RESUMO
Arsenic and its inorganic compounds affect numerous organs and systemic functions, such as the nervous and hematopoietic systems, liver, kidneys, and skin. Despite a large number of studies on arsenic toxicity, rare reports have investigated the leukopenia incidence in workers exposed to arsenic. In workplaces, the main source of workers' exposure is the contaminated air by the inorganic arsenic in mines, arsenic or copper smelter industries, and chemical factories. Erythropoiesis inhibition is one of the arsenic effects and it is related to regulatory factor GATA-1. This factor is necessary for the normal differentiation of early erythroid progenitors. JAK-STAT is an important intracellular signal transduction pathway responsible for the mediating normal functions of several cytokines related to cell proliferation and hematopoietic systems development and regulation. Arsenic inactivates JAK-STAT by inhibiting JAK tyrosine kinase and using the IFNγ pathway. The intravascular hemolysis starts after the absorption phase when arsenic binds to the globin of hemoglobin in erythrocytes and is transported into the body, which increases the oxidation of sulfhydryl groups in hemoglobin. So, this article intends to highlight the potential leukopenia risk via inhalation for workers exposed to arsenic and suggests a possible mechanism for this leukopenia through the JAK-signal transducer and activator of transcription (STAT) pathway inhibition.
Assuntos
Arsênio , Leucopenia , Exposição Ocupacional , Humanos , Arsênio/toxicidade , Janus Quinases/metabolismo , Leucopenia/induzido quimicamente , Leucopenia/epidemiologia , Exposição Ocupacional/efeitos adversos , Transdução de Sinais/efeitos dos fármacos , Fatores de Transcrição STAT/metabolismoRESUMO
Introducción. El dengue es la enfermedad transmitida por mosquitos con mayor propagación mundial en los últimos años. Presenta un amplio espectro de manifestaciones clínicas y, en ocasiones, evoluciona a un estado crítico llamado dengue grave. Su tratamiento es de sostén. La información disponible acerca de las características clínicas, epidemiológicas y de laboratorio de la enfermedad en la población pediátrica es limitada. Objetivo. Describir la epidemiología y las manifestaciones clínicas y de laboratorio de la enfermedad. Población y métodos. Estudio descriptivo, observacional y retrospectivo. Incluyó pacientes entre 1 y 180 meses asistidos por dengue probable o confirmado en un hospital de niños, desde el 01 de enero de 2020 hasta el 31 de mayo de 2020. Resultados. Se incluyeron 85 pacientes por criterios microbiológicos de positividad o clínicoepidemiológicos. Veinticinco (29 %) confirmados por RT-PCR, todos serotipos DENV-1. La mediana de edad fue de 108 meses (rango intercuartílico: 84-144). Las principales manifestaciones clínicas fueron fiebre, cefalea y mialgias. Los hallazgos de laboratorio más importantes fueron leucopenia, trombocitopenia y elevación de transaminasas. Conclusión. El reconocimiento y la comprensión de las alteraciones clínicas y de laboratorio que se presentan durante la enfermedad pueden permitir un abordaje eficaz y contribuir a la reducción de cuadros clínicos más graves en los niños.
Introduction. Dengue has been the most widespread mosquito-borne disease worldwide in recent years. It develops with a broad spectrum of clinical manifestations and sometimes progresses to a critical condition known as severe dengue. It is managed with supportive treatment. Available information about its clinical, epidemiological, and laboratory characteristics in the pediatric population is limited. Objective. To describe the clinical, epidemiological, and laboratory characteristics of dengue. Population and methods. Descriptive, observational, and retrospective study. It included patients aged 1 to 180 months seen due to probable or confirmed dengue at a children's hospital between 1/1/2020 and 5/31/2020. Results. A total of 85 patients with positive microbiological or clinical-epidemiological criteria were included. Of these, 25 (29%) were confirmed by RT-PCR; all corresponded to DENV-1 serotype. Patients' median age was 108 months (interquartile range: 84144). The main clinical manifestations were fever, headache, and myalgia. The most important laboratory findings were leukopenia, thrombocytopenia, and high transaminase levels. Conclusion. The recognition and understanding of clinical and laboratory alterations that occur during dengue disease may allow an effective approach and help to reduce the more severe clinical form in children.
Assuntos
Humanos , Animais , Lactente , Pré-Escolar , Criança , Adolescente , Trombocitopenia , Dengue/diagnóstico , Dengue/epidemiologia , Leucopenia , Estudos Retrospectivos , Febre/epidemiologia , SorogrupoRESUMO
Introduction. Dengue has been the most widespread mosquito-borne disease worldwide in recent years. It develops with a broad spectrum of clinical manifestations and sometimes progresses to a critical condition known as severe dengue. It is managed with supportive treatment. Available information about its clinical, epidemiological, and laboratory characteristics in the pediatric population is limited. Objective. To describe the clinical, epidemiological, and laboratory characteristics of dengue. Population and methods. Descriptive, observational, and retrospective study. It included patients aged 1 to 180 months seen due to probable or confirmed dengue at a children's hospital between 1/1/2020 and 5/31/2020. Results. A total of 85 patients with positive microbiological or clinical-epidemiological criteria were included. Of these, 25 (29%) were confirmed by RT-PCR; all corresponded to DENV-1 serotype. Patients' median age was 108 months (interquartile range: 84-144). The main clinical manifestations were fever, headache, and myalgia. The most important laboratory findings were leukopenia, thrombocytopenia, and high transaminase levels. Conclusion. The recognition and understanding of clinical and laboratory alterations that occur during dengue disease may allow an effective approach and help to reduce the more severe clinical form in children.
Introducción. El dengue es la enfermedad transmitida por mosquitos con mayor propagación mundial en los últimos años. Presenta un amplio espectro de manifestaciones clínicas y, en ocasiones, evoluciona a un estado crítico llamado dengue grave. Su tratamiento es de sostén. La información disponible acerca de las características clínicas, epidemiológicas y de laboratorio de la enfermedad en la población pediátrica es limitada. Objetivo. Describir la epidemiología y las manifestaciones clínicas y de laboratorio de la enfermedad. Población y métodos. Estudio descriptivo, observacional y retrospectivo. Incluyó pacientes entre 1 y 180 meses asistidos por dengue probable o confirmado en un hospital de niños, desde el 01 de enero de 2020 hasta el 31 de mayo de 2020. Resultados. Se incluyeron 85 pacientes por criterios microbiológicos de positividad o clínico-epidemiológicos. Veinticinco (29 %) confirmados por RT-PCR, todos serotipos DENV-1. La mediana de edad fue de 108 meses (rango intercuartílico: 84-144). Las principales manifestaciones clínicas fueron fiebre, cefalea y mialgias. Los hallazgos de laboratorio más importantes fueron leucopenia, trombocitopenia y elevación de transaminasas. Conclusión. El reconocimiento y la comprensión de las alteraciones clínicas y de laboratorio que se presentan durante la enfermedad pueden permitir un abordaje eficaz y contribuir a la reducción de cuadros clínicos más graves en los niños.
Assuntos
Dengue , Leucopenia , Trombocitopenia , Animais , Humanos , Criança , Dengue/diagnóstico , Dengue/epidemiologia , Estudos Retrospectivos , Sorogrupo , Febre/epidemiologiaRESUMO
INTRODUCTION AND AIM: Thiopurine-related leukopenia is associated with polymorphisms in the thiopurine methyltransferase (TPMT) and nucleoside diphosphate-linked moiety X type motif 15 (NUDT15) genes. However, those polymorphisms explain only a fraction of thiopurine-related leukopenia. Our aim was to study the role of an inosine triphosphate pyrophosphatase (ITPA) polymorphism in patients with inflammatory bowel disease (IBD) and thiopurine-related leukopenia that was unexplained by the TPMT and NUDT15 polymorphisms. MATERIAL AND METHODS: We enrolled consecutive IBD patients on thiopurines (azathioprine or 6-mercaptopurine) from January 2019-March 2020, at a tertiary care center in North India. The presence of the ITPA (C.94Câ¯>â¯A) polymorphism was evaluated in all patients, along with its association with thiopurine-related leukopenia. RESULTS: Of the 33 patients (from a total of 119 patients) that developed leukopenia, 8 had the TPMT (nâ¯=â¯1) or NUDT15 (nâ¯=â¯7) polymorphism. Of the remaining 111 patients, their mean age was 36.36⯱â¯13.54 years and 57 (51.3%) were males. Twenty-five (21.01%) had unexplained leukopenia. The ITPA polymorphism was detected in 4 (16%) patients in the unexplained leukopenia group and 24 (27.9%) patients in the non-leukopenia group (pâ¯=â¯0.228). The odds ratio for predicting leukopenia with the ITPA polymorphism was 0.4921 (95% CI 0.1520-1.5830, pâ¯=â¯0.234). CONCLUSION: The ITPA (C.94Câ¯>â¯A) polymorphism was frequently detected in the study population but was not predictive for leukopenia in patients with IBD on thiopurine therapy.
Assuntos
Citopenia , Doenças Inflamatórias Intestinais , Leucopenia , Metiltransferases , Purinas , Compostos de Sulfidrila , Masculino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Feminino , Inosina/efeitos adversos , Pirofosfatases/genética , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/genética , Leucopenia/induzido quimicamente , Leucopenia/genética , Inosina TrifosfataseRESUMO
Ciprofloxacin (CIP) is an antibiotic commonly used in human and veterinary medicine. It is present in the aquatic environment, but we still know very little about its effect on non-targeted organisms. This study aimed to evaluate the effects of long-term exposure to environmental CIP concentrations (1, 10, and 100 µg.L-1) in males and females of Rhamdia quelen. After 28 days of exposure, we collected the blood for the analysis of hematological and genotoxic biomarkers. Additionally, we measured 17 ß-estradiol and 11 keto-testosterone levels. After the euthanasia, we collected the brain and the hypothalamus to analyze acetylcholinesterase (AChE) activity and neurotransmitters, respectively. The liver and gonads were assessed for biochemical, genotoxic, and histopathological biomarkers. At 100 µg.L-1 CIP, we observed genotoxicity in the blood, nuclear morphological changes, apoptosis, leukopenia, and a reduction of AChE in the brain. In the liver was observed oxidative stress and apoptosis. At 10 µg.L-1 CIP, leukopenia, morphological changes, and apoptosis were presented in the blood and a reduction of AChE in the brain. Apoptosis, leukocyte infiltration, steatosis, and necrosis occurred in the liver. Even at the lowest concentration (1 µg.L-1), adverse effects such as erythrocyte and liver genotoxicity, hepatocyte apoptosis, oxidative stress, and a decrease in somatic indexes were observed. The results showed the importance of monitoring CIP concentrations in the aquatic environment that cause sublethal effects on fish.
Assuntos
Peixes-Gato , Leucopenia , Poluentes Químicos da Água , Animais , Masculino , Humanos , Feminino , Ciprofloxacina/farmacologia , Acetilcolinesterase , Fígado , Biomarcadores , Poluentes Químicos da Água/toxicidadeRESUMO
El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial. Se deben incluir siempre la determinación de los niveles de cobre dentro del abordaje diagnóstico de todo paciente con enfermedad gastrointestinal crónica, con diarrea crónica, síndrome de mala absorción o reducción significativa de la ingestión en la dieta, y que desarrolle síntomas neurológicos sugestivos de compromiso de los cordones, ya que se ha reportado que el retraso en el diagnóstico de las mielopatías se asocia con pobres desenlaces neurológicos.
Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.
Assuntos
Doenças da Medula Espinal , Cobre , Ataxinas , Anemia , Leucopenia , Síndromes de MalabsorçãoRESUMO
BACKGROUND: Cytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post-SOT in selected countries outside of Europe and North America. METHODS: MEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV-related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient-reported outcomes, and economic burden. RESULTS: Of 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post-SOT were respectively, 10.3%-63.2% (9 studies) and 0%-19.0% (17 studies). Recurrence occurred in 35.4%-41.0% cases (3 studies) and up to 5.3% recipients died of CMV-associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment-related adverse events with GCV included neutropenia (2%-29%), anemia (13%-48%), leukopenia (11%-37%), and thrombocytopenia (13%-24%). Data on economic burden were scarce. CONCLUSION: Outside of North America and Europe, rates of CMV infection/disease post-SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment-associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.
Assuntos
Infecções por Citomegalovirus , Leucopenia , Transplante de Órgãos , Adulto , Humanos , Citomegalovirus , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Europa (Continente)/epidemiologia , América do Norte/epidemiologia , Ganciclovir , Transplante de Órgãos/efeitos adversosRESUMO
OBJECTIVE: To outline the characteristics of Kikuchi-Fujimoto disease (KFD) in children and analyze factors associated with severe and recurring courses. METHODS: Electronic medical records of children histopathologically diagnosed with KFD at Seoul National University Bundang Hospital from March 2015 to April 2021 were retrospectively reviewed. RESULTS: A total of 114 cases (62 males) were identified. The mean patient age was 12.0 ± 3.5 years. Most patients came to medical attention with cervical lymph node enlargement (97.4%) and fever (85%); 62% had a high-grade fever (≥39°C). Prolonged fever (≥14 days) was seen in 44.3% and was associated with a high-grade fever (P = .004). Splenomegaly, oral ulcer, or rash was present in 10.5%, 9.6%, and 15.8%, respectively. Laboratory findings showed leukopenia, anemia, and thrombocytopenia in 74.1%, 49%, and 24%, respectively. Sixty percent of cases had a self-limited course. Antibiotics were initially prescribed in 20%. A corticosteroid was prescribed in 40% of patients and was associated with oral ulcer (P = .045) and anemia (P = .025). Twelve patients (10.5%) had a recurrence with a median interval of 19 months. No risk factor for recurrence was identified in multivariable analysis. Clinical characteristics of KFD were similar between our current and previous studies. However, antibiotics use decreased (P < .001); nonsteroidal anti-inflammatory drugs use increased (P < .001), and, although statistically not significant, corticosteroid treatment also increased. CONCLUSIONS: Over a span of 18 years, the clinical characteristics of KFD did not change. Patients presenting with high-grade fever, oral ulcer, or anemia may benefit from corticosteroid intervention. All patients should be monitored for recurrence.
Assuntos
Linfadenite Histiocítica Necrosante , Leucopenia , Úlceras Orais , Masculino , Humanos , Criança , Adolescente , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/diagnóstico , Estudos Retrospectivos , Úlceras Orais/complicações , Úlceras Orais/tratamento farmacológico , Corticosteroides/uso terapêutico , Febre/complicações , Antibacterianos/uso terapêutico , Leucopenia/tratamento farmacológicoRESUMO
OBJECTIVE: To determine the predictors of the occurrence of severe autoimmune hemolytic anemia (AIHA) and its impact on damage accrual and mortality in SLE patients. METHODS: Factors associated with time to severe AIHA (hemoglobin level ≤7 g/dL) occurring from the onset of SLE symptoms were examined by Cox proportional hazards regressions. The association of severe AIHA with mortality was examined by logistic regression analyses while its impact on damage was by negative binomial regression. RESULTS: Of 1,349 patients, 49 (3.6%) developed severe AIHA over a mean (SD) follow-up time of 5.4 (3.8) years. The median time from the first clinical manifestation to severe AIHA was 111 days (IQR 43-450). By multivariable analysis, male sex (HR 2.26, 95% CI 1.02-4.75, p = 0.044), and higher disease activity at diagnosis (HR 1.04, 95% CI 1.01-1.08, p = 0.025) were associated with a shorter time to severe AIHA occurrence. Of the SLEDAI descriptors, only hematologic (leukopenia and/or thrombocytopenia) showed a certain trend toward significance in the multivariable analysis (HR 2.36, 95% CI 0.91-6.13, p = 0.0772). Severe AIHA contributed neither to damage nor to mortality. CONCLUSIONS: Severe AIHA occurs during the early course of SLE. Male sex and higher disease activity at diagnosis emerged as independent predictors of a shorter time to severe AIHA occurrence. Although not statistically significant, hematological abnormalities at SLE diagnosis could predict the occurrence of severe AIHA in a shorter time. Damage and mortality did not seem to be impacted by the occurrence of severe AIHA.
Assuntos
Anemia Hemolítica Autoimune , Leucopenia , Lúpus Eritematoso Sistêmico , Trombocitopenia , Humanos , Masculino , Lúpus Eritematoso Sistêmico/complicações , América Latina , Hispânico ou Latino , Anemia Hemolítica Autoimune/complicações , Trombocitopenia/complicaçõesRESUMO
Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengue compared with COVID-19. Participants with fever or respiratory symptoms and aged ≥18 years enrolled May 2012-January 2021 with dengue, influenza, or SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction were included. We calculated adjusted odds ratios (aORs) and 95% CIs using logistic regression to assess clinical characteristics of participants with COVID-19 compared to those with dengue or influenza, adjusting for age, subregion, and days from illness onset to presentation for clinical care. Among 13,431 participants, we identified 2,643 with dengue (N = 303), influenza (N = 2,064), or COVID-19 (N = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1-3]), dengue (3 days [2-4]), and COVID-19 cases (4 days [2-7]; P < 0.001). Cough (aOR: 0.12 [95% CI: 0.07-0.19]) and shortness of breath (0.18 [0.08-0.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8-43.5]) and thrombocytopenia (24.4 [13.3-45.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8-12.1]). In summary, cough, shortness of breath, facial flushing, and thrombocytopenia helped distinguish between dengue and COVID-19. Although few features distinguished influenza from COVID-19, presentation > 4 days after symptom onset suggests COVID-19. These findings may assist clinicians making time-sensitive decisions regarding triage, isolation, and management while awaiting pathogen-specific testing.
Assuntos
COVID-19 , Dengue , Influenza Humana , Leucopenia , Trombocitopenia , Adulto , Humanos , Adolescente , COVID-19/diagnóstico , Porto Rico/epidemiologia , SARS-CoV-2 , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Tosse , Serviço Hospitalar de Emergência , Instituições de Assistência Ambulatorial , Dengue/diagnóstico , Dengue/epidemiologia , DispneiaRESUMO
New treatments have increased the life expectancy of pediatric patients diagnosed with malignant hematological diseases, often at the cost of protracting their immunocompromised state in the form of prolonged neutropenia. This neutropenic state favors the development of bacterial and fungal infections. Moreover, recent years have seen a series of changes in the epidemiology of fungal and Clostridium infections. These changes necessitate adaptations to the management of pediatric patients with febrile neutropenia, who are at risk of further increases in already high rates of morbidity and mortality. This article discusses the current bases for the management of febrile neutropenia and associated emerging fungal infections, as well as the epidemiology, diagnosis, and treatment of Clostridioides difficile in pediatric patients diagnosed with malignant hematological diseases.
Assuntos
Neutropenia Febril , Leucopenia , Micoses , Neoplasias , Humanos , Criança , Antibacterianos , Neoplasias/complicações , Neoplasias/terapia , Micoses/induzido quimicamente , Micoses/tratamento farmacológico , Micoses/epidemiologia , Neutropenia Febril/etiologia , Neutropenia Febril/terapiaRESUMO
cistite hemorrágica e a cistite intersticial expressam uma etiologia variável, desde idiopática à provocada por fármacos, dentre eles a ciclofosfamida. A cistite apresenta tratamento multifatorial, e o potencial efeito satisfatório do uso da medicina complementar, vem ganhando espaço na prática médica. Assim o objetivo do presente estudo foi avaliar o efeito protetivo do extrato bruto de Echinodorus grandiflorus sobre a bexiga de ratos induzidos a cistite por ciclofosfamida. Utilizou-se neste estudo, 35 ratos, machos, Wistar, com peso médio de 321g, que foram submetidos a indução de cistite com uso de ciclofosfamida por via intraperitoneal e tratados com diferentes doses de extrato de Echinodorus grandiflorus (30, 100, 300mg) e o grupo controle com o fármaco Mesna. Todos os animais foram mortos no décimo sétimo dia e suas bexigas urinarias foram ressecadas para avaliação macro e microscópica, além da análise de hemograma e leucograma. A análise do sangue mostrou leucopenia com diferença significativa em todos os animais que receberam a ciclofosfamida. Observou-se que a dose de 300mg/kg do extrato bruto da planta, apresentou efeito protetivo no urotélio vesical, porém, inferior ao uso de Mesna. Diante dos resultados apresentados neste estudo sugere-se que o extrato de Echinodorus grandiflorus apresenta efeito protetivo no urotélio vesical na dose de 300mg/kg, porém estudos futuros quanto a dose e também a uma possível associação terapêutica ao Mesna devam ser realizados. Por se tratar de uma patologia com prevalência importante e ser muitas vezes desagradável e limitante à vida, faz-se necessário o empenho em métodos terapêuticos alternativos aos atuais, afim de, diminuírem os custos e efeitos colaterais dos métodos já documentados.
Hemorrhagic cystitis and interstitial cystitis have a variable etiology, from idiopathic to drug-induced, including cyclophosphamide. Cystitis has a multifactorial treatment, and the potential satisfactory effect of the use of complementary medicine has been gaining ground in medical practice. Thus, the aim of the present study was to evaluate the protective effect of the crude extract of Echinodorus grandiflorus on the bladder of rats induced to cystitis by cyclophosphamide. In this study, 35 male Wistar rats, with an average weight of 321g, were submitted to cystitis induction with intraperitoneal use of cyclophosphamide and treated with different doses of Echinodorus grandiflorus extract (30, 100, 300mg) and the control group with the drug Mesna. All animals were killed on the seventeenth day and their urinary bladders were resected for macro and microscopic evaluation, in addition to the analysis of blood count and leukogram. Blood analysis showed leukopenia with a significant difference in all animals that received cyclophosphamide. It was observed that the dose of 300mg/kg of the crude extract of the plant had a protective effect on the vesical urothelium, however, it was inferior to the use of Mesna. In view of the results presented in this study, it is suggested that the Echinodorus grandiflorus extract has a protective effect on the vesical urothelium at a dose of 300mg/kg, but future studies regarding the dose and also a possible therapeutic association with Mesna should be carried out. Because it is a pathology with significant prevalence and is often unpleasant and life-limiting, it is necessary to commit to alternative therapeutic methods to the current ones, in order to reduce the costs and side effects of the methods already documented.
cistitis hemorrágica y la cistitis intersticial tienen una etiología variable, desde idiopática hasta inducida por fármacos, incluida la ciclofosfamida. La cistitis tiene un tratamiento multifactorial, y el potencial efecto satisfactorio del uso de la medicina complementaria ha ido ganando terreno en la práctica médica. Así, el objetivo del presente estudio fue evaluar el efecto protector del extracto crudo de Echinodorus grandiflorus sobre la vejiga de ratas inducidas a cistitis por ciclofosfamida. En este estudio, 35 ratas Wistar macho, con un peso promedio de 321g, fueron sometidas a inducción de cistitis con uso intraperitoneal de ciclofosfamida y tratadas con diferentes dosis de extracto de Echinodorus grandiflorus (30, 100, 300mg) y el grupo control con el fármaco Mesna. Todos los animales fueron sacrificados al decimoséptimo día y sus vejigas urinarias fueron resecadas para evaluación macro y microscópica, además del análisis de hemograma y leucograma. El análisis de sangre mostró leucopenia con una diferencia significativa en todos los animales que recibieron ciclofosfamida. Se observó que la dosis de 300 mg/kg del extracto crudo de la planta tuvo un efecto protector sobre el urotelio vesical, sin embargo, fue inferior al uso de Mesna. En vista de los resultados presentados en este estudio, se sugiere que el extracto de Echinodorus grandiflorus tiene un efecto protector sobre el urotelio vesical a una dosis de 300 mg/kg, pero se deben realizar estudios futuros sobre la dosis y también una posible asociación terapéutica con Mesna. llevado a cabo. Por tratarse de una patología con una prevalencia importante y muchas veces desagradable y
Assuntos
Animais , Ratos , Ratos Wistar , Urotélio , Ciclofosfamida , Cistite , Alismataceae , Bexiga Urinária , Preparações Farmacêuticas , LeucopeniaRESUMO
ABSTRACT Introduction: Hematologic abnormalities are common in HIV and involve all blood cell lineages. A study on cytopenias, as correlated with disease progression, can be valuable in resource-limited settings. This study aimed to determine the hematologic profile of HIV patients and its association with CD4 count and antiretroviral (ARV) treatment. Methods: This is a retrospective cohort study involving adult Filipino HIV patients with complete blood count (CBC) and CD4 count determinations prior to the initiation of ARV treatment and after ≥6 months of ARV treatment. Logistic regression was performed to determine the association between cytopenias and a CD4 count <200 cells/μL. Results: The study included 302 patients. Anemia was the most common cytopenia. Anemia and leukopenia were associated with an increased likelihood of having a CD4 count <200 cells/μL in ARV-naïve patients. In ARV-treated patients, leukopenia was associated with an increased probability of having a CD4 count <200 cells/μL. An increase in hemoglobin, white blood cell (WBC) and platelet counts was observed after ≥6 months of ARV treatment. Conclusion: Anemia and leukopenia can be used as markers of immune status in HIV-infected individuals and improvement in the CBC parameters can be used to assess response to ARV treatment. Routine monitoring of hematologic parameters is recommended.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Infecções por HIV , Terapia Antirretroviral de Alta Atividade , Leucopenia , Antígenos CD4 , AnemiaRESUMO
INTRODUCTION: Down syndrome is associated with various congenital anomalies and metabolic alterations such as hematological alterations. Values for the major hematological indicators vary with age and sex, but these values have not been described for Mexican children with Down syndrome. OBJECTIVE: To describe the complete blood count (CBC) values of pediatric patients with Down syndrome in México and report the most common non-malignant hematological alterations. MATERIALS AND METHODS: The analysis includes data from 450 patients with Down syndrome, 55.5% ware males, aged 0-18 years who were patients at the Mexican National Institute of Pediatrics and whose clinical charts included CBC panel results for the period January 2008 through March 2018. RESULTS: A total of 3438 CBC panels were analyzed with descriptive statistics to find the values and statistical dispersion of the major indicators, with percentiles, and reported separately by sex and age group. The most common non-malignant hematological alterations found were macrocytic anemia, leukopenia, lymphopenia, and thrombocytosis. There were differences in values in all three series. CONCLUSIONS: The CBC panels and hematological alterations are summarized for patients with Down syndrome.
Assuntos
Síndrome de Down , Leucopenia , Trombocitopenia , Contagem de Células Sanguíneas , Criança , Síndrome de Down/complicações , Feminino , Humanos , Masculino , México , Trombocitopenia/complicaçõesRESUMO
OBJECTIVE: To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn's disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine. METHODS: Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher's exact test for qualitative variables. RESULTS: Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker. CONCLUSION: Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.
Assuntos
Doenças Inflamatórias Intestinais , Leucopenia , Adulto , Azatioprina/efeitos adversos , Proteína C-Reativa , Humanos , Doenças Inflamatórias Intestinais/induzido quimicamente , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Leucopenia/induzido quimicamente , Leucopenia/tratamento farmacológico , Leucopenia/epidemiologia , Mesalamina/efeitos adversos , PrevalênciaRESUMO
Leukopenia is associated with the consumption of peripheral leukocytes, decreasedproduction due to endotoxemia and septicemia, medullary hypoplasia, nutritional diseases orautoimmune reactions. In a case report by Narita et al, Echinacea angustifolia demonstrated theeffectiveness of treatment of leukopenia in penguins. Aims:Report the evolution of homeopathictreatment in 5 dogs' patients between 3 and 5 years old, presenting leukopenia. Methodology:The homeopathic treatment was chosen, using Echinaceaangustifolia due to its immunostimulant andimmunomodulatory actions, which evolution was analyzed by blood tests. The exposedinformation is consented by the tutors. Results:The same protocol was made for all of the patients, including 4 globules of Echinacea angustifolia 6 cH orally, every 12 hours for 30 days. The first dog attended on 07/21/2021, presented 4.000 leukocytes, which increased to 6.800 on 08/17/2021. Thesecond patient attend on 12/07/2021 presented 4.700 leukocytes, increasing to 6.800 on 01/25/2022. The third patient attended on 08/24/2021 presented 5.400 leukocytes, which increased to 6.800 on 10/15/2021. The fourth patient presented 4.300 leukocytes on 01/13/2022, increasing to 5.500 on 02/11/2022. The fifth patient presented on12/12/2021 4.600 leukocytes, increasing to 8.400 on 02/03/2022. Therefore, the average of the first collection was 3.681 leukocytes and in the second there was an increase to 6.860 leukocytes (T-test, p= 0,0167). Conclusion:The use of the homeopathic medicine Echinacea angustifolia shows great results, being a viableoption for the treatment of leukopenia, without the side effects.
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Cães , Terapêutica Homeopática , Leucopenia/terapiaRESUMO
BACKGROUND: In 2016/2017 we had a major epidemic of chikungunya (CHIK) in Brazil, with many deaths. We evaluated to factors associated with deaths from CHIK that occurred in the city of Fortaleza, Brazil. METHODS: A matched case-control study was conducted (1:2), by sex, age (± 5 years) and neighborhood. Cases were CHIK deaths that occurred between January 1 and December 31, 2017, in Fortaleza, Brazil, and which were laboratory confirmed. Controls were laboratory confirmed CHIK patients occurring in the same neighborhood and in the same period, but which did not progress to death. RESULTS: 82 cases of CHIK and 164 controls were included. Considering the clinical history, significant associations were found between other chronic heart diseases (OR 3.8; CI: 1.53-9.26) and chronic kidney disease (OR 12.77; CI: 2.75-59.4). In the multivariate analysis of the variables related to signs and symptoms, fever (OR: 19.23 CI: 1.73-213.78), abdominal pain (OR: 3; 74 CI: 1.06-13.16), apathy (OR: 11.62 CI: 2.95-45.82) and dyspnea (OR: 50.61; CI: 12.37-207.18) were identified with greater likelihood of death from CHIK. It also stood out that altered blood glucose was associated with cases with a worse prognosis (OR: 13.5; CI: 1.3-135.0). Among the laboratory findings, only lymphocytes and albumin were not associated with greater likelihood of death. CONCLUSION: The factors related with deaths were chronic kidney disease and previous heart disease, presence of fever, abdominal pain, apathy, dyspnea and arthritis and laboratory findings such as leukocytosis, leukopenia, thrombocytopenia, neutropenia and lymphopenia.
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Febre de Chikungunya , Vírus Chikungunya , Leucopenia , Insuficiência Renal Crônica , Dor Abdominal , Brasil/epidemiologia , Estudos de Casos e Controles , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Dispneia , Febre , Humanos , Fatores de RiscoRESUMO
Abstract Introduction The novel SARS-CoV-2 infection has been spreading around the world since January 2020 causing the Corona Virus Disease 2019. Leukopenia, lymphopenia and hypercoagulability with elevated D- Dimers have been described in COVID-19 patients to date. This study aimed to clarify if some blood parameters can be used as biomarkers to facilitate diagnosis and establish prognosis. Methods: We selected patients who had tested positive for SARS-CoV-2 and had had a hemogram performed between the March 15 and April 15, 2020. Socio-demographic and analytical data were obtained from 274 patients at admission in two Portuguese public hospitals. We then analyzed the hemogram parameters at admission in the intensive care and collected data on patient survival during the SARS-CoV-2 disease follow-up. The data were analyzed using appropriate statistical tests. Results: Patients requiring the intensive care unit (ICU) present an increase in leukocytes and neutrophils (+3.1 × 109/L and +6.4 × 109/L, respectively), a lymphocyte decrease and a platelet rise (-1.6 × 109/L and +60.8 × 109/L, respectively). The erythrocytes, hemoglobin and median globular volume tend to decrease (-0.5 × 1012, - 1.2 g/dL; -3 fL, respectively). The lactic acid dehydrogenase (LDH) at admission was significantly higher (+58.1 U/L). The age, sex, platelets, lymphocyte count neutrophil counts, neutrophil/lymphocyte ratio, erythrocytes and cell hemoglobin concentration mean (CHCM) are independently associated with mortality (odds ratio (OR) = 0.046, p < 0.001; OR = 0.2364, p= 0.045; OR = 9.106, p= 0.001; OR = 0.194, p= 0.033; OR = 0.062, p= 0.003; OR = 0.098, p= 0.002; OR = 9.021, p < 0.001; OR = 7.016, p= 0.007, respectively). Conclusion The hematological data at admission in the health care system can predict the mortality of the SARS-CoV-2 infection and we recommend its use in the clinical decisions and patient prognosis evaluation.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , SARS-CoV-2 , COVID-19/mortalidade , Doenças Hematológicas , Padrões de Referência , Contagem de Células Sanguíneas , Biomarcadores , Mortalidade , Trombofilia , Unidades de Terapia Intensiva , Leucopenia , LinfopeniaRESUMO
A infecção causada pelo vírus da dengue gera quase 400 milhões de novos casos a cada ano especialmente nos países tropicais e subtropicais, sendo considerada um problema de saúde pública em todo o mundo. Trata-se de uma doença sistêmica e infectocontagiosa, que pode ser classificada como dengue com ou sem sinais de alarme, e dengue grave. As alterações hematológicas estão relacionadas com a gravidade da doença e direcionam condutas médicas. Neste estudo foram realizadas buscas nas plataformas CAPES, LILACS e PubMed no período de janeiro de 2014 a janeiro de 2021 com o objetivo de reunir e avaliar artigos publicados que traziam informações sobre as alterações hematológicas na infecção de dengue grave. Após revisão minuciosa, foram incluídos no estudo um total de 15 artigos e os principais dados observados foram: diminuição da contagem de plaquetas (66,7%), aumento do hematócrito (26,6%), aumento do tempo de tromboplastina parcial ativada (26,6%) e leucopenia (26,6%).
The infection caused by the dengue virus generates almost 400 million new cases each year, especially in tropical and subtropical countries, being considered a public health problem worldwide. It is a systemic and infectious disease, which can be classified as dengue with or without alarm signs, and severe dengue. Hematological changes are related to the severity of the disease and may guide medical procedures. In this study, researches were carried out on the CAPES, LILACS and PubMed platforms with the aim of gathering and evaluating published articles that brought information about hematological changes in severe dengue infection from January 2014 to January 2021. After thorough review, a total of 15 articles were included in the study and the main data observed were: decreased platelet count (66.7%), increased hematocrit (26.6%), increased activated partial thromboplastin time (26.6%) and leukopenia (26.6%).
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Dengue Grave , Trombocitopenia , Revisões Sistemáticas como Assunto , Hemorragia , LeucopeniaRESUMO
The Canine Monocytic Ehrlichiosis (CME) is an infectious disease that commonly affects dogs of all breeds and ages. It is caused by the bacterium Ehrlichia canis and is transmitted by the tick Rhipicephalus sanguineus. The disease may pre-sent itself in the acute, subclinical, and chronic forms. The present study reports the case of a 2-year-old male Border Collie with advanced stage CME, attended at the Pet Clinic of the Veterinary Hospital of the University Federal de Jataí, which resul-ted in medullary aplasia. The diagnosis of marrow aplasia was based on the necroscopic and histopathological examinations. At necropsy, the diaphyses of the long bones were filled with diffuse, strongly whitish and pasty tissue, typical of the adipose tissue, also found in the femoral epiphyses. The histopathology showed unilocular adipose tissue as the major constituent of the bone marrow and rare islands of marrow cells. These findings were compatible with severe hypoplasia of the red bone mar-row and hyperplasia of the white bone marrow, affecting hematopoiesis, resulting in the laboratory alterations observed in the hematocrit, WBC, and plateletogram.(AU)
A erliquiose monocítica canina (EMC) é uma doença infecciosa que comumente afeta cães de todas as raças e idades. Causada pela bactéria Ehrlichia canis e transmitida pelo carrapato Rhipicephalus sanguineus, a doença pode apresentar-se nas for-mas aguda, subclínica e crônica. O presente trabalho relata o caso de um cão, raça Border Collie, macho, 2 anos de idade, com EMC em estágio avançado, atendido no Setor de Clínica de Animais de Companhia do Hospital Veterinário da Universidade Federal de Jataí, caso este que resultou em aplasia medular. O diagnóstico da aplasia de medula baseou-se na realização de exames necroscópico e histopatológico. Na necropsia verificou-se a diáfise de ossos longos preenchida por tecido difuso, seve-ramente esbranquiçado e pastoso, característico de tecido adiposo, também encontrado em epífises femorais. No histopatoló-gico foi verificado tecido adiposo unilocular como maior constituinte da medula óssea e raras ilhas de células medulares. Esses achados foram compatíveis com hipoplasia severa de medula óssea vermelha e hiperplasia de medula óssea branca, afetando a hematopoiese resultando nas alterações laboratoriais verificadas no eritrograma, leucograma e plaquetograma.(AU)