Ifosfamide is an antineoplastic drug widely used in the treatment of paediatric malignancies. However, in up to 50% of patients, it is associated with nephrotoxicity ranging from asymptomatic tubulopathy to overt renal failure. A two-year-old Caucasian boy was diagnosed with stage IV Burkitt lymphoma, with hepatic and renal and bone marrow involvement. Baseline evaluation showed GFR of 60 mL/min/1.73 m2. He started chemotherapy with LMB 96 protocol group B with 5 courses of chemotherapy with vincristine, cyclophosphamide, doxorubicin, prednisone, and intrathecal administration of cytarabine and methotrexate. After the first chemo protocol, the patient was in remission and recovered normal renal function, but three months later he relapsed with involvement of the liver and kidneys. The patient initiated a salvage regimen with R-ICE (rituximab - ifosfamide, carboplatin, etoposide) intrathecal methotrexate and cytarabine and allogeneic stem cell transplantation was proposed. After achieving complete remission, he underwent allogeneic stem cell transplantation with busulfan and cyclophosphamide. Graft versus host disease prophylaxis was made with tacrolimus and methotrexate and infection prophylaxis with fluconazole and acyclovir. However, during treatment of the relapse, the patient presented downward crossing of weight and height centiles without recovery after treatment terminus and, following transplantation, consecutive laboratory testing suggested tubulopathy. Upon nephrologist referral, he was diagnosed with Fanconi syndrome and adequate supplementation was initiated with improvement of the patient’s general condition and slow centile catch up. After literature review, the most probable causing agent was determined to be ifosfamide, as the nephrotoxic effects of the other medications prescribed tend to be reversible after stopping. Nephrotoxicity secondary to chemotherapy is a major cause of morbidity in paediatric cancer survivors. Our case represents a rare situation with unspecific clinical signs. Clinicians must be alert to the necessity of close monitoring to identify renal toxicity, mainly tubular dysfunction, as early as possible and allow adequate supplementation, which is crucial in preventing side effects.
ABSTRACT The aim of this study was to create and test a new mice 3D-voxel phantom named DM_BRA for mice and human first-estimation radiopharmaceutical dosimetry. Previously, the article reviews the state-of-art in animal model development. Images from Digimouse CT database were used in the segmentation and on the generation of the voxelized phantom. Simulations for validation of the DM_BRA model was performed at 0.015, 0.1, 0.5, 1 and 4 MeV photons with heart-source. Specific Absorbed Fractions (SAF) data were compared with literature data. The organ masses of DM_BRA correlated well with existing models based on the same dataset; however, few small organ masses hold significant variations. The SAF data in most simulated cases were statistically equal to a significant level of 0.01 to the reference data.
The Brazilian market of herbal medicine is in increasing expansion; however, the lack of standardization and the bad quality of the plant raw materials constitute a crucial problem for the production of quality herbal medicines. In this work, herbal drugs consisting of leaves (samples A, B, C) and tinctures (samples D, E, F) of guaco purchased in the Central Market and from pharmacies in Belo Horizonte, respectively, were evaluated. Physical-chemical tests such as organoleptic characterization, determination of foreign matter, total ash and water content were performed on the samples of herbal drugs. The organoleptic characterization, measures of pH and density of the tincture samples were also determined. TLC and RP-HPLC profiles of the herbal drugs and tinctures were obtained and the quantification of coumarin (used as a marker compound) by RP HPLC was determined. The analyzed samples showed one or more of the evaluated parameters outside of the values recognized by the Brazilian Pharmacopoeia. This demonstrates the need for the quality control of the plant raw materials, in order to guarantee quality and safety in herbal medicine.
O mercado brasileiro de fitoterápicos encontra-se em crescente expansão, porém a falta de padronização e a má qualidade da matéria-prima vegetal constituem um problema crucial na produção de fitoterápicos de qualidade. Neste trabalho, foram avaliadas drogas vegetais constituídas de folhas (amostras A, B, C) e tinturas (amostras D, E, F) de guaco, adquiridas no Mercado Central e em farmácias de manipulação de Belo Horizonte, respectivamente. Realizaram-se testes físicoquímicos de caracterização organoléptica, determinação de matéria estranha, teores de água e cinzas totais para as amostras de drogas vegetais e caracterização organoléptica, medidas de pH e de densidade para as amostras de tinturas. Foram obtidos os perfis cromatográficos por CCD e CLAE-FR e fez-se a quantificação da cumarina (marcador químico), por CLAE-FR. As amostras analisadas apresentaram um ou mais dos parâmetros avaliados fora dos valores preconizados pela farmacopéia brasileira, evidenciando-se a necessidade da realização do controle de qualidade de matérias-primas vegetais, para se obter medicamentos fitoterápicos de qualidade, eficientes e seguros.
Burns are a significant health problem in Brazil, but there have been few data collected that could shape treatment and prevention programs. To help overcome that knowledge gap, this study looked at the types of accidents and the characteristics of 138 burn patients admitted into the burn unit of the University of São Paulo Hospital in Ribeirão Preto, state of São Paulo, Brazil, between November, 1991, and December, 1993. Patient charts were reviewed to collect data on age, sex, region of the body affected, burn depth and surface affected, agent causing the burn, and circumstances in which the burn happened. Of the 138 cases, 71% occurred in the home. In 50% of all accidents the victims were children. Boiling water was the agent responsible for 59% of the accidents among children younger than 3 years of age; fuel alcohol used in the home for cooking and other purposes caused 57% of the accidents among children between 7 and 11 years, the most affected pediatric group. Among adults, the group between 20 and 39 years of age was the most affected (23%); 84% of the victims in this age group were male. Seventeen percent of all cases involved adult males at work. Women suffered burns in accidents at home (67%) and in suicide-related events (33%). Seventy-five percent of the suicide cases were women. The strategies to reduce the incidence of burn injuries should aim at eliminating environmental risk factors and implementing educational programs disseminated through radio and television.
As queimaduras são um problema de saúde significativo no Brasil. Contudo, até hoje, existem poucos dados disponíveis para orientar programas de tratamento e prevenção. Com o intuito de preencher esta lacuna, o presente estudo examina os tipos de acidentes e as características dos 138 pacientes que sofreram queimaduras e foram internados na unidade de queimados do Hospital Escola da Universidade de São Paulo em Ribeirão Preto, estado de São Paulo, Brasil, entre novembro de 1991 e dezembro de 1993. A partir do prontuário dos pacientes, foram coletados dados sobre idade, sexo, área do corpo afetada pela queimadura, profundidade e extensão da queimadura, agente causador e circunstância em que ocorreram as queimaduras. Do total de casos, 71% ocorreram na casa da vítima e 50% envolveram crianças. A água fervente foi responsável por 59% dos acidentes entre as crianças com menos de 3 anos; o álcool utilizado em casa foi responsável por 40% dos acidentes com crianças entre 7 e 11 anos, o grupo mais atingido entre os pacientes pediátricos. Entre os adultos, os pacientes com idade ente 20 e 39 anos foram os mais atingidos (23%); destes, 84% eram do sexo masculino. Dezessete por cento do número total de casos envolveu adultos do sexo masculino em situações de trabalho. Os pacientes adultos do sexo feminino queimaram-se em situações domésticas (67%) e tentativas de suicídio (33%). Setenta e cinco por cento dos pacientes que tentaram o suicídio através da queimadura eram do sexo feminino. As estratégias para redução da incidência do trauma térmico deveriam atender a dois pontos principais: a eliminação de fatores de risco no próprio ambiente e a implementação de programas educativos, veiculados principalmente através de meios de comunicação como o rádio e a televisão.