ABSTRACT
The aim of this study was to determine if bone marrow mononuclear cell (BMMC) transplantation is safe for moderate to severe idiopathic dilated cardiomyopathy (IDC). Clinical trials have shown that this procedure is safe and effective for ischemic patients, but little information is available regarding non-ischemic patients. Twenty-four patients with IDC, optimized therapy, age 46 ± 11.6 years, 17 males, NYHA classes II-IV, and left ventricular ejection fraction <35 percent were enrolled in the study. Clinical evaluation at baseline and 6 months after stem cell therapy to assess heart function included echocardiogram, magnetic resonance imaging, cardiopulmonary test, Minnesota Quality of Life Questionnaire, and NYHA classification. After cell transplantation 1 patient showed a transient increase in enzyme levels and 2 patients presented arrhythmias that were reversed within 72 h. Four patients died during follow-up, between 6 and 12 weeks after therapy. Clinical evaluation showed improvement in most patients as reflected by statistically significant decreases in Minnesota Quality of Life Questionnaire (63 ± 17.9 baseline vs 28.8 ± 16.75 at 6 months) and in class III-IV NYHA patients (18/24 baseline vs 2/20 at 6 months). Cardiopulmonary exercise tests demonstrated increased peak oxygen consumption (12.2 ± 2.4 at baseline vs 15.8 ± 7.1 mL·kg-1·min-1 at 6 months) and walked distance (377.2 ± 85.4 vs 444.1 ± 77.9 m at 6 months) in the 6-min walk test, which was not accompanied by increased left ventricular ejection fraction. Our findings indicate that BMMC therapy in IDC patients with severe ventricular dysfunction is feasible and that larger, randomized and placebo-controlled trials are warranted.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Marrow Transplantation , Cardiomyopathy, Dilated/surgery , Feasibility Studies , Follow-Up Studies , Severity of Illness Index , Treatment OutcomeSubject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Myocardial InfarctionABSTRACT
Os autores apresentam dados especificos que comprovam a alta incidencia da sifilis nas gestantes que frequentam a maternidade do Hospital Universitario Antonio Pedro (Niteroi - RJ), onde obtiveram cerca de 5% de reacoes sorologicas positivas (VDRL) num total de 17.639 amostras do sangue do cordao umbilical examinadas, concentrando-se a positividade, na grande maioria dos casos, nas diluicoes 1:16 e 1:32, enquanto que a mortalidade incluiu mais fortemente nas diluicoes mais elevadas (1:32 e 1:64).Baseados nos dados estatisticos obtidos, procuram tracar o "perfil da gestante sifilitica" como o de "uma mulher gravida,de baixa condicao social, geralmente de cor preta, solteira, com idade entre 15 e 20 anos, que nao frequentou o ambulatorio pre -natal". Finalmente, sugerem maior propaganda do exame pre-natal para combater a morbidade e a mortalidade da sifilis neonatal