RESUMO
PURPOSE: Brain metastases (BM) occur in 15-35% of patients with metastatic breast cancer, conferring poor prognosis and impairing quality of life. Clinical scores have been developed to classify patients according to their prognosis. We aimed to check the utility of the Breast Graded Prognostic Assessment (B-GPA) and its modified version (mB-GPA) and compare them in routine clinical practice. METHODS: This is an ambispective study including all patients with breast cancer BM treated in a single cancer comprehensive center. We analyzed the overall survival (OS) from BM diagnosis until death. The Kaplan-Meier method and Cox proportional hazard regression model were used in the analyses. ROC curves were performed to compare both scores. RESULTS: We included 169 patients; median age was 50 years. HER2-positive and triple negative patients were 33.7% and 20.7%, respectively. At the last follow-up, 90% of the patients had died. Median OS was 12 months (95% confidence interval 8.0-16.0 months). OS was worse in patients with > 3 BM and in patients with triple negative subtype. CONCLUSIONS: In our series, we confirm that B-GPA and mB-GPA scores correlated with prognosis. ROC curves showed that B-GPA and mB-GPA have similar prognostic capabilities, slightly in favor of mB-GPA.
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Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Neoplasias da Mama/mortalidade , Neoplasias da Mama/química , Neoplasias da Mama/classificação , Neoplasias da Mama/patologia , Intervalos de Confiança , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Qualidade de Vida , Curva ROC , Receptor ErbB-2 , Neoplasias de Mama Triplo Negativas/mortalidade , Neoplasias de Mama Triplo Negativas/patologiaRESUMO
Introducción: El mielomeningocele (MMC) es una de las malformaciones congénitas más severas compatible con la vida. El 90% de los pacientes presenta vejiga neurogénica que debe ser evaluada y tratada precozmente. Objetivos: Describir la evaluación y tratamiento nefrourológico recibido por pacientes con MMC hasta el momento de la primera consulta en el Hospital Garrahan (periodo pre-ingreso). Describir la evaluación realizada y el tratamiento urológico implementado a partir del ingreso al hospital Garrahan (periodo post-ingreso). Evaluar la prevalencia de Enfermedad Renal Crónica (ERC). Población y Métodos: Se realizó un estudio con diseño clínico analítico, retrospectivo, longitudinal sobre pacientes con MMC de 1 mes a 18 años derivados al Hospital Garrahan para atención ambulatoria en los años 2011 y 2012. Resultados: Se incluyeron115 pacientes. Al momento de la derivación al hospital ("pre-ingreso") 7% de los pacientes habían logrado completar evaluación nefrourológica, (ecografía vesicorenal, urodinamia, Cistouretrografía, Centellograma renal y Creatininemia). Tratamiento: 33% vaciaban vejiga por CIL o vesicostomía y 21% recibían Oxibutinina. A partir del ingreso al seguimiento en el Garrahan 83% lograron completar la evaluación, y en función del resultado de la misma se indicó CIL en 87% y Oxibutinina en el 66% de los pacientes. La prevalencia de ERC al ingreso fue de 43%; la mayoría en estadio I. Conclusiones: La mayoría de los pacientes con MMC fueron derivados al hospital de tercer nivel con evaluaciones urológicas incompletas y sin el tratamiento adecuado de la vejiga neurogénica. El inicio del seguimiento interdisciplinario en un hospital de alta complejidad facilitó la realización de las evaluaciones necesarias y la implementación del tratamiento adecuado (AU)
Introduction: Myelomeningocele (MMC) is one of the most severe congenital malformations compatible with life. Of all the patients, 90% presents with a neurogenic bladder requiring early evaluation and treatment. Objectives: To describe the uronephrological evaluation and treatment received by patients with MMC up to the first consultation at Garrahan Hospital (pre-follow-up period). To describe the urological evaluation and treatment implemented from referral to Garrahan Hospital (follow-up period). To evaluate the prevalence of chronic kidney disease (CKD). Population and Methods: A retrospective, longitudinal study with a clinical, analytical design was conducted in patients with MMC between 1 months and 18 years of age referred to Garrahan Hospital for outpatient care in 2011 and 2012. Results: 115 patients were included. At the time of referral to the hospital ("pre-follow-up") 7% of the patients had undergone complete uronephrological evaluation (kidney-bladder ultrasonography, urodynamic studies, cystourethrography, renal scintigraphy, and creatininemia levels). Treatment: 33% emptied their bladder by CIC or vesicostomy and 21% received oxybutynin. From follow-up initiation at Garrahan Hospital, 83% underwent complete evaluation, and based on the results CIC was indicated in 87% and oxybutynin in 66% of the patients. On admission, prevalence of CKD was 43%; with stage I in the majority of the patients. Conclusions: The majority of the patients with MMC were referred to a third-level hospital with incomplete urological studies and without adequate treatment of the neurogenic bladder. Initiation of interdisciplinary follow-up at a tertiary hospital allowed for the necessary studies and implementation of adequate treatment (AU)
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Equipe de Assistência ao Paciente , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia , Meningomielocele/complicações , Meningomielocele/diagnóstico , Meningomielocele/epidemiologia , Insuficiência Renal Crônica/terapia , Testes de Função RenalRESUMO
Se presenta un caso del primer Bypass cerebro vascular realizado en Bolivia por un aneurisma gigante de arteria carotida interna derecha, en segmento cavernoso tratado mediante bypass de alto flujo de arteria carótida externa a arteria cerebral media derecha, con injerto de arteria radial y posterior oclusión y exclusión del aneurisma. Se desciben los pasos de la cirugia y se destacan las dificultades de la tecnica y los beneficios de la cirugia. SE discuten los elementos a considerar en la toma de decisiones para la indicación y realización del bypass en el tratamiento de los aneurismas gigantes de la ACI.
Assuntos
Artéria Carótida InternaRESUMO
Objetivo Analizar los trabajos, sobre el acoso entre profesionales de enfermería: prevalencia, factores de riesgo y consecuencias. Método: Revisión sistemática de las publicaciones científicas sobre el acoso entre el personal de enfermería, en la última década. Se consultaron diferentes bases de datos nacionales (Dialnet, ISOC Ciencias Sociales y Humanidades, IME Biomedicina) e internacionales (CINHAL, Medline, PsycINFO, PubMed Central), así como directorios de revistas con acceso abierto (DOAJ). En todos los casos, se limitó la búsqueda al intervalo 2005-2014. Los criterios establecidos fueron: 1) estudios que analicen el acoso laboral entre el personal de enfermería; 2) cualquier diseño metodológico; 3) que aporten datos empíricos sobre el estado de la cuestión; 4) con acceso al texto completo; y 5) escritos en inglés, español o portugués. De un total de 96 publicaciones, fueron seleccionadas 18. Resultados: Los resultados muestran una prevalencia de acoso, entre el personal de enfermería, en torno al 17-20%. Se identifican factores de riesgo como: edad inferior a 30 años, corta trayectoria profesional, y trabajar en determinadas unidades o turnos. Las consecuencias para la víctima fueron: problemas psicológicos, bajo rendimiento y deterioro de relaciones sociales. Conclusiones: Destacar la escasa producción científica sobre el tema y la necesidad de desarrollar instrumentos, que permitan una evaluación ajustada de las conductas de intimidación y acoso, entre profesionales de la enfermería.
Objective To analyze studies on mobbing among nursing professionals, risk factors, and consequences. Method: This is a systematic review of scientific works on mobbing among nursing staff published during the last decade (2005-2014). National (Dialnet, ISOC Ciencias Sociales y Humanidades, IME Biomedicina) and international (CINHAL, Medline, PsycINFO, PubMed Central) databases, as well as directories of open access journals were consulted. Established criteria were: 1) studies analyzing mobbing among nursing staff; 2) any methodological design; 3) offering empirical data on the topic; 4) access to the full text; 5) written in English, Spanish, or Portuguese. From a total of 96 studies identified, 18 were finally selected. Results: The findings show a prevalence of mobbing among nursing staff of around 17-20%. Risk factors such as age younger than 30 years old, brief professional trajectory, and being working in specific units or shifts were identified. Among the consequences, psychological problems, low productivity, and social relations deteriorations were identified. Conclusions: It is important to highlight the scanty scientific production on the topic, and also the necessity to develop instruments which allow an adequate assessment of harassment conducts among nursing professionals.
Objetivo Analisar os trabalhos sobre o assédio entre profissionais de enfermagem: prevalência, fatores de risco e consequências. Método: Revisão sistemática das publicações científicas sobre o assédio entre os trabalhadores de enfermagem na última década. Consultaram-se diferentes bases de dados nacionais (Dialnet ISOC Ciencias Sociales y Humanidades, IME Biomedicina) e internacionais (CINHAL, Medline, PsycINFO, PubMed Central), assim como diretórios de revistas com livre acesso (DOAJ). Em todos os casos, limitou-se à busca do intervalo de 2005-2014. Os critérios estabelecidos foram: 1) estudos que analisem o assédio laboral entre os trabalhadores de enfermagem, 2) qualquer desenho metodológico, 3) que aportem dados empíricos sobre o estado da questão, 4) com acesso ao texto completo, e, 5) escritos em inglês, espanhol e português. De um total de 96 publicações, foram escolhidas 18. Resultados: Os resultados mostram uma prevalência de assédio, entre os trabalhadores de enfermagem, em volta a 17-20%. Identificam-se fatores de risco como: idade inferior a 30 anos, curta trajetória professional, e trabalhar em determinadas unidades ou turnos. As consequências para a vítima foram: problemas psicológicos, baixo rendimento e deterioro de relações sociais. Conclusões: Destacar a escassa produção científica de enfermagem sobre o tema, e a necessidade de desenvolver instrumentos, que permitam uma avaliação ajustada das condutas de intimidação e assédio, entre profissionais da enfermagem.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Enfermagem , Estresse Ocupacional , Recursos Humanos de EnfermagemRESUMO
Objetivo: Determinar la ubicación y nivel del cenit gingival de dientes anterosuperiores y comparar ambos parametros con el uso del calibrador digital y compas de puntas secas según género y hemiarcada. Materiales y Métodos: Se incluyeron modelos de estudio del maxilar superior de 20 estudiantes de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia con edad promedio de 21,05 años (18-24). Se registró en ellos los parámetros mencionados tanto con calibrador digital como con compas y regla. La comparación de mediciones fue mediante la prueba t de Student, y U de Mann Whitney, además se aplicó el coeficiente de correlación de Pearson. Resultados: El promedio del desplazamiento del cenit gingival usando el calibrador digital en el incisivo central (IC), incisivo lateral (IL) y canino (C) fue de 0,72mm, 0,36mm y 0, 11mm distal del eje longitudinal del diente respectivamente, el promedio con uso del compás fue de 0,71mm, 0,39mm y 0,11mm en el IC, IL Y C distal del eje axial respectivamente. La distancia promedio del nivel del cenit gingival con calibrador fue de 0,59 mm y con compás de 0,63 mm. No se observaron diferencias estadísticamente significativas en ninguno de los casos (p>0,05), se encontró alta correlación entre las mediciones con ambos instrumentos, además no se encontró diferencia estadísticamente significativa en las mediciones por género y hemiarcada. Conclusión: El compás puede ser utilizado como método alternativo para dichas mediciones por ser más accesible y sencillo de usar.
Objective: To locate the displacement of the gingival zenith and the gingival zenith level of the maxillary anterior teeth and compare both parameters using the digital caliper and the two points divider by gender and quadrants. Materials and Methods: It was included models of the maxillary arc of twenty students of the School of Dentistry of the Peruvian University Cayetano Heredia with an average age of 21.05 years (18-24). In the models were measured the mentioned parameters with a digital caliper and with a two points divider and a ruler. The test t-Student and the test U-Mann Whitney were used to compare measurements; also the Pearson correlation coefficient was applied. Results: The average of the gingival zenith displacement using the digital caliper was of 0.72mm, 0.36mm and 0.11mm for the central incisor (CI), lateral incisor (LI) and canine (C) distal to the axis respectively, and using the two points divider the measurements were of 0.71mm, 0.39mm and 0.11mm for the CI, LI and C distal to the axis respectively. The distance of the gingival zenith level was of 0.59mm with the caliper while with the two points divider was 0.63mm. There were no statistically significant difference in any of the cases (p>0.05), it was found a high correlation between both measurements; also there were no significant difference about gender or quadrant. Conclusion: Two points divider can be used as an alternative measurement instrument for the parameters mentioned since is more accessible and easy to use.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Adulto Jovem , Dente , Gengiva , Estética DentáriaRESUMO
INTRODUCTION: In adults with type 1 diabetes mellitus (DM1), a 25% of risk of hypocortisolism has been found through a low dose ACTH test with negative antibodies suggesting other causes of hypothalamic-pituitary-adrenal axis dysfunction. AIM: To evaluate adrenal function in pediatric patients with DM1 and correlate the results with the frequency of hypoglycemia and metabolic control. METHODS: Sixty-nine patients were enrolled, age 12.3 (5.7-18.1); 50 boys and 19 girls. A 20% had additional autoimmune diseases. Mean hemoglobin A1c (HbA1c) was 8.1% and insulin dose was 1.14 U/kg/d. After an overnight fast, a low dose ACTH test (1 µg) was performed. Basal and stimulated cortisol concentrations, DHEAS, and plasma renin activity (PRA) were measured. A cortisol response post-ACTH below 18 µg/dL was considered abnormal. RESULTS: 58% of the tested patients had an abnormal response to ACTH test. These patients also had lower DHEAS concentrations, but were not different in diabetes duration, HbA1C, severe hypoglycemia, ACTH, or PRA concentrations compared to those who had a normal cortisol post-ACTH. One patient out of 59, had a positive anti-21-hydroxylase antibody (21OHA) and presented a poor response to ACTH. CONCLUSIONS: We found a significant proportion of our patients having a subnormal cortisol response independent of the presence of anti-adrenal cell antibodies. We did not find a correlation with metabolic control, probably due to the good metabolic control of this group. The absence of 21OHA does not rule out subclinical hypocortisolism in this population. Our results suggest testing adrenal function in children with DM1.
Assuntos
Córtex Suprarrenal/metabolismo , Insuficiência Adrenal/complicações , Hormônio Adrenocorticotrópico , Diabetes Mellitus Tipo 1/complicações , Regulação para Baixo , Hidrocortisona/metabolismo , Adolescente , Córtex Suprarrenal/efeitos dos fármacos , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/imunologia , Insuficiência Adrenal/fisiopatologia , Doenças Autoimunes/complicações , Doenças Autoimunes/epidemiologia , Criança , Pré-Escolar , Chile/epidemiologia , Sulfato de Desidroepiandrosterona/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/imunologia , Regulação para Baixo/efeitos dos fármacos , Feminino , Humanos , Hidrocortisona/sangue , Hiperglicemia/epidemiologia , Hiperglicemia/fisiopatologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/fisiopatologia , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Renina/sangue , Risco , Índice de Gravidade de DoençaRESUMO
Objetivo: Mostrar la experiencia del uso de la gammacamara portátil en la localización intraoperatoria del ganglio centinela en cáncer de mama. Material y Métodos: Fueron incluidas en el estudio 103 pacientes mujeres con diagnostico de cáncer de mama con axila clínica y radiologicamente negativa. Se realizo inyección periareolar de un radiotrazador y de la sustancia colorante azul patente. Se adquirieron imágenes planares de la axila antes y durante la extracción del ganglio centinela. Se utilizo en el intraoperatorio una gammacámara portátil para la visualización del o los ganglios centinelas. Se comprobó ôcampo libreõ en todos los pacientes con la gammacámara portátil. Resultados: El promedio de la edad de los pacientes fue 52.5 años. La media de tamaño tumoral fue de 2.5 cm. La media de ganglios encontrados fue de 1.9 ganglios centinelas por paciente. Se localizaron los ganglios centinelas en el 91.2% de los pacientes, de los cuales 24 pacientes presentaron metástasis. El uso de la gamma cámara intraoperatoria mostro una sensibilidad de 97.8% y especificidad de 88.9% para la visualización de ganglios centinelas. Conclusiones: El empleo de la gammacamara portátil intraoperatoria en la localización del ganglio centinela en cáncer de mama es un método de alta sensibilidad y especificidad, útil para determinar, que todos los ganglios centinelas han sido extirpados, es decir ôcampo libreõ.
Objective: To show the experience of the use of portable gamma camera intraoperative node localization in breast cancer sentinel. Material and Methods: The study included 103 female patients diagnosed with breast cancer with clinical axillary and radiologically negative. Periareolar injection was performed a radiotracer and blue dye substance patent. It planar images acquired before and during axillary sentinel lymph node removal. Was used in the intraoperative a portable gamma camera for viewing or sentinel node was found "free field" for all patients the portable gamma camera. Results: The mean age of patients was 52.5 years. The mean tumor size was 2.5 cm. The average nodes found was 1.9 sentinel nodes per patient. Sentinel nodes were found in 91.2% of patients, of whom 24 patients had metastases. The use of intraoperative gamma camera showed a sensitivity 97.8% and specificity of 88.9% for the visualization of sentinel nodes. Conclusions: The use of intraoperative portable gamma camera in the location of the sentinel node in cancer breast is a method of high sensitivity and specificity, useful to determine that all sentinel nodes have been removed and free field.
Assuntos
Humanos , Feminino , Biópsia de Linfonodo Sentinela , Câmaras gama , Neoplasias da Mama , Epidemiologia DescritivaRESUMO
The aim of the present work was to study the effect of a restricted diet on carbohydrate metabolism in submandibular glands of female prepuber rats and the influence of arachidonic acid derivatives. Rats of 21 days of age were divided into three groups. Group I: normally fed rats. Group II: restricted diet (50% of the normal food intake). Group III: normally restricted diet with re-feeding. The baseline concentration of tissue glycogen was significantly higher in Group II than in I or III and after 60 min of incubation in a glucose free medium all groups showed a glycogen drop. In addition, the glucose metabolism was increased in Group II. Cycloxigenase inhibitors failed to alter (14)CO(2) levels in Groups I and III. In Group II, indomethacin and acetylsalicylic acid inhibited glucose metabolism, which was reverted by PGE(2) addition. The exogenous arachidonic acid metabolism and different eicosanoids showed that restricted diet significantly increased the production of PGE(2) but diminished PGF(2)(alpha) production. Our results suggest that a restricted diet would lead to a new dynamic equilibrium of glucose homeostasis. Prostaglandins E(2) and F(2)(alpha) would participate by adapting the source of energy to tissue demands while maintaining the metabolic features that characterize puberty.
Assuntos
Dieta , Dinoprostona/fisiologia , Glucose/metabolismo , Glândula Submandibular/metabolismo , Animais , Ácido Araquidônico/administração & dosagem , Ácido Araquidônico/metabolismo , Metabolismo dos Carboidratos/efeitos dos fármacos , Dióxido de Carbono/análise , Inibidores de Ciclo-Oxigenase/farmacologia , Feminino , Glicogênio/análise , Indometacina/farmacologia , Ratos , Ratos Wistar , Glândula Submandibular/químicaRESUMO
Introducción: la reacción inflamatoria (RI) es una secuencia compleja de acontecimientos que ocurren en los tejidos de los seres vivos luego de lesión celular. Se puede manifestar objetivamente para el cirujano mediante la presencia de hallazgos macroscópicos abdominales observados durante la cirugía (1,2,3). El objetivo del presente estudio fue evidenciar la reacción inflamatoria en el abdomen de la rata expuesta a: bilis, clips de titanio y fragmentos de gasa. Material y métodos: se realizó un modelo experimental en el Laboratorio de Cirugía de la Universidad Francisco Marroquín. Se utilizaron 100 ratas de la especie Wistar a las cuales les fueron asignadas en forma aleatoria cifras numéricas para clacificarlas así...
Assuntos
Animais , Ratos , Abdome , Bile , Corpos Estranhos/complicações , Complicações Pós-Operatórias , Ratos , Reação a Corpo Estranho/etiologia , Pesos e MedidasRESUMO
INTRODUCTION: Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) have demonstrated efficacy in advanced Parkinson's disease (PD). We aimed to assess the clinical utility of these procedures in terms of the quality of life, and to determine the pre and postsurgical characteristics related to the outcome. METHOD: A prospective study was conducted on a cohort of 20 patients with advanced PD who underwent bilateral DBS: 14 in STN and 6 in GPi. They were assessed according to the CAPSIT-PD protocol before and after surgery, with a mean follow-up of 9 and 11 months, respectively. The main outcome variables were change in the UPDRS III score in off efficacy and the PDQ-39 quality of life questionnaire score (clinical utility). RESULTS: The STN group improved their UPDRS III in off by a mean of 35% (p = 0.001) and their PDQ-39 by 21% (p = 0.026). The GPi group improved their UPDRS III in off by 21% (p = 0.028) and their PDQ-39 by 37% (p = 0.116). The presurgical levodopa-equivalent dose was a positive predictor of the efficacy and clinical utility of STN DBS and a negative predictor of the efficacy of GPi DBS. In both groups, the clinical utility was determined by improvement in functional disability in off scales. CONCLUSIONS: Bilateral DBS demonstrated middle-term efficacy and clinical utility in the treatment of advanced PD. The presurgical levodopa-equivalent dose was a predictor of the efficacy and clinical utility of DBS.
Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson/terapia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Isolated uteri from rats fed with a normal diet convert [14C]arachidonate into eicosanoids: PGE(2), PGF(2alpha), TXB(2) and 6-keto-F(1alpha). Restricted diet (50% of the normal diet, during 25 days) diminishes the levels of PGE(2), PGF(2alpha) and TXB(2). The addition of Interleukin-1alpha to the Krebs-Ringer bicarbonate medium increases sharply the production of eicosanoids. Inhibitors of nitric oxide synthase, Nomega-nitro-L-arginine methyl ester or aminoguanidine, do not prevent eicosanoids increase. Conversely, NS-398 (a selective inhibitor of COX-2) blocks the increase of eicosanoids while PGE(2) blocks eicosanoids production mediated by IL-1alpha. Other experiments with uteri of underfed rats confirm that interleukin-1alpha produces an increase in the glucose metabolism. The addition of Nomega-nitro-L-arginine methyl ester, aminoguadinine or NS-398 blocked such stimulation. It is concluded that Interleukin-1alpha produces an increase of glucose metabolism in uteri isolated from underfed rats by two different mechanisms, both involving COX-2: (1) nitric oxide independent and (2) nitric oxide dependent.
Assuntos
Ácido Araquidônico/metabolismo , Glucose/metabolismo , Interleucina-1/farmacologia , Isoenzimas/metabolismo , Prostaglandina-Endoperóxido Sintases/metabolismo , Útero/efeitos dos fármacos , Útero/metabolismo , Animais , Ácido Araquidônico/farmacologia , Dióxido de Carbono/metabolismo , Ciclo-Oxigenase 2 , Dieta , Eicosanoides/metabolismo , Feminino , Isoenzimas/antagonistas & inibidores , Óxido Nítrico/metabolismo , Nitrobenzenos/farmacologia , Ratos , Ratos Wistar , Proteínas Recombinantes , Sulfonamidas/farmacologiaRESUMO
A 25-day dietary restriction (50% of the normal diet) produce a fall in the production of 14CO2 from 14C-glucose in rats isolated uteri. The addition of 10 or 20 ngml(-1) interleukin 1alpha (IL-1alpha) or interleukin 2(IL-2) to the Krebs-Ringer bicarbonate solution medium stimulates glucose metabolism in uteri from underfed rats. Such concentrations are not effective in control rats. The addition of Nomega-nitro-L arginine methyl ester--an inhibitor of both the constitutive and inducible forms of nitric oxide synthase (NOS)--and of aminoguadinine--a preferential inhibitor of the inducible form of NOS--block such stimulation. In other experiments, the addition to the medium of arginine-a substrate for the formation of nitric oxide-increases interleukin stimulation of glucose metabolism, which is blocked by NOS inhibitor. At the same time, NS-398--a selective inhibitor of inducible cyclooxygenase (COX)--eliminates the interleukin metabolism stimulation. We conclude that IL-1alpha and IL-2 produce an increase of glucose metabolism in uteri isolated from underfed rats. Nitric oxide produced by the inducible form of NOS mediates the interleukins-induced glucose metabolism stimulation with the participation of inducible COX.
Assuntos
Restrição Calórica , Glucose/metabolismo , Interleucina-1/farmacologia , Interleucina-2/farmacologia , Isoenzimas/metabolismo , Óxido Nítrico/metabolismo , Prostaglandina-Endoperóxido Sintases/metabolismo , Útero/efeitos dos fármacos , Animais , Dióxido de Carbono/metabolismo , Radioisótopos de Carbono , Ciclo-Oxigenase 2 , Dieta , Feminino , Óxido Nítrico Sintase/antagonistas & inibidores , Óxido Nítrico Sintase/metabolismo , Ratos , Ratos Wistar , Útero/metabolismoRESUMO
The investigation of methicillin resistance in Staphylococcus aureus (MRSA) is a serious problem for the physician and microbiologist. Accurate and rapid detection is essential for the use of appropriate antimicrobial therapy and for the control of nosocomial spread of the resistant strain. The performance characteristics of the MicroScan Overnight Conventional Pos Combo 12 panels (MOCP), BBL Crystal MRSA ID (CR), E-test and agar screen plate (Muller Hinton agar with oxacillin 6 micrograms/ml and 4% NaCl) (AS) were evaluated for the detection of oxacillin resistance. Thirty S. aureus clinically significant strains with different PFGE (Pulse Field Gel Electrophoresis) banding pattern were tested, and 22 of them were mecA positive by PCR. These strains were also analyzed by mecA and Tn554 polymorphism. All mecA positive strains were classified as methicillin resistant by MOCP and E-test. CR and AS failed to detect oxacillin resistance in 2 strains. One false positive was only detected by E-test. Accurate testing for the presence of MRSA may reduce the need for empiric therapy with vancomycin for patients with staphylococcal infections. According to our results the best performance was obtained with MOCP. However, as a rapid method, CR gave acceptable sensitivity for clinical purposes.
Assuntos
Proteínas de Bactérias/análise , Proteínas de Transporte/análise , Hexosiltransferases , Resistência a Meticilina , Testes de Sensibilidade Microbiana/métodos , Muramilpentapeptídeo Carboxipeptidase/análise , Peptidil Transferases , Staphylococcus aureus/efeitos dos fármacos , Meios de Cultura , Resistência a Medicamentos/genética , Farmacorresistência Bacteriana Múltipla/genética , Eletroforese em Gel de Campo Pulsado , Humanos , Resistência a Meticilina/genética , Oxacilina/farmacologia , Proteínas de Ligação às Penicilinas , Reação em Cadeia da Polimerase , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Vancomicina/farmacologiaRESUMO
The investigation of methicillin resistance in Staphylococcus aureus (MRSA) is a serious problem for the physician and microbiologist. Accurate and rapid detection is essential for the use of appropriate antimicrobial therapy and for the control of nosocomial spread of the resistant strain. The performance characteristics of the MicroScan Overnight Conventional Pos Combo 12 panels (MOCP), BBL Crystal MRSA ID (CR), E-test and agar screen plate (Muller Hinton agar with oxacillin 6 micrograms/ml and 4
NaCl) (AS) were evaluated for the detection of oxacillin resistance. Thirty S. aureus clinically significant strains with different PFGE (Pulse Field Gel Electrophoresis) banding pattern were tested, and 22 of them were mecA positive by PCR. These strains were also analyzed by mecA and Tn554 polymorphism. All mecA positive strains were classified as methicillin resistant by MOCP and E-test. CR and AS failed to detect oxacillin resistance in 2 strains. One false positive was only detected by E-test. Accurate testing for the presence of MRSA may reduce the need for empiric therapy with vancomycin for patients with staphylococcal infections. According to our results the best performance was obtained with MOCP. However, as a rapid method, CR gave acceptable sensitivity for clinical purposes.
RESUMO
The investigation of methicillin resistance in Staphylococcus aureus (MRSA) is a serious problem for the physician and microbiologist. Accurate and rapid detection is essential for the use of appropriate antimicrobial therapy and for the control of nosocomial spread of the resistant strain. The performance characteristics of the MicroScan Overnight Conventional Pos Combo 12 panels (MOCP), BBL Crystal MRSA ID (CR), E-test and agar screen plate (Muller Hinton agar with oxacillin 6 micrograms/ml and 4
NaCl) (AS) were evaluated for the detection of oxacillin resistance. Thirty S. aureus clinically significant strains with different PFGE (Pulse Field Gel Electrophoresis) banding pattern were tested, and 22 of them were mecA positive by PCR. These strains were also analyzed by mecA and Tn554 polymorphism. All mecA positive strains were classified as methicillin resistant by MOCP and E-test. CR and AS failed to detect oxacillin resistance in 2 strains. One false positive was only detected by E-test. Accurate testing for the presence of MRSA may reduce the need for empiric therapy with vancomycin for patients with staphylococcal infections. According to our results the best performance was obtained with MOCP. However, as a rapid method, CR gave acceptable sensitivity for clinical purposes.
RESUMO
The effect of a 25-day restricted diet (50% of the normal food intake) on uterine glucose metabolism of ovariectomized (25 days) and non-ovariectomized rats, was studied. Underfeeding reduces (14)CO(2) production from U(14)C-glucose in intact animal. However, in spayed rats, results are the opposite. In intact rats receiving a low food intake, the effect of the addition to the KRB medium of various agonist opioids, was studied. Dinorphin A did not bring about any change. On the other hand, beta endorphin increased glucose metabolism. Also, the addition of Dago and Dadle increased (14)CO(2) production, while their corresponding specific blockers, beta-FNA and Naltrindole, reversed it. Ovariectomized rats subjected to food restriction are not affected by opioid agonists. In vitro morphine, like endogenous opioids, increased (14)CO(2) in intact restricted diet rats. Arachidonic acid metabolism in these rats show that underfeeding brings about a decrease in PGF(2 alpha) and PGE(2), but the addition of morphine does not alter this situation, for which eicosanoids metabolites are not related to the effect of morphine. The morphine effect was not altered by naloxone. The subcutaneous injection of morphine increased glucose metabolism in intact underfed animals, while naloxone reduced (14)CO(2) in spayed rats subjected to underfeeding. It can be concluded that uteri from ovariectomized rats receiving a restricted diet are influenced by a mechanism of upregulation related to endogenous opioids. These likely originate in other tissues, and so prevent us from seeing the morphine effect.
Assuntos
Eicosanoides/biossíntese , Glucose/metabolismo , Morfina/farmacologia , Entorpecentes/farmacologia , Peptídeos Opioides/farmacologia , Útero/efeitos dos fármacos , Animais , Técnicas de Cultura , Dinorfinas/farmacologia , Ingestão de Alimentos , Ala(2)-MePhe(4)-Gly(5)-Encefalina/farmacologia , Leucina Encefalina-2-Alanina/farmacologia , Feminino , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Ovariectomia , Ratos , Ratos Wistar , Útero/metabolismo , beta-Endorfina/farmacologiaRESUMO
As part of the SENTRY Antimicrobial Surveillance Program, a total of 1078 Acinetobacter species and 842 Stenotrophomonas maltophilia isolates were collected between January 1997 and December 1999 from 5 geographic regions (Canada, the United States, Latin America, Europe, and the Asia-Pacific). The frequency of infections (by geographic region and body site), including those due to imipenem-resistant Acinetobacter species and trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant S. maltophilia, was evaluated. The possibility of seasonal variations in bloodstream infections caused by Acinetobacter species was studied, as was the activity of several therapeutic antimicrobials against all strains. Acinetobacter species and S. maltophilia were most frequently associated with pulmonary infections, independent of the region evaluated. In contrast, patterns of antimicrobial resistance markedly varied among distinct geographic regions, especially for nosocomial isolates. Although the carbapenems were the most active antimicrobials against Acinetobacter species, nearly 11.0% of the nosocomial isolates were resistant to this drug group in both regions. TMP-SMZ, ticarcillin-clavulanic acid, gatifloxacin, and trovafloxacin were the only agents with consistent therapeutic activity against S. maltophilia isolates. Rates of resistance to TMP-SMZ ranged from 2% in Canada and Latin America to 10% in Europe. The geographic differences in resistance patterns among Acinetobacter species and S. maltophilia isolates observed in this study emphasize the importance of local surveillance in determining the most adequate therapy for acinetobacter and S. maltophilia infections and the possible clonal, epidemic nature of occurrence.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter/efeitos dos fármacos , Resistência a Múltiplos Medicamentos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Stenotrophomonas maltophilia/efeitos dos fármacos , Infecções por Acinetobacter/microbiologia , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Canadá/epidemiologia , Carbapenêmicos/farmacologia , Carbapenêmicos/uso terapêutico , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Europa (Continente)/epidemiologia , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Lactente , Recém-Nascido , América Latina/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estações do Ano , Estados Unidos/epidemiologiaRESUMO
The effect of underfeeding over glucose metabolism in uteri isolated from ovariectomized and non-ovariectomized rats subjected to a restricted diet for 25 days (50% of the normal food intake), was studied. Underfeeding decreases (14)CO(2) formation from U(14) C-glucose in intact animal uteri. While in ovariectomized rats (25 days), the effect is the opposite. The addition of morphine 10(-6) M to the medium does not affect rats fed ad libitum. However, (14)CO(2) levels increase significantly in intact animals receiving a restricted diet. In ovariectomized rats morphine does not show any activity, regardless of the type of diet rats were subjected to. None of the rat groups seems to be sensitive to naloxone 10(-6) M. The s.c. injection of morphine (4 mg.kg (-1)) increases glucose metabolism only in intact rats provided with a restricted diet, while naloxone (2.5 mg.kg (-1) ) produces a decrease of ( 14)CO(2) in ovariectomized underfed animals. To conclude, morphine either 'in vivo' or 'in vitro' is active only in uteri from intact rats subjected to underfeeding. Naloxone produces a decrease in (14)CO(2) production, particularly when it is s.c. injected to ovariectomized rats undergoing a dietary restriction. Since the uterus does not react to naloxone, the effect of the opiod blocker may be the result of endogenous opioids originated in other tissues.