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We report a patient with multiple myeloma (MM) and polyarthritis of large joints. During the staging of the disease, bone marrow diffusely involved by MM was clearly demonstrated by 99mTc-2-methoxy-isobutyl-isonitrile (MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) but not by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT images. On the other hand, a very intense uptake of 18F-FDG was detected in periarticular tissues of multiple joints, with nonabnormal 99mTc-MIBI accumulation. Rheumatology tests were negative. A subsequent bone scintigraphy demonstrated radiolabeled bisphosphonate accumulation in periarticular tissues, suggesting amyloid arthropathy.
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Objective: To report the outcomes of a systematic literature review of guidelines and consensus on the management of paroxysmal nocturnal hemoglobinuria (PNH) and describe the main therapeutic options available worldwide. Methods: A systematic literature review was conducted in April 2018 with no time limit and reported in line with the PRISMA statement. The AGREE II instrument was used to determine the quality of each guideline included in the systematic review. Results: Eight guidelines/consensus were eligible, one developed by an international group, two in Spain, and one each in Turkey, Germany, Argentina, Australia and the United Kingdom. Supportive treatment with erythrocyte transfusion, anticoagulants and steroids is indicated by all guidelines and consensus. The use of erythropoietin is suggested by three of them. Recommendations for the prescription of eculizumab were consistent in all but one guideline, published in 2005. Allogeneic hematopoietic stem cell transplantation is reported as the only potentially curative treatment for PNH, although its association with high mortality and morbidity rates is emphasized, being indicated for a selected group of patients. The AGREE II scores applied for each domain showed in general a low and heterogeneous methodological quality among guidelines. Conclusion: Despite the low and heterogeneous methodological quality, in general the comparison of guidelines and consensus for PNH management showed consistent recommendations regarding supportive care, eculizumab and hematopoietic stem cell transplantation.
Objetivo: Relatar os desfechos de uma revisão sistemática da literatura de diretrizes e documentos de consenso sobre o manejo da hemoglobinúria paroxística noturna (HPN) e descrever as principais opções terapêuticas disponíveis mundialmente. Métodos: Uma revisão sistemática da literatura foi conduzida em abril de 2018 sem limite temporal e realizada de acordo com a recomendação PRISMA. O instrumento AGREE II foi utilizado para determinar a qualidade de cada diretriz incluída na revisão. Resultados: Foram elegíveis oito diretrizes/consensos, um desenvolvido por um grupo internacional, dois na Espanha e um em cada um dos países a seguir: Turquia, Alemanha, Argentina, Austrália e Reino Unido. O tratamento de suporte com transfusão de eritrócitos, anticoagulantes e esteroides é indicado por todos os documentos. A eritropoetina é indicada por três deles. A recomendação de prescrição do eculizumabe foi consistente em todos, exceto em um publicado em 2005. O transplante alogênico de células-tronco hematopoéticas é reportado como o único tratamento com potencial curativo para a HPN, apesar de uma enfática associação com maiores taxas de mortalidade e morbidade, sendo indicado para grupos selecionados de pacientes. Os escores AGREE II aplicados para cada domínio demonstraram, em geral, qualidade metodológica baixa e heterogênea entre as diretrizes. Conclusão: Apesar da qualidade metodológica baixa e heterogênea, em geral, a comparação de diretrizes e consensos para o manejo da HPN demonstrou recomendações consistentes quanto ao uso de tratamento de suporte, eculizumabe e transplante alogênico de células-tronco hematopoiéticas.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Revisão Sistemática , Hemoglobinúria ParoxísticaRESUMO
BACKGROUND: The polymorphisms of IL28B have been described as important in the pathogenesis of infections caused by some viruses. The aim of this research was to evaluate whether IL28B gene polymorphisms (SNP rs8099917 and SNP rs12979860) are associated with HAM/TSP. METHODS: The study included 229 subjects, classified according to their neurological status in two groups: Group I (136 asymptomatic HTLV-1 carriers) and Group II (93 HAM/TSP patients). The proviral loads were quantified, and the rs8099917 and rs12979860 SNPs in the region of IL28B-gene were analyzed by StepOnePlus Real-time PCR System. RESULTS: A multivariate model analysis, including gender, age, and HTLV-1 DNA proviral load, showed that IL28B polymorphisms were independently associated with HAM/TSP outcome in rs12979860 genotype CT (OR = 2.03; IC95%â= 0.96-4.27) and in rs8099917 genotype GG (OR = 7.61; IC95%â = 1.82-31.72). CONCLUSION: Subjects with SNP rs8099917 genotype GG and rs12979618 genotype CT may present a distinct immune response against HTLV-1 infection. So, it seems reasonable to suggest that a search for IL28B polymorphisms should be performed for all HTLV-1-infected subjects in order to monitor their risk for disease development; however, since this is the first description of such finding in the literature, we should first replicate this study with more HTLV-1-infected persons to strengthen the evidence already provided by our results.
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Infecções por HTLV-I/virologia , Interleucinas/genética , Paraparesia Espástica Tropical/genética , Polimorfismo de Nucleotídeo Único/genética , Adulto , Idoso , Feminino , Genótipo , Infecções por HTLV-I/complicações , Vírus Linfotrópico T Tipo 1 Humano , Humanos , Interferons , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Provírus/genética , Reação em Cadeia da Polimerase em Tempo Real , Carga ViralRESUMO
JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar o efeito do aspartame em ratas tratadas durante a prenhez e o reflexo do tratamento em seus fetos. MÉTODO: Foram estudadas 33 ratas (11 em cada grupo) da espécie Rattus norvegicus albinus Wistar, com peso médio de 200 g divididas em três grupos distintos: G1 (controle - água), G2 (aspartame - 25 mg/kg/dia) e G3 (aspartame - 50 mg/kg/dia), cujo tratamento ocorreu a partir do 8º ao 12º dia de prenhez. Realizaram-se as determinações séricas de glicose, triglicerídeos, colesterol total e colesterol HDL dos animais. Para as análises estatísticas utilizou-se a Análise de Variância, seguidas pela comparação múltipla, por meio do teste de Tukey (p < 0,05). RESULTADOS: As ratas tratadas do G3 apresentaram as maiores taxas de glicose, colesterol total e HDL. Com relação aos dados morfométricos, o G2 apresentou maior média nas medidas do cordão umbilical e do peso da placenta, com diferença estatisticamente significante apenas no peso da placenta. O G2 apresentou maior média no peso corpóreo e no peso do encéfalo, com diferença estatística, entre todos os grupos, para as duas medidas. Os fetos das ratas tratadas com aspartame (25 e 50 mg/kg/dia) apresentaram resultado estatisticamente significante de malformações em comparação com o G1. CONCLUSÃO: O uso de aspartame pela gestante deve ser restrito a menos que a quantidade diária máxima recomendada.
BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effect of aspartame in rats treated during pregnancy and its consequences on their fetuses. METHOD: We studied 33 rats (11 in each group) of the species Rattus norvegicus Wistar albinos, weighing an average of 200 g that were divided into three groups: G1 (control - water), G2 (aspartame 25 mg/kg/day), and G3 (aspartame 50 mg/kg/day), whose treatment occurred from the 8th to the 12th day of pregnancy. The levels of serum glucose, triglycerides, total cholesterol and HDL cholesterol of the animals were determined. For statistical analysis we used Variance Analysis followed by multiple comparisons using the Tukey test (p < 0.05).RESULTS: The rats treated with G3 showed the highest rates of glucose, total cholesterol and HDL. Regarding the morphometric data, the rats treated with G2 had higher average in measurements of the umbilical cord and placental weight. There was statistically significance only in placental weight. The group of fetuses of rats treated with G2 had higher average in body and brain weights, with statistical difference between all groups for both measures. The fetuses of rats treated with aspartame (25 and 50 mg/kg/day) showed a statistically significant result of malformations compared with the control group. CONCLUSION: The use of aspartame for pregnant women should be restricted to less than the maximum recommended daily dosage
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Animais , Ratos , Aspartame/administração & dosagem , Prenhez , Ratos WistarRESUMO
Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) share routes of transmission and some individuals have dual infection. Although some studies point to a worse prognosis of hepatitis C virus in patients co-infected with HTLV-1, the interaction between these two infections is poorly understood. This study evaluated the influence of HTLV-1 infection on laboratory parameters in chronic HCV patients. Twelve HTLV-1/HCV-coinfected patients were compared to 23 patients infected only with HCV, in regard to demographic data, risk factors for viral acquisition, HCV genotype, presence of cirrhosis, T CD4+ and CD8+ cell counts and liver function tests. There was no difference in regard to age, gender, alcohol consumption, smoking habits, HCV genotype or presence of cirrhosis between the groups. Intravenous drug use was the most common risk factor among individuals co-infected with HTLV-1. These patients showed higher TCD8+ counts (p = 0.0159) and significantly lower median values of AST and ALT (p = 0.0437 and 0.0159, respectively). In conclusion, we have shown that HCV/HTLV-1 co-infected patients differs in laboratorial parameters involving both liver and immunological patterns. The meaning of these interactions in the natural history of these infections is a matter that deserves further studies.
O vírus da hepatite C (VHC) e vírus linfotrópico humano tipo 1 (HTLV-1) compartilham formas de transmissão e algumas pessoas apresentam coinfecção. Embora alguns estudos apontem para um pior prognóstico da infecção pelo VHC em pacientes coinfectados com HTLV-1, a interação entre estas infecções é mal compreendida. Este estudo avaliou a influência da infecção pelo HTLV-1 em parâmetros laboratoriais de pacientes com VHC. 12 coinfectados VHC/HTLV-1 foram comparados com 23 pacientes monoinfectados com VHC, no que diz respeito aos dados demográficos, fatores de risco para aquisição viral, genótipo do VHC, presença de cirrose, contagens de linfócitos T CD4+ e CD8+ e testes de função hepática. Não houve diferença em relação à idade, sexo, consumo de álcool, tabagismo, genótipo do VHC ou presença de cirrose entre os grupos. O uso de drogas injetáveis foi o fator de risco mais comum entre coinfectados. Esses pacientes apresentaram maiores contagens de linfócitos T CD8+ e valores medianos de AST e ALT significativamente mais baixos (p = 0,0437 e 0,0159, respectivamente). Em conclusão, demonstrou-se que os pacientes com VHC/HTLV-1 diferem quanto aos parâmetros hepáticos e imunológicos. O significado destas diferenças na história natural destas infecções é um assunto que merece estudos mais aprofundados.
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por HTLV-I/complicações , Hepatite C Crônica/complicações , Genótipo , Infecções por HTLV-I/sangue , Infecções por HTLV-I/imunologia , Hepacivirus/genética , Hepatite C Crônica/sangue , Hepatite C Crônica/imunologia , Fatores de RiscoRESUMO
Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) share routes of transmission and some individuals have dual infection. Although some studies point to a worse prognosis of hepatitis C virus in patients co-infected with HTLV-1, the interaction between these two infections is poorly understood. This study evaluated the influence of HTLV-1 infection on laboratory parameters in chronic HCV patients. Twelve HTLV-1/HCV-coinfected patients were compared to 23 patients infected only with HCV, in regard to demographic data, risk factors for viral acquisition, HCV genotype, presence of cirrhosis, T CD4+ and CD8+ cell counts and liver function tests. There was no difference in regard to age, gender, alcohol consumption, smoking habits, HCV genotype or presence of cirrhosis between the groups. Intravenous drug use was the most common risk factor among individuals co-infected with HTLV-1. These patients showed higher TCD8+ counts (p = 0.0159) and significantly lower median values of AST and ALT (p = 0.0437 and 0.0159, respectively). In conclusion, we have shown that HCV/HTLV-1 co-infected patients differs in laboratorial parameters involving both liver and immunological patterns. The meaning of these interactions in the natural history of these infections is a matter that deserves further studies.
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Infecções por HTLV-I/complicações , Hepatite C Crônica/complicações , Relação CD4-CD8 , Feminino , Genótipo , Infecções por HTLV-I/sangue , Infecções por HTLV-I/imunologia , Hepacivirus/genética , Hepatite C Crônica/sangue , Hepatite C Crônica/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The present study was done to estimate the prevalence of Hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) infection in the general population residing in the municipality of Säo Paulo, and to evaluate the level of knowledge related to the various modes of infection transmission by and protection against the different viruses. Blood samples and health questionnaires were collected from 1,059 individuals. The study design used an inductive metod of predictive statistical inferences through randomized sampling stratifield by sex, age and residence region. The estimated prevalence rated found were: Hepatitis A = 66.59 percent (63.75 percent - 69.44 per cent CI); Hepatitis B = 5.94 percent (4.50 percent-7.35 percent); Hepatitis C =1.42 percent (0,70 percent - 2.12 percent); Hepatitis E = 1.68 percent (0.91 percent - 2.46 percent). The frequency of hepatitis was similar in males and females. HAV showed an estimated prevalence of 56.16 percent in the population up to 17 years old, increasing to 65.30 percent in individuals between 18 and 29 years. The infection reached its peak of 90 percent in individuals 40 years of age or older. The study showed a greater tendency of dissemination of HBV among the population between 15 and 17 years. This specific age group showed an estimated prevalence of active infection of 1.04 percent (0.43 percent - 1.65 percent CI), and also demonstrated an ascending level of acquired immunity with an estimated prevalence of 4.90 percent (3.60 percent - 6.20 percent CI). HCV demonstrated an estimated prevalence of 1.42 percent (0.70 percent - 2.12 percent CI). This specific infection occurred more frequently among adults 30 years of age or older, with the prevalence reaching a peak of 3.80 percent among the group aged 50 to 59 years. HEV showed zero prevalence among the age group between 2 and 9 years. This was followed by a slighty ascending rate starting from age 10, with an estimated prevalence of 1.05 percent (0.94 percent - 3.04 percent CI) among those 10 to 14 years of age....