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1.
Ann Otol Rhinol Laryngol ; 129(5): 512-516, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31888343

RESUMO

BACKGROUND: Prior studies have demonstrated associations between serum eosinophilia and chronic rhinosinusitis (CRS) pathogenesis. However, the association of serum eosinophilia with histopathology profiling in CRS has not been fully delineated and may help better characterize CRS disease burden prior to surgery. METHODS: A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Complete blood count (CBC) with differential was drawn within 4 weeks prior to FESS. Serum eosinophilia was defined as >6.0% (>0.60 th/µL). Histopathology variables were compared among patients. RESULTS: A total of 177 CRS patients (37 with serum eosinophilia and 140 with normal serum eosinophilia) were analyzed. Compared to CRS patients with normal serum eosinophil counts, CRS patients with serum eosinophilia demonstrated increased polypoid disease (67.6% vs 35.0%, P < .001), eosinophil aggregates (45.9% vs 20.7%, P = .003), and eosinophils per high-power field (>5/HPF) (67.6% vs 40.7%, P = .003). CONCLUSION: CRS patients with serum eosinophilia demonstrated severe disease burden on histopathology with high levels of polypoid disease and tissue eosinophilia. However, a considerable number of patients without serum eosinophilia demonstrated eosinophilic disease on histopathology, indicating that preoperative serum eosinophilia alone could not be reliably used to predict eosinophilic CRS. LEVEL OF EVIDENCE: 4.


Assuntos
Eosinofilia/sangue , Eosinófilos/patologia , Rinite/complicações , Sinusite/complicações , Doença Crônica , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Período Pré-Operatório , Estudos Retrospectivos , Rinite/sangue , Rinite/diagnóstico , Índice de Gravidade de Doença , Sinusite/sangue , Sinusite/diagnóstico
2.
Med Clin North Am ; 104(1): 1-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757229

RESUMO

Physicians may encounter blood or tissue eosinophilia through a routine complete blood count with differential or a tissue pathology report. In this article, the basic biology of eosinophils is reviewed and definitions of blood eosinophilia, as well as the challenges of defining tissue eosinophilia, are discussed. Conditions associated with eosinophilia are briefly discussed as well as a general approach to evaluating eosinophilia. Future challenges include determining which eosinophil-associated diseases benefit from eosinophil-targeted therapy and identifying biomarkers for disease activity and diagnosis.


Assuntos
Eosinofilia/diagnóstico , Eosinófilos/metabolismo , Biomarcadores/sangue , Eosinofilia/sangue , Eosinofilia/etiologia , Humanos , Contagem de Leucócitos , Índice de Gravidade de Doença
3.
Environ Toxicol ; 35(1): 27-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31498972

RESUMO

In 2011, a link between humidifier disinfectants and patients with idiopathic pulmonary fibrosis was identified in Korea, and Kathon was suggested as one of the causative agents. In this study, Kathon induced apoptotic cell death along with membrane damage at 24 h post-exposure. Additionally, on day 14 after a single instillation with Kathon, the total number of pulmonary cells and the levels of TNF-α, IL-5, IL-13, MIP-1α, and MCP-1α clearly increased in the lung of mice. The proportion of natural killer cells and eosinophils were significantly elevated in the spleen and the bloodstream, respectively, and the level of immunoglobulin (Ig) A, but not IgG, IgM, and IgE, dose-dependently increased. Therefore, we suggest that inhaled Kathon may induce eosinophilia-mediated disease in the lung by disrupting homeostasis of pulmonary surfactants. Considering that eosinophilia is closely related to cancer and fibrosis, further studies are needed to understand the relationship between them.


Assuntos
Desinfetantes/toxicidade , Eosinofilia/induzido quimicamente , Pulmão/efeitos dos fármacos , Surfactantes Pulmonares/metabolismo , Tiazóis/toxicidade , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular , Citocinas/imunologia , Eosinofilia/sangue , Eosinofilia/imunologia , Eosinófilos/citologia , Humanos , Imunoglobulina A/sangue , Exposição por Inalação/efeitos adversos , Pulmão/imunologia , Pulmão/metabolismo , Pulmão/patologia , Masculino , Camundongos , Camundongos Endogâmicos ICR
5.
Asia Pac J Clin Nutr ; 28(3): 550-557, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464401

RESUMO

BACKGROUND AND OBJECTIVES: Cow milk allergy is the most common food allergic disease in young infants and vitamin D has a critical role in regulating intestinal inflammation. METHODS AND STUDY DESIGN: To determine roles of vitamin D in cow milk allergy, fifty-six young infants with cow milk allergy were enrolled. The serum 25-hydroxyvitamin D (25OHD), total and specific IgE, circulating regulatory T lymphocytes, and blood eosino-phil counts were determined. RESULTS: The serum 25OHD in cow milk allergy and age-matched infants were sim-ilar (68.3±38.9 nmol/L versus 72.9±33.1 nmol/L, p>0.05), 71% Cow milk allergy infants (40/56) had serum 25OHD lower than 75 nmol/L compared to 66% (37/56) in the controls. The cow milk allergy infants with 25OHD lower than 75 nmol/L had persistent blood eosinophilia and delayed resolution of symptoms after cow milk elimination compared to those with 25OHD above 75 nmol/L (odd ratio 3.7, 95% CI 1.1-12.6, p<0.05). The serum 25OHD inversely correlated with blood eosinophil counts after cow milk elimination (r=-0.37, p<0.01). Cow milk allergy infants with 25OHD lower than 50 nmol/L (vitamin D deficiency, n = 22) were in general at younger age (1.6±0.6 months) compared to infants with insufficient (50-75 nmol/L) or normal (>=75 nmol/L) group (4.3±1.2 and 4.6±0.9 months, respectively, p<0.001). CONCLUSIONS: Low serum vitamin D associates with persistent blood eosinophilia and symptoms in young cow milk allergy infants.


Assuntos
Eosinofilia/sangue , Hipersensibilidade a Leite , Deficiência de Vitamina D/sangue , Animais , Linfócitos T CD4-Positivos , Bovinos , Humanos , Lactente , Recém-Nascido , Vitamina D/análogos & derivados , Vitamina D/sangue
7.
Artigo em Inglês | MEDLINE | ID: mdl-31114180

RESUMO

Background: There are currently limited real-world data on the clinical burden of illness in patients with COPD who continue to exacerbate despite receiving triple therapy. The aim of this study was to compare the burden of COPD in patients with and without a phenotype characterized by a high blood eosinophil count and high risk of exacerbations while receiving triple therapy. Methods: This retrospective cohort study (GSK ID: 207323/PRJ2647) used UK Clinical Practice Research Datalink records linked with Hospital Episode Statistics. Eligible patients had a COPD medical diagnosis code recorded between January 1, 2004 and December 31, 2014, and a blood eosinophil count recorded on/after that date. Patients were followed from index date (first qualifying blood eosinophil count) until December 31, 2015. The study phenotype was defined as ≥2 moderate/≥1 severe acute exacerbation of COPD (AECOPD) in the year prior to the index date, current use of multiple-inhaler triple therapy (MITT), and blood eosinophil count ≥150 cells/µL on the index date. Outcomes measured during follow-up included moderate/severe AECOPDs, severe AECOPDs, all-cause mortality, primary care (GP) clinical consultations, and non-AECOPD-related unscheduled hospitalizations. Results: Of 46,814 patients eligible for inclusion, 2512 (5.4%) met the definition of the study phenotype. Adjusted rate ratios (95% CI) of moderate/severe AECOPDs and all-cause mortality in patients with the study phenotype versus those without were 2.32 (2.22, 2.43) and 1.26 (1.16, 1.37), respectively. For GP visits and non-AECOPD-related unscheduled hospitalizations, adjusted rate ratios (95% CI), in patients with the study phenotype versus those without, were 1.09 (1.05, 1.12) and 1.31 (1.18, 1.46), respectively. Conclusion: Patients with COPD and raised blood eosinophil counts who continue to exacerbate despite MITT represent a distinct subgroup who experience substantial clinical burden and account for high healthcare expenditure. There is a need for more effective management and therapeutic options for these patients.


Assuntos
Corticosteroides/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Broncodilatadores/administração & dosagem , Efeitos Psicossociais da Doença , Eosinofilia/sangue , Eosinófilos , Antagonistas Muscarínicos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Progressão da Doença , Quimioterapia Combinada , Eosinofilia/diagnóstico , Eosinofilia/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Fenótipo , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Reino Unido/epidemiologia
8.
Clin Lab ; 65(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30775878

RESUMO

Myelodysplastic syndromes (MDS) with basophilia or eosinophilia are very rare and portend poor prognoses. We present a rare patient who had MDS with excess blasts as well as peripheral basophilia and concurrent bone marrow (BM) basophilia/eosinophilia. She had a complex karyotype including 5q and 7q deletions; however, no oncogenic mutations were observed on next-generation sequencing of 54 genes known to be frequently mutated in acute myeloid leukemia/MDS. Peripheral basophilia resolved after decitabine treatment. Ours is the first report to describe a genome-wide analysis and the use of decitabine to successfully treat basophilia in an MDS patient with concurrent BM basophilia/eosinophilia.


Assuntos
Deleção Cromossômica , Eosinofilia/genética , Estudo de Associação Genômica Ampla/métodos , Síndromes Mielodisplásicas/genética , Antimetabólitos Antineoplásicos/uso terapêutico , Basófilos/efeitos dos fármacos , Basófilos/patologia , Cromossomos Humanos Par 5/genética , Cromossomos Humanos Par 7/genética , Decitabina/uso terapêutico , Eosinofilia/sangue , Eosinofilia/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/tratamento farmacológico
9.
J Dermatol ; 46(4): 334-337, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30714650

RESUMO

The role of eosinophil in systemic sclerosis (SSc) is still controversial. In the present study, the relationship between skin ulcers and peripheral blood eosinophilia were analyzed in patients with SSc. We retrospectively investigated the clinical records of all patients who were diagnosed with SSc on the basis of American College of Rheumatology/European League Against Rheumatism 2013 criteria, and were followed up for more than 2 years at Wakayama Medical University. As a result, maximum eosinophil counts during the 2-year follow-up period were 20-983/mm3 (median, 270), whereas maximum eosinophil percentages were 0.5-14.1% (median, 5.3%) in peripheral blood of 47 SSc patients. On the other hand, patients with skin ulcers during the 2-year follow up showed significantly increased maximum eosinophil counts compared with those without (median, 520 vs 228/mm3 ; P = 0.0001). Maximum eosinophil percentage was also significantly higher in patients with skin ulcers (median, 9.7% vs 4.6%; P = 0.00001). To note, in four of the nine patients with skin ulcers, the timing of emerging of the maximum eosinophil counts was associated with the ulcer development during the 2-year follow up. These results suggest that eosinophils are involved in the pathogenesis of vascular dysfunction of SSc. Larger studies should be performed to clarify the exact mechanism of ulcer formation caused by eosinophilia in SSc patients in the future.


Assuntos
Eosinofilia/complicações , Eosinófilos , Escleroderma Sistêmico/complicações , Úlcera Cutânea/etiologia , Eosinofilia/sangue , Seguimentos , Humanos , Contagem de Leucócitos , Estudos Longitudinais , Estudos Retrospectivos , Escleroderma Sistêmico/sangue , Úlcera Cutânea/sangue
11.
Laryngoscope ; 129(3): 551-557, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30478909

RESUMO

OBJECTIVE: The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient-reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES). METHODS: We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient-Reported Outcomes (TSS-PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin-1 and eotaxin-2. RESULTS: After treatment, significant reductions were observed for all the symptom scores. Forty-two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin-1 and eotaxin-2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders. CONCLUSION: NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:551-557, 2019.


Assuntos
Acetatos/uso terapêutico , Oftalmopatias/tratamento farmacológico , Antagonistas de Leucotrienos/uso terapêutico , Doenças Nasais/tratamento farmacológico , Quinolinas/uso terapêutico , Acetatos/sangue , Adulto , Asma/sangue , Asma/complicações , Biomarcadores/sangue , Eosinofilia/sangue , Eosinofilia/complicações , Oftalmopatias/etiologia , Feminino , Humanos , Antagonistas de Leucotrienos/sangue , Masculino , Doenças Nasais/etiologia , Estudos Prospectivos , Quinolinas/sangue , Rinite/sangue , Rinite/complicações , Síndrome
12.
Eur J Gastroenterol Hepatol ; 31(2): 157-162, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30113369

RESUMO

BACKGROUND: Eosinophilic gastroenteritis (EoGE) can be diagnosed on the basis of histologic criteria; however, the pathology is considered to be heterogeneous. There is no consensus on the management of this enigmatic disorder with an unknown etiology. PATIENTS AND METHODS: Data for patients diagnosed with EoGE and followed up over a 1-year period were analyzed. Their symptoms, patterns of flares, and type of treatment were documented. The shift in peripheral blood eosinophil levels was also examined. RESULTS: A total of 10 (mean age, 44 years; range: 31-70 years; women, 5) patients were diagnosed with EoGE. The most frequent presenting symptom was abdominal pain, and eight patients were classified with mucosal type of EoGE. Chronic disease or multiple flares were observed in seven out of 10 (70.0%) patients, and all of them had a history of allergy. Four were corticosteroid dependent (three relapsed during corticosteroid tapering and one following corticosteroid withdrawal). One of them received anti-IL5 monoclonal antibody that enabled corticosteroid dose tapering. In four patients with highly elevated initial eosinophil levels at diagnosis, the peripheral eosinophil level correlated with the amelioration and deterioration of their symptoms. The remaining three patients had a single flare without relapse. Two had no history of allergy. CONCLUSION: EoGE is a unique disorder with a variable clinical course. Although further studies are required to confirm our observations, the presence of other allergic disorders is associated with chronicity or multiple flares. Peripheral eosinophil level may be an effective biomarker for recurrence in patients with severe systemic disorders at diagnosis.


Assuntos
Enterite/patologia , Eosinofilia/patologia , Eosinófilos/patologia , Gastrite/patologia , Dor Abdominal/etiologia , Corticosteroides/administração & dosagem , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Biópsia , Progressão da Doença , Esquema de Medicação , Endoscopia Gastrointestinal , Enterite/sangue , Enterite/complicações , Enterite/tratamento farmacológico , Eosinofilia/sangue , Eosinofilia/complicações , Eosinofilia/tratamento farmacológico , Feminino , Seguimentos , Gastrite/sangue , Gastrite/complicações , Gastrite/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
J Pediatr Hematol Oncol ; 41(1): 47-50, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30334901

RESUMO

An acquired, transient bleeding disorder that predominantly affects children in Southeast Asia has been reported for the last 4 decades. The condition has been named idiopathic purpura with gray platelets (IPGP) or acquired platelet dysfunction with eosinophilia. In a retrospective review from a private pediatric clinic over an 8-year period, 10 consecutive children were diagnosed as IPGP with a mean age of 8.4 (3.7 to 16.2) years. Eosinophilia (>0.5×10/L) was absent in 1, while gray platelets were consistently found in all cases with a mean proportion of 64.5% (40% to 80%). Platelet aggregation tests were performed in 9 patients with abnormal responses consistent with platelet storage pool defect. All children recovered completely and spontaneously from 1 to 4 months after diagnosis without specific therapy. In an otherwise well child who presents abruptly with easy bruising and a platelet count >100×10/L, IPGP can be readily recognized as an acquired form of gray platelet syndrome. Eosinophilia is common but not mandatory for diagnosis.


Assuntos
Plaquetas/metabolismo , Síndrome da Plaqueta Cinza/sangue , Agregação Plaquetária , Púrpura/sangue , Adolescente , Plaquetas/patologia , Criança , Pré-Escolar , Eosinofilia/sangue , Eosinofilia/patologia , Feminino , Síndrome da Plaqueta Cinza/patologia , Humanos , Masculino , Testes de Função Placentária , Contagem de Plaquetas , Púrpura/patologia , Remissão Espontânea , Estudos Retrospectivos
14.
Cutan Ocul Toxicol ; 38(2): 131-135, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30360658

RESUMO

PURPOSE: To evaluate retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), subfoveal choroidal thickness (SFCT), and central retinal thickness (CRT) in asthmatic children who were under inhaled corticosteroid treatment by using Swept-Source Optical Coherence Tomography (SS-OCT). MATERIAL AND METHODS: Fifty-three children were prospectively analyzed in the study. Group 1 included 31 asthmatic children and group 2 included 22 healthy children. Asthmatic children received a dose 250 µg daily of inhaled fluticasone propionate (Flexotide, GlaxoSmithKline, Middlesex, UK). Allergy parameters including, exposure to smoke, eosinophil count, percentage of eosinophils, immunoglobuline (Ig) E levels, number of asthma attacks, number of sensitivity to allergens and follow-up time were recorded. The RNFLT, GCLT, SFCT, and CRT were analyzed with SS-OCT and the data were compared between the groups. RESULTS: There were 13 girls (41.9%) and 18 boys (58.1%) in group 1 and 13 girls (59.1%) and 9 boys (40.9%) in group 2 (p = 0.22). The mean age was 9.3 ± 2.2 years in group 1 and 9.9 ± 1.5 years in group 2 (p = 0.08). The mean CRT (239.26 ± 34.56 µm versus 226.82 ± 26.23 µm, p = 0.22) and mean SFCT (273.97 ± 40.95 µm versus 280.41 ± 32.78 µm, p = 0.54) did not significantly differ between the groups. The superior, inferior, and average RNFLT were significantly lower in group 1 than group 2 (p < 0.05). There were significant correlations between total corticosteroid dose and RNFLT (p < 0.05) and between IgE levels and GCLT (p < 0.05). CONCLUSIONS: The SS-OCT revealed that asthmatic children under inhaled corticosteroid treatment have lower RNFLT than healthy subjects.


Assuntos
Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/diagnóstico por imagem , Asma/tratamento farmacológico , Fluticasona/uso terapêutico , Tomografia de Coerência Óptica , Administração por Inalação , Adolescente , Asma/sangue , Criança , Eosinofilia/sangue , Eosinofilia/diagnóstico por imagem , Eosinofilia/tratamento farmacológico , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Testes Cutâneos
15.
Laryngoscope ; 129(4): 794-799, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30593672

RESUMO

OBJECTIVES/HYPOTHESIS: Failure after sinus surgery is multifactorial, but often due to recurrence of inflammatory mucosal disease. Postoperative steroid requirements for controlling mucosal inflammation may provide insight into predicting which patients require more aggressive medical therapy to prevent disease relapse. STUDY DESIGN: Retrospective chart review. METHODS: A review was performed of patients who underwent functional endoscopic sinus surgery (FESS) for refractory chronic rhinosinusitis (CRS). Sino-Nasal Outcome Test-22 scores and cumulative prednisone dose (milligrams) requirements at 1, 3, and 6 months postoperatively were reviewed. A structured histopathology report of 11 variables was accessed to correlate histopathology with postoperative steroid requirements. RESULTS: One hundred one patients were reviewed including 42 CRS with nasal polyps and 59 CRS without nasal polyps patients. CRS patients with eosinophilia required greater cumulative steroids to control disease at 1-, 3-, and 6-month postoperative intervals (P < .026, P < .007, P < .013, respectively) compared to patients without eosinophilia. Patients with tissue eosinophil aggregates required the highest cumulative steroids at 1-, 3-, and 6-month postoperative intervals (P < .003, P < .001, P < .001, respectively). When removing patients with eosinophil aggregates from the eosinophilia group, no difference persisted between patients with eosinophilia and those without eosinophilia at all intervals (P = .664, P = .735, P = .800, respectively). No other histopathology variable correlated with postoperative steroid requirement. CONCLUSIONS: Tissue eosinophil aggregates appear to be the largest driving factor for increased prednisone requirements after sinus surgery to control mucosal disease than mere presence of eosinophils. This key finding may identify patients at high risk for failure after sinus surgery and guide more proactive postoperative management. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:794-799, 2019.


Assuntos
Anti-Inflamatórios/uso terapêutico , Eosinófilos/efeitos dos fármacos , Mucosa Nasal/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Prednisona/uso terapêutico , Doença Crônica , Eosinofilia/sangue , Eosinofilia/complicações , Eosinofilia/etiologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/efeitos dos fármacos , Pólipos Nasais/sangue , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Rinite/sangue , Rinite/complicações , Rinite/cirurgia , Sinusite/sangue , Sinusite/complicações , Sinusite/cirurgia , Resultado do Tratamento
16.
Lab Med ; 50(1): 87-92, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30016448

RESUMO

Anaplastic large cell lymphoma (ALCL) is a lymphoma of T-cell origin, characterized by the presence of large lymphoid cells with abundant cytoplasm and pleomorphic, often horseshoe-shaped nuclei (hallmark cells), as well as strong and uniform expression of cluster of differentiation (CD)30. Two distinct clinicopathologic categories of ALCL include primary cutaneous ALCL and systemic ALCL. Systemic ALCL is further classified into anaplastic lymphoma kinase (ALK)-positive, ALK-negative, and breast implant-associated ALCL. Most ALCLs occurring in adults are ALK negative and present in lymph nodes rather than extranodal sites.Primary diagnosis of ALCL in the pleural fluid is extremely rare, with no convincing recent reports available that are based in current understanding of this entity. Herein, we describe a well-characterized case of ALK-negative ALCL with no rearrangement but amplification of DUSP22/IRF4, diagnosed by cytologic examination of the pleural effusion in a 68-year-old white man with a 3-year history of unexplained eosinophilia and pulmonary infiltrates. Also, we present a review of the literature and discuss the current understanding of ALCL based on the 2016 revision of the World Health Organization (WHO) classification of lymphoid neoplasms.


Assuntos
Eosinofilia/patologia , Linfoma Anaplásico de Células Grandes/patologia , Derrame Pleural/patologia , Idoso , Diagnóstico Diferencial , Eosinofilia/sangue , Humanos , Linfoma Anaplásico de Células Grandes/sangue , Masculino , Derrame Pleural/sangue
17.
BMJ Case Rep ; 11(1)2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30580305

RESUMO

Eosinophilic fasciitis (EF) is a syndrome of unknown aetiology characterised by progressive collagenous thickening of the subcutaneous fascia. Limb oedema can precede the skin thickening and induration classically associated with EF. We describe a case of EF in a 31-year-old woman who presented to her general practitioner with lower limb oedema and stiffness. Blood tests in primary care showed a persistently raised alanine transferase (ALT). No hepatic cause for her raised ALT was found despite investigation. The unusual manner of her presentation led to delay in her referral to the autoimmune connective tissue disease (CTD) clinic. This case illustrates the importance of considering autoimmune CTD such as EF in young patients presenting with limb oedema and raised ALT, as early treatment influences prognosis and functional recovery.


Assuntos
Alanina Transaminase/sangue , Doenças Autoimunes/sangue , Edema/sangue , Eosinofilia/sangue , Fasciite/sangue , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/patologia , Diagnóstico Diferencial , Edema/etiologia , Edema/patologia , Eosinofilia/complicações , Eosinofilia/patologia , Fasciite/complicações , Fasciite/patologia , Feminino , Humanos , Extremidade Inferior/patologia
18.
Respir Med ; 145: 48-56, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30509716

RESUMO

BACKGROUND: Individuals with obesity are more likely to develop asthma, but the exact mechanism is still uncertain and several hypotheses have been raised, such as the release of inflammatory mediators secreted by adipose tissue. OBJECTIVE: To assess the effects of weight loss in patients submitted to bariatric surgery on pulmonary and systemic inflammation. METHOD: The study evaluated patients undergoing bariatric surgery (Roux-en-Y gastric bypass) with the diagnosis of asthma, except smokers. The patients were evaluated at the time of entry into a preoperative weight loss group (T1), just before bariatric surgery (T2), six months after surgery (T3), and 12 months after surgery (T4). The following were measured: anthropometric data, dosage of systemic inflammatory markers by means of blood collection, pulmonary inflammatory markers obtained by induced sputum collection, pulmonary function parameters, and asthma activity assessed by a Asthma Control Test (ACT) questionnaire. RESULTS: Nineteen patients participated in the study. There were significant reductions in the systemic levels of interleukin (IL)-8 (p = 0.002), C-reactive protein (CRP) (p = 0.003), leptin (p = 0.001) and tumor necrosis factor (TNF)-α (p = 0.007), and significant increase in the systemic levels of IL-6 (p = 0.004) over time and adiponectin in T2 (p = 0.025). In regards to pulmonary inflammation, there were significant reductions in the sputum levels of TNF-α (p < 0.001). There was no significant improvement of the pulmonary function parameters (p > 0.05) and significant improvement in asthma activity scores (p < 0.0001). CONCLUSION: Weight loss was associated with significant changes in the systemic and pulmonary inflammatory profiles of individuals with asthma, leading to a better asthma control as a result of an increase in some anti-inflammatory mediators and a reduction of pro-inflammatory mediators.


Assuntos
Adipocinas/metabolismo , Asma/metabolismo , Asma/fisiopatologia , Pulmão/fisiopatologia , Obesidade/complicações , Perda de Peso/fisiologia , Adulto , Asma/complicações , Asma/diagnóstico , Biomarcadores/sangue , Eosinofilia/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/metabolismo , Obesidade/fisiopatologia , Testes de Função Respiratória , Índice de Gravidade de Doença , Fatores de Tempo
19.
Sci Data ; 5: 180275, 2018 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-30512017

RESUMO

Glucocorticoids are first-line agents for the treatment of many eosinophil-associated disorders; however, their effects on human eosinophils remain poorly understood. To gain an unbiased, genome-wide view of the early transcriptional effects of glucocorticoids on human eosinophils in vivo, RNA sequencing was performed on purified blood eosinophils obtained before and 30, 60, and 120 minutes after administration of a single dose of oral prednisone (1 mg/kg) to three unrelated healthy subjects with hypereosinophilia of unknown significance. The resulting dataset is of high quality and suitable for differential expression analysis. Flow cytometry and qPCR were then performed on three additional cohorts of human subjects, to validate the key findings at the transcript and protein levels. The resulting datasets provide a resource for understanding the response of circulating human eosinophils to glucocorticoid administration.


Assuntos
Eosinófilos , Perfilação da Expressão Gênica , Glucocorticoides , Dexametasona/farmacologia , Eosinofilia/sangue , Eosinofilia/tratamento farmacológico , Eosinófilos/efeitos dos fármacos , Eosinófilos/metabolismo , Glucocorticoides/metabolismo , Glucocorticoides/uso terapêutico , Humanos , Prednisona/farmacologia , Análise de Sequência de RNA
20.
Zhonghua Jie He He Hu Xi Za Zhi ; 41(10): 783-786, 2018 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-30347550

RESUMO

Objective: To improve the clinical recognition of eosinophilic granulomatosis with polyangiitis(EGPA) in clinical manifestations, diagnosis and treatment. Methods: The clinical manifestations, pathological characteristic, imaging manifestations, diagnosis and the therapy of three patients with EGPA were presented. Results: These 3 patients had asthma-like symptoms and extrapulmonary manifestations of systemic vasculitis. They were 20, 40 and 44 years old. All of them were female.They denied exposure or contact. Chest radiographic examination showed that the most common features were nodule shadow and tree-in-bud in the lung. The pathological manifestation was characterized by hypereosinophilia, high total IgE(over 300 KU/L) and high CRP(over 14.1mg/L). The FeNO of 2 patients was over 100ppb. The ANCA of these 3 patients was negative. The pulmonary pathology was observed had eosinophil infiltration in the alveolar, interstitial and vessel for 3 cases. The clinical manifestations were nonspecific. All patients were treated by glucocorticoid and immune-inhibitor(alkylating agents or purine synthesis inhibitors) therapy. Because patients were complicated with other organs involved, they needed long-time treatment. Conclusions: This disease is diverse and complex, with a lack of pathognomonic symptoms. We should highly suspect eosinophilic granulomatosis with polyangiitis, when the patients present severe asthma and eosinophilia. Early detection, early treatment, and the prognosis could be better.


Assuntos
Síndrome de Churg-Strauss/fisiopatologia , Eosinofilia/diagnóstico , Granulomatose com Poliangiite/fisiopatologia , Pulmão/patologia , Adulto , Asma/etiologia , Síndrome de Churg-Strauss/complicações , Eosinofilia/sangue , Feminino , Granulomatose com Poliangiite/complicações , Humanos , Prognóstico
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