High prevalence of indinavir-associated renal complications in Thai HIV-infected patients.

BACKGROUND: Indinavir (IDV) is the protease inhibitor (PI) used most often in resource-limited countries. The present study aimed to determine the prevalence of IDV-associated renal complications as well as their clinical characteristics. MATERIAL AND METHOD: The authors reviewed all patients participating in cohorts of indinavir-containing regimens at the HIV-NAT research center during the period of indinavir treatment. Patients who had pre-existing renal diseases were excluded. Renal toxicities included presence of urologic symptoms, nephrolithiasis, abnormal urine sediments, crystalluria and loss of renal function. Radiological studies of KUB system were reviewed as well. RESULTS: Two-hundred and four patients treated with IDV were included. Median (IQR) follow up period was 216 (150-312) weeks. One hundred and eighty patients were treated with ritonavir-boosted regimens at some point, and 24 patients were treated only with unboosted regimens. Leukocyturia (51.9%) was the most common finding of IDV-associated renal complications. Thirty-five percent of patients had urologic symptoms such as flank pain or dysuria. Almost half of the patients had significant loss of renal function that was associated with prolonged use of IDV The most common radiological finding was nephrolithiasis. Less common, but of greater clinical importance, are nephrocalcinosis or renal atrophy. CONCLUSION: A high prevalence of IRC was found in Thai HIV-infected patients. As long as no other cost-effective boosted PI regimens are available, strategies to prevent irreversible loss of renal function are warranted.

Arsenic trioxide in the management of acute promyelocytic leukaemia.

Arsenical compounds were used as early as 2000 BC, both as medicines as well as poisons. Arsenicals gained importance in the beginning of the last century as the primary mode of treating syphilis. In 1931, Folkner and Scott used an arsenical preparation called Fowler's solution in the treatment of chronic myeloid leukaemia. This continued to be used until the introduction of busulphan in 1953. In the 1970s, arsenic trioxide was introduced for the treatment of acute promyelocytic leukaemia in China and was found to be extremely effective in treating this condition. Since then, numerous in vitro and in vivo studies have confirmed this observation. This article reviews the pathogenesis of acute promyelocytic leukaemia, the possible mechanism of action of arsenic trioxide in this condition and the literature on its use in the treatment, with special reference to the clinical and molecular response rates, toxicity and pharmacology of this compound. It also attempts to address the role of arsenic trioxide in the present algorithm for the treatment of acute promyelocytic leukaemia.

Leucemia promielocitica aguda: experiencia argentina con acido trans-retinoico / Acute promyelocytic leukemia: Argentine experience with transretinoic acid

Hemos tratado 77 pacientes con leucemia aguda promielocítica (LPA), con un protocolo abierto siendo evaluables 66 (59 de novo, 6 recaídas, l secundaria a una mielodisplasia) con ácido all-transretinoico en la inducción. Recibieron una dosis de 45 mg/m2 -30 mg/m2 hasta la remisión. De los 64 pacientes evaluables para remisión, 50 la alcanzaron (78 por ciento); de los 14 pacientes que no la lograron, 10 fallecieron por sangrado, 3 por síndrome retinoico. A los 49 pacientes en remisión se les propuso tratamiento post-remisión; 6 no pudieron hacerlo y de ellos 5 fallecieron; para el resto de la población la sobrevida libre de enfermedad fue, al año, del 81 por ciento (IC95 90 por ciento -66 por ciento) y a los 2 años de 74 por ciento (IC 91 por ciento -52 por ciento). Nuestros resultados son similares a los de otros grupos y nos parecen satisfactorios para continuar con el mismo protocolo.

Pathogenesis of wasting disease after cyclophosphamide treatment of neonatal mice.

Cyclophosphamide is a potent immunosuppressive agent and is being widely used in organ transplantation. The effects of this anti-rejection drug on lymphoid organs are poorly understood. Newborn Swiss mice injected with various doses of cyclophosphamide suffered from wasting disease at 4 weeks post treatment. The incidence of wasting disease was dose dependent. Haematological picture of the wasting animals revealed leukocytosis of variable degree. Lymphocyte/granulocyte ratio was not inhibited. The cyclophosphamide treatment caused shrinkage of lymphoid organs. Bone marrow showed degeneration of haematopoietic cells. The failure to sustain lymphopoiesis by the potential lymphoid sites following cyclophosphamide treatment and the associated immunological insufficiency resulted in the fatal wasting disease.

Leucocitosis neonatal asociada a la administración prenatal de dexametasona / Neonatal leucocytosis associated with prenatal administration on dexamethasone

La administración de esteroides a la madre, que presenta amenaza de parto prematuro, produce en la mayoria de las veces una aceleración de la maduración pulmonar fetal que contribuye a prevenir o disminuir el riesgo de la enfermedad de la membrana hialina en el recién nacido. En la presente contribuición comunicamos el caso de un neonato pretérmino, de sexo femenino, con peso de nacimiento de 1.050 g. 32 semanas de gestación (por examen físico), que presentó una marcada leucocitosis durante los primeros días de vida como consecuencia de la administración de dexametasona a la madre