RESUMO
The incidence of C. dubliniensis in South America has not yet been determined. In the present study, oral swab samples were taken from 108 HIV-infected/AIDS individuals attending 6 separate Brazilian HIV-treatment centers to determine the incidence of C. dubliniensis in this population. Swabs were plated onto CHROMagar Candida medium and 155 isolates, presumptively identified as C. albicans or C. dubliniensis were further investigated. In a preliminary screen for C. dubliniensis, 13 of the 155 isolates showed no or poor growth at 42 degrees C, and all them were subjected to randomly amplified polymorphic DNA (RAPD) and polymerase chain reaction (PCR) analysis using C. dubliniensis-specific primers. We confirmed that 4 out of 13 isolates were C. dubliniensis, representing an incidence rate of 2.8% for the Brazilian HIV-infected population infected with yeasts exhibiting green colonies on CHROMagar Candida. This value is significantly lower than those reported in Ireland and the United States.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Candida/isolamento & purificação , Candidíase Bucal/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Antifúngicos/farmacologia , Brasil/epidemiologia , Candida/efeitos dos fármacos , Candida/genética , Candidíase Bucal/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Estudos Prospectivos , Técnica de Amplificação ao Acaso de DNA PolimórficoRESUMO
A new live oral cholera vaccine, Peru-15, was studied for safety, immunogenicity, and excretion in 2 groups of healthy volunteers. Twelve inpatient volunteers received freshly harvested vaccine in doses of either 10(7) or 10(9) cfu. Subsequently 50 outpatient volunteers received freeze-dried vaccine in doses of 10(8) or 10(9) cfu or placebo in a three-cell, double-masked, placebo-controlled trial. The strain was well tolerated at all dose levels, and it stimulated high levels of vibriocidal antibodies in most inpatient volunteers and in all outpatient volunteers. Although antitoxin responses were less frequent and of lower magnitude than the vibriocidal responses, antitoxin responses were seen in >60% of the outpatient volunteers. About 60% of the volunteers excreted the vaccine in their feces; however, fecal excretion did not correlate with serologic responses. It is concluded that Peru-15 is a safe and immunogenic oral vaccine for cholera.
Assuntos
Vacinas contra Cólera/imunologia , Administração Oral , Adolescente , Adulto , Vacinas contra Cólera/administração & dosagem , Vacinas contra Cólera/efeitos adversos , Fezes/microbiologia , Feminino , Humanos , Imunização , Masculino , Pessoa de Meia-IdadeRESUMO
During development of Peru-15, a new live oral vaccine for cholera, the role of buffer needed to be evaluated. Generally, oral bacterial vaccines are acid labile and need to be administered by using a formulation which protects them from gastric acid. We compared three different buffers for use with Peru-15, including a standard bicarbonate-ascorbic acid buffer, Alka-Seltzer, and a new electrolyte-rice buffer, CeraVacx. Saline served as the control. Thirty-nine healthy adult volunteers received Peru-15 (10(8) CFU) with one of the three buffers or saline in a double-masked study. The volunteers were monitored for symptoms for 7 days after the dose, serum was tested for antibody responses by vibriocidal antibody and immunoglobulin G antitoxin enzyme-linked immunosorbent assays, and stool samples were tested for excretion of the vaccine strain. Side effects were minimal in all groups. All 30 volunteers who took Peru-15 with a buffer showed significant rises in vibriocidal antibody titer. The magnitude of the rises was higher in the CeraVacx group than in the other two buffer groups. Four of nine volunteers who took the vaccine with saline also showed increased titers, but they were lower than those in any of the three buffer groups. Excretion of the vaccine strain was similar in the buffer groups, but excretion was not associated with the magnitude of the vibriocidal responses. Excretion of Peru-15 was not detected in the saline group. We conclude that buffer does amplify the serological response to Peru-15 and that CeraVacx may provide benefits not provided by other buffers.
Assuntos
Vacinas contra Cólera/administração & dosagem , Administração Oral , Adolescente , Adulto , Antitoxinas/sangue , Soluções Tampão , Vacinas contra Cólera/imunologia , Fezes/microbiologia , Humanos , Pessoa de Meia-Idade , Pacientes AmbulatoriaisRESUMO
The outcomes of mild hyperphenylalaninemia (MHP) in three children of two sisters were compared. The IQ of the child from an untreated pregnancy was 105; the developmental quotients of the two infant offspring from treated and untreated pregnancies were 122 and 114, respectively. The IQ of the sister with untreated MHP was 101; that of the sister who received dietary treatment for MHP during infancy was 90. Thus MHP and maternal MHP appear to have been clinically inconsequential in this family.
Assuntos
Inteligência , Fenilalanina/sangue , Complicações na Gravidez , Adulto , Desenvolvimento Infantil , Diabetes Gestacional/sangue , Diabetes Gestacional/tratamento farmacológico , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Inteligência/genética , Masculino , Fenilalanina/genética , Fenilcetonúrias/sangue , Fenilcetonúrias/dietoterapia , Fenilcetonúrias/genética , GravidezRESUMO
Documentation of muscle involvement in a child thought to have dermatomyositis may require the performance of invasive procedures such as electromyography and/or muscle biopsy. We describe four patients with dermatomyositis in whom magnetic resonance imaging (MRI) demonstrated the muscle involvement. The involved muscles had increased signal intensity on the T2-weighted images (SE 2500/80) and normal appearance on the T1-weighted images (SE 600/20). The involvement of the muscles was not uniform. There was good correlation between the distribution of muscle involvement by MRI and functional testing. Follow-up MRI scans in patients with favorable outcome demonstrated that the affected muscles had returned to normal signal intensity. Although the MRI findings are not specific, in the proper clinical context they may be helpful in establishing the diagnosis of dermatomyositis. MRI may also be used in establishing an appropriate muscle biopsy site. In addition, MRI may be used for monitoring the progress of the disease.
Assuntos
Dermatomiosite/diagnóstico , Imageamento por Ressonância Magnética , Músculos/patologia , Adolescente , Criança , Pré-Escolar , Dermatomiosite/patologia , Dermatomiosite/fisiopatologia , Humanos , Contração Muscular , Músculos/fisiopatologia , Prognóstico , Amplitude de Movimento ArticularRESUMO
The high mortality rate from coronary heart disease (CHD) among Indians compared to Negroes in Trinidad led us to test plasma lipid profiles to see whether dietary or genetic factors might be involved. There were no interracial differences in the composition of plasma cholesterol ester fatty acids of the tested women and neonates. This finding suggests that dietary fat does not account for the interracial difference in CHD, nor does the cause appear to be due to genetic differences in lipid profiles, as there was no significant difference between values for plasma triglycerides, total cholesterol, high density lipoprotein (HDL) cholesterol, apo-I, apo-II, apo B or cholesterol ester fatty acids in the cord blood of each racial group. Blood samples were collected from 69 nonpregnant and 71 postpartum, fasted Negro and Indian women. Also taken were 71 umbilical cord blood samples. The mean triglyceride level was significantly lower in the Negro nonpregnant and postpartum women than in the Indians. HDL cholesterol and apo-I values were lower in the Indian women. There were no significant differences in the total cholesterol and apo B measurements. The triglyceride values for postpartum women were higher than those of the nonpregnant Negroes and Indians (75% and 47%, respectively), whereas the total cholesterol and HDL cholesterol, apo A-I and apo A-II ranged from 9% to 29% higher in the postpartum women. Apo B was about 40% higher postpartum in both ethnic groups. The high CHD rate of Indians in Trinidad cannot be explained by dietary factors, plasma total cholesterol or fatty acid composition.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Ácidos Graxos/sangue , Sangue Fetal/análise , Lipoproteínas/sangue , Adulto , Apolipoproteínas/sangue , População Negra , Colesterol/sangue , Feminino , Humanos , Índia/etnologia , Recém-Nascido , Período Pós-Parto/sangue , Gravidez , Trinidad e TobagoRESUMO
The medical records of 47 children with dermatomyositis who were seen in the pediatric rheumatology clinic at the University of Michigan between 1964 and 1982 were reviewed. Although most children with dermatomyositis have a good prognosis, the best predictor of both good functional recovery and minimal calcinosis is early treatment after the onset of symptoms, using high doses of prednisone for an adequate length of time. Of the children given such treatment, 78% had good functional outcomes, and disabling calcinosis was seen in 20% or less. Children given treatment late in the course of disease and with low doses of steroids are more likely to be functionally limited and have a greater amount of dystrophic calcium salt deposition. In our study, only 33% of patients given such treatment had a mild disease course with good functional outcome. We have identified a subgroup of children with dermatomyositis who appear to do poorly despite optimal therapeutic regimens. These patients are distinguished by a severe disease course responding minimally to corticosteroid therapy and manifested by persistent muscle weakness, elevations of muscle enzyme activity, and severe generalized cutaneous vasculitis. These children are at high risk for the development of exoskeleton-like calcification; consideration should be given to combined immunosuppressive therapy early in the course of disease.
Assuntos
Calcinose/etiologia , Dermatomiosite/complicações , Adolescente , Calcinose/diagnóstico por imagem , Calcinose/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Músculos/diagnóstico por imagem , Distrofias Musculares/etiologia , Prednisona/uso terapêutico , Prognóstico , Radiografia , Estudos Retrospectivos , RiscoRESUMO
Three patients who developed renal papillary necrosis while receiving long-term, high-dose aspirin therapy for juvenile rheumatoid arthritis are presented. It appears that aspirin alone or aspirin in combination with other drugs is the causative agent. The incidence and biologic significance of renal papillary necrosis are insufficient to alter the use of aspirin as the drug of choice in management of JRA. It is recommended that all children with JRA be encouraged to drink ample fluids and be followed with periodic urinalysis and blood pressure measurements. Those children who develop hematuria or hypertension should be evaluated by excretory urography.
Assuntos
Artrite Juvenil/complicações , Aspirina/efeitos adversos , Necrose Papilar Renal/induzido quimicamente , Adolescente , Artrite Juvenil/tratamento farmacológico , Criança , Feminino , Humanos , Necrose Papilar Renal/complicações , Masculino , Fatores de TempoRESUMO
Sera of children with juvenile rheumatoid arthritis and other connective tissue diseases were tested for antibodies to native DNA by a radiolabeled-binding assay. Normal values were obtained in 130 children with JRA, including 28 with uveitis and 14 with selective IgA deficiency. Normal values were also found in sera from children with dermatomyositis, scleroderma, polyarteritis, ankylosing spondylitis, and a variety of other nonconnective tissue diseases. The only sera with elevated DNA-binding assays were from children with systemic lupus erythematosus. On the basis of these data, increased levels of antibodies to native DNA distinguished patients with active SLE from children with JRA.
Assuntos
Artrite Juvenil/imunologia , Autoanticorpos/análise , DNA/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Adolescente , Artrite Juvenil/diagnóstico , Autoanticorpos/metabolismo , Criança , DNA/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , MasculinoRESUMO
In this report the clinical, laboratory, and histopathologic findings of nine children with polyarteritis are reviewed. All have had evidence of systemic involvement. Eight presented with fever, calf pain, erythematous painful nodules, and elevation of the acute-phase reactants. All were treated with prednisone at a dosage of 2 mg/kg/day. All of the children are alive but have had relapses at least once during the course of tapering the dosage of corticosteroids. Serious complications of disease have included myocardial infarction, hypertension, and impaired renal function.