Hemorragia postparto en pacientes con obesidad y/o anemia durante el embarazo: revisión sistemática

Introducción: actualmente la anemia y la obesidad durante el embarazo se consideran factores de riesgo modificables para hemorragia postparto. Estos pueden ser evitados desde el control prenatal y su manejo preconcepcional contribuye de una forma importante en la reducción de la morbimortalidad materno y perinatal. Metodología: se realizó una revisión sistemática de literatura con componente meta-analítico según la evidencia disponible hasta la fecha. Los términos mesH incluyeron postpartum hemorrhage, severe anemia, overweight, obesity entre otros. Todos los artículos fueron clasificados por su evidencia antes de calcular el componente meta-analítico. Resultados: se encontraron un total de 321 artículos relacionados con anemia, y 276 para obesidad, de los cuales 8 y 14 respectivamente cumplieron criterios para su selección. La mayoría de artículos fueron clasificados como evidencia IV para anemia y II-III para obesidad. Las causas más frecuentes de exclusión fueron el título y el tipo de estudio. Tanto la anemia como la obesidad (clasificada por IMC) muestran OR conjuntos no estadísticamente significativo y con intervalos de confianza amplios, aunque la tendencia de riesgo conjunto es a mayor peso, mayor riesgo de hemorragia. Discusión: los resultados de la revisión sistemática permiten mostrar tanto a la anemia como la obesidad como factores que muestran una tendencia al riesgo para hemorragia postparto, sin resultados estadísticamente significativos. Faltan más estudios sobre el tema en el país.MetodologíaSe realizó una revisión sistemática de literatura con componente meta-analítico según la evidencia disponible hasta la fecha. Los términos mesH incluyeron postpartum hemorrhage, severe anemia, overweight, obesity entre otros. Todos los artículos fueron clasificados por su evidencia antes de calcular el componente meta-analítico. ResultadosSe encontraron un total de 321 artículos relacionados con anemia, y 276 para obesidad, de los cuales 8 y 14 respectivamente cumplieron criterios para su selección. La mayoría de artículos fueron clasificados como evidencia IV para anemia y II-III para obesidad. Las causas más frecuentes de exclusión fueron el título y el tipo de estudio. Tanto la anemia como la obesidad (clasificada por IMC) muestran OR conjuntos no estadísticamente significativo y con intervalos de confianza amplios, aunque la tendencia de riesgo conjunto es a mayor peso, mayor riesgo de hemorragia. DiscusiónLos resultados de la revisión sistemática permiten mostrar tanto a la anemia como la obesidad como factores que muestran una tendencia al riesgo para hemorragia postparto, sin resultados estadísticamente significativos. Faltan más estudios sobre el tema en el país.

Anemia during adjuvant non-taxane chemotherapy for early breast cancer: Incidence and risk factors from two trials of the International Breast Cancer Study Group

GOAL OF THE WORK: Anemia is a common side effect of chemotherapy. Limited information exists about its incidence and risk factors. The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence in patients with early breast cancer who received adjuvant chemotherapy. MATERIALS AND METHODS: We evaluated risk factors for anemia in pre- and post/perimenopausal patients with lymph node-positive early breast cancer treated with adjuvant chemotherapy in two randomized trials. All patients received four cycles of doxorubicin and cyclophosphamide (AC) followed by three cycles of cyclophosphamide, methotrexate, fluorouracil (CMF). Anemia incidence was related to baseline risk factors. Multivariable analysis used logistic and Cox regression. MAIN RESULTS: Among the 2,215 available patients, anemia was recorded in 11% during adjuvant chemotherapy. Grade 2 and 3 anemia occurred in 4 and 1% of patients, respectively. Pretreatment hemoglobin and white blood cells (WBC) were significant predictors of anemia. Adjusted odds ratios (logistic regression) comparing highest versus lowest quartiles were 0.18 (P < 0.0001) for hemoglobin and 0.52 (P = 0.0045) for WBC. Age, surgery type, platelets, body mass index, and length of time from surgery to chemotherapy were not significant predictors. Cox regression results looking at time to anemia were similar. CONCLUSIONS: Moderate or severe anemia is rare among patients treated with AC followed by CMF. Low baseline hemoglobin and WBC are associated with a higher risk of anemia.

Anemia hemolítica : desafio diagnóstico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

What are RBC-transfusion-dependence and -independence?

The term RBC-transfusion-dependence is widely-used by hematologists to describe a condition of severe anemia typically arising when erythropoiesis is reduced such that a person continuously requires =1 RBC-transfusions over a specified interval. Defining a person as RBC-transfusion-dependent has important implications in diverse hematological disorders especially because it strongly-correlated with decreased survival. Conversely, becoming RBC-transfusion-independent or receiving fewer RBC-transfusions over a specified interval is defined as improvement or response in many disease- and/or therapy-setting. Whether this correlates with improved survival is controversial. We used a structured expert-panel consensus panel process to define RBC-transfusion-dependence and -independence or improvement. We suggest these definitions may prove useful to persons studying or treating these diseases.

5-Lipoxygenase plays a role in the control of parasite burden and contributes to oxidative damage of erythrocytes in murine Chagas` disease

Chagas` disease is accompanied by severe anemia and oxidative stress, which may contribute to mortality. In this study, we investigated the role of 5-lipoxygenase (5-LO) in the control of parasitism and anemia associated with oxidative damage of erythrocytes in experimental Trypanosoma cruzi infection. Wild-type C57BL/6, 129Sv mice treated or not with nordihydroguaiaretic acid (NDGA, 5-LO inhibitor), mice lacking the 5-LO enzyme gene (5-LO(-/-)) and inducible nitric oxide synthase gene (iNOS(-/-)) were infected with the Y strain of T cruzi. impairment of 5-LO resulted in increased numbers of trypomastigote forms in the blood and amastigote forms in the heart of infected mice. We assessed oxidative stress in erythrocytes by measuring oxygen uptake, induction time and chemiluminescence following treatment with tert-butyl hydroperoxide (TBH). Our results show that 5-LO metabolites increased lipid peroxidation levels in erythrocytes during the early phase of murine T cruzi infection. NDGA treatment reduced oxidative damage of erythrocytes in C57BL/6 T cruzi-infected mice but not in C57BL/6 iNOS-/- infected mice, showing that the action of NDGA is dependent on endogenous nitric oxide (NO). In addition, our results show that 5-LO metabolites do not participate directly in the development of anemia in infected mice. We conclude that 5-LO products may not only play a major role in controlling heart tissue parasitism, i.e., host resistance to acute infection with T cruzi in vivo, but in the event of an infection also play an important part in erythrocyte oxidative stress, an NO-dependent effect. (C) 2009 Elsevier B.V. All rights reserved.

American visceral leishmaniasis: Factors associated with lethality in the state of São Paulo, Brazil

Objectives. To identify factors associated with death in visceral leishmaniasis (VL) cases. Patients and Methodology. We evaluated prognostic factors for death from VL in São Paulo state, Brazil, from 1999 to 2005. A prognostic study nested in a clinical cohort was carried out by data analysis of 376 medical files. A comparison between VL fatal cases and survivors was performed for clinical, laboratory, and biological features. Association between variables and death was assessed by univariate analysis, and the multiple logistic regression model was used to determine adjusted odds ratio for death, controlling confounding factors. Results. Data analysis identified 53 fatal cases out of 376 patients, between 1999 and 2005 in São Paulo state. Lethality was 14.1 (53/376), being higher in patients older than fifty years. The main causes of death were sepsis, bleeding, liver failure, and cardiotoxicity due to treatment. Variables significantly associated with death were severe anemia, bleeding, heart failure, jaundice, diarrhea, fever for more than sixty days, age older than fifty years, and antibiotic use. Conclusion. Educational health measures are needed for the general population and continuing education programs for health professionals working in the affected areas with the purpose of identifying and treating early cases, thus preventing the disease evolution towards death. © 2012 Geraldine Madalosso et al.

Estudo da hipoplasia sanguínea e quantificação imunofenotípica de células CD45+ no sangue e na medula óssea de cães com doença renal crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência dos níveis de ferritina sérica, das mutações no gene da beta globina e dos valores das enzimas de detoxificação Catalase e Glutationa S -Transferase na expressão fenotípica de Beta Talassemia Heterozigota

Pós-graduação em Genética - IBILCE

Estudo por PCR em tempo real de três polimorfismos em genes envolvidos na resposta imune em pacientes infectados por Plasmodium vivax da população de Belém-PA

A malária é uma doença infecciosa que atinge aproximadamente 40% da população mundial em mais de 100 países e consiste em um grave problema de saúde pública. As citocinas são moléculas importantes na resposta imune contra a malária e atuam através do estímulo ou inibição da ativação, proliferação e/ ou diferenciação de células, além de regularem a secreção de anticorpos e de outras citocinas. Nesse trabalho investigamos três polimorfismos de nucleotídeo único (SNP) que podem influenciar em uma maior ou menor síntese das citocinas TNF-a e IFN-g. Em relação à malária, os polimorfismos já foram associados com a malária grave, malária cerebral e anemia grave e também com outras doenças infecciosas, auto-imunes e com o câncer. Foram incluídos no estudo oitenta e um (81) pacientes com malária por Plasmodium vivax (primeira infecção) e cento e trinta (130) indivíduos sadios, ambos da população de Belém – PA. As freqüências genotípicas e alélicas foram pesquisadas através da técnica de discriminação alélica por PCR em tempo real e os resultados foram comparados entre os dois grupos. Parâmetros clínicos foram utilizados para tentar associar uma maior gravidade das manifestações da malária e a presença dos polimorfismos entre os pacientes. As freqüências foram semelhantes entre os dois grupos estudados. O alelo TNF-238*A não mostrou relação com nenhum dos parâmetros clínicos enquanto o alelo TNF-376*A estava relacionado com menores níveis plasmáticos de TNF-a e com uma menor intensidade dos sintomas. Os pacientes portadores do alelo IFN+874*A apresentaram menor intensidade da parasitemia. Assim os resultados obtidos não indicam associação dos polimorfismos com a ocorrência da malária na população estudada, mas com alguns dos parâmetros clínicos investigados, e podem auxiliar futuros estudos para tentar esclarecer como as mutações nos genes de citocinas podem influenciar na ocorrência e na evolução clínica da malária e de outras doenças infecciosas e parasitárias.

Avaliação da intervenção na deficiência de ferro com fortificação de ferro aminoquelato: estudo em crianças de creches do município de Lins-SP

Pós-graduação em Pediatria - FMB

Electrocardiographic evaluation and serum cardiac troponin I levels in anemic dogs with blood parasitosis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Isoeritrólise neonatal eqüina

Equine neonatal isoerythrolysis is a neonatal foals’ illness. Results from the incompatibility of blood type between the foal and the mare and mediated by maternal antibody absorbed by the colostrum against foal’s red blood cells. Characterized by a type ll hypersensitivity reaction, where the exhibition of the organism to a strange antigen, that it takes the sensitization of the lymphocytes B that after the removal of the antigens by the reticule-endothelial system the production of immunoglobulin is decreased, with the formation of cellular immunological will cause the occurrence of the illness in foal of sensitized mares. The most important clinical signs are severe anemia and jaundice, and this illness should be differentiated of other as: hemolysis induced by bacterial toxins, diseases of the hepatobiliary system, disseminated intravascular coagulation and incompatibility in blood transfusions. Like the sensitization happens during the previous incompatible foal’s birth, most cases occur in foals of multiparous mares. However during the first pregnancy the mare can generate a foal with neonatal 7 isoerythrolysis if she have developed placental anomaly in the beginning of the pregnancy which blood cells in her circulation

Pathology of dogs in Campo Grande, MS, Brazil naturally co-infected with Leishmania infantum and Ehrlichia canis

Different parasites that commonly occur concomitantly can influence one another, sometimes with unpredictable effects. We evaluated pathological aspects of dogs naturally co-infected with Leishmania infantum and Ehrlichia canis. The health status of the dogs was investigated based on histopathological, hematological and biochemical analyses of 21 animals infected solely with L. infantum and 22 dogs co-infected with L. infantum and E. canis. The skin of both groups showed chronic, predominantly lymphohistioplasmacytic inflammatory reaction. The plasmacytosis in the lymphoid tissues was likely related with the hypergammaglobulinemia detected in all the dogs. The disorganization of extracellular matrix found in the reticular dermis of the inguinal region and ear, characterized by the substitution of thick collagen fibers for thin fibers, was attributed to the degree of inflammatory reaction, irrespective of the presence of parasites. In addition, the histopathological analysis revealed that twice as many dogs in the co-infected group presented Leishmania amastigotes in the ear skin than those infected solely with Leishmania, increasing the possibility of becoming infected through sand fly vectors. Our findings highlight the fact that the health of dogs infected concomitantly with L. infantum and E. canis is severely compromised due to their high levels of total plasma protein, globulins, alkaline phosphatase and creatine kinase, and severe anemia.