ABSTRACT
A asma é uma das doenças crônicas de maior frequência na infância. Parcela significativa de crianças com asma desenvolve sintomas nos primeiros anos de vida, mas nem sempre a sua confirmação diagnóstica é fácil. Outras causas de sibilância que podem gerar confusão diagnóstica, além da complexidade para a obtenção de medidas objetivas, tais como a realização de provas de função pulmonar nessa faixa etária, são justificativas para esse fato. Especialistas na abordagem desses pacientes, da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria, após revisão extensa da literatura pertinente elaboraram esse documento, onde são comentados os possíveis agentes etiológicos, prevalência, diagnóstico diferencial, assim como tratamento e prevenção da sibilância e asma em pré-escolares.
Asthma is one of the most frequent chronic diseases in childhood. A significant portion of children with asthma develop symptoms in the first years of life, but diagnostic confirmation is not always easy. The difficulty is justified by other causes of wheezing that can generate diagnostic confusion, and by the complexity involved in obtaining objective measures such as pulmonary function tests in this age group. Specialists with expertise in the approach of these patients, from both the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics, after extensive review of the pertinent literature, developed this document to discuss possible etiological agents, prevalence, differential diagnosis, as well as treatment and prevention of wheezing and asthma in preschool children.
Subject(s)
Humans , Child, Preschool , Patients , Asthma , Societies, Medical , Respiratory Sounds , Guidelines as Topic , Pediatrics , Association , Respiratory Function Tests , Respiratory Syncytial Viruses , Retroviridae , Signs and Symptoms , Therapeutics , Bacteria , Chronic Disease , Prevalence , Enterovirus D, Human , Diagnosis, Differential , Allergy and Immunology , Age GroupsABSTRACT
Iron is an essential metal for cell survival that is regulated by the peptide hormone hepcidin. However, its influence on certain diseases is directly related to iron metabolism or secondary to underlying diseases. Genetic alterations influence the serum hepcidin concentration, which can lead to an iron overload in tissues, as observed in haemochromatosis, in which serum hepcidin or defective hepcidin synthesis is observed. Another genetic imbalance of iron is iron-refractory anaemia, in which serum concentrations of hepcidin are increased, precluding the flow and efflux of extra- and intracellular iron. During the pathogenesis of certain diseases, the resulting oxidative stress, as well as the increase in inflammatory cytokines, influences the transcription of the HAMP gene to generate a secondary anaemia due to the increase in the serum concentration of hepcidin. To date, there is no available drug to inhibit or enhance hepcidin transcription, mostly due to the cytotoxicity described in the in vitro models. The proposed therapeutic targets are still in the early stages of clinical trials. Some candidates are promising, such as heparin derivatives and minihepcidins. This review describes the main pathways of systemic and genetic regulation of hepcidin, as well as its influence on the disorders related to iron metabolism.
Subject(s)
Hepcidins/genetics , Hepcidins/metabolism , Iron Metabolism Disorders/genetics , Iron Metabolism Disorders/metabolism , Iron/metabolism , Anemia, Iron-Deficiency/genetics , Anemia, Iron-Deficiency/metabolism , Cation Transport Proteins/metabolism , Erythropoiesis , Gene Expression Regulation , Hemochromatosis/genetics , Hemochromatosis/metabolism , Hepcidins/blood , Homeostasis , Humans , Inflammation/genetics , Inflammation/metabolism , Oxidative StressABSTRACT
For human immunodeficiency virus (HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy (HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.
ABSTRACT
Hepatitis C virus (HCV) is endemic worldwide and according to the World Health Organization (WHO), there are about 150 million chronic carriers worldwide. The infection is a leading cause of liver diseases like cirrhosis and hepatocellular carcinoma (HCC); thus, HCV infection constitutes a critical public health problem. There are increasing efforts worldwide in order to reduce the global impact of hepatitis C through the implementation of programmatic actions that may increase the awareness of viral hepatitis and also improve surveillance, prevention, and treatment. In Brazil, about 1,5 million people have been chronically infected with HCV. The country has a vast territory with uneven population density, and hepatitis C incidence rates are variable with the majority of cases concentrated in the most populated areas. Currently, the main priorities of Brazilian Ministry of Health's strategies for viral hepatitis management include the prevention and early diagnosis of viral hepatitis infections; strengthening of the healthcare network and lines of treatment for sexually transmitted diseases, viral hepatitis, and AIDS; improvement and development of surveillance, information, and research; and promotion of universal access to medication. This review aims to summarize the available data on hepatitis C epidemiology and current status of efforts in prevention and infection control around the world and in Brazil.
Subject(s)
Hepatitis C/epidemiology , Brazil , Hepatitis C/prevention & control , Hepatitis C/therapy , Hepatitis C/transmission , HumansABSTRACT
BACKGROUND: Paraoxonase-1 (PON1) activity is suggested to be altered in individuals infected with human immunodeficiency virus type-1 (HIV-1). We investigated PON1 activity in individuals receiving different regimens of highly active antiretroviral therapy (HAART). METHODS: PON1 activity was evaluated in 91 HIV-1 seronegative and 624 HIV-1 infected individuals (115 were not undergoing therapy (ART-naïve), and 509 were receiving HAART). HIV-1 infected individuals were treated with the following: efavirenz (EFV; n = 195) or nevirapine (NVP; n = 95) or lopinavir/ritonavir (LOP/r; n = 219). Serum levels of total cholesterol (TC), HDL, and low-density lipoprotein (LDL) fractions and the atherogenic indices (AI, TC : HDL, and LDL : HDL ratios) were determined. RESULTS: PON1 activity (U/L) was lower in the ART-naïve group compared with the other groups. PON1 activity correlated with CD4+ T-cell number of ART-naïve group (r = 0,121; P = 0,014). The LOP/r group showed a reduction in HDL and an increase in AI (TC : HDL ratio) in comparison with other groups. CONCLUSION: PON1 activity was reduced in untreated individuals, but not in individuals receiving HAART. PON1 activity correlated with the number of CD4+ T-cells. The findings suggest that the activity of PON1 is associated with the immune status of HIV-1 infected individuals.
Subject(s)
Anti-HIV Agents/pharmacology , Aryldialkylphosphatase/blood , CD4-Positive T-Lymphocytes/drug effects , HIV Infections/enzymology , HIV-1/immunology , Adult , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/virology , Female , HIV Infections/drug therapy , HIV Infections/immunology , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Antibodies against low-density lipoproteins (LDLs) that have been oxidized are associated with development of atherosclerotic lesions. In individuals infected with human immunodeficiency virus type 1 (HIV-1) with or without therapy, dyslipidemia and increased cardiovascular risk are observed. METHODS: Serum levels of IgG antibodies against oxidized LDLs (IgG anti-oxLDL Abs) were determined by assay in 151 HIV-1-infected patients. Of these, 42 patients did not receive anti-retroviral therapy (ART-naïve), whereas 109 received highly active anti-retroviral therapy (HAART) consisting of lopinavir/ritonavir (LOP/r; n=50), efavirenz (EFV; n=30) and nevirapine (NVP; n=29) associated with nucleoside reverse transcriptase inhibitors. HIV-1 seronegative individuals (n=43) participated in the study. The following parameters were quantified: total cholesterol and its fractions, atherogenic indices (AIs), apolipoproteins A1 and B100, high sensitivity C-reactive protein, CD4+ and CD8+ T cells, and HIV-1-RNA. RESULTS: Levels of IgG anti-oxLDL Abs were significantly higher (p<0.05) in the LOP/r group compared with the EFV and/or NVP and the seronegative group: median 0.32 (0.15, 0.58; 95% confidence interval) vs. 0.25 (0.13, 0.53) vs. 0.18 (0.04, 0.38), respectively. HIV-1-infected ART-naïve patients (n=42) presented antibodies levels similar to those observed for the LOP/r group, 0.33 (0.13, 0.63; p>0.05). The levels of IgG anti-oxLDL Abs correlated with an increase in AIs (r=0.216; p=0.036) and triglycerides (r=0.220; p=0.044) in the LOP/r group, and AIs in the ART-naïve group (r=0.300; p=0.046). CONCLUSIONS: Patients treated with LOP/r showed higher levels of IgG anti-oxLDL Abs compared with patients treated with EFV or NVP regimens, and these levels were associated with an increase in AIs.
Subject(s)
Atherosclerosis/blood , Dyslipidemias/blood , HIV Infections/blood , HIV Infections/drug therapy , HIV-1/isolation & purification , Immunoglobulin G/blood , Lipoproteins, LDL/immunology , Protease Inhibitors/therapeutic use , Adult , Antiretroviral Therapy, Highly Active , Atherosclerosis/immunology , Atherosclerosis/virology , Female , HIV Infections/immunology , HIV Infections/virology , Humans , Male , Middle Aged , Risk Factors , Young AdultABSTRACT
The aim of our study was to evaluate the benefits of supplementation with 800 mg/day of alpha-tocopherol with regard to cellular viability in HIV-1 seropositive patients undergoing anti-retroviral therapy. A total of 29 patients participated in the study, of whom 14 were given the supplement and 15 a placebo. The analyses were carried out before treatment commenced and after 60, 120 and 180 days. The plasma levels of HIV-1 RNA showed a significant decrease as a consequence of treatment time in the groups studied (p = 0.0001), although the difference between the treatments over time was not verified (p = 0.7343). The percentage of viable lymphocytes showed a significant increase as a consequence of treatment time in both groups studied (p = 0.0002) and a significant difference between the treatments over time (p = 0.0472). The percentage of lymphocytes in apoptosis showed a significant reduction over time (p = 0.0003), as well as a significant difference between the treatments over time (p = 0.0321). The significant increase in cellular viability indicates that supplementation with alpha-tocopherol offers an additional positive effect on cellular preservation in HIV-1 individuals undergoing anti-retroviral therapy; however, it represents an additional risk of anti-retroviral therapeutic failure, possibly due to drug-drug interaction involving up-regulation of metabolic clearance.
Subject(s)
Anti-HIV Agents/therapeutic use , Antioxidants/therapeutic use , HIV Infections/drug therapy , HIV-1/drug effects , Lymphocytes/drug effects , alpha-Tocopherol/therapeutic use , Adult , Anti-HIV Agents/blood , CD4-CD8 Ratio , Cell Survival/drug effects , Dietary Supplements , Double-Blind Method , Drug Therapy, Combination , Female , HIV-1/genetics , Humans , Male , RNA, Viral/blood , alpha-Tocopherol/bloodABSTRACT
Realizou-se estudo retrospectivo de 72 pacientes com ferimentos traumáticos de reto, atendidos no Serviço de Cirurgia de Emergência do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, no período de julho de 1981 a julho de 1988. Quarenta e cinco pacientes (62,5%) foram vítimas de ferimento por arma de fogo, 14 (19,4%) por empalaçäo, dez (13,8%) por traumatismo fechado e três (4,1%) por ferimento por arma branca. A lesäo acometeu a porçäo intraperitoneal do reto em 32 pacientes (44,4%) e em 40 (55,5%) a porçäo extraperitoneal. A conduta adotada nas lesöes intraperitoneais foi sutura primária (14 pacientes), associada à colostomia (17 pacientes) e em um caso foi realizada cirurgia de Hartmann. Nas lesöes extraperitoneais, a conduta foi laparatomia com sutura do ferimento, colostomias e lavagem do cólon distal à colostomia e drenagem. A morbidade foi de 27,8%, sendo que a maioria das complicaçöes (70%) foram de natureza infecciosa. Sete pacientes faleceram (9,7%), quatro deles em conseqüencia à sepsis. Tanto a morbidade quanto a mortalidade pelos ferimentos do reto estiveram nitidamente relacionados à complicaçöes infecciosas decorrentes do atraso no diagnóstico. Por isso, achamos que todos os esforços devem ser concentrados no intuito de estabelecer o diagnóstico precoce
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Male , Female , Rectum/injuries , Wounds, Penetrating/surgery , Aged, 80 and over , Colostomy , Drainage , Emergencies , Foreign Bodies , Retrospective Studies , Wounds, Penetrating/complications , Wounds, Penetrating/mortalityABSTRACT
As hemorragias digestivas originárias do intestino delgado apresentam dificuldades diagnósticas quanto a topografia e etiologia. Os autores estudaram dois pacientes portadores de lesöes do intestino delgado, com hemorragia digestiva com manisfetaçäo básica. Graças à utilizaçäo do radiofármaco Tc99 puderam localizar o sangramento através da cintilografia abdominal. No caso de paciente com divertículo de Meckel houve captaçäo do Tc99m pela mucosa gástrica ectópica, permitindo inferir-se ser o mesmo responsável pelo sangramento. No outro caso, o escape de hemácias marcadas pelo Tc99m para o lume intestinal sugeria a localizaçäo da lesäo, que posteriormente, foi identificada, morfologicamente, através do trânsito intestinal. Ambos os casos foram operados, comprovando-se no primeiro paciente a existência do divertículo de Menckel e no segundo um leiomioblastoma, tumor raro da parede do intestino delgado. O tratamento consistiu em ambos da exérese de segmento intestinal com a lesäo. A propósito destes dois casos os autores comentam o papel dos diversos métodos diagnóstico por imagem e concluem pela grande importância das técnicas que utilizam os radiofármacos para a localizaçäo de lesöes sangrantes do intestino delgado
Subject(s)
Adult , Middle Aged , Male , Gastrointestinal Hemorrhage , Technetium , Meckel Diverticulum/complications , Gastrointestinal Hemorrhage/etiology , Intestine, SmallABSTRACT
Os autores apresentam a casuística da 3: Clínica Cirúrgica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo (16 casos), e da clínica privada de dois dos autores (3 casos), totalizando 19 casos de tumor de desmóide, sendo 13 desmóides abdominais, cinco extra abdominais e um intra abdominal. Realizam também revisäo bibliográfica sobre o assunto comparando seus dados com os da literatura e tecem comentários quanto à etiologia, incidência, localizaçäo, achados clínicos, diagnóstico, tratamento, evoluçäo e prognóstico dos tumores desmóides
Subject(s)
Middle Aged , Humans , Male , Female , Adult , Fibroma , Fibroma/diagnosis , Fibroma/etiologyABSTRACT
Os autores estudaram retrospectivamente 276 doentes internados na 3ª Clínica Cirúrgica do Hospital das Clínicas no período de Janeiro de l984 a Dezembro de l986, com idade igual ou superior a 65 anos. Em todos pacientes estudou-se doenças clínicas associadas e os índices de mortalidade. Cerca de 60% operados por doenças benignas predominando as hernioplastias, sendo os demais submetidos a intervençöes maiores por patologias biliares, gastrointestinais e oncológicas. As taxas de morbidade (50,1%) e de mortalidade (1,6%) säo semelhantes às encontradas na literatura. Apresentamos as regras a serem obedecidas no pré, intra e pós-operatória no manuseio do doente idoso com indicaçäo cirúrgica
Subject(s)
Aged , Male , Female , General Surgery , Postoperative Care , Preoperative Care , Risk Groups , Age FactorsABSTRACT
Descreve-se uma tática para realizaçäo de colangiografia operatória de controle após coledocolitotomia. A técnica proposta permite a remoçäo completa de bolhas de ar evitando interpretaçöes erradas das imagens radiográficas obtidas
Subject(s)
Cholangiography , Gallstones/surgery , Intraoperative CareABSTRACT
Os autores apresentam, uma revisäo objetiva das principais emergências resultantes da evoluçäo patogenética da doença péptica ulcerosa - gástrica e duodenal. As complicaçöes - perfuraçäo, sangramento e estenose pilórica - säo detalhadamente analisadas em seus diversos aspectos clínicos, quanto ao diagnóstico e orientaçäo terapêutica mais adequada, particularmente no que se refere ao tratamento conservador e à indicaçäo do tratamento cirúrgico
Subject(s)
Humans , Emergencies , Duodenal Ulcer/surgery , Stomach Ulcer/surgeryABSTRACT
Faz-se a revisäo de 416 prontuários de doentes portadores de hérnias inguinocrurais, internados na 3§ Clínica Cirúrgica do Hospital das Clínicas da FMUSP, no período de janeiro de 1978 a janeiro de 1981. Analisaram a incidência de hérnias nas diferentes idades, demonstrando predomínio de hérnias oblíquas externas no adulto. O estudo mostrou que a utilizaçäo de técnica operatória adequada para cada caso resultou em pequeno número de complicaçöes. A indicaçäo de deambulaçäo e alta precoces parecem näo ter aumentado o número de recidivas. Estas ocorreram em 12 doentes (3,2%), média que pode ser considerada baixa, dadas as peculiaridades dos doentes que nos procuram
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Hernia, Inguinal/surgery , Postoperative Complications , Recurrence , Intraoperative ComplicationsABSTRACT
Foi realizado um estudo duplo-cego, comparativo entre o tinidazol e placebo para se verificar o efeito profilático do tinidazol sobre infecçöes do pós-operatório de cirurgias abdominais em 40 pacientes submetidos à cirurgia do fechamento de colostomia temporária. Todos os pacientes receberam uma dieta sem resíduos por três dias e um preparo mecânico dos cólons com lavagem intestinal. Na véspera da cirurgia, 10-12 horas antes, os pacientes receberam placebo ou tinidazol, sob forma de comprimidos com idêntica aparência; a dose de tinidazol foi de 2 g (4 comprimidos), ingeridos em uma única tomada. A avaliaçäo dos pacientes no pós-operatório mostrou que no grupo tinidazol, ocorreram duas infecçöes cirúrgicas (10%) leves, enquanto que no grupo placebo ocorreram nove infecçöes (45%), sendo quatro delas severas e uma muito severa; esta diferença entre os grupos, foi significativa (p <0.05). No grupo placebo, isolaram-se 21 espécies bacterianas, das quais três eram anaeróbicas e apenas duas espécies aeróbicas foram isoladas no grupo tinidazol (p < 0.001). Nenhuma reaçäo adversa foi observada em ambos os grupos tratados. Conclui-se que este estudo comprovou o efeito profilático do tinidazol, sobre as infecçöes pós-operatórias, em pacientes submetidos à cirurgia de fechamento de colostomia
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Colostomy , Surgical Wound Infection/prevention & control , Tinidazole/therapeutic use , Clinical Trials as Topic , Double-Blind MethodABSTRACT
A dilataçäo cística das vias biliares intrahepáticas (DCVBI), conhecida como moléstia de Caroli, é uma afecçäo infreqüente passando muitas vezes desapercebida. Até hoje pouco mais de 100 casos foram descritos; os métodos mais modernos de investigaçäo e diagnóstico têm permitido, porém, a detecçäo mais freqüente desta anomalia. Teve-se oportunidade de tratar nos últimos anos três pacientes com DCVBI; discutem-se os diferentes aspectos concernentes ao diagnóstico e tratamento, confrontando-se seus resultados com as informaçöes na literatura. Em todos os três casos, os sintomas mais precocemente referidos foram dores em cólicas no abdome superior nos primeiros anos de vida. Em um destes pacientes as crises dolorosas estavam associadas à icterícia e febre, sendo que colangite prolongada acabou levando à uma cirrose biliar secundária e ao hipodesenvolvimento somático. No que tange ao tratamento, em dois pacientes foi realizada uma hepático-jejunoanastomose intrahepática e no terceiro uma hepatectomia esquerda. Nos dois pacientes de maior idade havia, por ocasiäo da cirurgia, cálculos no interior da via biliar dilatada
