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1.
Rev. clín. esp. (Ed. impr.) ; 213(2): 88-96, mar. 2013.
Artigo em Espanhol | IBECS | ID: ibc-110563

RESUMO

Introducción. Los objetivos fueron: a) describir la mortalidad y sus variables asociadas en la neumonía aguda comunitaria (NAC) a Streptococcus pneumoniae (S. pneumoniae); b) identificar aspectos terapéuticos a mejorar; c) identificar los principales serotipos de S. pneumoniae, y d) conocer la cobertura potencial de la vacuna antineumocócica 23 valente. Material y método. Criterio de inclusión: NAC en pacientes mayores de 16 años. Se consideró NAC neumocócica si al ingreso hospitalario se aisló S. pneumoniae desde la sangre y/o se detectó la presencia de antígeno neumocócico capsular en orina. Criterios de exclusión: negativa al consentimiento informado o infección neumocócica en el mes previo al ingreso. Resultados. Se identificaron 192 pacientes con edad promedio de 54,6±19,2 años. Comorbilidades más frecuentes: diabetes, EPOC e inmunodepresión. Se detectaron bacteriemias en 147 pacientes. Los serotipos más frecuentes fueron: 7F, 1 y 3. Ninguna cepa fue resistente a los betalactámicos y 8 (5,4%) a la eritromicina. Cobertura potencial de la vacuna antineumocócica 23 valente: 93%. Fallecieron 37 pacientes. Variables asociadas a la mortalidad: shock en las primeras 72h desde el ingreso al hospital (OR:7,51; IC 95%:2,94-19,17) y demora en el inicio de la antibioticorapia ≥6h (OR:2,47; IC 95%:1,00-6,17). Conclusiones. La mortalidad de la NAC neumocócica fue del 19,3%; las únicas 2 variables asociadas a ella fueron el shock séptico y la demora ≥6h en el inicio de la antibioticoterapia. Adicionalmente el mencionado retraso constituye el principal factor terapéutico a mejorarse en el futuro. El serotipo más frecuente fue el 7F. La cobertura potencial de la vacuna 23 valente es cercana al 90%(AU)


Introduction. The objectives of the present study were: a) to describe the mortality rate and its associated variables in community-acquired pneumoniae (CAP) due to Streptococcus pneumoniae (S. pneumoniae), b) to identify therapeutic issues to improve and c) to describe the main serotypes of S. pneumoniae and d) to know the potential coverage of antipneumococcal 23-valent vaccine. Materials and methods. Inclusion criteria were age >16 years-old hospitalized due to PAC. Pneumococcal PAC etiology was considered if S. pneumoniae was isolated from blood culture and/or positive capsular urinary antigen detected at hospital admission. Exclusion criteria were patients who refused participation and/or pneumococcal infection diagnosis was made within the last month before hospital admission. Results. A total of 192 patients were included, mean age 54.6±19.2 years. The most frequent comorbidities were diabetes, COPD and immunosupression. There were 147 patients with bacteremia. The most frequent serotypes were 7F, 1 and 3. Beta-lactamic resistant microorganisms were not identified and only 8 (5.4%) strains were erythromycin-resistant. Potential anti-pneumococcal 23-valent vaccine coverage was 93%. Thirty seven patients died. Variables associated with mortality were shock within the first 72h of hospital admission (OR:7.51; 95% CI:2.94-19.17) and antibiotic delay ≥6h (OR:2.47; 95% CI:1.00-6.17). Conclusions. Pneumococcal pneumonia mortality was 19.3%. Septic shock and antibiotic delay ≥6h since hospital admission were associated with hospital mortality. The most frequent serotype was 7F. The potential anti-pneumococcal vaccine coverage is almost 90%(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae , Razão de Chances , Intervalos de Confiança , Prognóstico
2.
Rev Clin Esp (Barc) ; 213(2): 88-96, 2013 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23178082

RESUMO

INTRODUCTION: The objectives of the present study were: (a) to describe the mortality rate and its associated variables in community-acquired pneumoniae (CAP) due to Streptococcus pneumoniae (S. pneumoniae), (b) to identify therapeutic issues to improve, (c) to describe the main serotypes of S. pneumoniae and (d) to know the potential coverage of antipneumococcal 23-valent vaccine. MATERIALS AND METHODS: Inclusion criteria were age >16 years-old hospitalized due to PAC. Pneumococcal PAC etiology was considered if S. pneumoniae was isolated from blood culture and/or positive capsular urinary antigen detected at hospital admission. Exclusion criteria were patients who refused participation and/or pneumococcal infection diagnosis was made within the last month before hospital admission. RESULTS: A total of 192 patients were included, mean age 54.6 ± 19.2 years. The most frequent comorbidities were diabetes, COPD and immunosupression. There were 147 patients with bacteremia. The most frequent serotypes were 7F, 1 and 3. Beta-lactamic resistant microorganisms were not identified and only 8 (5.4%) strains were erythromycin-resistant. Potential anti-pneumococcal 23-valent vaccine coverage was 93%. Thirty-seven patients died. Variables associated with mortality were shock within the first 72 h of hospital admission (OR: 7.51; 95% CI: 2.94-19.17) and antibiotic delay ≥6 h (OR: 2.47; 95% CI: 1.00-6.17). CONCLUSIONS: Pneumococcal pneumonia mortality was 19.3%. Septic shock and antibiotic delay ≥6 h since hospital admission were associated with hospital mortality. The most frequent serotype was 7F. The potential anti-pneumococcal vaccine coverage is almost 90%.


Assuntos
Pneumonia Pneumocócica/mortalidade , Streptococcus pneumoniae/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Tipagem Bacteriana , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Farmacorresistência Bacteriana , Feminino , Seguimentos , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vacinas Pneumocócicas , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Pneumonia Pneumocócica/terapia , Estudos Prospectivos , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/fisiologia , Resultado do Tratamento , Uruguai , Adulto Jovem
3.
Crit Care Med ; 27(11): 2474-9, 1999 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-10579267

RESUMO

OBJECTIVE: To investigate whether exogenous L-arginine, the substrate for nitric oxide synthase, modulates systemic hemodynamics in sepsis. DESIGN: Prospective, controlled study in a sheep model of sepsis. SETTING: Animal research facility in a university hospital. SUBJECTS: Adult sheep weighing between 35 and 55 kg. INTERVENTIONS: Adult sheep sedated and mechanically ventilated, were monitored with a pulmonary arterial catheter and an ileal tonometer. Four groups of sheep were studied: nonseptic, septic, nonseptic treated with L-arginine, and septic treated with L-arginine. Sepsis was induced by the intravenous administration of Escherichia coli (1.5x10(8) colony-forming units/kg for 30 mins). L-arginine was administered as an intravenous bolus (200 mg/kg for 10 mins) before the septic challenge followed by 200 mg/kg/hr for 300 mins. MEASUREMENTS AND MAIN RESULTS: Sepsis induced a state of acidosis, hyperlactatemia, hypoxemia, and gastric intramucosal acidosis. During the first 30 mins after the septic challenge, there was a decrease in cardiac index and blood pressure, and an increase in systemic vascular resistance. Thereafter, blood pressure returned to baseline values, and systemic vascular resistance fell. Treatment with L-arginine in nonseptic sheep did not induce any biochemical or hemodynamic effect. In septic sheep, treatment with L-arginine was associated with a greater increase in systemic vascular resistance during the first 30 mins, and a more marked decrease in blood pressure and systemic vascular resistance after 180 mins. CONCLUSIONS: Exogenous administration of L-arginine does not induce hemodynamic effects in normal animals, exacerbates the acute vasoconstriction associated with the intravenous infusion of E. coli and potentiates the sepsis-induced vasodilation. Our results suggest that a) nitric oxide production is not constitutively modulated by exogenous L-arginine, b) L-arginine probably enhances the sepsis-induced sympathetic discharge, and c) L-arginine becomes rate-limiting for the formation of nitric oxide at approximately 3 hrs after the initiation of the septic challenge.


Assuntos
Arginina/farmacologia , Bacteriemia/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacos , Acidose/sangue , Acidose/tratamento farmacológico , Acidose/etiologia , Animais , Bacteriemia/sangue , Bacteriemia/complicações , Bacteriemia/terapia , Gasometria , Modelos Animais de Doenças , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/fisiopatologia , Infecções por Escherichia coli/terapia , Concentração de Íons de Hidrogênio , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipóxia/sangue , Hipóxia/tratamento farmacológico , Hipóxia/etiologia , Injeções Intravenosas , Ácido Láctico/sangue , Leucopenia/sangue , Leucopenia/tratamento farmacológico , Leucopenia/etiologia , Estudos Prospectivos , Pressão Propulsora Pulmonar/efeitos dos fármacos , Respiração Artificial , Ovinos , Resultado do Tratamento
4.
J Reprod Fertil ; 57(1): 79-85, 1979 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-513009

RESUMO

The ultrastructure and the spontaneous and drug-induced contractility of the testicular capsule of 18 boars were investigated. Isometric recordings were obtained in vitro using strips of the tunica albuginea isolated from various regions of the testis. Maximal contractile activity was found in the strips of the posterior border of the testis, in which the histological studies (light and electron microscopy) showed abundant typical smooth muscle cells distributed in layers parallel to the testicular long axis. These cells were largely aggregated in the inner layer of the testicular capsule, which displayed contractile activity similar to that of the entire tunica albuginea. The outer layer of the tunica albuginea was almost totally devoid of smooth muscle fibres and showed little or no contractility. The spontaneous contractions were rhythmic and exhibited an amplitude of 20--70 mg and a frequency of 5--30 contractions/10 min. Norepinephrine, acetylcholine and oxytocin all produced an increase of the contractility of the tunica albuginea, consisting mainly in a rise of the tone.


Assuntos
Contração Muscular , Suínos/fisiologia , Testículo/fisiologia , Acetilcolina/farmacologia , Animais , Masculino , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiologia , Músculo Liso/ultraestrutura , Norepinefrina/farmacologia , Ocitocina/farmacologia , Estimulação Química , Testículo/ultraestrutura
5.
J Perinat Med ; 7(5): 243-9, 1979.
Artigo em Inglês | MEDLINE | ID: mdl-501508

RESUMO

In order to find a reliable index of fetal wellbeing, maternal estriol, hCS and oxytocinase levels were related with condition of the neonate. Fifty six high risk pregnancies were studied. Estriol and hCS were determined by specific radioimmunoassay and oxytocinase with a colorimetric method. The condition of the newborn was evaluated by the APGAR score. Neonates were divided into two groups, depressed (APGAR score 0-6) and vigorous (APGAR score 7-10). When the mean birthweights of both groups were statistically different, maternal estriol levels were corrected to avoid the influencing factor of newborn weight. Mean maternal estriol level corresponding to vigorous newborns was 46.73 ng/ml. This value was statistically higher than that corresponding to the group of depressed newborns, which was 26.25 ng/ml (Fig. 1). The mean birthweight of depressed infants (2,382.75 g) was statistically lower than that of the vigorous group (3,044.75 g). The corrected mean maternal estriol values of vigorous neonates (45.44 ng/ml) was different from that of depressed ones (25.14 ng/ml) (Fig. 2). When patients were divided according to maternal diseases (diabetes, vascular pathology, Rh sensitization) serum estriol levels of the mother were statistically different according to the Apgar score of the newborns. There was no significant difference between serum hCS and oxytocinase levels of mothers with depressed and vigorous newborns. Discarding fetal weight as an influencing factor in maternal hormone level, our results indicate the suitability of maternal serum estriol determinations to predict condition of the newborns in high risk pregnancies.


Assuntos
Aminopeptidases/sangue , Índice de Apgar , Cistinil Aminopeptidase/sangue , Estriol/sangue , Hormônio do Crescimento/sangue , Complicações na Gravidez/sangue , Peso ao Nascer , Cistinil Aminopeptidase/fisiologia , Estriol/fisiologia , Feminino , Hormônio do Crescimento/fisiologia , Humanos , Recém-Nascido , Atividade Motora , Gravidez
10.
Fertil Steril ; 28(2): 205-8, 1977 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-556704

RESUMO

This investigation was designed to determine the influence of the estrous cycle on the response of ovarian smooth muscle to oxytocin. Muscular activity in vivo was studied by recording intraovarian pressure. Intra-aortic injections of oxytocin were given to the rats at all stages of the estrous cycle. The effect of oxytocin was evaluated by the number of responding ovaries and the magnitude of the responses. According to these parameters, a greater response was observed during proestrus, compared with the other cycle stages. The significance of these results id discussed.


Assuntos
Estro , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Ocitocina/farmacologia , Animais , Relação Dose-Resposta a Droga , Feminino , Manometria , Ovário/efeitos dos fármacos , Ocitocina/administração & dosagem , Gravidez , Ratos
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