Induction Therapy With Cisplatin, 5-Fluorouracil, Leucovorin, and Paclitaxel in Patients With Head and Neck Cancer.

BACKGROUND/AIM: This study aimed to evaluate the toxicities and response rate of a modified TPF (docetaxel, cisplatin, and 5-fluorouracil) protocol in patients with locally advanced head and neck cancer (ECOG performance status ≤1). PATIENTS AND METHODS: Induction treatment consisted of cisplatin 25 mg/m2/day as a 90 min infusion for three consecutive days, leucovorin 20 mg/m2/day as a bolus for four consecutive days, 5-fluorouracil (5-FU) 370 mg/m2/day as a bolus for four consecutive days, and paclitaxel 60 mg/m2 as a 1-h infusion on Days 1, 8, and 15, repeated every 3-4 weeks (twelve cycles to 6 patients). RESULTS: The main toxicities were grade 1 neuropathy, mucositis, and fatigue. There were four episodes of severe toxicities (grade ≥3). There was one early death, and 2 patients were discontinued due to hematological toxicity. Other side effects included neutropenia, nausea, diarrhea, and vomiting. CONCLUSION: Induction therapy with cisplatin, 5-fluorouracil, leucovorin, and paclitaxel in head and neck cancer is not feasible because of severe toxicity.

Challenging Diagnosis of Low-grade Fibromyxoid Sarcoma of the Chest Wall: Case Report / Diagnóstico Desafiador de Sarcoma Fibromixoide de Baixo Grau de Parede Torácica: Relato de Caso / Diagnóstico Desafiante de Sarcoma Fibromixoide de Bajo Grado de Pared Torácica: Informe de Caso

Introduction: Low-grade fibromyxoid sarcoma (LGFMS) is a rare special subtype of fibrosarcoma, it is more common in the trunk and proximal limbs. First described by Evans in 1987, this tumor is also named Evans tumor. Diagnosis of LGFMS may be quite challenging, either due to the low suspicion rate of the tumor or low specificity of its morphological pattern and immunohistochemical profile, a phenomenon that is magnified when tumor location is less usual, such as in the chest wall. The present article presents a challenging case of LGFMS of the chest wall. Case report: Female, 58-year-old patient was referred to the oncology referral clinic with a breast tumor. Diagnostic investigation included imaging tests (breast US and chest CT scan) and core needle biopsy. CT scan revealed the epicenter of the tumor in the left anterior thoracic wall. Biopsy to evaluate the histologic type of tumor was carried out and the result was inconclusive. Therefore, surgical excision of the tumor was performed. Histopathology and immunohistochemistry studies of the surgical specimen confirmed the diagnosis of LGFMS of the chest wall. Currently, after 36 months of the surgical excision, the patient is still doing well and continues under clinical follow-up. Conclusion: Although the diagnosis of LGFMS of the chest wall is challenging, it should be done correctly, since these cases require a long and thorough clinical follow-up

Introdução:O sarcoma fibromixoide de baixo grau (SFBG) é um subtipo especial de fibrossarcoma de ocorrência rara, sendo mais frequente em tronco e parte proximal dos membros. Esse tumor, primeiramente descrito por Evans em 1987, também pode ser chamado de "tumor de Evans". O diagnóstico de SFBG pode ser bastante desafiador tanto por ser um tumor pouco suspeitado como pelo fato de seu padrão morfológico e perfil imuno-histoquímico serem pouco específicos, fenômeno magnificado quando a localização é menos usual, como na parede torácica. O presente artigo apresenta um caso desafiador de SFBG de parede torácica. Relato do caso: Paciente, sexo feminino, 58 anos, foi encaminhada ao serviço de referência oncológica com tumor em região mamária. Realizou-se investigação diagnóstica com exames de imagens (ultrassonografia das mamas e tomografia computadorizada ­ TC de tórax) e biópsia por agulha grossa. A TC de tórax evidenciou que o tumor tinha epicentro na parede torácica anterior esquerda. Não houve conclusão sobre o tipo histológico do tumor. Foi realizada excisão cirúrgica. O histopatológico e a imuno-histoquímica da peça cirúrgica permitiram o diagnóstico de SFBG de parede torácica. Atualmente, 36 meses após a excisão do tumor, a paciente está bem e em seguimento clínico. Conclusão: Apesar de o diagnóstico de um SFBG de parede torácica ser desafiador, é importante realizá-lo adequadamente, uma vez que esses casos exigem um seguimento clínico longo e minucioso

Introducción: El sarcoma fibromixoide de bajo grado (SFBG) es un subtipo especial de fibrosarcoma de rara aparición, siendo más frecuente en tronco y parte proximal de las extremidades. Descrito por primera vez por Evans en 1987, este tumor también ha sido llamado tumor de Evans. El diagnóstico de un SFBG puede ser bastante desafiante, tanto porque es un tumor poco sospechado como porque su patrón morfológico y perfil inmunohistoquímico son poco específicos, fenómeno magnificado cuando la localización del tumor es inusual, como en la pared torácica. El objetivo de este estudio es informar un caso desafiante de SFBG de pared torácica. Informe del caso: Una paciente de 58 años con un tumor en la mama fue derivada al centro de referencia de oncología. La investigación diagnóstica incluyó pruebas de imagen (US de mama y TC de tórax) y biopsia con aguja gruesa. La TC de tórax reveló el epicentro del tumor en la pared torácica anterior izquierda. Se realizó biopsia del tipo histológico de tumor el y el resultado no fue concluyente. Por lo tanto, se realizó la extirpación quirúrgica del tumor. Los estudios de histopatología e inmunohistoquímica de la pieza quirúrgica confirmaron el diagnóstico de SFBG de pared torácica. Actualmente, a los 36 meses de la extirpación quirúrgica, la paciente sigue evolucionando bien y continúa en seguimiento clínico. Conclusión: Aunque el diagnóstico de un SFBG de pared torácica es desafiante, es importante realizarlo adecuadamente, ya que estos casos requieren un seguimiento clínico prolongado y exhaustivo

Carcinoma adenoide cístico cutâneo primário no couro cabeludo com metástases pulmonares: um relato de caso / Primary cutaneous adenoid cystic carcinoma in the scalp with pulmonary metastases: a case report

O carcinoma adenoide cístico cutâneo primário (CACCP) é um câncer extremamente raro, com uma taxa estimada de ocorrência de 0,23 caso/1.000.000 de pessoas ao ano. Paciente do sexo masculino, 60 anos de idade, apresentou lesão no couro cabeludo em 2017. Inicialmente, não foi possível realizar o diagnóstico histopatológico. Em 2018, biópsia e imuno-histoquímica indicaram tratar-se de CACCP (tratamento realizado com cirurgia e radioterapia). Em 2020, ocorreu nova recidiva local, sendo realizada ressecção cirúrgica. Paciente apresentou recidiva sistêmica (metástases pulmonares). Foi realizado tratamento quimioterápico. Atualmente, as metástases pulmonares estão estáveis e o CACCP progrediu para paquimeninges.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare tumor with an estimated incidence rate of 0.23 cases/1,000,000 people per year. A 60-year-old man presented a scalp lesion in 2017. Initially, it was not possible to perform a histopathologic diagnosis. In 2018, surgical biopsy and immunohistochemistry of the local skin recurrence indicated a diagnosis of PCACC (treatment was surgery and radiotherapy). In 2020, a new local tumor recurred and was surgically resected. The patient had systemic metastases (pulmonary metastases) and underwent chemotherapy. Currently, the pulmonary metastases are stable. The PCACC has progressed to pachymeninges

Malignant Phyllodes Tumor of the Breast: Case Report / Tumor Filoide Maligno de Mama: Relato de Caso / Tumor Phyllodes Maligno de Mama: Reporte de Caso

Introduction: Phyllodes tumors (PT) are rare and account for 0.3% to 0.5% of all breast tumors. PT may be classified as benign, borderline or malignant. The aim of this study was to report a case of malignant PT of the breast. Case report: A 27-year-old woman presented with a mass in the left breast with histopathological features of malignancy (results of US of the breast: an oval, lobulated hypoechogenic lesion, measuring 7.7 cm ­ BI-RADS® 4C). A segmental resection (SR) of the breast was performed and histopathology study of the surgical specimen confirmed a malignant PT. Adjuvant radiotherapy was used for supplemental treatment. One year later, the patient had a local recurrence of the primary tumor and underwent a new SR of the left breast. There was no indication of breast reirradiation. At about 31 months after diagnosis (September 2019 ­ April 2022), the patient is well and adherent to periodical clinical follow-up. Conclusion: This study presents a case of malignant PT that occurred in a young patient and had a more aggressive course

Introdução: Os tumores filoides (TF) são raros e representam entre 0,3% e 0,5% dos tumores de mama, podendo ser classificados como benignos, borderline ou malignos. O objetivo deste estudo foi relatar um caso de TF maligno de mama. Relato do caso: Mulher, 27 anos de idade, apresentando nódulo em mama esquerda com características histopatológicas de malignidade (resultados da ultrassonografia de mamas: lesão hipoecogênica, oval e lobulada, com 7,7 cm ­ BI-RADS® 4C). Foi realizada ressecção segmentar (RS) da mama e o histopatológico da peça cirúrgica mostrou tratar-se de um TF maligno. Como tratamento complementar, foi realizado radioterapia adjuvante. A paciente apresentou recidiva local do tumor primário em cerca de apenas um ano, sendo realizada nova RS da mama esquerda. Não houve indicação de reirradiação da mama. Em 31 meses após o diagnóstico (setembro de 2019 ­ abril de 2022), a paciente encontra-se em bom estado geral e realizando seguimento clínico periódico. Conclusão: Este estudo apresenta um caso de TF maligno que ocorreu em uma paciente jovem e teve um curso mais agressivo

Introducción: Los tumores phyllodes (TP) son poco frecuentes y representan del 0,3% al 0,5% de todos los tumores de mama. Los TP pueden clasificarse como benigno, limítrofe o maligno. El objetivo de este estudio fue reportar un caso de TP maligno de mama. Reporte del caso: Una mujer de 27 años se presentó con una masa en la mama izquierda con características histopatológicas de malignidad (resultados de la ecografía de mama: lesión hipoecogénica ovalada y lobulada, de 7,7 cm ­ BI-RADS® 4C). Se realizó una resección segmentaria (RS) de la mama y el estudio histopatológico de la pieza quirúrgica confirmó un TP maligno. Se utilizó radioterapia adyuvante como tratamiento complementario. Un año después, la paciente presentó una recidiva local del tumor primario y fue sometida a una nueva RS de mama izquierda. No hubo indicación de reirradiación mamaria. Aproximadamente 31 meses después del diagnóstico (septiembre de 2019 ­ abril de 2022), la paciente se encuentra bien y se adhiere al seguimiento clínico periódico. Conclusión: Este estudio presenta un caso de TP maligno que ocurrió en una paciente joven y tuvo un curso más agresivo. Palabras clave: neoplasias de la mama; tumor filoide; mastectomía

Use of lopinavir/ritonavir associated with ergotamine resulting in foot amputation: brief communication.

A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation.

Use of lopinavi//ritonavir associated with ergoamine resulting in foot amputattion: brief communicatoon / Uso de lopinavir/ritonavir associado com ergotamina resultando em amputação de pé: comunicação breve

A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation.

Mulher de 32 anos infectada pelo HIV 1, vinha utilizando zidovudina/lamivudina 300/150 mg um comprimido duas vezes ao dia e lopinavir/ritonavir 200/50 mg dois comprimidos duas vezes ao dia e profilaxia com sulfametoxazol-trimetoprim 800/160 mg uma vez ao dia, sem profilaxia com macrolídeos. A paciente apresentou enxaqueca severa com prescrição da associação tartarato de ergotamina 1 mg, cafeína 100 mg, paracetamol 220 mg, sulfato de hiosciamina 87,5 mcg, sulfato de atropina 12,5 mcg, dois comprimidos na crise, seguido de um comprimido a cada 30 minutos, com no máximo seis comprimidos ao dia. A paciente ingeriu seis comprimidos em um dia, surgindo uma dor em tornozelo esquerdo três dias depois, que evoluiu para ergotismo e amputação do pé.

Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy.

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy / Gota aguda como manifestação da síndrome inflamatória de reconstituição imune após início de terapia antirretroviral

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

A síndrome inflamatória da reconstituição imune (IRIS) observada quando do início da terapia antirretroviral em indivíduos com infecção pelo HIV envolve mais comumente manifestações novas ou piora clínica de desordens infecciosas, previamente subclínicas ou não. Muito mais raras são as descrições de casos de IRIS de natureza não-infecciosa, embora representem importantes desafios ao diagnóstico e tratamento. Neste relato descrevemos um paciente HIV-positivo do sexo masculino, de 34 anos, sem antecedentes de gota e que desenvolveu monoartrite de gota um mês após início de terapia antirretroviral de alta atividade.

Estudo dos transtornos cognitivos decorrentes da infecção pelo HIV-1 / Study of cognitive dysfunction in HIV-1 infected patients

A infecção pelo vírus da imunodeficiência humana atinge o Sistema Nervoso Central nos estágios iniciais, causando manifestações neuropsicológicas. Com o objetivo de estudar o desempenho de indivíduos infectados por este vírus em relação às funções cognitivas, foram avaliados 20 pacientes com contagem de linfócitos CD4+ acima de 200 células/mm³, utilizando-se a Escala de Inteligência Wechsler para Adultos. Destes, cinco (25 por cento) eram do sexo masculino e 15 (75 por cento) do sexo feminino, com média de idade de 39,65 desvio-padrão de 10,15 anos. A contagem média de linfócitos CD4+ foi 467,20 desvio-padrão de 215,45 células/mm?. Dentre quatorze pacientes que fizeram uso de terapia antirretroviral de alta atividade foi observado um caso com desempenho das funções cognitivas atenção e aprendizagem muito abaixo da média; os demais (n=13) tiveram desempenho dentro da média. Por meio da Escala de Inteligência Wechsler para Adultos foi possível detectar desempenho abaixo do nível médio do funcionamento cognitivo em indivíduos com resultado positivo para vírus da imunodeficiência humana, mesmo em vigência de terapia antirretroviral de alta atividade.

In its early stages, HIV-1 infection involves the Central Nervous System causing neuropsychological manifestations. With the aim of studying the cognitive functions in HIV-1-infected patients, a total of 20 patients infected with HIV-1 with CD4+ lymphocyte count >200 cells/mm³ were studied in accordance with the Wechsler Adult Intelligence Scale (WAIS-III). The present study comprised 20 patients, 5 (25 percent) male and 15 (75 percent) female, with a mean age of 39.65 and standard deviation of 10.15 years. The mean CD4+ lymphocyte count was 467.20 with a standard deviation of 215.45 cells/mm³. Amongst the 14 patients who received highly active anti-retroviral therapy (HAART), we noted 1 case in which the performance of the cognitive functions, attention span and learning, was considered to be very low according to WAIS-III, and the remaining (n=13) patients who were treated with HAART demonstrated a performance that was not considered to be outside of the WAIS-III mean. By using WAIS-III testing, it was possible to detect performance of the cognitive functions considered to be very low in HIV-1 infected individuals, even with those receiving HAART.

Estudo dos transtornos cognitivos decorrentes da infecção pelo HIV-1 / Study of cognitive dysfunction in HIV-1 infected patients

A infecção pelo vírus da imunodeficiência humana atinge o Sistema Nervoso Central nos estágios iniciais, causando manifestações neuropsicológicas. Com o objetivo de estudar o desempenho de indivíduos infectados por este vírus em relação às funções cognitivas, foram avaliados 20 pacientes com contagem de linfócitos CD4+ acima de 200 células/mm³, utilizando-se a Escala de Inteligência Wechsler para Adultos. Destes, cinco (25 por cento) eram do sexo masculino e 15 (75 por cento) do sexo feminino, com média de idade de 39,65 desvio-padrão de 10,15 anos. A contagem média de linfócitos CD4+ foi 467,20 desvio-padrão de 215,45 células/mm?. Dentre quatorze pacientes que fizeram uso de terapia antirretroviral de alta atividade foi observado um caso com desempenho das funções cognitivas atenção e aprendizagem muito abaixo da média; os demais (n=13) tiveram desempenho dentro da média. Por meio da Escala de Inteligência Wechsler para Adultos foi possível detectar desempenho abaixo do nível médio do funcionamento cognitivo em indivíduos com resultado positivo para vírus da imunodeficiência humana, mesmo em vigência de terapia antirretroviral de alta atividade.(AU)

In its early stages, HIV-1 infection involves the Central Nervous System causing neuropsychological manifestations. With the aim of studying the cognitive functions in HIV-1-infected patients, a total of 20 patients infected with HIV-1 with CD4+ lymphocyte count >200 cells/mm³ were studied in accordance with the Wechsler Adult Intelligence Scale (WAIS-III). The present study comprised 20 patients, 5 (25 percent) male and 15 (75 percent) female, with a mean age of 39.65 and standard deviation of 10.15 years. The mean CD4+ lymphocyte count was 467.20 with a standard deviation of 215.45 cells/mm³. Amongst the 14 patients who received highly active anti-retroviral therapy (HAART), we noted 1 case in which the performance of the cognitive functions, attention span and learning, was considered to be very low according to WAIS-III, and the remaining (n=13) patients who were treated with HAART demonstrated a performance that was not considered to be outside of the WAIS-III mean. By using WAIS-III testing, it was possible to detect performance of the cognitive functions considered to be very low in HIV-1 infected individuals, even with those receiving HAART.(AU)

Heavy metal pollution downstream the abandoned Coval da Mó mine (Portugal) and associated effects on epilithic diatom communities.

This study examined trace-element concentrations in 39 sediment samples collected in the vicinity of the abandoned Coval da Mó mine, and evaluated the anthropogenic contaminant effects and other environmental variables in the taxonomic composition, structure and morphological changes of benthic diatom communities. The results show the existence of extremely high contamination in Pb, Zn and Cd (the mean values exceed the background values 376, 96 and 19 times, respectively) on the first 2.5 km in the water flow direction. Also Co, Cu, Mn and Ni are present in high concentrations. Dilution by relatively uncontaminated sediment reduces metal concentrations downstream, but Zn concentrations increase downstream Fílvida stream, as a result of several factors such as sewage and agriculture. To evaluate the biological effects caused by Pb, Cd and Zn, three sites were selected. In the stressed environment, near the mining area (C232), diatoms were extremely rare, however there was a slight recovery at site C79 located 2km downstream. Fragilaria capucina var. rumpens, Fragilaria cf. crotonensis and Achnanthidium minutissimum showed abnormal valves which may be related to high levels of metals. Six km downstream, in Fílvida stream (C85), an increase in species richness and diversity was registered while the relative percentage of valve teratologies was lower. In the absence of OM, nutrients and low pH the diatom community patterns must be attributed to the metal concentration at some sites. Considering that community diversity can be affected by abiotic and biotic variables and valve deformations are caused by a small number of variables, basically metals, and acid conditions, we consider the presence of teratologies as an indication of the presence of metals.

Normal plasma antithrombin activity in patients with relapsing-remitting and secondary progressive multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is an inflammatory disease characterized by multifocal areas of central nervous system (CNS) demyelination. Activation of coagulation factors and fibrin deposition are observed around CNS blood vessels in experimental autoimmune encephalomyelitis, an animal model of MS. Antithrombin (AT) is a potent anticoagulant with remarkable anti-inflammatory properties, and its inhibitory effects on coagulation and inflammation may play a role in the pathogenesis and clinical course of MS. We studied the association between plasma AT activity and clinical forms of MS. PATIENTS AND METHODS: A total of 69 patients, 37 with relapsing-remitting and 32 with secondary progressive MS, were included in the study. A control group (CG) of 34 normal subjects was also studied. Plasma AT activity (Stachrom ATIII) was quantified using a chromogenic activity assay with normal reference values ranging from 70% to 120% of AT activity. RESULTS: We found no difference between plasma AT levels in patients and those in CG. We also found no association of AT levels with activity of disease, duration of disease progression, level of neurological disability, and treatment. CONCLUSION: We found no association between plasma AT activity and RRMS or SPMS. It remains to be studied whether exists or not an association between abnormal plasma AT activity and other MS forms.

[Prevalence of HIV-syphilis coinfection in a university hospital in the city of Rio de Janeiro in 2005]. / Prevalência da co-infecção HIV-sífilis em um hospital universitário da cidade do Rio de Janeiro no ano de 2005.

This was a study on the prevalence of HIV-syphilis coinfection among 830 HIV/AIDS patients who were being followed up as outpatients at a hospital in Rio de Janeiro between January and May 2005. The participants underwent laboratory tests at the venereal disease research laboratory (VDRL) consisting of CD4+/CD8+ cell counts and viral load tests. They answered questions about their sociodemographic characteristics and past medical history of syphilis. The prevalence of syphilis was 2.7% (22 patients) and the ratio between men and women with coinfection was approximately 4:1. Homosexual men were the category most affected. We did not find any association between coinfection and age, schooling and the laboratory parameters tested. Out of the total number of patients with syphilis, 73% (16) reported previous treatment; of these, 14 (88%) were reinfected, while two (12%) underwent inappropriate treatment. The presence of HIV-syphilis coinfection among patients undergoing routine follow-up signals the need to advise them to adopt safe sex practices, during their outpatient visits.

Highly aggressive squamous cell carcinoma in an HIV-infected patient

Formas altamente agressivas de carcinoma cutâneo de células escamosas vêm sendo reconhecidas como uma importante complicação da infecção pelo HIV. Descrevemos o caso de um paciente do sexo masculino, de 59 anos, que se apresentou com uma lesão altamente agressiva de SCC na região do couro cabeludo, com destruição do osso parietal subjacente e curso clínico fulminante.

Highly aggressive squamous cell carcinoma in an HIV-infected patient.

Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.

Reduction of electromyographic noise in the signal-averaged electrocardiogram by spectral decomposition.

This paper proposes a technique to improve the quality of high-resolution electrocardiogram by weighting the coherent average of beats by a function of the energy of the corrupting myoelectric noise, prior to subsequent detection of ventricular late potentials. The results obtained with 20 patients indicate the method requires fewer beats than conventional nonweighted average to achieve the same noise level.

Testing genotypic and phenotypic resistance in human immunodeficiency virus type 1 isolates of clade B and other clades from children failing antiretroviral therapy.

The emergence of resistance to antiretroviral drugs is a major obstacle to the successful treatment of human immunodeficiency virus type 1 (HIV-1)-infected patients. In this work, we correlate clinical and virological trends such as viral load (VL) and CD4 counts to genotypic and phenotypic antiretroviral (ARV) resistance profiles of HIV-1 isolates from the B and non-B subtypes found in vertically infected children failing ARV therapy. Plasma samples were collected from 52 vertically HIV-1-infected children failing different ARV therapies. Samples underwent HIV-1 pol sequencing and phenotyping and were clustered into subtypes by phylogenetic analysis. Clinical data from each patient were analyzed together with the resistance (genotypic and phenotypic) data obtained. Thirty-five samples were from subtype B, 10 samples were non-B (subtypes A, C, and F), and 7 were mosaic samples. There was no significant difference concerning treatment data between B and non-B clades. Prevalence of known drug resistance mutations revealed slightly significant differences among B and non-B subtypes: L10I, 21 and 64%, K20R, 13 and 43%, M36I, 34 and 100%, L63P, 76 and 36%, A71V/T, 24 and 0%, and V77I, 32 and 0%, respectively, in the protease (0.0001