Celso A. Rodrigues

Tuberculosis: an uncommon cause of cerebral venous thrombosis?

Several infectious etiologies are related to cerebral venous thrombosis (CVT), but a review of literature showed only few cases related to tuberculosis (TB), and only one with neurological manifestations. We report an unusual case of CVT related to TB and mutation in prothrombin gene. A 38-man black presented abrupt right hemiparestesis, and hemiparesis. Investigations revealed CVT. Cerebral spinal fluid (CSF) examination evidenced an infection by Mycobacterium. He was heterozygous for G20210A prothrombin mutation. Probably, hypercoagulability mechanisms of TB, added to mutation of prothrombin gene increase the risk of CVT.

Antioxidant vitamins C and E supplementation increases markers of haemolysis in sickle cell anaemia patients: a randomized, double-blind, placebo-controlled trial.

Erythrocytes from sickle cell anaemia (SCA) patients continuously produce larger amounts of pro‐oxidants than normal cells. Oxidative stress seems to primarily affect the membrane and results in haemolysis. The use of antioxidants in vitro reduces the generation of pro‐oxidants. To evaluate the impact of vitamins C (VitC) and E (VitE) supplementation in SCA patients, patients over 18 years were randomly assigned to receive VitC 1400 mg + VitE 800 mg per day or placebo orally for 180 d. Eighty‐three patients were enrolled (44 vitamins, 39 placebo), median age 27 (18–68) years, 64% female. There were no significant differences between the two groups regarding clinical complications or baseline laboratorial tests. Sixty percent of the patients were VitC deficient, 70% were VitE deficient. Supplementation significantly increased serum VitC and E. However, no significant changes in haemoglobin levels were observed, and, unexpectedly, there was a significant increase in haemolytic markers with vitamin supplementation. In conclusion, VitC + VitE supplementation did not improve anaemia and, surprisingly, increased markers of haemolysis in patients with SCA and S‐β0‐thalassaemia. The exact mechanisms to explain this findings and their clinical significance remain to be determined.

Bilateral Central Retinal Vein Occlusion Associated with Multiple Myeloma

Purpose: To report a case of simultaneous bilateral central retinal vein occlusion (CRVO) associated with multiple myeloma. Methods: A 65-year-old woman had sudden, painless loss of vision in both eyes for 20 days. Ophthalmologic examination revealed bilateral CRVO. Appropriate medical workup was conducted, and multiple myeloma was diagnosed as the underlying cause. Results: Clinical support and chemotherapy effectively controlled paraprotein production, leading to improvement of both systemic and ocular alterations. Conclusions: Many conditions have been noted to be associated with CRVO. Based on a Medline search, this is the first report of simultaneous bilateral CRVO as the first manifestation of multiple myeloma, illustrating the need for a primary care ophthalmologist to be involved in the basic assessment for associated underlying diseases in retinal disorders.

Transplante de sangue de cordão umbilical - SCU

The frequent use of umbilical cord blood as the source of hematopoietic stem cells, both in children and adults who do not have related donors, has led to the establishment of a better standardization of selection criteria aiming at improving the results. The choice of the umbilical cord blood unit should be based on the total number of nucleated cells and the number of differences in the human leukocyte antigen (HLA) system. When a unit has minimal cellularity, the use of a double cord blood transplant should be considered. When two or more units have similar characteristics, the choice may be determined by the CD34 count, ABO compatibility and the quality and speed to obtain the unit.

Seleção de doador de medula óssea ou sangue periférico

A compatibilidade HLA e o fator mais valorizado na escolha do doador de medula ossea voluntario, preconizando-se a realizacao de HLA de alta resolucao nos locos HLA-A,B,C, DRB1 e DQB1. Tem sido dado preferencia para o doador com consanguinidade alelica 8x8 (A,B,C, DRB1). Na presenca de incompatibilidade na classe-I sugere-se a busca de doador com compatibilidade DQB1 (9x10). Ja as incompatibilidades dos locos DPB1 nao constituem criterio de exclusao de doador, exceto quando existir presenca de anticorpo contra o loco HLA-DP do doador.

Optimisation of a quantitative polymerase chain reaction-based strategy for the detection and quantification of human herpesvirus 6 DNA in patients undergoing allogeneic haematopoietic stem cell transplantation

Human herpesvirus 6 (HHV-6) may cause severe complications after haematopoietic stem cell transplantation (HSCT). Monitoring this virus and providing precise, rapid and early diagnosis of related clinical diseases, constitute essential measures to improve outcomes. A prospective survey on the incidence and clinical features of HHV-6 infections after HSCT has not yet been conducted in Brazilian patients and the impact of this infection on HSCT outcome remains unclear. A rapid test based on real-time quantitative polymerase chain reaction (qPCR) has been optimised to screen and quantify clinical samples for HHV-6. The detection step was based on reaction with TaqMan® hydrolysis probes. A set of previously described primers and probes have been tested to evaluate efficiency, sensitivity and reproducibility. The target efficiency range was 91.4% with linearity ranging from 10-106 copies/reaction and a limit of detection of five copies/reaction or 250 copies/mL of plasma. The qPCR assay developed in the present study was simple, rapid and sensitive, allowing the detection of a wide range of HHV-6 loads. In conclusion, this test may be useful as a practical tool to help elucidate the clinical relevance of HHV-6 infection and reactivation in different scenarios and to determine the need for surveillance.

Severe gangrene by cold agglutinemia

Doenca da aglutinina a frio e uma patologia caracterizada pela producao de anticorpos contra antigenos especificos da membrana eritrocitaria, geralmente de classe IgM, que aglutinam hemacias em temperaturas abaixo de 32o C. Relatamos um caso de gangrena e insuficiencia renal em uma mulher de 77 anos com pneumonia atipica. Anemia hemolitica secundaria a crioaglutininas foi observada. O tratamento com antibioticos e corticoides foi eficaz com regressao do quadro, porem foi necessaria a amputacao de todos os dedos do pe (falanges) bilateralmente, preservando o restante dos pes (tarsos e metatarsos). Anemia hemolitica secundaria a crioaglutininas manifesta-se frequentemente por acrocianose e fenomeno de Raynaud. Gangrena e uma complicacao incomum dessa doenca, principalmente quando secundaria a etiologia infecciosa, sendo observada apenas em pacientes com altos titulos persistentes. Esta correlacionada frequentemente com causa infecciosa (Mycoplasma spp, virus Epstein-Barr, citomegalovirus, virus Influenza A, adenovirus, Legionella spp), linfoproliferativas B e idiopaticas. Suspeita clinica de crioaglutininemia deve ser confirmada e tratada prontamente em funcao da risco de possiveis complicacoes graves.