Our results indicate that 1 in 10 persons develops influenza each year in Peru, with the highest incidence in young children. Active community-based surveillance allows for a better understanding of the true burden and seasonality of disease that is essential to plan the optimal target groups, timing, and cost of national influenza vaccination programs.

A cirurgia cardíaca não foge à regra. Apesar de ser sofisticado método de tratamento invasivo, observamos a ocorrência de quadros infecciosos gravíssimos que desafiam a competência da equipe cirúrgica e dos centros de tratamento cardiológico.A abertura do esterno para possibilitar o acesso ao coração, introduzida por MILTON (1,2) , em 1897, e popularizada por JULIAN (3) et al., tem sido evitada sempre que possível. Lança-se mão de procedimentos cardiológicos invasivos com cateteres ou balões (4) e, ultimamente, de abordagens cirúrgicas através de reduzidas incisões torácicas com ou sem o auxílio de videotoracoscopia (5)(6)(7)(8)(9)(10)(11) , com excelentes resultados.A incidência de mediastinite nos procedimentos operatórios cardíacos em que se pratica esternotomia é pequena, variando de 0,4 a 5% (12,13) . A mortalidade desta temível complicação, no entanto, é alta, variando de 14 a 47% (14) . Além desta alta mortalidade, verifica-se considerável aumento dos custos do tratamento após esta complicação, quase triplicando estes valores (15,16) .Os fatores de risco parecem ser muitos, podendo ser citados: associação de diabete melito e

Summary:Major histocompatibility complex (MHC) class II deficiency is a rare form of primary combined immunodeficiency that can only be corrected by stem cell transplantation. We report a 4.-year-old girl with MHC class II deficiency who underwent a related CBT due to graft failure following T cell-depleted non-identical BMT. The patient is alive and well 2 years after the second transplant. A sustained hematopoietic engraftment and a progressive immune recovery have been detected. We conclude that cord blood may be an effective source of hematopoietic stem cells for patients with immunodeficiency disorders including diseases with a high rate of graft failure. Keywords: SCID; cord blood transplantation; T celldepleted BMT Major histocompatibility complex (MHC) class II deficiency is a rare form of primary combined immunodeficiency syndrome characterized by defective expression of HLA class II antigens, inconsistent and incomplete expression of HLA class I molecules, and lack of cellular and humoral immune response to foreign antigens.1,2 Usually the infections begin in the first year of life, often leading to death in early childhood.3 At present the only curative therapy is BMT. 4,5 We report the case of a girl with MHC class II deficiency who underwent a successful related umbilical cord blood transplant (CBT) due to graft failure following a T cell-depleted non-identical bone marrow transplantation. Case reportIn May 1994, a girl was born at term by caesarean section after an uncomplicated pregnancy. During the neonatal period she received BCG immunization without any local or systemic responses. Four brothers, two of them twins, died before the age of 2 years of recurrent pneumonia. Her maternal aunt had died from coqueluche in her childhood. Although the parents are from a small village they are unaware that they may be related. At 4 months she had thrush that disappeared with nistatin. At 7 months she presented with failure to thrive, bilateral otitis and urinary tract infection. She was subsequently hospitalized three times for diarrhea, otitis and dehydration.In June 1995, at the age of 13 months, she was admitted to our institution because of failure to thrive, chronic diarrhea and persistent thrush. The diagnosis of MHC class II deficiency was based on the family and personal history of recurrent severe infections, and was confirmed by the absence of DR antigen expression on monocytes and B lymphocytes with normal expression of HLA class I antigens. Red blood cell concentrations of adenosine deaminase and purine nucleoside phosphorylase were normal. The immunologic results are shown in Table 1. Intravenous immune globulin (IVIG) and prophylactic trimethoprimsulfamethoxazole were begun after this diagnosis.In March 1996, no identical family donor was found and a two-antigen mismatched BMT from the father was performed. Conditioning consisted of busulfan (5 mg/kg/day from day Ϫ9 to day Ϫ6), cyclophosphamide (50 mg/kg/day from day Ϫ5 to day Ϫ2); moreover, monoclonal anti-LFA1 antibody (0.2 mg/kg/day from...

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50%) no tronco de coronária esquerda, sendo indicada, a princípio, angioplastia coronariana com implante de stent. Após 3 meses, realizou-se cirurgia de revascularização miocárdica em razão de reestenose. A isquemia miocárdica é uma causa importante de óbito e deve ser prontamente tratada. A abordagem percutânea pode ser a primeira escolha ou servir como ponte para a cirurgia.]]>