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2.
Nutrients ; 14(10)2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35631138

RESUMO

The aim of the study was to evaluate the vitamin D status in hospitalized COVID-19 patients and the correlation with C reactive protein (CRP), ferritin, fibrinogen, and peripheral blood leukocytes, as well as inflammatory derived indices. A prospective study was performed on 203 COVID-19 hospitalized patients, classified by disease severity. Blood was collected after admission, and inflammatory biomarkers and vitamin D status were assessed using routine laboratory procedures. No significant correlation was found between vitamin D serum levels and disease severity stratified by different age groups. However, the highest vitamin D levels were found in patients with mild disease: median 29.39 (IQR 12.12-44.02) ng/mL, while for moderate and severe forms the serum levels were significantly lower: median 15.10 (IQR 9.56-24.11) ng/mL for moderate, and 18.86 (IQR 12.50-27.88) ng/mL for severe; p = 0.009. Patients with no comorbidities showed a significantly higher level of vitamin D median 24.72 (IQR 16.05-31.52) ng/mL compared to subjects with at least one comorbidity: median 16.02 (IQR 9.81-25.22) ng/mL, p = 0.004. We did not find an association between vitamin D levels and inflammatory biomarkers except for significantly lower vitamin D levels in moderate and severe COVID-19 compared to mild disease forms.


Assuntos
COVID-19 , Deficiência de Vitamina D , Biomarcadores , Humanos , Estudos Prospectivos , Vitamina D , Vitaminas
3.
J Crit Care Med (Targu Mures) ; 7(3): 170-183, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34722920

RESUMO

Despite substantial advancements in diagnosis and specific medical therapy in pulmonary arterial hypertension patients' management, this condition continues to represent a major cause of mortality worldwide. In pulmonary arterial hypertension, the continuous increase of pulmonary vascular resistance and rapid development of right heart failure determine a poor prognosis. Against targeted therapy, patients inexorable deteriorate over time. Pulmonary arterial hypertension patients with acute right heart failure who need intensive care unit admission present a complexity of the disease pathophysiology. Intensive care management challenges are multifaceted. Awareness of algorithms of right-sided heart failure monitoring in intensive care units, targeted pulmonary hypertension therapies, and recognition of precipitating factors, hemodynamic instability and progressive multisystem organ failure requires a multidisciplinary pulmonary hypertension team. This paper summarizes the management strategies of acute right-sided heart failure in pulmonary arterial hypertension adult cases based on recently available data.

4.
Medicine (Baltimore) ; 100(2): e24316, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466220

RESUMO

INTRODUCTION: Mycoplasma pneumoniae (MP) infection in infants is usually overlooked and it might result in important complications if left untreated. MP-induced arthritis is probably the least common extrapulmonary manifestation and frequently leads to delays in the diagnosis. PATIENT CONCERNS: We report the case of a 2-year-old female child admitted in our clinic for prolonged fever (onset 2 weeks before the admission), for which the general practitioner established the diagnosis of acute pharyngitis and recommended antibiotics. But the fever persisted and the patient was referred to a pediatrician. DIAGNOSIS: The laboratory tests revealed leukocytosis with neutrophilia, elevated C-reactive protein and liver cytolysis. The blood and urine cultures, as well as the serological hepatitis B and C, toxoplasmosis, Epstein Barr virus, Rubella, Herpes virus, and cytomegalovirus were negative. The chest X-ray established the diagnosis of pneumonia. The fever persisted for approximately 2 weeks after admission. On the 2nd week of admission, the patient began to experience gait difficulties complaining of pain in the right hip and ankle. The cardiology and pneumology consults revealed no pathological findings. The evolution was favorable after the initiation of Levofloxacin and MP infection was detected as we suspected. Moreover, the ultrasound of the hip revealed a mild joint effusion, while the ankle joint appeared to be normal at ultrasound. Thus, we established the diagnosis of hip and ankle arthritis based on the clinical and ultrasound findings. INTERVENTIONS: Levofloxacin by vein was continued for 5 days, replaced afterwards with clarithromycin orally for 2 weeks. OUTCOMES: The gait difficulties persisted for approximately 5 months from the initial diagnosis, and improved once the titer of immunoglobulin M anti-MP antibodies lowered considerably. After more than 8 months, the patient was completely asymptomatic and the immunoglobulin M anti-MP was close to the normal range. CONCLUSION: The awareness of MP-induced arthritis in children represents the cornerstone in preventing diagnostic delays and initiating the proper treatment.


Assuntos
Artrite Infecciosa/microbiologia , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/microbiologia , Antibacterianos/uso terapêutico , Pré-Escolar , Feminino , Humanos , Levofloxacino/uso terapêutico
6.
BMC Infect Dis ; 20(1): 221, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171247

RESUMO

BACKGROUND: The goal of the study was to evaluate a potential role for tumor necrosis factor alpha (TNF-α) genetic variability as biomarker in sepsis. In particular, we aimed to determine if single nucleotide polymorphisms (SNPs) of TNF-α gene are associated with sepsis in terms of risk, severity and outcome. METHODS: We performed a prospective study on 163 adult critically ill septic patients (septic shock 65, sepsis 98, further divided in 40 survivors and 123 deceased) and 232 healthy controls. Genotyping of TNF-α SNPs (-308G/A, -238G/A, -376G/A and +489G/A) was performed for all patients and controls and plasma cytokine levels were measured during the first 24 h after sepsis onset. RESULTS: TNF-α +489G/A A-allele carriage was associated with significantly lower risk of developing sepsis and sepsis shock (AA+AG vs GG: OR = 0.53; p = 0.004; 95% CI = 0.34-0.82 and OR = 0.39; p = 0.003; 95% CI = 0.21-0.74, respectively) but not with sepsis-related outcomes. There was no significant association between any of the other TNF-α promoter SNPs, or their haplotype frequencies and sepsis or septic shock risk. Circulating TNF-α levels were higher in septic shock; they were not correlated with SNP genotype distribution; GG homozygosity for each polymorphism was correlated with higher TNF-α levels in septic shock. CONCLUSIONS: TNF-α +489G/A SNP A-allele carriage may confer protection against sepsis and septic shock development but apparently does not influence sepsis-related mortality. Promoter TNF-α SNPs did not affect transcription and were not associated with distinct sepsis, septic shock risk or outcomes.


Assuntos
Progressão da Doença , Polimorfismo de Nucleotídeo Único , Choque Séptico/genética , Choque Séptico/mortalidade , Fator de Necrose Tumoral alfa/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Biomarcadores , Estado Terminal , Suscetibilidade a Doenças , Feminino , Haplótipos/genética , Homozigoto , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Regiões Promotoras Genéticas , Estudos Prospectivos
7.
J Crit Care Med (Targu Mures) ; 5(3): 90-96, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31431921

RESUMO

In recent years, a new form of medicine has become increasingly significant, namely, personalised medicine (PM). PM is a form of care in which treatment is tailored for an individual patient. PM is about using multiple data sets to create a digital human mapping. A person's biological traits are determined by the interactions of hundreds of genes and gene networks, as well as external factors such as diet and exercise. Combining and then investigating these multiple databases with powerful statistical tools, allows a new understanding of how genetic intricacy drives health and disease and so leads to a closer personalised medical approach that targets each individual's unique genetic make-up. Sepsis is a systemic inflammatory response to infection, ranging from systemic inflammatory response syndrome (SIRS) to septic shock and multiple organ dysfunction syndromes (MODS). Sepsis is the most common cause of death in intensive care patients. Treatments in an ICU may need to be adapted to the continuous and rapid changes of the disease, making it challenging to identify a single target. PM is thus seen as the future of sepsis treatment in the ICU. The fact that individual patients respond differently to treatment should be regarded as a starting point in the approach to providing treatment. The disease itself comes secondary to this concept.

8.
Rom J Morphol Embryol ; 60(1): 69-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31263829

RESUMO

AIM: Evaluating the role of interleukin-6 (IL-6) as an early predictor of sepsis in a murine model. MATERIALS AND METHODS: The study divided 26 Wistar rats into two experimental groups in which sepsis was induced through the intraperitoneal injection of different Escherichia coli cultures [Group 1: Extended-spectrum beta-lactamase (ESBL)-producing culture and Group 2: Standardized ATCC35218 culture] and a control group. IL-6 levels were determined at 5 and 24 hours post-inoculation and immunohistochemistry (IHC) was performed on tissue samples from the sacrificed animals. RESULTS: Mean plasma IL-6 levels in Group 1 peaked at 5 hours [37.4 pg∕mL; standard deviation (SD) = 2.4 pg∕mL] and decreased at 24 hours (34 pg∕mL; SD=3.2 pg∕mL) after inoculation. IL-6 levels in Group 1 were elevated compared to Group 2, at 5 hours (33.7 pg∕mL; SD=3.3 pg∕mL; p=0.019) and non-significantly so at 24 hours (32.5 pg∕mL; SD=2.4 pg∕mL; p=0.233). The results did not show an increase over control levels at either 5 hours (37.6 pg∕mL; SD=3.4 pg∕mL) or 24 hours (40.8 pg∕mL; SD=2.9 pg∕mL) after inoculation. The IHC shows a varying degree of IL-6 expression across all organ types studied. No statistically significant correlations were found between the tissue level quantification of IL-6 and serum values at 24 hours in either group. CONCLUSIONS: For an early stage of infection/inflammation, serum levels of IL-6 are not correlated with tissue-level inflammation disproving a potential role of IL-6 as a very precocious diagnostic and predictor test. Accumulation of IL-6 in lung, kidney and spleen tissue can be observed from the beginning of inflammation.


Assuntos
Interleucina-6/sangue , Sepse/sangue , Animais , Modelos Animais de Doenças , Feminino , Imuno-Histoquímica , Camundongos , Ratos , Ratos Wistar , Taxa de Sobrevida
9.
Med Teach ; 41(6): 619-624, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30661485

RESUMO

Romania is a country in south-east Europe, which has experienced major changes in political, educational, and healthcare systems. At the time of writing this paper, there are thirteen accredited Faculties of Medicine, which offer students from all over the world the possibility of becoming doctors. Students in Romania follow a six-year program of activity and there are courses taught in Romanian, English, French, and Hungarian. In this paper, we outline the organization of Romanian medical education at undergraduate and postgraduate levels and we indicate the opportunities for curriculum development.


Assuntos
Educação Médica/organização & administração , Currículo , Atenção à Saúde/organização & administração , Educação Médica/normas , Avaliação Educacional , Humanos , Romênia , Critérios de Admissão Escolar
10.
J Crit Care Med (Targu Mures) ; 5(4): 136-139, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31915719

RESUMO

INTRODUCTION: As chronic HIV infection is prone to co-infections more than any other infectious condition, many severely immune-depressed patients require advanced diagnostic investigations and complex treatment. CASE REPORT: The case of a 30-year-old severely immune-depressed patient with AIDS, who developed neurological impairment and was diagnosed with encephalitis is presented. Multiple diagnostic approaches had to be used in order to identify the etiologic agents responsible for the clinical, immunological and biological evolution. Despite using advanced laboratory investigations and complex treatment, the patient developed multiple organ dysfunction syndromes that led to a fatal outcome. CONCLUSIONS: Establishing etiologic relations and treatment priorities in patients with severe immunodeficiency and co-infections can prove difficult, underlining the need of rapid syndromic testing.

11.
J Crit Care Med (Targu Mures) ; 4(1): 17-22, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29967896

RESUMO

BACKGROUND: Known also as Osler's triad, Austrian syndrome is a complex pathology which consists of pneumonia, meningitis and endocarditis, all caused by the haematogenous dissemination of Streptococcus pneumoniae. The multivalvular lesions are responsible for a severe and potential lethal outcome. CASE REPORT: The case of a 51-year-old female patient, with a past medical history of splenectomy, is presented. She developed bronchopneumonia, acute meningitis and infective endocarditis as a result of Streptococcus pneumoniae infection and subsequently developed multiple organ dysfunction syndromes which led to a fatal outcome. Bacteriological tests did not reveal the etiological agent. The histopathological examination showed a severe multivalvular endocarditis, while a PCR based molecular analysis from formalin fixed valvular tissue identified Streptococcus pneumoniae as the etiologic agent. CONCLUSIONS: The presented case shows a rare syndrome with a high risk of morbidity and mortality. Following the broad-spectrum treatment and intensive therapeutic support, the patient made unfavourable progress which raised differential diagnosis problems. In this case, the post-mortem diagnosis demonstrated multiple valvular lesions occurred as a result of endocarditis.

12.
Transpl Infect Dis ; 20(4): e12904, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29668074

RESUMO

BACKGROUND: Nocardiosis is a life-threatening opportunistic infection. Solid organ transplant (SOT) recipients are at higher risk (incidence 0.04%-3.5%) of developing nocardiosis. Rate of nocardiosis in the Southwestern US may be high due to environmental factors. METHODS: We performed a retrospective review study on 54 SOT patients diagnosed with Nocardia between 1997 and 2016 at our center. To explore the association of various risk factors with both the development of disseminated disease and mortality, a series of Fisher's exact tests was used. FINDINGS: Incidence of nocardiosis in SOT patients was 2.65%. Fisher's exact tests revealed no association between development of disseminated disease and the following variables: transplant rejection (P = 1), elevated tacrolimus levels (P = .4), and CMV viremia (P = .06). Also, we did not find any association between mortality and the variables we evaluated: type of transplant, transplant rejection, renal failure, disseminated nocardia, and patient's age. Overall mortality and 1-year mortality were 17% and 11%. INTERPRETATION: Based on our findings, daily 1 DS TMP/SMX prophylaxis did not appear to provide reliable protection against nocardiosis. However, we could not state definitely that TMP/SMX prophylaxis was or wasn't protective because of lack control group. None of the Fisher's exact tests revealed associations between the tested risk factors and either disease dissemination or mortality. This could be due to a true lack of association between the variables in each pair. However, it is also likely that our relatively small sample size limited our power to detect underlying relationships that may be present. Compared with other studies, 1-year mortality was lower at our institution (11% vs 16%).


Assuntos
Rejeição de Enxerto/epidemiologia , Nocardiose/epidemiologia , Nocardia/isolamento & purificação , Infecções Oportunistas/epidemiologia , Transplante de Órgãos/efeitos adversos , Adulto , Idoso , Antibacterianos/uso terapêutico , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Incidência , Masculino , Pessoa de Meia-Idade , Nocardiose/imunologia , Nocardiose/microbiologia , Nocardiose/prevenção & controle , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Sudoeste dos Estados Unidos/epidemiologia , Tacrolimo , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
13.
Medicine (Baltimore) ; 96(43): e8399, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29069036

RESUMO

Interpersonal and communication skills are 2 essential qualities of every physician. These are separate and distinct parts of the professional character of every physician. In pediatrics these abilities present even a higher impact.We performed a survey-type prospective study based on questionnaires on 100 subjects, equally divided into 4 groups: 25 children, 25 pediatricians, 25 care-givers (parents, tutors, and relatives), and 25 health care staff, in a Tertiary Pediatric Clinic from Romania, between January 2017 and April 2017.We included 100 participants in our study, equally divided into 4 groups: pediatric patients, pediatricians, care-givers, and health care staff. The 1st group comprised 25 children diagnosed with different chronic conditions, presenting the age between 5 and 14 years. The male gender predominated among the children (57%). The lowest general average score for "Communication" section was encountered among pediatricians group, 3.8, while the other 3 groups presented the same average score for this section, that is, 4.6. The children and the health care staff offered the same average score for "Transparency," that is, 4.6, while the pediatricians offered a score of 4.5, and the care-givers of 4.7. The lowest average score for the item "Hospital environment" was given by the doctors, that is, 3.3, followed by care-givers with a score of 3.6, health care staff 3.7, and children with an average score of 3.8. All the 4 groups included in the study offered a general average of 4.9 out of 5 for the "Intercultural issues" section. The lowest average score for "Time management" section was offered by both children and pediatricians, that is, 4.1, while care-givers and health care staff had a slightly better perception regarding this item, offering 4.2 and 4.3, respectively.The opinion among the 4 groups included in the study was generally similar regarding the 5 items assessed by our questionnaires. Therefore, the main aspects that need to be improved in the health care system in downward order are the following: hospital environment, time management, communication, transparency, and intercultural issues.


Assuntos
Cuidadores/psicologia , Comunicação , Pessoal de Saúde/psicologia , Pediatras/psicologia , Relações Médico-Paciente , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Romênia , Inquéritos e Questionários
14.
Adv Clin Exp Med ; 26(3): 475-481, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28791823

RESUMO

BACKGROUND: The prevalence of primitive pulmonary arterial hypertension (PAH) in patients with human immunodeficiency virus infection (HIV) is estimated at approximately 0.5%, significantly higher than in the general population. OBJECTIVES: This study aimed to assess the echocardiographic modifications in HIV-associated pulmonary arterial hypertension (PAH). MATERIAL AND METHODS: A group of 117 patients, aged under 16, with horizontally transmitted HIV staged according to the U.S. Center for Disease Control and Prevention criteria, were included in this prospective study, with echocardiographic abnormalities in 79 children. The study group consisted of 27 HIV-infected patients with PAH, while the control group consisted of 38 patients with normal ultrasound features. The diagnostic criterion for PAH was the presence of a mean pulmonary artery pressure above 25 mm Hg, determined at 2 consecutive measurements having at least 6 months distance between them. All subjects underwent a complex echocardiographic assessment, including assessment of left and right ventricular hypertrophy and evaluation of left ventricular function, associated with determination of the immunological stage. RESULTS: We recorded the presence of PAH in 27 patients (23.08%), in whom an average value of 31.48 mm Hg was recorded for pulmonary artery pressure. All patients had mild forms of PAH. Age, gender and immunological stage showed no significant differences in the PAH group compared to patients in the control group. Right ventricular hypertrophy was encountered in 95.23% and left ventricular hypertrophy in 88.88% of the patients with PAH. Left ventricular dysfunction, a complication of pulmonary hypertension, was relatively rare (11.11%). CONCLUSIONS: In children with HIV infection, PAH is present in a relatively mild form and does not correlate with the clinical and immunological stage of HIV infection, evolving as a seemingly primitive condition.


Assuntos
Infecções por HIV/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Adolescente , Ecocardiografia/métodos , Feminino , Humanos , Hipertensão Pulmonar/virologia , Estudos Longitudinais , Masculino , Prevalência , Estudos Prospectivos , Artéria Pulmonar/virologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/virologia , Função Ventricular Esquerda/fisiologia
15.
Case Rep Oncol ; 10(2): 542-547, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28690530

RESUMO

Hodgkin lymphoma with symptomatic osseous involvement can have a similar presentation to osteomyelitis. Common findings in symptoms, laboratory workup, and imaging can make it very difficult to distinguish between the two diseases. Excisional biopsy should be pursued if fine-needle biopsy is equivocal and suspicion of lymphoma is high. We report a case of a 40-year-old man who presented with a history of marine animal sting on his neck and later developed erythema in the area, chest pain, constitutional symptoms, adenopathy, and imaging classic for sternal osteomyelitis. Fortunately, initial biopsy prompted the possibility of lymphoma, and further workup was initiated, which confirmed Hodgkin lymphoma. This case is a good reminder that malignancies and infections can share many common features, and keeping a broad differential diagnosis can be lifesaving. Proper staging and risk stratification of Hodgkin lymphoma help determine the optimal treatment.

16.
J Crit Care Med (Targu Mures) ; 3(1): 5-11, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29967864

RESUMO

Sepsis is an injurious systemic host response to infection, which can often lead to septic shock and death. Recently, the immune-pathogenesis and genomics of sepsis have become a research topic focusing on the establishment of diagnostic and prognostic biomarkers. As yet, none have been identified as having the necessary specificity to be used independently of other factors in this respect. However the accumulation of current evidence regarding genetic variations, especially the single nucleotide polymorphisms (SNPs) of cytokines and other innate immunity determinants, partially explains the susceptibility and individual differences of patients with regard to the evolution of sepsis. This article outlines the role of genetic variation of some serum proteins which have the potential to be used as biomarker values in evaluating sepsis susceptibility and the progression of the condition.

17.
J Crit Care Med (Targu Mures) ; 3(3): 123-127, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29967884

RESUMO

Pulmonary abscess or lung abscess is a lung infection which destroys the lung parenchyma leading to cavitations and central necrosis in localised areas formed by thick-walled purulent material. It can be primary or secondary. Lung abscesses can occur at any age, but it seems that paediatric pulmonary abscess morbidity is lower than in adults. We present the case of a one year and 5-month-old male child admitted to our clinic for fever, loss of appetite and an overall altered general status. Laboratory tests revealed elevated inflammatory biomarkers, leukocytosis with neutrophilia, anaemia, thrombocytosis, low serum iron concentration and increased lactate dehydrogenase level. Despite wide-spectrum antibiotic therapy, the patient's progress remained poor after seven days of treatment and a CT scan established the diagnosis of a large lung abscess. Despite changing the antibiotic therapy, surgical intervention was eventually needed. There was a slow but steady improvment and eventually, the patient was discharged after approximately five weeks.

18.
BMJ Case Rep ; 20162016 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-27903576

RESUMO

Coccidioidomycosis is an insidious infection caused by Coccidioides spp (C. immitis and C. posadasii). Disseminated disease occasionally involves tendon sheaths and synovium of the joints leading to tenosynovitis. Here, we describe the case of a 72-year-old woman from southern Arizona, who presented with right ankle pain, redness and swelling for 2 months. Her serum IgG was positive for C. immitis on complement fixation, and her MRI of the right ankle joint showed extensive tenosynovitis of the right peroneal tendons, and subtalar joint effusions with associated synovitis. The purpose of this case is to report an extremely rare manifestation of disseminated C. immitis, that is, peroneal tenosynovitis and challenges involved with diagnosis and treatment. We also document that azole therapy is an effective treatment option for peroneal tenosynovitis caused by C. immitis, and we had to double the dose for slow symptom resolution with 4-week trial with usual 400 mg oral dose of fluconazole.


Assuntos
Antifúngicos/uso terapêutico , Coccidioides , Coccidioidomicose/tratamento farmacológico , Fluconazol/uso terapêutico , Neuropatias Fibulares/tratamento farmacológico , Tenossinovite/tratamento farmacológico , Idoso , Articulação do Tornozelo/microbiologia , Coccidioidomicose/microbiologia , Feminino , Humanos , Neuropatias Fibulares/microbiologia , Tenossinovite/microbiologia
19.
Rom J Morphol Embryol ; 57(3): 951-957, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28002510

RESUMO

OBJECTIVE: The objective of this study is to evaluate if the immunohistochemical expression of a pulmonary apoptosis marker and plasma level of Fas ligand (FasL) correlates with the dose- and time-dependent severity of lung injury, induced by the administration of lipo-polysaccharide (LPS) in an endotoxemic rat model. MATERIALS AND METHODS: Our study included 30 male Wistar rats, randomly divided into three groups: one control group (n=6) and two experimental groups (n=12÷group), in whom we induced endotoxemia by intraperitoneal injection of progressively increasing doses of LPS (5, 10 mg÷kg). We measured FasL plasma levels of the rats at different time points and analyzed the relationships with markers of lung injury. To investigate the level of caspase 3-protein expression, the immunohistochemistry of the lung tissue was assessed. RESULTS: The median percentage of caspase 3-stained cells for the 5 mg÷kg LPS dose was 0.36%, for the 10 mg÷kg LPS dose was 0.4% and for the control group was 0.03% (p<0.0001). The elevated expression levels of caspase 3 were consistent with the altered lung morphologies observed (rs=0.88). LPS administration in rats resulted in a significant dose-dependent increase in the levels of plasma FasL (p<0.0001). These levels correlated with markers of lung injury: degree of hypoxemia (rs=-0.42), histological measured lung injury score (rs=0.72), the density of the caspase 3 staining cells in the immunohistochemistry assessment of apoptosis (rs=0.81) and with the plasma RAGE (receptor for advanced glycated end-products) values (rs=0.70). CONCLUSIONS: Apoptosis is increased in edotoxemia induced lung injury and is likely to contribute to alveolar injury.


Assuntos
Caspase 3/metabolismo , Proteína Ligante Fas/metabolismo , Lesão Pulmonar/patologia , Animais , Apoptose , Humanos , Masculino , Ratos , Ratos Wistar
20.
Medicine (Baltimore) ; 95(41): e5125, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27741135

RESUMO

BACKGROUND: Over the last decades Staphylococcus aureus (SA) has become the dominant etiology of native valve infective endocarditis, with the community-acquired methicillin-sensible Staphylococcus aureus (CA-MSSA) strains being the prevailing type. CASE: We report here a case of extremely severe CA-MSSA aortic valve acute endocarditis associated with persistent Staphylococcus aureus bacteremia (SAB) in a previously healthy man and include a literature review.The patient developed severe and rare complications (purpura, purulent pericarditis, intracerebral hematoma, and rhabdomyolysis) through systemic embolism; they required drainage of pericardial empyema and cerebral hematoma, the latter eventually caused a fatal outcome. The strains recovered from sequential blood culture sets and pericardial fluid were MSSA negative for genes encoding for staphylococcal toxic shock syndrome toxin (TSST)-1 and Panton-Valentine leukocidin. C, G, and I enterotoxin genes were detected. CONCLUSIONS: This case with unusually severe evolution underlines the limited ability of vancomycin to control some MSSA infections, possibly due to potential involvement of SA virulence factors, hence the importance of clinical vigilance for community SAB cases.


Assuntos
Endocardite/complicações , Hematoma Subdural Intracraniano/etiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pericardite/etiologia , Rabdomiólise/etiologia , Infecções Estafilocócicas/complicações , Adulto , Biópsia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Endocardite/diagnóstico , Endocardite/microbiologia , Evolução Fatal , Hematoma Subdural Intracraniano/diagnóstico , Humanos , Masculino , Pericardite/diagnóstico , Rabdomiólise/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia
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