RESUMO
Toda vez que a lo largo de 3 meses hay una caída del 50% del filtrado glomerular estamos en presencia de lo que se define como deterioro rápidamente evolutivo de la función renal. Si además es acompañado de un sedimento urinario activo, inferimos estar frente a una glomerulopatía rápidamente evolutiva, una microangiopatía trombótica, una enfermedad renal ateroembólica o una nefritis intersticial. La mayoría de las veces la celeridad con que se inicia el tratamiento impacta en el resultado del mismo, lo que con frecuencia obliga a realizarlo en forma empírica. No obstante, como la terapéutica a emplear no es inocua, debemos extremar las medidas diagnósticas para definir la etiología, este caso es un ejemplo de ello
Whenever there is a 50% drop in glomerular filtration over 3 months we are in the presence of what is defined as rapidly progressive deterioration of renal function. If it is also accompanied by an active urinary sediment, it is inferred that one of these may be taking place: a rapidly progressive glomerulonephritis, a thrombotic microangiopathy, an atheroembolic renal disease or an interstitial nephritis. In most cases the speed with which the treatment is initiated impacts on its result, which often requires that it is done empirically. However, as the therapy used is not innocuous, we must maximize diagnostic measures to define the etiology; this case is an example of this
Assuntos
Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologiaRESUMO
The discharge of sewage effluents into low-order streams has negative effects on water quality. Macrophytes can be efficient in the treatment of this wastewater due to the removal of the main pollutants. The genotoxicity of sewage-polluted water discharging into La Choza stream was evaluated by testing with Allium cepa. Also, a phytoremediation assay with continuous recirculation of the residual water was conducted for 12 days. Three treatments were carried out. One treatment (Hr) was performed with a macrophyte (Hydrocotyle ranunculoides), and two treatments were conducted without macrophytes: with lighting (Ai) and without lighting (Ao). The wastewater was toxic according to all the evaluated indexes (mitotic index, frequency of chromosomal aberrations and micronucleus). High concentrations of ammonium, dissolved inorganic nitrogen (DIN), total (TP) and soluble reactive phosphorous (SRP) and indicators of faecal contamination were determined in the wastewater. The ammonium, DIN, SRP and TP loads at the end of the assay were significantly lower in the treatments with light (Hr and Ai). So, the nutrient removal was due to their absorption and adsorption by the periphyton and H. ranunculoides. Our results lead us to recommend the maintenance and planting of macrophytes in lowland streams subject to sewage pollution.
Assuntos
Biodegradação Ambiental , Centella/química , Monitoramento Ambiental , Esgotos/análise , Poluentes Químicos da Água/análise , Nitrogênio/análise , Fósforo/análise , Eliminação de Resíduos Líquidos , Poluição da Água , Qualidade da ÁguaRESUMO
Hospital wastewater (HWW) constitutes a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. In the present work we investigated toxicity and genotoxicity of wastewaters from the public hospital of Buenos Aires (Argentina). The effluent from the sewage treatment plant (STP) serving around 10 million inhabitants was also evaluated. The study was carried out between April and September 2012. Toxicity and genotoxicity assessment was performed using the green algae Pseudokirchneriella subcapitata and the Allium cepa test, respectively. Toxicity assay showed that 55% of the samples were toxic to the algae (%I of growth between 23.9 and 54.8). The A. cepa test showed that 40% of the samples were genotoxic. The analysis of chromosome aberrations (CA) and micronucleus (MN) showed no significant differences between days and significant differences between months. The sample from the STP was not genotoxic to A. cepa but toxic to the algae (%I = 41%), showing that sewage treatment was not totally effective. This study highlights the need for environmental control programs and the establishment of advanced and effective effluent treatment plants in the hospitals, which are merely dumping the wastewaters in the municipal sewerage system.
RESUMO
Thrombotic microangiopathy (TMA), a severe complication of renal transplantation, is a pathological process involving microvascular occlusion, thrombocytopenia, and microangiopathic hemolytic anemia. It generally appears within the first weeks after transplantation, when immunosuppressive drugs are used at high doses. De novo TMA may also be drug-induced when calcineurin inhibitors or proliferation signal inhibitors are used. We report three cases of de novo drug-induced TMA in renal transplant patients who were managed by replacing calcineurin inhibitors or proliferation signal inhibitors with belatacept, a primary maintenance immunosuppressive drug, which blocks the CD28 costimulation pathway, preventing the activation of T lymphocytes. To identify the cause of TMA, we ruled out HUS, hepatitis C serology, HIV serology, parvovirus B19, cytomegalovirus, anti-HLA antibodies, and prolonged activated partial thromboplastin time. We suspect that the TMA was caused by the calcineurin inhibitors or proliferation signal inhibitors. Belatacept treatment was initiated at a dose of 10 mg/kg on days 1, 5, 14, 28, 60, and 90; maintenance treatment was 5 mg/kg once a month for 1 year. Belatacept, in combination with other agents, prevented graft rejection in three patients.
RESUMO
OBJECTIVES: We describe our experiences with, and compare the outcomes of, 2 groups of renal transplant patients treated with thymoglobulin or antithymocyte globulin-Fresenius as induction therapy at transplant to reduce the incidence of acute rejection and prevent delayed allograft function. MATERIALS AND METHODS: Twenty-four recipients of deceased-donor or living-donor kidney transplants received thymoglobulin, and 23 patients received antithymocyte globulin-Fresenius. Patient and graft survival and efficacy and safety were assessed at 3 months. RESULTS: The demographic characteristics of both groups were comparable, but the predominant donor type was significantly different. Incidence of complications, delayed graft function, and creatinine concentrations were comparable in both groups. At 3 months after the transplant, patient survival rate was 92% in the thymoglobulin group and 96% in the antithymocyte globulin-Fresenius group (P > .05), and death-censored graft survival rate for both groups was not significantly different. Average hematocrit and lymphocyte, neutrophil, and platelet counts were comparable in both groups at 3 months' follow-up. Average white blood count at 1 month was significantly different between the groups: at 5.62 ± 2.45 × 103 cells/mm³ in the thymoglobulin group and 7.85 ± 4.10 × 103 cells/mm³ in the ATG-F group (P < .05). CONCLUSIONS: Considering the study design limitations, we observed that our group of treated patients, safety, and efficacy of thymoglobulin and antithymocyte globulin-Fresenius were generally comparable.
Assuntos
Soro Antilinfocitário/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Adulto , Biomarcadores/sangue , Função Retardada do Enxerto/sangue , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/prevenção & controle , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Presentamos un caso en el que, por primera vez en América latina, se utilizó eculizumab, un anticuerpo que inhibe la activación terminal del complemento, para la prevención de rechazo mediado por anticuerpos (RMA) en un receptor de trasplante renal con títulos altos de anticuerpos anti-HLA específico de donante preformados. El paciente, un hombre de 51 años de edad, trasplantado por segunda vez, receptor de un injerto de donante vivo relacionado, recibió, antes del trasplante, cuatro sesiones de plasmaféresis y terapia con tacrolimus y micofenolato sódico hasta el día del trasplante. La terapia de inducción fue con inmunoglobulina antitimocítica e inmunoglobulina intravenosa(IVIg). La administración de eculizumab fue del siguiente modo: 1200 mg. dos horas antes del trasplante; 600mg dentro de las primeras 24 horas posteriores al trasplante; durante un mes, una vez por semana, 600 mg. Al día 30, una dosis de 1200 mg. A un mes del trasplante, el paciente muestra buena función del injerto.(AU)
Assuntos
Pessoa de Meia-Idade , Anticorpos , Transplante de Rim , Tolerância ao TransplanteRESUMO
Presentamos un caso en el que, por primera vez en América latina, se utilizó eculizumab, un anticuerpo que inhibe la activación terminal del complemento, para la prevención de rechazo mediado por anticuerpos (RMA) en un receptor de trasplante renal con títulos altos de anticuerpos anti-HLA específico de donante preformados. El paciente, un hombre de 51 años de edad, trasplantado por segunda vez, receptor de un injerto de donante vivo relacionado, recibió, antes del trasplante, cuatro sesiones de plasmaféresis y terapia con tacrolimus y micofenolato sódico hasta el día del trasplante. La terapia de inducción fue con inmunoglobulina antitimocítica e inmunoglobulina intravenosa(IVIg). La administración de eculizumab fue del siguiente modo: 1200 mg. dos horas antes del trasplante; 600mg dentro de las primeras 24 horas posteriores al trasplante; durante un mes, una vez por semana, 600 mg. Al día 30, una dosis de 1200 mg. A un mes del trasplante, el paciente muestra buena función del injerto.
Assuntos
Pessoa de Meia-Idade , Anticorpos , Tolerância ao Transplante , Transplante de RimRESUMO
Los líquidos residuales provenientes de hospitales constituyen un riesgo potencial para los ecosistemas y la salud humana debido a la presencia de compuestos tóxicos y genotóxicos. El objetivo de este trabajo fue analizar la toxicidad y la genotoxicidad de los efluentes provenientes del Hospital de Clínicas José de San Martín (Buenos Aires). Las muestras del efluente se tomaron durante los días y horarios de mayor actividad del hospital y se separaron en dos fracciones: acuosa y orgánica (extractos). Los ensayos de toxicidad se realizaron en la fracción acuosa utilizando dos especies de algas verdes: Pseudokirchneriella subcapitata y Chlorella vulgaris. La genotoxicidad se evaluó en las dos fracciones mediante el ensayo de Salmonella/ microsomas en ausencia y presencia de mezcla S9, utilizando las cepas TA98 y TA100. Veintinueve muestras de un total de 53 muestras analizadas resultaron tóxicas para P. subcapitata (entre 18 y 55 % de inhibición), mientras que sólo 8 muestras lo fueron para C. vulgaris (entre 21 y 50 % de inhibición). Ninguna de las muestras resultó genotóxica para Salmonella, ni en los extractos ni en las fracciones acuosas. De los tres ensayos utilizados, P. subcapitata fue el más sensible, siendo el ensayo más apropiado para el monitoreo de estos efluentes.(AU)
Wastewaters from hospitals constitute a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. The objective of this work was to analyze the toxicity and genotoxicity of wastewaters from the "Hospital de Clínicas José de San Martín" (Buenos Aires). Wastewater samples were obtained during the days and hours of major hospital activities and they were separated into two fractions: aqueous and organic (extracts). The toxicity assays were performed for the aqueous fraction using the green algae species: Pseudokirchneriella subcapitata and Chlorella vulgaris. Genotoxicity was assessed for the two fraction samples using the Salmonella/microsome assay in presence and in absence of S9 mix, with the strains TA98 and TA100. Twenty nine of the 53 total analyzed samples were toxic to P. subcapitata (between 18 and 55 % inhibition), whereas only 8 samples were toxic to C. vulgaris (between 21 and 50 % inhibition). None of the samples resulted genotoxic to Salmonella. Of the three tests used, P. subcapitata was the most sensible, resulting in the most suitable species to be used in hospital wastewaters monitoring.(AU)
RESUMO
Los líquidos residuales provenientes de hospitales constituyen un riesgo potencial para los ecosistemas y la salud humana debido a la presencia de compuestos tóxicos y genotóxicos. El objetivo de este trabajo fue analizar la toxicidad y la genotoxicidad de los efluentes provenientes del Hospital de Clínicas José de San Martín (Buenos Aires). Las muestras del efluente se tomaron durante los días y horarios de mayor actividad del hospital y se separaron en dos fracciones: acuosa y orgánica (extractos). Los ensayos de toxicidad se realizaron en la fracción acuosa utilizando dos especies de algas verdes: Pseudokirchneriella subcapitata y Chlorella vulgaris. La genotoxicidad se evaluó en las dos fracciones mediante el ensayo de Salmonella/ microsomas en ausencia y presencia de mezcla S9, utilizando las cepas TA98 y TA100. Veintinueve muestras de un total de 53 muestras analizadas resultaron tóxicas para P. subcapitata (entre 18 y 55 % de inhibición), mientras que sólo 8 muestras lo fueron para C. vulgaris (entre 21 y 50 % de inhibición). Ninguna de las muestras resultó genotóxica para Salmonella, ni en los extractos ni en las fracciones acuosas. De los tres ensayos utilizados, P. subcapitata fue el más sensible, siendo el ensayo más apropiado para el monitoreo de estos efluentes.
Wastewaters from hospitals constitute a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. The objective of this work was to analyze the toxicity and genotoxicity of wastewaters from the "Hospital de Clínicas José de San Martín" (Buenos Aires). Wastewater samples were obtained during the days and hours of major hospital activities and they were separated into two fractions: aqueous and organic (extracts). The toxicity assays were performed for the aqueous fraction using the green algae species: Pseudokirchneriella subcapitata and Chlorella vulgaris. Genotoxicity was assessed for the two fraction samples using the Salmonella/microsome assay in presence and in absence of S9 mix, with the strains TA98 and TA100. Twenty nine of the 53 total analyzed samples were toxic to P. subcapitata (between 18 and 55 % inhibition), whereas only 8 samples were toxic to C. vulgaris (between 21 and 50 % inhibition). None of the samples resulted genotoxic to Salmonella. Of the three tests used, P. subcapitata was the most sensible, resulting in the most suitable species to be used in hospital wastewaters monitoring.
Assuntos
Eliminação de Águas Residuárias/efeitos adversos , Compostos Químicos/efeitos adversos , Genotoxicidade/análise , Resíduos de Serviços de Saúde/efeitos adversos , Antibacterianos/efeitos adversos , Salmonella typhimurium , Bioensaio/métodos , ClorófitasRESUMO
Increase of bovine livestock rates in fragile areas of the Rolling Pampa entails a high risk of biological contamination. This biological contamination is regulated by edaphic variables such as texture, which control biological contaminants transport towards water bodies. In this work bacterial adsorption was correlated with individual particle sizes in 27 soils of a typical basin of the Rolling Pampa with slow centrifugation techniques. Bacterial adsorption values, using E. coli (ATCC 8739), ranged between 25.3 and 73.3% and significant correlation (R² = 0.6) was found between bacterial adsorption and clay content. This correlation was improved when particles smaller than 3 µm were considered (R² = 0.64) highlighting the capacity of very fine silt in adsorption mechanisms. Data obtained were compared with those proposed by Ling et al. (2002), finding similar slope but different intercept. This difference disappeared when a wild strain, isolated from bovine manures present in the basin, was used, since a bacterial adsorption increase of 48% was found.
Assuntos
Escherichia coli/fisiologia , Microbiologia do Solo , Solo/química , Adsorção , Silicatos de Alumínio , Animais , Argentina , Bovinos/microbiologia , Argila , Fezes/microbiologia , Tamanho da Partícula , Dióxido de Silício , Especificidade da Espécie , Propriedades de SuperfícieRESUMO
El aumento de la carga animal vacuna en la Pampa Ondulada asociado a áreas frágiles supone un importante riesgo de contaminación biológica. Dicha contaminación está regulada por variables edáficas, como la textura, que controlan el transporte de contaminantes biológicos hacia los cuerpos de agua. En el presente trabajo se correlacionó la adsorción bacteriana del suelo con distintos tamaños de partículas individuales correspondientes a 27 suelos provenientes de una cuenca de la Pampa Ondulada. Para ello se utilizó una técnica de centrifugación lenta. Los valores de adsorción bacteriana, empleando en la determinación Escherichia coli ATCC 8739, variaron entre 25,3% y 73,3%, y el tamaño de partícula que mejor se correlacionó con esta propiedad fue el correspondiente a la fracción de arcillas (R² = 0,6). Esta correlación mejoró al considerar conjuntamente a todas las partículas menores de 3 µm (R² = 0,64), lo que resalta la capacidad de los limos muy finos en el fenómeno de adsorción. La curva de ajuste elaborada con los datos experimentales se comparó con la obtenida de acuerdo con el modelo propuesto por Ling et al. (2002). Se encontraron similitudes en la pendiente, no así en la ordenada al origen. Esta diferencia desapareció al emplear en la determinación una cepa autóctona aislada de deyecciones animales provenientes de la cuenca estudiada, dado que dicha cepa evidenció una adsorción 48% superior a la observada con la cepa de colección.
Increase of bovine livestock rates in fragile areas of the Rolling Pampa entails a high risk of biological contamination. This biological contamination is regulated by edaphic variables such as texture, which control biological contaminants transport towards water bodies. In this work bacterial adsorption was correlated with individual particle sizes in 27 soils of a typical basin of the Rolling Pampa with slow centrifugation techniques. Bacterial adsorption values, using E. coli (ATCC 8739), ranged between 25.3 and 73.3% and significant correlation (R² = 0.6) was found between bacterial adsorption and clay content. This correlation was improved when particles smaller than 3 µm were considered (R² = 0.64) highlighting the capacity of very fine silt in adsorption mechanisms. Data obtained were compared with those proposed by Ling et al. (2002), finding similar slope but different intercept. This difference disappeared when a wild strain, isolated from bovine manures present in the basin, was used, since a bacterial adsorption increase of 48% was found.
Assuntos
Animais , Bovinos , Escherichia coli/fisiologia , Microbiologia do Solo , Solo/química , Adsorção , Silicatos de Alumínio , Argentina , Fezes/microbiologia , Tamanho da Partícula , Dióxido de Silício , Especificidade da Espécie , Propriedades de SuperfícieRESUMO
El objetivo del trabajo fue determinar el aporte de carga tóxica y genotóxica al sistema cloacal urbano por los efluentes de hospital. Se utilizaron dos sistemas biológicos, el ensayo de Ames y el de Saccharomyces cerevisiae D7, observando toxicidad solo en los extractos puros y genotoxicidad en 4 de las 9 muestras analizadas. La genotoxicidad observada podría producir un impacto ambiental de importancia en el ecosistema y para la salud humana
Assuntos
Argentina , Genotoxicidade , Redes de Esgoto , Resíduos de Serviços de Saúde , Toxicidade , ArgentinaRESUMO
El objetivo del trabajo fue determinar el aporte de carga tóxica y genotóxica al sistema cloacal urbano por los efluentes de hospital. Se utilizaron dos sistemas biológicos, el ensayo de Ames y el de Saccharomyces cerevisiae D7, observando toxicidad solo en los extractos puros y genotoxicidad en 4 de las 9 muestras analizadas. La genotoxicidad observada podría producir un impacto ambiental de importancia en el ecosistema y para la salud humana
Assuntos
Resíduos de Serviços de Saúde , Redes de Esgoto , Toxicidade , Genotoxicidade , Argentina , ArgentinaRESUMO
Trata-se do primeiro relato de ocorrência de Yersinia rohdei na Argentina, isolada de água de recreaçäo da Laguna del Monte, Província de Buenos Aires.A cepa foi classificada como Y.rohdei biotipo 1, sorotipo 0:38 e fagotipo Xo.