Metahemoglobinemia adquirida inducida por fármacos antipalúdicos / Acquired methemoglobinemia induced by antymalaric drugs

Clásicamente se describe cianosis como niveles de hemoglobina desoxigenada en sangre periférica por encima de 5g/dl; sin embargo se ha dejado a un lado, que dicha expresión clínica no sólo responde a esta condición, sino también a la acumulación distal de pigmentos anómalos producto de la alteración en la morfología habitual de la molécula de hemglobina o el estado químico de ésta. Por tal motivo, se presenta un interesante caso clínico en paciente masculino de 35 años de edad, quien consulta por cuadro febril agudo y diagnóstico de Paludismo por Plasmodium vivax, iniciando tratamiento antipalúdico. Posteriormente presenta, en ausencia de fiebre, cianosis peribucal y acral acompañada de disminución de la saturación a 83% por oximetría de pulso. El diagnóstico se basó en la evidencia clínica y la oximetría de pulso, el manejo terapéutico consistió en la administración de oxígeno húmedo y bolos de azul de metileno, notando franca mejoría clínica(AU)

Methemoglobinemia has traditionally been described in multiple studies. Cyanosis, and deoxygenated hemoglobin levels in peripheral blood above 5g / dL, not only responds to this condition, but also to the distal accumulation of anomalous pigments as products of an alteration in the normal morphology of the haemoglobin molecule or chemical state of this. An interesting case report is presented in a male, who after the diagnosis of Plasmodium Vivax Malaria and malaria treatment presenteded perioral the and distal cyanosis, as well as desaturation of 83% by oximetry. The diagnosis was based on clinical evidence and pulse oximetry, and therapeutic approach was based on the administration of wet oxygen and methylene blue bowling, showing marked clinical improvement(AU)

Protective effect of Clerodendrum colebrookianum leaves against iron-induced oxidative stress and hepatotoxicity in Swiss albino mice.

Liver toxicity due to iron overload leads to oxidative damage of proteins, lipids and nucleic acids which in turn manifests several human diseases. Here, we evaluated the improving effect of Clerodendrum colebrookianum leaf on iron overload induced liver injury along with in vitro iron chelation and the protection of Fenton reaction induced DNA damage was conducted. Iron overload was induced by intraperitoneal administration of iron-dextran into mice. Post oral administration of different doses of the extract (50, 100 and 200 mg/kg body weight) showed significant decrease in different biochemical markers such as liver iron, serum ferritin and serum enzyme levels, along with decreased lipid peroxidation, protein oxidation and collagen content. In addition, the extract effectively enhanced the antioxidant enzyme levels and also exhibited the potential activity of the reductive release of ferritin iron. The protective effect of C. colebrookianum extract on injured liver was furthermore supported by the histopathological studies that showed improvement histologically. In conclusion, the present results demonstrated the hepatoprotective efficiency of C. colebrookianum leaf in iron overloaded mice, and hence, a potential iron chelating drug for iron overload diseases.

El Campus Virtual de Salud Pública: seis años de formar recursos humanos en México / Virtual Campus of Public Health: six years of human resources education in Mexico

Este trabajo muestra, desde el punto de vista de la normatividad de la Organización Panamericana de la Salud (OPS), el proceso de gestación, la metodología de implementación y los resultados obtenidos de la iniciativa de formación de recursos humanos en salud vía e-learning a través del Campus Virtual de Salud Pública de la Universidad de Guadalajara, México, a seis años de su inicio. Se trata de un informe especial del trabajo realizado por el comité institucional del campus virtual en la región occidental de México para generar un portal de Internet que se ajustara a los lineamientos del Modelo Estratégico establecido por el Nodo México y la OPS para la Región de las Américas. Este Campus Virtual inició sus actividades en el año 2007. Su filosofía es el uso de software libre y la colaboración entre instituciones. El nodo fue implementado en un año y ha logrado capacitar a más de 500 profesionales de la salud a través de cursos virtuales, su plataforma educativa y un repositorio de recursos virtuales de aprendizaje con interoperabilidad con los repositorios de México y de la Región de las Américas. El comité del Campus Virtual de la Universidad de Guadalajara ha intentado respetar lo más posible al modelo propuesto, lo que ha permitido cumplir la mayoría de los objetivos fijados en el plan de trabajo inicial, aunque ha enfrentado una serie de dificultades administrativas y de motivación de sus integrantes.

This paper discusses the gestation process, implementation methodology, and results obtained from the initiative to use e-learning to train human resources for health, six years after the launch of the Virtual Campus of Public Health of the University of Guadalajara (Mexico); the discussion is framed by Pan American Health Organization (PAHO) standards and practices. This is a special report on the work done by the institutional committee of the Virtual Campus in western Mexico to create an Internet portal that follows the guidelines of the strategic model established by Nodo México and PAHO for the Region of the Americas. This Virtual Campus began its activities in 2007, on the basis of the use of free software and institutional collaboration. Since the initial year of implementation of the node, over 500 health professionals have been trained using virtual courses, the node's educational platform, and a repository of virtual learning resources that are interoperable with other repositories in Mexico and the Region of the Americas. The University of Guadalajara Virtual Campus committee has followed the proposed model as much as possible, thereby achieving most of the goals set in the initial work plan, despite a number of administrative challenges and the difficulty of motivating committee members.

Biochemical and Mitochondrial Changes Induced by Cd, Fe and Zn in Limnodrillus hoffmeisteri / Cambios Bioquímicos y Mitocondriales Inducidos por Cd, Fe y Zn en Limnodrillus hoffmeisteri

The effects of sublethal concentrations of cadmium (0.64 µg/L), iron (0.043 mg/L) and zinc (0.31 mg/L) and a mixture of these metals on succinate dehydrogenase (SD) and alkaline phosphatase (AP) activity and on structural changes in the mitochondria of epithelium cells of the digestive tract were examined in the oligochaete Limnodrillus hoffmeisteri after 96 h of exposure in artificial sediments. SD activity was significantly inhibited, particularly in treatments with Cd alone (92.57 percent), while AP increased its activity with Cd alone (73.23 percent). However, when this metal was mixed with Fe and Zn, the inhibition of SD activity was lower (67.82 percent) than with Cd alone, showing an antagonistic effect and AP increased its activity (73.26 percent). Mitochondria were structurally damaged by exposure to Cd alone. However, in the metal mixtures, the toxic effects may exert interactive effects eliciting a less structural damage in the mitochondria of epithelium cells of the digestive tract than when Cd is alone.

Se estudió el efecto de las concentraciones subletales de Cd (0,64 µg/L), Fe (0,043 mg/L) y Zn (0,31 mg/L) en forma aislada y en mezcla sobre la actividad de la succinato deshidrogenasa (SD) y la fosfatasa alcalina (AP) en las mitocondrias de las células epiteliales del tracto digestivo en el oligoqueto Limnodrillus hoffmeisteri después de 96 h de exposición en sedimentos artificiales. La SD se inhibió significativamente, particularmente en los tratamientos con Cd en forma aislada (92,57 por ciento), mientras que la AP se incrementó con Cd en forma aislada (73,23 por ciento). Sin embargo, cuando este metal se mezcló con Fe y Zn, la inhibición de la SD fue menor (67,82 por ciento) que con Cd en forma aislada, lo que mostró un efecto antagonístico y la AP incrementó su actividad (73,23 por ciento). Sin embargo, cuando este metal estaba en mezcla con Fe y Zn, la inhibición de la SD fue menor (67,82 por ciento) que con Cd en forma aislada, mostrando un efecto antagonístico y un incremento en la actividad de la AP (73,26 por ciento). Las mitocondrias fueron dañadas estructuralmente por exposición al Cd en forma aislada. Sin embargo, con los metales en mezcla, los efectos tóxicos pudieron ejercer efectos interactivos provocando un menor daño estructural en la mitocondria de las células del epitelio del tracto digestivo que cuando el Cd estaba en forma aislada.

Cancer Morbidity of Foundry Workers in Korea

Foundry workers are potentially exposed to a number of carcinogens. This study was conducted to describe the cancer incidence associated with employment in small-sized Korean iron foundries and to compare those findings to the Korean population. Cancer morbidity in 208 Korean foundries was analyzed using the Standardized Incidence Ratio (SIR) and Standardized Rate Ratio (SRR). Overall cancer morbidity in foundry workers (SIR=1.11, 95% confidence interval [CI]=1.01-1.21) was significantly higher than that of Korean general population. Lung cancer (SIR=1.45, 95%CI=1.11-1.87) and lymphohematopoietcic cancer (SIR=1.58, 95%CI=1.00-2.37) in production workers were significantly high compared to Korean general population. Stomach cancer in fettling (SRR=2.10, 95%CI=1.10-4.01) and lung cancer in molding (SRR=3.06, 95%CI=1.22-7.64) and in fettling (SRR=2.63, 95%CI=1.01-6.84) were there significant elevations compared to office workers. In this study, statistically significant excess lung cancer was observed in production workers comparing to Korean general population and office workers. Also, cancer morbidity of overall cancer, lung cancer and stomach cancer was significantly increased with duration of employment at ten and more years comparing to Korean general population. These findings suggest in causal association between exposure to carcinogens during foundry work and cancer morbidity.

Synergistic effect of LPS, IFN-gamma and iron on apoptosis of Balb/c mice macrophages following nitric oxide production

Previous studies have demonstrated that the nitric oxide [NO] dependent death of murine peritoneal macrophages activated in vitro with IFN- gamma and LPS is mediated through apoptosis. In the present study, we investigated the synergistic effect of LPS, IFN- gamma and iron on NO production and apoptosis. After determination of iron cytotoxicity, the peritoneal macrophages of Balb/c mice were cultured with iron, LPS, and IFN- gamma separately, or a mixture of these for 18 hr at 37 C, Then after 18 hr incubation, the level of NO in supernatant was measured by the Griess method. At the same time, after incubation with ethidium bromide and acridine orange dye, the apoptotic macrophages were detected by fluorescence microscopy. NO production was significantly greater than the control group in macrophages exposed to iron, LPS, or IFN- gamma alone [P=0.02], while no significant difference was detected in apoptosis rate in the presence of LPS [.P=0.08]. However, the differences were remarkable between NO production and apoptosis rate in the presence of iron, LPS and IFN- gamma [P

Evaluation of toxicity of heavy metals for Escherichia coli growth

Iron is essential to virtually all organisms but it can be toxic in excess. High concentration of iron and other trace elements could restricted bacterial growth and modify their metabolic pattern as well. However, this study aimed to find out the influence of iron, chromium, cadmium and synergism or antagonism between these elements on growth of a gram negative bacterium. In the series of experiments, E. coli has been cultured in a nutrient broth which supplemented with Fe[+2], Fe[+3], Cr[+3], Cd[+2] alone or in combination with together, at 37°C for 5 h. Bacterial growth was measured every half an hour using spectrophotometer. Findings obtained from this study indicated that bacterial growth reduced at presence of 1 mM/L concentration of Fe[+3] and 0.5 mM/L Fe[+2] in comparison with control. Growth of the bacteria was completely inhibited by 1 mM/L concentration of iron [II]. Chromium has also inhibitory effects on growth of the bacteria and cadmium is very toxic. Cr[+3] and Cd[+] have antagonism effect with iron on the growth of bacteria. This work suggested that trace elements could interact in their metabolism in bacteria. It has also concluded that toxic effects of trace element could be another view against pathogenic bacteria particularly in complex with antibacterial activity of various antibiotics

Evaluation of toxicity of iron, chromium and cadmium on Bacillus cereus growth

High concentration of iron and other trace elements could restrict bacterial growth and modify their metabolic pattern as well. However, this study aimed to find out the influence of iron, chromium, cadmium and synergism or antagonism between these elements on the growth of a gram positive bacterium. In a series of experiments, Bucillus cereus was cultured in a nutrient broth which supplemented with Fe[+2], Fe[+3], Cr[+3], Cd[+2] separately, or in combination with each other, at 37°C for 5 hours. Bacterial growth was measured every half - hour, using spectrophotometer. The results indicated that bacterial growth rate reduced in the presence of 0.5 mM/L concentration of Fe[+2] or Fe[+3], in comparison with control and the growth of bacteria was inhibited by 1 mM/L concentration of iron. The results also revealed that Fe [III] as well as Fe [II] was toxic for bacteria. Chromium had partial inhibitory effects on the growth of bacteria and cadmium was very toxic. Cr[+3] and Cd[+] had antagonistic effect with iron on the growth of bacteria. Data obtained here provide a potentially interesting conceptual advance in toxic effects of trace elements on pathogenic bacteria

HFE mutation H63D predicts risk of iron over load in thalassemia intermedia irrespective of blood transfusions.

Iron overload is a well-documented complication in thalassemia intermedia. Moreover, it is seen that the number of blood transfusions received does not correlate with the degree of overload. Since, HFE gene is associated with iron overload; the present study was conducted in an attempt to evaluate its role in thalassemia intermedia. The subjects were consecutive thalassemia intermedia cases attending the Hematology outpatient clinic. Controls were healthy hospital staff with negative family history of hemolytic anemia or liver disease. The molecular analysis for HFE mutations H63D and C282Y were done with primers described earlier. ELISA was used to measure serum ferritin. Sixty-three patients of thalassemia intermedia including 48 beta-homozygous/heterozygous thalassemia intermedia and 15 HbE-beta-thalassemia were studied. Six (12.5%) of the former and two (13.3%) of the latter were heterozygous for H63D; one of which, a 51-year old male also had clinical features of hemochromatosis. In healthy controls, prevalence of H63D heterozygosity was 7.5% (6/80). An interesting feature observed was that though the age and transfusions taken were similar in both groups, the serum ferritin greater than 500 ng/dl were observed in all patients (100%) with HFE mutation whereas it was seen in 12/42 (28.6 %) of patients without the mutation (p = 0.002). Thus, it is concluded that thalassemia intermedia patients with co-existent HFE mutation have a higher likelihood of developing iron overload and may require early iron chelation.

Estudio toxicológico de un inyectable apócrifo conteniendo hierro como principio activo / Toxicological study of a counterfeit medicinal product containing iron sorbitol

Una mujer embarazada murió luego de la administración parenteral de un preparado de hierro (sorbitol),producto que fue identificado por la Autoridad Sanitaria Argentina como un medicamento apócrifo. Su análisis químico determinó que el contenido de hierro era 3.5 veces mayor al rotulado. Los estudios toxicológicos demostraron que su administración representa un riesgo sanitario y podría ser el causante de la muerte.

After the injection of an iron sorbitol preparation a pregnant woman died. Its chemical analysis determined a hugeamount of iron (3.5-fold higher than the labeled). Results obtained by toxicological studies show that such medicinal product represents a sanitary risk and probably it could be presumed as the cause of death.

Estrés oxidativo, prooxidantes y enfermedad de Crohn / Oxidative stress, prooxidants and Crohn disease

The frequency of Crohn disease shows a significant increase in the last century. Affected patients show a misbalance between production of free radicals and anti oxidant defenses. Thus, one of the increasingly accepted htypotheses to explain the origin of this disease, is the oxidative stress that occurs in the intestinal mucosa. Dietary factors including self administered vitamin and mineral supplemets may play a role, especially when they contain excessive amounts of iron and copper, known for their prooxidant capacities. Unfortunately, little is known about how these metals may influence the antioxidant defenses in the intestinal mucosa. This article reviews the literature on the why and how these elements may act on individuals susceptible to develop Crohm disease, including the evidence supporting the hypothesis that oxidative stress in the intestinal mucosa is an important pathogenetic factor.

Distúrbios da vitamina A e do Ferro em pacientes submetidos à hemodiálise / Disorders of vitamin A and iron in patients undergoing hemodialysis / Trastornos de la vitamina A y hierro en pacientes sometidos a hemodiálisis

Introdução: As concentrações séricas de vitamina A e do ferro se encontram alteradas na insuficiência renal crônica. Objetivo: Discutir os aspectos que envolvem as alterações metabólicas e funcionais da vitamina A e do ferro em pacientes submetidos à hemodiálise. Métodos: Foi realizada uma seleção de estudos relevantes a partir de banco de dados (Medline, Scielo e Lilacs), bem como a partir de livros e teses acadêmicas sobre o tema. Resultados: Segundo a pesquisa bibliográfica, as concentrações séricas de vitamina A se encontram elevadas na insuficiência renal crônica, porém pouco se sabe sobre os possíveis efeitos tóxicos do excesso dessa vitamina no tratamento dialítico. Entre os fatores que ppodem contribuir para esse quadro estão à diminuição da conversão do retinol a ácido retinóico, que é uma função do rim e um acúmulo da proteína carreadora do retinol. A deficiência de ferro afeta mais de 50% dos pacientes em diálise e as perdas desse micronutriente, estimadas para esses pacientes ficam em torno de 1,5 a 3 g por ano. A suplementação com ferro e eritropoietina tem frequentemente restaurado os níveis de hematócrito para valores normais ou próximos aos normais. No entanto, recentemente, tem se levantado à questão de que grandes doses ferro parenteral podem estar associadas com a morbimortalidade, principalmente por infecção e doenças cardiovasculares. Conclusão: Uma melhor compreensão dos aspectos metabólicos da vitamina A e do ferro, em pacientes recebendo hemodiálise, contribuirá para uma abordagem terapêuticas mais racional .

Background: Serum concentrations of vitamin A and iron are altered in chronic renal failure. Objective: To discuss the aspects that involve the metabolic and functional alterations of vitamin A and iron in patients undergoing hemodialysis. Methods: We performed a selection of relevant studies from the database (Medline, Lilacs and Scielo) as well as from books and academic theses on the subject. Results: According to the literature, serum concentrations of vitamin A are elevated in chronic renal failure, but little is known about the possible toxic effects of excess of vitamin A in dialysis. PPOD Among the factors that contribute to this framework are to decrease the conversion of retinol to retinoic acid, which is a function of the kidney and a buildup of retinol binding protein. Iron deficiency affects more than 50% of patients on dialysis and loss of this micronutrient, these patients are estimated to be around 1.5 to 3 g per year. Supplementation with iron and erythropoietin is often restored the levels of hematocrit to normal or near-normal. However, it has recently risen to the point that large doses of parenteral iron may be associated with morbidity and mortality, mainly due to infection and cardiovascular diseases. Conclusion: A better understanding of metabolic aspects of vitamin A and iron in patients receiving hemodialysis, contribute to a more rational therapeutic approach.

Antecedentes: Las concentraciones séricas de vitamina A y hierro son alterados en la insuficiencia renal crónica. Objetivo: Discutir los aspectos que involucran las alteraciones metabólicas y funcionales de la vitamina A y hierro en pacientes sometidos a hemodiálisis. Métodos: Se realizó una selección de los estudios pertinentes de la base de datos (Medline, Lilacs y Scielo), así como de libros y tesis académicas sobre el tema. Resultados: De acuerdo a la literatura, las concentraciones séricas de vitamina A se encuentran elevados en la insuficiencia renal crónica, pero poco se sabe sobre los posibles efectos tóxicos del exceso de vitamina A en diálisis. PPOD Entre los factores que contribuyen a este marco son la reducción de la conversión de retinol a ácido retinoico, que es una función del riñón y una acumulación de la proteína transportadora de retinol. La deficiencia de hierro afecta a más del 50% de los pacientes en diálisis y la pérdida de este micronutriente, estos pacientes se estima en alrededor de 1,5 a 3 g por año. La suplementación con hierro y eritropoyetina suele ser restaurado los niveles de hematocrito a lo normal o casi normal. Sin embargo, recientemente ha aumentado hasta el punto de que grandes dosis de hierro parenteral puede estar asociada con una morbilidad y mortalidad, principalmente debido a la infección y las enfermedades cardiovasculares. Conclusión: Una mejor comprensión de los aspectos metabólicos de la vitamina A y hierro en pacientes sometidos a hemodiálisis, contribuir a un enfoque terapéutico más racional.

Effect of iron chlorosis on some metabolic components in apple trees at Nobaria, Egypt

The study revealed that leaf Fe-chlorosis seems to cause a disturbance in nitrogen and carbohydrate metabolism in apple trees [Malus domestica, Borkh.] variety Delicious. Total and soluble nitrogen and total free amino acids increased significantly in chlorotic leaves, while insoluble nitrogen and protein were markedly decreased. Proline was not alterd between healthy and chlorotic leaves in both seasons. In comparison with chlorotic leaves, healthy ones had significantly higher levels of soluble sugars, polysaccharides and total available carbohydrates and consequently the C/P ratio was higher in healthy than in chlorotic leaves

Effect of mild iron overload on liver and kidney lipid peroxidation

1. Hepatotoxicity is the most common finding in patients with iron overload since the liver is the major recipient of iron excess, even though the kidney could be a target of iron toxicity. The effect of iron overload was studied in the early stages after iron-dextran injection inrats, as a model for secondary hemocromatosis. 2. Total hepatic and kidney iron content was markedly over control values 20h after the iron administration. Plasma GOT, GPT and LDH activities were not affected, suggesting that liver cell permeability was not affected by necrosis. 3. Spontaneous liver chemiluminescence was measured as an indicator of oxidative stress and lipid peroxidation. Light emission was increased four-fold 6 h after iron supplementation. 4. Increases in the generation of thiobarbituric acid reactive substances (TBARS) in liver and kidney homogenates were detected after iron administration. 5. The activities of catalase, SOD and glutathione peroxidase were determined. Enzymatic activities declined in liver homogenates by 25, 36 and 32 por cento, respectively, 20 h after iron injection. These activities were not affected in kidney as compared to control values, except for SOD activity that was decreased by 26 por cento. 6. The content of alfa-tocopherol was decreased by 31 por cento in whole kidney homogenates and by 40 por cento in plasma. 7. Our data indicate that lipid peroxidation occurs after mild iron overload both in liver and kidney. Enzymatic antioxidantes are consumed significantly in liver and alfa-tocopherol content decreases in kidney, suggesting an organ-specific antioxidant effect