RESUMO
Se realizó una evaluación de la seguridad y eficacia del procedimiento de la biopsia renal percutánea BRP de riñones nativos bajo control ecográfico simultáneo. Se revisaron las historias clínicas de todos los pacientes que fueron biopsiados en el período comprendido entre enero de 2005 y diciembre de 2008 en el Servicio de Nefrología del Hospital de Pediatría Juan P. Garrahan. Se excluyeron del análisis los procedimientos realizados bajo anestesia general y en riñón transplantado. Se evaluaron 117 procedimientos realizados en 114 pacientes: 59 varones (50.4%) y 55 mujeres (49.6%). Las indicaciones más frecuentes de BRP fueron: proteinuria masiva o significativa con o sin hematuria 45 (38,6%), Lupus Eritematoso Sistémico 32 (27.4%) y síndrome nefrótico cortico-resistente 23 (20%); otras menos frecuentes estuvieron representadas por: Púrpura de Schönlein-Henoch 7 (6%), insuficiencia renal aguda (IRA) 5 (4%) e insuficiencia renal crónica (IRC) 5 (4%). No se produjeron eventos adversos (EA) en 97 (83%) procedimientos. En 20 (17%), se produjeron EA. Los EA no serios fueron 9: microhematuria (n=3), macrohematuria (n=3) y dolor lumbar (n=3). Los 11 restantes fueron EAS (serios) que correspondieron a hematomas perirrenales de los cuales 2 requirieron transfusión de glóbulos rojos. Las muestras obtenidas fueron suficientes para el diagnóstico en 113 procedimientos (97%), con un número de glomérulos de 30 ± 11. Los resultados demostraron que el procedimiento de BRP con disparador automático, anestesia local y control ecográfico simultáneo es seguro y eficaz. El número de EAS registrados en este estudio es similar o menor según las series analizadas. A diferencia de la publicación internacional en nuestro centro se realiza el procedimiento con el paciente despierto (AU)
In this study we evaluated the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB) of native kidneys. The clinical charts of all patients that underwent PRB between January 2005 and December 2008 at the Department of Nephrology of the Pediatric Hospital Juan P. Garrahan were reviewed. Procedures performed under general anesthesia and in transplanted kidneys were excluded from the analysis. We evaluated 117 procedures performed in 114 patients: 59 were male (50.4%) and 55 female (49.6%). The most frequent indications for PRB were: massive or significant proteinuria with or without hematuria 45 (38,6%), systemic lupus erythematosus 32 (27.4%), and steroid-resistant nephrotic syndrome 23 (20%); other less frequent indications were: Henoch-Schönlein purpura 7 (6%), acute renal insufficiency (ARI) 5 (4%), and chronic renal insufficiency (CRI) 5 (4%). No adverse events (AE) were observed in 97 (83%) procedures. AE were seen in 20 (17%). There were 9 minor AE: microhematuria (n=3), gross hematuria (n=3), and lumbar pain (n=3). Serious AE observed were perinephric hematoma in 11 patients of whom 2 required red blood cell transfusions. The sample size was sufficient for diagnosis in 113 procedures (97%), with a number of glomeruli of 30 ± 11. The results show that ultrasoundguided PRB with an automatic trigger and local anesthesia is a safe and effective procedure. The number of serious AE in this study is similar to or lower than reported in previous series. Unlike other international series, at our center the procedure is performed while the patient is awake (AU)
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Ultrassonografia de Intervenção , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Nefropatias/diagnóstico , Segurança , EficáciaRESUMO
El sindrome linfoproliferativo post transplante (SLPT) se presenta en pacientes transplantados en quienes la inmunosupresión crónica induce una proliferación linfoidea maligna monoclonal indistinguible del linfoma No Hodgkin. El éxito de los transplantes de órganos se incremento a partir de las nuevas terapias inmunosupresoras, los avances en las técnicas quirúrgicas, y los cuidados postoperatorios. Sin embargo pueden aparecer complicaciones como las infecciones oportunistas, enfermedades malignas secundarias, el SLPT y el rechazo, que reflejan la alteración del balance inmunológico del receptor. Propósito: Describir la incidencia, distribución y hallazgos por imágenes en el SLPT post transplante renal en una población de pacientes pediátricos. Población y Métodos: Se evaluaron los registros de los pacientes con transplante renal realizados entre diciembre 1988 y junio 2001. Se consignaron: clínica al diagnóstico del SLPT; tiempo postransplante; esquema inmunosupresor recibido, hallazgos por imágenes en radiología, ultrasonografía (US), tomografía computada (TC) y/o resonancia magnética (RM), variedad histológica, tratamiento y evolución: Resultados: En el período evaluado se realizaron 346 transplantes en 328 pacientes. Nueve de ellos presentaron SLPT (2.7%). En todos los casos la sospecha clínica fue confirmada por imágenes. El tratamiento incluyó reducción de la inmunosupresión. Los estudios por imágenes constituyen un elemento diagnóstico significativo en la evaluación de los pacientes con transplante tanto en el seguimiento programado como ante la sospecha clínica de SLPT.
Assuntos
Criança , Diagnóstico por Imagem , Transplante de Rim/efeitos adversos , Transtornos LinfoproliferativosRESUMO
El cáncer de colon es el tumor gastrointestinal más frecuente en EE.UU. y probablemente en nuestro medio. Lograr una correcta estadificación modifica la conducta terapéutica. En los últimos años el concepto de ganglio centinela descripto por Morton para el melanoma fue logrando aceptación en distintas patologías (mama, vulva, etc.). En nuestro análisis preliminar hemos logrado identificar el ganglio centinela en todos los pacientes. El hallazgo del mismo es una técnica simple y económica. En estudios posteriores se incluirá la técnica con inmunohistoquímica y cortes seriados con el fin de intentar demostrar la utilidad de éste método para hallar micrometástasis
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias do Colo , Neoplasias Colorretais , Metástase Linfática/patologia , Neoplasias Retais , Excisão de Linfonodo , Metástase Linfática/diagnóstico , Estadiamento de NeoplasiasRESUMO
El cáncer de colon es el tumor gastrointestinal más frecuente en EE.UU. y probablemente en nuestro medio. Lograr una correcta estadificación modifica la conducta terapéutica. En los últimos años el concepto de ganglio centinela descripto por Morton para el melanoma fue logrando aceptación en distintas patologías (mama, vulva, etc.). En nuestro análisis preliminar hemos logrado identificar el ganglio centinela en todos los pacientes. El hallazgo del mismo es una técnica simple y económica. En estudios posteriores se incluirá la técnica con inmunohistoquímica y cortes seriados con el fin de intentar demostrar la utilidad de éste método para hallar micrometástasis (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias Retais/diagnóstico , Metástase Linfática/patologia , Estadiamento de Neoplasias/métodos , Excisão de Linfonodo/métodos , Metástase Linfática/diagnósticoRESUMO
Cerebellar symptoms at onset are unusual in HTLV-I/II-associated tropical spastic paraparesis (TSP). A prospective study of neurological disorders in Panama (1985-1990) revealed 13 patients with TSP and 3 with HTLV-I/II-associated spinocerebellar syndrome (HSCS) presenting at onset loss of balance, wide-based stance and gait, truncal instability, and mild leg ataxia (vermian cerebellar syndrome), with absent upper limb dysmetria but with postural tremor, downbeat nystagmus, and dysarthria. In 4-5 years, spinal cord manifestations of TSP developed, including spastic paraparesis, pyramidal signs, bladder and sphincter disturbances. Two patients were infected with HTLV-I and another one, a Guaymi Amerindian woman, with HTLV-II. Magnetic resonance imaging (MRI) demonstrated cerebellar atrophy involving predominantly the superior vermis. Mild axonal peripheral neuropathy in the lower limbs, dorsal column involvement and inflammatory myopathy were found by neurophysiology studies. There are 14 similar cases reported in Japan and Canada, but to our knowledge these are the first documented cases of HSCS in the tropics. A cerebellar syndrome constitutes another form of presentation of HTLV-I/II infection of the nervous system.
Assuntos
Cerebelo/patologia , Cerebelo/virologia , Infecções por Deltaretrovirus/complicações , Infecções por Deltaretrovirus/patologia , Vírus Linfotrópico T Tipo 1 Humano/fisiologia , Vírus Linfotrópico T Tipo 2 Humano/fisiologia , Degenerações Espinocerebelares/patologia , Degenerações Espinocerebelares/virologia , Cerebelo/fisiopatologia , Infecções por Deltaretrovirus/virologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Panamá , Degenerações Espinocerebelares/fisiopatologiaRESUMO
To examine risk factors for human T cell lymphotropic virus type II (HTLV-II) infection, a case-control study was conducted among the Guaymi Indians of Panama. In females, HTLV-II seropositivity was associated with early sexual intercourse (15 years; odds ratio [OR], 2.50; 95% confidence interval [CI], 1.11-6.14) and number of lifetime sex partners. One partner increased risk of seropositivity by 30% (OR, 1.30; CI, 1.05-1.64), and risk increased with number of partners. Similar risk was associated with number of long-term sexual relationships. Among males, intercourse with prostitutes was associated with HTLV-II seropositivity (OR, 1.68; CI, 1.04-2.72). These data support a role for sexual transmission in HTLV-II infection. Association of seropositivity with primary residence in a traditional village (OR, 3.75; CI, 1.02-15.38) and lack of formal education (0 vs. >6 years [OR, 3.89; CI, 1.67-9.82]) observed in males may reflect differences in sexual practices associated with acculturation.
Assuntos
Infecções por HTLV-II/epidemiologia , Indígenas Centro-Americanos , Comportamento Sexual , Adolescente , Adulto , Criança , Feminino , Infecções por HTLV-II/transmissão , Humanos , Masculino , Panamá/epidemiologia , Fatores de Risco , Assunção de Riscos , Fatores Sexuais , Trabalho SexualRESUMO
Circulating embryotoxic factors could be responsible for reproductive failures observed in patients suffering from recurrent spontaneous abortions (RSA) and endometriosis. The mouse bioassay has been widely used to detect such factors, since sera from these patients inhibit early embryonic development. This bioassay consists in the in-vitro culture of two-cell mouse embryos in the presence of different sera up to the blastocyst stage (72 h of culture). In the present study experiments were performed over long culture times (3-7 days), from two-cell to spreading stages, to determine the in-vitro effect of sera obtained from RSA or endometriosis patients, as well as the effect of interferon (INF)-gamma on embryo development. An embryotoxicity cut-off value of 45% blastocyst formation was established using control sera. When development to the blastocyst stage was considered only 25% of RSA and 20% of endometriosis sera were embryotoxic. However, all RSA sera significantly inhibited hatching (P < 0.05) and spreading stages (P < 0.01). IFN-gamma (10 micrograms/ml) (P < 0.001) did not impair early embryo development, but significantly inhibited blastocyst spreading. These observations suggest that culture to advanced embryonic stages increases the sensitivity of the bioassay and that IFN-gamma alters in-vitro peri-implantation mouse embryo development.
Assuntos
Blastocisto/efeitos dos fármacos , Blastocisto/fisiologia , Proteínas Sanguíneas/toxicidade , Infertilidade Feminina/sangue , Interferon gama/toxicidade , Aborto Espontâneo/sangue , Animais , Técnicas de Cultura , Endometriose/sangue , Feminino , Humanos , Camundongos , GravidezRESUMO
Objetivo: analizar la experiencia con la biopsia del Ganglio Centinela (G.C.) y sus implicancias terapéuticas en el melanoma. Metodología, Material y Método: entre diciembre 94 y abril 98, a 64 pacientes (pac) portadores de melanoma estadíos I y II se les realizó biopsia del G.C. Treinta y ocho eran varones y sus edades oscilaron entre 17 y 72 años (x 45). El espesor del tumor primario fue Breslow 0,5 a 1,49 mm 27 pac. 1,50 a 2,99 mm 21 pac, 3 a 3,99 mm 10 pac, y >4mm 3 pac; sin datos 3 pac. Su localización fue dorso 20, miembro superior 15, miembro inferior 13, tronco 13 y cabeza y cuello 3. Entre 2 y 4 hs previas a la biopsia del G.C. se realizó linfografía isotópica (LI) y marcación de piel sobre ganglio. Se utilizó inyección intradérmica de Azul Patente para su tinción. Resultados: la LI predijo la localización del ganglio en 61/64 pac (95,3 por ciento), con drenaje unilateral en 53 pac y bilateral en 11. El G.C. fue único en 50 pac y doble en 14 pac. No se lo pudo hallar en 2 pac (3 por ciento). La biopsia diferida mostró metástasis en 8 pac (12,5 por ciento). En ningún paciente con Breslow < 3 mm se halló otro ganglio comprometido además del G.C. en la pieza del vaciamiento subsiguiente. No hubo complicaciones. Con un seguimiento medio de 18 meses (1-41 m) sólo un paciente con biopsia del G.C. negativa desarrolló enfermedad en la axila y a distancia simultáneamente. Conclusiones: los vaciamientos ganglionares podrían no ser necesarios en pacientes con biopsia del G.C.+ y tumores primarios < 3 mm de espesor. Estas linfadenectomías superselectivas reducirían morbilidad y costos
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Excisão de Linfonodo , Melanoma , Metástase Linfática/diagnóstico , Imuno-Histoquímica , Excisão de Linfonodo , Melanoma , Metástase Linfática , Seleção de Pacientes , Reação em Cadeia da PolimeraseRESUMO
Objetivo: analizar la experiencia con la biopsia del Ganglio Centinela (G.C.) y sus implicancias terapéuticas en el melanoma. Metodología, Material y Método: entre diciembre 94 y abril 98, a 64 pacientes (pac) portadores de melanoma estadíos I y II se les realizó biopsia del G.C. Treinta y ocho eran varones y sus edades oscilaron entre 17 y 72 años (x 45). El espesor del tumor primario fue Breslow 0,5 a 1,49 mm 27 pac. 1,50 a 2,99 mm 21 pac, 3 a 3,99 mm 10 pac, y >4mm 3 pac; sin datos 3 pac. Su localización fue dorso 20, miembro superior 15, miembro inferior 13, tronco 13 y cabeza y cuello 3. Entre 2 y 4 hs previas a la biopsia del G.C. se realizó linfografía isotópica (LI) y marcación de piel sobre ganglio. Se utilizó inyección intradérmica de Azul Patente para su tinción. Resultados: la LI predijo la localización del ganglio en 61/64 pac (95,3 por ciento), con drenaje unilateral en 53 pac y bilateral en 11. El G.C. fue único en 50 pac y doble en 14 pac. No se lo pudo hallar en 2 pac (3 por ciento). La biopsia diferida mostró metástasis en 8 pac (12,5 por ciento). En ningún paciente con Breslow < 3 mm se halló otro ganglio comprometido además del G.C. en la pieza del vaciamiento subsiguiente. No hubo complicaciones. Con un seguimiento medio de 18 meses (1-41 m) sólo un paciente con biopsia del G.C. negativa desarrolló enfermedad en la axila y a distancia simultáneamente. Conclusiones: los vaciamientos ganglionares podrían no ser necesarios en pacientes con biopsia del G.C.+ y tumores primarios < 3 mm de espesor. Estas linfadenectomías superselectivas reducirían morbilidad y costos (AU)
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Idoso , Melanoma/cirurgia , Metástase Linfática/diagnóstico , Excisão de Linfonodo/normas , Melanoma/complicações , Seleção de Pacientes , Metástase Linfática/diagnóstico por imagem , Excisão de Linfonodo/métodos , Reação em Cadeia da Polimerase/estatística & dados numéricos , Imuno-HistoquímicaRESUMO
We present a case of a 60 year old male with end stage dilated cardiomyopathy in NYHA functional class IV in whom a partial left ventriculectomy was performed, a new surgical procedure developed in Brazil and done for the first time in Chile. Left ventricular size reduction produced an objective improvement on echocardiographic parameters of left ventricular function as well as in patient's NYHA functional class in the early post operative period.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Dilatada/cirurgia , Ventrículos do Coração/cirurgia , Disfunção Ventricular Esquerda/cirurgia , Volume Cardíaco , Humanos , Masculino , Pessoa de Meia-Idade , Volume SistólicoRESUMO
OBJECTIVE: To evaluate pulmonary function and exercise capacity in children with myelomeningocele. STUDY DESIGN: Prospective evaluation in a randomly selected cohort of 12 subjects (10 to 17 years of age) with myelomeningocele and 12 control subjects matched for age, sex, and arm span. METHODS: Spirometry, lung volumes, maximum respiratory pressures, maximum oxygen expenditure during arm ergometry, and anaerobic threshold were measured. RESULTS: Mean total lung capacity and fractional lung volumes were significantly lower in case subjects than control subjects. Eleven subjects (92%) had a reduced forced vital capacity; seven (58%) had restrictive disease as evidenced by reductions in total lung capacity with normal or increased forced expiratory volume in 1 second/forced vital capacity ratio. Nine subjects (75%) had respiratory muscle weakness as evidenced by reduced maximum respiratory pressures or a low maximum voluntary ventilation. Exercise capacity was reduced as evidenced by a lower maximum oxygen consumption at peak exercise (13.8 +/- 4.8 vs 21.3 +/- 7.5 ml/min per kilogram of body weight; p < 0.02) and a lower anaerobic threshold (12.4 +/- 5.1 vs 17.3 +/- 4.2 ml/min per kilogram; p < 0.01) than the control group. Though the majority of subjects with myelomeningocele had a significant degree of restrictive disease, respiratory muscle weakness, or both, only one subject had pulmonary symptoms during exercise. CONCLUSIONS: Though most subjects with myelomeningocele had a significant degree of restrictive lung disease, respiratory muscle weakness, or both, exercise capacity was mostly limited by arm weakness. Skeletal muscle weakness may mask the symptoms of an underlying pulmonary abnormality, which may not be evident unless a pathologic cause of increased ventilation is present. Pulmonary function testing is suggested to screen for these abnormalities.
Assuntos
Tolerância ao Exercício , Pneumopatias Obstrutivas/etiologia , Meningomielocele/complicações , Meningomielocele/fisiopatologia , Insuficiência Respiratória/etiologia , Adolescente , Limiar Anaeróbio , Peso Corporal , Estudos de Casos e Controles , Criança , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Consumo de Oxigênio , Estudos Prospectivos , Capacidade VitalRESUMO
The identification of different mutations which cause cystic fibrosis (CF) in Argentine patients has been performed. Initially, 10 of the most commonly mutated loci in 228 independent chromosomes were analyzed. Each allele was detected by PCR amplification of DNA samples either directly on polyacrylamide gels, by restriction enzyme digestion and agarose gels electrophoresis, or by hybridization with allele specific oligonucleotides. The delta F508 mutation was found in 57% of the alleles. The frequencies of the other CF mutations were as follows: G542X 3.9%, W1282X 3.1%, N1303K 1.7%, 1717 1-G-->A 0.9%, R553X 0.4%, R1162X 0.4%, whereas G551D, delta I507 and S549N were not found. This direct mutation analysis enabled the detection of 155/228 CF alleles (67%). Of the remaining 73 unidentified CF alleles, 22 were investigated for the 27 exons by DGGE and 9 rare mutations were identified. The incidence of the main CF mutations analyzed was similar to that of the South European population and markedly different from other Latin American countries. The mutation data presented here may be useful for designing DNA testing strategies for CF in Argentina.
Assuntos
Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística/genética , Genética Populacional , Mutação , Argentina , Criança , Cromossomos Humanos , Fibrose Cística/complicações , Eletroforese , Frequência do Gene , Homozigoto , Humanos , Pneumopatias/complicações , Pneumopatias/genética , Pâncreas/fisiopatologia , Reação em Cadeia da PolimeraseRESUMO
More than 18 million persons in the the world are estimated to have been infected with human immunodefeiciency virus (HIV), the cause of the acquired immunodeficiency syndrome (AIDS). As immunodeficiency progresses, these persons become susceptible to a wide variety of opportunistic infections (OIs). The spectrum of OIs varies among regions of the world. Tuberculosis is the most common serious OI in sub-Saharan Africa and is also more common in Latin America and in Asia than in the United States. Bacterial infections such as toxoplasmosis, cryptosporidiosis, and isosporaisis are also common in Latin America. Fungal infections, including cryptococcosis and Penicillium marneffei infection, appear to be prevalent in Southeast Asia. Despite limited health resources in these regions, some measures that are recommended to prevent OIs in the United States may be useful for prolonging and improving the quality of life of HIV-infected persons. These include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pnemococcal vaccine to prevent disease due to Streptococcus pneumoniae. Research is needed to determine the spectrum of OIs and the efficacy of various prevention measures in resource-poor nations, and health officials need to determine a minimum standard of care for HIV-infected persons. An increasing problem in the developing world, HIV/AIDS should receive attention comparable to other tropical diseases (AU).
Assuntos
Humanos , Infecções Oportunistas Relacionadas com a AIDS , Anti-Infecciosos , Antituberculosos , Vacinas Bacterianas , Quimioterapia Combinada , Isoniazida , Sulfametizol , Trimetoprima , Pesquisa , África , Ásia , Países em Desenvolvimento , América Latina/epidemiologia , Região do Caribe/epidemiologiaRESUMO
OBJECTIVE: To determine the frequency of mother-to-child transmission of human T-lymphotropic virus type II (HTLV-II) and to explore its association with breast-feeding. DESIGN: Prospective study of children born to a cohort of HTLV-II-infected pregnant women and a cross-sectional study of older siblings of these children. METHODS: Maternal sera were screened with an HTLV-I enzyme immunoassay that detects antibody to both HTLV-I and HTLV-II. Confirmatory serologic testing and viral typing were performed by Western blot, radioimmunoprecipitation assay, enzyme immunoassay with HTLV type-specific proteins, and polymerase chain reaction (PCR) analysis of DNA from peripheral blood mononuclear cells. The presence of HTLV was evaluated in children by serial serologic and PCR testing. Molecular analysis of PCR products from infected mother-child pairs was performed by means of restriction fragment length polymorphism of HTLV-II long-terminal repeated sequences. RESULTS: Twenty-nine HTLV-II-infected women were identified, and these 29 women had 30 pregnancies during the study. Of 28 live infants born to infected women, 19 were examined and none was infected with HTLV-II. Sixteen older children less than 10 years of age who were born previously to the infected women were also examined; two were infected with HTLV-II. One infected child was breast fed for 2 months and the second was not breast fed. The viral patterns of restriction fragment length polymorphism in the two infected children were distinct, but the viral pattern in each child was identical to that of her mother's virus, suggesting mother-to-child transmission. Overall, among examined children, 1 of 7 breast-fed children (14%; 95% confidence interval: 0, 40) and 1 of 28 children who were not breast fed (3.6%; 95% confidence interval: 0, 10) were infected with HTLV-II. CONCLUSION: Mother-to-child transmission of HTLV-II occurs both with and without breast-feeding and at rates similar to those of HTLV-I. We believe that this is the first demonstration of mother-to-child transmission of HTLV-II in the absence of breast-feeding.
Assuntos
Vírus Linfotrópico T Tipo 2 Humano/isolamento & purificação , Troca Materno-Fetal , Western Blotting , Aleitamento Materno , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , HIV-1/isolamento & purificação , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Técnicas Imunoenzimáticas , Lactente , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Gravidez , Estudos ProspectivosRESUMO
Human T-cell lymphotropic virus type I (HTLV-I) is endemic in the Caribbean basin and in Japan. HTLV-II, a closely related virus, is endemic in several groups of native Americans, including Panamanian Guaymi. In Panama, a nationwide HTLV-I/II seroprevalence of 1-2% has been reported. We evaluated the frequency of HTLV-I/II infection in patients with neurologic diseases admitted to state tertiary hospitals in Panama City between 1985 and 1990. Nineteen of 322 patients with eligible diagnoses had antibodies to HTLV-I/II, 17 with HTLV-I and 2 with HTLV-II. HTLV-I was associated with spastic paraparesis (13 of 23, 56.5% versus 4 of 299, 1.3%, p < 0.001) and with cerebellar syndrome (2 of 13, 15.4%) and multiple sclerosis (2 of 54, 3.7%) (p < 0.05 for both diseases compared with subject with none of these diagnoses). The two HTLV-I infected patients with cerebellar syndrome later developed spastic paraparesis. HTLV-II infection was noted in one patient with cerebellar syndrome and one with amyotrophic lateral sclerosis. All patients with other diagnoses were seronegative. Among patients with spastic paraparesis, HTLV-I-infected patients were clinically indistinguishable from seronegative subjects. There is apparently an overlapping clinical spectrum of neurologic diseases associated with HTLV-I and HTLV-II infection.
Assuntos
Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Adolescente , Adulto , Idoso , Doenças Cerebelares/complicações , Doenças Cerebelares/epidemiologia , DNA Viral/análise , Feminino , Anticorpos Anti-HTLV-I/análise , Infecções por HTLV-I/complicações , Anticorpos Anti-HTLV-II/análise , Infecções por HTLV-II/complicações , Vírus Linfotrópico T Tipo 1 Humano/genética , Vírus Linfotrópico T Tipo 2 Humano/genética , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/epidemiologia , Doenças do Sistema Nervoso/complicações , Panamá/epidemiologia , Paraparesia Espástica Tropical/complicações , Paraparesia Espástica Tropical/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , SíndromeRESUMO
Guaymi Indians, a non-intravenous drug-using population in which human T cell lymphotropic virus type II (HTLV-II) is endemic, were studied in Changuinola, Panama, to identify the prevalence and modes of transmission of HTLV-II. A population-based survey showed that 352 (9.5%) of the 3686 participants were seropositive for HTLV-II. Infection rates were the same for male and female subjects and increased significantly with age, beginning in young adulthood. HTLV-II infection status was highly concordant among spouses (P < .001) and between mother and child; of children aged 1-10 years, 36 of 219 born to seropositive mothers were seropositive compared with 3 of 997 born to seronegative mothers (P < .001). The strong associations of HTLV-II infection with age and with an infected spouse in adults and of infection in children with infection in their mothers strongly suggest sexual and mother-to-child transmission of HTLV-II in this population.
Assuntos
Infecções por HTLV-II/transmissão , Doenças Virais Sexualmente Transmissíveis/transmissão , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Anticorpos Anti-HTLV-II/sangue , Infecções por HTLV-II/epidemiologia , Infecções por HTLV-II/imunologia , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Masculino , Pessoa de Meia-Idade , Panamá/epidemiologia , Prevalência , Fatores de Risco , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Doenças Virais Sexualmente Transmissíveis/imunologiaRESUMO
The purpose of this study was to determine the stated willingness of parents/caretakers to allow the administration of multiple, injected immunizations to their children at a single visit. Two hundred eighty-one parents/caretakers accompanying their children to an inner-city pediatric clinic were presented with hypothetical situations in which their children would be due for two, three, or four injections to complete their series of age-appropriate immunizations. Given a scenario of two needed injections, 24 (8.5%) of the 281 parents/caretakers preferred to divide the injections between two visits; for three injections, 119 (42.3%) preferred two visits; and for four injections, 164 (58.4%) preferred two visits. The commonly stated preference of our predominantly minority parent/caretaker population to divide more than two injections between two visits seriously conflicts with the US Public Health Service's National Vaccine Advisory Committee's recommendations and potentially exacerbates immunization delays. Therefore, physicians must be prepared to strongly urge simultaneous administration of all needed vaccine doses at any opportunity.
Assuntos
Atitude Frente a Saúde , Imunização/normas , Injeções/psicologia , Adulto , Distribuição de Qui-Quadrado , Feminino , Política de Saúde , Humanos , Imunização/psicologia , Lactente , Masculino , Grupos Minoritários , Pais/psicologia , Papel do Médico , Estados Unidos , População UrbanaRESUMO
OBJECTIVE: To compare the reading level required to understand childhood immunization information forms with the reading grade level of an inner-city parent/caretaker population. DESIGN: Descriptive study (parents/caretakers). SETTING: Inner-city pediatric clinic. PARTICIPANTS: One hundred fifty English-speaking, low-income parent/caretakers. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: The reading level of our parent population ranged from grades 2.9 to 13.3, with a median grade level of 6.90. The reading levels required for the three vaccine information pamphlets issued in 1992 by the Centers for Disease Control and Prevention (Atlanta, Ga) averaged 11.1 (approximately at the level of a high school junior). Eighty-six percent of our parents/caretakers did not have a reading level sufficient to cope with the easiest of the forms. CONCLUSIONS: The vaccine information pamphlets require a reading level beyond the capability of the vast majority of our parent population. Therefore, the goal of informed consent clearly is not being met.
Assuntos
Compreensão , Termos de Consentimento , Imunização , Consentimento Livre e Esclarecido , Folhetos , Consentimento dos Pais , Leitura , Populações Vulneráveis , Adolescente , Adulto , Cuidadores , Escolaridade , Feminino , Promoção da Saúde , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Pais , PediatriaRESUMO
We conducted a study to look for a simian counterpart of human T-lymphotropic virus (HTLV) in wild-caught monkeys in the Republic of Panama. Serum specimens were obtained from 102 monkeys (Ateles fusciceps, n = 75; Alouatta villosa, n = 18; and Cebus capucinus, n = 9) captured in Panama's Darien rain forest in 1979-1980. Specimens were screened for HTLV antibody by enzyme-linked immunosorbent assay, and reactive specimens were further tested by Western blot. None of the 102 specimens were seropositive for HTLV. Our findings provide no evidence for an HTLV-like virus in New World primates from Panama, but the sample size was small, and further studies are warranted.