RESUMEN
BACKGROUND: Patients with neurogenic bladder caused by spinal cord injury or myelomeningocele empty their bladder several times a day by intermittent catheterization. Bacteriuria without symptoms of infection is frequently present in these patients. Occasionally a clone of Escherichia coli that has been carried for weeks without symptoms causes a symptomatic urinary tract infection. Virulence factors are commonly expressed among E. coli causing infection in patients with normal urinary tracts. However, it is unknown whether expression of virulence factors by an E. coli clone colonizing the neurogenic bladder increases the risk of subsequent infection. In this study we examined the prevalence of virulence factor expression among E. coli isolated from the periurethra and urine of patients with neurogenic bladder. METHODS: The prevalence of virulence factors was examined among E. coli isolated from the periurethra and urine in patients with neurogenic bladder who received intermittent catheterization and were followed for 6 months. Representative isolates from the 37 clonal types of E. coli detected in the periurethra and urine of children with neurogenic bladder were assessed for O antigen, hemolysin, aerobactin, serum resistance and type I and P-adhesin. RESULTS: All clones were serum-resistant and expressed type I adhesin, none expressed aerobactin and two expressed hemolysin. The presence of P-adhesin was not unique to clones associated with symptomatic infection. The presence of P-adhesin carried for weeks in a clone did not predict subsequent infection in the neurogenic bladder. CONCLUSION: Bacterial virulence factors did not predict infection of the neurogenic bladder.
Asunto(s)
Infecciones por Escherichia coli/epidemiología , Escherichia coli/patogenicidad , Uretra/microbiología , Vejiga Urinaria Neurogénica/microbiología , Orina/microbiología , Adolescente , Antibacterianos/administración & dosificación , Niño , Preescolar , Recuento de Colonia Microbiana , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/diagnóstico , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Prevalencia , Factores de Riesgo , Sensibilidad y Especificidad , Vejiga Urinaria Neurogénica/terapia , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/métodos , VirulenciaRESUMEN
A low dose (0.5 mg) of thyrotropin-releasing hormone (TRH), a short-acting tripeptide with known analeptic properties, was administered to eight depressed patients 5 minutes after ECT session 3 or 4 in a double-blind, placebo-controlled crossover design. After TRH infusion the patients displayed selectively better performance on a battery of neuropsychological tests than they did after placebo infusion. Further exploration with pharmacological probes to mitigate ECT postictal cognitive deficits is warranted.
Asunto(s)
Trastornos del Conocimiento/prevención & control , Trastorno Depresivo/terapia , Terapia Electroconvulsiva , Hormona Liberadora de Tirotropina/administración & dosificación , Adulto , Presión Sanguínea/efectos de los fármacos , Trastornos del Conocimiento/etiología , Estudios Cruzados , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Terapia Electroconvulsiva/efectos adversos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Placebos , Hormona Liberadora de Tirotropina/uso terapéuticoRESUMEN
In this paper we describe the findings from two preliminary experiments, a human and an animal study, investigating whether thyrotropin-releasing hormone (TRH) can mitigate electroconvulsive therapy (ECT)-induced cognitive deficits. Our results suggest further explorations of TRH and its analogs as possible therapeutic agents for these deficits. We speculate that the major cause of the ECT-induced cognitive deficits is a decrease in cholinergic transmission in the central nervous system. Treatments such as TRH, which enhance cholinergic activity, can reverse the cognitive deficits.