RESUMO
Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68%) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52%) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.
Assuntos
Clostridium tetani/patogenicidade , Úlcera da Perna/microbiologia , Miíase/microbiologia , Úlcera por Pressão/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Falciforme , Animais , Causalidade , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Lactente , Insetos/crescimento & desenvolvimento , Larva , Hanseníase , Masculino , Pessoa de Meia-Idade , Miíase/parasitologia , Tétano/microbiologiaRESUMO
En la insuficiencia renal crónica (IRC), la anemia es una de las complicaciones más frecuentes, ésta es de tipo hipoproliferativo y su principal causa es el déficit relativo de eritropoyetina. El tratamiento fue, hasta la obtención de eritropoyetina por métodos recombinantes (rHuEpo), las transfusiones y los estimulantes eritropoyéticos, como los andrógenos. Actualmente existen muchas evidencias clínicas de la utilidad de la rHuEpo en el tratamiento de la anemia de la IRC. La mayoría de estos ensayos clínicos fueron realizados en adultos y en ellos se mostró no sólo la mejoría de los datos hematimétricos, sino también de la calidad de vida. Este trabajo se realizó en 18 pacientes pediátricos que estaban sometidos a regímenes de hemodiálisis crónica. El objetivo del mismo fue demostrar la seguridad y eficacia de la rHuEpo en los niños durante un año de tratamiento. El 94,2 por ciento de los pacientes evaluados alcanzaron la tasa de hemoglobina que habíamos planeado (10 gr por ciento), el único paciente que no lo logró tenía fibrosis medular. Los efectos adversos fueron similares a los observados en la población de adultos siendo la exacerbación de la hipertensión arterial el más frecuente. En seis niños se evaluó la capacidad física post tratamiento, todos se demosntró una mejoría de los índices de eficiencia. Se concluye que la rHuEpo es efectiva y segura en niños con IRC y anemia aumentando el número de glóbulos rojos evitando las transfusiones y mejorando el rendimiento físico que se relaciona con mejoría en la calidad de vida
Assuntos
Criança , Adolescente , Humanos , Masculino , Feminino , Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Diálise Renal , Proteínas Recombinantes de Fusão/uso terapêutico , Anemia/etiologia , Protocolos Clínicos , Eritropoetina/efeitos adversos , Eritropoetina/farmacologia , Hemoglobinas/análise , Injeções Intravenosas , Injeções Subcutâneas , Insuficiência Renal Crônica/complicações , Pressão Arterial , Proteínas Recombinantes de Fusão/efeitos adversos , Proteínas Recombinantes de Fusão/farmacologiaRESUMO
En la insuficiencia renal crónica (IRC), la anemia es una de las complicaciones más frecuentes, ésta es de tipo hipoproliferativo y su principal causa es el déficit relativo de eritropoyetina. El tratamiento fue, hasta la obtención de eritropoyetina por métodos recombinantes (rHuEpo), las transfusiones y los estimulantes eritropoyéticos, como los andrógenos. Actualmente existen muchas evidencias clínicas de la utilidad de la rHuEpo en el tratamiento de la anemia de la IRC. La mayoría de estos ensayos clínicos fueron realizados en adultos y en ellos se mostró no sólo la mejoría de los datos hematimétricos, sino también de la calidad de vida. Este trabajo se realizó en 18 pacientes pediátricos que estaban sometidos a regímenes de hemodiálisis crónica. El objetivo del mismo fue demostrar la seguridad y eficacia de la rHuEpo en los niños durante un año de tratamiento. El 94,2 por ciento de los pacientes evaluados alcanzaron la tasa de hemoglobina que habíamos planeado (10 gr por ciento), el único paciente que no lo logró tenía fibrosis medular. Los efectos adversos fueron similares a los observados en la población de adultos siendo la exacerbación de la hipertensión arterial el más frecuente. En seis niños se evaluó la capacidad física post tratamiento, todos se demosntró una mejoría de los índices de eficiencia. Se concluye que la rHuEpo es efectiva y segura en niños con IRC y anemia aumentando el número de glóbulos rojos evitando las transfusiones y mejorando el rendimiento físico que se relaciona con mejoría en la calidad de vida (AU)
Assuntos
Criança , Adolescente , Humanos , Masculino , Feminino , Anemia/tratamento farmacológico , Diálise Renal , Eritropoetina/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Anemia/etiologia , Eritropoetina/efeitos adversos , Eritropoetina/farmacologia , Proteínas Recombinantes de Fusão/efeitos adversos , Proteínas Recombinantes de Fusão/farmacologia , Hemoglobinas/análise , Insuficiência Renal Crônica/complicações , Pressão Sanguínea/efeitos dos fármacos , Injeções Intravenosas , Injeções Subcutâneas , Protocolos ClínicosRESUMO
Anemia associated to chronic renal failure (CRF) is a very frequent disorder. Twenty five per cent of adult patients under hemodialysis require periodical transfusions to maintain acceptable quality of life. This anemia is due mainly to a relative deficit of erythropoietin (EPO). Thanks to recombinant DNA techniques, EPO availability has made it possible to treat this population with the hormone. Most of the reported experience has been obtained from adult patients and literature on children is scarce. For this reason, a controlled prospective trial on 18 patients (9 males and 9 females) with a mean age of 12.4 years (range 7-17) was conducted, evaluating hematimetric response, safety of treatment and effect on quality of life after one year of treatment. Seventeen patients could be evaluated; mean follow-up was of 365 days (180-323). Treatment started with an administration scheme of 25 U/kg/dose, i.v. route, three times weekly, and dose was corrected according to the hematimetric response. Target hemoglobin was set in 10 g%. Mean dose required to reach target was 101.5 +/- 37.7 U/kg/dose (50-200) three times weekly and time elapsed was of 223.3 days (175-355). Only one patient did not achieve target hemoglobin value with the maximal dose planned (200 U/kg/dose). Bone marrow biopsy in this patient showed alpha widespread fibrosis secondary to hyperparathyroidism caused by CRF. Direct correlation was found between the required rHuEPO dose and basal levels of serum alkaline phosphatase (Table 2). Results obtained in status performance on six patients showed significant increase in all the variables under analysis (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Diálise Renal , Adolescente , Análise de Variância , Anemia/etiologia , Criança , Feminino , Hemoglobinas/análise , Humanos , Falência Renal Crônica/complicações , Masculino , Estudos Prospectivos , Proteínas Recombinantes/uso terapêuticoRESUMO
Anemia associated to chronic renal failure (CRF) is a very frequent disorder. Twenty five per cent of adult patients under hemodialysis require periodical transfusions to maintain acceptable quality of life. This anemia is due mainly to a relative deficit of erythropoietin (EPO). Thanks to recombinant DNA techniques, EPO availability has made it possible to treat this population with the hormone. Most of the reported experience has been obtained from adult patients and literature on children is scarce. For this reason, a controlled prospective trial on 18 patients (9 males and 9 females) with a mean age of 12.4 years (range 7-17) was conducted, evaluating hematimetric response, safety of treatment and effect on quality of life after one year of treatment. Seventeen patients could be evaluated; mean follow-up was of 365 days (180-323). Treatment started with an administration scheme of 25 U/kg/dose, i.v. route, three times weekly, and dose was corrected according to the hematimetric response. Target hemoglobin was set in 10 g
. Mean dose required to reach target was 101.5 +/- 37.7 U/kg/dose (50-200) three times weekly and time elapsed was of 223.3 days (175-355). Only one patient did not achieve target hemoglobin value with the maximal dose planned (200 U/kg/dose). Bone marrow biopsy in this patient showed alpha widespread fibrosis secondary to hyperparathyroidism caused by CRF. Direct correlation was found between the required rHuEPO dose and basal levels of serum alkaline phosphatase (Table 2). Results obtained in status performance on six patients showed significant increase in all the variables under analysis (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)
RESUMO
In five subjects with normal renal function, intravenous dopamine, at a rate of 6 ug/kg/min, produces a renal vasodilation, increase in Na excretion and reduction in urinary osmolality, without modification in glomerular filtration rate. These effects were reversed by intravenous indomethacin (2 mg/kg), suggesting that the renal effects of dopamine might depend on normal prostaglandins production.
Assuntos
Antagonistas de Dopamina , Taxa de Filtração Glomerular/efeitos dos fármacos , Indometacina/farmacologia , Rim/efeitos dos fármacos , Adulto , Humanos , Pessoa de Meia-Idade , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
In five subjects with normal renal function, intravenous dopamine, at a rate of 6 ug/kg/min, produces a renal vasodilation, increase in Na excretion and reduction in urinary osmolality, without modification in glomerular filtration rate. These effects were reversed by intravenous indomethacin (2 mg/kg), suggesting that the renal effects of dopamine might depend on normal prostaglandins production.