Clinical management of renal transplant patients with hepatitis C virus infection treated with cyclosporine or tacrolimus.
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Adult↗
Biomedical subjects
P Sierra
Publications and source records attributed to P Sierra.
Diterpenoids from Haplopappus rigidus.
Fractionation of the aerial parts of Haplopappus rigidus Phil., directed by the brine shrimp lethality test (BST), has led to the isolation of two new diterpenoids, rigidusol and deacetylrigidusol. Their structures were established as 13-hydroxy-18-acetoxy-cis-cleroda-3,14-diene (8betaH, 10betaH, 19beta, 20alpha form) and 13,18-dihydroxy-cis-cleroda-3,14-diene (8betaH, 10betaH, 19beta, 20alpha form), respectively. Rigidusol exhibit moderate cytotoxic activity against human breast adenocarcinoma cell line MCF-7. Their structures were established by spectral data, in particular using 2D NMR spectroscopy (DEPT, DQF-COSY, HMQC and HMBC).
Asteraceae↗
Fungal flora on cutaneous and mucosal surfaces of cats infected with feline immunodeficiency virus or feline leukemia virus.
OBJECTIVE: To compare cutaneous and mucosal mycoflora in cats infected with FIV or FeLV with that in noninfected cats. ANIMALS: 85 client-owned cats; 24 seropositive for FIV, 10 seropositive for FeLV, 1 seropositive for both viruses, and 50 seronegative for both viruses. PROCEDURE: Cutaneous specimens were obtained from the coat and external acoustic meatus (ear canal) and mucosal specimens from the oropharynx and rectum. Fungi were isolated from specimens, using Sabouraud dextrose agar incubated at 27 or 37 C for cutaneous and mucosal specimens, respectively. RESULTS: Fungal colonies were cultured from at least 1 specimen from 83 of 85 (97.6%) cats. The most common fungal isolates were Aspergillus spp (cultured from 59.3% of all specimens), Penicillium spp (50.0%), Cladosporium spp (44.2%), Scopulariopsis spp (41.8%), and lipophilic yeasts of the genus Malassezia (31.4%). A greater diversity of fungal genera was isolated from retrovirus-infected cats, and Malassezia spp were more commonly recovered from these cats, compared with noninfected cats. Candida albicans, Cryptococcus neoformans, and dermatophytes (eg, Microsporum canis) were rarely isolated from any cat. Significant differences in frequency of isolation of C. neoformans and dermatophytes were not found between infected and noninfected cats. CONCLUSIONS AND CLINICAL RELEVANCE: Cats infected with FIV or FeLV may have a greater diversity of cutaneous and mucosal mycoflora than noninfected cats. However, infected cats may be no more likely than noninfected cats to expose humans to zoonotic fungi such as C. albicans, C. neoformans, and M. canis.
Animals↗
Bioaccumulation of manganese and its toxicity in feral pigeons (Columba livia) exposed to manganese oxide dust (Mn3O4).
Manganese tetroxide (Mn3O4) is a product from the combustion of methylcyclopentadienyl manganese tricarbonyl. Exposure to high levels of manganese can lead to serious health effects especially to the central nervous and respiratory systems. Very few studies on the effects of long-term low level exposure to Mn3O4 have been reported. The present study was therefore conducted to examine the bioaccumulation and toxicity of manganese in various organs of feral pigeons (Columba livia) when exposed to low levels of Mn3O4 via inhalation and hence to find any possible relationship between these two parameters. A total of 22 pigeons was exposed to 239 micrograms/m3 of manganese for 7 h/day, 5 days/week for 5, 9, and 13 consecutive weeks. Manganese concentrations in various tissues, e.g., brain (mesencephalon), lung, liver, intestine, pancreas, kidney, muscle, bone, and whole blood, were measured by neutron activation analysis. Various biochemical parameters in blood, e.g., hematocrit, total proteins, glucose, uric acid, alanine aminotransferase, total iron, blood urea nitrogen and triglycerides, were also measured. Manganese concentrations in brain, lung, and bone were significantly higher in Mn3O4-exposed pigeons (0.59, 0.58, and 3.02 micrograms wet tissue, respectively) than in the control group (0.46, 0.19, 1.74 micrograms/g wet tissue, respectively). However, except for total proteins such exposure did not produce any changes in various biochemical parameters which were within the normal values. Thus these results have shown that, despite significant bioaccumulation of manganese in some tissues, no significant toxic effects could be seen.
Administration, Inhalation↗
Insulin-like growth factor-I improves glucose utilization in tumor necrosis factor-treated rats under hyperinsulinemic-euglycemic conditions.
The purpose of this study was to determine the effects of insulin-like growth factor-I (IGF-I) on glucose metabolism in normal and tumor necrosis factor (TNF)-treated rats under euglycemic and hyperinsulinemic conditions. During a hyperinsulinemic clamp (10 mU/kg.min), rats further received either saline or IGF-I (3.33 micrograms/kg.min) infusion for 2 hours. Glucose kinetics were determined with [3H-3]-glucose. Glucose utilization in peripheral tissues was examined by glucose uptake using [14C-2]-deoxyglucose (14C-DG) and by glycogen content in select tissues. The results showed that TNF infusion significantly decreased the rate of glucose infusion required to maintain euglycemia. TNF decreased glycogen content significantly in liver and marginally in abdominis muscle. TNF also decreased glucose uptake in muscle, although the decrease was only statistically significant compared with IGF-I infusion. In addition, TNF significantly reduced plasma IGF-I concentration. However, during hyperinsulinemic and euglycemic conditions, exogenous IGF-I significantly increased glucose uptake in muscle and glycogen storage in the liver and abdominis muscle in both saline- and TNF-treated groups. IGF-I normalized each of the effects of TNF in the rats, including those on plasma IGF-I, glucose uptake in muscle, and glycogen content in liver and abdominis muscle. These data suggest that under hyperinsulinemic and euglycemic conditions, TNF-treated rats, although resistant to insulin, have a normal response to IGF-I, indicating that the TNF-induced defect in the insulin pathway may not be a step in the IGF-I pathway.
Animals↗
[Potential and real drug interactions in critical care patients].
OBJECTIVES: To detect potential drug interactions occurring during treatment of critically ill patients and to evaluate the real clinical and analytical repercussions of such interactions. PATIENTS AND METHODS: Seventy consecutive patients in a six-bed medical-surgical intensive care unit (ICU) were studied prospectively over a period of five months. The pharmacological department of the hospital provided the drugs through a computerized unit dosing system, using a program that gave warnings of possible drug interactions as each patient's treatment was entered. Interactions were cataloged according to clinical importance following the criteria of Hansten. The repercussions were evaluated by clinical and analytical monitoring. RESULTS: On hundred two potential interactions were detected in 44.3% of patients (1.5 interactions per patient). In 6 patients (19.3%) analytical alterations were observed but only 2 (6.4%) of them presented clinical manifestations. Most of the interactions were cataloged as being of moderate clinical importance. Digoxin was the most frequently implicated drug. The number of drugs administered per patient was 14.7 and patients receiving the most drugs were the most likely to experience and interaction. We found a significant correlation (p < 0.05) between the number of interactions and age, APACHE III score, length of ICU stay and number of drugs administered. CONCLUSIONS: The frequently of drug interactions in critically ill patients can be high, given the large number of drugs they receive. Although the real clinical repercussions of interactions are few, physicians should watch for them and the act appropriately.
Critical Care↗
Protein and lipid refeeding changes protein metabolism and colonic but not small intestinal morphology in protein-depleted rats.
In this study, we fed rats a 2% casein AIN 76 diet for 2 wk to produce protein malnutrition. We determined in these animals the effects of different concentrations of dietary protein refeeding (2% and 20% casein) on recovery and gut mucosal repletion and the potential role of type of dietary fat in the regulation of protein metabolism and mucosal growth by providing conventional long-chain triglyceride (LCT), a structured lipid composed of long-, medium- and short-chain fatty acids (SC/SL), or a physical mixture of the same components present in the structured lipid given as individual pure triglycerides (SC/PM) along with adequate amounts of protein and energy. The results confirmed that protein malnutrition can be reversed rapidly by protein refeeding, as indicated by an increase in body weight, positive nitrogen balance, liver growth and elevations in plasma concentrations of insulin-like growth factor-1, leucine and albumin. In the colon, crypt cell number, crypt depth and number of crypt cells in the rapidly proliferating fraction of the colon were greater in rats fed the higher protein diet. However, the general architecture of small intestinal mucosa, including duodenum, jejunum and ileum, was not affected by protein malnutrition. Although the number of colonic cells was similar with fat refeeding, there were significantly fewer displaying the proliferating cell nuclear antigen in the colonic epithelium when rats were fed SC/PM compared with SC/SL. Therefore, changes in colonic mucosal proliferation were only seen with repletion by adequate protein and by SC/SL feeding.
Absorption↗
The efficacy and optimum time of administration of ranitidine in the prevention of the acid aspiration syndrome.
In order to evaluate the efficacy of a single oral dose of ranitidine 150 mg and the optimum time for its administration, we studied pH and volume measurements in 138 surgical patients, who formed six groups according to the time elapsed from ranitidine administration to gastric fluid aspiration as follows: group A: no ranitidine, group B: 60-90 min, group C: 91-120 min, group D: 121-150 min, group E: 151-180 min and group F: > 180 min. The patients from groups B, C, D, E and F had a significant increase in gastric pH and a significant decrease in gastric fluid volume when compared to the patients from group A. 33.3% (95% CI 16.63-53.22%) of patients in group A were deemed 'at risk' of acid aspiration compared to 0.9% (95% CI 0.02-4.90%) in the other groups. No significant differences were found between the patients receiving ranitidine after 60 min with respect to risk of acid aspiration. It is concluded that a single oral dose of ranitidine 150 mg is effective against the acid aspiration syndrome 60 min after administration.
Adult↗
[Perioperative mortality in elderly patients undergoing general surgery].
OBJECTIVE: To determine wether the physical status (ASA category) and surgical conditions could predict mortality in elderly general surgery patients. PATIENTS AND METHODS: This was a prospective study of patients greater than or equal 85 years of age who underwent elective or emergency surgery under general anesthesia between January 1987 and December 1991. Hospital mortality was defined as death occurring before discharge. Logical regression analysis (Cox's modeling) was used to assess group survival. RESULTS: One hundred and nine patients undergoing 117 operations were enrolled. Major surgery was performed in 70%; 44% were removals of malignant tumors and 84% were under general anesthesia. Hospital deaths occurred in 10%; the only significant predictors were neoplastic disease and emergency status. Mortality was 43% one year after surgery; significant predictors of death were prior physical status, neoplasia and emergency status. CONCLUSIONS: Neoplastic disease, emergency status and poor physical condition are factors that predict mortality in patients 85 or older who undergo general surgery.
Aged↗
[Allergic reactions during anesthesia].
Anaphylactic reaction during anesthesia is a constant source of concern for anesthesiologists, given that the rates of death and serious complications are high and predicting which patients will be susceptible is impossible. All substances used in the perioperative period carry a certain risk of releasing histamine and triggering an allergic reaction, though muscle relaxants are the drugs usually implicated. The incidence of serious anaphylaxis ranges between 1:4,000 and 1:23,000 anesthetic procedures, with mortality set at 3-9% and morbidity 10 times higher. Clinical signs vary from mild symptoms to anaphylactic shock and cardiac arrest. The diagnostic procedure to follow upon observing an allergic reaction is to first identify the responsible mechanism and later the responsible agent, as well as drugs that can be used safely. Prophylaxis is based mainly on recognizing predisposed patients before surgery and following recommendations and pharmacological protocols based on better understanding of the pathophysiological mechanisms that cause anaphylactic reaction and on experience in managing them.
Analgesics↗
[Usefulness of the preoperative electrocardiogram in elective surgery].
OBJECTIVES: To assess the prevalence of abnormal electrocardiograms (ECG) recorded routinely in patients undergoing elective surgery as well as the prevalence of ECG abnormalities that could not be predicted by the patient's medical history. To determine the influence of ECG results on patient care. To identify patient groups at high risk for abnormal ECG. PATIENTS AND METHODS: Retrospective study of 2,146 patients scheduled for non cardio-thoracic surgery requiring anesthesia. Two physicians reviewed the preoperative ECG reports in consultation with a cardiologist. The reports were considered normal, abnormal but expected or abnormal and unexpected based on agreement or not with the patient's medical history. RESULTS: The 161 (7.4%) patients for whom data was missing were excluded. Preoperative ECGs were performed in 1,898 (95.6%) cases. Abnormal ECG results were reported for 351 (18.5%), most often for men, patients over 45 years of age, those classified ASA III-V, those with cardiovascular disease, kidney failure and diabetes mellitus. Two hundred seventy unexpected abnormalities were found in 234 (12.3%) patients. Of these, 117 (43.3%) were considered major. The unexpected abnormalities motivated changes of attitude toward 4 (1.7%) patients, but new treatment was established for only 2 (0.8%) of them. The prevalence of unexpected abnormalities was higher in men, patients over 45 years of age and those classified as ASA III-V. CONCLUSIONS: The prevalence of unexpected preoperative ECG abnormalities among non cardio-thoracic surgical patients is high but the influence of such results is minimal. The sensitivity and specificity of preoperative ECG for detecting electrocardiographic abnormalities are low. We suggest that performance of ECG before surgery is useful in patients over 45 years of age or in those with cardiovascular disease, chronic kidney failure, diabetes mellitus, physical state ASA III-V and those for whom it has not been possible to obtain an adequate medical history or perform a complete physical.
Adolescent↗
[Succinylcholine induces hyperpotassemia in patients in critically ill patients].
OBJECTIVE: To study changes in kalemia caused by succinylcholine administration to patients in critical care, and the possible association of succinylcholine with clinical and analytical data, severity-of-disease classification, duration of stay in the intensive care unit (ICU) and immobility. PATIENTS AND METHODS: Twenty-three patients admitted to the ICU, none of whom suffered burns, polytrauma or neuromuscular disease, and who had received 1.5 mg/kg succinylcholine on 28 occasions, usually to facilitate tracheal intubation. Kalemia was analyzed before neuromuscular relaxation and 5 and 30 min afterwards. Electrocardiographic II and V5 derivations and invasive arterial pressure were monitored in all patients. The increase in kalemia at 5 min correlated with age, sex, weight, APACHE II score, days in ICU, current and accumulated immobility, and analytical parameters such as glycemia, creatinine, GOT, bilirubinemia, pH and creatine kinase. The kalemia of these patients was compared with that of 15 patients in acceptable general state who had undergone scheduled surgery. RESULTS: Kalemia increased significantly from a mean baseline level of 4.2 (0.9) mEq/l to 5.5 (1.4) at 5 min and 4.6 (0.9) at 30 min in ICU patients. In the non ICU patients there were no statistically significant changes. Kalemia at 5 min was correlated with baseline (r = 0.84; p < 0.0001), days in the ICU (r = 0.39; p < 0.05) and weight (r = 0.46; p < 0.05). The mean increase in kalemia at 5 min was 0.5 mEq/l in patients who stayed less than 10 days, 1.8 mEq/l in those whose stay was from 10 to 30 days and 1.4 mEq/l in patients who stayed longer than 30 days. The percent increase in kalemia correlated directly (r = 0.7; p < 0.001) with days in the ICU and with accumulated immobility in patients whose ICU stay was less than 30 days. For ICU stays longer than 30 days the correlation was negative (r = -0.98; p = 0.03). Electrocardiographic changes were recorded in 2 patients with brief sinus bradycardia having no hemodynamic repercussions. CONCLUSIONS: The use of succinylcholine in critically ill patients causes a brief but significant increase in kalemia, with slight and rare electrocardiographic changes. The effect varies according to the length of time spent in the ICU and the degree of immobility, with maximum increases seen when the ICU stay is between 10 and 30 days. Patient immobility may play an important pathophysiological role. The indications for use of succinylcholine in critically ill patients should be very strict, particularly during the period of greatest sensitivity.
Adult↗
Fish oil feeding improves muscle glucose uptake in tumor necrosis factor-treated rats.
This study was conducted to characterize the effects of fish oil and sunflower oil on hepatic glucose production and peripheral glucose utilization during infusion of saline or tumor necrosis factor (TNF), using the euglycemic-hyperinsulinemic clamp technique combined with a primed-constant tracer infusion of high-performance liquid chromatography-purified 3H-3-glucose for estimation of whole-body glucose appearance and utilization rates. Insulin 10 mU/kg.min was infused to reach a plasma insulin level of 200 microU/mL. 14C-1-deoxyglucose (14C-DG) uptake was also measured in specific tissues following intravenous bolus administration. The results showed that during a hyperinsulinemic-euglycemic clamp, infusion of TNF 20 micrograms/kg for 3 hours resulted in a significant reduction of glucose infusion and a significant increase of hepatic glucose production in both dietary groups as compared with saline infusion, indicating a state of insulin resistance induced by TNF. The results also showed that TNF infusion significantly decreased the rate of 14C-DG uptake in muscle in the sunflower oil group but not in the fish oil group, suggesting that fish oil is able to restore to normal the glucose utilization impaired by TNF. These observations suggest that in hyperinsulinemic and euglycemic conditions, prefeeding with fish oil significantly improves glucose uptake in muscle tissue, but does not alter the increase in hepatic glucose production during TNF infusion.
Animals↗
Occupational and environmental exposure of automobile mechanics and nonautomotive workers to airborne manganese arising from the combustion of methylcyclopentadienyl manganese tricarbonyl (MMT).
Inhalation exposure to manganese (Mn) was measured for a group of garage mechanics and a control group of nonautomotive workers. The airborne Mn exposure of 35 garage mechanics suspected of being relatively highly exposed to Mn from MMT was measured at the workplace over one-week period. It also was measured for 30 nonautomotive workers at the University of Montreal. The environmental exposure also was measured for the two groups, as was the exposure to three other metals, aluminum (Al), iron (Fe), and zinc (Zn). At work the mechanics were exposed to Mn concentrations varying from 0.010 to 6.673 micrograms m-3 with a mean of 0.45 microgram m-5, while the control group was exposed to concentrations varying from 0.011 to 1.862 microgram m-3 with a mean of 0.04 microgram m-3. The mean environmental exposure for the two groups was similar to the Mn concentrations gathered in Montreal in 1992. Workplace concentrations of Al, Fe, and Zn also were higher for the garage mechanics. The results suggest that less than 10% of the Mn exposure of the garage mechanics was due to MMT. The levels of the metals measured were below the established limits for industrial and even environmental exposure.
Air Pollutants, Occupational↗
[Severe hypophosphatemia and coma in a critically ill patient].
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Aged↗
[Prolonged sedation with midazolam in critically ill patients undergoing artificial ventilation].
OBJECTIVES: To analyze the dose of midazolam needed for induction and maintenance of sedation, as well as its hemodynamic repercussions in critically ill patients requiring mechanical ventilation. PATIENTS AND METHODS: We studied 20 adult patients requiring mechanical ventilation for respiratory failure in the intensive care unit. An induction dose of 1 mg/min midazolam was given until the patient became drowsy (eyes closed but opened again) and this level of sedation was maintained by continuous intravenous perfusion. We calculated induction dose, maintenance dose and their correlation with age, weight, general state (APACHE-II index), liver function, hematocrit and blood chemistry. RESULTS: The induction dose was 4.76 +/- 3.4 mg and correlated with weight and plasma albumin levels. The maintenance dose of 6.4 +/- 3.97 mg/h did not correlate with any of the parameters studied. A statistically significant reduction in arterial pressure was observed. CONCLUSIONS: The sedation dose of midazolam in critically ill patients is related to weight and plasma albumin levels. Recovery time is related to mean maintenance dose.
APACHE↗
Occupational and environmental exposure of garage workers and taxi drivers to airborne manganese arising from the use of methylcyclopentadienyl manganese tricarbonyl in unleaded gasoline.
Occupational and environmental exposure to airborne manganese has been measured for two groups of workers in Montreal, taxi drivers and garage mechanics. In Canada methylcyclopentadienyl manganese tricarbonyl (MMT) has replaced lead as an anti-knock agent in gasoline and represents a potentially important source of manganese contamination for the population in general and for the two chosen groups of workers in particular. Twenty workers (10 taxi drivers and 10 garage mechanics) wore a personal air sampler for five consecutive working days and two off-work periods. The amount of total Mn on each filter was determined by neutron activation analysis and then converted to atmospheric Mn concentrations. The values obtained varied from 0.004 microgram m-3 to 2.067 micrograms m-3. At work the garage mechanics were exposed to an average of 0.250 microgram m-3 and the taxi drivers to 0.024 microgram m-3. Off-work, the two groups were exposed respectively to an average of 0.007 microgram m-3 and 0.011 microgram m-3. In the garages there was twice as much Mn in the air on days when the doors were closed compared to days when they were left opened (0.314 micrograms m-3/0.152 microgram m-3). The levels found in this study remain well below the established limits for occupational and environmental airborne exposure. These results will lead to further studies to positively identify the source of Mn as MMT and to explore other pathways leading to the contamination of the general population.
Air Pollutants↗
[Pneumocystis carinii infection. Various aspects on its clinical and laboratory diagnosis].
P carinii is an opportunistic pathogenic agent able to produce severe infection that must be diagnosed promptly. We analyzed 138 samples from 100 patients suspected of having infection by P carinii. The ortho-toluidine blue and the methenamine stains were used to analyze the samples. Infection was demonstrated in 18 patients, 13 adults and 5 children. Underlying disease was AIDS in 7 and other immunosuppressive disorders in the rest. No immunocompetent patient was infected with P carinii. Proper sample collection is important for diagnosis. When bronchoalveolar lavage is not possible, pharyngo-tracheal aspirate in children and sputum sampling after assisted coughing in adults are recommended. At least 2 staining methods and proper controls are advisable.
Adult↗