RESUMO
INTRODUCTION: Patients with end-stage renal disease (ESRD) have a higher incidence of coronary artery disease (CAD). Hence, it is crucial to evaluate CAD before renal transplantation. This study compares the utility of pharmacologic single-photon emission computed-tomography (SPECT) imaging directly to coronary angiography for diagnosis of CAD with correlation to cardiovascular risk factors. METHOD: Retrospective review of asymptomatic renal failure patients who underwent both SPECT and coronary angiography to identify obstructive CAD between the years 2008-2016. Ninety-four ESRD subjects were evaluated. RESULTS: Myocardial perfusion SPECT study found, when compared to coronary angiography demonstrated for CAD, the sensitivity of 93.3% with a specificity of 73.4%. Importantly, the negative predictive value for coronary artery disease was 96%. With seven or more cardiac risk factors, 66.7% of patients had obstructive coronary artery disease. Among all the risk factors examined, patients with a previous history of coronary artery disease had a 68% risk of obstructive coronary artery disease. CONCLUSION: Comparing myocardial perfusion imaging SPECT findings with coronary angiography in patients with ESRD, a sensitivity of 93.3% and a specificity of 73% were observed. Of all the risk factors examined, patient with the previous history of CAD was the single most significant risk factor for CAD in 68% of cases.
Assuntos
Doenças Cardiovasculares/patologia , Angiografia Coronária/métodos , Falência Renal Crônica/complicações , Imagem de Perfusão do Miocárdio/métodos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Falência Renal Crônica/diagnóstico por imagem , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
Lipid from microalgae is one of the putative oil resources to facilitate the biodiesel production during this era of energy dissipation and environmental pollution. In this study, the key parameters such as biomass productivity, lipid productivity and lipid content were evaluated at the early stationary phase of Chlamydomonas reinhardtii, CC1010 cultivated in nutrient starved (nitrogen, phosphorous), glucose (0.05%, 0.1%, 0.15% and 0.2%) and vitamin B12 supplementation (0.001%, 0.002% and 0.003%) in Tris-Acetate-Phosphate (TAP) medium. The lipid content in nitrogen starved media was 61% which is 2.34 folds higher than nutrient sufficient TAP medium. Glucose supplementation has lead to proportional increase in biomass productivity with the increasing concentration of glucose whereas vitamin B12 supplementations had not shown any influence in lipid and biomass production. Further, fatty acid methyl ester (FAME) profiling of C. reinhardtii, CC 1010 has revealed more than 80% of total SFA (saturated fatty acid) and MUFA (mono unsaturated fatty acid) content. Quality checking parameters of biodiesel like cetane number, saponification value, iodine number and degree of unsaturation were analyzed and the biodiesel fuel properties were found to be appropriate as per the international standards, EN 14214 and ASTM D6751. Conclusively, among all the treatments, nitrogen starvation with 0.1% glucose supplementation had yielded high lipid content in C. reinhardtii, CC 1010.
Assuntos
Biocombustíveis , Biotecnologia/métodos , Chlamydomonas reinhardtii/crescimento & desenvolvimento , Chlamydomonas reinhardtii/metabolismo , Ácidos Graxos/biossíntese , Biocombustíveis/normas , Biomassa , Ácidos Graxos/análise , Cromatografia Gasosa-Espectrometria de Massas , Glucose/metabolismo , Lipídeos/análise , Lipídeos/biossíntese , Microalgas/crescimento & desenvolvimento , Microalgas/metabolismo , Microscopia Confocal , Nitrogênio/metabolismo , Fósforo/metabolismoRESUMO
The present study aimed to determine the prevalence of and relationship between dental caries and dental fluorosis at varying levels of fluoride in drinking water. The study was conducted among 3007 school children in the age group of 12 to 16 years in 2 districts of Haryana having varying fluoride levels in drinking water. Type III examination for dental caries according to the WHO index and dental fluorosis estimation according to Dean's index was done. The prevalence of dental caries decreased from 48.02% to 28.07% as fluoride levels increased from 0.5 to 1.13 ppm, but as the fluoride level increased further to 1.51 ppm, there was no further reduction in caries prevalence, but there was a substantial increase in fluorosis prevalence. The optimum level of fluoride in drinking water was found to be 1.13 ppm, at which there was maximum caries reduction with minimum amount of esthetically objectionable fluorosis.
Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Água Potável/efeitos adversos , Água Potável/química , Exposição Ambiental/estatística & dados numéricos , Fluoretos/análise , Fluorose Dentária/epidemiologia , Adolescente , Criança , Feminino , Humanos , Índia/epidemiologia , Masculino , RiscoRESUMO
OBJECTIVE: To investigate protective effect of Coleus aromaticus leaf extract against naphthalene induced hepatotoxicity in rats. METHODS: Eighteen male rats were divided into three groups. Group I rats were treated as control. Group II rats were intraperitoneally administered with naphthalene (435 mg/kg b.wt) dissolved in corn oil once a day for a period of 30 days. Group III rats were treated with leaf extract (100 mg/kg b.wt) dissolved in 0.9% saline and naphthalene (435 mg/kg b.wt) dissolved in corn oil once a day for a period of 30 days. RESULTS: Significant protective effect was observed against naphthalene induced liver damage, which appeared evident from the response levels of marker enzymes (aspartate transaminase, alanine transaminase, acid phosphatase, alkaline phosphatase and lactate dehydrogenase). The biochemical components viz. triglycerides, free fatty acids, cholesterol acyl transferase, high-density lipoprotein, low-density lipoprotein, cholesterol and bilirubin were found to be increased in liver and serum of naphthalene stressed rats when compared to control. CONCLUSION: Treatment of naphthalene intoxicated rats with plant extract reversed these distorted parameters to near normal levels. Liver histology showed supportive evidence regarding the protective nature of plant extract against fatty changes induced by naphthalene. The present study provides a scientific rationale for using C. aromaticus in the management of liver disorders.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Coleus/química , Naftalenos/toxicidade , Fitoterapia , Extratos Vegetais/uso terapêutico , Animais , Doença Hepática Induzida por Substâncias e Drogas/enzimologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Avaliação Pré-Clínica de Medicamentos , Sequestradores de Radicais Livres/análise , Fígado/efeitos dos fármacos , Fígado/enzimologia , Fígado/patologia , Masculino , Fenóis/análise , Folhas de Planta/química , Plantas Medicinais/química , Ratos , Ratos WistarRESUMO
PURPOSE: The purpose of this study was to determine the association of dental erosion with dietary factors and oral hygiene practices among 5-year-old schoolchildren in Belgaum, Karnataka, India. METHODS: A random sample of 1,002 5-year-old children was drawn from Belgaum schools. Erosion was assessed using the modified Smith and Knight index. A self-designed questionnaire was used to probe into the details of the children's dietary practices. RESULTS: Frequency of consumption of beverages, canned juices, tamarind, and honey, a mixed diet, and frequency of teeth cleaning were significant predictors of dental erosion. Oral hygiene practices like timing of cleaning teeth and materials used did not show significant association with dental erosion. CONCLUSION: Certain dietary factors like canned juice, raw mango, gooseberry, tamarind, honey, buttermilk, and beverages showed significant correlation with dental erosion. Dietary counseling must take this into consideration.
Assuntos
Dieta/estatística & dados numéricos , Erosão Dentária/epidemiologia , Bebidas/estatística & dados numéricos , Queijo/estatística & dados numéricos , Pré-Escolar , Citrus , Estudos Transversais , Cucumis sativus , Produtos Fermentados do Leite/estatística & dados numéricos , Esmalte Dentário/patologia , Dentina/patologia , Comportamento Alimentar , Feminino , Alimentos em Conserva/estatística & dados numéricos , Frutas , Mel/estatística & dados numéricos , Humanos , Índia/epidemiologia , Masculino , Mangifera , Higiene Bucal/estatística & dados numéricos , Ribes , Tamarindus , Erosão Dentária/classificação , Escovação Dentária/estatística & dados numéricosRESUMO
OBJECTIVE: Fluoride has been an effective tool to prevent dental caries but efforts have been on to establish optimal level of fluoride in drinking water in different communities. The present study seeks to establish the safe and acceptable concentration of fluoride in drinking water which would lead to maximum caries protection with least amount of clinically observable dental fluorosis. STUDY DESIGN: 30 villages from 2 districts of Haryana were classified according to differing levels of fluoride in the drinking water. 3007 school children (1558 males & 1449 female)] were examined and the DMFT score was related to the level of fluoride in drinking water. RESULTS: The caries prevalence was maximum (48.02%) in the area having 0.50 ppm fluoride in drinking water The children from area having the 1.13 ppm fluoride level had the least caries prevalence i.e. 28.07%. CONCLUSION: The results of the present study did not suggest any additional anticaries benefit beyond 1.13 ppm fluoride level. The present investigation showed that the optimalfluoride levels for drinking water for our conditions were near 1.13ppm (1-1.2 ppm) as there was maximum caries protection with least amount of esthetically objectionable fluorosis at that level.
Assuntos
Cariostáticos/análise , Cárie Dentária/epidemiologia , Doenças Endêmicas , Fluoretos/análise , Abastecimento de Água/análise , Adolescente , Cariostáticos/administração & dosagem , Criança , Índice CPO , Relação Dose-Resposta a Droga , Estudos Epidemiológicos , Feminino , Fluoretos/administração & dosagem , Humanos , Índia/epidemiologia , Masculino , Prevalência , SegurançaRESUMO
OBJECTIVES: There are different approaches for treating recurrent hepatitis C viral infection after a liver transplant. However, sustained virologic response is achieved in < 40% of infected allografts. We examined sustained virologic response improvement using a prolonged course of peginterferon and aggressive use of ribavirin. PATIENTS AND METHODS: From October 1998 to May 2008, 24 patients (13 male, 11 female; mean age at transplant, 49.4 +/- 7.7 years) received a prolonged course of peginterferon and ribavirin (range, 48-180 weeks). The mean interval from liver transplant to hepatitis C antiviral therapy was 26.6 +/- 27.8 months. Patients began weight-based standard dosages of peginterferon and ribavirin. In case of hemolysis, patients were treated with Epogen, with and without blood transfusions. RESULTS: Fourteen patients (58.3%) had an end of treatment response, and 8 patients (33.3%) maintained sustained virologic response after the first course of therapy. Of 10 patients who did not respond to the first course, 6 received an extended course of antiviral therapy after a mean of 15 +/- 4.6 weeks from completion of first course. Five of these 6 patients achieved end of treatment response and maintained a sustained virologic response, resulting in an overall end of treatment response in 17 patients and a sustained virologic response in 13 patients. Twenty-two patients experienced hemolysis and were treated with Epogen. Fifteen patients received blood transfusions. Ribavirin dosage was reduced in 12 patients, and peginterferon dosage was reduced in 2 patients. CONCLUSIONS: Aggressive use of ribavirin and prolonged course of peginterferon provided sustained virologic response in 54.1% of liver transplant recipients with recurrent hepatitis C virus-infection. More prospective studies are warranted to evaluate the benefit of this approach fully.
Assuntos
Antivirais/administração & dosagem , Hepatite C/tratamento farmacológico , Interferon-alfa/administração & dosagem , Transplante de Fígado , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Adulto , Antivirais/efeitos adversos , Transfusão de Sangue , Esquema de Medicação , Quimioterapia Combinada , Epoetina alfa , Eritropoetina/uso terapêutico , Feminino , Genótipo , Hematínicos/uso terapêutico , Hemólise/efeitos dos fármacos , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/etnologia , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Polietilenoglicóis/efeitos adversos , RNA Viral/sangue , Proteínas Recombinantes , Recidiva , Estudos Retrospectivos , Ribavirina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
Honesty and integrity are key characteristics expected of a doctor, although academic misconduct amongst medical students is not new. Academic integrity provides the foundation upon, which a flourishing academic life rests. The aim of this study was to investigate the attitude of undergraduate dental students about the seriousness of cheating behaviours and to determine the rate of malpractice amongst these students. A self designed closed ended questionnaire was distributed to 300 undergraduate students in a Dental Institution in India, to rate the seriousness of six cheating behaviours and to assess the rate of malpractice. The response rate was 100%. Two of the six cheating behaviours were considered by at least 61% of the students as very serious cheating behaviours. Almost 70% of the students agreed that they have involved in malpractice in examinations at least once. The majority also felt that cheating in examinations will not have any significant effect on their future. This study has revealed that cheating is an important issue, which needs to be addressed for the benefit of the society at large.
Assuntos
Atitude do Pessoal de Saúde , Enganação , Faculdades de Odontologia , Estudantes de Odontologia/psicologia , Humanos , Índia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Alpha 1 antitrypsin (A1A) is a 52 kD glycoprotein that is mainly synthesized in the liver. As a major protease inhibitor, it binds to and neutralizes neutrophil elastase, thereby limiting the damage to the normal tissues after an inflammatory response. A deficiency in A1A leads to end-stage liver disease, both in children and in adults. In addition, the deficiency also has a detrimental effect in the lungs of the adult population. Alpha 1 antitrypsin deficiency is corrected with hepatic replacement; however, the changes in pulmonary functions have not been studied before and after liver transplant. The purpose of this study was to observe the changes in the pulmonary functions of patients who underwent liver transplant for the treatment of A1A deficiency. MATERIALS AND METHODS: Nine patients underwent liver transplant for A1A deficiency. Seven patients (5 men, 2 women; mean age, 49.95 -/+ 7.09 years) had their pulmonary function tests available before the liver transplant (mean, 5.6 -/+ 3.4; range, 0.9-10.1 months) and after the liver transplant (mean, 30.3 -/+ 18.4, range 7.8-48.1 months) for analysis. RESULTS: The mean, preliver, transplant, FEV1 was 2.69 -/+ 0.9 L, which was nearly unchanged after the liver transplant to a mean of 2.7 -/+ 1.2 L. During the mean total interval of nearly 3 years, an estimated decline of 250 mL in FEV1 was expected. CONCLUSIONS: It appears from the results of our study that liver transplant probably prevented the progression of pulmonary disease in A1A-deficient patients. Further study and close, postliver, transplant follow-up is warranted to support our initial findings.
Assuntos
Falência Hepática/cirurgia , Transplante de Fígado/fisiologia , Pulmão/fisiopatologia , Deficiência de alfa 1-Antitripsina/complicações , Deficiência de alfa 1-Antitripsina/cirurgia , Adulto , Progressão da Doença , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Humanos , Falência Hepática/etiologia , Falência Hepática/fisiopatologia , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/fisiopatologia , Testes de Função Respiratória , Estudos Retrospectivos , Fumar/fisiopatologia , Deficiência de alfa 1-Antitripsina/fisiopatologiaRESUMO
PURPOSE: The purpose of this descriptive, cross-sectional study was to determine the prevalence and distribution of dental erosion among 5-year-old schoolchildren in Belgaum, North Karnataka, India. METHODS: A random sample of 1,100 5-year-old schoolchildren who met the inclusion criteria were included in the study, of whom 1,002 actively participated. The questionnaire given to parents pertained to sociodemographic factors, and the parents were instructed to maintain their child's 3-day diary to assess his/her existing dietary habits. Later, the questionnaire was collected and a clinical examination for dental erosion was performed. A modified Smith and Knight index was used to assess the extent of dental erosion. The child's socioeconomic status was assessed using Kuppuswamy's classification. Statistical analysis was performed using the chi-square test, Spearman's rank correlation coefficient tests and multiple logistic regression analysis. RESULTS: The prevalence of dental erosion was approximately 29% (with a higher prevalence observed in females). CONCLUSION: A statistically significant association was found between diet type, type and time of exposure to acidic diet and dental erosion.
Assuntos
Erosão Dentária/epidemiologia , Distribuição de Qui-Quadrado , Pré-Escolar , Estudos Transversais , Comportamento Alimentar , Feminino , Humanos , Índia/epidemiologia , Modelos Logísticos , Masculino , Índice de Gravidade de Doença , Classe Social , Inquéritos e Questionários , População UrbanaRESUMO
BACKGROUND: Transjugular intrahepatic portosystemic shunts (TIPS) have been used to control symptomatic portal hypertension in patients awaiting liver transplant. Although their role in pretransplantation patients is well established, their role in posttransplantation patients is unclear. STUDY DESIGN: Retrospective analyses were performed for 18 liver-transplant recipients who underwent TIPS for recurrent end-stage liver disease. Patients were evaluated in regard to gender, age, diagnoses, allograft type, indication for TIPS, portal pressures, laboratory results, Model for End-Stage Liver Disease (MELD) score, and outcomes. RESULTS: Median days from transplant to TIPS was 939 days (range, 122 to 3,415 days). Indications included variceal bleeding (n=2) and ascites (n=16). Ten patients (56%) responded to TIPS; TIPS prevented bleeding in both patients with varices, and it achieved symptomatic benefit in half of all patients with ascites. TIPS reduced median portal pressures from 22 mmHg (range, 17 to 50 mmHg) to 16 mmHg (range, 11 to 22 mmHg) and median portosystemic pressure gradients from 18 mmHg (range, 8 to 30 mmHg) to 8 mmHg (range, 2 to 12 mmHg). It increased median Model for End-Stage Liver Disease scores from 16 (range, 12 to 29) to 17 (range, 10 to 34) immediately and to 22 (range, 10 to 35) at 1 month. Six patients (33%) underwent retransplantation at a median of 58 days (range, 21 to 71 days) post-TIPS. Of the remaining 12 patients, 3 (25%) were alive and well at a median of 90 days (range, 78 to 1,169 days) post-TIPS; 9 (75%) died at a median of 99 days (range, 13 to 1,400 days) post-TIPS. Subgroup analysis failed to demonstrate significant differences between patients whose ascites responded to TIPS (n=8) and patients whose ascites did not (n=8). Responders were younger, had higher baseline portal pressures, greater reductions in portal-systemic pressure gradients, and better hepatic function. CONCLUSIONS: Though small, this was the largest series to date of TIPS in liver-transplant recipients. Overall, 56% of patients responded to TIPS. No single factor predicted response or nonresponse of ascites to TIPS. Without retransplantation, 75% of patients died. Careful selection is necessary when considering TIPS for patients with ascites.
Assuntos
Transplante de Fígado , Adolescente , Adulto , Ascite/cirurgia , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Hepatite C/cirurgia , Humanos , Hipertensão Portal/prevenção & controle , Hipertensão Portal/cirurgia , Falência Hepática/cirurgia , Falência Hepática/virologia , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta , Derivação Portossistêmica Transjugular Intra-Hepática , Período Pós-Operatório , Recidiva , Reoperação , Resultado do TratamentoRESUMO
BACKGROUND: Occurrence of posttransplant lymphoproliferative disorder (PTLD) after transplantation is known. Drastic reduction or withdrawal of immunosuppression with anti-viral therapy for Ebstein-Barr virus (EBV) is the primary treatment for all PTLD. Many PTLD are B cell in origin have CD20 antigen on the cell surface. Rituximab is a chimeric anti CD20 antibody, which has been used to treat PTLD with variable success. This study aims to report long-term experience with rituximab for PTLD from a single center. METHODS: Seventeen patients (13 male, 4 female, mean age 51.2 years) received rituximab to treat PTLD. Five patients received rituximab with drastic reduction in immunosuppression (primary). Nine patients received rituximab after failure of primary therapy (rescue) and three patients received it after resolution of PTLD (prophylactic). Mean follow-up period was 60 months. RESULTS: Overall 1-, 3-, and 5-year patient survivals were 64.7%, 47.1% and 35.3%, respectively. In the primary group, three patients had complete and one had partial response; however, only two (40%) patients are currently alive. In the rescue group, none of the patients had a complete response, four patients had partial response, and only two (22%) patients are currently alive. In the prophylactic group, two patients died at 28 and 41 months due to recurrence and graft failure, respectively. CONCLUSION: Sixty percent (3 of 5) of patients who received rituximab as primary therapy had complete resolution, and 44% (4 of 9) of patients who received it as rescue therapy had partial response. Overall 5-year patient survival was a disappointing 35%.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Fatores Imunológicos/uso terapêutico , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Anticorpos Monoclonais Murinos , Antígenos CD/imunologia , Feminino , Humanos , Transplante de Rim/mortalidade , Transplante de Rim/patologia , Transplante de Fígado/mortalidade , Transplante de Fígado/patologia , Transtornos Linfoproliferativos/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Rituximab , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Response surface methodology and central composite rotary design (CCRD) was employed to optimize a fermentation medium for the production of alkali-stable cellulase-free xylanase by Aspergillus fischeri in solid-state fermentation at pH 9.0 with wheat bran as substrate. The four variables involved in this study were sodium nitrite, potassium dihydrogen phosphate, magnesium sulphate and yeast extract. The statistical analysis of the results showed that, in the range studied, only sodium nitrite had a significant effect on xylanase production. The optimized medium containing (in g/l) NaNO(2)-7.0, K2HPO(4)-1.0, MgSO(4)-0.5 and yeast extract-5.0 resulted in 1.9-fold increased level of alkali-stable xylanase (1024 U/g wheat bran) production compared to initial level (540 U/g) after 72 h of fermentation, whereas its value predicted by the quadratic model was 931 U/g. The level of protease activity was considerably decreased in optimized medium, thus helping to preserve the xylanase activity and demonstrating another advantage of applying statistical experimental design.
Assuntos
Aspergillus/enzimologia , Endo-1,4-beta-Xilanases/biossíntese , Meios de Cultura/química , Estabilidade Enzimática , Fermentação , Concentração de Íons de Hidrogênio , Fatores de TempoRESUMO
Aspergillus niger NRRL330 produces extracellular beta-fructofuranosidase (Ffase), and its production is subject to repression by hexoses in the medium. After ultraviolet mutagenization and selection, seven derepressed mutants resistant to 2-deoxyglucose (2-DG) were isolated on Czapek's minimal medium containing glycerol. One of the mutants, designated DGRA-1, produced higher levels of Ffase. A considerable difference occurred in the mutants with reference to hexokinase and intracellular acid phosphatase activities. The hexokinase activity of the mutant DGRA-1 (0.69 U/mg) was 1.8-fold higher than the wild type (0.38 U/mg). Intracellular acid phosphatase activity of the mutant DGRA-1 (0.83 U/g of mycelia) was twofold higher than that of the wild type (0.42 U/g of mycelia), suggesting that phosphorylation and dephosphorylation steps could attribute to the 2-DG resistance of A. niger. However, additional mutations could account for the increased production of Ffase in the mutant DGRA-1.
Assuntos
Fosfatase Ácida/metabolismo , Aspergillus niger/genética , Desoxiglucose/metabolismo , Hexoquinase/metabolismo , beta-Frutofuranosidase/metabolismo , Aspergillus niger/enzimologia , Aspergillus niger/metabolismo , Mutação , beta-Frutofuranosidase/genéticaRESUMO
BACKGROUND: Chronic renal failure leads to amenorrhea, and successful pregnancy is rare. The aim of the present report is to examine the outcome of pregnancies under tacrolimus after kidney transplantation (KTx) and simultaneous kidney-pancreas transplantation (SPKTx). METHOD: All pregnancies under tacrolimus after KTx or SPKTx from 1993 to April 2002 were retrospectively examined. Renal function and the mother's survival were followed until December 2002. RESULTS: Thirteen mothers after KTx delivered 19 babies, and 2 mothers after SPKTx delivered 3 babies. All mothers survived the pregnancy and retained allograft function. One mother had a stillborn baby from an unrecognized amniotic fluid leak and a small ischemic placenta. The mean gestational period was 34.4 +/- 5.1 weeks. Mean birth weight was 2373 +/- 1001 g. Birth-weight percentile to gestational period was 40 +/- 28. None of the mothers experienced rejection during the pregnancy. Three pregnancies in mothers with KTx experienced toxemia of pregnancy, and one mother with SPKTx developed pre-eclampsia during both pregnancies. Five mothers (6 deliveries, 27.3%) required caesarian section. During the follow-up period, one mother died from a cerebrovascular accident. Another five mothers returned to dialysis 55.6 +/- 32.4 months after the last delivery and 99.4+28.5 months after the last KTx. Both SPKTx mothers have maintained normal renal and pancreatic allograft function 42 and 62 months postdelivery. CONCLUSION: All mothers survived the pregnancy. One baby was stillborn. Forty-one percent of babies were either preterm or premature, and 27% of babies were delivered by caesarean section. Toxemia of pregnancy or pre-eclampsia was observed in 23% of pregnancies postKTx and SPKTx. None of the mothers experienced rejection during their pregnancy.
Assuntos
Transplante de Rim/fisiologia , Transplante de Pâncreas/fisiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Tacrolimo/uso terapêutico , Peso ao Nascer , Feminino , Humanos , Imunossupressores/uso terapêutico , Recém-Nascido , Testes de Função Renal , Transplante de Rim/imunologia , Masculino , Transplante de Pâncreas/imunologia , Gravidez , Estudos RetrospectivosRESUMO
BACKGROUND: Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience. METHODS: All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart. RESULTS: Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97%) survived the pregnancy, and 36 allografts (97%) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4+/-3.2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9%) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797+/-775 g, with 38 babies (78%) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54+/-23. Four babies (8.5%) had a birth weight percentile of less than 25, and 28 babies (59.6%) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression. CONCLUSION: The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus.
Assuntos
Imunossupressores/administração & dosagem , Transplante de Fígado , Pré-Eclâmpsia/epidemiologia , Resultado da Gravidez/epidemiologia , Tacrolimo/administração & dosagem , Anormalidades Múltiplas/epidemiologia , Adolescente , Adulto , Anti-Inflamatórios/farmacologia , Peso ao Nascer , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Fludrocortisona/farmacologia , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Hipertensão/epidemiologia , Recém-Nascido , Rim/fisiologia , Fígado/fisiologia , Hepatopatias/mortalidade , Hepatopatias/fisiopatologia , Hepatopatias/cirurgia , Prednisona/administração & dosagem , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Gravidez em Diabéticas/epidemiologia , Estudos Prospectivos , Taxa de Sobrevida , Transplante HomólogoRESUMO
With the advent of highly active antiretroviral therapy (HAART), HIV positivity is no longer a contraindication for liver transplantation. Some of the antiretroviral agents, particularly protease inhibitors (e.g., ritonavir, indinavir, and nelfinavir) have been described as potent inhibitors of the metabolism of certain immunosuppressive drugs. In this article we describe a profound interaction between tacrolimus and Kaletra (Abbott Laboratories, Chicago, IL) (a combination of lopinavir and ritonavir) in 3 liver transplantation patients. Patient 1, who was maintained on a 5 mg twice daily dose of tacrolimus with a trough blood concentration around 10.6 ng/mL, required only 0.5 mg of tacrolimus per week after addition of Kaletra to achieve similar tacrolimus blood concentrations, with a half-life of 10.6 days. In patient 2, the area under the blood concentration versus time curve for tacrolimus increased from 31 ng/mL/h to 301 ng/mL/h after addition of Kaletra, with a corresponding half-life of 20 days. When the patient was subsequently switched to nelfinavir, the half-life decreased to 10.3 days. Patient 3, who was maintained with 4 to 8 mg/d of tacrolimus and a corresponding blood concentration of 10 ng/mL before Kaletra, required a tacrolimus dose of 1 mg/wk and tacrolimus concentrations of 5 ng/mL with Kaletra. In conclusion, a combination of lopinavir and ritonavir led to a much more profound increase in tacrolimus blood concentrations than use of single protease inhibitor, nelfinavir. A tacrolimus dose of less than 1 mg/wk may be sufficient to maintain adequate blood tacrolimus concentrations in patients on Kaletra. Patients may not need a further dose of tacrolimus for 3 to 5 weeks depending on liver function when therapy with Kaletra is initiated. Great caution is required in the management of tacrolimus dosage when Kaletra is introduced or withdrawn in HIV-positive patients after liver transplantation, particularly in the presence of hepatic dysfunction.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/administração & dosagem , Imunossupressores/farmacocinética , Hepatopatias/complicações , Transplante de Fígado , Pirimidinonas/administração & dosagem , Ritonavir/administração & dosagem , Tacrolimo/farmacocinética , Adulto , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/sangue , Hepatopatias/cirurgia , Lopinavir , Masculino , Pessoa de Meia-Idade , Tacrolimo/sangueRESUMO
Chemical analysis of electroplating effluent revealed the presence of very high concentrations of nickel (393 ppm) in the effluent. Bioassay was carried out to test the toxicity of nickel chloride to Aspergillus niger. In contrast to 50% conidial inhibition at 1.7 mM nickel, hyphal extension was affected even at a lower concentration (0.4 mM), suggesting that hyphae are more sensitive than conidia to nickel. An increase in nickel concentration resulted in a proportionate decrease in the hyphal extension. Nickel (II)-resistant mutants of A. niger M1, M2, and M3, were obtained using direct selection, stepwise adaptation, and ultraviolet mutation techniques. Biosorption of Ni (II) by the mutant M3 was 50% more than that of its parent strain.