RESUMO
In this article the authors describe a clinical case of acute rheumatic fever (according to revised Jones criteria, American Heart Association [AHA], 1992) with cardiac tamponade, emphasizing this uncommon presentation. An adolescent patient with a clinical picture of cardiac tamponade was seen in the emergency department. Clinical progression and tests demonstrated rheumatic carditis with an initial manifestation of pericarditis with cardiac tamponade. This report aims to warn physicians about the diagnosis of rheumatic carditis in an unusual clinical presentation, in cases of cardiac tamponade, particularly in school-aged children and adolescents in countries with a high prevalence of rheumatic fever. The literature contains only two documented cases of cardiac tamponade related to acute rheumatic fever, and this case represents a third.
Assuntos
Tamponamento Cardíaco/etiologia , Febre Reumática/complicações , Cardiopatia Reumática/complicações , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Captopril/uso terapêutico , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/tratamento farmacológico , Criança , Progressão da Doença , Diuréticos/uso terapêutico , Feminino , Furosemida/uso terapêutico , Gentamicinas/uso terapêutico , Humanos , Oxacilina/uso terapêutico , Penicilina G Benzatina/uso terapêutico , Pericardiocentese , Prednisona/uso terapêutico , Inibidores da Síntese de Proteínas/uso terapêutico , Febre Reumática/diagnóstico , Febre Reumática/tratamento farmacológico , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/tratamento farmacológicoRESUMO
The function of gene products can be altered at many levels, including the mutation of gene sequence and the change in steady state levels of mRNA and/or protein by various mechanisms. The cumulative malfunction of specific gene products underlies many pathological conditions such as the multi-step and multi-cause acquisition of cancer. Here we discuss two oligonucleotide-based strategies in which these compounds target defective gene products acting either as antiprotein or anticode agents. The SELEX technique (systematic evolution of ligands by exponential enrichment) is an antiprotein approach in which nuclease-resistant DNA or RNA aptamers are selected by their ability to bind their protein targets with high affinity and specificity of the same range as antibodies. Such inhibitors were previously evolved against a great variety of targets, including receptors, growth factors and adhesion molecules implicated in the genesis of some kinds of cancer. Moreover, some results have already been obtained in animal models. The antigene technology interferes with earlier steps in the information flow leading from gene to protein. In this approach selective gene silencing is provided by the formation of stable and specific complexes between triplex forming molecules and their DNA targets. The feasibility of this strategy as well as a molecular mechanism for the action of antigene oligonucleotides has been demonstrated in cellular systems and in vivo. The use of oligonucleotide drugs (of either the antiprotein or the anticode type) as a viable approach to cancer therapy is limited by some common problems that will be discussed.
Assuntos
Sistemas de Liberação de Medicamentos/métodos , Neoplasias/tratamento farmacológico , Oligonucleotídeos/síntese química , Oligonucleotídeos/uso terapêutico , Inibidores da Síntese de Proteínas/síntese química , Inibidores da Síntese de Proteínas/uso terapêutico , Proteínas/antagonistas & inibidores , Animais , DNA de Neoplasias/efeitos dos fármacos , Código Genético/efeitos dos fármacos , Humanos , Neoplasias/metabolismo , Oligonucleotídeos/química , Biossíntese de Proteínas , RNA Neoplásico/efeitos dos fármacosRESUMO
In a recent report we have shown that a protein synthesis inhibitor, cycloheximide (CHX), is able to block the mossy fiber sprouting (MFS) that would otherwise be triggered by pilocarpine (Pilo)-induced status epilepticus (SE), and also gives relative protection against hippocampal neuronal death. Under this condition animals still showed spontaneous recurrent seizures (SRS) which led us to question the role played by sprouted mossy fibers in generating those seizures. In both patients and animal models of epilepsy the relative contribution of SE (when present) and/or SRS for the development of MFS is not known. In the present study we investigated the relationship between MFS, SE and SRS, and evaluated whether the CHX-induced blockade of MFS was transient or permanent in nature. We performed a chronic study which included animals subject to Pilo-induced SE in the presence of CHX and sacrificed between 8 and 10 months later, and animals that were subject to Pilo-induced SE in the presence of CHX and underwent a reinduction of SE with Pilo, 45 days after the first induction, but this time in the absence of CHX. Re-induction of SE or a long period of chronic seizures, were able to trigger supragranular MFS even in animals where the first (or only) SE event was triggered in the presence of CHX. MFS did not show any association with the frequency of SRS, and thus seemed to depend more critically on time. Our current findings allow us to suggest that MFS are neither the cause nor the consequence of SRS in the pilocarpine model.
Assuntos
Fibras Musgosas Hipocampais/fisiologia , Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia , Animais , Cicloeximida/uso terapêutico , Masculino , Fibras Musgosas Hipocampais/efeitos dos fármacos , Agonistas Muscarínicos , Pilocarpina , Inibidores da Síntese de Proteínas/uso terapêutico , Ratos , Ratos Wistar , Convulsões/induzido quimicamente , Estado Epiléptico/induzido quimicamente , Estado Epiléptico/tratamento farmacológicoRESUMO
A clinical trial was conducted in Argentina to determine the efficacy of clarithromycin plus lansoprazole for the treatment of Helicobacter pylori in duodenal ulcers and non-ulcer dyspepsia. PCR-RFLP was conducted on an 820-bp amplified product of the ureC gene of H. pylori to determine the genetic heterogeneity of 83 pretreatment and 21 post-treatment isolates. Twelve different restriction patterns were observed when digested with Sau 3A or Hha I, resulting in 40 different RFLP types. Comparison of isolates before treatment to after treatment showed that 20 of 20 patients had the same RFLP type. In addition, the presence of the cytotoxin-associated gene (cagA) and the vacuolating gene (vacA) were determined. All pretreatment isolates were positive for vacA whereas 75% of the pretreatment isolates were positive for cagA. The results of this study indicate that a high degree of heterogeneity exists among H. pylori and that infection is not limited to a small number of RFLP types.