RESUMO
OBJECTIVE: To evaluate hepatic drug metabolism, as determined by the formation of monoethylglycinexylidide (MEGX) after lidocaine injection and indocyanine green (ICG) clearance, in patients with sickle cell disease. STUDY DESIGN: A case-control study including 19 patients with homozygous hemoglobin S, and 13 age- and sex-matched black control subjects. Serum MEGX concentration was measured after intravenous injection of 1 mg/kg (maximum 50 mg) lidocaine. ICG (0.5 mg/kg) was injected concomitantly and absorbance (805 nm) of serum was measured over time to determine its volume of distribution, serum half-life, and hepatic blood flow. RESULTS: MEGX formation at 15 minutes was decreased in patients with sickle cell disease compared with formation in the control subjects (39.9 +/- 18.0 vs 65.6 +/- 50.0 micrograms/L, respectively, p < 0.02). The volume of distribution of ICG was increased in patients with sickle cell disease compared with that in the control subjects (0.21 +/- 0.09 vs 0.11 +/- 0.03 L/kg, p < 0.01). This partly accounts for the decreased MEGX formation. The ICG half-life was similar in both groups (3.8 +/- 1.5 vs 3.1 +/- 1.0 min). Hepatic blood flow, derived from ICG clearance, was increased in sickle cell patients compared with that of the control subjects (12.2 +/- 4.5 vs 8.1 +/- 2.1 ml/kg/min, p < 0.01). CONCLUSION: Hepatic drug metabolism, as assessed by MEGX formation after lidocaine injection, is impaired in patients with sickle cell disease. This impairment may have clinical implications when using hepatically metabolized medications in patients with sickle cell disease.
Assuntos
Anemia Falciforme/metabolismo , Lidocaína , Fígado/metabolismo , Adulto , Anemia Falciforme/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Corantes , Técnica de Diluição de Corante , Feminino , Meia-Vida , Homozigoto , Humanos , Verde de Indocianina , Lactente , Lidocaína/análogos & derivados , Lidocaína/metabolismo , Lidocaína/farmacocinética , Fígado/fisiopatologia , Circulação Hepática , Testes de Função Hepática , Masculino , Fatores de TempoRESUMO
A DNA probe (Gen-Probe PACE 2) detects portions of viable and nonviable organisms, and test results could remain positive after effective treatment of genital Neisseria gonorrhoeae infection. Twenty patients underwent test-of-cure studies 6 to 11 days after standard treatment for gonorrhea; in each case the DNA probe finding was negative. The Gen-Probe PACE 2 probe is reliable for test-of-cure study as early as 6 days after treatment.
Assuntos
Sondas de DNA , Gonorreia/diagnóstico , Adolescente , Adulto , Técnicas Bacteriológicas , Ceftriaxona/uso terapêutico , DNA Bacteriano/análise , Estudos de Avaliação como Assunto , Feminino , Gonorreia/tratamento farmacológico , Humanos , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
Continuous nasojejunal and intermittent nasogastric feedings were compared in a controlled prospective study in 21 low-birth-weight infants. The groups were comparable in regard to period of gestation, birth weight, head circumference, and clinical findings. Cumulative weight gain, caloric and fluid intake, percent weight lost, blood chemistry values, and complications were used in evaluating the two groups. Upon completion of the 21-day study, N/J infants were found to have had statistically better weight gain, caloric intake, and fluid intake (p = 0.05-0.001) during the early part of the study. Weight loss was less in the N/J group (p less than 0.01). Neither group had abnormalities of blood chemistry or significant complications. It is concluded that N/J feeding in the low-birth-weight neonate is a safe, effective means of early nutritional intake, with advantages most pronounced during the first two weeks of life.
Assuntos
Nutrição Enteral/métodos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro , Jejuno , Bactérias/isolamento & purificação , Peso ao Nascer , Análise Química do Sangue , Cefalometria , Permeabilidade do Canal Arterial/complicações , Nutrição Enteral/instrumentação , Enterocolite Pseudomembranosa/complicações , Fezes/análise , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/complicações , Intubação Gastrointestinal/métodos , Mucosa Nasal/microbiologia , Sangue Oculto , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/complicaçõesRESUMO
The enteric flora of a group of antibiotic-treated patients and two groups of non-antibiotic-treated individuals were studied for antibiotic resistance patterns and presence of transferable R-factors. The former group consisted of 100 hospitalised patients, the latter two groups consisted of 200 hospitalised patients and 200 individuals from rural communities in Jamaica. The occurrence of multiple-resistant organisms with transferable R-factors was significantly higher in the antibiotic-treated group. R-factors were also more common in the hospitalised, non-treated group than in the non-hospitalised, non-treated group. Follow-up studies on hospitalised patients showed a tendency to increased occurrence of R-factors with duration of hospitalisation, whether the patients were treated with antibiotics or not. These studies have shown that both antibiotic treatment and hospitalisation promote the occurrence of R-factors.