RESUMEN
Romaine lettuce in the U.S. is primarily grown in California or Arizona and either processed near the growing regions (source processing) or transported long distance for processing in facilities serving distant markets (forward processing). Recurring outbreaks of Escherichia coli O157:H7 implicating romaine lettuce in recent years, which sometimes exhibited patterns of case clustering in Northeast and Midwest, have raised industry concerns over the potential impact of forward processing on romaine lettuce food safety and quality. In this study, freshly harvested romaine lettuce from a commercial field destined for both forward and source processing channels was tracked from farm to processing facility in two separate trials. Whole-head romaine lettuce and packaged fresh-cut products were collected from both forward and source facilities for microbiological and product quality analyses. High-throughput amplicon sequencing targeting16S rRNA gene was performed to describe shifts in lettuce microbiota. Total aerobic bacteria and coliform counts on whole-head lettuce and on fresh-cut lettuce at different storage times were significantly (p < 0.05) higher for those from the forward processing facility than those from the source processing facility. Microbiota on whole-head lettuce and on fresh-cut lettuce showed differential shifting after lettuce being subjected to source or forward processing, and after product storage. Consistent with the length of pre-processing delays between harvest and processing, the lettuce quality scores of source-processed romaine lettuce, especially at late stages of 2-week storage, was significantly higher than of forward-processed product (p < 0.05).
Asunto(s)
Escherichia coli O157 , Microbiota , Microbiología de Alimentos , Lactuca , Escherichia coli O157/genética , Inocuidad de los Alimentos , Recuento de Colonia Microbiana , Manipulación de Alimentos , Contaminación de Alimentos/análisisRESUMEN
The venom of Crotalus ornatus (vCo) poses a threat to human health, as it contains a mixture of toxins that can cause cytotoxic, necrotic, and hemolytic effects. The present study assessed methanolic and acetone extracts from leaves and flowers of Larrea tridentata, as well as the bark of Quercus virginiana as potential suppressors of the toxic effects of vCo in vitro. The content of total phenols, flavonoids, and tannins of the plant extracts were quantified for the suppression of vCo cytotoxicity in two cell culture models, human lymphocytes and porcine aortic endothelial (PAE) cells. Extracts from Q. virginiana displayed a greater concentration of total phenols, flavonoids, and tannins. Co-incubation of lymphocytes and PAE cells with fixed concentrations of vCo and plant extracts resulted in decreased vCo-induced cytotoxicity. A 24-hour co-incubation of lymphocytes with vCo (2.36 ± 0.17 µg/mL) and 0.5 µg/mL of methanolic leaf extract from L. tridentata (LLM) significantly suppressed the venom-induced cytotoxicity by 37.33 ± 8.33%. Similarly, the LLM extract (4 µg/mL) caused a significant decrease in vCo cytotoxicity after 24 hours in PAE cells. In contrast, while the acetone extract of Q. virginiana bark (QA) suppressed cytotoxicity by 29.20 ± 3.51% (p < 0.001) in lymphocytes, it failed to protect PAE cells against vCo after 24 hours. In PAE cells, a shorter 4-hour co-incubation showed significant suppression of cytotoxicity with both extracts. Our results collectively suggest that LLM and QA possess cytoprotective properties against the in vitro toxic effects of vCo, and thus establish extracts from these plants as potential therapeutic interventions against Crotalus envenomation.
Asunto(s)
Larrea , Quercus , Acetona , Animales , Crotalus , Flavonoides , Metanol , Fenoles , Extractos Vegetales/toxicidad , Porcinos , Taninos , PonzoñasRESUMEN
INTRODUCTION: Introduction: persistent dysphagia affects 15 % of stroke patients and contributes to malnutrition, aspiration, and death. This study aimed to characterize patients with post-stroke dysphagia who underwent percutaneous endoscopic gastrostomy (PEG), and to assess the impact of PEG feeding on nutritional status and outcome. Methods: an observational and retrospective study using records from patients with post-stroke dysphagia who underwent PEG. Body mass index (BMI), serum albumin, transferrin, and cholesterol were recorded at the time of PEG insertion (T0) and 3 months later (T3). The evolution of these parameters was analyzed and compared to survival. Results: we obtained data from 158 patients (53.2 % males) with a median age of 75 years. Most strokes were ischemic (n = 135, 85.4 %). Median time between stroke and PEG was 2 months. Median survival after gastrostomy was 16 months. At admission, 41.6 % of patients had low BMI, 62.3 % low albumin, 68.6 % low transferrin, and 59.6 % low cholesterol levels. The prevalence of low albumin and low transferrin was higher in the patients who underwent PEG more than 2 months after stroke. A significant increase in albumin and transferrin, and a normalization of cholesterol levels was observed after 3 months of PEG feeding. Mortality was 12.9 %, 27.7 %, and 40 % at 1, 3, and 12 months, respectively. Survival was lower in patients with low albumin, transferrin or total cholesterol at admission. Conclusions: the prevalence of malnutrition is high among patients with post-stroke dysphagia. PEG feeding improves albumin, transferrin, and cholesterol levels. Early post-PEG mortality is high and must be considered on an individual basis.
INTRODUCCIÓN: Introducción: la disfagia persistente afecta al 15 % de los pacientes con accidente cerebrovascular (AVC) y contribuye a producir desnutrición, aspiración y muerte. Este estudio tuvo como objetivo caracterizar a los pacientes con disfagia post-AVC sometidos a gastrostomía endoscópica percutánea (PEG) y evaluar el impacto de la alimentación con PEG sobre el estado nutricional. Métodos: estudio observacional y retrospectivo que utiliza registros de pacientes con disfagia post-AVC sometidos a PEG. El índice de masa corporal (IMC) y los niveles de albúmina, transferrina y colesterol séricos se registraron en el momento de la inserción de la PEG (T0) y 3 meses después (T3). La evolución de estos parámetros se analizó y comparó con la supervivencia. Resultados: se obtuvieron datos de 158 pacientes (53,2 % hombres) con una edad media de 75 años. La mayoría de los AVC fueron isquémicos (n = 135, 85,4 %). El tiempo medio entre el AVC y la PEG fue de 2 meses. La supervivencia media después de la gastrostomía fue de 16 meses. Al ingreso, el 41,6 % de los pacientes presentaba un IMC bajo, el 62,3 % un nivel bajo de albúmina, el 68,6 % un nivel bajo de transferrina y el 59,6 % un nivel bajo de colesterol. La prevalencia de los niveles bajos de albúmina y de transferrina fue mayor en los pacientes que se sometieron a la PEG más de 2 meses después del AVC. Se observó un aumento significativo de la albúmina y la transferrina, y una normalización de los niveles de colesterol, después de 3 meses de alimentación con PEG. La mortalidad fue del 12,9 %, 27,7 % y 40 % a 1, 3 y 12 meses, respectivamente. La supervivencia fue menor en los pacientes con nivel bajo de albúmina, transferrina o colesterol total al ingreso. Conclusiones: la prevalencia de la malnutrición es alta entre los pacientes con disfagia post-AVC. La alimentación con PEG mejora los niveles de albúmina, transferrina y colesterol. La mortalidad temprana post-PEG es alta y debe considerarse de forma individual.
Asunto(s)
Trastornos de Deglución/diagnóstico por imagen , Endoscopía Gastrointestinal/métodos , Terapia Nutricional/métodos , Accidente Cerebrovascular/complicaciones , Adulto , Anciano , Índice de Masa Corporal , Trastornos de Deglución/etiología , Femenino , Humanos , Masculino , Desnutrición/dietoterapia , Desnutrición/prevención & control , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
AIMS: Eugenol is a natural compound found in the essential oils of many aromatic plants. The compound is used as a local anesthetic because of its inhibitory effect on the voltage-gated Na+ channels (Nav), which are expressed in the nociceptive neurons. Eugenol has shown wide range of activities in the cardiovascular system; most of these activities are attributed to the modulation of voltage-sensitive Ca2+ channels. However, its action on Nav1.5, the main subtype of Nav expressed in the mammalian myocardium, is unknown. The interaction of eugenol with Nav1.5 could also contribute to its antiarrhythmic properties in vitro and ex vivo. We investigated the compound's effect on sodium current (INa) and its possible cardiac antiarrhythmic activity. METHODS: The effect of eugenol on cardiac contractility was investigated using isolated atrium from guinea pig (for isometric force measurements). The compound's effect on INa was evaluated using human embryonic cell transiently expressing human Nav1.5 and patch-clamp technique. KEY FINDINGS: Eugenol caused negative inotropic and chronotropic effects in the atria. In the ex vivo arrhythmia model, eugenol decreased atrial pacing disturbance induced by ouabain. Eugenol reduced the INa in a concentration-dependent manner. Furthermore, the compound left-shifted the stationary inactivation curve, delayed recovery from inactivation of the INa, and preferentially blocked the channel in the inactivated state. Importantly, eugenol was able to attenuate the late sodium current. All these aspects are considered to be antiarrhythmic. SIGNIFICANCE: Overall, our findings demonstrate that eugenol has antiarrhythmic activity due, at least in part, to its interaction with Nav1.5.
Asunto(s)
Antiarrítmicos/uso terapéutico , Arritmias Cardíacas/tratamiento farmacológico , Eugenol/uso terapéutico , Corazón/efectos de los fármacos , Canal de Sodio Activado por Voltaje NAV1.5/metabolismo , Animales , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/fisiopatología , Femenino , Cobayas , Células HEK293 , Corazón/fisiopatología , Humanos , Masculino , Técnicas de Placa-ClampRESUMEN
OBJECTIVE: Vitamin D plays a major role in biological processes. Its deficiency is associated with increased morbidity and mortality. Patients who have undergone endoscopic gastrostomy (PEG) present with protein-energy malnutrition, and may be at risk for Vitamin D deficiency, due to their age, less sunlight exposure and lower dietary intake. We aimed to determine the prevalence of hypovitaminosis D in PEG-patients, its change under PEG-feeding, and its relationship with serum proteins and risk factors for Vitamin D deficiency. METHODS: This was a prospective observational study, over 4 weeks, after gastrostomy. Data were collected at the initial PEG procedure (T0), and after 4 weeks (T1). Initial evaluation included age, gender, underlying disorder, NRS-2002, BMI, serum albumin, transferrin and Vitamin D. At T1 we assessed Vit. D, albumin, and transferrin. Vitamin D was performed with Electrochemiluminescence through Elecsys 2010 assay. Patients were fed with blended homemade meals. RESULTS: 200 patients (118 males), 22-92 years of age, were studied. There were initial low values for Vit. D (181), albumin (96), transferrin (121), and BMI (124). A correlation was found between Vit. D and serum albumin (r=0.49, p=0.005) but not with transferrin (r=0.26, p=0.195). At T1 the subgroup who had Vit. D levels assessed (n=48) was part of the initial study group maintained low levels of Vitamin D despite nutritional intervention. CONCLUSION: We recommend systematic Vitamin D supplementation of PEG fed patients using homemade meals or at least screening for hypovitaminosis D as a routine part of their care.
Asunto(s)
Nutrición Enteral , Gastrostomía/efectos adversos , Desnutrición Proteico-Calórica/terapia , Deficiencia de Vitamina D/epidemiología , Vitamina D/sangre , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Trastornos de Deglución/complicaciones , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Desnutrición Proteico-Calórica/sangre , Desnutrición Proteico-Calórica/etiología , Factores de Riesgo , Albúmina Sérica/análisis , Factores de Tiempo , Transferrina/análisis , Vitamina D/administración & dosificación , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/etiología , Vitaminas/administración & dosificación , Adulto JovenAsunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Infecciones por VIH/virología , Neoplasias Hepáticas/tratamiento farmacológico , Sorafenib/uso terapéutico , Anciano , Carcinoma Hepatocelular/virología , Coinfección/complicaciones , Coinfección/tratamiento farmacológico , Coinfección/virología , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Hepacivirus , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , Hepatitis C/virología , Humanos , Quimioterapia de Inducción , Neoplasias Hepáticas/virología , MasculinoRESUMEN
INTRODUCTION: Introduction: starvation is usual in patients referred for endoscopic gastrostomy (PEG). A high risk of refeeding syndrome (RS) may contribute to poor prognosis. Objectives: this study aims to: a) evaluate serum phosphorus and magnesium when patients underwent PEG; b) determine the mortality rate during the first week and first month of enteral nutrition; and c) assess if hypophosphatemia or hypomagnesemia are associated with early mortality. Material and methods: retrospective study with patients followed in the Artificial Nutrition Clinic and died under PEG feeding. General nutritional assessment included NRS 2002, anthropometry and serum proteins. Serum phosphorus and magnesium were measured immediately before gastrostomy. Survival was recorded and compared to electrolyte and nutritional status. Results: one hundred and ninety-seven patients (137 men/60 women) aged 26-100 years. Most underwent PEG due to neurologic disorders (60.9%) and were malnourished according to body mass index (BMI) and serum proteins. Low phosphorus and magnesium were found in 6.6% and 4.6%, respectively. Hypophosphatemia was associated with malnutrition (p < 0.05). Mean survival was 13.7 ± 15.4 months. Mortality was 4.6% in the first week and 13.2% in the first month post-gastrostomy. Overall survival was shorter in malnourished patients but malnutrition did not directly influence early mortality (p > 0.05). Hypophosphatemia was associated with mortality during the first week (p = 0.02) and the first month of PEG feeding (p = 0.02). Conclusions: hypophosphatemia was uncommon but predicted early mortality after PEG. Although RS may be less frequent than expected, hypophosphatemia may be used as a RS marker and RS is the probable cause of increase early mortality in hypophosphatemic PEG-fed patients.
INTRODUCCIÓN: Introducción: la inanición es habitual en pacientes referenciados para gastrostomía endoscópica (PEG). Un riesgo alto de síndrome de realimentación (SR) puede contribuir a un mal pronóstico. Objetivos: este estudio pretende: a) estudiar el fósforo y el magnesio séricos cuando los pacientes son sometidos a PEG; b) determinar la tasa de mortalidad durante la primera semana y el primer mes de nutrición entérica; y c) evaluar si la hipofosfatemia y la hipomagnesemia se asocian con una mortalidad temprana. Material y métodos: estudio retrospectivo con pacientes seguidos en la consulta de nutrición artificial y que fallecieron utilizando alimentación por PEG. La evaluación nutricional genérica ha incluido el NRS 2002, la antropometría y la determinación de las proteínas séricas. El fósforo y el magnesio séricos se han determinado inmediatamente antes de la gastrostomía. La sobrevida fue registrada y comparada con el perfil iónico y el estado nutricional de los pacientes. Resultados: el estudio se realizó en 197 pacientes (137 hombres/60 mujeres) de 26-100 años. La mayoría se sometieron a PEG por trastornos neurológicos (60,9%) y estaban desnutridos de acuerdo con el índice de masa corporal (IMC) y las proteínas séricas. El fósforo y el magnesio séricos estaban bajos, con un 6,6% y un 4,6%, respectivamente. La hipofosfatemia se asoció con la desnutrición (p < 0,05). La sobrevida media fue de 13,7 ± 15,4 meses. Se ha registrado una mortalidad del 4,6% en la primera semana y del 13,2% en el primer mes después de la gastrostomía. La sobrevida general fue más corta en los pacientes desnutridos, pero la desnutrición no ha afectado directamente a la mortalidad temprana (p > 0,05). La hipofosfatemia se asoció con la mortalidad durante la primera semana (p = 0,02) y el primer mes de alimentación con PEG (p = 0,02). Conclusiones: la hipofosfatemia fue infrecuente, pero predijo una mortalidad temprana después del PEG. Aunque el SR es aparentemente menos frecuente de lo esperado, la hipofosfatemia puede ser utilizada como un marcador del SR y el SR es probablemente la causa de una mortalidad temprana en pacientes hipofosfatémicos alimentados con PEG.
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Gastrostomía/mortalidad , Hipofosfatemia/mortalidad , Periodo Preoperatorio , Síndrome de Realimentación/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Femenino , Humanos , Magnesio/sangre , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Fósforo/sangre , Pronóstico , Síndrome de Realimentación/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Clinical nutrition is emerging as a major area in gastroenterology practice. Most gastrointestinal disorders interfere with digestive physiology and compromise nutritional status. Refeeding syndrome (RS) may increase morbidity and mortality in gastroenterology patients. Literature search using the keywords "Refeeding Syndrome", "Hypophosphatemia", "Hypomagnesemia" and "Hypokalemia". Data regarding definition, pathophysiology, clinical manifestations, risk factors, management and prevention of RS were collected. Most evidence comes from case reports, narrative reviews and scarse observational trials. RS results from the potentially fatal shifts in fluid and electrolytes that may occur in malnourished patients receiving nutritional therapy. No standard definition is established and epidemiologic data is lacking. RS is characterized by hypophosphatemia, hypomagnesemia, hypokalemia, vitamin deficiency and abnormal glucose metabolism. Oral, enteral and parenteral nutrition may precipitate RS. Awareness and risk stratification using NICE criteria is essential to prevent and manage malnourished patients. Nutritional support should be started using low energy replacement and thiamine supplementation. Correction of electrolytes and fluid imbalances must be started before feeding. Malnourished patients with inflammatory bowel disease, liver cirrhosis, chronic intestinal failure and patients referred for endoscopic gastrostomy due to prolonged dysphagia present high risk of RS, in the gastroenterology practice. RS should be considered before starting nutritional support. Preventive measures are crucial, including fluid and electrolyte replacement therapy, vitamin supplementation and use of hypocaloric regimens. Gastroenterology patients must be viewed as high risk patients but the impact of RS in the outcome is not clearly defined in current literature.
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Gastroenterología/métodos , Desnutrición/terapia , Estado Nutricional , Apoyo Nutricional/efectos adversos , Síndrome de Realimentación/etiología , Humanos , Desnutrición/diagnóstico , Desnutrición/etiología , Desnutrición/fisiopatología , Pronóstico , Síndrome de Realimentación/diagnóstico , Síndrome de Realimentación/fisiopatología , Síndrome de Realimentación/terapia , Factores de RiesgoRESUMEN
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may also be related with severe electrolyte changes in PEG-fed patients and contribute to poor prognosis. OBJECTIVE: This study aims to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. METHODS: Retrospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016, having head/neck cancer or neurologic dysphagia, who died under PEG feeding. Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium and phosphorus) were evaluated immediately before the gastrostomy procedure. Survival after PEG until death was recorded in months. RESULTS: We evaluated 101 patients, 59 with electrolyte alterations at the moment of the gastrostomy. Sodium was altered in 32 (31.7%), magnesium in 21 (20.8%), chlorine in 21 (20.8%), potassium in 14 (13.8%), calcium in 11 (10.9 %) and phosphorus in 11 (10.9%). The survival of patients with low sodium (<135 mmol/L) was significantly lower when compared to patients with normal/high values, 2.76 months vs 7.80 months, respectively (P=0.007). CONCLUSION: Changes in serum electrolytes of patients undergoing PEG were very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent was hyponatremia, which was associated with significantly shorter survival, probably reflecting severe systemic metabolic distress.
Asunto(s)
Trastornos de Deglución/sangre , Electrólitos/sangre , Endoscopía/métodos , Nutrición Enteral/métodos , Gastrostomía/métodos , Neoplasias de Cabeza y Cuello/sangre , Adulto , Anciano , Anciano de 80 o más Años , Calcio/sangre , Trastornos de Deglución/mortalidad , Trastornos de Deglución/terapia , Endoscopía/mortalidad , Femenino , Gastrostomía/mortalidad , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/terapia , Humanos , Hiponatremia/epidemiología , Magnesio/sangre , Masculino , Persona de Mediana Edad , Fósforo/sangre , Portugal/epidemiología , Potasio/sangre , Pronóstico , Estudios Retrospectivos , Cloruro de Sodio/sangreRESUMEN
ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may also be related with severe electrolyte changes in PEG-fed patients and contribute to poor prognosis. OBJECTIVE: This study aims to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. METHODS: Retrospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016, having head/neck cancer or neurologic dysphagia, who died under PEG feeding. Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium and phosphorus) were evaluated immediately before the gastrostomy procedure. Survival after PEG until death was recorded in months. RESULTS: We evaluated 101 patients, 59 with electrolyte alterations at the moment of the gastrostomy. Sodium was altered in 32 (31.7%), magnesium in 21 (20.8%), chlorine in 21 (20.8%), potassium in 14 (13.8%), calcium in 11 (10.9 %) and phosphorus in 11 (10.9%). The survival of patients with low sodium (<135 mmol/L) was significantly lower when compared to patients with normal/high values, 2.76 months vs 7.80 months, respectively (P=0.007). CONCLUSION: Changes in serum electrolytes of patients undergoing PEG were very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent was hyponatremia, which was associated with significantly shorter survival, probably reflecting severe systemic metabolic distress.
RESUMO CONTEXTO: A gastrostomia endoscópica percutânea (PEG) é a via de eleição preferencial para a nutrição entérica de longa duração. A disfagia neurológica e as neoplasias cervico-faciais constituem as principais indicações para PEG por poderem conduzir a desnutrição energético-proteica e alterações hidroeletrolíticas, com potencial impacto negativo no equilíbrio metabólico. A síndrome de realimentação pode também estar associada a alterações hidroeletrolíticas graves em doentes alimentados por PEG e contribuir para um mau prognóstico. OBJETIVO: Avaliar as alterações das concentrações séricas dos principais eletrólitos e a eventual associação entre os valores séricos alterados e o prognóstico dos doentes gastrostomizados. Métodos - Estudo retrospetivo realizado em doentes seguidos na Consulta de Nutrição Artificial do Hospital Garcia de Orta, propostos e submetidos a PEG, de 2010 a 2016 e que faleceram sob nutrição por PEG. Consideraram-se os valores séricos dos iões em estudo avaliados imediatamente antes do procedimento endoscópico de gastrostomia, obtidos por consulta do processo clínico. A sobrevida, após a realização da PEG até à morte foi registrada em meses. RESULTADOS: Avaliaram-se 101 doentes. A sobrevida média pós-gastrostomia foi 6,55 meses. Destes, 59 apresentaram alterações de alguns iões no momento da realização da PEG. O sódio estava alterado em 31 (30,6%), magnésio em 20 (19,8%), cloro em 19 (18,8%), potássio em 14 (13,8%), cálcio em 10 (9,9%) e o fósforo em 9 (8,9%). Quando comparada a sobrevida dos doentes com valores de sódio baixo (<135 mmol/L) com a dos doentes com valores normais/elevados, esta foi 2,76 meses vs 7,80 meses, respectivamente (P=0,007). CONCLUSÃO: As alterações dos eletrólitos séricos nos doentes submetidos a PEG foram muito frequentes, com mais de metade dos doentes a apresentarem pelo menos uma alteração aquando da realização do procedimento. A alteração mais frequente foi a hiponatrémia, associando-se a pior prognóstico com sobrevida significativamente mais curta, refletindo provavelmente um grave compromisso metabólico sistêmico.
Asunto(s)
Gastrostomía/métodos , Trastornos de Deglución/sangre , Nutrición Enteral/métodos , Electrólitos/sangre , Endoscopía/métodos , Neoplasias de Cabeza y Cuello/sangre , Fósforo/sangre , Portugal/epidemiología , Potasio/sangre , Pronóstico , Gastrostomía/mortalidad , Cloruro de Sodio/sangre , Trastornos de Deglución/mortalidad , Trastornos de Deglución/terapia , Calcio/sangre , Estudios Retrospectivos , Endoscopía/mortalidad , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/terapia , Hiponatremia/epidemiología , Magnesio/sangre , Persona de Mediana EdadRESUMEN
The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparotomy with tissue sampling did not clarify ascites etiology. During hospital admission, patient status gradually deteriorated, severe malnutrition developed and ascites became refractory to diuretics. Total parenteral nutrition and octreotide therapy were started and maintained for 3 weeks with ascites resolution and no relapse after oral diet resumption. Chylous ascites is a rare entity with several causes that compromise intra-abdominal lymphatic drainage. This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients.
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Ascitis Quilosa/etiología , Ascitis Quilosa/terapia , Fármacos Gastrointestinales/uso terapéutico , Infecciones por VIH/complicaciones , Octreótido/uso terapéutico , Nutrición Parenteral Total , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Endoscopic gastrostomy (PEG) fed patients, including those with neurologic disorders (ND) or head and neck cancer (HNC) present high malnutrition risk and speech difficulties. Teams taking care of these patients need to rely on anthropometric data. Skinfold thickness (TSF) is used to assess nutritional status, but the use of heavy, large and expensive metal calipers may become a limitation. This study aimed to compare and correlate TSF measurements using a metal caliper and a plastic caliper in PEG fed patients. METHODS: Prospective observational study on adult PEG fed patients. TSF was measured using plastic Ross and Lange metal calipers. Paired measurements were compared and correlated. RESULTS: Fifty-one patients, 37 men (72.5%), 14 women (27.5%): 28 (54.9%) ND patients; 23 (45.1%) with HNC. In total, 94 TSF measurements were performed using both plastic and metal calipers. Significant association was found between TSF measurements with the two equipments (rs = 0.94; p < 0.001). High correlation was observed between TSF measurements using both calipers for both genders (men: rs = 0.93; p < 0.001; women: rs = 0.96; p < 0.001), age (< 65 years: rs = 0.98; p < 0.001; ≥ 65 years: rs = 0.88; p < 0.001), underlying condition (ND: rs = 0.91; p < 0.001; HNC: rs = 0.95; p < 0.001) and time of TSF evaluation (before PEG: rs = 0.95; p < 0,001; after PEG: rs = 0.92; p < 0.001). CONCLUSIONS: TSF measurements obtained with small, light and cheap plastic Ross caliper were equivalent to those obtained with larger, heavier and more expensive metal caliper. For everyday clinical practice, plastic calipers may be suitable for teams taking care of PEG fed patients in hospital wards, outpatient clinic and home visits.
Asunto(s)
Nutrición Enteral/instrumentación , Gastrostomía , Evaluación Nutricional , Grosor de los Pliegues Cutáneos , Adolescente , Adulto , Factores de Edad , Endoscopía Gastrointestinal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Estudios Prospectivos , Factores Sexuales , Adulto JovenRESUMEN
Background: Endoscopic gastrostomy (PEG) fed patients, including those with neurologic disorders (ND) or head and neck cancer (HNC) present high malnutrition risk and speech difficulties. Teams taking care of these patients need to rely on anthropometric data. Skinfold thickness (TSF) is used to assess nutritional status, but the use of heavy, large and expensive metal calipers may become a limitation. This study aimed to compare and correlate TSF measurements using a metal caliper and a plastic caliper in PEG fed patients. Methods: Prospective observational study on adult PEG fed patients. TSF was measured using plastic Ross and Lange metal calipers. Paired measurements were compared and correlated. Results: Fifty-one patients, 37 men (72.5%), 14 women (27.5%): 28 (54.9%) ND patients; 23 (45.1%) with HNC. In total, 94 TSF measurements were performed using both plastic and metal calipers. Significant association was found between TSF measurements with the two equipments (rs = 0.94; p < 0.001). High correlation was observed between TSF measurements using both calipers for both genders (men: rs = 0.93; p < 0.001; women: rs = 0.96; p < 0.001), age (< 65 years: rs = 0.98; p < 0.001; ≥ 65 years: rs = 0.88; p < 0.001), underlying condition (ND: rs = 0.91; p < 0.001; HNC: rs = 0.95; p < 0.001) and time of TSF evaluation (before PEG: rs = 0.95; p < 0,001; after PEG: rs = 0.92; p < 0.001). Conclusions: TSF measurements obtained with small, light and cheap plastic Ross caliper were equivalent to those obtained with larger, heavier and more expensive metal caliper. For everyday clinical practice, plastic calipers may be suitable for teams taking care of PEG fed patients in hospital wards, outpatient clinic and home visits (AU)
Introducción: los pacientes alimentados por gastrostomía endoscópica (PEG), incluyendo aquellos con enfermedades neurológicas o cáncer de cabeza y cuello, presentan un riesgo elevado de desnutrición. Los equipos que cuidan a estos pacientes se basan frecuentemente en datos antropométricos. El pliegue cutáneo del tríceps (TSF) se utiliza para evaluar el estado nutricional, pero la utilización de adipómetros metálicos pesados, grandes y costosos puede convertirse en una limitación. El presente estudio pretende comparar y correlacionar las mediciones de la TSF usando un adipómetro metálico y de plástico en pacientes alimentados por PEG. Métodos: estudio observacional prospectivo en pacientes alimentados por PEG. La TSF se midió utilizando el adipómetro metálico de Lange y el adipómetro plástico de Ross. Las mediciones emparejadas se compararon y correlacionaron. Resultados: cincuenta y un pacientes, 37 hombres (72,5%), 14 mujeres (27,5%): 28 (54,9%) pacientes neurológicos; 23 (45,1%) con cáncer de cabeza y cuello. En total, se efectuaron 94 mediciones utilizando ambos los adipómetros (de plástico y metálico). Se encontró una asociación significativa entre las mediciones de TSF con los dos tipos de adipómetros (rs = 0,94; p < 0,001). Se observó también una correlación fuerte entre las mediciones de TSF utilizando ambos adipómetros para ambos los géneros (hombres: rs = 0,93; p < 0,001; mujeres: rs = 0,96; p < 0,001), edad (< 65 años: rs = 0,98; p < 0,001; ≥ 65 años: rs = 0,88; p < 0,001), enfermedad de base (neurológicos: rs = 0,91; p < 0,001, cáncer: rs = 0,95; p < 0,001) y tiempo de evaluación (antes de PEG: rs = 0,95; p < 0,001; después de PEG: rs = 0,92; p < 0,001). Conclusiones: las mediciones de TSF obtenidas con adipómetros de plástico Ross, pequeños, ligeros y menos costosos, fueron equivalentes aquellos en que se utilizaron adipómetros metálicos grandes, pesados y más caros. Los adipómetros de plástico pueden ser más adecuados para la práctica clínica diaria de los equipos que abordan pacientes alimentados por PEG en régimen de ambulatorio o internamiento (AU)
Asunto(s)
Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Gastrostomía/métodos , Gastrostomía , Desnutrición/complicaciones , Desnutrición/dietoterapia , Estado Nutricional/fisiología , Antropometría/métodos , Adiposidad/fisiología , Tejido Adiposo/fisiología , Estudios Prospectivos , 28599RESUMEN
BACKGROUND: Prostate cancer is a major contributor to mortality worldwide, and significant efforts are being undertaken to decipher specific cellular and molecular pathways underlying the disease. Chronic stress is known to suppress reproductive function and promote tumor progression in several cancer models, but our understanding of the mechanisms through which stress contributes to cancer development and progression is incomplete. We therefore examined the relationship between stress, modulation of the gonadotropin-releasing hormone (GnRH) system, and changes in the expression of cancer-related genes in the rat prostate. METHODS: Adult male rats were acutely or repeatedly exposed to restraint stress, and compared to unstressed controls and groups that were allowed 14 days of recovery from the stress. Prostate tissue was collected and frozen for gene expression analyses by PCR array before the rats were transcardially perfused; and brain tissues harvested and immunohistochemically stained for Fos to determine neuronal activation. RESULTS: Acute stress elevated Fos expression in the paraventricular nucleus of the hypothalamus (PVH), an effect that habituated with repeated stress exposure. Data from the PCR arrays showed that repeated stress significantly increases the transcript levels of several genes associated with cellular proliferation, including proto-oncogenes. Data from another array platform showed that both acute and repeated stress can induce significant changes in metastatic gene expression. The functional diversity of genes with altered expression, which includes transcription factors, growth factor receptors, apoptotic genes, and extracellular matrix components, suggests that stress is able to induce aberrant changes in pathways that are deregulated in prostate cancer. CONCLUSIONS: Our findings further support the notion that stress can affect cancer outcomes, perhaps by interfering with neuroendocrine mechanisms involved in the control of reproduction.
Asunto(s)
Expresión Génica , Oncogenes , Próstata/metabolismo , Estrés Fisiológico , Estrés Psicológico , Animales , Biomarcadores , Transformación Celular Neoplásica , Sistema Endocrino/metabolismo , Hipotálamo/metabolismo , Masculino , Metástasis de la Neoplasia , Neoplasias de la Próstata/etiología , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Proteínas Proto-Oncogénicas c-fos/genética , Proteínas Proto-Oncogénicas c-fos/metabolismo , Ratas , Transducción de SeñalRESUMEN
BACKGROUND AND OBJECTIVES: Patients undergoing endoscopic gastrostomy (PEG) present with protein-energy malnutrition (PEM) but little is known about zinc status. Our aim was to evaluate serum zinc, its relationship with serum proteins and with the nature of the underlying disorder, during the first 3 months of PEG feeding. METHODS AND STUDY DESIGN: Prospective observational study during a 3-month period after gastrostomy. Data was collected at initial PEG procedure (T0), after 4 (T1) and 12 weeks (T3). Initial evaluation included: age, gender, disorder causing dysphagia, Neurological Dysphagia (ND) or Head and Neck Cancer (HNC), NRS-2002, BMI, albumin, transferrin, zinc. At T1 and T3, a blood sample was collected for zinc, albumin, transferrin. Serum zinc evaluation was performed with ICP-AES - Inductively Coupled Plasma-Atomic Emission Spectroscopy. Patients were fed with homemade meals. RESULTS: A total of 146 patients (89 males), 21-95 years were studied: HNC-56, ND-90 and low BMI in 78. Initial low zinc in 122; low albumin in 77, low transferrin in 94; low values for both proteins in 66. Regarding the serum protein evolution, their levels increase T0-T3, most patients reaching normal values. zinc has a slower evolution, most patients still displaying low zinc at T3. Significant differences between the 3 moments for zinc (p=0.011), albumin (p<0.0001) and transferrin (p=0.014). CONCLUSION: PEG patients are prone to PEM and zinc deficiency. Most patients present decreased zinc, suggesting that zinc deficiency is common in PEG candidates and is not corrected during 3 months of enteral feeding. Zinc deficiency should be expected and teams taking care of PEG patients should use zinc supplementation.
Asunto(s)
Trastornos de Deglución/sangre , Nutrición Enteral/métodos , Gastrostomía , Laparoscopía , Desnutrición Proteico-Calórica/etiología , Zinc/sangre , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Femenino , Gastrostomía/efectos adversos , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/complicaciones , Estudios Prospectivos , Albúmina Sérica/análisis , Transferrina/análisis , Zinc/deficienciaRESUMEN
BACKGROUND & AIMS: Patients who underwent endoscopic gastrostomy (PEG) present protein-energy malnutrition, but little is known about Trace Elements (TE), Zinc (Zn), Copper (Cu), Selenium (Se), Iron (Fe), Chromium (Cr). Our aim was the evaluation of serum TE in patients who underwent PEG and its relationship with serum proteins, BMI and nature of underlying disorder. METHODS: A prospective observational study was performed collecting: patient's age, gender, underlying disorder, NRS-2002, BMI, serum albumin, transferrin and TE concentration. We used ferrozine colorimetric method for Fe; Inductively Coupled Plasma-Atomic Emission Spectroscopy for Zn/Cu; Furnace Atomic Absorption Spectroscopy for Se/Cr. The patients were divided into head and neck cancer (HNC) and neurological dysphagia (ND). RESULTS: 146 patients (89 males), 21-95 years: HNC-56; ND-90. Low BMI in 78. Low values mostly for Zn (n = 122) and Fe (n = 69), but less for Se (n = 31), Cu (n = 16), Cr (n = 7); low albumin in 77, low transferrin in 94 and 66 with both proteins low. Significant differences between the groups of underlying disease only for Zn (t140.326 = -2,642, p < 0.01) and a correlation between proteins and TE respectively albumin and Zn (r = 0.197, p = 0.025), and albumin and Fe (r = 0.415, p = 0.000). CONCLUSIONS: When gastrostomy was performed, patients display low serum TE namely Zn, but also Fe, less striking regarding others TE. It was related with prolonged fasting, whatever the underlying disease. Low proteins were associated with low TE. Teams taking care of PEG-patients should use Zn supplementation and include other TE evaluation as part of the nutritional assessment of PEG candidates.
Asunto(s)
Enfermedades Carenciales/etiología , Trastornos de Deglución/fisiopatología , Estado Nutricional , Desnutrición Proteico-Calórica/etiología , Oligoelementos/deficiencia , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Terapia Combinada , Enfermedades Carenciales/diagnóstico , Enfermedades Carenciales/epidemiología , Enfermedades Carenciales/prevención & control , Trastornos de Deglución/sangre , Trastornos de Deglución/cirugía , Trastornos de Deglución/terapia , Nutrición Enteral , Femenino , Gastrostomía , Humanos , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Portugal/epidemiología , Estudios Prospectivos , Desnutrición Proteico-Calórica/diagnóstico , Desnutrición Proteico-Calórica/epidemiología , Desnutrición Proteico-Calórica/prevención & control , Riesgo , Espectrofotometría Atómica , Oligoelementos/sangre , Adulto JovenRESUMEN
BACKGROUND AND AIMS: endoscopic gastrostomy (PEG) patients usually present protein-energy malnutrition, but little is known about selenium deficiency. We aimed to assess serum selenium evolution when patients underwent PEG, after 4 and 12 weeks. We also evaluated the evolution of albumin, transferrin and Body Mass Index and the influence of the nature of the underlying disease. METHODS: a blood sample was obtained before PEG (T0), after 4 (T1) and 12 (T3) weeks. Selenium was assayed using GFAAS (Furnace Atomic Absorption Spectroscopy). The PEG patients were fed through homemade meals. Patients were studied as a whole and divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). RESULTS: we assessed 146 patients (89 males), between 21-95 years old: HNC-56; ND-90. Normal values of selenium in 79% (n=115); low albumin in 77, low transferrin in 94, low values for both serum proteins in 66. Low BMI in 78. Selenium has slow evolution, with most patients still displaying normal Selenium at T3 (82%). Serum protein levels increase from T0 to T3, most patients reaching normal values. The nature of the underlying disease is associated with serum proteins but not with selenium. CONCLUSIONS: low serum selenium is uncommon when PEG is performed, after 4 and 12 weeks of enteral feeding and cannot be related with serum proteins levels or dysphagia cause. Enteral nutrition using customized homemade kitchen meals is satisfactory to prevent or correct Selenium deficiency in the majority of PEG patients.
Introducción y objetivos: los pacientes con gastrostomía endoscópica (GEP) presentan malnutrición calórica- proteica, pero poco se conoce sobre la deficiencia de selenio. Estudiamos la evolución del selenio sérico en el momento de la GEP y después 4 y 12 semanas. Además, evaluamos la evolución de albúmina, transferrina, índice de masa corporal (IMC) y la influencia de la enfermedad subyacente. Métodos: obtenemos una muestra de sangre antes de la gastrostomía (T0), y después de 4 (T1) y 12 (T3) semanas. El selenio fue valorado mediante GFAAS (Furnace Atomic Absorption Spectroscopy). Los enfermos consumieron alimentos de preparación doméstica. Los pacientes fueron estudiados como un grupo y después separados en dos grupos: cánceres de cabeza y cuello (CCC) y disfagia neurológica (DN). Resultados: 146 enfermos (89 hombres), entre 2195 años: CCC-56, DN-90. Valores normales de selenio en 79% (n = 115), albúmina baja: 77 enfermos, transferrina baja: 94, las dos proteínas bajas: 66, IMC bajo: 78. El selenio ha demostrado una evolución lenta en el 82% de los enfermos presentando selenio normal en T3. Las proteínas séricas incrementaron sus valores en T0-T3, la mayoría de los enfermos alcanzó niveles normales. La enfermedad subyacente, CCC o DN, se relacionó con las proteínas, pero no con el selenio. Conclusiones: el selenio sérico bajo es poco común antes de la gastrostomía; después de 4 y 12 semanas de nutrición enteral no tiene relación con las proteínas séricas ni con la enfermedad que causa la disfagia. La nutrición con alimentación de preparación doméstica es suficiente para prevenir o corregir la deficiencia de selenio de la mayoría de los enfermos.
Asunto(s)
Trastornos de Deglución/terapia , Endoscopía Gastrointestinal , Nutrición Enteral , Gastrostomía , Selenio/deficiencia , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/terapia , Desnutrición Proteico-Calórica/etiología , Desnutrición Proteico-Calórica/terapia , Selenio/sangre , Adulto JovenRESUMEN
Background and aims: endoscopic gastrostomy (PEG) patients usually present protein-energy malnutrition, but little is known about selenium deficiency. We aimed to assess serum selenium evolution when patients underwent PEG, after 4 and 12 weeks. We also evaluated the evolution of albumin, transferrin and Body Mass Index and the influence of the nature of the underlying disease. Methods: a blood sample was obtained before PEG (T0), after 4 (T1) and 12 (T3) weeks. Selenium was assayed using GFAAS (Furnace Atomic Absorption Spectroscopy). The PEG patients were fed through homemade meals. Patients were studied as a whole and divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). Results: we assessed 146 patients (89 males), between 21-95 years old: HNC-56; ND-90. Normal values of selenium in 79% (n=115); low albumin in 77, low transferrin in 94, low values for both serum proteins in 66. Low BMI in 78. Selenium has slow evolution, with most patients still displaying normal Selenium at T3 (82%). Serum protein levels increase from T0 to T3, most patients reaching normal values. The nature of the underlying disease is associated with serum proteins but not with selenium. Conclusions: low serum selenium is uncommon when PEG is performed, after 4 and 12 weeks of enteral feeding and cannot be related with serum proteins levels or dysphagia cause. Enteral nutrition using customized homemade kitchen meals is satisfactory to prevent or correct Selenium deficiency in the majority of PEG patients (AU)
Introducción y objetivos: los pacientes con gastrostomía endoscópica (GEP) presentan malnutrición calórica-proteica, pero poco se conoce sobre la deficiencia de selenio. Estudiamos la evolución del selenio sérico en el momento de la GEP y después 4 y 12 semanas. Además, evaluamos la evolución de albúmina, transferrina, índice de masa corporal (IMC) y la influencia de la enfermedad subyacente. Métodos: obtenemos una muestra de sangre antes de la gastrostomía (T0), y después de 4 (T1) y 12 (T3) semanas. El selenio fue valorado mediante GFAAS (Furnace Atomic Absorption Spectroscopy). Los enfermos consumieron alimentos de preparación doméstica. Los pacientes fueron estudiados como un grupo y después separados en dos grupos: cánceres de cabeza y cuello (CCC) y disfagia neurológica (DN). Resultados: 146 enfermos (89 hombres), entre 21-95 años: CCC-56, DN-90. Valores normales de selenio en 79% (n=115), albúmina baja: 77 enfermos, transferrina baja: 94, las dos proteínas bajas: 66, IMC bajo: 78. El selenio ha demostrado una evolución lenta en el 82% de los enfermos presentando selenio normal en T3. Las proteínas séricas incrementaron sus valores en T0-T3, la mayoría de los enfermos alcanzó niveles normales. La enfermedad subyacente, CCC o DN, se relacionó con las proteínas, pero no con el selenio. Conclusiones: el selenio sérico bajo es poco común antes de la gastrostomía; después de 4 y 12 semanas de nutrición enteral no tiene relación con las proteínas séricas ni con la enfermedad que causa la disfagia. La nutrición con alimentación de preparación doméstica es suficiente para prevenir o corregir la deficiencia de selenio de la mayoría de los enfermos (AU)
Asunto(s)
Humanos , Desnutrición Proteico-Calórica/fisiopatología , Nutrición Enteral , Selenio/deficiencia , Gastrostomía , Gastroscopía , Transferrinas/análisis , Albúmina Sérica/análisis , Índice de Masa Corporal , Estudios ProspectivosRESUMEN
Quinolinate (QUIN) neurotoxicity has been attributed to degenerative events in nerve tissue produced by sustained activation of N-methyl-D-aspartate receptor (NMDAr) and oxidative stress. We have recently described the protective effects that selenium (Se), an antioxidant, produces on different markers of QUIN-induced neurotoxicity (Santamaría et al., 2003, J Neurochem 86:479-488.). However, the mechanisms by which Se exerts its protective actions remain unclear. Since some of these events are thought to be related with inhibition of deadly molecular cascades through the activation of antioxidant selenoproteins, in this study we investigated the effects of Se on QUIN-induced cell damage elicited by the nuclear factor kappaB (NF-kappaB) pathway, as well as the time-course response of striatal glutathione peroxidase (GPx) activity. Se (sodium selenite, 0.625 mg/kg/day, i.p.) was administered to rats for 5 days, and 120 min after the last administration, animals received a single striatal injection of QUIN (240 nmol/mul). Twenty-four hours later, their striata were tested for the expression of IkappaB-alpha (the NF-kappaB cytosolic binding protein), the immunohistochemical expression of NF-kappaB (evidenced as nuclear expression of P65), caspase-3-like activation, and DNA fragmentation. Additional groups were killed at 2, 6, and 24 h for measurement of GPx activity. Se reduced the QUIN-induced decrease in IkappaB-alpha expression, evidencing a reduction in its cytosolic degradation. Se also prevented the QUIN-induced increase in P65-immunoreactive cells, suggesting a reduction of NF-kappaB nuclear translocation. Caspase-3-like activation and DNA fragmentation produced by QUIN were also inhibited by Se. Striatal GPx activity was stimulated by Se at 2 and 6 h, but not at 24 h postlesion. Altogether, these data suggest that the protective effects exerted by Se on QUIN-induced neurotoxicity are partially mediated by the inhibition of proapoptotic events underlying IkappaB-alpha degradation, NF-kappaB nuclear translocation, and caspase-3-like activation in the rat striatum, probably involving the early activation of GPx.
Asunto(s)
Cuerpo Estriado/efectos de los fármacos , Fragmentación del ADN/efectos de los fármacos , Fármacos Neuroprotectores/farmacología , Ácido Quinolínico/toxicidad , Selenio/farmacología , Transducción de Señal/efectos de los fármacos , Animales , Western Blotting , Cuerpo Estriado/metabolismo , Cuerpo Estriado/patología , Glutatión Peroxidasa/efectos de los fármacos , Glutatión Peroxidasa/metabolismo , Proteínas I-kappa B/efectos de los fármacos , Proteínas I-kappa B/metabolismo , Inmunohistoquímica , Masculino , FN-kappa B/efectos de los fármacos , FN-kappa B/metabolismo , Ratas , Ratas WistarRESUMEN
La alergia al polen es un problema sanitario importante en Costa Rica. Este volumen presenta una revisión junto con nuevos datos sobre el tema, para el cual no parece haber estudios igualmente detallados en otros países latinoamericanos, Junto a la descripción de los métodos de muestreo se presenta además una introducción a los otros trabajos agrupados en este suplemento. Se comparó cien sujetos sanos, no alérgicos, con 480 pacientes de rinitis, conjuntivitis, asma bronquial y/o dermatitis atópica. El polen de la familia Poaceae es el principal en cuanto a sensibilización alérgica Tipo I, porque (1) porduce gran cantidad de polen, (2) se encuentra en variedad de climas y hábitats y (3) sus proteínas son particularmente alergénicas. En 1986, un 0.33 por ciento de la población del país se convirtió en nuevos pacientes de alergia, y la tendencia es al aumento. Los métodos normales resultaron satisfactorios al ser aplicados a polen congelado con una vida activa media de tres años. Las pruebas epicutáneas se realizaron por dos años consecutivos usando únicamente mezclas de extractos la primera etapa y luego extractos de cada especie para una segunda etapa. Todos 1/10 p/v, glicerinados.