RESUMO
Hepatitis E has always been related to morbidity in pregnant women. Its epidemiology is not well understood in Brazil. Therefore, we tested sera from 209 pregnant women and 199 female blood donors, collected at a single center in Curitiba, Brazil. The Wantai assay was used for testing the anti-hepatitis E virus (anti-HEV), immunoglobulin G (IgG), and an in-house polymerase chain reaction process for testing HEV RNA. Anti-HEV was detected in 22.5% of the total group, 19% in the pregnant women group, and 26% in the blood donor group (P = 0.11), a much higher prevalence when compared with other studies in Brazil. Demographical analysis showed that 92.4% were born in the South Region of Brazil, 4.9% in the Southeast, and 2.7% were distributed over other regions of the country. With respect to their origin, 99% were from the South, 0.7% from the Southeast, and 0.2% from the Central-West regions. Income, education, race, number of pregnancies, and abortion did differ significantly when comparing both the groups (P < 0.001). Age >30 (P = 0.012) and the number (>3) of pregnancies (P = 0.008) were related to anti-HEV positivity. All anti-HEV IgG-positive females were HEV RNA negative. In conclusion, HEV positivity was found in one out of five young women, which showed an urgent need for further epidemiological studies in Brazil.
Assuntos
Doadores de Sangue , Anticorpos Anti-Hepatite/sangue , Hepatite E/epidemiologia , Gestantes , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Imunoglobulina G/sangue , Reação em Cadeia da Polimerase , Gravidez , RNA Viral/sangue , Fatores de Risco , Estudos Soroepidemiológicos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Vertical transmission constitutes the main route for child infection by the HIV-1 virus (human immune deficiency virus). This study aimed to investigate the clinical and laboratory evolution of children with vertically transmitted HIV/AIDS. METHODS: This was a retrospective descriptive study based on data gathered from the medical records of all the children who were seen at a specialized care unit between January 1998 and June 2006. RESULTS: Eighty children who met the inclusion criteria were evaluated. In the cases 56 (70%) of the children, their mothers were diagnosed as HIV-positive after childbirth. The delivery was vaginal for 44 (55%) of the children. Fifty-six children (70%) were breastfed by their mothers for periods ranging from one to more than 12 months. Failure to use or incomplete use of the ACTG 076 protocol was documented in 63 (78.5%) of the cases. CONCLUSIONS: The findings from our study are a cause for considerable concern and show failures of medical care for mothers and children, particularly with regard to prevention of transmission.
Assuntos
Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
INTRODUÇÃO: a transmissão vertical constitui a principal via de infecção infantil pelo vírus HIV-1 (vírus da imunodeficiência humana). A presente pesquisa tem como objetivo estudar a evolução clínica e laboratorial de crianças vivendo com HIV/AIDS decorrente da transmissão vertical. MÉTODOS: trata-se de um estudo descritivo, retrospectivo, realizado a partir da coleta de dados em prontuário médico de todas as crianças atendidas em um Serviço de Assistência Especializada, no período de janeiro de 1998 a junho de 2006. RESULTADOS: foram avaliadas 80 crianças que preencheram critérios de inclusão. Observou-se que em 56 (70 por cento) crianças, o diagnóstico da infecção pelo HIV na mãe deu-se após o parto e que em 44 (55 por cento) o parto foi via vaginal. Amamentação ao seio materno foi documentada em 56 (70 por cento) crianças e esta variou de um mês até mais de 12 meses. A não utilização ou uso incompleto do Protocolo ACTG 076 foi documentado em 63 (78,5 por cento) casos. CONCLUSÕES: os dados observados em nosso estudo são bastante preocupantes e revelam falha na assistência materno-infantil, especialmente voltada para prevenção da transmissão.
INTRODUCTION: Vertical transmission constitutes the main route for child infection by the HIV-1 virus (human immune deficiency virus). This study aimed to investigate the clinical and laboratory evolution of children with vertically transmitted HIV/AIDS. METHODS: This was a retrospective descriptive study based on data gathered from the medical records of all the children who were seen at a specialized care unit between January 1998 and June 2006. RESULTS: Eighty children who met the inclusion criteria were evaluated. In the cases 56 (70 percent) of the children, their mothers were diagnosed as HIV-positive after childbirth. The delivery was vaginal for 44 (55 percent) of the children. Fifty-six children (70 percent) were breastfed by their mothers for periods ranging from one to more than 12 months. Failure to use or incomplete use of the ACTG 076 protocol was documented in 63 (78.5 percent) of the cases. CONCLUSIONS: The findings from our study are a cause for considerable concern and show failures of medical care for mothers and children, particularly with regard to prevention of transmission.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Brasil/epidemiologia , Infecções por HIV/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
We transplanted 47 patients with Fanconi anemia using an alternative source of hematopoietic cells. The patients were assigned to the following groups: group 1, unrelated bone marrow (N = 15); group 2, unrelated cord blood (N = 17), and group 3, related non-sibling bone marrow (N = 15). Twenty-four patients (51%) had complete engraftment, which was not influenced by gender (P = 0.87), age (P = 0.45), dose of cyclophosphamide (P = 0.80), nucleated cell dose infused (P = 0.60), or use of anti-T serotherapy (P = 0.20). Favorable factors for superior engraftment were full HLA compatibility (independent of the source of cells; P = 0.007) and use of a fludarabine-based conditioning regimen (P = 0.046). Unfavorable factors were > or = 25 transfusions pre-transplant (P = 0.011) and degree of HLA disparity (P = 0.007). Intensity of mucositis (P = 0.50) and use of androgen prior to transplant had no influence on survival (P = 0.80). Acute graft-versus-host disease (GVHD) grade II-IV and chronic GVHD were diagnosed in 47 and 23% of available patients, respectively, and infections prevailed as the main cause of death, associated or not with GVHD. Eighteen patients are alive, the Kaplan-Meyer overall survival is 38% at approximately 8 years, and the best results were obtained with related non-sibling bone marrow patients. Three recommendations emerged from the present study: fludarabine as part of conditioning, transplant in patients with < 25 transfusions and avoidance of HLA disparity. In addition, an extended family search (even when consanguinity is not present) seeking for a related non-sibling donor is highly recommended.
Assuntos
Anemia de Fanconi/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Ciclofosfamida/uso terapêutico , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/prevenção & controle , Antígenos HLA/análise , Teste de Histocompatibilidade , Humanos , Imunossupressores/uso terapêutico , Masculino , Análise Multivariada , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Transplante Homólogo/imunologia , Transplante Homólogo/métodos , Resultado do TratamentoRESUMO
We transplanted 47 patients with Fanconi anemia using an alternative source of hematopoietic cells. The patients were assigned to the following groups: group 1, unrelated bone marrow (N = 15); group 2, unrelated cord blood (N = 17), and group 3, related non-sibling bone marrow (N = 15). Twenty-four patients (51 percent) had complete engraftment, which was not influenced by gender (P = 0.87), age (P = 0.45), dose of cyclophosphamide (P = 0.80), nucleated cell dose infused (P = 0.60), or use of anti-T serotherapy (P = 0.20). Favorable factors for superior engraftment were full HLA compatibility (independent of the source of cells; P = 0.007) and use of a fludarabine-based conditioning regimen (P = 0.046). Unfavorable factors were > or = 25 transfusions pre-transplant (P = 0.011) and degree of HLA disparity (P = 0.007). Intensity of mucositis (P = 0.50) and use of androgen prior to transplant had no influence on survival (P = 0.80). Acute graft-versus-host disease (GVHD) grade II-IV and chronic GVHD were diagnosed in 47 and 23 percent of available patients, respectively, and infections prevailed as the main cause of death, associated or not with GVHD. Eighteen patients are alive, the Kaplan-Meyer overall survival is 38 percent at ~8 years, and the best results were obtained with related non-sibling bone marrow patients. Three recommendations emerged from the present study: fludarabine as part of conditioning, transplant in patients with <25 transfusions and avoidance of HLA disparity. In addition, an extended family search (even when consanguinity is not present) seeking for a related non-sibling donor is highly recommended.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Anemia de Fanconi/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Doença Aguda , Doença Crônica , Ciclofosfamida/uso terapêutico , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/prevenção & controle , Teste de Histocompatibilidade , Antígenos HLA/análise , Imunossupressores/uso terapêutico , Análise Multivariada , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Transplante Homólogo/imunologia , Transplante Homólogo/métodosRESUMO
A protective herd effect has been described after susceptible populations of children are vaccinated with conjugate Haemophilus influenzae type b (Hib). Hib carriage was studied in children aged 6-24 months attending day care centers in two cities in southern Brazil (Curitiba and Porto Alegre). In Curitiba, routine immunization with Hib polyribosylribitol phosphate polysaccharide-tetanus toxoid conjugate vaccine (PRP-T) in combination with diphtheria-tetanus toxoids-pertussis vaccine (PRP-T/DTP) has been offered since September 1996; DTP vaccine alone is routinely given in Porto Alegre. Children in Porto Alegre (n=643) were 8 times less likely to have received adequate Hib vaccination and 4 times more likely to be Hib carriers than children in Curitiba (n=647; i.e., point prevalence of oropharyngeal colonization, 4.8% vs. 1.2%). Point prevalence of carriage with non-type b or other nontypeable Hi was similar in children of both cities. There was a vaccination effect on carriage rates in children who received a primary 3-dose series, independent of the booster dose, suggesting that a booster may be unnecessary to induce population protection.
Assuntos
Vacina contra Difteria, Tétano e Coqueluche , Vacinas Anti-Haemophilus , Haemophilus influenzae/isolamento & purificação , Orofaringe/microbiologia , Toxoide Tetânico , Vacinas Conjugadas , Brasil , Portador Sadio/microbiologia , Creches , Pré-Escolar , Etnicidade , Feminino , Haemophilus influenzae/fisiologia , Habitação , Humanos , Lactente , MasculinoRESUMO
A herbal tea (called an abafado in Brazil) prepared from the dried leaves of lemongrass was administered to healthy volunteers. Following a single dose or 2 weeks of daily oral administration, the abafado produced no changes in serum glucose, urea, creatinine, cholesterol, triglycerides, lipids, total bilirubin, indirect bilirubin, GOT, GPT, alkaline phosphatase, total protein, albumin, LDH and CPK. Urine analysis (proteins, glucose, ketones, bilirubins, occult blood and urobilinogen) as well as EEG and EKG showed no abnormalities. There were slight elevations of direct bilirubin and of amylase in some of the volunteers, but without any clinical manifestation. These results taken together indicate that lemongrass as used in Brazilian folk medicine is not toxic for humans. The eventual hypnotic effect of lemongrass was investigated in 50 volunteers who ingested samples of lemongrass and a placebo under double-blind conditions. The parameters (i.e. sleep induction, sleep quality, dream recall and rewakening) did not show any effect of lemongrass as compared to the placebo. Eighteen subjects with high scores of trait-anxiety were submitted to an anxiety-inducing test following taking lemongrass or placebo under double-blind conditions. Their anxiety levels were similar, indicating that the abafado of the plant does not have anxiolytic properties. It is concluded that lemongrass, one of the most popular Brazilian herbal medicines, used for its alleged CNS-depressant effects, is atoxic but lacks hypnotic or anxiolytic properties.
Assuntos
Ansiolíticos , Hipnóticos e Sedativos , Medicina Tradicional , Extratos Vegetais/toxicidade , Plantas Medicinais , Poaceae , Administração Oral , Adulto , Amilases/sangue , Ansiedade , Bilirrubina/sangue , Encéfalo/efeitos dos fármacos , Brasil , Eletrocardiografia , Eletroencefalografia , Feminino , Coração/efeitos dos fármacos , Humanos , Masculino , Fitoterapia , Extratos Vegetais/administração & dosagemRESUMO
Em esquema de duplo anonimato (doubleblind), 13 voluntarios sadios ingeriram 975mg de apirina, apresentada sob 3 tipos diferentes de comprimidos: aspirina sintetizada no Brasil por laboratorio nacional sem antiacidos(aspirina NQ-comprimidos A); aspirina NQ tamponada com glicinato de aluminio e carbonato de magnesio (comprimidos B); e aspirina comercial importada, sem antiacidos (comprimidos C). Dosagens plasmaticas mostraram que o nivel de salicilato ao fim de 2 horas era identico para os 3 tipos de comprimidos e que este nivel era atingido mais rapidamente com os comprimidos tamponados (B)