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BACKGROUND: Dermatophytosis is a common fungal infection of the skin and nails. Insufficient data exist regarding the clinico-epidemiological profile of dermatophytosis and the usefulness of individualized homeopathic medicines (IHMs) for patients visiting a homeopathy outpatient department (OPD). OBJECTIVES: This article undertakes a clinico-epidemiological profiling of dermatophytosis and the usefulness of IHMs in its management. METHODS: This open-label, pre-post, comparative observational study was conducted in a homeopathy OPD from November 2018 to February 2020. IHMs were prescribed based on symptom totality and repertorization. A numeric rating scale (NRS) and the Dermatology Life Quality Index (DLQI) patient questionnaires were used, and results were analyzed using SPSS-IBM version 20. RESULTS: Data from a total of 103 patients, mean age 29.65 ± 15.40 years, were analyzed. Tinea cruris was the most common infection (29.1%), followed by tinea corporis (13.6%). After 3 months of treatment, significant reductions in NRS and DLQI scores were observed (8.51 ± 1.24 to 0.59 ± 0.83, p < 0.001, and 16.28 ± 5.30 to 1.44 ± 1.56, p < 0.001, respectively), with Sepia (15.5%), Sulphur (14.6%), Calcarea carbonica (11.7%), Natrum muriaticum (9.7%) and Bacillinum (8.7%) being the most frequently prescribed medicines. There was no significant correlation between occupation, sex, home location or marital status and the clinical types of dermatophytosis. No adverse events were reported. CONCLUSION: T. cruris and T. corporis were prevalent dermatophytic infections. The decrease in NRS and DLQI scores associated with homeopathy indicates its usefulness as an integrative treatment option for dermatophytosis. Further research in larger and more diverse population samples is needed.
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BACKGROUND: There is scarcity of data on outcome of COVID-19 in patients with hematological malignancies. Primary objective of study was to analyse the 14-day and 28-day mortality. Secondary objectives were to correlate age, comorbidities and remission status with outcome. METHODS: Retrospective multicentre observational study conducted in 11 centres across India. Total 130 patients with hematological malignancies and COVID-19 were enrolled. RESULTS: Fever and cough were commonest presentation. Eleven percent patients were incidentally detected. Median age of our cohort was 49.5 years. Most of our patients had a lymphoid malignancy (n = 91). One-half patients (52%) had mild infection, while moderate and severe infections contributed to one-fourth each. Sixty seven patients (52%) needed oxygen For treatment of COVID-19 infection, half(n = 66) received antivirals. Median time to RT-PCR COVID-19 negativity was 17 days (7-49 days). Nearly three-fourth (n = 95) of our patients were on anticancer treatment at time of infection, of which nearly two-third (n = 59;64%) had a delay in chemotherapy. Overall, 20% (n = 26) patients succumbed. 14-day survival and 28-day survival for whole cohort was 85.4% and 80%, respectively. One patient succumbed outside the study period on day 39. Importantly, death rate at 1 month was 50% and 60% in relapse/refractory and severe disease cohorts, respectively. Elderly patients(age ≥ 60) (p = 0.009), and severe COVID-19 infection (p = 0.000) had a poor 14-day survival. The 28-day survival was significantly better for patients in remission (p = 0.04), non-severe infection (p = 0.00), and age < 60 years (p = 0.05). CONCLUSIONS: Elderly patients with hematological malignancy and severe covid-19 have worst outcomes specially when disease is not in remission.
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COVID-19/epidemiologia , Neoplasias Hematológicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/terapia , Criança , Pré-Escolar , Comorbidade , Feminino , Neoplasias Hematológicas/terapia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
Chiral salalen ligands derived from (S)-proline and derivatives of salicyaldehydes were synthesized, and their in-situ generated Cu (II) complexes were evaluated in the asymmetric Henry reaction. Salalen ligand of different substituents on the phenyl moiety showed remarkable effect on the enantioselectivity of nitro-aldol product of 4-nitrobenzaldehyde and nitromethane. Cu (II) complex generated in situ with (S)-2-(tert-butyl)-6-((2-(((2-hydroxy-3-methylbenzylidene)amino)methyl)pyrrolidin-1-yl)methyl) phenol (10 mol%) and Cu (OAc)2 .H2 O (10 mol%), found to be better catalyst for nitro-aldol reaction between 4-nitrobenzaldehyde and nitromethane, gave corresponding product in 85% yield and 88% enantiomeric excess (ee) in isopropanol at 35°C after 40 hours. The catalyst also used for the Henry reaction with different substituted benzaldehydes and corresponding products were obtained in 22% to 99% yields with 66% to 92% ee. Henry reaction of 4-nitrobenzaldehyde and prochiral nitroethane gave anti-selective product (dr = 79/21; anti/syn) in a 91% yield with 80% ee.
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Neurological manifestations in familial hemophagocytic lymphohistiocytosis (FHL) are common, seen in up to 73% of patients in their course of disease. However, in majority of the cases central nervous system manifestations are associated with other clinical and laboratory parameters of hemophagocytic lymphohistiocytosis. We report here a case with FHL2 in whom hemophagocytic lymphohistiocytosis was a presenting manifestation which responded to specific therapy, however, there was isolated central nervous system relapse while patient was in remission and off therapy. FHL2 was confirmed on the basis of reduced perforin expression and homozygous mutation in PRF1at codon 637 in exon 3 (c.673C>T p.Arg225Trp).
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Doenças Desmielinizantes/etiologia , Linfo-Histiocitose Hemofagocítica/genética , Transtornos dos Movimentos/etiologia , Debilidade Muscular/etiologia , Mutação de Sentido Incorreto , Perforina/genética , Adulto , Tronco Encefálico/diagnóstico por imagem , Pré-Escolar , Códon/genética , Ciclosporina/uso terapêutico , Doenças Desmielinizantes/diagnóstico por imagem , Dexametasona/uso terapêutico , Éxons/genética , Feminino , Ferritinas/sangue , Lobo Frontal/diagnóstico por imagem , Humanos , Imunossupressores/uso terapêutico , Linfo-Histiocitose Hemofagocítica/sangue , Linfo-Histiocitose Hemofagocítica/diagnóstico por imagem , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Metotrexato/uso terapêutico , Perforina/deficiência , Recidiva , Infecções Respiratórias/etiologiaRESUMO
OBJECTIVES: The long-term consequences of COVID-19 survivors care and post-coronavirus infection are not yet well understood. The review aims to see whether homoeopathy can help COVID-19 survivors recover from its consequences and improve their quality of life. CONTENT: A systematic search of published articles for post-COVID sequelae and the impact of Homoeopathy were conducted. For the literature search, the major electronic bio-medical database PubMed/MEDLINE was used. In addition, supplementary searches were conducted through the references of those published articles. SUMMARY: A total of 113 records were identified of which 61 studies included for this review. Homoeopathy is effective in the treatment of mental disorders including anxiety and depressive disorder (ADD), some research studies have found, although systematic reviews disagree. Likewise, some medical societies denounce homoeopathy for pain management; other literature shows that it can be used to treat pain effectively. Homoeopathy can aid in the treatment of cardiovascular diseases, as Crataegus, a homoeopathic medication, was found to be just as effective as a standard angiotensin-converting enzyme (ACE) inhibitor and diuretic treatment for minor cardiac insufficiency. The outcomes for Chronic Fatigue Syndrome (CFS), Influenza, and Acute Respiratory Tract Infections (ARTIs) are also promising. OUTLOOK: Based on the results of homoeopathy in non-COVID conditions, it can be thought of in the management of post-COVID-19 outcomes. Consequently, we propose that while investigating post-COVID-19 patient rehabilitation, homoeopathic management may be included as part of the follow-up route and as much data as possible in the context of homoeopathy should be collected, so that in future, the role of homoeopathy in dealing with it can be better demonstrated.
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BACKGROUND: Since the effectiveness of ayurvedic and herbal plaque control agents in reducing plaque in gingivitis is inconsistent across multiple trials, we conducted a study to evaluate their overall effect on dental plaque index (PI), gingival index, and bacterial colony counts (CC) of debris in gingivitis patients. MATERIALS AND METHODS: We searched major electronic biomedical databases (PubMed/Medline, CAM-QUEST®, EBSCOhost, Google Scholar, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials) from August 2004 to August 2021 for randomized control trials on gingivitis using ayurvedic, herbal plaque control agents, and oil pulling therapy as interventions. We grouped comparable outcome parameters of similar products and estimated the standard mean difference (SMD) for pooled effect size with 95% confidence intervals (CI) using RevMan 5.4.1 software. Risk-of-bias (ROB) assessment followed the Cochrane Collaboration's recommended approach. RESULTS: We found 554 articles of 2,806 patients after searching of which 41 randomized clinical trials were considered for meta-analysis. Ayurvedic plaque control agents (Plaque index (PI): SMD = -0.52, 95% CI (-0.94, -0.11); CC: SMD = -1.70, 95% CI (-5.06, 1.67)), (Oil pulling therapy: PI: SMD = -0.38, 95% CI (-1.45, 0.68); CC: SMD = -1.04, 95% CI (-2.20, 0.11)), (Herbal plaque control agents: PI: SMD = -0.58, 95% CI (-1.55, 0.39)), (Triphala: PI: SMD = -0.65, 95% CI (-1.32, 0.03)) were found as good as control. Significant reduction in the gingival index and bacterial colony count was also seen. CONCLUSIONS: In addition to conventional dental care, ayurvedic and herbal plaque control agents may help in plaque reduction, gingival inflammation, and bacterial growth. They are safe and may be recommended in community dentistry practices.(PROSPERO registration number: CRD42021274656).
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Background: Stationary cycling is the popular, preferred, and convenient form of exercise. During exercise, autonomic modulation is seen which can be assessed by heart rate variability (HRV). The aim of the study was to evaluate the changes in HRV during mild-intensity cycling exercise. Materials and Methods: An observational cross-sectional study was done on 20 healthy male volunteers with the age (35.44 ± 4.12), height (71.12 ± 11.98), and weight (161.23 ± 11.65), BMI (27.12 ± 3.49) attending various YOGA sessions in AYUSH OPD. Volunteers underwent an exercise program at the mild intensity of 30% to 50% of maximal heart rate on a stationary cycle for 20 min. HRV was recorded by the HRV mobile unit Dynamika Machine at rest, every 5 min (4×) over 20 min and during the recovery period. Repeated measures of analysis of variance with post-hoc analysis with Bonferroni and Holm's multiple comparisons. Results: Significant change was observed in mean heart rate and time domain parameters. Frequency domain parameters that showed significant change were total power, High Frequency- HF (ms2), Very Low Frequency -VLF (ms2), Low Frequency -LF (ms2), and Very Low Frequency %-VLF (%). Conclusions: The HRV parameters conclusively point towards cardiac parasympathetic withdrawal and sympathetic dominance at the initiation of exercise. With the progression of exercise, the sympathetic influence is retained. In the recovery period parasympathetic reactivation gains control over heart rate as well as HRV. The HRV response to exercise challenges may be helpful in designing exercise programs based on variations in the autonomic response.
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Present study was aimed to evaluate the wound healing activity of aqueous extract of leaves and roots of Coleus aromaticus using excisional wound model in albino rats. The aqueous extracts were prepared using maceration method and were applied as 5% and 10% ointment. The wound healing activity of these extracts was compared with a standard drug povidone-iodine ointment. The healing tissue was also tested for tensile strength, hydroxyproline content and protein content. The histopathological examination of healing tissue was also performed. Ten percent ointment of aqueous extract of root showed complete epithelization after 12 days (p <0.01) and 5% ointment of leaf extract showed complete healing after 16 days (p <0.01).
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Coleus , Extratos Vegetais/farmacologia , Cicatrização/efeitos dos fármacos , Animais , Feminino , Masculino , Folhas de Planta , Raízes de Plantas , Ratos , Ratos WistarRESUMO
OBJECTIVES: The aim of this review is to summarise and appraise the findings of various studies on Trikatu. CONTENT: COVID-19 or SARS-CoV-2 disease a pandemic principally contaminating the respiratory tract and bringing about Severe Acute Respiratory Syndrome is liable for significant mortality around the world. Far-fetched, there is no exact treatment accessible till today. Consequently, it is critical to discover the alternative methodology which can decrease the weight of illness. Trikatu powder recommended by authorities for the management of mild cases of COVID-19 is a conventional ayurvedic formulation containing three spices; Zingiber officinale, Piper nigrum, and Piper longum. A comprehensive search of the articles published since inception to 01/08/2020 on Trikatu was carried out. Major electronic medical databases such as Pub Med/MEDLINE and Cochrane Database of Systematic Reviews were used for the literature search. SUMMARY: A total of 21 records were identified by electronic searches between since inception to 01/08/2020 of which 13 records were included for review. The reviewed articles highlight Trikatu as a safe, anti-inflammatory, and immune-modulatory property by suppression of the production of pro-inflammatory cytokines TNF-a, IL-1b, IL-6, IL-17, alteration in levels of circulating immune complexes, anti-dyslipidaemia agent by reduced triglycerides and LDL cholesterol and increased HDL cholesterol, enhancing bio-availability of co-drug by reducing the elimination half-life (t1/2ß) and zero time intercept of the elimination phase. OUTLOOK: The findings of this review seem to show Trikatu as a potential anti-inflammatory, anti-dyslipidaemia, and immune-modulatory ayurvedic formulation can be used for combating flu like illnesses and also in the management of COVID-19 as an adjuvant. However, rigorous double blind randomized controlled trials with larger sample size are warranted for better validation in such clinical conditions.
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Tratamento Farmacológico da COVID-19 , Alcenos , Humanos , Piperidinas , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND AIMS: Spinal cord injury (SCI) is a medically untreatable condition for which stem cells have created hope in the last few years. Earlier pre-clinical reports have shown that transplantation of bone marrow (BM) mesenchymal stromal cells (MSC) in SCI-simulated models can produce encouraging results. In a clinical pilot study, we investigated the growth kinetics of BM MSC from SCI patients, their safety and functional improvement post-transplantation. METHODS: Thirty patients with clinically complete SCI at cervical or thoracic levels were recruited and divided into two groups based on the duration of injury. Patients with <6 months of post-SCI were recruited into group 1 and patients with >6 months of post-SCI were included into group 2. Autologous BM was harvested from the iliac crest of SCI patients under local anesthesia and BM MSC were isolated and expanded ex vivo. BM MSC were tested for quality control, characterized for cell surface markers and transplanted back to the patient via lumbar puncture at a dose of 1 x 10(6) cells/kg body weight. RESULTS: At the time of writing, three patients had completed 3 years of follow-up post-BM MSC administration, 10 patients 2 years follow-up and 10 patients 1 year follow-up. Five patients have been lost to follow-up. None of the patients have reported any adverse events associated with BM MSC transplantation. CONCLUSIONS: The results indicate that our protocol is safe with no serious adverse events following transplantation in SCI patients. The number of patients recruited and the uncontrolled nature of the trial do not permit demonstration of the effectiveness of the treatment involved. However, the results encourage further trials with higher doses and different routes of administration in order to demonstrate the recovery/efficacy if any, in SCI patients.
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Células da Medula Óssea/metabolismo , Transplante de Células-Tronco Mesenquimais , Traumatismos da Medula Espinal/terapia , Células Estromais/metabolismo , Adolescente , Adulto , Células da Medula Óssea/patologia , Proliferação de Células , Células Cultivadas , Potenciais Somatossensoriais Evocados , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Paraplegia , Projetos Piloto , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/fisiopatologia , Células Estromais/patologia , Transplante AutólogoRESUMO
Between January 2001 and December 2003, 67 patients with acute leukemia were evaluated prospectively for hemostatic abnormality at presentation, of which 43 (64.2%) had acute lymphoblastic leukemia and 24 (35.8%) had acute myelogenous leukemia. At presentation, 27 patients (40.3%) had bleeding manifestations. Thrombocytopenia was present in 57 patients (85%), and 33(49.3%) had some abnormality of global coagulation markers. Disseminated intravascular coagulation was defined by International Society of Thrombosis and Hemostasis criteria. Disseminated intravascular coagulation was more often associated with bleeding manifestations in acute myelogenous leukemia cases than in acute lymphoblastic leukemia cases. Two patients presented disseminated intravascular coagulation on day 7 of chemotherapy, without any bleeding manifestations. Four of 15 evaluated cases who had a bleeding or infection complication after day 7 of induction therapy also had disseminated intravascular coagulation. It is recommended that all patients with leukemia be investigated for disseminated intravascular coagulation at presentation.
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Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/epidemiologia , Leucemia Mieloide Aguda/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asparaginase/uso terapêutico , Criança , Pré-Escolar , Ciclofosfamida/uso terapêutico , Citarabina/uso terapêutico , Feminino , Humanos , Incidência , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Mercaptopurina/uso terapêutico , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Prednisona/uso terapêutico , Estudos Prospectivos , Indução de Remissão , Vincristina/uso terapêuticoRESUMO
Lymphomas with subtle patterns in the marrow can be a diagnostic challenge, unless a high index of suspicion is maintained. We present two patients with aggressive lymphomas who presented with cytopenias and the subsequent bone marrow examinations yielded surprising results. These cases highlight the potential usefulness of a bone marrow examination in the diagnosis of lymphomas in the absence of nodal or other tissue specimens.
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Congenital vitamin K-dependent coagulation factor deficiency is a very rare bleeding disorder, which usually presents with episodes of intracerebral bleed in the first few weeks of life, sometimes leading to a fatal outcome. We report a case of combined factor deficiency of vitamin K-dependent factors in which the patient presented with both intracerebral bleeding, and possibly also thrombosis, and responded to a vitamin K supplement along with fresh frozen plasma.
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Deficiência de Vitamina K/congênito , Fatores de Coagulação Sanguínea/metabolismo , Consanguinidade , Hemorragia/etiologia , Humanos , Lactente , Trombose Intracraniana/sangue , Trombose Intracraniana/etiologia , Masculino , Deficiência de Vitamina K/sangue , Deficiência de Vitamina K/complicações , Deficiência de Vitamina K/genéticaRESUMO
Copper plays an essential role in numerous enzymatic reactions in the human body and hypocupremia manifests itself as cytopenias and/or neuropathy. Copper deficiency is also a mimic of dysplasia, and this may cause diagnostic difficulties with true myelodysplasia. In this case report, we present a patient with anaemia, thrombocytopenia and marginally decreased leucocyte count, who was found to have low copper levels. In addition, he had isolated 20q deletion and a small paroxysmal nocturnal haemoglobinuria clone, which have not been reported previously. His counts normalized after steroid therapy followed by copper supplementation. This case is presented to highlight the fact that copper deficiency may be present without the characteristic morphologic changes, and may be coexisting with other abnormalities.
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Parkinson's disease (PD) is a progressive neurodegenerative disease for which stem cell research has created hope in the last few years. Seven PD patients aged 22 to 62 years with a mean duration of disease 14.7+/-7.56 years were enrolled to participate in the prospective, uncontrolled, pilot study of single-dose, unilateral transplantation of autologous bone-marrow-derived mesenchymal stem cells (BM-MSCs). The BM-MSCs were transplanted into the sublateral ventricular zone by stereotaxic surgery. Patients were followed up for a period that ranged from 10 to 36 months. The mean baseline "off" score was 65+/-22.06, and the mean baseline "on" score was 50.6+/-15.85. Three of 7 patients have shown a steady improvement in their "off"/"on" Unified Parkinson's Disease Rating Scale (UPDRS). The mean "off" score at their last follow-up was 43.3 with an improvement of 22.9% from the baseline. The mean "on" score at their last follow-up was 31.7, with an improvement of 38%. Hoehn and Yahr (H&Y) and Schwab and England (S&E) scores showed similar improvements from 2.7 and 2.5 in H&Y and 14% improvement in S&E scores, respectively. A subjective improvement was found in symptoms like facial expression, gait, and freezing episodes; 2 patients have significantly reduced the dosages of PD medicine. These results indicate that our protocol seems to be safe, and no serious adverse events occurred after stem-cell transplantation in PD patients. The number of patients recruited and the uncontrolled nature of the trial did not permit demonstration of effectiveness of the treatment involved. However, the results encourage future trials with more patients to demonstrate efficacy.
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Células da Medula Óssea/citologia , Transplante de Células-Tronco Mesenquimais , Doença de Parkinson/cirurgia , Recuperação de Função Fisiológica , Adulto , Células Cultivadas , Estudos de Viabilidade , Seguimentos , Humanos , Imunofenotipagem , Imageamento por Ressonância Magnética , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Pessoa de Meia-Idade , Doença de Parkinson/patologia , Projetos Piloto , Técnicas Estereotáxicas , Transplante Autólogo , Resultado do Tratamento , Adulto JovemAssuntos
Encefalopatias/diagnóstico , Calcinose/diagnóstico , Diabetes Insípido Nefrogênico/diagnóstico , Encefalopatias/complicações , Encefalopatias/mortalidade , Calcinose/complicações , Calcinose/mortalidade , Diabetes Insípido Nefrogênico/complicações , Diabetes Insípido Nefrogênico/mortalidade , Humanos , Lactente , Masculino , Prognóstico , Medição de Risco , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
Protein C, protein S, and antithrombin III were measured in 35 patients with acute leukemia (13 with AML and 22 with ALL). Low levels of proteins C and S were present in 15 (42.9%) and 20 (57.1%) patients, respectively, and 6 patients had low levels of antithrombin (ATIII). Seven patients also had DIC at presentation. There were no significant differences in the levels of protein C, protein S, and ATIII in patients with or without DIC. Twenty patients were available for re-evaluation at the end of induction therapy. The low levels of protein C and ATIII found at diagnosis had risen to normal levels at the end of the induction therapy, while low =levels of protein S remained in 75% of the patients. One patient with low protein C at presentation developed myocardial infarction on day 15, and another patient died of progressive neuropathy. No other thrombotic manifestations were seen. Whether the low protein C, protein S, or antithrombin levels predispose patients with acute leukemia to thrombosis in the absence of DIC is not known.
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Antitrombina III/análise , Leucemia Mieloide Aguda/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Proteína C/análise , Proteína S/análise , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Asparaginase/administração & dosagem , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/etiologia , Feminino , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Mercaptopurina/administração & dosagem , Metotrexato/administração & dosagem , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Valor Preditivo dos Testes , Prednisona/administração & dosagem , Trombose/sangue , Trombose/etiologia , Vincristina/administração & dosagemRESUMO
We studied 130 consecutive cases of acute leukemia over a 2-year period and identified 9 cases (6.9%) with active tuberculosis (TB). Eight patients with TB had acute myeloid leukemia (AML). Patients with AML were more likely to develop TB as compared to patients with acute lymphoblastic leukemia (ALL) despite the wider use of steroids and radiotherapy in ALL protocols {OR 4.41 (CI 0.53-36.44)}. Only 1 patient died of disseminated TB during post induction neutropenia. All other patients were successfully managed using current anti-tuberculous therapy (ATT). On the whole, TB did not cause any undue delay in chemotherapy and did not flare up during subsequent chemotherapy cycles. However it is not a commonly described infection in acute leukemia and a high index of suspicion is warranted especially in areas endemic for TB.
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Leucemia/complicações , Tuberculose/etiologia , Doença Aguda , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Incidência , Leucemia/terapia , Leucemia Mieloide , Masculino , Neutropenia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologiaRESUMO
Therapeutic approaches are not well established in patients with myelodysplastic syndrome (MDS). We evaluated response to cyclosporin A (CyA) in 19 cases with MDS who were enrolled for the study [13 refractory anemia (RA), 5 refractory anemia with excess of blasts (RAEB), and 1 refractory anemia with ringed sideroblasts (RARS)]. Bone marrow was normocellular in ten, hypercellular in five, and hypocellular in four cases. Fifteen patients were transfusion dependent and the rest were not transfusion dependent but with a hemoglobin range of 6.4-8.8 g% with a mean of 7.4 g%. CyA was given at a dose of 3-5 mg/kg per day. A major response was observed in seven patients with RA, which was sustained on follow-up. Four cases of RA showed minor response and two cases of RA did not respond to CyA therapy. A minor response was also seen in one RAEB and one RARS case, while one RAEB case that initially showed a major response relapsed on therapy. The first effect of therapy was evident after a mean period of 2.5 months. A rise in platelets and leukocyte count was seen in three and two cases, respectively. One case developed renal failure on therapy and later died of septicemia. Response to CyA was independent of bone marrow cellularity. CyA could be an effective mode of therapy in patients with MDS especially those having RA.