ABSTRACT
The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.
RESUMEN: Indetectable = Intransmisible (I = I) comunica que las personas que viven con VIH (PVVIH) y reciben tratamiento antirretroviral (TAR) no transmitirán el VIH a sus parejas sexuales. En este estudio, describimos la concienciación sobre I = I entre las minorías sexuales y de género (MSG) de Brasil, México y Perú según el estado de VIH autoreportado (PVVIH, negativo, desconocido) durante 2021 utilizando una encuesta en línea. Se estimaron dos modelos mediante regresión de Poisson para cada grupo: Modelo A, que incluyó factores sociodemográficos (país, sexo, edad, raza, educación e ingresos) y Modelo B, que incluyó recibir TAR (para PVVIH) o comportamiento de riesgo, uso de PrEP y percepción de riesgo (para VIH negativo o desconocido). Se incluyó 21,590 encuestados (Brasil: 61%, México: 30%, Perú: 9%). Entre aquellos negativos para VIH (74%) y con estado desconocido (12%), el 13% utilizó alguna vez PrEP. Entre las PVVIH (13%), el 93% reportó recibir actualmente TAR. La concienciación de I = I fue del 89% tanto en Brasil como en México, superior al 64% de Perú. La concienciación de I = I fue mayor entre PVVIH (96%) que entre los VIH-negativos (88%) y los VIH-desconocidos (70%). En los modelos multivariados, las PVVIH con menor educación eran menos conscientes de I = I, mientras que los que tomaban TAR eran más conscientes. Entre los VIH-negativos, las personas no cisgéneros, con menores ingresos y con menor educación eran menos consciente de I = I, mientras que los que tenían experiencia usando PrEP eran más conscientes. En conclusión, la concienciación sobre I = I varió según el estado serológico de VIH, las características sociodemográficas y el comportamiento de riesgo. El concepto de I = I debe difundirse a través de estrategias educativas, incluyendo un enfoque en MSG para combatir el estigma del VIH.
Subject(s)
HIV Infections , Health Knowledge, Attitudes, Practice , Self Report , Sexual and Gender Minorities , Humans , Male , Female , HIV Infections/drug therapy , HIV Infections/psychology , HIV Infections/epidemiology , Adult , Brazil/epidemiology , Peru/epidemiology , Sexual and Gender Minorities/psychology , Sexual and Gender Minorities/statistics & numerical data , Middle Aged , Mexico/epidemiology , Young Adult , Adolescent , Sexual Behavior/psychology , Risk-Taking , Surveys and Questionnaires , Sexual Partners , Pre-Exposure Prophylaxis/statistics & numerical dataABSTRACT
Sickle cell disease (SCD) is an autosomal recessive genetic disorder. It is the most frequent structural hemoglobinopathy worldwide, and it is produced by an alteration in the globin chain genes. In Chile, there is no data on the prevalence of SCD since it is considered a very rare condition. The incidence of this disease has been increasing due to migration of people from areas with greater presence of SCD. It is important to know and consider this diagnosis in a selected group of patients with anemia, in order to prevent and treat the different complications of this disease. This article reviews the most recent information that shows new concepts in the knowledge of the physiopathology, and especially publications of guidelines and consensus in relation to the diagnosis and management of this con dition.
Subject(s)
Anemia, Sickle Cell , Anemia, Sickle Cell/diagnosis , Anemia, Sickle Cell/physiopathology , Anemia, Sickle Cell/therapy , Combined Modality Therapy , Diagnosis, Differential , Humans , PrognosisABSTRACT
La enfermedad de células falciformes (ECF) es un trastorno genético autosómico recesivo. Es la hemoglobinopatía estructural más frecuente en todo el mundo y se produce por alteración en los genes de la cadena de globina. En Chile, no hay datos sobre la prevalencia de la ECF ya que es considerada una condición muy rara. La incidencia de esta enfermedad ha venido aumentando debido a la migra ción de personas de áreas con mayor prevalencia de ECF. Por esta razón resulta importante conocer y considerar este diagnóstico en un grupo seleccionado de pacientes con anemia, para prevenir y tratar las diferentes complicaciones de la enfermedad. En este artículo se revisan los nuevos aportes en el conocimiento de la fisiopatología, con especial énfasis en aquellas publicaciones de consenso y guías relacionadas al diagnóstico y manejo de esta entidad.
Sickle cell disease (SCD) is an autosomal recessive genetic disorder. It is the most frequent structural hemoglobinopathy worldwide, and it is produced by an alteration in the globin chain genes. In Chile, there is no data on the prevalence of SCD since it is considered a very rare condition. The incidence of this disease has been increasing due to migration of people from areas with greater presence of SCD. It is important to know and consider this diagnosis in a selected group of patients with anemia, in order to prevent and treat the different complications of this disease. This article reviews the most recent information that shows new concepts in the knowledge of the physiopathology, and especially publications of guidelines and consensus in relation to the diagnosis and management of this con dition.
Subject(s)
Humans , Anemia, Sickle Cell/diagnosis , Anemia, Sickle Cell/physiopathology , Anemia, Sickle Cell/therapy , Prognosis , Combined Modality Therapy , Diagnosis, DifferentialABSTRACT
En el presente estudio se presentan los resultados de una investigación cualitativa cuyo objetivo fue reconstruir las Representaciones Sociales del abuso sexual intrafamiliar de mujeres adultas habitantes de dos comunas de la Región Metropolitana, Chile. Fueron entrevistadas 52 mujeres adultas: madres con hijos abusados sexualmente por un familiar o conocido cercano, mujeres sin hijos y mujeres con hijos sin ser abusados. Las entrevistas fueron transcritas textualmente y analizadas según los procedimientos metodológicos formulados por Glaser y Strauss en la Teoría Fundada Empíricamente. La sección resultados incluye un Análisis Descriptivo de la información recolectada, de la cual se desprenden cuatro categorías: antecedentes contextuales, antecedentes de género, experiencias de su historia sexual y reacción a la develación de abuso sufrida por un menor; Análisis Relacional entre los antecedentes y reacción; y finalmente un Modelo Hipotético Interpretativo donde se explican los factores asociados al abuso intrafamiliar en las mujeres adultas.
This study presents the results of a qualitative research whose objective was to reconstruct the social representations of intrafamilial sexual abuse of adult women living in two municipalities of the Metropolitan Region, Chile. We interviewed 52 adult women: mothers with children sexually abused by a family member or close acquaintance, childless women and women with children without being abused. The interviews were transcribed verbatim and analyzed according to the methodological procedures formulated by Glaser and Strauss in empirically grounded theory. The results section includes a descriptive analysis of the data collected, from which emerge four categories: contextual history, gender history, experiences of sexual history and reaction to the unveiling of abuse suffered by a minor; Relational Analysis between the background and reaction, and finally an Interpretive hypothetical model which explains the factors associated with domestic abuse in adult women.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Child Abuse, Sexual/psychology , Mothers/psychology , Social Perception , Self Concept , Chile , Interviews as Topic , Marital Status , Gender Identity , Qualitative Research , SociologyABSTRACT
BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. OBJECTIVES: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences. .
Subject(s)
Adenomatous Polyps/pathology , Colonic Neoplasms/pathology , Colonic Polyps/pathology , Rectal Neoplasms/pathology , Severity of Illness Index , Colonoscopy , Female , Humans , Male , Middle Aged , Neoplasm Grading , Prospective StudiesABSTRACT
ANTECEDENTES: Se ha descrito que las lesiones planas y deprimidas colorrectales, llamadas también no polipoides (LNP) tienen una histología más avanzada que las polipoides o protruidas (LP). OBJETIVOS: Comparar el grado de avance histológico de las LNP con el de las LP, a nivel del colon y recto. Validar el uso de un Índice de Avance Histológico (IAH) para objetivar estas diferencias. METODOLOGÍA: Estudio observacional, prospectivo, realizado en adultos programados a colonoscopía en un Centro Endoscópico privado de Lima- Perú. Dos grupos: 417 pacientes con LNP (planas, deprimidas y de crecimiento lateral o LST) y 405 pacientes con solo LP. RESULTADOS: 417/ 8,248 pacientes (5%) tuvieron LNP; 368 (4.5%) planas, 27(0.32%) deprimidas y 22(0.26%) LST. Según nuestro IAH, las lesiones planas y polipoides mostraron similar avance histológico. Las LST tuvieron una histología más avanzada y las deprimidas alcanzaron los valores más altos. Las lesiones planas tuvieron mayor tendencia que las polipoides a situarse en colon derecho (31% vs 22% p< 0.01), a presentar histología aserrada (9% vs 2% p< 0.01) y displasia de alto grado (5% vs 3% NS), pero menor tendencia al cáncer (0.2% vs 1% NS). Comparadas con las polipoides, las deprimidas tuvieron similar displasia de alto grado (3.7% /NS) pero una alta proporción de cáncer (18 % p < 0.01), mientras que las LST se localizaron sobre todo en colon derecho y recto, con componente velloso en 23% (p< 0.01) y displasia de alto grado en 32% (p< 0.01), pero no cáncer. CONCLUSIONES: Las lesiones planas mostraron un grado de avance histológico similar a las polipoides, pero las de crecimiento lateral si tuvieron una histología más avanzada y las deprimidas desarrollaron cáncer en una elevada proporción. El Índice de Avance Histológico fue una herramienta útil para comparar los grupos y resaltar sus diferencias.
BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. Objectives: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences.
Subject(s)
Humans , Colorectal Neoplasms , Colonic Polyps , Histological Techniques , Prospective Studies , Observational Studies as TopicABSTRACT
Medullary thyroid cancer can appear sporadically or as part of a multiple endocrine neoplasia type 2A or 2B. In both conditions, it is associated with mutations of proto oncogene RET (rearranged during transfection). We report a 14 years old male presenting with a bone lesion in the skull followed by a hard cevical mass. A CAT scan showed an invasive thyroid nodule with involvement of regional lymph nodes , osteolytic lesions in skull, spine and ribs and liver metastases. Serum calcitonin was markedly elevated (9752 pg/ml, normal below 14 pg/ml). Fine needle biopsy showed a medullary thyroid carcinoma and the patient was subjected to a total thyroidectomy and radical cervical dissection. In the postoperative period the patient required calcium and vitamin D supplementation. Serum calcitonin 15 days after surgery was 11.692 pg/ml. Palliative radiotherapy was indicated for spine pain. A percutaneous gastrostomy was indication for nutritional support. The molecular study did not detect mutations of RET gene between exons 10 and 16.
Subject(s)
Humans , Male , Adolescent , Carcinoma, Medullary/surgery , Carcinoma, Medullary/diagnosis , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Biopsy, Fine-Needle , Calcitonin/blood , Carcinoma, Medullary/pathology , /diagnosis , /diagnosis , Thyroid Neoplasms/pathology , Positron-Emission Tomography , Proto-Oncogene Proteins c-ret , Thyroidectomy , Tomography, X-Ray ComputedABSTRACT
El objeto del presente estudio fue analizar las dietas de 39 mujeres (edad media = 34.3 años; IMC medio = 26.2 kg/m²) sanas y con lactancia exclusiva, mediante Encuesta Dietética de Recordatorio de 24 horas y utilizando el software Dial®, centrándonos en el aporte diario de calcio y vitamina D. La población a estudio se agrupó en función de si su ingesta en calcio era mayor (no restrictivas) o menor (restrictivas) a la Ingesta de Referencia para la Población según la Unión Europea. Los resultados obtenidos revelaron inicialmente que en un 64 por ciento de dicha población (restrictivas) el aporte energético seguía una tendencia deficitaria, siendo de 2042.7 ± 458.3 kcal. Además su ingesta de calcio (812.4 ± 211.2 mg/día) fue inferior (p<0.01) a la recomendada, así como la ingesta en vitamina D, en donde su aporte diario también fue deficitario (1.71 ± 1.59 µg/día) respecto al resto de la población (no restrictivas). Tras estos resultados, se puede concluir que un alto porcentaje de estas madres se encuentra por debajo de las recomendaciones nutricionales durante su etapa de lactancia, siendo aconsejable que fueran informadas por los profesionales sanitarios sobre los hábitos alimentarios requeridos en este periodo.
The aim of this study was to analyze the diets of 39 healthy, lactating women (average age = 34.3 years; average BMI = 26.2 kg/m²) by a 24-hour dietary recall. This investigation was focused on calcium and vitamin D intake. Nutrients were estimated using the software Dial®. These participants were divided into calcium restrictors, defined as calcium intake <1200 mg/day, and non-restrictors (>1200 mg/day). The results showed that 64 percent of the study population (restrictors) reported a mean energy intake (2042.7 ± 458.3 kcal), calcium intake (812.4 ± 211.2 mg/day) and vitamin D intake (1.71 ± 1.59 µg/day) below the adequate intake level (AI) and lower than non-restrictors estimated intakes (p<0.01). The conclusion of this study is that a high percentage of the lactating women consume a diet below nutritional recommendations during this stage. It is recommended that health professionals should inform these mothers about the correct dietary habits during this period.
Subject(s)
Humans , Female , Adult , Breast Feeding , Calcium, Dietary , Dietary Minerals/analysis , Nutritional Status , Vitamin D Deficiency , Maternal NutritionABSTRACT
Las células madre son la base de la medicina regenerativa, cuyo objetivo es la reparación de tejidos dañados por diversas enfermedades. Células madre adultas se han identificado en una multiplicidad de tejidos y se usan en la actualidad en muchas áreas de la medicina. El uso mejor conocido es el trasplante de células hematopoiéticas que se utiliza desde hace décadas en el tratamiento de enfermedades hematológicas (leucemia). A pesar de las expectativas de la comunidad científica y los medios de comunicación, la mayoría de las otras aplicaciones de las células madre son experimentales. Múltiples barreras deben resolverse para su aplicación: integración a tejidos dañados y sobrevida prolongada en los mismos, proliferación de suficiente números de células para hacer esta función, diferenciación en las estirpes deseadas, entre otras. Una de las áreas de evaluación de terapia con células madre que ejemplifican estas dificultades es la reparación de tejido miocárdico dañado por enfermedad coronaria.
Stem cells are the basis of regenerative medicine, which focuses on the repair of damaged tissue resulting from various diseases. Adult stem cells have been identified in multiple tissues and are currently used in several areas of medicine. The best known use is the transplantation of hematopoietic stem cells, which has been ongoing for decades for the treatment of hematological diseases like leukemia. Despite great expectations in the scientific community and media, most clinical uses of stem cells remain experimental. Multiple biological barriers need to be overcome to incorporate these therapies: integration of stem cells into damaged tissues and long term functioning in them, proliferation of enough quantities of stem cells to repair tissue, differentiation into desired lineages, among others. One of the areas currently undergoing extensive evaluation of stem cell therapy is the repair of damaged miocardium secondary to ischemic heart disease.
Subject(s)
Humans , Stem Cell Transplantation , Hematopoietic Stem Cell Transplantation , Regenerative MedicineABSTRACT
Severe adenovirus (ADV) infections have become increasingly important in immunocompromised patients, mainly in pediatric stem cell transplant recipients. We report a case of disseminated ADV infection leading to death in a 12-year-old stem cell transplant recipient. The diagnosis was confirmed by viral isolation and viral genome detection in tissues and blood. Main issues associated with infection, diagnosis and therapeutic alternatives are reviewed. This case should alert clinicians to suspect and study this agent in high risk patients and highlights the importance of having antiviral drugs for ADV available in Chile.
Subject(s)
Adenovirus Infections, Human/diagnosis , Hematopoietic Stem Cell Transplantation/adverse effects , Immunocompromised Host , Adenovirus Infections, Human/immunology , Child , Fatal Outcome , Humans , Immunocompromised Host/immunology , Male , Severity of Illness IndexABSTRACT
Reversible posterior leukoencephalopathy syndrome (PLS) is characterized by headache, clouding of sensorium, visual disturbances and seizures. It is associated to hypertension, renal disease or immunosuppressive therapy. We report three males, aged 9, 12 and 16 years and one female, aged 5 years wih PLS associated to immunosuppressive therapy. All had seizures and three had headache and clouding of sensorium. One case was associated to an hypertensive emergency, one to liver failure and one to high tacrolimus levels. Magnetic resonance imaging showed lesions in the white matter in two patients and in the gray matter in the other two. The lapse between the start of immunosuppressive treatment and neurological symptoms ranged from 4 days to 6 months. All received antiepileptic drugs and immunosuppressive therapy was changed or decreased, with complete clinical recovery.
Subject(s)
Anticonvulsants/therapeutic use , Immunosuppressive Agents/adverse effects , Posterior Leukoencephalopathy Syndrome/chemically induced , Tacrolimus/adverse effects , Adolescent , Child , Child, Preschool , Female , Humans , Magnetic Resonance Imaging , Male , Posterior Leukoencephalopathy Syndrome/drug therapyABSTRACT
Las infecciones graves por adenovirus (ADV) tienen una importancia creciente en pacientes inmuno-comprometidos, en especial en niños sometidos a trasplante de precursores hematopoyéticos (TPH). Se reporta un caso de infección por ADV inicialmente gastrointestinal y luego diseminada, de curso fatal, en un niño de 12 años, post LPH. El diagnóstico se confirmó mediante aislamiento viral y detección de genoma viral en tejidos y sangre. Se revisan los principales aspectos de la infección por ADV, su diagnóstico y las posibilidades terapéuticas. Este caso debe alertar a los médicos clínicos para sospechar y estudiar este agente viral en pacientes de alto riesgo y enfatiza la importancia de disponer en Chile de antivirales para su tratamiento.
Severe adenovirus (ADV) infections have become increasingly important in immunocompromised patients, mainly in pediatric stem cell transplant recipients. We report a case of disseminated ADV infection leading to death in a 12-year-old stem cell transplant recipient. The diagnosis was confirmed by viral isolation and viral genome detection in tissues and blood. Main issues associated with infection, diagnosis and therapeutic alternatives are reviewed. This case should alert clinicians to suspect and study this agent in high risk patients and highlights the importance of having antiviral drugs for ADV available in Chile.
Subject(s)
Child , Humans , Male , Adenovirus Infections, Human/diagnosis , Hematopoietic Stem Cell Transplantation/adverse effects , Immunocompromised Host , Adenovirus Infections, Human/immunology , Fatal Outcome , Immunocompromised Host/immunology , Severity of Illness IndexABSTRACT
Reversible posterior leukoencephalopathy syndrome (PLS) is characterized by headache, clouding of sensorium, visual disturbances and seizures. It is associated to hypertension, renal disease or immunosuppressive therapy. We report three males, aged 9, 12 and 16 years and one female, aged 5 years wih PLS associated to immunosuppressive therapy. All had seizures and three had headache and clouding of sensorium. One case was associated to an hypertensive emergency, one to liver failure and one to high tacrolimus levels. Magnetic resonance imaging showed lesions in the white matter in two patients and in the gray matter in the other two. The lapse between the start of immunosuppressive treatment and neurological symptoms ranged from 4 days to 6 months. All received antiepileptic drugs and immunosuppresive therapy was changed or decreased, with complete clinical recovery.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Anticonvulsants/therapeutic use , Immunosuppressive Agents/adverse effects , Posterior Leukoencephalopathy Syndrome/chemically induced , Tacrolimus/adverse effects , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/drug therapyABSTRACT
The aim of this study was to analyze the diets of 39 healthy, lactating women (average age = 34.3 years; average BMI = 26.2 kg/ m2) by a 24-hour dietary recall. This investigation was focused on calcium and vitamin D intake. Nutrients were estimated using the software Dial. These participants were divided into calcium restrictors, defined as calcium intake < 1200 mg/day, and non-restrictors (> 1200 mg/day). The results showed that 64% of the study population (restrictors) reported a mean energy intake (2042.7 +/- 458.3 kcal), calcium intake (812.4 +/- 211.2 mg/day) and vitamin D intake (1.71 +/- 1.59 microg/day) below the adequate intake level (AI) and lower than non-restrictors estimated intakes (p < 0.01). The conclusion of this study is that a high percentage of the lactating women consume a diet below nutritional recommendations during this stage. It is recommended that health professionals should inform these mothers about the correct dietary habits during this period.
Subject(s)
Breast Feeding , Calcium, Dietary/administration & dosage , Diet/standards , Nutritional Requirements , Vitamin D/administration & dosage , Vitamins/administration & dosage , Adult , Diet/statistics & numerical data , Dietary Supplements/statistics & numerical data , Female , Humans , Lactation/physiology , Milk, Human/chemistry , Nutrition Assessment , Nutritional Status/physiology , Statistics, Nonparametric , Young AdultABSTRACT
Background: Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosupressive therapy (IT). Aim: To report the experience in the management of SAA. Patients and methods: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. Results: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. Conclusions: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Anemia, Aplastic/therapy , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Anemia, Aplastic/mortality , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Cyclosporine/therapeutic use , Follow-Up Studies , Immunosuppressive Agents/adverse effects , Methylprednisolone/therapeutic use , Prognosis , Risk Factors , Severity of Illness Index , Transplantation, Homologous , Treatment OutcomeABSTRACT
BACKGROUND: Wiskott-Aldrich syndrome (WAS) is an X linked congenital disease that presents as eczema, thrombocytopenia and immune deficiency. The only curative procedure for this illness is hematopoietic stem cell transplant (HSCT), preferably from a healthy HLA identical sibling donor. Cord blood is becoming an excellent alternative as stem cell source from unrelated donors. AIM: To report our experience with HSCT in children with WAS. PATIENTS AND METHODS: Six boys with WAS diagnosed at 1 to 6 months of age were transplanted at our institution. All of them developed eczema and thrombocytopenia. Two had episodes of severe bleeding and three had repetitive infections (two with recurrent pulmonary infections and one a recurrent otitis). Three patients had a positive family history. Two received HSCT from sibling donors and four from unrelated cord blood donors at 7 months to 4 years of age. RESULTS: AH 6 patients had full hematopoietic engraftment after transplantation. Three had mild chronic graft-versus- host disease which responded to immune suppressive therapy. One patient died of cytomegalovirus related pneumonia 111 days after grafting. The other 5 patients are alive and healthy 11 to 104 months after transplantation. CONCLUSIONS: HSCT is an effective treatment for patients with WAS. The procedure should be done as soon as diagnosis is confirmed and before life threatening infections occur.
Subject(s)
Cord Blood Stem Cell Transplantation , Hematopoietic Stem Cell Transplantation , Transplantation Conditioning , Wiskott-Aldrich Syndrome/surgery , Child , Child, Preschool , Cord Blood Stem Cell Transplantation/adverse effects , Fatal Outcome , Graft vs Host Disease/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Infant , Male , Thrombocytopenia/etiology , Treatment OutcomeABSTRACT
Background: Wiskott-Aldrich syndrome (WAS) is an X linked congenital disease that presents as eczema, thrombocytopenia and immune deficiency. The only curative procedure for this illness is hematopoietic stem cell transplant (HSCT), preferably from a healthy HLA identical sibling donor. Cord blood is becoming an excellent alternative as stem cell source from unrelated donors. Aim: To report our experience with HSCT in children with WAS. Patients and methods: Six boys with WAS diagnosed at 1 to 6 months of age were transplanted at our institution. All of them developed eczema and thrombocytopenia. Two had episodes of severe bleeding and three had repetitive infections (two with recurrent pulmonary infections and one a recurrent otitis). Three patients had a positive family history. Two received HSCT from sibling donors and four from unrelated cord blood donors at 7 months to 4 years of age. Results: AH 6 patients had full hematopoietic engraftment after transplantation. Three had mild chronic graft-versus- host disease which responded to immune suppressive therapy. One patient died of cytomegalovirus related pneumonia 111 days after grafting. The other 5 patients are alive and healthy 11 to 104 months after transplantation. Conclusions: HSCT is an effective treatment for patients with WAS. The procedure should be done as soon as diagnosis is confirmed and before life threatening infections occur.
Subject(s)
Child , Child, Preschool , Humans , Infant , Male , Cord Blood Stem Cell Transplantation , Hematopoietic Stem Cell Transplantation , Transplantation Conditioning , Wiskott-Aldrich Syndrome/surgery , Cord Blood Stem Cell Transplantation/adverse effects , Fatal Outcome , Graft vs Host Disease/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Thrombocytopenia/etiology , Treatment OutcomeABSTRACT
BACKGROUND: Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosuppressive therapy (IT). AIM: To report the experience in the management of SAA. PATIENTS AND METHODS: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. RESULTS: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. CONCLUSIONS: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis.
Subject(s)
Anemia, Aplastic/therapy , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Adolescent , Anemia, Aplastic/mortality , Child , Child, Preschool , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Cyclosporine/therapeutic use , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/adverse effects , Male , Methylprednisolone/therapeutic use , Prognosis , Risk Factors , Severity of Illness Index , Transplantation, Homologous , Treatment OutcomeABSTRACT
La enfermedad de von Willebrand (EVW) es la coagulopatía más frecuente en niños. Una de las principales complicaciones de la adenoamigdalectomía es la hemorragia. Debido a su patología de base, representan un gran desafío aquellos pacientes con EVW a quienes se efectúa esta cirugía. Desde hace algunos años, se utiliza desmopresina (DDAVP) para el manejo de esta patología. Se estudiaron restrospectivamente 15 pacientes pediátricos portadores de EVW tipo I, adenoamigdalectomizados en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Todos fueron hospitalizados y, previa medición del Factor VIII plasmático, se les proporcionó DDAVP. Una hora después de iniciada la infusión, se controló este factor. Si se incrementaba en 50 por ciento del valor basal, la cirugía se efectuaba sin aporte de hemoderivados; de lo contrario, se indicaba crioprecipitado. En ambos casos se utilizó ácido tranexámico como coadyuvante.La respuesta a DDAVP fue positiva en 13 pacientes (87 por ciento). En los 2 pacientes en quienes ésta no se observó se les suministró crioprecipitado. Todo el grupo estudiado evolucionó satisfactoriamente. No fue necesario utilizar crioprecipitado de apoyo o cirugías de revisión. Se concluye que DDAVP evita el uso de hemoderivados en la mayoría de los pacientes con EVW tipo I sometidos a adenoamigdalectomía, no posee efectos adversos relevantes y no aumenta los costos de la cirugía.
Subject(s)
Humans , Male , Adolescent , Female , Infant , Child , Deamino Arginine Vasopressin/therapeutic use , von Willebrand Diseases/drug therapy , Factor VIII/analysis , Chile , Postoperative Complications , Retrospective Studies , Hemorrhage , TonsillectomyABSTRACT
El tratamiento de la metrorragia postparto contempla enfoques quirúrgicos conservadores para aquellas pacientes en quienes se desea conservar la fertilidad. En ellas la ligadura de arterias hipogástricas muestra buenos resultados en el control del sangrado, además ha mostrado éxito en lograr embarazos posteriores. Se presenta un caso clínico manejado por los autores y se analiza la literatura disponible.