RESUMEN
BACKGROUND: Moyamoya disease is an occlusion of the terminal portion of internal carotid arteries and proximal portion of middle and anterior cerebral arteries of unknown origin. Moyamoya syndrome is associated with meningitis, tuberculosis, syphilis, head trauma, head irradiation, brain tumor, von Recklinghausen's disease, tuberous sclerosis, Marfan syndrome, sickle cell anemia, arteriosclerosis, hypertension, and oral contraceptive use. To our knowledge, acquired immunodeficiency syndrome (AIDS) as a cause of moyamoya syndrome has not been reported in an adult population. OBJECTIVE: We report a case of moyamoya syndrome in a patient with AIDS and without other conditions associated with occlusion of the circle of Willis and formation of collateral network at the base of the brain and basal ganglia. METHODS: We present a case report. RESULTS: A 29-year-old woman with an 8-year history of AIDS on multiple antiretroviral medications presented with recurrent tingling of the left extremities which 1 month later progressed to mild hemiparesis and dysarthria. During the next few months the patient developed progressive cognitive decline and on-and-off fluctuations in the degree of hemiparesis. Brain magnetic resonance imaging showed multiple small subcortical infarct's in both parietal lobes. Magnetic resonance angiography showed occlusion of middle cerebral arteries distal internal carotid arteries, with prominent collateral network. Cerebral angiography confirmed moyamoya pattern. Lumbar puncture showed: white blood cell count 1, red blood cell count 418, protein 56, glucose 53, negative bacterial and acid-fast bacilli smear and culture, negative VDRL test, India ink, cryptococcal antigen, cytology and negative polymerase chain reaction for cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, and herpes simplex virus type 1 and 2. Electroencephalography showed diffuse background slowing. CONCLUSIONS: We hypothesize that human immunodeficiency virus (HIV) caused central nervous system vasculitis, which eventually led to formation of moyamoya pattern. No other definite causes of central nervous system vasculitis were found in our patient. Cerebrovascular disorders should be considered in patients with HIV/AIDS with focal neurologic deficit. Moyamoya syndrome as a cause of stroke should be considered in patients with HIV/AIDS, especially as survival improves.
Asunto(s)
Arteritis del Sistema Nervioso Central por SIDA/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedad de Moyamoya/virología , Arteritis del Sistema Nervioso Central por SIDA/tratamiento farmacológico , Arteritis del Sistema Nervioso Central por SIDA/patología , Arteritis del Sistema Nervioso Central por SIDA/virología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/patología , Adulto , Fármacos Anti-VIH/uso terapéutico , Aspirina/uso terapéutico , Fármacos Cardiovasculares/uso terapéutico , Angiografía Cerebral/métodos , Electroencefalografía , Femenino , Humanos , Angiografía por Resonancia Magnética , Enfermedad de Moyamoya/tratamiento farmacológico , Enfermedad de Moyamoya/patología , Resultado del TratamientoRESUMEN
A sensitive, specific and selective liquid chromatography/tandem mass spectrometric method has been developed and validated for the simultaneous determination of irbesartan and hydrochlorothiazide in human plasma. Plasma samples were prepared using protein precipitation with acetonitrile, the two analytes and the internal standard losartan were separated on a reverse phase C(18) column (50mmx4mm, 3microm) using water with 2.5% formic acid, methanol and acetonitrile (40:45:15, v/v/v (%)) as a mobile phase (flow rate of 0.70mL/min). Irbesartan and hydrochlorothiazide were ionized using ESI source in negative ion mode, prior to detection by multiple reaction monitoring (MRM) mode while monitoring at the following transitions: m/z 296-->269 and m/z 296-->205 for hydrochlorothiazide, 427-->175 for irbesartan. Linearity was demonstrated over the concentration range 0.06-6.00microg/mL for irbesartan and 1.00-112.00ng/mL for hydrochlorothiazide. The developed and validated method was successfully applied to a bioequivalence study of irbesartan (300mg) with hydrochlorothiazide (12.5mg) tablet in healthy volunteers (N=36).
Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/sangre , Compuestos de Bifenilo/sangre , Cromatografía Líquida de Alta Presión , Diuréticos/sangre , Hidroclorotiazida/sangre , Espectrometría de Masa por Ionización de Electrospray , Espectrometría de Masas en Tándem , Tetrazoles/sangre , Administración Oral , Adolescente , Adulto , Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacocinética , Compuestos de Bifenilo/administración & dosificación , Compuestos de Bifenilo/farmacocinética , Calibración , Precipitación Química , Cromatografía Líquida de Alta Presión/normas , Estudios Cruzados , Diuréticos/administración & dosificación , Diuréticos/farmacocinética , Combinación de Medicamentos , Estabilidad de Medicamentos , Humanos , Hidroclorotiazida/administración & dosificación , Hidroclorotiazida/farmacocinética , Irbesartán , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Espectrometría de Masa por Ionización de Electrospray/normas , Comprimidos , Espectrometría de Masas en Tándem/normas , Tetrazoles/administración & dosificación , Tetrazoles/farmacocinética , Equivalencia Terapéutica , Adulto JovenAsunto(s)
Hipertensión/fisiopatología , Placenta/irrigación sanguínea , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Útero/irrigación sanguínea , Velocidad del Flujo Sanguíneo , Presión Sanguínea/efectos de los fármacos , Dihidralazina/farmacología , Femenino , Corazón Fetal/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipertensión/diagnóstico por imagen , Labetalol/farmacología , Placenta/fisiopatología , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Cintigrafía , Flujo Sanguíneo Regional/efectos de los fármacos , Útero/fisiopatologíaRESUMEN
Twenty-one Salmonella enteritidis isolates were recovered from several poultry farms in three states in the Sudan over an eighteen-month period. The infection was disseminated from a distributing company which had imported infected fertilized eggs and parent stock. The Sudan S. enteritidis epidemic which devastated many poultry farms during 1990 was attributable and concurrent to that in Europe in particular and throughout the world in general.