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1.
Crit Care ; 20(1): 331, 2016 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-27745551

RESUMO

BACKGROUND: The aim was to test the primary hypothesis that in patients suffering from shock, treatment with N-acetylcysteine (NAC) plus deferoxamine (DFX) decreases the incidence of acute kidney injury (AKI). METHODS: A double-blind, randomized, placebo-controlled trial was conducted in a general intensive care unit in an academic hospital. Patients were included if they had new-onset hypotension, defined as mean arterial blood pressure <60 mmHg or requirement for vasopressor medication. A loading dose of NAC or placebo of 50 mg/kg in 4 h was administered intravenously. After the loading dose, patients received 100 mg/kg/day for the next 48 h. DFX or placebo was administered once at 1000 mg at a rate of 15/mg/kg/h. The primary outcome was the incidence of AKI. RESULTS: A total of 80 patients were enrolled in the study. The incidence of AKI was 67 % in the placebo arm and 65 % in the treatment group (relative risk (RR) 0.89 (0.35-2.2)). Furthermore, NAC plus DFX was effective in decreasing the severity and duration of AKI, and patients in the treatment group had lower serum creatinine levels at discharge. No severe adverse event associated with treatment was reported. The effects of NAC plus DFX could be secondary to the attenuation of early inflammatory response and oxidative damage. CONCLUSION: The administration of NAC plus DFX to critically ill patients who had a new episode of hypotension did not decrease the incidence of AKI. TRIAL REGISTRATION: Clinicaltrials.gov NCT00870883 (Registered 25 March 2009.).


Assuntos
Acetilcisteína/administração & dosagem , Injúria Renal Aguda/tratamento farmacológico , Estado Terminal/terapia , Desferroxamina/administração & dosagem , Hipotensão/tratamento farmacológico , Injúria Renal Aguda/epidemiologia , Adulto , Idoso , Estado Terminal/epidemiologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Sequestradores de Radicais Livres/administração & dosagem , Humanos , Hipotensão/epidemiologia , Incidência , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade
2.
Tomazini, Bruno M; Nassar Jr, Antonio Paulo; Lisboa, Thiago Costa; Azevedo, Luciano César Pontes de; Veiga, Viviane Cordeiro; Catarino, Daniela Ghidetti Mangas; Fogazzi, Debora Vacaro; Arns, Beatriz; Piastrelli, Filipe Teixeira; Dietrich, Camila; Negrelli, Karina Leal; Jesuíno, Isabella de Andrade; Reis, Luiz Fernando Lima; Mattos, Renata Rodrigues de; Pinheiro, Carla Cristina Gomes; Luz, Mariane Nascimento; Spadoni, Clayse Carla da Silva; Moro, Elisângela Emilene; Bueno, Flávia Regina; Sampaio, Camila Santana Justo Cintra; Silva, Débora Patrício; Baldassare, Franca Pellison; Silva, Ana Cecilia Alcantara; Veiga, Thabata; Barbante, Leticia; Lambauer, Marianne; Campos, Viviane Bezerra; Santos, Elton; Santos, Renato Hideo Nakawaga; Laranjeiras, Ligia Nasi; Valeis, Nanci; Santucci, Eliana; Miranda, Tamiris Abait; Patrocínio, Ana Cristina Lagoeiro do; Carvalho, Andréa de; Sousa, Eduvirgens Maria Couto de; Sousa, Ancelmo Honorato Ferraz de; Malheiro, Daniel Tavares; Bezerra, Isabella Lott; Rodrigues, Mirian Batista; Malicia, Julliana Chicuta; Silva, Sabrina Souza da; Gimenes, Bruna dos Passos; Sesin, Guilhermo Prates; Zavascki, Alexandre Prehn; Sganzerla, Daniel; Medeiros, Gregory Saraiva; Santos, Rosa da Rosa Minho dos; Silva, Fernanda Kelly Romeiro; Cheno, Maysa Yukari; Abrahão, Carolinne Ferreira; Oliveira Junior, Haliton Alves de; Rocha, Leonardo Lima; Nunes Neto, Pedro Aniceto; Pereira, Valéria Chagas; Paciência, Luis Eduardo Miranda; Bueno, Elaine Silva; Caser, Eliana Bernadete; Ribeiro, Larissa Zuqui; Fernandes, Caio Cesar Ferreira; Garcia, Juliana Mazzei; Silva, Vanildes de Fátima Fernandes; Santos, Alisson Junior dos; Machado, Flávia Ribeiro; Souza, Maria Aparecida de; Ferronato, Bianca Ramos; Urbano, Hugo Corrêa de Andrade; Moreira, Danielle Conceição Aparecida; Souza-Dantas, Vicente Cés de; Duarte, Diego Meireles; Coelho, Juliana; Figueiredo, Rodrigo Cruvinel; Foreque, Fernanda; Romano, Thiago Gomes; Cubos, Daniel; Spirale, Vladimir Miguel; Nogueira, Roberta Schiavon; Maia, Israel Silva; Zandonai, Cassio Luis; Lovato, Wilson José; Cerantola, Rodrigo Barbosa; Toledo, Tatiana Gozzi Pancev; Tomba, Pablo Oscar; Almeida, Joyce Ramos de; Sanches, Luciana Coelho; Pierini, Leticia; Cunha, Mariana; Sousa, Michelle Tereza; Azevedo, Bruna; Dal-Pizzol, Felipe; Damasio, Danusa de Castro; Bainy, Marina Peres; Beduhn, Dagoberta Alves Vieira; Jatobá, Joana DArc Vila Nova; Moura, Maria Tereza Farias de; Rego, Leila Rezegue de Moraes; Silva, Adria Vanessa da; Oliveira, Luana Pontes; Sodré Filho, Eliene Sá; Santos, Silvana Soares dos; Neves, Itallo de Lima; Leão, Vanessa Cristina de Aquino; Paes, João Lucidio Lobato; Silva, Marielle Cristina Mendes; Oliveira, Cláudio Dornas de; Santiago, Raquel Caldeira Brant; Paranhos, Jorge Luiz da Rocha; Wiermann, Iany Grinezia da Silva; Pedroso, Durval Ferreira Fonseca; Sawada, Priscilla Yoshiko; Prestes, Rejane Martins; Nascimento, Glícia Cardoso; Grion, Cintia Magalhães Carvalho; Carrilho, Claudia Maria Dantas de Maio; Dantas, Roberta Lacerda Almeida de Miranda; Silva, Eliane Pereira; Silva, Antônio Carlos da; Oliveira, Sheila Mara Bezerra de; Golin, Nicole Alberti; Tregnago, Rogerio; Lima, Valéria Paes; Silva, Kamilla Grasielle Nunes da; Boschi, Emerson; Buffon, Viviane; Machado, André SantAna; Capeletti, Leticia; Foernges, Rafael Botelho; Carvalho, Andréia Schubert de; Oliveira Junior, Lúcio Couto de; Oliveira, Daniela Cunha de; Silva, Everton Macêdo; Ribeiro, Julival; Pereira, Francielle Constantino; Salgado, Fernanda Borges; Deutschendorf, Caroline; Silva, Cristofer Farias da; Gobatto, Andre Luiz Nunes; Oliveira, Carolaine Bomfim de; Dracoulakis, Marianna Deway Andrade; Alvaia, Natália Oliveira Santos; Souza, Roberta Machado de; Araújo, Larissa Liz Cardoso de; Melo, Rodrigo Morel Vieira de; Passos, Luiz Carlos Santana; Vidal, Claudia Fernanda de Lacerda; Rodrigues, Fernanda Lopes de Albuquerque; Kurtz, Pedro; Shinotsuka, Cássia Righy; Tavares, Maria Brandão; Santana, Igor das Virgens; Gavinho, Luciana Macedo da Silva; Nascimento, Alaís Brito; Pereira, Adriano J; Cavalcanti, Alexandre Biasi.
Rev. bras. ter. intensiva ; 34(4): 418-425, out.-dez. 2022. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1423667

RESUMO

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.


ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

3.
Toxicon ; 90: 299-307, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25194746

RESUMO

It has been demonstrated that the cytotoxic effect of BJcuL, the lectin isolated from Bothrops jararacussu venom, on human gastric carcinoma is accompanied by the inhibition of extracellular matrix adhesion, cytoskeleton disassembly and apoptosis induction. The present study aimed to evaluate the apoptosis mechanisms triggered by the BJcuL interaction with specific glycans on the surface of HT29 human colon adenocarcinoma cells. The results demonstrated that BJcuL interacts with glycoligands targets on the cell, which were inhibited in the presence of d-galactose. It shows a dose-dependently cytotoxic effect that is inhibited in the presence of d-galactose. A dose-dependent cell aggregation decrease was also observed for the HT29 cells. Analysis of cell proliferation inhibition was assessed by anti-PCNA and demonstrated that lectin diminishes PCNA expression when compared with untreated cells. Differences in apoptotic marker expression estimated by immunohistochemistry revealed that the lectin promotes an increase in TRAIL expression, leading to an increase in the expression of FADD, caspase-8 and Bax. Besides the increased expression of apoptosis-related proteins, our results revealed that the lectin promotes a mitochondrial respiration decrease and a 75% increase in the amount of cytochrome c released. Together these results suggest that the cytotoxicity of BJcuL can sensitize pro-apoptotic proteins in the cytoplasm and mitochondria, leading to the apoptotic cascade.


Assuntos
Apoptose/efeitos dos fármacos , Caspases/metabolismo , Neoplasias do Colo/patologia , Venenos de Crotalídeos/toxicidade , Mitocôndrias/efeitos dos fármacos , Permeabilidade/efeitos dos fármacos , Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Neoplasias do Colo/enzimologia , Neoplasias do Colo/metabolismo , Células HT29 , Humanos , Lectinas Tipo C
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