RESUMO
O mieloma múltiplo é uma neoplasia progressiva e incurável de células B, caracterizado pela proliferação desregulada e clonal de plasmócitos na medula óssea. A síndrome de hiperviscosidade é uma das complicações relacionadas às gamopatias monoclonais, sendo considerada emergência oncológica. O objetivo deste estudo foi descrever o quadro clínico de um paciente diagnosticado com mieloma múltiplo que apresentou síndrome de hiperviscosidade, avaliando a prevalência de sinais e sintomas, bem como características fisiopatológicas dessa entidade clínica. Foi revisado o prontuário de um paciente internado na enfermaria da Clínica Médica do Hospital Regional do Cariri (CE) no período de junho a julho de 2018. Além disso, foi realizada revisão de literatura em base de dados (PubMed®) direcionada ao tema proposto. O diagnóstico de mieloma múltiplo foi comprovado por mielograma, sendo prontamente iniciada a corticoterapia e avaliada a resposta clínica após essa terapêutica. Apesar de incomum e menos frequentemente relacionada ao mieloma múltiplo, a síndrome de hiperviscosidade está relacionada a uma grande taxa de mortalidade quando apresenta diagnóstico tardio. A terapia de primeira linha indicada para a síndrome de hiperviscosidade foi a plasmaferese, no entanto, as condições clínicas (instabilidade hemodinâmica) impossibilitaram sua realização. O desfecho deste caso foi o óbito do paciente. Concluiu-se que o diagnóstico precoce e a intervenção terapêutica estão diretamente relacionados à ocorrência de menor incidência de complicações relacionadas ao mieloma múltiplo e à síndrome de hiperviscosidade.
Multiple myeloma is a progressive and incurable B-cell neoplasm characterized by unregulated and clonal proliferation of plasmocytes in the bone marrow. Hyperviscosity syndrome is one of the complications related to monoclonal gammopathies and is considered an oncological emergency. The aim of this study was to describe the clinical condition of a patient diagnosed with multiple myeloma who presented hyperviscosity syndrome, evaluating the prevalence of symptoms and signs, as well as the pathophysiological characteristics of this clinical entity. The medical records of a patient admitted to the Internal Medicine ward of the Hospital Regional do Cariri (CE) from June to July of 2018 were reviewed. In addition, we conducted a literature review in a database (PubMed®) directed to the theme proposed. The diagnosis of multiple myeloma was confirmed by myelogram, and corticosteroid therapy was promptly initiated and the clinical response was evaluated after this therapy. Although uncommon and less frequently related to multiple myeoloma, hyperviscosity syndrome is related to a high mortality rate when diagnosed late. The first line therapy indicated to hyperviscosity syndrome was plasmapheresis; however, the clinical conditions (hemodynamic instability) precluded its performance. The outcome of this case was the patient's death. Thus, it was concluded that early diagnosis and therapeutic intervention are directly related to the occurrence of lower incidence of complications related to multiple myeloma and hyperviscosity syndrome.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Viscosidade Sanguínea , Melena/etiologia , Neoplasias de Plasmócitos/complicações , Hipergamaglobulinemia/etiologia , Mieloma Múltiplo/complicações , Cuidados Paliativos , Eletroforese das Proteínas Sanguíneas , gama-Globulinas/análise , Dexametasona/uso terapêutico , Mielografia , Radiografia , Fármacos Cardiovasculares/uso terapêutico , Microglobulina beta-2/análise , Corticosteroides/uso terapêutico , Evolução Fatal , Hipergamaglobulinemia/diagnóstico , Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Intestinos/irrigação sanguínea , Isquemia/cirurgia , Isquemia/complicações , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/sangue , Mieloma Múltiplo/diagnóstico por imagemRESUMO
OBJECTIVES: To evaluate long-term effects on gamma-globulins and autoantibodies of abatacept (ABA) versus tumor necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients. METHOD: Eighteen RA patients undergoing abatacept (ABA-RA) and 18 age/sex-matched patients treated with TNFi (TNFi-RA) were compared regarding clinical data, total gamma-globulins (TGG), specific subtypes (IgG, IgM, IgA), free light chains (FLC), IgM/IgG rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP3), and anti-mutated citrullinated vimentin (anti-MCV), assessed before and every 6 months, up to 24 months. EXCLUSION CRITERIA: previous abatacept/rituximab or low TGG (< 0.7 g/dL). RESULTS: At baseline, female sex (78 vs. 78%), age (55 vs. 53 years), DAS28 (5.73 vs. 5.67), TGG (1.4 vs. 1.35 g/dL), IgG (1168 vs. 1079 mg/dL), IgM (107 vs. 113 mg/dL), IgA (333 vs. 322 mg/dL), kappa (342 vs. 249 mg/dL), lambda (170 vs. 150 mg/dL), IgM-RF (76 vs. 53 UI), IgG-RF (63 vs. 25 UI), anti-CCP3 (216 vs. 189 UI), and anti-MCV (202 vs. 102 UI) were comparable in ABA-RA and TNFi-RA (p > 0.05). Similar disease activity improvement was observed in both groups. In ABA-RA, significant decreases (p < 0.05) were observed in TGG (1.4 vs. 1.05 g/dL), IgG (1168 vs. 997), IgA (333 vs. 278 mg/dL), kappa (342 vs. 257 mg/dL), lambda (170 vs. 144 mg/dL), IgM-RF (76 vs. 37 UI), IgG-RF (65 vs. 24 UI), anti-CCP3 (216 vs. 183 UI), and anti-MCV (202 vs. 60 UI) at 6 months, without further decreases. In contrast, TNFi-RA showed no decrease in any of such parameters. ABA-RA also had more often transient IgG levels under the lower limit of normality (66.7% vs. 33.3%, p = 0.046). No severe infection occurred. DAS28, ESR, and CRP correlated significantly to gamma-globulins and FLC at baseline (p < 0.05), but these correlations were longitudinally lost in ABA-RA, but not in TNFi-RA. CONCLUSION: ABA, but not TNFi, induces a safe, persistent, long-term, and non-progressive reduction in gamma-globulins and autoantibodies, including anti-MCV. This pattern is dissociated from disease activity control.Key Points⢠ABA induces a long-term and non-progressive reduction in gamma-globulins and FLC, which occurs regardless of disease activity control.⢠ABA-induced reduction in gamma-globulins and FLC promotes a dissociation of such parameters and disease activity.⢠The same pattern of reduction is observed in autoantibodies: IgM-RF, IgG-RF, anti-CCP3, and anti-MCV.⢠Low transient IgG can be observed in RA patients treated with ABA, but does not correlate to infection.
Assuntos
Abatacepte/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Autoanticorpos/imunologia , Inibidores do Fator de Necrose Tumoral/uso terapêutico , gama-Globulinas/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/análise , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunossupressores , Masculino , Pessoa de Meia-Idade , Fator Reumatoide/imunologia , Índice de Gravidade de Doença , Vimentina/imunologia , gama-Globulinas/análiseRESUMO
El proteinograma por electroforesis (PxE) sérico es solicitado para detectar modificaciones del perfil proteico. El objetivo del trabajo fue evaluar las alteraciones de la zona gammaglobulina y su correspondencia con distintos estados clínico-patológicos. Se incluyeron 7.259 pacientes (1-89 años) a los que en 2013 se les solicitó PxE. Según el trazado densitométrico, en la zona gammaglobulina se reconocieron diferentes grupos: hipogammaglobulinemia (<0,60 g/dL), hipergammaglobulinemia policlonal (≥1,80 g/dL), banda monoclonal (BM) y bandas oligoclonales. Prevaleció la hipergammaglobulinemia policlonal (4,2%), seguida por BM (1,4%) e hipogammaglobulinemia (0,8%). Hipergammaglobulinemia policlonal (>3 g/dL) se observó en: hepatitis autoinmune, cirrosis, síndrome de Sjögren, enfermedad mixta del tejido conectivo, HIV, hepatitis C y enfermedad de Castleman. El hallazgo de BM correspondió a 47% de pacientes con gammapatía monoclonal de significado incierto y 40% con mieloma múltiple; el 0,5% fueron casos nuevos. Con hipogammaglobulinemias, en adultos prevaleció la inmunosupresión terapéutica (55%), seguida por diabetes/síndrome metabólico/hipotiroidismo (23%); en niños, 22% por inmunosupresión y 78% con hipogammaglobulinemia no clasificada como inmunodeficiencia primaria. Se concluye que en 6,4% de los PxE se observó alteración de la zona gammaglobulina; prevaleció la hipergammaglobulinemia policlonal. En 1 de cada 200 PxE se pesquisó un paciente con BM. El hallazgo de hipergammaglobulinemia policlonal o BM se correspondió con distintos estados clínico-patológicos.
Serum protein electrophoresis (PEP) is requested to screen changes in the protein profile. The aim of this study was to evaluate alterations in the gamma globulin zone and correspondence with various clinical and pathological states. 7259 patients were included (1-89 years of age) who had been requested a PEP in 2013. According to the densitometric tracing, in the gamma globulin zone different groups were recognized: hypogammaglobulinemia (<0.60 g/dL), polyclonal hypergammaglobulinemia (≥1,80 g/dL), monoclonal band (MB) and oligoclonal band. The polyclonal hypergammaglobulinemia prevailed (4.2%), followed by MB (1.4%) and hypogammaglobulinemia (0.8%). Polyclonal hypergammaglobulinemia (>3 g/dL) was observed in autoimmune hepatitis, alcoholic cirrhosis, Sjögren's syndrome, mixed connective tissue disease, HIV, hepatitis C and Castleman's disease. The MB finding corresponded to a 47% of patients with monoclonal gammopathy of undetermined significance and 40% with multiple myeloma; 0.5% were new cases. In adults, hipogammaglobulinemias prevailed in therapeutic immunosuppression cases (55%), followed by patients with diabetes/ metabolic syndrome/ hypothyroidism (23%); in children, 22% with immunosuppression and 78% corresponded to hipogammaglobulinemias not classified as primary immunodeficiency. To conclude, an alteration in the gamma globulin zone was observed in 6.4% of PEP. In 1 out of 200 PEP MB was found. The finding of polyclonal hypergammaglobulinemia or MB corresponded to different clinicopathological states.
O proteinograma por eletroforese (PXE) sérico é solicitado para detectar modificações no perfil proteíco. O objetivo do trabalho foi avaliar as alterações da área gammaglobulina e sua correspondência com diversos estados clínico-patológicos. Incluíram-se 7259 pacientes (1-89 anos) aos quais, em 2013, foi solicitado um PxE. De acordo com o traçado densitométrico, na área gammaglobulina, diferente grupos foram reconhecidos: hipogammaglobulinemia (<0,60 g/dL), hipergammaglobulinemia policlonal (≥1,80 g/dL), banda monoclonal (BM) e bandas oligoclonais. Prevaleceu a hipergammaglobulinemia policlonal (4,2%), seguida por BM (1,4%) e hipogammaglobulinemia (0,8%). Hipergammaglobulinemia policlonal (>3 g/dL) foi observada em: Hepatite autoimune, cirrose, síndrome de Sjögren, doença mista do tecido conjuntivo, HIV, hepatite C e doença de Castleman. O achado de BM correspondeu a 47% de pacientes com gammapatia monoclonal de significado indeterminado e 40% com mieloma múltiplo; 0,5% eram casos novos. Com hipogammaglobulinemias em adultos prevaleceu a imunossupressão terapêutica (55%), seguida por diabete/síndrome metabólica/hipotireoidismo (23%); em crianças, 22% por imunossupressão e 78% com hipogammaglobulinemia não classificados como imunodeficiência primária. Conclui-se que em 6,4% dos PxE foi observada alteração da área gammaglobulina; prevaleceu a hipergammaglobulinemia policlonal. Em 1 de cada 200 PxE foi encontrado um paciente com BM. O achado de hipergammaglobulinemia policlonal ou BM se correspondeu com diferentes estados clínico-patológicos.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , gama-Globulinas/análise , Eletroforese/métodos , gama-Globulinas , Eletroforese em Gel de Ágar , Hipergamaglobulinemia/patologiaRESUMO
Tityus serrulatus (Ts) venom is composed of a mixture of toxins presenting diverse biological functions. However, although this venom has been studied over the past three decades, omics analysis revealed that most of its toxins are not identified or their biological activities are unknown. Ts19 Frag-II is included in this group, which function is still uncertain. This study aimed to expand the biological activities of Ts19 Frag-II through in vivo investigation. Our results demonstrates that mice challenged with Ts19 Frag-II presented biochemical alterations, increasing serum levels of urea, ALT and ß-globulin, besides decreasing γ-globulins. Moreover, this toxin was also able to induce immunological alterations, increasing NO, IL-6, TNF-α and IL-17, being considered a proinflammatory toxin. The increase of IL-17 was unprecedented regarding Ts toxins and could be a result of the overall produced-effect of cells of innate immunity cells (neutrophils, monocytes, natural killers and lymphoid tissue inducers - LTis) as well as of adaptive immunity (Th17 cells). This study expanded the biological activities of Ts19 Frag-II, suggesting that this toxin could be contributing to the Ts envenoming through alterations of biochemical parameters as well as triggering the inflammatory response.
Assuntos
Interleucina-17/sangue , Peptídeos/imunologia , Peptídeos/toxicidade , Venenos de Escorpião/imunologia , Venenos de Escorpião/toxicidade , Alanina Transaminase/sangue , Animais , beta-Globulinas/análise , Imunidade Inata , Interleucina-6/sangue , Masculino , Camundongos Endogâmicos BALB C , Óxido Nítrico/sangue , Escorpiões/química , Fator de Necrose Tumoral alfa/sangue , Ureia/sangue , gama-Globulinas/análiseRESUMO
A raça Crioula Lageana apresenta-se como uma alternativa para a pecuária moderna, devido a sua grande variabilidade genética, rusticidade e adaptação às condições ambientais do Planalto Catarinense. Estas características podem influenciar importantes eventos fisiológicos, os quais deveriam ser investigados, pois podem auxiliar no desenvolvimento de futuros programas de melhoramento animal. Sabe-se que a falha da transferência de imunidade passiva (TIP) constitui um importante fator para a elevação dos índices de mortalidade neonatal na espécie bovina. Desta forma, torna-se indispensável à avaliação dos aspectos relacionados à TIP em bezerros da raça Crioula Lageana variedade mocha e a sua comparação com outras raças de corte criadas no Planalto Serrano Catarinense. Com o objetivo de avaliar e comparar a TIP e o proteinograma sérico foram selecionados dois grupos experimentais compostos por 11 bezerros da raça Crioula Lageana variedade mocha e 14 bezerros da raça Aberdeen Angus (Red Angus). Amostras de sangue foram colhidas por meio da venopunção jugular para a mensuração da proteína total sérica (PTS), eletroforese das proteínas séricas em gel de agarose, atividade da gamaglutamiltransferase (GGT) e concentração de imunoglobulinas G (IgG) por meio do método de turvação pelo sulfato de zinco nos períodos entre 24 e 36 horas, 15, 30, 60, 90, 120, 150 e 180 dias de vida. A análise estatística dos dados foi realizada por meio da análise de variância de medidas repetidas (ANOVA), teste de Tukey para a comparação entre médias (P<0,05) e correlação entre as variáveis. Ao analisar os valores de PTS, globulinas, gamaglobulinas, IgG e atividade sérica de GGT ao nascimento (24 a 36 horas) pode se afirmar que houve adequada TIP não havendo diferença significativa entre as raças, exceto para a atividade sérica da GGT. Observaram-se variações fisiológicas na curva de proteínas séricas do nascimento até os 180 dias de idade. Forte correlação positiva foi observada entre os valores de gamaglobulina e IgG (r=0,814 para CL e r=0,877 para AA), PTS (r=0,783 para CL e r=0,947 para AA), globulinas (r=0,945 para CL e r=0,985 para AA), evidenciando que estas variáveis foram bons indicadores da TIP em bezerros ao segundo dia de vida (24-36 horas). A correlação entre gamaglobulinas e atividade da GGT foi fracamente positiva (r=0,251) para bovinos da raça Crioula Lageana variedade mocha e fortemente positiva (r=0,815) para a raça Aberdeen Angus (Red Angus), o qual foi admitido a grande variação nos valores da GGT após 24 horas de vida do bezerro. Não houve diferença na TIP entre as raças Crioula Lageana variedade mocha e Aberdeen Angus (Red Angus), ocorrendo de maneira bem-sucedida em ambas as raças. Pode-se sugerir que a raça Crioula Lageana variedade mocha seja mais tardia na síntese ativa de anticorpos, ressaltando a precocidade dos taurinos evidenciada na raça Aberdeen Angus (Red Angus).(AU)
The Criollo Lageano breed is an alternative for modern farming, due to its high genetic variability, rusticity and adaptation to environmental conditions of the Plateau of Santa Catarina, Brazil. These characteristics can influence important physiological events which should be investigated, because they can assist in developing future programs of animal breeding. It is known that failure of passive transfer (FPT) is an important factor for the increase in neonatal mortality in cattle. Thus, it is essential to evaluate aspects related to FPT in Criollo Lageano calves and the comparison with other beef breed created in the Plateau of Santa Catarina. Aiming to evaluate and to compare the passive transfer of immunity and serum protein concentrations, two experimental groups of 11 calves of Criollo Lageano (CL) hornless variety and 14 Aberdeen Angus (Red Angus) calves were selected. Blood samples were collected by jugular venipuncture for the measurement of total serum protein (TSP) by serum protein electrophoresis in agarose gel and the activity of gamma glutamyl transferase (GGT) and concentration of immunoglobulin G (IgG) by the method of the turbidity zinc sulphate, between 24 and 36 hours, 15, 30, 60, 90, 120, 150 and 180 days. Statistical analysis of data was performed by analysis of variance (ANOVA), Tukey test for comparison of means (P<0.05) and correlation between variables. Values of TSP, globulins, immunoglobulins, IgG and serum GGT activity at birth (24-36 hours) confirmed that there was adequate TIP with no significant difference between the races, except for the serum GGT activity. Physiological variations in the curve of serum proteins from birth to 180 days of age were identified. Strong positive correlation was found between the values of gamma globulin and IgG (r=0.814 and r=0.877 for CL to AA), PTS (r=0.783 and r=0.947 for CL to AA), globulins (r=0.945 and r=0.985 for CL to AA), indicating that these variables will be good indicators of TIP in calves at the second day of life (24-36 hours). The correlation between gamma globulin and activity of GGT was weakly positive (r=0.251) for CL and strongly positive (r=0.815) for the Aberdeen Angus (Red Angus), in which a wide variation in GGT values after 24 hours of life of the calf were noticed. No difference was found in FPT between Criollo Lageano hornless variety and Aberdeen Angus (Red Angus), and was successful way in both breeds. It can be suggested that Criollo Lageano hornless variety breed is later in active antibody synthesis, highlighting the precocity of taurine evident in Aberdeen Angus (Red Angus) breed.(AU)
Assuntos
Animais , Bovinos , Animais Recém-Nascidos/sangue , Proteínas Sanguíneas/análise , gama-Globulinas/análise , Imunização Passiva/veterinária , Imunoglobulinas/análise , gama-Glutamilciclotransferase/sangueRESUMO
A raça Crioula Lageana apresenta-se como uma alternativa para a pecuária moderna, devido a sua grande variabilidade genética, rusticidade e adaptação às condições ambientais do Planalto Catarinense. Estas características podem influenciar importantes eventos fisiológicos, os quais deveriam ser investigados, pois podem auxiliar no desenvolvimento de futuros programas de melhoramento animal. Sabe-se que a falha da transferência de imunidade passiva (TIP) constitui um importante fator para a elevação dos índices de mortalidade neonatal na espécie bovina. Desta forma, torna-se indispensável à avaliação dos aspectos relacionados à TIP em bezerros da raça Crioula Lageana variedade mocha e a sua comparação com outras raças de corte criadas no Planalto Serrano Catarinense. Com o objetivo de avaliar e comparar a TIP e o proteinograma sérico foram selecionados dois grupos experimentais compostos por 11 bezerros da raça Crioula Lageana variedade mocha e 14 bezerros da raça Aberdeen Angus (Red Angus). Amostras de sangue foram colhidas por meio da venopunção jugular para a mensuração da proteína total sérica (PTS), eletroforese das proteínas séricas em gel de agarose, atividade da gamaglutamiltransferase (GGT) e concentração de imunoglobulinas G (IgG) por meio do método de turvação pelo sulfato de zinco nos períodos entre 24 e 36 horas, 15, 30, 60, 90, 120, 150 e 180 dias de vida. A análise estatística dos dados foi realizada por meio da análise de variância de medidas repetidas (ANOVA), teste de Tukey para a comparação entre médias (P<0,05) e correlação entre as variáveis. Ao analisar os valores de PTS, globulinas, gamaglobulinas, IgG e atividade sérica de GGT ao nascimento (24 a 36 horas) pode se afirmar que houve adequada TIP não havendo diferença significativa entre as raças, exceto para a atividade sérica da GGT. Observaram-se variações fisiológicas na curva de proteínas séricas do nascimento até os 180 dias de idade. [...] (AU)
The Criollo Lageano breed is an alternative for modern farming, due to its high genetic variability, rusticity and adaptation to environmental conditions of the Plateau of Santa Catarina, Brazil. These characteristics can influence important physiological events which should be investigated, because they can assist in developing future programs of animal breeding. It is known that failure of passive transfer (FPT) is an important factor for the increase in neonatal mortality in cattle. Thus, it is essential to evaluate aspects related to FPT in Criollo Lageano calves and the comparison with other beef breed created in the Plateau of Santa Catarina. Aiming to evaluate and to compare the passive transfer of immunity and serum protein concentrations, two experimental groups of 11 calves of Criollo Lageano (CL) hornless variety and 14 Aberdeen Angus (Red Angus) calves were selected. Blood samples were collected by jugular venipuncture for the measurement of total serum protein (TSP) by serum protein electrophoresis in agarose gel and the activity of gamma glutamyl transferase (GGT) and concentration of immunoglobulin G (IgG) by the method of the turbidity zinc sulphate, between 24 and 36 hours, 15, 30, 60, 90, 120, 150 and 180 days. Statistical analysis of data was performed by analysis of variance (ANOVA), Tukey test for comparison of means (P<0.05) and correlation between variables. Values of TSP, globulins, immunoglobulins, IgG and serum GGT activity at birth (24-36 hours) confirmed that there was adequate TIP with no significant difference between the races, except for the serum GGT activity. Physiological variations in the curve of serum proteins from birth to 180 days of age were identified. [...] (AU)
Assuntos
Animais , Lactente , Bovinos , Imunização Passiva/veterinária , Proteínas Sanguíneas/análise , Imunoglobulinas/análise , gama-Globulinas/análise , Globulinas/análise , gama-Glutamiltransferase/sangueRESUMO
Background: Some reports indicate that calves produced by in vitro fertilization (IVF) may have excessive birth weights, increasing the rates of dystocia. Prolonged labor can cause the birth of lethargic calves that slowly ingest colostrum; this may compromise the intestinal absorption of immunoglobulins. Although the number of beef calves produced by IVF is high in Brazil, there have been few physiological studies examining the neonatal period in such cases. The aim of this study was to evaluate the passive transfer of immunity, and characterize the variation in serum protein concentrations, in Nelore calves up to 35 days of age, comparing naturally conceived calves with those conceived by IVF. Materials, Methods & Results: Forty healthy newborn Nelore calves were randomly selected and allocated into two groups (n = 20) according to their method of conception (natural versus IVF), and each group was composed of ten males and ten females. All calves were born and raised on the same farm, and kept with their mothers on extensive management condition. Blood samples were collected between 24 and 36 h after birth, and at 7, 14, 21, 28, and 35 days of age. Total protein (TP) concentration in serum was measured by the biuret method, and gamma-glutamyl transferase (GGT) serum activity was measured by the kinetic method. Concentrations of serum albumin, as well as alpha 1-, alpha 2 [...](AU)
Assuntos
Animais , Lactente , Bovinos , Proteínas Sanguíneas/análise , Fenômenos Fisiológicos , gama-Globulinas/análise , Animais Recém-Nascidos , Imunoglobulina G , Fertilização in vitro/veterinária , Distocia/veterináriaRESUMO
Background: Some reports indicate that calves produced by in vitro fertilization (IVF) may have excessive birth weights, increasing the rates of dystocia. Prolonged labor can cause the birth of lethargic calves that slowly ingest colostrum; this may compromise the intestinal absorption of immunoglobulins. Although the number of beef calves produced by IVF is high in Brazil, there have been few physiological studies examining the neonatal period in such cases. The aim of this study was to evaluate the passive transfer of immunity, and characterize the variation in serum protein concentrations, in Nelore calves up to 35 days of age, comparing naturally conceived calves with those conceived by IVF. Materials, Methods & Results: Forty healthy newborn Nelore calves were randomly selected and allocated into two groups (n = 20) according to their method of conception (natural versus IVF), and each group was composed of ten males and ten females. All calves were born and raised on the same farm, and kept with their mothers on extensive management condition. Blood samples were collected between 24 and 36 h after birth, and at 7, 14, 21, 28, and 35 days of age. Total protein (TP) concentration in serum was measured by the biuret method, and gamma-glutamyl transferase (GGT) serum activity was measured by the kinetic method. Concentrations of serum albumin, as well as alpha 1-, alpha 2 [...]
Assuntos
Animais , Lactente , Bovinos , Animais Recém-Nascidos , Fenômenos Fisiológicos , Imunoglobulina G , Proteínas Sanguíneas/análise , gama-Globulinas/análise , Distocia/veterinária , Fertilização in vitro/veterináriaRESUMO
OBJECTIVE: To assess the outcome of giant cell hepatitis combined with autoimmune hemolytic anemia in early childhood. STUDY DESIGN: We report on 16 children with this disease evaluated over a 28-year period. RESULTS: Children (nine boys; median age, 6 months) presented with jaundice, hepatomegaly, elevated aminotransferases, a positive Coombs test, and diffuse giant-cell transformation of hepatocytes on histology. Treatment with prednisone and azathioprine, plus, in three children, cyclosporine, resulted in complete remission in eight, partial remission in six, and failure in two. Relapses of hepatitis and/or anemia occurred in 11 and 10 children, respectively, requiring prolonged high levels of immunosuppression, and splenectomy or Rituximab, respectively. Treatment was stopped after a mean duration of 6 years, with no relapse, in seven children, with a median follow-up of 14 years. One child is alive 9 years after liver transplantation. Four children died of sepsis or multiple organ failure. CONCLUSIONS: Giant cell hepatitis combined with autoimmune hemolytic anemia requires rigorous treatment. Immunosuppressive therapy results in remission in most cases. A complete cure can be expected after several years of intensive treatment. Liver transplantation may be associated with prolonged survival.
Assuntos
Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/terapia , Células Gigantes/patologia , Hepatite/complicações , Hepatite/terapia , Fígado/patologia , Anemia Hemolítica Autoimune/mortalidade , Anticorpos Monoclonais Murinos/uso terapêutico , Azatioprina/uso terapêutico , Bilirrubina/sangue , Teste de Coombs , Ciclosporina/uso terapêutico , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Hepatite/mortalidade , Hepatócitos/patologia , Hepatomegalia/etiologia , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Lactente , Icterícia/etiologia , Transplante de Fígado , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Prednisona/uso terapêutico , Recidiva , Indução de Remissão , Rituximab , Sepse/mortalidade , Esplenectomia , Esplenomegalia/etiologia , Transaminases/sangue , Resultado do Tratamento , gama-Globulinas/análiseRESUMO
BACKGROUND & AIMS: Patients with autoimmune hepatitis (AIH) frequently have liver failure (LF) at the time of diagnosis; their response to immunosuppressive therapy has not been thoroughly analyzed. We evaluated the outcomes of children with AIH and LF who received immunosuppressive therapy and analyzed predictors of liver function recovery. METHODS: We collected data from 237 children that had AIH between September 1996 and December 2008; 50 had LF (defined as prothrombin time <50%) and had not received prior treatment. Patients were treated with either 2 mg/kg/day prednisone at doses up to 60 mg/day (n = 13) or 1 mg/kg/day prednisone at doses up to 40 mg/day plus cyclosporine at blood levels of 200 ± 50 ng/mL (n = 37). RESULTS: Of the 50 patients studied, 45 (90%) achieved prothrombin time >50% in a median time of 24 days (range of 4-257 days); 93% of these patients achieved this within the first 90 days of treatment. Two of the 45 patients who responded to immunosuppression required liver transplantation because of complications related to portal hypertension, and 3 died because of infection. Three of the 5 nonresponders received liver transplants - 1 remained on the waiting list, and the other died because of central nervous system bleeding. Infection was the only independently associated significant factor that delayed recovery from LF (odds ratio = 7.7, 95% confidence interval, 1.5-40). Each therapeutic approach had similar efficacy. CONCLUSIONS: Most pediatric patients with AIH recover after LF with immunosuppressive therapy; liver transplantation could be avoided or delayed. Infection was the most frequent cause of morbidity and mortality in these patients.
Assuntos
Ciclosporina/uso terapêutico , Glucocorticoides/uso terapêutico , Hepatite Autoimune/tratamento farmacológico , Imunossupressores/uso terapêutico , Falência Hepática/terapia , Prednisona/uso terapêutico , Adolescente , Bilirrubina/sangue , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Hepatite Autoimune/complicações , Humanos , Infecções/complicações , Infecções/mortalidade , Falência Hepática/etiologia , Transplante de Fígado , Masculino , Tempo de Protrombina , Estudos Retrospectivos , Transaminases/sangue , gama-Globulinas/análise , gama-Glutamiltransferase/sangueRESUMO
We studied the secretory IgA (sIgA) response of the mucosal urinary tract of malnourished children before and after nutritional rehabilitation. sIgA concentration (mg/l) was determined by ELISA in 187 children aged 3 months to 5 years. The children, who frequented a day care center, were divided into four groups, according to nutritional status: 57 were eutrophic, 49 were undergrown, 57 were moderately malnourished and 24 were severely malnourished. In addition, dip slide (Urotube, Roche) and dip-stick (Combur 9-Boehringer) tests showed that children had no bacteriuria or any other urinary abnormalities. Plasma albumin concentration (g/dl) was significantly lower (P < 0.005) in the severely malnourished group (mean 3.0 +/- 0.3 SD) than in the eutrophic group (mean 4.0 +/- 0.5 SD). When each nutritional state was analyzed, no significant differences in the sIgA were found between the 0 [symbol: see text]1 and 1 [symbol: see text]5 year age range. In the moderately and severely malnourished groups, sIgA (0.36 and 0.45, respectively) was significantly lower than in the eutrophic (0.69) and undergrown (0.75) groups. Ninety-five children were included in the 8-month follow-up study; 30 children were excluded from the follow-up because 4 had bacteriuria, 11 had leukocyturia, 8 had proteinuria and 7 had hematuria. Among the malnourished children, 40% showed nutritional improvement (P < 0.05) and significantly increased sIgA as compared to reference values for the eutrophic and undergrown groups. These data suggest that malnourished children have a significantly lower urinary sIgA than eutrophic children. After nutritional rehabilitation, they develop local immunity with a significant increase in sIgA.
Assuntos
Imunoglobulina A Secretora/urina , Estado Nutricional , Sistema Urinário/imunologia , Proteínas Sanguíneas/análise , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mucosa , Albumina Sérica/análise , gama-Globulinas/análiseRESUMO
We studied the secretory IgA (sIgA) response of the mucosal urinary tract of malnourished children before and after nutritional rehabilitation. sIgA concentration (mg/l) was determined by ELISA in 187 children aged 3 months to 5 years. The children, who frequented a day care center, were divided into four groups, according to nutritional status: 57 were eutrophic, 49 were undergrown, 57 were moderately malnourished and 24 were severely malnourished. In addition, dip slide (Urotube, Roche) and dip-stick (Combur 9-Boehringer) tests showed that children had no bacteriuria or any other urinary abnormalities. Plasma albumin concentration (g/dl) was significantly lower (P<0.005) in the severely malnourished group (mean 3.0 + ou - 0.3 SD) than in the eutrophic group (mean 4.0 + ou - 0.5 SD). When each nutritional state was analyzed, no significant differences in the sIgA were found between the 0 --- 1 and 1 -- 5 year age range. In the moderately and severely malnourished groups, sIgA (0.36 and 0.45, respectively) was significantly lower than in the eutrophic (0.69) and undergrown (0.75) groups. Ninety-five children were included in the 8-month follow-up study; 30 children were excluded from the follow-up because 4 had bacteriuria, 11 had leukocyturia, 8 had proteinuria and 7 had hematuria. Among the malnourished children, 40 per cent showed nutritional improvement (P<0.05) and significantly increased sIgA as compared to reference values for the eutrophic and undergrown groups. These data suggest that malnourished children have a significantly lower urinary sIgA than eutrophic children. After nutritional rehabilitation, they develop local immunity with a significant increase in sIgA.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Imunoglobulina A Secretora/urina , Estado Nutricional , Sistema Urinário , Proteínas Sanguíneas/análise , gama-Globulinas/análise , Mucosa , Albumina Sérica/análiseRESUMO
Introducción. En este trabajo se presentan hechos clínicos y de laboratorio que sustentan la existencia de un síndrome no descrito con anterioridad y aún no totalmente estudiando, que aparece durante el proceso de recuperación en los niños gravemente desnutridos. Los principales hallazgos clínicos estriban en fenómenos de hipertensión porta-intra-hepática de intensidad más o menos marcada y con duración aproximada de un mes, que aparecen de 20 a 40 días después de la iniciación del tratamiento. Resultados. La hepatomegalia, que es el primer signo, es intensa y progresiva, afecta mayormente al lóbulo izquierdo y guarda una relación inversa con la intensidad de la esteatosis hepática, demostrada por las biopsias del hígado. Aparejada a la hepatomegalia está la presencia de abdomen globoso, red venosa colateral y ascitis. Otros fenómenos son: la aparición de hipertricosis en frente, cintura escapular y muslos, así como el desarrollo de telangiectasias. Tardíamente, y en ausencia de parasitosis intestinal o evidencia de alergia, se observa el desarrollo de eosinofilia más o menos marcada con mala respuesta a la adrenalina y normalización de las proteínas totales del plasma y pruebas de turbidez de timol progresivamente más anormales. Conclusión. Se insiste en que la patogenia de este cuadro no está definitivamente establecida, pero se hacen algunas consideraciónes a título de hipótesis de trabajo
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Albuminas , Ascite/etiologia , Biópsia , Transfusão de Sangue , Dietoterapia , gama-Globulinas/análise , Hepatomegalia , Distúrbios Nutricionais/complicações , Distúrbios Nutricionais/dietoterapia , Distúrbios Nutricionais/fisiopatologia , Distúrbios Nutricionais/terapia , Proteínas Sanguíneas/análiseRESUMO
El control de hemoderivados en Venezuela se inició hace más de veinte años y ha sido actualizado a medida que han progresado las investigaciones en el área. Por tanto, ante el riesgo de transmisión de Hepatitis B, C y VIH, se comenzó a realizar el despistaje de estos agentes en hemoderivados empleando las técnicas de detección en muestras de sangre, por lo que el objetivo de este trabajo es demostrar su aplicabilidad en el control del producto final. Los productos analizados fueron albúminas, gammaglobulinas, factor VIII, globulinas específicas tanto puras como realizando diluciones, a fin de evaluar posibles interacciones no específicas. Los resultados demuestran la aplicabilidad de estos kits a nivel del producto final y su importancia, como herramienta para garantizar la calidad de los hemoderivados importados y producidos en el país
Assuntos
Humanos , Masculino , Feminino , Albuminas/análise , Albuminas/química , Análise Química do Sangue , Fator VIII/análise , Fator VIII/química , gama-Globulinas/análise , gama-Globulinas/química , Hepatite C , VenezuelaRESUMO
An apyrase and an alpha-glucosidase were detected in the salivary glands extracts of adult Aedes albopictus. The apyrase is a 61,000 Da secreted protein that hydrolyses ATP and ADP. This protein is synthe-sized in adults and is preferentially accumulated in the distal lateral lobes of the female salivary glands. The alpha-glucosidase is a secreted 67,000 Da protein. This enzyme is synthesized during adult life and accumulated in the proximal-lateral lobes of both males and females. The results are discussed and compared with data previously obtained with Aedes aegypti salivary glands.
Assuntos
Aedes/enzimologia , Apirase/análise , Insetos Vetores/enzimologia , Glândulas Salivares/enzimologia , alfa-Glucosidases/análise , Animais , Apirase/metabolismo , Centrifugação com Gradiente de Concentração/métodos , Feminino , Masculino , Peso Molecular , Padrões de Referência , Glândulas Salivares/metabolismo , Soroalbumina Bovina/análise , Ultracentrifugação , alfa-Glucosidases/metabolismo , gama-Globulinas/análiseRESUMO
O diagnóstico e seguimento das paraproteinemias requer a identificaçäo e tipagem de paraproteínas (PP). A imunoeletroforese (IEF) é o método comumente usado embora demorado e pouco sensível. A técnica de imunofixaçäo (IF) é superior por ser mais sensível, rápida e de fácil interpretaçäo, particularmente no reconhecimento de PP presentes em baixa concentraçäo no soro e/ou urina. Consiste de fase eletroforética, seguida de fixaçäo, quando o anti-soro é colocado sobre o gel, precipitando a proteína. Objetivo. Este estudo objetiva padronizar a técnica de IF e compará-la à IEF. Métodos. Foram estudados os soros de 28 pacientes, sendo 25 portadores de mieloma múltiplo e 3 com hipergamaglobulinemia policlonal, comparados com 6 indivíduos normais. Todos foram submetidos à eletroforese (EF) em gel de agarose, à IEF e à IF. Resultados. O principal problema na padronizaçäo da IF foi a determinaçäo da diluiçäo que estabelecesse proporçäo ideal entre antígeno e anticorpo. A concentraçäo sérica ideal da PP, neste estudo, variou de 28 a 35 g/dL. A PP foi detectada e caracterizada por ambas as técnicas em 21 (84 por cento) dos indivíduos e näo detectada por nenhuma delas em 2 (8 por cento). Em outros 2, somente a IF conseguiu identificar a PP. Näo houve banda monoclonal à EF e à IEF que näo fosse identificada pela IF. Conclusäo. Nossos resultados permitem concluir que a IF é mais sensível que a IEF e deve ser incorporada à rotina de diagnóstico
Assuntos
Humanos , Hipergamaglobulinemia/diagnóstico , Mieloma Múltiplo/diagnóstico , Paraproteínas/análise , gama-Globulinas/análise , Imunoeletroforese/normasRESUMO
Diagnosis and follow up of paraproteinaemias require identification and typing of paraproteins. Immunoelectrophoresis is the most commonly used method, though a lengthy one and with low sensitivity. Immunofixation is more sensitive, faster and of easier interpretation, specially when monoclonal proteins are present in low concentration in the serum and/or urine. Immunofixation includes two steps. The first is electrophoresis; the second is immunofixation of the separated antigen by use of antiserum. The latter step is accomplished by layering the antiserum over the agarose gel immediately after electrophoretic separation of the proteins resulting in antigen/antibody precipitation. PURPOSE--The objective of this study is to standardize the technique of immunofixation and compare it to immunoelectrophoresis. METHOD--The serum of 28 patients (25 with multiple myeloma and 3 with polyclonal hypergammaglobulinaemia) was analysed and compared to 6 normal subjects. All were submitted to electrophoresis on agarose gel, immunoelectrophoresis and immunofixation. RESULTS--Dilution of the serum to produce a concentration suitable for immunofixation is critical. In our study the correct paraprotein concentration was 28 to 35 g/dl. Both methods detected and identified the paraprotein in 21 (84%) of the samples and in 2 (8%) it was not detected at all. In two of the samples, only immunofixation was able to detect and identify the paraprotein. There was not any monoclonal band observed either through the electrophoresis or immunoelectrophoresis that was not detected by the immunofixation. CONCLUSION--These results show that immunofixation is more sensitive than immunoelectrophoresis and therefore should be incorporated into diagnosis routine.
Assuntos
Hipergamaglobulinemia/diagnóstico , Mieloma Múltiplo/diagnóstico , Paraproteínas/análise , Eletroforese das Proteínas Sanguíneas/normas , Humanos , Hipergamaglobulinemia/sangue , Imunoeletroforese/normas , Mieloma Múltiplo/sangue , gama-Globulinas/análiseRESUMO
Forty children with a diagnosis of Visceral Toxocariasis were evaluated prospectively from February 1982 to June 1989. Diagnosis was established by clinical, laboratory and serological (ELISA - ES Toxocara canis antigen) evaluations. A great clinical polymorphism was found in our patients, ranging from unspecific or absent manifestations to an exuberant symptomatology. The laboratory findings were: leukocytosis, eosinophilia and elevation of serum gammaglobulin and isohemagglutinin levels. No significant relationship between clinical findings and laboratory parameters was found. Serology (ELISA) was a method of great diagnostic support but did not show a correlation with clinical and laboratory findings in this study. There was a significant relationship between pulmonary manifestations and the presence of signs and/or symptoms, when the patients were sent to us. Our findings, especially the high incidence of pulmonary manifestations, suggest that Visceral Toxocariasis has to be included in the differential diagnostic of children with pulmonary manifestations, characteristic epidemiological data and associated eosinophilia.
Assuntos
Larva Migrans Visceral/diagnóstico , Criança , Pré-Escolar , Diagnóstico Diferencial , Eosinofilia/complicações , Feminino , Hemaglutininas/sangue , Humanos , Lactente , Larva Migrans Visceral/sangue , Larva Migrans Visceral/complicações , Larva Migrans Visceral/fisiopatologia , Leucocitose/complicações , Masculino , Estudos Prospectivos , gama-Globulinas/análiseRESUMO
OBJECTIVE: To compare the clinical course; laboratory and radiological features of women and men with ankylosing spondylitis (AS). METHODS: Retrospective review of charts of 41 women and 41 men with AS (25 B27+ and 16 B27- in each group) individually matched for age at onset and disease duration. RESULTS: No differences were observed in the clinical picture in either sex, but the disease was less severe in women than in men with lesser duration of uveitis attacks, lower leukocyte counts (p < 0.05), lower levels of gamma-globulins (p < 0.05), and longer asymptomatic periods. At the end of the study, women had less restriction of spinal extension (p = NS), less sequelae of uveitis without significant visual loss (p = NS), required fewer hip replacements, had less frequency of bamboo spine (p < 0.02), and better functional class (p < 0.0027) than men. CONCLUSION: There are no significant clinical or radiographic differences between women and men with AS. However, the disease was more severe in men and these features may be due to sexual dimorphism.
Assuntos
Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Contagem de Leucócitos , Masculino , Prevalência , Radiografia , Estudos Retrospectivos , Caracteres Sexuais , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia , gama-Globulinas/análiseRESUMO
Se estudio el efecto de la gamaglobulina humana intravenosa (GGHIV)(Sandoblogulin) sobre la reacción alogénica in vitro mediante el cultivo mixto de linfocitos (CML) en individuos normales. LA GGHIV en concentraciones superiores a 0.5 mg/ml inhibió en 61 por ciento y 99 por ciento la respuesta proliferativa. Se descartó que la inhibición fuese debida a factores citotóxicos presentes en la GGHIV comercial y/o deficit nutricional en los medios de cultivo. La incubación de los CML con 4 mg/ml de GGHIV durante 4 h/37 grados Centigrados produjo un 74 por ciento de inhibición. Se observó un efecto más acentuado al preincubar las células estimuladoras. La adición de GGHIV al CML, ocasionó una inhibición dependiente del tiempo de adición, mayor entre las 0 horas (h)(90 por ciento) y las 48 h (40 por ciento). El fenómeno inhibitorio no fue específico sobre la reacción alogénica puesto que también se encontró sobre la respuesta proliferativa a concavalina A (Con A) (63 por ciento), fitohematoglutinina A (PHA) (62 por ciento) y derivado protéico purificado (PPD) (84 por ciento). La inhibición sobre el CML, se revirtió parcialmente con la adición de 100 U de IL-2rH en las primeras 24h. La GGHIV redujo en un 79 por ciento la expresión del receptor de IL-2 al quinto día del CML. Los resultados de cuantificación de IL-1B en los sobrenadantes de CML con y sin GGHIV no arrojaron datos concluyentes. Se discuten los posibles mecanismos de acción y futuras utilidades de la GGHIV como inmunomoduladora en los transplantes de tejidos.