RESUMO
The analysis of 387 cases of mandibular fractures complicated by posttraumatic infections is presented. These infections were quite diverse - from local suppuration of soft tissues surrounding the fracture to widespread processes affecting fatty tissue planes, including the anterior and posterior mediastinum. Infectious complications determine the injury outcome in each case - recovery, disability, or death. Two clinical observations with lethal outcomes are described.
Assuntos
Fraturas Mandibulares , Humanos , Fraturas Mandibulares/complicações , Estudos RetrospectivosRESUMO
Parasitic diseases are rare in forensic practice. The article presents two observations of dirofilariasis in the facial area. Clinical signs, characteristics, surgical treatment, and description of the parasite extracted from the subcutaneous tissue of the paraorbital region are given.
Assuntos
Dirofilariose , Animais , Humanos , Dirofilariose/diagnóstico , Dirofilariose/parasitologia , Dirofilariose/cirurgia , Medicina LegalRESUMO
The objective of the present study was to elucidate the peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process. The case report described in this paper demonstrates that the unfavourable outcome of an injury is not infrequently attributable to the inadequacy and drawbacks of the existing schemes for the provision of medical aid. However, the health status of the victim depends on the life-threatening character of the primary injury and its naturally developing infectious complications.
Assuntos
Infecções Bacterianas/patologia , Atenção à Saúde/normas , Erros de Diagnóstico , Traumatismos Maxilofaciais/patologia , Lesões do Pescoço/patologia , Ferimentos Perfurantes/patologia , Adulto , Infecções Bacterianas/etiologia , Infecções Bacterianas/terapia , Atenção à Saúde/legislação & jurisprudência , Erros de Diagnóstico/legislação & jurisprudência , Evolução Fatal , Patologia Legal , Humanos , Masculino , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/terapia , Lesões do Pescoço/complicações , Lesões do Pescoço/terapia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/terapiaRESUMO
Two cases of severe injuries to the head and the neck are reported. Both patients recovered after the traumas.
Assuntos
Traumatismos Craniocerebrais/diagnóstico , Lesões do Pescoço/diagnóstico , Ferimentos Perfurantes/diagnóstico , Adulto , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/cirurgia , Resultado do Tratamento , Ferimentos Perfurantes/cirurgiaRESUMO
The objective of the present work was to consider problems pertaining to forensic medical examination of injuries to the neck and dentition system complicated by pyoinflammatory processes. Two clinical observations are reported to illustrate significant difficulties encountered by forensic medical experts during assessment of the severity of harm inflicted to human health in the cases requiring differential characteristic of injuries, evaluation of opportuneness and completeness of the provided medical aid, and the role of these factors in the development of fatal pyoseptic complications. Special emphasis is laid on the analysis of possibilities to attain these goals based on the "Medical criteria for the assessment of severity of harm inflicted to human health" (2008).
Assuntos
Celulite (Flegmão)/diagnóstico , Medicina Legal , Fraturas Mandibulares/diagnóstico , Lesões do Pescoço/diagnóstico , Fraturas dos Dentes/diagnóstico , Índices de Gravidade do Trauma , Ferimentos Perfurantes/diagnóstico , Adulto , Celulite (Flegmão)/complicações , Celulite (Flegmão)/terapia , Evolução Fatal , Medicina Legal/métodos , Humanos , Masculino , Fraturas Mandibulares/complicações , Fraturas Mandibulares/terapia , Lesões do Pescoço/complicações , Lesões do Pescoço/terapia , Fraturas dos Dentes/complicações , Fraturas dos Dentes/terapia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/terapiaRESUMO
The present study has demonstrated that a trauma inflicted to the medial facial region complicated by orbital phlegmona and similar injuries are characterized by specific morphological features differing in terms of localization and potential consequences that provide a basis for their categorization from the standpoint of severity of harm to human health.
Assuntos
Celulite (Flegmão)/etiologia , Celulite (Flegmão)/patologia , Traumatismos Faciais/patologia , Patologia Legal , Doenças Orbitárias/etiologia , Doenças Orbitárias/patologia , Índices de Gravidade do Trauma , Adulto , Idoso , Traumatismos Faciais/complicações , Humanos , MasculinoAssuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Cetorolaco de Trometamina/uso terapêutico , Medicina Bucal , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Cetorolaco de Trometamina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Segurança , Síndrome , Fatores de TempoRESUMO
The programme was aimed at audit of the parameters of antibacterial therapy for acute otitis media in adult outpatients in 8 cities of Russia (Smolensk, Volgograd, Ekaterinburg, Yaroslavl, Nizhny Novgorod, Tyumen, Ryazan, Vladivostok). The information sources were the case records. The data from the records were structurally fixed in specially designed individual registration charts for further computer processing. The analysis of the results showed that the real practice of the antibacterial therapy for acute otitis media was not based on a unique approach and did not mainly correspond to the present standards. Ampicillin proved to be preferential, whereas it is known that the drug of choice for such cases is amoxicillin. Antibacterial agents with low activity against the basic pathogens of the infection (doxycycline and others) and high toxicity (co-trimoxazol) were often prescribed, while the recommended up-to-date antibiotics (amoxicillin/clavulanate and others) were prescribed extremely rare or not prescribed at all. Scientifically unreasonable combined antibiotic therapy and prescription of parenteral drugs not rational for the treatment of outpatients were practiced.
Assuntos
Antibacterianos/uso terapêutico , Otite Média/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Resistance of Haemophilus influenzae from clinical isolates can be predicted on the basis of results of antimicrobial susceptibility of nasopharyngeal isolates. The carriage rate and the antimicrobial susceptibility of H. influenzae isolated in healthy children attending day-care centres in Moscow, Smolensk and Yartsevo was studied. The susceptibility of ampicillin, amoxycillin/clavulanate, cefaclor, erythromycin, roxithromycin, clarithromycin and trimethoprim-sulphamethoxazole were determined by the E-test. The mean carriage rate of H. influenzae was 44%. Resistance of H. influenzae to ampicillin was 2.3%, to amoxycillin/clavulanate 0.7%, to cefaclor 0.7%, to clarithromycin 18.7% and to trimethoprim-sulphamethoxazole 21%. These included strains that showed intermediate-resistance. The antimicrobial resistance profiles varied in different centres. The clinical use of trimethoprim-sulphamethoxazole should be restricted because of the high resistance of H. influenzae to antifolate compounds.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/efeitos dos fármacos , Nariz/microbiologia , Faringe/microbiologia , Criança , Creches , Pré-Escolar , Haemophilus influenzae/enzimologia , Humanos , Testes de Sensibilidade Microbiana , Resistência a TrimetoprimaAssuntos
Celulite (Flegmão)/complicações , Doenças dos Nervos Cranianos/etiologia , Nervo Hipoglosso , Infecções por Klebsiella/etiologia , Pescoço , Nervo Laríngeo Recorrente , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefazolina/administração & dosagem , Cefazolina/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/cirurgia , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Doenças dos Nervos Cranianos/tratamento farmacológico , Drenagem , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Fatores de TempoRESUMO
BACKGROUND: It has been previously shown that study of susceptibility of nasopharyngeal isolates in healthy carriers can predict resistance in clinical isolates. The purpose of this multicenter study was to determine the carriage rate of Streptococcus pneumoniae in healthy children attending day-care centers in Moscow, Smolensk and Yartsevo, Russia, and in vitro activity of penicillin G, amoxicillin/clavulanate, cefaclor, erythromycin, roxithromycin, clarithromycin and trimethoprim-sulfamethoxazole (TMP-SMX) against representative isolates. METHODS: Included in this study were 305 pneumococcal isolates from 733 children attending 9 day-care centers in Moscow, Smolensk and Yartsevo. All children enrolled in this study were <7 years of age. MICs of selected antimicrobials were determined by Etest. Serotyping of selected pneumococcal isolates was done with pool and type antisera. RESULTS: The carriage rate of S. pneumoniae in the 3 centers varied from 44.9% to 66.0% (mean, 55.9%). Susceptibility testing was performed with 305 (74.4%) of 410 isolates. Only 23 (7.5%) of 305 pneumococcal isolates were penicillin-intermediate (range, 2.8 to 12.8%) with no penicillin-resistant strains. All tested pneumococci were susceptible to amoxicillin/clavulanate. Macrolides possessed comparable activity against S. pneumoniae, at 4.6% resistant strains for both erythromycin (range, 1.1 to 17.1%) and clarithromycin (range, 1.7 to 17.1%). The highest level of resistance was observed with TMP-SMX, 53.4% (range, 43.8 to 70.9%). Of 23 strains 20 (87.0%) with intermediate resistance to penicillin were serotyped. The most prevalent serotype was 14 (5 isolates), followed by serogroups 19 (4) and 23 (4). CONCLUSIONS: Resistance to penicillin, other beta-lactams and macrolides does not seem to be a problem for Russia now. The high level of resistance to TMP-SMX considerably restricts its usage for the treatment of pneumococcal infections.
Assuntos
Resistência Microbiana a Medicamentos , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Creches/normas , Pré-Escolar , Resistência a Múltiplos Medicamentos , Humanos , Testes de Sensibilidade Microbiana , Valor Preditivo dos Testes , Federação Russa , Sorotipagem , Infecções Estreptocócicas/microbiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Resistência a TrimetoprimaAssuntos
Celulite (Flegmão)/complicações , Infecção Focal Dentária/complicações , Mediastinite , Algoritmos , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/cirurgia , Celulite (Flegmão)/terapia , Implantação Dentária/efeitos adversos , Diagnóstico Diferencial , Erros de Diagnóstico , Drenagem , Humanos , Mediastinite/diagnóstico , Mediastinite/etiologia , Mediastinite/terapia , Pescoço , Supuração/etiologia , Fatores de Tempo , Tomografia Computadorizada por Raios XAssuntos
Quimioterapia Combinada/uso terapêutico , Penicilinas/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Adolescente , Assistência Ambulatorial , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Ampicilina/administração & dosagem , Ampicilina/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Quimioterapia Combinada/administração & dosagem , Eritromicina/administração & dosagem , Eritromicina/uso terapêutico , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Injeções Intramusculares , Penicilina G/administração & dosagem , Penicilina G/uso terapêutico , Penicilinas/administração & dosagem , Estudos Retrospectivos , Federação Russa , Resultado do TratamentoRESUMO
Two mutants of bacterial formate dehydrogenase from Pseudomonas sp.101 (EC 1.2.1.2, FDH)-C255S (FDH-S) and C255M (FDH-M), were obtained and its properties were studied. Both mutations provided the high resistance to inactivation by Hg2+. Slow inactivation of mutants by DTNB reveals the presence in FDH molecule of another essential cysteine residue. Specific activities of FDH, FDH-S and FDH-M were 16, 16 and 9.5 U/mg of protein, respectively. Km on formate was 7.5, 7.5 and 20 mM and Km on NAD(+)-0.1, 0.3 and 0.6 mM for FDH, FDH-S and FDH-M, respectively. Mutations of Cys255 on Ser or Met resulted in increasing of enzyme stability at 25 degrees C and decreasing of thermostability (above 45 degrees C). Data obtained show that Cys255 is unique residue for providing both enzyme thermostability and catalytically optimal binding of coenzyme.
Assuntos
Cisteína/metabolismo , Formiato Desidrogenases/metabolismo , Metionina/metabolismo , Mutação , Pseudomonas/enzimologia , Serina/metabolismo , Sequência de Aminoácidos , Sequência de Bases , Catálise , Cisteína/genética , Ácido Ditionitrobenzoico/farmacologia , Estabilidade Enzimática , Formiato Desidrogenases/antagonistas & inibidores , Formiato Desidrogenases/genética , Cinética , Mercúrio/farmacologia , Metionina/genética , Dados de Sequência Molecular , Oligonucleotídeos , Homologia de Sequência de Aminoácidos , Serina/genéticaAssuntos
Cisteína/metabolismo , Escherichia coli , Formiato Desidrogenases/genética , Mutagênese Sítio-Dirigida , Sequência de Bases , Catálise , Clonagem Molecular , Ácido Ditionitrobenzoico/farmacologia , Estabilidade Enzimática , Formiato Desidrogenases/antagonistas & inibidores , Formiato Desidrogenases/metabolismo , Temperatura Alta , Mercúrio/farmacologia , Dados de Sequência MolecularRESUMO
The authors describe the results of studying lipid peroxidation, total antioxidant activity of plasma and the content of essential trace elements (iron, copper, zinc and selenium) in 35 healthy neonates and in 32 with intrauterine hypotrophy, grades I-III, at birth and the course of the early neonatal period. It has been found that in the neonates with a history of intrauterine hypotrophy, activation of lipid peroxidation resulted in the decrease of plasma antioxidant activity and in the changes of the concentration of essential trace elements.
Assuntos
Retardo do Crescimento Fetal/metabolismo , Recém-Nascido/metabolismo , Peroxidação de Lipídeos , Oligoelementos/sangue , Feminino , Humanos , Malondialdeído/sangue , Gravidez , Valores de ReferênciaRESUMO
NAD-dependent formate dehydrogenase (EC 1.2.1.2), was isolated from the methanol-utilizing yeast Candida methylica. Two purification techniques for the enzyme from the crude yeast extract have been developed: a two-step procedure, involving a sequential application of DEAE-cellulose ion-exchange chromatography and Sephadex G-200 gel filtration, and a single-step procedure, preparative isoelectric focusing in a granulated gel layer. The enzyme proved to be electrophoretically homogeneous. It consisted of two identical subunits with a relative molecular mass of 46 000, each containing one -SH group related to manifestation of the catalytic activity. The Michaelis constant was 1 X 10(-4) M for NAD and 1.3 X 10(-2) M for formate. Formate dehydrogenase was inhibited with p-chlormercuribenzoate, iodoacetamide, dithionitrobenzoate, cyanide and azide.
Assuntos
Aldeído Oxirredutases/isolamento & purificação , Candida/enzimologia , Formiato Desidrogenases/isolamento & purificação , NAD/fisiologia , Cromatografia DEAE-Celulose , Eletroforese em Gel de Poliacrilamida , Formiato Desidrogenases/biossíntese , Concentração de Íons de Hidrogênio , Focalização Isoelétrica , Peso Molecular , Especificidade por Substrato , Compostos de Sulfidrila/análiseRESUMO
A kinetic analysis of the mechanism of action of NAD-dependent formate dehydrogenase (EC 1.2.1.2) from the methanol-utilizing yeast Candida methylica has been carried out. The dependence of the initial reaction rate on substrate concentrations and the inhibition by the reaction products and substrate analogs were investigated. The data obtained suggest that the kinetics of the formate dehydrogenase action are consistent with the formation of a ternary enzyme--substrate complex. NAD is the first substrate and NADH is the last product of the reaction, respectively.
Assuntos
Aldeído Oxirredutases/metabolismo , Candida/enzimologia , Formiato Desidrogenases/metabolismo , Cinética , Oxirredução , Ligação ProteicaRESUMO
NAD-dependent formate dehydrogenase was purified from a cell-free extract of methanol-consuming yeast Candida methylica, using chromatography on DEAE-cellulose and gel-filtration on Sephadex G-200. The enzyme is electrophoretically homogeneous, consists of two identical subunits with molecular weight of 46,000 and is active within the pH range of 6-9; the Km values for NAD and formate are 1 . 10(-4) and 1,3 . 10(-2) M, respectively. Formate dehydrogenase is inhibited by p-chloromercurybenzoate, iodoacetate, dithionitrobenzoate and azide.