Síndrome ATRA: experiência de 10 anos / ATRA Syndrome: 10 year experience

A leucemia promielocítica aguda (LPA) é um subtipo de leucemia mielóide aguda (LMA) responsável por 10 por cento de todas as LMAs. Geralmente, o tratamento da LPA consiste de quimioterapia e uso de ácido transretinóico (ATRA). O maior efeito colateral do ATRA é a "Síndrome ATRA", que ocorre com uma freqüência de quase 30 por cento. Estudamos a apresentação clínica e a incidência da Síndrome ATRA em pacientes com LPA admitidos no Hospital São Paulo (da Escola Paulista de Medicina-UNIFESP). Treze pacientes com LPA fizeram uso de ATRA. A síndrome foi diagnosticada em cinco pacientes (38 por cento) com idade média de 29 anos e que estavam,em média, no décimo dia do uso de ATRA. Os achados clínicos mais freqüentes foram insuficiência respiratória, infiltrado pulmonar à radiografia e febre. Este relato chama a atenção para a necessidade do diagnóstico precoce dessa síndrome, com a introdução de dexametasona ao primeiro sinal no intuito de êxito terapêutico.

Anti-HIV-1/2 antibody detection by dot-ELISA in oral fluid of HIV positive/AIDS patients and voluntary blood donors

Serology is the primary means for identifying patients with HIV infection and Acquired Immunodeficiency Syndrome (AIDS). Testing of serum by serologic methods has been extensively used since 1985, not only for clinical diagnosis but also for epidemiological surveillance and donor screening in blood banks. Fast serological diagnostic techniques are now being developed, using urine and oral fluid, as an alternative for anti-HIV antibody screening, and many parallel studies are proving its accuracy. The purpose of this study was to evaluate the sensitivity, specificity,accuracy, positive predictive value (PPV) and negative predictive value(NPV) of the ImmunoComb II HIV 1&2 Saliva test from Orgenics(Dot-ELISA) compared to the routine exams (ELISA and Western Blot) of HIV positive/ AIDS patients, undergoing antiretroviral treatment or not, in different stages of the disease's evulution, and compared to serologic testing of known HIV negative patients by the use of serum ELISA (blood donors). To accomplish this, patients of the Immunogenic Deficiencies Control Center (CCDI) and voluntary blood donors of the Blood Bank Center of the Medical School of Säo Paulo/Federal University of Säo Paulo(EPM-UNIFESP) were evaluated. Sensitivity of Dot-ELISA in oral fluid was 100 percent, specificity 97.08 percent, PPV 96.66 percent and NPV 100 percent. The method used in this case study was shown to be highly sensitive and specific, being useful particularly epedemiological sur veillance and screening.