RESUMO
OBJECTIVES: This study discusses incidence and clinical profile of pulmonary involvement in leptospirosis in South Gujarat. It also tries to evaluate the effect of high dose glucocorticoid pulse therapy (GPT) on it. METHOD: A study was carried out on hundred and two patients of suspected leptospirosis, referred to Government Medical College, New Civil Hospital, Surat between June 99 to September 99. The incidence, clinical profile, and specific investigations were studied in patients having pulmonary involvement. Some of the patients were given high dose glucocorticoid pulse therapy. Their outcomes were compared with those who had not been given glucocorticoid pulse therapy. RESULTS: Out of seventy seven seropositive patients 13 (16.8%) developed pulmonary involvement. Mortality was two out of eight patients in the group that received GPT and four out of five patients in the group that did not receive GPT. Two patients who died in the steroid treated group received the drug after 12 hours of onset of dyspnea. CONCLUSIONS: High dose GPT should be given as early as possible after the onset of dyspnea to all the patients with pulmonary involvement in leptospirosis. Further studies are required to establish the GPT as a standard regimen in treatment of pulmonary involvement in leptospirosis.
Assuntos
Adulto , Idoso , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Índia , Infusões Intravenosas , Leptospirose/diagnóstico , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Probabilidade , Estudos Prospectivos , Pulsoterapia , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Infertility and ovarian disorders may occur not only due to imbalance in the steroid hormones but also due to the alteration in the immune function. A number of autoimmune disorders of the ovary, such as polycystic ovarian syndrome, premature ovarian failure and autoimmune oophoritis, have been documented. Both the cell mediated and humoral immune responses play an important role in these disorders. Cytokines secreted by the immune cells could have an adverse effect on ovarian steroidogenesis whereas the production of pathogenic T cells could lead to autoimmune disease of the ovary. Autoantibodies to granulosa and theca cells as well as zona pellucida of the oocyte have also been documented in women indicating that autoimmunity plays an important role in infertility. Thus the endocrine and the immune system work hand in hand to regulate ovarian function.