RESUMO
En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)
In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Febre Amarela/diagnóstico , Dengue Grave/diagnóstico , Testes de Química Clínica , Hematologia , Bilirrubina/análise , Plaquetas , Hemoglobinas , Creatina/análiseRESUMO
Organ transplantation is the gold standard therapy for the majority of patients with terminal organ failure. However, it is still a limited treatment especially due to the low number of brain death (BD) donors in relation to the number of waiting list recipients. Strategies to increase the quantity and quality of donor organs have been studied, and the administration of exendin-4 (Ex-4) to the donor may be a promising approach. Male Wistar rats were randomized into 3 groups: (1) control, without central nervous system injury; (2) BD induced experimentally, and (3) BD induced experimentally + Ex-4 administered immediately after BD induction. After BD induction, animals were monitored for 6 h before blood collection and kidney biopsy. Kidney function was assessed by biochemical quantification of plasma kidney markers. Gene and protein expressions of inflammation- and stress-related genes were evaluated by RT-qPCR and immunoblot analysis. Animals treated with Ex-4 had lower creatinine and urea levels compared with controls. BD induced oxidative stress in kidney tissue through increased expression of Ucp2, Sod2 and Inos, and Ex-4 administration reduced the expression of these genes. Ex-4 also induced increased expression of the anti-apoptotic Bcl2 gene. Nlrp3 and Tnf expressions were up-regulated in the BD group compared with controls, but Ex-4 treatment had no effect on these genes. Our findings suggest that Ex-4 administration in BD rats reduces BD-induced kidney damage by decreasing the expression of oxidative stress genes and increasing the expression of Bcl2.
Assuntos
Exenatida/metabolismo , Exenatida/farmacologia , Rim/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Morte Encefálica , Creatina/análise , Citocinas/metabolismo , Modelos Animais de Doenças , Exenatida/fisiologia , Genes bcl-2/efeitos dos fármacos , Inflamação/metabolismo , Rim/metabolismo , Transplante de Rim , Masculino , Proteína 3 que Contém Domínio de Pirina da Família NLR/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Doadores de Tecidos , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Ureia/análiseRESUMO
OBJECTIVE: Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma. MATERIALS AND METHODS: Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens. RESULTS: There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%). CONCLUSION: This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.
Assuntos
Carcinoma/diagnóstico por imagem , Espectroscopia de Prótons por Ressonância Magnética/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Colina/análise , Creatina/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Adulto JovemRESUMO
ABSTRACT Objective: Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma. Materials and methods: Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens. Results: There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%). Conclusion: This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Espectroscopia de Prótons por Ressonância Magnética/métodos , Valores de Referência , Colina/análise , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Creatina/análiseRESUMO
Creatine (Cr) plays an important role in storage and transmission of phosphate-bound energy. Cerebral creatine deficiency syndromes comprise three inherited defects in Cr biosynthesis and transport. The aim of this study was to investigate whether Cr and Guanidinoacetate (GAA) can be detected in saliva of healthy subjects and to establish the relationship between salivary and plasma levels of these molecules. An adapted gas chromatography (GC) method is described for the quantification of Cr and GAA biomarkers in saliva. Reference values were established for GAA and Cr in saliva. These values were age dependent (p= 0.001). No difference between genders was observed. We detected a difference between GAA and Cr concentrations in saliva and in plasma. The GC method for simultaneous determination of GAA and Cr in human saliva is fast, reliable, sensitive, non-invasive and precise to use as a biochemical approach in early detection of cerebral creatine deficiency syndromes.
La creatina (Cr) juega un importante rol en el almacenamiento y el transporte de energía unida al fosfato. Los síndromes de deficiencia de creatina cerebral comprenden tres defectos genéticos en la biosíntesis y transporte de creatina. Es propósito de este estudio investigar si el guanidinoacetato (GAA) y la Cr pueden ser detectados en saliva de sujetos sanos e investigar la relación entre los valores de GAA y Cr en saliva con los niveles en plasma de estas moléculas. Se describe un método modificado de cromatografía gaseosa para la cuantificación de los biomarcadores, Cr y GAA en este biofluído. Se establecieron valores de referencia para GAA y Cr. Estos valores dependen de la edad (P=0.001). No se observaron diferencias entre género. Se detectó una diferencia entre la concentración de GAA y Cr en saliva con respecto al plasma. El método adaptado de cromatografía gaseosa para la determinación simultánea de GAA y Cr en saliva humana es fácil, seguro, sensible, no invasivo y preciso para utilizar como aproximación bioquímica en la detección temprana de los síndromes de deficiencia de creatina cerebral.
Assuntos
Creatina/análise , Creatina/metabolismo , Glicina/análogos & derivados , Saliva/química , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Glicina/análise , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto JovemRESUMO
OBJECTIVE: A long-lasting concern has prevailed for the identification of predictive biomarkers for high-grade gliomas (HGGs) using MRI. However, a consensus of which imaging parameters assemble a significant survival model is still missing in the literature; we investigated the significant positive or negative contribution of several MR biomarkers in this tumour prognosis. METHODS: A retrospective cohort of supratentorial HGGs [11 glioblastoma multiforme (GBM) and 17 anaplastic astrocytomas] included 28 patients (9 females and 19 males, respectively, with a mean age of 50.4 years, standard deviation: 16.28 years; range: 13-85 years). Oedema and viable tumour measurements were acquired using regions of interest in T1 weighted, T2 weighted, fluid-attenuated inversion recovery, apparent diffusion coefficient (ADC) and MR spectroscopy (MRS). We calculated Kaplan-Meier curves and obtained Cox's proportional hazards. RESULTS: During the follow-up period (3-98 months), 17 deaths were recorded. The median survival time was 1.73 years (range, 0.287-8.947 years). Only 3 out of 20 covariates (choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios and age) showed significance in explaining the variability in the survival hazards model; score test: χ2 (3) = 9.098, p = 0.028. CONCLUSION: MRS metabolites overcome volumetric parameters of peritumoral oedema and viable tumour, as well as tumour region ADC measurements. Specific MRS ratios (Cho/Naa, L-L/Cr) might be considered in a regular follow-up for these tumours. Advances in knowledge: Cho/Naa ratio is the strongest survival predictor with a log-hazard function of 2.672 in GBM. Low levels of lipids-lactate/Cr ratio represent up to a 41.6% reduction in the risk of death in GBM.
Assuntos
Biomarcadores/análise , Neoplasias Encefálicas/patologia , Glioma/patologia , Espectroscopia de Ressonância Magnética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Neoplasias Encefálicas/mortalidade , Colina/análise , Creatina/análise , Feminino , Glioma/mortalidade , Humanos , Ácido Láctico/análise , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Objective: To quantify salivary creatinine levels patients with end-stage renal disease (ESRD) before, during, and after hemodialysis sessions. Material and Methods: Sixty-eight individuals, aged between 4 and 25 years, were selected, and among these, 34 were diagnosed with ESRD and were undergoing hemodialysis (Group 1) and 34 were clinically healthy patients (Group 2). Saliva samples were collected before, during, and after hemodialysis sessions for Group 1 and compared with those of Group 2. Stimulated saliva flow rate (SSFR), buffer capacity (BC), pH, and salivary creatinine levels were determined. Shapiro-Wilk test, followed by the Friedman, Mann-Whitney and ANOVA tests were used to analyze the variables. Results: Mean SSFR values of Group 1 at the three stages of hemodialysis sessions did not differ from those of Group 2. Furthermore, BC and pH values were within their normal limits, and no difference was detected between the two groups. Mean salivary creatinine levels at baseline and during hemodialysis were significantly higher in Group 1 that in Group 2, but these values were not different between Groups at the end of hemodialysis. Conclusion: Salivary creatinine levels reduce significantly after hemodialysis sessions suggesting that saliva may be used to monitor the efficiency of hemodialysis or even indicate the moment at which it should start.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Creatina/análise , Diálise Renal/métodos , Insuficiência Renal Crônica/diagnóstico , Saliva/microbiologia , Análise de Variância , Rim , Estatísticas não ParamétricasRESUMO
Caffeine and creatine are ingredients in the most popular dietary supplements consumed by soccer players. However, some products may not contain the disclosed amounts of the ingredients listed on the label, compromising the safe usage and the effectiveness of these supplements. Therefore, the aim of this study was to evaluate the content of caffeine and creatine in dietary supplements consumed by Brazilian soccer players. The results obtained were compared with the caffeine content listed on the product label. Two batches of the supplement brands consumed by ≥ 50% of the players were considered for analysis. The quantification of caffeine and creatine in the supplements was determined by a high-performance liquid chromatography system with UV detector. Nine supplements of caffeine and 7 supplements of creatine met the inclusion criteria for analysis. Eight brands of caffeine and five brands of creatine showed significantly different values (p < .05) as compared with the values stated on the label. There were no significant differences between the two batches of supplements analyzed, except for one caffeine supplement. It can be concluded that caffeine and creatine dietary supplements consumed by Brazilian soccer players present inaccurate values listed on the label, although most presented no difference among batches. To ensure consumer safety and product efficacy, accurate information on caffeine and creatine content should be provided on all dietary supplement labels.
Assuntos
Cafeína/análise , Creatina/análise , Suplementos Nutricionais , Atletas , Brasil , Relação Dose-Resposta a Droga , Análise de Alimentos , Rotulagem de Alimentos , Humanos , FutebolRESUMO
PURPOSE: To evaluate the renal and hepatic function, through biochemical analysis after 14 days of creatine supplementation in physically inactive rats. METHODS: Twenty four male, adult, Wistar rats were used which were kept in individual metabolic cages and were distributed into four groups, and received the following treatments by gavage:1) CONTROL: distilled water; 2)Creatine 0.5g/Kg/day; 3) Creatine 1g/Kg/day; 4) Creatine 2g/Kg/day. Their urinary outputs as well as food and water intake were daily measured. At the end of the experiment, the animals were euthanized and serum samples were stored for biochemical analysis. RESULTS: Creatine supplementation at the doses given produced no significant changes in plasma levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, albumin, total cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol, triglycerides, glucose, creatinine, urea, and creatinine clearance, compared to control group (p> 0.05) Similarly, water and food intake, as well as urinary output, did not show significant changes among the four groups studied. CONCLUSION: At the doses used, oral creatine supplementation did not result in renal and/or hepatic toxicity.
Assuntos
Creatina/administração & dosagem , Creatina/toxicidade , Suplementos Nutricionais/toxicidade , Rim/efeitos dos fármacos , Fígado/efeitos dos fármacos , Alanina Transaminase/sangue , Albuminas/análise , Fosfatase Alcalina/sangue , Animais , Aspartato Aminotransferases/sangue , Glicemia/análise , Colesterol/sangue , Creatina/análise , Creatinina/sangue , Rim/metabolismo , Fígado/metabolismo , Masculino , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Fatores de Tempo , Triglicerídeos/sangue , Ureia/sangueRESUMO
PURPOSE: To evaluate the renal and hepatic function, through biochemical analysis after 14 days of creatine supplementation in physically inactive rats. METHODS: Twenty four male, adult, Wistar rats were used which were kept in individual metabolic cages and were distributed into four groups, and received the following treatments by gavage:1) Control: distilled water; 2)Creatine 0.5g/Kg/day; 3) Creatine 1g/Kg/day; 4) Creatine 2g/Kg/day. Their urinary outputs as well as food and water intake were daily measured. At the end of the experiment, the animals were euthanized and serum samples were stored for biochemical analysis. RESULTS: Creatine supplementation at the doses given produced no significant changes in plasma levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, albumin, total cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol, triglycerides, glucose, creatinine, urea, and creatinine clearance, compared to control group (p> 0.05) Similarly, water and food intake, as well as urinary output, did not show significant changes among the four groups studied. CONCLUSION: At the doses used, oral creatine supplementation did not result in renal and/or hepatic toxicity. .
Assuntos
Animais , Masculino , Creatina/administração & dosagem , Creatina/toxicidade , Suplementos Nutricionais/toxicidade , Rim/efeitos dos fármacos , Fígado/efeitos dos fármacos , Alanina Transaminase/sangue , Albuminas/análise , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Glicemia/análise , Colesterol/sangue , Creatina/análise , Creatinina/sangue , Rim/metabolismo , Fígado/metabolismo , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Fatores de Tempo , Triglicerídeos/sangue , Ureia/sangueRESUMO
OBJECTIVE: To analyze the agreement rate of proton magnetic spectroscopy with magnetic resonance image (MRI) and surface electroencephalography (EEG) in extratemporal neocortical epilepsies. METHODS: A cross-sectional study, type series of cases included 33 patients, age range 13-59 years old, of both gender, presenting structural alteration identified by MRI (75.8%) or by neurophysiologic techniques (72.7%). The variables were alterations of N-acetyl-aspartate/choline, N-acetyl-aspartate/creatine, choline/creatine, and N-acetyl-aspartate/cho-line+creatine coefficient of asymmetry. RESULTS: Agreement rates of lateralization by coefficient of asymmetry of NAA/Cho, NAA/Cr, Co/Cr, and NAA/Cho+Cr with MRI, independent of alteration of surface EEG, were equal to 93.3, 57.9, 15.4, and 93.3%, respectively, modifying to 100, 33.3, 0, and 100%, in 16 patients, with lateralization agreement of MRI and surface EEG. CONCLUSION: Proton magnetic spectroscopy agreed better with MRI to lateralization of epileptogenic zone than with surface EEG.
Assuntos
Eletroencefalografia/métodos , Epilepsias Parciais/patologia , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Adolescente , Adulto , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Química Encefálica , Colina/análise , Creatina/análise , Estudos Transversais , Epilepsias Parciais/fisiopatologia , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Objective To analyze the agreement rate of proton magnetic spectroscopy with magnetic resonance image (MRI) and surface electroence-phalography (EEG) in extratemporal neocortical epilepsies. Methods A cross-sectional study, type series of cases included 33 patients, age range 13–59 years old, of both gender, presenting structural alteration identified by MRI (75.8%) or by neurophysiologic techniques (72.7%). The variables were alterations of N-acetyl-aspartate/choline, N-acetyl-aspartate/creatine, choline/creatine, and N-acetyl-aspartate/cho-line+creatine coefficient of asymmetry. Results Agreement rates of lateralization by coefficient of asymmetry of NAA/Cho, NAA/Cr, Co/Cr, and NAA/Cho+Cr with MRI, independent of alteration of surface EEG, were equal to 93.3, 57.9, 15.4, and 93.3%, respectively, modifying to 100, 33.3, 0, and 100%, in 16 patients, with lateralization agreement of MRI and surface EEG. Conclusion Proton magnetic spectroscopy agreed better with MRI to lateralization of epileptogenic zone than with surface EEG. .
Objetivo Analisar a taxa de concordância da espectroscopia de prótons de hidrogênio com imagem de ressonância magnética (IRM) e o eletrencefalograma (EEG) de superfície nas epilepsias neocorticais extratemporais. Métodos Estudo transversal, série de casos, incluiu 33 pacientes, com idade de 13 a 59 anos, de ambos os gêneros, apresentando alteração estrutural à IRM (75,8%) ou neurofisiológica à (72,7%). As variáveis estudadas foram as alterações dos coeficientes de assimetria de N-acetil-aspartato/colina, N-acetil-aspartato/crea-tina, Colina/Creatina e N-acetil-aspartato/colina+creatina. Resultados As taxas de concordância de lateralização dos coeficientes de assimetria de NAA/Co, NAA/Cr, Co/Cr e NAA/Co+Cr com a IRM, independentemente de alterações do EGG de superfície, passaram de 93,3, 57,9, 15,4, 93,3%, respectivamente, para 100, 33,3, zero, 100%, em 16 pacientes, mostrando concordância de lateralização entre IRM e EEG de superfície. Conclusão A espectroscopia de prótons de hidrogênio concordou melhor com a lateralização da zona epileptogênica pela IRM do que com o EEG de superfície. .
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Eletroencefalografia/métodos , Epilepsias Parciais/patologia , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Ácido Aspártico/análise , Ácido Aspártico/análogos & derivados , Química Encefálica , Estudos Transversais , Colina/análise , Creatina/análise , Epilepsias Parciais/fisiopatologia , Lateralidade FuncionalRESUMO
Huntington's disease (HD) is a neurologic disorder that is not completely understood; its fundamental physiological mechanisms and chemical effects remain somewhat unclear. Among these uncertainties, we can highlight information about the concentrations of brain metabolites, which have been widely discussed. Concentration differences in affected, compared to healthy, individuals could lead to the development of useful tools for evaluating the progression of disease, or to the advance of investigations of different/alternative treatments. The aim of this study was to compare the thalamic concentration of metabolites in HD patients and healthy individuals using magnetic resonance spectroscopy. We used a 2.0-Tesla magnetic field, repetition time of 1500 ms, and echo time of 135 ms. Spectra from 40 adult HD patients and 26 control subjects were compared. Quantitative analysis was performed using the LCModel method. There were statistically significant differences between HD patients and controls in the concentrations of N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG; t-test, P<0.001), and glycerophosphocholine+phosphocholine (GPC+PCh; t-test, P=0.001) relative to creatine+phosphocreatine (Cr+PCr). The NAA+NAAG/Cr+PCr ratio was decreased by 9% and GPC+PCh/Cr+PCr increased by 17% in patients compared with controls. There were no correlations between the concentration ratios and clinical features. Although these results could be caused by T1 and T2 changes, rather than variations in metabolite concentrations given the short repetition time and long echo time values used, our findings point to thalamic dysfunction, corroborating prior evidence.
Assuntos
Doença de Huntington/metabolismo , Espectroscopia de Ressonância Magnética , Doenças Talâmicas/metabolismo , Tálamo/fisiopatologia , Adolescente , Adulto , Idoso , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Estudos de Casos e Controles , Creatina/análise , Deutério , Dipeptídeos/análise , Feminino , Glicerilfosforilcolina/análise , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Fosfocreatina/análise , Fosforilcolina/análise , Doenças Talâmicas/diagnóstico , Repetições de Trinucleotídeos , Adulto JovemRESUMO
Huntington's disease (HD) is a neurologic disorder that is not completely understood; its fundamental physiological mechanisms and chemical effects remain somewhat unclear. Among these uncertainties, we can highlight information about the concentrations of brain metabolites, which have been widely discussed. Concentration differences in affected, compared to healthy, individuals could lead to the development of useful tools for evaluating the progression of disease, or to the advance of investigations of different/alternative treatments. The aim of this study was to compare the thalamic concentration of metabolites in HD patients and healthy individuals using magnetic resonance spectroscopy. We used a 2.0-Tesla magnetic field, repetition time of 1500 ms, and echo time of 135 ms. Spectra from 40 adult HD patients and 26 control subjects were compared. Quantitative analysis was performed using the LCModel method. There were statistically significant differences between HD patients and controls in the concentrations of N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG; t-test, P<0.001), and glycerophosphocholine+phosphocholine (GPC+PCh; t-test, P=0.001) relative to creatine+phosphocreatine (Cr+PCr). The NAA+NAAG/Cr+PCr ratio was decreased by 9% and GPC+PCh/Cr+PCr increased by 17% in patients compared with controls. There were no correlations between the concentration ratios and clinical features. Although these results could be caused by T1 and T2 changes, rather than variations in metabolite concentrations given the short repetition time and long echo time values used, our findings point to thalamic dysfunction, corroborating prior evidence.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Doença de Huntington/metabolismo , Espectroscopia de Ressonância Magnética , Doenças Talâmicas/metabolismo , Tálamo/fisiopatologia , Ácido Aspártico/análise , Ácido Aspártico/análogos & derivados , Estudos de Casos e Controles , Creatina/análise , Deutério , Dipeptídeos/análise , Glicerilfosforilcolina/análise , Atividade Motora , Fosfocreatina/análise , Fosforilcolina/análise , Repetições de Trinucleotídeos , Doenças Talâmicas/diagnósticoRESUMO
PURPOSE: This study was designed to compare the efficacy of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) by Pseudomonas aeruginosa or Acinetobacter baumannii. METHODS: A prospective cohort study was performed. Patients >18 years of age with the diagnosis of VAP or VAT who received appropriate therapy for >48 h were analyzed. The primary outcome was 30-day mortality. Clinical covariates were assessed and compared between the groups. RESULTS: A total of 67 episodes were analyzed: 45 (67 %) treated with polymyxin B and 22 (33 %) with comparators. The crude 30-day mortality was 53 % (24 of 45) in the polymyxin B group and 27 % (6 of 22) in the comparator group (P = 0.08). Multivariable analysis using Cox regression models indicated that polymyxin B treatment was independently associated with increased mortality. CONCLUSIONS: Polymyxin B treatment in the currently recommended dosage may be inferior to other drugs in the treatment of VAP and VAT caused by organisms tested as susceptible in vitro to this agent.
Assuntos
Acinetobacter baumannii/efeitos dos fármacos , Bronquite/tratamento farmacológico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Polimixina B/uso terapêutico , Pseudomonas aeruginosa/efeitos dos fármacos , Traqueíte/tratamento farmacológico , APACHE , Infecções por Acinetobacter/tratamento farmacológico , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bronquite/microbiologia , Bronquite/mortalidade , Creatina/análise , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Avaliação de Medicamentos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/mortalidade , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/mortalidade , Polimixina B/administração & dosagem , Modelos de Riscos Proporcionais , Estudos Prospectivos , Infecções por Pseudomonas/tratamento farmacológico , Traqueíte/microbiologia , Traqueíte/mortalidade , Resultado do TratamentoRESUMO
There is a current lack of clarity regarding the use of Fourier-transform infrared spectroscopy (FT-IR) to evaluate intramuscular concentrations of creatine (Cr). Thus, the aim of this study was to assess the FT-IR spectral features of tibialis anterior muscle in rats submitted in conditions that were expected to perturb the Cr pool. First, an experiment was performed to ensure that FT-IR was able to detect the Cr intramuscular in sedentary and supplemented rats (Experiment 1). The effect of physical exercise on spectral muscle features was then examined, especially in relation to the spectroscopy markers (Experiment 2). Using pure Cr (control), it was possible to verify that only the peaks centered at 1308 and 1396 cm(-1) of all the spectra showed the same peak positions, indicating these FT-IR shifts as indirect markers of Cr intramuscular content. Experiment 2 revealed a higher Cr content for the Cr-supplemented and exercised animals than the rats of other groups. In conclusion, it was demonstrated that FT-IR spectroscopy using 1396 cm(-1) and mainly 1308 band was able to monitor Cr muscle content in rats sedentary, Cr-supplemented, and submitted to physical training. Besides, FT-IR could be a feasible method for the nondestructive assessment of Cr skeletal muscle content.
Assuntos
Creatina/análise , Músculo Esquelético/química , Condicionamento Físico Animal/fisiologia , Animais , Creatina/metabolismo , Masculino , Músculo Esquelético/metabolismo , Ratos , Ratos Wistar , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
Background: Heart failure (HF) is characterized, among other features, by the development of alterations in myocardial energy metabolism, involving a decrease in glucose utilization and increased free fatty acid uptake by cardiomyocytes, associated with decreased deposits of high-energy phosphates (creatine phosphate/ creatine transporter). Magnetic resonance (MR) imaging allows a direct and noninvasive assessment of myocardial metabolites. Aim: To measure myocardial creatine and lipids by MR spectroscopy among patients with HF. Material and Methods: Cardiac MR spectroscopy (1.5 Tesla) with Hydrogen antenna and single voxel acquisition was performed in fve patients with non-ischemic heart failure, aged 58 ± 9.7 years, (60 percent males) and 5 healthy volunteers matched for age and sex. We analyzed the signals of creatine (Cr), lipids (L) and water (W) in the interventricular septum, establishing the water/lipid (W/L) and water/creatine (W/Cr) index to normalize the values obtained. Results: Among patients, left ventricular ejection fraction was 32 ± 6.9 percent, 60 percent were in functional capacity II, 60 percent had hypertension and one was diabetic. Spectroscopic curves showed a depletion of total Cr, evidenced by the W/ Cr index, among patients with heart failure, when compared with healthy controls (1.46 ± 1.21 and 5.96 ± 2.25 respectively, p < 0,05). Differences in myocardial lipid content, measured as the W/L index, were not significant (5.06 ± 2.66 and 1.80 ± 1.62 respectively, p = 0.08). Conclusions: Among patients with heart failure of non-ischemic etiology, there is a depletion of creatine levels measured by MR spectroscopy.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Creatina/análise , Insuficiência Cardíaca/metabolismo , Lipídeos/análise , Espectroscopia de Ressonância Magnética , Miocárdio/química , Estudos de Casos e Controles , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Água/químicaRESUMO
BACKGROUND: Heart failure (HF) is characterized, among other features, by the development of alterations in myocardial energy metabolism, involving a decrease in glucose utilization and increased free fatty acid uptake by cardiomyocytes, associated with decreased deposits of high-energy phosphates (creatine phosphate/creatine transporter). Magnetic resonance (MR) imaging allows a direct and noninvasive assessment of myocardial metabolites. AIM: To measure myocardial creatine and lipids by MR spectroscopy among patients with HF. MATERIAL AND METHODS: Cardiac MR spectroscopy (1.5 Tesla) with Hydrogen antenna and single voxel acquisition was performed in five patients with non-ischemic heart failure, aged 58 ± 9.7 years, (60% males) and 5 healthy volunteers matched for age and sex. We analyzed the signals of creatine (Cr), lipids (L) and water (W) in the interventricular septum, establishing the water/lipid (W/L) and water/creatine (W/Cr) index to normalize the values obtained. RESULTS: Among patients, left ventricular ejection fraction was 32 ± 6.9%, 60% were in functional capacity II, 60% had hypertension and one was diabetic. Spectroscopic curves showed a depletion of total Cr, evidenced by the W/ Cr index, among patients with heart failure, when compared with healthy controls (1.46 ± 1.21 and 5.96 ± 2.25 respectively, p < 0,05). Differences in myocardial lipid content, measured as the W/L index, were not significant (5.06 ± 2.66 and 1.80 ± 1.62 respectively, p = 0.08). CONCLUSIONS: Among patients with heart failure of non-ischemic etiology, there is a depletion of creatine levels measured by MR spectroscopy.
Assuntos
Creatina/análise , Insuficiência Cardíaca/metabolismo , Lipídeos/análise , Espectroscopia de Ressonância Magnética , Miocárdio/química , Estudos de Casos e Controles , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Água/químicaRESUMO
Despite the implication of fronto-striatal circuits in attention-deficit/hyperactivity disorder (ADHD), there is a lack of information on the role of these regions, especially the thalamus, in the heterogeneity of ADHD. We assessed the (1)H-magnetic resonance spectroscopy profile in ventromedial prefrontal cortex (VMPFC)-thalamic-striatal regions bilaterally in three groups of subjects (age range 18-24 years old): ADHD inattentive type (ADHD-I; n = 9), ADHD combined type (ADHD-C; n = 10) and non-ADHD controls (n = 12). The peaks of N-acetylaspartate, Choline (Cho), myo-inositol (mI), creatine (Cr) and glutamate-glutamine-GABA (Glx) to Cr were calculated. Subjects with ADHD-C showed lower mI/Cr ratio in the right VMPFC than controls, higher Cho/Cr ratio in the left thalamus-pulvinar than the ADHD-I group and higher Glx/Cr ratio in left putamen than individuals with ADHD-I and controls. This metabolic profile suggests a disruption of fronto-striato-thalamic structures in the ADHD-C as a result of lower neuronal energetic metabolism.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Transtorno do Deficit de Atenção com Hiperatividade/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Prosencéfalo/diagnóstico por imagem , Prosencéfalo/metabolismo , Adolescente , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Ácido Aspártico/metabolismo , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Colina/análise , Colina/metabolismo , Corpo Estriado/diagnóstico por imagem , Corpo Estriado/metabolismo , Corpo Estriado/fisiopatologia , Creatina/análise , Creatina/metabolismo , Diagnóstico Diferencial , Metabolismo Energético/fisiologia , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/metabolismo , Lobo Frontal/fisiopatologia , Lateralidade Funcional/fisiologia , Ácido Glutâmico/análise , Ácido Glutâmico/metabolismo , Glutamina/análise , Glutamina/metabolismo , Humanos , Inositol/análise , Inositol/metabolismo , Masculino , Prosencéfalo/fisiopatologia , Pulvinar/diagnóstico por imagem , Pulvinar/metabolismo , Pulvinar/fisiopatologia , Putamen/diagnóstico por imagem , Putamen/metabolismo , Putamen/fisiopatologia , Cintilografia , Tálamo/diagnóstico por imagem , Tálamo/metabolismo , Tálamo/fisiopatologia , Adulto Jovem , Ácido gama-Aminobutírico/análise , Ácido gama-Aminobutírico/metabolismoRESUMO
OBJECTIVES: To determine the metabolite levels (myo-inositol [MI], choline [Cho], glutamate [Glx], creatine [Cr] and N-acetylaspartate [NAA]) visible on magnetic resonance spectroscopy in patients with chronic hepatic failure, before and after liver transplantation and to correlate these data with results of neuropsychiatric tests and clinical findings. METHODS: Twenty five patients with chronic hepatic failure from the Liver Transplantation Unit of the Federal University of Parana were prospectively studied. Patients were submitted to clinical evaluation and magnetic resonance spectroscopy. Thirty healthy volunteers also submitted to the same evaluations. Sixteen of the 25 patients were evaluated after liver transplantation. RESULTS: Before liver transplantation, significant reductions in MI/Cr and Cho/Cr and a significant increase in Glx/Cr were observed in patients with hepatic encephalopathy compared with healthy subjects. The Ross's criteria for spectroscopic diagnosis of the hepatic encephalopathy (MI/Cr and Cho/Cr lower than 2 SD of controls) demonstrated a sensitivity of 61.54%, specificity of 91.67% and accuracy of 76%, further Cho/Cr was the best parameter. Spectroscopy after liver transplantation showed changes in the metabolite ratios compared with the pretransplantation status. CONCLUSION: Magnetic resonance spectroscopy permits an accurate diagnosis of hepatic encephalopathy. Improvement of metabolic ratios after liver transplantation suggests an important role of MI and Cho in the development of hepatic encephalopathy.