RESUMO
Patients hospitalized for acute asthma treated with a pre-established algorithm could decrease hospital stay and critical bed (PICU) requirement. The objective of this article was to implement and evaluate the impact of a pre-established algorithm to treat children hospitalized for acute asthma. It is a cross-sectional and comparative study, with a prospective sample for convenience, of asthmatic children between 5 and 15 years admitted during 2017 without response to the first line of treatment in the emergency department. Patients with cardiorespiratory comorbidities and with direct admission to PICU were excluded. An algorithm was applied for 2 hours and its effectiveness was evaluated by a clinical score (PAS: English Pediatric Asthma Score). 55 patients were admitted, mean age 8.02 years, 41.8% female. The PAS decreased from 8 to 5 points at the end of the algorithm (p <0.001). When comparing the results obtained with the group treated the previous year, without algorithm application in 51 patients with similar demographic characteristics, a shorter hospitalization was observed (0.6 days versus 0.95 days (p <0.0368)). The algorithm in acute asthma unified treatment criteria and times in its application. A rapid decrease in clinical score and a shorter hospital stay were observed.
Los pacientes hospitalizados por asma agudo tratados con un algoritmo preestablecido, podrían disminuir la estancia hospitalaria y requerimiento de cama crítica (UCIP). El objetivo de este trabajo fue el de implementar y evaluar el impacto de un algoritmo preestablecido para tratar a niños hospitalizados por asma aguda. Es un estudio transversal y comparativo, con una muestra prospectiva por conveniencia, de niños asmáticos entre 5 y 15 años ingresados durante el 2017 sin respuesta a la primera línea de tratamiento en el servicio de urgencia. Se excluyeron pacientes con comorbilidades cardiorespiratorias y con ingreso directo a UCIP. Se aplicó un algoritmo durante 2 horas evaluando su efectividad mediante puntaje clínico (PAS, por su sigla en inglés Pediatric Asthma Score). Ingresaron 55 pacientes, edad media 8,02 años, 41,8% sexo femenino. El PAS disminuyó de 8 a 5 puntos al finalizar algoritmo (p <0,001). Al comparar los resultados obtenidos con el grupo tratado el año anterior, sin aplicación de algoritmo en 51 pacientes con similares características demográficas, se observó una hospitalización más breve (0,6 días versus 0,95 días (p < 0,0368)). El algoritmo en asma aguda unificó criterios de tratamiento y los tiempos en su aplicación. Se observó una rápida disminución del puntaje clínico y menor estancia hospitalaria.
Assuntos
Asma/terapia , Algoritmos , Criança Hospitalizada , Doença Aguda , Avaliação de Resultados em Cuidados de SaúdeRESUMO
Introducción: Los antibióticos constituyen uno de los grupos farmacológicos de mayor prescripción y uso, ocupando el primer o segundo lugar en los gastos de farmacia de un hospital. Se estima que el 70% el uso de los antibióticos es inadecuado. Objetivo: Determinar el perfil de utilización de antibióticos en hospitales de tercer y cuarto nivel de atención de tres departamentos de Paraguay durante el 2017. Material y métodos: Estudio observacional, descriptivo de corte transversal con muestreo probabilístico. El diseño muestral considera como estratos los niveles de atención: cuarto y de tercer nivel de atención donde se seleccionaron hospitales en forma aleatoria en 3 departamentos. Se realizó un corte de prevalencia de una semana y se contabilizó la proporción bajo tratamiento con antibióticos y en caso de estar recibiendo ATB el motivo de indicación, tipo de antibiótico, vía de administración , dosis , intervalo , tiempo de antibioticoterapia. Resultados: Fueron incluidos en el estudio, 638 pacientes, el 63,67%(403) fueron mujeres, y el 26,09% (162) tenía una edad mayor a 50 años. El 70,69% (451) utilizó antibiótico, el 53,27% (236) de los casos se utilizó con fines profilácticos. El 34,60% (219) no usó de manera adecuada el antibiótico. Conclusión: La proporción de uso de antibiótico y uso inadecuado fueron elevados. En su mayoría fueron con fines profilácticos Considerando la elevada utilización de antimicrobianos es imperativo desarrollar estrategias de control de prescripciones a través de comisiones de control de infección además de proporcionar una educación continua a los profesionales de salud a nivel hospitalario. Palabras claves : Profilaxis Antibiótica, Farmacorresistencia Microbiana, Uso Racional de los Medicamentos.
Introduction :Antibiotics are one of the pharmacological groups of greater prescription and use, occupying the first or second place in the pharmacy expenses of a hospital. It is estimated that 70% of the use of antibiotics is inadequate. Objective: To determine the profile of antibiotic use in hospitals of third and fourth level of attention of three departments of Paraguay during 2017. Material and methods: Observational study, descriptive cross section with probabilistic sampling. The sample design considers levels of care as strata: fourth and third level of care where hospitals were randomly selected in 3 departments of Paraguay during 2017. A prevalence cut of one week was carried out and the proportion under treatment was counted with antibiotics and in case of receiving ATB the indication reason, type of antibiotic, route of administration, dose, interval, time of antibiotic therapy. Results: Sixty-eight patients were included in the study, 63.67% (403) were female, and 26.09% (162) were older than 50 years. 70.69% (451) used antibiotics, 53.27% (236) of the cases were used for prophylactic purposes. 34.60% (219) did not use the antibiotic properly. Conclusion: The proportion of antibiotic use was 70.69%, most were for prophylactic purposes and the highest proportion of the indications of antibiotics in hospitals is inadequate, in turn 34.60% of antibiotics are used improperly. For all the above, it is imperative to implement intervention strategies and control the use of antibiotics to reduce the use of antibiotics in hospitals. Key words: Antibiotic Prophylaxis, Microbial drug resistanc, Rational use of medicines.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Antibioticoprofilaxia , Farmacorresistência Bacteriana/efeitos dos fármacosRESUMO
INTRODUCTION: Some epileptic syndromes are characterised by seizures that are difficult to control and are associated to delayed neuropsychomotor development, which results in a deterioration in the patient's quality of life as well as in that of his or her family. AIM: To evaluate the use of cannabidiol as adjuvant therapy in patients with refractory epilepsies. PATIENTS AND METHODS: An observational study was conducted by means of a survey addressed to the patient's caregiver. Data collected included information about the patient and the caregiver, changes observed in the seizures, neuropsychological effects, side effects and the family's overall perception following the use of cannabidiol. RESULTS: The evaluation examined 15 patients with refractory epilepsies, who received cannabidiol over a period ranging from one month to one year. The frequency of seizures decreased in 40% of the patients, 60% of the patients were seen to have control over 50% of their seizures and in 27% of them the seizures disappeared completely. Neurocognitive changes were also reported: behaviour improved in 73%; 60% reported an improvement in language; in 50% sleep improved; 43% reported improvements in eating habits; and 100% said their mood had improved. The overall perception of the illness was that there had been improvements in 73% of respondents. The most common side effects were drowsiness and fatigue. CONCLUSIONS: These results suggest a possible beneficial effect of cannabidiol on the control of seizures and on the improvement of certain neurocognitive aspects in patients with refractory epilepsies.
TITLE: Cannabidiol: uso en epilepsias refractarias.Introduccion. Algunos sindromes epilepticos se caracterizan por crisis de dificil control y asocian un retraso en el desarrollo neuropsicomotor, lo que conlleva un deterioro en la calidad de vida del paciente y su familia. Objetivo. Evaluar el uso del cannabidiol como tratamiento adyuvante en pacientes con epilepsias refractarias. Pacientes y metodos. Se realizo un estudio observacional por medio de una encuesta dirigida a la persona cuidadora del paciente. Se valoro la informacion sobre el paciente y el cuidador, cambios observados sobre las crisis, efectos neuropsicologicos, efectos adversos y percepcion global de la familia tras el uso del cannabidiol. Resultados. Se evaluo a 15 pacientes con epilepsias refractarias, quienes recibieron cannabidiol durante un periodo de un mes a un año. En el 40% de los pacientes hubo una disminucion en la frecuencia de las crisis, en el 60% de los pacientes se observo un control de mas del 50% de las crisis y en el 27% las crisis desaparecieron totalmente. Tambien se comunicaron cambios neurocognitivos: en el 73% hubo una mejoria del comportamiento; el 60% notifico una mejoria en el lenguaje; el 50%, en el sueño; el 43%, en la alimentacion; y el 100%, en el estado de animo. La percepcion global sobre la enfermedad notifico una mejoria en el 73%. Los efectos adversos mas frecuentes fueron somnolencia y fatiga. Conclusiones. Estos resultados sugieren un posible efecto beneficioso del cannabidiol sobre el control de las crisis y en la mejoria de ciertos aspectos neurocognitivos en pacientes con epilepsias refractarias.
Assuntos
Canabidiol/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto JovemRESUMO
INTRODUCTION: Rolandic epilepsy or benign childhood epilepsy with centrotemporal spikes is called benign because its seizures are usually favourable and due to the spontaneous normalisation of the electroencephalogram on reaching puberty. Nevertheless, evidence has been found of the impact on cognitive development with the presence of heterogeneous cognitive deficits, especially related to persistent intercritical discharges during non-REM sleep. The aim of this study is to examine the epileptogenic networks involved in the neuropsychological disorders of this pathology. DEVELOPMENT: A common feature of the atypical developments is persistent epileptic activity during slow sleep, which plays an important role in the development of the neurocognitive deficits that are associated to this pathology. Factors such as the age at onset of the epilepsy, the onset of the atypical development, the location of the interictal discharges and the continuous epileptic activity during sleep that persists for more than two years can trigger changes in the functioning of the neurocognitive networks. This may result in deficits in the neuropsychological functions, which may even be irreversible. CONCLUSIONS: A close clinical and electroencephalographic follow-up is necessary. Moreover, formal neuropsychological studies must be conducted as of the onset of benign childhood epilepsy with centrotemporal spikes. This is even more necessary in cases in which there is an obvious atypical development in order to detect and prevent the neuropsychological deficits before they establish themselves on a definitive basis.
TITLE: Las alteraciones neuropsicologicas son frecuentes en la epilepsia rolandica y sus evoluciones atipicas.Introduccion. La epilepsia rolandica o epilepsia benigna de la infancia con puntas centrotemporales se denomina benigna debido a lo favorables que suelen ser sus crisis y a la espontanea normalizacion del electroencefalograma al llegar a la pubertad, aunque se ha demostrado el impacto sobre el desarrollo cognitivo con la presencia de deficits cognitivos heterogeneos, relacionados especialmente con las descargas intercriticas persistentes durante el sueño no REM. El objetivo de este trabajo es estudiar las redes epileptogenas involucradas en los trastornos neuropsicologicos de esta patologia. Desarrollo. Las evoluciones atipicas tienen en comun una actividad epileptica persistente durante el sueño lento, que desempeña un papel importante en el desarrollo de los deficits neurocognitivos que se asocian a esta patologia. Factores como la edad de inicio de la epilepsia, el inicio de la evolucion atipica, la localizacion de las descargas interictales y la actividad epileptica continua durante el sueño que persista durante mas de dos años pueden provocar cambios en el funcionamiento de las redes neurocognitivas, con los consecuentes deficits en las funciones neuropsicologicas, que incluso pueden resultar irreversibles. Conclusiones. Es necesario un seguimiento cercano tanto clinico como electroencefalografico; ademas, deben realizarse estudios neuropsicologicos formales desde el inicio de la epilepsia benigna de la infancia con puntas centrotemporales y mas en los casos que es evidente una evolucion atipica para detectar y prevenir los deficits neuropsicologicos antes de que se instauren definitivamente.
Assuntos
Transtornos Cognitivos/etiologia , Cognição , Epilepsia Rolândica/psicologia , Fatores Etários , Eletroencefalografia , Epilepsia Rolândica/fisiopatologia , Humanos , Testes Neuropsicológicos , Convulsões/fisiopatologia , Convulsões/psicologia , SonoRESUMO
Two experiments were carried out to examine in vitro quality and in vivo fertility of rabbit semen diluted in ultra-high temperature (UHT) skim milk. In the first experiment, pooled ejaculates of 10 adult rabbits were divided in three aliquots. Each aliquot was diluted in saline solution, TrisC or UHTm extender and kept at room temperature for 24 h. Sperm quality assessment was performed during all the incubation periods. In the second experiment, 27 adult rabbit does were inseminated with semen incubated for 5 h. Embryo recovery was performed 96 h after insemination. Results showed that treatments diluted in UHTm registered the highest values of spermatozoon with total motility, intact and functional plasma membrane and greater number of embryos recovered in rabbit does. We conclude that UHT skim milk would be a good extender for improved intra-uterine insemination in rabbits and to keep sperm cells for several hours at room temperature.
Assuntos
Temperatura Alta , Leite , Preservação do Sêmen/métodos , Espermatozoides , Animais , Membrana Celular , Feminino , Fertilização , Inseminação Artificial , Masculino , Coelhos , Análise do Sêmen , Contagem de Espermatozoides , Motilidade dos EspermatozoidesRESUMO
Introducción. Al convertir dopamina en norepinefrina la dopamina β-hidroxilasa (DβH) regula el tono dopaminérgico y adrenérgico. Los alelos rs1989787, rs1611115 y rs1108580 del gen DβH se asocian con actividad deficiente de la enzima y por eso evaluamos sus influencias sobre variables cardiovasculares clínicas, bioquímicas y farmacológicas. Métodos: A 44 voluntarios sanos con los haplotipos triple homocigoto nativo (CC/CC/AA), triple heterocigoto (CT/CT/AG), doble homocigoto mutado (TT/CC/GG) y homocigoto mutado para el rs1611115 (CC/TT/AA) les medimos presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca (FC) en posición decúbito, sentado, de pie, bajo estímulo de frío, con la maniobra de Valsalva y post ingestión de clonidina; adicionalmente medimos actividad enzimática por espectrofotometría y concentraciones séricas de dopamina y norepinefrina por ELISA. Resultados: Edad promedio 21,6±3,5 años, 54,5 porciento mujeres. No hubo diferencias de PAS, PAD y FC obtenidas bajo diferentes condiciones; sólo encontramos cambios significativos en los descensos de la PAS y la PAD postingestión de clonidina. No hubo relación de las variables clínicas, bioquímicas y farmacológicas mencionadas con los alelos rs1989787 y rs1108580, pero los portadores del alelo mutado T del rs1611115 sí tenían frecuencias cardíacas estadísticamente inferiores a los portadores del alelo nativo C. La actividad enzimática y las concentraciones de dopamina y norepinefrina no se correlacionaron con las variables cardiovasculares, pero se encontró correlación directa entre la actividad de la enzima y las concentraciones de norepinefrina. Conclusión: El polimorfismo -970C>T del gen DβH es el único asociado con menores frecuencias cardíacas en portadores del alelo mutado T.
Introduction. To the converting dopamine in norepinephrine the enzymedopamine β-hydroxylase (DβH) regulates dopaminergic and adrenergictone. The alleles rs1989787, rs1611115 and rs1108580 of the gene DβH areassociated with deficient activity of the enzyme and thus the influence ofthese SNPs in clinical, biochemical and pharmacological variables relatedwith the cardiovascular system was evaluated. Methods: 44 healthy volunteerswith homozygous triple native (CC/CC/AA), triple heterozygous (CT/CT/AG), double mutated homozygous (TT/CC/GG) and mutated homozygoushaplotypes for the rs1611115 (CC/TT/AA) were subjected to measurementsof systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) in the positions prone, sitting, standing, under cold stimulus, with theValsalva maneuver and after clonidine ingestion; additionally the enzymaticactivity of the DβH and the concentrations of dopamine and norepinephrinewere determined by spectrophotometry and ELISA, respectivelly. Results: Theaverage age of the group was 21.6±3.5 years, and 54.5% were women. Therewere no differences in SBP, DBP and HR obtained under different conditions;we only found significant changes in SBP and DBP decrease after clonidineingestion. There were no associations between clinical, biochemical andpharmacological variables with the rs1989787 and rs1108580 alleles, however,carriers of the mutant allele T of the rs1611115 had heart rates statisticallylower than the native C allele carriers. Neither enzymatic activity nor dopamineand norepinephrine levels were correlated with cardiovascular variables, but adirect correlation between enzyme activity and norepinephrine concentrationswas found. Conclusion: The-970C>T polymorphism of DβH gene is the onlyone associated with lower heart rates in carriers of the mutated allele T.
Assuntos
Humanos , Dopamina beta-Hidroxilase , Farmacogenética , Polimorfismo GenéticoRESUMO
We have already shown that seminal collection method affects seminal plasma composition and sperm quality in Corriedale rams. In this study, we evaluated the effect of seminal plasma collected by electroejaculation or artificial vagina on sperm resistance to cryodamage. Seminal plasma of five rams of the Corriedale breed collected by artificial vagina or electroejaculation was added before freezing to sperm cells collected by the two methods, and post-thaw quality parameters were evaluated. We found that seminal plasma has no effect on sperm resistance to cryodamage. However, we observed significantly higher percentages of sperm with intact and functional plasma membrane, intact acrosome and greater fertilizing potential after thawing in samples obtained by electroejaculation. This study demonstrates that sperm collected by electroejaculation are more resistant to damage caused by cryopreservation than those collected by artificial vagina.
Assuntos
Criopreservação/veterinária , Ejaculação/fisiologia , Estimulação Elétrica/métodos , Preservação do Sêmen/veterinária , Sêmen/fisiologia , Ovinos/fisiologia , Animais , MasculinoRESUMO
Linoleic acid (LA) is a polyunsaturated fatty acid present in high concentrations in bovine follicular fluid; when added to maturation culture media, it affects oocyte competence (depending on the type and concentration of LA used). To date, little is known about the effective level of incorporation of LA and there is apparently no information regarding its esterification into various lipid fractions of the oocyte and its effect on neutral lipid storage. Therefore, the objective was to assess the uptake and subcellular lipid distribution of LA by analyzing incorporation of radiolabeled LA into oocyte polar and neutral lipid classes. The effects of various concentrations of LA on the nuclear status and cytoplasmic lipid content of bovine oocytes matured in vitro was also analyzed, with particular emphasis on intermediate concentrations of LA. Neutral lipids stored in lipid droplets were quantified with a fluorescence approach. Linoleic acid at 9 and 43 µM did not affect the nuclear status of oocytes matured in vitro, and 100 µM LA inhibited germinal vesicle breakdown, resulting in a higher percentage of oocytes arrested at the germinal state (43.5 vs. 3.0 in controls; P < 0.05). Bovine oocytes actively incorporated LA from the maturation medium (83.4 pmol LA per 100 oocytes at 22 hours of incubation; P < 0.05) and metabolized it mainly into major lipid classes, e.g., triacylglycerols and phospholipids (61.1% and 29.3%, respectively). Supplementation of the maturation medium with LA increased triacylglycerol accumulation in cytoplasmic lipid droplets at all concentrations assayed (P < 0.05). In conclusion, LA added to a defined maturation medium at concentrations that did not alter the nuclear status of bovine oocytes matured in vitro (9 and 43 µM) improved their quality by increasing the content of neutral lipids stored in lipid droplets. By directing the free fatty acid (LA) to triacylglycerol synthesis pathways and increasing the degree of unsaturation of membrane phospholipids, the oocyte was protected from lipotoxic effects (with an expectation of improved cryotolerance).
Assuntos
Bovinos , Ácido Linoleico/administração & dosagem , Metabolismo dos Lipídeos/efeitos dos fármacos , Oócitos/crescimento & desenvolvimento , Oócitos/metabolismo , Animais , Radioisótopos de Carbono , Núcleo Celular/efeitos dos fármacos , Núcleo Celular/fisiologia , Células Cultivadas , Meios de Cultura , Citoplasma/química , Citoplasma/efeitos dos fármacos , Citoplasma/metabolismo , Relação Dose-Resposta a Droga , Ácidos Graxos não Esterificados/metabolismo , Feminino , Marcação por Isótopo , Ácido Linoleico/metabolismo , Lipídeos/análise , Oócitos/ultraestrutura , Triglicerídeos/metabolismoRESUMO
The aim of the present research was to develop a low cost and easy to perform vitrification method for in vitro-produced cattle embryos. Effect of container material was evaluated (plastic straw compared to glass capillary, experiment 1), two volume sample (1 compared to 0.5 microL, experiment 2) and warming solution composition medium (Tissue Culture Medium 199 (TCM-199) compared to phosphate buffered saline (PBS), experiment 3) as modifications of the open pulled straw (OPS) system in order to reduce embryo damage caused by exposure to cold. In all experiments, day 7 and expanded blastocysts of cattle were exposed to the vitrification solution 1 for 3 min and 30s in solution 2. After this, embryos were placed in a droplet and loaded in a narrow end container, and immediately submerged into liquid nitrogen. For warming, vitrified embryos were plunged into warming solution 1 for 3 min, and transferred into warming solution 2 for 1 min. Fresh embryos kept in culture were used as control group. Hatching rates were recorded in all cases at day 13. In experiment 1 there was no significant effect of container material on hatching rates. Postwarming survival rate of vitrified embryos was lower than control (27.5% plastic straws, 18.9% glass capillary and 80.5% control, P<0.05). In experiment 2, there was no significant effect of volume in hatching rates (58.3% 1 microL, 61.3% 0.5 microL and 80.5% control, P<0.05). In experiment 3, the composition of the holding medium of warming solution influenced hatching rates (84.1% TCM-199, 74.8% PBS and 91.1% control P<0.05). These data suggest that neither glass capillaries nor reduced sample volume could improve hatching rates after vitrification-warming with open pulled straw (OPS) procedure, and that PBS can replace TCM-199 in warming solutions, but lesser hatching rates should be expected.
Assuntos
Bovinos/embriologia , Criopreservação , Embrião de Mamíferos , Embalagem de Produtos , Soluções/farmacologia , Animais , Bovinos/fisiologia , Sobrevivência Celular/efeitos dos fármacos , Criopreservação/métodos , Criopreservação/veterinária , Crioprotetores/farmacologia , Meios de Cultura/farmacologia , Relação Dose-Resposta a Droga , Técnicas de Cultura Embrionária , Feminino , Fertilização in vitro/métodos , Fertilização in vitro/veterinária , Vidro , Temperatura Alta , Plásticos/farmacologia , Embalagem de Produtos/instrumentação , Embalagem de Produtos/métodosRESUMO
This study was conducted to investigate in early postpartum suckled beef cows with and without FSH pre-stimulation: (i) the influence of the postpartum period on the number and quality of oocytes recovered by ovum pick-up (OPU), (ii) the overall efficiency of the OPU/IVP embryos from days 30 to 80 postpartum and (iii) if repeated OPU negatively affect fertility following a fixed-time artificial insemination protocol. After parturition suckled Angus cows (n = 30) were divided in three groups (n = 10 group(-1)). All cows were anestrous at the commencement of experimental treatments (30.0 +/- 3.2 days postpartum, mean +/- SD; range 25-34 days). Group 1 treatments included: dominant follicle ablation (DFA), FSH treatment and OPU procedure 5 days after DFA. A total of 9 mg FSH (Ovagen) was administered s.c. once a day over 2 days at equal doses (4.5 + 4.5mg). For fertility test the cows received an intravaginal progesterone treatment from Days 78 to 86 postpartum and were fixed-time artificially inseminated (FTAI) at 56 and 72 h after device removal. Group 2: as cited for Group 1 with no FSH treatment. In both groups, OPU was repeated four times (Days 35, 49, 63 and 77 postpartum) and the collected oocytes classified as viable were in vitro matured, fertilized and presumptive embryos cultured for 8 days. Group 3 (Control FTAI): cows that had not previously aspirations were FTAI as Groups 1 and 2. Pregnancy was diagnosed by means ultrasonography 39 days after FTAI. The numbers (mean +/- SEM) of follicles visible and aspirated at the time of OPU in FSH-treated cows were greater (P < 0.05) than in non-treated cows (10.6 +/- 0.6 and 8.4 +/- 0.4 vs. 8.0 +/- 0.5 and 4.6 +/- 0.3, respectively). Following FSH treatment, the number (mean +/- SEM) of recovered oocytes per cow per OPU session and percentage of viable oocytes were greater in the treated (P < 0.05) than in non-treated animals (3.0 +/- 0.1 and 39.5% vs. 1.5 +/- 0.1 and 30.0%). The cleavage and embryo development rates were similar (P > 0.05) for both groups (14.8 and 6.4% vs. 16.6 and 5.5%). After FTAI the pregnancy rates were not different (P > 0.05) among groups (70, 60 and 90% for Groups 1, 2 and 3, respectively). We can conclude that (1) FSH-treated suckled postpartum cows can be a source of oocytes for in vitro fertilization and (2) repeated DFA/OPU applied during postpartum period did not affect the subsequent fertility following FTAI.
Assuntos
Desenvolvimento Embrionário/fisiologia , Fertilidade/fisiologia , Inseminação Artificial/veterinária , Recuperação de Oócitos/métodos , Indução da Ovulação/métodos , Período Pós-Parto , Animais , Biópsia por Agulha Fina , Bovinos , Feminino , Fertilidade/efeitos dos fármacos , Hormônio Foliculoestimulante/administração & dosagem , Hormônio Foliculoestimulante/farmacologia , Masculino , Folículo Ovariano/diagnóstico por imagem , Folículo Ovariano/patologia , Período Pós-Parto/fisiologia , Gravidez , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Vagina/diagnóstico por imagemRESUMO
To assess bladder function in systemic lupus erythematosus (SLE) patients with recurrent urinary tract infections (UTIs). A convenience sample of consecutive patients with SLE (American College of Rheumatology criteria), with recurrent UTIs (>/=3 events in the preceding 12 months), without history of central nervous system involvement, urolithiasis or preceding tuberculosis were studied. Disease activity (SLEDAI-2K), damage (SDI), lower urinary tract symptoms [Pelvic pain and Urgency/Frequency (PUF) and the Interstitial Cystitis Symptom and Problem Index (ICSPI) scales] and Autonomic Symptom Profile (ASP) were assessed. All patients underwent urological examination and urodynamic assessment with cystometry, uroflow, micturition and urethral pressure profile. Ten patients (nine women) were included. The majority of the patients reported urinary symptoms: urgency (n = 8), frequency (n = 8), nocturia (n = 9) and pain (n = 10). The patients had a mean (SD) ICSPI score of 18.4 (9.8), PUF score of 17.4 (5.3) and ASP weighted score of 31.7 (16.1). Abnormal urodynamics findings were identified in seven of the 10 patients, including small bladder capacity (two patients), reduced bladder sensation (four patients), subnormal urinary flow rate (one patient) and a significant amount of residual urine (two patients). The urodynamics findings suggest that bladder dysfunction could be one of the mechanisms involved on the occurrence of recurrent UTIs in patients with SLE. These findings have potential implications for the proper assessment and management of SLE patients with recurrent UTIs. Further studies are needed to corroborate our results.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Doenças da Bexiga Urinária/etiologia , Infecções Urinárias/etiologia , Transtornos Urinários/etiologia , Feminino , Humanos , Masculino , Recidiva , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/fisiopatologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/fisiopatologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia , Urina , UrodinâmicaRESUMO
BACKGROUND: The nasal vaccine candidate (NASVAC), comprising hepatitis B virus (HBV) surface (HBsAg) and core antigens (HBcAg), has been shown to be highly immunogenic in animal models. METHODS: A phase I double-blinded, placebo-controlled randomized clinical trial was carried out in 19 healthy male adults with no serologic markers of immunity/infection to HBV. This study was aimed at exploring the safety and immunogenic profile of nasal co-administration of both HBV recombinant antigens. The trial was performed according to Good Clinical Practice guidelines. Participants ranged in age from 18 to 45 years and were randomly allocated to receive a mixture of 50 microg HBsAg and 50 microg HBcAg or 0.9% physiologic saline solution, as a placebo, via nasal spray in a five-dose schedule at 0, 7, 15, 30, and 60 days. A total volume of 0.5 ml was administered in two dosages of 125 microl per nostril. Adverse events were actively recorded 1 h, 6 h, 12 h, 24 h, 48 h, 72 h, 7 days and 30 days after each dose. Anti-HBs and anti-HBc titers were evaluated using corresponding ELISA kits at days 30 and 90. RESULTS: The vaccine candidate was safe and well tolerated. Adverse reactions included sneezing (34.1%), rhinorrhea (12.2%), nasal stuffiness (9.8%), palate itching (9.8%), headache (9.8%), and general malaise (7.3%). These reactions were all self-limiting and mild in intensity. No severe or unexpected events were recorded during the trial. The vaccine elicited anti-HBc seroconversion in 100% of subjects as early as day 30 of the immunization schedule, while a seroprotective anti-HBs titer (>or=10 IU/l) was at a maximum at day 90 (75%). All subjects in the placebo group remained seronegative during the trial. CONCLUSION: The HBsAg-HBcAg vaccine candidate was safe, well tolerated and immunogenic in this phase I study in healthy adults. To our knowledge, this is the first demonstration of safety and immunogenicity for a nasal vaccine candidate comprising HBV antigens.
Assuntos
Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Vacinas contra Hepatite B/administração & dosagem , Vírus da Hepatite B/imunologia , Hepatite B/prevenção & controle , Administração Intranasal , Adolescente , Adulto , Método Duplo-Cego , Hepatite B/imunologia , Hepatite B/virologia , Anticorpos Anti-Hepatite B/imunologia , Antígenos do Núcleo do Vírus da Hepatite B/genética , Antígenos de Superfície da Hepatite B/genética , Vacinas contra Hepatite B/efeitos adversos , Vírus da Hepatite B/genética , Humanos , Imunidade nas Mucosas/imunologia , Masculino , Pessoa de Meia-Idade , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/efeitos adversos , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/efeitos adversosRESUMO
Cytotoxic proteins and prodigiosin obtained from Serratia marcescens strains are known to induce tumor cell death, nevertheless its combination has not been studied. In this paper we evaluate the combined effects of these molecules in a panel of tumor cell lines. The results showed a marked inhibitory effect on the growth of tumor cell lines derived from tumors (i.e., melanoma) which are highly resistant to conventional anticancer drugs, while normal cells were less sensitive than tumor cells. TUNEL (TdT-mediated dUTP nick end labeling) and electrophoresis of HEp-2 cell DNA treated with MG2327 preparation [containing the P50 protein belonging to the serralysins and prodigiosin, from S. marcescens CMIB4202] showed a pattern of DNA fragments typically associated with apoptosis. Interestingly, prodigiosin enhanced by 1.6-fold the cytotoxic effect of P50 when acting in combination on HEp-2 cells. The broad cytotoxic activity of the combination on tumor cells as well as its selectivity open new frontiers in cancer therapy.
Assuntos
Antibacterianos/farmacologia , Antineoplásicos/farmacologia , Proteínas de Bactérias/farmacologia , Neoplasias/tratamento farmacológico , Prodigiosina/farmacologia , Serratia marcescens/química , Antibacterianos/isolamento & purificação , Apoptose , Proteínas de Bactérias/isolamento & purificação , DNA de Neoplasias/análise , Quimioterapia Combinada , Eletroforese em Gel de Ágar , Humanos , Marcação In Situ das Extremidades Cortadas , Prodigiosina/isolamento & purificação , Células Tumorais CultivadasRESUMO
Among 23 pediatric patients who underwent orthotopic liver transplant (OLT), we report two (11 and 26 months old) with posttransplant lymphoproliferative disease (PTLD) that occurred in the early posttransplantation period. They were Epstein-Barr Virus (EBV)-negative and received graft from EBV-positive donors. The surveillance for EBV viremia using serial EBV polymerase chain reaction determinations in the peripheral blood was positive at 10 and 90 days after OLT concomitant with symptoms of primary infection, both patients were treated with gancyclovir. The patients should progression to a Burkitt's and a non-Hodgkin's lymphoma that appeared 3 months posttransplantation. They were treated by withdrawal of immunosuppression and six courses of cyclophosphamide as well as anti-CD20 monoclonal antibody (Rituximab) every 21 days. One patient experienced acute graft rejection, which resolved with steroids and low doses of tacrolimus, she is free of disease at 24 months after the end of treatment. The other patient relapsed with a cerebral lymphoma, receiving aggressive chemotherapy, but died due to sepsis. In conclusion, PTLD occurred among in 2/23 patients who underwent OLT and appeared in the first quarter post OLT. The risk factors associated with early PTLD were primary EBV infection after OLT, young age, and EBV-negative recipient receiving a transplant from an EBV-positive donor. Antiviral treatment alone was inefficient; withdrawal of immunosuppression and courses of Rituximab and cyclophosphamide were well tolerated and controlled PTLD. The risk of graft rejection was increased by withdrawal of immunosuppression. One patient died.
Assuntos
Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/epidemiologia , Atresia Biliar/cirurgia , Linfoma de Burkitt/diagnóstico , Pré-Escolar , Progressão da Doença , Infecções por Vírus Epstein-Barr/diagnóstico , Evolução Fatal , Feminino , Humanos , Lactente , Linfoma/diagnóstico , Período Pós-Operatório , Resultado do TratamentoRESUMO
AIMS: Gluten ingestion in coeliac disease is associated with alterations of the intestinal mucosa, especially the expansion of the lamina propria. Antiendomysium and antireticulin antibodies may result from interactions between gliadin and extracellular matrix components. By behaving as autoantigens, connective tissue proteins could initiate mucosal damage. This study evaluates changes in the distribution of laminin, type IV collagen, and fibronectin in the mucosa of patients with coeliac disease in an attempt to explain the alterations of mucosal morphology. METHODS: Intestinal biopsies were obtained from patients with coeliac disease on admission and while on a gluten free diet. The distribution of type IV collagen, laminin, fibronectin, and alpha-smooth muscle actin was evaluated by immunofluorescence and by immunogold labelling and electron microscopy. RESULTS: In patients with coeliac disease, the intensity of type IV collagen, laminin, and fibronectin immunofluorescent staining was decreased and less well defined than in controls, with frequent breaches in the basement membrane; fibronectin staining was weak in the distal third of the elongated crypts and absent under the flat surface. The distribution of smooth muscle fibre in the distal lamina propria of flat mucosae was altered. The distribution of these proteins was normal as assessed by immunoelectron microscopy. CONCLUSIONS: The intensity of staining of some components of the basement membrane is decreased in coeliac disease and the distribution of smooth muscle fibres is altered. These changes may result from interactions between gliadin and components of the extracellular matrix and may play a role in the genesis of mucosal lesions and in the damage to the epithelium.
Assuntos
Doença Celíaca/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Mucosa Intestinal/metabolismo , Membrana Basal/metabolismo , Doença Celíaca/dietoterapia , Doença Celíaca/patologia , Colágeno Tipo IV/metabolismo , Fibronectinas/metabolismo , Técnica Indireta de Fluorescência para Anticorpo , Glutens/administração & dosagem , Humanos , Laminina/metabolismo , Microscopia ImunoeletrônicaRESUMO
BACKGROUND: Follow-up of celiac patients in Chile is often interrupted when adolescents are referred to adult gastroenterologists. AIM: To study the evolution of patients with celiac disease when they reach adolescence or young adulthood. PATIENTS AND METHODS: Current adherence to gluten-free diet and its relation to symptoms and circulating antiendomysial antibodies were evaluated in the 58 confirmed celiac patients older than 12 years of age controlled at 3 hospitals in Santiago. RESULTS: Mean age at the moment of this assessment was 17.8 +/- 5 years, 65.5% were women, 12.5% were at nutritional risk (-IDS) while 20% were overweight/obese. Although all patients declared themselves asymptomatic, a focused questionnaire revealed that 26% suffered some symptoms. Only 24.1% followed a strict gluten-free diet. Eight of 20 patients who ate gluten-containing diets had negative antiendomysial antibodies (EMA), three of whom turned positive within 6 to 9 months. In three of four (asymptomatic) cases that accepted a new jejunal biopsy, histology was abnormal. One patient who followed a strict diet had EMA (+) and normal histology. CONCLUSIONS: These results confirm that after childhood, symptoms abate significantly in celiac patients. The observed sensitivity and specificity of EMA makes necessary to maintain small intestinal biopsies as the gold standard for diagnosis and confirmation of the disease.
Assuntos
Doença Celíaca/diagnóstico , Gastroenterologia , Adolescente , Adulto , Atitude Frente a Saúde , Autoanticorpos/análise , Estatura , Índice de Massa Corporal , Peso Corporal , Doença Celíaca/imunologia , Doença Celíaca/patologia , Chile , Dieta , Feminino , Seguimentos , Humanos , Masculino , Sensibilidade e EspecificidadeRESUMO
Diazepam, chlordiazepoxide, and midazolam are determined by high-perfromance, thin-layer chromatography (HPTLC). Results are compared with those obtained by liquid chromatography (LC) and gas chromatography (GC). Analytical conditions for all the methods are also described. Validation parameters for linearity, precision, detection, and quantitative limits are informed. Correlation study of HPTLC with LC and GC gave a correlation factor between 0.98 and 0.99. The obtained results showed that HPTLC, LC, and GC techniques are comparable for determination of such benzodiazepins in the requested working range to be analyzed in raw materials.
Assuntos
Benzodiazepinas/análise , Cromatografia Gasosa , Cromatografia Líquida , Cromatografia em Camada FinaRESUMO
BACKGROUND: Although clinical manifestations of celiac disease may change throughout life, clinical, histologic, immunologic, and genetic studies show that there are incomplete forms of this condition, making it difficult to define the disease at a given moment. Because there is no information published in the Latin American-Amerindian population, this study was conducted to assess relations between these parameters in Chileans with celiac disease and their first-degree relatives. METHODS: Sixty-two persons with confirmed celiac disease (mean age, 17.9 +/- 5.1 years; 78.3% females) and 126 relatives (mean age, 27.9 +/- 17.2 years; 65.1% females) were evaluated. Clinical manifestations, antiendomysial antibodies (EMAs), and human leukocyte antigen (HLA) haplotypes were studied in patients. Additionally, jejunal biopsy specimens were assessed (light microscopy) in EMA-positive (EMA+) relatives. RESULTS: Of the patients, 24.1% adhered to a strict gluten-free diet; 26% were oligosymptomatic, and none were malnourished; 45% were EMA+; 13.8% who ingested gluten were EMA-negative (EMA-); one patient consuming a strict gluten-free diet was EMA+. The DQA1*0501 allele was present in the highest frequency (48%, P < 0.0005), whereas combinations of DQ8 were predominant. Of the relatives, 4.8% were EMA+; they had a significantly higher frequency of diarrhea, weight loss, and anorexia (P < 0.03); and all had abnormal histology in biopsy specimens. CONCLUSIONS: After childhood, celiac disease is oligosymptomatic and is often unrecognized by patients. Disease in 13.8% of patients and in 4.8% relatives appeared as incomplete forms of celiac disease. Predominance of DQ8 HLA haplotypes reflects the genetic Spanish-Mapuche heritage of this population.