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BACKGROUND: To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting. METHODS: 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months. RESULTS: Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates. CONCLUSION: Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.
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Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Dexametasona/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Implantes de Medicamento , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Estudos RetrospectivosRESUMO
PURPOSE: To report a case of wound neovascularization (Swan syndrome) one year after trabeculectomy favorably treated with two intravitreal ranibizumab injections. OBSERVATIONS: A 79-year-old woman under coumadin treatment for atrial fibrillation experienced relapsing decreased vision in her left eye due to vitreous hemorrhage. She had had a past history of ocular hypertension corneal decompensation after phacoemulsification that required a Descemet Membrane Endothelial Keratoplasty and a subsequent trabeculectomy. After clearance of the hemorrhage, examination showed neovascularization not in the retina but surrounding the sclerostomy wound of the trabeculectomy, being diagnosed as a Swan syndrome. After two intravitreal injections of ranibizumab, gonioscopy showed complete resolution of the new vessels. No further recurrences have been reported and IOP has remained controlled without glaucomatous changes 7 months after the last injection. Clinical features and patient characteristics are described. CONCLUSION AND IMPORTANCE: Anti-vascular endothelial growth factor intravitreal injections may be a good and safe alternative to manage vitreous hemorrhage secondary to wound neovascularization of the trabeculectomy site.
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BACKGROUND: Metastasis to the brain is a major challenge with poor prognosis. The blood-brain barrier (BBB) is a significant impediment to effective treatment, being intact during the early stages of tumor development and heterogeneously permeable at later stages. Intravenous injection of tumor necrosis factor (TNF) selectively induces BBB permeabilization at sites of brain micrometastasis, in a TNF type 1 receptor (TNFR1)-dependent manner. Here, to enable clinical translation, we have developed a TNFR1-selective agonist variant of human TNF that induces BBB permeabilization, while minimizing potential toxicity. METHODS: A library of human TNF muteins (mutTNF) was generated and assessed for binding specificity to mouse and human TNFR1/2, endothelial permeabilizing activity in vitro, potential immunogenicity, and circulatory half-life. The permeabilizing ability of the most promising variant was assessed in vivo in a model of brain metastasis. RESULTS: The primary mutTNF variant showed similar affinity for human TNFR1 than wild-type human TNF, similar affinity for mouse TNFR1 as wild-type mouse TNF, undetectable binding to human/mouse TNFR2, low potential immunogenicity, and permeabilization of an endothelial monolayer. Circulatory half-life was similar to mouse/human TNF and BBB permeabilization was induced selectively at sites of micrometastases in vivo, with a time window of ≥24 hours and enabling delivery of agents within a therapeutically relevant range (0.5-150 kDa), including the clinically approved therapy, trastuzumab. CONCLUSIONS: We have developed a clinically translatable mutTNF that selectively opens the BBB at micrometastatic sites, while leaving the rest of the cerebrovasculature intact. This approach will open a window for brain metastasis treatment that currently does not exist.
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Barreira Hematoencefálica , Neoplasias Encefálicas , Animais , Barreira Hematoencefálica/metabolismo , Encéfalo/metabolismo , Neoplasias Encefálicas/tratamento farmacológico , Camundongos , Trastuzumab , Fator de Necrose Tumoral alfa/metabolismoRESUMO
INTRODUCTION: Phase III clinical trials of dexamethasone intravitreal implant for diabetic macular oedema (DMO) have reported significant improvements in visual acuity (VA). Studies evaluating the treatment of DMO in routine clinical practice provide data to identify areas that need improvement. This study evaluated 12-month treatment outcomes of dexamethasone implant for DMO in routine clinical practice. METHODS: Retrospective data analysis of eyes that started dexamethasone implant for DMO from 1 June 2013 to 30 April 2019 in routine clinical practice tracked in the Fight Retinal Blindness! Registry. RESULTS: Of the 4282 eyes (2518 patients) that started DMO treatment in the specified period, 267 (6%) eyes (204 patients) received 454 dexamethasone implant injections. Two-fifths (106 eyes) had received prior treatment for DMO. The mean (95% confidence interval [CI]) VA change at 12 months was 1.8 (- 0.5, 4.2) letters from the mean (standard deviation [SD]) VA of 56.5 (19.8) letters at baseline, with 41% eyes achieving at least 20/40. The mean (95% CI) change in central subfield thickness over 1 year was - 79 (- 104, - 54) µm from a mean (SD) of 459 (120) µm at baseline. Eyes that completed 1 year of follow-up received a median (Q1, Q3) of 2 (1, 2) dexamethasone implants. One-tenth of phakic eyes received cataract surgery while 2% had a pressure response requiring anti-glaucoma medications. CONCLUSIONS: One-year treatment outcomes of dexamethasone intravitreal implant for DMO in routine clinical practice were inferior to those in the clinical trials perhaps because of fewer treatments in clinical practice.
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PURPOSE: To investigate the incidence, characteristics, and baseline predictors of poor visual outcomes in eyes with diabetic macular edema (DME) receiving intravitreal therapy in routine clinical practice. DESIGN: Observational study. PARTICIPANTS: Treatment-naïve eyes starting intravitreal therapy for DME between 2014 and 2018 tracked in the Fight Retinal Blindness! registry. We examined 2 groups with poor visual outcomes: (1) those with sustained vision loss of > 10 letters from baseline without recovery of visual acuity (VA); and (2) those with a VA of < 55 letters at 2 years. Respective controls were eyes that did not experience poor visual outcomes. METHODS: Kaplan-Meier curves analyzed the proportion of eyes that experienced poor outcomes. Cox proportional hazards models evaluated the potential baseline predictors of poor outcomes. MAIN OUTCOME MEASURES: The proportion of eyes that experienced poor visual outcomes within 2 years of treatment initiation and its baseline predictors. RESULTS: The proportion of eyes with sustained VA of ≥ 10 letter loss was 14% at 2 years; 16% of eyes had VA of ≤ 55 letters 2 years after starting intravitreal therapy. Initial treatment with intravitreal corticosteroid was independently associated with a higher incidence of ≥ 10 letter loss (hazard ratio [HR], 3.21; 95% confidence interval [CI], 1.60-6.44; P < 0.01). No improvement in the VA at 3 months after starting treatment was associated with ≥ 10 letter loss (HR, 6.81; 95% CI, 4.11-11.27; P < 0.01) and VA of ≤ 55 letters at 2 years (HR, 4.28; 95% CI, 2.66-6.89; P < 0.01). The other factors related to higher risk of VA of ≤ 55 letters were older age (HR, 1.02 per year; 95% CI, 1-1.04; P = 0.04) and poor baseline VA (HR, 0.68 per 5 letters; 95% CI, 0.65-0.72, P < 0.001). CONCLUSIONS: Fourteen percent of eyes managed with intravitreal therapy in routine clinical care experienced ≥ 10 letter loss and 16% had VA of ≤55 letters 2 years after starting the treatment for DME. The identification of the incidence and predictors of poor outcomes provides a more accurate assessment of the potential benefit from intravitreal therapy.
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Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inibidores da Angiogênese , Bevacizumab , Cegueira/diagnóstico , Cegueira/epidemiologia , Cegueira/etiologia , Diabetes Mellitus/tratamento farmacológico , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Ranibizumab , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Fator A de Crescimento do Endotélio Vascular , Transtornos da Visão/tratamento farmacológicoRESUMO
AIM AND OBJECTIVE: This study aimed to evaluate the performance of and indication for different surgical techniques in the management of uveitic glaucoma (UG). MATERIALS AND METHODS: A retrospective audit of records of all patients with UG who underwent ≥1 glaucoma surgery, between January 2007 and December 2016. The main outcomes were intraocular pressure (IOP) and the need for antihypertensive medication at each follow-up visit. The total number of surgical interventions needed to control IOP was recorded. Postoperative interventions and complications were analyzed. RESULTS: Forty eyes from 34 patients were assessed. Overall, baseline IOP was 30.7 ± 8.2 mm Hg, and postoperative mean IOP at the last visit was 16.4 ± 2.0 mm Hg, with a mean follow-up of 28 months. Antihypertensive medications were reduced from 2.8 ± 0.8 to 0.8 ± 1.2. During the follow-up, 61.8% of the eyes required only one glaucoma surgery. There was no correlation between the location of uveitis and the total number of glaucoma surgeries required. The greatest IOP reductions were in cases treated with non-penetrating deep sclerectomy (21%), Ahmed valve (23%), and cyclophotocoagulation (CPC) (51%); in cases where an Ahmed implant was the first surgical option, a 43% reduction was achieved. CONCLUSION: Filtering procedures, glaucoma drainage devices, and CPC are all good options for IOP control in UG, but all are prone to failure over time. With respect to IOP reduction, the safety profile, and postoperative care, Ahmed implants and CPC might be the best first surgical option. CLINICAL SIGNIFICANCE: The article highlights the versatility of the surgical techniques required to treat UG, which is one of the most difficult types of glaucoma to manage. HOW TO CITE THIS ARTICLE: Ventura-Abreu N, Mendes-Pereira J, Pazos M, et al. Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital. J Curr Glaucoma Pract 2021;15(2):52-57.
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Objetivo: Caracterizar el tratamiento laparoscópico de pacientes con colecistitis difícil en el Servicio de Cirugía I del Hospital Universitario de Caracas durante el quinquenio2017-2021. Métodos: Estudio retrospectivo, observacional, descriptivo y de corte transversal. Muestra de tipo no probabilístico por conveniencia, seleccionada de la base de datos del Departamento de Historias Médicas del Hospital Universitario de Caracas. El análisis estadístico se realizó con el programa SPSS en su versión 26. Resultados: se recolectaron61 Historias Clínicas con características de colecistectomías laparoscópicas difíciles, el grupo etario más numeroso con67,19%, fue entre 30-59 años; sexo predominante: el femenino con 85,2%; el 42,62% de los pacientes presentaron a su ingreso: litiasis vesicular simple, el cólico vesicular persistente fue la complicación más frecuente con 31,23%. El 65,57% se ubicó en Grado I según Nassar como hallazgo intraoperatorio más frecuente, y según Parkland el 75,40% en grado I, sin individuos afectados con Grado V. Todos los casos fueron tratados quirúrgicamente (colecistectomía laparoscópica total).Conclusión: el total de los pacientes sometidos a tratamiento quirúrgico con hallazgos de colecistectomía laparoscópica difícil, se completó mediante colecistectomía laparoscópica total(AU)
Objective: To characterize the surgical treatment of difficult cholecystectomy in the Chair of Clinical and Surgical therapeutics "A" / Surgery Service I of the University Hospital of Caracas during the five-year period 2017 -2021.Methods: A retrospective, observational, descriptive and cross-sectional study will be carried out. The sample will be of anon-probabilistic type for convenience, selecting from the listof patients in the database of the Department of Medical Records of the Hospital Universitario de Caracas. The statistical analyzes will be carried out with the SPSS program in its version 26. Results: 61 difficult laparoscopic cholecystectomies were observed, the most frequent age group with 67.19%, was between 30-59 years, the female sex with 85.2% was the predominantone. 42.62% of the admission diagnoses were simple gallstones, followed by persistent gallbladder colic as the most frequent complication with 31.23%. 65.57% represent Grade I accordingto Nassar as the most frequent intraoperative finding and according to Parkland 75.40% represented by grade I, leaving Grade V without affected individuals. 100% of the sample were surgically treated by total laparoscopic cholecystectomy. Conclusion: the total number of patients undergoing surgical treatment with difficult laparoscopic cholecystectomy findingswas completed by total laparoscopic cholecystectomy(AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ductos Biliares , Colecistectomia LaparoscópicaRESUMO
Se hace un análisis de la Evolución Histórica del Sistema Nacional de Salud en Venezuela desde 1909 hasta el año 2023. Se realizó un desglose de seis etapas: etapa "A" o Gomecista (1905 1935), etapa "B" o de la Segunda Guerra Mundial (1936- 1945), etapa "C" o de la División de Hospitales(1946-1949), etapa "D" o Perezjimenista (1950 1958), etapa "E" o de inicio de la Democracia (1959 1963), etapa "F" de Modelo Curativo y de Expansión Hospitalaria (1963 1998),etapa "G" de la Revolución Bolivariana (1999 2023). Se analizó también el Plan Nacional de Salud 2019 2025(AU)
An analysis of the Historical Evolution of the National Health System in Venezuela is made from 1909 to the year 2023. A breakdown of six stages is made: stage "A" or Gomez (1905 - 1935), stage "B" or Second World War (1936-1945),stage "C" or the Hospital Division (1946-1949), stage "D" or Perezjimenista (1950-1958), stage "E" or the beginning of Democracy (1959-1963), stage "F" of the Curative Model and Hospital Expansion (1963-1998), stage "G" of the Bolivarian Revolution (1999 - 2023). The National Health Plan 2019 -2025 is also analyzed(AU)
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Humanos , Masculino , Feminino , História da Medicina , Venezuela , Acesso à Atenção Primária , Política de SaúdeRESUMO
Background: Prognostic markers for risk stratification of patients with gastrointestinal high-grade neuroendocrine carcinomas (GI-NECs) are lacking; we designed and validated a prognostic score for overall survival (OS). Methods: Consecutive patients diagnosed in five neuroendocrine specialist European centers were included. Patients were divided into three cohorts: a training cohort (TC), an external validation cohort (EVC), and a prospective validation cohort (PVC). Prognostic factors were identified by log-rank test, Cox-regression, and logistic regression analyses. The derived score was internally and externally validated. All statistical tests were two-sided. Results: Of 395 patients screened, 313 were eligible (TC = 109 patients, EVC = 184 patients, and PVC = 20 patients). The derived prognostic score included five variables: presence of liver metastases, alkaline phosphatase (ALK), lactate dehydrogenase (LDH), Eastern Cooperative Oncology Group performance status (ECOG PS), and Ki67. In multivariable analysis, the score was prognostic for OS (hazard ratio [HR] = 1.86, 95% confidence interval [CI] = 1.47 to 2.35, P < .001) and had good discrimination (C-index = 0.76) and calibration (mean error = 0.021, 90th percentile = 0.037) in the TC. These results were validated in the EVC and PVC, in which our score was able to prognosticate for OS when adjusted for other prognostic variables in the multivariable analysis (HR = 1.85, 95% CI = 1.27 to 2.71, P = .001; and HR = 4.51, 95% CI = 1.87 to 10.87, P = .001, respectively). The score classified patients into two groups with incremental risk of death: group A (0-2 points, 181 patients [63.9%], median OS = 19.4 months, 95% CI = 16.1 to 25.1) and group B (3-6 points, 102 patients [36.1%], median OS = 5.2 months, 95% CI = 3.6 to 6.9). Conclusions: The GI-NEC score identifies two distinct patient cohorts; it provides a tool for clinicians when making treatment decisions and may be used as a stratification factor in future clinical trials.
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Carcinoma Neuroendócrino/secundário , Neoplasias Gastrointestinais/patologia , Neoplasias Hepáticas/secundário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Biomarcadores Tumorais/análise , Carcinoma Neuroendócrino/química , Feminino , Neoplasias Gastrointestinais/química , Indicadores Básicos de Saúde , Humanos , Antígeno Ki-67/análise , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/métodos , Taxa de Sobrevida , Adulto JovemRESUMO
La forma en que se manejan los problemas biomecánicos en niños constituye un tema contro-versial en el campo de la rehabilitación física. Se desarrolló un proceso investigativo con el objetivo de: describir la evolución de un grupo de pacientes pediátricos mayores de dos años diagnosticados con pie plano atendidos en consulta de fisioterapia en la ciudad de Riobamba; la que fue de tipo observacional descriptivo, de corte longitudinal, cuya población de estudio estuvo constituida por las fichas de control, evaluación y valoración de 30 niños mayores de 2 años que acudieron a consulta de fisioterapia acompañados de un tutor legal por presentar signos de alteraciones de la huella plantar (pie plano). Se observó un predominio de los pacien-tes con edades comprendidas entre cuatro y cinco años, para un 33 y 27% respectivamente. El 93% de los participantes presentó alteraciones de la huella plantar comprobada mediante medi-ción utilizando el plantígrafo, pero el 53% tuvo pie plano fisiológico. Luego de aplicados los ejercicios de Risser, los datos reflejaron una elevación de la cifra de huella plantar normal hasta el 33% y una disminución en el grado de afectación en el 35% de los niños diagnosticados. Los resultados de la recuperación fueron ratificados mediante el análisis del desgaste del calzado en los pacientes pediátricos en cuestión.
The way how biomechanical problems are handled is a controversial topic in the field of physi-cal rehabilitation. This is a research was carried out in order to describe the evolution of a group of pediatric patients over two years of age diagnosed with flat feet treated in a physiotherapy consultation in the city of Riobamba. This research was of observational descriptive type and longitudinal-cut. The study population consisted of the control, evaluation and assessment cards of 30 children over 2 years of age who attended a physiotherapy consultation accompanied by a legal guardian to show signs of alterations in the footprint (flat foot). A predominance of patients between four and five years of age with 33% and 27% respectively was observed. 93% of the participants presented alterations of the footprint checked by the means of a machine for measu-ring foot plant, but 53% had physiological flat feet. After applying the Risser exercises, the data was reflected in the figure of normal footprint up to 33%, and a decrease of affectation in 35% of the children diagnosed. The results of the recovery were confirmed through the analysis of footwear wear in the pediatric patients in question.
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Masculino , Feminino , Pré-Escolar , Deformidades do Pé , Pé Chato , Doenças Musculoesqueléticas , Ortopedia , Medicina Física e Reabilitação , CriançaRESUMO
Thyroid hormone entry into cells is facilitated by transmembrane transporters. Mutations of the specific thyroid hormone transporter, MCT8 (Monocarboxylate Transporter 8, SLC16A2) cause an X-linked syndrome of profound neurological impairment and altered thyroid function known as the Allan-Herndon-Dudley syndrome. MCT8 deficiency presumably results in failure of thyroid hormone to reach the neural target cells in adequate amounts to sustain normal brain development. However during the perinatal period the absence of Mct8 in mice induces a state of cerebral cortex hyperthyroidism, indicating increased brain access and/or retention of thyroid hormone. The contribution of other transporters to thyroid hormone metabolism and action, especially in the context of MCT8 deficiency is not clear. We have analyzed the role of the heterodimeric aminoacid transporter Lat2 (Slc7a8), in the presence or absence of Mct8, on thyroid hormone concentrations and on expression of thyroid hormone-dependent cerebral cortex genes. To this end we generated Lat2-/-, and Mct8-/yLat2-/- mice, to compare with wild type and Mct8-/y mice during postnatal development. As described previously the single Mct8 KO neonates had a transient increase of 3,5,3'-triiodothyronine concentration and expression of thyroid hormone target genes in the cerebral cortex. Strikingly the absence of Lat2 in the double Mct8Lat2 KO prevented the effect of Mct8 inactivation in newborns. The Lat2 effect was not observed from postnatal day 5 onwards. On postnatal day 21 the Mct8 KO displayed the typical pattern of thyroid hormone concentrations in plasma, decreased cortex 3,5,3'-triiodothyronine concentration and Hr expression, and concomitant Lat2 inactivation produced little to no modifications. As Lat2 is expressed in neurons and in the choroid plexus, the results support a role for Lat2 in the supply of thyroid hormone to the cerebral cortex during early postnatal development.
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Sistema y+ de Transporte de Aminoácidos/metabolismo , Córtex Cerebral/metabolismo , Cadeias Leves da Proteína-1 Reguladora de Fusão/metabolismo , Hipertireoidismo/metabolismo , Proteínas de Membrana Transportadoras/metabolismo , Sistema y+ de Transporte de Aminoácidos/genética , Animais , Animais Recém-Nascidos , Feminino , Cadeias Leves da Proteína-1 Reguladora de Fusão/genética , Hipertireoidismo/genética , Masculino , Proteínas de Membrana Transportadoras/genética , Camundongos , Transportadores de Ácidos Monocarboxílicos , Simportadores , Tri-Iodotironina/metabolismoRESUMO
Mutations of the monocarboxylate transporter 8 (MCT8) cause a severe X-linked intellectual deficit and neurological impairment. MCT8 is a specific thyroid hormone (T4 and T3) transporter and the patients also present unusual abnormalities in the serum profile of thyroid hormone concentrations due to altered secretion and metabolism of T4 and T3. Given the role of thyroid hormones in brain development, it is thought that the neurological impairment is due to restricted transport of thyroid hormones to the target neurons. In this work we have investigated cerebral metabolism in mice with Mct8 deficiency. Adult male mice were infused for 30 minutes with (1-(13)C) glucose and brain extracts prepared and analyzed by (13)C nuclear magnetic resonance spectroscopy. Genetic inactivation of Mct8 resulted in increased oxidative metabolism as reflected by increased glutamate C4 enrichment, and of glutamatergic and GABAergic neurotransmissions as observed by the increases in glutamine C4 and GABA C2 enrichments, respectively. These changes were distinct to those produced by hypothyroidism or hyperthyroidism. Similar increments in glutamate C4 enrichment and GABAergic neurotransmission were observed in the combined inactivation of Mct8 and D2, indicating that the increased neurotransmission and metabolic activity were not due to increased production of cerebral T3 by the D2-encoded type 2 deiodinase. In conclusion, Mct8 deficiency has important metabolic consequences in the brain that could not be correlated with deficiency or excess of thyroid hormone supply to the brain during adulthood.
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Encéfalo/metabolismo , Proteínas de Membrana Transportadoras/deficiência , Proteínas de Membrana Transportadoras/genética , Neurotransmissores/metabolismo , Animais , Ativação Enzimática , Técnicas de Inativação de Genes , Hipertireoidismo/metabolismo , Iodeto Peroxidase/metabolismo , Masculino , Camundongos , Transportadores de Ácidos Monocarboxílicos , Oxirredução , Simportadores , Hormônios Tireóideos/metabolismo , Iodotironina Desiodinase Tipo IIRESUMO
The inhibition of NADPH oxidase has become a potential therapeutic target for oxidative stress-related diseases. We investigated whether vanillin modifies hepatic O(2) consumption associated with Kupffer cell functioning. The influence of vanillin on Kupffer cell functioning was studied in isolated perfused rat liver by colloidal carbon (CC) infusion (0.5 mg ml(-1)), concomitantly with sinusoidal efflux of lactate dehydrogenase (LDH) as an organ viability parameter. CC infusion increased the rate of O(2) consumption of the liver above basal values, an effect that represents the respiratory burst activity of Kupffer cells. However, CC-dependent respiratory burst activity was suppressed by previous infusion of 2 mM vanillin. Vanillin did not affect the liver CC uptake rate and liver sinusoidal efflux of LDH efflux. These findings, elicited by vanillin, were reproduced by the well-established NADPH oxidase inhibitor apocynin. In conclusion, vanillin suppresses the respiratory burst activity of Kupffer cells as assessed in intact liver, which may be associated with the inhibition of macrophage NADPH oxidase activity. Such a finding may have relevance in conditions underlying Kupffer cell-dependent up-regulation of the expression and release of pro-inflammatory mediators by redox-dependent mechanisms.
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Anti-Inflamatórios/farmacologia , Benzaldeídos/farmacologia , Coloides/farmacologia , Células de Kupffer/metabolismo , Fígado/metabolismo , Explosão Respiratória/efeitos dos fármacos , Animais , Carbono/farmacologia , Inibidores Enzimáticos/farmacologia , L-Lactato Desidrogenase/metabolismo , Fígado/citologia , Fígado/efeitos dos fármacos , Masculino , NADPH Oxidases/antagonistas & inibidores , Consumo de Oxigênio/efeitos dos fármacos , Ratos , Ratos Sprague-DawleyRESUMO
Activation of transcription factor Nrf2 was investigated in the isolated perfused rat liver infused with 0.5 mg of colloidal carbon (CC)/ml for 5-15 min to stimulated Kupffer cell function. Infusion of CC enhanced liver O(2) consumption over basal levels, with a time-dependent increase in CC-induced O(2) uptake, at constant rates of CC phagocytosis by Kupffer cells, as assessed histologically, and adequate viability conditions of the livers, as shown by the marginal (0.34 %) total sinusoidal lactate dehydrogenase (LDH) efflux over intrahepatic LDH activity. Under these conditions, cytosolic protein levels of Nrf2 (Western blot) and inhibitor of Nrf2 Keap1 progressively declined by CC infusion, those of nuclear Nrf2 increased, leading to enhancement in the nuclear/cytosolic Nrf2 ratios. It is concluded that the respiratory burst of CC-stimulated Kupffer cells triggers Nrf2 activation in the perfused liver, a response that may afford cellular protection under pro-oxidant conditions underlying Kupffer cell stimulation.
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Carbono/farmacologia , Células de Kupffer/efeitos dos fármacos , Fígado/efeitos dos fármacos , Fator 2 Relacionado a NF-E2/genética , Proteínas/genética , Animais , Coloides , Citosol/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Peptídeos e Proteínas de Sinalização Intracelular , Proteína 1 Associada a ECH Semelhante a Kelch , Células de Kupffer/citologia , Células de Kupffer/metabolismo , L-Lactato Desidrogenase/análise , Fígado/citologia , Fígado/metabolismo , Ativação de Macrófagos/efeitos dos fármacos , Masculino , Fator 2 Relacionado a NF-E2/metabolismo , Técnicas de Cultura de Órgãos , Consumo de Oxigênio/efeitos dos fármacos , Perfusão , Fagocitose/efeitos dos fármacos , Proteínas/metabolismo , Ratos , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio/metabolismo , Explosão Respiratória/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacosRESUMO
Se efectuó un estudio descriptivo, de serie de casos, de 57 neonatos fallecidos en el Hospital "Dr. Antonio Penados del Barrio" de San Benito Petén en Guatemala, desde enero hasta junio del 2011, con vistas a caracterizar las defunciones neonatales producidas según variables clinicoepidemiológicas. La información se obtuvo de las historias clínicas de los neonatos y de los datos de la atención prenatal a la madre. En la serie se identificaron 85,9 % de madres con riesgos, entre los cuales tuvieron mayor frecuencia: hipertensión arterial, asma, diabetes mellitus, sepsis urinaria y ausencia de controles prenatales. La mortalidad predominó en las primeras 24 horas después del nacimiento y estuvo vinculada a factores, tales como prematuridad, enfermedad de la membrana hialina, síndrome de aspiración de meconio y sepsis neonatal.
A descriptive serial cases study of 57 neonates who died in "Dr. Antonio Penados del Barrio", San Benito Petén Hospital, in Guatemala was carried out from January to June, 2011, with the objective of characterizing neonatal deaths occurring according to clinical and epidemiological variables. The information was obtained from the medical records of neonates and from data of the prenatal care to the mother. In the series 85,9% of mothers were identified with risks, among which hypertension, asthma, diabetes mellitus, urinary sepsis and absence of prenatal control had the higher frequencies. Mortality prevailed in the first 24 hours after birth and it was linked to factors such as prematurity, hyaline membrane disease, meconium aspiration syndrome and neonatal sepsis.
RESUMO
Se efectuó un estudio descriptivo, de serie de casos, de 57 neonatos fallecidos en el Hospital Dr Antonio Penados del Barrio" de San Benito Petén en Guatemala, desde enero hasta junio del 2011, con vistas a caracterizar las defunciones neonatales producidas según variables clinicoepidemiológicas. La información se obtuvo de las historias clínicas de los neonatos y de los datos de la atención prenatal a la madre. En la serie se identificaron 85,9 por ciento de madres con riesgos, entre los cuales tuvieron mayor frecuencia: hipertensión arterial, asma, diabetes mellitus, sepsis urinaria y ausencia de controles prenatales. La mortalidad predominó en las primeras 24 horas después del nacimiento y estuvo vinculada a factores, tales como prematuridad, enfermedad de la membrana hialina, síndrome de aspiración de meconio y sepsis neonatal(AU)
A descriptive serial cases study of 57 neonates who died in Dr Antonio Penados del Barrio, San Benito Petén Hospital, in Guatemala was carried out from January to June, 2011, with the objective of characterizing neonatal deaths occurring according to clinical and epidemiological variables. The information was obtained from the medical records of neonates and from data of the prenatal care to the mother. In the series 85,9 percent of mothers were identified with risks, among which hypertension, asthma, diabetes mellitus, urinary sepsis and absence of prenatal control had the higher frequencies. Mortality prevailed in the first 24 hours after birth and it was linked to factors such as prematurity, hyaline membrane disease, meconium aspiration syndrome and neonatal sepsisAU)
Assuntos
Humanos , Masculino , Mortalidade Infantil , Cuidado Pré-Natal , Mortalidade Perinatal , Recém-Nascido , Epidemiologia DescritivaRESUMO
Se realizó un estudio descriptivo y transversal para evaluar la calidad en la ejecución del Programa de Prevención y Control de la Conducta Suicida en el Policlínico Mario Muñoz Monroy de Santiago de Cuba durante el 2007, teniendo en cuenta el desempeño cientificotécnico y la satisfacción de los usuarios. Mediante la creación de un grupo de expertos se establecieron criterios explícitos, descriptivos y normativos, así como se construyeron indicadores y prefijaron estándares. Se constató que la estructura no garantizaba un idóneo cumplimiento del Programa y existía insuficiente competencia profesional de los prestatarios del Sector, debido a la poca capacitación e insatisfacción con respecto a su contenido, todo lo cual pudo influir en los resultados inadecuados de los indicadores previstos.
A descriptive and cross-sectional study to evaluate the quality in the implementation of the Prevention and Control Program of the Suicidal Behavior was carried out in Mario Muñoz Monroy Polyclinic in Santiago de Cuba during 2007, taking into account the scientific technical performance and the satisfaction of the users. By means of the creation of a group of experts explicit, descriptive and normative approaches were established, as well as indicators were built and standards were preset. It was verified that the structure didn't guarantee a suitable implementation of the Program and there was insufficient professional competence in workers of the Sector, due to the little training and dissatisfaction with regard to its content, all this could influence in the inadequate results of the foreseen indicators.
Assuntos
Humanos , Tentativa de Suicídio/prevenção & controle , Programas Nacionais de Saúde , Competência Profissional , Garantia da Qualidade dos Cuidados de Saúde , Suicídio/prevenção & controle , Estudos Transversais , Epidemiologia DescritivaRESUMO
Se realizó un estudio descriptivo y transversal para evaluar la calidad en la ejecución del Programa de Prevención y Control de la Conducta Suicida en el Policlínico Mario Muñoz Monroy de Santiago de Cuba durante el 2007, teniendo en cuenta el desempeño cientificotécnico y la satisfacción de los usuarios. Mediante la creación de un grupo de expertos se establecieron criterios explícitos, descriptivos y normativos, así como se construyeron indicadores y prefijaron estándares. Se constató que la estructura no garantizaba un idóneo cumplimiento del Programa y existía insuficiente competencia profesional de los prestatarios del Sector, debido a la poca capacitación e insatisfacción con respecto a su contenido, todo lo cual pudo influir en los resultados inadecuados de los indicadores previstos(AU)
A descriptive and cross-sectional study to evaluate the quality in the implementation of the Prevention and Control Program of the Suicidal Behavior was carried out in Mario Muñoz Monroy Polyclinic in Santiago de Cuba during 2007, taking into account the scientific technical performance and the satisfaction of the users. By means of the creation of a group of experts explicit, descriptive and normative approaches were established, as well as indicators were built and standards were preset. It was verified that the structure didn't guarantee a suitable implementation of the Program and there was insufficient professional competence in workers of the Sector, due to the little training and dissatisfaction with regard to its content, all this could influence in the inadequate results of the foreseen indicators(AU)
Assuntos
Humanos , Garantia da Qualidade dos Cuidados de Saúde , Suicídio/prevenção & controle , Tentativa de Suicídio/prevenção & controle , Programas Nacionais de Saúde , Competência Profissional , Epidemiologia Descritiva , Estudos TransversaisRESUMO
El hiperparatiroidismo primario es posiblemente la endocrinopatía más frecuente después de la diabetes mellitus y el hipertiroidismo. Se describe el caso de una paciente con hiperparatiroidismo de larga evolución, en cuyo cuadro clínico primaron las manifestaciones óseas (dolores y fracturas) y permaneció durante varios años con valores normales de calcio y fósforo. Finalmente fue operada y evolucionó satisfactoriamente.
Primary hyperparathyroidism is the most likely frequent endocrinopathy after diabetes mellitus and hyperthyroidism. The case of a patient with hyperparathyroidism of long progress is described, which clinical pattern was mainly characterized by bone manifestations (pains and fractures). During several years she had normal calcium and phosphorus values, and finally she was operated on and made good progress.