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1.
Rev. neurol. (Ed. impr.) ; 70(1): 23-32, 1 ene., 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187125

RESUMO

Introducción: Un mecanismo plausible que puede contribuir a la resistencia a fármacos en la epilepsia es la falta de llegada de los fármacos al tejido encefálico, causado por cambios en la actividad de los transportadores ABC. El principal argumento a favor de esta hipótesis es que la resistencia ocurre frente a una gran variedad de fármacos antiepilépticos con distintos mecanismos de acción, lo que sugiere un fenómeno subyacente no específico que limita la efectividad de los tratamientos farmacológicos. Desarrollo: Se realiza una revisión bibliográfica de los transportadores ABC, su papel en la fisiología normal de la barrera hematoencefálica y en la resistencia a fármacos en la epilepsia, tanto en estudios en humanos como en modelos animales. Se revisan además los estudios de variantes genéticas en los genes ABCB1 y ABCC2, que codifican para estos transportadores, y los recientes estudios genómicos en la epilepsia y patologías afines, discutiendo sus alcances y limitaciones. Conclusiones: Hasta ahora, la asociación de variantes genéticas de transportadores ABC con la resistencia a fármacos anticonvulsionantes sigue siendo materia de debate. Se espera que la creciente masificación y accesibilidad a tecnologías de secuenciación modernas permitan establecer marcadores genéticos que otorguen una aproximación de medicina de precisión para el tratamiento de la epilepsia


Introduction: A plausible mechanism that may contribute to drug resistance in epilepsy is the failure of drugs to reach the brain tissue, caused by changes in the activity of ABC transporters. The main argument in favour of this hypothesis is that resistance occurs against a wide variety of antiepileptic drugs with different mechanisms of action, suggesting a non-specific underlying phenomenon that limits the effectiveness of drug treatments. Development: A review of the literature on ABC transporters, their role in the normal physiology of the blood-brain barrier and drug resistance in epilepsy, both in human studies and in animal models, is conducted. Studies of genetic variants in the ABCB1 and ABCC2 genes, which code for these transporters, and recent genomic studies in epilepsy and related pathologies are also reviewed, followed by a discussion of their scope and limitations. Conclusions: To date, the association of genetic variants of ABC transporters with resistance to anticonvulsant drugs remains a matter of debate. The increasingly widespread use and accessibility of modern sequencing technologies is expected to allow the establishment of genetic markers that provide a precision medicine based approach to the treatment of epilepsy


Assuntos
Humanos , Animais , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/metabolismo , Resistência a Medicamentos , Anticonvulsivantes/uso terapêutico , Transportadores de Cassetes de Ligação de ATP/metabolismo , Medicina de Precisão/métodos , Farmacogenética , Testes Farmacogenômicos , Transportadores de Cassetes de Ligação de ATP/genética , Barreira Hematoencefálica/efeitos dos fármacos , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados
2.
Arch. bronconeumol. (Ed. impr.) ; 55(12): 627-633, dic. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-186396

RESUMO

Introduction: Lung cancer is a major public health problem, as the second causes of cancer related death worldwide, with relatively low survival rates, and accessible drug resistance. Long non-coding RNAs (LncRNAs) have been identified as activator in lung cancer with elusive mechanisms. We aimed to detect the regulation of LncRNA MALAT1 in the proliferation and gefitinib resistance in lung cancer cells. Methods: MALAT1 in A549 and HCC 1299 human lung adenocarcinoma cell lines was silenced by shRNA or overexpressed using plasmid, and the cell viability and cell proliferation were evaluated by MTT assay and soft agar colony formation assay. RNA levels were detected by RT-PCR, and the protein expression was measured by western blot. The binding between MALAT1 and miR-200a was validated by luciferase reporter assays using pSi-Chech 2 vectors. Results: The cell viability and proliferation of A549 cells transfected with MALAT1 shRNA were significantly lower than the control. The MALAT1 expression in gefitinib resistant A549 cells was upregulated. miR-200a significantly inhibited the fluorescence of pSi-Check 2 vector with MALAT1 gene, suggesting the direct binding between MALAT1 and miR-200a. In addition, LncRNA MALAT1 promotes ZEB1 expression in A549 cells. Conclusion: Our study showed that MALAT1 promoted the proliferation and gefitinib resistance of lung cancer cells by sponging miR-200a, which regulates expression of ZEB1 in the A549 cells. This MALAT1/miR-200a axis could serve as new therapeutic target for lung cancer treatment


Introducción: El cáncer de pulmón es un importante problema de salud pública. Constituye la segunda causa de muerte por cáncer en el mundo y se asocia a tasas de supervivencia relativamente bajas y a resistencia a fármacos accesibles. Los RNA largos no-codificantes (lncRNA) se han identificado como activadores en el cáncer de pulmón con mecanismos aún no esclarecidos. El objetivo de este estudio fue detectar la regulación del LncRNA MALAT1 en la proliferación y la resistencia de las células tumorales de pulmón. Métodos: La expresión de MALAT1 se silenció con un shRNA o se sobreexpresó mediante el uso de un plásmido en las líneas celulares de adenocarcinoma pulmonar humano A459 y HCC. La viabilidad celular y la proliferación se evaluaron mediante un ensayo MTT y el ensayo de formación de colonias en agar blando. Los niveles de RNA se detectaron con RT-PCR y los niveles de proteína se midieron con Western Blot. La unión entre MALAT1 y miR-200a se validó gracias a un ensayo de luciferasa utilizando vectores pSi-Chech 2. Resultados: La viabilidad y la proliferación de las células A549 transfectadas con el shRNA contra MALAT1 resultaron significativamente más bajas que en el control. Se produjo un incremento en la expresión de MALAT1 en las células A549 resistentes a gefitinib. MiR-200a inhibió significativamente la fluorescencia del vector pSi-Check 2 que contenía el gen MALAT1, sugiriendo la unión directa entre MALAT1 y miR-200a. Además, el LncRNA de MALAT1 promovió la expresión de ZEB1 en las células A549. Conclusión: Nuestro estudio demuestra que MALAT1 promovió la proliferación y resistencia a gefitinib en células tumorales de pulmón actuando como "esponja" de miR-200a, que regula la expresión de ZEB1 en células A549


Assuntos
Humanos , MicroRNAs/genética , Proteínas de Ligação a RNA/genética , RNA Longo não Codificante/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias Pulmonares/diagnóstico , Resistência a Medicamentos/efeitos dos fármacos , Adenocarcinoma/diagnóstico , Gefitinibe/uso terapêutico , Reação em Cadeia da Polimerase
3.
Farm. hosp ; 43(6): 187-193, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187480

RESUMO

Objetivo: Mepolizumab está indicado como tratamiento adicional del asma eosinofílica refractaria grave. Las diferencias observadas en subgrupos poblacionales según recuento eosinofílico plasmático, existencia de pacientes con altos niveles de inmunoglobulina E candidatos a omalizumab y mepolizumab, e impacto económico de mepolizumab obligan a realizar estudios económicos para tomar decisiones clínicas eficientes. El objetivo fue realizar un análisis de coste/eficacia e impacto presupuestario de mepolizumab. Método: Se realizó la comparación de costes e impacto presupuestario del uso de mepolizumab desde la perspectiva del Sistema Nacional de Salud. Las alternativas valoradas fueron corticosteroides sistémicos inhalados + agonista ß2 de larga duración y/o corticosteroides sistémicos orales en pacientes con asma alérgica grave no mediada por inmunoglobulina E, y este tratamiento junto a omalizumab en pacientes con asma eosinofílica alérgica mediada por inmunoglobulina E. La eficacia se evaluó mediante exacerbaciones clínicamente relevantes evitadas. Se valoraron los costes directos asociados a exacerbación. Resultados: El coste incremental medio de mepolizumab respecto a omalizumab es de 797 euros por paciente y año. Considerando precio alternativo con descuento de omalizumab, incluir mepolizumab para pacientes con asma eosinofílica alérgica y mediada por inmunoglobulina E supondría incrementar el gasto público de 2,3 a 4,6 millones de euros. Teniendo en cuenta el precio notificado de omalizumab, la introducción gradual de mepolizumab en el Sistema Nacional de Salud supondría ahorrar 3,6 millones de euros en tres años. Para pacientes con asma grave no mediada por inmunoglobulina E, el coste/exacerbación evitada al añadir mepolizumab es de 15.085 euros, con un impacto presupuestario en tres años de 578,4 millones de euros, asumiendo una penetración progresiva de mepolizumab en el mercado. En los pacientes con ≥ 500 eosinófilos/µl, este coste disminuye a 7.767 euros por exacerbación evitada, con un impacto presupuestario de 183,2 millones de euros en tres años con penetración progresiva de mepolizumab. Conclusiones: La comparación de costes entre mepolizumab y omalizumab en pacientes con asma eosinofílica mediada por inmunoglobulina E señala como razonable utilizar el fármaco de menor coste, promoviendo competencia de precios. Asimismo, priorizar su uso en pacientes con asma eosinofílica refractaria grave no mediada por inmunoglobulina E y niveles plasmáticos ≥ 500 eosinófilos/µl permitiría mejorar la eficiencia y disminuir el impacto presupuestario


Objective: Mepolizumab is indicated as additional treatment of severe refractory eosinophilic asthma. Differences in subgroups according to plasmatic eosinophil count, existence of patients with high levels of immunoglobulin E candidates for omalizumab and mepolizumab, and budget impact of mepolizumab require economic studies for efficient clinical decisions. The objective was to perform a cost-efficacy and budget impact analysis of mepolizumab. Method: An analysis of comparison of costs and budgetary impact of use of mepolizumab has been performed from National Health System perspective. Evaluated alternatives were inhaled systemic corticosteroids + long-acting ß2-agonist and/or oral systemic corticosteroids in patients with severe allergic asthma not mediated by immunoglobulin E, and the same treatment associated with omalizumab in patients with immunoglobulin E-mediated allergic eosinophilic asthma. Efficacy was assessed by clinically relevant exacerbations avoided. Direct costs associated with exacerbation were assessed Results: An average incremental cost of 797 euros/patient-year was estimated. Considering alternative price with discount for omalizumab, including mepolizumab for patients with immunoglobulin E-mediated allergic eosinophilic asthma would increase public spending from 2.3 to 4.6 million euros. According reported price for omalizumab, gradual introduction of mepolizumab into the National Health System would save 3.6 million euros in three years. For patients with immunoglobulin E-not mediated severe asthma, adding mepolizumab presented a cost/exacerbation avoided of 15,085 euros and a budgetary impact for three years of 578.4 million euros according a progressive penetration of mepolizumab in market. In patients with ≥ 500 eosinophils/μL, cost/exacerbation avoided is reduced to 7,767 euros and the budgetary impact is 183.2 million euros in three years according progressive penetration of mepolizumab. Conclusions: With analysis of cost comparison of mepolizumab vs. omalizumab in patients with eosinophilic immunoglobulin E-mediated asthma, it would be reasonable to prioritize the drug more economic to promote price competition. According this pharmacoeconomic study, prioritizing mepolizumab in patients with immunoglobulin E-not mediated severe refractory eosinophilic asthma and higher plasmatic eosinophil count (≥ 500 eosinophils/μL) would improve efficiency and decrease budgetary impact


Assuntos
Humanos , Antiasmáticos/economia , Antiasmáticos/uso terapêutico , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Asma/tratamento farmacológico , Asma/economia , Asma/imunologia , Custos e Análise de Custo , Custos de Medicamentos , Resistência a Medicamentos , Eosinófilos , Imunoglobulina E/imunologia , Espanha
4.
Aten. prim. (Barc., Ed. impr.) ; 51(8): 494-498, oct. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185752

RESUMO

Aim: To determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy. Design: Cross-sectional prospective study. Location: Community of Getafe (Madrid). Primary care level. Participants: 100 E. coli strains, randomly chosen, isolated from the urine (104-105 cfu/ml) of different patients from primary care centers in the Getafe area. Main measurements The antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI. Results. Strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p = 0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p = 0.013) and ciprofloxacin (81.8% vs. 63.3%, p = 0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤ 65 years age group compared to the older age group (78.3% vs. 50%, respectively, p = 0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤ 65 years versus > 65 years), both in uncomplicated and complicated UTI. Conclusions: Clinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care


Objetivo: Determinar los patrones de sensibilidad antibiótica de cepas de Escherichia coli aisladas de pacientes adultos con infección del tracto urinario (ITU), y estratificar los resultados por edad y tipo de ITU para verificar si existen diferencias estadísticamente significativas que puedan ayudar a los médicos a la prescripción de una mejor antibioterapia empírica. Diseño: Estudio transversal prospectivo. Emplazamiento Comunidad de Getafe (Madrid). Nivel de atención primaria. Participantes:100 cepas de E. coli, escogidas al azar, aisladas de orina (104 ->105 ufc/ml) de diferentes pacientes de centros de atención primaria del área de Getafe. Mediciones principales: Se evaluó la sensibilidad antibiótica de las cepas y los resultados se estratificaron por edad y tipo de ITU. Se analizaron los datos clínicos y demográficos de los pacientes de los que provenían, clasificándose cada episodio como ITU complicada o ITU no complicada. Resultados: Las cepas aisladas de pacientes con ITU no complicada mostraron una sensibilidad antibiótica significativamente mayor que las de ITU complicada a amoxicilina (65,9% vs. 30,6%, p = 0.001), amoxicilina/clavulánico (95,5% vs. 77,6%, p = 0.013) y ciprofloxacino (81,8% vs. 63,3%, p = 0.047). En la ITU complicada, la sensibilidad al ciprofloxacino fue significativamente mayor en el grupo de edad ≤ 65 años en comparación con el grupo de mayor edad (78,3% vs. 50%, p = 0.041). Para el resto de antibióticos no se observaron diferencias significativas cuando se compararon por edad (≤ 65 versus > 65), tanto en ITU no complicada como complicada. Conclusiones: Los datos clínicos y demográficos de los pacientes con ITU son de gran importancia en los resultados de la sensibilidad antibiótica en E. coli. Los antibiogramas estratificados por características de los pacientes podrían facilitar una mejor selección de antibioterapia empírica para las ITU en atención primaria


Assuntos
Humanos , Infecções Urinárias/diagnóstico por imagem , Infecções Urinárias/tratamento farmacológico , Sensibilidade e Especificidade , Resistência a Medicamentos , Infecções Comunitárias Adquiridas/epidemiologia , Estudos Transversais , Estudos Prospectivos , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/microbiologia
5.
Endodoncia (Madr.) ; 37(2): 8-20, sept. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-186295

RESUMO

Objetivos. Los objetivos de este son: 1. Evaluar el consumo de medicamentos, así como la automedicación entre los individuos que acuden a realizarse una endodoncia. 2.Evaluar la mejoría de sintomatología tras la toma de medicación. 3. Evaluar la ansiedad dental entre los pacientes sometidos a tratamiento endodóntico previo a la intervención. Material y Métodos: Se realizó un estudio de tipo observacional, transversal y comparativo, consistente en una encuesta sobre pacientes mayores de 16 años que acudieron a una clínica universitaria odontológica. Resultados: Se recopilaron 167 encuestas entre septiembre de 2017 y marzo del 2018, siendo válidas 131 y no válidas 36, cuyos resultados más destacados fueron los siguientes: · Ingesta de antibióticos + analgésicos y/o AINES (40,6%)· Ingesta analgésicos y/o AINES (59,4%). Origen de esa medicación; 44,6% prescrita por el odontólogo, seguida del 42,7% que corresponde a la tomada por decisión propia, 10,8% al médico de cabecera, 2,7% a urgencias y 0% al farmacéutico y de origen homeopático. Media de ansiedad en la escala de 4,38. La media de ansiedad en mujeres: 5 y en hombres: 3,2 (p: 0.0066). Grupo con algún tipo de formación académica; media de ansiedad: 4,24 y grupo sin ningún estudio; media de ansiedad: 8,75 (p: 0.0144). Conclusiones: Los pacientes encuestados tenían una alta tendencia a la automedicación, utilizándose fundamentalmente analgésicos y/o AINES. Además, referían mejoría en el día de la intervención tras haber tomado algún tipo de medicamento. Los pacientes encuestados sufrieron un grado de ansiedad medio previo a la realización del tratamiento endodóntico


Objectives: The objectives of this study are: 1. To evaluate the consumption of medicines as well as self-medication among the individuals who undergo endodontics.2. To evaluate the improvement of symptoms after taking medication. 3. To evaluate dental anxiety among patients undergoing endodontic treatment prior to the intervention. Material and Methods: An observational, transversal and comparative study was carried out, consisting of a survey of patients over 16 years of age who attended a university dental clinic. Results: In this study 167 surveys were collected, between September 2017 and March 2018, with 131 valid and 36 invalid. Taking antibiotics + analgesics and/or NSAIDs (40.6%) and analgesics and/or NSAIDs (59.4%); Origin of that medication; 44.6% prescribed by the dentist, followed by the 42.7% prescribed by the dentist, 10.8% by the general practitioner, 2.7% by the emergency department and 0% by the pharmacist and homeopathic origin. Average anxiety on the 4.38 scale. Average anxiety in women: 5 and in men: 3.2 (p: 0.0066).Group with some type of academic training; mean anxiety: 4.24 and group without any study; mean anxiety: 8.75 (p: 0.0144). Conclusions: The patients surveyed had a high tendency to self-medication, mainly using analgesics and/or NSAIDs. They also reported improvement on the day of the intervention after having taken some type of medication. The patients surveyed suffered a medium degree of anxiety prior to the endodontic treatment


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Automedicação/tendências , Ansiedade/psicologia , Endodontia/métodos , Avaliação de Medicamentos/métodos , Sobremedicalização , Estudos Transversais , Resistência a Medicamentos , Epidemiologia Descritiva , Pulpite/tratamento farmacológico , Inquéritos e Questionários
6.
Arch. Soc. Esp. Oftalmol ; 94(7): 331-336, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185187

RESUMO

Objetivo: Presentar los resultados del tratamiento con luz pulsada regulada (IPL) en pacientes con ojo seco. Material y métodos: Estudio retrospectivo. Se analizaron historias clínicas de pacientes con ojo seco sometidos a terapia IPL en quienes no se logró un control satisfactorio de los síntomas luego de terapia médica. Se evaluó previo al inicio y al final de la terapia una escala analógica visual de síntomas y además el tiempo de rotura de la película lagrimal (tBUT), test de Schirmer y puntuación de Van Bijsterveld. Se realizó un análisis de medidas repetidas con SPSS comparando los resultados antes y después de realizar la terapia IPL. Resultados: Se analizaron 50 ojos de 25 pacientes: 9 hombres (36%) y 16 mujeres (64%); se encontró una mediana de edad de 59 años (RIC 52-64). La mediana en la escala de síntomas fue de 8 (RIC 8-9) y 3 (RIC 2-4) antes y después del tratamiento con IPL (p<0,05). El tBUT tuvo una mediana de 4 (RIC 3-5) y 10 (RIC 8-11), el test de Schirmer de 13 (RIC 12-15) y 15 (RIC 13-20) y la puntuación de Van Bijsterveld de 3 (RIC 3-4) y 2 (RIC 2-3) antes y después del tratamiento, respectivamente (p < 0,05 en todos los análisis). Conclusiones: La terapia de IPL para el ojo seco es una excelente opción de tratamiento: muestra mejoría objetiva mediante la estabilización de la película lagrimal y tinción de superficie ocular, así como también mejoría subjetiva evidenciada en los síntomas manifestados por los pacientes


Objective: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease. Material and methods: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee. Results: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59 years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P < .05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P < .05, for all measurements). Conclusion: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Síndromes do Olho Seco/terapia , Terapia Combinada , Estudos Transversais , Resistência a Medicamentos , Síndromes do Olho Seco/etiologia , Estudos Retrospectivos , Rosácea/complicações , Índice de Gravidade de Doença , Síndrome de Sjogren/complicações , Resultado do Tratamento
8.
Int. microbiol ; 22(1): 41-48, mar. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-184812

RESUMO

Microalgal-bacterial co-cultures were employed for the treatment of artificially prepared metal-rich wastewaters in this study. For the purpose, highly metal-resistant microalgal and bacterial species were isolated from a leading wastewater channel flowing through Lahore, Pakistan, and characterized at the molecular level. The microbial identities were proved after BLAST analysis. The microalgal (Chlorella vulgaris-BH1) and bacterial (Exiguobacterium profundum-BH2) species were then co-cultured in five different proportions. Five different proportions of potentially mutualistic microbial co-cultures (comprising of microalgal to bacterial cells in ratios of 1:3, 2:3, 3:3, 3:1, and 3:2) prepared thus were employed to remediate artificially prepared metal-loaded wastewaters. Three randomly selected toxic metals (Cu, Cr, and Ni) were used in this study to prepare metal-rich wastewaters. The microalgal-bacterial co-cultures were then exposed independently to the wastewaters containing 100 ppm of each of the above mentioned metals. The inoculated wastewaters were incubated maximally for a period of 15 days. The metal uptake was noted periodically after every 5 days. The results of the present study depicted that maximally about 78.7, 56.4, and 80% of Cu, Cr, and Ni were removed, respectively after an incubation period of 15 days. The microbial co-culture consisting of microalgal to bacterial cells in a ratio of 3:1 showed the highest remedial potential. The findings of the present study will be helpful in developing effective microalgal-bacterial consortia for economical, efficient, and environment-friendly rehabilitation of the polluted sites


No disponible


Assuntos
Bacillales/metabolismo , Chlorella vulgaris/metabolismo , Técnicas de Cocultura , Metais/metabolismo , Poluentes Químicos da Água/metabolismo , Bacillales/efeitos dos fármacos , Bacillales/crescimento & desenvolvimento , Chlorella vulgaris/efeitos dos fármacos , Chlorella vulgaris/crescimento & desenvolvimento , Poluentes Químicos da Água/toxicidade , Resistência a Medicamentos , Metais/toxicidade , Paquistão
10.
Nefrología (Madrid) ; 39(1): 67-72, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181911

RESUMO

Introducción: El presente estudio tiene como objetivo destacar la importancia de la monitorización ambulatoria de la presión arterial (MAPA) y de los parámetros de lesión subclínica de órgano diana en el diagnóstico de hipertensión refractaria (HR). Métodos: Se estudiaron pacientes con diagnóstico de HR (n = 112). Se analizaron variables demográficas, antropométricas, riesgo cardiovascular y lesión subclínica de órgano diana y se relacionaron con la confirmación de HR a través de la MAPA. Resultados: Del total de 112 pacientes con el diagnóstico de HR derivados desde atención primaria se confirmaron mediante MAPA el 61,6% de los casos (n = 69). Se observaron diferencias estadísticamente significativas (p < 0,001) en la aparición de lesión subclínica de órgano diana en los hipertensos refractarios respecto a los pseudorrefractarios. Un 84% de los pacientes con HR presentaban microalbuminuria: 66,25 ± 30,7 mg/dl). El 44,9% tienen una enfermedad renal crónica estadio 3 con filtrado glomerular medio de 59 ml/min/1,73 m2. El 56,5% presentaba hallazgos ecocardiográficos de hipertrofia de ventrículo izquierdo. El examen de fondo de ojo reveló que un 64% de los pacientes presentaban retinopatía hipertensiva. Las 3 variables que se asociaron a mayor riesgo de HR fueron la presencia de microalbuminuria, retinopatía hipertensiva e hipertrofia de ventrículo izquierdo por ecocardiograma (OR 5,7, 6,2 y 11,2, respectivamente). Conclusiones: Nuestro estudio demuestra que la búsqueda sistemática de daño de órgano diana, especialmente en lo referente a albuminuria, es una herramienta sencilla y barata, con un valor predictivo de HR alto (85%). Podría ser de utilidad en circunstancias en las que es necesario priorizar la realización de MAPA


Introduction: We aimed to assess the effectiveness of ambulatory blood pressure monitoring (ABPM) and subclinical target organ damage parameters for diagnosis of resistant hypertension (RH). Methods: We assessed demographic and anthropometric variables, the incidence of cardiovascular events and subclinical target organ damage (n = 112). We also studied the relationship between these variables and the ABPM results. Results: Of the 112 patients referred from primary care with a diagnosis of RH, 69 (61.6%) were confirmed by ABPM. We found statistically significant differences (P < .001) between patients with RH and pseudo-resistant hypertension in the appearance of subclinical target organ damage. A percentage of 84 of the patients had microalbuminuria: 66.25 ± 30.7 mg/dl); 44.9% had stage 3 chronic kidney disease: the average glomerular filtration was 59 ml/min/1.73m2; and 56.5% had left ventricular hypertrophy on echocardiography. Fundoscopy revealed that 64% of the patients had hypertensive retinopathy. Three variables were associated with an increased HR risk: microalbuminuria, hypertensive retinopathy and left ventricular hypertrophy (OR 5.7, 6.2 and 11.2, respectively). Conclusions: This study shows that the systematic testing for target organ damage, particularly in terms of albuminuria, is a simple and inexpensive tool, with a high predictive value for RH (85%), which could be useful for prioritising patients who need ABPM


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Monitorização Ambulatorial da Pressão Arterial , Retinopatia Hipertensiva/complicações , Hipertrofia Ventricular Esquerda/complicações , Anti-Hipertensivos/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Resistência a Medicamentos , Estudos Prospectivos , Estudos Transversais , Estudos de Coortes , Fatores de Risco
11.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(supl.2): 3-9, dic. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-177041

RESUMO

Darunavir es el inhibidor de la proteasa de referencia en el tratamiento antirretroviral. Dispone de un desarrollo completo con datos de ensayos clínicos de distribución aleatoria a lo largo de todo el espectro de la infección por el VIH, con 2 dosificaciones distintas e indicaciones claras de cuándo debe usarse cada una de ellas. Se ha estudiado en monoterapia, biterapia y triterapia. Asimismo, se puede administrar potenciado con ritonavir o cobicistat. Los datos indican que es el antirretroviral con mayor barrera frente al desarrollo de resistencias y que se mantiene más tiempo unido a su receptor de actuación (proteasa), con el tiempo de disociación más prolongado. Su limitado impacto sobre las mutaciones seleccionadas en la proteasa por otros inhibidores y su elevada barrera frente a la resistencia han motivado que su extenso uso comercial se haya asociado con una reducción progresiva de las mutaciones circulantes en la proteasa con impacto frente a su actividad. Información sobre el suplemento: este artículo forma parte del suplemento titulado "Darunavir, cobicistat, emtricitabina y tenofovir alafenamida coformulados en el tratamiento de la infección por el VIH", que ha sido patrocinado por Janssen


Darunavir is the gold standard protease inhibitor in antiretroviral treatment. It has undergone complete development through randomised clinical trials throughout the entire spectrum of HIV infection, with 2 different dosages and clear indications of when to use each one of them. It has been studied in mono, dual and triple therapy. It can also be administered boosted with either ritonavir or cobicistat. The data indicate that it is the antiretroviral with the greatest barrier against resistance development and that it is the drug with the longest residence time bound to its receptor (protease), thus having the longest dissociation time. Its limited impact on selected mutations in the protease by other inhibitors and its high barrier against resistance have resulted in its widespread commercial use being associated with a steady decrease in the mutations circulating in the protease having an impact on its activity. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen


Assuntos
Humanos , Infecções por HIV/tratamento farmacológico , Darunavir/uso terapêutico , Inibidores da Protease de HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Quimioterapia Combinada , Resistência a Medicamentos/genética , Mutação
12.
Nutr. hosp ; 35(4): 993-995, jul.-ago. 2018.
Artigo em Espanhol | IBECS | ID: ibc-179896

RESUMO

Caso clínico: presentamos un paciente varón de 85 años con polidipsia, poliuria e hipertrigliceridemia severa de 27 años de evolución, sin pancreatitis, persistente y resistente a tratamientos dietético y farmacológico. Se diagnosticó de hiperglicerolemia por déficit de glicerol kinasa (GKD) en base a: suero transparente no lipémico, aumento de glicerol en plasma y orina, sin aumento de glicerol 3 fosfato y deleción, no descrita previamente, en el gen de la glicerol kinasa. Discusión: un tratamiento dietético correcto con comidas frecuentes y rico en carbohidratos complejos, sin medicación, mejoró la sintomatología


Case report: we present an 85-year-old patient with polydipsia, polyuria and severe hypertriglyceridemia of 27 years of evolution, without pancreatitis, resistant to dietary and pharmacological treatments. He was diagnosed of hyperglycerolemia due to glycerol kinase defi ciency (GKD) based on: transparent non-lipemic serum, with glycerol increase in plasma and urine, without glycerol 3 phosphate increase, and a deletion, not previously described, in the glycerol kinase gene. Discussion: a correct dietary treatment with frequent meals and rich in complex carbohydrates, without medication, improved the symptomatology


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Glicerol Quinase/deficiência , Glicerol Quinase/genética , Hipertrigliceridemia/terapia , Hipertrigliceridemia/etiologia , Dieta , Resistência a Medicamentos , Deleção de Genes
13.
Pharm. pract. (Granada, Internet) ; 16(2): 0-0, abr.-jun. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174791

RESUMO

Background: Hypertension is an important public health problem worldwide. There is lack of data on uncontrolled blood pressure in developing countries. Objectives: To determine the magnitude and predicting factors of uncontrolled blood pressure in hypertensive patients attending Gondar university hospital, Ethiopia. Methods: A hospital-based cross-sectional survey was conducted from July 2015 to March 2016. All hypertensive patients were followed and the blood pressure levels were measured. Binary logistic regression analysis was done to determine the predictors of uncontrolled blood pressure. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results: Of the total 578 hypertension patients, 543 (93.9%) fulfilled the study criteria and were included in the final analysis. The mean age of the participants was 55.96±14.6 years. Nearly two-third (58.2%) of the participants were females. More than one-tenth (11.4%) of the respondents had uncontrolled blood pressure. High salt intake carried six times more risk of uncontrolled blood pressure. Elderly individuals had lower risk as compared to young age group. However, comorbidities were not related with uncontrolled blood pressure. Conclusions: Blood pressure control was relatively high in the hospital studied. High salt intake was strongly linked with uncontrolled blood pressure. Individuals with high salt intake should be followed for their medication experience and disease knowledge


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Dieta Hipossódica , Etiópia/epidemiologia , Hipertensão/complicações , Resistência a Medicamentos , Fatores de Risco , Efeito Idade , Sódio na Dieta/administração & dosagem , Hipertensão/terapia , Estudos Transversais
14.
Allergol. immunopatol ; 46(2): 175-180, mar.-abr. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-172177

RESUMO

Background: Invariant natural killer T (iNKT) cells play complex functions in the immune system, releasing both Th1 and Th2 cytokines. The role of iNKT cells in human asthma is still controversial and never described in severe therapy-resistant asthma in children. The objective of this work was to analyse iNKT frequency in peripheral blood of children with severe therapy-resistant asthma (STRA), compared to children with milder asthma and healthy controls. Methods: Children with asthma (n = 136) (non-severe and STRA) from a referral centre and healthy controls (n = 40) were recruited. Peripheral blood mononuclear cells were isolated, stained with anti-CD3 and anti-iNKT (Vα24Jα18), and analysed through flow cytometry. Atopic status was defined by measuring specific IgE in serum. Airway inflammation was assessed by induced sputum. Results: Children with asthma presented an increased frequency of CD3+iNKT+ cells (median 0.38% IQR 0.18-1.9), compared to healthy controls (median 0.26% IQR 0.10-0.43) (p = 0.025). Children with STRA also showed an increased frequency of iNKT cells (1.5% IQR 1.05-2.73) compared to healthy controls and non-severe asthmatic children (0.35% IQR 0.15-1.6; p = 0.002). The frequency of iNKT cells was not different between atopic and non-atopic children. In addition, iNKT cells were not associated with any inflammatory pattern of induced sputum studied. Conclusion: Our data suggests that iNKT cells play a role in paediatric asthma, which is also associated with the severity of disease, but independent of the atopic status (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Asma/imunologia , Antiasmáticos/uso terapêutico , Células T Invariáveis Associadas à Mucosa/imunologia , Células T Matadoras Naturais/imunologia , Resistência a Medicamentos/imunologia , Citocinas/imunologia , Células Th1/imunologia , Células Th2/imunologia , Complexo CD3/imunologia , Estudos Transversais
15.
Fontilles, Rev. leprol ; 31(4): 291-311, ene.-abr. 2018. tab, maps, graf
Artigo em Espanhol | IBECS | ID: ibc-173250

RESUMO

Antecedentes: Después de tres décadas de implementación de la multiterapia (MDT), consistente en una combinación de rifampicina, dapsona y clofazimina, en Malasia la aparición de resistencia farmacológica del Mycobacterium leprae constituye una preocupación, ya que puede llevar al fracaso del tratamiento y la recidiva de la enfermedad. Objetivos: Determinar el modelo de resistencia farmacológica del M. leprae en Malasia. Métodos: Se analizaron los cultivos en almohadilla plantar de ratón (MFP) de todas las biopsias cutáneas de pacientes con lepra borderline lepromatosa y lepra lepromatosa enviados a la Unidad de la Lepra, Laboratorio Nacional de Salud Publica, Sungai Buloh, Malasia, entre 1997-2013. Resultados: Se realizaron 651 cultivos MFP. La edad media de los pacientes fue de 41 anos (rango: 6-88). La proporción varón/hembra era de 3·8:1. Cuatrocientos cuarenta y cuatro pacientes (69·1%) eran malayos. La proporción de M. leprae positivo en cultivo era del 66·6% (433 of 651). El Índice Bacteriologico (IB) y el Índice Morfológico (IM) promedios para los cultivos positivos fue de 3·7 and 2·8 respectivamente. El IB y el IM de los que no crecieron en la MFP eran significativamente menores que los que presentaban cultivos positivos (P < 0·001). La dapsona presento el mayor índice de resistencia del 55% (238 of 433). Sin embargo, el elevado grado de resistencia a la dapsona (0·01%) fue de 6·24%. Hubo 407 MFP con rifampicina 0·003% y 12 (2·9%) resultaron resistentes a la misma. La clofazimina presento el menor grado de resistencia intermedia (0·001%) que fue del 0·2% (1 of 429). No había diferencias significativas entre el patrón de resistencia y género o nacionalidad de los pacientes. Conclusiones: Mas de la mitad de los cultivos MFP presentaron resistencia de baja intensidad a la dapsona; menos del 3% eran resistentes a la rifampicina y la resistencia a la clofazimina resulto muy baja


Background: After three decades of implementing multidrug therapy (MDT) consisting of rifampicin, dapsone and clofazimine in Malaysia, the drug resistance pattern of Mycobacterium leprae is a growing concern as it may lead to failure of treatment and relapse of disease. Objective: To determine the drug resistance patterns of M. leprae in Malaysia. Methods: Mouse footpad (MFP) culture of all skin biopsy samples from patients with borderline lepromatous and lepromatous leprosy sent to the Leprosy Unit, National Public Health Laboratory, Sungai Buloh, Malaysia between 1997-2013 were retrospectively studied. Results: There were 651 MFP cultures performed. The mean age of patients was 41 years old (range: 6-88). The male: female ratio was 3·8:1. Four hundred and forty four patients (69·1%) were Malaysian. The rate of positive M. leprae culture was 66·6% (433 of 651). The mean Bacteriological Index (BI) and median Morphological Index (MI) for those with positive culture were 3·7 and 2·8 respectively. The mean BI and MI of those which failed to grow in the MFP were significantly lower than those with positive cultures (P < 0·001). Dapsone has the highest resistance rate of 55% (238 of 433). Nevertheless, high degree dapsone resistance (0·01%) was 6·24%. There were 407 MFP tests using rifampicin 0·003% and 12 (2·9%) were resistant to it. Clofazimine has the lowest intermediate degree (0·001%) resistance rate of 0·2% (1 of 429). There were no significant differences between the drug resistance pattern and the gender or the nationality of the patients. Conclusion: More than half of our positive MFP cultures showed low-level resistance to dapsone; less than 3% were resistant to rifampicin, and clofazimine resistance remained very low


Assuntos
Animais , Camundongos , Mycobacterium leprae , Mycobacterium leprae/isolamento & purificação , Resistência a Medicamentos , Resistência Microbiana a Medicamentos , Meios de Cultura/farmacologia , Cultura de Vírus/veterinária , Malásia/epidemiologia , Dapsona , Rifampina , Estudos Retrospectivos , Estudos Transversais
16.
Emergencias (St. Vicenç dels Horts) ; 30(1): 21-27, feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-169891

RESUMO

Objetivo. Las elevadas tasas de resistencia a fluoroquinolonas han hecho de la ceftriaxona una de las principales opciones terapéuticas en las infecciones del tracto urinario febriles (ITUF). El objetivo del estudio es identificar factores predictivos de infección por microorganismos resistentes a ceftriaxona (MRC) en ITUF comunitaria en hombres. Métodos. Estudio transversal ambispectivo en el que se incluyeron hombres con ITUF atendidos en el servicio de urgencias de un hospital comarcal. Resultados. Se incluyeron 552 episodios de ITUF, 103 (18,6%) causadas por MRC. Los pacientes con ITUF por MRC tenían mayor edad, más frecuencia de ITUF relacionada con la atención sanitaria (ITUF-AS), demencia, diabetes mellitus, neoplasia, ITU previa, patología urológica, ITUF complicada y antecedente de tratamiento antibiótico reciente. Las variables independientemente asociadas a ITUF por MRC fueron la cirrosis hepática (OR 6,00; IC 95%: 1,25-28; p = 0,025), tener una ITUF-AS (OR 2,3; IC 95%: 1,23-4,27; p = 0,009) y el consumo previo de antibióticos (OR 2,15; IC 95%: 1,23-3,76; p = 0,007). Entre los componentes de la ITUF-AS, el antecedentes de estancia en centro larga estancia (OR 2,90; IC 95%: 1,21-7,16; p = 0,017) y entre los antibióticos el consumo de penicilinas con/sin inhibidores de betalactamasa (OR 2,16; IC 95%: 1,05-4,42; p = 0,035) se asociaron a ITUF por MRC. Conclusiones. La cirrosis, presentar una ITUF-AS, especialmente provenir de un centro de larga estancia, y el consumo reciente de antibióticos, principalmente de penicilinas con/sin inhibidores de betalactamasa, son factores de riesgo de ITUF por MRC en hombres (AU)


Background and objectives. Because of high rates of resistance to fluoroquinolones, ceftriaxone has become one of the main options for treating febrile urinary tract infection (FUTI). This study aimed to identify predictors of ceftriaxone resistance in community-acquired FUTIs in men. Methods. Cross-sectional ambispective study enrolling men with FUTIs treated in the emergency department of a local area hospital in Spain. Results. A total of 552 FUTI episodes were studied; 103 (18.6%) were caused by a ceftriaxone-resistant microorganism. Variables associated with a ceftriaxone-resistant FUTI were older age, health care-associated FUTI, dementia, diabetes mellitus, neoplasms, a history of UTIs, urologic disease, and complicated FUTI. Patients with ceftriaxone-resistant FUTIs also had higher rates of recent antibiotic treatment. Independent variables associated with FUTI due to a ceftriaxone resistant microorganism were cirrhosis of the liver (odds ratio [OR], 6,00 95% CI, 1.25-28; P = .025), health care associated FUTI (OR, 2.3 95% CI, 1.23-4.27; P = .009), and prior treatment with antibiotics (OR, 2.15; 95% CI, 1.23-3.76 P = .007). Components of health care-associated FUTI were a history of admission to a long-term residence (OR, 2.90 95% CI, 1.21-7.16; P = .017) and use of penicillins with or without beta-lactamase inhibitors (OR, 2.16; 95% CI, 1.05-4.42; P = .035). Conclusion. Cirrhosis of the liver; history of health care-associated FUTI, especially in patients residing in a long-term care facility; and recent use of antibiotics, mainly penicillins with or without beta-lactamase inhibitors, are risk factors for ceftriaxone-resistant FUTI in men (AU)


Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Valor Preditivo dos Testes , Ceftriaxona/uso terapêutico , Resistência a Medicamentos , Infecções Urinárias/tratamento farmacológico , Fatores de Risco , Febre/complicações , Febre/etiologia , Estudos Transversais/métodos , Urina/microbiologia , beta-Lactamas/uso terapêutico , Análise Multivariada
17.
Nefrología (Madrid) ; 38(1): 87-91, ene.-feb. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-170086

RESUMO

Severe congestive heart failure (CHF) patients are prone to hyponatremia. Peritoneal dialysis (PD) is increasingly used for long-term management of refractory CHF patients. The glucose polymer icodextrin was proposed to be a good option for fluid removal in such patients. A small, although statistically significant reduction in serum sodium (∼2mmol/l) consistently observed in multiple trials, is considered as not clinically relevant. Here we reported five refractory CHF patients who demonstrated sodium drop by median of 8meq/l (range 5.4-8.3meq/l) after icodextrin was added to their program. It seems that icodextrin may contribute to clinically relevant hyponatremia if the hyponatremia is compounded by other factors. Patients with extremely severe congestive heart failure are susceptible to this complication (AU)


Los pacientes con insuficiencia cardíaca congestiva grave son propensos a sufrir hiponatremia. La diálisis peritoneal se utiliza cada vez más para el tratamiento a largo plazo de los pacientes con insuficiencia cardíaca congestiva resistentes al tratamiento. El polímero de glucosa icodextrina se propuso como una buena opción para la ultrafiltración. Una reducción pequeña, aunque estadísticamente significativa, del sodio sérico (∼2mmol/l) observada sistemáticamente en numerosos ensayos no se considera de relevancia clínica. En este documento informamos de 5 casos de pacientes con insuficiencia cardíaca congestiva resistentes al tratamiento que presentaron una caída de las concentraciones de sodio en una mediana de 8mEq/l (intervalo 5,4-8,3mEq/l) después de la adición de icodextrina a su programa. Parece ser que la icodextrina puede contribuir a una hiponatremia clínicamente relevante si se combina con otros factores. Los pacientes con insuficiencia cardíaca congestiva muy grave son propensos a esta complicación (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiponatremia/etiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Diálise Peritoneal/métodos , Soluções para Diálise/uso terapêutico , Resistência a Medicamentos , Insuficiência Cardíaca/terapia , Análise Multivariada
18.
Rev. Soc. Esp. Dolor ; 25(1): 21-25, ene.-feb. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170626

RESUMO

La neuralgia trigeminal clásica (NTC) es una cuadro clínico que se caracteriza por un dolor abrupto, generalmente unilateral, de paroxismos dolorosos breves y muy severos de distribución trigeminal en una o más de sus ramas. Actualmente, múltiples guías clínicas recomiendan a la carbamazepina y oxcarbazepina como la primera línea de tratamiento médico, logrando un adecuado control del dolor en aproximadamente en un 90 % de los pacientes. Cuando los pacientes no responden adecuadamente al tratamiento médico, comúnmente se comienza a considerar las intervenciones neuroquirúrgicas como la opción terapéutica a seguir. Descripción del caso: paciente de género femenino, de 70 años de edad, consulta al Servicio de Dolor orofacial del Hospital del Salvador por presentar un dolor facial severo en lado izquierdo. La paciente presentaba historia de haber sido diagnosticada con NTC posteriormente confirmado con neuroimagen. Al momento de la consulta se encontraba en tratamiento de carbamazepina sin lograr adecuado control del dolor, por lo que había ingresado a una lista de espera para procedimiento neuroquirúrgico. Al examen clínico se pudo corroborar la existencia de varios focos de dolor orofacial músculo-esqueléticos, identificables con el motivo de consulta y no correlativo a la NTC. En este caso clínico los autores presentarán cómo otras fuentes de dolor orofacial pueden coexistir con la NTC, complicando el manejo de la neuralgia; además, y más importante aún, se presentará cómo un adecuado diagnóstico y tratamiento de los cuadros de dolor orofacial puede contribuir al manejo a una NTC refractaria al tratamiento farmacológico (AU)


Classical Trigeminal Neuralgia (CTN) is a clinical condition characterized by a sudden, usually unilateral, brief, and recurrent excruciating pain paroxysms, with distribution in one or more division of the trigeminal nerve. Carbamazepine and oxcarbamazepine are often recommended as the first-line of medical treatment in many clinical guidelines, providing an adequate pain relief in about 90 % of the patients; of which those who are refractory to medical treatment should be considered for surgical treatment. Case description: The authors will present a clinical case of a 70-year-old female patient, who consulted to the Hospital del Salvador's Orofacial Pain Service for presenting a severe facial pain in her left side. The patient had a history of being diagnosed with CTN confirmed with a neuroimaging, not responsive at the time of consultation to pharmacological treatment with carbamazepine. The main complaint was a severe and diffuse facial pain with null response to CTN pharmacologic treatment, so consequently, the patient was put on a waiting list for a neurosurgical procedure. At examination, several sources of musculoskeletal orofacial pain were identified, which were consistent with the chief complaint of the patient and not correlative to the CTN paroxysms. The authors will present a clinical case, illustrating how comorbid regional orofacial pain syndromes can complicate management of a CTN, and most importantly how a well addressed orofacial pain treatment could be decisive in a CTN refractory to medical treatment (AU)


Assuntos
Humanos , Feminino , Idoso , Neuralgia do Trigêmeo/diagnóstico , Dor Facial/etiologia , Resistência a Medicamentos , Diagnóstico Diferencial , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Neuralgia do Trigêmeo/tratamento farmacológico , Osteoartrite/diagnóstico , Carbamazepina/uso terapêutico , Procedimentos Neurocirúrgicos , Manipulação Ortopédica , Analgésicos Opioides/efeitos adversos
19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(2): 91-94, feb. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-170696

RESUMO

Objetivo: Generar una secuencia consenso a partir de los datos de secuenciación masiva obtenidos en estudios de resistencias a antiretrovirales, que sea representativa de la secuencia Sanger y que sirva para estudios de epidemiología molecular. Material y métodos: En 62 pacientes se obtuvo la secuencia de transcriptasa reversa-proteasa, mediante Sanger (Trugene-Siemens), y NGS (454GSJunior-Roche). Las secuencias consenso NGS se generaron con Mesquite, seleccionando umbrales 10%, 15% y 20%. Para el estudio filogenético se empleó MEGA. Resultados: Utilizando el umbral 10%, 17/62 pacientes presentaron secuencias pareadas NGS-Sanger, con una mediana de bootstrap del 88% (IQR83,5-95,5). La asociación aumenta a 36/62 pacientes y el bootstrap, a 94% (IQR85,5-98), y alcanza el máximo al 20% en 61/62 pacientes, bootstrap 99% (IQR98-100). Conclusión: Mostramos un método seguro para generar secuencias consenso NGS para su uso en estudios de epidemiología molecular procesadas con umbral 20%, de fácil uso y aplicación en los servicios de microbiología clínica (AU)


Objective: To show how to generate a consensus sequence from the information of massive parallel sequences data obtained from routine HIV anti-retroviral resistance studies, and that may be suitable for molecular epidemiology studies. Material and methods: Paired Sanger (Trugene-Siemens) and next-generation sequencing (NGS) (454 GSJunior-Roche) HIV RT and protease sequences from 62 patients were studied. NGS consensus sequences were generated using Mesquite, using 10%, 15%, and 20% thresholds. Molecular evolutionary genetics analysis (MEGA) was used for phylogenetic studies. Results: At a 10% threshold, NGS-Sanger sequences from 17/62 patients were phylogenetically related, with a median bootstrap-value of 88% (IQR83.5-95.5). Association increased to 36/62 sequences, median bootstrap 94% (IQR85.5-98)], using a 15% threshold. Maximum association was at the 20% threshold, with 61/62 sequences associated, and a median bootstrap value of 99% (IQR98-100). Conclusion: A safe method is presented to generate consensus sequences from HIV-NGS data at 20% threshold, which will prove useful for molecular epidemiological studies (AU)


Assuntos
Humanos , Adulto , HIV , Infecções por HIV/epidemiologia , Análise de Sequência/métodos , Epidemiologia Molecular/métodos , Resistência a Medicamentos , Epidemiologia Molecular/estatística & dados numéricos , Inibidores da Transcriptase Reversa/análise , Inibidores da Transcriptase Reversa/isolamento & purificação , Filogenia , Antirretrovirais
20.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(2): 100-103, feb. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-170698

RESUMO

Introducción: Se describe la epidemiología molecular de las enterobacterias productoras de carbapenemasas en un hospital terciario. Material y métodos: Se incluyeron todos los aislamientos de enterobacterias productoras de carbapenemasas obtenidos entre febrero de 2015 y marzo de 2016 en el Hospital Universitario 12 de Octubre (Madrid). Se utilizaron métodos fenotípicos y moleculares. Resultados: Se identificaron 7 especies bacterianas, predominando Klebsiella pneumoniae (K. pneumoniae) (78,9%) y Enterobacter cloacae (E. cloacae) (16,4%). La resistencia en K. pneumoniae y E. cloacae para carbapenemes fue del 88,7 y 88,6% para ertapenem, 21,4 y 54,3% para imipenem, y 20,8 y 34,3% para meropenem. El tipo de carbapenemasa más frecuente en K pneumoniae fue OXA-48 (91,1%) y en E. cloacae VIM (71,4%). Se identificaron 9 tipos clonales de K. pneumoniae, incluyendo uno mayoritario perteneciente al tipo de secuencia ST11, y 16 de E. cloacae. Conclusiones: El incremento actual de enterobacterias productoras de carbapenemasas se debe en gran medida a la diseminación de K. pneumoniae productora de OXA-48 (AU)


Introduction: A description is presented on the molecular epidemiology of carbapenemase-producing enterobacteriaceae infection in a tertiary hospital. Material and methods: A study was made on all the carbapenemase-producing enterobacteriaceae isolations obtained between February 2015 and March 2016 in the Hospital Universitario 12 de Octubre (Madrid). Phenotypic and molecular methods were used. Results: A total of 7 bacterial species were identified, with the majority being Klebsiella pneumoniae (K. pneumoniae) (78.9%) and Enterobacter cloacae (E. cloacae) (16.4%). The resistance of K. pneumoniae and E. cloacae for carbapenems was 88.7 and 88.6% for ertapenem, 21.4 and 54.3% for imipenem, and 20.8 and 34.3% for meropenem, respectively. The most frequent carbapenemase type was OXA-48 (91.1%) and VIM (71.4%) in E. cloacae. A total of 9K. pneumoniae clonal types were identified, including a majority pertaining to the sequence type ST11. In E. cloacae, 16 clonal types were identified. Conclusions: The current increase in carbapenemase-producing enterobacteriaceae is mainly due to the spread of OXA-48-producing K. pneumoniae (AU)


Assuntos
Humanos , Epidemiologia Molecular/métodos , Enterobacteriaceae/isolamento & purificação , Infecções/epidemiologia , Proteus mirabilis , Proteus mirabilis/isolamento & purificação , Infecções/microbiologia , Klebsiella pneumoniae , Klebsiella pneumoniae/isolamento & purificação , Resistência a Medicamentos
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