Coinfección HIV /Trypanosoma cruzi: dinámica microbiológica y farmacocinética de los medicamentos / HIV/Trypanosoma cruzi co-infection: microbiological dynamics and pharmacokinetics of drugs

INTRODUCCION Los pacientes coinfectados HIV/T. cruzi pueden presentar reactivaciones de la infección por T. cruzi, con severas consecuencias para su salud y alta mortalidad. El tratamiento tripanocida con nifurtimox o benznidazol (BNZ) en la fase crónica podría ser una estrategia para reducir el riesgo de la reactivación de la enfermedad de Chagas en personas HIV positivas. Sin embargo, la información sobre las interacciones entre los fármacos antichagásicos con medicamentos antirretrovirales es inexistente, y es escaso el conocimiento respecto de la cinética parasitaria y viral en los pacientes coinfectados. OBJETIVOS Ampliar el conocimiento de la coinfección HIV/T.cruzi sobre; interacciones entre los fármacos tripanocidas y los antirretrovirales, y la dinámica viral y parasitológica en pacientes que reciban benznidazol durante el tratamiento antirretroviral y en el seguimiento. METODOS Estudio multicéntrico descriptivo observacional prospectivo. Población; pacientes con coinfección por HIV y T. cruzi, bajo tratamiento antirretroviral efectivo, que deseen realizar tratamiento tripanocida y participar de un estudio de investigación. Previo y durante el tratamiento tripanocida se realizan los cuidados estándar para ambas infecciones, y se tomaran muestras para realización de carga viral, recuento de cd4, dosaje de antirretrovirales, carga parasitaria, dosaje de tripanocidas y metabolitos. RESULTADOS Fueron incorporados 8 de 12 pacientes estipulados. Todos tuvieron excelente tolerancia al BNZ, sin modificación de las mediciones de carga viral ni recuento de CD4 durante el tratamiento tripanocida DISCUSIÓN De manera preliminar impresiona que el BNZ es muy bien tolerado, por lo que si hubiese interacción de medicamentos y hubiera mayor concentración de cualquiera de ellos esto no genera toxicidad, y si hubiera menor concentración de los antirretrovirales no ha modificado la carga viral de los participantes

Effects on fibrinogen, fibrin, and blood coagulation of proteolytic extracts from fruits of Pseudananas macrodontes, Bromelia balansae, and B. hieronymi (Bromeliaceae) in comparison with bromelain.

Extracts rich in cysteine proteases obtained from fruits of Pseudananas macrodontes (Pm), Bromelia balansae (Bb), and B. hieronymi (Bh) have previously shown an anti-inflammatory effect on animal models. Given the close relationship between hemostasis and inflammation, it is attractive to investigate therapeutic agents capable of modulating both systems. The aim of this work was to study the effect of Pm, Bb, and Bh on fibrin(ogen) and blood coagulation compared with stem bromelain (Bro). Action on fibrinogen was electrophoretically and spectrophotometrically evaluated, fibrinolytic activity was measured both electrophoretically and by the fibrin plate assay, and the effect on blood coagulation was studied by conventional coagulation tests (PT and APPT). All extracts showed the same proteolytic preference for fibrinogen subunits, that is Aα > Bß, whereas γ was partially hydrolyzed by 100-fold concentration increase. Unlike Bro, cysteine proteases of Pm, Bb, and Bh increased absorbance at 540 nm of fibrinogen solution, suggesting thrombin-like activity, which was time-dependent and reached maximum values at lower concentration. All extracts showed the same proteolytic preference for fibrin subunits; however Pm, Bb, and Bh showed lower fibrinolytic activity than Bro at the assayed concentrations. Although Bb acted only as anticoagulant, Pm, Bh, and unexpectedly Bro showed dual action on blood coagulation: at low concentration showed procoagulant effect and at high concentration anticoagulant effect. Results reveal new plant species as potential sources of pharmacological agents for the treatment of a wide range of hemostatic disorders as well as to wound healing.

Universal versus selective screening for the detection, control and prognosis of gestational diabetes mellitus in Argentina.

In all, 1,702 unselected pregnant women from the city of La Plata were tested for gestational diabetes mellitus (GDM) and evaluated to determine GDM prevalence and risk factors. In women with GDM, we evaluated compliance with guidelines for GDM management, and perinatal complications attributable to GDM. GDM prevalence was 5.8%, and its risk factors were pre-gestational obesity, previous hyperglycaemia, age > 30 years, previous GDM (and its surrogate markers). In primi-gravida (PG) subjects, GDM was equally prevalent in the presence (4.2%) or absence (4.0%) of risk factors. In multi-gravida (MG) women, although risk factors doubled the prevalence of GDM (8.6%), in the absence of risk factors GDM prevalence was similar to that of PG women (3.9%). Half of all women with GDM received inadequate post-diagnosis obstetric control, and this induced a fourfold increase in infant perinatal complications. In conclusion, all non-hyperglycaemic 24-28-week pregnant women should be tested for GDM, although particular attention must be paid to MG women with risk factors.