Recurrent pneumonia caused by genetic immunodeficiency: a prophylactic and rehabilitative approach

Recurrent infections are a consequence of a series of genetic diseases characterized by deficiency in the immunological response. One of these diseases is the agammaglobulinemia, which is characterized by the basic defect in the maturation of lymphocytes B. The carrier of this kind of immunodeficiency, which is linked to the X (XLA) chromosome, has had primary pneumonias that have evolved into secondary pneumonias (chronic lungs with sequelae) after the third or fourth year of life. The clinical and rehabilitative quest for prophylaxis against the XLA immunodeficiency is accomplished in order to avoid the evolution of the bacterial infection into sequelae and loss of pulmonary function, which propitiates the recurrence of the disease and deteriorates the life quality of the patient. Forty cases of recurrent respiratory infections were studied. Some of them were associated with primary respiratory diseases without investigation of serum immunoglobulins and some were not. Casuistics was performed according to data from medical records with pertinent treatments collected from January 1997 to September 2004 at the Specialized Physiotherapy Center. Age average was 2.7 years of life. It is statistically impossible to precise results concerning only the immunosuppressed patients due to the lack of specific diagnosis. That is explained by the fact that recurrent XLA pneumonias may be attributed to the gastroesophageal reflux disease or to bronchial asthma. However, the improved results showed by the pulmonary function as preventive strategy were attributed to the respiratory physiotherapy, since intravenous immunoglobulin replacement therapies were not performed. Respiratory physiotherapy acts as a supportive factor in the healing process and occupies a fundamental role in the prophylaxis against recurrent respiratory clinical features, especially those of obstructive and secretionary characteristics.

Neurofibromatose tipo 1: aspectos clínicos e radiológicos / Neurofibromatosis type 1: clinical and radiological aspects

A neurofibromatose tipo 1 é uma doença genética com incidência de aproximadamente 1:3.000 habitantes e caracteriza-se, principalmente, pelo envolvimento sistêmico e progressivo, manifestando-se por deformidade física e comprometimento de funções neurológicas. O diagnóstico da neurofibromatose tipo 1 deve ser realizado o mais precocemente possível, por meio de exames clínicos e história familial, sendo indispensável o uso de exames de imagem como radiografia, tomografia computadorizada e ressonância magnética para diagnóstico, acompanhamento terapêutico e controle das lesões, prevenindo complicações. Neste estudo são abordados aspectos clínicos e radiológicos da neurofibromatose tipo 1, considerando características clínicas, base genética, alterações ósseas no tórax, coluna vertebral, membros superiores e inferiores, e cranioencefálicas.

Neurofibromatosis type 1 is a genetic disease with an incidence of approximately 1 in 3,000 people, characterized mainly by systemic and progressive involvement, manifesting by physical deformity and compromising of neurological functions. The diagnosis of the neurofibromatosis type 1 must be performed the earliest possible through clinical exams and familial history. The use of imaging diagnosis as radiography, computed tomography, and magnetic resonance imaging is valuable for diagnosis, treatment, follow-up of patients and control of lesions, preventing complications. In this study we describe the clinical and radiological aspects of the neurofibromatosis type 1, considering clinical features, genetics, bone alterations in chest, vertebral column, upper and lower limbs, and craniofacial abnormalities.

Iron deficiency anemia in children: a challenge for public health and for society

A anemia ferropriva é a principal carência nutricional no mundo, com etiologia relacionada a múltiplos fatores, e afeta crianças e gestantes principalmente nos países em desenvolvimento. O presente artigo apresenta uma revisão da literatura na área visando oferecer um panorama sucinto da ocorrência de anemia ferropriva no Brasil. O texto mostra a etiologia dessa doença, quais são os grupos de risco, sua alta prevalência em algumas regiões do Brasil e as conseqüências da carência de ferro em crianças. Além disso, procurando apontar alguns caminhos para a erradicação dessa doença, o artigo aborda as formas de controle da anemia ferropriva, bem como alguns programas preventivos e/ou de tratamento que foram ou estão sendo implementados em municípios brasileiros. Os autores concluem enfatizando a necessidade de serem multiplicados, em nosso país, esses tipos de programas a partir de uma política que envolva não só os poderes públicos, mas também toda a comunidade.

Hiper-homocisteinemia em pacientes submetidos a transplante renal / Hyperhomocysteinemia in renal transplant recipients

A doença vascular do transplante apresenta fisiopatogenia semelhante a do processo de envelhecimento vascular e da aterosclerose. Consequentemente, genes cujas enzimas estão ligadas a esse processo, como a enzima metilenotetrahidrofolato redutase (MTHFR) que participa do metabolismo da homocisteína e formação da placa aterosclerótica, passaram a ser valorizados no processo etiopatológico da disfunção crônica do transplante (DCTx). Neste estudo, as frequências dos polimorfismo MTHFR (C677T e A1298C) e os níveis plasmáticos de homocisteína (Hcy) foram avaliados em 45 pacientes submetidos a transplante renal no mínimo há 12 meses, 21 com DCTx e 24 com função renal normal (FN). A quantificação da hemocisteína foi realizada por cromatografia líquida/espectrometria de massas sequencial (LC-MS/MS) e a investigação dos polimorfismo MTHFR pela análise de comprimento de fragmentos de restrição (PCR-RFLP). O genótipo 677CT/1298AC foi associado ao nível moderado de Hcy em pacientes com DCTx

p53 gene analysis in childhood B non - Hodgkin's lymphoma

CONTEXT: Mutations or deletions in the tumor-suppressor gene p53 are among the commonest genetic changes found in human neoplasms including breast, lung and bowel cancers. In hematological malignancies, p53 is most often mutated in Burkitt's lymphoma, with p53 mutations present in 30 to 40 percent of tumor samples and in 70 percent of cell lines. OBJECTIVE: To analyze the p53 gene alterations in child patients with B non-Hodgkin's lymphoma. DESIGN: Descriptive study. SETTING: Tertiary oncology care center. PARTICIPANTS: The study investigated 12 patients with childhood B non-Hodgkin's lymphoma (Burkitt's lymphoma). Screening for p53 mutations was done by polymerase chain reaction - single strand conformational polymorphism (PCR-SSCP) analysis of exon 5 to 8/9 of the gene. RESULTS: Abnormal polymerase chain reaction - single strand conformational polymorphism migration pattern was observed in 4 patients (33.3 percent), one on exon 6 and three on exon 7. Positive cases included 2 patients who died from disease. CONCLUSION: These preliminary results suggest that p53 mutations are quite frequent in children with Burkitt's lymphoma and may play a role in lymphoma genesis or disease progression