RESUMO
INTRODUCTION: Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition. MATERIAL AND METHODS: Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done. RESULTS: Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy. CONCLUSIONS: In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Transplante das Ilhotas Pancreáticas/psicologia , Transplante Heterólogo/psicologia , Adolescente , Animais , Ansiedade , Depressão , Humanos , Entrevistas como Assunto , Transplante das Ilhotas Pancreáticas/métodos , Motivação , Pais/psicologia , Satisfação do Paciente , Autonomia Pessoal , Suínos , Transplante Heterólogo/métodosRESUMO
BACKGROUND: Pulmonary tuberculosis (PTB) develops by a complex combination of environmental factors with genetic susceptibility. In this context, an association between human leukocyte antigens (HLAs) and tuberculosis has been examined in several populations, but results have been controversial. DESIGN AND MEASUREMENTS: A prospective evaluation of class II HLA genotypes was completed by the polymerase chain reaction (PCR) sequence-specific primer technique and PCR sequence-specific oligonucleotide hybridization in a Mexican population. SETTING: This study was conducted at the Clinical Service of Tuberculosis and the Department of Immunology, National Institute of Respiratory Diseases, Mexico City, Mexico. PATIENTS: Four groups were examined: 95 healthy subjects; 50 nonimmunosuppressed PTB patients; 15 HIV-infected patients (stage IVc in the Centers for Disease Control and Prevention [CDC] classification system for AIDS) with PTB; and 37 HIV-infected patients in the asymptomatic stage (CDC stage II). RESULTS: The frequencies of alleles DQA1*0101 (odds ratio [OR], 6.18; 95% confidence interval [CI], 2.38 to 16.08), DQB1*0501 (OR, 6.16; 95% CI, 2.44 to 17.71), and DRB1*1501 (OR, 7.92; 95% CI, 2.71 to 23.14) were significantly increased in nonimmunosuppressed patients with PTB when compared with healthy subjects. By contrast, frequencies of allele DQB1*0402 and antigens DR4 and DR8 were significantly decreased in patients with PTB. Additionally, a significantly higher frequency of the DRB1*1101 allele was found in HIV-positive subjects (OR, 6.67; 95% CI, 2.13 to 20.83). CONCLUSION: The genetic influence associated with the HLA system appears to have an important role in the development of PTB, although this susceptibility may not be relevant in patients with severe immunodeficiency diseases such as AIDS.
Assuntos
Genes MHC da Classe II , Antígenos HLA-D , Tuberculose Pulmonar/genética , Infecções Oportunistas Relacionadas com a AIDS/genética , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Alelos , Predisposição Genética para Doença , Genótipo , Humanos , Hospedeiro Imunocomprometido , México/epidemiologia , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Reação em Cadeia da Polimerase , Estudos Prospectivos , Tuberculose Pulmonar/etnologia , Tuberculose Pulmonar/imunologiaRESUMO
We did a prospective, comparative, experimental study with 30 patients with moderate to severe atopic dermatitis from the allergy section from September 1994 to March, 1995. The test laboratory examination was performed in all patients: complete blood cell count, immunoglobulins A, G, M and E determination, lymphocyte subpopulations CD3, CD4, CD8, CD4-CD8 proportion, CD25, rosette formation for B and T lymphocytes, coproparasitoscopic examination, throat and nose cultures, nasal cytology, skin tests of cellular immunity to PPD, thrichophytin, candidine, varidasa; skin prick test to poliens, fungi, inhalants and foods. All patients underwent to a sign and symptom grading score system as follows: the parameters were erythema, pruritus, eczema, papule valorated on a scale from 0 a 4+( O = no symptoms, + = mild, ++ = moderate, + ++= severe, ++ ++ = very severe). Initially all patients received one placebo unit every 15 days orally 3 times, then one after 30 days. Laboratory examination was performed and then treatment with transfer factor was initiated, initially 1 unit every 15 days three times and the fourth 30 days after. 15 days after the last dose a new immunological valoration was done. Results demonstrate a CD4 cell decrement, blood eosinophil and lgE dissemination although they're not statistically significative. There was a statistically significative improvement in the 4 clinical parameters: erythema, eczema, pruritus and populous with the use of Transfer Factor.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Dermatite Atópica/imunologia , Adolescente , Adulto , Linfócitos B/imunologia , Relação CD4-CD8 , Criança , Pré-Escolar , Feminino , Humanos , Imunidade Celular , Estudos Longitudinais , Masculino , Linfócitos T/imunologiaRESUMO
A prospective, comparative, random study was conducted with 40 patients treated with ebastine vs. terfenadine. The purpose of the study was to evaluate the efficacy of both as second generation antihistamines used in the treatment of allergic rhinitis. Ten milligrams of ebastine was administered once a day before breakfast (fasting), in 5 and 10 year old children and 20 mg in 11 to 15 year olds. Ebastine was more efficient in the control of symptoms (rhinorrhea, nasal obstruction, sneezing, eye and nose itching) than terfenadine from the seventh day on, (p 0.05). Tolerance to ebastine was good, although a small number of patients (1.5%) suffered collateral symptoms: sleepiness, headaches and nausea. The two doses of ebastine (10 or 20 mg depending on the patients age) had overall efficacy rates better than terfenadine (p 0.05%).
Assuntos
Butirofenonas/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Piperidinas/uso terapêutico , Rinite Alérgica Perene/tratamento farmacológico , Rinite Alérgica Sazonal/tratamento farmacológico , Terfenadina/uso terapêutico , Adolescente , Criança , Pré-Escolar , Eosinofilia/etiologia , Feminino , Humanos , Imunoglobulina E/sangue , Contagem de Leucócitos , Masculino , Estudos Prospectivos , Rinite Alérgica Perene/complicações , Rinite Alérgica Perene/imunologia , Rinite Alérgica Sazonal/complicações , Rinite Alérgica Sazonal/imunologiaRESUMO
Thirty patients both sexes with ages between 1-52 years old, thinking that they are allergic to penicillin, were studied because they were found to have some clinic symptoms immediately after the administration of penicillin procain I.M. (intramuscle) such as urticaria, angioedema, anaphylactic shock and Stevens-Johnson syndrome. In order to confirm or to discard this asseveration an in-vitro lymphocyte transformation test was realized, with the venous peripherical blood of each patient, using the greater determinative of penicillin: the peniciloil. The results obtained were twelve negatives, twelve on doubt and six positives. These results show that the in-vitro lymphocyte transformation test may be useful to decide, when a patient could be considered allergic or not to penicillin.