Isolation, Characterization and Virulence Potential of Tenacibaculum dicentrarchi in Salmonid Cultures in Chile.

In this study, we isolated, identified and characterized isolates of Tenacibaculum dicentrarchi in Atlantic salmon (Salmo salar) farmed in Chile for the first time. In 2010 and 2014, mortalities were observed in Atlantic salmon (average weight 25-30 and 480-520 g, respectively) at an aquaculture centre in Puerto Montt, Chile. Severe tail rots, frayed fins and, in some cases, damaged gills were detected. Wet smear analyses of these lesions revealed a high occurrence of Gram-negative, filamentous bacteria. Microbiological analysis of infected gill and tail tissues yielded six bacterial isolates. All were identified as T. dicentrarchi through polyphasic taxonomy, which included phenotypic characterization, 16S rRNA sequencing and multilocus sequence typing. The latter method revealed a close relationship of the Chilean genotype with the T. dicentrarchi type strain and two Norwegian Atlantic cod (Gadus morhua) isolates. The pathogenic potential of the TdChD05 isolate was assessed by challenging Atlantic salmon and rainbow trout (Oncorhynchus mykiss) for one hour, which resulted in mean cumulative mortality rates of 65% and 93%, respectively, as well as clinical signs 14 days post-challenge. However, challenged Coho salmon (Oncorhynchus kisutch) presented no mortalities or clinical signs of infection. These findings indicate that the geographical and host distribution of T. dicentrarchi is wider than previously established and that this bacterium may have negative impacts on salmonid cultures.

Effect of zinc supplementation on the morbidity, immune function, and growth of low-birth-weight, full-term infants in northeast Brazil.

In Brazil, the highest incidence of low birth weight (LBW) occurs in the northeast, and diarrhea and respiratory infections are the main causes of infant mortality and morbidity. We hypothesized that LBW infants may be zinc deficient, and that this might be adversely affecting their immune function, morbidity, and postnatal growth. We therefore examined the effect of zinc supplementation on these outcomes during the first 6 mo of life. LBW full-term infants (mean birth weight 2337 g) were given daily for 8 wk either 5 mg Zn (n = 71), 1 mg Zn (n = 68), or a placebo (n = 66). Morbidity was determined prospectively through daily home visits (except on Sunday) during weeks 0-8, then twice weekly in weeks 9-26. Anthropometric measurements were made at 0, 4, 8, 17, and 26 wk. Immune function was assessed at 8 wk by the phytohemagglutinin skin test. Supplementation (5 mg Zn) was associated with a 28% reduction in diarrhea prevalence over the 6-mo period [after adjustment for confounders (P = 0.043)], and a 33% reduction in the prevalence of cough (NS, adjusted prevalence P = 0.073). All infants had a positive immune response at 8 wk. Although supplementation had no significant effect on weight and length gains from 0 to 26 wk, infants given 5 mg Zn gained more weight than infants given placebo during weeks 17-26 (P = 0.024, analysis of variance). There was no effect on any outcome with 1 mg Zn. We conclude that 5 mg Zn/d is of benefit to LBW, full-term infants who only have a modest weight deficit.

Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil.

OBJECTIVE: To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population. DESIGN: A prospective double-blind, part-randomised efficacy trial. SETTING: A low-income population in Pernambuco, northeast Brazil, where the economy is largely dependent on sugar-cane production, and where over 90% of deliveries occur in health facilities. SUBJECTS: During a 20-month period, all singleton, term infants weighing 1500-2499 g born to families of low income ( < US $280/month) were enrolled at birth (n = 205). At 6 and 12-months, the numbers tested were 163 and 138 respectively. INTERVENTION: Infants born from January 1993-January 1994 were randomly assigned to receive daily, except Sundays, a placebo (n = 66) or 1 mg zinc (n = 68). Those born February-August 1994 were given 5 mg zinc (n = 71). Supplementation was for eight weeks, starting at birth. Field workers visited each infant at home to administer the supplement. RESULTS: At 6 and 12-months, mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found. At 12-months, behaviour was also assessed on 5 ratings. Ratings were highest in infants given 5 mg zinc (P = 0.042). CONCLUSIONS: Zinc supplementation (5 mg/d) for eight weeks may reverse some of the poor behaviours, particularly responsiveness, exhibited by low birth weight infants. No amelioration of their mental and psychomotor deficits was found.

PIP: Severe zinc deficiency, widespread in developing countries, has been associated with cognitive and psychomotor impairment in animal studies. The capability of zinc supplementation, to reduce the deficits in mental development and behavior found in low-birth-weight term infants, was assessed in a prospective study conducted in a low-income community in Pernambuco, Brazil. All 205 singleton, term infants, delivered at the local hospital in a 20-month period and weighing 1500-2499 g at birth, were enrolled. Infants born from January 1993 to January 1994, were randomly assigned to receive either a placebo (n = 66) or 1 mg of zinc (n = 68) 6 days a week. The 71 low-birth-weight infants delivered from February to August 1994, were given 5 mg of zinc 6 days a week. Supplementation administered by local health workers was initiated at birth and lasted for 8 weeks. Mental and psychomotor development was measured at 6 and 12 months of age by the Bayley Scales of Infant Development. There were no significant differences between infants in the 3 study groups on this test. Also at 12 months, infant behavior was assessed on 5 scales. Ratings for one of these scales (responsiveness to tester) were significantly higher in infants who received 5 mg of zinc than in the 2 other groups, and the 5 mg zinc group also had the highest scores on the 4 other scales. Further studies are urged to investigate the effect of zinc provided later in life, and for longer periods of time, on the development of low-birth-weight infants.

[Anemias in preschool children: diagnosis, treatment and evaluation, Recife-PE, Brazil]. / Anemias em pre-escolares: diagnostico, tratamento e avaliação Recife-PE, Brasil.

The diagnosis and the effects of treatment of anemia were assessed in children aged 6-71 months. A total of 1,161 preschool children from a health center of INAMPS (Instituto Nacional de Assistência Médica e Previdência Social) in Recife, Pernambuco, was studied. Hemoglobin was determined by the method described by Hainline. WHO criteria were used to identify anemia. According to their age, nutritional status and family income, the children were divided into groups, and those with anemia were treated with ferrous sulphate and an anti-helminthic (mebendazole). Anemia prevalence was substantially higher in children aged 2 years, and a statistically significant association (0.01 level) was found between anemia and nutritional status and family income. After treatment, hemoglobin values were normal in 40% of the anemic children; simultaneously, mean hemoglobin values increased from 9.11 to 10.3 g/dl which was statistically significant (p less than 0.001). This investigation is part of a collaborative study performed in four Brazilian states to offer "know-how" to a national program for combating iron deficiency anemia.

[Nutritional status of children under 6, according to land tenure, in rural areas of the State of Pernambuco, Northeast of Brazil]. / Estado nutricional de crianças menores de seis anos, segundo posse da terra, em áreas rurais do Estado de Pernambuco, Nordeste do Brasil.

The purpose of this investigation was to analyze the distribution of protein-energy malnutrition, anemia and hypovitaminosis A in relation to accessibility and size of rural lands. About 689 families from the Agreste rural area (Pernambuco, North-East Brazil) were studied. A total of 1,257 children under 6 years of age were distributed in four groups according to the size of the land. The nutritional status was assessed according to the criteria of Gómez, Ariza-Macías and Seoane-Latham, modified by Batista Filho. In accordance with the Gómez' method, 55.1% of the children suffered from some degree of malnutrition. About 67.0% of the landless families suffered from malnutrition, in contrast to 25% of the landowners who had 50 or more than 50 hectares of land (p less than 0.01). Hemoglobin was determined in 976 children; 38.9% of them suffered from anemia. No significant differences were detected among the several groups of land tenants. Serum retinol levels were measured in 412 children and a high incidence of hypovitaminosis A was detected: 24% had serum retinol levels below 20 mcg/100 ml. No significant association was found in relation to the different land tenure groups. These data demonstrate a high prevalence of protein-energy malnutrition, anemia and hypovitaminosis A. A significant correlation between protein-energy malnutrition and the size of the land was also found, demonstrating that this region is one of the most affected by food and nutritional problems.

The influence of low birth weight body proportionality and postnatal weight gain on anthropometric measures of 8-year-old children: a cohort study in Northeast Brazil.

BACKGROUND/OBJECTIVES: Low birth weight (LBW) and rapid postnatal weight gain are associated with future high body adiposity; however, the cumulative effect of LBW and postnatal weight gain remains unclear. The aim of this study was to investigate the influence of body proportionality of LBW infants and postnatal weight gain on body mass index (BMI) and waist circumference (WC) of 8-year-old children. SUBJECTS/METHODS: A nested cross-sectional study was conducted in a cohort of children followed from birth to 6 months and reassessed at 8 years of age. The sample consisted of 167 children born at full term (67 with LBW and 100 with appropriate birth weight). Stunted LBW was defined as length <-2 z-score and wasted LBW as length ⩾ -2 z- score and Ponderal Index <2.5. Rapid growth was defined as weight gain greater than 0.67 s.d. score from birth to 6 months. Multivariate linear regression analysis was used to investigate the net effect of LBW and postnatal weight gain on BMI and WC, controlled for sex, total breastfeeding, socioeconomic status and maternal nutrition. RESULTS: The stunted and wasted LBW contributed significantly to the reduction of BMI and WC, and together explained 10% of the variation of these measurements. Rapid weight gain in the first 6 months of life, shorter total breastfeeding duration, higher socioeconomic status and maternal BMI significantly explained the increase in child BMI and WC. CONCLUSIONS: It was concluded that LBW led to lower body measurements, whereas rapid postnatal weight gain determined higher BMI and WC among school age children.

Risk factors associated with hepatic steatosis: a study in patients in the Northeast Brazil.

INTRODUCTION: Although there are several studies in the international literature regarding hepatic steatosis, few large-scale studies of risk factors are available. OBJECTIVE: To verify potential risk factors associated with hepatic steatosis, such as: alcohol consumption, overweight, dyslipidemia, hypertension, and type 2 diabetes mellitus. METHODS: This is a case series study including a control group (without hepatic steatosis), carried out at the gastroenterology outpatient clinic in Northeast Brazil. The sample was composed of 219 patients with hepatic steatosis and 82 without the disease. RESULTS: There was an association between hepatic steatosis and socioeconomic status. Prevalence Ratio (PR) for family income ≤ 2 minimum wage was (PR = 1.35 CI 95%, 1.18-1.54) and education level < primary education (PR = 1.44, CI 95%,1.27-1.64). Regarding anthropometric and clinical characteristics and lipid profile, there was an association with overweight (PR = 1.59, CI 95%, 1.38-1.83), abdominal circumference in the range of very high risk (PR = 2.28, IC 95%,1.68-3.09), hypertension (PR = 1.30, CI 95%, 1.15-1.48) and type 2 diabetes mellitus (PR = 1.23, CI 95%, 1.07-1.64), low HDL-cholesterol (PR = 1,96, CI 95%, 1.55-2.48), hypertriglyceridemia (PR = 2.10, CI 95%, 1.64-2.68). In the regression model three variables remained independently associated to hepatic steatosis, abdominal circumference in the range of very high risk (PRadjusted = 1.74), low HDL-cholesterol (PRadjusted = 1.39) and overweight (PRadjusted = 1.28). CONCLUSION: The results showed an association of hepatic steatosis with some risk factors, being abdominal circumference (very high risk) the most strongly associated, followed by low HDL-cholesterol and overweight.

Integración de plataformas tecnológicas por productos, entre la Universidad de Carabobo y el Sistema Público Nacional de Salud, mediante la estrategia de comunidades virtuales / Integration of technology platforms for products from the Carabobo University and National Public health system, through Virtual Communities Strategy

Esta investigación, propone la integración sistemática de las plataformas tecnológicas de la Universidad de Carabobo, en su Facultad de Ciencias de la Salud-Sede Aragua, con la del Sistema Público Nacional de Salud, a través del desarrollo de productos de las Nuevas Tecnologías de Información y Comunicación, en este caso, haciendo uso de la estrategia de comunidades virtuales. Las comunidades virtuales, constituyen espacios propicios de desarrollo de las redes sociales, que con la llegada de la Internet permiten su creación y progreso más allá del contexto físico. Se empleó la modalidad de proyecto factible, para el diseño de un prototipo de curso on line, considerado como experiencia piloto, para la enseñanza de la estrategia de comunidades virtuales, Grupos Yahoo - Facebook, como recurso de mediación de experiencias de aprendizaje en las Pasantías de Ejercicio Profesional en Ciencias de la Salud. Fundamentan la propuesta, principios de convergencia tecnológica, de encuentro de saberes, la necesidad de construcción de la ciudadanía digital en salud, la búsqueda de representaciones sociales de la tecnología, la inclusión digital de las comunidades para su autonomía y bienestar, implicando también el desarrollo de espacios virtuales de emancipación, que finalmente asienten una tecnología supeditada a lo humano, a la justicia social.

The research proposes the systematic integration of technology platforms at the Carabobo University, in its Health Sciences Faculty, Aragua headquarters with the National Public Health System, through out development by informational and communication technologies products. Also virtual community strategy was involved. Virtual communities constitute appropriate spaces for the development of social networks, that with the advent of the Internet allows the creation and development beyond the physical context. This approach used the feasible project modality. Here, it was developed an online course for teaching virtual communities strategy, as a learning mediation resource experiences in the Professional Internships Health Sciences Practice. Characterize the proposed system, the principles of technological convergence, the coming together of knowledge, the construction of digital citizenship and health technology search social representations, digital community inclusion destiny to their autonomy and welfare, virtual emancipation spaces development, finally settled all technology subject to the humanity and social justice.

Epidural analgesia in children: planning, organization and development of a new program.

BACKGROUND: The goal of the present work is to describe the development and results of the pediatric epidural analgesia program at the ''Hospital Nacional de Pediatria Prof. Dr. J. P. Garrahan'' in Argentina. METHODS: Patients with thoracotomy, abdominal surgery, osteotomy, amputations or severe trauma were included in the program. The program provided training to the entire staff, control and record of pain treatment and its consequences, 24 h a day availability of anesthesia staff and standard polices and procedures. RESULTS: One hundred fifty children under 16 years of age (median age 11 years, median weight 35 kg) were included in the program during the first 18 months. The median of maximum pain reported during activity was 1 (interquartile range 1 to 4 points) using the Visual Analogue Scale (VAS) or Objective Pain Scale (OPS). Eighty seven children (CI 95% 50% to 67%) presented with postoperative nausea and vomiting, urinary retention, itching, motor blockade or sedation. No patient presented with respiratory depression, hypotension, local anaesthetic toxicity, epidural catheter related infection or death during the program evaluation. The postoperative care program enabled a 98-day reduction in treatment in the intensive care unit. CONCLUSION: The safe use of pediatric epidural analgesia in general wards may require the careful selection of patients, systematic assessment by trained personnel, training of medical and nursing personnel, clear distribution of responsibilities, use of printed indications, systematic record of pain, sedation and complications, information and education of patients and parents, supply of systems for airway resuscitation and management and continuous quality control and revision of the methods.

Procedencia de pacientes diagnosticados en la unidad proyecto aragua: importancia para el programa de fibrosis quística / Origin of patients diagnosed in the proyect init aragua: relevace for cystic fibrosis program

La fibrosis quística es una enfermedad con patrón de herencia autosómico recesivo que afecta los sistemas respiratorio y digestivo en forma crónica y casi siempre subletal. En Venezuela han documentado que la frecuencia de la enfermedad es baja y la distribución no es homogénea. Este trabajo presenta la información sobre la procedencia geográfica según frecuencia de casos con Fibrosis Quística diagnosticados en la Unidad Proyecto Aragua de la Universidad de Carabobo, desde junio de 1993 a junio de 2008. A partir de la revisión de las historias clínicas de los pacientes que acudieron para la indagación de dicha enfermedad se tomaron los datos sobre sexo del paciente, edad al momento del diagnóstico, lugar de nacimiento de padres, abuelos y bisabuelos. Se diseñó el Índice de Procedencia para Fibrosis Quística. Se obtuvo 3,96% de positividad en los casos referidos y 76,2% se encuentran en edades entre 0 - 4 años. Se recibió referencia de 22 estados del país. El Indice de Procedencia de los estados de mayor a menor resultó en este orden Apure, Portuguesa, Anzoátegui, Lara, Trujillo, Guárico, Yaracuy, Carabobo y Aragua. Aparecieron otros focos: Siqui- Siqui en Lara, San Fernando y San Juan de Payara en Apure y Yaritagua, Aroa y Salom en Yaracuy. Las evidencias de epidemiología genética encontrados, pueden ser considerados por el Programa Nacional de Fibrosis Quística del Ministerio del Poder Popular para la Salud para el establecimiento de centros diagnósticos y el eventual programa de identificación.

Cystic fibrosis (CF) is a disease with autosomal recessive patron that affects the digestive and respiratory systems in chronic and almost always in sublethal form. Epidemiological studies in Venezuela have documented that the incidence of the disease is low and the distribution is not homogeneous. This paper presents information on the geographical origin of patients diagnosed in the Unidad Proyecto Aragua (UPA) of Universidad de Carabobo Sede Aragua (University of Carabobo, Aragua Campus), from June of 1993 to June 2008. After reviewing medical records of patients who came for the detection of CF data were taken from the patient's sex, age at diagnosis, birthplace of parents, grandparents and great grandparents. Was design the provenance index (IP) of CF. Was obtained 3,96% of positivity to CF in referred cases and 76,2% are aged 0 to 4 years. Reference was received from 22 states in the country. the (IP) of the states from high to low provenance result: Apure, Portuguesa, Anzoátegui, Lara, Trujillo, Guárico, Yaracuy, Carabobo and Aragua. Others outbreaks appeared: Siqui-Siqui in Barquisimeto, San Fernando, San Juan de Payara in Apure and Yaritagua, Aroa and Salom in Yaracuy. Arguments of genetic epidemiology found must be considered by the National Program for Cystic Fibrosis of the Ministry of People's Power for Health for the establishment of diagnosis centers and eventual neonatal identification program in areas of greater frequency that showed the study.

[Beta 2 microglobulin in some hematologic neoplasms]. / Beta 2 microglobulina en algunas neoplasias hematológicas.

Beta 2 microglobulin is a low molecular weight protein integrating the light chain HLA antigens. Its serum concentration is increased in different neoplasias and in renal failure. Using solid phase RIA we determined the concentration of beta 2 microglobulin in plasma and spinal fluid of 57 healthy individuals and patients with hematologic neoplasia. Serum levels were 1.34 +/- 0.34 mg/l and spinal fluid levels were 1.3 +/- 0.7 mg/l in healthy subjects. Serum levels in 29 patients with myeloma was 7.51 mg/l, significantly higher in those with renal failure (12.35 mg/l) compared to those without (4.54). In 30 patients with non-Hodgkin lymphoma the mean serum levels were 2.90 mg/l, significantly greater in those with active disease (3.18) than in those with remission (1.5). No difference was found according to the degree of malignancy. Patients with acute lymphatic leukemia had elevated values of beta 2 microglobulin while the disease was active (3.37 mg/l), decreasing to normal levels after remission (1.79 mg/l). Spinal fluid levels of beta 2 microglobulin were elevated only in patients with central nervous system involvement. Our results indicate that serum levels of beta 2 microglobulin are helpful in patients with hematologic neoplasia in assessing the activity of the disease and tumor mass, especially in multiple myeloma.

Postnatal growth patterns of full-term low birth weight infants in Northeast Brazil are related to socioeconomic status.

Low birth weight has many adverse consequences, some of which might be ameliorated if there is good postnatal compensatory, or catch-up, growth. We monitored growth, morbidity and feeding patterns in a cohort of 133 full-term, low birth weight infants from poor families in Pernambuco, Brazil, and investigated the relative contributions of a number of socioeconomic, maternal and infant variables to postnatal growth. Growth was measured at 4, 8, 17, 26 and 52 wk of age. Differential growth patterns were most marked during the first 8 wk of life, and the gains in z-score during this interval were strongly associated with attained z-scores at 12 months (r = 0.62 for weight and 0.64 for length). In a multivariate model, socioeconomic variables explained 21.4% of the variation in maximum gain in weight-for-age z-score achieved during the 12-month period, maternal weight explained a further 4.4%, infant birth length 4.7% and neonatal illness 5.4%. For maximum gain in length-for-age z-score, socioeconomic variables accounted for 24.4% of the variance, maternal height 4.9%, maternal smoking 3.3% and neonatal illness 3.1%. We surmise that the early differential growth patterns are set in utero and are indirectly affected prenatally by socioeconomic status.

[The influence of technological progress on perinatal indices in the central area of Santiago]. / Influencia del progreso tecnológico en los indices perinatológicos en el Area Central de Santiago.

PIP: The authors investigated the global and adjusted rates of early neonatal mortality, perinatal mortality, stillbirth rates, and low birthweight rates, all occurring between 1975-81 in the Central Health Area of Santiago. While these parameters are compared with national and international indicators, significant advances can be observed in these levels. The authors point out that this can be accounted for by the modern technology utilized in the neonatal units, along with a significant decrease in the incidence of premature births. At the Obstetrical and Gynecological Service, Hospital P. Jaraquemada, the rate of premature births (below 2500 g) was 6.1% in 1981, the lowest level ever observed. (author's modified)^ieng

Low birth weight and morbidity from diarrhea and respiratory infection in northeast Brazil.

OBJECTIVE: To compare morbidity and mortality rates of low birth weight (LBW) and appropriate birth weight infants born at term, focusing on diarrheal and respiratory infections. STUDY DESIGN: A cohort of 133 LBW infants (1500 to 2499 gm) and 260 appropriate birth weight infants (3000 to 3499 gm), individually matched by sex and season of birth, were followed for the first 6 months of life. None had congenital anomalies and all were from poor families living in the interior of Pernambuco, northeast Brazil. Data on infant deaths, hospitalizations, and morbidity were collected prospectively through daily home visits (except Sundays) from birth through week 8, then twice weekly for weeks 9 to 26. The effects of birth weight were assessed with a variety of multivariable techniques, controlling for confounders. RESULTS: Of the LBW infants, 56% were wasted (thin), 23% were stunted, and 17% were both wasted and stunted. The LBW infants (median 2380 gm) experienced a sevenfold higher mortality rate and fourfold higher rate of hospitalization than appropriate birth weight infants. Almost all deaths and hospitalizations were in the postneonatal period. The LBW infants also experienced 33% more days with diarrhea and 32% more days with vomiting (p = 0.003 in each case). The prevalences of cough and fever were not significantly different. CONCLUSIONS: Infant deaths, hospitalizations, and diarrheal morbidity are increased in term LBW infants who have only a modest weight deficit.

PIP: During January-December 1993, in the interior of Pernambuco State, northeast Brazil, researchers recruited 133 low birth weight (LBW) (1500-2499 g) infants and 260 sex- and birth season-matched controls of appropriate birth weight (ABW) (3000-3499 g) from the maternity wards of hospitals in five communities. All infants were randomly assigned to receive either 1 mg zinc/day for 8 weeks or a placebo. All infants came from low income families. The researchers compared their morbidity, especially diarrhea and respiratory tract infections, and mortality rates during the first 6 months of life. Zinc supplement had no effect on any of the outcome measures. LBW infants were more likely than ABW infants to die (7.5% vs. 0.8%; adjusted hazard rate ratio [AHRR] = 6.58; p = .006) and to be hospitalized (24.8% vs. 6.5%; AHRR = 4.09; p .001) during the first 6 months of life. Yet the rate of consultations with medical personnel was essentially the same for both groups. 90% of the LBW deaths occurred in the postneonatal period, the underlying causes being diarrhea and respiratory infections. For both LBW and ABW infants, diarrhea was the main cause of hospitalization. Both groups experienced little diarrhea during the first 6 weeks of life. Thereafter, LBW infants suffered a higher prevalence of diarrhea than ABW infants up until 5 months. Beginning with day 1, LBW infants experienced more vomiting than ABW infants. Both groups experienced increasing rates of cough and fever throughout the 6-month period. Differences between the two groups were less pronounced than they were for diarrhea or vomiting. LBW infants were more likely to be sick longer with diarrhea and vomiting than ABW infants (p .001), but the difference in prevalence was less significant (p = .043). The onset of diarrhea was strongly associated with feeding mode (hazard rate ratio = 1.56 for partially breast-fed infants and 2.34 for infants no longer breast fed; p .001) as was the onset of vomiting (0.95 and 1.86, respectively; p .001 for the latter). LBW infants suffered more deaths, hospitalizations, and diarrhea morbidity than ABW infants.

[Myelodysplasias: clinical experience with 35 patients]. / Mielodisplasias: experiencia clínica en 35 pacientes.

Myelodysplasia, characterized by varied reductions of peripheral blood elements with normal or hypercellular bone marrow, is relatively frequent among older patients and may evolve to acute leukemia. We reviewed findings in 35 patients whom, according to the FAB classification were distributed as follows: simple refractory anemia (RA) 34%, sideroblastic refractory anemia (SRA) 14%, refractory anemia with excess blast forms (RAEB) 31%, chromic myelomonocytic leukemia (CMML) 12% and refractory anemia with excess blast forms in transformation (RAEBT) 9%. Cytogenetic studies performed in 16 patients were abnormal in 5 (31%), all among patients with poor prognosis forms of the disorder. All patients had anemia; thrombopenia and neutropenia were more frequent in subtypes RAEB, CMML and RAEBT). Mean survival rate was 30 months, significantly greater in RA and SRA compared to the other groups. Infections and development of acute leukemia were the causes of death.

[Cytogenetic studies in myelodysplasias]. / Estudios citogeneticos en mielodisplasias.

Cytogenetic studies were performed in 29 patients with myelodysplasia, 12 males and 17 females with a mean age of 61 years. The distribution of patients according to FAB groups were as follows: refractory anemia (RA) 7, sideroblastic refractory anemia SRA) 6, refractory anemia with excess blasts (RAEB) 12 and refractory anemia with transformation excess blasts (RAEB-t) 4. Cytogenetic anomalies were found in 48% over all, 78% in patients with RAEB and RAEB-t forms and only 23% in patients with simpler forms of myelodysplasia. Multiple and complex chromosomal alterations were found in 50% of abnormal studies, only in patients with complex forms. In general, structural rearrangements and deletions were less frequent than numeric defects, with a slight preponderance of chromosomal losses. Alterations of chromosomes 5, 7, 28, 21, 22, 8, 11 and 15 were the most commonly observed. Survival was decreased from 60 months in patients with normal karyotype to 6 months in those with chromosomal alterations. Thus, chromosomal abnormalities are related to excess blasts and to survival in patients with myelodysplasia.

[Chronic myeloid leukemia: cytogenetic and molecular study and its relationship with the disease course]. / Leucemia mieloide crónica: estudio citogenético y molecular y su relación con la evolución de la enfermedad.

The aim of this study was to perform a cytogenetic and molecular study in patients with chronic myelogenous leukemia and to seek a possible relation between bcr gene break points and the clinical evolution of the disease. The cytogenetic study allowed to establish the presence of Ph chromosome and the molecular study localized the break point in bcr region of chromosome 22 using the Southern technique, hybridizing with bcr fragment derived probes bcr1 and bcr2. Forty eight patients were studied, 27 male (aged 46.5 years) and 21 female (aged 56). Forty seven patients were Ph +. A rearrangement in 3' bcr region was found in 25 patients and in 5' region in 23. During the follow up period 20 patients developed a blast crisis or accelerated phase. In 11 of these the rearrangement was in region'3 and their chronic phase lasted a mean of 33.1 months; in 9 the rearrangement was in region 5' and their chronic phase lasted 44.1 months. There were no differences in event-free survival between those with rearrangement in region 3' or 5', however these was a tendency towards a longer chronic phase duration in those with 5' breaks. The lack of correlation between the location of break points and the evolution of the disease may be due to a selection of patients with a better evolution and the exclusion of those with a rapid progression to blast crisis or accelerated phase.