Oral health as a predictive factor for oral mucositis

OBJECTIVES: Oral mucositis is a complication frequently associated with hematopoietic stem cell transplantation, decreasing a patient's quality of life and increasing the occurrence of opportunistic infections. The purpose of this study was to determine the incidence and severity of oral mucositis and to assess the correlation of this disease with the oral health of an individual at the time of hematopoietic stem cell transplantation. METHODS: Before transplantation, patients' oral health and inflammatory conditions were determined using the gingival index and the plaque index, which are based on gingival bleeding and the presence of dental plaque, respectively. Additionally, the dental health status was determined using the decayed, missing, and filled teeth index. The monitoring of oral mucositis was based on the World Health Organization grading system and was performed for five periods: from Day 0 to D+5, from D+6 to D+10, from D+11 to D+15, from D+16 to D+20, and from D+21 to D+30. RESULTS: A total of 97 patients (56% male and 44% female) who underwent hematopoietic stem cell transplantation at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo between January 2008 and July 2009 were prospectively examined. The incidence of ulcerative mucositis was highest from days +6 to +10 and from days +11 to +15 in the patients who underwent autologous and allogeneic hematopoietic stem cell transplantation, respectively. CONCLUSION: The data, including the dental plaque and periodontal status data, showed that these oral health factors were predictive of the incidence and severity of oral mucositis in a cohort of patients with similar conditioning regimens before hematopoietic stem cell transplantation. .

Prevalence of celiac disease among blood donors in São Paulo: the most populated city in Brazil

OBJECTIVE: Celiac disease is a permanent enteropathy caused by the ingestion of gluten, which leads to an immunemediated inflammation of the small intestine mucosa. The prevalence of celiac disease varies among different nations and ethnic backgrounds, and its diversity is determined by genetic and environmental factors. São Paulo city is one of the largest cities in the world, with a vast population and an important history of internal migratory flow from other Brazilian regions, as well as immigration from other, primarily European, countries, resulting in significant miscegenation. The aim of the present study was to estimate the prevalence of adults with undiagnosed celiac disease among blood donors of São Paulo by collecting information on the ancestry of the population studied. METHODS: The prevalence of celiac disease was assessed by screening for positive IgA transglutaminase and IgA endomysium antibodies in 4,000 donors (volunteers) in the Fundação Pró-Sangue Blood Center of São Paulo, São Paulo, Brazil. The antibody-positive subjects were asked to undergo a small bowel biopsy. RESULTS: Of the 4,000 subjects, twenty-four had positive tests, although both antibody tests were not always concordant. For example, ten subjects were positive for IgA tissue transglutaminase only. In twenty-one positive patients, duodenal biopsies were performed, and the diagnosis of celiac disease was confirmed in fourteen patients (Marsh criteria modified by Oberhuber). In this group, 67% claimed to have European ancestry, mainly from Italy, Portugal and Spain. CONCLUSION: The prevalence of celiac disease is at least 1:286 among supposedly healthy blood bank volunteers in São Paulo, Brazil.

Busulfan and melphalan as conditioning regimen for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia in first complete remission

BACKGROUND: Allogeneic hematopoietic stem cell transplantation with HLA-identical donors has been established for the treatment of acute myeloid leukemia patients for over 30 years with a cure rate of 50 percent to 60 percent. OBJECTIVES: To analyze the overall survival of patients and identify factors that influence the outcomes of this type of transplant in patients in 1st complete remission who received a busulfan and melphalan combination as conditioning regimen. METHODS: Twenty-five consecutive patients with acute myeloid leukemia were enrolled between 2003 and 2008. The median age was 34 years old (Range: 16 - 57 years). All patients received cyclosporine and methotrexate for prophylaxis against graft-versus-host disease. Median neutrophil engraftment time was 16 days (Range: 7 - 22 days) and 17 days (Range: 7 - 46 days) for platelets. Sinusoidal obstructive syndrome was observed in three patients, seven had grade II acute graft-versus-host disease and one extensive chronic graft-versus-host disease. RESULTS: The overall survival by the Kaplan-Meier method was 48 percent after 36 months with a plateau at 36 months after transplantation. Intensive consolidation with high-dose arabinoside resulted in an improved survival (p-value = 0.0001), as did grade II acute graft-versus-host disease (p-value = 0.0377) and mild chronic graft-versus-host disease (p-value < 0.0001). Thirteen patients died, five due to infection within 100 days of transplant, two due to hemorrhages, one to infection and graftversus-host disease and three relapses followed by renal failure (one) and infection (two). The cause of death could not be determined for two patients. CONCLUSION: The busulfan and melphalan conditioning regimen is as good as other conditioning regimens providing an excellent survival rate.

Autologous hematopoietic stem cell transplantation in classical Hodgkin's lymphoma

BACKGROUND: Hodgkin's lymphoma has high rates of cure, but in 15 percent to 20 percent of general patients and between 35 percent and 40 percent of those in advanced stages, the disease will progress or will relapse after initial treatment. For this group, hematopoietic stem cell transplantation is considered one option of salvage therapy. OBJECTIVES: To evaluate a group of 106 patients with Hodgkin's lymphoma, who suffered relapse or who were refractory to treatment, submitted to autologous hematopoietic stem cell transplantation in a single transplant center. METHODS: A retrospective study was performed with data collected from patient charts. The analysis involved 106 classical Hodgkin's lymphoma patients who were consecutively submitted to high-dose chemotherapy followed by autologous transplants in a single institution from April 1993 to December 2006. RESULTS: The overall survival rates of this population at five and ten years were 86 percent and 70 percent, respectively. The disease-free survival was approximately 60 percent at five years. Four patients died of procedure-related causes but relapse of classical Hodgkin's lymphoma after transplant was the most frequent cause of death. Univariate analysis shows that sensitivity to pre-transplant treatment and hemoglobin < 10 g/dL at diagnosis had an impact on patient survival. Unlike other studies, B-type symptoms did not seem to affect overall survival. Lactic dehydrogenase and serum albumin concentrations analyzed at diagnosis did not influence patient survival either. CONCLUSION: Autologous hematopoietic stem cell transplantation is an effective treatment strategy for early and late relapse in classical Hodgkin's lymphoma for cases that were responsive to pre-transplant chemotherapy. Refractory to treatment is a sign of worse prognosis. Additionally, a hemoglobin concentration below 10 g/dL at diagnosis of Hodgkin's lymphoma has a negative impact on the survival of patients after transplant. As far as we know this relationship has not been previously reported.

Porfirias: quadro clínico, diagnóstico e tratamento / Porphyrias: clinical presentation, diagnosis and treatment

As porfirias são doenças incomuns e de herança genética na maior parte doscasos. As porfirias são divididas em eritropoiéticas, hepáticas agudas e hepáticas crônicas. Os subtipos de maior relevância clínica são a porfiria cutânea tarda e a porfiria intermitenteaguda. O diagnóstico das porfirias pode ser bastante difícil, dada a sobreposição de quadros clínicos e achados bioquímicos. A precisão do diagnóstico depende da dosagem de porfirinasurinárias e fecais, da análise da atividade enzimática de eritrócitos e, eventualmente, da pesquisa de mutações. O objetivo do presente artigo é realizar revisão literária das porfirias,com ênfase no diagnóstico e tratamento de seus diversos subtipos...

Porphyrias are uncommon diseases that have genetic inheritance in the majorityof the cases. Porphyrias are divided in: erythropoietic porphyria, acute hepatic porphyria and chronic hepatic porphyria. The subtypes with major clinical relevance are porphyria cutaneatarda and acute intermittent porphyria. Diagnosing porphyrias may be quite difficult, as there is significant overlapping between clinical and biochemical findings. The diagnosis depends on the measurement of urinary and fecal porphyrins, enzymatic analysis of erythrocytes and, eventually, analysis of mutations. The main purpose of this article is to make a review of porphyrias, with emphasis on diagnosis and treatment of its several subtypes...

O papel do médico na redução do risco residual da transmissão do vírus da imunodeficiência humana (HIV) por transfusão de sangue e hemocomponentes / Aprenda a pronunciar The physician's role in risk reduction transmission virus transmission human immunodeficiency (HIV) by blood and blood component transfusion

A transmissão do HIV por transfusão sanguínea ainda é um problema mundial. Em países em desenvolvimento, o risco residual estimado da transmissão sanguínea do HIV é bem maior do que nos países desenvolvidos.Não é incomum que os bancos de sangue recebam candidatos que foram orientados por seus médicos a doar sangue para realizar teste de HIV.Os critérios clínicos de triagem de doadores são baseados em dois princípios, a proteção ao doador e a proteção ao receptor, e têm por objetivo garantir que a doação de sangue seja um ato médico seguro.O teste utilizado para identificação da infecção pelo HIV no sangue doado é de fundamental importância para a medicina transfusional. Uma limitação dos testes de detecção de anticorpos anti-HIV consiste no período conhecido como ?janela imunológica?.A vigilância contínua do perfil dos doadores de risco é necessária e útil para direcionar as ações dos serviços de hemoterapia e da saúde pública da nossa população.A classe médica tem papel essencial na prevenção da transmissão do HIV por transfusões sanguíneas.

Hemolytic disease of the newborn due to anti-U

Anti-U is a rare red blood cell alloantibody that has been found exclusively in blacks. It can cause hemolytic disease of the newborn and hemolytic transfusion reactions. We describe the case of a female newborn presenting a strongly positive direct antiglobulin test due to an IgG antibody in cord blood. Anti-U was recovered from cord blood using acid eluate technique. Her mother presented positive screening of antibodies with anti-U identified at delivery. It was of IgG1 and IgG3 subclasses and showed a titer of 32. Monocyte monolayer assay showed moderate interaction of Fc receptors with maternal serum with a positive result (3.1 percent). The newborn was treated only with 48 hours of phototherapy for mild hemolytic disease. She recovered well and was discharged on the 4th day of life. We conclude that whenever an antibody against a high frequency erythrocyte antigen is identified in brown and black pregnant women, anti-U must be investigated

Liver histology in co-infection of hepatitis C Virus (HCV) and hepatitis G virus (HGV)

As little is known about liver histology in the co-infection of hepatitis C virus (HCV) and hepatitis G virus (HGV), HGV RNA was investigated in 46 blood donors with hepatitis C, 22 of them with liver biopsy: co-infection HCV / HGV (n = 6) and HCV isolated infection (n = 16). Besides staging and grading of inflammation at portal, peri-portal and lobular areas (Brazilian Consensus), the fibrosis progression index was also calculated. All patients had no symptoms or signs of liver disease and prevalence of HGV / HCV co-infection was 15.2 percent. Most patients had mild liver disease and fibrosis progression index, calculated only in patients with known duration of infection, was 0.110 for co-infection and 0.130 for isolated HCV infection, characterizing these patients as "slow fibrosers". No statistical differences could be found between the groups, although a lesser degree of inflammation was always present in co-infection. In conclusion co-infection HCV / HGV does not induce a more aggressive liver disease, supporting the hypothesis that HGV is not pathogenic

Resolvendo um caso de ABO discrepante através da genotipagem rápida por PCR-RFLP / Solving an ABO complex discrepancy by rapid genotyping using PCR-RFLP

O uso das reaçöes de hemaglutinaçäo para identificar discrepâncias ABO pode consumir um grande tempo e dificultar sua interpretaçäo. Com o conhecimento da base molecular dos antígenos do grupo sangüíneo ABO, o PCR-RFLP foi usado para elucidar um caso complexo de discrepância ABO. Materiais e Métodos: Um bebê do sexo feminino com sete meses de idade foi admitido no hospital com o diagnóstico de mielofibrose e anemia. Os testes pré-transfusionais usando o gel-teste demonstraram ser a paciente do grupo sangüíneo A, com teste de antiglobulina direto e pesquisa de anticorpos negativos. A paciente tinha um resultado prévio de tipagem AB. Nos testes de saliva foram detectados as substâncias A e B. Como testes imuno-hematológicos se mostraram inconclusivos, o PCR-RFLP foi feito usando amostras de sangue da paciente e da mäe. Após extraçäo do DNA genômico, dois fragmentos específicos do gene ABO (exon 6 e 7) foram ampliados usando os primers mo-46/mo-57 e mo-71/mo101 e digeridos com as enzimas Kpn I e Hpa II. Os produtos digeridos foram analisados por eletroforese em gel de agarose. Resultados: Após o PCR-RFLP na amostra do bebê, foram encontrados os fragmentos 309, 252, 223, 204, 150, 137 e 119 pb, confirmando o genótipo A2B, e na amostra da mäe foram encontrados os fragmentos 309, 252, 223, 150 e 137 pb, confirmando, também, o genótipo A2B. Conclusäo: Nos casos de discrepância ABO, a determinaçäo do grupo sangüíneo ABO pode ser feita pelo PCR-RFLP

Significance of isolated hepatitis B core antibody in blood donors from Säo Paulo

The clinical significance of isolated anti-HBc is still a challenge. To elucidate the real importance of this finding in our blood donors, an investigation algorithm was tested. One hundred and twelve isolated anti-HBc seropositive blood donors underwent clinical evaluation and retesting of HBV markers. Those who presented repeatedly reactive isolated anti-HBc, received a single dose of hepatitis B recombinant vaccine to verify anti-HBs early response. A HBV-DNA determination by PCR was done for those who did not test positive to anti-HBs after vaccine. The level of anti-HBc was recorded as a ratio of the sample-to-cut-off values (S:C ratio) in 57 candidates at donation. Comparing true and false-positive anti-HBc results, the different S:C ratios of them were statistically significant and when less than 2, implying in a false-positive result probability over 80 percent. A high percent of false-positive results (16.07 percent) was verified after anti-HBc retesting. HBV immunity was characterized in 49.11 percent, either by anti-HBs detection in retesting (15.18 percent), or after a single dose HBV vaccination (33.93 percent). HBV-DNA was negative in all tested donors. In conclusion, this algorithm was useful to clarify the meaning of isolated anti-HBc in most of our blood donors

Chronic hepatitis C virus infections in brazilian patients: association with genotypes, clinical parameters and response to long term alpha interferon therapy

No presente estudo, avaliamos a importancia clinico-epidemiologica da genotipagem do VHC em 130 pacientes com diagnostico histologico de hepatite cronica C e sua influencia na resposta terapeutica sustentada. Nao se observou associacao entre os genotipos e os aspectos clinico-epidemiologicos como sexo, idade, vias de trasmissao, presenca ou nao de cirrose e tempo de infeccao. Dos 130 pacientes, 113 foram submetidos a tratamento com...

Detection of hepatitis B virus DNA by the polymerase chain reaction in anti-HBE positive chronic hepatitis B patients

A deteccao do DNA do Virus da Hepatite B pela Reacao em cadeia Polimerase (PCR) foi comparada com os outros marcadores sorologicos virais (AgHBs, AgHBe e anti-HBe) numa serie de 49 pacientes com hepatite cronica B, incluindo 12 que apresentaram clareamento espontaneo do AgHBs. Nenhum caso AgHBs negativo foi PCR positivo, mas 33/37 (89,2 por cento) dos casos AgHBs positivos foram PCR positivos (p<0,0001). Entre as amostras AgHBs positivas, 9 foram AgHBe positivas e anti-HBe negativas, todas elas PCR positivas....

Recidiva em anemia esferocitica pos-esplenectomia consequente a presenca de bacos acessorios / Recurrence of spherocytic anemia postsplenectomy due to accessory spleens

Tres anos apos esplenectomia total indicada para tratamento de uma paciente portadora de anemia esferocitica se instalou quadro compativel com recidiva intensa de anemia. A investigacao clinica revelou presenca de dois bacos acessorios com 3,5 e 4 cm de diametro localizados ao ultra-som e ao mapeamento com tecnecio. Com estes achados indicou-se laparotomia que confirmou presenca dos bacos acessorios e a remocao destes normalizou quadro hematologico. O desenvolvimento esplenico, a partir da quinta semana de vida intra-uterina ao nivel do mesogastrio dorsal, com a formacao do baco embrionario multilobulado justifica a possibilidade da presenca de bacos acessorios, se nao ocorrer processo de coalescencia total dos lobulos esplenicos primitivos. Estes fatos alertam e orientam a conduta intra-operatoria que o cirurgiao deve buscar quando da realizacao de esplenectomia para o tratamento da doenca hemolitica, se recidivas decorrentes do funcionamento de bacos acessorios queiram ser evitadas.

Mastocitose sistemica benigna: relato de dois casos / Benign systemic mastocytosis: study of 2 cases

Sao apresentados dois casos de mastocitose sistemica benigna secundaria a urticaria pigmentosa (up), com evolucao clinica superior a 16 anos. Em um dos casos a UP iniciou-se aos dois meses de idade e evoluiu para forma sistemica em menos de dois anos. Em outro paciente a UP iniciou-se aos 22 anos de idade e o diagnostico de MSB foi realizado apos 30 anos de evolucao. Ambos os casos apresentavam lesoes cutaneas, hepatoesplenomegalia e sintomas gastrointestinais. Mielograma demonstrou envolvimento medular; em um caso a biopsia revelou mielofibrose. A terapeutica com antagonistas histaminicos "H IND. 1" e "H IND. 2" com cetotifeno ofereceu bom controle dos sintomas.

Efeito da ticlopidina e do dipiridamol sobre a agregaçäo e contagem das plaquetas de pacientes com agina crônica estável / The effect of ticlopidine and dipyridamole on platelet aggregation and count in patients with chronic stable angina pectoris

Objetivo - Comparar o efeito da ticlopidina e do dipiridamol sobre a agregaçäo e a contagem plaquetárias nos pacientes com insuficiência coronariana crônica estável. Casuística e Métodos - Foram estudados 80 pacientes com idade média de 58,3 ñ 5,8 anos, portadores de insuficiência coronariana crônica estável, divididos em dois grupos de 40 pacientes e cada grupo tratado com ticlopidina ou dipiridamol. A agreagaçäo e contagem de plaquetas foram realizadas antes do início das drogas, e na primeira e quarta semanas de tratamento. Resultados - Ao final da quarta semana de tratamento observou-se hipogregabilidades espontânea, induzida pelo aDP e pela adrenalina em, respectivamente, 82,5%, 72,5% e 67,5% dos pacientes do grupo dipiridamol, a hipoagregabilidade espontânea, induzida pelo aDO e pela adrenalina foi, respectivamene, de 40%, 30% e 27,5% (p < 0,001). A contagem das plaquetas permaneceu inalterada para ambos os grupos. Conclusäo - O efeito antiagregante plaquetário da ticlopidina é significantemente maior que o do dipiridamol, e pode ser droga alternativa na prevençäo de complicaçöes cardiovasculares

Ativadores do plasminogênio como agentes trombolíticos no infarto do miocardio / Plasminogen activators as thrombolytic agents in myocardical infarction

O tratamento atual do oclusäo aguda das coronárias inclui o uso de agentes trombolíticos. A experiência do Instituto do Coraçäo (HCFMUSP) num período entre 1981 e 1985, demonstrou que a infusäo intracoronária de estreptoquinase em 117 pacientes com infarto do miocárdio, foi capaz de recanalizar 87% das artérias coronárias. Várias drogas com especificidade para a fibrina foram desenvolvidas recentemente: 1) Ativador tecidual do plasminogênio (t-PA); 2) Ativador tipo uroquinase de cadeia simples (scuPA); 3) Complexo Plasminogênio-Estreptoquinase acilado (APSAC). Os autores discutem as propriedades dos agentes trombolíticos no tratamento do infarto do miocárdio