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Introduction: Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces rapid production of IgM, IgA, and IgG antibodies directed to multiple viral antigens that may have impact diverse clinical outcomes. Methods: We evaluated IgM, IgA, and IgG antibodies directed to the nucleocapsid (NP), IgA and IgG to the Spike protein and to the receptor-binding domain (RBD), and the presence of neutralizing antibodies (nAb), in a cohort of unvaccinated SARS-CoV-2 infected individuals, in the first 30 days of post-symptom onset (PSO) (T1). Results: This study included 193 coronavirus disease 2019 (COVID-19) participants classified as mild, moderate, severe, critical, and fatal and 27 uninfected controls. In T1, we identified differential antibody profiles associated with distinct clinical presentation. The mild group presented lower levels of anti-NP IgG, and IgA (vs moderate and severe), anti-NP IgM (vs severe, critical and fatal), anti-Spike IgA (vs severe and fatal), and anti-RBD IgG (vs severe). The moderate group presented higher levels of anti-RBD IgA, comparing with severe group. The severe group presented higher levels of anti-NP IgA (vs mild and fatal) and anti-RBD IgG (vs mild and moderate). The fatal group presented higher levels of anti-NP IgM and anti-Spike IgA (vs mild), but lower levels of anti-NP IgA (vs severe). The levels of nAb was lower just in mild group compared to severe, critical, and fatal groups, moreover, no difference was observed among the more severe groups. In addition, we studied 82 convalescent individuals, between 31 days to 6 months (T2) or more than 6 months (T3), PSO, those: 12 mild, 26 moderate, and 46 severe plus critical. The longitudinal analyzes, for the severe plus critical group showed lower levels of anti-NP IgG, IgA and IgM, anti-Spike IgA in relation T3. The follow-up in the fatal group, reveals that the levels of anti-spike IgG increased, while anti-NP IgM levels was decreased along the time in severe/critical and fatal as well as anti-NP IgG and IgA in several/critical groups. Discussion: In summary, the anti-NP IgA and IgG lower levels and the higher levels of anti-RBD and anti-Spike IgA in fatal compared to survival group of individuals admitted to the intensive care unit (ICU). Collectively, our data discriminate death from survival, suggesting that anti-RBD IgA and anti-Spike IgA may play some deleterious effect, in contrast with the potentially protective effect of anti-NP IgA and IgG in the survival group.
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COVID-19 , Humanos , SARS-CoV-2 , Anticorpos Antivirais , Anticorpos Neutralizantes , Nucleocapsídeo , Imunoglobulina G , Imunoglobulina A , Imunoglobulina MRESUMO
The in vitro algaecide activity of quaternary ammonium (QA) against Prototheca isolated from bovine clinical mastitis was investigated, in which the clinical severity was scored, milk samples were subjected to microbiological culture, and algal species were identified by molecular typing. A total of 4275 milk clinical samples of different cows from ten large dairy farms were used. Forty-four (1%) samples of cows from three dairy farms yielded growth of Prototheca, of which 88.6% (39/44) were identified as Prototheca bovis and 11.3% (5/44) as Prototheca sp. by MALDI-TOF MS, whereas 100% of the isolates were identified as P. bovis using PCR sequencing of the cytb gene. Among cows for which clinical severity scoring was available, 78.8% (26/33) and 21.2% (7/33) had mild and moderate infections, respectively, whereas no animal showed severe clinical signs. The algaecide activity of QA in Prototheca was observed in low concentrations among all isolates, in 20.4% (9/44) at 35 ppm, 36.4% (16/44) at 17 ppm, and 43.2% (19/44) at an 8 ppm, in addition to activity on three reference Prototheca strains. Overall, the study highlights the predominance of P. bovis as the causative agent of algal mastitis in bovines. Prototheca induced abnormalities preponderantly in the milk and mammary gland tissue of cows, and to our knowledge, our study is the first to apply clinical severity scoring in protothecal mastitis. In addition, the study underlines the activity of QA in low concentrations against Prototheca, indicating its potential use as an antiseptic/disinfectant in milking facilities and dairy environments.
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BACKGROUND: The prevalence of obesity has increased dramatically in children worldwide. Obesity has been recognized as a risk factor for more serious viral respiratory infections, mainly in adults. OBJECTIVE: To study the relationship between overnutrition (obesity and overweight) and clinical severity in children hospitalized with acute respiratory infections of viral origin. METHODS: One hundred and forty-three clinical records of children between 2 and 18 years old hospitalized for acute respiratory infection at Clínica Dávila (2014-2018) were analyzed, recording the respiratory viruses detected at the time of hospitalization, weight, and height. Nutritional status was estimated using Z score or body mass index, according to age. RESULTS: Eighty-tree3 children (58%) were positive for more than one respiratory virus. The main virus detected in monoinfection was adenovirus (9.8%), followed by respiratory syncytial virus (7.7%) and parainfluenza virus (7.7%). There were no deaths. Patients with obesity presented more days of hospitalization (P = .04), oxygen therapy (P = .03) and mechanical ventilation (P < .001), as well as a higher probability of requiring mechanical ventilation (P = .001) and of ICU admission (P = .003) compared with children with normal weight. Patients with overweight presented more days of mechanical ventilation (P < .001) than patients with normal weight. No significant differences were found between the presence of viral coinfection and nutritional status. CONCLUSION: Overnutrition is associated with greater severity of viral respiratory infection in hospitalized children.
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Infecções Respiratórias , Viroses , Vírus , Humanos , Criança , Pré-Escolar , Adolescente , Estudos Retrospectivos , Sobrepeso/epidemiologia , Viroses/epidemiologia , Infecções Respiratórias/epidemiologia , Obesidade/epidemiologia , Fatores de RiscoRESUMO
The nutritional status is a determinant of the immune response that promotes a cellular homeostasis. In particular, adequate selenium levels lead to a better antioxidant and immune response. The aim of this work is to assess whether blood selenium levels, at time of SARS-CoV-2 infection, have an impact on the development and severity of COVID-19. A systematic review and meta-analysis of comparative and descriptive studies using MeSH terms, selenium and COVID-19 was performed. We searched bibliographic databases up to 17 July 2022 in PubMed and ScienceDirect. Studies that reported data on blood selenium levels were considered. A total of 629 articles were examined by abstract and title, of which 595 abstracts were read, of which 38 were included in the systematic review and 11 in the meta-analysis. Meta-analysis was conducted to mean difference (MD) with a 95 % confidence interval (CI), and heterogeneity was tested by I2 with random factors with a MD between selenium levels, mortality, morbidity and healthy subjects with a P-value of 0â 05. Selenium levels were higher in healthy people compared to those in patients with COVID-19 disease (six studies, random effects MD: test for overall effect Z = 3â 28 (P = 0â 001), 97 % CI 28â 36 (11â 41-45â 31), P < 0â 00001), but without difference when compared with the degree of severity in mild, moderate or severe cases. In conclusion, the patients with active SARS-CoV-2 infection had lower selenium levels than the healthy population. More studies are needed to evaluate its impact on clinical severity through randomised clinical trials.
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COVID-19 , Selênio , Humanos , SARS-CoV-2 , AntioxidantesRESUMO
Introduction: Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces rapid production of IgM, IgA, and IgG antibodies directed to multiple viral antigens that may have impact diverse clinical outcomes. Methods: We evaluated IgM, IgA, and IgG antibodies directed to the nucleocapsid (NP), IgA and IgG to the Spike protein and to the receptor-binding domain (RBD), and the presence of neutralizing antibodies (nAb), in a cohort of unvaccinated SARS-CoV-2 infected individuals, in the first 30 days of post-symptom onset (PSO) (T1). Results: This study included 193 coronavirus disease 2019 (COVID-19) participants classified as mild, moderate, severe, critical, and fatal and 27 uninfected controls. In T1, we identified differential antibody profiles associated with distinct clinical presentation. The mild group presented lower levels of anti-NP IgG, and IgA (vs moderate and severe), anti-NP IgM (vs severe, critical and fatal), anti-Spike IgA (vs severe and fatal), and anti-RBD IgG (vs severe). The moderate group presented higher levels of anti-RBD IgA, comparing with severe group. The severe group presented higher levels of anti-NP IgA (vs mild and fatal) and anti-RBD IgG (vs mild and moderate). The fatal group presented higher levels of anti-NP IgM and anti-Spike IgA (vs mild), but lower levels of anti-NP IgA (vs severe). The levels of nAb was lower just in mild group compared to severe, critical, and fatal groups, moreover, no difference was observed among the more severe groups. In addition, we studied 82 convalescent individuals, between 31 days to 6 months (T2) or more than 6 months (T3), PSO, those: 12 mild, 26 moderate, and 46 severe plus critical. The longitudinal analyzes, for the severe plus critical group showed lower levels of anti-NP IgG, IgA and IgM, anti-Spike IgA in relation T3. The follow-up in the fatal group, reveals that the levels of anti-spike IgG increased, while anti-NP IgM levels was decreased along the time in severe/critical and fatal as well as anti-NP IgG and IgA in several/critical groups. Discussion: In summary, the anti-NP IgA and IgG lower levels and the higher levels of anti-RBD and anti-Spike IgA in fatal compared to survival group of individuals admitted to the intensive care unit (ICU). Collectively, our data discriminate death from survival, suggesting that anti-RBD IgA and anti-Spike IgA may play some deleterious effect, in contrast with the potentially protective effect of anti-NP IgA and IgG in the survival group.
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BACKGROUND: Although the pathogenesis of myasthenia gravis (MG) is well known, prognostic markers are not yet available. We assessed the utility of anti-acetylcholine receptor (AChR) antibody (AChR-ab) titer and concentration of C3, C4, and C5a as potential severity biomarkers in MG. METHODS: Levels of C3, C4, C5a, and AChR-ab were measured in 60 AChR-ab-positive patients with MG. Their relationship with clinical severity was analyzed using the activities of daily living (ADL) and MG composite (MGC) scales. RESULTS: AChR-ab titer correlated with severity of MG according to ADL (p = 0.002) and MGC scales (p = 0.001). When patients were classified according to disease duration, a statistically significant correlation between AChR-ab titer and clinical severity was only found in the subgroup of patients with fewer than 5 years from symptoms onset. C5a levels showed a positive correlation with MG severity according to the ADL scale (p = 0.041; τb = 0.18), although C5a levels were not different from the control group. DISCUSSION: AChR-ab titers and C5a levels could potentially be considered markers of severity in patients with MG.
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Introducción: La emergencia de la COVID-19 se ha convertido en un serio problema de salud a nivel mundial. La identificación de comorbilidades asociadas a la presentación clínica grave de la COVID-19, es de importancia para el adecuado abordaje terapéutico de los pacientes afectados. Objetivo: Evaluar el riesgo de COVID-19 con presentación clínica grave en pacientes con comorbilidades. Material y métodos: Se realizó una revisión sistemática y meta-análisis en bases de datos especializadas en busca de artículos publicados hasta el 20 de marzo de 2020, que aportaran información sobre la asociación entre la gravedad de la presentación clínica de la COVID-19 y comorbilidades. Se empleó la razón de probabilidades con un intervalo de confianza de 95 por ciento, y modelos de efectos fijos o aleatorios. Resultados: En el análisis fueron incluidos 13 estudios para un total de 99 817 pacientes. Se obtuvieron los efectos globales para la hipertensión arterial (RP: 4,05; IC 95 por ciento: 3,45-4,74), enfermedad cardiovascular (RP: 4,39; IC 95 por ciento: 3,29-5,87), Diabetes Mellitus (RP: 3,53; IC 95 por ciento: 2,79-4,47), hábito de fumar (RP: 2,87; IC 95 por ciento: 1,81-4,54), enfermedades respiratoria (RP: 2,73; IC 95 por ciento: 2,55-2,94), renal (RP: 5,60; IC 95 por ciento: 4,13-7,60) y hepática crónicas (RP: 1,98 (IC 95 por ciento: 1,08-3,64) e inmunodeficiencias (RP: 2,90; IC 95 por ciento: 2,06-4,09), en pacientes graves en comparación con pacientes no graves. Conclusiones: La enfermedad renal crónica, la enfermedad cardiovascular, la hipertensión arterial y la Diabetes Mellitus están entre las comorbilidades que mayor riesgo implican para una presentación clínica grave en pacientes con COVID-19, seguidas en importancia por las inmunodeficiencias, hábito de fumar, enfermedad respiratoria crónica y enfermedad hepática crónica(AU)
Introduction: The recent emergence of COVID-19 has become a serious global health problem. The identification of comorbidities associated with the clinical severity in COVID-19 patients is of paramount significance for the appropriate therapeutic approach of affected patients. Objective: To evaluate the risk of severe clinical presentation of COVID-19 in patients with comorbidities. Materials and methods: A systematic literature search and meta-analysis was conducted in specialized databases to obtain information from articles published until March 20, 2020. All relevant papers with information on the association between clinical severity and comorbidities were included. The odds ratio with 95 percent confidence interval and fixed or random effect models were used. Results: Thirteen studies were included for a total of 99 817 patients. Global effects were obtained for hypertension (OR: 4.05; 95 percent CI: 3.45-4.74), cardiovascular disease (OR: 4.39; 95 percent CI: 3.29-5.87), diabetes mellitus (OR: 3.53; 95 percent CI: 2.79-4.47), smoking (OR: 2.87; 95 percent CI: 1.81-4.54), chronic lung disease (OR: 2.73; 95 percent CI: 2.55-2.94), chronic kidney disease (OR: 5.60; 95 percent CI: 4.13-7.60), chronic liver disease (OR: 1.98; 95 percent CI: 1.08-3.64), and immunodeficiency (OR: 2.90; 95 percent CI: 2.06-4.09) in severe patients compared with non-severe patients. Conclusions: Chronic kidney disease, cardiovascular disease, hypertension and diabetes are among the comorbidities with the highest risk of severe clinical presentation in COVID-19 patients, followed in importance by immunodeficiency, smoking, chronic lung disease and chronic liver disease(AU)
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Humanos , Masculino , Feminino , Comorbidade , Razão de Chances , Risco , COVID-19/epidemiologia , Intervalos de ConfiançaRESUMO
SUMMARY OBJECTIVE: We aimed to evaluate the efficacy of liquid or foam sclerotherapy of varicose veins using venous clinical severity scores and possible complications. METHODS: A total of 318 patients (268 females, 50 males) who were treated with liquid or foam sclerotherapy between January 2012 and December 2012 were included in this study. RESULTS: Skin necrosis was observed in only 6 patients (1. 8%), thrombophlebitis in 10 patients (3. 1%), and hyperpigmentation in 18 patients (5. 6%) in this study group. The mean venous clinical severity score was calculated as: pain score, 1. 23 ± 0.88; varicose vein score,1.85 ± 0. 8; edema score, 0.64 ± 0.77). Pain and edema decreased at the control examination, 1 month after completion of sclerotherapy sessions. Varicose veins completely disappeared after sclerotherapy. While the decrease in edema in the foam sclerotherapy group was significantly less (P<0.001), the decline in pain showed an increasing trend (P=0.069). While skin necrosis did not develop after foam sclerotherapy, rates of pigmentation and local thrombophlebitis were similar (P>0.05). CONCLUSION: In conclusion, we observed that both sclerotherapy methods are effective with a low rate of complications, alleviating the complaints of patients with small varicose veins, and providing considerable improvement in venous clinical severity scores.
RESUMO OBJETIVO: Nosso objetivo foi avaliar a eficácia de líquido ou espuma na escleroterapia de varizes por meio de escores de gravidade clínica venosa e possíveis complicações. MÉTODOS: Um total de 318 pacientes (268 do sexo feminino, 50 do sexo masculino) tratados com escleroterapia com espuma ou líquido entre janeiro de 2012 e dezembro de 2012 foi incluído neste estudo. RESULTADOS: Necrose da pele foi observada em apenas seis pacientes (1,8%), tromboflebite em dez pacientes (3,1%) e hiperpigmentação em 18 pacientes (5,6%) neste grupo de estudo. A média do escore de gravidade clínica venosa foi calculado como: dor pontuação 1,23±0,88, veia varicosa pontuação 1,85±0,8, edema pontuação 0,64±0,77. Dor e edema reduzido no exame de controle um mês após a conclusão das sessões de escleroterapia. Varizes desapareceram completamente após a escleroterapia. Enquanto a diminuição do edema no grupo de escleroterapia com espuma foi significativamente menor (P<0,001), o decréscimo do nível de dor mostrou uma tendência a ser maior (P=0,069). Ainda que necrose da pele não tenha se desenvolvido após escleroterapia com espuma, as taxas de pigmentação e tromboflebite local foram semelhantes (P>0,05). CONCLUSÃO: Observou-se que ambos os métodos de escleroterapia são eficazes, com baixa taxa de complicações, aliviando as queixas de pacientes com varizes pequenas, e proporcionando uma melhora considerável nos escores de gravidade clínica venosa.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Varizes/terapia , Escleroterapia/métodos , Varizes/complicações , Índice de Gravidade de Doença , Medição da Dor , Escleroterapia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Dor Processual , Pessoa de Meia-IdadeRESUMO
Objetivos: evaluar los resultados obtenidos con el uso de la toxina botulínica A en la corrección del estrabismo paralítico e identificar los factores asociados que influyen sobre la respuesta terapéutica. Métodos: se realizó un estudio descriptivo en una serie de 93 casos con estrabismo paralítico, que recibieron tratamiento con toxina botulínica A. Resultados: se diagnosticaron 53 casos con estrabismo leve, 38 moderado y solo dos en estado grave. El tiempo de evolución y la gravedad clínica fueron los factores asociados que interfirieron con la respuesta terapéutica. Conclusiones: la toxina botulínica A es efectiva en la mayoría de los casos tratados. Los mejores resultados se obtienen en los casos con menor grado de desviación y con menor tiempo de evolución entre el inicio del estrabismo y la inyección del medicamento(AU)
Objectives: to assess the results of the use of botulinum toxin A in correcting paralytic strabismus and to identify those associated factors that have an impact on the therapeutic response. Methods: a descriptive study of a series of 93 cases with paralytic strabismus which were treated with botulinum toxin A. Results: fifty three cases were diagnosed with mild, 38 with moderate and just two with severe strabismus. The time of progression and the clinical severity were related factors that influence the therapeutic response. Conclusions: botulinum toxin A is effective in most of cases. The best results are achieved in those people with lower deviation degree and less time of progression elapsed from the onset of strabismus to the administration of the injected medication(AU)
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Humanos , Masculino , Feminino , Adulto , Estrabismo/diagnóstico , Estrabismo/terapia , Toxinas Botulínicas Tipo A/uso terapêutico , Epidemiologia Descritiva , Estudos Prospectivos , Estudos de Coortes , Estudo ObservacionalRESUMO
Objetivos: evaluar los resultados obtenidos con el uso de la toxina botulínica A en la corrección del estrabismo paralítico e identificar los factores asociados que influyen sobre la respuesta terapéutica. Métodos: se realizó un estudio descriptivo en una serie de 93 casos con estrabismo paralítico, que recibieron tratamiento con toxina botulínica A. Resultados: se diagnosticaron 53 casos con estrabismo leve, 38 moderado y solo dos en estado grave. El tiempo de evolución y la gravedad clínica fueron los factores asociados que interfirieron con la respuesta terapéutica. Conclusiones: la toxina botulínica A es efectiva en la mayoría de los casos tratados. Los mejores resultados se obtienen en los casos con menor grado de desviación y con menor tiempo de evolución entre el inicio del estrabismo y la inyección del medicamento(AU)
Objectives: to assess the results of the use of botulinum toxin A in correcting paralytic strabismus and to identify those associated factors that have an impact on the therapeutic response. Methods: a descriptive study of a series of 93 cases with paralytic strabismus which were treated with botulinum toxin A. Results: fifty three cases were diagnosed with mild, 38 with moderate and just two with severe strabismus. The time of progression and the clinical severity were related factors that influence the therapeutic response. Conclusions: botulinum toxin A is effective in most of cases. The best results are achieved in those people with lower deviation degree and less time of progression elapsed from the onset of strabismus to the administration of the injected medication(AU)
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Humanos , Masculino , Feminino , Adulto , Evolução Clínica , Estrabismo/diagnóstico , Estrabismo/terapia , Toxinas Botulínicas Tipo A/uso terapêutico , Tempo para o Tratamento , Epidemiologia Descritiva , Estudos Prospectivos , Estudos de Coortes , Estudo ObservacionalRESUMO
O acidente vascular cerebral (AVC) representa a terceira causa de morte em vários países do mundo e principal causa de incapacidade física. O objetivo deste estudo foi investigar por meio de uma equipe multidisciplinar a severidade clínica e a independência funcional de pacientes hemiplégicos pós-AVC. Trata-se de estudo descritivo composto por quarenta hemiplégicos atendidos nos quatro maiores serviços públicos de fisioterapia da cidade de Natal (RN). Foram utilizados uma ficha de avaliação, a medida de independência funcional e o NIHSS. A amostra é predominantemente feminina(55 por cento), AVC isquêmico(90 por cento), hemisfério cerebral direito(52,5 por cento) e fator de risco hipertensão(90 por cento). A média da severidade clínica é 13,32±4,7 e da independência funcional, 54,6±17,15. Não houve diferença significativa entre as médias funcionais dos pacientes quanto ao lado do AVC (pvalor=0,66). Existiu relação significativa entre severidade clínica e independência funcional (r=-0,45 pvalor=0,003). A severidade clínica e a dependência funcional de pacientes com AVC, ao darem entrada na fisioterapia, são significativas e evidenciam a necessidade de, além do tratamento clássico, serem incentivadas condutas educacionais que visem à conscientização da população.
This article investigates the severity and functional independence of hemiplegics patients' post-acute stroke by means of a multidisciplinary clinical staff. It is a descriptive study composed by 40 hemiplegics attended at the four largest physiotherapy public services in Natal, Rio Grande do Norte State. The methods used were an evaluation form, Functional Independence Measure and NIHSS. The results showed a sample predominantly female (55 percent), stroke ischemic (90 percent), right brain hemisphere (52.5 percent) and Hypertension Risk Factor (90 percent). The mean of clinical severity and functional independence was 13.32±4.7 and 54.6±17.15 respectively. There was no significant difference between the mean of functionality about stroke side (pvalue = 0.66). There is a significant relation between clinical severity and functional independence (r = -0.45 pvalue=0.003). It can be concluded that the level of clinical severity and functional dependence of stroke patients that make use of public physiotherapy services is significant and show the necessity, beyond the classic treatment, to be encouraged preventive educational actions to improve knowledge of this population.
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividades Cotidianas , Modalidades de Fisioterapia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/reabilitação , Doença Aguda , Brasil , Setor Público , Índice de Gravidade de DoençaRESUMO
This study verified the correlation between the serum levels of TNF alpha and different clinical forms of tuberculosis. We described a group of 24 patients presenting several clinical forms of tuberculosis and a control group of 13 healthy individuals. The levels of TNF alpha were measured by bioassay method. The levels of TNF-alpha had significant differences between the tuberculosis and control groups. The patients with abnormal chest X-Ray findings had higher TNF alpha levels (15328.48 ± 4602.19 pg/mL) when compared to patients with normal X-Rays (3353.18 ± 1495.29 pg/mL) (p<0.05). Patients that lost weight had higher TNF alpha levels (15468.54 ± 4580.54 pg/mL) than those that didn't loose weight (2904.98 ± 1367.89) (p<0.05). The levels of TNF alpha were higher in patients with a positive PPD skin test than in those with a negative PPD test (p<0.05). There was a positive correlation between patients' clinical severity and the serum levels of TNF alpha. In patients with successive measurements of TNF alpha, we observed that there was a drop in cytokine levels, and also a clinical improvement concomitantly. We concluded that there was a correlation between serum TNF alpha levels and chest X-Ray alterations, loss of weight, positive PPD skin test and clinical severity in patients with tuberculosis. There was evidence of a worse clinical outcome in patients with tuberculosis that presented higher TNF alpha serum levels.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Índice de Gravidade de Doença , Tuberculose/sangue , Fator de Necrose Tumoral alfa/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Adulto JovemRESUMO
A anemia falciforme é considerada uma doença heterogênea com diferentes graus de gravidade clínica apesar de ser causada pela mutação de um único nucleotídeo (Glu6Val) no gene da globina b. A total compreensão desta doença permitirá a descoberta de terapias contra alvos fisiopatológicos específicos. Este artigo revisa alguns dos fatores associados à modulação do fenótipo da anemia falciforme, incluindo fatores eritrocitários e fatores extrínsecos aos eritrócitos.
Sickle cell anemia is a heterogeneous disorder with different degrees of clinical severity despite of being caused by a single base pair mutation (Glu6Val) of the ß-globin gene. Understanding this disease will allow us to discover therapies of specific pathophysiological targets. This article reviews some of the factors that can modulate the phenotype of sickle cell anemia, including red blood cell factors and factors extrinsic to the red blood cells.