RESUMO
BACKGROUND AND AIM: The best strategy for managing patients with resolved hepatitis B virus infection (HBsAg negative, anti-HBc antibodies positive with or without anti-HBs antibodies) and hematological malignancies under immunosuppressive therapies has not been defined. The aim of this study was to prospectively analyze the risk of hepatitis B virus reactivation in these patients. MATERIAL AND METHODS: Twenty-three patients (20 positive for anti-HBs) were enrolled. Eleven patients underwent hematopoietic stem cell transplantation (autologous in 7 cases, allogeneic in 4 cases) while the remaining 12 were treated with immunosuppressive regimens (including rituximab in 9 cases). RESULTS: During the study no patient presented acute hepatitis. However, three anti-HBc/anti-HBs positive patients who were treated with allogeneic hematopoietic stem cell transplantation demonstrated hepatitis B virus reactivation within 12 months from transplant. No one of the remaining patients showed hepatitis B virus reverse seroconversion. CONCLUSIONS: Allogeneic hematopoietic stem cell transplantation is a high risk condition for late hepatitis B virus reactivation in patients with resolved infection. Reverse seroconversion seems to be a rare event in anti-HBc/anti-HBs positive patients submitted to autologous hematopoietic stem cell transplantation or systemic chemotherapy with or without rituximab.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Vírus da Hepatite B/patogenicidade , Hepatite B/virologia , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Ativação Viral , Adulto , Idoso , Antivirais/uso terapêutico , Biomarcadores/sangue , DNA Viral/sangue , Feminino , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/imunologia , Hepatite B/sangue , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/genética , Vírus da Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
Thrombotic complications in hematologic malignancies have important clinical implications. In this meta-analysis we sought to obtain accurate estimates of the thrombotic risk in lymphoma patients. Articles were searched in electronic databases and references. Eighteen articles were identified (29 cohorts, 18 018 patients and 1149 events). Pooled incidence rates (IRs) were calculated by the use of a method based on the exact maximum likelihood binomial distribution. The global IR of thrombosis was 6.4% (95% confidence interval [CI] 6.0%-6.8%). The global IRs of venous or arterial events were 5.3% (95% CI, 5.0%-5.7%) and 1.1% (95% CI, 0.9%-1.2%), respectively. The IR of thrombosis observed in subjects with non-Hodgkin lymphoma (NHL) was 6.5% (95% CI, 6.1%-6.9%), significantly greater than that observed for patients with Hodgkin lymphoma (4.7%; 95% CI, 3.9%-5.6%). Within NHL, patients with high-grade disease had a greater risk of events (IR 8.3%; 95% CI, 7.0%-9.9%) than low-grade disease (IR 6.3%; 95% CI, 4.5%-8.9%). This meta-analysis shows that the IR of thrombosis in lymphoma patients is quite high, especially in those with NHL at an advanced stage of the disease. These results may help better defining lymphoma populations at high thrombotic risk, to whom prophylactic approaches could be preferentially applied.
Assuntos
Linfoma/complicações , Trombose/complicações , Trombose/epidemiologia , Adulto , Estudos de Coortes , Doença de Hodgkin/complicações , Humanos , Linfoma não Hodgkin/complicações , RiscoRESUMO
A instalaçäo de um laboratório de fertilizaçäo in vitro inicia-se pelo planejamento da equipe que o comandará, para após escolher o protocolo de induçäo da ovulaçäo, como colher os oócitos, como manusear os oócitos e embriöes, como preparar os espermatozóides e inseminar e como transferir os embriöes. Apesar da situaçäo econômica atual e dos altos investimentos, a fertilizaçäo in vitro já é factível a custos ao alcance de grande parte da populaçäo, principalmente com a entrada no mercado de meios de cultura prontos para uso e de fabricantes brasileiros de materiais de consumo.
Assuntos
Humanos , Feminino , Gravidez , Fertilização in vitro , Laboratórios/organização & administração , Indução da Ovulação/métodos , Laboratórios/normas , Oócitos , Controle de Qualidade , Transferência Embrionária/métodosRESUMO
Para a instalaçäo de um banco de sêmen e necessário planejar o cadastramento das amostras, critérios de avaliaçäo dos doadores e do sêmen, colheita e classificaçäo do material, escolha do meio crioprotetor, armazenamento e recuperaçäo dos espermatozóides após descongelamento. Os espermatozóides armazenados säo utilizados para inseminaçöes ou fertilizaçöes, homóloga ou heteróloga, aumentando o sucesso da clínica de reprodutpo.
Assuntos
Humanos , Masculino , Preservação do Sêmen/métodosRESUMO
Estimated 14 oocytes recoveries in 12 patients between 22 to 38 years of age and 45 to 75Kg weight has been done with endovaginal ultrasound. Local paracervial anesthesia using 400mg of xylocaine 2 per cent without vasoconstrictor and induction and maintenance with propofol (Diprivan) IV 110 to 250mg were performed; in two patients 50 mg of tiophental was used too. Seven patients used clomiphene citrate, HMG and HCG, and seven patients used leuprolide acetate, HMG and HCG. There was not ever more than two hours.