RESUMO
OBJECTIVES: We assessed the outcomes of patients with a first myocardial infarction with ST segment elevation, with and without the development of abnormal Q waves after thrombolysis. BACKGROUND: Prethrombolytic era studies report conflicting short-versus long-term mortality in the overall non-Q wave population, probably related to its heterogeneity. METHODS: Patients with no electrocardiographic (ECG) confounding factors or evidence of previous infarction were included. Q wave infarction was defined as a Q wave duration > or = 30 ms in lead aVF; R wave > or = 40 ms in lead V1; any Q wave or R wave < or = 10 ms and < or = 0.1 mV in lead V2; or Q wave > or = 40 ms in at least two of the following leads: I, aVL, V4, V5 or V6. In-hospital clinical events and mortality at 30 days and 1 year were assessed. RESULTS: No Q waves developed in 4,601 (21.3%) of the 21,570 patients. This group comprised more women and had a lower Killip class, lower weight and less anterior baseline ST elevation. The non-Q wave group had less in-hospital cardiogenic shock (2.1% vs. 3.3%, p < 0.0001), less heart failure (8.5% vs. 13.9%, p < 0.0001) and a trend toward less stroke (0.7% vs. 1.0%, p = 0.07) but an increased use of angioplasty (28% vs. 24%, p = 0.0001). The unadjusted mortality rate in the non-Q wave group was lower at 30 days (0.9% vs. 1.8%, p = 0.0001) and 1 year (2.7% vs. 4.2%, p = 0.0001), as was the adjusted 30-day mortality rate (4.8% vs. 5.3%, p < 0.0001). CONCLUSIONS: Patients with no ECG confounding factors or evidence of previous infarction who do not develop Q waves after thrombolysis have a better 30-day and 1-year prognosis than patients with a Q wave infarction.
Assuntos
Fibrinolíticos/uso terapêutico , Sistema de Condução Cardíaco , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/fisiopatologia , Ativadores de Plasminogênio/uso terapêutico , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Ensaios Clínicos como Assunto , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
Natural killer cell stimulatory factor (NKSF) or interleukin-12 (IL-12) is a heterodimeric cytokine with pleiomorphic effects on T and NK cells, including induction of lymphokine production, mitogenesis, and enhancement of spontaneous cytotoxic activity. Similarly to IL-2, NKSF/IL-12 enhances NK cell-mediated cytotoxicity within a few hours and independently from induced proliferation. This effect is independent from other induced cytokines, because it is not prevented by antibodies neutralizing interferon (IFN)-alpha, IFN-beta, IFN-gamma, IL-2 or tumor necrosis factor (TNF)-alpha and, unlike the induction of IFN-gamma production by peripheral blood lymphocytes, it does not require HLA class II-positive accessory cells. Enhanced cytotoxicity is accompanied by morphologic changes in NK cells, including a significant increase in the number of cytoplasmic granules. In addition to the previously described ability to enhance the cytotoxic activity of NK cells against tumor-derived target cells, NKSF/IL-12 is also a potent stimulator of cytotoxicity against virus-infected cells, either fibroblasts acutely infected with herpes viruses or T cell lines chronically infected with human immunodeficiency virus-1. NK cell-mediated antibody-dependent cytotoxicity or anti-CD16 antibody-redirected lysis is not significantly enhanced by NKSF/IL-12. However, the ability of resting peripheral blood T cells to mediate anti-CD3 antibody-redirected lysis is enhanced by 18-h incubation with NKSF/IL-12, indicating that this lymphokine can modulate the cytotoxic capability of both NK and T cells.
Assuntos
Citotoxicidade Imunológica/efeitos dos fármacos , Substâncias de Crescimento/farmacologia , Interleucinas/farmacologia , Células Matadoras Naturais/efeitos dos fármacos , Animais , Células CHO , Células Cultivadas , Cricetinae , Antígenos HLA-DR/análise , Humanos , Interleucina-12 , Células Matadoras Naturais/imunologia , Receptores de IgG/fisiologia , Células Tumorais Cultivadas , Vírus/imunologiaRESUMO
Septicemia continues to be an important cause of neonatal morbidity and mortality. The bacteria most commonly responsible are group B beta-hemolytic streptococci and Escherichia coli, but regional differences exist. Recently sepsis caused by Staphylococcus epidermidis has occurred with increasing frequency in several neonatal intensive care units. Other organisms are less commonly responsible. The choice of antibiotics for suspected sepsis is based on the possible organisms involved and their antibiotic susceptibility patterns, which vary from hospital to hospital and at different times in the same hospital. Currently recommended initial therapy consists of a penicillin and an aminoglycoside, usually ampicillin and gentamicin. The addition of vancomycin is indicated when staphylococcal septicemia is suspected. During outbreaks of neonatal sepsis caused by aminoglycoside-resistant gram-negative bacteria, the use of third-generation cephalosporins or acylaminopenicillins may be appropriate, depending on the results of susceptibility tests. Continuing efforts to develop antibiotics for the treatment of neonatal sepsis are warranted.
Assuntos
Antibacterianos/uso terapêutico , Sepse/tratamento farmacológico , Aminoglicosídeos , Ampicilina/uso terapêutico , Aztreonam , Bactérias/efeitos dos fármacos , Cefalosporinas/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Quimioterapia Combinada , Humanos , Imipenem , Mortalidade Infantil , Recém-Nascido , Resistência às Penicilinas , Penicilinas/uso terapêutico , Sepse/mortalidade , Tienamicinas/uso terapêuticoRESUMO
Ninety-one healthy children were immunized with one of three preparations of the OKA strain of live attenuated varicella zoster virus in order to gain sufficient information on safety and immunogenicity to justify vaccine studies in immunosuppressed children. The OKA-Biken vaccine was studied in a dose response trial. Two additional clinical trails were conducted with the OKA strain that was further passaged: a frozen aqueous (OKA-RIT-Aq) form and a lyophilized (OKA-RIT-Ly) form were tested. With each of these vaccines clinical reactivity was minimal and virus shedding, viremia, and transmission of the vaccine virus were absent. Excellent seroconversion rates of 100 and 94% were induced with approximately 500 pfu of OKA-Biken and OKA-RIT-Ly vaccine, respectively. A lower seroconversion rate was noted for OKA-RIT-Aq, presumably on the basis of defective individual vials. Diluted OKA-Biken vaccine induced less seroconversion but even the 5 pfu dose produced antibody responses in 81% of the vaccinees. In vitro specific cellular immune responses to varicella virus antigens were demonstrated in each group of vaccinees, including all but two of those vaccines who failed to seroconvert. The data indicate that two preparations of the OKA strain are sufficiently safe and immunogenic in healthy children to support further studies in immunocompromised children.
Assuntos
Varicela/prevenção & controle , Herpesvirus Humano 3/imunologia , Vacinas Virais , Anticorpos Antivirais/análise , Divisão Celular , Criança , Ensaios Clínicos como Assunto , Humanos , Imunidade Celular , Linfócitos/citologiaRESUMO
Three siblings developed severe (two) or fatal (one) infectious mononucleosis. This family differed from previously described kindreds with a susceptibility to overwhelming Epstein-Barr virus infections in that: (1) both males and females were affected; (2) they had a history of the recurrent bacterial infections; (3) they produced the full spectrum of antibodies to EBV in the expected range of titers; and (4) survivors recovered completely. Two of these youths, but not their parents or an unaffected sibling with mild IM, had a deficiency of natural killer activity that did not respond to preincubation of their peripheral blood mononuclear cells with interferon. NK activity may have an important role in controlling infections with EBV.
Assuntos
Mononucleose Infecciosa/genética , Transtornos Linfoproliferativos/genética , Adolescente , Adulto , Consanguinidade , Suscetibilidade a Doenças , Feminino , Imunofluorescência , Herpesvirus Humano 4 , Humanos , Mononucleose Infecciosa/diagnóstico , Mononucleose Infecciosa/imunologia , Células Matadoras Naturais/imunologia , Masculino , Síndrome , Cromossomo XRESUMO
We recently have described destruction of cells infected with herpes simplex virus by the combination of specific antibody and either lymphocytes or monocyte-macrophages. Because of the role of these cells in viral immunity and the severity of HSV in neonates and pregnant women, cord blood from 11 healthy neonates and peripheral blood from seven of their postpartum mothers were analyzed for MP and lymphocyte antibody-dependent cellular cytotoxicity against cells infected with HSV. Cord blood yielded more lymphocytes and maternal blood fewer lymphocytes than did blood from adult female control subjects. Baseline cytotoxicity of cord MP and lymphocytes and maternal lymphocytes was significantly lower than control values. There was no significant difference in MP or lymphocyte ADCC, although maternal ADCC tended to be lower than that of control subjects. Analysis of cord plasma indicated that antibody able to participate in lymphocyte and MP ADCC crosses the placenta. These data demonstrate intact ADCC but possible defects in baseline cytotoxicity with leukocytes obtained from neonates and pregnant women. Further consideration of the use of HSV antibody for prevention and therapy of neonatal HSV infection is suggested.