Actividad en suero de CK y CK-MB en pacientes con infección por el virus dengue / Serum activity of CK and CK-MB in patients with dengue virus infection

RESUMEN Objetivo Determinar la actividad en suero de CK y CK-MB en pacientes con dengue. Métodos Se realizó un estudio de corte en el Departamento de Antioquia. La población de estudio estuvo constituida por 54 pacientes con diagnóstico de dengue y por 10 controles sanos. A todos los participantes se les tomó muestra de suero para confirmar la infección por dengue y para hacer la medición de la actividad de CK y CK-MB. Resultados La mediana de la edad de los casos de dengue fue 18 años y la de los controles fue 28,5 años. La mitad de los pacientes con dengue (50,9 %) y ninguno del grupo control presentaron CK-MB elevada. Ningún paciente presentó miocarditis, sin embargo, se observó CK-MB elevada en 33,3 %, 44,4 % y 40 % de los casos con bradicardia, taquicardia e hipotensión respectivamente. En 29,6 % de los pacientes con dengue se detectó CK elevada, en contraste con 10 % en el grupo control. Se observó actividad de CK en pacientes con dengue con presencia de síntomas como vómito, hematemesis y dolor abdominal, 87,5 %, 60 % y 50 % respectivamente. Conclusiones En este estudio ningún paciente con dengue presentó cardiopatía o miositis, sin embargo, el hecho de encontrar mayor frecuencia de CK y CK-MB elevadas en los pacientes con dengue con respecto al grupo control, sugiere compromiso del músculo estriado y cardíaco en este grupo. Por esta razón sería pertinente el monitoreo de estas enzimas en pacientes con dengue como parte de la evolución de la enfermedad.(AU)

ABSTRACT Objective To determine the serum activity of CK and CK-MB in patients with dengue infection. Methods A cross section study was conducted in the State of Antioquia, Colombia. The study population consisted in 54 patients with diagnosis of dengue infection and 10 healthy controls. A blood sample was taken from all participants to confirm dengue infection and to measure the activity of CK and CK-MB. Results The median age of dengue cases was 18 years and the median age of healthy controls was 28.5 years. Half of dengue patients (50.9 %) had elevated levels of CK-MB, in contrast with the healthy controls in which none presented increase of this enzyme. No patient presented myocarditis; however, elevated CK-MB was observed in 33.3 %, 44.4 % and 40 % of cases with bradycardia, tachycardia and hypotension respectively. In 29.6 % of the dengue patients, high level of CK was detected, in contrast to 10 % in the control group. Activity of CK elevated was observed in dengue patients with symptoms such as vomiting, hematemesis and abdominal pain, 87.5 %, 60 % and 50 %, respectively. Conclusions In this study, no patient with dengue infection had heart disease or myositis; however, the finding of a higher frequency of elevated level CK and CK-MB in the dengue patients compared to the control group suggests the involvement of the striated muscle and of the cardiac muscle in this group. For this reason, the monitoring of these enzymes should be considered as part of the monitoring of patients with dengue.(AU)

Abnormalities in Chromosomes 1q and 13 Independently Correlate With Factors of Poor Prognosis in Multiple Myeloma

BACKGROUND: We comprehensively profiled cytogenetic abnormalities in multiple myeloma (MM) and analyzed the relationship between cytogenetic abnormalities of undetermined prognostic significance and established prognostic factors. METHODS: The karyotype of 333 newly diagnosed MM cases was analyzed in association with established prognostic factors. Survival analysis was also performed. RESULTS: MM with abnormal karyotypes (41.1%) exhibited high international scoring system (ISS) stage, frequent IgA type, elevated IgG or IgA levels, elevated calcium levels, elevated creatine (Cr) levels, elevated β2-microglobulin levels, and decreased Hb levels. Structural abnormalities in chromosomes 1q, 4, and 13 were independently associated with elevated levels of IgG or IgA, calcium, and Cr, respectively. Chromosome 13 abnormalities were associated with poor prognosis and decreased overall survival. CONCLUSIONS: This is the first study to demonstrate that abnormalities in chromosomes 1q, 4, and 13 are associated with established factors for poor prognosis, irrespective of the presence of other concurrent chromosomal abnormalities. Chromosome 13 abnormalities have a prognostic impact on overall survival in association with elevated Cr levels. Frequent centromeric breakpoints appear to be related to MM pathogenesis.

Implante de marcapasso cardíaco definitivo em paciente com síndrome bradicardia-taquicardia, transplantado renal e com persistência de veia cava superior esquerda / Pacemaker implantation in a patient with bradycardia-tachycardia syndrome, kidney transplantation and persitent left superior vena cava

A persistência da veia cava superior esquerda é rara, principalmente quando associada a ausência da veiacava superior direita, e mais ainda quando associada a síndrome bradicardia-taquicardia. Relata-se o caso em queo diagnóstico dessa anomalia venosa foi feito durante o implante de marcapasso cardíaco artificial definitivo paratratamento de síndrome bradicardia-taquicardia. O paciente havia sido submetido a transplante renal e apresentavafunção renal limítrofe, razão pela qual se optou por não utilizar contraste para realização de venografia, dandopreferência à análise do trajeto do fio guia.

Persistent left superior vena cava is a rare anomaly, mainly when associated with absent right superiorvena cava, especially when associated with bradycardia-tachycardia syndrome. We report the case of a patient,whose diagnosis of venous anomaly was made during definitive artificial pacemaker implantation for treatment ofbradycardia-tachycardia syndrome. The patient had been submitted to a kidney transplantation and had borderlinerenal function, and therefore we chose not to use a guidewire instead of contrast media to perform venography.

Falha de estimulação ventricular por variação aguda do limiar de comando induzida pela propafenona em portadora de marcapasso definitivo: relato de caso / Ventricular stimulation failure due to acute propafenone-induced command threshold variation in a patient with permanent pacemaker: case report

Relata-se o caso de uma paciente que, durante troca do gerador do marcapasso definitivo, foi tratada com propafenona após desenvolver fibrilação atrial no período intraoperatório. Os limiares eram moderadamente aumentados no pré-operatório, entretanto, estáveis. Horas após a administração de 600 mg de propafenona, a paciente apresentou síncope justificada pela perda de comando ventricular. A avaliação do dispositivo mostrava perda de captura por aumento do limiar ventricular medido em 5,0V/0,6 ms, corrigida por estimulação com energia máxima de saída do gerador. No dia seguinte, após nova avaliação, o limiar havia retornado ao valor previamente aferido e a energia de saída do gerador diminuiu, mantendo-se estável após seis meses de seguimento...

This is the case report of a patient who was treated with propafenone during the exchange of a permanent pacemaker generator, after the development of atrial fibrillation during the procedure. The thresholds were moderately increased in the preoperative period, however, they were stable. Hours after the administration of 600 mg of propafenone, the patient had a syncope which was explained by the loss of ventricular command. The evaluation of the device showed there was loss of capture due to the ventricular threshold increase, which as measured as 5.0V/0.6 ms and was adjusted by stimulation with maximum outlet energy of the generator. On the following day, after a new assessment, the values had returned to normal, the generator outlet energy decreased, and remained stable after six months of follow-up...

Allopurinol-induced DRESS syndrome mimicking biliary obstruction

An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8degrees C), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.

Analysis of Correlation between 24-Hour Urinary Sodium and the Degree of Blood Pressure Control in Patients with Chronic Kidney Disease and Non-Chronic Kidney Disease

We investigated the association between 24-hr urinary sodium (24UNA) and adequacy of blood pressure (BP) control in patients with chronic kidney disease (CKD) and nonCKD. All data were collected retrospectively by accessing the electrical medical records in patients with 24-hr urine collection and serum creatinine. Enrolled 400 subjects were subgrouped by the amount of 24UNA, or CKD stage. The appropriate BP was defined as BP or =90 mEq/day was 2.441 (1.249-4.772, P=0.009) higher than that of 24UNA <90 mEq/day among participants with proteinuria. There was difference in the amount of 24UNA between CKD and non-CKD except each stage of CKD group. In conclusion, salt intake estimated by 24-hr urine sodium excretion is a risk factor to achieve appropriate BP control.

Effect of Bilirubin on Triglyceride Synthesis in Streptozotocin-Induced Diabetic Nephropathy

We aimed to elucidate the effect of bilirubin on dyslipidemia and nephropathy in a diabetes mellitus (DM) type I animal model. Sprague-Dawley rats were separated into control, DM, and bilirubin-treated DM (Bil) groups. The Bil group was injected intraperitoneally with 60 mg/kg bilirubin 3 times per week and hepatoma cells were cultured with bilirubin at a concentration of 0.3 mg/dL. The Bil group showed lower serum creatinine levels 5 weeks after diabetes onset. Bilirubin treatment also decreased the amount of mesangial matrix, lowered the expression of renal collagen IV and transforming growth factor (TGF)-beta1, and reduced the level of apoptosis in the kidney, compared to the DM group. These changes were accompanied by decreased tissue levels of hydrogen superoxide and NADPH oxidase subunit proteins. Bilirubin decreased serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), free fatty acids, and triglycerides (TGs), as well as the TG content in the liver tissues. Bilirubin suppressed protein expression of LXRalpha, SREBP-1, SCD-1, and FAS, factors involved in TG synthesis that were elevated in the livers of DM rats and hepatoma cells under high-glucose conditions. In conclusion, bilirubin attenuates renal dysfunction and dyslipidemia in diabetes by suppressing LXRalpha and SREBP-1 expression and oxidative stress.

A Case of Late Onset-Acute Tubulointerstitial Nephritis with Infliximab and Mesalazine Treatment in a Patient with Crohn's Disease / 대한소화기학회지

Infliximab is a chimeric anti-tumor necrosis factor-alpha monoclonal antibody. Infusion related reactions and infection are well known side effects of infliximab; however, renal complications have not been well recognized. We report on a patient with late onset-acute tubulointerstitial nephritis (ATIN) after treatment with infliximab and mesalazine for Crohn's disease. A 25-year-old woman was admitted with a purpuric rash on both lower extremities and arthralgia. She had been diagnosed with Crohn's disease 5.6 years previously and had been treated with mesalazine and infliximab. Serum creatinine level, last measured one year ago, was elevated from 0.6 mg/dL to 1.9 mg/dL. Results of urinalysis, ultrasound, and serologic examinations were normal. With a tentative diagnosis of Henoch-Schonlein purpura, oral prednisolone was given, and serum creatinine decreased to 1.46 mg/dL, but was elevated to 2.6 mg/dL again at two months after discontinuation of prednisolone. Renal biopsy indicated that ATIN was probably induced by drug, considering significant infiltration of eosinophils. Concomitant use of infliximab with mesalazine was supposed to trigger ATIN. Oral prednisolone was administered, and serum creatinine level showed partial recovery. Thus, ATIN should be suspected as a cause of renal impairment in Crohn's disease even after a long period of maintenance treatment with infliximab and mesalazine.

Evaluation of microalbuminuria in patients with systemic sclerosis as an indicator of early renal damage and increased morbidity

Renal involvement and systemic vascular damage have been shown to be significantly affecting prognosis in systemic sclerosis. Microalbuminuria detection in SSc patients as an indicator of early renal involvement and its correlation with various SSc clinical, laboratory parameters and severity of organ systems' damage assessed by Scleroderma Assessment Questionnaire. Forty SSc patients [33 females and 7 males] with mean age of 27.48 +/- 12.56 years and mean disease duration of 6.2 +/- 4.14 years were included. Twenty-four [60%] had lSSc; 13 [32.5%] had dSSc and 3 [7.5%] patients had SSc sine scleroderma. Eight [20%] had microalbuminuria and 9 [22.5%] patients had decreased creatinine clearance. Albumin/creatinine ratio was significantly higher among dSSc patients compared to those with lSSc and SSc sine scleroderma [X[2] = 9.077; p = 0.01]. Albumin/creatinine ratio showed significant positive correlations with telangiectasia [r = 0.322; p = 0.04] and mRodnan's skin score [r = 0.352; p = 0.026] and negative correlations with inter-incisor distance [r = -0.525; p = 0.001] and pleurisy [r = -0.446; p = 0.004]. Albumin/creatinine ratio correlated significantly and positively with IMSS and IDS indices of SAQ [r = 0.378, 0.32; p = 0.016, 0.044, respectively]. SSc patients with microalbuminuria showed significantly higher mean IDS than those without [1.058 vs. 0.631, p = 0.04]. No statistically significant correlations were found between creatinine clearance and the different demographic, clinical features and the indices of SAQ. Microalbuminuria compared to creatinine clearance may be a more sensitive indicator of early renal affection and predictor of increased morbidity

New Decision Criteria for Selecting Delta Check Methods Based on the Ratio of the Delta Difference to the Width of the Reference Range Can Be Generally Applicable for Each Clinical Chemistry Test Item

BACKGROUND: Many laboratories use 4 delta check methods: delta difference, delta percent change, rate difference, and rate percent change. However, guidelines regarding decision criteria for selecting delta check methods have not yet been provided. We present new decision criteria for selecting delta check methods for each clinical chemistry test item. METHODS: We collected 811,920 and 669,750 paired (present and previous) test results for 27 clinical chemistry test items from inpatients and outpatients, respectively. We devised new decision criteria for the selection of delta check methods based on the ratio of the delta difference to the width of the reference range (DD/RR). Delta check methods based on these criteria were compared with those based on the CV% of the absolute delta difference (ADD) as well as those reported in 2 previous studies. RESULTS: The delta check methods suggested by new decision criteria based on the DD/RR ratio corresponded well with those based on the CV% of the ADD except for only 2 items each in inpatients and outpatients. Delta check methods based on the DD/RR ratio also corresponded with those suggested in the 2 previous studies, except for 1 and 7 items in inpatients and outpatients, respectively. CONCLUSIONS: The DD/RR method appears to yield more feasible and intuitive selection criteria and can easily explain changes in the results by reflecting both the biological variation of the test item and the clinical characteristics of patients in each laboratory. We suggest this as a measure to determine delta check methods.

New Decision Criteria for Selecting Delta Check Methods Based on the Ratio of the Delta Difference to the Width of the Reference Range Can Be Generally Applicable for Each Clinical Chemistry Test Item

BACKGROUND: Many laboratories use 4 delta check methods: delta difference, delta percent change, rate difference, and rate percent change. However, guidelines regarding decision criteria for selecting delta check methods have not yet been provided. We present new decision criteria for selecting delta check methods for each clinical chemistry test item. METHODS: We collected 811,920 and 669,750 paired (present and previous) test results for 27 clinical chemistry test items from inpatients and outpatients, respectively. We devised new decision criteria for the selection of delta check methods based on the ratio of the delta difference to the width of the reference range (DD/RR). Delta check methods based on these criteria were compared with those based on the CV% of the absolute delta difference (ADD) as well as those reported in 2 previous studies. RESULTS: The delta check methods suggested by new decision criteria based on the DD/RR ratio corresponded well with those based on the CV% of the ADD except for only 2 items each in inpatients and outpatients. Delta check methods based on the DD/RR ratio also corresponded with those suggested in the 2 previous studies, except for 1 and 7 items in inpatients and outpatients, respectively. CONCLUSIONS: The DD/RR method appears to yield more feasible and intuitive selection criteria and can easily explain changes in the results by reflecting both the biological variation of the test item and the clinical characteristics of patients in each laboratory. We suggest this as a measure to determine delta check methods.

Efeito do uso de meia elástica sobre os níveis dos biomarcadores de lesão muscular em atletas de voleibol após atividade física / Effect of elastic stockings on biomarkers levels of muscle soreness in volleyball players after exercise

OBJETIVO: Avaliar os níveis plasmáticos dos biomarcadores de lesão muscular, a saber, creatina quinase, lactato desidrogenase e mioglobina, em atletas profissionais de voleibol após exercícios musculares anaeróbicos, com e sem uso de meia elástica. MÉTODOS: Foram avaliadas dez jogadoras profissionais de voleibol, com idades entre 18 e 25 anos, utilizando ou não meia elástica (Sport Active®, Venosan, Abreu e Lima, Brasil), com compressão de 20 a 30 mmHg abaixo do joelho. As dosagens foram feitas em três momentos: M0, início da manhã, com as atletas em repouso sem uso de meia elástica; M1, início da manhã, após a realização de atividade física com uso de meia elástica; M2, sete dias depois, após a realização dos mesmos exercícios, porém sem uso de meia elástica. Aplicou-se a escala de Borg após cada série de atividade física para avaliação do esforço. RESULTADOS: Os valores médios obtidos para creatina quinase e lactato desidrogenase foram, respectivamente, de 117,7±40,2 e 134,2±11,3 U/L, em M0; 138,2±47,2 e 157,9±10,1 U/L, em M1; e 161,3±59,9 e 177,2±18,8 U/L, em M2. Os valores médios obtidos para mioglobina foram de 31,5±6,5; 34,9±5,6 e 38,6±12,6 µg/L nos momentos M0, M1 e M2, respectivamente. Houve diferenças estatisticamente significativas (Tukey) entre M1 e M2 para os valores de creatina quinase (p=0,0007) e lactato desidrogenase (p=0,000), mas não para os valores de mioglobina (p=0,1135). Os escores da escala de Borg em M1 e M2 foram, respectivamente, de 17,8 e 18,2, sem diferença estatisticamente significante entre eles (Wilcoxon). CONCLUSÃO: O uso da meia elástica foi associado a menores níveis plasmáticos dos biomarcadores de lesão muscular após exercício físico.

OBJECTIVE:To assess plasma levels of muscle soreness biomarkers, namely creatine kinase, lactate dehydrogenase, and myoglobin, in professional volleyball players following anaerobic exercise with and without the use of elastic stockings. METHODS: Ten female volleyball players aged 18 to 25 years-old were assessed with and without below-knee 20 to 30 mmHg compression stockings (Sport Active®, Venosan, Abreu e Lima, Brazil). Biomarker levels were assessed at three different moments: M0, early in the morning, with the athletes at rest, not using elastic stockings; M1, early in the morning, following a bout of exercise using elastic stockings; M2, seven days later, following the same bout of exercise, however not using elastic stockings. The Borg scale was used after each series of exercise to evaluate the physical effort. RESULTS: The means values obtained for creatine kinase and lactate dehydrogenase were, respectively, 117.7±40.2 and 134.2±11.3 U/L at M0; 138.2±47.2 and 157.9±10.1 U/L at M1; and 161.3±59.9 and 177.2±18.8 U/L at M2. The mean values obtained for myoglobin were 31.5±6.5; 34.9±5.6 and 38.6±12.6 µg/L at the moments M0, M1 and M2, respectively. Statistically significant differences were observed between M1 and M2 (Tukey) for creatine kinase (p=0.0007) and lactate dehydrogenase (p=0.000), but not for myoglobin (p=0.1135). Borg scale scores obtained at M1 and M2 were, respectively, 17.8 and 18.2, without statistically significant differences between them (Wilcoxon). CONCLUSION: The use of elastic stockings was associated with lower plasma levels of biomarkers of muscle injury after exercise.

Evaluation of phytoconstituents and anti-nephrotoxic and antioxidant activities of monochoria vaginalis

Monochoria vaginalis is an herbaceous medicinal plant used to treat, liver problems India. Acetaminophen is a commonly used analgesic and antipyretic agent which, at high doses, causes liver and kidney necrosis in man and animals. The aim of the present study is to evaluate phytoconstituents and investigate the nephroprotective and antioxidant activities of the ethanol extract of Monochoria vaginalis on acetaminophen induced toxicity in rats. Phytoconstituents like n-hexadecanoic acid, 3-methyl- acetate-1-butanol, 1,1,3-triethoxy- propane, Z,Z,Z-1,4,6,9 - nonadecatetraene, undecanoic acid, 3-trifluoroacetoxy penta decane and 4-ethyl-5-octyl-2,2-bis [trifluoromethyl] - cis-l,3-dioxalone were identified from ethanol extract of Monochoria vaginalis by using a gas chromatograph-mass spectrograph [GC MS]. Biochemical studies show that there is an increase in the levels of serum urea and creatinine along with an increase in the body weight and reduction in the levels of uric acid in acetaminophen induced groups. These values are retrieved significantly by treatment with Monochoria vaginalis extracts at two different doses. The antioxidant studies reveal that the levels of renal SOD, CAT, GSH and GPx in the APAP treated animals are increased significantly along with a reduced MDA content in ethanol extract of Monochoria vaginalis treated groups. Apart from these, histopathological changes also reveal the protective nature of the Monochoria vaginalis extract against acetaminophen induced necrotic damage of renal tissues. In conclusion, these data suggest that the ethanol extract of Monochoria vaginalis can prevent renal damage from APAP induced nephrotoxicity in rats and it is likely to be mediated through active phytoconstituents and its antioxidant activities

Myelomatous Pleural Effusion: A Case Series in a Single Institution and Literature Review / 대한진단검사의학회지

BACKGROUND: Myelomatous pleural effusion (MPE) is rare in myeloma patients. We present a consecutive series of patients with MPE in a single institution. METHODS: We retrospectively reviewed the medical records of 19 patients diagnosed with MPE between 1989 and 2008 at the Asan Medical Center. Diagnoses were confirmed by cytologic identification of malignant plasma cells in the pleural fluid. RESULTS: Our patients showed dominance of IgA (36.8%) and IgD (31.6%) subtypes. Of 734 myeloma patients, the incidence of MPE was remarkably high for the IgD myeloma subtype (16.7%), compared to the other subtypes (1.4% for IgG and 4.6% for IgA). At the time of diagnosis of MPE, elevated serum beta2-microglobulin, anemia, elevated serum lactate dehydrogenase, and elevated creatinine levels were found in 100%, 89.5%, 83.3%, and 57.9% of the patients, respectively. Approximately one-third (31.3%) of the patients had adenosine deaminase (ADA) activities in their pleural fluid exceeding the upper limit of the reported cutoff values for tuberculous pleural effusion (55.8 U/L). Chromosome 13 abnormality was seen in 77.8% of the tested patients. The median survival period from the development of MPE was 2.8 months. CONCLUSIONS: Patients with MPE have aggressive clinical and laboratory characteristics. The preponderance of IgD myeloma in MPE patients is a noteworthy finding because IgD myeloma is a rare subtype. Elevated ADA activity in the pleural fluid is also noteworthy, and may be helpful for detecting MPE. Physicians treating myeloma patients should monitor the development of MPE and consider the possibility of a worse clinical course.

A new experimental model for acute hepatic failure in rats / Novo modelo experimental em ratos para insuficiência hepática aguda

PURPOSE: To develop a reliable surgical model of acute hepatic failure and hyperammonemia in rats that avoids porto-systemic shunt and bile duct ligation, applicable to hepatic encephalopathy research. METHODS: The pedicles of right lateral and caudate lobes were exposed and clamped. One hour later, the animal was reopened, clamps were released and anterior subtotal hepatectomy (resection of median and left lateral lobes) was performed, comprising 75 percent of liver removal. Four hours after hepatectomy, blood samples and liver tissues were collected from ALF and control groups. RESULTS: Differences between ALF and control groups were significant for ALT, AST, total and direct bilirubin, sodium, potassium, alkaline phosphatasis, gamma-glutamyltransferase and most important, ammonia. Histologically, significant differences were noticed between groups. CONCLUSION: The model is useful for the study of specific aspects of ALF and the development of new therapeutic approaches.

OBJETIVO: Desenvolver um modelo cirúrgico de IHA e hiperamonemia em ratos, que evita o shunt porto-sistêmico e a ligadura do ducto biliar, que seja aplicável à pesquisa de encefalopatia hepática. MÉTODOS: Após anestesia geral e laparotomia mediana, os pedículos dos lobos laterais direito e caudado foram isolados e clampeados. Após 1 hora, o animal foi reaberto, os clampes retirados e foi realizada hepatectomia anterior subtotal (ressecção dos lobos médio e lateral esquerdo), compreendendo a remoção de 75 por cento do parênquima. Quatro horas após a hepatectomia, amostras de sangue e tecido hepático foram coletadas nos grupos IHA e controle. RESULTADOS: Diferenças entre os grupos IHA e controle foram significativas para ALT, AST, bilirrubina total e direta, sódio, potássio, fosfatase alcalina, gama glutamiltransferase e principalmente amônia. Histologicamente, diferenças significativas foram observadas entre os grupos. CONCLUSÃO: O modelo é útil para o estudo de aspectos específicos da IHA e o desenvolvimento de novas abordagens terapêuticas.

Action of tacrolimus on Wistar rat kidneys implanted with Walker 256 carcinosarcoma / Estudo da ação do tacrolimus em rins de ratos Wistar implantados com carcinossarcoma de Walker

PURPOSE: To evaluate the development of Walker 256 tumor in male Wistar rats treated with tacrolimus using an experimental kidney tumor model. METHODS: 40 male Wistar rats were divided into four groups: Tumor group (TU) (n=10), Tacrolimus-Tumor group (TT) (n=10), Tacrolimus group (TC) (n=10) and Control group (C) (n=10). Treatment with tacrolimus was performed in groups TT and TC. Under anesthesia, the right kidney of each animal of TU and TT was accessed through a supraumbilical incision and inoculated with a 0.1mL solution containing 2x10(6) tumor cells (Walker 256 carcinosarcoma tumor cells). Group TC was treated with a saline solution. All the animals of groups TC and TT were treated with tacrolimus (5mg/kg/day) by gavage for 15 days. TU group animals received saline by gavage for 15 days. On the 15th postoperative day, all animals were submitted to euthanasia and blood sampling for analysis of serum creatinine (Cr) and blood urea nitrogen (BUN). Abdominal gross examination was performed, the right kidney removed and prepared for histological analysis by hematoxylin-eosin staining. The resulting data were submitted to statistical analysis by ANOVA. RESULTS: Statistical significance was found when comparing creatinine level between groups TU, TT and TC -TT group culminated with a marked increased in creatinine levels (Cr=1.013 ± 0.3028 mg/mL), TU group (Cr=0.5670 ± 0.03536 mg/dL) P=0.00256, TC group (Cr =0.711 ± 0.1653 mg/mL) P= 0.02832. Statistical significance was found when comparing BUN levels in TT group (71.32 ± 17.14 mg/mL), compared with TU group (45.83 ± 5.046 mg/dL), P=0.000318. There were no statistically significant differences between groups TT and TC (61.23 ± 9.503 mg/mL) P=0.7242. Histological analysis showed a poor evolution in TT group with multiple foci of hemorrhage and cortical invasion by the Walker tumor. CONCLUSION: The Tacrolimus-treated group developed a more aggressive tumor and a drug-related nephrotoxic effect.

OBJETIVO: Avaliar as alterações na evolução do carcinosarcoma 256 de Walker, inoculado no rim de ratos Wistar, sob tratamento imunossupressor com o tacrolimus. MÉTODOS: Foram utilizados 40 ratos Wistar, machos divididos em quatro grupos de 10: grupo Tumor (TU), Tumor-Tacrolimus (TT), Tacrolimus (TC) e Controle (C). Os ratos dos grupos TU e TT foram inoculados com 0,1 mL de solução contendo 2x10(6) células do tumor de Walker no parênquima do rim direito. Os dos grupos TC e TT receberam tratamento com tacrolimus na dose de 5mg/kg de peso, via gavagem orogástrica durante 15 dias. Os ratos do grupo TU receberam solução salina isotônica pH 7,2. Ao 15º dia de evolução, todos foram submetidos à eutanásia. Amostras de sangue eram coletadas para dosagem de creatinina (Cr) e uréia (Ur) e posteriormente realizada nefrectomia para avaliação histológica. RESULTADOS: As dosagens séricas de creatinina foram maiores no grupo TT (Cr = 1,013±0,3028 mg/mL), que diferiu significantemente dos grupos TU (Cr=0,5670 ± 0,03536 mg/dL) com p=0,00256 e do TC (Cr=0,711 ± 0,1653 mg/mL) com p=0,02832. As dosagens séricas de uréia foram maiores no grupo TT (71,32 ± 17,14 mg/mL), que diferiu significantemente do grupo TU (45,83 ± 5,046mg/dL) com p=0,000318, mas comparado ao grupo TC (61,23 ± 9,503 mg/mL) não houve diferença significante (p=0,7242). No inventário da cavidade abdominal dos grupos TU e TT, observou-se presença macroscópica de tumor em todos os rins direitos; não foram evidenciadas efusões ascíticas, formação de bridas ou metástases tumorais em outros órgãos ou tecidos adjacentes aos rins direitos. CONCLUSÃO: O tacrolimus exerceu efeito nefrotóxico e induziu exacerbação do crescimento do tumor de Walker 256, quando implantado no rim de ratos Wistar.

Effect of [urografin] on left ventriular diastolic and renal functions after cardiac catheterization

is to evaluate the effects of iodinated contrast media "urografin" on kidney functions and left ventricular diastolic function indices in patients underwent coronary angiography. It included 100 patients with normal kidney function 57 male [57%] and 43 female [43%]. The patients are classified into four groups:- group A: diabetic hypertensive patients, group B: only diabetic patients, group C: only hypertensive patients and group D: non diabetic, non-hypertensive patients. For all patients history taking and clinical examination, standard 12 lead ECG, abdominal ultrasonography to exclude renal medical diseases, Echo-Doppler study before, immediately and 7 days after cardiac catheterization for assessment of left ventricular diastolic functions, and kidney function tests before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization. We found an increase in blood urea, serum creatinine and decrease in creatinine clearance [not reaching the significant level] at the first day after contrast administration [P> 0.05]; However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day [P< 0.05] and return to normal at the seventh day [P< 0.05]. Also we found that the level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11 +/- 0.19 before coronary angiography changed to 1.24 +/- 0.17 immediately after coronary angiography and 1.79+0.13 three days after coronary angiography and 1.27+0.12 after seven days of coronary angiography. It was noted that the level of serum creatinine is increased by 25% or > 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography. The effects of contrast agents on kidney functions were significantly higher in groups [A] and [B] than that of groups [C] and [D] and there was a significant positive correlation between the dose of contrast media and the effect on kidney functions [P< 0.05]. Also, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups [P> 0.05] immediately after and seven days after radio contrast administration. However, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography [P> 0.05]. So the effect of radiocontrast agents after coronary angiograpghy on kidney functions is benign and transient starting within 1-2 days reaching the peak at 3-5 days and then returning to base line within 7-10 days. This effect is significantly higher in diabetic hypertensive patients than that in non-diabetic, non-hypertensive patients with positive correlation between the dose of contrast media and kidney functions. However, the ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices

Clinical Features and Predictive Factors of Acute Hepatitis A Complicated with Acute Kidney Injury / 대한소화기학회지

BACKGROUND/AIMS: We assessed the clinical features and prognosis of acute viral hepatitis A (AHA) complicated with acute kidney injury (AKI) and elucidated predictive factors for AKI in patients with AHA. METHODS: We reviewed medical record of 391 patients with AHA admitted at our institution since 2000. RESULTS: AKI was present in 45 patients (11.5%). The proportion of the AKI group increased since 2008 (5.4% before 2008 vs. 15.9% since 2008, p=0.001). The AKI group was older than the non-AKI group (35.7+/-8.7 years vs. 31.3+/-7.8 years, p=0.002). Other baseline clinical characteristics were similar between two groups. Initial hemoglobin, platelet, and serum albumin were significantly low and prothrombin time, serum bilirubin, creatinine, AST, and ALT were significantly high in the AKI group. Hepatic encephalopathy, ascites, gastrointestinal bleeding, and sepsis were more frequently observed in the AKI group. While six patients (13%) in the AKI group received liver transplantation (LT) but three patients died within one month, one patient in the non-AKI group receiving LT is alive. Multivariate analysis showed that older age (OR 1.07, 95% CI 1.02-1.12), initial thrombocytopenia <150,000/mm2 (OR 2.85, 95% CI 1.24-6.57), prothrombin time (PT) prolongation (OR 5.34, 95% CI 2.55-11.19), and hypoalbuminemia (OR 8.24, 95% CI 2.53-26.86) were independently associated with the occurrence of AKI. CONCLUSIONS: AHA with AKI is an increasing problem showing significant morbidity and mortality in Korea. AKI is highly associated with older age, initial thrombocytopenia, PT prolongation, or low serum albumin, and has bad prognostic effect.

Clinical features of patients with fulminant hepatitis A requiring emergency liver transplantation: comparison with acute liver failure due to other causes / 대한간학회지

BACKGROUND/AIMS: According to recent prevalence of hepatitis A virus (HAV) infection, acute liver failure (ALF) due to HAV infection is observed frequently in parallel. The aim of this study was to elucidate the clinical, laboratory, and pathologic features of patients who have undergone emergency liver transplantation (LT) due to fulminant HAV infection. METHODS: Clinical, laboratory, and pathologic data of 11 transplant recipients with anti-HAV IgM-positive ALF between December 2007 and May 2009 were analyzed, and compared with data of 10 recipients who underwent LT for the management of ALF due to other causes. RESULTS: The median age of the patients with HAV-related ALF was 34 years (range: 15-43 years). The levels of hemoglobin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatinine were higher and the level of bilirubin was lower in the HAV-related ALF group than in the other group (P=0.005, 0.001, 0.001, 0.010, and 0.003, respectively). The time from the onset of initial symptoms to the development of encephalopathy was shorter in the HAV-related ALF group than in the other group (median 5 days, range: 4-13 days; P<0.001). In patients with HAV-related ALF, laboratory findings and clinical prognostic parameters including the Acute Liver Failure Study Group prognostic index, King's College criteria, and model for endstage liver disease (MELD) and Child-Pugh scores were not associated with the grade of hepatic encephalopathy or time of progression to encephalopathy. CONCLUSIONS: The results of this study indicate that the clinical condition of patients with HAV-related ALF requiring emergency LT aggravates rapidly. Prognostic parameters are not sufficient for discriminating transplant candidates in patients with fulminant hepatitis A.

Inibidor da ECA e concentrações do peptídeo natriurético do tipo B, em idosos com insuficiência cardíaca / ACE inhibitors and plasma B-type natriuretic peptide levels in elderly patients with heart failure / Inhibidor de la enzima conversora de la angiotensina y concentraciones del péptido natriurético de tipo B, en personas adultas mayores con insuficiencia cardiaca

Fundamento: Ensaios clínicos demonstraram os benefícios dos inibidores da ECA (IECA) na atividade neuro-hormonal e na capacidade funcional de pacientes com insuficiência cardíaca (IC), com a magnitude desses efeitos sendo proporcional à dose desses agentes. Entretanto, a sistemática exclusão dos idosos, observada na maioria desses estudos, tem questionado a validação e incorporação de tais resultados na população geriátrica. Objetivo: Avaliar os efeitos de diferentes doses de quinapril, um IECA com meia vida biológica >24 horas, nas concentrações plasmáticas do PNB, nas distâncias percorridas no teste da caminhada de 6 minutos (TC-6 min) e na incidência de reações adversas, em idosos com IC sistólica. Métodos: Foram avaliados 30 pacientes (76,1 ± 5,3 anos; 15 mulheres), IC II-III (NYHA), FE ventricular esquerda < 40% (33,5 ± 4,5%), em uso de diuréticos (30), digoxina (24) e nitratos (13). As avaliações foram realizadas no momento da inclusão (basal) e a cada dois meses, com a adição de 10, 20, 30 e 40 mg de quinapril. Resultados: Completados oito meses, as concentrações do PNB foram 67,4% menores e as distâncias percorridas no TC-6 min 64,9% maiores em relação à condição basal. Hipotensão arterial com sintomas de baixo débito cerebral e/ou disfunção renal não foram observadas, possibilitando o emprego da dose máxima de quinapril em todos os pacientes. Conclusão: Os resultados demonstraram os benefícios dos IECA no perfil neuro-hormonal e na capacidade funcional de idosos com IC sistólica, bem como a relação positiva entre a dose e o efeito desses fármacos.

Background: Clinical trials have demonstrated the benefits of ACE inhibitors (ACEI) in the neurohormonal activity and in the functional capacity of patients with heart failure (HF), and also that these effects are dose dependent. However, since elderly individuals have been systematically excluded from the majority of these studies, the validation and incorporation of these results in the geriatric population has been questioned. Objective: To evaluate the effects of different doses of quinapril, an ACEI with a > 24-hour biological half-life, on plasma BNP levels, on the distance walked in the 6-minute walk test (6MWT) and on the incidence of adverse reactions in elderly individuals with systolic HF. Methods: A total of 30 patients (76.1 ± 5.3 years; 15 women), in NYHA functional class II-III HF, with left ventricular EF < 40% (33.5 ± 4.5%), on diuretics (30), digoxin (24) and nitrates (13) were included. The patients were assessed at baseline and every two months, with escalating doses of quinapril of 10, 20, 30 and 40 mg.Results: After eight months, BNP levels were 67.4% lower and the distance walked in the 6MWT was 64.9% longer in relation to baseline. Arterial hypotension with symptoms of low cerebral blood flow and/or renal dysfunction was not observed, so that the maximum quinapril dose could be used in all patients. Conclusion: The results demonstrated the benefits of ACEI on the neurohormonal profile and functional capacity of elderly individuals with systolic HF, as well as the positive relationship between dose and effect of these drugs.

Fundamento: Ensayos clínicos revelaron los beneficios de los inhibidores de la enzima conversora de la angiotensina (IECA) en la actividad neurohormonal y en la capacidad funcional de pacientes con insuficiencia cardiaca (IC). La magnitud de esos efectos fue proporcional a la dosificación de esos agentes. Sin embargo, la sistemática exclusión de las personas adultas mayores, observada en la mayoría de esos estudios, ha conllevado al cuestionamiento de la validación e incorporación de dichos resultados en la población geriátrica. Objetivo: Evaluar los efectos de diferentes dosis de quinapril, un IECA con vida media biológica >24 horas, en las concentraciones plasmáticas del péptido natriurético de tipo B (PNB), en las distancias recorridas en el test de marcha de 6 minutos (TM6m) y en la incidencia de reacciones adversas, en personas adultas mayores con IC sistólica. Métodos: Se evaluaron a 30 pacientes (76,1 ± 5,3 años; 15 mujeres), IC II-III (NYHA), fracción de eyección (FE) ventricular izquierda < 40% (33,5 ± 4,5%), en uso de diuréticos (30), digoxina (24) y nitratos (13). Las evaluaciones se realizaron a la inclusión (basal) y a cada dos meses, con la adición de 10, 20, 30 y 40 mg de quinapril. Resultados: Completados ocho meses, las concentraciones del PNB fueron de un 67,4% menor y las distancias recorridas en el TM6m de un 64,9% mayor con relación a la condición basal. No se observaron hipotensión arterial con síntomas de bajo débito cerebral y/o disfunción renal, posibilitando así el empleo de la dosificación máxima de quinapril en todos los pacientes. Conclusión: Los resultados revelaron los beneficios de los IECA en el perfil neurohormonal y en la capacidad funcional de personas adultas mayores con IC sistólica, así como la relación positiva entre la dosificación y el efecto de esos fármacos.