Contribution of the interferon-gamma release assay to tuberculosis diagnosis in children and adolescents.

SETTING: As conclusive data on the performance of interferon-gamma release assays (IGRAs) in paediatric TB are lacking, many guidelines do not recommend their use for TB diagnosis in this population in Brazil. OBJECTIVE: To evaluate the performance of an IGRA by investigating its concordance with the tuberculin skin test (TST) and the role of IGRAs in clinical management and treatment outcomes in children with TB. DESIGN: A historic cohort study was used to evaluate the performance of T-SPOT®.TB (ELISpot) and other tests, such as the TST, in paediatric patients with or without immunodeficiency who were under investigation for latent tuberculous infection (LTBI) or active tuberculosis (TB). RESULTS: Of 86 paediatric patients evaluated, 41 (48%) were immunocompetent and 45 (52%) immunocompromised. All patients underwent T-SPOT.TB, while 63 underwent both ELISpot and TST; test results were concordant in 50 patients (79.4%): 22/31 (71%) in immunocompetent (κ = 0.418, P = 0.02) and 28/32 (87.5%) in immunocompromised patients (κ = 0.526, P = 0.003). TB was diagnosed on the basis of the ELISpot result in 21% (18/86) cases; the contribution of the ELISpot assay was greater in immunocompetent patients than in those who were immunocompromised (13/41, 31.7% vs. 5/45, 11.1%, χ2 P = 0.038). CONCLUSION: ELISpot and TST results were moderately concordant in both groups of patients. ELISpot contribution was higher among immunocompetent patients than among immunocompromised patients.

New Radiation Dosimetry Estimates for [18F]FLT based on Voxelized Phantoms.

3'-Deoxy-3-[18F]fluorothymidine, or [18F]FLT, is a positron emission tomography (PET) tracer used in clinical studies for noninvasive assessment of proliferation activity in several types of cancer. Although the use of this PET tracer is expanding, to date, few studies concerning its dosimetry have been published. In this work, new [18F]FLT dosimetry estimates are determined for human and mice using Monte Carlo simulations. Modern voxelized male and female phantoms and [18F]FLT biokinetic data, both published by the ICRP, were used for simulations of human cases. For most human organs/tissues the absorbed doses were higher than those reported in ICRP Publication 128. An effective dose of 1.70E-02 mSv/MBq to the whole body was determined, which is 13.5% higher than the ICRP reference value. These new human dosimetry estimates obtained using more realistic human phantoms represent an advance in the knowledge of [18F]FLT dosimetry. In addition, mice biokinetic data were obtained experimentally. These data and a previously developed voxelized mouse phantom were used for simulations of animal cases. Concerning animal dosimetry, absorbed doses for organs/tissues ranged from 4.47 ± 0.75 to 155.74 ± 59.36 mGy/MBq. The obtained set of organ/tissue radiation doses for healthy Swiss mice is a useful tool for application in animal experiment design.

[The prevalence of anemia in pregnant women in their first visit to health centers of a metropolitan area, Brazil]. / Prevalência de anemia em gestantes de primeira consulta em centros de saúde de área metropolitana, Brasil.

Three hundred and sixty-three pregnant women enrolled in the Pregnancy Medical Care Program of S. Paulo Health Department from the district of Butantan, S. Paulo city, Brazil, were studied at the first routine consultation. At the time they were examined they were not given any medicine containing iron, folic acid or vitamin B12. Their average age was 25 and 65.9% belonged to families with a monthly per capita income below US$ 50.00. Only 3.1% had a per capita income above U$$ 150.00. The prevalence of anemia was 12.4%. The hemoglobin concentration (grams/dl) in the first trimester was significantly higher than in the second and third trimester of pregnancy. The prevalence of anemia in the first trimesters (3.6%) was significantly smaller than that found in the second (20.9%) and third semesters (32.1%). Those women who had had more than three gestations presented a higher prevalence of anemia than those with less than three, and the prevalence of anemia was higher in the group whose families had a monthly per capita income below US$ 25.00.

Early diagnosis of ABO haemolytic disease of the newborn.

To assess the usefulness of cord blood tests in diagnosing ABO-haemolytic disease of the newborn (ABO-HDN), 132 term, adequate for gestational age (AGA) neonates were evaluated. The tests studied and their significant results were: quantitative elution test (greater than or equal to 1/16), direct Coombs test (positive), bilirubin concentration (greater than or equal to 4 mg/dl). In none of the 56 O+ newborn infants delivered by O+ women were the results of any test positive. Of the 76 A+ and B+ newborn infants delivered by O+ women, 17 (22%) developed ABO-HDN. When the combined result of any two tests was positive, the sensitivity, the specificity and the positive predictive accuracy for the diagnosis of ABO-HDN was higher than for any one of the isolated tests. The probability that ABO-HDN was present when the results of at least two cord blood tests were positive was 70%, and the probability that ABO-HDN was not present when less than two cord blood tests gave positive results was 93%. It is suggested that the combination of quantitative elution test, bilirubin concentration and direct Coombs test in the cord blood is useful for an early diagnosis of ABO-HDN.

Tratamiento con cabergolina de un paciente con un macroadenoma hipofisario gigante clínicamente no funcionante: respuesta clínica, hormonal y reducción del tamaño tumoral / Cabergoline treatment in a man with a giant, clinically non-functioning pituitary macroadenoma: clinical and hormonal response and reduction in tumor size

La extensión extraselar de los tumores hipofisarios a la base del cráneo es poco frecuente. Comunicamos el caso de un varón de 52 años de edad con un macroadenoma hipofisario gigante clínicamente no funcionante y amplia extensión extrahipofisaria que se presenta con clínica lentamente progresiva, originada mayoritariamente por efecto masa (cefaleas, pérdida de conciencia y alteraciones campimétricas, del olfato y el gusto) y repercusión hormonal (hipogonadismo central, insuficiencia suprarrenal secundaria e hiperprolactinemia leve). La extraordinaria dimensión tumoral (con extensión supraselar al seno cavernoso izquierdo, al lóbulo temporal izquierdo, al clivus, al seno esfenoidal y a los espacios masticatorios bilaterales) hizo desestimar el abordaje quirúrgico, por lo que se inició tratamiento con cabergolina, un agonista dopaminérgico con afinidad por los receptores de dopamina D2, con una acción más selectiva, potente y duradera que la bromocriptina. A los 8 meses de iniciado el tratamiento se consiguió la normalización de los valores hormonales y una marcada reducción de la masa tumoral, efecto que prosiguió a lo largo de los 3 años de seguimiento de este paciente; en la actualidad persiste un pequeño resto tumoral, con normalidad de las imágenes obtenidas por resonancia magnética nuclear de la adenohipófisis y la neurohipófisis, el tallo y la cisterna supraselar. A propósito de este caso, se discute la posibilidad de tratamiento dopaminérgico de los adenomas hipofisarios gigantes, tanto macroprolactinomas como no funcionantes, así como las posibles estrategias predictoras de respuesta a éste, sus riesgos, sus efectos adversos a largo plazo y sus complicaciones en el tiempo (AU)