ABSTRACT
Objective: To detect the levels of interleukin-27 (IL-27) and interferon-γ (IFN-γ) in pleural effusion, and to explore the values of IL-27 and IFN-y in the diagnosis of tuberculous pleuritis. Methods: A total of 88 patients with pleural effusion were selected and divided into tuberculous pleural effusion (TPE) group (n = 4 4), malignant pleural effusion group (n = 2 0), parapneumonia pleural effusion group (n = 12), and transudative pleural effusion group (n = 1 2) . The levels of IL-27, IFN-y and adenosine deaminase (ADA) in pleural effusion of the patients in various groups were detected; the receiver operating characteristic (ROC) curve was drawn to evaluate their diagnostic values for tuberculous pleuritis. Results: The levels of IL-27 and IFN-γ in pleural effusion of the patients in TPE group were significantly higher than the other three groups (P < 0 . 05). The areas under ROC curve (AUC) of IL-27, IFN-γ and ADA in pleural effusion in diagnosis of tuberculous pleuritis were 0. 96, 0. 79 and 0. 92, respectively; the specificities were 94. 4%, 89. 5% and 92. 1%, respectively; the sensitivities were 100%, 61. 4% and 78. 6%, respectively. The specificity (97. 4%) of combined detection of IL-27, IFN-γ and ADA was higher than those of single detection. Conclusion: The levels of IL-27, IFN-γ and ADA in pleural effusion can be used as an effective method to the differential diagnosis of tuberculous pleuritis. Detection of IL-27 in pleural effusion has a higher diagnostic value for tuberculous pleuritis than IFN-γ and ADA. Combined detection of IL-27, IFN-y and ADA has the important value in the diagnosis of tuberculous pleuritis.
ABSTRACT
INTRODUCCIÓN: el tratamiento de la hepatitis crónica C continúa siendo un reto. La combinación que mejores resultados ha demostrado, es la de interferón con ribavirina, pero puede originar efectos adversos con dificultades para la adherencia al tratamiento que en ocasiones, incluso, obligan a suspenderlo. OBJETIVO: identificar las reacciones adversas del tratamiento de la combinación de interferón con ribavirina. MÉTODOS: se realizó un estudio de una serie de 13 pacientes con hepatitis crónica C, atendidos durante los años 2006 y 2007 en consulta especializada del Hospital Universitario Vladimir Ilich Lenin tratados con interferón alfa-2b humano recombinante y ribavirina (Heberviron). RESULTADOS: la fiebre, cefalea, escalofríos, astenia, mialgias y artralgias fueron los efectos adversos más frecuentes, así como síntomas digestivos: anorexia, náuseas, epigastralgia; psíquicos: depresión; hematológicos: anemia y leucopenia. Se observó hipotiroidismo asociado a un cuadro reumatoide en una paciente en la que fue necesario suspender el tratamiento, así como en uno con trombopenia y otro con leucopenia. CONCLUSIONES: al indicar tratamiento con Heberviron al paciente con hepatitis crónica C, hay que tener presente, la frecuencia y magnitud de los efectos secundarios, pues pueden interferir con la adherencia y la respuesta al tratamiento, y ocasionar un impacto negativo en la calidad de vida de los pacientes
INTRODUCTION: The treatment of chronic hepatitis C is still a challenge. The combination with the better results is that of interferon with ribavirin, but it may to create adverse effects including difficulties to follow the treatment which on occasions, even to oblige us to suspend it. OBJECTIVE: To identify the adverse reactions to treatment with the combination of interferon and ribavirin. METHODS: A study was conducted in 13 patients presenting with chronic hepatitis C seen during 2006 and 2007 in the specialized consultation of the "Vladimir Ilich Lenin" University Hospital treated with human recombinant alpha-2b interferon (Heberviron). RESULTS: Fever, headache, chills, asthenia, myalgias and arthralgias were the more frequent adverse effects, as well as digestive symptoms: anorexia, nauseas, epigastralgia and the psychic type: depression, and hematologic type: anemia and leukopenia. Also, there was a hypothyroidism associated with a rheumatoid picture in a patient being necessary to suspend the treatment, as well as in another presenting with thrombopenia and another one with leukopenia. CONCLUSIONS: Prescribing the treatment with Heberviron in the patient with chronic hepatitis C, we must to take into account the frequency and magnitude of side effects, since it may be to interfere with fulfilment of and with the response to treatment and also to create a negative impact in the quality of life of patients
ABSTRACT
A utilização do Transplante alogeneico de Células Tronco Hematopoiéticas para o tratamento de malignidades é em grande parte prejudicada pela ocorrência da Doença Enxerto contra Hospedeiro (DECH). A grande maioria dos esforços para reduzir a incidência da DECH resultou na diminuição do efeito Enxerto contra Leucemia (ECL), com aumento na recaída pós-transplante, sugerindo que os efeitos enxerto contra Hospedeiro (ECH) e ECL estão intimamente ligados. Para separar esses efeitos, é preciso caracterizar os mecanismos imunológicos envolvidos com cada um deles. Neste trabalho, foi caracterizado um sistema capaz de discriminar e quantificar os efeitos ECH e ECL: hospedeiros BALB/c ou F1(B6XDBA/2) irradiados letalmente receberam medula óssea (MO) de C57BL/6 administrada junto com células T esplênicas de camundongos C57BL/6 normais ou deficientes em Interferon-γ (GKO), acompanhadas de células do mastocitoma P815 expressando GFP. O efeito ECH foi avaliado pela mortalidade, por parâmetros clínicos (peso, pele, diarréia, postura e atividade) e por histopatologia (pele, fígado e intestino), e o efeito ECL foi avaliado pela quantidade de células leucêmicas no sangue, baço, fígado, linfonodos e medula óssea, utilizando-se citometria de fluxo. Foi verificado que o efeito ECL em órgãos linfóides secundários (OLS) era independente da produção de IFN-γ. No fígado, o efeito ECL foi dependente de IFN-γ apenas quando o efeito ECH era parcial. Na MO, o ECL foi estritamente dependente de IFN-γ, independente da magnitude do ECH. A avaliação da produção de citocinas nos OLS mostrou que as células T aloreativas produziam IL-17A apenas nos receptores de células leucêmicas, independente de IFN-γ. Em contraste com receptores normais, em receptores leucêmicos de células T GKO a patologia intestinal é moderada, e os danos no fígado ocorrem principalmente no parênquima, com preservação dos espaços vasculares. O efeito ECH observado na ausência de IFN-γ correlaciona-se com o efeito ECL em todos os órgãos avaliados exceto na MO. Esses resultados levantam importantes questões relacionadas ao controle da doença residual mínima e à resposta imune na MO, um santuário de micrometástases. IL-17A, presente apenas em receptores de células leucêmicas e independente de IFN-γ, não foi suficiente para eliminar as células malignas da MO. Nossos resultados sugerem que a resposta anti-tumoral é sítioespecífica, provavelmente refletindo diferentes condições ambientais impostas por diferentes órgãos. Nós acreditamos que o estudo dos mecanismos indutores e efetores dos efeitos ECH e ECL, nos diferentes órgãos alvo, nos possibilitará desenvolver novos tratamentos que inibam a DECH enquanto mantenham o efeito ECL.
The clinical use of allogeneic stem cell transplantation for cancer treatment is seriously hampered by the occurrence of graft-versus-host disease (GVHD). For the most part, efforts to reduce the incidence of GVHD have also diminished graft-versusleukemia (GVL) responses, with increased tumor relapse, suggesting that the Graftversus- Host (GVH) and the GVL effects are intimately linked. To separate these effects, the immunological mechanisms related to each one must be characterized. In this work, a system able to discriminate and quantify the GVH and GVL effects was characterized: Radiation bone marrow (BM) chimeras were prepared using BM cells from C57BL/6 administered into BALB/c or F1(B6XDBA/2) hosts, together with splenic T cells from C57BL/6 or Interferon-γ (IFN- γ) knockout mice. These chimeras were injected IV with P815 mastocytoma cells transduced with GFP. The GVH effect was evaluated by the mortality rate, clinical parameters (weight, skin, diarrhea, hunching and activity) and histopathology (skin, liver and intestine), and the GVL effect was evaluated by the amount of leukemia cells in the blood, spleen, liver, lymph nodes and bone marrow, using flow cytometry. It was verified that the GVL effect was present in secondary lymphoid organs (SLOs) regardless IFN-γ production. In the liver, the GVL was dependent on IFN-γ only when the GVH effect was partial. In the BM, the GVL was strictly dependent on IFN- γ, and independent of the GVH magnitude. Evaluation of the cytokine production in SLOs showed that alloreactive T cells produced IL-17A only in leukemic recipients, independently of IFN- γ. By contrast with normal recipients, in leukemic recipients of GKO T cells the intestinal pathology was mild and the liver damage was mainly in the parenchyma, preserving the vascular spaces. The GVH effect observed in the absence of IFN-γ correlates with the GVL effect in every organ except in the BM. These results raise important questions related to the control of minimal residual disease and the immune response in the BM, a sanctuary of micrometastasis. IL17A, present only in leukemic recipients and independent of IFN- γ, was not enough to eliminate malignant cells from the BM. Our results suggest that the anti-tumor response is site specific, probably reflecting different environmental conditions imposed by different organs. We believe that studying the inductive and effector mechanisms of GVH and GVL effects in different target organs will enable us to design new treatments to prevent GVHD while maintaining the GVL effect.