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Abstract Introduction and objectives: macrolides are widely used antibiotics for which a greater frequency of cardiovascular events related to increased arrhythmias has been reported. This study seeks to describe some cardiovascular complications of the use of macrolides in ICU patients. Materials and methods: this was a descriptive cross-sectional study which included adult patients admitted to the Medical Intensive Care Unit at the Fundación Cardioinfantil who received antibiotic treatment with clarithromycin in 2013 and 2015. Results: the collected sample was 38 patients. The median age was 64 years, and clarithromycin was most frequently used for treating community-acquired infections, with pneumonia being the most common diagnosis. The frequency of atrial fibrillation or flutter was 7.89%, and ventricular tachycardia 2.63%. The most frequently used concomitant medication was quetiapine at 28.95%. The main cause of death was respiratory failure. Conclusions: the frequency of arrhythmias was high in our study, although the most frequent cause of death was respiratory failure. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1336).
Resumen Introducción y objetivos: los macrólidos son antibióticos ampliamente utilizados con los cuales se ha reportado una mayor frecuencia de eventos cardiovasculares relacionados con aumento de arritmias. Mediante este estudio, se busca describir algunas complicaciones cardiovasculares con el uso de macrólidos en pacientes en UCI. Materiales y métodos: se realizó un estudio descriptivo de corte transversal en el que se incluyeron pacientes adultos que ingresaron a la unidad de cuidado intensivo médico de la Fundación Cardioinfantil y que recibieron tratamiento antibiótico con claritromicina durante los años 2013 y 2015. Resultados: la muestra recolectada fue de 38 pacientes, la mediana de edad fue de 64 años y la claritromicina se usó más frecuentemente en el tratamiento de infecciones adquiridas en la comunidad, siendo la neumonía el diagnóstico más común. La frecuencia de arritmias tipo fibrilación o flutter auricular fue de 7.89% y de taquicardia ventricular 2.63%. El medicamento concomitante más frecuentemente usado fue la quetiapina con 28.95%. La principal causa de muerte fue falla respiratoria. Conclusiones: la frecuencia de arritmias fue alta en nuestro, aunque la causa de muerte más frecuente fue falla respiratoria.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1336).
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Macrolídeos , Pneumonia , Claritromicina , Fatores de Risco de Doenças Cardíacas , Unidades de Terapia IntensivaRESUMO
Objective: The goal of this study was to compare the microbiology of severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring admission to the intensive care unit (ICU), in patients with pneumonia compared to those that did not have. Methods: We conducted a retrospective cross-sectional study that included patients with severe COPD exacerbation. We took microbiologic and serologic samples to study the etiology of the exacerbation and chest X-ray to see whether or not it had associated pneumonia. Results: Ninety-one patients were included in the study. 53/91 (58%) had pneumonia. The most prevalent bacteria isolated were H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), mixed flora (9.9%) and methicillin-susceptible Staphylococcus aureus (9.9%). A statistically significant difference could not be demonstrated between the two groups. We detected 24.2% of bacterial resistance in both groups, the most frequent being AMPc (13 cases). Discussion: Bacterial pneumonia in COPD patients is higher in comparison with patients with acute exacerbation. Even though we did not find a significant difference in the microbiology of the groups with or without pneumonia, there are variables such as past smoking related to having pneumonia. Patients with pneumonia also had higher severity scores.
Objetivo: Comparar la microbiología de las exacerbaciones graves de EPOC (Enfermedad Pulmonar Obstructiva Crónica) que requieren ingreso a la unidad de cuidados intensivos, con y sin neumonía Métodos: se realizó un estudio transversal retrospectivo que incluyó pacientes con exacerbación grave de EPOC que requieren ingreso a la Unidad de Cuidados Intensivos (UCI). Tomamos muestras microbiológicas y serológicas para estudiar la etiología de la exacerbación y radiografía de tórax para ver si tenía o no una neumonía asociada. Seguimos a los pacientes durante su ingreso en la UCI y evaluamos el resultado de la hospitalización. Resultados: se incluyeron 91 pacientes en el estudio. 53/91 ( 58%) tuvieron confirmación de neumonía. Las bacterias más prevalentes aisladas fueron H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), flora mixta (9.9%) y S. aureus meticilino sensible. (9.9% ). No se pudo demostrar una diferencia estadísticamente significativa entre los dos grupos. Detectamos una resistencia bacteriana del 24,2% en ambos grupos, siendo la más frecuente AMPc (13 casos). Discusión: la neumonía bacteriana en pacientes con EPOC es más alta cuando se compara con pacientes con exacerbación aguda. Aunque no encontramos una diferencia significativa en la microbiología de los grupos con o sin neumonía, existen variables como antecedente de cigarrillo asociadas a tener neumonía. Los pacientes con neumonía así mismo tuvieron mayores índices de severidad.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Recidiva , Cuidados Críticos , Doença Pulmonar Obstrutiva Crônica , Microbiologia , Pneumonia , Fumar , Estudos TransversaisRESUMO
Abstract Background: Piracanjuba (Brycon orbignyanus) is a fish species highly affected by anthropogenic actions such as overfishing, water pollution, and hydroelectric developments. This species is currently considered in danger of extinction. Objective: To analyze the genetic diversity of a natural population (NP) and two captive broodstocks (SA and SB) of B. orbignyanus. Methods: Samples of caudal fins (NP: 24, SA: 30, and SB: 30) were collected. DNA was extracted and amplified for six RAPD primers and four microsatellite loci. Results: Sixty polymorphic fragments and 17 microsatellite alleles were detected. High intrapopulation heterozygosity (NP: 0.692, SA: 0.724, and SB: 0.686) was observed. Thirty-eight fragments and six alleles were shared among NP, SA, and SB. The FIS and Shannon's Index of diversity revealed a lack of inbreeding within groups. AMOVA analyses and FST indicated very high (NP vs SA and SB) and small (SA vs SB) genetic differentiation, confirmed by genetic distance and identity, number of migrants and a dendrogram, which revealed the formation of two genetic groups. Conclusions: The two marker types showed similar variability. The groups have adequate genetic variability, with high differentiation between NP and SA-SB, and similarity between broodstocks.
Resumen Antecedentes: Piracanjuba (Brycon orbignyanus) es una especie de pez fuertemente impactada por acciones antrópicas como sobrepesca, contaminación del agua y proyectos hidroeléctricos. Esta especie está considerada en peligro de extinción. Objetivo: Analizar la diversidad genética de una población natural (NP) y de dos lotes de reproductores (SA y SB) de B. orbignyanus en cautiverio. Métodos: Se colectaron 84 muestras de aleta caudal (NP: 24, SA: 30 y SB: 30). El ADN fue extraído y amplificado para seis cebadores RAPD y cuatro loci microsatélites. Resultados: Se obtuvieron 60 fragmentos polimórficos y 17 alelos microsatélites. Se observó alta heterocigosidad intra-poblacional (NP: 0,692; SA: 0,724 y SB: 0,686). Treinta y ocho fragmentos y seis alelos fueron compartidos entre NP, SA y SB. Los valores de FIS e índice de Shannon mostraron ausencia de endogamia entre los grupos. Los análisis de ANOVA y FST indicaron alta (NP vs SA y SB) y pequeña (SA vs SB) diferenciación genética; resultados confirmados por la distancia e identidad genética, número de migrantes y dendograma, evidenciando la formación de dos grupos genéticos. Conclusiones: Los grupos poseen adecuada variabilidad genética, con alta diferenciación entre NP vs SA-SB y similitud entre los lotes de reproductores.
Resumo Antecedentes: Piracanjuba (Brycon orbignyanus) é uma espécie peixe fortemente impactada por ações antrópicas como sobrepesca, poluição e construção de hidrelétricas. Atualmente, essa espécie engloba a lista de peixes que correm perigo de extinção. Objetivo: Analisar a diversidade genética de uma população natural (NP) e de dois estoques de reprodutores em cativeiro (SA e SB) de B. orbignyanus. Métodos: Foram coletadas amostras de nadadeira caudal de 84 indivíduos (NP: 24, SA: 30 e SB: 30). O DNA foi extraido e amplificado para seis primers RAPD e quatro loci microssatélites. Resultados: Foram obtidos 60 fragmentos polimórficos e 17 alelos microssatélites. Foi observada uma alta heterozigosidade intra-populacional (NP: 0,692; SA: 0,724 e SB: 0,686). Trinta e oito fragmentos e seis alelos foram compartilhados entre NP, SA e SB. Os valores de FIS e índice de Shannon demonstraram ausência de endogamia entre os grupos. As análises de AMOVA e FST indicaram alta (NP vs SA e SB) e pequena (SA vs SB) diferenciação genética, resultados confirmados pela distância e identidade genética, número de migrantes e dendrograma, que evidenciaram a formação de dois grupamentos genéticos. Conclusões: Os grupos possuem adequada variabilidade genética, com alta diferenciação entre NP e SA-SB e similaridade entre os estoques de reprodutores.
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The golden mussel, Limnoperna fortunei a highly invasive species in Brazil, has generated productive, economical, and biological impacts. To evaluate genetic structure and variability of L. fortunei populations present in fish farms in the reservoirs of Canoas I (CANFF), Rosana (ROSFF), and Capivara (CAPFF) (Paranapanema River, Paraná, Brazil), eight microsatellite loci were amplified. Five of those eight loci resulted in 38 alleles. The observed heterozygosity (Ho) was lower than the expected heterozygosity (He) in all populations, with a deviation from the Hardy-Weinberg equilibrium (HWE). The average value for the inbreeding coefficient (Fis) was positive and significative for all populations. There was higher genetic variability within populations than among them. The fixation index (Fst) showed a small genetic variability among these populations. The occurrence of gene flow was identified in all populations, along with the lack of a recent bottleneck effect. The clustering analysis yielded K = 2, with genetic similarity between the three populations. The results demonstrate low genetic structure and suggest a founding population with greater genetic variability (ROSFF). Our data point to the possible dispersal of L. fortunei aided by anthropic factors in the upstream direction. It was concluded that the three populations presented a unique genetic pool for Paranapanema River, with occurrence of gene flow.
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ABSTRACT: Brycon orbignyanus, popularly known in Brazil as piracanjuba, is a fish with great economic value but whose natural population drastically decreased in number during the last years. In this context, genetic variability studies of natural stocks and in restocking programs are fundamental for the adoption of conservation measures. Current analysis verifies the cross-amplification of heterologous primers in B. orbignyanus. Fifty-two primers of the species Brycon opalinus, Brycon hilarii, Brycon insignis, Prochilodus sp., Piaractus mesopotamicus, Colossoma macropomum and Oreochromis niloticus were tested. Primers with the best reproducibility were applied to a sample of 20 individuals and the genetic parameters were calculated. Nine primers provided good results for cross-amplification with B. orbignyanus, involving (BoM5 and BoM13) of Brycon opalinus, (Bh5, Bh6, Bh8, Bh13 and Bh16) of Brycon hilarii, (Bc48-10) of Brycon insignis and (Par80) of Prochilodus argenteus. Primers of Piaractus mesopotamicus, Colossoma macropomum and Oreochromis niloticus failed to provide amplification or provided non-specificity. Results demonstrated the possibility of using primers of different species and genera of B. orbignyanus, facilitating genetic studies on the species.
RESUMO: A piracanjuba (Brycon orbignyanus) é um peixe de grande valor econômico que nos últimos anos tem apresentado uma redução drástica em suas populações naturais. Nesse contexto, estudos de variabilidade genética dos estoques naturais e nos programas de repovoamento são fundamentais para adoção de medidas conservacionistas. O objetivo do presente trabalho foi verificar a amplificação cruzada de primers heterologos em B. orbignyanus. Foram avaliados um total de 52 primers das espécies Brycon opalinus, Brycon hilarii, Brycon insignis, Prochilodus sp., Piaractus mesopotamicus, Colossoma macropomum e Oreochromis niloticus. Os primers com melhor reprodutibilidade foram aplicados a uma amostra de 20 indivíduos e os parâmetros genéticos foram calculados. Nove primers apresentaram resultados satisfatórios de amplificação cruzada com B. orbignyanus, sendo das espécies Brycon opalinus (BoM5 e BoM13), Brycon hilarii (Bh5, Bh6, Bh8, Bh13 e Bh16), Brycon insignis (Bc48-10) e Prochilodus argenteus (Par80). Os primers de Piaractus mesopotamicus, Colossoma macropomum e Oreochromis niloticus não apresentaram amplificação ou apresentaram inespecificidade. Os resultados revelaram a possibilidade da utilização de primers de diferentes espécies e gênero em B. orbignyanus, o que facilita a realização de estudos genéticos nessa espécie.
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Introducción: Las infecciones asociadas a ventilación mecánica son causa importante de morbimortalidad en el paciente crítico. La diferenciación entre traqueobronquitis y neumonía no es siempre fácil, y es controvertida. Algunos trabajos describen aumento de mortalidad, mayor estancia en Unidades de Cuidado Intensivo (UCI), mayor requerimiento de ventilación mecánica e incremento de costos en pacientes con traqueobronquitis asociada a ventilador (TAV), sin diferencias significativas en pacientes con neumonía asociada a ventilador (NAV). Estos estudios no describen el comportamiento clínico y epidemiológico de la TAV y la NAV como 2 entidades independientes, por lo que es necesario describirlo. Métodos: Estudio multicéntrico de cohorte prospectiva, de pacientes adultos que desarrollaron TAV o NAV durante su estancia en UCI, entre noviembre de 2013 y octubre de 2014. A cada una de las variables demográficas, clínicas, de laboratorio y de desenlace, como tiempo de ventilación mecánica, estancia hospitalaria y muerte, se le realizó análisis descriptivo; para evaluar las diferencias entre los grupos se utilizó test de chi cuadrado, t de Student o U de Mann Whitney. Resultados: Se incluyó a 143 pacientes, con edad promedio de 55 años, 57% eran hombres, de 6 países en Latinoamérica; 63% con NAV y 37% con TAV. Las comorbilidades más frecuentes fueron cardiovascular (44%) y neurológica (30%); esta última fue más frecuente en TAV (41,5 vs. 23%; p = 0,02). No se encontró diferencia en APACHE II de ingreso. El índice SOFA fue mayor en NAV (8 vs. 5; p = 0,02). No hubo diferencias en el aislamiento microbiológico, ni en los patrones de resistencia bacteriana entre las 2 entidades. Se observó mayor número de complicaciones cardiovasculares y SDRA en pacientes con NAV. No se encontró diferencia entre los 2 grupos en estancia en UCI, los días de ventilación mecánica ni en mortalidad. Conclusiones: La prevalencia de TAV fue mayor a lo descrito hasta ahora en la literatura. No se encontraron diferencias significativas en el aislamiento microbiológico, la resistencia bacteriana ni el esquema antibiótico utilizado en los 2 grupos. Aunque la NAV cursó con mayor proporción de complicaciones médicas asociadas, el hallazgo de una estancia hospitalaria, tiempo de ventilación mecánica y mortalidad similares sustenta la importancia clínica de la TAV.
Introduction: The infections associated with mechanical ventilation are a major cause of morbidity and mortality in critically ill patients. Limited studies report increased mortality and intensive care units (ICU) stays, requirements for mechanical ventilation and higher costs in ventilator-associated tracheobronchitis (TAV) in comparison to patients with ventilator-associated pneumonia (NAV). These studies do not describe the clinical and epidemiological behavior in the same population as independent entities, so it is necessary to describe the epidemiology of patients with TAV and NAV. Methods: Multicenter cross-sectional study of adult patients who developed TAV and/or NAV during their stay in the ICU in 2013 to 2014. A descriptive analysis was performed on each of the variables. For qualitative variables we assessed differences between groups using the Chi-squared test; for continuous variables, we used Student's t test or the Mann Whitney U test. Results: A total of 147 patients from 6 countries in Latin America were included; 63% with NAV and 37% with TAV. The average age was 55 years; 57% male. The most frequent comorbidity was cardiovascular (44%) and neurological (30%), the latter was more frequent in those with TAV (41.5 vs. 23%, P = .02). No differences were found in APACHE II on entry, but the difference appears in the SOFA index (8 vs. 5, P = .02). There were no differences in microbiological isolation, or bacterial resistance patterns between the 2 entities. A greater number of cardiovascular complications and ARDS were observed in patients with NAV. The ICU stay, days on mechanical ventilation and mortality were not different between the 2 groups. Conclusions: The TAV prevalence was higher than heretofore described in the literature. No significant differences were found in the microbiological isolation, bacterial resistance and antibiotic therapy used in the 2 groups, which might suggest that therapeutic approach be similar to that recommended for NAV. No differences were observed in clinical outcomes such as hospital stay, duration of mechanical ventilation and mortality, although NAV was associated with a greater proportion of medical complications.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pneumonia , Cuidados Críticos , Bronquite Crônica , Respiração Artificial , Epidemiologia , Assistência Centrada no Paciente , Cursos de Capacitação , América LatinaRESUMO
Cutaneous melanoma is a highly aggressive tumor developing from melanocytes, its incidence is increasing, and prognosis in advanced stages is daunting. New therapies have been approved during the recent years with unprecedented results, including inhibitors of MAPK/ERK pathway and immune checkpoint blockade (anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) as ipilimumab, anti-programmed cell death protein 1 (PD-L1) as pembrolizumab and anti-programmed cell death protein 1 ligand (PD-L1), among many others). The aim of this paper is to review currently available metastatic melanoma therapies focusing mainly on new therapies that have demonstrated effectiveness, after several decades of little progress in the treatment of this disease.
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Humanos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/tratamento farmacológico , Melanoma/tratamento farmacológico , Melanoma/secundário , Antineoplásicos/uso terapêutico , Neoplasias Cutâneas/genética , Protocolos de Quimioterapia Combinada Antineoplásica , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Terapia de Alvo Molecular , Melanoma/genética , Antineoplásicos/farmacologiaRESUMO
Cutaneous melanoma is a highly aggressive tumor developing from melanocytes, its incidence is increasing, and prognosis in advanced stages is daunting. New therapies have been approved during the recent years with unprecedented results, including inhibitors of MAPK/ERK pathway and immune checkpoint blockade (anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) as ipilimumab, anti-programmed cell death protein 1 (PD-L1) as pembrolizumab and anti-programmed cell death protein 1 ligand (PD-L1), among many others). The aim of this paper is to review currently available metastatic melanoma therapies focusing mainly on new therapies that have demonstrated effectiveness, after several decades of little progress in the treatment of this disease.
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Antineoplásicos/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/secundário , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Antineoplásicos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Melanoma/genética , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Terapia de Alvo Molecular , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Neoplasias Cutâneas/genéticaRESUMO
Objective. The aim of this study was evaluate the genetic diversity of the following broodstocks: piapara (Leporinus elongatus), dourado (Salminus brasiliensis), jundiá (Rhamdia quelen) and cachara (Pseudoplatystoma fasciatum) already useful for restocking programs in the Paranapanema, Iguaçu and Paraná Brazilian Rivers. Materials and methods. Samples from the caudal fin of 122 fish were analyzed. DNA was extracted by NaCl protocol. PCR products were separated by a horizontal agarose gel electrophoresis. The fragments were visualized by staining with ethidium bromide. Results. The amplification of 25 primers generated different fragments in studied species that allowed characterizing 440 fragments of 100-2900 bp. High percentage of polymorphic fragments (66.67 to 86.29), Shannon index (0.365 to 0.486) and genetic diversity of Nei (0.248 to 0.331) were detected. Conclusions. The level of genetic variability in the broodstocks was adequate for allowing their use in restocking programs in the studied Rivers. However, periodical monitoring studies of genetic variability in these stocks, the mating system, reproductive system and general management must be made to guarantee the preservation of wild populations.
Objetivo. El objetivo de este estudio fue evaluar la diversidad genética de los siguientes lotes de reproductores: piapara (Leporinus elongatus), dourado (Salminus brasiliensis), jundiá (Rhamdia quelen) y cachara (Pseudoplatystoma fasciatum) utilizados para programas de repoblación en los ríos brasileños Paranapanema, Iguaçu y Paraná. Materiales y métodos. Muestras de aleta caudal de 122 peces fueron analizadas. El ADN fue extraído por el protocolo de NaCl. Los productos de PCR fueron separados por electroforesis horizontal en gel de agarosa. Los fragmentos fueron visualizados por marcación con bromuro de etidio. Resultados. La amplificación de los 25 iniciadores produjo diferentes fragmentos en las especies estudiadas que permitieron caracterizar 440 fragmentos de 100 a 2900 pb. Fueron detectados un alto porcentaje de fragmentos polimórficos (66.67 a 86.29), de índice de Shannon (0.365 a 0.486) y de diversidad genética de Nei (0.248 a 0.331). Conclusiones. El nivel de variabilidad genética en los lotes de reproductores fue adecuado para su utilización en programas de repoblación en los ríos estudiados. Sin embargo, estudios de monitoreo periódico de la variabilidad genética en esos lotes, del sistema de cruzamiento, del sistema reproductivo y del manejo general deben ser realizados para garantizar la preservación de las populaciones naturales.