Tuberculosis in renal transplant patients: The experience of a single center in Medellín-Colombia, 2005-2013 / Tuberculose em pacientes transplantados renais: experiência de um único centro em Medellín-Colômbia, 2005-2013

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. .

Changes in Inward Rectifier K+ Channels in Hepatic Stellate Cells During Primary Culture

PURPOSE: This study examined the expression and function of inward rectifier K+ channels in cultured rat hepatic stellate cells (HSC). MATERIALS AND METHODS: The expression of inward rectifier K+ channels was measured using real-time RT-PCR, and electrophysiological properties were determined using the gramicidin-perforated patch-clamp technique. RESULTS: The dominant inward rectifier K+ channel subtypes were K(ir)2.1 and K(ir)6.1. These dominant K+ channel subtypes decreased significantly during the primary culture throughout activation process. HSC can be classified into two subgroups: one with an inward-rectifying K+ current (type 1) and the other without (type 2). The inward current was blocked by Ba2+ (100micrometer) and enhanced by high K+ (140mM), more prominently in type 1 HSC. There was a correlation between the amplitude of the Ba2+-sensitive current and the membrane potential. In addition, Ba2+ (300micrometer) depolarized the membrane potential. After the culture period, the amplitude of the inward current decreased and the membrane potential became depolarized. CONCLUSION: HSC express inward rectifier K+ channels, which physiologically regulate membrane potential and decrease during the activation process. These results will potentially help determine properties of the inward rectifier K+ channels in HSC as well as their roles in the activation process.

Effects of calcium, strontium, and barium on isolated phrenic nerve-diaphragm preparation of rat and their interactions with diltiazem and nifedipine.

Calcium (Ca2+), strontium (Sr2+), and barium (Ba2+) are expected to exert similar chemical and pharmacological effects. The effects of barium, strontium and calcium were studied on the contractions of rat phrenic nerve-diaphragm preparations, following electrical stimulation and their interactions with nifedipine (nif) and diltiazem (DZM) were also studied. Low doses of strontium chloride (SrCl2), barium chloride (BaCl2) and calcium chloride (CaCl2) were able to increase the force of contraction of the rat diaphragm when actively stimulated. Diltiazem inhibited the stimulant effects of Sr2+, Ba2+, and Ca2+. On the other hand, nifedipine blocked the effects of Sr2+ and Ca2+ but potentiated the effects of Ba2+. Strontium, barium, and calcium restored the contractility of the muscle following electrical stimulation when the tissue was in biological fluid absolutely depleted of calcium. These findings suggest that Sr2+ and Ba2+ may be able to substitute Ca2+ in the rat diaphragm for its contractions and nifedipine and diltiazem may follow different mechanisms of actions or channels in their blocking effects.

Bloqueo del ion bario sobre una coriente de potasio rectificadora entrante en ovocitos de rana xenopus laevis / Blockade of barium ions on inward rectifier potassium current study in frog's oocytes

Se caracterizó el efecto del ion bario (Ba²+) sobre un canal de potasio rectificador entrante endógeno (IRK-endo) de ovocitos de Xenopus laevis con la técnica de fijación de voltaje con 2 microelectrodos. Al modificar la [K+] o se provocó un cambio en el potencial de inversión y en el valor de la pendiente de la recta, tal y como se espera para una corriente predominantemente de K+. El bloqueo de IRK-endo por el Ba²+ externo presentó una baja afinidad del canal de dos formas diferentes. Una fue un bloqueo en el pico de corriente independiente de voltaje con una Kd de 0.9 ñ 0.1 mM. En contraste, un segundo efecto se observó al final del pulso (80 ms). Este bloqueo en la corriente es dependiente tanto de tiempo como de voltaje, con una Kd que muestra una dependencia de voltaje monoexponencial (t = 50 ñ 5 mV). Estos resultados sugieren la presencia de dos sitios de unión diferentes para el Ba²+; uno en la parte externa del canal y otro situado dentro del canal Nuestros resultados demuestran la existencia de canal. Nuestros resultados demuestran la existencia de una corriente endógena de K+ en ovocitos de Xenopus laevis con características semejantes a otras corrientes rectificadoras entrantes de K+ encontradas en otras especies

Elicitation of retinal spreading depression by barium ions

The association of potassium ions with the occurrence and propagation of spreading depression is well known. The effects of barium ions, a potassium-channel blocker, on spreading depression in isolated retina are described. Pulses of 1-4 mM BaCl2, when applied to the retina, first induce the reaction, the hinder the propagation of the wave which finally stops. The threshold level wihich triggers the reaction is 0.4-0.6 mM BaCl2 but it varies with the composition of the superfusing Ringer solution. For example, in retinas superfused with low NaCl, or NaCl partially substituted by sodium isothionate, spreading depression may be evoked by barium ions at micromolar concentrations, without changing the velocity of spreading. The delayed blocking actions observed with higher doses may predominantly affect the recovery processes of the wave front, and are related to the refractory period of a preceding spreading depression

Antidysrhythmic activity of some nonsteroidal anti inflammatory drugs against barium chloride and aconitine cardiac dysrhythmias in guinea pigs

In our previous work, some nonsteroidal anti-inflammatory drugs demonstrated a remarkable antidysrhythmic activity against ouabain-induced dysrhythmias in urethane-anaesthetized guinea pigs. The present study was undertaken to investigate any possible antidysrhythmic properties of these drugs against other models of experimentally-induced cardiac dysrhythmias achieved by the slow intravenous infusion of barium chloride and aconitine in guina pigs. Two methods have been used for this purpose. In the first method, the drugs were tested for their ability to revert an established barium chloride and aconditine-induced cardiac dysrhythmias. In the second, the tested drugs wee given in advance to visualize if they can protect the animal from the effect of a subsequent dose of the respective dysrhythmogenic agent. Ventricular dysrhythmia induced by barium chloride was reversed by an equivalent dose [20 g/Kg] of Tiaprofenic acid, Pirprofen, Indomethacin and Asprin. On the other hand, the tested drugs, in he same dose level, were unable to revert ventricular dysrhythmias induced by aconitine. Tiaprofenic acid, Indomethacin and Aspirin, in a dose level of 20 mg/Kg, were found to produce a significant protection against dysrhythmias induced by barium chloride and aconitine. Pirprofen, in a dose level of 20 mg/Kg, was unable to protect against bariumn chloride-induced dysrhythmnias whereas, in the same dose lvel, it roduced significant protectioin against ventricular dysrhhythmias induced by aconitine. No correlation was found toexist between the antidysrhythmic effectiveness of these drugs and their effect on the serum and cardiac tissue electrolytes [N2+, K+ and Ca2+]. The relevance of these findings was discussed

Inhibition of the effects of different agonists on the rat uterus and guinea-pig ileum by Mandevilla velutina extract

O extrato de Mandevilla velutina inibe as contraçöes induzidas pela bradicinina e cininogenases (calicreína, tripsina e tonina) no útero de rata. As contraçöes por angiotensina II e mesmo por cloreto de bário também foram inibidas, quando o íleo de cobaia foi usado, a contraçäo evocada pela histamina foi inibida. Esses experimentos sugerem que a inibiçäo causada pelo extrato de Mandevilla velutina näo é seletiva para bradicinina

Mechanism of potassium transport across proximal tubule epithelium in the rat

The mechanism of proximal tubule potassium reabsorption was studied by stopped-flow microperfusion and determination of potassium activities by ion-sensitive resin microelectrodes. The proximal tubule was unable to establish transepithelial potassium gradients. perfusion with 20 mM K+ turned the lumen 3 mV more negative, an effect abolished by Ba2+. the half-time for K+ activities to reach their stationary level after perfusion with 1 mMK+ was significantly increased by Ba2+ from 4.25 ñ 0.14sto 11.0 ñ 1.71s, and aftr perfusion with 20 mMK+, from 5.43 ñ 0.20 to 12.53 ñ 0.90s. These data indicate that a significant fraction of potassium is transferred across proximal tubule spithelium by a transcellular, K+-channel-dependent route

Magnesium and octylguanidinium inhibition of monovalent cation translocation in mitochondria

Nosotros hemos estudiado los efectos inhibitorios de varios cationes (OG+, Mg2+, Ca2+, Ba2+, Mn2+, La3+) sobre las vías"uniport" y de intercambio para el Na+ y el K+ en mitocondrias de hígado de rata. El hinchamiento de las mitocondrias suspendidas en acetato de sodio o de potasio indica que: 1. El influjo pasivo de Na+ a mitocondrias inhibidas no se ve afectado por OG+ (en el rango micromolar), y concentraciones milimolares de cationes polivalentes sólo inducen una inhibición pobre, siendo la secuencia La3+>Mn2+>Ca2+>Mg2+>Sr2+ = 0. 2. El influjo activo de sodio se inhibe en un 50% con Mg2+ 60 micronM o con OG+ 90 micronM. El La3+, Mn2+, Ca2+ y Sr2+ también inhiben el influjo de sodio (rango milimolar). Se necesitan 10 mM de Mg2+ o 35 micronM de OG+ para inhibir en un 50% el influjo activo de potasio. 3. La salida de cationes alcalinos de mitocondrias parcialmente hinchadas e inhibidas se bloquea en un 50% con 2 mM de Mg2+ o 105 micronM OG+ siempre que el sodio sea el principal catión permeable de la solución. Se necesitan 3 mM de Mg2+ o 38 micronM de OG+ para inhibir en un 50% a las mitocondrias suspendidas en acetato de potasio. 4. La salida de cationes alcalinos de mitocondrias activas parcialmente hinchadas suspendidas en acetato de sodio se ve favorecida por concentraciones superiores a 0.1-0.2 Mg2+ o 50-100 micronM OG+. Estos datos se ajustan a un mecanismo que involucra a un translocador que introduce Na+ en un proceso dependiente de energía y que es sensible a Mg2+ y OG+ y un intercambiador catión/H+, insensible a Mg2+ y OG+, que trabajan en balance dinámico