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Biomedical subjects

A S Grumach

Publications and source records attributed to A S Grumach.

30 records · Page 2Linked to original sources
PubMedDate not supplied

[Asthma - Clinical and epidemiological aspects of 237 outpatients in a specialized pediatric unit]

OBJECTIVE: The authors describe and evaluate epidemiological and clinical features of asthmatic outpatients attending a specialized pediatric unit. METHODS: Asthmatic patients of the Allergy and Immunology Unit of Department of Pediatrics (University of São Paulo) followed in the period from 1988 up to 1995 were evaluated in a non-randomized and retrospective study. The patients were submitted to a protocol for associated diseases (gastroesophageal reflux, toxocariasis, tuberculosis, immunodeficiencies and other atopic diseases). Asthma severity was classified according to the 1st Brazilian Consensus for Asthma Management. RESULTS: 237 patients (128M:109F) were admitted with mean age of 86 months. The first episode of wheezing occurred during the first year in 56% of them. Parental history of atopy was present in 61.6%. 53% of the patients had severe asthma in the first evaluation and it decreased for 35% at the time of this protocol. Cold weather (78.3%) and house dust (64.7%) were the commonest triggering factors. The following associated diseases were diagnosed: gastroesophageal reflux (n=57), toxocariasis (n=17), tuberculosis (n=7) and immunodeficiencies (n=16). 90.2% had other atopic conditions.CONCLUSION: The authors emphasize that the first asthmatic episode occurred earlier but there is a delay in sending the patients to specialized centers. The evaluation of clinical and epidemiological findings besides familial history are necessary for adequate treatment and early introduction of prophylactic measures.

Journal Article↗
PubMedDate not supplied

[Methotrexate for steroid-dependent asthmatic children and adolescents].

INTRODUCTION: The administration of methotrexate as an antiinflammatory drug in asthma has been discussed and most of the studies were developed in adults. Its indication is restricted to steroid-dependent or steroid-resistant asthmatic patients. OBJECTIVE: This study evaluates the clinical and espirometric parameters of steroid-dependent asthmatic children, receiving methotrexate therapy. METHODS: Perennial steroid-dependent asthmatic patients (prednisone 30 or 40 mg/dia), without associated disease, were evaluated by means of clinical and spirometric parameters. A maintenance dose of 10 to 17.5 mg/ week of methotrexate was administered. RESULTS: Six patients (3M;3F), aged 7 to 13 years old were included. There was improvement of clinical symptoms during the administration of methotrexate, in all patients, without significant change in the pulmonary function. During the use of methotrexate therapy three patients presented adverse reactions: leukopenia (1/3), vomiting (1/3) or Herpes zoster (1/3). The dose of prednisone was reduced in all patients, with total exclusion of prednisone in 3. Afterwards, there was a worsening of asthmatic symptoms in all patients, with reintroduction of corticosteroids. CONCLUSION: Methotrexate represents an alternative therapy for steroid-dependent asthmatics, and it may help to control symptoms of asthma and steroids use. Nevertheless, double-blind studies should be developed in children. Adverse effects must be considered before its indication, restricting its use to specialized centers.

English Abstract↗
PubMedDate not supplied

[The growth curve in asthmatic children].

The growth of 209 children with moderate and severe bronchial asthma seen at two different Health Care Centers for Bronchial Asthma Patients: (ICr and USP) was studied. The two groups differ mainly in socioeconomic level. Age at the onset of the disease, as well as duration and severity of the illness were considered. The first manifestations of the disease occurred before two years of age in 68.4% of the children. There was a predominance of males over females, with an almost 2:1 ratio in severe cases. The relationship between socioeconomic level and severity of the disease was highly significant (p less than 0.002). Weight and height were predominantly in the 50 percentile or below. This predominance was more evident for height. The height percentiles were significantly lower for the ICr group (p less than 0.01). Only 5.7% of the population studied had been submitted to prolonged (more than 3 months) corticoid treatment.

Adolescent↗
PubMedDate not supplied

Study of colostrum of a patient with selective IgA deficiency.

In a study of immunological factors in colostrum, we detected an 18-year old primipara with selective IgA deficiency and with a history of 3 previous hospitalizations for bronchopneumonia. Peripheral blood studies showed: IgG = 1240 mg%; IgM = 160 mg, and undetectable IgA on two different occasions. B lymphocyte measurement by immunofluorescence for membrane immunoglobulins, T lymphocyte determination by rosette formation with sheep red cells, and T lymphocyte determination with monoclonal antibodies of the Ortho series showed normal results. Salivary IgA was undetectable. The colostrum results were: undetectable IgA (mean, 19.2 g/l); IgM, 22,2 g/l (mean, 2.3 g/l); IgG, 1.3 g/l (mean, 0.7 g/l), and lysozyme, 214.2 mu/ml (mean, 157.1 mu/ml). The very high IgM levels detected in the colostrum of these patients are interpreted to be a compensatory factor for the lack of IgA.

Adolescent↗
PubMedDate not supplied

Chronic granulomatous disease of childhood: differential diagnosis and prognosis.

Of a total of 111 children with primary immunodeficiency, 20 had phagocytic disorders (18%) and 10 of them (8 boys and 2 girls) were diagnosed as chronic granulomatous disease (CGD). The children presented with repeated infections already during the first months of life. The main clinical findings were: abscess (n = 8), otitis (n = 8), pneumonia (n = 8), lymphadenitis and pyodermitis (n = 6) and septicemia (4), NBT reduction was almost absent in all the children, except one of them. Bactericidal activity against S. aureus and phagocytosis were impaired in CGD patients. Different patterns of laboratory tests and prognosis were observed and girls had a better evolution.

Adolescent↗
PubMedDate not supplied

[Severe combined immunodeficiency: description of a clinical case].

A Severe Combined Immunodeficiency (SCID) is a rare disease, with recessive autosomic or X linked inheritance. The clinical phenotype is related to the defect of specific antigen response. The authors describe a patient presenting recurrent infections, affected by SCID, with multiple hospitalizations. Immunologic evaluation was performed and adenosine deaminase deficiency was excluded. The patient was submitted to herniography and he died seven days after the surgery. The preparation for bone marrow transplantation was provided. The anatomo-pathological findings had showed immunologic system alterations. The early clinical diagnosis and the therapy are discussed.

Humans↗
PubMedDate not supplied

Application of a fluorochrome-lysostaphin assay to the detection of phagocytic and bactericidal disturbances in human neutrophils and monocytes.

The evaluation of phagocytic and microbicidal activities of the blood neutrophils has been recognized as one of the important tools for investigating phagocytic dysfunctions in patients with recurrent infections. In the present study, these activities were examined in neutrophils and monocytes from healthy adults and patients affected by primary phagocytic dysfunctions by using a modified fluorochromic microbicidal assay, discriminating simultaneously the extracellular adherence, ingestion and intracellular killing of Staphylococcus aureus Cowan I. The assay employs acridine orange staining, as described in Bellinati-Pires et al. (1989) (AO assay), but was modified by the addition of an alternative leukocyte treatment with 0.5 U/ml of lysostaphin (LS) for 5 min at 37 degrees C, after phagocytosis (AO-LS assay). The LS treatment was standardized to eliminate staphylococci adhered to the outer surface of the phagocytes without affecting the determination of intracellular live or dead bacteria, as demonstrated in normal neutrophils and monocytes. Our purpose in this study was to compare AO and AO-LS assays in order to evaluate the effect of LS on the determination of actually ingested staphylococci and to provide a means for improving the fluorochromic assay for detecting phagocytic defects, as well as bactericidal disturbances. By using the AO-LS assay, decreased ingestion of staphylococci by neutrophils in Chediak-Higashi Syndrome (CHS) was demonstrated. However, increased staphylococci adherence, as well as ingestion, was observed in neutrophils or monocytes from chronic granulomatous disease (CGD) patients, comparing AO and AO-LS assays. Bactericidal defect, which is a common feature in CHS and CGD, was detected in neutrophils or monocytes in both assays. We emphasize that such alterations were deduced by comparing the patients' results with those obtained from their respective normal controls and with the normal range of values previously established for 160 healthy adults. No alteration was observed in hyper IgE syndrome phagocytes. Despite the possible penetration of LS into the leukocytes, as stated in other studies, we concluded that a short period of phagocyte incubation with this enzyme increased the sensitivity of the fluorochromic assay to detect phagocytic defect without affecting the determination of the bactericidal activity. Moreover, comparations between AO and AO-LS assays may be important in the study of the initial pathways of staphylococci phagocyte interaction, including adherence by non-phagocytic receptors.

Adult↗
PubMedDate not supplied

Mycobacterium bovis dissemination (BCG strain) among immunodeficient Brazilian infants.

This study reports Mycobacterium bovis (BCG strain) dissemination in four primary immunodeficient (PID) patients. Their diagnoses were: chemotaxis defect, cellular immunodeficiency, combined immunodeficiency and chronic granulomatous disease (CGD). Patients were vaccinated with BCG (Moreau strain) between 17 days and 4 months of age. Identification of the BCG strain was performed in many sites, such as bone marrow, ganglionic mass, cerebrospinal fluid and in the site of vaccination. The first therapeutic schedule included rifampicin, isoniazid and ethambutol; no uniform treatment could be used for these patients. Therapy was adjusted as required on the basis of BCG sensitivity results. This study shows that PID patients are susceptible to BCG dissemination and demonstrates the importance of an early diagnosis for their prognosis.

Bacterial Vaccines↗
PubMedDate not supplied

[Drug hypersensitivity in AIDS patients: report of a case].

Drug allergy is a common symptom in HIV infected patients, with higher prevalence that in general population. We describe a child with AIDS and adverse reactions to several drugs indicated for Pneumocystis carinii prophylaxis and antibiotics. Reaction to intravenous pentamidine was present in this case and it is not an usual findings in HIV infected children. Alternative therapy and desensitization to TMP-SMX are also discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[X-linked agammaglobulinemia in nine patients: review of the literature].

The X-linked agammaglobulinemia (XLA) is a rare immunodeficiency, characterized by absence or accentuated diminuition of all the isotypes of serum immunoglobulins and greater susceptibility to infections, mainly after the sixth mouth of life. The authors present nine patients bearers of XLA, with recurrent infectious processes (pneumonias 7/9, otitis 7/9, sinusitis 5/9, sepsis 5/9, diarrheas 3/9, infectious arthritis 3/9, meningitis 3/9, pyodermitis 3/9, viral encephalitis 1/9), with the beginning of symptoms on average in a nine months life. The laboratory examination showed absence of antibody response, with normal cellular immunity. The patients received immunoglobulin with control of the infectious processes. Five children received prophylactic antibiotic therapy for sinusitis control. The precocious diagnosis of XLA is of extreme importance, with institution of therapy with intravenous immunoglobulin for reduction in infectious process occurrence and complications, besides improving the patient's life quality.

Agammaglobulinemia↗
PubMedDate not supplied

[Hereditary angioedema: clinical and laboratory aspects of 7 cases].

Hereditary angioedema is caused by a defect in C1 inhibitor activity (C1INH). Its occurrence is rare and it is associated with an autosomal dominant mode of inheritance. We describe seven patients (4M:3F), age from 12 to 50 years old, who are affected by hereditary angioedema; four of them belong to the same family. The main clinical manifestations were: angioedema of face, hands and feet (6/7) and abdominal pain (2/7). No triggering factors were associated with symptoms in 4/7 patients and trauma (2/7) and menses (1/7) were reported in the other three ones. One patient was submitted to laparotomy for partial intestinal resection, before diagnosis. Laboratory complement analysis revealed the absence of hemolytic function of complement, reduced C4 (6/7) and low C1INH levels. All patients received Danazol (100 mg/day) with clinical control. Hereditary angioedema has to be considered in the differential diagnosis of angioedema, since an early diagnosis of this immunodeficiency, leading to specific treatment in order to decrease the complications.

Adult↗