RESUMO
BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.
Assuntos
Países em Desenvolvimento , Recidiva Local de Neoplasia/terapia , Segunda Neoplasia Primária/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Suspensão de Tratamento/estatística & dados numéricos , Adolescente , América Central , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Imunofenotipagem , Renda , Lactente , Recém-Nascido , Masculino , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/mortalidade , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/mortalidade , Pobreza , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Prognóstico , Indução de Remissão , Taxa de Sobrevida , Suspensão de Tratamento/economiaRESUMO
Aporocotyle mariachristinae n. sp. and A. ymakara Villalba & Fernández, 1986 were collected from the bulbus arteriosus and ventral aorta of pink cusk-eels, Genypterus blacodes (Forster, 1801) from Patagonia, Argentina. A. mariachristinae n. sp. can be distinguished from all the species of Aporocotyle by the asymmetrical extension of posterior caeca (right posterior caecum longer, terminating at the area between mid-level of ovary and posterior body end; left posterior caecum shorter, terminating at the area between mid-level of cirrus sac and posterior to reproductive organs), the distribution of spines along the ventro-lateral body margins and the number of testes. The new species clearly differs from A. ymakara, from the same host species, in the esophagus / body length ratio, the absence of distal loops at caeca, the anterior caeca / posterior caeca length ratio, and the number of testes. Additionally, in A. ymakara the left posterior caecum may be longer than right posterior caecum, while in the new species left posterior caecum is always shorter. The specimen of A. ymakara collected from Argentina is also described. We also provide observations of the distribution of spines in different species of Aporocotyle, including new specimens of A. argentinensis Smith, 1969 from Merluccius hubbsi Marini, 1933. Molecular sequence data obtained from partial 18S and 28S rDNA regions were compared between the new species and other two species of Aporocotyle (A. argentinensis and A. spinosicanalis Williams, 1958). This is a new locality record for A. ymakara, extending the known geographical distribution for this species from Chile to Argentina, and the first report of two species of Aporocotyle in the same host species and locality.
Assuntos
Enguias/parasitologia , Doenças dos Peixes/parasitologia , Trematódeos/classificação , Infecções por Trematódeos/veterinária , Animais , Aorta/parasitologia , Argentina , DNA Ribossômico/química , Coração/parasitologia , RNA Ribossômico 18S/genética , RNA Ribossômico 28S/genética , Trematódeos/anatomia & histologia , Trematódeos/genética , Infecções por Trematódeos/parasitologiaRESUMO
A cytogenetic and/or cytochemical study was performed in 166 individuals with leukemia or related disorders, in two major Costa Rican hospitals. In those patients treated at an adult's hospital (14 years old and over), acute leukemias represented 66% of all cases. In that hospital the most frequent types of disorders were, in decreasing order: ANLL (> M1), ALL, CML (all of them showed the Ph chromosome) and MDS. In the cases from a childrens' hospital (< 14 years old) acute leukemias were 98%. Among them the order of frequency was: ALL (70%): ALL-1 (84%), ALL-2 (16%) and ANLL (27%): M5a > M3 > M4 > M5b. In ALL 85% were type B and occurred mostly in women while 15% of them were type T and more frequent in males. There was 5.6% infant leukemia, which presented a similar number of acute lymphoids and myeloids. The cytogenetic pattern was similar among Costa Rica and other tropical and temperate countries.
Assuntos
Leucemia Linfoide/genética , Leucemia Mieloide/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Cariotipagem , Leucemia Linfocítica Crônica de Células B/genética , Leucemia Linfocítica Crônica de Células B/metabolismo , Leucemia Linfoide/metabolismo , Leucemia Mieloide/metabolismo , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/metabolismo , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Disseminated histoplasmosis usually occurs in immunocompromised patients who reside in Histoplasma capsulatum-endemic regions. It has also been described in immunocompetent infants after exposure to a large inoculum of the pathogen resulting in case fatality rates of 40 to 50%. METHODS: From 1983 through 1996 all infants with documented disseminated histoplasmosis were treated with amphotericin B followed by daily ketoconazole for 3 months. Immunologic workups were performed at the time of diagnosis and at 4 to 6 weeks of therapy. Surviving patients were followed for at least 1 year. Time to resolution of signs and symptoms was recorded, as were complications. RESULTS: We managed 40 patients with disseminated histoplasmosis. The age in months at diagnosis was 15.3+/-10.2 (mean +/- SD), and 24 were male. All patients were from endemic regions and they presented with fever, spleen and/or liver enlargement and hematologic abnormalities. Diagnosis was made by histology and culture of bone marrow, spleen, lymph node, bronchoalveolar or liver samples. Twenty patients presented with T cell deficiency that resolved at 4 to 6 weeks of therapy in all of the retested patients, and 10 of 12 tested patients had hyperglobulinemia that resolved. Thirty-five (88%) patients were cured by treatment; 4 died and 1 relapsed. CONCLUSIONS: Disseminated histoplasmosis should be considered in infants from endemic areas who present with fever, hepatosplenomegaly and hematologic abnormalities. These patients develop transient hyperglobulinemia and T cell deficiency that resolve with treatment. Treatment with amphotericin B followed by an oral azole for 3 months is effective in most patients.
Assuntos
Histoplasmose , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Costa Rica/epidemiologia , Doenças Endêmicas , Feminino , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Histoplasmose/epidemiologia , Humanos , Lactente , Cetoconazol/uso terapêutico , Masculino , Análise de SobrevidaRESUMO
OBJECTIVES: To assess the efficacy and toxicity of very high doses of glucocorticoids in patients with congenital pure red cell aplasia (Diamond-Blackfan anemia) who did not respond to standard doses of prednisone. STUDY DESIGNS: We prospectively treated eight patients with transfusion-dependent Diamond-Blackfan anemia with high intravenous doses of methylprednisolone. All patients had previously not responded to one or more oral courses of prednisone in standard doses and were dependent on erythrocyte transfusions. Every patient initially received methylprednisolone at a dose of 30 mg/kg per day, followed by slow tapering for 4 weeks, but none responded. All patients then received a second treatment course starting at 100 mg of methylprednisolone per kilogram per day, again followed by slow tapering of the dosage. RESULTS: Three patients had a complete response that has been sustained for 21+, 31+, and 41+ months, respectively. One patient had a partial response. Toxic effects included a rise in serum alanine aminotransferase activity in all patients, transient diabetes mellitus in one child, and three episodes of bacteremia in two patients with intravenous access devices. CONCLUSIONS: We conclude that very high doses of methylprednisolone may induce sustained remission in some patients with transfusion-dependent Diamond-Blackfan anemia refractory to standard-dose prednisone therapy.
Assuntos
Anemia Refratária/tratamento farmacológico , Relação Dose-Resposta a Droga , Anemia de Fanconi/tratamento farmacológico , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Adolescente , Idade de Início , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Pré-Escolar , Protocolos Clínicos , Glucocorticoides/efeitos adversos , Humanos , Lactente , Metilprednisolona/efeitos adversos , Pneumocystis , Infecções por Pneumocystis/tratamento farmacológico , Infecções por Pneumocystis/prevenção & controle , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Estudos Prospectivos , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Anemia Hipocrômica/terapia , Aleitamento Materno , Ferro/uso terapêutico , Leite , Animais , Bovinos , Humanos , Lactente , Estudos ProspectivosRESUMO
In Arizona, undocumented pregnant Hispanic women without private care have no recourse but to enter an emergency room after labor begins. A survey we conducted showed over 150 such "emergency" births annually in Tucson. As a result, a prenatal care program, "Dar a Luz," specifically targeted at this population, was developed. It includes prenatal obstetrical care and anticipatory birthing education that is sensitive to Mexican-American traditions, community consciousness-raising, and a cooperative obstetrical agreement with Tucson hospitals. Bilingual community volunteers act as patient advocates, following these patients through pregnancy and accompanying them to emergency rooms for hospital deliveries. Based in an Hispanic neighborhood community center, professional and lay volunteers provide health care coordinated by medical students in the paracurricular Commitment to Underserved People Program at the University of Arizona College of Medicine.
Assuntos
Hispânico ou Latino , Cuidado do Lactente/organização & administração , Cuidado Pré-Natal/organização & administração , Fatores Etários , Arizona , Feminino , Idade Gestacional , Humanos , Recém-Nascido , México/etnologia , Gravidez , Fatores SocioeconômicosAssuntos
Anemia Aplástica/terapia , Corticosteroides/uso terapêutico , Anabolizantes/uso terapêutico , Anemia Aplástica/etiologia , Antibacterianos/uso terapêutico , Transfusão de Sangue , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Inseticidas/intoxicação , Masculino , Compostos OrganofosforadosRESUMO
Se analizan 29 pacientes con anemia aplastica adquirida atendidos en el Hospital Nacional de Ninos (Costa Rica) durante el periodo de 1968-1979. En el 38% de los casos no se logro establecer posibilidad etiologica. Las manifestaciones clinicas mas frecuentes fueron palidez y sangrado anormal y en ninguno se encontro esplenomegalia. El tratamiento fue a base de anabolicos y corticosteroides, resaltando la respuesta positiva a la metenolona intramuscular en cinco de siete pacientes que no habian respondido al anabolico oral.Fallecieron 12 pacientes (41.4%) y la supervivencia proyectada a cuatro anos fue de 39.2%
Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Anemia AplásticaRESUMO
Se analizan 222 casos de purpura trombocitopenica idiopatica (PTI) en ninos. La mayoria de ellos estuvo en edades comprendidas entre uno a seis anos. Las manifestaciones de sangrado fueron por lo regular de tipo leve o moderado, siendo poco frecuentes los sangrados severos y a nivel del sistema nervioso central. La evolucion aguda fue la mas frecuente, observada en 78% de los casos. De los 32 ninos que evolucionaron a la cronicidad, se esplenectomizaron 17; de estos, el 65% respondio favorablemente. El tratamiento con esteroides no parecio modificar la evolucion ni el pronostico de la PTI en estos ninos
Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Púrpura TrombocitopênicaRESUMO
In eighty nine anemic children, aged from 6 months to 13 years, the etiology of their anemia was studied: 67(75%) of the cases presented iron deficiency, 18(20%) iron and folate deficiency and 4 megaloblastic anemia (2 folate and 2 vitamin B12 deficiency). Patients with vitamin B12 deficiency showed severe pancytopenia and megaloblastic changes in bone marrow; but no morphological difference, either in circulating blood or bone marrow was found in patients with iron deficiency, compared to iron plus folate deficiency. The seric measurement of iron, folate and B12 were essential in order to establish the etiology of nutritional anemias. The majority of the children were accepted to the hospital for other causes than anemia, such as diarrhea (58%) and respiratory diseases (18%). Clinical features and the high incidence of anemia in children under two years of age are also discussed.
Assuntos
Anemia Hipocrômica/sangue , Anemia Sideroblástica/sangue , Deficiência de Ácido Fólico/complicações , Distúrbios Nutricionais/complicações , Adolescente , Anemia Hipocrômica/etiologia , Anemia Megaloblástica/sangue , Anemia Megaloblástica/etiologia , Anemia Sideroblástica/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Deficiência de Vitamina B 12/complicaçõesRESUMO
One hundred and twenty-five febrile episodes in 82 children with acute leukemia were studied; 46% of the patients were from urban and 54% from rural areas. The origin of the fever was identified in 91% of the episodes, prevailing pneumonia, septicemia, chickenpox and herpes zoster. The etiological agent was identified in 46% of the cases. A viral predominance was evident, and among them varicela-zoster, following in importance gram-negative bacteria. Histoplasma capsulatum and Pneumocystis carinii were isolated in two occassions each. Sepsis was found more frequently in children with active leukemia than in those in remission (p less than 0.001). Forty-four febrile episodes occurred in patients with less than 1,000 neutrophils/ul. The daily-risk rate of infection was higher in children fom rural than in those from urban areas (p less than 0.001). After clinical and laboratory studies, methicillin and gentamicin were used, in addition to carbenicillin or trimethoprim-sulfamethoxazole is selected cases. This treatment was effective in 86% of the cases. Twelve (15%) children died, 6 of whom were in remission at that moment.
Assuntos
Febre/etiologia , Infecções/complicações , Leucemia/complicações , Adolescente , Antibacterianos/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Contagem de Leucócitos , Masculino , Meningite/complicações , Neutropenia/etiologia , Infecções por Protozoários/complicações , Sepse/complicações , Viroses/complicaçõesRESUMO
Antithrombin III (AT III) and heparin antithrombin assay were estimated in 30 severely malnourished children and 40 normal children. The AT III was found significatively depressed and the heparin antithrombin assay showed a flat curve in the patients, which reflects a prethrombotic pattern in this group of children. Those findings agree with the high incidence of thrombosis reported in childhood malnutrition.
Assuntos
Antitrombina III/análise , Transtornos da Coagulação Sanguínea/complicações , Desnutrição Proteico-Calórica/complicações , Trombose/etiologia , Testes de Coagulação Sanguínea , Criança , Pré-Escolar , Feminino , Heparina/administração & dosagem , Humanos , Lactente , MasculinoRESUMO
Clinical features and treatment evaluation of 38 children with disseminated histoplasmosis were studied. Thirty-six cases presented the severe form and two of them showed the mild chronic type. A higher incidence of this disease was found in infants (65%) and in severe malnutrition (68%) and lethality in the overall group was 61%. Patients died either because they did not receive specific treatment or were given amphotericin for less than 15 days. These figures stress the importance of this treatment in disseminated histoplasmosis.
Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/microbiologia , Anfotericina B/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Histoplasmose/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Injeções Intravenosas , Trimetoprima/uso terapêuticoRESUMO
The study included 30 children with anemia and significant infectious process. The hematologic characteristics of this anemia were identified in their evolution and these findings were correlated with levels of serum iron to disclose whether variations are present to support the diagnosis of mixed etiology of the anemic syndrome. Transferrin saturation index was found to be the best parameter to diagnose iron deficiency in cases of anemia associated to infectious processes and due to the fact that 50% of these cases showed mixed etiology anemia, it seems reasonable that further integral studies should be carried out in this anemic syndrome.