required transfusion of packed erythrocytes. For the entire group, hospitalization decreased from a prehydroxyurea median of 3.9 +/- 2.0 days per month to 1.1 +/- 2.1 days per month of therapy (p = 0.09). For those subjects (n = 10) completing at least 1 year of treatment, the decrease in hospitalization from 4.1 +/- 2.2 to 1.0 +/- 1.7 days per month was significant (p = 0.03). CONCLUSIONS: In this pilot trial, hydroxyurea treatment of severe SCD in children was associated with improved hematologic parameters, acceptable toxic effects, and a trend to reduced hospitalization. Hydroxyurea appears to be a safe and potentially effective agent for the treatment of severe SCD in children. A prospective, controlled trial to investigate the efficacy of hydroxyurea in children is therefore warranted.
Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Hidroxiureia/uso terapêutico , Adolescente , Anemia Falciforme/sangue , Antidrepanocíticos/efeitos adversos , Criança , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Hemoglobinometria , Humanos , Hidroxiureia/efeitos adversos , Masculino , Resultado do Tratamento , Talassemia alfa/sangue , Talassemia alfa/tratamento farmacológico , Talassemia beta/sangue , Talassemia beta/tratamento farmacológicoRESUMO
A cohort of more than 500 children from Panama City, Panama was studied prospectively over five years for acquisition of antibody to Toxoplasma gondii. The direct agglutination test showed that 72 of 571 children seroconverted between one and six years of age, for a cumulative incidence of 12.6%. Children were examined by pediatricians quarterly, and illnesses that had occurred in the interval and their activities were noted on questionnaires. Thirty-eight variables were examined for their role as risk factors for seroconversion. There was a higher correlation between children's seroconversion and contact with dogs than with cats. Combinations of significant predictors without dogs explained only 67% of the seroconversions, but the same factors with dogs explained 90%. On the other hand, ingestion of raw or rare meat or eggs appeared to play no role in transmission. Cats were examined and 110 (45.6%) of 241 had Toxoplasma antibody on the first bleeding. Only two (0.5%) of 383 cat fecal specimens, when tested in mice, resulted in seroconversion. Ten (1.1%) of 924 soil samples resulted in seroconversion in mice that had been injected. Antibody to Toxoplasma was found in 52 (23.3%) of 226 rats (Rattus norvegicus) and two (0.035%) of 571 mice (Mus musculus). Two hundred sixteen birds of 16 different species were bled. Antibody to Toxoplasma was found in 13.4% of these birds, mostly in grackles, blue-gray tanagers, and doves. The rate of isolation of Toxoplasma was low: one of 23 in rats and three of 201 in birds. High relative risks (RRs) of transmission to children were predicted by contact histories with nursing dogs (RR = 5.8), weaned dogs (RR = 4.7), many flies (RR = 3.6), 6-12-month-old dogs (RR = 3.4), weaned cats (RR = 3.0), 6-12-month-old cats (RR = 2.7), nursing cats (RR = 2.5), much garbage (RR = 2.4), and many roaches (RR = 2.2). The high statistical correlation of dog contact with seroconversion in children suggests the possibility that dogs, by eating and rolling in cat feces, are instrumental in mechanically transmitting Toxoplasma infection. In addition, flies, and to a lesser extent, cockroaches, may have practically important roles in transmission.