RESUMO

Epidemiological studies show that having a history of cancer protects from the development of Alzheimer's Disease (AD), and vice versa, AD protects from cancer. The mechanism of this mutual protection is unknown. We have reported that the peripheral blood mononuclear cells (PBMC) of amnestic cognitive impairment (aMCI) and Alzheimer's Disease (AD) patients have increased susceptibility to oxidative cell death compared to control subjects, and from the opposite standpoint a cancer history is associated with increased resistance to oxidative stress cell death in PBMCs, even in those subjects who have cancer history and aMCI (Ca + aMCI). Cellular senescence is a regulator of susceptibility to cell death and has been related to the pathophysiology of AD and cancer. Recently, we showed that cellular senescence markers can be tracked in PBMCs of aMCI patients, so we here investigated whether these senescence markers are dependent on having a history of cancer. Senescence-associated ßeta-galactosidase (SA-ß-Gal) activity, G0-G1 phase cell-cycle arrest, p16 and p53 were analyzed by flow cytometry; phosphorylated H2A histone family member X (γH2AX) by immunofluorescence; IL-6 and IL-8 mRNA by qPCR; and plasmatic levels by ELISA. Senescence markers that were elevated in PBMCs of aMCI patients, such as SA-ß-Gal, Go-G1 arrested cells, IL-6 and IL-8 mRNA expression, and IL-8 plasmatic levels, were decreased in PBMCs of Ca + aMCI patients to levels similar to those of controls or of cancer survivors without cognitive impairment, suggesting that cancer in the past leaves a fingerprint that can be peripherally traceable in PBMC samples. These results support the hypothesis that the senescence process might be involved in the inverse association between cancer and AD.

Assuntos

Doença de Alzheimer , Disfunção Cognitiva , Neoplasias , Humanos , Leucócitos Mononucleares , Doença de Alzheimer/genética , Interleucina-6 , Interleucina-8 , Testes Neuropsicológicos , Disfunção Cognitiva/genética , Cognição , RNA Mensageiro

RESUMO

Rhizosphere microbial communities exert critical roles in plant health, nutrient cycling, and soil fertility. Despite the essential functions conferred by microbes, the source and acquisition of the rhizosphere are not entirely clear. Therefore, we investigated microbial community diversity and potential source using the only two native Antarctic plants, Deschampsia antarctica (Da) and Colobanthus quitensis (Cq), as models. We interrogated rhizosphere and bulk soil microbiomes at six locations in the Byers Peninsula, Livingston Island, Antarctica, both individual plant species and their association (Da.Cq). Our results show that host plant species influenced the richness and diversity of bacterial communities in the rhizosphere. Here, the Da rhizosphere showed the lowest richness and diversity of bacteria compared to Cq and Da.Cq rhizospheres. In contrast, for rhizosphere fungal communities, plant species only influenced diversity, whereas the rhizosphere of Da exhibited higher fungal diversity than the Cq rhizosphere. Also, we found that environmental geographic pressures (i.e., sampling site, latitude, and altitude) and, to a lesser extent, biotic factors (i.e., plant species) determined the species turnover between microbial communities. Moreover, our analysis shows that the sources of the bacterial communities in the rhizosphere were local soils that contributed to homogenizing the community composition of the different plant species growing in the same sampling site. In contrast, the sources of rhizosphere fungi were local (for Da and Da.Cq) and distant soils (for Cq). Here, the host plant species have a specific effect in acquiring fungal communities to the rhizosphere. However, the contribution of unknown sources to the fungal rhizosphere (especially in Da and Da.Cq) indicates the existence of relevant stochastic processes in acquiring these microbes. Our study shows that rhizosphere microbial communities differ in their composition and diversity. These differences are explained mainly by the microbial composition of the soils that harbor them, acting together with plant species-specific effects. Both plant species acquire bacteria from local soils to form part of their rhizosphere. Seemingly, the acquisition process is more complex for fungi. We identified a significant contribution from unknown fungal sources due to stochastic processes and known sources from soils across the Byers Peninsula.

RESUMO

Recent studies suggest that cellular senescence plays a role in Alzheimer's Disease (AD) pathogenesis. We hypothesize that cellular senescence markers might be tracked in the peripheral tissues of AD patients. Senescence hallmarks, including altered metabolism, cell-cycle arrest, DNA damage response (DDR) and senescence secretory associated phenotype (SASP), were measured in peripheral blood mononuclear cells (PBMCs) of healthy controls (HC), amnestic mild cognitive impairment (aMCI) and AD patients. Senescence-associated ßeta-galactosidase (SA-ß-Gal) activity, G0-G1 phase cell-cycle arrest, p16 and p53 were analyzed by flow cytometry, while IL-6 and IL-8 mRNA were analyzed by qPCR, and phosphorylated H2A histone family member X (γH2AX) was analyzed by immunofluorescence. Senescent cells in the brain tissue were determined with lipofuscin staining. An increase in the number of senescent cells was observed in the frontal cortex and hippocampus of advanced AD patients. PBMCs of aMCI patients, but not in AD, showed increased SA-ß-Gal compared with HCs. aMCI PBMCs also had increased IL-6 and IL8 mRNA expression and number of cells arrested at G0-G1, which were absent in AD. Instead, AD PBMCs had significantly increased p16 and p53 expression and decreased γH2Ax activity compared with HC. This study reports that several markers of cellular senescence can be measured in PBMCs of aMCI and AD patients.

Assuntos

Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/patologia , Biomarcadores , Senescência Celular , Disfunção Cognitiva/patologia , Humanos , Interleucina-6/genética , Interleucina-6/metabolismo , Leucócitos Mononucleares/metabolismo , RNA Mensageiro , Proteína Supressora de Tumor p53

RESUMO

BACKGROUND: Acute kidney injury (AKI) is increasingly encountered in community settings and contributes to morbidity, mortality, and increased resource utilization worldwide. In low-resource settings, lack of awareness of and limited access to diagnostic and therapeutic interventions likely influence patient management. We evaluated the feasibility of the use of point-of-care (POC) serum creatinine and urine dipstick testing with an education and training program to optimize the identification and management of AKI in the community in 3 low-resource countries. METHODS AND FINDINGS: Patients presenting to healthcare centers (HCCs) from 1 October 2016 to 29 September 2017 in the cities Cochabamba, Bolivia; Dharan, Nepal; and Blantyre, Malawi, were assessed utilizing a symptom-based risk score to identify patients at moderate to high AKI risk. POC testing for serum creatinine and urine dipstick at enrollment were utilized to classify these patients as having chronic kidney disease (CKD), acute kidney disease (AKD), or no kidney disease (NKD). Patients were followed for a maximum of 6 months with repeat POC testing. AKI development was assessed at 7 days, kidney recovery at 1 month, and progression to CKD and mortality at 3 and 6 months. Following an observation phase to establish baseline data, care providers and physicians in the HCCs were trained with a standardized protocol utilizing POC tests to evaluate and manage patients, guided by physicians in referral hospitals connected via mobile digital technology. We evaluated 3,577 patients, and 2,101 were enrolled: 978 in the observation phase and 1,123 in the intervention phase. Due to the high number of patients attending the centers daily, it was not feasible to screen all patients to assess the actual incidence of AKI. Of enrolled patients, 1,825/2,101 (87%) were adults, 1,117/2,101 (53%) were females, 399/2,101 (19%) were from Bolivia, 813/2,101 (39%) were from Malawi, and 889/2,101 (42%) were from Nepal. The age of enrolled patients ranged from 1 month to 96 years, with a mean of 43 years (SD 21) and a median of 43 years (IQR 27-62). Hypertension was the most common comorbidity (418/2,101; 20%). At enrollment, 197/2,101 (9.4%) had CKD, and 1,199/2,101 (57%) had AKD. AKI developed in 30% within 7 days. By 1 month, 268/978 (27%) patients in the observation phase and 203/1,123 (18%) in the intervention phase were lost to follow-up. In the intervention phase, more patients received fluids (observation 714/978 [73%] versus intervention 874/1,123 [78%]; 95% CI 0.63, 0.94; p = 0.012), hospitalization was reduced (observation 578/978 [59%] versus intervention 548/1,123 [49%]; 95% CI 0.55, 0.79; p < 0.001), and admitted patients with severe AKI did not show a significantly lower mortality during follow-up (observation 27/135 [20%] versus intervention 21/178 [11.8%]; 95% CI 0.98, 3.52; p = 0.057). Of 504 patients with kidney function assessed during the 6-month follow-up, de novo CKD arose in 79/484 (16.3%), with no difference between the observation and intervention phase (95% CI 0.91, 2.47; p = 0.101). Overall mortality was 273/2,101 (13%) and was highest in those who had CKD (24/106; 23%), followed by those with AKD (128/760; 17%), AKI (85/628; 14%), and NKD (36/607; 6%). The main limitation of our study was the inability to determine the actual incidence of kidney dysfunction in the health centers as it was not feasible to screen all the patients due to the high numbers seen daily. CONCLUSIONS: This multicenter, non-randomized feasibility study in low-resource settings demonstrates that it is feasible to implement a comprehensive program utilizing POC testing and protocol-based management to improve the recognition and management of AKI and AKD in high-risk patients in primary care.

Assuntos

Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Bolívia/epidemiologia , Criança , Pré-Escolar , Creatinina/sangue , Países em Desenvolvimento , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Lactente , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Testes Imediatos , Urinálise

RESUMO

Fungal endophyte associations have been suggested as a possible strategy of Antarctic vascular plants for surviving the extreme environmental conditions of Antarctica. However, the mechanisms by which this occurs are still poorly understood. The role of root fungal endophytes in nitrogen mineralization and nutrient uptake, as well as their impact on the performance of Antarctic plants, were studied. We tested root endophytes, isolated from Colobanthus quitensis and Deschampsia antarctica, for lignocellulolytic enzyme production, nitrogen mineralization, and growth enhancement of their host plants. Penicillium chrysogenum and Penicillium brevicompactum were identified using a molecular approach as the main root endophytes inhabiting C. quitensis and D. antarctica, respectively. Both root endophytes were characterized as psychrophilic fungi displaying amylase, esterase, protease, cellulase, hemicellulase, phosphatase and urease enzymatic activities, mainly at 4 °C. Moreover, the rates and percentages of nitrogen mineralization, as well as the final total biomass, were significantly higher in symbiotic C. quitensis and D. antarctica individuals. Our findings suggest that root endophytes exert a pivotal ecological role based not only to breakdown different nutrient sources but also on accelerating nitrogen mineralization, improving nutrient acquisition, and therefore promoting plant growth in Antarctic terrestrial ecosystems.

Assuntos

Nitrogênio , Penicillium , Desenvolvimento Vegetal , Regiões Antárticas , Ecossistema , Endófitos , Humanos , Penicillium/fisiologia , Plantas

RESUMO

Salinization of soils is one of the main sources of soil degradation worldwide, particularly in arid and semiarid ecosystems. High salinity results in osmotic stress and it can negatively impact plant grow and survival. Some plant species, however, can tolerate salinity by accumulating osmolytes like proline and maintaining low Na+ concentrations inside the cells. Another mechanism of saline stress tolerance is the association with symbiotic microorganism, an alternative that can be used as a biotechnological tool in susceptible crops. From the immense diversity of plant symbionts, those found in extreme environments such as Antarctica seems to be the ones with most potential since they (and their host) evolved in harsh and stressful conditions. We evaluated the effect of the inoculation with a consortium of plant growth-promoting rhizobacteria (PGPB) and endosymbiotic fungi isolated from an Antarctic plant on saline stress tolerance in different crops. To test this we established 4 treatments: (i) uninoculated plants with no saline stress, (ii) uninoculated plants subjected to saline stress (200 mM NaCl), (iii) plants inoculated with the microorganism consortium with no saline stress, and (iv) inoculated plants subjected to saline stress. First, we assessed the effect of symbiont consortium on survival of four different crops (cayenne, lettuce, onion, and tomato) in order to obtain a more generalized response of this biological interaction. Second, in order to deeply the mechanisms involved in salt tolerance, in lettuce plants we measured the ecophysiological performance (Fv/Fm) and lipid peroxidation to estimate the impact of saline stress on plants. We also measured proline accumulation and NHX1 antiporter gene expression (involved in Na+ detoxification) to search for possible mechanism of stress tolerance. Additionally, root, shoot, and total biomass was also obtained as an indicator of productivity. Overall, plants inoculated with microorganisms from Antarctica increased the fitness related traits in several crops. In fact, three of four crops selected to assess the general response increased its survival under salt conditions compared with those uninoculated plants. On the other hand, saline stress negatively impacted all measured trait, but inoculated plants were significantly less affected. In control osmotic conditions, there were no differences in proline accumulation and lipid peroxidation between inoculation treatments. Interestingly, even in control salinity, Fv/Fm was higher in inoculated plants after 30 and 60 days. Under osmotic stress, Fv/Fm, proline accumulation and NHX1 expression was significantly higher and lipid peroxidation lower in inoculated plants compared to uninoculated individuals. Moreover, inoculated plants exposed to saline stress had a similar final biomass (whole plant) compared to individuals under no stress. We conclude that Antarctic extremophiles can effectively reduce the physiological impact of saline stress in a salt-susceptible crops and also highlight extreme environments such as Antarctica as a key source of microorganism with high biotechnological potential.

RESUMO

La terapia de reemplazo renal continuo (CRRT, por sus siglas en inglés) se utiliza en pacientes críticamente enfermos con lesión renal aguda (LRA). Este tratamiento tiene una historia cargada de tintes pasionales y ambiciosos que han revolucionado el tratamiento en las Unidades de terapia intensiva. Avances tecnológicos permiten remover toxinas y ajustar líquidos y moléculas de manera paulatina y segura, lo que que plausiblemente mejora el pronóstico clínico. Las terapias continuas requieren una estrecha colaboración del equipo multidisciplinario. Aunque los datos no demuestran ventaja entre las distintas modalidades de tratamiento de sustitución renal, creemos que avanzamos hacia una estandarización del tratamiento con base en la evidencia, que ha de promover una continua mejoría en el tratamiento de pacientes críticos con LRA. En el presente artículo se comenta la evolución tecnológica, los componentes del circuito extracorpóreo, los pasos iniciales en el uso de las máquinas, los principios en mecanismos de transporte y, finalmente, las modalidades de mayor uso en CRRT.Continuous renal replacement therapy (CRRT) is used in critically ill patients with acute kidney injury. This modality of treatment, loaded with a history full of passion and ambition, has revolutionized treatment in intensive care units. Technological advances allow the removal of toxins and management of fluids and molecules in a gradual and safe way that plausibly improves the clinical prognosis. This technique requires close collaboration of the multidisciplinary team. Although data do not demonstrate an advantage among the different modalities of renal replacement therapy, we firmly believe that we are moving towards an evidence-based standardization of treatment, which should promote a continuous improvement in the management of critically ill patients with acute renal injury. The present study accomplishes the evolution of technology, the components of the extracorporeal circuit, the initial steps while using these dedicated machines, the principles of mechanisms of solute and water transport, and finally the most frequently prescribed modalities in CRRT.

Assuntos

Injúria Renal Aguda/terapia , Estado Terminal , Terapia de Substituição Renal/métodos , Comportamento Cooperativo , Medicina Baseada em Evidências , Humanos , Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração

RESUMO

Most climate and environmental change models predict significant increases in temperature and precipitation by the end of the 21st Century, for which the current functional output of certain symbioses may also be altered. In this context we address the following questions: 1) How the expected changes in abiotic factors (temperature, and water) differentially affect the ecophysiological performance of the plant Colobanthus quitensis? and 2) Will this environmental change indirectly affect C. quitensis photochemical performance and biomass accumulation by modifying its association with fungal endophytes? Plants of C. quitensis from King George Island in the South Shetland archipelago (62°09' S), and Lagotellerie Island in the Antarctic Peninsula (65°53' S) were put under simulated abiotic conditions in growth chambers following predictive models of global climate change (GCC). The indirect effect of GCC on the interaction between C. quitensis and fungal endophytes was assessed in a field experiment carried out in the Antarctica, in which we eliminated endophytes under contemporary conditions and applied experimental watering to simulate increased precipitation input. We measured four proxies of plant performance. First, we found that warming (+W) significantly increased plant performance, however its effect tended to be less than watering (+W) and combined warming and watering (+T°+W). Second, the presence of fungal endophytes improved plant performance, and its effect was significantly decreased under experimental watering. Our results indicate that both biotic and abiotic factors affect ecophysiological performance, and the directions of these influences will change with climate change. Our findings provide valuable information that will help to predict future population spread and evolution through using ecological niche models under different climatic scenarios.

Assuntos

Caryophyllaceae/fisiologia , Endófitos/fisiologia , Compostos Fitoquímicos/análise , Regiões Antárticas , Biomassa , Caryophyllaceae/química , Caryophyllaceae/microbiologia , Mudança Climática , Ecossistema , Temperatura

RESUMO

BACKGROUND AND OBJECTIVES: AKI is frequent and is associated with poor outcomes. There is limited information on the epidemiology of AKI worldwide. This study compared patients with AKI in emerging and developed countries to determine the association of clinical factors and processes of care with outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This prospective observational study was conducted among intensive care unit patients from nine centers in developed countries and five centers in emerging countries. AKI was defined as an increase in creatinine of ≥0.3 mg/dl within 48 hours. RESULTS: Between 2008 and 2012, 6647 patients were screened, of whom 1275 (19.2%) developed AKI. A total of 745 (58% of those with AKI) agreed to participate and had complete data. Patients in developed countries had more sepsis (52.1% versus 38.0%) and higher Acute Physiology and Chronic Health Evaluation (APACHE) scores (mean±SD, 61.1±27.5 versus 51.1±25.2); those from emerging countries had more CKD (54.3% versus 38.3%), GN (6.3% versus 0.9%), and interstitial nephritis (7.0% versus 0.6%) (all P<0.05). Patients from developed countries were less often treated with dialysis (15.5% versus 30.2%; P<0.001) and started dialysis later after AKI diagnosis (2.0 [interquartile range, 0.75-5.0] days versus 0 [interquartile range, 0-5.0] days; P=0.02). Hospital mortality was 22.0%, and 13.3% of survivors were dialysis dependent at discharge. Independent risk factors associated with hospital mortality included older age, residence in an emerging country, use of vasopressors (emerging countries only), dialysis and mechanical ventilation, and higher APACHE score and cumulative fluid balance (developed countries only). A lower probability of renal recovery was associated with residence in an emerging country, higher APACHE score (emerging countries only) and dialysis, while mechanical ventilation was associated with renal recovery (developed countries only). CONCLUSIONS: This study contrasts the clinical features and management of AKI and demonstrates worse outcomes in emerging than in developed countries. Differences in variations in care may explain these findings and should be considered in future trials.

Assuntos

Injúria Renal Aguda/terapia , Disparidades em Assistência à Saúde , Unidades de Terapia Intensiva , Diálise Renal , APACHE , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Adulto , Idoso , Biomarcadores/sangue , Brasil , China , Creatinina/sangue , Estado Terminal , Países em Desenvolvimento , Europa (Continente) , Feminino , Humanos , Índia , Rim/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , América do Norte , Estudos Prospectivos , Recuperação de Função Fisiológica , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Características de Residência , Respiração Artificial , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Regulação para Cima

RESUMO

BACKGROUND AND OBJECTIVES: The burden of AKI around the globe has not been systematically examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A systematic review (2004-2012) of large cohort studies was conducted to estimate the world incidence of AKI and its stages of severity and associated mortality, and to describe geographic variations according to countries, regions, and their economies. AKI definitions were reclassified according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system. Random-effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. RESULTS: There were 312 studies identified (n=49,147,878) , primarily in hospital settings. Most studies originated from North America, Northern Europe, and Eastern Asia, from high-income countries, and from nations that spent ≥5% of the gross domestic product on total health expenditure. Among the 154 studies (n=3,585,911) that adopted a KDIGO-equivalent AKI definition, the pooled incidence rates of AKI were 21.6% in adults (95% confidence interval [95% CI], 19.3 to 24.1) and 33.7% in children (95% CI, 26.9 to 41.3). The pooled AKI-associated mortality rates were 23.9% in adults (95% CI, 22.1 to 25.7) and 13.8% in children (95% CI, 8.8 to 21.0). The AKI-associated mortality rate declined over time, and was inversely related to income of countries and percentage of gross domestic product spent on total health expenditure. CONCLUSIONS: Using the KDIGO definition, 1 in 5 adults and 1 in 3 children worldwide experience AKI during a hospital episode of care. This analysis provides a platform to raise awareness of AKI with the public, government officials, and health care professionals.

Assuntos

Injúria Renal Aguda/epidemiologia , Saúde Global , Injúria Renal Aguda/economia , Injúria Renal Aguda/mortalidade , Adulto , África do Norte/epidemiologia , África Ocidental/epidemiologia , Ásia/epidemiologia , Austrália/epidemiologia , Criança , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Europa (Continente)/epidemiologia , Gastos em Saúde , Humanos , Incidência , Nova Zelândia/epidemiologia , América do Norte/epidemiologia , Índice de Gravidade de Doença , América do Sul/epidemiologia

RESUMO

Oceanic island ecosystems are particularly sensitive to El Niño effects due to their dependence on energy and nutrient inputs from marine systems. Seabirds play a key role in transporting resources of marine origin to insular ecosystems. We report tree-growth patterns showing how the effects of El Niño rainy events on tree species in a southern Pacific island depend on the presence of local seabird colonies. We performed manipulative experiments in order to assess the mechanisms underlying these patterns. Tree ring data showed that, in normal years, the growth of all tree species (Aextoxicon punctatum, Cryptocarya alba, and Pinus radiata) was significantly lower in seabird sites compared to adjacent patches without seabirds (control sites). In contrast, in El Niño years, trees formerly hosting seabird colonies grew more than those in control sites. Experiments showed that (1) pine plants on soil from seabird sites grew more than those on soil from control sites, (2) pine individuals with seabird feces on their leaves grew less than those sprayed with an aqueous solution, and (3) soil moisture had little effect on plant growth. The stress produced by massive cormorant nesting on trees, which impairs tree growth and physiological performance, is relieved during El Niño events because of seabird migration due to decreased prey availability and pouring rains that flood nests. Soils enriched by the seabird guano, together with the increased water availability associated with El Niño, foster the growth of trees from seabird sites. We suggest that El Niño may be a key determinant of tree performance in forest communities from island and coastal ecosystems of the Pacific Ocean.

Assuntos

Charadriiformes/fisiologia , Ecossistema , El Niño Oscilação Sul , Árvores/crescimento & desenvolvimento , Migração Animal , Animais , Ilhas do Pacífico , Fatores de Tempo

RESUMO

La afasia orienta, generalmente a pensar en una lesión localizada en el hemisferio dominante para la función del lenguaje, el que en la mayoría de los individuos y muy especialmente en los diestros es el hemisferio izquierdo. Por ello, la asociación afasia y hemiparesia derecha es una entidad de alta utilidad en el diagnóstico topográfico de la lesión, sin embargo, la interpretación se dificulta cuando, junto a la afasia existe una hemiparesia izquierda. En esos casos se plantean clínicamente tres alternativas: a. lesiones cerebrales bilaterales; b. lesión(es) unilateral(es) del hemisferio derecho en un individuo con dominancia manual diestra (afasia cruzada) o c. lesión(es) unilateral(es) del hemisferio derecho en un individuo no diestro (ambidextro o zurdo) con dominancia hemisférica derecha para el lenguaje

Assuntos

Humanos , Masculino , Pessoa de Meia-Idade , Afasia de Broca/etiologia , Dominância Cerebral , Afasia de Broca/diagnóstico , Transtornos da Linguagem/etiologia

Assuntos

Gravidez , Humanos , Feminino , Pré-Eclâmpsia/fisiopatologia , Complicações na Gravidez , Hipertensão/fisiopatologia

RESUMO

La GNMP, una entidad crónica y progresiva, frecuente en niños y adultos, produce insuficiencia renal terminal en un número significativo de pacientes. Estudios inmunohistopatológicos permiten distinguir las variedades 1 y 2 y posiblemente una tercera, cuyas manifestaciones clínicas particularmente en el niño menor son indistinguibles y en algunos enfermos semejan una GN difusa aguda de etiología estreptocócica o un síndrome nefrótico idiopático. En estos casos se requieren determinaciones seriadas del complemento sérico (C3 y C4) y biopsia renal para el diagnóstico diferencial clínico y tipificación histológica. Debido a su progresividad, se han ensayado numerosos regímenes terapéuticos. En la actualidad, los estudios que demuestran la participación de las plaquetas y de las células mononucleares en el proceso destructivo glomerular proporcionan un trasfondo racional para el empleo de medicaciones inhibidoras de la agregación y activación plaquetaria (aspirina y dipridamol) y antiinflamatorios de alta potencia como la prednisona. Estas substancias, usadas en conjunto diariamente y en forma alternada, respectivamente, en regímenes prolongados (3 a 5 años o más) e iniciados a los pocos meses de hecho el diagnóstico parecen haber logrado un control efectivo de la progresión de la glomerulopatía sin grandes efectos nocivos debidos al tratamiento. Su uso combinado ha aumentado significativamente la sobrevida de pacientes pediátricos y adultos en series clínicas publicadas recientemente. Es nuestra convicción que el tratamiento combinado descrito (aspirina-dipridamol-prednisona) es la terapia de elección en la GNMP independientemente de su tipo histológico y que otros tratamientos o la ausencia de este no es justificable

Assuntos

Humanos , Glomerulonefrite/patologia , Glomérulos Renais/ultraestrutura , Aspirina/uso terapêutico , Complemento C3/análise , Complemento C4/análise , Dipiridamol/uso terapêutico , Quimioterapia Combinada , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/etiologia , Prednisona/uso terapêutico

Assuntos

Gravidez , Camundongos , Animais , Feminino , Âmnio/farmacologia , Complexo Antígeno-Anticorpo/metabolismo , Fígado/patologia , Glomerulonefrite/induzido quimicamente , alfa-Fetoproteínas/farmacologia , Injeções , Sistema Fagocitário Mononuclear/fisiologia

RESUMO

La inducción de coagulación intravascular diseminada (CID) o una reacción semejante a la CID por una sola inyección de una substancia polianiónica: polianetol sulfonato (Liquoid) produjo microtrombosis renal y pulmonar. Las concentraciones plasmáticas de fibronectina (Fn) disminuyeron en 63% (P 0.01) en los primeros 15 min. que siguieron a la inyección y se mantuvieron disminuídos por lo menos 90 min., sugiriendo que, in vivo, el polianión interviene en la coprecipitación del Fibrógeno-Fibronectina ya que cuando las concentraciones circulantes de Fn son bajas aumentan la localización de Fibrinógeno I125 en los riñones y pulmones después de inyectar liquoid. En la microvasculatura renal y pulmonar se encontraron trombos que contenían fibrinógeno, fibrina, Fn., y antígeno relacionado con el factor VIII (VIII ag). Los estudios de inmuno emborronamiento mostraron cantidades significativas de productos de degradación de la Fn. Los estudios "in vitro" sugieren que el liquoid altera la movilidad electroforética pero no la detección de la Fn por inmunodifusión. De esta manera la reacción semejante a CID inducida por el polianión agrega y secuestra Fn en los microtrombos y resulta en fragmentación molecular de ésta. Como la Fn es importante para la función retículoendotelial es razonable suponer que la reducción de su concentración y su degradación asociada con la CID puedan contribuir significativamente a las alteraciones histopatológicas mediadas por la coagulopatía de consumo

Assuntos

Ratos , Animais , Masculino , Coagulação Intravascular Disseminada/induzido quimicamente , Fibronectinas/sangue , Polianetolsulfonato/farmacologia , Trombose/induzido quimicamente , Imunoeletroforese , Rim/ultraestrutura , Pulmão/ultraestrutura