ABSTRACT
Se describen como desafíos actuales en mucopolisacaridosis I la necesidad de una clasificación adecuada, vinculándola a las indicaciones terapéuticas; el diagnóstico temprano desde la pesquisa neonatal, sus ventajas y dificultades hasta la sospecha clínica de las formas grave y atenuada; el cuidado de la patología espinal y oftalmológica, desde el diagnóstico, el seguimiento y el tratamiento; las reacciones alérgicas por terapia de reemplazo enzimático, su diagnóstico y tratamiento. Por último, la transición hacia el cuidado adulto
Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Mucopolysaccharidosis I/diagnosis , Mucopolysaccharidosis I/therapy , Neonatal Screening , Mucopolysaccharidosis I/classification , Eye Diseases/diagnosis , Eye Diseases/therapy , Transition to Adult Care , Hypersensitivity/diagnosis , Hypersensitivity/therapyABSTRACT
Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care.
Se describen como desafíos actuales en mucopolisacaridosis I la necesidad de una clasificación adecuada, vinculándola a las indicaciones terapéuticas; el diagnóstico temprano desde la pesquisa neonatal, sus ventajas y dificultades hasta la sospecha clínica de las formas grave y atenuada; el cuidado de la patología espinal y oftalmológica, desde el diagnóstico, el seguimiento y el tratamiento; las reacciones alérgicas por terapia de reemplazo enzimático, su diagnóstico y tratamiento. Por último, la transición hacia el cuidado adulto.
Subject(s)
Hypersensitivity , Mucopolysaccharidosis I , Adult , Enzyme Replacement Therapy , Humans , Infant, Newborn , Mucopolysaccharidosis I/drug therapy , Mucopolysaccharidosis I/therapy , Neonatal ScreeningABSTRACT
Dados los avances sobre mucopolisacaridosis Icon posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario
Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up
Subject(s)
Humans , Mucopolysaccharidosis I/diagnosis , Mucopolysaccharidosis I/therapy , Pediatrics , Mucopolysaccharidosis I/etiology , Mucopolysaccharidosis I/genetics , AftercareABSTRACT
Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up.
Dados los avances sobre mucopolisacaridosis I con posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario.
Subject(s)
Mucopolysaccharidosis I , Argentina , Consensus , Humans , Mucopolysaccharidosis I/diagnosis , Mucopolysaccharidosis I/genetics , Mucopolysaccharidosis I/therapyABSTRACT
BACKGROUND: Allogeneic hematopoietic stem cell transplantation (AHSCT) represents the only curative treatment for the majority of pediatric patients with Myelodysplastic Syndrome (MDS). We aimed to evaluate overall survival (OS), disease-free survival (DFS), non-relapse mortality (NRM) and relapse incidence in children who underwent AHSCT for MDS in six institutions from Argentina. PROCEDURE: A retrospective analysis of 54 AHSCT was carried out in 52 patients (mean age: 9 years; range: 2-19; 35 males). RESULTS: MDS subtypes were refractory cytopenia of childhood (RCC) (n: 26, 50%), refractory anemia with excess blasts (RAEB) (n: 9, 18%), RAEB in transformation (RAEB-T) (n: 8, 15%) and juvenile myelomonocytic leukemia (JMML) (n: 9, 17%). At time of transplant, seven (13%) patients transformed to acute myeloid leukemia (AML) and two patients with RCC to RAEB. Donors were related in 32 cases (59%) and the stem cells source was: bone marrow (63%), peripheral blood (26%), and umbilical cord blood (11%). Five-year DFS and OS were 50% and 55% respectively; and for patients with JMML, 57% and 67% respectively. Cumulative incidence of NRM and relapse were 27% and 21% respectively. In the multivariate analysis, umbilical cord blood (HR 4.07; P = 0.025) and age ≥ 9 years at transplantation (HR 3.28; P = 0.017) were associated with lower OS; age and graft-versus-host disease (GVHD) had a higher NRM. CONCLUSIONS: In our series, more than half of the patients achieved long term OS with AHSCT. Less toxic conditioning regimens or more intensive GVHD prophylaxis could lead to better results in some children.
Subject(s)
Graft vs Host Disease/epidemiology , Hematopoietic Stem Cell Transplantation , Myelodysplastic Syndromes/therapy , Neoplasm Recurrence, Local/epidemiology , Adolescent , Adult , Argentina/epidemiology , Child , Child, Preschool , Female , Follow-Up Studies , Graft vs Host Disease/mortality , Humans , Infant , Male , Myelodysplastic Syndromes/mortality , Neoplasm Recurrence, Local/mortality , Prognosis , Retrospective Studies , Survival Rate , Transplantation Conditioning , Transplantation, Homologous , Young AdultABSTRACT
OBJECTIVE: To determine the prevalence of JAK2 V617F mutation and its clinical correlation in patients with chronic myeloproliferative disorders (CMD): polycythemia vera (PV), essential thrombocythemia (ET) and idiopathic myelofibrosis (IMF). MATERIALS AND METHODS: Detection of JAK2 V617F mutation by allele specific-PCR. RESULTS: One hundred and three patients with CMD were included in the study. JAK2 V617F distribution was PV 40/45 (89%), ET 30/43 (69%), and IMF 7/15 (47%). In PV and ET patients only, 18 had thrombosis at diagnosis and 12 during follow-up (these were microvascular: 11, venous: 7 and arterial: 12); of these 28/70 (40%) were JAK2pos versus 2/18 (11%) JAK2neg; P=0.02. In a median of 4 years, two patients with PV JAK2pos evolved to myelofibrosis and one patient with PV presented in leukemic transformation (JAK2pos before and after transformation); six patients died: four patients with IMF and two patients with PV. CONCLUSIONS: We found an association between JAK2 V617F and thrombotic events in patients with PV and ET.
Subject(s)
Alleles , Janus Kinase 2/genetics , Mutation, Missense , Myeloproliferative Disorders/genetics , Adult , Aged , Aged, 80 and over , Amino Acid Substitution , Chronic Disease , Female , Humans , Male , Middle Aged , Myeloproliferative Disorders/complications , Polymerase Chain Reaction , Prospective Studies , Thrombosis/etiology , Thrombosis/geneticsABSTRACT
Se presenta el caso de un paciente de sexo masculino, de un mes y medio de edad, con anemia hemolítica microangiopática y coagulopatía de consumo asociada a un hemangioma de rápido crecimiento (síndrome de Kasabach-Merritt). Se realiza una actualización diagnóstica y terapéutica de esta patología considerada de diferentes formas por otros autores
Subject(s)
Humans , Male , Infant , Hemangioma/complications , /therapeutic use , Tranexamic Acid/therapeutic use , Antifibrinolytic Agents/therapeutic use , Anemia, Hemolytic/etiology , Anemia, Hemolytic/drug therapy , Aspirin/therapeutic use , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/drug therapy , Cyclophosphamide/therapeutic use , Dipyridamole/therapeutic use , Hemangioma/diagnosis , Interferon-alpha/therapeutic use , Methylprednisolone/therapeutic use , Pentoxifylline/therapeutic use , Thrombocytopenia/drug therapy , Thrombocytopenia/etiologyABSTRACT
Se presenta el caso de un paciente de sexo masculino, de un mes y medio de edad, con anemia hemolítica microangiopática y coagulopatía de consumo asociada a un hemangioma de rápido crecimiento (síndrome de Kasabach-Merritt). Se realiza una actualización diagnóstica y terapéutica de esta patología considerada de diferentes formas por otros autores (AU)
