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1.
Updates Surg ; 76(3): 1091-1097, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38489129

RESUMO

INTRODUCTION: During the surge of the SARS-CoV-2 pandemic, studies revealed high complication and morbidity rates following surgical procedures in COVID-19 positive patients. Anesthetic and surgical societies swiftly developed strategies to mitigate these risks, including a recommended postponement of elective surgeries for a minimum of 7 weeks post-COVID infection. Nowadays, with a predominantly vaccinated population, it has become crucial to discern the influencing factors on post-COVID morbidity and mortality and a reevaluation of the existing recommendations pertaining to elective surgery. METHODS: A single-center case-control study was conducted, including patients who underwent surgery between November 2021 and March 2022 and met the inclusion criteria. Eighty COVID-19 positive patients were matched 1:1 with 80 controls, each undergoing an identical intervention within a 2-week time frame. The primary outcome was 30-day postoperative mortality and secondary outcome postoperative complications (respiratory and thromboembolic). RESULTS: At the time of surgery, 88.8% of patients in the case group and 92.5% in the control group had received at least one vaccine dose. Mortality and morbidity did not show a significant difference when comparing the case and control groups (7.5% vs 6.2%, p = 0.755; 11.3% vs 8.9%, p = 0.541 respectively). In the COVID-positive group, mortality was significantly associated with age over 70 years, ASA score over III, RCRI over 1, emergency procedures, and absence of thromboembolic prophylaxis. CONCLUSIONS: In contrast to previously reported findings, we did not observe an increased morbi-mortality in patients with perioperative COVID-19 infection. It may not be necessary to delay elective interventions, except in cases with a high-risk.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Estudos de Casos e Controles , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Idoso , Vacinas contra COVID-19/administração & dosagem , Vacinação , Adulto , Idoso de 80 Anos ou mais
2.
Nat Microbiol ; 7(7): 1001-1015, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35668112

RESUMO

Beneficial microorganisms are used to stimulate the germination of seeds; however, their growth-promoting mechanisms remain largely unexplored. Bacillus subtilis is commonly found in association with different plant organs, providing protection against pathogens or stimulating plant growth. We report that application of B. subtilis to melon seeds results in genetic and physiological responses in seeds that alter the metabolic and developmental status in 5-d and 1-month-old plants upon germination. We analysed mutants in different components of the extracellular matrix of B. subtilis biofilms in interaction with seeds and found cooperation in bacterial colonization of seed storage tissues and growth promotion. Combining confocal microscopy with fluorogenic probes, we found that two specific components of the extracellular matrix, amyloid protein TasA and fengycin, differentially increased the concentrations of reactive oxygen species inside seeds. Further, using electron and fluorescence microscopy and metabolomics, we showed that both TasA and fengycin targeted the oil bodies in the seed endosperm, resulting in specific changes in lipid metabolism and accumulation of glutathione-related molecules. In turn, this results in two different plant growth developmental programmes: TasA and fengycin stimulate the development of radicles, and fengycin alone stimulate the growth of adult plants and resistance in the phylloplane to the fungus Botrytis cinerea. Understanding mechanisms of bacterial growth promotion will enable the design of bespoke growth promotion strains.


Assuntos
Bacillus subtilis , Cucurbitaceae , Bacillus subtilis/metabolismo , Cucurbitaceae/microbiologia , Matriz Extracelular de Substâncias Poliméricas , Gotículas Lipídicas , Sementes/microbiologia
3.
Allergol Immunopathol (Madr) ; 48(6): 720-728, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32446785

RESUMO

BACKGROUND: Common Variable Immunodeficiency (CVID) is characterized by an impaired antibody production and a higher susceptibility to encapsulated bacterial infections. Lung disease is considered to be the most important cause of morbidity and mortality. METHODS: We analyzed clinical, radiological and functional characteristics in 80 patients with CVID assisted in the Unidad Inmunologia e Histocompatibilidad at Durand Hospital from 1982 to 2018. RESULTS: Of the 80 patients, 55 showed pathologic lung Computed Tomography (CT). Twenty of them (36.4%) showed bronchiectasis; 26 (47.3%) interstitial involvement associated with nodules and adenopathies called GLILD (granulomatous-lymphocytic interstitial lung disease); and nine patients (16.3%) showed other lesions. Nine percent of patients with lung disease showed CT progression; none of them had spirometry worsening. GLILD patients had normal and restrictive patterns in lung function tests, in equal proportions. Two patients - one with GLILD and the other one with bronchiectasis - had an increase in spirometric pattern severity without CT progression. Lung biopsy was performed in 19% of GLILD patients, all of whom had histopathologic diagnosis of Lymphoid Interstitial Pneumonia (LIP). CONCLUSIONS: GLILD is the major cause of lung disease in CVID. Computed tomography is useful for diagnosis but not necessary in follow-up, in which functional tests should have better correlation with clinical evolution, reducing radiation exposure. Biopsy should be indicated when the clinical diagnosis is unclear. Treatment should be considered whenever there is clear evidence of disease progression.


Assuntos
Bronquiectasia/epidemiologia , Imunodeficiência de Variável Comum/complicações , Doenças Pulmonares Intersticiais/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/estatística & dados numéricos , Bronquiectasia/diagnóstico , Bronquiectasia/imunologia , Imunodeficiência de Variável Comum/imunologia , Progressão da Doença , Suscetibilidade a Doenças/imunologia , Estudos de Viabilidade , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espirometria/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
4.
Respir Med ; 169: 106013, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32442110

RESUMO

BACKGROUND: It is essential to recognize and treat findings that can simulate or worsen symptoms to improve asthma control and thereby to reduce costs. Guidelines highlight a paranasal (PS) and chest computed tomography (CT) scan as a tool for disease evaluation and, although they suggest its indication in patients whom presentation is atypical, there are not well-defined criteria. OBJECTIVES: To describe the most common findings in the PS and chest CT in severe asthma patients and to analyse the characteristics of asthmatics with the finding of nasal polyps or bronchiectasis. METHODS: We retrospectively reviewed the medical records of 161 adults with confirmed severe asthma who had undergone to PS and/or chest CT. Clinical data from their electronic health record and the findings from a PS and/or chest CT within the last five years were collected. RESULTS: In the PS CT, 70.5% of patients presented mucous thickening and 46.7% presented nasal polyps. Both findings were associated with male gender and level of blood eosinophils. In chest CT, 28% of individuals showed atelectasis, 16.5% air trapping, 17.7% affectation of the small airway, 11.6% pulmonary infiltrates and 10.4% emphysema. Bronchiectasis were identified in 60.4% of subjects, who were older and had poorer lung function. CONCLUSION: Paranasal and thoracic computed tomography are important tools in the treatment of severe asthma because they allow us to detect highly prevalent findings in this disease that can lead to poorer control of it.


Assuntos
Asma/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Adulto , Idoso , Asma/complicações , Bronquiectasia/complicações , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/epidemiologia , Estudos Transversais , Eosinófilos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/epidemiologia , Prevalência , Atelectasia Pulmonar/complicações , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais
6.
Rev. salud pública (Córdoba) ; 20(1): 59-68, 2016. tab
Artigo em Espanhol | LILACS | ID: lil-788716

RESUMO

Las instituciones universitarias para lograr excelencia académica en los futuros profesionales exigen considerar a la educación con un signifi cado primordial. El presente trabajo identifi ca los contenidos en el área de salud en los materiales de ejercitación del Ciclo de Nivelación y las competencias específi cas en los diferentes Ejes Temáticos, desde la perspectiva de los profesores. Para identifi car los contenidos del área de salud se aplicó un instrumento con los ítems: objetivos, contenidos, actividades y bibliografía. Para indagar la perspectiva de los profesores se implementó un cuestionario a ocho informantes claves, que incluyó la valoración de las competencias específi cas en el área a su cargo. De acuerdo a lo trabajado, se reconoce la importancia de articulación entre educación y salud, en términos de vincular experiencia-formación de los docentes, conocimientos de los estudiantes y contenidos específi cos en relación al proceso salud-enfermedad, porque se transforma en retroalimentación para los Ciclos de Nivelación.


In order to achieve academic excellence in their future professionals, university institutions require the consideration of education with a fundamental meaning. This work identifi es the contents in the health section of the exercise material included in the Leveling Course and the specifi c competences in the different Main Topics, from the teachers´perspective. An instrument including the following items: objectives, contents, activities and biography was applied to identify the contents in the health section. To inquire about the teachers’ perspective a questionnaire was used with eight key informants; it included the assessment of specifi c competences in the area they are in charge of. As a conclusion, it is observed that it is important to articulate education and health, in terms of linking teachers’ experience-training, students’ knowledge and specifi c contents regarding the process health-illness, since it becomes feedback for the Leveling Courses.


As instituições universitárias, visando a excelência acadêmica nos futuros profi ssionais, exigem considerar a educação como tendo um signifi cado fundamental. Este documento identifi ca os conteúdos na área da saúde dos materiais de treinamento do Ciclo de Nivelamento e as competências específi cas nos diferentes Eixos Temáticos a partir da perspectiva dos professores. Para identifi car os conteúdos da área de saúde aplicou-se um instrumento composto dos itens: objetivos, conteúdos, atividades e bibliografi a. Para pesquisar a perspectiva dos professores aplicou-se um questionário a oito docentes-chave, que incluiu a avaliação de competências específi cas na área da sua responsabilidade.. De acordo com o trabalho, pode-se reconhecer a importância da articulação entre educação e saúde, em termos de articular a experiência-formação dos professores, os conhecimentos dos estudantes e os conteúdos específi cos em relação ao processo saúde-doença, pois ele torna-se em retroalimentacão para os Ciclos de Nivelamento.


Assuntos
Humanos , Masculino , Feminino , Educação Baseada em Competências , Educação Baseada em Competências/tendências , Estudantes de Ciências da Saúde , Estudantes de Ciências da Saúde/estatística & dados numéricos
7.
J Evol Biol ; 28(4): 851-63, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25722058

RESUMO

The role of pollinators in floral divergence has long attracted the attention of evolutionary biologists. Although abundant studies have reported the effect of pollinators on flower-shape variation and plant speciation, the influence of pollinators on plant species differentiation during rapid radiations and the specific consequences of shifts among similar pollinators are not well understood. Here, we evaluate the association between pollinators and floral morphology in a closely related and recently diversifying clade of Linaria species (sect. Supinae subsect. Supinae). Our approach combined pollinator observations, functional floral morphometric measures and phylogenetic comparative analyses. The fauna visiting Linaria species was determined by extensive surveys and categorized by a modularity algorithm, and the size and shape of flowers were analysed by means of standard and geometric morphometric measures. Standard measures failed to find relationships between the sizes of representative pollinators and flowers. However, discriminant function analyses of geometric morphometric data revealed that pollination niches are finer predictors of flower morphologies in Linaria if compared with phylogenetic relationships. Species with the most restrictive flowers displayed the most slender spurs and were pollinated by bees with larger proboscides. These restrictive flower shapes likely appeared more than once during the evolutionary history of the study group. We show that floral variation can be driven by shifts between pollinators that have been traditionally included in a single functional group, and discuss the consequences of such transitions for plant species differentiation during rapid radiations.


Assuntos
Abelhas , Flores/anatomia & histologia , Linaria/anatomia & histologia , Polinização , Animais , Evolução Biológica , Tamanho Corporal , Flores/fisiologia , Linaria/fisiologia , Filogenia
8.
J Intern Med ; 278(1): 50-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25476756

RESUMO

AIMS: Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy and fibrosis. HCM is an autosomal-dominant disease caused by more than 400 mutations in sarcomeric genes. Changes in nonsarcomeric genes contribute to its phenotypic heterogeneity. Cardiac fibrosis can be studied using late gadolinium enhancement (LGE) cardiac magnetic resonance imaging. We evaluated the potential role of two polymorphisms in nonsarcomeric genes on interstitial fibrosis in HCM. MATERIALS AND METHODS: Two polymorphisms in nonsarcomeric genes [ACE (deletion of 287 bp in the 16th intron) and RETN (-420C>G)] were analysed in 146 HCM patients. Cardiac fibrosis was assessed using LGE to determine the number of affected segments. RESULTS: Allelic frequencies in ACE and RETN polymorphisms were consistent with the Hardy-Weinberg equilibrium (both P > 0.05). We found that the presence of the polymorphic allele in the -420C>G RETN polymorphism was independently associated with the number of affected segments of LGE (P = 0.038). Increased circulating resistin concentration, measured by enzyme-linked immunosorbent assay, was associated with a higher degree of cardiac fibrosis. Myocardial fibrosis, assessed by Masson's trichrome staining, was associated with the -420C>G RETN polymorphism in 46 tissue samples obtained by septal myectomy (P = 0.044). CONCLUSIONS: The -420C>G RETN polymorphism was independently associated with the degree of cardiac fibrosis, assessed by LGE, in patients with HCM. In addition, there was an association between the polymorphism and the circulating resistin levels as well as with myocardial fibrosis in tissues obtained by myectomy. Investigating the physiological implication of the RETN polymorphism in HCM in combination with the use of imaging technologies might help to establish the severity of disease in patients with HCM.


Assuntos
Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/patologia , Miocárdio/patologia , Polimorfismo de Nucleotídeo Único , Resistina/genética , Adulto , Idoso , Cardiomiopatia Hipertrófica/sangue , Feminino , Fibrose , Gadolínio , Genótipo , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/genética , Estudos Prospectivos , Radioisótopos , Resistina/sangue , Índice de Gravidade de Doença
9.
Toxicol In Vitro ; 28(2): 300-6, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24287112

RESUMO

Cadmium and lead are persistent and ubiquitous metals that can cause several deleterious effects in living beings. Apoptosis and necrosis are two types of cell death that can be found after in vivo and in vitro exposure to these metals. In this study, isolated red blood cells from living captive Common buzzard (Buteo buteo) were exposed in vitro to different concentrations of lead, cadmium, and the mixture lead-cadmium in a proportion of 1:10 (similar to that found in previous field studies). Data obtained from dose-response curves were used to evaluate the interactive effects of metal mixtures on cell viability. In general, except for the exposure to NOEC, additivity was the most frequently observed response. As described in human, after in vitro exposure, lead was highly accumulated in buzzard erythrocytes, while cadmium accumulation was scarce. Finally, the type of cell death (apoptosis or necrosis) induced by the exposure to different concentrations of these heavy metals and their mixtures was evaluated in the red blood cells. Apoptosis was found to be the main type of cell death observed after cadmium and/or lead exposure. However, this exposure caused an increase in lysis or necrosis, especially if red blood cells were exposed to high doses.


Assuntos
Cádmio/toxicidade , Eritrócitos/efeitos dos fármacos , Chumbo/toxicidade , Aves Predatórias/fisiologia , Algoritmos , Animais , Apoptose/efeitos dos fármacos , Cádmio/sangue , Morte Celular/efeitos dos fármacos , Células Cultivadas , Relação Dose-Resposta a Droga , Interações Medicamentosas , Chumbo/sangue , Necrose
10.
Int. j. morphol ; 31(4): 1216-1222, Dec. 2013. ilus
Artigo em Espanhol | LILACS | ID: lil-702296

RESUMO

Karwinskia humboldtiana (Kh) es un arbusto venenoso responsable de numerosos casos de intoxicación accidental en humanos. En estudios previos en nuestro laboratorio reportamos un incremento de células cebadas en nervio periférico (NP) durante la intoxicación con Kh, este hallazgo no ha sido reportado previamente en otros órganos durante esta intoxicación por lo que en el presente estudio buscamos la presencia de estas células en otros órganos, además de distinguir subpoblaciones de células cebadas mediante reacciones histoquímicas para la identificación de los gránulos de secreción. El objetivo de este estudio fue evaluar la presencia de células cebadas en órganos distintos al NP y diferenciar histoquímicamente la composición de sus gránulos. Se utilizaron 32 ratas Wistar, se dividieron en cuatro grupos (n= 8) en donde 5 ratas de cada grupo fueron intoxicadas y 3 fueron control no intoxicadas. A las ratas intoxicadas se les administraron por vía oral 3,5 g/kg del fruto seco y molido de Kh fraccionados en 5 dosis de 1,5; 0,5, 0,5; 0,5 y 0,5 g/kg los días 0, 3, 7, 10 y 14 respectivamente. Las ratas control solo recibieron agua. Cada grupo fue sacrificado a diferentes tiempos según la evolución de la parálisis. Se obtuvieron muestras de Hígado, Riñón, Pulmón y SNP, se procesaron hasta obtener bloques de parafina, se obtuvieron cortes y se tiñeron con azul de toluidina, PAS, Azul alciano/PAS y Azul alciano/Safranina. Se identificó la presencia de células cebadas en NP y pulmón con la tinción de azul de toluidina y se realizo un estudio morfométrico observando un incremento progresivo del número de células cebadas por grupo así como variaciones histoquímicas en sus gránulos en cada etapa y órgano analizado, lo que sugiere la participación de las células cebadas y sus secreciones en cada una de las etapas de la intoxicación crónica con el fruto maduro de Kh.


Karwinskia humboldtiana (Kh) is a poisonous shrub causing a number of accidental intoxications in humans. In previous studies in our laboratory, we reported an increased number of mast cells present in peripheral nerve of Kh intoxicated rats. This finding has not been reported in other organs of intoxicated animals. For this reason, in the present study we searched for mast cells in several organs, identifying mast cell subpopulations on the basis of different histochemical reactivity of their secretory granules. Thus the objective of the present study was to evaluate the presence of mast cells in organs other than peripheral nerve and, to distinguish mast cells by their granule content, applying histochemical reactions. 32 Wistar rats were divided into 4 groups (n=8). For each group, 5 rats were intoxicated with Kh and 3 received water only as a control.Intoxicated rats received 3.5 g/ Kg body weight of dry powder of Kh fruits, fractionated in 5 doses as follows 1.5, 0.5, 0.5, 0.5, 05 on days 0, 3,7,10,14 respectively. Control rats received water only. Each group was killed at different times during paralysis evolution. Samples of liver, kidney, lung and brain, were obtained and processed by routine technique until paraffin embedding. Sections were obtained and stained with toluidine blue, PAS, alcian blue/PAS and alcian blue/safranin. Mast cells infiltrates were observed in peripheral nerve and lung. Mast cells were counted. An increasing number of mast cells were recorded as well as variations in the histochemical pattern of their granules for each organ. These findings suggest a role for mast cells and their secretions in the intoxication with mature fruit of Kh.


Assuntos
Animais , Ratos , Karwinskia/toxicidade , Mastócitos/patologia , Nervos Periféricos/patologia , Pulmão/patologia , Karwinskia/toxicidade , Ratos Wistar
11.
Rev Neurol ; 56(3): 137-42, 2013 Feb 01.
Artigo em Espanhol | MEDLINE | ID: mdl-23359074

RESUMO

INTRODUCTION: Carotid stenosis is a complication of cervical radiotherapy. In these cases carotid angioplasty has been considered as the elective revascularisation treatment. Yet, the indication to treat is under discussion due to the high rate of restenosis and the scarcity of studies conducted on the long-term development. AIMS: To report on a series of patients with carotid stenosis following radiotherapy who were treated by means of angioplasty, the aim being to analyse their long- and short-term development. PATIENTS AND METHODS: Of a series of 426 patients with carotid stenosis treated by endovascular means, 12 of them (2.8%) had previously received radiotherapy in the neck. All of them were submitted to a clinical and imaging follow-up. Data were collected concerning the rate of complications during the first four weeks and in the long term, as well as the rate of restenosis in the follow-up. RESULTS: The mean interval between radiotherapy and the detection of stenosis was 14.7 years. Ten patients (83.3%) were symptomatic. No complications occurred during the first four weeks following the angioplasty. The mean follow-up time was 45.09 months: 16.7% of patients presented a stroke, 8.3% suffered acute myocardial infarction and 33.3% died (16.6% due to cancer). At least six patients (50%) were diagnosed with restenosis, all equal to or greater than 50% and none of them were symptomatic. CONCLUSIONS: Carotid angioplasty is a safe, effective technique in stenosis following radiotherapy, with few short-term complications. The rate of carotid restenosis is high. The main cause of death is cancer.


Assuntos
Angioplastia , Lesões das Artérias Carótidas/etiologia , Estenose das Carótidas/cirurgia , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Carcinoma/radioterapia , Estenose das Carótidas/etiologia , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Laríngeas/radioterapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões por Radiação/etiologia , Recidiva , Stents
12.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 10(2): 63-70, dic. 2012. ilus, tab
Artigo em Espanhol | LILACS, BDNPAR | ID: lil-685736

RESUMO

Se presentan los resultados obtenidos en la validación de un método analítico por cromatografía líquida de alta resolución, para la determinación de ivabradina en comprimidos, el cual se diseñó para identificar y cuantificar a dicho analito, con la utilización de una columna RP-18 (150 x 4,6 mm) 5 µm y un detector UV-Vis a una λ: 285 nm. Dicho método se empleará para el control de la calidad y estabilidad de ivabradina comprimidos. El método fue validado siguiendo una metodología de trabajo de acuerdo a los lineamientos de la Conferencia Internacional sobre Armonización de Requisitos Técnicos para el Registro de Medicamentos de uso humano, Validación de procedimientos analíticos (ICH Q2), obteniendo los siguientes resultados: linealidad (r2 = 0,999), precisión Desviación estándar relativa (DSR) = 0,67 % para comprimidos del lote piloto y DSR=0,31% para comprimidos del lote comercial) y exactitud recuperación media=100,2%, demostrando de esta manera que el método propuesto es aplicable a la dosificación de ivabradina en comprimidos, tanto en el análisis del producto terminado cómo en los estudios de estabilidad.


Assuntos
Controle de Qualidade , Escalas de Preparação , Doenças Cardiovasculares/prevenção & controle
13.
Curr Med Chem ; 18(16): 2386-400, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21568918

RESUMO

Clopidogrel is a thienopyridine, which inhibits the platelet P2Y adenosine diphosphate (ADP) receptor termed P2Y(12). It is taken as a prodrug that requires biotransformation to an active metabolite by cytochrome P450 (CYP) isoenzymes. In addition, esterases shunt the majority of clopidogrel to an inactive pathway, whilst the remaining prodrug requires two separate CYP-dependent oxidative steps. PPIs might diminish the antiplatelet effects and the clinical effectiveness of clopidogrel possibly through inhibition of CYP2C19 and CYP3A4 isoenzymes. Treatment with clopidogrel and aspirin decreases recurrent cardiovascular events after an acute coronary syndrome. However, an inherent increment of major bleeding is also associated with antiplatelet therapy, as well as dyspepsia with aspirin. Also, major bleeding has been associated with high risk for ischemic events and mortality. For this reason, a proton pump inhibitor (PPI) is often co-prescribed to reduce the risk of gastrointestinal tract bleeding, but its concomitant use might reduce the inhibitory effect of clopidogrel on platelet aggregation. Nevertheless, doubts exist about the possible interaction of concomitant PPI use that may reduce the inhibitory effect of clopidogrel on platelet aggregation. Indeed, there is some controversy with regard to the true risk of cardiovascular adverse events arising from a potential drug-drug interaction between clopidogrel and PPI. In this article, we will review the current status and controversies in relation to a possible interaction between clopidogrel and PPIs.


Assuntos
Inibidores da Bomba de Prótons/farmacologia , Ticlopidina/análogos & derivados , Clopidogrel , Interações Medicamentosas , Resistência a Medicamentos , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/metabolismo , Humanos , Inibidores da Agregação Plaquetária/metabolismo , Inibidores da Agregação Plaquetária/farmacologia , Antagonistas do Receptor Purinérgico P2Y/farmacologia , Ticlopidina/metabolismo , Ticlopidina/farmacologia
15.
Rev Esp Anestesiol Reanim ; 57(5): 275-80, 2010 May.
Artigo em Espanhol | MEDLINE | ID: mdl-20527341

RESUMO

BACKGROUND AND OBJECTIVE: The latency times of midfemoral sciatic nerve blocks vary greatly. This study investigated the correlation between the type of motor response to nerve stimulation on the one hand and latency and block efficacy on the other. PATIENTS AND METHODS: We enrolled 215 consecutive patients (184 women) undergoing orthopedic foot surgery. A tourniquet was applied above the malleolus. The puncture location was found by palpating to locate the groove between the vastus lateralis and biceps femoris muscles, at the mid-point of the line between the posterior edge of the greater trochanter muscle and the insertion of the biceps femoris muscle in the popliteal fossa. A solution of equal proportions (1:1) of 1.5% mepivacaine (with bicarbonate 1:10) and 0.75% levobupivacaine was injected at a dose of 0.45 mL x kg(-1) (maximum 40 mL) using a 10-cm needle. Nerve stimulation was applied at 100-300 ms, 02-0.4 mA, and 2 Hz. Latency was classified as response in less than 15 minutes, in 15 to 30 minutes, or later than 30 minutes. RESULTS: The evoked motor response was inversion in 30 patients, flexion or extension in 38, plantar flexion in 101, dorsiflexion in 37, and eversion in 9. Shorter latencies (15 minutes) were observed in all patients with inversion or flexion/extension and in 84 (83%) of the 101 patients with plantar flexion. Mid-range latencies were observed in 13% of those with a plantar flexion response and in 29.7% of those with dorsiflexion. All 9 patients with eversion and 17 (45.9%) of the 37 patients with dorsiflexion had the longest latencies. The surgical block was complete for all patients. CONCLUSIONS: This approach provides an effective block with minimum latency in patients who have a flexion or extension motor response in the foot and/or fingers, inversion, or plantar flexion, which assumes that the injection has reached the common trunk of the sciatic or tibial nerve. However, a longer latency is associated with a peroneal motor response, particularly eversion.


Assuntos
Nervo Femoral/fisiologia , Pé/cirurgia , Bloqueio Nervoso/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/farmacologia , Bupivacaína/análogos & derivados , Bupivacaína/farmacologia , Feminino , Nervo Femoral/anatomia & histologia , Nervo Femoral/efeitos dos fármacos , Pé/anatomia & histologia , Pé/inervação , Humanos , Levobupivacaína , Masculino , Mepivacaína/farmacologia , Pessoa de Meia-Idade , Movimento , Procedimentos Ortopédicos , Estudos Prospectivos , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/fisiologia , Adulto Jovem
16.
Curr Med Chem ; 17(16): 1679-89, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20345350

RESUMO

Fabry disease (FD) is an X-linked glycosphingolipid storage disorder caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. This leads to a progressive accumulation of globotriaosylceramide (Gb3) in the lysosomes of different cells and tissues, causing principally ventricular hypertrophy, renal failure and cerebrovascular accidents, reducing lifespan both in hemizygous males and heterozygous females. Residual enzyme activity might lead to slow progression of the disease and result in the so-called cardiac or renal variants with delayed presentation. Two different forms of alpha-galactosidase A enzyme replacement therapies (ERT) are available for the treatment of FD, one genetically engineered in human cell line (agalsidase alfa, Replagal, Shire) and the other produced in a Chinese hamster ovary cell line (agalsidase beta, Fabrazyme, Genzyme). Although both proteins are structurally and functionally very similar, with the same amino acid sequence as the native human enzyme, they differ in the pattern of glycosilation of the protein depending on the originating cell line. Studies with both preparations have described a reduction in plasma, urinary sediment and tissue levels of Gb3, a decrease in the frequency of pain crisis and a reduction in left ventricular mass and improvement or stabilization of renal function. Studies have generally shown the greatest benefit when treatment is started at an early stage of the disease before extensive fibrosis or other irreversible tissue damage takes place. However, more data are needed to document long-term treatment outcomes. The aim of the present review is to provide an update overview of the two different forms of ERT for FD, their clinical effects in cardiac manifestations and their possible differences in terms of efficacy, side effects and safety profiles.


Assuntos
Terapia de Reposição de Enzimas/efeitos adversos , Terapia de Reposição de Enzimas/métodos , Doença de Fabry/tratamento farmacológico , Coração/efeitos dos fármacos , Animais , Ensaios Clínicos como Assunto , Doença de Fabry/imunologia , Doença de Fabry/patologia , Doença de Fabry/fisiopatologia , Coração/fisiopatologia , Humanos , Isoenzimas/efeitos adversos , Isoenzimas/farmacologia , Isoenzimas/uso terapêutico , Proteínas Recombinantes , alfa-Galactosidase/efeitos adversos , alfa-Galactosidase/farmacologia , alfa-Galactosidase/uso terapêutico
17.
Benef Microbes ; 1(3): 283-95, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21831765

RESUMO

The complex microbial population residing in the human gastrointestinal tract consists of commensal, potential pathogenic and beneficial species, which are probably perceived differently by the host and consequently could be expected to trigger specific transcriptional responses. Here, we provide a comparative analysis of the global in vitro transcriptional response of human intestinal epithelial cells to Lactobacillus acidophilus NCFM™, Lactobacillus salivarius Ls-33, Bifidobacterium animalis subsp. lactis 420, and enterohaemorrhagic Escherichia coli O157:H7 (EHEC). Interestingly, L. salivarius Ls-33 DCE-induced changes were overall more similar to those of B. lactis 420 than to L. acidophilus NCFM™, which is consistent with previously observed in vivo immunomodulation properties. In the gene ontology and pathway analyses both specific and unspecific changes were observed. Common to all was the regulation of apoptosis and adipogenesis, and lipid-metabolism related regulation by the probiotics. Specific changes such as regulation of cell-cell adhesion by B. lactis 420, superoxide metabolism by L. salivarius Ls-33, and regulation of MAPK pathway by L. acidophilus NCFM™ were noted. Furthermore, fundamental differences were observed between the pathogenic and probiotic treatments in the Toll-like receptor pathway, especially for adapter molecules with a lowered level of transcriptional activation of MyD88, TRIF, IRAK1 and TRAF6 by probiotics compared to EHEC. The results in this study provide insights into the relationship between probiotics and human intestinal epithelial cells, notably with regard to strain-specific responses, and highlight the differences between transcriptional responses to pathogenic and probiotic bacteria.


Assuntos
Bifidobacterium/fisiologia , Células Epiteliais/metabolismo , Escherichia coli/fisiologia , Regulação da Expressão Gênica , Intestinos/citologia , Lactobacillus/fisiologia , Linhagem Celular , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/microbiologia , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Mucosa Intestinal/metabolismo , Intestinos/efeitos dos fármacos , Intestinos/microbiologia , Modelos Biológicos , Probióticos/farmacologia , Transdução de Sinais , Ativação Transcricional/efeitos dos fármacos
19.
Actas Dermosifiliogr ; 100(5): 351-61, 2009 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-19558915

RESUMO

Unwanted hair is a common problem for which different types of light therapy have been developed as the treatment of choice. Since 1996, when the American Food and Drug Administration approved the first laser therapy for depilation, much progress has been made in light-based technology and lasers. Lasers and intense pulsed light sources with red or near infrared wavelengths (600 to 1200 nm) are the most widely used for removing hair as they target the melanin of the hair shaft, hair follicle epithelium, and hair matrix. The aim of this review is to describe and compare the different photodepilation methods currently available.


Assuntos
Remoção de Cabelo/métodos , Luz , Humanos
20.
Ecotoxicol Environ Saf ; 72(1): 37-44, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18579205

RESUMO

Cadmium, lead and cadmium-lead (1:10) induced apoptosis were studied using mallard blood cells. The allowable range in concentrations were: 0.01-0.5, 0.1-5.0, and 0.01:0.10-0.50:5.00 mM, for cadmium, lead and cadmium-lead, respectively. The lowest EC(50) achieved was for cadmium (0.22+/-0.04 mM). Two doses from each treatment group were chosen to study apoptosis and the presence of metals in cells. The percentage of apoptotic cells increased as the concentration of metals increased. The percentage of cells with intracellular metals was high for both exposure levels and the quantity of intracellular metal was greater for exposure to high concentrations. Morphological alterations for all types of exposure were related to the diverse range of effects that these metals have on membranes. We suggest that the decrease in the number of erythrocytes observed in specimens suffering from lead and cadmium poisoning is related to the induction of apoptosis.


Assuntos
Apoptose/efeitos dos fármacos , Intoxicação por Cádmio/sangue , Cádmio/toxicidade , Patos/sangue , Eritrócitos/metabolismo , Intoxicação por Chumbo/sangue , Chumbo/toxicidade , Animais , Cádmio/sangue , Cloreto de Cádmio/toxicidade , Sobrevivência Celular/efeitos dos fármacos , Eritrócitos/efeitos dos fármacos , Eritrócitos/patologia , Chumbo/sangue , Nitratos/toxicidade
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