Comparison of biochemical and immunological profile of pediatric patients with acute myeloid leukemia in relation to healthy individuals / Comparação do perfil bioquímico e imunológico de pacientes pediátricos com leucemia mieloide aguda e de indivíduos saudáveis

ABSTRACT OBJECTIVE: To compare the biochemical and immunological profiles of pediatric patients with acute myeloid leukemia (AML) with healthy children and adolescents. METHODS: This was a cross-sectional study in which 21 therapy-naïve patients with AML were compared with a group of 24 healthy individuals. The following data were analyzed: serum proteins, leucocytes and subgroups, erythrocytes, hematocrit, hemoglobin, platelets, cytokines in peripheral blood mononuclear cells cultures under spontaneous and BCG- or PHA-stimulated conditions, immunoglobulin A, and erythrocytic glutathione. Statistical analysis was performed using SPSS software, considering as significant p-values < 0.05. RESULTS: Serum albumin levels were higher (p < 0.0001) in the control group, as well as all the parameters related to red blood cells (p < 0.0001). For leucocytes and subgroups, no statistical difference was found between the AML and the control groups. For cytokines, the concentrations were significantly higher under spontaneous and BCG-stimulated conditions for TNF-a, IL-6, IL-10, and IFN-? in the control group. Under PHA-stimulated conditions, the concentration was higher (p = 0.002) only for IL-6. No difference was found between the two groups for the other cytokines and for IgA in the saliva. Erythrocytic glutathione was higher (p < 0.0001) in AML patients. CONCLUSIONS: It was possible to characterize the biochemical and immunological profile of pediatric patients with AML, as well as highlight some significant differences in these parameters when comparing with healthy children and adolescents.

RESUMO OBJETIVO: Comparar o perfil bioquímico e imunológico de pacientes pediátricos portadores de leucemia mieloide aguda (LMA) em relação a um grupo de crianças e adolescentes saudáveis. MÉTODOS Estudo transversal, em que foram avaliados 21 pacientes com LMA virgens de terapia e 24 indivíduos saudáveis. Foram analisados: proteínas séricas, leucócitos e subgrupos, eritrócitos, hematócrito, hemoglobina e plaquetas, citocinas em cultura de células mononucleares do sangue periférico sob condição espontânea e estimulada por BCG ou PHA, imunoglobulina A e glutationa eritrocitária. Análise estatística foi feita com o software SPSS considerando p < 0,05. RESULTADOS: Albumina sérica foi superior (p < 0,0001) no grupo de controle, bem como todos os parâmetros relacionados com os glóbulos vermelhos (p < 0,0001). Para os leucócitos e subgrupos não houve diferença estatística entre os pacientes com LMA e o grupo controle. As concentrações foram significativamente mais elevadas sob condições espontânea e estimulada por BCG para as citocinas TNF-a, IL-6, IL-10 e IFN-? no grupo controle. Sob condição estimulada com PHA a concentração foi superior (p = 0,002) apenas para a IL-6. Não houve diferença estatística para as demais citocinas e para IgA salivar entre os dois grupos. Glutationa eritrocitária foi superior (p < 0,0001) nos pacientes LMA. CONCLUSÕES: Diante do exposto, foi possível caracterizar o perfil bioquímico e imunológico de pacientes pediátricos com LMA, bem como evidenciar diferenças significativas em alguns desses parâmetros ao se compararem os indivíduos doentes e o grupo de crianças e adolescentes saudáveis.

Correlation between anthropometrics measurements, prealbumin level and transferin serum with Child-Pugh classification in evaluating nutritional status of liver cirrhosis patient.

AIM: to evaluate nutritional status by using anthropometrics and biochemistry examination and to determine the correlation between albumin, prealbumin and transferin serum level with anthropometrics measures in liver cirrhosis patient according to Child-Pugh classification. METHODS: study was conducted on 30 patients with liver cirrhosis Child-Pugh A, B and C. There were 8 patient of Child-Pugh A, 18 Child-Pugh B and 4 Child-Pugh C. Every patient underwent anthropometrics and biochemistry examination including ideal body weight (IBW), body mass index (BMI), triceps skin-fold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), albumin, prealbumin and transferin serum. We used statistical analysis Spearman and Pearson correlation test. RESULTS: by IBW and BMI measurement, most of liver cirrhosis patients indicated normal results. By MAMC measurement, there was no liver cirrhosis patient with good nutritional status. Most of them have slight and moderate malnutrition. There was no significant correlation between anthropometrics measurement with Child-Pugh score, with [p > 0.01]. And also, there was no significant relationship between albumin, prealbumin and serum transferin with anthropometrics measures, but there was significant correlation between prealbumin and transferin level with Child-Pugh score, with [p < 0.01]. CONCLUSION: the conclusion of this study is prealbumin and transferin level may be used to evaluate nutritional status of liver cirrhosis patient, and on the contrary with anthropometrics measures. There was no correlation between anthropometrics measures with albumin, prealbumin and transferin level.

Plasma levels of transthyretin and retinol-binding protein in child-A cirrhotic patients in relation to protein-calorie status and plasma amino acids, zinc, vitamin A and plasma thyroid hormones

Transthyretin and retinol-binding protein are sensitive markers of acute protein-calorie malnutrition both for early diagnosis and dietary evaluation. A preliminary study showed that retinol-binding protein is the most sensitive marker of protein-calorie malnutrition in cirrhotic patients, even those with the mild form of the disease (Child A). However, in addition to being affected by protein-calorie malnutrition, the levels of these short half-life-liver-produced proteins are also influenced by other factors of a nutritional (zinc, tryptophan, vitamin A, etc) and non-nutritional (Sex, aging, hormones, renal and liver functions and inflammatory activity) nature. These interactions were investigated in 11 adult male patients (49.9 + 9.2 years of age) with alcoholic cirrhosis (Child-Pugh grade A) and with normal renal function. Both transthyretin and retinol binding protein were reduced below normal levels in 55 percent of the patients, in close agreement with their plasma levels of retinol. In 67 percent of the patients (4/6), the reduced levels of transthyretin and retinol-binding protein were caused by altered liver function and in 50 percent (3/6) they were caused by protein-calorie malnutrition. Thus, the present data, taken as a whole, indicate that reduced transthyretin and retinol-binding protein levels in mild cirrhosis of the liver are mainly due to liver failure and/or vitamin A status rather than representating an isolated protein-calorie malnutrition indicator.

Studies on the components of the contact phase system in patients with acute nonlymphoblastic leukemia

The objective of the present study was to evaluate factors of the plasma kallikrein system in patients with acute nonlymphoblastic leukemia (ANLL), and compare the results to a normal control group. A prospective study was performed in the Tertiary Health Care Institution, Hemocentro, Campinas State University, Campinas, Sao Paulo, Brazil. Thirty-five patients, diagnosed as ANLL between 1988 and 1991, were considered for participation. Eleven patients were not elegible, according to the exclusion criteria: infection/septicemia, previous treatment of blood transfusion. The study was performed with 24 ANLL patients, average age 34 years (16-69 years), 14 men and 10 women. Nineteen healthy volunteers, workers from the Hematology Center, average age 32 years (21-59 years), 11 men and 8 women, were the control group. Plasmatic prekallikrein, C1-inhibitor, alpha 2-macroglobulin, activated partial thromboplastin time, prothrombin time, factor XII, factor XI, factor V and prealbumin were measured. Plasmatic prekallikrein (p=0.02) and prealbumin (p=0.03) were significantly decreased, and prothrombin time increased (p=0.003) in the patient group when compared to the control. Significant correlation (r=0.49, critical value=0.43, p<0.05) between prekallikrein and prealbumin, and between prothrombin time and factor V (r=0.54, critical value=0.44, p<0.05) was demonstrated in the patient group. No correlation was found between parameters analysed and circulant blast count or leukemia subgroups. Statistical analysis was performed by the Willcoxon test. Correlation between the parameters was also verified. These results suggest activation of the contact system or impaired liver synthesis in patients with ANLL, and could contribute to disease complications.

Study of serum prealbumin and serum alpha fetoprotein in cases of fulminant hepatic failure.

We studied serum prealbumin (SPA) and serum alpha fetoprotein (AFP) to assess liver cell injury and prognosis in patients with fulminant hepatic failure (FHF). We studied 21 patients of FHF of viral etiology, 10 acute viral hepatitis (AVH) and 10 healthy controls. Initial (on the day of admission) AFP levels were significantly elevated in FHF group (30.28 +/- 63.58 ng/ml, p < 0.01 compared to AVH and control group in whom it was undetectable. Serum AFP correlated well with deranged Liver Functions (LFT). In the Survivors (n = 4) of FHF, serial estimations (on Day 5 and Day 10 of admission) revealed declining AFP Levels, correlating with clinical recovery. SPA on admission was significantly reduced in FHF group (15.10 +/- 9 mg/dl p < 0.05) compared to AVH (37.0 +/- 9.34 mg/dl) and control group (40.25 +/- 5.92 mg/dl). Low SPA also correlated with deranged LFT. Serial estimations in the survivors (Day 5, Day 10) revealed rising SPA which correlated with clinical recovery.

Nutritional assessment and surgical risk makers in children submitted to cardiac surgery

Introduçäo e Objetivos: A desnutriçäo é freqüente em crianças cardiopatas e pode associar-se a uma maior morbidade no período pós-operatório. Com o objetivo de avaliar o estado nutricional de crianças portadoras de cardiopatias congênitas e o papel dos parâmetros de avaliaçäo nutricional em predizer complicaçöes pós-operatórias. Material e Métodos: Foram estudadas 50 crianças admitidas para cirurgia cardíaca eletiva, classificadas como de alto ou de baixo risco cirúrgico. Antes da cirurgia cada paciente era submetido a uma avaliaçäo nutricional, compreendendo parâmetros antropométricos e dosagem das proteínas plasmáticas. Resultados: A prevalência global de desnutriçäo de acordo com o critério de Waterlow foi de 78 por cento sendo 90 por cento no grupo de alto risco e 60 por cento no de baixo risco cirúrgico. Nas crianças de alto risco cirúrgico, medidas antropométricas do braço situadas abaixo do percentil 5 mostraram associaçäo significante com complicaçöes pós-operatórias gerais (circunferência braquial p=0,0019); circunferência muscular braquial, p=0,0419). A relaçäo de peso esperado para a estatura e as concentraçöes séricas de albumina e de transferrina näo tiveram papel prognóstico para morbidade pós-cirúrgica. O valor médio de pré-albumina foi significantemente inferior nas crianças de alto risco que desenvolveram infecçäo no pós-operatório quando comparado ao das que näo tiveram infecçäo (p < 0,01). Conclusäo: Embora a classificaçäo de risco nutricional tenha se mostrado um bom método para identificar subgrupos de pacientes com um risco adicional de morbidade pós-operatória, säo necessários testes mais sensíveis e específicos que permitam identificar individualmente essas crianças

Fatores reguladores dos níveis plasmáticos de transtiretina e proteína ligadora de retinol / Regulating factors of thr plama levels of transthyretin and retinol binding protein

A transtiretina (TTR) e a proteína ligadora do retinol (RBP) såo duas proteínas plamáticas de origem hepática fisiologicamente interligadas ao transporte da vitamina A e dos hormônios da tireóide. Por possuírem vida biológica curta e por responderem bem ao suprimento hepático de aminoácidos e/ou energia, essas proteínas constituem valiosos indicadores nutricionais no diagnóstico precoce da deficiência proteico-energética e/ou na detecçåo da eficácia da terapêutica nutricional. Entretanto, par ao entendimento da especificidade destes indicadores do estado proteico-energético, há necessidade de se conhecer os fatores controladores dos seus níveis séricos, exemplificados nåo só pelo próprio estado proteico-energético, como também pelos níveis de vitamina A, zinco e hormônios (tireóide, estrógenos, andrógenos e cortisol). Podem sofrer também influência das insuficiências hepática e renal e do estresse. Apenas quando excluídas as açöes desses demais fatores é que os resultados desses parâmetros podem ser adequadamente interpretados como indicativos do estado nutricional proteico-energético do indivíduo

Plasma fibronectin, transferrin and prealbumin in children with bacterial pneumonia with and without protein supplementation

The study included 100 patients with bacterial pneumonia, as well as 20 apparently healthy controls. Their ages ranged from 2-36 months. Any disease that could affect the plasma proteins, e.g. hepatic, renal and/or nutritional were excluded from the patients and controls. Patients were classified according to Downe's score for respiratory distress into mild [score <2], moderate [score 2-5] and severe [score >5]. The patients were subjected to full clinical examination, chest x-ray, tuberculin test, full blood picture and early morning fasting stomach aspirate for bacteriological studies. All patients and controls had fibronectin [Fn], transferrin [Tn] and Prealbumin [PA] measured initially and on follow up after 10 days for the patients. On systematic random basis, to every other case a high protein supplementation was given. Cases with bacterial pneumonia showed significantly lower values of mean +/- S.D. plasma Fn, Tn and PA than controls. Severe and moderate pneumonia, cases showed significantly lower values of plasma. Fn, Tn and PA than mild ones. Patients with non pneumococcal pneumonia showed significantly lower values of plasma Fn, Tn and PA than those with pneumococcal pneumonia. There was a strong positive significant correlation, between the 3 protein markers studied, i.e. Fn, Tn and PA, and estimation of one of them could save estimation of the others. Cases with mild pneumonia initially [as measured by Downe's score] that became either moderate or severe during the course of the disease, showed significantly lower values of Fn, Tn and PA than cases with wild pneumonia that became neither moderate nor severe. With recovery [with or without protein supplementation] follow up levels of Fn, Tn and PA were significantly higher than initially. These data, suggest that early estimation of protein markers may have a predictive value in forecasting the outcome of bacterial pneumonia. They are more accurate than using Downe's score only. The old myth of avoiding excessive intake of proteins during pneumonia is now obsolete. It is recommended, that high intake of proteins during the course of bacterial pneumonia speeds recovery

Valores de referencia de fracciones séricas de utilidad en estudios de nutrición, en niños / Quantitative determination of specific sera protein fractions, in children

Con el objeto de determinar valores de referencia de fracciones séricas específicas en niños, por el método de inmunodifusión radial sobre acetato de celulosa o gel de agarosa, se seleccionó al azar, una población infantil entre 1-16 años, concurrente al Hospital de Clínicas "José de San Martín". Sobre esta muestra poblacional, se determinó la concentración sérica de proteínas totales, prealbúmina, ceruloplasmina, fracción C3 de complemento, apolipoproteína A-I e inmunoglobulina (IgG, IgA, IgM). Los resultados se compararon con los hallazgos en la bibliografía nacional e internacional

Estado nutricional de pacientes portadores de cirrose hepática: relaçäo entre a gravidade da doença com a piora nutricional avaliada por indicadores antropométricos e bioquímicos / Nutritional status of patients carrier of liver cirrhosis: relationship betweem the severity of the disease and the nutritional aggravation evaluated by anthropometric and biochemical indicators

Com o objetivo de relacionar a gravidade do comprometimento hepático com o grau de desnutriçäo proteico-calórica foram estudados 53 pacientes, e sua maioria (75,5%), homens, todos acima de 26 anos, portadores de cirrose hepática, de etiologia preodmiantemente (81%) alcoólica. De acordo com a gravidade da doença os pacientes foram classificados, mediante parâmetros clínicos e laboratoriais, em Child A (19% dos casos), Child B (32%) e Child C (49%). A avaliaçäo do estado nutricional, feita por ocasiäo da primeira consulta, envolveu inquérito alimentar (recordatório de 24 horas), atropometria e exames laboratoriais. Quando comparados com os valores de referência verificou-se pela associaçäo dos indicadores antropométricos e bioquímicos que 57% dos pacientes eram desnutridos, ou com risco nutricional. Os indicadores ingestäo calórica, prega cutânea tricipital e pré-albumina sérica foram os que se mostraram mais intensamente relacionados com a piora da funçäo hepática seguidos da albumina, triptofano livre e linfócitos totais. O indicador nutricional mais fracamente relacionado com o estágio clínico da doença foi a ingestäo protéica; por outro lado 90% dos pacientes Child A apresentaram níveis baixos de proteína ligadora do retinol (RBP), esta taxa foi de 50% para a pré- albumina e para a circunferência muscular do braço. Portando, conclui-se que a desnutriçäo do cirrótico se caracteriza nos estágios clínicos iniciais como sendo protéica afetando tanto as proteínas viscerais como as somáticas. A deficiência calórica é progressiva, acompanhando o agravamento da disfunçäo hepática

Determinación de valores normales de fracciones séricas lábiles, de utilidad en estudios de nutrición / Determination of normal values of serum protein fractions, of utility in nutritional status

Con objeto de determinar los valores normales de fracciones séricas lábiles de utilidad en estudios de nutrición, por el método de inmunodifusión radial sobre acetato de celulosa, se relaciona, al azar, una población de mujeres entre 20-25 años, alumnas de la Cátedra de Nutrición de la Facultad de Farmacia y Bioquímica. Sobre esta muestra poblacional, se determina la concentración sérica de proteínas totales, transferrina, B lipoproteínas, prealbúmina,ceruloplasmina e inmunoglobulina A. Los resultados se comparan con los hallados en la bibliografía internacional.