Fat-free mass depletion in patients with COPD in Brazil: development of a new cutoff point and its relation with mortality and extrapulmonary manifestations.

BACKGROUND/OBJECTIVES: None of the cutoff points for fat-free mass index (FFMI) were tested for the Brazilian population, and it is unknown whether the available ones are able to discriminate extrapulmonary disease manifestations. This cross-sectional study aims to develop and validate a cutoff point for FFM depletion based on Brazilian patients with chronic obstructive pulmonary disease (COPD) and to verify its association and of previously published cutoffs with extrapulmonary manifestations. SUBJECTS/METHODS: A new cutoff point was obtained from the best FFMI value for discrimination of preserved exercise capacity in a sample of patients (n=57). The discriminative capacity was assessed in another sample (n=96). The new cutoff point and other previously published ones were tested to discriminate low exercise capacity, physical inactivity, sedentary lifestyle and low quality of life. A receiver operation characteristics curve with area under the curve (AUC) value was plotted and each cutoff points' discriminative capacity was calculated. Cox regression and Kaplan-Meier method assessed the association between the cutoff points and mortality. RESULTS: The new cutoff points for FFMI were 14.65 kg/m2 for women (AUC=0.744; sensitivity (Se)=0.88; specificity (Sp)=0.60) and 20.35 kg/m2 for men (AUC=0.565; Se=0.36; Sp=0.81). The new cutoffs were the best to discriminate poor exercise capacity assessed by walked distance in % predicted and quality of life. Only the new cutoff point was associated with mortality (HR=2.123; 95% CI: 1.03-4.33, P=0.039, log rank P=0.035). CONCLUSIONS: Only the new cutoff point was associated with all-cause mortality, and it had the highest discriminating capacity for exercise capacity and quality of life in Brazilian patients with COPD.

Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations / Evaluación histoquímica de la destrucción de la pared del vaso y la selectividad después del tratamiento con luz pulsada intensa en las malformaciones capilares

BACKGROUND: Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES: To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS: Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS: Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS: IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS

ANTECEDENTES: Entre las distintas estrategias para intentar mejorar la eficacia en el tratamiento de las malformaciones capilares tipo mancha en vino de Oporto (MC tipo MVO) están las fuentes de luz pulsada intensa. Existen hasta la fecha pocos estudios clínicos que avalen su utilidad en el tratamiento de las MC. Además, no disponemos de estudios histológicos que objetiven los efectos de la luz pulsada en la coagulación de estos vasos anómalos. OBJETIVOS: Evaluar los efectos histológicos de la luz pulsada en las MC tipo MVO. Intentamos comparar el daño epidérmico, dérmico y de la pared de los vasos después del tratamiento con distintos parámetros de IPL. MATERIAL Y MÉTODOS: Fueron realizadas 55 biopsias postratamiento en las MC de 15 pacientes. Las muestras fueron teñidas con cloruro de nitroblue tetrazolium. RESULTADOS: Quince pacientes (edad media: 39 años) fueron inscritos en este estudio. En esta serie los pacientes con mayor daño epidérmico fueron aquellos con un fototipo más alto (>IV). Las malformaciones de color rosa pálido eran especialmente resistentes al tratamiento, incluso con altas fluencias, duraciones de pulso corto y pulsos repetidos. Los pulsos de una mayor duración fueron especialmente eficaces en malformaciones capilares violáceas. CONCLUSIONES: Los equipos de IPL ofrecen una gran cantidad de opciones de tratamiento en las MC, sin embargo necesitamos conocer mejor sus efectos para realizar abordajes más eficaces y seguros. En este estudio hemos podido observar los efectos histológicos de los distintos pulsos sobre las MC tipo MVO

Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations.

BACKGROUND: Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES: To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS: Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS: Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS: IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS.

Polysensitisation to rubber additives and dyes in shoes and clothes

No disponible

Allergic hypersensitivity to Deflazacort

No disponible

Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin.

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.

Safety and efficacy of chimeric yellow Fever-dengue virus tetravalent vaccine formulations in nonhuman primates.

To construct chimeric YF/DEN viruses (ChimeriVax-DEN), the premembrane (prM) and envelope (E) genes of yellow fever (YF) 17D virus were replaced with those of each wild-type (WT) dengue (DEN) virus representing serotypes 1 to 4. ChimeriVax-DEN1-4 vaccine viruses were prepared by electroporation of Vero cells with RNA transcripts prepared from viral cDNA (F. Guirakhoo, J. Arroyo, K. V. Pugachev, C. Miller, Z.-X. Zhang, R. Weltzin, K. Georgakopoulos, J. Catalan, S. Ocran, K. Soike, M. Ratteree, and T. P. Monath, J. Virol. 75:7290-7304, 2001; F. Guirakhoo, K. Pugachev, J. Arroyo, C. Miller, Z.-X. Zhang, R. Weltzin, K. Georgakopoulos, J. Catalan, S. Ocran, K. Draper, and T. P. Monath, Virology 298:146-159, 2002). Progeny viruses were subjected to three rounds of plaque purifications to produce the Pre-Master Seed viruses at passage 7 (P7). Three further passages were carried out using U.S. current Good Manufacturing Practices (cGMP) to produce the Vaccine Lot (P10) viruses. Preclinical studies demonstrated that the vaccine candidates are replication competent and genetically stable and do not become more neurovirulent upon 20 passages in Vero cells. The safety of a tetravalent vaccine was determined and compared to that of YF-VAX in a formal monkey neurovirulence test. Brain lesions produced by the tetravalent ChimeriVax-DEN vaccine were significantly less severe than those observed with YF-VAX. The immunogenicity and protective efficacy of four different tetravalent formulations were evaluated in cynomolgus monkeys following a single-dose subcutaneous vaccination followed by a virulent virus challenge 6 months later. All monkeys developed low levels of viremia postimmunization, and all the monkeys that had received equal concentrations of either a high-dose (5,5,5,5) or a low-dose (3,3,3,3) formulation seroconverted against all four DEN virus serotypes. Twenty-two (92%) of 24 monkeys were protected as determined by lack of viremia post-challenge. This report is the first to demonstrate the safety of a recombinant DEN virus tetravalent vaccine in a formal neurovirulence test, as well as its protective efficacy in a monkey challenge model.

Bilateral choroidal neovascularization (CNV) associated with optic nerve drusen treated with photodynamic therapy with verteporfin.

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT. (Eur J Ophthalmol 2004; 14: 434-7).

Hypertrichosis in systemic lupus erythematosus (SLE).

We describe a 14-year-old female with systemic lupus erythematosus (SLE) involving the skin, joints and central nervous system who developed hypertrichosis of the upper eyelashes. This clinical finding has been observed in immunocompromised patients with acquired immune deficiency syndrome (AIDS), malnutrition, cancer or kala-azar. Although the pathogenic mechanism for this type of hypertrichosis is unknown, we believe the immunological defects seen in SLE may be responsible for such manifestation in our patient.

Photorefractive keratectomy for myopia in 98 eyes.

Photorefractive keratectomy (PRK) was performed on 98 consecutive normal myopic eyes with the Summit OmniMed laser System. The minimum follow-up was 3 months and 31 were followed for 6 months. Preoperative myopia ranged from -1.25 to -12.00 D. The myopic eyes were divided into 4 groups according to the amount of myopia: group 1 (-1.25 to -3.00 D), 17 eyes; group 2 (-3.12 to -6.00 D), 42 eyes; group 3 (-6.12 to -9.00 D), 29 eyes and group 4 (> 9.00 D), 10 eyes. In group 1 mean uncorrected visual acuity was 0.87 at 3 months, 1.0 at 6 months and all of the eyes were within 0.50 D of the attempted correction. In group 2 mean uncorrected visual acuity was 0.76 at 3 months, 0.87 at 6 months and 92.3% of the eyes were within 0.50 D of the attempted correction. In group 3 mean uncorrected visual acuity was 0.65 and 0.66 at 3 and 6 months respectively and 77.8% of eyes were within 0.50 D of the attempted refractive correction. In group 4, mean uncorrected visual acuity was 0.46 and 0.7 at 3 and 6 months, respectively, and 100% were within 0.50 D of the attempted correction. Two eyes lost 2 lines and 4 eyes gained 2 or more lines of their preoperative best spectacle corrected visual acuity. Three eyes exhibited steroid induced rise in intraocular pressure that was controlled with topical timolol. No serious complications occurred. Despite the short follow-up, photorefractive keratectomy with the 193 nm excimer laser appears to be an effective and safe treatment for the correction of myopia.

HLA antigens and lymphocytes in proliferative vitreoretinopathy.

An immunohistopathological study was performed on 33 epiretinal membrane specimens obtained during vitreoretinal surgery from patients with rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy (PVR). Immunofluorescence and immunoperoxidase methods were used to detect major histocompatibility complex or HLA antigens and immunocompetent cells, and to identify the cellular and the extracellular component of the proliferative tissue. The following antigens were detected in epiretinal membranes: cytokeratin in 18 (of 18 cases studied for this antigen), glial fibrillary acidic protein in 20 (of 20), vimentin in 20 (of 20), actin in 16 (of 18), fibronectin in 20 (of 20), macrophage CD68 in 16 (of 18), leukocyte common antigen in 12 (of 18), T-cell CD45R in 13 (of 22), HLA-ABC in 27 (of 33), HLA-DR in all the 33 membranes and HLA-DR alpha chain in 32 of 33 membranes. We observed the presence of macrophages and of an activated T-cell population in PVR membranes. HLA-DR antigen expression was found on pigmented and nonpigmented epithelial cells and on mononuclear cells in all epiretinal membranes. The HLA-DR expression on retinal pigmented epithelial cells could play a role in triggering a local immune response in PVR. These findings suggest the involvement of immunological phenomena and probable interactions between the immune system and peptide growth factors.

Vitreous fluorophotometry studies in retinitis pigmentosa.

Six patients with various genetic types of retinitis pigmentosa and ten carriers of the X-linked recessive type were studied by vitreous fluorophotometry. Kinetic vitreous fluorophotometry showed an alteration of the blood-retinal barrier (BRB) in patients with retinitis pigmentosa, even in those who had minimal fundoscopic abnormalities and only minor changes on the electroretinogram. Furthermore, an alteration of the BRB could be detected in the carriers of the X-linked recessive form of retinitis pigmentosa. In general, higher concentration of fluorescein in the vitreous correlated topographically with the extent of photoreceptor and retinal pigment epithelial disease, as well as with the presence of leakage from retinal capillaries.

Breakdown of the blood-retinal barriers and cystoid macular edema.

After reviewing the definition, incidence and main etiologic factors of cystoid macular edema (CME) the authors analyze the structural and physiologic characteristics of the macular area, including the blood-retinal barriers, and the basic concepts of retinal edema. Personal observations on three different groups of diseases associated with CME, retinitis pigmentosa, pars planitis and aphakia, are presented. CME evaluation was made by slit-lamp microscopy, fluorescein angiography and vitreous fluorophotometry. In the situations examined, the main factors involved in CME formation appear to be a marked increase in blood-retinal-barrier barrier permeability and alterations in retinal tissue compliance.