RESUMO
RESUMEN Material y métodos Estudio prospectivo multicéntrico. Se incluyeron 174 pacientes con CDT tratados consecutivamente desde junio 2014 hasta mayo 2015. Se los dividió en 2 grupos (ablacionados y no ablacionados) con 87 pacientes incluidos en cada uno. La respuesta inicial al tratamiento se determinó con la medición de tiroglobulina, anticuerpos anti-tiroglobulina y ecografía de cuello. Resultados Se compararon las características basales de ambos grupos y no se evidenciaron diferencias estadísticamente significativas: sexo femenino 84% y 88% (p = 0,5); edad promedio de 46,8 y 47,5 años (p = 0,7); carcinoma papilar variedad clásico 68% y 75,9% (p = 0,15), respectivamente. El resto de las características basales como tamaño tumoral, bilateralidad, multifocalidad, tiroiditis de Hashimoto y estadio tumoral tampoco mostraron diferencias significativas. La evaluación de la respuesta inicial al tratamiento se realizó en 64 pacientes del grupo ablacionado y en 76 del grupo no ablacionado. Se observó una respuesta excelente en 81% de pacientes ablacionados vs. 87% del grupo no ablacionado, con una frecuencia de respuesta estructural incompleta de 1,6% y 1,4%, respectivamente, (p = 0,9). Un 17% de los ablacionados y 12% de los no ablacionados presentaron una respuesta indeterminada. Conclusión: Los pacientes de bajo riesgo, ablacionados o no, presentan similares frecuencias de respuesta inicial excelente y estructural incompleta. El seguimiento a largo plazo podrá definir si estas respuestas iniciales se mantienen en el tiempo, lo que permitirá reducir la indicación de ablación con radioyodo en este grupo de pacientes con CDT.
ABSTRACT Patients and methods We included 174 patients; 87 patients in each group (ablated and nonablated). Assessment of the initial response to treatment was performed by measurement of thyroglobulin and anti-thyroglobulin antibodies and by neck ultrasonography. Results Baseline characteristics of both groups were compared, and no statistically significant differences were found: female sex 84% and 88,5%, respectively, (p = 0.5); mean age of 46.8 and 47.5 years, respectively (p = 0.7); papillary carcinoma classic variant 68% and 75.9%, respectively (p = 0.15). The remaining of the baseline characteristics such as tumor size, presence of bilaterality, multifocality, Hashimoto's thyroiditis and tumor stage were not statistically significant, either. The evaluation of the response to treatment was finally performed in 64 patients from the ablated group and in 76 from the non-ablated group. An excellent response to treatment was observed in 81% of ablated patients vs. 87% of the non-ablated group, with a frequency of structural incomplete response of 1.6% and 1.4%, respectively (p = 0.9). On the other hand, 17% and 12% of patients in each group had an indeterminate response. Conclusion Low-risk ablated and non-ablated patients have a similar frequency of excellent initial and structural incomplete response to treatment. Long-term follow-up is needed to establish whether these initial responses are maintained over time, and thus further refine the indications of RA in this group of patients with DTC.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/terapia , Resultado do Tratamento , Tempo de Reação/imunologia , Recidiva , Tireoidectomia/reabilitação , Radiocirurgia/reabilitaçãoRESUMO
Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a serious public health issue. Its evolution involves an acute stage, characterized by no specific symptoms, and the chronic stage during most individuals are asymptomatic, but about 30-40% of them become symptomatic presenting the cardiac or digestive disease. Host immune response mechanisms involved in symptomatic or asymptomatic chronic disease are not fully understood. The pro-inflammatory cytokines are crucial in host resistance. However, a fine control of this inflammatory process, by action of anti-inflammatory cytokines, is necessary to avoid tissue injury. This control was found to be responsible for no clinical manifestations in asymptomatic individuals. Toll-like receptors (TLRs) are extremely important in defining the cytokine profile released in response to a micro-organism. We found that patients with the cardiac form predominantly released the pro-inflammatory cytokines: IFN-γ, TNF-α and IL-17 with the involvement of both, TLR2 and TLR4. In contrast, patients with asymptomatic disease release predominantly the anti-inflammatory cytokines IL-10 and TGF-ß, but also with TLR2 and TLR4 participation. The mechanisms by which stimulation of the same TLRs results in release of different pattern of cytokines, depending on the patients group that is being evaluated, are discussed.
Assuntos
Doenças Assintomáticas , Cardiomiopatia Chagásica/imunologia , Leucócitos Mononucleares/imunologia , Receptor 2 Toll-Like/metabolismo , Receptor 4 Toll-Like/metabolismo , Trypanosoma cruzi/imunologia , Células Cultivadas , Doença Crônica , Citocinas/metabolismo , Diagnóstico Diferencial , Progressão da Doença , Feminino , Interações Hospedeiro-Patógeno/imunologia , Humanos , Masculino , Tempo de Reação/imunologiaRESUMO
The peripheral lung parenchyma has been studied as a component of the asthmatic inflammatory response. During induced constriction, tissue resistance increases in different asthma models. Approximately 60% of the asthmatic patients show early and late responses. The late response is characterized by more severe airway obstruction. In the present study, we evaluated lung parenchymal strips mechanics in ovalbumin-sensitized guinea pigs, trying to reproduce both early and late inflammatory responses. Oscillatory mechanics of lung strips were performed in a control group (C), in an early response group (ER), and in two late response groups: 17 h (L1) and 72 h (L2) after the last ovalbumin challenge. Measurements of resistance and elastance were obtained before and after ovalbumin challenge in C and ER groups and before and after acetylcholine challenge in all groups. Using morphometry, we assessed the density of eosinophils and smooth muscle cells, as well as collagen and elastin content in lung strips. The baseline and postagonist values of resistance and elastance were increased in ER, L1, and L2 groups compared with C (P < or = 0.001). The morphometric analysis showed an increase in alveolar eosinophil density in ER and L2 groups compared with C (P < 0.05). There was a significant correlation between eosinophil density in parenchymal strips of C, L1, and L2 groups and values of resistance and elastance postacetylcholine (r = 0.71, P = 0.001 and r = 0.74, P < 0.001, respectively). The results show that the lung parenchyma is involved in the late response, and the constriction response in this phase is related to the eosinophilic inflammation.
Assuntos
Formação de Anticorpos/imunologia , Antígenos/imunologia , Asma/imunologia , Pulmão/imunologia , Ovalbumina/imunologia , Tempo de Reação/imunologia , Animais , Asma/fisiopatologia , Broncoconstrição/imunologia , Broncoconstrição/fisiologia , Contagem de Células , Colágeno/análise , Elastina/análise , Eosinófilos/patologia , Eosinófilos/fisiologia , Cobaias , Pulmão/química , Pulmão/fisiopatologia , Masculino , Hipersensibilidade Respiratória/imunologia , Hipersensibilidade Respiratória/patologia , Hipersensibilidade Respiratória/fisiopatologia , Fatores de TempoRESUMO
The defense reactions against biological (Histoplasma capsulatum and Escherichia coli) and non-biological materials (China ink and nylon thread) were tested in vivo in third instar larvae of Dermatobia hominis. The cellular defense performed by larval hemocytes was observed under electron microscopy. China ink particles were phagocytosed by granular cells 5 h after injection. E. coli cells were internalized by granular cells as early as 5 min after injection and totally cleared 180 min post-injection, when many hemocytes appeared disintegrated and others in process of recovering. H. capsulatum yeasts provoked, 24 h after being injected, the beginning of nodule formation. Nylon thread was encapsulated 24 h after the introduction into the hemocoel. Our results suggest that granular cells were the phagocytic cells and also the responsible for the triggering of nodule and capsule formation. In the presence of yeasts cells and nylon thread, they released their granules that chemotactically attracted the plasmatocytes that on their turn, flattened to surround and isolate the foreign material.
Assuntos
Dípteros/imunologia , Hemócitos/imunologia , Imunidade Celular/fisiologia , Larva/imunologia , Fagócitos/imunologia , Animais , Quimiotaxia/imunologia , Dípteros/microbiologia , Escherichia coli/imunologia , Hemócitos/ultraestrutura , Histoplasma/imunologia , Tinta , Larva/microbiologia , Microscopia Eletrônica , Fagócitos/ultraestrutura , Fagocitose/imunologia , Tempo de Reação/imunologiaRESUMO
The defense reactions against biological (Histoplasma capsulatum and Escherichia coli) and non-biological materials (China ink and nylon thread) were tested in vivo in third instar larvae of Dermatobia hominis. The cellular defense performed by larval hemocytes was observed under electron microscopy. China ink particles were phagocytosed by granular cells 5 h after injection. E. coli cells were internalized by granular cells as early as 5 min after injection and totally cleared 180 min post-injection, when many hemocytes appeared disintegrated and others in process of recovering. H. capsulatum yeasts provoked, 24 h after being injected, the beginning of nodule formation. Nylon thread was encapsulated 24 h after the introduction into the hemocoel. Our results suggest that granular cells were the phagocytic cells and also the responsible for the triggering of nodule and capsule formation. In the presence of yeasts cells and nylon thread, they released their granules that chemotactically attracted the plasmatocytes that on their turn, flattened to surround and isolate the foreign material. (AU)
Assuntos
RESEARCH SUPPORT, NON-U.S. GOVT , Dípteros/imunologia , Hemócitos/imunologia , Imunidade Celular/fisiologia , Larva/imunologia , Fagócitos/imunologia , Quimiotaxia/imunologia , Dípteros/microbiologia , Escherichia coli/imunologia , Hemócitos/ultraestrutura , Histoplasma/imunologia , Tinta , Larva/microbiologia , Microscopia Eletrônica , Fagócitos/ultraestrutura , Fagocitose/imunologia , Tempo de Reação/imunologiaRESUMO
The defense reactions against biological (Histoplasma capsulatum and Escherichia coli) and non-biological materials (China ink and nylon thread) were tested in vivo in third instar larvae of Dermatobia hominis. The cellular defense performed by larval hemocytes was observed under electron microscopy. China ink particles were phagocytosed by granular cells 5 h after injection. E. coli cells were internalized by granular cells as early as 5 min after injection and totally cleared 180 min post-injection, when many hemocytes appeared disintegrated and others in process of recovering. H. capsulatum yeasts provoked, 24 h after being injected, the beginning of nodule formation. Nylon thread was encapsulated 24 h after the introduction into the hemocoel. Our results suggest that granular cells were the phagocytic cells and also the responsible for the triggering of nodule and capsule formation. In the presence of yeasts cells and nylon thread, they released their granules that chemotactically attracted the plasmatocytes that on their turn, flattened to surround and isolate the foreign material.
Assuntos
Dípteros/imunologia , Fagócitos/imunologia , Hemócitos/imunologia , Imunidade Celular/fisiologia , Larva/imunologia , Dípteros/microbiologia , Escherichia coli/imunologia , Fagócitos/ultraestrutura , Fagocitose/imunologia , Hemócitos/ultraestrutura , Histoplasma/imunologia , Tinta , Larva/microbiologia , Microscopia Eletrônica , Quimiotaxia/imunologia , Tempo de Reação/imunologiaRESUMO
CD4(+) T-cell lines (TCLs) from patients with clinically isolated syndromes (CIS) were selected with purified human myelin basic protein (MBP) and recombinant human myelin oligodendrocyte glycoprotein (rhMOG), at onset of neurological symptoms and when patients developed clinically definite multiple sclerosis (CDMS). The epitope specificity of each TCL was mapped with overlapping synthetic peptides. TCLs were assessed for their ability to secrete IFN-gamma, IL-4, and IL-6. Diverse patterns of epitope recognition were observed: (a) recognition of a broad spectrum of MBP peptide epitopes with evidence of shifts over time; (b) an initial T-cell response focused to a restricted segment of the MBP molecule (83-102) that broadened over the course of disease; and (c) persistence of a focused anti-MOG T-cell response. CIS patients who failed to develop CDMS maintained a focused epitope response against two to six MBP epitopes. Most MBP peptide-specific TCLs secreted considerable amounts of IFN-gamma and low amounts of IL-4 and IL-6, whereas anti rhMOG(Igd) peptide-specific TCLs secreted preferentially IL-4 and IL-6. These data raise important issues for the pathogenesis and treatment of multiple sclerosis (MS).
Assuntos
Especificidade de Anticorpos/imunologia , Citocinas/metabolismo , Epitopos/imunologia , Esclerose Múltipla/imunologia , Proteína Básica da Mielina/imunologia , Glicoproteína Associada a Mielina/imunologia , Linfócitos T/imunologia , Adolescente , Adulto , Células Cultivadas , Citocinas/imunologia , Feminino , Humanos , Interferon gama/imunologia , Interferon gama/metabolismo , Interleucina-4/imunologia , Interleucina-4/metabolismo , Interleucina-6/imunologia , Interleucina-6/metabolismo , Masculino , Esclerose Múltipla/sangue , Proteína Básica da Mielina/farmacologia , Proteínas da Mielina , Glicoproteína Associada a Mielina/farmacologia , Glicoproteína Mielina-Oligodendrócito , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/imunologia , Linfócitos T/efeitos dos fármacos , Linfócitos T/metabolismoRESUMO
O diagnóstico da febre reumática nem sempre é fácil e muitas vezes o pediatra fica confuso ao interpretar as queixas, avaliar os sinais do exame físico e as alteraçöes laboratoriais. As implicaçöes de um diagnóstico incorreto säo desastrosas por levarem a uma profilaxia desnecessária por vários anos e, por outro lado, a falta de um diagnóstico correto deixa o paciente vulnerável a um novo surto que poderá provocar ou agravar uma lesäo cardíaca, trazendo sérias conseqüências para a vida do paciente, inclusive colocando-a em risco. Nessa revisäo procuramos discutir e valorizar cada um dos elementos necessários ao diagnóstico, desde a amigdalite estreptocócica, o período de latência e os critérios de Jones
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Antiestreptolisina/imunologia , Erros de Diagnóstico , Febre Reumática/complicações , Febre Reumática/diagnóstico , Febre Reumática/etiologia , Infecções Estreptocócicas/diagnóstico , Tempo de Reação/imunologia , Artrite/diagnóstico , Coreia/diagnóstico , Miocardite/diagnóstico , Condições Sociais , TonsiliteRESUMO
La infección es una de las complicaciones graves en los pacientes sometidos a trasplante de órganos y la causa más frecuente de muerte en los trasplantados de riñon. En nuestro medio el control profiláctico de las infecciones bacterianas y virales se realiza de manera estricta, no así de las infecciones parasitarias. El presente artículo tiene como fin alertar al médico y señalar los lineamientos que deben seguirse para prevenir infecciones parasitarias en los enfermos que reciban un trasplante
Assuntos
Humanos , Transplante de Órgãos/efeitos adversos , Doenças Parasitárias/etiologia , Doenças Parasitárias/transmissão , Interações Hospedeiro-Parasita , Tempo de Reação/imunologiaRESUMO
Existe poca información del espectro clínico y del periodo de incubación de los pacientes con SIDA en América latina. Este estudio reporta el espectro clínico, supervivencia y periodo de incubación de un grupo de pacientes mexicanos infectados por el HIV-1 como resultado de la transfusión de sangre contaminada. Se analiza la información de 39 pacientes con conocimiento de las fechas de transfusión y diagnóstico de SIDA. El espectro clínico de la enfermedad se comparó con un grupo de pacientes mexicanos con SIDA infectados por vía sexual. La prevalencia y distribución de infecciones oportunistas fue similar en ambos grupos. Sin embargo, hubo diferencia significativa en la distribución de neoplasias oportunistas: el sarcoma de Kaposi sólo se observó en el grupo de pacientes infectados por vía sexual. El SIDA se desarrolló en los 48 meses siguientes a la transfusión; (el 3 por ciento en los primeros 12 meses después de la transfusión, el 50 por ciento alcanzó a los 29 meses, el 75 por ciento a los 36 meses, y el resto a los 4 años). La supervivencia media después de diagnóstico de SIDA fue de nueve meses. Una vez establecido el diagnóstico de SIDA, la supervivencia de este grupo de pacientes mexicanos es similiar a lo observado en otros pacientes con infección por HIV-1 adquirida por vía sexual. Estos hallazgos seugieren que la vía de exposición al HIV-1 tiene implicaciones pronósticas en la historia natural de la infección en la población mexicana.