RESUMO
El asma es una enfermedad que afecta mas del 5 por ciento de la población de los países industrializados y es un importante problema de salud pública en nuestro país; por lo tanto un tratamiento efectivo es importante para el control de sus síntomas. Para evaluar la efectividad del zileuton; un inhibidor de la enzima 5-lipoxigenasa, se diseñó un estudio doble ciego, randomizado, controlado con placebo. Un total de 25 pacientes con asma y un volumen espiratorio forzado en 1 segundo VEF-1 entre 40 por ciento y 70 por ciento de los valores de predicción y sin tratamiento con glucocorticoides orales ni inhalado; fueron seleccionados a recibir tratamiento con zileuton 600 mg (8 pacientes); zileuton 400 mg (9 pacientes) o placebo (8 pacientes) durante 9 semanas. Las variables estudiadas fueron pruebas de función pulmonar, frecuencia de exacerbaciones de asma que requirieron tratamiento con glucocorticoides, uso de agonistas beta-2 por vía inhalatoria, síntomas asmáticos; la seguridad del tratamiento fue elevada por el monitoreo de efectos adversos. Zileuton produjo un incremento del VEF-1 de 0,37 L. una hora posterior a la administración (p<0.001 vs placebo), equivalente a un incremento del 14,12 por ciento de la línea de la base. Después de 9 semanas, tratamiento con zileuton produjo una mejoría tanto de la función pulmonar como de los síntomas del asma. El incremento mayor fue observado con el grupo que recibió zileuton 600mg. Así, en este grupo el VEF-1 aumentó 0,48 L (2,57 L valor basal a 3,05 L día 64); equivalente a un incremento del 18,67 por ciento (p<0.02), comparado con 0.07 L de aumento del grupo placebo. Los síntomas diurnos y nocturnos, así como la frecuencia en el uso de beta-2 agonista también disminuyeron significativamente con el uso de ambas dosis de zileuton. sólo dos pacientes requirieron tratamiento con glucocorticoides (8 por ciento); uno en el grupo zileuton 400 mg y uno en el grupo placebo. Elevaciones de la transaminansas (tres veces del rango normal) fueron observadas en dos pacientes: uno en el grupo de zileuton 600 mg y otro en el grupo de placebo; ambos pacientes retornaron a valores normales al descontinuar el tratamiento. En conclusión, el tratamiento durante nueve semanas con un inhibidor de la 5-lipoxigenasa, produjo una mejoría significativa en el control del asma, tanto clínica como funcional
Assuntos
Humanos , Masculino , Feminino , Asma , Método Duplo-Cego , Inibidores de Lipoxigenase , Placebos , Saúde Pública , VenezuelaRESUMO
BACKGROUND: Acute leukemia (AL) in infants generally shows distinctive biologic features and has a poor prognosis. AIM: To study the frequency of the cytogenetic alteration of 11q23 chromosome or the recombination of MLL gene in infants less than 18 months old, with acute leukemia. PATIENTS AND METHODS: We analyzed 37 cases of AL in infants less than 18 months of age diagnosed in Chile from 1989 to 1999. The clinical features and cytogenetic/molecular defects of 11q23MLL gene rearrangement and their influence in prognosis were determined. RESULTS: There were 18 cases of acute Lymphoblastic leukemia (ALL) characterized by female sex (67%) high presenting leukocyte count (median 99 x 109/L), blast cells with a CD10 negative phenotype (50%) and 11q23/MLL rearrangement (39%). Molecular abnormalities of 11q23 were significantly associated with adverse prognosis, with an event free survival (EFS) of only 14 +/- 12%. Interestingly, infants with germ line 11q23 had a very good outcome with an EFS of 73 +/- 11% (p < 0.025). There were 19 cases of acute myeloblastic leukemia (AML) characterized by male sex (63%) high leukocyte count (median 93 x 109/L), FAB-MS morphology (53%) and 11q23/MLL rearrangement (53%). EFS was very poor, 20 +/- 9% and 33 +/- 4% for rearranged and germinal group respectively (p = NS), due to a high mortality rate during the first month of diagnosis. CONCLUSIONS: These findings demonstrate that Chilean ALL infants with 11q23 abnormalities have a very poor prognosis. However those with germinal state can enjoy a prolonged disease free survival with the current treatment protocols.
Assuntos
Cromossomos Humanos Par 11/genética , Rearranjo Gênico/genética , Leucemia Mieloide Aguda/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Southern Blotting , Chile/epidemiologia , Análise Citogenética , Intervalo Livre de Doença , Feminino , Humanos , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/mortalidade , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Prognóstico , Estudos ProspectivosRESUMO
We analysed 67 samples from Brazilian children of diverse ethnic origins with acute lymphoblastic leukaemia (ALL) for the presence of the TEL-AML1 fusion gene transcripts using reverse transcription polymerase chain reaction (RT-PCR). All 12 positive cases (20% of the 60 B-cell precursor ALL) had common (CD10+) ALL with a mean age of 4 years (range 1-10 years). We conclude that the frequency, age, distribution and clinical features of the TEL-AML1 fusion gene-positive ALL is similar in the diverse ethnic backgrounds of the Brazilian children to that in other countries with predominantly white Caucasian or oriental ethnicity. Apparent exceptions to this generality are discussed.
Assuntos
Linfoma de Burkitt/genética , Frequência do Gene , Leucemia-Linfoma de Células T do Adulto/genética , Proteínas de Fusão Oncogênica/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , População Negra , Brasil , Linfoma de Burkitt/etnologia , Criança , Pré-Escolar , Subunidade alfa 2 de Fator de Ligação ao Core , Feminino , Humanos , Lactente , Leucemia-Linfoma de Células T do Adulto/etnologia , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/etnologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , População BrancaRESUMO
Como parte de un estudio prospectivo, comparativo, investigador-ciego, 63 niños venezolanos (Rango de Edad: 1-12 años) con otitis media aguda (OMA), fueron distribuidos de manera aleatoria en dos grupos para recibir claritromicina (Clar) oral 7,5 mg/kg TID (n=32) o amoxicilina (Amox) 14 mg/kg TID (n=31), durante 10 días. Se realizaron evaluaciones clínicas que incluían pneumo-timpanoscopía y timpanometría, inmediatamente antes del incio de cada tratamiento a las 48 horas, 4 días y 10 días durante el tratamiento, así como a los 21 días post-tratamiento, respectivamente. En todos los pacientes se practicó timpanocentesis empleando un catéter protegido, con el fin de obtener una muestra microbiológica pre-tratamiento y en las visitas subsiguientes, si estaba clínicamente indicado. En 49 (77,7 por ciento) casos, un patógeno bacteriano potencial fue identificado. Los microorganismos más frecuentemente aislados fueron: S pneumoniae (11), H. influenzae (10), S. aureus (4), S. pyogenes (4), M. catarrhalis (4), y S. epidermidis (4). Se confirmó resistencia a Amox más no a Clar en 3 de 10 cepas de H. influenzae, y en 3 de 4 de cepas de M. catarrhalis aisladas (p<0,05). La tasa de cura post-tratamiento fue 96,8 por ciento para Clar y 87,0 por ciento para Amox, respectivamente (NS). No se observaron ningunas diferencias importantes con respecto a las tasas de recaída clínica o de eventos adversos que condujeran a la suspensión del tratamiento. La Clar fue igualmente efectiva que la Amox en el tratamiento de pacientes pediátricos venezolanos con OMA, resultando tanto en una alta tasa de curación clínica como una baja tasa de eventos adversos. En países como Venezuela donde los microorganismos productores de Beta-lactamasas son frecuentes, la Clar representa una alternativa conveniente a la Amox u otros antimicrobianos menos efectivos.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Amoxicilina/administração & dosagem , Antibacterianos/uso terapêutico , Claritromicina/administração & dosagem , Haemophilus influenzae/isolamento & purificação , Moraxella catarrhalis/isolamento & purificação , Otite Média/diagnóstico , Otite Média/patologia , Otite Média/tratamento farmacológico , Testes de Impedância Acústica/métodos , Streptococcus pyogenes/isolamento & purificação , Amoxicilina/farmacologia , Claritromicina/farmacologia , Infectologia , Técnicas Microbiológicas , PediatriaRESUMO
BACKGROUND: Adult T cell leukemia lymphoma is a lymphoproliferative syndrome etiologically associated to human T cell lymphotropic virus type I. AIM: To describe the clinical and laboratory features of 26 Caucasian Chilean patients, with HTLV-I positive adult T-cell leukemia lymphoma (ATLL). MATERIAL AND METHODS: Diagnostic criteria included clinical features, cell morphology, immunophenotype, HTLV-I serology and/or DNA analysis by Southern blot or PCR. RESULTS: According to the clinical presentation, 12 cases had the acute ATLL form, 6 had a lymphoma, 4 the chronic form and 4 had smoldering ATLL. The median presentation age was 50 years, younger than the Japanese patients, but significantly older than patients from other South American countries (e.g. Brasil, Jamaica, Colombia). The main clinical features: lymphadenopathy, skin lesions and hepatosplenomegaly, were similar in frequency to those of patients from other countries, except for the high incidence of associated neurological disease. Tropical Spastic Paraparesis (TSP) in our series of ATLL, was seen in one third of the patients (8/26). A T-cell immunophenotype was shown in all 26 cases and HTLV-I serology was positive in 25/26 patients. Molecular analysis on the seronegative patient showed clonal integration of proviral HTLV-I DNA into the lymphocytes DNA, and thus he may have been a poor responder to the retroviral infection. Proviral DNA integration was also demonstrated in 15/16 patients being clonal in 10, polyclonal in 3 (all smoldering cases) and oligoclonal in one. CONCLUSIONS: ATLL in Chile has similar clinical and laboratory features than the disease in other parts of the world, except for a younger age than Japanese patients but older than those from other Latin American countries and a high incidence of patients with associated TSP. Detailed morphological and immunophenotypic analysis of the abnormal circulating lymphocytes, together with the documentation of HTLV-I by serology and/or DNA analysis are key tests for the identification of this disease.
Assuntos
Leucemia-Linfoma de Células T do Adulto , Doença Aguda , Adulto , Idoso , Southern Blotting , Chile , Doença Crônica , DNA Viral/análise , Feminino , Anticorpos Anti-HTLV-I/análise , Humanos , Imunofenotipagem , Incidência , Leucemia-Linfoma de Células T do Adulto/epidemiologia , Leucemia-Linfoma de Células T do Adulto/genética , Leucemia-Linfoma de Células T do Adulto/imunologia , Leucemia-Linfoma de Células T do Adulto/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , PrognósticoRESUMO
Antihypertensive effect, platelet aggregation, and plasma lipid profile were studied in a group of 14 hypertensive patients with diastolic blood pressure between 96 and 116 mm Hg during placebo and terazosin phases. Terazosin, an alpha 1-adrenergic blocking agent, was given initially at the dosage of 1 mg daily. Then it was continued at a dosage of 2 mg daily and 5 mg daily respectively, each dosage for 4 weeks. Blood pressure was taken every 2 weeks. Ex vivo platelet aggregation induced by epinephrine, collagen, and adenosine diphosphate (ADP) were carried out twice during the first placebo phase, once at the end of each terazosin dosage, and once in the second placebo phase. Total cholesterol, HDL cholesterol, and triglycerides were measured at the end of first placebo and terazosin phases. Blood from eight patients was taken during the second placebo phase to carry out in vitro response of platelet aggregation induced by ADP, collagen, and epinephrine before and after incubation with terazosin (1, 2 and 5 micrograms/L or doxazosin (100, 200, and 500 micrograms/L for 5 min. Terazosin induced a statistically significant decrease in 14.2/8.0 mm Hg, 26.1/13.4 mm Hg, and 33.9/16.5 mm Hg in the supine position for 1, 2, and 5 mg/daily, respectively. No changes in heart rate were observed. Terazosin inhibited significant ex vivo platelet aggregation induced by epinephrine, collagen, and ADP in a range from 20% to 45% for different concentrations of inducers. Reductions in platelet aggregation seemed not to be dose dependent, as reductions were statistically equivalent for dosages of 1, 2, and 5 mg daily. Terazosin significantly reduced the level of total cholesterol (8.71%) and triglycerides (14.31%), and increased (although not significantly) levels of HDL cholesterol (3.91%). In vitro platelet aggregation was inhibited by doxazosin to a significant extent but not by terazosin.
Assuntos
Antagonistas Adrenérgicos alfa/farmacologia , Antagonistas Adrenérgicos alfa/uso terapêutico , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Inibidores da Agregação Plaquetária/farmacologia , Agregação Plaquetária/efeitos dos fármacos , Prazosina/análogos & derivados , Antagonistas de Receptores Adrenérgicos alfa 1 , Adulto , Idoso , Artérias/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Colesterol/sangue , Doxazossina/farmacologia , Doxazossina/uso terapêutico , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Técnicas In Vitro , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Prazosina/farmacologia , Prazosina/uso terapêutico , Triglicerídeos/sangueRESUMO
We report the different presentation features and clinical outcome between two identical infant twins with acute lymphoblastic leukaemia with a shared clonal disease and MLL gene rearrangement. One twin relapsed and died, but the other is in complete remission > 4 years after diagnosis. These data, and similar observations on other twin infants with leukaemia, suggest that despite a common clonal in utero, post-natally these leukaemias can evolve independently, at different rates, in the twinned individuals, and that the usually fatal leukaemia associated with t(4;11) MLL gene rearrangement can be effectively treated when the leukaemic burden is small.
Assuntos
Doenças em Gêmeos/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Proto-Oncogenes , Fatores de Transcrição , Gêmeos Monozigóticos , Medula Óssea/imunologia , Cromossomos Humanos Par 4 , Células Clonais , Proteínas de Ligação a DNA/genética , Feminino , Rearranjo Gênico , Histona-Lisina N-Metiltransferase , Humanos , Lactente , Cariotipagem , Proteína de Leucina Linfoide-Mieloide , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Prognóstico , Dedos de Zinco/genéticaRESUMO
We describe the clinical features and immunophenotype of 500 children and 131 adults with acute lymphoblastic leukemia (ALL), diagnosed between 1984 and 1993. Cases were classified, according to immunophenotype in B-cell ALL with three subtypes (pro-B or null, common and B) and T-cell ALL. Among children, common ALL accounted for 74% of cases and pro-B all was more common in children of less than one year (14%). B ALL was observed in 2% of children. Ten percent of children, mostly males, had T-cell ALL. The third part of these children had high leukocyte counts and a mediastinal mass. Children from Mapuche origin, compared with Caucasian children had a lower proportion of common ALL (36 and 74% respectively) and a higher proportions of T-cell ALL (41 and 10% respectively). Among adults common ALL was the most common phenotype (72%) followed by T-cell ALL (15%), pro-B ALL (11%) and B-cell ALL (2%). There was a lower incidence of children with common ALL with positive cytoplasmic immunoglobulin compared to North American or European studies (2 and 15-33% respectively) and a higher proportion of adults with common ALL compared with pro-B cell ALL, in contrast to European studies that show a higher proportion of patients with pro-B cell ALL. No other immunophenotypic, clinical or laboratory differences were observed with ALL from developed countries. It is concluded that the immunophenotyping of ALL allows a more precise diagnosis of this disease.
Assuntos
Imunofenotipagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Anticorpos Monoclonais , Medula Óssea , Criança , Pré-Escolar , Chile , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Lactente , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologiaRESUMO
We describe the clinical and laboratory features in three Caucasian Chilean patients with tropical spastic paraparesis (TSP) associated with/or preceded by a lymphoproliferative disorder involving cutaneous lesions and localised lymphadenopathy. The neurological symptoms and signs were characteristic of TSP and CSF examination revealed the presence of oligoclonal bands. All three patients had a moderate leucocytosis (10-14 x 10(9)/l) with eosinophilia and a minority (2-4%) of circulating atypical polylobed or ATLL-like lymphocytes. Lymph node histology showed a diffuse pattern of infiltration (1 case) and marked expansion of the paracortical zone with convoluted lymphocytes and immunoblasts (2 cases). Skin biopsy demonstrated a dermal lymphoid infiltration with epidermotropism. Antibodies to HTLV-I were detected in the serum and CSF in the three patients and Southern blot analysis of peripheral blood mononuclear cells showed a monoclonal integration of HTLV-I proviral DNA in one case whereas in the two others the pattern was indicative of low level polyclonal integration. All three patients were treated with prednisolone and one with PUVA with transient partial response on the skin and neurological manifestations. Two patients died months to 5 years from presentation and the other is alive 12 years from diagnosis with active neurological and skin disease. The simultaneous occurrence of HTLV-I associated TSP with smouldering ATLL and a cutaneous ATLL or pre-leukaemic form is discussed.
Assuntos
Leucemia de Células T/complicações , Paraparesia Espástica Tropical/complicações , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/líquido cefalorraquidiano , Anticorpos Antivirais/imunologia , Antígenos CD/imunologia , Southern Blotting , Dermatite Esfoliativa/complicações , Feminino , Humanos , Leucemia de Células T/patologia , Leucemia de Células T/virologia , Masculino , Pessoa de Meia-Idade , Terapia PUVA , Paraparesia Espástica Tropical/tratamento farmacológico , Paraparesia Espástica Tropical/patologia , Paraparesia Espástica Tropical/virologia , Prednisolona/uso terapêutico , Provírus/isolamento & purificação , Pele/patologia , Linfócitos T/imunologia , Linfócitos T/patologiaRESUMO
We describe the clinical and laboratory features of nine patients born in Chile with HTLV-I-positive adult T-cell leukemia/lymphoma (ATLL). All were adults (median age 51 years) of Caucasian origin without evidence of Indian or foreign extraction and none had been out of the country. The main disease features were organomegaly, cutaneous lesions, hypercalcemia and leukemia with atypical polylobed lymphocytes displaying a CD2+, CD3+, CD4+, CD8-, CD7- T-cell phenotype. Eight patients presented with acute type ATLL and one had a chronic form lasting for 16 months prior to the development of the acute phase. Lymph node histology (three cases) was consistent with a T-cell non-Hodgkin's lymphoma (large and small cells). Antibodies to HTLV-I were detected by ELISA and particle agglutination in the serum from eight of nine patients. DNA analysis showed HTLV-I proviral DNA in all seven cases investigated, including the single serologically negative patient. In five cases, HTLV-I was monoclonally integrated and in one case oligoclonal. In the seventh case viral DNA clonal status was ambiguous. Response to therapy was poor and median survival was 3 months (range 2-20 months). This study provides further evidence that HTLV-I is endemic in Chile, a non-tropical country where the two main diseases associated with HTLV-I, ATLL and TSP, are found.
Assuntos
Leucemia-Linfoma de Células T do Adulto/epidemiologia , Adulto , Idoso , Chile/epidemiologia , DNA Viral/análise , Saúde da Família , Feminino , Anticorpos Anti-HTLV-I/análise , Vírus Linfotrópico T Tipo 1 Humano/genética , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Imunofenotipagem , Leucemia-Linfoma de Células T do Adulto/imunologia , Leucemia-Linfoma de Células T do Adulto/virologia , Masculino , Pessoa de Meia-Idade , Provírus/genéticaRESUMO
A community survey of human T cell lymphotropic virus type I (HTLV-I) in Montserrat, West Indies, identified 22 instances in which 2 HTLV-I-seropositive adults lived within 60 m of each other (close pairs), compared with 7.8 expected (P < .001). Five of these close pairs were mother-offspring or husband-wife. The remaining 17 pairs were of unrelated members in separate households. The percentages of male-female (41%), female-female (41%), and male-male (18%) types in these 17 pairs were very similar to those among the 1377 similarly defined pairs in which neither or only 1 member was seropositive, affording no support for extramarital heterosexual activity as an explanation for the clustering observed. Thus, the demography of HTLV-I was not accounted for completely by sexual and mother-to-offspring transmission. The predominance of clustering of unrelated HTLV-I-seropositive individuals in locations with high mosquito infestation raised the possibility of sporadic transmission of HTLV-I by hematophagous insects.
Assuntos
Infecções por HTLV-I/epidemiologia , Adolescente , Adulto , Aedes , Idoso , Idoso de 80 Anos ou mais , Animais , Anticorpos Antivirais/análise , Demografia , Dengue/epidemiologia , Exposição Ambiental , Feminino , Infecções por HTLV-I/transmissão , Humanos , Insetos Vetores , Masculino , Pessoa de Meia-Idade , Índias Ocidentais/epidemiologiaRESUMO
This paper reports a case of adult T-cell leukemia/lymphoma associated with human T-cell lymphotropic virus type I (HTLV-I) diagnosed in a Chilean patient who developed after 1 1/2 years a crisis with a progressive sensorimotor polyneuropathy. Serum and cerebrospinal fluid HTLV-I antibody tests were positive and HTLV-I DNA was clonally integrated in peripheral lymphocytes. This case is unusual in having simultaneous neurological disease. Along with other recent data from South America, this suggests that the endemic area of HTLV-I may spread far beyond the Caribbean area.
Assuntos
Leucemia-Linfoma de Células T do Adulto/complicações , Doenças do Sistema Nervoso Periférico/complicações , Adulto , Feminino , HumanosRESUMO
The comparative in vitro effect of Erythromycin Lactobionate (E) on two different strains of T. gondii was assayed. Monolayers of mammalian cells in 4 ml of MEM + 2% calf serum were inoculated with Toxoplasma (1.5 to 2.5 x 10 5 parasites per flask) and thereafter incubated with different concentrations of E at 37o C for 24 h. Monolayers were then fixed and stained by Giemsa and Mean Number of Infective Units (MNIU) assessed. Human lung fibroblast cultures showed total inhibition and/or death of T. gondii with 100-200 mcg/ml of E and 81% decrease of MNIU at 20 mcg/ml of E (P< 0,05 as compared to controls) for both strains. Later experiments on monkey kidney cells showed a difference in sensitivity to E, between both T. gondii strains: while strains A showed 1 61% decrease in MNIU at 5 mcg/ml E (P< 0.005) strain B was sensitive only to a concentration of 50 mcg/ml E (66% reduction of MNIU, P< 0.005). A distint effect of E against intracellular T. gondii was shown. Results indicate that E, at concentrations similar to those reached in the human serum standard IV dose, may prove effective against infections due to sensitive Toxoplasma strains. Initial experiments suggest that the combination of E (1,25 mcg/ml) plus sulfisoxazole (0,25-25 mcg/ml), significantly increase the anti-toxoplasma effect of the individual agents
Assuntos
Eritromicina/farmacologia , Técnicas In Vitro , Toxoplasma/efeitos dos fármacosRESUMO
Las nuevas teofilinas de liberación prolongada son un aporte útil para el control del paciente asmático ya que facilitan el cumplimiento del tratamiento, reducen la frecuencia de efectos colaterales indeseables y proveen niveles plasmáticos más estables que las teofilinas convencionales. El presente estudio utilizó una teofilina de liberación prolongada (Theograd, Abbott), en un grupo de pacientes asmáticos estables venezolanos, la cual fue comparada en un diseño abierto y paralelo con el estándar internacional (Theodur, Key Pharmaceuticals). Los pacientes fueron evaluados desde el punto de vista inmunológico y clínico, además de lo cual se practicaron pruebas de función pulmonar y niveles plasmáticos de teofilina. Los resultados obtenidos evidenciaron una excelente respuesta clínica, manifiesta también en las pruebas de función pulmonar, particularmente a partir de la 2a. semana de tratamiento. Se propone un esquema de dosificación adaptado a la edad del paciente, que puede ser utilizado con y sin niveles plasmáticos de teofilina. Se enfatiza sin embargo la importancia de los niveles séricos en la individualización del tratamiento
Assuntos
Criança , Adolescente , Humanos , Masculino , Feminino , Asma/tratamento farmacológico , Teofilina/estatística & dados numéricosRESUMO
La otitis media aguda (OMA) es la segunda causa de consulta pediátrica en Venezuela, y la primera en otros países como los Estados Unidos de América. Desde 1970, un número creciente de reportes clínicos y microbiológicos indican un aumento gradual de la resistente a ampicilina del H. influenzae, el cual es el 2§ patógeno en orden de frecuencia encontrado en otitis media aguda. La combinación de E y SSZ ha demostrado ser efectiva no sólo contra H. influenzae resistente a la penicilina, sino contra la gran mayoría de las bacterias patógenas causantes de OMA. 358 niños fueron diagnosticados sufriendo de OMA fueron evaluados por 90 especialistas (pediatras, y otorrinolarinólogos) en 10 ciudades venezolanas. Todos los niños fueron tratados con una combinación de E uy SSZ* por diez días y la eficacia y seguridad del tratamiento fue evaluada. Los resultados fueron considerados excelentes en 61.2% y buenos en 33% de los pacientes (para un total de 94.2% de éxito terapéutico); 5% de los resultados se consideraron regulares y hubo 3 fallas terapéuticas (0.8%) así como 6 reportes de efectos colaterales que no requieron suspensión del tratamiento. Se concluyó que la combinación de E y SSZ es una excelente alternativa para el tratamiento de la otitis media aguda en niños
Assuntos
Lactente , Pré-Escolar , Criança , Adolescente , Humanos , Masculino , Feminino , Eritromicina/uso terapêutico , Otite Média/tratamento farmacológico , Sulfisoxazol/uso terapêutico , Quimioterapia CombinadaRESUMO
The presence of antibody to human T-cell leukaemia virus (HLTV-I) has been assessed in 2,143 men and women who represent 83% of all adults aged 35 to 69 years resident in a defined urban community in Trinidad. Individuals of African descent had a higher sero-positivity rate (7.0%) than those originating from India (1.4%), Europe (0%) or of mixed descent (2.7%). Women were infected more frequently than men, and the prevalence of infection increased with age in both sexes. Sero-positivity rates were significantly increased in adults who lived in housing of poor quality (p less than 0.001) or close to water courses (p less than 0.025). These data and others raise the possibility that one route of HLTV-I transmission may be via insect vectors under particular domestic circumstances.
Assuntos
Infecções por Deltaretrovirus/epidemiologia , Habitação , Adulto , Fatores Etários , Idoso , Anticorpos Antivirais/análise , Anticorpos Antideltaretrovirus , Infecções por Deltaretrovirus/etnologia , Infecções por Deltaretrovirus/transmissão , Feminino , Humanos , Insetos Vetores , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Trinidad e TobagoRESUMO
Ten out of 26 leukaemic patients who had emigrated from the Caribbean region to the United Kingdom had adult T-cell leukaemia with associated serum antibodies to HTLV I. Antibodies to HTLV were also detected in sera from a small proportion of non-leukaemic Caribbean immigrants but not in any sera from other (non-ATL) T-cell leukaemias or a variety of control groups. The long period between immigration to the UK and diagnosis of leukaemia (up to 30 years) suggests that an extensive latent period in disease development may exist. Cell lines were isolated from two patients with HTLV antibody-positive ATL and were shown to be virus-positive by electron microscopy and immunofluorescence using antibodies to the p19 and p24 viral proteins. HTLV1 provirus integration and active transcription were demonstrated by Southern blotting of DNA and in situ hybridization respectively using molecularly cloned HTLV1 probes. Virus from one of these cell lines could be transmitted to normal T cells by co-cultivation.
Assuntos
Anticorpos Antineoplásicos/análise , Anticorpos Antivirais/análise , Deltaretrovirus/imunologia , Leucemia/imunologia , Infecções por Retroviridae/imunologia , Adolescente , Adulto , Anticorpos Monoclonais , População Negra , Medula Óssea/microbiologia , Medula Óssea/ultraestrutura , Linhagem Celular , Criança , DNA Viral/análise , Deltaretrovirus/análise , Feminino , Imunofluorescência , Humanos , Leucemia/microbiologia , Leucemia/patologia , Linfoma/imunologia , Linfoma/microbiologia , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Hibridização de Ácido Nucleico , Infecções por Retroviridae/microbiologia , Infecções por Retroviridae/patologia , Reino Unido , Índias Ocidentais/etnologiaRESUMO
The neoplastic T cells from five patients with adult T cell lymphoma/leukemia (ATLL), born in the Caribbean, were studied with respect to immunoregulatory activity on pokeweed mitogen (PWM) driven immunoglobulin (Ig) synthesis as well as surface-marker phenotypes with monoclonal antibodies. The neoplastic T cells in all patients had an OKT1+4+8-11+M1-I1-3A1- phenotype, but differed in the reactivity with OKT3. None of the patients' cells exerted helper activity on PWM-induced Ig synthesis. The neoplastic cells of three patients had suppressor activity on PWM-induced Ig synthesis. All patients were positive for human T cell leukemia/lymphoma virus (HTLV) or had antibodies against HTLV antigens. It has previously been shown that the neoplastic cells in Japanese ATLL patients and in patients from the Caribbean are indistinguishable by morphology and marker phenotype. We now show them to be also similar with respect to their functional properties.
Assuntos
Leucemia/sangue , Linfoma/sangue , Linfócitos T Reguladores/imunologia , Linfócitos T/fisiologia , Adulto , Anticorpos Monoclonais/imunologia , Deltaretrovirus/imunologia , Feminino , Humanos , Imunoglobulinas/biossíntese , Leucemia/imunologia , Ativação Linfocitária , Linfoma/imunologia , Masculino , Pessoa de Meia-Idade , Mitógenos de Phytolacca americana/imunologia , Índias OcidentaisRESUMO
To determine whether the human T-cell lymphoma-leukemia virus (HTLV) is associated with particular cancers, patient sera were surveyed for HTLV-specific antibodies. An association was seen with aggressive cancers of mature T-cells, specifically Japanese adult T-cell leukemia (ATL) and T-cell lymphosarcoma cell leukemia (TLCL), a similar cancer of Caribbean blacks. Ninety to 100% of these patients possessed HTLV-specific antibody. Forty-seven and 20% of relatives of ATL and TLCL patients, respectively, and 12 and 4% of healthy donors from ATL and TLCL endemic areas were also antibody positive. Visceral organ involvement, hypercalcemia, and skin manifestation, features of ATL and TLCL, were often seen in other antibody-positive patients. Childhood cancers, most cutaneous T-cell and all non-T-cell leukemias and lymphomas, myeloid leukemias, Hodgkin's disease, and solid tumors were not associated with HTLV. Healthy United States donors and European patients with non-malignant diseases were antibody negative. HTLV is thus associated with a subtype of adult T-cell leukemia-lymphoma, clustered in viral endemic areas, with apparent racial and geographic predilection.
Assuntos
Linfoma/microbiologia , Retroviridae/análise , Linfócitos T , Adulto , Idoso , Anticorpos Antivirais/análise , Feminino , Humanos , Japão/etnologia , Leucemia/epidemiologia , Linfoma/imunologia , Masculino , Pessoa de Meia-Idade , Retroviridae/imunologia , Índias Ocidentais/etnologiaRESUMO
Type-C RNA tumor viruses have been implicated in the etiology of naturally occurring leukemias and lymphomas of animals. Human T-cell leukemia/lymphoma virus (HTLV) is the first human virus of this class consistently identified in association with a specific type of human leukemia/lymphoma. The isolation of HTLV was made possible by the ability to grow mature T-cells in tissue culture usually with T-cell growth factor (TCGF). We now report a cluster of adult T-cell leukemia/lymphoma among Blacks from the Caribbean in which all eight cases are positive for HTLV virus and/or antibody. These patients have disease that appears indistinguishable from Japanese adult T-cell leukemia/lymphoma which, as we have also reported, is associated with HTLV in over 90% of cases. The finding of HTLV antibodies in some of the normal population in the Caribbean and Japan, and the clustering of a specific form of T-cell leukemia/lymphoma in these virus-endemic areas, suggest that HTLV infection may be associated with the occurrence of a distinctive clinico-pathologic entity.