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1.
Pediatr Nephrol ; 39(11): 3233-3239, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38937297

RESUMO

BACKGROUND: Secondary pseudohypoaldosteronism (S-PHA) is a rare condition resulting from renal tubular resistance to aldosterone in children with urinary tract infection (UTI) and/or nephrourological malformations. It is characterized by nonspecific symptoms but with the potential for life-threatening complications. We aim to evaluate the clinical manifestations, diagnostic approach, and therapeutic interventions in children with S-PHA, along with a review of recent publications. METHODS: A retrospective observational descriptive study was conducted on S-PHA cases diagnosed over the last 15 years at a tertiary pediatric nephrology unit. The literature for the last 10 years was reviewed. RESULTS: Twelve patients (10 males, 6 days to 6 months) were identified. Weight loss was the main reason for consultation (50%). Ninety-two percent of patients had an underlying nephrourological pathology and 62% concomitant confirmed UTI. Seven out of 12 children were admitted to the PICU. A subsequent extrapontine myelinolysis was observed in one patient as neurological sequelae. Twenty-one articles related to S-PHA have been identified on PubMed and Embase. CONCLUSIONS: S-PHA should be considered in infants under 6 months of age with UTI and/or CAKUT. Obstructive anomalies and vesicoureteral reflux can be found, affecting both unilateral and bilateral systems. Early medical and surgical interventions are crucial and require close monitoring to avoid iatrogenic complications.


Assuntos
Pseudo-Hipoaldosteronismo , Infecções Urinárias , Humanos , Pseudo-Hipoaldosteronismo/diagnóstico , Pseudo-Hipoaldosteronismo/terapia , Pseudo-Hipoaldosteronismo/etiologia , Pseudo-Hipoaldosteronismo/genética , Masculino , Estudos Retrospectivos , Feminino , Lactente , Infecções Urinárias/diagnóstico , Infecções Urinárias/complicações , Infecções Urinárias/etiologia , Recém-Nascido , Anormalidades Urogenitais , Refluxo Vesicoureteral
2.
Lasers Surg Med ; 50(3): 222-229, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29168554

RESUMO

BACKGROUND/OBJECTIVE: Radiofrequency (RF) catheter ablation is a minimally invasive medical procedure used to thermally destroy the focus of cardiac arrhythmias. Novel optical techniques are now being integrated into RF catheters in order to detect the changes in tissue properties. Loss of birefringence due to fiber denaturation at around 70°C is related to changes in accumulated phase retardation and can be measured by polarization-sensitive optical coherence reflectometry (PS-OCR). Since irreversible thermal lesions are produced when the tissue reaches 50°C, our goal was to seek the mathematical relationship between both isotherms. MATERIALS AND METHODS: A two-dimensional model based on a coupled electric-thermal problem was built and solved using the finite element method. The model consisted of cardiac tissue, blood, and a non-irrigated electrode with a sensor embedded in its tip to maintain a specific target electrode temperature. Computer simulations were conducted by varying the tissue characteristics. Lesion depth was estimated by the 50°C isotherm, while the denaturation time (TD) was taken as the time at which the 70°C isotherm reached a depth of 0.75 mm (which corresponds to the optical depth reached by PS-OCR technology). RESULTS: A strong correlation (R2 > 0.83) was found between TD and lesion depth and an even stronger correlation (R2 > 0.96) was found between TD and the time required to achieve a specific lesion depth. For instance, the ablation time required to ensure a minimum lesion depth of 3 mm was 1.33 × TD + 3.93 × seconds. CONCLUSIONS: The computer results confirmed the strong relationship between denaturation time and lesion depth and suggest that measuring denaturation time by PS-OCR could provide information on the ablation time required to reach a specific lesion depth. Lasers Surg. Med. 50:222-229, 2018. © 2017 Wiley Periodicals, Inc.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter , Tomografia de Coerência Óptica , Birrefringência , Simulação por Computador , Estudos de Viabilidade , Humanos , Modelos Cardiovasculares
3.
Circ Arrhythm Electrophysiol ; 17(3): e012255, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38318720

RESUMO

BACKGROUND: Pulsed field ablation uses electrical fields to cause nonthermal cell death over several hours. Polarization-sensitive optical coherence reflectometry is an optical imaging technique that can detect changes in the tissue ultrastructure in real time, which occurs when muscular tissue is damaged. The objective of this study was to evaluate the ability of a polarization-sensitive optical coherence reflectometry system to predict the development of chronic lesions based on acute changes in tissue birefringence during pulsed field ablation. METHODS: Superior vena cava isolation was performed in 30 swine using a biphasic, bipolar pulsed field ablation system delivered with a nonirrigated focal tip catheter. Acute changes in tissue birefringence and voltage abatement were analyzed for each individual lesion. A high-resolution electroanatomical map was performed at baseline and 4 to 12 weeks after ablation to locate electrical gaps in the ablated area. RESULTS: A total of 141 lesions were delivered and included in the analysis. Acute electrical isolation based on the electroanatomical map was achieved in 96% of the animals, but chronic isolation was only seen in 14 animals (46%). The mean voltage abatement of lesions that showed recovery was 82.8%±14.6% versus 84.4%±17.4% for those that showed fibrosis (P=0.7). The mean acute reduction in tissue birefringence in points demonstrating fibrosis was 63.8%±11.3% versus 9.1%±0.1% in the points that resulted in electrical gaps. A threshold of acute reduction of birefringence of ≥20% could predict chronic lesion formation with a sensitivity of 96% and a specificity of 83%. CONCLUSIONS: Acute tissue birefringence changes assessed with polarization-sensitive optical coherence reflectometry during pulsed field ablation can predict chronic lesion formation and guide the ablation procedure although limited by the tissue thickness.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Suínos , Animais , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Veia Cava Superior/cirurgia , Tórax , Veias Pulmonares/cirurgia , Fibrose , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-39361228

RESUMO

This work focused on the co-encapsulation and simultaneous co-delivery of three different neuroprotective drugs in PLGA (poly(lactic-co-glycolic acid) microspheres for the treatment of glaucoma. For formulation optimization, dexamethasone (anti-inflammatory) and ursodeoxycholic acid (anti-apoptotic) were co-loaded by the solid-in-oil-in-water emulsion solvent extraction-evaporation technique as a first step. The incorporation of a water-soluble co-solvent (ethanol) and different amounts of dexamethasone resulted critical for the encapsulation of the neuroprotective agents and their initial release. The optimized formulation was obtained with 60 mg of dexamethasone and using an 80:20 dichloromethane:ethanol ratio. In the second step in the microencapsulation process, the incorporation of the glial cell line-derived neurotrophic factor (GDNF) was performed. The final prototype showed encapsulation efficiencies for each component above 50% with suitable properties for long-term application for at least 3 months. Physicochemical studies were performed by SEM, TEM, DSC, XRD, and gas chromatography. The evaluation of the kinetic release by the Gallagher-Corrigan analysis with Gorrasi correction helped to understand the influence of the co-microencapsulation on the delivery of the different actives from the optimized formulation. The final prototype was tested in a chronic glaucoma animal model. Rats received two intravitreal injections of the neuroprotective treatment within a 24-week follow-up study. The proposed formulation improved retinal ganglion cell (RGC) functionality examined by electroretinography. Also, it was able to maintain a neuroretinal thickness similar to that of healthy animals scanned by in vivo optical coherence tomography, and a higher RGC count on histology compared to glaucomatous animals at the end of the study.

5.
An Sist Sanit Navar ; 46(1)2023 Apr 25.
Artigo em Espanhol | MEDLINE | ID: mdl-37203318

RESUMO

Intracranial hypotension syndrome (IHS) is attributed to reduced cerebrospinal fluid (CSF) pressure. It may be spontaneous or secondary to a history of trauma or systemic disease. We present the case of an 11-year-old boy, with medical history of Marfan syndrome, with orthostatic headache and persistent vomiting (12 hours) following a fall on the sacrococcygeal region. Magnetic resonance showed extradural fluid collections at dorsal and lumbosacral levels, compatible with CSF leak. The condition was resolved with treatment, but the patient had two new episodes during the follow-up period. Thus, an epidural blood patch was performed two years after the first episode. Although HIS is uncommon in children, it should be suspected in patients with orthostatic headache, particularly if the patient presents a connectivopathy. Few studies have assessed the management of HIS in paediatric age. The case presented here and the reviewed available literature provides further data for these type of cases.


Assuntos
Hipotensão Intracraniana , Síndrome de Marfan , Masculino , Humanos , Criança , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/terapia , Síndrome de Marfan/complicações , Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/terapia , Imageamento por Ressonância Magnética , Cefaleia/terapia
6.
Bol Med Hosp Infant Mex ; 80(Supl 1): 82-86, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37490683

RESUMO

BACKGROUND: Takayasu arteritis is a large-vessel vasculitis which affects large-caliber elastic arteries, primarily the aorta and its main branches. It mainly affects women between 20-30 years, so it is rare in children. CASE REPORT: We describe the case of a 15-year-old female who was followed up since she was 9 years old due to celiac disease. At the age of 13, anaemia of chronic disorders associated to elevated C-reactive protein and erythrocyte sedimentation were detected. The patient remained asymptomatic. After excluding other diseases, we requested a positron emission computed tomography (PET-CT); lesions compatible with large-vessel vasculitis were detected. Cardiology evaluation showed an aneurysm in the right coronary artery. Angio-CT suggested Takayasu type III arteritis. CONCLUSIONS: The delay in the diagnosis of Takayasu arteritis in pediatric patients is quite common. In this case, we have found phase II lesions, with no previous phase I symptoms. However, PET-CT allowed the diagnosis of vasculitis, key to the diagnosis of the patient.


INTRODUCCIÓN: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. CASO CLÍNICO: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. CONCLUSIONES: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.


Assuntos
Doença Celíaca , Arterite de Takayasu , Humanos , Feminino , Criança , Adolescente , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Elétrons , Achados Incidentais
7.
An Pediatr (Engl Ed) ; 97(6): 398-404, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36302708

RESUMO

INTRODUCTION: Antibiotherapy regimens for management of acute streptococcal pharyngitis traditionally last 10 days, but the development of resistance to different antimicrobials has motivated the exploration of shorter courses. MATERIAL AND METHODS: We selected patients given a diagnosis of streptococcal pharyngitis in 2 paediatric caseloads of 1 primary care centre between June 2016 and April 2020. We compared outcomes in patients treated with 8- to 10-day courses versus 5- to 7-day courses. RESULTS: The analysis included 350 care episodes (252 patients). Sixty-four percent were managed with 8- to 10-day courses of antibiotherapy (group 1) and 36% with 5- to 7-day courses (group 2). There were no significant differences in the incidence of streptococcal pharyngitis or scarlet fever in the 3 months that followed (OR, 0.98; 95% confidence interval [CI], 0.46-2.03), with similar percentages in both groups (9.8% vs 9.5%). Overall, without differentiating based on the type of infection (streptococcal pharyngitis, scarlet fever or other streptococcal infections), we found similar outcomes (OR, 0.81; 95% CI, 0.41-1.59): 13.4% in group 1 and 11.1% in group 2. We also found no differences in the frequency of adverse events documented in the health records (OR, 0.29; 95% CI, 0.04-2.44): 2.7% in group 1 and 0.8% in group 2. CONCLUSIONS: In our experience, a shorter antibiotic course (5-7 days) is not less effective or more unsafe for management of acute streptococcal pharyngitis than the traditional 10-day course.


Assuntos
Faringite , Escarlatina , Infecções Estreptocócicas , Tonsilite , Humanos , Criança , Escarlatina/diagnóstico , Escarlatina/tratamento farmacológico , Escarlatina/epidemiologia , Antibacterianos/efeitos adversos , Streptococcus pyogenes , Estudos Retrospectivos , Tonsilite/tratamento farmacológico , Faringite/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
8.
Andes Pediatr ; 93(3): 428-433, 2022 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-35857015

RESUMO

Allan-Herndon-Dudley syndrome is a rare X-linked genetic disorder, caused by a deficiency of the monocarboxylate transporter 8 (MCT8), a specific transporter of thyroid hormones, with functions mainly at the brain level. The syndrome produces an early onset of severe neurological disorder, in which hypotonia predominates. OBJECTIVE: To present a rare case with an unexpected diagnosis, highlighting the usefulness of requesting a complete thyroid profile in every hypotonic male infant without a specific cause. CLINICAL CASE: A 10-month-old male infant with severe axial and peripheral hypotonia, global weakness with little spontaneous mobility, without head support or stable sitting. Complete metabolic and peripheral neurophysiological studies were performed. Genetic studies for spinal muscular atrophy, Prader Willi syndrome, and myotonic dystrophy were also performed. The trio exome analysis detected a probably pathogenic variant c.359C>T;p.(Ser120Phe), hemizygous in exon 1 of the SLC16A2 gene, inherited from the mother. Thyroid abnormalities as increased free triiodothyronine (T3) and thyroid-stimulating hormone (TSH), and delayed myelination were ob served. CONCLUSIONS: MCT8 deficiency should be considered in the case of the male infant with unex plained hypotonia and weakness without a determined cause. The diagnosis is guided by a thyroid profile including free T3 hormone, because it presents a characteristic thyroid profile with decreased free thyroxine (T4), increased free T3, and normal or slightly elevated TSH levels. In this case, the implementation of the trio exome analysis allows establishing an early certain diagnosis.


Assuntos
Hipotonia Muscular , Simportadores , Humanos , Lactente , Masculino , Deficiência Intelectual Ligada ao Cromossomo X , Transportadores de Ácidos Monocarboxílicos/genética , Hipotonia Muscular/etiologia , Hipotonia Muscular/genética , Atrofia Muscular , Simportadores/genética , Hormônios Tireóideos , Tireotropina
9.
Musculoskelet Sci Pract ; 62: 102681, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36334580

RESUMO

OBJECTIVE: To determine reference values, including the appropriate number of repetitions, and test-retest reliability of the torsion and conventional cervical joint position sense (JPS) tests. METHODS: Phase 1) Cross-sectional design to determine reference values and the appropriate number of repetitions; Phase 2) repeated-measures concordance design (test-retest reliability). Sixty-eight healthy participants performed 10 repetitions of randomized rotation left and right for both cervical JPS tests using a laser projected onto a target. Thirty participants returned for the same evaluation process one week later. RESULTS: The age-stratified reference values for the torsion JPS test showed greater absolute error as age increased. Stable levels of performance were obtained with 6-7 repetitions for both tests. Moderate to good reliability was found with 7 or more repetitions for left rotation [Torsion JPS test, Intraclass Correlation Coefficient (ICC; 95% CI) = 0.85 (0.68-0.93); Conventional JPS test, ICC = 0.78 (0.53-0.89)], and 6-7 or more repetitions for right rotation [Torsion JPS test, 6 repetitions, ICC = 0.79 (0.56-0.90); Conventional JPS test, 7 repetitions, ICC = 0.82 (0.61-0.91)]. Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) stabilized at 7 repetitions in both tests [Torsion JPS test (SEM ≤ 1.0°; MDC90 ≤ 2.4°; MDC95 ≤ 2.9°); Conventional JPS test (SEM ≤ 1.2°; MDC90 ≤ 2.8°; MDC95 ≤ 3.3°)]. CONCLUSIONS: The reference values generated for the torsion JPS test may help identify the presence of impairments cervical proprioception. At least 7 repetitions optimize stability, reliability and responsiveness in the torsion and conventional cervical JPS tests.


Assuntos
Propriocepção , Humanos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Estudos Transversais , Valores de Referência
10.
Drug Deliv ; 29(1): 2357-2374, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35904152

RESUMO

To create a chronic glaucoma animal model by a single intracameral injection of biodegradable poly lactic-co-glycolic acid (PLGA) microspheres (Ms) co-loaded with dexamethasone and fibronectin (MsDexaFibro). MsDexaFibro were prepared by a water-in-oil-in-water emulsion method including dexamethasone in the organic phase and fibronectin in the inner aqueous phase. To create the chronic glaucoma model, an interventionist and longitudinal animal study was performed using forty-five Long Evans rats (4-week-old). Rats received a single intracameral injection of MsDexafibro suspension (10%w/v) in the right eye. Ophthalmological parameters such as clinical signs, intraocular pressure (IOP), neuro-retinal functionality by electroretinography (ERG), retinal structural analysis by optical coherence tomography (OCT), and histology were evaluated up to six months. According to the results obtained, the model proposed was able to induce IOP increasing in both eyes over the study, higher in the injected eyes up to 6 weeks (p < 0.05), while preserving the ocular surface. OCT quantified progressive neuro-retinal degeneration (mainly in the retinal nerve fiber layer) in both eyes but higher in the injected eye. Ganglion cell functionality decreased in injected eyes, thus smaller amplitudes in PhNR were detected by ERG. In conclusion, a new chronic glaucoma animal model was created by a single injection of MsDexaFibro very similar to open-angle glaucoma occurring in humans. This model would impact in different fields such as ophthalmology, allowing long period of study of this pathology; pharmacology, evaluating the neuroprotective activity of active compounds; and pharmaceutical technology, allowing the correct evaluation of the efficacy of long-term sustained ocular drug delivery systems.


Assuntos
Modelos Animais de Doenças , Glaucoma de Ângulo Aberto , Glaucoma , Animais , Dexametasona , Fibronectinas , Glaucoma/induzido quimicamente , Glaucoma de Ângulo Aberto/induzido quimicamente , Glicóis , Humanos , Pressão Intraocular , Microesferas , Ratos , Ratos Long-Evans , Água
11.
Sci Rep ; 12(1): 20622, 2022 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-36450772

RESUMO

This study compares four different animal models of chronic glaucoma against normal aging over 6 months. Chronic glaucoma was induced in 138 Long-Evans rats and compared against 43 aged-matched healthy rats. Twenty-five rats received episcleral vein sclerosis injections (EPIm cohort) while the rest were injected in the eye anterior chamber with a suspension of biodegradable microspheres: 25 rats received non-loaded microspheres (N-L Ms cohort), 45 rats received microspheres loaded with dexamethasone (MsDexa cohort), and 43 rats received microspheres co-loaded with dexamethasone and fibronectin (MsDexaFibro cohort). Intraocular pressure, neuroretinal function, structure and vitreous interface were evaluated. Each model caused different trends in intraocular pressure, produced specific retinal damage and vitreous signals. The steepest and strongest increase in intraocular pressure was seen in the EPIm cohort and microspheres models were more progressive. The EPIm cohort presented the highest vitreous intensity and percentage loss in the ganglion cell layer, the MsDexa cohort presented the greatest loss in the retinal nerve fiber layer, and the MsDexaFibro cohort presented the greatest loss in total retinal thickness. Function decreased differently among cohorts. Using biodegradable microspheres models it is possible to generate tuned neurodegeneration. These results support the multifactorial nature of glaucoma based on several noxa.


Assuntos
Glaucoma , Doença Enxerto-Hospedeiro , Ratos , Animais , Microesferas , Ratos Long-Evans , Tonometria Ocular , Dexametasona
12.
Animals (Basel) ; 11(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34827925

RESUMO

Viral diseases challenge the health and welfare of pigs and undermine the sustainability of swine farms. Their efficient control requires early and reliable diagnosis, highlighting the importance of Point of Care (POC) diagnostics in veterinary practice. The objective of this study was to validate a novel POC system that utilizes Photonic Integrated Circuits (PICs) and microfluidics to detect swine viral pathogens using oral fluids and Porcine Parvovirus (PPV) and Porcine Circovirus 2 (PCV-2) as proofs of concept. The sensitivity and specificity of the device were calculated for both viruses, and Receiver Operating Characteristic (ROC) curves were drawn. PPV had an Area Under Curve (AUC) value of 0.820 (95% CI: 0.760 to 0.880, p < 0.0001), and its optimal efficiency threshold of detection shifts was equal to 4.5 pm (68.6% sensitivity, 77.1% specificity and Limit of Detection (LOD) value 106 viral copies/mL). PCV-2 had an AUC value of 0.742 (95% CI: 0.670 to 0.815, p < 0.0001) and an optimal efficiency threshold of shifts equal to 6.5 pm (69.5% sensitivity, 70.3% specificity and LOD 3.3 × 105 copies/mL). In this work, it was proven that PICs can be exploited for the detection of swine viral diseases. The novel device can be directly deployed on farms as a POC diagnostics tool.

13.
J Clin Med ; 10(16)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34441992

RESUMO

Chronic ocular hypertension (OHT) influences on refraction in youth and causes glaucoma in adulthood. However, the origin of the responsible mechanism is unclear. This study analyzes the effect of mild-moderate chronic OHT on refraction and neuroretina (structure and function) in young-adult Long-Evans rats using optical coherence tomography and electroretinography over 24 weeks. Data from 260 eyes were retrospectively analyzed in two cohorts: an ocular normotension (ONT) cohort (<20 mmHg) and an OHT cohort (>20 mmHg), in which OHT was induced either by sclerosing the episcleral veins (ES group) or by injecting microspheres into the anterior chamber. A trend toward emmetropia was found in both cohorts over time, though it was more pronounced in the OHT cohort (p < 0.001), especially in the ES group (p = 0.001) and males. IOP and refraction were negatively correlated at week 24 (p = 0.010). The OHT cohort showed early thickening in outer retinal sectors (p < 0.050) and the retinal nerve fiber layer, which later thinned. Electroretinography demonstrated early supranormal amplitudes and faster latencies that later declined. Chronic OHT accelerates emmetropia in Long-Evans rat eyes towards slowly progressive myopia, with an initial increase in structure and function that reversed over time.

14.
Biomedicines ; 9(6)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34208744

RESUMO

BACKGROUND: To compare two prolonged animal models of glaucoma over 24 weeks of follow-up. A novel pre-trabecular model of chronic glaucoma was achieved by injection of biodegradable poly lactic-co-glycolic acid (PLGA) microspheres (10-20 µm) (Ms20/10) into the ocular anterior chamber to progressively increase ocular hypertension (OHT). METHODS: Rat right eyes were injected to induce OHT: 50% received a suspension of Ms20/10 in the anterior chamber at 0, 2, 4, 8, 12, 16 and 20 weeks, and the other 50% received a sclerosing episcleral vein injection biweekly (EPIm). Ophthalmological clinical signs, intraocular pressure (IOP), neuroretinal functionality measured by electroretinography (ERG), and structural analysis of the retina, retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) protocols using optical coherence tomography (OCT) and histological exams were performed. RESULTS: Both models showed progressive neuroretinal degeneration (p < 0.05), and contralateral eye affectation. The Ms20/10 model showed a more progressive increase in IOP and better preservation of ocular surface. Although no statistical differences were found between models, the EPIm showed a tendency to produce thicker retinal and thinner GCL thicknesses, slower latency and smaller amplitude as measured using ERG, and more aggressive disturbances in retinal histology. In both models, while the GCL showed the greatest percentage loss of thickness, the RNFL showed the greatest and earliest rate of thickness loss. CONCLUSIONS: The intracameral model with biodegradable microspheres resulted more like the conditions observed in humans. It was obtained by a less-aggressive mechanism, which allows for adequate study of the pathology over longer periods.

15.
Invest Ophthalmol Vis Sci ; 62(13): 9, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34643665

RESUMO

Purpose: To evaluate differences by sex in the neuroretina of rats with chronic glaucoma over 24 weeks of follow-up, and to assess by sex the influence on neurodegeneration of different methods of inducing ocular hypertension. Methods: Forty-six Long-Evans rats-18 males and 28 females-with induced chronic glaucoma were analyzed. Glaucoma was achieved via 2 models: repeatedly sclerosing the episcleral veins (9 male/14 female) or by injecting poly(lactic-co-glycolic acid) microspheres measuring 20 to 10 µm (Ms20/10) into the anterior chamber (9 male/14 female). The IOP was measured weekly by tonometer; neuroretinal function was recorded by dark/light-adapted electroretinography at baseline and weeks 12 and 24; and structure was analyzed by optical coherence tomography using the retina posterior pole, retinal nerve fiber layer and ganglion cell layer protocols at baseline and weeks 8, 12, 18, and 24. Results: Males showed statistically significant (P < 0.05) higher IOP in both chronic glaucoma models, and greater differences were found in the episcleral model at earlier stages. Males with episclerally induced glaucoma showed a statistically higher increase in retinal thickness in optical coherence tomography recordings than females and also when comparing Ms20/10 at 12 weeks. Males showed a higher percentage of retinal nerve fiber layer thickness loss in both models. Ganglion cell layer thickness loss was only detected in the Ms20/10 model. Males exhibited worse dark/light-adapted functionality in chronic glaucoma models, which worsened in the episcleral sclerosis model at 12 weeks, than females. Conclusions: Female rats with chronic glaucoma experienced lower IOP and structural loss and better neuroretinal functionality than males. Sex and the ocular hypertension-inducing method influenced neuroretinal degeneration.


Assuntos
Glaucoma/complicações , Degeneração Retiniana/etiologia , Células Ganglionares da Retina/patologia , Animais , Modelos Animais de Doenças , Progressão da Doença , Eletrorretinografia , Feminino , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Masculino , Fibras Nervosas/patologia , Ratos , Ratos Long-Evans , Degeneração Retiniana/diagnóstico , Degeneração Retiniana/fisiopatologia , Fatores de Tempo , Tomografia de Coerência Óptica/métodos
16.
Pharmaceutics ; 13(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567776

RESUMO

Progressive degeneration of neuroretinal tissue with maintained elevated intraocular pressure (IOP) to simulate chronic glaucoma was produced by intracameral injections of poly (lactic-co-glycolic) acid (PLGA) microspheres (Ms) in rat eyes. The right eye of 39 rats received different sizes of PLGA-Ms (2 µL suspension; 10% w/v): 14 with 38-20 µm Ms (Ms38/20 model) and 25 with 20-10 µm particles (Ms20/10 model). This novel glaucoma animal model was compared to the episcleral vein sclerosis (EPI) model (25 eyes). Injections were performed at baseline, two, four and six weeks. Clinical signs, IOP, retina and optic nerve thicknesses (using in vivo optical coherence tomography; OCT), and histological studies were performed. An IOP increment was observed in all three groups, however, the values obtained from the PLGA-Ms injection resulted lower with a better preservation of the ocular surface. In fact, the injection of Ms20/10 created a gentler, more progressive, and more sustained increase in IOP. This IOP alteration was correlated with a significant decrease in most OCT parameters and in histological ganglion-cell count for the three conditions throughout the eight-week follow-up. In all cases, progressive degeneration of the retina, retinal ganglion cells and optic nerve, simulating chronic glaucoma, was detected by OCT and corroborated by histological study. Results showed an alternative glaucoma model to the well-known episcleral vein model, which was simpler to perform, more reproducible and easier to monitor in vivo.

17.
Biomedicines ; 9(12)2021 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-34944608

RESUMO

Glaucoma causes blindness due to the progressive death of retinal ganglion cells. The immune response chronically and subclinically mediates a homeostatic role. In current clinical practice, it is impossible to analyse neuroinflammation non-invasively. However, analysis of vitreous images using optical coherence tomography detects the immune response as hyperreflective opacities. This study monitors vitreous parainflammation in two animal models of glaucoma, comparing both healthy controls and sexes over six months. Computational analysis characterizes in vivo the hyperreflective opacities, identified histologically as hyalocyte-like Iba-1+ (microglial marker) cells. Glaucomatous eyes showed greater intensity and number of vitreous opacities as well as dynamic fluctuations in the percentage of activated cells (50-250 microns2) vs. non-activated cells (10-50 microns2), isolated cells (10 microns2) and complexes (>250 microns2). Smaller opacities (isolated cells) showed the highest mean intensity (intracellular machinery), were the most rounded at earlier stages (recruitment) and showed the greatest change in orientation (motility). Study of vitreous parainflammation could be a biomarker of glaucoma onset and progression.

18.
Drug Discov Today ; 24(8): 1644-1653, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30928691

RESUMO

Neurodegenerative diseases affecting the posterior segment of the eye are one of the major causes of irreversible blindness worldwide. The pathogenesis of these retinal pathologies is characterized by a multifactorial etiology, involving the complex interaction of different apoptotic mechanisms, suggesting that effective treatments will require a multimodal approach. Thus, combination therapy based on the potential synergistic activities of drugs with different mechanisms of action is currently receiving considerable attention. Here, we summarize several kinds of strategy for the co-administration of different drugs to the posterior segment of the eye, highlighting those that involve co-delivery from multiloaded drug delivery systems.


Assuntos
Oftalmopatias/tratamento farmacológico , Doenças Neurodegenerativas/tratamento farmacológico , Preparações Farmacêuticas/administração & dosagem , Segmento Posterior do Olho/efeitos dos fármacos , Animais , Terapia Combinada/métodos , Sistemas de Liberação de Medicamentos/métodos , Humanos
19.
An. sist. sanit. Navar ; 46(1): [e1031], Ene-Abr. 2023. ilus, tab
Artigo em Espanhol | IBECS (Espanha) | ID: ibc-221262

RESUMO

El síndrome de hipotensión intracraneal (SHI) es consecuencia del descenso de la presión de líquido cefalorraquídeo (LCR), espontáneo o secundario a antecedente traumático o enfermedad sistémica.Presentamos el caso de un niño de 11 años con cefalea ortostática y vómitos de 12 horas de evolución tras una caída sobre región sacrocoxígea; antecedente de síndrome de Marfan. La resonancia craneomedular mostró colecciones líquidas extradurales a nivel dorsal y lumbosacro compatibles con fístula de LCR. El cuadro se resolvió tras tratamiento, pero hubo dos nuevos episodios durante el seguimiento, por lo que se aplicó un parche hemático epidural a los dos años del inicio.Aunque el SHI es infrecuente en niños, debe sospecharse ante pacientes con cefalea ortostática, especialmente si existe patología favorecedora como enfermedades del tejido conectivo. Existe poca evidencia sobre el manejo en edad pediátrica, por lo que se presenta este caso y se realiza una revisión de la literatura.(AU)


Intracranial hypotension syndrome (IHS) is attributed to reduced cerebrospinal fluid (CSF) pressure. It may be spontaneous or secondary to a history of trauma or systemic disease. We present the case of an 11-year-old boy, with medical history of Marfan syndrome, with orthostatic headache and persistent vomiting (12 hours) following a fall on the sacrococcygeal region. Magnetic resonance showed extradural fluid collections at dorsal and lumbosacral levels, compatible with CSF leak. The condition was resolved with treatment, but the patient had two new episodes during the follow-up period. Thus, an epidural blood patch was performed two years after the first episode.Although HIS is uncommon in children, it should be suspected in patients with orthostatic headache, particularly if the patient presents a connectivopathy. Few studies have assessed the management of HIS in paediatric age. The case presented here and the reviewed available literature provides further data for these type of cases.(AU)


Assuntos
Humanos , Masculino , Criança , Hipotensão Intracraniana/diagnóstico , Hipotensão Intracraniana/tratamento farmacológico , Síndrome de Marfan , Cefaleia , Fístula , Líquido Cefalorraquidiano , Hipotensão Ortostática , Resultado do Tratamento , Pacientes Internados , Exame Físico , Avaliação de Sintomas , Doenças do Sistema Nervoso
20.
Bol. méd. Hosp. Infant. Méx ; 80(supl.1): 82-86, 2023. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1513771

RESUMO

Resumen Introducción: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. Caso clínico: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. Conclusiones: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.


Abstract Background: Takayasu arteritis is a large-vessel vasculitis which affects large-caliber elastic arteries, primarily the aorta and its main branches. It mainly affects women between 20-30 years, so it is rare in children. Case report: We describe the case of a 15-year-old female who was followed up since she was 9 years old due to celiac disease. At the age of 13, anaemia of chronic disorders associated to elevated C-reactive protein and erythrocyte sedimentation were detected. The patient remained asymptomatic. After excluding other diseases, we requested a positron emission computed tomography (PET-CT); lesions compatible with large-vessel vasculitis were detected. Cardiology evaluation showed an aneurysm in the right coronary artery. Angio-CT suggested Takayasu type III arteritis. Conclusions: The delay in the diagnosis of Takayasu arteritis in pediatric patients is quite common. In this case, we have found phase II lesions, with no previous phase I symptoms. However, PET-CT allowed the diagnosis of vasculitis, key to the diagnosis of the patient.

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