RESUMO
Cardiac damage is a frequent manifestation of Chagas disease, which is caused by the parasite Trypanosoma cruzi. Selenium (Se) is an essential micronutrient, the deficiency of which has been implicated in the development of cardiomyopathy. Our group has previously demonstrated that Se supplementation prevents myocardial damage during acute T. cruzi infection in mice. In this study, we analyzed the effect of Se treatment in cases of T. cruzi infection using prevention and reversion schemes. In the Se prevention scheme, mice were given Se supplements (2 ppm) starting two weeks prior to inoculation with T. cruzi(Brazil strain) and continuing until 120 days post-infection (dpi). In the Se reversion scheme, mice were treated with Se (4 ppm) for 100 days, starting at 160 dpi. Dilatation of the right ventricle was observed in the infected control group at both phases of T. cruzi infection, but it was not observed in the infected group that received Se treatment. Surviving infected mice that were submitted to the Se reversion scheme presented normal P wave values and reduced inflammation of the pericardium. These data indicate that Se treatment prevents right ventricular chamber increase and thus can be proposed as an adjuvant therapy for cardiac alterations already established by T. cruzi infection.
Assuntos
Doença de Chagas/tratamento farmacológico , Suplementos Nutricionais , Ventrículos do Coração/patologia , Selênio/uso terapêutico , Doença Aguda , Animais , Cardiomiopatia Chagásica/prevenção & controle , Doença de Chagas/patologia , Doença Crônica , Dilatação Patológica/prevenção & controle , Imageamento por Ressonância Magnética/métodos , Masculino , Camundongos , Selênio/administração & dosagemRESUMO
PURPOSE: To analyze outcomes of laser in situ keratomileusis (LASIK) performed on the flap and on the stromal bed at the same time in a primary treatment. SETTING: Instituto de la Visión, Buenos Aires, Argentina. METHODS: Twenty-two cases (13 female, 9 male) were studied retrospectively; the mean age of the patients was 33.15 years +/- 10.44 (SD). Inclusion criteria were low pachymetry or topographic asymmetry. Twenty cases (90.9%) presented with low pachymetry (512.2 +/- 21.40 mum), and 2 cases (9.1%) presented with topographic asymmetry (inferior-superior difference more than 1.5 diopters [D]). Ablation was performed on the flap from the back and on the bed. The flap was made using the Technolas Hansatome microkeratome and the ablation by the Technolas 217z excimer laser (both by Bausch & Lomb). Preoperatively, the spherical equivalent (SE) was -5.61 +/- 1.72 D, the cylinder was -1.78 +/- 1.24 D, and the best spectacle-corrected visual acuity (BSCVA) was 0.77 +/- 0.19. Difficulties and complications of the technique, efficacy and safety index, and aberrations were analyzed. RESULTS: According to the surgical plan and our nomogram, diopters corrected on the flap were -1.73 +/- 1.08 and on the bed were -4.77 +/- 1.89. The mean follow-up was 8.28 +/- 2.19 months. At 6 months, the SE was -0.21 +/- 0.39, vectorial change was 1.69 +/- 0.74, and the BSCVA was 0.77 +/- 0.20. Postoperatively, no eye had an increase in refractive astigmatism. Uncorrected visual acuity was 20/40 or better in all cases (100%) and 20/25 or better in 13 cases (59.1%). Regarding gained and lost lines of BSCVA, 54.5% conserved the lines, 18.2% lost 1 line, 9.1% gained 1 line, and 18.2% gained 2 lines. CONCLUSIONS: Simultaneous ablation on the flap and on the bed in cases of low pachymetry or topographical asymmetry was predictable, effective, and safe.
Assuntos
Substância Própria/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Miopia/cirurgia , Retalhos Cirúrgicos , Adulto , Substância Própria/diagnóstico por imagem , Topografia da Córnea , Dilatação Patológica/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Nomogramas , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia , Acuidade Visual/fisiologiaRESUMO
Mechanical ventilation plays a central role in the critical care setting; but its use is closely related with some life threatening complications as nosocomial pneumonia and low cardiac performance. One of the most severe complications is called ventilator-associated lung injury (VALI) and it includes: Barotrauma, volutrauma, atelectrauma, biotrauma and oxygen-mediated toxic effects and it is related with an inflammatory response secondary to the stretching and recruitment process of alveoli within mechanical ventilation. The use of some protective ventilatory strategies has lowered the mortality rate 10% approximately.
Assuntos
Barotrauma/etiologia , Lesão Pulmonar , Respiração Artificial/efeitos adversos , Doença Aguda , Resistência das Vias Respiratórias , Animais , Barotrauma/prevenção & controle , Ensaios Clínicos como Assunto , Dilatação Patológica/etiologia , Dilatação Patológica/prevenção & controle , Elasticidade , Hemodinâmica/fisiologia , Humanos , Estresse Oxidativo , Oxigênio/efeitos adversos , Oxigenoterapia/efeitos adversos , Respiração com Pressão Positiva/efeitos adversos , Pressão/efeitos adversos , Alvéolos Pulmonares/fisiopatologia , Edema Pulmonar/etiologia , Edema Pulmonar/patologia , Edema Pulmonar/prevenção & controle , Ratos , Respiração Artificial/métodos , Estresse MecânicoRESUMO
Mechanical ventilation plays a central role In the critical care setting; but its use is closely related with some life threatening complications as nosocomial pneumonia and low cardiac performance. One of the most severe complications is called ventilator-associated lung injury (VALI) and it includes: Barotrauma, volutrauma, atelectrauma, biotrauma and oxygen-mediated toxic effects and it is related with an inflammatory response secondary to the stretching and recruitment process of alveoli within mechanical ventilation. The use of some protective ventilatory strategies has lowered the mortality rate 10% approximately.
La importancia de la asistencia mecánica ventilatoria (AMV) en la Unidad de Cuidados Intensivos (UCI) es indiscutible; sin embargo, su uso está ligado con complicaciones como neumonía nosocomial y deterioro del rendimiento cardiaco, que en algunas ocasiones ponen en peligro la vida del enfermo. Una de las complicaciones más graves es el daño pulmonar asociado a la ventilación mecánica (DPVM). El DPVM se caracteriza por la presencia de edema pulmonar rico en proteínas. Se recomienda establecer cierto número de estrategias de protección pulmonar (EPP) para prevenir este tipo de lesión. Una vez instituidas, las EPP han demostrado una disminución de la mortalidad de aproximadamente 10%.