ABSTRACT
Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients. Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital. Methods: Retrospective and descriptive study. Results: In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%. Conclusion: Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant. .
Introdução: A tuberculose é uma infecção oportunista comum em pacientes transplantados renais. Objetivo: Oferecer uma descrição clínica e laboratorial de pacientes transplantados com diagnóstico de tuberculose e sua resposta ao tratamento durante o período entre 2005 e 2013 no Hospital Pablo Tobón Uribe. Métodos: Estudo retrospectivo descritivo. Resultados: Em 641 transplantes renais, a tuberculose foi confirmada em 12 pacientes. Destes, 25% tinham histórico de rejeição aguda e 50% apresentaram níveis de creatinina superiores a 1,5 mg/dl antes da infecção. A patologia geralmente se apresentava como pulmonar (50%) e disseminada (33,3%). A primeira fase do tratamento consistiu de três meses de HZRE (isoniazida, pirazinamida, rifampicina e etambutol) em 75% dos casos e HZME (isoniazida, pirazinamida, moxifloxacina e etambutol) em 25% dos pacientes. Durante a segunda fase do tratamento, 75% dos pacientes receberam isoniazida e rifampicina e 25% isoniazida e etambutol. A duração do tratamento variou entre seis e 18 meses. Em 41,7% dos pacientes, hepatotoxicidade foi associada ao início do tratamento da tuberculose. Durante o seguimento de um ano a função renal manteve-se estável e a taxa de mortalidade foi de 16,7%. Conclusão: A tuberculose foi responsável por diversos sintomas inespecíficos na população de transplantados renais estudada. Tuberculose pulmonar e disseminada foram as formas mais frequentes de acometimento e necessitaram de tratamento prolongado. Medicamentos contra a tuberculose apresentaram alta toxicidade e mortalidade. Esta infecção deve ser considerada quando o paciente apresenta síndrome febril de origem desconhecida, especialmente durante o primeiro ano após o transplante renal. .
Subject(s)
Animals , Female , Male , Mice , Locus Coeruleus/drug effects , Narcotics/pharmacology , Neural Inhibition/drug effects , Neurons/drug effects , Potassium Channels/metabolism , Barium/pharmacology , Calcium/metabolism , Enkephalin, Methionine/pharmacology , G Protein-Coupled Inwardly-Rectifying Potassium Channels , GTP-Binding Proteins/metabolism , Heterozygote , Homozygote , Ion Channel Gating/drug effects , Ion Channel Gating/physiology , Locus Coeruleus/cytology , Locus Coeruleus/physiology , Mice, Knockout , Membrane Potentials/drug effects , Membrane Potentials/physiology , Neural Inhibition/physiology , Neurons/physiology , Patch-Clamp Techniques , Protein Subunits , Potassium Channel Blockers/pharmacology , Potassium Channels, Inwardly Rectifying/antagonists & inhibitors , Potassium Channels, Inwardly Rectifying/deficiency , Potassium Channels, Inwardly Rectifying/genetics , Potassium Channels, Inwardly Rectifying/metabolism , Potassium Channels/deficiency , Potassium Channels/geneticsABSTRACT
A metionina-encefalina (Met-Enk) é um pentapeptídeo opióide derivado do prónormônio proencefalina A, presente em células neuroendócrinas e hematopoéticas. Estudos experimentais evidenciam seu papel na induçäo, ativaçäo e controle de eventos imunomoduladores, inclusive com potente efeito inibidor do crescimento tumoral. O presente estudo demonstra que o efeito inibidor da Met-Enk no crescimento de um fibro-histocitoma, em camundongos BALB/cJ, é influenciado pelo protocolo utilizado, via de administraçäo e dose do pentapeptídeo opióide utilizada no tratamento. A administraçäo de Met-Enk por via intracerebral retardou de forma eficiente o processo de tumorigênese, aumentando a sobrevida dos animais e reduzindo de forma significativa a área tumoral final. Dose baixa (0,25mg/Kg) de Met-Enk administrada por via intracerebral foi ainda mais potente no controle da tumorigênese
Subject(s)
Animals , Male , Mice , Enkephalin, Methionine/pharmacology , Histiocytoma, Benign Fibrous/pathology , Analysis of Variance , Enkephalin, Methionine/administration & dosage , Injections, Intradermal , Killer Cells, Natural/drug effects , Mice, Inbred BALB CABSTRACT
Protein malnutrition during suckling period or throughout the life affects the hypothalamic ß-endorphinergic system of adult rats. In the present study, rats were under nourished during suckling by feeding their dams an 8% casein diet whereas well-nourished dams recived a 25% casein diet from birth until weaning (21 day of postnatal life). After weaning, the offsprings were maintained with the same diet as their dams. When rats were 3 month-old, they were subjected to two-way active avoidance task. Protein malnutrition did not affect the performance in the two-way active avoidance task. Post-training ß-endorphin or Met-enkephalin administration impaired the retention of shuttle avoidance tast in both well-nourished and undernourished rats. However, the amnesic effect of the peptides was only achieved in undernourished rats with higher doses of apioids when compared to the well-nourished rats. These data suggest that undernourished rats present alterations in opioid sensitivity which may be related to changes in the levels of ß-endorphin previously observed both in brain and hypothalamus of early undernourished adults rats
Subject(s)
Animals , Rats , Avoidance Learning/drug effects , beta-Endorphin/pharmacology , Diet , Enkephalin, Methionine/pharmacology , Protein-Energy Malnutrition/complications , beta-Endorphin/metabolism , Enkephalin, Methionine/metabolism , Brain Chemistry , Rats, Inbred StrainsABSTRACT
Opioid activity of a homologous series of met-enkephalin alkylamides was analysed. In guinea pig ileum test, the hexylamide derivative was most active, whereas the isopropylamide derivative was most potent in analgesia test. The results suggest that structural changes of this type at the C-terminus of the pentapeptide improve the opioid activity.
Subject(s)
Amides , Animals , Chemical Phenomena , Chemistry , Enkephalin, Methionine/pharmacology , Guinea Pigs , Ileum/drug effects , Morphine/pharmacologyABSTRACT
Se probó el efecto de la inyección intracerebroventricular de varios neurotransmisores, dados en forma independiente y combinada (Ang. II, 200 ng; ACh., 6 µg; y met-encefalina, 50 µg) sobre la presión arterial media (PAM) de ratas albinas de la cepa Sprague-Dawley. Bajo anestesia con nembutal (35mg/Kg), se implantó una cánula metálica en el tercer ventrículo por los medios esteriotáxicos usuales y al tercer día el animal se anestesió de nuevo para la medición de la presión carótidea mediante un transductor de presión y registro continuo en un polígrafo fisiológico. La Ang. II aumentó la PAM; la acetilcolina mostró un aumento significativo en los primeros cinco minutos luego de la inyección y la met-encefalina no mostró ningún cambio significativo en al PAM. El efecto combinado mostró resultados interesantes. En vez de una potenciación del aumento de la presión arterial media, cuando ACh. y Ang. II se administrarón conjuntamente, no se observaron cambios estadísticamente significativos, por lo que su efecto se neutralizó. También, la met-encefalina bloqueó la respuesta hipertensora de la Ag. II al darse en forma combinada. Esto es compatible con la acción inhibitoria de la met-encefalinaen el sistema neuronal angiotensinérgico. Se especula acerca de un modelo hipotético que explica los hallazgos observados