RESUMO
Background Information regarding urinary biomarkers in Mestizo and Afro-Latin-American patients is very limited. We investigated whether levels of urinary neutrophil gelatinase-associated lipocalin (NGAL), and monocyte chemoattractant protein 1 (MCP-1) are good biomarkers to differentiate patients with lupus nephritis among Latin-American systemic lupus erythematosus (SLE) patients. Methods SLE patients meeting the revised American College of Rheumatology classification criteria for SLE were recruited. Urinary levels of NGAL and MCP-1 were measured using a commercial ELISA kit. Serum anti-C1q antibodies were measured by ELISA. SLE activity was measured with the systemic lupus erythematosus disease activity index (SLEDAI). Mann-Whitney tests were used to compare data and Spearman's rank correlations were used to examine associations between continuous variables. In addition, receiver operating characteristic curves were performed. Results One hundred and twenty SLE patients were recruited (87% women) with a median age of 32.8 ± 12.1 years and median disease duration of 7.3 ± 6.9 years. Afro-Latin-Americans had a significantly higher prevalence of lupus nephritis and higher SLEDAI scores than Mestizos. The three biomarkers were significantly higher in patients with lupus nephritis than in patients without lupus nephritis. In addition, urinary NGAL and MCP-1 were significantly higher in patients with active lupus nephritis than in inactive lupus nephritis. Urinary NGAL levels were significantly higher in Afro-Latin-American patients. A receiver operating characteristic curve for urinary biomarkers for lupus nephritis in all SLE patients showed a good level of sensitivity and specificity. Conclusion In our cohort of SLE patients, we found that urinary NGAL and MCP-1 in addition to anti-C1q antibodies were useful biomarkers for the identification of renal involvement and discrimination of active lupus nephritis among patients with renal disease.
Assuntos
Quimiocina CCL2/urina , Lipocalina-2/urina , Lúpus Eritematoso Sistêmico/complicações , Nefrite Lúpica/urina , Adulto , Autoanticorpos/sangue , Biomarcadores/sangue , Biomarcadores/urina , População Negra , Colômbia/epidemiologia , Complemento C1q/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Indígenas Sul-Americanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/etnologia , Nefrite Lúpica/diagnóstico , Nefrite Lúpica/etnologia , Nefrite Lúpica/etiologia , Masculino , Valor Preditivo dos Testes , Prevalência , Regulação para Cima , Urinálise/métodos , Adulto JovemRESUMO
Antiphospholipid syndrome (APS) affects young patients in the most productive years of their life, and the consequences of organic or tissue damage involve a decrease in health-related quality of life (HRQoL). While acute disease manifestations of APS are well known, information on the long-term prognosis and damage in affected patients is still very limited. Systemic lupus erythematosus (SLE) patients would be expected to experience long-term complications and even die as a consequence of APS. Organ damage in APS has been evaluated using different methods and definitions, including the SLICC/ACR Damage Index (SDI), which tend to underestimate aPL-related damage. A new damage index in APS has been proposed (DIAPS), and it seems to be more accurate than SDI. Given the implications for morbidity and mortality, it is imperative to assess accurately aPL-related damage and HRQoL in patients with APS.
Assuntos
Síndrome Antifosfolipídica/reabilitação , Qualidade de Vida , Síndrome Antifosfolipídica/complicações , Humanos , Lúpus Eritematoso Sistêmico/reabilitação , Prognóstico , Psicometria , Índice de Gravidade de Doença , Trombose/etiologiaRESUMO
In order to estimate the dose caused by internal radiation, it is necessary to know the specific absorbed fraction (SAF) values; through this work these values have been calculated using the Adult Male Reference Computational Phantom (RCP-AM) from the Publication 110 of the International Commission Radiologic Protection and the Monte Carlo transport code MCNPX. These values were calculated for a combination of 980 pairs of source and target organs, for a total of 12 energies. The results were validated and compared with the results reported by other authors: Hadid et al. (RCP-AM), Petoussi-Henss and Zankl (Golem) and the Oak Ridge National Laboratory (ORNL) stylised model reported by Cristy and Eckerman. Mostly, the SAF values calculated with the RCP-AM do not present significant differences in relation to its previous model Golem. When comparing the SAF values of RCP-AM with that of the ORNL stylised model, huge differences were found. These differences can be explained by the shape of the organs and their relative positions, which are more realistic in the voxelised phantoms.
Assuntos
Especificidade de Órgãos , Imagens de Fantasmas , Fótons , Doses de Radiação , Adulto , Carga Corporal (Radioterapia) , Simulação por Computador , Humanos , Masculino , Método de Monte Carlo , Valores de Referência , Eficiência Biológica RelativaRESUMO
The concern about accidents involving radioactive materials has led to the search of alternative methods to quickly identify and quantify radionuclides in workers and in the population. One of the options to face up an eventual demand for mass monitoring of internal contamination is the use of a nuclear medicine diagnostic equipment known as gamma camera, a device used to scan patients who have been administered specific amounts of radioactive materials for medical purposes. Although the gamma camera is used for image diagnosis, it can be calibrated with anthropomorphic phantoms or point sources for the quantification of radionuclide activities in the human body. This work presents a protocol for the calibration of gamma cameras for such application. In order to evaluate the suitability of this type of equipment, a gamma camera available in a public hospital located in Rio de Janeiro was calibrated for the in vivo measurement of 131I. The calibration includes the determination of detection efficiencies and minimum detectable activities for each radionuclide. The results show that the gamma camera presents enough sensitivity to detect activity levels corresponding to effective doses below 1 mSv. The protocol is the basis to establish a network of Nuclear Medicine Centres, located in public hospitals in eight countries of Latin America (Argentina, Brazil, Colombia, Cuba, Chile, Mexico, Peru and Uruguay) and in Spain that could be requested to collaborate in remediation actions in the event of an accident involving incorporation of radioactive materials. This protocol is one of the most significant outputs of the IAEA-ARCAL Project (RLA/9/049-LXXVIII) aimed to the Harmonization of Internal Dosimetry Procedures.
Assuntos
Algoritmos , Emergências , Câmaras gama/normas , Radioisótopos/análise , Contagem Corporal Total/instrumentação , Contagem Corporal Total/normas , Calibragem , InternacionalidadeRESUMO
The objective of this study was to analyse the prevalence and characteristics of the main clinical and immunological manifestations at the onset and during the evolution of the disease in a cohort of patients from Latin America (mainly of mestizo origin) and to compare the Latin American with the European patients. Clinical and serological characteristics of 100 APS patients from Mexico and Ecuador were collected in a protocol form that was identical to that used to study the ;Euro-Phospholipid' cohort. The cohort consisted of 93 female patients (93.0%) and seven (7.0%) male patients. There were 91 mestizos (91.0%), seven whites (7.0%) and two Amerindians (2.0%). The most common manifestations were livedo reticularis (40.0%), migraine (35.0%), inferior extremity deep vein thrombosis (32.0%), thrombocytopenia (28.0%) and hemolytic anemia (20.0%). Several clinical manifestations were more prevalent in Latin American than in European patients and they included mainly neurological (migraine, transient global amnesia, acute ischemic encephalopathy, amaurosis fugax) and cutaneous (livedo reticularis, skin ulcerations, superficial cutaneous necrosis, multiple subungual splinter hemorrhages) manifestations as well as hemolytic anemia. The APS has a wide variety of clinical and immunological manifestations at the onset and during the evolution of the disease and the ethnic origin in addition to environmental and socioeconomic factors can modify the disease expression.
Assuntos
Síndrome Antifosfolipídica/epidemiologia , Síndrome Antifosfolipídica/imunologia , Adolescente , Adulto , Idoso , Síndrome Antifosfolipídica/patologia , Criança , Estudos de Coortes , Equador/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
Under the auspices of the Regional Coordination Agreement for Latin America, representatives of the eight member states have participated in a project to improve radiological protection for workers exposed to unsealed sources of radiation. The design of the project was based on information obtained from a questionnaire circulated among the participants, from which the initial status of internal dosimetry services in each country was characterised. The objective of the project is to harmonize internal dosimetry procedures, with reference to International Atomic Energy Agency recommendations. After the implementation of new procedures and personnel training, four intercomparison exercises were carried out: measurement of iodine in thyroid phantoms, measurement of gamma emitters in urine samples, measurement of beta emitters in urine samples and internal dose assessments. This project has resulted in important improvements in internal dosimetry services in the region.
Assuntos
Bioensaio/métodos , Relações Interinstitucionais , Proteção Radiológica/métodos , Radiometria/métodos , Gestão da Segurança/métodos , Gestão da Segurança/organização & administração , América Latina , Doses de RadiaçãoRESUMO
The safety and immunogenicity of an intramuscular (i.m.) and intradermal (ID) formulation of autoclaved Leishmania (Leishmania) amazonensis vaccine was evaluated in 296 volunteers in a randomized, placebo-controlled, double-blind trial in Colombia. There were 4 vaccination groups: i.m. vaccine, i.m. placebo, ID vaccine, and ID placebo. The ID formulations were mixed with BCG as adjuvant at the time of injection. For each group, 3 vaccinations were given with a 20-day interval between injections, and adverse events were monitored at 20 min, and at 2, 7 and 21 days after each injection. BCG-induced adverse reactions resulted in cancellation of the third vaccine administration in the ID groups. Antibody titres did not differ significantly between the groups. Montenegro skin-test conversion was achieved by 86.4% and 90% of the i.m. vaccine group and by 25% and 5% of the i.m. placebo group 80 days and 1 year after vaccination, respectively. A significant increase in mean Leishmania-antigen lymphocyte proliferation indexes was observed after i.m. vaccine immunization, but not after i.m. placebo immunization, 80 days and 1 year after vaccination. Significant levels of IFN gamma but not IL-10 were observed 1 year after vaccination in the i.m. vaccine group compared to the i.m. placebo group. The good safety profile and evidence of Th1 immune reactions due to i.m. vaccination in this phase-I/II study suggest that a population-based phase-III efficacy trial of the i.m. vaccine should be initiated.
Assuntos
Leishmania mexicana/imunologia , Leishmaniose Cutânea/prevenção & controle , Vacinas de Produtos Inativados , Adjuvantes Imunológicos , Animais , Formação de Anticorpos , Método Duplo-Cego , Seguimentos , Humanos , Leishmaniose Cutânea/imunologiaRESUMO
In a nonblinded, therapeutic trial conducted in Colombia, 1.25-1.5 grams of mefloquine base given as a single oral dose or as 250 mg a day for 5-6 consecutive days was not efficacious in the treatment of New World cutaneous leishmaniasis. The drug had cured only 30.8 % of patients with leishmaniasis skin lesions by the 10th week after start of therapy as compared with a 27.9% complete cicatrization rate in historical controls treated with placebo tablets and an 86.3% cicatrization rate in historical controls who received meglumine antimoniate, 20 mg/ kg/day intramuscularly for 20 days, with no upper limit to daily dose. It is concluded that a single course treatment with mefloquine is not indicated as monotherapy in the treatment of Colombian cutaneous leishmaniasis primarily due to L. panamensis.