RESUMO
The redox-mediating capacity of magnetic reduced graphene oxide nanosacks (MNS) to promote the reductive biodegradation of the halogenated pollutant, iopromide (IOP), was tested. Experiments were performed using glucose as electron donor in an upflow anaerobic sludge blanket (UASB) reactor under methanogenic conditions. Higher removal efficiency of IOP in the UASB reactor supplied with MNS as redox mediator was observed as compared with the control reactor lacking MNS. Results showed 82% of IOP removal efficiency under steady state conditions in the UASB reactor enriched with MNS, while the reactor control showed IOP removal efficiency of 51%. The precise microbial transformation pathway of IOP was elucidated by high-performance liquid chromatography coupled to mass spectroscopy (HPLC-MS) analysis. Biotransformation by-products with lower molecular weight than IOP molecule were identified in the reactor supplied with MNS, which were not detected in the reactor control, indicating the contribution of these magnetic nano-carbon composites in the redox conversion of this halogenated pollutant. Reductive reactions of IOP favored by MNS led to complete dehalogenation of the benzene ring and partial rupture of side chains of this pollutant, which is the first step towards its complete biodegradation. Possible reductive mechanisms that took place in the biodegradation of IOP were stated. Finally, the novel and successful application of magnetic graphene composites in a continuous bioreactor to enhance the microbial transformation of IOP was demonstrated.
Assuntos
Bactérias/metabolismo , Meios de Contraste/metabolismo , Iohexol/análogos & derivados , Magnetismo/métodos , Nanocompostos/química , Anaerobiose , Biodegradação Ambiental , Reatores Biológicos/microbiologia , Biotransformação , Meios de Contraste/química , Iohexol/química , Iohexol/metabolismo , Magnetismo/instrumentação , Oxirredução , Esgotos/química , Esgotos/microbiologiaRESUMO
OBJECTIVE: To investigate the relative associations of renal function, obesity, and inflammation with serum leptin levels in children with chronic kidney disease (CKD). STUDY DESIGN: This was a cross-sectional analysis of 317 children from the Chronic Kidney Disease in Children study, a large cohort of pediatric patients with stage II-IV CKD. Linear regression modeling was used to evaluate the association of serum leptin level with glomerular filtration rate calculated using the plasma iohexol disappearance curve, demographics, body mass index (BMI), and cardiovascular risk factors, including inflammatory cytokines, insulin resistance, and serum lipid levels. RESULTS: In univariate analyses, elevated serum leptin level was significantly associated with increased BMI, older age, and female sex (P < .001 for all). Leptin level also correlated positively with serum triglycerides and insulin resistance (P < .001) and negatively with serum high-density lipoprotein cholesterol (P = .002). Leptin level was not associated with glomerular filtration rate calculated using the plasma iohexol disappearance curve or inflammatory cytokines. In multivariate analysis, BMI, age, female sex, and serum triglyceride levels were significantly associated with serum leptin level. CONCLUSION: Increased leptin production was associated with female sex, older age, and adiposity in children with mild to moderate CKD. Renal function was not associated with serum leptin level, indicating that decreased clearance does not contribute to elevated leptin levels.
Assuntos
Leptina/sangue , Insuficiência Renal Crônica/sangue , Adolescente , Índice de Massa Corporal , Criança , HDL-Colesterol/sangue , Estudos de Coortes , Meios de Contraste/química , Estudos Transversais , Citocinas/sangue , Dislipidemias/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Insulina/sangue , Resistência à Insulina , Iohexol/química , Modelos Lineares , Masculino , Análise Multivariada , Fatores de Risco , Triglicerídeos/sangueRESUMO
INTRODUCTION: Contrast media can cause acute renal failure by direct toxic effects on the tubular cells and kidney ischemia. Diabetics and hospitalized patients have a greater risk of developing contrast-induced nephropathy than the general population. OBJECTIVE: The cost effectiveness of iso and low-osmolality contrast media was assessed in high risk outpatients. MATERIALS AND METHODS: The analysis was based on a systematic literature review comparing the nephrotoxic effects of iso- to low-osmolality contrast media. Only direct costs were considered; these were obtained from the official tariff manual. Incremental cost-effectiveness ratios, efficiency curves and acceptability curves were calculated. Univariate sensitivity analyses were performed for costs and effects, as well as probabilistic analyses. Zero and 3% discounts were applied to results. The cost-effectiveness threshold was equal to the per capita GDP per life-year gained. RESULTS: Alternatives with Iopamidol and Iodixanol are preferable to the others, because both reduce risk of contrast-induced nephropathy and are less costly. The incremental cost-effectiveness of the Iodixanol alternative compared to the Iopamidol alternative is US$ 14,660 per additional life year gained; this is more than twice the threshold. CONCLUSION: The low-osmolality contrast medium, Iopamidol, appears to be cost-effective when compared with Iohexol or other low-osmolality contrast media (Iopromide, Iobitridol, Iomeprol, Iopentol and Ioxilan) in contrast-induced nephropathy, high-risk outpatients. The choice of the iso-osmolality contrast medium, Iodixanol, depends on its cost per vial and on the willingness to pay.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/economia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/terapia , Idoso , Colômbia/epidemiologia , Meios de Contraste/efeitos adversos , Meios de Contraste/química , Análise Custo-Benefício , Árvores de Decisões , Custos de Medicamentos/estatística & dados numéricos , Feminino , Gastos em Saúde , Hospitalização/economia , Humanos , Reembolso de Seguro de Saúde/economia , Iohexol/efeitos adversos , Iohexol/análogos & derivados , Iohexol/química , Iohexol/economia , Iopamidol/efeitos adversos , Iopamidol/química , Iopamidol/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Concentração Osmolar , Pacientes Ambulatoriais , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Risco , Ácidos Tri-Iodobenzoicos/efeitos adversos , Ácidos Tri-Iodobenzoicos/química , Ácidos Tri-Iodobenzoicos/economiaRESUMO
Introduction. Contrast media can cause acute renal failure by direct toxic effects on the tubular cells and kidney ischemia. Diabetics and hospitalized patients have a greater risk of developing contrast-induced nephropathy than the general population. Objective. The cost effectiveness of iso and low-osmolality contrast media was assessed in high risk outpatients. Materials and methods. The analysis was based on a systematic literature review comparing the nephrotoxic effects of iso- to low-osmolality contrast media. Only direct costs were considered; these were obtained from the official tariff manual. Incremental cost-effectiveness ratios, efficiency curves and acceptability curves were calculated. Univariate sensitivity analyses were performed for costs and effects, as well as probabilistic analyses. Zero and 3% discounts were applied to results. The cost-effectiveness threshold was equal to the per capita GDP per life-year gained. Results. Alternatives with Iopamidol and Iodixanol are preferable to the others, because both reduce risk of contrast-induced nephropathy and are less costly. The incremental cost-effectiveness of the Iodixanol alternative compared to the Iopamidol alternative is US$ 14,660 per additional life year gained; this is more than twice the threshold. Conclusion. The low-osmolality contrast medium, Iopamidol, appears to be cost-effective when compared with Iohexol or other low-osmolality contrast media (Iopromide, Iobitridol, Iomeprol, Iopentol and Ioxilan) in contrast-induced nephropathy, high-risk outpatients. The choice of the iso-osmolality contrast medium, Iodixanol, depends on its cost per vial and on the willingness to pay.
Introducción. Los medios de contraste pueden provocar falla renal aguda por toxicidad directa sobre las células tubulares e isquemia medular renal. Los pacientes diabéticos y los hospitalizados presentan mayor riesgo de desarrollar nefropatía inducida por medios de contraste que la población general. Objetivo. Establecer el costo-efectividad de los medios de contraste isosmolales e hiposmolales en pacientes con alto riesgo. Materiales and métodos. El análisis se basó en una revisión sistemática de la literatura científica, comparando los efectos nefrotóxicos de los medios isosmolales e hipoosmolales. Se consideraron sólo los costos directos, obtenidos del manual tarifario. Se calcularon las tasas del incremento del costo-efectividad, las curvas de eficiencia y de aceptabilidad. Se hicieron análisis univariados de sensibilidad para costos y efectos, así como probabilísticos. Se aplicaron tasas de descuento de 0 y 3 % a los resultados. Se usó como umbral de costo-efectividad por año de vida ganado, el producto interno bruto per cápita. Resultados. Las alternativas con Iopamidol y Iodixanol dominan a las demás porque reducen el riesgo de nefropatía inducida por contraste a un menor costo. La razón del incremento del costo-efectividad del iodixanol comparado con el iopamidol es de US$ 14.660 por año de vida ganado que más que duplica el umbral. Conclusión. El medio de baja osmolalidad, iopamidol, parece ser costo-efectivo comparado con iohexol u otros medios hiposmolares (iopromide, iobitridol, iomeprol, iopentol y ioxilan), en pacientes con alto riesgo de nefropatía inducida por contraste. La elección del medio hiposmolar, depende de la disponibilidad a pagar o del costo por ampolleta.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/economia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/terapia , Análise Custo-Benefício , Colômbia/epidemiologia , Meios de Contraste/efeitos adversos , Meios de Contraste/química , Árvores de Decisões , Custos de Medicamentos/estatística & dados numéricos , Gastos em Saúde , Hospitalização/economia , Reembolso de Seguro de Saúde/economia , Iohexol/efeitos adversos , Iohexol/análogos & derivados , Iohexol/química , Iohexol/economia , Iopamidol/efeitos adversos , Iopamidol/química , Iopamidol/economia , Tempo de Internação/economia , Programas Nacionais de Saúde/economia , Concentração Osmolar , Pacientes Ambulatoriais , Risco , Diálise Renal/economia , Diálise Renal , Ácidos Tri-Iodobenzoicos/efeitos adversos , Ácidos Tri-Iodobenzoicos/química , Ácidos Tri-Iodobenzoicos/economiaRESUMO
OBJECTIVE: To evaluate the effects of iodine contrast media and gadoteric acid in acute necrotizing pancreatitis. METHODS: Fifty rabbits were distributed in 5 groups: 10 rabbits were assigned in the control group (group 5) and 40 rabbits were assigned in the pancreatitis group, wherein acute necrotizing pancreatitis was induced through retrograde injection of 5% sodium taurocholate (1 mL/kg weight) in the main pancreatic duct. After 3 hours, they were randomized to receive endovenous iodinized nonionic contrast medium (group 1), iodinized ionic contrast medium (group 2), gadoteric acid (group 3), and physiological serum at 0.9% (group 4). Six hours after induction of pancreatitis, these animals were reoperated. During surgery, pancreatic tissue flow through laser Doppler, hematometric values, biochemistry, and histopathology analysis by hematoxylin and eosin were done. Statistical analysis using Kruskal-Wallis, Fisher-Freeman-Halton, and parametric t tests was performed. RESULTS: There was statistical significance when comparing tissue flow before and after induction of pancreatitis (P < 0.0001). Ionic and nonionic contrast media and gadoteric acid did not increase the grade of pancreatic necrosis (P > 0.05). CONCLUSIONS: Ionic and nonionic contrast media and gadoteric acid did not produce adverse effects in the present model of acute necrotizing pancreatitis.