RESUMO
BACKGROUND: Assessing the risk of cytomegalovirus (CMV) viremia in kidney transplant recipients (KTR) may be helpful to indicate in which patient it is worth starting antiviral treatment during preemptive strategy. METHODS: In 40 CMV-seropositive KTR preemptively treated with ganciclovir, we used interferon (IFN)-γ ELISpot test to evaluate whether monitoring T cells directed against phosphoprotein (pp) 65 and immediate early (IE)-1 antigens could predict the onset of viremia. RESULTS: CMV viremia occurred in 24 patients (60%) within 120 days after transplantation. Non-viremic patients had higher anti-pp65, anti-IE-1 T cells, and estimated glomerular filtration rate (eGFR) in the first 90 days after transplantation. At logistic regression, anti-pp65, anti-IE-1 T cells, and eGFR measured at day 30 were significantly associated with CMV infection. Cutoff values of 15 spot-forming cells (SFCs)/200,000 peripheral blood mononuclear cells (PBMCs) for anti-IE, 40 SFCs/200,000 PBMCs for anti-pp65, and 46.6 mL/min/1.73 m(2) for eGFR, respectively, predicted the risk of CMV infection with high sensitivity and specificity (area under the receiver operating characteristic curve >0.75). Using a classification tree model, we identified as high-risk patients those showing anti-pp65 <42 SFCs/200,000 PBMCs and eGFR <62 mL/min/1.73 m(2) , as well as anti-pp65 ≥42 and anti-IE-1 <6.5 SFCs/200,000 PBMCs. CONCLUSION: Monitoring CMV-specific T-cell responses and eGFR in the first month post transplant can identify patients at high risk of CMV infection, for whom preemptive antiviral therapy is recommended.
Assuntos
Infecções por Citomegalovirus/etiologia , Citomegalovirus/imunologia , Transplante de Rim/efeitos adversos , Linfócitos T/fisiologia , Adulto , DNA Viral/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/farmacologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , ViremiaRESUMO
The SINERGIE (South Italian Network for Rational Guidelines and International Epidemiology) project is intended to set up a collaborative network comprising virologists, clinicians and public health officials dealing with patients affected by HCV disease in the Calabria Region. A prospective observational data-base of HCV infection will be developed and used for studies on HCV natural history, response to treatment, pharmaco-economics, disease complications, and HCV epidemiology (including phylogenetic analysis). With this approach, we aim at improving the identification and care of patients, focusing on upcoming research questions. The final objective is to assist in improving care delivery and inform Public Health Authorities on how to optimize resource allocation in this area.
Assuntos
Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Bases de Dados Factuais , Diretrizes para o Planejamento em Saúde , Hepatite C/tratamento farmacológico , Humanos , Itália/epidemiologia , Saúde PúblicaRESUMO
OBJECTIVE: Cholinesterase (ChE) inhibitors are the only medications approved for the treatment of Alzheimer's disease (AD). The features of ChE inhibitors differ considerably. In addition to acetylcholinesterase (AChE) inhibition, rivastigmine also inhibits butrylcholinesterase (BuChE), providing dual AChE and BuChE inhibition. An observational study was performed to determine the response in routine clinical practice to switching AD patients to rivastigmine from a selective AChE inhibitor when that treatment no longer delivered a satisfactory clinical response. RESEARCH DESIGN AND METHODS: A prospective, multicentre, 3-month observational trial in patients with mild to moderately severe AD (adjusted Mini Mental State Examination [MMSE] score 10-26) deteriorating (at least 2 adjusted MMSE points in last 6 months) on selective AChE inhibitor treatment. Adjusted MMSE, activities of daily living (ADL) and instrumental activities of daily living (IADL), the Zarit caregiver burden and global function (short Clinical Global Impression of Change, CGIC) scores were noted before the switch and 3 months after the switch. RESULTS: 225 patients entered the study. The switches made were from donepezil to rivastigmine in (D-R) in 188 patients, galantamine to rivastigmine (G-R) in 33 patients and donepezil to galantamine (D-G) in four patients. Ten patients discontinued due to adverse events and eight for other reasons. More than half of the switches were within 36 hours of a patient's first treatment visit. In the D-R and G-R groups, 67.7% and 66.7% of patients responded (CGIC score < or = 4), respectively. In non-responders, worsening (CGIC score 5-7) was mild in approximately 80% or more of patients. Adjusted MMSE improved after the switch from both donepezil and galantamine to rivastigmine (+0.69 +/- 3.2, p = 0.008 and +0.6 +/- 1.6, p = 0.05, respectively). Mean ADL, IADL, and Zarit scores remained stable. The proportion of patients on concomitant antipsychotic therapy diminished by 30.5% and benzodiazepines were discontinued in all patients, except one. CONCLUSIONS: AD patients deteriorating on selective AChE inhibitor treatment can benefit from switching to a dual AChE-BuChE inhibitor, such as rivastigmine, in terms of stabilization of disease, improvement in cognitive function and reduction in the burden of concomitant psychoactive treatment. The switch was well tolerated. Confirmation of these results is required in a controlled study.
Assuntos
Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/uso terapêutico , Fenilcarbamatos/uso terapêutico , Acetilcolinesterase/metabolismo , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/fisiopatologia , Butirilcolinesterase/metabolismo , Feminino , Humanos , Entrevista Psiquiátrica Padronizada , Estudos Prospectivos , Rivastigmina , Resultado do TratamentoRESUMO
Lyme disease is very common in the countries of the northern hemisphere. In Italy it is endemic in some regions of the northern part of the country and it is more frequent during summer. In Calabria (south Italy) no cases have been reported. To document the presence and indigenous nature of Lyme disease in this territory we conducted a study from 1999 to 2002. We defined as indigenous cases those with erythema migrans with the following characteristics: dimensions equal to or greater than 5 cm; localization on an area of the skin where there was a tick bite; appearance between 4 and 30 days after the tick bite; appearance in patients who had not resided out of Calabria in the previous 3 months. We found 23 patients with the necessary characteristics to be defined indigenous cases. Since 15 of these cases (65.2%) were observed in the October - December trimester and no case was found in the July - September trimester, we suspect that in Calabria the disease follows a seasonal distribution which differs with respect to countries where it is historically endemic.
Assuntos
Doença de Lyme/epidemiologia , Adolescente , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Recém-Nascido , Itália/epidemiologia , Doença de Lyme/imunologia , Masculino , Pessoa de Meia-Idade , Estações do Ano , Estudos SoroepidemiológicosRESUMO
Fifty-four subjects suffering from TIA or Stroke underwent normal ECG and Holter ECG ten days after ischemic cerebral event in order to point out cardiac dysrhythmias as possible causes of TIA or Stroke. Holter ECG proved positive in 70.3% of subjects versus 38.8% of normal ECG (p < 0.001). We underline the utility of cardiological valuation in patients suffering from TIA or Stroke in order to search for cardiac causes of ischemic cerebral events and to prevent relapses.
Assuntos
Transtornos Cerebrovasculares/diagnóstico , Eletrocardiografia Ambulatorial , Cardiopatias/complicações , Ataque Isquêmico Transitório/diagnóstico , Arritmias Cardíacas/complicações , Arteriosclerose/complicações , Transtornos Cerebrovasculares/etiologia , Eletrocardiografia , Feminino , Cardiopatias/diagnóstico , Humanos , Ataque Isquêmico Transitório/etiologia , MasculinoRESUMO
INTRODUCTION: Polyomavirus BK nephropathy is emerging as a significant cause of interstitial nephritis and allograft dysfunction (1-2). CASE REPORT: Two patients with renal transplants from cadaveric kidneys were treated with Tacrolimus plus Mycophenolate Mofetil (MMF) and Cyclosporine plus MMF, respectively. Their renal function gradually deteriorated eight to twelve months after the transplant. The renal biopsy of the first patient showed signs of significant interstitial tubulite, which necessitated the anti-rejection therapy with intravenous steroid pulses. After the pulses there was an additional dramatic increase in plasmatic creatinine, which suggested a revaluation of the kidney biopsy because of suspected Polyomavirus BK (BKV) nephropathy. In fact, after a more careful review, the suspicion of BKV infection was confirmed by the presence of intranuclear inclusions of tubular epithelium cells and marked denudation of the tubular basal membrane. The subsequent screening in both cases confirmed the presence of decoy cells in the urine, while the immunohistochemical analysis of the renal biopsy was strongly positive for the SV40 antigen. Our diagnosis was that of interstitial nephritis due to Polyomavirus BK that, in the first patient, was expressed by more aggressive clinical progress, probably due to enhanced immunosuppression from incorrect diagnosis of the interstitial rejection. The pre-transplant clinical outcome of the first patient was characterised by proteinuric nephropathy without any histological confirmation. Furthermore, we observed abundant pre-transplant residual diuresis and glucose intolerance. All these elements led us to hypothesise that native kidneys could have a fundamental role as viral reservoirs. CONCLUSION: Even though we reconfirm the decisive role of the immunosuppressive therapy and of the donor s kidney as the fundamental causes of Polyomavirus reactivation, we believe that it cannot be the result of a possible active role by the native kidney. In fact, as already noted, the SV40 genome is important in the pathogenesis of focal gomerulosclerosis. Furthermore, reports of polyoma nephropathy in not-yet-transplanted patients could accredit the role of the native kidneys as important viral reservoirs capable of inducing nephropathy in renal transplant patients.
Assuntos
Vírus BK , Neoplasias Renais/etiologia , Transplante de Rim/efeitos adversos , Infecções por Polyomavirus/etiologia , Infecções Tumorais por Vírus/etiologia , Adulto , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Sepsis is an increasingly prevalent cause of death, and management in the early stage is a critical issue. However, microbiological findings are generally obtained late during the course of the disease. In this study, we evaluated the clinical utility of procalcitonin (PCT) in improving the diagnosis of bloodstream infections and the potential utility of the SeptiFast (SF) test, a multiplex pathogen detection system, in the etiological diagnosis of immunocompromised patients. Seventy-nine hospitalized immunocompromised patients were included in this study. Our results demonstrate that while the PCT value correlates highly with sepsis, the results do not discriminate adequately enough to justify its independent use as a diagnostic tool. The SF test, combined with blood cultures, improves microbiological data in immunocompromised patients, especially in cases of previous antibiotic therapy and invasive fungal infection.
Assuntos
Técnicas Bacteriológicas/métodos , Calcitonina/sangue , Técnicas de Diagnóstico Molecular/métodos , Precursores de Proteínas/sangue , Sepse/diagnóstico , Adolescente , Adulto , Idoso , Peptídeo Relacionado com Gene de Calcitonina , Criança , Pré-Escolar , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
We describe the case of a woman with primary progressive aphasia who, over a period of nine years, has shown no signs of clinical deterioration and has only a symptomatic language disturbance. Neuropsychological follow-up has revealed progressive language impairment, with the integrity of praxis, visuoperceptive gnosia and short term visuospatial memory remaining intact; the only impairment was that revealed by long-term memory tests.
Assuntos
Afasia/patologia , Idoso , Afasia/diagnóstico por imagem , Afasia/psicologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Testes Neuropsicológicos , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The clinical case presented is one of common iliac artery aneurysm, provoking a radicular compression symptomatology from L4 to S1. It is stressed that neurologic disorders having a radicular content are extremely rare in aorta-iliac vascular compressive pathology. In the case described, the involvement of several nerve roots is attributed to the aneurysm's unusual size (like a fetus' head) of the aneurysmatic sac.
Assuntos
Aneurisma/complicações , Artéria Ilíaca , Plexo Lombossacral , Síndromes de Compressão Nervosa/etiologia , Idoso , Aneurisma/patologia , Humanos , Artéria Ilíaca/patologia , Masculino , Síndromes de Compressão Nervosa/patologia , Raízes Nervosas Espinhais , Tomografia Computadorizada por Raios XRESUMO
We report a patient with MELAS treated for 24 months with idebenone and riboflavin, during which no stroke-like episodes occurred. Moreover neurological symptoms clearly improved, and a recovery of brain MRI and EEG abnormalities was observed. We conclude that the combined treatment with idebenone and riboflavin may restore the metabolic impairment in MELAS, possibly improving the long-term prognosis in these patients.
Assuntos
Antioxidantes/farmacologia , Benzoquinonas/farmacologia , Síndrome MELAS/tratamento farmacológico , Fármacos Fotossensibilizantes/farmacologia , Riboflavina/farmacologia , Adulto , Afasia de Wernicke/tratamento farmacológico , Afasia de Wernicke/etiologia , Afasia de Wernicke/patologia , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/etiologia , Infarto Cerebral/patologia , Esquema de Medicação , Quimioterapia Combinada , Transporte de Elétrons/efeitos dos fármacos , Transporte de Elétrons/genética , Humanos , Síndrome MELAS/complicações , Síndrome MELAS/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/genética , Mitocôndrias/metabolismo , Resultado do Tratamento , Ubiquinona/análogos & derivadosRESUMO
76 patients affected by acute ischemic encephalopathy due to i.c.a. occlusion have been examined through a Doppler nosography, in order to evaluate the influence of the type of collateral circle on the neurologic damage. Collateral circles between the external and internal carotid arteries were established through the ophthalmic artery in 80% of cases (A) and through the Willis circle in 70% of cases (B). Those two types of compensation do not seem to have prognostic value with regard to disability; on the contrary a remarkable difference was observed in the type of pathology (A = Stroke 40%, RIA 60%; B = 77%, RIA 23%).
Assuntos
Arteriopatias Oclusivas/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/fisiopatologia , Círculo Arterial do Cérebro/fisiopatologia , Circulação Colateral , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/fisiopatologia , Prognóstico , UltrassonografiaRESUMO
We report a case of subacute myopathy in a 47 years old man engaged on boiler maintenance at an oil-fired thermoelectric power station. The occupational history highlighted heavy exposure to inhalation of ash derived from mineral oil combustion and containing several elements, metals and metalloids, including vanadium and nickel. The presenting symptoms, clinical course and muscle histopathology suggest that exposure to toxic agents probably played an important part in the causation of the myopathy.
Assuntos
Doenças Musculares/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Óleos/toxicidade , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Doenças Musculares/patologiaRESUMO
The association of ischemic cerebrovascular lesions with livedo reticularis is known as Sneddon syndrome. It affects young subjects, primarily women, and its neurological manifestations are TIAs, ischemic stroke, progressive dementia and epileptic seizures. Its etiopathogenesis has still to be clarified. Some authors have associated it with an antiphospholipid antibody syndrome. Recently it has been assumed that a defect in blood coagulation may be involved in its pathogenesis. Here we report a case in which both an increase in coagulation factor VII activity and a deficiency in free protein S were documented.
Assuntos
Dermatopatias Vasculares/sangue , Dermatopatias Vasculares/diagnóstico , Adulto , Isquemia Encefálica/etiologia , Fator VII/fisiologia , Feminino , Humanos , Deficiência de Proteína S , SíndromeRESUMO
A case of a spontaneous cerebral hematoma in the left capsulo-nuclear area in an adolescent girl with congenital deficiency of coagulation Factor XIII is described.
Assuntos
Hemorragia Cerebral/complicações , Hemofilia A/complicações , Adolescente , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
Clinical, radiological and electrophysiological data in two patients with 'Miller Fisher syndrome' (MFS), characterized by ataxia, ophthalmoplegia and areflexia are reported. Of the many tests performed only the electrophysiological findings provided any clue to the site of the lesions and the structure involved, showing a significant pattern of brainstem dysfunction. The authors discuss the role of central and peripheral lesion theory in the light of these data and stress that electrophysiological findings lend considerable weight to the former and support the hypothesis that MFS should be recognize as a distinct clinical entity.
Assuntos
Ataxia/complicações , Oftalmoplegia/complicações , Reflexo Anormal , Ataxia/fisiopatologia , Tronco Encefálico/fisiopatologia , Eletrofisiologia , Potenciais Evocados Auditivos , Nervo Facial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/fisiopatologia , Reflexo Anormal/fisiologia , Síndrome , Nervo Trigêmeo/fisiopatologiaRESUMO
Reported here are the results of an open controlled study on the use of GM1 in cases of ischemic strokes in its acute phase. A statistically significant improvement was observed in cases treated with GM1 for neurological deficits (assessed by Mathew's rating scale, modified by Fritz-Werner) at 21, 60 and 120 days and for disability at 120 days.
Assuntos
Gangliosídeos/uso terapêutico , Ataque Isquêmico Transitório/tratamento farmacológico , Doença Aguda , Idoso , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
During a viral meningoencephalitis, a 60-year-old woman developed a full parkinsonian syndrome, unchanged four months after the onset. The viral researches demonstrated an increase of the anti-CMV antibodies, especially in the cerebrospinal fluid. CSF's and neuroimaging data are discussed.
Assuntos
Meningoencefalite/complicações , Doença de Parkinson Secundária/microbiologia , Feminino , Humanos , Meningoencefalite/microbiologia , Pessoa de Meia-IdadeRESUMO
A 41 year-old-man developed diplopia, bilateral ptosis, paralysis of conjugate eye movement upwards and horizontal, with dilated and fixed pupils, after an influenza syndrome. Radiological, cerebrospinal fluid and electrophysiological data were normal, except BAEPs. The different aetiologies and pathogenesis are discussed.
Assuntos
Ataxia/complicações , Influenza Humana/complicações , Doenças do Nervo Oculomotor/etiologia , Oftalmoplegia/complicações , Reflexo Anormal , Adulto , Humanos , Masculino , SíndromeRESUMO
Motor neuron diseases (MND) associations with paraproteinemia, lymphoma, hexosaminidase A deficiency and heavy-metal intoxication are of great interest. A case of amyotrophic lateral sclerosis (SLA) associated with multiple myeloma (monoclonal IgG paraproteinemia and K light chains) is reported. The detection of abnormal protein in 1988 and the increase of its serum level during 1989 were strictly correlated with the beginning and the worsening of the neurological disease. Shy and coll. in 1986 affirmed that association of paraproteins with MND is probably not merely the fortuitous association of a common laboratory abnormality and an uncommon disease. The reported case provides elements for a causal association between paraproteinemia and MND.
Assuntos
Esclerose Lateral Amiotrófica/complicações , Mieloma Múltiplo/complicações , Esclerose Lateral Amiotrófica/sangue , Humanos , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/sangueRESUMO
We studied 7 patients with internal carotid occlusion following spontaneous arterial dissection. All presented strokes, in one associated with Horner's syndrome. The doppler examination showed carotid occlusion, but only angiography established the diagnosis of vascular disease. Spontaneous recanalization was observed in 6 cases, treated only by antiplatelet drugs.