RESUMO
BACKGROUND: Drug-induced immune hemolytic anemia (DIIHA) is a rare but severe side effect caused by numerous drugs. Case reports and case series suggest that piperacillin-related DIIHA may be more common among patients with cystic fibrosis (CF). However, the prevalence is speculative. The aim of this prospective, observational study was determine the prevalence of DIIHA in such affected patients. METHODS AND MATERIALS: Patients with CF hospitalized for parenteral antibiotic therapy at Charité Universitätsmedizin Berlin, who had previously been exposed to IV antibiotics, were enrolled. Blood samples were collected on Days 3 and 12 of antibiotic treatment courses. Serological studies were performed using standard techniques with gel cards. Screening for drug-dependent antibodies (ddab) was performed in the presence of the drugs and their urinary metabolites. RESULTS: A total of 52 parenteral antibiotic cycles in 43 patients were investigated. Ddab against piperacillin were detected in two patients (4.7%). The direct AHG was positive with anti-IgG only in both patients. However only one of these patients developed mild immune hemolytic anemia. Both patients had been repeatedly treated with piperacillin without any evident hemolysis. There was no correlation between the exposure to piperacillin and the prevalence of ddab. CONCLUSION: Our prospective study indicates that piperacillin-induced ddab occur more frequently in patients with CF than previously suggested. The question related to the significance of piperacillin-dependent antibodies may reflect new aspects in this field.
Assuntos
Anemia Hemolítica/induzido quimicamente , Fibrose Cística/metabolismo , Piperacilina/toxicidade , Adulto , Anemia Hemolítica/metabolismo , Antibacterianos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos ProspectivosRESUMO
INTRODUCTION: The influence of chronic administration of losartan on gap junction conductance (gj), conduction velocity and interstitial fibrosis was investigated in the failing heart of 4-month-old cardiomyopathic hamsters (TO-2). After two months of administration of losartan (25 mg/kg/day/po) the number of cell pairs showing very low values of gj (28 nS) was significantly reduced whereas the group of cell pairs with larger values of gj (18-45 nS) was significantly increased. The conduction velocity measured with intracellular microelectrodes in the wall of the left ventricle was enhanced from 38+2.3 cm/s (n=25) (control) to 49+2 cm/s (n=24) (p<0.05) after losartan administration. Moreover, the number of ventricular fibres showing non-propagated action potentials was significantly decreased (p<0.05) by losartan. The % area of interstitial fibrosis measured in the wall of the left ventricle was reduced from 22+1.4% (n=18) to 14+1.3% (n=18) (p<0.05) after losartan administration. CONCLUSION: Chronic blockade of angiotensin II type 1 receptors increased gj in the failing heart. Moreover, the conduction velocity was enhanced in part by the increase of gj and in part by the decrease of interstitial fibrosis and structural remodelling.
Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Cardiomiopatia Dilatada/tratamento farmacológico , Junções Comunicantes/efeitos dos fármacos , Sistema de Condução Cardíaco/efeitos dos fármacos , Losartan/farmacologia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Animais , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/fisiopatologia , Comunicação Celular/efeitos dos fármacos , Cricetinae , Fibrose/tratamento farmacológico , Losartan/uso terapêutico , Masculino , Mesocricetus , Condução Nervosa/efeitos dos fármacosRESUMO
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