Complicaciones pulmonares de la neumonía química: A propósito de un caso / Pulmonary complications of chemical pneumonía; a case report

La aspiración de hidrocarburos puede causar un daño significativo a los pulmones al inducir una respuesta inflamatoria, alveolitis exudativa hemorrágica y pérdida de la función del tensioactivo pulmonar. El efecto secundario más grave de la aspiración de hidrocarburos es la neumonía por aspiración. Anteriormente se han notificado casos de neumotórax, neumatocele, síndrome de dificultad respiratoria aguda (SDRA), absceso pulmonar, fístula broncopleural, derrame pleural bilateral hemorrágico y pioneumotórax. En este artículo presentamos el caso de un paciente hospitalizado debido a neumonía por aspiración que desarrolló pleuritis y neumotórax después de ingerir disolvente para pintura. Se presenta este caso ya que raramente se ha informado en niños como causa de complicaciones pulmonares diferentes. Es necesario evaluar integralmente a los pacientes con complicaciones asociadas a la intoxicación por hidrocarburos. Debe evitarse el alta hospitalaria temprana de los pacientes, quienes deben ser controlados durante, al menos, 48 horas, aunque no tengan síntomas respiratorios. Debe considerarse que los pacientes con neumonía química pueden tener complicaciones pulmonares graves.

Hydrocarbon aspiration (HA) can cause significant lung disease by inducing an inflammatory response, hemorrhagic exudative alveolitis, and loss of surfactant function. The most serious side effect of HA is aspiration pneumonia. Pneumothorax, pneumatocele, acute respiratory distress syndrome (ARDS), pulmonary abscess, bronchopleural fistula, bilateral hemorrhagic pleural effusion and pyopneumothorax were previously reported. Hereby we report a patient hospitalized due to aspiration pneumonia who developed pleurisy and pneumothorax after drinking paint thinner. It is presented as it was seldom reported in children to cause distinct pulmonary complications. Patients with complaints associated withhydrocarbon poisoning must be fully evaluated. They must not be discharged from the hospital early and must be followed for at least 48 hours even if they don't have respiratory symptoms. It should be kept in mind that severe pulmonary complications can develop in patients with chemical pneumonia.

Anti-inflammatory, antinociceptive, and antipyretic effects of methanol extract of Cariniana rubra stem bark in animal models

Cariniana rubra Miers (Lecythidaceae), popularly known as "jequitibá-vermelho'', is a large Brazilian tree whose bark is used in infusion and decoction for the treatment of inflammatory conditions. This study aims to assess the anti-inflammatory, antinociceptive, and antipyretic effects of Cariniana rubra methanolic stem bark extract (EM Cr) using experimental animals. Anti-inflammatory activity of EM Cr was tested on carrageenan and dextran-induced rat paw edema, carrageenan-induced pleurisy in rats and acetic acid-increase vascular permeability in mice. Antinociceptive and antipyretic activities were evaluated using acetic acid-induced writhing, formalin and hot-plate tests in mice, as well as brewer's yeast-induced pyrexia in rats. The extract inhibitied carrageenan and dextran-induced edema, reduced exudate volume and leukocyte migration on the carrageenan-induced pleurisy and on the vascular permeability increase induced by acetic acid. The EM Cr inhibited nociception on the acetic acid-induced writhing and in the second phase of formalin test, and decreased rectal temperature. It was, however, inactive against thermal nociception.Phytochemical analysis with EM Cr showed the occurrence of saponins, triterpenes, sterols and phenolic compounds. Phytosterols (β-sitosterol, stigmasterol), pentacyclic triterpenes (α- and β-amyrin as a mixture), arjunolic acid, a phytosterol glycoside (sitosterol 3-O-β-D-glucopyranoside), and triterpenoid saponins (28-β-glucopyranosyl-23-O-acetyl arjunolic acid; 3-O-β-glucopyranosyl arjunolic acid and 28-O-[α-L-Rhamnopyranosyl-(1→2)-β-glucopyranosyl]-23- O-acetyl arjunolic acid) were the main identified compounds. It can be presumed that EM Cr caused their effects by inhibiting the liberation and/or action of different inflammatory mediators. These findings support the traditional use of Cariniana rubra preparations to treat inflammation.

Cariniana rubra Miers (Lecythidaceae), popularmente conhecido como "jequitibá-vermelho'', é uma árvore brasileira de grande porte, cuja casca é utilizada nas formas de infusão e decocção para o tratamento de condições inflamatórias. Os efeitos antiinflamatório, antinociceptivo e antipirético do extrato metanólico da casca do caule de Cariniana rubra (EM Cr) foram avaliados em animais experimentais. A atividade antiinflamatória do EM Cr foi testada nos modelos de edema depata induzido por carragenina e dextrana em ratos, pleurisia induzida por carragenina em ratos e permeabilidade vascular aumentada por ácido acético em ratos. As atividades antinociceptiva e antipirética foram avaliadas utilizando os modelos de nocicepções induzidos por ácido acético e formalina, placa quente em camundongos e de pirexia, pela injeção de levedura de cerveja em ratos. O extrato inibiu o edema induzido porcarragenina e dextrana, reduziu o volume de exsudato e a migração de leucócitos na pleurisia induzida por carragenina eo aumento da permeabilidade vascular induzida por ácidoacético. O EM Cr inibiu a nocicepção nas contorções induzidas por ácido acético e na segunda fase do teste de formalina e diminuiu a temperatura retal. No entanto, foi inefetivo no teste da placa quente. A análise química por via úmida deu resultados positivos para saponinas, triterpenos, esteroides e compostos fenólicos. Fitosteróis e triterpenóides pentacíclicos (β-sitosterol, estigmasterol, α and β-amirinas em mistura e ácido arjunólico) e as saponinas triterpenoidais: 3-O-β-D-glucopiranosideo de sitosterol; ácido arjunólico 28-β-glucopiranosila-23-O-acetila; ácido arjunólico 3-O-β-glucopiranosila e ácido arjunólico 28-O-[α-L-rhamnopiranosil-(1→2)-β-D-glucopiranosila]-23-O-acetila. Pode-se presumir que os efeitos do EM Cr foram causados pela inibição da liberação e/ou ação de diversos mediadores inflamatórios. Estes resultados validam o uso tradicional das preparações caseiras de Cariniana rubra para tratar a inflamação.

Methotrexate inhibits integrin adhesion molecules in the mouse model of pleurisy induced by carrageenan

The aim of this work was to analyze the effect of methotrexate (MTX) upon leukocyte migration and expression of adhesion molecules CD11a/CD18 in the lung, 4 and 48 h after inflammation induction by carrageenan in mice. The results showed that MTX significantly decreased leukocyte influx and CD11a expression in the lung at 4 and 48 h of pleurisy (P < 0.01). MTX also inhibited CD18 expression at 4 h but not 48 h of pleurisy (P < 0.01). These results proved that MTX at the studied doses had important anti-inflammatory properties, acting primarily on leukocyte migration from the pleural cavity to the lung via inhibition of CD11a/CD18 expression in the mouse model of inflammation.

O modelo experimental da pleurisia induzida pela carragenina, em camundongos é caracterizado pelo aumento da migração de leucócitos às custas de neutrófilos 4 h após a indução da inflamação pela carragenina na cavidade pleural de camundongos.. Após 48 h da indução da inflamação ocorre aumento de leucócitos do tipo mononucleares. O objetivo deste trabalho foi avaliar o efeito do metotrexato (MTX) sobre a migração de leucócitos, e a expressão de moléculas de adesão (CD11a/CD18), no pulmão 4 e 48 h após a inflamação induzida pela carragenina.Os resultados demonstraram que o MTX inibiu significativamente o influxo de leucócitos e a expressão de CD11a no pulmão 4 h e 48 h após a inflamação induzida pela carragenina (P < 0.01). O MTX inibiu a expressão de CD18 no pulmão 48 h após, mas não 4 h após esta resposta inflamatória (P < 0.01). Estes resultados demonstram que o MTX, nas doses estudadas, possui importante efeito antiinflamatório agindo principalmente sobre o influxo de leucócitos da cavidade pleural para os pulmões, via inibição da expressão de moléculas de adesão do tipo CD11a/CD18, no modelo da pleurisia induzida pela carragenina, em camundongos.

Pharmacological study of anti-allergic activity of Syzygium cumini (L) Skeels

Myrtaceae is a plant family widely used in folk medicine and Syzygium and Eugenia are among the most important genera. We investigated the anti-allergic properties of an aqueous leaf extract of Syzygium cumini (L.) Skeels (SC). HPLC analysis revealed that hydrolyzable tannins and flavonoids are the major components of the extract. Oral administration of SC (25-100 mg/kg) in Swiss mice (20-25 g; N = 7/group) inhibited paw edema induced by compound 48/80 (50 percent inhibition, 100 mg/kg; P <= 0.05) and, to a lesser extent, the allergic paw edema (23 percent inhibition, 100 mg/kg; P <= 0.05). SC treatment also inhibited the edema induced by histamine (58 percent inhibition; P <= 0.05) and 5-HT (52 percent inhibition; P <= 0.05) but had no effect on platelet-aggregating factor-induced paw edema. SC prevented mast cell degranulation and the consequent histamine release in Wistar rat (180-200 g; N = 7/group) peritoneal mast cells (50 percent inhibition, 1 æg/mL; P <= 0.05) induced by compound 48/80. Pre-treatment of BALB/c mice (18-20 g; N = 7/group) with 100 mg/kg of the extract significantly inhibited eosinophil accumulation in allergic pleurisy (from 7.662 ± 1.524 to 1.89 ± 0.336 x 10(6)/cavity; P <= 0.001). This effect was related to the inhibition of IL-5 (from 70.9 ± 25.2 to 12.05 ± 7.165 pg/mL) and CCL11/eotaxin levels (from 60.4 ± 8.54 to 32.8 ± 8.4 ng/mL) in pleural lavage fluid, using ELISA. These findings demonstrate an anti-allergic effect of SC, and indicate that its anti-edematogenic effect is due to the inhibition of mast cell degranulation and of histamine and serotonin effects, whereas the inhibition of eosinophil accumulation in the allergic pleurisy model is probably due to an impairment of CCL11/eotaxin and IL-5 production.

Anti-anaphylactic and anti-inflammatory effects of ternatin, a flavonoid isolated from Egletes viscosa Less

Ternatin, a tetramethoxy flavone isolated from Egletes viscosa Less (Compositae), was tested for its efficacy in modulating mouse passive cutaneous anaphylaxis (PCA) and rat carrageenan-induced pleurisy. Ternatin (12.5, 25 and 50 mg/kg, ip) caused a dose-dependent inhibition of IgG antibody-mediated 1.5-h homologous PCA as well as IgE antibody-mediated 48-h homologous PCA in 2-month old mice (N = 5 per group). The inhibitory activity of ternatin was more potent on IgE-mediated PCA (47-79%) than on IgG (45-59%). In the rat carrageenan pleurisy test, ternatin (25 and 50 mg/kg, ip) reduced the response to carrageenan at 5 h both by decreasing exudate volume (33-40%) and leukocyte number (60%) in 5-6-month old rats (N = 6 per group). In contrast, indomethacin (2 mg/kg, po), a known cyclooxygenase inhibitor, showed greater potency in the inhibition of exudate volume (57%) and leukocyte number (77%). These results show that ternatin has both anti-inflammatory and anti-anaphylactic properties and suggest that it may be a useful alternative to anti-allergic drugs of the disodium cromoglycate (DSCG) type for use in bronchial asthma

Endotoxin induces eosinophil accumalation in the rat pleural cavity

Changes in eosinophil counts after intrathoracic (it) injection of endotoxin (LPS) were investigated in Wistar rats (150 - 180 g). Increasing doses of endotoxin (62.5 - 500 ng/cavity) induced a dose-dependent increase in the number of eosinophils recovered from the rat pleural cavity 24 h later. The eosinophilia was apparent within 24 h, peaked within 48 h (from 0.76 ñ 0.12 to 3.68 ñ 0.51 eosinophils x 10**6/cavity, P < 0.001) and returned to basal levels 120h after the it inection of endotoxin (250 ng/cavity). Endotoxin (3 ng - 4 µg/ml) failed to attract eosinophilis in vitro under conditions in which PAF-acether induced a dose-related response. These findings indicate that endotoxin-induced eosinophil migration in vivo is mediated by a secondary mechanism

PAF-acether and the acute inflammatory reaction

PAF-aceter é um fosfolipídio que exerce um papel importante na reaçäo inflamatória aguda. No modelo experimental do edema da para de rato e pleurisia, a reaçäo induzida pelo PAF era acompanhada de hemoconcentraçäo, embora esses processos pareçam ser mediados por mecanismos distintos. Antagonistas específicos do PAF, como BN 52021 e WEB 2086, inibem 60% do edema induzido pelo PAF. Leucotrienos e mecanismos histaminérgicos envolvendo receptores H2 parecem participar no processo. A participaçäo do sistema adrenérgico e de metabólitos da ciclooxigenase é controversa. Infiltraçäo de leucócitos, observada após a injeçäo de PAF, e plaquetas näo säo necessárias para a formaçäo de edema. Auto-dessensibilizaçäo induzida pelo PAF pôde ser observada, sendo seletiva e dependente a interaçäo do PAF com receptores específicos em um processo de regulaçäo depressiva ("dow-regulation"). Nenhuma participaçäo deo PAF foi observada na reaçäo inflamatória induzida pela carregenina, contrariamente áquela provocada pelo zimosan, que é principalmente dependente do PAF-aceter

Effect of iv administered hyperosmotic sodium chloride on carrageenan-induced pleurisy in adrenalectomized and intact rats

The effect of administration of hyperosmotic NaCl (2ml, 7.8% NaCl, iv) on carregeenan induced pleurism was determined in adrenalectomized and intact rats. tThe volume of the pleural exudate was significantly reduced 4 h after induction by treatment with hyperosmotic NaCl for both adrenalectomized (0.08 - 0.16 ml) and intact (0.03 - 0.08 ml) animals compared to their untreated controls (0.56 - 0.44 ml and 0.26 - 0.15 ml, respectively). Similarly, hyperosmotic NaCl treatment significantly reduced the total number of inflammatory cells in the pleural cavity: 29.60 x 10**6 cells for adrenalectomized animlas and 28.90 x 10**6 ñ 11.43 x 10**6 cells for intact animals compared to 63.67 x 10**6 cells for their untreated controls. Tretament with isotonic saline did not affect carrageenan-induced pleurisy. These data suggest that chemical mediator(s) of inflammation may be involved in the mechanism(s) of action of a hyperosmotic NaCl solution on the acute inflammatory response

Late eosinophil mobilization induced by PAF-acether in the pleural cavity of rats

In view of the rapid degradation of PAF in biological fluids, this study was designed to determine if late eosinophil infiltration induced in rats by PAF was deriived from its direct chemotatic action. A significant and selective 5-fold increase in the pleural eosinophil counts was detected 24 h after intrapleural PAF injection. The transfer of 6-h PAF washings to the pleural cavity of recipient rats also induced a 3-fold selective accumulation of eosinophils. The protein synthesis inhibitor cycloheximide abolished the pleural eosinophil migration and the generation of transferable chemotactic activity when administered to donor but not to recipient rats. These findings suggest that a secondary protein mediator accounts for the late eosinophil mobilization induced by PAF