RESUMO
EXpanding Treatment for Existing Neurological Disease (EXTEND) investigated whether hydroxycarbamide lowers transcranial Doppler (TCD) velocities in Jamaican children with sickle cell anaemia (SCA) and elevated TCD velocity with or without previous stroke. Forty-three children (age 2-17 years) with baseline maximum time-averaged mean velocity (TAMV) ≥ 170 cm/s were stratified into three risk categories based on treatment status and stroke history: Group 1 (no history of stroke, on hydroxycarbamide, n = 12); and Groups 2 (no stroke, no hydroxycarbamide, n = 21) and 3 (previous stroke, no hydroxycarbamide, n = 10). Open-label hydroxycarbamide at 20 mg/kg/day was commenced, with escalation to maximum tolerated dose (MTD) based on mild marrow suppression (average dose 25·4 ± 4·5 mg/kg/day). TCD was performed every six months with brain magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) at baseline and after 18-months of hydroxycarbamide. The maximum TAMV decreased significantly compared to baseline (24 ± 30 cm/s, P < 0·0001), with similar declines in all groups. Clinical stroke occurred in five children, one in Group 1, none in Group 2, and four in Group 3, P = 0·0032, comparing group incidence rates. Brain MRI/MRA was stable in children without clinical stroke. EXTEND documents the feasibility and benefits of hydroxycarbamide at MTD to lower TCD velocities and reduce stroke risk in children with SCA and no history of primary stroke in low-resource settings without transfusion management.
Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Hidroxiureia/uso terapêutico , Ultrassonografia Doppler Transcraniana , Adolescente , Anemia Falciforme/fisiopatologia , Velocidade do Fluxo Sanguíneo , Transtornos Cerebrovasculares/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Jamaica , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Estudos Prospectivos , Recidiva , Método Simples-Cego , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
BACKGROUND: Few studies have investigated the relationship between physical activity (PA) of low intensity and duration with quality of life (QoL) among individuals at risk or with cardiovascular disease (CVD). OBJECTIVES: To investigate whether PA of different intensity and duration moderates the relationship between CVD and its risk factors (obesity, hypertension, diabetes, dyslipidaemia) and QoL in adults. METHODS: Population-based cross-sectional studies using data from the EpiFloripa Cohort Study (Southern Brazil; n = 1,220, 38.8±12.0 years, 48.2% males) and the North West Adelaide Health Study (NWAHS, South Australia; n = 1,661, 43.7±11.1 years, 49.7% males). The physical and psychological domains of QoL were assessed using the WHOQOL-Bref (EpiFloripa) or the SF-36 (NWAHS) questionnaires. The diagnosis of CVD and its risk factors were self-reported. PA was self-reported and quantified by its intensity ["walking" or moderate/vigorous (MVPA)] and duration (none, 1-150, ≥150 min/week). Both studies were analysed separately, and results were adjusted for sociodemographic variables. RESULTS: Participants at risk or with CVD from both studies showed a lower QoL than 'healthy' individuals with a stronger relationship for the physical domain. PA duration showed a direct-trend relationship with QoL, but the associations were stronger for MVPA in both studies. However, when stratified by health status, the magnitude of the association between "walking" duration and a higher physical QoL was greater among those at risk or with CVD compared to 'healthy' individuals. Conversely, among Australians with CVD, MVPA was associated with a better physical QoL only when its duration was ≥150 min/week. All associations were stronger in the NWAHS than in the Brazilian study. CONCLUSIONS: "Walking" was more prevalent than MVPA and was consistently associated with a better physical QoL among those at risk or with CVD. These findings should be considered in the design of public health interventions designed to increase PA and improve QoL.
Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Qualidade de Vida , Adulto , Austrália/epidemiologia , Brasil/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
This study investigated the association of nutritional and haematological variables with maximum time-averaged mean velocity (TAMV) measured by transcranial Doppler (TCD) velocity and the agreement of classification between two protocols. TCD categories included: normal (<170 cm/s), conditional (170-199 cm/s) and abnormal (≥200 cm/s) based on TAMV in distal internal carotid artery (dICA), middle cerebral artery (MCA), internal carotid bifurcation, anterior and posterior cerebral arteries. Of 358 children with sickle cell anaemia (SCA) examined, the mean age (±standard deviation) was 7·4 ± 2·7 years; 13·1% and 6·7% had conditional and abnormal velocities, respectively. Children with abnormal TCD velocities had higher prevalence of prior stroke (P = 0·006). Increased TAMV was associated with younger age (P = 0·001), lower weight (P = 0·001), height (P = 0·007) and oxygen saturation (P = 0·005). There was no association of TAMV with height-age or body mass index (BMI) z-scores. Adjusting for gender, BMI z-score, age, previous stroke and oxygen saturation, mean corpuscular volume (P = 0·005) and reticulocyte count (P = 0·013) were positively associated with TAMV, while haemoglobin concentration (P = 0·009) was negatively associated. There was good agreement [99%; weighted Kappa 0·98 (95% confidence interval 0·89-1), P = 0·0001] in TCD classification using data from five vessels versus two vessels (dICA and MCA). Haematological variables, rather than nutritional status, may be useful markers that identify high-risk children with SCA.
Assuntos
Anemia Falciforme , Artérias Cerebrais , Circulação Cerebrovascular , Hemoglobinas/metabolismo , Estado Nutricional , Ultrassonografia Doppler Transcraniana , Fatores Etários , Anemia Falciforme/sangue , Anemia Falciforme/diagnóstico por imagem , Anemia Falciforme/fisiopatologia , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Peso Corporal , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Jamaica , Masculino , Fatores SexuaisRESUMO
BACKGROUND: Sickle cell disease is the most common monogenic hereditary disease in Brazil. Although strokes are one of the main causes of morbidity and mortality in these patients, the use of transcranial Doppler to identify children at risk is not universally used. OBJECTIVE: To develop Brazilian guidelines for the use of transcranial Doppler in sickle cell disease children and adolescents, so that related health policies can be expanded, and thus contribute to reduce morbidity and mortality. METHODS: The guidelines were formulated in a consensus meeting of experts in transcranial Doppler and sickle cell disease. The issues discussed were previously formulated and scientific articles in databases (MEDLINE, SciELO and Cochrane) were carefully analyzed. The consensus for each question was obtained by a vote of experts on the specific theme. RESULTS: Recommendations were made, including indications for the use of transcranial Doppler according to the sickle cell disease genotype and patients age; the necessary conditions to perform the exam and its periodicity depending on exam results; the criteria for the indication of blood transfusions and iron chelation therapy; the indication of hydroxyurea; and the therapeutic approach in cases of conditional transcranial Doppler. CONCLUSION: The Brazilian guidelines on the use of transcranial doppler in sickle cell disease patients may reduce the risk of strokes, and thus reduce the morbidity and mortality and improve the quality of life of sickle cell disease patients.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Hemoglobina Falciforme , Criança , Adolescente , Guia , Ultrassonografia Doppler Transcraniana/métodos , Acidente Vascular Cerebral/prevenção & controle , Anemia Falciforme/diagnóstico , Anemia Falciforme/terapiaRESUMO
BACKGROUND: Sickle cell disease is the most common monogenic hereditary disease in Brazil. Although strokes are one of the main causes of morbidity and mortality in these patients, the use of transcranial Doppler to identify children at risk is not universally used. OBJECTIVE: To develop Brazilian guidelines for the use of transcranial Doppler in sickle cell disease children and adolescents, so that related health policies can be expanded, and thus contribute to reduce morbidity and mortality. METHODS: The guidelines were formulated in a consensus meeting of experts in transcranial Doppler and sickle cell disease. The issues discussed were previously formulated and scientific articles in databases (MEDLINE, SciELO and Cochrane) were carefully analyzed. The consensus for each question was obtained by a vote of experts on the specific theme. RESULTS: Recommendations were made, including indications for the use of transcranial Doppler according to the sickle cell disease genotype and patients age; the necessary conditions to perform the exam and its periodicity depending on exam results; the criteria for the indication of blood transfusions and iron chelation therapy; the indication of hydroxyurea; and the therapeutic approach in cases of conditional transcranial Doppler. CONCLUSION: The Brazilian guidelines on the use of transcranial doppler in sickle cell disease patients may reduce the risk of strokes, and thus reduce the morbidity and mortality and improve the quality of life of sickle cell disease patients.
RESUMO
This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.
Assuntos
Cristianismo , Religião e Sexo , Medicina Reprodutiva , Adolescente , Feminino , Humanos , Entrevistas como Assunto , Jamaica , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To determine whether long-term transfusion improves growth in children with sickle cell anemia. STUDY DESIGN: In the Stroke Prevention Trial for Sickle Cell Anemia Study, patients were randomized to receive long-term transfusion (CTX) or standard care (STC). Transfusions were administered every 3 to 5 weeks, and hemoglobin S levels were maintained at 30% pretransfusion for an average of 2 years. Serial height and weight measurements (obtained every 3 months), body mass index (BMI) values, and growth z-scores were analyzed. RESULTS: Children in the CTX (n=53) and STC (n=41) groups were similar at baseline. After 24 months, the z-scores for height, weight, and BMI of those receiving CTX had improved significantly, whereas no changes occurred in the STC group. Patients in the CTX group approached normal height-for-age and weight-for-age z-scores. Patients from a large historical control group had significantly lower weight and height growth velocities than patients in the CTX group. CONCLUSIONS: Patients in the Stroke Prevention Trial for Sickle Cell Anemia Study who received CTX had improved height and weight and BMI over a 2-year period. Higher hemoglobin levels resulting from transfusion may improve growth by lowering energy expenditure. In addition to the prevention of vasoocclusive events, CTX results in significant improvement in the growth of children with sickle cell disease.
Assuntos
Anemia Falciforme/terapia , Crescimento , Adolescente , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Transfusão de Sangue , Estatura , Peso Corporal , Criança , Pré-Escolar , Humanos , Hidroxiureia/uso terapêutico , Modelos Lineares , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
The results of studies of strokes in children who are sickle cell anemia carriers are presented in this work. The roles of transfusions and transcranial Doppler to predict patients with a high risk of having a stroke are emphasized.
Neste relato são apresentados os resultados de estudos de acidente vascular cerebral em crianças portadoras de anemia falciforme. É enfatizado o papel das transfusões e do doppler transcraniano em predizer quais os pacientes que encontram-se sob risco de apresentarem acidente vascular cerebral.
Assuntos
Humanos , Anemia Falciforme/complicações , Acidente Vascular CerebralRESUMO
Repeated episodes of allergic contact dermatitis burden patients with disability and expense, as well as considerable discomfort. In this paper we describe safe and practical alternatives for allergens present on the 1984-1985 "standard patch test tray" of the American Academy of Dermatology. In addition, we have provided information on alternatives for other important and common allergens encountered today. For each allergen, in addition to the molecular weight, we have given the Chemical Abstracts Number (CAS). This will be especially useful when the American Academy of Dermatology has in operation its computerized data bank, cross-linking chemicals with commercial products. In the near future, a physician will be able to obtain rapidly either the ingredients of a given product, or a list of commercial products containing a specific allergen, or both. This information will increase immensely the importance of searching for allergens by patch testing.
Assuntos
Humanos , Alérgenos , Dermatite de Contato , Química , Testes do EmplastroRESUMO
Although patch testing continues to be one of the most useful office tools of the inquiring dermatologist, the procedure is not used as often as patients deserve. This article reviews the use of the patch test and emphasizes its utility in the practice of dermatology. Although simple to perform, the test requires experience and keen objectivity for accurate interpretation. The rewards are great, however, as between 5% and 10% of dermatology practice consists of contact dermatitis. Failure to diagnose this percentage of patients accurately constitutes an important omission on our parts.