RESUMEN
The use of natural products is a promising approach for treating visceral leishmaniosis. (-)-α-Bisabolol is a sesquiterpene that have been proved active in vivo on Leishmania infantum-infected mice without showing toxicity. A single-centre, parallel-group, randomized, exploratory study was designed to assess its efficacy in a canine leishmaniosis model involving naturally infected dogs. In this clinical trial, 12 dogs were allocated into two groups and were treated with either meglumine antimoniate (100 mg/kg) through subcutaneous route or (-)-α-bisabolol (30 mg/kg) through oral route for two treatment series of 30 days, separated by a 30-day interval. A 4-month follow-up period was established as well. Parasite loads in bone marrow, lymph node and blood were estimated through quantitative PCR. Antibody titres were determined through immunofluorescence antibody test and cytokine expression values were estimated through real-time reverse transcription-PCR. Treatment safety was assessed through the evaluation of weight, gastrointestinal alterations and hematological and biochemical parameters in blood. Analyses were performed before and after treatment, and after a 4-months follow-up period. Treatment with the sesquiterpene was effective at decreasing parasite loads and increasing gamma-interferon expression level. Dogs treated with (-)-α-bisabolol did not show any toxicity sign. These results were better than those obtained using the reference drug, meglumine antimoniate. The natural compound seemed to induce a Th1 immune response that led to parasitological and clinical improvement without showing any safety issue, suggesting a high potential for the treatment of canine and human visceral leishmaniosis.
Asunto(s)
Antiprotozoarios/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Leishmaniasis Visceral/veterinaria , Sesquiterpenos/uso terapéutico , Animales , Anticuerpos Antiprotozoarios/sangre , Perros , Leishmaniasis Visceral/tratamiento farmacológico , Meglumina/administración & dosificación , Meglumina/uso terapéutico , Antimoniato de Meglumina , Sesquiterpenos Monocíclicos , Compuestos Organometálicos/administración & dosificación , Compuestos Organometálicos/uso terapéutico , Carga de Parásitos , Sesquiterpenos/administración & dosificación , Resultado del TratamientoRESUMEN
Cutaneous leishmaniasis treatment remains challenging due to the absence of a satisfactory treatment. The screening of natural compounds is a valuable strategy in the search of new drugs against leishmaniasis. The sesquiterpene (-)-α-bisabolol is effective in vivo against visceral leishmaniasis due to Leishmania infantum, but its mechanism of action remains elusive. The aim of this study is to validate this promising compound against the causative species of Old World cutaneous leishmaniasis and to get an insight into its antileishmanial mode of action. The compound was evaluated on L. tropica promastigotes and intracellular amastigotes using bone marrow-derived macrophages and its cytotoxicity was evaluated on L929 fibroblasts. The reactive oxygen species generation was evaluated using a sensitive probe. Mitochondrial depolarization was assessed evaluating the fluorescence due to rhodamine 123 in a flow cytometer. Apoptosis was investigated by measuring the fluorescence due to annexin V and propidium iodide in a flow cytometer. The ultrastructure of treated promastigotes and intracellular amastigotes was analysed through transmission electron microscopy. (-)-α-Bisabolol was active against L. tropica intracellular amastigotes displaying an inhibitory concentration 50 % of 25.2 µM and showing low cytotoxicity. This compound induced time and dose-dependent oxidative stress, mitochondrial depolarization and phosphatidilserine externalization (a marker of apoptosis). These effects were noticed at a low concentration and short exposure time. In the ultrastructural analyses, the treated parasites showed mitochondrial disruption, presence of electron-dense structures and chromatin condensation. These results suggest that this natural compound induces oxidative stress and mitochondrial-dependent apoptosis on Leishmania without disturbing the plasma membrane.
Asunto(s)
Antiprotozoarios/farmacología , Apoptosis/efectos de los fármacos , Leishmania infantum/efectos de los fármacos , Leishmaniasis Cutánea/parasitología , Mitocondrias/efectos de los fármacos , Sesquiterpenos/farmacología , Animales , Antiprotozoarios/química , Línea Celular , Humanos , Leishmania infantum/citología , Leishmania infantum/metabolismo , Macrófagos/efectos de los fármacos , Macrófagos/metabolismo , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Ratones , Mitocondrias/metabolismo , Sesquiterpenos Monocíclicos , Estrés Oxidativo/efectos de los fármacos , Especies Reactivas de Oxígeno/metabolismo , Sesquiterpenos/químicaRESUMEN
This study aims to describe how anesthesia teams handle unforeseen events that may affect the patients' health. More precisely, it investigates the mechanisms of decisions made by anesthesia teams to manage unthought-of situations, i.e. situations that have not been foreseen as "possible" ones before their occurrence. An empirical study, based on the analysis of simulated situations, was conducted in a pediatric anesthesia service of a university hospital in France. The results highlighted three ways of managing unthought-of situations (determined management, cautious management and overwhelmed management). They support the hypothesis of a collective cognitive trade-off, whereby teams would behave as virtual operators, with their own collective trade-off between "understanding" and "doing". The discussion of the results questions the assessment criteria, the safety perspectives we adopt and the possible ways to improve the management of unforeseen situations.
Asunto(s)
Anestesia/efectos adversos , Anestesiología , Seguridad del Paciente , Garantía de la Calidad de Atención de Salud , Administración de la Seguridad/métodos , Conducta Cooperativa , Francia , Hospitales Universitarios , Humanos , Comunicación Interdisciplinaria , Periodo IntraoperatorioRESUMEN
Many of the drugs used to treat leishmaniasis are associated with numerous adverse effects. Agents of natural origin have shown activity against different parasites. With this background, an in vitro study was conducted on the activity of (-)alpha-bisabolol, the principal component of Chamomilla recutita essential oil, against Leishmania infantum promastigotes, the main species responsible for human leishmaniasis in Spain. At the two highest concentrations tested (1000 and 500mug/ml), (-)alpha-bisabolol and pentamidine (control agent) achieved 100% inhibition of L. infantum promastigote. These in vitro data can be considered promising in support of the therapeutic use of (-)alpha-bisabolol preparations to treat leishmaniasis caused by L. infantum species.
Asunto(s)
Antiprotozoarios/farmacología , Leishmania infantum/efectos de los fármacos , Matricaria/química , Aceites Volátiles/farmacología , Extractos Vegetales/farmacología , Sesquiterpenos/farmacología , Sesquiterpenos Monocíclicos , Pruebas de Sensibilidad Parasitaria , Pentamidina/farmacologíaRESUMEN
Analysing adverse events is part of the medical practice in so far as the part it plays is outstanding in terms of feedback and improved healthcare safety. The integrated implementation of this practice is based on a four-dimensional system: strategic (corporate policies), cultural (safety-oriented cultural mindset), structural (dedicated organization and resources) and technical (methodologies and utilities). Two case studies illustrate the sequencing process from selecting the to-be-analyzed event down to figuring out the appropriate action plan. Beyond the visible and obvious origin, thanks to the implemented methods such as causal tree or ALARM method, far-fetched analysis elements and identified factors likely to explain events can be discovered. Comments on the role and terms of feedback are also hereto expressed.
Asunto(s)
Garantía de la Calidad de Atención de Salud , Administración de la Seguridad/métodos , Reacción a la Transfusión , Retroalimentación , Femenino , Humanos , Errores Médicos/prevención & control , Persona de Mediana Edad , Cultura Organizacional , Política Organizacional , EmbarazoRESUMEN
Risk management is a major stake for healthcare organisations. In a systemic approach, the process is based on methods and tools, of which the main ones are mentioned, for general application by clinical or technical teams, for some of them with quality and risk management support.
Asunto(s)
Administración de Instituciones de Salud , Administración de los Servicios de Salud , Gestión de Riesgos/métodos , Prevención de Accidentes , Humanos , Errores Médicos/prevención & control , Garantía de la Calidad de Atención de Salud/organización & administración , Gestión de Riesgos/organización & administración , Conducta de Reducción del Riesgo , Administración de la Seguridad/organización & administraciónRESUMEN
As part of its policy of constant quality improvement, Etablissement francais du sang (EFS) des pays de la Loire (Pays de la Loire Regional Blood Transfusion Centre) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immunohaematological tests and labile blood products (LBP). The polling tool selected by agreement between the Saint Nazaire's hospital management and Quality Assurance (QA) Department was a questionnaire that permitted item rating and free commentary. It addressed the personnel's perception of the quality of erythrocyte immunohaematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed an 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving LBP distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.
Asunto(s)
Transfusión Sanguínea , Satisfacción en el Trabajo , Personal de Hospital , Transfusión Sanguínea/normas , Comunicación , Recolección de Datos , Francia , Humanos , Relaciones Médico-Paciente , Relaciones Profesional-PacienteRESUMEN
As part of its policy of constant quality improvement, Etablissement Français du Sang (EFS) des Pays de la Loire (Pays de la Loire Regional blood transfusion institution) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immuno-hematological tests and labile blood products. The polling tool selected by agreement between the hospital management and quality assurance department was a questionnaire that permitted item rating and free commentary. It addressed the personnel's perception of the quality of erythrocyte immuno-hematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed a 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving labile blood product distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.
Asunto(s)
Transfusión Sanguínea , Satisfacción Personal , Personal de Hospital/psicología , Francia , Hospitales Generales , HumanosRESUMEN
A case of palisaded, encapsulated neuroma of the lower lip has been presented. To the best of our knowledge, this is the first reported instance in the dental literature. The lesion characteristically occurs on the skin of the face near the oral, nasal, and orbital mucocutaneous junctions and, therefore, is readily visible to the oral diagnostician. It occurs most often in middle-aged individuals and, although it may clinically mimic other lesions, the operative finding of an easily enucleated mass near a mucocutaneous junction should suggest this lesion in the differential diagnosis. Histologically, the lesion is characterized by three distinct zones--an outer compressed fibrous connective tissue capsule, an inner myxomatous zone, and a central zone of proliferating Schwann's cells arranged in interlacing fascicles with areas of palisaded cells and organoid structures. The lesion is treated by enucleation or excision and has no tendency to recur.