ABSTRACT
BACKGROUND: Patients with tuberculosis (TB) may develop multi-organ failure and require admission to intensive care. In these cases, the mortality rates are as high as 78% and may be caused by suboptimal serum concentrations of first-line TB drugs. This study aims to compare the pharmacokinetics of oral rifampin, isoniazid, pyrazinamide and ethambutol patients in intensive care units (ICU) to outpatients and to evaluate drug serum concentrations as a potential cause of mortality. METHODS: A prospective pharmacokinetic (PK) study was performed in Amazonas State, Brazil. The primary PK parameters of outpatients who achieved clinical and microbiological cure were used as a comparative target in a non-compartmental analysis. RESULTS: Thirteen ICU and twenty outpatients were recruited. The clearance and volume of distribution were lower for rifampin, isoniazid, pyrazinamide and ethambutol. ICU thirty-day mortality was 77% versus a cure rate of 89% in outpatients. CONCLUSIONS: ICU patients had a lower clearance and volume of distribution for rifampin, isoniazid, pyrazinamide and ethambutol compared to the outpatient group. These may reflect changes to organ function, impeded absorption and distribution to the site of infection in ICU patients and have the potential to impact clinical outcomes.
ABSTRACT
The yerba mate leaf metabolic composition depends mainly on genetics, sex, plant and leaf age, light intensity, harvest time, climate, and fertilization. In yerba mate, the secondary sexual dimorphism (SSD), the leaf metabolic SSD association with the frequency of leaf harvests, and the stability of the metabolites in the two genders over the years is not known. It was hypothesized that (1) the SSD in the metabolite segregation would differ among the winter and summer growth pauses, (2) females would show lower metabolite concentrations, and (3) the metabolic concentrations would show stability over the years on the same plants, not obligatorily associated with the SSD stability expression. Variations in theobromine, caffeine, chlorogenic and caffeic acids were correlated to the increasing time since the previous harvest, especially in females. However, the frequency of the metabolic SSD were associated with the studied growth pauses, rejecting the first hypothesis. No regular gender superiority was expressed in the yerba mate leaf secondary metabolites, rejecting our second hypothesis, even though more cases of superior female metabolite accumulation were identified. The stability of the leaf protein was preserved over the four years, with no SSD cases observed. The leaf methylxanthines were time stable, while the decrease in the phenolic content occurred with tree aging, which was not associated with the SSD expression, partially proving our third hypothesis. The novelty was related to the time stability of the leaf metabolic SSD observed over the winter and summer growth pauses, and over the four consecutive years without a regular expression of the male- or female-biased concentrations in the studied metabolites. To demystify the random metabolic gender responses in yerba mate, gender-orientated experiments with a high number of tree repetitions must be conducted, including clonal plants grown in various environments, such as monoculture and agroforestry, or on plantations in different climates and altitudes.
ABSTRACT
BACKGROUND: Tuberculosis (TB) patients admitted to intensive care units (ICU) have high mortality rates. It is uncertain whether the pharmacokinetics of first-line TB drugs in ICU patients are different from outpatients. This study aims to compare the pharmacokinetics of oral ethambutol in TB patients in ICU versus TB outpatients and to determine whether contemporary dosing regimens achieve therapeutic exposures. METHODS: A prospective population pharmacokinetic study of ethambutol was performed in Amazonas State, Brazil. Probability of target attainment was determined using AUC/MIC > 11.9 and Cmax/MIC > 0.48 values. Optimized dosing regimens were simulated at steady state. RESULTS: Ten ICU patients and 20 outpatients were recruited. Ethambutol pharmacokinetics were best described using a two-compartment model with first-order oral absorption. Neither ICU patients nor outpatients consistently achieved optimal ethambutol exposures. The absorption rate for ethambutol was 2-times higher in ICU patients (p < 0.05). Mean bioavailability for ICU patients was >5-times higher than outpatients (p < 0.0001). Clearance and volume of distribution were 93% (p < 0.0001) and 53% (p = 0.002) lower in ICU patients, respectively. CONCLUSIONS: ICU patients displayed significantly different pharmacokinetics for an oral fixed-dose combination administration of ethambutol compared to outpatients, and neither patient group consistently achieved pre-defined therapeutic exposures.
ABSTRACT
The photo-Fenton process was performed with four radiation settings to treat clinical analysis laboratory wastewater (CALWW) from a hospital, with the aim of evaluating its treatability and acute toxicity response in Daphnia magna and Lactuca sativa. The experiments were performed in a borosilicate bench-scale conventional reactor for 320 min. The light radiation was suspended 13 cm from the CALWW surface for mild radiation or immersed into the matrix for intense radiation. All photo-Fenton experimental conditions were set at pH 3.0, 15 mg L-1 of Fe2+, and initial H2O2 of 300 mg L-1. The initial Fe2+ concentration was converted to Fe3+ ion in the first 15 min of photooxidation for all processes. Furthermore, the intense radiation processes regenerated Fe2+ faster than other systems. Neither mild UVA-Vis nor mild UVC-Vis radiation significantly treated the organic matter or phenols. However, mild UVC-Vis resulted in a higher biodegradability transformation rate (biochemical oxygen demand/chemical oxygen demand 0.51), indicating that it could treat more recalcitrant organic matter than mild UVA-Vis. Intense radiation proved to be more efficient, with a chemical oxygen demand removal rate of 95% for intense UVA-Vis and 99% for intense UVC-Vis treatments. All treatments reduced acute toxicity in D. magna. Moreover, photo-Fenton treatment by intense UVA-Vis decreased toxicity ~98%, compared to mild and intense UVC-Vis, ~75%. Both of the mild radiation treatments inhibited the germination of L. sativa seeds. The intense UVA-Vis photo-Fenton treatment was the only setting that removed phytotoxicity, resulting in a non-significant effect, and the intense UVC-Vis treatment inhibited the seed growth.
Subject(s)
Wastewater , Water Pollutants, Chemical , Animals , Hospitals , Hydrogen Peroxide , Iron , Laboratories , Oxidation-Reduction , Water Pollutants, Chemical/analysisABSTRACT
Of all cyanobacteria, Microcystis aeruginosa is the most commonly found species in bloom episodes all over the world. This species is known to produce cyanopeptides with hepatotoxic effects, namely microcystins (MCs). In this regard, Advanced Oxidation Processes (AOPs) have been widely studied for cyanotoxin degradation, but very few studies focused on cyanobacteria inactivation combined with toxin removal. To our knowledge, this is the first report of the photo-Fenton process application focusing on M. aeruginosa inactivation and microcystin-LR (MC-LR) degradation. This research work aimed to evaluate the photo-Fenton process under three different conditions with regard to Fe2+/H2O2 ratios (0.6/10, 5/50, and 20/100 mg L-1) at the initial near-neutral pH. Process efficiency was measured by immediate cell density reduction, growth inhibition, effect on MC-LR concentrations, and scanning electron microscopy (SEM) to analyze any alterations in cell morphology. Growth inhibition test (GIT) results pointed to cell inactivation under all conditions tested, and MC-LR concentrations were reduced below WHO's maximum limit at medium and higher concentrations of reagents. The possible mechanisms of cell inactivation by oxidative species are discussed.
Subject(s)
Marine Toxins/metabolism , Microcystins/metabolism , Microcystis/metabolism , Ferrous Compounds/analysis , Ferrous Compounds/pharmacology , Hydrogen Peroxide/analysis , Hydrogen Peroxide/pharmacology , Hydrogen-Ion Concentration , Microcystis/cytology , Microcystis/drug effects , Oxidation-ReductionABSTRACT
Microcystins are a group of cyanotoxins with known hepatotoxic effects, and their presence in drinking water represents a public health concern all over the world. The main objective of this work was to evaluate the solar photo-Fenton process at near-neutral pH in the degradation of microcystin-LR (MC-LR) under conditions close to those found in bloom episodes, with a high concentration of cell debris and natural organic matter (NOM). The influence of experimental parameters such as Fe2+ and H2O2 concentrations, reaction matrix, and the presence of scavenger ions, as well as ecotoxicity before and after treatment, was also evaluated. The reaction matrix was obtained from Microcystis aeruginosa cultivated in ASM-1 medium (ACE1 and ACE2 extracts). H2O2 and Fe2+ concentrations were optimized by 22 factorial design with the central point in a bench-scale solar reactor, using ACE1 extract, and the improved condition was applied in a compound parabolic collector (CPC) reactor, for the ACE2, natural water (RVW) and natural water with M. aeruginosa crude extract (RVCE). Matrix effect assays indicated that radical scavengers present in the medium were responsible for the decrease in the mineralization rates. The solar photo-Fenton process in the CPC reactor achieved COD (75%) and MC-LR (70%) reduction after 120 min at pH = 7.8, [H2O2]/COD = 3.18 and [H2O2]/[Fe2+] = 10 for the ACE2 sample. When the same conditions were applied to the RVCE sample, the process removed 77% of DOC and up to 99% of MC-LR after 45 min of the reaction. Sinapis alba bioassays showed that there was no increase in ecotoxicity after the solar photo-Fenton treatment. These results demonstrate the potential of the solar photo-Fenton process at neutral pH as an additional step in the treatment of natural matrices contaminated with microcystins. In addition, the work reinforces the importance of bioassays in treatment process monitoring.
Subject(s)
Ferrous Compounds/chemistry , Hydrogen Peroxide/chemistry , Marine Toxins/chemistry , Microcystins/chemistry , Sunlight , Hydrogen-Ion Concentration , Oxidation-ReductionABSTRACT
In this research, we developed and validated a liquid chromatography coupled to mass spectrometry (LC-QToF-MS) method for simultaneous quantification of the anti-tuberculosis drugs ethambutol, isoniazid, pyrazinamide and rifampicin in human plasma. Plasma samples spiked with cimetidine (internal standard) were extracted using protein precipitation with acetonitrile containing 1% formic acid. Separation was performed using a C18 column under flow gradient conditions with water and acetonitrile, both containing 5 mm ammonium formate and 0.1% formic acid. The method was validated according to the ANVISA and US Food and Drug Administration guidelines for bioanalytical method validation. The calibration curve was linear over a concentration range of 0.2-5 µg ml-1 for ethambutol, 0.2-7.5 µg ml-1 for isoniazid, 1-40 µg ml-1 for pyrazinamide and 0.25-2 µg ml-1 for rifampicin, all with adequate precision and accuracy. The method was reproducible, selective and free of carryover and matrix effects. The validated LC-QToF-MS method was successfully applied to real samples and shown to be applicable to future therapeutic and pharmacokinetic monitoring studies.
Subject(s)
Antitubercular Agents/blood , Chromatography, High Pressure Liquid/methods , Ethambutol/blood , Isoniazid/blood , Mass Spectrometry/methods , Pyrazinamide/blood , Rifampin/blood , Humans , Plasma/chemistryABSTRACT
Increased concentrations of nutrients in water bodies caused by effluent discharge, fertilizers and other inputs can lead to artificial eutrophication, increasing the primary productivity, bringing well-known and serious consequences to the environment (such as excessive macrophyte and microalgae growth). Most strategies for phytoplankton control in aquatic ecosystems result in metal accumulation or toxic by-product formation after chlorination. Concerning this matter, the photo-Fenton process (usually applied in wastewater treatment and degradation of a variety of contaminants) has been studied for water and effluent disinfection. However, its application in microalgae inactivation has not been reported until now. Therefore, this work aimed to evaluate the process effectiveness in inactivating microalgae, using Desmodesmus subspicatus as a model. Photo-Fenton experiments were carried out at the lab scale, at 105 cells per mL with 20 mg L-1 of H2O2 and 5 mg L-1 of Fe2+ (complexed with oxalic acid). The cell concentration and Growth Inhibition Test (GIT) were used to evaluate the process efficiency and Scanning Electron Microscopy (SEM) to analyze any alterations in the cell morphology. After performing the photo-Fenton reaction, the individual contribution of the reactants and radiation was investigated. The cell concentration was not significantly reduced during the photo-Fenton reaction, but SEM images indicated possible morphology alterations and the GIT showed the loss of cell viability after 30 minutes of exposure. Effects on the cell growth were also observed when exposed only to hydrogen peroxide.
Subject(s)
Chlorophyta/metabolism , Microalgae/metabolism , Waste Disposal, Fluid , Water Pollutants, Chemical/metabolism , Cell Count , Cell Survival/drug effects , Chlorophyta/cytology , Chlorophyta/drug effects , Ferrous Compounds/pharmacology , Hydrogen Peroxide/pharmacology , Microalgae/cytology , Microalgae/drug effects , Microscopy, Electron, Scanning , Photochemical Processes , Reactive Oxygen Species/metabolism , Water Pollutants, Chemical/chemistryABSTRACT
In this work, the photocatalytic degradation of selected estrogens (E2 and EE2) was evaluated, using bench-scale and continuous treatment systems assisted by artificial UV-A and solar radiation. Processes based on the use of TiO2 permit an efficient degradation of E2 and EE2 estrogens, usually at reaction times lower than 15 min. Especially remarkable is the high degradation efficiency shown by sunlight-assisted processes, which are extremely favored by the high efficiency of compound parabolic collectors.