ABSTRACT
We investigated whether genetic variations of the beta-2 adrenergic receptor (ADRB2) modulate the haemodynamic response following spinal anaesthesia for caesarean delivery. We focused on the effects of haplotypes formed by combinations of the Arg16Gly and Gln27Glu polymorphisms. Clinical data from 143 healthy parturients were collected. Only the ArgGln haplotype appeared to influence the risk of hypotension, most probably through a recessive mode of inheritance (p=0.027). Therefore, patients were grouped according to ArgGln homozygosity in two groups: presence of one or no copies of the haplotype (n=120) or two copies of the haplotype (n=23). Both groups presented similar baseline characteristics. Comparatively, patients homozygous for the ArgGln haplotype presented consistently higher blood pressure levels throughout the evaluation period (p=0.001 for systolic arterial pressure variation from baseline). In conclusion, our results demonstrate that haplotype variations of the the ADRB2 modulate the haemodynamic response following spinal anaesthesia for caesarean delivery.
Subject(s)
Anesthesia, Obstetrical , Anesthesia, Spinal , Cesarean Section , Hemodynamics/genetics , Hemodynamics/physiology , Receptors, Adrenergic, beta/genetics , Adult , Alleles , Arterial Pressure/physiology , DNA/genetics , Female , Genotype , Haplotypes , Humans , Hypertension/genetics , Hypertension/physiopathology , Hypotension/epidemiology , Hypotension/physiopathology , Kaplan-Meier Estimate , Polymorphism, Genetic , Pregnancy , Young AdultABSTRACT
Background: Unknown fever (UF) is a frequent pathology in children and its main etiology are viral infections. The identification of bacterial infection with antibiotics requirements is still on debate. Objective: Determine the characteristics of patients with suspicion of an invasive bacterial infection (IBI) and evaluate the contribution of C reactive protein (CRP) and leukocytes with absolute neutrophyl count (ANC). Method: Prospective-descriptive study of 640 patients between 6 weeks and 36 months-old, with UF and IBI suspicion, admitted in Infectology from the Emergency Room of Hospital Sotero del Rio between 2005 - 2007. Results: 53,7 percent of cases had a confirmed IBI, most commonly urinary tract infection (80,17 percent). A significantly difference was found between CRP, leukocytes and ANC, but the Roe curve did not show a relevant difference. It was not possible to determine a specific level of CRP, leukocytes and ANC for a better IBI discrimination.
Introducción: El síndrome febril sin foco (SFSF) es una patología frecuente en niños, su principal causa son infecciones virales. La identificación de los pacientes que requieren antibióticos, sigue siendo un tema de debate. Objetivo: Evaluar parámetros clínicos y de laboratorio y su utilidad para la decisión de indicación de antibiótico en niños de 6 semanas a 3 años que consultan al servicio de urgencia y su diagnóstico es un SFSF con sospecha de infección bacteriana. Pacientes y Métodos: Estudio descriptivo prospectivo realizado en 640 pacientes entre 6 semanas y 36 meses de edad, hospitalizados o derivados a infectología desde la urgencia del Hospital Dr. Sótero del Río, en quienes se sospechó IBI, durante los años 2005 a 2007. Resultados: Se confirmó IBI en 53,7 por ciento de los pacientes, siendo la localización más frecuente la vía urinaria (80,17 por ciento), bacteriemia (9 por ciento) y neumonía (8,75 por ciento). Hubo diferencia estadísticamente significativa entre el promedio de PCR, RAN y leucocitos entre los pacientes con IBI confirmadas y el resto, sin embargo, en las curvas de ROC estas diferencias no son relevantes. Conclusión: En los pacientes con SFSF y sospecha de IBI la principal causa es la ITU. No fue posible determinar un punto de corte de PCR, RAN o leucocitos para este grupo de pacientes, pues la curva de ROC no resultó significativa.