Antifungal activity of linalool against fluconazole-resistant clinical strains of vulvovaginal Candida albicans and its predictive mechanism of action

Candida albicans is the most frequently isolated opportunistic pathogen in the female genital tract, with 92.3% of cases in Brazil associated with vulvovaginal candidiasis (VVC). Linalool is a monoterpene compound from plants of the genera Cinnamomum, Coriandrum, Lavandula, and Citrus that has demonstrated a fungicidal effect on strains of Candida spp., but its mechanism of action is still unknown. For this purpose, broth microdilution techniques were applied, as well as molecular docking in a predictive manner for this mechanism. The main results of this study indicated that the C. albicans strains analyzed were resistant to fluconazole and sensitive to linalool at a dose of 256 µg/mL. Furthermore, the increase in the minimum inhibitory concentration (MIC) of linalool in the presence of sorbitol and ergosterol indicated that this molecule possibly affects the cell wall and plasma membrane integrity of C. albicans. Molecular docking of linalool with proteins that are key in the biosynthesis and maintenance of the cell wall and the fungal plasma membrane integrity demonstrated the possibility of linalool interacting with three important enzymes: 1,3-β-glucan synthase, lanosterol 14α-demethylase, and Δ 14-sterol reductase. In silico analysis showed that this monoterpene has theoretical but significant oral bioavailability, low toxic potential, and high similarity to pharmaceuticals. Therefore, the findings of this study indicated that linalool probably causes damage to the cell wall and plasma membrane of C. albicans, possibly by interaction with important enzymes involved in the biosynthesis of these fungal structures, in addition to presenting low in silico toxic potential.

Efeito do estresse térmico calórico agudo e crônico sobre a qualidade oocitária de bovinos de raças adaptadas / Effect of acute and chronic caloric heat stress on oocyte quality of adapted breeds cattle

Nos trópicos, o uso de raças adaptadas tem sido uma estratégia para minimizar o efeito do estresse térmico calórico (ETC). No entanto, faltam informações que quantifiquem o estresse e o seu efeito sobre a reprodução dessas raças. O objetivo deste estudo foi avaliar a qualidade do oócito recuperado e alguns parâmetros fisiológicos indicadores de ETC em bovinos de raças adaptadas. Animais Bos taurus x Bos indicus (n=6) e Bos taurus (raça Pantaneira; n=12), localizados na região de transição entre o Cerrado e o Pantanal brasileiro, foram submetidos à aspiração folicular guiada por ultrassonografia (OPU) em diferentes condições climáticas. Foram realizadas oito sessões de OPU, com intervalo mínimo de sete dias e máximo de 54 dias entre as coletas. Para caracterização climática, foi realizado o cálculo do índice de temperatura e umidade (ITU). Foram quantificados os ITUs do dia da OPU, sete dias antes e 60 dias antes de cada sessão. Os parâmetros fisiológicos e a viabilidade oocitária de fêmeas das raças Girolando e Pantaneira não foram afetados negativamente por ITUs entre 72 e 78. O ETC crônico (60 dias) parece afetar a viabilidade oocitária de doadoras na raça Pantaneira quando ITU é superior a 75.(AU)

In tropical regions, the use of adapted breeds has been a strategy to minimize the effect of heat stress (HS) in cattle. However, information quantifying stress and its effect on reproduction of these breeds is lacking. The aim of this study was to evaluate the quality of the recovered oocyte and some physiological parameters that indicate HS in adapted breed. Bos taurus x Bos indicus (n=6) and Pantaneira (n=12) cows, located in the transition region between Cerrado and Brazilian Pantanal, underwent follicular aspiration guided by ultrasound (OPU) in different weather conditions. Eight sessions of OPU were carried out, with a minimum interval of 7 days and maximum 54 days between sessions. For weather characterization, the temperature and humidity index (THI) was calculated. THI of the day of OPU, 7 days before and 60 days before each session were calculated. The physiological parameters and oocyte viability of Girolando and Pantaneira cows were not negatively influenced under ITU between 72 and 78. The chronic HS (60 days)may affect the oocyte viability of Pantaneira donors when ITU is over 75.(AU)

Padronização e teste da plataforma de força em padrão ortostático em cães / Test and standardize of force platelet in ortostatic pattern in dogs

O objetivo deste trabalho foi padronizar e testar o uso da plataforma de força em padrão ortostático em cães, na avaliação do apoio e distribuição do peso nos membros, permitindo visualizar uma possível transferência em pacientes ortopédicos com afecções articulares. Foram realizadas avaliações clínica - graus de claudicação e exame radiográfico - e biomecânica na plataforma de força, por coleta estática de 16 pacientes cirúrgicos ortopédicos com afecções coxofemoral da rotina hospitalar (grupo tratado), e de seis cães saudáveis, sem histórico de problemas ortopédicos (grupo-controle). Com base no grupo-controle, foi possível delinear uma metodologia adequada para cães em coleta estática e testá-la no grupo tratado. A plataforma em padrão ortostático mostrou ser um parâmetro objetivo, eficiente e mais sensível que os demais, sendo seu uso adequado na avaliação de pacientes ortopédicos.

The purpose of this work was to standardize and test the use of the force platform in ortostatic pattern in dogs, to approach the support assessment and weight distribution in the limbs, allowing the visualization of the transfer possibility in surgical orthopedics patients with hip diseases. Clinical evaluation - lameness degrees and radiografic exam - and biomechanical evaluation were accomplished through the force plate for static collection of 16 surgical orthopedics patients with hip diseases in hospital routine (control-group) and 6 healthy dogs without a report of orthopedics problems (treatment-group). The control-group for outline allowed an appropriate methodology at static collection in dogs. The platform in ortostátic pattern was efficient and a more sensitive and objective parameter than the others, being of appropriate use in the evaluation of an orthopedic patient.

Análise de série temporal para avaliação do perfil sorológico da leptospirose bovina no estado do Rio Grande do Sul de 1996 a 2006 / Time-series analysis for evaluating serological pattern of bovine leptospirosis in the state of Rio Grande do Sul from 1996 to 2006

A leptospirose é uma das principais enfermidades responsáveis pela baixa produtividade nos sistemas pecuários bovinos, sendo associada à redução na produção de leite, infertilidade, aborto, natimortalidade, além de aumento nos custos com despesas de assistência veterinária, vacinas e testes laboratoriais. Este estudo teve como objetivo analisar dados laboratoriais de sorologia para leptospirose bovina no Estado do Rio Grande do Sul, durante um período de 1996 a 2006, visando detectar tendências na frequência de reagentes e gerar hipóteses sobre a variação da frequência de soropositivos ao longo deste período. Análises de regressão linear e modelo linear generalizado foram realizadas para detectar tendências e verificar fatores que influenciam na frequência de soropositivos, respectivamente. Durante o período de 11 anos, foram analisadas 18.806 amostras de soro, sendo que 9.385 resultaram positivas (49,9%). A análise da série temporal por sorovar revelou uma tendência linear crescente estatisticamente significativa na frequência dos seguintes sorovares: Australis, Autumnalis, Bratislava, Copenhageni, Grippotyphosa, Pyrogenes e Tarassovi (p < 0,01). Por outro lado, foi observada uma tendência decrescente estatisticamente significativa na frequência dos sorovares Hardjo e Wolffi (p < 0,01) ao longo do período avaliado. Houve uma associação estatisticamente significativa entre índices pluviométricos (mm) e o número de soropositivos para Leptospira spp. (p = 0,01, OR = 1,003).

Leptospirosis is an infectious disease that causes losses of productivity in cattle due to reduction of milk production, reproductive disorders and calf mortality, while also increasing costs associated with veterinary care, vaccines and diagnostic tests. The objective of this study was to analyze serological findings for bovine leptospirosis in the State of Rio Grande do Sul, Brazil, in order to detect temporal trends in the frequency of seropositive animals and to generate hypothesis about the fluctuation in seroprevalence along the period from 1996 to 2006. Simple linear regression and generalized linear models were used to analyze trends and verify factors influencing the frequency of seropositive animals, respectively. During 11 years, 18,806 serum samples were analyzed, in which 9,385 were positive (49.9%). The time-series analysis by serovars revealed a statistically significant increasing trend in the frequency of the following serovars: Australis, Autumnalis, Bratislava, Copenhageni, Grippotyphosa, Pyrogenes and Tarassovi (p < 0.01). Conversely, a statistically significant decreasing trend was observed for the serovars Hardjo and Wolffi (p < 0.01). There was a significant association between rain precipitation (mm) and the number of samples seropositive for leptospirosis (p = 0.01, OR = 1,003).

Antifungal activity of the naphthoquinone beta-lapachone against disseminated infection with Cryptococcus neoformans var. neoformans in dexamethasone-immunosuppressed Swiss mice

The in vivo antifungal activity of the naphthoquinone beta-lapachone against disseminated infection by Cryptococcus neoformans was investigated. Swiss mice were immunosuppressed daily with dexamethasone (0.5 mg per mouse) intraperitoneally for 3 days, the procedure was repeated 4 days later, and the animals were then challenged intravenously with C. neoformans (10(6) CFU/mL) 1 week later. Seven days after infection, the mice were divided into groups and treated daily with beta-lapachone (10 mg/kg, iv) for 7 (N = 6) and 14 days (N = 10). Amphotericin B (0.5 mg/kg) was used as comparator drug and an additional group received PBS. Treatment with beta-lapachone cleared the yeast from the spleen and liver, and the fungal burden decreased approximately 10(4) times in the lungs and brain 14 days after infection when compared to the PBS group (P < 0.05). This result was similar to that of the amphotericin B-treated group. Protection was suggestively due to in vivo antifungal activity of this drug and apparently not influenced by activation of the immune response, due to similar leukocyte cell counts among all groups. This study highlights the prospective use of beta-lapachone for treatment of disseminated cryptococcosis.

Programa de saúde da família: inclusão dos usuários na escolha dos serviços oferecidos / Family health program: inclusion of users in the choice of services offered

A Lei 8.142 de 28 de dezembro de 1990 que dispõe sobre a participação da comunidade na gestão do Sistema Único de Saúde legitimou a participação popular nas decisões a serem tomadas neste setor através de um controle social, mas a população ainda não se sente participante desse processo decisório. Objetivo: Com essa pesquisa objetivou-se identificar as contradições existentes no processo de escolha dos programas de saúde oferecidos nas Unidades de Saúde da Família. Materiais e Métodos: Empregou-se um estudo do tipo exploratório-descritivo, com abordagem qualitativa, na qual a produção do material empírico foi possibilitada pelo uso da técnica da entrevista semi-estruturada e estabelecimento da posição social dos entrevistados, mediante o uso da Técnica de Análise de Discurso. Resultado: Na amostra pesquisada, a participação dos usuários dos serviços de saúde, na escolha dos serviços oferecidos é parcial e unilateral, pois não é chamada a opinar sobre sua locação e alcance. Conclusão: Concluí-se que o processo de montagem dos programas de saúde que compõem as Unidades de Saúde da Família ainda não conta com a participação da comunidade o que interfere no atendimento das necessidades de saúde da população.

Law 8142 of December 28, 1990 that provides for community participation in the management of the Unified Health System legitimized popular participation in decisions to be taken in this sector through a social control, but the population still does not feel this process participant making. Objective: In this research aimed to identify the contradictions in the process of choosing health programs offered at the Family Health Units. Materials and Methods: We applied an explorative study, descriptive, qualitative approach, in which the production of the empirical material was made possible by the use of the technique of semi-structured interview and the establishment of the social position of respondents through the use of the technique Discourse Analysis. Results: In this sample the participation of users of health services, choice of services offered is partial and unilateral because it is not called upon to opine on its location and scope. Conclusion: We conclude that the assembly process of health programs that make up the Family Health Unit has yet to community participation which interferes in meeting the health needs of the population.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 ± 14) with disease from 0.4 to 23 years (6.7 ± 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0). RLS was detected in 12 cases (27 percent). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52 percent) and excessive daytime sleepiness in 3 cases (6.8 percent). Fatigue was present in 32 subjects (73 percent) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

Fungal encephalitis following bone marrow transplantation: clinical findings and prognosis.

BACKGROUND: Central nervous system fungal infections (FI) are important complications and a cause of mortality in patients who receive hematopoietic stem cell transplantation (HSCT). AIMS: To study the clinical aspects of fungal encephalitis (FE). SETTINGS AND DESIGN: The study was carried out at the HSCT Center of the Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil. MATERIALS AND METHODS: Clinical records and autopsy reports from patients submitted to HSCT with a diagnosis of FE. RESULTS: Twelve patients were diagnosed with FE presenting with lowered level of consciousness, hemiparesis and seizures. We were able to identify two subgroups regarding susceptibility to FE: (1) patients with early onset FI and severe leucopenia, and (2) patients with later onset FI with graft-versus-host disease using immunosuppressive drugs. Eleven of the patients died directly due to the neurological complication, all had post-mortem confirmation of the diagnosis of FI. CONCLUSIONS: These clinical, paraclinical and temporal patterns may provide the opportunity for earlier diagnosis and interventions.

Processo avaliativo em estágios supervisionados: uma contribuição para o estudo / Evaluation process in supervised training: a contribution for the study

Partindo do pressuposto que o processo avaliativo nos estágios supervisionados encontra-se vinculado a uma abordagem pedagógica tradicional, neste estudo buscou-se compreender o processo avaliativo realizado no estágio supervisionado de um curso de gradução em enfermagem em atividade no nordeste brasileiro. Os participantes foram quatro enfermeiros, dois supervisores diretos e dois indiretos. A análise do material empírico se deu através da técnica de Análise de Discurso e os resultados evidenciaram que a maioria dos entrevistados utilizava elementos de diferentes abordagens pedagógicas para a prática do porcesso avaliativo. As contradições observadas relacionaram-se à função dos supervisores diretos e indiretos neste processo, bem como à utilização de abordagens que desconsideram o desenvolvimento crítico, reflexivo e questionador, necessário a uma formação profissional socialmente compprometida. Concluiu-se que há uma urgente necessidade de mudanças no porcesso avaliativo vigente, a partir do uso de práticas pedagógicas que propiciem uma formação integral ao aluno, superando as vertentes tradicionais, tendo em vista o modelo da saúde vigente e o perfil profissional que ele requer

Allogeneic hematopoietic stem cell transplantation from an alternative stem cell source in Fanconi anemia patients: analysis of 47 patients from a single institution

We transplanted 47 patients with Fanconi anemia using an alternative source of hematopoietic cells. The patients were assigned to the following groups: group 1, unrelated bone marrow (N = 15); group 2, unrelated cord blood (N = 17), and group 3, related non-sibling bone marrow (N = 15). Twenty-four patients (51 percent) had complete engraftment, which was not influenced by gender (P = 0.87), age (P = 0.45), dose of cyclophosphamide (P = 0.80), nucleated cell dose infused (P = 0.60), or use of anti-T serotherapy (P = 0.20). Favorable factors for superior engraftment were full HLA compatibility (independent of the source of cells; P = 0.007) and use of a fludarabine-based conditioning regimen (P = 0.046). Unfavorable factors were > or = 25 transfusions pre-transplant (P = 0.011) and degree of HLA disparity (P = 0.007). Intensity of mucositis (P = 0.50) and use of androgen prior to transplant had no influence on survival (P = 0.80). Acute graft-versus-host disease (GVHD) grade II-IV and chronic GVHD were diagnosed in 47 and 23 percent of available patients, respectively, and infections prevailed as the main cause of death, associated or not with GVHD. Eighteen patients are alive, the Kaplan-Meyer overall survival is 38 percent at ~8 years, and the best results were obtained with related non-sibling bone marrow patients. Three recommendations emerged from the present study: fludarabine as part of conditioning, transplant in patients with <25 transfusions and avoidance of HLA disparity. In addition, an extended family search (even when consanguinity is not present) seeking for a related non-sibling donor is highly recommended.

O trabalho de enfermagem no Hospital Dia na perspectiva da reforma psiquiátrica em João Pessoa – Paraíba / Nursing work of nursing at a day hospital in João Pessoa in the Perspective of the psychiatric reform

Relatamos uma investigação para apreender temas que explicam o trabalho de enfermagem, no Hospital-Dia, na perspectiva da reforma psiquiátrica em João Pessoa-PB. Utilizamos o referencial do materialismo histórico e dialético e o trabalho como categoria analítica. O material empírico foi analisado pela técnica de análise do discurso. O estudo revelou um tema coincidente, mudar o modelo de assistência psiquiátrica tradicional, e, nesse sentido, o trabalho de enfermagem incorpora além da qualidade formal, técnica-especializada, uma qualidade política indicando um novo significado ao processo de trabalho de enfermagem.

A saúde mental no PSF e o trabalho de enfermagem / Mental health in the PSF and the work of nursing

Pesquisa com a finalidade de compreender os limites/possibilidades de implementação de ações de saúde mental nos serviços da rede básica de saúde do município de Cabedelo - PB, na perspectiva da Reforma Psiquiátrica proposta no país. Tem referencial teórico-metodológico no Materialismo Histórico e Dialético. O material empírico foi analisado pela técnica de análise do discurso. Os resultados indicaram que o processo de trabalho dos enfermeiros identifica-se com o processo de trabalho Assistir (Cuidar/Fazer). Preserva aspectos do modelo tradicional, mas, incorpora outros enfoques da Saúde Coletiva, num movimento que requer a compreensão dos pressupostos do movimento pela Reforma Psiquiátrica para a transformação do processo de trabalho de enfermagem, no sentido da inclusão social e da integralidade da assistência.

Susceptibilidade a antimicrobianos de bactérias isoladas de otite externa em cães / Antimicrobial sensitivity of bacteria from otitis externa in dogs

The occurrence of canine externa otitis in Fortaleza-Ceará is reported. About 91.5 percent of the animals with clinical signs were positive to bacterial culture. Among all infections, 49.5 percent were mixed infections and the most common pathogens were Staphylococcus spp coagulase negative or positive and Pseudomonas aeruginosa. The most effective antimicrobials for Staphylococcus coagulase negative were: the quinolones, the aminoglicoside netilmycin and the beta-lactams, excepted ampicillin, penicillin and oxacilin; for Staphylococcus coagulase positive were: cefotoxin, amoxicillin + clavulanic acid, imipenem, netilmycin and cephatoxin; for Pseudomonas aeruginosa were: ciprofloxacin, tobramycin and imipenem.

Perfil hematológico e avaliação eletroforética das proteínas séricas de cães com cinomose / Hematological profile and electrophoretic evaluation of serum proteins of dogs with canine distemper

The hematological and serum proteins electrophoretic profiles of 13 dogs with distemper (Lentz inclusion body in leukocytes) were studied. The most frequent hematological findings were: normocitic normocromic anemia (61%), leukopenia (46%), left shount (54%), trombocytopenia (69%) and lymphopenia (85%). Electrophoretic analysis of serum proteins showed hypoproteinemia (54%), with reduced albumin and increased alfa-2 globulin. These findings can be used to support the clinical diagnosis of canine distemper.

Relação entre mortalidade adulta e indicadores socioeconômicos nas Regioes Metropolitanas do Brasil / Relation of adult mortality and socioeconomical data on metropolitan regions of Brazil

PURPOSE: To evaluate the association between the adult mortality, in the age range between 10 and 64 years old in 2000, and socioeconomic indicators for 16 metropolitan regions of Brazil. METHODS: From the datas of the Mortality System from the Ministry of Heath, were calculated the crude mortality rates (CMR) to all the causes of dead and sex, for the 16 metropolitan regions in Brazil. As a form of guarantee the spacial camparability, the CMR were standardized by age and sex, achieving the total mortality-standardized rates and for sex by the direct method of standardization. The correlation of Pearson was obtained for the 9 indicators and the analysis of cluster was used for the agroupment of the metropolitan regions. RESULTS: The matrix of correlation of Pearson showed significant correlation only between the TMSR, the urbanization degree and residence with rubbish collection. Three groups of metropolitan regions were identified. CONCLUSION: The analysis of agroupment identified three groups: 1--Porto Alegre, São Paulo, Vitória, Curitiba, Maceió, Rio de Janeiro e recife; 2--Florianópolis, Natal, Fortaleza, Brasília e São Luís e 3--Goiânia, Belo Horizonte, Salvador e Belém, that showed be significantly different by analysis of variance (P = 0.000).

A framework based on Web service orchestration for bioinformatics workflow management

Bioinformatics activities are growing all over the world, with proliferation of data and tools. This brings new challenges: how to understand and organize these resources and how to provide interoperability among tools to achieve a given goal. We defined and implemented a framework to help meet some of these challenges. Four issues were considered: the use of Web services as a basic unit, the notion of a Semantic Web to improve interoperability at the syntactic and semantic levels, and the use of scientific workflows to coordinate services to be executed, including their interdependencies and service orchestration.

Long-term outcome of 25 children and adolescents with severe aplastic anemia treated with antithymocyte globulin

Severe aplastic anemia (SAA) is probably an immune-mediated disorder, and immunosuppressive therapy is recommended for patients with no available donor for bone marrow transplant. Between October 1984 and November 1987, 25 consecutive children and adolescents with SAA with no HLA-compatible marrow donor received equine antithymocyte globulin (ATG) (15 mg kg-1 day-1) for 10 days. The patients were evaluated 6 weeks, 6 months, and 12 months after starting ATG treatment. Thereafter, patients were evaluated yearly until July 1998. Median age was 10 years (range, 1.5-20 years), granulocyte counts on referral ranged from 0.032 to 1.4 x 10(9)/l (median 0.256 x 10(9)/l), and 12 patients had granulocyte counts < 0.2 x 10(9)/l. At a median follow-up of 9.6 years (range, 8.6-11.8 years), 10 patients (40 percent) remained alive with good marrow function. No morphologic evidence of hematological clonal disorders has been observed, although two patients probably have acquired clonal chromosomal abnormalities (trisomy 8 and del(6)q21, respectively). Responses to ATG were observed between 6 weeks and 6 months from the start of treatment in 60 percent of evaluable patients. The response rate was not different in patients whose granulocyte count at diagnosis was < 0.2 x 10(9)/l, or in those who were < 10 years of age. This study supports the view that, when compared with supportive measures, ATG is an effective treatment for children or adolescents with SAA. Although these results are inferior to those reported for marrow transplantation or more intensive immunosuppressive regimens, these patients who responded to ATG are long-term survivors with stable peripheral blood counts and a low rate of relapse.

Hydrolysis of xylans by enzyme systems from solid cultures of Trichoderma harzianum strains

Xylanase activity was isolated from crude extracts of Trichoderma harzianum strains C and 4 grown at 28oC in a solid medium containing wheat bran as the carbon source. Enzyme activity was demonstrable in the permeate after ultrafiltration of the crude extracts using an Amicon system. The hydrolysis patterns of different xylans and paper pulps by xylanase activity ranged from xylose, xylobiose and xylotriose to higher xylooligosaccharides. A purified ß-xylosidase from the Trichoderma harzianum strain released xylose, xylobiose and xylotriose from seaweed, deacetylated, oat spelt and birchwood xylans. The purified enzyme was not active against acetylated xylan and catalyzed the hydrolysis of xylooligosaccharides, including xylotriose, xylotetraose and xylopentaose. However, the enzyme was not able to degrade xylohexaose. Xylanase pretreatment was effective for hardwood kraft pulp bleaching. Hardwood kraft pulp bleached in the XEOP sequence had its kappa number reduced from 13.2 to 8.9 and a viscosity of 20.45 cp. The efficiency of delignification was 33

Effect of all-trans retinoic acid on newly diagnosed acute promyelocytic leukemia patients: results of a Brazilian center

Thirty-seven patients with acute promyelocytic leukemia (APL) were treated with all-trans retinoic acid (ATRA). Patients received 45 mg m-2 day-1 po of ATRA until complete remission (CR) was achieved, defined as: a) presence of less than 5 percent blasts in the bone marrow, with b) white blood cells >103/mm3, c) platelets >105/mm3 and d) hemoglobin concentration >8 g/dl, with no blood or platelet transfusions. Thirty-one (83.7 percent) patients achieved CR by day 50, and 75 percent of these before day 30. Correction of the coagulopathy, achieved between days 2 and 10 (mean, 3 days), was the first evidence of response to treatment. Only one patient had been previously treated with chemotherapy and three had the microgranular variant M3 form. Dryness of skin and mucosae was the most common side effect observed in 82 percent of the patients. Thrombosis, hepatotoxicity and retinoid acid syndrome (RAS) were observed in 7 (19 percent), 6 (16 percent) and 4 (11 percent) patients, respectively. Thirteen (35 percent) patients had to be submitted to chemotherapy due to hyperleukocytosis (above 40 x 103/mm3) and six of these presented with new signs of coagulopathy after chemotherapy. Four (11 percent) patients died secondarily to intracerebral hemorrhage (IH) and two (5.4 percent) dropped out of the protocol due to severe ATRA side effects (one RAS and one hepatotoxicity). RAS and IH were related strictly to hyperleukocytosis. The reduced use of platelets and fresh frozen plasma probably lowered the total cost of treatment. We conclude that ATRA is an effective agent for inducing complete remission in APL patients

Estudo clínico e ecocardiográfico das alteraçöes do aparelho mitral em crianças com cardite reumática grave. Aspecto de prolapso ou ruptura / Clinical and echocardiographic study of mitral valve in children with severe rheumatic carditis. Aspects of prolapse or rupture

Objetivo - Descrever casos de cardite reumática com aspecto ecocardiográfico de prolapso ou ruptura de cordoalha da mitral. Métodos - foram estudados 16 casos de cardite aguda (entre 5 e 15 anos), sendo que em 10 havia aspecto de prolapso mitral (grupo 2). As medidas das cordoalhas anteriores e anéis foram comparadas a 5 casos de febre reumática fora da atividade com dilataçäo de ventrículo esquerdo com insuficiência aórtica (grupo 3) e a 20 crianças normais com mesmas idades. Nos grupos 1 e 2 repemos as medidas após o tratamento. Resultados - A média das medidas no grupo 1 foi cordoalha naterior 26,48 + ou - 11,46 mm, diâmetro do anel 32,13 + ou - 7,35 mm; no grupo 2, respectivamente 29,72 + ou - 4,57 mm e 35,63 + ou - 7 mm e no grupo 3, 34,52 + ou - 6,8 mm para cordoalha anterior e 34,8 + ou - 4,61 mm para o anel. Entre as crianças normais as medidas foram, respectivamente, 18,19 + ou - 4,26 mm e 24,66 + ou - 2,85 mm. Após imunossupressäo (corticoterapia) ocorreur melhora do aspecto ecocardiogrfco em alguns casos. A analise estatística revelou que comparando as medidas das crianças dos grupos 1 e 2 com as normais, a diferença foi significativa, mas näo com as do grupo 3. Comparando as medidas antes e depois do tratamento também näo houve diminuiçäo siginificativa (grupo 1 e 2). Conclusäo - a cardite aguda provocou, nestes casos, alongamento significativo das cordoalhas e dilataçäo do anel mitral. A diminuiçäo das medidas após o tratamento näo foi significativa.

Purpose - To describe cases of rheumatic carditis with echocardiographic aspects of prolapse or rupture of mitral structures. Methods - We described 16 cases of acute carditis (ages between 5-15 years). In 10 (group 1) there was aspect of mitral prolapse, in 6 (group 2) aspect of "flail". The measurements of anterior chordae and anuli were compared to the ones of 5 cases of chronic rheumatic fever with dilated left ventricle and aortic regurgitation (group 3) and to 20 normal children of same ages. The same measurements were repeated after treatment. Results - The mean of the measurements in group I was; 26.48±11.46mm ­ anterior chordae; 32.13±7.35mm anuli; in the group 2 was respectively 29.63±4.57mm and 35.63±7mm. In the group 3 anterior chordae was 34.52 ±6.8mm, anuli: 34.8 ±4.61mm. In the normal group, respectively was: 18.19±4.26mm and 24.66±2.85mm. After corticosteroid many cases improved. In the statistical. In the statistical analyses, the measurements among patients of group 1 and 2 compared to normal children, the difference was significant but it was not compared to group 3. Comparing the measurements pre and post treatment the decrease was not significant. Conclusion ­ The acute carditis in these cases lead to significant elongation of anterior chordae and dilatation of anuli, but there was not a significant decrease after treatment