Plasma von Willebrand factor as a predictor of survival in pulmonary arterial hypertension associated with congenital heart disease

Biomarkers have been identified for pulmonary arterial hypertension, but are less well defined for specific etiologies such as congenital heart disease-associated pulmonary arterial hypertension (CHDPAH). We measured plasma levels of eight microvascular dysfunction markers in CHDPAH, and tested for associations with survival. A cohort of 46 inoperable CHDPAH patients (age 15.0 to 60.2 years, median 33.5 years, female:male 29:17) was prospectively followed for 0.7 to 4.0 years (median 3.6 years). Plasma levels of von Willebrand factor antigen (VWF:Ag), tissue plasminogen activator (t-PA) and its inhibitor (PAI-1), P-selectin, reactive C-protein, tumor necrosis factor alpha, and interleukin-6 and -10 were measured at baseline, and at 30, 90, and 180 days in all subjects. Levels of six of the eight proteins were significantly increased in patients versus controls (13 to 106 percent increase, P < 0.003). Interleukin-10 level was 2.06 times normal (P = 0.0003; Th2 cytokine response). Increased levels of four proteins (t-PA, PAI-1, P-selectin, and interleukin-6) correlated with disease severity indices (P < 0.05). Seven patients died during follow-up. An average VWF:Ag (mean of four determinations) above the level corresponding to the 95th percentile of controls (139 U/dL) was independently associated with a high risk of death (hazard ratio = 6.56, 95 percentCI = 1.46 to 29.4, P = 0.014). Thus, in CHDPAH, microvascular dysfunction appears to involve Th2 inflammatory response. Of the biomarkers studied, plasma vWF:Ag was independently associated with survival.

Rosuvastatin and vascular dysfunction markers in pulmonary arterial hypertension: a placebo-controlled study

We investigated whether chronic rosuvastatin administration could improve the abnormalities of the circulating levels of vascular dysfunction markers in pulmonary arterial hypertension (PAH). Sixty patients, aged 13 to 60 years, with idiopathic (N = 14) or congenital heart disease-associated PAH (N = 46) were equally but randomly assigned to rosuvastatin treatment (10 mg a day, orally) or placebo for 6 months in a blind fashion. Plasma levels of P-selectin, tissue-plasminogen activator and its inhibitor as well as von Willebrand factor antigen were measured by enzyme-linked immunoassay before and after 1, 3, and 6 months of treatment. Baseline levels of biomarkers were elevated (68, 16, 45 and 46 percent increase relative to controls, for P-selectin, von Willebrand factor antigen, tissue-plasminogen activator and its inhibitor, respectively; P < 0.001). P-selectin values at baseline, 1, 3, and 6 months were 39.9 ± 18.5, 37.6 ± 14.6, 34.8 ± 14.6, and 35.4 ± 13.9 ng/mL, respectively, for the rosuvastatin group and 45.7 ± 26.8, 48.0 ± 26.9, 48.1 ± 25.7, and 45.7 ± 25.6 ng/mL for the placebo group. The P-selectin level was lower in the rosuvastatin group compared with placebo throughout treatment (P = 0.037, general linear model). A trend was observed towards a decrease in tissue-plasminogen activator in the statin group (16 percent reduction, P = 0.094), with no significant changes in the other markers. Since P-selectin is crucial in inflammation and thrombosis, its reduction by rosuvastatin is potentially relevant in the pathophysiological scenario of PAH.

Resistência e tolerância a antibióticos em cepas de Staphylococcus aureus isoladas de pacientes do HUAP-UFF / Resistance and tolerance to antibiotics in strains of Staphylococcus aureus isolated from patients attending in the HUAP-UFF

A resistência e a tolerância a amicacina (Am), cefalotina (Ce), cefoxitina (Cx) e oxacilina (Ox) foram determiandas em 51 cepas de Staphylococcus aureus isoladas de diferentes pacientes das enfermarias do HUAP-UFF. Os valores mais elevados das concentraçöes mínimas inibitórias (CMls) foram superiores aqueles encontrados nos Estados Unidos, para os quatro antibióticos. A tolerância (CMB/CMI > ou = 16) verificada foi a seguinte: Ox (21,6%), Ce (11,8%), Am(8,9%) e Cx2,0%). Os nossos resultados indicam que uma antibioticoterapia racional e objetiva deve estar respaldada na relaçäo: CMB/CMI. Informaçäo, apenas, sobre o efeito inibitório (CMI) näo dá chance ao clínico de identificar bactérias tolerantes. Por outro lado, tentativas para debelar infecçöes causadas por cepas resistentes ( ou tolerantes), através do aumento da concentraçäo do antibiótico, pode resultar no fracasso da antibioticoterapia, imposto pela limitaçäo da solubilidade do antibiótico ou pelo desencadeamento de efeitos colaterais, por exemplo

Fibrose retroperitoneal idiopática. Efeito da corticoterapia sobre os parâmetros de funçäo renal / Idiopathic peritoneal fibrosis and the effects of steroids upon the renal function

Apresenta-se um caso de fibrose retroperitoneal idiopática em que a córticoterapia foi efetiva em melhorar a funçäo renal, sendo a ureterolise realizada posteriormente, com o paciente em melhores condiçöes clínicas. Os autores concluem que a terapêutica com corticósteroides é benéfica no manejo da insuficiência renal obstrutiva da fibrose retroperitoneal idiopática