Efficacy of glutamine-supplemented parenteral nutrition on short-term survival following allo-SCT: a randomized study.

Fifty-three patients with hematological malignancies who underwent Allo-SCT from HLA-identical siblings were randomly assigned to receive glutamine-enriched parenteral nutrition-PN (GlPN, n=27) or standard PN (PN, n=26), in isonitrogenous solutions. Deaths (D+100 and D+180), infections, acute GVHD, length of stay, time of neutropenia and intestinal permeability (IP) were studied. Ages, gender, diagnosis, disease status and treatment variables were equally distributed between groups. Survival on D+180 was increased in GlPN (74%) vs PN (46%), P=0.03 (log-rank), as on D+100 (P=0.05). Most deaths occurred before D+100, especially in PN (10/26, 39%) vs GlPN (4/27, 15%). GVHD was the most frequent cause of death (8/21, 38%), especially in PN (n=6, five before D+100). Other outcomes were not affected. IP was affected on admission, was not affected by glutamine enrichment, but consistently worsened throughout the study. Results showed that GlPN was efficacious in increasing short-term survival after Allo-SCT. Benefits of glutamine seem to be independent of mucosal protection, as IP was not affected by its use. A trend to a lower incidence of GVHD deaths may suggest an immunomodulatory role of glutamine.

Trends in underweight, overweight and body mass index among elderly population of Brazil.

OBJECTIVE: To evaluate body mass index (BMI - kg/m2) trend of the elderly (superior 60 y) in the poorest (Northeast) and richest (Southeast) regions of Brazil. METHOD: Household surveys conducted in 1975, 1989 and 1997 measured weight and stature of a probabilistic sample of about 18,000 elderly people. Weighted prevalences were calculated and analysis took into account the sample design. RESULTS: In the entire period, the prevalence of overweight doubled reaching 37.4% for men and 50.6% for women in the most recent survey. Although there was an important reduction in the prevalence of underweight, these percentages were still high in the poorest region for both sexes in 1997 (13%). The increase in BMI in the period from 1975 to 1989 was significant for all subgroups, except for the men living in the rural area of the richest region, but this group was the only one that presented a significant increase in the BMI in the 1989--1997 period. CONCLUSIONS: Overweight has highly prevalent among the elderly. However there was no trend of increasing BMI in the last period, except for men living in the rural area of the richest region. Underweight is still an important nutritional problem in the poorest region.

Efficacy of oxamniquine and praziquantel in the treatment of Schistosoma mansoni infection: a controlled trial.

OBJECTIVE: To evaluate the therapeutic efficacy of oxamniquine and praziquantel, the two most clinically important schistosomicide drugs, and to compare the accuracy of faecal examination with the accuracy of oogram in testing for Schistosoma mansoni infection. METHODS: In a triple-masked and randomized controlled trial, 106 patients infected with S. mansoni were randomly allocated to one of three statistically homogeneous groups. One group was given 60 mg/kg praziquantel per day for three consecutive days, another was given two daily doses of 10 mg/kg oxamniquine, and the placebo group received starch. Faecal examinations (days 15, 30, 60, 90, 120, 150, and 180 after treatment) and biopsy of rectal mucosa by quantitative oogram (days 30, 60, 120, and 180) were used for the initial diagnosis and for evaluating the degree of cure. The chi2 test and the Kruskal-Wallis test were used to compare variables in the three groups. Survival analysis (Kaplan-Meier) and the log-rank test were used to evaluate the efficacy of the treatments. FINDINGS: The sensitivity of stool examinations ranged from 88.9% to 94.4% when patients presented with >5000 S. mansoni eggs per gram of tissue (oogram); when the number of eggs dropped to <1000 eggs per gram, sensitivity was reduced (range, 22.7-34.0%). When cure was evaluated by stool examination, oxamniquine and praziquantel had cure rates of 90.3% and 100%, respectively. However, when the oogram was used as an indicator of sensitivity, the oxamniquine cure rate dropped dramatically (to 42.4%), whereas the rate for praziquantel remained high, at 96.1%. CONCLUSIONS: Praziquantel was significantly more effective than oxamniquine in treating S. mansoni infection. The oogram was markedly more sensitive than stool examinations in detecting S. mansoni eggs and should be recommended for use in clinical trials with schistosomicides.

Whipple's disease. Report of five cases with different clinical features.

Whipple's disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.

[Schistosomiasis mansoni--drug treatment]. / Esquistossomose mansoni--tratamento medicamentoso.

It is the specific treatment of mansoni schistosomiasis that aims to act directed on the parasite, through chemotherapy. Constitutes fundamental indication to the treatment of schistosomiasis active forms, that is, these determined by the presence of living eggs in the feces or in material from rectal biopsy, since eventual contra indications are respected. Two are the medicaments actually used: oxamniquine, used in the single dosage of 15 mg/kg, V.O. for adults and 20 mg/kg V.O. for children divided in two doses, offers a percentage of 30 to 40% of cures, evaluated by quantitative "oogram" and praziquantel, in the single dose of 60 mg/kg V.O., presents a cure index of 30%, however in sequential doses, of 60 mg/kg during 3 days or 30 mg/kg, 6 days, cure percentage is elevated to 95%, evaluated by oogram. The evaluation of the treatment by quantitative or qualitative examination methods does not show the same sensibility. The percentage of cure according to feces examination, the quantitative of Kato-Katz or the qualitative (sedimentation), showed indexes from 90 to 100%, for either one of the drugs, even in single dose, which evidences the difference of methodology of therapeutic evaluation. Tolerance to both medicaments is from good to regular, with collateral effects in 30 to 40% of the patients.

Analytical characterization of urinary proteins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis in renal disease. Clinical and histopathological correlations.

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis is a method allowing the separation of proteins according to their molecular sizes. For this reason this method is rather useful for the classification of proteinurias as tubular, glomerular, or mixed. In the present study a good correlation was observed between the results of urine electrophoresis in sodium dodecyl sulphate-polyacrylamide gel and both clinical and histopathological data from 32 patients with different forms of renal disease.