ABSTRACT
Paciente de 7 anos, sexo masculino, portador de miocardiopatia restritiva relacionada ao gene BAG3 e histórico de hipertensão pulmonar com insuficiência tricúspede importante, admitido para avalição de transplante cardíaco. Após a cirurgia deu entrada na UTI estável mas evoluiu no 1º PO com acidose metabólica, choque refratário ao volume e hipoxemia refratária a manobras de fisioterapia. Os níveis de metahemoglobina foram dosados e o óxido nítrico foi imediatamente suspenso. Iniciou-se administração endovenosa de azul de metileno na dose 3mg/kg com melhora progressiva do quadro clínico. Os níveis de metahemoglobina eram 29,05 e 5,2 ao início e final da administração da droga, respectivamente. Conclusão: Metahemoglobinemia deve ser suspeitada em pacientes que utilizam NO. Níveis elevados de metahemoglobina no sangue podem ser incompatíveis com a vida. O tratamento deve ser instituído de forma rápida e eficaz.
A 7-year-old boy was admitted for evaluation to heart transplantation with a restrictive cardiopathy congenital associated to BAG3 gene. During childhood, he developed high pulmonary hipertension with a significant tricuspid insufficiency. At first post-operative, patient has evoluted with metabolic acidosis, shock refractory to volume and refractory hypoxemia presented at maneuvers physiotherapy. The levels of methemoglobin were checked on laboratory and the nitric oxide was immediately suspended. It started the administration of methylene blue in 3 mg/kg with progressive improvement of clinical situation. Levels of metheboglobin were 29,05 before the treatment and 5,2 after methylene blue administration. Conclusion: Metahemoglobinemia must be suspected in patients using NO. Elevated levels of metahemoglobin may be incompatible with life. Treatment should be instituted quickly and effectively.
Subject(s)
Humans , Male , Child , Child , Heart Transplantation , Hemoglobins , Methemoglobinemia , Methemoglobin/analysis , Nitric Oxide , PediatricsABSTRACT
Marine endophytic bacteria are a valuable source of novel antibacterial in combating pathogenic isolates of methicillin-resistant Staphylococcus aureus (MRSA), a global nosocomial problem today. The aim of this study was to assess in vitro anti-MRSA activity of extracts from bacteria endophyte of marine sponge Haliclona fascigera collected from Setan Island, South Coast of West Sumatra, Indonesia. Anti-MRSA activity test carried out by the agar diffusion method using paper disk. The endophytic bacteria from sponge were isolated using dilution method and pour plate method on NA media. From the sponge were obtained 26 isolates of bacterial endophytic then propagated in NB media. The liquid media was then extracted using ethyl acetate solvent. Antimicrobial activity test carried out by the agar diffusion method using paper disk. The antibacterial activity assay was conducted with the extract concentrations of 5 %. Chloramphenicol was used as a positive control agent. The zone of inhibition was measured and expressed in millimeters. There were 12 isolates of the bacteria that considered active to MRSA. Mean of inhibition zones ranged from 11.1±0.17 to 15.17±0.76. Characterization and identification of endophytic bacteria were conducted to several bioactive bacteria. The identification method was performed using Gram staining and biochemical test.