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Background and Objectives: Hemodialysis patients (HD) and kidney transplant recipients (KTRs) have been heavily impacted by COVID-19, showing increased risk of infection, worse clinical outcomes, and higher mortality rates than the general population. Although mass vaccination remains the most successful measure in counteracting the pandemic, less evidence is available on vaccine effectiveness in immunodepressed subjects previously infected and recovered from COVID-19. Materials and Methods: This study aimed at investigating the ability to develop an adequate antibody response after vaccination in a 2-dose series against SARS-CoV-2 in HD patients and KTR that was administered after laboratory and clinical recovery from COVID-19. Results: Comparing SARS-CoV-2 S1/S2 IgG levels measured before and after 2 doses of mRNA vaccine (BNT162b2 vaccine, Comirnaty, Pfizer-BioNTech or mRNA-1273 vaccine, Spikevax, Moderna), highly significant increases of antibody titers were observed. The antibody peak level was reached at 3 months following second dose administration, regardless of the underlying cause of immune depression and the time of pre-vaccine serology assessment after negativization. Conclusions: Our data indicate that HD patients and KTR exhibit a satisfying antibody response to a 2-dose series of mRNA vaccine, even in cases when infection-induced humoral immunity was poor or rapidly fading. Further studies are needed to evaluate the role of booster doses in conferring effective and durable protection in weak patient categories.
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Vacuna nCoV-2019 mRNA-1273 , Vacuna BNT162 , COVID-19 , Trasplante de Riñón , Vacuna nCoV-2019 mRNA-1273/inmunología , Anticuerpos Antivirales , Formación de Anticuerpos , Vacuna BNT162/inmunología , COVID-19/inmunología , COVID-19/prevención & control , Humanos , Inmunoglobulina G , Diálisis Renal , SARS-CoV-2 , Vacunas de Productos InactivadosRESUMEN
The development of acute kidney injury (AKI) in polytrauma patients is a common and serious complication, with an incidence ranging from 6% to 50%. Polytrauma is a complex pathological condition that involves the collaboration of various specialists. On one hand, hemodynamic stabilization through fluid therapy and aminic support, with specific attack protocols, managed by anesthetists. On the other hand, if necessary, the initiation of renal replacement therapy such as Continuous Renal Replacement Therapy (CRRT), managed by nephrologists. CRRT is chosen both for managing fluid balance and ensuring the removal of toxic substances, as well as for proper control of electrolytes and acid-base balance.
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Lesión Renal Aguda , Traumatismo Múltiple , Grupo de Atención al Paciente , Lesión Renal Aguda/terapia , Lesión Renal Aguda/etiología , Humanos , Traumatismo Múltiple/terapia , Traumatismo Múltiple/complicaciones , Fluidoterapia , Terapia de Reemplazo Renal ContinuoRESUMEN
Cystic fibrosis is an autosomal recessive disorder caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The most recent therapeutic approach to cystic fibrosis aims to correct structural and functional abnormalities of CFTR protein. CFTR modulators including ivacaftor-tezacaftor-elexacaftor are used in patients with F508del mutation, with clinical improvement. To date, there are no experiences of CFTR modulator therapy in cystic fibrosis patients with organ transplantation and severe renal impairment. We report the case of a patient diagnosed with cystic fibrosis with F508del mutation, who underwent liver transplantation at the age of 19 and started hemodialysis at the age of 24 due to end-stage renal disease secondary to membranous glomerulonephritis. She was treated with Kaftrio (ivacaftor-tezacaftor-elexacaftor) with clinical benefits on appetite, improvement of body mass index, and reduction of pulmonary exacerbations. A reduction of dosage to 75% of the standard dose was required due to alterations of the liver function. Conclusions. Use of CFTR modulators in patient with cystic fibrosis, liver transplant and end-stage renal disease could be considered safe but a clinical and laboratoristic monitoring of hepatic function is needed.
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Aminofenoles , Fibrosis Quística , Fallo Renal Crónico , Trasplante de Hígado , Quinolonas , Femenino , Humanos , Fibrosis Quística/complicaciones , Fibrosis Quística/tratamiento farmacológico , Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/metabolismo , Regulador de Conductancia de Transmembrana de Fibrosis Quística/uso terapéutico , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/cirugía , Diálisis Renal , MutaciónRESUMEN
A hit-to-lead campaign pursuing the identification of novel inhalant small-molecule phosphatidylinositol 3-kinase (PI3K) inhibitors for the treatment of inflammatory respiratory diseases is disclosed. A synthetically versatile pyridazin-3(2H)-one scaffold was designed, and three exit vectors on the core moiety were used to explore chemical diversity and optimize pharmacological and absorption, distribution, metabolism, and excretion (ADME) properties. Desired modulation of PI3Kδ selectivity and cellular potency as well as ADME properties in view of administration by inhalation was achieved. Intratracheal administration of lead compound 26 resulted in a promising pharmacokinetic profile, thus demonstrating that the optimization strategy of in vitro profiles successfully translated to an in vivo setting.
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Fosfatidilinositol 3-Quinasa Clase I , Inhibidores de las Quinasa Fosfoinosítidos-3 , Piridazinas , Animales , Humanos , Inhibidores de las Quinasa Fosfoinosítidos-3/farmacología , Inhibidores de las Quinasa Fosfoinosítidos-3/química , Inhibidores de las Quinasa Fosfoinosítidos-3/farmacocinética , Inhibidores de las Quinasa Fosfoinosítidos-3/síntesis química , Administración por Inhalación , Piridazinas/química , Piridazinas/farmacología , Piridazinas/farmacocinética , Piridazinas/síntesis química , Fosfatidilinositol 3-Quinasa Clase I/antagonistas & inhibidores , Fosfatidilinositol 3-Quinasa Clase I/metabolismo , Relación Estructura-Actividad , Descubrimiento de Drogas , Ratas , Ratones , Masculino , Inhibidores de Proteínas Quinasas/farmacología , Inhibidores de Proteínas Quinasas/farmacocinética , Inhibidores de Proteínas Quinasas/química , Inhibidores de Proteínas Quinasas/administración & dosificaciónRESUMEN
Neurofurans are formed in vivo in the human brain as a consequence of an increased oxidative stress, and they could be valuable biomarkers of the neuronal oxidative stress. In this paper, an enantioselective stereodivergent approach to two key neurofuran precursors, belonging to the AC and ST classes, has been developed starting from a single achiral precursor, the meso-diol 11. The absolute configuration of the THF cores was secured by a Pd-catalyzed asymmetric allylic alkylation using (S,S)-L1 and (R,R)-L2 ligands, respectively.
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Compuestos Alílicos/química , Furanos/síntesis química , Paladio/química , Catálisis , Ciclización , Furanos/química , Estructura Molecular , EstereoisomerismoRESUMEN
The thiopeptide antibiotic baringolin has been synthesized, and its structure and stereochemistry have been confirmed. The use of a strategy based on palladium-catalyzed cross-couplings permitted a modular construction of this natural product.
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Antibacterianos/síntesis química , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Fragmentos de Péptidos/síntesis química , Péptidos Cíclicos/síntesis química , Piridinas/química , Infecciones Estafilocócicas/tratamiento farmacológico , Compuestos de Sulfhidrilo/síntesis química , Antibacterianos/farmacología , Pruebas de Sensibilidad Microbiana , Estructura Molecular , Fragmentos de Péptidos/farmacología , Péptidos Cíclicos/farmacología , Infecciones Estafilocócicas/microbiología , Estereoisomerismo , Relación Estructura-Actividad , Compuestos de Sulfhidrilo/farmacologíaRESUMEN
Acute Kidney Injury (AKI) is associated with a great increase in morbidity and mortality in severely burned patients and occurs as a complication in more than 25% of these cases. The onset of ARF may be early or late. Early AKI depends mainly on reduced cardiac output resulting from fluid loss, rhabdomyolysis, or hemolysis. Late AKI, instead, is usually a consequence of sepsis and is often associated with multiorgan failure (MOF). The first sign of AKI is the contraction of diuresis despite adequate volemic filling, which is followed by elevation of serum urea and creatinine. Fluid therapy is the main treatment in the burned victim: in the first few hours after injury, it aims to avoid hypovolemic shock and the possible related MOF, while later it becomes the cornerstone of treatment, besides antibiotic therapy in the case of sepsis onset. Particular care must also be taken in the choice of administered drugs in order to avoid possible nephrotoxic damage in addition to burning injury. Hemodialytic renal replacement therapy is used both for water balance management in patients requiring massive fluid infusions and for blood purification purposes to control the metabolic state, acid-base balance, and electrolytes abnormality. Our team has been collaborating for over 25 years in the management of severely burned patients admitted to the Centro Grandi Ustionati at the Bufalini Hospital in Cesena.
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Lesión Renal Aguda , Quemaduras , Sepsis , Humanos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/prevención & control , Quemaduras/complicaciones , Quemaduras/terapia , Fluidoterapia , Diálisis Renal , Terapia de Reemplazo Renal/métodos , Sepsis/complicacionesRESUMEN
PI3Kδ is a lipid kinase which plays a key role in airway inflammatory conditions. Accordingly, the inhibition of PI3Kδ can be considered a valuable strategy for the treatment of chronic respiratory diseases such as Asthma and Chronic obstructive pulmonary disease (COPD). In this work, we describe our efforts to identify new PI3Kδ inhibitors following an "inhalation by design" strategy. Starting from the identification of a purine scaffold, we carried out a preliminary SAR expansion which led to the identification of a new hit characterized by a high enzymatic potency and moderate PI3Kδ selectivity. A subsequent optimization led to novel purine based derivatives with favorable in vitro ADME profiles, which might represent promising starting points for future development of new inhaled drug candidates.
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Asma , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Asma/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Administración por Inhalación , Purinas/farmacología , Purinas/uso terapéutico , Fosfatidilinositol 3-Quinasa Clase IRESUMEN
Nephropathic subjects with impaired immune responses show dramatically high infection rates of coronavirus disease 2019 (COVID-19). This work evaluated the ability to acquire and maintain protective antibodies over time in 26 hemodialysis patients and 21 kidney transplant recipients. The subjects were followed-up through quantitative determination of circulating SARS-CoV-2 S1/S2 IgG and neutralizing antibodies in the 6-month period after clinical and laboratory recovery. A group of 143 healthcare workers with no underlying chronic pathologies or renal diseases recovered from COVID was also evaluated. In both dialysis and transplanted patients, antibody titers reached a zenith around the 3rd month, and then a decline occurred on average between the 270th and 300th day. Immunocompromised patients who lost antibodies around the 6th month were more common than non-renal subjects, although the difference was not significant (38.5% vs. 26.6%). Considering the decay of antibody levels below the positivity threshold (15 AU/mL) as "failure", a progressive loss of immunisation was found in the overall population starting 6 months after recovery. A longer overall antibody persistence was observed in severe forms of COVID-19 (p = 0.0183), but within each group, given the small number of patients, the difference was not significant (dialysis: p = 0.0702; transplant: p = 0.1899). These data suggest that immunocompromised renal patients recovered from COVID-19 have weakened and heterogeneous humoral responses that tend to decay over time. Despite interindividual variability, an association emerged between antibody persistence and clinical severity, similar to the subjects with preserved immune function.
RESUMEN
BACKGROUND/AIMS: The coronavirus disease 2019 (CO-VID-19) pandemic is the major current health emergency worldwide, adding a significant burden also to the community of nephrologists for the management of their patients. Here, we analyzed the impact of COVID-19 infection in renal patients to assess the time to viral clearance, together with the production and persistence of IgG and IgM antibody response, in consideration of the altered immune capacity of this fragile population. METHODS: Viral clearance and antibody kinetics were investigated in 49 renal patients recovered from COVID-19 infection: 7 of them with chronic decompensated renal failure, 31 under dialysis treatment, and 11 kidney transplant recipients. RESULTS: The time span between the diagnosis of infection and recovery based on laboratory testing (2 negative nasopharyngeal swabs in consecutive days) was 31.7 ± 13.3 days. Three new positive cases were detected from 8 to 13 days following recovery. At the first serological determination after swab negativization, all the patients developed IgG and IgM antibodies. The semiquantitative analysis showed a progressive increase in IgG and a slow reduction in IgM. DISCUSSION/CONCLUSION: In subjects with decompensated chronic kidney disease, under dialysis and in transplant recipients, viral clearance is lengthened compared to the general population. However, in spite of their common status of immunodepression, all of them were able to produce specific antibodies. These data might provide useful insights for monitoring and planning health-care activities in the weak category of patients with compromised renal function recovered from COVID-19.
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COVID-19/inmunología , COVID-19/virología , Trasplante de Riñón , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/análisis , COVID-19/epidemiología , Femenino , Tasa de Filtración Glomerular , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/inmunología , Fallo Renal Crónico/terapia , Cinética , Masculino , Persona de Mediana Edad , Nasofaringe/inmunología , Nasofaringe/virología , Estudios Retrospectivos , Receptores de Trasplantes , Resultado del TratamientoRESUMEN
Endogenous nitro-fatty acids, acting as partial agonist of PPARγ, are able to lower the insulin and glucose levels without the side effects associated with common antidiabetic drugs. (E)-12-Nitrooctadec-12-enoic acid, a potent activator of this peroxisome receptor, was synthesized in a very efficient sequence via a Henry-retro-Claisen ring fragmentation, followed by a novel enzymatic cleavage of methyl esters. The latter method was then applied in the last step of the synthesis of a few labile natural products, such as prostaglandins, isoprostanes, and phytoprostanes.
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Fluoroacetatos , Hipoglucemiantes/síntesis química , Ácidos Linoleicos/síntesis química , Nitrocompuestos/síntesis química , PPAR gamma/agonistas , PPAR gamma/química , Anhídridos Acéticos , Ésteres , Hidrólisis , Hipoglucemiantes/metabolismo , Ácidos Linoleicos/química , Ácidos Linoleicos/metabolismo , Espectroscopía de Resonancia Magnética , Estructura Molecular , Nitrocompuestos/química , Nitrocompuestos/metabolismo , PPAR gamma/metabolismo , Ácido Trifluoroacético/síntesis química , Ácido Trifluoroacético/químicaRESUMEN
BACKGROUND: In hemodialysis patients, a tunneled-cuffed permanent catheter is mandatory when the arteriovenous fistula is not feasible. The major risks of the use of tunneled-cuffed permanent catheter are bloodstream infections. The aim of this study is to analyze bloodstream infections from tunneled-cuffed permanent catheter in hemodialysis patients. METHODS: An observational prospective study was carried out and 79 hemodialysis patients with tunneled-cuffed permanent catheter were enrolled. Patients were divided into those with bloodstream infections from tunneled-cuffed permanent catheter and those without. Their clinical and laboratory characteristics were compared. An original tunneled-cuffed permanent catheter lock therapy sequence was carried out combined with systemic antibiotic therapy. In case of antibiotic resistance, the tunneled-cuffed permanent catheter was removed. RESULTS: The patients affected by bloodstream infections from tunneled-cuffed permanent catheter were 16/79 (20.3%). The bloodstream infection from tunneled-cuffed permanent catheter's incidence rate was 0.52 per 1000 catheter days. Twenty-three bloodstream infections from tunneled-cuffed permanent catheter were found in 16/79 patients who used tunneled-cuffed permanent catheter. Staphylococcus aureus was the cause of bloodstream infection from tunneled-cuffed permanent catheter in 35% of the cases and Staphylococcus epidermidis in 30% of the cases. Risk factors were infection located in other organs and the presence of peripheral obstructive arterial disease. CONCLUSION: The enrolled cohort showed a reduced bloodstream infection from tunneled-cuffed permanent catheter incidence rate in comparison with the reference value (1 per 1000 catheter days). To reduce the number of bloodstream infections from tunneled-cuffed permanent catheter, hand hygiene and asepsis management of the tunneled-cuffed permanent catheter during the connection to the extracorporeal circuit and an original tunneled-cuffed permanent catheter lock therapy sequence seem to be the most efficient measures. Infections of other organs and the presence of peripheral obstructive arterial disease are the most important risk factors for bloodstream infections from tunneled-cuffed permanent catheter.
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Catéteres de Permanencia , Diálisis Renal , Ajuste de Riesgo/métodos , Sepsis , Anciano , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/mortalidad , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/microbiología , Femenino , Humanos , Italia/epidemiología , Masculino , Estudios Prospectivos , Diálisis Renal/efectos adversos , Diálisis Renal/instrumentación , Diálisis Renal/métodos , Factores de Riesgo , Sepsis/etiología , Sepsis/microbiología , Sepsis/mortalidad , Análisis de Supervivencia , Dispositivos de Acceso Vascular/efectos adversos , Dispositivos de Acceso Vascular/microbiologíaRESUMEN
We report the case of a 93-year-old woman on haemodialysis treatment for more than 30 months and with multiple comorbidities who recovered from a Covid-19 infection without any significant clinical problems. The patient has shown a delay in viral clearance with swab test negativization (confirmed) after 33 days; after testing positive again, she has resulted persistently negative, (confirmed after 49 days). After the first negative swab, IgG and IgM antibodies have been found; these have remained persistently positive after a month. As well as highlighting an unexpected resilience in an extremely fragile context, the analysis of this case draws attention to patients' management and, potentially, to the need to arrange dialysis treatments in isolation for some time after their "laboratory recovery".
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Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Diálisis Renal , Sobrevivientes , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Betacoronavirus/aislamiento & purificación , COVID-19 , Prueba de COVID-19 , Calcitriol/uso terapéutico , Técnicas de Laboratorio Clínico , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Heparina/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Nasofaringe/virología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , SARS-CoV-2 , Factores de Tiempo , Tratamiento Farmacológico de COVID-19RESUMEN
Equations are derived for the electric potentials [electroencephalogram (EEG)] produced by dipolar sources in a multiregion bicentric-spheres volume-conductor head model. Being the equations valid for an arbitrary number of regions, our proposal is a generalization of many spherical models presented so far in literature, each of those regarded as a particular case of our multiregion model. Moreover, our approach allows considering new features of the head volume-conductor to better approximate electrical properties of the real head.
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Mapeo Encefálico/métodos , Encéfalo/fisiología , Diagnóstico por Computador/métodos , Electroencefalografía/métodos , Cabeza/fisiología , Modelos Neurológicos , Animales , Simulación por Computador , Campos Electromagnéticos , HumanosRESUMEN
EEG-based source localization techniques use scalp-potential data to estimate the location of underlying neural activity. EEG source location reconstruction requires the assumption of a source model and the assumption of a conductive head model. Brain lesions can present conductivity values that are dramatically different from those of surrounding normal tissues and have to be included in head models for accurate neural source reconstruction. It is therefore necessary to analyze subjects' anatomic images (using MRI or computed tomography) to identify lesion type and to assign the appropriate conductivity value. Source localization accuracy may be influenced by uncertainties in tissue conductivity assignment during head model construction. The authors present a sensitivity study quantifying the effect of uncertainty in brain lesion conductivity assignment on EEG dipole source localization. They adopted an eccentric-spheres head model in which an eccentric bubble approximated the effects of actual brain lesions. After simulating EEG signal measurement in 64 different pathologic situations, an inverse dipole fitting procedure was carried out, assuming an incorrect lesion conductivity assignment ranging from a half to twice the real value. Incorrect lesion conductivity assignment led to markedly wrong source reconstruction for highly conductive lesions like liquid-filled ones (localization errors as much as 1.7 cm). Conversely, low sensitivity to uncertainties in conductivity assignment was found for lesions with low conductivity like calcified tumors. The authors propose a method based on residual error analysis to improve the lesion conductivity estimate. This procedure can identify lesion tissue conductivity with only a few percent error and guarantees source localization errors less than 5 mm.
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Encefalopatías/fisiopatología , Neoplasias Encefálicas/fisiopatología , Electroencefalografía/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética , Transmisión Sináptica/fisiología , Tomografía Computarizada por Rayos X , Encéfalo/fisiopatología , Encefalopatías/diagnóstico , Neoplasias Encefálicas/diagnóstico , Potenciales Evocados/fisiología , Humanos , Modelos Neurológicos , Modelos Teóricos , Neuronas/fisiología , Proyectos de InvestigaciónRESUMEN
This paper examines the solidification/stabilisation treatment of two fly ash samples from a Municipal Solid Waste (MSW) incineration plant using a lime-pozzolan binder. The two examined fly ash samples were characterised by a high chloride and sulphate content and by a significant concentration of heavy metals. The effective development of hydrate phases during hydration of hydraulic lime-fly ash mixtures allows us to stabilise numerous pollutants in hardened pastes. The release of pollutants into the leachants is limited and decreases with the curing period of the pastes.
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Compuestos de Calcio/química , Carbono/química , Cloruros/química , Óxidos/química , Eliminación de Residuos/métodos , Sulfatos/química , Ceniza del Carbón , Incineración , Metales Pesados/química , Material ParticuladoRESUMEN
In this paper an application of new procedures for atmospheric particulate analysis is illustrated. PM10, PAHs (benzo[a]anthracene (BaA), benzo[b]fluoranthene (BbF), benzo[j]fluoranthene (BjF), benzo[k]fluoranthene (BkF), benzo[a]pyrene (BaP), indeno[1, 2, 3-cd]pyrene (Ip), dibenzo[a, h]anthracene (DbA)) and heavy metals (Cu, Ni, Zn, Co, Mn, Cd, Fe and Pb) were investigated. PM10 determination was performed by gravimetric method, PAHs were measured by GC-MS, and heavy metals by HPIC. An air quality monitoring campaign on the territory of Bari municipality has been organised, and its results are shown.
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Contaminantes Atmosféricos/análisis , Metales Pesados/análisis , Hidrocarburos Policíclicos Aromáticos/análisis , Monitoreo del Ambiente/métodos , Cromatografía de Gases y Espectrometría de Masas , Humanos , Italia , Tamaño de la Partícula , Población UrbanaRESUMEN
Several analogues of baringolin (1) were prepared to evaluate the role of its characteristic thiazoline ring and pentapeptidic tail with the aim of defining structure-activity relationships for these moieties. The thiazoline ring appeared as a crucial moiety to maintain a broad scope of activities against different Gram-positive bacteria. Further modifications were performed to simplify the structure of the natural product and assess the role of its tail, resulting in an enhanced in vitro performance. Analogue 25, with the thiazole-containing macrocycle and a 4-aminocyclohexane-1-carboxylic acid moiety in place of the pentapeptidic tail, was identified as a much more potent analogue, capable of overcoming the absence of the thiazoline ring and performing extraordinarily well against all strains tested. This is the first library of thiopeptide analogues produced by chemical synthesis alone, which demonstrates the robustness and convenience of the synthetic strategy used.
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Antibacterianos/síntesis química , Péptidos Cíclicos/química , Tiazoles/síntesis química , Antibacterianos/farmacología , Bacterias Grampositivas/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Relación Estructura-Actividad , Tiazoles/farmacologíaRESUMEN
The first total synthesis of Aeruginazole A, prepared via a convergent strategy that involved both solid-phase peptide synthesis and solution phase chemistry and that enabled conservation of the stereochemistry of the intermediates, is reported.
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Péptidos Cíclicos/síntesis química , Tiazoles/síntesis química , Conformación Molecular , Péptidos Cíclicos/química , Estereoisomerismo , Tiazoles/químicaRESUMEN
@#<p style="text-align: justify;">Bipolar Disorder has been one of the leading psychiatric conditions here in the Philippines. . It is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening period of normal mood (euthymia). The frequency, duration, and severity of manic and/or depressive episodes varies and is unique to each individual (Haber, 1997). In general, there are five in every 100 Filipinos who are suffering from some form of depression, and other may have a different reaction such as hyperactivity or swinging from depression to euphoria, unable to function normally, and in real danger of hurting themselves and others. Sadly, many of those with bipolar illness are left undiagnosed and, consequently, untreated. This case study presents how nurses play a role in helping patients overcome the challenges of having a psychiatric illness particularly those with Bipolar Disorder. </p>